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1.
Intern Med ; 60(24): 3857-3864, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34911872

RESUMO

Objective Ceftriaxone (CTRX) is a widely used antibiotic because of its long plasma half-life and good tissue transmission. Many of the reported studies on CTRX-associated pseudolithiasis were performed in children. Although some studies have been published in adults, there are no studies limited to elderly people. The present study investigated CTRX-associated pseudolithiasis and explored its risk factors in the elderly. Methods We retrospectively reviewed 133 elderly patients (≥65 years old) treated with CTRX. Pseudolithiasis was defined as stones or sludge newly appearing in the gallbladder, as detected by computed tomography after the administration of CTRX. We evaluated the risk factors for pseudolithiasis using multivariate regression and inverse probability of treatment weighting analyses. Results Among the 133 patients, 24 (18%) developed CTRX-associated pseudolithiasis. In a multivariate analysis, the CTRX dose [odds ratio (OR) 4.54, 95% confidence interval (CI) 1.36-15.07, p=0.012] and CTRX treatment duration (OR 2.80, 95% CI 1.06-8.04, p=0.043) were significantly associated with pseudolithiasis formation. The cut-off value of the total CTRX dose associated with pseudolithiasis formation was 19 g. A propensity analysis determined that the frequency of pseudolithiasis was increased in patients treated with >19 g total CTRX compared with those who received ≤19 g in total (OR 4.06, 95% CI 1.45-11.32, p=0.008). Conclusion The incidence rate of CTRX-induced pseudolithiasis is high in elderly people, and the CTRX dose and CTRX treatment duration are significant risk factors for pseudolithiasis. A total dose of >19 g increases the likelihood of pseudolithiasis formation in elderly people treated with CTRX.


Assuntos
Ceftriaxona , Colelitíase , Adulto , Idoso , Antibacterianos/efeitos adversos , Ceftriaxona/efeitos adversos , Criança , Humanos , Estudos Retrospectivos , Fatores de Risco
2.
Lakartidningen ; 1182021 11 02.
Artigo em Sueco | MEDLINE | ID: mdl-34730833

RESUMO

Neisseria gonorrhoeae causes the sexually transmitted infection gonorrhoea, which can result in serious complications, e.g. infertility and ectopic pregnancy. The incidence of gonorrhoea is high internationally and has dramatically increased in Sweden during the last 10 years. Gonorrhoea mostly manifests as urethritis, cervicitis, and/or extragenital infections (in pharynx, rectum and eye). Urogenital infections in women and particularly pharyngeal and rectal gonorrhoea are frequently asymptomatic. Nucleic acid amplification tests (NAATs) are recommended for diagnostics, but culture remains imperative for antimicrobial susceptibility testing. Antimicrobial resistance in N. gonorrhoeae is a major concern, which compromises management and control of gonorrhoea globally. Diagnosed gonorrhoea should always be treated and the recommended first-line treatment is an injection with a high dose of ceftriaxone. Test-of-cure is recommended for all cases approximately two weeks after treatment.


Assuntos
Gonorreia , Antibacterianos/uso terapêutico , Ceftriaxona/uso terapêutico , Feminino , Gonorreia/diagnóstico , Gonorreia/tratamento farmacológico , Gonorreia/epidemiologia , Humanos , Incidência , Suécia/epidemiologia
3.
Wiad Lek ; 74(9 cz 2): 2323-2336, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34824179

RESUMO

OBJECTIVE: The aim: In this work we developed a method of continuous recrystallization to meet industrial requirements. PATIENTS AND METHODS: Materials and methods: Continuous recrystallization method was investigated using porous ceramic filter for water purification with pour size less than 1 µm, that ensures high mixing rate of ethanol and water. RESULTS: Results and conclusions: The results of experiments using crystallization through ceramic filter, gives superior products in particle size, and produced needle shaped ceftriaxone crystals form, that showed significant improvement in dissolution time and obtained ceftriaxone sodium powder to be reconstituted in injectable formula that give clear solution without insoluble microparticles.


Assuntos
Ceftriaxona , Sódio , Cerâmica , Humanos , Solubilidade , Solventes
5.
Ann Intern Med ; 174(10): ITC145-ITC160, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34633834

RESUMO

Gonorrhea and chlamydia rates have risen to record-high levels in the United States over the past decade. Because these infections are often asymptomatic, effective clinical management relies on screening of asymptomatic patients, particularly women younger than 25 years and men who have sex with men. If undetected and untreated, gonorrhea and chlamydia can lead to infertility, ectopic pregnancy, and chronic pelvic pain and can facilitate HIV acquisition and transmission. Primary care providers need to be aware of recent changes in recommended treatments for both infections.


Assuntos
Infecções por Chlamydia/epidemiologia , Gonorreia/epidemiologia , Antibacterianos/uso terapêutico , Azitromicina/uso terapêutico , Ceftriaxona/uso terapêutico , Infecções por Chlamydia/diagnóstico , Infecções por Chlamydia/tratamento farmacológico , Doxiciclina/uso terapêutico , Feminino , Gentamicinas/uso terapêutico , Gonorreia/diagnóstico , Gonorreia/tratamento farmacológico , Humanos , Masculino
6.
Am J Case Rep ; 22: e933093, 2021 Oct 03.
Artigo em Inglês | MEDLINE | ID: mdl-34601486

RESUMO

BACKGROUND We present a case of Group B Streptococcus (Streptococcus agalactiae or GBS) meningitis in a non-pregnant woman that likely originated from acute otitis media. Although invasive Group B Streptococcal infections are increasing in the United States, GBS meningitis is still rare in non-pregnant adults. At the end, we discuss risk factors for this disease and data that suggest that invasive GBS infection is increasing in the adult and elderly populations of the United States. CASE REPORT Our patient was a 55-year-old woman with a history of juvenile rheumatoid arthritis who presented with altered mental status after failure of outpatient treatment of otitis media with oral doxycycline and steroids. Upon admission, she was initially afebrile and hemodynamically stable, but she had a rapid decline and required emergent intubation. Blood cultures grew GBS. CSF PCR analysis performed by BioFire® FilmArray® Meningitis/Encephalitis Panel revealed GBS. Middle-ear fluid and CSF cultures drawn after 1 day of antibiotic therapy did not grow any organisms. Treatment was achieved with high-dose intravenous ceftriaxone for 14 days, and tympanoplasty. At the end of 14 days of antibiotic therapy, the patient had full neurological recovery, without any residual neurological deficits. CONCLUSIONS GBS meningitis is classically associated with neonatal disease, but invasive GBS infection is fairly common in adults and appears to be increasing in incidence secondary to increasing populations living with diabetes, immunosuppressed conditions, and advanced age. Central nervous system infection with this organism is still rare. In this case report we describe a non-pregnant woman who presented with GBS meningitis.


Assuntos
Meningites Bacterianas , Otite Média , Infecções Estreptocócicas , Adulto , Idoso , Ceftriaxona , Feminino , Humanos , Recém-Nascido , Meningites Bacterianas/diagnóstico , Meningites Bacterianas/tratamento farmacológico , Pessoa de Meia-Idade , Otite Média/complicações , Infecções Estreptocócicas/complicações , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/tratamento farmacológico , Streptococcus agalactiae
8.
Zhonghua Yu Fang Yi Xue Za Zhi ; 55(2): 207-211, 2021 Feb 06.
Artigo em Chinês | MEDLINE | ID: mdl-34645181

RESUMO

Objective: To analyze the antimicrobial resistance characteristics of 538 Neisseria meningitidis isolated from 2005 to 2019 in China. Method: Total of 538 Neisseria meningitidis strains collected from 30 provinces in China from 2005 to 2019. Antimicrobial susceptibility test were performed based on the standards of clinical and laboratory standardization association (CLSI) including 11 recommended antibiotics. Gradient diffusion method was used to detect the antibiotic sensitivity of Neisseria meningitidis. Results: All 538 strains were sensitive to azithromycin, meropenem, chloramphenicol, rifampicin and ceftriaxone. As to other six antibiotics, the antibiotics sensitivity rates were cefotaxime (97.4%, 524 strains), ampicillin (87.7%, 472 strains), penicillin (84.8%, 456 strains), minocycline (95.2%, 512 strains), ciprofloxacin (24.9%, 134 strains) and trimethoprim/sulfamethoxazole (11.2%, 60 strains) respectively. Conclusions: Neisseria meningitidis isolated from 2005-2019 in China were all sensitive to azithromycin, meropenem, chloramphenicol, rifampicin and ceftriaxone. It should highlight Neisseria meningitidis resistant to cefotaxime, ampicillin and penicillin. Ciprofloxacin and sulfamethoxazole are not recommended as the priority choice for clinical treatment and prophylactic medication.


Assuntos
Anti-Infecciosos , Neisseria meningitidis , Antibacterianos/farmacologia , Ceftriaxona , Humanos , Testes de Sensibilidade Microbiana
9.
Int J Nanomedicine ; 16: 5937-5953, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34511899

RESUMO

Purpose: Development of new strategies for oral delivery of existing antibiotics administered exclusively through intravenous route is one of the global priorities of pharmaceutical research. The encapsulation of these active pharmaceutical agents within nanosized natural products offers several traits due to their tunable surface properties. Ceftriaxone (CTX) is an injectable, third-generation cephalosporin that suffers poor oral bioavailability. Methods: In the present study, ionic gelation of two biopolymers, namely chitosan (CH) and shellac (SH), was implemented to consolidate CTX, within elegant nanoparticles (NPs) for oral administration that would increase its bioavailability and sustainability. Quality by design approach (23 full factorial design) was adopted to optimize CTX-loaded nanoparticles. The optimized formula (F2) was characterized through transmission electron microscopy (TEM), Fourier transform infrared (FT-IR) spectroscopy and differential scanning calorimetry (DSC). In vitro release behavior and stability study were also evaluated. Pharmacokinetic studies of enteric-coated hard gelatin capsules (HGCs) loaded with F2-NPs were finally assessed. Results: The optimized spherical F2-NPs had a mean particle size of 258 nm, zeta potential of about +30.1 and appreciable drug entrapment efficiency of 83%. The in vitro drug release profile of F2-NPs in pH 7.4 experienced biphasic configuration with an initial burst release for an hour, followed by a sustained release over 15 h with Higuchi model and non-Fickian diffusion mechanism (R2=0.9852). High stability upon storage at refrigerated and room temperature for 3 months and good flow properties (θ= 32.2 and HR= 1.13) of the optimized formula were also conferred. In vivo pharmacokinetic assessment in rabbits fruitfully displayed 92% absolute bioavailability of CTX. Conclusion: The obtained results provide evidence for the potential combination of CH and SH in NPs preparation to enhance the oral bioavailability of CTX.


Assuntos
Quitosana , Nanopartículas , Administração Oral , Animais , Disponibilidade Biológica , Ceftriaxona , Portadores de Fármacos , Tamanho da Partícula , Coelhos , Espectroscopia de Infravermelho com Transformada de Fourier
10.
Clin Infect Dis ; 73(5): 808-815, 2021 09 07.
Artigo em Inglês | MEDLINE | ID: mdl-34492693

RESUMO

BACKGROUND: Since 2014, Neisseria gonorrhoeae azithromycin (AZM) susceptibility has declined in the United States, but high-level AZM resistance (HL-AZMR) has been infrequent and sporadic. We describe a cluster of 14 N. gonorrhoeae isolates with HL-AZMR identified in Indianapolis over 13 months. METHODS: N. gonorrhoeae culture specimens (genital and extragenital) were collected from attendees of the Bell Flower Clinic. Isolates underwent antimicrobial susceptibility testing (AST) using Etest. AZM minimum inhibitory concentrations ≥256 µg/mL were classified as HL-AZMR. Local disease intervention specialists interviewed patients whose isolates demonstrated HL-AZMR and conducted partner services. Relatedness of isolates was investigated by genomic analyses. RESULTS: During 2017-2018, AST was performed in 1016 N. gonorrhoeae isolates collected at the Bell Flower Clinic. Fourteen isolates (1.4%) from 12 men collected over 13 months demonstrated HL-AZMR; all were cephalosporin susceptible. Of the 12 men, 9 were white and reported male sex partners. Nine of the men were able to be retested; all were cured with 250-mg ceftriaxone plus 1-g AZM. Two men named each other as partners; no other partners in common were reported. Genomic analysis demonstrated close relatedness of the HL-AZMR isolates and a novel combination of a mosaic-mtrR promoter along with 23S ribosomal RNA mutations that appear to have emerged from circulating strains. CONCLUSIONS: The close genetic relatedness with limited epidemiologic linkages between patients highlights the challenges of gonorrhea partner investigations and suggests undetected local transmission. Local AST, rapid public health action, and epidemiologic investigations combined with genomic analysis provides a multipronged approach to understanding an outbreak of sexually transmitted disease.


Assuntos
Gonorreia , Neisseria gonorrhoeae , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Azitromicina/farmacologia , Ceftriaxona , Farmacorresistência Bacteriana , Gonorreia/tratamento farmacológico , Gonorreia/epidemiologia , Humanos , Indiana , Masculino , Testes de Sensibilidade Microbiana , Neisseria gonorrhoeae/genética
11.
Hosp Pediatr ; 11(10): e243-e248, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34551919

RESUMO

OBJECTIVES: Although ceftriaxone has been the first-line treatment of Lyme meningitis, the 2020 Infectious Disease Society of America, American College of Rheumatology, and American Academy of Neurology guideline recommends either doxycycline or ceftriaxone. Our objective was to explore recent trends in enteral antibiotic treatment of children with Lyme meningitis. METHODS: Using International Classification of Diseases, 10th Revision codes for case identification, we performed a multicenter retrospective study of patients ≤21 years of age presenting to a pediatric hospital contributing to the Pediatric Health Information System who were diagnosed with Lyme meningitis from 2015 to 2020. Our primary outcome was treatment with parenteral antibiotics, defined by either a procedure code for indwelling catheter placement or >7 days of inpatient parenteral Lyme disease-specific therapy. To examine trends over the study period, we used a generalized estimating equation, with parenteral antibiotics as the dependent variable and study year as the independent variable, adjusted for patient age, sex, race, ethnicity, and insurance status clustered by hospital. RESULTS: We identified 239 patients with Lyme meningitis treated at 24 participating centers. Overall, 48 (20.0%) were treated with parenteral antibiotics, with a declining rate over the study period (43.8% in 2015 to 8.9% in 2020). After adjustment, the odds of treatment with a parenteral antibiotic decreased over the study period (adjusted odds ratio 0.57; 95% confidence interval 0.41-0.80). CONCLUSIONS: Parenteral antibiotic treatment of children with Lyme meningitis has been on the decline in advance of the published clinical guideline. Carefully designed comparative effectiveness studies are needed to examine the effect of oral versus parenteral treatment regimens on clinical outcomes.


Assuntos
Doença de Lyme , Meningite , Antibacterianos/uso terapêutico , Ceftriaxona , Criança , Humanos , Doença de Lyme/diagnóstico , Doença de Lyme/tratamento farmacológico , Doença de Lyme/epidemiologia , Meningite/tratamento farmacológico , Estudos Retrospectivos , Resultado do Tratamento
12.
J Biol Chem ; 297(4): 101188, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34529975

RESUMO

Resistance to the extended-spectrum cephalosporin ceftriaxone in the pathogenic bacteria Neisseria gonorrhoeae is conferred by mutations in penicillin-binding protein 2 (PBP2), the lethal target of the antibiotic, but how these mutations exert their effect at the molecular level is unclear. Using solution NMR, X-ray crystallography, and isothermal titration calorimetry, we report that WT PBP2 exchanges dynamically between a low-affinity state with an extended ß3-ß4 loop conformation and a high-affinity state with an inward ß3-ß4 loop conformation. Histidine-514, which is located at the boundary of the ß4 strand, plays an important role during the exchange between these two conformational states. We also find that mutations present in PBP2 from H041, a ceftriaxone-resistant strain of N. gonorrhoeae, increase resistance to ceftriaxone by destabilizing the inward ß3-ß4 loop conformation or stabilizing the extended ß3-ß4 loop conformation to favor the low-affinity drug-binding state. These observations reveal a unique mechanism for ceftriaxone resistance, whereby mutations in PBP2 lower the proportion of target molecules in the high-affinity drug-binding state and thus reduce inhibition at lower drug concentrations.


Assuntos
Ceftriaxona/química , Farmacorresistência Bacteriana , Neisseria gonorrhoeae/enzimologia , D-Ala-D-Ala Carboxipeptidase Tipo Serina/química , Substituição de Aminoácidos , Sítios de Ligação , Mutação de Sentido Incorreto , Neisseria gonorrhoeae/genética , Estrutura Secundária de Proteína , D-Ala-D-Ala Carboxipeptidase Tipo Serina/genética , D-Ala-D-Ala Carboxipeptidase Tipo Serina/metabolismo
13.
J Med Case Rep ; 15(1): 458, 2021 Sep 17.
Artigo em Inglês | MEDLINE | ID: mdl-34530901

RESUMO

BACKGROUND: Authorities need to recognize that, while rare, gonorrhea can be transmitted nonsexually, and should not be presumed definitive evidence of abuse. We report the unusual case of a girl diagnosed with Neisseria gonorrhoeae after bathing in a heavily frequented hot pool at the edge of the crater lake Specchio di Venere ("Mirror of Venus") on Pantelleria Island, Italy. CASE PRESENTATION: Two days after bathing in the pool, this 11-year-old Austrian girl developed vulvovaginitis that partially settled with antifungal cream. Subsequent swabs cultured positive for Neisseria gonorrhoeae. Family members tested negative. The child adamantly denied any sexual contact, and no opportunities for sexual exposure could be identified. It was therefore concluded that she must have acquired the infection from pool water contaminated by gonococcus after a 2-day incubation period. The infection was successfully treated with ceftriaxone and azithromycin with no adverse effects. CONCLUSIONS: The pools are shallow, close to body temperature, isotonic, slightly acidic from CO2 bubbles, and contain organic particles, all potentially supporting survival of gonococcus. There are historical case reports in the literature of gonococcal epidemics in children's hospitals being traced to common baths. It is imperative that all cases of gonococcal infection in children are fully investigated, including examining all other relevant family members, to determine whether sexual assault has occurred. This is not a diagnosis to be missed. However, both sexual and nonsexual transmission are possible. A presumption that a gonococcal infection is diagnostic of sexual abuse can be dire, with children wrongfully removed from their parents' care, and their caregivers facing false charges of sexual crimes. Our case serves to illustrate that the very uncommon diagnosis of gonorrhea in a child may be the result of nonsexual transmission of the infection, and that contaminated hot pools are a very rare source of infection that should be considered.


Assuntos
Gonorreia , Neisseria gonorrhoeae , Antibacterianos/uso terapêutico , Azitromicina , Banhos , Ceftriaxona , Criança , Feminino , Gonorreia/diagnóstico , Gonorreia/tratamento farmacológico , Humanos
14.
BMC Infect Dis ; 21(1): 998, 2021 Sep 23.
Artigo em Inglês | MEDLINE | ID: mdl-34556028

RESUMO

BACKGROUND: Actinomyces odontolyticus is not commonly recognized as a causative microbe of liver abscess. The detection and identification of A. odontolyticus in laboratories and its recognition as a pathogen in clinical settings can be challenging. However, in the past decades, knowledge on the clinical relevance of A. odontolyticus is gradually increasing. A. odontolyticus is the dominant oropharyngeal flora observed during infancy [Li et al. in Biomed Res Int 2018:3820215, 2018]. Herein we report a case of severe infection caused by A. odontolyticus in an immunocompromised patient with disruption of the gastrointestinal (GI) mucosa. CASE PRESENTATION: We present a unique case of a patient with human immunodeficiency virus infection who was admitted due to liver abscess and was subsequently diagnosed as having coinfection of A. odontolyticus, Streptococcus constellatus, and Candida albicans during the hospital course. The empirical antibiotics metronidazole and ceftriaxone were replaced with the intravenous administration of fluconazole and ampicillin. However, the patient's condition deteriorated, and he died 3 weeks later. CONCLUSION: This report is one of the first to highlight GI tract perforation and its clinical relevance with A. odontolyticus infection. A. odontolyticus infection should be diagnosed early in high-risk patients, and increased attention should be paid to commensal flora infection in immunocompromised individuals.


Assuntos
Infecções por HIV , Abscesso Hepático , Actinomyces , Ampicilina , Ceftriaxona , Infecções por HIV/complicações , Humanos , Abscesso Hepático/diagnóstico , Masculino
15.
BMJ Case Rep ; 14(9)2021 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-34489258

RESUMO

A 62-year-old woman with a history of end-stage renal disease on haemodialysis, essential hypertension and type 2 diabetes mellitus was diagnosed with sepsis and placed on 600 mg oral linezolid every 12 hours and 1 g intravenous ceftriaxone every 24 hours. Blood cultures grew Streptococcus dysgalactiae, and she was switched to intravenous ceftriaxone 2 g daily. Platelet counts slowly trended down after starting ceftriaxone reaching 5 K/µL on day 12 of treatment. Ceftriaxone was discontinued and heparin-induced thrombocytopaenia was ruled out. She was switched to vancomycin and her platelet count improved. Given the temporal relationship between changing platelet counts and starting and discontinuing ceftriaxone, a diagnosis of drug-induced thrombocytopaenia was made.


Assuntos
Diabetes Mellitus Tipo 2 , Preparações Farmacêuticas , Trombocitopenia , Ceftriaxona/efeitos adversos , Diabetes Mellitus Tipo 2/tratamento farmacológico , Feminino , Humanos , Pessoa de Meia-Idade , Streptococcus , Trombocitopenia/induzido quimicamente
16.
BMJ Case Rep ; 14(9)2021 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-34588202

RESUMO

A 16-year-old man was hospitalised with a painful space-occupying lesion in his posterior neck involving muscles, soft tissues, C1 cervical vertebra and vital cervical blood vessels. The true-cut biopsy showed inflammatory tissue. The microbiological analysis, which combined classical bacteriological and molecular methods, yielded at least four different anaerobic species. The patient was treated successfully with a prolonged course of ceftriaxone and metronidazole.


Assuntos
Abscesso , Osteomielite , Abscesso/diagnóstico por imagem , Abscesso/tratamento farmacológico , Adolescente , Ceftriaxona , Vértebras Cervicais/diagnóstico por imagem , Humanos , Masculino , Pescoço , Osteomielite/diagnóstico por imagem , Osteomielite/tratamento farmacológico
17.
BMJ Case Rep ; 14(9)2021 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-34580131

RESUMO

We report one of the unusual presentations of disseminated gonococcal infection. This case report describes a 24-year-old woman who presented with disseminated gonococcal infection manifesting as meningitis. Cerebrospinal fluid (CSF) and throat swab PCR were positive for Neisseria gonorrhoeae Blood and CSF cultures were negative for bacterial growth. The patient was treated with a total of 14 days of intravenous ceftriaxone. She was discharged with no neurological sequelae.


Assuntos
Gonorreia , Meningite , Adulto , Antibacterianos/uso terapêutico , Ceftriaxona/uso terapêutico , Feminino , Gonorreia/complicações , Gonorreia/diagnóstico , Gonorreia/tratamento farmacológico , Humanos , Meningite/tratamento farmacológico , Neisseria gonorrhoeae , Reação em Cadeia da Polimerase , Adulto Jovem
18.
Appl Environ Microbiol ; 87(20): e0048821, 2021 09 28.
Artigo em Inglês | MEDLINE | ID: mdl-34347523

RESUMO

Multidrug-resistant (MDR) Escherichia coli strains that carry extended-spectrum ß-lactamases (ESBLs) or colistin resistance gene mcr-1 have been identified in the human gut at an increasing incidence worldwide. In this study, we isolated and characterized MDR Enterobacteriaceae from the gut microbiota of healthy Singaporeans and show that the detection rates for ESBL-producing and mcr-positive Enterobacteriaceae are 25.7% (28/109) and 7.3% (8/109), respectively. Whole-genome sequencing analysis of the 37 E. coli isolates assigned them into 25 sequence types and 6 different phylogroups, suggesting that the MDR E. coli gut colonizers are highly diverse. We then analyzed the genetic context of the resistance genes and found that composite transposons played important roles in the cotransfer of blaCTX-M-15/55 and qnrS1, as well as the acquisition of mcr-1. Furthermore, comparative genomic analysis showed that 12 of the 37 MDR E. coli isolates showed high similarity to ESBL-producing E. coli isolates from raw meat products in local markets. By analyzing the core genome single nucleotide polymorphisms (SNPs) shared by these isolates, we identified possible clonal transmission of an MDR E. coli clone between human and raw meat, as well as a group of highly similar IncI2 (Delta) plasmids that might be responsible for the dissemination of mcr-1 in a much wider geographic region. Together, these results suggest that antibiotic resistance may be transmitted between different environmental settings by the expansion of MDR E. coli clones, as well as by the dissemination of resistance plasmids. IMPORTANCE The human gut can harbor both antibiotic-resistant and virulent Escherichia coli which may subsequently cause infections. In this study, we found that multidrug-resistant (MDR) E. coli isolates from the gut of healthy Singaporeans carry a diverse range of antibiotic resistance mechanisms and virulence factor genes and are highly diverse. By comparing their genomes with the extended-spectrum ß-lactamase (ESBL)-producing E. coli isolates from raw meat products that were sampled at a similar time from local markets, we detected an MDR E. coli clone that was possibly transmitted between humans and raw meat products. Furthermore, we also found that a group of resistance plasmids might be responsible for the dissemination of colistin resistance gene mcr-1 in Singapore, Malaysia, and Europe. Our findings call for better countermeasures to block the transmission of antibiotic resistance.


Assuntos
Escherichia coli/isolamento & purificação , Microbioma Gastrointestinal , Antibacterianos/farmacologia , Ceftriaxona/farmacologia , Farmacorresistência Bacteriana Múltipla/genética , Escherichia coli/genética , Escherichia coli/metabolismo , Proteínas de Escherichia coli/genética , Fezes/microbiologia , Contaminação de Alimentos/análise , Humanos , Carne/microbiologia , Filogenia , Polimorfismo de Nucleotídeo Único , Singapura , Sequenciamento Completo do Genoma , beta-Lactamases/metabolismo
20.
Pan Afr Med J ; 38: 358, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34367437

RESUMO

Gonorrhea is all diseases caused by Neisseria gonorrhoeae. Prepubertal child is more susceptible to N. gonorrhoeae infection because the vagina is alkaline and contains no estrogen. Gonorrhea vaginitis is the most common form of gonorrhoea in prepubertal children beyond neonatal period. Transmission in child can be through sexual contact (abuse) or non-sexual contact. Gonorrhea vaginitis in children more often asymptomatic, with clinical manifestation such as mucopurulent discharge, vaginal pruritus and vulval erythema. Supporting examination comprise of gram staining from vaginal discharge, culture and nucleic acid amplification testing (NAAT). Ceftriaxone is drug of choice gonorrhea without complication in children. We report a case of 4 year and 9-month female girl that was diagnosed by history taking and supporting examination from gram staining and polymerase chain reaction (PCR) from vaginal discharge, and then treated with single dose ceftriaxone 125 mg intramuscular that gave clinical improvement.


Assuntos
Antibacterianos/administração & dosagem , Gonorreia/diagnóstico , Neisseria gonorrhoeae/isolamento & purificação , Vaginose Bacteriana/diagnóstico , Ceftriaxona/administração & dosagem , Pré-Escolar , Feminino , Gonorreia/tratamento farmacológico , Humanos , Reação em Cadeia da Polimerase , Vaginose Bacteriana/tratamento farmacológico , Vaginose Bacteriana/microbiologia
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