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Sample records for piperacillin

  1. Myoclonic jerks secondary to piperacillin and nafcillin

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    Michael A. Meyer

    2014-06-01

    Full Text Available A 66-year-old male receiving intravenous piperacillin and nafcillin for a post-surgical wound infection developed intermittent myoclonic jerks of all four extremities that disappeared after discontinuation of these two medications. In addition there was a mild yet definite intermittent encephalopathic effect; head computed tomography examination as negative and there was no prior history for seizure or myoclonus. These two beta lactam ring antibiotics are structurally similar to penicillin, which is well known to induce not only myoclonus but also seizure activity by reducing the gamma-aminobutyric acid (GABA induced inhibitory currents by inducing an open chloride channel block of the GABA type A receptors within the brain. Clinicians need to be fully aware of the potential epileptogenic effects of piperacillin, nafcillin, and related antibiotics.

  2. Piperacillin-Associated Pulmonary Infiltrates with Eosinophilia: A Case Report

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    Olivia Ling-I Tseng

    2010-01-01

    Full Text Available A case of pulmonary infiltrates with eosinophilia attributed to piperacillin/tazobactam therapy is described. A 54-year-old woman was treated for a suspected severe urinary tract infection with piperacillin/tazobactam. Four days later, she developed fever, chills, shortness of breath and intermittent chest pains. Eosinophilia was noted in peripheral blood and, subsequently, on bronchoalveolar lavage. Transbronchial biopsy showed tissue infiltrates with eosinophilia. No evidence of bacterial, fungal and parasitic infection, or vasculitis was observed. Her symptoms and peripheral eosinophilia subsided after drug discontinuation and oral prednisone treatment. Piperacillin is an extended-spectrum penicillin antibiotic prescribed for moderate to severe infections. The common adverse reactions to piperacillin include nausea, vomiting, diarrhea and rash. Pulmonary infiltrates with eosinophilia is a rare adverse reaction, but one that may result in significant morbidity. Physicians should be aware of this rare but important adverse reaction to piperacillin.

  3. Piperacillin plus Tazobactam induced Drug Hypersensitivity Reaction: A Case Report

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    Modi RS; Sattigeri BM; Patel AH

    2015-01-01

    Penicillin alone or with combination should be used in hospitalized patients to treat bacterial infections with great precautions since penicillin is known to produce hypersensitivity reactions very commonly. A 53 year old hospitalized male patient having tibia fracture was initially given ceftriaxone plus salbactum and amikacin as an antibacterial therapeutics. Subsequently patient was treated with Pipzo (Inj. Piperacillin plus Tezobactum; 4.5 gm.) on the basis of anti- bacterial sensitivity...

  4. Galactomannan detection from piperacillin-tazobactam brands available in the Brazilian market

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    Melissa Orzechowski Xavier

    2009-10-01

    Full Text Available Piperacillin-tazobactam is a broad spectrum antimicrobial agent that can cause false-positive results in the commercial Platelia Aspergillus EIA test. So far, no study has been performed in Latin America to evaluate the clinical implication of this finding. Here we studied the potential for galactomannan detection in piperacillin-tazobactam batches commercialized in the Brazilian market. Five batches from distinct laboratories were tested in duplicate in the Platelia Aspergillus EIA according to the manufacturer's instructions. Only one drug showed crossreaction at a cut-off of 0.5. Human serum was spiked with this particular drug aiming to mimic achievable piperacillin-tazobactam concentrations in the serum. Results were all negative for galactomannan detection, even at high drug concentrations. Results from this pilot study suggest that piperacillin-tazobactam might not be a clinically significant cause of false-positive results in the Platelia Aspergillus EIA test in Brazil.

  5. Galactomannan detection from piperacillin-tazobactam brands available in the Brazilian market.

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    Xavier, Melissa Orzechowski; Pasqualotto, Alessandro Comarú; Aquino, Valério Rodrigues; Sukiennik, Teresa Cristina Teixeira; Severo, Luiz Carlos

    2009-10-01

    Piperacillin-tazobactam is a broad spectrum antimicrobial agent that can cause false-positive results in the commercial Platelia Aspergillus EIA test. So far, no study has been performed in Latin America to evaluate the clinical implication of this finding. Here we studied the potential for galactomannan detection in piperacillin-tazobactam batches commercialized in the Brazilian market. Five batches from distinct laboratories were tested in duplicate in the Platelia Aspergillus EIA according to the manufacturer's instructions. Only one drug showed crossreaction at a cut-off of 0.5. Human serum was spiked with this particular drug aiming to mimic achievable piperacillin-tazobactam concentrations in the serum. Results were all negative for galactomannan detection, even at high drug concentrations. Results from this pilot study suggest that piperacillin-tazobactam might not be a clinically significant cause of false-positive results in the Platelia Aspergillus EIA test in Brazil.

  6. Drug Fever Induced by Piperacillin/Tazobactam in a Scoliosis Patient: A Case Report.

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    Li, Zheng; Shen, Jianxiong; Li, Qiyi; Chan, Matthew Tak Vai; Wu, William Ka Kei

    2015-11-01

    Drug fever is frequently underrecognized by clinicians despite its common occurrence. Fever induced by piperacillin/tazobactam has not been reported in scoliosis correction surgery.Drug fever caused by piperacillin/tazobactam in a scoliosis patient was described.A 36-year-old woman with adult scoliosis undergoing correction surgery was reported. She developed a fever after an intake of piperacillin/tazobactam for 3 days. Eosinophil count, erythrocyte sedimentation rate, and C-reactive proteins were increased in her blood examination. Thorough history, chest radiography, blood cultures, physical examination, and urinalysis revealed no evidences of fever. A drug fever is therefore considered. The fever lasted for 2 weeks and her body temperature come back to normal 4 days after piperacillin/tazobactam cessation.Fever could be caused by piperacillin/tazobactam. The drug fever's diagnosis is easily confounded by a co-occurring infection. Therefore, it is crucial for clinicians to doubt drugs as a reason when no other origin of fever could be identified in a patient.

  7. Teicoplanin plus ciprofloxacin versus gentamicin plus piperacillin in the treatment of febrile neutropenic patients.

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    Kelsey, S M; Weinhardt, B; Collins, P W; Newland, A C

    1992-06-01

    Teicoplanin plus ciprofloxacin was compared with gentamicin plus piperacillin for the empirical treatment of fever in 80 neutropenic patients. A favourable response was seen in 78% of patients receiving teicoplanin plus ciprofloxacin and in 49% receiving gentamicin plus piperacillin (p less than 0.05). When microbiologically documented episodes were analysed separately, the response to teicoplanin plus ciprofloxacin was favourable in 81% of patients whereas only 35% responded favourably to gentamicin plus piperacillin (p = 0.034). Gram-positive organisms accounted for 76% of bacterial isolates, Staphylococcus epidermidis being the most common pathogen. Ten of 12 (83%) Staphylococcus epidermidis infections resolved when treated with teicoplanin plus ciprofloxacin as compared with 2 of 8 (25%) treated with gentamicin plus piperacillin. Teicoplanin is at least as effective as gentamicin plus piperacillin in the empirical treatment of febrile neutropenic patients and may be more effective in situations where gram-positive organisms are prevalent. The high incidence of gram-positive infections in our unit justifies the use of an agent with specific activity against gram-positive organisms in the first-line antibiotic regimen.

  8. Ex vivo pharmacodynamic study of piperacillin alone and in combination with tazobactam, compared with ticarcillin plus clavulanic acid.

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    Van der Auwera, P; Duchateau, V; Lambert, C; Husson, M; Kinzig, M; Sörgel, F

    1993-01-01

    Ten volunteers received piperacillin (4 g), piperacillin (4 g) plus tazobactam (0.5 g) (Tazocin), and ticarcillin (3 g) plus clavulanic acid (0.2 g) (Timentin) intravenously over 30 min in a cross-over blinded scheme. Blood samples were obtained 0.5 and 3 h after the end of infusion to measure by (high-pressure liquid chromatography) the concentration and bactericidal titers against 70 gram-negative bacilli. Serum time-kill curves were done against 35 strains to measure killing rates and area under the time-kill curve. Using the measure of serum bactericidal activity, ticarcillin-clavulanic acid and piperacillin-tazobactam were equally effective against Pseudomonas aeruginosa, Escherichia coli, Enterobacter cloacae, Serratia marcescens, and Bacteroides fragilis. Piperacillin-tazobactam was superior to ticarcillin-clavulanic acid against piperacillin-resistant Klebsiella pneumoniae (4 to 16 times) and S. marcescens (2 to 4 times). By using the area under the time-kill curve, piperacillin-tazobactam was equivalent to ticarcillin-clavulanic acid against piperacillin-susceptible strains; piperacillin-tazobactam was significantly more active than piperacillin against piperacillin-resistant strains and was more active than ticarcillin-clavulanic acid when the sample obtained 3 h after the end of infusion to volunteers was considered. Serum piperacillin concentrations (mean +/- standard error of the mean; in mg/liter) were 115 +/- 13 at 0.5 h and 7.4 +/- 1.4 at 3 h after the administration of piperacillin alone and 105.5 +/- 12.6 (0.5 h) and 7.7 +/- 1.6 after the administration of piperacillin-tazobactam. Serum tazobactam concentrations (in milligram per liter) were 13.1 +/- 1.4 at 0.5 h and 1.2 +/- 0.2 at 3 h. The piperacillin-tazobactam ratio was 8 +/- 0.3 at 0.5 h and 6.2 +/- 0.5 at 3 h. Piperacillin-tazobactam appears promising against beta-lactamase-producing gram-negative bacilli. PMID:8239597

  9. Empirical antibiotic treatment with piperacillin-tazobactam in patients with microbiologically-documented biliary tract infections

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    Gabrio Bassotti; Fabio Chistolini; Francis Sietchiping-Nzepa; Giuseppe de Roberto; Antonio Morelli

    2004-01-01

    AIM: To report our experience with empiric antimicrobial monotherapy (piperacillin/tazobactam, of which no data are available in such specific circumstances) in microbiologically-documented infections in patients with benign and malignant conditions of the biliary tract.METHODS: Twenty-three patients, 10 with benign and 13 with malignant conditions affecting the biliary tree and microbiologically-documented infections were recruited and the efficacy of empirical antibiotic therapy was assessed.RESULTS: The two groups featured similar demographic and clinical data. Overall, the infective episodes were most due to Gram negative agents, more than 60% of such episodes (mostly in malignant conditions) were preceded by invasive instrumental maneuvers. Empirical antibiotic therapy with a single agent (piperacillin/tazobactam) was effective in more than 80% of cases. No deaths were reported following infections.CONCLUSION: An empiric therapeutic approach with piperacillin/tazobactam is highly effective in biliary tract infections due to benign or malignant conditions.

  10. Pharmacokinetics and pharmacodynamics of piperacillin-tazobactam in 42 patients treated with concomitant CRRT.

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    Bauer, Seth R; Salem, Charbel; Connor, Michael J; Groszek, Joseph; Taylor, Maria E; Wei, Peilin; Tolwani, Ashita J; Fissell, William H

    2012-03-01

    Current recommendations for piperacillin-tazobactam dosing in patients receiving continuous renal replacement therapy originate from studies with relatively few patients and lower continuous renal replacement therapy doses than commonly used today. This study measured the pharmacokinetic and pharmacodynamic characteristics of piperacillin-tazobactam in patients treated with continuous renal replacement therapy using contemporary equipment and prescriptions. A multicenter prospective observational study in the intensive care units of two academic medical centers was performed, enrolling patients with AKI or ESRD receiving piperacillin-tazobactam while being treated with continuous renal replacement therapy. Pregnant women, children, and patients with end stage liver disease were excluded from enrollment. Plasma and continuous renal replacement therapy effluent samples were analyzed for piperacillin and tazobactam levels using HPLC. Pharmacokinetic and pharmacodynamic parameters were calculated using standard equations. Multivariate analyses were used to examine the association of patient and continuous renal replacement therapy characteristics with piperacillin pharmacokinetic parameters. Forty-two of fifty-five subjects enrolled had complete sampling. Volume of distribution (median=0.38 L/kg, intraquartile range=0.20 L/kg) and elimination rate constants (median=0.104 h(-1), intraquartile range=0.052 h(-1)) were highly variable, and clinical parameters could explain only a small fraction of the large variability in pharmacokinetic parameters. Probability of target attainment for piperacillin was 83% for total drug but only 77% when the unbound fraction was considered. There is significant patient to patient variability in pharmacokinetic/pharmacodynamic parameters in patients receiving continuous renal replacement therapy. Many patients did not achieve pharmacodynamic targets, suggesting that therapeutic drug monitoring might optimize therapy.

  11. Single-Dose Pharmacokinetics of Piperacillin/Tazobactam in Hispaniolan Amazon Parrots ( Amazona ventralis ).

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    Carpenter, James W; Tully, Thomas N; Gehring, Ronette; Guzman, David Sanchez-Migallon

    2017-06-01

    To determine the pharmacokinetics of piperacillin/tazobactam in Hispaniolan Amazon parrots ( Amazona ventralis ), 8 healthy adult parrots of both sexes were used in a 2-part study. In a pilot study, piperacillin (87 mg/kg) in combination with tazobactam (11 mg/kg) was administered intramuscularly (IM) to 2 birds, and blood samples were obtained at 0, 0.5, 1, 1.5, 2, 3, 4, 6, 8, and 10 hours after administration. Based on the results obtained, a main study was done in which piperacillin/tazobactam was administered at 2 different doses. In 3 birds, the initial dose of piperacillin (87 mg/kg)/tazobactam (11 mg/kg) IM was administered, and in 3 birds, the dose was doubled to piperacillin (174 mg/kg)/tazobactam (22 mg/kg) IM. In all 6 birds, blood samples were obtained at 0, 5, 15, and 30 minutes and at 1, 1.5, 2, 2.5, 3, and 4 hours after administration. Quantification of plasma piperacillin and tazobactam concentrations was determined by validated liquid chromatography-mass spectrometry assay. Pharmacokinetic parameters were determined by noncompartmental analysis. After intramuscular administration, the mean ± standard error values of T1/2 (h) was 0.52 ± 0.05 and 0.32 ± 0.07, Tmax (h) was 0.28 ± 0.09 and 0.25 ± 0.10, Cmax (μg/mL) was 86.34 ± 20.62 and 9.03 ± 2.88, and Cmax/dose was 0.99 ± 0.24 and 0.83 ± 0.26 for piperacillin (87 mg/kg) and tazobactam (11 mg/kg), respectively. When the doses were doubled, the T1/2 (h) was 0.65 ± 0.08 and 0.34 ± 0.02, Tmax (h) was 0.28 ± 0.12 and 0.14 ± 0.06, Cmax (μg/mL) was 233.0 ± 6.08 and 22.13 ± 2.35, and Cmax/dose was 1.34 ± 0.03 and 1.02 ± 0.11 for piperacillin and tazobactam, respectively. Results indicate that piperacillin is rapidly absorbed and reaches high initial concentrations; however, it is also rapidly eliminated in the Hispaniolan Amazon parrot, and tazobactam has similar pharmacokinetics as piperacillin. Administration of piperacillin at 87 mg/kg IM q3-4h is recommended for this species to control

  12. Development and implementation of a piperacillin-tazobactam extended infusion guideline.

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    Heinrich, Lynley S; Tokumaru, Sheri; Clark, Nina M; Garofalo, John; Paek, Jamie L; Grim, Shellee A

    2011-12-01

    Administration of β-lactam antibiotics by extended infusion optimizes the pharmacodynamic properties and bactericidal activity of these agents resulting in a potential improvement in patient outcomes and reduction in drug expenditure. Consequently, a pharmacist-led piperacillin-tazobactam extended 4-hour infusion guideline was implemented hospital-wide at a 500-bed academic medical center. Each piperacillin-tazobactam infusion was prospectively monitored for 5 weeks to ensure accurate administration and identify barriers to guideline adherence. Overall, a total of 103 patients received 1215 doses of piperacillin-tazobactam by extended infusions. In all, 98% of the doses were administered at the correct extended infusion rate and 94% of the doses were given at the scheduled time. There were a total of 20 missed doses and 53 delayed doses, accounting for 2% and 4% of the total administered doses, respectively. The primary barrier to adherence was the patient not being on the unit at the time of the scheduled dose followed by the piperacillin-tazobactam dose not being available on the floor. While insufficient power prevented meaningful evaluation of clinical outcomes, we anticipate a conservative annual estimated cost savings of $108,529. Key elements contributing to our success included consistent pharmacy leadership, multidisciplinary involvement, thorough inservicing to health care professionals, hospital-wide implementation, and extensive quality assurance monitoring.

  13. In vitro activity of moxifloxacin and piperacillin/sulbactam against pathogens of acute cholangitis

    Institute of Scientific and Technical Information of China (English)

    Andreas Weber; Wolfgang Huber; Klaus Kamereck; Philipp Winkle; Petra Voland; Hans Weidenbach; Roland M Schmid; Christian Prinz

    2008-01-01

    AIM:To analyze the in vitro activity of moxifioxacin and piperacillin/sulbactam against pathogens isolated from patients with acute cholangitis.METHODS:In this prospective study a total of 65 patients with acute cholangitis due to biliary stone obstruction (n = 7),benign biliary stricture (n =16),and malignant biliary stricture (n = 42) were investigated with regard to spectrum of bacterial infection and antibiotic resistance.Pathogens were isolated from bile cultures in all study patients.In 22 febrile patients,blood cultures were also obtained.In vitro activity of moxifloxacin and piperacillin/sulbactam was determined by agar diffusion.RESULTS:Thirty-one out of 65 patients had positive bile and/or blood cultures.In 31 patients,63 isolates with 17 different species were identified.The predominant strains were Enterococcus species (26/63),Ecoli (13/63) and Klebsiella species (8/63).A comparable in vitro activity of moxifloxacin and piperacillin/sulbactam was observed for E.coli and Klebsiella species.In contrast,Enterococcus species had higher resistances towards moxifloxacin.Overall bacteria showed antibiotic resistances in vitro of 34.9% for piperacillin/sulbactam and 36.5% for moxifloxacin.CONCLUSION:Enterococcus species,E.coli andKlebsiella species were the most common bacteria isolated from bile and/or blood from patients with acute cholangitis.Overall,a mixed infection with several species was observed,and bacteria showed a comparable in vitro activity for piperacillin/sulbactam and moxifloxacin.

  14. Cross-Canada Survey of Resistance of 2747 Aerobic Blood Culture Isolates to Piperacillin/Tazobactam and Other Antibiotics

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    Kevin R Forward

    1998-01-01

    Full Text Available OBJECTIVE: To compare the activity of piperacillin/tazobactam with that of other broad parenteral antibiotics against aerobic and facultative anaerobic blood culture isolates in a Canada-wide survey.

  15. Population Pharmacokinetics of Piperacillin in the Early Phase of Septic Shock

    DEFF Research Database (Denmark)

    Öbrink-Hansen, Kristina; Juul, Rasmus Vestergaard; Storgaard, Merete

    2015-01-01

    Antibiotic dosing in septic shock patients poses a challenge for clinicians due to the pharmacokinetic variability seen in this patient population. Piperacillin/tazobactam is often used for empirical treatment, and initial appropriate dosing is crucial for reducing mortality. Accordingly, we...... bolus dosing as well as dosing by extended and continuous infusion increases the probability of attaining therapeutic plasma concentrations. For septic shock patients with preserved or augmented renal function, dose increment or prolonged infusion of the drug need to be considered....

  16. Wound Penetration of Cefazolin, Ciprofloxacin, Piperacillin, Tazobactam, and Vancomycin During Negative Pressure Wound Therapy

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    Rowan, Matthew P.; Niece, Krista L.; Rizzo, Julie A.; Akers, Kevin S.

    2017-01-01

    Objective: Negative pressure wound therapy (NPWT) uses subatmospheric pressure as a noninvasive adjunct to treat wounds and has demonstrated clinical efficacy by accelerating healing of a variety of acute and chronic wounds. NPWT may also play a role in preventing or treating wound infections, possibly by increasing wound penetration of antibiotics. However, clinical data in patients undergoing antibiotic and NPWT treatment are limited. Approach: To evaluate the wound penetration of antibiotics in NPWT patients, we conducted a prospective, observational study of burn and trauma patients treated with NPWT and systemic antibiotics. We evaluated the plasma pharmacokinetic profile of systemic vancomycin, ciprofloxacin, cefazolin, and piperacillin/tazobactam, as well as total and unbound antibiotic concentrations in wound exudate from the same patients. Results: Data from 32 patients with 37 wounds undergoing NPWT demonstrated that vancomycin, ciprofloxacin, and piperacillin/tazobactam all penetrated wounds with exudate to plasma concentration ratios more than 0.8. Cefazolin did not penetrate wounds in patients undergoing NPWT as effectively, with an average exudate to plasma concentration ratio of 0.51. Innovation: Clinical data on the wound penetration of antibiotics in patients undergoing NPWT are limited, but these data suggest that antibiotics have different capacities for wound penetration during NPWT that should be considered when making clinical decisions. Conclusion: This initial report suggests that (1) vancomycin, ciprofloxacin, and piperacillin/tazobactam effectively penetrate wounds during NPWT and (2) cefazolin as well as other antibiotics may not penetrate wounds during NPWT.

  17. Characterization of Piperacillin/Tazobactam-Resistant Klebsiella oxytoca Recovered from a Nosocomial Outbreak.

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    Ai Fujita

    Full Text Available We characterized 12 clinical isolates of Klebsiella oxytoca with the extended-spectrum β-lactamase (ESBL phenotype (high minimum inhibitory concentration [MIC] values of ceftriaxone recovered over 9 months at a university hospital in Japan. To determine the clonality of the isolates, we used pulsed-field gel electrophoresis (PFGE, multi-locus sequence typing (MLST, and PCR analyses to detect blaRBI, which encodes the β-lactamase RbiA, OXY-2-4 with overproduce-type promoter. Moreover, we performed the isoelectric focusing (IEF of β-lactamases, and the determination of the MICs of β-lactams including piperacillin/tazobactam for 12 clinical isolates and E. coli HB101 with pKOB23, which contains blaRBI, by the agar dilution method. Finally, we performed the initial screening and phenotypic confirmatory tests for ESBLs. Each of the 12 clinical isolates had an identical PFGE pulsotype and MLST sequence type (ST9. All 12 clinical isolates harbored identical blaRBI. The IEF revealed that the clinical isolate produced only one β-lactamase. E. coli HB101 (pKOB23 and all 12 isolates demonstrated equally resistance to piperacillin/tazobactam (MICs, >128 μg/ml. The phenotypic confirmatory test after the initial screening test for ESBLs can discriminate β-lactamase RbiA-producing K. oxytoca from β-lactamase CTX-M-producing K. oxytoca. Twelve clinical isolates of K. oxytoca, which were recovered from an outbreak at one university hospital, had identical genotypes and produced β-lactamase RbiA that conferred resistance to piperacillin/tazobactam. In order to detect K. oxytoca isolates that produce RbiA to promote research concerning β-lactamase RbiA-producing K. oxytoca, the phenotypic confirmatory test after the initial screening test for ESBLs would be useful.

  18. Pharmacokinetics of piperacillin and tazobactam in plasma and subcutaneous interstitial fluid in critically ill patients receiving continuous venovenous haemodiafiltration.

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    Varghese, Julie M; Jarrett, Paul; Boots, Robert J; Kirkpatrick, Carl M J; Lipman, Jeffrey; Roberts, Jason A

    2014-04-01

    This prospective pharmacokinetic study aimed to describe plasma and interstitial fluid (ISF) pharmacokinetics of piperacillin and tazobactam in critically ill patients on continuous venovenous haemodiafiltration (CVVHDF). Piperacillin/tazobactam (4g/0.5g) was administered every 8h and CVVHDF was performed as a 3-3.5L/h exchange using a polyacrylonitrile filter with a surface area of 1.05m(2). Serial blood (pre- and post-filter), filtrate/dialysate, urine and ISF concentrations were measured. Subcutaneous tissue ISF concentrations were determined using microdialysis. A total of 407 samples were collected. Median peak plasma concentrations were 210.5 (interquartile range=161.5-229.0) and 29.4 (27.9-32.0) mg/L and median trough plasma concentrations were 64.3 (49.0-68.9) and 12.3 (7.7-13.7) mg/L for piperacillin and tazobactam, respectively. The plasma elimination half-life was 6.4 (4.6-8.7) and 7.3 (4.6-11.8) h, volume of distribution 0.42 (0.29-0.49) and 0.32 (0.24-0.36) L/kg, total clearance 5.1 (4.2-6.2) and 3.8 (3.3-4.2) L/h and CVVHDF clearance 2.5 (2.3-3.1) and 2.5 (2.3-3.2) L/h for piperacillin and tazobactam, respectively. The tissue penetration ratio or ratio of area under the concentration-time curve of the unbound drug in ISF to plasma (unbound AUCISF/AUCplasma) was ca. 1 for both piperacillin and tazobactam. This is the first report of concurrent plasma and ISF concentrations of piperacillin and tazobactam during CVVHDF. For the CVVHDF settings used in this study, a dose of 4.5g piperacillin/tazobactam administered evry 8h resulted in piperacillin concentrations in plasma and ISF >32mg/L throughout most of the dosing interval. Copyright © 2014. Published by Elsevier B.V.

  19. Drug fever induced by piperacillin/tazobactam in an elderly patient with underlying human immunodeficiency virus (HIV) infection.

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    Swe, Thein; Ali, Mir; Naing, Akari Thein

    2016-07-20

    Our search of the literature revealed no detailed case reports about drug fever induced by piperacillin/tazobactam in a patient with HIV infection although there were a few case reports about drug fever due to piperacillin/tazobactam with other comorbidities. A 63-year-old male patient with HIV positive was admitted for acute cholecystitis. He was started on piperacillin/tazobactam. For the next 8 days, he had intermittent fever up to 103°F (39.4°C) with relative bradycardia although he showed clinical improvement. There was no laboratory or imaging findings suggestive of another infectious source and drug fever was suspected. The antibiotics were stopped and after 48 hours no fever was observed until the day of discharge. Piperacillin/tazobactam can induce fever in patients with cystic fibrosis and in patients with other conditions. Drug fever may be more prevalent in patients with HIV infection. It has no characteristic pattern and may not be associated with eosinophilia.

  20. Continuous versus intermittent administration of piperacillin-tazobactam in intensive care unit patients with ventilator-associated pneumonia

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    Fanak Fahimi

    2012-01-01

    Full Text Available Background and Aims: Ventilator-associated pneumonia (VAP is one of the most common Intensive Care Unit (ICU-acquired infection. The aim of this study was to compare the clinical outcome of continuous and intermittent administration of piperacillin-tazobactam by serial measurements of the Clinical Pulmonary Infection Score (CPIS. Subjects and Methods: Groups were designed as parallel and the study was designed as quasi-experimental and conducted at a semi-closed ICU between September 2008 and May 2010. Patients received 3.375 g (piperacillin 3 g/tazobactam 0.375 g either through intermittent infusion every 6 h for 30 min [Intermittent Infusion (II group; n = 30] or through continuous infusion every 8 h for 4 h [Continuous Infusion (CI group; n = 31]. CPIS was used to assess the clinical diagnosis and outcome of VAP patients. Results: Sex, age, Acute Physiology and Chronic Health Evaluation II II score on ICU admission, diagnosis and underlying disease of VAP patients were not significantly different in the CI (n = 31 and II (n = 30 groups. Duration of mechanical ventilation, length of stay, total number of antibiotics used per patient and duration of piperacillin/tazobactam treatment were similar in both groups. Mortality rates of VAP patients were similar between both groups during hospitalization. Conclusion: There was no significant difference in clinical outcomes of patients receiving piperacillin-tazobactam via CI or II when measured by serial CPIS score.

  1. Influence of renal function on the pharmacokinetics of piperacillin/tazobactam in intensive care unit patients during continuous venovenous hemofiltration.

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    Arzuaga, Alazne; Maynar, Javier; Gascón, Alicia R; Isla, Arantxazu; Corral, Esther; Fonseca, Fernando; Sánchez-Izquierdo, José Angel; Rello, Jordi; Canut, Andrés; Pedraz, José Luis

    2005-02-01

    The pharmacokinetics of piperacillin/tazobactam (4 g/0.5 g every 6 or 8 hours, by 20-minute intravenous infusion) were studied in 14 patients with acute renal failure who underwent continuous venovenous hemofiltration with AN69 membranes. Patients were grouped according to severity (CL(CR) 50 mL/min). A noncompartmental analysis was performed. The sieving coefficient (0.78 +/- 0.28) was similar to the unbound fraction (0.65 +/- 0.24) for tazobactam, but it was significantly different (0.34 +/- 0.25) from the unbound fraction (0.78 +/- 0.14) for piperacillin. Extracorporeal clearance was 37.0% +/- 28.8%, 12.7% +/- 12.6%, and 2.8% +/- 3.2% for piperacillin in each group and 62.5% +/- 44.9%, 35.4% +/- 17.0%, and 13.1% +/- 8.0% for tazobactam. No patients presented tazobactam accumulation. In patients with CL(CR) MIC90 values were 100% for a panel of 19 pathogens, but in those with CL(CR) > 50 mL/min, t(%)ss >MIC90 indexes were 55.5% and 16.6% for pathogens with MIC90 values of 32 and 64. The extracorporeal clearance of piperacillin/tazobactam is clinically significant in patients with CL(CR) > 50 mL/min, in which the risk of underdosing and clinical failure is important and extra doses are required.

  2. [In vitro inhibition of granulopoiesis by beta-lactam antibiotics. Comparison of piperacillin, mezlocillin, ceftriaxone and ceftazidime].

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    Marie, J P; Thevenin, D; Zittoun, R

    1986-12-20

    The mechanism of neutropenia induced by beta-lactam antibiotics was explored by studying the action of these drugs on granulopoiesis in vitro. Normal bone marrows were cultivated in the presence of increasing concentrations of piperacillin (10 marrows), mezlocillin, ceftriaxone and ceftazidime (5 marrows each) in order to find out whether these antibiotics exhibited toxicity to granulocyte-monocyte precursors. A dose-dependent inhibition of granulopoiesis was found in all cases. When the doses used were equivalent to maximum plasma concentrations in vivo, inhibition was minimal with piperacillin and mezlocillin and much more pronounced with the cephalosporins. This dose-dependent inhibition suggests that toxicity is involved in the mechanism of neutropenia induced by beta-lactam antibiotics.

  3. Intravenous piperacillin/tazobactam plus fluoroquinolone prophylaxis prior to prostate ultrasound biopsy reduces serious infectious complications and is cost effective

    Directory of Open Access Journals (Sweden)

    Remynse LC

    2011-08-01

    Full Text Available Louis C Remynse III, Patrick J Sweeney, Kevin A Brewton, Jay M LonswayUrology Associates of Battle Creek, PC, Battle Creek, MI, USAAbstract: Infectious complications related to prostate ultrasound and biopsy have increased in the past decade with the emergence of increasing fluoroquinolone bacterial resistance. We investigated the addition of intravenous (iv piperacillin/tazobactam immediately prior to prostate ultrasound and biopsy with standard fluoroquinolone prophylaxis to determine if it would decrease the incidence of serious infectious complications after prostate ultrasound and biopsy. Group 1 patients were a historic control of 197 patients who underwent prostate ultrasound and biopsy with standard fluoroquinolone prophylaxis. Group 2 patients, 104 patients, received standard fluoroquinolone prophylaxis and the addition of a single dose of iv piperacillin/tazobactam 30 minutes prior to prostate ultrasound and biopsy. There were ten serious bacterial infectious complications in group 1 patients. No patients in group 2 developed serious bacterial infections after prostate ultrasound and biopsy. There was approximately a 5% incidence of serious bacterial infection in group 1 patients. Subgroup analysis revealed an almost 2.5 times increased risk of infection in diabetes patients undergoing prostate ultrasound and biopsy. There was a 10% risk of serious bacterial infection in diabetics compared with a 3.8% risk group 1 nondiabetes patients. The addition of a single dose of iv piperacillin/tazobactam along with standard fluoroquinolone prophylaxis substantially reduces the risk of serious bacterial infection after prostate ultrasound and biopsy (P < 0.02.Keywords: piperacillin/tazobactam, fluoroquinolone, prostate biopsy, infectious complications

  4. Free radicals properties of gamma-irradiated penicillin-derived antibiotics: piperacillin, ampicillin, and crystalline penicillin.

    Science.gov (United States)

    Wilczyński, Sławomir; Pilawa, Barbara; Koprowski, Robert; Wróbel, Zygmunt; Ptaszkiewicz, Marta; Swakoń, Jan; Olko, Paweł

    2014-03-01

    The aim of this work was to determine the concentrations and properties of free radicals in piperacillin, ampicillin, and crystalline penicillin after gamma irradiation. The radicals were studied by electron paramagnetic resonance (EPR) spectroscopy using an X-band spectrometer (9.3 GHz). Gamma irradiation was performed at a dose of 25 kGy. One- and two-exponential functions were fitted to the experimental data, in order to assess the influence of the antibiotics' storage time on the measured EPR lines. After gamma irradiation, complex EPR lines were recorded confirming the presence of a large number of free radicals formed during the irradiation. For all tested antibiotics, concentrations of free radicals and parameters of EPR spectra changed with storage time. The results obtained demonstrate that concentration of free radicals and other spectroscopic parameters can be used to select the optimal parameters of radiation sterilization of β-lactam antibiotics. The most important parameters are the constants τ (τ (1(A),(I)) and τ (2(A),(I))) and K (K (0(A),(I)), K (1(A),(I)), K (2(A),(I))) of the exponential functions that describe free radicals decay during samples storage.

  5. Empiric Piperacillin-Tazobactam versus Carbapenems in the Treatment of Bacteraemia Due to Extended-Spectrum Beta-Lactamase-Producing Enterobacteriaceae.

    Science.gov (United States)

    Ng, Tat Ming; Khong, Wendy X; Harris, Patrick N A; De, Partha P; Chow, Angela; Tambyah, Paul A; Lye, David C

    2016-01-01

    Extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae are a common cause of bacteraemia in endemic countries and may be associated with high mortality; carbapenems are considered the drug of choice. Limited data suggest piperacillin-tazobactam could be equally effective. We aimed to compare 30-day mortality of patients treated empirically with piperacillin-tazobactam versus a carbapenem in a multi-centre retrospective cohort study in Singapore. Only patients with active empiric monotherapy with piperacillin-tazobactam or a carbapenem were included. A propensity score for empiric carbapenem therapy was derived and an adjusted multivariate analysis of mortality was conducted. A total of 394 patients had ESBL-Escherichia.coli and ESBL-Klebsiella pneumoniae bacteraemia of which 23.1% were community acquired cases. One hundred and fifty-one received initial active monotherapy comprising piperacillin-tazobactam (n = 94) or a carbapenem (n = 57). Patients who received carbapenems were less likely to have health-care associated risk factors and have an unknown source of bacteraemia, but were more likely to have a urinary source. Thirty-day mortality was comparable between those who received empiric piperacillin-tazobactam and a carbapenem (29 [30.9%] vs. 17 [29.8%]), P = 0.89). Those who received empiric piperacillin-tazobactam had a lower 30-day acquisition of multi-drug resistant and fungal infections (7 [7.4%] vs. 14 [24.6%]), Pcarbapenem.

  6. The influence of sulbactam on the in vitro activity of mezlocillin, piperacillin and cefotaxime.

    Science.gov (United States)

    Bauernfeind, A; Grimm, H; Klietmann, W; Opferkuch, W; Werner, H

    1996-04-01

    In a multicentre study, the in-vitro activity of mezlocillin (MEZ, Chemical Abstract Service [CAS] 51481-65-3), piperacillin (PIP, CAS 61477-96-1) and cefotaxime (CTX, CAS 63527-52-6) against mezlocillin-resistant organisms was determined alone and in combination with the beta-lactamase inhibitor sulbactam (SBT, CAS 68373-14-8). A total of 870 strains were investigated (481 Enterobacteriaceae, 57 Pseudomonas aeruginosa, 41 Acinetobacter spp., 194 Bacteroides fragilis and 97 Staphylococcus spp.). MIC values were determined using the agar dilution test (aerobic organisms) or the microbroth dilution test (Bacteroides spp.) in accordance with Deutsche Industrie für Normung 58 940. SBT was added in fixed concentrations of 5 mg/l and 10 mg/l. For all combinations with SBT investigated, the geometric mean of the MIC and the MIC(50) and MIC(90) values were reduced as compared with the antibiotic alone (without SBT). Consequently, the proportion of sensitive strains was appreciably increased, for example in the Enterobacteriaceae: MEZ 1%, MEZ + 10 mg/l SBT 53%; PIP 4%, PIP + 10 mg/l SBT 54%; CTX 52%, CTX + 10 mg/l SBT 68%. The effect of SBT was especially pronounced on Bacteroides spp. For this organism, the proportion of sensitive strain rose from 2% to 97% (MEZ), 6% to 95% (PIP) and from 7% to 98% (CTX). The results show that adding SBT appreciably enhances the activity of MEZ, PIP and CTX against resistant strains of microorganism, and extends the activity spectrum to include anaerobic organisms. Thus the availability of SBT as a single-agent preparation for use in combination with various beta-lacta antibiotics represents a worthwhile enlargement of the therapeutic armamentarium for treating bacterial infections.

  7. Carbapenems and piperacillin/tazobactam for the treatment of bacteremia caused by extended-spectrum β-lactamase-producing Proteus mirabilis.

    Science.gov (United States)

    Tsai, Hsih-Yeh; Chen, Yen-Hsu; Tang, Hung-Jen; Huang, Chi-Chang; Liao, Chun-Hsing; Chu, Fang-Yeh; Chuang, Yin-Ching; Sheng, Wang-Huei; Ko, Wen-Chien; Hsueh, Po-Ren

    2014-11-01

    This study was intended to delineate the role of carbapenems and piperacillin/tazobactam in treating bacteremia caused by extended-spectrum β-lactamase (ESBL)-producing Proteus mirabilis. We performed a multicenter and retrospective study of the patients with ESBL-producing P. mirabilis bacteremia. The outcomes of the patients treated by piperacillin/tazobactam or a carbapenem for at least 48 hours and the MICs of the prescribed drugs for these isolates were analyzed. Forty-seven patients with available clinical data were included. The overall 30-day mortality rate was 29.8%. All available isolates (n = 44) were susceptible to ertapenem, meropenem, and doripenem, and 95.6% were susceptible to piperacillin/tazobactam; however, only 11.4% of the isolates were susceptible to imipenem. Among the 3 patients infected with isolates exhibiting non-susceptibility to imipenem (MIC ≥2 mg/L) who were treated with imipenem, none died within 28 days. The 30-day (14.3% versus 23.1%, P = 0.65) or in-hospital (19.1% versus 30.8%, P = 0.68) mortality rate of 21 patients treated by a carbapenem was lower than that of 13 treated by piperacillin/tazobactam. However, among those treated by piperacillin/tazobactam, the mortality rate of those infected by the isolates with lower piperacillin/tazobactam MICs (≤0.5/4 mg/L) was lower than that of the isolates with MICs of ≥1/4 mg/L (0%, 0/7 versus 60%, 3/5; P = 0.045). ESBL-producing P. mirabilis bacteremia is associated with significant mortality, and carbapenem therapy could be regarded as the drugs of choice. The role of piperacillin/tazobactam, especially for the infections due to the isolates with an MIC ≤0.5/4 mg/L, warrants more clinical studies.

  8. Clinical outcomes with alternative dosing strategies for piperacillin/tazobactam: a systematic review and meta-analysis.

    Directory of Open Access Journals (Sweden)

    Hui Yang

    Full Text Available A better dosing strategy can improve clinical outcomes for patients. We sought to compare the extended or continuous infusion with conventional intermittent infusion of piperacillin/tazobactam, investigating which approach is better and worthy of recommendation for clinical use.Articles were gathered from PubMed, Web of Science, ProQuest, Science Direct, Cochrane, two Chinese literature databases (CNKI, Wan Fang Data and related ICAAC and ACCP conferences. Randomized controlled and observational studies that compared extended or continuous infusion with conventional intermittent infusion of piperacillin/tazobactam were identified from the databases above and analyzed. Two reviewers independently extracted and investigated the data. A meta-analysis was performed using Revman 5.2 software. The quality of each study was assessed. Sensitivity analysis and publication bias were evaluated.Five randomized controlled trials and nine observational studies were included in this study. All included studies had high quality and no publication bias was found. Compared to the conventional intermittent infusion approach, the extended or continuous infusion group had a significantly higher clinical cure rate (OR 1.88, 95% CI 1.29-2.73, P = 0.0009 and a lower mortality rate (OR 0.67, 95% CI 0.50-0.89, P = 0.005. No statistical difference was observed for bacteriologic cure (OR 1.40, 95% CI 0.82-2.37, P = 0.22 between the two dosing regimens. The sensitivity analysis showed the results were stable.Our systematic review and meta-analysis suggested that the extended or continuous infusion strategy of piperacillin/tazobactam should be recommended for clinical use considering its higher clinical cure rate and lower mortality rate in comparison with conventional intermittent strategy. Data from this study could be extrapolated for other β-lactam antimicrobials. Therefore, this dosing strategy could be considered in clinical practice.

  9. Population pharmacokinetic analysis of nonlinear behavior of piperacillin during intermittent or continuous infusion in patients with cystic fibrosis.

    Science.gov (United States)

    Vinks, Alexander A; Den Hollander, Jan G; Overbeek, Shelley E; Jelliffe, Roger W; Mouton, Johan W

    2003-02-01

    The purpose of this study was to describe the nonlinear pharmacokinetics of piperacillin observed during intermittent infusion and continuous infusion by using a nonparametric population modeling approach. Data were 120 serum piperacillin concentration measurements from eight adult cystic fibrosis (CF) patients. Individual pharmacokinetic parameter estimates during intermittent infusion or continuous infusion were calculated by noncompartmental analysis and with a maximum iterative two-stage Bayesian estimator. To simultaneously describe concentration-time data during intermittent infusion and continuous infusion, nonlinear models were parameterized as two-compartment Michaelis-Menten models. Models were fit to the data with the nonparametric expectation maximization algorithm. The calculations were executed on a remote supercomputer. Nonlinear models were evaluated by log-likelihood estimates, residual plots, and R(2) values, and predictive performance was based on bias (mean weighted error [MWE]) and precision (mean weighted square error [MWSE]). A linear pharmacokinetic model could not describe combined intermittent infusion and continuous infusion data well. A good population model fit to the intermittent infusion and continuous infusion data was obtained with the constructed nonlinear models. Maximum a posteriori probability (MAP) Bayesian R(2) values for the nonlinear models were 0.96 to 0.97. Median parameter estimates for the best nonlinear model were as follows: K(m), 58 +/- 75 mg/liter (mean and standard deviation); V(max), 1,904 +/- 1,009 mg/h; volume of distribution of the central compartment, 14.1 +/- 3.0 liters; k(12), 0.63 +/- 0.41 h(-1); and k(21), 0.37 +/- 0.19 h(-1). The median bias (MWE) and precision (MWSE) values for MAP Bayesian estimation with the Michaelis-Menten model were 0.05 and 4.6 mg/liters, respectively. The developed nonlinear pharmacokinetic models can be used to optimize piperacillin therapy administered via continuous infusion in

  10. Therapeutic drug monitoring of piperacillin-tazobactam using spent dialysate effluent in patients receiving continuous venovenous hemodialysis.

    Science.gov (United States)

    Connor, Michael J; Salem, Charbel; Bauer, Seth R; Hofmann, Christina L; Groszek, Joseph; Butler, Robert; Rehm, Susan J; Fissell, William H

    2011-02-01

    Sepsis and multisystem organ failure are common diagnoses affecting nearly three-quarters of a million Americans annually. Infection is the leading cause of death in acute kidney injury, and the majority of critically ill patients who receive continuous dialysis also receive antibiotics. Dialysis equipment and prescriptions have gradually changed over time, raising concern that current drug dosing recommendations in the literature may result in underdosing of antibiotics. Our research group directed its attention toward antibiotic dosing strategies in patients with acute renal failure (ARF), and we sought data confirming that patients receiving continuous dialysis and antibiotics actually were achieving therapeutic plasma drug levels during treatment. In the course of those investigations, we explored "fast-track" strategies to estimate plasma drug concentrations. As most antimicrobial antibiotics are small molecules and should pass freely through modern high-flux hemodialyzer filters, we hypothesized that continuous renal replacement therapy (CRRT) effluent could be used as the medium for drug concentration measurement by reverse-phase high-pressure liquid chromatography (HPLC). Here we present the first data demonstrating this approach for piperacillin-tazobactam. Paired blood and dialysate trough-peak-trough samples were drawn from 19 patients receiving piperacillin-tazobactam and continuous venovenous hemodialysis (CVVHD). Total, free, and dialysate drug concentrations were measured by HPLC. Dialysate drug levels predicted plasma free drug levels well (r(2) = 0.91 and 0.92 for piperacillin and tazobactam, respectively) in all patients. These data suggest a strategy for therapeutic drug monitoring that minimizes blood loss from phlebotomy and simplifies analytic procedures.

  11. Clinical cure of ventilator-associated pneumonia treated with piperacillin/tazobactam administered by continuous or intermittent infusion.

    Science.gov (United States)

    Lorente, Leonardo; Jiménez, Alejandro; Martín, María M; Iribarren, José Luis; Jiménez, Juan José; Mora, María L

    2009-05-01

    The standard mode of administration of piperacillin treatment is by intermittent infusion. However, continuous infusion may be advantageous as beta-lactam antibiotics exhibit time-dependent antibacterial activity. In previous studies, we found a higher rate of clinical cure of ventilator-associated pneumonia (VAP) by continuous infusion rather than intermittent infusion of meropenem and ceftazidime. Therefore, the objective of this historical cohort study was to establish the clinical efficacy of piperacillin/tazobactam (PIP/TAZ) administered by continuous and intermittent infusion in the treatment of VAP in patients without renal failure. Logistic regression analysis showed a higher probability of clinical cure of VAP by continuous compared with intermittent infusion when the microorganism responsible for VAP had a minimum inhibitory concentration (MIC) of 8 microg/mL [8/9 (88.9%) vs. 6/15 (40.0%); odds ratio (OR)=10.79, 95% confidence interval (CI) 1.01-588.24; P=0.049] or 16 microg/mL [7/8 (87.5%) vs. 1/6 (16.7%); OR=22.89, 95% CI 1.19-1880.78; P=0.03]. Thus, administration of PIP/TAZ by continuous infusion may be considered more effective than intermittent infusion for the treatment of VAP caused by Gram-negative bacteria when the MIC of the microorganism responsible for VAP is 8-16 microg/mL in patients without renal failure.

  12. Tolerability of piperacillin/tazobactam in children and adolescents after high dose radio-/chemotherapy and autologous stem cell transplantation.

    Science.gov (United States)

    Nürnberger, W; Bönig, H; Burdach, S; Göbel, U

    1998-01-01

    The combination of piperacillin with tazobactam (PIP/TAZ) extends the activity of piperacillin against gram-positive, gram-negative, and anaerobic bacteria. The broad-spectrum of this formulation, together with its low degree of organ toxicity observed in adults, makes PIP/TAZ a tempting choice for children with radio-/chemotherapy-induced neutropenia. However, the use of PIP/TAZ is not yet approved for children under 12 years of age. The tolerability of PIP/TAZ was assessed in 19 children and adolescents between 2 and 18 years of age who developed a fever during aplasia after high dose radio-/chemotherapy and autologous stem cell transplantation (HD-SCT) for primary multifocal or relapsed solid tumours. Treatment with PIP/TAZ was initiated on average 3 days after HD-SCT, and the treatment was continued for approximately 10 days. Both clinical observation and laboratory studies showed no relevant alterations that would have been attributable to PIP/TAZ treatment. These results indicate that PIP/TAZ appears to be well tolerated in children during the acute phase of HD-SCT.

  13. Population pharmacokinetics of piperacillin and tazobactam in critically ill patients undergoing continuous renal replacement therapy: application to pharmacokinetic/pharmacodynamic analysis.

    Science.gov (United States)

    Asín-Prieto, Eduardo; Rodríguez-Gascón, Alicia; Trocóniz, Iñaki F; Soraluce, Amaia; Maynar, Javier; Sánchez-Izquierdo, José Ángel; Isla, Arantxazu

    2014-01-01

    To evaluate the pharmacokinetics of piperacillin/tazobactam in critically ill patients undergoing continuous renal replacement therapy (CRRT) and to assess the success of the therapy against susceptible bacteria. Sixteen patients undergoing CRRT with different degrees of renal function were included in the study. Blood and ultrafiltrate samples were drawn after administration of piperacillin/tazobactam (4/0.5 g) every 4, 6 or 8 h. The data were analysed by a population approach using NONMEM 7.2. The probability of target attainment (PTA) of maintaining free piperacillin levels above the MIC during the entire dosing interval was estimated by simulation of intermittent and continuous infusions. The pharmacokinetics of piperacillin and tazobactam were best described by two-compartment models where the elimination of both drugs was conditioned by renal [dependent on creatinine clearance (CLCR)], non-renal and extracorporeal clearances. A 20 min infusion of piperacillin/tazobactam administered every 6 h provided high PTAs against MICs ≤ 32 mg/L in patients with severe renal failure. In patients with normal or moderate renal function PTAs ≥ 90% were only obtained up to MICs ≤ 8 mg/L with short infusions. However, simulating continuous infusion, higher probabilities of success were obtained against MICs of 32 and 16 mg/L when CLCR was 50 and 100 mL/min, respectively. Population pharmacokinetic models have been developed and validated for piperacillin and tazobactam. Based on the pharmacokinetic/pharmacodynamic analysis, dosing recommendations are given considering the residual renal function of the patient and the MIC for the isolated bacteria.

  14. Immune-mediated severe hemolytic crisis with a hemoglobin level of 1.6 g/dl caused by anti-piperacillin antibodies in a patient with cystic fibrosis.

    Science.gov (United States)

    Kunzmann, S; Thomas, W; Mayer, B; Kuhn, S; Hebestreit, H

    2010-04-01

    We report a 23-year-old female patient with cystic fibrosis developing severe intravascular hemolysis with a minimal hemoglobin level of 1.6 g/dl after 7 days of treatment with piperacillin, consistent with an immune-mediated hemolytic crisis. Twenty days later, the patient could leave the hospital in good condition without any neurological deficit. To our knowledge, this is the lowest reported hemoglobin value caused by hemolytic anemia with intact survival. As piperacillin is commonly used in patients with cystic fibrosis, it is important to monitor the full-blood counts of patients during treatment with piperacillin and to be aware of the potential for hemolytic anemia to develop. Anti-piperacillin antibodies should be considered whenever these patients develop hemolytic anemia or a positive direct antiglobulin test (DAT). Furthermore, drug-fever under piperacillin application could be a warning sign for the development of hemolytic anemia.

  15. Clinical outcomes with extended or continuous versus short-term intravenous infusion of carbapenems and piperacillin/tazobactam: a systematic review and meta-analysis.

    Science.gov (United States)

    Falagas, Matthew E; Tansarli, Giannoula S; Ikawa, Kazuro; Vardakas, Konstantinos Z

    2013-01-01

    We sought to study whether the better pharmacokinetic and pharmacodynamic (PK/PD) properties of carbapenems and piperacillin/tazobactam, when the duration of infusion is longer, were associated with lower mortality. PubMed and Scopus were searched for studies reporting on patients treated with extended (≥3 hours) or continuous (24 hours) versus short-term duration (20-60 minutes) infusions of carbapenems or piperacillin/tazobactam. Fourteen studies were included (1229 patients). Mortality was lower among patients receiving extended or continuous infusion of carbapenems or piperacillin/tazobactam compared to those receiving short-term (risk ratio [RR], 0.59; 95% confidence interval [CI], .41-.83). Patients with pneumonia who received extended or continuous infusion had lower mortality than those receiving short-term infusion (RR, 0.50; 95% CI, 0.26-0.96). Data for other specific infections were not available. The available evidence from mainly nonrandomized studies suggests that extended or continuous infusion of carbapenems or piperacillin/tazobactam was associated with lower mortality. Well-designed randomized controlled trials are warranted to confirm these findings before such approaches become widely used.

  16. Stability of ampicillin, piperacillin, cefotaxime, netilmicin and amikacin in an L-amino acid solution prepared for total parenteral nutrition of newborn infants

    DEFF Research Database (Denmark)

    Goldstein, K; Colding, H; Andersen, G E

    1988-01-01

    The stability of ampicillin, piperacillin and cefotaxime, alone or in combination with either netilmicin or amikacin, was tested by microbiological methods at 29 degrees C (ampicillin, also at 22 degrees C) in an L-amino acid solution specially prepared for newborn infants. In the case of ampicil...

  17. In vitro and in vivo activities of piperacillin-tazobactam and meropenem at different inoculum sizes of ESBL-producing Klebsiella pneumoniae.

    Science.gov (United States)

    Harada, Y; Morinaga, Y; Kaku, N; Nakamura, S; Uno, N; Hasegawa, H; Izumikawa, K; Kohno, S; Yanagihara, K

    2014-11-01

    The inoculum effect is a laboratory phenomenon in which the minimal inhibitory concentration (MIC) of an antibiotic is increased when a large number of organisms are exposed. Due to the emergence of extended-spectrum β-lactamase-producing Klebsiella pneumoniae (ESBL-Kpn) infections, the inoculum effect of ESBL-Kpn on β-lactams was studied in vitro and in vivo using an experimental model of pneumonia. The in vitro inoculum effect of 45 clinical ESBL-Kpn isolates on β-lactams was evaluated at standard (10(5) CFU/mL) and high (10(7) CFU/mL) organism concentrations. The MIC50 of piperacillin-tazobactam, cefotaxime and cefepime was increased eight-fold or more and that of meropenem was increased two-fold. The in vivo inoculum effect was evaluated in an ESBL-Kpn pneumonia mouse model treated with bacteriostatic effect-adjusted doses of piperacillin-tazobactam (1000 mg/kg four times daily, %T>MIC; 32.60%) or meropenem (100 mg/kg twice daily, %T>MIC; 28.65%) at low/standard (10(4) CFU/mouse) and high (10(6) CFU/mouse) inocula. In mice administered a low inoculum, no mice died after treatment with piperacillin-tazobactam or meropenem, whereas all the control mice died. In contrast, in the high inoculum model, all mice in the piperacillin-tazobactam-treated group died, whereas all meropenem-treated mice survived and had a decreased bacterial load in the lungs and no invasion into the blood. In conclusion, meropenem was more resistant to the inoculum effect of ESBL-Kpn than piperacillin-tazobactam both in vitro and in vivo. In the management of severe pneumonia caused by ESBL-Kpn, carbapenems may be the drugs of choice to achieve a successful outcome.

  18. Stability of piperacillin sodium-tazobactam sodium and ranitidine hydrochloride in 0.9% sodium chloride injection during simulated Y-site administration.

    Science.gov (United States)

    Choi, J S; Burm, J P; Jhee, S S; Chin, A; Ulrich, R W; Gill, M A

    1994-09-15

    The stability of piperacillin sodium plus tazobactam sodium and ranitidine hydrochloride in 0.9% sodium chloride injection during simulated Y-site administration was studied. Triplicate test solutions of piperacillin 40 mg/mL plus tazobactam 5 mg/mL (as the sodium salts) or piperacillin 80 mg/mL plus tazobactam 10 mg/mL (as the sodium salts) were mixed 1:1 with ranitidine 0.5 and 2.0 mg/mL (as the hydrochloride salt). The solutions were stored at 23 degrees C, and samples were removed at zero, one, two, and four hours for measurement of drug concentration by stability-indicating high-performance liquid chromatography. At the time of sampling and before any dilution, each sample was visually inspected for color and precipitation, and pH was determined. At all sampling times, the concentrations of piperacillin, tazobactam, and ranitidine were > 90% of initial concentrations. There were no substantial changes in pH or color. Tazobactam 5 mg/mL (as the sodium salt) and ranitidine 0.5 and 2 mg/mL (as the hydrochloride salt) in 0.9% sodium chloride injection were stable for up to four hours during simulated Y-site administration. Piperacillin 80 mg/mL plus tazobactam 10 mg/mL (as the sodium salts) and ranitidine 0.5 and 2 mg/mL (as the hydrochloride salt) were stable for up to four hours during simulated Y-site administration.

  19. Carbapenems Versus Piperacillin-Tazobactam for Bloodstream Infections of Nonurinary Source Caused by Extended-Spectrum Beta-Lactamase-Producing Enterobacteriaceae.

    Science.gov (United States)

    Ofer-Friedman, Hadas; Shefler, Coral; Sharma, Sarit; Tirosh, Amit; Tal-Jasper, Ruthy; Kandipalli, Deepthi; Sharma, Shruti; Bathina, Pradeep; Kaplansky, Tamir; Maskit, Moran; Azouri, Tal; Lazarovitch, Tsilia; Zaidenstein, Ronit; Kaye, Keith S; Marchaim, Dror

    2015-08-01

    A recent, frequently quoted study has suggested that for bloodstream infections (BSIs) due to extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL) Escherichia coli, treatment with β-lactam/β-lactamase inhibitors (BLBLIs) might be equivalent to treatment with carbapenems. However, the majority of BSIs originate from the urinary tract. A multicenter, multinational efficacy analysis was conducted from 2010 to 2012 to compare outcomes of patients with non-urinary ESBL BSIs who received a carbapenem (69 patients) vs those treated with piperacillin-tazobactam (10 patients). In multivariate analysis, therapy with piperacillin-tazobactam was associated with increased 90-day mortality (adjusted odds ratio, 7.9, P=.03). For ESBL BSIs of a non-urinary origin, carbapenems should be considered a superior treatment to BLBLIs.

  20. Piperacillin-tazobactam-induced linear IgA bullous dermatosis presenting clinically as Stevens-Johnson syndrome/toxic epidermal necrolysis overlap.

    Science.gov (United States)

    Adler, N R; McLean, C A; Aung, A K; Goh, M S Y

    2017-04-01

    Linear IgA bullous dermatosis (LABD) is a subepidermal autoimmune bullous disease characterized by linear IgA deposition at the basement membrane zone, which is visualized by direct immunofluorescence. Patients with LABD typically present with widespread vesicles and bullae; however, this is not necessarily the case, as the clinical presentation of this disease is heterogeneous. LABD clinically presenting as Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN) is an infrequent, yet well-described phenomenon. Most cases of LABD are idiopathic, but some cases are drug-induced. Multiple drugs have been implicated in the development of LABD. We report a case of piperacillin-tazobactam-induced LABD presenting clinically as SJS/TEN overlap. This is the first reported case of a strong causal association between piperacillin-tazobactam and the development of LABD.

  1. Microbiological activity of ceftolozane/tazobactam, ceftazidime, meropenem, and piperacillin/tazobactam against Pseudomonas aeruginosa isolated from children with cystic fibrosis.

    Science.gov (United States)

    Kuti, Joseph L; Pettit, Rebecca S; Neu, Natalie; Cies, Jeffrey J; Lapin, Craig; Muhlebach, Marianne S; Novak, Kimberly J; Nguyen, Sean T; Saiman, Lisa; Nicolau, David P

    2015-09-01

    The activity of ceftolozane/tazobactam was tested against 50 nonduplicate Pseudomonas aeruginosa from 18 cystic fibrosis children collected in 2012-2014. These isolates were multidrug resistant with susceptibility to meropenem, ceftazidime, and piperacillin/tazobactam of 46%, 58%, and 50%, respectively. Ceftolozane/tazobactam was the most active with MIC50, MIC90, and percent susceptibility of 2mg/L, 8 mg/L, and 86%.

  2. Clinical Correlation of the CLSI Susceptibility Breakpoint for Piperacillin- Tazobactam against Extended-Spectrum-β-Lactamase-Producing Escherichia coli and Klebsiella Species†

    Science.gov (United States)

    Gavin, Patrick J.; Suseno, Mira T.; Thomson, Richard B.; Gaydos, J. Michael; Pierson, Carl L.; Halstead, Diane C.; Aslanzadeh, Jaber; Brecher, Stephen; Rotstein, Coleman; Brossette, Stephen E.; Peterson, Lance R.

    2006-01-01

    We assessed infections caused by extended-spectrum-β-lactamase-producing Escherichia coli or Klebsiella spp. treated with piperacillin-tazobactam to determine if the susceptibility breakpoint predicts outcome. Treatment was successful in 10 of 11 nonurinary infections from susceptible strains and in 2 of 6 infections with MICs of >16/4 μg/ml. All six urinary infections responded to treatment regardless of susceptibility. PMID:16723596

  3. Outbreak of Ampicillin/Piperacillin-Resistant Klebsiella Pneumoniae in a Neonatal Intensive Care Unit (NICU: Investigation and Control Measures

    Directory of Open Access Journals (Sweden)

    Patrizia Farruggia

    2013-02-01

    Full Text Available Klebsiella pneumoniae is a frequent cause of infectious outbreaks in Neonatal Intensive Care Units (NICUs. The aim of this paper is to describe an outbreak occurred in a 13-bed NICU and the control measures adopted in order to interrupt the chain of transmission. We described the microbiological investigations, the NICU staff compliance to the infection control measures by means of a specifically designed check-list and the control measures adopted. Six cases of primary bloodstream infections sustained by ampicillin/piperacillin-resistant Klebsiella pneumoniae were observed over a two-month period. One culture obtained from a 12% saccarose multiple-dose solution allowed the growth of Klebsiella pneumoniae. During the inspections performed by the Hospital Infection Control Team, using the check-list for the evaluation of the NICU staff compliance to the infection control measures, several breaches in the infection control policy were identified and control measures were adopted. In our case the definition of a specific check-list led to the adoption of the correct control measures. Further studies would be helpful in order to develop a standard check-list able to identify critical flows in the adhesion to the guidelines. It could be used in different NICUs and allow to obtain reproducible levels of infection control.

  4. Therapeutic drug monitoring of beta-lactam antibiotics - Influence of sample stability on the analysis of piperacillin, meropenem, ceftazidime and flucloxacillin by HPLC-UV.

    Science.gov (United States)

    Pinder, Nadine; Brenner, Thorsten; Swoboda, Stefanie; Weigand, Markus A; Hoppe-Tichy, Torsten

    2017-09-05

    Therapeutic drug monitoring (TDM) is a useful tool to optimize antibiotic therapy. Increasing interest in alternative dosing strategies of beta-lactam antibiotics, e.g. continuous or prolonged infusion, require a feasible analytical method for quantification of these antimicrobial agents. However, pre-analytical issues including sample handling and stability are to be considered to provide valuable analytical results. For the simultaneous determination of piperacillin, meropenem, ceftazidime and flucloxacillin, a high performance liquid chromatography (HPLC) method including protein precipitation was established utilizing ertapenem as internal standard. Long-term stability of stock solutions and plasma samples were monitored. Furthermore, whole blood stability of the analytes in heparinized blood tubes was investigated comparing storage under ambient conditions and 2-8°C. A calibration range of 5-200μg/ml (piperacillin, ceftazidime, flucloxacillin) and 2-200μg/ml (meropenem) was linear with r(2)>0.999, precision and inaccuracy were beta-lactam antibiotics in whole blood tubes were found to remain within specifications for 8h when stored at 2-8°C but not at room temperature. The presented method is a rapid and simple option for routine TDM of piperacillin, meropenem, ceftazidime and flucloxacillin. Whereas long-term storage of beta-lactam samples at -80°C is possible for at least 9 months, whole blood tubes are recommended to be kept refrigerated until analysis. Copyright © 2017 Elsevier B.V. All rights reserved.

  5. In vitro susceptibility of multi-drug resistant Pseudomonas aeruginosa and extended-spectrum β-lactamase-producing Klebsiella pneumoniae isolated from clinical specimens at Bugando Medical Centre, Tanzania to Piperacillin-Tazobactam.

    Science.gov (United States)

    Petro, Daudi; Mushi, Martha F; Moremi, Nyambura; Iddi, Shabani; Mirambo, Mariam; Seni, Jeremiah; Mshana, Stephen E

    2014-01-01

    Pseudomonas spp. and Klebsiella pneumoniae are common causes of serious health care associated infections (HCAIs) worldwide. The treatment options for infections caused by multi-drug resistant (MDR) organisms are limited to tigecycline and carbapenems. A total of 172 isolates of multi-drug resistant Pseudomonas. spp and extended-spectrum β- (ESBL) producing Klebsiella pneumoniae isolated from clinical specimens at the Bugando Medical Centre were tested for their in vitro susceptibility to piperacillin-tazobactam 100/10μg using disc diffusion test as recommended by Clinical Laboratory Standard Institute (CLSI). Out of 59 multi-drug resistant Pseudomonas spp, 54 (92.0%) were susceptible to piperacillin-tazobactam while of 113 ESBL producing Klebsiella pneumoniae, 55 (48.7%) were susceptible to piperacillin-tazobactam 100/10μg. Also, 20 (34.0%) of the Pseudomonas spp were both ESBL producers and susceptible to piperacillin-tazobactam 100/10μg. A significant proportion of Pseudomonas spp isolates from clinical specimens in our setting are susceptible to piperacillin/tazobactam. This study shows that piperacillin-tazobactam offer a better option to clinicians for the treatment of health care associated infections due to Pseudomonas spp. and ESBL producing Klebsiella pneumoniae in our setting and other health facilities where these organisms are of significance.

  6. Incidence and impact on clinical outcome of infections with piperacillin/tazobactam resistant Escherichia coli in ICU: A retrospective study

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    Mounier Roman

    2008-05-01

    Full Text Available Abstract Background Escherichia coli infections are frequent in ICU patients. The increased resistance to fluoroquinolones and amoxicillin/clavulanate of this pathogen mandates the prescription of broad-spectrum antibiotics such as piperacillin/tazobactam (PIP-TAZ or third generation cephalosporins (3GC. Methods To assess incidence and impact on clinical outcome of infections with PIP-TAZ resistant E. coli in ICU patients, we conducted a retrospective cohort study with infections due to PIP-TAZ resistant (PIP-TAZ R or to PIP-TAZ susceptible strains (PIP-TAZ S between 1 January 2002 and 30 June 2004. Results Of 83 strains, 13 were PIP-TAZ R: 2 strains produced an extended-spectrum β-lactamase (2%, 11 produced a high level penicillinase (13%. Prior amoxicillin or amoxicillin/clavulanate prescription was reported in 7 cases (54% of infections with PIP-TAZ R isolates and in 15 cases (21% of infections with PIP-TAZ S isolates (p = 0.03. Time of onset of the infection from hospital admission was longer in case of infections with PIP-TAZ R than with PIP-TAZ S isolates (22 ± 32 vs 10 ± 21 days, p = 0.01. The overall ICU mortality rate was 38%. Mortality and length of stay in ICU were similar in case of infections with PIP-TAZ R isolates and with PIP-TAZ S isolates. Conclusion Infections with PIP-TAZ R E. coli are frequent in ICU patients. No prognostic impact of this pattern of resistance was found. Prescription of PIP-TAZ for empirical treatment of E. coli infections in ICU however exposes to inappropriate therapy.

  7. Efficacy and safety of tazobactam/piperacillin as an empirical treatment for the patients of adult and child with febrile neutropenia in Japan.

    Science.gov (United States)

    Tamura, Kazuo; Akiyama, Nobu; Kanda, Yoshinobu; Saito, Masahiro

    2015-09-01

    Tazobactam/piperacillin (4.5 g for adults and 90 mg/kg body weight for children, every 6 h) was administered to Japanese patients with febrile neutropenia to evaluate its defervescence and clinical efficacy and safety. The pharmacokinetics in children were also examined. Defervescence efficacy at day 4 of the treatment was achieved in 50.0% of 94 adult and 62.5% of 8 pediatric patients, respectively. The defervescence efficacy rate in relation to the neutrophil count in adults was 37.5% for the patients with a neutrophil count of less than 100/μL and 62.5% for that between 100 and 500/μL. The clinical efficacy rate at day 7 and at the end or discontinuation of the treatment was 79.6% and 59.1% in adult patients, respectively, and 57.1% and 75.0% in pediatric patients, respectively. Fifteen strains of causative bacteria were isolated in 13 adult patients at baseline. All strains were eradicated within 4 days of the treatment. The side effects that occurred in adult and pediatric patients during the treatment were all known and not specific to febrile neutropenia patients. The pharmacokinetics profiles of tazobactam/piperacillin in children with febrile neutropenia are unlikely to be different from those in children with a common bacterial infection and without any immunosuppressive conditions. The study results in Japanese patients with febrile neutropenia demonstrate that tazobactam/piperacillin treatment is efficacious and safe in adults. As for pediatric patients, given the limited number of cases studied, further investigation is needed (Clinical trial number: Japic CTI-121728).

  8. [Concentration of tazobactam/piperacillin in the cerebrospinal fluid of patients with Haemophilus influenzae type B meningitis].

    Science.gov (United States)

    Fukasawa, Chie; Hoshino, Tadashi; Kutsuna, Satoru; Sawada, Kyoko; Sato, Hiroko; Ishiwada, Naruhiko

    2013-09-01

    While the incidence of Haemophilus influenzae type b (Hib) meningitis is expected to decrease with the widespread use of the Hib vaccine, the resistance of Hib has actually increased. Therefore, selection of the initial antibiotics used for treatment must be performed with resistant bacteria, including beta-lactamase negative ampicillin resistant H. influenzae (BLNAR), in mind. Tazobactam/piperacillin (TAZ/PIPC) has a satisfactory minimum inhibitory concentration (MIC) against BLNAR and is a beta-lactamase inhibitor. Although there is no insurance coverage for its use in patients with meningitis, the penetration of TAZ/PIPC into cerebrospinal fluid (CSF) in animal experiments promises a satisfactory result, and we have been using a combination of ceftriaxone (CTRX) and TAZ/PIPC as an initial treatment and a resistant bacteria countermeasure in patients with Hib meningitis at our hospital since 2008. We examined the concentration of TAZ/PIPC in CSF to further investigate the possibility of using TAZ/PIPC as an antibiotic treatment against bacterial meningitis. In cases treated with a 1: 8 drug formulation of TAZ/PIPC against Hib meningitis at our hospital, we used the remaining portion of a CSF sample collected after the initiation of TAZ/PIPC administration and then measured the concentrations of TAZ and PIPC in the CSF. Six specimens from 5 patients between the ages of 6 and 59 months were examined. The dosage of TAZ/PIPC was 95.7-113.6 mg/kg/dose x 3 times/day, and the CSF concentrations at 0-105 minutes after the completion of the administration were 0.319-1.32 microg/mL for TAZ and 2.54-7.74 microg/mL for PIPC. With the approved dosage, the peak concentration level during the acute period indicated a sufficient CSF concentration level for the antibacterial and beta-lactamase inhibition effects against Hib. As an antibiotic treatment for H. influenzae meningitis, the combined usage of TAZ/PIPC is likely to be effective as a resistant bacteria countermeasure, in

  9. Piperacillin and Tazobactam Injection

    Science.gov (United States)

    ... effects of your treatment using laboratory tests and physical examinations. It is important to keep all appointments ... health care provider as soon as possible: tenderness warmth irritation drainage redness swelling pain

  10. Antibacterial Mode of Action of Cinnamomum verum Bark Essential Oil, Alone and in Combination with Piperacillin, Against a Multi-Drug-Resistant Escherichia coli Strain.

    Science.gov (United States)

    Yap, Polly Soo Xi; Krishnan, Thiba; Chan, Kok-Gan; Lim, Swee Hua Erin

    2015-08-01

    This study aimed to investigate the mechanism of action of the cinnamon bark essential oil (CB), when used singly and also in combination with piperacillin, for its antimicrobial and synergistic activity against beta-lactamase TEM-1 plasmid-conferred Escherichia coli J53 R1. Viable count of this combination showed a complete killing profile at 20 h and further confirmed its synergistic effect by reducing the bacteria cell numbers. Analysis on the stability of treated cultures for cell membrane permeability by CB when tested against sodium dodecyl sulfate revealed that the bacterial cell membrane was disrupted by the essential oils. Scanning electron microscopy observation and bacterial surface charge measurement also revealed that CB causes irreversible membrane damage and reduces the bacterial surface charge. In addition, bioluminescence expression of Escherichia coli [pSB1075] and E. coli [pSB401] by CB showed reduction, indicating the possibility of the presence of quorum sensing (QS) inhibitors. Gas-chromatography and mass spectrometry of the essential oil of Cinnamomum verum showed that trans-cinnamaldehyde (72.81%), benzyl alcohol (12.5%), and eugenol (6.57%) were the major components in the essential oil. From this study, CB has the potential to reverse E. coli J53 R1 resistance to piperacillin through two pathways; modification in the permeability of the outer membrane or bacterial QS inhibition.

  11. A randomized trial of the efficacy and safety of sequential intravenous/oral moxifloxacin monotherapy versus intravenous piperacillin/tazobactam followed by oral amoxicillin/clavulanate for complicated skin and skin structure infections

    NARCIS (Netherlands)

    Gyssens, I.C.J.; Dryden, M.; Kujath, P.; Nathwani, D.; Schaper, N.; Hampel, B.; Reimnitz, P.; Alder, J.; Arvis, P.

    2011-01-01

    OBJECTIVES: The primary aim of the RELIEF study was to evaluate the efficacy and safety of two sequential intravenous (iv)/oral regimens: moxifloxacin iv/oral versus piperacillin/tazobactam (TZP) iv followed by oral amoxicillin/clavulanate (AMC). PATIENTS AND METHODS: The study had a prospective, ra

  12. 哌拉西林钠舒巴坦钠引起高热、白细胞减少1例%Piperacillin sodium and sulbactam sodium for injection induced high fever, leukopenia:a case report

    Institute of Scientific and Technical Information of China (English)

    师艳芳; 武剑; 齐晓莲; 黄小钦

    2014-01-01

    A 21-year-old female in puerperium, suffering from intracranial venous thrombosis and pulmonary infection was treated with low molecular weight heparin subcutaneous for anticoagulation, injection of piperacillin sodium and sulbactam sodium for anti-infection therapy. Her temperature was normal 2 days later. But a high fever appeared and white blood cells decreased to 2.77×109/L when she had been treated with piperacillin sodium and sulbactam sodium for 7 days. The patient's temperature returned to normal after stopped usage of piperacillin sodium and sulbactam sodium for injection and continued anticoagulation. White blood cells count became normal 2 weeks later. The patient was diagnosed as drug fever of piperacillin sodium and sulbactam sodium for injection.%一例21岁产褥期女性患者因颅内静脉血栓形成、肺部感染给予低分子皮下注射抗凝,哌拉西林钠舒巴坦钠静脉滴注抗感染诊疗,2d后体温正常。哌拉西林舒巴坦使用1周后再次出现高热、白细胞降至2.77×109/L,停用哌拉西林钠舒巴坦钠,并继续抗凝后体温恢复正常出院。2周后复查血白细胞恢复正常,确定为哌拉西林钠舒巴坦钠所致药物热。

  13. Retrospective investigation of the clinical effects of tazobactam/piperacillin and sulbactam/ampicillin on aspiration pneumonia caused by Klebsiella pneumoniae.

    Science.gov (United States)

    Tsukada, Hiroki; Sakai, Kunihiko; Cho, Hiromi; Kimura, Yuka; Tetsuka, Takafumi; Nakajima, Haruhiko; Ito, Kazuhiko

    2012-10-01

    Klebsiella pneumoniae is an important causative bacterium of aspiration pneumonia in many elderly patients. We retrospectively investigated the clinical effects of the early treatment of aspiration pneumonia and background factors in 24 patients from whom Klebsiella pneumoniae was isolated. Sulbactam/ampicillin (SBT/ABPC) was selected for early treatment in 12 of the 24 patients diagnosed with aspiration pneumonia, and tazobactam/piperacillin (TAZ/PIPC) was selected for the other patients. The effective rates and success rates of early treatment were significantly higher in the TAZ/PIPC group than in the SBT/ABPC group (p = 0.003 and 0.027, respectively). Although no significant difference was noted because of the limited number of cases, the survival rates after 30 days were 91.7 and 58.3 % in the TAZ/PIPC and SBT/ABPC groups, respectively. Several bacteria isolated with Klebsiella pneumoniae were resistant bacteria, such as methicillin-resistant Staphylococcus aureus or Pseudomonas aeruginosa, and no anaerobe or extended-spectrum β-lactamase-producing Klebsiella pneumoniae was isolated. Thirteen and 11 of the 24 cases were classified as healthcare-associated pneumonia (HCAP) and hospital-acquired pneumonia (HAP), respectively, with no case classified as community-acquired pneumonia (CAP). As population aging progresses, the frequency of aspiration pneumonia classified as HCAP will increase. To cover anaerobes, it is necessary to select antibacterial drugs, such as TAZ/PIPC, for early treatment in consideration of resistant gram-negative bacteria to improve the outcome, and not drugs with weak activity against these bacteria.

  14. Comparative pharmacoeconomics and efficacy analysis of a new antibiotic adjuvant entity and piperacillin-tazobactam for the management of intra-abdominal infections: A retrospective study

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    Sandip Jadhav

    2016-01-01

    Full Text Available Objective: To analyze the comparative efficacy of piperacillin-tazobactam (PIP-TAZ and ceftriaxone-sulbactam with adjuvant (CSA in the treatment of intra-abdominal infections (IAIs and to assess the costs associated with respective therapies. Methods: The present study analyzed the data collected from 94 IAI patients treated at a tertiary-care hospital. Patient characteristics, infection types, surgical procedures, antibiotic therapies, treatment durations were recorded and overall cost involved in the infections management was estimated in Indian rupee. Results: In total, 46 patients received PIP-TAZ and 48 patients received CSA. The clinical cure was seen in 39.13% patients of PIP-TAZ group and 62.50% patients of CSA group. The patients diagnosed with mixed culture (Gram-positive and negative infections, needed additional cover of clindamycin to achieve clinical success. The failure patients from PIP-TAZ group were shifted to meropenem therapy. For the patients where meropenem and CSA therapy failed, colistin was given as an additional cover. Comparative cost expenditure analysis of the two drug treatment groups revealed that, the overall treatment cost for patients cured with empirical PIP-TAZ group was 51.79% more than that of CSA therapy. The strongest predictor of the increase in treatment costs was clinical failure. Similar trends were maintained for the patients cured with clindamycin additional therapy and change of therapy, with PIP-TAZ group accounting 36.11% and 39.99% more expenditure than CSA group. Conclusions: This study demonstrates that CSA has comparatively higher efficacy as compared to PIP-TAZ when used along with metronidazole in patients with different types of IAIs. Pharmacoeconomic analysis clearly shows that starting appropriate empirical antibiotic therapy has a large impact on the cost of treatment in management of IAIs and selection of CSA, can significantly reduce the cost involved in the treatment.

  15. Randomized controlled trial of piperacillin-tazobactam, cefepime and ertapenem for the treatment of urinary tract infection caused by extended-spectrum beta-lactamase-producing Escherichia coli.

    Science.gov (United States)

    Seo, Yu Bin; Lee, Jacob; Kim, Young Keun; Lee, Seung Soon; Lee, Jeong-A; Kim, Hyo Youl; Uh, Young; Kim, Han-Sung; Song, Wonkeun

    2017-06-07

    Due to limited therapeutic options, the spread of extended-spectrum beta-lactamases (ESBLs) have become a major public health concern. We conducted a prospective, randomized, open-label comparison of the therapeutic efficacy of piperacillin-tazobactam (PTZ), cefepime, and ertapenem in febrile nosocomial urinary tract infection with ESBL-producing Escherichia coli (ESBL-EC). This study was conducted at three university hospitals between January 2013 and August 2015. Hospitalized adult patients presenting with fever were screened for healthcare-associated urinary tract infection (HA-UTI). When ESBL-EC was solely detected and susceptible to a randomized antibiotic in vitro, the case was included in the final analysis. Participants were treated for 10-14 days with PTZ, cefepime, or ertapenem. A total of 66 participants were evenly assigned to the PTZ and ertapenem treatment groups. After the recruitment of six participants, assignment to the cefepime treatment group was stopped because of an unexpectedly high treatment failure rate. The baseline characteristics of these participants did not differ from participants in other treatment groups. The clinical and microbiological response to PTZ treatment was estimated to be 94% and was similar to the response to ertapenem treatment. The efficacy of cefepime was 33.3%. In the cefepime group, age, Charlson comorbidity index, genotype, and minimal inhibitory concentration (MIC) did not significantly affect the success of treatment. Similarly, genotype seemed to be irrelevant with respect to clinical outcome in the PTZ group. Expired cases tended to involve septic shock with a high Charlson comorbidity index and high MIC. Results from this study suggest that PTZ is effective in the treatment of urinary tract infection caused by ESBL-EC when the in vitro test indicates susceptibility. In addition, cefepime should not be used as an alternative treatment for urinary tract infection caused by ESBL-EC. The trial was registered with

  16. Role of piperacillin/tazobactam as a carbapenem-sparing antibiotic for treatment of acute pyelonephritis due to extended-spectrum β-lactamase-producing Escherichia coli.

    Science.gov (United States)

    Yoon, Young Kyung; Kim, Jong Hun; Sohn, Jang Wook; Yang, Kyung Sook; Kim, Min Ja

    2017-04-01

    Extended-spectrum β-lactamase-producing Escherichia coli (ESBL-Ec) is a frequent cause of acute pyelonephritis (APN), requiring carbapenem therapy. However, alternatives to carbapenems are needed due to the emergence of carbapenemase-producing micro-organisms. The purpose of this study was to compare the clinical efficacy of piperacillin/tazobactam (TZP) versus ertapenem in the treatment of adult patients with APN caused by ESBL-Ec. A retrospective observational study of APN caused by ESBL-Ec susceptible to TZP was performed at a university-affiliated hospital in the Republic of Korea between February 2011 and June 2013. All adult patients initially treated with in vitro-active TZP were compared with those treated with ertapenem to evaluate antibiotic clinical efficacy. The primary endpoint was treatment failure, defined as a composite of in-hospital mortality, change of initial antibiotic regimen and microbiological eradication failure. During the study period, 68 patients prescribed TZP and 82 patients prescribed ertapenem were eligible for inclusion in the study. There was no significant difference between the two treatment groups in the occurrence of in-hospital mortality, change of initial antibiotic regimen or microbiological eradication failure. In the multivariate analyses, predictors associated with treatment failure included septic shock [odds ratio (OR) = 4.27, 95% confidence interval (CI) 1.66-10.99] and recent administration of immunosuppressive agents (OR = 2.84, 95% CI 1.02-7.91). However, the type of antibiotic was not associated with treatment failure. TZP could be an effective alternative to ertapenem for the treatment of APN caused by ESBL-Ec, sparing carbapenem consumption in the multidrug-resistant era. Copyright © 2017 Elsevier B.V. and International Society of Chemotherapy. All rights reserved.

  17. A single-center evaluation of the risk for colonization or bacteremia with piperacillin-tazobactam- and cefepime-resistant bacteria in patients with acute leukemia receiving fluoroquinolone prophylaxis.

    Science.gov (United States)

    Nguyen, A D; Heil, E L; Patel, N K; Duffy, A; Gilmore, S

    2016-04-01

    Fluoroquinolone prophylaxis is indicated to prevent neutropenic fever in patients with acute leukemia. However, fluoroquinolone use has been associated with development of multi-drug-resistant Pseudomonas aeruginosa and extended spectrum β-lactamase producing gram-negative bacilli. Due to a presumed risk of multi-drug resistance associated with fluoroquinolone prophylaxis, patients admitted to our hospital with neutropenic fever receive empiric carbapenem therapy until cultures are negative for 72 h or identification of an organism. Our study seeks to identify the incidence of multi-drug-resistant organism colonization and bacteremia among patients who receive fluoroquinolone prophylaxis and to evaluate duration of empiric carbapenem therapy. A retrospective review of adult patients with acute leukemia receiving a fluoroquinolone as outpatient infection prophylaxis, admitted to our tertiary cancer center for treatment of neutropenic fever was completed. Surveillance and blood cultures were reviewed for antibiotic resistance. Duration of empiric carbapenem therapy was reviewed. One hundred patients and 177 admissions for neutropenic fever were included. Six patients harbored a piperacillin-tazobactam-resistant organism found during routine surveillance. Among these patients, two bacteremias were identified, one of which was a piperacillin-tazobactam-resistant organism. Five bacteremias were identified among 83 patients with negative surveillance cultures. Among the bloodstream infections, five organisms isolated were fluoroquinolone resistant. No cefepime-resistant organism was isolated on surveillance or bloodstream cultures. Adherence to the institution guideline of narrowing antibiotics after 72 h of negative cultures occurred in only 13% of neutropenic fever cases. The average duration of carbapenem therapy in 177 neutropenic fever episodes was 4.4 days. Our findings show that among our patient population, there is a low risk of bacteremia with a

  18. Impurity profiling of piperacillin sodium and tazobactam sodium for injection by micellar electrokinetic chromatography%胶束电动色谱检测注射用哌拉西林钠三唑巴坦钠的杂质谱

    Institute of Scientific and Technical Information of China (English)

    刘浩; 刘畅

    2011-01-01

    目的 针对现行HPLC方法的不足之处,采用胶束电动色谱技术检测注射用哌拉西林钠三唑巴坦钠的杂质谱.方法 方法建立过程中分别采用压力辅助-胶束电动色谱和短端进样法对药品中的有关物质进行筛查,以便得到较为完整的杂质谱和分析目标;为证实分离系统的专属性和有效性,分别采用杂质对照品、半制备HPLC和梯度洗脱HPLC-电喷雾离子阱质谱对杂质谱中的主要杂质进行了确认.结果 采用该方法,9个已知杂质、其他未知杂质、哌拉西林以及三唑巴坦之间均分离良好.新方法可对注射用哌拉西林钠三唑巴坦钠的杂质进行更为有效而全面的分离分析.结论 该方法可应用于注射用哌拉西林钠三唑巴坦钠的杂质谱检测.%Objective Considering the shortcoming of current HPLC methods, a micellar electrokinetic chromatography method was established to detect the impurity profile of piperacillin sodium and tazobactam sodium for injection. Methods In order to obtain full impurity profile, the pressure-assisted micellar electrokinetic chromatography and the "short-end-injection" technique were utilized during the method development. Impurity reference standards, semi-preparative HPLC, and gradient HPLC-electrospray ion trap mass spectrometry were used to confirm the selectivity and validity of the separation system. Results The novel method could provide efficient and comprehensive separation for the impurities of piperacillin sodium and tazobactam sodium for injection. Conclusion Using the novel method, nine known impurities, other unknown impurities, piperacillin and tazobactam could be separated. This method can be used for the impurity profiling of piperacillin sodium and tazobactam sodium for injection.

  19. Eficacia de la monoterapia con piperacilina-tazobactam en infecciones del área maxilofacial Efficacy of single drug therapy with piperacillin-tazobactam in infections of the maxillofacial area

    Directory of Open Access Journals (Sweden)

    M. Delgado Sánchez

    2004-04-01

    Full Text Available Objetivo: Las infecciones del área maxilofacial representan un motivo habitual de consulta para los cirujanos maxilofaciales, siendo las más frecuentes las de origen dental. Estas infecciones son frecuentemente polimicrobianas, por lo que el objetivo del presente estudio ha sido evaluar la eficacia clínica y seguridad de piperacilina-tazobactam en el tratamiento de las infecciones del área maxilofacial. Diseño del estudio: Estudio multicéntrico y prospectivo en donde 79 pacientes con infecciones del área maxilofacial recibieron piperacilina-tazobactam como tratamiento antibiótico. Resultados: La evolución clínica de los pacientes fue favorable en un 97,5% de los pacientes y la eficacia microbiológica obtenida al final del tratamiento fue del 96,2%. Se presentaron reacciones adversas en 5 pacientes (6,3%: 2 casos de mareo, 2 de dispepsia y un caso de flebitis. En ningún caso se precisó la discontinuación del fármaco. Conclusiones: La eficacia clínica y microbiológica junto con la escasez de efectos adversos presentados, hace de piperacilina-tazobactam una alternativa eficaz en el manejo de estas infecciones.Abstract: Objective: Maxillofacial infections are a frequent cause for consulting maxillofacial surgeons. Dental problems are the most frequent source of infections, these being typically polymicrobial. For these reasons, safety and efficacy of piperacillin/tazobactam in maxillofacial infections were evaluated in this study. Design: Multicenter and prospective study in which seventy-nine patients with maxillofacial infections were treated with piperacillin/tazobactam. Results: 97.5% of the evaluable patients were clinically cured or improved and the bacteriologic eradication rate was 96.2%. Five out of 79 (6.3% had an adverse event (two dyspepsia, two dizziness and one phlebitis. No deaths were attributable to the study drug. Conclusions: Piperacillin/tazobactam is a good single drug treatment choice for maxillofacial

  20. HPLC法同时测定人血浆中哌拉西林/他唑巴坦的浓度及健康人体药动学研究%Determination of piperacillin/tazobactam in human plasma by high-performance liquid chromatography and its pharmacokinetics

    Institute of Scientific and Technical Information of China (English)

    孙亚欣; 朱旭; 邱枫; 何晓静; 赵明明; 肇丽梅; 郭启勇

    2012-01-01

    目的 采用HPLC法同时测定人血浆中哌拉西林/他唑巴坦的浓度,并考察12名健康受试者分别单次静脉滴注注射用哌拉西林钠/他唑巴坦钠(2 g/0.5 g、3g/0.75 g和4g/1 g)后的人血浆中药动学行为.方法 血浆样品经乙腈沉淀蛋白,以茶碱为内标,二氯甲烷提取去杂质,水相进样,采用梯度洗脱的方式同时测定哌拉西林/他唑巴坦,经Capcell Pak MG C18柱分离,220 nm波长检测.结果 哌拉西林的血浆样品线性范围为0.4~400 μg·mL-1,他唑巴坦的为0.4~100 μg·mL-1;方法提取回收率为92.5%~ 97.4%,日内和日间精密度均小于12.2%.对3个剂量组的Cmax、AUC0-1进行相关性分析,他唑巴坦的相关系数分别为0.898和0.893,哌拉西林的分别为0.900和0.909.结论 采用HPLC法同时测定哌拉西林/他唑巴坦,准确性好,操作简单;药动学研究结果表明:血浆中哌拉西林/他唑巴坦体内动力学行为符合线性药动学,不同剂量组性别间的药动学参数差异无统计学意义.%Objective A simple and rapid high-performance liquid chromatographic method has been developed and validated for the simultaneous determination of piperacillin/tazobactam in human plasma. This study was to assess dose proportionality following a 0.5 h intravenous infusion single doses (2 g/0. 5 g、03 g/ 0. 75 g and 4 g/1 g) of piperacillin/tazobactam in Chinese male and female healthy volunteers, and to provide further information on its pharmacokinetics. Methods Plasma samples were deproteinized with acetonitrile followed by extraction of piperacillin/tazobactam with dichloromethane and injection of the upper aqueous phase by using theophylline as internal standard. The analysis was conducted on a Capcell Pak MG C18 column with gradient elution,and the detecting wavelength was 220 nm. Results The method was linear at plasma levels from 0.4 to 400 μg o mL-1 for piperacillin and from 0.4 to 100 μg o mL-1 for tazobactam. The correlation

  1. Detection of Escherichia coli and Associated β-Lactamases Genes from Diabetic Foot Ulcers by Multiplex PCR and Molecular Modeling and Docking of SHV-1, TEM-1, and OXA-1 β-Lactamases with Clindamycin and Piperacillin-Tazobactam

    Science.gov (United States)

    Shahi, Shailesh K.; Singh, Vinay K.; Kumar, Ashok

    2013-01-01

    Diabetic foot ulcer (DFU) is a common and devastating complication in diabetes. Antimicrobial resistance mediated by extended-spectrum β-lactamases (ESBLs) production by bacteria is considered to be a major threat for foot amputation. The present study deals with the detection of Escherichia coli and the prevalence of blaTEM, blaSHV and blaOXA genes directly from biopsy and swab of foot ulcers of diabetic patients. In total, 116 DFU patients were screened, of which 42 suffering with severe DFUs were selected for this study. Altogether 16 E. coli strains were successfully isolated from biopsy and/or swab samples of 15 (35.71%) patients. ESBL production was noted in 12 (75%) strains. Amplification of β-lactamase genes by multiplex PCR showed the presence of blaCTX-M like genes in 10 strains, blaTEM and blaOXA in 9 strains each, and blaSHV in 8 of the total 16 strains of E. coli. Out of the ten antibiotics tested, E. coli strains were found to be resistant to ampicillin (75%), cefoxitin (56.25%), cefazolin (50%), meropenem (37.5%), cefoperazone (25%), cefepime (31.25%), ceftazidime (56.25%), and cefotaxime (68.75%) but all showed sensitivity (100%) to clindamycin and piperacillin-tazobactam. 3D models of the most prevalent variants of β-lactamases namely TEM-1, SHV-1, OXA-1, and ESBL namely CTX-M-15 were predicted and docking was performed with clindamycin and piperacillin-tazobactam to reveal the molecular basis of drug sensitivity. Docking showed the best docking score with significant interactions, forming hydrogen bond, Van der Waals and polar level interaction with active site residues. Findings of the present study may provide useful insights for the development of new antibiotic drugs and may also prevent ESBLs-mediated resistance problem in DFU. The novel multiplex PCR assay designed in this study may be routinely used in clinical diagnostics of E. coli and associated blaTEM, blaSHV, and blaOXA like genes. PMID:23861873

  2. COMPARISON OF ANTIMICROBIAL SENSITIVITY TO OLDER AND NEWER QUINOLONES VERSUS PIPERACILLIN-TAZOBACTAM, CEFEPIME AND MEROPENEM IN FEBRILE PATIENTS WITH CANCER IN TWO REFERRAL PEDIATRIC CENTERS IN TEHRAN, IRAN

    Directory of Open Access Journals (Sweden)

    Ali Nateghian

    2014-06-01

    Full Text Available Infection in pediatric cancer patients has become a concerning problem due to increasing antimicrobial resistance. The goal of this study was to determine the antimicrobial resistance patterns of blood isolates from pediatric oncology patients in Iran to determine if quinolones are appropriate for empiric therapy. Methods Children with cancer who were admitted with or developed fever during admission to Aliasghar Children’s Hospital or Mahak Hospitals July 2009 through June 2011 were eligible for enrollment. Two blood cultures were obtained.  Antimicrobial sensitivity test was performed for ciprofloxacin, moxifloxacin, gatifloxacin, meropenem, cefepime, and piperacillin-tazobactam on isolates from children who were bacteremic. Results Blood cultures were positive for 39 episodes in 169 enrolled children but 9 episodes were excluded as blood cultures were thought to be contaminated,  yielding a bacteremia rate of 29/160 (18%. The mean age of children and the stage of malignancy did not differ between those with and without bacteremia. Meropenem was the most likely antibiotic to cover isolates (97% with cefepime having the lowest coverage rate (21%. Quinolone coverage ranged from 63%  to 76%. Conclusion Quinolones are not suitable for use as empiric therapy in febrile pediatric oncology patients in Iran.

  3. Piperacillin/tazobactam as an alternative antibiotic therapy to carbapenems in the treatment of urinary tract infections due to extended-spectrum β-lactamase-producing Enterobacteriaceae: an in silico pharmacokinetic study.

    Science.gov (United States)

    Guet-Revillet, Hélène; Tomini, Elise; Emirian, Aurélie; Join-Lambert, Olivier; Lécuyer, Hervé; Zahar, Jean-Ralph; Jullien, Vincent

    2017-01-01

    Piperacillin/tazobactam (TZP) as an alternative treatment to carbapenems for infections involving extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae (ESBL-PE) remains debated. In this study, the probabilities of pharmacodynamic (PD) target attainment with different TZP regimens in ESBL-producing Escherichia coli (ESBL-Ec) and Klebsiella pneumoniae (ESBL-Kp) were evaluated in the context of pyelonephritis. Minimum inhibitory concentrations (MICs) of 144 ESBL-Ec and 111 ESBL-Kp from pyelonephritis were measured, and two previously published population pharmacokinetic models were used to determine by Monte Carlo simulation the probabilities of reaching two PD targets (50%fT>MIC and 100%fT>MIC) with TZP doses of 4 g three times daily and 4.5 g four times daily given as short (1 h) or prolonged (4 h) infusions or as 12-18 g/day continuous infusions. Only MICs of the 133 ESBL-Ec and 74 ESBL-Kp strains susceptible to TZP according to inhibition zone diameter were considered for the simulations. Results were similar with the two models, and only prolonged and continuous infusions allowed to reach 50%fT>MIC with a probability of >90% irrespective of bacterial species. Continuous infusion and prolonged infusion combined with the maximum dosage were the only condition allowing to achieve 100%fT>MIC with a probability of >70% with this population of ESBL-Ec. A probability of >90% to reach 100%fT>MIC with ESBL-Kp could be obtained only with the 18 g/day continuous-infusion regimen. TZP may be used for treatment for mild pyelonephritis involving susceptible ESBL-Ec provided that administration modalities are optimised. Conversely, for ESBL-Kp the risk of treatment failure may be higher, supporting the use of continuous infusion.

  4. Efficacy and safety of piperacillin-tazobactam in treatment of bronchiectasis with Pseudomonas aeruginosa infections%哌拉西林/他唑巴坦治疗支气管扩张合并铜绿假单胞菌感染的疗效与安全性评价

    Institute of Scientific and Technical Information of China (English)

    刘学东; 魏风芹; 栾念旭; 魏东

    2013-01-01

    目的 评价哌拉西林/他唑巴坦静脉注射对支气管扩张合并铜绿假单胞菌感染患者的临床疗效和安全性.方法 确诊为支气管扩张合并铜绿假单胞菌感染患者106例,随机分为哌拉西林/他唑巴坦(治疗组)56例和哌拉西林/舒巴坦(对照组)50例;治疗组给予哌拉西林/他唑巴坦以2.5g,2次/d静脉滴注,对照组给予哌拉西林/舒巴坦3.0g,2次/d静脉滴注;疗程均为10~14 d,所有入选病例均完成治疗,未因药物不良反应而中止治疗.结果 哌拉西林/他唑巴坦治疗组痊愈21例,显效30例,总有效率为91.07%;对照组痊愈15例,显效25例,总有效率为80.00%;治疗组治疗有效率高于对照组,差异有统计学意义(P<0.05),哌拉西林/他唑巴坦治疗组临床疗效更好,两组不良反应无明显差异.结论 哌拉西林/他唑巴坦静脉注射安全、有效地治疗支气管扩张合并铜绿假单胞菌感染患者,且具有低附加损害的特点,无1例患者出现伪膜性肠炎及二重真菌感染,值得临床推广.%OBJECTIVE To evaluoate the ofticoiy and fatety of pioerallin-tazo baetam in treat ment of brochiectasis with pseudo monas aeruginosa infections. METHODS A total of 106 patients who were diagnosed as bronchiectasis with P. aeruginosa infections were randomly divided into the treatment group with piperacillin-tazobactam (n = 56) and the control group with piperacillin-sulbactam (n = 50). The treatment group was treated with 2. 5 g of piperacillin-tazobactam, twice a day for intravenous infusion, while the control group was treated with 3. 0g of piperacillin-sulbactam, twice a day for intravenous infusion, with the treatment course of 10-14 days. All the participants finished the treatment, and no cases stopped the treatment due to the antibiotics adverse reactions. RESULTS In the treatment group , there were 21 cases cured and 30 cases valid with the total effective rate of 91. 07%; in the control, there were 15

  5. Current situation of evaluation and application with alternative dosing regimens for piperacillin sodium-tazobactam sodium%哌拉西林钠-他唑巴坦钠优选给药方案的评估及应用的研究现状

    Institute of Scientific and Technical Information of China (English)

    李园园; 于锋

    2014-01-01

    Objective To offer reference to reasonable clinical use of piperacillin sodium sodium-tazobactam sodium .Methods We reviewed pharmacokinetic/pharmacodynamic studies , clinical trails and implementation of piperacillin sodium-tazobactam sodi-um alternative dosing regimen in recent .Results The alternative dosing regimens , prolonged and continuous infusion , could maximise the likelihood of achieving desirable pharmacodynamic targets and improve clinical effectiveness .Conclusion It’ s needed to improve the strategies of alternative dosing regimens for clinical practice .%目的:为哌拉西林钠-他唑巴坦钠的临床合理用药提供参考。方法对哌拉西林钠-他唑巴坦钠的优选给药方案的药动/药效学研究、临床试验及具体实施情况进行综述。结果哌拉西林钠-他唑巴坦钠的优选给药方案(延长输注或持续输注)可最大化地达到药效学目标,改善临床有效性。结论需积极完善优化方案用于临床实践的策略。

  6. Clinical study on piperacillin/tazobactam through different intermittent infusion in treatment of hospital-acquired pneumonia in senile patients%不同间断静脉滴注哌拉西林/他唑巴坦治疗老年医院获得性肺炎临床研究

    Institute of Scientific and Technical Information of China (English)

    蒋灵红; 杨平满; 程正文; 胡余敏

    2012-01-01

    目的 比较不同间断静脉滴注哌拉西林/他唑巴坦治疗老年医院获得性肺炎(HAP)的临床效果及安全性.方法 将老年HAP随机分为两组,对照组予哌拉西林/他唑巴坦2.5g,1次/8 h,试验组予哌拉西林/他唑巴坦3.75g,1次/12 h,加入生理盐水100ml中静脉滴注,疗程均为10~14 d.结果 试验组与对照组的临床治愈率、总有效率、细菌清除率分别为51.43%、82.86%、80.00%和52.78%、83.33%、80.56%,药物相关不良反应发生率为8.57%和8.33%,两组差异均无统计学意义;不良反应主要为轻微胃肠不适、肝功能损害及白细胞减少,对症处理后均缓解.结论 哌拉西林/他唑巴坦7.5g分别1次/8 h或1次/12 h静脉滴注治疗老年HAP均有良好疗效和安全性,而1次/8 h给药可能更加有效.%OBJECTIVE To compare the clinical efficacy and safety of piperacillin/tazobactam through different intermittent infusion in the treatment of senile patients with hospital acquired pneumonia. METHODS In this randomized,controlled clinical trial, the senile patients with hospital acquired pneumonia were randomly divided into 2 groups. The patients in the control group were randomized to receive piperacillin/tazobactam either by iv infusion 2. 5 g for 8 hours once, and the study group was treated with 3. 75 g of piperacillin/tazobactam for 12 hours once and intravenous infusion with 100 ml normal saline, the treatment course was 10— 14 days in both groups. RESULTS The cure rate, total effective rate and the bacterial eradication rate were 51. 43% ,82. 86% ,and 80. 00% , respectively in the study group, and were 52. 78% ,83. 33% , and 80. 56% , respectively in the control group, the incidence rates of the antibiotic-associated adverse reactions were 8. 57% and 8. 33% (respectively, the differences were not statistically significant; the main adverse reactions were the slight gastrointestinal upset, hepatic dysfunction, and leucopenia, which got

  7. 哌拉西林他唑巴坦和阿莫西林克拉维酸在小儿支气管肺炎中的治疗效果比较%Treatment effects comparison of piperacillin tazobactam and amoxicillin clavulanic acid in the treatment of children bronchial pneumonia

    Institute of Scientific and Technical Information of China (English)

    李书平

    2016-01-01

    Objective:To explore the treatment effect of piperacillin tazobactam and amoxicillin clavulanic acid in the treatment of children bronchial pneumonia.Methods:80 children patients with bronchial pneumonia were selected.They were randomly divided into the observation group and the control group.The two groups were given amoxicillin clavulanic acid and piperacillin tazobactam treatment.The treatment effects of the two groups were observed.Results:The difference of total effective rates of two groups was not statistically significant(P>0.05).The treatment cost of the observation group was lower than that of the control group.Conclusion:The curative effect of amoxicillin clavulanic acid in the treatment of children bronchial pneumonia is remarkable,and the treatment cost is low.%目的:探讨哌拉西林他唑巴坦和阿莫西林克拉维酸在小儿支气管肺炎中的治疗效果。方法:收治支气管肺炎患儿80例,随机分为观察组和对照组,两组分别给予阿莫西林克拉维酸和哌拉西林他唑巴坦治疗。观察两组的治疗效果。结果:两组总有效率差异无统计学意义(P>0.05)。观察组的治疗成本低于对照组。结论:阿莫西林克拉维酸在小儿支气管肺炎治疗中疗效显著,且治疗成本低。

  8. The clinical evaluation of piperacillin and sulbactam sodium in treatment of respiratory, urinary tracts and orther infections in 579 patients%哌拉西林-舒巴坦治疗呼吸和泌尿系统等感染579例临床分析

    Institute of Scientific and Technical Information of China (English)

    周炯; 赵妍; 郭伟; 曹秋梅; 赵淑敏; 李桂萍; 马小军

    2011-01-01

    Objective To evaluate the clinical efficacy and safety of piperacillin and sulbactam sodium combinations in the treatment of common infections. Methods This was a multi-centre, prospective and open study. All subjects from 57 wards caught common infection like respiratory ( RTI) or urinary diseases ( UTI). The dosages of piperacillin and sulbactam sodium combinations 2. 5 g injection were determined according to indications:for adult, 2. 5 g or 5 g per time, 2 time/day; for severe or obstinate infection, 2.5 g or 5 g per time, 3 time/day. General information, clinical response pre- and posttreatment, infected locus, drug recipe and protocol, prognosis and adverse reaction were recorded. Results Data of 579 cases were collected with 388 males and 191 females. The average age was (66. 8 ± 17. 0) years. There were 500 patients who were suffering with RTI, with 362 cases of pneumonia, 102 of acute exacerbation of chronic bronchitis, and 36 of other infections. There were 50 cases with UTI, with 31 of simple urinary tract infection, and 19 of complex urinary tract infection. In addition, there were 9 cases of combined RTI and UTI, and 20 of other infections including peritonitis. The average duration of antimicrobial for RTI and UTI was (8. 65 ± 3. 78 ) days and (7. 45 ± 3. 46) days respectively with the total efficacy rate was 92. 6% and 98. 0% respectively for RTI and UTI. The incidence of adverse events was only 0.86% (5 cases), including nausea, rash, itching, ALT elevation and suspected drug induced fever in each one. Conclusion Piperacillin and sulbactam sodium compound had high clinical efficacy and safety in the treatment of common infections including RTI and UTI.%目的 评价哌拉西林-舒巴坦治疗呼吸和泌尿系统感染的疗效与安全性.方法 多中心、前瞻性、开放的临床研究.研究对象来自北京市15家三级医院、14家二级医院的57个病区的呼吸、泌尿系统感染者,按照适应证选

  9. 哌拉西林/三唑巴坦治疗血液病发热性中性粒细胞减少症的有效性和安全性的临床研究%Clinical effects and safety of piperacillin/tazobactam in treating neutropenic febrile patients with malignant hematopathy

    Institute of Scientific and Technical Information of China (English)

    刘开彦; 贾晋松; 李娟; 王椿; 吴德沛; 胡亮钉; 黄晓军

    2009-01-01

    目的 评价哌拉西林/三唑巴坦对治疗血液病发热性中性粒细胞减少症患者的临床疗效和安全性.方法 采用前瞻性、非对照、开放性多中心临床试验对中性粒细胞减少伴发热患者进行研究.哌拉西林/三唑巴坦剂量为每8 h给予4.5 g,缓慢静脉滴注30 min以上,在体温恢复正常或中性粒细胞减少症缓解后继续使用至少4~5 d.结果 共有218例粒缺伴发热血液病患者人选,其中造血干细胞移植组33例,非移植组185例.根据取得临床感染证据的等级不同分为:(1)不明原因发热(FUO)162例(74.31%);(2)临床确定感染(CDI)33例(15.14%);(3)微生物学确定感染(MDI)23例(10.55%).本次临床试验治疗总有效率为65.60%,细菌清除率为71.43%,不良反应发生率为5.04%.治疗起效时间(2.5±1.2)d,平均用药时间(9.4±8.1)d.造血干细胞移植组与非移植组患者疗效比较差异无统计学意义(x2=2.058,P>0.05),且两者在起效时间上差异亦无统计学意义(t=1.892,P>0.05).参加试验粒缺患者经哌拉西林/三唑巴坦治疗后血象白细胞和绝对中性粒细胞计数均较治疗前显著上升(t=4.092,P0.05, and t = 1.892,P >0.05). After the piperacillin/tazobactam treatment the white blood cell count and absolute neutrophile granulocyte count of the patients significantly increased(t =4.092, P <0.01 ;t = 4.248, P < 0.01). However, the hepatic and renal functions did not change obviously after tratmemt. Conclusions Piperaeillin/tazobaetam therapy is effective and safe empirical antibacterial therapy in febrile neutropenie patients with hematological malignancies.

  10. Modified Augmented Renal Clearance Score Predicts Rapid Piperacillin and Tazobactam Clearance in Critically Ill Surgery and Trauma Patients

    Science.gov (United States)

    2014-04-24

    ARC Score§ Outcome 1 44 F Surgical complication Intra-abdominal infection 3.375 g every 6 h 202.3 4 15 7 Clinical cure 2 47 M MVC Sepsis 3.375 g...every 6 h 100.7 7 12 9 Clinical cure 3 62 M MVC GNR bacteremia 4.5 g every 6 h 98.0 2 7 4 Clinical cure 4 25 M Intestinal volvulus Intra-abdominal...abscess 3.375 g every 6 h 97.8 2 8 7 Clinical cure 5 20 M MVC Sepsis 4.5 g every 6 h 178.6 6 15 9 Clinical cure 6 57 F Small bowel obstruction Suspected VAP

  11. Penetration of piperacillin-tazobactam into human prostate tissue and dosing considerations for prostatitis based on site-specific pharmacokinetics and pharmacodynamics.

    Science.gov (United States)

    Kobayashi, Ikuo; Ikawa, Kazuro; Nakamura, Kogenta; Nishikawa, Genya; Kajikawa, Keishi; Yoshizawa, Takahiko; Watanabe, Masahito; Kato, Yoshiharu; Zennami, Kenji; Kanao, Kent; Tobiume, Motoi; Yamada, Yoshiaki; Mitsui, Kenji; Narushima, Masahiro; Morikawa, Norifumi; Sumitomo, Makoto

    2015-08-01

    This study aimed to investigate the penetration of PIPC-TAZ into human prostate, and to assess effectiveness of PIPC-TAZ against prostatitis by evaluating site-specific PK-PD. Patients with prostatic hypertrophy (n = 47) prophylactically received a 0.5 h infusion of PIPC-TAZ (8:1.2-0.25 g or 4-0.5 g) before transurethral resection of the prostate. PIPC-TAZ concentrations in plasma (0.5-5 h) and prostate tissue (0.5-1.5 h) were analyzed with a three-compartment PK model. The estimated model parameters were, then used to estimate the drug exposure time above the minimum inhibitory concentration for bacteria (T > MIC, the PD indicator for antibacterial effects) in prostate tissue for six PIPC-TAZ regimens (2.25 or 4.5 g; once, twice, three times or four times daily; 0.5 h infusions). Prostate tissue/plasma ratio of PIPC was about 36% both for the maximum drug concentration (Cmax) and the area under the drug concentration-time curve (AUC). Against MIC distributions for isolates of Escherichia coli, Klebsiella species and Proteus species, regimens of 4.5 g twice daily and 2.25 g three times daily achieved a >90% probability of attaining the bacteriostatic target for PIPC (30% T > MIC) in prostate tissue; regimens of 4.5 g three times daily and 2.25 g four times daily achieved a >90% probability of attaining the bactericidal target for PIPC (50% T > MIC) in prostate tissue. However, against Pseudomonas aeruginosa isolates, none of the tested regimens achieved a >90% probability. PIPC-TAZ is appropriate for the treatment of prostatitis from the site-specific PK-PD perspective. Copyright © 2015. Published by Elsevier Ltd.

  12. Piperacillin population pharmacokinetics in critically ill patients with multiple organ dysfunction syndrome receiving continuous venovenous haemodiafiltration: effect of type of dialysis membrane on dosing requirements

    National Research Council Canada - National Science Library

    Ulldemolins, Marta; Martín-Loeches, Ignacio; Llauradó-Serra, Mireia; Fernández, Javier; Vaquer, Sergi; Rodríguez, Alejandro; Pontes, Caridad; Calvo, Gonzalo; Torres, Antoni; Soy, Dolors

    2016-01-01

    ...) receiving continuous venovenous haemodiafiltration (CVVHDF), to identify the sources of PK variability and evaluate different dosing regimens to develop recommendations based on clinical parameters...

  13. Efficacy and safety of IV/PO moxifloxacin and IV piperacillin/tazobactam followed by PO amoxicillin/clavulanic acid in the treatment of diabetic foot infections: results of the RELIEF study

    NARCIS (Netherlands)

    Schaper, N.C.; Dryden, M.; Kujath, P.; Nathwani, D.; Arvis, P.; Reimnitz, P.; Alder, J.; Gyssens, I.C.J.

    2013-01-01

    OBJECTIVE: The aim was to compare the efficacy and safety of two antibiotic regimens in patients with diabetic foot infections (DFIs). METHODS: Data of a subset of patients enrolled in the RELIEF trial with DFIs requiring surgery and antibiotics were evaluated retrospectively. DFI was diagnosed on t

  14. A systematic review of clinical outcomes with alternative dosing strategies for piperacillin/tazobactam%不同输注方式对帕拉西林-他唑巴坦钠临床疗效影响的Meta分析

    Institute of Scientific and Technical Information of China (English)

    陈路佳; 李斌; 高波; 江滨

    2015-01-01

    目的:系统评价不同输注方式对帕拉西林-他唑巴坦钠临床疗效的影响.方法:在PubMed,Web of Science,ProQuest,Embase,ScienceDirect,Cochrane上检索所有2015年1月1日前所有相关文献,采用Revman 5.3软件进行分析.结果:共纳入2篇RCT和10篇观察性研究文献,结果显示延长给药组或连续给药组相对于传统给药方法,能降低临床死亡率[OR 0.68,CI(0.53,0.88),P=0.003],但临床有效率差异无统计学意义[OR 0.84,CI(0.83,2.50),P=0.20].结论:帕拉西林-他唑巴坦钠采用延长或连续输注的方式可以降低死亡率,临床值得推荐.

  15. 哌拉西林-三唑巴坦治疗中性粒细胞减少症发热的疗效观察%Efficacy of piperacillin-tazobactam in the treatment of febrile neutropenia

    Institute of Scientific and Technical Information of China (English)

    王晓冬; 祝彪; 陈姣; 王春森; 万纯黔; 肖蓉; 张晋林

    2004-01-01

    目的:观察哌拉西林-三唑巴坦治疗中性粒细胞减少症发热的临床疗效及安全性.方法:将65例中性粒细胞减少症发热的患者随机分为2组,在常规治疗的基础上,治疗组32例,采用哌拉西林-三唑巴坦4.5 g,静脉滴注,每8小时1次;对照组33例,给予亚胺培南0.5 g,静脉滴注,每8小时1次.2组疗程均为7~14 d.结果:哌拉西林-三唑巴坦组治愈率为78.1%,有效率为90.6%,细菌清除率为94.4%;亚胺培南组治愈率为78.8%,有效率为87.9%,细菌清除率为94.7%,两组比较差异无显著性(P>0.05).结论:哌拉西林-三唑巴坦在治疗中性粒细胞减少症发热中疗效确切,使用安全.

  16. Drug: D08380 [KEGG MEDICUS

    Lifescience Database Archive (English)

    Full Text Available 8380.gif Antibacterial Same as: C14034 ATC code: J01CA12 Semisynthetic penicillin: extended spectrum penicil...TIBACTERIALS, PENICILLINS J01CA Penicillins with extended spectrum J01CA12 Piperacillin D08380 Piperacillin

  17. Late-Onset Enterobacter cloacae Sepsis in Very-Low-Birth-Weight Neonates: Experience in a Medical Center

    Directory of Open Access Journals (Sweden)

    Hsiao-Neng Chen

    2009-02-01

    Conclusion: E. cloacae infection in VLBW neonates usually presents with non-specific symptoms and signs. Early recognition of sepsis and empirical combination of piperacillin (or piperacillin and tazobactam and gentamicin (or amikacin may be useful for treatment of sepsis caused by this highly virulent pathogen.

  18. In Vitro Activities of Antibiotic Combinations Against Clinical Isolates of Pseudomonas Aeruginosa

    Directory of Open Access Journals (Sweden)

    Yen-Hsu Chen

    2004-06-01

    Full Text Available Combination therapy has been recommended to treat Pseudomonas aeruginosa infections worldwide. The purpose of the present study was to determine the in vitro activities of piperacillin, cefepime, aztreonam, amikacin, and ciprofloxacin alone and in combination against 100 clinical isolates of P. aeruginosa from one medical center in southern Taiwan. The combination susceptibility assay was performed using the checkerboard technique. The percentage of resistance of P. aeruginosa to single agents in our study was relatively high for the Asia-Pacific area, except to aztreonam. Piperacillin plus amikacin exhibited the highest potential for synergy (59/100 in this study. Moreover, a high percentage of synergism was also noted with amikacin combined with cefepime (7/100 or aztreonam (16/100. The combination of two beta-lactams, such as cefepime with piperacillin, and aztreonam with cefepime or piperacillin, showed synergistic effects against some P. aeruginosa isolates. Although ciprofloxacin is a good anti-pseudomonal agent, a very low potential for synergy with other antibiotics was demonstrated in this study. No antagonism was exhibited by any combination in our study. Among piperacillin-resistant strains, there was synergy with a beta-lactam plus amikacin, including the combination of piperacillin and amikacin. However, the combination of two beta-lactams, such as piperacillin and cefepime or aztreonam, did not have any synergistic activity against these strains. In summary, the combinations of amikacin with the tested beta-lactams (piperacillin, aztreonam, cefepime had a greater synergistic effect against P. aeruginosa, even piperacillin-resistant strains, than other combinations. Understanding the synergistic effect on clinical strains may help clinicians choose better empirical therapy in an area with high prevalence of multidrug-resistant P. aeruginosa.

  19. Impact of antibacterial drugs on human serum paraoxonase-1 (hPON1) activity:an in vitro study

    Institute of Scientific and Technical Information of China (English)

    Hakan Syt; Elif Duygu Kaya; kr Beydemir

    2014-01-01

    Objective:To investigate the in vitro effects of the antibacterial drugs, meropenem trihydrate, piperacillin sodium, and cefoperazone sodium, on the activity of human serum paraoxonase Methods: hPON1 was purified from human serum using simple chromatographic methods, including DEAE-Sephadex anion exchange and Sephadex G-200 gel filtration chromatography. Results:The three antibacterial drugs decreased in vitro hPON1 activity. Inhibition mechanisms meropenem trihydrate was noncompetitive while piperacillin sodium and cefoperazone sodium were competitive. Conclusions:Our results showed that antibacterial drugs significantly inhibit hPON1 activity, both in vitro, with rank order meropenem trihydrate piperacillin sodium cefoperazone sodium in vitro.

  20. Development of EUCAST disk diffusion method for susceptibility testing of the Bacteroides fragilis group isolates

    DEFF Research Database (Denmark)

    Nagy, Elisabeth; Justesen, Ulrik Stenz; Eitel, Zsuzsa

    2015-01-01

    -clavulanic acid, cefoxitin, clindamycin, imipenem, metronidazole, moxifloxacin, piperacillin/tazobactam, tigecycline by agar dilution method previously. The inhibition zones of the same antibiotics including meropenem disc were determined by the disc diffusion on Brucella blood agar supplemented with haemin...

  1. Nosocomial Gram-negative bacteremia in intensive care: epidemiology, antimicrobial susceptibilities, and outcomes

    Directory of Open Access Journals (Sweden)

    Wendy Irene Sligl

    2015-08-01

    Conclusions: ICU-acquired Gram-negative bacteremia is associated with high mortality. Resistance to ciprofloxacin, piperacillin/tazobactam, and carbapenems was common. Coronary artery disease, immune suppression, and inadequate empiric antimicrobial therapy were independently associated with increased mortality.

  2. Nosocomial bacteremia and catheter infection by Bacillus cereus in an immunocompetent patient.

    Science.gov (United States)

    Hernaiz, C; Picardo, A; Alos, J I; Gomez-Garces, J L

    2003-09-01

    We present a case of Bacillus cereus bacteremia and catheter infection in an immunocompetent patient subjected to abdominal surgery, who recovered following central catheter removal and treatment with piperacillin/tazobactam.

  3. Angina monocitica con sovrainfezione da Prevotella denticola: caso clinico

    Directory of Open Access Journals (Sweden)

    Maria Teresa Allù

    2005-06-01

    Full Text Available Monocytic angina with superinfection of Prevotella denticola: clinical case Monocytic angina is a clinical sindrome caused by Epstein-Barr virus characterized by fever, pharyngitis, exudative tonsillitis, swollen lymphoglands, splenomegaly and hepatomegaly.The inflamed pharynx and necrotic tonsils of infectious mononucleosis are subject to bacterial superinfection initially or during the course of the illness; the reduced PO2 tension and low oxidation-reduction potential that prevail in a vascular and necrotic tissues favour the growth of anaerobes. In this article we reported the clinical case of a ten years old children, who presented fever and tonsillopharyngitis; he was treated with cefotaxime and piperacillin, he did not improve in health. He was admitted to hospital (Department of Otorhinolaryngology. The patient was treated with aminoglycoside (tobramycin, piperacillin and cortisone; the clinical situation deteriorated. Pus sample was collected from the tonsils and cultured. Isolated strain from culture anaerobic was identified biochemically (Rapid-ID32ANA.The microorganism isolated was: Prevotella denticola (oral anaerobic gram-negative rods; β-lactamase production was tested by using the chromogenic cephalosporin disk test.The susceptibility to antibiotics was performed according to NCCLS recommendations. Prevotella denticola (β-lactamase production was resistant to penicillin, cefoxitin, cefotetan, piperacillin, clindamycin and metronidazole it was susceptible to piperacillin-tazobactam, amoxicillin-clavulanate, ticarcillin-clavulanate, imipenem and chloramphenicol. Children was treated with piperacillin-tazobactam, with rapid symptomatic relief.

  4. Comparative in vitro activities of seven new beta-lactams, alone and in combination with beta-lactamase inhibitors, against clinical isolates resistant to third generation cephalosporins

    Directory of Open Access Journals (Sweden)

    Varsha Gupta

    Full Text Available We examined the drug susceptibility pattern of Gram-negative bacilli to seven new beta-lactams. A total of 277 non-duplicate gramnegative bacilli strains belonging to the Enterobacteriaceae family, Pseudomonas and Acinetobacter species, isolated from various clinical samples were tested for susceptibility to imipenem, piperacillin/tazobactam, cefoperazone/sulbactam, ticarcillin/clavulanate, cefdinir, cefepime and cefpirome with the disk diffusion technique. The percentage resistance was low for imipenem (7.2%, piperacillin/tazobactam (2.8%, cefoperazone/sulbactam (5.4%. However, a high frequency of resistance was observed to ticarcillin/clavulanate (83.9%, cefdinir (70.6%, cefepime (45.5% and cefpirome (84.4%. We conclude that imipenem, piperacillin/tazobactam and cefoperazone/sulbactam are effective antibiotics in our environment, whereas ticarcillin/clavulanate, cefdinir, cefepime and cefpirome are relatively uneffective.

  5. Impact of antibacterial drugs on human serum paraoxonase-1(hPON1)activity:an in vitro study

    Institute of Scientific and Technical Information of China (English)

    Hakan; Syt; Elif; Duygu; Kaya; Skr; Beydemir

    2014-01-01

    Objective:To investigate the in vitro effects of the antihacterial drugs,mcropenem trihydrate.piperacillin sodium,and cefoperazone sodium,on the activity of human serum paraoxonase mPOND.Methods:hPQN1 was purified from human serum using simple chromatographic methods.including DEAE-Sephadex anion exchange and Sephadex G-200 gel filtration chromatography.Results:The three antihacterial drugs decreased in vitro hPON1 activity.Inhibition mechanisms meropcnem trihydrate was noncompetitive while piperacillin sodium and cefoperazone sodium were competitive.Conclusions:Our results showed that antihacterial drugs significantly inhibit hPON1 activity,both in vitro,with rank order meropenem trihydrate piperacillin sodium cefoperazone sodium in vitro.

  6. In vitro antianaerobic activity of ertapenem (MK-0826) compared to seven other compounds.

    Science.gov (United States)

    Hoellman, Dianne B; Kelly, Linda M; Credito, Kim; Anthony, Lauren; Ednie, Lois M; Jacobs, Michael R; Appelbaum, Peter C

    2002-01-01

    Ertapenem, imipenem, meropenem, ceftriaxone, piperacillin, piperacillin-tazobactam, clindamycin, and metronidazole were agar dilution MIC tested against 431 anaerobes. Imipenem, meropenem, and ertapenem were the most active beta-lactams (MICs at which 50% of the strains are inhibited [MIC(50)s], 0.125 to 0.25 microg/ml; MIC(90)s, 1.0 to 2.0 microg/ml). Time-kill studies revealed that ertapenem at two times the MIC was bactericidal for 9 of 10 strains after 48 h. The kinetics for other beta-lactams were similar to those of ertapenem.

  7. The non-enzymatic inactivation of thirteen beta-lactam antibiotics in human faeces

    NARCIS (Netherlands)

    Jansen, G; Weissing, F; de Vries-Hospers, H; Tonk, R; van der Waaij, D

    1992-01-01

    In order to obtain a method that could predict the in vitro inactivation of an antibiotic in the digestive tract, the non-enzymatic inactivation of 13 beta-lactam antibiotics by human faeces was investigated. Benzylpenicillin, amoxicillin, amoxicillin/clavulanate, cloxacillin, piperacillin, temocill

  8. Drug–laboratory interaction between beta-lactam antibiotics and the galactomannan antigen test used to detect mould infections

    Directory of Open Access Journals (Sweden)

    Kristin A. Otting

    Full Text Available Several studies have demonstrated that piperacillin/tazobactam produces a false-positive result for the galactomannan antigen test. However, the most recent literature has demonstrated that this interaction is no longer a concern. There is little information regarding the drug–laboratory interaction with the generics of piperacillin/tazobactam or other broad-spectrum beta-lactams, such as ceftaroline, doripenem, imipenem/cilastatin, and meropenem. The purpose of this study was to determine if a drug–laboratory interaction exists with these antibiotics. Tests showed that one lot of imipenem/cilastatin by Hospira Healthcare India Private Limited produced a false-positive result for the galactomannan antigen test. All other medications tested, including piperacillin/tazobactam from seven manufacturers and imipenem/cilastatin by Hospira Inc., did not produce positive results. Since the reason for this drug–laboratory interaction with imipenem/cilastatin is unknown, more studies are needed to further investigate this interaction. Providers also should be educated of these findings: no drug–laboratory interaction with piperacillin/tazobactam and a possible drug–laboratory interaction with imipenem/cilastatin (Hospira Healthcare India Private Limited.

  9. Susceptibility to antibiotics of aerobic bacteria isolated from community acquired secondary peritonitis in children: therapeutic guidelines might not always fit with and everyday experience.

    Science.gov (United States)

    Castagnola, Elio; Bandettini, Roberto; Ginocchio, Francesca; Perotti, Maddalena; Masa, Daniela La; Ciucci, Antonella; Loy, Anna; Caviglia, Ilaria; Haupt, Riccardo; Guida, Edoardo; Pini Prato, Alessio; Mattioli, Girolamo; Buffa, Piero

    2013-08-01

    Appendicitis is a frequent clinical condition in normal children that may be complicated by community-acquired secondary peritonitis (CASP). We evaluated the potential efficacy of different drugs for initial treatment of this condition, as recommended by recent Consensus Conference and Guidelines for paediatric patients. Susceptibility to ampicillin-sulbactam, ertapenem, gentamycin, piperacillin, piperacillin-tazobactam, vancomycin, and teicoplanin was evaluated according to EUCST 2012 recommendations in aerobic bacteria isolated from peritoneal fluid in CASP diagnosed from 2005 to 2011 at 'Istituto Giannina Gaslini', Genoa, Italy. A total of 114 strains were analysed: 83 E. coli, 15 P. aeruginosa, 6 Enterococci, and 10 other Gram-negatives. Resistance to ampicillin-sulbactam was detected in 37% of strains, while ertapenem showed a potential resistance of 13% (all P. aeruginosa strains). However, the combination of these drugs with gentamicin would have been increased the efficacy of the treatment to 99 and 100%, respectively. Resistance to piperacillin-tazobactam was 3%, while no strain was resistant to meropenem. Our data suggest that monotherapy with ampicillin-sulbactam or ertapenem for community-acquired secondary peritonitis would present a non-negligible rate of failure, but the addition of gentamycin to these drugs could reset to zero this risk. On the contrary, monotherapy with piperacillin-tazobactam or meropenem is highly effective.

  10. Induction of beta-lactamase production in Pseudomonas aeruginosa biofilm

    DEFF Research Database (Denmark)

    Giwercman, B; Jensen, E T; Høiby, N

    1991-01-01

    Imipenem induced high levels of beta-lactamase production in Pseudomonas aeruginosa biofilms. Piperacillin also induced beta-lactamase production in these biofilms but to a lesser degree. The combination of beta-lactamase production with other protective properties of the biofilm mode of growth...

  11. Vancomycin-resistant Clostridium innocuum bacteremia following oral vancomycin for Clostridium difficile infection.

    Science.gov (United States)

    Hung, Yuan-Pin; Lin, Hsiao-Ju; Wu, Chi-Jung; Chen, Po-Lin; Lee, Jen-Chieh; Liu, Hsiao-Chieh; Wu, Yi-Hui; Yeh, Fang Hao; Tsai, Pei-Jane; Ko, Wen-Chien

    2014-12-01

    An 85 year-old male initially admitted for septic shock due to urinary tract infection experienced Clostridium difficile-associated diarrhea during hospitalization and was treated by oral vancomycin. His clinical course was complicated by cytomegalovirus colitis and then vancomycin-resistant Clostridium innocuum bacteremia, which was cured by uneventfully parenteral piperacillin-tazobactam therapy. Copyright © 2014 Elsevier Ltd. All rights reserved.

  12. Successful treatment of multiresistant Achromobacter xylosoxidans bacteremia in a child with acute myeloid leukemia.

    Science.gov (United States)

    Tugcu, Deniz; Turel, Ozden; Aydogan, Gonul; Akcay, Arzu; Salcioglu, Zafer; Akici, Ferhan; Sen, Hulya; Demirkaya, Metin; Taskin, Necati; Gurler, Nezahat

    2015-01-01

    Achromobacter xylosoxidans is an aerobic gram-negative bacillus and important cause of bacteremia in immunocompromised patients. We describe a leukemia pediatric patient with severe neutropenia who developed bacteremia with A xylosoxidans resistant to multiple antibiotics, and treated the patient with tigecycline and piperacillin-tazobactam in addition to supportive medications.

  13. Central line-related bacteraemia due to Roseomonas mucosa in a neutropenic patient with acute myeloid leukaemia in Piraeus, Greece.

    Science.gov (United States)

    Christakis, G B; Perlorentzou, S; Alexaki, P; Megalakaki, A; Zarkadis, I K

    2006-08-01

    A case of central venous catheter-related bacteraemia due to Roseomonas mucosa in a neutropenic patient with acute myelogenous leukaemia is reported. The patient was successfully treated with amikacin and piperacillin-tazobactam. The clinical isolate was identified as R. mucosa by 16S rRNA gene sequencing.

  14. Drug: D02251 [KEGG MEDICUS

    Lifescience Database Archive (English)

    Full Text Available 535.1737 535.5701 D02251.gif Antibacterial ATC code: J01CA12 Semisynthetic penicillin: extended spectrum pen...M ANTIBACTERIALS, PENICILLINS J01CA Penicillins with extended spectrum J01CA12 Piperacillin D02251 Piperacil

  15. Time-kill studies of the antianaerobe activity of garenoxacin compared with those of nine other agents.

    Science.gov (United States)

    Credito, Kim L; Jacobs, Michael R; Appelbaum, Peter C

    2003-04-01

    The activities of garenoxacin, ciprofloxacin, levofloxacin, moxifloxacin, trovafloxacin, amoxicillin-clavulanate, piperacillin-tazobactam, imipenem, clindamycin, and metronidazole against 20 anaerobes were tested. At two times the MIC, garenoxacin was bactericidal against 19 of 20 strains after 48 h and against 17 of 20 after 24 h. Other drugs, except clindamycin (which gave lower killing rates), gave killing rates similar to those for garenoxacin.

  16. Bacteroides faecis and Bacteroides intestinalis recovered from clinical specimens of human intestinal origin.

    Science.gov (United States)

    Lee, Yangsoon; Kim, Hyun Soo; Yong, Dongeun; Jeong, Seok Hoon; Lee, Kyungwon; Chong, Yunsop

    2015-01-01

    We report three cases of recently named Bacteroides spp. isolates, two B. faecis isolates and one B. intestinalis isolate from clinical specimens of inpatients at a Korean tertiary-care hospital in 2011. All isolates were susceptible to piperacillin-tazobactam, imipenem, meropenem, chloramphenicol, and metronidazole.

  17. COMMON INFECTIONS OF THE EAR

    African Journals Online (AJOL)

    Enrique

    April 2004 Vol.22 No.4 CME. 193. KAREN COHEN. MB ChB ... the ear canal and they are usually in the 40 - 50-year age group. ... Treatment. The treatment of choice is intravenous antibiotics consisting of aminoglyco- side, piperacillin and ...

  18. Cholangitis with septic shock caused by Raoultella planticola.

    Science.gov (United States)

    Yokota, Kazuhisa; Gomi, Harumi; Miura, Yoshimasa; Sugano, Kentaro; Morisawa, Yuji

    2012-03-01

    Raoultella planticola (formerly Klebsiella planticola) is a Gram-negative bacterium that has been rarely reported in association with human infection. Here we describe a case of cholangitis complicated with septic shock caused by R. planticola in an immunocompromised patient with advanced cancer who underwent endoscopic retrograde cholangiopancreatography to extract common bile duct stones. The infection was cleared by piperacillin-tazobactam treatment.

  19. Nonfermenting gram-negative bacilli infections in a tertiary care hospital in Kolar, Karnataka

    Directory of Open Access Journals (Sweden)

    A Malini

    2009-01-01

    Conclusion : P. aeruginosa and A. baumannii were the common NFGNB isolated in our study from patients of, urinary tract infection, bacteremia, surgical site infections, and ventilator associated pneumonia. P. aeruginosa showed good sensitivity to imipenem, amikacin, and cefoperazone while A. baumannii showed good sensitivity to imipenem and piperacillin.

  20. The relationship between antimicrobial consumption and the rates of resistance of Klebsiela pneumoniae in respiratory unit

    Institute of Scientific and Technical Information of China (English)

    YANG Xin-yun; ZHUO Chao; XIAO Xiang-lin; YUAN Jin-Ping; YANG Ling

    2008-01-01

    Objective To investigate the relationship between the consumption of antibacterial agents and resistance rate of Klebsiela pneumoniae(KP)in the hospital respiratory unit for 3 consecutive years in 2005-2007. Methods The total antibacterial consumption expressed as defined DDDs/100BD, as well as resistance rate of total KP and producing ESBLs KP were collected, and their correlation was analyzed. Results The rate of resistance of KP to cefoperazone/sulbactam, Cefepime, Imipenem, Moxifloxacin was significantly positively associated with the consumption of Cefotaxime, Ceftazidime, Moxifloxacin, Amikacin respectively;A significant positive association was observed between the rate of resistance of KP to Piperacillin/Tazobactam, Ceftriaxone and the consumption of Imipenem; The rate of resistance of KP to Piperacillin, Cefotaxime, Ciprofloxacin was significantly positively associated with the consumption of Levofloxacin. ESBLs producing bacilli of KP were detected in 44 of 75 isolates (58.7%), The rate of resistance of producing ES-BLs KP to Piperacillin/Tazobactarn, Ceftriaxone was significantly positively associated with the consumption of Imipenem, Ceftazidime; A significant positive association was observed between the rate of resistance of producing ESBLs KP to Piperacillin, Imipenem and the consumption of Moxifloxacin. There was no significant correlation in other drugs. Conclusions A relationship existed between antimicrobial consumption and rates of resistance of KP in the hospital respiratory unit. We must use antibiotics carefully and with reason to control and lessen the drug resistance of bacterial.

  1. Identification of a group of Haemophilus influenzae penicillin-binding proteins that may have complementary physiological roles

    Energy Technology Data Exchange (ETDEWEB)

    Malouin, F.; Parr, T.R. Jr.; Bryan, L.E. (Eli Lilly Company, Indianapolis, IN (USA))

    1990-02-01

    (35S)penicillin bound to different Haemophilus influenzae proteins in assays performed at 20, 37, or 42{degrees}C. Penicillin-binding proteins 3a, 3b, 4, and 4' formed a group characterized by their affinity for moxalactam, cefotaxime, and piperacillin. Penicillin-binding protein 4' showed specific properties that may reflect its complementary role in septation.

  2. Top Guns: The “Maverick” and “Goose” of Empiric Therapy

    Science.gov (United States)

    Efird, Jimmy T.; Guidry, Christopher A.; Dietch, Zachary C.; Willis, Rhett N.; Shah, Puja M.; Sawyer, Robert G.

    2016-01-01

    Abstract Background: Vancomycin and piperacillin-tazobactam are commonly used first guns in the empiric management of critically ill patients. Current studies suggest an increased prevalence of acute kidney injury with concomitant use, however, these studies are few and limited by small sample size. The purpose of this study was to compare the prevalence of nephrotoxicity after treatment with vancomycin alone and concomitant vancomycin and piperacillin-tazobactam treatment at our institution. Hypothesis: Concomitant vancomycin and piperacillin-tazobactam–treated patients will experience greater prevalence of nephrotoxicity compared with vancomycin-only treated patients. Methods: This was a retrospective cohort of patients treated with vancomycin for gram-positive or mixed infections in our facility from 2005 to 2009 who were not receiving hemodialysis at the time of admission. Included patients were stratified by treatment with vancomycin, vancomycin/piperacillin-tazobactam, or vancomycin/an alternative gram-negative rod (GNR) antibiotic. p values for categorical variables were computed using χ2 while continuous variables were computed using Kruskal-Wallis. Variables deemed statistically significant (< 0.05) were included in the multivariable, log-binomial regression model. Relative risk (RR) and 95% confidence intervals (CI), and p values were computed using a generalized estimating equation (GEE) approach with robust standard errors (i.e., Huber White “sandwich variance” estimates) to accommodate a correlated data structure corresponding to multiple episodes of infection per individual. Results: A total of 530 patients with 1,007 episodes of infection, were treated with vancomycin (150 patients/302 episodes of infection), vancomycin/piperacillin-tazobactam (213 patients/372 episodes of infection), or vancomycin/GNR alternative (167 patients/333 episodes of infection). Patient demographics, comorbidities, sites of infection, and organisms of infection were

  3. Top Guns: The "Maverick" and "Goose" of Empiric Therapy.

    Science.gov (United States)

    Davies, Stephen W; Efird, Jimmy T; Guidry, Christopher A; Dietch, Zachary C; Willis, Rhett N; Shah, Puja M; Sawyer, Robert G

    2016-02-01

    Vancomycin and piperacillin-tazobactam are commonly used first guns in the empiric management of critically ill patients. Current studies suggest an increased prevalence of acute kidney injury with concomitant use, however, these studies are few and limited by small sample size. The purpose of this study was to compare the prevalence of nephrotoxicity after treatment with vancomycin alone and concomitant vancomycin and piperacillin-tazobactam treatment at our institution. Concomitant vancomycin and piperacillin-tazobactam-treated patients will experience greater prevalence of nephrotoxicity compared with vancomycin-only treated patients. This was a retrospective cohort of patients treated with vancomycin for gram-positive or mixed infections in our facility from 2005 to 2009 who were not receiving hemodialysis at the time of admission. Included patients were stratified by treatment with vancomycin, vancomycin/piperacillin-tazobactam, or vancomycin/an alternative gram-negative rod (GNR) antibiotic. p values for categorical variables were computed using χ(2) while continuous variables were computed using Kruskal-Wallis. Variables deemed statistically significant (< 0.05) were included in the multivariable, log-binomial regression model. Relative risk (RR) and 95% confidence intervals (CI), and p values were computed using a generalized estimating equation (GEE) approach with robust standard errors (i.e., Huber White "sandwich variance" estimates) to accommodate a correlated data structure corresponding to multiple episodes of infection per individual. A total of 530 patients with 1,007 episodes of infection, were treated with vancomycin (150 patients/302 episodes of infection), vancomycin/piperacillin-tazobactam (213 patients/372 episodes of infection), or vancomycin/GNR alternative (167 patients/333 episodes of infection). Patient demographics, comorbidities, sites of infection, and organisms of infection were compared among groups. After adjusting for

  4. Correlation between antibiotic consumption and resistance of Gram-negative bacteria causing healthcare-associated infections at a university hospital in Taiwan from 2000 to 2009.

    Science.gov (United States)

    Lai, Chih-Cheng; Wang, Cheng-Yi; Chu, Chen-Chen; Tan, Che-Kim; Lu, Ching-Lan; Lee, Yi-Chieh; Huang, Yu-Tsung; Lee, Ping-Ing; Hsueh, Po-Ren

    2011-06-01

    This study investigated the correlation between antibiotic consumption and antimicrobial resistance in Gram-negative bacteria causing healthcare-associated infections at a university hospital in Taiwan from 2000 to 2009. Disc susceptibility data of Escherichia coli, Klebsiella pneumoniae, Enterobacter cloacae, Serratia marcescens, Proteus spp., Pseudomonas aeruginosa, Acinetobacter spp., Stenotrophomonas maltophilia and other non-fermentative Gram-negative bacilli causing healthcare-associated infections were evaluated. Data on annual patient-days and annual consumption (defined daily doses per 1000 patient-days) of extended-spectrum cephalosporins, β-lactam/β-lactamase inhibitor combinations, carbapenems, aminoglycosides and fluoroquinolones were analysed. The trend of total consumption of extended-spectrum cephalosporins, β-lactam/β-lactamase inhibitor combinations, carbapenems, aminoglycosides and fluoroquinolones significantly increased between 2000 and 2003 and remained stable between 2004 and 2009. The decreasing use of gentamicin and amikacin in recent years was associated with increasing susceptibility of E. coli, E. cloacae, S. marcescens and P. aeruginosa to gentamicin, as well as increasing susceptibility of P. aeruginosa to amikacin. The use of piperacillin/tazobactam was positively correlated with the prevalence of piperacillin/tazobactam-resistant E. coli and S. maltophilia. In contrast, the use of cefotaxime and piperacillin/tazobactam was negatively correlated with the prevalence of cefotaxime-resistant E. coli and piperacillin/tazobactam-resistant S. maltophilia, respectively. The consumption of fluoroquinolones was positively correlated with the rates of ciprofloxacin-resistant E. coli, piperacillin/tazobactam-resistant P. aeruginosa and ceftazidime-resistant S. maltophilia. The relationship between antibiotic prescription and the rates of resistance for Gram-negative bacteria is complicated; every type of antimicrobial agent or even

  5. Synergistic activity of coriander oil and conventional antibiotics against Acinetobacter baumannii.

    Science.gov (United States)

    Duarte, A; Ferreira, S; Silva, F; Domingues, F C

    2012-02-15

    In this study we investigated the existence of synergistic antibacterial effect between coriander (Coriandrum sativum L.) essential oil and six different antibacterial drugs (cefoperazone, chloramphenicol, ciprofloxacin, gentamicin, tetracycline and piperacillin). The antibacterial activity of coriander oil was assessed using microdilution susceptibility testing and synergistic interaction by checkerboard assays. The association of coriander essential oil with chloramphenicol, ciprofloxacin, gentamicin and tetracycline against Acinetobacter baumannii showed in vitro effectiveness, which is an indicator of a possible synergistic interaction against two reference strains of A. baumannii (LMG 1025 and LMG 1041) (FIC index from 0.047 to 0.375). However, when tested the involvement between coriander essential oil and piperacillin or cefoperazone, the isobolograms and FIC index showed an additive interaction. The in vitro interaction could improve the antimicrobial effectiveness of ciprofloxacin, gentamicin and tetracycline and may contribute to resensitize A. baumannii to the action of chloramphenicol.

  6. A 16-year retrospective surveillance report on the pathogenic features and antimicrobial susceptibility of Pseudomonas aeruginosa isolates from FAHJU in Guangzhou representative of Southern China.

    Science.gov (United States)

    Xie, Jinhong; Yang, Ling; Peters, Brian M; Chen, Lequn; Chen, Dingqiang; Li, Bing; Li, Lin; Yu, Guangchao; Xu, Zhenbo; Shirtliff, Mark E

    2017-09-01

    Pseudomonas aeruginosa is a major pathogen responsible for nosocomial infections. A 16-year retrospective report from 2000 to 2015 was conducted to assess the antimicrobial resistance of P. aeruginosa in Southern China. A total of 1387 P. aeruginosa were collected from inpatients and outpatients. Susceptibility testing results were interpreted according to the Clinical and Laboratory Standards Institute (CLSI, 2015). Piperacillin, piperacillin-tazobactam, ceftazidime, aminoglycosides and carbapenems remained to be active against P. aeruginosa, with resistance rates ranging from 5.6% to 29.7%. Generally, ampicillin, ampicillin-sulbactam, ceftriaxone and trimethoprim-sulfamethoxazole nearly lost the effect on P. aeruginosa, as the resistance rates increase up to 90%. Notably, sputum and blood specimen showed higher resistance rates than other sources in carbapenems, suggesting more caution should be paid on the choice of antibiotic against infections associated with respiratory tract. Copyright © 2017 Elsevier Ltd. All rights reserved.

  7. blaGES carrying Pseudomonas aeruginosa isolates from a public hospital in Rio de Janeiro, Brazil

    Directory of Open Access Journals (Sweden)

    Flávia L. P. C. Pellegrino

    2006-08-01

    Full Text Available Previous analysis of Pseudomonas aeruginosa class-1 integrons from Rio de Janeiro, Brazil, revealed the blaGES gene in one isolate. We screened isolates of two widespread PFGE genotypes, A and B, at a public hospital in Rio, for the presence of blaGES. The gene was detected in all seven P. aeruginosa isolates belonging to genotype B. Three of the seven genotype-B isolates were resistant to amikacin, aztreonam, ceftazidime, cefepime, ciprofloxacin, gentamicin, imipenem, meropenem, piperacillin-tazobactam and ticarcillin-clavulanic acid. The other four isolates were resistant to all these agents, except gentamicin, imipenem, meropenem and piperacillin-tazobactam. A synergistic effect between ceftazidime and imipenem or clavulanic acid suggested the production of GES-type ESBL.

  8. Fabrication, characterization and in vitro profile based interaction with eukaryotic and prokaryotic cells of alginate-chitosan-silica biocomposite.

    Science.gov (United States)

    Balaure, Paul Catalin; Andronescu, Ecaterina; Grumezescu, Alexandru Mihai; Ficai, Anton; Huang, Keng-Shiang; Yang, Chih-Hui; Chifiriuc, Carmen Mariana; Lin, Yung-Sheng

    2013-01-30

    This work is focused on the fabrication of a new drug delivery system based on polyanionic matrix (e.g. sodium alginate), polycationic matrix (e.g. chitosan) and silica network. The FT-IR, SEM, DTA-TG, eukaryotic cell cycle and viability, and in vitro assay of the influence of the biocomposite on the efficacy of antibiotic drugs were investigated. The obtained results demonstrated the biocompatibility and the ability of the fabricated biocomposite to maintain or improve the efficacy of the following antibiotics: piperacillin-tazobactam, cefepime, piperacillin, imipenem, gentamicin, ceftazidime against Pseudomonas aeruginosa ATCC 27853 and cefazolin, cefaclor, cefuroxime, ceftriaxone, cefoxitin, trimethoprim/sulfamethoxazole against Escherichia coli ATCC 25922 reference strains.

  9. Antibiotic susceptibility of Acinetobacter species in intensive care unit in Montenegro.

    Science.gov (United States)

    Mijovic, Gordana; Pejakov, Ljubica; Vujosevic, Danijela

    2016-08-01

    The global increase in multidrug resistance of Acinetobacter has created widespread problems in the treatment of patients in intensive care units (ICUs). The aim of this study was to assess the current level of antimicrobial susceptibility of Acinetobacter species in ICU of Clinical Centre of Montenegro and determine their epidemiology. Antibiotic susceptibility was tested in 70 isolates of Acinetobacter collected from non-repeating samples taken from 40 patients. The first nine isolates were genotyped by repetitive sequence-based PCR (rep-PCR). Tigecycline was found to be the most active antimicrobial agent with 80.6% of susceptibility. All the isolates were multidrug resistant with fully resistance to cefalosporinas, piperacillin and piperacillin/tazobactam. More than half of them (58.5%) were probably extensively resistant. Seven out of nine examined strains were clonally related by rep-PCR. Our results showed extremely high rate of multidrug resistance (MDR) of Acinetobacter isolates and high percentage of its clonally spreading.

  10. Antibiotic therapy for Listeria monocytogenes bacteremia.

    Science.gov (United States)

    Hung, C C; Chang, S C; Chen, Y C; Hsieh, W C; Luh, K T

    1995-01-01

    Listeria monocytogenes has been recognized as an important pathogen in immunocompromised patients, but it has been rarely reported in Taiwan. We reviewed 13 cases of L. monocytogenes bacteremia at National Taiwan University Hospital over a 12-year period. All of the patients had underlying diseases. Fever was the most common presenting symptom, and neurologic signs were found in 6 patients. Most of the patients received penicillin G, ampicillin or piperacillin with an aminoglycoside. Corticosteroids were used in 9 of 13 patients. The overall mortality directly due to L. monocytogenes bacteremia was 31%. However, patients treated with cephalosporins or oxacillin had higher mortality than those treated with penicillin G, ampicillin or piperacillin (p = 0.05). Given the increasing number of immunosuppressed patients in Taiwan, it is likely that more cases will be encountered. Physicians in Taiwan should be aware of L. monocytogenes bacteremia and its treatment.

  11. Multidrug and heavy metal-resistant Raoultella planticola isolated from surface water.

    Science.gov (United States)

    Koc, Serkan; Kabatas, Burak; Icgen, Bulent

    2013-08-01

    A surface water isolate of Raoultella sp. having both multidrug- and multimetal-resistant ability was isolated and identified as Raoultella planticola. R. planticola displayed resistance to 15 drugs like ampicillin, amoxicillin/clavulanic acid, aztreonam, erythromycin, imipenem, oxacillin, pefloxacin, penicillin, piperacillin, piperacillin/tazobactam, rifampin, sulbactam/cefoperazone, ticarsillin, ticarsillin/clavulanic acid, vancomycin, and to 11 heavy metals like aluminum, barium, copper, iron, lead, lithium, manganese, nickel, silver, strontium, and tin. The multidrug and multi-metal-resistant R. planticola may remain present in the environment for a long time. Due to a possible health risk of these pathogenic bacteria, a need exists for an accurate assessment of their acquired resistance to multiple drugs and metals.

  12. A catheter related sepsis case caused by Pantoea agglomerans

    Directory of Open Access Journals (Sweden)

    Fadime Yılmaz

    2015-04-01

    microorganism was sensitive to piperacillin-tazobactam, so, patient's therapy was not changed. After treatment, when the general condition of the patient healed, he was discharged by ending antibiotics on the sixteenth day. This case report, is intended to call attention to the risk of the growth of catheter-associated sepsis and antibioterapi are lated to P. agglomerans which is rarely seen on immunocompromised patients.

  13. NEW THERAPEUTIC FORMULATIONS WITH AN ANTIBACTERIAL EFFECT, BASED ON PLANT EXTRACTS

    OpenAIRE

    Liliana Cristina Soare; Ionica Deliu; Ion Iosub; Codruţa-Mihaela Dobrescu; Mariana Ferdeş

    2012-01-01

    The antibacterial effects produced by anthocyanins and other bioactive plant compounds are weaker than those generated by antibiotics. In some cases, the combination of extract-antibiotic can cause synergistic effects, also the purpose of the research was to develop and test new antibiotic - plant extract formulations. New potential antimicrobial formulations was done by soaking discs impregnated with piperacillin or tetracycline with different extract. The tested microorganisms were: Staphyl...

  14. Ofloxacin intravenous. Compatibility with other antibacterial agents.

    Science.gov (United States)

    Janknegt, R; Stratermans, T; Cilissen, J; Lohman, J J; Hooymans, P M

    1991-10-18

    The physical and chemical compatibility of ofloxacin (infusion solution 100 ml = 200 mg) with amoxicillin, amoxicillin + clavulanic acid, flucloxacillin, tobramycin, gentamicin, clindamycin, vancomycin, ceftazidime and piperacillin was investigated. Upon admixture with flucloxacillin a precipitate formed between 7 and 24 hours. No other physical or chemical incompatibilities were observed with any of the other combinations. Ofloxacin may be safely combined with the tested antimicrobial drugs, except for flucloxacillin.

  15. Susceptibility to penicillin derivatives among third-generation cephalosporin-resistant Enterobacteriaceae recovered on hospital admission.

    Science.gov (United States)

    Mischnik, Alexander; Baumert, Philipp; Hamprecht, Axel; Rohde, Anna; Peter, Silke; Feihl, Susanne; Knobloch, Johannes; Gölz, Hanna; Kola, Axel; Obermann, Birgit; Querbach, Christiane; Willmann, Matthias; Gebhardt, Friedemann; Tacconelli, Evelina; Gastmeier, Petra; Seifert, Harald; Kern, Winfried V

    2017-01-01

    As part of the multicenter Antibiotic Therapy Optimisation Study-the largest study on the prevalence of third-generation cephalosporin-resistant Enterobacteriaceae carriage upon hospital admission-minimum inhibitory concentration values were generated for ampicillin/sulbactam, amoxicillin/clavulanic acid, piperacillin/tazobactam, mecillinam, mecillinam/clavulanic acid, and temocillin against third-generation cephalosporin-resistant Escherichia coli, Klebsiella species and Enterobacter species.

  16. A multicenter study on the effect of continuous hemodiafiltration intensity on antibiotic pharmacokinetics

    OpenAIRE

    Roberts, Darren M.; Liu, Xin; Roberts, Jason A; Nair, Priya; Cole, Louise; Roberts, Michael S; Lipman, Jeffrey; Bellomo, Rinaldo; ,

    2015-01-01

    Introduction Continuous renal replacement therapy (CRRT) may alter antibiotic pharmacokinetics and increase the risk of incorrect dosing. In a nested cohort within a large randomized controlled trial, we assessed the effect of higher (40 mL/kg per hour) and lower (25 mL/kg per hour) intensity CRRT on antibiotic pharmacokinetics. Methods We collected serial blood samples to measure ciprofloxacin, meropenem, piperacillin-tazobactam, and vancomycin levels. We calculated extracorporeal clearance ...

  17. Pharmacodynamic profiling of commonly prescribed antimicrobial drugs against Escherichia coli isolates from urinary tract

    Directory of Open Access Journals (Sweden)

    Gabriel Trova Cuba

    Full Text Available Since antimicrobial resistance among uropathogens against current first line agents has affected the management of severe urinary tract infection, we determined the likelihood that antibiotic regimens achieve bactericidal pharmacodynamic exposures using Monte Carlo simulation for five antimicrobials (ciprofloxacin, ceftriaxone, piperacillin/tazobactam, ertapenem, and meropenem commonly prescribed as initial empirical treatment of inpatients with severe community acquired urinary tract infections. Minimum inhibitory concentration determination by Etest was performed for 205 Brazilian community urinary tract infection Escherichia coli strains from 2008 to 2012 and 74 E. coli bloodstream strains recovered from a surveillance study. Pharmacodynamic exposure was modeled via a 5000 subject Monte Carlo simulation. All isolates were susceptible to ertapenem and meropenem. Piperacillin/tazobactam, ceftriaxone and ciprofloxacin showed 100%, 97.5% and 83.3% susceptibility among outpatient isolates and 98.6%, 75.7% and 64.3% among inpatient isolates, respectively. Against outpatient isolates, all drugs except ciprofloxacin (82.7% in aggressive and 77.6% in conservative scenarios achieved high cumulative fraction of response: car-bapenems and piperacillin/tazobactam cumulative fraction of responses were close to 100%, and ceftriaxone cumulative fraction of response was 97.5%. Similar results were observed against inpatients isolates for carbapenems (100% and piperacillin/tazobactam (98.4%, whereas ceftriaxone achieved only 76.9% bactericidal cumulative fraction of response and ciprofloxacin 61.9% (aggressive scenario and 56.7% (conservative scenario respectively. Based on this model, standard doses of beta-lactams were predicted to deliver sufficient pharmacodynamic exposure for outpatients. However, ceftriaxone should be avoided for inpatients and ciprofloxacin empirical prescription should be avoided in both inpatients and outpatients with complicated

  18. In vitro antibiotic susceptibilities of Burkholderia mallei (causative agent of glanders) determined by broth microdilution and E-test.

    Science.gov (United States)

    Heine, H S; England, M J; Waag, D M; Byrne, W R

    2001-07-01

    In vitro susceptibilities to 28 antibiotics were determined for 11 strains of Burkholderia mallei by the broth microdilution method. The B. mallei strains demonstrated susceptibility to aminoglycosides, macrolides, quinolones, doxycycline, piperacillin, ceftazidime, and imipenem. For comparison and evaluation, 17 antibiotic susceptibilities were also determined by the E-test. E-test values were always lower than the broth dilution values. Establishing and comparing antibiotic susceptibilities of specific B. mallei strains will provide reference information for assessing new antibiotic agents.

  19. Etiologies of septic shock in a pediatric emergency department population.

    Science.gov (United States)

    Gaines, Nakia N; Patel, Binita; Williams, Eric A; Cruz, Andrea T

    2012-11-01

    Knowledge of pediatric sepsis etiologies is needed to optimize empiric therapy. A retrospective cross-sectional review of 428 children with clinically diagnosed sepsis found that 13% had lobar pneumonia, 12% bacteremia and 10% viral infections. No etiologies were found in 76%. Empiric antibiotic coverage of vancomycin/piperacillin-tazobactam/gentamicin for immunocompromised children and vancomycin/nafcillin/cefotaxime for previously healthy children would have covered all bacteremic children.

  20. Pharmacodynamic profiling of commonly prescribed antimicrobial drugs against Escherichia coli isolates from urinary tract.

    Science.gov (United States)

    Cuba, Gabriel Trova; Pignatari, Antonio Carlos Campos; Patekoski, Katya Silva; Luchesi, Lucimila Jorge; Kiffer, Carlos Roberto Veiga

    2014-01-01

    Since antimicrobial resistance among uropathogens against current first line agents has affected the management of severe urinary tract infection, we determined the likelihood that antibiotic regimens achieve bactericidal pharmacodynamic exposures using Monte Carlo simulation for five antimicrobials (ciprofloxacin, ceftriaxone, piperacillin/tazobactam, ertapenem, and meropenem) commonly prescribed as initial empirical treatment of inpatients with severe community acquired urinary tract infections. Minimum inhibitory concentration determination by Etest was performed for 205 Brazilian community urinary tract infection Escherichia coli strains from 2008 to 2012 and 74 E. coli bloodstream strains recovered from a surveillance study. Pharmacodynamic exposure was modeled via a 5000 subject Monte Carlo simulation. All isolates were susceptible to ertapenem and meropenem. Piperacillin/tazobactam, ceftriaxone and ciprofloxacin showed 100%, 97.5% and 83.3% susceptibility among outpatient isolates and 98.6%, 75.7% and 64.3% among inpatient isolates, respectively. Against outpatient isolates, all drugs except ciprofloxacin (82.7% in aggressive and 77.6% in conservative scenarios) achieved high cumulative fraction of response: carbapenems and piperacillin/tazobactam cumulative fraction of responses were close to 100%, and ceftriaxone cumulative fraction of response was 97.5%. Similar results were observed against inpatients isolates for carbapenems (100%) and piperacillin/tazobactam (98.4%), whereas ceftriaxone achieved only 76.9% bactericidal cumulative fraction of response and ciprofloxacin 61.9% (aggressive scenario) and 56.7% (conservative scenario) respectively. Based on this model, standard doses of beta-lactams were predicted to deliver sufficient pharmacodynamic exposure for outpatients. However, ceftriaxone should be avoided for inpatients and ciprofloxacin empirical prescription should be avoided in both inpatients and outpatients with complicated urinary tract

  1. Simultaneous determination of 14 β-lactam antibiotics in cosmetic products by liquid chromatography tandem mass spectrometry method

    Institute of Scientific and Technical Information of China (English)

    Cai Sheng Wu; Jin Lan Zhang; Yan Ling Qiao; Yi Lin Wang; Zhi Rong Chen

    2011-01-01

    In this study, a simple and rapid high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS) method was established and validated to determine the 14 β-lactam antibiotics in cosmetic products, including 1 (ceftazidime), 2 (cefaclor), 3 (cefdinir), 4 (ampicillin), 5 (cefalexin), 6 (ceftezole), 7 (cefotaxim), 8 (cefradine), 9 (cefuroxime), 10 (cephazoline), 11 (cefathiamidine), 12 (cefoperazone), 13 (cafalotin), 14 (piperacillin).

  2. Multidrug-Resistant Bacterial Colonization of Combat-Injured Personnel at Admission to Medical Centers After Evacuation from Afghanistan and Iraq

    Science.gov (United States)

    2011-07-01

    Tobramycin -lactams Ampicillin/sulbactam Piperacillin/tazobactam Ceftazidime Cefepime Carbapenems Imipenem/cilastatin Meropenem Fluoroquinolones ... antibiotics .8,17,18 Our results also support a shift in the MDRO threat from ACB to ESBL-producing E. coli and Klebsiella species. This is supportive...Wilkins S55 broad-spectrum antibiotics .14,24 Two missions have been con- ducted specifically to review the infection control challenges and practice at

  3. A Galleria mellonella infection model reveals double and triple antibiotic combination therapies with enhanced efficacy versus a multidrug-resistant strain of Pseudomonas aeruginosa.

    Science.gov (United States)

    Krezdorn, Jessica; Adams, Sophie; Coote, Peter J

    2014-07-01

    The aim of this study was to compare the inhibitory effect of antibiotic combinations in vitro with efficacy in Galleria mellonella larvae in vivo to identify efficacious combinations that target Pseudomonas aeruginosa. P. aeruginosa NCTC 13437, a multidrug-resistant strain resistant to β-lactams and aminoglycosides, was used. Susceptibility to cefotaxime, piperacillin, meropenem, amikacin, levofloxacin and colistin alone, or in dual or triple combinations, was measured in vitro via a 24 h time-kill assay. In vitro results were then compared with the efficacy of the same dual or triple antibiotic combinations versus G. mellonella larvae infected with P. aeruginosa. G. mellonella haemolymph burden of P. aeruginosa was determined over 96 h post-infection and treatment with the most potent combination therapies. Many dual and triple combinations of antibiotics displayed synergistic inhibition of multidrug-resistant P. aeruginosa in vitro. There was little correlation between combinations that were synergistic in vitro and those that showed enhanced efficacy in vivo versus infected G. mellonella larvae. The most potent dual and triple combinations in vivo were cefotaxime plus piperacillin, and meropenem plus piperacillin and amikacin, respectively. Fewer combinations were found to offer enhanced therapeutic benefit in vivo compared with in vitro. The therapeutic benefit arising from treatment with antibiotic combinations in vivo correlated with reduced larval burden of P. aeruginosa. This study has identified antibiotic combinations that merit further investigation for their clinical potential and has demonstrated the utility of using G. mellonella to screen for novel antibiotic treatments that demonstrate efficacy in vivo.

  4. Changes in antibiotic usage and susceptibility in nosocomial Enterobacteriaceae and Pseudomonas isolates following the introduction of ertapenem to hospital formulary.

    Science.gov (United States)

    Graber, C J; Hutchings, C; Dong, F; Lee, W; Chung, J K; Tran, T

    2012-01-01

    There is concern that widespread usage of ertapenem may promote cross-resistance to other carbapenems. To analyse the impact that adding ertapenem to our hospital formulary had on usage of other broad-spectrum agents and on susceptibilities of nosocomial Enterobacteriaceae and Pseudomonas isolates, we performed interrupted time-series analyses to determine the change in linear trend in antibiotic usage and change in mean proportion and linear trend of susceptibility pre- (March 2004-June 2005) and post- (July 2005-December 2008) ertapenem introduction. Usage of piperacillin-tazobactam (P=0·0013) and ampicillin-sulbactam (P=0·035) declined post-ertapenem introduction. For Enterobacteriaceae, the mean proportion susceptible to ciprofloxacin (P=0·016) and piperacillin-tazobactam (P=0·038) increased, while the linear trend in susceptibility significantly increased for cefepime (P=0·012) but declined for ceftriaxone (P=0·0032). For Pseudomonas, the mean proportion susceptible to cefepime (P=0·011) and piperacillin-tazobactam (P=0·028) increased, as did the linear trend in susceptibility to ciprofloxacin (P=0·028). Notably, no significant changes in carbapenem susceptibility were observed.

  5. Pharmacokinetics of piperacillan after intramuscular injection in red-tailed hawks (Buteo jamaicensis) and great horned owls (Bubo virginianus).

    Science.gov (United States)

    Robbins, P K; Tell, L A; Needham, M L; Craigmill, A L

    2000-03-01

    This study characterized and compared the pharmacokinetics of piperacillin after single 100 mg/kg i.m. injections in nine red-tailed hawks (Buteo jamaicensis) and five great horned owls (Bubo virginianus) over 48 hr by a modified agar well diffusion microbial inhibition assay. The mean maximum plasma piperacillin concentrations were 204 microg/ml and 221 microg/ml for the hawks and owls, respectively, and times of maximum concentrations were 15 min and 30 min, respectively. The calculated mean terminal elimination half-lives were 77 min in the hawks and 118 min in the owls. Area-under-the-curve values were 218 +/- 52 microg x hr/ml in the hawks and 444 +/- 104 microg x hr/ml in the owls. On the basis of the most common minimal inhibitory concentration (90%) for various bacterial isolates from clinical samples of 8 microg/ml, analysis of the data suggests that the maximum dosing interval for piperacillin at 100 mg/kg in medium sized raptors should be 4-6 hr.

  6. Comparative antimicrobial susceptibility of aerobic and facultative bacteria from community-acquired bacteremia to ertapenem in Taiwan

    Directory of Open Access Journals (Sweden)

    Fung Chang-Phone

    2007-07-01

    Full Text Available Abstract Background Ertapenem is a once-a-day carbapenem and has excellent activity against many gram-positive and gram-negative aerobic, facultative, and anaerobic bacteria. The susceptibility of isolates of community-acquired bacteremia to ertapenem has not been reported yet. The present study assesses the in vitro activity of ertapenem against aerobic and facultative bacterial pathogens isolated from patients with community-acquired bacteremia by determining and comparing the MICs of cefepime, cefoxitin, ceftazidime, ceftriaxone, ertapenem, piperacillin, piperacillin-tazobactam, ciprofloxacin, amikacin and gentamicin. The prevalence of extended broad spectrum β-lactamases (ESBL producing strains of community-acquired bacteremia and their susceptibility to these antibiotics are investigated. Methods Aerobic and facultative bacteria isolated from blood obtained from hospitalized patients with community-acquired bacteremia within 48 hours of admission between August 1, 2004 and September 30, 2004 in Chang Gung Memorial Hospital at Keelung, Taiwan, were identified using standard procedures. Antimicrobial susceptibility was evaluated by Etest according to the standard guidelines provided by the manufacturer and document M100-S16 Performance Standards of the Clinical Laboratory of Standard Institute. Antimicrobial agents including cefepime, cefoxitin, ceftazidime, ceftriaxone, ertapenem, piperacillin, piperacillin-tazobactam, ciprofloxacin, amikacin and gentamicin were used against the bacterial isolates to test their MICs as determined by Etest. For Staphylococcus aureus isolates, MICs of oxacillin were also tested by Etest to differentiate oxacillin-sensitive and oxacillin-resistant S. aureus. Results Ertapenem was highly active in vitro against many aerobic and facultative bacterial pathogens commonly recovered from patients with community-acquired bacteremia (128/159, 80.5 %. Ertapenem had more potent activity than ceftriaxone, piperacillin

  7. [Analysis of drug resistance of Acinetobacter baumannii in wound of children with traffic injury and its relationship with antibiotic use].

    Science.gov (United States)

    Liu, S; Wang, C; Fu, Y X

    2017-07-20

    Objective: To know the drug resistance of Acinetobacter baumannii (AB) in wound of children with traffic injury and its relationship with antibiotic use. Methods: Wound exudate of 226 children with traffic injury admitted to our unit from January 2010 to December 2015 were collected. API bacteria identification panels and fully automatic microbiological identification system were used to identify pathogens. Kirby-Bauer paper disk diffusion method was used to detect the drug resistance of pathogens to 18 antibiotics including amoxycillin/clavulanic acid, piperacillin/tazobactam, and imipenem. The detection situation of pathogen of children's wounds and drug resistance of detected AB to 18 antibiotics in each year were collected. Forty-six AB positive children (2 children excluded) were divided into imipenem-resistant group (IR, n=19) and non imipenem-resistant group (NIR, n=25) according to whether AB was 100% resistant to imipenem. Drug resistance of AB in wounds of children to 18 antibiotics in two groups was compared. The antibiotic use of AB positive children was collected, and the antibiotic use intensity of children in two groups was compared. Data were processed with Fisher's exact test, independent sample t test, and corrected t test. Results: (1) The detection rates of pathogen in wounds of children in 2010-2015 were 95.6% (43/45), 89.8% (53/59), 81.3% (148/182), 81.1% (107/132), 81.6% (120/147), and 77.5% (62/80), respectively, showing a trend of decreasing year by year. A total of 665 strains and 75 pathogens were detected, and the top 5 pathogens with detection rate from high to low were AB, Pseudomonas aeruginosa, Enterobacter cloacae, Staphylococcus epidermidis, and Escherichia coli, respectively. (2) Drug resistance rates of AB to amoxycillin/clavulanic acid, cefazolin, aztreonam, and piperacillin were all 100%, while AB was 100% sensitive to polymyxin, and the total drug resistance rates of AB to the other 13 antibiotics were all above 50%. The drug

  8. Sequential antibiotic and growth factor releasing chitosan-PAAm semi-IPN hydrogel as a novel wound dressing.

    Science.gov (United States)

    Pulat, Mehlika; Kahraman, Anıl Sera; Tan, Nur; Gümüşderelioğlu, Menemşe

    2013-01-01

    The aim of this study is to prepare a novel wound dressing material which provides burst release of an antibiotic in combination with sustained release of growth factor delivery. This might be beneficial for the prevention of infections and to stimulate wound healing. As a wound dressing material, the semi-interpenetrating network (semi-IPN) hydrogel based on polyacrylamide (PAAm) and chitosan (CS) was synthesized via free radical polymerization. Ethylene glycol dimethacrylate was used for cross-linking of PAAm to form semi-IPN hydrogel. The hydrogel shows high water content (∼1800%, in dry basis) and stable swelling characteristics in the pH range of the wound media (∼4.0-7.4). The antibiotic, piperacillin-tazobactam, which belongs to the penicillin group was loaded into the hydrogel. The therapeutic serum dose of piperacillin-tazobactam for topic introduction was reached at 1st hour of the release. Additionally, in order to increase the mitogenic activity of hydrogel, epidermal growth factor (EGF) was embedded into the CS-PAAm in different amounts. Cell culture studies were performed with L929 mouse fibroblasts and the simulated cell growth was investigated by 3-(4,5-dimethylthiazol-2-yl)-diphenyltetrazolium bromide assay. The successful sustained release behavior of CS-PAAm hydrogel for EGF maintained the presence of EGF in the culture up to 5 days and the highest mitochondrial activities were recorded for the 0.4 μg EGF-loaded/mg of hydrogel group. In conclusion, CS-PAAm semi-IPN hydrogel loaded with piperacillin-tazobactam and EGF could be proposed for an effective system in wound-healing management.

  9. Cefepime restriction improves gram-negative overall resistance patterns in neonatal intensive care unit

    Directory of Open Access Journals (Sweden)

    Orlei Ribeiro de Araujo

    Full Text Available Antibiotic restriction can be useful in maintaining bacterial susceptibility. The objective of this study was verify if restriction of cefepime, the most frequently used cephalosporin in our neonatal intensive care unit (NICU, would ameliorate broad-spectrum susceptibility of Gram-negative isolates. Nine hundred and ninety-five premature and term newborns were divided into 3 cohorts, according to the prevalence of cefepime use in the unit: Group 1 (n=396 comprised patients admitted from January 2002 to December 2003, period in which cefepime was the most used broad-spectrum antibiotic. Patients in Group 2 (n=349 were admitted when piperacillin/tazobactam replaced cefepime (January to December 2004 and in Group 3 (n=250 when cefepime was reintroduced (January to September 2005. Meropenem was the alternative third-line antibiotic for all groups. Multiresistance was defined as resistance to 2 or more unrelated antibiotics, including necessarily a third or fourth generation cephalosporin, piperacillin/tazobactam or meropenem. Statistics involved Kruskal-Wallis, Mann-Whitney and logrank tests, Kaplan-Meier analysis. Groups were comparable in length of stay, time of mechanical ventilation, gestational age and birth weight. Ninety-eight Gram-negative isolates were analyzed. Patients were more likely to remain free of multiresistant isolates by Kaplan-Meier analysis in Group 2 when compared to Group 1 (p=0.017 and Group 3 (p=0.003. There was also a significant difference in meropenem resistance rates. Cefepime has a greater propensity to select multiresistant Gram-negative pathogens than piperacillin/tazobactam and should not be used extensively in neonatal intensive care.

  10. Cefepime restriction improves gram-negative overall resistance patterns in neonatal intensive care unit

    Directory of Open Access Journals (Sweden)

    Orlei Ribeiro de Araujo

    2007-04-01

    Full Text Available Antibiotic restriction can be useful in maintaining bacterial susceptibility. The objective of this study was verify if restriction of cefepime, the most frequently used cephalosporin in our neonatal intensive care unit (NICU, would ameliorate broad-spectrum susceptibility of Gram-negative isolates. Nine hundred and ninety-five premature and term newborns were divided into 3 cohorts, according to the prevalence of cefepime use in the unit: Group 1 (n=396 comprised patients admitted from January 2002 to December 2003, period in which cefepime was the most used broad-spectrum antibiotic. Patients in Group 2 (n=349 were admitted when piperacillin/tazobactam replaced cefepime (January to December 2004 and in Group 3 (n=250 when cefepime was reintroduced (January to September 2005. Meropenem was the alternative third-line antibiotic for all groups. Multiresistance was defined as resistance to 2 or more unrelated antibiotics, including necessarily a third or fourth generation cephalosporin, piperacillin/tazobactam or meropenem. Statistics involved Kruskal-Wallis, Mann-Whitney and logrank tests, Kaplan-Meier analysis. Groups were comparable in length of stay, time of mechanical ventilation, gestational age and birth weight. Ninety-eight Gram-negative isolates were analyzed. Patients were more likely to remain free of multiresistant isolates by Kaplan-Meier analysis in Group 2 when compared to Group 1 (p=0.017 and Group 3 (p=0.003. There was also a significant difference in meropenem resistance rates. Cefepime has a greater propensity to select multiresistant Gram-negative pathogens than piperacillin/tazobactam and should not be used extensively in neonatal intensive care.

  11. MULTIPLE LIVER ABSCESS BY MIXED BACTERIAL ETIOLOGY: AN UNUSUAL CASE REPORT

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    Mannur

    2012-11-01

    Full Text Available ABSTRACT: Pyogenic liver abscess is a serious disease, which is potentially fatal if left untreated. In developed countries, pyogenic abscesses are the most common but worldwide, amoebae are the most common cause. We report a 60-ye ar-old diabetic woman with a 2 months history of pain abdomen, 1 month history of high fev er and anorexia who had multiple liver abscess caused by anaerobic Actinomyces species and Enterococcus faecalis and was complicated by peritonitis. Treatment included prompt percutaneous drainage coupled with long-term intravenous administration of Amikacin, M etronidazole and Piperacillin/ Tazobactum. The patient later died due to peritoniti s.

  12. Detection of AmpC Beta-Lactamase in Escherichia coli: Comparison of Three Phenotypic Confirmation Assays and Genetic Analysis▿†

    OpenAIRE

    Peter-Getzlaff, S; Polsfuss, S; Poledica, M.; Hombach, M.; Giger, J.; Böttger, E C; Zbinden, R.; Bloemberg, G. V.

    2011-01-01

    Two mechanisms account for AmpC activity in Escherichia coli, namely, mutations in the ampC promoter and attenuator regions resulting in ampC overexpression and acquisition of plasmid-carried ampC genes. In this study, we analyzed 51 clinical E. coli isolates with reduced susceptibility to amoxicillin-clavulanic acid, piperacillin-tazobactam, or extended-spectrum cephalosporins for the presence of AmpC production. Three phenotypic AmpC confirmation assays (cefoxitin-cloxacillin disk diffusion...

  13. A Case of Liver Abscess with Desulfovibrio desulfuricans Bacteremia

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    Saho Koyano

    2015-01-01

    Full Text Available Desulfovibrio spp. are gram-negative, sulfate-reducing, and anaerobic bacteria found in the digestive tract of humans. Because Desulfovibrio spp. are infrequent causative agents of infectious diseases and are difficult to isolate and to identify from clinical specimens, the appropriate antibiotic therapy to infection with Desulfovibrio spp. has not been determined. We report the first case of liver abscess with bacteremia due to Desulfovibrio desulfuricans to show the clinical presentation and treatment. The patient was successfully treated with intravenous piperacillin-tazobactam and oral amoxicillin-clavulanic acid.

  14. Susceptibility of meropenem and comparators tested against 30,634 Enterobacteriaceae isolated in the MYSTIC Programme (1997-2003).

    Science.gov (United States)

    Turner, Philip J

    2004-12-01

    A total of 30,634 global Enterobacteriaceae isolates collected from the MYSTIC (Meropenem Yearly Surveillance Test Information Collection) Programme were tested using a reference methodology against meropenem and seven other broad-spectrum agents commonly used in the hospital setting (1997-2003). The most active compound was meropenem (99.6% susceptible), followed by imipenem (98.4%), cefepime (94.0%), gentamicin (86.8%), piperacillin/tazobactam (85.8%), ceftazidime (85.0%), ciprofloxacin (84.6%), and tobramycin (84.5%). Continued surveillance of antimicrobial compounds' in vitro activity is necessary to recommend regimens that are likely to be effective in clinical practice.

  15. Meropenem in cystic fibrosis patients infected with resistant Pseudomonas aeruginosa or Burkholderia cepacia and with hypersensitivity to beta-lactam antibiotics

    DEFF Research Database (Denmark)

    Ciofu, Oana; Jensen, Tim; Pressler, Tacjana

    1996-01-01

    OBJECTIVE: To assess the efficacy and safety of meropenem, administered on a compassionate basis to 62 cystic fibrosis (CF) patients (age: 24plus minus6 years) with hypersensitivity reactions to beta-lactam antibiotics and/or infection by bacteria resistant to other antibiotics. METHODS: Fifty......), ciprofloxacin 1.2 (9.7), piperacillin 49 (16.3), ceftazidime 26 (23), aztreonam 26 (35), imipenem 6.4 (not determined) and meropenem 5.1 (4.8). No statistically significant increase in the MICs of meropenem for either pathogen occurred during therapy. Of the 124 courses, 115 were tolerated without any clinical...

  16. [Antimicrobial sensitive of Morganella morganii].

    Science.gov (United States)

    Zalas-Wiecek, Patrycja; Michalska, Anna; Sielska, Barbara; Gospodarek, Eugenia

    2011-01-01

    The aim of this study was the evaluation of the antimicrobial sensitive of Morganella morganii rods isolated from clinical samples. This study included 50 of M. morganii strains isolated in the Clinical Microbiology Department of dr. A. Jurasz University Hospital in 2008-2009. All of strains were sensitive to carbapenems (imipenem, meropenem, ertapenem, doripenem) and piperacillin/tazobactam and most of them to beta-lactam antibiotics, aminoglycosides and fluorochinolons. Resistance to tetracyclines demonstrated 38,0% strains and to doxycycline - 40,0%. One out of 6 strains isolated from urine samples were sensitive to nitrofurantoin. Extended Spectrum Beta-Lactamases were produced by 5 (10,0%) strains.

  17. Clinically significant anaerobic bacteria isolated from patients in a South African academic hospital: antimicrobial susceptibility testing.

    Science.gov (United States)

    Naidoo, S; Perovic, O; Richards, G A; Duse, A G

    2011-09-27

    BACKGROUND. Increasing resistance to some antimicrobial agents among anaerobic bacteria has made susceptibility patterns less predictable. METHOD. This was a prospective study of the susceptibility data of anaerobic organisms isolated from clinical specimens from patients with suspected anaerobic infections from June 2005 until February 2007. Specimens were submitted to the microbiology laboratory at Charlotte Maxeke Johannesburg Academic Hospital, where microscopy, culture and susceptibility testing were performed the using E test® strip minimum inhibitory concentration method. Results were interpreted with reference to Clinical and Laboratory Standards Institute guidelines for amoxicillin-clavulanate, clindamycin, metronidazole, penicillin, ertapenem, cefoxitin, ceftriaxone, chloramphenicol and piperacillin-tazobactam. RESULTS. One hundred and eighty anaerobic isolates were submitted from 165 patients. The most active antimicrobial agents were chloramphenicol (100% susceptible), ertapenem (97.2%), piperacillin-tazobactam (99.4%) and amoxicillin-clavulanic acid (96.7%). Less active were metronidazole (89.4%), cefoxitin (85%), clindamycin (81.7%), ceftriaxone (68.3%) and penicillin (33.3%). CONCLUSION. Susceptibility testing should be performed periodically to identify emerging trends in resistance and to modify empirical treatment of anaerobic infections.

  18. IDENTIFICATION AND ANTIBIOTIC RESISTANCE PROFILE OFENTEROBACTERIACEAE SPECIES AND LACTOBACILLUS SPP. ISOLATED FROM HONEY BEES (APIS MELLIFERA DIGESTIVE TRACT

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    Lukáš Hleba

    2014-02-01

    Full Text Available Honey bees play important role in agricultural environment as main pollinators. Its important for many agricultural and wild plants. Also honey bee are producers of honey, which is consumed directly and it should be not a heat treatment. Many bacteria can be survive in honey for long time. Some of these bacteria are human and animal facultative pathogens, including Enterobactericaeae genera. If these bacteria contain antibiotic resistant genes than it can to leads to troubles in healing of some of bacterial infections. Lactobacillus spp. can be a reservoir of resistant genes for pathogenic bacterial strains. In this study we isolated Enterobacteriaceae strains from digestive tracts of honey bees. These strains was tested to the eight selected antibiotics by disc diffusion method and strains were indentified by MALDI TOF MS Biotyper. From this study we determined resistance to piperacillin in the highest level. Equally, we determined that Citrobacter gillenii was resistant to three antibiotics (piperacillin, chloramphenicol and levofloxacin from eight. Resistance to other antibiotics were determined in low levels and other indentified bacteria were resistant to one antibiotic, if any. Also we detected resistance in Lactobacillus spp. and determined MICs distribution for some selected antibiotics. For absence of similar studies we could not to discuss our results and we think that further experiments and studies are needed.

  19. Comparative Evaluation of the in-vitro Activity of Six β-lactam/β-lactamase Inhibitor Combinations against Gram Negative Bacilli.

    Science.gov (United States)

    Sood, Smita

    2013-02-01

    The extensive use of the β-lactam antibiotics in hospitals and in the community has created major resistance problems which has led to increased morbidity, mortality and healthcare costs. The use of the β-lactamase inhibitors in combination with the β-lactam antibiotics is currently the most successful strategy used for circumventing the resistance mechanisms. To evaluate the in-vitro activity of six commercially available β-lactam/β-lactamase inhibitor combinations against Gram Negative Bacilli (GNB). A total of 384 non duplicate, consecutive, gram negative bacilli (278 Enterobacteriaceae and 106 non fermenters) isolated from various clinical samples were subjected to antimicrobial sensitivity testing by the Kirby-Bauer method. The following β-lactam/β-lactamase inhibitor combinations were tested: amoxycillin-clavulanic acid, ampicillin-sulbactam, cefoperazonesulbactam, piperacillin-tazobactam, cefepime-tazobactam and ticarcillin-clavulanic acid. Against the Enterobacteriacae, the sensitivity of Cefepime- tazobactam was 90. 64%, followed by Cefoperazone-sulbactam (84.89%) and Piperacillin - tazobactam (53.95 %). The sensitivity of the non fermenters was the highest for Cefepime- tazobactam (49.04%) and was least for Ampicillin-sulbactam and Amoxycillinclavulanic acid (4.71% each). Cefepime-tazobactam was sensitive for all the extended spectrum β-lactamase (ESBL) isolates. Among the six β-lactam/β-lactamase inhibitor combinations tested, Cefepime-tazobactam exhibited the best in-vitro activity against the gram negative bacilli isolated at our centre.

  20. [Post-operative bacteremia caused by multidrug-resistant Aerococcus viridans in a patient with gall bladder cancer].

    Science.gov (United States)

    Tekin Koruk, Süda; Bayraktar, Mehmet; Ozgönül, Abdullah; Tümer, Seray

    2010-01-01

    Aerococcus viridans is a gram-positive, catalase and oxidase negative, microaerophylic and non-motile coccus which is rarely associated with human infections such as endocarditis, meningitis, artritis and bacteremia. We report a case of bacteremia due to A. viridans in a 61-years-old man with malignant gall bladder neoplasm. The patient underwent a surgical operation and on the 5th day of operation he had severe abdominal pain, vomiting, high fever and discharge from operation site. He was transferred to intensive care unit and blood cultures were obtained. Piperacillin-tazobactam was initiated as empirical therapy. Blood cultures performed in Bactec system (Becton Dickinson, USA) yielded catalase negative, gram-positive cocci in tetrads. The isolate was pyrrolidonyl aminopeptidase (PYR) positive and produced alfa-hemolysis on sheep blood agar. These cocci were identified as A. viridans by Vitek 2 Compact System (BioMerieux, France) and identification was confirmed by using mini API System (BioMerieux, France). Antibiotic susceptibility testing performed with Kirby-Bauer disk diffusion method revealed that the isolate was susceptible to trimethoprim-sulfamethoxazole, tigecycline and vancomycin and resistant to penicillin, ampicillin, piperacillin-tazobactam, ceftriaxone, erythromycin, clindamycin and amikacin. The patient was successfully treated with vancomycin (2 x 1 g/day) and completely recovered without complication. In conclusion, A. viridans should be suspected as an opportunistic pathogen in immunocompromised patients and these patients should be treated according to the antibiotic susceptibility test results.

  1. The determination of resistance to ertapenem and other antibiotics with ESBL product of Enterobacteriaceae isolated from urine samples

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    Aytekin Çıkman

    2014-09-01

    Full Text Available Objective: Enterobacteriaceae is the most frequently isolated bacteria in urinary system infections. This study investigated the antibiotic susceptibility including ertapenem and extended-spectrum beta-lactamase production of bacteria belons to Enterobacteriaceae isolated from the urinary culture. Methods: Enterobacteriaceae strains, identified by using conventional methods in our laboratory between January 2012 and March 2012, were included the study. The antibiotic susceptibilities were investigated with the KirbyBauer disc diffusion method and the ESBL productions were examined with the double-disc synergy method in accordance with the suggestions of Clinical and Laboratory Standards Institute. Results:In the study, a total of 148 strains were isolated (117 E.coli, 23 Klebsiella spp. and 4 Proteus spp. and 4 Enterobacter spp.. While 26 of E.coli strains (22%, and 8 of Klebsiella spp. strains (35% were considered ESBL positive, no ESBL roduction was determined for Proteus spp. and Enterobacter spp. strains. All the isolated strains were found to be susceptible to ertapenem and meropenem. Amikacin, piperacillin-tazobactam and cefoxitin were determined to be other antibiotics with the greatest effect on Enterobacteriaceae species. Conclusion: Ertapenem was observed to be alternative in the treatment of Enterobacteriaceae isolated from the urinary culture. Carbapenems in particular, amikacin, piperacillin-tazobactam and cefoxitin were found to be the most effective antibiotics in the treatment of this infection.

  2. [Not Available].

    Science.gov (United States)

    Calbiac, Pascale De; Lamoureux, Fabien; Pourrat, Xavier; Bretault, Lydia; Marchand, Sophie; Grassin, Jacqueline; Antier, Daniel

    2006-01-01

    Treatment of Bronchial Superinfections: Data Related to Stability of Antibiotics in Portable Pumps. Given many data about the stability of antibiotics in portable pump (elastomer) are lacking, this study was designed to make a point about available data and to evaluate the stability of antibiotics when exposed to temperature within 35°C (average temperature measured in real conditions of use). First, to collect information about the stability of antibiotics in portable pump and to confront them with the local antibiotics protocols dedicated to the treatment of bronchial superinfection in patients with cystic fibrosis; second, to evaluate the stability of piperacillin associated with tazobactam at 35°C. While measured concentrations in tazobactam did not show significant variation during the study, piperacillin measurements showed a major reduction of concentration (up to 33%), both time and concentration related to. Such information must be pointed out to prescribers and patients to ensure a cold accumulator is placed in the pump can'ying-bag and to limit the duration of infusion to 24h with a single pump. This experimental program will keep on going with the stability study of both ticarcillin and cefsulodin in portable pump. Copyright © 2006 Société Française de Pharmacologie et de Thérapeutique. Publié par Elsevier Masson SAS.

  3. Utilizing Monte Carlo Simulations to Optimize Institutional Empiric Antipseudomonal Therapy

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    Sarah J. Tennant

    2015-12-01

    Full Text Available Pseudomonas aeruginosa is a common pathogen implicated in nosocomial infections with increasing resistance to a limited arsenal of antibiotics. Monte Carlo simulation provides antimicrobial stewardship teams with an additional tool to guide empiric therapy. We modeled empiric therapies with antipseudomonal β-lactam antibiotic regimens to determine which were most likely to achieve probability of target attainment (PTA of ≥90%. Microbiological data for P. aeruginosa was reviewed for 2012. Antibiotics modeled for intermittent and prolonged infusion were aztreonam, cefepime, meropenem, and piperacillin/tazobactam. Using minimum inhibitory concentrations (MICs from institution-specific isolates, and pharmacokinetic and pharmacodynamic parameters from previously published studies, a 10,000-subject Monte Carlo simulation was performed for each regimen to determine PTA. MICs from 272 isolates were included in this analysis. No intermittent infusion regimens achieved PTA ≥90%. Prolonged infusions of cefepime 2000 mg Q8 h, meropenem 1000 mg Q8 h, and meropenem 2000 mg Q8 h demonstrated PTA of 93%, 92%, and 100%, respectively. Prolonged infusions of piperacillin/tazobactam 4.5 g Q6 h and aztreonam 2 g Q8 h failed to achieved PTA ≥90% but demonstrated PTA of 81% and 73%, respectively. Standard doses of β-lactam antibiotics as intermittent infusion did not achieve 90% PTA against P. aeruginosa isolated at our institution; however, some prolonged infusions were able to achieve these targets.

  4. Pseudomembranous colitis and toxic megacolon due to C. difficile in an inpatient hospitalized for home accident

    Directory of Open Access Journals (Sweden)

    Piergiorgio Chiriacò

    2015-05-01

    Full Text Available Clostridium difficile infection (CDI is the main cause of hospital-acquired diarrhea. It can result in symptoms ranging from moderate diarrhea to pseudomembranous colitis. Among the risk factors, there is antibiotic therapy, responsible for intestinal flora disruption.A 72-year-old man presented to the Emergency Room for a home accident, a fall, that resulted in a cranio-facial trauma and tibio-tarsal fracture. He was administered cefazolin. Then he underwent surgery and the antibiotic therapy was switched to teicoplanin + levofloxacin; three days after, he started having diarrhea and mild fever. Rifaximin was added. A further exacerbation prompted the replacement of antibiotic therapy with tazobactam-piperacillin and metronidazole. Owing to the detection in fecal examination of CDI signs, tazobactam-piperacillin were replaced with vancomicin. Due to the persistence of symptoms, the worsening of physical conditions and the onset of pseudomembranous colitis and toxic megacolon, fidaxomicin therapy was started, with symptom resolution in few days. A patient’s follow-up at five months post-treatment showed no CDI recurrence.http://dx.doi.org/10.7175/cmi.v9i1s.1158

  5. Ventilator-associated pneumonia due to Shewanella putrefaciens.

    Science.gov (United States)

    Tucker, Calvin; Baroso, Genelyn; Tan, Paul

    2010-06-15

    The first reported U.S. case of ventilator-associated pneumonia evidently caused by Shewanella putrefaciens is described. A 39-year-old man with severe head trauma was found face down and unresponsive in a river after a watercraft accident. After being resuscitated and transferred to the intensive care unit, the patient received treatment for a subarachnoid hemorrhage and spinal injuries. The patient was also found to have decreased breath sounds bilaterally. On hospital day 7, bronchoalveolar lavage was performed due to acute febrile illness and thick pulmonary secretions. The patient was treated empirically with i.v. vancomycin and cefepime. The culture results suggested pneumonia due to methicillin-sensitive Staphylococcus aureus and colonization with Pseudomonas aeruginosa. The vancomycin and cefepime were replaced with nafcillin, after which the pneumonia resolved. The patient continued to be febrile, with leukocytosis on hospital day 14. A subsequent bronchoalveolar lavage culture performed that day revealed the presence of S. putrefaciens. According to the culture and susceptibility results, S. putrefaciens was resistant to ampicillin-sulbactam and exhibited sensitivity to cefepime, piperacillin, piperacillin-tazobactam, gentamicin, ciprofloxacin, levofloxacin, and meropenem. The patient received a 14-day course of cefepime, eliminating any further sign of the pathogen. Over the next two months, the patient's condition continued to improve, and he was eventually discharged to a rehabilitation facility. A 39-year-old man developed ventilator-associated pneumonia evidently caused by S. putrefaciens. The pneumonia resolved after treatment with cefepime.

  6. Evaluation of polymorphisms in pbp4 gene and genetic diversity in penicillin-resistant, ampicillin-susceptible Enterococcus faecalis from hospitals in different states in Brazil.

    Science.gov (United States)

    Infante, Victor Hugo Pacagnelli; Conceição, Natália; de Oliveira, Adriana Gonçalves; Darini, Ana Lúcia da Costa

    2016-04-01

    The aim of the present study was to verify whether penicillin-resistant, ampicillin-susceptible Enterococcus faecalis (PRASEF) occurred in Brazil prior to the beginning of the 21st century, and to verify whether ampicillin susceptibility can predict susceptibility to other β-lactams in E. faecalis with this inconsistent phenotype. The presence of polymorphisms in the pbp4 gene and genetic diversity among the isolates were investigated. Of 21 PRASEF analyzed, 5 (23.8%) and 4 (19.0%) were imipenem and piperacillin resistant simultaneously by disk diffusion and broth dilution respectively, contradicting the current internationally accepted standards of susceptibility testing. Sequencing of pbp4 gene revealed an amino acid substitution (Asp-573→Glu) in all PRASEF isolates but not in the penicillin-susceptible, ampicillin-susceptible E. faecalis. Most PRASEF (90.5%) had related pulsed-field gel electrophoresis profiles, but were different from other PRASEF described to date. Results demonstrate that penicillin-resistant, ampicillin-susceptible phenotype was already a reality in the 1990s in E. faecalis isolates in different Brazilian states, and some of these isolates were also imipenem- and piperacillin-resistant; therefore, internationally accepted susceptibility criteria cannot be applied to these isolates. According to pbp4 gene sequencing, this study suggests that a specific amino acid substitution in pbp4 gene found in all PRASEF analyzed is associated with penicillin resistance.

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

    Science.gov (United States)

    Hamze, Monzer; Dabboussi, Fouad; Izard, Daniel

    2003-01-01

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

  8. Respiratory infections by Achromobacter xylosoxidans in a cohort of Cystic Fibrosis patients: identification, antimicrobial susceptibility and molecular epidemiology

    Directory of Open Access Journals (Sweden)

    Antonietta Lambiase

    2010-03-01

    Full Text Available Pulmonary infections by Gram-negative bacteria such as Achromobacter xylosoxidans are recovered frequently in patients with Cystic Fibrosis. Aims of this study were to value the isolation frequency of A.xylosoxidans strains in a cohort of Cystic Fibrosis patients, to investigate their antimicrobial sensitivity and to establish possible clonal likeness among strains.A retrospective study was undertaken between January 2004 and December 2008 on 300 patients receiving care at the Regional Cystic Fibrosis Centre of “Federico II” University, Naples. Sputum samples were collected and selective media as well as commercial systems for bacterial identification were used. The activity of antimicrobial agents was determined using diffusion and micro-dilution methods. For DNA-fingerprinting, a genomic DNA macrorestriction followed by pulsed-field gel electrophoresis was carried out. A total of 238 strains from 51 patients were isolated. Strains were resistant to aztreonam, about half of these were resistant to gentamicin and trimethoprim-sulphamethoxazole. They were sensitive to piperacillin, piperacillin/tazobactam, and also to carbapenems, quinolones, cephalosporines. Macrorestriction analysis applied on some isolates showed substantial heterogeneity among strains.Actually, the prognostic role of A. xylosoxidans in Cystic Fibrosis is unclear, but this finding must imply difficulties on therapeutic approach. So, it is need to be on the look out regard such microorganisms. Preliminary results of DNA-fingerprinting indicate no evidence of clonal likeness and then of patient-to-patient spread.

  9. ESBL Detection: Comparison of a Commercially Available Chromogenic Test for Third Generation Cephalosporine Resistance and Automated Susceptibility Testing in Enterobactericeae.

    Science.gov (United States)

    El-Jade, Mohamed Ramadan; Parcina, Marijo; Schmithausen, Ricarda Maria; Stein, Christoph; Meilaender, Alina; Hoerauf, Achim; Molitor, Ernst; Bekeredjian-Ding, Isabelle

    2016-01-01

    Rapid detection and reporting of third generation cephalosporine resistance (3GC-R) and of extended spectrum betalactamases in Enterobacteriaceae (ESBL-E) is a diagnostic and therapeutic priority to avoid inefficacy of the initial antibiotic regimen. In this study we evaluated a commercially available chromogenic screen for 3GC-R as a predictive and/or confirmatory test for ESBL and AmpC activity in clinical and veterinary Enterobacteriaceae isolates. The test was highly reliable in the prediction of cefotaxime and cefpodoxime resistance, but there was no correlation with ceftazidime and piperacillin/tazobactam minimal inhibitory concentrations. All human and porcine ESBL-E tested were detected with exception of one genetically positive but phenotypically negative isolate. By contrast, AmpC detection rates lay below 30%. Notably, exclusion of piperacillin/tazobactam resistant, 3GC susceptible K1+ Klebsiella isolates increased the sensitivity and specificity of the test for ESBL detection. Our data further imply that in regions with low prevalence of AmpC and K1 positive E. coli strains chromogenic testing for 3GC-R can substitute for more time consuming ESBL confirmative testing in E. coli isolates tested positive by Phoenix or VITEK2 ESBL screen. We, therefore, suggest a diagnostic algorithm that distinguishes 3GC-R screening from primary culture and species-dependent confirmatory ESBL testing by βLACTATM and discuss the implications of MIC distribution results on the choice of antibiotic regimen.

  10. Mechanism of resistance and antibacterial susceptibility in extended-spectrum β-lactamase phenotype Klebsiella pneumoniae and Klebsiella oxytoca isolated between 2000 and 2010 in Japan.

    Science.gov (United States)

    Sato, Takafumi; Hara, Takafumi; Horiyama, Tsukasa; Kanazawa, Sachi; Yamaguchi, Takahiro; Maki, Hideki

    2015-05-01

    Clinical isolates of Klebsiella pneumoniae and Klebsiella oxytoca collected from 20 Japanese medical facilities between 2000 and 2010 were analysed to evaluate the mechanisms of resistance and antibacterial susceptibilities to 14 antimicrobials. Overall, eight of 484 (1.6%) K. pneumoniae and 19 of 359 (5.3%) K. oxytoca were determined to be extended-spectrum β-lactamase (ESBL) phenotype isolates, and the identified ESBLs amongst the K. pneumoniae isolates were CTX-M-2, -3, -14 and -15, and SHV-12. In contrast, overproduction of chromosomal β-lactamase OXY-2, which was due to a distinct mutation at the - 10 promoter region of this gene, conferred the ESBL phenotype to all the K. oxytoca isolates except one. Based on the Clinical and Laboratory Standards Institute breakpoints, all the ESBL phenotype K. pneumoniae were susceptible to doripenem, flomoxef, moxalactam (latamoxef), cefmetazole and tazobactam/piperacillin, whereas the ESBL phenotype K. oxytoca were susceptible to ceftazidime and ceftibuten in addition to the above, with the exception of tazobactam/piperacillin. Amongst the oral antimicrobials, ceftibuten was relatively effective against both ESBL phenotype Klebsiella species compared with levofloxacin and amoxicillin/clavulanic acid.

  11. Surveillance of Pseudomonas in COPD patients in a tertiary care hospital

    Directory of Open Access Journals (Sweden)

    Raakhee Baby T

    2015-05-01

    Full Text Available Background: Chronic pulmonary disease is increasing day by day due to lifestyle of general population. Smoking and air pollution are important factors. The present study was carried out to know the bacteriological profile of such cases. Methods: A total of 64 patients suffering with COPD were included in this study. Purulent sputum was collected from all the patients and subjected to routine bacteriological study. Culture positive were identified by routine bacteriological methods and antimicrobial susceptibility tests were performed using Kirby-Bauer disk diffusion method, MIC were determined following CLSI guidelines. Results: Out of 64 samples, 51 showed culture positive. Among aerobic bacteria, Pseudomonas was found to be predominant (54.05% which was immediately followed by Klebsiella (45.94%. Amikacin was found to be effective (90%, followed by imipenim (85% and trimethoprim (85%. The ureidopenicillin, piperacillin showed 70% sensitivity. All the strains were resistant to ampicillin and co-trimoxazole (100%. Conclusion: Antipseudomonal agents, imipenim and piperacillin were effective though slight resistance was noted. Therefore continuous monitoring of antipseudomonal agents is necessary to combat the development of resistance. Health education regarding smoking and air pollution needs to be strongly implemented. [Int J Res Med Sci 2015; 3(5.000: 1209-1212

  12. Pharmacokinetic-pharmacodynamic profiling of four antimicrobials against Gram-negative bacteria collected from Shenyang, China

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    Shang Hong

    2010-06-01

    Full Text Available Abstract Background To examine common antimicrobial regimens used in eradicating certain nosocomial Gram-negative pathogens and determine which ones are likely to be the most suitable as empirical choices in Shenyang, China. Methods A 5000-subject Monte Carlo simulation was conducted to determine the cumulative fraction of response (CFR for meropenem, imipenem, cefepime, piperacillin/tazobactam and levofloxacin against Escherichia coli, Klebsiella pneumoniae, Enterobacter cloacae, Acinetobacter baumannii and Pseudomonas aeruginosa collected in 2006 and 2007 from Shenyang. Results Meropenem and imipenem had the highest CFRs against the Enterobacteriaceae (97%-100%, followed by cefepime. No antibiotic simulated regimen achieved optimal CFR against P. aeruginosa and A. baumannii. Piperacillin/tazobactam dosed at 4.5 g q8h achieved the lowest CFR against all bacteria. Conclusions This study suggests that the carbapenems provide the greatest likelihood of clinical success for the Enterobacteriaceae, and combination therapy might be needed when choosing empirical therapy, especially when A. baumannii or P. aeruginosa are suspected.

  13. Mechanisms of interaction among subinhibitory concentrations of antibiotics, human polymorphonuclear neutrophils, and gram-negative bacilli.

    Science.gov (United States)

    Mandell, L A; Afnan, M

    1991-07-01

    Our hypothesis was that pretreatment of bacteria with subinhibitory concentrations (sub-MICs) of antibiotics enhances the susceptibility of the organisms to killing by human polymorphonuclear neutrophils (PMNs). Our purpose was to study a variety of drugs with different mechanisms of action and to determine whether the mechanism and locus of action altered the sub-MIC effect. The following outcome measures were used: ingestion and killing of bacteria by PMNs, bacterial killing in the absence of phagosome formation, and binding requirements of the bacteria to PMNs. The antibiotics used were representative of a variety of classes, including beta-lactams (piperacillin and imipenem) and quinolones (ciprofloxacin). Bacterial uptake and killing were measured by using standard techniques, and results were analyzed by using the analysis-of-variance technique and Dunnett's t test. Pretreatment of Escherichia coli with all drugs showed significantly enhanced killing of bacteria by PMNs, which was independent of ingestion by the phagocytes. Even in the absence of phagosome formation, statistically significant killing persisted with piperacillin-pretreated bacteria but not with imipenem- or ciprofloxacin-pretreated organisms. The opsonization experiments showed that contact between bacteria and PMNs was necessary for killing to occur. The sub-MIC effect appears to be independent of the locus or mechanism of action of the antibiotic. It results in enhanced killing by PMNs which is independent of ingestion and also may persist even in the absence of phagosome formation. Killing is dependent upon specific contact between bacteria and an intact phagocyte.

  14. ESBL Detection: Comparison of a Commercially Available Chromogenic Test for Third Generation Cephalosporine Resistance and Automated Susceptibility Testing in Enterobactericeae

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    El-Jade, Mohamed Ramadan; Parcina, Marijo; Schmithausen, Ricarda Maria; Stein, Christoph; Meilaender, Alina; Hoerauf, Achim; Molitor, Ernst

    2016-01-01

    Rapid detection and reporting of third generation cephalosporine resistance (3GC-R) and of extended spectrum betalactamases in Enterobacteriaceae (ESBL-E) is a diagnostic and therapeutic priority to avoid inefficacy of the initial antibiotic regimen. In this study we evaluated a commercially available chromogenic screen for 3GC-R as a predictive and/or confirmatory test for ESBL and AmpC activity in clinical and veterinary Enterobacteriaceae isolates. The test was highly reliable in the prediction of cefotaxime and cefpodoxime resistance, but there was no correlation with ceftazidime and piperacillin/tazobactam minimal inhibitory concentrations. All human and porcine ESBL-E tested were detected with exception of one genetically positive but phenotypically negative isolate. By contrast, AmpC detection rates lay below 30%. Notably, exclusion of piperacillin/tazobactam resistant, 3GC susceptible K1+ Klebsiella isolates increased the sensitivity and specificity of the test for ESBL detection. Our data further imply that in regions with low prevalence of AmpC and K1 positive E. coli strains chromogenic testing for 3GC-R can substitute for more time consuming ESBL confirmative testing in E. coli isolates tested positive by Phoenix or VITEK2 ESBL screen. We, therefore, suggest a diagnostic algorithm that distinguishes 3GC-R screening from primary culture and species-dependent confirmatory ESBL testing by βLACTATM and discuss the implications of MIC distribution results on the choice of antibiotic regimen. PMID:27494134

  15. Risk factors for Clostridium difficile-associated diarrhea among hospitalized adults with fecal toxigenic C. difficile colonization.

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    Lin, Hsiao-Ju; Hung, Yuan-Pin; Liu, Hsiu-Chuan; Lee, Jen-Chieh; Lee, Chih-I; Wu, Yi-Hui; Tsai, Pei-Jane; Ko, Wen-Chien

    2015-04-01

    Patients with toxigenic Clostridium difficile colonization (tCDC) are at risk of developing C. difficile-associated diarrhea (CDAD). However, the risk factors of hospitalized patients with tCDC developing CDAD are not clear. We conducted an 18-month prospective study at a medical ward in a district hospital in southern Taiwan. Within 48 hours of admission, weekly stool samples from asymptomatic hospitalized patients were obtained to detect fecal CDC. A polymerase chain reaction for tcdB was performed to determine toxigenic isolates. CDAD was diagnosed if the patient had diarrhea and toxigenic C. difficile present in a stool sample. A total 483 patients with stool samples were eligible for the study. Eighty-six (17.8%) patients had tCDC after screening, of whom 14 (16.3%) developed CDAD during follow-up. Among those with tCDC, patients with subsequent CDAD were more likely to have diabetes mellitus (p = 0.01) and to have received piperacillin-tazobactam (p = 0.04), or proton-pump inhibitors (PPIs; p = 0.04) than those without developing CDAD. The variables were statistically significant as determined by multivariate analysis. However, the 60-day crude mortality rates among tCDC patients with and without subsequent development of CDAD were similar. Diabetes mellitus and recent receipt of piperacillin-tazobactam or PPIs are independent risk factors for the development of CDAD among hospitalized patients with tCDC. Copyright © 2013. Published by Elsevier B.V.

  16. Relationship between pharmacokinetics and pharmacodynamics of beta-lactams and outcome.

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    Sádaba, B; Azanza, J R; Campanero, M A; García-Quetglas, E

    2004-11-01

    The in-vitro susceptibility of an organism and the pharmacokinetics of an antimicrobial agent are two basic factors on which the choice of standardised treatment regimens is based. However, the inter-individual variability of these factors, which modifies the exposure of bacteria to an antibiotic in terms of time and quantity, is not usually taken into account. In 87 patients treated with beta-lactams (ceftriaxone, cefepime or piperacillin), the probability of failure was greater when the infectious process was located in tissues with barriers to the distribution of beta-lactams. Mean MICs of piperacillin and cefepime, but not ceftriaxone, were below the breakpoints in cases of both recovery and failure, but organisms isolated from patients with a poor outcome had higher MICs. Therefore, the use of breakpoints to determine the susceptibility of microorganisms was not satisfactory in predicting the outcome for a large number of patients. If MICs are determined and plasma concentrations are monitored, dosages can be adjusted according to these parameters, thereby allowing antibiotic treatment to be individualised.

  17. Wound infections secondary to snakebite in central Taiwan

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    Li-Wen Huang

    2012-01-01

    Full Text Available There are very few microbiological data on wound infections following snakebites. The objective of this study was to investigate the treatment of secondary infection following snakebites in central Taiwan. Microbiological data and antibiotic sensitivity of wound cultures were retrospectively analyzed from December 2005 to October 2007 in a medical center in central Taiwan. A total of 121 snakebite patients participated in the study. Forty-nine (40.5% subjects were bitten by cobra (Naja atra; 34 of them had secondary infection, and 24 of them (70.6% needed surgical intervention. Cobra bites caused more severe bacterial infection than other snakebites. Morganella morganii was the most common pathogen, followed by Aeromonas hydrophila and Enterococcus. Gram-negative bacteria were susceptible to amikacin, trimethoprim/sulfamethoxazole, cefotaxime, cefepime, ciprofloxacin, and piperacillin/tazobactam. Enterococcus were susceptible to ampicillin, gentamicin, penicillin and vancomycin. It is reasonable to choose piperacillin/tazobactam, quinolone, second- or third-generation cephalosporin for empirical therapy following snakebite. Surgical intervention should be considered for invasive soft tissue infections.

  18. Antianaerobe activity of ceftobiprole, a new broad-spectrum cephalosporin.

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    Ednie, Lois; Shapiro, Stuart; Appelbaum, Peter C

    2007-05-01

    Agar dilution testing of 463 anaerobes showed most Gram-positive beta-lactamase-negative strains (other than some Clostridium difficile and Peptostreptococcus anaerobius), as well as both beta-lactamase-positive and beta-lactamase-negative strains of Fusobacterium nucleatum, to have ceftobiprole MIC values of Ceftobiprole was less active against beta-lactamase-positive Gram-negative bacilli, especially the members of the Bacteroides fragilis group. Like ceftobiprole, piperacillin was active mainly against beta-lactamase-negative strains, though MIC values for piperacillin were often 1 to 2 dilutions higher than for ceftobiprole. Carbapenems had MIC values < or =4 microg/L against all except some C. difficile and 2 strains of B. fragilis. All strains were susceptible to metronidazole, and all bacteria, except C. difficile and a single Bacteroides distasonis strain, were susceptible to chloramphenicol. Clindamycin resistance was seen in most anaerobe groups, whereas high moxifloxacin MICs were found mainly among the B. fragilis and Prevotella groups, and a few C. difficile and F. nucleatum strains.

  19. Evaluation of a Semiquantitative Matrix-Assisted Laser Desorption Ionization-Time of Flight Mass Spectrometry Method for Rapid Antimicrobial Susceptibility Testing of Positive Blood Cultures.

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    Jung, Jette S; Hamacher, Christina; Gross, Birgit; Sparbier, Katrin; Lange, Christoph; Kostrzewa, Markus; Schubert, Sören

    2016-11-01

    With the increasing prevalence of multidrug-resistant Gram-negative bacteria, rapid identification of the pathogen and its individual antibiotic resistance is crucial to ensure adequate antiinfective treatment at the earliest time point. Matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) mass spectrometry for the identification of bacteria directly from the blood culture bottle has been widely established; however, there is still an urgent need for new methods that permit rapid resistance testing. Recently, a semiquantitative MALDI-TOF mass spectrometry-based method for the prediction of antibiotic resistance was described. We evaluated this method for detecting nonsusceptibility against two β-lactam and two non-β-lactam antibiotics. A collection of 30 spiked blood cultures was tested for nonsusceptibility against gentamicin and ciprofloxacin. Furthermore, 99 patient-derived blood cultures were tested for nonsusceptibility against cefotaxime, piperacillin-tazobactam, and ciprofloxacin in parallel with MALDI-TOF mass spectrometry identification from the blood culture fluid. The assay correctly classified all isolates tested for nonsusceptibility against gentamicin and cefotaxime. One misclassification for ciprofloxacin nonsusceptibility and five misclassifications for piperacillin-tazobactam nonsusceptibility occurred. Identification of the bacterium and prediction of nonsusceptibility was possible within approximately 4 h.

  20. Prevalence of antimicrobial resistance among clinical isolates of Bacteroides fragilis group in Canada in 2010-2011: CANWARD surveillance study.

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    Karlowsky, James A; Walkty, Andrew J; Adam, Heather J; Baxter, Melanie R; Hoban, Daryl J; Zhanel, George G

    2012-03-01

    Clinical isolates of the Bacteroides fragilis group (n = 387) were collected from patients attending nine Canadian hospitals in 2010-2011 and tested for susceptibility to 10 antimicrobial agents using the Clinical and Laboratory Standards Institute (CLSI) broth microdilution method. B. fragilis (59.9%), Bacteroides ovatus (16.3%), and Bacteroides thetaiotaomicron (12.7%) accounted for ~90% of isolates collected. Overall rates of percent susceptibility were as follows: 99.7%, metronidazole; 99.5%, piperacillin-tazobactam; 99.2%, imipenem; 97.7%, ertapenem; 92.0%, doripenem; 87.3%, amoxicillin-clavulanate; 80.9%, tigecycline; 65.9%, cefoxitin; 55.6%, moxifloxacin; and 52.2%, clindamycin. Percent susceptibility to cefoxitin, clindamycin, and moxifloxacin was lowest for B. thetaiotaomicron (n = 49, 24.5%), Parabacteroides distasonis/P. merdae (n = 11, 9.1%), and B. ovatus (n = 63, 31.8%), respectively. One isolate (B. thetaiotaomicron) was resistant to metronidazole, and two isolates (both B. fragilis) were resistant to both piperacillin-tazobactam and imipenem. Since the last published surveillance study describing Canadian isolates of B. fragilis group almost 20 years ago (A.-M. Bourgault et al., Antimicrob. Agents Chemother. 36:343-347, 1992), rates of resistance have increased for amoxicillin-clavulanate, from 0.8% (1992) to 6.2% (2010-2011), and for clindamycin, from 9% (1992) to 34.1% (2010-2011).

  1. Changes in gram negative microorganisms’ resistance pattern during 4 years period in a referral teaching hospital; a surveillance study

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    Khalili Hossein

    2012-09-01

    Full Text Available Abstract Background and purpose Surveillance studies evaluating antimicrobial susceptibilities are of great value in preventing the spread of resistant pathogens by elucidating the trend of resistance in commonly used antibiotics and as a consequence providing information for prescribing the most appropriate agent. This study is a longitudinal antimicrobial resistance surveillance study designed to evaluate the trend in antimicrobial resistance to gram negative microorganisms from 2007 to 2010. Method During a four-year period (2007–2010 isolates derived from all patients admitted to infectious diseases ward of Imam Khomeini Hospital, the major referral center for infectious disease in Iran with the highest admission rates, were evaluated. Based on disk diffusion method and zone of inhibition size, the microorganism was regarded as to be sensitive, resistant or has intermediate susceptibility to the antimicrobial agents. Results The widest spread Gram-negative microorganism in all of isolates taken together in our study was E.coli (30% followed by Stenotrophomonas maltophilia in 28.6% and Enterobacter spp. in 11.9%, respectively. The susceptibility to amikacin, imipenem, piperacillin/tazobactam, and nitrofurantoin was equal or above 50% for all microorganisms over four years. However, the susceptibility to ampicillin, ampicillin/sulbactam, cefotaxim, and ceftriaxone was less than 50% in derived isolates during the study period. Conclusion In conclusion, the finding of the present study revealed that resistance rate to common antimicrobial agents in Iran is growing and isolates were susceptible mostly to broad-spectrum antibiotics including imipenem and piperacillin/tazobactam.

  2. Antimicrobial Susceptibilities of Aerobic and Facultative Gram-Negative Bacilli from Intra-abdominal Infections in Patients from Seven Regions in China in 2012 and 2013.

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    Zhang, Hui; Yang, Qiwen; Liao, Kang; Ni, Yuxing; Yu, Yunsong; Hu, Bijie; Sun, Ziyong; Huang, Wenxiang; Wang, Yong; Wu, Anhua; Feng, Xianju; Luo, Yanping; Hu, Zhidong; Chu, Yunzhuo; Chen, Shulan; Cao, Bin; Su, Jianrong; Gui, Bingdong; Duan, Qiong; Zhang, Shufang; Shao, Haifeng; Kong, Haishen; Badal, Robert E; Xu, Yingchun

    2015-10-19

    To evaluate the antimicrobial susceptibility of Gram-negative bacilli that caused hospital-acquired and community-acquired intra-abdominal infections (IAIs) in China between 2012 and 2013, we determined the susceptibilities to 12 antimicrobials and the extended-spectrum β-lactamase (ESBL) statuses of 3,540 IAI isolates from seven geographic areas in China in a central laboratory using CLSI broth microdilution and interpretive standards. Most infections were caused by Escherichia coli (46.3%) and Klebsiella pneumoniae (19.7%). Rates of ESBL-producing E. coli (P = 0.031), K. pneumoniae (P = 0.017), and Proteus mirabilis (P = 0.004) were higher in hospital-acquired IAIs than in community-acquired IAIs. Susceptibilities of enterobacteriaceae to ertapenem, amikacin, piperacillin-tazobactam, and imipenem were 71.3% to 100%, 81.3% to 100%, 64.7% to 100%, and 83.1% to 100%, respectively, but imipenem was ineffective against P. mirabilis (Zhe) area where the rates of carbapenem resistance were also highest. Ertapenem, amikacin, piperacillin-tazobactam, and imipenem are the most efficacious antibiotics for treating IAIs in China, especially those caused by E. coli or K. pneumoniae. Resistance to cephalosporins and carbapenems is more common in the Jiang-Zhe area than in other regions in China.

  3. Virulence and antimicrobial susceptibility of clinical and environmental strains of Aeromonas spp. from northeastern Brazil.

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    Castelo-Branco, Débora de Souza Collares Maia; Guedes, Glaucia Morgana de Melo; Brilhante, Raimunda Sâmia Nogueira; Rocha, Marcos Fábio Gadelha; Sidrim, José Júlio Costa; Moreira, José Luciano Bezerra; Cordeiro, Rossana de Aguiar; Sales, Jamille Alencar; Riello, Giovanna Barbosa; de Alencar, Lucas Pereira; Paiva, Manoel de Araújo Neto; Vasconcelos, David Caldas; de Menezes, Isis Sousa Bezerra; de Ponte, Yago Brito; Sampaio, Célia Maria de Souza; Monteiro, André Jalles; Bandeira, Tereza de Jesus Pinheiro Gomes

    2015-08-01

    The aims of the present study were to isolate and identify clinical and environmental strains of Aeromonas spp. by means of biochemical tests and the automated method VITEK 2 and to investigate the presence of the virulence genes cytotoxic enterotoxin (act), hemolysin (asa-1), and type III secretion system (ascV), and also the in vitro antimicrobial susceptibility of the strains. From the clinical isolates, 19 Aeromonas hydrophila, 3 Aeromonas veronii bv. sobria, and 1 Aeromonas caviae were identified, while from the environmental strains, 11 A. hydrophila, 22 A. veronii bv. sobria, 1 A. veronii bv. veronii, and 1 A. caviae were recovered. The gene act was detected in 69.5% of clinical isolates, asa-1 in 8.6%, and ascV in 34.7%. In the environmental strains, the detection rates were 51.4%, 45.7%, and 54.2% for the genes act, asa-1, and ascV, respectively. Resistance to amoxicillin-clavulanate and piperacillin-tazobactam was observed in 15 and 3 clinical strains, respectively, and resistance to ceftazidime, meropenem, imipenem, ciprofloxacin, and trimethoprim-sulfamethoxazole was observed in 1 strain for each drug. Resistance to amoxicillin-clavulanate and piperacillin-tazobactam was detected in 17 and 1 environmental strain, respectively. Higher resistance percentages were observed in clinical strains, but environmental strains also showed this phenomenon and presented a higher detection rate of virulence genes. Thus, it is important to monitor the antimicrobial susceptibility and pathogenic potential of the environmental isolates.

  4. Genetic Lineages and Antimicrobial Resistance in Pseudomonas spp. Isolates Recovered from Food Samples.

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    Estepa, Vanesa; Rojo-Bezares, Beatriz; Torres, Carmen; Sáenz, Yolanda

    2015-06-01

    Raw food is a reservoir of Pseudomonas isolates that could be disseminated to consumers. The presence of Pseudomonas spp. was studied in food samples, and the phenotypic and genotypic characterizations of the recovered isolates were analyzed. Two samples of meat (3%, turkey and beef) and 13 of vegetables (22%, 7 green peppers and 6 tomatoes) contained Pseudomonas spp. A total of 20 isolates were identified, and were classified as follows (number of isolates): P. aeruginosa (5), P. putida (5), P. nitroreducens (4), P. fulva (2), P. mosselli (1), P. mendocina (1), P. monteilii (1), and Pseudomonas sp. (1). These 20 Pseudomonas isolates were clonally different by pulsed-field-gel-electrophoresis, and were resistant to the following antibiotics: ticarcillin (85%), aztreonam (30%), cefepime (10%), imipenem (10%), and meropenem (5%), but were susceptible to ceftazidime, piperacillin, piperacillin-tazobactam, doripenem, gentamicin, tobramycin, amikacin, ciprofloxacin, norfloxacin, and colistin. Only one strain (Ps158) presented a class 1 integron lacking the 3' conserved segment. The five P. aeruginosa strains were typed by multilocus sequence typing in five different sequence-types (ST17, ST270, ST800, ST1455, and ST1456), and different mutations were detected in protein OprD that were classified in three groups. One strain (Ps159) showed a new insertion sequence (ISPa47) truncating the oprD gene, and conferring resistance to imipenem.

  5. Etiological and Resistance Profile of Bacteria Involved in Urinary Tract Infections in Young Children

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    Antonio Sorlózano-Puerto

    2017-01-01

    Full Text Available Background. The objective of this study was to identify the bacteria most frequently responsible for urinary tract infection (UTI in the population of under-2-year-olds in our geographic area and to evaluate the activity of antibiotics widely used for UTI treatment during a 4-year study period. Materials and Methods. A retrospective analysis was conducted of data on the identification and susceptibility of microorganisms isolated in urine samples from children under 2 years of age. Results. A total of 1,045 uropathogens were isolated. Escherichia coli accounted for the majority (60.3% of these, followed by Enterococcus faecalis (22.4% and Klebsiella spp. (6.5%. The highest E. coli susceptibility rates (>90% were to piperacillin-tazobactam, cefuroxime, cefotaxime, ceftazidime, imipenem, gentamicin, nitrofurantoin, and fosfomycin, and the lowest were to amoxicillin-clavulanic acid and cotrimoxazole. Among all bacteria isolated, we highlight the overall high activity of piperacillin-tazobactam, imipenem, nitrofurantoin, and fosfomycin against both community and hospital isolates and the reduced activity of amoxicillin-clavulanic acid, cephalosporins, gentamicin, and cotrimoxazole. There was no significant change in the total activity of any of the studied antibiotics over the 4-year study period. Conclusion. Empiric treatment with amoxicillin-clavulanic acid, cotrimoxazole, cephalosporins, and gentamicin may be inadequate due to their limited activity against uropathogens in our setting.

  6. Results of high-risk neutropenia therapy of hematology–oncology patients in a university hospital in Uruguay

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    Boada Burutaran, Matilde; Guadagna, Regina; Grille, Sofia; Stevenazzi, Mariana; Guillermo, Cecilia; Diaz, Lilian

    2014-01-01

    Background Febrile neutropenia is an important cause of mortality and morbidity in hematology–oncology patients undergoing chemotherapy. The management of febrile neutropenia is typically algorithm-driven. The aim of this study was to assess the results of a standardized protocol for the treatment of febrile neutropenia. Methods A retrospective cohort study (2011–2012) was conducted of patients with high-risk neutropenia in a hematology–oncology service. Results Forty-four episodes of 17 patients with a median age of 48 years (range: 18–78 years) were included. The incidence of febrile neutropenia was 61.4%. The presence of febrile neutropenia was associated with both the duration and severity of neutropenia. Microbiological agents were isolated from different sources in 59.3% of the episodes with bacteremia isolated from blood being the most prevalent (81.3%). Multiple drug-resistant gram-negative bacilli were isolated in 62.5% of all microbiologically documented infections. Treatment of 63% of the episodes in which the initial treatment was piperacillin/tazobactam needed to be escalated to meropenem. The mortality rate due to febrile neutropenia episodes was 18.5%. Conclusion The high rate of gram-negative bacilli resistant to piperacillin/tazobactam (front-line antibiotics in our protocol) and the early need to escalate to carbapenems raises the question as to whether it is necessary to change the current protocol. PMID:25638764

  7. Results of high-risk neutropenia therapy of hematology-oncology patients in a university hospital in Uruguay

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    Matilde Boada Burutaran

    2015-02-01

    Full Text Available Background: Febrile neutropenia is an important cause of mortality and morbidity in hematology-oncology patients undergoing chemotherapy. The management of febrile neutropenia is typically algorithm-driven. The aim of this study was to assess the results of a standardized protocol for the treatment of febrile neutropenia. Methods: A retrospective cohort study (2011-2012 was conducted of patients with high-risk neutropenia in a hematology-oncology service. Results: Forty-four episodes of 17 patients with a median age of 48 years (range: 18-78 years were included. The incidence of febrile neutropenia was 61.4%. The presence of febrile neutropenia was associated with both the duration and severity of neutropenia. Microbiological agents were isolated from different sources in 59.3% of the episodes with bacteremia iso- lated from blood being the most prevalent (81.3%. Multiple drug-resistant gram-negative bacilli were isolated in 62.5% of all microbiologically documented infections. Treatment of 63% of the episodes in which the initial treatment was piperacillin/tazobactam needed to be escalated to meropenem. The mortality rate due to febrile neutropenia episodes was 18.5%. Conclusion: The high rate of gram-negative bacilli resistant to piperacillin/tazobactam (frontline antibiotics in our protocol and the early need to escalate to carbapenems raises the question as to whether it is necessary to change the current protocol.

  8. Evaluation of Enterococcus faecalis clinical isolates with 'penicillin-resistant, ampicillin-susceptible' phenotype as reported by Vitek-2 Compact system.

    Science.gov (United States)

    Tan, Yen Ee; Ng, Lily S Y; Tan, Thean Yen

    2014-10-01

    It has been recently reported that ampicillin susceptibility cannot accurately predict piperacillin and imipenem susceptibilities in penicillin-resistant, ampicillin-susceptible (Pen-R, Amp-S) Enterococcus faecalis isolates, contrary to the current Clinical and Laboratory Standards Institute (CLSI) recommendations. This has important therapeutic implications. Such isolates were noted after the use of Vitek-2 Compact system AST-GP67 susceptibility cards in a Singapore general hospital and they were increasing in numbers. The primary aim of this study was to evaluate these clinical isolates against microbroth dilution (MBD) technique and other commonly used antimicrobial susceptibility test (AST) methods for penicillin and ampicillin. The secondary aim was to evaluate whether ampicillin susceptibility could indeed be a reliable surrogate marker for piperacillin and imipenem susceptibilities in E. faecalis isolates that were confirmed Pen-R, Amp-S.From 2009 to 2013, a total of 49 isolates (5%) of 983 non-duplicate E. faecalis tested by Vitek-2 displayed the 'Pen-R, Amp-S' phenotype in a general hospital in Singapore. These were tested against MBD which was the reference method, Etest and disc diffusion for penicillin and ampicillin. Susceptibilities to piperacillin and imipenem were also tested using MBD. In addition, β-lactamase production test was performed. Forty E. faecalis isolates with penicillin-susceptible, ampicillin-susceptible (Pen-S, Amp-S) phenotype were included for comparative purposes.The categorical agreement rate was 100% for all AST methods in ampicillin reporting for the 'Pen-R, Amp-S' group of E. faecalis isolates. However, a large number of isolates (46 isolates, 93.9%) fell into the major error category for penicillin testing by the Vitek-2 system. Penicillin minimum inhibitory concentrations (MICs) generated by the Vitek-2 system for the majority of these isolates were two doubling dilutions higher compared to those obtained by the reference

  9. Failure of levofloxacin treatment in community-acquired pneumococcal pneumonia

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    Grossi Paolo

    2005-11-01

    Full Text Available Abstract Background Streptococcus pneumoniae is the leading cause of community-acquired pneumonia (CAP. High global incidence of macrolide and penicillin resistance has been reported, whereas fluoroquinolone resistance is uncommon. Current guidelines for suspected CAP in patients with co-morbidity factors and recent antibiotic therapy recommend initial empiric therapy using one fluoroquinolone or one macrolide associated to other drugs (amoxicillin, amoxicillin/clavulanate, broad-spectrum cephalosporins. Resistance to fluoroquinolones is determined by efflux mechanisms and/or mutations in the parC and parE genes coding for topoisomerase IV and/or gyrA and gyrB genes coding for DNA gyrase. No clinical cases due to fluoroquinolone-resistant S. pneumoniae strains have been yet reported from Italy. Case presentation A 72-year-old patient with long history of chronic obstructive pulmonary disease and multiple fluoroquinolone treatments for recurrent lower respiratory tract infections developed fever, increased sputum production, and dyspnea. He was treated with oral levofloxacin (500 mg bid. Three days later, because of acute respiratory insufficiency, the patient was hospitalized. Levofloxacin treatment was supplemented with piperacillin/tazobactam. Microbiological tests detected a S. pneumoniae strain intermediate to penicillin (MIC, 1 mg/L and resistant to macrolides (MIC >256 mg/L and fluoroquinolones (MIC >32 mg/L. Point mutations were detected in gyrA (Ser81-Phe, parE (Ile460-Val, and parC gene (Ser79-Phe; Lys137-Asn. Complete clinical response followed treatment with piperacillin/tazobactam. Conclusion This is the first Italian case of community-acquired pneumonia due to a fluoroquinolone-resistant S. pneumoniae isolate where treatment failure of levofloxacin was documented. Molecular analysis showed a group of mutations that have not yet been reported from Italy and has been detected only twice in Europe. Treatment with piperacillin

  10. An update on the management of urinary tract infections in the era of antimicrobial resistance.

    Science.gov (United States)

    Bader, Mazen S; Loeb, Mark; Brooks, Annie A

    2017-03-01

    Urinary tract infections (UTIs) caused by antibiotic-resistant Gram-negative bacteria are a growing concern due to limited therapeutic options. Gram-negative bacteria, specifically Enterobacteriaceae, are common causes of both community-acquired and hospital acquired UTIs. These organisms can acquire genes that encode for multiple antibiotic resistance mechanisms, including extended-spectrum-lactamases (ESBLs), AmpC- β -lactamase, and carbapenemases. The assessment of suspected UTI includes identification of characteristic symptoms or signs, urinalysis, dipstick or microscopic tests, and urine culture if indicated. UTIs are categorized according to location (upper versus lower urinary tract) and severity (uncomplicated versus complicated). Increasing rates of antibiotic resistance necessitate judicious use of antibiotics through the application of antimicrobial stewardship principles. Knowledge of the common causative pathogens of UTIs including local susceptibility patterns are essential in determining appropriate empiric therapy. The recommended first-line empiric therapies for acute uncomplicated bacterial cystitis in otherwise healthy adult nonpregnant females is a 5-day course of nitrofurantion or a 3-g single dose of fosfomycin tromethamine. Second-line options include fluoroquinolones and β-lactams, such as amoxicillin-clavulanate. Current treatment options for UTIs due to AmpC- β -lactamase-producing organisms include fosfomycin, nitrofurantion, fluoroquinolones, cefepime, piperacillin-tazobactam and carbapenems. In addition, treatment options for UTIs due to ESBLs-producing Enterobacteriaceae include nitrofurantion, fosfomycin, fluoroquinolones, cefoxitin, piperacillin-tazobactam, carbapenems, ceftazidime-avibactam, ceftolozane-tazobactam, and aminoglycosides. Based on identification and susceptibility results, alternatives to carbapenems may be used to treat mild-moderate UTIs caused by ESBL-producing Enterobacteriaceae. Ceftazidime-avibactam, colistin

  11. Epidemic and virulence characteristic of Shigella spp. with extended-spectrum cephalosporin resistance in Xiaoshan District, Hangzhou, China.

    Science.gov (United States)

    Zhang, Chuan-Ling; Liu, Qing-Zhong; Wang, Juan; Chu, Xu; Shen, Li-Meng; Guo, Yuan-Yu

    2014-05-15

    Shigellae have become increasingly resistant to the extended-spectrum cephalosporin (ESC) worldwide and pose a great challenge to anti-infection treatment options. The purpose of this study was to determine the resistance, cephalosporin resistance mechanisms, virulence characteristic and genotype of ESC-resistant Shigella. From 2008 to 2012, Shigella isolates collected from diarrhea patients were detected for antibiotics sensitivity by disk diffusion, cephalosporin resistance determinants and virulence genes using polymerase chain reaction (PCR) and genotyping through enterobacterial repetitive intergenic consensus sequence PCR (ERIC-PCR). A total of 356 Shigella isolates were gathered, and 198 (55.6%, 58 S. flexneri and 140 S. sonnei) were resistant to ESC. All ESC-resistant isolates were susceptible to imipenem, and only 0.5% isolate was resistant to piperacillin/tazobactam. ESC-resistant S. flexneri showed high degrees of resistance to ampicillin (100%), ampicillin/sulbactam (96.6%), piperacillin (100%), trimethoprim/sulfamethoxazole (74.1%), ciprofloxacin (74.1%), levofloxacin (53.4%), ceftazidime (58.6%) and cefepime (58.6%). ESC-resistant S. sonnei exhibited high resistance rates to ampicillin (100%), piperacillin (100%) and trimethoprim/sulfamethoxazole (96.4%). Cephalosporin resistance genes were confirmed in 184 ESC-resistant isolates. bla(CTX-M) types (91.8%, mainly bla(CTX-M-14), bla(CTX-M-15) and bla(CTX-M-57)) were most prevalent, followed by bla(OXA-30) (26.3%). Over 99.0% ESC-resistant isolates harbored virulence genes ial, ipaH, virA and sen. However, set1 were more prevalent in ESC-resistant S. flexneri isolates than in S. sonnei isolates. ERIC-PCR results showed that 2 and 3 main genotypes were detected in ESC-resistant S. flexneri and S. sonnei, respectively. Our findings indicated that a high prevalence of ESC-resistant Shigella mediated mainly by bla(CTX-M) with stronger resistance and virulence, and the existence of specific clones

  12. Antibiotic susceptibility of Serratia marcescens and Serratia liquefaciens.

    Science.gov (United States)

    Traub, W H

    2000-01-01

    Over a period of 20 years, a total of 1,603 Serratia isolates were recovered from clinical specimens and examined for susceptibility to 29 antimicrobial drugs using the Bauer-Kirby agar disk diffusion test. Serratia marcescens was recovered most frequently (n = 1,409), followed by S. liquefaciens (n = 172); other Serratia species were scarce. During the 2-decade observation period there occurred 35 putative episodes/clusters of nosocomial cross-infection and 1 pseudo-outbreak due to S. marcescens, but none due to S. liquefaciens. The antimicrobial susceptibility data for S. marcescens and S. liquefaciens were subdivided into two observation periods: I = 1980-1993, and II = 1993-1999. The crude data (series A) obtained for S. marcescens were corrected in two ways: by the omission of repetitive patient isolates (series B) and the additional removal of outbreak isolates except for index case isolates (series C). Comparison of data obtained in series IC and IIC disclosed an increase in the susceptibility of S. marcescens to ampicillin + sulbactam, cefotaxime, chloramphenicol, doxycycline, fosfomycin, gentamicin, piperacillin, piperacillin + tazobactam, timentin and tobramycin during observation period II. Conversely, there was a decrease in susceptibility to ciprofloxacin, nalidixic acid and trovafloxacin, and slightly diminished susceptibility to norfloxacin and ofloxacin during observation period II as compared with the previous period. The crude data obtained for S. liquefaciens required no correction, as there were only a few repeat isolates. There was an increase in susceptibility to ampicillin, ampicillin + sulbactam, cefuroxime, doxycycline, fosfomycin, nitrofurantoin and polymyxin B (clear inhibition zones). However, there was an inexplicable decrease in susceptibility to piperacillin + tazobactam. Cocarde growth around polymyxin B disks was noted with 55.8% of the S. marcescens isolates as compared with 6.8% of the S. liquefaciens isolates. Slime around

  13. The potential of antimicrobials to induce thrombocytopenia in critically ill patients: data from a randomized controlled trial.

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    Maria Egede Johansen

    Full Text Available BACKGROUND: Antimicrobial-induced thrombocytopenia is frequently described in the literature among critically ill patients. Several antimicrobials have been implicated, although experimental evidence to demonstrate causality is limited. We report, using a randomized trial, the potential of antimicrobials to induce thrombocytopenia. METHODS: Randomized trial allocated patients to antimicrobial treatment according to standard- of-care (SOC group or drug-escalation in case of procalcitonin increases (high-exposure group. Patients were followed until death or day 28. Thrombocytopenia defined as absolute (platelet count ≤ 100 x 109/L or relative (≥ 20% decrease in platelet count. Analyses were performed in the two randomized groups and as a merged cohort. RESULTS: Of the 1147 patients with platelet data available, 18% had absolute thrombocytopenia within the first 24 hours after admission to intensive care unit and additional 17% developed this complication during follow-up; 57% developed relative thrombocytopenia during follow-up. Absolute and relative thrombocytopenia day 1-4 was associated with increased mortality (HR: 1.67 [95% CI: 1.30 to 2.14]; 1.71 [95% CI: 1.30 to 2.30], P<0.0001, respectively. Patients in the high-exposure group received more antimicrobials including piperacillin/tazobactam, meropenem and ciprofloxacin compared with the SOC group, whereas cefuroxime was used more frequently in the SOC group (p<0.05. Risk of absolute and relative thrombocytopenia (RR: 0.9 [0.7-1.3], p=0.7439; 1.2 [1.0-1.4], p=0.06; respectively, as well as absolute platelet count (daily difference, high-exposure vs. SOC -1.7 [-3.8-0.5], p=0.14 was comparable between groups. In observational analyses, use of ciprofloxacin and piperacillin/tazobactam predicted risk of relative thrombocytopenia (vs. cefuroxime, RR: 2.08 [1.48-2.92]; 1.44 [1.10-1.89], respectively, however only ciprofloxacin were associated with a reduction in absolute platelet count (p=0

  14. [Investigation of the frequency of PER-1 type beta-lactamase and antimicrobial resistance rates in nosocomial isolates of Pseudomonas aeruginosa].

    Science.gov (United States)

    Atilla, Aynur; Eroğlu, Cafer; Esen, Saban; Sünbül, Mustafa; Leblebicioğlu, Hakan

    2012-01-01

    Pseudomonas aeruginosa which is a common cause of nosocomial infections, usually leads to treatment difficulties due to multi-drug resistance. PER-1 type extended-spectrum beta-lactamase (ESBL) producing bacteria are shown to be common in Turkey. Since limited number of antibiotics such as antipseudomonal penicillins, cephalosporins, aminoglycosides, fluoroquinolones and carbapenems are available for the treatment of P.aeruginosa infections, it is essential to monitor and eventually control the spread of antibiotic resistance genes. The aims of this study were to investigate the presence of PER-1 type ESBLs in nosocomial P.aeruginosa isolates and to evaluate their resistance to some commonly used antibiotics. A total of 110 P.aeruginosa strains isolated from clinical samples [40 urine, 26 exudate, 20 blood, 24 others (sputum, tracheal aspirate, tissue biopsy, cerebrospinal fluid, pleural fluid, conjunctiva)] of the inpatients who were proven to have nosocomial infections in Ondokuz Mayıs University Faculty of Medicine Hospital between May 2002-June 2003 were included in the study. Identification of the isolates was performed by ATB system ID 32 GN (bio-Merieux, France). Antibiotic susceptibilities were detected by standard disk diffusion method and PER-1 type ESBL was searched by polymerase chain reaction using PER-1 and PER- 2 primers. PER-1 positivity was detected in 62 of 110 (56.4%) P.aeruginosa isolates and 51 of 65 (78.5%) ceftazidime-resistant strains. The highest susceptibility rate was detected for ciprofloxacin (76.4%), while the lowest susceptibility rate was for ticarcillin-clavulanic acid (22.7%). Rates of resistance to beta-lactam agents (excluding piperacillin/tazobactam), amikacin and gentamicin were statistically significantly higher for PER-1 positive strains than PER-1 negative ones. Resistance rates to ceftazidime, cefepime, aztreonam, piperacillin and ticarcillin-clavulanic acid in PER-1 positive isolates versus negative ones were as 82.3% vs

  15. [Antibiotic Consumption and the Development of Antibiotic Resistance in Surgical Units].

    Science.gov (United States)

    Tammer, I; Geginat, G; Lange, S; Kropf, S; Lodes, U; Schlüter, D; Lippert, H; Meyer, F

    2016-02-01

    Antibiotic resistence is increasing worldwide. A longitudinal analysis of the influence of the density of antibiotic use on the development of resistance in surgical units was undertaken. Over five years the incidence of pathogens and the resistance rates of isolates from patients of normal surgical units and those of a surgical ICU at a university hospital were examined. The resistence rates were correlated with the density of antibiotic use - calculated from the antibiotic consumption (in DDD) and the number of patient-days. At both units, Enterobacteriaceae and Enterococci were mostly cultured. Among the Enterobacteriaceae, E. coli, Klebsiella spp., Proteus mirabilis and Enterobacter predominated. In the group of Enterococci, E. faecalis predominated at wards whereas at ICU E. faecium was the most frequent. Anaerobes ranked third at normal wards and Candida spp. at ICU. From 2007 to 2011, there was an increasing resistance against ciprofloxacin in P. mirabilis (r = 0.87; p = 0.054) and against imipenem (r = 0.86; p = 0.06) and piperacillin (r = 0.81; p = 0.09) in P. aeruginosa at normal wards. At ICU, the resistance rates of imipenem in P. aeruginosa rose (r = 0.88; p = 0.049). Resistance against ciprofloxacin in E. coli increased (r = 0.65; p = 0.23). Due to the increasing use of ciprofloxacin and meropenem at normal wards, the density of antibiotic usage rose 1.4 %/year (r = 0.94; p = 0.02). Despite the increase of meropenem use at ICU (r = 0.9; p = 0.035), the total antibiotic uptake rate remained almost constant. The antibiotic usage density was 3-fold higher at ICU than at normal wards. At normal wards, the ciprofloxacin usage correlated with the rate of resistance against ciprofloxacin in P. mirabilis P. m. At ICU, an association was detected between the uptake rate of ceftazidime and the rate of resistance against cefotaxime in the CES group. In P. aeruginosa, the use of piperacillin and the rate

  16. DRESS Syndrome in the ICU: When a Patient Is Treated with Multiple Drugs

    Directory of Open Access Journals (Sweden)

    Florent Moriceau

    2016-01-01

    Full Text Available The Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS syndrome is life-threatening. It associates a skin condition with hematological and visceral disorders. The DRESS syndrome diagnosis in the intensive care unit (ICU is difficult as clinical features are nonspecific. Furthermore, the need to treat patients with multiple drugs usually prevents the identification of the causative drug. We report the case of a patient who developed two bouts of DRESS caused by piperacillin-tazobactam, the first being complicated with a distributive shock. Cases of DRESS occurring inside ICU are seldom reported. However, any intensivist may encounter this situation during his career and should be aware of its diagnostic and management specific aspects.

  17. Optimal sampling theory and population modelling - Application to determination of the influence of the microgravity environment on drug distribution and elimination

    Science.gov (United States)

    Drusano, George L.

    1991-01-01

    The optimal sampling theory is evaluated in applications to studies related to the distribution and elimination of several drugs (including ceftazidime, piperacillin, and ciprofloxacin), using the SAMPLE module of the ADAPT II package of programs developed by D'Argenio and Schumitzky (1979, 1988) and comparing the pharmacokinetic parameter values with results obtained by traditional ten-sample design. The impact of the use of optimal sampling was demonstrated in conjunction with NONMEM (Sheiner et al., 1977) approach, in which the population is taken as the unit of analysis, allowing even fragmentary patient data sets to contribute to population parameter estimates. It is shown that this technique is applicable in both the single-dose and the multiple-dose environments. The ability to study real patients made it possible to show that there was a bimodal distribution in ciprofloxacin nonrenal clearance.

  18. Changing bacteriological profile and mortality trends in community acquired pneumonia

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    Sagar Khadanga

    2014-01-01

    Full Text Available There are very few and conflicting Indian data regarding the bacteriological etiology of community acquired pneumonia (CAP. Adding to this agony, there is no credible data from the eastern part of India. This is a cross-sectional study and descriptive in nature over a period of 1-year. Of the 464 cases of the study population, we could isolate aerobic bacteria in 149 patients (32.1%. Streptococcus pneumoniae has been identified as the most common organism causing CAP (68/149. Gram-negative bacilli (GNB as a group exceeded marginally over S. pneumoniae (69/149. Among GNB, Pseudomonas aeruginosa was the most common organism (31/69, followed by Klebsiella pneumoniae (29/69. Staphylococcus aureus was identified in (12/149 cases. Co-amoxyclav is still the most sensitive drug for S. pneumoniae. P. aeruginosa was most sensitive to imipenam followed by piperacillin-tazobactam.

  19. NEW THERAPEUTIC FORMULATIONS WITH AN ANTIBACTERIAL EFFECT, BASED ON PLANT EXTRACTS

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    Liliana Cristina Soare

    2012-12-01

    Full Text Available The antibacterial effects produced by anthocyanins and other bioactive plant compounds are weaker than those generated by antibiotics. In some cases, the combination of extract-antibiotic can cause synergistic effects, also the purpose of the research was to develop and test new antibiotic - plant extract formulations. New potential antimicrobial formulations was done by soaking discs impregnated with piperacillin or tetracycline with different extract. The tested microorganisms were: Staphylococcus aureus ATCC 25923, Streptococcus sp., Escherichia coli 820B, soil bacterium 23S, and Enterobacter cloacae. The combination of antibiotics with extracts determined, only for some of the microorganisms tested, better antibacterial effects than those caused by the antibiotic or the extract.

  20. In vitro activity of Ro 23-9424, a dual-acting cephalosporin-quinolone antimicrobial agent.

    Science.gov (United States)

    Qadri, S M; Ueno, Y; Saldin, H; Cunha, B A

    1993-10-01

    In vitro activity of new dual-acting antibacterial Ro 23-9429 was tested against 1294 bacterial isolates from patients in a major tertiary care referral hospital in Saudi Arabia. Its activity was compared with that of ciprofloxacin, fleroxacin, ampicillin, cephalothin, cefoxitin, cefotaxime, ceftazidime, piperacillin, oxacillin, gentamicin, amikacin, imipenem, and vancomycin. Of the 621 members of Enterobacteriaceae tested, every single isolate was inhibited by Ro 23-9429 at minimum inhibitory concentration ranging between < .03 and 8 micrograms/mL. No other antimicrobial tested was as active as this dual-acting cephalosporin-fluoroquinolone. Similarly, all of the 255 isolates of Acinetobacter, Aeromonas hydrophila, Pseudomonas aeruginosa, and Xanthomonas maltophilia were susceptible to Ro 23-9429. It inhibited all the 120 isolates of methicillin-resistant Staphylococcus aureus. Its in vitro activity against coagulase-negative staphylococci and enterococci was superior or comparable to that of other drugs that are commonly used in clinical practice.

  1. Comparative antibacterial activity of the aminothiazolyl cephalosporin RU 29,246.

    Science.gov (United States)

    Qadri, S M; Ueno, Y; Saldin, H; Tullo, D D; Lee, G C

    1993-01-01

    A total of 1,007 clinical isolates from a tertiary care center were tested against RU 29,246, ampicillin, cephalothin, cefoxitin, ceftazidime, Augmentin, oxacillin, piperacillin, gentamicin, amikacin and vancomycin. Bacteria tested consisted of 479 strains of Enterobacteriaceae, 64 pseudomonads, 18 Xanthomonas, 42 other gram-negative bacilli, 56 enterococci and 348 isolates of staphylococci. RU 29,246 showed excellent in vitro activity inhibiting > 90% of Escherichia coli, Klebsiella pneumoniae, K. oxytoca, Enterobacter, Proteus mirabilis, Providencia, Morganella, Salmonella, Shigella, Aeromonas hydrophila, and methicillin-susceptible Staphylococcus aureus at an MIC of 0.5-1.0 mg/l. Seventy-seven percent coagulase-negative staphylococci had an MIC of 1.0-4.0 mg/l. All strains of Pseudomonas aeruginosa and X. maltophilia were resistant to RU 29,246. Fifty-six percent of the enterococcal isolates were inhibited by 1.0-16.0 mg/l of RU 29,246.

  2. Lemierre's syndrome

    DEFF Research Database (Denmark)

    Johannesen, Katrine M; Bodtger, Uffe

    2016-01-01

    This is a systematic review of cases with Lemierre's syndrome (LS) in the past 5 years. LS is characterized by sepsis often evolving after a sore throat or tonsillitis and then complicated by various septic emboli and thrombosis of the internal jugular vein. Symptoms include sepsis, pain, and...... necrophorum. We found a total of 137 cases of LS, of which 47 were infected with F. necrophorum and others with Staphylococcus and Streptococcus. Complications of this rare but severe disease included osteomyelitis, meningitis, and acute respiratory distress syndrome. Mortality was extremely high in the pre......-antibiotic era but has diminished with the advent of antibiotics. This review showed a mortality rate of only 2% of which none of the cases involved fusobacteria. Duration of treatment varied; a 4-6-week course of carbapenem or piperacillin/tazobactam in combination with metronidazole was optimum. Other...

  3. Acute tubulointerstitial nephritis following intravenous immunoglobulin therapy in a male infant with minimal-change nephrotic syndrome.

    Science.gov (United States)

    Tanaka, H; Waga, S; Tateyama, T; Sugimoto, K; Kakizaki, Y; Yokoyama, M

    1999-10-01

    A boy aged 4 years with nephrotic syndrome (NS) was referred to our hospital because of the third relapse of NS. Hypogammaglobulinemia associated with massive proteinuria was observed at the presentation. Residual urinary tract infection required intravenous piperacillin and immunoglobulin therapy (IVIG). Soon after IVIG, he complained of high fever with chills, bilateral knee joint pain, dry cough and chest discomfort. Although he did not develop renal insufficiency, a transient increase in the urinary beta2-microglobulin and decrease in the serum complement hemolytic activity were observed. These clinical manifestations spontaneously ceased. A percutaneous renal biopsy for his NS performed 19 days after the episode of allergic reaction revealed tubulointerstitial nephritis (TIN) with marked eosinophil infiltrates. Glomeruli showed minor glomerular abnormalities. Renal complications associated with IVIG treatment have been reported to date, however, acute TIN has rarely been seen.

  4. Pharmacodynamic Profiling of Antimicrobials against Gram-negative Respiratory Isolates from Canadian Hospitals

    Directory of Open Access Journals (Sweden)

    Rebecca A. Keel

    2011-01-01

    Full Text Available The objective of this study was to assess the profile of a variety of dosing regimens for common intravenous antibiotics against contemporary Enterobacter cloacae, Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa isolates collected in Canada during 2009, using pharmacodynamic modelling techniques. Monte Carlo simulation was conducted for standard and/or prolonged infusion regimens of cefepime, ceftazidime, ceftriaxone, ciprofloxacin, doripenem, ertapenem, meropenem and piperacillin/tazobactam. The cumulative fraction of response (CFR was calculated using bactericidal targets for each regimen against each species. All cefepime, doripenem, ertapenem and meropenem regimens achieved optimal exposures against Enterobacteriaceae, whereas target attainment was organism and dose dependent for the other agents. These results support that the currently recommended antimicrobial dosing regimens generally attain acceptable exposures to achieve the requisite pharmacodynamic targets against the Enterobacteriaceae species; however, they fall short of obtaining optimal bactericidal exposures against P aeruginosa.

  5. Medical management of urethral and colonic perforation associated with urinary catheterization in a kitten.

    Science.gov (United States)

    Whittemore, Jacqueline C; Zucca, Lynda

    2003-09-15

    A 6-week-old male kitten was evaluated because of stranguria and possible urethral blockage; a urinary catheter placed during general anesthesia penetrated the urethral and colonic walls and entered the colon. Treatment was conservative, with fluids administered i.v., administration of piperacillin, and supportive care. The kitten never became febrile or clinically ill and continued to thrive. There was no development of clinical signs consistent with stricture, diverticulum, or fistula formation. Complications from urethral perforation include infection and urethral stricture. Reconstructive surgery is considered the treatment of choice for traumatic urethral-colonic perforation. However, surgery may not be feasible or may be cost-prohibitive in certain situations. In such instances, medical management may provide a reasonable alternative to euthanasia.

  6. Human infection with Shewanella putrefaciens and S. algae: report of 16 cases in Martinique and review of the literature.

    Science.gov (United States)

    Vignier, Nicolas; Barreau, Morgane; Olive, Claude; Baubion, Emilie; Théodose, Rafaelle; Hochedez, Patrick; Cabié, André

    2013-07-01

    Shewanella spp. are saprophytic bacteria that are part of the marine microflora in warm climates and are rarely pathogenic. However, Shewanella spp. infections are being increasingly reported, and there has been no comprehensive review of the literature describing these infections. This article reports 16 cases of Shewanella spp. infections in Martinique since 1997 and reviews another 239 cases reported in the literature since 1973. Patients experienced soft tissue infections, ear infection, or abdominal and biliary tract infections. A skin or mucosal portal of entry was found for 53% of the patients and exposure to the marine environment was reported for 44%; 79% of patients had an underlying condition. Bacteriema were frequent (28%). Most (87%) patients recovered, although ear infections can become chronic. Death occurred in 13% of the patients. Most Shewanella spp. isolates are susceptible to cefotaxime (95%), piperacillin and tazobactam (98%), gentamicin (99%), and ciprofloxacin (94%).

  7. Achromobacter Xylosoxidans Bloodstream Infection in Elderly Patient with Hepatocellular Carcinoma: Case Report and Review of Literature.

    Science.gov (United States)

    Raghuraman, Kausalya; Ahmed, Nishat H; Baruah, Frincy K; Grover, Rajesh K

    2015-01-01

    Achromobacter xylosoxidansis a nonfermentative Gram-negative organism, known to cause opportunistic infection in humans. We report a case of septicemia in a 76-year-old male patient with underlying hepatocellular carcinoma due to A. xylosoxidans, which showed a different antimicrobial susceptibility pattern from what is usually reported. From aerobic blood culture of the patient, A. xylosoxidans was isolated which was found to be sensitive to amoxicillin-clavulanic acid, piperacillin-tazobactam, ceftazidime, cefoperazone-sulbactam, meropenem, minocycline, tigecycline, and trimethoprim/sulfamethoxazole. The patient recovered with amoxicillin-clavulanic acid treatment, which was given empirically to the patient. The present case highlights the possible role of amoxicillin-clavulanic acid for treatment of bloodstream infection with A. xylosoxidans.

  8. Achromobacter Xylosoxidans bloodstream infection in elderly patient with Hepatocellular Carcinoma: Case report and review of literature

    Directory of Open Access Journals (Sweden)

    Kausalya Raghuraman

    2015-01-01

    Full Text Available Achromobacter xylosoxidansis a nonfermentative Gram-negative organism, known to cause opportunistic infection in humans. We report a case of septicemia in a 76-year-old male patient with underlying hepatocellular carcinoma due to A. xylosoxidans, which showed a different antimicrobial susceptibility pattern from what is usually reported. From aerobic blood culture of the patient, A. xylosoxidanswas isolated which was found to be sensitive to amoxicillin-clavulanic acid, piperacillin-tazobactam, ceftazidime, cefoperazone-sulbactam, meropenem, minocycline, tigecycline, and trimethoprim/sulfamethoxazole. The patient recovered with amoxicillin-clavulanic acid treatment, which was given empirically to the patient. The present case highlights the possible role of amoxicillin-clavulanic acid for treatment of bloodstream infection with A. xylosoxidans.

  9. 抗菌药物干预对产ESBLs菌医院感染的影响%Antibacterials intervention:the Impact of ESBL (+) Bacterium in Neuro-ICU

    Institute of Scientific and Technical Information of China (English)

    王志宏; 何宏; 樊明超; 姜云霞; 李连弟

    2014-01-01

    Objective The aim of this study was to clarify the effect of ESBL (+) bacterium under the replacement of third generation cephalosporin by in Neurosurgical Intensive Care Unit.Methods We tested the quantity of ESBL ( +) bacterium ( Escherichia coli and Klebsiella pneumoniae ) , and compared the rate of proliferation before and after using Piperacillin-Tazobac-tam;Likewise we cultivated the production of patients'airway before and after using Piperacillin-Tazobactam, and the bacterium were isolated for drug sensitivity test , to analysis the rate of ESBL (+) bacterium in these two periods.Results After using Piperacillin-Tazobactam, the proliferation rate of ESBL (+) bacterium degraded from 33.3%to 18.8%.(P<0.05).The proliferation rate of ESBL (+) Klebsiella pneumoniae decreased from 72.2%to 50%(P<0.05), this rate of ESBL (+) Escherichia coli degraded from 72.2%to 50%(P<0.05).Conclusion Replacement of third generation cephalosporin by Piperacillin-Tazobactam could de-grade the rate of ESBL (+) bacterium in Neurosurgical Intensive Care Unit.%目的:研究哌拉西林-他唑巴坦替换第三代头孢菌素应用于神经ICU患者的临床价值,探讨其对产ESBLs菌株医院感染发生的影响。方法在哌拉西林-他唑巴坦临床干预前后,检测患者直肠拭子存在产ESBLs的大肠埃希菌,肺炎克雷伯杆菌的情况,比较前后两阶段的产ESBLs细菌的临床寄殖率;并对哌拉西林-他唑巴坦临床干预前后患者的气道分泌物进行培养鉴定、分析药物敏感性,比较前后两阶段产ESBLs细菌发生率变化。结果哌拉西林-他唑巴坦干预后,大肠埃希菌,肺炎克雷伯杆菌产ESBLs菌寄殖率从33.3%降至18.8%( P<0.05)。产ESBLs肺炎克雷伯杆菌比率从72.2%降至50%(P<0.05),产ESBLs大肠埃希菌比率从75%降至39.58%(P<0.05)。结论在神经ICU病区使用哌拉西林-他唑巴坦替换第三代头孢菌素可降低单元内产ESBLs细菌

  10. Late Complication after Superficial Femoral Artery (SFA) Aneurysm: Stent-graft Expulsion Outside the Skin

    Energy Technology Data Exchange (ETDEWEB)

    Pecoraro, Felice, E-mail: felicepecoraro@libero.it; Sabatino, Ermanno R.; Dinoto, Ettore; Rosa, Giuliana La; Corte, Giuseppe; Bajardi, Guido [University of Palermo, Vascular Surgery Unit (Italy)

    2015-10-15

    A 78-year-old man presented with a 7-cm aneurysm in the left superficial femoral artery, which was considered unfit and anatomically unsuitable for conventional open surgery for multiple comorbidities. The patient was treated with stent-graft [Viabhan stent-graft (WL Gore and Associates, Flagstaff, AZ)]. Two years from stent-graft implantation, the patient presented a purulent secretion and a spontaneous external expulsion through a fistulous channel. No claudication symptoms or hemorrhagic signs were present. The pus and device cultures were positive for Staphylococcus aureus sensitive to piperacillin/tazobactam. Patient management consisted of fistula drainage, systemic antibiotic therapy, and daily wound dressing. At 1-month follow-up, the wound was closed. To our knowledge, this is the first case of this type of stent-graft complication presenting with external expulsion.

  11. Study of Pseudomonas Aeroginosa resistance to Penicillines, Cephalosporins and Aminoglycosides

    Directory of Open Access Journals (Sweden)

    Maleknezhad P

    1998-07-01

    Full Text Available Drug therapy and prophylaxy in infectious diseases, from hygienic and economical point of view, are very important. Infections caused by pseudomonas aeroginosa were particularly severe, with high mortality rates. In the recent years pseudomonas aeroginosa continued to cause the most severe, life-thereating infections in burned patients, in spite of the introduction of a wide variety of antibiotics advised specifically for their anti pseudomonal activity. The aim of this study, in which many cases of ps.aeroginosa infections are assessed is to identify the drug resistance of this bacteria to penicillines, cephalosporins and aminoglycosides by antibiotic sensitivity test (disk ager diffusion. Results as percent of resistance to each antibiotic were 89% to carbenicillin, 55% to piperacillin, 89% to mezlocillin, 89.5% to ticarcillin+clavulonic acid, 85% to ceftriaxone, 95% to tobramycin, 5% of all isolates were not sensitive to any antibiotics.

  12. In vitro potency and combination testing of antimicrobial agents against Neisseria gonorrhoeae.

    Science.gov (United States)

    Bharat, Amrita; Martin, Irene; Zhanel, George G; Mulvey, Michael R

    2016-03-01

    Antimicrobial resistant Neisseria gonorrhoeae is a major concern to public health due to decreased susceptibility to frontline antimicrobials. To find agents that are active against N. gonorrhoeae, we tested antimicrobials alone or in combination by Etest gradient strips. The potencies (as assessed by minimum inhibitory concentrations) of twenty-five antimicrobials were evaluated against nine reference strains of N. gonorrhoeae (WHO F, G, K, L, M, N, O, P and ATCC 49226). Potency was greatest for netilmicin, quinupristin-dalfopristin, ceftriaxone, ertapenem and piperacillin-tazobactam. Combinations of azithromycin, moxifloxacin, or gentamicin with ceftriaxone, doripenem, or aztreonam were tested against reference isolates and the fractional inhibitory concentration index (FICI) was calculated. All nine combinations resulted in indifference (>0.5 FICI ≤ 4). Combinations with FICI gonorrhoeae. These data on antimicrobials with higher potency and combinations that did not show antagonism can help to guide larger scale susceptibility studies for antimicrobial resistant N. gonorrhoeae.

  13. Investigation of Burkholderia cepacia nosocomial outbreak with high fatality in patients suffering from diseases other than cystic fibrosis.

    Science.gov (United States)

    Shehabi, Asem A; Abu-Al-Soud, Waleed; Mahafzah, Azmi; Khuri-Bulos, Najwa; Abu Khader, Ilham; Ouis, Ibn-Sina; Wadström, Torkel

    2004-01-01

    Over a 1-y period, 26 inpatients at the Jordan University Hospital in Amman were detected with bacteraemia (23 cases) or respiratory tract colonized with B. cepacia (3 cases). A combination of genetic identification and molecular typing has proved that all cases were caused by a single epidemic strain of B. cepacia genomovar IIIa. Nosocomial infections could be documented in 21/26 (81%) patients, mostly with severe underlying or malignant diseases other than cystic fibrosis, but the source of infection was undetected. The overall mortality related to infection with B. cepacia was 42%. All B. cepacia isolates were resistant to ampicillin, amikacin, carbenicillin and gentamicin; and mostly susceptible to piperacillin, chloramphenicol, cotri-moxazole, tetracycline, ceftazidime, and tazocin (62-88%). This study demonstrates the nosocomial and high fatality of B. cepacia genomovar IIIa in Jordanian patients suffering from diseases other than cystic fibrosis.

  14. Antibiotic resistance profiles of Pseudomonas aeruginosa strains isolated from patients with acute exacerbation of chronic obstructive pulmonary disease

    Directory of Open Access Journals (Sweden)

    Nagihan Demir

    2014-12-01

    For typing and antibiotic susceptibility of isolates the Phoenix bacterial identification system (Becton Dickinson, USA was used.[¤]RESULTS[|]The antibiotic resistance rates of P. aeruginosa were 42.3% for cefepime, 41% for levofloxacin, 38.7% for ciprofloxacin, 29.4% for ceftazidime, 21.7% for cefoperazone / sulbactam, 17.9% for gentamicin, 17.9% for piperacillin / tazobactam, 8.9% for imipenem, 5.1% for amikacin and 2.5% for meropenem. Twenty eight (35.9% of the isolates were found to be sensitive to all of these antibiotics. Forty six (58.9% of the patients had steroid and 56 (71.8% of the patients had broad-spectrum antibiotic use.[¤]CONCLUSION[|]In acute exacerbations of chronic obstructive pulmonary disease, the inspection of antibiotic susceptibility of Pseudomonas infection would be beneficial for patient's health and the country's economy.[¤

  15. Changes in resistance percentage to antibiotics in Pseudomonas aeruginosa and Acinetobacter baumannii strains isolated from blood cultures of intensive care unit patients

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    Berrin Uzun

    2014-05-01

    was found in resistance percentage of cefepime and amikacin in the second period compared with the first (p values were 0.0003, 0.0000. Resistance percentage of ampicillin-sulbactam, piperacillin-tazobactam and imipenem was increased (p values were 0.0003, 0.0210, 0.0033. There was no colistin resistance determined in both species. Tigecycline resistance was not found in A. baumannii isolates.[¤]CONCLUSION[|]Active surveillance of antibiotic resistance percentages of isolated strains especially in ICUs serves to determine empirical treatment regimens in every institution. The present study emphasized that antibiotic usage policy is an important step to combat hospital infections. Consequently, infection control measures should be taken, empirical treatment regimens should be constantly reviewed, and should be determined according to active surveillance data in order to decrease resistance percentages.[¤

  16. Elizabethkingia meningoseptica: an emerging pathogen causing meningitis in a hospitalized adult trauma patient.

    Science.gov (United States)

    Tak, V; Mathur, P; Varghese, P; Misra, M C

    2013-01-01

    A 23-year-old male patient who was a follow-up case of neurosurgery presented to our emergency department with a history of high-grade fever and clinical features of meningitis for 1 week. The cerebrospinal fluid (CSF) was sent to our laboratory for culture. The culture demonstrated growth of 1-2 mm in diameter light yellow coloured colonies of Gram-negative bacilli on chocolate and blood agar. There was no growth on MacConkey agar. The bacterium was multidrug resistant. Based upon the growth characteristics, bio-chemical reactions, drug susceptibility pattern and identification by Vitek 2 system the isolate was identified as Elizabethkingia meningoseptica. Patient was treated with injection piperacillin-tazobactam, injection vancomycin and cotrimoxazole tablets for 21 days along with intrathecal injection of tigecycline and finally, patient improved clinically and the CSF cultures became sterile. The presence in hospital environment along with multidrug resistance makes E. meningoseptica a successful emerging nosocomial pathogen.

  17. Serratia marcescens osteomyelitis in Cushing's disease.

    Science.gov (United States)

    Martins, Hugo F G; Raposo, Alexandra; Baptista, Isabel; Almeida, Julio

    2015-11-30

    We report a case of a 46-year-old man with fever, hypotension and arthralgias of the ankles and knees after brain surgery for a pituitary tumour causing Cushing's disease. Blood and urine cultures isolated Serratia marcescens; antibiotic susceptibility testing showed sensitivity to piperacillin-tazobactan and ciprofloxacin. Articular MRI showed inflammation and necrosis of both knees and ankles, and left hip and right elbow (compatible with osteomyelitis). Culture of an ankle abscess on the ankle joint was positive for Serratia marcescens. Bone scintigraphy confirmed osteomyelitic lesions. Medical treatment included antibiotics and strong opioid therapy for 14 weeks. The patient was discharged clinically improved maintaining ciprofloxacin for 24 additional weeks based on clinical and analytic recovery.

  18. Positive direct antiglobulin tests due to clavulanic acid.

    Science.gov (United States)

    Williams, M E; Thomas, D; Harman, C P; Mintz, P D; Donowitz, G R

    1985-01-01

    Clavulanic acid, a beta-lactamase inhibitor, was found to be associated with the development of a positive direct antiglobulin test. Of 23 antibiotic courses in patients treated with ticarcillin, clavulanic acid, and tobramycin, 10 (43.5%) developed positive direct antiglobulin tests versus 2 of 26 (7.7%) patients treated with piperacillin and tobramycin (P = 0.0044). In vitro immunohematological studies showed that clavulanic acid caused a nonimmunologic adsorption of plasma proteins onto the erythrocyte surface. Hemolysis was not associated with such nonimmunologic adsorption. However, the resulting positive antiglobulin test might delay cross matching of blood products for transfusions or interfere with the evaluation of true immune-mediated hemolytic anemia. PMID:3872623

  19. Empiric antibiotic therapy in a child with cancer and suspected septicemia

    Directory of Open Access Journals (Sweden)

    Desiree Caselli

    2012-01-01

    Full Text Available Improved outcome in the treatment of in childhood cancer results not only from more aggressive and tailored cancer-directed therapy, but also from improved supportive therapy and treatment of life-threatening infectious complications. Prompt and aggressive intervention with empiric antibiotics has reduced the mortality in this group of patients. Physical examination, blood tests, and blood cultures must be performed, and antibiotic therapy must be administered as soon as possible. Beta-lactam monotherapy, such as piperacillin-tazobactam or cefepime, may be an appropriate empiric therapy of choice for all clinically stable patients with neutropenic fever. An anti-pseudomonal beta-lactam antibiotic plus gentamicin is recommended for patients with systemic compromise.

  20. Antimicrobial resistance in the Bacteroides fragilis group in faecal microbiota from healthy Danish children.

    Science.gov (United States)

    Sydenham, Thomas Vognbjerg; Jensen, Betina Hebbelstrup; Petersen, Andreas Munk; Krogfelt, Karen Angeliki; Justesen, Ulrik Stenz

    2017-05-01

    The Bacteroides fragilis group constitute a significant portion of the human gut microbiota and comprise a major proportion of anaerobic bacteria isolated in human infections. We established a baseline of antimicrobial susceptibility rates in the B. fragilis group in the intestinal tract of relatively antibiotic-naive healthy Danish children. From 174 faecal samples collected from children attending day care, 359 non-duplicate isolates were screened for antimicrobial susceptibility. Of these, 0.0%, 1.9%, 5.0% and 21.2% of isolates were intermediate-susceptible or resistant to metronidazole, meropenem, piperacillin/tazobactam and clindamycin, respectively. Eighteen additional studies reporting susceptibility rates in the B. fragilis group bacteria were identified by conducting a literature search. Heterogeneity among results from studies of B. fragilis group antimicrobial susceptibility rates in faecal microbiota exists. Copyright © 2017 Elsevier B.V. and International Society of Chemotherapy. All rights reserved.

  1. Pharmacovigilance Programme of India: Recent developments and future perspectives

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    Vivekanandan Kalaiselvan

    2016-01-01

    Full Text Available Promoting safe use of medicines is a priority of Indian Pharmacopoeia Commission that functions as the National Coordination Center (NCC for Pharmacovigilance Programme of India (PvPI. One hundred and seventy-nine adverse drug reactions (ADRs monitoring centers currently report ADRs to NCC. Current India contribution to global safety database reaches 3% and the completeness score is 0.93 out of 1. NCC is taking several measures to enhance patient safety including capacity building for monitoring, surveillance, collaboration with national health programs and other organizations to increase ADR reporting and to ensure that PvPI is a vital knowledge database for Indian regulators. The Central Drugs Standard Control Organization has notified important safety label changes on drugs such as carbamazepine and piperacillin + tazobactam in the year 2015, other drugs are under monitoring for regulatory interventions.

  2. Delftia acidovorans and ndash; Isolated from Umbilical Venous Tip of a Neonate: A Case Study and Mini- review

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    YUKTI SHARMA

    2015-06-01

    Full Text Available Delftia acidovorans, previously known as Comamonas acidovorans is an aerobic, non-fermentative, Gram negative rod. We report a case of 2 day old male baby, delivered preterm and admitted to NICU with respiratory distress and shock. Umbilical Venous Tip culture grew Delftia acidovorans. It was sensitive to Amikacin, Gentamicin, Tobramycin, Piperacillin and ndash;Tazobactum, Imipenem, Meropenem. Patient was treated with meropenem, teicoplanin and fluconazole while awaiting reports for blood culture and UVL tip culture. Baby became afebrile and later was discharged. Delftia acidovorans is an unusual organism which has been isolated from cases of line related sepsis. Very few cases have been reported from India. To the best of our knowledge, this is the first case report from North India. [Natl J Med Res 2015; 5(2.000: 166-168

  3. Bacteremia caused by Pseudomonas luteola in pediatric patients.

    Science.gov (United States)

    Bayhan, Gulsum Iclal; Senel, Saliha; Tanir, Gonul; Ozkan, Sengul

    2015-01-01

    Pseudomonas luteola has rarely been reported as a human pathogen. The clinical manifestations of P. luteola bacteremia and its susceptibility to antibiotics have not been characterized. This retrospective study was conducted at a 382-bed tertiary care center in Turkey. During the 9-year study period, 7 patients (5 females and 2 males) were diagnosed with P. luteola bacteremia. Six of these patients had hospital-acquired bacteremia, whereas 1 patient had community-acquired P. luteola infection. All patients had monomicrobial bacteremia. Antimicrobial susceptibility testing revealed that all strains of P. luteola were sensitive to amikacin, gentamicin, trimethoprim-sulfamethoxazole, and meropenem, and that all strains were resistant to piperacillin-tazobactam, aztreonam, and colistin. In conclusion, we believe that P. luteola can cause both community- and hospital-acquired bacteremia. Amikacin, gentamicin, trimethoprim-sulfamethoxazole, and meropenem were effective against P. luteola in the present study.

  4. Adaptive Laboratory Evolution of Antibiotic Resistance Using Different Selection Regimes Lead to Similar Phenotypes and Genotypes

    DEFF Research Database (Denmark)

    Jahn, Leonie Johanna; Munck, Christian; Ellabaan, Mostafa M Hashim

    2017-01-01

    Antibiotic resistance is a global threat to human health, wherefore it is crucial to study the mechanisms of antibiotic resistance as well as its emergence and dissemination. One way to analyze the acquisition of de novo mutations conferring antibiotic resistance is adaptive laboratory evolution....... However, various evolution methods exist that utilize different population sizes, selection strengths, and bottlenecks. While evolution in increasing drug gradients guarantees high-level antibiotic resistance promising to identify the most potent resistance conferring mutations, other selection regimes...... compare the geno- and phenotypes of Escherichia coli after evolution to Amikacin, Piperacillin, and Tetracycline under four different selection regimes. Interestingly, key mutations that confer antibiotic resistance as well as phenotypic changes like collateral sensitivity and cross-resistance emerge...

  5. Imipenem resistance in nonfermenters causing nosocomial urinary tract infections.

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    Taneja N

    2003-07-01

    Full Text Available Nonfermenting gram-negative bacilli (nonfermenters have emerged as important nosocomial pathogens causing opportunistic infections in immunocompromised hosts. These organisms show high level of resistance to b-lactam agents, fluoroquinolones and aminoglycosides. Imipenem is a carbapenem antibiotic, which can be very useful for treatment of infections caused by nonfermenters. Eighty-five nonfermenters causing nosocomial UTI were tested for MIC to imipenem by agar dilution method. Resistance to other antimicrobial agents was compared between imipenem sensitive (S and resistance (R groups. Overall 36.4% of nonfermenters were resistant to imipenem. Forty two percent of P. aeruginosa and 18.5% of Acinetobacter baumanii were imipenem resistant. Other nonfermenters showed variable resistance, resistance in Alcaligenes spp. being very high. More than 70% of the nonfermenters were resistant to ceftazidime, gentamicin and ciprofloxacin. Piperacillin and amikacin had the best in vitro susceptibility. No significant difference was found in the antibiotic susceptibility profile among imipenem sensitive (S or resistant (R strains.

  6. Klebsiella pneumoniae with multiple antimicrobial resistance

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    Caio Mendes

    2004-02-01

    Full Text Available A Klebsiella pneumoniae strain was isolated from the urine of a patient at one of the centers participating in the 2001 edition of the MYSTIC program in Brazil. The initial phenotypic findings of the isolated K. pneumoniae presented an unusual MIC of 8 mug/mL to meropenem, 2 mug/mL to imipenem, elevated MICs to broad spectrum cephalosporins (ceftazidime/cefotaxime/cefepime MIC > 256 mug/mL, aminoglycosides (gentamycin > 256 mug/mL and tobramycin = 48 mug/mL, piperacillin/tazobactam (MIC > 256 mug/mL and susceptibility to ciprofloxacin (MIC = 0.25 mug/mL. The strain also tested positive for ESBL production with double-disk and E-test methodologies. More detailed investigation revealed that the strain produced a SHV-4 type enzyme and also lacked a 36 kDa outer membrane porin.

  7. Control of multi-resistant bacteria and ventilator-associated pneumonia: is it possible with changes in antibiotics?

    Directory of Open Access Journals (Sweden)

    Elisa M. Jukemura

    2007-08-01

    Full Text Available Potent antimicrobial agents have been developed as a response to the development of antibiotic-resistant bacteria, which especially affect patients with prolonged hospitalization in Intensive Care Units (ICU and who had been previously treated with antimicrobials, especially third-generation cephalosporins.This study was to determine how changes in the empirical treatment of infections in ICU patients affect the incidence of Gram-negative bacteria species and their susceptibility to antimicrobials, and examine the impact of these changes on nosocomial infections. A prospective interventional study was performed in a university hospital during two periods: 1 First period (September 1999 to February 2000; and 2 Second period (August 2000 to December 2000; empirical treatment was changed from ceftriaxone and/or ceftazidime in the first period to piperacillin/tazobactam in the second. ICU epidemiological and infection control rates, as well as bacterial isolates from upper airways were analyzed. Ceftazidime consumption dropped from 34.83 to 0.85 DDD/1000 patients per day (p=0.004. Piperacillin/tazobactam was originally not available; its consumption reached 157.07 DDD/1000 patients per day in the second period (p=0.0002. Eighty-seven patients and 66 patients were evaluated for upper airway colonization in the first and second periods, respectively. There was a significant decrease in the incidence of K. pneumoniae (p=0.004 and P. mirabilis (p=0.036, restoration of K. pneumoniae susceptibility to cephalosporins (p<0.0001 and reduction of ventilator-associated pneumonia rates (p<0.0001. However, there was an increase in P. aeruginosa incidence (p=0.005 and increases in ceftazidime (p=0.003 and meropenem (p<0.0001 susceptibilities. Changing antimicrobial selective pressure on multi-resistant Gram-negative bacteria helps control ventilator-associated pneumonia and decreases antimicrobial resistance.

  8. The identification, typing, and antimicrobial susceptibility of Pseudomonas aeruginosa isolated from mink with hemorrhagic pneumonia.

    Science.gov (United States)

    Qi, Jing; Li, Lulu; Du, Yijun; Wang, Shourong; Wang, Jinwen; Luo, Yanbo; Che, Jie; Lu, Jinxing; Liu, Hui; Hu, Guangchun; Li, Jixia; Gong, Yanwen; Wang, Guisheng; Hu, Ming; Shiganyan; Liu, Yuqing

    2014-06-04

    The biological characteristics and molecular epidemiology of Pseudomonas aeruginosa associated with mink hemorrhagic pneumonia from Shandong province of eastern China were determined in this study. From 2010 to 2011, 30 mink P. aeruginosa isolates were identified from lung, fecal and feed samples of clinical cases and subjected to serotyping, antimicrobial susceptibility testing and pulsed-field gel electrophoresis (PFGE) using SpeI. The P. aeruginosa isolates belonged to four serotypes-21 of type G, four of type I, three of type M, one of type B, and one non-typable strain. The strains were divided into four large groups as determined by PFGE. Isolates from the group 2 were highly homologous and were obtained from the same region as an epidemic. All of the isolates were sensitive to piperacillin, piperacillin/tazobactam, ceftazidime, cefepime, imipenem, amikacin, gentamicin and tobramycin and resistant to ampicillin, cefuroxime and cefuroxime axetil. A high frequency of resistance was found to ampicillin/sulbactam, cefazolin, cefotetan, ceftriaxone, nitrofurantoin, and trimethoprim/sulfamethoxazole (96.7%). Resistance to ticarcillin/clavulanic acid, ciprofloxacin and levofloxacin was less common (13.3%). There was no relationship between antibiotic resistance and serotype distribution of the isolates. The epidemic serotype of P. aeruginosa from the mink hemorrhagic pneumonia in Shandong province was type G, which was a clone of commonly found in this province. These findings reveal the genetic similarities and antimicrobial susceptibility profiles of P. aeruginosa from clinical cases of mink hemorrhagic pneumonia and will facilitate the prevention and control of the disease in Shandong province of China.

  9. Incidence of ESBL producers amongst Gram-negative bacilli isolated from intra-abdominal infections across India (based on SMART study, 2007 data).

    Science.gov (United States)

    Chaudhuri, B N; Rodrigues, C; Balaji, V; Iyer, R; Sekar, U; Wattal, Chand; Chitnis, D S; Dhole, T N; Joshi, Sangeeta

    2011-05-01

    This study was conducted in 9 centers spread over India from January 1 to December 31, 2007 to monitor in vitro susceptibility of Gram-negative bacilli to Group I carbapenem, ertapenem and other antimicrobials in intra-abdominal infections and to identify early changes in susceptibility pattern of community or hospital acquired organisms, with a focus on ESBL producers. Gram-negative bacilli isolated from intra-abdominal samples of patients with documented intra-abdominal infections were processed for identification by conventional/ automated methods and antimicrobial susceptibility by Micro-Scan (Siemens) MIC panel against 12 antimicrobials (3rd and 4th generation cephalosporins, Groups I and II carbapenems, amikacin, levofloxacin, amoxicillin-clavulanic acid and piperacillin-tazobactam). A total of 588 isolates were identified, of which 351 (60%) were E. coli and 114 (19%) were Klebsiella spp. 79% of E. coli and 70% of Klebsiella spp. were ESBL producers in general. 110 of E. coli and 35 of Klebsiella isolates were from community-acquired intra-abdominal infections. 80% of E. coli and 63% of Klebsiella isolates from community-acquired infections were ESBL producers, against 79% of E. coli and 73% of Klebsiella isolates from hospital-acquired infections. Amongst the ESBL-positive isolates of E. coli, 94% were susceptible in vitro to ertapenem, 96% to imipenem and 76% to piperacillin-tazobactam. For ESBL-positive isolates of Klebsiella spp., the corresponding figures were 80%, 94% and 59% respectively. The study showed a high incidence of ESBL-producers amongst Enterobacteriaceae isolates from intra-abdominal infections in both community-acquired and hospital-acquired settings across India. Ertapenem was comparable with imipenem against ESBL-positive E. coli isolates, while imipenem was more effective than ertapenem against ESBL-positive Klebsiella isolates.

  10. Antibiotic Resistance Pattern of Pseudomonas Aeruginosa, Isolated from Patient with Burn Wound Infection in Guilan,Iran

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    Iraj Nikokar

    2013-03-01

    Full Text Available Background and Objectives: Antibiotic resistance of Pseudomonas aeruginosa remains a major problem in burn patients. The main objective of this study was to determine the antibiotic resistance pattern and frequency of class 1 integrons among P. aeruginosa strains isolated from patients with burn wound infections in a new Burn Centre in Guilan, Iran.Materials and Methods: The bacterial isolates were collected from 182 patients with burn wound infections and P. aeruginosa species were identified by standard bacteriological methods. The drug susceptibility test, using 11 antimicrobial agents, was performed for all the isolates via agar disk diffusion method. PCR was carried out for the detection of integrons.Results: Out of a total of 182 hospitalized patients in the burn center assessed, 86 (47% found to have P. aeruginosa in their isolates. Resistance rates to various antibiotics were as follows: cloxacillin (91.8%, cotrimoxazole (86%, cephazolin (83.7%, carbenicillin (74.4%, piperacillin (69.9%, ceftazidime (68.8%, ciprofloxacin (66.3%, tobramycin (58.2%, amikacin (48.8% and gentamicin (37.2%, while the most effective antibiotic was imipenem with a resistance rate of 23.3%. Thirty nine (45.3% isolates were detected as multi-drug resistant. The PCR results showed that 37 (43% P. aeruginosa isolates and 27 (69.2% multi-drug resistant strains harbored class 1 integrons. A significant correlation was obtained between the presence of integrons and resistance against imipenem, ceftazidime, piperacillin and ciprofloxacin (P < 0.001.Conclusion: Optimization of using antimicrobial agents and control of infection is recommended to prevent the increasing population of drug resistant organisms in the new burn centre setting in this study. Furthermore, the high frequency of class 1 integrons among multi-drug resistant strains might be responsible for dissemination of antibiotic resistance gene.

  11. Restricted Parenteral Antibiotics Usage Policy in a Tertiary Care Teaching Hospital in India.

    Science.gov (United States)

    Tiwari, Smita Anand; Ghongane, Balasheb Baburao; Daswani, Bharti Ramchandra; Dabhade, Sangeeta Sanjay

    2017-05-01

    The indoor hospital use of antibiotic irrationally has been a growing concern in the recent past. For the patients and providers of health care services this kind of drug consumption account for a major chunk of the budget. To assess the outcome of restriction on the use of parenteral antibiotics with respect to their utilization and monetary benefits, in a tertiary care hospital in India. Data details were collected regarding drug utilization two months before and after restriction respectively. A total 1605 patient records assessed. Drug utilization was expressed as DDD/100 patient bed days. Use of Carbapenems were restricted to culture positive cases only. Antibiotics started for patients as per clinical judgment were issued for only five days. Culture sensitivity reports verified physically on a special indent form, before every antibiotic issued thereafter. Piperacillin-tazobactum (DDD/100 BD 1.72 before and 1.29 after restrictions) was the commonly used antibiotic. Considering values expressed in DDD/100 BD before and after restriction respectively, substantial decrease in consumption of antibiotics like Imipenem- Cilastin (0.22 to 0.16), meropenem (0.30 to 0.09), piperacillin-tazobactum (1.72 to 1.29), teicoplanin (0.24 to 0.05) and vancomycin (0.69 to 0.40) was observed. An increase in consumption of amoxicillin-clavulanic acid (0.90 to 1.04) and clarithromycin (0.44 to 0.55) noted, pointing to a shift in antibiotic use. Restriction decreased expenditure burden on these antibiotics by INR 1,45,911 (17.31%). Restriction of antibiotics cuts down consumption and benefits hospital budget immensely.

  12. Persistent Bacteremia from Pseudomonas aeruginosa with In Vitro Resistance to the Novel Antibiotics Ceftolozane-Tazobactam and Ceftazidime-Avibactam

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    Louie Mar Gangcuangco

    2016-01-01

    Full Text Available Ceftazidime-avibactam and ceftolozane-tazobactam are new antimicrobials with activity against multidrug-resistant Pseudomonas aeruginosa. We present the first case of persistent P. aeruginosa bacteremia with in vitro resistance to these novel antimicrobials. A 68-year-old man with newly diagnosed follicular lymphoma was admitted to the medical intensive care unit for sepsis and right lower extremity cellulitis. The patient was placed empirically on vancomycin and piperacillin-tazobactam. Blood cultures from Day 1 of hospitalization grew P. aeruginosa susceptible to piperacillin-tazobactam and cefepime identified using VITEK 2 (Biomerieux, Lenexa, KS. Repeat blood cultures from Day 5 grew P. aeruginosa resistant to all cephalosporins, as well as to meropenem by Day 10. Susceptibility testing performed by measuring minimum inhibitory concentration by E-test (Biomerieux, Lenexa, KS revealed that blood cultures from Day 10 were resistant to ceftazidime-avibactam and ceftolozane-tazobactam. The Verigene Blood Culture-Gram-Negative (BC-GN microarray-based assay (Nanosphere, Inc., Northbrook, IL was used to investigate underlying resistance mechanism in the P. aeruginosa isolate but CTX-M, KPC, NDM, VIM, IMP, and OXA gene were not detected. This case report highlights the well-documented phenomenon of antimicrobial resistance development in P. aeruginosa even during the course of appropriate antibiotic therapy. In the era of increasing multidrug-resistant organisms, routine susceptibility testing of P. aeruginosa to ceftazidime-avibactam and ceftolozane-tazobactam is warranted. Emerging resistance mechanisms to these novel antibiotics need to be further investigated.

  13. First national survey of antibiotic susceptibility of the Bacteroides fragilis group: emerging resistance to carbapenems in Argentina.

    Science.gov (United States)

    Fernández-Canigia, Liliana; Litterio, Mirta; Legaria, María C; Castello, Liliana; Predari, Silvia C; Di Martino, Ana; Rossetti, Adelaida; Rollet, Raquel; Carloni, Graciela; Bianchini, Hebe; Cejas, Daniela; Radice, Marcela; Gutkind, Gabriel

    2012-03-01

    The antibiotic susceptibility rates of 363 clinical Bacteroides fragilis group isolates collected from 17 centers in Argentina during the period from 2006 to 2009 were as follows: piperacillin-tazobactam, 99%; ampicillin-sulbactam, 92%; cefoxitin, 72%; tigecycline, 100%; moxifloxacin, 91%; and clindamycin, 52%. No metronidazole resistance was detected in these isolates during this time period. Resistance to imipenem, doripenem, and ertapenem was observed in 1.1%, 1.6%, and 2.3% of B. fragilis group strains, respectively. B. fragilis species showed a resistance profile of 1.5% to imipenem, 1.9% to doripenem, and 2.4% to ertapenem. This is the first report of carbapenem resistance in Argentina. The cfiA gene was present in 8 out of 23 isolates, all of them belonging to the B. fragilis species and displaying reduced susceptibility or resistance to carbapenems (MICs ≥ 4 μg/ml). Three out of eight cfiA-positive isolates were fully resistant to carbapenems, while 5 out of 8 isolates showed low-level resistance (MICs, 4 to 8 μg/ml). The inhibition by EDTA was a good predictor of the presence of metallo-β-lactamases in the fully resistant B. fragilis strains, but discrepant results were observed for low-level resistant isolates. B. fragilis was more susceptible to antimicrobial agents than other Bacteroides species. Bacteroides vulgatus species was the most resistant to ampicillin-sulbactam and piperacillin-tazobactam, and B. thetaiotaomicron/ovatus strains showed the highest level of resistance to carbapenems, with an unknown resistance mechanism. B. vulgatus and the uncommon non-Bacteroides fragilis species were the most resistant to moxifloxacin, showing an overall resistance rate of 15.1%.

  14. BACTERIOLOGICAL PROFILE AND ANTIBIOTIC SENSITIVITY PATTERN IN ACUTE EXACERBATION OF ADVANCED CASES OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD

    Directory of Open Access Journals (Sweden)

    Avik

    2016-01-01

    Full Text Available Acute exacerbations are significant and frequent events in the natural history of chronic obstructive pulmonary disease. Majority of these exacerbations are of infectious aetiology, bacteria being responsible for 30-50% of these cases. With not many studies of similar type being conducted in the Indian context, this study was undertaken with the purpose of determining the bacteriology of acute exacerbations of chronic obstructive pulmonary disease in hospitalized patients with advanced disease and their antibiotic susceptibility pattern to formulate a cost effective algorithm for antibiotic usage while at the same time reducing the chances of emergence of drug resistance. Sputum sample from a total of 338 patients were send for Gram’s stain and culture sensitivity testing using an array of the commonly used antibiotics. Pathogenic bacteria were isolated from 203 (60.1% samples. Gram negative bacteria were isolated from 79.8 percent (162/203 cases while the rest were Gram positive. Klebsiella species were the commonest (49.2%; 100/203 Gram negative isolates from the sputum samples. Among the gram negative organisms, Carbapenem had the highest sensitivity (90.2% followed by Amikacin, Ciprofloxacin and Piperacillin-Tazobactam. Linezolid was found to be 100 percent sensitive amongst the Gram positive organisms while both Amoxicillin Clavulanate and Azithromycin showed a rather low sensitivity profile overall. 5.0 percent of the Klebsiella infections were multi drug resistant. It was thereby concluded that either Amikacin, Ciprofloxacin or Piperacillin-Tazobactam for be considered for Gram negative organisms and Linezolid be considered for Gram positive organisms as first line antibiotics in empirical therapy while Carbapenems may be kept as reserve drugs should the first line drugs fail.

  15. A surveillance study of antimicrobial resistance of gram-negative bacteria isolated from intensive care units in eight hospitals in Turkey.

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    Günseren, F; Mamikoğlu, L; Oztürk, S; Yücesoy, M; Biberoğlu, K; Yuluğ, N; Doğanay, M; Sümerkan, B; Kocagöz, S; Unal, S; Cetin, S; Calangu, S; Köksal, I; Leblebicioğlu, H; Günaydin, M

    1999-03-01

    This study was carried out with the participation of eight hospitals in Turkey to determine the frequency of gram-negative bacteria isolated in intensive care units (ICU) and to compare their resistance rates to selected antibiotics. Aerobic gram-negative bacteria isolated from ICUs during 1996 were studied. Antibiotic susceptibilities to imipenem, ceftazidime, ceftazidime-clavulanate, ceftriaxone, cefotaxime, cefepime, cefodizime, cefuroxime, piperacillin/tazobactam, amoxycillin-clavulanate, gentamicin, amikacin and ciprofloxacin were determined by Etest. A total of 748 isolates were obtained from 547 patients. The majority of organisms were isolated from the respiratory (38.8%) and urinary tracts (30.9%). Pseudomonas spp. were the most frequently isolated gram-negative species (26.8%), followed by Klebsiella spp. (26.2%). Escherichia coli, Acinetobacter spp. and Enterobacter spp. were the other commonly isolated organisms. High resistance rates were observed for all antibiotics studied. Imipenem appeared to be the most active agent against the majority of isolates. Although resistance rates exceeded 50%, ciprofloxacin, cefepime and amikacin were found to be relatively effective. Extended-spectrum beta-lactamase (ESBL) production appeared to be a major mechanism of resistance to beta-lactam antibiotics. In contrast to ceftazidime-clavulanate, piperacillin/tazobactam showed poor activity against organisms thought to produce ESBL, suggesting the presence of an enzyme resistant to tazobactam action. This study has yielded high rates of resistance in aerobic gram-negative isolates from ICUs in Turkey. High resistance rates to all the other antibacterials studied leave imipenem as the only reliable agent for the empirical treatment of ICU infections in Turkey.

  16. Antibacterial activity of Argemone mexicana L. against multidrug resistant Pseudomonas aeruginosa, isolated from clinical samples

    Institute of Scientific and Technical Information of China (English)

    Mahesh C Sahu; Nagen K Debata; Rabindra N Padhy

    2012-01-01

    Objective: To monitor the antipseudomonad activity of the weed Argemone mexicana (A.mexicana), with multidrug strains isolated from clinical samples. Methods: Antibiogram of isolated strains were done with disc diffusion method and antipseudomonad activity was monitored with the agar well diffusion method. Results: Twenty seven strains of Pseudomonas aeruginosa (P. aeruginosa) were isolated from clinical samples from a hospital; among them, 22 were resistant to antibiotics (μg/disc): cefotaxime-30, 16 to amoxyclav-30, 15 to ofloxacin-5, 13 to gentamicin-10, 10 to piperacillin-100/tazobactam-10, 8 to amikacin-30, 7 to gatifloxacin-30, 6 to netilmicin-30, 4 to piperacillin100, 3 to imipenem-10 and 3 strains to nitrofurantoin-300. Each strain was resistant to several antibiotics at specified levels. Of these 27 clinical strains, 15 antibiotic-resistant strains and a antibiotic-sensitive standard strain were used in monitoring antimicrobial activity of leaf-extracts using 3 organic solvents (acetone, methanol and ethanol) and water of the weed, prickly poppy (A. mexicana L.). The methanol-extract had the highest level of antipseudomonad activity both with cold and hot extracts, confirmed by separate Kruskal-Wallis H tests. With the Student’s t-test it was ascertained that the hot extraction concentrate yielded promising antipseudomonad activity than the cold extraction with methanol. Values of minimum inhibitory concentration (MIC) of extracts of A. mexicana using acetone, methanol and ethanol as solvents were 10, 8 and 8 mg/mL, respectively; corresponding values of minimum bactericidal concentration (MBC) were 32, 28 and 24 mg/mL for these solvents, respectively.Conclusions:This study suggests that A. mexicana leaf can be used as complementary medicinein treating diseases caused by multidrug resistant strains of P. aeruginosa.

  17. Imipenem-resistant Pseudomonas aeruginosa: risk factors for nosocomial infections.

    Science.gov (United States)

    Onguru, Pinar; Erbay, Ayse; Bodur, Hurrem; Baran, Gulseren; Akinci, Esragul; Balaban, Neriman; Cevik, Mustafa Aydin

    2008-12-01

    The aim of this study was to determine the risk factors for nosocomial infections of imipenem-resistant Pseudomonas aeruginosa (IRPA). A prospective case-control study was performed at a tertiary care hospital in Ankara from January to December 2004. The patients with nosocomial P. aeruginosa infection were included in the study. The features of the patients with IRPA infections were compared to those with imipenem-sensitive P. aeruginosa (ISPA) infections. Only the first isolation of P. aeruginosa was considered. Nosocomial infections were defined according to Center for Disease Control (CDC) criteria. IRPA was isolated from 75 (44.1%) patients, and ISPA was isolated from 95 (55.9%) patients during the study period. IRPA were most frequently isolated from endotracheal aspirate (19%) cultures (p=0.048), whereas ISPA were most frequently isolated from urine (28%) cultures (p=0.023). In multivariate analysis, a longer duration of hospital stay until P. aeruginosa isolation (odds ratio [OR], 1.027; 95% confidence interval [CI], 1.002-1.054, p=0.034), arterial catheter administration (OR, 2.508; 95% CI, 1.062-5.920, p=0.036), vancomycin (OR, 2.882; 95% CI, 1.130-7.349, p=0.027), piperacillin-tazobactam (OR, 6.425; 95% CI, 2.187-18.875, p=0.001), and imipenem (OR, 3.580; 95% CI, 1.252-10.245, p=0.017) treatment within the 14 days before isolation of IRPA were independently associated with imipenem resistance. It was concluded that treatment with imipenem, vancomycin and piperacillin-tazobactam were major risk factors for IRPA infections in hospitalized patients. The nosocomial occurrence of IRPA was also strongly related to the duration of hospital stay, arterial catheter administration.

  18. Vancomycin and Five Broad-spectrum Antibiotic Utilization Evaluation in an Educational Medical Center in One Year

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    SiminDokht Shoaei

    2015-10-01

    Full Text Available  Background: Antibiotics can be life saving if they are used correctly, and can have unwanted side effects specially resistance with incorrect use. Unfortunately in fear of no response, physicians use broad spectrum antibiotics meticulously. In this Drug Utilization Evaluation (DUE, improper use of Vancomycin and five broad-spectrum antibiotics are studied to find faults and solution for this problem. Methods:This descriptive cross-sectional study performed during the March of 2012 to March of 2013.DUE of Imipenem, Meropenem, Piperacillin-Tazobactam, Cefepime, Ciprofloxacin and Vancomycin was done in 6 wards of Imam Hossein Hospital in Tehran. Demographic, clinical, laboratory, imaging and treatment data were looked for in medical records of 686 patients. Evaluation was done by three infectious disease specialist based on reference text book of Mandell’s Principles and Practice of Infectious Diseases 2010 and IDSA Guidelines. Results:This study showed 38.5% of prescriptions were correct and the remained 61.5% were incorrect with different faults predominantly incorrect overuse in 51.1%.Ciprofloxacin was the most common incorrect used drug in 74.8% cases and Piperacillin-Tazobactam with 48.7% cases had the least common incorrect use. There was no fault in prescription of antibiotics observing age and sex (pregnancy, breast feeding factors. Conclusions:Our results reveal a significant high level of the inappropriate use of Antibiotics mostly as overuse and empirically without culture results. It is needed to establish continuing medical education (CME courses and a locally conformable guideline of antibiotic use based on antibiogram results.

  19. Characterization of Pseudomonas aeruginosa strains isolated from burned patients hospitalized in a major burn center in Tehran, Iran.

    Science.gov (United States)

    Ranjbar, Reza; Owlia, Parviz; Saderi, Horie; Mansouri, Sadegh; Jonaidi-Jafari, Nematollah; Izadi, Morteza; Farshad, Shohreh; Arjomandzadegan, Mohammad

    2011-01-01

    Pseudomonas aeruginosa is an important life-threatening nosocomial pathogen and plays a prominent role in serious infections in burned patients. The current study was undertaken to characterize P. aeruginosa strains isolated from burned patients in Tehran, Iran. The study was conducted in a major burn center in Tehran, Iran in 2007. A total of seventy specimens obtained from different clinical origin with positive culture results for P. aeruginosa were included in the study. Antimicrobial susceptibility test was performed according to the standard CLSI guideline. The relationship between the strains was also determined using antimicrobial drug resistance pattern analysis and plasmid profiling. All strains were multi drug resistant. The percentage of resistance to tested antibiotics was: imipenem 97.5%, amikacin 90%, piperacillin 87.5%, ceftizoxime 72.7%, gentamicin 67.5%, ciprofloxacin 65%, ceftriaxone 60%, and ceftazidime 57.5%. Thirteen resistant phenotypes were recognized, R3 (TET, IPM, AMK, CIP, PIP, GM, CAZ, CRO, CT) was the predominant resistance pattern seen in 27.5% of isolates. Results obtained from E-test showed that 100% of P. aeruginosa strains were resistant to cefoxitin, 97% to cefotetan, 93% to ticarcillin, 89% to ticarcillin/clav, 76% to gentamicin and imipenem, 63% to piperacillin, 49% to tetracycline, and 20% to meropenem. Nine different plasmid profiles were observed among the strains. The current study showed an increase rate of resistance for some antibiotics tested among P. aeruginosa strains isolated from burned patients in Tehran. A combination of antibiotic susceptibility testing and profile plasmid analysis, which are relatively cheap and available methods, showed to be useful to characterize the clinical strains of P. aeruginosa isolated from burned patients in Iran.

  20. Prevalence of CTX-M-Type β-Lactamases in Multi–Drug Resistant Escherichia coli Isolates from North of Iran, Rasht

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    Tolou Babaei Hematti

    2015-02-01

    Full Text Available   Introduction : One of the most important resistance determinants in Enterobacteriaceae are extended spectrum β-lactamases (ESBLs. During the last decade, CTX-M types ESBLs have increased considerably and become the most common ESBLs worldwide which are the major causes of the urinary tract infections (UTIs. The aim of this study was to determine the antibiotic resistance patterns and the frequency of the CTX-M β-lactamases among multi-drug resistant (MDR Escherichia coli (E. coli isolates from northern Iranian patients with UTI.   Materials and method s: Thirty three E. coli isolates from urine samples were applied in this study. Double disk synergy test (DDST was applied for identification of ESBL phenotypes in E. coli isolates. The ESBL related genes, CTX-M group (1, 2, 8 and 9, were amplified by polymerase chain reaction (PCR.   Results : All E. coli isolates showed sensitivity to piperacillin and 55% of the isolates were resistant to 3rd and 4th cephalosporins. The presence of the blaCTX-M gene in 88% of the ESBL producing isolates was approved based on molecular method. CTX-M (1, 2, 8 and 9 containing E. coli isolates showed resistance to more antibiotics than non-CTX-M isolates. CTX-M-1 was the most prevalent CTX-M determinant in ESBL producing E. coli isolates. Discussion and conclusion : Based on the results of the present study, the preferred antibiotic against CTX-M type ESBL-producing E. coli strains in north of Iran, Rasht, should be piperacillin. Although, CTX-M type ESBLs prevalence was nearly low in the studied MDR E. coli isolates, but controlling these low prevalence isolates is important .

  1. Antimicrobial agents' utilization and cost pattern in an Intensive Care Unit of a Teaching Hospital in South India

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    Nikhilesh Anand

    2016-01-01

    Full Text Available Background and Aims: High utilization and inappropriate usage of antimicrobial agents (AMAs in an Intensive Care Unit (ICU increases resistant organisms, morbidity, mortality, and treatment cost. Prescription audit and active feedback are a proven method to check the irrational prescription. Measuring drug utilization in DDD/100 bed-days is proposed by the WHO to analyze and compare the utilization of drugs. Data of AMAs utilization are required for planning an antibiotic policy and for follow-up of intervention strategies. Hence, in this study, we proposed to evaluate the utilization pattern and cost analysis of AMA used in the ICU. Methodology: A prospective observational study was conducted for 1 year from January 1, 2014, to December 31, 2014, and the data were obtained from the ICU of a tertiary care hospital. The demographic data, disease data, relevant investigation, the utilization of different classes of AMAs (WHO-ATC classification as well as individual drugs and their costs were recorded. Results: One thousand eight hundred and sixty-two prescriptions of AMAs were recorded during the study period with an average of 1.73 ± 0.04 prescriptions/patient. About 80.4% patients were prescribed AMAs during admission. Ceftriaxone (22.77% was the most commonly prescribed AMA followed by piperacillin/tazobactam (15.79%, metronidazole (12%, amoxicillin/clavulanic acid (6.44%, and azithromycin (4.34%. Ceftriaxone, piperacillin/tazobactam, metronidazole, and linezolid were the five maximally utilized AMAs with 38.52, 19.22, 14.34, 8.76, and 8.16 DDD/100 bed-days respectively. An average cost of AMAs used per patient was 2213 Indian rupees (INR. Conclusion: A high utilization of AMAs and a high cost of treatment were noticed which was comparable to other published data, though an increased use of newer AMAs such as linezolid, clindamycin, meropenem, colistin was noticed.

  2. Prevalence of blaNDM, blaPER, blaVEB, blaIMP, and blaVIM Genes among Acinetobacter baumannii Isolated from Two Hospitals of Tehran, Iran

    Science.gov (United States)

    Fallah, Fatemeh; Noori, Maryam; Goudarzi, Hossein; Karimi, Abdollah; Erfanimanesh, Soroor; Alimehr, Shadi

    2014-01-01

    Background and Objectives. The aim of this study was to determine the frequency of blaNDM, blaPER, blaVEB, blaIMP, and blaVIM type genes among A. baumannii isolates from hospitalized patients in two hospitals in Tehran, Iran. Patients and Methods. Antibiotic susceptibility tests were performed by Kirby-Bauer disc diffusion and Broth microdilution methods. The frequency of MBL (metallo-beta-lactamase) and ESBL (extended-spectrum-beta-lactamase) producers was evaluated by CDDT. The β-lactamases genes were detected by PCR and sequencing methods. Results. The resistance of A. baumannii isolates against tested antibiotics was as follows: 103 (95.4%) to ceftazidime, 108 (100%) to cefotaxime, 105 (95.7%) to cefepime, 99 (91.7%) to imipenem, 99 (91.7%) to meropenem, 87 (80.6%) to amikacin, 105 (97.2%) to piperacillin, 100 (92.6%) to ciprofloxacin, 103 (95.4%) to piperacillin/tazobactam, 44 (40.7%) to gentamicin, 106 (98.1%) to ampicillin/sulbactam, 106 (98.1%) to co-trimoxazole, 87 (80.6%) to tetracycline, and 1 (1.8%) to colistin. Using combined disk diffusion test, 91 (84.2%) and 86 (86.86%) were ESBL and MBL producers, respectively. The prevalence of blaPER-1, blaVEB-1, blaIMP-1, and blaVIM-1 genes was 71 (78.03%), 36 (39.5%), 3 (3.48%), and 15 (17.44%), respectively. Conclusions. The prevalence of ESBLs and MBLs-producing A. baumannii strains detected in this study is a major concern and highlights the need of infection control measures. PMID:25133013

  3. Prevalence of blaNDM, blaPER, blaVEB, blaIMP, and blaVIM Genes among Acinetobacter baumannii Isolated from Two Hospitals of Tehran, Iran

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    Fatemeh Fallah

    2014-01-01

    Full Text Available Background and Objectives. The aim of this study was to determine the frequency of blaNDM, blaPER, blaVEB, blaIMP, and blaVIM type genes among A. baumannii isolates from hospitalized patients in two hospitals in Tehran, Iran. Patients and Methods. Antibiotic susceptibility tests were performed by Kirby-Bauer disc diffusion and Broth microdilution methods. The frequency of MBL (metallo-beta-lactamase and ESBL (extended-spectrum-beta-lactamase producers was evaluated by CDDT. The β-lactamases genes were detected by PCR and sequencing methods. Results. The resistance of A. baumannii isolates against tested antibiotics was as follows: 103 (95.4% to ceftazidime, 108 (100% to cefotaxime, 105 (95.7% to cefepime, 99 (91.7% to imipenem, 99 (91.7% to meropenem, 87 (80.6% to amikacin, 105 (97.2% to piperacillin, 100 (92.6% to ciprofloxacin, 103 (95.4% to piperacillin/tazobactam, 44 (40.7% to gentamicin, 106 (98.1% to ampicillin/sulbactam, 106 (98.1% to co-trimoxazole, 87 (80.6% to tetracycline, and 1 (1.8% to colistin. Using combined disk diffusion test, 91 (84.2% and 86 (86.86% were ESBL and MBL producers, respectively. The prevalence of blaPER-1, blaVEB-1, blaIMP-1, and blaVIM-1 genes was 71 (78.03%, 36 (39.5%, 3 (3.48%, and 15 (17.44%, respectively. Conclusions. The prevalence of ESBLs and MBLs-producing A. baumannii strains detected in this study is a major concern and highlights the need of infection control measures.

  4. Control of multidrug resistant bacteria in a tertiary care hospital in India

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    Jaggi Namita

    2012-06-01

    Full Text Available Abstract Background The objective of this study was to assess the impact of antimicrobial stewardship programs on the multidrug resistance patterns of bacterial isolates. The study comprised an initial retrospective analysis of multidrug resistance in bacterial isolates for one year (July 2007-June 2008 followed by prospective evaluation of the impact of Antimicrobial Stewardship programs on resistance for two years and nine months (July 2008-March 2011. Setting A 300-bed tertiary care private hospital in Gurgaon, Haryana (India Findings Methods Study Design • July 2007 to June 2008: Resistance patterns of bacterial isolates were studied. • July 2008: Phase I intervention programme Implementation of an antibiotic policy in the hospital. • July 2008 to June 2010: Assessment of the impact of the Phase I intervention programme. • July 2010 to March 2011: Phase II intervention programme: Formation and effective functioning of the antimicrobial stewardship committee. Statistical correlation of the Defined daily dose (DDD for prescribed drugs with the antimicrobial resistance of Gram negatives. Results Phase I intervention programme (July 2008 resulted in a decrease of 4.47% in ESBLs (E.coli and Klebsiella and a significant decrease of 40.8% in carbapenem-resistant Pseudomonas. Phase II intervention (July 2010 brought a significant reduction (24.7% in carbapenem-resistant Pseudomonas. However, the resistance in the other Gram negatives (E.coli, Klebsiella, and Acinetobacter rose and then stabilized. A positive correlation was observed in Pseudomonas and Acinetobacter with carbapenems and cefoperazone-sulbactam. Piperacillin-tazobactam showed a positive correlation with Acinetobacter only. E.coli and Klebsiella showed positive correlation with cefoparazone-sulbactam and piperacillin-tazobactam. Conclusion An antimicrobial stewardship programme with sustained and multifaceted efforts is essential to promote the judicious use of antibiotics.

  5. Interaction of zwitterionic penicillins with the OmpF channel facilitates their translocation.

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    Danelon, Christophe; Nestorovich, Ekaterina M; Winterhalter, Mathias; Ceccarelli, Matteo; Bezrukov, Sergey M

    2006-03-01

    To study translocation of beta-lactam antibiotics of different size and charge across the outer bacterial membrane, we combine an analysis of ion currents through single trimeric outer membrane protein F (OmpF) porins in planar lipid bilayers with molecular dynamics simulations. Because the size of penicillin molecules is close to the size of the narrowest part of the OmpF pore, penicillins occlude the pore during their translocation. Favorably interacting penicillins cause time-resolvable transient blockages of the small-ion current through the channel and thereby provide information about their dynamics within the pore. Analyzing these random fluctuations, we find that ampicillin and amoxicillin have a relatively high affinity for OmpF. In contrast, no or only a weak interaction is detected for carbenicillin, azlocillin, and piperacillin. Molecular dynamics simulations suggest a possible pathway of these drugs through the OmpF channel and rationalize our experimental findings. For zwitterionic ampicillin and amoxicillin, we identify a region of binding sites near the narrowest part of the channel pore. Interactions with these sites partially compensate for the entropic cost of drug confinement by the channel. Whereas azlocillin and piperacillin are clearly too big to pass through the channel constriction, dianionic carbenicillin does not find an efficient binding region in the constriction zone. Carbenicillin's favorable interactions are limited to the extracellular vestibule. These observations confirm our earlier suggestion that a set of high-affinity sites at the narrowest part of the OmpF channel improves a drug's ability to cross the membrane via the pore.

  6. Antibiotics regulate the immune response in both presence and absence of lipopolysaccharide through modulation of Toll-like receptors, cytokine production and phagocytosis in vitro.

    Science.gov (United States)

    Bode, Christian; Diedrich, Britta; Muenster, Stefan; Hentschel, Viktoria; Weisheit, Christina; Rommelsheim, Kuno; Hoeft, Andreas; Meyer, Rainer; Boehm, Olaf; Knuefermann, Pascal; Baumgarten, Georg

    2014-01-01

    The inflammatory response to pathogen-associated molecular patterns such as lipopolysaccharide (LPS) in sepsis is mediated via Toll-like receptors (TLRs). Since TLRs also trigger various immune functions, including phagocytosis, their modulation is a promising strategy in the treatment of sepsis. As antibiotics have immunomodulatory properties, this study examined the effect of commonly used classes of antibiotics on i) the expression of TLRs and cytokines and ii) the phagocytic activity under sepsis-like conditions in vitro. This was achieved by incubating THP-1 monocytes and peripheral blood mononuclear cells (PBMCs) obtained from patients after open-heart surgery with the addition of LPS and six key antibiotics (piperacillin, doxycycline, erythromycin, moxifloxacin or gentamicin). After 24h, mRNA levels of both cytokines (IL-1β, IL-6) and TLRs (1, 2, 4, and 6) were monitored and phagocytosis was determined following coincubation with Escherichia coli. Each antibiotic differentially regulated the gene expression of the investigated TLRs and cytokines in monocytes. Erythromycin, moxifloxacin and doxycyclin displayed the strongest effects and changed mRNA-levels of the investigated genes up to 5.6-fold. Consistent with this, antibiotics and, in particular, moxifloxacin, regulated the TLR-and cytokine expression in activated PBMCs obtained from patients after open-heart surgery. Furthermore, piperacillin, doxycyclin and moxifloxacin inhibited the phagocytic activity of monocytes. Our results suggest that antibiotics regulate the immune response by modulating TLR- and cytokine expression as well as phagocytosis under septic conditions. Moxifloxacin, doxycycline and erythromycin were shown to possess the strongest immunomodulatory effects and these antibiotic classes should be considered for future immunomodulatory studies in sepsis.

  7. Occurrence and antimicrobial susceptibility of Salmonella isolates recovered from the pig slaughter process in Romania.

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    Morar, Adriana; Sala, Claudia; Imre, Kálmán

    2015-01-15

    Reported human salmonellosis cases have increased in Romania. Antibiotic susceptibility testing of Salmonella strains isolated from pork and chicken meat indicate a worrying multidrug resistance pattern. This study aimed to investigate the occurrence of Salmonella and to evaluate the antibiotic resistance of Salmonella strains in a pig slaughterhouse-processing complex, which receives animals from 30% of the large industrialized swine farms in Romania. A total of 108 samples, including pork (n = 47), packaged pork products (n = 44), scald water sludge (n = 8), and detritus from the hair removal machine of the slaughterhouse (n = 9) were examined for the presence of Salmonella through standard methods. The antibiotic susceptibility of the isolated strains to 17 antibiotics was tested using the Vitek 2 system. Twenty-six (24.1%) samples were found to be Salmonella positive; this included 25.5% of meat samples and 15.9% of packaged products, as well as samples from two different points of the slaughter (41.2%). Resistance was observed against tetracycline (61.5%), ampicillin (50%), piperacillin (50%), trimethoprim-sulfamethoxazole (34.6%), amoxicillin/clavulanic acid (26.9%), nitrofurantion (23.1%), cefazolin (15.4%), piperacillin/tazobactam (7.7%), imipenem (3.8%), ciprofloxacin (3.8%), and norfloxacin (3.8%). No resistance towards cefoxitin, cefotaxime, ceftazidime, cefepime, amikacin, and gentamicin was found. Our study demonstrated the occurrence of multidrug-resistant Salmonella strains in the investigated pork production complex and highlighted it as a potential source of human infections. The results demonstrate the seriousness of antibiotic resistance of Salmonella in Romania, while providing a useful insight for the treatment of human salmonellosis by specialists.

  8. Influence of regular reporting on local Pseudomonas aeruginosa and Acinetobacter spp. sensitivity to antibiotics on consumption of antibiotics and resistance patterns.

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    Djordjevic, Z M; Folic, M M; Jankovic, S M

    2017-10-01

    Regular surveillance of antimicrobial resistance is an important component of multifaceted interventions directed at the problem with resistance of bacteria causing healthcare-associated infections (HAIs) in intensive care units (ICUs). Our aim was to analyse antimicrobial consumption and resistance among isolates of Pseudomonas aeruginosa and Acinetobacter spp. causing HAIs, before and after the introduction of mandatory reporting of resistance patterns to prescribers. A retrospective observational study was conducted between January 2011 and December 2015, at an interdisciplinary ICU of the Clinical Centre Kragujevac, Serbia. The intervention consisted of continuous resistance monitoring of all bacterial isolates from ICU patients and biannual reporting of results per isolate to prescribers across the hospital. Both utilization of antibiotics and density of resistant isolates of P. aeruginosa and Acinetobacter spp. were followed within the ICU. Resistance densities of P. aeruginosa to all tested antimicrobials were lower in 2015, in comparison with 2011. Although isolates of Acinetobacter spp. had lower resistance density in 2015 than in 2011 to the majority of investigated antibiotics, a statistically significant decrease was noted only for piperacillin/tazobactam. Statistically significant decreasing trends of consumption were recorded for third-generation cephalosporins, aminoglycosides and fluoroquinolones, whereas for the piperacillin/tazobactam, ampicillin/sulbactam and carbapenems, utilization trends were decreasing, but without statistical significance. In the same period, increasing trends of consumption were observed for tigecycline and colistin. Regular monitoring of resistance of bacterial isolates in ICUs and reporting of summary results to prescribers may lead to a significant decrease in utilization of some antibiotics and slow restoration of P. aeruginosa and Acinetobacter spp. susceptibility. © 2017 John Wiley & Sons Ltd.

  9. Prevalence of Gram-negative Pathogens and their antimicrobial susceptibility in bacterial meningitis in pediatric cases

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    Yash Pal Chugh

    2012-07-01

    Full Text Available The present study was conducted to find out the prevalence and spectrum of Gram negative pathogens causing bacterial meningitis and their antimicrobial susceptibility pattern in a tertiary care hospital. The cerebrospinal fluid (CSF (3-5 ml was collected from 638 admitted children clinically suspected of septic meningitis. Bacterial isolates were identified and antimicrobial susceptibility was assessed by the Kirby-Bauer disk diffusion method. Of the 638 samples tested 102 (15.99% were culture positive. Male to female (M:F ratio was 1.62:1. The maximum incidence of 45 (44.12% cases was found in children (1-12 yrs; in institutional deliveries the incidence was 58 (56.86% cases. Further, the incidence of 51 cases was found from May to August. Escherichia coli (E. coli were commonest, seen in 9 (25% cases followed by Acinetobacter spp., Citrobacter spp. and Klebsiella spp. with 6 (16.67% cases each. Enterobacter spp., Neisseria spp. and Pseudomonas aeruginosa were isolated in 3 (8.33% cases each. E. coli, Acinetobacter spp, Citrobacter spp and Klebsiella spp isolates were 100% susceptible to meropenem, piperacillin-tazobactam and cefoperazone-sulbactam and 100% resistant to cotrimoxazole and tetracycline. All strains of Neisseria spp, Enterobacter spp and Pseudomonas spp. were 100% susceptible to meropenem followed by gatifloxacin. These were 100% resistant to tetracycline and cotrimoxazole. Neisseria spp. were also 100% susceptible to pristinamycin. In septic meningitis Gram negative organisms are less common (35.29%. Of the isolates, more common Gram negative isolates included E. coli, Acinetobacter Spp., Citrobacter Spp., and Klebsiella spp. and these isolates were 100% susceptible to meropenem, piperacillin-tazobacatam and cefoperazone-sulbactam. Hence, empirical therapy should be formulated according to antimicrobial susceptibility patterns.

  10. Doxycycline Induces Expression of P Glycoprotein in MCF-7 Breast Carcinoma Cells

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    Mealey, Katrina L.; Barhoumi, Rola; Burghardt, Robert C.; Safe, Stephen; Kochevar, Deborah T.

    2002-01-01

    P-glycoprotein (P-gp) overexpression by tumor cells imparts resistance to multiple antineoplastic chemotherapeutic agents (multiple drug resistance). Treatment of tumor cells with chemotherapeutic agents such as anthracyclines, epipodophyllotoxins, and Vinca alkaloids results in induction of P-gp expression. This study was performed to determine if clinically relevant antimicrobial drugs (i.e., drugs that are used to treat bacterial infections in cancer patients) other than antineoplastic agents can induce expression of P-gp in MCF-7 breast carcinoma cells. Expression of P-gp and MDR1 mRNA was determined in samples from MCF-7 cells that were treated in culture with doxorubicin (positive control) and the antimicrobial drugs doxycycline, piperacillin, and cefoperazone. The functional status of P-gp was assessed using laser cytometry to determine intracellular doxorubicin concentrations. The MTT (3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyltetrazolium bromide) assay was used to determine if the cytotoxicity of experimental drugs was related to their ability to induce P-gp expression. MCF-7 cells treated with doxycycline (MCF-7/doxy) were stimulated to overexpress P-gp, whereas cells treated with piperacillin and cefoperazone did not overexpress P-gp. MCF-7/doxy cells were compared to a positive-control subline, MCF-7/Adr, previously selected for doxorubicin resistance, and to MCF-7 cells treated with doxorubicin (MCF-7/doxo). All three sublines overexpressed P-gp and MDR1 mRNA and accumulated less intracellular doxorubicin than did control MCF-7 cells. P-gp expression was induced only by experimental drugs that were cytotoxic (doxorubicin and doxycycline). Doxycycline, a drug that has been used for treatment of bacterial infections in cancer patients, can induce functional P-gp expression in cancer cells, resulting in multidrug resistance. PMID:11850258

  11. Characterization of Pseudomonas Aeruginosa Strains Isolated from Burned Patients Hospitalized in A Major Burn Center in Tehran, Iran

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    Mohammad Arjomandzadegan

    2011-10-01

    Full Text Available Pseudomonas aeruginosa is an important life-threatening nosocomial pathogen and plays a prominent role in serious infections in burned patients. The current study was undertaken to characterize P. aeruginosa strains isolated from burned patients in Tehran, Iran. The study was conducted in a major burn center in Tehran, Iran in 2007. A total of seventy specimens obtained from different clinical origin with positive culture results for P. aeruginosa were included in the study. Antimicrobial susceptibility test was performed according to the standard CLSI guideline. The relationship between the strains was also determined using antimicrobial drug resistance pattern analysis and plasmid profiling. All strains were multi drug resistant. The percentage of resistance to tested antibiotics was: imipenem 97.5%, amikacin 90%, piperacillin 87.5%, ceftizoxime 72.7%, gentamicin 67.5%, ciprofloxacin 65%, ceftriaxone 60%, and ceftazidime 57.5%. Thirteen resistant phenotypes were recognized, R3 (TET, IPM, AMK, CIP, PIP, GM, CAZ, CRO, CT was the predominant resistance pattern seen in 27.5% of isolates. Results obtained from E-test showed that 100% of P. aeruginosa strains were resistant to cefoxitin, 97% to cefotetan, 93% to ticarcillin, 89% to ticarcillin/clav, 76% to gentamicin and imipenem, 63% to piperacillin, 49% to tetracycline, and 20% to meropenem. Nine different plasmid profiles were observed among the strains. The current study showed an increase rate of resistance for some antibiotics tested among P. aeruginosa strains isolated from burned patients in Tehran. A combination of antibiotic susceptibility testing and profile plasmid analysis, which are relatively cheap and available methods, showed to be useful to characterize the clinical strains of P. aeruginosa isolated from burned patients in Iran.

  12. Antibiotic resistance in healthcare-related and nosocomial spontaneous bacterial peritonitis.

    Science.gov (United States)

    Lutz, Philipp; Nischalke, Hans Dieter; Krämer, Benjamin; Goeser, Felix; Kaczmarek, Dominik J; Schlabe, Stefan; Parcina, Marijo; Nattermann, Jacob; Hoerauf, Achim; Strassburg, Christian P; Spengler, Ulrich

    2017-01-01

    Spontaneous bacterial peritonitis (SBP) can be life threatening in patients with liver cirrhosis. In contrast to community-acquired SBP, no standard treatment has been established for healthcare-related and nosocomial SBP. We prospectively collected healthcare-related and nosocomial SBP cases from March 2012 till February 2016 at the Department of Internal Medicine I of the University of Bonn and analysed the prevalence of antibiotic resistance among the isolated bacteria. SBP was diagnosed according to international guidelines. Ciprofloxacin, ceftriaxone and meropenem were used as reference substance for resistance to quinolones, third-generation cephalosporins and carbapenems, respectively. Ninety-two SBP episodes in 86 patients were identified: 63 episodes (69%) were nosocomial. Escherichia coli, Klebsiella species, enterococci and streptococci were most frequently isolated. Frequencies of these microorganisms were comparable for healthcare-related and nosocomial SBP (14% vs. 11%, 14% vs. 8%, 14% vs. 5% and 10% vs. 6%, respectively). In general, antibiotic resistance was higher in isolates from nosocomial than from healthcare-related SBP (50% vs. 18% for quinolones, 30% vs. 11% for piperacillin-tazobactam; P > 0·05), but comparable concerning third-generation cephalosporins (30% vs. 33%). All microorganisms were sensitive to carbapenems apart from nosocomial infections with Enterococcus faecium (n = 3) and Candida albicans (n = 1) due to intrinsic resistance or lack of microbiological efficacy, respectively. No multidrug-resistant microorganisms were detected. Resistance to initial antibiotic treatment affected 30-day survival negatively (18% vs. 68%; P = 0·002). Resistance to initial antibiotic treatment was associated with increased mortality. With resistance to cephalosporins being frequent, piperacillin-tazobactam or carbapenems might be preferred as treatment of SBP. © 2016 Stichting European Society for Clinical Investigation Journal Foundation.

  13. A multicenter study on the effect of continuous hemodiafiltration intensity on antibiotic pharmacokinetics.

    Science.gov (United States)

    Roberts, Darren M; Liu, Xin; Roberts, Jason A; Nair, Priya; Cole, Louise; Roberts, Michael S; Lipman, Jeffrey; Bellomo, Rinaldo

    2015-03-13

    Continuous renal replacement therapy (CRRT) may alter antibiotic pharmacokinetics and increase the risk of incorrect dosing. In a nested cohort within a large randomized controlled trial, we assessed the effect of higher (40 mL/kg per hour) and lower (25 mL/kg per hour) intensity CRRT on antibiotic pharmacokinetics. We collected serial blood samples to measure ciprofloxacin, meropenem, piperacillin-tazobactam, and vancomycin levels. We calculated extracorporeal clearance (CL), systemic CL, and volume of distribution (Vd) by non-linear mixed-effects modelling. We assessed the influence of CRRT intensity and other patient factors on antibiotic pharmacokinetics. We studied 24 patients who provided 179 pairs of samples. Extracorporeal CL increased with higher-intensity CRRT but the increase was significant for vancomycin only (mean 28 versus 22 mL/minute; P = 0.0003). At any given prescribed CRRT effluent rate, extracorporeal CL of individual antibiotics varied widely, and the effluent-to-plasma concentration ratio decreased with increasing effluent flow. Overall, systemic CL varied to a greater extent than Vd, particularly for meropenem, piperacillin, and tazobactam, and large intra-individual differences were also observed. CRRT dose did not influence overall (systemic) CL, Vd, or half-life. The proportion of systemic CL due to CRRT varied widely and was high in some cases. In patients receiving CRRT, there is great variability in antibiotic pharmacokinetics, which complicates an empiric approach to dosing and suggests the need for therapeutic drug monitoring. More research is required to investigate the apparent relative decrease in clearance at higher CRRT effluent rates. ClinicalTrials.gov NCT00221013. Registered 14 September 2005.

  14. Sensitivity pattern of Gram negative bacteria to the new β-lactam/ β-lactamase inhibitor combination: Cefepime/tazobactam

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    Abdul Ghafur

    2012-03-01

    Full Text Available Objectives: Increasing prevalence of carbapenem-resistant Gram negative bacteria has prompted researchers to explorealternative antibiotic options. Different ß-lactam/ß-lactamase inhibitor (BL/BLI combinations are used in manycountries, as a carbapenem saving strategy. The purpose of our study was to evaluate the sensitivity pattern of cefepime/tazobactam combination in comparison to piperacillin/tazobactam, cefoperazone/sulbactam, cefepime andcarbapenem agents.Materials and methods: We conducted retrospective analysis of the sensitivity pattern of Gram negative bacterialisolates in Apollo Speciality Hospital; a 300 bedded, tertiary care Oncology, Neurosurgical and Orthopaedic Centre inSouth India.Results: Out of the 1003 Gram negative, non-repetitive isolates collected over a period of one year; 60.5% were sensitiveto piperacillin-tazobactam, 46.2% to cefepime, 80.4% to cefepime/tazobactam, 71.3% to cefoperazone-sulbactam,79.1% to imipenem and 78.2% to meropenem. Addition of tazobactam increased the susceptibility of cefepime from46.2% to 80.4% in gram negative isolates in general; from 34.4 to 87.9% in E. coli, from 42.3 to 81.0% to Klebsiella, from72.0 to 81.4% in Pseudomonas and 17.2-54.5% to Acinetobacter.Conclusion: Cefepime/tazobactam provided a better invitro sensitivity profile than other BL-BLI combinations studied.This in vitro data needs to be confirmed by clinical studies. J Microbiol Infect Dis 2012; 2(1: 5-8

  15. Control of multi-resistant bacteria and ventilator-associated pneumonia: is it possible with changes in antibiotics?

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    Elisa M. Jukemura

    Full Text Available Potent antimicrobial agents have been developed as a response to the development of antibiotic-resistant bacteria, which especially affect patients with prolonged hospitalization in Intensive Care Units (ICU and who had been previously treated with antimicrobials, especially third-generation cephalosporins.This study was to determine how changes in the empirical treatment of infections in ICU patients affect the incidence of Gram-negative bacteria species and their susceptibility to antimicrobials, and examine the impact of these changes on nosocomial infections. A prospective interventional study was performed in a university hospital during two periods: 1 First period (September 1999 to February 2000; and 2 Second period (August 2000 to December 2000; empirical treatment was changed from ceftriaxone and/or ceftazidime in the first period to piperacillin/tazobactam in the second. ICU epidemiological and infection control rates, as well as bacterial isolates from upper airways were analyzed. Ceftazidime consumption dropped from 34.83 to 0.85 DDD/1000 patients per day (p=0.004. Piperacillin/tazobactam was originally not available; its consumption reached 157.07 DDD/1000 patients per day in the second period (p=0.0002. Eighty-seven patients and 66 patients were evaluated for upper airway colonization in the first and second periods, respectively. There was a significant decrease in the incidence of K. pneumoniae (p=0.004 and P. mirabilis (p=0.036, restoration of K. pneumoniae susceptibility to cephalosporins (p<0.0001 and reduction of ventilator-associated pneumonia rates (p<0.0001. However, there was an increase in P. aeruginosa incidence (p=0.005 and increases in ceftazidime (p=0.003 and meropenem (p<0.0001 susceptibilities. Changing antimicrobial selective pressure on multi-resistant Gram-negative bacteria helps control ventilator-associated pneumonia and decreases antimicrobial resistance.

  16. Metabolomics analysis identifies intestinal microbiota-derived biomarkers of colonization resistance in clindamycin-treated mice.

    Science.gov (United States)

    Jump, Robin L P; Polinkovsky, Alex; Hurless, Kelly; Sitzlar, Brett; Eckart, Kevin; Tomas, Myreen; Deshpande, Abhishek; Nerandzic, Michelle M; Donskey, Curtis J

    2014-01-01

    The intestinal microbiota protect the host against enteric pathogens through a defense mechanism termed colonization resistance. Antibiotics excreted into the intestinal tract may disrupt colonization resistance and alter normal metabolic functions of the microbiota. We used a mouse model to test the hypothesis that alterations in levels of bacterial metabolites in fecal specimens could provide useful biomarkers indicating disrupted or intact colonization resistance after antibiotic treatment. To assess in vivo colonization resistance, mice were challenged with oral vancomycin-resistant Enterococcus or Clostridium difficile spores at varying time points after treatment with the lincosamide antibiotic clindamycin. For concurrent groups of antibiotic-treated mice, stool samples were analyzed using quantitative real-time polymerase chain reaction to assess changes in the microbiota and using non-targeted metabolic profiling. To assess whether the findings were applicable to another antibiotic class that suppresses intestinal anaerobes, similar experiments were conducted with piperacillin/tazobactam. Colonization resistance began to recover within 5 days and was intact by 12 days after clindamycin treatment, coinciding with the recovery bacteria from the families Lachnospiraceae and Ruminococcaceae, both part of the phylum Firmicutes. Clindamycin treatment caused marked changes in metabolites present in fecal specimens. Of 484 compounds analyzed, 146 (30%) exhibited a significant increase or decrease in concentration during clindamycin treatment followed by recovery to baseline that coincided with restoration of in vivo colonization resistance. Identified as potential biomarkers of colonization resistance, these compounds included intermediates in carbohydrate or protein metabolism that increased (pentitols, gamma-glutamyl amino acids and inositol metabolites) or decreased (pentoses, dipeptides) with clindamycin treatment. Piperacillin/tazobactam treatment caused

  17. Extended spectrum beta-lactamase detection in gram-negative bacilli of nosocomial origin

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    Dechen C Tsering

    2009-01-01

    Full Text Available Background: Resistance to third generation cephalosporins by acquisition and expression of extended spectrum beta lactamase (ESBL enzymes among gram-negative bacilli is on a rise. The presence of ESBL producing organisms significantly affects the course and outcome of an infection and poses a challenge to infection management worldwide. Materials and Methods: In the period from June 2007 to 2008, we collected 1489 samples from patients suspected of nosocomial infection. The isolates were identified based on colony morphology and biochemical reaction. Gram negative bacilli resistant to third generation cephalosporins were tested for ESBL by double disc synergy test (DDST- a screening test and then phenotypic confirmatory test. Antimicrobial susceptibility testing was done by modified Kirby Bauer disc diffusion method. Results: From the sample of 238 gram-negative bacilli, we isolated Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumoniae, Citrobacter freundii, Proteus mirabilis, Morganella morganii and Enterobacter cloacae. Following both methods, 34% isolates were ESBL-positive. The ESBL producing isolates were significantly resistant (p < 0.01 to ampicillin, piperacillin, piperacillin/tazobactam, trimethoprim/sulfamethoxazole, tetracycline, ciprofloxacin and gentamicin as compared to non-ESBL producers. Multidrug resistance was significantly (p < 0.01 higher (69.14% in ESBL positive isolates than non-ESBL isolates (21.66%. Conclusion: High prevalence of ESBL in our hospital cannot be ignored. ESBL producers can be detected by DDST and phenotypic confirmatory test with equal efficacy. The sensitivity of screening test improved with the use of more than one antibiotic and addition of one or two antibiotics would not increase cost and labor. We recommend DDST using multiple antibiotics in all microbiology units as a routine screening test.

  18. Application of Antibiotics Rotation to Control Bacterial Resistance in Neonatal Intensive Care Unit%轮换抗生素控制细菌耐药在新生儿重症监护病房中的应用

    Institute of Scientific and Technical Information of China (English)

    李敏许; 张兰; 周伟; 杨勇

    2011-01-01

    Objective To explore the effect of antibiotics rotation on reducing bacterial resistance in neonatal intensive care unit (NICU). Methods Five hundred and two neonates who were treated with antibiotics (ceftazime ,piperacillin/tazobactam or cefotaxime ) in the NICU of Dongguan Maternal and Child Healthcare Hospital during Jan. 2007 to Jan. 2010 were recruited. The changes of bacterial resistance in 108 neonates infected by klebsiella pneumoniae subspecies during 5 study periods of rotation use of ceftazime and piperacillin/tazobactam were observed. The children were treated with eeftazime, piperacillin/tazobactam or cefotaxime casually in 12 - month's baseline period,and treated with ceftazime and piperacillin/tazobactam alternately in the following four 6 - month's periods. Results As the suspended use of ceftazime extended ,the rate of ceftazime - resistant klebsiella pneumoniae subspecies decreased from 59.3% in baseline period to 40.4% in period 3 ,and 45.9% in period 4, the rate of ceftazime - resistant klebsiella pneumoniae subspecies had significant difference among the 5 periods (x2 = 3. 992 ,P < 0.05 ). The piperacillin/tazobactam resistance decreased from 6.7% in baseline period to 2.6% in period 4,and 4. 5% in period 5 ,the rate of piperacillin/tazobactam - resistant klebsiella pneumoniae subspecies had significant difference among the 5 periods(x2 = 4. 683,P < 0.05 ). The rate of cefotaxime resistance decreased yearly, the cefotaxime resistance decreased from 59.8% in baseline period to 47.8% in period 2,45.4% in period 3,40. 4% in period 4 ,and 33.6% in period 5 ,the rate of cefotaxime - resistant klebsiella pneumoniae subspecies had significant difference among the 5 periods(x2 = 3. 896,P <0.05 ) ,but the rate of cefotaxime resistance was still high after 2 years suspended use, and could not be eliminated. Couclusions Antibiotic rotation in a relative closed environment can reduce bacterial resistance. It takes longer than 2

  19. SENSITIVITY TO ANTIBIOTICS, ANTISEPTICAL NOSOCOMIAL PSEUDOMONAS AERUGINOSA, ISOLATED IN UROLOGICAL PATIENTS

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    Rymsha E.V.

    2015-05-01

    cultures around the disks with antibiotics. To explore sensitivity to antiseptics used commercial samples drug Decesan® (decamethoxin of 0.02% solution ("YURI-PHARM", Ukraine, Miramistin® 0.01% solution (benzyldimethyl-myristoylation- Propylamine chloride monohydrate (ZAO Pharmaceutical firm "Darnitsa" and Chlorhexidine (chlorhexidine digluconate 0.05% solution (PJSC "Monfarm". Comparative evaluation of sensitivity of microorganisms to the test preparations was determined by the minimum bactericidal concentration (MBsC standard method, serial dilutions of the drug in a liquid medium (μg⁄ml. Results and discussion. Just received 20 nosocomially strains of P. аeruginosa. Isolated strains had the typical morphology polymorphic thin sticks, gramnegative on dense nutrient media formed a rounded, translucent colonies with a smooth edge, with a blue-green pigment. The biochemical properties referenceusa gram-negative bacteria were determined using Neverlast-24 (PLIVA – Lachema a. s. Brno, Czech Republic. The results of the determination of antibiotics susceptibility of tested strains P. aeruginosa. The greatest activity against the studied strains of P. аeruginosa had Meropenem, amikacin, ceftazidime and imipenem. Nimensa frequency of resistant strains identified to Meropenem were insensitive to 10% of strains of P. aeruginosa. From resistant to Meropenem 6 strains had perekhresne resistance to imipenem. The second activity with β-lactam antibiotics were identified ceftazidime. Insensitive to it were 5%. Antoniniani penicillins were less active than the carbapenems and ceftazidime.So resistant to Pirillo/tazobactam were 30% of the isolates. The most frequent combinations of stability were gentamicin – piperacillin 55,3%, gentamicin – piperacillinpiperacillin/tazobactam 35%. One strain of P. aeruginosa possessed simultaneously resistant to all antibiotics. Decesan and Miramistin had the same sensitivity P. aeruginosa (62.5± 8.94 μg∕ ml and 62.5±16,04

  20. Risk factors for ventilator-associated pneumonia caused by meningeal septic flavobacterium in cardiac ICU and analysis of drug resistance%心外科ICU脑膜败血性黄杆菌致呼吸机相关性肺炎危险因素及耐药性分析

    Institute of Scientific and Technical Information of China (English)

    王珂; 王伟

    2013-01-01

    目的 探讨ICU脑膜败血性黄杆菌所致呼吸机相关性肺炎(VAP)危险因素及耐药性.方法 采用回顾性调查方法,对2009-2011年心外科ICU42例脑膜败血性黄杆菌所致VAP患者临床资料进行统计分析.结果 0~3岁患儿占80.95%,≥60岁患者占19.05%;机械通气天数平均≥1周,患者合并有≥3种侵入性操作;所有患者均有较长时间使用广谱抗菌药物史;脑膜败血性黄杆菌对哌拉西林/他唑巴坦、头孢哌酮/舒巴坦、磺胺甲噁唑/甲氧苄啶耐药率<5.0%,对庆大霉素、妥布霉素、哌拉西林、头孢噻肟耐药率>90.0%;部分呼吸机外置管道及附件采样监测出脑膜败血性黄杆菌.结论 低龄、长时间入住ICU、机械通气时间较长、多种侵入性操作、广谱抗菌药物使用及呼吸机管道附件消毒是否彻底,是心外ICU患者发生脑膜败血性黄杆菌致VAP的危险因素;哌拉西林/他唑巴坦、头孢哌酮/舒巴坦是抗感染治疗的首选药.%OBJECTIVE To investigate the risk factors and etiology on ventilator-associated pneumonia caused by meningeal septic flavobacterium in cardiac ICU.METHODS By means of the retrospective review,the clinical data of 42 patients with ventilator-associated pneumonia caused by meningeal septic flavobacterium in cardiac ICU from 2009 to 2011 was statistically analyzed.RESULTS The children aged from 0 to 3 years old accounted for 80.95%,and the patients aged more than 60 years accounted for 19.05 %; the average duration of mechanical ventilation was no less than 1 week,and the patients underwent no less than three invasive operations; all of the patients had the long history of using broad-spectrum antimicrobial drugs; the drug resistance rates of Meningeal septic flavobacterium to piperacillin/tazobactam,cefoperazone sodium/sulbactam,and trimethoprim and sulphamethoxazole were under 5.0%,and the drug resistance rates to gentamicin,tobramycin,piperacillin

  1. 2007-2010年革兰阴性菌对抗菌药物的敏感性分析%Drug susceptibility of gram-negative bacteria in 2007-2010

    Institute of Scientific and Technical Information of China (English)

    郭宏玥

    2013-01-01

    OBJECTIVE To understand the isolation of the common gram-negative bacilli and the drug susceptibility rates to commonly used antibiotics from Jan 2007 to Dec 2010 so as to provide the basis for the rational use of antimicrobial agents. METHODS The gram-negative bacilli isolated from the clinical specimens from Jan 2007 to Dec 2010 were retrospectively analyzed, the drug susceptibility testing was performed. RESULTS A total of 14 784 strains of gram-negative bacteria were isolated within four years, mainly consisting of 2260 strains of Pseudomonas aeruginosa (15. 29%), 2700 strains of Acinetobacter baumannii (18. 26%), 6241 strains of Escherichia colt (31. 87 % ) , and 2139 strains of Klebsiella pneumoniae (11. 80). The drug susceptibility rates of P. aeruginosa to aztreonam, amikacin, levofloxacin, ceftazidime, cefepime, piperacillin, cefoperazone-sulbactam, piperacillin-sul-bactam, imipenem, and meropenem were higher than 50. 00%. A. baumannii strains maintained high antibacterial activity against cefoperazone-sulbactam, imipenem, piperacillin-tazobactam, meropenem, and amkacin, with the drug susceptibility rates higher than 50. 00%. Only ESBLs-producing E. coli and K. pneumoniae strains showed high antibacterial activity against enzyme-containing inhibitors and the carbapenems. CONCLUSION The clinicians should focus on the drug susceptibility testing and use antibiotics reasonably on the basis of the result of drug susceptibility testing.%目的 了解医院2007年1月-2010年12月临床常见革兰阴性菌的分离情况及其对常用抗菌药物的敏感率,为临床合理使用抗菌药物提供依据.方法 回顾性分析2007年1月-2010年12月临床标本分离出的革兰阴性杆菌,并对其进行药敏试验.结果 4年共检出革兰阴性菌14784株,主要为铜绿假单胞菌2260株占15.29%,鲍氏不动杆菌2700株占18.26%,大肠埃希菌6241株占31.87%,肺炎克雷伯菌2139株占11.80;铜绿假单胞菌对氨曲南、阿米

  2. Antimicrobial susceptibilities of aerobic and facultative gram-negative bacilli isolated from Chinese patients with urinary tract infections between 2010 and 2014.

    Science.gov (United States)

    Yang, Qiwen; Zhang, Hui; Wang, Yao; Xu, Zhipeng; Zhang, Ge; Chen, Xinxin; Xu, Yingchun; Cao, Bin; Kong, Haishen; Ni, Yuxing; Yu, Yunsong; Sun, Ziyong; Hu, Bijie; Huang, Wenxiang; Wang, Yong; Wu, Anhua; Feng, Xianju; Liao, Kang; Luo, Yanping; Hu, Zhidong; Chu, Yunzhuo; Lu, Juan; Su, Jianrong; Gui, Bingdong; Duan, Qiong; Zhang, Shufang; Shao, Haifeng; Badal, Robert E

    2017-03-06

    The objective of this study was to investigate the distribution and susceptibility of aerobic and facultative Gram-negative bacilli isolated from Chinese patients with UTIs collected within 48 h (community acquired, CA) or after 48 h (hospital acquired, HA) of hospital admission. From 2010 to 2014, the minimum inhibitory concentrations (MICs) of 12 antibiotics for 4,332 aerobic and facultative Gram-negative bacilli, sampled in 21 hospitals in 16 cities, were determined by the broth microdilution method. Enterobacteriaceae composed 88.5% of the total isolates, with Escherichia coli (E. coli) (63.2%) the most commonly isolated species, followed by Klebsiella pneumoniae (K. pneumoniae) (12.2%). Non-Enterobacteriaceae accounted for only 11.5% of all isolates and included mainly Pseudomonas aeruginosa (P. aeruginosa) (6.9%) and Acinetobacter baumannii (A. baumannii) (3.3%). Among the antimicrobial agents tested, the susceptibility rates of E.coli to the two carbapenems, ertapenem and imipenem as well as amikacin and piperacillin-tazobactam ranged from 92.5 to 98.7%. Against K. pneumonia, the most potent antibiotics were imipenem (92.6% susceptibility), amikacin (89.2% susceptibility) and ertapenem (87.9% susceptibility). Although non-Enterobacteriaceae did not show high susceptibilities to the 12 common antibiotics, amikacin exhibited the highest in vitro activity against P. aeruginosa over the 5-year study period, followed by piperacillin-tazobactam, imipenem, ceftazidime, cefepime, ciprofloxacin, and levofloxacin. The Extended Spectrum Beta-Lactamase (ESBL) rates decreased slowly during the 5 years in E. coli from 68.6% in 2010 to 59.1% in 2014, in K. pneumoniae from 59.7 to 49.2%, and in Proteus mirabilis (P. mirabilis) from 40.0 to 26.1%. However, the ESBL rates were different in 5 regions of China (Northeast, North, East, South and Middle-China). E. coli and K. pneumonia were the major pathogens causing UTIs and carbapenems and amikacin retained the highest

  3. Evaluation of a Mixing versus a Cycling Strategy of Antibiotic Use in Critically-Ill Medical Patients: Impact on Acquisition of Resistant Microorganisms and Clinical Outcomes.

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    Nazaret Cobos-Trigueros

    Full Text Available To compare the effect of two strategies of antibiotic use (mixing vs. cycling on the acquisition of resistant microorganisms, infections and other clinical outcomes.Prospective cohort study in an 8-bed intensive care unit during 35- months in which a mixing-cycling policy of antipseudomonal beta-lactams (meropenem, ceftazidime/piperacillin-tazobactam and fluoroquinolones was operative. Nasopharyngeal and rectal swabs and respiratory secretions were obtained within 48h of admission and thrice weekly thereafter. Target microorganisms included methicillin-resistant S. aureus, vancomycin-resistant enterococci, third-generation cephalosporin-resistant Enterobacteriaceae and non-fermenters.A total of 409 (42% patients were included in mixing and 560 (58% in cycling. Exposure to ceftazidime/piperacillin-tazobactam and fluoroquinolones was significantly higher in mixing while exposure to meropenem was higher in cycling, although overall use of antipseudomonals was not significantly different (37.5/100 patient-days vs. 38.1/100 patient-days. There was a barely higher acquisition rate of microorganisms during mixing, but this difference lost its significance when the cases due to an exogenous Burkholderia cepacia outbreak were excluded (19.3% vs. 15.4%, OR 0.8, CI 0.5-1.1. Acquisition of Pseudomonas aeruginosa resistant to the intervention antibiotics or with multiple-drug resistance was similar. There were no significant differences between mixing and cycling in the proportion of patients acquiring any infection (16.6% vs. 14.5%, OR 0.9, CI 0.6-1.2, any infection due to target microorganisms (5.9% vs. 5.2%, OR 0.9, CI 0.5-1.5, length of stay (median 5 d for both groups or mortality (13.9 vs. 14.3%, OR 1.03, CI 0.7-1.3.A cycling strategy of antibiotic use with a 6-week cycle duration is similar to mixing in terms of acquisition of resistant microorganisms, infections, length of stay and mortality.

  4. Antimicrobial susceptibility of Gram-negative ESKAPE pathogens isolated from hospitalized patients with intra-abdominal and urinary tract infections in Asia-Pacific countries: SMART 2013-2015.

    Science.gov (United States)

    Karlowsky, James A; Hoban, Daryl J; Hackel, Meredith A; Lob, Sibylle H; Sahm, Daniel F

    2017-01-01

    Gram-negative ESKAPE pathogens (Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa and Enterobacter spp.) are responsible for increases in antimicrobial-resistant infections worldwide. We determined in vitro susceptibilities to eight parenteral antimicrobial agents using Clinical and Laboratory Standards Institute broth microdilution methodology for Gram-negative ESKAPE pathogens isolated from hospitalized patients with intra-abdominal infections (IAIs) (n=3052) and urinary tract infections (UTIs) (n=1088) in 11 Asia-Pacific countries/regions from 2013 to 2015. Amikacin (98.3, 96.4 %), imipenem (97.1, 95.5 %) and ertapenem (95.3, 93.2 %) demonstrated the highest rates of susceptibility for isolates of K. pneumoniae from IAI and UTI, respectively, whereas susceptibility to advanced-generation cephalosporins was <84 and <71 %, respectively. K. pneumoniae with an extended-spectrum β-lactamase-positive phenotype were more common in UTI (27.1 %) than IAI (16.2 %). Imipenem and amikacin were the most active agents against extended-spectrum β-lactamase-positive K. pneumoniae from IAI (95.1, 91.8 %) and UTI (94.9, 92.3 %), respectively, whereas <54 % were susceptible to piperacillin-tazobactam. Against Enterobacter spp. and P. aeruginosa, amikacin demonstrated the highest rates of susceptibility for isolates from IAI (99.7, 95.5 %) and UTI (90.9, 91.5 %), respectively. K. pneumoniae, Enterobacter spp. and P. aeruginosa from urine demonstrated lower susceptibility to levofloxacin (74.1, 81.8 and 73.8 %) than from IAI (87.6, 91.8 and 85.4 %). For A. baumannii, rates of susceptibility to all agents tested were <43 %. We conclude that the studied Gram-negative ESKAPE pathogens demonstrated reduced susceptibility to commonly prescribed advanced-generation cephalosporins, piperacillin-tazobactam and levofloxacin, while amikacin and carbapenems were the most active. Ongoing surveillance to monitor evolving resistance trends and

  5. 2011年夏季某院分离志贺菌特点及某地区志贺菌血清型流行趋势分析%Characters of shigella strains in certain hospital and epidemic tendency analysis of shigella serotypes in ceratin area

    Institute of Scientific and Technical Information of China (English)

    刘志远; 马玉芝; 潘健; 张婷菊; 康利新; 刘贵建

    2012-01-01

    Objective To analyze the epidemiological features of shigella strains separated in this Hospital in 2011 ,and to the explore variation trend of shigella serotypes in Beijing. Methods Shigella strains were identified with Vitek Ⅱ Compact. Serotype was detected with serological testing. Drug susceptibility was determined by K-B methods. Results 15 strains of shigella were isolated, including 14 of Shigella sonnei and 1 of Shigella flexneri. No strains were sensitive to Trimethoprim-sulfamethoxazole, Pip-eracillin, Ampicillin. All Shigella sonnei strains were sensitive to Ciprofloxacin, Levofloxacin, Amikacin, Cefoxitin, Ceftazidime, Az-treonam,Cefepime,Imipenem,Piperacillin-tazobactam. Conclusion Shigella sonnei might be new prevalent serotype in Beijing. It might be improper to perform drug susceptibility only for ampicillin,a fluoroquinolone,and trimethoprim-sulfamethoxazole as suggested by CLSI.%目的 了解该院2011年分离的志贺菌及相关病例特点,结合其他区县志贺菌分离情况,总结北京市志贺菌血清型转变特点.方法 Vitek Ⅱ Compact鉴定志贺菌,血清玻片凝集法鉴定血清型,药敏试验采用K-B法.结果 共分离获得志贺菌15株,其中宋内Ⅰ型14株,福氏F2a型1株;15株菌对复方新诺明、哌拉西林、氨苄西林均耐药,14株宋内Ⅰ型菌对环丙沙星、左氧氟沙星、阿米卡星、头孢他啶、头孢西丁、亚胺培南、头孢吡肟、氨曲南、哌拉西林/他唑巴坦均敏感.结论 宋内Ⅰ型志贺菌为主要分离菌,对环丙沙星、左氧氟沙星、阿米卡星、头孢他啶、头孢西丁、亚胺培南、头孢吡肟、氨曲南、哌拉西林/他唑巴坦保持高度敏感;宋内志贺菌已成为北京市流行志贺菌的主要血清型.

  6. Update on management options in the treatment of nosocomial and ventilator assisted pneumonia: review of actual guidelines and economic aspects of therapy

    Directory of Open Access Journals (Sweden)

    Wilke M

    2013-12-01

    Full Text Available Michael Wilke,1 Rolf Grube1 1Dr. Wilke GmbH, Munich, Germany Objective: Nosocomial or more exactly, hospital-acquired (HAP and ventilator-associated pneumonia (VAP are frequent conditions when treating intensive care unit (ICU patients that are only exceeded by central line-associated bloodstream infections. In Germany, approximately 18,900 patients per year suffer from a VAP and another 4,200 from HAP. We therefore reviewed the current guidelines about HAP and VAP, from different sources, regarding the strategies to address individual patient risks and medication strategies for initial intravenous antibiotic treatment (IIAT. Material and methods: We conducted an analysis of the recent guidelines for the treatment of HAP. The current guidelines of the American Thoracic Society, the treatment recommendations of the Paul-Ehrlich-Gesellschaft (PEG, the guidelines from the British Society for Antimicrobial Chemotherapy, the VAP guideline of the Canadian Critical Care trials group, as well as the new German S3-guideline for HAP were examined. Results: All guidelines are based on grading systems that assess the evidence underlying the recommendations. However, each guideline uses different grading systems. One common aspect of these guidelines is the risk assessment of the patients for decision making regarding IIAT. Most guidelines have different recommendations depending on the risk of the presence of multidrug resistant (MDR bacteria. In guidelines using risk assessment, for low-risk patients (early onset, no MDR risk aminopenicillins with beta-lactamase inhibitors (BLI, second or third generation cephalosporins, quinolones, or ertapenem are recommended. For patients with higher risk, imipenem, meropenem, fourth generation cephalosporins, ceftazidime or piperacillin/tazobactam are recommended. The PEG recommendations include a combination therapy in cases of very high risk (late onset, MDR risk, ICU, and organ failure of either piperacillin

  7. Ceftolozane-tazobactam activity against drug-resistant Enterobacteriaceae and Pseudomonas aeruginosa causing healthcare-associated infections in Australia and New Zealand: Report from an Antimicrobial Surveillance Program (2013-2015).

    Science.gov (United States)

    Pfaller, M A; Shortridge, D; Sader, H S; Flamm, R K; Castanheira, M

    2017-07-19

    To evaluate the in vitro activity of ceftolozane-tazobactam and comparator agents tested against isolates of Enterobacteriaceae and Pseudomonas aeruginosa from patients in Australia and New Zealand with healthcare-associated infection. A total of 1459 gram-negative organisms (440 P. aeruginosa and 1019 Enterobacteriaceae) were consecutively collected from 11 medical centers located in Australia and New Zealand. The organisms were tested for susceptibility by broth microdilution methods as described by the CLSI M07-A10 document and the results interpreted according to EUCAST and CLSI breakpoint criteria. Ceftolozane-tazobactam (MIC50/90, 0.25/0.5μg/mL; 97.7/95.9% susceptible [CLSI/EUCAST]), meropenem (MIC50/90, ≤0.06/≤0.06μg/mL; 99.8/99.9% susceptible [CLSI/EUCAST]) and amikacin (MIC50/90, 2/4μg/mL; 99.8/99.6% susceptible [CLSI/EUCAST]) were the most active compounds tested against Enterobacteriaceae. Enterobacteriaceae isolates displayed susceptibility rates to other β-lactam agents ranging from 95.3/94.4% for cefepime, 94.1/91.4% for piperacillin-tazobactam, and 93.3/91.5% for ceftazidime using CLSI/EUCAST breakpoints. Among the Enterobacteriaceae isolates tested, 0.1% were CRE and 6.6% exhibited an ESBL non-CRE phenotype. Whereas ceftolozane-tazobactam showed good activity against ESBL non-CRE phenotype strains of Enterobacteriaceae (MIC50/90, 0.5/2μg/mL), it lacked useful activity (MIC, >32μg/mL) against the single isolate with a CRE resistant phenotype. Ceftolozane-tazobactam was the most potent (MIC50/90, 0.5/2μg/mL) β-lactam agent tested against P. aeruginosa isolates, inhibiting 95.7% at an MIC of ≤4μg/mL. Ceftolozane-tazobactam was the most active β-lactam agent tested against P. aeruginosa and demonstrated higher in vitro activity than currently available cephalosporins and piperacillin-tazobactam when tested against Enterobacteriaceae. Copyright © 2017 International Society for Chemotherapy of Infection and Cancer. Published by Elsevier

  8. Indagine epidemiologica locale sulle infezioni sostenute da Pseudomonas aeruginosa, Stenotrophomonas maltophilia, Burkholderia cepacia e sensibilità agli antibiotici di questi microrganismi.

    Directory of Open Access Journals (Sweden)

    Valeria Di Marcello

    2007-03-01

    Full Text Available Background: The aim of this local surveillance study was to determine the distribution of Pseudomonas aeruginosa, Stenotrophomonas maltophilia, Burkholderia cepacia in our geographic area, their impact in the hospital and community acquired infections and their resistance to antimicrobial agents currently used in the treatment of infections due to these microrganisms. Materials and Methods: During the period January 2001 - June 2003, 14.200 clinical isolates were collected from urine,wounds, catheters, body fluids, blood, respiratory tract specimens. Bacterial identifications were performed according to the standard methods (Murray, 2003 and antibiotic susceptibility tests were carry out in microassay by the automated system MicroScan (Dade Behring, Milano, Italy.The following antimicrobial agents were tested: piperacillin (PIP, ticarcillin (TIC, piperacillin-tazobactam (TZP, ticarcillin-clavulanic acid (TTC, ceftazidime (CAZ, ceftriaxone (CRO, aztreonam (ATM, imipenem (IPM, trimethoprim-sulfamethoxazole (SXT, gentamicin (CN, amikacin (AK, tobramycin (TOB, ciprofloxacin (CIP. Results: A total of 994 Pseudomonadaceae were isolated from in- (67% and out-patients (33%.They were P.aeruginosa (81%, other Pseudomonas species as P.fluorescens and P.putida (8%, S.maltophilia (9% and B.cepacia (2%.The great majority of the strains were collected from respiratory tract specimens (70% and urine (15%.The divisions from which derived the greater quantity of isolates were pediatric (33.8%, intensive care (22.7% and pneumology (10% units.Antibiotics more active against P. aeruginosa were IPM, CAZ,AK and TZP. IPM was effective against B. cepacia also.The other drugs, except SXT, displayed against this microrganism high rates of resistance. Even S. maltophilia was not susceptible to much antimicrobial agents, whereas SXT was the drug more active against this germ. Conclusion: P. aeruginosa was the microrganism more frequently isolated among non-fermenting Gram

  9. Analysis of use of anti-infectives in the hospital pharmacy%某住院药房抗感染药物使用情况分析

    Institute of Scientific and Technical Information of China (English)

    李秀敏; 范胜军

    2010-01-01

    Objective To analyze the use of anti-infectives in our hospital pharmacy and to provide basis for rational clinical use of anti-infectives. Methods The analysis was conducted using the methods of defined daily use and order of consumption sum based on the raw data retrieved from Hospital Drug Inventory Management System. Results Anti-infectives using proportion after November droped. The use of varieties followed by the biggest amount of injection cefminox sodium,piperacillin sodium and sulbactam sodium for injection,cefazolin sodium needles. Medication is the highest frequency of piperacillin sodium and sulbactam sodium needles,cefminox needle,needle penicillin sodium. Conclusion Use of anti-infectives'situation wholely became stable. β-lactams,Quinolones was our clinical anti-infection treatment leading medicine. The individual frequency of use high variety took the amount rise,and it explained that still waited for the standard in antibiotics use.%目的 分析住院药房抗感染药物的使用情况,为临床合理应用抗感染药提供参考.方法 根据"药局库存管理程序"的原始数据资料,按金额、限定日剂量进行排序、分析.结果 抗感染药物使用比例从11月份后有所下降,使用金额最大的品种依次是注射用头孢米诺钠、注射用哌拉西林钠舒巴坦钠、头孢唑啉钠针,用药频率最高的是哌拉西林钠舒巴坦钠针、头孢米诺钠针、青霉素钠针.结论 抗感染用药情况整体趋稳,β-内酰胺类、喹诺酮类是临床抗感染治疗的主导药物,个别使用频率较高的品种占用金额上升,说明在抗菌药物的使用上仍有待规范.

  10. AB022. A case of severe leptospirosis with acute respiratory distress syndrome

    Science.gov (United States)

    Akritidou, Sofia; Panagiotidou, Evangelia; Sourla, Evdokia; Konstanta, Soultana; Kotoulas, Serafim-Xrisovalantis; Bikos, Vasilios; Bagalas, Vasilios; Katalin, Fekete; Pitsiou, Georgia; Ioannis, Stanopoulos; Athanasia, Pataka

    2016-01-01

    Leptospirosis is a microbial infection which occurs in humans and animals and is caused by Leptospira (Leptospira spp.). In Greece, it occurs at a frequency of 0.22:100,000, and 24 severe cases have been reported in 2013. It manifests in three forms: anicteric (90%), icteric (5–10%) and severe. Severe leptospirosis can be a rare cause of acute respiratory distress syndrome (ARDS), leading to intubation, jaundice, alveolar bleeding and multi-organ failure. A 71-year-old male patient presented at the emergency department with dyspnea on exertion, fever, gastrointestinal disorders, muscle aches and fatigue, that started four days ago. Occupation with pigeons was also reported. Blood gas analysis revealed severe type I respiratory failure, and a chest CT was performed, revealing ARDS. The patient was intubated. Acute renal failure (urea: 238, creatinine: 4.81) that required renal replacement therapy developed along with increased bilirubin (max value of total: 8.2 with direct: 7.42), and positive direct and indirect Coombs test. Moreover, hemorrhage through the tracheal tube complicated the clinical condition, resulting to obstruction of tracheal tube. Furthermore, anemia, thrombocytopenia and severe leycocytosis were also observed (white blood cells: 42,620). Diffuse alveolar hemorrhage due to vasculitis and connective tissue disease was suspected, and a complete immunological control was ordered. Infectious pathogens, such as Str. Pneumoniae, Legionella, Mycoplasma, Leptospira spp., Chlamidia, HBV, HCV, influenza were also suspected and all the necessary samples were tested. He received levofloxacin, piperacillin/tazobactam, vibramycin, and oseltamivir, but after receiving the positive results for leptospira, antibiotic treatment was revised with the final choice of levofloxacin and piperacillin/tazobactam. Despite improvement of renal and liver function, leycocytosis, CRP and PCT values, high fever begun that was attributed at first to the Jarisch

  11. To investigate the impact facots of dose of drug in intravenous infusion for decision-making%浅析静脉用药过程中影响药物剂量的护理因素及对策

    Institute of Scientific and Technical Information of China (English)

    卢桂华

    2012-01-01

    Objective To investigate the impact facots of dose of drug in intravenous infusion for decision-making. Methods 80 cases used of piperacillin tazobactam were randomly divided into control and experimental groups, using double-blind study, collection residual liquid of the original bottles and infusion tube, calculating drug dose, with daily infusion process in the control group, while strict intervention infusion process in experimental group. Average of drug residues between two groups with t-test. Results In control group, piperacillin tazobactam sodium content of the residual liquid average was(0. 9256 ± 0. 1189) g; experimental group ( 0. 2654 ± 0. 0398 ) g, P = 0. 000, the difference was statistically significant. Conclusion In intravenous drug preparation and the infusion process, strict rules of the nurses to reduce the residual liquid of drug.%目的 探讨静脉治疗过程中影响药物剂量的护理因素及对策.方法 80例输注哌拉西林钠他唑巴坦钠患者随机分为对照组和实验组,并采用双盲研究,收集原药瓶和输液器中的残留液计算残留药物剂量,对照组为护士日常输液流程,实验组为研究人员严格干预下输液流程.两组残留药物平均数进行t检验.结果 对照组残余药液平均含量为(0.9256±0.1189)g;实验组为(0.2654±0.0398)g(P=0.000),差异有统计学意义.结论 静脉药物配制及输液过程中,护理人员严格操作规程,可减少药液的残留.

  12. Identification and molecular characterization of Escherichia coli blaSHV genes in a Chinese teaching hospital.

    Science.gov (United States)

    Zhu, Mei; Yang, Guangjian; Li, Ailing; Zong, Li; Dong, Zhaoguang; Lu, Junwan; Zhang, Kaibo; Cheng, Cong; Chang, Qingli; Wu, Xiuying; Ying, Jianchao; Li, Xianneng; Ding, Li; Zheng, Haixiao; Yu, Junping; Ying, Jun; Xu, Teng; Yi, Huiguang; Li, Peizhen; Li, Kewei; Wu, Songquan; Bao, Qiyu; Wang, Junrong

    2017-02-05

    Escherichia coli (E. coli) commonly reside in human intestine and most E. coli strains are harmless, but some serotypes cause serious food poisoning. This study identified and molecularly characterized blaSHV genes from 490 E. coli strains with multi-drug resistance in a hospital population. PCR and molecular cloning and southern blot were performed to assess functions and localizations of this resistant E. coli gene and the pulsed-field gel electrophoresis (PFGE) was utilized to demonstrate the clonal relatedness of the positive E. coli strains. The data showed that 4 of these 490 E. coli strains (4/499, 0.8%) carried blaSHV genes that included EC D2485 (blaSHV-5), EC D2487 (blaSHV-5), EC D2684 (blaSHV-11) and EC D2616 (blaSHV-195, a novel blaSHV). Analysis of blaSHV open-reading frame showed that blaSHV-5 had a high hydrolysis activity to the broad-spectrum penicillin (ampicillin or piperacillin), ceftazidime, ceftriaxone, cefotaxime and aztreonam. blaSHV-195 and blaSHV-11 had similar resistant characteristics with high hydrolysis activities to ampicillin and piperacillin, but low activities to cephalosporins. Moreover, the two blaSHV-5 genes were located on a transferable plasmid (23kb), whereas the other two blaSHV variants (blaSHV-11 and blaSHV-195) seemed to be located in the chromosomal material. Both EC D2485 and EC D2487 clones isolated in 2010 had the same DNA finger printing profile and they might be the siblings of clonal dissemination. The data from the current study suggest that the novel blaSHV and clonal dissemination may be developed, although blaSHV genes were infrequently identified in this hospital population. The results of the work demonstrate the necessity for molecular surveillance in tracking blaSHV-producing strains in large teaching hospital settings and emphasize the need for epidemiological monitoring.

  13. Transconjugation and genotyping of the plasmid-mediated AmpC β-lactamase and extended-spectrum β-lactamase genes in Klebsiella pneumoniae

    Institute of Scientific and Technical Information of China (English)

    SHI Wei-feng; ZHOU Jun; QIN Jian-ping

    2009-01-01

    Backgroud AmpC β-lactamases and extended-spectrum β-lactamases (ESBLs) are becoming predominant causes of resistance to third and forth-generation cephalosporins in Klebsiella pneumoniae (K. Pneumoniae). It is very difficult to treat infectious diseases caused by multidrug-resistant K. Pneumoniae. The purpose of the present study was to investigate transconjugation and characteristics of β-lactamase genes in K. Pneumoniae producing AmpC β-lactamases and ESBLs.Methods AmpC β-lactamases were detected by three-dimension test and ESBLs by disc confirmatory test. Minimum inhibitory concentrations (MICs) were determined by agar dilution. Transfer of resistance to EC600 (Rif') was attempted by conjugation in broth and screened on agar containing cefotaxime (2 μg/ml) plus rifampin (1024 μg/ml). The genes encoding AmpC or ESBLs and their transconjugants were detected by PCR and verified by DNA sequencing. Results The resistant rates to ampicillin and piperacillin were 100% in 18 isolates of K. Pneumoniae. However, imipenem was still of great bactericidal activity on K. Pneumoniae, and its MIC50 was 0.5 μg/mL. Eleven β-lactamase genes, including TEM-1, TEM-11, SHV-13, SHV-28, CTX-M-9, CTX-M-22, CTX-M-55, OXA-1, LEN, OKP-6 and DHA-1, were found from 18 isolates. And at least one β-lactamase gene occurred in each isolate. To our surprise, there were six β-lactamase genes in the CZ04 strain. Among 18 isolates of K. Pneumoniae, the partial resistant genes in 8 isolates were conjugated successfully, which had 100% homological sequence with donors by sequence analysis. Compared with donors, 8 transconjugants had attained resistance to most β-lactams, including ampicillin, piperacillin, cefoxitin, cefotaxime and aztreonam, or even amikacin and gentamicin.Conclusions R plasmids can be easily transferred between the resistant and sensitive negative bacilli. It is very difficult to block and prevent the spread of antimicrobial resistance. So more attention should be paid

  14. Change of drug resistance of Acinetobacter baumannii causing respiratory tract infection in ICU and effect of intervention%ICU呼吸道感染鲍氏不动杆菌耐药性变迁及干预效果

    Institute of Scientific and Technical Information of China (English)

    陈炜; 屠传建; 金玲玲; 罗佳

    2012-01-01

    目的 了解重症监护病房(ICU)呼吸道感染鲍氏不动杆菌耐药性变迁,为临床控制多药耐药菌感染提供依据.方法 对2008-2010年医院痰标本分离的908株鲍氏不动杆菌进行药敏测定,并针对多药耐药性进行干预.结果 2009年鲍氏不动杆菌的耐药性比2008年增加,氨曲南、头孢曲松、头孢噻肟、哌拉西林耐药率>90.0%,2010年通过干预措施后鲍氏不动杆菌的耐药性比2009年有延缓趋势,氨曲南、头孢曲松、哌拉西林耐药率<75.0%.结论 鲍氏不动杆菌呈多药耐药性,应重视医护人员手卫生,加强口腔护理和消毒隔离,合理使用抗菌药物.%OBJECTIVE To study the change of drug resistance of Acinetobacter baumannii in the intensive care unit of our hospital, and to provide the reference for controlling the infection of drug resistant bacteria. METHODS Antibiotics susceptibility test of 908 strains of A. Baumannii was performed from 2008 to 2010, and multidrug resistance was intervened. RESULTS Drug resistance of A. Baumannii was increased in 2009 compared to 2008. The resistance rates to aztreonam, ceftriaxone, cefotaxime, piperacillin were > 90. 0%. Through intervention measures, drug resistance was reduced in 2010, the resistance rates to aztreonam, ceftriaxone, piperacillin declined to <75. 0%. CONCLUSION A. Baumannii are multiple antimicrobial-resistant bacteria. To control the infection caused by A. Baumannii in ICU, medical staff hand hygiene, oral care, disinfection, isolation, rational use of antimicrobial agents should be highlighted.

  15. A multidisciplinary intervention to reduce infections of ESBL- and AmpC-producing, gram-negative bacteria at a University Hospital.

    Directory of Open Access Journals (Sweden)

    Jenny Dahl Knudsen

    Full Text Available In response to a considerable increase in the infections caused by ESBL/AmpC-producing Klebsiella pneumonia in 2008, a multidisciplinary intervention, with a main focus on antimicrobial stewardship, was carried out at one university hospital. Four other hospitals were used as controls. Stringent guidelines for antimicrobial treatment and prophylaxis were disseminated throughout the intervention hospital; cephalosporins were restricted for prophylaxis use only, fluoroquinolones for empiric use in septic shock only, and carbapenems were selected for penicillin-allergic patients, infections due to ESBL/AmpC-producing and other resistant bacteria, in addition to their use in severe sepsis/septic shock. Piperacillin-tazobactam ± gentamicin was recommended for empiric treatments of most febrile conditions. The intervention also included education and guidance on infection control, as well as various other surveillances. Two year follow-up data on the incidence rates of patients with selected bacterial infections, outcomes, and antibiotic consumption were assessed, employing before-and-after analysis and segmented regression analysis of interrupted time series, using the other hospitals as controls. The intervention led to a sustained change in antimicrobial consumption, and the incidence of patients infected with ESBL-producing K. pneumoniae decreased significantly (p<0.001. The incidences of other hospital-associated infections also declined (p's<0.02, but piperacillin-tazobactam-resistant Pseudomonas aeruginosa and Enterococcus faecium infections increased (p's<0.033. In wards with high antimicrobial consumption, the patient gut carrier rate of ESBL-producing bacteria significantly decreased (p = 0.023. The unadjusted, all-cause 30-day mortality rates of K. pneumoniae and E. coli were unchanged over the four-year period, with similar results in all five hospitals. Although not statistically significant, the 30-day mortality rate of patients

  16. A 5-year Surveillance Study on Antimicrobial Resistance of Acinetobacter baumannii Clinical Isolates from a Tertiary Greek Hospital

    Science.gov (United States)

    2016-01-01

    Background Acinetobacter baumannii has emerged as a major cause of nosocomial outbreaks. It is particularly associated with nosocomial pneumonia and bloodstream infections in immunocompromised and debilitated patients with serious underlying pathologies. Over the last two decades, a remarkable rise in the rates of multidrug resistance to most antimicrobial agents that are active against A. baumannii has been noted worldwide. We evaluated the rates of antimicrobial resistance and changes in resistance over a 5-year period (2010–2014) in A. baumannii strains isolated from hospitalized patients in a tertiary Greek hospital. Materials and Methods Identification of A. baumannii was performed by standard biochemical methods and the Vitek 2 automated system, which was also used for susceptibility testing against 18 antibiotics: ampicillin/sulbactam, ticarcillin, ticarcillin/clavulanic acid, piperacillin, piperacillin/tazobactam, cefotaxime, ceftazidime, cefepime, imipenem, meropenem, gentamicin, amikacin, tobramycin, ciprofloxacin, tetracycline, tigecycline, trimethoprim/sulfamethoxazole, and colistin. Interpretation of susceptibility results was based on the Clinical and Laboratory Standards Institute criteria, except for tigecycline, for which the Food and Drug Administration breakpoints were applied. Multidrug resistance was defined as resistance to ≥3 classes of antimicrobial agents. Results Overall 914 clinical isolates of A. baumannii were recovered from the intensive care unit (ICU) (n = 493), and medical (n = 252) and surgical (n = 169) wards. Only 4.9% of these isolates were fully susceptible to the antimicrobials tested, while 92.89% of them were multidrug resistant (MDR), i.e., resistant to ≥3 classes of antibiotics. ICU isolates were the most resistant followed by isolates from surgical and medical wards. The most effective antimicrobial agents were, in descending order: colistin, amikacin, trimethoprim/sulfamethoxazole, tigecycline, and tobramycin

  17. Lettuce and fruits as a source of multidrug resistant Acinetobacter spp.

    Science.gov (United States)

    Carvalheira, Ana; Silva, Joana; Teixeira, Paula

    2017-06-01

    The role of ready-to-eat products as a reservoir of pathogenic species of Acinetobacter remains unclear. The objective of the present study was to evaluate the presence of Acinetobacter species in lettuces and fruits marketed in Portugal, and their susceptibility to antimicrobials. Acinetobacter spp. were isolated from 77.9% of the samples and these microorganisms were also found as endophytes (i.e. present within the plant tissue) in 12 of 20 samples of lettuces analysed. Among 253 isolates that were identified as belonging to this genus, 181 presented different PFGE profiles, representing different strains. Based on the analysis of the partial sequence of rpoB, 175 strains were identified as members of eighteen distinct species and the remaining six strains may represent five new candidate species since their rpoB sequence similarities with type strains were less than 95%. Acinetobacter calcoaceticus and Acinetobacter johnsonii were the most common species, both with the frequency of 26.5%; and 11% of the strains belong to the Acinetobacter baumannii group (i.e. A. baumannii, Acinetobacter pittii, Acinetobacter seifertii and Acinetobacter nosocomialis), which is most frequently associated with nosocomial infections. Overall, the strains were least susceptible to piperacillin (80.1%), piperacillin-tazobactam (64.1%), ceftazidime (43.1%), ciprofloxacin (16.6%), trimethoprim-sulfamethoxazole (14.9%), imipenem (14.4%) and colistin (13.3%). The most active antimicrobials were minocycline and tetracycline, with 0.6% and 3.9% of strains resistant, respectively. About 29.8% of the strains were classified as multidrug-resistant (MDR), 4.4% as extensively drug-resistant (XDR) and the prevalence of MDR strains within the A. baumannii group (25%) was similar to other species (30.4%). The presence of clinically important species as well as MDR strains in lettuces and fruits may be a threat to public health considering that they may transmit these pathogens to environments

  18. Relationship between resistance rate of pathogen and utilization strength ofβ-lactam in general surgery department%普外科病原菌耐药率与β-内酰胺类药物使用强度的关系

    Institute of Scientific and Technical Information of China (English)

    方圆; 陈涛; 李晓华; 刘平; 陈楠

    2016-01-01

    Objective To evaluate the relationship between the resistance change trend of pathogen and the dosages of β-lactam in general surgery department. Methods To make statistics and to analyze the relationship on the resistance rate of main pathogen and the utilization strength of β-lactam, which were detected from 2012 to 2014, applied the statistical software. Results There were correlation between the utilization strength of ceftizoxime and the resistance rate of escherichia coli and klebsiella pneumonia, between the utilization strength of cefepime and the resistance rate of klebsiella pneumonia, there was no correlation between the utilization strength of piperacillin-tazobactam and the resistance rate of enterobacteriaceae, there was correlation all monitoring cultivated varieties and the resistance rate of pseudomonas aeruginosa. Conclusion Enterobacteriaceae is also the key point of infection treatment in general surgery department. The third generation cephalosporin in the treatment of bacterial infection of enterobacteriaceae is chosen carefully in general surgery department. Piperacillin-tazobactam should be chosen on patients with the ESBLs risk of enterobacteriaceae.%目的:评价普外科病原菌耐药变化趋势与β-内酰胺类用量间的关系。方法统计2012~2014年检出主要病原菌耐药率及β-内酰胺类使用强度,运用统计软件分析两者的相关性。结果头孢唑肟使用强度与大肠埃希菌、肺炎克雷伯菌耐药率间均有相关性,头孢吡肟与肺炎克雷伯菌对其耐药率间有相关性,哌拉西林他唑巴坦使用强度与肠杆菌科耐药率间无相关性,所有监测品种均与铜绿假单胞菌耐药率间有相关性。结论肠杆菌科细菌仍是普外科治疗感染的重点。普外科慎重选择三代头孢治疗肠杆菌科细菌感染,对有感染产ESBLs肠杆菌科细菌风险的患者,可选择哌拉西林他唑巴坦。

  19. Analysis on drug-resistance and molecular epidemiology of Acinetobacter baumannii isolated from the clinical samples in two Chinese hospitals

    Institute of Scientific and Technical Information of China (English)

    WEI FENG SHI; ZHI MI HUANG; NING XU

    2006-01-01

    In the present study, the drug-resistance genes encoding β-lactamases, aminoglycoside modifying enzymes, DNA topoisomerases and integron as well as their molecular epidemiology were investigated by means of analyzing the drug-resistance and molecular epidemiology of Acinebacter baumannii isolated from the clinical samples in two hospitals in Changzhou and Huzhou city of Jiangsu and Zhejiang province from July 2000 to March 2005. The minimal inhibitory concentrations (MICs) of these 307 isolates were detected by automatic microbiological system, and 35 strains against 5-fluoroquinolones were performed by agar dilution assay. Meanwhile, the resistant genes in 80 isolates were amplified by PCR with identification by DNA sequencer. It was found that most of the 307 isolates of A. baumannii were resistant to multiple antibiotics tested, in which the resistance rates of the isolates against piperacillin, piperacillin/tazobactam, amoxacillin/clavulanic acid, cefotaxime, ceftazidime,cefepime, gentamicin, amikacin, ciprofloxacin, chloramphenicol and sulfamethoxazole/trimethoprim were all above 35%, but those of imipenem and meropenem were quite low, ranged only 2.6% and 3.3 %. In addition, it was also demonstrated that the positive rates of TEM and SHV β-lactamase genes accounted for 93.8% and 22.5% respectively, and those of the aminoglycoside-modifying enzyme genes including aacC1, aacC2, aacC3, aacC4, aacC4A, aphA6, ant(2")-Ⅰ and ant(3")-Ⅰ were 58.8%, 8.8%, 7.5%, 28.8%, 45.0%, 2.5%, 28.8% and 65.0% respectively. The mutations in the quinolone-resistant determining region (QRDR) of gyrA and parC genes indicated that substitution in Ser-83 residue of GyrA protein was most frequently occurred among strains with MIC for ciprofloxacin of more than 4 μg/ml, whereas a double mutation at Ser-83 residue of gyrA and Ser-80 of parC was found in strains with MIC of ciprofloxacin of more than 8 μg/ml. As to the positive rates of class 1 integron (Int Ⅰ -1) and qacE△1-sul

  20. Nationwide survey of the development of drug resistance in the pediatric field in 2000-2001, 2004, 2007, 2010, and 2012: evaluation of the changes in drug sensitivity of Haemophilus influenzae and patients' background factors.

    Science.gov (United States)

    Shiro, Hiroyuki; Sato, Yoshitake; Toyonaga, Yoshikiyo; Hanaki, Hideaki; Sunakawa, Keisuke

    2015-04-01

    The Drug-Resistant Pathogen Surveillance Group in Pediatric Infectious Disease has conducted surveillance of pediatric patients with respiratory tract infections, meningitis, and sepsis five times (in 2000-2001 [period 1], 2004 [period 2], 2007 [period 3], 2010 [period 4], and 2012 [period 5]). With respect to the clinically isolated Haemophilus influenzae, the drug susceptibility, the frequency of drug-resistant strains, and patients' background factors in each period have already been reported. Here we evaluate trends in the development of drug resistance in H. influenzae, and the relationship between the development of drug resistance and patients' background factors in the aforementioned five periods. H. influenzae derived from pediatric patients with respiratory tract infections that had been previously collected (period 1, 448 isolates; period 2, 376 isolates; period 3, 386 isolates; period 4, 484 isolates; and period 5, 411 isolates) were analyzed. The proportions of ß-lactamase-nonproducing ampicillin (ABPC)-intermediate resistant (BLNAI) strains + β-lactamase-nonproducing ABPC-resistant (BLNAR) strains were 28.8% in period 1, 59.3% in period 2, 61.1% in period 3, 58.1% in period 4, and 63.5% in period 5, showing a rapid increase from period 1 to period 2 followed by an almost constant rate of approximately 60%. The proportion of ß-lactamase-producing ABPC-resistant (BLPAR) strains + ß-lactamase-producing clavulanic acid/amoxicillin-resistant (BLPACR) strains was 4.4% in period 3, which was somewhat low; however, there were no significant changes in the proportions of these strains, which ranged between 6.4% and 8.7% throughout the surveillance period except for period 3. The drugs whose MIC90 values against BLNAR strains were low throughout the surveillance included piperacillin (0.25 μg/mL) and tazobactam/piperacillin (0.125-0.25 μg/mL) in the penicillins; cefditoren and ceftriaxone (0.25-0.5 μg/mL for both) in the cephems; meropenem (0.5-1

  1. Activity and interactions of antibiotic and phytochemical combinations against Pseudomonas aeruginosa in vitro

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    Premkumar Jayaraman, Meena K Sakharkar, Chu Sing Lim, Thean Hock Tang, Kishore R. Sakharkar

    2010-01-01

    Full Text Available In this study the in vitro activities of seven antibiotics (ciprofloxacin, ceftazidime, tetracycline, trimethoprim, sulfamethoxazole, polymyxin B and piperacillin and six phytochemicals (protocatechuic acid, gallic acid, ellagic acid, rutin, berberine and myricetin against five P. aeruginosa isolates, alone and in combination are evaluated. All the phytochemicals under investigation demonstrate potential inhibitory activity against P. aeruginosa. The combinations of sulfamethoxazole plus protocatechuic acid, sulfamethoxazole plus ellagic acid, sulfamethoxazole plus gallic acid and tetracycline plus gallic acid show synergistic mode of interaction. However, the combinations of sulfamethoxazole plus myricetin shows synergism for three strains (PA01, DB5218 and DR3062. The synergistic combinations are further evaluated for their bactericidal activity against P. aeruginosa ATCC strain using time-kill method. Sub-inhibitory dose responses of antibiotics and phytochemicals individually and in combination are presented along with their interaction network to suggest on the mechanism of action and potential targets for the phytochemicals under investigation. The identified synergistic combinations can be of potent therapeutic value against P. aeruginosa infections. These findings have potential implications in delaying the development of resistance as the antibacterial effect is achieved with lower concentrations of both drugs (antibiotics and phytochemicals.

  2. Evaluation of removal efficiency of human antibiotics in wastewater treatment plants in Bangkok, Thailand.

    Science.gov (United States)

    Sinthuchai, Donwichai; Boontanon, Suwanna Kitpati; Boontanon, Narin; Polprasert, Chongrak

    2016-01-01

    This study aimed to investigate the antibiotic concentration at each stage of treatment and to evaluate the removal efficiency of antibiotics in different types of secondary and advanced treatment, as well as the effects of the location of their discharge points on the occurrence of antibiotics in surface water. Eight target antibiotics and four hospital wastewater treatment plants in Bangkok with different conventional and advanced treatment options were investigated. Antibiotics were extracted by solid phase extraction and analysed by high performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS). The antibiotic with the highest concentration at influent was cefazolin at 13,166 ng/L, while the antibiotic with the highest concentration at effluent was sulfamethoxazole at 1,499 ng/L. The removal efficiency of antibiotics from lowest to highest was sulfamethoxazole, piperacillin, clarithromycin, metronidazole, dicloxacillin, ciprofloxacin, cefazolin, and cefalexin. The adopted conventional treatment systems could not completely remove all antibiotics from wastewater. However, using advanced treatments or disinfection units such as chlorination and UV could increase the antibiotic removal efficiency. Chlorination was more effective than UV, ciprofloxacin and sulfamethoxazole concentration fluctuated during the treatment process, and sulfamethoxazole was the most difficult to remove. Both these antibiotics should be studied further regarding their contamination in sludge and suitable treatment options for their removal.

  3. Antibiotic prescription and cost patterns in a general intensive care unit

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    Krivoy N

    2007-06-01

    Full Text Available Antibiotic prescription habits, cost pattern, and the prospective intervention in an Intensive Care Unit were analyzed. Methods: Data on antibiotic utilization and costs were collected prospectively from individual electronic charts from August 2003 to January 2004, and retrospectively from August to December 2002. Results: A total of 180 and 107 patients were surveyed in 2002 and 2003. In 2002, Piperacillin-Tazobactam (13.8% and Imipenem/Cilastin (11.2% were the most prescribed medications; while, in 2003, Vancomycin (12.6% and Imipenem/Cilastin (11.3% were prescribed, respectively. Total defined daily dose (DDD and Drug Utilization 90% (DU90% index for 2002 and 2003 were 2031.15 and 2325.90 DDDs (p>0.1 and 1777.57 and 2079.61 DU90%, respectively (p>0.1. The Median Total Cost /100 admission days (CI 95% were NIS13,310 (11,110;18,420 and NIS13,860 (6,710;18,020 (p=0.66, respectively. Conclusions: Interventional programs should focus on promoting infectious control with rational antibiotic prescription aimed at minimizing the future emergence of bacterial resistance and futile expenses.

  4. Degradation kinetics and mechanism of β-lactam antibiotics by the activation of H2O2 and Na2S2O8 under UV-254nm irradiation.

    Science.gov (United States)

    He, Xuexiang; Mezyk, Stephen P; Michael, Irene; Fatta-Kassinos, Despo; Dionysiou, Dionysios D

    2014-08-30

    The extensive production and usage of antibiotics have led to an increasing occurrence of antibiotic residuals in various aquatic compartments, presenting a significant threat to both ecosystem and human health. This study investigated the degradation of selected β-lactam antibiotics (penicillins: ampicillin, penicillin V, and piperacillin; cephalosporin: cephalothin) by UV-254nm activated H2O2 and S2O8(2-) photochemical processes. The UV irradiation alone resulted in various degrees of direct photolysis of the antibiotics; while the addition of the oxidants improved significantly the removal efficiency. The steady-state radical concentrations were estimated, revealing a non-negligible contribution of hydroxyl radicals in the UV/S2O8(2-) system. Mineralization of the β-lactams could be achieved at high UV fluence, with a slow formation of SO4(2-) and a much lower elimination of total organic carbon (TOC). The transformation mechanisms were also investigated showing the main reaction pathways of hydroxylation (+16Da) at the aromatic ring and/or the sulfur atom, hydrolysis (+18Da) at the β-lactam ring and decarboxylation (-44Da) for the three penicillins. Oxidation of amine group was also observed for ampicillin. This study suggests that UV/H2O2 and UV/S2O8(2-) advanced oxidation processes (AOPs) are capable of degrading β-lactam antibiotics decreasing consequently the antibiotic activity of treated waters.

  5. Utilizzo di Etest nell’antibiogramma diretto da emocoltura su bacilli Gram negativi a crescita rapida e Staphylococcus spp.

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    Pietro Casella

    2004-03-01

    Full Text Available The objective of this study was to compare E test antibiotic gradient performed directly from positive blood coltures with Vitek 2 System for rapid susceptibility testing.A total of 47 strains of Gram negative rapid growers and 37 strains of Staphylococcus spp. (10 strains S. aureus and 27 coagulase negative were investigated. Direct testing of susceptibility to amikacin, imipenem, piperacillin-tazobactam, and ciprofloxacin was evaluated for Gram negative strains, and to oxacillin,ofloxacin, and imipenem for Gram positive. The rate of correlation resulted 99.4% for Gram negative strains (187/188 and 97% for Gram positive strains (144/148.Major errors (i.e. reported as resistant by the Etest but shown to be sensible by the Vitek were observed and regarding one strain of P. aeruginosa for imipenem and two strains of Staphylococcus coagulase negative for oxacillin and imipenem. Etest resulted useful for direct testing susceptibility from blood and may lead to cost reducttion.

  6. Evaluation of antimicrobial resistance pattern of nosocomial and community bacterial pathogens at a teaching hospital in Tehran,Iran.

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    Samin Zamani

    2014-03-01

    Full Text Available Antimicrobial resistance in pathogens not only in hospitals but also in the community has become an important public health problem. The aim of this study was to determine the antimicrobial resistance patterns of predominant pathogens from hospitalized and outpatients in a university hospital in Tehran, Iran. A total of 820 samples of common Gram-negative and Gram-positive bacteria were collected from a major referral and teaching hospital affiliated to Tehran University of Medical Sciences in Iran during April 2010 to February 2011. The pattern of antibiotic resistance was determined by disk diffusion test as recommended by the Clinical Laboratory and Standards Institute (CLSI. Gram-negative bacilli were the most isolated pathogens. Acinetobacter spp. and Pseudomonas aeruginosa (P. aeruginosa was the most antibiotic-resistant pathogens. Imipenem and piperacillin/tazobactam were the most active antimicrobials against gram-negative bacilli whereas vancomycin was the antimicrobial agent most consistently active against the Gram-positive cocci. Community-acquired organisms were more susceptible to antimicrobial drugs tested than nosocomial isolates. The rates of antibiotic resistance among isolated pathogens in this study were approximately similar to other studies. However, high rates of antibiotic resistance among Acinetobacter spp and P. aeruginosa, the most isolated pathogens, indicating that antibiotic policy is urgently needed to prevent the resistance development ago.

  7. Class Ⅰ integron with a novel cassette array in an ESBL-producing multidrug-resistant Klebsiella pneumoniae isolate

    Institute of Scientific and Technical Information of China (English)

    Bing Gu; Mingqing Tong; Wangsheng Zhao; Shiyang Pan; Yuanhua Wei; Peijun Huang

    2006-01-01

    Objective: To analyze the molecular mechanism of integron mediated multi-resistance in an ESBL-producingK. Pneumoniae NJ 12 isolate. Methods: Susceptibility test was carried out by Kirby-Bauer method. Class Ⅰ, Ⅱ and Ⅲ integrons were detected by integrase gene PCR with primers that annealed to conserved regions of integron-encoded integrase genes intIl, intI2 and intI3.The variable region of integron was amplified by integron PCR with primers that targeted the conserved flanking regions, and the PCR product was sequenced. Six aminoglycoside modifying-enzyme genes, including ant ( 2")- Ⅰ , ant ( 3")- Ⅰ , aac (3)- Ⅰ , aac ( 3 )- Ⅱ , aac (6')- Ⅰ , and aac (6')- Ⅱ, were detected. Results: K. Pneumoniae NJ 12 was resistant to nine antibiotics, including piperacillin,ampicillin, cefuroxime, ceftazidime, cefotaxime, aztreonam, streptomycin, gentamicin and amikacin. This isolate was shown that there was positive with class Ⅰ integron, ant(2")- Ⅰ , ant(3")- Ⅰ , aac(3)-Ⅱ and aac(6')- Ⅰ modifying-enzyme genes. Neither class Ⅱ nor Ⅲ integron was detected; DNA sequencing of the fragment amplified by integron PCR revealed a novel cassette array aadB-cat-blaoxa-10/aadA1. Conclusion: Class Ⅰ integron with a novel cassette array in an ESBL-producing multidrug-resistant K. Pneumoniae NJ 12 isolate was reported from Nanjing area of China, with the GenBank accession number DQ141319.

  8. The Detection of Bacteria and Resistance in Children Community-acquired Pneumonia%小儿社区获得性肺炎的细菌学检测和耐药性分析

    Institute of Scientific and Technical Information of China (English)

    李树青; 沈玲; 徐风芝; 韩炳鑫

    2013-01-01

    Objective To analysis the bacterial etiology and resistance in children community-acquired pneumonia in Weifang . Methods 2526 children were included in this study since January 2005.The standard operation procedure of clinical test and VITEK-60 were used to separate and indentify bacteria .And disk diffusion method was used for the antibiotics sensitive test .Results ①Pathogens were detected in 52.90% of study patients.Bacteria accounted for 1417 isolates,Gram positive coccus for 61.75% and Gram negative bacilli ( G-) for 38.2%.Eight bacteria such as Group A streptococcus ,Streptococcus pneumoniae ,E.coli,Staphylococcus aureus ,Epidermis staphy-lococcus,Klebsiella pneumoniae ,Group D streptococcus and Pseudomonas aeruginosa represented the greatest proportion with 79.1%.②Group A streptococcus was sensitive to β-lactam antibiotics ,and 62.34%resistance to erythromycin .For Streptococcus pneumoniae ,the rate of resistance to penicillin was 21.5%,and to cefuroxime,ceftriaxone,amoxicillin,piperacillin/tazobactam were 7.6%~13.0%.For Staphy-lococcus aureus and Epidermis staphylococcus ,the rates of resistance to penicillin and erythromycin were 81%~90%,and to other β-lactam antibiotics were 30%.For E.coli,the rate of resistance to ampicillin was 92.4%,and to otherβ-lactam antibiotics and amikacin were 20%~30%.Klebsiella pneumoniae was resist to most antibiotics ,except ciprofloxacin ,cefoperazone/sulbactam ,piperacillin/tazobactam .For Pseudo-monas aeruginosa,the rate of resistance to ceftriaxone was 46.5%,to cefoperazone/sulbactam,piperacillin/tazobactam,amikacin,ceftazidime, ciprofloxacin were 0 ~4.2%.Conclusion Group A streptococcus , Streptococcus pneumoniae , E.coli, Staphylococcus aureus , Epidermis staphylococcus ,Klebsiella pneumoniae ,Group D streptococcus and Pseudomonas aeruginosa arewere the common pathogens of community -ac-quired pneumonia in children in Weifang .Streptococcus pneumoniae iswas resistance to penicillin .Gram negative bacilli iswas

  9. Resistenza ai principali antibiotici dei microrganismi isolati presso l’ospedale “Luigi Sacco” di Milano nel periodo 1997-2001

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    Giampietro Nardi

    2003-03-01

    Full Text Available Antibiotic resistance of commonly isolated bacterial species at “L. Sacco” Hospital of Milan (Italy is evaluated in the period 1997-2001. Staphylococcus aureus and Staphylococcus epidermidis are quite completely resistant to penicillin, while the agents with β-lactamase inhibitors are more active against Staphylococcus aureus than against Staphylococcus epidermidis. Also cephalotin and eritromycine are more active against Staphylococcus aureus than against Staphylococcus epidermidis. Cephalosporins are active against beta-haemolytic streptococci, while Streptococcus pyogenes shows a resistance of 25-30% against erytromicin. For Streptococcus pneumoniae there is a sporadic, not increasing, resistance to penicillin. Enterococcus faecalis shows an increasing resistance for the year 2001 against cotrimoxazole, but ampicillin and imipenem are always active against this species. Aztreonam is always active against Escherichia coli, while there is resistance to piperacillin (20-25% and ampicillin (35-45%. Resistance to cephalotin is increasing in time, while cefotaxime is always active. For Haemophilus influenzae there is a certain resistance to ampicillin (10-20%. Pseudomonas aeruginosa is often resistant to widespectrum penicillins and to imipenem and ciprofloxacin (30%. With the only exclusion of a great increase of resistance of Enterococcus faecalis to cotrimoxazole in the year 2001, all the other patterns of resistance appear to be comparable in each of the five years considered. Substantially we do not observe an increase of antibiotic resistance.

  10. Bacteremia due to Achromobacter xylosoxidans in neonates: clinical features and outcome

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    Ozden Turel

    Full Text Available OBJECTIVE: We report an outbreak of Achromobacter xylosoxidans at a neonatal intensive care unit. We aimed to present clinical, laboratory and treatment data of the patients. Materials and METHODS: All consecutive episodes of bacteremia due to A. xylosoxidans at our neonatal intensive care unit, beginning with the index case detected at November 2009 until cessation of the outbreak in April 2010, were evaluated retrospectively. RESULTS: Thirty-four episodes of bacteremia occurred in 22 neonates during a 6-month period. Among the affected, 90% were preterm newborns with gestational age of 32 weeks or less and 60% had birth weight of 1000 g or less. Endotracheal intubation, intravenous catheter use, total parenteral nutrition and prolonged antibiotic therapy were the predisposing conditions. Presenting features were abdominal distention, thrombocytopenia and neutropenia. The mortality rate was 13.6% and the majority of isolates were susceptible to piperacillin-tazobactam, carbapenems and trimethoprim-sulfametoxazole, and resistant to gentamycin. More than half were breakthrough infections. Despite intensive efforts to control the outbreak by standard methods of hand hygiene, patient screening and isolation, containment could be achieved only after the neonatal intensive care unit was relocated. The investigation was not able to single out the source of the outbreak. CONCLUSION: A. xylosoxidans has the potential to cause serious infections in premature babies. More studies are needed to determine the importance of different sources of infection in hospital units.

  11. Risk factors and antimicrobial susceptibility in ventilator associated pneumonia: a brief report

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    Shahin Babazadeh

    2012-12-01

    Full Text Available Background: Ventilator associated pneumonia (VAP is one of the serious complications of ventilatory support, occurring in ICUs. The aim of this study was to determine various risk factors associated with the acquisition of Acinetobacter infection and its antimicrobial susceptibility pattern.Methods: This cross-sectional study was performed in the ICUs of Rasoul-e-Akram Hospital in Tehran, Iran during the year 2011. A total of 51 endobronchial aspirates from intubated patients who had been clinically diagnosed to have VAP were studied bacteriologically. The in vitro susceptibility was determined by disk-diffusion and broth microdilution MIC methods.Results: Out of 51 patients with VAP, 35 (66.66% had positive cultures for Acineto-bacter species. In vitro susceptibility test revealed that a high percentage of isolates were resistant to imipenem, piperacillin-tazobactam, third generation cephalosporines, and aminoglycosides.Conclusion: The antimicrobial resistance of gram negative bacteria, particularly Acine-tobacter species, is increasing and preventive measures need to be taken as a matter of urgency.

  12. Antibiotic therapy for inducible AmpC β-lactamase-producing Gram-negative bacilli: what are the alternatives to carbapenems, quinolones and aminoglycosides?

    Science.gov (United States)

    Harris, P N A; Ferguson, J K

    2012-10-01

    Some bacteria that possess chromosomally determined AmpC β-lactamases may express these enzymes at a high level following exposure to β-lactams, either by induction or selection for derepressed mutants. This may lead to clinical failure even if an isolate initially tests susceptible in vitro, a phenomenon best characterised by third-generation cephalosporin therapy for Enterobacter bacteraemia or meningitis. Several other Enterobacteriaceae, such as Serratia marcescens, Citrobacter freundii, Providencia spp. and Morganella morganii (often termed the 'ESCPM' group), may also express high levels of AmpC. However, the risk of clinical failure with β-lactams that test susceptible in vitro is less clear in these species than for Enterobacter. Laboratories frequently do not report β-lactam or β-lactamase inhibitor combination drug susceptibilities for ESCPM organisms, encouraging alternative therapy with quinolones, aminoglycosides or carbapenems. However, quinolones and carbapenems present problems with selective pressure for multiresistant organisms, and aminoglycosides with potential toxicity. The risk of emergent AmpC-mediated resistance for non-Enterobacter spp. appears rare in clinical studies. Piperacillin/tazobactam may remain effective and may be less selective for AmpC derepressed mutants than cephalosporins. The potential roles for agents such as cefepime or trimethoprim/sulfamethoxazole are also discussed. Clinical studies that better define optimal treatment for this group of bacteria are required.

  13. Occurrence of Ambler Class B Metallo-β-Lactamase Gene in Imipenem-Resistant Pseudomonas Aeruginosa Strains Isolated from Clinical Samples

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    Zeynab Golshani

    2014-02-01

    Full Text Available Background: 5TMetallo-β-lactamase (MBLs can hydrolyze a broad spectrum of beta-lactams, including penicillins, cephalosporins, and carbapenems. Genes encoding these enzymes are located on the plasmid that can easily be transferred to other bacteria. The aim of this study was to isolate and identify the Pseudomonas aeruginosa strains encoding VIM1 gene, in clinical samples, using the PCR technique. Materials and Methods: During a 4 month period, 100 strains of Pseudomonas aeruginosa from clinical specimens were collected. Standard tests were performed to identify strains of Pseudomonas aeruginosa. Resistance to antibiotics was examined and then the PCR was used to detect VIM1gene. Results:In this study, the highest rates of resistance to antibiotics, amikacin and cefotaxime was observed (65% and 62%, the lowest resistance to antibiotics piperacillin (48% and imipenem and cefepime with 55% resistance was reported. DDST method was performed for 37 strains for the MBl detection. Among the 37 isolate, 30 strains were MBL-producing with imipenem-EDTA method. Twelve strains (18% were carriers of VIM1 gene using the PCR method. Conclusion: In the present study, the prevalence of strains producing MBL genes in strains of hospitals is a growing trend; correct prescription of medications can prevent the spread of resistant pathogens. It is suggested that molecular methods for rapid detection of resistance genes can be used to prevent the spread of this genes.

  14. Potentiation activity of multiple antibacterial agents by Salvianolate from the Chinese medicine Danshen against methicillin-resistant Staphylococcus aureus (MRSA

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    Qing-Qing Liu

    2016-05-01

    Full Text Available Salvianolate (SAL is a prescribed medicine from the Chinese herb Danshen (Salvia miltiorrhiza Bunge. It has been widely used in treatment of coronary and other diseases with significant effects. The in vitro antimicrobial activities of SAL against infectious pathogens were assayed and its combined effects on 10 clinical isolates of SCCmec III type methicillin-resistant Staphylococcus aureus (MRSA with ten antibiotics were evaluated. Susceptibility to each agent alone was tested using a broth microdilution method, and the chequerboard and time-kill experiments were used for the combined activities. The results showed MIC was 128–256 mg/L for SAL used alone against MRSA. Significant synergies were observed for SAL/Ampicillin (Fosfomycin, Erythromycin, Piperacillin-tazobactam or Clindamycin combination against over half of the isolates, with their MICs reduced by times of dilution (TOD to 4–32 (FICIs 0.375–0.5, respectively. SAL/AMP combination showed the best combined effect of synergy on bacteriostatic and bactericidal activities, while SAL/AMK combination reversed the resistance of MRSA to AMK. The results demonstrated that SAL enhanced widely the in vitro anti-MRSA efficacy of the ten antibacterial agents, which had potential for combinatory therapy of patients infected with MRSA and warrants further investigations.

  15. Multiple healthcare-associated infections in a patient with Crohn's disease: Case report

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    Jorge Bélem Oliveira Júnior

    2016-07-01

    Full Text Available Background and Objective: Healthcare-associated infections (HAIs are the main cause of death in hospitalized individuals worldwide, related with preexisting disease and invasive procedures. The present study aimed to identify the microorganisms in a immunosuppressed patient and their antimicrobial resistance profile. Case report: A 33-year-old man with Crohn's disease was admitted in a hospital for an enterostomy and cholecystectomy, with postoperative fever and gastrointestinal bleeding. Infections of the urinary tract, into the bloodstream and associated with vascular catheter were evaluated by collect of urine, blood and secretions from catheter tips, individually plated on specific media for direct identification and antibiogram in VITEK® 2. Two different vascular catheters samples and a hemoculture revealed Staphylococcus aureus strains β-lactamases producers, with macrolide-lincosamide-streptogramin B (MLS B and methicillin resistance phenotypes (MRSA, and one indication of VISA (Vancomycin-intermediate S. aureus. Pseudomonas aeruginosa and P. luteola were detected in catheter tips with different resistance profile, whereas Trichosporon asahii and Klebsiella pneumonia (ciprofloxacin/levofloxacin resistant were isolated from urine. Amikacin, meropenem polymyxin B, piperacillin/tazobactam, ciprofloxacin, cefepime and amphotericin B were administered to this patient. Conclusions: The patient survived even after multiple infections with pathogens usually envolved in HAIs and mortality in brazilian hospitals.

  16. Interactions of antimicrobial combinations in vitro: the relativity of synergism.

    Science.gov (United States)

    Blaser, J

    1990-01-01

    Interactions of combinations of netilmicin, amikacin, piperacillin, imipenem, azlocillin, ceftazidime or moxalactam were studied in vitro against Pseudomonas aeruginosa, Escherichia coli, Klebsiella pneumoniae and Staphylococcus aureus. Microtiter checkerboard technique was compared with standard killing curve method and with killing curves obtained in kinetic in vitro models mimicking single or multiple dosing regimens according to human pharmacokinetics. Antibiotic combinations were classified as antagonistic, indifferent or synergistic. Disagreement between classification by checkerboard and by kinetic model was found in 14 of 33 combinations studied (42%). Further analysis by standard killing curve method demonstrated that synergism or antagonism is a relative, not an absolute feature of drug combinations against given pathogens. Factors contributing to disagreements included the concentrations studied relative to the bacterial sensitivity, the ratio of concentrations of the two drugs tested, the size of the bacterial inoculum and the endpoint of the interaction assessment. Standard in vitro methods do not consider changes of antibiotic concentrations over time during combination therapy. Concentrations studied are defined according to bacterial sensitivity (fractions of MIC). Therefore, they may or may not relate to those at the infected site. The observed discrepancies between standard methods for testing drug interaction and a model which more closely reflects human pharmacokinetics support the argument that standard synergy testing provides incomplete data to reliably design clinical combination therapy.

  17. Update on bovine mastitis etiological, clinical and treatment aspects in Khartoum state, Sudan.

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    Mohammed Salih R.R.

    2015-11-01

    Full Text Available This study was conducted in certain area at Khartoum State determine the causative agent of bovine mastitis and the susceptibility of different isolates to different antibiotics use for treatment of bovine mastitis. The total number of dairy cows, which were examined in 34 investigated farms, equals 500. The result as follows: 55% acute mastitis, 44% chronic mastitis and 1% gangrenous mastitis. The isolated genera were as follows: 74% Bacillus spp., 24% Staphylococcus spp., 1% Corynebacterium spp. and 1% Klebsiella spp. The isolated species were as follows: 31% Bacillus coagulans, 11% B. cereus, 9% B. subtilis, 9% B. licheniformis, 4% B. circulans, 2% B. lentus, 3% B. mycoides, 3% B. amyloliquefaciens, 2% B. megaterium, 16% Staphylococcus aureus, 8% Staphylococcus hyicus, 1% Corynebacterium spp. and 1% Klebsiella spp. Lastly, the sensitivity test was applied using different antibiotics were as follows: Hundred percent of isolates were sensitive for Chloramphenicol and Ciprofloxacin, 91.6% for Gentamycin and Piperacillin/ Tazobactam, 83.3% for Pefloxacin and Tetracycline, 75% for Amikacin and Ofloxacin, 66.6% for Ceftizoxime, 33.3% for Co-Trimoxazole and Cefotaxime and 16.6% for Ampicillin/ Sulbactam. This study was depended at routine works at microbiological laboratory.

  18. PK-PD modeling of β-lactam antibiotics: in vitro or in vivo models?

    Science.gov (United States)

    de Araujo, Bibiana Verlindo; Diniz, Andrea; Palma, Eduardo Célia; Buffé, Cândida; Dalla Costa, Teresa

    2011-06-01

    A modified E(max)-pharmacokinetic-pharmacodynamic (PK-PD) model was previously proposed in literature for describing the antimicrobial activity of β-lactam antibiotics based on in vitro experiments. However, bacteria behave differently in vitro and in vivo. Thus, the aims of this study were to model the killing effect of piperacillin (PIP) against Escherichia coli on immunocompromised infected rats using this model and to compare the parameters obtained in vitro and in vivo for the same bacteria/drug combination. The PK-PD parameters determined in vitro and in vivo were as follows: generation rate constant of 1.30 ± 0.10 and 0.76 ± 0.20 h(-1), maximum killing effect of 3.11 ± 0.27 and 1.38 ± 0.20 h(-1) and concentration to produce 50% of the maximum effect of 5.44 ± 0.03 and 1.31 ± 0.27 μg ml(-1), respectively. The comparison between the in vitro and in vivo parameters was not straightforward and had to take into consideration the intrinsic differences of the models involved. So far, the main application of the PK-PD model evaluated is for the comparison of different antimicrobial agent's potency and efficacy, under equivalent conditions.

  19. Flare-Up Diverticulitis in the Terminal Ileum in Short Interval after Conservative Therapy: Report of a Case

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    Kensuke Nakatani

    2016-01-01

    Full Text Available Diverticulitis in the terminal ileum is uncommon. Past reports suggested that conservative therapy may be feasible to treat terminal ileum diverticulitis without perforation; however, there is no consensus on the therapeutic strategy for small bowel diverticulitis. We present a 37-year-old man who was referred to our hospital for sudden onset of abdominal pain and nausea. He was diagnosed with diverticulitis in the terminal ileum by computed tomography (CT. Tazobactam/piperacillin hydrate (18 g/day was administered. The antibiotic treatment was maintained for 7 days, and the symptoms disappeared after the treatment. Thirty-eight days after antibiotic therapy, he noticed severe abdominal pain again. He was diagnosed with diverticulitis in terminal ileum which was flare-up of inflammation. He was given antibiotic therapy again. Nine days after antibiotic therapy, laparoscopy assisted right hemicolectomy and resection of 20 cm of terminal ileum were performed. Histopathology report confirmed multiple ileal diverticulitis. He was discharged from our hospital 12 days after the surgery. Colonoscopy was performed two months after the surgery and it revealed no finding suggesting inflammatory bowel disease. Surgical treatment should be taken into account as a potential treatment option to manage the diverticulitis in the terminal ileum even though it is not perforated.

  20. Molecular detection and antimicrobial resistance of Klebsiella pneumoniae from house flies (Musca domestica) in kitchens, farms, hospitals and slaughterhouses.

    Science.gov (United States)

    Ranjbar, Reza; Izadi, Morteza; Hafshejani, Taghi T; Khamesipour, Faham

    2016-01-01

    Identifying disease vectors and pathogens is one of the key steps in controlling vector-borne diseases. This study investigated the possible role of house flies (Musca domestica) as vectors in the transmission of Klebsiella pneumoniae in Chaharmahal VA Bakhtiari and Isfahan provinces of Iran. House flies were captured from household kitchens, cattle farms, chicken farms, animal hospitals, human hospitals and slaughterhouses. Isolation of K. pneumoniae from external surfaces and guts of the flies was performed using MacConkey agar (MA) and thioglycollate broth (TGB). Identification of the isolates was performed with phenotypic techniques and polymerase chain reaction (PCR). A total of 600 house flies were sampled during the study period from different locations in four different seasons. Overall, 11.3% of the captured house flies were positive for K. pneumoniae. In Chaharmahal VA Bakhtiari province, the prevalence was 12.7%, while in Isfahan province, 10.0% of the sampled house flies were infected with K. pneumoniae. Season-wise, the highest prevalence of infections among the house flies was in summer. The organisms were highly resistant to ampicillin, amoxicillin, cefotaxime and piperacillin. A lowest level of resistance was observed for imipenem/cilastatin. The findings of this study demonstrated that house flies are potential vectors of antibiotic-resistant K. pneumoniae in Isfahan and Chaharmahal provinces, Iran. Control efforts for infections caused by this particular bacterium should take M. domestica into account.

  1. The treatment of diabetic foot infections: focus on ertapenem

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    Michael Edmonds

    2009-11-01

    Full Text Available Michael EdmondsDiabetic Foot Clinic, King’s College Hospital, Denmark Hill, London, UKAbstract: Clinically, 3 distinct stages of diabetic foot infection may be recognized: localized infection, spreading infection and severe infection. Each of these presentations may be complicated by osteomyelitis. Infection can be caused by Gram-positive aerobic, and Gramnegative aerobic and anaerobic bacteria, singly or in combination. The underlying principles are to diagnose infection, culture the bacteria responsible and treat aggressively with antibiotic therapy. Localized infections with limited cellulitis can generally be treated with oral antibiotics on an outpatient basis. Spreading infection should be treated with systemic antibiotics. Severe deep infections need urgent admission to hospital for wide-spectrum intravenous antibiotics. Clinical and microbiological response rates have been similar in trials of various antibiotics and no single agent or combination has emerged as most effective. Recently, clinical and microbiological outcomes for patients treated with ertapenem were equivalent to those for patients treated with piperacillin/tazobactam. It is also important to judge the need for debridement and surgery, to assess the arterial supply to the foot and consider revascularization either by angioplasty or bypass if the foot is ischemic. It is also important to achieve metabolic control. Thus infection in the diabetic foot needs full multidisciplinary treatment.Keywords: diabetes, foot, infection, antibiotics, ertapenem

  2. A managed multidisciplinary programme on multi-resistant Klebsiella pneumoniae in a Danish university hospital.

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    Andersen, Stig Ejdrup; Knudsen, Jenny Dahl

    2013-11-01

    Bacteria-producing extended spectrum β-lactamase (ESBL) enzymes are resistant to commonly used antimicrobials. In 2008, routine monitoring revealed a clonal hospital outbreak of ESBL-producing Klebsiella pneumoniae (ESBL-KP). At a 510-bed Danish university hospital, a multidisciplinary change project inspired by Kotter's Eight Steps of Change was designed. In addition to revision of antimicrobial guidelines and restriction of selected antimicrobials, the complex, managed, multi-faceted intervention comprised training and education, enhanced isolation precautions, and a series of actions to improve the infection control measures and standardise procedures across the hospital. A prospective interrupted time series design was used to analyse data collected at hospital level from January 2008 through December 2011. Though overall antimicrobial consumption remained unaffected, the intervention led to intended, immediate and sustained reduction in the use of cefuroxime, and an increase in the use of ertapenem, piperacillin/tazobactam and β-lactamase sensitive penicillin. Moreover, a postintervention reduction in the rate of ESBL-KP in diagnostic samples and in the incidence of ESBL-KP infections was observed. The intervention may also have reduced the need for isolation precautions and may have shortened each isolation period. The results indicate that an immediate and sustained change in the antimicrobial consumption and a decreasing rate of ESBL-KP are achievable through the application of a managed, multi-faceted intervention that does not require ongoing antibiotic stewardship.

  3. Selection of first-line i.v. antibiotics for acute pyelonephritis in patients requiring emergency hospital admission.

    Science.gov (United States)

    Yasufuku, Tomihiko; Shigemura, Katsumi; Yamashita, Masuo; Arakawa, Soichi; Fujisawa, Masato

    2011-04-01

    Febrile urinary tract infections (UTIs) often require the intravenous infusion of antibiotics and/or hospitalization. Acute pyelonephritis (AP) is one of the most severe forms of UTI, and the antibiotics we should use as the first line and the risk factors for treatment failure remain controversial. The objective of this study was to investigate the efficacy of i.v. antibiotics selected for the treatment of febrile AP and to examine the risk factors for antibiotic resistance. We set risk factors for antibiotic treatment failure such as age, sex, and the presence of underlying urinary tract disease. We classified all cases into 49 cases of complicated AP and 24 cases of uncomplicated AP according to the presence of underlying urinary tract diseases, and examined the characteristics of the patients and the efficacy of the antibiotics used in this study. We investigated risk factors which relate to initial treatment failure and the duration of antibiotic treatment. Initial antibiotic treatment failure was significantly correlated to C-reactive protein in complicated AP and to positive blood culture in uncomplicated AP. We revealed a significant correlation between the duration of the given antibiotics and diabetes mellitus or positive blood culture in uncomplicated AP, and tazobactam/piperacillin was significantly related to prolongation of antibiotic treatment in complicated AP. In conclusion, in this study, a positive blood culture was the representative risk factor that related to both initial treatment failure and longer duration of the given antibiotics in uncomplicated AP.

  4. Should β-lactam antibiotics be administered by continuous infusion in critically ill patients? A survey of Australia and New Zealand intensive care unit doctors and pharmacists.

    Science.gov (United States)

    Cotta, Menino O; Dulhunty, Joel M; Roberts, Jason A; Myburgh, John; Lipman, Jeffrey

    2016-06-01

    Although there is a biological precedent for administration of β-lactam antibiotics by continuous or extended infusion, there is no definitive evidence of a survival benefit compared with intermittent administration. The aim of this study was to explore clinician uncertainty with regard to the administration of β-lactam antibiotics by continuous infusion. Doctors and pharmacists in Australian and New Zealand intensive care units (ICUs) were surveyed to investigate current β-lactam antibiotic administration practices as well as the degree of uncertainty regarding the benefit of continuous infusion of two commonly used broad-spectrum β-lactams, namely meropenem and piperacillin/tazobactam (TZP). There were 111 respondents to the survey. Intermittent infusion was reported as standard practice for meropenem (73.9%) and TZP (82.0%). A greater proportion of pharmacists compared with doctors believed continuous infusion to be more effective than intermittent administration (85.4% vs. 34.3%, respectively; P infusion resulted in better patient outcomes (65.9% and 74.6%, respectively; P = 0.85). Overall, 91.0% of respondents were prepared to enrol eligible patients into a definitive randomised controlled trial on β-lactam antibiotic administration. In conclusion, there is equipoise among clinicians working in Australian and New Zealand ICUs as to whether administration by continuous infusion offers a survival benefit in critically ill patients.

  5. [Pseudomonas aeruginosa bacteriaemia: new clinical and therapeutic aspects ].

    Science.gov (United States)

    Janbon, F; Despaux, E; Lepeu, G; Jonquet, O; Santoni, A; Balmayer, B; Bertrand, A

    1982-06-01

    Fifty one cases of Pseudomonas aeruginosa bacteriaemia observed during the last 12 years are reported. Thirty five patients were over fifty years old; 92 p. cent were admitted for several days and about 50 p. cent were in post-operative period. A previous antibiotherapy and an impaired status are promotive factors. The respiratory or peritoneal origins are the most frequent. All patients were feverish; 24 have had an infectious shock which was inaugural in 12 cases. Seven pneumonitis, 3 endocarditis, one pericarditis and 2 osteitis were observed. An ecthyma gangrenosum was noted in three patients. Mortality was 70 p. cent. Comparison between recovered and died patients improved bad prognosis of old age, post operative period, neoplasic, previous organica weakness and pulmonary or peritoneal origins. Used alone, colimycin has seemed to be more effective than aminosid antibiotics; but their association with betalactamins was better. An in vitro study of the susceptibility of 100 Pseudomonas aeruginosa strains has proved the interest of piperacillin and cefsulodin; azlocillin, cefoperazone and ceftriaxone are just less effective.

  6. 分离自腹泻儿童志贺菌的耐药性及分子流行病学研究%Drug resistance and molecular epidemiology of Shigella isolated from children with diarrhea

    Institute of Scientific and Technical Information of China (English)

    张传领; 沈利蒙; 楚旭; 毛剑锋; 董华丽

    2012-01-01

    Objective To investigate the prevalence and antibiotic resistance of Shigella isolated from children with diarrhea for the guidance of clinical treatment and prevention and control of bacillary dysentery.Method A total of 156 strains of Shigella were isolated from feces of children with diarrhea in Zhejiang Xiaoshan Hospital from January 2008 to December 2010.The antimicrobial resistance of the strains was detected by disk diffusion method and the extended-spectrum beta-lactamases (ESBLs) in these isolates were determined using phenotypic confirmatory test; the isolates of ESBLs producing Shigella sonnei were analyzed by REP-PCR.Result Among 156 strains of Shigella isolated,the most common groups were Shigella sonnei (130 strains,accounting for 83.3%) and Shigella fleaneri (26 strains,accounting for 16.7%),and 81 (51.9%) strains were identified as ESBLs producers,and the positive rates in 2008,2009 and 2010 were 32.0%,41.4% and 59.8%,respectively.The results of antibiotic susceptibility test displayed that the resistance rates of ESBLs producing Shigella to ampicillin,cotrimoxazole,cefotaxime,piperacillin were higher than 90%.However,the resistance rates to cefepime,ceftazidime,levofloxacin and ciprofloxacin were low; The resistance of ESBLs producing strains to piperacillin (100% vs.77.3%),cefotaxime(100% vs.0),ceftazidime(14.8% vs.0),cefepime(28.4% vs.0),cotrimoxazole(95.1%vs.86.7%) was significantly higher than that of non-ESBLs producing strains (x2 =20.605,156.000,12.037,24.979,45.040,respectively ;P < 0.05).No isolate was resistant to piperacillin/tazobactam and imipenem.There were 7 genotypes among 74 ESBLs producing Shigella sonnei,respectively type A (50),type B (12),type C (8),type D (1),type E (1),type F (1),and type G (1).Conclusion The isolation rate of ESBLs-producing isolate was high in Shigella from pediatric patients with diarrhea,and the number is going up year by year,and these ESBLs producing Shigella sonnei strains

  7. The Resistance Phenotype and Molecular Epidemiology of Klebsiella pneumoniae in Bloodstream Infections in Shanghai, China, 2012–2015

    Science.gov (United States)

    Xiao, Shu-zhen; Wang, Su; Wu, Wen-man; Zhao, Sheng-yuan; Gu, Fei-fei; Ni, Yu-xing; Guo, Xiao-kui; Qu, Jie-ming; Han, Li-zhong

    2017-01-01

    Klebsiella pneumoniae (K.pneumoniae) is a common nosocomial pathogen causing bloodstream infections. Antibiotic susceptibility surveillance and molecular characterization will facilitate prevention and management of K. pneumoniae bloodstream infections. K. pneumoniae isolates causing bloodstream infections were consecutively collected between January 2012 and December 2015 in Shanghai. Eighty isolates (20 per year) were randomly selected and enrolled in this study. Drug susceptibility were determined by the disk diffusion method. Polymerase chain reaction (PCR) was employed to detect extended-spectrum β-lactamases (ESBLs), carbapenemases, and seven housekeeping genes of K. pneumoniae. eBURST was used for multi-locus sequence typing (MLST). More than 50% isolates were resistant to cefuroxime, ampicillin-sulbactam, and piperacillin, while carbapenems had lower resistant rates than other antibiotics. Of the 80 isolates, 22 produced ESBLs, and 14 were carbapenemase producers. In the ESBL-producing K. pneumoniae isolates, the most common ESBL genes were blaSHV and blaCTX−M. Thirteen carbapenemase producers harbored blaKPC−2 and one other carried blaNDM−5. ST11 (14/80) was the most frequent sequence type (ST), followed by ST15 (7/80) and ST29 (4/80). Our data revealed high prevalence of antibiotic resistant K. pneumoniae isolates from bloodstream infections but their genetic diversity suggested no clonal dissemination in the region. Also, one K. pneumoniae isolate harbored blaNDM−5 in this study, which was firstly reported in Shanghai. PMID:28280486

  8. Multidrug-resistant Pseudomonas aeruginosa lower respiratory tract infections in the intensive care unit: Prevalence and risk factors.

    Science.gov (United States)

    Trinh, Trang D; Zasowski, Evan J; Claeys, Kimberly C; Lagnf, Abdalhamid M; Kidambi, Shravya; Davis, Susan L; Rybak, Michael J

    2017-09-01

    Intensive care unit (ICU) admission is a risk for multidrug-resistant (MDR) Pseudomonas aeruginosa, but factors specific to critically ill pneumonia patients are not fully characterized. Objective was to determine risk factors associated with MDR P. aeruginosa pneumonia among ICU patients. This was a retrospective case-control study of P. aeruginosa pneumonia in the ICU; cystic fibrosis and colonizers were excluded. Risk factors included comorbid conditions and prior healthcare exposure (anti-pseudomonal antibiotics, hospitalizations, nursing home, P. aeruginosa colonization/infection, mechanical ventilation). Of 200 patients, 47 (23.5%) had MDR P. aeruginosa pneumonia. Independent predictors for MDR were ≥24h antibiotics in the preceding 90days (carbapenems, fluoroquinolones, and piperacillin-tazobactam) (odds ratio, 3.6 [95% CI, 1.6-8.1]) and nursing home residence (2.3 [1.1-4.9]). MDR P. aeruginosa remains prevalent among ICU patients with pneumonia. Given poor outcomes with delayed therapy, patients should be thoroughly assessed for prior anti-pseudomonal antibiotic exposure and nursing home residency. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. Toxin profiles, PCR ribotypes and resistance patterns of Clostridium difficile: a multicentre study in China, 2012-2013.

    Science.gov (United States)

    Gao, Qiong; Wu, Shi; Huang, Haihui; Ni, Yuxing; Chen, Ye; Hu, Yunjian; Yu, Yunsong

    2016-12-01

    A total of 178 clinical isolates of Clostridium difficile were collected from five major teaching hospitals representing northern, eastern and southern China from August 2012 to July 2013. Among the 178 isolates, 162 (91.0%) were toxigenic, including 66 (40.7%) toxin A-negative, toxin B-positive, 95 (58.6%) toxin A-positive, toxin B-positive and only 1 (0.6%) toxin A-, toxin B- and binary toxin-positive. Twenty-nine different PCR ribotypes were identified, of which 017 (21.0%), 012 (17.3%) and novel type H (16.7%) were the most prevalent. PCR ribotypes 027 and 078 were not found. All toxigenic strains were susceptible to metronidazole, vancomycin and piperacillin/tazobactam. Resistance to moxifloxacin, clindamycin, erythromycin, tetracycline, chloramphenicol, fusidic acid, imipenem, linezolid and rifampicin was observed in 45.1%, 79.6%, 75.3%, 46.9%, 3.7%, 29.6%, 4.9%, 2.5% and 12.3% of the isolates, respectively. Ribotype 017 showed resistance to more antimicrobial agents tested than other ribotype strains. Copyright © 2016 Elsevier B.V. and International Society of Chemotherapy. All rights reserved.

  10. Fulminant Staphylococcus lugdunensis septicaemia following a pelvic varicella-zoster virus infection in an immune-deficient patient: a case report

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    Woznowski M

    2010-09-01

    Full Text Available Abstract Introduction The deadly threat of systemic infections with coagulase negative Staphylococcus lugdunensis despite an appropriate antibiotic therapy has only recently been recognized. The predominant infectious focus observed so far is left-sided native heart valve endocarditis, but bone and soft tissue infections, septicaemia and vascular catheter-related bloodstream infections have also been reported. We present a patient with a fatal Staphylococcus lugdunensis septicaemia following zoster bacterial superinfection of the pelvic region. Case presentation A 71-year old male diagnosed with IgG kappa plasmocytoma presented with a conspicuous weight loss, a hypercalcaemic crisis and acute renal failure. After initiation of haemodialysis treatment his condition improved rapidly. However, he developed a varicella-zoster virus infection of the twelfth thoracic dermatome requiring intravenous acyclovir treatment. Four days later the patient presented with a fulminant septicaemia. Despite an early intravenous antibiotic therapy with ciprofloxacin, piperacillin/combactam and vancomycin the patient died within 48 hours, shortly before the infective isolate was identified as Staphylococcus lugdunensis by polymerase chain reaction. Conclusion Despite S. lugdunensis belonging to the family of coagulase-negative staphylococci with an usually low virulence, infections with S. lugdunensis may be associated with an aggressive course and high mortality. This is the first report on a Staphylococcus lugdunensis septicaemia following a zoster bacterial superinfection of the pelvic region.

  11. Beta Lactamase Producing Clostridium perfringens Bacteremia in an Elderly Man with Acute Pancreatitis

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    Rashmi Mishra

    2016-01-01

    Full Text Available Clostridium perfringens bacteremia is associated with adverse outcomes. Known risk factors include chronic kidney disease, malignancy, diabetes mellitus, and gastrointestinal disease. We present a 74-year-old man admitted with confusion, vomiting, and abdominal pain. Exam revealed tachycardia, hypotension, lethargy, distended abdomen, and cold extremities. He required intubation and aggressive resuscitation for septic shock. Laboratory data showed leukocytosis, metabolic acidosis, acute kidney injury, and elevated lipase. CT scan of abdomen revealed acute pancreatitis and small bowel ileus. He was started on vancomycin and piperacillin-tazobactam. Initial blood cultures were positive for C. perfringens on day five. Metronidazole and clindamycin were added to the regimen. Repeat CT (day 7 revealed pancreatic necrosis. The patient developed profound circulatory shock requiring multiple vasopressors, renal failure requiring dialysis, and bacteremia with vancomycin-resistant enterococci. Hemodynamic instability precluded surgical intervention and he succumbed to multiorgan failure. Interestingly, our isolate was beta lactamase producing. We review the epidemiology, risk factors, presentation, and management of C. perfringens bacteremia. This case indicates a need for high clinical suspicion for clostridial sepsis and that extended spectrum beta lactam antibiotic coverage may be inadequate and should be supplemented with use of clindamycin or metronidazole if culture is positive, until sensitivities are known.

  12. Role of novel multidrug efflux pump involved in drug resistance in Klebsiella pneumoniae.

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    Vijaya Bharathi Srinivasan

    Full Text Available BACKGROUND: Multidrug resistant Klebsiella pneumoniae have caused major therapeutic problems worldwide due to the emergence of the extended-spectrum β-lactamase producing strains. Although there are >10 major facilitator super family (MFS efflux pumps annotated in the genome sequence of the K. pneumoniae bacillus, apparently less is known about their physiological relevance. PRINCIPAL FINDINGS: Insertional inactivation of kpnGH resulting in increased susceptibility to antibiotics such as azithromycin, ceftazidime, ciprofloxacin, ertapenem, erythromycin, gentamicin, imipenem, ticarcillin, norfloxacin, polymyxin-B, piperacillin, spectinomycin, tobramycin and streptomycin, including dyes and detergents such as ethidium bromide, acriflavine, deoxycholate, sodium dodecyl sulphate, and disinfectants benzalkonium chloride, chlorhexidine and triclosan signifies the wide substrate specificity of the transporter in K. pneumoniae. Growth inactivation and direct fluorimetric efflux assays provide evidence that kpnGH mediates antimicrobial resistance by active extrusion in K. pneumoniae. The kpnGH isogenic mutant displayed decreased tolerance to cell envelope stressors emphasizing its added role in K. pneumoniae physiology. CONCLUSIONS AND SIGNIFICANCE: The MFS efflux pump KpnGH involves in crucial physiological functions besides being an intrinsic resistance determinant in K. pneumoniae.

  13. A Rare Case of Pneumonia Caused by Shewanella putrefaciens.

    Science.gov (United States)

    Patel, Rajshree; Abraham, Albin; Thomas, Johnson; Zhi, Wanqing; Ahmed, Shadab; Verley, Janice

    2012-01-01

    Shewanella putrefaciens is a gram-negative, nonfermentative, oxidase positive, motile bacillus that produces hydrogen sulphide. It is found widely in the nature especially in marine environments. In some very rare cases Shewanella putrefaciens can be a human pathogen. It can produce a wide variety of clinical syndromes including bacteremia as well as skin and soft tissue infections. However, pneumonia due to S. putrefaciens is rare; there are a total of 4 reported cases in the literature. We present a case of 63-year-old male who was presented to emergency room status after cardiac arrest, fell into sea water face down. On the second day of hospitalization, he was diagnosed to have pneumonia based on the clinical, radiological, and laboratory findings. Empirical antibiotic treatment with vancomycin and piperacillin/tazobactam combination was initiated. Gram-stained smear of endotracheal aspirate yielded gram-negative bacteria, and the isolate grown from endotracheal aspirate culture was identified as S. putrefaciens by Biomerieux API 20 NE technique. On review of the literature and according to culture and sensitivity results, therapy in our patient was changed to cefepime. Patient's pneumonia improved with treatment with cefepime. We believe that our patient developed pneumonia evidently caused by S. putrefaciens, after near drowning in sea water. The pneumonia resolved after treatment with cefepime.

  14. A Rare Case of Pneumonia Caused by Shewanella putrefaciens

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    Rajshree Patel

    2012-01-01

    Full Text Available Shewanella putrefaciens is a gram-negative, nonfermentative, oxidase positive, motile bacillus that produces hydrogen sulphide. It is found widely in the nature especially in marine environments. In some very rare cases Shewanella putrefaciens can be a human pathogen. It can produce a wide variety of clinical syndromes including bacteremia as well as skin and soft tissue infections. However, pneumonia due to S. putrefaciens is rare; there are a total of 4 reported cases in the literature. We present a case of 63-year-old male who was presented to emergency room status after cardiac arrest, fell into sea water face down. On the second day of hospitalization, he was diagnosed to have pneumonia based on the clinical, radiological, and laboratory findings. Empirical antibiotic treatment with vancomycin and piperacillin/tazobactam combination was initiated. Gram-stained smear of endotracheal aspirate yielded gram-negative bacteria, and the isolate grown from endotracheal aspirate culture was identified as S. putrefaciens by Biomerieux API 20 NE technique. On review of the literature and according to culture and sensitivity results, therapy in our patient was changed to cefepime. Patient’s pneumonia improved with treatment with cefepime. We believe that our patient developed pneumonia evidently caused by S. putrefaciens, after near drowning in sea water. The pneumonia resolved after treatment with cefepime.

  15. High genetic diversity of Enterococcus faecium and Enterococcus faecalis clinical isolates by pulsed-field gel electrophoresis and multilocus sequence typing from a hospital in Malaysia.

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    Weng, Poh Leng; Ramli, Ramliza; Shamsudin, Mariana Nor; Cheah, Yoke-Kqueen; Hamat, Rukman Awang

    2013-01-01

    Little is known on the genetic relatedness and potential dissemination of particular enterococcal clones in Malaysia. We studied the antibiotic susceptibility profiles of Enterococcus faecium and Enterococcus faecalis and subjected them to pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST). E. faecium and E. faecalis displayed 27 and 30 pulsotypes, respectively, and 10 representative E. faecium and E. faecalis isolates (five each) yielded few different sequence types (STs): ST17 (2 isolates), ST78, ST203, and ST601 for E. faecium, and ST6, ST16, ST28, ST179, and ST399 for E. faecalis. Resistance to tazobactam-piperacillin and ampicillin amongst E. faecium isolates was highly observed as compared to E. faecalis isolates. All of the isolates were sensitive to vancomycin and teicoplanin. The presence of epidemic and nosocomial strains of selected E. faecium STs: 17, 78, and 203 and E. faecalis ST6 as well as high rates of resistance to multiple antibiotics amongst E. faecium isolates is of a particular concern.

  16. Development and validation of a fast and uniform approach to quantify β-lactam antibiotics in human plasma by solid phase extraction-liquid chromatography-electrospray-tandem mass spectrometry.

    Science.gov (United States)

    Colin, Pieter; De Bock, Lies; T'jollyn, Huybrecht; Boussery, Koen; Van Bocxlaer, Jan

    2013-01-15

    Monitoring of plasma antibiotic concentrations is necessary for individualization of antimicrobial chemotherapy dosing in special patient populations. One of these special populations of interest are the post-bariatric surgery patients. Until today, little is known on the effect of this procedure on drug disposition and efficacy. Therefore, close monitoring of antimicrobial plasma concentrations in these patients is warranted. A fast and uniform ultra-high-performance liquid chromatography (UPLC) method with tandem mass spectrometric detection (MS/MS) has been developed and qualified for the simultaneous quantification of β-lactam antibiotics in human plasma. Compounds included in this multi-component analysis are: amoxicillin, ampicillin, phenoxymethylpenicillin, piperacillin, cefuroxime, cefadroxil, flucloxacillin, meropenem, cefepime, ceftazidime, tazobactam, linezolid and cefazolin. After spiking of five different stable isotope labelled internal standards, plasma samples were prepared for UPLC-MS/MS analysis by mixed-mode solid phase extraction. The developed method was proven to be free of (relative) matrix effects and proved to be reliable for the quantification of 12 out of 13 β-lactam antibiotics. As a proof of concept the method has been applied to plasma samples obtained from a healthy volunteer treated with amoxicillin. The analytical method is suitable for use in a therapeutic drug monitoring setting, providing the clinician with reliable measurements on β-lactam antibiotic plasma concentrations in a timely manner.

  17. Lack of effect of cell-wall targeted antibacterials on biofilm formation and antifungal susceptibility of Candidaspecies

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    Gisela Myrian de Lima Leite

    2014-09-01

    Full Text Available The use of central venous catheters (CVC and broad-spectrum antibacterials are among the main risk factors for the development of candidemia in patients admitted to intensive care units (ICU. It is known that some antibacterials increase the resistance of these yeasts to azole antifungals. Thus, the aim of this research was to determine whether yeast present in CVC colonizations previously exposed to cell-wall targeted antibacterials benefit from a reduction in susceptibility to fluconazole and voriconazole, facilitating their ability to form biofilms. Candida albicans, C. tropicalis, C. glabrata, C. parapsilosis and C. guilhermondii were seeded into antibacterial (cefepime, meropenem, vancomycin, and piperacillin-tazobactam gradient plates produced in Mueller-Hinton Agar. The susceptibility to fluconazole and voriconazole and the biofilm formation of the yeasts were tested before and after exposure to the antibacterials. None of the antibacterials exerted a significant effect on the in vitro susceptibility of the yeasts to the antifungal agents or on their ability to form biofilms. These results suggest that increased candidemia in ICU patients is not attributable to possible alterations in the yeasts, but is more likely caused by a weakening of the patient's general condition after long exposure to infection.

  18. Isolation and characterization of numerous novel phages targeting diverse strains of the ubiquitous and opportunistic pathogen Achromobacter xylosoxidans.

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    Wittmann, Johannes; Dreiseikelmann, Brigitte; Rohde, Christine; Rohde, Manfred; Sikorski, Johannes

    2014-01-01

    The clinical relevance of nosocomially acquired infections caused by multi-resistant Achromobacter strains is rapidly increasing. Here, a diverse set of 61 Achromobacter xylosoxidans strains was characterized by MultiLocus Sequence Typing and Phenotype MicroArray technology. The strains were further analyzed in regard to their susceptibility to 35 antibiotics and to 34 different and newly isolated bacteriophages from the environment. A large proportion of strains were resistant against numerous antibiotics such as cephalosporines, aminoglycosides and quinolones, whereas piperacillin-tazobactam, ticarcillin, mezlocillin and imipenem were still inhibitory. We also present the first expanded study on bacteriophages of the genus Achromobacter that has been so far a blank slate with respect to phage research. The phages were isolated mainly from several waste water treatment plants in Germany. Morphological analysis of all of these phages by electron microscopy revealed a broad diversity with different members of the order Caudovirales, including the families Siphoviridae, Myoviridae, and Podoviridae. A broad spectrum of different host ranges could be determined for several phages that lysed up to 24 different and in part highly antibiotic resistant strains. Molecular characterisation by DNA restriction analysis revealed that all phages contain linear double-stranded DNA. Their restriction patterns display distinct differences underlining their broad diversity.

  19. Simultaneous determination of nine β-lactam antibiotics in human plasma by an ultrafast hydrophilic-interaction chromatography-tandem mass spectrometry.

    Science.gov (United States)

    Abdulla, Alan; Bahmany, Soma; Wijma, Rixt A; van der Nagel, Bart C H; Koch, Birgit C P

    2017-08-15

    Contemporary β-lactam antibiotic dosing is debatable in severely ill patients, since the occurrence of pathophysiological changes in critical illness can result in great inter-individual variability. Therapeutic drug monitoring (TDM) is a commonly used dosing strategy to optimize exposure and thereby minimize toxicity and maximize the efficacy. Currently, TDM of β-lactam antibiotics is rarely performed, due to poor availability in clinical practice. We describe an ultrafast Hydrophilic-Interaction Chromatography (HILIC) based UPLC-MS/MS method for the determination of amoxicillin, benzylpenicillin, cefotaxime, cefuroxime, ceftazidime, flucloxacillin, imipenem, meropenem and piperacillin in human plasma. This method involves simple sample preparation steps and was comprehensively validated according to standard FDA guidelines. For all analytes, mean accuracy and precision values were within the acceptance value. The lower and upper limits of quantification were found to be sufficient to cover the therapeutic range for all antibiotics. Finally, the method was successfully applied in a large pharmacokinetic study performed in the intensive care setting, and the feasibility of the analytical procedure was demonstrated in routine clinical practice. To the best of our knowledge, we report here the first HILIC-based UPLC-MS/MS assay for the determination of β-lactam antibiotics in human plasma. This simple, sensitive and ultrafast assay requires small-volume samples and can easily be implemented in clinical laboratories to promote the TDM of β-lactam antibiotics. Copyright © 2017 Elsevier B.V. All rights reserved.

  20. Evaluation of Risk Factors for Antibiotic Resistance in Patients with Nosocomial Infections Caused by Pseudomonas aeruginosa.

    Science.gov (United States)

    Sonmezer, Meliha Cagla; Ertem, Gunay; Erdinc, Fatma Sebnem; Kaya Kilic, Esra; Tulek, Necla; Adiloglu, Ali; Hatipoglu, Cigdem

    2016-01-01

    Background. Pseudomonas aeruginosa (P. aeruginosa) is resistant to various antibiotics and can cause serious nosocomial infections with high morbidity and mortality. In this clinical study, we investigated the risk factors in patients who were diagnosed with P. aeruginosa-related nosocomial infection. Methods. A retrospective case control study including patients with P. aeruginosa-related nosocomial infection. Patients who were resistant to any of the six antibiotics (imipenem, meropenem, piperacillin-tazobactam, ciprofloxacin, amikacin, and ceftazidime) constituted the study group. Results. One hundred and twenty isolates were isolated. Various risk factors were detected for each antibiotic in the univariate analysis. In the multivariate analysis, previous cefazolin use was found as an independent risk factor for the development of imipenem resistance (OR = 3.33; CI 95% [1.11-10.0]; p = 0.03), whereas previous cerebrovascular attack (OR = 3.57; CI 95% [1.31-9.76]; p = 0.01) and previous meropenem use (OR = 4.13; CI 95% [1.21-14.07]; p = 0.02) were independent factors for the development of meropenem resistance. For the development of resistance to ciprofloxacin, hospitalization in the neurology intensive care unit (OR = 4.24; CI 95% [1.5-11.98]; p = 0.006) and mechanical ventilator application (OR = 11.7; CI 95% [2.24-61.45]; p = 0.004) were independent risk factors. Conclusion. The meticulous application of contact measures can decrease the rate of nosocomial infections.

  1. Effectiveness of antibiotic combination therapy as evaluated by the Break-point Checkerboard Plate method for multidrug-resistant Pseudomonas aeruginosa in clinical use.

    Science.gov (United States)

    Nakamura, Itaru; Yamaguchi, Tetsuo; Tsukimori, Ayaka; Sato, Akihiro; Fukushima, Shinji; Mizuno, Yasutaka; Matsumoto, Tetsuya

    2014-04-01

    Multidrug-resistant Pseudomonas aeruginosa (MDRP) strains are defined as having resistance to the following 3 groups of antibiotics: carbapenems, aminoglycosides, and fluoroquinolones. Antibiotic combinations have demonstrated increased activity in vitro compared with a single agent. As an in vitro method of determining the combination activity of antibiotics, the Break-point Checkerboard Plate (BC-plate) can be used routinely in clinical microbiology laboratories. We evaluated the effectiveness of the BC-plate for MDRP infections in clinical settings. We retrospectively selected cases of MDRP infection treated with combination therapy of antibiotics in Tokyo Medical University Hospital (1015 beds), Tokyo, Japan, from November 2010 to October 2012. A total of 28 MDRP strains were clinically isolated from 28 patients during the study period. This study design is a case series of MDRP infection. Six infections among the 28 patients were treated based on the results of the BC-plate assay, and the 6 strains tested positive for MBL. One patient had pneumonia, 3 had urinary tract infections, 1 had vertebral osteomyelitis, and 1 had nasal abscess. The combination of aztreonam with amikacin demonstrated the most frequently recognized in vitro effect (5 patients). Next, aztreonam with ciprofloxacin and piperacillin with amikacin revealed equivalent in vitro effects (3 patients, respectively). The clinical cure rate was 83.3% (5/6 patients). Antibiotic combination therapy based on the results of the BC-plate assay might indicate the effective therapy against MDRP infection in clinical settings.

  2. New options of antibiotic combination therapy for multidrug-resistant Pseudomonas aeruginosa.

    Science.gov (United States)

    Nakamura, I; Yamaguchi, T; Tsukimori, A; Sato, A; Fukushima, S; Matsumoto, T

    2015-01-01

    Several antibiotic combinations have demonstrated increased activity against multidrug-resistant Pseudomonas aeruginosa (MDRP) in vitro compared with a single antibiotic. The aim of this study was to investigate the activity against MDRP of some aminoglycosides in combination with monobactam, piperacillin (PIPC), and carbapenem. Clinical isolates of MDRP were collected between November 2010 and October 2012 from patients in Tokyo Medical University Hospital, Tokyo (1,015 beds). Our new method was designed to evaluate three concentrations around the breakpoint of each drug using the Checkerboard method. The aminoglycosides tested were amikacin (AMK), tobramycin (TOB), and arbekacin (ABK). Ciprofloxacin, PIPC, and biapenem (BIPM), which have been reported to demonstrate combination effects, were also tested. Sixty-six MDRP strains were identified from the 2,417 P. aeruginosa strains. Of the 66, 27 tested positive for metallo-β-lactamase (MBL). Aztreonam (AZT) with AMK or ABK was the most effective against MDRP. PIPC with AMK or ABK were somewhat effective. AZT with AMK or ABK were more effective against MBL-positive strains than MBL-negative strains. However, PIPC with AMK or ABK were more effective against MBL-negative strains than MBL-positive strains. Combination activities showed differences between MBL-positive and MBL-negative strains.

  3. Prior colonization is associated with increased risk of antibiotic-resistant Gram-negative bacteremia in cancer patients☆,☆☆

    Science.gov (United States)

    Kleinberg, Michael; Sorkin, John D.; Netzer, Giora; Johnson, Jennifer K.; Shardell, Michelle; Thom, Kerri A.; Harris, Anthony D.; Roghmann, Mary-Claire

    2015-01-01

    We hypothesized that prior colonization with antibiotic-resistant Gram-negative bacteria is associated with increased risk of subsequent antibiotic-resistant Gram-negative bacteremia among cancer patients. We performed a matched case-control study. Cases were cancer patients with a blood culture positive for antibiotic-resistant Gram-negative bacteria. Controls were cancer patients with a blood culture not positive for antibiotic-resistant Gram-negative bacteria. Prior colonization was defined as any antibiotic-resistant Gram-negative bacteria in surveillance or non-sterile-site cultures obtained 2–365 days before the bacteremia. Thirty-two (37%) of 86 cases and 27 (8%) of 323 matched controls were previously colonized by any antibiotic-resistant Gram-negative bacteria. Prior colonization was strongly associated with antibiotic-resistant Gram-negative bacteremia (odds ratio [OR] 7.2, 95% confidence interval [CI] 3.5–14.7) after controlling for recent treatment with piperacillin-tazobactam (OR 2.5, 95% CI 1.3–4.8). In these patients with suspected bacteremia, prior cultures may predict increased risk of antibiotic-resistant Gram-negative bacteremia. PMID:24582582

  4. Rates of antimicrobial resistance in latin america (2004-2007 and in vitro activity of the glycylcycline tigecycline and of other antibiotics

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    Flávia Rossi

    2008-10-01

    Full Text Available As a part of the Tigecycline Evaluation and Surveillance Trial (T.E.S.T., Gram-positive and Gram-negative bacterial isolates were collected from 33 centers in Latin America (centers in Argentina, Brazil, Chile, Colombia, Guatemala, Honduras, Jamaica, Mexico, Panama, Puerto Rico, and Venezuela from January 2004 to September 2007. Argentina and Mexico were the greatest contributors of isolates to this study. Susceptibilities were determined according to Clinical Laboratory Standards Institute guidelines. Resistance levels were high for most key organisms across Latin America: 48.3% of Staphylococcus aureus isolates were methicillin-resistant while 21.4% of Acinetobacter spp. isolates were imipenem-resistant. Extended-spectrum β-lactamase were reported in 36.7% of Klebsiella pneumoniae and 20.8% of E. coli isolates. Tigecycline was the most active agent against Gram-positive isolates. Tigecycline was also highly active against all Gram-negative organisms, with the exception of Pseuodomonas aeruginosa, against which piperacillin-tazobactam was the most active agent tested (79.3% of isolates susceptible. The in vitro activity of tigecycline against both Gram-positive and Gram-negative isolates indicates that it may be an useful tool for the treatment of nosocomial infections, even those caused by organisms that are resistant to other antibacterial agents.

  5. Community acquired pneumonia due to gram negative bacilli and its antibiotic sensitivity pattern in a tertiary care centre

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    Ashish Jitendranath

    2016-08-01

    Results: During the study period in 120 cases of pneumonia, there was growth of pathogenic organism. Among the GNB isolated Klebsiella spp was the most common organism isolated at 33.9% followed by Pseudomonas aeruginosa and Escherichia coli at 22.1%. Out of the 53 gram negative samples isolated 4 (7% were Amp C positive, 10 (18.8% were ESBL positive and there was one single case of MBL. The antibiotic sensitivity showed that all the isolates were sensitive to colisitin (100%, while Klebsiella spp, Pseudomonas spp, and Escherichia coli were 100% sensitive to imipenem and meropenem. Resistance pattern of all the isolates showed that the isolates exhibited high resistance to amoxycillin-clavulunate, cefuroxime and cotrimoxazole. While resistance against ceftazidime and cefipime was >40%. On the other hand, isolates showed a low level of resistance against piperacillin tazobactam and cefoperazone-sulbactam. Extremely low level of resistance was observed against imipenem and meropenem, while colistin showed no resistance among the isolates obtained in this study. Conclusions: The study showed that gram-negative bacteria and P. aeruginosa form a relevant part of the microbial pattern of CAP in patients who require hospitalization, particularly those with severe CAP. Initiating antibiotics with gram negative coverage should be considered in this subgroup of patients since initiating the correct antibiotic plays a critical role in the outcome of pneumonia. [Int J Res Med Sci 2016; 4(8.000: 3121-3124

  6. A case report of thyroid storm induced by acute sepsis

    Institute of Scientific and Technical Information of China (English)

    Chiu-Yin Yeh; Wen-Liang Yu

    2016-01-01

    Thyroid storm is a rare but life-threatening condition, which can be induced by many critical diseases. We reported a 40-year-old woman with thyroid goiter manifesting with acute sepsis-induced hyperthyroidism. She mainly presented with abdominal bloating, diarrhea, lower limbs edema and exertional dyspnea. The lactate was 9.5 mmol/L and procalcitonin was 3.8 ng/mL, suggesting acute sepsis. The thyroid echo showed bilateral thyroid goiter. Relevant data included a thyroid-stimulating hormone level of 0.03 mIU/mL;free tetraiodothyronine, 5.67 ng/dL;thyroid-stimulating hormone receptor antibody, 76.9%(normal range, < 14%); and antimicrosomal antibody titer, 1:102 400 (normal range,<1:100), suggesting toxic goiter with thyroid storm. Piperacillin/tazobactam, methimazole and Lugol's iodine achieved a good outcome. The symptoms of early sepsis and those of thyroid storm could be similar. Therefore, a careful history taking, a thorough physical examination and a high degree of suspicion could make early diagnosis and appropriate treatment.

  7. Identification of Genomic Species of Acinetobacter Isolated from Burns of ICU Patients.

    Science.gov (United States)

    Shaykh Baygloo, Nima; Bouzari, Majid; Rahimi, Fateh; Abedini, Fereydoon; Yadegari, Sima; Soroushnia, Mohsen; Beigi, Fahimeh

    2015-10-01

    The worldwide emergence of multi-drug resistant (MDR) bacteria in recent years has caused many problems for hospitals and patients, especially intensive care unit patients. Among these clinically important MDR bacteria are Acinetobacter baumannii complex species (A. baumannii, Acinetobacter genomic species 3 and Acinetobacter genomic species 13TU) that cause a wide range of infections. The sequencing and bioinformatics analysis of a part of the Zone 1 of rpoB gene was performed for species identification of Acinetobacter isolates obtained from ICU patients with infected burns hospitalized in a hospital in Isfahan, Iran, over a 9-month period. Antibiotic sensitivity of Acinetobacter isolates was investigated using the disk diffusion method and different classes of antibiotics including amikacin, cefotaxime, ceftriaxone, ciprofloxacin, imipenem and piperacillin. Acinetobacter spp. were isolated from 10 of 80 (12.5%) investigated patients. All of the 10 Acinetobacter isolates were identified as Acinetobacter baumannii and multi-drug resistant according to antibiotic susceptibility tests. Of the Acinetobacter baumannii complex members, only A. baumannii species was identified among the isolates obtained from patients with infected burns in an Isfahan hospital over a 9-month period.

  8. [Epidemiological profile and antibiotic susceptibility of Pseudomonas aeruginosa isolates within the burned patient hospitalized in the intensive care burn unit].

    Science.gov (United States)

    Lamia, Thabet; Bousselmi, K; Saida, Ben Redjeb; Allah, Messadi Amen

    2007-02-01

    Pseudomonas aeruginosa plays a predominant role as an etiological agent involved in serious infections in burned patients. Treatment of these infections is frequently complicated by antibiotic resistance, a problem that is is increasing in recent years. The objective of this study is to analyze epidemiological profile and antibiotic susceptibility of P. aeruginosa isolates within the burned patients admitted in our intensive care department. During a period of 4 years (2000/2003), 828 burn patients were admitted. The survey of antibiotic susceptibility of P. aeruginosa showed high percentages of resistance to the different antibiotics. 60.9% of strains were resistant to piperacillin, 53.4% to ceftazidime, 37.6% to imipenem, 70.6% to cefsulodine, 59.3% to tobramycin, 80% to gentamicin, 62.4% to amikacin and 53.4% to ciprofloxacin. It is necessary to implement urgent measures to prevent the spreading of this multiresistant strain. These measures include: sensible limitation of the use of antimicrobial agent, strict disinfection and hygienic procedures.

  9. A case report of thyroid storm induced by acute sepsis

    Directory of Open Access Journals (Sweden)

    Chiu-Yin Yeh

    2016-03-01

    Full Text Available Thyroid storm is a rare but life-threatening condition, which can be induced by many critical diseases. We reported a 40-year-old woman with thyroid goiter manifesting with acute sepsis-induced hyperthyroidism. She mainly presented with abdominal bloating, diarrhea, lower limbs edema and exertional dyspnea. The lactate was 9.5 mmol/L and procalcitonin was 3.8 ng/mL, suggesting acute sepsis. The thyroid echo showed bilateral thyroid goiter. Relevant data included a thyroid-stimulating hormone level of 0.03 μIU/mL; free tetraiodothyronine, 5.67 ng/dL; thyroid-stimulating hormone receptor antibody, 76.9% (normal range, < 14%; and antimicrosomal antibody titer, 1:102400 (normal range, < 1:100, suggesting toxic goiter with thyroid storm. Piperacillin/tazobactam, methimazole and Lugol's iodine achieved a good outcome. The symptoms of early sepsis and those of thyroid storm could be similar. Therefore, a careful history taking, a thorough physical examination and a high degree of suspicion could make early diagnosis and appropriate treatment.

  10. Are elderly end-stage renal disease patients more susceptible for drug resistant organisms in their sputum?

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    Subash Shantha Ghanshyam

    2010-01-01

    Full Text Available End stage renal disease (ESRD patients are at risk for pneumonia in view of their impaired immune status. Similar empiric antibiotic regimens are used in elderly as well as young ESRD patients with respiratory tract infections. We conducted an observational, cross sectional study between June 2007 and June 2008 in 100 ESRD patients half being > 65 yrs. All patients had positive sputum culture and chest X-ray findings of pneumonia Streptococcus pneumoniae was the commonest in younger while Klebsiella pneumoniae in > 65yrs old patients. Elderly patients had significant resistance to common antibiotics. Ceftrioxone was the most suitable antibiotic in the younger patients while a combination of piperacillin with gentamycin was the best choice in the geriatric age group. In conclusion, organisms cultured from sputum in ESRD patients with pneumo-nia were different in the ESRD patients of more than and less than 65 years of age as well as the drug susceptibility. We should probably redefine the management of pneumonia according to the sensitivities in our local populations to better treat these patients.

  11. Characterisation of successive Acinetobacter baumannii isolates from a deceased haemophagocytic lymphohistiocytosis patient.

    Science.gov (United States)

    Choi, Hyeon Jin; Kil, Min Cheol; Choi, Ji-Young; Kim, Sun Ju; Park, Ki-Sup; Kim, Yae-Jean; Ko, Kwan Soo

    2017-01-01

    In this study, 38 Acinetobacter baumannii isolates successively isolated from blood, skin swabs and tracheal aspirates from a single patient who died from haemophagocytic lymphohistiocytosis were investigated. The isolates were collected between March 2012 and August 2012. A. baumannii genotypes were determined by multilocus sequence typing (MLST) and pulsed-field gel electrophoresis (PFGE). In vitro antimicrobial susceptibility testing was performed and colistin heteroresistance and persistence were evaluated. The structure of AbaR resistance islands was explored, and serum sensitivity was determined. Based on MLST analysis, all 38 A. baumannii isolates showed the same sequence type (ST138). However, PFGE analysis showed that isolates from blood samples belonged to different genotypes depending on the isolation time: whilst blood isolates obtained at the early stages showed restriction patterns similar to those of isolates from other sources, isolates obtained at later stages exhibited a distinct pattern. All isolates were resistant to imipenem, cefepime, ciprofloxacin and piperacillin/tazobactam. Five isolates from tracheal aspirates and one from a skin swab were resistant to polymyxins, and two isolates from skin swabs and one from another source were non-susceptible to tigecycline. All colistin-susceptible isolates showed heteroresistance to colistin, and four were persisters. Isolates from blood showed higher survival rates against human serum than those from other sources. This study shows that the patient was infected with more than one A. baumannii strain. Heteroresistance, persistence or evasion of the innate immune response may explain the failure of antimicrobial treatments in this patient.

  12. Distribution, detection of enterotoxigenic strains and antimicrobial drug susceptibility patterns of bacteroides fragilis group in diarrheic and non-diarrheic feces from brazilian infants.

    Science.gov (United States)

    Ferreira, Débora Paula; Silva, Vânia Lúcia; Guimarães, Danielle Aparecida; Coelho, Cíntia Marques; Zauli, Danielle Alves Gomes; Farias, Luiz Macêdo; Carvalho, Maria Auxiliadora Roque; Diniz, Claudio Galuppo

    2010-07-01

    Despite the importance of gastrointestinal diseases and their global distribution, affecting millions of individuals around the world, the role and antimicrobial susceptibility patterns of anaerobic bacteria such as those in the Bacteroides fragilis group (BFG) are still unclear in young children. This study investigated the occurrence and distribution of species in the BFG and enterotoxigenic strains in the fecal microbiota of children and their antimicrobial susceptibility patterns. Diarrheic (n=110) and non-diarrheic (n=65) fecal samples from children aged 0-5 years old were evaluated. BFG strains were isolated and identified by conventional biochemical, physiological and molecular approaches. Alternatively, bacteria and enterotoxigenic strains were detected directly from feces by molecular biology. Antimicrobial drug susceptibility patterns were determined by the agar dilution method according to the guidelines for isolated bacteria. BFG was detected in 64.3% of the fecal samples (55% diarrheic and 80.4% non-diarrheic), and 4.6% were enterotoxigenic. Antimicrobial resistance was observed against ampicillin, ampicillin/sulbactam, piperacillin/tazobactam, meropenem, ceftriaxone, clindamycin and chloramphenicol. The data show that these bacteria are prevalent in fecal microbiota at higher levels in healthy children. The molecular methodology was more effective in identifying the B. fragilis group when compared to the biochemical and physiological techniques. The observation of high resistance levels stimulates thoughts about the indiscriminate use of antimicrobial drugs in early infancy. Further quantitative studies are needed to gain a better understanding of the role of these bacteria in acute diarrhea in children.

  13. Achromobacter xylosoxidans infection in an adult cystic fibrosis unit in Madrid.

    Science.gov (United States)

    Llorca Otero, Laura; Girón Moreno, Rosa; Buendía Moreno, Buenaventura; Valenzuela, Claudia; Guiu Martínez, Alba; Alarcón Cavero, Teresa

    2016-03-01

    Achromobacter xylosoxidans is an emerging pathogen in cystic fibrosis (CF). Although the rate of colonization by this microorganism is variable, prevalence is increasing in CF units. A microbiological/clinical study was conducted on of adult CF patients harboring A. xylosoxidans. Identification and susceptibility testing were performed using MicroScan (Siemens). Decline in lung function was assessed using the variable, annual percentage loss of FEV1 (forced expiratory volume in 1s). A. xylosoxidans was isolated in 18 (19.8%) of 91 patients over a 14-year period. Mean age was 26.6 years (18-39 years). Nine patients (9.8%) were chronically colonized. Piperacillin/tazobactam and imipenem were the most active antibiotics. Mean annual decline in lung function in chronically colonized patients was 2.49%. A. xylosoxidans is a major pathogen in CF. A decreased lung function was observed among patients who were chronically colonized by A. xylosoxidans. Antibiotic therapy should be started early in order to prevent chronic colonization by this microorganism. Copyright © 2015 Elsevier España, S.L.U. y Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

  14. EVALUATION OF CLINICAL, DIAGNOSTIC AND TREATMENT OUTCOME IN ACUTE EXACERBATION OF BRONCHIECTASIS IN ADULTS

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    Vinod Kolla

    2017-08-01

    Full Text Available BACKGROUND Bronchiectasis is defined as “abnormal and permanent dilatation of one or more bronchi due to weakening or destruction of the muscular and elastic components of the bronchial walls.” HRCT has become the gold standard to diagnose bronchiectasis. Antibiotics and chest physiotherapy are main forms of management. The aim of the study is to study the outcome of treatment in acute exacerbation of bronchiectasis in adults. MATERIALS AND METHODS This study was done prospectively in the Department of Respiratory Medicine in Rajarajeswari Medical College and Hospital from November 1, 2015, to April 30, 2017. Out of 55 cases admitted during the study period, 44 cases (10 females were eligible for participation in the study. 2 cases of Kartagener’s syndrome under follow up in our department for past 3 years were included. Flexible bronchoscopy was done in 31 patients. RESULTS Cough with sputum was the commonest symptom. Breathlessness was documented in 32 patients. Arterial blood gas analysis was abnormal in 29 patients. Haemoptysis in 13 cases. History of antituberculous therapy was present in 34 patients. Digital clubbing was present in 30 patients. Pedal oedema was documented in 14 cases. Associated cultures were positive in 28 cases. CONCLUSION The most frequent form of bronchiectasis is post-tuberculous. Pseudomonas aeruginosa is the most frequently isolated bacteria. The most frequent concomitant disease in bronchiectasis is COPD. Piperacillin/tazobactum is the most effective antibiotic for initial empirical treatment of acute exacerbations of bronchiectasis.

  15. Antibiotic Resistance Pattern in Pseudomonas Aeruginosa Species Isolated at a Tertiary Care Hospital, Ahmadabad

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    Rajat Rakesh M

    2012-04-01

    Full Text Available Introduction: Pseudomonas aeruginosa (Ps.aeruginosa is one of the important bacterial pathogens isolated from various samples. Despite advances in medical and surgical care and introduction of wide variety of antimicrobial agents against having anti-pseudomonal activities, life threatening infection caused by Ps. aeruginosa continues to cause complications in hospital acquired infections. Several different epidemiological studies indicate that antibiotic resistance is increasing in clinical isolates. Material and Method: This study was conducted during April 2009 to april 2010. During this period total of 630 samples were tested, in which 321 samples showed growth of bacteria. Out of 321 samples, 100 clinical isolates of Pseudomonas aeruginosa were isolated. The samples were selected on the basis of their growth on routine MacConkey medium which showed lactose Non-fermenting pale colonies which were oxidase test positive and on Nutrient agar pigmented and non-pigmented colonies with oxidase positive. Antimicrobial susceptibility of all the isolates was performed by the disc-diffusion (Modified-Kirby Baur disc diffusion method according to CLSIs guidelines. Result: In present study, maximum isolates of Ps. aeruginosa isolated from various samples are resistant to tobramycin (68% followed by gentamycin (63%, piperacillin (50%, ciprofloxacin (49% and ceftazidime (43%. Conclusion: To prevent the spread of the resistant bacteria, it is critically important to have strict antibiotic policies while surveillance programmes for multidrug resistant organisms and infection control procedures need to be implemented. [National J of Med Res 2012; 2(2.000: 156-159

  16. The third quarter of 2012 antimicrobial drug use survey analysis in our hospital%我院2012年三季度抗菌药物使用调查分析

    Institute of Scientific and Technical Information of China (English)

    杨作英

    2013-01-01

      目的:探讨我院抗菌药物使用情况,为临床合理用药提供参考。方法:利用计算机软件管理系统检索2012年三季度抗菌药物使用情况。结果:数量、金额排序前两位的分别是“阿莫西林胶囊、注射用哌拉西林钠他唑巴坦钠”、“注射用头孢美唑钠、注射用头孢哌酮钠他唑巴坦钠”。结论:特殊使用级抗菌药物有过度使用的现象,有待干预。%Objective:Explore our hospital antimicrobial use, and provide a reference for the clinical use of drugs.Methods:Computer software management system to retrieve the third quarter of 2012,the use of antimicrobial agents.Results:Quantity, the amount of sort 2 are“amoxicillin capsules”,“Piperacillin Sodium and Tazobactam Sodium for Injection”,“Cefmetazole Sodium for Injection”,“Cefoperzone Sodium and Tazobactam Sodium for Injection”.Conclusions:Excessive use of special use grade antibacterial drugs to be intervention.

  17. Phenotypic Detection of Metallo-Beta-Lactamases in Carbapenem Resistant Acinetobacter baumannii Isolated from Pediatric Patients in Pakistan

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    Muneeza Anwar

    2016-01-01

    Full Text Available Multidrug resistant A. baumannii has emerged as an important and problematic human pathogen as it is the causative agent of several types of infections especially in neonates and immunocompromised patients because they have least capacity to fight against infections. Carbapenems are used as last resort antibiotics for treating these infections but currently resistance against carbapenems due to MBL production is on the rise. The objective of this study was to determine the frequency of antibiotic resistance in A. baumannii and also to compare the efficacy of combined disk test and double disk synergy test for detection of metallo-beta-lactamases. A total of 112 A. baumannii were identified from various clinical samples and antibiotic susceptibility profile was determined by Kirby-Bauer Disk Diffusion method. Out of 112, 66 (58.9% isolates were resistant to both imipenem and meropenem (OXOID. These resistant isolates were tested for carbapenemase production, and 55 (83.3% were carbapenemase producers by Modified Hodge Test. These isolates were further tested for MBL production by combined disk test and double disk synergy test. Out of 66, 49 isolates were positive by both methods, CDT and DDST, and only one isolate was detected as negative (with kappa value = 0.038. All MBL producing strains showed remarkable resistance to cephalosporins, fluoroquinolones, aminoglycosides, and piperacillin/tazobactam (OXOID. The antibiotic resistance was very high in A. baumannii which were isolated from children in Pakistan specially attending a nephrology unit.

  18. Anti-amebic antibody activity in patients, determined with antigens prepared from virulent parasites (indirect hemagglutination assay and enzyme-linked immunosorbent assay).

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    Israeli, Eitan; Talis, Batya; Peled, Nehama; Snier, Rachella; El-On, Joseph

    2007-09-01

    The serology of amebiasis is affected by low sensitivity and specificity. To evaluate the advantage of the indirect hemagglutination assay and enzyme-linked immunosorbent assay in the diagnosis of amebiasis, using Entamoeba histolytica soluble antigen (macerated amebic antigens) prepared from four different virulent isolates, continuously cultivated in the presence of the original enteric bacteria. Using IHA and ELISA with MAA antigen we examined 147 sera samples from patients with gastrointestinal symptoms, and 11 sera from amebiasis cases (confirmed by microscopy and copro-antigen ELISA). Of 104 of the 147 (70.7%) symptomatic cases that were amebiasis positive by IHA, 81 (55.1%) were positive by MAA-ELISA. In addition, of 11 amebiasis cases confirmed by microscopy and copro-antigen ELISA, 7 (64%) were amebiasis positive by both tests. Four species of bacteria were isolated from the ameba cultures: Escherichia coli, Morganella morganii, Proteus mirabilis, and Streptococcus lactis. Elimination of the bacteria from the cultures by an antibiotics cocktail containing gentamicin, imipenem, piperacillin-tazobactam and vancomycin was the preferred method. Absorption of patients' sera to bacterial antigen prior to serological analysis had only a marginal effect. These results indicate a correlation of 61% between the ELISA developed in this study and the IHA tests in the diagnosis of amebiasis.

  19. “UROPATHOGENS”: PREVALENCE AND ANTIBIOGRAM OF GRAM NEGATIVE BACILLI WITH SPECIAL REFERENCE TO EXTEN DED SPECTRUM BETA LACTAMASE PRODUCTION

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    Vandana

    2012-12-01

    Full Text Available ABSTRACT: This study was performed on culture and sensitivit y of 6,951 urine samples, received in the Department of Microbiology, Christia n Medical College & Hospital, Ludhiana from out patients and in patients having urinary tra ct infection (UTI .A total of 2,276 samples were found out to be culture positive, out of which 1,727 samples yielded gram negative organisms. Various isolates included 1,237 Escheric hia coli (E. coli, 262 Klebsiella pneumoniae,47 Acinetobacter lwoffi, 39 Proteus mirab ilis,39 Enterobacter aerogenes and 03 Pseudomonas aeruginosa. Extended spectrum beta lacta mase (ESBL production was studied in multidrug resistant E. coli. And Klebsiella pneumoni ae, out of which 28.29% E.coli and 30.53% Klebsiella pneumoniae yielded positive results. Our r esults suggest that the physician should be aware of high prevalence of ESBL producing E.coli and Klebsiella pneumonia which are the two common uropathogens, and should plan their therapy re gime accordingly. However, Acinetobacter species were mainly associate d with nosocomial UTI whereas Enterobacter species were isolated mostly from out pa tients. Various uropathogens causing community acquired as well as nosocomial UTI showed poor response to cephalexin whereas resistant strains from both types of UTI exhibited g ood susceptibility to piperacillin/tazobactum combination.

  20. Monte Carlo simulations: maximizing antibiotic pharmacokinetic data to optimize clinical practice for critically ill patients.

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    Roberts, Jason A; Kirkpatrick, Carl M J; Lipman, Jeffrey

    2011-02-01

    Infections in critically ill patients continue to result in unacceptably high morbidity and mortality. Although few data exist for correlating antibiotic exposure with outcome, antibiotic dosing is likely to be highly important for maximizing resolution of infection in many patients. The practical and financial difficulties of performing pharmacokinetic (PK) studies in critically ill patients mean that analyses to maximize data such as Monte Carlo simulation (MCS) are highly valuable. MCS uses computer software to perform virtual clinical trials. The building blocks for MCS are: firstly, a robust population PK model from the patient population of interest; secondly, descriptors of the effect of covariates that influence the PK parameters; thirdly, description of the susceptibility of bacteria to the antibiotic and finally a PK/pharmacodynamic (PD) target associated with antibiotic efficacy. Probability of target attainment (PTA) outputs can then be generated that describe the proportion of patients that will achieve a pre-specified PD target for an MIC distribution. Such analyses can then inform dosing requirements, which can be used to have a high likelihood of achieving PK/PD targets for organisms with different MICs. In this issue of JAC, Zelenitsky et al. provide a very useful example of MCS for interpreting the optimal methods for dosing meropenem, piperacillin/tazobactam, cefepime and ceftobiprole in critically ill patients.

  1. Antibiotic resistance patterns of more than 120 000 clinical Escherichia coli isolates in Southeast Austria, 1998-2013.

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    Badura, A; Feierl, G; Pregartner, G; Krause, R; Grisold, A J

    2015-06-01

    Antibiotic resistance patterns of more than 120 000 clinical Escherichia coli isolates were retrospectively analysed. Isolates originated from both hospitalized patients and outpatients from the region of southeast Austria from 1998 to 2013. Except for amoxicillin/clavulanic acid, nitrofurantoin and piperacillin/tazobactam, all of the antibiotics analysed showed increasing proportions of resistant isolates over time, which were most prominent for ampicillin (from 25.4% in 1998 to 40% in 2013), cefotaxime (0.1% to 6.7%), ceftazidime (0.3% to 14.2%), ciprofloxacin (4.3% to 16.7%) and trimethoprim/sulfamethoxazole (14.6% to 24.8%). There was a marked increase in extended-spectrum β-lactamase-positive isolates (0.1% to 6.3%) starting in 2005, with male patients and hospital-related patients showing a higher increase than female patients and outpatients. Proportions of resistant isolates for most antibiotics were generally higher for male patients and hospital-related patients. Amikacin, nitrofurantoin and trimethoprim/sulfamethoxazole showed a marked increase in resistance proportions among male subjects aged 10 to 19 years which were absent for female subjects, indicating a strong modulation potential of host characteristics.

  2. March 2015 critical care case of the month: it's not always sepsis

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    Morgan D

    2015-03-01

    Full Text Available No abstract available. Article truncated at 150 words. History of Present Illness: A 57-year-old man with multiple co-morbidities including diabetes mellitus presented with wet gangrene of the right foot and hypotension. He had diabetic ketoacidosis and acute kidney injury. He was admitted to the medical intensive care unit, given intravenous fluids and treated with insulin therapy, piperacillin/tazobactam and vancomycin. Initial blood cultures grew Methicillin-resistant Staphylococcus aureus (MRSA. The podiatry service performed a right transmetatarsal amputation. Subsequently, he did well and was transferred to a medical floor for further care. Three weeks later, following resolution of the initial sepsis, he developed persistently high fevers with hemodynamic instability despite continued antibiotic therapy. He was transferred back to the MICU for presumed sepsis.Past Medical History, Social History and Family History: The past medical history was significant for diabetes, hypertension, COPD, coronary artery disease and hepatitis C. He did not smoke nor drink alcohol. Family history was non-contributory. Physical Examination: On ...

  3. [PCR-RAPD typing of carbapenem-resistant Pseudomonas aeruginosa strains].

    Science.gov (United States)

    Bogiel, Tomasz; Gospodarek, Eugenia

    2010-01-01

    P. aeruginosa rods are opportunistic pathogens responsible generally for nosocomial infections. Resistance to carbapenems, observed among them, is a serious threat due to ability to be transmitted between bacterial species. The aim of our study was to evaluate the usefulness of PCR-RAPD technique in typing of 16 carbapenem-resistant P. aeruginosa strains isolated in 2007 from different patients of University HospitalNo. 1 of dr A. Jurasz Collegium Medicum of L. Rydygier in Bydgoszcz Nicolaus Copernicus University in Toruń. Study shows increasing frequency of isolation that type of strains when compared to 2006. Percentage of carbapenem-resistant isolates raised from 12,4% in 2006 to 22.9% in 2007. The majority of examined strains were obtained from patients of the Intensive Care Units (25.0%) and were isolated from bronchoalveolar lavage (25.0%), urine (25.0%) and wound swabs (18.8%) samples. Examined P. aeruginosa strains demonstrated resistance to doripenem (81.3%) and piperacillin (75.0%) and susceptibility to colistin (100.0%), amikacin (81.3%), netilmicin and norfloxacin (75.0% each). Using PCR-RAPD amplification with 208 and 272 primers, 14 and 16 DNA patterns were obtained, respectively. Usefulness of PCR-RAPD in carbapenem-resistant P. aeruginosa strains typing was proved in case of strains presenting similar and/or different antimicrobials susceptibility patterns.

  4. Escherichia coli Isolated from Urinary Tract Infections of Lebanese Patients between 2000 and 2009: Epidemiology and Profiles of Resistance

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    Ziad Daoud

    2011-01-01

    Full Text Available The purpose of this study was to investigate the bacterial etiology of urinary tract infections in one of the busiest hospitals of Lebanon and to examine the epidemiologic and microbiologic properties of Escherichia coli isolated from urinary tract infections of Lebanese patients over a 10-year period. Methods. This retrospective study analyzed the data generated between 2000 and 2009 (10,013 Gram-positive and Gram-negative bacteria. Bacterial identification was based on standard culture and biochemical characteristics of isolates. Antimicrobial susceptibility was tested by the disk diffusion method, and ESBL production was detected by synergy with third-generation cephalosporins and amoxiclav. Results. E. coli was the most frequent isolate throughout the ten years (60.64% of the total isolates. It was followed by Klebsiella pneumoniae and Proteus sp., Pseudomonas aeruginosa, Enterococcus sp., and Streptococcus agalactiae. E. coli occurred more frequently in women (69.8% than in men (61.4%. The lowest percentage of susceptibility of E. coli was manifested against piperacillin and ampicillin. An increase in the production of ESBL was observed (2.3% in 2000 to 16.8% in 2009. Conclusions. The etiology of urinary tract infections and their susceptibility profiles are important to be evaluated in countries like Lebanon where a severe misuse of antibiotics at all levels is observed.

  5. Evaluation of antimicrobial resistance pattern of nosocomial and community bacterial pathogens at a teaching hospital in Tehran,Iran.

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    Zamani, Samin; Nasiri, Mohammad Javad; Khoshgnab, Behshad Noorazar; Ashrafi, Abbas; Abdollahi, Alireza

    2014-01-01

    Antimicrobial resistance in pathogens not only in hospitals but also in the community has become an important public health problem. The aim of this study was to determine the antimicrobial resistance patterns of predominant pathogens from hospitalized and outpatients in a university hospital in Tehran, Iran. A total of 820 samples of common Gram-negative and Gram-positive bacteria were collected from a major referral and teaching hospital affiliated to Tehran University of Medical Sciences in Iran during April 2010 to February 2011. The pattern of antibiotic resistance was determined by disk diffusion test as recommended by the Clinical Laboratory and Standards Institute (CLSI). Gram-negative bacilli were the most isolated pathogens. Acinetobacter spp. and Pseudomonas aeruginosa (P. aeruginosa) was the most antibiotic-resistant pathogens. Imipenem and piperacillin/tazobactam were the most active antimicrobials against gram-negative bacilli whereas vancomycin was the antimicrobial agent most consistently active against the Gram-positive cocci. Community-acquired organisms were more susceptible to antimicrobial drugs tested than nosocomial isolates. The rates of antibiotic resistance among isolated pathogens in this study were approximately similar to other studies. However, high rates of antibiotic resistance among Acinetobacter spp and P. aeruginosa, the most isolated pathogens, indicating that antibiotic policy is urgently needed to prevent the resistance development ago.

  6. Elizabethkingia meningosepticum in a Patient with Six-Year Bilateral Perma-Catheters

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    Konstantin Boroda

    2014-01-01

    Full Text Available Elizabethkingia meningosepticum (EM is a saprophyte which is ubiquitous in nature, but not normally present in the human flora. Instances of infection are rare in the USA, but EM may be an emerging pathogen among immune-compromised patients. EM can cause a variety of infections, but nosocomial pneumonia and bacteremia have been the most commonly reported among immune-compromised adults. EM has proven difficult to treat with a mortality rate of 23%–41% in adult bacteremia. This is likely due to its resistance to commonly used empiric antibiotics for Gram-negative infections. A review of the literature suggests that there has been a shift EM’s susceptibility profile over time along with a great variability in antibiotic susceptibilities reported. This signifies the importance of close monitoring of these changes. In this report we present a case of a 64-year-old male with end stage renal disease and bilateral subclavian perma-catheters, who was admitted with systemic inflammatory response syndrome. While initial peripheral blood cultures were negative, cultures later drawn from his perma-catheters revealed Corneybacterium species and EM. The patient was initially treated with empiric vancomycin and piperacillin-tazobactam. After antibiotics susceptibilities became available, he was treated with levofloxacin and ceftazidime. The patient improved, was culture negative, and later had perma-catheter removal.

  7. [Acute Pyelonephritis and Candidemia Due to Candida lusitaniae: A Case Report].

    Science.gov (United States)

    Tsuboi, Motoyuki; Uno, Shunsuke; Hase, Ryota; Yano, Yudai; Sando, Eiichiro; Otsuka, Yoshihito; Hosokawa, Naoto

    2016-03-01

    Although candiduria is becoming increasingly common among hospitalized patients, Candida lusitaniae is a rare pathogen that account for less than 1% of Candida species isolated from urine. Ascending pyelonephritis and candidemia due to Candida species are uncommon complications. We report herein on a case of acute pyelonephritis and candidemia due to C. lusitaniae. A 66-year-old man presented with a high fever during hospitalization at our hospital following septic shock due to ischial osteomyelitis treated with tazobactam/piperacillin for 29 days. We suspected acute pyelonephritis, and urinary Gram staining showed only yeasts and leucocytes. The next day, blood culture and urine culture tested positive and showed yeast-like fungi. We diagnosed acute pyelonephritis and candidemia due to Candida species and started treatment with fluconazole. C. lusitaniae was identified on the hospital day 34 and treated with fluconazole for 14 days. Candida albicans was the most prevalent species isolated from the urinary tract, however non-albicans Candida species have emerged and are now dominant because of the advent and increasing use of fluconazole. C. lusitaniae is a rare but important pathogen, that is generally susceptible to fluconazole and resistant to amphotericin B. It is necessary to choose an appropriately effective antifungal drug based on identification of the fungal species.

  8. Resistance among Gram-negative ESKAPE pathogens isolated from hospitalized patients with intra-abdominal and urinary tract infections in Latin American countries: SMART 2013-2015

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    James A. Karlowsky

    Full Text Available ABSTRACT Gram-negative ESKAPE pathogens (Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species are important etiologic agents of nosocomial infection that are frequently resistant to broad-spectrum antimicrobial agents. Gram-negative ESKAPE pathogens were collected from hospitalized patients in 11 Latin American countries from 2013 to 2015 as part of the Study for Monitoring Antimicrobial Resistance Trends (SMART global surveillance program. In total, 2113 isolates from intra-abdominal infections (IAI and 970 isolates from urinary tract infections (UTI were tested against antimicrobial agents using standardized CLSI broth microdilution methodology. Of the agents tested, amikacin demonstrated the highest rates of susceptibility (% for K. pneumoniae (92.2, 92.3, Enterobacter spp. (97.5, 92.1, and P. aeruginosa (85.3, 75.2 isolates from both IAI and UTI, respectively. Ertapenem (68.5, 62.6 and imipenem (79.2, 75.9 showed substantially higher rates of susceptibility (% than other β-lactams, including piperacillin-tazobactam (35.9, 37.4 against ESBL-positive isolates of K. pneumoniae from IAI and UTI, respectively. Rates of susceptibility to all agents tested against A. baumannii were ≤30.9%. Gram-negative ESKAPE pathogens isolated from Latin America demonstrated compromised in vitro susceptibility to commonly prescribed broad-spectrum, parenteral antimicrobial agents. Continued surveillance is warranted. New antimicrobial agents with potent activity against Gram-negative ESKAPE pathogens are urgently needed.

  9. Patterns of antimicrobial resistance in a surgical intensive care unit of a university hospital in Turkey

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    Balci Iclal

    2006-10-01

    Full Text Available Abstract Background Several studies have reported higher rates of antimicrobial resistance among isolates from intensive care units than among isolates from general patient-care areas. The aims of this study were to review the pathogens associated with nosocomial infections in a surgical intensive care unit of a university hospital in Turkey and to summarize rates of antimicrobial resistance in the most common pathogens. The survey was conducted over a period of twelve months in a tertiary-care teaching hospital located in the south-eastern part of Turkey, Gaziantep. A total of 871 clinical specimens from 615 adult patients were collected. From 871 clinical specimens 771 bacterial and fungal isolates were identified. Results Most commonly isolated microorganisms were: Pseudomonas aeruginosa (20.3%, Candida species (15% and Staphylococcus aureus (12.9%. Among the Gram-negative microorganisms P. aeruginosa were mostly resistant to third-generation cephalosporins (71.3–98.1%, while Acinetobacter baumannii were resistant in all cases to piperacillin, ceftazidime and ceftriaxone. Isolates of S. aureus were mostly resistant to penicillin, ampicillin, and methicillin (82–95%, whereas coagulase-negative staphylococci were 98.6% resistant to methicillin and in all cases resistant to ampicillin and tetracycline. Conclusion In order to reduce the emergence and spread of antimicrobial-resistant pathogens in ICUs, monitoring and optimization of antimicrobial use in hospitals are strictly recommended. Therefore local resistance surveillance programs are of most value in developing appropriate therapeutic guidelines for specific infections and patient types.

  10. Distribution, Detection of Enterotoxigenic Strains and Antimicrobial Drug Susceptibility Patterns of Bacteroides Fragilis Group in Diarrheic and Non-Diarrheic Feces from Brazilian Infants

    Science.gov (United States)

    Ferreira, Débora Paula; Silva, Vânia Lúcia; Guimarães, Danielle Aparecida; Coelho, Cíntia Marques; Zauli, Danielle Alves Gomes; Farias, Luiz Macêdo; Carvalho, Maria Auxiliadora Roque; Diniz, Claudio Galuppo

    2010-01-01

    Despite the importance of gastrointestinal diseases and their global distribution, affecting millions of individuals around the world, the role and antimicrobial susceptibility patterns of anaerobic bacteria such as those in the Bacteroides fragilis group (BFG) are still unclear in young children. This study investigated the occurrence and distribution of species in the BFG and enterotoxigenic strains in the fecal microbiota of children and their antimicrobial susceptibility patterns. Diarrheic (n=110) and non-diarrheic (n=65) fecal samples from children aged 0–5 years old were evaluated. BFG strains were isolated and identified by conventional biochemical, physiological and molecular approaches. Alternatively, bacteria and enterotoxigenic strains were detected directly from feces by molecular biology. Antimicrobial drug susceptibility patterns were determined by the agar dilution method according to the guidelines for isolated bacteria. BFG was detected in 64.3% of the fecal samples (55% diarrheic and 80.4% non-diarrheic), and 4.6% were enterotoxigenic. Antimicrobial resistance was observed against ampicillin, ampicillin/sulbactam, piperacillin/tazobactam, meropenem, ceftriaxone, clindamycin and chloramphenicol. The data show that these bacteria are prevalent in fecal microbiota at higher levels in healthy children. The molecular methodology was more effective in identifying the B. fragilis group when compared to the biochemical and physiological techniques. The observation of high resistance levels stimulates thoughts about the indiscriminate use of antimicrobial drugs in early infancy. Further quantitative studies are needed to gain a better understanding of the role of these bacteria in acute diarrhea in children. PMID:24031535

  11. A Rare Case of Pneumopericardium in the Setting of Tuberculous Constrictive Pericarditis

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    Lauro L. Abrahan IV

    2017-01-01

    Full Text Available A 28-year-old Filipino male was admitted due to high-grade fevers and dyspnea on a background of chronic cough and weight loss. Due to clinical and echocardiographic signs of cardiac tamponade, emergency pericardiocentesis was performed on his first hospital day. Five days after, chest radiographs showed new pockets of radiolucency within the cardiac shadow, indicative of pneumopericardium. On repeat echo, air microbubbles admixed with loculated effusion were visualized in the anterior pericardial space. Constrictive physiology was also supported by a thickened pericardium, septal bounce, exaggerated respiratory variation in AV valve inflow, and IVC plethora. A chest CT scan confirmed the presence of an air-fluid level within the pericardial sac. The patient was started on a quadruple antituberculosis regimen and IV piperacillin-tazobactam to cover for superimposed acute bacterial pericarditis. Pericardiectomy was performed as definitive management, with stripped pericardium measuring 5–7 mm thick and caseous material extracted from the pericardial sac. Histopathology was consistent with tuberculosis. This report highlights pneumopericardium as a rare complication of pericardiocentesis. We focused on the utility of echocardiography for diagnosing and monitoring this condition on a background of tuberculous constrictive pericarditis, ultimately convincing us that pericardiectomy was necessary, instead of the usual conservative measures for pneumopericardium.

  12. Trace incorporation of heavy water reveals slow and heterogeneous pathogen growth rates in cystic fibrosis sputum

    Science.gov (United States)

    Kopf, Sebastian H.; Sessions, Alex L.; Cowley, Elise S.; Reyes, Carmen; Van Sambeek, Lindsey; Hu, Yang; Orphan, Victoria J.; Kato, Roberta; Newman, Dianne K.

    2016-01-01

    Effective treatment for chronic infections is undermined by a significant gap in understanding of the physiological state of pathogens at the site of infection. Chronic pulmonary infections are responsible for the morbidity and mortality of millions of immunocompromised individuals worldwide, yet drugs that are successful in laboratory culture are far less effective against pathogen populations persisting in vivo. Laboratory models, upon which preclinical development of new drugs is based, can only replicate host conditions when we understand the metabolic state of the pathogens and the degree of heterogeneity within the population. In this study, we measured the anabolic activity of the pathogen Staphylococcus aureus directly in the sputum of pediatric patients with cystic fibrosis (CF), by combining the high sensitivity of isotope ratio mass spectrometry with a heavy water labeling approach to capture the full range of in situ growth rates. Our results reveal S. aureus generation times with a median of 2.1 d, with extensive growth rate heterogeneity at the single-cell level. These growth rates are far below the detection limit of previous estimates of CF pathogen growth rates, and the rates are slowest in acutely sick patients undergoing pulmonary exacerbations; nevertheless, they are accessible to experimental replication within laboratory models. Treatment regimens that include specific antibiotics (vancomycin, piperacillin/tazobactam, tobramycin) further appear to correlate with slow growth of S. aureus on average, but follow-up longitudinal studies must be performed to determine whether this effect holds for individual patients.

  13. Bacteriology and changes in antibiotic susceptibility in adults with community-acquired perforated appendicitis.

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    Hong Gil Jeon

    Full Text Available This study evaluated bacterial etiology and antibiotic susceptibility in patients diagnosed with community-acquired perforated appendicitis over a 12-year-period. We retrospectively reviewed records of adult patients diagnosed with perforated appendicitis at an 800-bed teaching hospital between January 2000 and December 2011. In total, 415 culture-positive perforated appendicitis cases were analyzed. Escherichia coli was the most common pathogen (277/415, 66.7%, followed by Streptococcus species (61/415, 14.7%. The susceptibility of E. coli to ampicillin, piperacillin/tazobactam, ceftriaxone, cefepime, amikacin, gentamicin, and imipenem was 35.1%, 97.1%, 97.0%, 98.2%, 98.9%, 81.8%, and 100%, respectively. The overall susceptibility of E. coli to quinolones (ciprofloxacin or levofloxacin was 78.7%. During the study period, univariate logistic regression analysis showed a significant decrease in E. coli susceptibility to quinolones (OR = 0.91, 95% CI 0.84-0.99, P = 0.040. We therefore do not recommend quinolones as empirical therapy for community-acquired perforated appendicitis.

  14. Determination of the prevalence of extended spectrumβ-lactamase in clinical samples collected from Dehradun City Hospital

    Institute of Scientific and Technical Information of China (English)

    Narayan Sharma; Ripan Mujumdar; Rajeev Kumar Gautam

    2016-01-01

    Objective:To detect extended spectrumβ-lactamase (ESBL) and determine its prevalence in various clinical samples collected from Dehradun City Hospital. Methods:The samples were first cultured in MacConkey’s agar plates by streak plate method, then identified by Gram staining and biochemical tests. The isolated bacterial strains were then tested for antibiotic susceptibility by Kirby-Bauer method. TheESBL detection is then carried out by double disc diffusion method. Results: Off the 56 samples cultured, 21 strains were identified which were sixEscherichia coli(E. coli), sixKlebsiella, fourProteus, fourPseudomonas aeruginosa (P. aeruginosa) and only oneAcinetobacter. Eight out of 21 (38.1%) strains including three ofE. coli, three ofKlebsiella and two ofP. aeruginosa, were found to be resistance to all five antibiotics (piperacillin, amikacin, ampicillin, gentamicin, and ciprofloxacin). Initial screening using four antibiotics (cefotaxime, ceftazidime, aztreonam and ceftriaxone) and the final confirmatory test using ceftazidime/clavulanic acid and ceftazidime alone showed that 19.05% of all strains isolated wereESBL producers. Individually, 16.67%E. coli, 16.67%Klebsiella pneumoniae, 25%P. aeruginosa and 100%Acinetobacter were found to beESBL producers. Conclusions:Antibiotic resistance byESBL has become a major risk factor worldwide, therefore routine checkup and accordingly prescription are suggested.

  15. Flare-Up Diverticulitis in the Terminal Ileum in Short Interval after Conservative Therapy: Report of a Case

    Science.gov (United States)

    Nakatani, Kensuke; Okada, Shinichiro; Matsumoto, Risa; Komuro, Hiroyasu; Iida, Maki; Tsujimoto, Shiro; Suganuma, Toshiyuki

    2016-01-01

    Diverticulitis in the terminal ileum is uncommon. Past reports suggested that conservative therapy may be feasible to treat terminal ileum diverticulitis without perforation; however, there is no consensus on the therapeutic strategy for small bowel diverticulitis. We present a 37-year-old man who was referred to our hospital for sudden onset of abdominal pain and nausea. He was diagnosed with diverticulitis in the terminal ileum by computed tomography (CT). Tazobactam/piperacillin hydrate (18 g/day) was administered. The antibiotic treatment was maintained for 7 days, and the symptoms disappeared after the treatment. Thirty-eight days after antibiotic therapy, he noticed severe abdominal pain again. He was diagnosed with diverticulitis in terminal ileum which was flare-up of inflammation. He was given antibiotic therapy again. Nine days after antibiotic therapy, laparoscopy assisted right hemicolectomy and resection of 20 cm of terminal ileum were performed. Histopathology report confirmed multiple ileal diverticulitis. He was discharged from our hospital 12 days after the surgery. Colonoscopy was performed two months after the surgery and it revealed no finding suggesting inflammatory bowel disease. Surgical treatment should be taken into account as a potential treatment option to manage the diverticulitis in the terminal ileum even though it is not perforated. PMID:28097035

  16. Resistance trends among clinical isolates in China reported from CHINET surveillance of bacterial resistance, 2005-2014.

    Science.gov (United States)

    Hu, F-P; Guo, Y; Zhu, D-M; Wang, F; Jiang, X-F; Xu, Y-C; Zhang, X-J; Zhang, C-X; Ji, P; Xie, Y; Kang, M; Wang, C-Q; Wang, A-M; Xu, Y-H; Shen, J-L; Sun, Z-Y; Chen, Z-J; Ni, Y-X; Sun, J-Y; Chu, Y-Z; Tian, S-F; Hu, Z-D; Li, J; Yu, Y-S; Lin, J; Shan, B; Du, Y; Han, Y; Guo, S; Wei, L-H; Wu, L; Zhang, H; Kong, J; Hu, Y-J; Ai, X-M; Zhuo, C; Su, D-H; Yang, Q; Jia, B; Huang, W

    2016-03-01

    With the aim of gathering temporal trends on bacterial epidemiology and resistance from multiple laboratories in China, the CHINET surveillance system was organized in 2005. Antimicrobial susceptibility testing was carried out according to a unified protocol using the Kirby-Bauer method or automated systems. Results were analyzed according to Clinical and Laboratory Standards Institute (CLSI) 2014 definitions. Between 2005 and 2014, the number of bacterial isolates ranged between 22,774 and 84,572 annually. Rates of extended-spectrum β-lactamase production among Escherichia coli isolates were stable, between 51.7 and 55.8%. Resistance of E. coli and Klebsiella pneumoniae to amikacin, ciprofloxacin, piperacillin/tazobactam and cefoperazone/sulbactam decreased with time. Carbapenem resistance among K. pneumoniae isolates increased from 2.4 to 13.4%. Resistance of Pseudomonas aeruginosa strains against all of antimicrobial agents tested including imipenem and meropenem decreased with time. On the contrary, resistance of Acinetobacter baumannii strains to carbapenems increased from 31 to 66.7%. A marked decrease of methicillin resistance from 69% in 2005 to 44.6% in 2014 was observed for Staphylococcus aureus. Carbapenem resistance rates in K. pneumoniae and A. baumannii in China are high. Our results indicate the importance of bacterial surveillance studies.

  17. Incidence of multidrug-resistant pseudomonas spp. in ICU patients with special reference to ESBL, AMPC, MBL and biofilm production

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    Richa Gupta

    2016-01-01

    Full Text Available Background: Multidrug-resistant (MDR Pseudomonas spp. have been reported to be the important cause of ICU infections. The appearance of ESBL, AmpC and MBL genes and their spread among bacterial pathogens is a matter of great concern. Biofilm production also attributes to antimicrobial resistance due to close cell to cell contact that permits bacteria to more effectively transfer plasmids to one another. This study aimed at determining the incidence of ESBL, AmpC, MBL and biofilm producing Pseudomonas spp. in ICU patients. Material and Methods: The clinical specimens were collected aseptically from 150 ICU patients from February 2012 to October 2013. Identification and antimicrobial susceptibility was performed according to Clinical and Laboratory Standards Institute (CLSI guidelines. ESBLs and AmpC were detected phenotypically and genotypically. MBL was detected by modified Hodge and imipenem-EDTA double-disk synergy test. Results: Pseudomonas spp. 35(28% were the most prevalent pathogen in ICU infections. Multidrug resistance and biofilm production was observed in 80.1% and 60.4% isolates, respectively. Prevalence of ESBL, AmpC and MBL was 22.9%, 42.8% and 14.4%, respectively. The average hospital stay was 25 days and was associated with 20% mortality. Conclusions: A regular surveillance is required to detect ESBL, AmpC and MBL producers especially in ICU patients. Carbapenems should be judiciously used to prevent their spread. The effective antibiotics, such as fluoroquinolones and piperacillin-tazobactum should be used after sensitivity testing.

  18. Elizabethkingia meningoseptica : An emerging pathogen causing meningitis in a hospitalized adult trauma patient

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    V Tak

    2013-01-01

    Full Text Available A 23-year-old male patient who was a follow-up case of neurosurgery presented to our emergency department with a history of high-grade fever and clinical features of meningitis for 1 week. The cerebrospinal fluid (CSF was sent to our laboratory for culture. The culture demonstrated growth of 1-2 mm in diameter light yellow coloured colonies of Gram-negative bacilli on chocolate and blood agar. There was no growth on MacConkey agar. The bacterium was multidrug resistant. Based upon the growth characteristics, bio-chemical reactions, drug susceptibility pattern and identification by Vitek 2 system the isolate was identified as Elizabethkingia meningoseptica. Patient was treated with injection piperacillin-tazobactam, injection vancomycin and cotrimoxazole tablets for 21 days along with intrathecal injection of tigecycline and finally, patient improved clinically and the CSF cultures became sterile. The presence in hospital environment along with multidrug resistance makes E. meningoseptica a successful emerging nosocomial pathogen.

  19. Postoperative bacteriuria, pyuria and urinary tract infection in patients with an orthotopic sigmoid colon neobladder replacement.

    Science.gov (United States)

    Shigemura, Katsumi; Tanaka, Kazushi; Arakawa, Soichi; Miyake, Hideaki; Fujisawa, Masato

    2014-02-01

    The purpose of this study is to investigate the prevalence of postoperative bacteriuria, pyuria and urine culture in patients with an orthotopic sigmoid colon neobladder replacement. Urine samples for bacteriuria, pyuria and urine culture, if necessary, were collected at 1, 3, 6, 9 and 12 months after surgery and the presence of blood culture and antibiotic-resistant strains, and their treatments on positive urine culture cases were investigated. Of 209 for bacteriuria and 207 for pyuria urine samples with evaluable data, 95 (45.5%) were positive for bacteriuria and 76 (36.7%) had pyuria (10 or more white blood cells per high-power field). Totally, 30 bacteria were isolated from urine culture of urinary tract infection (UTI) and Klebisiella pneumoniae, Escherichia coli, Staphylococcos aureus and Enterococcus spp. strains were representatively isolated. The incidence of pyuria significantly decreased over time (P=0.041) but that of bacteriuria did not (P=0.107). In them, there were six bacteria (20.7%) with antibiotic-resistant strains. The antibiotics used for their treatments representatively were levofloxacin in five cases, tazobactam/piperacillin in three cases and sulfamethoxazole/trimethoprim and cefepime, meropenem in two cases, respectively. In conclusion, these findings suggest that physicians taking care of sigmoid colon neobladder patients need to be aware of these high ratios of bacteriuria, pyuria and UTI, including bacteremia.

  20. Synthesis and biological activity of some new 1-benzyl and 1-benzoyl-3-heterocyclic indole derivatives.

    Science.gov (United States)

    El-Sawy, Eslam Reda; Bassyouni, Fatma A; Abu-Bakr, Sherifa H; Rady, Hanaa M; Abdlla, Mohamed M

    2010-03-01

    Starting from 1-benzyl- (2a) and 1-benzoyl-3-bromoacetyl indoles (2b) new heterocyclic, 2-thioxoimidazolidine (4a, b), imidazolidine-2,4-dione (5a, b), pyrano(2,3-d)imida-zole (8a, b and 9a, b), 2-substituted quinoxaline (11a, b-17a, b) and triazolo(4,3-a)quinoxaline derivatives (18a, b and 19a, b) were synthesized and evaluated for their antimicrobial and anticancer activities. Antimicrobial activity screening performed with concentrations of 0.88, 0.44 and 0.22 microg mm(-2) showed that 3-(1-substituted indol-3-yl)quinoxalin-2(1H)ones (11a, b) and 2-(4-methyl piperazin-1-yl)-3-(1-substituted indol-3-yl) quinoxalines (15a, b) were the most active of all the tested compounds towards P. aeruginosa, B. cereus and S. aureus compared to the reference drugs cefotaxime and piperacillin, while 2-chloro-3-(1-substituted indol-3-yl)quinoxalines (12a, b) were the most active against C. albicans compared to the reference drug nystatin. On the other hand, 2-chloro-3-(1-benzyl indol-3-yl) quinoxaline 12a display potent efficacy against ovarian cancer xenografts in nude mice with tumor growth suppression of 100.0 +/- 0.3 %.

  1. Successful re-implantation of implantable collamer lens after management of post-ICL methicillin-resistant Staphylococcus epidermidis endophthalmitis.

    Science.gov (United States)

    Kaur, Manpreet; Titiyal, Jeewan S; Sharma, Namrata; Chawla, Rohan

    2015-11-24

    A 29-year-old man presented with acute onset pain, redness and diminution of vision in the right eye 5 days after implantation of an implantable collamer lens (ICL). A diagnosis of postoperative endophthalmitis was made based on examination and ultrasonography. A vitreous tap was taken and intravitreal antibiotics (vancomycin 1 mg/0.1 ml+piperacillin-tazobactam 225 µg/0.1 mL) were administered. The vitreous culture revealed presence of methicillin-resistant Staphylococcus epidermidis. There was minimal improvement after 48 h; hence the ICL was explanted and repeat injection of intravitreal antibiotics administered. Following this, the endophthalmitis resolved and the patient achieved a corrected distance visual acuity of 20/25 4 weeks later. A repeat implantation of ICL was performed 9 months after the first surgery, following which the patient regained uncorrected distance visual acuity of 20/20. To our knowledge, this is the first case in which an ICL was re-implanted after successful resolution of endophthalmitis.

  2. 洋葱伯克霍尔德菌感染家兔抗感染疗效与体外药物敏感性的比较%Comparison of the anti-infective drug sensitivity in rabbit model of Burkholderia cepacia infection and the effect of antimicrobial sensitivity monitoring in vitro

    Institute of Scientific and Technical Information of China (English)

    吕火祥; 胡庆丰; 沈蓓琼; 杨广宇; 俞赛

    2011-01-01

    目的 使用无CLSI完整解释标准的药物,哌拉西林/他唑巴坦、替卡西林/棒酸、头孢吡肟治疗洋葱伯克霍尔德菌感染的家兔模型,观察比较何种体外药物敏感试验更能准确反应临床疗效.方法 57株临床分离的洋葱伯克霍尔德菌,感染57只家兔腹腔.将感染家兔分成3组(A、B、C组),每组19只;分别在48、72、96、120和144 h注射药物:A组每只家兔注射1 mL浓度为2 g/mL哌拉西林/他唑巴坦;B组每只家兔注射1 mL浓度为0.1 g/mL头孢吡肟;C组每只家兔注射1 mL浓度为0.6 g/mL替卡西林/棒酸.比较肉汤稀释法(MIC法)、K-B法及VITEK法检测的药物敏感性结果与体内药物治疗的疗效关系.结果 哌拉西林/他唑巴坦治疗组(A组),K-B法检测结果与家兔感染模型治疗过程相符率为72.2%,MIC法66.7%,VITEK法为66.7%.替卡西林/棒酸治疗组(B组),MIC法83.3%,VITEK法为77.8%,K-B法检测结果与家兔感染模型治疗过程相符率为50.0%.头孢吡肟治疗组(C组),MIC法88.9%,VITEK法为77.8%,K-B法检测结果与家兔感染模型治疗过程相符率为72.2%.结论 在3种药物敏感性检测法中,哌拉西林/他唑巴坦以K-B法检测结果与感染家兔的抗感染疗效最为接近;替卡西林/棒酸及头孢吡肟均以MIC法与感染家兔的抗感染疗效最为接近;针对洋葱伯克霍尔德菌的感染建议临床使用不同的方法检测不同的药物体外敏感性.%Objective To treat rabbit models of Burkholderia cepacia infection by using drugs without complete CLSI interpretive standard, including piperacillin/tazobactam, ticarcillin/clavulanic acid and cefepime, and compare which drug sensitivity test in vitro can more accurately reflect the clinical efficacy. Methods 57 clinical isolates of Burkholderia cepacia were used to infect 57 rabbits intraperitoneally. The infected rabbits were divided into 3 groups ( A, B and C), 19 in each group. Then, at48, 72, 96, 12 and 144 h, respectively, each

  3. Commonly prescribed β-lactam antibiotics induce C. trachomatis persistence/stress in culture at physiologically relevant concentrations.

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    Jennifer eKintner

    2014-04-01

    Full Text Available Chlamydia trachomatis, the most common bacterial sexually transmitted disease agent worldwide, enters a viable, non-dividing and non-infectious state (historically termed persistence and more recently referred to as the chlamydial stress response when exposed to penicillin G in culture. Notably, penicillin G-exposed chlamydiae can reenter the normal developmental cycle upon drug removal and are resistant to azithromycin-mediated killing. Because penicillin G is less frequently prescribed than other β-lactams, the clinical relevance of penicillin G-induced chlamydial persistence/stress has been questioned. The goal of this study was to determine whether more commonly used penicillins also induce C. trachomatis serovar E persistence/stress. All penicillins tested, as well as clavulanic acid, induced formation of aberrant, enlarged reticulate bodies (called aberrant bodies or AB characteristic of persistent/stressed chlamydiae. Exposure to the penicillins and clavulanic acid also reduced chlamydial infectivity by >95%. None of the drugs tested significantly reduced chlamydial unprocessed 16S rRNA or genomic DNA accumulation, indicating that the organisms were viable, though non-infectious. Finally, recovery assays demonstrated that chlamydiae rendered essentially non-infectious by exposure to ampicillin, amoxicillin, carbenicillin, piperacillin, penicillin V and clavulanic acid recovered infectivity after antibiotic removal. These data definitively demonstrate that several commonly used penicillins induce C. trachomatis persistence/stress at clinically relevant concentrations.

  4. 哌拉西林/三唑巴坦合剂

    Institute of Scientific and Technical Information of China (English)

    黄海辉; 张婴元

    2000-01-01

    @@当前在感染性疾病领域中,细菌耐药性的不断增长给治疗带来了很大困难,细菌耐药的主要机制之一是许多β-内酰胺类抗生素可被耐药菌产生的β-内酰胺酶所灭活。鉴于此,已有多种β-内酰胺酶抑制剂问世,并已广泛应用,如克拉维酸(clavulanic acid)、舒巴坦(sulbactam)等,近年来又研制了新的β-内酰胺酶抑制剂——三唑巴坦(tazobactam)。哌拉西林(piperacillin)和三唑巴坦(8∶1)的合剂1992年在法国上市。该合剂抗菌作用强,不良反应少见,能抑制耐药株所产生的β-内酰胺酶,国外用于治疗各系统感染获满意疗效。

  5. BACTERIAL SPECTRUM AND PATTERN OF ANTIMICROBIAL SENSITIVITY AMONG OUTPATIENTS WITH PNEUMONIA IN A TERTIARY CARE HOSPITAL

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    Sushma

    2015-04-01

    Full Text Available OBJECTIVES: To outline the spectrum of bacteria causing pneumonia and the pattern of antimicrobial sensitivity in outpatients with pneumonia in a tertiary care hospital in Himachal Pradesh. METHODS: Sputum of 108 immuno competent pneumonia patients attending outpatient departments of Medicine and Pulmonary medicine of Dr. R. P. Government Medical College , Kangra at Tanda was sent for Gram staining and culture and sensitivity testing. RESULTS: Commensals were detected in most of the cases (32 , 29.6% followed by Staphylococcus aureus in 17(15.7% and Streptococcus pneumoniae in 16(14.8%. This was followed by three Gram negative organisms namely E Coli (11 , 10.2% , Pseudomonas (10 , 9.2% and Klebsiella (8 , 7.2%. No growth was obtained in 7(6.5% and other organisms were isolated in 7(6.5% specimens. Staphylococcus aureus was sensitive to vancomycin , clindamycin , cefoxitin , azithromycin and cotrimoxazole. Streptococcus pneumoniae was found to be sensitive to vancomycin , clindamycin , gentamicin , azithromycin , penicillin , cotrimoxazole , amoxicillin +clavulanic acid. Klebsiella was found to be sensitive to imipenem , azithromycin , ciprofloxacin , gentamicin and amoxicillin +clavulanic acid. E coli was sensitive to imipenem , gentamicin and amoxicillin +clavulanic acid. Pseudomonas aeruginosa was found to be sensitive to gentamicin , cefta zidime , imipenem , ticarcillin and piperacillin. CONCLUSION: Staphylococcus aureus and Streptococcus pneumoniae are the commonest organism causing pneumonia. Streptococcus pneumoniae is resistant to many antibiotics. Azithromycin can be the first line therapy for pneumonia.

  6. Cost Effectiveness Analysis of 3 Kinds of Penicillins Antibiotics in Treatment of Pediatric Bronchial Pneumonia%3种青霉素类抗生素治疗儿科支气管肺炎的成本-效果分析

    Institute of Scientific and Technical Information of China (English)

    潘奇澄; 陆青云; 杨将

    2015-01-01

    Objective: To study the cost-effectiveness ratio of the treatment of bronchial pneumonia as a common disease in pediatrics with different therapeutic regimens and to find out the most reasonable clinical pathway. Methods: About 281 patients with bronchial pneumonia were chosen from hospitalized patients of pediatrics in our hospital in 2014. They were randomly divided into 3 groups, each group was given penicillin sodium for injection, amoxilinna and clavulanate potassium for injection and piperacillin sodium and tazobactam sodium for injection respectively for antimicrobial therapy and the assessment was made on therapeutic schemes according to the principle of pharmacoeconomics. Results: The cost-effectiveness ratio of penicillin sodium for injection, amoxicillin sodium and clavulanate potassium for injection and piperacillin sodium and tazobactam sodium for injection was 4 846.63 ~4 877.30, 1 985.79 and 2 548.10 yuan/each respectively. The incremental analysis showed that the therapeutic scheme with amoxicillin sodium and clavulanate potassium for injection had an obvious advantage as opposed to piperacillin sodium for injection, the incremental cost-effectiveness ratio of piperacillin sodium and tazobactam sodium for injection was 319.18 ~ 345.53 as opposed to penicillin sodium for injection and 9 905.63 as opposed to amoxilinna and clavulanate potassium for injection. Conclusion: The results showed the using amoxilinna and clavulanate potassium for injection is an optimal therapeutic scheme for antimicrobial treatment of pediatric bronchial pneumonia, with lower treatment cost and better effectiveness. It can be regarded as the most reasonable clinical pathway.%目的:研究不同药物治疗方案对儿科常见病支气管肺炎产生的成本-效果比,寻找最合理的临床路径。方法:在我院2014年儿科住院病例中选取支气管肺炎患者共281例,随机分成3组,分别给予注射用青霉素钠、注射用阿莫西林钠-克

  7. Coexistent Pseudogout and Mycobacterium avium-intracellulare Septic Arthritis in a Patient with HIV and ESRD

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    Wais Afzal

    2016-01-01

    Full Text Available Pseudogout is a crystal-induced arthropathy characterized by the deposition of calcium pyrophosphate dihydrate (CPPD crystals in synovial fluid, menisci, or articular cartilage. Although not very common, this entity can be seen in patients with chronic kidney disease (CKD. Septic arthritis due to Mycobacterium avium-intracellulare (MAI is a rare entity that can affect immunocompromised patients such as those with acquired immunodeficiency syndrome (AIDS or those who are on immunosuppressive drugs. Here, we describe a 51-year-old female who presented with fever, right knee pain, swelling, warmth, and decreased range of motion for several days. The initial assessment was consistent with pseudogout, with negative bacterial and fungal cultures. However, due to high white blood cell (WBC count in the synovial fluid analysis, she was empirically started on intravenous (IV vancomycin and piperacillin-tazobactam and discharged on IV vancomycin and cefepime, while acid-fast bacilli (AFB culture was still in process. Seventeen days later, AFB culture grew Mycobacterium avium-intracellulare (MAI, and she was readmitted for relevant management. This case illustrates that septic arthritis due to MAI should be considered in the differential diagnosis of septic arthritis in immunocompromised patients.

  8. In-vitro profile of a new beta-lactam, ceftobiprole, with activity against methicillin-resistant Staphylococcus aureus.

    Science.gov (United States)

    Jones, M E

    2007-06-01

    Ceftobiprole is a novel, broad-spectrum cephalosporin with in-vitro activity against common Gram-positive and Gram-negative organisms. It forms a stable inhibitory complex with Staphylococcus aureus penicillin-binding protein (PBP) 2' (2a), resulting in enhanced activity against methicillin-resistant S. aureus (MRSA). In recent studies of methicillin-susceptible S. aureus, the ceftobiprole MIC(90) value was most frequently Ceftobiprole is active against Enterococcus faecalis (MIC(90) = 4 mg/L), but not generally active against Enterococcus faecium (MIC(90) > 16 mg/L). Ceftobiprole displayed bactericidal activity against Gram-negative pathogens comparable to that of cefepime, ceftazidime or piperacillin-tazobactam in early studies. However, recent data show activity against Pseudomonas aeruginosa similar to that of cefepime but less than that of ceftazidime. Ceftobiprole, like cefepime, is stable in the presence of most class A non-extended spectrum beta-lactamases and inducible class C beta-lactamases. Ceftobiprole is a poor inducer of AmpC beta-lactamase and a poor substrate for hydrolysis by AmpC beta-lactamase. Studies of ceftobiprole in several animal models have demonstrated potent in-vivo efficacy against infections caused by MRSA, including strains intermediately resistant to vancomycin. It was also efficacious in murine infections caused by Gram-negative bacteria with MIC values ceftobiprole in vitro and in vivo suggests that it may have potential for empirical treatment of suspected Gram-negative and Gram-positive infections, including those caused by MRSA.

  9. Trends in antimicrobial resistance among Bacteroides species and Parabacteroides species in the United States from 2010-2012 with comparison to 2008-2009.

    Science.gov (United States)

    Snydman, D R; Jacobus, N V; McDermott, L A; Goldstein, E J C; Harrell, L; Jenkins, S G; Newton, D; Patel, R; Hecht, D W

    2017-02-01

    The susceptibility trends for Bacteroides fragilis and related species against various antibiotics were determined using data from 3 years of surveillance (2010-2012) on 779 isolates referred by 7 medical centers. The antibiotic test panel included imipenem, ertapenem, meropenem, ampicillin-sulbactam, piperacillin-tazobactam, cefoxitin, clindamycin, moxifloxacin, tigecycline, linezolid, chloramphenicol and . MICs were determined using the agar dilution CLSI reference method. Carbapenem resistance remained low (range 1.1%-2.5%) and unchanged from 2008 to 9 through 2010-2012. Resistance also remained low to the beta-lactam/beta-lactamase inhibitor combinations (1.1%-4.4%). While resistance to clindamycin and moxifloxacin remained high; rates were lower for B. fragilis in 2010-12 (24% and 19% respectively) compared to the earlier time frame of 2008-9 (29% and 35% respectively for the earlier time frame). There were notable species and resistance associations which have been demonstrated previously. No resistance to metronidazole or chloramphenicol resistance was seen. These data demonstrate the continued variability in resistance among Bacteroides and Parabacteroides species, but do demonstrate that carbapenems and beta-lactam/beta-lactamase inhibitor combinations remain very active throughout the United States. Copyright © 2016 Elsevier Ltd. All rights reserved.

  10. Metronidazole- and carbapenem-resistant bacteroides thetaiotaomicron isolated in Rochester, Minnesota, in 2014.

    Science.gov (United States)

    Sadarangani, Sapna P; Cunningham, Scott A; Jeraldo, Patricio R; Wilson, John W; Khare, Reeti; Patel, Robin

    2015-07-01

    Emerging antimicrobial resistance in members of the Bacteroides fragilis group is a concern in clinical medicine. Although metronidazole and carbapenem resistance have been reported in Bacteroides thetaiotaomicron, a member of the B. fragilis group, they have not, to the best of our knowledge, been reported together in the same B. thetaiotaomicron isolate. Herein, we report isolation of piperacillin-tazobactam-, metronidazole-, clindamycin-, ertapenem-, and meropenem-resistant B. thetaiotaomicron from a patient with postoperative intra-abdominal abscess and empyema. Whole-genome sequencing demonstrated the presence of nimD with at least a portion of IS1169 upstream, a second putative nim gene, two β-lactamase genes (one of which has not been previously reported), two tetX genes, tetQ, ermF, two cat genes, and a number of efflux pumps. This report highlights emerging antimicrobial resistance in B. thetaiotaomicron and the importance of identification and antimicrobial susceptibility testing of selected anaerobic bacteria. Copyright © 2015, American Society for Microbiology. All Rights Reserved.

  11. Performance of Vitek 2 for Antimicrobial Susceptibility Testing of Acinetobacter baumannii, Pseudomonas aeruginosa, and Stenotrophomonas maltophilia with Vitek 2 (2009 FDA) and CLSI M100S 26th Edition Breakpoints.

    Science.gov (United States)

    Bobenchik, April M; Deak, Eszter; Hindler, Janet A; Charlton, Carmen L; Humphries, Romney M

    2017-02-01

    The performances of Vitek 2 AST-GN69 and AST-XN06 cards were compared to Clinical and Laboratory Standards Institute (CLSI) reference broth microdilution (BMD) for 99 isolates of Pseudomonas aeruginosa, 26 Acinetobacter baumannii isolates, and 11 Stenotrophomonas maltophilia isolates. In total, 15 antimicrobials were evaluated, with 11 for P. aeruginosa, 14 for A. baumannii, and 2 for S. maltophilia Categorical agreement (CA) was assessed using both Vitek 2 breakpoints and 2016 CLSI M100S 26th edition breakpoints. The essential agreement values for P. aeruginosa, A. baumannii, and S. maltophilia were 99.5%, 99.2%, and 100%, respectively. The CA values for P. aeruginosa, A. baumannii, and S. maltophilia were 94.1%, 92.7%, and 95.5%, respectively, by the Vitek 2 breakpoints, and 93.4%, 92.3%, and 95.5%, respectively, by the CLSI breakpoints. Overall, the Vitek 2 performance was comparable to that of BMD using both Vitek 2 breakpoints and 2016 CLSI M100S 26th edition breakpoints. Improved performance was noted for the reformulated piperacillin-tazobactam and imipenem found on the AST-GN69 card, with no very major or major errors noted when using the CLSI breakpoints. Copyright © 2017 American Society for Microbiology.

  12. Epididymo-orchitis in an extremely preterm infant

    Directory of Open Access Journals (Sweden)

    Scott Morris

    2016-04-01

    Full Text Available Epididymo-orchitis (EO is a rare condition in the neonatal period. An underlying uropathy is variably associated with EO in published cases and more frequently seen in older children. In this case report, a male baby born at 26 weeks gestation had confirmed congenital Escherichia coli septicemia. The E. coli was sensitive to gentamicin, and he was treated with 10 days of intravenous gentamicin and cefotaxime, with normalization of markers of infection. He did not have a urinary catheter at any stage. He developed recurrent E. coli septicemia 19 days after ceasing antibiotics, in association with a tender scrotal swelling. A urine culture could not be obtained prior to commencing intravenous antibiotics. Surgical exploration revealed a right pyocele and a viable right testis. He was treated with 2 weeks of intravenous piperacillin and tazobactam and a further 2 weeks of oral amoxycillin and clavulanic acid. Urological investigations were normal. No further episodes of EO occurred, and follow-up showed normal testicular growth. This case adds weight to existing literature which suggests hematogenous spread as the most frequent cause of neonatal EO, without urinary tract abnormality. EO as cause of recurrent sepsis in the neonate after apparently adequate treatment of antecedent blood born infection is highlighted. Surgical exploration confirmed diagnosis, and evacuation of the pyocele assisted resolution of systemic sepsis and decompressed the testis.

  13. The efficiency of the multi-walled carbon nanotubes used for antibiotics removal from wastewaters generated by animal farms.

    Science.gov (United States)

    Soran, Maria-Loredana; Opriş, Ocsana; Lung, Ildikó; Kacso, Irina; Porav, Alin S; Stan, Manuela

    2017-07-01

    In the recent years, residual antibiotics are considered to be emerging environmental pollutants due to their continuous input and persistence into the aquatic ecosystem even at low concentrations. Therefore, these are necessary to develop efficient methods for the wastewater treatment. The present paper describes the efficiency of several types of multi-walled carbon nanotubes (MWCNTs) for the retention of the selected antibiotics (ampicillin, ceftazidime, cefepime, imipenem, piperacillin, tazobactam, tetracycline, erythromycin, ciprofloxacin, norfloxacin, vancomycin, gentamicin, sulfamethoxazole, and thrimetoprim) from aqueous (synthetic) solutions and wastewater samples. The functionalized MWCNTs were characterized by Fourier transform infrared spectroscopy (FT-IR), scanning electron microscopy (SEM), and transmission electron microscopy (TEM). The obtained antibiotic percentage of retention was evaluated by quantitative assessment using high-performance liquid chromatography coupled with the diode array, fluorescence, and mass spectrometer detector (HPLC-DAD/FD/MS), after the solid-phase extraction (SPE) with Oasis HLB cartridges. The retention percentages of the selected antibiotics from waters ranged between ∼40 and 97%, with the exception of sulfamethoxazole and trimethoprim. The best percentages of retention were obtained for norfloxacin 97.03% and ciprofloxacin 97.10%. The suspensions of the MWCNTs improved the antibiotics removal from wastewaters. Removal of antibiotics from wastewaters using nanotechnology, in order to reduce their negative effects and antibiotic resistance, is a promising tool in the future wastewaters treatment.

  14. Drug susceptibility and molecular epidemiology of Escherichia coli in bloodstream infections in Shanghai, China, 2011-2013.

    Science.gov (United States)

    Zhao, Sheng-Yuan; Wang, Yan-Chun; Xiao, Shu-Zhen; Jiang, Xiao-Fei; Guo, Xiao-Kui; Ni, Yu-Xing; Han, Li-Zhong

    2015-05-01

    Prevention and management of Escherichia coli bloodstream infections (EC-BSIs) have become increasingly complicated by antimicrobial resistance and rapid dissemination. We investigated the antimicrobial epidemiology and phylogenetic background of clinical E. coli isolates from patients with bloodstream infections in Shanghai from 2011 to 2013. Escherichia coli isolates causing bloodstream infections were consecutively collected between June 2011 and June 2013. Antimicrobial susceptibility testing was performed by disk diffusion. Drug resistance genes coding for extended-spectrum β-lactamases (ESBLs) and carbapenemases, and phylogenetic groups were detected by polymerase chain reaction. eBURST was used for multilocus sequence typing. Of the strains 128 collected, 80 produced ESBLs. No carbapenem-resistant isolates were found. The resistance rates to penicillins, fluoroquinolone, folate pathway inhibitors, tetracyclines and second generation cephalosporins were high. Molecular analysis showed that CTX-M-14 (40/80) was the most common β-lactamase, followed by CTX-M-55 (17/80) and CTX-M-15 (14/80). Phylogenetic group B2 predominated (37.5%), but phylogenetic group D exhibited the highest rates of ESBL production. ST131 (17/128) was the most common sequence type, followed by ST69 (12/128) and ST648 (10/128). The antimicrobial resistance rate was high among EC-BSI isolates, but amikacin, piperacillin-tazobactam and carbapenem could be options for empiric therapy. Genetic diversity showed no correlation with the nosocomial origin of the isolates.

  15. Synergistic effect of lipopeptide biosurfactant with antibiotics against Escherichia coli CFT073 biofilm.

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    Rivardo, Fabrizio; Martinotti, Maria Giovanna; Turner, Raymond Joseph; Ceri, Howard

    2011-04-01

    Biofilms are microcolonies of microbes adherent to biotic and abiotic surfaces, often responsible for chronic infections and medical device contamination. Escherichia coli is one of the prevalent pathogens involved in uropathogenic infections and contamination of catheters. A biosurfactant produced by Bacillus licheniformis V9T14 was tested alone and in association with various antibiotics against a mature 24-h uropathogenic E. coli CFT073 biofilm. Biofilm was grown on polystyrene pegs of a Calgary Biofilm Device, providing a tool to evaluate the efficacy of antimicrobial agents. Antibiotics tested were ampicillin, cefazolin, ceftriaxone, ciprofloxacin, piperacillin, tobramycin and trimethoprim/sulfamethoxazole (19:1). Biosurfactant alone at the concentrations tested was not able to remove the adherent cells of the pre-formed biofilm. However, the difference between the effect of antibiotic alone and in combination with the biosurfactant was significant and exceeded 1log(10) (90%) reduction in most cases. Results of this study indicate that V9T14 biosurfactant in association with antibiotics leads to a synergistic increase in the efficacy of antibiotics in biofilm killing, and in some combinations leads to total eradication of E. coli CFT073 biofilm. Copyright © 2011 Elsevier B.V. and the International Society of Chemotherapy. All rights reserved.

  16. Antibiotic susceptibility profile of bacteria isolated from natural sources of water from rural areas of East Sikkim

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    Shubra Poonia

    2014-01-01

    Full Text Available Background: Contamination of water, food, and environment with antibiotic-resistant bacteria poses a serious public health issue. Objective: The objective was to study the bacterial pollution of the natural sources of water in east Sikkim and to determine the antimicrobial profile of the bacterial isolates. Materials and Methods: A total of 225 samples, 75 each during winter, summer, and monsoon season were collected from the same source in every season for bacteriological analysis by membrane filtration method. Antibiotic susceptibility test was performed using standard disc diffusion method. Results: A total of 19 bacterial species of the genera Escherichia, Klebsiella, Proteus, Salmonella, Shigella, Enterobacter, Citrobacter, Morganella, Pseudomonas, Acinetobacter, Flavobacterium, and Serratia were isolated and their antimicrobial sensitivity tested. Generally, most bacterial isolates except Salmonella and Shigella species were found resistant to commonly used antibiotics such as ampicillin (57.5%, trimethoprim/sulfamethoxaole (39.1%, amoxicillin/clavulanic acid (37.4%, cefixime (34.5%, tetracycline (29.1%, ceftazidime (26.3%, ofloxacin (25.9%, amikacin (8.7%, and gentamicin (2.7% but sensitive to imipenem and piperacillin/tazobactam. Conclusion: Natural sources of water in east Sikkim are grossly contaminated with bacteria including enteropathogens. The consumption of untreated water from these sources might pose health risk to consumers.

  17. Nosocomial and Community-Acquired Spontaneous Bacterial Peritonitis in patients with liver cirrhosis in China: Comparative Microbiology and Therapeutic Implications

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    Shi, Lei; Wu, Dan; Wei, Lei; Liu, Suxia; Zhao, Peng; Tu, Bo; Xie, Yangxin; Liu, Yanan; Wang, Xinhua; Liu, Liying; Zhang, Xin; Xu, Zhe; Wang, Fusheng; Qin, Enqiang

    2017-01-01

    Spontaneous bacterial peritonitis (SBP) is a common complication of liver cirrhosis. This study was performed to compare the microbiological characteristics of nosocomial and community-acquired episodes of bacterial peritonitis in China. Five hundred and seventy-five strains were isolated from the ascitic fluid of cirrhotic patients from the Beijing 302 Hospital from January 2014 to December 2014. The patients in the community-acquired SBP (n = 311) and the nosocomial SBP (n = 264) groups exhibited significant differences in clinical symptoms (P < 0.01). In both groups, most of the bacteria were Escherichia coli, Klebsiella pneumoniae, coagulase-negative staphylococcus and Enterococcus. There were more frequent gram-positive cocci (G+ C) in the nosocomial group (n = 170). Compared with the community-acquired group, the proportion of Enterococcus was significantly increased in the nosocomial group (9.0% vs. 16.6%, P < 0.05). The resistance rate of the main pathogenic bacteria to the recommended first-line drug in the guideline was very high. Community-acquired and nosocomial SBP groups exhibited differences in clinical symptoms and antibiotic susceptibility tests. Optimal treatments should be provided for these patients. We recommend that cefoperazone/sulbactam or piperacillin/tazobactam should be used for the empirical treatment of SBP. PMID:28382951

  18. Effectiveness of Antipseudomonal Antibiotics and Mechanisms of Multidrug Resistance in Pseudomonas aeruginosa.

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    El ZOWALATYl, Mohamed E; Gyetvaii, Bpla

    2016-01-01

    Pseudomonas aeruginosa is a leading human pathogen that causes serious infections at various tissues and organs leading to life threatening health problems and possible deadly outcomes. Resistance patterns vary widely whether it is from hospitals or community acquired infections. Reporting resistance profiles to a certain antibiotics provide valuable information in a given setting, but may be extrapolated outside the sampling location. In the present study, P. aeruginosa isolates were screened to determine their susceptibilities against anti-pseudomonal antimicrobial agents and possible existing mechanisms of resistance were determined. Eighty-six isolates of P. aeruginosa were recovered. Isolates representing different resistance profiles were screened for the existence of three different resistance mechanisms including drug inactivation due to metallo-β-lactamases, drug impermeability by outer membrane proteins and drug efflux. All tested isolates showed uniform susceptibility (100%, n = 86/86) to piperacillin, meropenem, amikacin, and polymyxin B. A single isolate was found to be imipenem resistant (99%, n = 85/86). The possible mechanisms of resistance of P. aeruginosa to imipenem involve active drug efflux pumps, outer membrane impermeability as well as drug inactivating enzymes. These findings demonstrate the fundamental importance of the in vitro susceptibility testing of antibiotics prior to antipseudomonal therapy and highlight the need for a continuous antimicrobial resistance surveillance programs to monitor the changing resistance patterns so that clinicians and health care officials are updated as to the most effective therapeutic agents to combat the serious outcomes of P. aeruginosa infections.

  19. Chironomid egg masses harbour the clinical species Aeromonas taiwanensis and Aeromonas sanarellii.

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    Beaz-Hidalgo, Roxana; Shakèd, Tamar; Laviad, Sivan; Halpern, Malka; Figueras, María J

    2012-12-01

    Bacteria of the genus Aeromonas are found worldwide in aquatic environments and may produce human infections. In 2010, two new clinical species, Aeromonas sanarellii and Aeromonas taiwanensis, were described on the basis of one strain recovered from wounds of hospitalized patients in Taiwan. So far, only four environmental isolates of A. sanarellii and one of A. taiwanensis have been recorded from waste water in Portugal and an additional clinical strain of A. taiwanensis from the faeces of a patient with diarrhoea in Israel. In the present study, strains belonging to these two species were identified from chironomid egg masses from the same area in Israel by sequencing the rpoD gene. This represents a new environmental habitat for these novel species. The first data on the virulence genes and antibiotic susceptibility are provided. The isolates of these two new species possess multiple virulence genes and are sensitive to amikacin, aztreonam, cefepime, cefoxatime, ceftazidime, ciprofloxacin, gentamicin, piperacillin-tazobactam, tigecycline, tobramycin, trimethoprim-sulfamethoxazole and imipenem. The key phenotypic tests for the differentiation of these new species from their closest relative Aeromonas caviae included the utilization of citrate, growth at 45 °C in sheep blood agar and acid production of cellobiose.

  20. Increase in isolation of extended spectrum beta lactamase producing multidrug resistant non typhoidal Salmonellae in Pakistan

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    Khan Erum

    2010-04-01

    Full Text Available Abstract Background Increasing resistance to quinolones and ceftriaxone in non typhoidal Salmonellae is a global concern. Resistance to quinolone and 3rd generation cephalosporin amongst non typhoidal Salmonellae (NTS from Pakistan has been reported in this study. Methods Retrospective analysis of laboratory data was conducted (1990-2006. NTS were isolated and identified from clinical samples using standard microbiological techniques. Antimicrobial susceptibility testing was performed by Kirby Bauer. Extended spectrum beta lactamase production (ESBL was detected using combined disc method. Ciprofloxacin sensitivity was detected by nalidixic acid screening method. Minimum inhibitory concentration (MIC of ciprofloxacin was determined by agar dilution method. Statistical analysis was performed using SPSS version 13. Results Analysis of 1967 NTS isolates showed a significant increase in ciprofloxacin resistance from 23% in 2002 to 50.5% in 2006, with increased mean MIC values from 0.6 to 1.3 ug/mL. Ceftriaxone resistant NTS also increased and ESBL production was seen in 98.7% isolates. These isolates exhibited high resistance against amoxicillin clavulanic acid (57%, gentamicin (69%, amikacin (44% and piperacillin tazobactam (30%. No resistance to carbapenem was seen. Ceftriaxone resistance was significantly higher in children Conclusions Increase in quinolone and ceftriaxone NTS is a serious threat to public health requiring continuous surveillance and use of appropriate screening tests for laboratory detection.

  1. [Preliminary results of antibiotic resistance monitoring in the Netherlands].

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    Mevius, D J; Veldman, K T; van der Giessen, A; van Leeuwen, W J

    2000-03-01

    Qualitative tests are used to monitor antimicrobial resistance in bacteria of animal origin in the Netherlands. Quantitative information on trends in resistance is thus not obtained. Moreover, in general a limited panel of antibiotics is tested. The present study describes resistance in zoonotic food-borne pathogens Salmonella, Campylobacter, and Escherichia coli O157 isolated from human clinical cases and from faeces of healthy food animals in 1998 and 1999, as determined with quantitative susceptibility tests. The resistance of the indicator organisms E. coli and Enterococcus faecium isolated from faecal samples of broilers and pigs randomly sampled at slaughterhouses was also determined. For this end, faecal samples from veal calves were sampled in 1996 and 1997 at the three main Dutch veal calf slaughterhouses. In 1998 only a limited number of faecal samples of veal calves were taken at farms. For E. coli and Salmonella the following antibiotics were tested: amoxicillin, amoxicillin-clavulanic acid, piperacillin, cefotaxime, ceftazidime, imipenem, gentamicin, doxycycline, trimethoprim, trimethoprim/sulphamethoxazole, ciprofloxacin, chloramphenicol, florfenicol, carbadox, and flumequine. For E. faecium the following antibiotics were tested: amoxicillin, amoxicillin-clavulanic acid, chloramphenicol, doxycycline, erythromycin, vancomycin, teicoplanin, streptomycin ('high level' > 2000 mg/ml), gentamicin ('high level' > 500 mg/ml), ciprofloxacin, bacitracin, flavofosfolipol, salinomycin, quinupristin-dalfopristin, virginiamycin, tilmicosin, avilamycin, and everninomycin. For Campylobacter the following antibiotics were tested: erythromycin, doxycycline, gentamicin, carbadox, flavofosfolipol, ciprofloxacin, trimethoprim/sulphamethoxazole, amoxicillin, and metronidazole.

  2. Multidrug Resistance of Acinetobacter Baumannii in Ladoke Akintola University Teaching Hospital, Osogbo, Nigeria

    Science.gov (United States)

    Odewale, G.; Adefioye, O. J.; Ojo, J.; Adewumi, F. A.; Olowe, O. A.

    2016-01-01

    Acinetobacter baumannii is a ubiquitous pathogen that has emerged as a major cause of healthcare-associated infections at Ladoke Akintola University Teaching Hospital. Isolates were assayed according to standard protocol. The isolates were subjected to molecular techniques to detect blaOXA, blaTEM, blaCTX-M, and blaSHV genes in strains of the A. baumannii isolates. The prevalence of A. baumannii was 8.5% and was most prevalent among patients in the age group 51–60 (36%); the male patients (63.6%) were more infected than their female counterparts. Patients (72.7%) in the intensive care unit (ICU) were most infected with this organism. The isolates showed 100% resistance to both amikacin and ciprofloxacin and 90.9% to both ceftriaxone and ceftazidime, while resistance to the other antibiotics used in this study were: piperacillin (81.8%), imipenem (72.7%), gentamycin (72.2%), and meropenem (63.6%). None of the isolates was, however, resistant to colistin. PCR results showed that blaOXA, blaTEM, and blaCTX-M genes were positive in some isolates, while blaSHV was not detected in any of the isolates. This study has revealed that the strains of A. baumannii isolated are multiple drug resistant. Regular monitoring, judicious prescription, and early detection of resistance to these antibiotics are, therefore, necessary to check further dissemination of the organism. PMID:27766173

  3. Australian Group on Antimicrobial Resistance Australian Enterobacteriaceae Sepsis Outcome Programme annual report, 2014.

    Science.gov (United States)

    Bell, Jan M; Turnidge, John D; Coombs, Geoffrey W; Daley, Denise A; Gottlieb, Thomas; Robson, Jenny; George, Narelle

    2016-06-30

    The Australian Group on Antimicrobial Resistance performs regular period-prevalence studies to monitor changes in antimicrobial resistance in selected enteric Gram-negative pathogens. The 2014 survey was the second year to focus on blood stream infections. During 2014, 5,798 Enterobacteriaceae species isolates were tested using commercial automated methods (Vitek 2, BioMérieux; Phoenix, BD) and results were analysed using the Clinical and Laboratory Standards Institute (CLSI) and European Committee on Antimicrobial Susceptibility Testing (EUCAST) breakpoints (January 2015). Of the key resistances, non-susceptibility to the third-generation cephalosporin, ceftriaxone, was found in 9.0%/9.0% of Escherichia coli (CLSI/EUCAST criteria) and 7.8%/7.8% of Klebsiella pneumoniae, and 8.0%/8.0% K. oxytoca. Non-susceptibility rates to ciprofloxacin were 10.4%/11.6% for E. coli, 5.0%/7.7% for K. pneumoniae, 0.4%/0.4% for K. oxytoca, and 3.5%/6.5% in Enterobacter cloacae. Resistance rates to piperacillin-tazobactam were 3.2%/6.8%, 4.8%/7.2%, 11.1%/11.5%, and 19.0%/24.7% for the same 4 species respectively. Fourteen isolates were shown to harbour a carbapenemase gene, 7 blaIMP-4, 3 blaKPC-2, 3 blaVIM-1, 1 blaNDM-4, and 1 blaOXA-181-lke.

  4. Isolation and characterization of numerous novel phages targeting diverse strains of the ubiquitous and opportunistic pathogen Achromobacter xylosoxidans.

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    Johannes Wittmann

    Full Text Available The clinical relevance of nosocomially acquired infections caused by multi-resistant Achromobacter strains is rapidly increasing. Here, a diverse set of 61 Achromobacter xylosoxidans strains was characterized by MultiLocus Sequence Typing and Phenotype MicroArray technology. The strains were further analyzed in regard to their susceptibility to 35 antibiotics and to 34 different and newly isolated bacteriophages from the environment. A large proportion of strains were resistant against numerous antibiotics such as cephalosporines, aminoglycosides and quinolones, whereas piperacillin-tazobactam, ticarcillin, mezlocillin and imipenem were still inhibitory. We also present the first expanded study on bacteriophages of the genus Achromobacter that has been so far a blank slate with respect to phage research. The phages were isolated mainly from several waste water treatment plants in Germany. Morphological analysis of all of these phages by electron microscopy revealed a broad diversity with different members of the order Caudovirales, including the families Siphoviridae, Myoviridae, and Podoviridae. A broad spectrum of different host ranges could be determined for several phages that lysed up to 24 different and in part highly antibiotic resistant strains. Molecular characterisation by DNA restriction analysis revealed that all phages contain linear double-stranded DNA. Their restriction patterns display distinct differences underlining their broad diversity.

  5. Detection of the Klebsiella pneumoniae carbapenemase (KPC) in K. pneumoniae Isolated from the Clinical Samples by the Phenotypic and Genotypic Methods

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    Bina, Masoume; Pournajaf, Abazar; Mirkalantari, Shiva; Talebi, Malihe; Irajian, Gholamreza

    2015-01-01

    Background and Objective: The production of carbapenemases especially Klebsiella pneumoniae carbapenemase (KPC) is the most important mechanism of enzymatic resistance in isolated Enterobacteriaceae such as K. pneumoniae . The purpose of this study was detected of the carbapenemase producer K. pneumoniae strains with phenotypic and genotypic methods. Method: Out of 800 strains, 270 K. pneumoniae strains (33.7%), were obtained. Antibiotic susceptibility test was performed by disk diffusion method in accordance with CLSI guidelines. Carbapenem resistant strains were identified by the Modified Hodge Test based on CLSI instruction and PCR for surveying the presence of bla -KPC gene. Results: A total 270 K. pneumoniae strains were collected. Antibiotic susceptibility test results showed the highest and lowest resistance was related to piperacillin (60.6%) and carbapenems (14.6%) respectively. 80.5% (33 of 41) isolates were positive by MHT, but all of them (100%) were negative for amplification of the bla -KPC gene in the PCR method. Conclusion: The MHT was an appropriate method for approving carbapenemase production. Moreover, a laboratory could accept the carbapenemase production with PCR method for the bla-KPC gene, which has the additional profit of validating which KPC is present. PMID:26351485

  6. In Vitro and In Vivo Activities of OP0595, a New Diazabicyclooctane, against CTX-M-15-Positive Escherichia coli and KPC-Positive Klebsiella pneumoniae.

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    Morinaka, Akihiro; Tsutsumi, Yuko; Yamada, Keiko; Takayama, Yoshihiro; Sakakibara, Shiro; Takata, Toshihiko; Abe, Takao; Furuuchi, Takeshi; Inamura, Seiichi; Sakamaki, Yoshiaki; Tsujii, Nakako; Ida, Takashi

    2016-05-01

    Gram-negative bacteria are evolving to produce β-lactamases of increasing diversity that challenge antimicrobial chemotherapy. OP0595 is a new diazabicyclooctane serine β-lactamase inhibitor which acts also as an antibiotic and as a β-lactamase-independent β-lactam "enhancer" against Enterobacteriaceae Here we determined the optimal concentration of OP0595 in combination with piperacillin, cefepime, and meropenem, in addition to the antibacterial activity of OP0595 alone and in combination with cefepime, in in vitro time-kill studies and an in vivo infection model against five strains of CTX-M-15-positive Escherichia coli and five strains of KPC-positive Klebsiella pneumoniae An OP0595 concentration of 4 μg/ml was found to be sufficient for an effective combination with all three β-lactam agents. In both in vitro time-kill studies and an in vivo model of infection, cefepime-OP0595 showed stronger efficacy than cefepime alone against all β-lactamase-positive strains tested, whereas OP0595 alone showed weaker or no efficacy. Taken together, these data indicate that combinational use of OP0595 and a β-lactam agent is important to exert the antimicrobial functions of OP0595.

  7. Clinical analysis of antimicrobial resistance of Gram-negative bacilli isolated from patients with intra-abdominal infections%腹腔感染革兰阴性细菌耐药性临床分析

    Institute of Scientific and Technical Information of China (English)

    田文广; 黄文祥; 贾蓓; 辛小娟; 李崇智; 郑行萍; 史方静

    2011-01-01

    Objective To investigate epidemiological characteristics of Gram-negative bacilli (GNB) isolated from patients with non-recurrent intra-abdominal infections in our hospitals from 2008 to 2010, and to analyze antimicrobial resistance of GNB to common antibiotics and ESBLs-producing ratio of GNB. Methods A total of 290 cases of GNB were isolated from patients with intra-abdominal infections from 2008 to 2010. In antimicrobial susceptibility test, agar dilution method was applied for MIC determination according to NCCLS guidelines. All the data were analyzed using WHONET 5. 4 and SPSS 13. 0. Results In the total of 290 GNB, enterobacteriaceae accounted for 82. 7% and non-fermentative bacteria accounted for 17. 93%. There were six types of common bacteria in which E. Coli accounted for 55. 3% , and the ratio of Acinetobacter baumannii complex increased apparently (7. 96%). The positive rates of ESBLs production in E. Coli and Klebsiella spp were 74. 38% and 55. 56% , respectively. E. Coli was highly sensitive to carbapenems, piperacillin/tazobaetam and amikacin, but not to the third-generation cephalosporins and cefepime. The non-ESBLs-producing Klebsiella spp was sensitive to the twelve common anti-GNB antibiotics, while ESBLs-producing Klebsiella spp was sensitive to amikacin, piperacillin/tazobaetam and carbapenems. The susceptibility rates of Pseudomonas aerltgillosa to imipenem, piperacillin/tazobaetam and amikacin were all above 90% and to cefepime and two quinolones were 80% to 90% , but the susceptibility rate to ceftazidime decreased below 80%. The drug resistance rate of Acinetobacter baumannii to carbapenems was above 80%. Multidrug resistant (MDR) strains accounted for 32% , mainly including Acinetobacter baumannii complex and Pseudomonas aerltgillosa.Eighty percent MDR strains were resistant to almost all commonly used antibiotics. Conclusion The antimicrobial resistance of GNB isolated from patients with intra-abdominal infections increases apparently

  8. Five-Year Antimicrobial Susceptibility of Pseudomonas aeruginosa from a Local Tertiary Hospital in Bacolod City, Philippines

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    Alain C. Juayang

    2017-07-01

    Full Text Available Over five years, a total of 646 P. aeruginosa isolates was acquired from different clinical specimens and their resistance to the commonly used anti-pseudomonal antibiotics was determined. The majority of the isolates were from respiratory (60.99% and urinary sources (23.22% while the least came from transudates and exudates (2.01%. Most of the samples were acquired from older adults (77.55%, most of whom were admitted (67.03%. Amikacin was found to be the most effective drug with a resistance rate of 7.5%, followed by piperacillin/tazobactam (8.5% and gentamicin (13.5%. On the other hand, 26.7% of the isolates were resistant to levofloxacin. Almost 100% of the isolates were screened positive for AmpC production, which may suggest inducible resistance against expanded spectrum beta-lactamase. Furthermore, for the last three years, P. aeruginosa isolates from this area have been noted to have decreasing resistance only to aztreonam and gentamicin. Also, for five years, a mean MAR index of 0.17 was noted which indicates either proper antibiotic use or most isolates did not come from high-risk areas. Moreover, there was no significant difference in the resistance of P. aeruginosa when compared by specimen source (p = 0.662, but significant when compared by year band (p = 0.02.

  9. Correlation between levofloxacin consumption and the incidence of nosocomial infections due to fluoroquinolone-resistant Escherichia coli.

    Science.gov (United States)

    Wu, Hui-Hsiu; Liu, Hsin-Yi; Lin, Yi-Chun; Hsueh, Po-Ren; Lee, Yuarn-Jang

    2016-06-01

    The relationship between fluoroquinolone resistance in Escherichia coli isolates causing nosocomial infection and hospital antibiotic consumption were investigated. Restriction of levofloxacin use was implemented to control the incidence of fluoroquinolone-resistant E coli in the hospital. The study was conducted from January 2004 to December 2010. Antimicrobial agent consumption was obtained from the pharmacy computer system and presented as the defined daily doses per 1000 patient-days every 6 months. The incidence of fluoroquinolone-resistant E coli isolates causing nosocomial infections was obtained from the Department of Infection Control every 6 months. An antimicrobial stewardship program, restricting levofloxacain use, was implemented in July 2007. The incidence of fluoroquinolone-resistant E coli causing nosocomial infections was significantly correlated with fluoroquinolone usage (p = 0.005), but not with the use of third- or fourth-generation cephalosporins, piperacillin-tazobactam, or carbapenems. Parenteral (p = 0.002), oral (p = 0.018), and total levofloxacin (p = 0.001) use were significantly correlated with the extent of fluoroquinolone resistance. With a reduction of levofloxacin use, a decrease of the incidence of fluoroquinolone resistance in E coli isolates was observed. There is a significant correlation between levofloxacin use and the incidence of nosocomial fluoroquinolone-resistant E coli isolates. The incidence of fluoroquinolone-resistant E coli could be reduced by limiting levofloxacin consumption. Copyright © 2011. Published by Elsevier B.V.

  10. Short-term effect of antibiotic control policy on the usage patterns and cost of antimicrobials, mortality, nosocomial infection rates and antibacterial resistance.

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    Arda, Bilgin; Sipahi, Oguz Resat; Yamazhan, Tansu; Tasbakan, Meltem; Pullukcu, Husnu; Tunger, Alper; Buke, Cagri; Ulusoy, Sercan

    2007-07-01

    In 2003 Turkish government released a new budget application instruction for regulating the usage of parenteral antibiotics inside and outside of the hospitals. In this study it was aimed to evaluate the effect of this instruction on the overall usage of restricted antibiotics, their cost, overall mortality, bacterial resistance patterns and nosocomial infection rates in intensive care units (ICUs) of our setting for March-October 2002 and March-October 2003 periods. Overall daily defined dose/1000 patients/day of restricted drugs decreased, whereas unrestricted drugs increased significantly after the instruction. The cost of all analysed drugs in 2003 period was 540,303USD (-19.6%) less than 2002 period. Nosocomial infection rates in ICUs decreased significantly (pnosocomial bacteremia cases during the study period were analysed, amoxycilline/clavulanate, ciprofloxacin, cefuroxime, cefotaxime, piperacilline/tazobactam resistance and ESBL rate in Klebsiella pneumoniae decreased significantly (presistance in Escherichia coli and Acinetobacter baumannii increased significantly (pAntibiotic control is one of the most important and significant ways to save money, and to prevent antibacterial resistance.

  11. Pathogen profile and drug resistance analysis of spontaneous peritonitis in cirrhotic patients.

    Science.gov (United States)

    Li, Yong-Tao; Yu, Cheng-Bo; Huang, Jian-Rong; Qin, Zheng-Ji; Li, Lan-Juan

    2015-09-28

    To investigate the microbiological characteristics and drug resistance in liver cirrhosis patients with spontaneous peritonitis. We analyzed the data of patients with liver cirrhosis and abdominal infection at the First Affiliated Hospital of Zhejiang University between January 2011 and December 2013. Pathogens present in the ascites were identified, and their sensitivity to various antibiotics was determined. We isolated 306 pathogenic bacteria from 288 cases: In 178 cases, the infection was caused by gram-negative strains (58.2%); in 85 cases, gram-positive strains (27.8%); in 9 cases, fungi (2.9%); and in 16 cases, more than one pathogen. The main pathogens were Escherichia coli (E. coli) (24.2%), Klebsiella pneumoniae (18.9%), Enterococcus spp. (11.1%), and Staphylococcus aureus (7.5%). Of the 306 isolated pathogens, 99 caused nosocomial infections and 207 caused community-acquired and other infections. The E. coli and K. pneumoniae strains produced more extended-spectrum β-lactamases in cases of nosocomial infections than non-nosocomial infections (62.5% vs 38%, P antibiotics differed between nosocomial and non-nosocomial infections: Piperacillin/tazobactam was significantly more effective against non-nosocomial E. coli infections (4% vs 20.8%, P nosocomial infections (36.4% vs 86.3%, P infection in patients with liver cirrhosis are gram-negative, and drug resistance is significantly higher in nosocomial infections than in non-nosocomial infections.

  12. Antibiotic resistance patterns of Gram-negative and Gram-positive strains isolated from inpatients with nosocomial infections in a tertiary hospital in Beijing, China from 2011 to 2014.

    Science.gov (United States)

    Zhu, Xiaoyan; Tong, Aihua; Wang, Di; Sun, Huijie; Chen, Ling; Dong, Mei

    2016-06-27

    This study was to evaluate the resistance of antimicrobial agents against pathogens from inpatients with nosocomial infection collected in Beijing, China, during 2011-2014. Measurement of minimum inhibitory concentrations (MICs) was carried out using the broth microdilution method with the Clinical and Laboratory Standards Institute (CLSI) guidelines as the indicator. A total of 5442 Gram-negative and 806 Gram-positive isolates were collected in this study in 2011-2014. Two carbapenem-resistant strains appeared among Escherichia coli (E. coli), while imipenem-resistant isolates increased in proportion from 0% to 8.2% among Klebsiella pneumonia (K. pneumonia) during 4 year. Acinetobacter baumannii (A. baumannii) revealed severe antibacterial resistance to most antimicrobial agents. In contrast, a decreasing trend on resistance had been observed among Pseudomonas aeruginosa (P. aeruginosa) especially after 2012, range from 1.8% for co-trimoxazole to 13.5% for piperacillin. The resistance of Staphylococcus aureus (S. aureus) also had the lowest resistant to linezolid and vancomycin (0.1%). In summary, antimicrobial-resistant nosocomial pathogens have gradually increased from 2011 to 2014, so improved surveillance of hospital-acquired infections and effective infection-control measures may be the best way to solve the present problem.

  13. [Distribution and antibiotics resistance related to nosocomial pathogenic bacteria infection in patients after cardiac surgery].

    Science.gov (United States)

    Dang, Hai-ming; Song, Yue; Cao, Jian; Wu, Li-song; Dong, Ran

    2013-05-01

    To investigate the clinical distribution and antibiotics resistance of nosocomial infection caused pathogenic bacteria in patients after cardiac surgery. Clinical data from 612 patients after cardiac surgery under microbiologically documented nosocomial infection was retrospectively analyzed from January 2007 to December 2012. Identification on related bacterial was performed in an automatic ATB Expression system while antimicrobial susceptibility was tested by Kirby-Bauer method. were analyzed by WHONET5.4. There were 697 strains of clinical pathogenic bacilli isolates identified and 421 (60.4%) of them were isolated from sputum while 185 (26.5%) were from blood. Acinetobacter spp. (124 strains, 17.8%), Pseudomonas aeruginosa (85 strains, 12.2%) and Klebsiella pneumoniae (50 strains, 7.2%) were the predominant Gram-negative bacilli while S. epidermidis (75 strains, 10.8%) was the predominant Gram-positive cocci. The predominant eumycete was Candida albicans (43 strains, 6.2%). from the susceptibility test showed that carbapenems, cefoperazone/sulbactam and piperacillin/tazobactam were the most active antibiotics. The detection of meticillin-resistant Staphylococcus (MRS) were 82.9% in S aureus and 95.9% in coagulase negative Staphylococcus. There was no Staphylococcus strains resistant to vancomycin found. Non-fermenting Gram-negative bacilli and Staphylococcus appeared the important pathogens in patients after cardiac surgery. Drug resistance to antibiotics was quite common. Prevention on nosocomial infection and rational use of antibiotics remained very important in reducing the amount of drug resistant strains.

  14. Depression of vitamin B6 levels due to gentamicin.

    Science.gov (United States)

    Weir, M R; Keniston, R C; Enriquez, J I; McNamee, G A

    1990-06-01

    The renal toxicity of gentamicin is altered by dietary protein modifications, bicarbonate and acetazolamide administration, magnesium supplementation, polyaspartic acid, piperacillin, hypercalcemia and calcium channel blockers. Renal tissue gentamicin levels have an undetermined role. Reduction of renal pyridoxal 5'-phosphate (PLP- by gentamicin has been shown, as has protection from nephrotoxicity by administration of vitamin B6. To explore an interaction between gentamicin and vitamin B6, gentamicin (5 mg/kg) was given to rabbits by ip injection, with either pyridoxine (10 mg) or isovolemic saline for 3 weeks. There was not a difference between gentamicin levels for animals given gentamicin and pyridoxine versus those given gentamicin and saline. Gentamicin administration led to a 47% fall (p = .0001) in plasma PLP levels. Three days after the last gentamicin administration, the animals maintained a 32% decrease from the pre-gentamicin baseline values (p = 0.02). When pyridoxine was administered concurrently with gentamicin, the PLP rise of 49% was significant (p = 0.001). The mean level after the study (6%) was not significantly lower than baseline (p = .6). We believe that gentamicin interfers with vitamin B6 metabolism, but that vitamin B6 status does not affect levels of gentamicin. A number of drugs affect B6 levels, creating the potential for hypovitaminosis B6 to be an important mechanism of drug-drug interaction in seriously ill patients, particularly in sick newborns or the elderly with lower average PLP levels.

  15. Antimicrobial susceptibility of Pseudomonas aeruginosa in China: a review of two multicentre surveillance programmes, and application of revised CLSI susceptibility breakpoints.

    Science.gov (United States)

    Xiao, Meng; Wang, Yao; Yang, Qi-Wen; Fan, Xin; Brown, Mitchell; Kong, Fanrong; Xu, Ying-Chun

    2012-11-01

    The aim of this study was to review the antimicrobial susceptibility of Pseudomonas aeruginosa in China from two nationwide surveillance programmes, namely Surveillance by Etest and Agar Dilution of Nationwide Isolate Resistance (SEANIR) and the Study for Monitoring Antimicrobial Resistance Trends (SMART). A total of 1479 and 187 P. aeruginosa isolates were collected in SEANIR 2005-2008 and SMART 2008-2010, respectively. Minimum inhibitory concentrations of β-lactam/β-lactamase inhibitor combinations, cephalosporins, carbapenems, aminoglycosides and fluoroquinolones were determined and were interpreted following recently revised Clinical and Laboratory Standards Institute (CLSI) guidelines. From SMART, isolation rates of P. aeruginosa were observed to increase by year; moreover, decreasing trends in activity of all antimicrobials were seen. Multidrug-resistant P. aeruginosa strains accounted for 25.2% of SEANIR and 23.0% of SMART isolates. By applying new CLSI interpretive criteria, susceptibilities to piperacillin/tazobactam and carbapenems decreased by 5.4-12.8%. Antimicrobial resistance of the pseudomonads, including P. aeruginosa, remains a challenge for clinical treatment in China. This review emphasises the need for antibiotic stewardship and longitudinal surveillance.

  16. Case report: Infective endocarditis caused by Brevundimonas vesicularis

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    Chen Tun-Chieh

    2006-12-01

    Full Text Available Abstract Background There are few reports in the literature of invasive infection caused by Brevundimonas vesicularis in patients without immunosuppression or other predisposing factors. The choice of antimicrobial therapy for bacteremia caused by the pathogen requires more case experience to be determined. Case presentation The case of a 40-year-old previously healthy man with subacute endocarditis proposed to be contributed from an occult dental abscess is described. The infection was found to be caused by B. vesicularis on blood culture results. The patient recovered without sequelae after treatment with ceftriaxone followed by subsequent ciprofloxacin therapy owing to an allergic reaction to ceftriaxone and treatment failure with ampicillin/sulbactam. Conclusion To our knowledge, this is the first report of B. vesicularis as a cause of infective endocarditis. According to an overview of the literature and our experience, we suggest that third-generation cephalosporins, piperacillin/tazobactam, and ciprofloxacin are effective in treating invasive B. vesicularis infections, while the efficacy of ampicillin-sulbactam needs further evaluation.

  17. Effects of Combined Treatment with Sansanmycin and Macrolides on Pseudomonas aeruginosa and Formation of Biofilm

    Institute of Scientific and Technical Information of China (English)

    YUE LI; YUN-YING XIE; RU-XIAN CHEN; HONG-ZHANG XU; GUO-JI ZHANG; JIN-ZHE LI; XIAO-MIAN LI

    2009-01-01

    Objective To observe the effects of combined treatment with sansanmycin and macrolides on Pseudomonas aeruginosa and formation of biofilm. Methods Micro-dilution method was used to determine the minimal inhibitory concentrations (MICs) of sansanmycin, gentamycin, carbenicillin, polymyxin B, roxithromycin, piperacillin, and tazobactam. PA1 and PA27853 biofilms were observed under optical microscope after staining and under SEM after treatment with sansanmycin at different dosages and combined treatment with sansanmycin and roxithromycin. Viable bacteria in PA1 and PA27853 biofilms were counted after treatment with sansanmycin at different dosages or combined treatment with sansanmycin and roxithromycin. Results The MIC of sansanmycin was lower than that of gentamycin and polymyxin B, but was higher than that of carbenicillin. Roxithromycin enhanced the penetration of sansanmycin to PA1 and PA27853 strains through biofilms. PA1 and PA27853 biofilms were gradually cleared with the increased dosages of sansanmycin or with the combined sansanmycin and roxithromycin. Conclusion Sub-MIC levels of roxithromycin and sansanmycin substantially inhibit the generation of biofilms and proliferation of bacteria. Therefore, combined antibiotics can be used in treatment of intractable bacterial infection.

  18. Analysis of drug resistance in 1,861 strains of Acinetobacter baumannii

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    JIN, HAO; QIU, FAN; JI, HONG JIAN; LU, QIANG

    2016-01-01

    Acinetobacter baumannii is an emerging human pathogen that causes hospital-acquired infections. The trend in increased antimicrobial resistance limits the choice of effective antimicrobial agents. The present study reports the resistance to Acinetobacter baumannii and analyzes the associations between antibiotic use and resistance rates at a general hospital between 2010 and 2014. A total of 1,861 isolates were obtained from clinical cultures, accounting for 10.33% of all detected bacteria (1,861/18,016). The strains were mainly from respiratory samples (1,628 isolates, 87.5%) and the intensive care unit (696 isolates, 37.4%). The resistance rates of Acinetobacter baumannii to the majority of antibiotics were >50%, particularly the resistance rate to cefoperazone/sulbactam increased from 47.37 in 2011 to 89.25% in 2014. However, the rates of imipenem and cilastatin sodium decreased from 81.03 to 69.44% due to the antibiotic policy. There were Pearson significant associations between the use of three antibiotics and resistance in Acinetobacter baumannii to this drug, piperacillin/tazobactam (r=0.976, P<0.01), gentamicin (r=0.870, P<0.01) and cefoxitin (r=0.741, P<0.05). Therefore, a combination of drugs should be adopted to treat Acinetobacter baumannii infections. Microbiology laboratory support and surveillance policies are essential to control the emergence of multidrug-resistance Acinetobacter baumannii. PMID:27073633

  19. Efficacy of intravenous infusion of doripenem.

    Science.gov (United States)

    Restrepo, Marcos I

    2009-08-15

    Initial treatment of nosocomial pneumonia (NP), including ventilator-associated pneumonia (VAP), is usually empirical. The use of a broad-spectrum antibiotic regimen to treat NP-VAP that is active against suspected multidrug-resistant pathogens maximizes the likelihood of a favorable outcome. In a post hoc analysis of pooled data from 2 prospective, randomized, open-label, phase 3 NP-VAP trials, doripenem, a new broad-spectrum carbapenem with antipseudomonal activity, demonstrated noninferiority to standard comparator regimens (imipenem and piperacillin-tazobactam) with regard to clinical and microbiological outcomes. In subgroup analyses, doripenem continued to show noninferiority to the comparator drugs in achieving clinical and microbiological cures in populations at high risk of multidrug-resistant infection, such as patients with late-onset VAP (defined as patients who develop VAP >5 days after intubation) or those with NP-VAP caused by Pseudomonas aeruginosa or complicated by bacteremia. Overall, the clinical data indicate that doripenem has the potential to be an important option in the treatment of NP, including VAP.

  20. Epidemiology and resistance patterns in urinary pathogens from long-term care facilities and GP populations.

    LENUS (Irish Health Repository)

    Brabazon, E D

    2012-06-01

    Urinary tract infections (UTIs) are a major source of antimicrobial prescribing in the clinical setting and a potential reservoir for the emergence of resistant organisms. Although studies have been published on resistance rates for urinary pathogens from both hospital and general practitioner (GP) settings, there is little information from Long-Term Care Facilities (LTCFs) in Ireland. This study aimed to document the epidemiology and resistance rates in urinary isolates, in the LTCF and GP setting, from samples submitted to a typical microbiology laboratory. In 2010, there were 963 urinary isolates from LTCFs and 1,169 urinary isolates from GPs, identified from patients 65 years and over, with cytology suggestive of infection. E. coil was the most common causative organism identified. There were significantly higher levels of resistance to ampicillin, co-amoxiclav, ciprofloxacin, nitrofurantoin, trimethoprim, and piperacillin\\/tazobactam in the LTCF population compared to the GP population (e.g. for E. coli, 86%-v-69%; 30%-v- 21%; 58%-v-26%, 10%-v-3%, 68%-v-48%, 10%-v- 4% respectively). Isolates with resistance mechanisms to beta-lactams, were identified in both populations. Results presented in this paper demonstrate significant differences between resistance rates in LTCF and GP populations which suggest that there are implications for empiric antimicrobial prescribing for UTIs in the LTCF setting.

  1. Antibiotic resistance & pathogen profile in ventilator-associated pneumonia in a tertiary care hospital in India

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    Abhijit Chaudhury

    2016-01-01

    Results: VAP rates of 44.1, 43.8 and 26.3 were seen in 2011, 2012 and 2013, respectively. In all the three years, non-fermentative Gram-negative bacilli were the predominant organisms, followed by Pseudomonas spp. and Klebsiella spp. Staphylococcus aureus exhibited a downwards trend in prevalence from 50.0 per cent in 2011 to 34.9 per cent in 2013. An increase in vancomycin-resistant enterococci was seen from 4.3 per cent in 2012 to 8.3 per cent in 2013, while methicillin resistance amongst the S. aureus crossed the 50 per cent mark in 2013. An increasing trend in resistance was shown by Pseudomonas spp. for piperacillin-tazobactam (PTZ, amikacin and imipenem (IPM. For the non-fermenters, resistance frequency remained very high except for IPM (33.1% and polymyxin-B (2.4%. Interpretation & conclusions: Our findings show VAP as an important problem in the ICU setting. The incidence of multidrug-resistant pathogens was on the rise. The resistance pattern of these pathogens can help an institution to formulate effective antimicrobial policy. To have a comprehensive pan-India picture, multicentric studies are needed.

  2. Antibiotic prescribing policy and Clostridium difficile diarrhoea.

    LENUS (Irish Health Repository)

    O'Connor, K A

    2012-02-03

    BACKGROUND: Broad-spectrum antibiotics, particularly intravenous cephalosporins, are associated with Clostridium difficile diarrhoea. Diarrhoea due to C. difficile is a growing problem in hospitals, especially among elderly patients. AIM: To establish whether changing an antibiotic policy with the aim of reducing the use of injectable cephalosporins leads to a reduction in the incidence of C. difficile diarrhoea in elderly patients. DESIGN: Retrospective analysis. METHODS: A group of patients who were subject to the new antibiotic policy from the period following July 2000, were compared with patients who were admitted prior to July 2000 and were not subject to the new policy. Infections, antibiotic prescriptions and mortality rates were determined from case notes, and C. difficle diarrhoea rates from microbiological data. RESULTS: Intravenous cephalosporin use fell from 210 to 28 defined daily doses (p < 0.001) following the change in antibiotic policy, with a corresponding increase in piperacillin-tazobactam (p < 0.001) and moxifloxacin (p < 0.001) use. The new policy led to a significant reduction in C. difficile diarrhoea cases. The relative risk of developing C. difficile infection with the old policy compared to the new policy was 3.24 (95%CI 1.07-9.84, p = 0.03). DISCUSSION: The antibiotic policy was successfully introduced into an elderly care service. It reduced both intravenous cephalosporin use and C. difficile diarrhoea.

  3. Analysis of resistance, cross-resistance and antimicrobial combinations for Pseudomonas aeruginosa isolates from 1997 to 2009.

    Science.gov (United States)

    Master, Ronald N; Clark, Richard B; Karlowsky, James A; Ramirez, Julio; Bordon, Jose M

    2011-10-01

    Pseudomonas aeruginosa is a nosocomial and community-acquired pathogen associated with considerable patient morbidity and mortality. Multidrug resistance in P. aeruginosa is a concern owing to the limited therapeutic options available to treat infections due to this organism. In this study, rates of antimicrobial resistance of P. aeruginosa isolates collected by The Surveillance Network Database-USA (Eurofins Medinet, Chantilly, VA) from 1997 to 2009 were examined. The patient population and specimens were stratified according to patient setting and age as well as specimen source. Multidrug resistance was defined as resistance to three or more of the following antimicrobial agents: aztreonam; cefepime; ciprofloxacin; imipenem; gentamicin; and piperacillin/tazobactam (TZP). A total of 924740 P. aeruginosa isolates were examined in this study. Changes in resistance rates to individual antimicrobial agents were resistant P. aeruginosa to four, five and six antimicrobial agents. For isolates resistant to imipenem, aztreonam and gentamicin, ciprofloxacin had the highest cross-resistance rates. The greatest coverage against P. aeruginosa was by the combination of TZP plus amikacin (94%) followed by aztreonam plus amikacin (90%). Pseudomonas aeruginosa resistance rates remained steady or minimally declined to all antimicrobials from 1997 to 2009. Amongst the β-lactams, TZP has the greatest activity against P. aeruginosa. Copyright © 2011 Elsevier B.V. and the International Society of Chemotherapy. All rights reserved.

  4. Elizabethkingia meningosepticum in a Patient with Six-Year Bilateral Perma-Catheters.

    Science.gov (United States)

    Boroda, Konstantin; Li, Li

    2014-01-01

    Elizabethkingia meningosepticum (EM) is a saprophyte which is ubiquitous in nature, but not normally present in the human flora. Instances of infection are rare in the USA, but EM may be an emerging pathogen among immune-compromised patients. EM can cause a variety of infections, but nosocomial pneumonia and bacteremia have been the most commonly reported among immune-compromised adults. EM has proven difficult to treat with a mortality rate of 23%-41% in adult bacteremia. This is likely due to its resistance to commonly used empiric antibiotics for Gram-negative infections. A review of the literature suggests that there has been a shift EM's susceptibility profile over time along with a great variability in antibiotic susceptibilities reported. This signifies the importance of close monitoring of these changes. In this report we present a case of a 64-year-old male with end stage renal disease and bilateral subclavian perma-catheters, who was admitted with systemic inflammatory response syndrome. While initial peripheral blood cultures were negative, cultures later drawn from his perma-catheters revealed Corneybacterium species and EM. The patient was initially treated with empiric vancomycin and piperacillin-tazobactam. After antibiotics susceptibilities became available, he was treated with levofloxacin and ceftazidime. The patient improved, was culture negative, and later had perma-catheter removal.

  5. 药物诱发的免疫性溶血性贫血%Drug-induced immune hemolytic anemia

    Institute of Scientific and Technical Information of China (English)

    刘代红

    2012-01-01

    药物诱发的免疫性溶血性贫血( DIIHA)少见.临床表现为中重度溶血性贫血常见机制是产生药物依赖性抗体,常见药物为抗生素(如头孢替坦、头孢曲松钠和哌拉西林).少见机制是产生非药物依赖的自身抗体,致特发性温抗体型自身免疫性溶血性贫血,最常见药物是氟达拉滨.治疗首要是停药,并积极处理合并症.%Drug-induced immune hemolytic anemia (DHHA) is seldom seen,whose clinical manifestation is mild-to-severe hemolytic anemia. The common mechanism is the presence of drug-dependent antibodies,and the common drugs are antibiotics, such as cefotetan,ceftriaxone and piperacillin. On other hand,the uncommon mechanism is the presence of non-drug-dependent antibodies that can lead to idiopathic autoimmune hemolytic anemia. In such case,the most common drug is flu-darabine. Importantly,drug use should be stopped and the complications be actively treated.

  6. Antibiotic resistance of Vibrio cholera strains isolated from imported crocodiles from Thailand%泰国进口鳄鱼霍乱弧茵药敏试验

    Institute of Scientific and Technical Information of China (English)

    陈冬娥; 陈冠武; 苏建晖; 许先凯

    2012-01-01

    Twelve Vibrio cholera strains were isolated from sixty anal swabs in sampling inspection of the Crocodiles imported from Thailand. It was confirmed that the strains were non-O1, non-O139 Vibrio choleras by biochemical test and serological identification. Eighteen drugs were used in the antibiotic resistance test. The test showed that all the strains were sensitive to most drugs, moderately susceptible to acheomycin and resistance to ampicillin and piperacillin.%在某鳄鱼养殖场抽检的60份泰国进口鳄鱼肛拭子样品中,有12份检出霍乱弧菌。通过生化试验和血清学分型等鉴定,确认12株霍乱弧菌均为非0。非0。。群霍乱弧菌。采用18种抗菌药物进行药敏试验,结果显示所有菌株对大多数抗菌药物高度敏感,对四环素等药物中度敏感,对氨苄青霉素和氧呱嗪青霉素不敏感。

  7. Antimicrobial dosing in acute renal replacement.

    Science.gov (United States)

    Fissell, William H

    2013-01-01

    Acute kidney injury (AKI) is a common problem in hospitalized patients and is associated with significant morbidity and mortality. Two large trials showed no benefit from increased doses of renal replacement therapy (RRT) despite previous clinical data suggesting that increased clearance from RRT has beneficial effects. Since infection is the leading cause of death in AKI, my group and others hypothesized that increased RRT antibiotic clearance might create a competing morbidity. The data from my group, as well as those of other groups, show that many patients are underdosed when routine "1 size fits all" antibiotic dosing is used in patients with AKI receiving continuous RRT (CRRT). Here, concepts of drug distribution and clearance in AKI are briefly discussed and then 1 antibiotic (piperacillin) is discussed in depth to illustrate the challenges in applying the medical literature to clinical practice. The fact that published data on drug dosing in AKI and dialysis reflect the evolution of practice patterns and often do not apply to present prescribing habits is also discussed. A more general approach to drug dosing facilitates situation-specific prescribing by the nephrologist and critical care specialist. Copyright © 2013 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

  8. Prevalence of Gram Negative Bacteria in Diabetic Foot -A Clinico-Microbiological Study

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    G.S.Banashankari

    2012-07-01

    Full Text Available Aim and Objective: To determine the bacterial spectrum in diabetic foot lesions and analyze the antibiotic susceptibility pattern of the isolated bacteria. Methods and Methodology: Tissue samples/discharge/pus/ were cultured from 202 patients admitted for the treatment of diabetic foot infections. Specimens were tested by gram stain, culture and antibiotic sensitivity. Results: A total of 202 specimens were cultured, yielding 246 bacteria at the end of 18-24hrs. Gram negative aerobes were the most frequently isolated bacteria constituting 162 isolates (66%, followed by gram- positive aerobes 78 isolates (32%. Enterobacteriaceae group and P. aeruginosa strains were largely susceptible to imipenem (100%, piperacillin-tazobactam, ceftazidime, aminoglycosides, and ciprofloxacin. More than 70% of staphylococcus aureus was sensitive to methicillin. Cefoperazone + sulbactum showed about 67% sensitivity, while ciprofloxacin and amikacin were only 23% and 44% sensitive. MRSA was isolated in 20 cases (47% of S.aureus and Methicillin resistant coagulase negative staphylococcus in 2 cases (15% of coagulase negative staphylococcus. Methicillin resistant organisms were sensitive to vancomycin (95%. Conclusion: Diabetic foot infections are predominantly due to gram positive bacteria like Staphylococcus aureus or polymicrobial. There is a growing trend of isolating gram negative bacteria in these naïve lesions of the diabetic foot. The need for adequate gram negative antibacterial coverage at the commencement of diabetic foot therapy is essential to prevent and treat limb/life threatening infections.

  9. Distribution of the Strains of Multidrug-resistant, Extensively Drug-resistant, and Pandrug-resistant Pseudomonas aeruginosa Isolates from Burn Patients

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    Hajieh Ghasemian Safaei

    2017-01-01

    Full Text Available Background: Pseudomonas aeruginosa is an opportunistic and Gram-negative pathogen that is used as the most important factor in burn wound infections, and due to the rapid acquisition of multidrug resistance (MDR, it causes high mortality rates in these sectors. Thus, diagnosis and assessment of antibiotic resistance patterns are very important in these patients. The aim of this study was to evaluate antibiotic resistance pattern and determining P. aeruginosa MDR. Materials and Methods: In this study, phenotypic, biochemical, and polymerase chain reaction tests were used to identify P. aeruginosa from 120 wound burn samples that 96 samples were detected to P. aeruginosa species. In the next step, according to the Clinical and Laboratory Standard Institute standard guidelines, antibiogram test was performed by disk diffusion method for amikacin, ciprofloxacin, norfloxacin, gentamicin, cefepime, aztreonam, meropenem, colistin, ceftazidime, and piperacillin-tazobactam antibiotics. Antibiotic data were analyzed by WHONET software; finally, the rate of antibiotic resistance and MDR strains was determined. Results: The highest antibiotic resistance belonged to amikacin (94.8% and norfloxacin (90.6%; in contrast, colistin (8.3% had the lowest and the MDR strains were MDR (95.8% and extensively drug resistance (XDR (87.5%. Conclusion: In this study, there was MDR with an alarming rate including MDR (95.8%, XDR (87.5%, and pan-drug resistance (0%. As a result, given antibiotics to patients should be controlled by the antibiogram results to avoid increasing MDR strains.

  10. Comparison of the Resistance of Diabetic Foot Isolates with Community and Intensive Care Unit Resistance Rates

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    Filiz Pehlivanoğlu

    2011-12-01

    Full Text Available Objective: Using proper antibiotics in diabetic foot infections can save an extremity. The goal of this study was to determine the antibiotic susceptibility of the most frequent isolates from diabetic foot infections, to compare these results with those for species obtained from both intensive care unit and community-acquired infections, and to re-evaluate the empirical antimicrobial therapy in diabetic foot infections. Material and Methods: Antibiotic susceptibility testing was performed on bacteria from diabetic foot cultures, ICU and community-acquired infections. Skin and soft tissue samples of a total of 181 patients have been studied. Sensitivity to ampicillin/ sulbactam (SAM, ciprofloxacin (CIP, piperacillin/tazobactam (TZP, cefoperazone/sulbactam (SCF, amikacin (AN, meropenem (MEM and cefepime (FEP has been investigated. Results: Among the samples, reproduction was detected in 154 (85%, 132 of which (79.5% contained gram-negative bacteria (46 Enterobacter spp, 36 Pseudomonas spp, 30 Acinetobacter spp, 20 others. Resistance of bacteria isolated from diabetic foot cultures was less than the one of bacteria isolated from ICU and more than the one from community-acquired infections. However, an increased resistance was detected to ciprofloxacin, frequently used in urinary infections, in agents from community-acquired infections. Conclusion: In conclusion, due to the risk of possible loss of tissue/extremity and possible antibiotic resistance, treatment should be started empirically and continued considering the culture results. (The Me di cal Bul le tin of Ha se ki 2011; 49: 137-40

  11. Rates of antimicrobial resistance in latin america (2004-2007 and in vitro activity of the glycylcycline tigecycline and of other antibiotics

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    Flávia Rossi

    Full Text Available As a part of the Tigecycline Evaluation and Surveillance Trial (T.E.S.T., Gram-positive and Gram-negative bacterial isolates were collected from 33 centers in Latin America (centers in Argentina, Brazil, Chile, Colombia, Guatemala, Honduras, Jamaica, Mexico, Panama, Puerto Rico, and Venezuela from January 2004 to September 2007. Argentina and Mexico were the greatest contributors of isolates to this study. Susceptibilities were determined according to Clinical Laboratory Standards Institute guidelines. Resistance levels were high for most key organisms across Latin America: 48.3% of Staphylococcus aureus isolates were methicillin-resistant while 21.4% of Acinetobacter spp. isolates were imipenem-resistant. Extended-spectrum β-lactamase were reported in 36.7% of Klebsiella pneumoniae and 20.8% of E. coli isolates. Tigecycline was the most active agent against Gram-positive isolates. Tigecycline was also highly active against all Gram-negative organisms, with the exception of Pseuodomonas aeruginosa, against which piperacillin-tazobactam was the most active agent tested (79.3% of isolates susceptible. The in vitro activity of tigecycline against both Gram-positive and Gram-negative isolates indicates that it may be an useful tool for the treatment of nosocomial infections, even those caused by organisms that are resistant to other antibacterial agents.

  12. Patterns of Antimicrobial Resistance in the Causative Organisms of Spontaneous Bacterial Peritonitis: A Single Centre, Six-Year Experience of 1981 Samples

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    Sara Sheikhbahaei

    2014-01-01

    Full Text Available Background/Aims. Spontaneous bacterial peritonitis (SBP is one of the leading causes of morbidity and mortality in patients with cirrhosis. This study aims to determine the microbial agents of SBP and the pattern of antibiotic resistance, in a large number of ascitic samples. Methodology. In a cross-sectional, single center, hospital based study, 1981 consecutive ascitic fluid samples were recruited from 2005 to 2011. Samples were dichotomized into three-year periods, in order to assess the trend of resistance to the first-line empirical antibiotics. Results. SBP was found in 482 (24.33% of samples, of which 314 (65.15% were culture positive. The most prevalent isolated pathogen was E. coli (33.8%, followed by staphylococcus aureus (8.9% and Enterococcus (8.6%. No significant changes in the proportion of gram-negative/gram-positive infections occurred during this period. A percentage of resistant strains to cefotaxime (62.5%, 85.7%, ceftazidim (73%, 82.1%, ciprofloxacin (30, 59.8%, ofloxacin (36.8%, 50%, and oxacilin (35%, 51.6% were significantly increased. E. coli was most sensitive to imipenem, piperacillin-tazobactam, amikacin, ceftizoxime, and gentamicin. Conclusions. The microbial aetiology of SBP remains relatively constant. However, the resistance rate especially to the first-line recommended antibiotics was significantly increased. This pattern must be watched closely and taken into account in empirical antibiotic treatment.

  13. Distribution, detection of enterotoxigenic strains and antimicrobial drug susceptibility patterns of Bacteroides fragilis group in diarrheic and non-diarrheic feces from Brazilian infants

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    Débora Paula Ferreira

    2010-10-01

    Full Text Available Despite the importance of gastrointestinal diseases and their global distribution, affecting millions of individuals around the world, the role and antimicrobial susceptibility patterns of anaerobic bacteria such as those in the Bacteroides fragilis group (BFG are still unclear in young children. This study investigated the occurrence and distribution of species in the BFG and enterotoxigenic strains in the fecal microbiota of children and their antimicrobial susceptibility patterns. Diarrheic (n=110 and non-diarrheic (n=65 fecal samples from children aged 0-5 years old were evaluated. BFG strains were isolated and identified by conventional biochemical, physiological and molecular approaches. Alternatively, bacteria and enterotoxigenic strains were detected directly from feces by molecular biology. Antimicrobial drug susceptibility patterns were determined by the agar dilution method according to the guidelines for isolated bacteria. BFG was detected in 64.3% of the fecal samples (55% diarrheic and 80.4% non-diarrheic, and 4.6% were enterotoxigenic. Antimicrobial resistance was observed against ampicillin, ampicillin/sulbactam, piperacillin/tazobactam, meropenem, ceftriaxone, clindamycin and chloramphenicol. The data show that these bacteria are prevalent in fecal microbiota at higher levels in healthy children. The molecular methodology was more effective in identifying the B. fragilis group when compared to the biochemical and physiological techniques. The observation of high resistance levels stimulates thoughts about the indiscriminate use of antimicrobial drugs in early infancy. Further quantitative studies are needed to gain a better understanding of the role of these bacteria in acute diarrhea in children.

  14. Clinical Impact of Discordant Prescribing of Fluoroquinolones and Alternative Treatments in Escherichia coli Pyelonephritis.

    Science.gov (United States)

    Hong, Minh T; Seifert, Charles F

    2016-10-01

    The emergence of resistant Escherichia coli to fluoroquinolones (FQs) is of growing concern, yet the latest guidelines for the treatment of pyelonephritis still recommend FQs as first-line treatment. Our primary objective was to determine the impact of discordant prescribing of FQs in E coli pyelonephritis on hospital length of stay (LOS) and early clinical response (ECR). We retrospectively compared discordant and concordant prescribing of FQs for LOS and ECR. We also compared FQs, ceftriaxone, piperacillin/tazobactam, and carbapenems for these clinical outcomes. Forty-nine patients included in the comparison between discordant (n = 9) and concordant (n = 40) prescribing of FQs. There was significantly lower ECR in patients with discordant prescribing of FQs (38 of 40, 95% vs 5 of 9, 55.6%, P = .0074) and a trend toward longer LOS (4 [2.3] days vs 3 [2.0] days, P = .0571). Illness severity, estimated using Simplified Acute Physiology Score (SAPS II) score, was similar between groups (P = .717). There was a significantly decreased ECR and a trend toward increased LOS when FQs were used in FQ-resistant E coli. Regarding alternative treatment for E coli pyelonephritis, ceftriaxone was as effective as concordant FQs and significantly better than discordant FQs. © The Author(s) 2015.

  15. Correlation between drug resistance of Pseudomonas aeruginosa causing pneumonia and mortality%医院铜绿假单胞菌性肺炎对抗菌药物耐药性及死亡率相关性研究

    Institute of Scientific and Technical Information of China (English)

    冯娜娜; 李华茵; 宋元林; 王琴; 周春妹; 谢红梅

    2012-01-01

    OBJECTIVE To explore the drug resistance of Pseudomonas aeruginosa causing pneumonia and the related risk factors for mortality. METHODS This prospective cohort clinical study was conducted in a tertiary surgical intensive care unit (SICU) in Zhongshan Hospital, Fudan University. From Jan 2007 to Dec 2010. a total of 53 patients who underwent endotracheal intubation and ventilated for more than 48 hours and were with positive culture of P. aeruginosa were enrolled in this study; the drug susceptibility testing was performed by KB method. The vital signs, ventilation parameters, treatment regiments of the patients were recorded, the follow-up of the mortality within 28 days was carried out. RESULTS Of 8 commonly used antibiotics against P. aeruginosa, amikacin was with the lowest resistance rate of 15. 1%, followed by cefoperazone/sulbactam, meropenem, ceftazidime, cefepime, and imipenem) the resistance rate to piperacillin/tazobactam was the highest (47. 2%), the multidrug-resistant rate was 32.1% ; of 53 patients, 17 patients died and 11 patients died within 28 days; the drug resistance rates of P. aeruginosa to piperacillin/tazobactam and imipenem and the multidrug-resistance rate were much higher in death group than in the survival group (76. 5% vs 33. 3%, 58. 8% vs 27. 8%, and 58. 8% vs. 19.4%, respectively) (P<0. 05). There was significant difference between survivors and non-survivors for age (75. 5 vs 56. 0 respectively) (P<0. 05); of the patients in the death group, the survival days of the patients resistant to imipenem were less than those of the patients without imipenem-resistance (P=0. 025) ; multivariate logistic regression analysis showed that there was significant correlation between the age, duration of mechanical ventilation, multidrug-resistance of P. aeruginosa, resistance to piperacillin/tazobactam and the mortality. CONCLUSION For the dead patients,the survival days of imipenem-resistant patients are significantly shortened) the age, duration

  16. [Occurrence and antimicrobial susceptibility of Morganella morganii strains isolated from clinical samples].

    Science.gov (United States)

    Zalas-Wiecek, Patrycja; Gospodarek, Eugenia; Wróblewska, Joanna

    2012-01-01

    The aim of this study was the evaluation of occurrence and antimicrobial susceptibility of M morganii rods isolated from clinical samples. This study included 201 strains isolated in the Clinical Microbiology Department of Dr. A. Jurasz University Hospital in 2008-2010. Identification to species was carried out on the basis of the results of biochemical reactions included in the tests ID 32E and VITEK2 GN. Antimicrobial susceptibility of M. morganii rods was determined by the disk-diffusion method on Mueller-Hinton II Agar. Strains of M morganii most commonly isolated from skin and soft tissue, and material taken from the urinary tract, mainly from patients of Anesthesiology and Intensive Care Unit, Department of General and Vascular Surgery and Department of General Surgery and Endocrinology. All of M morganii strains isolated during the three years were susceptible to carbapenems. We reported decrease of strains susceptible to piperacillin and chloramphenicol. In 2010 we showed a higher percentage of strains intermediate to tigecycline, compared with 2009. We observed increase in the percentage of strains resistant to cefoperazone with sulbactam and reported decrease in the percentage of strains resistant and intermediate to aminoglycosides. Extended Spectrum Beta-Lactamases were produced by 13 (6,5%) of M morganii strains.

  17. Distribution of the Strains of Multidrug-resistant, Extensively Drug-resistant, and Pandrug-resistant Pseudomonas aeruginosa Isolates from Burn Patients.

    Science.gov (United States)

    Safaei, Hajieh Ghasemian; Moghim, Sharareh; Isfahani, Bahram Nasr; Fazeli, Hossein; Poursina, Farkhondeh; Yadegari, Sima; Nasirmoghadas, Pourya; Hosseininassab Nodoushan, Seyed Abolfazl

    2017-01-01

    Pseudomonas aeruginosa is an opportunistic and Gram-negative pathogen that is used as the most important factor in burn wound infections, and due to the rapid acquisition of multidrug resistance (MDR), it causes high mortality rates in these sectors. Thus, diagnosis and assessment of antibiotic resistance patterns are very important in these patients. The aim of this study was to evaluate antibiotic resistance pattern and determining P. aeruginosa MDR. In this study, phenotypic, biochemical, and polymerase chain reaction tests were used to identify P. aeruginosa from 120 wound burn samples that 96 samples were detected to P. aeruginosa species. In the next step, according to the Clinical and Laboratory Standard Institute standard guidelines, antibiogram test was performed by disk diffusion method for amikacin, ciprofloxacin, norfloxacin, gentamicin, cefepime, aztreonam, meropenem, colistin, ceftazidime, and piperacillin-tazobactam antibiotics. Antibiotic data were analyzed by WHONET software; finally, the rate of antibiotic resistance and MDR strains was determined. The highest antibiotic resistance belonged to amikacin (94.8%) and norfloxacin (90.6%); in contrast, colistin (8.3%) had the lowest and the MDR strains were MDR (95.8%) and extensively drug resistance (XDR) (87.5%). In this study, there was MDR with an alarming rate including MDR (95.8%), XDR (87.5%), and pan-drug resistance (0%). As a result, given antibiotics to patients should be controlled by the antibiogram results to avoid increasing MDR strains.

  18. Cepas de Pseudomonas spp. produtoras de metalo-betalactamase isoladas no Hospital Geral de Fortaleza Metallo-betalactamase producing Pseudomonas spp. strains isolated in the Hospital Geral de Fortaleza

    Directory of Open Access Journals (Sweden)

    Júlio César Nogueira Torres

    2006-10-01

    2002 to June 2003. Identification and sensibility tests were done by the MicroScan®/WalkAway automation system. The multiresisting strains were confirmed by the diffusion method in disk. The triage to detect MBLs productive samples was accomplished by the double diffusion method, using disks containing sodium mercaptoacetat. Among these samples, 24 (7.71% indicated production of MBLs and multiresistance standard in the midst of the studied strains. The antimicrobials to which the strains presented larger sensibility were piperacillin/tazobactam, with 255 (82% of sensibility, followed by isolated piperacillin with 229 (73.63%; imipenem with 195 (62.70%; ticarcillin/clavulanic acid with 193 (62.05%; and ceftazidime with 138 (44.37%. The detection of these samples configures an emerging problem, with important implications in the antimicrobial therapeutic.

  19. Drug sensitivity analysis of type 2 diabetes complicated with urinary tract infection in Handan City%邯郸市2型糖尿病伴尿路感染的药敏分析

    Institute of Scientific and Technical Information of China (English)

    高玉梅; 韩永霞; 冯采兰

    2013-01-01

    目的 分析2型糖尿病伴尿路感染病例药敏试验结果,以指导临床合理选择抗生素.方法 取糖尿病伴尿路感染患者的清洁中段尿进行培养,采用配套的药敏卡进行药敏试验;按糖尿病伴尿路感染和非糖尿病伴尿路感染分组进行分析.结果 糖尿病伴尿路感染组患者感染的菌种存在多样性,糖尿病伴尿路感染组比非糖尿病伴尿路感染组对亚胺培南(敏感率91.49%)、阿米卡星(敏感率53.19%)敏感率高,且两组比较,差异有统计学意义(P<0.05).两组对头孢哌酮/舒巴坦、哌拉西林/他唑巴坦敏感率均>60%,所有菌株均对亚胺培南、阿米卡星敏感;糖尿病伴尿路感染阳性组有4例合并肠球菌感染.结论 糖尿病伴尿路感染患者应根据药敏试验结果合理使用抗生素,亚胺培南、阿米卡星、头孢哌酮/舒巴坦、哌拉西林/他唑巴坦为敏感药物.%[Objective] To analyze the results of drug sensitive test of type 2 diabetes complicated with urinary tract infection cases, guide reasonable choice of antibiotics in clinic. [ Methods] The samples of clean midstream urine from patients with diabetes and u-rinary tract infection were cultured, and the drug sensitive test was conducted with targeted drug sensitivity cards. Two groups, which included the diabetes with urinary tract infection group and the non-diabetes with urinary tract infection group, were analyzed. [ Results] The patients in the diabetes with urinary tract infection group were infected with a variety of bacteria. The sensitivity to imipenem (91.49% ) and amikacin (53.19% ) of the diabetes with urinary tract infection group was higher than that of the non-diabetes with urinary tract infection group, and the differences were significant (P < 0. 05). The sensitivity to cefoperazone/ sulbactam and piperacillin/tazobactam of both two groups were higher than 60% , while all strains were sensitive to imipenem and amikacin. 4 cases were

  20. 河源市70株沙门菌的血清型、药敏结果及多重耐药性分析%Serotype distribution,drug resistance and multi-drug resistance of 70 cases Salmonella strains in Heyuan

    Institute of Scientific and Technical Information of China (English)

    汪云霞; 薛春玲; 黄东平

    2015-01-01

    Objective To analyze the serotype and antibiotic resistance of Salmonella in Heyuanand provide evidence for rational use of drugtreatmentclinical.Methods Clinical specimens were isolated and cultured at 35℃,manual biochemical identification and automated microbial identification system were used to identify suspicious Salmonella.The positive bacterial strains were executed susceptibility testing by disk diffusion method and serological test was used to identify the serotype.Results 45 strains of Salmonella typhimuriumwere identified from the 70 strains of Salmonella (64.28%),and 18 strains of Salmonella enteritidis (25.71%).These strains were seriously resistant to ampicillin,the resistance rate was up to 88.6%,the resistance rate to tetracycline and piperacillin was 82.9% and 81.4% respectively,the resistance rates to ciprofloxacin,levofloxacin and piperacillin tazobactam were lower than 10%,which has not been found resistant to imipenem and meropenem.There were 17 strains resistant to more than three antimicrobial agents,multi-resistant strains accounted for 58.6% of the total (41/70).Conclusions Salmonella typhimurium is the main serotype of Salmonella infection in Heyuan,the resistance of part of antimicrobial are significantly high,clinicians should choose medication based on susceptibility results,and avoid the emergence of multi-drug resistant.%目的 了解河源地区沙门菌的血清型分布及耐药情况,为指导临床合理用药提供依据.方法 35℃分离培养临床送检标本,可疑沙门菌经沙门菌五管生化鉴定及全自动微生物鉴定仪分析后,阳性菌株采用纸片扩散法进行药敏试验,再采用血清学试验进行分型.结果 70株沙门氏菌中鉴定出鼠伤寒沙门菌45株(64.28%),肠炎沙门菌18株(25.71%);耐药情况以氨苄西林的耐药率最高为88.6%,四环素、哌拉西林的耐药率亦较高,为82.9%、81.4%,对环丙沙星、左氧氟沙星、哌拉西林他唑巴

  1. An analysis of epidemiological characteristics and drug resistance of 44 cases of children Salmonella infections%儿童沙门菌感染44例流行病学特征和耐药分析

    Institute of Scientific and Technical Information of China (English)

    谭丽丽

    2014-01-01

    ObjectiveTo understand the epidemiological characteristics and drug resistance of children Salmonella infections in this area in recent years. Methods Salmonella strains of clinically diagnosed Salmonella infections which were extracted from the department of pediatrics and patients'clinical data from 2008 to 2012 in the microbiology laboratory in our hospital were analyzed retrospectively.Results44 Salmonella strains were mainly extracted from infants less than one year old (59.09%).There were eight serotypes,and Salmonella typhimurium was the main serotype (65.91%).The sensitivity of Salmonella typhimurium towards imipenem,ceftazidime,ceftriaxone and cefotaxime were 100.00%,100.00%,96.56% and 96.56% respectively;its sensitivity towards ampicillin, trimethoprim/sulfamethoxazole,piperacillin and ciprofloxacin were 24.14%,41.38%,41.38% and 55.17% respectively.Conclusion The majority of children Salmonella infections in this area are infant infections of Salmonella typhimurium.The Salmonella typhimurium has a high sensitivity to imipenem and the third generation cephalosporins,and a low sensitivity to ampicillin,trimethoprim/sulfamethoxazole,piperacillin and ciprofloxacin.%目的:了解近年本地区儿童沙门菌感染的流行病学特征和耐药性。方法回顾分析本院微生物室2008~2012年从儿科分离到的临床确诊为沙门菌感染的沙门菌株及临床资料。结果44株沙门菌主要分离自<1岁婴幼儿(占59.09%)。共分8种血清型,鼠伤寒沙门菌为主要血清型(占65.91%)。鼠伤寒沙门菌对亚胺培南、头孢他啶、头孢曲松、头孢噻肟敏感率分别为100.00%、100.00%、96.56%、96.56%;对氨苄西林,复方新诺明、哌拉西林、环丙沙星敏感率分别24.14%、41.38%、41.38%、55.17%。结论本地区儿童沙门菌感染以婴幼儿鼠伤寒沙门菌感染为主。鼠伤寒沙门菌对亚胺培南、三代头孢菌素敏感率高,对氨苄西林、复方新诺明、哌拉

  2. Actividad "in vitro" de diferentes antibacterianos sobre bacilos gram-negativos no fermentadores, excluidos Pseudomonas aeruginosa y Acinetobacter spp ‘In vitro' activity of different antimicrobial agents on gram-negative nonfermentative bacilli, excluding Pseudomonas aeruginosa and Acinetobacter spp

    Directory of Open Access Journals (Sweden)

    C.A. Vay

    2005-03-01

    antibacterianos a fin de abordar la elección correcta del mismo. Debido a la marcada multirresistencia de algunas especies, surge la necesidad del desarrollo de nuevos agentes antimicrobianos que posean actividad sobre este grupo de bacterias, así como tambien la búsqueda de combinaciones sinérgicas.Gram-negative nonfermentative bacilli (NFB are widely spread in the environment. Besides of difficulties for identification, they often have a marked multiresistance to antimicrobial agents, including those active against Pseudomonas aeruginosa. The objective of this study was to evaluate the ‘in vitro' activity of different antimicrobial agents on 177 gram-negative nonfermentative bacilli isolates (excluding Pseudomonas aeruginosa and Acinetobacter spp. isolated from clinical specimens. Minimum inhibitory concentrations (MIC were determined according to the Mueller Hinton agar dilution method against the following antibacterial agents: ampicillin, piperacillin, piperacillin-tazobactam, sulbactam, cefoperazone, cefoperazone-sulbactam, ceftazidime, cefepime, aztreonam, imipenem, meropenem, colistin, gentamicin, amikacin, trimethoprim-sulfamethoxazole, chloramphenicol, erythromycin, rifampin, norfloxacin, ciprofloxacin and minocycline. Seven isolates: Sphingobacterium multivorum (2 , Sphingobacterium spiritivorum (1, Empedobacter brevis (1, Weeksella virosa (1, Bergeyella zoohelcum (1 and Oligella urethralis (1, were tested for amoxicillin-clavulanic acid and ampicillin-sulbactam susceptibility, and susceptibility to cefoperazone or sulbactam was not determined. Multiresistance was generally found in Stenotrophomonas maltophilia, Burkholderia cepacia, Chryseobacterium spp., Myroides spp., Achromobacter xylosoxidans, and Ochrobactrum anthropi isolates. On the other hand, Pseudomonas stutzeri, Shewanella putrefaciens-algae, Sphingomonas paucimobilis, and Pseudomonas oryzihabitans, Bergeyella zoohelcum, Weeksella virosa and Oligella urethralis were widely susceptible to the

  3. Detection of a IMP-4 type metal beta lactamase-producing Klebsiella pneumonia highly resistant to carbapenem drugs%一株高度耐碳青霉烯类药物的肺炎克雷伯菌耐药性研究

    Institute of Scientific and Technical Information of China (English)

    王旭明; 李天娇; 莫成锦

    2011-01-01

    Objective To understand the resistant mechanism of a Klebsiella pneumonia strain highly resistant to to carbapenem drugs. Methods Both broth microdilution and Etest method were usef for antimicrobial susceptibility test of Klebsiella pneumonia to carbapenemases, modified Hodge test and double disk synergy method were uxed for phenotype detection and multiple groups of carbapenem resistance related gene primers PCR and sequencing was used for genotype determination with assistance of Beijing University Institute of Clinical Pharmacology. Results Klebsiella pneumonia resistant to on commonly used clinical imipenem (mic>32ug/ml),meropenem (mic>32ug/ml),the first to fourth generation of cephalosporins, quinolone and gentamicin, cefoxitin, aztreonam trimethoprim/sulphamethoxazole, telracycline minocycline, ampicillin, ampicillin/sulbactam, piperacillin, piperacillin/tazobactam, amoxicillin/clavulanic acid, cefoperazone/sulbactam, but sensitive to amikacin and polymyxin B. carbapenem resistance gene was blaIMP-4. Conclusion IMP-4 type metal lactamase Klebsiella pneumonia resistant to most common antibacterials has been detected in this hospital and attention be paid to monitoring and treatment.%目的 了解从临床患者病灶中分离到的一株高度耐碳青霉烯类药物的肺炎克雷伯菌的耐药机制.方法 药敏试验采用微量肉汤稀释法与etest法,碳青霉烯酶表型检测采用改良Hodge试验和双纸片增效法,其基因型测定采用多组碳青霉烯耐药相关基因引物PCR并测序,由北京大学临床药理研究所负责完成.结果 药敏测试结果除对阿米卡星和多粘菌素敏感外,对临床常用亚胺培南(mic>32ug/ml)、美罗培南(mic>32ug/ml)、一至四代的头孢菌素类、硅诺酮类以及庆大霉素、头孢西丁、氨曲南、复方新诺明、四环素、美满霉素、氨苄西林、氨苄西林/舒巴坦、哌拉西林、哌拉西林/他唑巴坦、阿莫西林/棒酸、头孢哌酮/舒巴坦,

  4. The study of antibiotic resistance profiles of Salmonella isolated in Nantong and characterization molecule mechnism%南通地区伤寒沙门菌质粒介导的耐药性转移的初步研究

    Institute of Scientific and Technical Information of China (English)

    孙晓雷; 冒群; 练维; 熊海平

    2013-01-01

    Objective To investigate antibiotic resistance profiles of Salmonella in Nantong and characterization of related molecule mechnism according the plasmids which are carrying antibiotic resistance genes. Methods 67 Salmonella strains were isolated in Nantong area during 2009-2011. The susceptibility of to antibiotics were tested by Microscan WalkAway40 and the disk diffusion assay. Plasmids detection were carried out for 67 strains Plasmid DNA was extracted by Alkaline lysis method. Conjugational transfer test was carried out using donor (Salmonella) and receiver(Escherichia coli), then mixed them at 37℃ for 24 hours. Results Resistance rate of 67 strains of salmonella to 14 antibiotics was 74.6% (50/67), some strains(31.3%, 50/67) can resistant to more than 2 antibiotics, and display multiple resistance characteristic.Part of 67 strains of Salmonella carry plasmids( 15%, 10/67), and the MW of plasmids is from 0.6~4kb. Most of strains (7/10) carry 1.4kb plasmid, and multiple resistance characteristic in Salmonella related to all these plasmids. Conclusion The strains of salmonella in Nantong area generally show multiple resistance to ampicillin and piperacillin. Resistance in Salmonella to cefepime and ammonia are higher than that of ampicillin,piperacillin and ceftazidime. Plasmids was limited existed in 67 strains of Salmonella. Not only small one(2kb) carry antibiotic resistant genes and transfer from donor to receiver.%目的 通过对南通地区伤寒沙门菌的耐药性分析,并对其携带的质粒进行PCR检测、分类其上的耐药基因,从而阐明定位于质粒上的整合子介导的耐药性传播的分子机制.方法 收集2009-2011年间南通地区的食源性伤寒沙门菌67株,采用K-B纸片扩散法进行药敏试验确定其耐药谱;筛选出多重耐药性菌株,提取质粒;选择携带质粒的耐药性菌株,以大肠埃希菌为受体进行接合试验.结果 南通地区沙门菌74.6%的沙门菌株(50/67)对

  5. 产ESBL大肠埃希菌和肺炎克雷伯菌的临床分布及耐药性特点%Clinical distribution of ESBL-producing E.coli and K.pneumoniae and analysis of drug resistance

    Institute of Scientific and Technical Information of China (English)

    张永恩; 陈茜; 牛肖梅; 彭丽娥

    2013-01-01

    Objective To investigate the drag resistance of extended-spectrum β-lactamase-producing E. coli (ESBL-EC) and ESBL-producing K. pneumoniae (ESBL-KP) in hospital. Methods The data of the resistance of ESBL-EC and ESBL-KP to commonly used antibiotics from clinical microbiology laboratory in the hospital from 2010 to 2011were analyzed. Results ESBL-EC and ESBL-KP were all totally sensitive to imipenem and cilastatin sodium, and highly sensitive to cefoxitin and amikacin (>80%). ESBL-EC and ESBL-KP showed descending drug resistance to ceftazidime and cefepime, but they were totally resistant to most/Mactam antibiotics (ampicillin, piperacil-lin, ticarcillin, cefazolin, ceftriaxone, cefotaxime, cefoperazone). ESBL-EC were highly sensitive to β-lactamase inhibitors (>92%), but ESBL-KP were less sensitive to /J-lactamase inhibitors (50%~89% to cefoperazone/sulbactam and 67%~92% to piperacillin/tazobactam). The drug resistance rates of ESBL-EC to levofloxacin were 57%~81% and that of ESBL-KP to levofloxacin were 16%~41%. Conclusion Choosing antibiotics according to the susceptibility test is one of the principles to increase the success rate of anti-infection treatment and reduce drug resistance. Carbapenems are the premium choice for ESBL-EC and ESBL-KP. β-lactamase inhibitors, cefoxitin and amikacin are also good choices.%目的 了解某综合医院产ESBL大肠埃希菌(ESBL-EC)和肺炎克雷伯菌(ESBL-KP)耐药性的变迁.方法 分析该医院2010-2011年临床微生物室上报医院感染控制科ESBL-EC及ESBL-KP对常用抗菌药物的耐药性变迁数据.结果 碳青霉烯类亚胺培南-西司他丁对ESBL-EC及ESBL-KP保持完全敏感,头孢西丁及阿米卡星对ESBL-EC及ESBL-KP均有良好的敏感性(>80%),头孢他啶及头孢吡肟耐药率逐年下降,但ESBL-EC及ESBL-KP对大多数β-内酰胺类药(氨苄西林,哌拉西林,替卡西林,头孢唑林,头孢曲松,头孢噻肟,头孢哌酮)完全耐药.含酶抑制剂对ESBL-EC

  6. 老年VAP嗜麦芽寡养单胞菌感染及耐药性分析%Infection and drug-resistance of Stenotrophomonas maltophilia in geriatric patients with ventilator-associated pneumonia

    Institute of Scientific and Technical Information of China (English)

    吴丽丽; 沈世恩; 魏凌云; 叶友仙; 于小妹

    2011-01-01

    目的 研究老年VAP嗜麦芽寡养单胞菌(SMA)感染及耐药特征.方法 从161例老年患者分离的30株嗜麦芽寡养单胞菌采用纸片扩散法进行药敏试验,并对抗生素耐药结果进行回顾性分析.结果 30株嗜麦芽寡养单胞菌对氨节西林、亚胺培南、美罗培南、头抱哇琳、氨曲南、庆大霉素、阿米卡星高度耐药(100%,96.6700,96.67%,93.3300,80.00肠,73.3300);对头胞吡肟,头胞他啶,头胞噻肟耐药率较高(50.00%,50.00%and60.00%),对左氧氟沙星,环丙沙星耐药率接近50%(40.0000,46.67%);但对复方新诺明、头孢哌酮/舒巴坦、哌拉西林/他唑巴坦耐药率较低(3.33%, 10.00 %,16.6700)0结论嗜麦芽寡养单胞菌对常用抗菌药物呈多重耐药,在老年VAP感染已十分严重,它的首选药物为复方新诺明、头孢哌酮/舒巴坦、哌拉西林/他唑巴坦.%To investigate the infectious and resistant characteristics of Stenotrophomonas maltophilia (S. maltophilia)in geriatric patients with ventilator-associated pneumonia (VAP), and improve the level of clinical prevention and therapy of S.maltophilia infection, 161 geriatric patients with ventilator respiration treatment were monitored objectively. The microbial sensitivity of 30 isolates of S. maltophilia and antibiotic test results were retrospectively analyzed. Thirty isolates of S. naltophilia were highly resistant to ampicillin, imipenem, meropenem, cefazolin, aztreonam, gentamicin, and amikacin respectively (100%, 96.67%, 96.67%, 93.33%, 80.00% and 73.33%, respectively); higher resistant to cefepime,ceftazidime, and cefotaxime respectively(550.00% ,50.00% and 60.00%, respectively). The resistance rates to levofloxacin and ciprofloxacin were close to 50.00% (40.00% and 46.67%, respectively), but lower to trimethoprim-sulfamethoxazole, cefoperazone/sulbactam and piperacillin/ tazobactam (3.33%, 10.00 % and 16.67 %, respectively). It's suggested that S. maltophilia shows

  7. 48株流感嗜血杆菌耐药性分析及β-内酰胺酶基因检测%Analysis on antimicrobial resistance and beta-lactamases gene detection of 48 haemophilus influenzae

    Institute of Scientific and Technical Information of China (English)

    桂和翠; 王中新; 沈继录

    2012-01-01

    resistant rate to cefepime, ceftriaxome, ciprofloxacin and levofloxacin was 6. 25%. The hemophilus influenzae were not resistant to piperacillin tazobatam and imipenem. The 10 resistant strains to ampicillin all produced β-lactamases. The prevalence of β-lactamase was 20. 83% . TEM gene was detected in all genotypes of β-lactamases-producing 10 strains. Conclusion The compound sulfamethoxazole and tetrocycline should not be used as empirical treatment of haemophilus influenzae infection. The ampicillin could be used as empirical treatment. The piperacillin-tazobatam and imipenem could be chosen ideally in ampicillin resistant straints. The more attentions should be paid to the resistance of haemophilus influenzae to Quinolone drugs. TEM type of β-lactamase production is the main ampicillin-resistant mechanism of the tested strain.

  8. 铜绿假单胞菌和鲍曼不动杆菌超广谱β-内酰胺酶的检测及耐药性分析%Detection and analysis of the resistance of extended-spectrum β-lactamase in Pseudomonas aeruginosa and in Acinetobacter baumannii

    Institute of Scientific and Technical Information of China (English)

    刘吉纯; 张艳菊; 郝英姿

    2011-01-01

    目的 了解产ESBLs铜绿假单胞菌(PA)和鲍曼不动杆菌(BA)的检出率并观察其耐药特性,为临床合理应用抗菌药物提供依据.方法 采用上海复星长征生物公司佰璐鉴定系统对临床分离株进行鉴定,药敏试验和ESBLs检测分别采用CLSI推荐的K-B纸片扩散法和表型确证试验进行,资料统计分析应用whonet5.3软件和SPSS-10.0软件.结果 产ESBLsPA检出率为19.25%,产ESBLsBA检出率为23.75%,产ESBLsPA的耐药率为对哌拉两林100%、阿莫两林100%、头孢他啶100%、阿米卡星35.48%、多黏菌素9.67%、亚胺培南12.90%,产ESBLsBA的耐药率为对哌拉西林100%、氨曲南100%、阿米卡星42.10%、多黏菌素0、亚胺培南15.78%,两组耐药率对比产ESBLs组高于非产酶组(P<0.05),但对阿米卡星、多黏菌素、亚胺培南均较敏感且无统计学差异P>0.05.结论 产ESBLsPA和AB在我院检出率较高,且具有多重耐药特点,阿米卡星、亚胺培南可以作为对抗产ESBLs检测阳性菌株的首选用药.%Objective To investigate the detectable rate of extended-spectrum p-lactamase(ESBLs) in Pseudomonas aeruginosa{PA) and in Acinetobacter baumannii(AB), Observe the characteristics of drug-resistance in ESBLs PA and ESBLs AB, and help us medicate reasonably in clinic. Methods Shanghai Fusun Bai Long biotechnology company the microbiological system was used to identify bacteria, antimicrobial susceptibility was tested by Kirby-bauer method and ESBLs were detected by the disk diffusion method described in CLSI. Whonet5.3 and SPSS-10.0 softwares were used to analyze the data. Results Producing ESBLs positive rate was 19.25% of PA and was 23.75% of AB, the resistance rates of producing ESBLs PA were: piperacillin 100%, amoxicillin 100%, ceftazidime 100%, amikacin 35.48%, polymyxin 9.67%, imipenem 12.90%, the resistance rates of producing ESBLs AB were: piperacillin 100%, aztreonam 100%, amikacin 42.10%, polymyxin 0, Imipenem 15.78%. Compared two

  9. Study on the Drug Resistance of Bacterial Pneumonia and Antibiotics in Our Hospital%我院细菌性肺炎的病原学研究

    Institute of Scientific and Technical Information of China (English)

    詹达天; 王秀川

    2011-01-01

    目的 研究我院细菌性肺炎患者对不同抗生素的耐药性.方法 共120例感染有细菌性肺炎患者,进行不同抗生素的药敏试验、抑菌圈大小和治愈人数的研究.结果 细菌对一线抗菌药物的耐药比例为28.3%.二线抗生素,如亚胺培南西司他丁钠、羧噻吩青霉素钠-棒酸钾的耐药的比例分别为:2.5%、4.2%.对三线抗生素的耐药比例为0%.一线抗生素中,氧哌嗪青霉素和阿奇霉素的抑菌圈最小,头孢呋肟、左氧氟沙星其次;二线抗生素其次;三线抗生素的抑菌圈最大.通过使用一二线抗生素,100%的患者可达到抗菌和治疗疾病的效果.结论 我院细菌性肺炎患者对不同抗生素的耐药性研究效果满意,且用一线和二线抗生素就能达到较好的临床效果.%Objective To study the drug resistance of bacterial pneumonia to different antibiotics in Wenchang district of Hainan province.Methods 120 patients with bacterial pneumonia were given drug sensitivity test of different antibiotics.The size of inhibition zone and curative rate were studied.Results The bacterial in patients had high drug resistance to first-line antibacterials such as Piperacillin ( 34/120 = 28.3% );the resistance to second-line antibiotics such as imipenem and cilasatin sodium,ticarcillin sodiumpotassium clavulanate was bad ( 2.5% ,4.2% ); the resistance rate to third-line antibiotics was 0%.Among first-line antibiotics, piperacillin and azithromycin had the smallest size of inhibition zone, cefuroxime and levofloxacin were the second.The size of all the second-line antibiotics were rather large.Vancomycin had the biggest inhibition zone among third-line antibiotics.Patients can obtain good effect through the use of firstline and second-line antibiotics.Conclusion The study effect of drug resistance of bacterial pneumonia to different antibiotics is satisfactory in our hospital.The use of first-line and second-line antibiotics can obtain better

  10. Pharmaceutical Care for a Brain Trauma Patient with Mixed Infection of Multiple Pathogenic Microorganisms by Clinical Pharmacists%临床药师参与1例脑外伤后多种微生物混合感染患者的药学监护

    Institute of Scientific and Technical Information of China (English)

    任彤; 丁建强; 朱军; 王军

    2013-01-01

    OBJECTIVE:To explore how the clinical pharmacists work best on pharmaceutical care for brain trauma patient,so as to provide reference for anti-infection treatment of the patients with mixed infection of multiple pathogenic microorganisms.METHODS:Clinical pharmacists participated in therapy for a brain trauma patient with mixed infection of multiple pathogenic microorganisms and provided advices on the formulation of anti-infection therapy scheme.Combination treatment strategy of fosfomycin and piperacillin/tazobactam was used,which was time difference attack therapy and amphotericin B ultrasonic atomizing inhalation.RESULTS:Clinical pharmacists provided reasonable therapy scheme and obtained good curative effect.The body temperature and routine blood test of the patient returned to normal and spontaneous breathing was maintained.Pharmaceutical care was enhanced for allergic shock induced by fosfomycin and nephrotoxicity of amphotericin B.CONCLUSIONS:Time difference attack therapy and amphotericin B ultrasonic atomizing inhalation of piperacillin/tazobactam combined with fosfomycin provide a choice for the treatment of mixed infection after severe brain trauma.Through clinical pharmacists provide pharmaceutical care and optimize therapy scheme,the effect of clinical treatment have been improved,the bacterial drug resistance and adverse drug reactions have been reduced.%目的:探讨临床药师在脑外伤患者的药学监护中如何发挥作用,为多种微生物混合感染患者的抗感染治疗提供参考.方法:临床药师参与1例脑外伤后多种微生物混合感染患者的联合治疗,对抗感染药物治疗方案的制订提出了具体意见,采取磷霉素联合哌拉西林/他唑巴坦时间差攻击疗法和两性霉素B超声雾化的治疗方案.结果:临床药师提供的合理治疗方案取得了良好的治疗效果,患者体温、血常规恢复正常,自主呼吸.治疗的同时加强对磷霉素可能导致过敏性休克、两性

  11. ICU多药耐药鲍氏不动杆菌的耐药性分析%Antimicrobial resistance of Acinetobacter baumanii in ICU

    Institute of Scientific and Technical Information of China (English)

    郑颖; 陈亮; 鲁艳

    2014-01-01

    目的:探讨综合医院ICU分离的多药耐药鲍氏不动杆菌(MDRAB)耐药性,为医师抗感染选择合适的抗菌药物提供参考依据。方法对2012年3所综合医院ICU分离的367株MDRAB耐药性进行了监测与统计分析;采用K-B法进行药敏检测,依据CLSI最新折点判断结果为敏感、中介、耐药,数据统计应用WHONET 5.5软件处理。结果 ICU分离的367株MDRAB在呼吸道标本中检出率最高,占67.6%;MDRAB耐药率>40.0%的药物包括磺胺甲噁唑/甲氧苄啶、阿米卡星、庆大霉素、头孢他啶、头孢噻肟、头孢吡肟、环丙沙星、左氧氟沙星和哌拉西林;耐药率<30.0%的抗菌药物有头孢哌酮/舒巴坦、哌拉西林/他唑巴坦。结论 ICU分离的MDRAB耐药性已非常严重,应加强执行卫生部发布的《抗菌药物临床应用管理办法》,将MDRAB纳入医院重点监控菌,实施医院多药耐药菌株预警制度,以警示临床医师,提高合理应用抗菌药物的责任感。%OBJECTIVE To investigate antimicrobial resistance of 367 multi-drug resistant Acinetobacter baumanii (MDRAB ) in ICU of three general hospitals to provide the reference for clinical anti-infective treatment . METHODS Retrospective review was performed for antimicrobial resistance of 367 MDRAB isolates in three gener-al hospitals in 2012 .The susceptibility testing was performed by K-B methods .The testing results were read as sensitive ,intermediary or resistant according to the newest breakpoints of CLSI .The WHONET 5 .5 software was used to process the data .RESULTS The detection rate of MDRAB from respiratory tract was the highest ,ac-counting for 67 .6% .The susceptibility results showed antibiotics with more than 40% of resistant rate included sulfamethoxazole/trimethoprim ,amikacin ,gentamicin ,cefazolin ,cefotaxime ,cefepime ,ciprofloxacin ,levofloxa-cin and piperacillin .Those with less than 30% of resistant rate were

  12. 老年呼吸机相关性肺炎鲍氏不动杆菌感染的耐药性分析%Drug resistance of Acinetobacter baumannii causing ventilator-associated pneumonia in senile patients

    Institute of Scientific and Technical Information of China (English)

    吴丽丽; 王丽君; 胡勤辛; 沈世恩; 于小妹

    2012-01-01

    目的 研究老年呼吸机相关性肺炎(VAP)鲍氏不动杆(ABA)感染的耐药特征,提高临床对鲍氏不动杆菌防治水平.方法 对131例老年呼吸机相艾性肺炎(VAP)患者分离的69株鲍氏不动杆菌进行药敏试验,并对抗菌药物耐药结果进行回顾性分析.结果 69株鲍氏不动杆菌对头孢哌酮/舒巴坦的耐药率最低,为44.93%;其次为亚胺培南、美罗培南和哌拉西林/他唑巴坦均为47.83%,对其余11种抗菌药物的耐药率均为60.87~97.10%;共检出33株耐亚胺培南ABA,泛耐药株(PDR)2株.结论 鲍氏不动杆菌对常用抗菌药物呈多药耐药(MDR);在老年呼吸机相关性肺炎(VAP)感染已十分严重,其首选药物为头孢哌酮/舒巴坦、亚胺培南、美罗培南和哌拉西林/他唑巴坦;应加大对鲍氏不动杆菌耐药性的监测力度,强调根据药敏结果选择用药.%OBJECTIVE To investigate the characteristics of drug resistance of Acinetobacter baumannii causing ventilator-associated pneumonia ( VAP ) in elderly patients so as to improve the level of clinical prevention of A. baumannii infections. MRTHODS A total of 131 geriatric patients with VAP were monitored. The drug susceptibility testing was performed for 69 isolates of A. baumannii isolated from the patients, the results of the drug susceptibility testing were analyzed retrospectively. RESULTS Totally 69 strains of A. baumannii showed the lowest drug resistance to cefoperazon/sulbactam (44. 93%), followed by imipenem, meropenem and piperacillin/ tazobactam(47.83%); the drug resistance rates to the rest of 11 antibiotics varied from 60. 87% to 97. 10%. A total of 33 imipenem-resistant strains and 2 pandrug-reistant strains were detected. CONCLUSION A. baumannii shows multidrug-resistant to commonly used antimicrobial agents) A. baumannii infections in the elderly patients with VAP has been extremely severes cefoperazone/sulbactam, imipenem, meropenem and piperacillin/tazobactam are

  13. Detection and drug resistance of acinetobacter baumannii in 2009%2009年检出鲍氏不动杆菌及耐药性分析

    Institute of Scientific and Technical Information of China (English)

    张丽娟; 罗进通; 舒晓春

    2011-01-01

    OBJECTIVE To investigate the clinical distribution and antimicrobial resistance of Acinetobacter baumannii. METHODS Drug resistance and clinical distribution of Ab during 2009 were analzsed and studied retrospectively. RESULTS A total of 90 strains of A. baumannii were mainly distributed in ICU department (33 strains), neurosurgery department (20 strains) and respiratory department (14 strains), and 82.2% of them came from phlegm specimen.The resistant rates to piperacillin, anpicillin, piperacillin/tazobactam, ceftazidime,ceftriaxone, cefepime, cefotaxime, gentamicin, amikacin, ciprofloxacin, ievofloxacin, norfloxacin,sulfamethoxazole, tetracycline were all >50% and with a high rate of multi-drug resistant. The resistant rates to imipenem and meropenem were 3. 3% & 5. 6%. CONCLUSION A. baumannii is most frequently detected in phlegm specimen and mainly distributed in ICU department, neurosurgery department and respiratory department.It's of great resistance to many kinds of antibiotics except for carbapenem (especially ICU), so antimicrobial agents should be chosen according to antimicrobial susceptibility test results.%目的 了解鲍氏不动杆菌的临床分布及其耐药性.方法 采用回顾性调查方法,对2009年临床分离的鲍氏不动杆菌的耐药率及临床分布进行统计分析.结果 90株鲍氏不动杆菌的分布以痰标本为主,占82.2%,其次是血液;科室分布以重症监护病房(ICU)、神经外科、呼吸内科为主,分别占36.7%、22.2%、15.6%;对哌拉西林、氨芐西林、哌拉西林/他唑巴坦、头孢他啶、头孢曲松、头孢吡肟、头孢噻肟、庆大霉素、阿米卡星、环丙沙星、左氧氟沙星、诺氟沙星、磺胺甲噁唑/甲氧苄啶、四环素的耐药率均>50.0%,且多药耐药率高,亚胺培南及美罗培南的耐药率仅为3.3%及5.6%.结论 鲍氏不动杆菌最常见于痰标本,主要分布于ICU、神经外科、呼吸科,对除碳青霉烯类外的常用抗菌

  14. 急性白血病化疗后继发感染性休克病原菌分布及耐药性分析%Analysis of the Distribution and Drug Resistance of Pathogenic Bacteria in Acute Leukemia Patients with Secondary Septic Shock after the Chemotherapy

    Institute of Scientific and Technical Information of China (English)

    陈文婷

    2015-01-01

    目的:分析及研究急性白血病化疗后继发感染性休克患者病原菌分布及耐药性情况。方法选取1363例急性白血病患者为研究对象,统计化疗后继发感染性休克的发生率,然后分析比较感染性休克者病原菌分布情况及其耐药性。结果 1363例急性白血病患者共75例发生感染性休克,发生率为5.50%,75例患者共检出104株病原菌,其中革兰阴性菌所占比例明显高于革兰阳性菌与真菌,革兰阴性菌对哌拉西林、氨苄西林及头孢唑林的耐药率明显高于对其他药物的耐药率,而革兰阳性菌对哌拉西林、氨苄西林及庆大霉素的耐药率明显高于对其他药物的耐药率,P均<0.05,均有显著性差异。结论急性白血病患者化疗后继发感染性休克患者的病原菌以革兰阴性菌为主,且其耐药情况突出,应引起重视。%Objective To analyze and study the distribution and drug resistance of pathogenic bacteria in acute leukemia patients with secondary septic shock after the chemotherapy .Methods 1 363 patients with acute leukemia were selected as re-search object ,and the rate of secondary septic shock after the chemotherapy of acute leukemia was analyzed ,and the distribution and drug resistance of pathogenic bacteria were analyzed and compared .Results In 1 363 patients,75 cases had septic shock , the rate was 5.50%,and 104 pathogenic bacteria were detected from 75 patients,the proportion of Gram-negative bacteria was higher than Gram-positive bacteria and fungus ,and the drug resistance rates of Gram-negative bacteria to piperacillin ,ampicillin and cefazolin were higher than those of other drugs ,the drug resistance rates of Gram-positive bacteria to piperacillin ,ampicillin and gentamicin were all higher than those of other drugs ,all P<0.05,there had significant differences .Conclusion Gram-nega-tive bacteria is the main pathogenic bacteria in acute leukemia patients with

  15. Analysis of the Pathogenic Bacteria of Peritoneal Dialysis Related Peritonitis and Their Drug Resistance%腹膜透析相关性腹膜炎致病菌及其耐药性分析

    Institute of Scientific and Technical Information of China (English)

    李慧敏; 彭月萍

    2014-01-01

    Objective To explore the pathogenic bacteria of peritoneal dialysis related peritonitis and their drug resistance so as to guide the clinical medication. Methods The culture and result of drug susceptibility test of 70 cases of peritoneal dialysis effluent in our peritoneal dialysis center from December, 2009 to August, 2013 were analyzed retrospectively. Of the patients, there were 50 males, 20 females, aged from 21 to 77, the average age was 46.8±26.3. Results Among them, reoccurrence occurred in 3 cases, relapse occurred in 1 case, 23 cases of positive drug susceptibility, the positive rate was 38.3%; including 10 cases of gram-posi-tive bacteria (43.5%), 12 cases of gram-negative bacteria (52.2%), 1 case of fungus (4.3%);gram-positive bacteria were sensitive to vancomycin, the drug resistance rate of penicillin was as high as 80%, the resistance rate of oxacillin was 83.3%, that of ery-thromycin was 100%;gram-negative bacteria were sensitive to meropenem, imipenem, amikacin, piperacillin sodium and tazobac-tam sodium, the sensitive rate of ceftazidime was higher (90%), but were resistant to ampicillin. Conclusion The proportion of gram-positive bacteria and gram-negative bacteria is almost the same, both of them are resistant to ampicillin. Gram-positive bac-teria are sensitive to vancomycin, and gram-negative bacteria are sensitive to meropenem, imipenem, amikacin, piperacillin sodium and tazobactam sodium.%目的:探讨腹膜透析相关性腹膜炎的致病菌及细菌耐药情况,指导临床用药。方法回顾性分析该腹膜透析中心2009年12月-2013年8月共70例腹膜炎患者的腹膜透析流出液培养+药敏结果。其中男性50例,女性20例,年龄21~77岁,平均(46.8±26.3)岁。结果其中复发3例,再发1例,药敏培养阳性23例,阳性率为38.3%,其中革兰氏阳性菌占10例(43.5%),革兰氏阴性菌12例(52.2%),真菌1例(4.3%);革兰阳性球菌对万古霉素均敏感,

  16. Antimicrobial resistance and homologκ analκsis of Staphκloccocus aureus isolated from neo-nates with skin infections%母婴同室新生儿皮肤感染金黄色葡萄球菌耐药性研究及同源性分析

    Institute of Scientific and Technical Information of China (English)

    宋风丽; 马秀华; 石鑫; 史伟; 王春霞; 刘盈; 马琳

    2014-01-01

    目的:了解母婴同室新生儿皮肤感染金葡菌耐药状况,探讨其同源性,为指导临床治疗和预防控制感染提供依据。方法对北京市大兴区人民医院皮肤感染的新生儿皮损分泌物进行细菌培养、鉴定及药敏试验,应用脉冲场凝胶电泳方法进行基因分型。结果新生儿皮肤感染率为2.1%;金葡菌13株,占30.2%;头孢唑林、阿莫西林或克拉维酸及哌拉西林或他唑巴坦对金葡菌具有良好的抗菌活性。脉冲场凝胶电泳示H组与I组图谱完全相同。结论治疗新生儿金葡菌所致皮肤感染首选头孢类抗生素、阿莫西林或克拉维酸、哌拉西林或他唑巴坦;预防和控制其感染,须加强对新生儿皮肤和脐部的护理。%Objective To investigate the antimicrobial resistance and homology analysis of Staphylococcus aureus ( S. aureus) isolated from with skin infections, thus to search for appropriate process to treat/prevent these skin disea-ses. Method Secretions of skin lesions from newborns with skin infections delivered in Obstetrics Department of Beijing Daxing People’s Hospital from Jan. 2012 to Jun. 2012 were collected,cultured and drug sensitivity test. Antibiotic resistances of S. aureus were determined. The genotype was detected with pulsed gel electrophoresis. Result Of 13 S. aureus isolated, the incidence was 30. 2%. Impetigo is the main disease of skin infection. S. au-reus was sensitive to cefazolin, amoxicillin/clavulanic acid and piperacillin/tazobactam. PFGE pattern of 13 strains showed 10 types, two type H and two type I which have the same pattern respectively. Conclusion The results sug-gest that effective clinical medication for skin and soft tissue infections caused by S. aureus are cefazolin, amoxicil-lin/clavulanic acid and piperacillin /tazobactam. It is important to disinfect all things the neonates may contact for preventing neonate infections caused by S. aureus.

  17. Application Analysis on Antibacterial Agents in Elderly Patients with Pulmonary Infection%老年患者肺部感染抗菌药物应用分析

    Institute of Scientific and Technical Information of China (English)

    邱新野; 尹月; 朱晓红; 王咏梅

    2012-01-01

    Objective To explore the rational use of antibacterial agents in elderly patients with pulmonary infection. Methods The retrospective survey method was adopted to statistically analyze the rationality of antibacterial agents used in 120 elderly cases of pulmonary infection. Prescriptions of 120 old patients with pulmonary infection were collected and analyzed. Results 15 cases of G+ cocci infection were mainly treated with azithromycin sodium dihydrogen phosphate and amoxicillin clavulanate potassium; 18 cases of G+ cocci, G- cocci and G- bacilli mixed infections were mainly treated with gatifloxacin sodium chloride injection;6 cases were G+ cocci and G~ cocci mixed infections;6 cases of G+ cocci mixed mycoplasma infection were mainly treated with amoxicillin clavulanate potassium; 15 cases were mycoplasma infection, which were mainly treated with amoxicillin clavulanate potassium and azithromycin sodium dihydrogen phosphate; no pathogenic bacteria were detected in 42 cases and 18 cases did not perform the pathogen detection. In the collected cases, piperacillin sodium and sulbactam sodium, and gatifloxacin injection were main applied drugs. Conclusion Elderly patients have many underlying diseases. Pulmonary infection is dominated by mixed pathogenic bacterial infection. The most commonly used antibiotics are amoxicillin clavulanate potassium, azithromycin disodium phosphate, gatifloxacin sodium chloride injection, piperacillin sodium and sulbactam sodium, etc. We should pay attention to the detection of the infected bacterial and antibiotics combination to reduce the occurrence of drug - resistance and adverse reactions.%目的 探讨老年患者肺部感染抗菌药物的合理应用.方法 采用回顾性调查方法,对120例老年患者肺部感染抗菌药物使用的合理性进行统计分析.结果 15例革兰阳性(G+)球菌感染,主要应用阿奇霉素磷酸二氢钠、阿莫西林克拉维酸钾进行治疗;18例G+球菌、革兰阴性(G-)球菌、G

  18. Drug resistance of extended spectrum β-lactamase-producing Escherichia coli and factors for enzyme production%产超广谱β-内酰胺酶大肠埃希菌的耐药性及产酶因素分析

    Institute of Scientific and Technical Information of China (English)

    穆海霞; 陈俊清; 吴容

    2011-01-01

    OBJECTIVE To explore the factors associated with production of extended spectrum fl- lactamase-producing Escherichia coli and the measures to prevent its sprgad and treatment. METHODS A total of 2Q5 E. Coli strains isolated from various specimens of in patients admitted from Jan 2008 to Jan 2010 were analysed. The drug resistance of these strains were analysed using KB method recommended by CLSI. RESULTS A total of 89 ESBLs-producing E. Coli were isolated from the 205 E. Coli strains during the 3 years. The isolation rate was 43. 5%. All ESBLs producing" strains were sensitive to imipenium and amikacin and the resistancerate to njtrofurantion piperacillin/tazobactam, cefoxitin was less than 10. 0%. The resistance rate remained almost the same in the 3 years. Prolon ged continuous use of antibiotics, high freguency of antibiotics usage, the use of the third generation cephalosporins, combination of antibiotics and frequent changes of antibiotics could induce the emergence of ESBLs producing strains. CONCLUSIONS The sensitivity rates of ESBLs producing strains to impenium amikacin, nitrofurantion, piperacillin/tagobactam and cefoxitin are higher than 90. 0% but the strains themselves are cross-resistant and multidrug-resistant to other antibiotics. Continuous use of antibiotics for a long time, the use of third generation cephalosporin, combination of antibiotics and frequent dressing can easily lead to ESBLs-producing.%目的 分析医院2008年1月-2010年1月产超广谱β-内酰胺酶(ESBLs)大肠埃希菌的耐药性及其产酶因素.方法收集2008年1月-2010年1月住院患者不同标本分离的大肠埃希菌205株,按照CLSI推荐的纸片扩散法(K-B法),进行耐药性检测和产ESBLs菌株的确认;产ESBLs组与非产ESBLs组之间比较计数资料采用t检验、卡方检验及多因素logistic回归进行分析.结果 205株大肠埃希菌中,检出产ESBLs大肠埃希菌89株,检出率43.4%;所有产ESBLs大肠埃希菌对亚胺培南

  19. A 17-year study of bloodstream Escherichia coli infection after liver transplantation: resistance rate,risk factor and mortality%肝移植术后大肠埃希菌血行感染耐药及危险因素分析

    Institute of Scientific and Technical Information of China (English)

    邰强; 郭志勇; 黄洁夫; 何晓顺; 胡安斌; 巫林伟; 鞠卫强; 朱晓峰; 王东平; 王国栋; 马毅

    2011-01-01

    Objective To explore the resistance rate,risk factors and mortality of Escherichia coli bloodstream infections (BSI) after liver transplantation.Methods From January 1993 to May 2010,a retrospective analysis of Escherichia coli in liver transplants were conducted.Results A total of 88 BSI occurred in 83/695 patients and Escherichia coli ( n =23 ) was most commonly found.Carbapenem and piperacillin-tazobactam were the most consistently active against Escherichia coli while the resistance rate to enterococcus for ciprofloxacin,gentamycin,ampicillin-clavulanic acid was over 60%.Univariate analysis identified the following variables as risk factors for Escherichia coli bacteremia:cholangioenterostomy ( P <0.001 ) and ductal complications ( P < 0.001 ).Escherichia coli bloodstream infection could increase the mortality at 15 days after bloodstream infection.No significant difference in mortality occurred at 30 days and 1 year after enterococcal bacteremia.Conclusion Escherichia coli after liver transplantation is resistant to agents but commonly active to carbapenem and piperacillin-tazobactam.The risk factor associated with Escherichia coli bloodstream infections are cholangioenterostomy and ductal complications.Escherichia coli bloodstream infection can increase the mortality at 15 days after bloodstream infection.%目的 探讨肝移植术后血行感染中大肠埃希菌的耐药、临床结果及危险因素.方法 回顾分析1993年1月至2010年5月,中山大学附属第一医院移植科肝移植术后血行感染中大肠埃希菌患者资料,对患者的资料(如:抗生素耐药、术式及危险因素)进行分类统计.结果 695例肝移植患者中,83例(7.6%)88次出现革兰阴性球菌血行感染,以大肠埃希菌(23例)最为常见.大肠埃希菌对碳青酶烯类抗生素均为100%敏感,对哌拉西林/他唑巴坦耐药率在5%以下,而对环丙沙星、庆大霉素、氨苄西林/克拉维酸耐药率基本都在60%以上.针

  20. Risk factors for and mortality of extended-spectrum-β-lactamase-producing Klebsiella pneumoniae and Escherichia coli nosocomial bloodstream infections Fatores de risco e mortalidade de infecções da corrente sanguínea por Klebsiella pneumoniae and Escherichia coli produtores de beta-lactamase de espectro estendido

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    Silvana Vargas Superti

    2009-08-01

    Full Text Available A case-control study, involving patients with positive blood cultures for Klebsiella pneumoniae (KP or Escherichia coli (EC EC and controls with positive blood cultures for non-ESBL-KP or EC, was performed to assess risk factors for extended-spectrum-β-lactamase (ESBL production from nosocomial bloodstream infections (BSIs. Mortality among patients with BSIs was also assessed. The study included 145 patients (81, 59.5% with K. pneumoniae and 64, 44.1% with E. coli BSI; 51 (35.2% isolates were ESBL producers and 94 (64.8% nonproducers. Forty-five (55.6% K. pneumoniae isolates were ESBL producers, while only six (9.4% E. coli isolates produced the enzyme. Multivariate analysis showed that recent exposure to piperacillin-tazobactam (adjusted Odds Ratio [aOR] 6.2; 95%CI 1.1-34.7 was a risk factor for ESBL BSI. K. pneumoniae was significantly more likely to be an ESBL-producing isolate than E. coli (aOR 6.7; 95%CI 2.3-20.2. No cephalosporin class was independently associated with ESBLs BSI; however, in a secondary model considering all oxymino-cephalosporins as a single variable, a significant association was demonstrated (aOR 3.7; 95%CI 1.3-10.8. Overall 60-day mortality was significantly higher among ESBL-producing organisms. The finding that piperacillin-tazobactam use is a risk factor for ESBL-production in KP or EC BSIs requires attention, since this drug can be recommended to limit the use of third-generation cephalosporins.Estudo de caso-controle, onde os casos foram pacientes com hemocultura positiva para Klebsiella pneumoniae (KP ou Escherichia coli (EC produtores de beta lactamase de espectro estendido (ESBL e os controles foram pacientes com hemoculturas positivas para EC ou KP não produtores de ESBL foi realizado para avaliar os fatores de risco para produção destas enzimas em infecções da corrente sanguínea (ICS. Mortalidade dos pacientes com ICS também foi avaliada. Foram incluídos 145 pacientes (81, 59,5% tinham Klebsiella

  1. 2011~2012年广州地区儿童腹泻病原菌分布及耐药性分析%Composition and drug resistance of pathogenic bacteria causing infantile diarrhea in Guangzhou from 2011 to 2012

    Institute of Scientific and Technical Information of China (English)

    黄莲芬; 刘海英; 谢永强; 钟华敏; 周珍文

    2015-01-01

    Objective To explore the main pathogenic bacteria and antibiotic resistance patterns in children with bacterial diar‐rhea from Guangzhou region .Methods Regular bacterial culture of stool samples from children with suspicious bacterial diarrhea was performed to isolate the pathogen during 2011 to 2012 ,followed by the analysis of its composition and serum type ,ward distri‐bution characteristics and drug resistance to 12 antimicrobacterial drugs .Results 416 strains of pathogenic bacteria were isolated from diarrhea children during 2011-2012 ,in which salmonella ,enteropathogenic E .coli ,Campylobacter jejuni and Candida albicans isolates accounted for 53 .61% ,37 .98% ,5 .29% and 1 .68% respectively .Drug resistance rate of the main strains to 12 antimicrobi‐al agents was 85 .25% to ampicillin ,54 .28% to compound sulfamethoxazole ,44 .70% to cefotaxime ,42 .53% to ceftriaxone , 40 .66% to chloramphenicol ,23 .55% to ceftazidime ,23 .36% to aztreonam ,14 .88% to ciprofloxacin ,8 .07% to cefepime ,7 .99% to cefperazone/sulbactam ,7 .42% to piperacillin/tazobactam respectively ,and no resistance to imipenem was detected .Conclusion The pathogenic bacteria causing diarrhea mainly includes salmonella ,pathogenic e .coli ,campylobacter jejuni in children from guang‐zhou region ,the top five sensitive antimicrobial reagents for the main strains includes imipenem ,piperacillin/tazobactam ,cefpera‐zone/sulbactam ,cefepime and ciprofloxacin .%目的:了解广州地区儿童细菌性腹泻主要病原菌分布及其耐药性。方法对2011~2012年疑似细菌性腹泻患儿大便标本进行细菌培养,分析病原菌分布特征及耐药性。结果2011~2012年共检出儿童腹泻病原菌416株,其中沙门菌属、致病性大肠埃希菌、空肠弯曲菌、白色念珠菌分别占53.61%、37.98%、5.29%、1.68%。主要病原菌对抗菌药物的耐药率分别为氨苄西林85.25%、复方磺胺甲噁唑54.28

  2. 儿童感染性腹泻病原菌分布及耐药分析%Distribution and Drug Resistance of Pathogens in Children With Infectious Diarrhea

    Institute of Scientific and Technical Information of China (English)

    曾彩屏

    2015-01-01

    目的:观察儿童感染性腹泻病原菌的分布情况,并对其耐药性进行分析。方法选取我院收治的培养出病原菌的1572例感染性腹泻患儿作为临床研究对象,取其大便标本进行常规的病原菌分离培养,采用ATP细菌鉴定仪对细菌进行鉴定,然后通过诊断血清凝集进行确认和分型,最后使用K-B纸片扩散法进行药敏试验分析。结果 1572例感染性腹泻患儿的大便标本中,共检出84株病原菌,阳性率为5.3%。20株大肠埃希菌对于多种抗菌药物均普遍具有耐药性,其中对于氨苄西林和哌拉西林的耐药率均非常高,共检出6株ESBL菌株,共占30.00%。沙门菌和志贺氏菌对于第3代头孢菌素和头孢哌酮/舒巴坦为基本敏感。所有菌株对于哌拉西林/他唑巴坦、亚胺培南类药物均比较敏感。结论儿童感染性腹泻应根据病原菌的分布及耐药性情况来选择合理的抗菌药物。%Objective To observe the distribution of pathogenic bacteria in children infectious diarrhea and investigate the drag resistance analysis. Methods Chose 1572 children with infectious diarrhea who were cultured pathogens as research objects. Took the stool specimens for routine pathogen isolation and culture, the bacteria identiifcation was used by ATP automatic detection machine, and then through the diagnosis of serum agglutination to get recognition and classifications. Finally, K-B method was used to analysis of drug sensitivity test. Results In 1572 cases of stool specimens in children with infectious diarrhea, 84 strains of pathogenic bacteria were detected, the positive rate was 5.3%. 20 strains of Escherichia coli are generally resistant to many kinds of antimicrobial agents, especially resistance to ampicillin and piperacillin were very high, a total of 6 of ESBL strain detection accounted for 30.00%.The third generation cephalosporins and cefoperazone/sulbactam were basically sensitive to both

  3. Analysis of pathogen distribution and resistance in lower respiratory tract infections from the Gerontologist Department%老年下呼吸道感染病原菌耐药性分析

    Institute of Scientific and Technical Information of China (English)

    姚反修; 曹婷婷

    2011-01-01

    Objective To analyze the pathogen distribution and resistance pattern of the positive clinical sputum specimens in our Gerontologist Department. Methods The bacteria and fungi were identified by API system. The susceptibility of antimicrobial and anti-fungal agents was tested by KB and Rosco disk diffusion method. The data were analyzed by WHONET 5.4 software. Results The positive rate of sputum specimens was 15. 7% in our Gerontologists Department. The pathogen of the top three isolating ate were Pseudomonas aemginosa(27.7% ) , lebsiella pneumoniae( 19.7% ), and Acinetobacterspecies (15. 6% ) . In view of the resistance, no Staphyiococ-cusspecies resistant to vancomycin, hile they were resistant to many other antimicrobial agents; the Enterobactericaeae were sensitive to meropenem, Imipenem, cefoperazone-sulbactam and piperacillin-tazobactam. But the sensitivity of Escherichia coli and Enterobacter cloacae was descend in quinolines; P. aerugiosa of Nonfermenteis was sensitive to meropenem, Imipenem > ceftazidime > piperacillin-tazobactam > cefoperazone-sulbactam, no Acinetobacter baumanniis resistant to carbapenems. Conclusion The major pathogenic bacteria in lower espiratory tract infections was Gram-negative bacteria. The pathogens in lower agpiratory tract infections have a high resistance rate to many antimicrobial agents. In view of the seriousness of this problem, we must give more attention to it and select antimicrobial agents rationally.%目的 了解老年下呼吸道感染常见病原菌的感染现状及耐药性规律.方法 采用API鉴定细菌及真菌,纸片扩散法测定细菌药物敏感性,Rosco纸片法测定真菌药物敏感性.结果 痰培养阳性率为15.7%,检出率前三位病原菌:铜绿假单胞菌(27.7%)、肺炎克雷伯菌(19.7%)及不动杆菌(15.6%),耐药性分析:葡萄球菌属未发现万古霉素耐药株,但对其它多种抗菌药物耐药;肠杆菌科细菌对碳青霉烯类、头孢哌酮舒巴坦和哌拉

  4. Emergence of serotype K1 Klebsiella pneumoniae ST23 strains co-producing the plasmid-mediated AmpC beta-lactamase DHA-1 and an extended-spectrum beta-lactamase in Korea

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    Hae Suk Cheong

    2016-11-01

    Full Text Available Abstract Background Serotype K1 Klebsiella pneumoniae has emerged as an important community pathogen causing various infections, including liver abscesses. Although serotype K1 K. pneumoniae community isolates have been reported as susceptible to most classes of antimicrobial agents, a few cases of infection caused by extended-spectrum beta-lactamase (ESBL-producing serotype K1 K. pneumoniae have recently been reported in Asian countries. We identified three ESBL-producing strains of serotype K1 K. pneumoniae and conducted a molecular characterization of their drug resistance. Methods Three ESBL-producing serotype K1 K. pneumoniae ST23 strains were identified from strains in the Asian Bacterial Bank. Antimicrobial susceptibility testing was performed using the broth microdilution method, and ESBL production was tested by the double-disk synergy test and a confirmatory test. PCR was performed to detect the genes for plasmid-mediated ESBL and AmpC beta-lactamases. Results All three strains were resistant to cefotaxime, ceftazidime, and piperacillin/tazobactam, and all were determined to be ESBL-producers. No known ESBL genes, including bla SHV, bla TEM, bla CTX-M, bla GES, bla PER, and bla VEB, were detected among the three strains. Of all plasmid-mediated AmpC beta-lactamase (PAB genes, including bla DHA-1, bla CMY, bla FOX, and bla MOX, the bla DHA-1 gene was detected in two of the strains. The PFGE patterns revealed that the two isolates carrying bla DHA-1 were closely related (84% similarity. Conclusions No ESBL genes were detected among three ESBL-producing serotype K1 K. pneumoniae ST23 strains. Two strains contained the PAB gene bla DHA-1. The emergence of resistant strains of community-origin serotype K1 K. pneumoniae has important implications for effective treatment and infection control practices.

  5. Characterisation of aerobic bacteria isolated from endotracheal aspirate in adult patients suspected ventilator associated pneumonia in a tertiary care center in Mangalore

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    Ramakrishna Pai Jakribettu

    2012-01-01

    Full Text Available Background and Objectives: Despite advances in antimicrobial therapy, better supportive care modalities and use of a wide range of preventive measures, ventilator-associated pneumonia (VAP continues to be an important cause of morbidity and mortality in intensive care unit (ICU. VAP requires a rapid diagnosis and initiation of appropriate antibiotic treatment, to prevent mortality and morbidity. Inappropriate and inadequate antibiotic treatment causes emergence of drug resistance in pathogens and poor prognosis in patients. Early detection of pathogens causing VAP helps to control their spread by administration of suitable antibiotics and proper infection control measures. The study was conducted to know the pathogens causing VAP in Fr. Muller Medical College Hospital, Mangalore, and their susceptibility pattern. Methods: A total of 100 patients, on mechanical ventilation for more than 48 h, who were suspected to have VAP were included in the study between December 2008 and November 2009. Their endotracheal aspirates (ETAs were collected and processed. From 100 ETA, 138 isolates of count >10 5 CFU/ mL were characterized and antibiogram was determined using standard antibiotics regime. Results: Incidence of VAP was found to be 44.2% among the mechanically ventilated patients. Klebsiella pneumoniae (34% was the most common pathogen isolated, followed by Pseudomonas aeruginosa (20%. Among them, most of the K. pneumoniae and P. aeruginosa isolates were resistant to penicillins, cephalosporins, fluoroquinolones was observed but were sensitive to piperacillin/tazobactum, cefaperazone/sulbactum, and carbapenems. All isolates were sensitive to amikacin. Interpretation and Conclusion: The present study shows prevalence of multidrug-resistant organisms in the study region. Klebsiella species was the most common pathogen isolated in ETA. Acinetobacter species were the most resistant pathogens prevailing in our ICU setup, leading to the increased mortality

  6. An outbreak of multidrug-resistant Serratia marcescens: The importance of continuous monitoring of nosocomial infections

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    Maida Šiširak

    2013-05-01

    Full Text Available Objectives. Serratia marcescens is a well-established as a nosocomial pathogen, resulting in considerable morbidity and mortality in immunocompromised patients. The aim of this study was to investigate an outbreak of Serratia marcescens at the Orthopaedic Clinic of the Clinical Center University of Sarajevo. Methods. A total of 96 strains from 79 patients were isolated. The isolates were identified by conventional methods. Susceptibility testing was performed by the discdiffusion method following CLSI guidelines. Results were confirmed by VITEC-2 Compact. Results. From January to December 2010, 96 strains from 79 patients were isolated at the Orthopaedic Clinic of the Clinical Center, University of Sarajevo.The strains were isolated from wound swabs, blood cultures and cerebrospinal fluid. The strains were identifed using current phenotypic methods as Serratia marcescens with identical biochemical characteristics and antibiotic susceptibility patterns. All strains were susceptible to imipenem, meropenem, amikacin, ciprofloxacin, levofloxacin and piperacillin/tazobactam. The infection control team was alerted and after investigation they discovered the same phenotype of Serratia marcescens in the anaesthetic vials used in procedures. This outbreak was extremely difficult to terminate, even with cohorting of patients, sterilisation of equipment, reinforcement of handwashing and deep-cleaning of facilities. The implementation of new control measures terminated the outbreak in February 2011. Conclusion. Continuous monitoring of nosocomial infections is indispensable. Phenotypic characterization of the isolates is useful for studying the relationship of microbial pathogens. The relationship of one clinical isolate to another during an outbreak is important in motivating the search for a common source or mode of transmission.

  7. Frequency and Characteristics of Infections Caused by Extended-Spectrum Beta-Lactamase-Producing Organisms in Neonates: A Prospective Cohort Study

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    Nandini Vijayakanthi

    2013-01-01

    Full Text Available This prospective cohort study was conducted to determine the frequency of infections caused by extended-spectrum beta-lactamase- (ESBL- producing organisms, various bacteria producing ESBL, antibiotic susceptibility of these organisms, and the risk factors associated with these infections in a neonatal intensive care unit in a tertiary care hospital in North India. Of the 150 neonates enrolled in the study, 47 culture-positive neonates were included in the study cohort and were divided into two groups: ESBL-positive (8 neonates and ESBL-negative (39 neonates cohorts. Various organisms were isolated from 72 culture samples in these 47 neonates. Of these, 10 culture samples grew ESBL-positive organisms and 62 samples grew ESBL-negative organisms. The frequency of ESBL-producing organisms was found to be 5.3%. ESBL infection incidence densities were found to be 3.4 per 1000 patient-days. Klebsiella (60% was the most common organism producing ESBL followed by Escherichia coli (30% and Pseudomonas (10%. Eighty percent of the ESBL-producing organisms were sensitive to piperacillin-tazobactam. Risk factors found significant by univariate analysis (P7 days, length of hospitalization, length of level 3 stay, prior antibiotic use, central venous catheter duration, peripherally inserted central venous catheter duration, and total parenteral nutrition duration. Factors that retained significance in the logistic regression model were duration of hospital stay (adjusted OR: 0.958, CI: 0.920–0.997, and P value = 0.037 and gestational age (adjusted OR: 1.39, CI: 1.037–1.865, and P value = 0.028. There was no significant difference in the mortality between the two groups.

  8. Lemierre’s syndrome: current perspectives on diagnosis and management

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    Johannesen KM

    2016-09-01

    Full Text Available Katrine M Johannesen,1 Uffe Bodtger1–3 1Department of Lung Medicine, Naestved Hospital, Naestved, 2Institute for Regional Health Research, University of Southern Denmark, Odense, 3Department of Pulmonology, Zealand University Hospital, Roskilde, Denmark Abstract: This is a systematic review of cases with Lemierre’s syndrome (LS in the past 5 years. LS is characterized by sepsis often evolving after a sore throat or tonsillitis and then complicated by various septic emboli and thrombosis of the internal jugular vein. Symptoms include sepsis, pain, and/or swelling in the throat or neck, as well as respiratory symptoms. Laboratory findings show elevated infectious parameters and radiological findings show thrombosis of the internal jugular vein and emboli in the lungs or other organs. The syndrome is often associated with an infection with Fusobacterium necrophorum. We found a total of 137 cases of LS, of which 47 were infected with F. necrophorum and others with Staphylococcus and Streptococcus. Complications of this rare but severe disease included osteomyelitis, meningitis, and acute respiratory distress syndrome. Mortality was extremely high in the pre-antibiotic era but has diminished with the advent of antibiotics. This review showed a mortality rate of only 2% of which none of the cases involved fusobacteria. Duration of treatment varied; a 4–6-week course of carbapenem or piperacillin/tazobactam in combination with metronidazole was optimum. Other treatment options included anticoagulants in 46% of cases, which is unwarrantedly high, as to date, no evidence of the positive effects of anticoagulants in LS exists. Only two cases had ligation of the internal jugular vein performed. This review confirms the rare, but severe aspects of LS. Mortality from LS in this day and age appears to be low, however the syndrome is difficult to recognize, and still requires the full attention of the clinician. Keywords: Lemierre’s syndrome

  9. 临床分离的129株鲍曼不动杆菌的耐药性分析%Analysis of clinical distribution and drug resistance of the Bauman acinetobacter

    Institute of Scientific and Technical Information of China (English)

    闫雳

    2012-01-01

    Objective:To explore the drug resistance and clinical distribution of Bauman acinetobacter,and provide a basis for controlling hospital infection. Methods: The clinical distribution, drug resistance and sample separation of 129 strains of Bauman acinetobacter were analysed, and the resistance rate of 14 kinds of commonly used antimicrobial agents were calculated. Results: Sputum specimen's detection rate with 72.09% was highest, patients came mainly from physicians and intensive care treatment ward. The drug resistance rates of only 3 types of antimicrobial agents in 129 stains Bauman acinetobacter were less than 30% ,imipenem,piperacillin/tazobactam and ampicillin/Shu TAZ were 24.80% ,26.35% and 27.90% ,respectively,the others drug resistance rates were more than 50%. Conclusions:As to the serious multi-drug resistance of Bauman adnetobacters, the resistance monitoring should be strengthened for directing clinical medication.%目的:了解鲍曼不动杆菌的耐药和临床分布情况,为防控医院感染提供依据.方法:对129株鲍曼不动杆菌的临床分布和常用抗菌药物的耐药情况进行分析.结果:痰标本检出率最高,为72.09%;患者主要分布在内科和重症监护治疗病房;分离出的129株鲍曼不动杆菌仅有3种药物耐药率50%.结论:鲍曼不动杆菌多重耐药严重,应加强耐药性监测,了解耐药变迁,为临床用药提供依据.

  10. Antimicrobial resistance in Dschang, Cameroon

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    Fusi-Ngwa Catherine Kesah

    2013-01-01

    Full Text Available Background: Health-care-associated and community infections remain problematic in most of Africa where the increasing incidences of diseases, wars, poverty, malnutrition, and general environmental deterioration have led to the gradual collapse of the health-care system. Detection of antimicrobial resistance (AMR remains imperative for the surveillance purposes and optimal management of infectious diseases. This study reports the status of AMR in pathogens in Dschang. Materials and Methods: From May 2009 to March 2010, the clinical specimens collected at two hospitals were processed accorded to the standard procedures. Antibiotic testing was performed by E test, and antimycotics by disc-agar diffusion, as recommended by the Clinical and Laboratory Standards Institute on pathogens comprising Staphylococcus aureus (100 strains, Enterococcus faecalis (35, Klebsiella pneumoniae (75, Escherichia coli (50, Proteus mirabilis (30, Pseudomonas aruginosa (50, Acinetobacter species (20, and Candida albicans (150 against common antimicrobials. Results: There was no vancomycin resistance in the cocci, the minimum inhibitory concentration for 90% of these strains MIC 90 was 3 μg/ml, methicillin-resistant S. aureus (MRSA was 43%, benzyl penicillin 89% resistance in S. aureus as opposed to 5.7% in E. faecalis. Low resistance (<10% was recorded to cefoxitin, cefotaxime, and nalidixic acid (MIC 90 3-8 μg/ml against the coliforms, and to ticarcillin, aztreonam, imipenem, gentamicin, and ciprofloxacin among the non-enterobacteria; tetracycline, amoxicillin, piperacillin, and chloramphenicol were generally ineffective. Resistance rates to fluconazole, clotrimazole, econazole, and miconazole were <55% against C. albicans. The pathogens tested exhibited multidrug-resistance. Conclusion: The present findings were intended to support antimicrobial stewardship endeavors and empiric therapy. The past, present, and the future investigations in drug efficacy will continue

  11. Molecular detection of AdeABC efflux pump genes in clinical isolates of Acinetobacter baumannii and their contribution in imipenem resistance

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    Ali Reza JaponiNejad

    2014-11-01

    Full Text Available Backgrand: Multi-drug resistance due to Acinetobacter baumannii strains has become a significant challenge. Efflux pump plays a vital role in the development of resistance in this bacteria. The aim of this study was to evaluate the frequency of the AdeABC efflux pump genes and its role in resistance to imipenem in clinical isolates of A.baumannii. Materials and methods: A total of 56 isolates of A.baumannii were collected from different clinical specimens of Valiasr hospital in the Arak –Iran and all isolates were identified by standard biochemical tests. The Antimicrobial susceptibility patterns were determined by disk diffusion method and minimum inhibitory concentrations of imipenemin via E-test strips with and without CCCP efflux pump inhibitor were determined according to CLSI guidelines. The PCR test was used to detect the AdeABC efflux pump genes in isolates. Results: All A.bumannii isolates were resistant to cefotaxim, ceftazidim, cefepim, cefoxitin, azteronam, piperacillin-tazobactam and ciprofloxacin, as well as all isolates were resistant to imipenem according to the results of the E-test method. Imipenem MIC with efflux pump inhibitor not reduced in all isolates and showed no differences in imipenem activity. The adeA, adeB and adeC genes were found in 100%, 100% and 96.5% of isolates, respectively. Conclusion: AdeABC efflux system contributes to resistance to other antibiotics and resistance to imipenem has not been involved with this efflux system in A.baumanni isolates in current study and other mechanism such as carbapenemase enzymes play vital role to imipenem resistance in A.baumanni isolates.

  12. Acquisition of carbapenem-resistant Gram-negative bacilli in intensive care unit: predictors and molecular epidemiology.

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    Marchenay, P; Blasco, G; Navellou, J-C; Leroy, J; Cholley, P; Talon, D; Bertrand, X; Gbaguidi-Haore, H

    2015-01-01

    We had for aim to determine the risk factors for acquiring carbapenem-intermediate or -resistant Gram-negative bacilli (CR-GNB) in an intensive care unit (ICU) and to identify the resistance mechanisms involved. We conducted an observational prospective cohort study during 6 months in medical and surgical ICUs of the Besançon Teaching Hospital. Patients with acquired CR-GNB were patients whose cultures (screening or diagnosis) became positive more than 48h after admission to the ICU. The risk factors for ICU-acquired CR-GNB were determined by multivariate logistic regression. CR-GNB isolates were typed by pulsed-field gel electrophoresis (PFGE) and screened for resistance mechanisms with phenotypic and genotypic tests. Twenty-three of the 347 included patients had acquired a CR-GNB. The multivariate analysis revealed significant associations between this acquisition and the duration of previous treatments with piperacillin-tazobactam (adjusted odds ratio [aOR], 1.13, P=0.02) and aminoglycosides (aOR, 1.62; P=0.005), but not with carbapenems. The CR-GNB strains were identified as Pseudomonas aeruginosa (n=10), Stenotrophomonas maltophilia (n=7), and Enterobacter cloacae (n=6). No acquired carbapenemase-producing strain was identified. PFGE typing identified 1 multiple clone among P. aeruginosa isolates (4 patients), whereas for the other bacteria, all the strains were different. Our study results suggest that the strategy to prevent the emergence and spread of CR-GNB should not be limited to the sole restriction of carbapenem use in ICU settings. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  13. Bacteriological Spectrum of Post Operative Orthopedic Implant Infections and Their Antibiogram

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    Satya Chandrika V

    2016-01-01

    Full Text Available Background: Infection is a major problem in orthopedics leading to implant failure and in severe cases, amputation and even mortality. Aim and Objectives: The aim of this study is to isolate and identify organisms from postoperative Orthopaedic implant infections and determine their antibiogram. Method and Materials: This prospective study was conducted on 50 cases of infected implants from Orthopaedics ward, Government General Hospital, st st Kakinda from 1 June 2014 to 1 November 2014 after obtaining clearance from Institutional Ethics Committee. Pus samples were collected using two sterile swabs. One is used for Gram's stain and the other for inoculation on MacConkey and Blood agar. Isolates were identied according to the standard protocols and antibiotic sensitivity was done by Kirby Bauer's disc diffusion technique. Results: Out of 50 samples, 45(90% were culture positive and 5(10% were sterile for aerobic bacteria. Staphylococcus aureus (30% is common isolate followed by Coagulase Negative Staphylococci (CONS (20%, Escherichia coli (16%, Klebsiella sps (10% , Pseudomonas aeruginosa (6%, Acinetobacter species (4%, Proteus species (4%. Most of Gram positive cocci are resistant to Methicillin (64% followed by Ciprooxin (36% and Cotrimoxazole (28%. They were mostly sensitive to Vancomycin, Linezolid, Amoxycillin Clavulanic acid and Cefotaxime. Gram negative bacilli are resistant to Cotrimoxazole (65% followed by Ciprooxacin (60% and Ceftriaxone (60% and sensitive to Carbapenems (80%, Piperacillin Tazobactam (60% and Amoxycillin Clavulanic acid (60%. Extended Spectrum Beta Lactamase (ESBL production is seen in 60% of Gram negative bacilli. Conclusions: The incidence of multidrug resistance pathogens as a cause of implant infections is rising. Adequate preventive measures should be enforced to prevent the spread of antibiotic resistant organisms

  14. Transfer of penicillin resistance from Streptococcus oralis to Streptococcus pneumoniae identifies murE as resistance determinant.

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    Todorova, Katya; Maurer, Patrick; Rieger, Martin; Becker, Tina; Bui, Nhat Khai; Gray, Joe; Vollmer, Waldemar; Hakenbeck, Regine

    2015-09-01

    Beta-lactam resistant clinical isolates of Streptococcus pneumoniae contain altered penicillin-binding protein (PBP) genes and occasionally an altered murM, presumably products of interspecies gene transfer. MurM and MurN are responsible for the synthesis of branched lipid II, substrate for the PBP catalyzed transpeptidation reaction. Here we used the high-level beta-lactam resistant S. oralis Uo5 as donor in transformation experiments with the sensitive laboratory strain S. pneumoniae R6 as recipient. Surprisingly, piperacillin-resistant transformants contained no alterations in PBP genes but carried murEUo5 encoding the UDP-N-acetylmuramyl tripeptide synthetase. Codons 83-183 of murEUo5 were sufficient to confer the resistance phenotype. Moreover, the promoter of murEUo5 , which drives a twofold higher expression compared to that of S. pneumoniae R6, could also confer increased resistance. Multiple independent transformations produced S. pneumoniae R6 derivatives containing murEUo5 , pbp2xUo5 , pbp1aUo5 and pbp2bUo5 , but not murMUo5 sequences; however, the resistance level of the donor strain could not be reached. S. oralis Uo5 harbors an unusual murM, and murN is absent. Accordingly, the peptidoglycan of S. oralis Uo5 contained interpeptide bridges with one L-Ala residue only. The data suggest that resistance in S. oralis Uo5 is based on a complex interplay of distinct PBPs and other enzymes involved in peptidoglycan biosynthesis.

  15. Epidemiology of acute otitis in pediatric patients

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    Maddalena Perotti

    2011-03-01

    Full Text Available Introduction. Acute otitis is one of the most common pediatric infectious diseases that requires an accurate diagnosis in order to direct appropriate therapy to reduce the risk of complications. In this study pathogens collected from pediatric patients and their antibiotic susceptibility patterns were evaluated. Methods. Between May 2009 and May 2010, 739 samples (swabs taken from nasopharynx in case of acute otitis media and/or from ears in case of acute external otitis, collected from 680 patients, suffering of otalgia, admitted to the emergency department of our Hospital were studied.The specimens were submitted for routine bacterial cultures and the susceptibility tests were performed according to Clinical Laboratory Standards. Nitrocefin was used to detect ß-lactamase activity. Results. 316 samples (42.8% of 739 were negative, 102 (13.8% were positive for Streptococcus pneumoniae, 97 (13.1% for Moraxella catarrhalis, 68 (9.2% for Haemophilus influenzae, 62 (8.4% for Pseudomonas aeruginosa, 49 (6.6% for Staphylococcus aureus, 36 (4.9% for Streptococcus pyogenes, 5 (0.7% for Gram negative and 4 (0.5% for Candida spp. Antibiotic susceptibility tests showed that amikacin, ceftazidime, ciprofloxacin, imipenem, meropenem and piperacillin/tazobactam were active against all Gram negative strains isolated.We found one strain of MRSA. Of 102 Streptococcus pneumoniae, 5 (4.9% were penicillin resistant and 25 (24.5% were erythromycin resistant, showing the prevalence of constitutive phenotype (80%. All M. catarrhalis strains were ß-lactamase producers while all H. influenzae were ß-lactamase negatives. Conclusions. The prevalent etiological agents in pediatric acute otitis are S. pneumoniae, M. catharralis, and H. influenzae, as reported in literature. In external acute otitis P. aeruginosa prevails in particular in summer.

  16. Extended spectrum β-lactamase and plasmid mediated quinolone resistance in Escherichia coli fecal isolates from healthy companion animals in Algeria.

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    Yousfi, Massilia; Mairi, Assia; Touati, Abdelaziz; Hassissene, Lila; Brasme, Lucien; Guillard, Thomas; De Champs, Christophe

    2016-07-01

    The aim of this study was to evaluate the rate of fecal carriage of Escherichia coli strains producing Extended-spectrum β-lactamases (ESBLs) and plasmid-mediated quinolone resistance (PMQR) isolated from healthy pets (dogs and cats) in Algeria. Fecal samples from 171 healthy pets (102 dogs and 69 cats) in one veterinary practice and private owners were included. After isolates identification, antibiotic susceptibility was determined by disk diffusion procedure. ESBL were detected by combination disk tests. PCR and sequencing were used to characterize genes encoding ESBLs and PMQR. Transfer of ESBL and PMQR genes was assessed by conjugation experiments. Phylogenetic groups of E. coli were determined by PCR. Of the 171 animals, 20 carried an ESBL producing E. coli giving a prevalence of ESBL fecal carriage of 11.7%. All isolates were susceptible to carbapenems, cefoxitin, piperacillin-tazobactam, amikacin and fosfomycine. For the rest of the tested β-lactams, susceptibility rates ranged from 35% to 70% for cefepime and amoxicillin-clavulanic acid respectively. Concerning the non-beta-lactams antibiotics, the rates of susceptibility ranged between 5% to trimethoprim and 95% for chloramphenicol. The beta-lactamase genes identified in E. coli isolates were blaCTX-M-15, blaCTX-M-1, blaSHV-12 and blaTEM-1. The PMQR determinants aac(6')-Ib-cr, qnrS1 and qnrB5 genes were identified in 15 isolates. Transconjugants were obtained for two isolates. Phylogenetic analysis showed that E. coli isolates belong to commensal phylogroups of A and B1. We reported here for the first time in Algeria ESBL and PMQR-producing E. coli in healthy cats and dogs.

  17. Molecular characterisation of extended-spectrum β-lactamase- and plasmid AmpC-producing Escherichia coli strains isolated from broilers in Béjaïa, Algeria.

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    Belmahdi, Mohamed; Bakour, Sofiane; Al Bayssari, Charbel; Touati, Abdelaziz; Rolain, Jean-Marc

    2016-09-01

    This study aimed to characterise the molecular support of antibiotic resistance in expanded-spectrum cephalosporin (ESC)-resistant Escherichia coli isolates recovered from healthy broilers in Béjaïa, northeast Algeria. A total of 61 intestinal swabs from slaughtered broilers from four regions in Béjaïa locality, Algeria, were collected between February and April 2014, from which 20 ESC-resistant E. coli strains were isolated. Escherichia coli isolates were identified by classical biochemical and MALDI-TOF methods. Antibiotic susceptibility testing was performed using disk diffusion and Etest methods. Screening for β-lactamases, aminoglycoside-modifying enzyme (AME)-encoding genes and qnr determinants was performed by PCR and sequencing. Clonal relatedness was determined using molecular typing by multilocus sequence typing (MLST). Antibiotic susceptibility testing revealed that the isolates showed high rates of resistance (>90%) to amoxicillin, amoxicillin/clavulanic acid, piperacillin/tazobactam, aztreonam, ceftazidime, streptomycin, tobramycin, nalidixic acid and ciprofloxacin. Low rates of resistance were observed for kanamycin (35%), amikacin (30%), cefoxitin (20%) and cefotaxime (15%). Molecular characterisation revealed that all of the isolates expressed the blaTEM-1 gene. Fourteen of them harboured the blaSHV-12 gene, two harboured the blaCTX-M-1 gene and four isolates harboured blaCMY-2. Screening for AME-encoding genes demonstrated that all isolates contained the aadA gene. In addition, qnrA was detected as the quinolone resistance determinant in 13 isolates. MLST revealed four known sequence types (STs), including ST744, ST38, ST1011 and ST2179, as well as one new sequence type (ST5086). Here we report the first study describing the clonal diversity of extended-spectrum β-lactamase (ESBL)- and plasmid AmpC-producing E. coli isolated from healthy broilers in Algeria.

  18. Emerging Carbapenem-Resistant Pseudomonas aeruginosa Isolates Carrying blaIMP Among Burn Patients in Isfahan, Iran

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    Radan, Mohsen; Moniri, Rezvan; Khorshidi, Ahmad; Gilasi, Hamidreza; Norouzi, Zohreh; Beigi, Fahimeh; Dasteh Goli, Yasaman

    2016-01-01

    Background Metallo-β-lactamase (MBL)-producing Pseudomonas aeruginosa is a significant pathogen in burn patients. Objectives The aim of this study was to determine the prevalence of carbapenem-resistant P. aeruginosa isolates, including those resistant to imipenemase (IMP), in a burn unit in Isfahan, Iran. Patients and Methods One hundred and fifty P. aeruginosa isolates from burn patients were tested for antibiotic susceptibility by the disc diffusion method in accordance with CLSI guidelines. Production of MBL was identified with the EDTA disk method. DNA was purified from the MBL-positive isolates, and detection of the blaIMP gene was performed with PCR. Results Fifty-seven out of 150 (38%) isolates were multi-drug resistant (MDR), and 93 (62%) were extensively-drug resistant (XDR). Among all isolates, the resistance rate to ciprofloxacin, tobramycin, imipenem, meropenem, amikacin, ceftazidime, and cefepime was higher than 90%, while the resistance rates to piperacillin/tazobactam and aztreonam were 70.7% and 86%, respectively. Colistin and polymyxin B remained the most effective studied antibiotics. All of the imipenem-resistant P. aeruginosa isolates were MBL-positive, and 107 out of 144 (74.3%) of the MBL isolates were positive for the blaIMP gene. Conclusions The results of this study show that the rate of P. aeruginosa-caused burn wound infections was very high, and many of the isolates were resistant to three or more classes of antimicrobials. Such extensive resistance to antimicrobial classes is important because few treatment options remain for patients with burn wound infections. blaIMP-producing P. aeruginosa isolates are a rising threat in burn-care units, and should be controlled by conducting infection-control assessments.

  19. In vitro biofilm formation by uropathogenic Escherichia coliand their antimicrobial susceptibility pattern

    Institute of Scientific and Technical Information of China (English)

    Poovendran Ponnusamy; Vidhya Natarajan; Murugan Sevanan

    2012-01-01

    Objective:To detect in vitro biofilm formation of uropathogenic Escherichia coli(E. coli)(UPEC) strains isolated from urine specimens and also to determine their antimicrobial susceptibility pattern using 13 commonly used antibiotics.Methods: The present study comprised of166 urine specimens collected from tertiary care hospitals in and around Coimbatore, South India. All the specimens were subjected to gram staining, bacterial culture and theE. coli strains were screened for biofilm formation using Tube Method(TM), Congo Red Agar(CRA) and Tissue Culture Plate method(TCP) respectively. Subsequently, the antimicrobial susceptibility test was performed by Kirby Bauer-disk diffusion method for the biofilm and non-biofilm producingE. colistrains.Results: Of the100 (60.2 %)E. coli strains,72 strains displayed a biofilm positive phenotype under the optimized conditions in the Tube Method and the strains were classified as highly positive(17, 23.6%), moderate positive(19, 26.3 %) and weakly positive(36, 50.0 %), similarly under the optimized conditions on Congo Red agar medium, biofilm positive phenotype strains were classified as highly positive(23, 23 %), moderate positive(37, 37 %)and weakly positive (40, 40%). While inTCP method, the biofilm positive phenotype strains were also classified as highly positive(6, 6 %), moderate positive (80, 80 %)and weakly positive(14, 14 %), it didn’t not correlate well with the tube method for detecting biofilm formation in E. coli. The rates of antibiotic resistance of biofilm producingE. coliwere found to be 100 % for chloramphenicol and amoxyclav (amoxicillin and clavulanic acid),86% for gentamicin and cefotaxime,84% for ceftazidime,83% for cotrimoxazole and piperacillin/tazobactam,75% for tetracycline and70% for amikacin.Conclusions: This study reveals the prevalence and antimicrobial susceptibility pattern of biofilm and non-biofilm producing uropathogenic E. coli strains.

  20. Susceptibility, phenotypes of resistance, and extended-spectrum β-lactamases in Acinetobacter baumannii strains

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    Elzbieta Tryniszewska

    2012-04-01

    Full Text Available Acinetobacter baumannii plays an increasing role in the pathogenesis of infections in humans. The bacilli are frequently isolated from patients treated in intensive care units. A growing resistance to antibiotics is leading to the emergence of strains that are multidrug-resistant and resistant to all available agents. The objective of this study was to assess susceptibility to antibiotics and to determine the presence and current level of the extended-spectrum β-lactamases (ESBLs and attempt to isolate the Acinetobacter baumannii strain carrying the blaPER gene. A total of 51 strains of A. baumannii identified by phenotypic features were examined. That the strains belonged to the species was confirmed by the presence of the blaOXA-51-like; gene. A broth microdilution method was used for antibacterial susceptibility testing. The occurrence of ESBLs was determined using phenotypic double-disk synergy tests. The PCR technique was used to confirm the presence of the blaPER-1; gene encoding ESBL. The most active antibiotics were meropenem, cefepime and ampicillin/sulbactam, with susceptibility shown by 76.5%, 60.8% and 56.9% of the strains, respectively. The strains exhibited the highest resistance (> 75% to piperacillin, tetracycline, ciprofloxacin and cefotaxime. Phenotypic tests revealed ESBL mechanism of resistance in approximately 20% of Acinetobacter baumannii isolates. However, the PCR technique did not confirm the presence of the blaPER-1; gene in any of the Acinetobacter baumannii strains examined in our hospital. Acinetobacter baumannii strains demonstrate considerable resistance to many groups of antibiotics. Our findings indicate the involvement of enzymes belonging to families other than PER β-lactamase in resistance to β-lactams in A. baumannii.

  1. Efflux pump, the masked side of beta-lactam resistance in Klebsiella pneumoniae clinical isolates.

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    Jean-Marie Pages

    Full Text Available BACKGROUND: Beta-lactamase production and porin decrease are the well-recognized mechanisms of acquired beta-lactam resistance in Klebsiella pneumoniae isolates. However, such mechanisms proved to be absent in K. pneumoniae isolates that are non susceptible to cefoxitin (FOX and susceptible to amoxicillin+clavulanic acid in our hospital. Assessing the role of efflux pumps in this beta-lactam phenotype was the aim of this study. METHODOLOGY/FINDINGS: MICs of 9 beta-lactams, including cloxacillin (CLX, and other antibiotic families were tested alone and with an efflux pump inhibitor (EPI, then with both CLX (subinhibitory concentrations and EPI against 11 unique bacteremia K. pneumoniae isolates displaying the unusual phenotype, and 2 ATCC strains. CLX and EPI-dose dependent effects were studied on 4 representatives strains. CLX MICs significantly decreased when tested with EPI. A similar phenomenon was observed with piperacillin+tazobactam whereas MICs of the other beta-lactams significantly decreased only in the presence of both EPI and CLX. Thus, FOX MICs decreased 128 fold in the K. pneumoniae isolates but also 16 fold in ATCC strain. Restoration of FOX activity was CLX dose-dependent suggesting a competitive relationship between CLX and the other beta-lactams with regard to their efflux. For chloramphenicol, erythromycin and nalidixic acid whose resistance was also due to efflux, adding CLX to EPI did not increase their activity suggesting differences between the efflux process of these molecules and that of beta-lactams. CONCLUSION: This is the first study demonstrating that efflux mechanism plays a key role in the beta-lactam susceptibility of clinical isolates of K. pneumoniae. Such data clearly evidence that the involvement of efflux pumps in beta-lactam resistance is specially underestimated in clinical isolates.

  2. Current Situation of Antimicrobial Resistance and Genetic Differences in Stenotrophomonas maltophilia Complex Isolates by Multilocus Variable Number of Tandem Repeat Analysis

    Science.gov (United States)

    Song, Jae-Hoon

    2016-01-01

    Background Stenotrophomonas maltophilia is one of several opportunistic pathogens of growing significance. Several studies on the molecular epidemiology of S. maltophilia have shown clinical isolates to be genetically diverse. Materials and Methods A total of 121 clinical isolates tentatively identified as S. malophilia from seven tertiary-care hospitals in Korea from 2007 to 2011 were included. Species and groups were identified using partial gyrB gene sequences and antimicrobial susceptibility testing was performed using a broth microdilution method. Multi locus variable number of tandem repeat analysis (MLVA) surveys are used for subtyping. Results Based on partial gyrB gene sequences, 118 isolates were identified as belonging to the S. maltophilia complex. For all S. maltophilia isolates, the resistance rates to trimethoprime-sulfamethoxazole (TMP/SMX) and levofloxacin were the highest (both, 30.5%). Resistance rate to ceftazidime was 28.0%. 11.0% and 11.9% of 118 S. maltophilia isolates displayed resistance to piperacillin/tazobactam and tigecycline, respectively. Clade 1 and Clade 2 were definitely distinguished from the data of MLVA with amplification of loci. All 118 isolates were classified into several clusters as its identification. Conclusion Because of high resistance rates to TMP/SMX and levofloxacin, the clinical laboratory department should consider providing the data about other antimicrobial agents and treatment of S. maltophilia infections with a combination of antimicrobials can be considered in the current practice. The MLVA evaluated in this study provides a fast, portable, relatively low cost genotyping method that can be employed in genotypic linkage or transmission networks comparing to analysis of the gyrB gene. PMID:28032486

  3. Reduction in fluoroquinolone use following introduction of ertapenem into a hospital formulary is associated with improvement in susceptibility of Pseudomonas aeruginosa to group 2 carbapenems: a 10-year study.

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    Cook, Paul P; Gooch, Michael; Rizzo, Shemra

    2011-12-01

    We examined the effect of the addition of ertapenem to our hospital formulary on the resistance of nosocomial Pseudomonas aeruginosa to group 2 carbapenems (imipenem, meropenem, and doripenem). This was a retrospective, observational study conducted between 1 January 2000 and 31 January 2009 at a large, tertiary-care hospital. Autoregressive integrated moving average (ARIMA) regression models were used to evaluate the effect of ertapenem use on the susceptibility of Pseudomonas aeruginosa to group 2 carbapenems as well as on the use of the group 2 carbapenems, ciprofloxacin, and other antipseudomonal drugs (i.e., tobramycin, cefepime, and piperacillin-tazobactam). Resistance was expressed as a percentage of total isolates as well as the number of carbapenem-resistant bacterial isolates per 10,000 patient days. Pearson correlation was used to assess the relationship between antibiotic use and carbapenem resistance. Following the addition of ertapenem to the formulary, there was a statistically significant decrease in the percentage of Pseudomonas aeruginosa isolates resistant to the group 2 carbapenems (P = 0.003). Group 2 carbapenem use and the number of carbapenem-resistant Pseudomonas aeruginosa isolates per 10,000 patient days did not change significantly over the time period. There was a large decrease in the use of ciprofloxacin (P = 0.0033), and there was a correlation of ciprofloxacin use with the percentage of isolates resistant to the group 2 carbapenems (ρ = 0.47, P = 0.002). We suspect that the improvement in susceptibility of Pseudomonas aeruginosa to group 2 carbapenems was related to a decrease in ciprofloxacin use.

  4. ANTIBIOTIC SUSCEPTIBILITY PATTERN OF KLEBSIELLA PNEUMONIAE ISOLATED FROM CASES OF URINARY TRACT INFECTION IN A TERTIARY CARE SETUP

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    Anila

    2016-04-01

    Full Text Available bidity and a high economic burden for treatment. Klebsiella pneumoniae accounts for 2nd highest organism isolated from urine samples of UTI patients after Escherichia coli. The management of UTI is complicated by the increasing prevalence of antibiotic resistant strains of Klebsiella pneumonia. Therefore, knowledge of the antibiotic resistance patterns of the pathogen is important not only to provide an appropriate therapy, but also for the prevention of resistance amongst the microbe. OBJECTIVE The present study was therefore undertaken to determine the antibiotic susceptibility pattern of Klebsiella pneumonia causing UTI in patients admitted to a tertiary care hospital. MATERIAL AND METHODS The details of Klebsiella pneumonia grown in urine samples received in the Department of Microbiology, MOSC Medical College, were collected from the laboratory registers. These urine samples were then processed using standard methods and antibiotic susceptibility testing was done by Kirby Bauer’s disc diffusion method. RESULT During the period of 4 months, 35 urine samples yielding Klebsiella pneumonia were processed. These strains showed 100% resistance to Ampicillin, around 70–85% resistance to first, second and third generation Cephalosporins. They showed maximum sensitivity to Imipenem (74.3%, followed by Colistin (77%, Amikacin (65.7%, Meropenem (65.7% and Piperacillin-Tazobactam (65.7%. CONCLUSION In our study, the high rate of resistance to routinely prescribed drugs like Co-trimoxazole, Norfloxacin and Nitrofurantoin could be attributed to the frequent use of these antibiotics. Carbapenems (Imipenem or Meropenem and Amikacin should be considered as reserved drugs, especially for nosocomial infections

  5. Surveillance of Extended-Spectrum β-Lactamase-producing Carriage in a Japanese Intensive Care Unit: a Retrospective Analysis

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    Yasumasa Kawano

    2016-11-01

    Full Text Available Background The effectiveness of surveillance to identify extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-E carriers is controversial during a non-outbreak situation. We performed additional stool cultures for ESBL-E among intensive care unit (ICU patients already under active surveillance by means of sputum and urine cultures. We aimed to assess the efficacy of stool cultures for screening for ESBL-E in a non-outbreak situation. Methods We conducted a retrospective cohort study in an ICU. Sputum and urine samples were cultured for ESBL-E surveillance purposes from January to September 2013 (phase 1. Stool cultures were routinely performed in addition from January to September 2014 (phase 2. Antimicrobial use density values and clinical outcomes were investigated and compared between phase 1 and 2. Results We identified 512 and 478 patients in phase 1 and phase 2, respectively. ESBL-E were found in the feces of 65 (13.6% patients in phase 2. The antimicrobial use density values (expressed as defined daily doses per 1,000 bed-days were not significantly different between the two phases for fluoroquinolones (7 vs. 10, p = 0.376, third-generation cephalosporins (24.2 vs. 29.5, p = 0.724, tazobactam/ piperacillin (44.6 vs. 57.3, p = 0.489, and carbapenems (73 vs. 55.5, p = 0.222. Moreover, there were no significant differences in ICU mortality and length of stay (11.5% vs. 9.8%, p = 0.412, and 9 vs. 10 days, p = 0.28, respectively. Conclusions Stool culture seemed ineffective in improving the antimicrobial use density of broad-spectrum antimicrobials, clinical outcomes, and ICU length of stay, and is not recommended for surveillance of ESBL-E in a non-outbreak situation.

  6. Third generation cephalosporin resistant Enterobacteriaceae and multidrug resistant gram-negative bacteria causing bacteremia in febrile neutropenia adult cancer patients in Lebanon, broad spectrum antibiotics use as a major risk factor, and correlation with poor prognosis

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    Rima eMoghnieh

    2015-02-01

    Full Text Available Bacteremia remains a major cause of life-threatening complications in patients receiving anticancer chemotherapy. The spectrum and susceptibility profiles of causative microorganisms differ with time and place. Data from Lebanon are scarce. We aim at evaluating the epidemiology of bacteremia in cancer patients in a university hospital in Lebanon, emphasizing antibiotic resistance and risk factors of multi-drug resistant organism (MDRO-associated bacteremia.This is a retrospective study of 75 episodes of bacteremia occurring in febrile neutropenic patients admitted to the hematology-oncology unit at Makassed General Hospital, Lebanon, from October 2009-January 2012.It corresponds to epidemiological data on bacteremia episodes in febrile neutropenic cancer patients including antimicrobial resistance and identification of risk factors associated with third generation cephalosporin resistance (3GCR and MDRO-associated bacteremia. Out of 75 bacteremias, 42.7% were gram-positive (GP, and 57.3% were gram-negative (GN. GP bacteremias were mostly due to methicillin-resistant coagulase negative staphylococci (28% of total bacteremias and 66% of GP bacteremias. Among the GN bacteremias, Escherichia coli (22.7% of total, 39.5% of GN organisms and Klebsiellapneumoniae(13.3% of total, 23.3% of GN organisms were the most important causative agents. GN bacteremia due to 3GC sensitive (3GCS bacteria represented 28% of total bacteremias, while 29% were due to 3GCR bacteria and 9% were due to carbapenem-resistant organisms. There was a significant correlation between bacteremia with MDRO and subsequent intubation, sepsis and mortality. Among potential risk factors, only broad spectrum antibiotic intake >4 days before bacteremia was found to be statistically significant for acquisition of 3GCR bacteria. Using carbapenems or piperacillin/ tazobactam>4 days before bacteremia was significantly associated with the emergence of MDRO (p value<0.05.

  7. Update on resistance of Bacteroides fragilis group and related species with special attention to carbapenems 2006-2009.

    Science.gov (United States)

    Snydman, D R; Jacobus, N V; McDermott, L A; Golan, Y; Goldstein, E J C; Harrell, L; Jenkins, S; Newton, D; Pierson, C; Rosenblatt, J; Venezia, R; Gorbach, S L; Queenan, A M; Hecht, D W

    2011-08-01

    The susceptibility trends for the species of the Bacteroides fragilis group against various antibiotics were determined using data from 4 years [2006-2009] on 1957 isolates referred by 8 medical centers participating in a National Survey for the Susceptibility of B. fragilis. The antibiotic test panel included doripenem, ertapenem, imipenem, meropenem, ampicillin:sulbactam, piperacillin:tazobactam, cefoxitin, clindamycin, moxifloxacin, tigecycline, chloramphenicol and metronidazole. MICs were determined using agar dilution methods following CLSI recommendations. Genetic analysis of isolates from 2008 with elevated MICs (>2 μg/mL) to one or more of the carbapenems to detect presence of the cfiA gene was performed using PCR methodology. The results showed an increase in the resistance rates to the β-lactam antibiotics. High resistance rates were seen for clindamycin and moxifloxacin (as high as 60% for clindamycin and >80% for moxifloxacin), with relatively stable low resistance (5.4%) for tigecycline. For carbapenems, resistance in B. fragilis was 1.1%-2.5% in 2008-9. One isolate resistant to metronidazole (MIC 32 μg/mL) was observed as well as isolates with elevated MICs to chloramphenicol (16 μg/mL). Genetic analysis indicated that the cfiA gene was present in some but not all of the isolates with high MICs to the carbapenems. These data indicate that there continue to be changes in susceptibility over time, and that resistance can be seen among the carbapenems. High antibiotic resistance rates tend to be associated with specific species.

  8. Clinical evaluation of the need for carbapenems to treat community-acquired and healthcare-associated pneumonia.

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    Kamata, Kazuhiro; Suzuki, Hiromichi; Kanemoto, Koji; Tokuda, Yasuharu; Shiotani, Seiji; Hirose, Yumi; Suzuki, Masatsune; Ishikawa, Hiroichi

    2015-08-01

    Carbapenems have an overall broad antibacterial spectrum and should be protected against from the acquisition of drug resistance. The clinical advantages of carbapenem in cases of pneumonia have not been certified and the need for antipseudomonal antimicrobial agents to treat healthcare-associated pneumonia (HCAP) remains controversial. We introduced an antimicrobial stewardship program for carbapenem and tazobactam/piperacillin use and investigated the effects of this program on the clinical outcomes of 591 pneumonia cases that did not require intensive care unit management, mechanical ventilation or treatment with vasopressor agents [221 patients with community-acquired pneumonia (CAP) and 370 patients with HCAP]. Compared with the pre-intervention period, age, comorbidities and the severity and etiology of pneumonia did not differ during the intervention period. Carbapenems were rarely used during the intervention period in cases of pneumonia (CAP: 12% vs. 1%, HCAP: 13% vs. 1%), while antipseudomonal beta-lactam use was reduced from 33% to 8% among cases with HCAP. This reduction in the rate of carbapenem administration did not have an impact on the prognosis in the cases of CAP, and the in-hospital mortality was lower among the patients with HCAP during the intervention period (15% vs. 5%, p = 0.013). The causes of death in the cases of HCAP were not directly related to pneumonia during the intervention period. The current study shows that carbapenem use can be avoided in cases of CAP or HCAP that are not in a critical condition. The frequent use of antipseudomonal beta-lactams does not improve the clinical outcomes of HCAP.

  9. Retrospective survey and evaluation of first-line antibiotics for chemotherapy-induced febrile neutropenia in patients with acute myeloid leukemia

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    Mukoyama, Naoki; Nakashima, Marie; Miyamura, Koichi; Yoshimi, Akira; Noda, Yukihiro; Mori, Kazuhiro

    2017-01-01

    ABSTRACT Patients with acute leukemia are susceptible to chemotherapy-induced severe myelosuppression, and therefore are at a high risk for febrile neutropenia (FN). In such cases, the use of broad-spectrum antibiotics such as fourth-generation cephalosporins and carbapenems is recommended as first-line antimicrobial treatment; however, the effectiveness of these agents in patients with acute myeloid leukemia (AML) has not been investigated in detail. We retrospectively examined and evaluated the effectiveness of first-line antibiotic treatment regimens for chemotherapy-induced FN in patients with AML in Japanese Red Cross Nagoya Daiichi Hospital. The evaluated first-line treatment regimens were as follows: cefozopran (CZOP) + amikacin (AMK) in 38 cases, cefepime (CFPM) alone in 2 cases, CFPM + AMK in 2 cases, piperacillin (PIPC) + AMK in 2 cases, and CZOP alone in 1 case. Additionally, prophylactic antifungal agents were administered in all cases. Markedly effective, effective, moderately effective, and ineffective responses occurred in 31.1%, 8.9%, 8.9%, and 51.1%, respectively, of the treated cases. The response rate, defined as the combination of markedly effective and effective outcomes, was 40.0%. In 11 cases, impairment of renal functions were observed, and they were associated with combination treatments including AMK; nine of these were associated with a glycopeptide. The combination of CZOP with AMK (84.4%) was the most commonly used first-line treatment for FN in patients with AML; carbapenem or tazobactam/PIPC has never been used for treatment of such cases. Our findings demonstrate that fourth-generation cephems will be an effective first-line treatment for FN in patients with AML in our hospital. PMID:28303057

  10. Epidemiological and clinical features associated with colonisation/infection by Acinetobacter baumannii with phenotypic heterogeneous resistance to carbapenems.

    Science.gov (United States)

    Fernández-Cuenca, Felipe; Gómez-Sánchez, M; Rodríguez-Baño, Jesús; Martínez-Martínez, Luis; Vila, Jordi; Bou, Germán; Pascual, Alvaro

    2012-09-01

    The objective of this study was to identify risk factors for the acquisition of Acinetobacter baumannii with phenotypic heterogeneous resistance (PHR) to carbapenems and to determine whether these factors are similar to those associated with A. baumannii not showing this phenotype. Microbiological and clinical data from 211 patients included in the GEIH-Ab 2000 project were used. Isolates of A. baumannii were studied for their susceptibility to imipenem (IPM) by microdilution and for PHR to IPM as determined by the presence of colonies growing within the inhibition zone of IPM disks. Isolates were divided into three groups: (i) IPM-PHR isolates, i.e. susceptible and non-susceptible A. baumannii displaying PHR to IPM; (ii) non-IPM-PHR isolates, i.e. susceptible A. baumannii showing an inhibition halo but no colonies growing within it; and (iii) IPM-FR isolates, i.e. fully resistant A. baumannii displaying no halo of inhibition. IPM-PHR isolates of A. baumannii were more commonly isolated from respiratory tract samples and less commonly from urine, and were more frequently causes of infection than were IPM-FR isolates. Independent risk factors identified in patients with IPM-PHR isolates were Intensive Care Unit admission, surgery, and previous use of piperacillin/tazobactam or carbapenems, whilst risk factors for IPM-FR and IPM-PHR were previous use of cephalosporins and isolation from a urine sample. In conclusion, risk factors associated with colonisation/infection by isolates of A. baumannii with PHR to carbapenems are similar to those previously described for isolates resistant to carbapenems.

  11. In vitro activity of tigecycline and comparators against gram-negative bacteria isolated from a tertiary hospital in Alexandria, Egypt.

    Science.gov (United States)

    Mohamed, Nelly M; Youssef, Alaa A F

    2011-12-01

    The emergence of infections caused by multidrug-resistant Gram-negative bacteria, in particular Pseudomonas aeruginosa, Acinetobacter baumannii, and Klebsiella pneumoniae, has necessitated the search for alternative therapy by either introducing new agents or renewing interest in old agents. This study compares the in vitro activity of tigecycline (TIG), recently introduced to Egyptian market, to other potentially active antimicrobials as Colistin (COL), imipenem (IPM), levofloxacin (LEV), and piperacillin/tazobactam (PIP/TAZ) against 67 Gram-negative clinical isolates obtained from El- Meery Hospital in Alexandria, Egypt. El-Meery Hospital is a 1,500-bed tertiary teaching hospital where TIG has not been previously used. Based on MIC(90)s, TIG was found to be a comparator to IPM and COL (MIC(90)= 8 μg/ml). LEV and PIP/TAZ were less active than TIG exhibiting high MIC(90)s. TIG inhibited 100% of Escherichia coli and K. pneumoniae and 60% of Ps. aeruginosa and A. baumannii isolates. In time-kill studies against IPM-resistant isolates, TIG showed bactericidal activity after 6 hours of contact against the Enterobacteriaceae isolates and after 3 hours for the tested Ps. aeruginosa isolates at 4× and 8× MIC. Against A. baumannii, TIG exerted a bacteriostatic effect. TIG demonstrated variable ability to suppress biofilm formation affecting mainly E. coli and A. baumannii isolates. These results point TIG to be a promising agent in treatment of infections caused by strains for which adequate therapy has been limited. As far as we know, this is the first report evaluating the in vitro activity of TIG against Egyptian clinical isolates.

  12. In vitro activity of antibiotics alone and in combination against Actinobacillus actinomycetemcomitans.

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    Yogev, R; Shulman, D; Shulman, S T; Glogowski, W G

    1986-01-01

    The MICs for 90% of the organisms tested (MIC90S) of 11 antibiotics against 24 clinical isolates of Actinobacillus actinomycetemcomitans were determined by the MIC 2000 system. The lowest MIC90S (16 micrograms/ml) were observed with ceftriaxone and rifampin. The next lowest MIC90S were found with cephapirin, tetracycline, and chloramphenicol (3.12 micrograms/ml). The MIC90S of penicillin, ampicillin, ticarcillin, piperacillin, and amikacin were each greater than or equal to 12.5 micrograms/ml. Antibiotic synergy was studied by the killing curve method and was defined as a greater than or equal to 2 log10 reduction in CFU when two antibiotics were used in combination at one-fourth the MBC for each compared with the effect of each antibiotic alone at one-half the MBC. Synergism between rifampin and penicillin, cephapirin, or ceftriaxone was tested for with 12 A. actinomycetemcomitans strains. In 7 of 37 instances, synergism was demonstrated for the combinations rifampin plus ceftriaxone (n = 3) or rifampin plus penicillin (n = 4); in 9 instances, an additive effect was noted, and impaired killing with drug combinations compared with the effect of a single antibiotic was suggested in 4 strains. The majority of strains were indifferent to the combinations. Similarly, variable results were observed when the combination of trimethoprim and cephapirin was tested against eight A. actinomycetemcomitans strains. Our data suggest that rifampin and cephapirin are the most active of the 11 antibiotics studied against A. actinomycetemcomitans. In addition, in vitro synergism between rifampin and other antibiotics or between trimethoprim and cephapirin was not consistently demonstrable.

  13. Detection of Primary T Cell Responses to Drugs and Chemicals in HLA-Typed Volunteers: Implications for the Prediction of Drug Immunogenicity.

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    Faulkner, Lee; Gibson, Andrew; Sullivan, Andrew; Tailor, Arun; Usui, Toru; Alfirevic, Ana; Pirmohamed, Munir; Naisbitt, Dean J; Kevin Park, B

    2016-12-01

    A number of serious adverse drug reactions are caused by T cells. An association with HLA alleles has been identified with certain reactions, which makes it difficult to develop standardized preclinical tests to predict chemical liability. We have recently developed a T cell priming assay using the drug metabolite nitroso sulfamethoxazole (SMX-NO). We now report on reproducibility of the assay, establishment of a biobank of PBMC from 1000 HLA-typed volunteers, and generation of antigen-specific responses to a panel of compounds. Forty T cell priming assays were performed with SMX-NO; 5 gave weak responses (1.5-1.9) and 34 showed good (SI 2.0-3.9) or strong responses (SI  > 4.0) using readouts for proliferation and cytokine release. Thus, SMX-NO can be used as a model reagent for in vitro T cell activation. Good to strong responses were also generated to haptenic compounds (amoxicillin, piperacillin and Bandrowski's base) that are not associated with an HLA risk allele. Furthermore, responses were detected to carbamazepine (in HLA-B*15:02 donors), flucloxacillin (in 1 HLA-B*57:01 donor) and oxypurinol (in HLA-B*58:01 donors), which are associated with HLA-class I-restricted forms of hypersensitivity. In contrast, naïve T cell priming to ximelagatran, lumiracoxib, and lapatinib (HLA-class II-restricted forms of hypersensitivity) yielded negative results. Abacavir, which activates memory T cells in patients, did not activate naïve T cells from HLA-B*57:01 donors. This work shows that the priming assay can be used to assess primary T cell responses to drugs and to study mechanisms T cell priming for drugs that display HLA class I restriction. Additional studies are required to investigate HLA-class II-restricted reactions.

  14. Relationship between ceftolozane-tazobactam exposure and selection for Pseudomonas aeruginosa resistance in a hollow-fiber infection model.

    Science.gov (United States)

    VanScoy, Brian D; Mendes, Rodrigo E; Castanheira, Mariana; McCauley, Jennifer; Bhavnani, Sujata M; Jones, Ronald N; Friedrich, Lawrence V; Steenbergen, Judith N; Ambrose, Paul G

    2014-10-01

    It is important to understand the relationship between antibiotic exposure and the selection of drug resistance in the context of therapy exposure. We sought to identify the ceftolozane-tazobactam exposure necessary to prevent the amplification of drug-resistant bacterial subpopulations in a hollow-fiber infection model. Two Pseudomonas aeruginosa challenge isolates were selected for study, a wild-type ATCC strain (ceftolozane-tazobactam MIC, 0.5 mg/liter) and a clinical isolate (ceftolozane-tazobactam MIC, 4 mg/liter). The experiment duration was 10 days, and the ceftolozane-tazobactam dose ratio (2:1) and dosing interval (every 8 h) were selected to approximate those expected to be used clinically. The studied ceftolozane-tazobactam dosing regimens ranged from 62.5/31.25 to 2,000/1,000 mg per dose in step fold dilutions. Negative-control arms included no treatment and tazobactam at 500 mg every 8 h. Positive-control arms included ceftolozane at 1 g every 8 h and piperacillin-tazobactam dosed at 4.5 g every 6 h. For the wild-type ATCC strain, resistance was not selected by any ceftolozane-tazobactam regimen evaluated. For the clinical isolate, an inverted-U-shaped function best described the relationship between the amplification of a drug-resistant subpopulation and drug exposure. The least (62.5/31.25 mg) and most (2,000/1,000 mg) intensive ceftolozane-tazobactam dosing regimens did not select for drug resistance. Drug resistance selection was observed with intermediately intensive dosing regimens (125/62.5 through 1,000/500 mg). For the intermediately intensive ceftolozane-tazobactam dosing regimens, the duration until the selection for drug resistance increased with dose regimen intensity. These data support the selection of ceftolozane-tazobactam dosing regimens that minimize the potential for on-therapy drug resistance selection.

  15. Occurrence and sensitivity profile of extended spectrum beta-lactamase-producing Enterobacteriaceae at a tertiary hospital in Southern Brazil

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    Cristina Letícia Rugini

    2015-12-01

    Full Text Available Abstract: INTRODUCTION: Nosocomial infections are closely associated with antimicrobial drug resistance. One of the most important mechanisms of resistance to β-lactam antibiotics is the production of extended spectrum β-lactamases (ESBLs. The objective of the present study was to evaluate the prevalence and antimicrobial susceptibility profile of ESBL-producing strains and to assess the evolution of antimicrobial drug resistance between 2007 and 2013 at the Hospital São Vicente de Paulo, Passo Fundo, State of Rio Grande do Sul, Brazil. METHODS: We conducted a descriptive, observational, cross-sectional study. Bacterial culture was performed from January to December 2013. The antimicrobial susceptibility profile of these cultures was determined using the disk diffusion method. Phenotypic screening for ESBL production was performed using the disk approximation method. RESULTS : We analyzed a total of 19,112 cultures, 11.5% of which were positive for Enterobacteriaceae. Of these, 30.3% of the isolates were positive for ESBL production, and the most prevalent species was Klebsiella sp. (37.5%. Over 95% of these isolates showed reduced susceptibility to all cephalosporins, aztreonam, and amoxicillin/clavulanic acid. The isolates also showed high sensitivity to the following antimicrobials: amikacin, meropenem, and piperacillin/tazobactam. Overall, the resistance rates among ESBL-producing Enterobacteriaceae decreased from 2007 to 2013. CONCLUSIONS : In our hospital, the increased sensitivity to certain antimicrobial agents seems to be directly related to the implementation of improvements in the methods to prevent and control nosocomial infections in addition to the natural development of other resistance mechanisms.

  16. [In vitro study of the flow duration of antibiotics solutions prepared in elastomeric infusion devices: effect of cold storage for 3 to 7days].

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    Grangeon-Chapon, C; Robein-Dobremez, M-J; Pin, I; Trouiller, P; Allenet, B; Foroni, L

    2015-09-01

    Within the cystic fibrosis patients' home care, EMERAA network ("Together against Cystic fibrosis in Rhone-Alpes and Auvergne") organizes parenteral antibiotics cures at home prepared in elastomeric infusion devices by hospital pharmacies. However, patients and nurses found that the durations of infusion with these devices were often longer than the nominal duration of infusion indicated by their manufacturer. This study aimed to identify the potential different causes in relation to these discordances. Three hundred and ninety devices of two different manufacturers are tested in different experimental conditions: three antibiotics each at two different doses, duration of cold storage (three days or seven days) or immediate tests without cold storage, preparation and storage of the solution in the device (protocol Device) or transfer in the device just before measurement (protocol Pocket). All tests highlighted a longer flow duration for devices prepared according to the protocol Device versus the protocol Pocket (P=0.004). Flow duration is increased in the case of high doses of antibiotics with high viscosity such as piperacilline/tazobactam. The results of this in vitro study showed the impact of: (1) the time between the filling of the device and the flow of the solution; (2) cold storage of elastomeric infusion devices; (3) concentration of antibiotics and therefore the viscosity of the solution to infuse. It is therefore essential that health care teams are aware of factors, which may lead to longer infusion durations with these infusion devices. When the additional time for infusion remain acceptable, it should be necessary to inform the patient and to relativize these lengthening compared to many benefits that these devices provide for home care. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  17. Endothelial Cell Toxicity of Vancomycin Infusion Combined with Other Antibiotics.

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    Drouet, Maryline; Chai, Feng; Barthélémy, Christine; Lebuffe, Gilles; Debaene, Bertrand; Décaudin, Bertrand; Odou, Pascal

    2015-08-01

    French guidelines recommend central intravenous (i.v.) infusion for high concentrations of vancomycin, but peripheral intravenous (p.i.v.) infusion is often preferred in intensive care units. Vancomycin infusion has been implicated in cases of phlebitis, with endothelial toxicity depending on the drug concentration and the duration of the infusion. Vancomycin is frequently infused in combination with other i.v. antibiotics through the same administrative Y site, but the local toxicity of such combinations has been poorly evaluated. Such an assessment could improve vancomycin infusion procedures in hospitals. Human umbilical vein endothelial cells (HUVEC) were challenged with clinical doses of vancomycin over 24 h with or without other i.v. antibiotics. Cell death was measured with the alamarBlue test. We observed an excess cellular death rate without any synergistic effect but dependent on the numbers of combined infusions when vancomycin and erythromycin or gentamicin were infused through the same Y site. Incompatibility between vancomycin and piperacillin-tazobactam was not observed in our study, and rinsing the cells between the two antibiotic infusions did not reduce endothelial toxicity. No endothelial toxicity of imipenem-cilastatin was observed when combined with vancomycin. p.i.v. vancomycin infusion in combination with other medications requires new recommendations to prevent phlebitis, including limiting coinfusion on the same line, reducing the infusion rate, and choosing an intermittent infusion method. Further studies need to be carried out to explore other drug combinations in long-term vancomycin p.i.v. therapy so as to gain insight into the mechanisms of drug incompatibility under multidrug infusion conditions.

  18. Pharmacokinetic optimisation of beta-lactams for the treatment of ventilator-associated pneumonia

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    G. L. Drusano

    2007-08-01

    Full Text Available Rational therapy of ventilator-associated pneumonia requires choosing the right drug at the right dose. The choice of dose depends on the microbiological goal, the range of minimum inhibitory concentrations (MICs for likely pathogens, the extent of the drug's protein binding and, in humans, pharmacokinetics. If protein binding and the distribution of pharmacokinetic parameters are known, as well as the likely pathogens and MICs in a given setting, Monte Carlo simulations can be used to calculate the likelihood that a given dose will attain an identified microbiological goal. For beta-lactams, the antibacterial effect depends on the percentage of time (%T during the dosing interval that the free (nonprotein bound antibiotic concentration remains above the MIC (%T >MIC; the required values are smaller for carbapenems than for penicillins or cephalosporins. Dat