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Sample records for cefuroxime

  1. Cefuroxime

    MedlinePLUS

    ... gonorrhea; Lyme disease; and infections of the ears, throat, sinuses, urinary tract, and skin. Cefuroxime is in ... diaper rash painful sores in the mouth or throat vaginal itching and discharge Cefuroxime may cause other ...

  2. Cefuroxime Injection

    MedlinePLUS

    Cefuroxime injection is used to treat certain infections caused by bacteria including pneumonia and other lower respiratory tract (lung) ... blood, bone, joint, and urinary tract infections. Cefuroxime injection may also be used before, during, and sometimes ...

  3. Concentration of cefuroxime in serum and middle ear effusion after single dose treatment with cefuroxime axetil.

    PubMed

    Haddad, J; Isaacson, G; Respler, D S; Hart, R W; Yilmaz, H M; Collins, J J; Bluestone, C D

    1991-04-01

    Antimicrobial agents play an important role in the treatment of patients with acute otitis media and otitis media with effusion (OME). The study was undertaken to determine the concentrations of cefuroxime in the blood and middle ear effusions (MEE) of children between 6 and 12 years of age with acute otitis media and chronic OME after a single oral dose administration of cefuroxime axetil, the ester prodrug of cefuroxime. Cefuroxime axetil (250 mg) was administered 2 to 6 hours before either myringotomy for acute otitis media or myringotomy and tube insertion for chronic OME. Blood samples and middle ear aspirates were obtained from 31 children and the samples were analyzed by high performance liquid chromatography. Cefuroxime was recovered in measurable concentrations in all serum samples and in 15 (79%) of the 19 MEE specimens analyzed. No correlation was seen between cefuroxime MEE concentrations and effusion type, bacteriology or serum concentrations. This study shows that cefuroxime does penetrate into MEE when OME is present and that therapeutic concentrations can be achieved in some patients. PMID:2062625

  4. Nonlinear intestinal absorption kinetics of cefuroxime axetil in rats.

    PubMed Central

    Ruiz-Balaguer, N; Nacher, A; Casabo, V G; Merino, M

    1997-01-01

    Cefuroxime is commercially available for parenteral administration as a sodium salt and for oral administration as cefuroxime axetil, the 1-(acetoxy)ethyl ester of the drug. Cefuroxime axetil is a prodrug of cefuroxime and has little, if any, antibacterial activity until hydrolyzed in vivo to cefuroxime. In this study, the absorption of cefuroxime axetil in the small intestines of anesthetized rats was investigated in situ, by perfusion at four concentrations (11.8, 5, 118 and 200 microM). Oral absorption of cefuroxime axetil can apparently be described as a specialized transport mechanism which obeys Michaelis-Menten kinetics. Parameters characterizing absorption of prodrug in free solution were obtained: maximum rate of absorption (Vmax) = 289.08 +/- 46.26 microM h-1, and Km = 162.77 +/- 31.17 microM. Cefuroxime axetil transport was significantly reduced in the presence of the enzymatic inhibitor sodium azide. On the other hand, the prodrug was metabolized in the gut wall through contact with membrane-bound enzymes in the brush border membrane before absorption occurred. This process reduces the prodrug fraction directly available for absorption. From a bioavailability point of view, therefore, the effects mentioned above can explain the variable and poor bioavailability following oral administration of cefuroxime axetil. Thus, future strategies in oral cefuroxime axetil absorption should focus on increasing the stability of the prodrug in the intestine by modifying the prodrug structure and/or targeting the compound to the absorption site. PMID:9021205

  5. Use of cefuroxime for women with community-onset acute pyelonephritis caused by cefuroxime-susceptible or -resistant Escherichia coli

    PubMed Central

    Chang, U-Im; Kim, Hyung Wook; Wie, Seong-Heon

    2016-01-01

    Background/Aims: Efforts to decrease the use of extended-spectrum cephalosporins are required to prevent the selection and transmission of multi-drug resistant pathogens, such as extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae. The objectives of this study were to assess the clinical efficacy of intravenous cefuroxime as an empirical antibiotic for the treatment of hospitalized women with acute pyelonephritis (APN) caused by Escherichia coli. Methods: We analyzed the clinical and microbiologic database of 328 hospitalized women with community-onset APN. Results: Of 328 women with APN, 22 patients had cefuroxime-resistant E. coli APN, and 306 patients had cefuroxime-susceptible E. coli APN. The early clinical success rates were significantly higher (p = 0.001) in the cefuroxime-susceptible group (90.8%, 278/306) than in the cefuroxime-resistant group (68.2%, 15/22) at 72 hours. The clinical cure rates at 4 to 14 days after completing antimicrobial therapy were not significantly different in the cefuroxime-resistant or -susceptible groups, with 88.2% (15/17) and 97.8% (223/228; p = 0.078), respectively. The microbiological cure rates were not significantly different and were 90.9% (10/11) and 93.4% (128/137), respectively (p =0.550). The median duration of hospitalization in the cefuroxime-resistant and -susceptible groups was 10 days (interquartile range [IQR], 8 to 13) and 10 days (IQR, 8 to 14), respectively (p =0.319). Conclusions: Cefuroxime, a second-generation cephalosporin, can be used for the initial empirical therapy of community-onset APN if tailored according to uropathogen identification and susceptibility results, especially in areas where the prevalence rate of ESBL-producing uropathogens is low. PMID:26767868

  6. Bioequivalence and population pharmacokinetic modeling of two forms of antibiotic, cefuroxime lysine and cefuroxime sodium, after intravenous infusion in beagle dogs.

    PubMed

    Zhao, Longshan; Li, Qing; Li, Xingang; Yin, Ran; Chen, Xiaohui; Geng, Lulu; Bi, Kaishun

    2012-01-01

    To investigate the bioequivalence and the population pharmacokinetics of cefuroxime lysine and cefuroxime sodium in healthy beagle dogs. A randomized 2-period crossover design in 18 healthy beagle dogs after receiving 20, 40, and 80 mg/kg of cefuroxime lysine or cefuroxime sodium was conducted. A 3-compartment open model was used as the basic model for the population pharmacokinetic study. Both of the antibiotics exhibited dose-proportional pharmacokinetics over the dose range of 20-80 mg/kg. The mean relative bioavailability of cefuroxime lysine versus cefuroxime sodium was 1.05 (range, 0.71 to 1.42), with a significant difference between males and females. The estimates of population pharmacokinetic of CL, V(1), Q(2), V(2), Q(3), V(3) were 3.74 mL/h, 1.70 mL, 29.5 mL/min, 3.58 mL, 0.31 mL/min, and 158 mL for cefuroxime lysine and 4.10 mL/h, 1.00 mL, 38.5 mL/min, 4.19 mL, 0.06 mL/min, and 13.6 mL for cefuroxime sodium, respectively. The inter-individual variability was determined to be less than 29.1%. A linear pharmacokinetic was revealed for cefuroxime lysine and cefuroxime sodium in dogs after intravenous infusion, and the bioequivalence of these forms of the antibiotic was observed with the significant gender-related differences in mean relative bioavailability of cefuroxime lysine versus cefuroxime sodium. PMID:22911056

  7. Bioequivalence and Population Pharmacokinetic Modeling of Two Forms of Antibiotic, Cefuroxime Lysine and Cefuroxime Sodium, after Intravenous Infusion in Beagle Dogs

    PubMed Central

    Zhao, Longshan; Li, Qing; Li, Xingang; Yin, Ran; Chen, Xiaohui; Geng, Lulu; Bi, Kaishun

    2012-01-01

    To investigate the bioequivalence and the population pharmacokinetics of cefuroxime lysine and cefuroxime sodium in healthy beagle dogs. A randomized 2-period crossover design in 18 healthy beagle dogs after receiving 20, 40, and 80 mg/kg of cefuroxime lysine or cefuroxime sodium was conducted. A 3-compartment open model was used as the basic model for the population pharmacokinetic study. Both of the antibiotics exhibited dose-proportional pharmacokinetics over the dose range of 20–80 mg/kg. The mean relative bioavailability of cefuroxime lysine versus cefuroxime sodium was 1.05 (range, 0.71 to 1.42), with a significant difference between males and females. The estimates of population pharmacokinetic of CL, V1, Q2, V2, Q3, V3 were 3.74 mL/h, 1.70 mL, 29.5 mL/min, 3.58 mL, 0.31 mL/min, and 158 mL for cefuroxime lysine and 4.10 mL/h, 1.00 mL, 38.5 mL/min, 4.19 mL, 0.06 mL/min, and 13.6 mL for cefuroxime sodium, respectively. The inter-individual variability was determined to be less than 29.1%. A linear pharmacokinetic was revealed for cefuroxime lysine and cefuroxime sodium in dogs after intravenous infusion, and the bioequivalence of these forms of the antibiotic was observed with the significant gender-related differences in mean relative bioavailability of cefuroxime lysine versus cefuroxime sodium. PMID:22911056

  8. Preservative efficacy in cefuroxime and ceftazidime eye drop formulations.

    PubMed

    Barnes, A R; Nash, S

    1994-10-01

    The efficacy of various common antimicrobial preservatives was tested in eye drop formulations containing the cephalosporin antibiotics cefuroxime and ceftazidime. The British Pharmacopoeia test for the efficacy of antimicrobial preservatives was used and the formulations were challenged with Staphylococcus aureus, Pseudomonas aeruginosa and Candida albicans. The survival of organisms was monitored over 14 days. Cefuroxime sodium, 50 mg/ml, was studied in simple aqueous solution, and dissolved in an artificial tear formulation, Sno Tears (Smith and Nephew Pharmaceuticals), which contains benzalkonium chloride 0.004% w/v. Ceftazidime (50 mg/ml) was also studied in these two vehicles and, in addition, in a phenylmercuric acetate solution (0.002% w/v) and chlorhexidine acetate (0.02% w/v). Cefuroxime and ceftazidime contributed little, in the short-term, towards a microbicidal preservative effect in the unpreserved aqueous formulations, even against organisms for which they were active. Cefuroxime was adequately preserved in a vehicle of Sno Tears, which contains benzalkonium chloride as the antimicrobial preservative. Ceftazidime was less well preserved in this vehicle, but it was superior to phenylmercuric acetate (0.002% w/v) or chlorhexidine acetate (0.02% w/v). PMID:7806604

  9. Assessment of sodium hyaluronate gel as vehicle for intracameral delivery of cefuroxime in endophthalmitis prophylaxis.

    PubMed

    Uhart, M; Pirot, F; Boillon, A; Senaux, E; Tall, L; Diouf, E; Burillon, C; Padois, K; Falson, F; Leboucher, G; Pivot, C

    2010-10-15

    Sodium cefuroxime is a second-generation cephalosporin widely used at 10mg/mL for endophthalmitis prophylaxis after cataract surgery. Sodium cefuroxime solution is usually conditioned in pre-filled syringes then frozen for storage. In the present study, 0.2% sodium hyaluronate gel, natural extracellular polymer used in wound healing, was compared to conventional saline solution (0.9% sodium chloride) as drug delivery systems for cefuroxime loading in pre-filled syringes. Therefore, the temperature (4 and 25 degrees C) and time of storage (up to 21 days) varied in order to appreciate both cefuroxime and vehicle stability. Furthermore, the kinetics of drug release from both hyaluronate gel and saline solution were compared since in vitro sets of dialysis experiments. Results indicated that cefuroxime loaded in either saline solution or hyaluronate hydrogel was found stable in pre-filled syringes stored at 4 degrees C for 21 days, whereas cefuroxime degradations products appeared from the 2nd day of storage at 25 degrees C. Both drug delivery systems were found bioequivalent, although statistically slower cefuroxime dialysis was evidenced by using sodium hyaluronate vehicle. Noteworthy, cefuroxime concentration in drug delivery systems during dialysis experiment remained greater than the minimum inhibitory concentrations reported for resistant strains. In conclusion, the present stability and release study confirmed that sodium hyaluronate hydrogel is a promising vehicle for cefuroxime intracameral delivery in endophthalmitis prophylaxis. PMID:20637851

  10. Contribution of efflux to cefuroxime resistance in clinical isolates of Escherichia coli.

    PubMed

    Kllman, Owe; Fendukly, Faiz; Karlsson, Inga; Kronvall, Gran

    2003-01-01

    Retrospective data showed that resistance to cefuroxime among clinical blood culture isolates of Escherichia coli (2.67%) was more common than resistance to cefotaxime (0.59%) and ceftazidime (1.48%). 30 clinical isolates of E. coli with various degrees of resistance to cefuroxime were selected for the present studies. Antibiotic susceptibility to beta-lactam antibiotics was determined with the disc-diffusion method and for cefuroxime also with the E-test. The ability to grow in the presence of organic solvents was determined as a phenotypical measure of efflux. The organic solvent tolerance (OST) was graded on a scale from 1 to 5. Antibiotic susceptibility to cefuroxime, cefotaxime, ceftazidime and loracarbef was also determined in the presence of a known efflux pump inhibitor, MC-207,110. The strains that were organic solvent tolerant had significantly higher minimal inhibitory concentration (MIC) values for cefuroxime than the other E. coli strains (median 24 mg/l, range 4 to > 256 mgn/l vs median 4 mg/l, range 2-64 mg/l) and significantly lower cefuroxime zone diameters (p < 0.02). In the strains with most pronounced organic solvent tolerance, i.e. the cyclohexane-tolerant strains, the cefuroxime MIC values were decreased 2-fold (p < 0.03) and the zone diameters increased (p < 0.02) by the addition of an efflux pump inhibitor, MC-207,110. The findings supported the hypothesis that efflux contributes to cefuroxime resistance in E. coli. PMID:14514145

  11. Unexpected death due to cefuroxime-induced disulfiram-like reaction.

    PubMed

    Dong, Hongmei; Zhang, Ji; Ren, Liang; Liu, Qian; Zhu, Shaohua

    2013-01-01

    Cefuoxime, a second-generation cephalosporin, is used in the treatment of Gram-positive infections. Here, we report a case cefuroxime-induced disulfiram-like reaction which led to sudden death of the patient. PMID:24014919

  12. Antibiotic prophylaxis during clean neurosurgery: a large, multicenter study using cefuroxime.

    PubMed

    Holloway, K L; Smith, K W; Wilberger, J E; Jemsek, J G; Giguere, G C; Collins, J J

    1996-01-01

    Cefuroxime is a second-generation cephalosporin with in vitro activity against the organisms that are commonly associated with neurosurgical wound infections. Other properties of cefuroxime are an elimination half-life of 1.3 hours, which yields prolonged serum concentrations, and its ability to penetrate the blood-brain barrier in proportion to the degree of inflammation. A prospective, multicenter, open-label study was conducted to evaluate the efficacy and safety of cefuroxime for antibiotic prophylaxis in patients undergoing clean neurosurgery. Cefuroxime 1.5 g was given intravenously 25 to 60 minutes before surgery; for procedures lasting more than 3 hours, cefuroxime 750 mg was given intravenously 8 hours after the initial dose. Patients were examined before surgery, daily during hospitalization, and at 8 weeks after surgery. A total of 956 adults were enrolled in the study. The most common procedures in study patients were laminectomy (41.8% of patients) or craniotomy (24.3%), and the mean duration of surgery was 3.2 hours. Infection occurred in 2 (0.3%) of 592 assessable patients by the time of discharge and in 1 additional patient by the 8-week follow-up evaluation for a total of 3 (0.5%) of 560 assessable patients. Drug-related adverse events occurred in 5 (0.5%) of 956 patients. These results indicate that antibiotic prophylaxis with cefuroxime is associated with a low incidence of postoperative wound infection and is well tolerated in patients undergoing clean neurosurgery. PMID:8851455

  13. Evaluation of cefuroxime axetil and cefadroxil suspensions for treatment of pediatric skin infections.

    PubMed Central

    Jacobs, R F; Brown, W D; Chartrand, S; Darden, P; Drehobl, M A; Yetman, R; Ossi, M J

    1992-01-01

    A randomized, single-blind, multicenter study was conducted to evaluate the safety and efficacy of cefuroxime axetil and cefadroxil suspensions for the treatment of skin or skin structure infections in 287 children. Each drug was given at a dosage of 30 mg/kg of body weight per day in two divided doses. Staphylococcus aureus and Streptococcus pyogenes, or a combination of the two, were the primary pathogens isolated from infected skin lesions. A satisfactory bacteriological response (cure or presumed cure) was obtained in 97.1 and 94.3% of children in the cefuroxime axetil and cefadroxil groups, respectively (P greater than 0.05). Satisfactory clinical responses (cure or improvement) were more likely to occur in cefuroxime axetil recipients than in cefadroxil recipients (97.8 versus 90.3%; P less than 0.05). Both regimens were equally well tolerated, with adverse events occurring in 7.9 and 6.1% of cefuroxime axetil and cefadroxil recipients, respectively. There were more patients who refused to take cefuroxime axetil (7 of 189) than there were who refused to take cefadroxil (0 of 98), but the difference was not statistically significant (P = 0.1). In this study, cefuroxime axetil was at least as effective as cefadroxil in resolving skin and skin structure infections in children. PMID:1416842

  14. Comparison of HPLC and UV spectrophotometric methods for the determination of cefuroxime sodium in pharmaceutical products.

    PubMed

    Vieira, D C M; Salgado, H R N

    2011-08-01

    This paper describes the development and evaluation of a HPLC and UV spectrophotometric methods to quantify cefuroxime sodium in injectables. HPLC analysis were carried out using a C18 Wat 054275 column and a mobile phase composed of methanol and water (70:30), with a flow rate of 0.8 mL/min and UV detection at 280 nm. For the spectrophotometric analysis, water was used as solvent and the wavelength of 280 nm was selected for the detection. Both methods were found to quantify cefuroxime sodium in injectables accurately. Therefore HPLC and UV methods presented the most reliable results for the analyses of injectables. PMID:21801481

  15. Improvement in Dissolution Rate of Cefuroxime Axetil by using Poloxamer 188 and Neusilin US2

    PubMed Central

    Sruti, J.; Patra, Ch. N.; Swain, S. K.; Beg, S.; Palatasingh, H. R.; Dinda, S. C.; Rao, M. E. Bhanoji

    2013-01-01

    A combination of fusion and surface adsorption techniques was used to enhance the dissolution rate of cefuroxime axetil. Solid dispersions of cefuroxime axetil were prepared by two methods, namely fusion method using poloxamer 188 alone and combination of poloxamer 188 and Neusilin US2 by fusion and surface adsorption method. Solid dispersions were evaluated for solubility, phase solubility, flowability, compressibility, Kawakita analysis, Fourier transform-infrared spectra, differential scanning calorimetry, powder X-ray diffraction study, in vitro drug release, and stability study. Solubility studies showed 12- and 14-fold increase in solubility for solid dispersions by fusion method, and fusion and surface adsorption method, respectively. Phase solubility studies showed negative ΔG0tr values for poloxamer 188 at various concentrations (0, 0.25, 0.5, 0.75 and 1%) indicating spontaneous nature of solubilisation. Fourier transform-infrared spectra and differential scanning calorimetry spectra showed that drug and excipients are compatible with each other. Powder X-ray diffraction study studies indicated that presence of Neusilin US2 is less likely to promote the reversion of the amorphous cefuroxime axetil to crystalline state. in vitro dissolution studies, T50% and mean dissolution time have shown better dissolution rate for solid dispersions by fusion and surface adsorption method. Cefuroxime axetil release at 15 min (Q15) and DE15 exhibited 23- and 20-fold improvement in dissolution rate. The optimized solid dispersion formulation was stable for 6 months of stability study as per ICH guidelines. The stability was ascertained from drug content, in vitro dissolution, Fourier transform-infrared spectra and differential scanning calorimetry study. Hence, this combined approach of fusion and surface adsorption can be used successfully to improve the dissolution rate of poorly soluble biopharmaceutical classification system class II drug cefuroxime axetil. PMID:23901163

  16. Chitosan-based intragastric delivery of cefuroxime axetil: development and in-vitro evaluation of mucoadhesive approach.

    PubMed

    Nagar, Mitesh; Yadav, Adhikrao V

    2012-12-01

    To have advantages of reduced dosing frequency, improved bioavailability and effective delivery system of Cefuroxime Axetil, a Chitosan based intragastric sustained release microbead formulation of Cefuroxime Axetil was developed. The drug delivery system was prepared by ionotropic gelation of Chitosan in presence of sodium tripolyphosphate as polyanion and optimized by box-behnken experimental design. Response surface methodology was applied to evaluate various vitro characteristics of prepared mucoadhesive microbeads. Multiple independent variables were optimized to achieve responses of interest, thereby to get the desired sustained release profile of Cefuroxime Axetil in gastric environment. PMID:22780098

  17. Intracameral cefuroxime and moxifloxacin used as endophthalmitis prophylaxis after cataract surgery: systematic review of effectiveness and cost-effectiveness

    PubMed Central

    Linertov, Renata; Abreu-Gonzlez, Rodrigo; Garca-Prez, Lidia; Alonso-Plasencia, Marta; Cordovs-Dorta, Luis Mateo; Abreu-Reyes, Jos Augusto; Serrano-Aguilar, Pedro

    2014-01-01

    Postoperative endophthalmitis is one of the most serious potential complications of ocular lens surgery. Its incidence can be reduced by means of antibiotic prophylaxis. Although the prophylactic use of intracameral cefuroxime has been extended, other drugs, such as moxifloxacin, have arisen as alternatives. We performed a systematic literature review on the effectiveness and efficiency of intracameral cefuroxime and moxifloxacin for the prophylaxis of postoperative endophthalmitis after cataract surgery. Several bibliographic databases were searched up to October 2010 and were updated up to January 2013. Outcomes were the onset of endophthalmitis after surgery and the cost-effectiveness ratio of using both antibiotic prophylaxis alternatives. The following were included: a clinical trial reported in two papers, six observational studies, and an economic evaluation. All studies assessed cefuroxime compared with another antibiotic prophylaxis or no prophylaxis. The only randomized controlled trial performed by the European Society of Cataract and Refractive Surgery found that intracameral cefuroxime is significantly more effective than not using prophylaxis or the use of a topical antibiotic. The observational studies support these results. The economic evaluation compared different prophylaxis regimens and concluded that intracameral cefuroxime showed the best cost-effectiveness ratio. Both the observational studies and the economic evaluation have methodological limits that reduce their validity. This review confirmed that cefuroxime can prevent endophthalmitis after cataract surgery. Further randomized controlled trials, with large sample sizes, are required to compare different antibiotic prophylaxis regimens. PMID:25152613

  18. Prophylactic use of gentamicin/flucloxacillin versus cefuroxime in surgery: a meta analysis of clinical studies

    PubMed Central

    Luo, Shaoning; Lai, Yu; Liu, Chunxin; Chen, Yi; Qiao, Xiaoyu

    2015-01-01

    Purpose: To conduct meta-analyses of all available studies comparing efficacies of prophylactic cefuroxime and prophylactic gentamicin/flucloxacillin (Gen/Flu) in preventing post-operative wound infections and their association with risks of Clostridium difficile infections and post-operative renal impairment. Methods: Published studies including both prophylactic cefuroxime and prophylactic Gen/Flu used in surgery were included for meta analysis. Outcomes were analyzed using a random-effect model or a fixed-effect model depending on the heterogeneity across the included studies. Results: Gen/Flu prophylaxis showed similar efficacy as cefuroxime prophylaxis in preventing post-operative wound infections and was associated with a significantly lower risk of Clostridium difficile infection, but it was associated with a higher risk of post-operative renal impairment, especially in orthopedic surgery. Conclusions: Our findings that Gen/Flu prophylaxis was associated with significantly higher risk of post-operative renal impairment dictate that benefits and risks of Gen/Flu prophylaxis should be carefully assessed and balanced, and each patient should be evaluated individually so that a proper antibiotic prophylaxis regimen could be chosen. PMID:26770380

  19. Prophylaxis with teicoplanin and cefuroxime reduces the rate of prosthetic joint infection after primary arthroplasty.

    PubMed

    Tornero, Eduard; García-Ramiro, Sebastian; Martínez-Pastor, Juan C; Bori, Guillem; Bosch, Jordi; Morata, Laura; Sala, Marta; Basora, Misericordia; Mensa, Josep; Soriano, Alex

    2015-02-01

    The aim of this study was to compare the prosthetic joint infection (PJI) rate after total joint arthroplasty in two consecutive periods of treatment with different antibiotic prophylaxes: cefuroxime versus cefuroxime plus teicoplanin. We retrospectively reviewed 1,896 patients who underwent total hip arthroplasty or total knee arthroplasty between March 2010 and February 2013. From March 2010 to August 2011, patients received 1.5 g of cefuroxime during induction of anesthesia and another 1.5 g 2 h later (the C group). From September 2011, 800 mg of teicoplanin was added to cefuroxime (the CT group). Throughout the period studied, there were no variations in pre- or postoperative protocols. Univariate and multivariate analyses were performed to evaluate independent predictors of PJI. There were 995 (55.7%) patients in the C group and 791 (44.3%) in the CT group. Patients in the CT group had a significantly lower PJI rate than patients in the C group (1.26% versus 3.51%, P=0.002). There were no infections due to Staphylococcus aureus in the CT group (0% versus 1.6% in the C group, P<0.001). A stepwise forward Cox regression model identified male sex (hazard ratio [HR], 3.85; 95% confidence interval [CI], 2.09 to 7.18), a body mass index of ≥35 kg/m2 (HR, 2.93; 95% CI, 1.37 to 6.27), the presence of lung disease (HR, 2.46; 95% CI, 1.17 to 5.15), and red blood cell transfusion (HR, 3.70; 95% CI, 1.89 to 7.23) to be independent variables associated with a higher risk of PJI. The addition of teicoplanin was associated with a lower risk of infection (HR, 0.35; 95% CI, 0.17 to 0.74). In conclusion, the addition of teicoplanin to cefuroxime during primary arthroplasty was associated with a significant reduction in the global PJI rate due to a reduction of infections caused by Gram-positive bacteria. PMID:25403662

  20. Development and validation of a microbiological agar assay for determination of cefuroxime sodium in pharmaceutical preparations.

    PubMed

    Schmidt, Cleber A; Agarrayua, Danielle A; Laporta, Luciane V; Machado, Jaison C; Manfio, Maria L; Bittencourt, Celso F

    2009-06-01

    Cefuroxime (CFU) is a semi-synthetic cephalosporin with a relatively broad-spectrum antimicrobial activity, and belongs to the second generation of cephalosporins. Regarding the quality control of medicines, a validated microbiological assay for determination of cefuroxime sodium in pharmaceutical formulations has not been reported yet. With this purpose, this paper reports the development and validation of a simple, sensitive, accurate and reproducible agar diffusion method to quantify CFU sodium in injectable formulations. The assay is based on the inhibitory effect of CFU upon the strain of Staphylococcus aureus ATCC 6538P used as test microorganism. The results were treated statistically by analysis of variance and were found to be linear (r=0.9998) in the selected range of 8.0-32.0 microg/ml; precise [repeatability: relative standard deviation (RSD)=1.56%; intermediate precision: between-day RSD=1.27%; between analyst RSD=1.13%] and accurate (101.58%). The bioassay specificity was studied by evaluation of degraded sample at 50 degrees C with analysis at 0, 24 and 48 h in parallel with the pharmacopeial liquid chromatography method for CFU. The results demonstrated the validity of the proposed bioassay, which allows reliable quantitation of CFU sodium in pharmaceutical samples and therefore can be used as a useful alternative methodology for the routine quality control of this medicine. PMID:19344741

  1. Pharmacokinetics of cefuroxime after intravenous, intramuscular, and subcutaneous administration to dogs.

    PubMed

    Albarellos, G A; Montoya, L; Lorenzini, P M; Passini, S M; Lupi, M P; Landoni, M F

    2016-02-01

    Cefuroxime pharmacokinetic profile was investigated in 6 Beagle dogs after single intravenous, intramuscular, and subcutaneous administration at a dosage of 20mg/kg. Blood samples were withdrawn at predetermined times over a 12-h period. Cefuroxime plasma concentrations were determined by HPLC. Data were analyzed by compartmental analysis. Peak plasma concentration (Cmax ), time-to-peak plasma concentration (Tmax ), and bioavailability for the intramuscular and subcutaneous administration were (meanSD) 22.99 7.87?g/mL, 0.430.20h, and 79.7014.43% and 15.373.07?g/mL, 0.990.10h, and 77.2221.41%, respectively. Elimination half-lives and mean residence time for the intravenous, intramuscular, and subcutaneous administration were 1.120.19h and 1.490.21h; 1.130.13 and 1.790.24h; and 1.040.23h and 2.210.23h, respectively. Significant differences were found between routes for Ka , MAT, Cmax , Tmax , t(a) , and MRT. T>MIC=50%, considering a MIC of 1?g/mL, was 11h for intravenous and intramuscular administration and 12h for the subcutaneous route. When a MIC of 4?g/mL is considered, T>MIC=50% for intramuscular and subcutaneous administration was estimated in 8h. PMID:25982523

  2. No Resistance to Penicillin, Cefuroxime, Cefotaxime, or Vancomycin in Pneumococcal Pneumonia

    PubMed Central

    Yayan, Josef; Ghebremedhin, Beniam; Rasche, Kurt

    2015-01-01

    Objectives: Group B Streptococcus is a primary source of pneumonia, which is a leading cause of death worldwide. During the last few decades, there has been news of growing antibiotic resistance in group B streptococci to penicillin and different antibiotic agents. This clinical study retrospectively analyzes antimicrobial resistance in inpatients who were diagnosed with group B streptococcal pneumonia. Methods: All of the required information from inpatients who were identified to have group B streptococcal pneumonia was sourced from the database at the Department of Internal Medicine of HELIOS Clinic Wuppertal, Witten/Herdecke University, in Germany, from 2004-2014. Antimicrobial susceptibility testing was performed for the different antimicrobial agents that were regularly administered to these inpatients. Results: Sixty-six inpatients with a mean age of 63.3 ± 16.1 years (45 males [68.2%, 95% CI 60.0%-79.4%] and 21 females [31.8%, 95% CI 20.6%-43.0%]) were detected to have group B streptococcal pneumonia within the study period from January 1, 2004, to August 12, 2014. Group B Streptococcus had a high resistance rate to gentamicin (12.1%), erythromycin (12.1%), clindamycin (9.1%), and co-trimoxazole (3.0%), but it was not resistant to penicillin, cefuroxime, cefotaxime, or vancomycin (P < 0.0001). Conclusion: No resistance to penicillin, cefuroxime, cefotaxime, or vancomycin was detected among inpatients with pneumonia caused by group B streptococci. PMID:26664260

  3. Clinical comparison of cefuroxime axetil, cephalexin and cefadroxil in the treatment of patients with primary infections of the skin or skin structures.

    PubMed

    Gooch, W M; Kaminester, L; Cole, G W; Binder, R; Morman, M R; Swinehart, J M; Wisniewski, M; Yilmaz, H M; Collins, J J

    1991-01-01

    This study was designed to compare the clinical and bacteriological efficacy of three oral cephalosporins, cefuroxime axetil, cephalexin and cefadroxil, in the treatment of patients with mild to moderate infections of the skin or skin structures. A total of 330 patients were enrolled at 10 centers and were randomly assigned to receive cefuroxime axetil 250 mg (n = 107), cephalexin 500 mg (n = 111) or cefadroxil 500 mg (n = 112), twice daily for 10 days. Patients were assessed for their clinical and bacteriological responses once during treatment (3-5 days) and twice after treatment (1-3 and 10-14 days). A total of 353 bacterial isolates were obtained: Staphylococcus aureus (41%), Staphylococcus epidermidis (33%) and Streptococcus pyogenes (5%). A satisfactory clinical outcome (cure or improvement) was achieved in 97% (89/92), 89% (80/90) and 94% (82/87) of the clinically evaluable patients treated with cefuroxime axetil, cephalexin or cefadroxil, respectively (p = 0.047, cefuroxime axetil vs. cephalexin). With respect to the eradication of the bacterial pathogens, a satisfactory outcome (cure or presumed cure) was obtained in 96% (69/72), 85% (60/71) and 93% (63/68) of bacteriologically evaluable patients treated with cefuroxime axetil, cephalexin and cefadroxil, respectively (p = 0.026, cefuroxime axetil vs. cephalexin). All three study drugs were well tolerated, with adverse events affecting the gastrointestinal system most commonly reported. There were no significant differences between treatment groups in the incidence of drug-related adverse events. PMID:1769413

  4. Effects of test conditions on the susceptibility of staphylococci in vitro to cephradine, cephaloridine, cephalexin, and cefuroxime.

    PubMed

    Bayston, R; Swinden, J

    1981-02-01

    Methicillin-resistant staphylococci were tested for susceptibility to cephradine, cephaloridine, cephalexin, and cefuroxime and 30 degree C and 37 degree C on ordinary media and on media of enhanced osmotic strength. The coagulase-negative strains were divided into Staphylococcus epidermis and Staphylococcus hominis. Generally the number of susceptible strains decreased with low incubation temperature and osmotic support. When Staphylococcus aureus was tested against cephalexin and cefuroxime, most were susceptible at 37 degree C whereas all were resistant at 30 degree C. A similar trend was found in the case of cephradine, where it was accentuated by osmotic support. While almost all strains of Staph. epidermidis were sensitive to all four drugs under all test conditions, the susceptibility of Staph. hominis was generally decreased by either lower incubation temperature or osmotic support or both. PMID:7229101

  5. Cefuroxime, thiamphenicol, spectinomycin, and penicillin G in uncomplicated infections due to penicillinase-producing strains of Neisseria gonorrhoeae.

    PubMed Central

    Tupasi, T E; Crisologo, L B; Torres, C A; Calubiran, O V; de Jesus, I

    1983-01-01

    The use of cefuroxime and thiamphenicol in uncomplicated gonococcal infection was studied in 562 women confined to a clinic to preclude reinfection before cultural confirmation of cure. Cefuroxime was as effective as spectinomycin in the treatment of infections due to penicillinase-producing strains of Neisseria gonorrhoeae (PPNG) and was significantly more effective than 4.8 units of aqueous procaine penicillin G with probenecid among non-penicillinase-producing (non-PPNG) strains. Thiamphenicol was highly effective against PPNG, but the failure rate in infections with non-PPNG was high and appeared to be related to the minimum inhibitory concentrations of thiamphenicol. This rate was not, however, significantly higher than that for PPNG strains. Thiamphenicol might therefore be used as an alternative for infections due to PPNG strains. If, however, thiamphenicol is used widely, selection of more resistant strains and thus an increasing proportion of failures may be expected. PMID:6221775

  6. Removal of amoxicillin and cefuroxime axetil by advanced membranes technology, activated carbon and micelle-clay complex.

    PubMed

    Awwad, Mohammad; Al-Rimawi, Fuad; Dajani, Khuloud Jamal Khayyat; Khamis, Mustafa; Nir, Shlomo; Karaman, Rafik

    2015-01-01

    Two antibacterials, amoxicillin trihydrate and cefuroxime axetil spiked into wastewater were completely removed by sequential wastewater treatment plant's membranes, which included activated sludge, ultrafiltration (hollow fibre and spiral wound membranes with 100 and 20 kDa cut-offs), activated carbon column and reverse osmosis. Adsorption isotherms in synthetic water which employed activated carbon and micelle-clay complex (octadecyltrimethylammonium-montmorillonite) as adsorbents fitted the Langmuir equation. Qmax of 100 and 90.9 mg g(-1), and K values of 0.158 and 0.229 L mg(-1) were obtained for amoxicillin trihydrate using activated carbon and micelle-clay complex, respectively. Filtration of antibacterials in the ppm range, which yielded variable degrees of removal depending on the volumes passed and flow rates, was simulated and capacities for the ppb range were estimated. Stability study in pure water and wastewater revealed that amoxicillin was totally stable for one month when kept at 37°C, whereas cefuroxime axetil underwent slow hydrolysis to cefuroxime. PMID:25686519

  7. Comparison of single-dose cefuroxime axetil with ciprofloxacin in treatment of uncomplicated gonorrhea caused by penicillinase-producing and non-penicillinase-producing Neisseria gonorrhoeae strains.

    PubMed Central

    Thorpe, E M; Schwebke, J R; Hook, E W; Rompalo, A; McCormack, W M; Mussari, K L; Giguere, G C; Collins, J J

    1996-01-01

    A randomized, multicenter, investigator-blind trial was conducted to compare the efficacies of cefuroxime axetil and ciprofloxacin for treatment of patients with uncomplicated gonorrhea caused by penicillinase-producing Neisseria gonorrhoeae (PPNG). A total of 832 patients (434 females and 398 males) received a single oral dose of cefuroxime axetil (1,000 mg [417 patients]) or ciprofloxacin (500 mg [415 patients]). N. gonorrhoeae was eradicated from the cervix in 114 of 118 (97%) and 118 of 119 (99%) bacteriologically evaluable females treated with cefuroxime axetil and ciprofloxacin, respectively (P = 0.213; difference, -2%; 95% confidence interval, -6 to 1%), and from the urethra in 154 of 166 (93%) and 171 of 171 (100%) bacteriologically evaluable male patients treated with cefuroxime axetil and ciprofloxacin, respectively (P < 0.001; difference, -7%; 95% confidence interval, -11 to -3%). Both treatments were effective in eradicating N. gonorrhoeae in females with rectal infections (cefuroxime axetil, 29 of 30 [97%]; ciprofloxacin, 25 of 25 [100%]; P = 1.00). In small numbers of patients, cefuroxime axetil was less effective than ciprofloxacin in treating males with pharyngeal infections (eradication in 4 of 10 and in 8 of 8 patients, respectively; P = 0.013). PPNG was eradicated from the cervix in 22 of 23 (96%) and 32 of 32 (100%) bacteriologically evaluable female patients treated with cefuroxime axetil and ciprofloxacin, respectively (P = 0.418; difference, -4%; 95% confidence interval, -13 to 4%), and from the urethra in 35 of 36 (97%) and 34 of 34 (100%) bacteriologically evaluable male patients treated with cefuroxime axetil and ciprofloxacin, respectively (P = 1.00; difference, -3%; 95% confidence interval, -8 to 3%). The incidences of drug-related adverse events were similar for the two study drugs. In summary, treatment with a single oral dose of cefuroxime axetil is as effective as treatment with a single oral dose of ciprofloxacin in eradicating PPNG from males and females with uncomplicated gonorrhea (urethral and endocervical), and both regimens are well-tolerated. However, in the present study, cefuroxime axetil was less effective than ciprofloxacin in treating urethral gonococcal infections in male patients, although both study drugs were highly effective in treating cervical gonococcal infections in female patients. PMID:9124839

  8. Population pharmacokinetic models for cefuroxime and metronidazole used in combination as prophylactic agents in colorectal surgery: Model-based evaluation of standard dosing regimens.

    PubMed

    Asn-Prieto, Eduardo; Soraluce, Amaia; Trocniz, Iaki F; Campo Cimarras, Eugenia; Senz de Ugarte Sobrn, Jaione; Rodrguez-Gascn, Alicia; Isla, Arantxazu

    2015-05-01

    The antibiotics used for prophylaxis in colorectal surgery must maintain appropriate plasma concentrations during the entire surgery to avoid surgical site infections caused by aerobes and anaerobes; cefuroxime plus metronidazole is one of the combinations used. The aim of this study was to evaluate the adequacy of cefuroxime plus metronidazole administration as prophylaxis in colorectal surgery. In total, 63 patients electively undergoing rectal or colon surgery were administered 1500mg of cefuroxime and 1500mg of metronidazole in 15-min and 1-h infusions, respectively, prior to surgery. Blood samples were withdrawn during and after surgery for determination of plasma concentrations by high-performance liquid chromatography. Population pharmacokinetic models were developed using NONMEM 7.2.0. Pharmacokinetic/pharmacodynamic (PK/PD) simulations were performed to explore the ability of different dosage regimens to achieve the pharmacodynamic targets. Pharmacokinetics for both antibiotics were best described by a two-compartment model. Elimination of cefuroxime was conditioned by creatinine clearance (CLCr). The half-life of cefuroxime was 1.5h for patients with normal renal function and 4.9h in patients with renal impairment. Elimination and distribution of metronidazole were affected by patient body weight (BW). PK/PD analysis revealed that a single-dose protocol of 1500mg of cefuroxime and metronidazole is adequate in short surgeries (?2h). However, for longer surgeries, recommendations are suggested depending on the patient's CLCr and BW. Additional doses of cefuroxime are needed for patients with moderate renal impairment or those presenting normal renal function. For metronidazole, an additional dose is needed for patients with a BW of 90kg. PMID:25758019

  9. Formulation and evaluation of cefuroxim loaded submicron particles for ophthalmic delivery.

    PubMed

    Andrei, Gabriela; Peptu, C?t?lina A; Popa, Marcel; Desbrieres, Jacques; Peptu, Cristian; Gardikiotis, Fotios; Costuleanu, Marcel; Costin, D?nut; Dupin, Jean Charles; Uhart, Arnaud; Tamba, Bogdan I

    2015-09-30

    Chitosan gelatin particles could be the ideal candidate for intraocular drug delivery due to their desirable properties. Double crosslinking in double emulsion has been used as an original and reliable method for particles preparation and their morphology has been optimized considering the main synthesis parameters such as polymers ratio, crosslinker amount, stirring speed, tensioactive amount and ionic crosslinking time, respectively. The particles have been analyzed for their physical-chemical properties (swelling degree, drug loading and release capacity, surface characteristics, etc.), the enzymatic degradation properties along with in vivo ocular investigations (ocular biodistribution, in vivo drug release). In the present study cefuroxim was used as a model drug, which is generally used in the prophylaxis of postoperative endophthalmitis following cataract surgery after intraocular administration. The present study proved that the dimensions and the physical-chemical properties of the particles can be modulated (by varying the preparation parameters) to facilitate the administration, the biodistribution and the drug release in the specific segment of the eye. This experimental study demonstrated also the ability of fluorescent nanoparticles to penetrate ocular tissues close to the administration site (intravitreal injection) and especially their tendency to migrate deep in the retina at time intervals of 72 h. PMID:26211903

  10. Preparation and characterization of cefuroxime axetil solid dispersions using hydrophilic carriers

    PubMed Central

    Gorajana, Adinarayana; Rajendran, Adhiyaman; Yew, Lee Mun; Dua, Kamal

    2015-01-01

    Aim: The objective of the current study is to increase the dissolution rate of cefuroxime axetil (CA) by formation of binary CA solid dispersion using water soluble carriers such as polyvinylpyrrolidone (PVP K30) and polyethylene glycol (PEG 4000). Methods: Solid dispersions (SDs) between CA and PVP K30/PEG 4000 were formed by dissolving both compounds in a common solvent, methanol, which were rotary evaporated at 40°C for 12 h. Physical mixtures between CA and PVP K30/PEG 4000 were also formulated as to compare the efficiency of SDs. The physicochemical properties of CA and all its formulations were then characterized using differential scanning calorimetric analysis (DSC), powder X-ray diffraction studies (PXRD), and Fourier transform infrared spectroscopy (FTIR). Results: All SD formulations were found to have a higher dissolution rate comparatively to pure CA, while only physical mixtures of PVP K30 were found having a significantly higher dissolution rate. The enhancement of dissolution rate SD by PVP K30 may be caused by increase wettability, solubility, reduction in particle size or the formation of CA β crystalline. Increment of dissolution rate of CA SDs by PEG 4000 similarly may be caused by increase wettability, solubility, and reduction in particle size. This phenomenon may also be caused by amorphization as suggested by DSC and PXRD. Conclusions: The SD of CA with PVP K30 and PEG 4000, lends an ample credence for better therapeutic efficacy. PMID:26258059

  11. Eradication of Biofilm-Like Microcolony Structures of Borrelia burgdorferi by Daunomycin and Daptomycin but not Mitomycin C in Combination with Doxycycline and Cefuroxime

    PubMed Central

    Feng, Jie; Weitner, Megan; Shi, Wanliang; Zhang, Shuo; Zhang, Ying

    2016-01-01

    Lyme disease, caused by Borrelia burgdorferi, is the most common vector-borne disease in the United States and Europe. While the majority of Lyme disease patients can resolve their symptoms if treated promptly, 10–20% of patients suffer from prolonged symptoms called post-treatment Lyme disease syndrome (PTLDS). Although the cause for PTLDS is unclear, one possibility is the presence of bacterial persisters not effectively cleared by the current Lyme antibiotics. Recent studies identified several drug candidates including daptomycin, daunomycin, doxorubicin, and mitomycin C that had good activity against B. burgdorferi persisters. However, their relative activities against B. burgdorferi persisters have not been evaluated under the same conditions. In this study, we tested the anti-persister activities of these drugs against both 7-day and 15-day old stationary phase cultures of B. burgdorferi individually as well as in combination with Lyme antibiotics doxycycline and cefuroxime (Ceftin). Our findings demonstrate daunomycin and daptomycin were more active than mitomycin C in single drug comparison at 10 and 20 μM, as well as in drug combinations with doxycycline and cefuroxime. In addition, daunomycin was more active than doxorubicin which correlated with their ability to stain and accumulate in B. burgdorferi. The two drug combination of doxycycline and cefuroxime was unable to eradicate biofilm-like microcolonies of B. burgdorferi persisters. However, the addition of either daunomycin or daptomycin to the doxycycline + cefuroxime combination completely eradicated the biofilm-like structures and produced no visible bacterial regrowth after 7 and 21 days, while the addition of doxorubicin was unable to prevent regrowth at either 7 or 21 day subculture. Mitomycin C in combination with doxycycline and cefuroxime caused no regrowth at 7 days but visible spirochetal regrowth occurred after 21 day subculture. Furthermore, we found that cefuroxime (Ceftin), the third commonly used and most active antibiotic to treat Lyme disease, could replace cefoperazone (a drug no longer available in the US) in the daptomycin + doxycycline combination with complete eradication of the biofilm-like structures as shown by lack of any regrowth in subcultures. Our findings may have implications for improved treatment of Lyme disease. PMID:26903956

  12. Eradication of Biofilm-Like Microcolony Structures of Borrelia burgdorferi by Daunomycin and Daptomycin but not Mitomycin C in Combination with Doxycycline and Cefuroxime.

    PubMed

    Feng, Jie; Weitner, Megan; Shi, Wanliang; Zhang, Shuo; Zhang, Ying

    2016-01-01

    Lyme disease, caused by Borrelia burgdorferi, is the most common vector-borne disease in the United States and Europe. While the majority of Lyme disease patients can resolve their symptoms if treated promptly, 10-20% of patients suffer from prolonged symptoms called post-treatment Lyme disease syndrome (PTLDS). Although the cause for PTLDS is unclear, one possibility is the presence of bacterial persisters not effectively cleared by the current Lyme antibiotics. Recent studies identified several drug candidates including daptomycin, daunomycin, doxorubicin, and mitomycin C that had good activity against B. burgdorferi persisters. However, their relative activities against B. burgdorferi persisters have not been evaluated under the same conditions. In this study, we tested the anti-persister activities of these drugs against both 7-day and 15-day old stationary phase cultures of B. burgdorferi individually as well as in combination with Lyme antibiotics doxycycline and cefuroxime (Ceftin). Our findings demonstrate daunomycin and daptomycin were more active than mitomycin C in single drug comparison at 10 and 20 μM, as well as in drug combinations with doxycycline and cefuroxime. In addition, daunomycin was more active than doxorubicin which correlated with their ability to stain and accumulate in B. burgdorferi. The two drug combination of doxycycline and cefuroxime was unable to eradicate biofilm-like microcolonies of B. burgdorferi persisters. However, the addition of either daunomycin or daptomycin to the doxycycline + cefuroxime combination completely eradicated the biofilm-like structures and produced no visible bacterial regrowth after 7 and 21 days, while the addition of doxorubicin was unable to prevent regrowth at either 7 or 21 day subculture. Mitomycin C in combination with doxycycline and cefuroxime caused no regrowth at 7 days but visible spirochetal regrowth occurred after 21 day subculture. Furthermore, we found that cefuroxime (Ceftin), the third commonly used and most active antibiotic to treat Lyme disease, could replace cefoperazone (a drug no longer available in the US) in the daptomycin + doxycycline combination with complete eradication of the biofilm-like structures as shown by lack of any regrowth in subcultures. Our findings may have implications for improved treatment of Lyme disease. PMID:26903956

  13. Enhancement in photocatalytic activity of NiO by supporting onto an Iranian clinoptilolite nano-particles of aqueous solution of cefuroxime pharmaceutical capsule

    NASA Astrophysics Data System (ADS)

    Pourtaheri, Asieh; Nezamzadeh-Ejhieh, Alireza

    2015-02-01

    NiO/nano-clinoptilolite (NiO-NCP) was prepared by ion exchanging process of the prepared ball-mill nano-clinoptilolite particles with nickel(II) chloride aqueous solution. The prepared composite was characterized by XRD, UV-Vis DRS, TEM and FT-IR and then used as a catalyst in the photodegradation of cefuroxime (CF) using Hg lamp. The best experimental parameters were obtained as: 0.025 g L-1 of the photocatalyst containing 13.3% NiO, 50 times diluted cefuroxime solution at pH 5. The degradation extent was monitored by UV-Vis spectroscopy and the results were confirmed by HPLC and COD. The kinetics of the photodegradation process obeyed the Langmuir-Hinshelwood model.

  14. Enhancement in photocatalytic activity of NiO by supporting onto an Iranian clinoptilolite nano-particles of aqueous solution of cefuroxime pharmaceutical capsule.

    PubMed

    Pourtaheri, Asieh; Nezamzadeh-Ejhieh, Alireza

    2015-02-25

    NiO/nano-clinoptilolite (NiO-NCP) was prepared by ion exchanging process of the prepared ball-mill nano-clinoptilolite particles with nickel(II) chloride aqueous solution. The prepared composite was characterized by XRD, UV-Vis DRS, TEM and FT-IR and then used as a catalyst in the photodegradation of cefuroxime (CF) using Hg lamp. The best experimental parameters were obtained as: 0.025 g L(-1) of the photocatalyst containing 13.3% NiO, 50 times diluted cefuroxime solution at pH 5. The degradation extent was monitored by UV-Vis spectroscopy and the results were confirmed by HPLC and COD. The kinetics of the photodegradation process obeyed the Langmuir-Hinshelwood model. PMID:25233023

  15. In vitro/in vivo comparison of cefuroxime release from poly(ε-caprolactone)-calcium sulfate implants for osteomyelitis treatment.

    PubMed

    Yaprakci, Volkan; Erdemli, Ozge; Kayabolen, Alisan; Tezcaner, Aysen; Bozkurt, Fatih; Keskin, Dilek

    2013-01-01

    This study aimed to investigate the release of cefuroxime axetil (CF) and calcium from poly(ε-caprolactone) (PCL)-calcium sulfate (CaS) implants (PCL:CaS 2:1-10% CF; PCL:CaS 2:1-20% CF; PCL:CaS 1:1-10% CF) for treating infectious bone diseases. Bioactivity, crystallinity and strength, and release profiles under standard and pressurized release conditions were studied. PCL:CaS 2:1-20% CF had slower release than 10% loading. These groups had no significant change in CF and Ca release in response to pressure. The PCL:CaS 1:1 group had the slowest release despite having higher CaS, probably due to more compaction of discs. In contrast, pressure caused significant differentiation of CF and Ca(2+) release. The presence of CaS enhanced mechanical properties and bioactivity of discs. SEM and XPS results showed calcium-phosphate containing accumulations on surfaces upon SBF incubation. CF-loaded implants were applied in a rabbit osteomyelitis model. In vivo CF release was enhanced with increased CaS proportions, suggesting that in vivo release conditions are closer to pressurized in vitro conditions. In the control group, there was still some inflammation in the bone and no complete coverage with bone was achieved in the defect site. Discs provided a suitable surface for regeneration of bone. However, bone formation in the PCL:CaS 1:1 disc implanted group was more complete and regular than in the 2:1 group. PMID:23586705

  16. Determination of cefuroxime lysine in rat brain microdialysates by ultra-fast liquid chromatography with UV and tandem mass spectrometry: application to an acute toxicokinetic study.

    PubMed

    Zhao, Longshan; Li, Qing; Zhu, Heyun; Chen, Xiaohui; Bi, Kaishun

    2014-09-01

    Cefuroxime lysine is a new second-generation cephalosporins, which can penetrate the blood-brain barrier to cure the meningitis. In order to investigate its acute toxicokinetic study after intraperitoneal injection of 675?mg/kg cefuroxime lysine, a sensitive and clean ultra-fast liquid chromatography-tandem mass spectrometry (UFLC-MS/MS) method for the determination of cefuroxime lysine in microdialysate samples was developed and validated, which was compared with UFLC-UV as a reference method. Chromatographic separation was performed on a Shim-pack XR-ODS C18 column (75??3.0?mm, 2.2?m), with an isocratic elution of 0.1% formic acid in acetonitrile-0.1% formic acid in water (45:55, v/v) for LC-MS and acetonitrile-20?mm potassium dihydrogen phosphate (pH?3.0,20:80, v/v) for LC-UV. The lower limit of detection was 0.01?g/mL for LC-MS and 0.1?g/mL for LC-UV method, with the same corresponding linearity range of 0.1-50?g/mL. The intra- and inter-day precisions (relative standard deviation) for both methods were from 1.1 to 8.9%, while the accuracy was all within 10.9%. The results of both methods were finally compared using paired t-test; the results indicated that the concentrations measured by the two methods correlated significantly (p?

  17. A multicenter, randomized study comparing the efficacy and safety of intravenous and/or oral levofloxacin versus ceftriaxone and/or cefuroxime axetil in treatment of adults with community-acquired pneumonia.

    PubMed Central

    File, T M; Segreti, J; Dunbar, L; Player, R; Kohler, R; Williams, R R; Kojak, C; Rubin, A

    1997-01-01

    Five hundred ninety patients were enrolled in a prospective, multicenter, randomized trial comparing the efficacy and safety of 7 to 14 days of levofloxacin treatment with that of ceftriaxone and/or cefuroxime axetil in the management of community-acquired pneumonia in adults. Patients received either intravenous and/or oral levofloxacin (500 mg once daily) or the comparative agents, parenteral ceftriaxone (1 to 2 g once to twice daily) and/or oral cefuroxime axetil (500 mg twice daily). Erythromycin or doxycycline could be added to the comparator arm at the investigator's discretion. The decision to use an intravenous or oral antimicrobial agent for initial therapy was made by the investigator. Clinical and microbiological evaluations were completed at the baseline, during treatment, 5 to 7 days posttherapy, and 3 to 4 weeks posttherapy. Four hundred fifty-six patients (226 given levofloxacin and 230 administered ceftriaxone and/or cefuroxime axetil) were evaluable for clinical efficacy. Streptococcus pneumoniae and Haemophilus influenzae were isolated in 15 and 12%, respectively, of clinically evaluable patients. One hundred fifty atypical pathogens were identified: 101 were Chlamydia pneumoniae, 41 were Mycoplasma pneumoniae, and 8 were Legionella pneumophila. Clinical success at 5 to 7 days posttherapy was superior for the levofloxacin group (96%) compared with the ceftriaxone and/or cefuroxime axetil group (90%) (95% confidence interval [CI] of -10.7 to -1.3). Among patients with typical respiratory pathogens who were evaluable for microbiological efficacy, the overall bacteriologic eradication rates were superior for levofloxacin (98%) compared with the ceftriaxone and/or cefuroxime axetil group (85%) (95% CI of -21.6 to -4.8). Levofloxacin eradicated 100% of the most frequently reported respiratory pathogens (i.e., H. influenzae and S. pneumoniae) and provided a >98% clinical success rate in patients with atypical pathogens. Both levofloxacin and ceftriaxone-cefuroxime axetil eradicated 100% of the S. pneumoniae cells detected in blood culture. Drug-related adverse events were reported in 5.8% of patients receiving levofloxacin and in 8.5% of patients administered ceftriaxone and/or cefuroxime axetil. Gastrointestinal and central and peripheral nervous system adverse events were the most common events reported in each treatment group. In conclusion, these results demonstrate that treatment with levofloxacin is superior to ceftriaxone and/or cefuroxime axetil therapy in the management of community-acquired pneumonia in adults. PMID:9303395

  18. Continuous versus short-term infusion of cefuroxime: assessment of concept based on plasma, subcutaneous tissue, and bone pharmacokinetics in an animal model.

    PubMed

    Tttrup, Mikkel; Bibby, Bo M; Hardlei, Tore F; Bue, Mats; Kerrn-Jespersen, Sigrid; Fuursted, Kurt; Sballe, Kjeld; Birke-Srensen, Hanne

    2015-01-01

    The relatively short half-lives of most ?-lactams suggest that continuous infusion of these time-dependent antimicrobials may be favorable compared to short-term infusion. Nevertheless, only limited solid-tissue pharmacokinetic data are available to support this theory. In this study, we randomly assigned 12 pigs to receive cefuroxime as either a short-term or continuous infusion. Measurements of cefuroxime were obtained every 30 min in plasma, subcutaneous tissue, and bone. For the measurements in solid tissues, microdialysis was applied. A two-compartment population model was fitted separately to the drug concentration data for the different tissues using a nonlinear mixed-effects regression model. Estimates of the pharmacokinetic parameters and time with concentrations above the MIC were derived using Monte Carlo simulations. Except for subcutaneous tissue in the short-term infusion group, the tissue penetration was incomplete for all tissues. For short-term infusion, the tissue penetration ratios were 0.97 (95% confidence interval [CI], 0.67 to 1.39), 0.61 (95% CI, 0.51 to 0.73), and 0.45 (95% CI, 0.36 to 0.56) for subcutaneous tissue, cancellous bone, and cortical bone, respectively. For continuous infusion, they were 0.53 (95% CI, 0.33 to 0.84), 0.38 (95% CI, 0.23 to 0.57), and 0.27 (95% CI, 0.13 to 0.48) for the same tissues, respectively. The absolute areas under the concentration-time curve were also lower in the continuous infusion group. Nevertheless, a significantly longer time with concentrations above the MIC was found for continuous infusion up until MICs of 4, 2, 2, and 0.5 ?g/ml for plasma and the same three tissues mentioned above, respectively. For drugs with a short half-life, like cefuroxime, continuous infusion seems to be favorable compared to short-term infusion; however, incomplete tissue penetration and high MIC strains may jeopardize the continuous infusion approach. PMID:25313214

  19. Activity of WY-49605 compared with those of amoxicillin, amoxicillin-clavulanate, imipenem, ciprofloxacin, cefaclor, cefpodoxime, cefuroxime, clindamycin, and metronidazole against 384 anaerobic bacteria.

    PubMed Central

    Spangler, S K; Jacobs, M R; Appelbaum, P C

    1994-01-01

    The National Committee for Clinical Laboratory Standards agar dilution method was used to compare the in vitro activity of WY-49605 (also called SUN/SY 5555 and ALP-201), a new broad-spectrum oral penem, to those of amoxicillin, amoxicillin-clavulanate, imipenem, ciprofloxacin, cefaclor, cefpodoxime, cefuroxime, clindamycin, and metronidazole against 384 clinically isolated anaerobes. These anaerobic organisms included 90 strains from the Bacteroides fragilis group, 87 Prevotella and Porphyromonas strains, non-B. fragilis group Bacteroides strains, 56 fusobacteria, 55 peptostreptococci, 49 gram-positive non-spore-forming rods, and 47 clostridia. Overall, WY-49605 had an MIC range of 0.015 to 8.0 micrograms/ml, an MIC at which 50% of the isolates are inhibited (MIC50) of 0.25 microgram/ml, and an MIC at which 90% of the isolates are inhibited (MIC90) of 2.0 micrograms/ml. Good activity against all anaerobe groups was observed, except for Clostridium difficile and lactobacilli (MIC50s of 4.0 and 2.0 micrograms/ml, respectively, and MIC90s of 8.0 and 2.0 micrograms/ml, respectively). Imipenem had an MIC50 of 0.03 microgram/ml and an MIC90 of 0.25 microgram/ml. Ciprofloxacin was much less active (MIC50 of 2.0 micrograms/ml and MIC90 of 16.0 micrograms/ml). By comparison, all oral beta-lactams were less active than WY-49605, with susceptibilities as follows: amoxicillin MIC50 of 8.0 micrograms/ml and MIC90 of > 256.0 micrograms/ml), amoxicillin-clavulanate MIC50 of 1.0 microgram/ml and MIC90 of 8.0 micrograms/ml, cefaclor MIC50 of 8.0 micrograms/ml and MIC90 of > 32.0 micrograms/ml, cefpodoxime MIC50 of 4.0 micrograms/ml and MIC90 of > 32.0 micrograms/ml, and cefuroxime MIC50 of 4.0 micrograms/ml and MIC90 of > 32.0 micrograms/ml. Clindamycin was active against all groups except some members of the B. fragilis group, Fusobacterium varium, and some clostridia ( overall MIC50 of 0.5 micrograms/ml and overall MIC90 of 8.0 micrograms/ml). Metronidazole was active (MIC of less than or equal to 4.0 micrograms/ml) against all gram-negative anaerobic rods, but most gram-positive non-spore-forming rods, some peptostreptococci, and some clostridia were less susceptible. To date, WY-49605 is the most active oral beta-lactam against anaerobes: these results suggest clinical evaluation for clinical indications suitable for oral therapy. PMID:7872754

  20. An investigation into the release of cefuroxime axetil from taste-masked stearic acid microspheres. III. The use of DSC and HSDSC as means of characterising the interaction of the microspheres with buffered media.

    PubMed

    Robson, H; Craig, D Q; Deutsch, D

    2000-05-25

    Stearic acid coated cefuroxime axetil (SACA) microspheres have been studied using differential scanning calorimetry (DSC) and high sensitivity DSC (HSDSC) in order to examine the interaction between the spheres and a range of buffer systems, with a view to further enhance the understanding of the mechanism of drug release developed in earlier studies [Robson et al., 1999, 2000]. DSC studies indicated that after immersion in Sorensens modified phosphate buffer (SMPB) pH 5.9 followed by washing and drying, no change in the thermal properties of the spheres was detected up to 60 min of immersion, with a single endotherm noted at circa 56 degrees C, that corresponded to the melting of the stearic acid used in this study; similar results were obtained for systems immersed in distilled water. After immersion in SMPB pH 7.0 and 8.0, however, a second peak was noted at approximately 67 degrees C that increased in magnitude relative to the lower temperature endotherm with increasing exposure time to the medium. Spheres that had not been previously washed prior to drying showed complete conversion to the higher temperature endotherm for these two buffers. Systems which had been exposed to a range of pH 7.0 buffers (citrate-phosphate buffer (CPB), phosphate buffer mixed (PBM), boric acid buffer (BAB)) were then examined. Only the CPB systems showed evidence for conversion to the higher melting form. PBM systems to which further sodium had been added were then examined. A maximum conversion was found at 0.05 M sodium, which was in agreement with the maximum in release rate found in a previous study [Robson et al., 2000]. HSDSC was then used to examine systems that were immersed in the buffer. For SMPB, pH 5.9 and distilled water, only the endotherm corresponding to the stearic acid melting was seen. However, for SMPB pH 7.0 and 8.0, three peaks were seen, two corresponding to those seen for the DSC studies and a further lower temperature peak at circa 44 degrees C. Studies on PBM systems to which additional sodium had been added showed small levels of conversion to the higher temperature form at higher sodium contents. The data was discussed in terms of the correlation with earlier dissolution studies on the same systems [Robson et al., 1999; 2000]. PMID:10878327

  1. Lyme Disease Treatment (Beyond the Basics)

    MedlinePLUS

    ... symptoms) is treated with oral antibiotics, usually doxycycline , amoxicillin , or cefuroxime , taken daily. Doxycycline is given for 10 to 21 days, and amoxicillin and cefuroxime are given for 14 to 21 ...

  2. Ampicillin and Sulbactam Injection

    MedlinePLUS

    ... Ampicillin is in a class of medications called penicillin-like antibiotics. It works by stopping the growth ... pharmacist if you are allergic to ampicillin, sulbactam, penicillin, cephalosporin antibiotics such as cefaclor, cefadroxil, cefuroxime (Ceftin, ...

  3. Evaluation of cefazolin as a surrogate marker for cefpodoxime susceptibility for urinary tract isolates.

    PubMed

    Bookstaver, David A; Bland, Christopher M; Arroyo, Miguel A

    2015-10-01

    Of the cephalosporins, cefpodoxime has the most published clinical data for the treatment of urinary tract infections. In 2014, the Clinical and Laboratory Standards Institute (CLSI) guidelines recommended that cefazolin should be used as the surrogate marker for cefpodoxime among urinary tract isolates, replacing cephalothin. This study attempted to determine how well cefazolin serves as the surrogate marker. Additionally, it investigated how cefuroxime compared with cefazolin as a surrogate marker. The MicroScan Walkaway Plus system was used to determine susceptibility for cefazolin and cefuroxime on consecutive urine cultures with a colony count of ≥ 50 000 organisms. Only Escherichia coli, Klebsiella pneumoniae and Proteus mirabilis isolates were included, following CLSI guidelines. Simultaneously, an Etest for cefpodoxime was conducted. The cefpodoxime interpretation was compared with that of the other two agents, and the categorical agreement was calculated, defined as the percentage of identical susceptibility interpretations. Cefazolin (92 %) had a significantly higher categorical agreement than cefuroxime (85 %) among 284 isolates (P = 0.011). The major error rate was 4.4 % for cefazolin and 1.1 % for cefuroxime. The very major error rate was 64 % for cefazolin and 18 % for cefuroxime among the 11 cefpodoxime-resistant isolates. Cefazolin was a better predictor of cefpodoxime susceptibility than the previously recommended agent, cephalothin. However, cefuroxime had better major and very major error rates than cefazolin. PMID:26219948

  4. Is single-dose fosfomycin trometamol a good alternative for asymptomatic bacteriuria in the second trimesterof pregnancy?

    PubMed

    Bayrak, Omer; Cimentepe, Ersin; Inegöl, Ilknur; Atmaca, Ali Fuat; Duvan, Candan Iltemir; Koç, Akif; Turhan, Nilgün Oztürk

    2007-05-01

    Untreated asymptomatic bacteriuria has been associated with acute pyelonephritis, which may have a role in many maternal and fetal complications. Acute pyelonephritis in pregnancy is related to anemia, septicemia, transient renal dysfunction, and pulmonary insufficiency. A randomized study was conducted to assess the clinical and microbiological efficacy of a single dose of fosfomycin trometamol for the treatment of asymptomatic bacteriuria in the second trimester of pregnancy compared with a 5-day regimen of cefuroxime axetyl. Forty-four women received fosfomycin trometamol and 40 women received cefuroxime axetyl. There were no statistically significant differences between both groups regarding the mean age and mean duration of pregnancy. Therapeutic success was achieved in 93.2% of the patients treated with fosfomycin trometamol vs 95% of those treated with cefuroxime axetyl. A single dose of fosfomycin trometamol is a safe and effective alternative in the treatment of asymptomatic urinary tract infections in the second trimester of pregnancy. PMID:16941068

  5. Endophthalmitis prophylaxis in cataract surgery: overview of current practice patterns in 9 European countries.

    PubMed

    Behndig, Anders; Cochener, Beatrice; Gell, Jos Luis; Kodjikian, Laurent; Mencucci, Rita; Nuijts, Rudy M M A; Pleyer, Uwe; Rosen, Paul; Szaflik, Jacek P; Tassignon, Marie-Jos

    2013-09-01

    Data on practice patterns for prophylaxis against infectious postoperative endophthalmitis (IPOE) during cataract surgery in 9 European countries were searched in national registers and reviews of published surveys. Summary reports assessed each nation's IPOE rates, nonantibiotic prophylactic routines, topical and intracameral antibiotic use, and coherence to the European Society of Cataract & Refractive Surgeons (ESCRS) 2007 guidelines. Although the reliability and completeness of available data vary between countries, the results show that IPOE rates differ significantly. Asepsis routines with povidone-iodine and postoperative topical antibiotics are generally adopted. Use of preoperative and perioperative topical antibiotics as well as intracameral cefuroxime varies widely between and within countries. Five years after publication of the ESCRS guidelines, there is no consensus on intracameral cefuroxime use. Major obstacles include legal barriers or persisting controversy about the scientific rationale for systematic intracameral cefuroxime use in some countries and, until recently, lack of a commercially available preparation. PMID:23988244

  6. Beta-lactam antibiotics modulate T-cell functions and gene expression via covalent binding to cellular albumin

    PubMed Central

    Mor, Felix; Cohen, Irun R.

    2013-01-01

    Recent work has suggested that beta-lactam antibiotics might directly affect eukaryotic cellular functions. Here, we studied the effects of commonly used beta-lactam antibiotics on rodent and human T cells in vitro and in vivo on T-cell–mediated experimental autoimmune diseases. We now report that experimental autoimmune encephalomyelitis and adjuvant arthritis were significantly more severe in rats treated with cefuroxime and other beta-lactams. T cells appeared to mediate the effect: an anti-myelin basic protein T-cell line treated with cefuroxime or penicillin was more encephalitogenic in adoptive transfer experiments. The beta-lactam ampicillin, in contrast to cefuroxime and penicillin, did not enhance encephalomyelitis, but did inhibit the autoimmune diabetes developing spontaneously in nonobese diabetic mice. Gene expression analysis of human peripheral blood T cells showed that numerous genes associated with T helper 2 (Th2) and T regulatory (Treg) differentiation were down-regulated in T cells stimulated in the presence of cefuroxime; these genes were up-regulated in the presence of ampicillin. The T-cell protein that covalently bound beta-lactam antibiotics was found to be albumin. Human and rodent T cells expressed albumin mRNA and protein, and penicillin-modified albumin was taken up by rat T cells, leading to enhanced encephalitogenicity. Thus, beta-lactam antibiotics in wide clinical use have marked effects on T-cell behavior; beta-lactam antibiotics can function as immunomodulators, apparently through covalent binding to albumin. PMID:23382225

  7. Relationship between phylogenetic groups, antibiotic resistance and patient characteristics in terms of adhesin genes in cystitis and pyelonephritis isolates of Escherichia coli.

    PubMed

    Er, Doganhan Kadir; Dundar, Devrim; Uzuner, Huseyin; Osmani, Agim

    2015-12-01

    Extraintestinal pathogenic Escherichia coli (E.coli) is considered as the main causative agent of urinary tract infections worldwide. The relationship between antimicrobial resistance, phylogenetic groups, patient characteristics and adhesin virulence genes are complex and not fully understood. In this study, among 146 urinary isolates of E. coli, phylogenetic groups and various adhesin virulence genes were examined with multiplex Polymerase Chain Reaction methods. Patient characteristics divided into sex, cystitis and pyelonephritis; community-acquired and hospital-acquired; complicated and uncomplicated infection. Antimicrobial resistance was also determined. The papAH gene was seen more often in pyelonephritis than cystitis and female than male patients. iha gene was more frequent in hospital-acquired infections than in community-acquired infections. sfa/focDE was more frequent in ampicillin, amikacin, gentamicin, nalidixic acid, norfloxacin, cefuroxime, ceftriaxone, cefazolin, cefotaxime, ciprofloxacin and trimethoprim/sulfamethoxazole susceptible and extended-spectrum ?-lactamase (ESBL) and multi-drug resistance (MDR) negative isolates. focG was seen more often in nalidixic acid, norfloxacin, cefuroxime, ceftriaxone, ciprofloxacin susceptible and MDR negative isolates. fimH and papAH were more commonly observed in amoxicillin/clavulanic acid and cefotaxime susceptible isolates, respectively. iha and afa/draBC genes were more frequent in resistant isolates than the susceptible ones; for iha, in ampicillin, amoxicillin/clavulanic acid, nalidixic acid, cefuroxime, ceftriaxone resistant and ESBL and MDR positive isolates; for afa/draBC, in cefotaxime, cefuroxime, ciprofloxacin, trimethoprim/sulfamethoxazole resistant and ESBL and MDR positive isolates, this trend was observed. ST 131 E.coli virulence gene pattern has a direct effect on resistance profile. Isolates belong to that clonal group has MDR and commonly harbour afa/draBC and iha genes. Our findings may provide new insights into the relationships between pathogenesis, patient characteristics and resistance of E. coli UTI. PMID:26518125

  8. Electron spin resonance studies of some irradiated pharmaceuticals

    NASA Astrophysics Data System (ADS)

    Gibella, M.; Crucq, A.-S.; Tilquin, B.; Stocker, P.; Lesgards, G.; Raffi, J.

    2000-03-01

    Five antibiotics belonging to the cephalosporins and penicillins groups have been irradiated: anhydrous ampicilline acid, amoxicilline acid trihydrate, cefuroxime sodium salt, cloxacilline sodium salt monohydrate and ceftazidime pentahydrate. ESR studies have been carried out, showing the influence of irradiation and storage parameters on the nature and concentration of the free radicals trapped. These results may be used to detect an irradiation treatment on such pharmaceuticals.

  9. Postoperative nosocomial endophthalmitis: is perioperative antibiotic prophylaxis advisable? A single centre's experience.

    PubMed

    Ness, T; Kern, W V; Frank, U; Reinhard, T

    2011-06-01

    We report the endophthalmitis rate after cataract surgery in patients preoperatively given topical povidone-iodine and gentamicin-containing irrigation fluid as prophylaxis without intracameral cefuroxime or perioperative topical antibiotics. In a retrospective clinical study, we included patients undergoing cataract surgery over a 12-year period at one large university teaching hospital. Data from 26,566 cataract procedures were analysed. Cases of postoperative endophthalmitis were identified and diagnosed both clinically and microbiologically. A total of 26,566 cataract procedures were reviewed, and we identified 16 patients with postoperative endophthalmitis (rate: 0.6 per 1000 operations, or 0.06%; 95% confidence interval: 0.03-0.09%). A causative micro-organism was detected in 81.3% (13/16) of the cases. Most organisms were Gram-positive bacteria (10/13) with susceptibility to cefuroxime (9/10) and/or fluoroquinolones (4/8), and/or resistance to aminoglycosides (10/10). The three Gram-negative pathogens were susceptible to cefuroxime, aminoglycosides, and fluoroquinolones. Using our regimen of topical povidone-iodine and gentamicin irrigation, we observed a low postoperative endophthalmitis rate not differing from the infection rates recently reported in other large studies. We speculate that neither intracameral cefuroxime nor perioperative levofloxacin eye drops are necessary to minimise postoperative infectious complications following cataract surgery, and we suggest that the European Society of Cataract and Refractive Surgery guidelines (in which perioperative antibiotics are mandatory) therefore be revisited to permit alternative effective regimens for the prevention of postoperative infections following cataract surgery. PMID:21450368

  10. Early secondary suture versus healing by second intention of incisional abscesses.

    PubMed

    Hermann, G G; Bagi, P; Christoffersen, I

    1988-07-01

    A controlled trial was set up to compare the treatment of wound abscesses, occurring after laparotomy, with either early secondary suture combined with cefuroxime and metronidazole given intravenously or by healing by second intention. The secondary suture was performed two days after wound drainage and resulted in a significant reduction (p less than 0.01) in healing time without complications. No reinfections occurred. PMID:3289132

  11. [Sensitivity of "Haemophilus influenzae" to 5 antibiotics and rapid detection of its resistance to ampicilin (author's transl)].

    PubMed

    Piot, P; van DYCK, E; Pattyn, S R

    1977-02-01

    Sensitivity of Haemophilus influenzae to 5 antibiotics has been determined by the agar dilution method. Two strains out of 165 are resistant to ampicillin and 5% to tetracycline. All strains were sensitive to chloramphenicol, cotrimoxazole and cefuroxime. A simple test for rapid detection of beta-lactamase with a chromogenic cephalosporin and sensitivity testing by an agar diffusion method were evaluated for Haemophilus. PMID:322045

  12. Haemophilus influenzae with Non-Beta-Lactamase-Mediated Beta-Lactam Resistance: Easy To Find but Hard To Categorize.

    PubMed

    Skaare, Dagfinn; Lia, Astrid; Hannisdal, Anja; Tveten, Yngvar; Matuschek, Erika; Kahlmeter, Gunnar; Kristiansen, Bjrn-Erik

    2015-11-01

    Haemophilus influenzae is a major pathogen, and beta-lactams are first-line drugs. Resistance due to altered penicillin-binding protein 3 (rPBP3) is frequent, and susceptibility testing of such strains is challenging. A collection of 154 beta-lactamase-negative isolates with a large proportion of rPBP3 (67.5%) was used to evaluate and compare Etest (Haemophilus test medium [HTM]) and disk diffusion (EUCAST method) for categorization of susceptibility to aminopenicillins and cefuroxime, using MICs generated with broth (HTM) microdilution and clinical breakpoints from CLSI and EUCAST as the gold standards. In addition, the proficiency of nine disks in screening for the rPBP3 genotype (N526K positive) was evaluated. By Etest, both essential and categorical agreement were generally poor (<70%), with high very major errors (VME) (CLSI, 13.0%; EUCAST, 34.3%) and falsely susceptible rates (FSR) (CLSI, 87.0%; EUCAST, 88.3%) for ampicillin. Ampicillin (2 ?g) with adjusted (+2 mm) zone breakpoints was superior to Etest for categorization of susceptibility to ampicillin (agreement, 74.0%; VME, 11.0%; FSR, 28.3%). Conversely, Etest was superior to 30 ?g cefuroxime for categorization of susceptibility to cefuroxime (agreement, 57.1% versus 60.4%; VME, 2.6% versus 9.7%; FSR, 7.1% versus 26.8%). Benzylpenicillin (1 unit) (EUCAST screening disk) and cefuroxime (5 ?g) identified rPBP3 isolates with highest accuracies (95.5% and 92.2%, respectively). In conclusion, disk screening reliably detects rPBP3 H. influenzae, but false ampicillin susceptibility is frequent with routine methods. We suggest adding a comment recommending high-dose aminopenicillin therapy or the use of other agents for severe infections with screening-positive isolates that are susceptible to aminopenicillins by gradient or disk diffusion. PMID:26354813

  13. High prevalence of penicillin resistance and comparative in vitro activity of various antibiotics in clinical isolates of streptococcus pneumoniae isolated in the Province of Hainaut during winter 2004.

    PubMed

    Vanhoof, R; Brouillard, J; Dame, S; d'Hondt, N; Haccourt, A; Mansoor, I; Marchal, J F; Philippart, I; Trigaux, F; Van Bosterhaut, B; Rossi, C; Van Bossuyt, E

    2005-01-01

    A total of 154 isolates of Streptococcus pneumoniae obtained from 8 different centres in the province of Hainaut were included in this study. The susceptibilities to penicillin, amoxicillin, cefuroxime, ciprofloxacin, moxifloxacin, erythromycin and tetracycline were determined by a microdilution technique following NCCLS recommendations. Decreased susceptibility to penicillin was 32.5% (23.4% intermediate and 9.1% high-level). The other insusceptibility rates were as follows: amoxicillin 1.9% [0% Resistance (R)], cefuroxime 23.4% (R 22.1%), ciprofloxacin 9.1% (R 1.3%), erythromycin 39.6% (R 38.3%), and tetracycline 31.8% (R 30.5%). No decreased susceptibility was found for moxifloxacin. MICs of amoxicillin, cefuroxime, erythromycin and tetracycline rose with those of penicillin for penicillin-insusceptible isolates. Most penicillin-insusceptible isolates remained fully susceptible to amoxicillin (94%), while moxifloxacin and ciprofloxacin kept an activity on 100% and 92% of these isolates respectively. Phenotypes with triple or quadruple insusceptibility were present in 31.2% of the isolates. Penicillin-insusceptible isolates showed a co-insusceptibility of 36.7% to erythromycin, 30.0% to tetracycline and 3.3% to ciprofloxacin. PMID:16502595

  14. Analysis of the role of Bacillus subtilis σ(M) in β-lactam resistance reveals an essential role for c-di-AMP in peptidoglycan homeostasis.

    PubMed

    Luo, Yun; Helmann, John D

    2012-02-01

    The Bacillus subtilis extracytoplasmic function (ECF) σ factor σ(M) is inducible by, and confers resistance to, several cell envelope-acting antibiotics. Here, we demonstrate that σ(M) is responsible for intrinsic β-lactam resistance, with σ(X) playing a secondary role. Activation of σ(M) upregulates several cell wall biosynthetic enzymes including one, PBP1, shown here to be a target for the beta-lactam cefuroxime. However, σ(M) still plays a major role in cefuroxime resistance even in cells lacking PBP1. To better define the role of σ(M) in β-lactam resistance, we characterized suppressor mutations that restore cefuroxime resistance to a sigM null mutant. The most frequent suppressors inactivated gdpP (yybT) which encodes a cyclic-di-AMP phosphodiesterase (PDE). Intriguingly, σ(M) is a known activator of disA encoding one of three paralogous diadenylate cyclases (DAC). Overproduction of the GdpP PDE greatly sensitized cells to β-lactam antibiotics. Conversely, genetic studies indicate that at least one DAC is required for growth with depletion leading to cell lysis. These findings support a model in which c-di-AMP is an essential signal molecule required for cell wall homeostasis. Other suppressors highlight the roles of ECF σ factors in counteracting the deleterious effects of autolysins and reactive oxygen species in β-lactam-treated cells. PMID:22211522

  15. The Roles of Tight Junctions and Claudin-1 in the Microbubble-Mediated Ultrasound-Induced Enhancement of Drug Concentrations in Rat Prostate.

    PubMed

    Shang, Yonggang; Dong, Xiaoxiao; Han, Guangwei; Li, Jia; Cui, Dong; Liu, Chengcheng; Li, Longkun; Yi, Shanhong

    2015-12-01

    Although microbubble-mediated ultrasound irradiation can enhance the prostate permeability, little is known about the mechanism. In our study, the healthy, adult male SD rats were divided into four groups: the BC, US, MB, and MMUS groups. A therapeutic ultrasound apparatus was used to treat the rats prostates in the presence of circulating MBs. Cefuroxime was injected to assess prostate permeability by HPLC. The structures of prostate tissues and TJs were observed by light and transmission electron microscopy. Western blot was used to assess claudin-1 expression. After treatment of microbubble-mediated ultrasound irradiation, the cefuroxime concentrations in the prostate were significantly increased. HE staining demonstrated that the gland epithelial cell layer became dropsical, thick, and disordered. In transmission electron microscopy, the TJs between adjacent capillary endothelial cells or gland epithelial cells were disjointed and partly interrupted. Furthermore, western blot showed the expression of claudin-1 was significantly decreased. However, these findings were not observed in the prostates exposed to microbubble or ultrasound alone, as well as the healthy control rats. In conclusion, microbubble-mediated ultrasound irradiation significantly enhanced the prostate permeability and improve the cefuroxime concentrations in prostate. The changes in TJs structure and the decreased claudin-1 expression may play important roles in this process. PMID:26289600

  16. Effervescence Assisted Fusion Technique to Enhance the Solubility of Drugs.

    PubMed

    Alam, Mohd Aftab; Al-Jenoobi, Fahad I; Al-Mohizea, Abdullah M; Ali, Raisuddin

    2015-12-01

    The solubility of five poorly soluble drugs was enhanced by using an effervescence assisted solid dispersion (EASD) technique. EASDs were prepared by using modified fusion method. Drug and hydrophilic carrier were melted, and in this molten mixture, effervescence was generated by adding effervescence couple comprising organic acid (citric acid) and carbonic base (sodium bicarbonate). Solubility of drug powders, solid dispersions, and EASDs was determined at 25°C using shake flask method. Atorvastatin calcium, cefuroxime axetil, clotrimazole, ketoconazole, and metronidazole benzoate were estimated using a spectrophotometer at 246, 280, 260, 230, and 232 nm (λ max), respectively. Solubility of atorvastatin calcium (from 100 to 345 μg/ml), cefuroxime axetil (from 441 to 1948 μg/ml), clotrimazole (from 63 to 677 μg/ml), ketoconazole (from 16 to 500 μg/ml), and metronidazole benzoate (from 112 to 208 μg/ml) in EASDs was enhanced by 3.45-, 4.4-, 10.7-, 31.2-, and 1.8-fold, respectively. Scanning electron micrographs of drug powder, solid dispersion, and EASDs were compared. Scanning electron micrographs of EASDs showed a uniform distribution of drug particles in the carrier matrix. Morphology (size and shape) of cefuroxime axetil particles was altered in solid dispersion as well as in EASD. EASDs showed better solubility enhancement than conventional solid dispersions. The present technique is better suitable for drugs having a low melting point or melt without charring. Effervescence assisted fusion technique of preparing solid dispersions can be employed for enhancing solubility, dissolution, and bioavailability of poorly soluble drugs. PMID:26265190

  17. The value of perioperative antibiotics on the success of oral free flap reconstructions.

    PubMed

    Mcke, Thomas; Rohleder, Nils H; Rau, Andrea; Ritschl, Lucas M; Kesting, Marco; Wolff, Klaus-Dietrich; Mitchell, David A; Loeffelbein, Denys J

    2015-10-01

    The subject of the presented study was to monitor and compare problems and outcomes of reconstructive surgery with microvascular free flaps in the head and neck region between groups of patients treated with perioperative antibiotics and a group of patients without antibiotics. Patients requiring oral reconstructive surgery following cancer resections with microvascular free flaps were prospectively evaluated (2007-2012). Antibiotic therapy was started 30 min before the operation and administered for 10 days. Three hundred and fifty patients were included (208 male, 59.4%; 142 female, 40.6%; mean age 59.8??13.2 years). 330 patients received perioperative antibiotics. Twenty patients (5.7%) who received no antibiotics for specific reasons served as the control group. Wound infections developed in 33 of 122 patients (27%) who received benzylpenicillin, 17 of 88 patients (19.3%) who received amoxicillin combined with sulbactam and 25 of 120 patients (20.8%) who received cefuroxime. Ten patients (50%) who did not receive antibiotics developed wound infections. Receiving no antibiotics or penicillin showed no benefit (P?=?0.11). Those receiving cefuroxime showed significantly lower incidence of wound infections (P?=?0.034; risk decreased by the factor 2.88). The use of amoxicillin combined with sulbactam showed the lowest rate of wound infections (P?=?0.018; risk decreased by the factor 3.46). The use of amoxicillin combined with sulbactam appears to be the most appropriate prophylactic antibiotic followed by cefuroxime in oral microsurgical free flap reconstructions. These data may serve as a guide until a controlled multicenter prospective trial is performed comparing newer antibiotics against current standards. 2015 Wiley Periodicals, Inc. Microsurgery 35:507-511, 2015. PMID:26251066

  18. Simultaneous determination of most prescribed antibiotics in multiple urban wastewater by SPE-LC-MS/MS.

    PubMed

    Rossmann, Julia; Schubert, Sara; Gurke, Robert; Oertel, Reinhard; Kirch, Wilhelm

    2014-10-15

    A rapid analytical method was developed for the application of a long-term monitoring (>one year) of the most prescribed and often in hospitals used antibiotics in diverse wastewaters of an urban sewage treatment plant (STP). Additionally to the selected multi-class antibiotics amoxicillin, penicillin V and piperacillin (penicillins), cefotaxime and cefuroxime (cephalosporins), azithromycin, clarithromycin and roxithromycin (macrolids), ciprofloxacin and levofloxacin-ofloxacin (fluoroquinolones), clindamycin (lincosamide), doxycycline (tetracycline), sulfamethoxazole (sulfonamide) and trimethoprim (dihydrofolate reductase inhibitor), the bioactive metabolite clindamycin-sulfoxide, the reserve antibiotic vancomycin (glycopeptide) and as tracer of the STP the anticonvulsant carbamazepine and the antifungal fluconazole were involved. The analytical method combines a low-sample-volume solid phase extraction (SPE), followed by a chromatographic separation using a reversed phase (RP) and hydrophilic interaction liquid chromatography (HILIC) technique, respectively, coupled to a triple quadrupole mass spectrometer. Detection was performed with multiple reaction monitoring (MRM) measured with positive electrospray ionization (ESI+). The extraction efficiency of different SPE cartridges and optimized pH-values of the preparation procedure were tested. Finally, the extraction of antibiotics was realized with the Oasis HLB cartridge and a pH adjustment at 3.5. An external calibration curve in diluted blank urine was used for quality control of the sample set of daily composite samples of the STP for the duration of one year monitoring. The squared coefficient of determination (r(2)) in the concentration range (20-20,000ng/L or 100-100,000ng/L) of the calibration curves for the method was higher than 0.99 for all determined substances. The limit of quantification (LoQ) ranged between 0.8ng/L (azithromycin) and 245.1ng/L (vancomycin). Furthermore, a standard addition was used for quantification in wastewater samples. The process efficiencies ranged from 20% (doxycycline) to 134% (cefuroxime) in influent samples and from 31% (doxycycline) to 171% (cefuroxime) in effluent samples of the STP. All selected substances have been found in wastewater samples. Cefuroxime, doxycycline, levofloxacin, piperacillin, sulfamethoxazole and carbamazepine showed highest concentrations up to 6.2μg/L. PMID:25171505

  19. Brevundimonas vesicularis septic arthritis in an immunocompetent child.

    PubMed

    Sofer, Yael; Zmira, Samra; Amir, Jacob

    2007-01-01

    Septic arthritis is a rapidly destructive form of joint disease. The most common causative agents in children are Staphylococcus aureus and Kingella kingae, followed by group A Streptococcus and Streptococcus pneumoniae, and in neonates, enterobacteracea and group B Streptococcus. In this paper, we describe a previously healthy toddler with septic arthritis of the shoulder joint caused by Brevundimonas vesicularis. Prompt treatment with cefuroxime resulted in a full recovery. This is the first report of septic arthritis in humans caused by this microorganism, and the first description of B. vesicularis infection in an immunocompetent child. PMID:16941131

  20. Antimicrobial Resistance of Salmonella enterica Isolates from Tonsil and Jejunum with Lymph Node Tissues of Slaughtered Swine in Metro Manila, Philippines

    PubMed Central

    Ng, Kamela Charmaine S.; Rivera, Windell L.

    2014-01-01

    Due to frequent antibiotic exposure, swine is now recognized as potential risk in disseminating drug-resistant Salmonella enterica strains. This study thus subjected 20 randomly selected S. enterica isolates from tonsil and jejunum with lymph node (JLN) tissues of swine slaughtered in Metro Manila, Philippines, to VITEK 2 antimicrobial susceptibility testing (AST). The test revealed all 20 isolates had resistance to at least one antimicrobial agent, in which highest occurrence of resistance was to amikacin (100%), cefazolin (100%), cefuroxime (100%), cefuroxime axetil (100%), cefoxitin (100%), and gentamicin (100%), followed by ampicillin (50%), and then by sulfamethoxazole trimethoprim (30%). Three multidrug-resistant (MDR) isolates were detected. The sole S. enterica serotype Enteritidis isolate showed resistance to 12 different antibiotics including ceftazidime, ceftriaxone, amikacin, gentamicin, and tigecycline. This study is the first to report worldwide on the novel resistance to tigecycline of MDR S. enterica serotype Enteritidis isolated from swine tonsil tissues. This finding poses huge therapeutic challenge since MDR S. enterica infections are associated with increased rate of hospitalization or death. Thus, continual regulation of antimicrobial use in food animals and prediction of resistant serotypes are crucial to limit the spread of MDR S. enterica isolates among hogs and humans. PMID:24724034

  1. Fosfomycin trometamol: a review of its use as a single-dose oral treatment for patients with acute lower urinary tract infections and pregnant women with asymptomatic bacteriuria.

    PubMed

    Keating, Gillian M

    2013-11-01

    Fosfomycin trometamol (fosfomycin tromethamine) [Monuril(®), Monurol(®), Monural(®)] is approved in numerous countries worldwide, mainly for the treatment of uncomplicated urinary tract infections (UTIs). Fosfomycin has good in vitro activity against common uropathogens, such as Escherichia coli (including extended-spectrum β-lactamase-producing E. coli), Proteus mirabilis, Klebsiella pneumoniae and Staphylococcus saprophyticus, and the susceptibility of uropathogens to fosfomycin has remained relatively stable over time. A single oral dose of fosfomycin trometamol 3 g (the approved dosage) achieves high concentrations in urine. Results of recent randomized trials indicate that single-dose fosfomycin trometamol had similar clinical and/or bacteriological efficacy to 3- to 7-day regimens of ciprofloxacin, norfloxacin, cotrimoxazole or nitrofurantoin in women with uncomplicated lower UTIs. In addition, single-dose fosfomycin trometamol had similar bacteriological efficacy to a 5-day course of cefuroxime axetil or a 7-day course of amoxicillin/clavulanic acid in pregnant women with asymptomatic bacteriuria, and similar clinical and/or bacteriological efficacy to a 5-day course of cefuroxime axetil or amoxicillin/clavulanic acid or a 3-day course of ceftibuten in pregnant women with a lower UTI. Single-dose fosfomycin trometamol was generally well tolerated, with gastrointestinal adverse events (e.g. diarrhoea, nausea) reported most commonly. In conclusion, single-dose fosfomycin trometamol is an important option for the first-line empirical treatment of uncomplicated lower UTIs. PMID:24202878

  2. Sensitive chemiluminescence determination of thirteen cephalosporin antibiotics with luminol-copper(II) reaction.

    PubMed

    Du, Jianxiu; Li, Hong

    2010-10-01

    A new chemiluminescence reaction, the luminol-Cu(2+) reaction, was investigated for the determination of thirteen (13) cephalosporin antibiotics, namely cefalexin, cefadroxil, cefradine, cefazolin sodium, cefaclor, cefuroxime axetil, cefotaxime sodium, cefoperazone sodium, ceftriaxone sodium, ceftazidime, cefetamet pivoxil hydrochloride, cefixime, and cefpodoxime. It was found that, without adding any special oxidant, strong chemiluminescent (CL) signal could be produced from the reaction of the alkaline luminol with the above-mentioned antibiotics in the presence of Cu(2+). The experimental conditions for the reaction were carefully optimized with flow-injection mode. The detection limits are 0.3 ng/mL cefalexin, 3 ng/mL cefadroxil, 0.3 ng/mL cefradine, 0.02 μg/mL cefazolin sodium, 0.8 ng/mL cefaclor, 0.02 μg/mL cefuroxime axetil, 5 ng/mL cefotaxime sodium, 0.02 μg/mL cefoperazone sodium, 0.8 ng/mL ceftriaxone sodium, 1 ng/mL ceftazidime, 0.08 ng/mL cefetamet pivoxil hydrochloride, 0.8 ng/mL cefixime, and 2 ng/mL cefpodoxime. The proposed method was validated by direct application to commercial formulations and spiked milk samples containing cefradine. A possible reaction mechanism is also discussed. PMID:20925986

  3. Ultrafast quantification of ?-lactam antibiotics in human plasma using UPLC-MS/MS.

    PubMed

    Carlier, Mieke; Stove, Veronique; De Waele, Jan J; Verstraete, Alain G

    2015-01-26

    There is an increasing interest in monitoring plasma concentrations of ?-lactam antibiotics. The objective of this work was to develop and validate a fast ultra-performance liquid chromatographic method with tandem mass spectrometric detection (UPLC-MS/MS) for simultaneous quantification of amoxicillin, cefuroxime, ceftazidime, meropenem and piperacillin with minimal turn around time. Sample clean-up included protein precipitation with acetonitrile containing 5 deuterated internal standards, and subsequent dilution of the supernatant with water after centrifugation. Runtime was only 2.5 min. Chromatographic separation was performed on a Waters Acquity UPLC system using a BEH C18 column (1.7 ?m, 100 mm 2.1 mm) applying a binary gradient elution of water and methanol both containing 0.1% formic acid and 2 mmol/L ammonium acetate on a Water TQD instrument in MRM mode. All compounds were detected in electrospray positive ion mode and could be quantified between 1 and 100 mg/L for amoxicillin and cefuroxime, between 0.5 and 80 mg/L for meropenem and ceftazidime, and between 1 and 150 mg/L for piperacillin. The method was validated in terms of precision, accuracy, linearity, matrix effect and recovery and has been compared to a previously published UPLC-MS/MS method. PMID:25531875

  4. In vitro susceptibility of Escherichia coli strains isolated from urine samples obtained in mainland China to fosfomycin trometamol and other antibiotics: a 9-year surveillance study (2004–2012)

    PubMed Central

    2014-01-01

    Background As a result of extensive use of fluroquinlones and cephalosporins, urinary tract pathogens producing extended-spectrum beta-lactamase (ESBL) pose a considerable clinical challenge in the treatment of UTIs. In the present study we retrospectively assessed the susceptibility of E. coli strains to fosfomycin trometamol and other antibiotics commonly used for the treatment of such infections. Methods A total of 908 nonreplicate clinical E. coli urinary isolates were collected from 20 Chinese hospitals over four consecutive 1-year periods between October 2004 and June 2012. Susceptibility to antimicrobial agents fosfomycin trometamol, piperacillin-tazobactam, cefuroxime, cefotaxime, cefepime, imipenem, amikacin, levofloxacin, and nitrofurantoin was determined using the agar dilution method. A reference strain E. coli (ATCC 25922) was used as a positive control. Results were analyzed using Chi-square test or Fisher’s exact tests. Results Fosfomycin trometamol, piperacillin-tazobactam, amikacin, and imipenem were consistently the most active agents against most of the isolates. There was a decline in susceptibility to cefuroxime, cefotaxime, and cefepime between 2004 and 2010. We showed that 528 of the 908 E. coli isolates (58.1%) produced ESBLs. The ESBL-positive rates increased from 41.7% in 2004−2005 to 60.9% in 2011−2012. ESBL-producing E. coli isolates showed significantly higher resistance rates to levofloxacin than the ESBL-negative isolates. Fosfomycin trometamol, piperacillin-tazobactam, amikacin, and imipenem had good activity against both levofloxacin-susceptible and levofloxacin- nonsusceptible isolates (sensitivity rate > 90%). However susceptibility of levofloxacin-resistant isolates to cefuroxime, cefotaxime, cefepime, amikacin, and nitrofurantoin was significantly lower than that of levofloxacin-susceptible isolates. Conclusions Owing to the increase in the bacterial resistance across the world, the European Urology Association has recommended fosfomycin trometamol as the drug of choice in its Guidelines on Urological Infections released in 2013. Our results confirm this recommendation for use in China and continued monitoring of the susceptibility of E. coli to fosfomycin trometamol is need with the widely use of the drug in China. PMID:24502648

  5. Moxifloxacin Induced Seizures -A Case Report.

    PubMed

    Shi, Jiana; Xu, Huimin

    2014-09-01

    A 73-year-old female patient developed a generalized tonic-clonic seizure on the 6th day after treatment with moxifloxacin 400 mg daily intravenously for appendicitis. This patient had atrial fibrillation and history of a surgery for intracerebral hemorrhage, with impaired renal function and liver function, but without history of seizures. Moxifloxacin was discontinued and switched to cefuroxime. The patient remained seizure-free at discharge four days later. The naranjo adverse drug reaction probability scale score was 4, indicating a possible adverse reaction to moxifloxacin. The potential risk factors related to moxifloxacin-induced seizures are discussed. It highlights that preexisting central nervous system disease, elderly female with lower bodyweight and severe renal impairment may be the risk factors involved in moxifloxacin-induced seizures. PMID:26175984

  6. Emergence of Extensively Drug-Resistant Haemophilus parainfluenzae in Switzerland

    PubMed Central

    Tinguely, Regula; Seiffert, Salome N.; Furrer, Hansjakob; Perreten, Vincent; Droz, Sara

    2013-01-01

    Two homosexual men were colonized in the urethra with Haemophilus parainfluenzae nonsusceptible to ampicillin (MIC, 8 ?g/ml), amoxicillin-clavulanate (MIC, 4 ?g/ml), cefotaxime (MIC, 1.5 ?g/ml), cefepime (MIC, 3 ?g/ml), meropenem (MIC, 0.5 ?g/ml), cefuroxime, azithromycin, ciprofloxacin, tetracycline, and chloramphenicol (all MICs, ?32 ?g/ml). Repetitive extragenic palindromic PCR (rep-PCR) showed that the strains were indistinguishable. The isolates had amino acid substitutions in PBP3, L4, GyrA, and ParC and possessed Mef(A), Tet(M), and CatS resistance mechanisms. This is the first report of extensively drug-resistant (XDR) H. parainfluenzae. PMID:23545526

  7. External Bacterial Flora and Antimicrobial Susceptibility Patterns of Staphylococcus spp. and Pseudomonas spp. Isolated from Two Household Cockroaches, Blattella germanica and Blatta orientalis.

    PubMed

    Menasria, Taha; Tine, Samir; Mahcene, Djaouida; Benammar, Leyla; Megri, Rochdi; Boukoucha, Mourad; Debabza, Manel

    2015-04-01

    A study was performed to estimate the prevalence of the external bacterial flora of two domestic cockroaches (Blattella germanica and Blatta orientalis) collected from households in Tebessa (northeast Algeria). Three major bacterial groups were cultured (total aerobic, enterobacteria, and staphylococci) from 14 specimens of cockroaches, and antibiotic susceptibility was tested for both Staphylococcus and Pseudomonas isolates. Culturing showed that the total bacterial load of cockroaches from different households were comparable (P<0.001) and enterobacteria were the predominant colonizers of the insect surface, with a bacterial load of (2.1 10? CFU/insect), whereas the staphylococci group was the minority. Twenty-eight bacterial species were isolated, and susceptibility patterns showed that most of the staphylococci isolates were highly susceptible to chloramphenicol, gentamycin, pristinamycin, ofloxacin, clindamycin, and vancomycin; however, Pseudomonas strains exhibited resistance to amoxicillin/clavulanic acid, imipenem, and the second-generation antibiotic cephalosporin cefuroxime. PMID:25966760

  8. Principles of Antibiotic Prophylaxis in Total Joint Arthroplasty: Current Concepts.

    PubMed

    Bosco, Joseph A; Bookman, Jared; Slover, James; Edusei, Emmanuel; Levine, Brett

    2015-08-01

    Infection is a rare, serious complication following total joint arthroplasty and constitutes a considerable emotional and financial burden for patients, surgeons, and healthcare systems. Prevention of surgical site and periprosthetic joint infections is crucial. This requires knowledge of the microorganisms that commonly cause these infections, including Staphylococcus species. Selection of the appropriate antibiotic regimen to treat infection remains controversial, but cefazolin and cefuroxime are the most commonly recommended antibiotics for prophylaxis. Appropriate timing of administration before surgery, with redosing performed as needed, can help to ensure optimal antibiotic concentration during surgery. Given the increasing evidence that S aureus colonization is a risk factor for periprosthetic joint infection, an exploration of the potential benefits of preoperative S aureus carrier screening and decolonization protocols is warranted. The use of antibiotic-loaded bone cement in primary total joint arthroplasty and antibiotic powder at wound closure are other controversial topics that require additional research. PMID:26209148

  9. In vitro antimicrobial susceptibility of Listeria monocytogenes isolated in the UK and other Listeria species.

    PubMed

    MacGowan, A P; Holt, H A; Bywater, M J; Reeves, D S

    1990-10-01

    The MICs and MBCs of 21 antimicrobial agents were determined for 103 strains of Listeria monocytogenes isolated in the UK and 27 strains of other Listeria species. Ampicillin, penicillin, azlocillin, imipenem, gentamicin, netilmicin, amikacin, erythromycin, rifampicin, trimethoprim, clindamycin and vancomycin had good activity, while cephalothin, chloramphenicol, ciprofloxacin and ofloxacin were less active, and cefuroxime, enoxacin, norfloxacin and fosfomycin were the least active. Tetracycline had good activity against many strains, but the MIC was high for some. Unlike the other Listeria species tested, Listeria ivanovii was susceptible to fosfomycin. Inoculum size and media employed were shown to affect the MBC, tryptose phosphate broth yielding higher MBCs than Mueller-Hinton or Isosensitest broths. PMID:2124539

  10. Chromatographic studies of some cephalosporins on thin layers of silica gel G-zinc ferrocyanide.

    PubMed

    Singh, Dhruv K; Maheshwari, Gunjan

    2010-10-01

    A simple, selective and precise thin-layer chromatographic method has been developed for the analysis of eight cephalosporin antibiotics, namely cephadroxil, cephalexin, cefixime, cefaclor, cefpodoxime proxetil, cefuroxime axetil, cefotaxime sodium and ceftriaxone sodium. The hR(F) values of these cephalosporins were investigated on silica gel G-zinc ferrocyanide layers. Mixing of zinc ferrocyanide with silica gel G resulted in a decrease in hR(F) values, removal of tailing and better resolutions. The influence of silica gel G-zinc ferrocyanide ratio and mobile phases on the chromatographic behavior of cephalosporins on thin layers was investigated. Cephalosporins were selectively separated in their binary and ternary synthetic mixtures and pharmaceutical formulations. Quantitative separations of cephalosporins from their synthetic mixtures were also achieved with good recoveries (97.8-100.3%). PMID:20853462

  11. Methicillin-resistant coagulase-negative staphylococci (MRCoNS) by disk diffusion method.

    PubMed

    Rahman, A; Hossain, M A; Paul, S K; Sultana, S; Haque, N; Kabir, M R; Hoque, S M

    2013-04-01

    The antimicrobial susceptibility of 80 coagulase-negative staphylococci (CoNS) isolates from surgical wound, pus from infected skin lesions, burn exudates and diabetic ulcer exudates of patients in Mymensingh Medical College Hospital, Bangladesh, was evaluated in order to see their pattern of antimicrobial resistance. The study was carried out in the department of Microbiology, Mymensingh Medical College during the period from July 2009 to May 2011. The 80 CoNS isolates were subjected to antimicrobial susceptibility to relevant antibiotics including oxacillin by disk diffusion method. Out of 80 CoNS isolates, the highest number were resistant to oxacillin 36(45%), followed by gentamicin 32(40%), cefuroxime 25(31%), ceftriaxone 24(30%) and ciprofloxacin 18(22%). All isolates of CoNS were sensitive to imipenem and vancomycin. As MRCoNS were found multidrug resistant, therefore, antibiotic sensitivity must be done prior to treatment in infections caused by these species. PMID:23715340

  12. Nosocomial infections at Kenyatta National Hospital Intensive-Care Unit in Nairobi, Kenya.

    PubMed

    Ngumi, Z W W

    2006-01-01

    The objective of this study was to identify the common bacteria isolated from patients, antibiotics used, sensitivity patterns, therapeutic procedures and cleaning protocols practised in Kenyatta National Hospital Intensive-Care Unit (ICU). Kenyatta National Hospital is a 1,800-bed referral and tertiary-care hospital which is also the Teaching University Hospital. The ICU has 20 beds. Two members of staff, a consultant and a senior nurse, did the study. Out of 195 patients admitted to the unit during the study period, 137 (70.3%) received antibiotics. The most frequently prescribed antibiotics included meropenem, ceftazidime, cefuroxime, piperacillin tazobactam, vancomycin, Augmentin and Flagyl. The most common bacteria isolated were Pseudomonas aeruginosa,Klebsiella, Citrobacter, Staphylococcus aureus, Staphylococcus pneumoniae, Acinetobactor and Escherichia coli isolated from tracheal aspirate, urine, blood and pus swabs. PMID:16490968

  13. Prevalence and antimicrobial resistance of methicillin resistant Staphylococcus epidermidis isolated at Mymensingh Medical College Hospital.

    PubMed

    Haque, N; Bari, M S; Bilkis, L; Hossain, M A; Haque, S; Haque, N; Islam, M A; Mahmud, N U; Kalam, A; Hasan, M S; Haque, M A

    2010-04-01

    The study was done to determine the drug resistance pattern of Methicillin resistant Staphylococcus epidermidis (MRSE) isolated from different clinical specimens at Mymensingh Medical College Hospital, Mymensingh during the period from July 2007 to June 2008. A total of 32 Staphylococcus epidermidis were isolated from 200 different clinical specimens by standard microbiological techniques. Antimicrobial susceptibility of all the isolates was carried out by disk diffusion method as per recommendation of Clinical and Laboratory Standard Institute 2007. Out of 32 Staphylococcus epidermidis 18(56.25%) were detected as Methicillin resistant Staphylococcus epidermidis (MRSE) by disk diffusion method. In this study, Methicillin resistant Staphylococcus epidermidis showed multidrug resistance. Resistant to penicillin, amoxycillin, oxacillin and cloxacillin was 100% followed by gentamycin (56%), erythromycin (50%), doxycycline (44%), cephradine (44%), ciprofloxacin (39%), fucidic acid (33%), cefuroxime (33%) and ceftriaxone (28%). All isolates of MRSE were susceptible to rifampicin and vancomycin. PMID:20395905

  14. [Lyme borreliosis in children. Epidemiology, diagnosis, clinical treatment, and therapy].

    PubMed

    Fingerle, V; Huppertz, H-I

    2007-06-01

    In Europe, Lyme borreliosis is the most common disease communicated by ticks and especially affects the skin, nervous system, joints, and heart. It is caused by at least four species of the spirochete Borrelia burgdorferi. The various pathologies are classified as early forms (erythema migrans, borrelia lymphocytom, early neuroborreliosis, carditis) or late forms (arthritis, acrodermatitis chronica atrophicans, chronic neuroborreliosis). The accuracy of serodiagnosis is 20-50% with erythema migrans, 70-90% with early neuroborreliosis, and nearly 100% with Lyme arthritis. Following special indications, the agent is confirmed by skin biopsy or spinal or joint puncture. Oral therapy is performed with amoxicillin, doxycycline, and cefuroxime, and intravenous therapy uses ceftriaxone, cefotaxime, or penicillin G. All in all, the prognosis of treated Lyme borreliosis is good. In childhood permanent defects are extremely rare, even following long-term manifestation at an early age. PMID:17729432

  15. Comparative in vitro activity of the new oral cephalosporin Bay v 3522 against aerobic and anaerobic bacteria.

    PubMed

    Rylander, M; Nord, C E; Norrby, S R

    1990-10-01

    The in vitro activity of the new oral cephalosporin Bay v 3522 against 229 aerobic and 330 anaerobic clinical isolates was determined using the agar dilution technique. For comparison, amoxicillin, amoxicillin/clavulanate, cefaclor, cefadroxil, cefuroxime, cephalexin, ciprofloxacin, clindamycin, co-trimoxazole, doxycycline, erythromycin and metronidazole (only anaerobic bacteria) were tested. Bay v 3522 was found to have high activity against Staphylococcus aureus, Staphylococcus epidermidis, Enterococcus faecalis, Streptococcus pneumoniae, Streptococcus pyogenes, Branhamella catarrhalis, Haemophilus influenzae, anaerobic cocci, Propionibacterium acnes, Clostridium perfringens and fusobacteria. When tested against a higher inoculum or using the broth dilution technique, the activity of Bay v 3522 showed little dependence on inoculum size and the bactericidal activity was similar to inhibitory activity in most bacterial groups. Bay v 3522 may be useful in the treatment of skin, soft tissue and respiratory tract infections. Clinical studies are thus warranted. PMID:2261923

  16. Antibiotic prophylaxis: different practice patterns within and outside the United States

    PubMed Central

    Schwartz, Stephen G; Grzybowski, Andrzej; Flynn, Harry W

    2016-01-01

    Endophthalmitis remains a rare but important cause of visual loss. Prophylaxis strategies are important to reduce rates of endophthalmitis after cataract surgery, intravitreal injection, and other procedures. There is substantial variability between the US and the rest of the world. During cataract surgery, intracameral antibiotics are commonly used in many nations, especially in Europe, but are less commonly used in the US. A randomized clinical trial from the European Society of Cataract and Refractive Surgeons reported an approximately fivefold reduction in endophthalmitis rates associated with intracameral cefuroxime but these results are controversial. There are no randomized clinical trials regarding endophthalmitis associated with intravitreal injection. Topical antibiotics are commonly used in many nations, but are less commonly used in the US. At this time, there is no global consensus and it appears unlikely that additional major clinical trials will conclusively define the optimal endophthalmitis prophylaxis techniques. PMID:26869761

  17. Fecal bacterial microflora of newborn infants during intensive care management and treatment with five antibiotic regimens.

    PubMed

    Bennet, R; Eriksson, M; Nord, C E; Zetterstrm, R

    1986-01-01

    Aerobic and anaerobic fecal bacterial flora of normal newborn infants, of preterm newborn infants without other health problems and of five groups of newborn infants treated with combinations of benzylpenicillin, cloxacillin, flucloxacillin, ampicillin, cefuroxime, cefoxitin and gentamicin were compared. Preterm birth alone was associated with growth of Klebsiella which could be attributed to a higher rate of cesarean section in preterm than in term infants. All antibiotic regimens led to a pronounced suppression of anaerobic flora and overgrowth of Klebsiella but not with other gram-negative aerobic bacteria. A slight colonization with Clostridium difficile and Clostridium perfringens occurred. Disturbances of the intestinal microbial ecology can be expected in newborn infants after preterm birth by cesarean section and/or treatment with antibiotics, including some penicillins that are usually regarded as relatively harmless in this respect in adults. PMID:3763418

  18. Occurrence of multidrug resistance to oral antibiotics among Escherichia coli urine isolates from outpatient departments in Germany: extended-spectrum β-lactamases and the role of fosfomycin.

    PubMed

    Kresken, Michael; Pfeifer, Yvonne; Hafner, Dieter; Wresch, Rebecca; Körber-Irrgang, Barbara

    2014-10-01

    The in vitro activities of fosfomycin and seven other antibiotics commonly used for oral treatment of urinary tract infections (UTIs) were evaluated for 499 Escherichia coli isolated from urine samples during a nationwide laboratory-based surveillance study in 2010. Overall, the highest resistance rates were found for amoxicillin (42.9%), followed by amoxicillin/clavulanic acid (32.7%), trimethoprim/sulfamethoxazole (SXT) (30.9%), ciprofloxacin (19.8%), cefuroxime (10.0%), cefpodoxime (8.6%) and cefixime (8.2%). One-half of the isolates (n=252; 50.5%) were fully susceptible to the eight drugs, whilst only 6 strains (1.2%) were resistant to fosfomycin. Combined resistance to amoxicillin, cefuroxime, ciprofloxacin and SXT was detected in 29 isolates (5.8%). Moreover, 40 isolates (8.0%) produced an extended-spectrum β-lactamase (ESBL), including CTX-M-type ESBLs detected in 39/40 isolates (97.5%) and a TEM-52 ESBL in 1 strain (2.5%). The predominant CTX-M-type ESBL was CTX-M-15 (27/39; 69.2%). Of the 27 CTX-M-15 producers, 19 (70.4%) belonged to the clonal lineage E. coli O25b-ST131. All but one ESBL-producing strains were fosfomycin-susceptible. In view of the emergence of multidrug resistance to standard oral antibiotics, these data support that oral fosfomycin (trometamol salt) may represent a valuable option in the treatment of uncomplicated UTIs. PMID:25223936

  19. Comparative in-vitro activity of levofloxacin against isolates of bacteria from adult patients with community-acquired lower respiratory tract infections.

    PubMed

    Casellas, J M; Gilardoni, M; Tome, G; Goldberg, M; Ivanovic, S; Orduna, M; Dolmann, A; Ascoli, M; Ariza, H; Montero, J M

    1999-06-01

    This study was conducted to evaluate the activity of levofloxacin in comparison with a range of antibacterial agents against recent isolates obtained consecutively from patients with community-acquired pneumonia (CAP) or acute exacerbation of chronic bronchitis (AECB) during the period 1995 to 1996. Susceptibility testing was carried out by either microdilution or the Etest, and interpreted according to NCCLS breakpoints. The activity of levofloxacin was compared with that of amoxycillin, amoxycillin-clavulanate, cefuroxime, cefixime, erythromycin, roxithromycin, clarithromycin, azithromycin, ofloxacin and ciprofloxacin. Clinically significant numbers of bacteria were recovered from 31 CAP and 94 AECB specimens. The predominant bacterial species in the CAP specimens were Streptococcus pneumoniae (21 isolates) and Haemophilus influenzae (four isolates). The AECB isolates mainly consisted of S. pneumoniae (38%), Moraxella catarrhalis (26%), H. influenzae (19%) and Pseudomonas aeruginosa (10%). The overall percentage susceptible of the isolates for each antibiotic was: amoxycillin, 64%; amoxycillin-clavulanate, 89%; cefuroxime, 87%; cefixime, 78%; erythromycin, 85%; roxithromycin, 87%; clarithromycin, 87%; azithromycin, 85%; ofloxacin, 95%; ciprofloxacin, 95%; and levofloxacin, 97%. The activities of levofloxacin and the other agents were also compared against 40 S. pneumoniae isolates, of which 20 were penicillin-non-susceptible, recovered from CAP and AECB specimens during the period 1994 to 1996. These strains were all susceptible to levofloxacin, but only 50% were susceptible to ciprofloxacin and 80% to ofloxacin. Twenty M. catarrhalis, 20 H. influenzae and 20 methicillin-susceptible S. aureus isolates were also all susceptible to levofloxacin. Furthermore, 20 community-acquired P. aeruginosa isolates showed similar percentage susceptible rates to levofloxacin and ciprofloxacin. These in-vitro results suggest that levofloxacin may be useful in the treatment of community-acquired lower respiratory tract infections. PMID:10404336

  20. Increased expression levels of chromosomal AmpC β-lactamase in clinical Escherichia coli isolates and their effect on susceptibility to extended-spectrum cephalosporins.

    PubMed

    Paltansing, Sunita; Kraakman, Margriet; van Boxtel, Ria; Kors, Ivo; Wessels, Els; Goessens, Wil; Tommassen, Jan; Bernards, Alexandra

    2015-02-01

    Forty-nine clinical Escherichia coli isolates, both extended-spectrum β-lactamase (ESBL) negative and ESBL positive, were studied to investigate whether increased AmpC expression is a mechanism involved in cefoxitin resistance and if this influences the third-generation cephalosporin activity. Nine of 33 (27.2%) cefoxitin-resistant (minimum inhibitory concentration [MIC] >8 mg/L) isolates showed hyperproduction of chromosomal AmpC (c-AmpC) based on (1) at least two positive tests using AmpC inhibitors, (2) mutations in the promoter/attenuator regions, and (3) a 6.1- to 163-fold increase in c-ampC expression by quantitative reverse transcription-polymerase chain reaction. In ESBL-negative isolates, MICs of ceftazidime and cefotaxime were mostly above the wild-type (WT) level, but below the S/I breakpoint (EUCAST guideline), except for one isolate with MICs of 4 mg/L. No plasmid-mediated AmpCs were found. Periplasmic extracts of nine c-AmpC hyperproducers were preincubated with or without cefuroxime or ceftazidime and analyzed by sodium dodecyl sulfate-polyacrylamide gel electrophoresis. Cefuroxime and ceftazidime were stable to hydrolysis but acted as inhibitors of the enzyme. None of these isolates showed loss of porins. Thus, cefoxitin resistance has low specificity for detecting upregulated c-AmpC production. c-AmpC hyperproducing E. coli is mostly still susceptible to third-generation cephalosporins but less than WT E. coli. Surveillance of cefoxitin-resistant E. coli to monitor developments in the activity of third-generation cephalosporins against c-AmpC hyperproducers is warranted. PMID:25188329

  1. Profiling of β-Lactam Selectivity for Penicillin-Binding Proteins in Streptococcus pneumoniae D39

    PubMed Central

    Kocaoglu, Ozden; Tsui, Ho-Ching T.; Winkler, Malcolm E.

    2015-01-01

    Selective fluorescent β-lactam chemical probes enable the visualization of the transpeptidase activity of penicillin-binding proteins (PBPs) at different stages of bacterial cell division. To facilitate the development of new fluorescent probes for PBP imaging, we evaluated 20 commercially available β-lactams for selective PBP inhibition in an unencapsulated derivative of the D39 strain of Streptococcus pneumoniae. Live cells were treated with β-lactam antibiotics at different concentrations and subsequently incubated with Bocillin FL (Boc-FL; fluorescent penicillin) to saturate uninhibited PBPs. Fluorophore-labeled PBPs were visualized by sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) and fluorescence scanning. Among 20 compounds tested, carbapenems (doripenem and meropenem) were coselective for PBP1a, PBP2x, and PBP3, while six of the nine penicillin compounds were coselective for PBP2x and PBP3. In contrast, the seven cephalosporin compounds tested display variability in their PBP-binding profiles. Three cephalosporin compounds (cefoxitin, cephalexin, and cefsulodin) and the monobactam aztreonam exhibited selectivity for PBP3, while only cefuroxime (a cephalosporin) was selective for PBP2x. Treatment of S. pneumoniae cultures with a sublethal concentration of cefuroxime that inhibited 60% of PBP2x activity and less than 20% of the activity of other PBPs resulted in formation of elongated cells. In contrast, treatment of S. pneumoniae cultures with concentrations of aztreonam and cefoxitin that inhibited up to 70% of PBP3 activity and less than 30% of other PBPs resulted in no discernible morphological changes. Additionally, correlation of the MIC and IC50s for each PBP, with the exception of faropenem, amdinocillin (mecillinam), and 6-APA, suggests that pneumococcal growth inhibition is primarily due to the inhibition of PBP2x. PMID:25845878

  2. Comparison of five different susceptibility test methods for detecting antimicrobial agent resistance among Haemophilus influenzae isolates.

    PubMed

    Giger, O; Mortensen, J E; Clark, R B; Evangelista, A

    1996-03-01

    The detection of antimicrobial agent resistance among ninety-eight Haemophilus influenzae isolates was assessed by six different antibiotic test methods: agar dilution on Mueller-Hinton agar supplemented with 5% lysed horse blood (MH-LHB), E-test using both Haemophilus test medium (HTM) agar and chocolate Mueller-Hinton (CMH) agar plates, Vitek Haemophilus susceptibility cards, and three overnight microdilution systems that included two commercial systems, Micro-Media and MicroScan, and the reference broth microdilution method using HTM broth. Agents tested in the study included ampicillin, amoxicillin/clavulanic acid (A/C), cefaclor, cefuroxime, cefotaxime, ceftriaxone, chloramphenicol, and trimethoprim/sulfamethoxazole. Both the reference HTM microbroth dilution method and agar dilution correctly classified all nine of the beta-lactamase negative ampicillin resistant (BLNAR) isolates. Each of the other test methods failed to detect one of the BLNAR strains, either because of growth failure (Micro-Media and MicroScan) or miscategorization of an isolate as susceptible (E-Test HTM, E-Test CMH, and Vitek). None of the test methods detected all six isolates identified as A/C resistant by HTM microbroth dilution. Of the remaining antimicrobials tested, ampicillin and cefuroxime yielded data that could be compared by all test methods. The very major, major, and minor errors for these two antimicrobials in comparison to the reference HTM microdilution method were as follows: Micro-Media (1.7%, 0%, and 4.8%); MicroScan (11.9%, 0%, and 8.1%); E-Test HTM (1.6%, 0%, and 2.0%); E-Test CMH (1.6%, 1.6%, and 4.6%); Vitek (8.1%, 0%, and 3.1%); and agar dilution on MH-LHB (0%, 0%, and 4.6%). Micro-Media and MicroScan panels failed to support the growth of 4.1% and 5.1% of the isolates, respectively. PMID:8724400

  3. Heat inactivation of beta-lactam antibiotics in milk.

    PubMed

    Zorraquino, M A; Roca, M; Fernandez, N; Molina, M P; Althaus, R

    2008-06-01

    The presence of residues of antimicrobial substances in milk is one of the main concerns of the milk industry, as it poses a risk of toxicity to public health, and can seriously influence the technological properties of milk and dairy products. Moreover, the information available on the thermostability characteristics of these residues, particularly regarding the heat treatments used in control laboratories and the dairy industry, is very scarce. The aim of the study was, therefore, to analyze the effect of different heat treatments (40 degrees C for 10 min, 60 degrees C for 30 min, 83 degrees C for 10 min, 120 degrees C for 20 min, and 140 degrees C for 10 s) on milk samples fortified with three concentrations of nine beta-lactam antibiotics (penicillin G: 3, 6, and 12 microg/liter; ampicillin: 4, 8, and 16 microg/liter; amoxicillin: 4, 8, and 16 microg/liter; cloxacillin: 60, 120, and 240 microg/liter; cefoperazone: 55, 110, and 220 microg/liter; cefquinome: 100, 200, and 400 microg/liter; cefuroxime: 65, 130, and 260 microg/liter; cephalexin: 80, 160, and 220 microg/ liter; and cephalonium: 15, 30, and 60 microg/liter). The method used was a bioassay based on the inhibition of Geobacillus stearothermophilus var. calidolactis. The results showed that heating milk samples at 40 degrees C for 10 min hardly produced any heat inactivation at all, while the treatment at 83 degrees C for 10 min caused a 20% loss in penicillin G, 27% in cephalexin, and 35% in cefuroxime. Of the three dairy industry heat treatments studied in this work, low pasteurization (60 degrees C for 30 min) and treatment at 140 degrees C for 10 s only caused a small loss of antimicrobial activity, whereas classic sterilization (120 degrees C for 20 min) showed a high level of heat inactivation of over 65% for penicillins and 90% for cephalosporins. PMID:18592745

  4. Perioperative antibiotics for prevention of acute endophthalmitis after cataract surgery

    PubMed Central

    Gower, Emily W; Lindsley, Kristina; Nanji, Afshan A; Leyngold, Ilya; McDonnell, Peter J

    2014-01-01

    Background Endophthalmitis is a severe inflammation of the anterior and/or posterior chambers of the eye that may be sterile or associated with infection. It is a potentially vision-threatening complication of cataract surgery. Prophylactic measures for endophthalmitis are targeted against various sources of infection. Objectives The objective of this review was to evaluate the effects of perioperative antibiotic prophylaxis for endophthalmitis following cataract surgery. Search methods We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2012, Issue 10), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE, (January 1950 to October 2012), EMBASE (January 1980 to October 2012), Latin American and Caribbean Literature on Health Sciences (LILACS) (January 1982 to October 2012), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 25 October 2012. We also searched for additional studies that cited any included trials using the Science Citation Index. Selection criteria We included randomized controlled trials that enrolled adults undergoing cataract surgery (any method and incision type) for lens opacities due to any origin. Trials that evaluated preoperative antibiotics, intraoperative (intracameral, subconjunctival or systemic) or postoperative antibiotic prophylaxis for acute endophthalmitis were included. We did not include studies that evaluated antiseptic preoperative preparations using agents such as povidone iodine, nor did we include studies that evaluated antibiotics for treating acute endophthalmitis after cataract surgery. Data collection and analysis Two review authors independently reviewed abstracts and full-text articles for eligibility, assessed the risk of bias for each included study, and abstracted data. Main results Four studies met the inclusion criteria for this review, including 100,876 adults and 131 endophthalmitis cases. While the sample size is very large, the heterogeneity of the study designs and modes of antibiotic delivery made it impossible to conduct a formal meta-analysis. Interventions investigated in the studies included the utility of adding vancomycin and gentamycin to the irrigating solution compared with standard balanced saline solution irrigation alone, use of intracameral cefuroxime and/or topical levofloxacin perioperatively, periocular penicillin injections and topical chloramphenicol-sulphadimidine drops compared with topical antibiotics alone, and mode of antibiotic delivery (subconjunctival versus retrobulbar injections). Two studies with adequate sample sizes to evaluate a rare outcome found reduced risk of endophthalmitis with antibiotic injections during surgery compared with topical antibiotics alone: risk ratio (RR) 0.33, 95% confidence interval (CI) 0.12 to 0.92 (periocular penicillin versus topical chloramphenicol-sulphadimidine) and RR 0.21, 95% CI 0.06 to 0.74 (intracameral cefuroxime versus topical levofloxacin). Another study found no significant difference in endophthalmitis when comparing subconjunctival versus retrobulbar antibiotic injections (RR 0.85, 95% CI 0.55 to 1.32). The fourth study which compared irrigation with balanced salt solution (BSS) alone versus BSS with antibiotics was not sufficiently powered to detect differences in endophthalmitis between groups. The risk of bias among studies was low to unclear due to information not being reported. Authors' conclusions Multiple measures for preventing endophthalmitis following cataract surgery have been studied. One of the included studies, the ESCRS (European Society of Cataract and Refractive Surgeons) study, was performed using contemporary surgical technique and employed cefuroxime, an antibiotic comm

  5. Prevalence of ?-Lactamase Producing Escherichia coli from Retail Meat in Turkey.

    PubMed

    Pehlivanlar nen, Sevda; Aslanta?, zkan; ?ebnem Y?lmaz, Ebru; Krekci, Cemil

    2015-09-01

    Extended spectrum ?-lactamase (ESBL) and plasmid-mediated AmpC ?-lactamase (pAmpC) producing Escherichia coli have been shown to be present in humans and animals representing a significant problem worldwide. This study aimed to search the presence of ESBL and/or AmpC-producing E. coli in retail meats (chicken and beef) in Turkey. A total of 88 ?-lactamase-producing E. coli were isolated from chicken (n = 81/100) and beef meat (n = 7/100) samples and their susceptibility to several antimicrobials were tested using disc diffusion method. E. coli isolates were further characterized for their phylogenetic groups. ?-Lactamase encoding (blaTEM , blaSHV , blaOXA , blaCTX-M , and blaAmpC ) and quinolone resistance genes (qnrA, qnrB, qnrS, qepA, and acc(6')-Ib-cr) were also secreened by polymerase chain reaction (PCR). However, in regard to ?-lactamase genes, 84 of 88 isolates were positive for blaCTX-M-1 (n = 39), blaCTX-M-3 (n = 5), blaCTX-M-15 (n = 4), blaTEM-1b (n = 2), blaSHV-12 (n = 1), blaCTX-M-1 /blaTEM-1b (n = 10), blaCTX-M-1 /blaTEM-1b /blaSHV-5 (n = 1), blaCTX-M-1 /blaCMY-2 (n = 1) and blaTEM-1b /blaCMY-2 (n = 6), blaCTX-M-15 /blaSHV-12 (n = 1), blaCTX-M-15 /blaTEM-1b (n = 1), blaTEM-1b /blaSHV-12 (n = 1), and blaCMY-2 (n = 12) genes. Resistance to cefuroxime (75.6% and 85.7%), nalidixic acid (89% and 85.7%), tetracycline (91.4% and 100%), streptomycin (40.2% and 100%), and trimethoprim-sulfamethoxazole (36.6% and 85.7%) was observed among strains isolated from chicken and beef, respectively. However, all isolates were found to be susceptible to amikacin, imipenem, and cefepime. Resistance to ampicillin and cefoxitin was significantly linked to blaCMY-2 gene, while there was a significant correlation between CTX-M type ESBL and antimicrobial resistance to cefuroxime and streptomycin (P < 0.05). The results of this study suggest that raw chicken retail meats are highly contaminated with ESBL-producing E. coli implementing a great risk to human health in Turkey. PMID:26256548

  6. The Potential of Antimicrobials to Induce Thrombocytopenia in Critically Ill Patients: Data from a Randomized Controlled Trial

    PubMed Central

    Johansen, Maria Egede; Jensen, Jens-Ulrik; Bestle, Morten Heiberg; Hein, Lars; Lauritsen, Anne berg; Tousi, Hamid; Larsen, Kim Michael; Lken, Jesper; Mohr, Thomas; Thormar, Katrin; Johansson, Pr I.; Cozzi-Lepri, Alessandro; Lundgren, Jens D.

    2013-01-01

    Background Antimicrobial-induced thrombocytopenia is frequently described in the literature among critically ill patients. Several antimicrobials have been implicated, although experimental evidence to demonstrate causality is limited. We report, using a randomized trial, the potential of antimicrobials to induce thrombocytopenia. Methods Randomized trial allocated patients to antimicrobial treatment according to standard- of-care (SOC group) or drug-escalation in case of procalcitonin increases (high-exposure group). Patients were followed until death or day 28. Thrombocytopenia defined as absolute (platelet count ?100x109/L) or relative (?20% decrease in platelet count). Analyses were performed in the two randomized groups and as a merged cohort. Results Of the 1147 patients with platelet data available, 18% had absolute thrombocytopenia within the first 24 hours after admission to intensive care unit and additional 17% developed this complication during follow-up; 57% developed relative thrombocytopenia during follow-up. Absolute and relative thrombocytopenia day 1-4 was associated with increased mortality (HR: 1.67 [95% CI: 1.30 to 2.14]; 1.71 [95% CI: 1.30 to 2.30], P<0.0001, respectively). Patients in the high-exposure group received more antimicrobials including piperacillin/tazobactam, meropenem and ciprofloxacin compared with the SOC group, whereas cefuroxime was used more frequently in the SOC group (p<0.05). Risk of absolute and relative thrombocytopenia (RR: 0.9 [0.7-1.3], p=0.7439; 1.2 [1.0-1.4], p=0.06; respectively), as well as absolute platelet count (daily difference, high-exposure vs. SOC -1.7 [-3.8-0.5], p=0.14) was comparable between groups. In observational analyses, use of ciprofloxacin and piperacillin/tazobactam predicted risk of relative thrombocytopenia (vs. cefuroxime, RR: 2.08 [1.48-2.92]; 1.44 [1.10-1.89], respectively), however only ciprofloxacin were associated with a reduction in absolute platelet count (p=0.0005). Conclusion High exposure to broad-spectrum antimicrobials does not result in a reduction in thrombocytopenia in critically ill patients. However, single use of ciprofloxacin, and less so piperacillin/tazobactam, may contribute to a lower platelet count. Trial Registration ClinicalTrials.gov NCT00271752 http://clinicaltrials.gov/ct2/show/NCT00271752 PMID:24312305

  7. Effect of beta-lactamase inhibitors on minimum inhibitory concentration of ampicillin and amoxicillin for Staphylococcus aureus strains.

    PubMed

    Paniagua, G L; Monroy, E; Garca, O; Vaca, S

    1998-01-01

    Seventy strains of Staphylococcus aureus isolated from the nasopharynx (80%), urinary tract (16%), skin (1 strain) and eyes (2 strains) of patients at the clinical laboratory "El eritrocito" were analyzed. Susceptibility to 12 antibiotics was tested by the method of Kirby-Bauer. Minimal inhibitory concentration (MIC) of ampicillin, ampicillin + sulbactam, amoxicillin and amoxicillin + clavulanic acid were determined by plate dilution. Percentages of resistance were: Penicillin and ampicillin (100%), ceftazidime (81.4%), erythromycin (68.6%), tetracycline (31.4%) trimethoprim-sulphametoxasol (25.7%), dicloxacillin and pefloxacin (12.8%), cefuroxime and cefotaxime (4.3%), gentamicin (2.8%), cephalothin (0%). All strains were resistant to three or more antibiotics, with higher percentages of resistance to four (31.4%), three (27.1%), five (21.4%) and six (12.9%) drugs. One strain was resistant to nine antibiotics and 5.9% were resistant to seven. 97.5% of the strains were beta-lactamase-positive. The MIC50 of ampicillin and amoxicillin was 500 micrograms/ml and the MIC90 were 1727 micrograms/ml and 2000 micrograms/ml, respectively. beta-lactamase inhibitors sulbactam and clavulanic acid reduced these values eightfold, except for the MIC50 of ampicillin + sulbactam whose reduction was sixteen fold. These results show that the combination of beta-lactamic + beta-lactamase inhibitor was more efficient than cephalosporins for killing these beta-lactamase-positive strains. PMID:10932741

  8. Vaginal foreign body mimicking cervical cancer in postmenopausal woman – case study

    PubMed Central

    Słabuszewska-Jóźwiak, Aneta; Ledowicz, Witold; Jakiel, Grzegorz

    2015-01-01

    We present a case report of a 73-year-old, postmenopausal woman with detailed history of breast cancer and oncology treatment including tamoxifen therapy. She presented at the clinic of gynecology and obstetrics with recurrent inflammation of the urinary and genital tract and suspicion of a cervical mass. She also presented occasional abdominal complaints and malodorous vaginal discharge. These symptoms were observed in the patient for several years. Before hospitalization she received many kinds of empirical, antimicrobial treatment such as chlorquinaldol, metronidazole, nifuratel, and nystatin. She did not receive further guidance from doctors about the causes of ailments and further diagnostic and treatment capabilities. In our clinic a detailed diagnostic process including ultrasound transvaginal examination and a minisurgical procedure revealed the presence of a vaginal foreign body (which turned out to be a plastic, shampoo bottle cap) surrounded by a mass of inflamed tissue mimicking a cervical tumor. All symptoms and complaints subsided after surgical removal of the foreign body and antibacterial therapy with metronidazole and cefuroxime. Our study draws attention to the need of thorough gynecological care including prophylaxis, especially in the case of complaints of an intimate nature. Even trivial, frequently occurring disorders can be dangerous and require proper and responsible doctor's supervision and management through the healing process. PMID:26528112

  9. Liquid chromatography/tandem mass spectrometry assay for the simultaneous determination of cefoperazone and sulbactam in plasma and its application to a pharmacokinetic study.

    PubMed

    Zhou, Yingjie; Zhang, Jing; Guo, Beining; Yu, Jicheng; Shi, Yaoguo; Wang, Minggui; Zhang, Yingyuan

    2010-11-15

    A rapid and highly sensitive liquid chromatography-tandem mass spectrometric (LC-MS/MS) method for simultaneous determination of cefoperazone sodium and sulbactam sodium in human plasma was developed. The analytes and internal standard (IS), cefuroxime sodium, were extracted from human plasma via liquid-liquid extraction with ethyl acetate and separated on a Waters Xterra C18 column within 3.5 min. Quantitation was performed on a triple quadrupole mass spectrometer employing electrospray ionization technique, operating in selected reaction monitoring (SRM) and negative ion mode. The precursor to product ion transitions monitored for cefoperazone, sulbactam and IS were m/z 644.1?528.0, 232.1?140.0, and 423.0?362.0, respectively. The assay was validated in the linear range of 0.1-20 ?g/mL for cefoperazone and 0.02-4 ?g/mL for sulbactam. The intra- and inter-day precisions (CV%) were within 8.39% for each analyte. The recoveries were greater than 87.3% for cefoperazone and 87.2% for sulbactam. Each analyte was found to be stable during all sample storage, preparation and analytical procedures. The method was successfully applied in a pharmacokinetic study of Sulperazon injection in six hospital-acquired pneumonia (HAP) patients. PMID:20971044

  10. Antibiotic resistance of lactobacilli isolated from two italian hard cheeses.

    PubMed

    Belletti, Nicoletta; Gatti, Monica; Bottari, Benedetta; Neviani, Erasmo; Tabanelli, Giulia; Gardini, Fausto

    2009-10-01

    One hundred forty-one lactobacilli strains isolated from natural whey starter cultures and ripened Grana Padano and Parmigiano Reggiano cheeses were tested for their susceptibility to 13 antibiotics, in particular, penicillin G, ampicillin, amoxicillin, oxacillin, cephalotin, cefuroxime, vancomycin, gentamicin, tetracycline, erythromycin, clindamycin, co-trimoxazole, and nitrofurantoin. The strains belonged to the species Lactobacillus helveticus, L. delbrueckii subsp. lactis, L. rhamnosus, and L. casei. The strains of the first two species were isolated from whey starter cultures, and the strains of the last two species were from the ripened cheeses. Significant differences among the strains in their antibiotic resistance were found in relation to the type of cheese and, especially, the strains from Parmigiano Reggiano were more resistant to gentamicin and penicillin G. The strains isolated in the ripened cheese were generally more resistant than those isolated from natural whey starter cultures; in particular, significant differences regarding oxacillin, vancomycin, cephalotin, and co-trimoxazole were observed. Finally, no significant difference in relation to the type of cheese was found among the thermophilic lactobacilli isolated from whey cultures, while the facultatively heterofermentative lactobacilli isolated from Parmigiano Reggiano showed higher resistance toward gentamicin and penicillin G than did the same species isolated from Grana Padano. PMID:19833040

  11. Minimum inhibitory concentrations of selected antimicrobials against Escherichia coli and Trueperella pyogenes of bovine uterine origin.

    PubMed

    de Boer, Melvin; Heuer, Cord; Hussein, Hassan; McDougall, Scott

    2015-07-01

    Minimum inhibitory concentrations (MIC) of 9 antimicrobials for isolates of 2 common bovine intrauterine bacterial pathogens, Escherichia coli (n=209) and Trueperella pyogenes (n=35), were determined using broth microdilution methodology. The isolates were recovered from dairy cows from 7 herds postpartum using the cytobrush technique. The pathogens were initially identified using phenotypic techniques. Additionally, PCR was used to confirm the identity of T. pyogenes isolates and to categorize the E. coli isolates into phylogenetic groups A, B1, B2, and D. Minimum inhibitory concentrations in excess of published cut-points or bimodal distributions of MIC indicated potential antimicrobial resistance to ampicillin, cefuroxime, cephapirin, and oxytetracycline for E. coli, and to oxytetracycline for T. pyogenes. Of the antimicrobials tested, ticarcillin/clavulanic acid, ceftiofur, and enrofloxacin had the lowest MIC for these 2 pathogens. Differences in MIC of some antimicrobials were found between herds, age, breeds, and E. coli phylogenetic groups. Isolation of E. coli with an MIC ?8?g/mL of oxytetracycline at 23d postpartum was associated with a lower probability of pregnancy within 6wk of commencement of breeding compared with those isolates with an MIC <8?g/mL (relative risk=0.66). Minimum inhibitory concentrations for uterine pathogens were determined for isolates from New Zealand dairy cows. However, in the absence of either epidemiological or clinical interpretive criteria, the interpretation of these MIC remains unclear. Further studies are required to define interpretative criteria, including determination of pharmacokinetic and pharmacodynamic profiles for antimicrobials. PMID:25935246

  12. Spectrophotometric complexation of cephalosporins with palladium (II) chloride in aqueous and non-aqueous solvents

    NASA Astrophysics Data System (ADS)

    Bagheri Gh., A.; Yosefi rad, A.; Rezvani, M.; Roshanzamir, S.

    2012-04-01

    The complexation reaction of cephalosporins namely cefotaxime (CTX), cefuroxime (CRX), and cefazolin (CEFAZ) with palladium (II) ions have been studied in water and DMF in 25 C by the spectrophotometric methods. The method is based on the formation of yellow to yellowish brown complex between palladium (II) chloride and the investigated cephalosporins in the presence of sodium lauryl sulfate (SLS) as surfactant. The complexation process was optimized in terms of pH, temperature and contact time. The stoichiometry of all the complexes was found to be 2:1 (metal ion/ligand) for CTX, CRX, and 1:2 for CEFAZ. The stoichiometry of palladium (II)-cephalosporins was estimated by mole ratio and continuous variation methods and emphasized by the KINFIT program. These drugs could be determined by measuring the absorbance of each complex at its specific ?max. The results obtained are in good agreement with those obtained using the official methods. The proposed method was successfully applied for the determination of these compounds in their dosage forms.

  13. Aerococcus christensenii as Part of Severe Polymicrobial Chorioamnionitis in a Pregnant Woman

    PubMed Central

    Carlstein, Catrine; Marie Søes, Lillian; Jørgen Christensen, Jens

    2016-01-01

    Chorioamnionitis is a potentially life threatening infection of the fetal membranes, commonly caused by ascending bacteria from the vagina and cervix. In our case, a healthy nullipara with a term pregnancy presented clinical signs of infection after induced labour with an intracervical balloon. Thick green and foul smelling amniotic fluid was observed and culture showed massive growth of Aerococcus christensenii, a facultative anaerob species found in the human vagina, previously only rarely alleged to cause invasive infection. Additional testing with 16S rRNA gene analysis also identified the presence of Gemella asaccharolytica, Snethia sanguinegens, Parvimonas micra and Streptobacillus moniliformis. The patient was treated with cefuroxime and metronidazole and recovered quickly. The newborn showed no signs of infection. This case points at the possible role of these pathogens in female genital tract infections. The case also underlines the importance of the combination of culture and culture independent diagnostic approaches to reveal possible polymicrobial natures of selected infections, in this case chorioamnionitis. PMID:27014376

  14. Non-chemotherapy drug-induced agranulocytosis in a tertiary hospital.

    PubMed

    Navarro-Martnez, R; Chover-Sierra, E; Cauli, O

    2016-03-01

    Drug-induced agranulocytosis is a rare haematological disorder considered as severe adverse drug reaction. Due to its low incidence, the number of studies are low and the variability of clinical features and presentation in hospitalized patients is rarely described. Awe performed an observational, transversal and retrospective study in the haematology and toxicology unit in a tertiary hospital located in Spain (Valencia) (1996-2010) in order to assess its incidence, the drugs involved, the management and outcomes of drug-induced agranulocytosis. Twenty-one cases of agranulocytosis were retrieved. All of them presented severe and symptomatic agranulocytosis (fever and infection). The most common drug associated with drug-induced agranulocytosis was metamizole administration but other drugs belonging to different pharmacological classes as well (carbimazol, sulfasalazine, bisoprolol, itraconazole, amitryptiline, ketorolac and claritomicine+cefuroxime). No differences between sex and age were found in relationship with the manifestations or course of agranulocytosis. In contrast, a significantly negative association was found between age of patients and the percentage of increase in neutrophil count. Administration of human granulocyte colony-stimulating factor did not significantly enhance the recovery of the process or the restoration of leucocytes count, suggesting a limited utility in this type of agranulocytosis. PMID:25845587

  15. [Short communication: comparison of susceptibilities of Escherichia coli urinary tract isolates against fosfomycin tromethamine and different antibiotics].

    PubMed

    Aykut Arca, Ebru; Karabiber, Nihal

    2007-01-01

    The aim of this study was to investigate the susceptibilities of Escherichia coli strains isolated from urine samples, against fosfomycin tromethamine and different antibiotics in the period of October-December 2004 in a local hospital in Ankara, Turkey. A total of 120 E. coli strains isolated from urine cultures of subjects who were admitted to outpatient clinics were included to the study. The identification and antimicrobial susceptibility tests (against amikacin, amoxicillin/clavulanate, ampicillin, cefepime, cefoxitin, cefotaxime, cefuroxime, cefalotin, ciprofloxacin, gentamicin, levofloxacin, meropenem, nitrofurantoin, piperacillin, piperacillin/tazobactam and trimethoprim/sulphametoxazole) were performed by a commercial automatized system (Phoenix, Becton Dickinson, USA). Fosfomycin tromethamine susceptibility was studied by Kirby Bauer disk diffusion method according to the CLSI criteria. Only one strain (0.8%) was found resistant to fosfomycin tromethamine, while no resistance was determined against amikacin and meropenem. Most of the isolates were found susceptible to nitrofurantoin (90%), cefoxitin (82.5%), gentamicin (81%), piperacillin/tazobactam (81%), cefepime (79%) and cefotaxime (%79%). All of the E. coli isolates which were resistant to ciprofloxacin and levofloxacin (44% and 43%, respectively) were found susceptible to fosfomycin tromethamine. In conclusion, since E. coli is by far the most prevalent community acquired urinary tract pathogen, fosfomycin tromethamine seems to be a reasonable alternative for the ampirical therapy of uncomplicated urinary tract infections. PMID:17427560

  16. Cefditoren: Comparative efficacy with other antimicrobials and risk factors for resistance in clinical isolates causing UTIs in outpatients

    PubMed Central

    2012-01-01

    Background To investigate a possible role of Cefditoren, a recently marketed in Greece third-generation oral cephalosporin in urinary infections of outpatients. Methods During a multicenter survey of Enterobacteriaceae causing UTIs in outpatients during 2005–2007, Cefditoren MICs were determined by agar dilution method in a randomly selected sample of uropathogens. Susceptibility against 18 other oral/parenteral antimicrobials was determined according to Clinical and Laboratory Standards Institute methodology. Results A total of 563 isolates (330 Escherichia coli, 142 Proteus mirabilis and 91 Klebsiella spp) was studied; MIC50/MIC90 of Cefditoren was 0.25/0.5 mg/L respectively, with 97.1% of the isolates being inhibited at 1 mg/L. All 12 strains producing ESBLs or AmpC enzymes were resistant to cefditoren. Susceptibility rates (%) for amoxicillin/clavulanic acid, cefuroxime axetil, cefotaxime, ciprofloxacin, trimethoprim/sulfamethoxazole and fosfomycin were 93.1- 94.1- 96.8-93.1-71.9 and 92.8% respectively. Cefditoren MIC was significantly higher in nalidixic/ciprofloxacin non-susceptible strains; resistance to cefditoren was not associated with resistance to mecillinam, fosfomycin nitrofurantoin and aminoglycosides. Multivariate analysis demonstrated history of urinary infection in the last two weeks or three months as risk factors for cefditoren resistance. Conclusions Cefditoren exhibited enhanced in vitro activity against the most common uropathogens in the outpatient setting, representing an alternative oral treatment option in patients with risk factors for resistance to first-line antibiotics. PMID:23009290

  17. In vitro susceptibility of community-acquired urinary tract pathogens to commonly used antimicrobial agents in Spain: a comparative multicenter study (2002-2004).

    PubMed

    Garcia Garcia, M I; Munoz Bellido, J L; Garcia Rodriguez, J A

    2007-06-01

    The susceptibility patterns of 2724 uropathogens isolated in 9 Spanish regions during 2002, and 3013 obtained in 2004 were determined. The antibiotics tested were fosfomycin trometamol, amoxicillin, co-amoxiclav, cefixime, cefuroxime-axetil, pipemidic, ceprofloxacin, trimethoprim plus sulphamethoxazole and nitrofurantoin. Escherichia coli was the main pathogen in both studies (73% vs. 68.3%) followed by Proteus mirabilis 7.2% vs. 6.4%) and Klebsiella pneumoniae (5.4% vs. 5.2%). Enteroccocus spp. (4.7% vs. 6.8%), Streptoccocus agalactiae (1.7% vs. 3.1%) and Staphyloccocus saprophyticus (0.7% vs. 1.3%)were the most frequent Gram-positive pathogens. 31.3% of E. coli in 2002 and 32% in 2004 were susceptible to all antibiotics tested. Around 40% of E. coli were resistant to a single agent. 21.6-24.1% were resistant to two antibiotics. 35.4% of first period isolates, and 37.6% of second period ones were resistant to two or more classes of antibiotics. Fosfomycin (2.1- 2.8%) and nitrofurantoin (3.5-5.7%) had the lowest resistance rates for E. coli. Amoxicillin (58.2-58.7%), co-trimoxazole (30.8-33.8%) and ciprofloxacin (22.6-22.7%) showed the highest resistance rates, and their suitability as empiric treatments for UTI should probably be re-evaluated. PMID:17594920

  18. Diagnosis, treatment, and prognosis of erythema migrans and Lyme arthritis.

    PubMed

    Feder, Henry M; Abeles, Micha; Bernstein, Megan; Whitaker-Worth, Diane; Grant-Kels, Jane M

    2006-01-01

    Most patients with erythema migrans, the pathognomonic rash of Lyme disease, do not recall a deer tick bite. The rash is classically 5 to 68 cm of annular homogenous erythema (59%), central erythema (30%), central clearing (9%), or central purpura (2%). Serologic testing is not indicated for patients with erythema migrans, because initially, the result is usually negative. Successful treatment of a patient with erythema migrans can be accomplished with 20 days of oral doxycycline, amoxicillin, or cefuroxime axetil. Patients with Lyme arthritis usually present with a mildly painful swollen knee. Patients with Lyme arthritis have markedly positive serology and can usually be successfully treated with 28 days of oral doxycycline or amoxicillin. Some patients may have persistent effusion despite 4 to 8 weeks of antibiotics and may need synovectomy. Persistent effusion is not due to persistent infection. Antibiotic therapy for more than 8 weeks for patients with Lyme disease is not indicated. Chronic Lyme disease due to antibiotic resistant infection has not been demonstrated. PMID:17113969

  19. Spectrophotometric complexation of cephalosporins with palladium (II) chloride in aqueous and non-aqueous solvents.

    PubMed

    Bagheri Gh, A; Yosefi rad, A; Rezvani, M; Roshanzamir, S

    2012-04-01

    The complexation reaction of cephalosporins namely cefotaxime (CTX), cefuroxime (CRX), and cefazolin (CEFAZ) with palladium (II) ions have been studied in water and DMF in 25 °C by the spectrophotometric methods. The method is based on the formation of yellow to yellowish brown complex between palladium (II) chloride and the investigated cephalosporins in the presence of sodium lauryl sulfate (SLS) as surfactant. The complexation process was optimized in terms of pH, temperature and contact time. The stoichiometry of all the complexes was found to be 2:1 (metal ion/ligand) for CTX, CRX, and 1:2 for CEFAZ. The stoichiometry of palladium (II)-cephalosporins was estimated by mole ratio and continuous variation methods and emphasized by the KINFIT program. These drugs could be determined by measuring the absorbance of each complex at its specific λmax. The results obtained are in good agreement with those obtained using the official methods. The proposed method was successfully applied for the determination of these compounds in their dosage forms. PMID:22286057

  20. Profiling of β-lactam selectivity for penicillin-binding proteins in Escherichia coli strain DC2.

    PubMed

    Kocaoglu, Ozden; Carlson, Erin E

    2015-05-01

    Penicillin-binding proteins (PBPs) are integral players in bacterial cell division, and their catalytic activities can be monitored with β-lactam-containing chemical probes. Compounds that target a single PBP could provide important information about the specific role(s) of each enzyme, making identification of such molecules important. We evaluated 22 commercially available β-lactams for inhibition of the PBPs in live Escherichia coli strain DC2. Whole cells were titrated with β-lactam antibiotics and subsequently incubated with a fluorescent penicillin derivative, Bocillin-FL (Boc-FL), to label uninhibited PBPs. Protein visualization was accomplished by sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) separation and fluorescent scanning. The examined β-lactams exhibited diverse PBP selectivities, with amdinocillin (mecillinam) showing selectivity for PBP2, aztreonam, piperacillin, cefuroxime, cefotaxime, and ceftriaxone for PBP3, and amoxicillin and cephalexin for PBP4. The remaining β-lactams did not block any PBPs in the DC2 strain of E. coli or inhibited more than one PBP at all examined concentrations in this Gram-negative organism. PMID:25733506

  1. ESBL-producing Enterobacteriaceae: occurrence, risk factors for fecal carriage and strain traits in the Swiss slaughter cattle population younger than 2 years sampled at abattoir level.

    PubMed

    Reist, Martin; Geser, Nadine; Hchler, Herbert; Schrrer, Sara; Stephan, Roger

    2013-01-01

    During the past decade extended-spectrum beta-lactamase (ESBL) producing Enterobacteriaceae have become a matter of great concern in human and veterinary medicine. In this cross-sectional study fecal swabs of a geographically representative number of Swiss cattle at slaughterhouse level were sampled i) to determine the occurrence of ESBL producing Enterobacteriaceae in the Swiss slaughter cattle population younger than 2 years, and ii) to assess risk factors for shedding ESBL producing Enterobacteriaceae. In total, 48 (8.4%; 95% C.I. 6.3-11.1%) independent ESBL producing Enterobacteriaceae were detected among the 571 tested animals. Species identification revealed 46 E. coli strains, one Enterobacter cloacae and one Citrobacter youngae. In view of beta-lactam antibiotics, all 48 isolates were resistant to ampicillin, cephalothin and cefpodoxime. Forty-five (93.8%) isolates were resistant cefuroxime; one (2.1%) isolate to cefoxitin, 28 (58.3%) isolates to cefotaxime, 2 (4.2%) isolates to ceftazidime, and 2 (4.2%) isolates to cefepime. Risk factors for shedding ESBL producing Enterobacteriaceae were (i) age (OR 0.19 and 0.12 in age category 181 d to 1 y and 1 y to 2 y compared to ?180 d), (ii) primary production type, meaning dairy compared to beef on farm of origin (OR 5.95), and (iii) more than 1 compared to less than 1 animal movement per d per 100 animals on farm of origin (OR 2.37). PMID:23977126

  2. Synergistic activity of biocides and antibiotics on resistant bacteria from organically produced foods.

    PubMed

    Fernández Fuentes, Miguel Angel; Abriouel, Hikmate; Gadea, Rebeca; Pérez Pulido, Rubén; Gálvez, Antonio; Ortega, Elena

    2014-10-01

    Synergism between biocides and antibiotics was investigated in 20 biocide and antibiotic-resistant bacterial strains that were previously isolated from organically produced foods, according to their antimicrobial resistance profiles. Most of the antibiotic/biocide combinations yielded synergistic interactions, reducing the inhibitory concentrations of biocides and antibiotics by 4- to 16-fold. Among enterococci, synergism with biocides was detected for amoxicillin (AM), cefuroxime (CX), erythromycin (EM), ciprofloxacin (CP), and trimethoprim/sulphametoxazol (T/S). Among staphylococci, interactions were synergistic (AM) and either synergistic or indifferent (CX and EM, depending on biocide). Among the three methicillin-resistant Staphylococcus aureus clinical strains included in the study, the combinations of methicillin and triclosan or hexachlorophene acted synergistically in all strains, but interactions were either synergistic or indifferent for the other biocides, depending on the strain. All combinations tested were synergistic for Lactobacillus (AM, CX, EM, and CP) and Micrococcus (AM, EM). In Salmonella, interactions were indifferent (AM, CX, EM, and CP) or synergistic (T/S). Synergism with biocides was also detected in Klebsiella isolates (AM, CX, and T/S), Enterobacter sp. (AM, CX, EM, and T/S), Pantoea (AM, CX, EM, CP, and T/S), and Chryseobacterium sp. (EM). These results suggest that combinations of biocides and antibiotics may open new possibilities to combat antimicrobial resistance. PMID:24660956

  3. Acute chest syndrome in children with sickle cell disease.

    PubMed

    Srair, H A; Owa, J A; Aman, H A; Madan, M A

    1995-01-01

    Acute chest syndrome (ACS) is an acute pulmonic process in patients with sickle cell disease. We prospectively studied 50 patients with ACS admitted to the Pediatric Medical Ward during one year period (Jan. 1993 through Dec. 1993). Twenty eight of them were males and twenty two were females giving a male: female ratio of 1.2:1. The age ranged between one and 12 years. Twelve (24%) of the patients had chest pain on presentation. Twenty seven (54%) patients had significant temperature (> 38 degrees C). The x-ray findings showed that the right lung was involved in 30 patients, the left in 10 patients and both lungs in 10 patients. Three patients had pleural effusion that required chest tube insertion. Laboratory profiles showed that the erythrocyte sedimentation rate ranged between 15 and 90 mm/h, and their hemoglobin ranged between 4.2 gm and 12 gm/dl. Seven (14%) patients had significantly positive mycoplasma pneumoniae titer. None of the blood cultures was positive. All of our patient received antibiotic, usually either Cefuroxime or Ceftriaxone with Erythromycin in addition to other supportive measures such as blood transfusion, oxygen therapy and hydration therapy. PMID:10829868

  4. Antimicrobial Resistance in More than 100,000 Escherichia coli Isolates According to Culture Site and Patient Age, Gender, and Location ?

    PubMed Central

    Sahuquillo-Arce, Jos Miguel; Selva, Mara; Perpin, Hctor; Gobernado, Miguel; Armero, Carmen; Lpez-Qulez, Antonio; Gonzlez, Francisco; Vanaclocha, Hermelinda

    2011-01-01

    Escherichia coli and the antimicrobial pressure exerted on this microorganism can be modulated by factors dependent on the host. In this paper, we describe the distribution of antimicrobial resistance to amikacin, tobramycin, ampicillin, amoxicillin clavulanate, cefuroxime, cefoxitin, cefotaxime, imipenem, ciprofloxacin, fosfomycin, nitrofurantoin, and trimetoprim-sulfametoxazole in more than 100,000 E. coli isolates according to culture site and patient age, gender, and location. Bayesian inference was planned in all statistical analysis, and Markov chain Monte Carlo simulation was employed to estimate the model parameters. Our findings show the existence of a marked difference in the susceptibility to several antimicrobial agents depending on from where E. coli was isolated, with higher levels of resistance in isolates from medical devices, the respiratory system, and the skin and soft tissues; a higher resistance percentage in men than in women; and the existence of a clear difference in antimicrobial resistance with an age influence that cannot be explained merely by means of an increase of resistance after exposure to antimicrobials. Both men and women show increases in resistance with age, but while women show constant levels of resistance or slight increases during childbearing age and greater increases in the premenopausal age, men show a marked increase in resistance in the pubertal age. In conclusion, an overwhelming amount of data reveals the great adaptation capacity of E. coli and its close interaction with the host. Sex, age, and the origin of infection are determining factors with the ability to modulate antimicrobial resistances. PMID:21220537

  5. Wound prophylaxis in thoracic surgery: a new approach.

    PubMed Central

    Walker, W S; Faichney, A; Raychaudhury, T; Prescott, R J; Calder, M A; Sang, C T; Cameron, E W; Walbaum, P R

    1984-01-01

    A prospective double blind, randomised study was performed in 100 patients undergoing major elective thoracic surgery to assess a new method of prophylaxis of wound infection using one preincisional intraparietal infiltration of cefuroxime sodium along the line of proposed incision as the sole protection against wound infection. A significant (p less than 0.01) reduction in the incidence of wound infection occurred in the antibiotic treated group (2%) compared with the control group (20%), who received by the same route the same volume of saline only. The groups were comparable with respect to age, sex, pathological condition, and operative variables. The use of additional antibiotics was significantly greater in the control group (p less than 0.01), largely owing to a much greater incidence of postoperative pulmonary infection in the control group (60%) than in the antibiotic treated group (40%). No morbidity was associated with this technique. The organisms found in oesophageal and bronchial operative luminal specimens did not correlate with postoperative wound or pulmonary infection or with organisms causing these infections. Reductions in wound and pulmonary infection rates equivalent to those produced by conventional multiple dose parenteral regimens were achieved by this technique. PMID:6367129

  6. Vaginal foreign body mimicking cervical cancer in postmenopausal woman - case study.

    PubMed

    Ciebiera, Micha?; S?abuszewska-J?wiak, Aneta; Ledowicz, Witold; Jakiel, Grzegorz

    2015-09-01

    We present a case report of a 73-year-old, postmenopausal woman with detailed history of breast cancer and oncology treatment including tamoxifen therapy. She presented at the clinic of gynecology and obstetrics with recurrent inflammation of the urinary and genital tract and suspicion of a cervical mass. She also presented occasional abdominal complaints and malodorous vaginal discharge. These symptoms were observed in the patient for several years. Before hospitalization she received many kinds of empirical, antimicrobial treatment such as chlorquinaldol, metronidazole, nifuratel, and nystatin. She did not receive further guidance from doctors about the causes of ailments and further diagnostic and treatment capabilities. In our clinic a detailed diagnostic process including ultrasound transvaginal examination and a minisurgical procedure revealed the presence of a vaginal foreign body (which turned out to be a plastic, shampoo bottle cap) surrounded by a mass of inflamed tissue mimicking a cervical tumor. All symptoms and complaints subsided after surgical removal of the foreign body and antibacterial therapy with metronidazole and cefuroxime. Our study draws attention to the need of thorough gynecological care including prophylaxis, especially in the case of complaints of an intimate nature. Even trivial, frequently occurring disorders can be dangerous and require proper and responsible doctor's supervision and management through the healing process. PMID:26528112

  7. The Escherichia coli phylogenetic group B2 with integrons prevails in childhood recurrent urinary tract infections.

    PubMed

    Kljalg, Siiri; Truusalu, Kai; Stsepetova, Jelena; Pai, Kristiine; Vainume, Inga; Sepp, Epp; Mikelsaar, Marika

    2014-05-01

    The aim of our study was to characterize the phylogenetic groups of Escherichia coli, antibiotic resistance, and containment of class 1 integrons in the first attack of pyelonephritis and in subsequent recurrences in young children. Altogether, 89 urine E. coli isolates from 41 children with urinary tract infection (UTI) were studied for prevalence and persistence of phylogenetic groups by pulsed-field gel electrophoresis (PFGE), antibacterial resistance by minimal inhibitory concentrations (MIC) and class 1 integrons by PCR. Phylogenetic group B2 was most common (57%), followed by D (20%), A (18%) and B1 (5%). Overall resistance to betalactams was 61%, trimethoprim-sulfamethoxazole 28%, and was not associated with phylogenetic groups. According to PFGE, the same clonal strain persisted in 77% of patients. The persistence was detected most often in phylogenetic group B2 (70%). Phylogenetic group B2 more often contained class 1 integrons than group A. Integron positive strains had higher MIC values of cefuroxime, cefotaxime, and gentamicin. In conclusion, phylogenetic group B2 was the most common cause of the first episode of pyelonephritis, as well as in case of the persistence of the same strain and contained frequently class 1 integrons in childhood recurrent UTI. An overall frequent betalactam resistance was equally distributed among phylogenetic groups. PMID:24033434

  8. Analysis of the effect of integrons on drug-resistant Staphylococcus aureus by multiplex PCR detection

    PubMed Central

    REN, CHUNFENG; ZHAO, YONGJING; SHEN, YAN

    2013-01-01

    The aim of this study was to detect class I, II and III integrons using multiplex PCR, and to analyze the role that these integrons play in mediating multidrug-resistant Staphylococcus aureus (SA). The sensitivity of SA to 20 types of antibiotics was examined using the K-B method. A genomic DNA extraction kit was used for extracting genomic DNA and a high-purity 96 plasmid extraction kit was used for extracting plasmid DNA. Class I, II and III integrons were amplified using multiplex PCR. Agarose gel electrophoresis was used for analysing amplification products. The positive rate of class I and II integrons in the plasmid DNA from SA was higher compared to that of the genomic DNA. The positive rate of class I integrons was highest in the group with multidrug resistance to amoxicillin/clavulanic acid, piperacillin/tazobactam, ciprofloxacin, tetracycline, rifampin, imipenem, cefazolin, cefuroxime, levofloxacin and gentamicin. As regards integron detection in the plasmids from drug-resistant SA strians obtained from sputum, blood, cerebrospinal fluid, drainage fluid, excretion and urine specimens, the difference in the detection rate of class I integrons among the six types of specimens was significant. Multiplex PCR is an effective method to detect class I, II and III integrons. The SA plasmid is the main carrier transferring integrons. Integrons mediate the formation of SA multidrug resistance. PMID:23337960

  9. Design, synthesis and biological evaluation of 4-benzoyl-1-dichlorobenzoylthiosemicarbazides as potent Gram-positive antibacterial agents.

    PubMed

    Paneth, Agata; Plech, Tomasz; Kaproń, Barbara; Hagel, Dominika; Kosikowska, Urszula; Kuśmierz, Edyta; Dzitko, Katarzyna; Paneth, Piotr

    2016-06-01

    Twelve 4-benzoyl-1-dichlorobenzoylthiosemicarbazides have been tested as potential antibacterials. All the compounds had MICs between 0.49 and 15.63 µg/ml toward Micrococcus luteus, Bacillus cereus, Bacillus subtilis and Staphylococcus epidermidis indicating, in most cases, equipotent or even more effective action than cefuroxime. In order to clarify if the observed antibacterial effects are universal, further research were undertaken to test inhibitory potency of two most potent compounds 3 and 11 on clinical isolates of Staphylococcus aureus. Compound 11 inhibited the growth of methicillin-sensitive S. aureus (MSSA) at MICs of 1.95-7.81 µg/ml, methicillin-resistant S. aureus (MRSA) at MICs of 0.49-1.95 µg/ml and MDR-MRSA at MIC of 0.98 and 3.90 µg/ml, respectively. Finally, inhibitory efficacy of 3 and 11 on planktonic cells and biofilms formation in clinical isolates of S. aureus and Haemophilus parainfluenzae was tested. The majority of cells in biofilm populations of MSSA and MRSA were eradicated at low level of 3, with MBICs in the range of 7.82-15.63 µg/ml. PMID:25897586

  10. Study of the Electrophoretic Behavior of Cephalosporins by Capillary Zone Electrophoresis

    PubMed Central

    Hancu, Gabriel; Sasebe?i, Adina; Rusu, Aura; Kelemen, Hajnal; Ciurba, Adriana

    2015-01-01

    Purpose: The aim of the study was the characterization of the electrophoretic behavior of cephalosporins from different generation having different structural characteristics in order to develop a rapid, simple and efficient capillary electrophoretic method for their identification and simultaneous separation from complex mixtures. Methods: Ten cephalosporin derivatives (cefaclor, cefadroxil, cefalexin, cefazolin, cefoxitin, cefuroxime, cefoperazone, cefotaxime, ceftazidime, ceftriaxone) were analyzed by capillary zone electrophoresis using different background electrolyte solutions at different pH values. Electrophoretic mobilities of the analytes were calculated, the influence of the electrophoretic parameteres on the separation was established and the analytical conditions were optimized. Results: Taking into consideration their structural and chemical properties cephalosporins can be detected over a pH range between 6 and 10. The best results were obtained using a buffer solution containing 25 mM disodium hydrogenophosphate - 25 mM sodium dihydrogenophosphate, at a pH 7.00, + 25 kV voltage at a temperature of 25 C, UV detection at 210 nm. Using the optimized analytical conditions we achieved the simultaneous baseline separation for seven cephalosporins in less then 10 minutes. Conclusion: Using the described optimized electrophoretic procedures, capillary electrophoresis can be used for the identification and determination of cephalosporins in formulated pharmaceutical products and for their separation from complex mixtures. PMID:26236661

  11. Resistance phenotypes and genotypes among multiple-antimicrobial-resistant Salmonella enterica subspecies enterica serovar Choleraesuis strains isolated between 2008 and 2012 from slaughter pigs in Okinawa Prefecture, Japan

    PubMed Central

    MATAYOSHI, Masanao; KITANO, Takashi; SASAKI, Tetsu; NAKAMURA, Masaji

    2015-01-01

    A total of 349 Salmonella enterica subspecies enterica serovar Choleraesuis (S. Choleraesuis) strains, which were isolated between 2008 and 2012 from 349 pigs at two slaughterhouses in Okinawa Prefecture, Japan, were investigated for antimicrobial susceptibility and the presence of antimicrobial resistance genes. All isolates were resistant to at least four antimicrobial agents. The antimicrobial agents for which isolates showed a high incidence of resistance were as follows: ampicillin (100%) and streptomycin (100%), followed by gentamicin (99.7%), oxytetracycline (99.7%), sulfamethoxazole/trimethoprim (99.4%), nalidixic acid (40.1%) and oxolinic acid (40.1%). All isolates were sensitive to cefuroxime, ceftiofur, colistin, fosfomycin, enrofloxacin, orbifloxacin and danofloxacin. The predominant resistance phenotypes and genotypes were: resistance to ampicillin, streptomycin, gentamicin, oxytetracycline and sulfamethoxazole/trimethoprim (58.5%, 204/349) and blaTEM-strA-strB-aadA1-aadA2-aacC2-tet (B)-sul1-sul2-dhfrXII-dhfrXIII (36.1%, 126/349). The quinolone resistance-determining regions (QRDRs) of gyrA, gyrB, parC and parE of the quinolone-resistant isolates (n=12) showed amino acid substitutions of Ser-83→Phe or Asp-87→Tyr in GyrA and Ser-107→Ala in ParC. To our knowledge, this is the first report on the molecular characterization of antimicrobial resistance among S. Choleraesuis strains in Japan. PMID:25715779

  12. [Intraocular Lens as a Drug Delivery Device: State of the Art and Future Perspective].

    PubMed

    Eibl-Lindner, K H; Wertheimer, C; Kampik, A

    2016-02-01

    Development of an intraocular lens (IOL) as a drug delivery device has been pursued for many years and is a promising concept in modern cataract surgery. Common postoperative conditions such as posterior capsule opacification (PCO), intraocular inflammation or the rare but severe complications of cataract surgery like endophthalmitis are potential therapeutic targets for a drug-eluting IOL. There are three techniques of pharmacological IOL modification: Firstly, surface modification of the IOL ("coating"); secondly, IOL optic modification ("soaking") and lastly, loading the IOL haptics with a slow release system. The last option does not interfere with the IOL optics at all. Therefore, a broad spectrum of pharmacological agents needs to be assessed in preclinical and clinical studies to determine which agent/IOL combination is safe and efficient. For pharmacological PCO prophylaxis, erufosine-loaded IOLs are of great clinical interest. Heparin-coated IOLs might become clinically relevant for attenuation of intraocular inflammation after cataract surgery and cefuroxime-loaded IOLs for endophthalmitis prophylaxis. PMID:26878733

  13. Epidemiological characteristics and molecular typing of Salmonella enterica serovar Typhi during a waterborne outbreak in Eastern Anatolia

    PubMed Central

    BAYRAM, Y; GDCO?LU, H; OTLU, B; AYPAK, C; GRSOY, N C; ULU, H; BERKTA?, M

    2011-01-01

    In this study, we aimed to study the molecular and epidemiological characteristics of Salmonella enterica serovar Typhi (S. typhi) outbreak in Eastern Anatolia. Six hundred and thirty-seven patients from the same county with clinical diagnosis of typhoid fever were investigated with conventional methods from stool, urine and blood specimens. Antibiotic susceptibility tests and identifications were performed for positive specimens. Clonal relationships between the isolates were investigated using pulsed field gel electrophoresis (PFGE) method. A questionnaire was completed for the water consumption habits of patients. Of 91 culture positive specimens, 76 were blood, 13 were stool and 2 were urine. The isolates were resistant to ampicillin, ampicillin/sulbactam, chloramphenicol, cefuroxime, amikacin, gentamicin and trimethoprimsulfamethoxazole. Although there was a single band difference in some isolates, PFGE results indicated that this was an outbreak caused by single strain according to the Tenover criteria. This outbreak thought to be associated with the consumption of tap water contaminated with sewage represents a breakdown of the basic public health and civil engineering infrastructure. Appropriate public health measures should be taken in order to avoid such outbreaks in the future. PMID:21929877

  14. Management of acute otitis media in an era of increasing antibiotic resistance.

    PubMed

    Klein, J O

    1999-10-01

    Development of resistance to available antimicrobial agents has been identified in every decade since the introduction of the sulfonamides in the 1930s. Current concerns for management of acute otitis media (AOM) are multi-drug resistant Streptococcus pneumoniae and beta-lactamase producing Haemophilus influenzae and Moraxella catarrhalis. In the USA, amoxicillin remains the drug for choice for AOM. Increasing the current dose to 80 mg/kg/day in two doses provides increased concentrations of drug in serum and middle ear fluid and captures additional resistant strains of S. pneumoniae. For children who fail initial therapy with amoxicillin an expert panel convened by the Centers for Disease Control and Prevention suggested amoxicillin-clavulanate, cefuroxime axetil or intramuscular ceftriaxone. To protect the therapeutic advantage of antimicrobial agents used for AOM, it is important to promote judicious use of antimicrobial agents and avoid uses if it is likely that viral infections are the likely cause of the disease, to implement programs for parent education and to increase the accuracy of diagnosis of AOM. Conjugate polysaccharide pneumococcal vaccines are currently in clinical trial; early results indicate protective levels of antibody can be achieved with a three dosage schedule beginning at 2 months of age. Finally, alternative medicine remedies may be of value for some infectious diseases including AOM; garlic extract is bactericidal for the major bacterial pathogens of AOM but is heat- and acid-labile and loose activity when cooked or taken by mouth. PMID:10577768

  15. Antimicrobial Susceptibilities of Aeromonas spp. Isolated from Environmental Sources?

    PubMed Central

    Huddleston, Jennifer R.; Zak, John C.; Jeter, Randall M.

    2006-01-01

    Aeromonas spp. are ubiquitous aquatic bacteria that cause serious infections in both poikilothermic and endothermic animals, including humans. Clinical isolates have shown an increasing incidence of antibiotic and antimicrobial drug resistance since the widespread use of antibiotics began. A total of 282 Aeromonas pure cultures were isolated from both urban and rural playa lakes in the vicinity of Lubbock, Texas, and several rivers in West Texas and New Mexico. Of these, at least 104 were subsequently confirmed to be independent isolates. The 104 isolates were identified by Biolog and belonged to 11 different species. The MICs of six metals, one metalloid, five antibiotics, and two antimicrobial drugs were determined. All aeromonads were sensitive to chromate, cobalt, copper, nickel, zinc, cefuroxime, kanamycin, nalidixic acid, ofloxacin, tetracycline, and sulfamethoxazole. Low incidences of trimethoprim resistance, mercury resistance, and arsenite resistance were found. Dual resistances were found in 5 of the 104 Aeromonas isolates. Greater numbers of resistant isolates were obtained from samples taken in March versus July 2002 and from sediment versus water. Plasmids were isolated from selected strains of the arsenite- and mercury-resistant organisms and were transformed into Escherichia coli XL1-Blue MRF?. Acquisition of the resistance phenotypes by the new host showed that these resistance genes were carried on the plasmids. Mercury resistance was found to be encoded on a conjugative plasmid. Despite the low incidence of resistant isolates, the six playa lakes and three rivers that were sampled in this study can be considered a reservoir for antimicrobial resistance genes. PMID:16950901

  16. Ecological antibiotic policy.

    PubMed

    Hiby, N

    2000-09-01

    Development of resistance to antibiotics is a major problem worldwide. The normal oropharyngeal flora, the intestinal flora and the skin flora play important roles in this development. Within a few days after the onset of antibiotic therapy, resistant Escherichia coli, Haemophilus influenzae and Staphylococcus epidermidis can be detected in the normal flora of volunteers or patients. Horizontal spread of the resistance genes to other species, e.g. Salmonella spp., Staphylococcus aureus and Streptococcus pneumoniae, occurs by conjugation or transformation. An ecologically sound antibiotic policy favours the use of antibiotics with little or no impact on the normal flora. Prodrug antibiotics which are not active against the bacteria in the mouth and the intestine (before absorption) and which are not excreted to a significant degree via the intestine, saliva or skin are therefore preferred. Prodrugs such as pivampicillin, bacampicillin, pivmecillinam and cefuroxime axetil are favourable from an ecological point of view. Experience from Scandinavia supports this, since resistance to mecillinam after 20 years of use is low (about 5%) and stable. PMID:11051626

  17. Hyperammonemic encephalopathy induced by a combination of valproate and pivmecillinam.

    PubMed

    Lokrantz, C-M; Eriksson, B; Rosn, I; Asztely, F

    2004-04-01

    We describe the clinical and neurophysiological findings in a case of hyperammonemic encephalopathy. A 72-year-old woman taking valproate (VPA), as monotherapy for her partial epilepsy developed urinary tract infection. She was treated with pivmecillinam 600 mg daily. The following days she deteriorated and became stuporous. At admission her serum ammonia level was increased (113 mmol/l) but the liver function appeared normal. EEG showed bilateral triphasic waves and continuous high-amplitude delta-theta wave. The patient recovered rapidly after discontinuation of VPA and i.v. treatment with cefuroxime for her urinary tract infection. VPA-induced hyperammonemic encephalopathy in adults is a rare phenomenon, especially when VPA is used as monotherapy. It has been suggested that the VPA-induced hyperammonemic encephalopathy is due to reduced serum carnitine concentration. Pivmecillinam, a widely used antibiotic for treatment of urinary tract infections, is also known to decrease the serum carnitine concentration. Our case shows that caution is required when treatment with VPA is combined with pivmecillinam due to the risk of developing hyperammonemic encephalopathy. PMID:15016014

  18. Ecological antibiotic policy.

    PubMed

    Hiby

    2000-08-01

    Development of resistance to antibiotics is a major problem worldwide. The normal oropharyngeal flora, the intestinal flora and the skin flora play important roles in this development. Within a few days after the onset of antibiotic therapy, resistant Escherichia coli, Haemophilus influenzae and Staphylococcus epidermidis can be detected in the normal flora of volunteers or patients. Horizontal spread of the resistance genes to other species, e.g. SALMONELLA: spp., Staphylococcus aureus and Streptococcus pneumoniae, occurs by conjugation or transformation. An ecologically sound antibiotic policy favours the use of antibiotics with little or no impact on the normal flora. Prodrug antibiotics which are not active against the bacteria in the mouth and the intestine (before absorption) and which are not excreted to a significant degree via the intestine, saliva or skin are therefore preferred. Prodrugs such as pivampicillin, bacampicillin, pivmecillinam and cefuroxime axetil are favourable from an ecological point of view. Experience from Scandinavia supports this, since resistance to mecillinam after 20 years of use is low (about 5%) and stable. PMID:10969054

  19. Ultrasound-assisted matrix solid phase dispersive extraction for the simultaneous analysis of ?-lactams (four penicillins and eight cephalosporins) in milk by high performance liquid chromatography with photodiode array detection.

    PubMed

    Karageorgou, Eftichia G; Samanidou, Victoria F; Papadoyannis, Ioannis N

    2012-10-01

    The application of ultrasound-assisted matrix solid phase dispersive extraction for the confirmatory analysis of 12 ?-lactam antibiotics in milk by high performance liquid chromatography with photodiode array detection has been proposed herein. Four penicillins (cloxacillin, dicloxacillin, oxacillin, and amoxicillin) and eight cephalosporins (cefaclor, cefadroxil, ceftiofur, cefuroxime, cefoperazone, cefazolin, cephalexin, and cefotaxime) are effectively extracted using a mixed sorbent of Quick Easy Cheap Effective Rugged Safe technique and OASIS HLB providing a matrix free from any endogenous interference. Examined analytes were well resolved on an Inertsil ODS-3 analytical column with a mobile phase of CH(3)COONH(4) (0.05 M) and acetonitrile delivered under a gradient program. 1,7-Dimethyl-xanthine was used as internal standard. The method was validated meeting the European Legislation determining linearity, selectivity, stability, decision limit, detection capability, accuracy, precision, and ruggedness according to the Youden approach. Recoveries of all antibiotics rated from 85.0 to 115.7%, while RSD values were <12.7%. Finally, the method was successfully applied to milk samples purchased from local market. PMID:22941669

  20. Fatal complications of intramuscular and intra-articular injections.

    PubMed

    Kortelainen, M L; Särkioja, T

    1990-01-01

    Four fatalities related to intramuscular and intra-articular injections are reported. In two of these cases a Staphylococcus aureus sepsis developed, as a consequence of injections into the left hip joint in one and in the lateral upper quadrant of the gluteal region in the other. The intra-articular injection of triamcinolone produced severe pain, but no marked signs of purulent arthritis were seen at autopsy, probably because of the anti-inflammatory effect of the corticosteroid. A cutaneous infection was seen in the gluteal region of the other patient, but no apparent abscess formation. In another case of intra-articular injection, purulent knee joint arthritis developed after an injection of glucosaminoglycan. The patient died of renal insufficiency, which was probably connected with the treatment of the arthritis with tobramycin and cefuroxim. The fourth case was that of a mentally ill patient who suffered sudden cardiac arrest after an intramuscular injection of chlorpromazine, but with no apparent signs of an anaphylactic reaction. It is suggested that vasodilatation and drop in blood pressure caused by the chlorpromazine could have had some effect, while cardiotoxicity of other psychotropic drugs with which he had been treated cannot be ruled out. PMID:2220134

  1. Novel Genes Related to Ceftriaxone Resistance Found among Ceftriaxone-Resistant Neisseria gonorrhoeae Strains Selected In Vitro.

    PubMed

    Gong, Zijian; Lai, Wei; Liu, Min; Hua, Zhengshuang; Sun, Yayin; Xu, Qingfang; Xia, Yue; Zhao, Yue; Xie, Xiaoyuan

    2016-04-01

    The emergence of ceftriaxone-resistantNeisseria gonorrhoeaeis currently a global public health concern. However, the mechanism of ceftriaxone resistance is not yet fully understood. To investigate the potential genes related to ceftriaxone resistance inNeisseria gonorrhoeae, we subcultured six gonococcal strains with increasing concentrations of ceftriaxone and isolated the strains that became resistant. After analyzing several frequently reported genes involved in ceftriaxone resistance, we found only a single mutation inpenA(A501V). However, differential analysis of the genomes and transcriptomes between pre- and postselection strains revealed many other mutated genes as well as up- and downregulated genes. Transformation of the mutatedpenAgene into nonresistant strains increased the MIC between 2.0- and 5.3-fold, and transformation of mutatedftsXincreased the MIC between 3.3- and 13.3-fold. Genes encoding the ABC transporters FarB, Tfq, Hfq, and ExbB were overexpressed, whilepilM,pilN, andpilQwere downregulated. Furthermore, the resistant strain developed cross-resistance to penicillin and cefuroxime, had an increased biochemical metabolic rate, and presented fitness defects such as prolonged growth time and downregulated PilMNQ. In conclusion, antimicrobial pressure could result in the emergence of ceftriaxone resistance, and the evolution of resistance ofNeisseria gonorrhoeaeto ceftriaxone is a complicated process at both the pretranscriptional and posttranscriptional levels, involving several resistance mechanisms of increased efflux and decreased entry. PMID:26787702

  2. An eight-year survey of the antimicrobial susceptibility patterns of 85,971 bacteria isolated from patients in a district general hospital and the local community.

    PubMed

    MacGowan, A P; Brown, N M; Holt, H A; Lovering, A M; McCulloch, S Y; Reeves, D S

    1993-04-01

    Antimicrobial susceptibilities were determined for 85,971 bacteria isolated from clinical specimens in the microbiology department of a single district general hospital during the eight-year period between 1984 and 1991. The isolates included 45,786 coliforms, 4483 Proteus spp. and 2644 Pseudomonas spp. from urine and 13,324 Staphylococcus aureus, 7311 beta-haemolytic streptococci, 4741 coliforms, 3643 Pseudomonas spp., 2778 Haemophilus influenzae, 638 Proteus spp. and 623 Streptococcus pneumoniae from other sites (excluding blood). Patterns of susceptibility remained largely unchanged during the study period, except for a decline in the susceptibility of Proteus spp. to trimethoprim between 1984 and 1988 which had reversed itself by 1990 and a reduction in the susceptibilities of Pseudomonas spp. and S. aureus to ciprofloxacin between 1986 and 1991. The susceptibilities of coliforms which had been isolated from sites other than the urinary tract to ampicillin, cefazolin and cefuroxime decreased between 1984 and 1988 but a more variable pattern was noted in subsequent years. Susceptibility of S. aureus to penicillin fell during the first five years of the study but has remained stable since. No change was observed in the susceptibility pattern of H. influenzae. In our experience, gentimicin-resistant Gram-negative bacilli, methicillin-resistant S. aureus and penicillin-resistant S. pneumoniae were rarely isolated. PMID:8514649

  3. Automated ribotyping and antibiotic resistance determining of Bacillus spp from conjunctiva of diabetic patients

    PubMed Central

    Argun K?van, Serta; K?van, Merih; Glll, Glay

    2014-01-01

    Objective(s): We aimed to characterize the phenotype and genotype of Bacillus spp isolated from diabetic patients eyes, by studying the drug sensitivity patterns with a disc-diffusion method. Materials and Methods: Fifty eyes of 25 patients with type II diabetes mellitus, with at least 10 years of diabetes history, were included in the study. We analyzed the eyes for the presence of Bacillus spp.; presumptive isolates were identified by morphological, and biochemical tests, and confirmed by the VITEK system. Automated EcoRI ribotyping was performed with a RiboPrinter Microbial Characterization System. We determined the antibiotic resistance of the isolates by the KirbyBauer disc diffusion test. Results: Seven out of 25 patients were on insulin treatment; 7 on oral anti-diabetic medication; and 11 on combination therapy of insulin and oral medications. Among the 28 Bacillus spp isolates, 14 were B. cereus, 11 were B. pumilus, 2 were B. mojavensis and 1 was B. subtilis. Almost all the strains were either resistant or multiresistant, particularly towards cefuroxime, methicillin, and ceftazidime. Conclusion: Diabetic patients seem to be more prone to B. cereus infections than healthy individuals. It would be greatly beneficial to understand and recognize the prevalence of microorganisms and their resistance patterns for better outcome in ocular surgeries. PMID:24711899

  4. Molecular identification and antimicrobial susceptibility of Nocardia spp. isolated from bovine mastitis in Brazil.

    PubMed

    Condas, Larissa A Z; Ribeiro, Márcio G; Yazawa, Katsukiyo; de Vargas, Agueda P Castagna; Salerno, Tatiana; Giuffrida, Rogério; Langoni, Hélio; Melville, Priscila A; Biesdorf, Sônia; Matsuzawa, Tetsuhiro; Gonoi, Tohru; Kastelic, John P; Barkema, Herman W

    2013-12-27

    Nocardia spp. infections can cause severe damage to the mammary gland due to suppurative pyogranulomatous lesions and lack of clinical cure in response to conventional antimicrobial therapy. Although Nocardia infections are considered relatively uncommon in cows, there has been an apparent worldwide increase in the incidence of bovine mastitis caused by Nocardia spp, perhaps due to environmental transmission of this ubiquitous pathogen. The objectives of present study were to determine: (i) species distribution of 80 Nocardia isolates involved in bovine mastitis (based on molecular methods); and (ii) antimicrobial susceptibility pattern of all isolates from three geographical areas in Brazil. In this study, Nocardia nova (80%) was the most frequently isolated species, followed by Nocardia farcinica (9%). Additionally, Nocardia puris, Nocardia cyriacigeorgica, Nocardia veterana, Nocardia africana, and Nocardia arthritidis were detected using 16S rRNA sequencing. This is apparently the first report of N. puris, N. veterana, N. cyriacigeorgica, N. arthritidis and N. africana in association with bovine mastitis. Based on the disk diffusion test, isolates were most frequently resistant to cloxacillin (75%), ampicillin (55%) and cefoperazone (47%), whereas few Nocardia spp. were resistant to amikacin, cefuroxime or gentamicin. PMID:24060098

  5. Ceftriaxone-Resistant Salmonella enterica Serotype Typhimurium Sequence Type 313 from Kenyan Patients Is Associated with the blaCTX-M-15 Gene on a Novel IncHI2 Plasmid

    PubMed Central

    Okoro, Chinyere; Kiiru, John; Omuse, Geoffrey; Langridge, Gemma; Kingsley, Robert A.; Dougan, Gordon; Revathi, Gunturu

    2015-01-01

    Multidrug-resistant bacteria pose a major challenge to the clinical management of infections in resource-poor settings. Although nontyphoidal Salmonella (NTS) bacteria cause predominantly enteric self-limiting illness in developed countries, NTS is responsible for a huge burden of life-threatening bloodstream infections in sub-Saharan Africa. Here, we characterized nine S. Typhimurium isolates from an outbreak involving patients who initially failed to respond to ceftriaxone treatment at a referral hospital in Kenya. These Salmonella enterica serotype Typhimurium isolates were resistant to ampicillin, chloramphenicol, cefuroxime, ceftriaxone, aztreonam, cefepime, sulfamethoxazole-trimethoprim, and cefpodoxime. Resistance to ?-lactams, including to ceftriaxone, was associated with carriage of a combination of blaCTX-M-15, blaOXA-1, and blaTEM-1 genes. The genes encoding resistance to heavy-metal ions were borne on the novel IncHI2 plasmid pKST313, which also carried a pair of class 1 integrons. All nine isolates formed a single clade within S. Typhimurium ST313, the major clone of an ongoing invasive NTS epidemic in the region. This emerging ceftriaxone-resistant clone may pose a major challenge in the management of invasive NTS in sub-Saharan Africa. PMID:25779570

  6. [Bacterial colonization of chronic wounds. Studies on outpatients in a university dermatology clinic with special consideration of ORSA].

    PubMed

    Dissemond, J; Schmid, E N; Esser, S; Witthoff, M; Goos, M

    2004-03-01

    In this retrospective investigation, we documented the bacterial colonization of 79 patients with chronic wounds, who had been treated between January 2002 and May 2003 in an outpatient wound healing clinic of a university dermatology program. We isolated 106 facultative pathogenic bacterial strains of which 56 were Staphylococcus aureus, 19 Pseudomonas aeruginosa, 11 Escherichia coli, 4 Proteus mirabilis, 4 Enterobacter cloacae, 2 Serratia marcescens, 2 Streptococcus group G und 8 further species. 68 of these bacterial strains were gram-positive and 46 gram-negative. Moreover we identified one patient with Candida parapsilosis. Therefore, 70.8% of all patients showed Staphylococcus aureus in their chronic wounds. Determination of the specific resistances showed 17 patients to be colonized with oxacillin- resistant Staphylococcus aureus (ORSA) strain; this corresponds to 21.5% of all patients. Consequently, 30.4% of all Staphylococcus aureus isolates were ORSA strains. All of the ORSA isolates were sensitive to vancomycin. Sensitivity to tetracycline was documented in 15, to amikacin in 13, to clindamycin in 7, to gentamicin and erythromycin in 6 of the ORSA-positive patients. In the case of trimethoprim/sulfamethoxazole, 10 were sensitive and 3 were intermediate in sensitivity. Beside the obligate resistance to oxacillin, penicillin G, ampicillin, cefuroxime and imipenem, none of the ORSA was sensitive to ofloxacin. The results of our investigations demonstrate the actual spectrum of bacterial colonization in chronic wounds of patients in an university dermatologic wound clinic and underline the growing problem of ORSA. PMID:15029435

  7. [Enterobacterial susceptibility to antibiotics in northern Lebanon (1998-2001)].

    PubMed

    Hamze, Monzer; Dabboussi, Fouad; Izard, Daniel

    2003-01-01

    The purpose of this study was to assess the epidemiology of local enterobacterial susceptibility to antibiotics. Between 1 January, 1998, and 31 December, 2001, we studied the sensitivity of 2,238 Enterobacteria to 26 different antibiotic agents in northern Lebanon, in the Microbiology department and Laboratory of the Islami Hospital, Tripoli, Lebanon. We used the diffusion disk method and complied with the guidelines of the French Microbiology Society antibiogram committee. Urinary samples were the most frequent source (67.5%), followed by blood cultures (12.7%). The dominant species in blood cultures was S. typhi (44.7%). We found 194 strains that produced extended-spectrum beta lactamases (ESBL), with the highest prevalence in Serratia spp. (44.3%), followed by Klebsiella pneumoniae (23.7%), Escherichia coli (20.7%) and Klebsiella oxytoca (11.3%). The global susceptibility of these strains to aminopenicillin was 15%; it reached 30% when combined with clavulanic acid. Susceptibility of the ESBL strains to these agents was 0%. The global susceptibility (and that of the ESBL strains, when greater than 0%) to other antibiotics was as follows: ticarcillin 38.5%, piperacillin 38.5%, piperacillin-tazobactam 88% (64%), imipenem 99.4%, (100%), cefalexin 41%, cefoxitin 65% (40.3%), cefuroxime 75%, amikacin 89%, chloramphenicol 30%, gentamicin 78% (42%), tetracycline 28% (16%), minocycline 30% (18.4%), colistin 67% (75%), nitrofuran 40% (45%), cotrimoxazol 40% (13%), nalidixic acid 53% (5.6%), pefloxacin 63% (23%), ciprofloxacin 71% (39%), and levofloxacin 72% (47%). PMID:14530123

  8. Antibiotic resistance profiles among mesophilic aerobic bacteria in Nigerian chicken litter and associated antibiotic resistance genes1.

    PubMed

    Olonitola, Olayeni Stephen; Fahrenfeld, Nicole; Pruden, Amy

    2015-05-01

    The effect of global antibiotic use practices in livestock on the emergence of antibiotic resistant pathogens is poorly understood. There is a paucity of data among African nations, which suffer from high rates of antibiotic resistant infections among the human population. Escherichia (29.5%), Staphylococcus (15.8%), and Proteus (15.79%) were the dominant bacterial genera isolated from chicken litter from four different farms in Zaria, Nigeria, all of which contain human pathogenic members. Escherichia isolates were uniformly susceptible to augmentin and cefuroxime, but resistant to sulfamethoxazole (54.5%), ampicillin (22.7%), ciprofloxacin (18.2%), cephalothin (13.6%) and gentamicin (13.6%). Staphylococcus isolates were susceptible to ciprofloxacin, gentamicin, and sulfamethoxazole, but resistant to tetracycline (86.7%), erythromycin (80%), clindamycin (60%), and penicillin (33.3%). Many of the isolates (65.4%) were resistant to multiple antibiotics, with a multiple antibiotic resistance index (MARI) ? 0.2. sul1, sul2, and vanA were the most commonly detected antibiotic resistance genes among the isolates. Chicken litter associated with antibiotic use and farming practices in Nigeria could be a public health concern given that the antibiotic resistant patterns among genera containing pathogens indicate the potential for antibiotic treatment failure. However, the MARI values were generally lower than reported for Escherichia coli from intensive poultry operations in industrial nations. PMID:25725076

  9. Electrophoretic properties of beta-lactam and serum protein conjugates.

    PubMed

    Zdziarski, P

    2000-01-01

    Beta-lactam antibiotics can easy bind to protein. Available information on the nature of the conjugates is rather poor. In this study, agarose electrophoresis was used to determine and comparison physicochemical properties of the complexes. Benzylpenicillin, ampicillin, cefoperazone, cefotaxime, ceftazidime, cefuroxime, ceftriaxone, imipenem and serum protein were used for free generation drug-protein conjugates. Agarose electrophoresis shows heterogeneous migration of the conjugates. Interestingly-binding of benzylpenicillin and ampicillin exerts an effect on electrophoretic migration of albumin and globulin, but others--only serum albumin. Binding of ampicillin shows down migration of all anionic fractions of plasma protein, benzylpenicillin--anionic and cationic. Otherwise--migration of albumin was accelerate by others. This finding can explain higher frequency of penicillins hypersensitivity than cephalosporins, carbapenems or monobaktams. The commercially available and cheap procedure allows to execute the screening of physicochemical properties, which exert an effect on electrophoretic mobility of protein i.e. electric charge and molecule length (Stockes's diameter). Therefore, the electrophoretic mobility modification probably reflects the transformation of molecular weight, charge and space structure serum proteins by binding of beta-lactam antibiotics. PMID:11243245

  10. Resistance phenotypes and genotypes among multiple-antimicrobial-resistant Salmonella enterica subspecies enterica serovar Choleraesuis strains isolated between 2008 and 2012 from slaughter pigs in Okinawa Prefecture, Japan.

    PubMed

    Matayoshi, Masanao; Kitano, Takashi; Sasaki, Tetsu; Nakamura, Masaji

    2015-06-01

    A total of 349 Salmonella enterica subspecies enterica serovar Choleraesuis (S. Choleraesuis) strains, which were isolated between 2008 and 2012 from 349 pigs at two slaughterhouses in Okinawa Prefecture, Japan, were investigated for antimicrobial susceptibility and the presence of antimicrobial resistance genes. All isolates were resistant to at least four antimicrobial agents. The antimicrobial agents for which isolates showed a high incidence of resistance were as follows: ampicillin (100%) and streptomycin (100%), followed by gentamicin (99.7%), oxytetracycline (99.7%), sulfamethoxazole/trimethoprim (99.4%), nalidixic acid (40.1%) and oxolinic acid (40.1%). All isolates were sensitive to cefuroxime, ceftiofur, colistin, fosfomycin, enrofloxacin, orbifloxacin and danofloxacin. The predominant resistance phenotypes and genotypes were: resistance to ampicillin, streptomycin, gentamicin, oxytetracycline and sulfamethoxazole/trimethoprim (58.5%, 204/349) and blaTEM-strA-strB-aadA1-aadA2-aacC2-tet (B)-sul1-sul2-dhfrXII-dhfrXIII (36.1%, 126/349). The quinolone resistance-determining regions (QRDRs) of gyrA, gyrB, parC and parE of the quinolone-resistant isolates (n=12) showed amino acid substitutions of Ser-83?Phe or Asp-87?Tyr in GyrA and Ser-107?Ala in ParC. To our knowledge, this is the first report on the molecular characterization of antimicrobial resistance among S. Choleraesuis strains in Japan. PMID:25715779

  11. Short-duration, single-agent antibiotic prophylaxis for meningitis in trans-sphenoidal surgery.

    PubMed

    Little, Andrew S; White, William L

    2011-12-01

    Perioperative bacterial meningitis after trans-sphenoidal surgery for pituitary and parasellar lesions is an uncommon but serious complication. Little evidence guides the choice of chemoprophylaxis in this setting. To begin to address this deficiency, we investigated the incidence of perioperative meningitis in 442 patients who underwent trans-sphenoidal surgery and received a short chemoprophylaxis regimen with a single agent and did not require lumbar drainage. In 2005 we instituted a standardized antibiotic prophylaxis protocol for trans-sphenoidal surgery that utilized intravenous cefuroxime, a second-generation cephalosporin with broad coverage and excellent spinal fluid penetration, administered 30 min before surgery and 8 h later. The primary endpoint was the incidence of perioperative (within 30 days of surgery) bacterial meningitis. Data from The Barrow Pituitary Outcomes Project, a prospectively maintained patient research database, were supplemented with review of medical records and hospital discharge codes. There were no cases of perioperative meningitis. Three patients developed delayed meningitis associated with persistent or recurrent spinal fluid leakage 2-8 months after surgery. Perioperatively, seven patients received additional antibiotics for urinary tract infections. A single-agent, short-duration chemoprophylaxis regimen for trans-sphenoidal surgery is effective at preventing perioperative meningitis in patients who do not require lumbar drainage after surgery. The results of this regimen compare favorably to historical rates achieved with longer regimens that use two antibiotics. Future studies will investigate the role prophylactic antibiotics play in nasal mucosa healing and sinusitis. PMID:21347665

  12. [Antibiotic resistance patterns of Escherichia coli strains isolated from urine cultures in Turkey: a meta-analysis].

    PubMed

    Aykan, Sadiye Berna; Ciftci, Ihsan Hakk?

    2013-10-01

    Escherichia coli is the most frequently isolated microorganism from both community-acquired and nosocomial urinary tract infections in Turkey. A large number of studies concerning antibiotic susceptibility of E.coli have been published from different centers throughout the country. The aim of this study was to evaluate the antibiotic resistance patterns of E.coli strains isolated from urine cultures by a meta-analysis in published medical literature between the years of 1996-2012 in Turkey. The study was planned and conducted in accordance with the declaration of PRISMA and describes the methods of literature search, the determining criteria for inclusion and evaluation of articles, data collection and statistical analysis. To find the published series Google Scholar and PubMed international databases were used to access published manuscripts evaluated according to the determined criteria for acceptance and rejection. For each study, general data and antibiotic resistance rates were collected as a common unit. Publications considered as lacking in appropriate content was eliminated from the study. Statistical analysis of the data obtained were 95% confidence intervals, and p? 0.05 value was considered as significant difference. A total of 228 articles were found to be published during 1996-2012 period, while 101 of them were included in the meta-analysis according to the eligibility criteria. The analyses indicated that nitrofurantoin and piperacillin resistance rates have been decreased, whereas ciprofloxacin, cefepime, co-trimoxazole and extended-spectrum beta-lactamase (ESBL) positivity rates have been increased during the study period. The increases in the rates of ciprofloxacin and cefepime resistance and and ESBL production were statistically-significant (p< 0.05). A significant reduction in resistance rates for ampicilin, amoxicillin-clavulanate, and amikacin was noted in pediatric patients between 2002-2012. Ceftriaxone, imipenem, gentamicin and amikacin resistance were not homogenous between the geographical regions, and statistically significant differences were observed for amoxicillin-clavulanate, cefuroxime and ciprofloxacin resistance rates (p< 0.05). Antibiotic resistance rates, except for imipenem, in bacterial strains, isolated from hospitalized patients were found significantly higher in strains obtained from outpatients. The differences between those groups were significant in terms of ampicilin, amoxicillin-clavulanate, cefuroxime, ceftriaxone, trimethoprim-sulfamethoxazole, gentamicin, ciprofloxacin, amikacin and cefepime resistances (p< 0.05). It has been noted that antibiotic resistance patterns of E.coli strains isolated from urine cultures between 1996-2012 demonstrated significant variability, and many studies were based only on laboratory data. The results of this meta-analysis demonstrated that the resistance rates in commonly-used antibiotics for empirical therapy were high. In conclusion, information obtained by systematic evaluation of national data will be valuable for the determination of optimal antibiotic regimens and in prevention of unnecessary antibiotic use. PMID:24237429

  13. Antimicrobial resistance of Campylobacter jejuni and Campylobacter coli from poultry in Italy.

    PubMed

    Giacomelli, Martina; Salata, Cristiano; Martini, Marco; Montesissa, Clara; Piccirillo, Alessandra

    2014-04-01

    This study was aimed at assessing the antimicrobial resistance (AMR) of Campylobacter isolates from broilers and turkeys reared in industrial farms in Northern Italy, given the public health concern represented by resistant campylobacters in food-producing animals and the paucity of data about this topic in our country. Thirty-six Campylobacter jejuni and 24 Campylobacter coli isolated from broilers and 68 C. jejuni and 32 C. coli from turkeys were tested by disk diffusion for their susceptibility to apramycin, gentamicin, streptomycin, cephalothin, cefotaxime, ceftiofur, cefuroxime, ampicillin, amoxicillin+clavulanic acid, nalidixic acid, flumequine, enrofloxacin, ciprofloxacin, erythromycin, tilmicosin, tylosin, tiamulin, clindamycin, tetracycline, sulfamethoxazole+trimethoprim, chloramphenicol. Depending on the drug, breakpoints provided by Comité de l'antibiogramme de la Société Française de Microbiologie, Clinical and Laboratory Standards Institute, and the manufacturer were followed. All broiler strains and 92% turkey strains were multidrug resistant. Very high resistance rates were detected for quinolones, tetracycline, and sulfamethoxazole+trimethoprim, ranging from 65% to 100% in broilers and from 74% to 96% in turkeys. Prevalence of resistance was observed also against ampicillin (97% in broilers, 88% in turkeys) and at least three cephalosporins (93-100% in broilers, 100% in turkeys). Conversely, no isolates showed resistance to chloramphenicol and tiamulin. Susceptibility prevailed for amoxicillin+clavulanic acid and aminoglycosides in both poultry species, and for macrolides and clindamycin among turkey strains and among C. jejuni from broilers, whereas most C. coli strains from broilers (87.5%) were resistant. Other differences between C. jejuni and C. coli were observed markedly in broiler isolates, with the overall predominance of resistance in C. coli compared to C. jejuni. This study provides updates and novel data on the AMR of broiler and turkey campylobacters in Italy, revealing the occurrence of high resistance to several antimicrobials, especially key drugs for the treatment of human campylobacteriosis, representing a potential risk for public health. PMID:24320689

  14. The erratic antibiotic susceptibility patterns of bacterial pathogens causing urinary tract infections

    PubMed Central

    Ahmed, Iftkhar; Sajed, Muhammad; Sultan, Aneesa; Murtaza, Iram; Yousaf, Sohail; Maqsood, Bushra; Vanhara, Petr; Anees, Mariam

    2015-01-01

    Increasing trend of antibiotic resistance and expression of Extended Spectrum Beta Lactamases (ESBLs) are serious threats for public health as they render the treatment ineffective. Present study was designed to elucidate the antibiotic-susceptibility patterns of ESBL and non-ESBL producing E. coli and K. pneumoniae causing urinary tract infections so that the ineffective antibiotics could be removed from the line of treatment. The bacterial isolates obtained from the urine of patients visiting a tertiary health care facility were cultured for strain identification using API20E. Antimicrobial susceptibility and ESBL detection were done by Kirby-bauer diffusion technique. Almost 53.4 % isolates of E. coli and 24.5 % isolates of K. pneumoniae were found to be ESBL producers. The ESBL producing bacteria were found to be more resistant towards various antibiotics. The most effective drugs against E. coli ESBL isolates were imipenem (99.54 %), ampicillin-sulbactam (97.48 %), piperacillin-tazobactam (96.86 %), fosfomycin (94.51 %), amikacin (92.26 %) and nitrofurantoin (90.68 %). The most effective drugs against K. pneumoniae ESBL isolates were imipenem (97.62 %), piperacillin-tazobactam (95.35 %), ampicillin-sulbactam (90.48 %) and amikacin (88.37 %). The antibiotics having the highest resistance, particularly by the ESBL producers were amoxicillin clavulanic acid, sulphamethoxalzole/ trimethoprim, cefuroxime, cefpirome, ceftriaxone and ciprofloxacin. Most of the isolates showed multi drug resistance (MDR). High frequency of ESBL producing E. coli and K. pneumoniae were observed as compared to previous data. Penicillins, cephalosporins and some representatives of fluoroquinolones were least effective against the common UTIs and are recommended to be removed from the line of treatment. PMID:26648826

  15. Nanohybrid based on antibiotic encapsulated layered double hydroxide as a drug delivery system.

    PubMed

    Khan, Sher Bahadar; Alamry, Khalid A; Alyahyawi, Nedaa A; Asiri, Abdullah M; Arshad, Muhammad Nadeem; Marwani, Hadi M

    2015-02-01

    Nanohybrid of cefuroxime (CFO) with layered double hydroxide (LDH) has been prepared, and the rate of dissolution and bioavailability of CFO using nanohybrid as a drug delivery system has been broadly studied. The intercalation process was confirmed by X-ray diffraction, Fourier transform infrared spectroscopy, and thermogravimetric analysis. The CFO contents were found to be 19.0 wt% in the nanohybrid. The release mechanism of CFO was investigated with respect to anion and pH of the dissolution media such as gastric, intestinal and blood simulated media. The effect of pH was evaluated on the release of CFO from nanohybrid, and the dissolution of CFO from the nanohybrid was found to be a slow process at pH 4.0, 6.8, and 7.4. Further the addition of Cl ion and PAM in release media did not affect the release rate of drug at pH 4.0 and 6.8, while at pH 7.4, Cl ion and PAM have significant role on the drug release. At pH 1.2, the release study shows that LDH dissolved in the acidic medium and CFO released in its molecular form. The release behavior suggests two mechanisms that are responsible for the release of CFO from nanohybrid: weathering (dependent on the pH) and ion exchange (highly dependent on the anions). Surface reactions mediated by solid weathering ruled the release in gastric fluid, whereas anion exchange determined CFO release in lysosomal, intestinal, and blood medium. In order to evaluate the drug release mechanism, the released data were fitted by mathematical models describing various kinetic. PMID:25399066

  16. Antimicrobial Resistance Pattern and Their Beta-Lactamase Encoding Genes among Pseudomonas aeruginosa Strains Isolated from Cancer Patients

    PubMed Central

    Zafer, Mai M.; Al-Agamy, Mohamed H.; El-Mahallawy, Hadir A.; Amin, Magdy A.; Ashour, Mohammed Seif El-Din

    2014-01-01

    This study was designed to investigate the prevalence of metallo-?-lactamases (MBL) and extended-spectrum ?-lactamases (ESBL) in P. aeruginosa isolates collected from two different hospitals in Cairo, Egypt. Antibiotic susceptibility testing and phenotypic screening for ESBLs and MBLs were performed on 122 P. aeruginosa isolates collected in the period from January 2011 to March 2012. MICs were determined. ESBLs and MBLs genes were sought by PCR. The resistant rate to imipenem was 39.34%. The resistance rates for P. aeruginosa to cefuroxime, cefoperazone, ceftazidime, aztreonam, and piperacillin/tazobactam were 87.7%, 80.3%, 60.6%, 45.1%, and 25.4%, respectively. Out of 122 P. aeruginosa, 27% and 7.4% were MBL and ESBL, respectively. The prevalence of blaVIM-2, blaOXA-10-, blaVEB-1, blaNDM-, and blaIMP-1-like genes were found in 58.3%, 41.7%, 10.4%, 4.2%, and 2.1%, respectively. GIM-, SPM-, SIM-, and OXA-2-like genes were not detected in this study. OXA-10-like gene was concomitant with VIM-2 and/or VEB. Twelve isolates harbored both OXA-10 and VIM-2; two isolates carried both OXA-10 and VEB. Only one strain contained OXA-10, VIM-2, and VEB. In conclusion, blaVIM-2- and blaOXA-10-like genes were the most prevalent genes in P. aeruginosa in Egypt. To our knowledge, this is the first report of blaVIM-2, blaIMP-1, blaNDM, and blaOXA-10 in P. aeruginosa in Egypt. PMID:24707471

  17. Antimicrobial susceptibilities of Escherichia coli isolates as agents of community-acquired urinary tract infection (2008–2014)

    PubMed Central

    Yılmaz, Nisel; Ağuş, Neval; Bayram, Arzu; Şamlıoğlu, Pınar; Şirin, M. Cem; Derici, Yeşer Karaca; Hancı, Sevgi Yılmaz

    2016-01-01

    Objective Urinary tract infections (UTIs) are among the most frequently seen community-acquired infections worldwide. E. coli causes 90% of urinary system infections. To guide the empirical therapy, the resistance pattern of E. coli responsible for community-acquired UTI was evaluated throughout a seven-year period in this study. Material and methods The urine cultures of patients with urinary tract infections admitted to outpatient clinics between 1st January 2008 and 31st December 2014 were analyzed. Presence of ≥105 colony-forming units/mL in urine culture media was considered as significant for UTI. Isolated bacteria were identified by standard laboratory techniques or automated system VITEK2 (BioMerieux, France) and BD PhoenixTM 100 (BD, USA), as required. Antibiotic susceptibility testing was performed by Kirby-Bauer disk diffusion method using Clinical Laboratory Standard Institute (CLSI) criteria. Results A total of 13281 uropathogens were isolated. Overall E. coli accounted for 8975 (67%) of all isolates. Resistance rates of E. coli to antimicrobial agents was demonstrated to be as follows: ampicillin 66.9%, cefazolin 30.9%, cefuroxime 30.9%, ceftazidime 14.9%, cefotaxime 28%, cefepime 12%, amoxicillin-clavulanic acid 36.9%, trimethoprim-sulfamethoxazole (TMP-SXT) 20%, ciprofloxacin 49.9%, amikacin 0.3%, gentamycin 24%, nitrofurantoin 0.9%, and fosfomycin 4.3%. There was no resistance to imipenem nor meropenem. The frequency of ESBL-producing E. coli strains was 24%. Conclusion It is concluded that fosfomycin and nitrofurantoin are appropriate empirical therapy for community-acquired UTI empirical therapy, but the fluoroquinolones and the TMP-SXT shall not be used in the emprical treatment of UTI at this stage. In conclusion, as resistance rates show regional differences, it is necessary to regularly examine regional resistance rates to determine the appropriate empiric antibiotic treatment and national antibiotic usage policies must be reorganized according to data obtained from these studies. PMID:27011879

  18. Solid-phase extraction in combination with dispersive liquid-liquid microextraction and ultra-high performance liquid chromatography-tandem mass spectrometry analysis: the ultra-trace determination of 10 antibiotics in water samples.

    PubMed

    Liang, Ning; Huang, Peiting; Hou, Xiaohong; Li, Zhen; Tao, Lei; Zhao, Longshan

    2016-02-01

    A novel method, solid-phase extraction combined with dispersive liquid-liquid microextraction (SPE-DLLME), was developed for ultra-preconcentration of 10 antibiotics in different environmental water samples prior to ultra-high performance liquid chromatography-tandem mass spectrometry detection. The optimized results were obtained as follows: after being adjusted to pH4.0, the water sample was firstly passed through PEP-2 column at 10mLmin(-1), and then methanol was used to elute the target analytes for the following steps. Dichloromethane was selected as extraction solvent, and methanol/acetonitrile (1:1, v/v) as dispersive solvent. Under optimal conditions, the calibration curves were linear in the range of 1-1000ngmL(-1) (sulfamethoxazole, cefuroxime axetil), 5-1000ngmL(-1) (tinidazole), 10-1000ngmL(-1) (chloramphenicol), 2-1000ngmL(-1) (levofloxacin oxytetracycline, doxycycline, tetracycline, and ciprofloxacin) and 1-400ngmL(-1) (sulfadiazine) with a good precision. The LOD and LOQ of the method were at very low levels, below 1.67 and 5.57ngmL(-1), respectively. The relative recoveries of the target analytes were in the range from 64.16% to 99.80% with relative standard deviations between 0.7 and 8.4%. The matrix effect of this method showed a great decrease compared with solid-phase extraction and a significant value of enrichment factor (EF) compared with dispersive liquid-liquid microextraction. The developed method was successfully applied to the extraction and analysis of antibiotics in different water samples with satisfactory results. PMID:26780712

  19. Diagnosis, treatment, and prevention of Lyme disease in children.

    PubMed

    Eppes, Stephen C

    2003-01-01

    The approaches to diagnosing and treating Lyme disease (LD) have been improved and refined as a result of basic and clinical research, and considerable practical experience. In addition, there have been recent studies that have allowed improvements in the ability to prevent infection with Borrelia burgdorferi. This paper will review the relevant literature and address recent developments in the diagnosis, treatment, and prevention of LD. Issues specifically related to the management of children will be identified. Controversies regarding treatment approaches will be examined in some detail. Understanding the clinical manifestations, or stage, of LD is crucial when approaching both diagnosis and treatment. Early localized disease is best diagnosed by recognizing the characteristic skin lesion, erythema migrans. Early disease will frequently, but not always, be accompanied by a detectable antibody response, particularly IgM antibody to the spirochete. Late disease, chiefly arthritis, is generally associated with high levels of IgG antibody. Western blot technology allows confirmation of enzyme immunoassay results and is especially useful when the latter is in the low or equivocal range. Early localized disease responds well to oral antibacterial therapy. Early disseminated disease, often associated with neurologic findings, may require parenteral therapy. The arthritis associated with LD frequently responds to oral antibacterials, but some refractory cases may require intravenous therapy, and occasionally surgery. Doxycycline is the oral antibacterial of choice, while amoxicillin and cefuroxime axetil are alternatives that may be preferred in young children. Owing to its long half-life and once daily dose administration, intravenous ceftriaxone has become the accepted standard for parenteral therapy. Tick avoidance has long been the mainstay for preventing LD. Antibacterial prophylaxis, using doxycycline, for tick bites has been shown to be an effective approach to prevention, but its relevance to pediatrics is uncertain. Vaccines designed to prevent infection have also been developed. PMID:12765486

  20. Prevalence of Asymptomatic Bacteriuria and its Antibacterial Susceptibility Pattern Among Pregnant Women Attending the Antenatal Clinic at Kanpur, India

    PubMed Central

    Nawani, Manju

    2014-01-01

    Background: Symptomatic and asymptomatic bacteriuria (ASB) is common in pregnant women. Pregnancy enhances the progression from ASB to symptomatic bacteriuria, which if left untreated, could lead to acute pyelonephritis and other adverse outcomes such as prematurity, postpartum, hypertensive disease, anaemia, UTIs and higher foetal mortality rates. Aim: To identify the prevalence of ASB, the most common causative microorganisms and the antibacterial susceptibilities of the isolated microorganisms at a tertiary care centre at Kanpur, India. Materials and Methods: A total number of 300 asymptomatic pregnant women were screened for ASB by urine culture by using a semi quantitative culture method. Results: In this study, significant bacteriuria was found in only 22 cases (7.3%). Growth of contaminants was seen in 40 cases (13.3%). Among cases which showed positive cultures, 48.9% were primigravidae and 51.1% were multigravidae. Highest incidence was reported in age group of 21-30 years. The predominant organisms which were isolated were Escherichia coli, followed by Klebsiella pneumoniae, Enterococcus faecalis, Staphylococcus aureus and Proteus mirabilis. Escherichia coli, the most common isolate, was found to be only 61% and 70% sensitive to ampicillin and amoxicillin + clavulanate, respectively. Sensitivity to ceftriaxone and ciprofloxacin was 95%, and sensitivity to amikacin was 99%. Hundred percent sensitivity was found for the broad spectrum pencillins, imipenem, and meropenem. Klebsiella pneumoniae, the second most frequent organism which was grown on culture, was only 11% sensitive to ampicillin, while sensitivity to amoxicillin + clavulanate and cefuroxime was 86%. 100% sensitivity was found for cefepime, ceftriaxone, ciprofloxacin, imipenem and meropenem. Conclusion: Routine urine culture test should be carried out for all antenatal women, to detect asymptomatic bacteriuria, and every positive case should be treated with appropriate antibiotic therapy, to prevent any obstetric complication which is associated with pregnancy. PMID:24959438

  1. Antibiotic resistance and molecular typing among cockle (Anadara granosa) strains of Vibrio parahaemolyticus by polymerase chain reaction (PCR)-based analysis.

    PubMed

    Sahilah, A M; Laila, R A S; Sallehuddin, H Mohd; Osman, H; Aminah, A; Ahmad Azuhairi, A

    2014-02-01

    Genomic DNA of Vibrio parahaemolyticus were characterized by antibiotic resistance, enterobacterial repetitive intergenic consensus-polymerase chain reaction (ERIC-PCR) and random amplified polymorphic DNA-polymerase chain reaction (RAPD-PCR) analysis. These isolates originated from 3 distantly locations of Selangor, Negeri Sembilan and Melaka (East coastal areas), Malaysia. A total of 44 (n = 44) of tentatively V. parahaemolyticus were also examined for the presence of toxR, tdh and trh gene. Of 44 isolates, 37 were positive towards toxR gene; while, none were positive to tdh and trh gene. Antibiotic resistance analysis showed the V. parahaemolyticus isolates were highly resistant to bacitracin (92%, 34/37) and penicillin (89%, 33/37) followed by resistance towards ampicillin (68%, 25/37), cefuroxime (38%, 14/37), amikacin (6%, 2/37) and ceftazidime (14%, 5/37). None of the V. parahaemolyticus isolates were resistant towards chloramphenicol, ciprofloxacin, ceftriaxone, enrofloxacin, norfloxacin, streptomycin and vancomycin. Antibiogram patterns exhibited, 9 patterns and phenotypically less heterogenous when compared to PCR-based techniques using ERIC- and RAPD-PCR. The results of the ERIC- and RAPD-PCR were analyzed using GelCompare software. ERIC-PCR with primers ERIC1R and ERIC2 discriminated the V. parahaemolyticus isolates into 6 clusters and 21 single isolates at a similarity level of 80%. While, RAPD-PCR with primer Gen8 discriminated the V. parahaemolyticus isolates into 11 clusters and 10 single isolates and Gen9 into 8 clusters and 16 single isolates at the same similarity level examined. Results in the presence study demonstrated combination of phenotypically and genotypically methods show a wide heterogeneity among cockle isolates of V. parahaemolyticus. PMID:24068534

  2. The erratic antibiotic susceptibility patterns of bacterial pathogens causing urinary tract infections.

    PubMed

    Ahmed, Iftkhar; Sajed, Muhammad; Sultan, Aneesa; Murtaza, Iram; Yousaf, Sohail; Maqsood, Bushra; Vanhara, Petr; Anees, Mariam

    2015-01-01

    Increasing trend of antibiotic resistance and expression of Extended Spectrum Beta Lactamases (ESBLs) are serious threats for public health as they render the treatment ineffective. Present study was designed to elucidate the antibiotic-susceptibility patterns of ESBL and non-ESBL producing E. coli and K. pneumoniae causing urinary tract infections so that the ineffective antibiotics could be removed from the line of treatment. The bacterial isolates obtained from the urine of patients visiting a tertiary health care facility were cultured for strain identification using API20E. Antimicrobial susceptibility and ESBL detection were done by Kirby-bauer diffusion technique. Almost 53.4 % isolates of E. coli and 24.5 % isolates of K. pneumoniae were found to be ESBL producers. The ESBL producing bacteria were found to be more resistant towards various antibiotics. The most effective drugs against E. coli ESBL isolates were imipenem (99.54 %), ampicillin-sulbactam (97.48 %), piperacillin-tazobactam (96.86 %), fosfomycin (94.51 %), amikacin (92.26 %) and nitrofurantoin (90.68 %). The most effective drugs against K. pneumoniae ESBL isolates were imipenem (97.62 %), piperacillin-tazobactam (95.35 %), ampicillin-sulbactam (90.48 %) and amikacin (88.37 %). The antibiotics having the highest resistance, particularly by the ESBL producers were amoxicillin clavulanic acid, sulphamethoxalzole/ trimethoprim, cefuroxime, cefpirome, ceftriaxone and ciprofloxacin. Most of the isolates showed multi drug resistance (MDR). High frequency of ESBL producing E. coli and K. pneumoniae were observed as compared to previous data. Penicillins, cephalosporins and some representatives of fluoroquinolones were least effective against the common UTIs and are recommended to be removed from the line of treatment. PMID:26648826

  3. Correlation of Culture Positivity, PCR Positivity, and Burden of Borrelia burgdorferi Sensu Lato in Skin Samples of Erythema Migrans Patients with Clinical Findings

    PubMed Central

    Stupica, Daa; Lusa, Lara; Maraspin, Vera; Bogovi?, Petra; Vidmar, Darja; ORourke, Maria; Traweger, Andreas; Livey, Ian; Strle, Franc

    2015-01-01

    Background Limited data are available regarding the relationship of Borrelia burden in skin of patients with erythema migrans (EM) and the disease course and post-treatment outcome. Methods We studied 121 adult patients with EM in whom skin biopsy specimens were cultured and analyzed by quantitative PCR for the presence of Borreliae. Evaluation of clinical and microbiological findings were conducted at the baseline visit, and 14 days, 2, 6, and 12 months after treatment with either amoxicillin or cefuroxime axetil. Results In 94/121 (77.7%) patients Borrelia was detected in skin samples by PCR testing and 65/118 (55.1%) patients had positive skin culture result (96.8% B. afzelii, 3.2% B. garinii). Borrelia culture and PCR results correlated significantly with the presence of central clearing and EM size, while Borrelia burden correlated significantly with central clearing, EM size, and presence of newly developed or worsened symptoms since EM onset, with no other known medical explanation (new or increased symptoms, NOIS). In addition, the logistic regression model for repeated measurements adjusted for time from inclusion, indicated higher Borrelia burden was a risk factor for incomplete response (defined as NOIS and/or persistence of EM beyond 14 days and/or occurrence of new objective signs of Lyme borreliosis). The estimated association between PCR positivity and unfavorable outcome was large but not statistically significant, while no corresponding relationship was observed for culture positivity. Conclusions Higher Borrelia burden in EM skin samples was associated with more frequent central clearing and larger EM lesions at presentation, and with a higher chance of incomplete response. PMID:26352832

  4. Representative input load of antibiotics to WWTPs: Predictive accuracy and determination of a required sampling quantity.

    PubMed

    Marx, Conrad; Mhlbauer, Viktoria; Schubert, Sara; Oertel, Reinhard; Ahnert, Markus; Krebs, Peter; Kuehn, Volker

    2015-06-01

    Predicting the input loads of antibiotics to wastewater treatment plants (WWTP) using certain input data (e.g. prescriptions) is a reasonable method if no analytical data is available. Besides the spatiotemporal uncertainties of the projection itself, only a few studies exist to confirm the suitability of required excretion data from literature. Prescription data with a comparatively high resolution and a sampling campaign covering 15 months were used to answer the question of applicability of the prediction approach. As a result, macrolides, sulfamethoxazole and trimethoprim were almost fully recovered close to 100% of the expected input loads. Nearly all substances of the beta-lactam family exhibit high elimination rates during the wastewater transport in the sewer system with a low recovery rate at the WWTP. The measured input loads of cefuroxime, ciprofloxacin and levofloxacin fluctuated greatly through the year which was not obvious from relatively constant prescribed amounts. The latter substances are an example that available data are not per se sufficient to monitor the actual release into the environment. Furthermore, the extensive data pool of this study was used to calculate the necessary number of samples to determine a representative annual mean load to the WWTP. For antibiotics with low seasonality and low input scattering a minimum of about 10 samples is required. In the case of antibiotics exhibiting fluctuating input loads 30 to 40 evenly distributed samples are necessary for a representative input determination. As a high level estimate, a minimum number of 20-40 samples per year is proposed to reasonably estimate a representative annual input load of antibiotics and other micropollutants. PMID:25776917

  5. Beta- lactam antibiotics stimulate biofilm formation in non-typeable haemophilus influenzae by up-regulating carbohydrate metabolism.

    PubMed

    Wu, Siva; Li, Xiaojin; Gunawardana, Manjula; Maguire, Kathleen; Guerrero-Given, Debbie; Schaudinn, Christoph; Wang, Charles; Baum, Marc M; Webster, Paul

    2014-01-01

    Non-typeable Haemophilus influenzae (NTHi) is a common acute otitis media pathogen, with an incidence that is increased by previous antibiotic treatment. NTHi is also an emerging causative agent of other chronic infections in humans, some linked to morbidity, and all of which impose substantial treatment costs. In this study we explore the possibility that antibiotic exposure may stimulate biofilm formation by NTHi bacteria. We discovered that sub-inhibitory concentrations of beta-lactam antibiotic (i.e., amounts that partially inhibit bacterial growth) stimulated the biofilm-forming ability of NTHi strains, an effect that was strain and antibiotic dependent. When exposed to sub-inhibitory concentrations of beta-lactam antibiotics NTHi strains produced tightly packed biofilms with decreased numbers of culturable bacteria but increased biomass. The ratio of protein per unit weight of biofilm decreased as a result of antibiotic exposure. Antibiotic-stimulated biofilms had altered ultrastructure, and genes involved in glycogen production and transporter function were up regulated in response to antibiotic exposure. Down-regulated genes were linked to multiple metabolic processes but not those involved in stress response. Antibiotic-stimulated biofilm bacteria were more resistant to a lethal dose (10 g/mL) of cefuroxime. Our results suggest that beta-lactam antibiotic exposure may act as a signaling molecule that promotes transformation into the biofilm phenotype. Loss of viable bacteria, increase in biofilm biomass and decreased protein production coupled with a concomitant up-regulation of genes involved with glycogen production might result in a biofilm of sessile, metabolically inactive bacteria sustained by stored glycogen. These biofilms may protect surviving bacteria from subsequent antibiotic challenges, and act as a reservoir of viable bacteria once antibiotic exposure has ended. PMID:25007395

  6. Characteristics of urinary tract infection pathogens and their in vitro susceptibility to antimicrobial agents in China: data from a multicenter study

    PubMed Central

    Qiao, Lu-Dong; Chen, Shan; Yang, Yong; Zhang, Kai; Zheng, Bo; Guo, Hong-Feng; Yang, Bo; Niu, Yuan-Jie; Wang, Yi; Shi, Ben-Kang; Yang, Wei-Min; Zhao, Xiao-Kun; Gao, Xiao-Feng; Chen, Ming; Tian, Ye

    2013-01-01

    Objective This study assessed the characteristics of pathogens identified in clinical isolates from patients with urinary tract infection (UTI) and their in vitro sensitivity to commonly used antibiotics in the clinical setting in China. Design and setting Multicenter study was conducted between January and December 2011 in 12 hospitals in China. Participants Urine samples were collected from 356 symptomatic patients treated in the study hospitals for acute uncomplicated cystitis, recurrent UTI or complicated UTI. Primary and secondary outcome measures Minimal inhibitory concentrations (MICs) were measured using broth microdilution according to the Clinical and Laboratory Standards Institute 2011 guidelines. Thirteen antimicrobial agents were tested: fosfomycin tromethamine, levofloxacin, moxifloxacin, cefdinir, cefixime, cefaclor, cefprozil, cefuroxime, amoxicillin/clavulanic acid, cefotaxime, azithromycin, nitrofurantoin and oxacillin. Escherichia coli isolates were screened and extended spectrum β-lactamases (ESBL) production was confirmed by a double-disk synergy test. Results 198 urine samples were culture-positive and 175 isolates were included in the final analysis. E coli was detected in 50% of cultures, followed by Staphylococcus epidermidis (9%), Enterococcus faecalis (9%) and Klebsiella pneumoniae (5%). The detection rate of ESBL-producing E coli was 53%. Resistance to levofloxacin was the most common among all the isolates. Nitrofurantoin and fosfomycin tromethamine had the greatest activity against E coli; overall, 92% and 91% of isolates were susceptible to these antimicrobials. E faecalis had the highest susceptibility rates to fosfomycin tromethamine (100%). Conclusions The most frequently identified pathogens in our patients were ESBL-producing E coli and E faecalis. Fosfomycin tromethamine and nitrofurantoin showed a good antimicrobial activity against UTI pathogens. They may represent good options for the empiric treatment of patients with UTI. PMID:24334199

  7. Are all beta-lactams similarly effective in the treatment of methicillin-sensitive Staphylococcus aureus bacteraemia?

    PubMed

    Paul, M; Zemer-Wassercug, N; Talker, O; Lishtzinsky, Y; Lev, B; Samra, Z; Leibovici, L; Bishara, J

    2011-10-01

    Methicillin-sensitive Staphylococcus aureus (MSSA) is susceptible to many beta-lactams. We compared cloxacillin and cefazolin, the first-line recommended antibiotics, and other beta-lactams in the treatment of MSSA bacteraemia. This was a retrospective cohort study. Included were adult patients with clinically-significant MSSA bacteraemia treated with a beta-lactam that was started within 48 h after blood cultures were taken. We separated between empirical treatment administered to the patient before receipt of final blood culture results and definitive treatment administered thereafter. Univariate and multivariable analyses for 30-day (empirical treatment) and 90-day (definitive treatment) mortality were conducted, including the type of beta-lactam administered to the patient. Five-hundred and forty-one patients were included for the analysis of empirical treatment and 498 patients alive at 7 days were evaluable for definitive treatment. Empirical treatment with cloxacillin or cefazolin (n = 131) was associated with lower 30-day mortality as compared with cefuroxime (n = 98, p 0.058), ceftriaxone or cefotaxime (n = 194, p 0.008) and beta-lactam-beta-lactamase combinations (n = 61, p 0.013), with adjusted odds ratios (OR) for death ranging from 1.98 to 2.68. Definitive treatment with cefazolin (n = 72) was not significantly different from cloxacillin (n = 281); adjusted OR for 90-day mortality 0.91 (95% confidence interval 0.47-1.77). Treatment with cefazolin both in the empirical and definitive periods was not significantly different from cloxacillin; adjusted OR 0.81 (95% confidence interval 0.18-3.62). Treatment of MSSA bacteraemia with cefazolin is not significantly different from treatment with cloxacillin, while treatment with other beta-lactams, including second and third generation cephalosporins, might be associated with higher mortality. PMID:21073629

  8. A mutation of the RNA polymerase β' subunit (rpoC) confers cephalosporin resistance in Bacillus subtilis.

    PubMed

    Lee, Yong Heon; Nam, Ki Hyun; Helmann, John D

    2013-01-01

    In bacteria, mutations affecting the major catalytic subunits of RNA polymerase (encoded by rpoB and rpoC) emerge in response to a variety of selective pressures. Here we isolated a Bacillus subtilis strain with high-level resistance to cefuroxime (CEF). Whole-genome resequencing revealed only one missense mutation affecting an invariant residue in close proximity to the C-terminal DNA-binding domain of RpoC (G1122D). Genetic reconstruction experiments demonstrate that this substitution is sufficient to confer CEF resistance. The G1122D mutation leads to elevated expression of stress-responsive regulons, including those of extracytoplasmic function (ECF) σ factors (σ(M), σ(W), and σ(X)) and the general stress σ factor (σ(B)). The increased CEF resistance of the rpoC(G1122D) strain is lost in the sigM rpoC(G1122D) double mutant, consistent with a major role for σ(M) in CEF resistance. However, a sigM mutant is very sensitive to CEF, and this sensitivity is still reduced by the G1122D mutation, suggesting that other regulatory effects are also important. Indeed, the ability of the G1122D mutation to increase CEF resistance is further reduced in a triple mutant strain lacking three ECF σ factors (σ(M), σ(W), and σ(X)), which are known from prior studies to control overlapping sets of genes. Collectively, our findings highlight the ability of mutations in RNA polymerase to confer antibiotic resistance by affecting the activity of alternative σ factors that control cell envelope stress-responsive regulons. PMID:23070162

  9. PubMed Central

    RABIRAD, N.; MOHAMMADPOOR, M.; RASTEGAR LARI, A.; SHOJAIE, A.; ALEBOUYEH, M.

    2014-01-01

    Summary Introduction. The choice of antimicrobial treatment for septicemia is often empirical and based on the knowledge of local antimicrobial activity patterns of the most common bacteria causing such bloodstream infections. The current study aimed to study the prevalence of bacterial pathogens causing septicemia and their antimicrobial resistant profiles in hospital admitted patients. Methods. This cross sectional study done at Children's Medical Center, Tehran, Iran. We examined 168 bacterial strains isolated from 186 clinically diagnosed septicemia cases refereed at Children's Medical Center, Tehran, Iran Over a period of twelve months from July 2010 to 2011 July. 11446 blood samples from patients of clinically suggestive septicemia were evaluated. Results. Bacterial strains were isolated from 910 (7.95%) of blood cultures. Gram-negative bacteria identified were Pseudomonas species (20.5%), Pseudomonas aeruginosa (1.86%), Salmonella spp (1.09%), Acinetobacter naumannii (8.13%), Escherichia coli (4.06%), Klebsiella spp (5.16%). Gram-negative pathogens were more than gram positive in bloodstream infections. Antimicrobial susceptibility testing was done according to Clinical and Laboratory Standards Institute (CLSI, USA) guidelines against: amikacin ampicillin, amoxicillin, amoxiclav, cefuroxime, cefotaxime, ceftazidime, cefoperazone tetracycline, chloramphenicol, ciprofloxacin, gentamicin. Resistanc to different antibiotics in the most important isolated bacteria were: 32.1 %, 10.8%, 87.8%, 96%, 39.1%, 35.2, 49.4%, 69%, 80.02%, 22%, 59%, 30.1% respectively, for Pseudomonas spp, 32%, 3.7%, 84.2 %, 83.2%, 80.1%, 75.4%, 44.8%, 45.2%, 33.3%, 19%, 34.1, 11.5% respectively for Acinetobacter species. Discussion. Resistant to majority of the antimicrobial agents for several pathogens implicated in bloodstream infections, particularly in Gram-negative bacteria, can make complication in treatment of infection cause by them. PMID:25916028

  10. Prevalence of Class 1 Integrons and Extended Spectrum Beta Lactamases among Multi-Drug Resistant Escherichia coli Isolates from North of Iran

    PubMed Central

    Mehdipour Moghaddam, Mohammad Javad; Mirbagheri, Adeleh Alsadat; Salehi, Zivar; Habibzade, Seyyed Mahmood

    2015-01-01

    Background: Extended spectrum beta lactamases (ESBLs) are an important cause of transferable multidrug resistance (MDR) in gram-negative bacteria. The most described ESBL genes are generally found within integron-like structures as mobile genetic elements. The aim of this study was to identify the accompanying of class 1 integrons and ESBLs in the MDR E. coli isolates. Methods: Susceptibility to antimicrobial agents was determined for 33 E. coli strains by the disk diffusion method. Double-disk synergy test was applied for screening ESBL. To identify the strains carrying integrons, the conserved regions of integron-encoded integrase gene intI1 were amplified. For detection of gene cassettes, 5?CS and 3?CS primers were used. Results: All E. coli isolates were identified as multi-drug resistant. More than 50% of the isolates were resistant to tetracycline, cephalothin, cefuroxime, amoxicillin-clavulanic acid, and third generation cephalosporines. Nearly all of the isolates displayed sensitivity to piperacillin. There was a significant correlation between production of ESBL and resistance to all antibiotics except for ciprofloxacin and piperacillin (P < 0.01). Thirty two MDR strains (97%) included class 1 integron, and some isolates that included integrons were similar in the size of gene cassettes. The isolates were different in the resistance profiles; however, some others had similar resistance profiles. Of eight ESBL positive isolates, seven (87.5%) carried class 1 integrons. Conclusion: Class 1 integrons were frequent in MDR and also ESBL-producing E. coli isolates. High prevalence of class 1 integrons confirms that integron-mediated antimicrobial gene cassettes are important in E. coli resistance profile. PMID:26220727

  11. A review of prophylactic antibiotics use in plastic surgery in China and a systematic review.

    PubMed

    Li, Ge-hong; Hou, Dian-ju; Fu, Hua-dong; Guo, Jing-ying; Guo, Xiao-bo; Gong, Hui

    2014-12-01

    The purpose of this study was to investigate the use of antibiotic prophylaxis for plastic surgical procedures at our hospital, and to perform a systematic literature review of randomized controlled trials evaluating the use of prophylactic antibiotics in plastic surgery. The records of patients who received plastic surgical procedures with Class I surgical incisions between 2009 and 2010 were retrospectively reviewed. A systematic literature review was conducted for studies examining the use of prophylactic antibiotics for Class I surgical wounds. A total of 13,997 cases with Class I surgical incisions were included. Prophylactic antibiotics were given in 13,865 cases (99.1%). The antibiotics used were primarily cefuroxime, clindamycin, metronidazole, cefoxitin sodium, and gentamicin. The average duration of administration was 4.84 ± 3.07 (range, 1-51) days. Antibiotics were administered postoperatively in >99% of cases while preoperative antibiotic administration was only given in 32 cases (0.23%). Wound infections occurred in 21 cases for an overall infection rate of 0.15%. Fourteen studies met the inclusion criteria of the systematic review. There was marked variation in the timing of antibiotic administration with antibiotics given pre-, peri-, and postoperatively. Of studies that compared the use of prophylactic antibiotics with placebo, a reduction in wound infections was noted in 4 trials and no difference was noted in 6 trials. No significant difference in infection rates was shown between the prophylactic and postoperative arms. In conclusion, prophylactic antibiotics are overused in plastic surgical procedures. Evidence-based guidelines for the use of prophylactic antibiotics in plastic surgical procedures are needed. PMID:25448649

  12. [Determination of 9 cephalosporin drug residues in beef by ultra performance liquid chromatography-tandem mass spectrometry].

    PubMed

    Bai, Guotao; Chu, Xiaogang; Pan, Guoqing; Li, Xiuqin; Yong, Wei

    2009-07-01

    A confirmative method to determine 9 cephalosporin residues in beef by ultra performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) was developed. The sample was homogenized and extracted with acetonitrile and water for 1 min at 14,000 r/min, centrifuged at 10,000 r/min and 4 degrees C for 10 min. A total of 2 mL saturated sodium chloride solution was added to avoid foaming during the acetonitrile evaporation, the acetonitrile was evaporated below 37 degrees C using a rotary evaporator, and then cleaned up on an Oasis HLB (500 mg, 6 mL) SPE column by washing with 5 mL water and eluting with acetonitrile-water (7:3, v/v). The eluate was blown to dryness under a stream of nitrogen and adjusted to 3.0 mL with water. The separation was carried out on an ACQUITY UPLC BEH C18 column within 5 min, analyzed by UPLC-MS/MS system with external standard method. The limits of quantification (LOQs) of cefuroxime, ceftiofur and cefalonium were 10, 0.5 and 0.5 microg/kg, respectively; the LOQs of other cephalosporins were 1.0 microg/kg. The recoveries of cephalosporins ranged from 74.2% to 119% and the relative standard deviations (RSDs) ranged from 2.9% to 15% for the spiked beef sample. The method is quick, easy, very sensitive and suitable for the determination of cephalosporin residues in beef. PMID:19938495

  13. Body mass and weight thresholds for increased prosthetic joint infection rates after primary total joint arthroplasty.

    PubMed

    Lübbeke, Anne; Zingg, Matthieu; Vu, Diemlan; Miozzari, Hermes H; Christofilopoulos, Panayiotis; Uçkay, Ilker; Harbarth, Stephan; Hoffmeyer, Pierre

    2016-04-01

    Background and purpose - Obesity increases the risk of deep infection after total joint arthroplasty (TJA). Our objective was to determine whether there may be body mass index (BMI) and weight thresholds indicating a higher prosthetic joint infection rate. Patients and methods - We included all 9,061 primary hip and knee arthroplasties (mean age 70 years, 61% women) performed between March 1996 and December 2013 where the patient had received intravenous cefuroxime (1.5 g) perioperatively. The main exposures of interest were BMI (5 categories: < 24.9, 25-29.9, 30-34.9, 35-39.9, and ≥ 40) and weight (5 categories: < 60, 60-79, 80-99, 100-119, and ≥ 120 kg). Numbers of TJAs according to BMI categories (lowest to highest) were as follows: 2,956, 3,350, 1,908, 633, and 214, respectively. The main outcome was prosthetic joint infection. The mean follow-up time was 6.5 years (0.5-18 years). Results - 111 prosthetic joint infections were observed: 68 postoperative, 16 hematogenous, and 27 of undetermined cause. Incidence rates were similar in the first 3 BMI categories (< 35), but they were twice as high with BMI 35-39.9 (adjusted HR = 2.1, 95% CI: 1.1-4.3) and 4 times higher with BMI ≥ 40 (adjusted HR = 4.2, 95% CI: 1.8-9.7). Weight ≥ 100 kg was identified as threshold for a significant increase in infection from the early postoperative period onward (adjusted HR = 2.1, 95% CI: 1.3-3.6). Interpretation - BMI ≥ 35 or weight ≥ 100 kg may serve as a cutoff for higher perioperative dosage of antibiotics. PMID:26731633

  14. Profiles of acute bacterial meningitis isolates in children in National Hospital, Abuja

    PubMed Central

    Iregbu, Kenneth C.; Abdullahi, N.

    2015-01-01

    Background: Acute bacterial meningitis (ABM) is an important cause of morbidity and mortality throughout the world. It is an acute medical emergency that requires urgent rational antibiotic therapy, especially in neonates and young infants. Determining the pattern and susceptibility of isolates of ABM among children for prompt treatment of this important cause of mortality and morbidity is very important. This study determined the types and the antimicrobial susceptibility pattern of ABM isolates among children at the National Hospital, Abuja. Materials and Methods: This is a retrospective study carried out at the National Hospital Abuja (NHA), Nigeria. Laboratory data for a period of 3 years, January 2010-December 2013 were reviewed, and all bacterial isolates and their antibiotics sensitivity testing results for children aged 0-15 years, and other relevant information extracted and analyzed. Study center was the NHA. Results: Twenty-eight bacterial pathogens were isolated from a total of 542 cerebrospinal specimens over the study period, giving a yield of 5.2%. The four most common pathogens isolated were Staphylococcus aureus (32.2%), Klebsiella pneumoniae (21.5%), Streptococcus pneumoniae (17.6%), and Escherichia coli (14.3%). Whereas, 28.6% of all the infections occurred in neonates alone, children 2 years and below had 85.7% of all the infections, with male preponderance. Isolates of S. aureus and S. pneumonia tested were both 100% susceptible to amoxicillin-clavulanic acid and Cefuroxime; S. pneumoniae was equally sensitive to Ceftriaxone. K. pneumoniae was 100% sensitive to Imipenem, but 83% to ceftriaxone. 75% of the isolated E. coli strains were sensitive to ceftriaxone, amoxicillin-clavulanic acid, and amikacin, 100% sensitive to imipenem. Conclusion: Meningitis in children as seen in the National hospital is almost equally caused by both Gram-positive and Gram-negative organisms, predominantly by S. aureus, S. pneumoniae, K. pneumoniae, and E. coli. Available drugs remain active against these organisms. PMID:26759518

  15. A rare case of acetabulum osteomyelitis mimicking bone sarcoma.

    PubMed

    Anagnostakos, Konstantinos; Schmitt, Eduard; Orth, Patrick

    2014-08-01

    A 57-year-old man presented to the authors' department with pain over the right hip joint over a 3-month period. External magnetic resonance imaging showed a structure in the right acetabulum that was highly suspicious for a bone sarcoma. External 3-phase bone scintigraphy substantiated the suspected diagnosis. A computer tomography-guided biopsy was performed. Microbiologic examination showed a Staphylococcus aureus strain. Histopathologic findings showed chronic fibrous osteomyelitis. Because of doubts about these findings made by radiologists, open biopsy with retrieval of bony samples from the acetabulum and hip joint puncture was repeated. At that time, the serum C-reactive protein level was 48.8 mg/dL and the white blood cell count was 5600 10?/L. Microbiologic examination showed a S aureus and a Staphylococcus epidermidis strain in both regions. Results of blood cultures were negative. Based on these findings, the decision was made to perform a septic femoral head and neck resection. After meticulous debridement, necrosectomy, and pulsatile lavage, a gentamicin and vancomycin-impregnated cement spacer was implanted. Postoperatively, systemic antibiotic treatment with cefuroxime and rifampicin was administered for 4 weeks, followed by 2 weeks of oral antibiotics. Mobilization was allowed under toe-touch bearing of the operated extremity. The further postoperative course was uneventful. Prosthesis implantation was performed after 3 months. White blood cell count and C-reactive protein values were normal at the time of surgery. Histologic and microbiologic examination of tissue samples taken intraoperatively showed no evidence of persistent infection. At follow-up after 1 year, the patient had no complaints and has no local or systemic signs of infection. PMID:25199160

  16. Antibiogram of Stenotrophomonas maltophilia Isolated From Nkonkobe Municipality, Eastern Cape Province, South Africa

    PubMed Central

    Adegoke, Anthony Ayodeji; Okoh, Anthony I.

    2014-01-01

    Background: Assessment of resistance genes is imperative, as they become disseminated to bacterial flora in plants and to the indigenous bacterial community, and thus ultimately contributes to the clinical problems of antibiotic resistant pathogens. Objectives: The research was to assess the antibiotic characteristics and incidence of sul3 genes of Stenotrophomonas maltophilia isolates recovered from rhizospheres plant in Nkonkobe Municipality. Materials and Methods: Identification and assessment of resistance genes (sul2 and sul3 genes) were carried out using polymerase chain reaction (PCR). Analytical profile index (API) was used for biochemical characterization for identification before the PCR. Antibiotic susceptibility test was carried out using the approved guidelines and standards of Clinical Laboratory Standard Institute (CLSI). Results: A total of 125 isolates were identified, composed of 120 (96%) from grass root rhizosphere and 5 (4%) from soil butternut root rhizosphere. In vitro antibiotic susceptibility tests showed varying resistances to meropenem (8.9%), cefuroxime (95.6 %), ampicillin-sulbactam (53.9%), ceftazidime (10.7%), cefepime (29.3 %), minocycline (2.2%), kanamycin (56.9%), ofloxacin (2.9%), levofloxacin (1.3%), moxifloxacin (2.8%), ciprofloxacin (24.3%), gatifloxacin (1.3%), polymyxin B (2.9 %), cotrimoxazole (26.1%), trimethoprim (98.6%) and aztreonam (58%). The isolates were susceptible to the fluoroquinolones (74.3-94.7%), polymycin (97.1%) and meropenem (88.1%). The newest sulphonamide resistance gene, sul3, was detected among the trimethoprim-sulfamethoxazole (cotrimoxazole)-resistant isolates, while the most frequent sulphonamide-resistant gene in animal source isolates, sul2, was not. Conclusions: The commensal S. maltophilia isolates in the Nkonkobe Municipality environment harbored the resistant gene sul3 as clinical counterparts, especially from the perspective of reservoirs of antibiotic resistance determinants. PMID:25789125

  17. High prevalence and risk factors of fecal carriage of CTX-M type extended-spectrum beta-lactamase-producing Enterobacteriaceae from healthy rural residents of Taian, China.

    PubMed

    Zhang, Hongna; Zhou, Yufa; Guo, Shuyuan; Chang, Weishan

    2015-01-01

    The study was carried out to understand the prevalence of CTX-M type extended-spectrum beta-lactamase (ESBL)-harboring Enterobacteriaceae and to analyze risk factors related with fecal carriage in healthy rural residents in Taian, China. A total of 620 stool samples were collected from rural residents. The ESBL-positive Enterobacteriaceae was screened using ChromID ESBL agar, and then further confirmed by double-disk diffusion. The CTX-M genes were determined using polymerase chain reaction. The risk factors associated with fecal carriage of CTX-M-positive isolates were analyzed using the standard statistic methods. 458 isolates carrying CTX-M gene (458/620, 73.9%) were obtained from different individuals, and the most dominant genotype was CTX-M-9 group (303/458, 66.2%). The dominant species were Escherichia coli (E. coli; 403/458, 88.0%) and Klebsiella pneumoniae (K. pneumoniae; 26/458, 5.7%) among the isolates carrying CTX-M genes. All the CTX-M producers were resistant to ampicillin, cefazolin, cefuroxime, and ceftriaxone, but were all susceptible to biapenem, imipenem, and meropenem. The results of multivariate logistic regression model identified the enrollment in formal education (OR 2.321; 95% CI 1.302-3.768; P= 0.039), the hospitalization history within the last 6 months (OR 1.753; 95% CI 1.127-2.584; P= 0.031) and the antibiotics use within the last 6 months (OR 1.892; 95% CI 1.242-2.903; P= 0.034). The three variables were significantly associated with carriage of CTX-M ESBL producers (x (2) = 21.21; df = 3; P< 0.001). The prevalence of fecal carriage of CTX-M ESBL-producing Enterobacteriaceae among healthy rural humans in Taian was high, and the recent antibiotic use and hospitalization history may be the important contributors. PMID:25870591

  18. Synthetic amphibian peptides and short amino-acids derivatives against planktonic cells and mature biofilm of Providencia stuartii clinical strains.

    PubMed

    Ostrowska, Kinga; Kamysz, Wojciech; Dawgul, Ma?gorzata; R?alski, Antoni

    2014-01-01

    Over the last decade, the growing number of multidrug resistant strains limits the use of many of the currently available chemotherapeutic agents. Furthermore, bacterial biofilm, due to its complex structure, constitutes an effective barrier to conventional antibiotics. The in vitro activities of naturally occurring peptide (Citropin 1.1), chemically engineered analogue (Pexiganan), newly-designed, short amino-acid derivatives (Pal-KK-NH2, Pal-KKK-NH2, Pal-RRR-NH2) and six clinically used antimicrobial agents (Gatifloxacin, Ampicilin, Cefotaxime, Ceftriaxone, Cefuroxime and Cefalexin) were investigated against planktonic cells and mature biofilm of multidrug-resistant Providencia stuartii strains, isolated from urological catheters. The MICs, MBCs values were determined by broth microdilution technique. Inhibition of biofilm formation by antimicrobial agents as well as biofilm susceptibility assay were tested using a surrogate model based on the Crystal Violet method. The antimicrobial activity of amino-acids derivatives and synthetic peptides was compared to that of clinically used antibiotics. For planktonic cells, MICs of peptides and antibiotics ranged between 1 and 256 ?g/ml and 256 and ? 2048 ?g/ml, respectively. The MBCs values of Pexiganan, Citropin 1.1 and amino-acids derivatives were between 16 and 256 ?g/ml, 64 and 256 ?g/ml and 16 and 512 ?g/ml, respectively. For clinically used antibiotics the MBCs values were above 2048 ?g/ml. All of the tested peptides and amino-acids derivatives, showed inhibitory activity against P. stuartii biofilm formation, in relation to their concentrations. Pexiganan and Citropin 1.1 in concentration range 32 and 256 ?g/ml caused both strong and complete suppression of biofilm formation. None of the antibiotics caused complete inhibition of biofilm formation process. The biofilm susceptibility assay verified the extremely poor antibiofilm activity of conventional antibiotics compared to synthetic peptides. The obtained results showed that synthetic peptides are generally more potent and effective than clinically used antibiotics. PMID:25804062

  19. [Antibiotic resistance rates of extended spectrum beta-lactamase producing Escherichia coli and Klebsiella spp. strains isolated from urinary tract infections in a private hospital].

    PubMed

    Akyar, I?in

    2008-10-01

    The aim of this study was to detect the antibiotic resistance rates of extended spectrum beta-lactamase (ESBL) producing Escherichia coli and Klebsiella spp. strains isolated from urinary tract infections (UTIs) in Private Acibadem Hospital, Istanbul, Turkey. A total of 1100 E. coli and 356 Klebsiella spp. strains isolated from 17.028 urine cultures which were processed between October 2006 and August 2007 in the clinical laboratory, were included to the study. Identification of bacteria and antibiotic susceptibility tests were performed by Phoenix (Becton Dickinson, USA) automated system. Of E. coli strains 12% (n= 132) were found positive for ESBL, while this rate was 12% (n= 41) for Klebsiella spp. strains (38 K.pneumoniae, 3 K. oxytoca). The resistance rates of ESBL producing E. coli and Klebsiello spp. strains were found as follows respectively; 3% and 2.4% for amikacin, 3% and 85.4% for nitrofurantoin, 0% and 4.9% for fosfomycin, 5.3% and 100% for cefoxitin, 21.2% and 58.5% for piperacilin/tazobactam, 34.8% and 41.5% for gentamicin, 68.9% and 58% for trimethoprim/sulfamethoxazole (TMP-SMX), 75.9% and 56.1% for tobramycin, 80.3% and 21.9% for ciprofloxacin and norfloxacin. All of the ESBL positive E. coli and Klebsiella spp. strains were resistant to ampicilin, aztreonam, cefazolin, cefepime, ceftazidime, ceftriaxone and cefuroxime-sodium; while all of the ESBL positive E. coli and Klebsiella spp. strains were sensitive to imipenem and meropenem. The rates of resistance obtained in this study were higher than the rates obtained in other studies performed in our country. This could be attributed to the different antibiotic use policies of different centers or to more frequent use of antibiotics by the patients applied to private hospitals, owing to their higher socioeconomical status and easier attainment of antibiotics without prescription. PMID:19149097

  20. Antimicrobial susceptibility profiles of human and piglet Clostridium difficile PCR-ribotype 078

    PubMed Central

    2013-01-01

    In the last decade, outbreaks of nosocomial Clostridium difficile infections (CDI) occurred worldwide. A new emerging type, PCR-ribotype 027, was the associated pathogen. Antimicrobial susceptibility profiles of this type were extensively investigated and used to partly explain its spread. In Europe, the incidence of C. difficile PCR-ribotype 078 recently increased in humans and piglets. Using recommendations of the European Committee on Antimicrobial Susceptibility Testing (EUCAST) and the Clinical and Laboratory Standards Institute (CLSI) we studied the antimicrobial susceptibility to eight antimicrobials, mechanisms of resistance and the relation with previously prescribed antimicrobials in human (n=49) and porcine (n=50) type 078 isolates. Human and porcine type 078 isolates showed similar antimicrobial susceptibility patterns for the antimicrobials tested. In total, 37% of the isolates were resistant to four or more antimicrobial agents. The majority of the human and porcine isolates were susceptible to amoxicillin (100%), tetracycline (100%) and clindamycin (96%) and resistant to ciprofloxacin (96%). More variation was found for resistance patterns to erythromycin (76% in human and 59% in porcine isolates), imipenem (29% in human and 50% in porcine isolates) and moxifloxacin (16% for both human and porcine isolates). MIC values of cefuroxim were high (MICs >256mg/L) in 96% of the isolates. Resistance to moxifloxacin and clindamycin was associated with a gyr(A) mutation and the presence of the erm(B) gene, respectively. A large proportion (96%) of the erythromycin resistant isolates did not carry the erm(B) gene. The use of ciprofloxacin (humans) and enrofloxacin (pigs) was significantly associated with isolation of moxifloxacin resistant isolates. Increased fluoroquinolone use could have contributed to the spread of C. difficile type 078. PMID:23566553

  1. The bactericidal activity of ?-lactam antibiotics is increased by metabolizable sugar species

    PubMed Central

    Thorsing, Mette; Bentin, Thomas; Givskov, Michael; Tolker-Nielsen, Tim

    2015-01-01

    Here, the influence of metabolizable sugars on the susceptibility of Escherichia coli to ?-lactam antibiotics was investigated. Notably, monitoring growth and survival of mono- and combination-treated planktonic cultures showed a 1000- to 10?000-fold higher antibacterial efficacy of carbenicillin and cefuroxime in the presence of certain sugars, whereas other metabolites had no effect on ?-lactam sensitivity. This effect was unrelated to changes in growth rate. Light microscopy and flow cytometry profiling revealed that bacterial filaments, formed due to ?-lactam-mediated inhibition of cell division, rapidly appeared upon ?-lactam mono-treatment and remained stable for up to 18?h. The presence of metabolizable sugars in the medium did not change the rate of filamentation, but led to lysis of the filaments within a few hours. No lysis occurred in E. coli mutants unable to metabolize the sugars, thus establishing sugar metabolism as an important factor influencing the bactericidal outcome of ?-lactam treatment. Interestingly, the effect of sugar on ?-lactam susceptibility was suppressed in a strain unable to synthesize the nutrient stress alarmone (p)ppGpp. Here, to the best of our knowledge, we demonstrate for the first time a specific and significant increase in ?-lactam sensitivity due to sugar metabolism in planktonic, exponentially growing bacteria, unrelated to general nutrient availability or growth rate. Understanding the mechanisms underlying the nutritional influences on antibiotic sensitivity is likely to reveal new proteins or pathways that can be targeted by novel compounds, adding to the list of pharmacodynamic adjuvants that increase the efficiency and lifespan of conventional antibiotics. PMID:26243263

  2. Antibiotic susceptibility survey of Neisseria gonorrhoeae in Thailand.

    PubMed

    Clendennen, T E; Echeverria, P; Saengeur, S; Kees, E S; Boslego, J W; Wignall, F S

    1992-08-01

    The antibiotic susceptibilities of Neisseria gonorrhoeae isolates obtained from patients attending sexually transmitted disease clinics in Cholburi and Bangkok, Thailand, were determined by agar dilution. Some 28.2% of isolates produced beta-lactamase. A total of 97.9% of beta-lactamase-positive and 51% of beta-lactamase-negative isolates tested were resistant to penicillin (MICs, greater than or equal to 2 micrograms/ml), 70% of isolates tested were resistant to tetracycline (MICs, greater than or equal to 2 micrograms/ml), and 91% of isolates tested were susceptible to spectinomycin (MICs, less than or equal to 64 micrograms/ml). The MICs for 90% of isolates for the other drugs tested were 2 micrograms/ml for erythromycin, 2 micrograms/ml for cefoxitin, 1 micrograms/ml for cefuroxime, 0.125 micrograms/ml for cefpodoxime, 0.06 micrograms/ml for cefotaxime, 0.25 micrograms/ml for ceftazidime, 0.03 micrograms/ml for ceftizoxime, 0.03 micrograms/ml for ceftriaxone, 0.03 micrograms/ml for cefixime, 0.06 micrograms/ml for aztreonam, 0.008 micrograms/ml for ciprofloxacin, 0.125 micrograms/ml for norfloxacin, and 0.075 micrograms/ml for ofloxacin. Fewer than 1.5% of isolates were resistant to the extended-spectrum cephalosporins tested. Some 0.3% or fewer isolates were resistant to broad-spectrum cephalosporins, fluoroquinolones, or the monobactam aztreonam. Antibiotic resistance among N. gonorrhoeae isolates from Cholburi and Bangkok in May 1990 appeared to be primarily limited to penicillin and tetracycline, which are no longer used to control gonorrhea. Spectinomycin, which has been in general use against gonorrhea in Thailand since 1983, has dwindling utility, with resistance at a level of 8.9%. PMID:1416851

  3. Incidence of antibiotics resistance among uropathogens in Omani children presenting with a single episode of urinary tract infection.

    PubMed

    Sharef, Sharef W; El-Naggari, Mohamed; Al-Nabhani, Dana; Al Sawai, Ali; Al Muharrmi, Zakaria; Elnour, Ibtisam

    2015-01-01

    Urinary tract infection (UTI) is one of the most common community-acquired infections. Different organisms can be the cause of UTI in children, with resistance to antibiotics becoming a significant problem in the choice of treatment. Worldwide studies have documented the prevalence of uropathogens in different countries. However, there is no previous study documenting the incidence of different uropathogens in Oman. We aim to report the most common uropathogens and their antibiotic sensitivity patterns in children presenting with documented, single episode UTI at a tertiary hospital in Oman. A retrospective analysis of all Omani children below 14 years who presented with a case of first documented UTI to SQUH between September 2008 and August 2012 was conducted. Data were obtained from the patients' electronic records in the hospital information system. Data were then analyzed using SSPS (Statistical Package for Social Sciences program, Version 20, IBM, Chicago, IL, USA). In the retrospective review of all urine cultures, 438 positive urine cultures were identified. Out of those, 208 (47.5%) belonged to children with their first episode of UTI. Thirty-three patients were excluded and 75 patients were included in the final analysis. Escherichia coli was the most frequently encountered uropathogen in our cohort (69%), followed by Klebsiella pneumoniae infection (17%). Nearly half (46.6%) of these two common organism were resistant to Cotrimoxazole, while 31% of them were resistant to Augmentin. Twenty-four percent of the E. coli and K. pneumoniae strains were resistant to Cefuroxime, and only 10% were resistant to nitrofurantoin. Both Augmentin and Cotrimoxazole should not be the first line antibiotics to treat UTI. PMID:25755002

  4. Genotypes and phenotypes of Shiga toxin-producing Escherichia coli (STEC) in Abeokuta, Southwestern Nigeria

    PubMed Central

    Olowe, Olugbenga Adekunle; Aboderin, Bukola W; Idris, Olayinka O; Mabayoje, Victor O; Opaleye, Oluyinka O; Adekunle, O Catherine; Olowe, Rita Ayanbolade; Akinduti, Paul Akinniyi; Ojurongbe, Olusola

    2014-01-01

    Purpose To characterize the prevalence of hemolytic Shiga toxin-producing Escherichia coli (STEC) with a multidrug-resistant pattern in different age groups in Abeokuta, Nigeria. Methods Nonrepetitive E. coli isolates were collected from 202 subjects with or without evidence of diarrhea. Each isolate was biochemically identified and antimicrobial susceptibility testing was performed using the disk diffusion method. A sorbitol fermentation test of all the E. coli isolates was done and the minimum inhibitory concentration of suspected STEC was measured by the standard broth microdilution method to determine antibiotic resistance. The genotypes of stx1, stx2, and hlyA were determined by polymerase chain reaction assay. Results The majority of subjects were aged ≥40 years (41.6%) and were female (61.9%). Of the 202 subjects, 86.1% had STEC isolates (P<0.05). A high rate of STEC isolates resistant to amoxicillin (90.6%), cefotaxime (77.7%), and cefuroxime (75.7%) was observed. Resistance to amoxicillin, gentamicin, and cefotaxime was demonstrated with a minimum inhibitory concentration >16 μg/mL in 13.9%, 11.4%, and 10.4% of the isolates, respectively. The prevalence of stx1, stx2, and hlyA was 13.9%, 6.9%, and 2.0%, respectively; 5.5% of stx1 were in the 0–10-year-old age group, 3.5% of stx2 were aged ≥40 and above, and 1.0% of the hlyA isolates were in the 0–10-year-old age group. Conclusion The prevalence of virulent STEC is a public health concern. The use of polymerase chain reaction assay should aid quick detection of this virulent serotype and help curb the severe epidemic of human diseases associated with STEC infections. PMID:25342913

  5. Prevalence and characterisation of non-cholerae Vibrio spp. in final effluents of wastewater treatment facilities in two districts of the Eastern Cape Province of South Africa: implications for public health.

    PubMed

    Okoh, Anthony I; Sibanda, Timothy; Nongogo, Vuyokazi; Adefisoye, Martins; Olayemi, Osuolale O; Nontongana, Nolonwabo

    2015-02-01

    Vibrios and other enteric pathogens can be found in wastewater effluents of a healthy population. We assessed the prevalence of three non-cholerae vibrios in wastewater effluents of 14 wastewater treatment plants (WWTP) in Chris Hani and Amathole district municipalities in the Eastern Cape Province of South Africa for a period of 12 months. With the exception of WWTP10 where presumptive vibrios were not detected in summer and spring, presumptive vibrios were detected in all seasons in other WWTP effluents. When a sample of 1,000 presumptive Vibrio isolates taken from across all sampling sites were subjected to molecular confirmation for Vibrio, 668 were confirmed to belong to the genus Vibrio, giving a prevalence rate of 66.8 %. Further, molecular characterisation of 300 confirmed Vibrio isolates revealed that 11.6 % (35) were Vibrio parahaemolyticus, 28.6 % (86) were Vibrio fluvialis and 28 % (84) were Vibrio vulnificus while 31.8 % (95) belonged to other Vibrio spp. not assayed for in this study. Antibiogram profiling of the three Vibrio species showed that V. parahaemolyticus was ?50 % susceptible to 8 of the test antibiotics and ?50 % resistant to only 5 of the 13 test antibiotics, while V. vulnificus showed a susceptibility profile of ?50 % to 7 of the test antibiotics and a resistance profile of ?50 % to 6 of the 13 test antibiotics. V. fluvialis showed ?50 % resistance to 8 of the 13 antibiotics used while showing ?50 % susceptibility to only 4 antibiotics used. All three Vibrio species were susceptible to gentamycin, cefuroxime, meropenem and imipenem. Multiple antibiotic resistance patterns were also evident especially against such antibiotics as tetracyclin, polymixin B, penicillin G, sulfamethazole and erythromycin against which all Vibrio species were resistant. These results indicate a significant threat to public health, more so in the Eastern Cape Province of South Africa which is characterised by widespread poverty, with more than a third of the population directly relying on surface water sources for drinking and daily use. PMID:25167817

  6. pspK gene prevalence and characterization of non-typable Streptococcus pneumonia isolates from Asian countries.

    PubMed

    Na, In Young; Baek, Jin Yang; Park, In Ho; Kim, Dae Hun; Song, Jae-Hoon; Ko, Kwan Soo

    2015-05-01

    Recently, it has been reported that some non-typable (NT) Streptococcus pneumoniae isolates from Korea and other countries contained a novel gene pspK in the capsular polysaccharide synthesis (cps) locus. In this study, we investigated the presence of pspK in 120 NT S. pneumoniae isolates from 12 Asian countries; isolate characteristics were also examined. The presence of pspK was assayed by PCR. Clonality of NT S. pneumoniae isolates containing pspK was investigated by MLST and PFGE. Antimicrobial susceptibility testing was performed and the structure of pspK was also determined. Nineteen NT isolates (15.8?%) were identified as containing pspK: two isolates from Korea, four from Vietnam, two from Hong Kong, eight from Thailand, and one each from Taiwan, the Philippines and Saudi Arabia. Seven isolates from Korea, Vietnam and Thailand were identified as ST1106, whereas just one or two belonged to ST310, ST393, ST10137, ST2754 or ST4136. All but one of the ST1106 NT isolates showed non-susceptibility to penicillin, and all isolates were resistant to cefuroxime, erythromycin, clindamycin and trimethoprim/sulfamethoxazole. The structure of pspK was similar amongst 20 isolates, which had a R1-R2-like region and a variable number of repeats in the repetitive region. However, one isolate (P05-11) from the Philippines lacked the R1-R2 region. NT S. pneumoniae isolates containing pspK were distributed across several Asian countries. Although MLST analysis suggested that most pspK-containing NT S. pneumoniae isolates may have emerged independently, ST1106 isolates with the selective advantage of antimicrobial resistance may have disseminated clonally throughout the countries. PMID:25750083

  7. Multiply resistant nontyphoidal Salmonella gastroenteritis in children.

    PubMed

    Maiorini, E; Lopez, E L; Morrow, A L; Ramirez, F; Procopio, A; Furmanski, S; Woloj, G M; Miller, G; Cleary, T G

    1993-02-01

    From January, 1990, to December 31, 1990, 75 children with multiply resistant Salmonella gastroenteritis were studied at the Children's Hospital "Ricardo Gutierrez" of Buenos Aires. These children ranged from 1 month to 15 years of age. Infection was community-acquired in 20 (26.6%), nosocomially acquired in 50 (66.7%) and undetermined in 5. Thirty-nine (52%) had grossly bloody stools. Fever occurred at some point in the clinical course in 61 children (81.3%) with a duration of 1 to 33 days (mean, 6.7 days). The duration of diarrhea (1 to 69 days) was longer in those who developed complications (P < 0.001). Six (8%) developed enterocolitis (2 with bowel perforation), 1 had a pulmonary abscess and 8 (11.4%) had bacteremia; 4 children died (5.3%). Salmonella typhimurium was the most common serovar (85.3%). Ninety percent minimum inhibitory concentration studies demonstrated that all strains were resistant to ampicillin (> 128 micrograms/ml), cephalothin (> 128 micrograms/ml), cefuroxime (> 128 micrograms/ml), nalidixic acid (> 256 micrograms/ml), rifampin (> 256 micrograms/ml), gentamicin (> 256 micrograms/ml) and tobramycin (256 micrograms/ml); 77.3% of strains were resistant to ceftazidime (32 micrograms/ml), 97.6% to netilmicin (> 256 micrograms/ml), 92.8% to amikacin (256 micrograms/ml), 24.4% to isepamicin (32 micrograms/ml), 5.3% to chloramphenicol (4 micrograms/ml) and 2.7% to cefoxitin (2 micrograms/ml). The 90% minimum inhibitory concentration of cefotaxime and ceftazidime was reduced by the addition of clavulanate. Aggressive multiply resistant Salmonella strains are a major pediatric problem in Buenos Aires. PMID:8426772

  8. Prevalence of Device-associated Nosocomial Infections Caused By Gram-negative Bacteria in a Trauma Intensive Care Unit in Libya

    PubMed Central

    Zorgani, Abdulaziz; Abofayed, Atef; Glia, Abdulhakim; Albarbar, Ashrf; Hanish, Sami

    2015-01-01

    Objectives Device-associated nosocomial infections (DANIs) have a major impact on patient morbidity and mortality. Our study aimed to determine the distribution rate of DANIs and causative agents and patterns of antibiotic resistance in the trauma-surgical intensive care unit (ICU).? Methods Our study was conducted at Abusalim Trauma Hospital in Tripoli, Libya. All devices associated with nosocomial infections, including central venous catheters (CVC), endotracheal tubes (ETT), Foleys urinary catheters, chest tubes, nasogastric tubes (NGT), and tracheostomy tubes, were removed aseptically and examined for Gram-negative bacteria (GNB).? Results During a one-year study period, 363 patients were hospitalized; the overall mortality rate was 29%. A total of 79 DANIs were identified, the most common site of infection was ETT (39.2%), followed by urinary catheters (19%), NGTs (18%), tracheostomy tubes (11%), CVCs (10%), and chest tubes (3%). The most frequently isolated organisms were Klebsiella pneumonia, Acinetobacter baumannii, and Pseudomonas aeruginosa (30%, 20%, and 14%, respectively). Extremely high resistance rates were observed among GNB to ampicillin (99%), cefuroxime (95%), amoxicillin-clavulante (92%), and nitrofurantoin (91%). Lower levels of resistance were exhibited to amikacin (38%), imipenem (38%), and colistin (29%). About 39% of the isolates were defined as multi-drug resistant (MDR). Overall, extended spectrum ?-lactmase producers were expressed in 39% of isolates mainly among K. pneumonia (88%). A. baumannii isolates exhibited extremely high levels of resistance to all antibiotics except colistin (100% sensitive). In addition, 56.3% of A. baumannii isolates were found to be MDR. P. aeruginosa isolates showed 46%55% effectiveness to anti-pseudomonas antibiotics.? Conclusion High rates of DANIs and the emergence of MDR organisms poses a serious threat to patients. There is a need to strengthen infection control within the ICU environment, introduce surveillance systems, and implement evidence-based preventive strategies. PMID:26366261

  9. Natural antibiotic susceptibility of strains of Serratia marcescens and the S. liquefaciens complex: S. liquefaciens sensu stricto, S. proteamaculans and S. grimesii.

    PubMed

    Stock, I; Grueger, T; Wiedemann, B

    2003-07-01

    The natural susceptibility of 77 strains of Serratia marcescens and 41 strains of the S. liquefaciens complex (S. liquefaciens sensu stricto (n=21), S. grimesii (n=10), S. proteamaculans (n=10)) to 70 antibiotics was examined using a microdilution procedure in Isosensitest broth (all strains) and cation-adjusted Mueller Hinton broth (some strains). All species were naturally resistant to benzylpenicillin, oxacillin, cefaclor, cefazolin, cefuroxime, numerous macrolides, lincosamides, streptogramins, glycopeptides, rifampicin and fusidic acid. Uniform natural sensitivity was found to most aminoglycosides, several acylureidopenicillins, ticarcillin, newer cephalosporins, carbapenems, aztreonam, quinolones and antifolates. Species-related differences in susceptibility affecting clinical assessment criteria were found for several agents. S. marcescens was less susceptible to some aminoglycosides than species of the S. liquefaciens group. It was the only species that was uniformly naturally resistant to tetracycline, amoxycillin, amoxycillin/clavulanate and loracarbef. Species of the S. liquefaciens group were naturally resistant and intermediate or naturally intermediate to the latter agents. Differences in susceptibility among the species of the S. liquefaciens complex were generally small. S. proteamaculans was most susceptible to sulphamethoxazole. S. liquefaciens sensu stricto was less susceptible than S. grimesii and S. proteamaculans to tetracyclines, chloramphenicol and nitrofurantoin; it was the only species uniformly naturally resistant to fosfomycin. This study suggested that all species examined probably express chromosomally-encoded AmpC beta-lactamases, but the amount of enzyme may vary from species to species. The naturally-occurring low-level expression of the S. marcescens aminoglycoside 6'-acetyltransferase AAC(6')-Ic and its absence in other Serratia spp. was supported by the data. All species of the S. liquefaciens complex should be considered as probable agents of human diseases. PMID:12842326

  10. Natural antimicrobial susceptibilities of strains of 'unusual' Serratia species: S. ficaria, S. fonticola, S. odorifera, S. plymuthica and S. rubidaea.

    PubMed

    Stock, Ingo; Burak, Sonja; Sherwood, Kimberley Jane; Gruger, Thomas; Wiedemann, Bernd

    2003-04-01

    The natural susceptibility to 71 antibiotics of 104 Serratia strains of Serratia ficaria (n = 15), Serratia fonticola (n = 18), Serratia odorifera (n = 16), Serratia plymuthica (n = 32) and Serratia rubidaea (n = 23) was examined. MICs were determined using a microdilution procedure in IsoSensitest broth for all the strains and in cation-adjusted Mueller-Hinton broth for some strains. With few exceptions, all species tested were uniformly naturally resistant to penicillin G, oxacillin, cefazolin, cefuroxime, all tested macrolides, lincosamides, streptogramins, glycopeptides, fusidic acid and rifampicin, and naturally sensitive to several aminoglycosides, piperacillin, piperacillin/tazobactam, carbapenems, some cephalosporins, fluoroquinolones and folate-pathway inhibitors. Major species-related differences in natural susceptibility affecting clinical assessment criteria were seen with tetracyclines, some aminoglycosides, aminopenicillins, ticarcillin, cefaclor, loracarbef, cefoxitin, pipemidic acid, chloramphenicol, nitrofurantoin and fosfomycin. Differences in susceptibility dependent on the medium were seen with macrolides, tetracycline, fosfomycin and some beta-lactams. The natural antibiotic susceptibility patterns suggest novel species-specific mechanisms of antibiotic resistance. Uncharacterized species-specific aminoglycoside-modifying enzymes and multidrug efflux systems affecting tetracyclines, quinolones and chloramphenicol are probably responsible for some of the phenotypes observed. The natural amoxicillin sensitivity of several strains of some species combined with natural resistance to some narrow-spectrum cephalosporins indicate the expression of naturally occurring beta-lactamases with unique substrate profiles. beta-Lactamases of representative strains of each species were characterized phenotypically and genotypically. It was shown that all species expressed naturally occurring AmpC beta-lactamases and, with respect to S. fonticola, also a species-specific class A beta-lactamase. Inducibility of these enzymes was shown in all species with the exception of S. rubidaea and four of five strains of S. plymuthica. PMID:12654765

  11. Antibiotic Susceptibility Pattern of ES?L Producing Klebsiella pneumoniae Isolated from Urine Samples of Pregnant Women in Karnataka

    PubMed Central

    N G, Manjula; C Math, Girish; Nagshetty, Kavita; Patil, Shripad A; Gaddad, Subhashchandra M

    2014-01-01

    Background: Klebsiella pneumoniae possess a new problem to health care professionals worldwide, which complicates and limits therapeutic options. It is one of the leading nosocomial bacterial pathogens, and the present study aims to determine the prevalence of ES?L producing K. pneumoniae isolates with their antibiotic susceptibility pattern in urine samples of the pregnant women with UTI. Materials and Methods: Using standard isolation and identification procedures a total of 41 isolates were obtained from 417 midstream urine samples of pregnant women with suspected UTI in Karnataka. The antibiotic resistance profile of each isolate was performed by Kirby-Bauer disc diffusion method and ES?L production by standard phenotypic method. Results: Isolation rate of K. pneumoniae in pregnant women was 19.9% and overall incidence rate was 9.8%. Among the 41 K. pneumoniae isolates, 26 (63.4%) were ES?L producers and all were found to be Multi Drug Resistance (MDR). The antibiotic susceptibility test (AST) for the isolates revealed that the highest number of K. pneumoniae were resistant to ampicillin (75.6%) followed by, nitrofurontoin and cefuroxime (73.1%) and least to chloramphenicol (12.1%). ES?L producers were highly resistance to nitrofurontoin (69.2%) and cotrimonazole (65.2%) and lower resistance was (7.6%) to amaikacin, observed. A higher resistance pattern to these two antibiotics was observed against ES?L non producing K. pneumonia but lowest to polymyxin B (13.3%) instead of amikacin (26.6%). All the isolates were found to be susceptible to imipenem. Conclusion: Present investigation revealed high prevalence of MDR- ES?L producing Klebsiella pneumoniae, which indicates dire need for effective ES?L surveillance in the community by using cost effective antimicrobials agents. PMID:25478341

  12. Mutations in Streptococcus pneumoniae penicillin-binding protein 2x: importance of the C-terminal penicillin-binding protein and serine/threonine kinase-associated domains for beta-lactam binding.

    PubMed

    Maurer, Patrick; Todorova, Katya; Sauerbier, Julia; Hakenbeck, Regine

    2012-06-01

    Penicillin-binding protein 2x (PBP2x) mutations that occur during the selection with beta-lactams are located within the central penicillin-binding/transpeptidase (TP) domain, and are believed to mediate resistance by interfering with the formation of a covalent complex of the active site serine with the antibiotic. We now investigated the effect of two point mutations found in two independently obtained laboratory mutants that are located at the surface of the TP domain with their side chains facing outside (G422D respectively R426C). They have no significant effect on resistance to cefotaxime in vivo or on binding to BocillinFL to the active site in vitro using purified PBP2x derivatives, thus apparently do not affect the active site directly. In contrast, in silico modeling revealed that they affect van der Waal's interactions with the PASTA1 (PBP and serine/threonine kinase associated) domain of the C-terminal extension and a noncovalent cefuroxime molecule found in the X-ray structure of an acylated PBP2x, suggesting some effect of the mutations on the interaction of the TP domain with PASTA1 and/or with the antibiotic associated with PASTA1. The effect of the PASTA domains on covalent binding of PBP2x to Bocillin FL was then investigated using a series of soluble truncated PBP2x derivatives. Deletion of 127 C-terminal residues, that is, of both PASTA domains, decreased binding dramatically by ?90%. Surprisingly, deletion of only 40 amino acids resulted in the same phenotype, whereas the absence of 30 amino acids affected binding marginally by 10%, documenting a crucial role of the C-terminal domain for beta-lactam binding. PMID:22455550

  13. Beta- Lactam Antibiotics Stimulate Biofilm Formation in Non-Typeable Haemophilus influenzae by Up-Regulating Carbohydrate Metabolism

    PubMed Central

    Wu, Siva; Li, Xiaojin; Gunawardana, Manjula; Maguire, Kathleen; Guerrero-Given, Debbie; Schaudinn, Christoph; Wang, Charles; Baum, Marc M.; Webster, Paul

    2014-01-01

    Non-typeable Haemophilus influenzae (NTHi) is a common acute otitis media pathogen, with an incidence that is increased by previous antibiotic treatment. NTHi is also an emerging causative agent of other chronic infections in humans, some linked to morbidity, and all of which impose substantial treatment costs. In this study we explore the possibility that antibiotic exposure may stimulate biofilm formation by NTHi bacteria. We discovered that sub-inhibitory concentrations of beta-lactam antibiotic (i.e., amounts that partially inhibit bacterial growth) stimulated the biofilm-forming ability of NTHi strains, an effect that was strain and antibiotic dependent. When exposed to sub-inhibitory concentrations of beta-lactam antibiotics NTHi strains produced tightly packed biofilms with decreased numbers of culturable bacteria but increased biomass. The ratio of protein per unit weight of biofilm decreased as a result of antibiotic exposure. Antibiotic-stimulated biofilms had altered ultrastructure, and genes involved in glycogen production and transporter function were up regulated in response to antibiotic exposure. Down-regulated genes were linked to multiple metabolic processes but not those involved in stress response. Antibiotic-stimulated biofilm bacteria were more resistant to a lethal dose (10 g/mL) of cefuroxime. Our results suggest that beta-lactam antibiotic exposure may act as a signaling molecule that promotes transformation into the biofilm phenotype. Loss of viable bacteria, increase in biofilm biomass and decreased protein production coupled with a concomitant up-regulation of genes involved with glycogen production might result in a biofilm of sessile, metabolically inactive bacteria sustained by stored glycogen. These biofilms may protect surviving bacteria from subsequent antibiotic challenges, and act as a reservoir of viable bacteria once antibiotic exposure has ended. PMID:25007395

  14. The Prevalence and Antibiotic Susceptibility Pattern of Salmonella typhi among Patients Attending a Military Hospital in Minna, Nigeria

    PubMed Central

    Adabara, N. U.; Ezugwu, B. U.; Momojimoh, A.; Madzu, A.; Hashiimu, Z.; Damisa, D.

    2012-01-01

    The threat to human health posed by antibiotic-resistant bacterial pathogens is of growing concern to medical practice. This study investigated the antibiotic sensitivity pattern of Salmonella typhi isolated from blood specimen. One hundred blood samples were collected from suspected typhoid fever patients in 31 Artillery Brigade Medical Centre, Minna, and were analyzed for S. typhi while antibiotic sensitivity testing was done Kirby-Bauer method. Sixty (60.0%) samples out of the total 100 were positive for bacterial growth. The organisms isolated 2 include Salmonella typhi; 45 (75.0%), Shigella; 6 (10.0%), E. coli; 3 (5.0%), Klebsiella; 3 (5.0%), Enterobacter; 2 (3.3%), and Citrobacter; 1 (1.7%). Result of the sensitivity test showed that the isolates were resistant to all the antibiotics; ceftriaxone, cefuroxime, amoxicillin, ampicillin, ciprofloxacin, and augmentin, which are the drug of choice routinely used in the study area for the treatment of typhoid fever. They were however sensitive to chloramphenicol and ofloxacin, which, unfortunately, are not used in this study area for the treatment of typhoid fever. There appear to be multiple drug resistant (MDR) strain of S. typhi in the study area. These may be as a result of overdependence or uncontrolled use of the few available antibiotics and/or inaccurate or inconclusive diagnosis resulting in the development and spread of resistant strains of S. typhi. The study, therefore, highlights the need for a strong collaboration between the physicians and the laboratory in the choice of antibiotics for the treatment of bacterial diseases in order to discourage the development of resistant strain of bacterial pathogen. PMID:23056954

  15. Detection limits of four antimicrobial residue screening tests for beta-lactams in goat's milk.

    PubMed

    Sierra, D; Sánchez, A; Contreras, A; Luengo, C; Corrales, J C; Morales, C T; de la Fe, C; Guirao, I; Gonzalo, C

    2009-08-01

    This study was conducted to compare the detection limits (DL) of several antibiotic residue screening tests with the maximum residue limits (MRL) authorized by the EU according to the guidance for the standardized evaluation of microbial inhibitor tests of the International Dairy Federation. Composite antibiotic-free milk samples from 30 primiparous Murciano-Granadina goats in good health condition were used to prepare test samples spiked with different concentrations of each antimicrobial. In total, 5,760 analytical determinations of 10 beta-lactam antibiotics (penicillin-G, ampicillin, amoxicillin, cloxacillin, oxacillin, dicloxacillin, cefadroxyl, cefalexin, cefoperazone, and cefuroxime) were performed using 4 antibiotic residue screening tests: the brilliant black reduction test BRT AiM (AiM-Analytik in Milch Produktions-und Vertriebs GmbH, München, Germany), Delvotest MCS (DSM Food Specialties, Delft, the Netherlands), Eclipse 100 (ZEU-Inmunotec SL, Zaragoza, Spain), and the Copan Milk Test (CMT; Copan Italia SpA, Brescia, Italy). For each method, we estimated the detection limits of the antimicrobial agents using a logistic regression model. Using the CMT and Delvotest on samples spiked with the 8 antibiotics for which MRL were available, DL were at or below the MRL. The BRT test provided DL at or below the MRL for all of the agents except cefalexin, whereas the Eclipse 100 method failed to detect 4 antibiotics (ampicillin, amoxicillin, cloxacillin, and cefoperazone) at MRL or below. Logistic regression-determined levels of agreement were highest for the CMT method (98.6 to 100%) and lowest for Eclipse 100 (66.3 to 100%). In general, agreement levels indicated good correlation between observed results and those predicted by logistic regression. The lowest b values (closely related to test sensitivity) were recorded for the cephalosporins (0.074 to 0.430) and highest for penicillin G, ampicillin, and amoxicillin (11.270 to 11.504). Delvotest and CMT best fulfilled IDF criteria for the ideal test for detecting antibiotic residues in milk. PMID:19620639

  16. Diversity and Antibiograms of Bacterial Organisms Isolated from Samples of Household Drinking-water Consumed by HIV-positive Individuals in Rural Settings, South Africa

    PubMed Central

    Mashao, M.B.; Bessong, P.O.; NKgau, T.F.; Momba, M.N.B.; Obi, C.L.

    2012-01-01

    Diarrhoea is a hallmark of HIV infections in developing countries, and many diarrhoea-causing agents are often transmitted through water. The objective of the study was to determine the diversity and antibiotic susceptibility profiles of bacterial organisms isolated from samples of household drinking-water consumed by HIV-infected and AIDS patients. In the present study, household water stored for use by HIV-positive patients was tested for microbial quality, and isolated bacterial organisms were analyzed for their susceptibility profiles against 25 different antibiotics. The microbial quality of water was generally poor, and about 58% of water samples (n=270) were contaminated with faecal coliforms, with counts varying from 2 colony-forming unit (CFU)/100 mL to 2.4104 CFU/100 mL. Values of total coliform counts ranged from 17 CFU/100 mL to 7.9105/100 mL. In total, 37 different bacterial species were isolated, and the major isolates included Acinetobacter lwoffii (7.5%), Enterobacter cloacae (7.5%), Shigella spp. (14.2%), Yersinia enterocolitica (6.7%), and Pseudomonas spp. (16.3%). No Vibrio cholerae could be isolated; however, V. fluvialis was isolated from three water samples. The isolated organisms were highly resistant to cefazolin (83.5%), cefoxitin (69.2%), ampicillin (66.4%), and cefuroxime (66.2%). Intermediate resistance was observed against gentamicin (10.6%), cefepime (13.4%), ceftriaxone (27.6%), and cefotaxime (29.9%). Levofloxacin (0.7%), ceftazidime (2.2%), meropenem (3%), and ciprofloxacin (3.7%) were the most active antibiotics against all the microorganisms, with all recording less than 5% resistance. Multiple drug resistance was very common, and 78% of the organisms were resistant to three or more antibiotics. Education on treatment of household water is advised for HIV-positive patients, and measures should be taken to improve point-of-use water treatment as immunosuppressed individuals would be more susceptible to opportunistic infections. PMID:23082625

  17. Risk Factors of Fecal Toxigenic or Non-Toxigenic Clostridium difficile Colonization: Impact of Toll-Like Receptor Polymorphisms and Prior Antibiotic Exposure

    PubMed Central

    Wu, Tai-Chieh; Liu, Hsiu-Chuan; Lee, Jen-Chieh; Lee, Chih-I; Wu, Yi-Hui; Wan, Lei; Tsai, Pei-Jane; Ko, Wen-Chien

    2013-01-01

    Background This study is to investigate the significance and risk factors of fecal toxigenic (tCdC) or non-toxigenic Clostridium difficile colonization (ntCdC) among hospitalized patients. Methods Adults admitted to medical wards in a district hospital between January 2011 and June 2012 were enrolled, and those with a history of colectomy, C. difficile fecal colonization or infection or receipt of either metronidazole or oral vancomycin within 3 months, were excluded. Stools collected within 48 hours after admission and every week during hospitalization were cultured for C. difficile. Findings Among the 441 enrolled patients, 84 (20.0%) had CdC at initial screening, including 58 (13.2%) with tCdC and 26 (6.8%) with ntCdC. Among patients with initial negative fecal screening for CdC, it took an average of 70.6 days or 66.5 days to develop tCdC or ntCdC during the study period. Finally 78 (17.7%) had tCdC and 34 (7.7%) had ntCdC. During the follow-up period, the patients with tCdC had a higher risk of CDAD (11/79, 14.1%) than those without CdC (3/328, 0.9%) and those with ntCdC (0/34, 0%) (P<0.001). In multivariate analysis, the TLR4 rs1927914 polymorphism (GG genotype) (odds ratio [OR] 4.4, 95% confidence interval [CI] 1.6–11.8, P = 0.003) and recent cefepime therapy (OR 5.3, 95% CI 2.1–13.2, P<0.001) were independently associated with tCdC, whereas recent cefuroxime (OR 11.7, 95% CI 2.3–60.2, P = 0.003) and glycopeptide therapy (OR 10.9, CI: 2.1–57.2, P = 0.005) associated with ntCdC. Conclusion The incidence of CDAD is highest in patients with tCdC and lowest in patients with ntCdC, and the TLR4 rs1927914 polymorphism GG genotype and recent cefepime therapy were independently associated with tCdC. PMID:23936050

  18. Lyme disease. Recognising and treating erythema migrans.

    PubMed

    2015-10-01

    Lyme disease is a tick-borne bacterial infection caused by Borrelia spirochetes. The first stage of infection involves a characteristic skin lesion, erythema migrans. Erythema migrans is a ring-shaped skin lesion, centred on the bite, which expands outwards. It usually appears within two weeks after a bite from an infected tick. If left untreated, the infection sometimes extends or progresses over a period of months or years, leading to potentially severe neurological, articular, cutaneous and cardiac complications. How is erythema migrans associated with Lyme disease recognised and managed? We conducted a systematic review of the literature using the standard Prescrire methodology. This review does not address the complications of Lyme disease. Diagnosis of erythema migrans is based on clinical findings in a patient with a possible or confirmed recent tick bite. Serological tests are not useful at this stage of the infection. Antibiotics shown to be active in vitro also proved effective in non-comparative trials. In randomised trials, amoxicillin, doxycycline, cefuroxime and ceftriaxone had similar efficacy, clearing signs and symptoms in about 90% of patients, with a relapse rate of less than 5% at 6 months. Azithromycin, clarithromycin, erythromycin, three macrolide antibiotics, appear to have lower efficacy. Doxycycline should not be used to treat pregnant or breast-feeding women, or children under 8 years old, due to a risk of tooth and bone disorders in children. In practice, a diagnosis of erythema migrans should be borne in mind when a patient presents with recent history of a possible or confirmed tick bite and skin lesions suggestive of erythema migrans. Oral amoxicillin or doxycycline will prevent progression of the infection to the potentially severe, later stages of Lyme disease. Routine antibiotic prophylaxis is not justified after a tick bite, even in an endemic area, as the risk of infection is low. It is best to monitor the skin around the bite and to prescribe an antibiotic only if erythema migrans develops, thus avoiding unnecessary treatment and adverse effects. PMID:26594731

  19. Risk of Acute Liver Injury Associated with the Use of Moxifloxacin and Other Oral Antimicrobials: A Retrospective, Population-Based Cohort Study

    PubMed Central

    Kaye, James A; Castellsague, Jordi; Bui, Christine L; Calingaert, Brian; McQuay, Lisa J; Riera-Guardia, Nuria; Saltus, Catherine W; Quinlan, Scott; Holick, Crystal N; Wahl, Peter M; Suzart, Kiliana; Rothman, Kenneth J; Wallander, Mari-Ann; Perez-Gutthann, Susana

    2014-01-01

    Study Objective To estimate the incidence and relative risk of a hospitalization or emergency visit for noninfectious liver injury in users of eight oral antimicrobialsamoxicillin, amoxicillin-clavulanic acid, clarithromycin, cefuroxime, doxycycline, levofloxacin, moxifloxacin, telithromycincompared with nonusers of these antimicrobials. Design Retrospective, observational cohort study with a nested case-control analysis. Data Source HealthCore Integrated Research Database. Patients Adults with continuous health plan enrollment for at least 6months before study entry who had a new dispensing of a study antimicrobial between July 1, 2001, and March 31, 2009. Cases had diagnoses indicating noninfectious liver injury during follow-up. To control for potentially confounding risk factors, 10 controls at risk for liver injury during follow-up were matched to each case by age, sex, and event date (liver injury date of the case), and analyses were adjusted for medical history, concomitant drugs, and health care service use. Measurements and Main Results Two physician reviewers (blind to exposure) validated the cases. Among 1.3 million antimicrobial users, we identified 607 cases of liver injury, including 82 cases of severe hepatocellular injury and 11 cases of liver failure. Liver injury incidence in nonusers of study antimicrobials was 35/100,000 person-years (95% confidence interval [CI] 2942/100,000 person-years). For valid cases, the adjusted relative risk among current users of multiple antimicrobials was 3.2 (95% CI 1.66.7). Levofloxacin had the highest relative risk for current single use (3.2, 95% CI 1.85.8). Relative risks were also elevated for amoxicillin-clavulanic acid (2.5, 95% CI 1.35.0), doxycycline (2.5, 95% CI 1.25.2), moxifloxacin (2.3, 95% CI 1.14.7), and amoxicillin (2.3, 95% CI 1.14.7). Conclusion The results support a comparatively high adjusted relative risk of liver injury among patients exposed concurrently to multiple antimicrobials and modest elevations in the risk for several antimicrobials used alone; however, we found little evidence of any strong effect of commonly used antimicrobials on the risk of liver injury. PMID:24865821

  20. No Outbreak of Vancomycin and Linezolid Resistance in Staphylococcal Pneumonia over a 10-Year Period

    PubMed Central

    Yayan, Josef; Ghebremedhin, Beniam; Rasche, Kurt

    2015-01-01

    Background Staphylococci can cause wound infections and community- and nosocomial-acquired pneumonia, among a range of illnesses. Staphylococcus aureus and methicillin-resistant S. aureus (MRSA) have been rapidly increasing as a cause of infections worldwide in recent decades. Numerous reports indicate that S. aureus and MRSA are becoming resistant to many antibiotics, which makes them very dangerous. Therefore, this study retrospectively investigated the resistance to antimicrobial agents in all hospitalized patients suffering from community- or nosocomial-acquired pneumonia due to S. aureus and MRSA. Methods Information from the study groups suffering from either community- or nosocomial-acquired pneumonia caused by S. aureus or MRSA was gathered by searching records from 2004 to 2014 at the HELIOS Clinic Wuppertal, Witten/Herdecke University, Germany. The findings of antibiotic resistance were analyzed after the evaluation of susceptibility testing for S. aureus and MRSA. Results Total of 147 patients (63.9%, 95% CI 57.5%–69.8%), mean age 67.9 ± 18.5 years, with pneumonia triggered by S. aureus, and 83 patients (36.1%, 95% CI 30.2%–42.5%), mean age 72.3 ± 13.8 years, with pneumonia due to MRSA. S. aureus and MRSA developed no resistance to vancomycin (P = 0.019 vs. < 0.0001, respectively) or linezolid (P = 0.342 vs. < 0.0001, respectively). MRSA (95.3%) and S. aureus (56.3%) showed a high resistance to penicillin. MRSA (87.7%) was also found to have a high antibiotic resistance against ß-lactam antibiotics, compared to S. aureus (9.6%). Furthermore, MRSA compared to S. aureus, respectively, had increased antibiotic resistance to ciprofloxacin (90.1% vs. 17.0%), cefazolin (89.7% vs. 10.2%), cefuroxime (89.0% vs. 9.1%), levofloxacin (88.2% vs. 18.4%), clindamycin (78.0% vs. 14.7%), and erythromycin (76.5% vs. 20.8%). Conclusion No development of resistance was found to vancomycin and linezolid in patients with pneumonia caused by S. aureus and MRSA. PMID:26398276

  1. Antimicrobial prophylaxis in patients with colorectal lesions undergoing endoscopic resection

    PubMed Central

    Zhang, Qi-Sheng; Han, Bing; Xu, Jian-Hua; Gao, Peng; Shen, Yu-Cui

    2015-01-01

    AIM: To investigate the effect of prophylaxis with antibiotics on clinical adverse events in patients who underwent endoscopic submucosal dissection (ESD) or endoscopic mucosal resection (EMR) for colorectal lesions. METHODS: From June 2011 to December 2013, a total of 428 patients were enrolled into the study, of which 214 patients admitted to hospital underwent EMR or ESD procedures. These patients were randomized to an antibiotic group, in which patients were given cefuroxime 1.5 g iv half an hour before and 6 h after surgery respectively, and a control group, in which patients were not given any antibiotic. A further 214 outpatients with small polyps treated by polypectomy were compared with controls that were matched by age and gender, and operations were performed as outpatient surgery. Recorded patient parameters were demographics, characteristics of lesions and treatment modality, and the size of the wound area. The primary outcome measures were clinical adverse events, including abdominal pain, diarrhea, hemotachezia, and fever. Secondary outcome measures were white blood cell count, C-reactive protein and blood culture. Additionlly, the relationship between the size of the wound area and clinical adverse events was analyzed. RESULTS: A total of 409 patients were enrolled in this study, with 107 patients in the control group, 107 patients in the antibiotic group, and another 195 cases in the follow-up outpatient group. The patients demographic characteristics, including age, gender, characteristics of lesions, treatment modality, and the size of the wound area were similar between the 2 groups. The rates of adverse events in the antibiotic group were significantly lower than in the control group: abdominal pain (2.8% vs 14.9%, P < 0.01), diarrhea (2.0% vs 9.3%, P < 0.05), and fever (0.9% vs 8.4%, P < 0.05) respectively. The levels of inflammatory markers also decreased significantly in the antibiotic group compared with the control group: leukocytosis (2.0% vs 11.2%, P < 0.01), and C-reactive protein (2.0% vs 10.7%, P < 0.05). Additionally, clinical adverse events were related to the size of the surgical wound area. When the surgical wound area was larger than 10 mm 10 mm, there were more clinical adverse events. CONCLUSION: Clinical adverse events are not uncommon after EMR or ESD procedures. Prophylactic antibiotics can reduce the incidence of clinical adverse events. This should be further explored. PMID:25914483

  2. Characterization of beta-lactamases from non-Bacteroides fragilis group Bacteroides spp. belonging to seven species and their role in beta-lactam resistance.

    PubMed Central

    Appelbaum, P C; Philippon, A; Jacobs, M R; Spangler, S K; Gutmann, L

    1990-01-01

    Twelve beta-lactamase-positive non-Bacteroides fragilis group Bacteroides spp. belonging to seven different species were examined by MIC determination and enzyme characterization. MICs of most beta-lactams except cefoxitin, cefotetan, imipenem, and meropenem were relatively high or very high. All enzymes hydrolyzed cephaloridine (Vmax, 100%; Km, 12 to 70 microM), cephalothin (Vmax, 25 to 826%; Km, 8 to 143 microM), cefamandole (Vmax, 13 to 158%; Km, 17 to 170 microM), and cefuroxime (hydrolysis rate, 19 to 98%), and 11 of 12 hydrolyzed cefotaxime (Vmax, 26 to 145%; Km, 13 to 127 microM); no hydrolysis of cefoxitin or moxalactam was observed. Penicillins were hydrolyzed at lower rates, with Vmax values less than or equal to 20% of that obtained with cephaloridine. Addition of clavulanate, sulbactam, or tazobactam led to a 4- to 2,048-fold lowering of MICs of penicillins as well as cephalosporins. All enzymes were inhibited by clavulanate (50% inhibitory concentration [IC50], 0.01 to 1.8 microM), sulbactam (IC50, 0.02 to 1.9 microM), tazobactam (IC50, 0.001 to 0.9 microM), cefoxitin (IC50, 0.002 to 0.35 microM), and moxalactam (IC50, 0.03 to 6.6 microM). No enzymes were inhibited by 100 microM EDTA or p-chloromercuribenzoic acid; an enzyme of one strain of B. loescheii was inhibited by 100 microM cloxacillin (IC50, 2.35 microM). Ten enzymes had optimal activity at pH 5.0 to 6.0, and two had optimal activity at pH 8.0. Isoelectric focusing revealed pIs between 4.2 and 5.6. These enzymes seem to belong to a previously unclassified group of beta-lactamases, related (but not identical) to beta-lactamases of the B. fragilis group. Images PMID:2073107

  3. Phylogenetic Distribution of Virulence Genes Among ESBL-producing Uropathogenic Escherichia coli Isolated from Long-term Hospitalized Patients

    PubMed Central

    Zhao, Ruike; Shi, Jinfang; Shen, Yimin; Li, Yanmeng; Han, Qingzhen; Zhang, Xianfeng; Gu, Guohao

    2015-01-01

    Objectives The present study was aimed to investigate the antibiotic resistance, virulence potential and phylogenetic grouping of ESBL-producing uropathogenic Escherichia coli (EP-UPEC) isolated from long-term hospitalized patients. Materials and Methods EP-UPEC isolates from September 2013 to June 2014 at a tertiary care hospital of China were screened for ESBL-production by the double disk diffusion test. Isolates with ESBL-phenotype were further characterized by antibiotic resistance testing, PCR of different ESBL and virulence genes, and phylogenetic grouping. Results One hundred and twenty EP-UPEC were isolated from long-term hospitalized patients. All EP-UPEC isolates were resistant to Ampicillin, Cefazolin, Cefuroxime, Cefotaxime, Cefoperazone and Ceftriaxone, and the majority of EP-UPEC isolates were resistant to Piperacillin (82.5%), Ciprofloxacin (81.2%), Trimethoprim-Sulfamethoxazole (72.5%). The isolates showed the highest sensitivity against Imipenem (98.4%), Piperacillin/tazobactam (96.7%), Cefoperazone/sulbactam (91.7%), Amikacin (90.8%) and Cefepime (75.8%). Nine different ESBL genotype patterns were observed and CTX-M type was the most prevalent ESBL genotype (42.5%, 51/120). Majority of EP-UPEC isolates possess more than one ESBL genes. EP-UPEC isolates belonged mainly to phylogenetic group B2(36.7%) and D(35.0%). The prevalence of traT, ompT, iss, PAI, afa, fimH and papC were 75.8%, 63.3%, 63.3%, 60.8%, 40.8%, 19.2% and 6.7%, respectively. The number of virulence genes (VGs) detected was significantly higher in group B2 than in group A (ANOVA, p<0.001), group B1(ANOVA, p= 0.012) and D (ANOVA, p<0.001). Conclusions EP-UPEC strains showed multidrug resistance and co-resistance to other non ?-lactam antibiotics. CTX-M was the most prevalent ESBL genotype and majority of EP-UPEC strains more than one ESBL genes. EP-UPEC strains belonged mainly to phylogenetic group B2 and D, and most of the virulence genes were more prevalent in group B2. PMID:26393125

  4. [Rectusbanding by polypropylene-mesh--a new method for incisional hernia repair].

    PubMed

    Kubo, G; Rose, J

    2002-07-01

    We report on a new method of incisional hernia repair applicable to any size. With exception of an area 1 cm medial of the m. rectus abdominis where the strip penetrates the anterior wall of the rectus sheath for a better fixation, the muscle ist looped in a loose way with a 2 cm wide band of polypropylene (Prolene(R)) on both sides at a distance of 2 cm depending on the size of the hernial opening. Different models of strips were used in 27 % of the cases adapted to anatomical particularities of the hernial opening. Anterior and posterior wall of the rectus sheath are closed by a continuous panacryl suture which covers the strip. Because of the wide subcutaneous excavation extending to the lateral margin of the rectus sheath an extensive drainage by Redon-Drainages as well as compression bandages are important therapeutical procedures until formation of seromas has finished. For perioperative antibiotic prophylaxis we used Cefuroxime (3 x 1,5 i. v.). From 07/1999 until 10/2001 75 patients underwent an operation in our department. The direct postoperative complications observed were: Seroma formation up to 300 ml after discharge in 5 patients (6,6 %) and wound infections in 2 patients (2,8 %). In none of the cases the mesh had to be removed. In a follow-up period of 6 to 24 months we found 2 recurrences in 60 patients (3,3 %). These were related to technical failures of the beginning. 64.9 % of the patients were free of complaints after 6 months and almost 96 % after one year. Only 3 patients (4 %) had to take analgetic drugs occasionally. With regard to the mobility of the abdominal wall we found no measurable limitation. The method of Rectusbanding is easy to learn for every surgeon and with little material the mesh-strip can be fixed safely. It can be cut to individual sizes and shapes adapted to the fascial proportions of the hernial opening. PMID:12122585

  5. Prevalence, Pathogenesis, Antibiotic Susceptibility Profiles, and In-vitro Activity of Selected Medicinal Plants Against Aeromonas Isolates from Stool Samples of Patients in the Venda Region of South Africa

    PubMed Central

    Obi, C.L.; Ramalivhana, J.; Samie, A.; Igumbor, E.O.

    2007-01-01

    The prevalence, pathogenic indices, such as haemolytic and haemagglutinating activities, antibiograms, and in-vitro activities of local medicinal plants against Aeromonas isolates in Vhembe district of Limpopo province, South Africa, were studied using standard microbiological methods. In total, 309 diarrhoeic stool samples were collected from patients attending five health centres in the region during December 2004–May 2005. Aeromonas species were identified using the API 20E system. The haemagglutinating and haemolytic activities of isolates on human, sheep, pig and chicken red blood cells were investigated. Antibiotic susceptibility profiles of the isolates to several antibiotics and in-vitro activity of local medicinal plants were also ascertained using previously-reported schemes. Results showed that 104 (33.6%) of the 309 samples were positive for Aeromonas species, of which 89 (85.6%) were Aeromonas hydrophila, 12 (11.5%) A. sobria, and three (2.9%) A. caviae. All strains of A. hydrophila and A. caviae produced haemolysis on sheep blood, while eight of the 12 A. sobria strains were haemolytic on sheep blood. The haemolytic activities of the isolates were variable on other red blood cells tested. High level of resistance was observed to amoxicillin and ampicillin, followed by cefuroxime (79%), chloramphenicol (74%), and erythromycin (65%). The carbapenems were the most active drugs with only 7% resistance to meropenem and 11% to imipenem. About 12% of the isolates were resistant to ciprofloxacin. The extracts of three of seven medicinal plants tested showed inhibitory activity against all Aeromonas isolates; these included acetone and hexane extracts of Pterocarpus angolensis, Syzygium cordatum, and Zornia milneana. The results suggest a high prevalence of Aeromonas species in the region. The isolates demonstrated multiple resistant profiles to different antibiotics tested. Some local medicinal plants were inhibitory to Aeromonas isolates, indicating a potential role in the management of Aeromonas-related infections. Structural elucidation of the active components may pave the way for the discovery of candidate templates for eventual drug design. Most isolates possessed important virulence characteristics based on their haemolytic and haemagglutinating ability. However, the genetic characterization of the isolates will further confirm their pathogenicity and the origin of multiple antibiotic resistance. PMID:18402186

  6. Diversity and antibiograms of bacterial organisms isolated from samples of household drinking-water consumed by HIV-positive individuals in rural settings, South Africa.

    PubMed

    Samie, A; Mashao, M B; Bessong, P O; NKgau, T F; Momba, M N B; Obi, C L

    2012-09-01

    Diarrhoea is a hallmark of HIV infections in developing countries, and many diarrhoea-causing agents are often transmitted through water. The objective of the study was to determine the diversity and antibiotic susceptibility profiles of bacterial organisms isolated from samples of household drinking-water consumed by HIV-infected and AIDS patients. In the present study, household water stored for use by HIV-positive patients was tested for microbial quality, and isolated bacterial organisms were analyzed for their susceptibility profiles against 25 different antibiotics. The microbial quality of water was generally poor, and about 58% of water samples (n=270) were contaminated with faecal coliforms, with counts varying from 2 colony-forming unit (CFU)/100 mL to 2.4x10? CFU/100 mL. Values of total coliform counts ranged from 17 CFU/100 mL to 7.9x10?/100 mL. In total, 37 different bacterial species were isolated, and the major isolates included Acinetobacter lwoffii (7.5%), Enterobacter cloacae (7.5%), Shigella spp. (14.2%), Yersinia enterocolitica (6.7%), and Pseudomonas spp. (16.3%). No Vibrio cholerae could be isolated; however, V. fluvialis was isolated from three water samples. The isolated organisms were highly resistant to cefazolin (83.5%), cefoxitin (69.2%), ampicillin (66.4%), and cefuroxime (66.2%). Intermediate resistance was observed against gentamicin (10.6%), cefepime (13.4%), ceftriaxone (27.6%), and cefotaxime (29.9%). Levofloxacin (0.7%), ceftazidime (2.2%), meropenem (3%), and ciprofloxacin (3.7%) were the most active antibiotics against all the microorganisms, with all recording less than 5% resistance. Multiple drug resistance was very common, and 78% of the organisms were resistant to three or more antibiotics. Education on treatment of household water is advised for HIV-positive patients, and measures should be taken to improve point-of-use water treatment as immunosuppressed individuals would be more susceptible to opportunistic infections. PMID:23082625

  7. Susceptibility of bacterial etiological agents to commonly-used antimicrobial agents in children with sepsis at the Tamale Teaching Hospital

    PubMed Central

    2013-01-01

    Background Bloodstream infections in neonates and infants are life-threatening emergencies. Identification of the common bacteria causing such infections and their susceptibility patterns will provide necessary information for timely intervention. This study is aimed at determining the susceptibilities of bacterial etiological agents to commonly-used antimicrobial agents for empirical treatment of suspected bacterial septicaemia in children. Methods This is a hospital based retrospective analysis of blood cultures from infants to children up to 14 years of age with preliminary diagnosis of sepsis and admitted to the Neonatal Intensive Care Unit (NICU) and Paediatric Wards of the Teaching Hospital Tamale from July 2011 to January 2012. Results Out of 331 blood specimens cultured, the prevalence of confirmed bacterial sepsis was 25.9% (86/331). Point prevalence for confirmed cases from NICU was 44.4% (28/63) and 21.6% (58/268) from the Paediatric ward. Gram positive cocci (GPC) were the predominant isolates with Coagulase positive (32.2%) and Coagulase-negative (28.7%) Staphylococci accounting for 60.9% of the total isolates. Gram negative rods (GNR) comprised 39.1% of all isolates with Klebsiella, E.coli and Salmonella being the most common organisms isolated. Klebsiella was the most frequent GNR from the NICU and Salmonella typhi was predominantly isolated from the paediatric ward. Acinetobacter showed 100.0% susceptibility to Ceftriaxone and Cefotaxime but was resistant (100.0%) to Ampicillin, Tetracycline and Cotrimoxazole. Escherichia coli and Klebsiella were 80.0% and 91.0% susceptible to Ceftriaxone and Cefotaxime respectively. Klebsiella species showed 8.3% susceptibility to Tetracycline but was resistant to Ampicillin and Cotrimoxazole. Escherichia coli showed 40.0% susceptibility to Ampicillin, Chloramphenicol and Cotrimoxazole; 20.0% susceptibility to Tetracycline and 80.0% susceptible to Gentamicin and Cefuroxime. Coagulase negative Staphylococci was susceptible to Gentamicin (72.0%) but Coagulase positive Staphylococci showed intermediate sensitivity to Gentamicin (42.9%). Conclusion Coagulase Negative, Coagulase Positive Staphylococci, Salmonella and Klebsiella were the aetiological agents of bloodstream infection among children at TTH. While gram-positive and gram-negative bacteria showed low susceptibility to Ampicillin, Tetracycline and Cotrimoxazole, the GNR were susceptible to Gentamicin and third-generation cephalosporins. PMID:23419199

  8. Prevalence of Extended Spectrum β-lactamase-Producing Klebsiella pneumoniae in Clinical Isolates

    PubMed Central

    Ali Abdel Rahim, Khalid Abdalla; Ali Mohamed, Ahmed Mohamed

    2014-01-01

    Background: Extended spectrum β-lactamase (ESBL) are gram-negative bacteria that produce the enzyme, β-lactamase, which can break down commonly used antibiotics, such as penicillin and cephalosporins, making infections with ESBL producing bacteria more difficult to treat. Extended spectrum β-lactamase-producing Klebsiella pneumoniae were first reported in 1983 from Germany, and since then a steady increase in resistance against cephalosporins has been seen causing health problems. Objectives: The aim of this study was to determine the prevalence of ESBL in strains of K. pneumoniae isolated from different clinical samples. Patients and Methods: One hundred and thirty isolates of K. pneumoniae were isolated from different clinical specimens from King Khalid hospital, Hafr Elbatin, Kingdom Saudi Arabia. These isolates were then characterized, tested for antimicrobial susceptibility and screened for ESBL production by the MicroScan WalkAway-96 SI System. Extended spectrum β-lactamase production was confirmed by the phenotypic confirmatory disc diffusion test (PCDDT) and the double disc synergy test (DDST). Results: Overall, 76.9% (100) of the isolates were resistant to cefuroxime, cefepime and cefazolin, 69.23% (90) were resistant to cefotaxime, and 46.15% (60) were resistant to cefoxitin. Extended spectrum β-lactamase was detected in 53.8% (70) of K. pneumoniae as detected by the MicroScan “WalkAway-96” SI System and 50.07% (66) by PCDDT and 46.15% (60) by DDST. All K. pneumoniae isolates were resistant to ampicillin followed by both piperacillin and mezlocillin 92.30% (120). K. pneumoniae isolates showed high sensitivity to imipenem (15.38%) (20), followed by ertapenem, tetracycline, tigecycline pipracilline/tazobactam and amikacin (23.07%) (30). Conclusions: Our study showed that the prevalence of ESBL-producing K. pneumoniae at King Khalid Hospital was significantly high. Routine detection of ESBL-producing microorganisms is required by each of the laboratory standard detection methods to control the spread of these infections and allow a proper therapeutic strategy. For detection, the phenotypic confirmatory disc diffusion test is simple, sensitive and cost effective. However, there is a need for larger scale drug susceptibility surveillance. PMID:25774279

  9. Consumption-based approach for predicting environmental risk in Greece due to the presence of antimicrobials in domestic wastewater.

    PubMed

    Iatrou, Evangelia I; Stasinakis, Athanasios S; Thomaidis, Nikolaos S

    2014-11-01

    The main objective of the current study was to estimate the potential environmental risks associated with human consumption of antimicrobials in Greece. Consumption data was collected for the 24 most often used antimicrobials for the years 2008-2010, and their predicted environmental concentrations (PECs) in raw and treated wastewater were calculated using mass balances and literature data on human excretion and elimination efficiency during wastewater treatment. The ecotoxicological risk was estimated by calculating the ratio of PEC to predicted no-effect concentration (PNEC) for three categories of aquatic organisms (algae, daphnids, and fish). PNEC values were calculated based on experimental ecotoxicity data and data originated from the Ecological Structure Activity Relationship (ECOSAR). PEC values in raw sewage ranged between 0.02 μg L(-1) (erythromycin) and 27 μg L(-1) (amoxicillin), while in treated wastewater, the highest concentration was predicted for cefuroxime axetil (6.6 μg L(-1)). Based on acute toxicity data for algae, risk quotient (RQ) values higher than 1 were obtained for 7 out of the 24 target antimicrobials in raw and treated wastewater, while no significant risk was estimated for daphnids and fish. Regarding the possible risk due to the chronic toxicity of antimicrobials, RQ values higher than 80 were obtained for amoxicillin and clarithromycin in algae. The use of baseline toxicity data from ECOSAR showed that the environmental risk from exposure to mixtures of antimicrobials was low for all three aquatic species. However, further studies on toxicity of mixtures should be performed as calculation of toxicity ratio (TR) values showed that 90 % of the target antimicrobials seem to exhibit a specific mode of toxic action when present in mixtures rather than baseline toxicity. As a result, an underestimation of toxicity based on the ECOSAR model is possible for the mixture of target antimicrobials. For Greek rivers where low (dilution factor, D<10) and medium (D=10-100) dilution of wastewater occurs, moderate to high risk is expected due to the existence of individual antimicrobials such as amoxicillin, clarithromycin, ciprofloxacin, azithromycin, erythromycin, and levofloxacin in discharged treated wastewater. PMID:24981036

  10. Bacterial bloodstream infections in HIV-infected adults attending a Lagos teaching hospital.

    PubMed

    Adeyemi, Adeleye I; Sulaiman, Akanmu A; Solomon, Bamiro B; Chinedu, Obosi A; Victor, Inem A

    2010-08-01

    An investigation was carried out during October 2005-September 2006 to determine the prevalence of bloodstream infections in patients attending the outpatient department of the HIV/AIDS clinic at the Lagos University Teaching Hospital in Nigeria. Two hundred and one patients--86 males and 115 females--aged 14-65 years were recruited for the study. Serological diagnosis was carried out on them to confirm their HIV status. Their CD4 counts were done using the micromagnetic bead method. Twenty mL of venous blood sample collected from each patient was inoculated into a pair of Oxoid Signal blood culture bottles for 2-14 days. Thereafter, 0.1 mL of the sample was plated in duplicates on MacConkey, blood and chocolate agar media and incubated at 37 degrees C for 18-24 hours. The CD4+ counts were generally low as 67% of 140 patients sampled had < 200 cells/microL of blood. Twenty-six bacterial isolates were obtained from the blood samples and comprised 15 (58%) coagulase-negative staphylococci as follows: Staphylococcus epidermidis (7), S. cohnii cohnii (1), S. cohnii urealyticum (2), S. chromogenes (1), S. warneri (2), S. scuri (1), and S. xylosus (1). Others were 6 (23%) Gram-negative non-typhoid Salmonella spp., S. Typhimurium (4), S. Enteritidis (2); Pseudomonas fluorescens (1), Escherichia coli (1), Ochrobactrum anthropi (1), Moraxella sp. (1), and Chryseobacterium meningosepticum. Results of antimicrobial susceptibility tests showed that coagulase-negative staphylococci had good sensitivities to vancomycin and most other antibiotics screened but were resistant mainly to ampicilin and tetracycline. The Gram-negative organisms isolated also showed resistance to ampicillin, tetracycline, chloramphenicol, and septrin. This study demonstrates that coagulase-negative staphylococci and non-typhoidal Salmonellae are the most common aetiological agents of bacteraemia among HIV-infected adults attending the Lagos University Teaching Hospital, Nigeria. The organisms were resistant to older-generation antibiotics often prescribed in this environment but were sensitive to vancomycin, cefotaxime, cefuroxime, and other new-generation antibiotics. PMID:20824974

  11. Histopathological Studies on Rabbits Infected by Bacteria Causing Infectious Keratitis in Human through Eye Inoculation

    PubMed Central

    Aldebasi, Yousef H.; Mohamed, Hala A.; Aly, Salah M.

    2014-01-01

    Aim This study aimed to investigate the pathogenic effect of bacteria causing infectious keratitis among patients through experimental study conducted on rabbits eyes with the aid of histopathology as eye infection is a common disease in developing countries that may complicate to loss of vision. Methodology 100 swab samples were collected from human infected eyes, at Qassim region during 2012, for the isolation of Pseudomonas aeruginosa and Staphylococcus aureus. The isolated pathogenic bacteria were tested to various antibiotics using some selected antibiotics discs through agar-well diffusion method. Then, experimental study conducted on 27 rabbits. The rabbits were divided randomly into three equal groups, each containing 9 rabbits. Rabbits of group (1) served as control group (Negative Control) and their eyes were inoculated with the buffer only. Rabbits of group (2) were inoculated through eyes with the isolated Pseudomonas aeruginosa. Rabbits of group (3) were inoculated through eyes with the isolated Staphylococcus aureus. Results Out of 100 collected swab samples from human infected eyes, Pseudomonas aeruginosa and Staphylococcus aureus were isolated with a total percentage of 25.21% and 15.65%; respectively and used in this study. Both bacterial isolates were sensitive to Gentamicin and Cefuroxime. Clinically, experimentally infected rabbits by Pseudomonas aeruginosa, revealed varying degree corneal abrasions, corneal abscess and dense corneal opacity. Histopathologically, at 3rd day post-infection (PI), the cornea revealed polymorpho-nuclear cells infiltration with loss of the outer epithelial lining. At 7th day PI, neutrophils were seen in the stroma. At 15th day PI, proliferation of fibroblasts and new vascularisation were seen in the stroma. Clinically, rabbits experimentally infected with Staphylococcus aureus, revealed corneal ulcers and focal abscesses. Histopathologically, at 3rd and 7th day PI, the cornea revealed edema and infiltration of leukocytes. At 15th day PI, hyperplasia of corneal epithelium and proliferation of keratocytes were evident. The liver and kidneys of experimented rabbits revealed no remarkable histopathological alterations along the period of experiment. Conclusion Pseudomonas aeruginosa and Staphylococcus aureus are common eye infection in human, both induced severe lesions in the eyes of rabbits that could interfere with vision, therefore, strict measures to control these infections in human is recommended. PMID:25505861

  12. An In Vitro Deletion in ribE Encoding Lumazine Synthase Contributes to Nitrofurantoin Resistance in Escherichia coli

    PubMed Central

    Vervoort, Jascha; Xavier, Basil Britto; Stewardson, Andrew; Coenen, Samuel; Godycki-Cwirko, Maciek; Adriaenssens, Niels; Kowalczyk, Anna; Lammens, Christine; Harbarth, Stephan; Goossens, Herman

    2014-01-01

    Nitrofurantoin has been used for decades for the treatment of urinary tract infections (UTIs), but clinically significant resistance in Escherichia coli is uncommon. Nitrofurantoin concentrations in the gastrointestinal tract tend to be low, which might facilitate selection of nitrofurantoin-resistant (NIT-R) strains in the gut flora. We subjected two nitrofurantoin-susceptible intestinal E. coli strains (ST540-p and ST2747-p) to increasing nitrofurantoin concentrations under aerobic and anaerobic conditions. Whole-genome sequencing was performed for both susceptible isolates and selected mutants that exhibited the highest nitrofurantoin resistance levels aerobically (ST540-a and ST2747-a) and anaerobically (ST540-an and ST2747-an). ST540-a/ST540-an and ST2747-a (aerobic MICs of >64 ?g/ml) harbored mutations in the known nitrofurantoin resistance determinants nfsA and/or nfsB, which encode oxygen-insensitive nitroreductases. ST2747-an showed reduced nitrofurantoin susceptibility (aerobic MIC of 32 ?g/ml) and exhibited remarkable growth deficits but did not harbor nfsA/nfsB mutations. We identified a 12-nucleotide deletion in ribE, encoding lumazine synthase, an essential enzyme involved in the biosynthesis of flavin mononucleotide (FMN), which is an important cofactor for NfsA and NfsB. Complementing ST2747-an with a functional wild-type lumazine synthase restored nitrofurantoin susceptibility. Six NIT-R E. coli isolates (NRCI-1 to NRCI-6) from stools of UTI patients treated with nitrofurantoin, cefuroxime, or a fluoroquinolone harbored mutations in nfsA and/or nfsB but not ribE. Sequencing of the ribE gene in six intestinal and three urinary E. coli strains showing reduced nitrofurantoin susceptibility (MICs of 16 to 48 ?g/ml) also did not identify any relevant mutations. NRCI-1, NRCI-2, and NRCI-5 exhibited up to 4-fold higher anaerobic MICs, compared to the mutants generated in vitro, presumably because of additional mutations in oxygen-sensitive nitroreductases. PMID:25246406

  13. An in vitro deletion in ribE encoding lumazine synthase contributes to nitrofurantoin resistance in Escherichia coli.

    PubMed

    Vervoort, Jascha; Xavier, Basil Britto; Stewardson, Andrew; Coenen, Samuel; Godycki-Cwirko, Maciek; Adriaenssens, Niels; Kowalczyk, Anna; Lammens, Christine; Harbarth, Stephan; Goossens, Herman; Malhotra-Kumar, Surbhi

    2014-12-01

    Nitrofurantoin has been used for decades for the treatment of urinary tract infections (UTIs), but clinically significant resistance in Escherichia coli is uncommon. Nitrofurantoin concentrations in the gastrointestinal tract tend to be low, which might facilitate selection of nitrofurantoin-resistant (NIT-R) strains in the gut flora. We subjected two nitrofurantoin-susceptible intestinal E. coli strains (ST540-p and ST2747-p) to increasing nitrofurantoin concentrations under aerobic and anaerobic conditions. Whole-genome sequencing was performed for both susceptible isolates and selected mutants that exhibited the highest nitrofurantoin resistance levels aerobically (ST540-a and ST2747-a) and anaerobically (ST540-an and ST2747-an). ST540-a/ST540-an and ST2747-a (aerobic MICs of >64 μg/ml) harbored mutations in the known nitrofurantoin resistance determinants nfsA and/or nfsB, which encode oxygen-insensitive nitroreductases. ST2747-an showed reduced nitrofurantoin susceptibility (aerobic MIC of 32 μg/ml) and exhibited remarkable growth deficits but did not harbor nfsA/nfsB mutations. We identified a 12-nucleotide deletion in ribE, encoding lumazine synthase, an essential enzyme involved in the biosynthesis of flavin mononucleotide (FMN), which is an important cofactor for NfsA and NfsB. Complementing ST2747-an with a functional wild-type lumazine synthase restored nitrofurantoin susceptibility. Six NIT-R E. coli isolates (NRCI-1 to NRCI-6) from stools of UTI patients treated with nitrofurantoin, cefuroxime, or a fluoroquinolone harbored mutations in nfsA and/or nfsB but not ribE. Sequencing of the ribE gene in six intestinal and three urinary E. coli strains showing reduced nitrofurantoin susceptibility (MICs of 16 to 48 μg/ml) also did not identify any relevant mutations. NRCI-1, NRCI-2, and NRCI-5 exhibited up to 4-fold higher anaerobic MICs, compared to the mutants generated in vitro, presumably because of additional mutations in oxygen-sensitive nitroreductases. PMID:25246406

  14. Antimicrobial susceptibility of respiratory isolates of Enterobacteriaceae and Staphylococcus aureus in Italy: incidence and trends over the period 1997-1999.

    PubMed

    Fontana, R; Lo Cascio, G; Ligozzi, M; Friscia, O; Oldoni, T

    2001-12-01

    The antibiotic susceptibility of members of the family Enterobacteriaceae and of Staphylococcus aureus strains isolated from the respiratory tract was assessed over the period 1997-1999 as part of the Italian Epidemiological Observatory survey sponsored by the Smith-Kline Foundation. A standardised method was used to determine the MICs of 22 antibiotics against isolates of Klebsiella pneumoniae (n=870), Escherichia coli (n=684), Enterobacter cloacae (n=342), Enterobacter aerogenes (n=187) and Serratia marcescens (n=135) as well as the MICs of 11 antibiotics against isolates of Staphylococcus aureus (n=1,606). Overall, the susceptibility rate of Enterobacteriaceae isolates was > or = 90% to 5 agents (meropenem, imipenem, amikacin, cefepime and gentamicin); 89-80% to 2 agents (ciprofloxacin and tobramycin); and <80% to 11 agents (cefotaxime, piperacillin-tazobactam, trimethoprim-sulfamethoxazole, cefetamet, ceftriaxone, ceftazidime, aztreonam, ticarcillin-clavulanate, tetracycline, piperacillin, cefuroxime, chloramphenicol, ticarcillin, amoxicillin-clavulanate and amoxicillin). During the 3-year monitoring period, antibiotic susceptibility increased in Klebsiella pneumoniae against amoxicillin-clavulanate, in Escherichia coli against third-generation cephalosporins and aztreonam, in Enterobacter aerogenes against amoxicillin and piperacillin-tazobactam and in Serratia marcescens against most of the antibiotics. In contrast, Enterobacter cloacae showed a tendency to develop resistance to cefetamet, amikacin and ciprofloxacin. Of the total number of Staphylococcus aureus strains, 38% were methicillin resistant. Nearly 80% of the methicillin-resistant strains displayed a multiresistance pattern (additional resistance to 2 or more non-beta-lactam antibiotics). Rates of susceptibility of particular species (Klebsiella pneumoniae, Escherichia coli, Staphylococcus aureus) were compared using strains from different geographical areas of Italy (northern, central and southern) and from different nosocomial areas (outpatients, intensive care unit [ICU] inpatients, non-ICU inpatients). Susceptibility of Klebsiella pneumoniae to several antibiotics was lower in southern Italy, whereas the incidence of methicillin-resistant strains was higher in northern and central Italy. The susceptibility of Escherichia coli was similar in all three areas. No significant differences in susceptibility of Klebsiella pneumoniae or Escherichia coli were found between strains from inpatients and outpatients or from inpatients admitted to ICU and non-ICU units. The incidence of methicillin-resistant Staphylococcus aureus was higher in ICU inpatients (52%) than in non-ICU inpatients (38%) and lower in outpatients (19%) than in inpatients. PMID:11837636

  15. [Tonsillitis and sore throat in childhood].

    PubMed

    Stelter, K

    2014-03-01

    Surgery of the tonsils is still one of the most frequent procedures during childhood. Due to a series of fatal outcome after hemorrhage in children in Austria in 2006, the standards and indications for tonsillectomy slowly change in Germany since that. However, there exist no national guidelines and the frequency of tonsil surgery varies in the country. In some districts eight times more children were tonsillectomized than in others. A tonsillectomy in children under 6 years should only be done if the child suffers from recurrent acute bacterially tonsillitis. In all other cases (i. e. hyperplasia of the tonsils) the low risk partial tonsillectomy should be the first line therapy. Postoperative pain and the risk of hemorrhage are much lower in partial tonsillectomy (=?tonsillotomy). No matter whether the tonsillotomy is done by laser, radiofrequency, shaver, coblation, bipolar scissor or Colorado needle, as long as the crypts are kept open and some tonsil tissue is left behind. Total extracapsular tonsillectomy is still indicated in severely affected children with recurrent infections of the tonsils, allergy to antibiotics, PFAPA syndrome (periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis) and peritonsillar abscess. With regard to the frequency and seriousness of the recurrent tonsillitis the indication for tonsillectomy in children is justified if 7 or more well-documented, clinically important, adequately treated episodes of throat infection occur in the preceding year, or 5 or more such episodes occur in each of the 2 preceding years (according to the paradise criteria). Diagnosis of acute tonsillitis is clinical, but sometimes it is hard to distinguish viral from bacterial infections. Rapid antigen testing has a very low sensitivity in the diagnosis of bacterial tonsillitis and swabs are highly sensitive but take a long time. In all microbiological tests the treating physician has to keep in mind, that most of the bacterials, viruses and fungi belong to the healthy flora and do no harm. Ten percent of the healthy children bear even streptococcus pyogenes all the time in the tonsils with no clinical signs. In these children decolonization is not necessary. Therefore, microbiological screening tests in children without symptoms are senseless and do not justify an antibiotic treatment (which is sometimes postulated by the kindergartens). The acute tonsillitis should be treated with steroids (e.g. dexamethasone), NSAIDs (e.g. ibuprofene) and betalactam antibiotics (e.g. penicillin or cefuroxime). With respect to the symptom reduction and primary healing the short-term late-generation antibiotic therapy (azithromycin, clarithromycin or cephalosporine for 3 to 5 days) is comparable to the long-term penicilline therapy. There is no difference in the course of healing, recurrence or microbiological resistance between the short-term penicilline therapy to the standard 10 days therapy, as well. On the other hand, only the 10 days antibiotic therapy has prooven to be effective in the prevention of rheumatic fever and glomerulonephritic diseases. The incidence of rheumatic heart disease is currently 0.5 per 100.000 children in school age. The main morbidity after tonsillectomy is pain and the late hemorrhage. Posttonsillectomy bleeding can occur till the whole wound is completely healed, which is normally after 3 weeks. Life-threatening hemorrhages occur often after smaller bleedings, which can spontaneously cease. That is why every hemorrhage, even the smallest, has to be treated properly and in ward. Patients and parents have to be informed about the correct behavior in case of hemorrhage with a written consent before the surgery. The handout should contain important adresses, phone numbers and contact persons. Almost all cases of fatal outcome after tonsillectomy were due to false management of hemorrhage. Especially in small children hemorrhage can be life-threatening because of the lower blood volume and the danger of aspiration with asphyxia. A massive hemorrhage is an extreme challenge for every pa

  16. Tonsillitis and sore throat in children.

    PubMed

    Stelter, Klaus

    2014-01-01

    Surgery of the tonsils is still one of the most frequent procedures during childhood. Due to a series of fatal outcomes after hemorrhage in children in Austria in 2006, the standards and indications for tonsillectomy have slowly changed in Germany. However, no national guidelines exist and the frequency of tonsil surgery varies across the country. In some districts eight times more children were tonsillectomized than in others. A tonsillectomy in children under six years should only be done if the child suffers from recurrent acute bacterially tonsillitis. In all other cases (i.e. hyperplasia of the tonsils) the low risk partial tonsillectomy should be the first line therapy. Postoperative pain and the risk of hemorrhage are much lower in partial tonsillectomy (=tonsillotomy). No matter whether the tonsillotomy is done by laser, radiofrequency, shaver, coblation, bipolar scissor or Colorado needle, as long as the crypts are kept open and some tonsil tissue is left behind. Total extracapsular tonsillectomy is still indicated in severely affected children with recurrent infections of the tonsils, allergy to antibiotics, PFAPA syndrome (periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis) and peritonsillar abscess. With regard to the frequency and seriousness of the recurrent tonsillitis the indication for tonsillectomy in children is justified if 7 or more well-documented, clinically important, adequately treated episodes of throat infection occur in the preceding year, or 5 or more of such episodes occur in each of the 2 preceding years (according to the paradise criteria). Diagnosis of acute tonsillitis is clinical, but sometimes it is hard to distinguish viral from bacterial infections. Rapid antigen testing has a very low sensitivity in the diagnosis of bacterial tonsillitis and swabs are highly sensitive but take a long time. In all microbiological tests the treating physician has to keep in mind, that most of the bacterials, viruses and fungi belong to the healthy flora and do no harm. Ten percent of healthy children even bear strepptococcus pyogenes all the time in the tonsils with no clinical signs. In these children decolonization is not necessary. Therefore, microbiological screening tests in children without symptoms are senseless and do not justify an antibiotic treatment (which is sometimes postulated by the kindergartens). The acute tonsillitis should be treated with steroids (e.g. dexamethasone), NSAIDs (e.g. ibuprofene) and betalactam antibiotics (e.g. penicillin or cefuroxime). With respect to the symptom reduction and primary healing the short-term late-generation antibiotic therapy (azithromycin, clarithromycin or cephalosporine for three to five days) is comparable to the long-term penicilline therapy. There is no difference in the course of healing, recurrence or microbiological resistance between the short-term penicilline therapy and the standard ten days therapy. On the other hand, only the ten days antibiotic therapy has proven to be effective in the prevention of rheumatic fever and glomerulonephritic diseases. The incidence of rheumatic heart disease is currently 0.5 per 100,000 children of school age. The main morbidity after tonsillectomy is pain and the late haemorrhage. Posttonsillectomy bleeding can occur till the whole wound is completely healed, which is normally after three weeks. Life-threatening haemorrhages occur often after smaller bleedings, which can spontaneously cease. That is why every haemorrhage, even the smallest, has to be treated properly and in ward. Patients and parents have to be informed about the correct behaviour in case of haemorrhage with a written consent before the surgery. The handout should contain important addresses, phone numbers and contact persons. Almost all cases of fatal outcome after tonsillectomy were due to false management of haemorrhage. Haemorrhage in small children can be especially life-threatening because of the lower blood volume and the danger of aspiration with asphyxia. A massive haemorrhage is an extreme challenge for eve

  17. Different antibiotic regimens for treating asymptomatic bacteriuria in pregnancy

    PubMed Central

    Guinto, Valerie T; De Guia, Blanca; Festin, Mario R; Dowswell, Therese

    2014-01-01

    Background Asymptomatic bacteriuria occurs in 5% to 10% of pregnancies and, if left untreated, can lead to serious complications. Objectives To assess which antibiotic is most effective and least harmful as initial treatment for asymptomatic bacteriuria in pregnancy. Search methods We searched the Cochrane Pregnancy and Childbirth Group’s Trials Register (March 2010) and reference lists of retrieved studies. Selection criteria Randomized controlled trials comparing two antibiotic regimens for treating asymptomatic bacteriuria. Data collection and analysis Review authors independently screened the studies for inclusion and extracted data. Main results We included five studies involving 1140 women with asymptomatic bacteriuria. We did not perform meta-analysis; each trial examined different antibiotic regimens and so we were not able to pool results. In a study comparing a single dose of fosfomycin trometamol 3 g with a five-day course of cefuroxime, there was no significant difference in persistent infection (risk ratio (RR) 1.36, 95% confidence interval (CI) 0.24 to 7.75), shift to other antibiotics (RR 0.08, 95% CI 0.00 to 1.45), or in allergy or pruritus (RR 2.73, 95% CI 0.11 to 65.24). A comparison of seven-day courses of 400 mg pivmecillinam versus 500 mg ampicillin, both given four times daily, showed no significant difference in persistent infection at two weeks or recurrent infection, but there was an increase in vomiting (RR 4.57, 95% CI 1.40 to 14.90) and women were more likely to stop treatment early with pivmecillinam (RR 8.82, 95% CI 1.16 to 66.95). When cephalexin 1 g versus Miraxid® (pivmecillinam 200 mg and pivampicillin 250 mg) were given twice-daily for three days, there was no significant difference in persistent or recurrent infection. A one- versus seven-day course of nitrofurantoin resulted in more persistent infection with the shorter course (RR 1.76, 95% CI 1.29 to 2.40), but no significant difference in symptomatic infection at two weeks, nausea, or preterm birth. Comparing cycloserine with sulphadimidine, no significant differences in symptomatic, persistent, or recurrent infections were noted. Authors’ conclusions We cannot draw any definite conclusion on the most effective and safest antibiotic regimen for the initial treatment of asymptomatic bacteriuria in pregnancy. One study showed advantages with a longer course of nitrofurantoin, and another showed better tolerability with ampicillin compared with pivmecillinam; otherwise, there was no significant difference demonstrated between groups treated with different antibiotics. Given this lack of conclusive evidence, it may be useful for clinicians to consider factors such as cost, local availability and side effects in the selection of the best treatment option. PMID:20824868

  18. Comparison of the incidence and predicted risk of early surgical site infections after breast reduction.

    PubMed

    Kompatscher, Peter; von Planta, Andreas; Spicher, Ivo; Seifert, Burkhardt; Vetter, Sebastian; Minder, Jacqueline; Beer, Gertrude M

    2003-01-01

    In plastic surgery, clean, elective operations such as breast reductions are anticipated to have low risk factors for infections (1.1-2.1%). To further lower or prevent surgical site infections (SSI), the efficacy of a prophylactic administration of anti-microbacterials remains a current controversial issue in plastic surgery. We report here the findings of a retrospective study in which we examined two groups of patients with breast reductions, one of which received a single-shot antimicrobacterial prophylaxis with cefuroxime preoperatively and the other who were given no anti-microbacterials. The aims were to determine the early SSI incidence of both groups, to classify breast reductions with respect to their inherent SSI risk by two widespread, combined risk scores, i.e., the National Nosocomial Infection Surveillance (NNIS) score and the Study on the Efficacy of Nosocomial Infection Control (SENIC) score, and to compare the actual SSI incidence to the predicted risk of the scores. In the divisions of plastic surgery at two hospitals, 153 patients (group I) and 136 patients (group II) could be included in the study in the 4-year period April 1997 to December 2001. Excluded were all patients with unilateral breast reduction or breast reconstruction and patients who were followed up less than 30 days postoperatively. The two groups were comparable with respect to demographic and clinical features such as age and risk factors, and there were no detectable significant intergroup differences in the general perioperative data. According to the NNIS and the SENIC scores, all operations were "clean," and the American Society of Anesthesiologists (ASA) score was < 3 in all patients. Although the mean duration of the operation was significantly different in the two groups (190 min in group I, 160 min in group II; p < 0.001, Mann-Whitney test; 75th percentile at and 4 and 3 h, respectively), it was longer than 2 h in both groups. The incidence of early infections was 3.9% in the first group, compared with 3.6% in the second group (p = 1.0, odds ratio = 1.07, 95% CI = 0.32-3.6). All infections were local and superficial; no general symptoms were noticed. Three patients had to be readmitted and two of these were reoperated. The rate of infections for both groups was higher than generally anticipated for this kind of clean operations and higher than predicted by the NNIS score for medium risk (predicted risk of 2.9%). The reason for this discrepancy is that the NNIS score is an inpatient risk score which does not include a postdischarge SSI surveillance. Using the NNIS definition of SSI we would have had an infection rate of 0% in both groups in our study. According to the SENIC score, breast reductions can be classified also as medium risk of SSI with a predicted risk of 3.9%, which showed a nearly perfect correspondence with the actual SSI incidence in both study groups. The reason for this increased, medium risk is the factor "operation time > 2 h," which is obviously an inherent risk factor in breast reductions. Among the multitude of patient and nonpatient SSI risk factors, in healthy women operation time was the only factor which could be clearly identified. PMID:15058556

  19. Antibiotic resistance of Lactobacillus pentosus and Leuconostoc pseudomesenteroides isolated from naturally-fermented Aloreña table olives throughout fermentation process.

    PubMed

    Casado Muñoz, María del Carmen; Benomar, Nabil; Lerma, Leyre Lavilla; Gálvez, Antonio; Abriouel, Hikmate

    2014-02-17

    Antimicrobial resistance of Lactobacillus pentosus (n=59) and Leuconostoc pseudomesenteroides (n=13) isolated from Aloreña green table olives (which are naturally-fermented olives from Málaga, Spain) to 15 antibiotics was evaluated. Most Lb. pentosus (95%) and all Lc. pseudomesenteroides were resistant to at least three antibiotics. Principal component analysis determined that the prevalence of antibiotic resistance in LAB throughout the fermentation process was highly dependent on the fermenter where the fermentation took place. All Lb. pentosus and Lc. pseudomesenteroides strains were highly sensitive to amoxicillin and ampicillin (MIC≤2 μg/ml), and also to chloramphenicol (MIC≤4 μg/ml), gentamicin and erythromycin (MIC≤16 μg/ml). However, they were phenotypically resistant to streptomycin (83-100%, MIC>256 μg/ml), vancomycin and teicoplanin (70-100%, MIC>128 μg/ml), trimethoprim (76% of Lb. pentosus and 15% of Lc. pseudomesenteroides, MIC>128 μg/ml), trimethoprim/sulfomethoxazol (71-100%, MIC>4-64 μg/ml) and cefuroxime (44% of Lb. pentosus and 85% of Lc. pseudomesenteroides, MIC>32-128 μg/ml). Lb. pentosus was susceptible to tetracycline and clindamycin, while 46% of Lc. pseudomesenteroides strains were resistant to these antibiotics. Only Lb. pentosus strains were resistant to ciprofloxacin (70%, MIC>4-64 μg/ml), although no mutations in the quinolone resistance determining regions of the genes encoding GyrA and ParC were found, thus indicating an intrinsic resistance. Similarly, no genes encoding possible transferable resistance determinants for the observed phenotypic resistance were detected by PCR. In some cases, a bimodal distribution of MICs was observed for some antibiotics to which both LAB species exhibited resistance. Nevertheless, such resistances resulted from an intrinsic mechanism, non-transferable or non-acquired resistance determinants which may in part be due to chromosomally encoded efflux pumps (NorA, MepA and MdeA). Results of the present study demonstrate that all Lb. pentosus and Lc. pseudomesenteroides strains lack transferable resistance-related genes (cat, bla, blaZ, ermA, ermB, ermC, msrA/B, ereA, ereB, mphA, mefA, tet(M), tet(O), tet(S), tet(W), tet(L), tet(K), aad(E), aac(6')-Ie-aph(2')-Ia, aph(2')-Ib, aph(2')-Ic, aph(2')-Id, aph(3')-IIIa, ant(4')-Ia, dfrA, dfrD, vanA, vanB, vanC and vanE) and should therefore, according to Qualified Presumption of Safety criteria, be considered safe for future application as starter cultures or as probiotics. PMID:24370969

  20. Neonatal septicaemia in Ilorin: bacterial pathogens and antibiotic sensitivity pattern.

    PubMed

    Mokuolu, A O; Jiya, N; Adesiyun, O O

    2002-06-01

    All cases of septicemia among neonates admitted to the neonatal intensive care unit of the University of Ilorin Teaching Hospital, Ilorin, Nigeria between Jan 1995 and Dec 1996 were studied. Our aims were (1) to assess the incidence and microbial epidemiology of neonatal sepsis, (2) to generate baseline data and necessary research question for a proposed study on predictors of neonatal sepsis in our centre. Microbiology records of patients with confirmed septicemia was reviewed. Each of these babies had a single venous blood sample from a peripheral vein taken under aseptic conditions and before commencement of antibiotics. The needed data were entered into a proforma. Of the 198 neonates screened for sepsis, there were 61 (30.8%) positive blood cultures. Twenty-nine (48%) of these were inborn. The total number of live births in the hospital during the study period was 4118, thus giving a hospital-based incidence of neonatal sepsis of 7.04/1000 for in-born patients. The male:female ratio was 1.2:1. Overall Staphylococcus aureus was the commonest pathogen, accounting for 18 (29.5%) of the total isolates. Other pathogens were as follows; coagulase negative Saphylococcus albus 15 (24.6%), Klebsiella spp 10 (16.4%) and unclassified Coliforms 9 (14.8%). The predominant organisms in the first 48 hours were Gram negative bacilli; accounting for (70%) of the 10 isolates. Between 3 and 7 days of life the Gram positive cocci accounted for 12 (60%) of the 20 isolates while the Gram negative bacilli represented 40%. After 7 days, the predominant organism was Staphylococcus aureus (38.8%) while coagulase-negative Staphylococci were isolated in 7 of 31 isolates (22.6%). The sensitivity pattern showed that 94% of the organisms were sensitive to azythromicin, 77.8% to streptomycin, 73.3% to gentamicin and 69.2% to ampicillin-sulbactam. For the cephalosporins the isolates showed a sensitivity rate of 69% to ceftriaxone, 66.7% to ceftazidime and 58.3% to cefuroxime. As a group the Gram positive organisms had 100% sensitivity to Azythromcin, 85% to ampicillin-sulbactam, 63% to ceftazidime and 62.5% to gentamicin. In the Gram negative group, the best overall sensitivity was to ceftriaxone (86.4%). Gentamicin had 85.7% while sensitivity to ceftazidime was 60%. The distribution of the organisms causing early and late onset sepsis were different. For early onset sepsis, the Gram negative bacilli as a group were the commonest organisms while Staphylococcus aureus was the commonest cause of late onset sepsis. There was a lower incidence of sepsis compared to reports from other parts of the country. This, in addition to differences in antibiotic sensitivity pattern call for more multi-centre studies on predictors of neonatal sepsis. The antibiotic sensitivity profiles suggest that the initial empirical choice of ampicillin-sulbactam and gentamicin appears to be the most rational for our environment. PMID:12518907

  1. Tonsillitis and sore throat in children

    PubMed Central

    Stelter, Klaus

    2014-01-01

    Surgery of the tonsils is still one of the most frequent procedures during childhood. Due to a series of fatal outcomes after hemorrhage in children in Austria in 2006, the standards and indications for tonsillectomy have slowly changed in Germany. However, no national guidelines exist and the frequency of tonsil surgery varies across the country. In some districts eight times more children were tonsillectomized than in others. A tonsillectomy in children under six years should only be done if the child suffers from recurrent acute bacterially tonsillitis. In all other cases (i.e. hyperplasia of the tonsils) the low risk partial tonsillectomy should be the first line therapy. Postoperative pain and the risk of hemorrhage are much lower in partial tonsillectomy (=tonsillotomy). No matter whether the tonsillotomy is done by laser, radiofrequency, shaver, coblation, bipolar scissor or Colorado needle, as long as the crypts are kept open and some tonsil tissue is left behind. Total extracapsular tonsillectomy is still indicated in severely affected children with recurrent infections of the tonsils, allergy to antibiotics, PFAPA syndrome (periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis) and peritonsillar abscess. With regard to the frequency and seriousness of the recurrent tonsillitis the indication for tonsillectomy in children is justified if 7 or more well-documented, clinically important, adequately treated episodes of throat infection occur in the preceding year, or 5 or more of such episodes occur in each of the 2 preceding years (according to the paradise criteria). Diagnosis of acute tonsillitis is clinical, but sometimes it is hard to distinguish viral from bacterial infections. Rapid antigen testing has a very low sensitivity in the diagnosis of bacterial tonsillitis and swabs are highly sensitive but take a long time. In all microbiological tests the treating physician has to keep in mind, that most of the bacterials, viruses and fungi belong to the healthy flora and do no harm. Ten percent of healthy children even bear strepptococcus pyogenes all the time in the tonsils with no clinical signs. In these children decolonization is not necessary. Therefore, microbiological screening tests in children without symptoms are senseless and do not justify an antibiotic treatment (which is sometimes postulated by the kindergartens). The acute tonsillitis should be treated with steroids (e.g. dexamethasone), NSAIDs (e.g. ibuprofene) and betalactam antibiotics (e.g. penicillin or cefuroxime). With respect to the symptom reduction and primary healing the short-term late-generation antibiotic therapy (azithromycin, clarithromycin or cephalosporine for three to five days) is comparable to the long-term penicilline therapy. There is no difference in the course of healing, recurrence or microbiological resistance between the short-term penicilline therapy and the standard ten days therapy. On the other hand, only the ten days antibiotic therapy has proven to be effective in the prevention of rheumatic fever and glomerulonephritic diseases. The incidence of rheumatic heart disease is currently 0.5 per 100,000 children of school age. The main morbidity after tonsillectomy is pain and the late haemorrhage. Posttonsillectomy bleeding can occur till the whole wound is completely healed, which is normally after three weeks. Life-threatening haemorrhages occur often after smaller bleedings, which can spontaneously cease. That is why every haemorrhage, even the smallest, has to be treated properly and in ward. Patients and parents have to be informed about the correct behaviour in case of haemorrhage with a written consent before the surgery. The handout should contain important addresses, phone numbers and contact persons. Almost all cases of fatal outcome after tonsillectomy were due to false management of haemorrhage. Haemorrhage in small children can be especially life-threatening because of the lower blood volume and the danger of aspiration with asphyxia. A massive haemorrhage is an extreme challenge for every paramedic or emergency doctor because of the difficult airway management. Intubation is only possible with appropriate inflexible suction tubes. All different surgical techniques have the risk of haemorrhage and even the best surgeon will experience a postoperative haemorrhage. The lowest risk of haemorrhage is after cold dissection with ligature or suturing. All “hot” techniques with laser, radiofrequency, coblation, mono- or bipolar forceps have a higher risk of late haemorrhage. Children with a hereditary coagulopathy have a higher risk of haemorrhage. It is possible, that these children were not identified before surgery. Therefore it is recommended by the Society of paediatrics, anaesthesia and ENT, that a standardised questionnaire should be answered by the parents before tonsillectomy and adenoidectomy. This 17-point-checklist questionnaire is more sensitive and easier to perform than a screening with blood tests (e.g. INR and PTT). Unfortunately, a lot of surgeons still screen the children preoperatively by coagulative blood tests, although these tests are inappropriate and incapable of detecting the von Willebrand disease, which is the most frequent coagulopathy in Europe. The preoperative information about the surgery should be done with the child and the parents in a calm and objective atmosphere with a written consent. A copy of the consent with the signature of the surgeon and both custodial parents has to be handed out to the parents. PMID:25587367