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Sample records for inappropriate antibiotic treatment

  1. Tigecycline Therapy for Nosocomial Pneumonia due to Carbapenem-Resistant Gram-Negative Bacteria in Critically Ill Patients Who Received Inappropriate Initial Antibiotic Treatment: A Retrospective Case Study.

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    Wu, Xiaomai; Zhu, Yefei; Chen, Qiuying; Gong, Liuyang; Lin, Jian; Lv, Dongqing; Feng, Jiaxi

    2016-01-01

    Background . Nosocomial pneumonia due to carbapenem-resistant Gram-negative bacteria (CRGNB) is a growing concern because treatment options are limited and the mortality rate is high. The effect of tigecycline (TGC) on nosocomial pneumonia due to CRGNB in patients who have received inappropriate initial empiric antibiotic treatment (IIAT) is unclear. Therefore, this study aimed to examine the effect of TGC on nosocomial pneumonia due to CRGNB in critically ill patients who had received IIAT. Methods . A retrospective study was conducted in an adult respiratory intensive care unit. Data were obtained and analyzed for all patients who were treated with TGC ≥ 3 days for microbiologically confirmed nosocomial pneumonia due to CRGNB and had experienced initial antibiotic failure. Clinical and microbiological outcomes were investigated. Results . Thirty-one patients with hospital-acquired pneumonia or ventilator-associated pneumonia were included in the study. The majority of the responsible organisms were carbapenem-resistant Acinetobacter baumannii (67.7%), followed by Klebsiella pneumoniae (16.1%) and Escherichia coli (9.7%). Twenty patients were treated with high-dose TGC therapy (100 mg every 12 h after a 200 mg loading dose), and the others received a standard-dose therapy (50 mg every 12 h after a 100 mg loading dose). The duration of TGC therapy was 14.3 ± 2.8 days. The global clinical cure rate and the microbiological eradication rate were 48.4% and 61.3%, respectively. The overall ICU mortality rate was 45.2%. A higher score on the Acute Physiology and Chronic Health Evaluation II and a longer duration of IIAT were associated with clinical failure. High-dose TGC therapy had a higher clinical success rate [65.0% (13/20) versus 18.2% (2/11), P = 0.023] and a lower ICU mortality rate [30.0% (6/20) versus 72.7% (8/11), P = 0.031] than the standard-dose therapy. Conclusions . TGC, especially a high-dose regimen, might be a justifiable option for

  2. [Reasons for inappropriate prescribing of antibiotics in a high-complexity pediatric hospital].

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    Ruvinsky, Silvina; Mónaco, Andrea; Pérez, Guadalupe; Taicz, Moira; Inda, Laura; Kijko, Ivana; Constanzo, Patricia; Bologna, Rosa

    2011-12-01

    Determine the reasons for inappropriate prescription of antibiotics and identify opportunities to improve prescription of these drugs in pediatric patients hospitalized in intermediate and intensive care units. A prospective, descriptive longitudinal study was conducted of pediatric patients in intermediate and intensive care units who received parenteral administration of antibiotics, with the exception of newborns, burn unit patients, and surgical prophylaxis patients. A univariate analysis and multiple logistic regression were performed. A total of 376 patients with a median of age of 50 months were studied (interquartile range [IQR] 14.5-127 months). Out of the total patients studied, 75% had one or more underlying conditions. A total of 40.6% of these patients had an oncologic pathology and 33.5% had neurological conditions. The remaining 25.9% had other underlying conditions. Antibiotic treatment was inappropriate in 35.6% of the patients studied (N = 134). In 73 (54.4%) of the 134 cases, inappropriate use was due to the type of antibiotic prescribed, the dose administered, or the treatment period. The 61 (45.5%) remaining cases did not require antibiotic treatment. In the multivariate analysis, the risk factors for inappropriate use of antibiotics were: administration of ceftriaxone OR 2 (95% CI, 1.3-3.7; P = 0.02); acute lower respiratory tract infection OR 1.8 (95% CI, 1.1-3.3; P < 0.04); onset of fever of unknown origin in hospital inpatients OR 5.55 (95% CI, 2.5-12; P < 0.0001); and febrile neutropenia OR 0.3 (95% CI, 0.1-0.7; P = 0.009). Inappropriate use of antibiotics was less common in the clinical conditions that were well-characterized. Prescribing practices that could be improved were identified through the preparation and circulation of guidelines for antibiotic use in hospital inpatients.

  3. Inappropriate antibiotic prescription for respiratory tract indications: most prominent in adult patients.

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    Dekker, Anne R J; Verheij, Theo J M; van der Velden, Alike W

    2015-08-01

    Numerous studies suggest overprescribing of antibiotics for respiratory tract indications (RTIs), without really authenticating inappropriate prescription; the strict criteria of guideline recommendations were not taken into account as information on specific diagnoses, patient characteristics and disease severity was not available. The aim of this study is to quantify and qualify inappropriate antibiotic prescribing for RTIs. This is an observational study of the (antibiotic) management of patients with RTIs, using a detailed registration of RTI consultations by general practitioners (GPs). Consultations of which all necessary information was available were benchmarked to the prescribing guidelines for acute otitis media (AOM), acute sore throat, rhinosinusitis or acute cough. Levels of overprescribing for these indications and factors associated with overprescribing were determined. The overall antibiotic prescribing rate was 38%. Of these prescriptions, 46% were not indicated by the guidelines. Relative overprescribing was highest for throat (including tonsillitis) and lowest for ear consultations (including AOM). Absolute overprescribing was highest for lower RTIs (including bronchitis). Overprescribing was highest for patients between 18 and 65 years of age, when GPs felt patients' pressure for an antibiotic treatment, for patients presenting with fever and with complaints longer than 1 week. Underprescribing was observed in overprescribing can help in the development of targeted strategies to improve GPs' prescribing routines for RTIs. © The Author 2015. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  4. Cost analysis of inappropriate treatments for suspected dermatomycoses

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    Emanuela Fiammenghi

    2015-06-01

    Full Text Available Superficial mycoses are estimated to affect more than 20-25% of the world’s population with a consistent increase over the years. Most patients referred to our clinic for suspected dermatomycoses have already been treated with pharmacotherapy, without a previous mycological examination and many show changes in the clinical manifestations. Indeed, some medications, such as steroids, antiviral, antibiotics and antihistamines are not able to erase a fungal infection, but also they can cause atypical clinical manifestations. The consequences of inappropriate treatment include delayed diagnosis, prolonged healing time, and additional costs. The aims of this study were (1 to evaluate the incidence of increased costs attributable to inappropriate therapy sustained by the National Health Service and patients and (2 to highlight the importance of mycological evaluation before starting treatment, in order to improve diagnostic accuracy. An observational retrospective and prospective study was performed from September 2013 to February 2014, in 765 patients referred to our center (University Hospital “ Federico II” in Naples, Italy, for suspected mycological infection. The following treatments (alone or in combination were defined as inappropriate: (1 cortisone in a patient with at least one positive site; (2 antifungals in (a patients with all negative sites or (b ineffective antifungal treatment (in terms of drug chosen, dose or duration in those with all positive sites; or (3 antibiotics; (4 antivirals or (5 antihistamines, in patients with ≥ 1 positive site. Five hundred and fifty patients were using medications before the assessment visit. The total amount of avoidable costs related to inappropriate previous treatments was € 121,417, representing 74% of the total treatment costs. 253/550 patients received drugs also after the visit. For these patients, the cost of treatment prescribed after mycological testing was € 42,952, with a decrease

  5. Inappropriate antibiotic prescription for respiratory tract indications : most prominent in adult patients

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    Dekker, Anne R. J.; Verheij, Theo J. M.; van der Velden, Alike W.

    Background. Numerous studies suggest overprescribing of antibiotics for respiratory tract indications (RTIs), without really authenticating inappropriate prescription; the strict criteria of guideline recommendations were not taken into account as information on specific diagnoses, patient

  6. Inappropriate treatments for patients with cognitive decline.

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    Robles Bayón, A; Gude Sampedro, F

    2014-01-01

    Some treatments are inappropriate for patients with cognitive decline. We analyse their use in 500 patients and present a literature review. Benzodiazepines produce dependence, and reduce attention, memory, and motor ability. They can cause disinhibition or aggressive behaviour, facilitate the appearance of delirium, and increase accident and mortality rates in people older than 60. In subjects over 65, low systolic blood pressure is associated with cognitive decline. Maintaining this figure between 130 and 140 mm Hg (145 in patients older than 80) is recommended. Hypocholesterolaemia < 160 mg/dl is associated with increased morbidity and mortality, aggressiveness, and suicide; HDL-cholesterol<40 mg/dl is associated with memory loss and increased vascular and mortality risks. Old age is a predisposing factor for developing cognitive disorders or delirium when taking opioids. The risks of prescribing anticholinesterases and memantine to patients with non-Alzheimer dementia that is not associated with Parkinson disease, mild cognitive impairment, or psychiatric disorders probably outweigh the benefits. Anticholinergic drugs acting preferentially on the peripheral system can also induce cognitive side effects. Practitioners should be aware of steroid-induced dementia and steroid-induced psychosis, and know that risk of delirium increases with polypharmacy. Of 500 patients with cognitive impairment, 70.4% were on multiple medications and 42% were taking benzodiazepines. Both conditions were present in 74.3% of all suspected iatrogenic cases. Polypharmacy should be avoided, if it is not essential, especially in elderly patients and those with cognitive impairment. Benzodiazepines, opioids and anticholinergics often elicit cognitive and behavioural disorders. Moreover, systolic blood pressure must be kept above 130 mm Hg, total cholesterol levels over 160 mg/dl, and HDL-cholesterol over 40 mg/dl in this population. Copyright © 2012 Sociedad Española de Neurolog

  7. Community Intervention Model to Reduce Inappropriate Antibiotic Use

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    Alder, Stephen; Wuthrich, Amy; Haddadin, Bassam; Donnelly, Sharon; Hannah, Elizabeth Lyon; Stoddard, Greg; Benuzillo, Jose; Bateman, Kim; Samore, Matthew

    2010-01-01

    Background: The Inter-Mountain Project on Antibiotic Resistance and Therapy (IMPART) is an intervention that addresses emerging antimicrobial resistance and the reduction of unnecessary antimicrobial use. Purpose: This study assesses the design and implementation of the community intervention component of IMPART. Methods: The study was conducted…

  8. How to avoid the inappropriate use of antibiotics in upper respiratory tract infections? A position statement from an expert panel.

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    Piltcher, Otávio Bejzman; Kosugi, Eduardo Macoto; Sakano, Eulalia; Mion, Olavo; Testa, José Ricardo Gurgel; Romano, Fabrizio Ricci; Santos, Marco Cesar Jorge; Di Francesco, Renata Cantisani; Mitre, Edson Ibrahim; Bezerra, Thiago Freire Pinto; Roithmann, Renato; Padua, Francini Greco; Valera, Fabiana Cardoso Pereira; Lubianca Neto, José Faibes; Sá, Leonardo Conrado Barbosa; Pignatari, Shirley Shizue Nagata; Avelino, Melissa Ameloti Gomes; Caixeta, Juliana Alves de Souza; Anselmo-Lima, Wilma Terezinha; Tamashiro, Edwin

    2018-02-25

    Bacterial resistance burden has increased in the past years, mainly due to inappropriate antibiotic use. Recently it has become an urgent public health concern due to its impact on the prolongation of hospitalization, an increase of total cost of treatment and mortality associated with infectious disease. Almost half of the antimicrobial prescriptions in outpatient care visits are prescribed for acute upper respiratory infections, especially rhinosinusitis, otitis media, and pharyngotonsillitis. In this context, otorhinolaryngologists play an important role in orienting patients and non-specialists in the utilization of antibiotics rationally and properly in these infections. To review the most recent recommendations and guidelines for the use of antibiotics in acute otitis media, acute rhinosinusitis, and pharyngotonsillitis, adapted to our national reality. A literature review on PubMed database including the medical management in acute otitis media, acute rhinosinusitis, and pharyngotonsillitis, followed by a discussion with a panel of specialists. Antibiotics must be judiciously prescribed in uncomplicated acute upper respiratory tract infections. The severity of clinical presentation and the potential risks for evolution to suppurative and non-suppurative complications must be taken into 'consideration'. Periodic revisions on guidelines and recommendations for treatment of the main acute infections are necessary to orient rationale and appropriate use of antibiotics. 'Continuous medical education and changes in physicians' and patients' behavior are required to modify the paradigm that all upper respiratory infection needs antibiotic therapy, minimizing the consequences of its inadequate and inappropriate use. Copyright © 2018 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

  9. Decreasing Inappropriate Use of Antibiotics in Primary Care in Four Countries in South America

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    Urbiztondo, Inés; Bjerrum, Lars; Caballero, Lidia

    2017-01-01

    High antibiotic prescribing and antimicrobial resistance in patients attending primary care have been reported in South America. Very few interventions targeting general practitioners (GPs) to decrease inappropriate antibiotic prescribing have been investigated in this region. This study assessed...... limited effect. A cluster randomized two-arm control trial was implemented. Healthcare centres from Bolivia, Argentina, Paraguay and Uruguay participating in the quality improvement program HAPPY AUDIT were randomly allocated to either intervention or control group. During ten consecutive weeks, GPs...... in the intervention group received evidence-based online feedback on the management of suspected RTIs. In patients with acute bronchitis, the intervention reduced the antibiotic prescribing rate from 71.6% to 56% (control group from 61.2% to 52%). In patients with acute otitis media, the intervention reduced...

  10. [Antibiotic treatments in urology].

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    Chaussade, H; Sunder, S; Bernard, L; Coloby, P; Guy, L; Karsenty, G; Bastide, C; Bruyère, F

    2013-11-01

    To define prescription modalities for the use of antibiotics in urology. A bibliographic research was performed using the MEDLINE database concerning all the antibiotics usable in urology. Treatments were classified by families; modes of action, indications in urology and adverse events have been detailed. Administrative files for commercial use have been consulted and associated with literature analysis. About 8 classes of antibiotics are usable in urology in a routine use. How they work, indications in urology and adverse events are discussed. Knowing that bacterial resistance to quinilones is increasing dramatically, it seems imperative to control the use of 8 classes of antibiotics. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  11. Requests for "inappropriate" treatment based on religious beliefs.

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    Orr, R D; Genesen, L B

    1997-06-01

    Requests by patients or their families for treatment which the patient's physician considers to be "inappropriate" are becoming more frequent than refusals of treatment which the physician considers appropriate. Such requests are often based on the patient's religious beliefs about the attributes of God (sovereignty, omnipotence), the attributes of persons (sanctity of life), or the individual's personal relationship with God (communication, commands, etc). We present four such cases and discuss some of the basic religious tenets of the three Abrahamic faith traditions as they relate to such requests. We suggest that religious reasons for requesting "inappropriate" treatment are "special" and deserve serious consideration. We offer guidance to assist clinicians and clinical ethicists as they attempt to resolve these conflicts, emphasising the importance of understanding the religious beliefs of the patient/surrogate and suggesting the assistance of a religious interpreter. We suggest open discussion with patients and families of both the clinical situation and the theological basis for these requests. We also suggest that clinicians use additional religious doctrines or principles from patients' own traditions to balance the reasons behind the requests. We conclude that most persistent requests for "inappropriate" treatment should be honoured.

  12. Inappropriate use of antibiotics in hospitals: the complex relationship between antibiotic use and antimicrobial resistance.

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    Cantón, Rafael; Horcajada, Juan Pablo; Oliver, Antonio; Garbajosa, Patricia Ruiz; Vila, Jordi

    2013-09-01

    Hospitals are considered an excellent compartment for the selection of resistant and multi-drug resistant (MDR) bacteria. The overuse and misuse of antimicrobial agents are considered key points fuelling this situation. Antimicrobial stewardship programs have been designed for better use of these compounds to prevent the emergence of resistant microorganisms and to diminish the upward trend in resistance. Nevertheless, the relationship between antibiotic use and antimicrobial resistance is complex, and the desired objectives are difficult to reach. Various factors affecting this relationship have been advocated including, among others, antibiotic exposure and mutant selection windows, antimicrobial pharmacodynamics, the nature of the resistance (natural or acquired, including mutational and that associated with horizontal gene transfer) and the definition of resistance. Moreover, antimicrobial policies to promote better use of these drugs should be implemented not only in the hospital setting coupled with infection control programs, but also in the community, which should also include animal and environmental compartments. Within hospitals, the restriction of antimicrobials, cycling and mixing strategies and the use of combination therapies have been used to avoid resistance. Nevertheless, the results have not always been favorable and resistant bacteria have persisted despite the theoretical benefits of these strategies. Mathematical models as well as microbiological knowledge can explain this failure, which is mainly related to the current scenario involving MDR bacteria and overcoming the fitness associated with resistance. New antimicrobials, rapid diagnostic and antimicrobial susceptibility testing and biomarkers will be useful for future antimicrobial stewardship interventions. Copyright © 2013 Elsevier España, S.L. All rights reserved.

  13. Medically Inappropriate or Futile Treatment: Deliberation and Justification 1

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    Misak, Cheryl J.; White, Douglas B.; Truog, Robert D.

    2016-01-01

    This paper reframes the futility debate, moving away from the question “Who decides when to end what is considered to be a medically inappropriate or futile treatment?” and toward the question “How can society make policy that will best account for the multitude of values and conflicts involved in such decision-making?” It offers a pragmatist moral epistemology that provides us with (1) a clear justification of why it is important to take best standards, norms, and physician judgment seriously and (2) a clear justification of why ample opportunity must be made for patients, families, and society to challenge those standards and norms. PMID:26681796

  14. Do physician outcome judgments and judgment biases contribute to inappropriate use of treatments? Study protocol

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    Lott Alison

    2007-06-01

    Full Text Available Abstract Background There are many examples of physicians using treatments inappropriately, despite clear evidence about the circumstances under which the benefits of such treatments outweigh their harms. When such over- or under- use of treatments occurs for common diseases, the burden to the healthcare system and risks to patients can be substantial. We propose that a major contributor to inappropriate treatment may be how clinicians judge the likelihood of important treatment outcomes, and how these judgments influence their treatment decisions. The current study will examine the role of judged outcome probabilities and other cognitive factors in the context of two clinical treatment decisions: 1 prescription of antibiotics for sore throat, where we hypothesize overestimation of benefit and underestimation of harm leads to over-prescription of antibiotics; and 2 initiation of anticoagulation for patients with atrial fibrillation (AF, where we hypothesize that underestimation of benefit and overestimation of harm leads to under-prescription of warfarin. Methods For each of the two conditions, we will administer surveys of two types (Type 1 and Type 2 to different samples of Canadian physicians. The primary goal of the Type 1 survey is to assess physicians' perceived outcome probabilities (both good and bad outcomes for the target treatment. Type 1 surveys will assess judged outcome probabilities in the context of a representative patient, and include questions about how physicians currently treat such cases, the recollection of rare or vivid outcomes, as well as practice and demographic details. The primary goal of the Type 2 surveys is to measure the specific factors that drive individual clinical judgments and treatment decisions, using a 'clinical judgment analysis' or 'lens modeling' approach. This survey will manipulate eight clinical variables across a series of sixteen realistic case vignettes. Based on the survey responses, we will be

  15. National cultural dimensions as drivers of inappropriate ambulatory care consumption of antibiotics in Europe and their relevance to awareness campaigns.

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    Borg, Michael A

    2012-03-01

    European countries exhibit significant geographical differences in antibiotic consumption per capita within ambulatory care, especially inappropriate use for colds/flu/sore throat (CFSt). One potential explanation could be national cultural differences resulting in varying perceptions and, therefore, influences. Publicly available data on the proportions of respondents in the 2009 Eurobarometer survey who had taken antibiotics for CFSt were tested for association against country scores derived from the Hofstede cultural dimension model. They were also correlated with knowledge of respondents about various key antibiotic facts. The Eurobarometer dataset incorporated 26,259 responses from all European Union (EU) countries except Cyprus. Using multiple regression, uncertainty avoidance and masculinity were identified as the two national cultural dimensions significantly associated with the use of antibiotics for CFSt (R-adjusted = 0.45; PCFSt was found to be inversely correlated with respondents' knowledge that antibiotics are ineffective against viruses (r=-0.724; P<0.001) and that misuse will render them ineffective in the longer term (r=-0.775; P<0.001). National cultural dimensions, especially uncertainty avoidance and masculinity, appear to have a very significant impact on inappropriate antibiotic use within European countries. Nevertheless, their influence can be reduced by making EU citizens more knowledgeable about antibiotics through appropriate messages and targeted campaigns.

  16. Functional Analysis and Treatment of Multiply Controlled Inappropriate Mealtime Behavior

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    Bachmeyer, Melanie H.; Piazza, Cathleen C.; Fredrick, Laura D.; Reed, Gregory K.; Rivas, Kristi D.; Kadey, Heather J.

    2009-01-01

    Functional analyses identified children whose inappropriate mealtime behavior was maintained by escape and adult attention. Function-based extinction procedures were tested individually and in combination. Attention extinction alone did not result in decreases in inappropriate mealtime behavior or a significant increase in acceptance. By contrast,…

  17. Effects of inappropriate empirical antibiotic therapy on mortality in patients with healthcare-associated methicillin-resistant Staphylococcus aureus bacteremia: a propensity-matched analysis.

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    Yoon, Young Kyung; Park, Dae Won; Sohn, Jang Wook; Kim, Hyo Youl; Kim, Yeon-Sook; Lee, Chang-Seop; Lee, Mi Suk; Ryu, Seong-Yeol; Jang, Hee-Chang; Choi, Young Ju; Kang, Cheol-In; Choi, Hee Jung; Lee, Seung Soon; Kim, Shin Woo; Kim, Sang Il; Kim, Eu Suk; Kim, Jeong Yeon; Yang, Kyung Sook; Peck, Kyong Ran; Kim, Min Ja

    2016-07-15

    The purported value of empirical therapy to cover methicillin-resistant Staphylococcus aureus (MRSA) has been debated for decades. The purpose of this study was to evaluate the effects of inappropriate empirical antibiotic therapy on clinical outcomes in patients with healthcare-associated MRSA bacteremia (HA-MRSAB). A prospective, multicenter, observational study was conducted in 15 teaching hospitals in the Republic of Korea from February 2010 to July 2011. The study subjects included adult patients with HA-MRSAB. Covariate adjustment using the propensity score was performed to control for bias in treatment assignment. The predictors of in-hospital mortality were determined by multivariate logistic regression analyses. In total, 345 patients with HA-MRSAB were analyzed. The overall in-hospital mortality rate was 33.0 %. Appropriate empirical antibiotic therapy was given to 154 (44.6 %) patients. The vancomycin minimum inhibitory concentrations of the MRSA isolates ranged from 0.5 to 2 mg/L by E-test. There was no significant difference in mortality between propensity-matched patient pairs receiving inappropriate or appropriate empirical antibiotics (odds ratio [OR] = 1.20; 95 % confidence interval [CI] = 0.71-2.03). Among patients with severe sepsis or septic shock, there was no significant difference in mortality between the treatment groups. In multivariate analyses, severe sepsis or septic shock (OR = 5.45; 95 % CI = 2.14-13.87), Charlson's comorbidity index (per 1-point increment; OR = 1.52; 95 % CI = 1.27-1.83), and prior receipt of glycopeptides (OR = 3.24; 95 % CI = 1.08-9.67) were independent risk factors for mortality. Inappropriate empirical antibiotic therapy was not associated with clinical outcome in patients with HA-MRSAB. Prudent use of empirical glycopeptide therapy should be justified even in hospitals with high MRSA prevalence.

  18. Bacterial meningitis antibiotic treatment.

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    Cohen, R; Raymond, J; Hees, L; Pinquier, D; Grimprel, E; Levy, C

    2017-12-01

    The implementation of pneumococal conjugate vaccines (PCVs) 7 then 13 valent (Prevenar13 ®) in 2010-2011 has significantly changed the profile of pneumococcal meningitis. Since 3 years, the National Pediatric Meningitis Network of the Pediatric Infectious Disease Group (GPIP) and the National Reference Centre of Pneumococci have reported no cases of meningitis due to pneumococcus resistant to third-generation cephalosporins (3GC): cefotaxime or ceftriaxone. In the light of these new data, vancomycin should no longer be prescribed at the initial phase of pneumococcal meningitis treatment (confirmed or only suspected) and this antibiotic should only be added when 3GC minimum inhibitory concentration of the strain isolated is greater than 0.5mg/L. For meningococcal meningitis, nearly 20% of strains have decreased susceptibility to penicillin and amoxicillin, but all remain susceptible to 3GC. The National Pediatric Meningitis Network is a valuable tool because it has been sufficiently exhaustive and sustainable over 15 years. Maintaining this epidemiologic surveillance will allow us to adapt, if necessary, new regimens for subsequent changes that could be induced by vaccination and/or antibiotic uses. © 2017 Elsevier Masson SAS. Tous droits réservés.

  19. Antibiotic treatment of biofilm infections

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    Ciofu, Oana; Rojo-Molinero, Estrella; Macià, María D.

    2017-01-01

    Bacterial biofilms are associated with a wide range of infections, from those related to exogenous devices, such as catheters or prosthetic joints, to chronic tissue infections such as those occurring in the lungs of cystic fibrosis patients. Biofilms are recalcitrant to antibiotic treatment due...... to multiple tolerance mechanisms (phenotypic resistance). This causes persistence of biofilm infections in spite of antibiotic exposure which predisposes to antibiotic resistance development (genetic resistance). Understanding the interplay between phenotypic and genetic resistance mechanisms acting...... on biofilms, as well as appreciating the diversity of environmental conditions of biofilm infections which influence the effect of antibiotics are required in order to optimize the antibiotic treatment of biofilm infections. Here, we review the current knowledge on phenotypic and genetic resistance...

  20. Inappropriate Tuberculosis Treatment Regimens in Chinese Tuberculosis Hospitals

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    Xue He, Guang; van den Hof, Susan; van der Werf, Marieke J.; Guo, Hui; Hu, Yuan Lian; Fan, Ji Huan; Zhang, Wei Min; Tostado, Christopher P.; Borgdorff, Martien W.

    2011-01-01

    This investigation of tuberculosis (TB) treatment regimens in 6 TB hospitals in China showed that only 18% of patients with new cases and 9% of patients with retreatment cases were prescribed standard TB treatment regimens. Adherence to treatment guidelines needs to be improved in TB hospitals to

  1. The Pharmacodynamics of Antibiotic Treatment

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    Imran Mudassar

    2006-01-01

    Full Text Available We derive models of the effects of periodic, discrete dosing or constant dosing of antibiotics on a bacterial population whose growth is checked by nutrient-limitation and possibly by host defenses. Mathematically rigorous results providing sufficient conditions for treatment success, i.e. the elimination of the bacteria, as well as for treatment failure, are obtained. Our models can exhibit bi-stability where the infection-free state and an infection-state are locally stable when antibiotic dosing is marginal. In this case, treatment success may occur only for sub-threshold level infections.

  2. Effect of a multi-faceted quality improvement intervention on inappropriate antibiotic use in children with non-bloody diarrhoea admitted to district hospitals in Kenya

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    Opondo Charles

    2011-11-01

    Full Text Available Abstract Background There are few reports of interventions to reduce the common but irrational use of antibiotics for acute non-bloody diarrhoea amongst hospitalised children in low-income settings. We undertook a secondary analysis of data from an intervention comprising training of health workers, facilitation, supervision and face-to-face feedback, to assess whether it reduced inappropriate use of antibiotics in children with non-bloody diarrhoea and no co-morbidities requiring antibiotics, compared to a partial intervention comprising didactic training and written feedback only. This outcome was not a pre-specified end-point of the main trial. Methods Repeated cross-sectional survey data from a cluster-randomised controlled trial of an intervention to improve management of common childhood illnesses in Kenya were used to describe the prevalence of inappropriate antibiotic use in a 7-day period in children aged 2-59 months with acute non-bloody diarrhoea. Logistic regression models with random effects for hospital were then used to identify patient and clinician level factors associated with inappropriate antibiotic use and to assess the effect of the intervention. Results 9, 459 admission records of children were reviewed for this outcome. Of these, 4, 232 (44.7% were diagnosed with diarrhoea, with 130 of these being bloody (dysentery therefore requiring antibiotics. 1, 160 children had non-bloody diarrhoea and no co-morbidities requiring antibiotics-these were the focus of the analysis. 750 (64.7% of them received antibiotics inappropriately, 313 of these being in the intervention hospitals vs. 437 in the controls. The adjusted logistic regression model showed the baseline-adjusted odds of inappropriate antibiotic prescription to children admitted to the intervention hospitals was 0.30 times that in the control hospitals (95%CI 0.09-1.02. Conclusion We found some evidence that the multi-faceted, sustained intervention described in this

  3. Treatment practices of households and antibiotic dispensing in medicine outlets in developing countries: The case of Ghana

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    Tersbøl, Britt Pinkowski

    2018-01-01

    Introduction: Antibiotic resistance, associated with inappropriate drug use, is a global public health threat. The pharmaceutical sectors in developing countries are poorly regulated leading to antibiotic sales and use without a prescription. The study documents the treatment of acute illnesses...... households. Most (65%) medicine-use events involved self-treatment with pharmaceuticals; 40% of medicineuse events involved antibiotics, often without a prescription. Although the number of antibiotic transactions without prescription in rural medicine outlets (n=139, 27.4%) was statistically significantly...... of antibiotics, community knowledge and use of antibiotics in ways inconsistent with biomedical recommendations, poverty and perceived barriers to formal healthcare were factors that influenced the inappropriate use of antibiotics. Conclusion: Self-medication, including antibiotic self-prescription, constitutes...

  4. Congenital short QT syndrome and implantable cardioverter defibrillator treatment: inherent risk for inappropriate shock delivery.

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    Schimpf, Rainer; Wolpert, Christian; Bianchi, Francesca; Giustetto, Carla; Gaita, Florenzo; Bauersfeld, Urs; Borggrefe, Martin

    2003-12-01

    A congenital short QT interval constitutes a new primary electrical abnormality associated with syncope and/or sudden cardiac death. We report on the initial use of implantable cardioverter defibrillator (ICD) therapy in patients with inherited short QT interval and discuss sensing abnormalities and detection issues. In five consecutive patients from two unrelated European families who had structurally normal hearts, excessively shortened QT intervals, and a strong positive family history of sudden cardiac death, ICDs were placed for primary and secondary prevention. Mean QT intervals were 252 +/- 13 ms (QTc 287 +/- 13 ms). Despite normal sensing behavior during intraoperative and postoperative device testing, 3 of 5 patients experienced inappropriate shock therapies for T wave oversensing 30 +/- 26 days after implantation. Programming lower sensitivities and decay delays prevented further inappropriate discharges. The congenital short QT syndrome constitutes a new clinical entity with an increased risk for sudden cardiac death. Currently, ICD treatment is the only therapeutic option. In patients with short QT interval and implanted ICD, increased risk for inappropriate therapy is inherent due to the detection of short-coupled and prominent T waves. Careful testing of ICD function and adaptation of sensing levels and decay delays without sacrificing correct arrhythmia detection are essential.

  5. Voluntary Rehabilitation? On Neurotechnological Behavioural Treatment, Valid Consent and (In)appropriate Offers.

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    Bomann-Larsen, Lene

    2013-04-01

    Criminal offenders may be offered to participate in voluntary rehabilitation programs aiming at correcting undesirable behaviour, as a condition of early release. Behavioural treatment may include direct intervention into the central nervous system (CNS). This article discusses under which circumstances voluntary rehabilitation by CNS intervention is justified. It is argued that although the context of voluntary rehabilitation is a coercive circumstance, consent may still be effective, in the sense that it can meet formal criteria for informed consent. Further, for a consent to be normatively valid ("take the wronging out of the act") under a coercive circumstance, the subject to be treated must (1) have the sovereign authority to consent, and (2) the offer-giver must be in the right normative position to make the offer. While I argue that subjects do have the sovereign authority to consent to treatment, I also argue that inappropriate offers yield invalid consents. Considerations on inappropriate offers should therefore inform which kinds of CNS intervention-based rehabilitation schemes the state may propose as part of the criminal justice system. Yet as I conclude in this paper, while there are some intrinsic constraints on voluntary rehabilitation programs, the main constraints on voluntary rehabilitation are likely to be contingent overriders. However, CNS intervention is not ruled out as such in the context of voluntary rehabilitation.

  6. Antibiotics for the treatment of rheumatoid arthritis

    OpenAIRE

    Ogrendik, Mesut

    2013-01-01

    Mesut OgrendikDivision Physical Therapy and Rheumatology, Nazilli State Hospital, Nazilli, TurkeyAbstract: Antibiotic treatment for rheumatoid arthritis (RA) commenced in the 1930s with the use of sulfasalazine. Later, tetracyclines were successfully used for the treatment of RA. In double-blind and randomized studies, levofloxacin and macrolide antibiotics (including clarithromycin and roxithromycin) were also shown to be effective in the treatment of RA. There have been several reports in t...

  7. Carbapenem resistance, inappropriate empiric treatment and outcomes among patients hospitalized with Enterobacteriaceae urinary tract infection, pneumonia and sepsis.

    Science.gov (United States)

    Zilberberg, Marya D; Nathanson, Brian H; Sulham, Kate; Fan, Weihong; Shorr, Andrew F

    2017-04-17

    Drug resistance among gram-negative pathogens is a risk factor for inappropriate empiric treatment (IET), which in turn increases the risk for mortality. We explored the impact of carbapenem-resistant Enterobacteriaceae (CRE) on the risk of IET and of IET on outcomes in patients with Enterobacteriaceae infections. We conducted a retrospective cohort study in Premier Perspective database (2009-2013) of 175 US hospitals. We included all adult patients with community-onset culture-positive urinary tract infection (UTI), pneumonia, or sepsis as a principal diagnosis, or as a secondary diagnosis in the setting of respiratory failure, treated with antibiotics within 2 days of admission. We employed regression modeling to compute adjusted association of presence of CRE with risk of receiving IET, and of IET on hospital mortality, length of stay (LOS) and costs. Among 40,137 patients presenting to the hospital with an Enterobacteriaceae UTI, pneumonia or sepsis, 1227 (3.1%) were CRE. In both groups, the majority of the cases were UTI (51.4% CRE and 54.3% non-CRE). Those with CRE were younger (66.6+/-15.3 vs. 69.1+/-15.9 years, p pneumonia or sepsis was comparable to other national estimates. Infection with CRE was associated with a four-fold increased risk of receiving IET, which in turn increased mortality, LOS and costs.

  8. A Review and Treatment Selection Model for Individuals with Developmental Disabilities Who Engage in Inappropriate Sexual Behavior.

    Science.gov (United States)

    Davis, Tonya N; Machalicek, Wendy; Scalzo, Rachel; Kobylecky, Alicia; Campbell, Vincent; Pinkelman, Sarah; Chan, Jeffrey Michael; Sigafoos, Jeff

    2016-12-01

    Some individuals with developmental disabilities develop inappropriate sexual behaviors such as public masturbation, disrobing, and touching others in an unwanted sexual manner. Such acts are problematic given the taboo nature of the behaviors and the potential for significant negative consequences, such as restricted community access, injury, and legal ramifications. Therefore, it is necessary to equip caregivers and practitioners with effective treatment options. The purpose of this paper is to review studies that have evaluated behavioral treatments to reduce inappropriate sexual behavior in persons with developmental disabilities. The strengths and weaknesses of each treatment are reviewed, and a model for treatment selection is provided.

  9. Quetiapine effective in treatment of inappropriate sexual behavior of lewy body disease with predominant frontal lobe signs.

    Science.gov (United States)

    Prakash, Ravi; Pathak, Amit; Munda, Sanjay; Bagati, Dhruv

    2009-01-01

    Dementia of Lewy body disease is the second most common degenerative cause of dementia after Alzheimer's disease, among all the dementias. The core features are a progressive dementia, fluctuations in cognitive functions, visual hallucinations, and spontaneous parkinsonism. Rapid eye movement sleep behavior disorder, severe neuroleptic sensitivity, and low dopamine transporter uptake in basal ganglia are other suggestive features. Behavioral abnormalities are commonly present in the form of aggressive behavior, irritability, and uninhibited behaviors. These are mostly seen in the advanced stages of dementia. However, inappropriate sexual behavior is uncommonly seen in such cases. Three types of inappropriate sexual behaviors commonly found in cases of dementia are sex talks, sexual acts, and implied sexual acts. Such inappropriate sexual behaviors have not been described adequately in dementia of Lewy body disease. We report inappropriate sexual behaviors in a case of dementia of Lewy body disease, which improved rapidly after treatment with quetiapine.

  10. Rational Use of Antibiotics in the Treatment of Functional Bowel Disorders

    Science.gov (United States)

    Di Stefano, Michele; Fasulo, Roberta; Corazza, Gino Roberto

    2010-01-01

    Functional gastrointestinal symptoms such us bloating, fullness, flatulence, diarrhea, and constipation due to irritable bowel syndrome (IBS) were recently attributed to small bowel bacterial overgrowth, a condition depending on the presence of an increased number of bacteria in the small bowel. However, the methodology used to describe this association may be harshly criticized, since it has already been shown to be quite inaccurate. As a result an inappropriate use of antibiotics was consequently generated. In fact, antibiotics could be effective in the treatment of functional complaints, but only in a limited subgroup of patients, characterized by an increase of fermentation at colonic level. In this review, we have examined the papers suggesting a pathophysiological link between IBS and small bowel bacterial overgrowth, underlining its inappropriateness, and put forth our personal view on the rationale for antibiotic use in IBS. PMID:27713358

  11. Rational Use of Antibiotics in the Treatment of Functional Bowel Disorders

    Directory of Open Access Journals (Sweden)

    Roberta Fasulo

    2010-07-01

    Full Text Available Functional gastrointestinal symptoms such us bloating, fullness, flatulence, diarrhea, and constipation due to irritable bowel syndrome (IBS were recently attributed to small bowel bacterial overgrowth, a condition depending on the presence of an increased number of bacteria in the small bowel. However, the methodology used to describe this association may be harshly criticized, since it has already been shown to be quite inaccurate. As a result an inappropriate use of antibiotics was consequently generated. In fact, antibiotics could be effective in the treatment of functional complaints, but only in a limited subgroup of patients, characterized by an increase of fermentation at colonic level. In this review, we have examined the papers suggesting a pathophysiological link between IBS and small bowel bacterial overgrowth, underlining its inappropriateness, and put forth our personal view on the rationale for antibiotic use in IBS.

  12. Antibiotics for the treatment of rheumatoid arthritis

    Directory of Open Access Journals (Sweden)

    Ogrendik M

    2013-12-01

    Full Text Available Mesut OgrendikDivision Physical Therapy and Rheumatology, Nazilli State Hospital, Nazilli, TurkeyAbstract: Antibiotic treatment for rheumatoid arthritis (RA commenced in the 1930s with the use of sulfasalazine. Later, tetracyclines were successfully used for the treatment of RA. In double-blind and randomized studies, levofloxacin and macrolide antibiotics (including clarithromycin and roxithromycin were also shown to be effective in the treatment of RA. There have been several reports in the literature indicating that periodontal pathogens are a possible cause of RA. Oral bacteria are one possible cause of RA. In this review, we aimed to investigate the effects of different antibiotics in RA treatment.Keywords: oral bacteria, treatment, disease-modifying antirheumatic drugs, periodontitis

  13. Inappropriate antibiotic prescribing and demand for antibiotics in patients with upper respiratory tract infections is hardly different in female versus male patients as seen in primary care

    DEFF Research Database (Denmark)

    Bagger, Kathrine; Nielsen, Anni Brit Sternhagen; Siersma, Volkert

    2015-01-01

    of a cross-sectional study including 15 022 patients with URTI (acute rhinitis, acute otitis media, acute sinusitis, acute pharyngotonsillitis) from Argentina, Denmark, Lithuania, Russia, Spain and Sweden (HAPPY AUDIT Project). The association between gender and unnecessary antibiotic prescriptions...

  14. Treatment approaches and antibiotic use for emergency dental treatment in Turkey

    Directory of Open Access Journals (Sweden)

    Kaptan RF

    2013-11-01

    Full Text Available Rabia Figen Kaptan,1 Faruk Haznedaroglu,2 Fatima Betul Basturk,3 Mehmet Baybora Kayahan11Department of Endodontics, Yeditepe University, 2Department of Endodontics, Istanbul University, 3Department of Endodontics, Marmara University, Istanbul, TurkeyAbstract: The purpose of this study was to gather information about Turkish general dental practitioners' treatment approaches towards endodontic emergencies, antibiotic-prescribing habits, and their participation in lifelong learning programs. Questionnaires were given to dentists who attended the 16th National Congress organized by the Turkish Dental Association. From 1,400 questionnaires distributed, 589 (43% were deemed usable in this study. This survey dealt with questions that were subdivided into two main topics: dental emergency treatment approaches, and antibiotic prescription and information on lifelong learning program participation. The statistical analysis was conducted with a Χ2 test at a significance level of P<0.05. For irreversible pulpitis cases in vital teeth, most of the dental practitioners (65.3% preferred single-visit root canal treatments. For teeth presenting a periapical lesion, the preferred treatment approach was root canal treatment (91.5%. The rate of prescription of analgesics and antibiotics was 21.7% in untreated acute apical periodontitis cases and 41% in acute apical abscess cases. Frequently prescribed antibiotics were amoxicillin–clavulanate (61.8% and amoxicillin (46.5%. There was a tendency for practitioners to attend congresses as their years of professional practice increased (P<0.0001. There have been discrepancies between taught and observed practice. Educational initiatives are needed to prevent inappropriate prescription of antibiotics.Keywords: antibiotic prescription, endodontic emergency, survey, Turkey

  15. Assessment of antibiotic resistance in Klebsiella pneumoniae exposed to sequential in vitro antibiotic treatments

    OpenAIRE

    Kim, Jeongjin; Jo, Ara; Chukeatirote, Ekachai; Ahn, Juhee

    2016-01-01

    Background Bacteria treated with different classes of antibiotics exhibit changes in susceptibility to successive antibiotic treatments. This study was designed to evaluate the influence of sequential antibiotic treatments on the development of antibiotic resistance in Klebsiella pneumoniae associated with ?-lactamase and efflux pump activities. Methods The antibiotic susceptibility, ?-lactamase activity, and efflux activity were determined in K. pneumoniae grown at 37??C by adding initial (0...

  16. Independent review of inappropriate identification, storage and treatment methods of polychlorinated biphenyl waste streams

    International Nuclear Information System (INIS)

    1997-07-01

    The purpose of the review was to evaluate incidents involving the inappropriate identification, storage, and treatment methods associated with polychlorinated biphenyl (PCB) waste streams originating from the V-tank system at the Test Area North (TAN). The team was instructed to perform a comprehensive review of Lockheed Martin Idaho Technologies Company (LMITCO's) compliance programs related to these incidents to assess the adequacy and effectiveness of the management program in all respects including: adequacy of the waste management program in meeting all LMITCO requirements and regulations; adequacy of policies, plans, and procedures in addressing and implementing all federal and state requirements and regulations; and compliance status of LMITCO, LMITCO contract team members, and LMITCO contract/team member subcontractor personnel with established PCB management policies, plans, and procedures. The V-Tanks are part of an intermediate waste disposal system and are located at the Technical Support Facility (TSF) at TAN at the Idaho National Engineering and Environmental Laboratory (INEEL). The IRT evaluated how a waste was characterized, managed, and information was documented; however, they did not take control of wastes or ensure followup was performed on all waste streams that may have been generated from the V-Tanks. The team has also subsequently learned that the Environmental Restoration (ER) program is revising the plans for the decontamination and decommissioning of the intermediate waste disposal system based on new information listed and PCB wastes. The team has not reviewed those in-process changes. The source of PCB in the V-Tank is suspected to be a spill of hydraulic fluid in 1968

  17. Motivos de la prescripción inadecuada de antibióticos en un hospital pediátrico de alta complejidad Reasons for inappropriate prescribing of antibiotics in a high-complexity pediatric hospital

    Directory of Open Access Journals (Sweden)

    Silvina Ruvinsky

    2011-12-01

    unit patients, and surgical prophylaxis patients. A univariate analysis and multiple logistic regression were performed. RESULTS: A total of 376 patients with a median of age of 50 months were studied (interquartile range [IQR] 14.5-127 months. Out of the total patients studied, 75% had one or more underlying conditions. A total of 40.6% of these patients had an oncologic pathology and 33.5% had neurological conditions. The remaining 25.9% had other underlying conditions. Antibiotic treatment was inappropriate in 35.6% of the patients studied (N = 134. In 73 (54.4% of the 134 cases, inappropriate use was due to the type of antibiotic prescribed, the dose administered, or the treatment period. The 61 (45.5% remaining cases did not require antibiotic treatment. In the multivariate analysis, the risk factors for inappropriate use of antibiotics were: administration of ceftriaxone OR 2 (95% CI, 1.3-3.7; P = 0.02; acute lower respiratory tract infection OR 1.8 (95% CI, 1.1-3.3; P < 0.04; onset of fever of unknown origin in hospital inpatients OR 5.55 (95% CI, 2.5-12; P < 0.0001; and febrile neutropenia OR 0.3 (95% CI, 0.1-0.7; P = 0.009. CONCLUSIONES: Inappropriate use of antibiotics was less common in the clinical conditions that were well-characterized. Prescribing practices that could be improved were identified through the preparation and circulation of guidelines for antibiotic use in hospital inpatients.

  18. Point-of-care C-reactive protein testing to reduce inappropriate use of antibiotics for non-severe acute respiratory infections in Vietnamese primary health care: a randomised controlled trial.

    Science.gov (United States)

    Do, Nga T T; Ta, Ngan T D; Tran, Ninh T H; Than, Hung M; Vu, Bich T N; Hoang, Long B; van Doorn, H Rogier; Vu, Dung T V; Cals, Jochen W L; Chandna, Arjun; Lubell, Yoel; Nadjm, Behzad; Thwaites, Guy; Wolbers, Marcel; Nguyen, Kinh V; Wertheim, Heiman F L

    2016-09-01

    Inappropriate antibiotic use for acute respiratory tract infections is common in primary health care, but distinguishing serious from self-limiting infections is difficult, particularly in low-resource settings. We assessed whether C-reactive protein point-of-care testing can safely reduce antibiotic use in patients with non-severe acute respiratory tract infections in Vietnam. We did a multicentre open-label randomised controlled trial in ten primary health-care centres in northern Vietnam. Patients aged 1-65 years with at least one focal and one systemic symptom of acute respiratory tract infection were assigned 1:1 to receive either C-reactive protein point-of-care testing or routine care, following which antibiotic prescribing decisions were made. Patients with severe acute respiratory tract infection were excluded. Enrolled patients were reassessed on day 3, 4, or 5, and on day 14 a structured telephone interview was done blind to the intervention. Randomised assignments were concealed from prescribers and patients but not masked as the test result was used to assist treatment decisions. The primary outcome was antibiotic use within 14 days of follow-up. All analyses were prespecified in the protocol and the statistical analysis plan. All analyses were done on the intention-to-treat population and the analysis of the primary endpoint was repeated in the per-protocol population. This trial is registered under number NCT01918579. Between March 17, 2014, and July 3, 2015, 2037 patients (1028 children and 1009 adults) were enrolled and randomised. One adult patient withdrew immediately after randomisation. 1017 patients were assigned to receive C-reactive protein point-of-care testing, and 1019 patients were assigned to receive routine care. 115 patients in the C-reactive protein point-of-care group and 72 patients in the routine care group were excluded in the intention-to-treat analysis due to missing primary endpoint. The number of patients who used antibiotics

  19. Antibiotic prescribing on admission to patients with pneumonia and prior outpatient antibiotic treatment: a cohort study on clinical outcome

    NARCIS (Netherlands)

    van de Garde, Ewoudt M. W.; Natsch, Stephanie; Prins, Jan M.; van der Linden, Paul D.

    2015-01-01

    Objective: Most pneumonia treatment guidelines recommend that prior outpatient antibiotic treatment should be considered when planning inpatient antibiotic regimen. Our purpose was to study in patients admitted for community-acquired pneumonia the mode of continuing antibiotic treatment at the

  20. Antibiotic prescribing on admission to patients with pneumonia and prior outpatient antibiotic treatment : A cohort study on clinical outcome

    NARCIS (Netherlands)

    Van De Garde, Ewoudt M W|info:eu-repo/dai/nl/304841528; Natsch, Stephanie; Prins, Jan M.; Van Der Linden, Paul D.

    2015-01-01

    Objective: Most pneumonia treatment guidelines recommend that prior outpatient antibiotic treatment should be considered when planning inpatient antibiotic regimen. Our purpose was to study in patients admitted for community-acquired pneumonia the mode of continuing antibiotic treatment at the

  1. Antibiotic prescribing on admission to patients with pneumonia and prior outpatient antibiotic treatment: a cohort study on clinical outcome

    NARCIS (Netherlands)

    Garde, E.M. van de; Natsch, S.S.; Prins, J.M.; Linden, P.D. van der

    2015-01-01

    OBJECTIVE: Most pneumonia treatment guidelines recommend that prior outpatient antibiotic treatment should be considered when planning inpatient antibiotic regimen. Our purpose was to study in patients admitted for community-acquired pneumonia the mode of continuing antibiotic treatment at the

  2. Protocol to disseminate a hospital-site controlled intervention using audit and feedback to implement guidelines concerning inappropriate treatment of asymptomatic bacteriuria.

    Science.gov (United States)

    Trautner, Barbara W; Prasad, Pooja; Grigoryan, Larissa; Hysong, Sylvia J; Kramer, Jennifer R; Rajan, Suja; Petersen, Nancy J; Rosen, Tracey; Drekonja, Dimitri M; Graber, Christopher; Patel, Payal; Lichtenberger, Paola; Gauthier, Timothy P; Wiseman, Steve; Jones, Makoto; Sales, Anne; Krein, Sarah; Naik, Aanand Dinkar

    2018-01-19

    Antimicrobial stewardship to combat the spread of antibiotic-resistant bacteria has become a national priority. This project focuses on reducing inappropriate use of antimicrobials for asymptomatic bacteriuria (ASB), a very common condition that leads to antimicrobial overuse in acute and long-term care. We previously conducted a successful intervention, entitled "Kicking Catheter Associated Urinary Tract Infection (CAUTI): the No Knee-Jerk Antibiotics Campaign," to decrease guideline-discordant ordering of urine cultures and antibiotics for ASB. The current objective is to facilitate implementation of a scalable version of the Kicking CAUTI campaign across four geographically diverse Veterans Health Administration facilities while assessing what aspects of an antimicrobial stewardship intervention are essential to success and sustainability. This project uses an interrupted time series design with four control sites. The two main intervention tools are (1) an evidence-based algorithm that distills the guidelines into a streamlined clinical pathway and (2) case-based audit and feedback to train clinicians to use the algorithm. Our conceptual framework for the development and implementation of this intervention draws on May's General Theory of Implementation. The intervention is directed at providers in acute and long-term care, and the goal is to reduce inappropriate screening for and treatment of ASB in all patients and residents, not just those with urinary catheters. The start-up for each facility consists of centrally-led phone calls with local site champions and baseline surveys. Case-based audit and feedback will begin at a given site after the start-up period and continue for 12 months, followed by a sustainability assessment. In addition to the clinical outcomes, we will explore the relationship between the dose of the intervention and clinical outcomes. This project moves from a proof-of-concept effectiveness study to implementation involving

  3. Fungal treatment for the removal of antibiotics and antibiotic resistance genes in veterinary hospital wastewater.

    Science.gov (United States)

    Lucas, D; Badia-Fabregat, M; Vicent, T; Caminal, G; Rodríguez-Mozaz, S; Balcázar, J L; Barceló, D

    2016-06-01

    The emergence and spread of antibiotic resistance represents one of the most important public health concerns and has been linked to the widespread use of antibiotics in veterinary and human medicine. The overall elimination of antibiotics in conventional wastewater treatment plants is quite low; therefore, residual amounts of these compounds are continuously discharged to receiving surface waters, which may promote the emergence of antibiotic resistance. In this study, the ability of a fungal treatment as an alternative wastewater treatment for the elimination of forty-seven antibiotics belonging to seven different groups (β-lactams, fluoroquinolones, macrolides, metronidazoles, sulfonamides, tetracyclines, and trimethoprim) was evaluated. 77% of antibiotics were removed after the fungal treatment, which is higher than removal obtained in conventional treatment plants. Moreover, the effect of fungal treatment on the removal of some antibiotic resistance genes (ARGs) was evaluated. The fungal treatment was also efficient in removing ARGs, such as ermB (resistance to macrolides), tetW (resistance to tetracyclines), blaTEM (resistance to β-lactams), sulI (resistance to sulfonamides) and qnrS (reduced susceptibility to fluoroquinolones). However, it was not possible to establish a clear link between concentrations of antibiotics and corresponding ARGs in wastewater, which leads to the conclusion that there are other factors that should be taken into consideration besides the antibiotic concentrations that reach aquatic ecosystems in order to explain the emergence and spread of antibiotic resistance. Copyright © 2016 Elsevier Ltd. All rights reserved.

  4. Inappropriate pharmacological treatment in older adults affected by cardiovascular disease and other chronic comorbidities: a systematic literature review to identify potentially inappropriate prescription indicators

    Directory of Open Access Journals (Sweden)

    Lucenteforte E

    2017-10-01

    Full Text Available Ersilia Lucenteforte,1 Niccolò Lombardi,1,* Davide Liborio Vetrano,2,* Domenico La Carpia,2,* Zuzana Mitrova,3 Ursula Kirchmayer,3 Giovanni Corrao,4 Francesco Lapi,5 Alessandro Mugelli,1 Alfredo Vannacci1 On behalf of the Italian Group for Appropriate Drug prescription in the Elderly (I-GrADE 1Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA, University of Florence, Florence, Italy; 2Department of Geriatrics Catholic University, Rome, Italy; 3Department of Epidemiology, ASL 1 Rome, Italy; 4Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy; 5Epidemiology Unit, ARS Toscana, Florence, Italy *These authors contributed equally to this work Abstract: Avoiding medications in which the risks outweigh the benefits in the elderly patient is a challenge for physicians, and different criteria to identify inappropriate prescription (IP exist to aid prescribers. Definition of IP indicators in the Italian geriatric population affected by cardiovascular disease and chronic comorbidities could be extremely useful for prescribers and could offer advantages from a public health perspective. The purpose of the present study was to identify IP indicators by means of a systematic literature review coupled with consensus criteria. A systematic search of PubMed, EMBASE, and CENTRAL databases was conducted, with the search structured around four themes and combining each with the Boolean operator “and”. The first regarded “prescriptions”, the second “adverse events”, the third “cardiovascular conditions”, and the last was planned to identify studies on “older people”. Two investigators independently reviewed titles, abstracts, full texts, and selected articles addressing IP in the elderly affected by cardiovascular condition using the following inclusion criteria: studies on people aged ≥65 years; studies on patients with no restriction on age but with data on subjects

  5. Bacteriocins: exploring alternatives to antibiotics in mastitis treatment

    Directory of Open Access Journals (Sweden)

    Reneé Pieterse

    2010-10-01

    Full Text Available Mastitis is considered to be the most costly disease affecting the dairy industry. Management strategies involve the extensive use of antibiotics to treat and prevent this disease. Prophylactic dosages of antibiotics used in mastitis control programmes could select for strains with resistance to antibiotics. In addition, a strong drive towards reducing antibiotic residues in animal food products has lead to research in finding alternative antimicrobial agents. In this review we have focus on the pathogenesis of the mastitis in dairy cows, existing antibiotic treatments and possible alternative for application of bacteriocins from lactic acid bacteria in the treatment and prevention of this disease.

  6. Diabetic foot infections: Current treatment and delaying the 'post-antibiotic era'.

    Science.gov (United States)

    Lipsky, Benjamin A

    2016-01-01

    Treatment for diabetic foot infections requires properly diagnosing infection, obtaining an appropriate specimen for culture, assessing for any needed surgical procedures and selecting an empiric antibiotic regimen. Therapy will often need to be modified based on results of culture and sensitivity testing. Because of excessive and inappropriate use of antibiotics for treating diabetic foot infections, resistance to the usually employed bacteria has been increasing to alarming levels. This article reviews recommendations from evidence-based guidelines, informed by results of systematic reviews, on treating diabetic foot infections. Data from the pre-antibiotic era reported rates of mortality of about 9% and of high-level leg amputations of about 70%. Outcomes have greatly improved with appropriate antibiotic therapy. While there are now many oral and parenteral antibiotic agents that have demonstrated efficacy in treating diabetic foot infections, the rate of infection with multidrug-resistant pathogens is growing. This problem requires a multi-focal approach, including providing education to both clinicians and patients, developing robust antimicrobial stewardship programmes and using new diagnostic and therapeutic technologies. Recently, new methods have been developed to find novel antibiotic agents and to resurrect old treatments, like bacteriophages, for treating these difficult infections. Medical and political leaders have recognized the serious global threat posed by the growing problem of antibiotic resistance. By a multipronged approach that includes exerting administrative pressure on clinicians to do the right thing, investing in new technologies and encouraging the profitable development of new antimicrobials, we may be able to stave off the coming 'post-antibiotic era'. Copyright © 2016 John Wiley & Sons, Ltd.

  7. Children with meningeal signs: predicting who needs empiric antibiotic treatment

    NARCIS (Netherlands)

    R. Oostenbrink (Rianne); K.G.M. Moons (Karel); M.J. Twijnstra; D.E. Grobbee (Diederick); H.A. Moll (Henriëtte)

    2002-01-01

    textabstractBACKGROUND: Since delayed diagnosis and treatment of bacterial meningitis worsens patient prognosis, clinicians have a low threshold to perform a lumbar puncture or to start empiric antibiotic treatment in patients suspected of having meningitis. OBJECTIVE: To develop a

  8. Antibiotic treatment of CF lung disease: from bench to bedside.

    Science.gov (United States)

    Bals, Robert; Hubert, Dominique; Tümmler, Burkhard

    2011-06-01

    Chronic infection of the respiratory tract is a hallmark of cystic fibrosis (CF). Antibiotic treatment has been used as one of the mainstays of therapy and together with other treatment modalities has resulted in increased survival of CF patients. Increasing resistance of CF-specific pathogens to various classes of antibiotics explains the need for novel antibiotic strategies. This review focuses on the future development of new antibiotic therapies, including: (1) New targets, (2) novel antibiotic regimens in CF, (3) new antibiotics, and (4) other investigational therapies. In addition, we briefly summarize developments in the area of microbial diagnostics and discuss interactions between the complex pulmonary microflora. Copyright © 2011 European Cystic Fibrosis Society. Published by Elsevier B.V. All rights reserved.

  9. Treatment failures after antibiotic therapy of uncomplicated urinary tract infections

    DEFF Research Database (Denmark)

    Bjerrum, Lars; Dessau, Ram B; Hallas, Jesper

    2002-01-01

    : Retrospective cohort study. MATERIAL: Data were retrieved from Odense Pharmaco Epidemiological Database and consisted of women receiving sulfamethizole (n = 44,716) or pivmecillinam (n = 3093) during the period 1990-99. MAIN OUTCOME MEASURES: Prescription of a new antibiotic drug appropriate for UTI within 4...... weeks after the initial treatment was considered as an indicator for a treatment failure. The risk of treatment failure was estimated by calculating the cumulative incidence proportion of new antibiotic prescriptions within 4 weeks after the initial treatment. RESULTS: A new antibiotic followed 8...

  10. [Antibiotic treatment for prevention of infectious complications in joint replacement].

    Science.gov (United States)

    Jahoda, D; Nyc, O; Pokorný, D; Landor, I; Sosna, A

    2006-04-01

    Prophylactic antibiotic treatment is mandatory in every operation involving an orthopedic implant. Carefully selected and correctly administered antibiotics can provide effective protection of the implant from bacterial colonization. The prevention of deep wound infection in joint replacement includes several procedures and measures which constitute three basic groups: 1) Promotion of patient's ability to resist infection (careful pre-operative preparation, elimination of potential infectious loci, good nutritional status, etc). 2) Optimal conditions for the operative wound (surgical technique, prophylactic antibiotics). 3) Reduction of the number of bacteria brought in the wound (control measures, super-sterile operating theatres). Clear rules for the system of prophylactic antibiotic treatment should be adopted. A program in which responsibility for antibiotic administration was shifted from the nursing staff to the anesthesiologist in the operating theatre showed improved outcomes and reduced costs. Poor timing of prophylactic antibiotic administration is one of the basic mistakes. If the wound happened to be contaminated during surgery, the first three post-operative hours would be most decisive for the development of infection. An effective bactericidal concentration of antibiotic should be present in tissues and serum immediately after surgery has begun. Therefore the appropriate time for antibiotic application is before a skin incision is made, and not after the operation has started; the highest serum and bone tissue levels appear 20 to 30 min. after intravenous antibiotic injection. To allow antibiotics to reach target tissues, they should be introduced at least 10 min. before tourniquet application. For long surgical procedures or when blood loss is high, an additional dose of antibiotics is recommended during the operation. If a sample for bacterial cultivation is required, antibiotic administration is postponed until during surgery. However, this is

  11. Applying optimization algorithms to tuberculosis antibiotic treatment regimens.

    Science.gov (United States)

    Cicchese, Joseph M; Pienaar, Elsje; Kirschner, Denise E; Linderman, Jennifer J

    2017-12-01

    Tuberculosis (TB), one of the most common infectious diseases, requires treatment with multiple antibiotics taken over at least 6 months. This long treatment often results in poor patient-adherence, which can lead to the emergence of multi-drug resistant TB. New antibiotic treatment strategies are sorely needed. New antibiotics are being developed or repurposed to treat TB, but as there are numerous potential antibiotics, dosing sizes and potential schedules, the regimen design space for new treatments is too large to search exhaustively. Here we propose a method that combines an agent-based multi-scale model capturing TB granuloma formation with algorithms for mathematical optimization to identify optimal TB treatment regimens. We define two different single-antibiotic treatments to compare the efficiency and accuracy in predicting optimal treatment regimens of two optimization algorithms: genetic algorithms (GA) and surrogate-assisted optimization through radial basis function (RBF) networks. We also illustrate the use of RBF networks to optimize double-antibiotic treatments. We found that while GAs can locate optimal treatment regimens more accurately, RBF networks provide a more practical strategy to TB treatment optimization with fewer simulations, and successfully estimated optimal double-antibiotic treatment regimens. Our results indicate surrogate-assisted optimization can locate optimal TB treatment regimens from a larger set of antibiotics, doses and schedules, and could be applied to solve optimization problems in other areas of research using systems biology approaches. Our findings have important implications for the treatment of diseases like TB that have lengthy protocols or for any disease that requires multiple drugs.

  12. Survival of Bactericidal Antibiotic Treatment by a Persister Subpopulation of Listeria monocytogenes

    DEFF Research Database (Denmark)

    Knudsen, Gitte Maegaard; Ng, Yin; Gram, Lone

    2013-01-01

    Listeria monocytogenes can cause the serious infection listeriosis, which despite antibiotic treatment has a high mortality. Understanding the response of L. monocytogenes to antibiotic exposure is therefore important to ensure treatment success. Some bacteria survive antibiotic treatment by form...

  13. Antibiotic resistance plasmids in wastewater treatment plants and ...

    African Journals Online (AJOL)

    Antibiotic resistance plasmids found in wastewater treatment plants (WWTPs) may represent a threat to public health if they are readily disseminated into the environment and ultimately into pathogenic bacteria. The wastewater environments provide an ideal ecosystem for development and evolution of antibiotic resistance ...

  14. Intravenous Versus Oral Antibiotics for Postdischarge Treatment of Complicated Pneumonia.

    Science.gov (United States)

    Shah, Samir S; Srivastava, Rajendu; Wu, Susan; Colvin, Jeffrey D; Williams, Derek J; Rangel, Shawn J; Samady, Waheeda; Rao, Suchitra; Miller, Christopher; Cross, Cynthia; Clohessy, Caitlin; Hall, Matthew; Localio, Russell; Bryan, Matthew; Wu, Gong; Keren, Ron

    2016-12-01

    Postdischarge treatment of complicated pneumonia includes antibiotics administered intravenously via a peripherally inserted central venous catheter (PICC) or orally. Antibiotics administered via PICC, although effective, may result in serious complications. We compared the effectiveness and treatment-related complications of postdischarge antibiotics delivered by these 2 routes. This multicenter retrospective cohort study included children ≥2 months and pneumonia between 2009 and 2012. The main exposure was the route of postdischarge antibiotic administration, classified as PICC or oral. The primary outcome was treatment failure. Secondary outcomes included PICC complications, adverse drug reactions, other related revisits, and a composite of all 4 outcomes, termed "all related revisits." Among 2123 children, 281 (13.2%) received antibiotics via PICC. Treatment failure rates were 3.2% among PICC and 2.6% among oral antibiotic recipients and were not significantly different between the groups in across-hospital-matched analysis (matched odds ratio [OR], 1.26; 95% confidence interval [CI], 0.54 to 2.94). PICC complications occurred in 7.1%. Adverse drug reactions occurred in 0.6% of children; PICC antibiotic recipients had greater odds of adverse drug reaction in across hospital matched analysis (matched OR, 19.1; 95% CI, 4.2 to 87.3). The high rate of PICC complications and differences in adverse drug reactions contributed to higher odds of the composite outcome of all related revisits among PICC antibiotic recipients (matched OR, 4.71; 95% CI, 2.97 to 7.46). Treatment failure rates between PICC and oral antibiotics did not differ. Children with complicated pneumonia should preferentially receive oral antibiotics at discharge when effective oral options are available. Copyright © 2016 by the American Academy of Pediatrics.

  15. Assessment of antibiotic resistance in Klebsiella pneumoniae exposed to sequential in vitro antibiotic treatments.

    Science.gov (United States)

    Kim, Jeongjin; Jo, Ara; Chukeatirote, Ekachai; Ahn, Juhee

    2016-12-09

    Bacteria treated with different classes of antibiotics exhibit changes in susceptibility to successive antibiotic treatments. This study was designed to evaluate the influence of sequential antibiotic treatments on the development of antibiotic resistance in Klebsiella pneumoniae associated with β-lactamase and efflux pump activities. The antibiotic susceptibility, β-lactamase activity, and efflux activity were determined in K. pneumoniae grown at 37 °C by adding initial (0 h) and second antibiotics (8 or 12 h). Treatments include control (CON; no first and second antibiotic addition), no initial antibiotic addition followed by 1 MIC ciprofloxacin addition (CON-CIP), no initial antibiotic addition followed by 1 MIC meropenem addition (CON-MER), initial 1/4 MIC ciprofloxacin addition followed by no antibiotic addition (1/4CIP-CON), initial 1/4 MIC ciprofloxacin addition followed by 1 MIC ciprofloxacin addition (1/4CIP-CIP), and initial 1/4 MIC ciprofloxacin addition followed by 1 MIC meropenem addition (1/4CIP-MER). Compared to the CON, the initial addition of 1/4 MIC ciprofloxacin inhibited the growth of K. pneumoniae throughout the incubation period. The ciprofloxacin treatments (CON-CIP and 1/4CIP-CIP) showed significant reduction in the number of K. pneumoniae cells compared to meropenem (CON-MER and 1/4CIP-MER). The 1/4CIP-CIP achieved a further 1 log reduction of K. pneumoniae, when compared to the 1/4CIP-CON and 1/CIP-MER. The increase in sensitivity of K. pneumoniae to cefotaxime, kanamycin, levofloxacin, nalidixic acid was observed for CON-CIP. Noticeable cross-resistance pattern was observed at the 1/4CIP-CIP, showing the increased resistance of K. pneumoniae to chloramphenicol, ciprofloxacin, kanamycin, levofloxacin, nalidixic acid norfloxacin, sulphamethoxazole/trimethoprim, and tetracycline. The levels of β-lactamase activities were estimated to be 8.4 μmol/min/ml for CON, 7.7 μmol/min/ml for 1/4CIP-CON and as low as 2.9 μmol/min/ml for CON

  16. Antibiotics

    Science.gov (United States)

    Antibiotics are powerful medicines that fight bacterial infections. Used properly, antibiotics can save lives. They either kill bacteria or ... natural defenses can usually take it from there. Antibiotics do not fight infections caused by viruses, such ...

  17. Antibiotic Treatment Affects Intestinal Permeability and Gut Microbial Composition in Wistar Rats Dependent on Antibiotic Class.

    Directory of Open Access Journals (Sweden)

    Monica Vera-Lise Tulstrup

    Full Text Available Antibiotics are frequently administered orally to treat bacterial infections not necessarily related to the gastrointestinal system. This has adverse effects on the commensal gut microbial community, as it disrupts the intricate balance between specific bacterial groups within this ecosystem, potentially leading to dysbiosis. We hypothesized that modulation of community composition and function induced by antibiotics affects intestinal integrity depending on the antibiotic administered. To address this a total of 60 Wistar rats (housed in pairs with 6 cages per group were dosed by oral gavage with either amoxicillin (AMX, cefotaxime (CTX, vancomycin (VAN, metronidazole (MTZ, or water (CON daily for 10-11 days. Bacterial composition, alpha diversity and caecum short chain fatty acid levels were significantly affected by AMX, CTX and VAN, and varied among antibiotic treatments. A general decrease in diversity and an increase in the relative abundance of Proteobacteria was observed for all three antibiotics. Additionally, the relative abundance of Bifidobacteriaceae was increased in the CTX group and both Lactobacillaceae and Verrucomicrobiaceae were increased in the VAN group compared to the CON group. No changes in microbiota composition or function were observed following MTZ treatment. Intestinal permeability to 4 kDa FITC-dextran decreased after CTX and VAN treatment and increased following MTZ treatment. Plasma haptoglobin levels were increased by both AMX and CTX but no changes in expression of host tight junction genes were found in any treatment group. A strong correlation between the level of caecal succinate, the relative abundance of Clostridiaceae 1 family in the caecum, and the level of acute phase protein haptoglobin in blood plasma was observed. In conclusion, antibiotic-induced changes in microbiota may be linked to alterations in intestinal permeability, although the specific interactions remain to be elucidated as changes in

  18. Treatment of impetigo: oral antibiotics most commonly prescribed.

    Science.gov (United States)

    Bolaji, Ranti S; Dabade, Tushar S; Gustafson, Cheryl J; Davis, Scott A; Krowchuk, Daniel P; Feldman, Steven R

    2012-04-01

    Impetigo is a highly contagious, superficial skin disease that is frequently seen in children. While data support the use of topical antibiotics for treatment, the medications actually prescribed in practice are not well documented. To determine the prescribing pattern of dermatologists and nondermatologists when treating impetigo and the demographics of the patients treated. National Ambulatory Medical Care Survey data on office visits for impetigo were analyzed from 1997 to 2007. Patient demographics and the treatments for impetigo were recorded. During this 10-year period, dermatologists managed an estimated 274,815 impetigo visits and nondermatologists an estimated 3,722,462 visits. Both dermatologists and nondermatologists most frequently prescribed oral antibiotics to treat impetigo. Topical antibiotics were second most common, and a variety of combination treatments were used. Oral antibiotics are the most common class of medications used to treat impetigo. There is an opportunity for physicians to take advantage of the equally efficacious topical antibiotics for treating impetigo. A shift towards topical antibiotics would likely decrease morbidity (resulting from adverse effects) associated with use of oral agents.

  19. Prescriber and Patient Responsibilities in Treatment of Acute Respiratory Tract Infections — Essential for Conservation of Antibiotics

    Directory of Open Access Journals (Sweden)

    Antonio C. Pignatari

    2013-06-01

    Full Text Available Inappropriate antibiotic use in normally self-limiting acute respiratory tract infections (RTIs, such as sore throat and the common cold, is a global problem and an important factor for increasing levels of antibiotic resistance. A new group of international experts—the Global Respiratory Infection Partnership (GRIP—is committed to addressing this issue, with the interface between primary care practitioners and their patients as their core focus. To combat the overuse of antibiotics in the community, and facilitate a change from prescribing empiric antibiotic treatment towards cautious deferment combined with symptomatic relief, there is a need to introduce and enhance evidence-based dialogue between primary care practitioners and their patients. Communication with patients should focus on the de-medicalisation of self-limiting viral infections, which can be achieved via a coherent globally endorsed framework outlining the rationale for appropriate antibiotic use in acute RTIs in the context of antibiotic stewardship and conservancy. The planned framework is intended to be adaptable at a country level to reflect local behaviours, cultures and healthcare systems, and has the potential to serve as a model for change in other therapeutic areas.

  20. Strategies to Combat Antibiotic Resistance in the Wastewater Treatment Plants

    Directory of Open Access Journals (Sweden)

    Fateme Barancheshme

    2018-01-01

    Full Text Available The main goal of this manuscript is to review different treatment strategies and mechanisms for combating the antibiotic resistant bacteria (ARB and antibiotic resistant genes (ARGs in the wastewater environment. The high amount of antibiotics is released into the wastewater that may promote selection of ARB and ARGs which find their way into natural environments. Emerging microbial pathogens and increasing antibiotic resistance among them is a global public health issue. The propagation and spread of ARB and ARGs in the environment may result in an increase of antibiotic resistant microbial pathogens which is a worldwide environmental and public health concern. A proper treatment of wastewater is essential before its discharge into rivers, lake, or sewage system to prevent the spread of ARB and ARGs into the environment. This review discusses various treatment options applied for combating the spread of ARB and ARGs in wastewater treatment plants (WWTPs. It was reported that low-energy anaerobic–aerobic treatment reactors, constructed wetlands, and disinfection processes have shown good removal efficiencies. Nanomaterials and biochar combined with other treatment methods and coagulation process are very recent strategies regarding ARB and ARGs removal and need more investigation and research. Based on current studies a wide-ranging removal efficiency of ARGs can be achieved depending on the type of genes present and treatment processes used, still, there are gaps that need to be further investigated. In order to find solutions to control dissemination of antibiotic resistance in the environment, it is important to (1 study innovative strategies in large scale and over a long time to reach an actual evaluation, (2 develop risk assessment studies to precisely understand occurrence and abundance of ARB/ARGs so that their potential risks to human health can be determined, and (3 consider operating and environmental factors that affect the

  1. Antibiotic Treatment Strategies for Community-Acquired Pneumonia in Adults

    NARCIS (Netherlands)

    Postma, Douwe F.; Van Werkhoven, Cornelis H.; Van Elden, Leontine J R; Thijsen, Steven F T; Hoepelman, Andy I M; Kluytmans, Jan A J W; Boersma, Wim G.; Compaijen, Clara J.; Van Der Wall, Eva; Prins, Jan M.; Oosterheert, Jan J.; Bonten, Marc J M

    2015-01-01

    BACKGROUND The choice of empirical antibiotic treatment for patients with clinically suspected community-acquired pneumonia (CAP) who are admitted to non-intensive care unit (ICU) hospital wards is complicated by the limited availability of evidence. We compared strategies of empirical treatment

  2. Cost-analysis of PCR-guided pre-emptive antibiotic treatment of Staphylococcus aureus infections: an analytic decision model.

    Science.gov (United States)

    Hübner, C; Hübner, N-O; Kramer, A; Fleßa, S

    2012-11-01

    The aim of this study is to examine whether rapid polymerase chain reaction (PCR)-based screening is a cost-efficient tool to optimize pre-emptive antibiotic therapy of methicillin-resistant and methicillin-sensitive Staphylococcus aureus (MRSA and MSSA, respectively) infections. A decision analytic cost model was developed, based on data from the peer-reviewed literature. Sensitivity analyses were undertaken to investigate the impact of variation in the MRSA rate, cost ratio of the cost of inappropriate antibiotic therapy to the cost of appropriate antibiotic therapy, PCR test cost, and total hospital costs per case. At a current MRSA rate of 24.5 % in Germany, PCR-guided treatment regimens are cost-efficient compared to empirical strategies. The costs of alternative treatment strategies differ, on average, up to 1,780 per case. An empirical MRSA treatment strategy is least costly when the cost ratio is less than 1.06. When the total hospital cost per MRSA case is increased, pre-emptive MSSA treatment with PCR tests achieves the lowest average cost. Early verification and adaptation of an initial pre-emptive antibiotic treatment of S. aureus infections using PCR-based tests are advantageous in Germany and other European countries. PCR tests, accordingly, should be considered as elements in antimicrobial stewardship programs.

  3. Antibiotic treatments of a methicillin-resistant Staphylococcus pseudintermedius infection in a dog: a case presentation.

    Science.gov (United States)

    Decristophoris, P; Mauri, F; Albanese, F; Carnelli, A; Vanzetti, T; Zinsstag, J

    2011-09-01

    We report the antibiotic treatments administered to a female dog with mastitis and successive pyoderma. Microbiological investigations allowed the identification of Staphylococcus pseudintermedius after 54 days of various antibiotic treatments. The isolate carried the mecA gene and was resistant to 9 of 15 tested antibiotics. Consistent antibiotic treatment of the infection was possible only after accurate microbiological diagnosis.

  4. Treatment costs of Mycobacterium ulcerans in the antibiotic era.

    Science.gov (United States)

    Pak, Jason; O'Brien, Daniel P; Quek, Tricia; Athan, Eugene

    2012-06-01

    Mycobacterium ulcerans infection results in significant disfiguring morbidity, and treatment is expensive. To estimate the cost of treatment in the antibiotic era, a retrospective study of 71 patients diagnosed and treated for M. ulcerans in the Bellarine Peninsula (Victoria, Australia) between 1998 and 2006 was performed. Patients were categorised into minor single episode infection, major single episode infection and recurrent disease. Data were collected on each treatment cost component. To determine the change from costs in the pre-antibiotic era, mean direct costs were compared with those from a study in a nearby region between 1991 and 1998. All costs were in Australian dollars in 2006-2007 prices. The mean overall cost was $6181 per episode, with the highest cost components being hospitalisation (mean $3977; 63%) and surgeon fees ($949; 12%). Treatment costs per episode increased significantly from minor infection ($2235) to major infection ($6338) to recurrent disease ($13 372). Compared with the pre-antibiotic era, costs have significantly decreased, with a 52% reduction in overall cost per episode, driven mainly by a reduction in hospitalisation costs. Therefore, earlier diagnosis and treatment of M. ulcerans, including the use of outpatient-based oral antibiotic regimens, has the potential to reduce the cost of treatment.

  5. Temporal dynamics of antibiotics in wastewater treatment plant influent.

    Science.gov (United States)

    Coutu, Sylvain; Wyrsch, V; Wynn, H K; Rossi, L; Barry, D A

    2013-08-01

    A yearlong field experimental campaign was conducted to reveal time scales over which antibiotic fluxes vary in the influent of a wastewater treatment plant (WTP). In particular, sampling was carried out to ascertain the amplitudes of monthly, daily and hourly fluctuations of several antibiotics. A total of 180 samples was collected at the entrance of a WTP in Lausanne, Switzerland. Sample concentrations were multiplied by flow rate to obtain monthly, daily and hourly mass fluxes of six antibiotics (trimethoprim, norfloxacin, ciprofloxacin, ofloxacin, clindamycin and metronidazole). Seasonality in mass fluxes was observed for all substances, with maximum values in winter being up to an order of magnitude higher than in summer. The hourly measurements of the mass flux of antibiotics were found to have a period of 12h. This was due to peaks in toilet use in the morning and early evening. In particular, the morning peak in flushing coincided with high concentrations (and hence high mass fluxes) due to overnight accumulation of substances in urine. However, little variation was observed in the average daily flux. Consequently, fluctuations in mass fluxes of antibiotics were mainly evident at the monthly and hourly time scales, with little variation on the day-week time scale. These results can aid in optimizing removal strategies and future sampling campaigns focused on antibiotics in wastewater. Copyright © 2013 Elsevier B.V. All rights reserved.

  6. Antibiotics.

    Science.gov (United States)

    Hariprasad, Seenu M; Mieler, William F

    2016-01-01

    The Endophthalmitis Vitrectomy Study (EVS) provided ophthalmologists with evidence-based management strategies to deal with endophthalmitis for the first time. However, since the completion of the EVS, numerous unresolved issues remain. The use of oral antibiotics has important implications for the ophthalmologist, particularly in the prophylaxis and/or management of postoperative, posttraumatic, or bleb-associated bacterial endophthalmitis. One can reasonably conclude that significant intraocular penetration of an antibiotic after oral administration may be a property unique to the newer-generation fluoroquinolones. Prophylactic use of mupirocin nasal ointment resulted in significant reduction of conjunctival flora with or without preoperative topical 5% povidone-iodine preparation. Ocular fungal infections have traditionally been very difficult to treat due to limited therapeutic options both systemically and intravitreally. Because of its broad spectrum of coverage, low MIC90 levels for the organisms of concern, good tolerability, and excellent bioavailability, voriconazole through various routes of administration may be useful to the ophthalmologist in the primary treatment of or as an adjunct to the current management of ocular fungal infections. © 2016 S. Karger AG, Basel.

  7. Bacteriophages as potential treatment option for antibiotic resistant bacteria.

    Science.gov (United States)

    Bragg, Robert; van der Westhuizen, Wouter; Lee, Ji-Yun; Coetsee, Elke; Boucher, Charlotte

    2014-01-01

    The world is facing an ever-increasing problem with antibiotic resistant bacteria and we are rapidly heading for a post-antibiotic era. There is an urgent need to investigate alterative treatment options while there are still a few antibiotics left. Bacteriophages are viruses that specifically target bacteria. Before the development of antibiotics, some efforts were made to use bacteriophages as a treatment option, but most of this research stopped soon after the discovery of antibiotics. There are two different replication options which bacteriophages employ. These are the lytic and lysogenic life cycles. Both these life cycles have potential as treatment options. There are various advantages and disadvantages to the use of bacteriophages as treatment options. The main advantage is the specificity of bacteriophages and treatments can be designed to specifically target pathogenic bacteria while not negatively affecting the normal microbiota. There are various advantages to this. However, the high level of specificity also creates potential problems, the main being the requirement of highly specific diagnostic procedures. Another potential problem with phage therapy includes the development of immunity and limitations with the registration of phage therapy options. The latter is driving research toward the expression of phage genes which break the bacterial cell wall, which could then be used as a treatment option. Various aspects of phage therapy have been investigated in studies undertaken by our research group. We have investigated specificity of phages to various avian pathogenic E. coli isolates. Furthermore, the exciting NanoSAM technology has been employed to investigate bacteriophage replication and aspects of this will be discussed.

  8. Antibiotics in the treatment of peri-implantitis

    NARCIS (Netherlands)

    van Winkelhoff, Arie Jan

    2012-01-01

    Purpose: To review and discuss current literature on the use of systemically administered or locally delivered antibiotics in the treatment of peri-implantitis. Materials and methods: A literature search was conducted using MEDLINE through the Pub Med database of the US National Library of Medicine

  9. Trends in antibiotic treatment of acute otitis media and treatment failure in children, 2000-2011.

    Directory of Open Access Journals (Sweden)

    Leah J McGrath

    Full Text Available Guidelines to treat acute otitis media (AOM were published in 2004. Initial declines in prescribing were shown, but it's unknown if they were sustained. We examine trends in antibiotic dispensing patterns to treat AOM among a large population of children. We also document trends in antibiotic failure.Children aged 3 months to 12 years with an AOM diagnosis, enrolled in a commercial claims database between January 1, 2000-December 31, 2011 were included. Pharmacy claims within 7 days of diagnosis were searched for antibiotic prescriptions. Antibiotic failure was defined as a dispensing of a different antibiotic class within 2-18 days after the first prescription. We analyzed trends in antibiotic use and failure by class of antibiotic and year.We identified over 4 million children under 13 years with AOM. The proportion of antibiotic dispensing decreased from 66.0% in 2005 to 51.9% in 2007, after which the instances of dispensing rebounded to pre-guideline levels. However, levels began decreasing again in 2010 and the antibiotic use rate in 2011 was 57.6%. Cephalosporin prescriptions increased by 41.5% over eleven years. Antibiotic failure decreased slightly, and macrolides had the lowest proportion of failures, while all other classes had failure rates around 10%.In recent years, antibiotic dispensing to treat AOM remains high. In addition, the use of broad-spectrum antibiotics is increasing despite having a high rate of treatment failure. Overprescribing of antibiotics and use of non-penicillin therapy for AOM treatment could lead to the development of antibiotic-resistant infections.

  10. Secular trends in the appropriateness of empirical antibiotic treatment in patients with bacteremia: a comparison between three prospective cohorts.

    Science.gov (United States)

    Daitch, Vered; Akayzen, Yulia; Abu-Ghanem, Yasmin; Eliakim-Raz, Noa; Paul, Mical; Leibovici, Leonard; Yahav, Dafna

    2018-03-01

    The objective of this study was to explore whether the percentage of inappropriate empirical antibiotic treatment in patients with bacteremia changed over time and to understand the factors that brought on the change. Three prospective cohorts of patients with bacteremia in three different periods (January 1st, 1988 to December 31st, 1989; May 1st, 2004 to November 30, 2004; May 1st, 2010 to April 30, 2011) were compared. Analysis was performed on a total of 811 patients. In 2010-2011, 55.9% (76/136) of patients with bacteremia received inappropriate empirical treatment, compared with 34.5% (170/493) and 33.5% (55/164) in the first and second periods, respectively, in a significant upward trend (p = 0.001). Resistance to antibiotics increased significantly during the study period. The following variables were included in the multivariate analysis assessing risk factors for inappropriate empirical treatment: study period (third period) [odds ratio, OR = 2.766 (95% confidence interval, CI, 1.655-4.625)], gender (male) [OR = 1.511 (1.014-2.253)], pathogen carrying extended-spectrum beta-lactamases [OR = 10.426 (4.688-23.187)], multidrug-resistant Acinetobacter baumannii [OR = 5.428 (2.181-13.513)], and skin/soft infections [OR = 3.23 (1.148-9.084)]. A model excluding microbiological data included: gender (male) [OR = 1.648 (1.216-2.234)], study period (third period) [OR = 2.446 (1.653-3.620)], hospital-acquired infection [OR = 1.551 (1.060-2.270)], previous use of antibiotics [OR = 1.815 (1.247-2.642)], bedridden patient [OR = 2.019 (1.114-3.658)], and diabetes mellitus [OR = 1.620 (1.154-2.274)]. We have observed a worrisome increase in the rate of inappropriate empirical treatment of bacteremia. We need tools that will allow us better prediction of the pathogen and its susceptibilities during the first hours of managing a patient suspected of a severe bacterial infection.

  11. Combined photo-Fenton-SBR process for antibiotic wastewater treatment

    International Nuclear Information System (INIS)

    Elmolla, Emad S.; Chaudhuri, Malay

    2011-01-01

    Highlights: · The work focused on hazardous wastewater (antibiotic wastewater) treatment. · Complete degradation of the antibiotics achieved by the treatment process. · The SBR performance was found to be very sensitive to BOD 5 /COD ratio below 0.40. · Combined photo-Fenton-SBR process is a feasible treatment process for the antibiotic wastewater. - Abstract: The study examined combined photo-Fenton-SBR treatment of an antibiotic wastewater containing amoxicillin and cloxacillin. Optimum H 2 O 2 /COD and H 2 O 2 /Fe 2+ molar ratio of the photo-Fenton pretreatment were observed to be 2.5 and 20, respectively. Complete degradation of the antibiotics occurred in one min. The sequencing batch reactor (SBR) was operated at different hydraulic retention times (HRTs) with the wastewater treated under different photo-Fenton operating conditions (H 2 O 2 /COD and H 2 O 2 /Fe 2+ molar ratio). The SBR performance was found to be very sensitive to BOD 5 /COD ratio of the photo-Fenton treated wastewater. Statistical analysis of the results indicated that it was possible to reduce the Fe 2+ dose and increase the irradiation time of the photo-Fenton pretreatment. The best operating conditions of the combined photo-Fenton-SBR treatment were observed to be H 2 O 2 /COD molar ratio 2, H 2 O 2 /Fe 2+ molar ratio 150, irradiation time 90 min and HRT of 12 h. Under the best operating conditions, 89% removal of sCOD with complete nitrification was achieved and the SBR effluent met the discharge standards.

  12. Combined photo-Fenton-SBR process for antibiotic wastewater treatment

    Energy Technology Data Exchange (ETDEWEB)

    Elmolla, Emad S., E-mail: em_civil@yahoo.com [Department of Civil Engineering, Faculty of Engineering, Al-Azhar University, Cairo (Egypt); Chaudhuri, Malay [Department of Civil Engineering, Universiti Teknologi PETRONAS, Bandar Seri Iskandar, 31750 Tronoh, Perak (Malaysia)

    2011-09-15

    Highlights: {center_dot} The work focused on hazardous wastewater (antibiotic wastewater) treatment. {center_dot} Complete degradation of the antibiotics achieved by the treatment process. {center_dot} The SBR performance was found to be very sensitive to BOD{sub 5}/COD ratio below 0.40. {center_dot} Combined photo-Fenton-SBR process is a feasible treatment process for the antibiotic wastewater. - Abstract: The study examined combined photo-Fenton-SBR treatment of an antibiotic wastewater containing amoxicillin and cloxacillin. Optimum H{sub 2}O{sub 2}/COD and H{sub 2}O{sub 2}/Fe{sup 2+} molar ratio of the photo-Fenton pretreatment were observed to be 2.5 and 20, respectively. Complete degradation of the antibiotics occurred in one min. The sequencing batch reactor (SBR) was operated at different hydraulic retention times (HRTs) with the wastewater treated under different photo-Fenton operating conditions (H{sub 2}O{sub 2}/COD and H{sub 2}O{sub 2}/Fe{sup 2+} molar ratio). The SBR performance was found to be very sensitive to BOD{sub 5}/COD ratio of the photo-Fenton treated wastewater. Statistical analysis of the results indicated that it was possible to reduce the Fe{sup 2+} dose and increase the irradiation time of the photo-Fenton pretreatment. The best operating conditions of the combined photo-Fenton-SBR treatment were observed to be H{sub 2}O{sub 2}/COD molar ratio 2, H{sub 2}O{sub 2}/Fe{sup 2+} molar ratio 150, irradiation time 90 min and HRT of 12 h. Under the best operating conditions, 89% removal of sCOD with complete nitrification was achieved and the SBR effluent met the discharge standards.

  13. Antibiotic treatment of verocytotoxin-producing Escherichia coli (VTEC) infection

    DEFF Research Database (Denmark)

    Agger, Morten; Scheutz, Flemming; Villumsen, Steen

    2015-01-01

    OBJECTIVES: A consensus has existed on not to treat verocytotoxin-producing Escherichia coli (VTEC)-infected individuals with antibiotics because of possible subsequent increased risk of developing haemolytic uraemic syndrome (HUS). The aim of this systematic review is to clarify the risk...... associated with antibiotic treatment during acute VTEC infection and in chronic VTEC carrier states. METHODS: A systematic search in PubMed identified 1 meta-analysis, 10 clinical studies and 22 in vitro/in vivo studies. RESULTS: Four clinical studies found an increased risk of HUS, four studies found...... no altered risk of HUS and two studies found a protective effect of antibiotics. In vitro and clinical studies suggest that DNA synthesis inhibitors should be avoided, whereas evidence from in vitro studies indicates that certain protein and cell wall synthesis inhibitors reduce the release of toxins from...

  14. Successful recovery from iatrogenic severe hypernatremia and severe metabolic acidosis resulting from accidental use of inappropriate bicarbonate concentrate for hemodialysis treatment

    Directory of Open Access Journals (Sweden)

    Guruprasad P Bhosale

    2015-01-01

    Full Text Available Bicarbonate dialysis is the treatment modality of choice for correction of metabolic acidosis in chronic renal failure. However, improper selection of dialysate concentrate can result in life-threatening human errors. We report a case of iatrogenic severe hypernatremia (sodium 207 mEq/L and severe metabolic acidosis (pH 6.65 that resulted due to accidental use of inappropriate bicarbonate concentrate for hemodialysis treatment. There was successful recovery in this patient with no neurological sequelae. To the best of our knowledge, this is the first case report in adults of severe hypernatremia along with severe metabolic acidosis due to error in the preparation of dialysis fluid.

  15. Fate of antibiotic resistant cultivable heterotrophic bacteria and antibiotic resistance genes in wastewater treatment processes.

    Science.gov (United States)

    Zhang, Songhe; Han, Bing; Gu, Ju; Wang, Chao; Wang, Peifang; Ma, Yanyan; Cao, Jiashun; He, Zhenli

    2015-09-01

    Antibiotic resistant bacteria (ARB) and antibiotic resistance genes (ARGs) are emerging contaminants of environmental concern. Heterotrophic bacteria in activated sludge have an important role in wastewater treatment plants (WWTPs). However, the fate of cultivable heterotrophic ARB and ARGs in WWPTs process remains unclear. In the present study, we investigated the antibiotic-resistant phenotypes of cultivable heterotrophic bacteria from influent and effluent water of three WWTPs and analysed thirteen ARGs in ARB and in activated sludge from anoxic, anaerobic and aerobic compartments. From each influent or effluent sample of the three plants, 200 isolates were randomly tested for susceptibility to 12 antibiotics. In these samples, between 5% and 64% isolates showed resistance to >9 antibiotics and the proportion of >9-drug-resistant bacteria was lower in isolates from effluent than from influent. Eighteen genera were identified in 188 isolates from influent (n=94) and effluent (n=94) of one WWTP. Six genera (Aeromonas, Bacillus, Lysinibacillus, Microbacterium, Providencia, and Staphylococcus) were detected in both influent and effluent samples. Gram-negative and -positive isolates dominated in influent and effluent, respectively. The 13 tetracycline-, sulphonamide-, streptomycin- and β-lactam-resistance genes were detected at a higher frequency in ARB from influent than from effluent, except for sulA and CTX-M, while in general, the abundances of ARGs in activated sludge from two of the three plants were higher in aerobic compartments than in anoxic ones, indicating abundant ARGs exit in the excess sledges and/or in uncultivable bacteria. These findings may be useful for elucidating the effect of WWTP on ARB and ARGs. Copyright © 2015 Elsevier Ltd. All rights reserved.

  16. SEM Analysis of Surface Impact on Biofilm Antibiotic Treatment.

    Science.gov (United States)

    Gomes, Luciana Calheiros; Mergulhão, Filipe José

    2017-01-01

    The aim of this work was to use scanning electron microscopy (SEM) to investigate the effect of ampicillin treatment on Escherichia coli biofilms formed on two surface materials with different properties, silicone (SIL) and glass (GLA). Epifluorescence microscopy (EM) was initially used to assess biofilm formation and killing efficiency on both surfaces. This technique showed that higher bacterial colonization was obtained in the hydrophobic SIL than in the hydrophilic GLA. It has also shown that higher biofilm inactivation was attained for GLA after the antibiotic treatment (7-log reduction versus 1-log reduction for SIL). Due to its high resolution and magnification, SEM enabled a more detailed analysis of the antibiotic effect on biofilm cells, complementing the killing efficiency information obtained by EM. SEM micrographs revealed that ampicillin-treated cells have an elongated form when compared to untreated cells. Additionally, it has shown that different materials induced different levels of elongation on cells exposed to antibiotic. Biofilms formed on GLA showed a 37% higher elongation than those formed on SIL. Importantly, cell elongation was related to viability since ampicillin had a higher bactericidal effect on GLA-formed biofilms. These findings raise the possibility of using SEM for understanding the efficacy of antimicrobial treatments by observation of biofilm morphology.

  17. Qualitative evaluation of antibiotic usage in pediatric patients

    Directory of Open Access Journals (Sweden)

    Hindra Irawan Satari

    2011-12-01

    Methods We performed a descriptive, retrospective study of matient medical records of those admitted to the pediatric ward from January 1 – June 30, 2009. Records were screened for patient antibiotic use, followed by qualitative evaluation using Gyssens algorithm on data from patient who received antibiotic treatment. Results We found 49.2% of subject were prescribed antibiotics. The majority of patients given antibiotics were aged 1 month - 1 year (39.3%. Antibiotic use was categorized by therapy type : empirical, prophylactic, or definitive. We found empirical therapy in 73% of cases, prophylactic in 8%, and definitive in 15%. Cefotaxime was the most common antibiotic used (25.1%, followed by ceftazidime (14% and cotrimoxazole (1%. 39.6% of subjects were given antibiotics appropriately, while 48.3% were given inappropriately. In 3.3% of patients, antibiotics were given without indication and in 8.8% there was insufficient data. Conclusions Of hospitalized patients receiving antibiotic treatment at the Departement of Child Health, Cipto Mangunkusumo Hospital, 39.6% were given antibiotic appropriately, while 48.3% were given antibiotics inappropriately. Cefotaxime was the most commonly used, as well as most inappropriately given antibiotic.

  18. Study of patterns of prescribing antibiotics in geriatric patients admitted to the medical wards in a tertiary care hospital

    OpenAIRE

    Ankita Bist; Gajanan P. Kulkarni; Kashinath M. Gumma

    2016-01-01

    Background: Evidence indicates high prevalence of inappropriate prescribing of medicines especially in the elderly. This can cause increased incidence of adverse drug reactions, morbidity, mortality and cost of treatment. Also inappropriate use of antibiotics promotes emergence of antimicrobial resistance. This study aims to study the prescribing patterns of antibiotics administered in geriatric patients, disease conditions for which the antibiotics were prescribed and adherence of these anti...

  19. Considering resistance in systematic reviews of antibiotic treatment.

    Science.gov (United States)

    Leibovici, Leonard; Soares-Weiser, Karla; Paul, Mical; Goldberg, Elad; Herxheimer, Andrew; Garner, Paul

    2003-10-01

    Microorganisms resistant to antibiotic drugs are a threat to the health and chances of survival of patients. Systematic reviews on antibiotic drugs that ignore the topic of resistance present readers with a skewed view, emphasizing short-term efficacy or effectiveness while ignoring long-term consequences. To examine whether systematic reviews of antibiotic treatment consider resistance; if not, to find out whether data on resistance were reported in the original trials; and based on that, to offer a framework for taking resistance into account in systematic reviews. The Cochrane Database of Systematic Reviews (the Cochrane Library, 2001, issue 2); and MEDLINE, 1996-2000. (i) Systematic reviews or meta-analyses of antimicrobial therapy, published during 1996-2000. (ii) Randomized, controlled trials abstracted in systematic reviews that addressed a topic highly relevant to antibiotic resistance. We examined each systematic review, and each article, to see whether the implications of resistance were discussed; and whether data on resistance were collected. Out of 111 systematic reviews, only 44 (40%) discussed resistance. Ten reviews (9%) planned or performed collection of data on the response of patients with susceptible or resistant isolates. In 22 systematic reviews (20%), collection of data on induction of resistance was planned or performed. The topic of 41 reviews was judged highly relevant to resistance, and these reviews extracted data from 337 articles, out of which we retrieved 279 articles (83%). In 201 (72%) articles, resistance was discussed or data pertaining to it were collected. Ninety-seven articles (35%) gave actual data on resistance of pathogens to the study drugs, 71 articles (25%) data on efficacy of antibiotic drugs in patients with susceptible and resistant pathogens, and 55 articles (20%) provided data on infection or colonization with resistant strains during treatment. Most systematic reviews on antibiotic treatment ignored the issue of

  20. Antibiotic resistance in community-acquired urinary tract infections

    African Journals Online (AJOL)

    the treatment of other infections would inevitably lead to the development of resistance. S Afr Med J 1994; 84: 600-602. Antibiotic resistance is a major problem in developing countries.' There are many reasons for this, including antibiotic use in animal feeds, inappropriate prescribing and poor sanitation. Resistance rates in ...

  1. Different recommendations for empiric first-choice antibiotic treatment of uncomplicated urinary tract infections in Europe

    DEFF Research Database (Denmark)

    McQuiston Haslund, Josephine; Rosborg Dinesen, Marianne; Nielsen, Anni Brit Sternhagen

    2013-01-01

    OBJECTIVE: Uncomplicated urinary tract infection (uUTI) is a common reason for antibiotic treatment in primary health care. Due to the increasing prevalence of antibiotic-resistant uropathogens it is crucial to use the most appropriate antibiotics for first-choice empiric treatment of u...

  2. Evaluation of Outpatient Antibiotic Use in Beijing General Hospitals in 2015

    Directory of Open Access Journals (Sweden)

    Chuan Yang

    2017-01-01

    Conclusions: Antibiotic use in Beijing general hospitals is generally low; however, inappropriate antibiotic use still exists. Inappropriately used antibiotics should be subject to rigorous control and management, and public policy initiatives are required to promote the judicious use of antibiotics.

  3. Antibiotic prescribing on admission to patients with pneumonia and prior outpatient antibiotic treatment: a cohort study on clinical outcome.

    Science.gov (United States)

    van de Garde, Ewoudt M W; Natsch, Stephanie; Prins, Jan M; van der Linden, Paul D

    2015-02-12

    Most pneumonia treatment guidelines recommend that prior outpatient antibiotic treatment should be considered when planning inpatient antibiotic regimen. Our purpose was to study in patients admitted for community-acquired pneumonia the mode of continuing antibiotic treatment at the outpatient to inpatient transition and the subsequent clinical course. Retrospective cohort study. Dutch PHARMO Record Linkage System. 7323 patients aged >18 years and hospitalised with pneumonia in the Netherlands between 2004 and 2010. We identified all prescribed antibiotics prior to, during and after hospitalisation. In case of prior outpatient treatment, the continuation of antibiotic treatment on admission was categorised as: no atypical coverage > no atypical coverage; atypical coverage > atypical coverage; no atypical coverage > atypical coverage; and atypical coverage > no atypical coverage. Length of hospital stay, in-hospital mortality and readmission within 30 days. Twenty-two per cent of the patients had received prior outpatient treatment, of which 408 (25%) patients were switched on admission to antibiotics with atypical coverage. There were no differences in length of hospital stay, in-hospital mortality or readmission rate between the four categories of patients with prior outpatient treatment. The adjusted HR for adding atypical coverage versus no atypical coverage was 0.91 (95% CI 0.55 to 1.51) for time to discharge. For in-hospital mortality and readmission within 30 days, the adjusted ORs were 1.09 (95% CI 0.85 to 1.34) and 0.59 (95% CI 0.30 to 1.18), respectively. This study found no association between mode of continuing antibiotic treatment at the outpatient to inpatient transition and relevant clinical outcomes. In particular, adding atypical coverage in patients without prior atypical coverage did not influence the outcome. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  4. Inhibiting scrapie neuroinvasion by polyene antibiotic treatment of SCID mice.

    Science.gov (United States)

    Beringue, V; Lasmézas, C I; Adjou, K T; Demaimay, R; Lamoury, F; Deslys, J P; Seman, M; Dormont, D

    1999-07-01

    The polyene antibiotic MS-8209 is currently one of the most effective drugs in the treatment of experimental scrapie. However, its mechanism of action and its site of intervention in the pathogenetical process of scrapie infection are largely unknown. It has been shown previously that the infection of immunodeficient SCID mice by the peripheral route provides a reliable model for direct scrapie neuroinvasion, bypassing the lymphoreticular system. Indeed, a proportion of SCID mice develop scrapie after a similar time to immunocompetent mice, despite their severe immune impairment. This model is now used to clarify the targets of MS-8209. In SCID mice, MS-8209 treatment protected against infection but did not prolong survival time. In SCID mice immunologically reconstituted prior to inoculation, the drug delayed the disease without an effect on the attack rate. These findings strongly suggest that MS-8209 acts by hampering the first step of the neuroinvasion process, i.e. the uptake of the infectious agent by peripheral nerve endings. The mechanism leading to the inhibition of agent propagation to nervous cells is discussed with regard to the properties of polyene antibiotics.

  5. Antibiotic treatment affects intestinal permeability and gut microbial composition in Wistar rats dependent on antibiotic class

    DEFF Research Database (Denmark)

    Tulstrup, Monica Vera-Lise; Christensen, Ellen Gerd; Carvalho, Vera

    2015-01-01

    Antibiotics are frequently administered orally to treat bacterial infections not necessarily related to the gastrointestinal system. This has adverse effects on the commensal gut microbial community, by disrupting the intricate balance between specific bacterial groups within this ecosystem...... potentially leading to dysbiosis. We hypothesized that modulation of community composition and function induced by antibiotics affects intestinal integrity depending on the antibiotic administered. To address this a total of 60 Wistar rats (n=12 per group) were dosed by oral gavage with either amoxicillin...

  6. treatment of common respiratory infections: the antibiotic dilemma

    African Journals Online (AJOL)

    Enrique

    antibiotic. Importantly, the study excluded patients with chronic bronchitis, asthma or chronic obstructive pulmonary disease. (COPD), and concluded that interventions are needed to reduce antibiotic prescribing to limit the progression of antibiotic resist- ance. How should clinicians responsibly approach the management of.

  7. The drinking water treatment process as a potential source of affecting the bacterial antibiotic resistance.

    Science.gov (United States)

    Bai, Xiaohui; Ma, Xiaolin; Xu, Fengming; Li, Jing; Zhang, Hang; Xiao, Xiang

    2015-11-15

    Two waterworks, with source water derived from the Huangpu or Yangtze River in Shanghai, were investigated, and the effluents were plate-screened for antibiotic-resistant bacteria (ARB) using five antibiotics: ampicillin (AMP), kanamycin (KAN), rifampicin (RFP), chloramphenicol (CM) and streptomycin (STR). The influence of water treatment procedures on the bacterial antibiotic resistance rate and the changes that bacteria underwent when exposed to the five antibiotics at concentration levels ranging from 1 to 100 μg/mL were studied. Multi-drug resistance was also analyzed using drug sensitivity tests. The results indicated that bacteria derived from water treatment plant effluent that used the Huangpu River rather than the Yangtze River as source water exhibited higher antibiotic resistance rates against AMP, STR, RFP and CM but lower antibiotic resistance rates against KAN. When the antibiotic concentration levels ranged from 1 to 10 μg/mL, the antibiotic resistance rates of the bacteria in the water increased as water treatment progressed. Biological activated carbon (BAC) filtration played a key role in increasing the antibiotic resistance rate of bacteria. Chloramine disinfection can enhance antibiotic resistance. Among the isolated ARB, 75% were resistant to multiple antibiotics. Ozone oxidation, BAC filtration and chloramine disinfection can greatly affect the relative abundance of bacteria in the community. Copyright © 2015 Elsevier B.V. All rights reserved.

  8. Exploring the correlations between antibiotics and antibiotic resistance genes in the wastewater treatment plants of hospitals in Xinjiang, China.

    Science.gov (United States)

    Li, Chao; Lu, Jianjiang; Liu, Jiang; Zhang, Genlin; Tong, Yanbing; Ma, Na

    2016-08-01

    Various antibiotics have been extensively used to treating infectious diseases in hospitals. In this study, the abundance and diversity of antibiotics and antibiotic resistance genes (ARGs) were observed in the wastewater samples from five hospitals in Xinjiang, China. The total concentrations of tetracyclines, sulphonamides, and quinolones in hospital influents ranged from 363.4 to 753.3 ng/L, 285.5 to 634.9 ng/L, and 1355.8 to 1922.4 ng/L, respectively. However, the removal efficiency of tetracyclines, sulphonamides, and quinolones in wastewater treatment processes ranged from 72.4 to 79.3 %, 36.0 to 52.2 %, and 45.1 to 55.4 %, respectively. The contamination levels of the selected ARGs varied in all wastewater samples. The highest relative concentrations of sul1, sul2, tetQ, and qnrS were significantly higher than those of other ARGs in this study. Significant positive correlations between the relative abundance of partial ARGs and concentrations of certain antibiotics were observed in hospital wastewaters. Results show that integrons played an important role in disseminating and distributing ARGs in microorganism systems. Furthermore, strong correlations were observed between tetQ, sulphonamide resistance genes (except sulA) and intI1. This study aimed to determine the contamination levels of antibiotics and ARGs and analyze the relationships among ARGs, and antibiotics and integron genes in hospital wastewaters.

  9. Solithromycin (CEM-101): A New Fluoroketolide Antibiotic and Its Role in the Treatment of Gonorrhea.

    Science.gov (United States)

    Mancuso, Alexandra M; Gandhi, Mona A; Slish, Judianne

    2018-04-01

    Solithromycin is a macrolide antibiotic that has undergone review for the treatment of community-acquired bacterial pneumonia. Solithromycin is also being investigated and has shown promise for the treatment of gonorrhea. With increasing antibiotic resistance, the development of novel antibiotics to combat infections is essential. The unique ribosome-binding stability of solithromycin and mild side effect profile make this a promising new antibiotic. This article will provide an overview on the mechanism of action, clinical efficacy, and safety of this drug for the treatment of gonorrhea. Relevant data were identified through a comprehensive literature search using multiple databases using the keywords solithromycin, CEM-101, and gonorrhea.

  10. Oral antibiotic treatment of left-sided infectious endocarditis verified by 16S-PCR

    DEFF Research Database (Denmark)

    Bruun, Louise E; Tønder, Niels; Hansen, Thomas Fritz

    2011-01-01

    Treatment of infectious endocarditis (IE) comprises intravenously administered antibiotic medications given at high doses for 4-6 weeks--sometimes even longer. Approximately 50% of patients referred to tertiary care centres require additional surgical intervention. At present there are few papers...... describing the effects of oral antibiotic treatment in IE, and only in patients with right-sided endocarditis. In this case report we present a patient with left-sided Streptococcus endocarditis successfully treated with oral antibiotic drugs....

  11. Development of Diazaquinomycin Class Antibiotics for the Treatment of Drug-Resistant TB Infections

    Science.gov (United States)

    2016-10-01

    Lakes antibiotic discovery program. February 4, 2014. UIC News Cover story: Highlights a Department of Defense grant between Drs. Murphy and...AWARD NUMBER: W81XWH-13-1-0171 TITLE: Development of Diazaquinomycin Class Antibiotics for the Treatment of Drug-Resistant TB Infections...Class Antibiotics for the Treatment of Drug-Resistant TB Infections 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) Scott Franzblau, Ph.D

  12. Intestinal microbiota composition after antibiotic treatment in early life : the INCA study

    NARCIS (Netherlands)

    Rutten, N B M M; Rijkers, G T; Meijssen, C B; Crijns, C E; Oudshoorn, J H; van der Ent, C K; Vlieger, A M; van der Ent, CK

    2015-01-01

    BACKGROUND: The acquisition and development of infant gut microbiota can be influenced by numerous factors, of which early antibiotic treatment is an important one. However, studies on the effects of antibiotic treatment in early life on clinical outcomes and establishment and development of the gut

  13. Australian consumer perspectives, attitudes and behaviours on antibiotic use and antibiotic resistance: a qualitative study with implications for public health policy and practice.

    Science.gov (United States)

    Lum, Elaine P M; Page, Katie; Nissen, Lisa; Doust, Jenny; Graves, Nicholas

    2017-10-10

    for high quality general practice consults conducted in a manner that increases consumer confidence in the treatment decision, regardless of whether an antibiotic is prescribed. To reduce inappropriate consumption of antibiotics and to more fully engage Australian consumers in mitigating antibiotic resistance, changes in health policy and practice are required.

  14. Australian consumer perspectives, attitudes and behaviours on antibiotic use and antibiotic resistance: a qualitative study with implications for public health policy and practice

    Directory of Open Access Journals (Sweden)

    Elaine P. M. Lum

    2017-10-01

    appropriate antibiotic use behaviours. Consumers also have expectations for high quality general practice consults conducted in a manner that increases consumer confidence in the treatment decision, regardless of whether an antibiotic is prescribed. To reduce inappropriate consumption of antibiotics and to more fully engage Australian consumers in mitigating antibiotic resistance, changes in health policy and practice are required.

  15. Antibiotic Concentrations Decrease during Wastewater Treatment but Persist at Low Levels in Reclaimed Water

    Science.gov (United States)

    Kulkarni, Prachi; Olson, Nathan D.; Raspanti, Greg A.; Rosenberg Goldstein, Rachel E.; Gibbs, Shawn G.; Sapkota, Amir; Sapkota, Amy R.

    2017-01-01

    Reclaimed water has emerged as a potential irrigation solution to freshwater shortages. However, limited data exist on the persistence of antibiotics in reclaimed water used for irrigation. Therefore, we examined the fate of nine commonly-used antibiotics (ampicillin, azithromycin, ciprofloxacin, linezolid, oxacillin, oxolinic acid, penicillin G, pipemidic acid, and tetracycline) in differentially treated wastewater and reclaimed water from two U.S. regions. We collected 72 samples from two Mid-Atlantic and two Midwest treatment plants, as well as one Mid-Atlantic spray irrigation site. Antibiotic concentrations were measured using liquid-chromatography- tandem mass spectrometry. Data were analyzed using Mann-Whitney-Wilcoxon tests and Kruskal Wallis tests. Overall, antibiotic concentrations in effluent samples were lower than that of influent samples. Mid-Atlantic plants had similar influent but lower effluent antibiotic concentrations compared to Midwest plants. Azithromycin was detected at the highest concentrations (of all antibiotics) in influent and effluent samples from both regions. For most antibiotics, transport from the treatment plant to the irrigation site resulted in no changes in antibiotic concentrations, and UV treatment at the irrigation site had no effect on antibiotic concentrations in reclaimed water. Our findings show that low-level antibiotic concentrations persist in reclaimed water used for irrigation; however, the public health implications are unclear at this time. PMID:28635638

  16. Post treatment of antibiotic wastewater by adsorption on activated carbon

    Science.gov (United States)

    Mullai, P.; Rajesh, V.

    2018-02-01

    The most common method of treating industrial wastewater involves biomethanation in anaerobic digesters. This biological treatment process is ineffective in color removal and it requires post-treatment methods. The color is the first contaminant in wastewater which affects the water bodies in several ways. As the anaerobically digested antibiotic wastewater was found with color, an attempt was made to remove color using granulated activated carbon as an adsorbent. Experiments were carried out in batch reactors to find out the color removal efficiency of the wastewater at four different dosages such as 25, 50, 75 and 100 mg of adsorbent material at each of the four different initial concentrations of effluent like 1956, 1450, 1251 and 1040 mg COD/L. The steady state values of color removal efficiencies were 96.6, 97.64, 98.64 and 99.63%, respectively, using 100 mg of activated carbon under shaking condition at the end of the 120th min. The effect of contact time on the percentage of color removal was also studied. It was observed that the adsorption of effluent obtained equilibrium at 120 minutes. The equilibrium data fitted well with the Langmuir and Freundlich isotherms.

  17. The antibiotic prevention and interventional treatment as well as medical imaging manifestations of rabbit discitis

    International Nuclear Information System (INIS)

    Sun Gang; Yuang Cheng; Huang Deqing; Dong Zhengjun

    1999-01-01

    Objective: To assess the role of antibiotic and interventional radiology in prevention and treatment of discitis and analyze the imaging manifestations of discitis. Methods: 24 rabbits were used to make discitis models, and were classified into 4 groups randomly, 6 cases per group: non-treatment group, prophylactic antibiotic group, therapeutic antibiotic group and interventional treatment group. In prophylactic antibiotics group, intravenous clindamycin was administered 3 day before inoculation of bacteria to disc. In therapeutic antibiotics group, 4-week course of intravenous antibiotics was commenced 1 week after the bacterial inoculation. In interventional treatment group, PLD were performed 1 week after the inoculation, with simultaneous intravenous antibiotics for a period of 1 week, 2 or 4 weeks after inoculation. The lumbar spines of all rabbits were examined by X-ray, CT, and MRI respectively. Needle biopsy of nuclear pulpous was obtained and experimental region of lumbar spine were removed for pathological examination. Results: In non-treatment group and therapeutic antibiotics group, all of the discs inoculated with bacteria developed radiographic and pathological evidence of discitis, including intervertebral space narrowing, inflammatory changes of disc tissue, and destruction of end-plates. In prophylactic antibiotics group, none of the discs developed radiographic and pathological evidences of discitis, the bacterial culture was negative. In interventional treatment group, disc narrowing was observed in medical image and fibrosis was found in nucleus region. There was no evidence of destruction of end-plate, the bacteria culture was negative. Conclusion: MRI is a relative sensitive method to detect discitis. Prophylactic antibiotics is a key measure to prevent discitis. The PLD treatment could hold back the pathological process of discitis. Once developed, intravenous antibiotic is unable to affect the course of discitis

  18. Multiple antibiotic resistance genes distribution in ten large-scale membrane bioreactors for municipal wastewater treatment.

    Science.gov (United States)

    Sun, Yanmei; Shen, Yue-Xiao; Liang, Peng; Zhou, Jizhong; Yang, Yunfeng; Huang, Xia

    2016-12-01

    Wastewater treatment plants are thought to be potential reservoirs of antibiotic resistance genes. In this study, GeoChip was used for analyzing multiple antibiotic resistance genes, including four multidrug efflux system gene groups and three β-lactamase genes in ten large-scale membrane bioreactors (MBRs) for municipal wastewater treatment. Results revealed that the diversity of antibiotic genes varied a lot among MBRs, but about 40% common antibiotic resistance genes were existent. The average signal intensity of each antibiotic resistance group was similar among MBRs, nevertheless the total abundance of each group varied remarkably and the dominant resistance gene groups were different in individual MBR. The antibiotic resistance genes majorly derived from Proteobacteria and Actinobacteria. Further study indicated that TN, TP and COD of influent, temperature and conductivity of mixed liquor were significant (Pantibiotic resistance genes distribution in MBRs. Copyright © 2016 Elsevier Ltd. All rights reserved.

  19. Impact of Chest Radiography on Antibiotic Treatment for Children With Suspected Pneumonia.

    Science.gov (United States)

    Nelson, Kyle A; Morrow, Christopher; Wingerter, Sarah L; Bachur, Richard G; Neuman, Mark I

    2016-08-01

    National guidelines discourage routine chest radiographs (CXRs) to confirm suspected pneumonia in children managed as outpatients. However, limiting CXRs may lead to antibiotic overuse. We examined the impact of CXRs and clinical suspicion on antibiotic treatment for children with suspected pneumonia. Children aged 3 months to 18 years undergoing CXR for suspected pneumonia in a pediatric emergency department were prospectively enrolled. Before CXR, physicians indicated their initial plan for antibiotics (yes or no) and clinical suspicion for radiographic pneumonia (75%). Subjects had radiographic pneumonia if their CXRs demonstrated definite or possible findings of pneumonia. We compared antibiotic treatment according to pre-CXR antibiotic plan and suspicion for pneumonia and CXR results. Among the 107 children with a plan for antibiotics before CXR, 72% ultimately received antibiotics compared with 19% of the 1503 children without a pre-CXR plan for antibiotics (P pneumonia were ultimately treated compared with 54% without radiographic pneumonia (P pneumonia were treated compared with 8% without radiographic pneumonia (P pneumonia was low (pneumonia, CXRs infrequently altered the initial plan for antibiotics. However, when clinical suspicion for pneumonia was low, the use of CXR may reduce unnecessary antibiotic use.

  20. Occurrence of antibiotics and antibiotic resistance genes in a sewage treatment plant and its effluent-receiving river.

    Science.gov (United States)

    Xu, Jian; Xu, Yan; Wang, Hongmei; Guo, Changsheng; Qiu, Huiyun; He, Yan; Zhang, Yuan; Li, Xiaochen; Meng, Wei

    2015-01-01

    The extensive use of antibiotics has caused the contamination of both antibiotics and antibiotic resistance genes (ARGs) in the environment. In this study, the abundance and distribution of antibiotics and ARGs from a sewage treatment plant (STP) and its effluent-receiving river in Beijing China were characterized. Three classes of antibiotics including tetracycline, sulfonamide and quinolone were quantified by LC-MS/MS. In the secondary effluent they were detected at 195, 2001 and 3866 ng L(-1), respectively, which were higher than in the receiving river water. A total of 13 ARGs (6 tet genes: tetA, tetB, tetE, tetW, tetM and tetZ, 3 sulfonamide genes: sul1, sul2 and sul3, and 4 quinolone genes: gryA, parC, qnrC and qnrD) were determined by quantitative PCR. For all ARGs, sulfonamide resistance genes were present at relatively high concentrations in all samples, with the highest ARG concentration above 10(-1). ARGs remained relatively stable along each sewage treatment process. The abundances of detected ARGs from the STP were also higher than its receiving river. Bivariate correlation analysis showed that relative tet gene copies (tetB/16S-rRNA and tetW/16S-rRNA) were strongly correlated with the concentrations of tetracycline residues (r(2)>0.8, presistance gene (qnrC/16S-rRNA) and the concentrations of enrofloxacin (ENR) was also determined. The difference of ARGs levels in the raw influent and secondary effluent suggested that the STP treatment process may induce to increase the abundance of resistance genes. The results showed that the sewage was an important repository of the resistance genes, which need to be effectively treated before discharge into the natural water body. Copyright © 2014 Elsevier Ltd. All rights reserved.

  1. The influence of antibiotic treatment of bitches in oestrus on their attractiveness to males during mating.

    Science.gov (United States)

    Dziecioł, M; Nizański, W; Stańczyk, E; Kozdrowski, R; Najder-Kozdrowska, L; Twardoń, J

    2013-01-01

    The aim of this study was to evaluate the influence of the antibiotic treatment, including the mode of drugs administration, on bitches' attractiveness to the stud dogs during mating. Moreover, we tried to estimate the possibility of aversive effect of the drug vehicle on the male behavior. In experiment I, four bitches in oestrus without antibiotic treatment (group A), four bitches treated with intravaginal antibiotic (group B) and four bitches treated with intramuscular antibiotic (group C) were presented to four stud dogs. In experiment II, bitches in oestrus (n = 5) were presented to the males (n = 2) before and after the application to the females' vulva the antibiotic carrier--Miglyol 840 (Sasol, Germany). In both experiments the presence of the typical sexual behavior of the males (sniffing, licking the vulva and anal region, mating attempts) was evaluated. In experiment III the reaction of the males to the samples containing oestrual discharge from the bitches untreated and treated with antibiotics was evaluated. In the last part of study the aversion reaction to the samples containing antibiotic and the antibiotic carrier was evaluated. The results of experiments showed that females treated with the antibiotics were less attractive to males than untreated females, regardless of the method of administration. We did not observe adverse effect of the antibiotic carrier but samples from the bitches treated with antibiotics were significantly less attractive to the males. We concluded that the reason for reduced attractiveness of the bitches in oestrus after antibiotic treatment was the changes in semiochemical signal emitted by treated females as a consequence of elimination of the vaginal bacterial flora, which seems to be involved in creation of the typical, recognizable by the stud dogs, oestrual signal but also by the possible covering effect of used drugs.

  2. Antibiotic treatment delay and outcome in acute bacterial meningitis

    DEFF Research Database (Denmark)

    Køster-Rasmussen, Rasmus; Korshin, André; Meyer, Christian N

    2008-01-01

    OBJECTIVES: To identify to what degree in-hospital delay of antibiotic therapy correlated to outcome in community acquired bacterial meningitis. METHODS: All cases of culture-positive cerebrospinal fluids in east Denmark from 2002 to 2004 were included. Medical records were collected retrospectiv......OBJECTIVES: To identify to what degree in-hospital delay of antibiotic therapy correlated to outcome in community acquired bacterial meningitis. METHODS: All cases of culture-positive cerebrospinal fluids in east Denmark from 2002 to 2004 were included. Medical records were collected......=1.30/h, CI: 1.08-1.57). The median delay to the first dose of adequate antibiotics was 1h and 39min (1h and 14min in children vs. 2h in adults, pmeningitis. CONCLUSION: The delay in antibiotic therapy correlated...

  3. Removal of antibiotics from surface and distilled water in conventional water treatment processes

    Science.gov (United States)

    Adams, C.; Wang, Y.; Loftin, K.; Meyer, M.

    2002-01-01

    Conventional drinking water treatment processes were evaluated under typical water treatment plant conditions to determine their effectiveness in the removal of seven common antibiotics: carbadox, sulfachlorpyridazine, sulfadimethoxine, sulfamerazine, sulfamethazine, sulfathiazole, and trimethoprim. Experiments were conducted using synthetic solutions prepared by spiking both distilled/ deionized water and Missouri River water with the studied compounds. Sorption on Calgon WPH powdered activated carbon, reverse osmosis, and oxidation with chlorine and ozone under typical plant conditions were all shown to be effective in removing the studied antibiotics. Conversely, coagulation/flocculation/sedimentation with alum and iron salts, excess lime/soda ash softening, ultraviolet irradiation at disinfection dosages, and ion exchange were all relatively ineffective methods of antibiotic removal. This study shows that the studied antibiotics could be effectively removed using processes already in use many water treatment plants. Additional work is needed on by-product formation and the removal of other classes of antibiotics.

  4. Antibiotic policy

    OpenAIRE

    Gyssens, Inge

    2011-01-01

    There is a clear association between antibiotic use and resistance both on individual and population levels. In the European Union, countries with large antibiotic consumption have higher resistance rates. Antibiotic resistance leads to failed treatments, prolonged hospitalisations, increased costs and deaths. With few new antibiotics in the Research & Development pipeline, prudent antibiotic use is the only option to delay the development of resistance. Antibiotic policy consists of prescrib...

  5. Antibiotic prescribing for children in primary care and adherence to treatment guidelines

    NARCIS (Netherlands)

    Ivanovska, V.; Hek, K.; Teeuwisse, A.K.; Leufkens, H.G.M.; Nielen, M.M.; van Dijk, L.

    OBJECTIVES: Antibiotic use is unnecessarily high for paediatric respiratory tract infections (RTIs) in primary care, and implementation of treatment guidelines is difficult in practice. This study aims to assess guideline adherence to antibiotic prescribing for RTIs in children and examine potential

  6. Antibiotic prescribing for children in primary care and adherence to treatment guidelines.

    NARCIS (Netherlands)

    Ivanovska, V.; Hek, K.; Mantel-Teeuwisse, A.K.; Leufkens, H.G.M.; Nielen, M.M.J.; Dijk, L. van

    2016-01-01

    Objectives Antibiotic use is unnecessarily high for paediatric respiratory tract infections (RTIs) in primary care, and implementation of treatment guidelines is difficult in practice. This study aims to assess guideline adherence to antibiotic prescribing for RTIs in children and

  7. Limited bacterial diversity within a treatment plant receiving antibiotic containing waste from bulk drug production

    NARCIS (Netherlands)

    Marathe, Nachiket P.; Shetty, Sudarshan A.; Shouche, Yogesh S.; Larsson, D.G.J.

    2016-01-01

    Biological treatment of waste water from bulk drug production, contaminated with high levels of fluoroquinolone antibiotics, can lead to massive enrichment of antibiotic resistant bacteria, resistance genes and associated mobile elements, as previously shown. Such strong selection may be boosted

  8. Antibiotic treatment preventing necrotising enterocolitis alters urinary and plasma metabolomes in preterm pigs

    DEFF Research Database (Denmark)

    Jiang, Pingping; Trimigno, Alessia; Stanstrup, Jan

    2017-01-01

    microbiome density and NEC lesions as previously reported, the antibiotic treatment employed in the current study affected the abundance of 44 metabolites in different metabolic pathways. In antibiotics-treated pigs, tryptophan metabolism favoured the kynurenine pathway, relative to the serotonin pathway...

  9. Microbial selectivity of UV treatment on antibiotic-resistant heterotrophic bacteria in secondary effluents of a municipal wastewater treatment plant.

    Science.gov (United States)

    Guo, Mei-Ting; Yuan, Qing-Bin; Yang, Jian

    2013-10-15

    Little is known about the microbial selectivity of UV treatment for antibiotic resistant bacteria, and the results of limited studies are conflicting. To understand the effect of UV disinfection on antibiotic resistant bacteria, both total heterotrophic bacteria and antibiotic resistant bacteria (including cephalexin-, ciprofloxacin-, erythromycin-, gentamicin-, vancomycin-, sulfadiazine-, rifampicin-, tetracycline- and chloramphenicol-resistant bacteria) were examined in secondary effluent samples from a municipal wastewater treatment plant. Bacteria resistant to both erythromycin and tetracycline were chosen as the representative of multiple-antibiotic-resistant bacteria and their characteristics after UV treatment were also investigated. UV disinfection results in effective inactivation for total heterotrophic bacteria, as well as all antibiotic resistant bacteria. After UV treatment at a fluence of 5 mJ/cm(2), the log reductions of nine types of antibiotic resistant bacteria varied from 1.0 ± 0.1 to 2.4 ± 0.1. Bacteria resistant to both erythromycin and tetracycline had a similar fluence response as did total heterotrophic bacteria. The findings suggest that UV disinfection could eliminate antibiotic resistance in wastewater treatment effluents and thus ensure public health security. Our experimental results indicated that UV disinfection led to enrichment of bacteria with resistance to sulfadiazine, vancomycin, rifampicin, tetracycline and chloramphenicol, while the proportions of cephalexin-, erythromycin-, gentamicin- and ciprofloxacin-resistant bacteria in the wastewater decreased. This reveals the microbial selectivity of UV disinfection for antibiotic resistant bacteria. Copyright © 2013 Elsevier Ltd. All rights reserved.

  10. Performance of Ozonation Process as Advanced Treatment for Antibiotics Removal in Membrane Permeate

    OpenAIRE

    Thanh Cao Ngoc Dan; Quyen Vo Thi Kim; Tin Nguyen Thanh; Thanh Bui Xuan

    2016-01-01

    There was an investigation into the removal of 6 types of antibiotics from hospital wastewater through membrane bioreactor (MBR) treatment and ozonation processes. Six types of antibiotics, namely, Sulfamethoxazole (SMZ), Norfloxacin (NOR), Ciprofloxacin (CIP), Ofloxacin (OFL), Erythromycin (ERY), and Vancomycin (VAN) which had high detection frequencies in collected samples from hospital wastewater treatment plant (HWTPs). After MBR treatment, the removal efficiencies of SMZ, NOR, OFL, and E...

  11. Effective antiprotease-antibiotic treatment of experimental anthrax

    Directory of Open Access Journals (Sweden)

    MacAfee Rebecca

    2005-04-01

    Full Text Available Abstract Background Inhalation anthrax is characterized by a systemic spread of the challenge agent, Bacillus anthracis. It causes severe damage, including multiple hemorrhagic lesions, to host tissues and organs. It is widely believed that anthrax lethal toxin secreted by proliferating bacteria is a major cause of death, however, the pathology of intoxication in experimental animals is drastically different from that found during the infectious process. In order to close a gap between our understanding of anthrax molecular pathology and the most prominent clinical features of the infectious process we undertook bioinformatic and experimental analyses of potential proteolytic virulence factors of B. anthracis distinct from lethal toxin. Methods Secreted proteins (other than lethal and edema toxins produced by B. anthracis were tested for tissue-damaging activity and toxicity in mice. Chemical protease inhibitors and rabbit immune sera raised against B. anthracis proteases were used to treat mice challenged with B. anthracis (Sterne spores. Results B. anthracis strain delta Ames (pXO1-, pXO2- producing no lethal and edema toxins secrets a number of metalloprotease virulence factors upon cultivation under aerobic conditions, including those with hemorrhagic, caseinolytic and collagenolytic activities, belonging to M4 and M9 thermolysin and bacterial collagenase families, respectively. These factors are directly toxic to DBA/2 mice upon intratracheal administration at 0.5 mg/kg and higher doses. Chemical protease inhibitors (phosphoramidon and 1, 10-phenanthroline, as well as immune sera against M4 and M9 proteases of B. anthracis, were used to treat mice challenged with B. anthracis (Sterne spores. These substances demonstrate a substantial protective efficacy in combination with ciprofloxacin therapy initiated as late as 48 h post spore challenge, compared to the antibiotic alone. Conclusion Secreted proteolytic enzymes are important pathogenic

  12. Broad-Spectrum Antibiotic Treatment and Subsequent Childhood Type 1 Diabetes

    DEFF Research Database (Denmark)

    Clausen, Tine D; Bergholt, Thomas; Bouaziz, Olivier

    2016-01-01

    BACKGROUND: Studies link antibiotic treatment and delivery by cesarean section with increased risk of chronic diseases through changes of the gut-microbiota. We aimed to evaluate the association of broad-spectrum antibiotic treatment during the first two years of life with subsequent onset...... of childhood type 1 diabetes and the potential effect-modification by mode of delivery. MATERIALS AND METHODS: A Danish nationwide cohort study including all singletons born during 1997-2010. End of follow-up by December 2012. Four national registers provided information on antibiotic redemptions, outcome...... and confounders. Redemptions of antibiotic prescriptions during the first two years of life was classified into narrow-spectrum or broad-spectrum antibiotics. Children were followed from age two to fourteen, both inclusive. The risk of type 1 diabetes with onset before the age of 15 years was assessed by Cox...

  13. Synergistic antimicrobial therapy using nanoparticles and antibiotics for the treatment of multidrug-resistant bacterial infection

    Science.gov (United States)

    Gupta, Akash; Saleh, Neveen M.; Das, Riddha; Landis, Ryan F.; Bigdeli, Arafeh; Motamedchaboki, Khatereh; Rosa Campos, Alexandre; Pomeroy, Kenneth; Mahmoudi, Morteza; Rotello, Vincent M.

    2017-06-01

    Infections caused by multidrug-resistant (MDR) bacteria pose a serious global burden of mortality, causing thousands of deaths each year. Antibiotic treatment of resistant infections further contributes to the rapidly increasing number of antibiotic-resistant species and strains. Synthetic macromolecules such as nanoparticles (NPs) exhibit broad-spectrum activity against MDR species, however lack of specificity towards bacteria relative to their mammalian hosts limits their widespread therapeutic application. Here, we demonstrate synergistic antimicrobial therapy using hydrophobically functionalized NPs and fluoroquinolone antibiotics for treatment of MDR bacterial strains. An 8-16-fold decrease in antibiotic dosage is achieved in presence of engineered NPs to combat MDR strains. This strategy demonstrates the potential of using NPs to ‘revive’ antibiotics that have been rendered ineffective due to the development of resistance by pathogenic bacteria.

  14. Role of symptomatic treatment in comparison to antibiotics in uncomplicated urinary tract infections

    International Nuclear Information System (INIS)

    Jamil, M.N.; Khan, R.M.; Sultan, B.; Farooq, U.

    2017-01-01

    Uncomplicated urinary tract infections (UTIs) are the most common bacterial infections among women presenting to primary care causing rapidly increasing strains of resistant bacteria to the growing antibiotic industry. Restricting antibiotics to necessary indications is the only solution. The objectives of the study were to compare the efficacy of symptomatic treatment vs antibiotic in patients with uncomplicated UTI, in terms of individual symptom score, i.e., frequency, urgency, dysuria, supra pubic pain scores and total symptoms scores. Methods: A randomized control trial (RCT) in 100 women (15-50 years) with symptoms of urinary frequency, urgency, dysuria and pain supra pubic region, associated with uncomplicated UTI, at Urology department, AMI, Abbottabad. Two treatment strategies were compared in uncomplicated UTI patient). Patients were randomized to antibiotic or symptomatic treatment groups on consecutive non-probability basis (50 in each group) given for 05 days. Efficacy of medications was assessed by comparing pre and post treatment symptom scores along with the post treatment scores of both groups compared to see statistical significance of difference by independent samples t-test. Results: There was a statistically significant difference in symptoms improvement in both treatment arms of all scores, i.e., p-value=0.000. Whereas only dysuria score was able to show a statistically significance of difference in post Rx scores comparison of both groups, p-value=0.004. Conclusions: Symptomatic treatment is not inferior to antibiotic treatment when proper patient selection is undertaken, resulting in decreased need for unnecessary antibiotics use. (author)

  15. Streptokinase Treatment Reverses Biofilm-Associated Antibiotic Resistance in Staphylococcus aureus

    DEFF Research Database (Denmark)

    Jørgensen, Nis Pedersen; Zobek, Natalia; Dreier, Cindy

    2016-01-01

    by combining antibiotic treatment with a fibrinolytic drug. We quantified S. aureus USA300 biofilms grown on peg-lids in brain heart infusion (BHI) broth with 0%–50% human plasma. Young (2 h) and mature (24 h) biofilms were then treated with streptokinase to determine if this lead to dispersal. Then......, the minimal biofilm eradication concentration (MBEC) of 24 h old biofilms was measured for vancomycin and daptomycin alone or in combination with 10 µg/mL rifampicin in the presence or absence of streptokinase in the antibiotic treatment step. Finally, biofilms were visualized by confocal laser scanning...... or daptomycin, which are commonly used antibiotics for treatment of S. aureus infections. Fibronolytic drugs have been used to treat thromboembolic events for decades, and our findings suggest that their use against biofilm infections has the potential to improve the efficacy of antibiotics in treatment of S...

  16. Antibiotic prescription in the treatment of odontogenic infection by health professionals: a factor to consensus.

    Science.gov (United States)

    González-Martínez, Raquel; Cortell-Ballester, Isidoro; Herráez-Vilas, José-María; Arnau-de Bolós, José-María; Gay-Escoda, Cosme

    2012-05-01

    To observe the attitude of dentists and family doctors in prescribing antibiotics for the treatment of dental infections. A poll was performed to determine the differences in the prescription of antibiotics for the treatment of odontogenic infection by dentists and family doctors of the primary care department of the Catalan Health Care Service. A hundred polls were distributed among family doctors, and another 100 ones among primary care dentists assigned to the Catalan Health Care Service of the Generalitat de Catalunya. Of the total of questionnaires distributed, 63 were retuned and answered from dentists and 71 from family doctors. Eighty-one percent of dentists included in the opinion poll considered amoxicillin as the first antibiotic choice for the treatment of odontogenic infections, while 73.2% of family doctors preferred the combination of amoxicillin and clavulanic acid. With regard to antibiotics of choice in patients allergic to penicillin, 67.7% of family doctors preferred macrolides (25.4% opted for clarithromycin, 25.4% for erythromycin and 16.9% for spiramycin). However, clindamycin was the antibiotic most frequently prescribed by dentists (66.7%), followed by erythromycin (28.6%). The results of this study show a large discrepancy in the criteria for the treatment of odontogenic infections on the part of leading professionals involved in the management of this condition. Although the most common prescription involved beta-lactam antibiotics in both groups, several significant differences have been detected with regard to the second antibiotic choice.

  17. Characterization of shifts of koala (Phascolarctos cinereus intestinal microbial communities associated with antibiotic treatment

    Directory of Open Access Journals (Sweden)

    Katherine E. Dahlhausen

    2018-03-01

    Full Text Available Koalas (Phascolarctos cinereus are arboreal marsupials native to Australia that eat a specialized diet of almost exclusively eucalyptus leaves. Microbes in koala intestines are known to break down otherwise toxic compounds, such as tannins, in eucalyptus leaves. Infections by Chlamydia, obligate intracellular bacterial pathogens, are highly prevalent in koala populations. If animals with Chlamydia infections are received by wildlife hospitals, a range of antibiotics can be used to treat them. However, previous studies suggested that koalas can suffer adverse side effects during antibiotic treatment. This study aimed to use 16S rRNA gene sequences derived from koala feces to characterize the intestinal microbiome of koalas throughout antibiotic treatment and identify specific taxa associated with koala health after treatment. Although differences in the alpha diversity were observed in the intestinal flora between treated and untreated koalas and between koalas treated with different antibiotics, these differences were not statistically significant. The alpha diversity of microbial communities from koalas that lived through antibiotic treatment versus those who did not was significantly greater, however. Beta diversity analysis largely confirmed the latter observation, revealing that the overall communities were different between koalas on antibiotics that died versus those that survived or never received antibiotics. Using both machine learning and OTU (operational taxonomic unit co-occurrence network analyses, we found that OTUs that are very closely related to Lonepinella koalarum, a known tannin degrader found by culture-based methods to be present in koala intestines, was correlated with a koala’s health status. This is the first study to characterize the time course of effects of antibiotics on koala intestinal microbiomes. Our results suggest it may be useful to pursue alternative treatments for Chlamydia infections without the use of

  18. USE OF ANTIBIOTIC CEMENT SPACERS/BEADS IN TREATMENT ...

    African Journals Online (AJOL)

    Background: Chronic musculoskeletal infection involving bone present a big challenge to orthopaedic surgeons. These include chronic osteomyelitis, septic non union and open fractures of long bones. Objective: The study was done to determine ... 'External fixators were applied after which antibiotic impregnated cement ...

  19. Successful treatment of recurrent cholangitis with antibiotic maintenance therapy

    NARCIS (Netherlands)

    van den Hazel, S. J.; Speelman, P.; Tytgat, G. N.; van Leeuwen, D. J.

    1994-01-01

    The impact of antibiotic maintenance therapy on the incidence of biliary tract infection was evaluated in patients with recurrent cholangitis after resection of a malignancy at the hepatic confluence. Thirty-eight of 54 patients (70%) experienced episodes of cholangitis. In 14 of the 38 patients

  20. Antibiotic treatment for Helicobacter pylori: Is the end coming?

    Science.gov (United States)

    Kim, Su Young; Choi, Duck Joo; Chung, Jun-Won

    2015-01-01

    Infection with the Gram-negative pathogen Helicobacter pylori (H. pylori) has been associated with gastro-duodenal disease and the importance of H. pylori eradication is underscored by its designation as a group I carcinogen. The standard triple therapy consists of a proton pump inhibitor, amoxicillin and clarithromycin, although many other regimens are used, including quadruple, sequential and concomitant therapy regimens supplemented with metronidazole, clarithromycin and levofloxacin. Despite these efforts, current therapeutic regimens lack efficacy in eradication due to antibiotic resistance, drug compliance and antibiotic degradation by the acidic stomach environment. Antibiotic resistance to clarithromycin and metronidazole is particularly problematic and several approaches have been proposed to overcome this issue, such as complementary probiotic therapy with Lactobacillus. Other studies have identified novel molecules with an anti-H. pylori effect, as well as tailored therapy and nanotechnology as viable alternative eradication strategies. This review discusses current antibiotic therapy for H. pylori infections, limitations of this type of therapy and predicts the availability of newly developed therapies for H. pylori eradication. PMID:26558152

  1. Urban wastewater treatment plants as hotspots for the release of antibiotics in the environment: a review.

    Science.gov (United States)

    Michael, I; Rizzo, L; McArdell, C S; Manaia, C M; Merlin, C; Schwartz, T; Dagot, C; Fatta-Kassinos, D

    2013-03-01

    Urban wastewater treatment plants (UWTPs) are among the main sources of antibiotics' release into various compartments of the environment worldwide. The aim of the present paper is to critically review the fate and removal of various antibiotics in wastewater treatment, focusing on different processes (i.e. biological processes, advanced treatment technologies and disinfection) in view of the current concerns related to the induction of toxic effects in aquatic and terrestrial organisms, and the occurrence of antibiotics that may promote the selection of antibiotic resistance genes and bacteria, as reported in the literature. Where available, estimations of the removal of antibiotics are provided along with the main treatment steps. The removal efficiency during wastewater treatment processes varies and is mainly dependent on a combination of antibiotics' physicochemical properties and the operating conditions of the treatment systems. As a result, the application of alternative techniques including membrane processes, activated carbon adsorption, advanced oxidation processes (AOPs), and combinations of them, which may lead to higher removals, may be necessary before the final disposal of the effluents or their reuse for irrigation or groundwater recharge. Copyright © 2012 Elsevier Ltd. All rights reserved.

  2. A review of the influence of treatment strategies on antibiotic resistant bacteria and antibiotic resistance genes.

    Science.gov (United States)

    Sharma, Virender K; Johnson, Natalie; Cizmas, Leslie; McDonald, Thomas J; Kim, Hyunook

    2016-05-01

    Antibiotic resistant bacteria (ARB) and antibiotic resistance genes (ARG) in the aquatic environment have become an emerging contaminant issue, which has implications for human and ecological health. This review begins with an introduction to the occurrence of ARB and ARG in different environmental systems such as natural environments and drinking water resources. For example, ARG or ARB with resistance to ciprofloxacin, sulfamethoxazole, trimethoprim, quinolone, vancomycin, or tetracycline (e.g., tet(A), tet(B), tet(C), tet(G), tet(O), tet(M), tet(W), sul I, and sul II) have been detected in the environment. The development of resistance may be intrinsic, may be acquired through spontaneous mutations (de novo), or may occur due to horizontal gene transfer from donor bacteria, phages, or free DNA to recipient bacteria. An overview is also provided of the current knowledge regarding inactivation of ARB and ARG, and the mechanism of the effects of different disinfection processes in water and wastewater (chlorination, UV irradiation, Fenton reaction, ozonation, and photocatalytic oxidation). The effects of constructed wetlands and nanotechnology on ARB and ARG are also summarized. Copyright © 2015 Elsevier Ltd. All rights reserved.

  3. New Is Old, and Old Is New: Recent Advances in Antibiotic-Based, Antibiotic-Free and Ethnomedical Treatments against Methicillin-Resistant Staphylococcus aureus Wound Infections.

    Science.gov (United States)

    Dou, Jian-Lin; Jiang, Yi-Wei; Xie, Jun-Qiu; Zhang, Xiao-Gang

    2016-04-25

    Staphylococcus aureus is the most common pathogen of wound infections. Thus far, methicillin-resistant S. aureus (MRSA) has become the major causative agent in wound infections, especially for nosocomial infections. MRSA infections are seldom eradicated by routine antimicrobial therapies. More concerning, some strains have become resistant to the newest antibiotics of last resort. Furthermore, horizontal transfer of a polymyxin resistance gene, mcr-1, has been identified in Enterobacteriaceae, by which resistance to the last group of antibiotics will likely spread rapidly. The worst-case scenario, "a return to the pre-antibiotic era", is likely in sight. A perpetual goal for antibiotic research is the discovery of an antibiotic that lacks resistance potential, such as the recent discovery of teixobactin. However, when considering the issue from an ecological and evolutionary standpoint, it is evident that it is insufficient to solve the antibiotic dilemma through the use of antibiotics themselves. In this review, we summarized recent advances in antibiotic-based, antibiotic-free and ethnomedical treatments against MRSA wound infections to identify new clues to solve the antibiotic dilemma. One potential solution is to use ethnomedical drugs topically. Some ethnomedical drugs have been demonstrated to be effective antimicrobials against MRSA. A decline in antibiotic resistance can therefore be expected, as has been demonstrated when antibiotic-free treatments were used to limit the use of antibiotics. It is also anticipated that these drugs will have low resistance potential, although there is only minimal evidence to support this claim to date. More clinical trials and animal tests should be conducted on this topic.

  4. New Is Old, and Old Is New: Recent Advances in Antibiotic-Based, Antibiotic-Free and Ethnomedical Treatments against Methicillin-Resistant Staphylococcus aureus Wound Infections

    Directory of Open Access Journals (Sweden)

    Jian-Lin Dou

    2016-04-01

    Full Text Available Staphylococcus aureus is the most common pathogen of wound infections. Thus far, methicillin-resistant S. aureus (MRSA has become the major causative agent in wound infections, especially for nosocomial infections. MRSA infections are seldom eradicated by routine antimicrobial therapies. More concerning, some strains have become resistant to the newest antibiotics of last resort. Furthermore, horizontal transfer of a polymyxin resistance gene, mcr-1, has been identified in Enterobacteriaceae, by which resistance to the last group of antibiotics will likely spread rapidly. The worst-case scenario, “a return to the pre-antibiotic era”, is likely in sight. A perpetual goal for antibiotic research is the discovery of an antibiotic that lacks resistance potential, such as the recent discovery of teixobactin. However, when considering the issue from an ecological and evolutionary standpoint, it is evident that it is insufficient to solve the antibiotic dilemma through the use of antibiotics themselves. In this review, we summarized recent advances in antibiotic-based, antibiotic-free and ethnomedical treatments against MRSA wound infections to identify new clues to solve the antibiotic dilemma. One potential solution is to use ethnomedical drugs topically. Some ethnomedical drugs have been demonstrated to be effective antimicrobials against MRSA. A decline in antibiotic resistance can therefore be expected, as has been demonstrated when antibiotic-free treatments were used to limit the use of antibiotics. It is also anticipated that these drugs will have low resistance potential, although there is only minimal evidence to support this claim to date. More clinical trials and animal tests should be conducted on this topic.

  5. The effectiveness of sewage treatment processes to remove faecal pathogens and antibiotic residues

    Science.gov (United States)

    Hendricks, Rahzia; Pool, Edmund John

    2012-01-01

    Pathogens and antibiotics enter the aquatic environment via sewage effluents and may pose a health risk to wild life and humans. The aim of this study was to determine the levels of faecal bacteria, and selected antibiotic residues in raw wastewater and treated sewage effluents from three different sewage treatment plants in the Western Cape, South Africa. Sewage treatment plant 1 and 2 use older technologies, while sewage treatment plant 3 has been upgraded and membrane technologies were incorporated in the treatment processes. Coliforms and Escherichia coli (E. coli) were used as bioindicators for faecal bacteria. A chromogenic test was used to screen for coliforms and E. coli. Fluoroquinolones and sulfamethoxazole are commonly used antibiotics and were selected to monitor the efficiency of sewage treatment processes for antibiotic removal. Enzyme Linked Immunosorbent Assays (ELISAs) were used to quantitate antibiotic residues in raw and treated sewage. Raw intake water at all treatment plants contained total coliforms and E. coli. High removal of E. coli by treatment processes was evident for treatment plant 2 and 3 only. Fluoroquinolones and sulfamethoxazole were detected in raw wastewater from all sewage treatment plants. Treatment processes at plant 1 did not reduce the fluoroquinolone concentration in treated sewage effluents. Treatment processes at plant 2 and 3 reduced the fluoroquinolone concentration by 21% and 31%, respectively. Treatment processes at plant 1 did not reduce the sulfamethoxazole concentration in treated sewage effluents. Treatment processes at plant 2 and 3 reduced sulfamethoxazole by 34% and 56%, respectively. This study showed that bacteria and antibiotic residues are still discharged into the environment. Further research needs to be undertaken to improve sewage treatment technologies, thereby producing a better quality treated sewage effluent. PMID:22242882

  6. A computational tool integrating host immunity with antibiotic dynamics to study tuberculosis treatment.

    Science.gov (United States)

    Pienaar, Elsje; Cilfone, Nicholas A; Lin, Philana Ling; Dartois, Véronique; Mattila, Joshua T; Butler, J Russell; Flynn, JoAnne L; Kirschner, Denise E; Linderman, Jennifer J

    2015-02-21

    While active tuberculosis (TB) is a treatable disease, many complex factors prevent its global elimination. Part of the difficulty in developing optimal therapies is the large design space of antibiotic doses, regimens and combinations. Computational models that capture the spatial and temporal dynamics of antibiotics at the site of infection can aid in reducing the design space of costly and time-consuming animal pre-clinical and human clinical trials. The site of infection in TB is the granuloma, a collection of immune cells and bacteria that form in the lung, and new data suggest that penetration of drugs throughout granulomas is problematic. Here we integrate our computational model of granuloma formation and function with models for plasma pharmacokinetics, lung tissue pharmacokinetics and pharmacodynamics for two first line anti-TB antibiotics. The integrated model is calibrated to animal data. We make four predictions. First, antibiotics are frequently below effective concentrations inside granulomas, leading to bacterial growth between doses and contributing to the long treatment periods required for TB. Second, antibiotic concentration gradients form within granulomas, with lower concentrations toward their centers. Third, during antibiotic treatment, bacterial subpopulations are similar for INH and RIF treatment: mostly intracellular with extracellular bacteria located in areas non-permissive for replication (hypoxic areas), presenting a slowly increasing target population over time. Finally, we find that on an individual granuloma basis, pre-treatment infection severity (including bacterial burden, host cell activation and host cell death) is predictive of treatment outcome. Copyright © 2014 Elsevier Ltd. All rights reserved.

  7. Occurrence of antibiotics in eight sewage treatment plants in Beijing, China.

    Science.gov (United States)

    Gao, Lihong; Shi, Yali; Li, Wenhui; Niu, Hongyun; Liu, Jiemin; Cai, Yaqi

    2012-02-01

    The occurrence, removal efficiency and seasonal variation of 22 antibiotics, including eight fluoroquinolones, nine sulfonamides and five macrolides, were investigated in eight sewage treatment plants (STPs) in Beijing, China. A total of 14 antibiotics were detected in wastewater samples, with the maximum concentration being 3.1 μg L(-1) in the influent samples and 1.2 μg L(-1) in the effluent samples. The most frequently detected antibiotics were ofloxacin, norfloxacin, sulfadiazine, sulfamethoxazole, erythromycin and roxithromycin; of these, the concentration of ofloxacin was the highest in most of the influent and effluent samples. Eighteen antibiotics were detected in the sludge samples, with concentrations ranging from 1.0×10(-1) to 2.1×10(4) μg kg(-1). The dominant antibiotics found in the sludge samples were the fluoroquinolones, with ofloxacin having the highest concentration in all the sludge samples. The antibiotics could not be removed completely by the STPs, and the mean removal efficiency ranged from -34 to 72%. Of all the antibiotics, the fluoroquinolones were removed comparatively more efficiently, probably due to their adsorption to sludge. Seasonal variation of the antibiotics in the sludge samples was also studied. The concentrations of antibiotics in winter were higher than in spring and autumn. Since the total levels of the fluoroquinolones detected in the influent samples were lower than the predicted no-effect concentration (PNEC) of 8.0 μg L(-1), the residues of these antibiotics would be unlikely to have adverse effects on microorganisms involved in sewage treatment processes. Copyright © 2011 Elsevier Ltd. All rights reserved.

  8. The microbiology and the efficacy of antibiotic-based medical treatment of chronic rhinosinusitis in Singapore.

    Science.gov (United States)

    Chin, C W D; Yeak, C L S; Wang, D Y

    2010-12-01

    Medical therapy including appropriate antibiotic treatment is advocated for the management of chronic rhinosinusitis (CRS), with sinus surgery reserved for treatment failures. This study investigates the microbiology of CRS and their response to culture-directed antibiotic treatment. Sinus aspirates of mucopus from 172 consecutive CRS patients, with (n=89) and without (n=83) previous antibiotic treatment, were obtained for bacterial culture at their first visit. Medical treatment which included initial empirical and subsequent culture-directed antibiotics was instituted. Endoscopic sinus surgery (FESS) was performed for patients with persistent CRS and/or complications of CRS. A follow-up of 12 months was scheduled for all patients. One hundred and twenty (69.8%) patients were treated successfully by with antibiotic-based medical therapy. Thirty-eight patients (22.1%) did not respond to medical treatment and eventually underwent FESS. The incidence of CRS with nasal polyps (CRSwNP) was higher in FESS group (n=13, 34.2%) than patients with medical treatment only (n=9, 6.7%). Staphylococcus aureus was the most common pathogen (n=43, 25%) and amongst patients with no prior antibiotic treatment, the incidence was higher in patients with CRSwNP (n=8, 53 %) than CRS without NP (CRSwoNP) (n=20, 27%). The rate of sensitivity of the cultured microbes to amoxicillin with clavulanate and cephalosporins was 78% and 70%, respectively. The microbiology of CRS in Singapore is described. Staphylococcus aureus appears to be the most common bacterial isolates in both CRS with and without nasal polyps. Medical treatment with CRS using culture-directed antibiotics is effective in the majority of patients, especially in patients without nasal polyps.

  9. Fungi of the murine gut: episodic variation and proliferation during antibiotic treatment.

    Directory of Open Access Journals (Sweden)

    Serena Dollive

    Full Text Available Antibiotic use in humans has been associated with outgrowth of fungi. Here we used a murine model to investigate the gut microbiome over 76 days of treatment with vancomycin, ampicillin, neomycin, and metronidazole and subsequent recovery. Mouse stool was studied as a surrogate for the microbiota of the lower gastrointestinal tract. The abundance of fungi and bacteria was measured using quantitative PCR, and the proportional composition of the communities quantified using 454/Roche pyrosequencing of rRNA gene tags. Prior to treatment, bacteria outnumbered fungi by >3 orders of magnitude. Upon antibiotic treatment, bacteria dropped in abundance >3 orders of magnitude, so that the predominant 16S sequences detected became transients derived from food. Upon cessation of treatment, bacterial communities mostly returned to their previous numbers and types after 8 weeks, though communities remained detectably different from untreated controls. Fungal communities varied substantially over time, even in the untreated controls. Separate cages within the same treatment group showed radical differences, but mice within a cage generally behaved similarly. Fungi increased ∼40-fold in abundance upon antibiotic treatment but declined back to their original abundance after cessation of treatment. At the last time point, Candida remained more abundant than prior to treatment. These data show that 1 gut fungal populations change radically during normal mouse husbandry, 2 fungi grow out in the gut upon suppression of bacterial communities with antibiotics, and 3 perturbations due to antibiotics persist long term in both the fungal and bacterial microbiota.

  10. A Randomised Non-inferiority Trial on the Effect of an Antibiotic or Non-antibiotic Topical Treatment Protocol for Digital Dermatitis in Dairy Cattle : a knowledge summary

    NARCIS (Netherlands)

    Jorritsma, R.; Nielen, M.; Dotinga, Amarins

    2017-01-01

    Objective: Investigation of the therapeutic effect of a protocol using non-antibiotic Intra Epidine (IE) spray containing copper and zinc chelate on M2 digital dermatitis (DD) lesions compared to a treatment protocol using antibiotic chlortetracycline (CTC) spray for non-inferiority testing.

  11. Use of antibiotics in the treatment of Crohn's disease.

    Science.gov (United States)

    Scribano, Maria Lia; Prantera, Cosimo

    2013-02-07

    Many data coming from animal models and clinical observations support an involvement of intestinal microbiota in the pathogenesis of Crohn's disease (CD). It is hypothesized in fact, that the development of chronic intestinal inflammation is caused by an abnormal immune response to normal flora in genetically susceptible hosts. The involvement of bacteria in CD inflammation has provided the rationale for including antibiotics in the therapeutic armamentarium. However, randomized controlled trials have failed to demonstrate an efficacy of these drugs in patients with active uncomplicated CD, even if a subgroup of patients with colonic location seems to get benefit from antibiotics. Nitroimidazole compounds have been shown to be efficacious in decreasing CD recurrence rates in operated patients, and the use of metronidazole and ciprofloxacin is recommended in perianal disease. However, the appearance of systemic side effects limits antibiotic long-term employment necessary for treating a chronic relapsing disease. Rifaximin, characterized by an excellent safety profile, has provided promising results in inducing remission of CD.

  12. Performance of Ozonation Process as Advanced Treatment for Antibiotics Removal in Membrane Permeate

    Directory of Open Access Journals (Sweden)

    Thanh Cao Ngoc Dan

    2016-06-01

    Full Text Available There was an investigation into the removal of 6 types of antibiotics from hospital wastewater through membrane bioreactor (MBR treatment and ozonation processes. Six types of antibiotics, namely, Sulfamethoxazole (SMZ, Norfloxacin (NOR, Ciprofloxacin (CIP, Ofloxacin (OFL, Erythromycin (ERY, and Vancomycin (VAN which had high detection frequencies in collected samples from hospital wastewater treatment plant (HWTPs. After MBR treatment, the removal efficiencies of SMZ, NOR, OFL, and ERY were 45%, 25%, 30%, and 16%, respectively. Among of them, almost no elimination was observed for CIP and VAN since their concentrations increased by 0.24 ± 0.18 (μg·l-1 and 0.83 ± 0.20 (μg·l-1, respectively. Then, residues of the antibiotics were removed from the MBR effluent by the ozonation process. The overall removal efficiencies of SMZ, NOR, CIP, OFL, ERY, and VAN were approximately 66 %, 88 %, 83 %, 80 %, 93 %, and 92 %, respectively. The reason might be depended on different ozone consumption of those antibiotics (ABS in a range of 313 to 1681 μg ABS·gO--1. Consequently, the ozonation process performed better in the antibiotics removal (e.g. CIP and VAN so ozonation could be considered as important support for the MBR treatment to reduce the risk of antibiotic residues.

  13. Antibiotics in Wastewater of a Rural and an Urban Hospital before and after Wastewater Treatment, and the Relationship with Antibiotic Use-A One Year Study from Vietnam.

    Science.gov (United States)

    Lien, La Thi Quynh; Hoa, Nguyen Quynh; Chuc, Nguyen Thi Kim; Thoa, Nguyen Thi Minh; Phuc, Ho Dang; Diwan, Vishal; Dat, Nguyen Thanh; Tamhankar, Ashok J; Lundborg, Cecilia Stålsby

    2016-06-14

    Hospital effluents represent an important source for the release of antibiotics and antibiotic resistant bacteria into the environment. This study aims to determine concentrations of various antibiotics in wastewater before and after wastewater treatment in a rural hospital (60 km from the center of Hanoi) and in an urban hospital (in the center of Hanoi) in Vietnam, and it aims to explore the relationship between antibiotic concentrations in wastewater before wastewater treatment and quantities of antibiotics used in the rural hospital, over a period of one year in 2013. Water samples were collected using continuous sampling for 24 h in the last week of every month. The data on quantities of antibiotics delivered to all inpatient wards were collected from the Pharmacy department in the rural hospital. Solid-phase extraction and high performance liquid chromatography-tandem mass spectrometry were used for chemical analysis. Significant concentrations of antibiotics were present in the wastewater both before and after wastewater treatment of both the rural and the urban hospital. Ciprofloxacin was detected at the highest concentrations in the rural hospital's wastewater (before treatment: mean = 42.8 µg/L; after treatment: mean = 21.5 µg/L). Metronidazole was detected at the highest concentrations in the urban hospital's wastewater (before treatment: mean = 36.5 µg/L; after treatment: mean = 14.8 µg/L). A significant correlation between antibiotic concentrations in wastewater before treatment and quantities of antibiotics used in the rural hospital was found for ciprofloxacin (r = 0.78; p = 0.01) and metronidazole (r = 0.99; p < 0.001).

  14. Antibiotics in Wastewater of a Rural and an Urban Hospital before and after Wastewater Treatment, and the Relationship with Antibiotic Use—A One Year Study from Vietnam

    Science.gov (United States)

    Lien, La Thi Quynh; Hoa, Nguyen Quynh; Chuc, Nguyen Thi Kim; Thoa, Nguyen Thi Minh; Phuc, Ho Dang; Diwan, Vishal; Dat, Nguyen Thanh; Tamhankar, Ashok J.; Lundborg, Cecilia Stålsby

    2016-01-01

    Hospital effluents represent an important source for the release of antibiotics and antibiotic resistant bacteria into the environment. This study aims to determine concentrations of various antibiotics in wastewater before and after wastewater treatment in a rural hospital (60 km from the center of Hanoi) and in an urban hospital (in the center of Hanoi) in Vietnam, and it aims to explore the relationship between antibiotic concentrations in wastewater before wastewater treatment and quantities of antibiotics used in the rural hospital, over a period of one year in 2013. Water samples were collected using continuous sampling for 24 h in the last week of every month. The data on quantities of antibiotics delivered to all inpatient wards were collected from the Pharmacy department in the rural hospital. Solid-phase extraction and high performance liquid chromatography-tandem mass spectrometry were used for chemical analysis. Significant concentrations of antibiotics were present in the wastewater both before and after wastewater treatment of both the rural and the urban hospital. Ciprofloxacin was detected at the highest concentrations in the rural hospital’s wastewater (before treatment: mean = 42.8 µg/L; after treatment: mean = 21.5 µg/L). Metronidazole was detected at the highest concentrations in the urban hospital’s wastewater (before treatment: mean = 36.5 µg/L; after treatment: mean = 14.8 µg/L). A significant correlation between antibiotic concentrations in wastewater before treatment and quantities of antibiotics used in the rural hospital was found for ciprofloxacin (r = 0.78; p = 0.01) and metronidazole (r = 0.99; p < 0.001). PMID:27314366

  15. Antibiotics in Wastewater of a Rural and an Urban Hospital before and after Wastewater Treatment, and the Relationship with Antibiotic Use—A One Year Study from Vietnam

    Directory of Open Access Journals (Sweden)

    La Thi Quynh Lien

    2016-06-01

    Full Text Available Hospital effluents represent an important source for the release of antibiotics and antibiotic resistant bacteria into the environment. This study aims to determine concentrations of various antibiotics in wastewater before and after wastewater treatment in a rural hospital (60 km from the center of Hanoi and in an urban hospital (in the center of Hanoi in Vietnam, and it aims to explore the relationship between antibiotic concentrations in wastewater before wastewater treatment and quantities of antibiotics used in the rural hospital, over a period of one year in 2013. Water samples were collected using continuous sampling for 24 h in the last week of every month. The data on quantities of antibiotics delivered to all inpatient wards were collected from the Pharmacy department in the rural hospital. Solid-phase extraction and high performance liquid chromatography-tandem mass spectrometry were used for chemical analysis. Significant concentrations of antibiotics were present in the wastewater both before and after wastewater treatment of both the rural and the urban hospital. Ciprofloxacin was detected at the highest concentrations in the rural hospital’s wastewater (before treatment: mean = 42.8 µg/L; after treatment: mean = 21.5 µg/L. Metronidazole was detected at the highest concentrations in the urban hospital’s wastewater (before treatment: mean = 36.5 µg/L; after treatment: mean = 14.8 µg/L. A significant correlation between antibiotic concentrations in wastewater before treatment and quantities of antibiotics used in the rural hospital was found for ciprofloxacin (r = 0.78; p = 0.01 and metronidazole (r = 0.99; p < 0.001.

  16. Mycobacterium Ulcerans Treatment – Can Antibiotic Duration Be Reduced in Selected Patients?

    Science.gov (United States)

    Cowan, Raquel; Athan, Eugene; Friedman, N. Deborah; Hughes, Andrew J.; McDonald, Anthony; Callan, Peter; Fyfe, Janet; O’Brien, Daniel P.

    2015-01-01

    Introduction Mycobacterium ulcerans (M. ulcerans) is a necrotizing skin infection endemic to the Bellarine Peninsula, Australia. Current treatment recommendations include 8 weeks of combination antibiotics, with adjuvant surgery if necessary. However, antibiotic toxicity often results in early treatment cessation and local experience suggests that shorter antibiotic courses may be effective with concurrent surgery. We report the outcomes of patients in the Barwon Health M. ulcerans cohort who received shorter courses of antibiotic therapy than 8 weeks. Methodology / Principal findings A retrospective analysis was performed of all M. ulcerans infections treated at Barwon Health from March 1, 1998 to July 31, 2013. Sixty-two patients, with a median age of 65 years, received ulcerans shorter than the current WHO recommended 8 weeks duration may be associated with successful outcomes. PMID:25658304

  17. Mycobacterium ulcerans treatment--can antibiotic duration be reduced in selected patients?

    Science.gov (United States)

    Cowan, Raquel; Athan, Eugene; Friedman, N Deborah; Hughes, Andrew J; McDonald, Anthony; Callan, Peter; Fyfe, Janet; O'Brien, Daniel P

    2015-02-01

    Mycobacterium ulcerans (M. ulcerans) is a necrotizing skin infection endemic to the Bellarine Peninsula, Australia. Current treatment recommendations include 8 weeks of combination antibiotics, with adjuvant surgery if necessary. However, antibiotic toxicity often results in early treatment cessation and local experience suggests that shorter antibiotic courses may be effective with concurrent surgery. We report the outcomes of patients in the Barwon Health M. ulcerans cohort who received shorter courses of antibiotic therapy than 8 weeks. A retrospective analysis was performed of all M. ulcerans infections treated at Barwon Health from March 1, 1998 to July 31, 2013. Sixty-two patients, with a median age of 65 years, received ulcerans shorter than the current WHO recommended 8 weeks duration may be associated with successful outcomes.

  18. Quality assessment of diagnosis and antibiotic treatment of infectious diseases in primary care

    DEFF Research Database (Denmark)

    Saust, Laura Trolle; Monrad, Rikke Nygaard; Hansen, Malene Plejdrup

    2016-01-01

    OBJECTIVE: To identify existing quality indicators (QIs) for diagnosis and antibiotic treatment of patients with infectious diseases in primary care. DESIGN: A systematic literature search was performed in PubMed and EMBASE. We included studies with a description of the development of QIs...... for diagnosis and antibiotic use in patients with infectious diseases in primary care. We extracted information about (1) type of infection; (2) target for quality assessment; (3) methodology used for developing the QIs; and (4) whether the QIs were developed for a national or international application. The QIs......, including 130 quality indicators for diagnosis and antibiotic treatment of infectious diseases in primary care. The majority of the identified quality indicators were focusing on the choice of antibiotics and only a few concerned the diagnostic process. All quality indicators were developed by means...

  19. Evaluation of the general public's knowledge, views and practices relating to appropriate antibiotic use in Qatar.

    Science.gov (United States)

    Moienzadeh, Atefeh; Massoud, Tasnim; Black, Emily

    2017-04-01

    Studies completed internationally have demonstrated an alarming number of patients believed antibiotics are indicated in the treatment of viral infections and other self-limited illnesses. Evaluation of patient practices relating to antibiotics have also demonstrated inappropriate use. Antibiotic misuse by patients and practitioners has been identified as a factor in the development of resistance. Current knowledge, views and practices relating to antibiotic use in Qatar is unknown. The primary objective of this study was to evaluate the general population's current antimicrobial knowledge, views and practices in Qatar. This study was designed as a self-administered cross-sectional survey. Eligible participants were residents of Qatar who were over the age of 18 and spoke English or Arabic. The questionnaire was developed based on previously published literature and objectives of this study. Data were collected at community pharmacies in Doha, Qatar. The majority of participants (95.8%) had taken antibiotics in the past. The median knowledge score of the study population was 4/8. Misconceptions relating to use of antibiotics for treatment of viral infections were common. Inappropriate use as evident by hoarding of antibiotics for future use and sharing antibiotics with family or friends was also identified in this study population. Community pharmacists in Qatar have an opportunity to improve knowledge of the general population regarding appropriate indications of antibiotics and risk of resistance with inappropriate use. © 2015 Royal Pharmaceutical Society.

  20. Occurrence and transformation of veterinary antibiotics and antibiotic resistance genes in dairy manure treated by advanced anaerobic digestion and conventional treatment methods.

    Science.gov (United States)

    Wallace, Joshua S; Garner, Emily; Pruden, Amy; Aga, Diana S

    2018-05-01

    Manure treatment technologies are rapidly developing to minimize eutrophication of surrounding environments and potentially decrease the introduction of antibiotics and antibiotic resistant genes (ARGs) into the environment. While laboratory and pilot-scale manure treatment systems boast promising results, antibiotic and ARG removals in full-scale systems receiving continuous manure input have not been evaluated. The effect of treatment on ARGs is similarly lacking. This study examines the occurrence and transformation of sulfonamides, tetracyclines, tetracycline degradation products, and related ARGs throughout a full-scale advanced anaerobic digester (AAD) receiving continuous manure and antibiotic input. Manure samples were collected throughout the AAD system to evaluate baseline antibiotic and ARG input (raw manure), the effect of hygenization (post-pasteurized manure) and anaerobic digestion (post-digestion manure) on antibiotic and ARG levels. Antibiotics were analyzed by liquid chromatography-tandem mass spectrometry (LC-MS/MS), and the ARGs tet(O), tet(W), sul1 and sul2 were analyzed by quantitative polymerase chain reaction (Q-PCR). Significant reductions in the concentrations of chlortetracycline, oxytetracycline, tetracycline and their degradation products were observed in manure liquids following treatment (p resistant genes remained unchanged. A cross-sectional study of dairy farms utilizing natural aeration and liquid-solid separation treatments was additionally performed to compare levels of antibiotics and ARGs found in AAD with the levels in common manure management systems. The concentration of antibiotics in raw manure varied greatly between farms while minimal differences in ARGs were observed. However, significant (p < 0.01) differences in the levels of antibiotics and ARGs (except tet(W)) were observed in the effluents from the three different manure management systems. Copyright © 2018 Elsevier Ltd. All rights reserved.

  1. Metagenomic Profiling of Antibiotic Resistance Genes and Mobile Genetic Elements in a Tannery Wastewater Treatment Plant

    OpenAIRE

    Wang, Zhu; Zhang, Xu-Xiang; Huang, Kailong; Miao, Yu; Shi, Peng; Liu, Bo; Long, Chao; Li, Aimin

    2013-01-01

    Antibiotics are often used to prevent sickness and improve production in animal agriculture, and the residues in animal bodies may enter tannery wastewater during leather production. This study aimed to use Illumina high-throughput sequencing to investigate the occurrence, diversity and abundance of antibiotic resistance genes (ARGs) and mobile genetic elements (MGEs) in aerobic and anaerobic sludge of a full-scale tannery wastewater treatment plant (WWTP). Metagenomic analysis showed that Pr...

  2. Inappropriate prescribing in the elderly.

    LENUS (Irish Health Repository)

    Gallagher, P

    2012-02-03

    BACKGROUND AND OBJECTIVE: Drug therapy is necessary to treat acute illness, maintain current health and prevent further decline. However, optimizing drug therapy for older patients is challenging and sometimes, drug therapy can do more harm than good. Drug utilization review tools can highlight instances of potentially inappropriate prescribing to those involved in elderly pharmacotherapy, i.e. doctors, nurses and pharmacists. We aim to provide a review of the literature on potentially inappropriate prescribing in the elderly and also to review the explicit criteria that have been designed to detect potentially inappropriate prescribing in the elderly. METHODS: We performed an electronic search of the PUBMED database for articles published between 1991 and 2006 and a manual search through major journals for articles referenced in those located through PUBMED. Search terms were elderly, inappropriate prescribing, prescriptions, prevalence, Beers criteria, health outcomes and Europe. RESULTS AND DISCUSSION: Prescription of potentially inappropriate medications to older people is highly prevalent in the United States and Europe, ranging from 12% in community-dwelling elderly to 40% in nursing home residents. Inappropriate prescribing is associated with adverse drug events. Limited data exists on health outcomes from use of inappropriate medications. There are no prospective randomized controlled studies that test the tangible clinical benefit to patients of using drug utilization review tools. Existing drug utilization review tools have been designed on the basis of North American and Canadian drug formularies and may not be appropriate for use in European countries because of the differences in national drug formularies and prescribing attitudes. CONCLUSION: Given the high prevalence of inappropriate prescribing despite the widespread use of drug-utilization review tools, prospective randomized controlled trials are necessary to identify useful interventions. Drug

  3. Adherence to antibiotic treatment guidelines and outcomes in the hospitalized elderly with different types of pneumonia.

    Science.gov (United States)

    Rossio, Raffaella; Franchi, Carlotta; Ardoino, Ilaria; Djade, Codjo D; Tettamanti, Mauro; Pasina, Luca; Salerno, Francesco; Marengoni, Alessandra; Corrao, Salvatore; Marcucci, Maura; Peyvandi, Flora; Biganzoli, Elia M; Nobili, Alessandro; Mannucci, Pier Mannuccio

    2015-06-01

    Few studies evaluated the clinical outcomes of Community Acquired Pneumonia (CAP), Hospital-Acquired Pneumonia (HAP) and Health Care-Associated Pneumonia (HCAP) in relation to the adherence of antibiotic treatment to the guidelines of the Infectious Diseases Society of America (IDSA) and the American Thoracic Society (ATS) in hospitalized elderly people (65 years or older). Data were obtained from REPOSI, a prospective registry held in 87 Italian internal medicine and geriatric wards. Patients with a diagnosis of pneumonia (ICD-9 480-487) or prescribed with an antibiotic for pneumonia as indication were selected. The empirical antibiotic regimen was defined to be adherent to guidelines if concordant with the treatment regimens recommended by IDSA/ATS for CAP, HAP, and HCAP. Outcomes were assessed by logistic regression models. A diagnosis of pneumonia was made in 317 patients. Only 38.8% of them received an empirical antibiotic regimen that was adherent to guidelines. However, no significant association was found between adherence to guidelines and outcomes. Having HAP, older age, and higher CIRS severity index were the main factors associated with in-hospital mortality. The adherence to antibiotic treatment guidelines was poor, particularly for HAP and HCAP, suggesting the need for more adherence to the optimal management of antibiotics in the elderly with pneumonia. Copyright © 2015 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

  4. The Composition and Spatial Patterns of Bacterial Virulence Factors and Antibiotic Resistance Genes in 19 Wastewater Treatment Plants

    OpenAIRE

    Zhang, Bing; Xia, Yu; Wen, Xianghua; Wang, Xiaohui; Yang, Yunfeng; Zhou, Jizhong; Zhang, Yu

    2016-01-01

    Bacterial pathogenicity and antibiotic resistance are of concern for environmental safety and public health. Accumulating evidence suggests that wastewater treatment plants (WWTPs) are as an important sink and source of pathogens and antibiotic resistance genes (ARGs). Virulence genes (encoding virulence factors) are good indicators for bacterial pathogenic potentials. To achieve a comprehensive understanding of bacterial pathogenic potentials and antibiotic resistance in WWTPs, bacterial vir...

  5. Assays of residual antibiotics after treatment of γ-ray and UV irradiation

    International Nuclear Information System (INIS)

    Shin, Ji Hye; Nam, Ji Hyun; Lee, Dong Hun; Yu, Seung Ho; Lee, Myun Joo

    2010-01-01

    The pollution of antibiotics is a major cause of spreading antibiotics resistant bacteria in the environment. Applications of ozonation, UV, and γ-ray irradiations have been introduced to remove antibiotics in the effluents from wastewater treatment system. In this study, we compared the chemical (HPLC) and biological (antimicrobial susceptibility test, AMS) assays in measuring of the concentrations of residual antibiotics after γ-ray and UV irradiation. Most samples were degraded by γ-ray irradiation (1 ∼ 2 kGy). However, lincomycin and tetracycline were not degraded by UV irradiation. The concentration of residual antibiotics, that was treated with γ-ray and UV irradiation, measuring by bioassay was similar to HPLC. The concentrations of γ-ray irradiated cephradine measured by AMS test were 2 times higher than of HPLC assay, indicating AMS test is more sensitive than HPLC assay. These results indicate that γ-ray irradiation technique is more useful than UV irradiation, and biological assay is more useful to detect the antibiotics and toxic intermediates in antibiotics degradation

  6. Occurrence, removal, and risk assessment of antibiotics in 12 wastewater treatment plants from Dalian, China.

    Science.gov (United States)

    Zhang, Xin; Zhao, Hongxia; Du, Juan; Qu, Yixuan; Shen, Chen; Tan, Feng; Chen, Jingwen; Quan, Xie

    2017-07-01

    In this study, the occurrence and removal efficiencies of 31 antibiotics, including 11 sulfonamides (SAs), five fluoroquinolones (FQs), four macrolides (MLs), four tetracyclines (TCs), three chloramphenicols (CAPs), and four other antibiotics (Others), were investigated in 12 municipal wastewater treatment plants (WWTPs) in Dalian, China. A total of 29 antibiotics were detected in wastewater samples with the concentration ranging from 63.6 to 5404.6 ng/L. FQs and SAs were the most abundant antibiotic classes in most wastewater samples, accounting for 42.2 and 23.9% of total antibiotic concentrations, respectively, followed by TCs (16.0%) and MLs (14.8%). Sulfamethoxazole, erythromycin, clarithromycin, azithromycin, ofloxacin, and norfloxacin were the most frequently detected antibiotics; of these, the concentration of ofloxacin was the highest in most of influent (average concentration = 609.8 ng/L) and effluent (average concentration = 253.4 ng/L) samples. The removal efficiencies varied among WWTPs in the range of -189.9% (clarithromycin) to 100% (enoxacin, doxycycline, etc), and more than 50% of antibiotics could not be efficiently removed with the removal efficiency less than 65%. An environmental risk assessment was also performed in the WWTP effluents by calculating the risk quotient (RQ), and high RQ values (>1) indicated erythromycin and clarithromycin might cause the ecological risk on organisms in surrounding water near discharge point of WWTPs in this area, which warrants further attention.

  7. The Side Effects of the Most Commonly Used Group of Antibiotics in Periodontal Treatments

    Directory of Open Access Journals (Sweden)

    Saimir Heta

    2018-01-01

    Full Text Available Antibiotic combinations are preferred for the treatment of periodontal diseases, with the aim of hitting the bacterial flora, according to its characteristics—aerobic, anaerobic, gram-negative, and gram-positive—with certain antibiotics that act on certain bacteria. The aim of this study is to analyze the side effects of the antibiotics used. Data on the side effects (preferably expressed in percentages of some antibiotics, the favorites in periodontal recipes, are gathered from the literature. These data are listed according to the antibiotic used. In the case of providing a periodontal prescription, the patient is at risk of allergy (5%, nephritis (3%, hematological problems (2–2.5%, gastrointestinal problems (5.5%, disturbance in the nervous system (2%, allergic signs on the skin (5.5%, and problems with electrolytes displayed in lower percentages. Interaction with different medications is present in almost all cases. The influence on the body systems is 4% in total, the maximum value of which is expressed on the skin, and the minimum value is expressed in the nervous system. Cross allergies are at a high value because of the expressed structural similarity of antibiotics. Given a recipe, we have a balance of the percentage of side effects, the percentage of bacterial resistance, and the percentage of the success of the recommended dose of antibiotics.

  8. Prognostic effect of pre- and post-admission antibiotic treatment in paediatric acute mastoiditis.

    Science.gov (United States)

    Carmel, E; Curotta, J H; Cheng, A T

    2017-01-01

    To evaluate the effect of pre- and post-admission antibiotic treatment in paediatric acute mastoiditis. Retrospective study. Eighty-eight children with acute mastoiditis, from 2003 to 2012, were studied to investigate the effect of antibiotic therapy on short and long-term sequelae. The median period of antibiotic therapy immediately following hospital discharge was 10 days (range, 5-49 days; standard deviation = 7.46). There were no sequelae within the fortnight following antibiotic therapy completion, but 14 of 40 patients had significant sequelae thereafter, including recurrent otorrhoea, acute otitis media and ventilation tube insertion requirement. Complication rates were significantly higher among patients who had pre-admission antibiotic therapy (52 per cent), compared to patients previously untreated (27 per cent). Paediatric acute mastoiditis patients treated with antibiotic therapy prior to admission are at higher risk for complication development. The advised time period for oral antibiotic therapy following hospital discharge remains as 10 days in all cases of uncomplicated acute mastoiditis.

  9. OPPORTUNITIES OF PROBIOTIC TREATMENT IN COMPLEX THERAPY OF ANTIBIOTIC-ASSOCIATED DIARRHEA IN CHILDREN

    Directory of Open Access Journals (Sweden)

    A.N. Surkov

    2011-01-01

    Full Text Available Disorder of normal intestinal flora is widespread state in children with different types of somatic pathology. Intestinal disbiosis disturbs homeostasis, leads to significant disorders in function of other organs and systems. Thus the correction of intestinal disbacteriosis is an actual problem of clinical pediatrics, and different specialists meet this problem. One of common causes of intestinal disbiosis is antibacterial treatment. Almost all antimicrobial drugs influence gastrointestinal tract and their administration lead to dyspepsia and antibiotic-associated diarrhea. Normalization of intestinal microflora is significant stage of complex treatment of these pathological states in children. The choice of probiotic drug should be well grounded. The article presents main data on epidemiology, pathogenesis, clinical symptoms, diagnostics and treatment of antibiotic-associated diarrhea in children, efficacy of probiotic drugs is demonstrated.Key words: children, indigenous intestinal microflora, antibiotic-associated diarrhea, probiotics, treatment.(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (2: 132–136

  10. Development of Antibiotic Resistance during Simulated Treatment of Pseudomonas aeruginosa in Chemostats.

    Science.gov (United States)

    Feng, Yanfang; Hodiamont, Caspar J; van Hest, Reinier M; Brul, Stanley; Schultsz, Constance; Ter Kuile, Benno H

    2016-01-01

    During treatment of infections with antibiotics in critically ill patients in the intensive care resistance often develops. This study aims to establish whether under those conditions this resistance can develop de novo or that genetic exchange between bacteria is by necessity involved. Chemostat cultures of Pseudomonas aeruginosa were exposed to treatment regimes with ceftazidime and meropenem that simulated conditions expected in patient plasma. Development of antibiotic resistance was monitored and mutations in resistance genes were searched for by sequencing PCR products. Even at the highest concentrations that can be expected in patients, sufficient bacteria survived in clumps of filamentous cells to recover and grow out after 3 to 5 days. At the end of a 7 days simulated treatment, the minimal inhibitory concentration (MIC) had increased by a factor between 10 and 10,000 depending on the antibiotic and the treatment protocol. The fitness costs of resistance were minimal. In the resistant strains, only three mutations were observed in genes associated with beta-lactam resistance. The development of resistance often observed during patient treatment can be explained by de novo acquisition of resistance and genetic exchange of resistance genes is not by necessity involved. As far as conclusions based on an in vitro study using P. aeruginosa and only two antibiotics can be generalized, it seems that development of resistance can be minimized by treating with antibiotics in the highest concentration the patient can endure for the shortest time needed to eliminate the infection.

  11. Antibiotic resistance of Streptococcus pneumoniae in children with acute otitis media treatment failure.

    Science.gov (United States)

    Zielnik-Jurkiewicz, Beata; Bielicka, Anna

    2015-12-01

    The emergence of antibiotic-resistant bacteria is a major cause of treatment failure in children with acute otitis media (AOM). This study aimed to analyze the types of bacterial strains in fluid isolated from the middle ear of children with AOM who did not respond to oral antibiotic treatment. We also determined the antibiotic resistance of the most frequently isolated bacterial strain (Streptococcus pneumoniae) found in these children. This was a prospective study of 157 children with AOM aged from 6 months to 7 years admitted due to unsuccessful oral antibiotic treatment. All children underwent a myringotomy, and samples of the middle ear fluid were collected for bacteriological examination. Positive bacterial cultures were obtained in 104 patients (66.2%), with Streptococcus pneumoniae (39.69%), Haemophilus influenzae (16.03%) Staphylococcus aureus (16.03%), Staphylococcus haemolyticus (6.9%) and Streptococcus pyogenes (5.34%) found most frequently. The majority (65.4%) of S. pneumoniae strains were penicillin-intermediate-resistant or penicillin-resistant, and 67.2% strains of S. pneumoniae were multidrug-resistant. We identified S. pneumoniae as the most frequently isolated pathogen from the middle ear in children with AOM treatment failure and determined that the majority of strains were antibiotic-resistant. We propose that the microbiological identification of bacterial strains and their degree of antibiotic resistance should be performed prior to therapy in order to choose the most appropriate antibiotic therapy for children with AOM treatment failure. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  12. Treatment of catheter-related bacteraemia with an antibiotic lock protocol: effect of bacterial pathogen.

    Science.gov (United States)

    Poole, Christopher V; Carlton, Donna; Bimbo, Lisa; Allon, Michael

    2004-05-01

    The standard therapy of dialysis catheter-related bacteraemia involves both systemic antibiotics and catheter replacement. We reported recently that instillation of an antibiotic lock (highly concentrated antibiotic solution) into the catheter lumen after dialysis sessions, in conjunction with systemic antibiotics, can successfully treat many episodes of catheter-related bacteraemia without requiring catheter removal. The present study evaluated whether the likelihood of achieving a cure with this protocol depends on the type of pathogen. This was a historically controlled interventional study of an antibiotic lock protocol for the treatment of catheter-related bacteraemia. We analysed prospectively the likelihood of clinical cure (fever resolution and negative surveillance cultures) with an antibiotic lock protocol among patients with dialysis catheter-related bacteraemia. In addition, infection-free catheter survival was evaluated for up to 150 days, and compared with that observed among patients managed with routine catheter replacement. Overall, the antibiotic lock protocol was successful in 33 of 47 infected patients (70%) with catheter-related bacteraemia. The likelihood of a clinical cure was 87% for Gram-negative infections, 75% for Staphylococcus epidermidis infections, and only 40% for Staphylococcus aureus infections (P = 0.04). The median infection-free catheter survival with the antibiotic lock protocol was longer than that observed among patients with routine catheter replacement (154 vs 71 days, P = 0.02). The clinical success of an antibiotic lock protocol in eradicating catheter-related bacteraemia while salvaging the catheter is highly dependent on the bacterial pathogen. Thus, the overall success rate in an individual dialysis programme will depend on the relative frequencies of different bacterial pathogens.

  13. Occurrence of antibiotics in pharmaceutical industrial wastewater, wastewater treatment plant and sea waters in Tunisia.

    Science.gov (United States)

    Tahrani, Leyla; Van Loco, Joris; Ben Mansour, Hedi; Reyns, Tim

    2016-04-01

    Antibiotics are among the most commonly used group of pharmaceuticals in human medicine. They can therefore reach surface and groundwater bodies through different routes, such as wastewater treatment plant effluents, surface runoff, or infiltration of water used for agricultural purposes. It is well known that antibiotics pose a significant risk to environmental and human health, even at low concentrations. The aim of the present study was to evaluate the presence of aminoglycosides and phenicol antibiotics in municipal wastewaters, sea water and pharmaceutical effluents in Tunisia. All analysed water samples contained detectable levels of aminoglycoside and phenicol antibiotics. The highest concentrations in wastewater influents were observed for neomycin and kanamycin B (16.4 ng mL(-1) and 7.5 ng mL(-1), respectively). Chloramphenicol was found in wastewater influents up to 3 ng mL(-1). It was observed that the waste water treatment plants were not efficient in completely removing these antibiotics. Chloramphenicol and florfenicol were found in sea water samples near aquaculture sites at levels up to, respectively, 15.6 ng mL(-1) and 18.4 ng mL(-1). Also aminoglycoside antibiotics were found near aquaculture sites with the highest concentration of 3.4 ng mL(-1) for streptomycin. In pharmaceutical effluents, only gentamycin was found at concentrations up to 19 ng mL(-1) over a sampling period of four months.

  14. Cecum lymph node dendritic cells harbor slow-growing bacteria phenotypically tolerant to antibiotic treatment.

    Directory of Open Access Journals (Sweden)

    Patrick Kaiser

    2014-02-01

    Full Text Available In vivo, antibiotics are often much less efficient than ex vivo and relapses can occur. The reasons for poor in vivo activity are still not completely understood. We have studied the fluoroquinolone antibiotic ciprofloxacin in an animal model for complicated Salmonellosis. High-dose ciprofloxacin treatment efficiently reduced pathogen loads in feces and most organs. However, the cecum draining lymph node (cLN, the gut tissue, and the spleen retained surviving bacteria. In cLN, approximately 10%-20% of the bacteria remained viable. These phenotypically tolerant bacteria lodged mostly within CD103⁺CX₃CR1⁻CD11c⁺ dendritic cells, remained genetically susceptible to ciprofloxacin, were sufficient to reinitiate infection after the end of the therapy, and displayed an extremely slow growth rate, as shown by mathematical analysis of infections with mixed inocula and segregative plasmid experiments. The slow growth was sufficient to explain recalcitrance to antibiotics treatment. Therefore, slow-growing antibiotic-tolerant bacteria lodged within dendritic cells can explain poor in vivo antibiotic activity and relapse. Administration of LPS or CpG, known elicitors of innate immune defense, reduced the loads of tolerant bacteria. Thus, manipulating innate immunity may augment the in vivo activity of antibiotics.

  15. Cecum Lymph Node Dendritic Cells Harbor Slow-Growing Bacteria Phenotypically Tolerant to Antibiotic Treatment

    Science.gov (United States)

    Dolowschiak, Tamas; Wotzka, Sandra Y.; Lengefeld, Jette; Slack, Emma; Grant, Andrew J.; Ackermann, Martin; Hardt, Wolf-Dietrich

    2014-01-01

    In vivo, antibiotics are often much less efficient than ex vivo and relapses can occur. The reasons for poor in vivo activity are still not completely understood. We have studied the fluoroquinolone antibiotic ciprofloxacin in an animal model for complicated Salmonellosis. High-dose ciprofloxacin treatment efficiently reduced pathogen loads in feces and most organs. However, the cecum draining lymph node (cLN), the gut tissue, and the spleen retained surviving bacteria. In cLN, approximately 10%–20% of the bacteria remained viable. These phenotypically tolerant bacteria lodged mostly within CD103+CX3CR1−CD11c+ dendritic cells, remained genetically susceptible to ciprofloxacin, were sufficient to reinitiate infection after the end of the therapy, and displayed an extremely slow growth rate, as shown by mathematical analysis of infections with mixed inocula and segregative plasmid experiments. The slow growth was sufficient to explain recalcitrance to antibiotics treatment. Therefore, slow-growing antibiotic-tolerant bacteria lodged within dendritic cells can explain poor in vivo antibiotic activity and relapse. Administration of LPS or CpG, known elicitors of innate immune defense, reduced the loads of tolerant bacteria. Thus, manipulating innate immunity may augment the in vivo activity of antibiotics. PMID:24558351

  16. Antibiotic treatment and mortality in patients with Listeria monocytogenes meningitis or bacteraemia

    DEFF Research Database (Denmark)

    Thønnings, S; Knudsen, J D; Schønheyder, H C

    2016-01-01

    . monocytogenes infections including the efficacy of empiric and definitive antibiotic therapies. Demographic, clinical and biochemical findings, antibiotic treatment and 30-day mortality for all episodes of L. monocytogenes bacteraemia and/or meningitis were collected by retrospective medical record review...... both. Significant risk factors for 30-day mortality were septic shock (OR 3.0, 95% CI 1.4-6.4), altered mental state (OR 3.6, 95% CI 1.7-7.6) and inadequate empiric antibiotic therapy (OR 3.8, 95% CI 1.8-8.1). Cephalosporins accounted for 90% of inadequately treated cases. Adequate definitive...... mortality in an adjusted analysis compared with meropenem (OR 0.3; 95% CI 0.1-0.8). In conclusion, inadequate empiric antibiotic therapy and definitive therapy with meropenem were both associated with significantly higher 30-day mortality....

  17. A multicenter randomized clinical trial investigating the cost-effectiveness of treatment strategies with or without antibiotics for uncomplicated acute diverticulitis (DIABOLO trial)

    NARCIS (Netherlands)

    Unlü, Cağdaş; de Korte, Niels; Daniels, Lidewine; Consten, Esther C. J.; Cuesta, Miguel A.; Gerhards, Michael F.; van Geloven, Anna A. W.; van der Zaag, Edwin S.; van der Hoeven, Joost A. B.; Klicks, Rutger; Cense, Huib A.; Roumen, Rudi M. H.; Eijsbouts, Quirijn A. J.; Lange, Johan F.; Fockens, Paul; de Borgie, Corianne A. J. M.; Bemelman, Wilem A.; Reitsma, Johannes B.; Stockmann, Hein B. A. C.; Vrouenraets, Bart C.; Boermeester, Marja A.

    2010-01-01

    Conservative treatment of uncomplicated or mild diverticulitis usually includes antibiotic therapy. It is, however, uncertain whether patients with acute diverticulitis indeed benefit from antibiotics. In most guidelines issued by professional organizations antibiotics are considered mandatory in

  18. A multicenter randomized clinical trial investigating the cost-effectiveness of treatment strategies with or without antibiotics for uncomplicated acute diverticulitis (DIABOLO trial)

    NARCIS (Netherlands)

    C.̧. Ünlü; N. de Korte (Niels); L. Daniels (Lidewine); E.C. Consten (Esther); M.A. Cuesta (Miguel); M.F. Gerhards (Michael); A.A. van Geloven (Anna); E.S. van der Zaag (Edwin); J.A.B. van der Hoeven (Joost); R. Klicks (Rutger); H.A. Cense (Huib); R.M. Roumen (Rudi); Q.A. Eijsbouts (Quirijn); J.F. Lange (Johan); P. Fockens (Paul); C.A. de Borgie (Corianne); W.A. Bemelman (Willem); J.B. Reitsma (Johannes); H.B.A.C. Stockmann; B.C. Vrouenraets (Bart); M.A. Boermeester (Marja)

    2010-01-01

    textabstractBackground. Conservative treatment of uncomplicated or mild diverticulitis usually includes antibiotic therapy. It is, however, uncertain whether patients with acute diverticulitis indeed benefit from antibiotics. In most guidelines issued by professional organizations antibiotics are

  19. Removal of antibiotics in conventional and advanced wastewater treatment: implications for environmental discharge and wastewater recycling.

    Science.gov (United States)

    Watkinson, A J; Murby, E J; Costanzo, S D

    2007-10-01

    Removal of 28 human and veterinary antibiotics was assessed in a conventional (activated sludge) and advanced (microfiltration/reverse osmosis) wastewater treatment plant (WWTP) in Brisbane, Australia. The dominant antibiotics detected in wastewater influents were cephalexin (med. 4.6 microg L(-1), freq. 100%), ciprofloxacin (med. 3.8 microg L(-1), freq. 100%), cefaclor (med. 0.5 microg L(-1), freq. 100%), sulphamethoxazole (med. 0.36 microg L(-1), freq. 100%) and trimethoprim (med. 0.34 microg L(-1), freq. 100%). Results indicated that both treatment plants significantly reduced antibiotic concentrations with an average removal rate from the liquid phase of 92%. However, antibiotics were still detected in both effluents from the low-to-mid ng L(-1) range. Antibiotics detected in effluent from the activated sludge WWTP included ciprofloxacin (med. 0.6 microg L(-1), freq. 100%), sulphamethoxazole (med. 0.27 microg L(-1), freq. 100%) lincomycin (med. 0.05 microg L(-1), freq. 100%) and trimethoprim (med. 0.05 microg L(-1), freq. 100%). Antibiotics identified in microfiltration/reverse osmosis product water included naladixic acid (med. 0.045 microg L(-1), freq. 100%), enrofloxacin (med. 0.01 microg L(-1), freq. 100%), roxithromycin (med. 0.01 microg L(-1), freq. 100%), norfloxacin (med. 0.005 microg L(-1), freq. 100%), oleandomycin (med. 0.005 microg L(-1), freq. 100%), trimethoprim (med. 0.005 microg L(-1), freq. 100%), tylosin (med. 0.001 microg L(-1), freq. 100%), and lincomycin (med. 0.001 microg L(-1), freq. 66%). Certain traditional parameters, including nitrate concentration, conductivity and turbidity of the effluent were assessed as predictors of total antibiotic concentration, however only conductivity demonstrated any correlation with total antibiotic concentration (p=0.018, r=0.7). There is currently a lack of information concerning the effects of these chemicals to critically assess potential risks for environmental discharge and water recycling.

  20. Parenteral and oral antibiotic duration for treatment of pediatric osteomyelitis: a systematic review protocol

    Science.gov (United States)

    2013-01-01

    Background Pediatric osteomyelitis is a bacterial infection of bones requiring prolonged antibiotic treatment using parenteral followed by enteral agents. Major complications of pediatric osteomyelitis include transition to chronic osteomyelitis, formation of subperiosteal abscesses, extension of infection into the joint, and permanent bony deformity or limb shortening. Historically, osteomyelitis has been treated with long durations of antibiotics to avoid these complications. However, with improvements in management and antibiotic treatment, standard of care is moving towards short durations of intravenous antibiotics prior to enteral antibiotics. Methods/Design The authors will perform a systematic review based on PRISMA guidelines in order to evaluate the literature, looking for evidence to support the optimal duration of parenteral and enteral therapy. The main goals are to see if literature supports shorter durations of either parenteral antibiotics and/or enteral antibiotics. Multiple databases will be investigated using a thorough search strategy. Databases include Medline, Cochrane, EMBASE, SCOPUS, Dissertation Abstracts, CINAHL, Web of Science, African Index Medicus and LILACS. Search stream will include medical subject heading for pediatric patients with osteomyelitis and antibiotic therapy. We will search for published or unpublished randomized and quasi-randomized controlled trials. Two authors will independently select articles, extract data and assess risk of bias by standard Cochrane methodologies. We will analyze comparisons between dichotomous outcomes using risk ratios and continuous outcomes using mean differences. 95% confidence intervals will be computed. Discussion One of the major dilemmas of management of this disease is the duration of parenteral therapy. Long parenteral therapy has increased risk of serious complications and the necessity for long therapy has been called into question. Our study aims to review the currently available

  1. Antibiotic treatment and the diagnosis of Streptococcus pneumoniae in lower respiratory tract infections in adults

    DEFF Research Database (Denmark)

    Korsgaard, Jens; Møller, Jens Kjølseth; Kilian, Mogens

    2005-01-01

    OBJECTIVE: To analyze the possible influence of antibiotic treatment on the results of different diagnostic tests for the diagnosis of lower respiratory tract infections with Streptococcus pneumoniae. MATERIAL AND METHODS: A prospective cohort of 159 unselected adult immunocompetent patients...... admitted to Silkeborg County Hospital in Denmark with community-acquired lower respiratory tract infections underwent microbiological investigations with fiber-optic bronchoscopy with bronchoalveolar lavage, blood and sputum culture and urine antigen test for type-specific polysaccharide capsular antigens...... was positive in both systems, making a total of 22 patients with documented pneumococcal infection. As a positive culture test was dependent on the absence of antibiotic treatment, whereas a positive urine antigen test depended on antibiotic treatment within 48 hours, the two tests were complementary...

  2. Putative biomarkers for evaluating antibiotic treatment: an experimental model of porcine Actinobacillus pleuropneumoniae infection

    DEFF Research Database (Denmark)

    Lauritzen, B.; Lykkesfeldt, J.; Skaanild, M.T.

    2003-01-01

    Biomarkers of infection were screened for their possible role as evaluators of antibiotic treatment in an aerosol infection model of porcine pneumonia caused by Actinobacillus pleuropneumoniae (Ap). Following infection of 12 pigs, clinical signs of pneumonia developed within 20 h, whereafter...... antibiotic treatment of acute Ap-infection ill pigs. The present model provides a valuable tool in the evaluation of antibiotic treatments, offering the advantage of clinical and pathological examinations combined with the use of biochemical infection markers....... the animals received a single dose of either danofloxacin (2.5 mg/kg) or tiamulin (10 mg/kg). To test the discriminative properties of the biomarkers, the dosage regimens were designed with an expected difference in therapeutic efficacy in favour of danofloxacin. Accordingly, the danofloxacin-treated pigs...

  3. Treatment of pediatric suppurative mastoiditis: is peripherally inserted central catheter (PICC) antibiotic therapy necessary?

    Science.gov (United States)

    Moore, Jeremy A; Wei, Julie L; Smith, Holly J; Mayo, Matthew S

    2006-07-01

    A review of the treatment of pediatric acute mastoiditis requiring surgical intervention managed with and without PICC therapy postoperatively. Retrospective study of 42 cases from 1989 to 2004 treated at a regional children's hospital. Sixteen patients received postoperative PICC therapy and 26 received a course of oral antibiotics. The PICC group received on average 12.12 days of intravenous antibiotics compared to only 3.53 days for the non-PICC group (P PICC group. There were no surgical complications. The total cost for outpatient PICC therapy increased treatment costs by approximately $1500 to $2500. Oral antibiotic therapy is sufficient after surgical intervention for acute pediatric suppurative mastoiditis without intracranial complications and does not result in adverse treatment outcome. Use of PICC therapy after surgical intervention for mastoiditis should be limited. B-3b.

  4. What Attitudes Could Influence Antibiotic Dispensing without Prescription?

    OpenAIRE

    Roque, Fátima; Soares, Sara; Breitenfeld, Luiza; Figueiras, Adolfo; Herdeiro, Maria Teresa

    2013-01-01

    Excessive and inappropriate use of antibiotics, are attributed to inadequate prescription and self-medication with antibiotics obtained from leftovers from previous courses or self-medication with antibiotics dispensed in pharmacies without prescription.

  5. Elucidating selection processes for antibiotic resistance in sewage treatment plants using metagenomics.

    Science.gov (United States)

    Bengtsson-Palme, Johan; Hammarén, Rickard; Pal, Chandan; Östman, Marcus; Björlenius, Berndt; Flach, Carl-Fredrik; Fick, Jerker; Kristiansson, Erik; Tysklind, Mats; Larsson, D G Joakim

    2016-12-01

    Sewage treatment plants (STPs) have repeatedly been suggested as "hotspots" for the emergence and dissemination of antibiotic-resistant bacteria. A critical question still unanswered is if selection pressures within STPs, caused by residual antibiotics or other co-selective agents, are sufficient to specifically promote resistance. To address this, we employed shotgun metagenomic sequencing of samples from different steps of the treatment process in three Swedish STPs. In parallel, concentrations of selected antibiotics, biocides and metals were analyzed. We found that concentrations of tetracycline and ciprofloxacin in the influent were above predicted concentrations for resistance selection, however, there was no consistent enrichment of resistance genes to any particular class of antibiotics in the STPs, neither for biocide and metal resistance genes. The most substantial change of the bacterial communities compared to human feces occurred already in the sewage pipes, manifested by a strong shift from obligate to facultative anaerobes. Through the treatment process, resistance genes against antibiotics, biocides and metals were not reduced to the same extent as fecal bacteria. The OXA-48 gene was consistently enriched in surplus and digested sludge. We find this worrying as OXA-48, still rare in Swedish clinical isolates, provides resistance to carbapenems, one of our most critically important classes of antibiotics. Taken together, metagenomics analyses did not provide clear support for specific antibiotic resistance selection. However, stronger selective forces affecting gross taxonomic composition, and with that resistance gene abundances, limit interpretability. Comprehensive analyses of resistant/non-resistant strains within relevant species are therefore warranted. Copyright © 2016 Elsevier B.V. All rights reserved.

  6. Antibiotic-resistant genes and antibiotic-resistant bacteria in the effluent of urban residential areas, hospitals, and a municipal wastewater treatment plant system.

    Science.gov (United States)

    Li, Jianan; Cheng, Weixiao; Xu, Like; Strong, P J; Chen, Hong

    2015-03-01

    In this study, we determined the abundance of 8 antibiotics (3 tetracyclines, 4 sulfonamides, and 1 trimethoprim), 12 antibiotic-resistant genes (10 tet, 2 sul), 4 antibiotic-resistant bacteria (tetracycline, sulfamethoxazole, and combined resistance), and class 1 integron integrase gene (intI1) in the effluent of residential areas, hospitals, and municipal wastewater treatment plant (WWTP) systems. The concentrations of total/individual targets (antibiotics, genes, and bacteria) varied remarkably among different samples, but the hospital samples generally had a lower abundance than the residential area samples. The WWTP demonstrated removal efficiencies of 50.8% tetracyclines, 66.8% sulfonamides, 0.5 logs to 2.5 logs tet genes, and less than 1 log of sul and intI1 genes, as well as 0.5 log to 1 log removal for target bacteria. Except for the total tetracycline concentration and the proportion of tetracycline-resistant bacteria (R (2) = 0.330, P antibiotics and the corresponding resistant bacteria (P > 0.05). In contrast, various relationships were identified between antibiotics and antibiotic resistance genes (P antibiotic-resistant bacteria (P < 0.01).

  7. Ceftriaxone Potentiates Warfarin Activity Greater Than Other Antibiotics in the Treatment of Urinary Tract Infections.

    Science.gov (United States)

    Saum, Lindsay M; Balmat, Ryan P

    2016-04-01

    The cephalosporin class has been associated with an increased risk of bleeding among elderly patients receiving warfarin. Urinary tract infections (UTI) are the most prevalent infection in elderly patients. To determine the extent of interaction between antibiotics used in the treatment of UTI, particularly specific cephalosporins and warfarin. A retrospective chart review was conducted on chronic warfarin patients with a diagnosis of UTI treated with ceftriaxone, a first-generation cephalosporin, penicillin, or ciprofloxacin. The primary outcome was the comparison of the extent of international normalized ratio (INR) change from baseline between each antibiotic group. The ceftriaxone group was found to have a statistically significant higher peak INR value compared to all other studied antibiotics (ceftriaxone: 3.56, first-generation cephalosporins: 2.66, penicillins: 2.98, ciprofloxacin: 2.3; P = .004), a statistically significant greater extent of change in INR value (+1.19, +0.66, +0.8, +0.275; P = .006), and a statistically significant greater percentage change in INR value when compared to ciprofloxacin (54.4% vs 12.7%; P = .037). Ceftriaxone interacts with warfarin to increase a patient's INR value more than other commonly administered antibiotics for UTI treatment. Other antibiotics should be preferred for UTI treatment in patients on warfarin. © The Author(s) 2014.

  8. Antibiotic complications during the treatment of Mycobacterium ulcerans disease in Australian patients.

    Science.gov (United States)

    O'Brien, Daniel P; Friedman, Deborah; Hughes, Andrew; Walton, Aaron; Athan, Eugene

    2017-09-01

    Antibiotics are the recommended first-line treatment for Mycobacterium ulcerans disease. Antibiotic toxicity is common in Australian patients, yet antibiotic complication rates and their risk factors have not been determined. To determine the incidence rate and risk factors for antibiotic toxicity in Australian patients treated for M. ulcerans disease. An analysis of severe antibiotic complications was performed using data from a prospective cohort of M. ulcerans cases managed at Barwon Health from 1 January 1998 to 30 June 2016. A severe antibiotic complication was defined as an antibiotic adverse event that required its cessation. Antibiotic complication rates and their associations were assessed using a Poisson regression model. A total of 337 patients was included; 184 (54.6%) males and median age 57 years (interquartile range (IQR) 36-73 years). Median antibiotic treatment duration was 56 days (IQR 49-76 days). Seventy-five (22.2%) patients experienced severe antibiotic complications after a median 28 days (IQR 17-45 days) at a rate of 141.53 per 100 person-years (95% confidence interval (CI) 112.86-177.47). Eleven (14.7%) patients required hospitalisation. Compared with rifampicin/clarithromycin combinations, severe complication rates were not increased for rifampicin/ciprofloxacin (rate ratio (RR) 1.49, 95% CI 0.89-2.50, P = 0.13) or rifampicin/moxifloxacin (RR 2.54, 95% CI 0.76-8.50, P = 0.13) combinations, but were significantly increased for 'other' combinations (RR 2.53, 95% CI 1.13-5.68, P = 0.03). In a multivariable analysis, severe complication rates were significantly increased with reduced estimated glomerular filtration rates (EGFR) (adjusted rate ratio (aRR) 2.65, 95% CI 1.24-5.65 for EGFR 60-89 mL/min and aRR 1.31, 95% CI 0.49-3.53 for EGFR 0-59 mL/min compared with EGFR ≥90 mL/min, P ulcerans treatment are high with increased rates independently associated with reduced renal function and female gender. © 2017 Royal Australasian

  9. Variation in antibiotic treatment for diabetic patients with serious foot infections: A retrospective observational study

    Directory of Open Access Journals (Sweden)

    Christiansen Cindy L

    2010-07-01

    Full Text Available Abstract Background Diabetic foot infections are common, serious, and diverse. There is uncertainty about optimal antibiotic treatment, and probably substantial variation in practice. Our aim was to document whether this is the case: A finding that would raise questions about the comparative cost-effectiveness of different regimens and also open the possibility of examining costs and outcomes to determine which should be preferred. Methods We used the Veterans Health Administration (VA Diabetes Epidemiology Cohorts (DEpiC database to conduct a retrospective observational study of hospitalized patients with diabetic foot infections. DEpiC contains computerized VA and Medicare patient-level data for VA patients with diabetes since 1998, including demographics, ICD-9-CM diagnostic codes, antibiotics prescribed, and VA facility. We identified all patients with ICD-9-CM codes for cellulitis/abscess of the foot and then sub-grouped them according to whether they had cellulitis/abscess plus codes for gangrene, osteomyelitis, skin ulcer, or none of these. For each facility, we determined: 1 The proportion of patients treated with an antibiotic and the initial route of administration; 2 The first antibiotic regimen prescribed for each patient, defined as treatment with the same antibiotic, or combination of antibiotics, for at least 5 continuous days; and 3 The antibacterial spectrum of the first regimen. Results We identified 3,792 patients with cellulitis/abscess of the foot either alone (16.4%, or with ulcer (32.6%, osteomyelitis (19.0% or gangrene (32.0%. Antibiotics were prescribed for 98.9%. At least 5 continuous days of treatment with an unchanged regimen of one or more antibiotics was prescribed for 59.3%. The means and (ranges across facilities of the three most common regimens were: 16.4%, (22.8%; 15.7%, (36.1%; and 10.8%, (50.5%. The range of variation across facilities proved substantially greater than that across the different categories of

  10. Immune Responses to Broad-Spectrum Antibiotic Treatment and Fecal Microbiota Transplantation in Mice.

    Science.gov (United States)

    Ekmekciu, Ira; von Klitzing, Eliane; Fiebiger, Ulrike; Escher, Ulrike; Neumann, Christian; Bacher, Petra; Scheffold, Alexander; Kühl, Anja A; Bereswill, Stefan; Heimesaat, Markus M

    2017-01-01

    Compelling evidence demonstrates the pivotal role of the commensal intestinal microbiota in host physiology and the detrimental effects of its perturbations following antibiotic treatment. Aim of this study was to investigate the impact of antibiotics induced depletion and subsequent restoration of the intestinal microbiota composition on the murine mucosal and systemic immunity. To address this, conventional C57BL/6j mice were subjected to broad-spectrum antibiotic treatment for 8 weeks. Restoration of the intestinal microbiota by peroral fecal microbiota transplantation (FMT) led to reestablishment of small intestinal CD4 + , CD8 + , and B220 + as well as of colonic CD4 + cell numbers as early as 7 days post-FMT. However, at d28 following FMT, colonic CD4 + and B220 + cell numbers were comparable to those in secondary abiotic (ABx) mice. Remarkably, CD8 + cell numbers were reduced in the colon upon antibiotic treatment, and FMT was not sufficient to restore this immune cell subset. Furthermore, absence of gut microbial stimuli resulted in decreased percentages of memory/effector T cells, regulatory T cells, and activated dendritic cells in the small intestine, colon, mesenteric lymph nodes (MLN), and spleen. Concurrent antibiotic treatment caused decreased cytokine production (IFN-γ, IL-17, IL-22, and IL-10) of CD4 + cells in respective compartments. These effects were, however, completely restored upon FMT. In summary, broad-spectrum antibiotic treatment resulted in profound local (i.e., small and large intestinal), peripheral (i.e., MLN), and systemic (i.e., splenic) changes in the immune cell repertoire that could, at least in part, be restored upon FMT. Further studies need to unravel the distinct molecular mechanisms underlying microbiota-driven changes in immune homeostasis subsequently providing novel therapeutic or even preventive approaches in human immunopathologies.

  11. Social influences on the duration of antibiotic treatment of clinical mastitis in dairy cows.

    Science.gov (United States)

    Swinkels, J M; Hilkens, A; Zoche-Golob, V; Krömker, V; Buddiger, M; Jansen, J; Lam, T J G M

    2015-04-01

    Clinical mastitis of dairy cows is a visible inflammation of the udder, which is usually caused by bacteria and treated with antibiotics. Although pressure is increasing to reduce antibiotic usage in livestock in the European Union, feedback from the field suggests that clinical mastitis treatment is frequently repeated after the initial per-label treatment, thereby extending treatment duration. The aim of this study was to explore the social factors influencing farmers' decision-making on the duration of antibiotic treatment of clinical mastitis. In total, 38 dairy farmers in the Netherlands (n=17) and Germany (n=21) were interviewed in a qualitative semi-structured way. Extended treatment was defined as any treatment longer than that given in label directions. Of the 38 farmers, 30 reported routine and 7 occasional extended antibiotic treatment. The interviewed farmers were sensitive toward social norms of other farmers and recognition for good stockmanship. Extended treatment is perceived as part of the social norm of "being a good farmer." The participants' perception was that mastitis is not treated "thoroughly" if clinical symptoms were still visible at the time of cessation of treatment, because it may persist or recur. As a result, treatment was frequently extended by repeating the initial label treatment. Farmers, specifically the more "cow-oriented" farmers, expressed insecurity on how to treat mastitis effectively. This insecurity made them more sensitive to comply with other farmers' injunctive ("what ought to be") and descriptive ("what is done") norms and the perceived veterinarians' informational norm that extended treatment is better, resulting in an approved social norm. Social approval reduces the insecurity of being perceived as a poor farmer; thus, extended treatment is emotionally rewarded. This social reward apparently outweighs the higher costs of more waste milk and more antibiotic usage. Perceived positive reference groups with whom the

  12. Gas Plasma Pre-treatment Increases Antibiotic Sensitivity and Persister Eradication in Methicillin-Resistant Staphylococcus aureus

    Science.gov (United States)

    Guo, Li; Xu, Ruobing; Zhao, Yiming; Liu, Dingxin; Liu, Zhijie; Wang, Xiaohua; Chen, Hailan; Kong, Michael G.

    2018-01-01

    Methicillin-resistant Staphylococcus aureus (MRSA) is a major cause of serious nosocomial infections, and recurrent MRSA infections primarily result from the survival of persister cells after antibiotic treatment. Gas plasma, a novel source of ROS (reactive oxygen species) and RNS (reactive nitrogen species) generation, not only inactivates pathogenic microbes but also restore the sensitivity of MRSA to antibiotics. This study further found that sublethal treatment of MRSA with both plasma and plasma-activated saline increased the antibiotic sensitivity and promoted the eradication of persister cells by tetracycline, gentamycin, clindamycin, chloramphenicol, ciprofloxacin, rifampicin, and vancomycin. The short-lived ROS and RNS generated by plasma played a primary role in the process and induced the increase of many species of ROS and RNS in MRSA cells. Thus, our data indicated that the plasma treatment could promote the effects of many different classes of antibiotics and act as an antibiotic sensitizer for the treatment of antibiotic-resistant bacteria involved in infectious diseases.

  13. Early surgery with antibiotics treatment had better clinical outcomes than antibiotics treatment alone in patients with pyogenic spondylodiscitis: a retrospective cohort study.

    Science.gov (United States)

    Tsai, Tsung-Ting; Yang, Shih-Chieh; Niu, Chi-Chien; Lai, Po-Liang; Lee, Ming-Hsun; Chen, Lih-Huei; Chen, Wen-Jer

    2017-04-27

    Pyogenic spondylodiscitis is a form of spinal infection that can result in severe back pain and even death. However, information is lacking on the relative effectiveness of various therapies. A retrospective chart review was conducted to investigate whether early surgical treatment of pyogenic spondylodiscitis coupled with intravenous antibiotics results in better patient prognoses than intravenous antibiotics therapy alone. All patients treated for pyogenic spondylodiscitis at a single medical center from July 2006 to July 2011 were retrospectively reviewed. The inclusion criteria consisted of diagnosis of an early stage infection without neurological deficit, and patients without severe sepsis who were suitable candidates for early surgery as determined by a Pittsburgh bacteremia score spondylodiscitis typically achieves a better prognosis, shorter hospitalization period, and subsequent significant improvement in kyphotic deformity and quality of life.

  14. Linezolid vs Glycopeptide Antibiotics for the Treatment of Suspected Methicillin-Resistant Staphylococcus aureus Nosocomial Pneumonia

    Science.gov (United States)

    O’Donnell, Max R.; Wiener, Renda Soylemez

    2011-01-01

    Background: Methicillin-resistant Staphylococcus aureus (MRSA) is an important cause of nosocomial pneumonia. Societal guidelines suggest linezolid may be the preferred treatment of MRSA nosocomial pneumonia. We investigated the efficacy of linezolid compared with glycopeptide antibiotics (vancomycin or teicoplanin) for nosocomial pneumonia. Methods: This was a systematic review and meta-analysis of English language, randomized, controlled trials comparing linezolid to glycopeptide antibiotics for suspected MRSA pneumonia in subjects > 12 years of age. A highly sensitive search of PubMed MEDLINE and Cochrane Central Register of Controlled Trials databases identified relevant studies. Results: Eight trials encompassing 1,641 subjects met entry criteria. Linezolid was not superior to glycopeptide antibiotics for end points of clinical success (relative risk [RR] linezolid vs glycopeptide, 1.04; 95% CI, 0.97-1.11; P = .28), microbiologic success (RR, 1.13; 95% CI, 0.97-1.31; P = .12), or mortality (RR, 0.91; 95% CI, 0.69-1.18; P = .47). In addition, clinical success in the subgroup of subjects with MRSA-positive respiratory tract culture (RR, 1.23; 95% CI, 0.97-1.57; P = .09) was not significantly different from those without MRSA (RR, 0.95; 95% CI, 0.83-1.09; P = .48), P for interaction, 0.07. The risk for adverse events was not different between the two antibiotic classes (RR, 0.96; 95% CI, 0.86-1.07; P = .48). Conclusion: Randomized controlled trials do not support superiority of linezolid over glycopeptide antibiotics for the treatment of nosocomial pneumonia. We recommend that decisions between linezolid or glycopeptide antibiotics for empirical or MRSA-directed therapy of nosocomial pneumonia depend on local availability, antibiotic resistance patterns, preferred routes of delivery, and cost, rather than presumed differences in efficacy. PMID:20864609

  15. Duration of antibiotic therapy in the intensive care unit

    Science.gov (United States)

    Zilahi, Gabor; McMahon, Mary Aisling; Povoa, Pedro

    2016-01-01

    There are certain well defined clinical situations where prolonged therapy is beneficial, but prolonged duration of antibiotic therapy is associated with increased resistance, medicalising effects, high costs and adverse drug reactions. The best way to decrease antibiotic duration is both to stop antibiotics when not needed (sterile invasive cultures with clinical improvement), not to start antibiotics when not indicated (treating colonization) and keep the antibiotic course as short as possible. The optimal duration of antimicrobial treatment for ventilator-associated pneumonia (VAP) is unknown, however, there is a growing evidence that reduction in the length of antibiotic courses to 7–8 days can minimize the consequences of antibiotic overuse in critical care, including antibiotic resistance, adverse effects, collateral damage and costs. Biomarkers like C-reactive protein (CRP) and procalcitonin (PCT) do have a valuable role in helping guide antibiotic duration but should be interpreted cautiously in the context of the clinical situation. On the other hand, microbiological criteria alone are not reliable and should not be used to justify a prolonged antibiotic course, as clinical cure does not equate to microbiological eradication. We do not recommend a ‘one size fits all’ approach and in some clinical situations, including infection with non-fermenting Gram-negative bacilli (NF-GNB) clinical evaluation is needed but shortening the antibiotic course is an effective and safe way to decrease inappropriate antibiotic exposure. PMID:28149576

  16. Enterobacter aerogenes and Enterobacter cloacae; versatile bacterial pathogens confronting antibiotic treatment

    Science.gov (United States)

    Davin-Regli, Anne; Pagès, Jean-Marie

    2015-01-01

    Enterobacter aerogenes and E. cloacae have been reported as important opportunistic and multiresistant bacterial pathogens for humans during the last three decades in hospital wards. These Gram-negative bacteria have been largely described during several outbreaks of hospital-acquired infections in Europe and particularly in France. The dissemination of Enterobacter sp. is associated with the presence of redundant regulatory cascades that efficiently control the membrane permeability ensuring the bacterial protection and the expression of detoxifying enzymes involved in antibiotic degradation/inactivation. In addition, these bacterial species are able to acquire numerous genetic mobile elements that strongly contribute to antibiotic resistance. Moreover, this particular fitness help them to colonize several environments and hosts and rapidly and efficiently adapt their metabolism and physiology to external conditions and environmental stresses. Enterobacter is a versatile bacterium able to promptly respond to the antibiotic treatment in the colonized patient. The balance of the prevalence, E. aerogenes versus E. cloacae, in the reported hospital infections during the last period, questions about the horizontal transmission of mobile elements containing antibiotic resistance genes, e.g., the efficacy of the exchange of resistance genes Klebsiella pneumoniae to Enterobacter sp. It is also important to mention the possible role of antibiotic use in the treatment of bacterial infectious diseases in this E. aerogenes/E. cloacae evolution. PMID:26042091

  17. Prescribing antibiotics to pediatric dengue: increasing risk of bacterial resistance

    Directory of Open Access Journals (Sweden)

    Dhanunjaya Sandopa

    2018-03-01

    Full Text Available Background Use of antibiotics to treat self-limiting viral infections like dengue fever (DF without any co-morbid conditions in pediatric patients is common practice in India, and a major contribution of the inappropriate use of antibiotics in the country. Objective To provide an analysis of diagnosis, grading, and prescribing of antibiotics in pediatric inpatients with DF in a tertiary care teaching hospital in India. Methods Data from case sheets of all pediatric inpatients (n=370 diagnosed with DF without co-morbid conditions were collected with regards to diagnosis, grading, presence, and appropriateness of antibiotic usage according to the 2009 WHO Guidelines, the National Vector Borne Disease Control Program (NVBDCP of India Guidelines, and the Hospital Infection Society (HIS Guidelines. Results Platelet count determination (50% of the cases was the major diagnostic method for dengue. Inappropriate grading of DF was seen in 20% of patients. Almost 75% of the 370 dengue cases were prescribed antibiotics for the expressed purpose of avoiding hospital-acquired infections. A single antibiotic was given in 225 cases (60.81%, 2 antibiotics in 33 (8.91 % cases, and 3 antibiotics in 9 (2.43% cases. Conclusions From the results it is clear that antibiotics were prescribed to treat DF where the antibiotics do not have any role. DF is a self-limiting viral infection that can be treated with proper management of hemodynamic status with IV fluids. To avoid the usage of antibiotics in the treatment of dengue, awareness has to be created in healthcare professionals regarding the treatment guidelines for dengue and appropriate use of antibiotics to avoid hospital acquired infections.

  18. A mixed treatment meta-analysis of antibiotic treatment options for bovine respiratory disease - An update.

    Science.gov (United States)

    O'Connor, A M; Yuan, C; Cullen, J N; Coetzee, J F; da Silva, N; Wang, C

    2016-09-15

    Bovine respiratory disease is the most economically important disease of feedlot cattle in North America. Choice of antibiotic is a critical factor for producers and veterinarians. We previously published a mixed-treatment comparison meta-analysis that combined evidence from published trials and published estimates of comparative efficacy for 12 antibiotics registered for use in the USA. Some of the comparative efficacy estimates were based only on indirect evidence. Since the original review was published, new studies that provide direct evidence of comparative efficacy have been published. We updated the original review to include the current evidence. We also compared the results from the indirect estimates from the prior model with the observed results from randomized control trials. We repeated the original search and found that five of the new studies met the criteria for inclusion in the updated review. Four of these studies provided new data on direct comparisons of active drugs. The results from one study (performed in 2002) that compared ceftiofur pinna and enrofloxacin were inconsistent with the network and were excluded from the analysis. Three new direct comparison studies examined gamithromycin compared with tulathromycin, florfenicol, and tilmicosin. The results of our analysis suggested that the indirect estimates from the prior model provided reasonable estimates of the risk ratios revealed by the primary studies. For example, for the comparison of gamithromycin (referent) with tulathromycin, the original model predicted a risk ratio of re-treatment of 0.54 (95% credible interval 0.27-0.87). The subsequent randomized controlled trial revealed that the observed risk ratio of re-treatment was 0.59 (95% confidence interval 0.45-0.78). The results of other comparisons were also similar. For the gamithromycin (referent) to florfenicol comparison, the observed randomized trial RR was 1.17 (95% confidence interval 0.83-1.64) and the indirect estimate of

  19. Fate of antibiotics during wastewater treatment and antibiotic distribution in the effluent-receiving waters of the Yellow Sea, northern China.

    Science.gov (United States)

    Zhang, Hanmin; Liu, Pengxiao; Feng, Yujie; Yang, Fenglin

    2013-08-15

    Antibiotics including three β-lactams, two fluoroquinolones and two macrolides, which were the top seven most prescribed antibiotics in Dalian, China, were selected to investigate their occurrence in six municipal wastewater treatment plants (WWTPs) and their distribution in the effluent-receiving waters of the Yellow Sea. Four WWTPs employing different treatment technologies were selected to explore the mechanism of antibiotics elimination during wastewater treatment. Results showed that fluoroquinolones and macrolides were dominant species in both WWTPs effluents and the surveyed coastal waters. Biodegradation was the main pathway for β-lactams removal, however, primary treatment performed better than biological treatment for fluoroquinolones removal. Concentrations of macrolides increased dramatically after the biological treatment, which was probably due to the release of macrolides enclosed in feces particles. In the surveyed coastal waters, reduction of antibiotic concentration with distance was observed. Potential environmental risk caused by the occurrence of these antibiotics should be evaluated in future work. Copyright © 2013 Elsevier Ltd. All rights reserved.

  20. Release of Antibiotic Resistant Bacteria by a Waste Treatment Plant from Romania.

    Science.gov (United States)

    Lupan, Iulia; Carpa, Rahela; Oltean, Andreea; Kelemen, Beatrice Simona; Popescu, Octavian

    2017-09-27

    The occurrence and spread of bacterial antibiotic resistance are subjects of great interest, and the role of wastewater treatment plants has been attracting particular interest. These stations are a reservoir of bacteria, have a large range of organic and inorganic substances, and the amount of bacteria released into the environment is very high. The main purpose of the present study was to assess the removal degree of bacteria with resistance to antibiotics and identify the contribution of a wastewater treatment plant to the microbiota of Someşul Mic river water in Cluj county. The resistance to sulfamethoxazole and tetracycline and some of their representative resistance genes: sul1, tet(O), and tet(W) were assessed in this study. The results obtained showed that bacteria resistant to sulphonamides were more abundant than those resistant to tetracycline. The concentration of bacteria with antibiotic resistance changed after the treatment, namely, bacteria resistant to sulfamethoxazole. The removal of all bacteria and antibiotic-resistant bacteria was 98-99% and the degree of removal of bacteria resistant to tetracycline was higher than the bacteria resistant to sulfamethoxazole compared to total bacteria. The wastewater treatment plant not only contributed to elevating ARG concentrations, it also enhanced the possibility of horizontal gene transfer (HGT) by increasing the abundance of the intI1 gene. Even though the treatment process reduced the concentration of bacteria by two orders of magnitude, the wastewater treatment plant in Cluj-Napoca contributed to an increase in antibiotic-resistant bacteria concentrations up to 10 km downstream of its discharge in Someşul Mic river.

  1. Identification of antibiotic-resistant Escherichia coli isolated from a municipal wastewater treatment plant.

    Science.gov (United States)

    Zanotto, Carlo; Bissa, Massimiliano; Illiano, Elena; Mezzanotte, Valeria; Marazzi, Francesca; Turolla, Andrea; Antonelli, Manuela; De Giuli Morghen, Carlo; Radaelli, Antonia

    2016-12-01

    The emergence and diffusion of antibiotic-resistant bacteria has been a major public health problem for many years now. In this study, antibiotic-resistance of coliforms and Escherichia coli were investigated after their isolation from samples collected in a municipal wastewater treatment plant in the Milan area (Italy) along different points of the treatment sequence: inflow to biological treatment; outflow from biological treatment following rapid sand filtration; and outflow from peracetic acid disinfection. The presence of E. coli that showed resistance to ampicillin (AMP) and chloramphenicol (CAF), used as representative antibiotics for the efficacy against Gram-positive and Gram-negative bacteria, was evaluated. After determining E. coli survival using increasing AMP and CAF concentrations, specific single-resistant (AMP R or CAF R ) and double-resistant (AMP R /CAF R ) strains were identified among E. coli colonies, through amplification of the β-lactamase Tem-1 (bla) and acetyl-transferase catA1 (cat) gene sequences. While a limited number of CAF R bacteria was observed, most AMP R colonies showed the specific resistance genes to both antibiotics, which was mainly due to the presence of the bla gene sequence. The peracetic acid, used as disinfection agent, showed to be very effective in reducing bacteria at the negligible levels of less than 10 CFU/100 mL, compatible with those admitted for the irrigation use of treated waters. Copyright © 2016. Published by Elsevier Ltd.

  2. Lactobacillus GG prevents recurrence of colitis in HLA-B27 transgenic rats after antibiotic treatment

    NARCIS (Netherlands)

    Dieleman, L. A.; Goerres, M. S.; Arends, A.; Sprengers, D.; Torrice, C.; Hoentjen, F.; Grenther, W. B.; Sartor, R. B.

    2003-01-01

    Bacteroides vulgatus induces colitis in gnotobiotic HLA-B27 transgenic (TG) rats while broad spectrum antibiotics prevent and treat colitis in specific pathogen free (SPF) TG rats although disease recurs after treatment ends. Lactobacilli treat human pouchitis and experimental colitis. We

  3. Pre-treatment with antibiotics and Escherichia coli to equalize the gut microbiota in conventional mice.

    Science.gov (United States)

    Linninge, Caroline; Ahrné, Siv; Molin, Göran

    2015-01-01

    The composition of the gut microbiota can vary widely between individual mice of the same batch and thereby affect the resulting outcome in experimental studies. Therefore, an efficient method is needed to equalize the gut microbiota prior to the start of critical experiments. In order to minimize variations in gut microbiota between animals and provide the animals with a Gram-negative flora exposing lipopolysaccharides in the cell-walls, C57BL/6 mice were given a mixture of ampicillin, metronidazole and clindamycin in the drinking water for 3 days and then Escherichia coli for two additional days. Treatment with antibiotics alone or with antibiotics in combination with E. coli was well tolerated by all animals. Body weight and liver weight were not affected, although higher hepatic fat content was found in treated animals (p diversity of the gut microbiota was strongly reduced in animals treated with antibiotics and antibiotics in combination with E. coli (p microbiota between different treatment groups. The described treatment efficiently equalized the gut microbiota and provided the animals with a strong abundance of Enterobacteriaceae without changing the total load of bacteria. This is a straightforward, lenient and efficient method of pre-treatment to equalize the gut microbiota of mice as a starting procedure of animal studies.

  4. Clinical significance of C-reactive protein values in antibiotic treatment for pyogenic liver abscess

    Science.gov (United States)

    Gao, Hai-Nv; Yuan, Wen-Xia; Yang, Mei-Fang; Zhao, Hong; Hu, Jian-Hua; Zhang, Xuan; Fan, Jun; Ma, Wei-Hang

    2010-01-01

    AIM: To investigate the clinical significance of C-reactive protein (CRP) values in determining the endpoint of antibiotic treatment for liver abscess after drainage. METHODS: The endpoints of antibiotic treatment in 46 patients with pyogenic liver abscess after complete percutaneous drainage were assessed by performing a retrospective study. After complete percutaneous drainage, normal CRP values were considered as the endpoint in 18 patients (experimental group), and normal body temperature for at least 2 wk were considered as the endpoints in the other 28 patients (control group). RESULTS: The duration of antibiotic treatment after complete percutaneous drainage was 15.83 ± 6.45 d and 24.25 ± 8.18 d for the experimental and the control groups, respectively (P = 0.001), being significantly shorter in the experimental group than in the control group. The recurrence rate was 0% for both groups. However, we could not obtain the follow-up data about 3 patients in the control group. CONCLUSION: CRP values can be considered as an independent factor to determine the duration of the antibiotic treatment for pyogenic liver abscess after complete percutaneous drainage. PMID:20939118

  5. Antibiotic treatment of acute gastroenteritis in children [version 1; referees: 2 approved

    Directory of Open Access Journals (Sweden)

    Eugenia Bruzzese

    2018-02-01

    Full Text Available Antibiotic therapy is not necessary for acute diarrhea in children, as rehydration is the key treatment and symptoms resolve generally without specific therapy. Searching for the etiology of gastroenteritis is not usually needed; however, it may be necessary if antimicrobial treatment is considered. The latter is left to the physician evaluation in the absence of clear indications. Antimicrobial treatment should be considered in severely sick children, in those who have chronic conditions or specific risk factors or in specific settings. Traveler’s diarrhea, prolonged diarrhea, and antibiotic-associated diarrhea may also require antibiotic therapy. Depending on the severity of symptoms or based on risk of spreading, empiric therapy may be started while awaiting the results of microbiological investigations. The choice of antibiotic depends on suspected agents, host conditions, and local epidemiology. In most cases, empiric therapy should be started while awaiting such results. Empiric therapy may be started with oral co-trimoxazole or metronidazole, but in severe cases parenteral treatment with ceftriaxone or ciprofloxacin might be considered.

  6. Incidence, risk factors and treatment of diarrhoea among Dutch travellers: reasons not to routinely prescribe antibiotics

    NARCIS (Netherlands)

    Belderok, Sanne-Meike; van den Hoek, Anneke; Kint, Joan A.; Schim van der Loeff, Maarten F.; Sonder, Gerard Jb

    2011-01-01

    Travellers' diarrhoea (TD) is the most common infectious disease among travellers. In the Netherlands, stand-by or prophylactic antibiotics are not routinely prescribed to travellers. This study prospectively assessed the incidence rate, risk factors, and treatment of TD among immunocompetent

  7. Incidence, risk factors and treatment of diarrhoea among Dutch travellers: reasons not to routinely prescribe antibiotics

    NARCIS (Netherlands)

    Belderok, S.M.; van den Hoek, A.; Kint, J.A.; van der Loeff, M.F.S.; Sonder, G.J.B.

    2011-01-01

    Background: Travellers' diarrhoea (TD) is the most common infectious disease among travellers. In the Netherlands, stand-by or prophylactic antibiotics are not routinely prescribed to travellers. This study prospectively assessed the incidence rate, risk factors, and treatment of TD among

  8. Distribution, fate and risk assessment of antibiotics in sewage treatment plants in Hong Kong, South China.

    Science.gov (United States)

    Leung, H W; Minh, T B; Murphy, M B; Lam, James C W; So, M K; Martin, Michael; Lam, Paul K S; Richardson, B J

    2012-07-01

    Occurrence, removal, consumption and environmental risks of sixteen antibiotics were investigated in several sewage treatment plants (STPs) featuring different treatment levels in Hong Kong, China. Cefalexin, ofloxacin and erythromycin-H(2)O were predominant with concentrations of 1020-5640, 142-7900 and 243-4740 ng/L in influent, respectively; their mass loads were comparable to levels reported in urban regions in China and were at the high end of the range reported for western countries. The target antibiotics behaved differently depending on the treatment level employed at the STPs and relatively higher removal efficiencies (>70%) were observed for cefalexin, cefotaxime, amoxicillin, sulfamethoxazole and chloramphenicol during secondary treatment. ß-lactams were especially susceptible to removal via the activated sludge process while macrolides were recalcitrant (norfloxacin (52%), differed greatly in their removal efficiencies, probably because of disparities in their pK(a) values which resulted in different sorption behaviour in sludge. Overall antibiotic consumption in Hong Kong was back-calculated based on influent mass flows and compared with available prescription and usage data. This model was verified by a good approximation of 82% and 141% to the predicted consumption of total ofloxacin, but a less accurate estimate was obtained for erythromycin usage. Risk assessment indicated that algae are susceptible to the environmental concentrations of amoxicillin as well as the mixture of the nine detected antibiotics in receiving surface waters. Copyright © 2011 Elsevier Ltd. All rights reserved.

  9. Antibiotic prophylaxis for dental treatment after prosthetic joint replacement: exploring the orthopaedic surgeon's opinion

    Directory of Open Access Journals (Sweden)

    Clare M. McNally, MPhil(Dent

    2016-09-01

    Conclusions: Australian orthopaedic surgeons continue to recommend antibiotic prophylaxis for dental treatment. The recording of PJI in relation to dental procedures into clinical registries would enable the development of consistent guidelines between professional groups responsible for the care of this patient group.

  10. Oral antibiotic treatment of left-sided infectious endocarditis verified by 16S-PCR

    DEFF Research Database (Denmark)

    Bruun, Louise E; Tønder, Niels; Hansen, Thomas Fritz

    2011-01-01

    Treatment of infectious endocarditis (IE) comprises intravenously administered antibiotic medications given at high doses for 4-6 weeks--sometimes even longer. Approximately 50% of patients referred to tertiary care centres require additional surgical intervention. At present there are few papers...

  11. Outpatient treatment with corticosteroids and antibiotics for acalculous cholecystitis in chronic granulomatous disease.

    Science.gov (United States)

    Rojo, Pablo; Ruiz-Contreras, Jesus; Gonzalez-Tome, Maribel; Serrano, Carmelo; Marin, Miguel Angel

    2005-11-01

    We report the outpatient management of acalculous colecistitis in an 18-y-old male with X-linked chronic granulomatous disease. The patient complained of abdominal pain and the initial ultrasound showed a gallbladder with a thickened wall. In chronic granulomatous disease, pain from a thickened gallbladder disappears after oral treatment with glucocorticoids and antibiotics.

  12. Predictors for individual patient antibiotic treatment effect in hospitalized community-acquired pneumonia patients

    NARCIS (Netherlands)

    Simonetti, A. F.; van Werkhoven, C. H.; Schweitzer, V. A.; Viasus, D.; Carratalà, J.; Postma, D. F.; Oosterheert, J. J.; Bonten, M. J.M.

    2017-01-01

    Objective: Our objective was to identify clinical predictors of antibiotic treatment effects in hospitalized patients with community-acquired pneumonia (CAP) who were not in the intensive care unit (ICU). Methods: Post-hoc analysis of three prospective cohorts (from the Netherlands and Spain) of

  13. Impact of appropriate empirical antibiotic treatment on recurrence and mortality in patients with bacteraemia

    DEFF Research Database (Denmark)

    Gradel, Kim O; Jensen, Ulrich S; Schønheyder, Henrik C

    2017-01-01

    Background: Data on the impact of empirical antibiotic treatment (EAT) on patient outcome in a population-based setting are sparse. We assessed the association between EAT and the risk of recurrence within one year, short-term- (2-30 days) and long-term (31-365 days) mortality in a Danish cohort...

  14. Acute felon and paronychia: Antibiotics not necessary after surgical treatment. Prospective study of 46 patients.

    Science.gov (United States)

    Pierrart, Jérôme; Delgrande, Damien; Mamane, William; Tordjman, Daniel; Masmejean, Emmanuel H

    2016-02-01

    Paronychia and felon are the most common infections of the hand. Surgical treatment is required once an abscess develops, but systematic use of postoperative antibiotic therapy remains open for discussion. Antibiotics both favor the selection of resistant bacteria and increase the cost of treatment. To our knowledge, no study has demonstrated their benefit following excision, yet many practitioners prescribe them systematically and empirically. In our current practices, we do not use antibiotic coverage following excision of uncomplicated paronychia or felon (no signs of arthritis, osteitis, flexor tenosynovitis, lymphangitis), except in potentially at-risk patients (immunosuppressed, diabetic, cardiac valve prosthesis recipient). Since this approach seems to lead to good outcomes, our objective was to evaluate them clinically in this study. Our prospective study included 46 patients who were not considered at risk. There were 26 cases of paronychia, 3 cases of felon and 17 patients presenting both paronychia and felon. All cases were abscessed and uncomplicated. All patients underwent surgical excision, and none received postoperative antibiotics. Follow-up took place on the day after surgery, at days 7, 14, 21 and 45. The main criterion for evaluation was healing of the infection and the wound. We recorded 45 cases of healing with no complications and a single case of recurrence. Surgical excision of paronychia or felon without antibiotic coverage gives excellent results with only rare recurrence. The single failure can be attributed to inadequate excision. Antibiotic therapy has no role in managing uncomplicated felon or paronychia in patients who are otherwise not at risk. Successful treatment depends above all on the completeness of the surgical excision. Copyright © 2016 SFCM. Published by Elsevier Masson SAS. All rights reserved.

  15. Monitoring and evaluation of antibiotic-resistant bacteria at a municipal wastewater treatment plant in China.

    Science.gov (United States)

    Huang, Jing-Jing; Hu, Hong-Ying; Lu, Sun-Qin; Li, Yi; Tang, Fang; Lu, Yun; Wei, Bin

    2012-07-01

    The prevalence of antibiotic-resistant bacteria in municipal wastewater treatment plants (WWTPs) is becoming a concern of public health. In order to acquire information on the emission of antibiotic-resistant bacteria from WWTP effluents into natural waters, both average antibiotic tolerance and concentrations of antibiotic-resistant bacteria in the effluent of a WWTP in Beijing, China were investigated. A new index of IC(50)/MIC ratio (the antibiotic concentration required to inhibit 50% of total heterotrophic bacteria compared to the highest minimum inhibitory concentration value of a group of pathogens according to a specific antibiotic, as defined by CLSI) was used to reflect the average antibiotic tolerance of total heterotrophic bacteria in the secondary effluent. The results showed that the IC(50)/MIC ratios of heterotrophic bacteria in the secondary effluent to penicillin, ampicillin, cephalothin, chloramphenicol and rifampicin were >2, >1, >1, and 1.08, respectively, which reflected a significantly high general level of heterotrophic bacteria found in the secondary effluent resistant to these five antibiotics. The concentrations of penicillin-, ampicillin-, cephalothin-, and chloramphenicol-resistant bacteria were as high as 1.5×10(4)-1.9×10(5), 1.2×10(4)-1.5×10(5), 8.9×10(3)-1.9×10(5) and 2.6×10(4)-2.0×10(5) CFU/mL, and the average percentages in relation to total heterotrophic bacteria were 63%, 47%, 55%, and 69%, respectively. The concentrations of tetracycline- and rifampicin-resistant bacteria were 840-6.1×10(3) and 310-6.1×10(4) CFU/mL with average percentages of 2.6% and 11%, respectively. Furthermore, our study found that five- and six-antibiotic-resistant bacteria were widely distributed in four types of enterobacteria from the secondary effluent. The presence of multiple-antibiotic-resistant bacteria from effluents of WWTPs into natural waters could pose a serious problem as a secondary pollutant of drinking water. Copyright © 2011

  16. Mortality in enterococcal bloodstream infections increases with inappropriate antimicrobial therapy

    DEFF Research Database (Denmark)

    Suppli, M.; Aabenhus, R.; Harboe, Z.B.

    2010-01-01

    Enterococcus species are common in nosocomial bloodstream infections and their incidence is rising. Although well recognized in several serious bacterial infections, the influence of appropriate antimicrobial therapy in enterococcal bacteraemia has not been fully settled. The aim of the study.......7-10), thrombocytopenia (3.9, 1.6-9.3), chronic liver failure (3.3, 1.1-10) and age >/=60 years (2.2, 0.99-5.0). Antibiotics not appropriately covering enterococci are frequently administered empirically in suspected bloodstream infections. Inappropriate antibiotic therapy was an independent risk factor for mortality...

  17. Pre-hospital antibiotic treatment and mortality caused by invasive meningococcal disease, adjusting for indication bias

    Directory of Open Access Journals (Sweden)

    Matute-Cruz Petra

    2009-04-01

    Full Text Available Abstract Background Mortality from invasive meningococcal disease (IMD has remained stable over the last thirty years and it is unclear whether pre-hospital antibiotherapy actually produces a decrease in this mortality. Our aim was to examine whether pre-hospital oral antibiotherapy reduces mortality from IMD, adjusting for indication bias. Methods A retrospective analysis was made of clinical reports of all patients (n = 848 diagnosed with IMD from 1995 to 2000 in Andalusia and the Canary Islands, Spain, and of the relationship between the use of pre-hospital oral antibiotherapy and mortality. Indication bias was controlled for by the propensity score technique, and a multivariate analysis was performed to determine the probability of each patient receiving antibiotics, according to the symptoms identified before admission. Data on in-hospital death, use of antibiotics and demographic variables were collected. A logistic regression analysis was then carried out, using death as the dependent variable, and pre-hospital antibiotic use, age, time from onset of symptoms to parenteral antibiotics and the propensity score as independent variables. Results Data were recorded on 848 patients, 49 (5.72% of whom died. Of the total number of patients, 226 had received oral antibiotics before admission, mainly betalactams during the previous 48 hours. After adjusting the association between the use of antibiotics and death for age, time between onset of symptoms and in-hospital antibiotic treatment, pre-hospital oral antibiotherapy remained a significant protective factor (Odds Ratio for death 0.37, 95% confidence interval 0.15–0.93. Conclusion Pre-hospital oral antibiotherapy appears to reduce IMD mortality.

  18. Pre-hospital antibiotic treatment and mortality caused by invasive meningococcal disease, adjusting for indication bias.

    Science.gov (United States)

    Perea-Milla, Emilio; Olalla, Julián; Sánchez-Cantalejo, Emilio; Martos, Francisco; Matute-Cruz, Petra; Carmona-López, Guadalupe; Fornieles, Yolanda; Cayuela, Aurelio; García-Alegría, Javier

    2009-04-03

    Mortality from invasive meningococcal disease (IMD) has remained stable over the last thirty years and it is unclear whether pre-hospital antibiotherapy actually produces a decrease in this mortality. Our aim was to examine whether pre-hospital oral antibiotherapy reduces mortality from IMD, adjusting for indication bias. A retrospective analysis was made of clinical reports of all patients (n = 848) diagnosed with IMD from 1995 to 2000 in Andalusia and the Canary Islands, Spain, and of the relationship between the use of pre-hospital oral antibiotherapy and mortality. Indication bias was controlled for by the propensity score technique, and a multivariate analysis was performed to determine the probability of each patient receiving antibiotics, according to the symptoms identified before admission. Data on in-hospital death, use of antibiotics and demographic variables were collected. A logistic regression analysis was then carried out, using death as the dependent variable, and pre-hospital antibiotic use, age, time from onset of symptoms to parenteral antibiotics and the propensity score as independent variables. Data were recorded on 848 patients, 49 (5.72%) of whom died. Of the total number of patients, 226 had received oral antibiotics before admission, mainly betalactams during the previous 48 hours. After adjusting the association between the use of antibiotics and death for age, time between onset of symptoms and in-hospital antibiotic treatment, pre-hospital oral antibiotherapy remained a significant protective factor (Odds Ratio for death 0.37, 95% confidence interval 0.15-0.93). Pre-hospital oral antibiotherapy appears to reduce IMD mortality.

  19. Women with symptoms of uncomplicated urinary tract infection are often willing to delay antibiotic treatment: a prospective cohort study.

    Science.gov (United States)

    Knottnerus, Bart J; Geerlings, Suzanne E; Moll van Charante, Eric P; ter Riet, Gerben

    2013-05-31

    Women presenting with symptoms of acute uncomplicated urinary tract infection (UTI) are often prescribed antibiotics. However, in 25 to 50% of symptomatic women not taking antibiotics, symptoms recover spontaneously within one week. It is not known how many women are prepared to delay antibiotic treatment. We investigated how many women presenting with UTI symptoms were willing to delay antibiotic treatment when asked by their general practitioner (GP). From 18 April 2006 until 8 October 2008, in a prospective cohort study, patients were recruited in 20 GP practices in and around Amsterdam, the Netherlands. Healthy, non-pregnant women who contacted their GP with painful and/or frequent micturition for no longer than seven days registered their symptoms and collected urine for urinalysis and culture. GPs were requested to ask all patients if they were willing to delay antibiotic treatment, without knowing the result of the culture at that moment. After seven days, patients reported whether their symptoms had improved and whether they had used any antibiotics. Of 176 women, 137 were asked by their GP to delay antibiotic treatment, of whom 37% (51/137) were willing to delay. After one week, 55% (28/51) of delaying women had not used antibiotics, of whom 71% (20/28) reported clinical improvement or cure. None of the participating women developed pyelonephritis. More than a third of women with UTI symptoms are willing to delay antibiotic treatment when asked by their GP. The majority of delaying women report spontaneous symptom improvement after one week.

  20. Impact of pre-application treatment on municipal sludge composition, soil dynamics of antibiotic resistance genes, and abundance of antibiotic-resistance genes on vegetables at harvest.

    Science.gov (United States)

    Lau, Calvin Ho-Fung; Li, Bing; Zhang, Tong; Tien, Yuan-Ching; Scott, Andrew; Murray, Roger; Sabourin, Lyne; Lapen, David R; Duenk, Peter; Topp, Edward

    2017-06-01

    In many jurisdictions sludge recovered from the sewage treatment process is a valued fertilizer for crop production. Pre-treatment of sewage sludge prior to land application offers the potential to abate enteric microorganisms that carry genes conferring resistance to antibiotics. Pre-treatment practices that accomplish this should have the desirable effect of reducing the risk of contamination of crops or adjacent water with antibiotic resistance genes carried in these materials. In the present study, we obtained municipal sludge that had been subjected to one of five treatments. There were, anaerobic-digestion or aerobic-digestion, in both instances with and without dewatering; and heat-treatment and pelletization. Each of the five types of biosolids was applied to an agricultural field at commercial rates, following which lettuce, carrots and radishes were planted. Based on qPCR, the estimated antibiotic gene loading rates were comparable with each of the five biosolids. However, the gene abundance in soil following application of the pelletized biosolids was anomalously lower than expected. Following application, the abundance of antibiotic resistance genes decreased in a generally coherent fashion, except sul1 which increased in abundance during the growing season in the soil fertilized with pelletized biosolids. Based on qPCR and high throughput sequencing evidence for transfer of antibiotic resistance genes from the biosolids to the vegetables at harvest was weak. Clostridia were more abundant in soils receiving any of the biosolids except the pelletized. Overall, the behavior of antibiotic resistance genes in soils receiving aerobically or anaerobically-digested biosolids was consistent and coherent with previous studies. However, dynamics of antibiotic resistance genes in soils receiving the heat treated pelletized biosolids were very different, and the underlying mechanisms merit investigation. Crown Copyright © 2017. Published by Elsevier B.V. All

  1. Bacterial fitness shapes the population dynamics of antibiotic-resistant and -susceptible bacteria in a model of combined antibiotic and anti-virulence treatment

    Science.gov (United States)

    Ternent, Lucy; Dyson, Rosemary J.; Krachler, Anne-Marie; Jabbari, Sara

    2015-01-01

    Bacterial resistance to antibiotic treatment is a huge concern: introduction of any new antibiotic is shortly followed by the emergence of resistant bacterial isolates in the clinic. This issue is compounded by a severe lack of new antibiotics reaching the market. The significant rise in clinical resistance to antibiotics is especially problematic in nosocomial infections, where already vulnerable patients may fail to respond to treatment, causing even greater health concern. A recent focus has been on the development of anti-virulence drugs as a second line of defence in the treatment of antibiotic-resistant infections. This treatment, which weakens bacteria by reducing their virulence rather than killing them, should allow infections to be cleared through the body׳s natural defence mechanisms. In this way there should be little to no selective pressure exerted on the organism and, as such, a predominantly resistant population should be less likely to emerge. However, before the likelihood of resistance to these novel drugs emerging can be predicted, we must first establish whether such drugs can actually be effective. Many believe that anti-virulence drugs would not be powerful enough to clear existing infections, restricting their potential application to prophylaxis. We have developed a mathematical model that provides a theoretical framework to reveal the circumstances under which anti-virulence drugs may or may not be successful. We demonstrate that by harnessing and combining the advantages of antibiotics with those provided by anti-virulence drugs, given infection-specific parameters, it is possible to identify treatment strategies that would efficiently clear bacterial infections, while preventing the emergence of antibiotic-resistant subpopulations. Our findings strongly support the continuation of research into anti-virulence drugs and demonstrate that their applicability may reach beyond infection prevention. PMID:25701634

  2. Bacterial fitness shapes the population dynamics of antibiotic-resistant and -susceptible bacteria in a model of combined antibiotic and anti-virulence treatment.

    Science.gov (United States)

    Ternent, Lucy; Dyson, Rosemary J; Krachler, Anne-Marie; Jabbari, Sara

    2015-05-07

    Bacterial resistance to antibiotic treatment is a huge concern: introduction of any new antibiotic is shortly followed by the emergence of resistant bacterial isolates in the clinic. This issue is compounded by a severe lack of new antibiotics reaching the market. The significant rise in clinical resistance to antibiotics is especially problematic in nosocomial infections, where already vulnerable patients may fail to respond to treatment, causing even greater health concern. A recent focus has been on the development of anti-virulence drugs as a second line of defence in the treatment of antibiotic-resistant infections. This treatment, which weakens bacteria by reducing their virulence rather than killing them, should allow infections to be cleared through the body׳s natural defence mechanisms. In this way there should be little to no selective pressure exerted on the organism and, as such, a predominantly resistant population should be less likely to emerge. However, before the likelihood of resistance to these novel drugs emerging can be predicted, we must first establish whether such drugs can actually be effective. Many believe that anti-virulence drugs would not be powerful enough to clear existing infections, restricting their potential application to prophylaxis. We have developed a mathematical model that provides a theoretical framework to reveal the circumstances under which anti-virulence drugs may or may not be successful. We demonstrate that by harnessing and combining the advantages of antibiotics with those provided by anti-virulence drugs, given infection-specific parameters, it is possible to identify treatment strategies that would efficiently clear bacterial infections, while preventing the emergence of antibiotic-resistant subpopulations. Our findings strongly support the continuation of research into anti-virulence drugs and demonstrate that their applicability may reach beyond infection prevention. Copyright © 2015 The Authors. Published by

  3. Antibiotic Treatment of Hospitalized Patients with Pneumonia Complicated by Clostridium Difficile Infection.

    Science.gov (United States)

    Zycinska, K; Chmielewska, M; Lenartowicz, B; Hadzik-Blaszczyk, M; Cieplak, M; Kur, Z; Krupa, R; Wardyn, K A

    2016-01-01

    Clostridium difficile infection (CDI) is one of the most common gastrointestinal complication after antimicrobial treatment. It is estimated that CDI after pneumonia treatment is connected with a higher mortality than other causes of hospitalization. The aim of the study was to assess the relationship between the kind of antibiotic used for pneumonia treatment and mortality from post-pneumonia CDI. We addressed the issue by examining retrospectively the records of 217 patients who met the diagnostic criteria of CDI. Ninety four of those patients (43.3 %) came down with CDI infection after pneumonia treatment. Fifty of the 94 patients went through severe or severe and complicated CDI. The distribution of antecedent antibiotic treatment of pneumonia in these 50 patients was as follows: ceftriaxone in 14 (28 %) cases, amoxicillin with clavulanate in 9 (18 %), ciprofloxacin in 8 (16.0 %), clarithromycin in 7 (14 %), and cefuroxime and imipenem in 6 (12 %) each. The findings revealed a borderline enhancement in the proportion of deaths due to CDI in the ceftriaxone group compared with the ciprofloxacin, cefuroxime, and imipenem groups. The corollary is that ceftriaxone should be shunned in pneumonia treatment. The study demonstrates an association between the use of a specific antibiotic for pneumonia treatment and post-pneumonia mortality in patients who developed CDI.

  4. Appropriateness of antibiotic prescription for targeted therapy of infections caused by multidrug-resistant bacteria: assessment of the most common improper uses in a tertiary hospital in southern Italy.

    Science.gov (United States)

    Viceconte, Giulio; Maraolo, Alberto Enrico; Iula, Vita Dora; Catania, Maria Rosaria; Tosone, Grazia; Orlando, Raffaele

    2017-09-01

    A huge proportion of antibiotic therapies for infections caused by multidrug-resistant bacteria (MDR) are inappropriate. In this study, we described the most common causes of inappropriateness of definitive antibiotic regimes in a large university hospital in southern Italy and we evaluated the impact on microbial eradication, length of stay, 30-day readmission and mortality. We retrospectively assessed 45 patients who received a definitive antibiotic therapy after isolation of multidrug-resistant Staphylococcus aureus, Enterococcus spp., Enterobacteriaceae, Pseudomonas aeruginosa and Acinetobacter spp. strains between 2014 and 2015. From the literature, we set a series of criteria to retrospectively determine the appropriateness of the therapy. In all, 61% of the prescribed antibiotic regimes were found to be inappropriate, especially due to incorrect drug dosage. It emerged that meropenem was the antibiotic most frequently inappropriately used. In 46% of infections caused by MDR but not extended-spectrum β-lactamase-producing Enterobacteriaceae, carbapenems were inappropriately administered. Microbial eradication was achieved in 87% of the appropriate therapy group compared to 31% of the inappropriate therapy group (chi-square=6.750, p<0.027). No statistically significant association was found between inappropriate therapy and the length of stay (chi-square=3.084, p=0.101) and 30-day readmission (p=0.103). Definitive antibiotic therapy in infections caused by multidrug-resistant bacteria in a large university hospital is often inappropriate, especially due to the drug dosing regimen, particularly in the case of meropenem and colistin. This inappropriateness has a significant impact on post-treatment microbial eradication in specimens collected after antibiotic therapy.

  5. The use of systemic antibiotics in the treatment of aggressive periodontal disease.

    Science.gov (United States)

    Seiler, Joseph S; Herold, Robert W

    2005-01-01

    General dentists frequently encounter patients with aggressive periodontal disease and should be able to diagnose and manage this disease properly. Periodontal care in the absence of a comprehensive treatment plan and proper therapy can result in the rapid progression of the disease and, ultimately, tooth loss. It is important for the general dentist to diagnose, inform, and treat the periodontal patient accurately, using referral and nonsurgical, surgical, and antimicrobial/antibiotic therapy. This article provides a brief history of the classification of aggressive periodontal disease, describes the microorganisms associated with aggressive periodontal disease, discusses the selection and use of systemic antibiotics in therapy, and lists the various antibiotic regimens for treating aggressive periodontal disease.

  6. Biology of Acinetobacter baumannii: Pathogenesis, Antibiotic Resistance Mechanisms, and Prospective Treatment Options

    Science.gov (United States)

    Lee, Chang-Ro; Lee, Jung Hun; Park, Moonhee; Park, Kwang Seung; Bae, Il Kwon; Kim, Young Bae; Cha, Chang-Jun; Jeong, Byeong Chul; Lee, Sang Hee

    2017-01-01

    Acinetobacter baumannii is undoubtedly one of the most successful pathogens responsible for hospital-acquired nosocomial infections in the modern healthcare system. Due to the prevalence of infections and outbreaks caused by multi-drug resistant A. baumannii, few antibiotics are effective for treating infections caused by this pathogen. To overcome this problem, knowledge of the pathogenesis and antibiotic resistance mechanisms of A. baumannii is important. In this review, we summarize current studies on the virulence factors that contribute to A. baumannii pathogenesis, including porins, capsular polysaccharides, lipopolysaccharides, phospholipases, outer membrane vesicles, metal acquisition systems, and protein secretion systems. Mechanisms of antibiotic resistance of this organism, including acquirement of β-lactamases, up-regulation of multidrug efflux pumps, modification of aminoglycosides, permeability defects, and alteration of target sites, are also discussed. Lastly, novel prospective treatment options for infections caused by multi-drug resistant A. baumannii are summarized. PMID:28348979

  7. Treatment with Antibiotics that Interfere with Peptidoglycan Biosynthesis Inhibits Chloroplast Division in the Desmid Closterium

    Science.gov (United States)

    Matsumoto, Hiroko; Takechi, Katsuaki; Sato, Hiroshi; Takio, Susumu; Takano, Hiroyoshi

    2012-01-01

    Charophytes is a green algal group closely related to land plants. We investigated the effects of antibiotics that interfere with peptidoglycan biosynthesis on chloroplast division in the desmid Closterium peracerosum–strigosum–littorale complex. To detect cells just after division, we used colchicine, which inhibits Closterium cell elongation after division. Although normal Closterium cells had two chloroplasts before and after cell division, cells treated with ampicillin, D-cycloserine, or fosfomycin had only one chloroplast after cell division, suggesting that the cells divided without chloroplast division. The antibiotics bacitracin and vancomycin showed no obvious effect. Electron microscopic observation showed that irregular-shaped chloroplasts existed in ampicillin-treated Closterium cells. Because antibiotic treatments resulted in the appearance of long cells with irregular chloroplasts and cell death, we counted cell types in the culture. The results suggested that cells with one chloroplast appeared first and then a huge chloroplast was generated that inhibited cell division, causing elongation followed by cell death. PMID:22815801

  8. Combined treatment with the antibiotics kanamycin and streptomycin promotes the conjugation of Escherichia coli.

    Science.gov (United States)

    Zhang, Peng-Yi; Xu, Pei-Pei; Xia, Zhi-Jie; Wang, Jing; Xiong, Juan; Li, Yue-Zhong

    2013-11-01

    It is widely accepted that antibiotics provide a critical selective pressure for the horizontal transfer of antibiotic resistance between bacterial species. This study demonstrated that a combination of low doses of kanamycin and streptomycin, which inhibited the growth of recipient and donor cells, respectively, had positive effects on the transmission of the conjugation plasmids pRK2013, pSU2007, and RP4 from Escherichia coli DH5α to HB101 at their minimum inhibitory concentrations (MICs). Administration of either antibiotic alone as well as other antibiotics in combination or alone did not have this effect. Two-dimensional electrophoresis revealed that 60 proteins were downregulated and 14 proteins were upregulated in the conjugation of E. coli DH5α (pRK2013) and HB101 in the presence of kanamycin and streptomycin. Of these proteins, 64 were subsequently identified by mass spectrometry. Two antibiotic-induced genes encoding oligopeptide-binding protein (OppA) and ribose-binding protein (RbsB) were further confirmed by quantitative real-time PCR. When these genes were deleted, the number of transconjugants decreased in the same fashion as when the cells were treated with kanamycin and streptomycin. These results indicate that the process of E. coli conjugation may be promoted by combination treatment with kanamycin and streptomycin and that two proteins potentially participated in this process. © 2013 Federation of European Microbiological Societies. Published by John Wiley & Sons Ltd. All rights reserved.

  9. Antibiotic Susceptibility Profile of Aeromonas Species Isolated from Wastewater Treatment Plant

    Directory of Open Access Journals (Sweden)

    Isoken H. Igbinosa

    2012-01-01

    Full Text Available This study assessed the prevalence of antibiotic-resistant Aeromonas species isolated from Alice and Fort Beaufort wastewater treatment plant in the Eastern Cape Province of South Africa. Antibiotic susceptibility was determined using the disc diffusion method, and polymerase chain reaction (PCR assay was employed for the detection of antibiotics resistance genes. Variable susceptibilities were observed against ciprofloxacin, chloramphenicol, nalidixic acid, gentamicin, minocycline, among others. Aeromonas isolates from both locations were 100% resistant to penicillin, oxacillin, ampicillin, and vancomycin. Higher phenotypic resistance was observed in isolates from Fort Beaufort compared to isolates from Alice. Class A pse1 β-lactamase was detected in 20.8% of the isolates with a lower detection rate of 8.3% for blaTEM gene. Class 1 integron was present in 20.8% of Aeromonas isolates while class 2 integron and TetC gene were not detected in any isolate. The antibiotic resistance phenotypes observed in the isolates and the presence of β-lactamases genes detected in some isolates are of clinical and public health concern as this has consequences for antimicrobial chemotherapy of infections associated with Aeromonas species. This study further supports wastewater as potential reservoirs of antibiotic resistance determinants in the environment.

  10. Nanostructured platforms for the sustained and local delivery of antibiotics in the treatment of osteomyelitis.

    Science.gov (United States)

    Uskokovic, Vuk

    2015-01-01

    This article provides a critical view of the current state of the development of nanoparticulate and other solid-state carriers for the local delivery of antibiotics in the treatment of osteomyelitis. Mentioned are the downsides of traditional means for treating bone infection, which involve systemic administration of antibiotics and surgical debridement, along with the rather imperfect local delivery options currently available in the clinic. Envisaged are more sophisticated carriers for the local and sustained delivery of antimicrobials, including bioresorbable polymeric, collagenous, liquid crystalline, and bioglass- and nanotube-based carriers, as well as those composed of calcium phosphate, the mineral component of bone and teeth. A special emphasis is placed on composite multifunctional antibiotic carriers of a nanoparticulate nature and on their ability to induce osteogenesis of hard tissues demineralized due to disease. An ideal carrier of this type would prevent the long-term, repetitive, and systemic administration of antibiotics and either minimize or completely eliminate the need for surgical debridement of necrotic tissue. Potential problems faced by even hypothetically "perfect" antibiotic delivery vehicles are mentioned too, including (i) intracellular bacterial colonies involved in recurrent, chronic osteomyelitis; (ii) the need for mechanical and release properties to be adjusted to the area of surgical placement; (iii) different environments in which in vitro and in vivo testings are carried out; (iv) unpredictable synergies between drug delivery system components; and (v) experimental sensitivity issues entailing the increasing subtlety of the design of nanoplatforms for the controlled delivery of therapeutics.

  11. Evaluating the vulnerability of surface waters to antibiotic contamination from varying wastewater treatment plant discharges

    International Nuclear Information System (INIS)

    Batt, Angela L.; Bruce, Ian B.; Aga, Diana S.

    2006-01-01

    Effluents from three wastewater treatment plants with varying wastewater treatment technologies and design were analyzed for six antibiotics and caffeine on three sampling occasions. Sulfamethoxazole, trimethoprim, ciprofloxacin, tetracycline, and clindamycin were detected in the effluents at concentrations ranging from 0.090 to 6.0 μg/L. Caffeine was detected in all effluents at concentrations ranging from 0.19 to 9.9 μg/L. These findings indicate that several conventional wastewater management practices are not effective in the complete removal of antibiotics, and their discharges have a large potential to affect the aquatic environment. To evaluate the persistence of antibiotics coming from the wastewater discharges on the surrounding surface waters, samples were collected from the receiving streams at 10-, 20- and 100-m intervals. Ciprofloxacin, sulfamethoxazole, and clindamycin (0.043 to 0.076 μg/L) were found as far as 100 m from the discharge point, which indicates the persistence of these drugs in surface waters. - This work investigates the extent of antibiotic concentrations in receiving waters from discharges of wastewater treatment plants

  12. [Antibiotics for treatment of infections by methicillin-resistant Staphylococcus aureus (MRSA)].

    Science.gov (United States)

    Stahlmann, R

    2014-10-01

    Over the last 50 years methicillin-resistant S. aureus (MRSA) spread globally. Vancomycin is still the most recommended antibiotic for MRSA-infections. Teicoplanin is an alternative glycopeptide with longer elimination half-life. Telavancin is a more recently developed derivative of vancomycin with similar clinical efficacy as vancomycin. It is not recommended for treatment of patients with renal insufficiency. Nephrotoxicity limits the therapeutic use of glycopeptide antibiotics. The oxazolidinone linezolid exhibits similar to superior therapeutic efficacy. Hematologic controls are necessary during treatment with this antibacterial agent. Neurotoxic effects have been observed mainly in patients who received prolonged linezolid treatment. Attention must be paid to possible interactions with concomitantly given drugs acting on the serotonergic system. New therapeutic options arise with ceftaroline, the first β-lactam antibiotic with activity against MRSA. However, controlled clinical trials with pulmonary MRSA infections have not been conducted with ceftaroline. Daptomycin, a lipopeptide, and tigecycline, a glycylcyclin are active in vitro against MRSA as well, but are also not indicated in pulmonary MRSA infections. These antibiotics show in an exemplary manner that antibacterial activity in vitro is an important prerequisite, but relevant data for a therapeutic decision should be derived from randomized controlled clinical double-blind trials. © Georg Thieme Verlag KG Stuttgart · New York.

  13. Combination Antibiotics as a Treatment for Chronic Chlamydia-Induced Reactive Arthritis

    Science.gov (United States)

    Carter, JD; Espinoza, LR; Inman, RD; Sneed, KB; Ricca, LR; Vasey, FB; Valeriano, J; Stanich, JA; Oszust, C; Gerard, HC; Hudson, AP

    2010-01-01

    Background Chlamydia trachomatis (Ct) and Chlamydophila (Chlamydia) pneumoniae (Cpn) are known triggers of reactive arthritis (ReA). These chlamydial species exist in a persistent metabolically active infection state in the synovium suggesting that persistent chlamydiae may be susceptible to antimicrobial agents. The goal of this study was to investigate whether a six-month course of combination antibiotics is an effective therapy for patients with chronic Chlamydia-induced ReA. Methods This study was a 9-month, double-blind, triple-dummy prospective trial assessing a 6-month course of combination antibiotics as a treatment for Chlamydia-induced ReA. Eligible patients were age 18 to 70 years, fulfilled the European Spondyloarthropathy Study Group (ESSG) Criteria, and had disease duration equal to or longer than 6 months. Subjects had to be polymerase chain reaction (PCR)-positive for Ct or Cpn in order to be randomized to therapy; randomization was performed in a 1:1:1 fashion. Treatment was for 6 months; the 3 groups included doxycycline 100mg twice daily and rifampin 300mg daily, azithromycin 500mg daily × 5 days then twice weekly and rifampin 300mg daily, or matching placebos. The primary efficacy endpoint was to assess the number of responders in the combination antibiotic group vs. placebo at month 6 compared to baseline. Responders were defined as those subjects who improved 20% or more in at least 4 of 6 variables without worsening in any one variable. Results 80 subjects were screened and 42 were randomized to treatment (27 to combination antibiotics and 15 to placebo). Subjects in each group had similar demographics and baseline characteristics. At month 6, 17/27 subjects (63%) randomized to combination antibiotics were responders compared to 3/15 (20%) on placebo (P-value = 0.01). Secondary efficacy endpoints showed similar results with significant improvement in the modified swollen joint count, tender joint count, physician global assessment (P

  14. Antibiotics with anaerobic ammonium oxidation in urban wastewater treatment

    Science.gov (United States)

    Zhou, Ruipeng; Yang, Yuanming

    2017-05-01

    Biofilter process is based on biological oxidation process on the introduction of fast water filter design ideas generated by an integrated filtration, adsorption and biological role of aerobic wastewater treatment process various purification processes. By engineering example, we show that the process is an ideal sewage and industrial wastewater treatment process of low concentration. Anaerobic ammonia oxidation process because of its advantage of the high efficiency and low consumption, wastewater biological denitrification field has broad application prospects. The process in practical wastewater treatment at home and abroad has become a hot spot. In this paper, anammox bacteria habitats and species diversity, and anaerobic ammonium oxidation process in the form of diversity, and one and split the process operating conditions are compared, focusing on a review of the anammox process technology various types of wastewater laboratory research and engineering applications, including general water quality and pressure filtrate sludge digestion, landfill leachate, aquaculture wastewater, monosodium glutamate wastewater, wastewater, sewage, fecal sewage, waste water salinity wastewater characteristics, research progress and application of the obstacles. Finally, we summarize the anaerobic ammonium oxidation process potential problems during the processing of the actual waste water, and proposed future research focus on in-depth study of water quality anammox obstacle factor and its regulatory policy, and vigorously develop on this basis, and combined process optimization.

  15. Assessing time to pulmonary function benefit following antibiotic treatment of acute cystic fibrosis exacerbations

    Directory of Open Access Journals (Sweden)

    O'Riordan Mary A

    2010-10-01

    Full Text Available Abstract Background Cystic Fibrosis (CF is a life-shortening genetic disease in which ~80% of deaths result from loss of lung function linked to inflammation due to chronic bacterial infection (principally Pseudomonas aeruginosa. Pulmonary exacerbations (intermittent episodes during which symptoms of lung infection increase and lung function decreases can cause substantial resource utilization, morbidity, and irreversible loss of lung function. Intravenous antibiotic treatment to reduce exacerbation symptoms is standard management practice. However, no prospective studies have identified an optimal antibiotic treatment duration and this lack of objective data has been identified as an area of concern and interest. Methods We have retrospectively analyzed pulmonary function response data (as forced expiratory volume in one second; FEV1 from a previous blinded controlled CF exacerbation management study of intravenous ceftazidime/tobramycin and meropenem/tobramycin in which spirometry was conducted daily to assess the time course of pulmonary function response. Results Ninety-five patients in the study received antibiotics for at least 4 days and were included in our analyses. Patients received antibiotics for an average of 12.6 days (median = 13, SD = 3.2 days, with a range of 4 to 27 days. No significant differences were observed in mean or median treatment durations as functions of either treatment group or baseline lung disease stage. Average time from initiation of antibiotic treatment to highest observed FEV1 was 8.7 days (median = 10, SD = 4.0 days, with a range of zero to 19 days. Patients were treated an average of 3.9 days beyond the day of peak FEV1 (median = 3, SD = 3.8 days, with 89 patients (93.7% experiencing their peak FEV1 improvement within 13 days. There were no differences in mean or median times to peak FEV1 as a function of treatment group, although the magnitude of FEV1 improvement differed between groups. Conclusions Our

  16. An Official ATS/AACN/ACCP/ESICM/SCCM Policy Statement : Responding to Requests for Potentially Inappropriate Treatments in Intensive Care Units

    NARCIS (Netherlands)

    Bosslet, Gabriel T.; Pope, Thaddeus M.; Rubenfeld, Gordon D.; Lo, Bernard; Truog, Robert D.; Rushton, Cynda H.; Curtis, J. Randall; Ford, Dee W.; Osborne, Molly; Misak, Cheryl; Au, David H.; Azoulay, Elie; Brody, Baruch; Fahy, Brenda G.; Hall, Jesse B.; Kesecioglu, Jozef; Kon, Alexander A.; Lindell, Kathleen O.; White, Douglas B.

    2015-01-01

    Background: There is controversy about how to manage requests by patients or surrogates for treatments that clinicians believe should not be administered. Purpose: This multisociety statementprovides recommendations to prevent and manage intractable disagreements about the use of such treatments in

  17. Combination antibiotic therapy for the treatment of infective endocarditis due to enterococci.

    Science.gov (United States)

    Leone, Sebastiano; Noviello, Silvana; Esposito, Silvano

    2016-06-01

    Enterococci are common causes of infective endocarditis (IE) in both health care and community-based setting. Enterococcal IE requires bactericidal therapy for an optimal outcome. For decades, cell-wall-active antimicrobial agents (penicillins or vancomycin) in combination with aminoglycosides were the cornerstone of the treatment; however, the emergence of antibiotic resistance has significantly reduced the efficacy of these regimens. Data for this review were identified by searches of MEDLINE and references from relevant articles on antibiotic combination regimens for the treatment of enterococcal IE. Abstracts presented in scientific conferences were not searched for. New effective and safe combination treatments, including double-β-lactam and daptomycin/β-lactam combination, are proving useful for the management of IE due to enterococci.

  18. Incidence, risk factors and treatment of diarrhoea among Dutch travellers: reasons not to routinely prescribe antibiotics.

    Science.gov (United States)

    Belderok, Sanne-Meike; van den Hoek, Anneke; Kint, Joan A; Schim van der Loeff, Maarten F; Sonder, Gerard Jb

    2011-10-29

    Travellers' diarrhoea (TD) is the most common infectious disease among travellers. In the Netherlands, stand-by or prophylactic antibiotics are not routinely prescribed to travellers. This study prospectively assessed the incidence rate, risk factors, and treatment of TD among immunocompetent travellers. Persons who attended the travel clinic of the Public Health Service Amsterdam in 2006-2007 before short-term travel to tropical and subtropical countries were invited to answer a questionnaire regarding sociodemographics and travel purpose; they were also asked to keep a daily structured travel diary, recording their itinerary, symptoms, and self-medication or consultation with a doctor. Diarrhoea episodes containing blood or mucous were considered severe. Of 1202 travellers, the median age was 38 years, and the median travel duration 3 weeks. Of all episodes, 96% were mild. The median duration of TD was 2 days and significantly shorter in subsequent episodes compared to first episodes (p sex, a Western country of birth, and tourism as the purpose of travel. The lowest risk was in travellers to South America. An independent risk factor for subsequent episodes was female sex. In total, 5% of travellers used antibiotics; of those, 92% had mild diarrhoea, and 53% received antibiotics over the counter. TD is common among travellers, but the overall course is mild, not requiring treatment. The incidence rates for first and second episodes are comparable. Female sex is a risk factor for the first episode, as well as subsequent ones. Prescription antibiotics are not needed in short-term healthy travellers.

  19. Ulcer pain in patients with venous leg ulcers related to antibiotic treatment and compression therapy.

    Science.gov (United States)

    Akesson, Nina; Oien, Rut Frank; Forssell, Henrik; Fagerström, Cecilia

    2014-09-01

    The aim of this study was to compare venous leg ulcer patients with and without ulcer pain to see whether ulcer pain affected the use of antibiotic treatment and compression therapy throughout healing. A total of 431 patients with venous leg ulcers were included during the study period. Every patient was registered in a national quality registry for patients with hard-to-heal leg, foot, and pressure ulcers. A high incidence of ulcer pain (57%) was found when the patients entered the study. Patients with ulcer pain had been treated more extensively with antibiotics both before and during the study period. Throughout healing there was a significant reduction of antibiotic use among patients in the 'no pain' group, from 44% to 23% (P=0.008). There was no significant difference between the two groups concerning compression therapy (85% vs. 88%), but 12% of patients in the 'pain' group did not get their prescribed compression compared with 6% of patients in the 'no pain' group. The groups did not differ significantly in terms of ulcer duration, ulcer size or healing time. This study shows a high incidence of ulcer pain, confirming that pain has a great impact on patients with venous leg ulcers. Results further suggest that the presence of ulcer pain increases the prescription of antibiotics but does not affect the use of compression therapy. Several advantages were found from using a national quality registry. The registry is a valuable clinical tool showing the importance of accurate diagnosis and effective treatment.

  20. Impact of extensive antibiotic treatment on faecal carriage of antibiotic-resistant enterobacteria in children in a low resistance prevalence setting.

    Science.gov (United States)

    Knudsen, Per Kristian; Brandtzaeg, Petter; Høiby, E Arne; Bohlin, Jon; Samuelsen, Ørjan; Steinbakk, Martin; Abrahamsen, Tore G; Müller, Fredrik; Gammelsrud, Karianne Wiger

    2017-01-01

    We prospectively studied the consequences of extensive antibiotic treatment on faecal carriage of antibiotic-resistant enterobacteria in a cohort of children with cystic fibrosis (CF) and a cohort of children with cancer compared to healthy children with no or low antibiotic exposure. The study was conducted in Norway in a low resistance prevalence setting. Sixty longitudinally collected faecal samples from children with CF (n = 32), 88 samples from children with cancer (n = 45) and 127 samples from healthy children (n = 70) were examined. A direct MIC-gradient strip method was used to detect resistant Enterobacteriaceae by applying Etest strips directly onto agar-plates swabbed with faecal samples. Whole genome sequencing (WGS) data were analysed to identify resistance mechanisms in 28 multidrug-resistant Escherichia coli isolates. The prevalence of resistance to third-generation cephalosporins, gentamicin and ciprofloxacin was low in all the study groups. At inclusion the prevalence of ampicillin-resistant E. coli and trimethoprim-sulfamethoxazole-resistant E. coli in the CF group compared to healthy controls was 58.6% vs. 28.4% (p = 0.005) and 48.3% vs. 14.9% (p = 0.001), respectively, with a similar prevalence at the end of the study. The prevalence of resistant enterobacteria was not significantly different in the children with cancer compared to the healthy children, not even at the end of the study when the children with cancer had been treated with repeated courses of broad-spectrum antibiotics. Children with cancer were mainly treated with intravenous antibiotics, while the CF group mainly received peroral treatment. Our observations indicate that the mode of administration of antibiotics and the general level of antimicrobial resistance in the community may have an impact on emergence of resistance in intestinal enterobacteria during antibiotic treatment. The WGS analyses detected acquired resistance genes and/or chromosomal mutations that explained the

  1. Impact of extensive antibiotic treatment on faecal carriage of antibiotic-resistant enterobacteria in children in a low resistance prevalence setting

    Science.gov (United States)

    Brandtzaeg, Petter; Høiby, E. Arne; Bohlin, Jon; Samuelsen, Ørjan; Steinbakk, Martin; Abrahamsen, Tore G.; Müller, Fredrik; Gammelsrud, Karianne Wiger

    2017-01-01

    We prospectively studied the consequences of extensive antibiotic treatment on faecal carriage of antibiotic-resistant enterobacteria in a cohort of children with cystic fibrosis (CF) and a cohort of children with cancer compared to healthy children with no or low antibiotic exposure. The study was conducted in Norway in a low resistance prevalence setting. Sixty longitudinally collected faecal samples from children with CF (n = 32), 88 samples from children with cancer (n = 45) and 127 samples from healthy children (n = 70) were examined. A direct MIC-gradient strip method was used to detect resistant Enterobacteriaceae by applying Etest strips directly onto agar-plates swabbed with faecal samples. Whole genome sequencing (WGS) data were analysed to identify resistance mechanisms in 28 multidrug-resistant Escherichia coli isolates. The prevalence of resistance to third-generation cephalosporins, gentamicin and ciprofloxacin was low in all the study groups. At inclusion the prevalence of ampicillin-resistant E. coli and trimethoprim-sulfamethoxazole-resistant E. coli in the CF group compared to healthy controls was 58.6% vs. 28.4% (p = 0.005) and 48.3% vs. 14.9% (p = 0.001), respectively, with a similar prevalence at the end of the study. The prevalence of resistant enterobacteria was not significantly different in the children with cancer compared to the healthy children, not even at the end of the study when the children with cancer had been treated with repeated courses of broad-spectrum antibiotics. Children with cancer were mainly treated with intravenous antibiotics, while the CF group mainly received peroral treatment. Our observations indicate that the mode of administration of antibiotics and the general level of antimicrobial resistance in the community may have an impact on emergence of resistance in intestinal enterobacteria during antibiotic treatment. The WGS analyses detected acquired resistance genes and/or chromosomal mutations that explained the

  2. Seasonality of antibiotic prescriptions for outpatients and resistance genes in sewers and wastewater treatment plant outflow.

    Science.gov (United States)

    Caucci, Serena; Karkman, Antti; Cacace, Damiano; Rybicki, Marcus; Timpel, Patrick; Voolaid, Veiko; Gurke, Robert; Virta, Marko; Berendonk, Thomas U

    2016-05-01

    To test the hypothesis of a seasonal relationship of antibiotic prescriptions for outpatients and the abundance of antibiotic resistance genes (ARGs) in the wastewater, we investigated the distribution of prescriptions and different ARGs in the Dresden sewer system and wastewater treatment plant during a two-year sampling campaign. Based on quantitative PCR (qPCR), our results show a clear seasonal pattern for relative ARGs abundances. The higher ARGs levels in autumn and winter coincide with the higher rates of overall antibiotic prescriptions. While no significant differences of relative abundances were observed before and after the wastewater treatment for most of the relative ARGs, the treatment clearly influenced the microbial community composition and abundance. This indicates that the ARGs are probably not part of the dominant bacterial taxa, which are mainly influenced by the wastewater treatment processes, or that plasmid carrying bacteria remain constant, while plasmid free bacteria decrease. An exception was vancomycin (vanA), showing higher relative abundance in treated wastewater. It is likely that a positive selection or community changes during wastewater treatment lead to an enrichment of vanA. Our results demonstrate that in a medium-term study the combination of qPCR and next generation sequencing corroborated by drug-related health data is a suitable approach to characterize seasonal changes of ARGs in wastewater and treated wastewater. © FEMS 2016. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  3. A novel method for imaging the pharmacological effects of antibiotic treatment on Clostridium difficile.

    Science.gov (United States)

    Endres, Bradley T; Bassères, Eugénie; Memariani, Ali; Chang, Long; Alam, M Jahangir; Vickers, Richard J; Kakadiaris, Ioannis A; Garey, Kevin W

    2016-08-01

    Clostridium difficile is a significant cause of nosocomial-acquired infection that results in severe diarrhea and can lead to mortality. Treatment options for C. difficile infection (CDI) are limited, however, new antibiotics are being developed. Current methods for determining efficacy of experimental antibiotics on C. difficile involve antibiotic killing rates and do not give insight into the drug's pharmacologic effects. Considering this, we hypothesized that by using scanning electron microscopy (SEM) in tandem to drug killing curves, we would be able to determine efficacy and visualize the phenotypic response to drug treatment. To test this hypothesis, supraMIC kill curves were conducted using vancomycin, metronidazole, fidaxomicin, and ridinilazole. Following collection, cells were either plated or imaged using a scanning electron microscope (SEM). Consistent with previous reports, we found that the tested antibiotics had significant bactericidal activity at supraMIC concentrations. By SEM imaging and using a semi-automatic pipeline for image analysis, we were able to determine that vancomycin and to a lesser extent fidaxomicin and ridinilazole significantly affected the cell wall, whereas metronidazole, fidaxomicin, and ridinilazole had significant effects on cell length suggesting a metabolic effect. While the phenotypic response to drug treatment has not been documented previously in this manner, the results observed are consistent with the drug's mechanism of action. These techniques demonstrate the versatility and reliability of imaging and measurements that could be applied to other experimental compounds. We believe the strategies laid out here are vital for characterizing new antibiotics in development for treating CDI. Copyright © 2016 Elsevier Ltd. All rights reserved.

  4. Resource Competition May Lead to Effective Treatment of Antibiotic Resistant Infections

    Science.gov (United States)

    Gomes, Antonio L. C.; Galagan, James E.; Segrè, Daniel

    2013-01-01

    Drug resistance is a common problem in the fight against infectious diseases. Recent studies have shown conditions (which we call antiR) that select against resistant strains. However, no specific drug administration strategies based on this property exist yet. Here, we mathematically compare growth of resistant versus sensitive strains under different treatments (no drugs, antibiotic, and antiR), and show how a precisely timed combination of treatments may help defeat resistant strains. Our analysis is based on a previously developed model of infection and immunity in which a costly plasmid confers antibiotic resistance. As expected, antibiotic treatment increases the frequency of the resistant strain, while the plasmid cost causes a reduction of resistance in the absence of antibiotic selection. Our analysis suggests that this reduction occurs under competition for limited resources. Based on this model, we estimate treatment schedules that would lead to a complete elimination of both sensitive and resistant strains. In particular, we derive an analytical expression for the rate of resistance loss, and hence for the time necessary to turn a resistant infection into sensitive (tclear). This time depends on the experimentally measurable rates of pathogen division, growth and plasmid loss. Finally, we estimated tclear for a specific case, using available empirical data, and found that resistance may be lost up to 15 times faster under antiR treatment when compared to a no treatment regime. This strategy may be particularly suitable to treat chronic infection. Finally, our analysis suggests that accounting explicitly for a resistance-decaying rate may drastically change predicted outcomes in host-population models. PMID:24349015

  5. Wastewater treatment plants as a hub between clinical and environmental antibiotic resistance

    Directory of Open Access Journals (Sweden)

    Norbert Kreuzinger

    2015-03-01

    Full Text Available Antibiotics (AB are among the most important pharmaceuticals applied in both, human and veterinarian medicine. As long as their use, concerns about an increase in resistance (ABR of originally targeted organisms exist. Within the last few years the significance of wastewater treatment plants and the release of antibiotic resistant bacteria (ARB or genes (ARG by discharged effluents got into the focus of scientific research. Within a wastewater treatment plant there are two specific conditions that could induce transfer of ARGs and selection of ARBs: • Low concentrations of antibiotics that are far below a therapeutically dose and can act as selection parameter for ABR • Living or dead resistant clinically relevant bacteria that can transfer their ARGs via different means to environmental bacteria that are adapted to usual environmental conditions and therefore can transfer ARGs to the gene pool of the aquatic environment Both aspects can be demonstrated by applying the concept of the “mutant selection window” to wastewater treatment plants that implies that between a miniumum inhibitory concentration (MIC and a higher mutant prevention concentration (MPC there is a concentration range where an antibiotic has an effect on the selection of ARBs. The pathway of resistance back from the environment to the human is not clear now and hardly investigated. As awareness ARBs and ARGs by wastewater treatment plants is there now, engineers are about to adopt existing treatment technologies for decreasing the release and are designing new technologies that even are able to inhibit their release to the aquatic environment.

  6. Removal of antibiotics from wastewater by sewage treatment facilities in Hong Kong and Shenzhen, China.

    Science.gov (United States)

    Gulkowska, A; Leung, H W; So, M K; Taniyasu, S; Yamashita, N; Yeung, Leo W Y; Richardson, Bruce J; Lei, A P; Giesy, J P; Lam, Paul K S

    2008-01-01

    Concentrations of nine antibiotics [erythromycin-H(2)O (ERY-H(2)O); trimethoprim (TMP); tetracycline (TET); norfloxacin (NOR); penicillin G (PEN G); penicillin V (PEN V); cefalexin (CLX); cefotaxim (CTX); and cefazolin (CFZ)] were measured in influent and effluent samples from four sewage treatment plants (STPs) in Hong Kong as well as in influent samples from one STP in Shenzhen. Levels of PEN V and CFZ were below method detection limits in all of the samples analyzed. CLX concentrations were the highest in most of the Hong Kong samples, ranging from 670 to 2900 ng/L and 240 to 1800 ng/L in influent and effluent samples, respectively, but CLX was not detected in the samples from Shenzhen. Comparatively lower concentrations were observed for ERY-H(2)O (470-810 ng/L) and TET (96-1300 ng/L) in the influent samples from all STPs in Hong Kong. CTX was found to be the dominant antibiotic in the Shenzhen STP influents with a mean concentration of 1100 ng/L, but occurred at lower concentrations in Hong Kong sewage. These results likely reflect regional variations in the prescription and use patterns of antibiotics between Hong Kong and Shenzhen. Antibiotic removal efficiencies depended on their chemical properties and the wastewater treatment processes used. In general, relatively higher removal efficiencies were observed for NOR (5-78%) and TET (7-73%), which are readily adsorbed to particulate matter, while lower removal efficiencies were observed for ERY-H(2)O (9-19%), which is relatively persistent in the environment. Antibiotics were removed more efficiently at Hong Kong STPs employing secondary treatment processes compared with those using primary treatment only. Concentrations of NOR measured in effluents from STPs in Hong Kong were lower than the predicted no-effect concentration of 8000 ng/L determined in a previous study. Therefore, concentrations of antibiotics measured in this preliminary study would be unlikely to cause adverse effects on microorganisms used

  7. The agricultural use of water treatment plant sludge: pathogens and antibiotic resistance

    Directory of Open Access Journals (Sweden)

    Ignacio Nadal Rocamora

    2015-12-01

    Full Text Available The use of water treatment plant sludge to restore degraded soils is customary agricultural practice, but it could be dangerous from the point of view of both health and the environment. A transient increase of either pathogenic or indicator microbial populations, whose persistence in time is variable and attributed to the characteristics of the soil (types of materials in the soil, any amendments (origin and treatments it has undergone or the weather (humidity and temperature mainly, has often been detected in soils treated with this kind of waste. Given their origin, water treatment plant sludges could lead to the transmission of a pathogens and b antibiotic-resistant microorganisms to human beings through the food chain and cause the spreading of antibiotic resistances as a result of their increase and persistence in the soil for variable periods of time. However, Spanish legislation regulating the use of sludges in the farming industry is based on a very restricted microbiological criterion. Thus, we believe better parameters should be established to appropriately inform of the state of health of soils treated with water treatment plant sludge, including aspects which are not presently assessed such as antibiotic resistance.

  8. Working Together to Define Antibiotic Appropriateness: Point Prevalence Survey in 47 Intensive Care Units from 12 US Hospitals, Partnership for Quality Care, March 2017

    Science.gov (United States)

    Trivedi, Kavita K; Ostrowsky, Belinda; Abbo, Lilian M; Srinivasan, Arjun; Bartash, Rachel; Cassera, Fred; Fleisher, Jorge; Kubiak, David W; Letourneau, Alyssa R; Nori, Priya; Parodi, Stephen; Aragon, Laura; Dollard, Eliza; Gagliardo, Christina; Ghitan, Monica; Giles, Amber; Mayer, Suri; Quevedo, Jennifer; Rieg, Gunter; Shteyman, Galina; Vargas, Jaclyn; Kelley, Shannon; Silver, Phyllis

    2017-01-01

    Abstract Background A national assessment of antibiotic appropriateness in intensive care units (ICUs) with benchmarking was performed to assist antibiotic stewardship programs (ASPs) identify improvement opportunities. Methods A Centers for Disease Control and Prevention tool was adapted by an expert panel from the Partnership for Quality Care (PQC), a coalition dedicated to high quality care in US hospitals, to validate appropriate antibiotic use measurement via a point prevalence survey on a single day. Data were collected by ASP personnel at each hospital, de-identified and submitted in aggregate to PQC for benchmarking. Hospitals identified reasons for inappropriate antibiotic use by category and antibiotics misused. Results Forty-seven ICUs from 12 PQC hospitals participated: California (2), Florida (2), Massachusetts (3), Minnesota (1), and New York (4). Most hospitals identified as teaching (83%) with 252-1550 bed size (median: 563) and 20–270 licensed ICU beds (median: 70). All hospitals reported a formal ASP. On March 1, 2017, 362 (54%) of 667 patients in participating ICUs were on antibiotics (range: 8-81 patients); 1 patient was not assessed. Of the remaining 361 antibiotic regimens, 112 (31%) were identified as inappropriate from among all 12 hospitals (range: 9-82%) (figure). The table displays inappropriate antibiotic use by ICU type. Reasons for inappropriate use included unnecessarily broad spectrum of activity (29%), duration longer than necessary (21%), and treatment of a non-infectious syndrome (19%). The antibiotic most commonly misused was vancomycin in 7 (58%) hospitals. Conclusion Up to 80% of antibiotic use in some ICUs is inappropriate, underscoring the need for ASP interventions, standardized assessment tools and benchmarking. Strategies should focus on de-escalation of broad-spectrum antibiotics and reducing duration of therapy. Disclosures D. W. Kubiak, Shionogi: Consultant, Consulting fee. Astellas Pharma: Consultant, Consulting

  9. Early investigational antibiotics for the treatment of acute exacerbations of chronic bronchitis.

    Science.gov (United States)

    Falagas, Matthew E; Georgiou, Maria

    2017-03-01

    Acute exacerbations in patients with chronic bronchitis are a leading cause of hospitalizations and death. Bacteria contribute significantly to such exacerbations. The aim of this review was to explore the potential role of investigational antibiotics in the treatment of these episodes. Areas covered: The available literature in PubMed database, in websites related to investigational drugs and in websites of the producing companies has been searched. The in vitro activity against pathogens involved in acute exacerbations of chronic bronchitis and the pharmacokinetic profile of antibiotics currently under development were taken into consideration for inclusion in the review. Expert opinion: Several novel antimicrobial agents have completed preclinical and Phase I studies and were well-tolerated. Further investigation is mandatory in order to evaluate their future in treatment of chronic bronchitis exacerbations and discover potential advantages compared to already approved antimicrobials.

  10. Fidaxomicin: a minimally absorbed macrocyclic antibiotic for the treatment of Clostridium difficile infections.

    Science.gov (United States)

    Soriano, Melinda M; Liao, Siyun; Danziger, Larry H

    2013-08-01

    Fidaxomicin was approved for the treatment of Clostridium difficile infections in 2011. It has a novel mechanism of action and narrow spectrum of activity that makes it unique among the currently used therapies for this disease. Phase III clinical studies demonstrated a benefit of fidaxomicin over vancomycin for the outcomes of recurrence and global cure or sustained clinical response. This observation was confirmed within specific populations, including those of older age, immunocompromised due to active cancers, and patients taking concomitant antibiotics. Additionally, fidaxomicin significantly reduced recurrence rates compared to vancomycin among patients receiving treatment for recurrent C. difficile episodes. Fidaxomicin represents an advance in therapy for the treatment of C. difficile infections.

  11. Sustained release of antibiotic complexed by multivalent ion: in vitro and in vivo study for the treatment of peritonitis.

    Science.gov (United States)

    Na, Seung Yeon; Oh, Se Heang; Kim, Tae Ho; Yoon, Jin A; Lee, In Soo; Lee, Jin Ho

    2014-12-10

    The main aims of this study are (i) the development of an antibiotic complexed with multivalent ion, which can allow sustained release of the antibiotic without any additional matrix or difficult process and (ii) the feasibility study of the ion-complexed antibiotic as a therapeutic technique for peritonitis treatment. An ion-complexed antibiotic is prepared by simple mixing of two aqueous solutions containing an ionized (water-soluble) drug (tetracycline) and a multivalent counter ionic compound. The ion-complexed antibiotic shows a continuous release of the antibiotic up to 21 days, and thus prolonged anti-bacterial effect by gradual ionic exchange between the multivalent ions in the complex and same-charged monovalent ions in surrounding medium. From the in vivo animal study using a cecum perforated peritonitis mouse model, the ion-complexed antibiotic group shows sufficient anti-bacterial effect and thus effectively treat the peritonitis because of the extermination of the contaminated enteric bacteria in the peritoneum during wound healing of injury cecum (by the sustained release of antibiotic from the ion complex). These results suggest that the ion-complexed antibiotic system may be promising for the effective treatment of the peritonitis caused by frequent gastrointestinal defect in clinical fields. Copyright © 2014 Elsevier B.V. All rights reserved.

  12. Metagenomic profiling of antibiotic resistance genes and mobile genetic elements in a tannery wastewater treatment plant.

    Directory of Open Access Journals (Sweden)

    Zhu Wang

    Full Text Available Antibiotics are often used to prevent sickness and improve production in animal agriculture, and the residues in animal bodies may enter tannery wastewater during leather production. This study aimed to use Illumina high-throughput sequencing to investigate the occurrence, diversity and abundance of antibiotic resistance genes (ARGs and mobile genetic elements (MGEs in aerobic and anaerobic sludge of a full-scale tannery wastewater treatment plant (WWTP. Metagenomic analysis showed that Proteobacteria, Firmicutes, Bacteroidetes and Actinobacteria dominated in the WWTP, but the relative abundance of archaea in anaerobic sludge was higher than in aerobic sludge. Sequencing reads from aerobic and anaerobic sludge revealed differences in the abundance of functional genes between both microbial communities. Genes coding for antibiotic resistance were identified in both communities. BLAST analysis against Antibiotic Resistance Genes Database (ARDB further revealed that aerobic and anaerobic sludge contained various ARGs with high abundance, among which sulfonamide resistance gene sul1 had the highest abundance, occupying over 20% of the total ARGs reads. Tetracycline resistance genes (tet were highly rich in the anaerobic sludge, among which tet33 had the highest abundance, but was absent in aerobic sludge. Over 70 types of insertion sequences were detected in each sludge sample, and class 1 integrase genes were prevalent in the WWTP. The results highlighted prevalence of ARGs and MGEs in tannery WWTPs, which may deserve more public health concerns.

  13. Metagenomic profiling of antibiotic resistance genes and mobile genetic elements in a tannery wastewater treatment plant.

    Science.gov (United States)

    Wang, Zhu; Zhang, Xu-Xiang; Huang, Kailong; Miao, Yu; Shi, Peng; Liu, Bo; Long, Chao; Li, Aimin

    2013-01-01

    Antibiotics are often used to prevent sickness and improve production in animal agriculture, and the residues in animal bodies may enter tannery wastewater during leather production. This study aimed to use Illumina high-throughput sequencing to investigate the occurrence, diversity and abundance of antibiotic resistance genes (ARGs) and mobile genetic elements (MGEs) in aerobic and anaerobic sludge of a full-scale tannery wastewater treatment plant (WWTP). Metagenomic analysis showed that Proteobacteria, Firmicutes, Bacteroidetes and Actinobacteria dominated in the WWTP, but the relative abundance of archaea in anaerobic sludge was higher than in aerobic sludge. Sequencing reads from aerobic and anaerobic sludge revealed differences in the abundance of functional genes between both microbial communities. Genes coding for antibiotic resistance were identified in both communities. BLAST analysis against Antibiotic Resistance Genes Database (ARDB) further revealed that aerobic and anaerobic sludge contained various ARGs with high abundance, among which sulfonamide resistance gene sul1 had the highest abundance, occupying over 20% of the total ARGs reads. Tetracycline resistance genes (tet) were highly rich in the anaerobic sludge, among which tet33 had the highest abundance, but was absent in aerobic sludge. Over 70 types of insertion sequences were detected in each sludge sample, and class 1 integrase genes were prevalent in the WWTP. The results highlighted prevalence of ARGs and MGEs in tannery WWTPs, which may deserve more public health concerns.

  14. Metagenomic analysis reveals wastewater treatment plants as hotspots of antibiotic resistance genes and mobile genetic elements.

    Science.gov (United States)

    Guo, Jianhua; Li, Jie; Chen, Hui; Bond, Philip L; Yuan, Zhiguo

    2017-10-15

    The intensive use of antibiotics results in their continuous release into the environment and the subsequent widespread occurrence of antibiotic resistant bacteria (ARB), antibiotic resistance genes (ARGs) and mobile genetic elements (MGEs). This study used Illumina high-throughput sequencing to investigate the broad-spectrum profiles of both ARGs and MGEs in activated sludge and anaerobically digested sludge from a full-scale wastewater treatment plant. A pipeline for identifying antibiotic resistance determinants was developed that consisted of four categories: gene transfer potential, ARG potential, ARGs pathway and ARGs phylogenetic origin. The metagenomic analysis showed that the activated sludge and the digested sludge exhibited different microbial communities and changes in the types and occurrence of ARGs and MGEs. In total, 42 ARGs subtypes were identified in the activated sludge, while 51 ARG subtypes were detected in the digested sludge. Additionally, MGEs including plasmids, transposons, integrons (intI1) and insertion sequences (e.g. ISSsp4, ISMsa21 and ISMba16) were abundant in the two sludge samples. The co-occurrence pattern between ARGs and microbial taxa revealed by network analysis indicated that some environmental bacteria (e.g. Clostridium and Nitrosomonas) might be potential hosts of multiple ARGs. The findings increase our understanding of WWTPs as hotspots of ARGs and MGEs, and contribute towards preventing their release into the downstream environment. Copyright © 2017 Elsevier Ltd. All rights reserved.

  15. Impact of Antibiotic Shortage on H. Pylori Treatment: A Step-Wise Approach for Pharmacist Management

    Directory of Open Access Journals (Sweden)

    Michelle M. Lamb

    2013-01-01

    Full Text Available The current drug shortage crisis involving multiple oral antibiotics has significantly impacted preferred therapeutic options for treatment of H.pylori infection. Pharmacists may help alleviate the impact of this shortage through a proposed step-wise approach which includes proper inventory management, verification of indication, evaluation of regimen, therapeutic monitoring, and communication with patients and providers regarding alternative therapy or symptomatic relief.   Type: Original Research

  16. Impact of Antibiotic Shortage on H. Pylori Treatment: A Step-Wise Approach for Pharmacist Management

    Directory of Open Access Journals (Sweden)

    Ann Lloyd, Pharm.D., BCPS

    2013-01-01

    Full Text Available The current drug shortage crisis involving multiple oral antibiotics has significantly impacted preferred therapeutic options for treatment of H.pylori infection. Pharmacists may help alleviate the impact of this shortage through a proposed step-wise approach which includes proper inventory management, verification of indication, evaluation of regimen, therapeutic monitoring, and communication with patients and providers regarding alternative therapy or symptomatic relief.

  17. Exploring antibiotic resistance genes and metal resistance genes in plasmid metagenomes from wastewater treatment plants

    OpenAIRE

    Li, An-Dong; Li, Li-Guan; Zhang, Tong

    2015-01-01

    Plasmids operate as independent genetic elements in microorganism communities. Through horizontal gene transfer, they can provide their host microorganisms with important functions such as antibiotic resistance and heavy metal resistance. In this study, six metagenomic libraries were constructed with plasmid DNA extracted from influent, activated sludge and digested sludge of two wastewater treatment plants. Compared with the metagenomes of the total DNA extracted from the same sectors of the...

  18. Diabetes increases the risk of an appendectomy in patients with antibiotic treatment of noncomplicated appendicitis.

    Science.gov (United States)

    Tsai, Ming-Chieh; Lin, Herng-Ching; Lee, Cha-Ze

    2017-07-01

    This retrospective cohort study examined whether diabetic patients have a higher risk for recurrent appendicitis during a 1-year follow-up period after successful antibiotic treatment for patients with acute uncomplicated appendicitis than nondiabetic patients using a population-based database. We included 541 appendicitis patients who received antibiotic treatment for acute appendicitis. We individually tracked each patient for a 1-year period to identify those who subsequently underwent an appendectomy during the follow-up period. Cox proportional hazard regressions suggested that the adjusted hazard ratio of an appendectomy during the 1-year follow-up period was 1.75 for appendicitis patients with diabetes than appendicitis patients without diabetes. We found that among females, the adjusted hazard ratio of an appendectomy was 2.18 for acute appendicitis patients with diabetes than their counterparts without diabetes. However, we failed to observe this relationship in males. We demonstrated a relationship between diabetes and a subsequent appendectomy in females who underwent antibiotic treatment for noncomplicated appendicitis. Copyright © 2016 Elsevier Inc. All rights reserved.

  19. A Qualitative Survey of Five Antibiotics in a Water Treatment Plant in Central Plateau of Iran

    Directory of Open Access Journals (Sweden)

    Mohsen Heidari

    2013-01-01

    Full Text Available Introduction. This study aimed to survey a total of five common human and veterinary antibiotics based on SPE-LC-MS-MS technology in a water treatment plant at central plateau of Iran. Also two sampling techniques, passive and grab samplings, were compared in the detection of selected antibiotics. Materials and Methods. In January to March 2012, grab and passive samples were taken from the influent and effluent of a water treatment plant. The samples were prepared using solid-phase extraction (SPE, and extracts were analyzed by liquid chromatography tandem mass spectrometry (LC-MS-MS. Results. The results showed that enrofloxacin, oxytetracycline, and tylosin were not detected in none of the samples. However, ampicillin was detected in the grab and passive samples taken from the influent (source water of the plant, and ciprofloxacin was detected in passive samples taken from the influent and effluent (finished water of the plant. Conclusion. The results imply that passive sampling is a better approach than grab sampling for the investigation of antibiotics in aquatic environments. The presence of ampicillin and ciprofloxacin in source water and finished water of the water treatment plant may lead to potential emergence of resistant bacteria that should be considered in future studies.

  20. Exploring Antibiotic Resistance Genes and Metal Resistance Genes in Plasmid Metagenomes from Wastewater Treatment Plants

    Directory of Open Access Journals (Sweden)

    An-Dong eLi

    2015-09-01

    Full Text Available Plasmids operate as independent genetic elements in microorganism communities. Through horizontal gene transfer, they can provide their host microorganisms with important functions such as antibiotic resistance and heavy metal resistance. In this study, six metagenomic libraries were constructed with plasmid DNA extracted from influent, activated sludge and digested sludge of two wastewater treatment plants. Compared with the metagenomes of the total DNA extracted from the same sectors of the wastewater treatment plant, the plasmid metagenomes had significantly higher annotation rates, indicating that the functional genes on plasmids are commonly shared by those studied microorganisms. Meanwhile, the plasmid metagenomes also encoded many more genes related to defense mechanisms, including ARGs. Searching against an antibiotic resistance genes (ARGs database and a metal resistance genes (MRGs database revealed a broad-spectrum of antibiotic (323 out of a total 618 subtypes and metal resistance genes (23 out of a total 23 types on these plasmid metagenomes. The influent plasmid metagenomes contained many more resistance genes (both ARGs and MRGs than the activated sludge and the digested sludge metagenomes. Sixteen novel plasmids with a complete circular structure that carried these resistance genes were assembled from the plasmid metagenomes. The results of this study demonstrated that the plasmids in wastewater treatment plants could be important reservoirs for resistance genes, and may play a significant role in the horizontal transfer of these genes.

  1. Long-term antibiotic treatment for non-cystic fibrosis bronchiectasis in adults: evidence, current practice and future use.

    Science.gov (United States)

    Goldman, N; Loebinger, M R; Wilson, R

    2016-12-01

    Bronchiectasis is defined pathologically by the permanent dilation of the bronchi and bronchioles and chronic airway inflammation. This is the outcome of a number of different aetiologies but up to half of bronchiectasis cases are labelled idiopathic. It is characterised by a chronic productive cough, haemoptysis, shortness of breath and recurrent infective exacerbations. Long-term antibiotics are used with the aim of reducing symptom severity and exacerbation frequency, improving quality of life and preventing disease progression. Areas covered: This perspective provides an overview of evidence and current practice for long-term oral, inhaled and pulsed intravenous antibiotic therapy in adults with non-cystic fibrosis bronchiectasis. Evidence was drawn from a recent systemic literature review. Expert commentary: An approach to long-term antibiotic treatment is provided. Side effects of treatment, methods of monitoring treatment success and actions to be considered if treatment fails are discussed. Emerging long-term antibiotic treatments and strategies are considered.

  2. Antibiotic treatment for the sexual partners of women with bacterial vaginosis.

    Science.gov (United States)

    Amaya-Guio, Jairo; Viveros-Carreño, David Andres; Sierra-Barrios, Eloisa Mercedes; Martinez-Velasquez, Mercy Yolima; Grillo-Ardila, Carlos F

    2016-10-01

    Bacterial vaginosis (BV) is an infection that has a prevalence between 10% to 50% worlwide. BV results in an imbalance of the normal vaginal flora. Microorganisms associated with BV have been isolated from the normal flora of the male genital tract, and their presence could be related to the recurrence of BV after antibiotic treatment. Therefore, the treatment of sexual partners could decrease the recurrence of infection and possibly the burden of the disease. To assess the effectiveness in women and the safety in men of concurrent antibiotic treatment for the sexual partners of women treated for BV. We searched the Cochrane Sexually Transmitted Infections Group Specialized Register (23 July 2016), CENTRAL (1991 to 23 July 2016), MEDLINE (1946 to 23 July 2016), Embase (1974 to 23 July 2016), LILACS (1982 to 23 July 2016), the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (23 July 2016), ClinicalTrials.gov (23 July 2016) and the Web of Science™ (2001 to 23 July 2016). We also handsearched conference proceedings, contacted trial authors and reviewed the reference lists of retrieved studies. Randomized controlled trials (RCTs) that compared the concurrent use of any antibiotic treatment with placebo, no intervention or any other intervention by the sexual partners of women treated for BV. Three review authors independently assessed trials for inclusion, extracted data and assessed the risk of bias in the included studies. We resolved any disagreements through consensus. We assessed the quality of the evidence using the GRADE approach. Seven RCTs (1026 participants) met our inclusion criteria, and pharmaceutical industry funded four of these trials. Five trials (854 patients) compared any antibiotic treatment of sexual partners with placebo. Based on high quality evidence, antibiotic treatment does not increase the rate of clinical or symptomatic improvement in women during the first week (risk ratio (RR) 0.99, 95% confidence

  3. Removal of antibiotics in wastewater by enzymatic treatment with fungal laccase - Degradation of compounds does not always eliminate toxicity.

    Science.gov (United States)

    Becker, Dennis; Varela Della Giustina, Saulo; Rodriguez-Mozaz, Sara; Schoevaart, Rob; Barceló, Damià; de Cazes, Matthias; Belleville, Marie-Pierre; Sanchez-Marcano, José; de Gunzburg, Jean; Couillerot, Olivier; Völker, Johannes; Oehlmann, Jörg; Wagner, Martin

    2016-11-01

    In this study, the performance of immobilised laccase (Trametes versicolor) was investigated in combination with the mediator syringaldehyde (SYR) in removing a mixture of 38 antibiotics in an enzymatic membrane reactor (EMR). Antibiotics were spiked in osmosed water at concentrations of 10μg·L(-1) each. Laccase without mediator did not reduce the load of antibiotics significantly. The addition of SYR enhanced the removal: out of the 38 antibiotics, 32 were degraded by >50% after 24h. In addition to chemical analysis, the samples' toxicity was evaluated in two bioassays (a growth inhibition assay and the Microtox assay). Here, the addition of SYR resulted in a time-dependent increase of toxicity in both bioassays. In cooperation with SYR, laccase effectively removes a broad range of antibiotics. However, this enhanced degradation induces unspecific toxicity. If this issue is resolved, enzymatic treatment may be a valuable addition to existing water treatment technologies. Copyright © 2016 Elsevier Ltd. All rights reserved.

  4. Antibiotic prescribing in public and private practice: a cross-sectional study in primary care clinics in Malaysia.

    Science.gov (United States)

    Ab Rahman, Norazida; Teng, Cheong Lieng; Sivasampu, Sheamini

    2016-05-17

    Antibiotic overuse is driving the emergence of antibiotic resistance worldwide. Good data on prescribing behaviours of healthcare providers are needed to support antimicrobial stewardship initiatives. This study examined the differences in antibiotic prescribing rates of public and private primary care clinics in Malaysia. We used data from the National Medical Care Survey (NMCS), a nationwide cluster sample of Malaysian public and private primary care clinics in 2014. NMCS contained demographic, diagnoses and prescribing from 129 public clinics and 416 private clinics. We identified all encounters who were prescribed antibiotic and analyse the prescribing rate, types of antibiotics, and diagnoses that resulted in antibiotic. Five thousand eight hundred ten encounters were prescribed antibiotics; antibiotic prescribing rate was 21.1 % (public clinics 6.8 %, private clinics 30.8 %). Antibiotic prescribing was higher in private clinics where they contributed almost 87 % of antibiotics prescribed in primary care. Upper respiratory tract infection (URTI) was the most frequent diagnosis in patients receiving antibiotic therapy and accounted for 49.2 % of prescriptions. Of the patients diagnosed with URTI, 46.2 % received antibiotic treatment (public 16.8 %, private 57.7 %). Penicillins, cephalosporins and macrolides were the most commonly prescribed antibiotics and accounted for 30.7, 23.6 and 16.0 % of all antibiotics, respectively. More recently available broad-spectrum antibiotics such as azithromycin and quinolones were more frequently prescribed in private clinics. Antibiotic prescribing rates are high in both public and private primary care settings in Malaysia, especially in the latter. This study provides evidence of excessive and inappropriate antibiotic prescribing for self-limiting conditions. These data highlights the needs for more concerted interventions targeting both prescribers and public. Improvement strategies should focus on reducing

  5. Fate and removal of various antibiotic resistance genes in typical pharmaceutical wastewater treatment systems.

    Science.gov (United States)

    Zhai, Wenchao; Yang, Fengxia; Mao, Daqing; Luo, Yi

    2016-06-01

    The high levels of antibiotic residues in pharmaceutical wastewater treatment plants (PWWTPs) make these plants the hotspots for the proliferation of antibiotic resistance genes (ARGs). This study investigated the fate and removal of 11 ARG subtypes for sulfonamide, tetracycline, β-lactam, and macrolide resistance in each processing stage of two full-scale PWWTPs in northern China. The levels of typical ARG subtypes in the final effluents ranged from (2.56 ± 0.13) × 10(1) to (2.36 ± 0.11) × 10(7) copies/ml. The absolute abundance of ARGs in effluents accounted for only 0.03-78.1 % of influents of the two PWWTPs, while the majority of the ARGs were transported to the dewatered sludge with concentrations from (2.65 ± 0.43) × 10(5) to (4.27 ± 0.03) × 10(10) copies/g dry weight (dw). The total loads of ARGs discharged through dewatered sludge plus effluent was 1.01-14.09-fold higher than that in the raw influents, suggesting the proliferation of ARGs occurred in the wastewater treatment. The proliferation of ARGs mainly occurs in biological treatment process, such as aeration tank, anoxic tank, sequencing batch reactor (SBR), and bio-contact oxidation, facilitates the proliferation of various ARGs, implying significant replication of certain ARG subtypes may be attributable to microbial growth. Chemical oxidation seems promising to remove ARGs, with removal efficiency ranged from 29.3 to 85.7 %, while the partial correlation analysis showed significant correlations between antibiotic concentration and ARG removal. Thus, the high antibiotic residues within the PWWTPs may have an influence on the proliferation, fate, and removal of the associated ARG subtypes.

  6. Limited Bacterial Diversity within a Treatment Plant Receiving Antibiotic-Containing Waste from Bulk Drug Production.

    Directory of Open Access Journals (Sweden)

    Nachiket P Marathe

    Full Text Available Biological treatment of waste water from bulk drug production, contaminated with high levels of fluoroquinolone antibiotics, can lead to massive enrichment of antibiotic resistant bacteria, resistance genes and associated mobile elements, as previously shown. Such strong selection may be boosted by the use of activated sludge (AS technology, where microbes that are able to thrive on the chemicals within the wastewater are reintroduced at an earlier stage of the process to further enhance degradation of incoming chemicals. The microbial community structure within such a treatment plant is, however, largely unclear. In this study, Illumina-based 16S rRNA amplicon sequencing was applied to investigate the bacterial communities of different stages from an Indian treatment plant operated by Patancheru Environment Technology Limited (PETL in Hyderabad, India. The plant receives waste water with high levels of fluoroquinolones and applies AS technology. A total of 1,019,400 sequences from samples of different stages of the treatment process were analyzed. In total 202, 303, 732, 652, 947 and 864 operational taxonomic units (OTUs were obtained at 3% distance cutoff in the equilibrator, aeration tanks 1 and 2, settling tank, secondary sludge and old sludge samples from PETL, respectively. Proteobacteria was the most dominant phyla in all samples with Gammaproteobacteria and Betaproteobacteria being the dominant classes. Alcaligenaceae and Pseudomonadaceae, bacterial families from PETL previously reported to be highly multidrug resistant, were the dominant families in aeration tank samples. Despite regular addition of human sewage (approximately 20% to uphold microbial activity, the bacterial diversity within aeration tanks from PETL was considerably lower than corresponding samples from seven, regular municipal waste water treatment plants. The strong selection pressure from antibiotics present may be one important factor in structuring the microbial

  7. Limited Bacterial Diversity within a Treatment Plant Receiving Antibiotic-Containing Waste from Bulk Drug Production.

    Science.gov (United States)

    Marathe, Nachiket P; Shetty, Sudarshan A; Shouche, Yogesh S; Larsson, D G Joakim

    2016-01-01

    Biological treatment of waste water from bulk drug production, contaminated with high levels of fluoroquinolone antibiotics, can lead to massive enrichment of antibiotic resistant bacteria, resistance genes and associated mobile elements, as previously shown. Such strong selection may be boosted by the use of activated sludge (AS) technology, where microbes that are able to thrive on the chemicals within the wastewater are reintroduced at an earlier stage of the process to further enhance degradation of incoming chemicals. The microbial community structure within such a treatment plant is, however, largely unclear. In this study, Illumina-based 16S rRNA amplicon sequencing was applied to investigate the bacterial communities of different stages from an Indian treatment plant operated by Patancheru Environment Technology Limited (PETL) in Hyderabad, India. The plant receives waste water with high levels of fluoroquinolones and applies AS technology. A total of 1,019,400 sequences from samples of different stages of the treatment process were analyzed. In total 202, 303, 732, 652, 947 and 864 operational taxonomic units (OTUs) were obtained at 3% distance cutoff in the equilibrator, aeration tanks 1 and 2, settling tank, secondary sludge and old sludge samples from PETL, respectively. Proteobacteria was the most dominant phyla in all samples with Gammaproteobacteria and Betaproteobacteria being the dominant classes. Alcaligenaceae and Pseudomonadaceae, bacterial families from PETL previously reported to be highly multidrug resistant, were the dominant families in aeration tank samples. Despite regular addition of human sewage (approximately 20%) to uphold microbial activity, the bacterial diversity within aeration tanks from PETL was considerably lower than corresponding samples from seven, regular municipal waste water treatment plants. The strong selection pressure from antibiotics present may be one important factor in structuring the microbial community in PETL

  8. Antibiotic Resistant Bacteria And Their Associated Resistance Genes in a Conventional Municipal Wastewater Treatment Plant

    KAUST Repository

    Aljassim, Nada I.

    2013-12-01

    With water scarcity as a pressing issue in Saudi Arabia and other Middle Eastern countries, the treatment and reuse of municipal wastewater is increasingly being used as an alternative water source to supplement country water needs. Standards are in place to ensure a safe treated wastewater quality, however they do not regulate pathogenic bacteria and emerging contaminants. Information is lacking on the levels of risk to public health associated with these factors, the efficiency of conventional treatment strategies in removing them, and on wastewater treatment in Saudi Arabia in general. In this study, a municipal wastewater treatment plant in Saudi Arabia is investigated to assess the efficiency of conventional treatment in meeting regulations and removing pathogens and emerging contaminants. The study found pathogenic bacterial genera, antibiotic resistance genes and antibiotic resistant bacteria, many of which were multi-resistant in plant discharges. It was found that although the treatments are able to meet traditional quality guidelines, there remains a risk from the discussed contaminants with wastewater reuse. A deeper understanding of this risk, and suggestions for more thorough guidelines and monitoring are needed.

  9. [Evaluation of antibiotic resistance in material isolated from the middle ear in children with acute otitis media not responding to standard antibiotic treatment].

    Science.gov (United States)

    Zielnik-Jurkiewicz, Beata; Bielicka, Anna

    2007-01-01

    An increasing antibiotic resistance of pathogens is the main cause of failures during treatment of acute otitis media (AOM). Aim. A qualitative and quantitative bacteriological analysis of material isolated from the middle ear in children with AOM treated with antibiotic without improvement. This is a prospective study performed in Department of Otolaryngology in Warsaw between 2005 and 2007. An examined group consisted of 72 children aged from 6 months to 17 years, admitted to Department of Otolaryngology because of failure of antibiotic therapy of AOM, severe course of this disease and complications of AOM or persistent AOM. In all children were performed the myryngotomy and/or ventilatory tube insertion and/or mastoidectomy and the material from the middle ear was collected to bacteriological examinations. The positive cultures were obtained in 63.9% patients. Streptococcus pneumoniae (40.4%), Staphylococcus aureus (14%), Haemophilus influenzae (10.5%) and Pseudomonas aeruginosa (10.5%) were the most frequently found bacteria in the culture of middle ear. beta-lactamase producing bacteria were isolated in 12 children (21.1% of isolated bacteria). Staphylococcus aureus (7 children, 12.3% of positive cultures) was the bacteria most frequent producing beta-lactamase. The most of organisms were susceptibility to amoxicillin/clavulanate--56.1% of bacteria from the middle ear. The most of organisms presented resistance to penicillin--63.9% of bacteria from the middle ear. Microbiological identifications and antibiotic resistance determination of pathogens isolated from the middle ear in children with AOM not responding to empirical antibiotic treatment gives possibility of the choice of an effective antibiotic and its proper dosage. The pathogenic bacterial flora isolated from the middle ear in children with AOM shows evidence to accomplishing changes in the most frequent pathogens causing acute otitis media in children.

  10. Low level of knowledge of heart attack symptoms and inappropriate anticipated treatment-seeking behaviour among older Chinese: a cross-sectional survey.

    Science.gov (United States)

    Chau, Pui Hing; Moe, Gordon; Lee, Siu Yin; Woo, Jean; Leung, Angela Y M; Chow, Chi-Ming; Kong, Cecilia; Lo, Wing Tung; Yuen, Ming Hay; Zerwic, Julie

    2018-03-26

    Prehospital delay of acute myocardial infarction (AMI) is common globally, and Hong Kong-home of a rapidly ageing Chinese population-is not an exception. Seeking emergency medical care promptly is important for patients. Treatment-seeking behaviours have been shown to be associated with knowledge of AMI symptoms and specific cultural beliefs. This study aimed to assess the level of knowledge of AMI symptoms and expected treatment-seeking behaviour among older Chinese in Hong Kong. A cross-sectional population-based survey was conducted at the Elderly Health Centres in Hong Kong from March to September 2016. Face-to-face interviews were conducted with a structured questionnaire based on previous studies and local adaptations. Among 1804 people aged 65 years and above who completed the questionnaire, chest pain (80.2%), palpitations (75.8%) and fainting (71.9%) were the major symptoms recognised as AMI related. Meanwhile, stomach ache (46.9%), coughing (45.4%) and neck pain (40.8%) were recognised as not AMI related. The mean expected discomfort intensity during AMI onset was 7.7 out of 10 (SD=2.1). Regarding the expected treatment-seeking behaviour, seeking non-emergent medical care was the most popular action when AMI symptoms emerged during the day, without chest pain or with lower discomfort intensity, whereas calling an ambulance was the most common option when AMI symptoms emerged at night or with high discomfort intensity. To minimise delays in seeking treatment, future health education should focus on increasing the public knowledge of AMI symptoms and the need to call an ambulance during an emergency. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  11. Concentration of facultative pathogenic bacteria and antibiotic resistance genes during sewage treatment and in receiving rivers.

    Science.gov (United States)

    Heß, Stefanie; Lüddeke, Frauke; Gallert, Claudia

    2016-10-01

    Whereas the hygienic condition of drinking and bathing water by law must be monitored by culture-based methods, for quantification of microbes and antibiotic resistance in soil or the aquatic environment, often molecular genetic assays are used. For comparison of both methods, knowledge of their correlation is necessary. Therefore the population of total bacteria, Escherichia coli, enterococci and staphylococci during sewage treatment and in receiving river water was compared by agar plating and quantitative polymerase chain reaction (qPCR) assays. In parallel, all samples were investigated for clinically relevant antibiotic resistance genes. Whereas plating and qPCR data for total bacteria correlated well in sewage after primary treatment, qPCR data of river water indicated higher cell numbers for E. coli. It is unknown if these cells are 'only' not growing under standard conditions or if they are dead. Corresponding to the amount of non-culturable cells, the 'breakpoints' for monitoring water quality should be adapted. The abundances of clinically relevant antibiotic resistance genes in river water were in the same order of magnitude or even higher than in treated sewage. For estimation of the health risk it is important to investigate which species carry respective genes and whether these genes are disseminated via gene transfer.

  12. Reductions of bacterial antibiotic resistance through five biological treatment processes treated municipal wastewater.

    Science.gov (United States)

    Yuan, Qing-Bin; Guo, Mei-Ting; Wei, Wu-Ji; Yang, Jian

    2016-10-01

    Wastewater treatment plants are hot spots for antibiotic-resistant bacteria (ARB) and antibiotic resistance genes (ARGs). However, limited studies have been conducted to compare the reductions of ARB and ARGs by various biological treatment processes. The study explored the reductions of heterotrophic bacteria resistant to six groups of antibiotics (vancomycin, gentamicin, erythromycin, cephalexin, tetracycline, and sulfadiazine) and corresponding resistance genes (vanA, aacC1, ereA, ampC, tetA, and sulI) by five bench-scale biological reactors. Results demonstrated that membrane bioreactor (MBR) and sequencing batch reactor (SBR) significantly reduced ARB abundances in the ranges of 2.80∼3.54 log and 2.70∼3.13 log, respectively, followed by activated sludge (AS). Biological filter (BF) and anaerobic (upflow anaerobic sludge blanket, UASB) techniques led to relatively low reductions. In contrast, ARGs were not equally reduced as ARB. AS and SBR also showed significant potentials on ARGs reduction, whilst MBR and UASB could not reduce ARGs effectively. Redundancy analysis implied that the purification of wastewater quality parameters (COD, NH4 (+)-N, and turbidity) performed a positive correlation to ARB and ARGs reductions.

  13. High-throughput quantification of antibiotic resistance genes from an urban wastewater treatment plant.

    Science.gov (United States)

    Karkman, Antti; Johnson, Timothy A; Lyra, Christina; Stedtfeld, Robert D; Tamminen, Manu; Tiedje, James M; Virta, Marko

    2016-03-01

    Antibiotic resistance among bacteria is a growing problem worldwide, and wastewater treatment plants have been considered as one of the major contributors to the dissemination of antibiotic resistance to the environment. There is a lack of comprehensive quantitative molecular data on extensive numbers of antibiotic resistance genes (ARGs) in different seasons with a sampling strategy that would cover both incoming and outgoing water together with the excess sludge that is removed from the process. In order to fill that gap we present a highly parallel quantitative analysis of ARGs and horizontal gene transfer potential over four seasons at an urban wastewater treatment plant using a high-throughput qPCR array. All analysed transposases and two-thirds of primer sets targeting ARGs were detected in the wastewater. The relative abundance of most of the genes was highest in influent and lower in effluent water and sludge. The resistance profiles of the samples cluster by sample location with a shift from raw influent through the final effluents and dried sludge to the sediments. Wastewater discharge enriched only a few genes, namely Tn25 type transposase gene and clinical class 1 integrons, in the sediment near the discharge pipe, but those enriched genes may indicate a potential for horizontal gene transfer. © FEMS 2016. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  14. Antibiotic resistance genes in municipal wastewater treatment systems and receiving waters in Arctic Canada

    DEFF Research Database (Denmark)

    Neudorf, Kara D.; Huang, Yan Nan; Ragush, Colin M.

    2017-01-01

    that the WWTPs provided only primary treatment. Low levels of the ARGs (2 log copies/mL) were observed in the effluent, demonstrating that bacteria residing in three northern WWTPs harbour ARGs conferring resistance to multiple clinically-relevant classes of antibiotics. Our results indicate that long......Domestic wastewater discharges may adversely impact arctic ecosystems and local indigenous people, who rely on being able to hunt and harvest food from their local environment. Therefore, there is a need to develop efficient wastewater treatment plants (WWTPs), which can be operated in remote...

  15. Impact of galacto-oligosaccharides on the gut microbiota composition and metabolic activity upon antibiotic treatment during in vitro fermentation.

    Science.gov (United States)

    Ladirat, Stephanie E; Schuren, Frank H J; Schoterman, Margriet H C; Nauta, Arjen; Gruppen, Harry; Schols, Henk A

    2014-01-01

    Prebiotics are considered to have potential to reduce disturbances in the gut microbiota induced by antibiotics. Results in literature are, however, not consistent. The current in vitro study conducted in a fermentation screening platform allowed to unambiguously compare the impact of galacto-oligosaccharides (GOS) on adult gut microbiota composition and activity upon treatment with four antibiotics at two doses. The changes in relative abundance of bacteria upon antibiotic treatment and the growth of Bifidobacterium and Lactobacillus upon GOS addition were antibiotic and dose dependent. This conclusion explains discrepancies in literature and indicates that particular combinations of GOS antibiotic should be studied. The combination GOS-Amoxicillin was especially of interest as, after decrease in Bifidobacterium levels, a recovery of mainly Bifidobacterium longum was observed and could be correlated with specific degradation patterns of GOS. Next to different degradation profiles of individual GOS, an accumulation of monosaccharides and intermediate organic acids was observed in antibiotic-treated microbiota as compared to nontreated microbiota. This showed that although GOS were utilized and beneficial bacteria could grow in 3 of 4 antibiotics tested, the metabolic activity of an antibiotic-treated microbiota was still disturbed as compared to the nontreated microbiota. © 2013 Federation of European Microbiological Societies. Published by John Wiley & Sons Ltd. All rights reserved.

  16. Antibiotic therapy for the treatment of methicillin-resistant Staphylococcus aureus (MRSA) infections in surgical wounds.

    Science.gov (United States)

    Gurusamy, Kurinchi Selvan; Koti, Rahul; Toon, Clare D; Wilson, Peter; Davidson, Brian R

    2013-08-20

    Methicillin-resistant Staphylococcus aureus (MRSA) infection after surgery is usually rare, but incidence can be up to 33% in certain types of surgery. Postoperative MRSA infection can occur as surgical site infections (SSI), chest infections, or bloodstream infections (bacteraemia). The incidence of MRSA SSIs varies from 1% to 33% depending upon the type of surgery performed and the carrier status of the individuals concerned. The optimal antibiotic regimen for the treatment of MRSA in surgical wounds is not known. To compare the benefits and harms of various antibiotic treatments in people with established surgical site infections (SSIs) caused by MRSA . In February 2013 we searched the following databases: The Cochrane Wounds Group Specialised Register; The Cochrane Central Register of Controlled Trials (CENTRAL); Database of Abstracts of Reviews of Effects (DARE); NHS Economic Evaluation Database; Health Technology Assessment (HTA) Database; Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid EMBASE; and EBSCO CINAHL. We included only randomised controlled trials (RCTs) comparing one antibiotic regimen with another antibiotic regimen for the treatment of SSIs due to MRSA. All RCTs irrespective of language, publication status, publication year, or sample size were included in the analysis. Two review authors independently decided on inclusion and exclusion of trials, and extracted data. We planned to calculate the risk ratio (RR) with 95% confidence intervals (CI) for comparing the binary outcomes between the groups and mean difference (MD) with 95% CI for comparing the continuous outcomes. We planned to perform the meta-analysis using both a fixed-effect and a random-effects model. We performed intention-to-treat analysis whenever possible. We included one trial involving 59 people hospitalised because of MRSA SSIs. Thirty participants were randomised to linezolid (600 mg either intravenously or orally every 12 hours for seven to 14 days

  17. Prevalence and proliferation of antibiotic resistance genes in two municipal wastewater treatment plants.

    Science.gov (United States)

    Mao, Daqing; Yu, Shuai; Rysz, Michal; Luo, Yi; Yang, Fengxia; Li, Fengxiang; Hou, Jie; Mu, Quanhua; Alvarez, P J J

    2015-11-15

    The propagation of antibiotic resistance genes (ARGs) is an emerging health concern worldwide. Thus, it is important to understand and mitigate their occurrence in different systems. In this study, 30 ARGs that confer resistance to tetracyclines, sulfonamides, quinolones or macrolides were detected in two activated sludge wastewater treatment plants (WWTPs) in northern China. Bacteria harboring ARGs persisted through all treatment units, and survived disinfection by chlorination in greater percentages than total Bacteria (assessed by 16S rRNA genes). Although the absolute abundances of ARGs were reduced from the raw influent to the effluent by 89.0%-99.8%, considerable ARG levels [(1.0 ± 0.2) × 10(3) to (9.5 ± 1.8) × 10(5) copies/mL)] were found in WWTP effluent samples. ARGs were concentrated in the waste sludge (through settling of bacteria and sludge dewatering) at (1.5 ± 2.3) × 10(9) to (2.2 ± 2.8) × 10(11) copies/g dry weight. Twelve ARGs (tetA, tetB, tetE, tetG, tetH, tetS, tetT, tetX, sul1, sul2, qnrB, ermC) were discharged through the dewatered sludge and plant effluent at higher rates than influent values, indicating overall proliferation of resistant bacteria. Significant antibiotic concentrations (2%-50% of raw influent concentrations) remained throughout all treatment units. This apparently contributed selective pressure for ARG replication since the relative abundance of resistant bacteria (assessed by ARG/16S rRNA gene ratios) was significantly correlated to the corresponding effluent antibiotic concentrations. Similarly, the concentrations of various heavy metals (which induce a similar bacterial resistance mechanism as antibiotics - efflux pumps) were also correlated to the enrichment of some ARGs. Thus, curtailing the release of antibiotics and heavy metals to sewage systems (or enhancing their removal in pre-treatment units) may alleviate their selective pressure and mitigate ARG proliferation in WWTPs. Copyright © 2015 Elsevier Ltd. All

  18. Antibiotic treatment of the hard tick Ixodes ricinus: Influence on Midichloria mitochondrii load following blood meal.

    Science.gov (United States)

    Ninio, Camille; Plantard, Olivier; Serra, Valentina; Pollera, Claudia; Ferrari, Nicola; Cafiso, Alessandra; Sassera, Davide; Bazzocchi, Chiara

    2015-07-01

    Midichloria mitochondrii is the most prevalent symbiont of the hard tick Ixodes ricinus, present in 100% of eggs and adult females of wild ticks. This bacterium is intracellular, and is the only known symbiont able to invade the mitochondria of the host cells. However, the role that M. mitochondrii plays in the host metabolism has yet to be elucidated. Multiple lines of evidence indicate the possibility of transmission of this bacterium to the vertebrate host during the tick blood meal. In order to investigate the role of M. mitochondrii in the biology of the tick host, we performed an antibiotic treatment on Ixodes ricinus individuals, with the aim of reducing/eliminating the symbiont, and to potentially observe the dynamic of bacterial infection in the tick host. We microinjected engorged adult females of I. ricinus with tetracycline, and we allowed the resulting larvae to feed on gerbils treated with the same antibiotic. The amount of M. mitochondrii was evaluated at different stages of the experiment using molecular techniques. In addition we evaluated the presence/absence of the symbiont DNA in the blood of gerbils used for the larval feeding. The performed treatments did not allow to eliminate the symbiont population from the host tick, however it allowed to reduce the multiplication that occurs after the larval blood meal. These results open the way for future experiments, using different antibiotic molecules, different administration methods and antibiotic administration on subsequent tick stages, to fulfill the goal of eliminating M. mitochondrii from the host I. ricinus, a major step in our understanding of the impact of this bacterium on ticks. Copyright © 2015 Elsevier GmbH. All rights reserved.

  19. A comparison of different antibiotic regimens for the treatment of infective endocarditis.

    Science.gov (United States)

    Martí-Carvajal, Arturo J; Dayer, Mark; Conterno, Lucieni O; Gonzalez Garay, Alejandro G; Martí-Amarista, Cristina Elena; Simancas-Racines, Daniel

    2016-04-19

    Infective endocarditis is a microbial infection of the endocardial surface of the heart. Antibiotics are the cornerstone of treatment, but their use is not standardised, due to the differences in presentation, populations affected and the wide variety of micro-organisms that can be responsible. To assess the existing evidence about the clinical benefits and harms of different antibiotics regimens used to treat people with infective endocarditis. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE Classic and EMBASE, LILACS, CINAHL and the Conference Proceedings Citation Index on 30 April 2015. We also searched three trials registers and handsearched the reference lists of included papers. We applied no language restrictions. We included randomised controlled trials assessing the effects of antibiotic regimens for treating possible infective endocarditis diagnosed according to modified Duke's criteria. We considered all-cause mortality, cure rates and adverse events as the primary outcomes. We excluded people with possible infective endocarditis and pregnant women. Three review authors independently performed study selection, 'Risk of bias' assessment and data extraction in duplicate. We constructed 'Summary of findings' tables and used GRADE methodology to assess the quality of studies. We described the included studies narratively. Four small randomised controlled trials involving 728 allocated/224 analysed participants met our inclusion criteria. These trials had a high risk of bias. Drug companies sponsored two of the trials. We were unable to pool the data due to the heterogeneity in outcome definitions and the different antibiotics used.The included trials compared the following antibiotic schedules. The first trial compared quinolone (levofloxacin) plus standard treatment (anti-staphylococcal penicillin (cloxacillin or dicloxacillin), aminoglycoside (tobramycin or netilmicin) and rifampicin) versus standard treatment

  20. Antibiotics for the treatment of leptospirosis: Systematic review and meta-analysis of controlled trials

    Directory of Open Access Journals (Sweden)

    Jaykaran Charan

    2013-01-01

    Full Text Available Leptospirosis is a zoonotic disease prevalent mainly in developing countries and is associated with high case fatality. Antibiotics especially penicillin are the mainstay of treatment for a suspected or confirm case of leptospirosis but role of Penicillin has not been evaluated systematically in the light of current evidence. The present systematic review and meta-analysis is done to evaluate the role of antibiotics in the treatment of leptospirosis. Parallel group clinical trials involving use of penicillin in treatment of leptospirosis were searched from all available sources. Ten clinical trials were found suitable as per laid inclusion criteria eligible for present systematic review and five clinical trials were included in meta-analysis. Clinical trials included for meta-analysis were compared on the basis of mortality, fever days, numbers of patients presenting with oliguria, and number of patients undergoing need-based dialysis. Analysis was done by comprehensive meta-analysis software 2. Qualitative outcomes are summarized as odds ratio and quantitative outcomes are summarized as standard mean difference with 95% confidence interval. Random and fixed models are used for analysis. There was no significant difference between penicillin group and controlled group for mortality (Odds ratio 1.59 (95% CI 0.59-4.29, P = 0.35, fever days (std difference in mean = −0.223 (95% CI 0.394-0.995, P = 0.358, number of patients presenting with oliguria (Odds ratio 1.795 (95% CI 0.325-9.929, P = 0.502, and number of patients who underwent need based dialysis (Odds ratio 1.587 (95% CI 0.919-2.731, P = 0.098. Role of various antibiotics in treatment of leptospirosis is uncertain, and can be attributed to nonavailability of adequate clinical trials. Role of penicillin in the treatment of leptospirosis can be debated.

  1. Resurgence of persisting non-cultivable Borrelia burgdorferi following antibiotic treatment in mice.

    Directory of Open Access Journals (Sweden)

    Emir Hodzic

    Full Text Available The agent of Lyme borreliosis, Borrelia burgdorferi, evades host immunity and establishes persistent infections in its varied mammalian hosts. This persistent biology may pose challenges to effective antibiotic treatment. Experimental studies in dogs, mice, and non-human primates have found persistence of B. burgdorferi DNA following treatment with a variety of antibiotics, but persisting spirochetes are non-cultivable. Persistence of B. burgdorferi DNA has been documented in humans following treatment, but the significance remains unknown. The present study utilized a ceftriaxone treatment regimen in the C3H mouse model that resulted in persistence of non-cultivable B. burgdorferi in order to determine their long-term fate, and to examine their effects on the host. Results confirmed previous studies, in which B. burgdorferi could not be cultured from tissues, but low copy numbers of B. burgdorferi flaB DNA were detectable in tissues at 2, 4 and 8 months after completion of treatment, and the rate of PCR-positive tissues appeared to progressively decline over time. However, there was resurgence of spirochete flaB DNA in multiple tissues at 12 months, with flaB DNA copy levels nearly equivalent to those found in saline-treated mice. Despite the continued non-cultivable state, RNA transcription of multiple B. burgdorferi genes was detected in host tissues, flaB DNA was acquired by xenodiagnostic ticks, and spirochetal forms could be visualized within ticks and mouse tissues by immunofluorescence and immunohistochemistry, respectively. A number of host cytokines were up- or down-regulated in tissues of both saline- and antibiotic-treated mice in the absence of histopathology, indicating host response to the presence of non-cultivable, despite the lack of inflammation in tissues.

  2. Antibiotics and Antibiotic Resistance

    Science.gov (United States)

    ... Drugs Resources for You Information for Consumers (Drugs) Buying & Using Medicine Safely Antibiotics and Antibiotic Resistance Antibiotics ... Antibiotic Resistance and Protect Public Health The White House Blog FDA’s Take on the Executive Order and ...

  3. Successful treatment using corticosteroid combined antibiotic for acute acalculous cholecystitis patients with systemic lupus erythematosus.

    Science.gov (United States)

    Liu, Wei; Chen, Weijie; He, Xiaodong; Qu, Qiang; Hong, Tao; Li, Binglu

    2017-07-01

    There is no consensus of treatments for acute acalculous cholecystitis with systemic lupus erythematosus (SLE). The study was aimed to investigate the effect of the corticosteroid for these patients.A series of patients who were diagnosed as acute acalculous cholecystitis with SLE in the period from January 2012 to December 2016 at our hospital were included. They accepted 2 different conservative treatment strategies initially: the treatment using moxifloxacin (the antibiotic group), and the treatment using corticosteroid combined moxifloxacin (the corticosteroid group). Then clinical manifestations, laboratory features, and outcomes were analyzed.The study identified 22 women Han Chinese patients with the SLE history of 2.8 ± 1.4 year. There was no significant difference in SLE history, Systemic Lupus Erythematosus Disease Activity Index-2000 (SLEDAI-2000), Systemic Lupus International Collaborating Clinics/American College of Rheumatology damage index (SLICC/ACR), hematologic examination results, and corticosteroid dosage between 2 groups. And there was no significant difference in the symptom of acute cholecystitis, duration of the symptoms, white blood level, and the thickness of gallbladder wall between 2 groups either. However, the SLEDAI-2000 of the corticosteroid group was lower than that of the antibiotic group (7.3 ± 1.4 vs 10.7 ± 3.0, P = .03), so was the SLICC/ACR (0.1 ± 0.3 vs 0.3 ± 0.5, P = .01). Moreover, total 11 of 12 patients were successfully treated in the corticosteroid group, only 1 patient got cholecystectomy because no improvement after conservative treatment. While 4 of 10 patients were successfully treated by moxifloxacin alone, 6 patients had to accept cholecystectomy in the antibiotic group. The rate of successful conservative treatment in the corticosteroid group was higher than that of the antibiotic group (P = .02). All patients were followed up at least 6 months, there was no statistical

  4. An update on new antibiotic prophylaxis and treatment for urinary tract infections in children.

    Science.gov (United States)

    Delbet, Jean Daniel; Lorrot, Mathie; Ulinski, Tim

    2017-10-01

    This review focuses on the treatment of urinary tract infections (UTI) in children and in particular its recent changes. Areas covered: Acute pyelonephritis, acute cystitis and asymptomatic bacteriuria or asymptomatic infections have to be clearly distinguished. Prompt treatment is required in pyelonephritis and cystitis, but not in asymptomatic bacteriuria or infection, in order to avoid selection of more virulent strains. This concept should be considered even in immunocompromised or bedridden children. In case of pyelonephritis, there should be no delay in beginning the antibiotic treatment in order to decrease the risk of long term complication, such as renal scars. Predisposing conditions for UTI, such as voiding anomalies and urinary tract malformation should be carefully evaluated. Expert opinion: One major concern is the increasing resistance to 3 rd generation cephalosporins. Therefore overconsumption in low-risk settings should be absolutely avoided. The prevalence of infections with E. coli producing extended spectrum ß-lactamase (ESBL) is increasing and pediatricians should be aware about the specific treatment options. Any recommendation about (initial) antibiotic treatment should be regularly updated and adapted to local resistance profiles and to economic factors in different health systems.

  5. Fate of antibiotic resistance genes in sewage treatment plant revealed by metagenomic approach.

    Science.gov (United States)

    Yang, Ying; Li, Bing; Zou, Shichun; Fang, Herbert H P; Zhang, Tong

    2014-10-01

    Antibiotic resistance has become a serious threat to human health. Sewage treatment plant (STP) is one of the major sources of antibiotic resistance genes (ARGs) in natural environment. High-throughput sequencing-based metagenomic approach was applied to investigate the broad-spectrum profiles and fate of ARGs in a full scale STP. Totally, 271 ARGs subtypes belonging to 18 ARGs types were identified by the broad scanning of metagenomic analysis. Influent had the highest ARGs abundance, followed by effluent, anaerobic digestion sludge and activated sludge. 78 ARGs subtypes persisted through the biological wastewater and sludge treatment process. The high removal efficiency of 99.82% for total ARGs in wastewater suggested that sewage treatment process is effective in reducing ARGs. But the removal efficiency of ARGs in sludge treatment was not as good as that in sewage treatment. Furthermore, the composition of microbial communities was examined and the correlation between microbial community and ARGs was investigated using redundancy analysis. Significant correlation between 6 genera and the distribution of ARGs were found and 5 of the 6 genera included potential pathogens. This is the first study on the fate of ARGs in STP using metagenomic analysis with high-throughput sequencing and hopefully would enhance our knowledge on fate of ARGs in STP. Copyright © 2014 Elsevier Ltd. All rights reserved.

  6. Inappropriate prescribing in geriatric patients.

    LENUS (Irish Health Repository)

    Barry, Patrick J

    2012-02-03

    Inappropriate prescribing in older people is a common condition associated with significant morbidity, mortality, and financial costs. Medication use increases with age, and this, in conjunction with an increasing disease burden, is associated with adverse drug reactions. This review outlines why older people are more likely to develop adverse drug reactions and how common the problem is. The use of different tools to identify and measure the problem is reviewed. Common syndromes seen in older adults (eg, falling, cognitive impairment, sleep disturbance) are considered, and recent evidence in relation to medication use for these conditions is reviewed. Finally, we present a brief summary of significant developments in the recent literature for those caring for older people.

  7. Antibiotic susceptibility, heteroresistance, and updated treatment strategies in Helicobacter pylori infection

    Directory of Open Access Journals (Sweden)

    Mascellino MT

    2017-07-01

    Full Text Available Maria Teresa Mascellino,1 Barbara Porowska,2 Massimiliano De Angelis,1 Alessandra Oliva1 1Department of Public Health and Infectious Diseases, 2Department of Cardio-Thoracic, Vascular, General Surgery and of Organ Transplants, Policlinico Umberto I, Rome, Italy Abstract: In this review, we discuss the problem of antibiotic resistance, heteroresistance, the utility of cultures and antibiotic susceptibility tests in Helicobacter pylori (Hp eradication, as well as the updated treatment strategies for this infection. The prevalence of antibiotic resistance is increasing all over the world, especially for metronidazole and clarithromycin, because of their heavy use in some geographical areas. Heteroresistance (simultaneous presence of both susceptible and resistant strains in different sites of a single stomach is another important issue, as an isolate could be mistakenly considered susceptible if a single biopsy is used for antimicrobial tests. We also examined literature data regarding eradication success rates of culture-guided and empiric therapies. The empiric therapy and the one based on susceptibility testing, in Hp eradication, may depend on several factors such as concomitant diseases, the number of previous antibiotic treatments, differences in bacterial virulence in individuals with positive or negative cultures, together with local antibiotic resistance patterns in real-world settings. Updated treatment strategies in Hp infection presented in the guidelines of the Toronto Consensus Group (2016 are reported. These suggest to prolong eradication therapy up to 14 days, replacing the old triple therapy with a quadruple therapy based on proton pump inhibitor (PPI, bismuth, metronidazole, and tetracycline for most of the patients, or as an alternative quadruple therapy without bismuth, based on the use of PPI, amoxicillin, metronidazole, and clarithromycin. The new drug vonoprazan, a first-in-class potassium-competitive acid blocker recently

  8. Targeted antibiotic treatment of lame sheep with footrot using either oxytetracycline or gamithromycin.

    Science.gov (United States)

    Strobel, H; Lauseker, M; Forbes, A B

    2014-01-11

    A study on parenteral antibiotic treatment in sheep footrot was conducted on 10 farms in southern Germany to obtain information on the efficacy of gamithromycin under practical use conditions compared with a positive control. On each farm, 20 (10 on one farm) lame sheep were clinically evaluated and divided into two groups. On day 1, sheep were treated once according to group with either long-acting oxytetracycline (OTC) at 20 mg/kg bodyweight or gamithromycin at 6 mg/kg; clinical responses were assessed 21 days later. When compared with day 1, both treatments reduced clinical lameness, as reflected in the reduction in the number of footrot-affected feet (OTC: 79.3 per cent; gamithromycin: 93.7 per cent) and in the severity of the lesions. The difference between the two treatments was significant (Pgamithromycin. Of the 33 sheep that were still lame on day 21, nine mildly affected animals were not re-treated and the remaining 24 sheep were re-treated with gamithromycin. On day 42, all but two (on the same farm) of the 33 sheep were cured, giving an overall response rate in this study to one or two parenteral antibiotic treatments of 99 per cent.

  9. Heat treatment effects on the antimicrobial activity of macrolide and lincosamide antibiotics in milk.

    Science.gov (United States)

    Zorraquino, M A; Althaus, R L; Roca, M; Molina, M P

    2011-02-01

    Antibiotic residues in milk can cause serious problems for consumers and the dairy industry. Heat treatment of milk may diminish the antimicrobial activity of these antibiotic residues. This study analyzed the effect of milk processing (60 °C for 30 min, 120 °C for 20 min, and 140 °C for 10 s) on the antimicrobial activity of milk samples fortified with three concentrations of three macrolides (erythromycin: 20, 40 and 80 μg/liter; spiramycin: 100, 200, and 400 μg/liter; and tylosin: 500, 1,000, and 2,000 μg/liter) and one lincosamide (lincomycin: 1,000, 2,000, and 4,000 μg/liter). To measure the loss of antimicrobial activity, a bioassay based on the growth inhibition of Micrococcus luteus was done. The data were analyzed using a multiple linear regression model. The results indicate that treatment at 120 °C for 20 min produces inactivation percentages of 93% (erythromycin), 64% (spiramycin), 51% (tylosin), and 5% (lincomycin), while treatment at 140 °C for 10 s results in generally lower percentages (30% erythromycin, 35% spiramycin, 12% tylosin, and 5% lincomycin). The lowest loss or lowest reduction of antimicrobial activity (21% erythromycin and 13% spiramycin) was obtained by treatment at 60 °C for 30 min. Copyright ©, International Association for Food Protection

  10. Use of antibiotics at a University Clinic Hospital: effect of protocolized antibiotic treatment in the evolution of hospital patients with infections.

    Science.gov (United States)

    Gómez-Gómez, Joaquin; García-Vázquez, Elisa; Bonillo, Cristina; Hernández-Torres, Alicia; Canteras-Jordana, Manuel

    2015-12-01

    To analyse factors associated to "failure" in patients under antibiotic (AB) treatment at a third level hospital. All patients receiving an AB treatment along April 2012 were prospectively observed and factors associated to failure were analyzed. Failure was defined as clinical or microbiological failure, relapse or death. Statistically significance was established as pprescriptions, being 178 considered as prophylactic AB prescriptions, 342 empirical treatments and 82 directed treatments as empiric treatments. Ceftriaxone and levofloxacin were the most used AB; choice of empirical and directed treatments were in line with protocols in 71% (242 of 342 cases) and 67% (55 of 82), respectively. Of all the patients receiving antibiotics for therapy (n=424), 402 had infection criteria (in 22 cases antibiotic treatment was deemed unnecessary since the patient showed no infectious process). Of these, 292 (72%) showed a good evolution, while the others were considered as failed therapies, either because of microbiological persistence in 49 (12.8%), relapse in 31 (7.71%) and death in en 30 (7.46%). Factors associated to "failure" were Charlson score ≥3 (OR 3.35; 95%CI 1.602-7.009); empirical and/or directed treatment not in keeping with the protocol (OR 5.68; 95%CI 2.898-11.217); and infection by ESBL and/or ciprofloxacin resistant E. coli (OR 4.43; 95%CI 1.492-13.184). A high rate of AB prescriptions in admitted patients correspond to empirical infection treatment, being ceftriaxone and levofloxacin the most used AB. Inadequate empirical and/or directed treatment is associated to clinical or microbiological failure and death.

  11. Use of antibiotics without medical prescription

    Directory of Open Access Journals (Sweden)

    Dalton Espíndola Volpato

    Full Text Available The inappropriate use of antibiotics for the treatment of infections is a worldwide problem that has implications for the cost of treatment and the development of resistant strains of bacteria. The use of antibiotics should follow specific criteria; they are on top of the list of self-medication drugs in countries that do not control their commercialization. OBJECTIVES: To determine the percentage of pharmacies that attend the public and sell antibiotics without medical prescription in a medium-sized city in Brazil, and analyze the variables involved in this procedure. MATERIALS AND METHODS: 107 of the 136 pharmacies registered in our city were evaluated. These pharmacies were visited by actresses who simulated having a sister with symptoms of a non-complicated rhino-sinusitis, so that they could obtain antibiotics without a medical prescription. Each pharmacy was visited only once; the only variable in the simulated clinical setting was the report of fever temperature, which was randomly assigned between 38.5 and 40 degrees Celsius. RESULTS: Antibiotics were offered in 58% of the pharmacies, and this offer was increased to 74% after the actresses insisted on having them. In 65.4% of the pharmacies, the actresses were attended by a pharmacist, and 84.2% of them said they would sell antibiotics. When the request for antibiotics was denied (26%, only 7.5% was due to absence of prescription. The most frequent reason for refusal to sell antibiotics, was because the attendant deemed it unnecessary (46.6% CONCLUSION: Antibiotics can be easily bought in the great majority of the pharmacies in our town without a medical prescription and a clear indication. Fever temperature did not modify the attendant's indication of the drug.

  12. Homeopathy outperforms antibiotics treatment in juvenile scallop Argopecten ventricosus: effects on growth, survival, and immune response.

    Science.gov (United States)

    Mazón-Suástegui, José Manuel; García-Bernal, Milagro; Saucedo, Pedro Enrique; Campa-Córdova, Ángel; Abasolo-Pacheco, Fernando

    2017-02-01

    Mortality from vibriosis in mollusk production is attributed to pathogenic bacteria, particularly Vibrio alginolyticus. Use of increasingly potent antibiotics has led to bacterial resistance and increased pathogenicity. Alternatives in sanitation, safety, and environmental sustainability are currently under analysis. To-date, homeopathy has been investigated in aquaculture of freshwater fish, but not in marine mollusks. The effect of the homeopathic complexes in the growth, survival, and immune response of the Catarina scallop Argopecten ventricosus were assessed. A bioassay to assess the potential of homeopathy in improving cultivation of juvenile A. ventricosus was conducted for 21 days, with a final challenge of 120 h with V. alginolyticus. The experimental design included two homeopathic formulas The homeopathic complex Passival, consisting of Passiflora incarnata 30 CH, Valeriana officinalis 30 CH, Ignatia amara 30 CH and Zincum valerianicum 30 CH plus Phosphoricum acid 30 CH (treatment TH1) or Silicea terra 30 CH (TH2), two antibiotics (ampicillin = AMP, oxytetracycline = OXY), and two reference treatments (without homeopathic or antibiotic treatment = CTRL, ethanol 30° GL = ETH). Additionally, a negative control CTRL- (untreated/uninfected) is included in the challenge test. Juvenile scallops (4.14 ± 0.06 mm, 13.33 mg wet weight) were cultivated in 4 L tanks provided with aerated, filtered (1 μm), and UV-sterilized seawater that was changed every third day. They were fed a blend of the microalgae Isochrysis galbana and Chaetoceros calcitrans (150,000 cells mL -1 twice a day). All treatments were directly added to the tank water and then 500 mL challenge units were inoculated with 1 × 10 7  CFU/mL (LD 50 ) of V. alginolyticus. Juveniles grew significantly larger and faster in height and weight with TH2 compared to the ETH and CTRL (P homeopathy is a viable treatment for this mollusk to reduce use of antibiotics in scallops and its

  13. Exploring bacterial infections: theoretical and experimental studies of the bacterial population dynamics and antibiotic treatment

    Science.gov (United States)

    Shao, Xinxian

    Bacterial infections are very common in human society. Thus extensive research has been conducted to reveal the molecular mechanisms of the pathogenesis and to evaluate the antibiotics' efficacy against bacteria. Little is known, however, about the population dynamics of bacterial populations and their interactions with the host's immune system. In this dissertation, a stochatic model is developed featuring stochastic phenotypic switching of bacterial individuals to explain the single-variant bottleneck discovered in multi strain bacterial infections. I explored early events in a bacterial infection establishment using classical experiments of Moxon and Murphy on neonatal rats. I showed that the minimal model and its simple variants do not work. I proposed modifications to the model that could explain the data quantitatively. The bacterial infections are also commonly established in physical structures, as biofilms or 3-d colonies. In contrast, most research on antibiotic treatment of bacterial infections has been conducted in well-mixed liquid cultures. I explored the efficacy of antibiotics to treat such bacterial colonies, a broadly applicable method is designed and evaluated where discrete bacterial colonies on 2-d surfaces were exposed to antibiotics. I discuss possible explanations and hypotheses for the experimental results. To verify these hypotheses, we investigated the dynamics of bacterial population as 3-d colonies. We showed that a minimal mathematical model of bacterial colony growth in 3-d was able to account for the experimentally observed presence of a diffusion-limited regime. The model further revealed highly loose packing of the cells in 3-d colonies and smaller cell sizes in colonies than plancktonic cells in corresponding liquid culture. Further experimental tests of the model predictions have revealed that the ratio of the cell size in liquid culture to that in colony cultures was consistent with the model prediction, that the dead cells

  14. How antibiotic resistances could change Helicobacter pylori treatment: A matter of geography?

    Science.gov (United States)

    Ierardi, Enzo; Giorgio, Floriana; Losurdo, Giuseppe; Di Leo, Alfredo; Principi, Mariabeatrice

    2013-12-07

    Therapeutic management of Helicobacter pylori (H. pylori) remains an unsolved issue. Indeed, no therapeutic regimen is able to cure the infection in all treated patients, and in many the infection persists despite the administration of several consecutive standard therapies. Although antibiotic resistance reports describe alarming results, the outcome of therapeutic regimens does not seem to parallel this scenario in most cases, since a successful performance is often reached in more than 80% of cases. However, the phenomenon of increasing antibiotic resistance is being closely studied, and the results show controversial aspects even in the same geographic area. For the continents of Europe, America, Asia, Africa, and Oceania, minimal and maximal values of resistance to the main antibiotics (clarithromycin, amoxicillin, metronidazole, and levofloxacin) feature wide ranges in different countries. The real enigma is therefore linked to the several different therapeutic regimens, which show results that often do not parallel the in vitro findings even in the same areas. A first aspect to be emphasized is that some regimens are limited by their use in very small geographic districts. Moreover, not all therapeutic trials have considered bacterial and host factors affecting the therapeutic outcome. The additional use of probiotics may help to reduce adverse events, but their therapeutic impact is doubtful. In conclusion, the "ideal therapy", paradoxically, appears to be a "utopia", despite the unprecedented volume of studies in the field and the real breakthrough in medical practice made by the discovery and treatment of H. pylori. The ample discrepancies observed in the different areas do not encourage the development of therapeutic guidelines that could be valid worldwide. On these bases, one of the main challenges for the future might be identifying a successful solution to overcome antibiotic resistances. In this context, geography must be considered a relevant

  15. Preclinical development of Ramizol, an antibiotic belonging to a new class, for the treatment of Clostridium difficile colitis.

    Science.gov (United States)

    Rao, Shasha; Prestidge, Clive A; Miesel, Lynn; Sweeney, Deb; Shinabarger, Dean L; Boulos, Ramiz A

    2016-12-01

    Antibiotic-resistant bacteria is a major threat to human health and is predicted to become the leading cause of death from disease by 2050. Despite the recent resurgence of research and development in the area, few antibiotics have reached the market, with most of the recently approved antibiotics corresponding to new uses for old antibiotics, or structurally similar derivatives thereof. We have recently reported an in silico approach that led to the design of an entirely new class of antibiotics for the bacteria-specific mechanosensitive ion channel of large conductance: MscL. Here, we present the preclinical development of one such antibiotic, Ramizol, a first generation antibiotic belonging to that class. We present the lack of interaction between Ramizol and other mammalian channels adding credibility to its MscL selectivity. We determine the pharmacokinetic profile in a rat model and show antibiotic translates to over 70% survival of hamsters in a Clostridium difficile colitis model. Lastly, initial in vitro data indicate that resistance to Ramizol occurs at a low frequency. In conclusion, we establish the potential of Ramizol as an effective new treatment for C. difficile associated disease.

  16. Use of behavioral economics and social psychology to improve treatment of acute respiratory infections (BEARI): rationale and design of a cluster randomized controlled trial [1RC4AG039115-01]--study protocol and baseline practice and provider characteristics.

    Science.gov (United States)

    Persell, Stephen D; Friedberg, Mark W; Meeker, Daniella; Linder, Jeffrey A; Fox, Craig R; Goldstein, Noah J; Shah, Parth D; Knight, Tara K; Doctor, Jason N

    2013-06-27

    Inappropriate antibiotic prescribing for nonbacterial infections leads to increases in the costs of care, antibiotic resistance among bacteria, and adverse drug events. Acute respiratory infections (ARIs) are the most common reason for inappropriate antibiotic use. Most prior efforts to decrease inappropriate antibiotic prescribing for ARIs (e.g., educational or informational interventions) have relied on the implicit assumption that clinicians inappropriately prescribe antibiotics because they are unaware of guideline recommendations for ARIs. If lack of guideline awareness is not the reason for inappropriate prescribing, educational interventions may have limited impact on prescribing rates. Instead, interventions that apply social psychological and behavioral economic principles may be more effective in deterring inappropriate antibiotic prescribing for ARIs by well-informed clinicians. The Application of Behavioral Economics to Improve the Treatment of Acute Respiratory Infections (BEARI) Trial is a multisite, cluster-randomized controlled trial with practice as the unit of randomization. The primary aim is to test the ability of three interventions based on behavioral economic principles to reduce the rate of inappropriate antibiotic prescribing for ARIs. We randomized practices in a 2 × 2 × 2 factorial design to receive up to three interventions for non-antibiotic-appropriate diagnoses: 1) Accountable Justifications: When prescribing an antibiotic for an ARI, clinicians are prompted to record an explicit justification that appears in the patient electronic health record; 2) Suggested Alternatives: Through computerized clinical decision support, clinicians prescribing an antibiotic for an ARI receive a list of non-antibiotic treatment choices (including prescription options) prior to completing the antibiotic prescription; and 3) Peer Comparison: Each provider's rate of inappropriate antibiotic prescribing relative to top-performing peers is reported back to

  17. Use of behavioral economics and social psychology to improve treatment of acute respiratory infections (BEARI): rationale and design of a cluster randomized controlled trial [1RC4AG039115-01] - study protocol and baseline practice and provider characteristics

    Science.gov (United States)

    2013-01-01

    Background Inappropriate antibiotic prescribing for nonbacterial infections leads to increases in the costs of care, antibiotic resistance among bacteria, and adverse drug events. Acute respiratory infections (ARIs) are the most common reason for inappropriate antibiotic use. Most prior efforts to decrease inappropriate antibiotic prescribing for ARIs (e.g., educational or informational interventions) have relied on the implicit assumption that clinicians inappropriately prescribe antibiotics because they are unaware of guideline recommendations for ARIs. If lack of guideline awareness is not the reason for inappropriate prescribing, educational interventions may have limited impact on prescribing rates. Instead, interventions that apply social psychological and behavioral economic principles may be more effective in deterring inappropriate antibiotic prescribing for ARIs by well-informed clinicians. Methods/design The Application of Behavioral Economics to Improve the Treatment of Acute Respiratory Infections (BEARI) Trial is a multisite, cluster-randomized controlled trial with practice as the unit of randomization. The primary aim is to test the ability of three interventions based on behavioral economic principles to reduce the rate of inappropriate antibiotic prescribing for ARIs. We randomized practices in a 2 × 2 × 2 factorial design to receive up to three interventions for non-antibiotic-appropriate diagnoses: 1) Accountable Justifications: When prescribing an antibiotic for an ARI, clinicians are prompted to record an explicit justification that appears in the patient electronic health record; 2) Suggested Alternatives: Through computerized clinical decision support, clinicians prescribing an antibiotic for an ARI receive a list of non-antibiotic treatment choices (including prescription options) prior to completing the antibiotic prescription; and 3) Peer Comparison: Each provider’s rate of inappropriate antibiotic prescribing relative to top

  18. Can pay-for-performance to primary care providers stimulate appropriate use of antibiotics?

    DEFF Research Database (Denmark)

    Dietrichson, Jens; Maria Ellegård, Lina; Anell, Anders

    2018-01-01

    , which act on fewer bacteria types, when possible. Inappropriate use of antibiotics is nonetheless widespread, not least for respiratory tract infections (RTI), a common reason for antibiotics prescriptions. We examine if pay-for-performance (P4P) presents a way to influence primary care physicians......' choice of antibiotics. During 2006-2013, eight Swedish health care authorities adopted P4P to make physicians select narrow-spectrum antibiotics more often in the treatment of children with RTI. Exploiting register data on all purchases of RTI antibiotics in a difference-in-differences analysis, wefind...... that P4P significantly increased the share of narrow-spectrum antibiotics. There are no signs that physicians gamed the system by issuing more prescriptions overall....

  19. Antibiotic-specific differences in the response of Staphylococcus aureus to treatment with antimicrobials combined with manuka honey

    Directory of Open Access Journals (Sweden)

    Michael eLiu

    2015-01-01

    Full Text Available Skin infections caused by antibiotic resistant Staphylococcus aureus are a significant health problem worldwide; often associated with high treatment cost and mortality rate. Complex natural products like New Zealand (NZ manuka honey have been revisited and studied extensively as an alternative to antibiotics due to their potent broad-spectrum antimicrobial activity, and the inability to isolate honey-resistant S. aureus. Previous studies showing synergistic effects between manuka-type honeys and antibiotics have been demonstrated against the growth of one methicillin-resistant S. aureus (MRSA strain. We have previously demonstrated strong synergistic activity between NZ manuka-type honey and rifampicin against growth and biofilm formation of multiple S. arueus strains. Here, we have expanded our investigation using multiple S. aureus strains and four different antibiotics commonly used to treat S. aureus-related skin infections: rifampicin, oxacillin, gentamicin and clindamycin. Using checkerboard microdilution and agar diffusion assays with S. aureus strains including clinical isolates and MRSA we demonstrate that manuka-type honey combined with these four antibiotics frequently produces a synergistic effect. In some cases when synergism was not observed, there was a significant enhancement in antibiotic susceptibility. Some strains that were highly resistant to an antibiotic when present alone become sensitive to clinically-achievable concentrations when combined with honey. However, not all of the S. aureus strains tested responded in the same way to these combinational treatments. Our findings support the use of NZ manuka-type honeys in clinical treatment against S. aureus-related infections and extend their potential use as an antibiotic adjuvant in combinational therapy. Our data also suggest that manuka-type honeys may not work as antibiotic adjuvants for all strains of S. aureus, and this may help determine the mechanistic processes

  20. Antibiotic treatment failure when consulting patients with respiratory tract infections in general practice

    DEFF Research Database (Denmark)

    Bordado Sköld, Margrethe; Aabenhus, Rune; Guassora, Ann Dorrit

    2017-01-01

    analysed using qualitative content analysis. Results: In patients with acute RTIs, GPs proposed and agreed to a medical definition of antibiotic treatment failure but believed patients’ views to differ significantly from this medical definition. GPs thought ATF affected their daily work only marginally......’ understanding of patients’ views of ATF. Methods: Qualitative study based on semi-structured, recorded interviews of 18 GPs between August and October 2012. The interviews started with discussion of a unique case of acute RTI involving ATF, followed by a more general reflection of the topic. Interviews were...

  1. Economic evaluation of antibiotic therapy versus appendicectomy for the treatment of uncomplicated acute appendicitis from the APPAC randomized clinical trial.

    Science.gov (United States)

    Sippola, S; Grönroos, J; Tuominen, R; Paajanen, H; Rautio, T; Nordström, P; Aarnio, M; Rantanen, T; Hurme, S; Salminen, P

    2017-09-01

    An increasing amount of evidence supports antibiotic therapy for treating uncomplicated acute appendicitis. The objective of this study was to compare the costs of antibiotics alone versus appendicectomy in treating uncomplicated acute appendicitis within the randomized controlled APPAC (APPendicitis ACuta) trial. The APPAC multicentre, non-inferiority RCT was conducted on patients with CT-confirmed uncomplicated acute appendicitis. Patients were assigned randomly to appendicectomy or antibiotic treatment. All costs were recorded, whether generated by the initial visit and subsequent treatment or possible recurrent appendicitis during the 1-year follow-up. The cost estimates were based on cost levels for the year 2012. Some 273 patients were assigned to the appendicectomy group and 257 to antibiotic treatment. Most patients randomized to antibiotic treatment did not require appendicectomy during the 1-year follow-up. In the operative group, overall societal costs (€5989·2, 95 per cent c.i. 5787·3 to 6191·1) were 1·6 times higher (€2244·8, 1940·5 to 2549·1) than those in the antibiotic group (€3744·4, 3514·6 to 3974·2). In both groups, productivity losses represented a slightly higher proportion of overall societal costs than all treatment costs together, with diagnostics and medicines having a minor role. Those in the operative group were prescribed significantly more sick leave than those in the antibiotic group (mean(s.d.) 17·0(8·3) (95 per cent c.i. 16·0 to 18·0) versus 9·2(6·9) (8·3 to 10·0) days respectively; P antibiotic therapy for uncomplicated appendicitis incurred lower costs than those who had surgery. © 2017 BJS Society Ltd Published by John Wiley & Sons Ltd.

  2. Host range of antibiotic resistance genes in wastewater treatment plant influent and effluent.

    Science.gov (United States)

    Hultman, Jenni; Tamminen, Manu; Pärnänen, Katariina; Cairns, Johannes; Karkman, Antti; Virta, Marko

    2018-04-01

    Wastewater treatment plants (WWTPs) collect wastewater from various sources for a multi-step treatment process. By mixing a large variety of bacteria and promoting their proximity, WWTPs constitute potential hotspots for the emergence of antibiotic resistant bacteria. Concerns have been expressed regarding the potential of WWTPs to spread antibiotic resistance genes (ARGs) from environmental reservoirs to human pathogens. We utilized epicPCR (Emulsion, Paired Isolation and Concatenation PCR) to detect the bacterial hosts of ARGs in two WWTPs. We identified the host distribution of four resistance-associated genes (tetM, int1, qacEΔ1and blaOXA-58) in influent and effluent. The bacterial hosts of these resistance genes varied between the WWTP influent and effluent, with a generally decreasing host range in the effluent. Through 16S rRNA gene sequencing, it was determined that the resistance gene carrying bacteria include both abundant and rare taxa. Our results suggest that the studied WWTPs mostly succeed in decreasing the host range of the resistance genes during the treatment process. Still, there were instances where effluent contained resistance genes in bacterial groups not carrying these genes in the influent. By permitting exhaustive profiling of resistance-associated gene hosts in WWTP bacterial communities, the application of epicPCR provides a new level of precision to our resistance gene risk estimates.

  3. Urban wastewater treatment plants as hotspots for antibiotic resistant bacteria and genes spread into the environment: a review.

    Science.gov (United States)

    Rizzo, L; Manaia, C; Merlin, C; Schwartz, T; Dagot, C; Ploy, M C; Michael, I; Fatta-Kassinos, D

    2013-03-01

    Urban wastewater treatment plants (UWTPs) are among the main sources of antibiotics' release into the environment. The occurrence of antibiotics may promote the selection of antibiotic resistance genes (ARGs) and antibiotic resistant bacteria (ARB), which shade health risks to humans and animals. In this paper the fate of ARB and ARGs in UWTPs, focusing on different processes/technologies (i.e., biological processes, advanced treatment technologies and disinfection), was critically reviewed. The mechanisms by which biological processes influence the development/selection of ARB and ARGs transfer are still poorly understood. Advanced treatment technologies and disinfection process are regarded as a major tool to control the spread of ARB into the environment. In spite of intense efforts made over the last years to bring solutions to control antibiotic resistance spread in the environment, there are still important gaps to fill in. In particular, it is important to: (i) improve risk assessment studies in order to allow accurate estimates about the maximal abundance of ARB in UWTPs effluents that would not pose risks for human and environmental health; (ii) understand the factors and mechanisms that drive antibiotic resistance maintenance and selection in wastewater habitats. The final objective is to implement wastewater treatment technologies capable of assuring the production of UWTPs effluents with an acceptable level of ARB. Copyright © 2013 Elsevier B.V. All rights reserved.

  4. Bacterial Communities and Antibiotic Resistance Communities in a Full-Scale Hospital Wastewater Treatment Plant by High-Throughput Pyrosequencing

    Directory of Open Access Journals (Sweden)

    Youngho Ahn

    2016-12-01

    Full Text Available The community of whole microbes and antibiotic resistance bacteria (ARB in hospital wastewater treatment plants (WWTP receiving domestic wastewater (DWW and hospital wastewater (HWW was investigated. Samples from an influent of a secondary clarifier, at each treatment train, were characterized for the whole microbial community and ARB on the antibiotic resistance database, based on high-throughput pyrosequencing. The pyrosequencing analysis revealed that the abundance of Bacteroidetes in the DWW sample was higher (~1.6 times than in the HWW sample, whereas the abundance of Proteobacteria in the HWW sample was greater than in the DWW sample. At the top twenty of the genus level, distinct genera were observed—Saprospiraceae in the DWW and Zoogloea in the HWW. Apart from the top twenty genera, minor genera showed various antibiotic resistance types based on the antibiotic resistance gene database.

  5. C-terminal provasopressin (copeptin) in patients with community-acquired pneumonia--influence of antibiotic pre-treatment: results from the German competence network CAPNETZ.

    Science.gov (United States)

    Krüger, Stefan; Ewig, Santiago; Kunde, Jan; Hanschmann, Alexa; Marre, Reinhard; Suttorp, Norbert; Welte, Tobias

    2009-07-01

    Recently, C-terminal provasopressin (copeptin) turned out to be predictive for mortality in community-acquired pneumonia (CAP). The aim of this study was to evaluate the influence of antibiotic pre-treatment on copeptin levels in CAP. We enrolled 370 hospitalized patients (66 +/- 17 years; 42% females) with proven CAP. Venous blood samples were collected at the time of inclusion into the study and as soon as possible after the diagnosis of CAP. Copeptin (B.R.A.H.M.S. AG, Henningsdorf, Germany) levels were determined in venous blood on admission. Eighty-five patients had antibiotic pre-treatment and 285 patients did not. Copeptin levels increased with increasing severity of CAP in patients without antibiotic pre-treatment but not in patients with antibiotic pre-treatment. Patients with prior antibiotic treatment showed significantly lower levels of copeptin [median (interquartile range): 12.8 (5.3-22.6) versus 20.8 (11.1-37.8) pmol/L, P antibiotic pre-treatment. Copeptin serum levels are higher in patients without antibiotic pre-treatment compared with those with antibiotic pre-treatment. Copeptin serum levels increase with an increasing severity of CAP in patients without, but not in patients with, antibiotic pre-treatment. Thus, antibiotic pre-treatment has to be taken into account for the correct interpretation of copeptin levels in CAP.

  6. [Inappropriate test methods in allergy].

    Science.gov (United States)

    Kleine-Tebbe, J; Herold, D A

    2010-11-01

    Inappropriate test methods are increasingly utilized to diagnose allergy. They fall into two categories: I. Tests with obscure theoretical basis, missing validity and lacking reproducibility, such as bioresonance, electroacupuncture, applied kinesiology and the ALCAT-test. These methods lack both the technical and clinical validation needed to justify their use. II. Tests with real data, but misleading interpretation: Detection of IgG or IgG4-antibodies or lymphocyte proliferation tests to foods do not allow to separate healthy from diseased subjects, neither in case of food intolerance, allergy or other diagnoses. The absence of diagnostic specificity induces many false positive findings in healthy subjects. As a result unjustified diets might limit quality of life and lead to malnutrition. Proliferation of lymphocytes in response to foods can show elevated rates in patients with allergies. These values do not allow individual diagnosis of hypersensitivity due to their broad variation. Successful internet marketing, infiltration of academic programs and superficial reporting by the media promote the popularity of unqualified diagnostic tests; also in allergy. Therefore, critical observation and quick analysis of and clear comments to unqualified methods by the scientific medical societies are more important than ever.

  7. Use of antibiotics in nursing homes--surveillance with different methods.

    Science.gov (United States)

    Eriksen, Hanne-Merete; Sæther, Anja Ramberg; Viktil, Kirsten K; Andberg, Lene; Munkerud, Marianne Winther; Willoch, Karin; Blix, Hege Salvesen

    2013-10-15

    Residents in nursing homes have a heightened risk of developing infections that should be treated with antibiotics. Inappropriate use of antibiotics may generate drug-related problems and increase resistance. In this study, we describe the use of antibiotics in nursing homes on the basis of prevalence surveys and drug sales statistics. Five nursing homes in Oslo participated in two one-day surveys in 2009. All use of systemic antibiotics was registered. The data collection was undertaken according to a protocol developed by the European Surveillance of Antimicrobial Consumption (ESAC) Network and was part of a European study. The nursing homes' drug sales statistics for systemic antibiotics during 2009, distributed by the number of bed days for each nursing home, were estimated. Information on indications for each antibiotic from the prevalence surveys was collated with sales data to achieve an estimate of how the purchased antibiotics were used. The prevalence surveys showed that more than 8% of the residents received antibiotics. Prophylactic treatment accounted for 33% of the prescriptions. A prevalence of antibiotic use of 10% was estimated from the drug sales statistics. Urinary tract infection was the most frequently registered indication. Pivmecillinam and methenamine were most frequently prescribed and most frequently purchased. Most courses of treatment were prescribed in accordance with the national guidelines for antibiotic use. The results from the drug sales statistics concurred well with the prevalence surveys, and the methods can thus be relevant for purposes of monitoring the use of antibiotics.

  8. Short-term antibiotic treatment has differing long-term impacts on the human throat and gut microbiome

    Energy Technology Data Exchange (ETDEWEB)

    Jakobsson, H.; Jernberg, C.; Andersson, A.F.; Sjolund-Karlsson, M.; Jansson, J.K.; Engstrand, L.

    2010-01-15

    Antibiotic administration is the standard treatment for the bacterium Helicobacter pylori, the main causative agent of peptic ulcer disease and gastric cancer. However, the long-term consequences of this treatment on the human indigenous microbiota are relatively unexplored. Here we studied short- and long-term effects of clarithromycin and metronidazole treatment, a commonly used therapy regimen against H. pylori, on the indigenous microbiota in the throat and in the lower intestine. The bacterial compositions in samples collected over a four year period were monitored by analyzing the 16S rRNA gene using 454-based pyrosequencing and terminal-restriction fragment length polymorphism (T-RFLP). While the microbial communities of untreated control subjects were relatively stable over time, dramatic shifts were observed one week after antibiotic treatment with reduced bacterial diversity in all treated subjects in both locations. While the microbiota of the different subjects responded uniquely to the antibiotic treatment some general trends could be observed; such as a dramatic decline in Actinobacteria in both throat and feces immediately after treatment. Although the diversity of the microbiota subsequently recovered to resemble the pre treatment states, the microbiota remained perturbed in some cases for up to four years post treatment. In addition, four years after treatment high levels of the macrolide resistance gene erm(B) were found, indicating that antibiotic resistance, once selected for, can persist for longer periods of time than previously recognized. This highlights the importance of a restrictive antibiotic usage in order to prevent subsequent treatment failure and potential spread of antibiotic resistance.

  9. Concurrent acute illness and comorbid conditions poorly predict antibiotic use in upper respiratory tract infections: a cross-sectional analysis

    Directory of Open Access Journals (Sweden)

    Perencevich Eli N

    2007-05-01

    Full Text Available Abstract Background Inappropriate antibiotic use promotes resistance. Antibiotics are generally not indicated for upper respiratory infections (URIs. Our objectives were to describe patterns of URI treatment and to identify patient and provider factors associated with antibiotic use for URIs. Methods This study was a cross-sectional analysis of medical and pharmacy claims data from the Pennsylvania Medicaid fee-for-service program database. We identified Pennsylvania Medicaid recipients with a URI office visit over a one-year period. Our outcome variable was antibiotic use within seven days after the URI visit. Study variables included URI type and presence of concurrent acute illnesses and chronic conditions. We considered the associations of each study variable with antibiotic use in a logistic regression model, stratifying by age group and adjusting for confounders. Results Among 69,936 recipients with URI, 35,786 (51.2% received an antibiotic. In all age groups, acute sinusitis, chronic sinusitis, otitis, URI type and season were associated with antibiotic use. Except for the oldest group, physician specialty and streptococcal pharyngitis were associated with antibiotic use. History of chronic conditions was not associated with antibiotic use in any age group. In all age groups, concurrent acute illnesses and history of chronic conditions had only had fair to poor ability to distinguish patients who received an antibiotic from patients who did not. Conclusion Antibiotic prevalence for URIs was high, indicating that potentially inappropriate antibiotic utilization is occurring. Our data suggest that demographic and clinical factors are associated with antibiotic use, but additional reasons remain unexplained. Insight regarding reasons for antibiotic prescribing is needed to develop interventions to address the growing problem of antibiotic resistance.

  10. The use of liposomal solutions of antibiotics in treatment of infected and festering wounds in children

    Directory of Open Access Journals (Sweden)

    Олег Владимирович Спахи

    2015-06-01

    Full Text Available Aim of research. To study the use of liposomal solutions of antibiotics in the complex treatment of infected and festering wounds in children.Materials and methods of research: The results of clinical and laboratory examinations of 77 children 3-18 years old with infected and festering wounds were analyzed. All children were distributed into groups of observation by the character of the treatment: in 37 sick children (the main group liposomal preparations were used in the complex treatment. Patients of the control group (40 children get the generally accepted complex treatment. The groups of comparison were statistically similar by the character and localization of pathological process, age, prescription of disease. In the main group an antibacterial-liposomal mixture was injected into the wound alongside with the generally accepted methods. The dynamics of the clinical, laboratory, cytological, bacteriological and morphological indicators was defined using the generally accepted technics. The general condition of patient’s organism was assessed with a help of laboratory methods of research (general clinical and biochemical analyses.Results. In the main group it was observed a persistent tendency to normalization of leukocytal formula and of the number of leukocytes in peripheral blood that reached normal values (p < 0,05 on 7th day. In 36 patients of the control group leukocytosis remained for 7 days. Evident differences of indicators of leukocytal index of intoxication and of an index of the shift of leukocytal formula in the main and the control groups were observed on 3-4th day. In addition its decrease was combined with diminution of an intensity of clinical symptoms and with decrease of manifestations of the local pathological process.Bacteriological examination of the nidus of inflammation in patients of examined groups revealed that in the main group the diminution of the degree of infectious contamination passed faster (p<0,05 – on

  11. Socioeconomic status and the likelihood of antibiotic treatment for signs and symptoms of pulmonary exacerbation in children with cystic fibrosis.

    Science.gov (United States)

    Schechter, Michael S; McColley, Susanna A; Regelmann, Warren; Millar, Stefanie J; Pasta, David J; Wagener, Jeffrey S; Konstan, Michael W; Morgan, Wayne J

    2011-11-01

    To determine whether socioeconomic status (SES) influences the likelihood of antibiotic treatment of pulmonary exacerbations in patients with cystic fibrosis (CF). We used data on 9895 patients ≤ 18 years old from the Epidemiologic Study of CF. After establishing an individual baseline of clinical signs and symptoms, we ascertained whether antibiotics were prescribed when new signs/symptoms suggested a pulmonary exacerbation, adjusting for sex, presence of Pseudomonas aeruginosa, the number of new signs/symptoms, and baseline disease severity. In a 12-month period, 20.0% of patients <6 years of age, 33.8% of patients 6 to 12 years of age, and 41.4% of patients 13 to 18 years of age were treated with any (oral, intravenous (IV), or inhaled) antibiotics; the percentage receiving IV antibiotics was 7.3%, 15.2%, and 20.9%, respectively. SES had little effect on treatment for pulmonary exacerbation with any antibiotics, but IV antibiotics were prescribed more frequently for patients with lower SES. SES-related disparities in CF health outcomes do not appear to be explained by differential treatment of pulmonary exacerbations. Copyright © 2011 Mosby, Inc. All rights reserved.

  12. Prescription pattern of antibiotic and analgesic in endodontic treatment in Kuwaiti population: A self-administered Survey

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    Manal J Al-Maslamani

    2014-01-01

    Full Text Available Introduction: Surgical and non-surgical endodontic treatment of involved teeth can necessitate prescription of analgesics and antimicrobials. The literature suggests confusion amongst practitioners regarding the need for adjunctive medication, mainly during non-surgical endodontic treatment, often leading to over-prescription. Aim: The aim of this study was to determine the current clinical practice of dentists participated in this study with respect to antibiotic and analgesic prescription patterns in their endodontic treatment management in Kuwait. Materials and Methods: Prescription patterns for antibiotics and analgesics were analyzed based on the responses to self-administered questionnaire (n = 169. Information was collected based on different clinical endodontic diagnostic scenarios. Statistical analysis was performed with SPSS software version 17.0 to determine relationships between prescription patterns, age, gender, and dental qualification (specialists and general dentists. Results: Ninety-two percent of dentists prescribed analgesics for the management of endodontic pain. While 16% prescribed antibiotics for severe dental pain; 62% prescribed antibiotics for acute apical abscesses. Significantly more male dentists prescribed antibiotics for dental pain than female dentists. No significant difference was found between general dental practitioners′ and specialists′ attitude toward drug prescriptions. Amoxicillin and ibuprofen were the most commonly prescribed medications. Conclusion: While the majority of dentists appeared to prescribe antibiotics and analgesics appropriately, some did not. This research confirmed previous studies and established a need for imparting information of evidence-based prescriptions protocols for the dentists surveyed in this study in Kuwait.

  13. Incidence, risk factors and treatment of diarrhoea among Dutch travellers: reasons not to routinely prescribe antibiotics

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    Belderok Sanne-Meike

    2011-10-01

    Full Text Available Abstract Background Travellers' diarrhoea (TD is the most common infectious disease among travellers. In the Netherlands, stand-by or prophylactic antibiotics are not routinely prescribed to travellers. This study prospectively assessed the incidence rate, risk factors, and treatment of TD among immunocompetent travellers. Methods Persons who attended the travel clinic of the Public Health Service Amsterdam in 2006-2007 before short-term travel to tropical and subtropical countries were invited to answer a questionnaire regarding sociodemographics and travel purpose; they were also asked to keep a daily structured travel diary, recording their itinerary, symptoms, and self-medication or consultation with a doctor. Diarrhoea episodes containing blood or mucous were considered severe. Results Of 1202 travellers, the median age was 38 years, and the median travel duration 3 weeks. Of all episodes, 96% were mild. The median duration of TD was 2 days and significantly shorter in subsequent episodes compared to first episodes (p Conclusions TD is common among travellers, but the overall course is mild, not requiring treatment. The incidence rates for first and second episodes are comparable. Female sex is a risk factor for the first episode, as well as subsequent ones. Prescription antibiotics are not needed in short-term healthy travellers.

  14. High-throughput profiling of antibiotic resistance genes in drinking water treatment plants and distribution systems.

    Science.gov (United States)

    Xu, Like; Ouyang, Weiying; Qian, Yanyun; Su, Chao; Su, Jianqiang; Chen, Hong

    2016-06-01

    Antibiotic resistance genes (ARGs) are present in surface water and often cannot be completely eliminated by drinking water treatment plants (DWTPs). Improper elimination of the ARG-harboring microorganisms contaminates the water supply and would lead to animal and human disease. Therefore, it is of utmost importance to determine the most effective ways by which DWTPs can eliminate ARGs. Here, we tested water samples from two DWTPs and distribution systems and detected the presence of 285 ARGs, 8 transposases, and intI-1 by utilizing high-throughput qPCR. The prevalence of ARGs differed in the two DWTPs, one of which employed conventional water treatments while the other had advanced treatment processes. The relative abundance of ARGs increased significantly after the treatment with biological activated carbon (BAC), raising the number of detected ARGs from 76 to 150. Furthermore, the final chlorination step enhanced the relative abundance of ARGs in the finished water generated from both DWTPs. The total enrichment of ARGs varied from 6.4-to 109.2-fold in tap water compared to finished water, among which beta-lactam resistance genes displayed the highest enrichment. Six transposase genes were detected in tap water samples, with the transposase gene TnpA-04 showing the greatest enrichment (up to 124.9-fold). We observed significant positive correlations between ARGs and mobile genetic elements (MGEs) during the distribution systems, indicating that transposases and intI-1 may contribute to antibiotic resistance in drinking water. To our knowledge, this is the first study to investigate the diversity and abundance of ARGs in drinking water treatment systems utilizing high-throughput qPCR techniques in China. Copyright © 2016 Elsevier Ltd. All rights reserved.

  15. Hypercalcemia, inappropriate calcitriol levels, and tuberculosis on hemodialysis.

    Science.gov (United States)

    Peces, R; Pobes, A; Díaz-Corte, C; Gago, E

    2000-08-01

    We describe a female patient undergoing hemodialysis who developed tuberculosis, hypercalcemia, and inappropriately elevated calcitriol levels. These findings suggest ectopic production of calcitriol by tuberculous granulomas. Successful treatment of tuberculosis led to a substantial decrease in the levels of calcium and calcitriol.

  16. Measuring coverage in MNCH: challenges in monitoring the proportion of young children with pneumonia who receive antibiotic treatment.

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    Harry Campbell

    Full Text Available Pneumonia remains a major cause of child death globally, and improving antibiotic treatment rates is a key control strategy. Progress in improving the global coverage of antibiotic treatment is monitored through large household surveys such as the Demographic and Health Surveys (DHS and the Multiple Indicator Cluster Surveys (MICS, which estimate antibiotic treatment rates of pneumonia based on two-week recall of pneumonia by caregivers. However, these survey tools identify children with reported symptoms of pneumonia, and because the prevalence of pneumonia over a two-week period in community settings is low, the majority of these children do not have true pneumonia and so do not provide an accurate denominator of pneumonia cases for monitoring antibiotic treatment rates. In this review, we show that the performance of survey tools could be improved by increasing the survey recall period or by improving either overall discriminative power or specificity. However, even at a test specificity of 95% (and a test sensitivity of 80%, the proportion of children with reported symptoms of pneumonia who truly have pneumonia is only 22% (the positive predictive value of the survey tool. Thus, although DHS and MICS survey data on rates of care seeking for children with reported symptoms of pneumonia and other childhood illnesses remain valid and important, DHS and MICS data are not able to give valid estimates of antibiotic treatment rates in children with pneumonia.

  17. Measuring coverage in MNCH: challenges in monitoring the proportion of young children with pneumonia who receive antibiotic treatment.

    Science.gov (United States)

    Campbell, Harry; El Arifeen, Shams; Hazir, Tabish; O'Kelly, James; Bryce, Jennifer; Rudan, Igor; Qazi, Shamim Ahmad

    2013-01-01

    Pneumonia remains a major cause of child death globally, and improving antibiotic treatment rates is a key control strategy. Progress in improving the global coverage of antibiotic treatment is monitored through large household surveys such as the Demographic and Health Surveys (DHS) and the Multiple Indicator Cluster Surveys (MICS), which estimate antibiotic treatment rates of pneumonia based on two-week recall of pneumonia by caregivers. However, these survey tools identify children with reported symptoms of pneumonia, and because the prevalence of pneumonia over a two-week period in community settings is low, the majority of these children do not have true pneumonia and so do not provide an accurate denominator of pneumonia cases for monitoring antibiotic treatment rates. In this review, we show that the performance of survey tools could be improved by increasing the survey recall period or by improving either overall discriminative power or specificity. However, even at a test specificity of 95% (and a test sensitivity of 80%), the proportion of children with reported symptoms of pneumonia who truly have pneumonia is only 22% (the positive predictive value of the survey tool). Thus, although DHS and MICS survey data on rates of care seeking for children with reported symptoms of pneumonia and other childhood illnesses remain valid and important, DHS and MICS data are not able to give valid estimates of antibiotic treatment rates in children with pneumonia.

  18. Enhanced biodegradation of antibiotic combinations via the sequential treatment of the sludge resulting from pharmaceutical wastewater treatment using white-rot fungi Trametes versicolor and Bjerkandera adusta.

    Science.gov (United States)

    Aydin, Sevcan

    2016-07-01

    While anaerobic treatment is capable of treating pharmaceutical wastewater and removing antibiotics in liquid phases, solid phases may still contain significant amounts of antibiotics following this treatment. The main goal of this study was to evaluate the use of white-rot fungi to remove erythromycin, sulfamethoxazole, and tetracycline combinations from biosolids. The degradation potential of Trametes versicolor and Bjerkandera adusta was evaluated via the sequential treatment of anaerobic sludge. Polymerase chain reaction-denaturing gradient gel electrophoresis (PCR-DGGE) analyses were used to identify competition between the autochthonous microbial communities and white-rot fungi. Solid-phase treatment using white-rot fungi substantially reduced antibiotic concentrations and toxicity in sludge. According to PCR-DGGE results, there is an association between species of fungus and antibiotic type as a result of the different transformation pathways of fungal strains. Fungal post-treatment of sludge represents a promising method of removing antibiotic combinations, therefore holding a significant promise as an environmentally friendly means of degrading the antibiotics present in sludge.

  19. Probiotics and antibiotic-associated diarrhea in children: A review and new evidence on Lactobacillus rhamnosus GG during and after antibiotic treatment.

    Science.gov (United States)

    Mantegazza, Cecilia; Molinari, Paola; D'Auria, Enza; Sonnino, Micol; Morelli, Lorenzo; Zuccotti, Gian Vincenzo

    2018-02-01

    Antibiotic associated diarrhea (AAD) is a common complication in childhood in the outpatient and inpatient settings. This review provides up to date information on the use of probiotics in the prevention and treatment of AAD, including that from Clostridium Difficile, in children. The most recently systematic reviews and subsequently published randomized controlleds trials are considered. Different single and multistrain probiotics are described; a specific recommendation for the use of Lactobacillus Rhamnosus GG (LGG) and Saccharomyces boulardii (Sb) emerges. New information on LGG survival under amoxicillin/clavulanate therapy in children is also provided. This information is relevant in view of the frequent use of this molecule in children, its association with AAD, and LGG's sensitivity to penicillin that might make this probiotic ineffective. In spite of a demonstrated positive effect of specific strains of probiotics on AAD, safety issues still remain among which the risk of associated severe infections and of antibiotic resistant gene exchange. Copyright © 2017 Elsevier Ltd. All rights reserved.

  20. Late treatment with polyene antibiotics can prolong the survival time of scrapie-infected animals.

    Science.gov (United States)

    Demaimay, R; Adjou, K T; Beringue, V; Demart, S; Lasmézas, C I; Deslys, J P; Seman, M; Dormont, D

    1997-12-01

    Amphotericin B (AmB) is one of the few drugs able to prolong survival times in experimental scrapie and delays the accumulation of PrPres, a specific marker of this disease in the brain in vivo. Previous reports showed that the AmB effect is observed only if the drug is administered around the time of infection. In the present study, intracerebrally infected mice were treated with AmB or one of its derivatives, MS-8209, between 80 and 140 days postinoculation. We observed an increased incubation time and a delay in PrPres accumulation and glial fibrillary acidic protein gene expression. Treatment starting at 80 days postinoculation was as efficient as long-term treatment starting the day of inoculation. Our results indicate that polyene antibiotics may interfere, throughout the course of the experimental disease, with the propagation of the scrapie agent.

  1. Bacterial biofilm mechanical properties persist upon antibiotic treatment and survive cell death

    International Nuclear Information System (INIS)

    Zrelli, K; Galy, O; Henry, N; Latour-Lambert, P; Ghigo, J M; Beloin, C; Kirwan, L

    2013-01-01

    Bacteria living on surfaces form heterogeneous three-dimensional consortia known as biofilms, where they exhibit many specific properties one of which is an increased tolerance to antibiotics. Biofilms are maintained by a polymeric network and display physical properties similar to that of complex fluids. In this work, we address the question of the impact of antibiotic treatment on the physical properties of biofilms based on recently developed tools enabling the in situ mapping of biofilm local mechanical properties at the micron scale. This approach takes into account the material heterogeneity and reveals the spatial distribution of all the small changes that may occur in the structure. With an Escherichia coli biofilm, we demonstrate using in situ fluorescent labeling that the two antibiotics ofloxacin and ticarcillin—targeting DNA replication and membrane assembly, respectively—induced no detectable alteration of the biofilm mechanical properties while they killed the vast majority of the cells. In parallel, we show that a proteolytic enzyme that cleaves extracellular proteins into short peptides, but does not alter bacterial viability in the biofilm, clearly affects the mechanical properties of the biofilm structure, inducing a significant increase of the material compliance. We conclude that conventional biofilm control strategy relying on the use of biocides targeting cells is missing a key target since biofilm structural integrity is preserved. This is expected to efficiently promote biofilm resilience, especially in the presence of persister cells. In contrast, the targeting of polymer network cross-links—among which extracellular proteins emerge as major players—offers a promising route for the development of rational multi-target strategies to fight against biofilms. (paper)

  2. Prolonged antibiotic treatment induces a diabetogenic intestinal microbiome that accelerates diabetes in NOD mice.

    Science.gov (United States)

    Brown, Kirsty; Godovannyi, Artem; Ma, Caixia; Zhang, YiQun; Ahmadi-Vand, Zahra; Dai, Chaunbin; Gorzelak, Monika A; Chan, YeeKwan; Chan, Justin M; Lochner, Arion; Dutz, Jan P; Vallance, Bruce A; Gibson, Deanna L

    2016-02-01

    Accumulating evidence supports that the intestinal microbiome is involved in Type 1 diabetes (T1D) pathogenesis through the gut-pancreas nexus. Our aim was to determine whether the intestinal microbiota in the non-obese diabetic (NOD) mouse model played a role in T1D through the gut. To examine the effect of the intestinal microbiota on T1D onset, we manipulated gut microbes by: (1) the fecal transplantation between non-obese diabetic (NOD) and resistant (NOR) mice and (2) the oral antibiotic and probiotic treatment of NOD mice. We monitored diabetes onset, quantified CD4+T cells in the Peyer's patches, profiled the microbiome and measured fecal short-chain fatty acids (SCFA). The gut microbiota from NOD mice harbored more pathobionts and fewer beneficial microbes in comparison with NOR mice. Fecal transplantation of NOD microbes induced insulitis in NOR hosts suggesting that the NOD microbiome is diabetogenic. Moreover, antibiotic exposure accelerated diabetes onset in NOD mice accompanied by increased T-helper type 1 (Th1) and reduced Th17 cells in the intestinal lymphoid tissues. The diabetogenic microbiome was characterized by a metagenome altered in several metabolic gene clusters. Furthermore, diabetes susceptibility correlated with reduced fecal SCFAs. In an attempt to correct the diabetogenic microbiome, we administered VLS#3 probiotics to NOD mice but found that VSL#3 colonized the intestine poorly and did not delay diabetes. We conclude that NOD mice harbor gut microbes that induce diabetes and that their diabetogenic microbiome can be amplified early in life through antibiotic exposure. Protective microbes like VSL#3 are insufficient to overcome the effects of a diabetogenic microbiome.

  3. Bacterial biofilm mechanical properties persist upon antibiotic treatment and survive cell death

    Science.gov (United States)

    Zrelli, K.; Galy, O.; Latour-Lambert, P.; Kirwan, L.; Ghigo, J. M.; Beloin, C.; Henry, N.

    2013-12-01

    Bacteria living on surfaces form heterogeneous three-dimensional consortia known as biofilms, where they exhibit many specific properties one of which is an increased tolerance to antibiotics. Biofilms are maintained by a polymeric network and display physical properties similar to that of complex fluids. In this work, we address the question of the impact of antibiotic treatment on the physical properties of biofilms based on recently developed tools enabling the in situ mapping of biofilm local mechanical properties at the micron scale. This approach takes into account the material heterogeneity and reveals the spatial distribution of all the small changes that may occur in the structure. With an Escherichia coli biofilm, we demonstrate using in situ fluorescent labeling that the two antibiotics ofloxacin and ticarcillin—targeting DNA replication and membrane assembly, respectively—induced no detectable alteration of the biofilm mechanical properties while they killed the vast majority of the cells. In parallel, we show that a proteolytic enzyme that cleaves extracellular proteins into short peptides, but does not alter bacterial viability in the biofilm, clearly affects the mechanical properties of the biofilm structure, inducing a significant increase of the material compliance. We conclude that conventional biofilm control strategy relying on the use of biocides targeting cells is missing a key target since biofilm structural integrity is preserved. This is expected to efficiently promote biofilm resilience, especially in the presence of persister cells. In contrast, the targeting of polymer network cross-links—among which extracellular proteins emerge as major players—offers a promising route for the development of rational multi-target strategies to fight against biofilms.

  4. Evaluation of a vegetative treatment system to reduce fecal microorganisms and antibiotic resistant bacteria in beef cattle feedlot runoff

    Science.gov (United States)

    Vegetative treatment systems designed to treat beef cattle feedlot runoff are an alternative to holding ponds and involve short-term runoff accumulation in basins and application to grass treatment areas. Field evaluations are needed to determine if pathogens, fecal indicators, and antibiotic resis...

  5. Inactivation and reactivation of antibiotic-resistant bacteria by chlorination in secondary effluents of a municipal wastewater treatment plant.

    Science.gov (United States)

    Huang, Jing-Jing; Hu, Hong-Ying; Tang, Fang; Li, Yi; Lu, Sun-Qin; Lu, Yun

    2011-04-01

    Reports state that chlorination of drinking water and wastewater affects the proportions of antibiotic-resistant bacteria by potentially assisting in microbial selection. Studies on the effect of chlorination on like species of antibiotic-resistant bacteria, however, have shown to be conflicting; furthermore, few studies have inspected the regrowth or reactivation of antibiotic-resistant bacteria after chlorination in wastewater. To understand the risks of chlorination resulting from potentially selecting for antibiotic-resistant bacteria, inactivation and reactivation rates of both total heterotrophic bacteria and antibiotic-resistant bacteria (including penicillin-, ampicillin-, tetracycline-, chloramphenicol-, and rifampicin-resistant bacteria) were examined after chlorinating secondary effluent samples from a municipal wastewater treatment plant in this study. Our experimental results indicated similar inactivation rates of both total heterotrophic bacteria and antibiotic-resistant bacteria. Microbial community composition, however, was affected by chlorination: treating samples with 10 mg Cl(2)/L for 10 min resulted in chloramphenicol-resistant bacteria accounting for nearly 100% of the microbial population in contrast to 78% before chlorination. This trend shows that chlorination contributes to selection of some antibiotic-resistant strains. Reactivation of antibiotic-resistant bacteria occurred at 2.0 mg Cl(2)/L for 10 min; specifically, chloramphenicol-, ampicillin-, and penicillin-resistant bacteria were the three prevalent groups present, and the reactivation of chloramphenicol-resistant bacteria exceeded 50%. Regrowth and reactivation of antibiotic-resistant bacteria in secondary effluents after chlorination with a long retention time could threaten public health security during wastewater reuse. Copyright © 2011 Elsevier Ltd. All rights reserved.

  6. Occurrence and removal of antibiotics and the corresponding resistance genes in wastewater treatment plants: effluents' influence to downstream water environment.

    Science.gov (United States)

    Li, Jianan; Cheng, Weixiao; Xu, Like; Jiao, Yanan; Baig, Shams Ali; Chen, Hong

    2016-04-01

    In this study, the occurrence of 8 antibiotics [3 tetracyclines (TCs), 4 sulfonamides, and 1 trimethoprim (TMP)], 12 antibiotic resistance genes (ARGs) (10 tet, 2 sul), 4 types of bacteria [no antibiotics, anti-TC, anti-sulfamethoxazole (SMX), and anti-double], and intI1 in two wastewater treatment plants (WWTPs) were assessed and their influences in downstream lake were investigated. Both WWTPs' effluent demonstrated some similarities, but the abundance and removal rate varied significantly. Results revealed that biological treatment mainly removed antibiotics and ARGs, whereas physical techniques were found to eliminate antibiotic resistance bacteria (ARBs) abundance (about 1 log for each one). UV disinfection did not significantly enhance the removal efficiency, and the release of the abundantly available target contaminants from the excess sludge may pose threats to human and the environment. Different antibiotics showed diverse influences on the downstream lake, and the concentrations of sulfamethazine (SM2) and SMX were observed to increase enormously. The total ARG abundance ascended about 0.1 log and some ARGs (e.g., tetC, intI1, tetA) increased due to the high input of the effluent. In addition, the abundance of ARB variation in the lake also changed, but the abundance of four types of bacteria remained stable in the downstream sampling sites.

  7. Peritoneal fluid culture and antibiotic treatment in patients with perforated appendicitis in a Pacific Island

    Directory of Open Access Journals (Sweden)

    Alexia Boueil

    2015-10-01

    Conclusion: Although antibiotic use may be considered as an adjunct to surgical intervention of AP, the appropriate use of preoperative antibiotics and modifications according to culture results are essential to prevent infectious complications.

  8. Systemic antibiotics in the treatment of aggressive periodontitis. A systematic review and a Bayesian Network meta-analysis.

    Science.gov (United States)

    Rabelo, Cleverton Correa; Feres, Magda; Gonçalves, Cristiane; Figueiredo, Luciene C; Faveri, Marcelo; Tu, Yu-Kang; Chambrone, Leandro

    2015-07-01

    The aim of this study was to assess the effect of systemic antibiotic therapy on the treatment of aggressive periodontitis (AgP). This study was conducted and reported in accordance with the PRISMA statement. The MEDLINE, EMBASE and CENTRAL databases were searched up to June 2014 for randomized clinical trials comparing the treatment of subjects with AgP with either scaling and root planing (SRP) alone or associated with systemic antibiotics. Bayesian network meta-analysis was prepared using the Bayesian random-effects hierarchical models and the outcomes reported at 6-month post-treatment. Out of 350 papers identified, 14 studies were eligible. Greater gain in clinical attachment (CA) (mean difference [MD]: 1.08 mm; p < 0.0001) and reduction in probing depth (PD) (MD: 1.05 mm; p < 0.00001) were observed for SRP + metronidazole (Mtz), and for SRP + Mtz + amoxicillin (Amx) (MD: 0.45 mm, MD: 0.53 mm, respectively; p < 0.00001) than SRP alone/placebo. Bayesian network meta-analysis showed additional benefits in CA gain and PD reduction when SRP was associated with systemic antibiotics. SRP plus systemic antibiotics led to an additional clinical effect compared with SRP alone in the treatment of AgP. Of the antibiotic protocols available for inclusion into the Bayesian network meta-analysis, Mtz and Mtz/Amx provided to the most beneficial outcomes. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  9. Xuebijing Injection Combined with Antibiotics for the Treatment of Spontaneous Bacterial Peritonitis in Liver Cirrhosis: A Meta-Analysis

    Directory of Open Access Journals (Sweden)

    Dan Han

    2018-01-01

    Full Text Available Background and Aim. Spontaneous bacterial peritonitis (SBP is one of the most common complications of liver cirrhosis. Antibiotics are the main treatment regimen of SBP. Traditional Chinese medicine Xuebijing injection has been used in such patients. Our study aimed to overview the efficacy of Xuebijing injection combined with antibiotics for the treatment of SBP. Method. We searched the PubMed, Embase, China National Knowledge Infrastructure, VIP, and Wanfang databases. The search items included “Xuebijing”, “peritonitis”, “liver cirrhosis”, and “random” to identify all relevant randomized controlled trials (RCTs. The Cochrane risk of bias tool was used to assess the study quality. The odd ratios (ORs with 95% confidence intervals (CIs were calculated by using a random-effect model. Heterogeneity was also calculated. Results. A total of 9 RCTs were included. The study quality was unsatisfied. The overall (OR = 2.95, 95% CI = 1.97–4.42, p<0.00001 and complete (OR = 2.18, 95% CI = 1.57–3.04, p<0.00001 responses were significantly higher in the Xuebijing injection combined with antibiotics group than the antibiotics alone group. The incidence of cirrhosis related complications, including hepatic encephalopathy and hepatorenal syndrome, was lower in the Xuebijing injection combined with antibiotics group than the antibiotics alone group. No significant heterogeneity was observed among studies. Conclusion. Additional use of Xuebijing injection may improve the efficacy of antibiotics for the treatment of SBP in liver cirrhosis. However, due to a low level of current evidence, we did not establish any recommendation regarding the use of Xuebijing injection for the treatment of SBP.

  10. Self-medication with antibiotics in Jordanian population.

    Science.gov (United States)

    Al-Azzam, Sayer I; Al-Husein, Belal A; Alzoubi, Firas; Masadeh, Majed M; Al-Horani, Mohammad Ali S

    2007-01-01

    A survey was conducted to estimate the prevalence of self-medication with antibiotics in Jordan and evaluate the factors associated with antibiotic misuse. Validated questionnaire was used to collect data from a sample of 1943 households (9281 persons) selected from among different cities in Jordan. 842 (39.5%) of 2133 antibiotic users identified via the survey had used antibiotics without a prescription within a one-month study period. Self-medication with antibiotics was found to be significantly associated with age, income, and level of education. The main reason for self-medication as reported by the participants was their previous experience on the efficacy of treatment. The main sources of antibiotics were the previously prescribed pharmaceuticals stored in the household and those purchased in pharmacies. The prevalence of self-medication with antibiotics in Jordan is alarmingly high. Given the growing global resistance to antibiotics and the documented health problems related to their inappropriate use, our findings may have major public health policy implications in Jordan.

  11. [Change in attitude towards antibiotic prescriptions among Icelandic general practitioners].

    Science.gov (United States)

    Matthíasdóttir, Anna Mjöll; Guðnason, Thórólfur; Halldórsson, Matthías; Haraldsson, Ásgeir; Kristinsson, Karl G

    2016-01-01

    Antibiotic use is a leading cause of antibiotic resistance and it is therefore important to reduce unnecessary prescribing in Iceland where antibiotic use is relatively high. The purpose of this study was to explore antibiotic prescribing practices among Icelandic physicians and compare the results with results of comparable studies from 1991 and 1995 conducted by the Directorate of Health, Iceland. A descriptive cross-sectional study was carried out among all general practitioners registered in Iceland in 1991 and 1995 and all physicians registered in March 2014. Data was collected with questionnaires regarding diagnosis and treatment of simple urinary tract infection, acute otitis media and pharyngitis. A multiple logistic regression analysis was performed and level of significance p≤0.05. Response rates were 85% and 93% in 1991 and 1995 but 31% in 2014. Proportion of physicians who consider themselves prescribing antibiotics more than 10 times per week was 36% in 1991, 32% in 1995 and 21% in 2014. Proportion of trimethoprim-sulfamethoxazole as first choice for simple urinary tract infection reduced from 43% and 45% to 8% in 2014. In 2014, general practitioners considered themselves 87% less likely to prescribe an antibiotic for acute otitis media than in 1991 (pAntibiotic prescribing practices have changed significantly in the past two decades in Iceland becoming more in line with clinical guidelines. Improvements are still needed to further reduce inappropriate antibiotic use.

  12. Impacts of Antibiotic and Bacteriophage Treatments on the Gut-Symbiont-Associated Blissus insularis (Hemiptera: Blissidae

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    Yao Xu

    2016-11-01

    Full Text Available The Southern chinch bug, Blissus insularis, possesses specialized midgut crypts that harbor dense populations of the exocellular symbiont Burkholderia. Oral administration of antibiotics suppressed the gut symbionts in B. insularis and negatively impacted insect host fitness, as reflected by retarded development, smaller body size, and higher susceptibility to an insecticide, bifenthrin. Considering that the antibiotics probably had non-lethal but toxic effects on host fitness, attempts were conducted to reduce gut symbionts using bacteriophage treatment. Soil-lytic phages active against the cultures of specific Burkholderia ribotypes were successfully isolated using a soil enrichment protocol. Characterization of the BiBurk16MC_R phage determined its specificity to the Bi16MC_R_vitro ribotype and placed it within the family Podoviridae. Oral administration of phages to fifth-instar B. insularis, inoculated with Bi16MC_R_vitro as neonates had no deleterious effects on host fitness. However, the ingested phages failed to impact the crypt-associated Burkholderia. The observed inactivity of the phage was likely due to the blockage of the connection between the anterior and posterior midgut regions. These findings suggest that the initial colonization by Burkholderia programs the ontogeny of the midgut, providing a sheltered residence protected from microbial antagonists.

  13. The Immune Response of Acanthaster planci to Oxbile Injections and Antibiotic Treatment

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    Alexandra Grand

    2014-01-01

    Full Text Available Bile salts have been recently identified as a rapid and effective method for killing A. planci. However the mechanistic basis of this new control method is poorly understood. This study explored the immune response(s of A. planci and/or pathogenesis resulting from the injection of bile salts. To account for the possible role of pathogenesis in causing high rates of mortality, A. planci was treated with antibiotics to minimise the incidence and severity of bacterial infections. No significant difference in the time to death between groups with and without antibiotic treatment was reported, suggesting a limited bacterial effect on the induction of disease and death of injected sea stars. The number of circulating coelomocytes increased significantly after injection confirming the induction of a strong immune response. Five types of circulating cells were identified: (1 phagocytes, (2 small hyaline cells, (3 colourless spherule cells, (4 red spherule cells, and (5 fusiform cells. Histological analysis of A. planci tissues showed that the mechanism leading to rapid mortality is related to necrosis and/or apoptosis, rather than transmissible disease. Therefore, bile salts are an effective and safe method for killing crown-of-thorns sea star in situ.

  14. Differential temporal changes of primary and secondary bacterial symbionts and whitefly host fitness following antibiotic treatments

    Science.gov (United States)

    Zhang, Chang-Rong; Shan, Hong-Wei; Xiao, Na; Zhang, Fan-Di; Wang, Xiao-Wei; Liu, Yin-Quan; Liu, Shu-Sheng

    2015-01-01

    Where multiple symbionts coexist in the same host, the selective elimination of a specific symbiont may enable the roles of a given symbiont to be investigated. We treated the Mediterranean species of the whitefly Bemisia tabaci complex by oral delivery of the antibiotic rifampicin, and then examined the temporal changes of its primary symbiont “Candidatus Portiera aleyrodidarum” and secondary symbiont “Ca. Hamiltonella defensa” as well as host fitness for three generations. In adults treated with rifampicin (F0), the secondary symbiont was rapidly reduced, approaching complete disappearance as adults aged. In contrast, the primary symbiont was little affected until later in the adult life. In the offspring of these adults (F1), both symbionts were significantly reduced and barely detectable when the hosts reached the adult stage. The F1 adults laid few eggs (F2), all of which failed to hatch. Mating experiments illustrated that the negative effects of rifampicin on host fitness were exerted via female hosts but not males. This study provides the first evidence of differential temporal reductions of primary and secondary symbionts in whiteflies following an antibiotic treatment. Studies that disrupt functions of bacterial symbionts must consider their temporal changes. PMID:26510682

  15. Antibiotic loaded chitosan bar. An in vitro, in vivo study of a possible treatment for osteomyelitis.

    Science.gov (United States)

    Aimin, C; Chunlin, H; Juliang, B; Tinyin, Z; Zhichao, D

    1999-09-01

    A biodegradable drug delivery system of a gentamicin loaded chitosan bar with sustained antibiotic effect is described. Chitosan has proven to be a biocompatible aminopolysaccharide and a matrix for controlled release of pharmaceuticals. Combined crosslinking, solvent evaporation, and a cylinder model cutting technique was used to prepare the chitosan bar. Sustained diffusion of gentamicin into the surrounding medium was seen using a release test in vitro. Approximately 11% gentamicin was released from the bar in the first 24 hours. The gentamicin released from the bar showed significant antibacterial activity. The bar implanted in the proximal portion of the rabbit tibia produced a low blood concentration of gentamicin, but a much higher concentration was produced in local bone and in the hematoma. In all bone tissue around the bar, the gentamicin concentration exceeded the minimum inhibitory concentration for the common causative organisms of osteomyelitis for approximately 8 weeks. The implant caused no systemic side effects. Based on these test results together with the chitosan characteristics of biodegradable, antibiotic, and immunologic activity, the gentamicin loaded chitosan bar seems to be a clinically useful method for the treatment of bone infection. This system has an advantage over other systems in that it avoids a second operation for removal of the carrier.

  16. Effects of In Vitro Antibiotic Resistance on Treatment: Bismuth-Containing Regimens

    Directory of Open Access Journals (Sweden)

    Naoki Chiba

    2000-01-01

    Full Text Available Bismuth compounds remain useful for Helicobacter pylori eradication therapy. These include colloidal bismuth subcitrate (CBS, bismuth subsalicylate (BSS and, most recently, ranitidine bismuth citrate (RBC. CBS appears to prevent the development of imidazole resistance when coadministered with nitroimidazoles. Traditional triple therapy with bismuth, metronidazole and tetracycline or amoxicillin (BMT/A only partially overcomes metronidazole resistance. However, the addition of a PPI to bismuth triple therapy largely overcomes established metronidazole resistance if treatment is given for at least one week or more. When RBC rather than PPI is used with clarithromycin, this dual regimen appears to be more effective in preventing the development of secondary clarithromycin resistance. The triple combination of RBC, metronidazole and clarithromycin appears to be effective against metronidazole resistant strains of H pylori. Thus, overall, there is some evidence that bismuth compounds may prevent the development of antibiotic resistance and that existing antibiotic resistance may at least be partially overcome in vitro and in vivo. With the growing emergence of H pylori resistance to metronidazole and clarithromycin, further research to clarify the role of bismuth compounds is required.

  17. Occurrence and fate of quinolone and fluoroquinolone antibiotics in a municipal sewage treatment plant.

    Science.gov (United States)

    Jia, Ai; Wan, Yi; Xiao, Yang; Hu, Jianying

    2012-02-01

    This study developed a method for analysis of nineteen quinolone and fluoroquinolone antibiotics (FQs) in sludge samples, and investigated the occurrence and fate of the FQs in a municipal sewage treatment plant (STP) with anaerobic, anoxic, and aerobic treatment processes. Eleven compounds, including pipemidic acid, fleroxacin, ofloxacin, norfloxacin, ciprofloxacin, enrofloxacin, lomefloxacin, sparfloxacin, gatifloxacin, moxifloxacin, and sarafloxacin (only in sludge), were detected in the STP. The predominance of ofloxacin and norfloxacin, followed by lomefloxacin, ciprofloxacin, gatifloxacin, and moxifloxacin, were found in wastewater, suspended solids, and sludge. The total concentrations of FQs were 2573 ± 241 ng/L, 1013 ± 218 ng/L, and 18.4 ± 0.9 mg/kg in raw sewage, secondary effluent, and sludge, respectively. Extremely low mass change percentages were observed for FQs in anaerobic, anoxic, and aerobic treatment units, suggesting biodegradation to be of minor importance in the removal of FQs in STPs. 50-87% of the initial FQs loadings (except for pipemidic acid (36%)) were ultimately found in the dewatered sludge. Mean removal efficiencies of FQs in the STP were 56-75%, except for new generation drugs such as moxifloxacin (40 ± 5%) and gatifloxacin (43 ± 13%). A significant positive correlation was found between removal efficiencies and K(d) of FQs. The major factor in the removal of FQs in the STP was sorption to sludge, which was not governed by hydrophobic interactions. The long-term cycling and persistence of FQs in the STP has made activated sludge as a huge reservoir of FQ antibiotics. Copyright © 2011 Elsevier Ltd. All rights reserved.

  18. Oral soft tissue infections: causes, therapeutic approaches and microbiological spectrum with focus on antibiotic treatment.

    Science.gov (United States)

    Götz, Carolin; Reinhart, Edeltraud; Wolff, Klaus-Dietrich; Kolk, Andreas

    2015-11-01

    Intraoral soft tissue infections (OSTI) are a common problem in dentistry and oral surgery. These abscesses are mostly exacerbated dental infections (OIDC), and some emerge as postoperative infections (POI) after tooth extraction (OITR) or apicoectomy (OIRR). The main aim of this study was to compare OIDC with POI, especially looking at the bacteria involved. An additional question was, therefore, if different antibiotic treatments should be used with OSTI of differing aetiologies. The impact of third molars on OSTI was evaluated and also the rates of POI after removal of third molars were specified. Patient data was collected from the patients' medical records and the results were statistically evaluated with SPSS (SPSS version 21.0; SPSS, IBM; Chicago, IL, USA). The inclusion criterion was the outpatient treatment of a patient with an exacerbated oral infection; the exclusion criteria were an early stage of infiltration without abscess formation; and a need for inpatient treatment. Periapical exacerbated infections, especially in the molar region were the commonest cause of OIDC. In the OITR group, mandibular tooth removal was the commonest factor (p=0.016). Remarkably, retained lower wisdom teeth led to significant number of cases in the OITR group (p=0.022). In our study we could not define differences between the causal bacteria found in patients with OIDC and POI. Due to resistance rates we conclude that amoxicillin combined with clavulanic acid seems to be the antibiotic standard for exacerbated intraoral infections independent of their aetiology. Copyright © 2015 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  19. A survey of primary care physician practices in antibiotic prescribing for the treatment of uncomplicated male gonoccocal urethritis

    Directory of Open Access Journals (Sweden)

    Blanchon Thierry

    2011-05-01

    Full Text Available Abstract Background The development of resistance to antimicrobial therapy by Neisseria gonorrhoeae causes on-going problems for individual case management of gonorrhoea. Surveillance data about N. gonorrhoeae have indicated an increase in the incidence of gonorrhoea in France in 2006. As a consequence of the development of antibiotic resistance in N. gonorrhoeae, French guidelines excluded fluoroquinolones as a standard treatment for N. gonorrhoeae. Ceftriaxone became the recommended treatment, associated with azithromycin for Clamydia trachomatis infection. Our aim was to describe the practice patterns of general practitioners (GPs in managing the antibiotic treatment of patients with symptoms suggestive of uncomplicated male urethritis. Methods We developed a clinical vignette describing a man with typical gonococcal urethritis symptoms to elicit questions about antibiotic treatment. We mailed the electronic questionnaire to a random sample of 1000 French GPs belonging to the Sentinelles Network. Results By the end of the survey period, 350 vignettes were received, yielding a response rate of 35%. Sixty-six GPs (20.2% prescribed the recommended antibiotics for the simultaneous treatment of N. gonorrhoeae and C. trachomatis infections, while 132 GPs (40.4% prescribed only non-recommended antibiotics, including ciprofloxacin in 69 cases (21.1%. General practitioners with less than 10 years in practice showed better compliance to guidelines than those with more years in practice (p Conclusions The results suggest a mismatch between the guidelines and the antibiotic treatment of male uncomplicated urethritis by French GPs, mostly among the subgroup of physicians who have been in practice longer. Educational approaches based on practice feedback need to be developed to improve these deficits in the quality of care.

  20. Potentially inappropriate prescribing in an Irish elderly population in primary care.

    LENUS (Irish Health Repository)

    Ryan, Cristín

    2009-12-01

    WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT: * Potentially inappropriate prescribing in older people is a well-documented problem and has been associated with adverse drug reactions and hospitalization. * Beers\\' criteria, Screening Tool of Older Persons\\' potentially inappropriate Prescriptions (STOPP) and Screening Tool to Alert doctors to Right Treatment (START) are screening tools that have been formulated to help physicians and pharmacists identify potentially inappropriate prescribing and potential prescribing omissions. * The prevalence of potentially inappropriate prescribing and prescribing omissions in the elderly population presenting to hospital with acute illness is high according to STOPP and START criteria.

  1. Predictive Value of Prior Colonization and Antibiotic Use for Third-Generation Cephalosporin-Resistant Enterobacteriaceae Bacteremia in Patients With Sepsis

    NARCIS (Netherlands)

    Rottier, Wouter C.; Bamberg, Yara R. P.; Dorigo-Zetsma, J. Wendelien; van der Linden, Paul D.; Ammerlaan, Heidi S. M.; Bonten, Marc J. M.

    2015-01-01

    Background. To prevent inappropriate empiric antibiotic treatment in patients with bacteremia caused by third-generation cephalosporin (3GC)-resistant Enterobacteriaceae (3GC-R EB), Dutch guidelines recommend beta-lactam and aminoglycoside combination therapy or carbapenem monotherapy in patients

  2. Environmental risk assessment of antibiotics in the Swedish environment with emphasis on sewage treatment plants.

    Science.gov (United States)

    Lindberg, Richard H; Björklund, Karin; Rendahl, Per; Johansson, Magnus I; Tysklind, Mats; Andersson, Barbro A V

    2007-02-01

    The potential risks associated with antibiotics present in the Swedish environment were assessed using concentrations found in hospital effluent, and sewage treatment waters and sludge, in combination with data on their environmental effects obtained from the literature. For the aqueous environment, measured environmental concentrations and effect/no observed effect concentration ratios were much lower than one in most cases. The only exceptions, where concentrations of the investigated substances were high enough to pose potential risks, were the concentrations of the two fluoroquinolones, ofloxacin and ciprofloxacin, in the hospital effluent. Treating digested dewatered sludge by heat did not fully eliminate norfloxacin or ciprofloxacin, thus pellets may still contain high amounts of these substances (sub to low mgkg(-1)dw). In leaching tests less than 1% of the amounts of these fluoroquinolones in the sludge or pellets reached the aqueous phase, indicating that their mobility is limited if sludge is used to fertilize soil.

  3. Carbazole antibiotics synthesis in a Streptomyces tendae bald mutant, created by acriflavine treatment.

    Science.gov (United States)

    Grammel, H; Wolf, H; Gilles, E D; Huth, F; Laatsch, H

    1998-01-01

    Acriflavine treatment on Streptomyces tendae generated a bald mutant (bld-1) with an altered antibiotic pattern. The parental strain produced nikkomycins and juglomycins, whereas the mutant bld-1 was only capable of juglomycin synthesis. The existence of a mutant defective in morphogenesis and in nikkomycin biosynthesis suggests a common regulation of these processes. An interesting finding of this study is that mutant bld-1 produced two carbazole derivatives, hitherto never seen in cultures of the parental strain. It seems likely that the DNA intercalating dye acriflavine, by mutagenesis, had activated cryptic genes which are involved in carbazole synthesis. The two carbazole derivatives were identified as the neuronal cell protecting compounds CS-79B and carquinostatin A, recently isolated from a wild-type of S. exfoliatus. We found that both substances showed antibacterial activity.

  4. Experimental Evolution of Escherichia coli Persister Levels Using Cyclic Antibiotic Treatments.

    Science.gov (United States)

    Van den Bergh, Bram; Michiels, Joran E; Michiels, Jan

    2016-01-01

    Persister cells are difficult to study owing to their transient nature and their usually small number in bacterial populations. In the past, numerous attempts have been made to elucidate persistence mechanisms. However, because of the challenges involved in studying persisters and the clear redundancy in mechanisms underlying their generation, our knowledge of molecular pathways to persistence remains incomplete. Here, we describe how to use experimental evolution with cyclic antibiotic treatments to generate mutants with an increased persister level in stationary phase, ranging from the initial ancestral level up to 100 %. This method will help to unravel molecular pathways to persistence, and opens up a myriad of new possibilities in persister research, such as the convenient study of nearly pure persister cultures and the possibility to investigate the role of time and environmental aspects in the evolution of persistence.

  5. Revisiting Antibiotic Resistance Spreading in Wastewater Treatment Plants – Bacteriophages as a Much Neglected Potential Transmission Vehicle

    Directory of Open Access Journals (Sweden)

    Rolf Lood

    2017-11-01

    Full Text Available The spread of antibiotic resistance is currently a major threat to health that humanity is facing today. Novel multidrug and pandrug resistant bacteria are reported on a yearly basis, while the development of novel antibiotics is lacking. Focus to limit the spread of antibiotic resistance by reducing the usage of antibiotics in health care, veterinary applications, and meat production, have been implemented, limiting the exposure of pathogens to antibiotics, thus lowering the selection of resistant strains. Despite these attempts, the global resistance has increased significantly. A recent area of focus has been to limit the spread of resistance through wastewater treatment plants (WWTPs, serving as huge reservoirs of microbes and resistance genes. While being able to quite efficiently reduce the presence of resistant bacteria entering any of the final products of WWTPs (e.g., effluent water and sludge, the presence of resistance genes in other formats (mobile genetic elements, bacteriophages has mainly been ignored. Recent data stress the importance of transduction in WWTPs as a mediator of resistance spread. Here we examine the current literature in the role of WWTPs as reservoirs and hotspots of antibiotic resistance with a specific focus on bacteriophages as mediators of genetic exchange.

  6. Three Cases With Inappropriate TSH Syndrome

    Directory of Open Access Journals (Sweden)

    Hatice Sebila Dökmetaş

    2012-12-01

    Full Text Available Inappropriate thyroid-stimulating hormone (TSH syndrome or central hyperthyroidism is a rare disorder characterized by inappropriately normal or elevated levels of TSH and elevated levels of T3 and T4. The syndrome is associated with TSH-secreting pituitary adenoma (TSHoma or thyroid hormone resistance (THR. Thyroid-releasing hormone stimulation test and T3 suppression test can be useful for the differential diagnosis of central hyperthyroidism. In the present study, we report three cases of inappropriate TSH syndrome diagnosed after TRH stimulation and T3 suppression tests. Turk Jem 2012; 16: 105-8

  7. [Management of inappropriate shocks/T-wave-oversensing in S-ICD®-patients].

    Science.gov (United States)

    Larbig, Robert; Bettin, Markus; Motloch, Lukas J; Fischer, Alicia; Bode, Niklas; Frommeyer, Gerrit; Reinke, Florian; Loeher, Andreas; Eckardt, Lars; Köbe, Julia

    2018-02-12

    Inappropriate shocks are a feared complication after implantable cardioverter-defibrillator (ICD) implantation and have a tremendous impact on quality of life. Inappropriate shocks in patients with subcutaneous ICD (S-ICD®, Boston Scientific, Marlborough, MA, USA) have various underlying causes. This review summarizes the current literature on this topic and lists possible treatment options.

  8. Zolav®: a new antibiotic for the treatment of acne

    Directory of Open Access Journals (Sweden)

    Dinant A

    2016-03-01

    Full Text Available Alexa Dinant,1 Ramiz A Boulos2,3 1AXD Pty Ltd, Semaphore Park, 2School of Chemical and Physical Sciences, Flinders University, Bedford Park, 3Boulos & Cooper Pharmaceuticals Pty Ltd, Port Adelaide, SA, Australia Background: Acne is a prominent skin condition affecting >80% of teenagers and young adults and ~650 million people globally. Isotretinoin, a vitamin A derivative, is currently the standard of care for treatment. However, it has a well-established teratogenic activity, a reason for the development of novel and low-risk treatment options for acne. Objective: To investigate the effectiveness of Zolav®, a novel antibiotic as a treatment for acne vulgaris. Materials and methods: Minimum inhibitory concentration of Zolav® against Propionibacterium acnes was determined by following a standard protocol using Mueller-Hinton broth and serial dilutions in a 96-well plate. Cytotoxicity effects on human umbilical vein endothelial cells and lung cells in the presence of Zolav® were investigated by determining the growth inhibition (GI50 concentration, total growth inhibition concentration, and the lethal concentration of 50% (LC50. The tryptophan auxotrophic mutant of Escherichia coli strain, WP2 uvrA (ATCC 49979, was used for the AMES assay with the addition of Zolav® tested for its ability to reverse the mutation and induce bacterial growth. The in vivo effectiveness of Zolav® was tested in a P. acnes mouse intradermal model where the skin at the infection site was removed, homogenized, and subjected to colony-forming unit (CFU counts. Results: Susceptibility testing of Zolav® against P. acnes showed a minimum inhibitory concentration of 2 µg/mL against three strains with no cytotoxicity and no mutagenicity observed at the highest concentrations tested, 30 µM and 1,500 µg/plate, respectively. The use of Zolav® at a concentration of 50 µg/mL (q8h elicited a two-log difference in CFU/g between the treatment group and the control

  9. Stepwise impact of urban wastewater treatment on the bacterial community structure, antibiotic contents, and prevalence of antimicrobial resistance.

    Science.gov (United States)

    Wang, Mingyu; Shen, Weitao; Yan, Lei; Wang, Xin-Hua; Xu, Hai

    2017-12-01

    Bacteria, antibiotics, and antibiotic resistance determinants are key biological pollutants in aquatic systems, which may lead to bacterial infections or prevent the cure of bacterial infections. In this study, we investigated how the wastewater treatment processes in wastewater treatment plants (WWTPs) affect these pollutants. We found that the addition of oxygen, polyaluminum chloride (PAC), and polyacrylamide (PAM), as well as ultraviolet (UV) disinfection could significantly alter the bacterial communities in the water samples. An overall shift from Gram-negative bacteria to Gram-positive bacteria was observed throughout the wastewater treatment steps, but the overall bacterial biomass was not reduced in the WWTP samples. The antibiotic contents were reduced by the WWTP, but the size of the reduction and the step when antibiotic degradation occurred differed among antibiotics. Ciprofloxacin, sulfamethoxazole and erythromycin could be removed completely by the WWTP, whereas cephalexin could not. The removal of ciprofloxacin, cephalexin, and erythromycin occurred in the anaerobic digester, whereas the removal of sulfamethoxazole occurred after the addition of PAC and PAM, and UV disinfection. Antimicrobial resistance determinants were highly prevalent in all of the samples analyzed, except for those targeting vancomycin and colistin. However, wastewater treatment was ineffective at removing antimicrobial resistance determinants from wastewater. There were strong correlations between intI1, floR, sul1, and ermB, thereby suggesting the importance of integrons for the spread of these antimicrobial resistance genes. In general, this study comprised a stepwise analysis of the impact of WWTPs on three biological pollutants: bacteria, antibiotics, and antimicrobial resistance determinants, where our results suggest that the design of WWTPs needs to be improved to address the threats due to these pollutants. Copyright © 2017 Elsevier Ltd. All rights reserved.

  10. Clinical and Histological Evaluation of the Efficacy of Antimicrobial Photodynamic Therapy used in addition to Antibiotic Therapy in Pericoronitis Treatment.

    Science.gov (United States)

    Eroglu, Cennet Neslihan; Tunc, Serap Keskin; Erten, Remzi; Usumez, Aslıhan

    2018-02-24

    Although antimicrobial efficacy of photodynamic therapy has been studied several times, there is no study investigating its efficacy on pericoronitis. This study aimed to determine whether antimicrobial photodynamic therapy combined with antibiotic therapy is clinically and histologically superior to antibiotic therapy alone in pericoronitis treatment. Patients (n = 40) with pericoronitis were divided into two groups (20 patients for each) to receive either antibiotic + indocyanine green + 810 nm wavelength diode laser (antimicrobial photodynamic therapy group) or antibiotic alone. Initial biopsy samples were obtained from the affected tissue of the patients at their first presentation to the clinic before any intervention. The second biopsy samples were obtained on the 3rd day of treatment in both groups from the tissue part not biopsied before; tooth extraction was then performed. All tissue samples were histologically examined to assess inflammatory cell response. Patients' pain (using Visual Analogue Scale) and lymphadenopathy (presence or absence) were clinically evaluated in the first 3 days and on the 7th day of treatment. In the antimicrobial photodynamic therapy group, 100% improvement was achieved regarding pain and lymphadenopathy at the end of the 7th day. Comparison of the inflammatory cell scores of the 2nd biopsy samples between the antibiotic alone and antimicrobial photodynamic therapy groups revealed a significant difference in favor of antimicrobial photodynamic therapy group. Antimicrobial photodynamic therapy combined with antibiotic therapy for pericoronitis treatment was found to be more successful as compared with the antibiotic therapy alone regarding clinical and histological outcomes. Copyright © 2018. Published by Elsevier B.V.

  11. Dissemination of veterinary antibiotics and corresponding resistance genes from a concentrated swine feedlot along the waste treatment paths.

    Science.gov (United States)

    Wang, Jian; Ben, Weiwei; Yang, Min; Zhang, Yu; Qiang, Zhimin

    2016-01-01

    Swine feedlots are an important pollution source of antibiotics and antibiotic resistance genes (ARGs) to the environment. This study investigated the dissemination of two classes of commonly-used veterinary antibiotics, namely, tetracyclines (TCs) and sulfonamides (SAs), and their corresponding ARGs along the waste treatment paths from a concentrated swine feedlot located in Beijing, China. The highest total TC and total SA concentrations detected were 166.7mgkg(-1) and 64.5μgkg(-1) in swine manure as well as 388.7 and 7.56μgL(-1) in swine wastewater, respectively. Fourteen tetracycline resistance genes (TRGs) encoding ribosomal protection proteins (RPP), efflux proteins (EFP) and enzymatic inactivation proteins, three sulfonamide resistance genes (SRGs), and two integrase genes were detected along the waste treatment paths with detection frequencies of 33.3-75.0%. The relative abundances of target ARGs ranged from 2.74×10(-6) to 1.19. The antibiotics and ARGs generally declined along both waste treatment paths, but their degree of reduction was more significant along the manure treatment path. The RPP TRGs dominated in the upstream samples and then decreased continuously along both waste treatment paths, whilst the EFP TRGs and SRGs maintained relatively stable. Strong correlations between antibiotic concentrations and ARGs were observed among both manure and wastewater samples. In addition, seasonal temperature, and integrase genes, moisture content and nutrient level of tested samples could all impact the relative abundances of ARGs along the swine waste treatment paths. This study helps understand the evolution and spread of ARGs from swine feedlots to the environment as well as assess the environmental risk arising from swine waste treatment. Copyright © 2016 Elsevier Ltd. All rights reserved.

  12. Primary Sjogren's syndrome associated with inappropriate ...

    African Journals Online (AJOL)

    A patient in whom primary Sjogren's syndrome and inappropriate antiduretic hormone secretion were associated is reported. This is the first report of such an association. The possible pathophysiological mechanisms are discussed and vasculitis proposed as the underlying pathogenetic mechanism.

  13. Occurrence and elimination of antibiotics at four sewage treatment plants in Japan and their effects on bacterial ammonia oxidation.

    Science.gov (United States)

    Ghosh, Gopal Chandra; Okuda, Takashi; Yamashita, Naoyuki; Tanaka, Hiroaki

    2009-01-01

    The occurrence and elimination of seventeen antibiotics (three macrolides: azithromycin, clarithromycin and roxithromycin; five quinolones: ciprofloxacin, enrofloxacin, levofloxacin, nalidixic acid and norfloxacin; five sulfonamides: sulfadimethoxine, sulfadimizine, sulfamerazine, sulfamethoxazole and sulfamonomethoxine; and others: tetracycline, lincomycin, salinomycin and trimethoprim) were investigated at four full-scale sewage treatment plants in Japan. The highest concentration was recorded for clarithromycin (1,129 to 4,820 ng/L) in influent, followed by azithromycin (160 to 1,347 ng/L), levofloxacin (255 to 587 ng/L) and norfloxacin (155 to 486 ng/L). A vary inconsistence picture was obtained with negative to over 90% removal. Nalidixic acid (53 to 100%) exhibited higher removal efficiency followed by norfloxacin (75 to 95%), levofloxacin (40 to 90%), ciprofloxacin (60 to 83%) and enrofloxacin (38 to 74%). Among macrolides, clarithromycin (50 to 88%) and azithromycin (34 to 86%) showed relatively higher removal efficiency than roxithromycin (-32 to 59%). For most of the antibiotics removal efficiency was higher in A2O and AO based secondary treatment process than CAS process. The effect of the antibiotics on bacterial ammonia oxidation determined by oxygen uptake rate presented that there was no significant effect below 0.05 mg/L of each antibiotics. Even at the same concentration, antibiotics in mixed condition had higher inhibition effects than individuals.

  14. Antibiotic use among older adults on an acute care general surgery service

    Science.gov (United States)

    Pollmann, André S.; Bailey, Jon G.; Davis, Philip J.B.; Johnson, Paul M.

    2017-01-01

    Background Antibiotics play an important role in the treatment of many surgical diseases that affect older adults, and the potential for inappropriate use of these drugs is high. Our objective was to describe antibiotic use among older adults admitted to an acute care surgery service at a tertiary care teaching hospital. Methods Detailed data regarding diagnosis, comorbidities, surgery and antibiotic use were retrospectively collected for patients 70 years and older admitted to an acute care surgery service. We evaluated antibiotic use (perioperative prophylaxis and treatment) for appropriateness based on published guidelines. Results During the study period 453 patients were admitted to the acute care surgery service, and 229 underwent surgery. The most common diagnoses were small bowel obstruction (27.2%) and acute cholecystitis (11.0%). In total 251 nonelective abdominal operations were performed, and perioperative antibiotic prophylaxis was appropriate in 49.5% of cases. The most common prophylaxis errors were incorrect timing (15.5%) and incorrect dose (12.4%). Overall 206 patients received treatment with antibiotics for their underlying disease process, and 44.2% received appropriate first-line drug therapy. The most common therapeutic errors were administration of second- or third-line antibiotics without indication (37.9%) and use of antibiotics when not indicated (12.1%). There was considerable variation in the duration of treatment for patients with the same diagnoses. Conclusion Inappropriate antibiotic use was common among older patients admitted to an acute care surgery service. Quality improvement initiatives are needed to ensure patients receive optimal care in this complex hospital environment. PMID:28930045

  15. Antibiotic use among older adults on an acute care general surgery service.

    Science.gov (United States)

    Pollmann, André S; Bailey, Jon G; Davis, Philip J B; Johnson, Paul M

    2017-12-01

    Antibiotics play an important role in the treatment of many surgical diseases that affect older adults, and the potential for inappropriate use of these drugs is high. Our objective was to describe antibiotic use among older adults admitted to an acute care surgery service at a tertiary care teaching hospital. Detailed data regarding diagnosis, comorbidities, surgery and antibiotic use were retrospectively collected for patients 70 years and older admitted to an acute care surgery service. We evaluated antibiotic use (perioperative prophylaxis and treatment) for appropriateness based on published guidelines. During the study period 453 patients were admitted to the acute care surgery service, and 229 underwent surgery. The most common diagnoses were small bowel obstruction (27.2%) and acute cholecystitis (11.0%). In total 251 nonelective abdominal operations were performed, and perioperative antibiotic prophylaxis was appropriate in 49.5% of cases. The most common prophylaxis errors were incorrect timing (15.5%) and incorrect dose (12.4%). Overall 206 patients received treatment with antibiotics for their underlying disease process, and 44.2% received appropriate first-line drug therapy. The most common therapeutic errors were administration of second- or third-line antibiotics without indication (37.9%) and use of antibiotics when not indicated (12.1%). There was considerable variation in the duration of treatment for patients with the same diagnoses. Inappropriate antibiotic use was common among older patients admitted to an acute care surgery service. Quality improvement initiatives are needed to ensure patients receive optimal care in this complex hospital environment.

  16. Abundance of antibiotic resistance genes in five municipal wastewater treatment plants in the Monastir Governorate, Tunisia.

    Science.gov (United States)

    Rafraf, Ikbel Denden; Lekunberri, Itziar; Sànchez-Melsió, Alexandre; Aouni, Mahjoub; Borrego, Carles M; Balcázar, José Luis

    2016-12-01

    Antimicrobial resistance is a growing and significant threat to global public health, requiring better understanding of the sources and mechanisms involved in its emergence and spread. We investigated the abundance of antibiotic resistance genes (ARGs) before and after treatment in five wastewater treatment plants (WWTPs) located in different areas of the Monastir Governorate (Tunisia). Three of these WWTPs (Frina, Sahline and Zaouiet) use a conventional activated sludge process as secondary treatment, whereas the WWTP located in Beni Hassen applies an ultraviolet disinfection step after the activated sludge process and the WWTP located in Moknine treats wastewater using naturally aerated lagoons as a secondary treatment process. The abundance of six ARGs (bla CTX-M , bla TEM , qnrA, qnrS, sul I and ermB) and the class 1 integron-integrase gene (intI1) were determined by quantitative PCR. All ARGs and the intI1 gene were detected in the wastewater samples, except the bla CTX-M gene, which was not detected in both influent and effluent samples from Sahline and Beni Hassen WWTPs, and the qnrS gene, which was not detected neither in the WWTP influent in Moknine nor in the WWTP effluent in Beni Hassen. Although the relative concentration of ARGs was generally found to be similar between samples collected before and after the wastewater treatment, the abundance of bla CTX-M , bla TEM , and qnrS genes was higher in the effluent of the Frina WWTP which, unlike other WWTPs, not only receives domestic or industrial sewage but also untreated hospital waste. To the best of our knowledge, this study quantified for the first time the abundance of ARGs in different Tunisian WWTPs, and the results agree with previous studies suggesting that conventional wastewater treatment does not efficiently reduce ARGs. Therefore, these findings could be useful to improve the design or operation of WWTPs. Copyright © 2016 Elsevier Ltd. All rights reserved.

  17. A computerized education module improves patient knowledge and attitudes about appropriate antibiotic use for acute respiratory tract infections.

    Science.gov (United States)

    Price, Erika Leemann; Mackenzie, Thomas D; Metlay, Joshua P; Camargo, Carlos A; Gonzales, Ralph

    2011-12-01

    Over-use of antibiotics for acute respiratory infections (ARIs) increases antimicrobial resistance, treatment costs, and side effects. Patient desire for antibiotics contributes to over-use. To explore whether a point-of-care interactive computerized education module increases patient knowledge and decreases desire for antibiotics. Bilingual (English/Spanish) interactive kiosks were available in 8 emergency departments as part of a multidimensional intervention to reduce antibiotic prescribing for ARIs. The symptom-tailored module included assessment of symptoms, knowledge about ARIs (3 items), and desire for antibiotics on a 10-point visual analog scale. Multivariable analysis assessed predictors of change in desire for antibiotics. Of 686 adults with ARI symptoms, 63% initially thought antibiotics might help. The proportion of patients with low (1-3 on the scale) desire for antibiotics increased from 22% pre-module to 49% post-module (pknowledge about antibiotics and ARIs. Learning correlated with changes in personal desire for antibiotics. By reducing desire for antibiotics, point-of-care interactive educational computer technology may help decrease inappropriate use for antibiotics for ARIs. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  18. Understanding Factors Contributing to Inappropriate Critical Care: A Mixed-Methods Analysis of Medical Record Documentation.

    Science.gov (United States)

    Neville, Thanh H; Tarn, Derjung M; Yamamoto, Myrtle; Garber, Bryan J; Wenger, Neil S

    2017-11-01

    Factors leading to inappropriate critical care, that is treatment that should not be provided because it does not offer the patient meaningful benefit, have not been rigorously characterized. We explored medical record documentation about patients who received inappropriate critical care and those who received appropriate critical care to examine factors associated with the provision of inappropriate treatment. Medical records were abstracted from 123 patients who were assessed as receiving inappropriate treatment and 66 patients who were assessed as receiving appropriate treatment but died within six months of intensive care unit (ICU) admission. We used mixed methods combining qualitative analysis of medical record documentation with multivariable analysis to examine the relationship between patient and communication factors and the receipt of inappropriate treatment, and present these within a conceptual model. One academic health system. Medical records revealed 21 themes pertaining to prognosis and factors influencing treatment aggressiveness. Four themes were independently associated with patients receiving inappropriate treatment according to physicians. When decision making was not guided by physicians (odds ratio [OR] 3.76, confidence interval [95% CI] 1.21-11.70) or was delayed by patient/family (OR 4.52, 95% CI 1.69-12.04), patients were more likely to receive inappropriate treatment. Documented communication about goals of care (OR 0.29, 95% CI 0.10-0.84) and patient's preferences driving decision making (OR 0.02, 95% CI 0.00-0.27) were associated with lower odds of receiving inappropriate treatment. Medical record documentation suggests that inappropriate treatment occurs in the setting of communication and decision-making patterns that may be amenable to intervention.

  19. Diversity and antibiotic resistance of Aeromonas spp. in drinking and waste water treatment plants.

    Science.gov (United States)

    Figueira, Vânia; Vaz-Moreira, Ivone; Silva, Márcia; Manaia, Célia M

    2011-11-01

    The taxonomic diversity and antibiotic resistance phenotypes of aeromonads were examined in samples from drinking and waste water treatment plants (surface, ground and disinfected water in a drinking water treatment plant, and raw and treated waste water) and tap water. Bacteria identification and intra-species variation were determined based on the analysis of the 16S rRNA, gyrB and cpn60 gene sequences. Resistance phenotypes were determined using the disc diffusion method. Aeromonas veronii prevailed in raw surface water, Aeromonas hydrophyla in ozonated water, and Aeromonas media and Aeromonas puntacta in waste water. No aeromonads were detected in ground water, after the chlorination tank or in tap water. Resistance to ceftazidime or meropenem was detected in isolates from the drinking water treatment plant and waste water isolates were intrinsically resistant to nalidixic acid. Most of the times, quinolone resistance was associated with the gyrA mutation in serine 83. The gene qnrS, but not the genes qnrA, B, C, D or qepA, was detected in both surface and waste water isolates. The gene aac(6')-ib-cr was detected in different waste water strains isolated in the presence of ciprofloxacin. Both quinolone resistance genes were detected only in the species A. media. This is the first study tracking antimicrobial resistance in aeromonads in drinking, tap and waste water and the importance of these bacteria as vectors of resistance in aquatic environments is discussed. Copyright © 2011 Elsevier Ltd. All rights reserved.

  20. Early antibiotic treatment for BAL-confirmed ventilator-associated pneumonia: a role for routine endotracheal aspirate cultures.

    Science.gov (United States)

    Michel, Fabrice; Franceschini, Bruno; Berger, Pierre; Arnal, Jean-Michel; Gainnier, Marc; Sainty, Jean-Marie; Papazian, Laurent

    2005-02-01

    To test whether routine quantitative cultures of endotracheal aspirates obtained before the onset of ventilator-associated pneumonia (VAP) could help to predict the causative microorganisms and to select early appropriate antimicrobial therapy before obtaining BAL culture results. Prospective observational study. French medical ICU. A total of 299 patients received mechanical ventilation for at least 48 h. Endotracheal aspiration (EA) was performed twice weekly in all mechanically ventilated patients. A diagnosis of VAP was made by BAL culture. Only the EA performed just before the suspicion of VAP (EA-pre) were evaluated. This strategy (ie, the EA-pre-based strategy) was compared with an antibiotic therapy that would have been prescribed if the recommendations of both the American Thoracic Society (ATS) and Trouillet et al (Am J Respir Crit Care Med 1998; 157:531-539) had been applied. VAP was diagnosed (by BAL culture) in 41 of the 75 patients in whom BAL was performed. Among the 41 BAL specimens that were positive for VAP, EA-pre had identified the same microorganisms (with the same antibiotic resistance patterns) in 34 cases (83%). In one case, EA-pre was not available at the time BAL was performed (a case of early-onset VAP), but the empiric antibiotic therapy was adequate. While EA-pre did not give the same results as the BAL culture, the antibiotic therapy based on the results of the EA-pre was adequate in four other cases. Finally, antibiotic therapy was delayed in only two cases. Antibiotic treatment was therefore adequate in 38 of the 40 assessable cases (95%). If the Trouillet-based strategy had been used, the antibiotic treatment would have been adequate in 34 of the 41 cases (83%; p = 0.15 [vs EA-pre strategy]). Based on the ATS classification, the antibiotic treatment would have been adequately prescribed in only 28 of the 41 cases (68%; p = 0.005 [vs EA-pre strategy]). Routine EA performed twice a week makes it possible to prescribe adequate

  1. Inappropriate prescribing: criteria, detection and prevention.

    LENUS (Irish Health Repository)

    O'Connor, Marie N

    2012-06-01

    Inappropriate prescribing is highly prevalent in older people and is a major healthcare concern because of its association with negative healthcare outcomes including adverse drug events, related morbidity and hospitalization. With changing population demographics resulting in increasing proportions of older people worldwide, improving the quality and safety of prescribing in older people poses a global challenge. To date a number of different strategies have been used to identify potentially inappropriate prescribing in older people. Over the last two decades, a number of criteria have been published to assist prescribers in detecting inappropriate prescribing, the majority of which have been explicit sets of criteria, though some are implicit. The majority of these prescribing indicators pertain to overprescribing and misprescribing, with only a minority focussing on the underprescribing of indicated medicines. Additional interventions to optimize prescribing in older people include comprehensive geriatric assessment, clinical pharmacist review, and education of prescribers as well as computerized prescribing with clinical decision support systems. In this review, we describe the inappropriate prescribing detection tools or criteria most frequently cited in the literature and examine their role in preventing inappropriate prescribing and other related healthcare outcomes. We also discuss other measures commonly used in the detection and prevention of inappropriate prescribing in older people and the evidence supporting their use and their application in everyday clinical practice.

  2. Drug Utilization and Inappropriate Prescribing in Centenarians.

    Science.gov (United States)

    Hazra, Nisha C; Dregan, Alex; Jackson, Stephen; Gulliford, Martin C

    2016-05-01

    To use primary care electronic health records (EHRs) to evaluate prescriptions and inappropriate prescribing in men and women at age 100. Population-based cohort study. Primary care database in the United Kingdom, 1990 to 2013. Individuals reaching the age of 100 between 1990 and 2013 (N = 11,084; n = 8,982 women, n = 2,102 men). Main drug classes prescribed and potentially inappropriate prescribing according to the 2012 American Geriatrics Society Beers Criteria. At the age of 100, 73% of individuals (79% of women, 54% of men) had received one or more prescription drugs, with a median of 7 (interquartile range 0-12) prescription items. The most frequently prescribed drug classes were cardiovascular (53%), central nervous system (CNS) (53%), and gastrointestinal (47%). Overall, 32% of participants (28% of men, 32% of women) who received drug prescriptions may have received one or more potentially inappropriate prescriptions, with temazepam and amitriptyline being the most frequent. CNS prescriptions were potentially inappropriate in 23% of individuals, and anticholinergic prescriptions were potentially inappropriate in 18% of individuals. The majority of centenarians are prescribed one or more drug therapies, and the prescription may be inappropriate for up to one-third of these individuals. Research using EHRs offers opportunities to understand prescribing trends and improve pharmacological care of the oldest adults. © 2016 The Authors. The Journal of the American Geriatrics Society published by Wiley Periodicals, Inc. on behalf of The American Geriatrics Society.

  3. [Inappropriate prescription in older patients: the STOPP/START criteria].

    LENUS (Irish Health Repository)

    Delgado Silveira, Eva

    2009-09-01

    Older people are a heterogeneous group of patients, often with multiple comorbidities for which they are prescribed a large number of drugs, leading to an increased risk of adverse drug reactions (ADR) and drug interactions. This risk is compounded by physiological age-related changes in physiology, changes in drug pharmacokinetics and pharmacodynamics, as well as by disease-related, functional and social issues. Inappropriate prescription of drugs is common in the older individuals and contributes to the increased risk of ADR. Several tools have been developed to detect potentially inappropriate prescription, the most frequently used in Spain being Beers\\' criteria. However, the value of these criteria is limited, especially as they were developed in a different healthcare system. In this article, the Spanish version of a new tool to detect potentially inappropriate prescriptions-STOPP (Screening Tool of Older Person\\'s Prescriptions) and START (Screening Tool to Alert doctors to Right i.e. appropriate, indicated Treatment) criteria-is presented. The creation, development, reliability, and use of these criteria in routine practice is described and discussed. These criteria have shown better sensitivity than Beers\\' criteria in detecting prescription problems and have the added value of being able to detect not only inappropriate prescription of some drugs, but also the omission of well indicated drugs. The STOPP\\/START criteria could become a useful screening tool to improve prescription in older people.

  4. Removal of antibiotics from piggery wastewater by biological aerated filter system: Treatment efficiency and biodegradation kinetics.

    Science.gov (United States)

    Chen, Jun; Liu, You-Sheng; Zhang, Jin-Na; Yang, Yong-Qiang; Hu, Li-Xin; Yang, Yuan-Yuan; Zhao, Jian-Liang; Chen, Fan-Rong; Ying, Guang-Guo

    2017-08-01

    This study aimed to investigate the removal efficiency and mechanism for antibiotics in swine wastewater by a biological aerated filter system (BAF system) in combination with laboratory aerobic and anaerobic incubation experiments. Nine antibiotics including sulfamonomethoxine, sulfachloropyridazine, sulfamethazine, trimethoprim, norfloxacin, ofloxacin, lincomycin, leucomycin and oxytetracycline were detected in the wastewater with concentrations up to 192,000ng/L. The results from this pilot study showed efficient removals (>82%) of the conventional wastewater pollutants (BOD 5 , COD, TN and NH 3 -N) and the detected nine antibiotics by the BAF system. Laboratory simulation experiment showed first-order dissipation kinetics for the nine antibiotics in the wastewater under aerobic and anaerobic conditions. The biodegradation kinetic parameters successfully predicted the fate of the nine antibiotics in the BAF system. This suggests that biodegradation was the dominant process for antibiotic removal in the BAF system. Copyright © 2017 Elsevier Ltd. All rights reserved.

  5. [Complete atrio-ventricular block as a first symptom of borreliosis: antibiotic treatment instead of pacemaker implantation].

    Science.gov (United States)

    Kaczmarek, Krzysztof; Deroń, Zbigniew; Janiszewski, Tomasz; Supeł, Karolina; Ptaszyński, Paweł; Ruta, Jan; Cygankiewicz, Iwona

    2013-01-01

    We present a 46-year-old male patient with complete atrio-ventricular block. A inflammatory etiology was suspected and finally lyme carditis was diagnosed. The conduction abnormalities disappeared with antibiotic treatment and a pacemaker implantation was not needed. Further follow-up of two years was uneventful.

  6. Effect of Antibiotic Treatment on the Gastrointestinal Microbiome of Free-Ranging Western Lowland Gorillas (Gorilla g. gorilla)

    Czech Academy of Sciences Publication Activity Database

    Vlčková, K.; Gomez, A.; Petrželková, Klára Judita; Whittier, C. A.; Todd, A. F.; Yeoman, C. J.; Nelson, K. E.; Wilson, B. A.; Stumpf, R. M.; Modrý, David; White, B. A.; Leigh, S. R.

    2016-01-01

    Roč. 72, č. 4 (2016), s. 943-954 ISSN 0095-3628 Institutional support: RVO:60077344 Keywords : antibiotics * medical treatment * gastrointestinal microbiome * illumina MiSeq * bacteria Subject RIV: EE - Microbiology, Virology Impact factor: 3.630, year: 2016

  7. Effect of Antibiotic Treatment on the Gastrointestinal Microbiome of Free-Ranging Western Lowland Gorillas (Gorilla g. gorilla)

    Czech Academy of Sciences Publication Activity Database

    Vlčková, K.; Gomez, A.; Petrželková, Klára Judita; Whittier, C. A.; Todd, A. F.; Yeoman, C. J.; Nelson, K. E.; Wilson, B. A.; Stumpf, R. M.; Modrý, D.; White, B. A.; Leigh, S. R.

    2016-01-01

    Roč. 72, č. 4 (2016), s. 943-954 ISSN 0095-3628 Institutional support: RVO:68081766 Keywords : Gorilla * Antibiotics * Medical treatment * Gastrointestinal microbiome * Illumina MiSeq * Bacteria Subject RIV: EG - Zoology Impact factor: 3.630, year: 2016

  8. Bioaerosol emissions and detection of airborne antibiotic resistance genes from a wastewater treatment plant

    Science.gov (United States)

    Li, Jing; Zhou, Liantong; Zhang, Xiangyu; Xu, Caijia; Dong, Liming; Yao, Maosheng

    2016-01-01

    Air samples from twelve sampling sites (including seven intra-plant sites, one upwind site and four downwind sites) from a wastewater treatment plant (WWTP) in Beijing were collected using a Reuter Centrifugal Sampler High Flow (RCS); and their microbial fractions were studied using culturing and high throughput gene sequence. In addition, the viable (fluorescent) bioaerosol concentrations for 7 intra-plant sites were also monitored for 30 min each using an ultraviolet aerodynamic particle sizer (UV-APS). Both air and water samples collected from the plant were investigated for possible bacterial antibiotic resistance genes and integrons using polymerase chain reaction (PCR) coupled with gel electrophoresis. The results showed that the air near sludge thickening basin was detected to have the highest level of culturable bacterial aerosols (up to 1697 CFU/m3) and fungal aerosols (up to 930 CFU/m3). For most sampling sites, fluorescent peaks were observed at around 3-4 μm, except the office building with a peak at 1.5 μm, with a number concentration level up to 1233-6533 Particles/m3. About 300 unique bacterial species, including human opportunistic pathogens, such as Comamonas Testosteroni and Moraxella Osloensis, were detected from the air samples collected over the biological reaction basin. In addition, we have detected the sul2 gene resistant to cotrimoxazole (also known as septra, bactrim and TMP-SMX) and class 1 integrase gene from the air samples collected from the screen room and the biological reaction basin. Overall, the screen room, sludge thickening basin and biological reaction basin imposed significant microbial exposure risks, including those from airborne antibiotic resistance genes.

  9. Role of outpatient parenteral antibiotic therapy in the treatment of community acquired skin and soft tissue infections in Singapore.

    Science.gov (United States)

    Chan, Monica; Ooi, Chee Kheong; Wong, Joshua; Zhong, Lihua; Lye, David

    2017-07-06

    Treatment of community acquired skin and soft tissue infections (SSTIs) is a common indication for outpatient parenteral antibiotic therapy (OPAT) in USA, UK and Australasia, however data from Asia are lacking. OPAT is well established within the Singapore healthcare since 2002, however, systematic use of OPAT for the treatment of SSTIs remains infrequent. In this report, we describe the treatment and outcome of patients with SSTIs referred directly from Emergency Department (ED) to OPAT for continuation of intravenous (IV) antibiotics in Singapore, thus avoiding potential hospital admission. This is a single center university hospital retrospective study of patients with SSTIs presenting to ED who were assessed to require IV antibiotics and accepted to the OPAT clinic for continuation of IV treatment. Exclusion criteria were: haemodynamic instability, uncontrolled or serious underlying co-morbidities, necessity for inpatient surgical drainage, facial cellulitis and cephalosporin allergy. Patients returned daily to the hospital’s OPAT clinic for administration of IV antibiotics and review, then switched to oral antibiotics on improvement. From 7 February 2012 to 31 July 2015, 120 patients with SSTIs were treated in OPAT. Median age was 56 years and 63% were male. Lower limbs were affected in 91%. Diabetes was present in 20%. Sixty-seven (56%) had been treated with oral antibiotics for a median duration of 3 days prior to OPAT treatment. Common symptoms were erythema (100%), swelling (96%), pain (88%) and fever (55%). Antibiotics administered were IV cefazolin with oral probenecid (71%) or IV ceftriaxone (29%) for median 3 days then oral cloxacillin (85%) for median 7 days. Clinical improvement occurred in 90%. Twelve patients (10%) were hospitalized for worsening cellulitis, with 4 patients requiring surgical drainage of abscess. Microbiological cultures from 2 patients with drained abscess grew methicillin sensitive Staphylococcus aureus (MSSA) and Klebsiella

  10. Knowledge, attitudes and practices concerning self-medication with antibiotics among university students in western China.

    Science.gov (United States)

    Lv, Bing; Zhou, Zhongliang; Xu, Guiping; Yang, Dingkun; Wu, Lina; Shen, Qian; Jiang, Minghuan; Wang, Xiao; Zhao, Guilan; Yang, Shimin; Fang, Yu

    2014-07-01

    To evaluate the knowledge, attitude and behaviours of university students on the use of antibiotics. A knowledge-attitude-practice questionnaire was developed and distributed to undergraduate students of Xi'an Jiaotong University, comprising 18 schools/colleges in Shaanxi Province, western China. Chi-square test and logistic regression analysis were applied to identify risk factors associated with self-medication with antibiotics. Of the 731 respondents (response rate = 73.1%), 294 (40.2%) had self-medicated with antibiotics in the past 6 months. Most of the antibiotics (59.2%) for self-medication were purchased without prescription in retail pharmacies. The median score of students' knowledge about antibiotics was 4 (IQR: 3-6) of a maximum possible score of 10. Students had moderately accurate beliefs towards antibiotics. More than half of the students (56.5%) were storing antibiotics frequently. During self-medication, 16.7% of students claimed to have experienced adverse reactions, and 30.6% had used antibiotics to prevent common colds. The majority preferred to use broad-spectrum antibiotics, and nearly half preferred intravenous antibiotics. Over 44% of students had changed antibiotic dosage, and 36.5% had switched to another antibiotic during the treatment course. Logistic regression analysis identified college and home town as independent risk factors for self-medication with antibiotics (P < 0.01). Undergraduate students had inadequate knowledge, moderately accurate beliefs and inappropriate practices concerning antibiotics, and a high rate of self-medication. This highlights the need for focused educational intervention and stricter governmental regulation concerning antibiotic use and sale in retail pharmacies. © 2014 John Wiley & Sons Ltd.

  11. Anaerobic treatment of antibiotic production wastewater pretreated with enhanced hydrolysis: Simultaneous reduction of COD and ARGs.

    Science.gov (United States)

    Yi, Qizhen; Zhang, Yu; Gao, Yingxin; Tian, Zhe; Yang, Min

    2017-03-01

    The presence of high concentration antibiotics in wastewater can disturb the stability of biological wastewater treatment systems and promote generation of antibiotic resistance genes (ARGs) during the treatment. To solve this problem, a pilot system consisting of enhanced hydrolysis pretreatment and an up-flow anaerobic sludge bed (UASB) reactor in succession was constructed for treating oxytetracycline production wastewater, and the performance was evaluated in a pharmaceutical factory in comparison with a full-scale anaerobic system operated in parallel. After enhanced hydrolysis under conditions of pH 7 and 85 °C for 6 h, oxytetracycline production wastewater with an influent chemical oxygen demand (COD) of 11,086 ± 602 mg L -1 was directly introduced into the pilot UASB reactor. With the effective removal of oxytetracycline and its antibacterial potency (from 874 mg L -1 to less than 0.61 mg L -1 and from 900 mg L -1 to less than 0.84 mg L -1 , respectively) by the enhanced hydrolysis pretreatment, an average COD removal rate of 83.2%, 78.5% and 68.9% was achieved at an organic loading rate of 3.3, 4.8 and 5.9 kg COD m -3  d -1 , respectively. At the same time, the relative abundances of the total tetracycline (tet) genes and a mobile element (Class 1 integron (intI1)) in anaerobic sludge on day 96 were one order of magnitude lower than those in inoculated sludge on day 0 (P anaerobic system treating oxytetracycline production wastewater with an influent COD of 3720 ± 128 mg L -1 after dilution exhibited a COD removal of 51 ± 4% at an organic loading rate (OLR) 1.2 ± 0.2 kg m -3  d -1 , and a total tet gene abundance in sludge was five times higher than the pilot-scale system (P anaerobic treatment of oxytetracycline production wastewater containing high concentrations of oxytetracycline with significantly lower generation of ARGs. Copyright © 2016 Elsevier Ltd. All rights reserved.

  12. Natural history of the infant gut microbiome and impact of antibiotic treatment on bacterial strain diversity and stability.

    Science.gov (United States)

    Yassour, Moran; Vatanen, Tommi; Siljander, Heli; Hämäläinen, Anu-Maaria; Härkönen, Taina; Ryhänen, Samppa J; Franzosa, Eric A; Vlamakis, Hera; Huttenhower, Curtis; Gevers, Dirk; Lander, Eric S; Knip, Mikael; Xavier, Ramnik J

    2016-06-15

    The gut microbial community is dynamic during the first 3 years of life, before stabilizing to an adult-like state. However, little is known about the impact of environmental factors on the developing human gut microbiome. We report a longitudinal study of the gut microbiome based on DNA sequence analysis of monthly stool samples and clinical information from 39 children, about half of whom received multiple courses of antibiotics during the first 3 years of life. Whereas the gut microbiome of most children born by vaginal delivery was dominated by Bacteroides species, the four children born by cesarean section and about 20% of vaginally born children lacked Bacteroides in the first 6 to 18 months of life. Longitudinal sampling, coupled with whole-genome shotgun sequencing, allowed detection of strain-level variation as well as the abundance of antibiotic resistance genes. The microbiota of antibiotic-treated children was less diverse in terms of both bacterial species and strains, with some species often dominated by single strains. In addition, we observed short-term composition changes between consecutive samples from children treated with antibiotics. Antibiotic resistance genes carried on microbial chromosomes showed a peak in abundance after antibiotic treatment followed by a sharp decline, whereas some genes carried on mobile elements persisted longer after antibiotic therapy ended. Our results highlight the value of high-density longitudinal sampling studies with high-resolution strain profiling for studying the establishment and response to perturbation of the infant gut microbiome. Copyright © 2016, American Association for the Advancement of Science.

  13. A survey of primary care physician practices in antibiotic prescribing for the treatment of uncomplicated male gonoccocal urethritis

    Science.gov (United States)

    2011-01-01

    Background The development of resistance to antimicrobial therapy by Neisseria gonorrhoeae causes on-going problems for individual case management of gonorrhoea. Surveillance data about N. gonorrhoeae have indicated an increase in the incidence of gonorrhoea in France in 2006. As a consequence of the development of antibiotic resistance in N. gonorrhoeae, French guidelines excluded fluoroquinolones as a standard treatment for N. gonorrhoeae. Ceftriaxone became the recommended treatment, associated with azithromycin for Clamydia trachomatis infection. Our aim was to describe the practice patterns of general practitioners (GPs) in managing the antibiotic treatment of patients with symptoms suggestive of uncomplicated male urethritis. Methods We developed a clinical vignette describing a man with typical gonococcal urethritis symptoms to elicit questions about antibiotic treatment. We mailed the electronic questionnaire to a random sample of 1000 French GPs belonging to the Sentinelles Network. Results By the end of the survey period, 350 vignettes were received, yielding a response rate of 35%. Sixty-six GPs (20.2%) prescribed the recommended antibiotics for the simultaneous treatment of N. gonorrhoeae and C. trachomatis infections, while 132 GPs (40.4%) prescribed only non-recommended antibiotics, including ciprofloxacin in 69 cases (21.1%). General practitioners with less than 10 years in practice showed better compliance to guidelines than those with more years in practice (p urethritis by French GPs, mostly among the subgroup of physicians who have been in practice longer. Educational approaches based on practice feedback need to be developed to improve these deficits in the quality of care. PMID:21592343

  14. Antibiotic treatment attenuates behavioral and neurochemical changes induced by exposure of rats to group a streptococcal antigen.

    Directory of Open Access Journals (Sweden)

    Dafna Lotan

    Full Text Available Post-streptococcal A (GAS sequelae including movement and neuropsychiatric disorders have been associated with improvement in response to antibiotic therapy. Besides eradication of infection, the underlying basis of attenuation of neuropsychiatric symptoms following antibiotic treatment is not known. The aim of the present study was to test the efficacy of antibiotic treatment in a rat model of GAS-related neuropsychiatric disorders. In the model, rats were not infected but were exposed to GAS-antigen or to adjuvants only (Control rats and treated continuously with the antibiotic ampicillin in their drinking water from the first day of GAS-antigen exposure. Two additional groups of rats (GAS and Control did not receive ampicillin in their drinking water. Behavior of the four groups was assessed in the forced swim, marble burying and food manipulation assays. We assessed levels of D1 and D2 dopamine receptors and tyrosine hydroxylase in the prefrontal cortex and striatum, and IgG deposition in the prefrontal cortex, striatum and thalamus. Ampicillin treatment prevented emergence of the motor and some of the behavioral alterations induced by GAS-antigen exposure, reduced IgG deposition in the thalamus of GAS-exposed rats, and tended to attenuate the increase in the level of TH and D1 and D2 receptors in their striatum, without concomitantly reducing the level of sera anti-GAS antibodies. Our results reinforce the link between exposure to GAS antigen, dysfunction of central dopaminergic pathways and motor and behavioral alterations. Our data further show that some of these deleterious effects can be attenuated by antibiotic treatment, and supports the latter's possible efficacy as a prophylactic treatment in GAS-related neuropsychiatric disorders.

  15. Bactericidal Antibiotics Promote Reactive Oxygen Species Formation and Inflammation in Human Sinonasal Epithelial Cells

    Science.gov (United States)

    Kohanski, Michael A; Tharakan, Anuj; Lane, Andrew P.; Ramanathan, Murugappan

    2015-01-01

    Background Bactericidal antibiotics have been shown to stimulate reactive oxygen species (ROS) formation in mammalian cells through mitochondrial dysfunction. This results in oxidative tissue damage that may have negative consequences for long-term antibiotic use. Antibiotics are widely and heavily used in the treatment of acute and chronic sinusitis, however the relationship between antibiotics and ROS formation in sinonasal epithelial cells (SNECs) has not yet been demonstrated. Methods Human SNECs were collected from patients during endoscopic sinus surgery and grown in culture at the air-liquid interface. Differentiated SNECs were stimulated with the bactericidal antibiotics amoxicillin and levofloxacin and the bacteriostatic antibiotic clarithromycin for 24-hours. Reactive oxygen species were quantified via fluorescence. Cell death was quantified by LDH secretion. Expression of inflammatory markers such as TNF-α and Nrf2 mediated antioxidant genes were measured by RT-PCR. Results Cultured SNECs treated with the bactericidal antibiotics amoxicillin and levofloxacin resulted in a significant increase in production of ROS (pbactericidal antibiotics leads to formation of ROS with an associated increase in inflammatory and antioxidant gene expression and cell death. This suggests that long term or inappropriate antibiotic use in the treatment of sinusitis, may result in oxidative tissue damage to the sinonasal epithelium. Future studies will explore the clinical implications of such damage to the sinonasal epithelium. PMID:26624249

  16. Sepsis National Hospital Inpatient Quality Measure (SEP-1): Multistakeholder Work Group Recommendations for Appropriate Antibiotics for the Treatment of Sepsis.

    Science.gov (United States)

    Septimus, Edward J; Coopersmith, Craig M; Whittle, Jessica; Hale, Caleb P; Fishman, Neil O; Kim, Thomas J

    2017-10-16

    The Center for Medicare and Medicaid Services adopted the Early Management Bundle, Severe Sepsis/Septic Shock (SEP-1) performance measure to the Hospital Inpatient Quality Reporting Program in July 2015 to help address the high mortality and high cost associated with sepsis. The SEP-1 performance measure requires, among other critical interventions, timely administration of antibiotics to patients with sepsis or septic shock. The multistakeholder workgroup recognizes the need for SEP-1 but strongly believes that multiple antibiotics listed in the antibiotic tables for SEP-1 are not appropriate and the use of these antibiotics, as called for in the SEP-1 measure, is not in alignment with prudent antimicrobial stewardship. To promote the appropriate use of antimicrobials and combat antimicrobial resistance, the workgroup provides recommendations for appropriate antibiotics for the treatment of sepsis. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.

  17. A New, Potent, and Placenta-Permeable Macrolide Antibiotic, Solithromycin, for the Prevention and Treatment of Bacterial Infections in Pregnancy.

    Science.gov (United States)

    Keelan, Jeffrey A; Payne, Matthew S; Kemp, Matthew W; Ireland, Demelza J; Newnham, John P

    2016-01-01

    Intrauterine infection-inflammation is a major cause of early preterm birth and subsequent neonatal mortality and acute or long-term morbidity. Antibiotics can be administered in pregnancy to prevent preterm birth either prophylactically to women at high risk for preterm delivery, or to women with diagnosed intrauterine infection, prelabor rupture of membranes, or in suspected preterm labor. The therapeutic goals of each of these scenarios are different, with different pharmacological considerations, although effective antimicrobial therapy is an essential requirement. An ideal antibiotic for these clinical indications would be (a) one that is easily administered and orally bioactive, (b) has a favorable adverse effect profile (devoid of reproductive toxicity or teratogenicity), (c) is effective against the wide range of microorganisms known to be commonly associated with intra-amniotic infection, (d) provides effective antimicrobial protection within both the fetal and amniotic compartments after maternal delivery, (e) has anti-inflammatory properties, and (f) is effective against antibiotic-resistant microorganisms. Here, we review the evidence from clinical, animal, and ex vivo/in vitro studies that demonstrate that a new macrolide-derived antibiotic - solithromycin - has all of these properties and, hence, may be an ideal antibiotic for the treatment and prevention of intrauterine infection--related pregnancy complications. While this evidence is extremely encouraging, it is still preliminary. A number of key studies need to be completed before solithromycin's true potential for use in pregnancy can be ascertained.

  18. A new, potent and placenta-permeable macrolide antibiotic, solithromycin, for the prevention and treatment of bacterial infections in pregnancy

    Directory of Open Access Journals (Sweden)

    Jeffrey A Keelan

    2016-04-01

    Full Text Available Intrauterine infection-inflammation is a major cause of early preterm birth and subsequent neonatal morbidity and acute or long-term mortality. Antibiotics can be administered in pregnancy to prevent preterm birth either prophylactically to women at high risk for preterm delivery, or to women with diagnosed intrauterine infection, prelabour rupture of membranes, or in suspected preterm labour. The therapeutic goals of each of these scenarios are different, with different pharmacological considerations, although effective antimicrobial therapy is an essential requirement. An ideal antibiotic for these clinical indications would be a one that is easily administered and orally bioactive, b has a favourable adverse effect profile (devoid of reproductive toxicity or teratogenicity, c is effective against the wide range of microorganisms known to be commonly associated with intra-amniotic infection, d provides effective antimicrobial protection within both the fetal and amniotic compartments after maternal delivery, e has anti-inflammatory properties, and f is effective against antibiotic resistant microorganisms. Here we review the evidence from clinical, animal and ex-vivo/in-vitro studies that demonstrates that a new macrolide-derived antibiotic - solithromycin - has all of these properties and hence may be an ideal antibiotic for the treatment and prevention of intrauterine infection-related pregnancy complications. While this evidence is extremely encouraging, it is still preliminary. A number of key studies need to be completed before solithromycin’s true potential for use in pregnancy can be ascertained.

  19. Photodynamic Treatment versus Antibiotic Treatment on Helicobacter pylori Using RAPD-PCR

    Science.gov (United States)

    El-Batanouny, M. H.; Amin, R. M.; Ibrahium, M. K.; El Gohary, S.; Naga, M. I.; Salama, M. S.

    2009-09-01

    Helicobacter pylori is one of the most common causes of chronic bacterial infections in humans and is important in the pathogenesis of gastrointestinal disease, such as duodenal ulcer, gastric ulcer, Gastric adenocarcinoma, and lymphoma. Gastric adenocarcinoma remains one of the leading causes of cancer death in the world. The objective of this study was to assess the effect of photodynamic treatment and medication treatment of Helicobacter pylori using RAPD-PCR. The lethal photosensitization effect was determined by mixing suspensions of H.pylori with Toluidine blue O (TBO) and plating out on blood agar before irradiation with Helium neon (He-Ne) 632.8 nm. The susceptibility of Helicobacter pylori isolates to metronidazole and azithromycin were examined by E-test. Nine random primers were used to screen genetic polymorphism in DNA of different H.pylori groups. Six of them produced RAPD products while three failed to generate any product. The resulting data showed that, although the overall genetic differences between control groups and laser treated groups was higher than that between control groups and azithromycin treated groups yet it still law genetic variability. The main cause of cell death of PDT using TBO as a photosensitizer was mainly cell wall and cytoplasmic membrane.

  20. Host-dependent Induction of Transient Antibiotic Resistance: A Prelude to Treatment Failure.

    Science.gov (United States)

    Kubicek-Sutherland, Jessica Z; Heithoff, Douglas M; Ersoy, Selvi C; Shimp, William R; House, John K; Marth, Jamey D; Smith, Jeffrey W; Mahan, Michael J

    2015-09-01

    Current antibiotic testing does not include the potential influence of host cell environment on microbial susceptibility and antibiotic resistance, hindering appropriate therapeutic intervention. We devised a strategy to identify the presence of host-pathogen interactions that alter antibiotic efficacy in vivo. Our findings revealed a bacterial mechanism that promotes antibiotic resistance in vivo at concentrations of drug that far exceed dosages determined by standardized antimicrobial testing. This mechanism has escaped prior detection because it is reversible and operates within a subset of host tissues and cells. Bacterial pathogens are thereby protected while their survival promotes the emergence of permanent drug resistance. This host-dependent mechanism of transient antibiotic resistance is applicable to multiple pathogens and has implications for the development of more effective antimicrobial therapies.

  1. Host-dependent Induction of Transient Antibiotic Resistance: A Prelude to Treatment Failure

    Directory of Open Access Journals (Sweden)

    Jessica Z. Kubicek-Sutherland

    2015-09-01

    Full Text Available Current antibiotic testing does not include the potential influence of host cell environment on microbial susceptibility and antibiotic resistance, hindering appropriate therapeutic intervention. We devised a strategy to identify the presence of host–pathogen interactions that alter antibiotic efficacy in vivo. Our findings revealed a bacterial mechanism that promotes antibiotic resistance in vivo at concentrations of drug that far exceed dosages determined by standardized antimicrobial testing. This mechanism has escaped prior detection because it is reversible and operates within a subset of host tissues and cells. Bacterial pathogens are thereby protected while their survival promotes the emergence of permanent drug resistance. This host-dependent mechanism of transient antibiotic resistance is applicable to multiple pathogens and has implications for the development of more effective antimicrobial therapies.

  2. Appendicitis during pregnancy in a Greenlandic Inuit woman; antibiotic treatment as a bridge-to-surgery in a remote area.

    Science.gov (United States)

    Dalsgaard Jensen, Trine; Penninga, Luit

    2016-05-18

    Appendicitis during pregnancy causes severe diagnostic problems, and is associated with an increase in perforation rate and morbidity compared to that in the normal population. In addition, it may cause preterm birth and fetal loss. In remote areas, appendicitis during pregnancy, besides presenting diagnostic problems, also creates treatment difficulties. In Northern Greenland, geographical distances are vast, and weather conditions can be extreme. We report a case of a Greenlandic Inuit woman who presented with appendicitis during pregnancy. The nearest hospital with surgical and anaesthetic care was located nearly 1200 km away, and, due to extreme weather conditions, she could not be transferred immediately. She was treated with intravenous antibiotic treatment, and after weather conditions had improved, she was transferred by aeroplane and underwent appendicectomy. She recovered without complications. Our case suggests that appendicitis during pregnancy may be treated with antibiotics in remote areas until surgical treatment is available. 2016 BMJ Publishing Group Ltd.

  3. Antibiotic treatment in patients with chronic low back pain and vertebral bone edema (Modic type 1 changes)

    DEFF Research Database (Denmark)

    Albert, H. B.; Sørensen, Joan S.; Berit Schiott, Christensen

    2013-01-01

    PURPOSE: Modic type 1 changes/bone edema in the vertebrae are present in 6 % of the general population and 35-40 % of the low back pain population. It is strongly associated with low back pain. The aim was to test the efficacy of antibiotic treatment in patients with chronic low back pain (>6...... in the vertebrae adjacent to the previous herniation. Patients were randomized to either 100 days of antibiotic treatment (Bioclavid) or placebo and were blindly evaluated at baseline, end of treatment and at 1-year follow-up. OUTCOME MEASURES: Primary outcome, disease-specific disability, lumbar pain. Secondary...... outcome leg pain, number of hours with pain last 4 weeks, global perceived health, EQ-5D thermometer, days with sick leave, bothersomeness, constant pain, magnetic resonance image (MRI). RESULTS: 144 of the 162 original patients were evaluated at 1-year follow-up. The two groups were similar at baseline...

  4. Strategies for decreasing multidrug antibiotic resistance: role of ototopical agents for treatment of middle ear infections.

    Science.gov (United States)

    Klein, Jerome O

    2002-10-01

    Change in the susceptibility of bacterial pathogens to antimicrobial agents is constant. The efficacy of a new drug may change as it is used in clinical settings, and resistant bacterial clones result from the encounter of drug and organism. Soon after the introduction of the sulfonamides in the mid-1930s, the first effective agents of the antimicrobial era, resistance of pneumococci and group A streptococci was evident. In each of the following decades, a different problem in multidrug resistance occurred among common bacterial pathogens: beta-lactamase-producing staphylococci in the 1950s; highly resistant gram-negative enteric bacteria in the 1960s; beta-lactamase-producing Haemophilus influenzae and Moraxella catarrhalis in the 1970s; and multidrug-resistant pneumococci in the 1980s. Antimicrobial resistance among respiratory pathogens is now a common clinical problem throughout the world, and its management is a part of routine office practice. Currently in the United States, about 25% of pneumococci are resistant to penicillin, and 25% of H influenzae and 90% of M catarrhalis produce beta-lactamase and would be inactivated by organisms producing the enzyme. The emergence of penicillin and multidrug-resistant pneumococci and beta-lactamase-producing strains of H influenzae and M catarrhalis have special importance for the management of infections of the middle ear. The widespread use of oral and parenteral antimicrobial drugs for appropriate and inappropriate uses has driven the emergence and spread of resistant organisms. This article discusses current susceptibility patterns of organisms involved in middle ear infections, risk factors associated with development of resistant strains, strategies for limiting the incidence and spread of resistant organisms and, as part of the strategy, use of ototopical rather than systemic antimicrobial drugs for chronic suppurative otitis media (CSOM) and acute otitis media (AOM) in children with tympanostomy tubes. Although

  5. Inappropriate shocks in the subcutaneous ICD

    DEFF Research Database (Denmark)

    Olde Nordkamp, Louise R A; Brouwer, Tom F; Barr, Craig

    2015-01-01

    shocks have been reported. METHODS: We analyzed the incidence, predictors and management of inappropriate shocks in the EFFORTLESS S-ICD Registry, which collects S-ICD implantation information and follow-up data from clinical centers in Europe and New Zealand. RESULTS: During a follow-up of 21 ± 13...... months, 48 out of 581 S-ICD patients (71% male, age 49 ± 18 years) experienced 101 inappropriate shocks (8.3%). The most common cause was cardiac signal oversensing (73%), such as T-wave oversensing. Eighteen shocks (18%) were due to supraventricular tachycardias (SVT), of which 15 occurred in the shock......-only zone. Cox-proportional hazard modeling using time-dependent covariates demonstrated that patients with a history of atrial fibrillation (HR 2.4) and patients with hypertrophic cardiomyopathy (HR 4.6) had an increased risk for inappropriate shocks, while programming the primary vector for sensing (from...

  6. Health Technology Assessment Fireside: Antibiotic Prophylaxis and Dental Treatment in Canada

    Directory of Open Access Journals (Sweden)

    Mario A. Brondani

    2013-01-01

    Full Text Available Objectives. This paper discusses the controversies surrounding the antibiotic prophylaxis preceding dental interventions within the following research question: how effective is dental antibiotic prophylaxis in preventing comorbidity and complications in those at risk? Methods. A synthesis of the available literature regarding antibiotic prophylaxis in dentistry was conducted under the lenses of Kazanjian’s framework for health technology assessment with a focus on economic concerns, population impact, social context, population at risk, and the effectiveness of the evidence to support its use. Results. The papers reviewed show that we have been using antibiotic prophylaxis without a clear and full understanding of its benefits. Although the first guideline for antibiotic prophylaxis was introduced in 1990, it has been revised on several occasions, from 1991 to 2011. Evidence-based clinical guidelines are yet to be seen. Conclusions. Any perceived potential benefit from administering antibiotic prophylaxis before dental procedures must be weighed against the known risks of lethal toxicity, allergy, and development, selection, and transmission of microbial resistance. The implications of guideline changes and lack of evidence for the full use of antibiotic prophylaxis for the teaching of dentistry have to be further discussed.

  7. Antibiotic resistant bacteria in urban sewage: Role of full-scale wastewater treatment plants on environmental spreading.

    Science.gov (United States)

    Turolla, A; Cattaneo, M; Marazzi, F; Mezzanotte, V; Antonelli, M

    2018-01-01

    The presence of antibiotic resistant bacteria (ARB) in wastewater was investigated and the role of wastewater treatment plants (WWTPs) in promoting or limiting antibiotic resistance was assessed. Escherichia coli (E. coli) and total heterotrophic bacteria (THB) resistance to ampicillin, chloramphenicol and tetracycline was monitored in three WWTPs located in Milan urban area (Italy), differing among them for the operating parameters of biological process, for the disinfection processes (based on sodium hypochlorite, UV radiation, peracetic acid) and for the discharge limits to be met. Wastewater was collected from three sampling points along the treatment sequence (WWTP influent, effluent from sand filtration, WWTP effluent). Antibiotic resistance to ampicillin was observed both for E. coli and for THB. Ampicillin resistant bacteria in the WWTP influents were 20-47% of E. coli and 16-25% of THB counts. A limited resistance to chloramphenicol was observed only for E. coli, while neither for E. coli nor for THB tetracycline resistance was observed. The biological treatment and sand filtration led to a decrease in the maximum percentage of ampicillin-resistant bacteria (20-29% for E. coli, 11-21% for THB). However, the conventionally adopted parameters did not seem adequate to support an interpretation of WWTP role in ARB spread. Peracetic acid was effective in selectively acting on antibiotic resistant THB, unlike UV radiation and sodium hypochlorite. The low counts of E. coli in WWTP final effluents in case of agricultural reuse did not allow to compare the effect of the different disinfection processes on antibiotic resistance. Copyright © 2017 Elsevier Ltd. All rights reserved.

  8. Addressing resistance to antibiotics in systematic reviews of antibiotic interventions

    NARCIS (Netherlands)

    Leibovici, Leonard; Paul, Mical; Garner, Paul; Sinclair, David J; Afshari, Arash; Pace, Nathan Leon; Cullum, Nicky; Williams, Hywel C; Smyth, Alan; Skoetz, Nicole; Del Mar, Chris; Schilder, Anne G M; Yahav, Dafna; Tovey, David

    Antibiotics are among the most important interventions in healthcare. Resistance of bacteria to antibiotics threatens the effectiveness of treatment. Systematic reviews of antibiotic treatments often do not address resistance to antibiotics even when data are available in the original studies. This

  9. Antibiotic treatment interruption of suspected lower respiratory tract infections based on a single procalcitonin measurement at hospital admission--a randomized trial

    DEFF Research Database (Denmark)

    Kristoffersen, K B; Søgaard, O S; Wejse, C

    2009-01-01

    Recent studies have suggested that procalcitonin (PCT) is a safe marker for the discrimination between bacterial and viral infection, and that PCT-guided treatment may lead to substantial reductions in antibiotic use. The present objective was to evaluate the effect of a single PCT measurement...... to either PCT-guided treatment or standard treatment. Antibiotic treatment duration in the PCT group was based on the serum PCT value at admission. The cut-off point for recommending antibiotic treatment was PCT > or =0.25 microg/L. Physicians could overrule treatment guidelines. The mean duration...... disease patients, the mean length of stay was reduced from 7.1 days in the control group to 4.8 days in the PCT group (p 0.009). It was concluded that the determination of a single PCT value at admission in patients with suspected LRTIs can lead to a reduction in the duration of antibiotic treatment by 25...

  10. Qualitative evaluation of antibiotic usage in pediatric patients

    OpenAIRE

    Hindra Irawan Satari; Agus Firmansyah; Theresia Theresia

    2011-01-01

    Background Antibiotics are among the most commonly prescribed drug for pediatric patients. Inappropriate use of antibiotics can increase morbidity, mortality, patient cost and bacterial antibiotic resistence. Antibiotic uses can be evaluated quantitatively and qualitatively. Objective To qualitatively evaluate antibiotic use in patients using Gyssens algorithm. Methods We performed a descriptive, retrospective study of matient medical records of those admitted to the pediatric ward fro...

  11. Competitive sorption and desorption behavior for three fluoroquinolone antibiotics in a wastewater treatment wetland soil.

    Science.gov (United States)

    Conkle, Jeremy L; Lattao, Charisma; White, John R; Cook, Robert L

    2010-09-01

    Significant amounts of pharmaceuticals are discharged into the environment through wastewater effluent. Sorption has been shown to be a significant aqueous removal pathway for many of these compounds. Competition between ciprofloxacin (CIP), ofloxacin (OFL) and norfloxacin (NOR) and their sorption to, and desorption from, a surrogate Louisiana wastewater treatment wetland soil were investigated to gain insight into the fate and transport of the pollutants within wastewater treatment wetlands. This study was undertaken in the context of a treatment wetland that continuously receives pharmaceuticals. Therefore it is important to understand the total capacity of this soil to sorb these compounds. Sorption to this treatment wetland soil was found to provide a major and potentially long-term removal pathway for these antibiotics from wastewater. LogK(F) values for all three compounds were between 4.09 and 3.90 for sorption and 4.24 and 4.05 microg(1-1/)(n)(cm(3))(1/)(n)g(-1) for desorption. The compounds were sorbed in amounts ranging from 60% to 90% for high and low loading, respectively. The majority of the compounds were sorbed to the soil within the first 20h, indicating that treatment wetland may not need long retention times (weeks to months) in order to remove these compounds. Sorption K(D) values for competition (20 ppm of each compound for 60 ppm of total fluoroquinolones) ranged from 2300 to 3800 cm(3)g(-1) which is between both the 20 (4300-5800 cm(3)g(-1)) and 60 (1300-3000 cm(3)g(-1)) ppm single compound K(D) values, indicating that there is competition between these three compound for sorption sites. Sorption and desorption data (single component and mixture) collectively provide the following evidence: (1) NOR and, to a lesser extent, CIP outcompete OFL for sorption sites, (2) OFL sorbes to its share of "quality" sorption sites, and (3) competition only occurs for lesser "quality" binding sites. Copyright (c) 2010 Elsevier Ltd. All rights reserved.

  12. Factors associated with inappropriate utilisation of emergency department services.

    Science.gov (United States)

    Selasawati, H G; Naing, L; Wan Aasim, W A; Winn, T; Rusli, B N

    2007-01-01

    This study was carried out to determine the associated factors and the reasons for inappropriate utilisation of Emergency Department (ED) services at Universiti Sains Malaysia Hospital. A case-control study was conducted with 170 cases from ED and 170 controls from the Outpatient Department (OPD). A self-administered questionnaire was designed and used to obtain sociodemographic data, knowledge on the functions of ED and OPD, health seeking attitude and behaviour, and reasons for seeking treatment at ED. The study found that gender, marital status, family size, shift work, perceived illness, and knowledge on the role and functions of ED and OPD were significant associated factors. The three most common reasons for inappropriate utilisation of ED were as follows: "due to severity of illness" (85%), "can't go to OPD during office hours" (42%), and "ED near my house" (27%).

  13. Photodynamic therapy associated with conventional endodontic treatment in patients with antibiotic-resistant microflora: a preliminary report.

    Science.gov (United States)

    Garcez, Aguinaldo S; Nuñez, Silvia C; Hamblim, Michael R; Suzuki, Hideo; Ribeiro, Martha S

    2010-09-01

    This study reports the antimicrobial effect of photodynamic therapy (PDT) combined with endodontic treatment in patients with necrotic pulp infected with microflora resistant to a previous antibiotic therapy. Thirty anterior teeth from 21 patients with periapical lesions that had been treated with conventional endodontic treatment and antibiotic therapy were selected. Microbiological samples were taken (1) after accessing the root canal, (2) after endodontic therapy, and (3) after PDT. All the patients had at least 1 microorganism resistant to antibiotics. PDT used polyethylenimine chlorin(e6) as a photosensitizer and a diode laser as a light source (P = 40 mW, t = 4 minutes, E = 9.6 J). Endodontic therapy alone produced a significant reduction in numbers of microbial species but only 3 teeth were free of bacteria, whereas the combination of endodontic therapy with PDT eliminated all drug-resistant species and all teeth were bacteria-free. The use of PDT added to conventional endodontic treatment leads to a further major reduction of microbial load. PDT is an efficient treatment to kill multi-drug resistant microorganisms. Copyright 2010 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

  14. Conservative Wait-and-See Therapy Versus Antibiotic Treatment for Nontuberculous Mycobacterial Cervicofacial Lymphadenitis in Children

    NARCIS (Netherlands)

    Lindeboom, Jerome A.

    2011-01-01

    Background. In this explorative study, 50 children with microbiologically confirmed nontuberculous mycobacterial cervicofacial lymphadenitis were randomized to either receive antibiotic therapy or follow a conservative wait-and-see approach. Our primary objective was to assess the time for all

  15. Distribution of antibiotic resistance in the effluents of ten municipal wastewater treatment plants in China and the effect of treatment processes.

    Science.gov (United States)

    Ben, Weiwei; Wang, Jian; Cao, Rukun; Yang, Min; Zhang, Yu; Qiang, Zhimin

    2017-04-01

    Municipal wastewater treatment plant (WWTP) effluents represent an important contamination source of antibiotic resistance, threatening the ecological safety of receiving environments. In this study, the release of antibiotic resistance to sulfonamides and tetracyclines in the effluents of ten WWTPs in China was investigated. Results indicate that the concentrations of antibiotic-resistant bacteria (ARB) and antibiotic resistance genes (ARGs) ranged from 1.1 × 10 1 to 8.9 × 10 3  CFU mL -1 and 3.6 × 10 1 (tetW) to 5.4 × 10 6 (tetX) copies mL -1 , respectively. There were insignificant correlations of the concentrations of ARB and ARGs with those of corresponding antibiotics. Strong correlations were observed between the total concentrations of tetracycline resistance genes and sulfonamide resistance genes, and both of which were significantly correlated with intI1 concentrations. Statistical analysis of the effluent ARG concentrations in different WWTPs revealed an important role of disinfection in eliminating antibiotic resistance. The release rates of ARB and ARGs through the effluents of ten WWTPs ranged from 5.9 × 10 12 to 4.8 × 10 15  CFU d -1 and 6.4 × 10 12 (tetW) to 1.7 × 10 18 (sul1) copies d -1 , respectively. This study helps the effective assessment and scientific management of ecological risks induced by antibiotic resistance discharged from WWTPs. Copyright © 2017 Elsevier Ltd. All rights reserved.

  16. Optimising the duration of antibiotic therapy for ventilator-associated pneumonia

    Directory of Open Access Journals (Sweden)

    J. Chastre

    2007-08-01

    Full Text Available Ventilator-associated pneumonia (VAP has traditionally been treated with a 14–21-day course of antibiotics. However, prolonged antibiotic therapy is associated with the emergence of multidrug-resistant strains, as well as higher toxicity and costs. In a large, randomised, controlled trial in patients with microbiologically confirmed VAP who received appropriate empirical antibiotic therapy, an 8-day antibiotic regimen was not associated with excess mortality or more episodes of recurrent pulmonary infection compared with a 15-day regimen. Amongst patients who developed recurrent infection, multidrug-resistant pathogens emerged less frequently in the group receiving 8 days of antibiotic therapy. The 8-day regimen was also not associated with excess mortality in the subgroup with VAP caused by nonfermentative Gram-negative bacilli, mostly Pseudomonas aeruginosa, although recurrent infections occurred more often. Pending confirmatory studies, an 8-day course of antibiotic therapy may be appropriate for many patients with ventilator-associated pneumonia, providing that initial antibiotic therapy is appropriate, the clinical course is favourable and extreme vigilance is maintained after stopping antibiotics. Patients whose initial treatment regimen was inappropriate, those infected with difficult-to-treat pathogens such as Pseudomonas aeruginosa, and immunocompromised patients and others at high risk for relapse are likely to require a longer duration of antibiotic therapy.

  17. Microbiological analysis and the outcomes of periodontal treatment with or without adjunctive systemic antibiotics-a retrospective study.

    Science.gov (United States)

    Eick, Sigrun; Nydegger, Jasmin; Bürgin, Walter; Salvi, Giovanni E; Sculean, Anton; Ramseier, Christoph

    2018-02-21

    The purpose of this retrospective study was to assess the impact of microbiological diagnostics on the outcomes of periodontal treatment with or without adjunctive use of systemic antibiotics. Patient files were screened for microbiological analysis before (T1) and after non-surgical periodontal therapy (T2). Medical history, diagnosis, clinical data, and results of the microbiological analysis were extracted from the patient's file. After descriptive statistics, logistic regression analysis was performed to model the presence of 90 and 50% reductions of numbers of sites with probing depths (PD) of ≥ 5 mm at T2 (90%-PD5 and 50%-PD5), respectively, against the presence of bacterial species, clinical diagnosis, and adjunctive use of systemic antibiotics. Eighteen patients diagnosed with aggressive periodontitis (AP, 17 with adjunctive antibiotics) and 84 with chronic periodontitis (CP, 31 with adjunctive antibiotics) were included in the analysis. Logistic modeling of bacteria at T1 to 90%-PD5 failed to show any statistical significance. Using 50%-PD5, presence of all Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola and in particular of T. denticola at T1 was associated with good response to therapy. Modeling of bacterial presence to 90-%PD5 and to 50-%PD5 at T2 found an association with absence of T. forsythia (90-%PD5 and 50-%PD5) and of T. denticola and Campylobacter rectus (50%-PD5). Modeling bacteria at T1, antibiotic group and oral hygiene at T2 on 50%-PD5 revealed odds ratio (OR) of the adjunctive antibiotic group between 2.70 and 52.4, of the oral hygiene between 3.27 and 4.11, and of the bacteria at T1 up to 28.6 (Porphyromonas gingivalis, T. forsythia, or T. denticola). Microbiological analysis of the most important species associated with periodontal diseases appears to support a clinically based decision for the adjunctive use of systemic antibiotics. The present findings appear to support the use microbiological testing to

  18. Antibiotic resistance in triclosan tolerant fecal coliforms isolated from surface waters near wastewater treatment plant outflows (Morris County, NJ, USA).

    Science.gov (United States)

    Middleton, June H; Salierno, James D

    2013-02-01

    Triclosan (TCS) is a common antimicrobial agent that has been detected in wastewater treatment plant (WWTP) effluent outflows. A link between TCS exposure and increased antibiotic resistance in microbes has been postulated. The purpose of this study was to evaluate whether fecal coliforms (FC) isolated from surface waters located near (WWTP) outflows display TCS resistance and, if so, whether such organisms exhibit increased resistance to antibiotics. Water samples were collected at two streams in Morris County, NJ that receive WWTP effluent: Loantaka Brook and the Whippany River. Water samples were collected at three sites within each location near the WWTP effluent outflow. Abiotic river parameters were measured and FCs were enumerated for each sample. River parameters were analyzed to determine if TCS or antibiotic resistance was correlated to water quality. Triclosan resistance levels were determined for individual isolates, and isolates were screened against seven classes of antibiotics at clinically relevant levels to assess cross-resistance. At Loantaka Brook, 78.8% of FC isolates were resistant to TCS with an average minimum inhibitory concentration (MIC) of 43.2 μg ml(-1). In addition, 89.6% of isolates were resistant to four classes of antibiotics and all were identified as Citrobacter freundii. There was a significant effect of stream location on mean TCS MIC values in the Loantaka Brook, with effluent isolates maintaining significantly higher MIC values compared to upstream isolates. At Whippany River sites, TCS resistant isolates were detected on 94% of sampling dates with a significant relationship between TCS resistance and multiple antibiotic resistances (≥ three antibiotic classes, p<0.001). TCS resistant isolates were significantly more resistant to chloramphenicol (p=0.007) and to nitrofurantoin (p=0.037) when compared to TCS sensitive isolates. Environmental FC isolates resistant to high level TCS included species of Escherichia, Enterobacter

  19. Inhaled antibiotics in the treatment of non-cystic fibrosis bronchiectasis: clinical and drug delivery perspectives.

    Science.gov (United States)

    Sugianto, Tiffanie Daisy; Chan, Hak-Kim

    2016-01-01

    Non-cystic fibrosis bronchiectasis (NCFB) is a chronic, progressive, suppurative lung disease characterized by permanent dilatation of bronchial subdivisions, which further causes accumulation of sputum and bacterial infections. The advent of inhaled antibiotics over the past two decades has been expected to effectively attenuate the problem of chronic bacterial infections in CF and NCFB subjects with higher, local drug concentrations and minimal systemic side effects. This review summarizes and evaluates current clinical evidence of efficacy and adverse effects of inhaled antibiotics in NCFB, as well as ongoing preclinical and clinical studies, followed by a discussion of issues and challenges in clinical practice and drug delivery strategies, together with future research directions. The evidence base of the clinical efficacy of inhaled antibiotics in NCFB is limited and the degrees of reported clinical benefits have been modest and conflicting. Challenges surrounding inhaled antibiotics application and development include the lack of knowledge of disease factors and optimum management strategies, unreceptive lung pathophysiology and the lack of factors that support compliance and tolerability. Nonetheless, research continues to give birth to new clinical findings and novel formulations such as combination antibiotics and sustained-release formulations, which add great value to the development of efficacious, safe and convenient inhalable antibiotics of the future.

  20. Effect of thermal treatments on the degradation of antibiotic residues in food.

    Science.gov (United States)

    Tian, Lei; Khalil, Salma; Bayen, Stéphane

    2017-11-22

    The thermal stability of antibiotics commonly detected in food is reviewed. To quantify degradation, 2 major techniques have been reported: liquid chromatography-based methods and microbiological tests. As the degradation products may also display some antimicrobial activity, microbiological tests may not be considered accurate analytical methods for quantifying antibiotic residues' degradation. Degradation percentages are summarized for different antibiotics and for various media (water, oil, milk, and animal tissues). Studies presented in the literature confirm that the thermal degradation of β-lactams, quinolones, sulfonamides, and tetracyclines can be described using a first-order kinetic model. Degradation rates, k, derived for this model for liquid matrix (water) at 100 °C, followed the general trend amongst antibiotic classes: β-lactams = tetracyclines (most heat-labile) > lincomycin > amphenicols > sulfonamides > oxfendazole > levamisole (most heat-stable). Although thermal processing results in a decrease in the concentration of parent antibiotic residues, degradation by-products have not been properly characterized to date. As some of these products were shown to be hazardous, further investigation is needed to determine their impact on food safety and human health. It is therefore currently difficult to definitively conclude whether or not antibiotic degradation during food processing is necessarily beneficial in terms of food safety.

  1. Prospective evaluation of antibiotic treatment for urological procedure in patients presenting with neurogenic bladder.

    Science.gov (United States)

    Weglinski, L; Rouzaud, C; Even, A; Bouchand, F; Davido, B; Duran, C; Salomon, J; Perronne, C; Denys, P; Chartier-Kastler, E; Dinh, A

    2016-09-01

    Patients presenting with neurogenic bladder often require urological procedures (urodynamic testing and botulinum toxin injections) and a preventive antibiotic therapy. We aimed to assess the efficacy of this little known strategy in a cohort of patients. All patients presenting with neurogenic bladder who underwent urological procedure were included in the study. They received an antibiotic therapy in accordance with the urine cytobacteriological examination results. The antibiotic therapy was initiated two days before the procedure and prolonged up until two days after the procedure if the culture was positive. Patients were treated with a single dose of fosfomycin-trometamol in case of a negative culture. The main study outcome was the occurrence of urinary tract infection (UTI), defined by a positive urine culture and symptoms, up until 14 days after the procedure. A total of 80 urological procedures were performed. Mean patient age was 47±13.1 years (sex ratio 1.22); 59 (73.8%) presented with asymptomatic bacteriuria before the procedure. Nine (11.1%) UTIs were recorded on Day 14, of which one (1.2%) was febrile. Two patients required an additional curative antibiotic therapy. No patient was hospitalized. Overall, 77.8% of UTIs were cured without antibiotic therapy. Screening and treating asymptomatic bacteriuria before urological procedures seems unnecessary and vainly exposes this population at high risk of infectious diseases to antibiotic therapies. This data should be confirmed by a randomized clinical trial. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  2. Pattern of prescription of antibiotics among dental practitioners in ...

    African Journals Online (AJOL)

    Background: Inappropriate use of antibiotics by clinicians leads to antibiotic resistance, and is a serious global health concern. Aim: The aim of this study was to determine antibiotic prescription practices of dental practitioners and their adherence to professional guidelines while treating oral health problems among children.

  3. Outpatient antibiotic prescriptions from 1992 to 2001 in The Netherlands

    NARCIS (Netherlands)

    Kuyvenhoven, MM; van Balen, FAM; Verheij, TJM

    2003-01-01

    Objectives: Although Dutch outpatient antibiotic prescription rates are low compared with other European countries, continuing to scrutinize trends in outpatient antibiotic use is important in order to identify possible increases in antibiotic use or inappropriate increases in the use of particular

  4. Chlorine and antibiotic-resistant bacilli isolated from an effluent treatment plant - doi: 10.4025/actascitechnol.v35i1.12951

    Directory of Open Access Journals (Sweden)

    Suzana Cláudia Silveira Martins

    2013-01-01

    Full Text Available Resistance to different concentrations of chlorine and the susceptibility to antibiotics by bacteria isolated from the final effluent of the Pici Campus wastewater treatment plant of the Federal University of Ceará (UFC is evaluated. Twelve strains, morphologically and biochemically identified as belonging to the genus Bacillus, were selected. The strains were submitted to sodium hypochlorite at different contact times and tested against the antibiotics amoxicillin, erythromycin, chloramphenicol, tetracycline, and vancomycin. All strains were resistant to concentration 0.1 ppm chlorine up to 30 minutes, but bacteria resistant to concentrations up to 5,000 ppm for 10 minutes were detected. Bacterial growth was impaired in 10,000 ppm concentration. The strains presented three antibiotic resistance profiles, 50% were sensitive to all antibiotics, 25% were resistant to one antibiotic and 25% were resistant to two antibiotics.  

  5. [Paradoxical reactions and responses during antibiotic treatment for Mycobacterium ulcerans infection (Buruli ulcer). Four cases from French Guiana].

    Science.gov (United States)

    Sambourg, E; Dufour, J; Edouard, S; Morris, A; Mosnier, E; Reynaud, Y; Sainte-Marie, D; Nacher, M; Guégan, J-F; Couppié, P

    2014-01-01

    In recent years, first-line therapy for Mycobacterium ulcerans infection in French Guiana has consisted of antibiotics active against this organism. Two regimens are used comprising rifampicin associated with clarithromycin or amikacin. We describe four patients presenting apparent worsening of their lesions during treatment: ulceration of a nodular lesion in a 32-year-old woman and worsening of an ulcerated lesion in three patients aged 16, 27 and 79 years. In these 4 patients, we concluded that the symptoms were caused by a paradoxical response or a reaction, a phenomenon already described in tuberculosis and leprosy. Such worsening is transient and must not be misinterpreted as failure to respond to treatment. The most plausible pathophysiological hypothesis involves the re-emergence of potentially necrotizing cellular immunity secondary to the loss of mycolactone, a necrotizing and immunosuppressive toxin produced by M. ulcerans, resulting from the action of the antibiotics. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  6. Combined antibiotic and free radical trap treatment is effective at combating Staphylococcus-aureus-induced septic arthritis

    Science.gov (United States)

    Sakiniene, Egidija; Collins, L Vincent

    2002-01-01

    Although early antibiotic treatment of patients with septic arthritis eradicates bacteria, joint destruction commonly results from the unregulated host inflammatory responses to infection. The spin trap compound phenyl-N-tert-butyl nitrone (PBN) has been shown to have both anti-inflammatory and antioxidant effects. The aim of this study was to assess the effect of combined systemic administration of PBN and cloxacillin on the development of Staphylococcus aureus arthritis. Three days after Naval Medical Research Institute (NMRI) mice were infected intravenously with S. aureus LS-1, daily treatment was started with cloxacillin alone, PBN alone, or cloxacillin and PBN. Arthritis, weight loss and general condition were evaluated for each mouse, and joints were analyzed histopathologically. Systemic administration of PBN in conjunction with cloxacillin ameliorated the course of experimental S. aureus arthritis, as evidenced by an increased cure rate. Thus, combinatorial antioxidant plus antibiotic anti-inflammatory therapies represent a potentially efficacious approach to the management of septic arthritis. PMID:12010570

  7. Inappropriate Intensive Care Unit admissions: Nigerian doctors ...

    African Journals Online (AJOL)

    2015-12-04

    Dec 4, 2015 ... Conclusion: Inappropriate ICU admissions were perceived as a common event and were mainly attributed to pressure from seniors, referring clinicians, and hospital management. Further work is ..... Financial support and sponsorship. Nil. Conflicts of interest. There are no conflicts of interest. References. 1.

  8. Prevalence and Predictors of Inappropriate Medications Prescribing ...

    African Journals Online (AJOL)

    Data analysis involved use of World Health Organization (WHO) prescribing indicators, Updated 2002 Beer's criteria and DRUG-REAX® system software package of MICROMEDEX (R) Healthcare Series to assess the prescribing pattern, identify potentially inappropriate medications and potential drug-drug interactions, ...

  9. Bullying and Inappropriate Behaviour among Faculty Personnel

    Science.gov (United States)

    Meriläinen, Matti; Sinkkonen, Hanna-Maija; Puhakka, Helena; Käyhkö, Katinka

    2016-01-01

    This study focuses on the degree, nature and consequences of bullying or inappropriate behaviour among faculty personnel (n = 303) in a Finnish university. A total of 114 (38%) faculty members answered the email questionnaire. According to the results, 15% of the respondents had experienced bullying; in addition, 45% had experienced inappropriate…

  10. Prevalence of inappropriate prescribing in primary care

    DEFF Research Database (Denmark)

    Bregnhøj, Lisbeth; Thirstrup, Steffen; Kristensen, Mogens Brandt

    2007-01-01

    OBJECTIVE: To describe the prevalence of inappropriate prescribing in primary care in Copenhagen County, according to the Medication Appropriateness Index (MAI) and to identify the therapeutic areas most commonly involved. SETTING: A cross-sectional study was conducted among 212 elderly ( >65 years...

  11. Missed opportunities and inappropriately given vaccines reduce ...

    African Journals Online (AJOL)

    Coverage would have increased by 10% for diphtheria pertusistetanus (DPT) doses DPTI and DPT2, and 7% for DPT3. Measles immunisation coverage would have increased by 19% had missed immunisation opportunities and inappropriately administered vaccinations been avoided. The overall missed opportunities rate ...

  12. The Composition and Spatial Patterns of Bacterial Virulence Factors and Antibiotic Resistance Genes in 19 Wastewater Treatment Plants.

    Science.gov (United States)

    Zhang, Bing; Xia, Yu; Wen, Xianghua; Wang, Xiaohui; Yang, Yunfeng; Zhou, Jizhong; Zhang, Yu

    2016-01-01

    Bacterial pathogenicity and antibiotic resistance are of concern for environmental safety and public health. Accumulating evidence suggests that wastewater treatment plants (WWTPs) are as an important sink and source of pathogens and antibiotic resistance genes (ARGs). Virulence genes (encoding virulence factors) are good indicators for bacterial pathogenic potentials. To achieve a comprehensive understanding of bacterial pathogenic potentials and antibiotic resistance in WWTPs, bacterial virulence genes and ARGs in 19 WWTPs covering a majority of latitudinal zones of China were surveyed by using GeoChip 4.2. A total of 1610 genes covering 13 virulence factors and 1903 genes belonging to 11 ARG families were detected respectively. The bacterial virulence genes exhibited significant spatial distribution patterns of a latitudinal biodiversity gradient and a distance-decay relationship across China. Moreover, virulence genes tended to coexist with ARGs as shown by their strongly positive associations. In addition, key environmental factors shaping the overall virulence gene structure were identified. This study profiles the occurrence, composition and distribution of virulence genes and ARGs in current WWTPs in China, and uncovers spatial patterns and important environmental variables shaping their structure, which may provide the basis for further studies of bacterial virulence factors and antibiotic resistance in WWTPs.

  13. Randomized clinical trial of observational versus antibiotic treatment for a first episode of CT-proven uncomplicated acute diverticulitis.

    Science.gov (United States)

    Daniels, L; Ünlü, Ç; de Korte, N; van Dieren, S; Stockmann, H B; Vrouenraets, B C; Consten, E C; van der Hoeven, J A; Eijsbouts, Q A; Faneyte, I F; Bemelman, W A; Dijkgraaf, M G; Boermeester, M A

    2017-01-01

    Antibiotics are advised in most guidelines on acute diverticulitis, despite a lack of evidence to support their routine use. This trial compared the effectiveness of a strategy with or without antibiotics for a first episode of uncomplicated acute diverticulitis. Patients with CT-proven, primary, left-sided, uncomplicated, acute diverticulitis were included at 22 clinical sites in the Netherlands, and assigned randomly to an observational or antibiotic treatment strategy. The primary endpoint was time to recovery during 6 months of follow-up. Main secondary endpoints were readmission rate, complicated, ongoing and recurrent diverticulitis, sigmoid resection and mortality. Intention-to-treat and per-protocol analyses were done. A total of 528 patients were included. Median time to recovery was 14 (i.q.r. 6-35) days for the observational and 12 (7-30) days for the antibiotic treatment strategy, with a hazard ratio for recovery of 0·91 (lower limit of 1-sided 95 per cent c.i. 0·78; P = 0·151). No significant differences between the observation and antibiotic treatment groups were found for secondary endpoints: complicated diverticulitis (3·8 versus 2·6 per cent respectively; P = 0·377), ongoing diverticulitis (7·3 versus 4·1 per cent; P = 0·183), recurrent diverticulitis (3·4 versus 3·0 per cent; P = 0·494), sigmoid resection (3·8 versus 2·3 per cent; P = 0·323), readmission (17·6 versus 12·0 per cent; P = 0·148), adverse events (48·5 versus 54·5 per cent; P = 0·221) and mortality (1·1 versus 0·4 per cent; P = 0·432). Hospital stay was significantly shorter in the observation group (2 versus 3 days; P = 0·006). Per-protocol analyses were concordant with the intention-to-treat analyses. Observational treatment without antibiotics did not prolong recovery and can be considered appropriate in patients with uncomplicated diverticulitis. Registration number: NCT01111253 (http://www.clinicaltrials.gov). © 2016 BJS Society Ltd Published by John

  14. Chronic urinary tract infections in patients with spinal cord lesions - biofilm infection with need for long-term antibiotic treatment.

    Science.gov (United States)

    Tofte, Nete; Nielsen, Alex C Y; Trøstrup, Hannah; Andersen, Christine B; Von Linstow, Michael; Hansen, Birgitte; Biering-Sørensen, Fin; Høiby, Niels; Moser, Claus

    2017-04-01

    Patients suffering from spinal cord injuries resulting in complete or incomplete paraplegia or tetraplegia are highly disposed to frequent, recurrent or even chronic urinary tract infections (UTIs). The reason for the increased risk of acquiring UTIs is multifactorial, including reduced sensation of classical UTI symptoms, incomplete bladder emptying, frequent catheterizations or chronic urinary tract catheters. Biofilms in relation to UTIs have been shown both on catheters, on concrements or as intracellular bacterial communities (IBCs). Due to the increased risk of acquiring recurrent or chronic UTIs and frequent antibiotic treatments, patients experience an increased risk of being infected with antibiotic-resistant bacteria like extended-spectrum β-lactamase-producing Escherichia coli or Klebsiella spp., but also bacteria like Pseudomonas aeruginosa inherently resistant to several antibiotics. Diagnosing the UTI can also be challenging, especially distinguishing harmless colonization from pathogenic infection. Based on a previous study showing activation of humoral immune response toward UTI pathogens in patients with spinal cord lesions (SCL), the present mini review is an evaluation of using antibody response as an indicator of chronic biofilm UTI. In addition, we evaluated the effect of long-term treatment with antibiotics in patients with SCLs and chronic UTI, defined by culturing of a uropathogen in the urine and elevated specific precipitating antibodies against the same uropathogen in a blood sample. Elimination of chronic UTI, decrease in specific precipitating antibody values and avoiding selection of new multidrug-resistant (MDR) uropathogens were the primary markers for effect of treatment. The results of this evaluation suggest that the long-term treatment strategy in SCL patients with chronic UTI may be effective; however, randomized prospective results are needed to confirm this. © 2017 APMIS. Published by John Wiley & Sons Ltd.

  15. Treatment of mice with sepsis following irradiation and trauma with antibiotics and synthetic trehalose dicorynomycolate (S-TDCM)

    International Nuclear Information System (INIS)

    Madonna, G.S.; Ledney, G.D.; Moore, M.M.; Elliott, T.B.; Brook, I.

    1991-01-01

    Compromise of antimicrobial defenses by irradiation can result in sepsis and death. Additional trauma can further predispose patients to infection and thus increase mortality. We recently showed that injection of synthetic trehalose dicorynomycolate (S-TDCM) significantly augments resistance to infection and increases survival of mice compromised either by whole-body irradiation with gamma radiation or equal mixtures of fission neutron and gamma radiation. In this study, C3H/HeN mice were given a lethal dose of gamma radiation (8.0 Gy) and an open wound (15% total body surface area [TBSA]) 1 hr later while anesthetized. Irradiated/wounded mice became more severely leukopenic and thrombocytopenic than mice exposed to radiation alone, and died from natural wound infection and sepsis within 7 days. S-TDCM given 1 hr postirradiation increased survival of mice exposed to radiation alone. However, this treatment did not increase survival of the irradiated/wounded mice. Systemic antibiotic therapy with gentamicin or ofloxacin for 10 days significantly increased survival time compared with untreated irradiated/wounded mice (p less than 0.01). Combination therapy with topical gentamicin cream and systemic oxacillin increased survival from 0% to 100%. Treatment with S-TDCM combined with the suboptimal treatment of topical and systemic gentamicin increased survival compared with antibiotic treatment alone. These studies demonstrate that post-trauma therapy with S-TDCM and antibiotics augments resistance to infection in immunocompromised mice. The data suggest that therapies which combine stimulation of nonspecific host defense mechanisms with antibiotics may increase survival of irradiated patients inflicted with accidental or surgical trauma

  16. External otitis and its treatment : is a group III steroid without antibiotics sufficent therapy? Experimental and clinical studies

    OpenAIRE

    Emgård, Per

    2005-01-01

    ABSTRACT External otitis and its treatment. Is a group III steroid without antibiotics sufficient therapy? – Experimental and clinical studies Per Emgård, Department of Otorhinolaryngology, University of Umeå and Ystad Hospital, Umeå and Ystad, Sweden External otitis is one of the most common ear, nose and throat (ENT) diagnoses in out-patient clinics. The clinical course of external otitis includes itching, pain, redness, swelling and effusion of the external auditory canal (EAC) with normal...

  17. Synthetic Beta-Lactam Antibiotic as a Selective Breast Cancer Cell Apoptosis Inducer: Significance in Breast Cancer Prevention and Treatment

    Science.gov (United States)

    2005-04-01

    lactams the name "penicillin" in 1928 after his discovery that molds from the Penicillium genus secrete powerful antimicrobial compounds, called beta...whi Nis required for antimicrobial activity . These antibiotics act as bactericidal agens by serv a sub te 1 pepti gylcaAtranspeptidase, the enzyme...ABSTRACT (Maximum 200 Words) Activation of the cellular apoptotic program is a current strategy for the prevention and treatment of human cancer including

  18. Soil-borne reservoirs of antibiotic-resistant bacteria are established following therapeutic treatment of dairy calves.

    Science.gov (United States)

    Liu, Jinxin; Zhao, Zhe; Orfe, Lisa; Subbiah, Murugan; Call, Douglas R

    2016-02-01

    We determined if antibiotics residues that are excreted from treated animals can contribute to persistence of resistant bacteria in agricultural environments. Administration of ceftiofur, a third-generation cephalosporin, resulted in a ∼ 3 log increase in ceftiofur-resistant Escherichia coli found in the faeces and pen soils by day 10 (P = 0.005). This resistant population quickly subsided in faeces, but was sustained in the pen soil (∼ 4.5 log bacteria g(-1)) throughout the trial (1 month). Florfenicol treatment resulted in a similar pattern although the loss of florfenicol-resistant E. coli was slower for faeces and remained stable at ∼ 6 log bacteria g(-1) in the soil. Calves were treated in pens where eGFP-labelled E. coli were present in the bedding (∼ 2 log g(-1)) resulting in amplification of the eGFP E. coli population ∼ 2.1 log more than eGFP E. coli populations in pens with untreated calves (day 4; P 10-fold greater contribution to the bedding reservoir compared with shedding of resistant bacteria in faeces. Treatment with therapeutic doses of ceftiofur or florfenicol resulted in 2-3 log g(-1) more bacteria than the estimated ID50 (2.83 CFU g(-1)), consistent with a soil-borne reservoir emerging after antibiotic treatment that can contribute to the long-term persistence of antibiotic resistance in animal agriculture. © 2015 Society for Applied Microbiology and John Wiley & Sons Ltd.

  19. Safety and efficacy of antibiotics compared with appendicectomy for treatment of uncomplicated acute appendicitis: meta-analysis of randomised controlled trials

    Science.gov (United States)

    Varadhan, Krishna K; Neal, Keith R

    2012-01-01

    Objective To compare the safety and efficacy of antibiotic treatment versus appendicectomy for the primary treatment of uncomplicated acute appendicitis. Design Meta-analysis of randomised controlled trials. Population Randomised controlled trials of adult patients presenting with uncomplicated acute appendicitis, diagnosed by haematological and radiological investigations. Interventions Antibiotic treatment versus appendicectomy. Outcome measures The primary outcome measure was complications. The secondary outcome measures were efficacy of treatment, length of stay, and incidence of complicated appendicitis and readmissions. Results Four randomised controlled trials with a total of 900 patients (470 antibiotic treatment, 430 appendicectomy) met the inclusion criteria. Antibiotic treatment was associated with a 63% (277/438) success rate at one year. Meta-analysis of complications showed a relative risk reduction of 31% for antibiotic treatment compared with appendicectomy (risk ratio (Mantel-Haenszel, fixed) 0.69 (95% confidence interval 0.54 to 0.89); I2=0%; P=0.004). A secondary analysis, excluding the study with crossover of patients between the two interventions after randomisation, showed a significant relative risk reduction of 39% for antibiotic therapy (risk ratio 0.61 (0.40 to 0.92); I2=0%; P=0.02). Of the 65 (20%) patients who had appendicectomy after readmission, nine had perforated appendicitis and four had gangrenous appendicitis. No significant differences were seen for treatment efficacy, length of stay, or risk of developing complicated appendicitis. Conclusion Antibiotics are both effective and safe as primary treatment for patients with uncomplicated acute appendicitis. Initial antibiotic treatment merits consideration as a primary treatment option for early uncomplicated appendicitis. PMID:22491789

  20. Detection of antibiotic resistance genes in wastewater treatment plant – molecular and classical approach

    Directory of Open Access Journals (Sweden)

    Ziembińska-Buczyńska Aleksandra

    2015-12-01

    Full Text Available Antibiotics are a group of substances potentially harmful to the environment. They can play a role in bacterial resistance transfer among pathogenic and non-pathogenic bacteria. In this experiment three representatives of medically important chemotherapeutics, confirmed to be present in high concentrations in wastewater treatment plants with HPLC analysis were used: erythromycin, sulfamethoxazole and trimethoprim. Erythromycin concentration in activated sludge was not higher than 20 ng L−1. N-acetylo-sulfamethoxazole concentration was 3349 ± 719 in winter and 2933 ± 429 ng L−1 in summer. Trimethoprim was present in wastewater at concentrations 400 ± 22 and 364 ± 60 ng L−1, respectively in winter and summer. Due to a wide variety of PCR-detectable resistance mechanisms towards these substances, the most common found in literature was chosen. For erythromycin: erm and mef genes, for sulfamethoxazole: sul1, sul2, sul3 genes, in the case of trimethoprim resistance dhfrA1 and dhfr14 were used in this study. The presence of resistance genes were analyzed in pure strains isolated from activated sludge and in the activated sludge sample itself. The research revealed that the value of minimal inhibitory concentration (MIC did not correspond with the expected presence of more than one resistance mechanisms. Most of the isolates possessed only one of the genes responsible for a particular chemotherapeutic resistance. It was confirmed that it is possible to monitor the presence of resistance genes directly in activated sludge using PCR. Due to the limited isolates number used in the experiment these results should be regarded as preliminary.

  1. Knowledge, awareness, and attitudes toward antibiotic use and antimicrobial resistance among Saudi population.

    Science.gov (United States)

    El Zowalaty, Mohamed E; Belkina, Tatiana; Bahashwan, Saleh A; El Zowalaty, Ahmed E; Tebbens, Jurjen Duintjer; Abdel-Salam, Hassan A; Khalil, Adel I; Daghriry, Safaa I; Gahtani, Mona A; Madkhaly, Fatimah M; Nohi, Nahed I; Khodari, Rafaa H; Sharahili, Reem M; Dagreery, Khlood A; Khormi, Mayisah; Habibah, Sarah Abuo; Medrba, Bayan A; Gahtani, Amal A; Hifthi, Rasha Y; Zaid, Jameelah M; Amshan, Arwa W; Alneami, Alqasim A; Noreddin, Ayman; Vlček, Jiří

    2016-10-01

    Background Inappropriate use of antibiotics is a public health problem of great concern. Objective To evaluate knowledge of antibiotics, race, gender and age as independent risk factors for self-medication. Setting Residents and population from different regions of Saudi Arabia. Methods We conducted a cross sectional survey study among residents. Data were collected between June 2014 to May, 2015 from 1310 participants and data were recorded anonymously. The questionnaire was randomly distributed by interview of participants and included sociodemographic characteristics, antibiotics knowledge, attitudes and behavior with respect to antibiotics usage. Main outcome measure Population aggregate scores on questions and data were analyzed using univariate logistic regression to evaluate the influence of variables on self-prescription of antibiotics. Results The response rate was 87.7 %. A cumulative 63.6 % of participants reported to have purchased antibiotics without a prescription from pharmacies; 71.1 % reported that they did not finish the antibiotic course as they felt better. The availability of antibiotics without prescription was found to be positively associated with self-medication (OR 0.238, 95 % CI 0.17-0.33). Of those who used prescribed or non-prescribed antibiotics, 44.7 % reported that they kept left-over antibiotics from the incomplete course of treatment for future need. Interestingly, 62 % of respondents who used drugs without prescription agreed with the statement that antibiotics should be access-controlled prescribed by a physician. We also found significant association between storage, knowledge/attitudes and education. Conclusions The overall level of awareness on antibiotics use among residents in Saudi Arabia is low. This mandates public health awareness intervention programs to be implemented on the use of antibiotics.

  2. Odontogenic bacteria in periodontal disease and resistance patterns to common antibiotics used as treatment and prophylaxis in odontology in Spain.

    Science.gov (United States)

    Maestre, J R; Bascones, A; Sánchez, P; Matesanz, P; Aguilar, Lorenzo; Giménez, M J; Pérez-Balcabao, I; Granizo, J J; Prieto, J

    2007-03-01

    Resistance in streptococci or Gram-negative bacteria is associated with antibiotic consumption. Scarce information exists on the antibiotic susceptibility of bacterial isolates from patients with periodontitis in countries with high antibiotic consumption, as this is an area in which microbiological testing is not performed in daily practice. The present study was undertaken to explore the susceptibility of bacterial isolates in periodontitis to antibiotics prescribed in odontology in Spain as treatment for local infections or prophylaxis for distant focal infections. Periodontal samples were prospectively collected in 48 patients classified by pocket depth of or=4 mm. Species were identified by culture, selecting the five most frequent morphotypes per sample, and polymerase chain reaction (PCR). Susceptibility was determined by E-test. A total of 261 isolates were identified: 72.9% patients had Streptococcus oralis; 70.8% Streptococcus mitis; 60.4% Prevotella buccae; 39.6% Prevotella denticola; 37.5% Fusobacterium nucleatum; 35.4% Prevotella intermedia; 25% Capnocytophaga spp.; 23% Veillonella spp.; 22.9% Prevotella melaninogenica and Streptococcus sanguis; and <20% other species. Streptococcus viridans resistance rates were 0% for amoxicillin, approximately 10% for clindamycin, 9-22% for tetracycline, and for azithromycin ranged from 18.2% for S. sanguis to 47.7% for S. mitis. Prevotella isolates were susceptible to amoxicillin-clavulanic acid, with amoxicillin resistance ranging from 17.1% in P. buccae to 26.3% in P. denticola. Metronidazole resistance was <6% in all Prevotella species, while clindamycin resistance ranged from 0 to 21.1%. beta-Lactamase production was positive in 54.1% Prevotella spp., 38.9% F. nucleatum, 30% Capnocytophaga spp., and 10% Veillonella spp. In this study, amoxicillin-clavulanic acid was the most active antibiotic against all species tested, followed by metronidazole in the case of anaerobes.

  3. Modulation of the gut microbiota with antibiotic treatment suppresses whole body urea production in neonatal pigs

    DEFF Research Database (Denmark)

    Puiman, Patrycja; Stoll, Barbara; Mølbak, Lars

    2013-01-01

    administered antibiotics, or probiotics affects whole body nitrogen and amino acid turnover. We quantified whole body urea kinetics, threonine fluxes, and threonine disposal into protein, oxidation, and tissue protein synthesis with stable isotope techniques. Compared with controls, antibiotics reduced...... decreased protein synthesis rate in the proximal SI and liver but did not affect the distal SI, colon, or muscle. Probiotics induced a bifidogenic microbiota and decreased plasma urea concentrations but did not affect whole body threonine or protein metabolism. Probiotics decreased protein synthesis...... in the proximal SI but not in other tissues. In conclusion, modulation of the gut microbiota by antibiotics and probiotics reduced hepatic ureagenesis and intestinal protein synthesis, but neither altered whole body net threonine balance. These findings suggest that changes in amino acid and nitrogen metabolism...

  4. Association of Broad- vs Narrow-Spectrum Antibiotics With Treatment Failure, Adverse Events, and Quality of Life in Children With Acute Respiratory Tract Infections.

    Science.gov (United States)

    Gerber, Jeffrey S; Ross, Rachael K; Bryan, Matthew; Localio, A Russell; Szymczak, Julia E; Wasserman, Richard; Barkman, Darlene; Odeniyi, Folasade; Conaboy, Kathryn; Bell, Louis; Zaoutis, Theoklis E; Fiks, Alexander G

    2017-12-19

    Acute respiratory tract infections account for the majority of antibiotic exposure in children, and broad-spectrum antibiotic prescribing for acute respiratory tract infections is increasing. It is not clear whether broad-spectrum treatment is associated with improved outcomes compared with narrow-spectrum treatment. To compare the effectiveness of broad-spectrum and narrow-spectrum antibiotic treatment for acute respiratory tract infections in children. A retrospective cohort study assessing clinical outcomes and a prospective cohort study assessing patient-centered outcomes of children between the ages of 6 months and 12 years diagnosed with an acute respiratory tract infection and prescribed an oral antibiotic between January 2015 and April 2016 in a network of 31 pediatric primary care practices in Pennsylvania and New Jersey. Stratified and propensity score-matched analyses to account for confounding by clinician and by patient-level characteristics, respectively, were implemented for both cohorts. Broad-spectrum antibiotics vs narrow-spectrum antibiotics. In the retrospective cohort, the primary outcomes were treatment failure and adverse events 14 days after diagnosis. In the prospective cohort, the primary outcomes were quality of life, other patient-centered outcomes, and patient-reported adverse events. Of 30 159 children in the retrospective cohort (19 179 with acute otitis media; 6746, group A streptococcal pharyngitis; and 4234, acute sinusitis), 4307 (14%) were prescribed broad-spectrum antibiotics including amoxicillin-clavulanate, cephalosporins, and macrolides. Broad-spectrum treatment was not associated with a lower rate of treatment failure (3.4% for broad-spectrum antibiotics vs 3.1% for narrow-spectrum antibiotics; risk difference for full matched analysis, 0.3% [95% CI, -0.4% to 0.9%]). Of 2472 children enrolled in the prospective cohort (1100 with acute otitis media; 705, group A streptococcal pharyngitis; and 667, acute sinusitis), 868

  5. Monitoring and evaluation of antibiotic resistance genes in four municipal wastewater treatment plants in Harbin, Northeast China

    International Nuclear Information System (INIS)

    Wen, Qinxue; Yang, Lian; Duan, Ruan; Chen, Zhiqiang

    2016-01-01

    The development and proliferation of antibiotic resistance in pathogenic and environmental microorganisms is of great concern for public health. In this study, the distribution and removal efficiency of intI1 and eight subtypes of antibiotic resistance genes (ARGs) for tetracycline, sulfonamides, beta-lactams resistance in four municipal wastewater treatment plants (WWTPs) in Harbin, which locates in Songhua River basin in cold areas of China, were monitored by real-time fluorescent quantitative PCR. The results showed that intI1 and 6 ARGs except for bla TEM and bla SHV were detected in wastewater and sludge samples and 0.3–2.7 orders of magnitude of ARGs removal efficiency in the four WWTPs were observed. The investigation on the removal of ARGs of different treatment units in one WWTP showed that the biological treatment unit played the most important role in ARGs removal (1.2–1.8 orders of magnitude), followed by UV disinfection, while primary physical treatment units can hardly remove any ARGs. Although all the WWTPs can remove ARGs effectively, ARGs concentrations are still relatively high in the effluent, their further attenuation should be investigated. - Highlights: • The distribution of 8 ARGs and intI1 in WWTPs in Harbin in winter were monitored. • ARGs removal in 4 WWTPs with different processes were investigated. • Biological treatment process plays the most important role in ARGs removal. • A relatively high level of ARGs is still present in the effluent after wastewater treatment. • Regional uses of antibiotics other than season temperature affects the fate of ARGs in WWTPs.

  6. Dialysate White Blood Cell Change after Initial Antibiotic Treatment Represented the Patterns of Response in Peritoneal Dialysis-Related Peritonitis

    Directory of Open Access Journals (Sweden)

    Pichaya Tantiyavarong

    2016-01-01

    Full Text Available Background. Patients with peritoneal dialysis-related peritonitis usually have different responses to initial antibiotic treatment. This study aimed to explore the patterns of response by using the changes of dialysate white blood cell count on the first five days of the initial antibiotic treatment. Materials and Methods. A retrospective cohort study was conducted. All peritoneal dialysis-related peritonitis episodes from January 2014 to December 2015 were reviewed. We categorized the patterns of antibiotic response into 3 groups: early response, delayed response, and failure group. The changes of dialysate white blood cell count for each pattern were determined by multilevel regression analysis. Results. There were 644 episodes in 455 patients: 378 (58.7% of early response, 122 (18.9% of delayed response, and 144 (22.3% of failure episodes. The patterns of early, delayed, and failure groups were represented by the average rate reduction per day of dialysate WBC of 68.4%, 34.0%, and 14.2%, respectively (p value < 0.001 for all comparisons. Conclusion. Three patterns, which were categorized by types of responses, have variable rates of WBC declining. Clinicians should focus on the delayed response and failure patterns in order to make a decision whether to continue medical therapies or to aggressively remove the peritoneal catheter.

  7. Dialysate White Blood Cell Change after Initial Antibiotic Treatment Represented the Patterns of Response in Peritoneal Dialysis-Related Peritonitis.

    Science.gov (United States)

    Tantiyavarong, Pichaya; Traitanon, Opas; Chuengsaman, Piyatida; Patumanond, Jayanton; Tasanarong, Adis

    2016-01-01

    Background. Patients with peritoneal dialysis-related peritonitis usually have different responses to initial antibiotic treatment. This study aimed to explore the patterns of response by using the changes of dialysate white blood cell count on the first five days of the initial antibiotic treatment. Materials and Methods. A retrospective cohort study was conducted. All peritoneal dialysis-related peritonitis episodes from January 2014 to December 2015 were reviewed. We categorized the patterns of antibiotic response into 3 groups: early response, delayed response, and failure group. The changes of dialysate white blood cell count for each pattern were determined by multilevel regression analysis. Results. There were 644 episodes in 455 patients: 378 (58.7%) of early response, 122 (18.9%) of delayed response, and 144 (22.3%) of failure episodes. The patterns of early, delayed, and failure groups were represented by the average rate reduction per day of dialysate WBC of 68.4%, 34.0%, and 14.2%, respectively (p value patterns, which were categorized by types of responses, have variable rates of WBC declining. Clinicians should focus on the delayed response and failure patterns in order to make a decision whether to continue medical therapies or to aggressively remove the peritoneal catheter.

  8. Multi-bacteria multi-antibiotic testing using surface enhanced Raman spectroscopy (SERS) for urinary tract infection (UTI) diagnosis

    Science.gov (United States)

    Hadjigeorgiou, Katerina; Kastanos, Evdokia; Pitris, Costas

    2013-06-01

    The inappropriate use of antibiotics leads to antibiotic resistance, which is a major health care problem. The current method for determination of bacterial susceptibility to antibiotics requires overnight cultures. However most of the infections cannot wait for the results to receive treatment, so physicians administer general spectrum antibiotics. This results in ineffective treatments and aggravates the rising problem of antibiotic resistance. In this work, a rapid method for diagnosis and antibiogram for a bacterial infection was developed using Surface Enhanced Raman Spectroscopy (SERS) with silver nanoparticles. The advantages of this novel method include its rapidness and efficiency which will potentially allow doctors to prescribe the most appropriate antibiotic for an infection. SERS spectra of three species of gram negative bacteria, Escherichia coli, Proteus spp., and Klebsiella spp. were obtained after 0 and 4 hour exposure to the seven different antibiotics. Bacterial strains were diluted in order to reach the concentration of (2x105 cfu/ml), cells/ml which is equivalent to the minimum concentration found in urine samples from UTIs. Even though the concentration of bacteria was low, species classification was achieved with 94% accuracy using spectra obtained at 0 hours. Sensitivity or resistance to antibiotics was predicted with 81%-100% accuracy from spectra obtained after 4 hours of exposure to the different antibiotics. This technique can be applied directly to urine samples, and with the enhancement provided by SERS, this method has the potential to be developed into a rapid method for same day UTI diagnosis and antibiogram.

  9. Antibiotic treatment in patients with low back pain associated with Modic changes Type 1 (bone oedema): a pilot study

    DEFF Research Database (Denmark)

    Albert, Hanne B.; Manniche, Claus; Sørensen, Joan S.

    2008-01-01

    changes and were treated with Amoxicillin-clavulanate (500 mg/125 mg) 3 x day for 90 days. All patients had previously participated in a randomized controlled trial (RCT) that investigated active conservative treatment for a lumbar herniated disc (n=166). All patients in that RCT who had Modic changes...... effect of antibiotic treatment was large in a group of patients with Modic changes suffering from persistent LBP following a disc herniation. These results provide tentative support for a hypothesis that bacterial infection may play a role in LBP with Modic changes and indicate the need for randomised...

  10. Oral versus intravenous antibiotic treatment for bone and joint infections (OVIVA): study protocol for a randomised controlled trial.

    Science.gov (United States)

    Li, Ho Kwong; Scarborough, Matthew; Zambellas, Rhea; Cooper, Cushla; Rombach, Ines; Walker, A Sarah; Lipsky, Benjamin A; Briggs, Andrew; Seaton, Andrew; Atkins, Bridget; Woodhouse, Andrew; Berendt, Anthony; Byren, Ivor; Angus, Brian; Pandit, Hemant; Stubbs, David; McNally, Martin; Thwaites, Guy; Bejon, Philip

    2015-12-21

    Bone and joint infection in adults arises most commonly as a complication of joint replacement surgery, fracture fixation and diabetic foot infection. The associated morbidity can be devastating to patients and costs the National Health Service an estimated £20,000 to £40,000 per patient. Current standard of care in most UK centres includes a prolonged course (4-6 weeks) of intravenous antibiotics supported, if available, by an outpatient parenteral antibiotic therapy service. Intravenous therapy carries with it substantial risks and inconvenience to patients, and the antibiotic-related costs are approximately ten times that of oral therapy. Despite this, there is no evidence to suggest that oral therapy results in inferior outcomes. We hypothesise that, by selecting oral agents with high bioavailability, good tissue penetration and activity against the known or likely pathogens, key outcomes in patients managed primarily with oral therapy are non-inferior to those in patients treated by intravenous therapy. The OVIVA trial is a parallel group, randomised (1:1), un-blinded, non-inferiority trial conducted in thirty hospitals across the UK. Eligible participants are adults (>18 years) with a clinical syndrome consistent with a bone, joint or metalware-associated infection who have received ≤7 days of intravenous antibiotic therapy from the date of definitive surgery (or the start of planned curative therapy in patients treated without surgical intervention). Participants are randomised to receive either oral or intravenous antibiotics, selected by a specialist infection physician, for the first 6 weeks of therapy. The primary outcome measure is definite treatment failure within one year of randomisation, as assessed by a blinded endpoint committee, according to pre-defined microbiological, histological and clinical criteria. Enrolling 1,050 subjects will provide 90 % power to demonstrate non-inferiority, defined as less than 7.5 % absolute increase in treatment

  11. Successful antibiotic treatment of Pseudomonas stutzeri-induced peritonitis without peritoneal dialysis catheter removal in continuous ambulatory peritoneal dialysis

    Directory of Open Access Journals (Sweden)

    Sung Wook Park

    2013-06-01

    Full Text Available Pseudomonas stutzeri is a Gram-negative, rod-shaped, motile, single polar-flagellated, soil bacterium that was first isolated from human spinal fluid and is widely distributed in the environment. It was isolated as an uncommon opportunistic pathogen from humans, and a few cases of P. stutzeri-induced peritonitis have been reported in patients undergoing continuous ambulatory peritoneal dialysis (CAPD. Catheter removal with antibiotic treatment is generally recommended because peritonitis by Pseudomonas species is commonly associated with catheter-related infection. Here, we describe the first case of P. stutzeri-induced peritonitis in an 82-year-old woman in Korea. She had received two antipseudomonal antibiotics, an aminoglycoside (isepamicin, Yuhan corporation, Seoul, Korea and a fluoroquinolone (ciprofloxacin, and was successfully treated without removal of the CAPD catheter.

  12. Fate and proliferation of typical antibiotic resistance genes in five full-scale pharmaceutical wastewater treatment plants

    Energy Technology Data Exchange (ETDEWEB)

    Wang, Jilu [College of Environmental Science and Engineering, Ministry of Education Key Laboratory of Pollution Processes and Environmental Criteria, Nankai University, Tianjin 300071 (China); Mao, Daqing, E-mail: mao@tju.edu.cn [School of Environmental Science and Engineering, Tianjin University, Tianjin 300072 (China); Mu, Quanhua [College of Environmental Science and Engineering, Ministry of Education Key Laboratory of Pollution Processes and Environmental Criteria, Nankai University, Tianjin 300071 (China); Luo, Yi, E-mail: luoy@nankai.edu.cn [College of Environmental Science and Engineering, Ministry of Education Key Laboratory of Pollution Processes and Environmental Criteria, Nankai University, Tianjin 300071 (China)

    2015-09-01

    This study investigated the characteristics of 10 subtypes of antibiotic resistance genes (ARGs) for sulfonamide, tetracycline, β-lactam and macrolide resistance and the class 1 integrase gene (intI1). In total, these genes were monitored in 24 samples across each stage of five full-scale pharmaceutical wastewater treatment plants (PWWTPs) using qualitative and real-time quantitative polymerase chain reactions (PCRs). The levels of typical ARG subtypes in the final effluents ranged from (2.08 ± 0.16) × 10{sup 3} to (3.68 ± 0.27) × 10{sup 6} copies/mL. The absolute abundance of ARGs in effluents accounted for only 0.6%–59.8% of influents of the five PWWTPs, while the majority of the ARGs were transported to the dewatered sludge with concentrations from (9.38 ± 0.73) × 10{sup 7} to (4.30 ± 0.81) × 10{sup 10} copies/g dry weight (dw). The total loads of ARGs discharged through dewatered sludge was 7–308 folds higher than that in the raw influents and 16–638 folds higher than that in the final effluents. The proliferation of ARGs mainly occurs in the biological treatment processes, such as conventional activated sludge, cyclic activated sludge system (CASS) and membrane bio-reactor (MBR), implying that significant replication of certain subtypes of ARGs may be attributable to microbial growth. High concentrations of antibiotic residues (ranging from 0.14 to 92.2 mg/L) were detected in the influents of selected wastewater treatment systems and they still remain high residues in the effluents. Partial correlation analysis showed significant correlations between the antibiotic concentrations and the associated relative abundance of ARG subtypes in the effluent. Although correlation does not prove causation, this study demonstrates that in addition to bacterial growth, the high antibiotic residues within the pharmaceutical WWTPs may influence the proliferation and fate of the associated ARG subtypes. - Highlights: • The ARGs in final discharges were 7

  13. Fate and proliferation of typical antibiotic resistance genes in five full-scale pharmaceutical wastewater treatment plants

    International Nuclear Information System (INIS)

    Wang, Jilu; Mao, Daqing; Mu, Quanhua; Luo, Yi

    2015-01-01

    This study investigated the characteristics of 10 subtypes of antibiotic resistance genes (ARGs) for sulfonamide, tetracycline, β-lactam and macrolide resistance and the class 1 integrase gene (intI1). In total, these genes were monitored in 24 samples across each stage of five full-scale pharmaceutical wastewater treatment plants (PWWTPs) using qualitative and real-time quantitative polymerase chain reactions (PCRs). The levels of typical ARG subtypes in the final effluents ranged from (2.08 ± 0.16) × 10 3 to (3.68 ± 0.27) × 10 6 copies/mL. The absolute abundance of ARGs in effluents accounted for only 0.6%–59.8% of influents of the five PWWTPs, while the majority of the ARGs were transported to the dewatered sludge with concentrations from (9.38 ± 0.73) × 10 7 to (4.30 ± 0.81) × 10 10 copies/g dry weight (dw). The total loads of ARGs discharged through dewatered sludge was 7–308 folds higher than that in the raw influents and 16–638 folds higher than that in the final effluents. The proliferation of ARGs mainly occurs in the biological treatment processes, such as conventional activated sludge, cyclic activated sludge system (CASS) and membrane bio-reactor (MBR), implying that significant replication of certain subtypes of ARGs may be attributable to microbial growth. High concentrations of antibiotic residues (ranging from 0.14 to 92.2 mg/L) were detected in the influents of selected wastewater treatment systems and they still remain high residues in the effluents. Partial correlation analysis showed significant correlations between the antibiotic concentrations and the associated relative abundance of ARG subtypes in the effluent. Although correlation does not prove causation, this study demonstrates that in addition to bacterial growth, the high antibiotic residues within the pharmaceutical WWTPs may influence the proliferation and fate of the associated ARG subtypes. - Highlights: • The ARGs in final discharges were 7–308 times higher than

  14. Mechanisms of action of systemic antibiotics used in periodontal treatment and mechanisms of bacterial resistance to these drugs.

    Science.gov (United States)

    Soares, Geisla Mary Silva; Figueiredo, Luciene Cristina; Faveri, Marcelo; Cortelli, Sheila Cavalca; Duarte, Poliana Mendes; Feres, Magda

    2012-01-01

    Antibiotics are important adjuncts in the treatment of infectious diseases, including periodontitis. The most severe criticisms to the indiscriminate use of these drugs are their side effects and, especially, the development of bacterial resistance. The knowledge of the biological mechanisms involved with the antibiotic usage would help the medical and dental communities to overcome these two problems. Therefore, the aim of this manuscript was to review the mechanisms of action of the antibiotics most commonly used in the periodontal treatment (i.e. penicillin, tetracycline, macrolide and metronidazole) and the main mechanisms of bacterial resistance to these drugs. Antimicrobial resistance can be classified into three groups: intrinsic, mutational and acquired. Penicillin, tetracycline and erythromycin are broad-spectrum drugs, effective against gram-positive and gram-negative microorganisms. Bacterial resistance to penicillin may occur due to diminished permeability of the bacterial cell to the antibiotic; alteration of the penicillin-binding proteins, or production of β-lactamases. However, a very small proportion of the subgingival microbiota is resistant to penicillins. Bacteria become resistant to tetracyclines or macrolides by limiting their access to the cell, by altering the ribosome in order to prevent effective binding of the drug, or by producing tetracycline/macrolide-inactivating enzymes. Periodontal pathogens may become resistant to these drugs. Finally, metronidazole can be considered a prodrug in the sense that it requires metabolic activation by strict anaerobe microorganisms. Acquired resistance to this drug has rarely been reported. Due to these low rates of resistance and to its high activity against the gram-negative anaerobic bacterial species, metronidazole is a promising drug for treating periodontal infections.

  15. Diurnal variations in the occurrence and the fate of hormones and antibiotics in activated sludge wastewater treatment in Oslo, Norway

    Energy Technology Data Exchange (ETDEWEB)

    Plosz, Benedek Gy., E-mail: benedek.plosz@niva.no [Norwegian Institute for Water Research, NIVA, Gaustadalleen 21, NO-0349, Oslo (Norway); Leknes, Henriette [Norwegian Institute for Air Research NILU, 2027 Kjeller (Norway); Liltved, Helge; Thomas, Kevin V. [Norwegian Institute for Water Research, NIVA, Gaustadalleen 21, NO-0349, Oslo (Norway)

    2010-03-15

    We present an assessment of the dynamics in the influent concentration of hormones (estrone, estriol) and antibiotics (trimethoprim, sulfamethoxazole, tetracycline, ciprofloxacin) in the liquid phase including the efficiency of biological municipal wastewater treatment. The concentration of estradiol, 17-{alpha}-ethinylestradiol, doxycycline, oxytetracycline, demeclocycline, chlortetracycline, cefuroxime, cyclophosphamide, and ifosfamide were below the limit of detection in all of the sewage samples collected within this study. Two different types of diurnal variation pattern were identified in the influent mass loads of selected antibiotics and hormones that effectively correlate with daily drug administration patterns and with the expected maximum human hormone release, respectively. The occurrence of natural hormones and antimicrobials, administered every 12 hours, shows a daily trend of decreasing contaminant mass load, having the maximum values in the morning hours. The occurrence of antibiotics, typically administered every 8 hours, indicates a daily peak value in samples collected under the highest hydraulic loading. The efficiency of biological removal of both hormones and antibiotics is shown to be limited. Compared to the values obtained in the influent samples, increased concentrations are observed in the biologically treated effluent for trimethoprim, sulfamethoxazole and ciprofloxacin, mainly as a result of deconjugation processes. Ciprofloxacin is shown as the predominant antimicrobial compound in the effluent, and it is present at quantities approximately 10 fold greater than the total mass of the other of the compounds due to poor removal efficiency and alternating solid-liquid partitioning behaviour. Our results suggest that, to increase the micro-pollutant removal and the chemical dosing efficiency in enhanced tertiary treatment, significant benefits can be derived from the optimisation of reactor design and the development of control schemes that

  16. Mechanisms of action of systemic antibiotics used in periodontal treatment and mechanisms of bacterial resistance to these drugs

    Directory of Open Access Journals (Sweden)

    Geisla Mary Silva Soares

    2012-06-01

    Full Text Available Antibiotics are important adjuncts in the treatment of infectious diseases, including periodontitis. The most severe criticisms to the indiscriminate use of these drugs are their side effects and, especially, the development of bacterial resistance. The knowledge of the biological mechanisms involved with the antibiotic usage would help the medical and dental communities to overcome these two problems. Therefore, the aim of this manuscript was to review the mechanisms of action of the antibiotics most commonly used in the periodontal treatment (i.e. penicillin, tetracycline, macrolide and metronidazole and the main mechanisms of bacterial resistance to these drugs. Antimicrobial resistance can be classified into three groups: intrinsic, mutational and acquired. Penicillin, tetracycline and erythromycin are broad-spectrum drugs, effective against gram-positive and gram-negative microorganisms. Bacterial resistance to penicillin may occur due to diminished permeability of the bacterial cell to the antibiotic; alteration of the penicillin-binding proteins, or production of β-lactamases. However, a very small proportion of the subgingival microbiota is resistant to penicillins. Bacteria become resistant to tetracyclines or macrolides by limiting their access to the cell, by altering the ribosome in order to prevent effective binding of the drug, or by producing tetracycline/macrolide-inactivating enzymes. Periodontal pathogens may become resistant to these drugs. Finally, metronidazole can be considered a prodrug in the sense that it requires metabolic activation by strict anaerobe microorganisms. Acquired resistance to this drug has rarely been reported. Due to these low rates of resistance and to its high activity against the gram-negative anaerobic bacterial species, metronidazole is a promising drug for treating periodontal infections.

  17. Preemptive antibiotic treatment based on gram staining reduced the incidence of ARDS in mechanically ventilated patients.

    Science.gov (United States)

    Matsushima, Asako; Tasaki, Osamu; Shimizu, Kentaro; Tomono, Kazunori; Ogura, Hiroshi; Shimazu, Takeshi; Sugimoto, Hisashi

    2008-08-01

    Ventilator-associated pneumonia (VAP) is one of the major complications in the intensive care unit. VAP sometimes results in acute respiratory distress syndrome (ARDS), and the associated mortality is high. We hypothesized that preemptive antibiotic therapy based on results of bedside gram staining would reduce the incidence of VAP. Patients who were endotracheally intubated in our intensive care unit for more than 72 hours were included. Patients younger than 16 years of age or patients died because of brain death were excluded. The study was divided into two periods. During the first period, we used antibiotics according to the American Thoracic Society guidelines. During the second period, antibiotics were given according to the results of bedside gram staining even before radiographic infiltrate appeared. One hundred twenty-eight patients and 133 patients were included in the first and second periods, respectively. The incidence of VAP was significantly decreased in the second period (first period, 22%; second period, 9%, p gram staining significantly reduced the incidences of VAP and ARDS without an increase in the use of antibiotics.

  18. Resolving Bacterial Contamination of Fuel Ethanol Fermentations with Beneficial Bacteria – an Alternative to Antibiotic Treatment

    Science.gov (United States)

    Fuel ethanol fermentations are not performed under aseptic conditions and microbial contamination reduces yields and can lead to costly “stuck fermentations.” Antibiotics are commonly used to combat contaminants, but these may persist in the distillers grains co-product. Among contaminants, it is kn...

  19. Stability of aztreonam in a portable pump reservoir used for home intravenous antibiotic treatment (HIVAT)

    NARCIS (Netherlands)

    Vinks, A A; Touw, D J; van Rossen, R C; Heijerman, H G; Bakker, W

    The stability of the monocyclic beta-lactam antibiotic aztreonam in portable pump reservoirs was studied during storage at temperatures of -20 degrees C and +5 degrees C and during drug delivery at 37 degrees C. Three 100-ml drug reservoirs and three glass containers containing 60 mg/ml aztreonam

  20. Effect of procalcitonin-guided antibiotic treatment on mortality in acute respiratory infections

    DEFF Research Database (Denmark)

    Schuetz, Philipp; Wirz, Yannick; Sager, Ramon

    2018-01-01

    BACKGROUND: In February, 2017, the US Food and Drug Administration approved the blood infection marker procalcitonin for guiding antibiotic therapy in patients with acute respiratory infections. This meta-analysis of patient data from 26 randomised controlled trials was designed to assess safety ...

  1. Vertebral endplate (modic) changes and the treatment of back pain using antibiotics

    DEFF Research Database (Denmark)

    Manniche, Claus

    2014-01-01

    Vertebral end-plate changes/modic changes are the MRI-image of inflammatory vertebral endplate damage, most often related to general disc degeneration. However, in a subgroup of patients disc infection may be the causal factor. In patients with prolonged back pain, the prevalence of modic changes......'. Most commonly, Propionibacterium acnes is involved. Long-term antibiotics may be effective....

  2. The spread of multi drug resistant infections is leading to an increase in the empirical antibiotic treatment failure in cirrhosis: a prospective survey.

    Science.gov (United States)

    Merli, Manuela; Lucidi, Cristina; Di Gregorio, Vincenza; Falcone, Marco; Giannelli, Valerio; Lattanzi, Barbara; Giusto, Michela; Ceccarelli, Giancarlo; Farcomeni, Alessio; Riggio, Oliviero; Venditti, Mario

    2015-01-01

    The spread of multi-resistant infections represents a continuously growing problem in cirrhosis, particularly in patients in contact with the healthcare environment. Our prospective study aimed to analyze epidemiology, prevalence and risk factors of multi-resistant infections, as well as the rate of failure of empirical antibiotic therapy in cirrhotic patients. All consecutive cirrhotic patients hospitalized between 2008 and 2013 with a microbiologically-documented infection (MDI) were enrolled. Infections were classified as Community-Acquired (CA), Hospital-Acquired (HA) and Healthcare-Associated (HCA). Bacteria were classified as Multidrug-Resistant (MDR) if resistant to at least three antimicrobial classes, Extensively-Drug-Resistant (XDR) if only sensitive to one/two classes and Pandrug-Resistant (PDR) if resistant to all classes. One-hundred-twenty-four infections (15% CA, 52% HA, 33% HCA) were observed in 111 patients. Urinary tract infections, pneumonia and spontaneous bacterial peritonitis were the more frequent. Forty-seven percent of infections were caused by Gram-negative bacteria. Fifty-one percent of the isolates were multi-resistant to antibiotic therapy (76% MDR, 21% XDR, 3% PDR): the use of antibiotic prophylaxis (OR = 8.4; 95%CI = 1.03-76; P = 0,05) and current/recent contact with the healthcare-system (OR = 3.7; 95%CI = 1.05-13; P = 0.04) were selected as independent predictors. The failure of the empirical antibiotic therapy was progressively more frequent according to the degree of resistance. The therapy was inappropriate in the majority of HA and HCA infections. Multi-resistant infections are increasing in hospitalized cirrhotic patients. A better knowledge of the epidemiological characteristics is important to improve the efficacy of empirical antibiotic therapy. The use of preventive measures aimed at reducing the spread of multi-resistant bacteria is also essential.

  3. A Point Prevalence Survey of Antibiotic Use in 18 Hospitals in Egypt

    Directory of Open Access Journals (Sweden)

    Maha Talaat

    2014-09-01

    Full Text Available Inappropriate antibiotic use leads to increased risk of antibiotic resistance and other adverse outcomes. The objectives of the study were to determine the prevalence and characteristics of antibiotic use in Egyptian hospitals to identify opportunities for quality improvement. A point prevalence survey was conducted in 18 hospitals in March 2011. A total of 3408 patients were included and 59% received at least one antibiotic, with the most significant use among persons <12 years and intensive care unit patients (p < 0.05. Third generation cephalosporin were the most commonly prescribed antibiotics (28.7% of prescriptions. Reasons for antibiotic use included treatment of community—(27% and healthcare-associated infections (11% and surgical (39% and medical (23% prophylaxis. Among surgical prophylaxis recipients, only 28% of evaluable cases received the first dose within two hours before incision and only 25% of cases received surgical prophylaxis for <24 h. The prevalence of antibiotic use in Egyptian hospitals was high with obvious targets for antimicrobial stewardship activities including provision of antibiotic prescription guidelines and optimization of surgical and medical prophylaxis practices.

  4. Antibiotic Resistance

    DEFF Research Database (Denmark)

    Munck, Christian

    of antimicrobial resistance: (1) adaptive mutations and (2) horizontal acquisition of resistance genes from antibiotic gene reservoirs. By studying the geno- and phenotypic changes of E. coli in response to single and drug-pair exposures, I uncover the evolutionary trajectories leading to adaptive resistance. I......Bacteria can avoid extinction during antimicrobial exposure by becoming resistant. They achieve this either via adaptive mutations or horizontally acquired resistance genes. If resistance emerges in clinical relevant species, it can lead to treatment failure and ultimately result in increasing...... morbidity and mortality as well as an increase in the cost of treatment. Understanding how bacteria respond to antibiotic exposure gives the foundations for a rational approach to counteract antimicrobial resistance. In the work presented in this thesis, I explore the two fundamental sources...

  5. Treatment of long bone osteomyelitis with a mechanically stable intramedullar antibiotic dispenser: nineteen consecutive cases with a minimum of 12 months follow-up.

    Science.gov (United States)

    Sancineto, Carlos Federico; Barla, Jorge Daniel

    2008-12-01

    Antibiotic cement beads are the most common system of local antibiotic delivery. Unfortunately, bead strings do not give mechanical support to the fracture site, stability being fundamental in osteomyelitis treatment. Local treatment associated with bone stability should improve the results in posttraumatic osteomyelitis. The objective of this article is to present our experience in the treatment of long bone osteomyelitis using an intramedullary, mechanically stable antibiotic dispenser. We present a retrospective review of a consecutive series of patients with a long bone osteomyelitis treated using an intramedullary, mechanically stable antibiotic dispenser. The dispenser used with a T-95 chest tube filled with poly(methyl methacrylate) + antibiotic (vancomycin, gentamycin, or both, tobramycin or imipenem; depending on culture results) and with a metal center (Ender nail). Fifteen patients were men and three were women, with an average age of 37 years (range, 18-52 years). In four cases, treatment involved the femur and in 15 the tibia. Positive cultures were obtained from each patient. Methicillin-resistant Staphylococcus aureus was isolated in 17 cases. The intramedullary dispenser was removed between 6 and 76 weeks after surgery. Success was defined as negative cultures after dispenser removal. Follow-up period was between 10 and 54 months. Negative cultures were obtained from intramedullary reaming after dispenser removal in all but one patient who could not finish treatment because of local intolerance to antibiotic treatment. None of the 17 patients presented an infection recurrence. The combination of local antibiotic treatment with bone segment stability showed acceptable results in our short series of patients. Further investigation on locked intramedullary antibiotic dispensers providing improved stability will help us learn about this difficult clinical scenario.

  6. Detection of 140 clinically relevant antibiotic-resistance genes in the plasmid metagenome of wastewater treatment plant bacteria showing reduced susceptibility to selected antibiotics.

    Science.gov (United States)

    Szczepanowski, Rafael; Linke, Burkhard; Krahn, Irene; Gartemann, Karl-Heinz; Gützkow, Tim; Eichler, Wolfgang; Pühler, Alfred; Schlüter, Andreas

    2009-07-01

    To detect plasmid-borne antibiotic-resistance genes in wastewater treatment plant (WWTP) bacteria, 192 resistance-gene-specific PCR primer pairs were designed and synthesized. Subsequent PCR analyses on total plasmid DNA preparations obtained from bacteria of activated sludge or the WWTP's final effluents led to the identification of, respectively, 140 and 123 different resistance-gene-specific amplicons. The genes detected included aminoglycoside, beta-lactam, chloramphenicol, fluoroquinolone, macrolide, rifampicin, tetracycline, trimethoprim and sulfonamide resistance genes as well as multidrug efflux and small multidrug resistance genes. Some of these genes were only recently described from clinical isolates, demonstrating genetic exchange between clinical and WWTP bacteria. Sequencing of selected resistance-gene-specific amplicons confirmed their identity or revealed that the amplicon nucleotide sequence is very similar to a gene closely related to the reference gene used for primer design. These results demonstrate that WWTP bacteria are a reservoir for various resistance genes. Moreover, detection of about 64 % of the 192 reference resistance genes in bacteria obtained from the WWTP's final effluents indicates that these resistance determinants might be further disseminated in habitats downstream of the sewage plant.

  7. Curative Treatment of Severe Gram-Negative Bacterial Infections by a New Class of Antibiotics Targeting LpxC

    Energy Technology Data Exchange (ETDEWEB)

    Lemaître, Nadine; Liang, Xiaofei; Najeeb, Javaria; Lee, Chul-Jin; Titecat, Marie; Leteurtre, Emmanuelle; Simonet, Michel; Toone, Eric J.; Zhou, Pei; Sebbane, Florent; Nacy, Carol A.

    2017-07-25

    ABSTRACT

    The infectious diseases caused by multidrug-resistant bacteria pose serious threats to humankind. It has been suggested that an antibiotic targeting LpxC of the lipid A biosynthetic pathway in Gram-negative bacteria is a promising strategy for curing Gram-negative bacterial infections. However, experimental proof of this concept is lacking. Here, we describe our discovery and characterization of a biphenylacetylene-based inhibitor of LpxC, an essential enzyme in the biosynthesis of the lipid A component of the outer membrane of Gram-negative bacteria. The compound LPC-069 has no known adverse effects in mice and is effectivein vitroagainst a broad panel of Gram-negative clinical isolates, including several multiresistant and extremely drug-resistant strains involved in nosocomial infections. Furthermore, LPC-069 is curative in a murine model of one of the most severe human diseases, bubonic plague, which is caused by the Gram-negative bacteriumYersinia pestis. Our results demonstrate the safety and efficacy of LpxC inhibitors as a new class of antibiotic against fatal infections caused by extremely virulent pathogens. The present findings also highlight the potential of LpxC inhibitors for clinical development as therapeutics for infections caused by multidrug-resistant bacteria.

    IMPORTANCEThe rapid spread of antimicrobial resistance among Gram-negative bacilli highlights the urgent need for new antibiotics. Here, we describe a new class of antibiotics lacking cross-resistance with conventional antibiotics. The compounds inhibit LpxC, a key enzyme in the lipid A biosynthetic pathway in Gram-negative bacteria, and are activein vitroagainst a broad panel of clinical isolates of Gram-negative bacilli involved in nosocomial and community infections. The present study also constitutes the first demonstration of the curative treatment of bubonic plague by a novel, broad

  8. Repeated Treatments with Chitosan in Combination with Antibiotics Completely Eradicate Uropathogenic Escherichia coli From Infected Mouse Urinary Bladders.

    Science.gov (United States)

    Erman, Andreja; Hergouth, Veronika Križan; Blango, Matthew G; Kos, Mojca Kerec; Mulvey, Matthew A; Veranic, Peter

    2017-08-01

    Uropathogenic Escherichia coli (UPEC), the primary causative agents of urinary tract infections, colonize and invade the epithelial cells of the bladder urothelium. Infection of immature urothelial cells can result in the formation of persistent intracellular reservoirs that are refractory to antibiotic treatments. Previously, we defined a novel therapeutic strategy that used the bladder cell exfoliant chitosan to deplete UPEC reservoirs. However, although a single treatment of chitosan followed by ciprofloxacin administration had a marked effect on reducing UPEC titers within the bladder, this treatment failed to prevent relapsing bacteriuria. We show here that repeated use of chitosan in conjunction with the antibiotic ciprofloxacin completely eradicates UPEC from the urinary tract and prevents the development of relapsing bouts of bacteriuria. In addition, microscopy revealed rapid restoration of bladder integrity following chitosan treatment, indicating that chitosan can be used to effectively combat recalcitrant bladder infections without causing lasting harm to the urothelium. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.

  9. Monitoring and evaluation of antibiotic resistance genes in four municipal wastewater treatment plants in Harbin, Northeast China.

    Science.gov (United States)

    Wen, Qinxue; Yang, Lian; Duan, Ruan; Chen, Zhiqiang

    2016-05-01

    The development and proliferation of antibiotic resistance in pathogenic and environmental microorganisms is of great concern for public health. In this study, the distribution and removal efficiency of intI1 and eight subtypes of antibiotic resistance genes (ARGs) for tetracycline, sulfonamides, beta-lactams resistance in four municipal wastewater treatment plants (WWTPs) in Harbin, which locates in Songhua River basin in cold areas of China, were monitored by real-time fluorescent quantitative PCR. The results showed that intI1 and 6 ARGs except for blaTEM and blaSHV were detected in wastewater and sludge samples and 0.3-2.7 orders of magnitude of ARGs removal efficiency in the four WWTPs were observed. The investigation on the removal of ARGs of different treatment units in one WWTP showed that the biological treatment unit played the most important role in ARGs removal (1.2-1.8 orders of magnitude), followed by UV disinfection, while primary physical treatment units can hardly remove any ARGs. Although all the WWTPs can remove ARGs effectively, ARGs concentrations are still relatively high in the effluent, their further attenuation should be investigated. Copyright © 2016 Elsevier Ltd. All rights reserved.

  10. Antibiotic prescription evaluation in the rehabilitation ward of a geriatric hospital.

    Science.gov (United States)

    Afekouh, H; Baune, P; Abbas, R; De Falvelly, D; Guermah, F; Haber, N

    2015-01-01

    We aimed to identify the indications for antibiotic prescriptions made to patients hospitalized in the rehabilitation ward of a geriatric hospital. Our final objective was to assess those prescriptions. Medical experts performed a prospective study of all antibiotic treatments prescribed in the rehabilitation ward over a 4-month period based on Gyssens' algorithm and on the local guidelines for anti-infective drugs. Treatments were considered appropriate when the indication, choice of agent, duration, and dose were approved by the experts. They were however considered unnecessary when the indication was incorrect, and they were deemed inappropriate when the experts approved the indication but considered that treatment modalities were not optimal. We also reviewed the prescription re-evaluation made 48 to 72hours after treatment initiation. We reviewed 142 prescriptions. Treatments had mainly been prescribed for respiratory tract infections (81 infections), urinary tract infections (41), skin infections (15), or abdominal infections (8). A total of 27 prescriptions (19%) were considered unnecessary mainly because a urinary tract infection diagnosis had been wrongly made (21 prescriptions). Half of the prescriptions were considered inappropriate: 38 prescriptions had an inappropriate spectrum of activity and 32 had an inadequate treatment duration. A total of 67 prescriptions (47.2%) had been reassessed 48-72hours after treatment initiation. Overall, 25 prescriptions (17.6%) were considered appropriate and were reassessed 48-72hours after treatment initiation. We now have a better understanding of antibiotic prescription in a rehabilitation ward context. We identified several points that need to be improved: update and improvement of the local guidelines, better training for prescribers, and creation of a supporting document for the reassessment of the prescriptions 48-72hours after treatment initiation. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  11. Antibiotic Treatment in End-of-Life Cancer Patients—A Retrospective Observational Study at a Palliative Care Center in Sweden

    Directory of Open Access Journals (Sweden)

    Maria Helde-Frankling

    2016-09-01

    Full Text Available Background: The aim of this study was to elucidate whether palliative cancer patients benefit from antibiotic treatment in the last two weeks of life when an infection is suspected. Method: We reviewed medical records from 160 deceased palliative cancer patients that had been included in previous studies on vitamin D and infections. Patients treated with antibiotics during the last two weeks of life were identified and net effects of treatment (symptom relief and possible adverse events were extracted from medical records. Results: Seventy-nine patients (49% had been treated with antibiotics during the last two weeks in life. In 37% (n = 29, the treatment resulted in evident symptom relief and among these 50% had a positive bacterial culture, 43% had a negative culture and in 7% no culture was taken. Among the patients with no or unknown effect of antibiotics, 50% had a positive culture. When the indication for antibiotic treatment was to avoid or treat sepsis, symptom relief was achieved in 50% of the patients (n = 19. Only 4% (n = 3 of the patients experienced adverse events of the treatment (diarrhea, nausea. Conclusions: Treating infections with antibiotics in the last weeks of life may improve the quality of life for palliative cancer patients, especially if sepsis is suspected or confirmed. According to our results, the beneficial effects outweigh the potentially negative outcomes.

  12. Therapeutic evaluation of prolonged infusions of β-lactam antibiotics in the treatment and management of critically ill patients

    Directory of Open Access Journals (Sweden)

    Jorge S. Amador

    2017-04-01

    Full Text Available Context: Critically ill patients has a large number of pathophysiological changes product of commitment and organ systems. Therefore, knowledge of the pharmacological properties of antimicrobials is essential to choose the best treatment. In order to optimize the response of antibiotic therapy and these drugs, new strategies have been proposed dosage, the most used drug application of the model, called: Pharmacokinetics/Pharmacodynamics (PK/PD. In the case of β-lactam antibiotics, the PK/PD model is known as time-dependent on the Minimum Inhibitory Concentration (Time > MIC. For optimal concentrations in β-lactam antibiotics, prolonged or continuous infusions, thus exposing the drug on the pathogen is achieved in a longer optimal concentrations through are used. Aims: To evaluate the therapeutic response of β-lactam antibiotics in critically ill patients with prolonged infusions by applying the model PK/ PD. Methods: Prospective observational study (concurrent cohort, taking as a control non-concurrent historic cohort, conducted for a period of seven months in the intensive care unit of the Hospital Clínico San Borja Arriarán (HCSBA, Santiago, Chile. Results: It was found a significant difference in number of days of hospitalization in ICU for the group bolus versus infusion group (12.5 ± 5.4 vs. 18 ± 9.7 days, IC: 1.5-9.5; p = 0.009. Conclusions: This study suggests that there would be a therapeutic advantage in the use of prolonged infusion in ICU stay duration.

  13. Microbiological, Histological, Immunological, and Toxin Response to Antibiotic Treatment in the Mouse Model of Mycobacterium ulcerans Disease

    Science.gov (United States)

    Almeida, Deepak V.; Zhang, Jihui; Robinson, Clive; Wansbrough-Jones, Mark; Grosset, Jacques H.

    2013-01-01

    Mycobacterium ulcerans infection causes a neglected tropical disease known as Buruli ulcer that is now found in poor rural areas of West Africa in numbers that sometimes exceed those reported for another significant mycobacterial disease, leprosy, caused by M. leprae. Unique among mycobacterial diseases, M. ulcerans produces a plasmid-encoded toxin called mycolactone (ML), which is the principal virulence factor and destroys fat cells in subcutaneous tissue. Disease is typically first manifested by the appearance of a nodule that eventually ulcerates and the lesions may continue to spread over limbs or occasionally the trunk. The current standard treatment is 8 weeks of daily rifampin and injections of streptomycin (RS). The treatment kills bacilli and wounds gradually heal. Whether RS treatment actually stops mycolactone production before killing bacilli has been suggested by histopathological analyses of patient lesions. Using a mouse footpad model of M. ulcerans infection where the time of infection and development of lesions can be followed in a controlled manner before and after antibiotic treatment, we have evaluated the progress of infection by assessing bacterial numbers, mycolactone production, the immune response, and lesion histopathology at regular intervals after infection and after antibiotic therapy. We found that RS treatment rapidly reduced gross lesions, bacterial numbers, and ML production as assessed by cytotoxicity assays and mass spectrometric analysis. Histopathological analysis revealed that RS treatment maintained the association of the bacilli with (or within) host cells where they were destroyed whereas lack of treatment resulted in extracellular infection, destruction of host cells, and ultimately lesion ulceration. We propose that RS treatment promotes healing in the host by blocking mycolactone production, which favors the survival of host cells, and by killing M. ulcerans bacilli. PMID:23516649

  14. Metagenomics shows that low-energy anaerobic-aerobic treatment reactors reduce antibiotic resistance gene levels from domestic wastewater.

    Science.gov (United States)

    Christgen, Beate; Yang, Ying; Ahammad, S Z; Li, Bing; Rodriquez, D Catalina; Zhang, Tong; Graham, David W

    2015-02-17

    Effective domestic wastewater treatment is among our primary defenses against the dissemination of infectious waterborne disease. However, reducing the amount of energy used in treatment processes has become essential for the future. One low-energy treatment option is anaerobic-aerobic sequence (AAS) bioreactors, which use an anaerobic pretreatment step (e.g., anaerobic hybrid reactors) to reduce carbon levels, followed by some form of aerobic treatment. Although AAS is common in warm climates, it is not known how its compares to other treatment options relative to disease transmission, including its influence on antibiotic resistance (AR) in treated effluents. Here, we used metagenomic approaches to contrast the fate of antibiotic-resistant genes (ARG) in anaerobic, aerobic, and AAS bioreactors treating domestic wastewater. Five reactor configurations were monitored for 6 months, and treatment performance, energy use, and ARG abundance and diversity were compared in influents and effluents. AAS and aerobic reactors were superior to anaerobic units in reducing ARG-like sequence abundances, with effluent ARG levels of 29, 34, and 74 ppm (198 ppm influent), respectively. AAS and aerobic systems especially reduced aminoglycoside, tetracycline, and β-lactam ARG levels relative to anaerobic units, although 63 persistent ARG subtypes were detected in effluents from all systems (of 234 assessed). Sulfonamide and chloramphenicol ARG levels were largely unaffected by treatment, whereas a broad shift from target-specific ARGs to ARGs associated with multi-drug resistance was seen across influents and effluents. AAS reactors show promise for future applications because they can reduce more ARGs for less energy (32% less energy here), but all three treatment options have limitations and need further study.

  15. Microbiological, histological, immunological, and toxin response to antibiotic treatment in the mouse model of Mycobacterium ulcerans disease.

    Directory of Open Access Journals (Sweden)

    Fred Stephen Sarfo

    Full Text Available Mycobacterium ulcerans infection causes a neglected tropical disease known as Buruli ulcer that is now found in poor rural areas of West Africa in numbers that sometimes exceed those reported for another significant mycobacterial disease, leprosy, caused by M. leprae. Unique among mycobacterial diseases, M. ulcerans produces a plasmid-encoded toxin called mycolactone (ML, which is the principal virulence factor and destroys fat cells in subcutaneous tissue. Disease is typically first manifested by the appearance of a nodule that eventually ulcerates and the lesions may continue to spread over limbs or occasionally the trunk. The current standard treatment is 8 weeks of daily rifampin and injections of streptomycin (RS. The treatment kills bacilli and wounds gradually heal. Whether RS treatment actually stops mycolactone production before killing bacilli has been suggested by histopathological analyses of patient lesions. Using a mouse footpad model of M. ulcerans infection where the time of infection and development of lesions can be followed in a controlled manner before and after antibiotic treatment, we have evaluated the progress of infection by assessing bacterial numbers, mycolactone production, the immune response, and lesion histopathology at regular intervals after infection and after antibiotic therapy. We found that RS treatment rapidly reduced gross lesions, bacterial numbers, and ML production as assessed by cytotoxicity assays and mass spectrometric analysis. Histopathological analysis revealed that RS treatment maintained the association of the bacilli with (or within host cells where they were destroyed whereas lack of treatment resulted in extracellular infection, destruction of host cells, and ultimately lesion ulceration. We propose that RS treatment promotes healing in the host by blocking mycolactone production, which favors the survival of host cells, and by killing M. ulcerans bacilli.

  16. Prospective study of the efficacy of antibiotics versus antitussive drugs for the management of URTI-related acute cough in children.

    Science.gov (United States)

    Zanasi, Alessandro; Lanata, Luigi; Saibene, Federico; Fontana, Giovanni; Dicpinigaitis, Peter V; Venier, Valentina; De Blasio, Francesco

    2016-01-01

    Acute cough is one of the most frequent symptoms prompting a visit to a health care provider, usually following a viral upper respiratory tract infection (URTI). The disproportionate use of antibiotics in children with URTIs, recently highlighted in the medical literature, could lead to associated side effects, without any beneficial effect. Although an early, albeit inappropriate, antibiotic prescription increases parental satisfaction, URTIs are predominantly viral infections and are generally self-limiting. Therefore the aim of this study was to analyze the effectiveness of antibiotics compared to symptomatic drugs (central and peripheral antitussives) on URTI-related cough in a pediatric population. This is a prospective observational study of 330 children who required pediatric consultation for acute cough. Severity, frequency and type of cough were assessed at baseline and after 6 days of treatment (antitussives n = 123, antibiotics n = 89 or combination of them n = 38) or no treatment (n = 80). The outcome of cough management after 6 days was analyzed in terms of resolution, improvement, no change or worsening of symptoms. Study assessments were performed using a standardized questionnaire administered to parents. Between children treated with antitussives or antibiotics, there was a statistically significant difference in the resolution of cough. Moreover, if considering peripheral antitussives, the resolution of cough was significantly higher with antitussives than with antibiotics (p < 0.01). There was no difference in cough resolution between children treated with antitussives and those receiving a combination of antibiotics and antitussives, either central and peripheral antitussives. Antibiotics are generally not useful nor appropriate in treating acute cough due to the common cold. Furthermore, inappropriate antibiotic use introduces the possibility of adverse side effects as well as promotion of antibiotic resistance. The

  17. The use of antibiotic drugs in everyday dental practice

    OpenAIRE

    Terzieva, Olivera; Petrovski, Mihajlo; Maksimov, Zlatko; Markoska, Aleksandra

    2017-01-01

    produce a severe illness or even become fatal. Antibiotics are antimicrobial agents useful in numerous bacterial infections. Increasingly we're seeing the inappropriate use of antibiotics. The purpose of this our study was to determine which are the most commonly used antibiotics and who are the most frequently antibiotic treated diseases. Materials and methods: For the realization of our purpose in our study were included 20 dental clinics. We registered the total number...

  18. Antimicrobial susceptibility testing before first-line treatment for Helicobacter pylori infection in patients with dual or triple antibiotic resistance.

    Science.gov (United States)

    Cosme, Angel; Montes, Milagrosa; Ibarra, Begoña; Tamayo, Esther; Alonso, Horacio; Mendarte, Usua; Lizasoan, Jacobo; Herreros-Villanueva, Marta; Bujanda, Luis

    2017-05-14

    To evaluate the efficacy of antimicrobial susceptibility-guided therapy before first-line treatment for infection in patients with dual or triple antibiotic resistance. A total of 1034 patients infected by Helicobacter pylori ( H. pylori ) during 2013-2014 were tested for antimicrobial susceptibility. 157 of 1034 (15%) patients showed resistance to two (127/1034; 12%) and to three (30/1034; 3%) antibiotics. Sixty-eight patients with dual H. pylori -resistance (clarithromycin, metronidazole or levofloxacin) were treated for 10 d with triple therapies: OAL (omeprazole 20 mg b.i.d., amoxicillin 1 g b.i.d., and levofloxacin 500 mg b.i.d.) 43 cases, OAM (omeprazole 20 mg b.i.d., amoxicillin 1 g b.i.d., and metronidazole 500 mg b.i.d.) 12 cases and OAC (omeprazole 20 mg b.id., amoxicillin 1 g b.i.d., and clarithromycin 500 mg b.i.d.) 13 cases based on the antimicrobial susceptibility testing. Twelve patients showed triple H. pylori -resistance (clarithromycin, metronidazole and levofloxacin) and received for 10 d triple therapy with OAR (omeprazole 20 mg b.id., amoxicillin 1 g b.i.d., and rifabutin 150 mg b.i.d.). Eradication was confirmed by 13C-urea breath test. Adverse effects and compliance were assessed by a questionnaire. Intention-to-treat eradication rates were: OAL (97.6%), OAM (91.6%), OAC (92.3%) and OAR (58.3%). Cure rate was significantly higher in naïve patients treated with OAR-10 compared to patients who had two or three previous treatment failures (83% vs 33%). Adverse events rates for OAL, OAM, OAC and OAR were 22%, 25%, 23% and 17%, respectively, all of them mild-moderate. Antimicrobial susceptibility-guided triple therapies during 10 d for first-line treatment leads to an eradication rate superior to 90% in patients with dual antibiotic H. pylori resistance.

  19. Should patients with hip joint prosthesis receive antibiotic prophylaxis before dental treatment?

    Directory of Open Access Journals (Sweden)

    Egil Lingaas

    2010-08-01

    Full Text Available The safety committee of the American Academy of Orthopedic Surgeons (AAOS recommended in 2009 that clinicians should consider antibiotic prophylaxis for all patients with total joint replacement before any invasive procedure that may cause bacteremia. This has aroused confusion and anger among dentists asking for the evidence. The present review deals with different aspects of the rationale for this recommendation giving attention to views both in favor of and against it.

  20. Antibiotic treatment and dose-response of bacterial activity associated with flatfish eggs

    OpenAIRE

    Mangor-Jensen, Anders; Jelmert, Anders

    1987-01-01

    Newly stripped and fertilized eggs from Plaice (Pleuronectes platessa) and Atlantic Halibut (Hipppoglossus hippoglossus) were incubated in 34 ppt sea water. 150 eggs (Plaice), 30 eggs (Halibut) or 20 glass beads were incubated in 30 ml seawater in light at 5.5°C. The antibiotics Oxytetracycline (-HCl) and Flumiquil were added to end concentration ranges 0 - 105 ppm and 0 - 60 ppm, respectively. With a method modified from Somville and Billen (1983) it was possibl...

  1. Use of antibiotics in the treatment of Crohn’s disease

    Science.gov (United States)

    Scribano, Maria Lia; Prantera, Cosimo

    2013-01-01

    Many data coming from animal models and clinical observations support an involvement of intestinal microbiota in the pathogenesis of Crohn’s disease (CD). It is hypothesized in fact, that the development of chronic intestinal inflammation is caused by an abnormal immune response to normal flora in genetically susceptible hosts. The involvement of bacteria in CD inflammation has provided the rationale for including antibiotics in the therapeutic armamentarium. However, randomized controlled trials have failed to demonstrate an efficacy of these drugs in patients with active uncomplicated CD, even if a subgroup of patients with colonic location seems to get benefit from antibiotics. Nitroimidazole compounds have been shown to be efficacious in decreasing CD recurrence rates in operated patients, and the use of metronidazole and ciprofloxacin is recommended in perianal disease. However, the appearance of systemic side effects limits antibiotic long-term employment necessary for treating a chronic relapsing disease. Rifaximin, characterized by an excellent safety profile, has provided promising results in inducing remission of CD. PMID:23429474

  2. Daptomycin and its immunomodulatory effect: consequences for antibiotic treatment of methicillin-resistant Staphylococcus aureus after heart surgery

    Directory of Open Access Journals (Sweden)

    Theodor eTirilomis

    2014-03-01

    Full Text Available Infections by methicillin-resistant Staphylococcus aureus (MRSA play an increasing role in the postoperative course. Although wound infections after cardiac surgery are rare, the outcome is limited by prolonged treatment with high mortality. Not only surgical debridement is crucial, but also antibiotic support. Next to vancomycin and linezolid, daptomycin gains increasing importance. Although clinical evidence is limited, daptomycin has immunomodulatory properties, resulting in the suppression of cytokine expression after host immune response stimulation by MRSA. Experimental studies showed an improved efficacy of daptomycin in combination with administration of vitamin E before infecting wounds by MRSA.

  3. Redeploying β-Lactam Antibiotics as a Novel Antivirulence Strategy for the Treatment of Methicillin-Resistant Staphylococcus aureus Infections

    Energy Technology Data Exchange (ETDEWEB)

    Waters, Elaine M.; Rudkin, Justine K.; Coughlan, Simone; Clair, Geremy C.; Adkins, Joshua N.; Gore, Suzanna; Xia, Guoqing; Black, Nikki S.; Downing, Tim; O' Neill, Eoghan; Kadioglu, Aras; O' Gara, James P.

    2016-11-14

    Innovative approaches to the use of existing antibiotics is an important strategy in efforts to address the escalating antimicrobial resistance crisis. Here, the beta-lactam antibiotic oxacillin was shown to significantly attenuate the virulence of MRSA despite the pathogen being resistant to this drug. Oxacillin-mediated repression of the Agr quorum-sensing system and altered cell wall architecture, was associated with reduced cytolytic activity and increased susceptibility to host killing. These findings support the inclusion of -lactam antibiotics as an adjunctive anti-virulence therapy in the treatment of MRSA infections, with the potential to significantly improve patient outcomes in a safe, cost effective manner.

  4. Revisiting Antibiotic Resistance Spreading in Wastewater Treatment Plants – Bacteriophages as a Much Neglected Potential Transmission Vehicle

    OpenAIRE

    Lood, Rolf; Ertürk, Gizem; Mattiasson, Bo

    2017-01-01

    The spread of antibiotic resistance is currently a major threat to health that humanity is facing today. Novel multidrug and pandrug resistant bacteria are reported on a yearly basis, while the development of novel antibiotics is lacking. Focus to limit the spread of antibiotic resistance by reducing the usage of antibiotics in health care, veterinary applications, and meat production, have been implemented, limiting the exposure of pathogens to antibiotics, thus lowering the selection of res...

  5. Ceftriaxone-induced immune hemolytic anemia as a life-threatening complication of antibiotic treatment of 'chronic Lyme disease'.

    Science.gov (United States)

    De Wilde, Maarten; Speeckaert, Marijn; Callens, Rutger; Van Biesen, Wim

    2017-04-01

    'Chronic Lyme disease' is a controversial condition. As any hard evidence is lacking that unresolved systemic symptoms, following an appropriately diagnosed and treated Lyme disease, are related to a chronic infection with the tick-borne spirochaetes of the Borrelia genus, the term 'chronic Lyme disease' should be avoided and replaced by the term 'post-treatment Lyme disease syndrome.' The improper prescription of prolonged antibiotic treatments for these patients can have an impact on the community antimicrobial resistance and on the consumption of health care resources. Moreover, these treatments can be accompanied by severe complications. In this case report, we describe a life-threatening ceftriaxone-induced immune hemolytic anemia with an acute kidney injury (RIFLE-stadium F) due to a pigment-induced nephropathy in a 76-year-old woman, who was diagnosed with a so-called 'chronic Lyme disease.'

  6. Local treatment of burns by honey is not appropriate | Ghezala | Pan ...

    African Journals Online (AJOL)

    ... sections of dying skin. This inappropriate initial local treatment with honey application could lead to severe complications. After gentle debridement with 0.25% chlorhexidine solution, and gentle scrubbing, all necrotic tissue was removed. After daily change of dressing and systemic antibiotics, the lesions recovered totally.

  7. POPI (Pediatrics: Omission of Prescriptions and Inappropriate prescriptions: development of a tool to identify inappropriate prescribing.

    Directory of Open Access Journals (Sweden)

    Sonia Prot-Labarthe

    Full Text Available INTRODUCTION: Rational prescribing for children is an issue for all countries and has been inadequately studied. Inappropriate prescriptions, including drug omissions, are one of the main causes of medication errors in this population. Our aim is to develop a screening tool to identify omissions and inappropriate prescriptions in pediatrics based on French and international guidelines. METHODS: A selection of diseases was included in the tool using data from social security and hospital statistics. A literature review was done to obtain criteria which could be included in the tool called POPI. A 2-round-Delphi consensus technique was used to establish the content validity of POPI; panelists were asked to rate their level of agreement with each proposition on a 9-point Likert scale and add suggestions if necessary. RESULTS: 108 explicit criteria (80 inappropriate prescriptions and 28 omissions were obtained and submitted to a 16-member expert panel (8 pharmacists, 8 pediatricians hospital-based -50%- or working in community -50%-. Criteria were categorized according to the main physiological systems (gastroenterology, respiratory infections, pain, neurology, dermatology and miscellaneous. Each criterion was accompanied by a concise explanation as to why the practice is potentially inappropriate in pediatrics (including references. Two round of Delphi process were completed via an online questionnaire. 104 out of the 108 criteria submitted to experts were selected after 2 Delphi rounds (79 inappropriate prescriptions and 25 omissions. DISCUSSION CONCLUSION: POPI is the first screening-tool develop to detect inappropriate prescriptions and omissions in pediatrics based on explicit criteria. Inter-user reliability study is necessary before using the tool, and prospective study to assess the effectiveness of POPI is also necessary.

  8. Inappropriate prescribing in outpatient healthcare: an evaluation of respiratory infection visits among veterans in teaching versus non-teaching primary care clinics

    Directory of Open Access Journals (Sweden)

    Diane M. Parente

    2017-03-01

    Full Text Available Abstract A recent study led by the Centers for Disease Control and Prevention (CDC revealed at least 30% of antibiotic prescriptions in the outpatient setting were inappropriate. In this study of all ages, among adult patients, results were similar to the overall population, with the majority of inappropriate prescribing relating to respiratory infections. We applied the same methodology to investigate rates of antibiotic prescribing for respiratory tract infections in outpatient primary care clinics at the Providence Veterans Affairs Medical Center. The results of our evaluation reflected comparable rates of inappropriate prescribing, but when stratified by teaching versus non-teaching primary care clinics, inappropriate prescribing was significantly higher in non-teaching clinics (17.6% vs 44.0%, p < .0001. Respiratory infection visits in non-teaching outpatient clinics may be a pragmatic target for antimicrobial stewardship programs.

  9. Changes in the structure of the microbial community associated with Nannochloropsis salina following treatments with antibiotics and bioactive compounds

    Directory of Open Access Journals (Sweden)

    Haifeng Geng

    2016-07-01

    Full Text Available Open microalgae cultures host a myriad of bacteria, creating a complex system of interacting species that influence algal growth and health. Many algal microbiota studies have been conducted to determine the relative importance of bacterial taxa to algal culture health and physiological states, but these studies have not characterized the interspecies relationships in the microbial communities. We subjected Nanochroloropsis salina cultures to multiple chemical treatments (antibiotics and quorum sensing compounds and obtained dense time-series data on changes to the microbial community using 16S gene amplicon metagenomic sequencing (21,029,577 reads for 23 samples to measure microbial taxa-taxa abundance correlations. Short-term treatment with antibiotics resulted in substantially larger shifts in the microbiota structure compared to changes observed following treatment with signaling compounds and glucose. We also calculated operational taxonomic unit (OTU associations and generated OTU correlation networks to provide an overview of possible bacterial OTU interactions. This analysis identified five major cohesive modules of microbiota with similar co-abundance profiles across different chemical treatments. The Eigengenes of OTU modules were examined for correlation with different external treatment factors. This correlation-based analysis revealed that culture age (time and treatment types have primary effects on forming network modules and shaping the community structure. Additional network analysis detected Alteromonadeles and Alphaproteobacteria as having the highest centrality, suggesting these species are keystone OTUs in the microbial community. Furthermore, we illustrated that the chemical tropodithietic acid, which is secreted by several species in the Alphaproteobacteria taxon, is able to drastically change the structure of the microbiota within 3 hours. Taken together, these results provide valuable insights into the structure of the

  10. Health Alliance for Prudent Prescribing, Yield and Use of Antimicrobial Drugs in the Treatment of Respiratory Tract Infections (HAPPY AUDIT)

    DEFF Research Database (Denmark)

    Bjerrum, Lars; Munck, Anders; Gahrn-Hansen, Bente

    2010-01-01

    BACKGROUND: Excessive and inappropriate use of antibiotics is considered to be the most important reason for development of bacterial resistance to antibiotics. As antibiotic resistance may spread across borders, high prevalence countries may serve as a source of bacterial resistance for countries...... of the project period. DISCUSSION: HAPPY AUDIT is an EU-financed project with the aim of contributing to the battle against antibiotic resistance through quality improvement of GPs' diagnosis and treatment of RTIs through development of intervention programmes targeting GPs, parents of young children and healthy...

  11. Evidence for short duration of antibiotic treatment for non-severe community acquired pneumonia (CAP in children - are we there yet? A systematic review of randomised controlled trials

    Directory of Open Access Journals (Sweden)

    Shalom Ben-Shimol

    2014-03-01

    Full Text Available Context: The ideal duration of antibiotic treatment for childhood community acquired pneumonia (CAP has not yet been established. Objective: A literature search was conducted to evaluate the efficacy of shorter than 7 days duration of oral antibiotic treatment for childhood non-severe CAP. Data sources: A systematic literature search was performed using the PubMed database. The search was limited to randomised controlled trials (RCTs conducted between January 1996 and May 2013 in children up to 18 years old. Search terms included pneumonia, treatment, duration, child, children, days, short, respiratory infection and non-severe (nonsevere. Study selection: Only RCTs of oral antibiotic treatment for non-severe CAP in children were included. Data extraction: Independent extraction of articles was done by 3 authors using a preformed questionnaire. Data synthesis: Eight articles meeting the selection criteria were identified: 7 from 2 developing countries (India and Pakistan, and 1 from a developed country (The Netherlands. Studies from developing countries used the World Health Organization clinical criteria for diagnosing CAP, which includes mainly tachypnoea. None of those studies included fever, chest radiography or any laboratory test in their case definition. The Dutch study case definition used laboratory tests and chest radiographies (x-rays in addition to clinical criteria. Five articles concluded that 3 days of treatment are sufficient for non-severe childhood CAP, 2 articles found 5 days treatment to be sufficient, and one article found no difference between 3 days of amoxicillin treatment and placebo. Conclusions: The efficacy of short duration oral antibiotic treatment for non-severe CAP in children has not been established in developed countries. Current RCTs from developing countries used clinical criteria that may have failed to appropriately identify children with true bacterial pneumonia necessitating antibiotic treatment. More RCTs

  12. Antepartum Antibiotic Treatment Increases Offspring Susceptibility to Experimental Colitis: A Role of the Gut Microbiota.

    Directory of Open Access Journals (Sweden)

    Peris Mumbi Munyaka

    Fu