Incidence of cephalosporin-induced anaphylaxis and clinical efficacy of screening intradermal tests with cephalosporins: A large multicenter retrospective cohort study.

BACKGROUND: Few studies have investigated the incidence of anaphylaxis induced by individual or structurally similar cephalosporins. The aims of the study were to assess the incidence of cephalosporin-induced anaphylaxis and evaluate the clinical efficacy of screening skin tests. METHODS: In this retrospective cohort study, we obtained information on total cephalosporin use and cephalosporin-induced anaphylaxis in intravenous cephalosporin recipients in 12 general hospitals between 2013 and 2015. Cephalosporins were divided into 4 groups according to similar side-chain structures. The incidence of cephalosporin-induced anaphylaxis was assessed for each cephalosporin, cephalosporin generation, and side-chain group. To verify the efficacy of screening intradermal tests (IDT) with cephalosporin, the 12 hospitals were assigned to the intervention or control group depending on whether they performed screening IDT before the administration of cephalosporins. RESULTS: We identified 76 cases of cephalosporin-induced anaphylaxis with 1 123 345 exposures to intravenous cephalosporins (6.8 per 100 000 exposures), and the incidence of fatal anaphylaxis by cephalosporin was 0.1 cases per 100 000 exposures. The highest incidences of anaphylaxis occurred in the ceftizoxime (13.0 cases per 100 000 exposures) and side-chain group 1 (cefepime, cefotaxime, ceftizoxime, ceftriaxone, and cefuroxime; 9.3 per 100 000). There was no case of anaphylaxis induced by cefoxitin, cefmetazole, cefminox, and cefotiam. The clinical effectiveness of routine screening IDT was not significant (P = .06). CONCLUSIONS: The incidence of cephalosporin-induced anaphylaxis differed according to individual drugs and side-chain structure. Screening IDT showed no clinical efficacy at a population level.

Short communication: Genetic characterization of antimicrobial resistance in Acinetobacter isolates recovered from bulk tank milk.

A total of 176 Acinetobacter isolates, including 57 Acinetobacter baumannii originally obtained from 2,287 bulk tank milk (BTM) samples in Korea was investigated for the genetic basis of antimicrobial resistance using molecular methods. In addition, the occurrence and cassette content of integrons were examined and the genetic diversity of A. baumannii strains identified was evaluated. Aminoglycoside-modifying enzyme genes were detected in 15 (88.2%) of the 17 aminoglycoside-resistant Acinetobacter isolates tested. The most common aminoglycoside-modifying enzyme gene identified was adenylyltransferase gene aadB (n = 9), followed by phosphotransferase genes aphA6 (n = 7) and aphA1 (n = 5). Of the 31 isolates resistant to tetracycline, tet(39) was detected in 20 of them. The genetic basis of resistance to sulfonamide was identified in 15 (53.6%) of 28 trimethoprim-sulfamethoxazole-resistant isolates and 9 (32.1%) of them carried both sul1 and sul2 genes. A blaADC-7-like gene was detected in 1 ß-lactam-resistant A. baumannii. Furthermore, class 1 integron was identified in 11 Acinetobacter isolates. Two gene cassettes dfrA15, conferring resistance to trimethoprim, and aadA2, conferring resistance to aminoglycosides, were identified in 8 Acinetobacter isolates. None of the isolates was positive for class 2 or class 3 integrons. Pulsed-field gel electrophoresis revealed that most of the A. baumannii strains from BTM samples were genetically diverse, indicating that the occurrence of A. baumannii strains in BTM was not the result of dissemination of a single clone. Elucidation of resistance mechanisms associated with the resistance phenotype and a better understanding of resistance genes may help in the development of strategies to control infections, such as mastitis, and to prevent further dissemination of antibiotic resistance genes. To the best of our knowledge, this is the first report of molecular characterization of antimicrobial-resistant Acinetobacter spp. from milk.

Prevalence and antimicrobial susceptibility of Acinetobacter from raw bulk tank milk in Korea.

The objective of this study was to determine the prevalence of Acinetobacter spp. in bulk tank milk (BTM) samples from different provinces of Korea and to analyze their antimicrobial susceptibility. Altogether, 2,287 BTM samples were investigated. Among them, Acinetobacter spp. were isolated from 176 BTM samples. Out of 176 Acinetobacter spp., 57 isolates were identified as Acinetobacter baumannii. None of the isolates were resistant to cefepime, imipenem, meropenem, ciprofloxacin, levofloxacin, or colistin. Resistance to amikacin, gentamicin, piperacillin, and cefotaxime was 2.3, 7.4, 2.3, and 4.0%, respectively. Acinetobacter spp. were least susceptible to tetracycline (17.6%), followed by trimethoprim-sulfamethoxazole (15.9%), ceftazidime (10.8%), and ampicillin-sulbactam (10.2%). Overall, A. baumannii strains were susceptible to most of the antimicrobial agents tested compared with other Acinetobacter spp. The Acinetobacter isolates showed 17 different patterns of antimicrobial resistance. The most frequent resistance profile observed was ampicillin-sulbactam (n=13), followed by tetracycline (n=9), ceftazidime-tetracycline (n=8), and trimethoprim-sulfamethoxazole-tetracycline (n=8). The results of this study confirmed that Acinetobacter, including A. baumannii strains, are present in BTM, which clearly showed the importance of examining BTM not only for foodborne pathogens but also for Acinetobacter spp., which could be of public health concern. To the best of our knowledge, this is the first report of Acinetobacter spp. in BTM samples from Korea.

Antimicrobial susceptibility of coagulase-negative staphylococci isolated from bovine mastitis between 2003 and 2008 in Korea.

A total of 1,444 coagulase-negative staphylococci (CNS) isolates from bovine mastitic milk samples collected during 2003-2008 in Korea were identified to the species level. Of 14 species identified, S. simulans, S. haemolyticus, and S. sciuri accounted for over 60% of the isolates. All the CNS isolates were tested for susceptibility to eight antimicrobials commonly used in dairy cattle. With a few exceptions, similar resistance patterns were observed among the CNS species: penicillin and ampicillin showed the lowest activity while amikacin, cephalothin, and gentamycin were highly effective. About 39% (557/1,444) of the CNS isolates were pan-susceptible, while 12% (175/1,444) showed resistance to four or more antimicrobials tested.

Raised serum interleukin 15 levels in Kawasaki disease.

BACKGROUND: Interleukin (IL)15 is a novel cytokine that induces T cell proliferation, B cell maturation, natural killer cell cytotoxicity, and may have a pivotal role in the pathogenesis of inflammatory disease, acting upstream from tumour necrosis factor alpha (TNFalpha). Kawasaki disease (KD) is an inflammatory disease, in which serum levels of inflammatory cytokines such as TNFalpha and IL6 are increased. OBJECTIVE: To examine the serum levels of IL15 in KD and to evaluate the role of IL15 in estimating the severity of inflammation in KD. RESULTS AND CONCLUSION: There was a significant increase in the mean (SD) serum levels of IL15 measured in the acute stage of KD (11.5 (5.8) pg/ml) compared with those in the subacute stage (1.3 (0.9) pg/ml) (p<0.01) and normal controls (0.9 (1.0) pg/ml) (p<0.01). The increase in IL15 correlated with the increase in TNFalpha (r(s)=0.66, p<0.01); however it did not correlate with the levels of erythrocyte sedimentation rate and C reactive protein, suggesting that IL15 may not be a useful marker in estimating the severity of inflammation in KD.

Staphylococcal enterotoxin B upregulates fas-mediated apoptosis of peripheral blood mononuclear cells in childhood atopic dermatitis.

Staphylococcal infection-producing superantigens, such as staphylococcal enterotoxin B (SEB), are presumed to play an important role of inflammatory processes in atopic dermatitis (AD). The aim of this study was to elucidate the apoptotic response of peripheral blood mononuclear cells (PBMCs) from children with AD. PBMCs from AD children were sampled and cultured with SEB stimulation. Levels of apoptosis and Fas expression were measured using flow cytometry; the soluble Fas ligand (sFasL) was also measured using the enzyme-linked immunosorbent assay method, and the expression of FasL in PBMCs was observed using reverse transcriptase-polymerase chain reaction. There was no difference in the initial levels of apoptosis and Fas expression in precultured PBMCs of AD patients and healthy donors. After culturing for 48 h under SEB stimulation, the apoptosis level and Fas expression were significantly upregulated in the PBMCs from AD children compared with that from the normal controls. In patients, the sFasL was significantly increased, and the expression of FasL was observed in messenger RNA of peripheral monocytes. These results suggest that the Fas/FasL system is involved in the apoptosis induced by SEB in AD, with simultaneous increases in sFasL and expression of FasL.

Iatrogenic fistula from the aorta to the left marginal coronary vein.

We report the first documented case of iatrogenic aortocoronary fistula to the left marginal coronary vein following coronary bypass surgery. Unique clinical data, findings from catheterization, and angiographic features are presented and compared with those in the seven previously reported cases of iatrogenic aortocoronary venous fistulae after coronary bypass operations.

Return to work after coronary angioplasty: a report from the National Heart, Lung, and Blood Institute Percutaneous Transluminal Coronary Angioplasty Registry.

Employment status was analyzed in 2,250 patients enrolled at 65 clinical centers in the NHLBI PTCA Registry. Patients were classified into 3 groups depending on the outcome of PTCA. In 63.6%, PTCA was successful without MI or CABG (Group A); in 25.3%, PTCA was unsuccessful and was followed by CABG (Group B); and in 11.1%, PTCA was unsuccessful and was followed by medical therapy alone (Group C). At entry, 68.3% of all patients were employed full- or part-time. The clinical characteristics of the 3 groups were different. Patients in Group C had a higher incidence of previous MI and previous CABG. In addition, patients in Group C had a significantly decreased baseline employment rate compared with those in Group A. At a mean follow-up of 1.5 years, there was a small but similar decrease in the percentage employed full- or part-time in all groups. Employment status also was analyzed in a subset of 1,150 patients working full- or part-time at baseline and aged 60 years or younger, who would be expected to have the highest return to work rates. At a mean follow-up of 1.4 years, 81 to 86% of patients remained working irrespective of the outcome of PTCA. However, patients with successful PTCA returned to work significantly sooner. The occurrence of chest pain during follow-up in these patients was an important predictor of return to work, irrespective of the outcome of dilatation. In patients with chest pain during follow-up, only 77% were working, compared with 90% of patients who had not had chest pain.

Relative cost of coronary angioplasty and bypass surgery in a one-vessel disease model.

A national study was carried out to determine the relative costs of PTCA and CABG. Baseline clinical criteria for the 2 groups were similar. Data were collected in 186 sets for the PTCA group and 175 sets for the CABG group. Male patients make up 81% of the PTCA group and 80% of the CABG group. Mean hospital stay was 12 +/- 5 days in the CABG group, compared with 4 +/- 2 days in the PTCA group (p less than 0.001). The base charges for hospital and professional components of the CABG procedure were $15,580 +/- $2,159, whereas the same charges for the PTCA procedure were $5,315 +/- $2,159 (p less than 0.001). With an 80% primary success rate, which was the group mean success rate, the average dollar savings per PTCA procedure would be $7,149, or $7,149,000 per 1,000 cases. Thus, PTCA for revascularization in 1-vessel CAD is significantly more cost-effective than CABG in the short term.

Percutaneous transluminal angioplasty of a large septal artery.

A severely stenotic, large-caliber, first septal artery was successfully dilated in a patient with refractory angina and nonsurgical, multivessel coronary artery disease. The success of this dilatation was related to favorable coronary anatomy and to the availability of a guidewire-directed dilatation catheter. Septal artery stenosis with or without surgically accessible stenoses in other coronary vessels represents a potential indication for percutaneous transluminal coronary angioplasty.

A computer model of the left ventricular epicardial surface for quantification of jeopardized myocardium.

A computer program has been developed that can be used to quantify the extent of probable myocardial damage which will result from occlusion of a jeopardized coronary vessel. The program, used as an adjunct to coronary arteriography, permits calculation of an area of an arbitrary segment of the left ventricular epicardial surface. This segmental area, when expressed as a fraction of the total LV epicardial area, is a measure of the myocardial mass supplied by a specific coronary arterial vessel. The computer program has been extended to include graphic, three-dimensional simulation of different views of the left ventricular epicardium.