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An international collaborative survey of susceptibility in community-acquired lower respiratory tract infection pathogens collected > 6000 strains from six countries during 1992 and 1993. The four major pathogens were Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis and Staphylococcus aureus. MICs of 15 antibiotics were determined and sensitivity interpretations applied using breakpoints based on those of the NCCLS. This analysis highlighted some anomalies, notably for beta-lactams against S. pneumoniae and macrolides against H. influenzae, where apparent sensitivity proportions did not accord with the distribution of MICs. Further analyses were undertaken in order to rank the antibiotics in order of potential usefulness for empirical treatment of LRTI: these included in-vitro potency (mode MIC and MIC90) and a pharmacodynamic comparison, using the ratio Cmax (free drug): MIC90. According to study breakpoints, the most active agents overall were, for S. pneumoniae, cefuroxime, clarithromycin, ofloxacin and chloramphenicol; for H. influenzae, azithromycin, amoxycillin/ clavulanate, cefixime, ceftriaxone, quinolones and doxycycline. However, other analyses suggested that the most active agents overall were, for S. pneumoniae, amoxycillin (+/- clavulanate) and ceftriaxone, and, for H. influenzae, quinolones, ceftriaxone, cefixime and amoxycillin/clavulanate. Overall, the antimicrobial agents with the greatest potential usefulness for empirical treatment were amoxycillin/ clavulanate, ceftriaxone, cefuroxime, ofloxacin and co-trimoxazole. The choice of empirical therapy depends upon local epidemiology and clinician choice, but the Project data may be of value in the decision-making process.
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S. typhi was isolated from 82 patients (44 in the cefixime group, 38 in the ofloxacin group) and 70 (85%) of the isolates were multidrug-resistant. Median (95% confidence interval, range) fever clearance times were 4.4 (4 to 5.2, 0.2 to 9.9) days for ofloxacin recipients and 8.5 (4.2 to 9, 1.8 to 15.2) days for cefixime-treated patients (P < 0.0001). There were 11 treatment failures (10 acute and one relapse) in the cefixime group and 1 acute treatment failure in the ofloxacin group (mean difference, 22%; 95% confidence interval, 9 to 36%).
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Between April 1, 2002, and March 31, 2003, a prospective cohort of patients 3 months to 5 years of age who were examined in the emergency department (ED) and diagnosed as having presumed febrile UTI were treated according to a clinical protocol. Patients were treated at the DTC unless they met exclusion criteria, in which case they were hospitalized. The DTC was open 7 days per week, including holidays, from 8:30 am to 4:30 pm. At the DTC, patients were initially treated with a daily dose of IV gentamicin, until the child had been afebrile for at least 24 hours, and with oral amoxicillin, until preliminary urine culture results were available. Children allergic to penicillin received gentamicin only. IV antibiotics were administered through peripheral IV access; the IV catheter's patency was maintained with injection of 50 U of heparin once daily throughout the treatment period. Parental satisfaction with the DTC experience was assessed with an anonymous, self-administered questionnaire.
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A series of new 7 beta-[(Z)-2-(2-aminothiazol-4-yl)-2-(carboxymethoxyimino)ace tamido] cephalosporins (1) having various substituted-vinylthio groups at the C-3 position of the cephen nucleus was synthesized and evaluated for antibacterial activity and oral absorption in rats in comparison with cefixime. Of these, the cephalosporins (1a and 1c) with a lower alkoxycarbonylvinylthio group (Z-form) at the C-3 position showed a potent antibacterial activity against Gram-negative bacteria, improved activity against Staphylococcus aureus as well as good oral absorption in rats. The structure-activity relationships of 1 are also presented.
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The antimicrobial susceptibility was studied by disk-diffusion and E-test. The genotyping was performed by NG-MAST method.
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Overall, 855 (41%) patients had either S. Typhi (n=581,28%) or S. Paratyphi A (n=274,13%) cultured from blood; 1,237 (59%) were culture negative. There were 139 (6.6%) treatment failures with one death. Except for the last trial with ceftriaxone, the fluoroquinolone gatifloxacin was associated with equivalent or better fever clearance times and lower treatment failure rates in comparison to all other antimicrobials. However, we additionally found the minimum inhibitory concentrations (MIC) against fluoroquinolones have risen significantly since 2005 and were associated with increasing fever clearance times. Notably, all organisms were susceptible to ceftriaxone throughout the study period (2005-2014) and the MICs against azithromycin declined, confirming the utility of these alternative drugs for enteric fever treatment.
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Susceptibility data for urogenital isolates from 56 women, 252 MSW, and 170 MSM were studied. The adjusted geometric mean ceftriaxone MIC was similar among women (0.0067 μg/mL; 95% confidence interval [CI], 0.0049-0.0092 μg/mL) and MSW (0.0060 μg/mL; 95% CI, 0.0053-0.0066 μg/mL). In contrast, the adjusted geometric mean ceftriaxone MIC was higher among MSM (0.0098 μg/mL; 95% CI, 0.0082-0.0119 μg/mL) than among MSW. This same pattern was observed for other antimicrobials, including cefixime and azithromycin
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This observational study was conducted at Dr. Essa's Laboratory over a period of 12 months ending in March 2012. Two hundred samples taken from conjunctiva of patients with conjunctivitis were cultured on routine medium and the antibiograms of bacterial isolates were determined by Kirby- Bauer disc diffusion method.
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STI services should be expanded further to health centers not currently offering STI care. Overtreatment for cervicitis in both SWs at reattendance and low-risk women with vaginal discharge are continuing problems. The WHO/UNAIDS STI service indicator criteria had limited application for the assessment of SW services but were adapted for local needs. Attendance of SWs in designated STI clinics appears to be a useful indicator for the acceptability and efficiency of the current national STI program.
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Streptococcus pneumoniae was recovered from 12 (50%) samples of middle ear fluid of 24 consecutive patients with AOME and in mixed culture of middle ear pathogens from one (4%) additional specimen. Two (15.3%) isolates had intermediate resistance to penicillin (minimal inhibitory concentration (MIC) 0.125 and 1.0 micrograms/mL). The antimicrobial susceptibility to various antimicrobials of 30 S pneumoniae strains recovered from patients seen in the last 12 months was also determined. One of the patients with AOME developed bacteremia that resolved uneventfully, whereas the other developed meningitis. MIC90 was determined from penicillin (2 micrograms/mL), erythromycin (> 32 micrograms/mL), cefaclor (32 micrograms/mL), loracarbef (> or = 64 micrograms/mL), cefixime (16 micrograms/mL), ceftibuten (> 64 micrograms/mL), chloramphenicol (16 micrograms/mL), cefpodoxime (4 micrograms/mL), ciprofloxacin (2 micrograms/mL), cephalexin (> or = micrograms/mL), augmentin (2 micrograms/mL), cefprozil (8 micrograms/mL), clindamycin (64 micrograms/mL), TMP-SXT (> 64 micrograms/mL), clarithromycin (32 micrograms/mL), rifampin (0.06 micrograms/mL), cefuroxime (2 micrograms/mL), cefotaxime (0.25 micrograms/mL), vancomycin (0.25 micrograms/mL), and imipenem (0.5 micrograms/mL). Cefprozil, vancomycin, and rifampin inhibited all strains, whereas cefpodoxime, cefuroxime, clindamycin, and clarithromycin exhibited very good activity.
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Respiratory infections with penicillin resistant pneumococci constitute an increasing health care problem. This paper describes the nosocomial spread of penicillin resistant pneumococci (PRP) on a pulmonary ward. During an eight-month period, minimal inhibitory concentrations (MICs) for penicillin and several other antibiotics were performed on all Streptococcus pneumoniae isolates that were shown to be penicillin resistant by a screening assay. The personal data and case history of all patients with penicillin resistant pneumococci were evaluated. Penicillin Resistant Pneumococci were cultured from 18 patients, 16 men (mean age 74 +/- 8 yrs) and 2 women (aged 54 and 60 yrs). Chronic obstructive pulmonary disease was diagnosed in 16 patients, 10 of which had an additional underlying disease (2 diabetes mellitus, 2 heart failure, 2 malignancy). Prior to culture of Penicillin Resistant Pneumococci, 11 out of 18 patients were treated with antibiotics, a beta-lactam in most instances. Ten out of 18 patients died during or shortly after hospitalization. The death of one patient seems to be directly related to infection with Penicillin Resistant Pneumococci. The five Penicillin Resistant Pneumococci isolates available for serotyping were all type 9. The minimal inhibitory concentrations for penicillin varied from 0.5 to 2.0 mg.l-1. High minimal inhibitory concentrations were also noted for cefixime (all over 4.0 mg.l-1) and ceftriaxone (0.5-1.0 mg.l-1). It is concluded that penicillin resistant pneumococci can spread rapidly among old and debilitated patients. Thus, patients with this infection should be barrier nursed.
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An HPLC method for the separation of seven cephalosporins [Cefepime (CEP), ceftazidime (CTA), ceftizaxime (CTI), ceftriaxone (CTR), cefotaxime (COT), cefixime (CIX) and cefoperazone (COP)] in human plasma and amniotic fluid has been developed. Optimization of the chromatographic method was performed in three steps: a series of initial experiments followed by two sets of experiments based on different experimental designs. The initial experiments were performed to decide the basic analytical requirements of the method. Then screening experiment fractional factorial design was used in order to decrease the number of parameters by eliminating parameters which having insignificant effect on responses. The parameters having significant effect were further optimized through a full factorial design. Having studied two responses (retention times and resolutions), a desirability function that assess the responses together, was used to find experimental conditions where the system generated desirable results. The desirable results were obtained with XTerra C18 (250 mm x 4.6mm, 5 microm i.d.) column, 40 mM phosphate buffer, pH 3.2, 18% MeOH, 0.85 mL min(-1) flow rate and 32 degrees C column temperature. Gradient elution with MeOH was applied. A simple and efficient solid-phase extraction was applied for the preparation of plasma and amniotic fluid samples. The validation parameters of the method were evaluated in accordance with ICH guideline. The method validated was applied to the analysis of CEP and COP in maternal venous, fetal venous and fetal arterial plasma, and to the analysis of CIX in maternal venous plasma and amniotic fluid.
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The aim of this retrospective study was to analyze the use of antibiotics in pediatrics in the Canary Islands during the period 2001-2005. We used the defined daily dose (DDD) as a technical unit of measurement as well as the DDD/1000 habitants/day (DHD), following the ATC classification system. The demographic data were obtained from individual patient health cards assigned to the primary care pediatricians. During the period 2001-2005, the total number of prescriptions for antibiotics in pediatrics was 1,207,726 at a cost of 6,119,679 Euros to the Canarian Health Service in Tenerife and 4,808,654 Euros in Las Palmas. The annual number of DHD in the Canary Islands decreased from 103,044 in 2001 to 68,168 in 2005. The cost for 1000 inhabitants/day (CHD) was 27,686 Euros and 19,183 Euros in Tenerife and Las Palmas, respectively. In analyzing the therapeutic classes of antibiotics, we found that the consumption of broad-spectrum penicillins (amoxicillin) in Tenerife decreased, while in Las Palmas it remained stable. There was also a significant decrease in the use of tetracyclines in both provinces. The DHD of beta-lactamase inhibitors was more significantly reduced in Tenerife than in LPA. The consumption of cephalosporins, mainly cefixime, was high in Tenerife, while in Las Palmas the second-generation cephalosporins (cefuroxime and cefaclor) were widely consumed. The use of macrolide antibiotics gradually decreased. Interestingly, there were 7,939 prescriptions for fluoroquinolones (mainly ciprofloxacin) in Tenerife and 4,846 in Las Palmas (mainly norfloxacin and ciprofloxacin). There were differences in the prescribing practices between Tenerife and Gran Canaria that don't coincide with changes in the microbiological spectrum. Prescribing practices in Las Palmas are based on scientific data, probably because of the continuing education courses on antibiotherapy that began in 2003.
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The uptake of two orally active beta-lactam antibiotics of different chemical structure, the zwitterionic alpha-aminocephalosporin cephalexin and the dianionic carboxymethoxyimino-cephalosporin cefixime, by brush border membrane vesicles obtained from rabbit small intestine and their molecular interaction with the H+/oligopeptide transport system were investigated. The uptake of both compounds was stimulated by an inwardly directed H(+)-gradient with a profound pH-maximum for cephalexin at pH 6outside and pH 7.4inside whereas cefixime uptake was maximal below pH 5outside. Modification of histidyl residues of membrane proteins led to a complete loss of pH dependence of transport of both cephalosporins. The uptake of cephalexin was competitively inhibited by cefixime and dipeptides and vice versa that of cefixime by cephalexin and dipeptides. The uptake of cefixime was trans-stimulated by cephalexin and glycyl-L-proline whereas cephalexin uptake could only be trans-stimulated by glycyl-L-proline, not by cefixime. Photoaffinity labeling with [3H]benzylpenicillin as a direct photoaffinity probe of the H+/oligopeptide transport system demonstrated a direct molecular interaction of both cephalexin and cefixime with this transporter in the pH range of 5-8. Thermal pretreatment of membrane vesicles inhibited the cephalexin transport system temperature-dependently, whereas cefixime uptake was not inhibited, but stimulated. Taken together we conclude that dianionic cephalosporins like cefixime bind to the transport system shared by oligopeptides and alpha-amino-beta-lactam antibiotics. Their transport across the enterocyte brush border membrane, however, may occur to a significant extent by a different transport system.
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To investigate whether multiple peptide transporters mediate absorption of beta-lactams carrying different charges at physiological pH, we used the human intestinal cell line Caco-2 and Xenopus laevis oocytes expressing the cloned rabbit intestinal peptide transporter PepT1. Characteristics of transport of the anionic cefixime and the zwitterionic cefadroxil were assessed by 1) flux studies using radiolabeled compounds, by 2) measuring changes in pHin in cells and oocytes as a consequence of substrate-mediated proton influx and 3) by applying the two-electrode voltage clamp technique to assess the electrophysiological phenomena associated with beta-lactam transport in oocytes expressing PepT1. Both beta-lactams were rapidly taken up into Caco-2 cells and oocytes expressing PepT1 by a pH-dependent and saturable transport pathway. Mutual inhibition suggested that acidic and zwitterionic compounds may share a common transporter. Cefixime and cefadroxil caused a significant decline in intracellular pH as a consequence of proton coupled substrate influx. Uptake of cefixime and cefadroxil via PepT1 expressed in oocytes was electrogenic indicating that transport of both beta-lactams is associated with movement of net positive charge. The more acidic pH required for rheogenic cefixime uptake in both cell systems, when compared to cefadroxil uptake in both cell systems, when compared to cefadroxil uptake, and the concomitant faster intracellular acidification indicates that cefixime most likely is taken up only in its nonionized form with an additional proton being cotransported. This is supported by the observation that cefixime uptake at different pH correlated significantly with the percentage of the nonionized species being present. From our studies we conclude that a single peptide transport system can mediate electrogenic uptake of the neutral form of beta-lactam antibiotics into intestinal epithelial cells.
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The synthesis, antibacterial activity and oral absorption of novel cephalosporins (3a-3d) having a 2-propenyl group at the C-3 position are described. Diphenylmethyl 7-amino-3-(2-propenyl)-3-cephem-4-carboxylate HCl (4) prepared from 7-aminocephalosporanic acid in 12 steps was acylated with various acid moieties to give cephems 3a-3d. The cephems 3a-3c showed similar antibacterial activities as cefixime. However, these cephems were not well absorbed orally.
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These results can be used for further studies on EHEC O157 as an emerging foodborne pathogen and its role in human infection in Libya.
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28 myelomeningocele patients (aged 2-30 years) with clinical symptoms of acute UTI participated in this open uncontrolled clinical trial at the Orthopedic University Hospital of Heidelberg (Dir.: Prof. Dr. H. Cotta). 4 patients were treated with 200 mg cefixime tablets bid, 24 patients received 4 mg/kg body weight cefixime suspension bid, according to age and weight of the patients. The duration of treatment was 6-10 days. Clinical and microbiological examinations were carried out before therapy as well as 1 day and 5 to 9 days after the end of treatment. The data of 25 patients could be evaluated for bacteriological and clinical efficacy. 5-9 days after treatment in 22 patients (88%) complete recovery was stated. In 3 patients a reinfection occurred. In 24 patients (96%) the baseline pathogens were eliminated under cefixime therapy. 5-9 days after the end of treatment in 3 patients reinfection was observed. Clinical side effects could be detected in 1 patient (vomiting). These results indicate that the oral cephalosporin cefixime is efficient and well tolerated in complicated UTI of myelomeningocele patients.
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Antibiotic therapy for Neisseria gonorrhoeae infections has evolved owing to the development of resistance to penicillin and tetracycline therapy. A variety of antimicrobials, including the fluoroquinolones, have been proposed as useful alternatives.
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An appropriate knowledge of antibacterial susceptibility of microorganisms would contribute to a rational antibiotic use and the success of treatment for chronic supportive otitis media.
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In this cross-sectional study, 100 strains of E. coli were isolated from patients with Urinary tract infection. After diagnosis of bacteria, genomes were extracted. Then, presence of integron class 1 was evaluated by using PCR. Antibiotic susceptibility testing method, the micro dilution broth was performed according to the standard CLSI2010. Data were analyzed using SPSS16 software.
The in-vitro activity of cefixime was studied with clinical isolates and compared with that of other agents. Cefixime exhibited good activity against the Enterobacteriaceae, Haemophilus influenzae, and Neisseria gonorrhoeae, including beta-lactamase producing strains. Activity was also high against Streptococcus pneumoniae and group A and group B beta-haemolytic streptococci. Staphylococcus aureus, faecal streptococci, anaerobic bacteria and Pseudomonas aeruginosa were not susceptible. Activity against susceptible isolates was comparable to cefotaxime and was normally superior to cefuroxime, cephalexin and amoxycillin. The pharmacokinetics of cefixime were studied in six healthy male volunteers, each receiving a 400 mg oral dose following an overnight fast. Tissue penetration of the antibiotic was estimated with a cantharides-induced blister method. The mean serum elimination half-life was 3.8 h, the mean peak concentration was 3.7 mg/l. Penetration into tissue fluid was rather slow [Tmax 6.7 h) but percentage penetration was high (132.6%). Urinary excretion was low with a 24 h recovery rate of less than 20%, though the concentrations achieved in urine exceeded the MICs of most common urinary tract pathogens for up to 24 h post-dose.
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Both isolates were resistant to cefixime, ciprofloxacin, penicillin and tetracycline and intermediate/resistant to azithromycin, but susceptible to ceftriaxone, gentamicin and spectinomycin. Both isolates had the type XXXIV penA mosaic allele in addition to previously described resistance mutations in the mtrR promoter (A deletion), porB1b (penB) (G101K and A102N) and ponA1 (L421P). Both isolates had an identical NG-MAST sequence type (ST4822) and MLST sequence type (ST1901).
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Radiographic and clinical healing occurred more successfully following 3Mixtatin treatment compared to treatment with MTA, it may lead to a paradigm shift in the pulpal treatment of primary teeth in the future.
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The in vitro effects of cefixime and cefdinir (CI 983), two so-called third-generation oral cephalosporin derivatives, on human polymorphonuclear and mononuclear phagocyte functions (random migration and chemotaxis, specific and nonspecific phagocytosis, nitroblue tetrazolium reduction, superoxide production, microbicidal activity) were studied. Neither antibiotic, in the range of its attainable therapeutic concentration, exhibited any toxic effect on random migration, chemotaxis, metabolic activation and microbicidal mechanisms of phagocytic cells. Cefixime did not interfere in phagocytosis while cefdinir enhanced both phagocytosis frequency and index. The modulating effect on phagocytosis exerted by cefdinir was achieved at very low antibiotic concentrations (0.06 mg/l for polymorphonuclear leukocytes and 0.03 mg/l for monocytes) when non-opsonized zymosan particles were used as phagocytic challenge. Moreover, the effect was demonstrated both in the presence of cefdinir and after pretreatment of cells with the antibiotic and its removal by washings. As for specific phagocytosis, parameters were slightly increased by cefdinir but only the phagocytosis index was significantly improved in the presence of 2 mg/l of antibiotic.
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This study concluded that in cases in which several antibiotics may be clinically effective, comparative tolerability and patient acceptance data should be considered for selection of appropriate therapy. High compliance and lower morbidity can result in lower costs and better quality of life.
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Urinary tract infection is the second most common clinical indication for empirical antibiotic treatment in primary and secondary health care settings. The incidence of diabetes mellitus throughout the world is increasing strikingly and in the long run, it has some major effects on the genitourinary system which makes diabetic patients more liable to urinary tract infection. This study is designed to reveal the distribution of uropathogens in diabetic patients according to age and sex, and corresponding resistance patterns.
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In 2014, participants were recruited from sexually transmitted infection clinics and through outreach in Jakarta, Yogyakarta, and Denpasar. Neisseria gonorrhoeae detection in genital specimens was performed with NG-qPCR at the Public Health Service in Amsterdam. Antimicrobial susceptibility was investigated using the Etest.
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Acute otitis media (AOM) is the most common diagnosis for which antibiotics are prescribed in children. However, due to their widespread use, we are witnesses to increased development of bacterial resistance to antibiotics. The purpose of this study was to evaluate the necessity of antibiotic treatment in patients with AOM. Our study included 314 children, aged between 2 months and 6 years. Children were divided into two groups: the first group included children with less severe forms of AOM, who received symptomatic therapy and "wait-and-see" approach (237 children); the second group presented with purulent ear infection and received antibiotic treatment from the beginning (77 children). After symptomatic therapy, resolution of the disease, without use of any antibiotics, was established in 61% of patients, compared to the overall sample of children with AOM. None of the children developed complications that would require surgical treatment. In the second group of children, receiving antibiotics, almost the same therapeutic effects (80%) were achieved with the use of amoxicillin, amoxicillin-clavulanate and cefixime, while the worst results were obtained after using azithromycin. The wait-and-see approach is recommended in forms of AOM without serious signs and symptoms, because it significantly reduces the use of antibiotics and their potential adverse effects.
A total of 1,527 clinically significant outpatient isolates of Streptococcus pneumoniae were prospectively collected in 30 different U.S. medical centers between November 1994 and April 1995. Overall, 23.6% of strains were not susceptible to penicillin, with 14.1% intermediate and 9.5% high-level resistant. The frequencies of recovery of intermediate and high-level resistant strains varied considerably between different medical centers and in different geographic areas. In general, intermediate and high-level penicillin resistance was most common with isolates of S. pneumoniae recovered from pediatric patients. The in vitro activities of 22 other antimicrobial agents were assessed against this collection of isolates. Ampicillin was consistently 1 twofold dilution less active than penicillin. Amoxicillin and amoxicillin-clavulanate were essentially equivalent to penicillin in activity. The rank order of activity for cephalosporins was cefotaxime = ceftriaxone > or = cefpodoxime > or = cefuroxime > cefprozil > or = cefixime > cefaclor = loracarbef > cefadroxil = cephalexin. The National Committee for Clinical Laboratory Standards [Performance Standards for Antimicrobial Susceptibility Testing, Sixth Information Supplement (M100-S6), 1995] has established MIC breakpoints for resistance (i.e., > or = 2 micrograms/ml) with three cephalosporins versus S. pneumoniae, namely, cefotaxime, ceftriaxone, and cefuroxime. The overall percentages of strains resistant to these three antimicrobial agents were 3, 5, and 12, respectively. The overall frequency of resistance was 10% with all three macrolides examined in this study, clarithromycin, erythromycin, and azithromycin. The overall percentages of chloramphenicol, tetracycline, and trimethoprim-sulfamethoxazole resistance were 4.3, 7.5, and 18, respectively. The resistance percentages among the cephalosporins, macrolides, chloramphenicol, tetracycline, and trimethoprim-sulfamethoxazole were consistently higher among penicillin-intermediate strains than among susceptible isolates and even higher still among organisms expressing high-level penicillin resistance. Multiply resistant strains represented 9.1% of the organisms examined in this study. Finally, rifampin resistance was uncommon (i.e., 0.5%), and vancomycin resistance was not detected. The quinopristin-dalfopristin combination was consistently active at concentrations of 0.25 to 4 micrograms/ml, but rates of resistance could not be determined in the absence of established interpretive criteria for MIC results.
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BK-218 is a novel cephalosporin with a dual route of administration and spectrum of activity most similar to that of second-generation cephalosporins. BK-218 was active against Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis but strains resistant to penicillins had higher MICs. BK-218 had greater activity (8-fold) than cefuroxime or cefaclor against oxacillin-susceptible Staphylococcus spp. Moderate BK-218 activity was observed against Neisseria gonorrhoeae and commonly isolated Enterobacteriaceae such as Escherichia coli (MIC90, 1 mg/l), Klebsiella spp. (MIC90, 2 mg/l), and Proteus mirabilis (MIC90, 2 mg/l). The following organisms were generally BK-218-resistant (MIC90, greater than 16 mg/l): Bacteroides fragilis, Pseudomonas spp., Acinetobacter spp., Xanthomonas maltophilia, Citrobacter spp., Enterobacter spp., indole-positive Proteus, Serratia spp., enterococci and oxacillin-resistant staphylococci.
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Comprehensive electronic medical records (EMR) have proven to be an effective tool for improving the safety and quality of healthcare. In particular, EMR has resulted in a significant reduction in antibiotic consumption and an improvement in rational antibiotic use. This study focused on evaluating the effectiveness of using a comprehensive EMR system to curb antibiotic abuse. A retrospective "before/after" investigation was conducted in an 850-bed nonprofit hospital. A comprehensive EMR was implemented to improve the management of medical practices during treatment and to track antibiotic prescriptions. Patient records on antibiotic use were identified by searching the hospital database from April 1 to October 30, 2011 (post-implementation) and compared with those of patients from April 1 to October 30, 2010 (pre-implementation). Outcome measures were defined daily doses (DDDs) of antibiotics per 1,000 patient-days and factors that influenced antibiotic consumption. Antibiotic consumption during the seven months with EMR management decreased from 727 DDDs to 480 DDDs per 1,000 patient-days (p < 0.001). The decreases in cefminox, cefoperazone combinations, cefixime, and gentamicin were notably significant. The type of medical insurance, patient age, and ordering department (importance coefficients of 0.1935, 0.1818 and 0.1756, respectively) were the most significant factors that influenced antibiotic consumption. An improvement in the rational antibiotic use was also observed in the length of antibiotic therapy, selection of appropriate antibiotic level, route of administration, and so on. Rational antibiotic use resulted in a lower mortality of 0.0644 % during the post-implementation period compared to 0.179 % during the pre-implementation period (p = 0.018). The comprehensive EMR system contributed to a significant reduction in antibiotic consumption and an improvement in rational antibiotic use.
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Urinary tract infections (UTIs), including cystitis and pyelonephritis, are the most common infectious diseases in childhood. Escherichia coli (E. coli) accounts for as much as 90% of the community-acquired and 50% of nosocomial UTIs. Therefore, identification of E. coli strains is important for both clinical and epidemiological implications. Understanding antibiotic resistance patterns and molecular characterization of plasmids and other genetic elements is also epidemiologically useful.
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Spinal epidural abscess is an infectious disorder with high morbidity and mortality rates, which is often associated with delayed diagnosis. We report a case of a 73-year-old man with cervical pyogenic spondylodiscitis complicated with epidural abscess following a prostatic biopsy. Clinical presentation included fever, malaise, neck rigidity in all axes, minor paresis of the right arm, and gait ataxia. A cervical vertebral magnetic resonance imaging (MRI) scan showed pyogenic spondylodiscitis with an epidural abscess. Blood, urine, and cerebrospinal fluid cultures were sterile. The patient was treated with intravenous vancomycin, metronidazole, and ceftazidime for 4 weeks, and was discharged from the hospital and treated with oral cloxacillin, metronidazole, and cefixime for another 2 weeks. His neurological symptoms disappeared completely, and he walked normally, without support. It is important for clinicians to be alert to symptoms accompanying back pain following a prostatic biopsy and to consider the possibility of a diagnosis of spinal abscess.
Chronic supportive otitis media (CSOM) is one of the commonest illnesses in ENT practice. This study was conducted to find out the various aerobic microorganisms associated with CSOM and their current antimicrobial susceptibility patterns to commonly used antimicrobials.
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Among 254 Neisseria gonorrhoeae isolates from a sexually transmitted infection (STI) clinic in northern Taiwan, 69 isolates were found to contain the mosaic penA (MA) gene and were associated with elevated cefixime and ceftriaxone MICs. Most of these MA gene-harboring isolates were also resistant to penicillin (71.4%) and ciprofloxacin (100%) and were from men who have sex with men (MSM) or from bisexual men (81.2%). Three major sequence types (ST835, ST2180, and ST2253) constituted 55.7% of these isolates. The major sequence types harboring the mosaic penA gene may represent major sexual networks responsible for the emergence/introduction and the spread of the multidrug-resistant clones in Taiwan.
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We compared the cost-effectiveness of two single-dose treatment strategies for adolescents with uncomplicated Neisseria gonorrhoeae cervicitis.