Pseudomonas aeruginosa infection-associated erythema multiforme in a Maltese dog.

An 8-year-old spayed female Maltese dog was referred with a 4-month history of multifocal pruritic erosive or ulcerative lesions on the head, ventral neck, chest, and abdomen; and chronic otitis externa. Biopsy revealed cytotoxic dermatitis and apoptotic keratinocytes with occasional lymphocytic satellitosis. Bacterial culture and antimicrobial susceptibility tests revealed multidrug-resistant Pseudomonas aeruginosa infection of the skin and ears. The skin lesions regressed after treatment of P. aeruginosa infection with ciprofloxacin. Based on the skin lesions, histological characteristics, and response to therapy, the dog was presumed to have erythema multiforme induced by P. aeruginosa infection. This case report emphasizes that P. aeruginosa infection could be a trigger of erythema multiforme in dogs. Key clinical message: Erythema multiforme caused by infection is rare and poorly characterized in the veterinary literature. This case report describes the clinical characteristics of, diagnostic approach to, and treatment of erythema multiforme caused by Pseudomonas aeruginosa.

Érythème polymorphe associé à une infection à Pseudomonas aeruginosa chez un bichon maltaisUne chienne bichon maltais stérilisée âgée de 8 ans a été référée avec des antécédents de lésions érosives ou ulcéreuses prurigineuses multifocales sur la tête, la partie ventrale du cou, la poitrine et l'abdomen, et une otite externe chronique depuis 4 mois. La biopsie a révélé une dermatite cytotoxique et des kératinocytes apoptotiques avec une satellitose lymphocytaire occasionnelle. La culture bactérienne et les tests de sensibilité aux antimicrobiens ont révélé une infection à Pseudomonas aeruginosa multirésistante de la peau et des oreilles. Les lésions cutanées ont régressé après traitement de l'infection à P. aeruginosa par la ciprofloxacine. Sur la base des lésions cutanées, des caractéristiques histologiques et de la réponse au traitement, le chien a été présumé avoir un érythème polymorphe induit par une infection à P. aeruginosa. Ce rapport de cas souligne que l'infection à P. aeruginosa pourrait être un déclencheur d'érythème polymorphe chez le chien.Message clinique clé :L'érythème polymorphe causé par une infection est rare et mal caractérisé dans la littérature vétérinaire. Ce rapport de cas décrit les caractéristiques cliniques, l'approche diagnostique et le traitement de l'érythème polymorphe causé par Pseudomonas aeruginosa.(Traduit par Dr Serge Messier).

Antibiotic use in surgical infections at a tertiary teaching hospital in Ghana.

Objective: The study aimed to assess antibiotic prescribing and use patterns at the Department of Surgery, Korle Bu Teaching Hospital. Design: A cross-sectional study design was employed in this study. Setting: The study was conducted at the Department of Surgery, Korle Bu Teaching Hospital. Participants: Forty-two prescribers out of 63 (67%) at the Department of Surgery responded to questionnaires. Over the study period, prescriptions and medical records of 1715 patients from the general surgery, neurosurgery, and urology units were reviewed. Main Outcome Measures: Percentage of prescriptions with antibiotics, percentage of prescribers using guidelines for antibiotic prescriptions, and percentage using culture and sensitivity to inform antibiotic prescriptions. Results: Of the 1715 prescriptions assessed, 75% (1294/1715) were from inpatients, and 45% (772/1715) included an antibiotic. Ciprofloxacin and metronidazole constituted 54% of antibiotic prescriptions from general surgery. Amoxicillin/clavulanic acid and ceftriaxone constituted 64.7% of antibiotic prescriptions from neurosurgery, and ceftriaxone and ciprofloxacin made up 37.7% of antibiotic prescriptions from urology. Microbiology testing was done for only 14.5% (9/62) of inpatients who received antibiotics for treatment. The choice of antibiotics was influenced mainly by doctors' previous experience (37/42, 88.1%). Conclusion: Antibiotics are widely used. About half of all prescriptions had antibiotics, with ciprofloxacin and metronidazole constituting more than half of antibiotic prescriptions from general surgery. Doctors mainly based their antibiotic prescriptions on previous experience and occasionally on microbiological investigations. Funding: None declared.

Incidence, antimicrobial susceptibility & out of pocket expenditure of severe enteric fever in Chandigarh, north India.

Background & objectives Burden estimates of enteric fever are required to make policy decisions on introducing typhoid vaccine in India. Incidence, antimicrobial susceptibility, and out-of-pocket expenditure (OOPE) of enteric fever are estimated in Chandigarh, India. Methods A hybrid (facility and community-based) surveillance system was set up at a secondary care hospital to enrol patients above six months of age, hospitalized with fever, from a defined catchment population from May 2018 to March 2020. Blood samples were collected and cultured using an automated system (BD BACTECTM blood culture system). The Salmonella Typhi and S. Paratyphi isolates were characterized for antimicrobial susceptibility. OOPE was recorded after 14 and 28 days of discharge. Results Blood samples were collected from 97 per cent of the 1650 study participants enrolled. The incidence of enteric fever was 226.8 per 1,00,000 person-years (PY), severe typhoid fever 156.9 per 1,00,000 PY, and severe paratyphoid fever 69.9 per 1,00,000 PY. Salmonella was highly susceptible to ampicillin, azithromycin, and ceftriaxone (99.25%) and least susceptible to ciprofloxacin (11.3%). The OOPE due to hospitalization of individuals infected with S. Paratyphi [INR 8696.6 (USD 116)] was significantly higher than the individuals infected with S. Typhi [INR 7309 (USD 97.5), P=0.01], and among cases who were hospitalized for more than seven days [INR 12,251 (USD 163.3)] as compared with those with a stay of 3-7 days [INR 8038.2 (USD 107.2)] or less than three days [INR 5327.8 (USD 71), P<0.001]. Interpretation & conclusions There was a high incidence of enteric fever, high OOPE, and resistance to ciprofloxacin.

Trends in antimicrobial resistance amongst Salmonella Typhi in Bangladesh: A 24-year retrospective observational study (1999-2022).

BACKGROUND: Rising antimicrobial resistance (AMR) in Salmonella Typhi restricts typhoid treatment options, heightening concerns for pan-oral drug-resistant outbreaks. However, lack of long-term temporal surveillance data on AMR in countries with high burden like Bangladesh is scarce. Our study explores the AMR trends of Salmonella Typhi isolates from Bangladesh, drawing comparisons with antibiotic consumption to optimize antibiotic stewardship strategies for the country. METHODOLOGY/PRINCIPAL FINDINGS: The typhoid fever surveillance from 1999 to 2022 included two pediatric hospitals and three private clinics in Dhaka, Bangladesh. Blood cultures were performed at treating physicians' discretion; cases were confirmed by microbiological, serological, and biochemical tests. Antibiotic susceptibility was determined following CLSI guidelines. National antibiotic consumption data for cotrimoxazole, ciprofloxacin, and azithromycin was obtained from IQVIA-MIDAS database for comparison. Over the 24 years of surveillance, we recorded 12,435 culture-confirmed typhoid cases and observed declining resistance to first-line drugs (amoxicillin, chloramphenicol, and cotrimoxazole); multidrug resistance (MDR) decreased from 38% in 1999 to 17% in 2022. Cotrimoxazole consumption dropped from 0.8 to 0.1 Daily defined doses (DDD)/1000/day (1999-2020). Ciprofloxacin non-susceptibility persisted at >90% with unchanged consumption (1.1-1.3 DDD/1000/day, 2002-2020). Low ceftriaxone resistance (<1%) was observed, with slightly rising MIC (0.03 to 0.12 mg/L, 1999-2019). Azithromycin consumption increased (0.1 to 3.8 DDD/1000/day, 1999-2020), but resistance remained ≤4%. CONCLUSION: Our study highlights declining MDR amongst Salmonella Typhi in Bangladesh; first-line antimicrobials could be reintroduced as empirical treatment options for typhoid fever if MDR rates further drops below 5%. The analysis also provides baseline data for monitoring the impact of future interventions like typhoid conjugate vaccines on typhoid burden and associated AMR.

Two cases of Francisella tularensis subspecies holartica prosthetic valve endocarditis, and review of the literature.

Francisella tularensis endocarditis is rare and difficult to diagnose, and only a few cases have been described. We report two new cases of endocarditis due to F. tularensis subsp. holarctica, with a favorable evolution after appropriate antibiotic therapy and valve replacement surgery, and review the 5 other cases reported in the literature. This rare infection may be suspected based on the local epidemiology and the patient's exposure factors. A regimen of ciprofloxacin and gentamicin, combined with surgical valve replacement if necessary, appears to be effective in treating F. tularensis endocarditis.

Comparative evaluation of antimicrobial efficacy of various intracanal medicament in young permanent teeth: An in vivo study.

INTRODUCTION: Bacteria and their byproducts are key contributors to the onset and perpetuation of pulpoperiapical pathosis. Intracanal medication is vital in achieving successful endodontic outcomes as it targets and eradicates remaining microorganisms following biomechanical preparation. AIM AND OBJECTIVE: The aim of the study was to compare and evaluate the antimicrobial efficacy of calcium hydroxide (CH) paste, triple antibiotic paste (TAP), and probiotics (PBs) as intracanal medicament in 12-17-year-old children undergoing root canal treatment for the management of infected pulpal tissues in young permanent teeth. MATERIALS AND METHODS: A total of 30 patients aged 12-17 years indicated for endodontic therapy in maxillary incisors and with no systemic complications were selected. They were randomly divided into three groups, i.e., Group I - CH group, Group II - TAP, and Group III - PB allocating 10 teeth in each group. After access opening, the first sample (S1) was collected by inserting a paper point into the root canal, the second sample (S2) was collected immediately after biomechanical preparation, and the third sample (S3) was collected after 7 days, i.e., postintracanal medication. Samples were sent for microbiological analysis to assess the microbial count, and statistical analysis was done for the obtained data. RESULTS: The three intracanal medicaments were successful in reducing the microbial counts of Enterococcus faecalis in the infected root canals. However, according to the results of the study, the PB group demonstrated greater effectiveness against E. faecalis compared to the CH group and displayed similar antimicrobial efficacy as the TAP group. CONCLUSION: PB exhibited antimicrobial efficacy comparable to TAP but greater than Ca (OH) 2 paste. Hence, PB can be utilized as an intracanal medicament in young permanent teeth.

Allergies to antibiotics among US women with uncomplicated urinary tract infection.

Uncomplicated urinary tract infections (uUTI) are generally treated empirically with antibiotics. However, antibiotic allergies limit the available oral treatment options for some patients. We assessed the proportion of self-reported antibiotic allergies among US women with uUTI. We performed a cross-sectional survey of US women (≥18 years) with a self-reported uUTI in the previous 60 days and an oral antibiotic prescription. Participants completed an online questionnaire about their most recent uUTI episode. Descriptive self-reported allergy data were stratified into subgroups by whether the participant had recurrent UTI (≥2 uUTIs in the past 6 months or ≥3 uUTIs in past 12 months, including the index episode), the number of different antibiotics given for the index episode (1, 2, ≥3), and whether the treatment was clinically aligned according to Infectious Diseases Society of America uUTI guidelines. Overall, 375 participants completed the questionnaire. The most commonly prescribed antibiotics were trimethoprim-sulfamethoxazole (SXT; 38.7%), ciprofloxacin (22.7%), and nitrofurantoin (18.9%). Most participants (62.7%) received only 1 antibiotic for their uUTI, and most (56.5%) were classified as having a non-recurrent uUTI. No antibiotic allergies were reported for most participants (69.3%), with 24.0% reporting 1 antibiotic allergy and 6.7% reporting ≥2 antibiotic allergies. Allergies to ≥2 antibiotic types were more common among participants classified as having recurrent uUTI, or who used multiple antibiotics to treat their uUTI. The most common allergy was to SXT (15.7%), followed by amoxicillin-clavulanate (8.3%) and ciprofloxacin (5.3%). Similar allergy trends were seen across subgroups, except higher rates of ciprofloxacin allergy were seen in participants given multiple antibiotics. Antibiotic allergies were relatively frequent in this uUTI cohort and the most common allergy was to SXT, which was the most prescribed antibiotic. Allergies to antibiotics reduce the available treatment options for uUTI in some patients.

Antibiotic Resistance Pattern in Intensive Care Unit of a Tertiary Care Hospital, Nepal.

Background Intensive care unit (ICU) is the especial department of the hospital where critically ill patients are treated with the unique type of technologies to revert back to functional by body's own mechanism. Therefore, there are lots of external intervention with chance of getting bacterial infections. Antibiotics are medicines used to prevent and treat such bacterial infections. However, due to selective broad spectrum antibiotic pressure there is great chances to develop antimicrobial resistance at any time during hospital stay in intensive care unit. Objective To find out the antibiotic resistance pattern among Gram negative bacteria in Intensive Care Unit. Method A Descriptive cross-sectional study was conducted in Department of Microbiology of Tertiary care center for 18 months On the basis of previous sample load census method was used to include 500 sample from intensive care unit during study period. Among them only Gram negative bacteria were included in the study. All the samples were processed following standard methodology. Result Out of 500 samples, growth was observed in 451 (90.2%) samples. Among all the isolates Escherichia coli (29.6%) was predominant organism. It had shown high resistance towards Ciprofloxacin (93.5%) even in urine sample Ciprofloxacin (86.9%). Conclusion Our study showed Escherichia coli as a major organism in intensive care unit. This was resistant to commonly used oral antibiotic leaving restricted option for use of higher antibiotics. Therefore, continuous surveillance of such bacterial pathogen is warranted with implementation of effective Infection Prevention and Control measures in Health Care setting with emphasis to critical care units.

Prediction of Antibiotic Susceptibility in E. coli Isolates Using Machine Learning.

Antimicrobial resistance (AMR) poses a significant global health threat, resulting in 4.96 million deaths in 2019, with projections reaching 10 million by 2050. This resistance, primarily due to the overuse of antibiotics, complicates the treatment of infections caused by various microorganisms, including the gram-negative bacterium Escherichia coli. Traditional culture-based methods for detecting AMR are slow and imprecise, hindering timely clinical decision-making. In contrast, whole genome sequencing offers a faster, more accurate alternative for AMR detection. A novel machine learning study leveraging whole genomic sequencing data to predict the phenotypic susceptibility of Escherichia coli to ciprofloxacin is presented. Using a novel dataset of 256 bacterial genomes and related susceptibility data, features were generated based on AMRFinderPlus findings and k-mer frequencies. The machine learning models, Random Forest and XGBoost, were evaluated using a five-fold cross-validation approach. Results showed that combining AMRFinderPlus and k-mer frequency features could achieve more than 90% accuracy using the XGBoost gradient boosting model. These findings suggest that the best results may be achieved using reference-free features combined with known gene markers.

Prevalence of sexually transmitted infections and associated risk factors among female sex workers in Guinea-Bissau.

OBJECTIVE: To estimate the prevalence of the curable sexually transmitted infections (STIs) Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium, Trichomonas vaginalis and Treponema pallidum, to identify associated risk factors and to assess ciprofloxacin resistance in N. gonorrhoeae-positive specimens among female sex workers (FSWs) in Guinea-Bissau. METHODS: For this cross-sectional study, FSWs were recruited from October 2014 to May 2019. A questionnaire on STI risk factors was completed by the study participants, and the women were asked to provide a vaginal swab for nucleic acid amplification tests for C. trachomatis, N. gonorrhoeae, M. genitalium, T. vaginalis (Aptima, Hologica), as well as a blood sample for T. pallidum serological testing and discriminatory HIV-testing. The prevalence of STIs was determined, and multivariate logistic regression was used to identify STI risk factors. RESULTS: The study included 467 women. The prevalence of current infection with any curable STI was 46.7%, and the most common pathogen was T. vaginalis (26.3%), followed by M. genitalium (21.9%), C. trachomatis (11.8%), N. gonorrhoeae (10.1%) and T. pallidum (2.8%). The proportion of asymptomatic infections among the diagnosed STIs was 61.8%, 61.5%, 55.3%, 55.3% and 52.2% for C. trachomatis, T. pallidum, N. gonorrhoeae, T. vaginalis and M. genitalium, respectively. The prevalence of the gyrA S91F mutation conferring ciprofloxacin resistance in N. gonorrhoeae-positive specimens was 84.0%. Significant risk factors for having a curable STI were age and HIV-1 infection, while use of female condoms was a protective factor. CONCLUSION: This study demonstrated that the prevalence of curable STIs was high among FSWs in Guinea-Bissau during the study period, indicating an unmet need for STI services. Moreover, the results indicated that symptomatic treatment might be insufficient, highlighting a need for periodic aetiological testing to facilitate detection of asymptomatic as well as symptomatic STIs to stop ongoing transmission.

Septicaemia due to Vibrio vulnificus: A tropical infection not to be taken lightly.

Vibrio vulnificus is a halophilic gram-negative bacillus that can cause fulminant septicaemia in immunocompromised patients. A 67-year-old man who was immunosuppressed as a result of cytotoxic chemotherapy presented with a brief history of fever, lethargy, myalgia, and reduced oral intake. He had recently travelled to the beach to consume seafood. His blood pressure was 81/47 mm Hg, necessitating fluid resuscitation followed by inotropic support and admission to the intensive care unit. His blood culture was positive for curved gram-negative bacilli. The isolate was oxidase-positive and produced an acid butt with an alkaline slant in triple sugar iron agar. Matrix-assisted laser desorption ionization-time of flight mass spectrometry conclusively identified the isolate as V. vulnificus. Intravenous ceftazidime plus ciprofloxacin were administered, and by the fifth day of admission, he was successfully transferred out to the general ward. In total, the patient completed a 14-day course of antibiotic therapy.

Patterns of fluoroquinolone utilization and resistance in a tertiary care hospital: a retrospective cross-sectional analysis study from a developing country.

BACKGROUND: Fluoroquinolones are the most commonly prescribed antibiotics. Because of their known tendency to drive antimicrobial resistance, their prescribing patterns need to be more restricted. This study aimed to describe the clinical practice of fluoroquinolone prescription, dose adjustments for renal impairment patients and bacterial resistance profiles, eventually providing evidence-based recommendations to optimize antibiotic prescribing practices in the local population. METHODS: This retrospective, cross-sectional study was conducted at An-Najah National University Hospital in Palestine. The data were collected from admitted patients who were given ciprofloxacin or levofloxacin from July 2021 to June 2023. Data from 692 inpatients across various hospital departments were examined (409 for levofloxacin and 283 for ciprofloxacin). Statistical analysis was performed via IBM SPSS version 23.0 to summarize the demographic, clinical, and epidemiological data. RESULTS: The sociodemographic profile revealed diverse age distributions, with 25.4% and 39% older than 50 years for ciprofloxacin and levofloxacin, respectively. Ciprofloxacin was predominantly used in the oncology department (28.2%), with surgical prophylaxis (22.6%) and febrile or afebrile neutropenia (21.1%) being the most common indications. Levofloxacin was predominantly used in the medical ward (45.7%), mainly for lower respiratory tract infection (58.8%) and prophylaxis for bone marrow transplantation (16.5%). Enterococcus and methicillin-resistant Staphylococcus aureus were the most commonly isolated pathogens, with 62.5% of the isolates demonstrating resistance to ciprofloxacin. Moreover, extended-spectrum beta-lactamase-producing Enterobacterales were the most common pathogen isolated, with 33.3% being resistant to levofloxacin. Statistical analysis revealed a significant association between the choice of antibiotic and the approach to therapy. Levofloxacin was significantly more likely than ciprofloxacin to be used as empiric therapy (p < 0.001), whereas ciprofloxacin was more likely to be used as targeted therapy (p < 0.001). CONCLUSIONS: This study investigated prescribing practices and resistance to levofloxacin and ciprofloxacin in a large hospital in a developing country. According to the bacterial resistance profiles, we conclude that there is a need for hospital departments to exercise greater restraint on the use of these antibiotics. To this end, further studies addressing the clinical efficacy of fluoroquinolones against the current treatment guidelines to evaluate their appropriateness should be carried out.

Alternative Approaches for the Management of Urinary Tract Infection with Crano-cure: A Randomized Clinical Trial.

Background: Urinary tract infection (UTI) is a renal infection that affects the urinary tract and is global problem related to health and many people are affected each year at some points of their lives. Modern studies about urinary tract infections show that almost one third of the world's population has been suffering from this ailment. Different antibacterial medicines have been reported to have resistance against pathogens. In order to overcome the problem, exploration for new and dynamic antibacterial agents from natural sources is the emerging trend. Primary Study Objective: The primary objective was to evaluate the efficacy and safety of the polyherbal test drug formulation, "Crano-cure", as treatment for UTIs. Methods/Design: In the current study, clinical trials were designed to evaluate the effects of the polyherbal formulation "Crano-cure" compared to the standard drug Ciprofloxacin in randomized, controlled multicenter trial of 205 patients, analyzing clinical outcomes and safety profiles. Setting and Participants: Conducted across multiple centers, including Shifa-ul-Mulk Memorial Hospital at Hamdard University Karachi and three other clinics, the study involved 205 patients aged 15-60, irrespective of their socioeconomic status. Intervention: Patients were classified into two groups i.e. control group (ciprofloxacin) and the test group (crane-cure). Polyherbal formulation of 500 mg Crano-cure capsules two times in a day were administered to the test group for 28 days. The control group was administered a control ciprofloxacin tablet 500 mg two times in a day for 28 days. Primary Outcome Measures: The drug was found safe for further clinical study after observing changes or improvements in UTI symptoms, urine culture and blood complete tests. The clinical trial was dully registered on the US National Library of Medicine, ClinicalTrials.gov Identifier: NCT04575493. The trial was accompanied in the instructions of EC (Ethical Committee). The study plan and procedures were displayed to the BASR (Board of Advance Studies and Research) and board members of the Ethical Committee (EC), which was ERB-2021-9-1. Results: Clinical study results revealed the effectiveness of Crano-cure in the management of UTIs symptoms and hematological and biochemical parameters including blood complete test, liver function tests, renal function tests and lipid profile. Moreover, the test drug Crano-cure revealed a significance level (P ≤ .05) in compliance and cost-effectiveness compared to control ciprofloxacin. Conclusion: In conclusion, Crano-cure is a safe and cost-effective alternate to Ciprofloxacin for treatment of UTIs.

Infection Inspection: using the power of citizen science for image-based prediction of antibiotic resistance in Escherichia coli treated with ciprofloxacin.

Antibiotic resistance is an urgent global health challenge, necessitating rapid diagnostic tools to combat its threat. This study uses citizen science and image feature analysis to profile the cellular features associated with antibiotic resistance in Escherichia coli. Between February and April 2023, we conducted the Infection Inspection project, in which 5273 volunteers made 1,045,199 classifications of single-cell images from five E. coli strains, labelling them as antibiotic-sensitive or antibiotic-resistant based on their response to the antibiotic ciprofloxacin. User accuracy in image classification reached 66.8 ± 0.1%, lower than our deep learning model's performance at 75.3 ± 0.4%, but both users and the model were more accurate when classifying cells treated at a concentration greater than the strain's own minimum inhibitory concentration. We used the users' classifications to elucidate which visual features influence classification decisions, most importantly the degree of DNA compaction and heterogeneity. We paired our classification data with an image feature analysis which showed that most of the incorrect classifications happened when cellular features varied from the expected response. This understanding informs ongoing efforts to enhance the robustness of our diagnostic methodology. Infection Inspection is another demonstration of the potential for public participation in research, specifically increasing public awareness of antibiotic resistance.

Quahogging in a Marine Habitat: An Extremely Rare Source of an Organism to Cause Endocarditis.

A 66-year-old man with a history of apical variant hypertrophic cardiomyopathy, heart failure with preserved ejection fraction (HFpEF), severe pulmonary hypertension, and prior Group B streptococcal mitral valve endocarditis four months before, presented with generalized body shakes and urinary incontinence. Computed tomography angiography revealed an acute left M1 occlusion. The patient underwent mechanical thrombectomy. Within 24 hours of presentation, he developed hypotension, tachycardia, and fever. Infectious workup revealed a leukocytosis. One out of two sets of blood cultures revealed bacteremia with Shewanella algae. A transthoracic echocardiogram revealed a large mitral valve vegetation with multiple mobile components portending a high thromboembolic risk, as evidenced by his acute presentation with multiple embolic infarcts. He was diagnosed with infectious endocarditis caused by Shewanella algae, a rare marine environment pathogen. He was treated with ciprofloxacin 750 mg twice daily orally and meropenem 2 g every eight hours intravenously with an initial decrease in the mitral valve vegetation size. He was discharged on ceftriaxone 2g and ciprofloxacin 750mg every 12 hours for a total of six weeks from his first negative blood cultures. He was monitored through transthoracic echocardiography as he continued medical management with levofloxacin 750 mg daily. Six months after his discharge from the hospital he developed worsening heart failure and elected to pursue comfort measures only.

An open-label, randomized, non-inferiority trial of the efficacy and safety of ciprofloxacin versus an aminoglycoside + ciprofloxacin in the treatment of bubonic plague (IMASOY): study protocol for a randomized control trial-an update to the published protocol.

This article reports an update to the protocol of the IMASOY trial, which was prospectively registered on clinicaltrials.gov (NCT04110340) in October 2019.

Improving Antibiotic Stewardship in a Pediatric Long-term Care Facility.

OBJECTIVES: Antimicrobial stewardship is little studied in pediatric long-term care facilities. We sought to determine whether empirical ciprofloxacin for febrile respiratory illnesses could be safely reduced in our pediatric long-term care facility. METHODS: All patients living in the 45-bed facility were included. A 1-year educational intervention for antimicrobial stewardship was implemented. Days of ciprofloxacin therapy, infections, microbiology, hospitalizations, other antibiotic use, methicillin-resistant Staphylococcus aureus and Clostridioides difficile infections, and mortality were recorded at regular intervals retrospectively from 5 years before intervention and prospectively for 8 years after intervention. Data were analyzed using statistical process control charts. RESULTS: A majority of patients had tracheostomy tubes (96%) and ventilator dependence (58%). Ciprofloxacin use declined by 76% (17 to 4 days/1000 facility patient days). Antibiotic prescriptions for bacterial tracheitis decreased by 89% (38 to 4 courses per 6-month period). No increases in positive blood or urine cultures, hospitalizations, or need for hospital antibiotics were observed. CONCLUSIONS: An antimicrobial stewardship intervention in a pediatric long-term care facility led to decreases in ciprofloxacin use, bacterial tracheitis diagnoses, and overall antibiotic use without increasing negative outcomes.

Ciprofloxacin versus levofloxacin prophylaxis in hematopoietic stem cell transplantation: A randomized trial.

OBJECTIVES: We aimed to assess whether there is a difference between ciprofloxacin and levofloxacin as prophylaxis in hematopoietic stem cell transplant (SCT) recipients. METHODS: This is a prospective, randomized trial in patients receiving SCT at Henry Ford Health in the United States of America. We randomly assigned patients (1:1) to receive ciprofloxacin or levofloxacin. The primary outcome was incidence of bloodstream bacterial infections (BSI) up to day 60 after SCT. RESULTS: Between June 4, 2018, and May 23, 2022, we randomly assigned 308 consecutive patients to receive ciprofloxacin (154 patients) or levofloxacin (154 patients). BSI was similar in both the ciprofloxacin and levofloxacin groups (18 [11.7%] vs 18 [11.7%]). Pneumonia was more frequent in the ciprofloxacin group compared to the levofloxacin group (18 [18%] vs 7 [23%]; relative risk 2.57, 95% CI 1.11-5.98; p = 0.028). There were no differences in neutrophil engraftment, fever, Clostridium difficile infection, relapse incidence, overall survival, nonrelapse mortality, length of stay post-SCT, or intensive care unit admission. CONCLUSION: Although both prophylaxis regimens demonstrated the same efficacy in SCT recipients, levofloxacin prophylaxis led to less pneumonia in the first 60 days post-SCT. TRIAL REGISTRATION: This study is registered on ClinicalTrials.gov, NCT03850379.

A phase ib clinical trial of oral ciprofloxacin and etoposide in subjects with resistant acute myeloid leukemia.

A phase 1b study was conducted to evaluate the safety and feasibility of ciprofloxacin and etoposide combination treatment in subjects with relapsed and refractory acute myeloid leukemia. Eleven subjects were enrolled in the study. Utilizing the standard '3 + 3' design, escalating ciprofloxacin doses (750 mg, 1000 mg) twice daily on D1-D10 in combination with a fixed dose (200 mg) of etoposide on D2-D8 were administered. Maximum tolerated dose was determined to be 1000 mg of ciprofloxacin in combination with 200 mg of etoposide. Serious adverse events occurred in 54.5% (n = 6) subjects and 91% (n = 10) subjects reported ≥ grade 3 toxicities. Nine subjects completed treatment, one had a dose-limiting toxicity, and one withdrew. One subject achieved complete remission with a duration of 111 days and one subject achieved morphologic leukemia-free state after cycle 1. While the combination demonstrated safety and an acceptable toxicity profile, only modest hematologic and clinical benefits were observed.This trial was registered at www.clinicaltrials.gov as #NCT02773732.