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1.
Artigo em Inglês | MEDLINE | ID: mdl-33378222

RESUMO

Acinetobacter spp. and Stenotrophomonas maltophilia are bacteria commonly associated with infections at the clinical settings. Reports of infections caused by environmental isolates are rare. Therefore, this study focused on determination of the antibiotic resistance patterns, antibiotic resistance genes, efflux pumps and virulence signatures of Acinetobacter spp. and S. maltophilia recovered from river water, plant rhizosphere and river sediment samples. The isolates were identified and confirmed using biochemical tests and PCR. The antimicrobial resistance profiles of the isolates were determined using Kirby Bauer disk diffusion assay and presence of antibiotic resistance and virulence genes were detected using PCR. S. maltophilia was more frequent in plant rhizosphere and sediment samples than the water samples. Acinetobacter spp. were mostly resistant to trimethoprim-sulfamethoxazole (96% of isolates), followed by polymyxin b (86%), cefixime (54%), colistin (42%), ampicillin (35%) and meropenem (19%). The S. maltophilia isolates displayed total resistance (100%) to trimethoprim- sulfamethoxazole, meropenem, imipenem, ampicillin and cefixime, while 80% of the isolates were resistant to ceftazidime. Acinetobacter spp. contained different antibiotic resistance genes such as sul1 (24% of isolates), sul2 (29%), blaOXA 23/51 (21%) and blaTEM (29%), while S. maltophilia harbored sul1 (8%) and blaTEM (20%). Additionally, efflux pump genes were present in all S. maltophilia isolates. The presence of multidrug resistant Acinetobacter spp. and Stenotrophomonas maltophilia in surface water raises concerns for community-acquired infections as this water is directly been used by the community for various purposes. Therefore, there is the need to institute measures aimed at reducing the risks of these infections and the resulting burden this may have on the health care system within the study area.


Assuntos
Acinetobacter/isolamento & purificação , Farmacorresistência Bacteriana Múltipla/efeitos dos fármacos , Água Doce/microbiologia , Genes Bacterianos , Infecções por Bactérias Gram-Negativas/microbiologia , Stenotrophomonas maltophilia/isolamento & purificação , Acinetobacter/efeitos dos fármacos , Acinetobacter/genética , Antibacterianos/farmacologia , Infecções Comunitárias Adquiridas/microbiologia , Farmacorresistência Bacteriana Múltipla/genética , Infecções por Bactérias Gram-Negativas/prevenção & controle , Humanos , Testes de Sensibilidade Microbiana , Risco , Stenotrophomonas maltophilia/efeitos dos fármacos , Stenotrophomonas maltophilia/genética , Combinação Trimetoprima e Sulfametoxazol/farmacologia
2.
BMC Infect Dis ; 20(1): 254, 2020 Mar 30.
Artigo em Inglês | MEDLINE | ID: mdl-32228480

RESUMO

BACKGROUND: To evaluate nasal carriage, antibiotic susceptibility and molecular characteristics of methicillin-resistant Staphylococcus aureus (MRSA), as well as the risk factors of MRSA colonization, in human immunodeficiency virus (HIV)-infected patients in northern Taiwan. METHODS: From September 2014 to November 2015, HIV-infected patients seeking outpatient care at four hospitals were eligible for this study. A nasal specimen was obtained from each subject for the detection of S. aureus and a questionnaire was completed by each subject. MRSA isolates once identified were characterized. RESULTS: Of 553 patients surveyed, methicillin-susceptible S. aureus (MSSA) was detected in 119 subjects (21.5%) and MRSA in 19 subjects (3.4%). Female gender, injection drug use, smoking, hepatitis C virus carrier, cancer and antibiotic use within 1 year were positively associated with MRSA colonization. By multivariate analysis, only cancer (adjust odds ratio (aOR) 7.78, [95% confidence interval (CI), 1.909-31.731]) and antibiotic use within 1 year (aOR 3.89, [95% CI, 1.219-12.433]) were significantly associated with MRSA colonization. Ten isolates were characterized as sequence type (ST) 59/staphylococcal chromosome cassette (SCC) IV or VT, endemic community strains in Taiwan, four isolates as ST 8/SCCmec IV (USA 300) and one isolate as ST 239/SCCmec IIIA, a hospital strain. All the community-associated MRSA isolates were susceptible to trimethoprim-sulfamethoxazole (TMP-SMX). CONCLUSIONS: Nasal MRSA carriage in HIV-infected patients seeking outpatient care was low (3.4%) in northern Taiwan. Most of the colonizing isolates were genetically endemic community strains and exhibited high susceptibility to TMP-SMX and fluoroquinolones. Cancer and antibiotic use within 1 year were associated with MRSA colonization.


Assuntos
Infecções por HIV/microbiologia , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Mucosa Nasal/microbiologia , Infecções Estafilocócicas/epidemiologia , Adulto , Antibacterianos/farmacologia , Feminino , Infecções por HIV/epidemiologia , Humanos , Masculino , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Infecções Estafilocócicas/microbiologia , Abuso de Substâncias por Via Intravenosa/complicações , Taiwan/epidemiologia , Combinação Trimetoprima e Sulfametoxazol/farmacologia
3.
Vet Microbiol ; 242: 108600, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32122605

RESUMO

Based on antimicrobial susceptibility testing (AST), correct classifications as susceptible, intermediate or resistant are challenging for some antimicrobial agent-bacterial species combinations. In this study, we investigated 19 equine Staphylococcus aureus isolates for their susceptibility to the combination sulfamethoxazole/trimethoprim (SXT) by using broth microdilution (BMD), agar disk diffusion (DD) and automated test systems. To elucidate the presence of the corresponding genetic resistance properties among the isolates, whole genome sequence analysis was performed and the genomes were screened for trimethoprim (TMP) resistance genes and mutations in the deduced FolP amino acid (aa) sequences, known to confer sulfonamide resistance. To check for hetero-resistance, zone diameters in DD were screened after 18 and 42 h of incubation. All 19 isolates harboured one of the TMP resistance genes dfrG or dfrS1. Three isolates had an aa exchange in their FolP aa sequence (F17L), which has previously been described to result in sulfonamide resistance. These isolates were classified as SXT-resistant by all methods. The remaining 16 isolates were classified as SXT-susceptible or -intermediate (BMD and/or DD) or SXT-resistant (mainly automated test systems). None of the isolates had relevant aa variations in their FolP aa sequences. All 19 isolates showed slight growth within their SXT inhibition zone by DD, pointing towards hetero-resistance. Overall, automated test systems classified isolates lacking genetic resistance determinants more frequently as SXT-resistant than DD and BMD. Therefore, further studies are needed to define a reliable method for SXT susceptibility testing.


Assuntos
Antibacterianos/farmacologia , Farmacorresistência Bacteriana/genética , Infecções Estafilocócicas/veterinária , Staphylococcus aureus/efeitos dos fármacos , Staphylococcus aureus/genética , Combinação Trimetoprima e Sulfametoxazol/farmacologia , Animais , Proteínas de Bactérias/genética , Cavalos/microbiologia , Testes de Sensibilidade Microbiana , Mutação , Infecções Estafilocócicas/microbiologia , Sequenciamento Completo do Genoma
4.
J Infect Public Health ; 13(5): 737-745, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32008927

RESUMO

INTRODUCTION: Increasing prevalence of antimicrobial resistance is a major concern especially in light of lack of new antimicrobial agents. Here, we present antibiotic resistance pattern of gram-negative bacteria (GNB) over six years (2013-2018) in a hospital in Saudi Arabia. MATERIALS AND METHODS: The study included a report of the cumulative antibiogram of GNB. Interpretation of the antibacterial susceptibility tests was based on the Clinical and Laboratory Standards Institute guidelines and VITEK® 2 system. RESULTS: There was a total of 32,890 GNB isolates and the most common were: Escherichia coli (69.8%), Klebsiella pneumoniae (17.2%) and Pseudomonas aeruginosa (12.8%). Antimicrobial susceptibility of P. aeruginosa and E. coli did not change overtime, however, susceptibility to ceftazidime decreased from 92% to 85% in P. aeuroginosa. Yearly antimicrobial susceptibility did not change significantly overtime for K. pneumoniae. ESBL isolates among K. peumoniae and E. coli was about 26% and 20%, respectively (p=0.0068). For ESBL E. coli, the least effective antibiotics were ciprofloxacin (26%) and trimethoprim-sulfamethoxazole (34%). For ESBL K. pneumoniae, gentamicin, ciprofloxacin, trimethoprim-sulfamethoxazole, and nitrofurantoin had poor activity. For K. pneumoniae, both ciprofloxacin (90%) and trimethoprim-sulfamethoxazole (86%) had better coverage than for E. coli. K. pneumoniae showed less susceptibility to nitrofurantoin than E. coli (20% vs. 92%). CONCLUSION: Antibiotic resistance among P. aeruginosa and E. coli did not change overtime (2013-2018) and the rate of ESBL-producing E. coli and K. pneumoniae was high. Thus, continued surveillance is needed.


Assuntos
Antibacterianos/farmacologia , Farmacorresistência Bacteriana/efeitos dos fármacos , Bactérias Gram-Negativas/efeitos dos fármacos , Hospitais/estatística & dados numéricos , Ceftazidima/farmacologia , Ciprofloxacino/farmacologia , Escherichia coli/efeitos dos fármacos , Humanos , Klebsiella pneumoniae/efeitos dos fármacos , Estudos Longitudinais , Testes de Sensibilidade Microbiana , Nitrofurantoína/farmacologia , Pseudomonas aeruginosa/efeitos dos fármacos , Arábia Saudita/epidemiologia , Fatores de Tempo , Combinação Trimetoprima e Sulfametoxazol/farmacologia
5.
J Hosp Infect ; 104(1): 46-52, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31505224

RESUMO

BACKGROUND: Levofloxacin has been considered as an alternative treatment for Stenotrophomonas maltophilia infection. However, levofloxacin-resistant S. maltophilia (LRSM) are emerging worldwide. AIM: To investigate LRSM risk factors in hospitalized patients and to determine antibiotic susceptibility patterns of LRSM isolates. METHODS: In a retrospective matched case-control-control study, LRSM patients (the case group) were compared with two control groups: levofloxacin-susceptible S. maltophilia (LSSM) patients (control group A) and non-S. maltophilia-infected patients (control group B). Conditional logistic regression was used to analyse risk factors for LRSM occurrence. Tigecycline, ceftazidime, colistin, and trimethoprim/sulfamethoxazole (TMP/SMX) susceptibilities in collected LRSM clinical isolates were determined. FINDINGS: A total of 105 LRSM, 105 LSSM, and 105 non-S. maltophilia-infected patients were analysed. The first multivariate analysis (cases vs group A) revealed that previous fluoroquinolones use was significantly associated with LRSM occurrence, and the second multivariate analysis (cases vs group B) revealed that previous fluoroquinolone use, previous intensive care unit stay, and the number of previous exposures to different classes of antibiotics were significantly associated with LRSM occurrence. Of all the LRSM isolates tested for antibiotic susceptibility, ceftazidime, TMP/SMX, tigecycline, and colistin resistance rates were 42.0, 99.0, 78.0, and 40.0%, respectively. CONCLUSION: LRSM antibiotic susceptibility patterns revealed multiple-drug resistance, which further limits treatment options for clinicians. To reduce LRSM occurrence, proper use of antibiotics, especially fluoroquinolones, is mandatory.


Assuntos
Antibacterianos/farmacologia , Farmacorresistência Bacteriana Múltipla/efeitos dos fármacos , Infecções por Bactérias Gram-Negativas/microbiologia , Levofloxacino/farmacologia , Stenotrophomonas maltophilia/isolamento & purificação , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Ceftazidima/farmacologia , Colistina/farmacologia , Feminino , Fluoroquinolonas/efeitos adversos , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Infecções por Bactérias Gram-Negativas/epidemiologia , Hospitalização/estatística & dados numéricos , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Testes de Sensibilidade Microbiana/métodos , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Stenotrophomonas maltophilia/efeitos dos fármacos , Taiwan/epidemiologia , Tigeciclina/farmacologia , Combinação Trimetoprima e Sulfametoxazol/farmacologia
6.
Curr Drug Metab ; 20(11): 898-906, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31702484

RESUMO

BACKGROUND: Cotrimoxazole (TMP-SMX) is concomitantly used as a primary prophylaxis of opportunistic infections with antiretroviral agents, such as Atazanavir (ATV). Results from an ex vivo study showed changes in intestinal absorption of ATV when rats were pretreated with TMP-SMX. The objective of this in vivo study is to determine the effect of TMP-SMX on the pharmacokinetics of ATV in rats. We also studied changes in gut microbiota induced by TMP-SMX. METHODS: We used the non-compartment analysis to compare the pharmacokinetics of ATV in a parallel group of rats treated with a low or therapeutic dose of TMP-SMX for nine days to untreated control rats. Gut microbiota was characterized using qPCR and High Throughput Sequencing of 16S rDNA. RESULTS: Rats treated with TMP-SMX showed a much broader exposure to ATV compared to the control group (AUC0-8h (ng.mL-1.h), 25975.9±4048.7 versus 2587.6±546.9, p=0.001). The main observation regarding the gut microbiota was a lower proportion of enterobacteria related to the administration of TMP-SMX. Moreover, the Total Gastrointestinal Transit Time (TGTT) was longer in the TMP-SMX treated group. CONCLUSION: Concomitant administration of TMP-SMX and ATV significantly increased ATV exposure in rats. This increase could be the result of a prolonged TGTT leading to an increase in the intestinal residence time of ATV favoring its absorption. Gut microbiota changes induced by TMP-SMX could be at the origin of this prolonged TGTT. If demonstrated in humans, this potential interaction could be accompanied by an increase in the adverse effects of ATV.


Assuntos
Antibacterianos/farmacologia , Sulfato de Atazanavir/farmacocinética , Microbioma Gastrointestinal , Inibidores da Protease de HIV/farmacocinética , Intestinos/microbiologia , Combinação Trimetoprima e Sulfametoxazol/farmacologia , Animais , Sulfato de Atazanavir/sangue , Inibidores da Protease de HIV/sangue , Humanos , Masculino , Ratos , Ratos Wistar
7.
BMC Microbiol ; 19(1): 244, 2019 11 06.
Artigo em Inglês | MEDLINE | ID: mdl-31694551

RESUMO

BACKGROUND: In light of rampant childhood diarrhoea, this study investigated bacterial pathogens from human and non-human sources in an urban informal settlement. Meat from informal abattoirs (n = 85), river water (n = 64), and diarrheic stool (n = 66) were collected between September 2015 and May 2016. A duplex real-time PCR, gel-based PCR, and CHROMagar™STEC were used to screen Tryptic Soy Broth (TSB) for diarrheic E. coli. Standard methods were used to screen for other selected food and waterborne bacterial pathogens. RESULTS: Pathogens isolated from stool, meat, and surface water included Salmonella enterica (6, 5, 0%), Plesiomonas shigelloides (9, 0, 17%), Aeromonas sobria (3, 3, 0%), Campylobacter jejuni (5, 5, 0%), Shigella flexneri (17, 5, 0%), Vibrio vulnificus (0, 0, 9%), and diarrheic E. coli (21, 3, 7%) respectively. All the isolates were resistant to trimethoprim-sulphamethoxazole. CONCLUSIONS: There was a high burden of drug resistant diarrheal pathogens in the stool, surface water and meat from informal slaughter. Integrated control measures are needed to ensure food safety and to prevent the spread of drug resistant pathogens in similar settings.


Assuntos
Bactérias/classificação , Infecções Bacterianas/epidemiologia , Diarreia/microbiologia , Fezes/microbiologia , Carne/microbiologia , Rios/microbiologia , Combinação Trimetoprima e Sulfametoxazol/farmacologia , Bactérias/efeitos dos fármacos , Bactérias/genética , Bactérias/isolamento & purificação , Infecções Bacterianas/tratamento farmacológico , Pré-Escolar , Diarreia/tratamento farmacológico , Diarreia/epidemiologia , Farmacorresistência Bacteriana Múltipla , Feminino , Microbiologia de Alimentos , Humanos , Lactente , Masculino , Vigilância da População , Prevalência , África do Sul/epidemiologia , Reforma Urbana
9.
Expert Rev Anti Infect Ther ; 17(10): 841-850, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31577912

RESUMO

Background: The drug supersaturation in the intestinal lumen for few hours could result in high bioavailability. The goal of this study was the development of a supersaturating drug delivery system containing sulfamethoxazole and trimethoprim at fixed dose combination (sulfamethoxazole:trimethoprim 5:1 w/w). Methods: The amorphous solid dispersions were formed at three different proportions containing 30, 50 and 70% of Eudragit EPO in the formulation. Results: The supersaturation state is formed by the amorphous drugs produced by spray drying technique, and the maintenance of this state is due to the chemical interactions between the drugs and the polymer selected, which was observed in the fluorescence interaction studies realized between the drugs and the polymer. The Formulation containing 70% of the polymer was able to produce and maintain the supersaturated state of both drugs for 24 h. Solid state characterization demonstrated the amorphization of the drugs in the solid dispersion and indicated the hydrogen bond formation responsible for the improvement in the apparent solubility. This formulation presented an improved antibacterial activity when compared to the combination of the drugs. Conclusion: For the first time, a supersaturating drug delivery system was developed to the complementary antibacterial drugs. This ternary formulation is a powerful alternative to improve oral absorption of recognized safety drugs, reducing the dose and consequently the antibiotic resistance emergence.


Assuntos
Antibacterianos/administração & dosagem , Sistemas de Liberação de Medicamentos , Combinação Trimetoprima e Sulfametoxazol/administração & dosagem , Administração Oral , Antibacterianos/química , Antibacterianos/farmacologia , Química Farmacêutica , Portadores de Fármacos/química , Combinação de Medicamentos , Humanos , Polímeros/química , Ácidos Polimetacrílicos/química , Solubilidade , Fatores de Tempo , Combinação Trimetoprima e Sulfametoxazol/química , Combinação Trimetoprima e Sulfametoxazol/farmacologia
10.
Clin Infect Dis ; 69(Suppl 2): S156-S163, 2019 09 05.
Artigo em Inglês | MEDLINE | ID: mdl-31505635

RESUMO

BACKGROUND: Bacterial meningitis is a major cause of mortality among children under 5 years of age. Senegal is part of World Health Organization-coordinated sentinel site surveillance for pediatric bacterial meningitis surveillance. We conducted this analysis to describe the epidemiology and etiology of bacterial meningitis among children less than 5 years in Senegal from 2010 and to 2016. METHODS: Children who met the inclusion criteria for suspected meningitis at the Centre Hospitalier National d'Enfants Albert Royer, Senegal, from 2010 to 2016 were included. Cerebrospinal fluid specimens were collected from suspected cases examined by routine bacteriology and molecular assays. Serotyping, antimicrobial susceptibility testing, and whole-genome sequencing were performed. RESULTS: A total of 1013 children were admitted with suspected meningitis during the surveillance period. Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus accounted for 66% (76/115), 25% (29/115), and 9% (10/115) of all confirmed cases, respectively. Most of the suspected cases (63%; 639/1013) and laboratory-confirmed (57%; 66/115) cases occurred during the first year of life. Pneumococcal meningitis case fatality rate was 6-fold higher than that of meningococcal meningitis (28% vs 5%). The predominant pneumococcal lineage causing meningitis was sequence type 618 (n = 7), commonly found among serotype 1 isolates. An ST 2174 lineage that included serotypes 19A and 23F was resistant to trimethoprim-sulfamethoxazole. CONCLUSIONS: There has been a decline in pneumococcal meningitis post-pneumococcal conjugate vaccine introduction in Senegal. However, disease caused by pathogens covered by vaccines in widespread use still persists. There is need for continued effective monitoring of vaccine-preventable meningitis.


Assuntos
Meningites Bacterianas/epidemiologia , Vacinas Pneumocócicas/administração & dosagem , Vigilância de Evento Sentinela , Pré-Escolar , Feminino , Haemophilus influenzae/classificação , Humanos , Lactente , Recém-Nascido , Masculino , Meningites Bacterianas/líquido cefalorraquidiano , Meningites Bacterianas/mortalidade , Neisseria meningitidis/classificação , Senegal/epidemiologia , Sorotipagem , Streptococcus pneumoniae/classificação , Combinação Trimetoprima e Sulfametoxazol/farmacologia , Vacinas Conjugadas/administração & dosagem , Sequenciamento Completo do Genoma
11.
Artigo em Inglês | MEDLINE | ID: mdl-31427295

RESUMO

We evaluated the activity of minocycline and comparator agents against a large number of Stenotrophomonas maltophilia (n = 1,289), Acinetobacter baumannii-Acinetobacter calcoaceticus species complex (n = 1,081), and Burkholderia cepacia complex (n = 101) isolates collected from 2014 to 2018 from 87 U.S. medical centers spanning all 9 census divisions. The isolates were collected primarily from hospitalized patients with pneumonia (1,632 isolates; 66.0% overall), skin and skin structure infections (354 isolates; 14.3% overall), bloodstream infections (266 isolates; 10.8% overall), urinary tract infections (126 isolates; 5.1% overall), intra-abdominal infections (61 isolates; 2.5% overall), and other infections (32 isolates; 1.3% overall). Against the A. baumannii-A. calcoaceticus species complex, colistin was the most active agent, exhibiting MIC50/90 values at ≤0.5/2 µg/ml and 92.4% susceptibility. Minocycline ranked second in activity, with MIC50/90 values at 0.25/8 µg/ml and susceptibility at 85.7%. Activity for these two agents was reduced against extensively drug-resistant and multidrug-resistant isolates of the Acinetobacter baumannii-Acinetobacter calcoaceticus species complex. Only two agents showed high levels of activity (susceptibility, >90%) against S. maltophilia, minocycline (MIC50/90, 0.5/2 µg/ml; 99.5% susceptible) and trimethoprim-sulfamethoxazole (MIC50/90, ≤0.5/1 µg/ml; 94.6% susceptible). Minocycline was active against 92.8% (MIC90, 4 µg/ml) of trimethoprim-sulfamethoxazole-resistant S. maltophilia isolates. Various agents exhibited susceptibility rates of nearly 90% against the B. cepacia complex isolates; these were trimethoprim-sulfamethoxazole (MIC50/90, ≤0.5/2 µg/ml; 93.1% susceptible), ceftazidime (MIC50/90, 2/8 µg/ml; 91.0% susceptible), meropenem (MIC50/90, 2/8 µg/ml; 89.1% susceptible), and minocycline (MIC50/90, 2/8 µg/ml; 88.1% susceptible). These results indicate that minocycline is among the most active agents for these three problematic potential pathogen groups when tested against U.S. isolates.


Assuntos
Acinetobacter baumannii/efeitos dos fármacos , Acinetobacter calcoaceticus/efeitos dos fármacos , Complexo Burkholderia cepacia/efeitos dos fármacos , Minociclina/farmacologia , Stenotrophomonas maltophilia/enzimologia , Infecções por Acinetobacter/tratamento farmacológico , Antibacterianos/farmacologia , Infecções por Burkholderia/tratamento farmacológico , Ceftazidima/farmacologia , Colistina/farmacologia , Farmacorresistência Bacteriana Múltipla/efeitos dos fármacos , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Humanos , Testes de Sensibilidade Microbiana/métodos , Combinação Trimetoprima e Sulfametoxazol/farmacologia
13.
Ann Pharmacother ; 53(11): 1153-1161, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31177803

RESUMO

Objective: To review the evidence for trimethoprim-sulfamethoxazole (TMP-SMX), clindamycin, doxycycline, and minocycline in the treatment of methicillin-resistant Staphylococcus aureus (MRSA) pneumonia. Data Source: MEDLINE, PubMed, EMBASE, Google, Google Scholar, Cochrane Central Register of Controlled Trials from 1946 to May 20, 2019. The search was performed with the keywords methicillin-resistant Staphylococcus aureus, MRSA, Staphylococcus aureus, pneumonia, trimethoprim, sulfamethoxazole drug combination, trimethoprim, sulfamethoxazole, TMP-SMX, co-trimoxazole, clindamycin, doxycycline, and minocycline. Data Extraction: Studies reporting the use of the above antibiotics for MRSA pneumonia treatment with clinical outcomes were included. Search parameters were limited to English language and human studies only. Data Synthesis: The search yielded 16 relevant articles: 6 TMP-SMX, 8 clindamycin, zero doxycycline, and 2 minocycline. For TMP-SMX, prospective randomized trials showed variable results; however, these studies were not specifically designed to assess MRSA pneumonia treatment. Retrospective studies with clindamycin suggested that it could be used as monotherapy or in combination with other anti-MRSA antibiotics. There was no evidence for doxycycline use, but 2 small retrospective reviews appeared to support minocycline as a treatment option. Relevance to Patient Care and Clinical Practice: These antibiotics are often used in clinical practice as potential treatment options for MRSA pneumonia. This article reviews the evidence for the clinical efficacy and safety of these agents. Conclusions: There are limited data to support use of TMP-SMX, clindamycin, doxycycline, or minocycline in MRSA pneumonia treatment. Randomized controlled trials are required to determine the effectiveness of these antibiotics. Clinicians should base their decision to use these agents on a case-by-case basis depending on clinical status and susceptibility results.


Assuntos
Clindamicina/uso terapêutico , Terapia Combinada/métodos , Doxiciclina/uso terapêutico , Minociclina/uso terapêutico , Pneumonia/tratamento farmacológico , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , Clindamicina/farmacologia , Doxiciclina/farmacologia , Humanos , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Minociclina/farmacologia , Estudos Retrospectivos , Combinação Trimetoprima e Sulfametoxazol/farmacologia
14.
Medicine (Baltimore) ; 98(24): e15942, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31192930

RESUMO

Emergent resistance to antibiotics among Streptococcus pneumoniae isolates is a severe problem worldwide. Antibiotic resistance profiles for S pneumoniae isolates identified from pediatric patients in mainland China remains to be established.The clinical features, antimicrobial resistance, and multidrug resistance patterns of S pneumoniae were retrospectively analyzed at 10 children's hospitals in mainland China in 2016.Among the collected 6132 S pneumoniae isolates, pneumococcal diseases mainly occurred in children younger than 5 years old (85.1%). The resistance rate of S pneumoniae to clindamycin, erythromycin, tetracycline, and trimethoprim/sulfamethoxazole was 95.8%, 95.2%, 93.6%, and 66.7%, respectively. The resistance rates of S pneumoniae to penicillin were 86.9% and 1.4% in non-meningitis and meningitis isolates, while the proportions of ceftriaxone resistance were 8.2% and 18.1%, respectively. Pneumococcal conjugate vaccine was administered to only 4.1% of patients. Penicillin and ceftriaxone resistance, underling diseases, antibiotic resistant risk factors, and poor prognosis appeared more frequently in invasive pneumococcal diseases. The incidence of multidrug resistance (MDR) was 46.1% in patients with invasive pneumococcal disease which was more than in patients with non-invasive pneumococcal disease (18.3%). Patients with invasive pneumococcal disease usually have several MDR coexistence.S pneumoniae isolates showed high resistance to common antibiotics in mainland China. Penicillin and ceftriaxone resistance rate of invasive streptococcal pneumonia patients were significantly higher than that of non-invasive S pneumoniae patients. Alarmingly, 46.1% of invasive clinical isolates were multidrug resistant, so it is important to continued monitor the resistance of S pneumoniae when protein conjugate vaccine (PCV13) is coming in mainland China.


Assuntos
Antibacterianos/farmacologia , Infecções Pneumocócicas/epidemiologia , Streptococcus pneumoniae/isolamento & purificação , Ceftriaxona/farmacologia , Criança , Pré-Escolar , China/epidemiologia , Farmacorresistência Bacteriana Múltipla , Eritromicina/farmacologia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Testes de Sensibilidade Microbiana , Penicilinas/farmacologia , Infecções Pneumocócicas/microbiologia , Estudos Retrospectivos , Streptococcus pneumoniae/efeitos dos fármacos , Combinação Trimetoprima e Sulfametoxazol/farmacologia
15.
J Med Microbiol ; 68(8): 1244-1252, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31184571

RESUMO

The high incidence of urinary tract infection (UTI) among women and children, in combination with a lack of antibiotic efficacy with regard to pathogen eradication and recurrence prevention, as well as the negative side effects associated with antibiotics, has led researchers to explore the role of non-steroidal anti-inflammatory drugs as a primary management strategy. The aim of this study was to determine whether ibuprofen (IBU) or one of its major metabolites, 2-carboxyibuprofen (CIBU), could affect the growth and adhesion of the two most common uropathogens, Escherichia coli and Enterococcus faecalis. The bacterial growth and adhesion to the urothelial cells of E. coli UTI89 and E. faecalis 1131 in the presence of physiologically relevant concentrations of IBU and CIBU were assessed. The effect of IBU on bacterial adhesion to urothelial cells was also assessed following exposure to trimethoprim/sulfamethoxazole (TMP/SMX) and nitrofurantoin. Bacterial growth was not affected by IBU. Further, only at high levels of IBU not regularly found in the bladder was there a significant increase in E. faecalis 1131 attachment at growth inhibitory concentrations of TMP/SMX. There was no effect on the attachment of E. faecalis or E. coli to urothelial cells in the presence of nitrofurantoin. These studies indicate that the beneficial effects of IBU for UTI management are likely mediated through its anti-inflammatory properties rather than direct interactions with uropathogens in the bladder.


Assuntos
Anti-Inflamatórios não Esteroides/farmacologia , Enterococcus faecalis/isolamento & purificação , Escherichia coli/isolamento & purificação , Ibuprofeno/farmacologia , Infecções Urinárias/microbiologia , Anti-Infecciosos Urinários/farmacologia , Bactérias/efeitos dos fármacos , Aderência Bacteriana/efeitos dos fármacos , Linhagem Celular , Enterococcus faecalis/efeitos dos fármacos , Enterococcus faecalis/crescimento & desenvolvimento , Enterococcus faecalis/fisiologia , Escherichia coli/efeitos dos fármacos , Escherichia coli/crescimento & desenvolvimento , Escherichia coli/fisiologia , Humanos , Ibuprofeno/análogos & derivados , Testes de Sensibilidade Microbiana , Viabilidade Microbiana/efeitos dos fármacos , Nitrofurantoína/farmacologia , Combinação Trimetoprima e Sulfametoxazol/farmacologia , Urotélio
16.
BMC Res Notes ; 12(1): 337, 2019 Jun 13.
Artigo em Inglês | MEDLINE | ID: mdl-31196155

RESUMO

OBJECTIVE: To assess the enteric bacteria, methicillin resistant S. aureus and antimicrobial susceptibility patterns from buses surfaces in Mekelle, Tigray, Ethiopia. RESULTS: A total of 300 swab samples were collected from the handle surfaces of the six city buses. The bacterial isolates revealed from the swab samples were E. coli, Enterobacter spp. and S. aureus. The overall positivity rates of E. coli, Enterobacter spp. and S. aureus were 8 (4%), 4 (1.3%) and 54 (18%) respectively. Methicillin resistant S. aureus was seen in 17 (5.7%) of the total 300 swab samples collected and 17 (31.5%) of the S. aureus isolates. All (100%) of the isolates of E. coli and Enterobacter spp. showed resistance for ampicillin and three-fourth of the isolates of E. coli and Enterobacter spp. displayed resistance for chloramphenicol (75%). Five antimicrobials (ampicillin, chloramphenicol, tetracycline, ciprofloxacin, and cotrimoxazole) have showed resistant for one isolate of E. coli. Likewise four antimicrobials (ampicillin, chloramphenicol, ciprofloxacin, and cotrimoxazole) have revealed resistant for one isolate of Enterobacter spp. Moreover, three isolates of S. aureus were also found resistance to four antibiotics.


Assuntos
Antibacterianos/farmacologia , Enterobacteriaceae/efeitos dos fármacos , Escherichia coli/efeitos dos fármacos , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Veículos Automotores , Ampicilina/farmacologia , Cloranfenicol/farmacologia , Ciprofloxacino/farmacologia , Farmacorresistência Bacteriana/efeitos dos fármacos , Enterobacteriaceae/isolamento & purificação , Escherichia coli/isolamento & purificação , Etiópia , Humanos , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Testes de Sensibilidade Microbiana , Tetraciclina/farmacologia , Combinação Trimetoprima e Sulfametoxazol/farmacologia
17.
J Med Microbiol ; 68(8): 1167-1172, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31199227

RESUMO

OBJECTIVES: Elizabethkingia meningoseptica is a multi-drug-resistant organism that is associated with high mortality and morbidity in newborn and immunocompromised patients. This study aimed to identify the best antimicrobial therapy for treating this infection. METHODS: A retrospective descriptive study was conducted from 2010 to 2017 in a tertiary paediatric hospital in Singapore. Paediatric patients aged 0 to 18 years old with a positive culture for E. meningoseptica from any sterile site were identified from the hospital laboratory database. The data collected included clinical characteristics, antimicrobial susceptibility and treatment, and clinical outcomes. RESULTS: Thirteen cases were identified in this study. Combination therapy with piperacillin/tazobactam and trimethoprim/sulfamethoxazole or a fluoroquinolone resulted in a cure rate of 81.8  %. The mortality rate was 15.4  % and neurological morbidity in patients with bacteraemia and meningitis remained high (75 %). CONCLUSIONS: Treatment with combination therapy of piperacillin/tazobactam and trimethoprim/sulfamethoxazole or a fluroquinolone was effective in this study, with low mortality rates being observed.


Assuntos
Antibacterianos/uso terapêutico , Infecções por Flavobacteriaceae/tratamento farmacológico , Fluoroquinolonas/uso terapêutico , Combinação Piperacilina e Tazobactam/uso terapêutico , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , Antibacterianos/farmacologia , Criança , Pré-Escolar , Feminino , Flavobacteriaceae/efeitos dos fármacos , Flavobacteriaceae/isolamento & purificação , Infecções por Flavobacteriaceae/epidemiologia , Infecções por Flavobacteriaceae/microbiologia , Fluoroquinolonas/farmacologia , Humanos , Lactente , Recém-Nascido , Masculino , Testes de Sensibilidade Microbiana , Combinação Piperacilina e Tazobactam/farmacologia , Estudos Retrospectivos , Fatores de Risco , Singapura/epidemiologia , Resultado do Tratamento , Combinação Trimetoprima e Sulfametoxazol/farmacologia
18.
Microb Pathog ; 135: 103611, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31247256

RESUMO

Class 1 integrons (Int1) contribute to antibiotic multiresistance in Gram-negative bacteria. Being frequently carried by conjugative plasmids, their spread would depend to some extent on their horizontal transfer to other bacteria. This was the main issue that was addressed in this work: the analysis of Int1 lateral transfer in the presence of different antibiotic pressures. Strains from a previously obtained collection of Escherichia coli K12 carrying natural Int1+ conjugative plasmids were employed as Int1 donors in conjugation experiments. Two recipient strains were used: an E. coli K12 and an uropathogenic E. coli isolate. The four antibiotics employed to select transconjugants in LB solid medium were ampicillin, trimethoprim, sulfamethoxazole, and co-trimoxazole. For this purpose, adequate final concentrations of the three last antibiotics had to be determined. Abundant transconjugants resulted from the mating experiments and appeared in most -but not all-selective plates. In those supplemented with sulfamethoxazole or co-trimoxazole, transconjugants grew or not depending on the genetic context of the recipient strain and on the type of gene conferring sulfonamide resistance (sul1 or sul2) carried by the Int1+ plasmid. The horizontal transfer of a recombinant plasmid bearing an Int1 was also assayed by transformation and these experiments provided further information on the viability of the Int1+ clones. Overall, results point to the existence of constraints for the lateral transfer of Int1 among E. coli bacteria, which are particularly evidenced under the antibiotic pressure of sulfamethoxazole or of its combined formula co-trimoxazole.


Assuntos
Farmacorresistência Bacteriana/genética , Escherichia coli K12/genética , Proteínas de Escherichia coli/genética , Transferência Genética Horizontal/genética , Integrons/genética , Sulfonamidas/farmacologia , Antibacterianos/farmacologia , Proteínas de Bactérias/genética , Proteínas de Transporte/genética , Conjugação Genética/efeitos dos fármacos , Combinação de Medicamentos , Farmacorresistência Bacteriana/efeitos dos fármacos , Escherichia coli K12/efeitos dos fármacos , Genes Bacterianos , Testes de Sensibilidade Microbiana , Viabilidade Microbiana/efeitos dos fármacos , Viabilidade Microbiana/genética , Plasmídeos/genética , Sulfametoxazol/farmacologia , Combinação Trimetoprima e Sulfametoxazol/farmacologia , Escherichia coli Uropatogênica/efeitos dos fármacos , Escherichia coli Uropatogênica/genética
19.
BMC Res Notes ; 12(1): 306, 2019 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-31142367

RESUMO

OBJECTIVE: The aim of this study was to investigate nasopharyngeal carriage rate and antibiotic susceptibility patterns of Streptococcus pneumoniae among school children. RESULTS: Three hundred eleven (43.8%) became culture positive for S. pneumoniae. The carriage rate among children, 3-5 years old was 62.5%, which was higher than the carriage rate of 38.6% among 6-13 years old children. Age ≤ 5 years and co-sleeping with siblings remained significantly associated with S. pneumoniae carriage. 155 (49.8%) of the isolates were resistant to co-trimoxazole, 152 (48.9%) of the isolates were resistant to tetracycline, and 88 (28.3%) of isolates were resistant to oxacillin. Multi drug resistant S. pneumoniae was observed in 90 (28.9%) of isolates. There is high prevalence of S. pneumoniae in primary school children in our study area. Relatively high carriage rate of resistance to oxacillin, tetracycline and co-trimoxazole were observed. These findings provide baseline data for future studies to further compare pneumococcal carriage rates and antibiotic resistance patterns.


Assuntos
Antibacterianos/farmacologia , Nasofaringe/microbiologia , Infecções Pneumocócicas/tratamento farmacológico , Streptococcus pneumoniae/efeitos dos fármacos , Adolescente , Animais , Portador Sadio/microbiologia , Criança , Pré-Escolar , Resistência Microbiana a Medicamentos/efeitos dos fármacos , Etiópia/epidemiologia , Feminino , Humanos , Masculino , Testes de Sensibilidade Microbiana , Infecções Pneumocócicas/epidemiologia , Infecções Pneumocócicas/microbiologia , Irmãos , Streptococcus pneumoniae/isolamento & purificação , Streptococcus pneumoniae/fisiologia , Tetraciclina/farmacologia , Combinação Trimetoprima e Sulfametoxazol/farmacologia , Vacinação
20.
BMC Infect Dis ; 19(1): 420, 2019 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-31088380

RESUMO

BACKGROUND: Urinary tract infection is an infection affecting infants and children. The aim of this study was to determine the etiology of urinary tract infection along with their antimicrobial resistance. METHODS: This cross-sectional study was conducted from June 2015 to January 2016 at Siddhi Memorial Hospital, Bhaktapur, Nepal. Urine samples were first cultured on cystine lactose electrolyte deficient agar and blood agar by semi-quantitative technique, and then incubated aerobically for 18-24 h at 37 °C. The identified bacterial isolates were tested for antimicrobial susceptibility by Kirby Bauer disc diffusion technique. RESULTS: Of 1599 urine samples, 12.3% samples showed significant bacterial growth. E. coli (58.7%) was the most common pathogen, followed by Klebsiella pneumoniae (22.5%). Most of the isolates were resistant to ampicillin and co-trimoxazole, while least were resistant to amikacin and nitrofurantoin. Higher multi-drug resistance (61.9%) was observed among isolates. CONCLUSIONS: E. coli and Klebsiella spp. were predominant cause of pediatric urinary tract infection in children. Higher susceptibility observed against aminoglycosides and nitrofurans make these drugs suitable in emergency.


Assuntos
Farmacorresistência Bacteriana , Infecções Urinárias/diagnóstico , Adolescente , Ampicilina/farmacologia , Ampicilina/uso terapêutico , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Criança , Pré-Escolar , Estudos Transversais , Farmacorresistência Bacteriana/efeitos dos fármacos , Escherichia coli/efeitos dos fármacos , Escherichia coli/isolamento & purificação , Feminino , Hospitais Pediátricos , Humanos , Lactente , Recém-Nascido , Klebsiella pneumoniae/efeitos dos fármacos , Klebsiella pneumoniae/isolamento & purificação , Masculino , Testes de Sensibilidade Microbiana , Nepal/epidemiologia , Combinação Trimetoprima e Sulfametoxazol/farmacologia , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , Infecções Urinárias/epidemiologia , Infecções Urinárias/microbiologia
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