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To characterize the diarrheal patients with Salmonella typhimurium (S. typhimurium) infections and to set up the first baseline for S. typhimurium pulsed-field gel electrophoresis (PFGE) patterns in Henan province, thus laying a foundation for comprehensive surveillance of Salmonella in human as well as foods.
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The Polish results of the international ARESC study are reported concerning clinical aspects, epidemiology, and antimicrobial susceptibility of uropathogens.
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A high rate of resistance was seen against ciprofloxacin (93.7%), aztreonam (86.8%), piperacillin (85.4%), ceftazidime (82.6%), amikacin (82%) and imipenem (79.2%). In total, 93.1% of the isolates were characterized as MDRPA. Biofilm formation was seen in 92.4% of the isolates. The prevalence of the exoA and nan1 genes were 75% and 11.8% among the isolates, respectively.
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We present the findings from this series of cases to reinforce the criteria for clinical diagnosis and to urge prompt therapeutic measures to treat cutaneous anthrax successfully to eliminate the unnecessary panic of anthrax.
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We report the first case in France of a high-level azithromycin-resistant Neisseria gonorrhoeae (minimum inhibitory concentration (MIC) = 96 mg/L) assigned to MLST7363 (NG-MAST ST6360), also resistant to ciprofloxacin and tetracycline but susceptible to ceftriaxone. The patient was a 51 year-old heterosexual man who returned following 1g azithromycin monotherapy. Mechanisms of azithromycin resistance were a C2599T mutation in the four copies of the rrl gene and a novel mutation in the promoter of the mtrR gene.
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Antibiotic resistance (AR) is a global phenomenon that has severe epidemiological ramifications world-wide. It has been suggested that antibiotics that have been discharged into the natural aquatic environments after usage or manufacture can promote the occurrence of antibiotic resistance genes (ARG). These environmental ARGs could serve as a reservoir and be horizontally transferred to human-associated bacteria and thus contribute to AR proliferation. The aim of this study was to investigate the anthropogenic load of antibiotics in Northern Pakistan and study the occurrence of ARGs in selected samples from this region. 19 sampling sites were selected; including six rivers, one dam, one canal, one sewage drain and four drug formulation facilities. Our results show that five of the rivers have antibiotic levels comparable to surface water measurements in unpolluted sites in Europe and the US. However, high levels of antibiotics could be detected in the downstream river in close vicinity of the 10 million city Lahore, 1100, 1700 and 2700 ng L(-1) for oxytetracycline, trimethoprim, and sulfamethoxazole respectively. Highest detected levels were at one of the drug formulation facilities, with the measured levels of 1100, 4100, 6200, 7300, 8000, 27,000, 28,000 and 49,000 ng L(-1) of erythromycin, lincomycin, ciprofloxacin, ofloxacin, levofloxacin, oxytetracycline, trimethoprim and sulfamethoxazole respectively. ARGs were also detected at the sites and the highest levels of ARGs detected, sulI and dfrA1, were directly associated with the antibiotics detected at the highest concentrations, sulfamethoxazole and trimethoprim. Highest levels of both antibiotics and ARGs were seen at a drug formulation facility, within an industrial estate with a low number of local residents and no hospitals in the vicinity, which indicates that the levels of ARGs at this site were associated with the environmental levels of antibiotics.
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Melioidosis is an important disease in Asia and Australia. It is very rare in Venezuela. We describe the case of a 50-year-old diabetic patient with several episodes of right tibial osteomyelitis, left shoulder arthritis, sternal osteomyelitis, right parietal osteomyelitis, and subperiosteal abscess, followed by septic arthritis of the right knee. In all cases Gram stain smear showed Gram-negative bacilli. Culture yielded Burkholderia pseudomallei, susceptible to third- and fourth-generation cephalosporins, ciprofloxacin and aztreonam, and resistant to aminoglycosides. He developed sepsis syndrome. Blood cultures and culture of abscess and joint fluids also revealed B. pseudomallei. The patient was treated with ceftazidime and ciprofloxacin, then cefepime and trimethoprim-sulfamethoxazole. He was discharged with suppressive therapy consisting of oral doxycycline and trimethoprim-sulfamethoxazole, and follow-up has continued to date. At this time he remains asymptomatic. Melioidosis is an extremely rare disease in our country. To our knowledge, this is only the second case reported in Venezuela.
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During follow-up, five patients in the study presented with recurrence, and three died as a result of an irrelevant cause. The remaining patients were followed up for a median of 108 months (range 97-132 months) without any signs of recurrence of infection. Recurrence of infection was 4.2 times more likely to occur in patients with positive Infecton scans [hazard ratio (HR): 4.2, confidence intervals 95%: 1.39-12.67, P=0.011]. Infecton had the highest sensitivity (83.3%), accuracy (69.69%) and negative predictive value (94.74%), whereas CRP had the highest specificity (76.92%).
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A variety of environmental factors, such as oxygen, pH, osmolarity and antimicrobial agents, modulate the expression of Salmonella pathogenicity islands (SPI) genes. This study investigated SPI-1 gene expression and the pathogenicity of quinolone-resistant Salmonella. mRNA expression levels of the invA and avrA genes, located in SPI-1, in quinolone-susceptible and quinolone-resistant Salmonella strains were determined using real-time fluorescent quantitative reverse transcription-polymerase chain reaction (RT-PCR). Twenty-five quinolone-resistant Salmonella mutants were derived from quinolone-susceptible strains by multiple-passage selection through increasing concentrations of ciprofloxacin in vitro, while an additional 15 strains were quinolone-resistant Salmonella clinical isolates. Sequence analysis showed no gene deletion or point mutations of nine SPI-1 genes (including invA and avrA) occurred in either the selected or clinical quinolone-resistant strains, while a single gyrA point mutation (S83F) was observed in all 40 quinolone-resistant strains. The mRNA expression levels of invA and avrA were significantly decreased (P<0.005) in quinolone-resistant strains (clinically acquired or experimentally selected in vitro), compared to the quinolone-susceptible strains. The resistant strains also had a slower growth rate combined with decreased epithelial cell invasion and intracellular replication in epithelial cells and macrophages. The results suggest that quinolone-resistance may be associated with lower virulence and pathogenicity than in quinolone-susceptible strains.
Oxacillin tests may fail to detect some methicillinresistant S. aureus populations. The objective of this study is to evaluate the discriminative capacity of the Clinical and Laboratory Standards Institute (CLSI) disk diffusion method with a cefoxitin 30 microg disk on S. aureus isolates with unusual phenotypic characteristics of antimicrobial resistance. We studied 53 clinical S. aureus isolates. The antimicrobial susceptibility of all isolates was routinely studied by the VITEK 2 System (bioMérieux). Methicillin resistance was also studied by CLSI oxacillin method and confirmed by a previously described multiplex polymerase chain reaction (PCR) method which permits S. aureus identification and simultaneous detection of methicillin resistance. MecA positive isolates presenting a diffuse growth within the zone of inhibition when exposed to oxacillin were considered heteroresistant; mecA negative, oxacillin intermediate or resistant isolates were considered borderline. All the isolates were tested with a cefoxitin 30 microg disk, according to the CLSI guidelines (susceptibility: > 22 mm; resistance: < 21 mm). Control strains for all assays included MRSA ATCC 43300 and MSSA ATCC 25923. The isolates formed four groups. Group I: 20 multiresistant, oxacillin susceptible and mecA negative isolates; group II: 16 resistant or with intermediate oxacillin susceptibility and mecA negative isolates; group III: 11 heteroresistant and mecA positive isolates; group IV: six mecA positive isolates with atypical resistance profiles (penicillin and oxacillin, or ciprofloxacin and erythromycin resistance). Thirty-five mecA negative isolates included in groups I and II showed inhibition zones > 22 mm; one isolate from group II showed 20 mm. The 17 mecA positive isolates from groups III and IV showed resistance to cefoxitin disk. The 30 microg cefoxitin disk diffusion method is proposed as an efficient method for the detection of methicillin resistance and permits a clear determination set S. aureus isolates, even those with atypical antimicrobial characteristics.
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This study aims to assess the resistance profiles of N. gonorrhoeae isolates sent to the Department of Clinical Microbiology in Vejle, Denmark, between 2003 and 2007, and to analyse their biochemical patterns.
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A total of 307 Pseudomonas aeruginosa isolates were included in the study. Among these isolates, 165 were isolated during Jan-June 2007 and 142 were isolated during Jan-June 2012. Among in-patients, there was a significant reduction in resistance rates of the isolates to ciprofloxacin (49% to 33%), ceftazidime (50% to 33%), meropenem (35% to 19%) and imipenem (28% to 14%) in 2012. Similarly, the rate of MDR Pseudomonas aeruginosa among the in-patients decreased from 37.9% in 2007 to 23.7% in 2012 (p value 0.0241). There was no significant difference in the resistance rates of the isolates from out-patients during the two study periods.
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The efficacy of fluoroquinolones (FQs) correlates with the pharmacokinetic/pharmacodynamic (PK-PD) parameter, AUC/MIC. To our knowledge, however, no prospective studies have reported the relationship between FQ efficacy and PK-PD parameters in intraabdominal infection; therefore, we prospectively investigated the relationship between the efficacy of intravenous ciprofloxacin (CPFX IV) and PK-PD parameters. The study included 16 patients diagnosed with peritonitis between 2006 and 2008: 14 patients infected with a single organism and 2 patients infected with more than one organism. Each patient was treated with CPFX IV (300 mg twice daily). The response rate was 56% (9 responders and 7 non-responders). Non-responders were infected with Escherichia coli, Pseudomonas aeruginosa, and Bacteroides fragilis (6 patients were infected with a single organism and 1 with more than one organism). Plasma drug concentrations were measured 1 h and 2 or 4 h after administration of CPFX IV. AUC for 24 h (AUC(0-24))/MIC values was calculated. The range of AUC(0-24)/MIC values in responders [95.3-3628.4 (geometric mean, 521.6)] was significantly different from that in non-responders [7.0-45.2 (geometric mean, 16.5)] (p = 0.001). The target AUC/MIC value of CPFX IV would be considered to be 45-95 in patients with peritonitis.
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clinicaltrials.gov Identifier: NCT00194532.
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This prospective study investigated the important epidemiologic aspects of Clostridium difficile infections (CDIs) among Jordanian adult hospitalized patients. A total of 300 stool specimens were investigated using culture and polymerase chain reaction methods for detection of C difficile, its toxins, and fluoroquinolone resistance. C difficile-positive cultures were found in 13.7% of the patients, and 73% of the isolates carried tcdA and/or tcdB toxin genes, and all C difficile isolates were negative for binary toxin. The isolates showed moderate level of resistance to both ciprofloxacin and levofloxacin, whereas metronidazole and vancomycin were highly susceptible. This study indicates the need for early detection of CDIs and prevention of its severe disease in hospitalized patients.
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S. aureus isolates were the most frequent bacteria isolated from otitis media and were highly sensitive to vancomycin and gentamicin, while gram-negative isolates were more sensitive to ciprofloxacin and gentamicin.
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Cutaneous anthrax should be considered as a possible diagnosis in cases with a painless ulcer with vesicles, edema, and a history of exposure to animals or animal products. Despite previous antibiotic use, taking smears and cultures should be encouraged. Treatment with penicillin G or penicillin procain alone is effective for cases with cutaneous anthrax without severe edema and superinfection.
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Because of significant proportion of non-E. coli isolates, CAUTIs represent important problem in this region. Due to high ampicillin and trimethoprim/sulfamethoxazole resistance rates for all analysed subsets these drugs should be left for empiric therapy, and it is highly recommended to perform urinalysis in all patients. Ciprofloxacin and nitrofurantoin should also be considered as the first-line therapy in women above 20 years of age and in children, respectively. Continuous surveillance of antibiotic resistance of CAUTIs as well as introduction of drug prescribing control is important.
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We prospectively collected healthcare-related and nosocomial SBP cases from March 2012 till February 2016 at the Department of Internal Medicine I of the University of Bonn and analysed the prevalence of antibiotic resistance among the isolated bacteria. SBP was diagnosed according to international guidelines. Ciprofloxacin, ceftriaxone and meropenem were used as reference substance for resistance to quinolones, third-generation cephalosporins and carbapenems, respectively.