Antibiotic Prophylaxis Is Associated with Subsequent Resistant Infections in Children with an Initial Extended-Spectrum-Cephalosporin-Resistant Enterobacteriaceae Infection.

The objective of this study was to assess the association between previous antibiotic use, particularly long-term prophylaxis, and the occurrence of subsequent resistant infections in children with index infections due to extended-spectrum-cephalosporin-resistant Enterobacteriaceae We also investigated the concordance of the index and subsequent isolates. Extended-spectrum-cephalosporin-resistant Escherichia coli and Klebsiella spp. isolated from normally sterile sites of patients aged <22 years were collected along with associated clinical data from four freestanding pediatric centers. Subsequent isolates were categorized as concordant if the species, resistance determinants, and fumC-fimH (E. coli) or tonB (Klebsiella pneumoniae) type were identical to those of the index isolate. In total, 323 patients had 396 resistant isolates; 45 (14%) patients had ≥1 subsequent resistant infection, totaling 73 subsequent resistant isolates. The median time between the index and first subsequent infections was 123 (interquartile range, 43 to 225) days. In multivariable Cox proportional hazards analyses, patients were 2.07 times as likely to have a subsequent resistant infection (95% confidence interval, 1.11 to 3.87) if they received prophylaxis in the 30 days prior to the index infection. In 26 (58%) patients, all subsequent isolates were concordant with their index isolate, and 7 (16%) additional patients had at least 1 concordant subsequent isolate. In 12 of 17 (71%) patients with E. coli sequence type 131 (ST131)-associated type 40-30, all subsequent isolates were concordant. Subsequent extended-spectrum-cephalosporin-resistant infections are relatively frequent and are most commonly due to bacterial strains concordant with the index isolate. Further study is needed to assess the role prophylaxis plays in these resistant infections.

Physicochemical behaviors of cationic gemini surfactant (14-4-14) based microheterogeneous assemblies.

A comprehensive study of micellization and microemulsion formation of a cationic gemini surfactant (tetramethylene-1,4-bis(dimethyltetradecylammonium bromide; 14-4-14) in the absence or presence of hydrophobically modified polyelectrolyte, sodium carboxymethylcellulose (NaCMC), has been conducted by conductometry, tensiometry, microcalorimetry, and fluorimetry methods at different temperatures. Both critical micelle concentration and degree of ionization of the surfactant have been observed to increase with increasing temperature. The interfacial and thermodynamic parameters were evaluated. The standard Gibbs free energy of micellization (ΔGm°) is negative, which decreases with increase in temperature. Larger entropic contribution is observed compared to the enthalpy. The interaction of 14-4-14 with NaCMC produces coacervates which was determined from turbidimetry method. The pseudoternary phase behavior of the microemulsion systems comprising water (or NaCMC as additive), 14-4-14, isopropanol (IP) or n-butanol (Bu) as cosurfactant, and isopropyl myristate (IPM) were studied at 298 K. Phase diagrams reveal that IP derived microemulsions (in the absence of NaCMC) offer a large isotropic region compared to Bu-derived systems at comparable physicochemical conditions. Increasing the concentration of IP or Bu decreases the isotropic region in the phase diagram. NaCMC influences the microemulsion zone, depending upon its concentration, and type of cosurfactant and surfantant/cosurfactant ratio. Dynamic light scattering and conductometric measurements show the size of the droplet, threshold temperature of percolation, scaling parameters, and activation energy of the percolation process of 14-4-14/IP or Bu derived microemulsion systems without/with NaCMC at various physicochemical conditions. Bu exerts a greater effect to reduce θt than IP as a cosurfactant (in the absence of NaCMC) at comparable ω. On the other hand, IP showed better percolating effect than Bu in the presence of NaCMC. Bu and IP (as cosurfactant) and NaCMC (as additive) influenced the microemulsion droplet size (Dh) to different extents under comparable conditions. Temperature insensitive microemulsions have been reported at the studied temperature range (298­353 K). 14-4-14/IP (1:2)-derived microemulsion showed a fractured surface at fixed ω = 15, where ω is the water and surfactant molar ratio, and temperature (298 K); whereas, large scale mesospheres comprising multiple closely winded nanoslices and spheroid morphology were formed in 14-4-14/IP and 14-4-14/Bu microemulsions, respectively, in the presence of 0.01 g % NaCMC, at comparable conditions. These systems revealed good antimicrobial activity toward the strains of Gram-positive Bacillus subtilis and Gram-negative Escherichia coli bacteria at 298 K, and inhibitory effect was governed by ω, type of cosurfactant, and bacterial strains.

Influence of temperature and organic solvents (isopropanol and 1,4-dioxane) on the micellization of cationic gemini surfactant (14-4-14).

The micellar properties of gemini surfactant, tetramethylene-1,4-bis(dimethyltetradecylammonium bromide) (14-4-14) in binary aqueous mixtures of isopropanol (IP) and 1,4-dioxane (DO) were investigated by tensiometric, conductometric and microcalorimetric methods in the temperature range of 298 to 323 K. The values of both critical micelle concentration (cmc) and degree of dissociation increase with increasing temperature and concentration of cosolvent. The energetics of micellization was determined from the temperature dependence of critical micelle concentration values. The standard Gibbs free energy of micellization (ΔG) was found to be negative and the negative value decreases with both temperature and concentration of cosolvent. The Gibbs free energy of micellization (ΔG) is mainly controlled by tail transfer free energy. The enthalpy of micellization obtained from direct calorimetry, Gibbs-Helmholtz equation and van't Hoff methods are presented and compared. Entropic contribution is found to be larger than the enthalpy and for all the systems, an enthalpy-entropy compensation phenomenon was obtained. Some interfacial parameters, e.g., Gibbs surface excess (Γmax), minimum area per surfactant molecule (Amin), surface pressure (Πcmc) were been calculated. The fluorimetric technique was used to understand the microenvironment of the solution under the influence of cosolvent. The micellar aggregation number of 14-4-14 in a binary mixed solvent was also determined from fluorimetry using pyrene as a probe. Two fluorophores, fluorescein and curcumin delivered the information of the peripheral region of the micellar interface and palisade region. The self-diffusion coefficients of the micellar media were evaluated using the cyclic voltammetry (CV) method. Such multi-technique investigation provides a new look into the role of solvation in micellization.