Delay in Antibiotic Administration Is Associated With Mortality Among Septic Shock Patients With Staphylococcus aureus Bacteremia.

OBJECTIVES: The relationship between the timing of antibiotics and mortality among septic shock patients has not been examined among patients specifically with Staphylococcus aureus bacteremia. DESIGN: Retrospective analysis of a Veterans Affairs S. aureus bacteremia database. SETTING: One-hundred twenty-two hospitals in the Veterans Affairs Health System. PATIENTS: Patients with septic shock and S. aureus bacteremia admitted directly from the emergency department to the ICU from January 1, 2003, to October 1, 2015, were evaluated. INTERVENTIONS: Time to appropriate antibiotic administration and 30-day mortality. MEASUREMENTS AND MAIN RESULTS: A total of 506 patients with S. aureus bacteremia and septic shock were included in the analysis. Thirty-day mortality was 78.1% for the entire cohort and was similar for those participants with methicillin-resistant S. aureus and methicillin-sensitive S. aureus bacteremia. Our multivariate analysis revealed that, as compared with those who received appropriate antibiotics within 1 hour after emergency department presentation, each additional hour that passed before appropriate antibiotics were administered produced an odds ratio of 1.11 (95% CI, 1.02-1.21) of mortality within 30 days. This odds increase equates to an average adjusted mortality increase of 1.3% (95% CI, 0.4-2.2%) for every hour that passes before antibiotics are administered. CONCLUSIONS: The results of this study further support the importance of prompt appropriate antibiotic administration for patients with septic shock. Physicians should consider acting quickly to administer antibiotics with S. aureus coverage to any patient suspected of having septic shock.

The effect of immunoregulation of Streptococcus lactis L16 strain upon Staphylococcus aureus infection.

BACKGROUND: Staphylococcus aureus is an important pathogen that causes various infections in medical facilities. However, resistance to multiple drugs has made this infection difficult to manage. Thus, new therapeutic strategies are urgently needed to solve this worldwide public health problem. The Streptococcus lactis L16 strain was isolated from the fermented hot chili sauce. To explore whether it can be used as a protective agent against S. aureus infection, we designed a mouse model of S. aureus infection to evaluate the therapeutic potency of S. lactis. Mice were grouped into pre-(P) and post-(T) S. aureus infection groups following oral administration of S. lactis L16. The protection and treatment effects were assessed by examining body weight, internal organ weight, serum cytokines and intestinal secretory IgA alternations. RESULT: Oral administration of the S. lactis L16 strain reduced the loss of body weight in mice post-infection and alleviated infection-induced hepatomegaly. In particular, the PL16 group (protection with L16) showed more effective resistance to S. aureus than the TL16 group (treatment with L16). The level of serum cytokine interferon gamma following oral administration of the L16 strain was remarkably increased during infection, as were interleukin-4 levels during convalescence. The probiotic L16 strain induced more sIgA production than S. aureus. CONCLUSION: Our data suggest that S. lactis L16 is an effective strain with anti-Staphylococcus activity. By regulating the Th1/Th2 response, S. lactis can effectively reduce lesions from infection, indicating its therapeutic potential in overcoming antibiotic resistance in this mouse infection model that mimics infections observed in humans.

Dietary Omega-3 Fatty Acids Increase Survival and Decrease Bacterial Load in Mice Subjected to Staphylococcus aureus-Induced Sepsis.

Sepsis caused by Staphylococcus aureus is increasing in incidence. With the alarming use of antibiotics,S. aureus is prone to become methicillin resistant. Antibiotics are the only widely used pharmacological treatment for sepsis. Interestingly, mice fed high-fat diet (HFD) rich in polyunsaturated fatty acids have better survival of S. aureus-induced sepsis than mice fed HFD rich in saturated fatty acids (HFD-S). To investigate what component of polyunsaturated fatty acids, i.e., omega-3 or omega-6 fatty acids, exerts beneficial effects on the survival of S. aureus-induced sepsis, mice were fed HFD rich in omega-3 or omega-6 fatty acids for 8 weeks prior to inoculation with S. aureus Further, mice fed HFD-S were treated with omega-3 fatty acid metabolites known as resolvins. Mice fed HFD rich in omega-3 fatty acids had increased survival and decreased bacterial loads compared to those for mice fed HFD-S after S. aureus-induced sepsis. Furthermore, the bacterial load was decreased in resolvin-treated mice fed HFD-S after S. aureus-induced sepsis compared with that in mice treated with vehicle. Dietary omega-3 fatty acids increase the survival of S. aureus-induced sepsis by reversing the deleterious effect of HFD-S on mouse survival.

Investigation on rifampicin administration from the standpoint of pharmacokinetics/pharmacodynamics in a neutropenic murine thigh infection model.

BACKGROUND: The purpose of this study was to examine the pharmacokinetics/pharmacodynamics of rifampicin against methicillin-susceptible Staphylococcus aureus (MSSA), methicillin-resistant S. aureus (MRSA), and vancomycin-intermediate S. aureus (VISA) in a neutropenic murine thigh infection model. METHODS: Three S. aureus isolates (MSSA [ATCC 25923], MRSA and VISA [Mu50]) with rifampicin MIC 0.06 to >256 µg/mL were tested. The efficacy was calculated as the change in bacterial density. A maximum effect model was used to determine the PK/PD index that best described the dose-response data. RESULTS: The area under the curve (AUC)/MIC and maximum concentration of drug in serum (Cmax/MIC) were the best correlated with in vivo efficacy (AUC/MIC, R(2) = 0.96; Cmax/MIC, R(2) = 0.97) for S. aureus ATCC 25923 strain, and the dose fractionation-response study did not show significantly different antimicrobial activity (p = 0.10). The AUC/MIC values associated with stasis and 1-log kill for the S. aureus ATCC 25923 strain were 386 and 952, respectively. On the other hand, no antimicrobial efficacy was observed against two strains (MRSA and VISA) with MIC of 128 µg/mL or more. CONCLUSION: Rifampicin demonstrated concentration-dependent killing. The AUC/MIC was a predictive PK/PD index.

Curcumin-Chitosan Nanocomposite Formulation Containing Pongamia pinnata-Mediated Silver Nanoparticles, Wound Pathogen Control, and Anti-Inflammatory Potential.

BACKGROUND: Because of its diverse range of use in several ethics of diagnosis and care of multiple diseases, nanotechnology has seen remarkable growth and has become a key component of medical sciences. In recent years, there has been rapid advancement in medicine and biomaterials. Nanomedicine aids in illness prevention, diagnosis, monitoring, and treatment. AIM: The purpose of this work is to evaluate the antibacterial, anti-inflammatory, and cytotoxic capabilities of green produced silver nanoparticle with the addition of curcumin-assisted chitosan nanocomposite (SCCN) against wound pathogenic as reducing agents. MATERIALS AND METHODS: The plant extract of Pongamia pinnata, silver nanoparticles, and its based curcumin nanoformulations was studied in this study utilizing UV visible spectrophotometer, selected area electron diffraction (SAED), and TEM. Anti-inflammatory, antimicrobial, and cytotoxic tests were performed on silver nanoparticles with the addition of curcumin-assisted chitosan nanocomposite (SCCN). Furthermore, these produced nanocomposites were coated on clinical silk and tested for antibacterial activity. RESULTS: The produced silver nanoparticle with the addition of curcumin-assisted chitosan nanocomposite (SCCN) has significant antibacterial activities against Pseudomonas aeruginosa and staphylococcus aureus. They are as well as possess anti-inflammatory activity and furthermore prove to be biocompatible. CONCLUSION: This advancement in the field of biomaterials, which means nanocomposite, not only helps to reduce the harmful effects of pathogenic organisms while representing an environmentally benign material but it also shows to be a material with zero danger to humans and the environment.

Septic arthritis of the pubic symphysis in pregnancy.

Septic arthritis of the pubic symphysis is a rare but serious entity which can be difficult to distinguish from common pregnancy-related problems. The following highlights the risk factors and clinical features of this uncommon condition and describes its diagnosis and management. The patient is a 26-year-old gravida 2 para 1 (second pregnancy that lasted >20 weeks and one prior term delivery) who presented to the labour and delivery triage unit of a tertiary care centre at 23 weeks' gestation with pelvis and hip pain. The patient had elevated inflammatory markers and Staphylococcal bacteraemia. MRI demonstrated pubic symphyseal septic arthritis and osteomyelitis. The patient underwent two fluoroscopy-guided joint aspirations; synovial fluid contained abundant neutrophils and grew colonies of methicillin-susceptible Staphylococcus aureus She then completed 6 weeks of intravenous antibiotic therapy. Repeat MRI of the pelvis at 31 weeks' gestation was favourable. The patient underwent caesarean delivery at 39 weeks' gestation without complication. Pelvic pain is common in pregnancy. However, abnormal musculoskeletal exam findings, historical elements and elevated inflammatory markers may suggest septic arthritis or osteomyelitis of the pubic symphysis. Accurate microbial identification, aggressive source control and multidisciplinary treatment are essential to optimal maternal and pregnancy outcomes.

Assessment of methicillin resistant Staphylococcus Aureus detection methods: analytical comparative study.

INTRODUCTION: The heterogeneous expression of methicillin resistance in Staphylococcus aureus (MRSA) affects the efficiency of tests available to detect it. The objective of this study was to assess four phenotypic tests used to detect MRSA. METHODS: This is an analytical comparative study conducted among sudanese patients during period from May 2012 to July 2014, Staphylococcus aureus strains were isolated and identified by conventional methods, and then confirmed by PCR detection of coagulase gene. PCR detection of mecA gene was used as a gold standard to assess oxacillin resistance screen agar base (ORSAB), oxacillin disc, cefoxitin disc (at different temperatures and incubation periods) and MRSA-latex agglutination test. S.aureus ATCC 25923 was used as control. Sensitivity and specificity were calculated. RESULTS: MRSA- latex agglutination was the most accurate test; it showed 100% of both sensitivity and specificity, followed by cefoxitin disc with sensitivity of 98.48% and specificity of 100%. However, both of oxacillin disc and oxacillin resistance screen agar base showed less accurate results, and were affected by incubation periods. Oxacillin disc after 24 h incubation both at 30°C and 35°C showed sensitivity and specificity values of 87.88% and 96.23%, respectively. However, after 48h incubation the test at 30°C showed sensitivity and specificity values of 89.39%, and 94.34%, respectively. At 35°C (48h) it showed values of 89.39%, 92.45% respectively. Specificity of ORSAB was more than oxacillin disc at 35°C after 24h incubation 98.11% and 96.23%, respectively. CONCLUSION: MRSA- latex agglutination and cefoxitin disc diffusion tests are recommended for routine detection of MRSA.

[Use of propiono-acidophilus milk in the complex treatment of intestinal dysbacteriosis in infants with staphylococcal infections and sepsis]. / Ispol'zovanie propionovo-atsidofil'nogo moloka v kompleksnom lechenii kishechnogo disbakterioza pri stafilokokkovoi infektsii i sepsise u detei grudnogo vozrasta.

Antistaphylococcal properties of the new lactic acid mixture propionic acidophilic milk (PAM) against the microbe isolated from feces of children suffering from staphylococcal sepsis were comparatively studied by the dilution and diffusion methods. PAM was found to have more pronounced antimicrobial properties against pathogenic staphylococcus than acidophilic milk and kefir. It is recommended to include PAM into the diet of children with intestinal dysbacteriosis.

[Influence of a diet enriched with polyunsaturated fatty acids on some indices of the metabolism and course of acute gastro-intestinal diseases in children in the 1st year of life]. / Vliianie diety, obogashchennoi polinenasyshchennymi zhirnymi kislotami, na nekotorye pokazateli obmena i techenie ostrykh zheludochno-kishechnykh zabolevanii u detei pervogo goda zhizni

The influence of new products "Vitalakt" and "Malysh", enriched with polyunsaturated fatty acids, on the evolution of acute gastro-intestinal diseases and the lipids metabolism characteristics (total lipids, cholesterol and its ethers, phospholipids, nonetherified fatty acids in the blood serum), as well as on blood serum, protein fractions was studied. A total of 137 children were examined and the diet of 87 of them included the new dairy products "Vitalakt" and Malysh". These new dairy mixtures have been found to exert a beneficial effect on the course of the disease, tended to normalize the blood serum lipids characteristics and to reduce dysproteinemia. All this warrants recommending the mixtures "Vitalakt" and "Malysh" to be included in the diet of infants in the first year of life, suffering from acute gastro-intestinal diseases.

Efficacy of leukocyte- and platelet-rich plasma gel (L-PRP gel) in treating osteomyelitis in a rabbit model.

Leukocyte- and platelet-rich plasma gel (L-PRP gel), a new autologous product which was previously utilized in several surgical procedures to enhance tissue healing, is now increasingly used as a promising treatment method for infections. In this study, we investigated the antibacterial property of L-PRP gel against Methicillin-resistive Staphylococcus aureus (MRSA, ATCC 43300) in a rabbit model of osteomyelitis. Tibial osteomyelitis was induced in 40 New Zealand white rabbits using the MRSA strain. Three weeks after induction, the rabbits with tibial osteomyelitis were randomly divided into four groups: Control group (no treatment); Van group (debridement and parenteral treatment with vancomycin alone); L-PRP gel + Van group (debridement and local L-PRP gel injection, plus parenteral treatment with vancomycin); L-PRP gel group (debridement and local L-PRP gel injection). All rabbits were sacrificed 6 weeks after debridement. The antibacterial efficacy was evaluated by radiological, microbiological, and histological examinations. Newly formed bone was also quantified. The best therapeutic efficacy, including infection elimination and bone defect repair, was observed in the L-PRP gel + Van group. Although not comparable to vancomycin, L-PRP gel also exibited antimicrobial efficacy in vivo. We believe that a combination of L-PRP gel and antibiotics could be a favorable alternative for the treatment of osteomyelitis.

In vitro and in vivo effects of two coconut oils in comparison to monolaurin on Staphylococcus aureus: rodent studies.

Since monolaurin, a monoglyceride formed in the human body in small quantities, has proven effective both in vitro and in vivo against certain strains of Staphylococcus aureus, an important question arises whether consuming a substance high in lauric acid content, such as coconut oil could increase intrinsic monolaurin production to levels that would be successful in overcoming staphylococcal and other microbial invaders. Both a cup plate method and a microdilution broth culture system were employed to test bacteriostatic and bactericidal effects of the test agents in vitro. To test effectiveness in vivo, female C3H/he mice (10-12 per group) were orally administered sterile saline (regular control), vancomycin (positive control), aqueous monolaurin, or two varieties of coconut oil (refined, bleached, deodorized coconut oil and virgin coconut oil) for 1 week before bacterial challenge and 30 days after. A final group received both monolaurin and vancomycin. In contrast to monolaurin, the coconut oils did not show bactericidal activity in vitro. In vivo, the groups receiving vancomycin, monolaurin, or the combination showed some protection--50-70% survival, whereas the protection from the coconut oils were virtually the same as control--0-16% survival. Although we did not find that the two coconut oils are helpful to overcome S. aureus infections, we corroborated earlier studies showing the ability of monolaurin to do such.