ABSTRACT
OBJECTIVE: Microbial infection plays an important role in exacerbation of chronic otitis media. The aim of this study was to analyse the microbiota in chronic otitis media in the context of local treatment. METHOD: In this prospective study, samples for microbiological examination were taken from 119 patients who underwent operation because of chronic otitis media. RESULTS: The results were compared between groups depending on the type of operation (none, tympanoplasty or radical), the presence of cholesteatoma or granulomatous tissue or discharge from the ear as a symptom of exacerbation. Antibiotic susceptibility of germs was analysed to define the strategy of treatment. A total of 209 samples were collected from 119 patients with chronic otitis media. CONCLUSION: Pseudomonas aeruginosa and Staphylococcus aureus were pathogens most frequently identified from the ear in the course of chronic otitis media. Pseudomonas aeruginosa was concerned with major pathology of the middle ear (radical surgery, cholesteatoma or granulomatous tissue, persisting discharge after treatment), whereas Staphylococcus aureus was obtained in dry perforations without other pathology in the middle-ear cavity. Ciprofloxacin was effective against Staphylococcus aureus, but Pseudomonas aeruginosa strains were ciprofloxacin resistant.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Ciprofloxacin/therapeutic use , Otitis Media/drug therapy , Otitis Media/microbiology , Pseudomonas aeruginosa/isolation & purification , Staphylococcus aureus/isolation & purification , Adolescent , Adult , Aged , Chronic Disease , Escherichia coli/isolation & purification , Female , Humans , Male , Middle Aged , Poland , Prospective Studies , Proteus mirabilis/isolation & purification , Young AdultABSTRACT
The link between the microbiome and cancer has led researchers to search for a potential probe for intracellular targeting of bacteria and cancer. Herein, we developed near infrared-emitting ternary AgInSe/ZnS quantum dots (QDs) for dual bacterial and cancer imaging. Briefly, water-soluble AgInSe/ZnS QDs were synthesized in a commercial kitchen pressure cooker. The as-synthesized QDs exhibited a spherical shape with a particle diameter of 4.5 ± 0.5 nm, and they were brightly fluorescent with a photoluminescence maximum at 705 nm. The QDs showed low toxicity against mouse mammary carcinoma (FM3A-Luc), mouse colon carcinoma (C26), malignant fibrous histiocytoma-like (KM-Luc/GFP) and prostate cancer cells, a greater number of accumulations in Staphylococcus aureus, and good cellular uptake in prostate cancer cells. This work is an excellent step towards using ternary QDs for diagnostic and guided therapy for prostate cancer.
Subject(s)
Prostatic Neoplasms/diagnosis , Prostatitis/diagnosis , Quantum Dots/analysis , Staphylococcus aureus/isolation & purification , Animals , Cell Line, Tumor , Colonic Neoplasms/diagnosis , Colonic Neoplasms/pathology , Female , Histiocytoma, Malignant Fibrous/diagnosis , Histiocytoma, Malignant Fibrous/pathology , Humans , Indium/chemistry , Male , Mammary Neoplasms, Animal/diagnosis , Mammary Neoplasms, Animal/pathology , Mice , Prostatic Neoplasms/diagnostic imaging , Prostatic Neoplasms/pathology , Prostatitis/diagnostic imaging , Prostatitis/pathology , Quantum Dots/chemistry , Selenium/chemistry , Silver/chemistry , Staphylococcus aureus/pathogenicity , Sulfides/chemistry , Water/chemistry , Zinc Compounds/chemistryABSTRACT
BACKGROUND AND OBJECTIVE: When administered for severe infections in intravenous drug users (IDUs) at a daily dose of 6 mg/kg, daptomycin displayed abnormal pharmacokinetic parameters compared with those seen in healthy volunteers; specifically, decreased trough and maximum concentrations (Ctrough; Cmax) and increased clearance (CL). The objective of this study was to evaluate the pharmacokinetics and pharmacodynamics of daptomycin administered at a daily dosage of 12 mg/kg for Staphylococcus aureus infective endocarditis (IE) in patients concomitantly treated with methadone, and to compare the results with those published in the literature for healthy controls treated with the same daily dose. METHODS: Antibiotic treatment included daptomycin (12 mg/kg daily) in combination with an antistaphylococcal ß-lactam (cefazolin 2 g three times a day). The minimum inhibitory concentration (MIC) of Staphylococcus aureus isolated through blood cultures was used to calculate pharmacokinetic and pharmacodynamic parameters such as the ratio of the area under the concentration-time curve over 24 h to the MIC (AUC0-24/MIC) and Cmax/MIC. RESULTS: Five IDUs hospitalized for IE were enrolled. The mean measured daptomycin Cmax and Ctrough were 54.1 µg/mL (CV: 0.32) and 8.7 µg/mL (CV: 0.59), respectively; the mean calculated AUC0-24 was 742.7 µg × h/mL (CV: 0.31). The estimated average volume of distribution at the steady state (Vd,ss) and the half-life (t1/2) were 316.5 mL/kg (CV: 0.53) and 14.4 h (CV: 0.30), respectively. The mean daptomycin clearance from plasma normalized for body weight (CLwp) was 17.3 mL/(h × kg) (CV: 0.33). The calculated average Cmax and AUC0-24 (183.7 µg/mL and 1277.4 µg × h/mL, respectively) were lower than and statistically significantly different from (p < 0.001 and p = 0.001, respectively) those expected for healthy volunteers. CONCLUSIONS: Treatment of Staphylococcus aureus IE in IDUs on methadone treatment requires the use of high daptomycin daily doses in order to achieve satisfactory pharmacodynamic parameters. Close monitoring of the daptomycin plasma concentration is suggested.
Subject(s)
Anti-Bacterial Agents/administration & dosage , Daptomycin/administration & dosage , Endocarditis, Bacterial/drug therapy , Methadone/administration & dosage , Adult , Anti-Bacterial Agents/pharmacokinetics , Anti-Bacterial Agents/pharmacology , Area Under Curve , Daptomycin/pharmacokinetics , Daptomycin/pharmacology , Dose-Response Relationship, Drug , Drug Interactions , Endocarditis, Bacterial/microbiology , Female , Half-Life , Humans , Male , Methadone/pharmacology , Microbial Sensitivity Tests , Middle Aged , Opiate Substitution Treatment , Staphylococcal Infections/drug therapy , Staphylococcal Infections/microbiology , Staphylococcus aureus/isolation & purification , Tissue DistributionABSTRACT
BACKGROUND: The temporal changes in the Staphylococcus aureus genotypes causing S. aureus bacteremia (SAB) and the corresponding clinical changes over the last decade in South Korea are rarely investigated. METHODS: A longitudinal study of adult SAB patients was conducted in a large referral hospital in Seoul, South Korea. Adult monomicrobial SAB patients were enrolled between August 2008 and December 2018. Genotyping was performed by multilocus sequence typing (MLST) and staphylococcal protein A (spa) typing. Trends in changes were identified by linear regression analysis. RESULTS: Of 1782 adult SAB patients, the blood isolates of 1,778 (99.8%) and 1,634 (91.7%) were determined to be MLST and spa type, respectively. ST5 (-2.626%/year) and ST239 (-0.354%/year) decreased during the study period (P < 0.001 for both), but ST72 (2.009%/yr)-and ST8 (0.567%/yr) increased (P < 0.001 for both). The most common genotype was changed from ST5 in 2008 (44.9%) to ST72 in 2018 (36.3%). Panton-Valentine leukocidin-positive spa-t008-MRSA (USA300) was found in 28.6%. Central venous catheter (CVC)-related SAB (-2.440%/yr) and persistent SAB (-1.016%/yr) decreased, but mortality and recurrence rates were unchanged. CONCLUSION: Over the last decade, the hospital clones ST5 and ST239 have been replaced by community genotype ST72. This was associated with decreased CVC-related and persistent SAB. Increased USA300 was observed in community and hospital settings. Further research is required to identify the reasons for the ST72 epidemic and predict the impending epidemic of ST8 strains, including USA300.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Bacteremia/epidemiology , Staphylococcal Infections/drug therapy , Staphylococcus aureus/drug effects , Staphylococcus aureus/isolation & purification , Aged , Antigens, Bacterial , Bacteremia/microbiology , Female , Genotype , Humans , Male , Microbial Sensitivity Tests , Middle Aged , Multilocus Sequence Typing , Republic of Korea/epidemiology , Staphylococcal Infections/diagnosis , Staphylococcal Infections/epidemiology , Staphylococcal Infections/microbiology , Staphylococcus aureus/geneticsABSTRACT
BACKGROUND: Impetigo is a contagious bacterial infection that affects the superficial skin layers. Increasing worldwide antimicrobial resistance (AMR) to existing topical agents commonly prescribed to treat impetigo is central to treatment failure. The Worldwide Health Organization developed a global action plan on AMR, but omitted information about AMR stewardship programs for topical antibiotics. OBJECTIVES: The review aims to provide information to clinicians and stakeholders regarding AMR and antimicrobial stewardship on topical antimicrobial drugs for impetigo treatment. METHODS: The literature searches reviewed the status of AMR to current topical antibiotics in impetigo, current therapeutic behavior, and concordance with antimicrobial stewardship principles. Two international panels convened to discuss the output of the searches, and the results of the panel discussions were used in the development of the manuscript. RESULTS: The literature search included clinical trials, research studies, clinical guidelines, consensus papers, and reviews (if they provided original data), published between January 2008 and May 2019. The articles were selected based on clinical relevancy of impetigo management, clinical efficacy, and safety of the treatment and antimicrobial resistance. The searches resulted in one-hundred and ninety-eight articles. After applying the eligibility criteria, nineteen articles met inclusion criteria and were considered in the present review. CONCLUSIONS: While published antimicrobial stewardship guidelines have focused on systemic antibiotics, few studies have attempted to evaluate topical antibiotic prescribing practices for impetigo treatment. Many of the topical impetigo treatments currently in use have developed resistance. The appropriate use of topical ozenoxacin can help eradicate impetigo while minimizing AMR.J Drugs Dermatol. 20(4):366-372. doi:10.36849/JDD.5795.
Subject(s)
Anti-Bacterial Agents/pharmacology , Antimicrobial Stewardship/standards , Impetigo/drug therapy , Staphylococcus aureus/drug effects , Administration, Cutaneous , Aminopyridines/pharmacology , Aminopyridines/standards , Aminopyridines/therapeutic use , Anti-Bacterial Agents/standards , Anti-Bacterial Agents/therapeutic use , Drug Prescriptions/standards , Drug Resistance, Bacterial , Humans , Microbial Sensitivity Tests , Practice Guidelines as Topic , Quinolones/pharmacology , Quinolones/standards , Quinolones/therapeutic use , Staphylococcus aureus/isolation & purification , Treatment OutcomeABSTRACT
INTRODUCTION: The patients in the intensive care unit have a higher risk of infections because of the poor general condition of these patients and the frequent application of invasive procedures with longer hospitalization length. Also, this group of patients tend to have resistant infections due to empirically widespread and uncontrolled use of broad-spectrum antibiotics. Hence, data are needed to determine appropriate empirical antibiotic therapy in intensive care patients. In this study, it was aimed to assess the distribution of microorganisms and antibiotic resistance profile from the samples taken from the patients in the intensive care unit. MATERIALS AND METHODS: Patients who were hospitalized in Ankara University Faculty of Medicine Chest Diseases Intensive Care Unit for more than 24 hours between December 2016 and December 2017 were included in our study. Demographic characteristics, comorbid diseases, clinical findings, results of sputum, tracheal aspirate, blood, urine, gaita and pus culture samples and antibiotic susceptibility test results were recorded prospectively. RESULT: A total of 287 patients, 150 males and 137 females, were included in the study. The mean age of all patients was 69.96 ± 14.4 years. Two hundred twenty-three positive cultures were detected in 1053 samples taken from 287 patients. Gram-negative bacilli constituted 55.1% of the 223 positive cultures. The most common microorganisms were Acinetobacter (16.6%), Staphylococcus (14.8%) and Klebsiella (10.8%). Colistin resistance was found to be 8.3% in the Acinetobacter strains and resistance rates of 97-100% were observed to other antibiotic groups. Thirty-three staphylococcus were isolated, 17 were S. aureus and 16 were coagulase-negative Staphylococcus. While 29.4% of S. aureus were resistant to methicillin (MRSA), vancomycin resistance was not detected. Meanwhile, the MRSA ratio was 62.5%, there was no vancomycin resistance among the coagulase-negative Staphylococcus. Klebsiella was the third most common microorganism and beta-lactamase producing Klebsiella strain was 62.5%. Gentamycin was found to be the most susceptible antibiotic in Klebsiella strains with a resistance rate of 20.8%. Pseudomonas aeruginosa constituted 9.4% of the cultures. While the resistance to colistin was not detected, resistance to piperacillin/tazobactam 42.8%, tobramycin, imipenem and meropenem 50% and ceftazidime 61.9%. The duration of hospitalization in patients with Acinetobacter isolated (23 [10-34] days vs 12.5 [5-24] days, p= 0.011) and the mortality rate (62.5% vs 37.5%, p= 0.008) were significantly higher than those who were not Acinetobacter isolated. CONCLUSIONS: In conclusion, gram-negative bacilli constitute the majority of the patients in intensive care unit. Acinetobacter, the most common microorganism, has a high resistance rate and has been associated with prolonged hospitalization and mortality.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Critical Care/organization & administration , Drug Resistance, Bacterial/drug effects , Drug Resistance, Microbial , Aged , Aged, 80 and over , Female , Gram-Negative Bacteria/drug effects , Gram-Negative Bacteria/isolation & purification , Humans , Intensive Care Units , Male , Microbial Sensitivity Tests , Middle Aged , Pseudomonas aeruginosa/drug effects , Staphylococcus aureus/drug effects , Staphylococcus aureus/isolation & purificationABSTRACT
The activities of dalbavancin and comparator agents were evaluated against Staphylococcus aureus isolated from the lower respiratory tract of cystic fibrosis (CF) and non-CF patients with pneumonia. Bacterial isolates (n = 357) were collected from CF patients in 36 medical centers worldwide (2018-2019) and susceptibility tested using reference broth microdilution. Susceptibility results from these isolates were compared with those for 725 S. aureus isolates consecutively collected from non-CF patients with pneumonia from the same medical centers over the same period. Only isolates determined to be the probable cause of pneumonia were included in the study. Susceptibility profiles were very similar among isolates from CF and non-CF patients. Dalbavancin exhibited potent activity (MIC50/90, 0.03/0.03 mg/L) and complete coverage (100.0% susceptibility) against isolates from CF and non-CF patients. Ceftaroline (MIC50/90, 0.25/1 mg/L) was active against 97.8% and 98.1% of isolates from CF and non-CF patients, respectively. Oxacillin resistance (MRSA) rates were 27.7% among CF and 28.7% among non-CF patients. Among MRSA isolates from CF/non-CF patients (n = 99/208), susceptibility to ceftaroline, clindamycin, levofloxacin, and tetracycline were 91.9%/93.3%, 58.6%/64.4%, 40.4%/29.3%, and 83.8%/89.4%, respectively. Dalbavancin demonstrated high potency against S. aureus from CF and non-CF patients and may represent a valuable treatment option for CF patients with MRSA pulmonary infection.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Cystic Fibrosis/microbiology , Pneumonia, Staphylococcal/drug therapy , Staphylococcus aureus/isolation & purification , Teicoplanin/analogs & derivatives , Cephalosporins/therapeutic use , Clindamycin/therapeutic use , Drug Resistance, Bacterial , Humans , Levofloxacin/therapeutic use , Methicillin-Resistant Staphylococcus aureus/isolation & purification , Microbial Sensitivity Tests , Oxacillin/therapeutic use , Pneumonia, Staphylococcal/microbiology , Teicoplanin/therapeutic use , Tetracycline/therapeutic use , CeftarolineABSTRACT
ETHNOPHARMACOLOGICAL RELEVANCE: Liu Shen Wan (LSW) is a traditional Chinese medicine (TCM) with detoxification and antiphlogistic activity; it is composed of bezoar, toad venom, musk, pearl powder, borneol and realgar. In recent years, LSW has been widely used in traditional medicine for the treatment of influenza, tonsillitis, pharyngitis, mumps, cancer and leukaemia. AIM OF STUDY: The anti-influenza virus properties of LSW and its inhibition of the inflammatory response was demonstrated in our previous research; however, the effect and potential mechanism of LSW against influenza induced secondary bacteria have remained obscure. Therefore, in the present study, a model of influenza virus PR8 with secondary infection by Staphylococcus aureus (S. aureus) in vitro and in mice was established to examine the effect and potential mechanism by which LSW inhibits bacterial adhesion and subsequent severe pneumonia after viral infection. MATERIALS AND METHODS: We investigated the effect of LSW on the PR8-induced adhesion of live S. aureus in A549 cells. RT-qPCR was used to detect the expression of adhesion molecules. Western blotting was used to determine the expression of CEACAM1, RIG-1, MDA5, p-NF-κB, and NF-κB in A549 cells. Inflammatory cytokines were detected using a Bio-Plex Pro Human Cytokine Screening Panel (R&D) in A549 cells and Mouse Magnetic Luminex Assays (R&D) in mice infected with PR8 virus and secondarily with S. aureus, respectively. Moreover, the survival rate, lung index, viral titre, bacterial loads and pathological changes in the lung tissue of mice infected with PR8 and S. aureus were investigated to estimate the effect of LSW in inhibiting severe pneumonia. RESULTS: LSW significantly decreased S. aureus adhesion following influenza virus infection in A549 cells, which may have occurred by suppressing expression of the adhesion molecule CEACAM1. In addition, treatment with LSW dramatically suppressed the induction of proinflammatory cytokines (CCL2/MCP-1 and CXCL-9/MIG) and chemokines (IL-6 and TNF-α) by PR8 infection following secondary LPS stimulation in A549 cells. Upregulation of related signalling proteins (RIG-I, MDA5 and NF-κB) induced by viruses and bacteria was suppressed by LSW in A549 cells. LSW significantly decreased the viral titres and bacterial load, prolonged survival time, and ameliorated lung inflammation and injury in mice with S. aureus infection secondary to PR8 infection. CONCLUSIONS: We demonstrated that LSW prevents S. aureus adherence to influenza virus-infected A549 cells, perhaps by inhibiting the expression of the adhesion molecule CEACAM1. The upregulation of proinflammatory cytokines and related signalling proteins induced by viruses and bacteria was suppressed by LSW in A549 cells. LSW significantly ameliorated lung injury caused by viral and secondary bacterial infection. These findings provide a further evaluation of LSW and suggest a beneficial effect of LSW for the prevention of secondary bacterial infection and related complications.
Subject(s)
Complex Mixtures/pharmacology , Influenza, Human/complications , Lung Diseases/drug therapy , Staphylococcal Infections/drug therapy , A549 Cells , Animals , Cytokines/metabolism , Dogs , Female , Humans , Influenza, Human/drug therapy , Lung Diseases/microbiology , Lung Diseases/virology , Madin Darby Canine Kidney Cells , Mice , Mice, Inbred BALB C , Staphylococcal Infections/microbiology , Staphylococcus aureus/isolation & purification , Survival RateABSTRACT
Tigecycline (TGC) resistance remains rare in Staphylococcus aureus worldwide. In this study, 12 TGC-resistant S. aureus mutants (TRSAm) were obtained displaying an increase in efflux activity. The isolates belonged to seven different genetic lineages, with a predominance of clonal complex 5 (CC5). Diverse genetic changes in mepA and mepR genes were found producing alterations in the amino acid sequences of the corresponding proteins (MepA and MepR, respectively). The most frequent amino acid change in MepA was Glu287Gly. All of the TRSAm exhibited different single nucleotide polymorphisms (SNPs) or insertions/deletions (InDels) in mepR causing premature stop codons or amino acid changes in MepR. Expression of mepA was significantly increased in TRSAm with different mutations in mepA and mepR. Of the 12 TRSAm, 6 also harboured mutations in rpsJ that resulted in amino acid changes in the S10 ribosomal protein, with Lys57 being the most frequently mutated site. Our findings demonstrate that these acquired mechanisms of TGC resistance are not restricted to a single type of genotypic background and that different lineages might have the same plasticity to develop TGC resistance. The impact of TGC selective pressure assessed by whole-genome sequencing in four selected strain pairs revealed mutations in other singular genes and IS256 mobilisation.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Drug Resistance, Bacterial/genetics , Membrane Transport Proteins/genetics , Staphylococcus aureus/drug effects , Staphylococcus aureus/genetics , Tigecycline/therapeutic use , Amino Acid Sequence/genetics , DNA, Bacterial/genetics , Genome, Bacterial/genetics , Humans , Microbial Sensitivity Tests , Polymorphism, Single Nucleotide/genetics , Staphylococcal Infections/drug therapy , Staphylococcus aureus/isolation & purificationABSTRACT
BACKGROUND: Impetigo, a highly contagious bacterial skin infection commonly occurring in young children, but adults may also be affected. The superficial skin infection is mainly caused by Staphylococcus aureus (S. aureus) and less frequently by Streptococcus pyogenes (S. pyogenes). Antimicrobial resistance has become a worldwide concern and needs to be addressed when selecting treatment for impetigo patients. An evidence-based impetigo treatment algorithm was developed to address the treatment of impetigo for pediatric and adult populations. METHODS: An international panel of pediatric dermatologists, dermatologists, pediatricians, and pediatric infectious disease specialists employed a modified Delphi technique to develop the impetigo treatment algorithm. Treatment recommendations were evidence-based, taking into account antimicrobial stewardship and the increasing resistance to oral and topical antibiotics. RESULTS: The algorithm includes education and prevention of impetigo, diagnosis and classification, treatment measures, and follow-up and distinguishes between localized and widespread or epidemic outbreaks of impetigo. The panel adopted the definition of localized impetigo of fewer than ten lesions and smaller than 36 cm2 area affected in patients of two months and up with no compromised immune status. Resistance to oral and topical antibiotics prescribed for the treatment of impetigo such as mupirocin, retapamulin, fusidic acid, have been widely reported. CONCLUSIONS: When prescribing antibiotics, it is essential to know the local trends in antibiotic resistance. Ozenoxacin cream 1% is highly effective against S. pyogenes and S. aureus, including methycyllin-susceptible and resistant strains (MRSA), and may be a suitable option for localized impetigo.J Drugs Dermatol. 2021;20(2):134-142. doi:10.36849/JDD.5475 THIS ARTICLE HAD BEEN MADE AVAILABLE FREE OF CHARGE. PLEASE SCROLL DOWN TO ACCESS THE FULL TEXT OF THIS ARTICLE WITHOUT LOGGING IN. NO PURCHASE NECESSARY. PLEASE CONTACT THE PUBLISHER WITH ANY QUESTIONS.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Critical Pathways/standards , Impetigo/drug therapy , Staphylococcus aureus/drug effects , Streptococcus pyogenes/drug effects , Aminopyridines/pharmacology , Aminopyridines/therapeutic use , Anti-Bacterial Agents/pharmacology , Antimicrobial Stewardship/standards , Bridged Bicyclo Compounds, Heterocyclic/pharmacology , Bridged Bicyclo Compounds, Heterocyclic/therapeutic use , Delphi Technique , Diterpenes/pharmacology , Diterpenes/therapeutic use , Drug Resistance, Bacterial , Evidence-Based Medicine/standards , Fusidic Acid/pharmacology , Fusidic Acid/therapeutic use , Humans , Impetigo/diagnosis , Impetigo/microbiology , Microbial Sensitivity Tests/standards , Mupirocin/pharmacology , Mupirocin/therapeutic use , Practice Guidelines as Topic , Quinolones/pharmacology , Quinolones/therapeutic use , Skin Cream/pharmacology , Skin Cream/therapeutic use , Staphylococcus aureus/isolation & purification , Streptococcus pyogenes/isolation & purification , Systematic Reviews as TopicABSTRACT
BACKGROUND: Intensive care units (ICU) are essential healthcare facility for life threatening conditions. Bacterial contamination of objects/instruments in ICU is an important source of nosocomial infections. This study is aimed to determine the level of bacterial contamination of instruments/objects which are commonly touched by healthcare workers and frequently come in contact with the neonates. METHODS: This hospital based prospective study was conducted in neonatal intensive care unit (NICU) of Manipal Teaching Hospital, Pokhara, Nepal. A total of 146 samples collected from surfaces of incubators, radiant warmers, suction tips, ventilators, stethoscopes, door handles, weighing machines, mothers' beds, phototherapy beds, laryngoscope, telephone sets, blood pressure machine, etc. formed the material of the study. Isolation, identification and antibiotic susceptibility of the bacterial isolates was performed by standard techniques. Blood culture isolates from NICU patients during the study period were compared with the environmental isolates. RESULTS: Out of 146 samples, bacterial growth was observed in 109. A total of 119 bacterial isolates were retrieved from 109 samples. Three common potential pathogens isolated were Escherichia coli (n = 27), Klebsiella species (n = 21) and Staphylococcus aureus (n = 18). Majority of E. coli and Klebsiella isolates were from incubators, suction tips and mothers' beds. Majority of S. aureus isolates were cultured from radiant warmers. Among S. aureus isolates, 33.3% (6/18) were methicillin resistant. Majority of the bacterial isolates were susceptible to gentamicin and amikacin. Common potential pathogens isolated from blood culture of NICU patients were S. aureus and Klebsiella species. CONCLUSION: High degree of bacterial contamination of objects/instruments in NICU was recorded. Isolation of potential pathogens like E. coli, Klebsiella species and S. aureus is a major threat of nosocomial infections. Blood culture data of NICU reflects possibility of nosocomial infections from contaminated sites. Gentamicin and amikacin may be used for empirical therapy in suspected cases of nosocomial infections in NICU.
Subject(s)
Equipment Contamination/statistics & numerical data , Intensive Care Units, Neonatal , Blood Culture , Cross Infection , Escherichia coli/isolation & purification , Hospitals, Teaching , Humans , Infant, Newborn , Klebsiella/isolation & purification , Microbial Sensitivity Tests , Nepal , Prospective Studies , Staphylococcus aureus/isolation & purification , Tertiary Care CentersABSTRACT
Antimicrobial resistance poses a serious threat to human health worldwide. Plant compounds may help to overcome antibiotic resistance due to their potential resistance modifying capacity. Several botanical extracts and pure polyphenolic compounds were screened against a panel of eleven bacterial isolates with clinical relevance. The two best performing agents, Cistus salviifolius (CS) and Punica granatum (GP) extracts, were tested against 100 Staphylococcus aureus clinical isolates, which resulted in average MIC50 values ranging between 50-80 µg/mL. CS extract, containing hydrolyzable tannins and flavonoids such as myricetin and quercetin derivatives, demonstrated higher activity against methicillin-resistant S. aureus isolates. GP extract, which contained mostly hydrolyzable tannins, such as punicalin and punicalagin, was more effective against methicillin-sensitive S. aureus isolates. Generalized linear model regression and multiple correspondence statistical analysis revealed a correlation between a higher susceptibility to CS extract with bacterial resistance to beta-lactam antibiotics and quinolones. On the contrary, susceptibility to GP extract was related with bacteria sensitive to quinolones and oxacillin. Bacterial susceptibility to GP and CS extracts was linked to a resistance profile based on cell wall disruption mechanism. In conclusion, a differential antibacterial activity against S. aureus isolates was observed depending on antibiotic resistance profile of isolates and extract polyphenolic composition, which may lead to development of combinatorial therapies including antibiotics and botanical extracts.
Subject(s)
Anti-Bacterial Agents , Cistus/chemistry , Plant Extracts/chemistry , Plant Extracts/pharmacology , Polyphenols/analysis , Polyphenols/pharmacology , Pomegranate/chemistry , Staphylococcus aureus/drug effects , Anti-Bacterial Agents/chemistry , Drug Resistance, Bacterial , Drug Tapering , Plant Extracts/isolation & purification , Staphylococcus aureus/isolation & purificationABSTRACT
BACKGROUND: Staphylococcal scalded skin syndrome (SSSS) is a skin disease characterized by blistering and desquamation caused by exfoliative toxins (ETs) of Staphylococcus aureus (S. aureus). Although many countries show predominance of methicillin-susceptible S. aureus (MSSA), cases of methicillin-resistant S. aureus (MRSA) have been reported. METHODS: Twenty-six children aged <15 years diagnosed with SSSS from January 2010 to December 2017 from three hospitals were included. S. aureus isolates from cases were analyzed for multilocus sequence types and ETs. Medical records were reviewed for clinical characteristics, treatment, and antimicrobial susceptibility patterns of S. aureus. RESULTS: Among the 26 cases, mean age was 2.3 years. According to skin manifestations patients were classified as generalized (n = 10, 38.5%), intermediate (n = 11, 42.3%), and abortive (n = 5, 19.2%). Among all cases, 96.2% (25/26) were due to MRSA and the macrolide-resistance rate was 92.3% (24/26). ST89 (n = 21, 80.8%) was the most prevalent clone, followed by single clones of ST1, ST5, ST72, ST121, and ST1507. The eta gene was detected in one (3.8%) isolate which was MSSA. The etb gene was detected in 14 (53.8%) isolates, all of which were ST89. Nafcillin or first-generation cephalosporin was most commonly prescribed (n=20, 76.9%). Vancomycin was administered in four patients (15.4%) and clindamycin in nine patients (34.6%). Among MRSA cases, there was no difference in duration of treatment when comparing the use of antimicrobials to which the causative bacteria were susceptible or non-susceptible (9.75 vs. 8.07 days, P > 0.05). CONCLUSION: S. aureus isolated from children with SSSS in Korea demonstrated a high prevalence of methicillin-resistant ST89 clones that harbored the etb gene. The predominance of MRSA suggests that antibiotics to which MRSA are susceptible may be considered for empirical antibiotic treatment in children with SSSS in Korea. Further studies on the role and effectiveness of systemic antibiotics in SSSS are warranted.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Drug Resistance, Bacterial , Exfoliatins/genetics , Staphylococcal Scalded Skin Syndrome/diagnosis , Staphylococcus aureus/metabolism , Anti-Bacterial Agents/pharmacology , Child, Preschool , Clindamycin/pharmacology , Clindamycin/therapeutic use , Drug Resistance, Bacterial/drug effects , Exfoliatins/metabolism , Female , Humans , Infant , Infant, Newborn , Male , Methicillin-Resistant Staphylococcus aureus/drug effects , Methicillin-Resistant Staphylococcus aureus/isolation & purification , Microbial Sensitivity Tests , Multilocus Sequence Typing , Republic of Korea , Staphylococcal Scalded Skin Syndrome/drug therapy , Staphylococcal Scalded Skin Syndrome/microbiology , Staphylococcus aureus/drug effects , Staphylococcus aureus/isolation & purification , Vancomycin/pharmacology , Vancomycin/therapeutic useABSTRACT
OBJECTIVES: We reported the impact of internal guidelines coupled with selective reporting of antibiotic susceptibility tests (srAST) on antibiotic adequacy in healthcare facilities. METHODS: This prospective study involved clinicians from three clinics with medical and surgical activities employing a full-time infectious disease (ID) specialist. Internal guidelines were updated in 2016. The clinics were working with the same laboratory, which delivered the srAST introduced in March 2017. Two weeks per month over a 6-month period, all isolated bacterial specimens, empirical antibiotic therapies (EAT) and the documented ones were analyzed. An EAT listed in the guidelines and a documented therapy mentioned in the srAST defined their adequacy. RESULTS: A total of 257 positive bacterial samples were analyzed in 199 patients, for which 106 infections were studied. Of these, 32% were urinary tract infections, 15% were primary bloodstream infections, 11% were bone infections, and 42% were other types of infection. The three main bacteria were Escherichia coli (27%), Staphylococcus aureus (24%), and Enterococcus faecalis (14%). The total number of antibiotic prescriptions was 168, with 75 (45%) EATs and 93 (55%) documented therapies. There were 35/75 (47%) adequate EATs and 86/93 (92%) adequate documented therapies. The ID specialist was not involved in 90/168 (53.5%) prescriptions, of which 43/90 (48%) were adequate, with 21/35 (60%) EATs and 22/86 (25%) documented therapies. There was a statistical correlation between compliance of the EATs with guidelines and of the documented therapy with srAST (p=0.02). CONCLUSION: Combining internal guidelines and srAST led to a high rate of antibiotic adequacy.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Infections/drug therapy , Microbial Sensitivity Tests/standards , Practice Guidelines as Topic , Aged , Aged, 80 and over , Antimicrobial Stewardship/methods , Bacteremia/drug therapy , Bone Diseases, Infectious/drug therapy , Escherichia coli/isolation & purification , Escherichia coli Infections/drug therapy , Female , France , Health Facilities , Humans , Male , Microbial Sensitivity Tests/methods , Middle Aged , Prospective Studies , Staphylococcal Infections/drug therapy , Staphylococcus aureus/isolation & purification , Urinary Tract Infections/drug therapyABSTRACT
Burn patients are at great risk of developing fungal wound infections. Fungi are frequently cultured from burn tissue specimens alone or in combination with bacteria. However, the spectrum of fungi in burn patients from Pakistan has not been reported previously. A retrospective laboratory-based study was conducted and data on all positive cultures from burn wounds were included. During the study period, specimens were cultured on appropriate media and incubated for anaerobic and aerobic growth. Clinical and demographic information recorded during clinical reporting was also collected. Seventy tissue cultures were positive for microorganisms. Of these, 27 (39%) had growth of either filamentous mold (17 cases) or Candida species (14 cases). Two cases had growth of both mold and yeast. Aspergillus flavus was the most common mold (9) followed by Fusarium species (3). Candida tropicalis was the most common yeast (7) followed by Candida parapsilosis (4). There was concomitant bacterial growth in 19 cases, predominantly of Staphylococcus aureus (13), Pseudomonas aeruginosa (8), and other Gram-negative rods (6). Of the 35 patients in which treatment history was available, 33 were receiving broad-spectrum antibiotics. A high incidence of fungal isolation was seen in this study. Their findings are consistent with the global increase in fungal infections in burn wounds. High index of suspicion by clinicians and revision of culture protocols in burn patients may be warranted for optimal patient management.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Burns/drug therapy , Burns/microbiology , Gram-Negative Bacteria/isolation & purification , Gram-Positive Bacteria/isolation & purification , Female , Humans , Male , Microbial Sensitivity Tests , Pakistan , Pseudomonas aeruginosa/isolation & purification , Retrospective Studies , Severity of Illness Index , Staphylococcus aureus/isolation & purification , Tertiary Care CentersABSTRACT
The burden of antibiotic resistance is currently estimated by mathematical modeling, without real count of resistance to key antibiotics. Here we report the real rate of resistance to key antibiotics in bacteria isolated from humans during a 5 years period in a large area in southeast in France. We conducted a retrospective study on antibiotic susceptibility of 539,107 clinical strains isolated from hospital and private laboratories in south of France area from January 2014 to January 2019. The resistance rate to key antibiotics as well as the proportion of bacteria classified as Difficult-to-Treat (DTR) were determined and compared with the Mann-Whitney U test, the χ2 test or the Fisher's exact test. Among 539,037 isolates, we did not observe any significant increase or decrease in resistance to key antibiotics for 5 years, (oxacillin resistance in Staphylococcus aureus, carbapenem resistance in enterobacteria and Pseudomonas aeruginosa and 3rd generation cephalosporin resistance in Escherichia coli and Klebsiella pneumoniae). However, we observed a significant decrease in imipenem resistance for Acinetobacter baumannii from 2014 to 2018 (24.19-12.27%; p = 0.005) and a significant increase of ceftriaxone resistance in Klebsiella pneumoniae (9.9-24.03%; p = 0.001) and Enterobacter cloacae (24.05-42.05%; p = 0.004). Of these 539,037 isolates, 1604 (0.3%) had a DTR phenotype. Over a 5-year period, we did not observe a burden of AR in our region despite a high rate of antibiotic consumption in our country. These results highlight the need for implementation of real-time AR surveillance systems which use factual data.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Bacteria/drug effects , Databases, Factual/statistics & numerical data , Drug Resistance, Bacterial , Microbial Sensitivity Tests/methods , Models, Theoretical , Acinetobacter baumannii/drug effects , Acinetobacter baumannii/isolation & purification , Bacteria/classification , Bacteria/isolation & purification , Escherichia coli/drug effects , Escherichia coli/isolation & purification , France , Humans , Pseudomonas aeruginosa/drug effects , Pseudomonas aeruginosa/isolation & purification , Retrospective Studies , Staphylococcus aureus/drug effects , Staphylococcus aureus/isolation & purificationABSTRACT
Bacteria are everywhere and pose severe threats to human health and safety. The rapid classification and sensitive detection of bacteria are vital steps of bacterial community research and the treatment of infection. Herein, we developed optical property-superior and heavy metal-free ZnCuInSe quantum dots (QDs) for achieving rapid discrimination of Gram-positive/Gram-negative bacteria by the naked eye; driven by the structural differences of bacteria, ZnCuInSe QDs are effective in binding to Gram-positive bacteria, especially Staphylococcus aureus (S. aureus), in comparison with Gram-negative bacteria and give discernable color viewed by the naked eye. Meanwhile, based on its distinctive fluorescence response, the accurate quantification of S. aureus was investigated with a photoluminescence system in the concentration ranges of 1 × 103 to 1 × 1011 CFU/mL, with a limit of detection of 1 × 103 CFU/mL. Furthermore, we demonstrated the feasibility of ZnCuInSe QDs as a fluorescence probe for imaging S. aureus. This simple strategy based on ZnCuInSe QDs provides an unprecedented step for rapid and effective bacterial discrimination, detection, and imaging.
Subject(s)
Copper/chemistry , Indium/chemistry , Quantum Dots/chemistry , Selenium/chemistry , Staphylococcus aureus/classification , Zinc/chemistry , Limit of Detection , Microbial Sensitivity Tests , Solubility , Staphylococcus aureus/isolation & purification , Water/chemistryABSTRACT
Objective: To investigate the clinical characteristics of pediatric methicillin-resistant Staphylococcus aureus (MRSA) infection and the antibiotic sensitivity of the isolates. Methods: The clinical data of children with MRSA infection and antibiotic sensitivity of the isolates from 11 children's hospitals in Infectious Diseases Surveillance of Paediatrics (ISPED) group of China between January 1, 2018 and December 31, 2018 were collected retrospectively. The children's general condition, high-risk factors, antimicrobial therapy and prognosis, differences in clinical disease and laboratory test results between different age groups, and differences of antibiotic sensitivity between community-acquired (CA)-MRSA and hospital-acquired (HA)-MRSA were analyzed. The t test and Wilcoxon rank sum test were used for statistical analysis of the quantitative data and Chi-square test were used for comparison of rates. Results: Among the 452 patients, 264 were males and 188 were females, aged from 2 days to 17 years. There were 233 cases (51.5%) in the ≤1 year old group, 79 cases (17.5%) in the>1-3 years old group, 29 cases (6.4%) in the >3-5 years old group, 65 cases (14.4%) in the >5-10 years old group, and 46 cases (10.2%) in the>10 years old group. The main distributions of onset seasons were 55 cases (12.2%) in December, 47 cases (10.4%) in February, 46 cases (10.2%) in November, 45 cases (10.0%) in January, 40 cases (8.8%) in March. There were 335 cases (74.1%) CA-MRSA and 117 (25.9%) cases HA-MRSA. Among all cases, 174 cases (38.5%) had basic diseases or long-term use of hormone and immunosuppressive drugs. During the period of hospitalization, 209 cases (46.2%) received medical interventions. There were 182 patients (40.3%) had used antibiotics (ß-lactams, glycopeptides, macrolides, carbapenems, oxazolones, sulfonamides etc) 3 months before admission. The most common clinical disease was pneumonia (203 cases), followed by skin soft-tissue infection (133 cases), sepsis (92 cases), deep tissue abscess (42 cases), osteomyelitis (40 cases), and septic arthritis (26 cases), suppurative meningitis (10 cases). The proportion of pneumonia in the ≤1 year old group was higher than the >1-3 years old group,>3-5 years old group,>5-10 years old group,>10 years old group (57.5% (134/233) vs. 30.4% (24/79), 31.0% (9/29), 38.5% (25/65), 23.9% (11/46), χ(2)=17.374, 7.293, 7.410, 17.373, all P<0.01) The proportion of skin and soft tissue infections caused by CA-MRSA infection was higher than HA-MRSA (33.4% (112/335) vs. 17.9% (21/117), χ(2)=10.010, P=0.002), and the proportion of pneumonia caused by HA-MRSA infection was higher than CA-MRSA (53.0% (62/117) vs. 42.1% (141/335), χ(2)=4.166, P=0.041). The first white blood cell count of the ≤1 year old group was higher than that children > 1 year old ((15±8)×10(9)/L vs. (13±7)×10(9)/L, t=2.697, P=0.007), while the C-reactive protein of the ≤1 year old group was lower than the 1-3 years old group,>5-10 years old group,>10 years old group (8.00 (0.04-194.00) vs.17.00 (0.50-316.00), 15.20 (0.23-312.00), 21.79(0.13-219.00) mg/L, Z=3.207, 2.044, 2.513, all P<0.05), there were no significant differences in procalcitonin (PCT) between different age groups (all P>0.05). After the treatment, 131 cases were cured, 278 cases were improved, 21 cases were not cured, 12 cases died, and 10 cases were abandoned. The 452 MRSA isolates were all sensitive to vancomycin (100.0%), linezolid (100.0%), 100.0% resistant to penicillin, highly resistant to erythromycin (85.0%, 375/441), clindamycin (67.7%, 294/434), less resistant to sulfonamides (5.9%, 23/391), levofloxacin (4.5%, 19/423), gentamicin (3.2%, 14/438), rifampicin (1.8%, 8/440), minocycline (1.1%, 1/91). The antimicrobial resistance rates were not significantly different between the CA-MRSA and HA-MRSA groups (all P>0.05). Conclusions: The infection of MRSA is mainly found in infants under 3 years old. The prevalent seasons are winter and spring, and MRSA is mainly acquired in the community. The main clinical diseases are pneumonia, skin soft-tissue infection and sepsis. No MRSA isolate is resistant to vancomycin, linezolid. MRSA isolates are generally sensitive to sulfonamides, levofloxacin, gentamicin, rifampicin, minocycline, and were highly resistant to erythromycin and clindamycin. To achieve better prognosis. clinicians should initiate anti-infective treatment for children with MRSA infection according to the clinical characteristics of patients and drug sensitivity of the isolates timely and effectively.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Methicillin-Resistant Staphylococcus aureus/drug effects , Methicillin/pharmacology , Staphylococcal Infections/drug therapy , Staphylococcal Infections/microbiology , Staphylococcus aureus/drug effects , Adolescent , Anti-Bacterial Agents/pharmacology , Child , Child, Preschool , China , Community-Acquired Infections/drug therapy , Community-Acquired Infections/epidemiology , Community-Acquired Infections/microbiology , Female , Humans , Infant , Male , Methicillin-Resistant Staphylococcus aureus/isolation & purification , Microbial Sensitivity Tests , Retrospective Studies , Staphylococcal Infections/diagnosis , Staphylococcus aureus/isolation & purification , Treatment OutcomeABSTRACT
BACKGROUND: Neonatal septicemia is a life threatening medical emergency that requires timely detection of pathogens with urgent rational antibiotics therapy. METHODS: A cross-sectional study was conducted between March 2017 to September 2018 among 317 septicemia suspected neonates at neonatal intensive care unit, Ayder Comprehensive Specialized Hospital, Mekelle, Tigray, North Ethiopia. A 3 mL of blood was collected from each participant. Identification of bacterial species was done using the standard microbiological techniques. Antibiotic sensitivity test was done using disk diffusion method. Data were entered and analyzed using computer software SPSS version 22. Bivariate and multivariate regression analysis was applied to determine the association between variables. RESULTS: Of the 317 (190 male and 127 female) neonates, 116 (36.6%) were found to be with culture proven septicemia. Klebsiella species were the predominant etiologic agents. Length of hospital stay (AOR (adjusted odds ratio) = 3.65 (2.17-6.13), p < 0.001) and low birth weight (AOR = 1.64 (1.13-2.78), p = 0.04) were the factors associated with neonatalsepticemia. Most isolates showeda frightening drug resistance rate to the commonly used antimicrobial drugs. K. pneumoniae, E. coli, Enterobacter and Citrobacter species were 57% to100% resistant to ceftazidime, ceftriaxone, gentamycin, amoxacillin-clavulunic acid and ampicillin. All, 9 (100%) isolates of S. aureus were resistant to oxacilline, ampicillin,erythromycin and gentamycin. Furthermore, 55.6% S. aureus isolates were Methicillin Resistant Staphylococcus aureus. CONCLUSION: Neonaltal septicemia is found to be significantly high in the present study. As most of the isolates are potentially related to hospital acquired infections, prevention and control policy should have to be more strengthening in the neonatal intensive care unit.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Bacteria , Neonatal Sepsis , Ampicillin/therapeutic use , Bacteria/classification , Bacteria/drug effects , Bacteria/isolation & purification , Citrobacter/drug effects , Citrobacter/isolation & purification , Cross-Sectional Studies , Drug Resistance, Bacterial , Enterobacter/drug effects , Enterobacter/isolation & purification , Escherichia coli/drug effects , Escherichia coli/isolation & purification , Ethiopia , Female , Humans , Infant, Newborn , Intensive Care Units, Neonatal , Klebsiella/drug effects , Klebsiella/isolation & purification , Male , Methicillin-Resistant Staphylococcus aureus/drug effects , Methicillin-Resistant Staphylococcus aureus/isolation & purification , Microbial Sensitivity Tests , Neonatal Sepsis/drug therapy , Neonatal Sepsis/microbiology , Oxacillin/therapeutic use , Staphylococcus aureus/drug effects , Staphylococcus aureus/isolation & purificationABSTRACT
PURPOSE: Staphylococcus aureus is a leading cause of keratitis requiring urgent antimicrobial treatment. However, rising antibiotic resistance has rendered current ophthalmic antibiotics increasingly ineffective. First, a diverse, ocular S. aureus strain set was evaluated for resistance to 6 commonly used ophthalmic antibiotics. Next, a recently discovered antimicrobial drug combination containing polymyxin B/trimethoprim (PT) + rifampin that displayed impressive efficacy toward S. aureus in both in vitro and in vivo studies was evaluated as a potential novel keratitis therapeutic through testing this combination's efficacy against the clinical strain set. METHODS: A total of 163 S. aureus isolates were collected either commercially or from the Flaum Eye Institute, University of Rochester. The minimum inhibitory concentrations of moxifloxacin, levofloxacin, vancomycin, erythromycin, tobramycin, rifampin, and PT were determined for the entire strain set to establish the incidence of resistance to current treatment options among a contemporary clinical isolate set and compared with the performance of PT + rifampin. RESULTS: Among all 163 isolates tested, high rates of antibiotic resistance were found toward erythromycin (69% resistance), moxifloxacin (33%), levofloxacin (40%), and tobramycin (17%). Conversely, the entire strain set, including multidrug resistant isolates, was sensitive to PT + rifampin, demonstrating the potency of this combination. CONCLUSIONS: We established that antibiotic resistance is pervasive among clinical S. aureus isolates, underscoring the concern for the effectiveness of current ophthalmic antibiotics. The drug combination of PT + rifampin, however, eradicated 100% of isolates tested, demonstrating the ability to overcome existing circulating resistance factors, and as such, might represent a promising therapeutic for S. aureus keratitis.