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A total of 79 Clostridium difficile strains from healthy young and elderly adults, elderly patients without gastrointestinal disease, elderly patients receiving antibiotics without gastrointestinal complications, and elderly patients with antibiotic-associated diarrhea or pseudomembranous colitis were tested for their susceptibilities to 24 antimicrobial agents. All of the 79 strains were inhibited by low concentrations of rifampicin, metronidazole, fusidic acid, vancomycin, ampicillin, and penicillin G. Strains were highly resistant to aminoglycosides, trimethoprim, sulfamethoxazole, nalidixic acid, and cycloserine and often resistant to neomycin, cefoxitin, and cefalexin. Wide variations in the susceptibility of C. difficile strains to erythromycin, clindamycin, lincomycin, chloramphenicol, and tetracycline were found. Strains resistant to erythromycin, clindamycin, and lincomycin were more frequently found among strains isolated from elderly adults than those isolated from young adults, with particularly high frequency among strains isolated from elderly patients receiving antibiotics. None of the 23 strains isolated from healthy young adults was resistant to chloramphenicol. All of the 14 strains resistant to erythromycin, clindamycin, lincomycin, and chloramphenicol were sensitive to tetracycline and all of the 15 strains resistant to erythromycin, clindamycin, lincomycin, and tetracycline were sensitive to chloramphenicol. Only one out of 19 tetracycline, resistant strains was highly toxigenic, whereas 42 (70%) of the 60 sensitive strains were highly toxigenic.
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A total of 75 patients with recurrent tonsillitis, between 15 and 44 years of age, were divided into three groups, two of which were treated with antibiotics before surgery. Bacteriological specimens were collected before treatment started and the microflora of the excised tonsils were analyzed. Bacteroides species were found in the tonsils of 83% of the patients, and 50% of these microorganisms were beta-lactamase producers. Other bacteria found were Staphylococcus aureus in 45%, beta-streptococci group A in 4%, and beta-streptococci groups C and G in 24%. Hemophilus species were isolated from 50%, but no strains produced beta-lactamase. Fusobacteria were recovered from 41%; one strain produced beta-lactamase. After administration of phenoxymethylpenicillin in doses of 1 g twice a day for nine days, the beta-streptococci were eliminated, but no change of the amount of S aureus, Hemophilus, Bacteroides, or fusobacteria was seen. Clindamycin in doses of 0.15 g four times daily for nine days diminished almost all bacteria except for the Hemophilus species.
We made a survey to investigate the incidence of clinical isolation and the trend of antimicrobial susceptibility of Methicillin-resistant Staphylococcus aureus (MRSA), isolated in 26 clinical laboratories. Among the 26 institutions, the frequency of MRSA was 22 to 64% (average: 42.1%) in 1988, 22 to 69% (average: 55.3%) in 1989 and 29 to 76% (average: 56.9%) in 1990, and increasing year by year. MRSA showed poor sensitivity to beta-lactam antibiotics, gentamicin, toburamycin and clindamycin. There was a significant difference in frequency of the minocycline-resistant strains and the ofloxacin-resistant strains among the 26 institutions. Albekacin, netilmicin, and vancomycin were most active against MRSA with a MIC90 of 1, 8 and 1 microgram/ml, respectively.
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Sludge generated in waste water treatment process can be a major sink for some pharmaceutical and personal care products (PPCPs). The land application of sewage sludge (in the form of biosolids in the United States) can therefore potentially introduce PPCPs into the environment. After treatment, biosolids are often subjected to a storage period before land application. However, little information is available with regard to the fate of PPCPs in biosolids during the storage. In this work, the persistence of seven pharmaceuticals and one antibacterial was evaluated using ultrasonic extraction and liquid-chromatography tandem mass spectrometry (LC-MS/MS). The impacts of aeration and sunlight exposure were investigated. During the experiment, no elimination was observed for carbamazepine, triclosan, and ciprofloxacin while elimination was found for tetracycline, doxycycline, clindamycin, erythromycin, and clarithromycin. Using an availability-adjusted kinetic model, the 50% dissipation time was 37 to >77d for tetracycline, 53 to >77d for doxycycline, 1.0-1.6d for clindamycin, 1.1-1.9d for clarithromycin, and 7.0-17d for erythromycin. Those compounds were found more persistent under anaerobic conditions than aerobic condition with a longer 50% dissipation time by a factor of 1.5-2. However, minor impact was observed from sunlight irradiation.
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The capacity of Staphylococcus aureus strain LUG855 to release Panton-Valentine leukocidin (PVL) in the presence of sub-inhibitory concentrations of anti-staphylococcal drugs was examined. Oxacillin enhanced PVL release 2.5-fold, while clindamycin, linezolid, fusidic acid and rifampicin were inhibitory, and vancomycin, pristinamycin, tetracycline, ofloxacin and co-trimoxazole had no effect. In combination with oxacillin, sub-inhibitory concentrations of clindamycin or rifampicin inhibited PVL induction significantly, linezolid was less inhibitory, and fusidic acid did not inhibit PVL induction by oxacillin. These data support the use of oxacillin in combination with clindamycin, rifampicin or linezolid for the treatment of PVL-positive S. aureus infections.
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Randomised double-blinded trials were included.
Although the highest burden of Streptococcus agalactiae infections has been reported in industrialized countries, studies on the characterization and epidemiology are still limited in developing countries and implementation of control strategies remains undefined. The aim of this retrospective study was to assess the epidemiological, clinical, and microbiological aspects of S. agalactiae infections in cancer patients treated at a Reference Brazilian National Cancer Institute - INCA, Rio de Janeiro, Brazil. We reviewed the clinical and laboratory records of all cancer patients identified as having invasive S. agalactiae disease during 2010-2014. The isolates were identified by biochemical analysis and tested for antimicrobial susceptibility. A total of 263 strains of S. agalactiae were isolated from cancer patients who had been clinically and microbiologically classified as infected. S. agalactiae infections were mostly detected among adults with solid tumors (94 %) and/or patients who have used indwelling medical devices (77.2 %) or submitted to surgical procedures (71.5 %). Mortality rates (in-hospital mortality during 30 days after the identification of S. agalactiae) related to invasive S. agalactiae infections (n = 28; 31.1 %) for the specific category of neoplasic diseases were: gastrointestinal (46 %), head and neck (25 %), lung (11 %), hematologic (11 %), gynecologic (4 %), and genitourinary (3 %). We also found an increase in S. agalactiae resistance to erythromycin and clindamycin and the emergence of penicillin-less susceptible isolates. A remarkable number of cases of invasive infections due to S. agalactiae strains was identified, mostly in adult patients. Our findings reinforce the need for S. agalactiae control measures in Brazil, including cancer patients.
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This study investigated the pharmacokinetics of fosmidomycin when given in combination with clindamycin at two dosage regimens in patients with acute uncomplicated falciparum malaria.
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From October 2010 to September 2011, we collected the specimen from 361 patients with lower respiratory tract infections in 16 institutions in Japan, and investigated the susceptibilities of isolated bacteria to various antibacterial agents and patients' characteristics. All of 399 strains that were isolated from specimen (mainly from sputum) and assumed to be bacteria causing in infection, were examined. The isolated bacteria were: Staphylococcus aureus 70, Streptococcus pneumoniae 65, Haemophilus influenzae 72, Pseudomonas aeruginosa (non-mucoid) 47, P. aeruginosa (mucoid) 14, Klebsiella pneumoniae 30, and Moraxella catarrhalis 39. Of 70 S. aureus strains, those with 2 μg/mL or less of MIC of oxacillin (methicillin-susceptible S. aureus: MSSA) and those with 4 μg/mL or more of MIC of oxacillin (methicillin-resistant S. aureus: MRSA) were 45 (64.3%) and 25 (35.7%) strains, respectively. Against MSSA, imipenem had the most potent antibacterial activity and inhibited the growth of all strains at 0.063 μg/mL or less. Against MRSA, vancomycin and arbekacin showed the potent activity and inhibited the growth of all the strains at 2 μg/mL. Linezolid also showed the great activity and inhibited the growth of all the strains at 2 μg/mL. Carbapenems and penems showed the most potent activities against S. pneumoniae and panipenem inhibited the growth of all the strains at 0.125 μg/mL. Imipenem and faropenem also had a preferable activity and inhibited the growth of all the strains at 0.5 and 1 μg/mL, respectively. In contrast, there were high-resistant strains (MIC: > 128 μg/mL) for erythromycin (44.6%) and clindamycin (24.6%). Against H. influenzae, levofloxacin showed the most potent activity and its MIC90 was 0.063 μg/mL or less. Meropenem showed the most potent activity against P. aeruginosa (mucoid) and its MIC90 was 0.5 μg/mL. Against the non-mucoid type of P. aeruginosa, tobramycin had the most potent activity and its MIC90 was 2 μg/mL. Against K. pneumoniae, cefozopran had the most potent activity and inhibited the growth of all the strains at 0.063 μg/mL or less. All the antibacterial agents except ampicillin generally showed a potent activity against M. catarrhalis and the MIC90 of them were 2 μg/mL or less. The majority number (54.8%) of the patients with respiratory infection was aged 70 years or older. Bacterial pneumonia and chronic bronchitis accounted for 58.7% and 24.4% of all the respiratory infection, respectively. The bacteria frequently isolated from the patients with bacterial pneumonia were S. aureus (20.6%), S. pneumoniae (18.0%), H. influenzae (13.6%), and P. aeruginosa (13.6%). S. aureus (17.2%), H. influenzae (20.2%), and P. aeruginosa (17.2%) also were frequently isolated from the patients with chronic bronchitis. The bacteria frequently isolated from the patients were S. pneumoniae (20.0%) and H. influenzae (20.0%) before administration of the antibacterial agents. The bacteria frequently isolated from the patients previously treated with cephems were S. aureus and H. influenzae, and the isolation frequencies were 25.0% and 20.0%, respectively. The bacteria frequently isolated from the patients previously treated with macrolides were P. aeruginosa and H. influenzae, the isolation frequencies were 25.9% and 22.2%, respectively.
Orthopedic surgeons at our institution have noticed an increase in the number of infections due to Propionibacterium acnes, especially following operations on the shoulder. We collected P. acnes isolates from our hospital microbiology laboratory for 1 year and performed antimicrobial susceptibility testing on 28 strains from the shoulder. Antibiotics with the lowest MIC values against P. acnes (MIC50 and MIC90) included penicillin G (0.006, 0.125), cephalothin (0.047 and 0.094), and ceftriaxone (0.016, 0.045), while others also showed activity. Strains resistant to clindamycin were noted.
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The purpose of our study was to determine retrospectively the risk factors for the acquisition of Enterococcus faecalis vs E. faecium bacteraemia, as well as the clinical outcomes of these patients. 62 patients with Enterococcus faecalis bacteraemia were compared to 31 patients with E. faecium bacteraemia. Haematologic malignancies, neutropenia, high-risk source and previous use of aminoglycosides, carbapenems, cephalosporins and clindamycin were significantly associated with E. faecium bacteraemia. Instead, urinary catheterization was found to be related to Enterococcus faecalis bacteraemia. The mortality rates within 7 d and 30 d were 13% and 27%, respectively, in patients with E. faecalis bacteraemia and 6% and 29%, respectively, in patients with E. faecium bacteraemia. There was no difference in mortality between E. faecalis and E. faecium bacteraemia, nor was there a difference in seriousness of disease at the time of bacteraemia. In the subgroups of patients with monomicrobial or clinically significant E. faecalis vs E. faecium bacteraemia, the mortality rates were similar to the results of all subjects. Our results do not support the theory that E. faecium would be a more virulent organism than E. faecalis.
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GV129606 is a new parenteral trinem antibiotic belonging to the beta-lactam class. It combines broad-spectrum activity (against gram-negative and -positive bacteria, aerobes and anaerobes), with high potency and resistance to beta-lactamases. Comparative in vitro and in vivo antibacterial activities were determined for GV129606 against more than 400 recent clinical isolates (aerobes, including beta-lactamase producers, and anaerobes), using representative antibacterial agents (meropenem, piperacillin, ceftazidime, cefpirome, ciprofloxacin, and gentamicin for aerobes and metronidazole, cefoxitin, piperacillin, and clindamycin for anaerobes). Against methicillin-susceptible staphylococci and streptococci, GV129606 and meropenem were the most active of the drugs tested. GV129606 showed an MIC for 90% of strains tested (MIC90) ranging from < or =0.015 to 0.06 microg/ml against methicillin-susceptible staphylococci and Streptococcus sanguis, Streptococcus pyogenes, and Streptococcus agalactiae. Against penicillin-susceptible and -resistant Streptococcus pneumoniae isolates, GV129606, meropenem, and cefpirome showed MIC90s of < or =0.015 and 1 microg/ml, respectively. Meropenem was the most active compound against members of the family Enterobacteriaceae with MIC90s of < or =0.5 microg/ml. Against these species, GV129606 possessed activity superior to those of piperacillin, ceftazidime, cefpirome, and gentamicin, with MIC90s of < or =8 microg/ml, but its activity was two- to sixfold less than that of ciprofloxacin (with the exception of Proteus rettgeri and Providencia stuartii). Haemophilus spp., Moraxella catarrhalis, Neisseria gonorrhoeae, and Pseudomonas aeruginosa were also included in the spectrum of GV129606. GV129606 showed good antianaerobe activity, similar to metronidazole. It was stable against all clinically relevant beta-lactamases (similar to meropenem). The in vitro activity was confirmed in vivo against septicemia infections induced in mice by selected gram-positive and -negative bacteria with 50% effective doses (ED50s) of < or =0.05 and < or =0.5 mg/kg of body weight/dose, respectively. GV129606 was as effective as meropenem against septicemia in mice caused by ceftazidime-resistant Pseudomonas aeruginosa, exhibiting an ED50 of 0.33 mg/kg/dose.
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A reversed-phase high-performance liquid chromatographic (HPLC) assay method has been developed for determining pirlimycin in human serum and urine. The method involves chloroform extraction of pirlimycin free base followed by derivatization with 9-fluorenylmethylchloroformate to form a carbamate ester. The reaction is rapid, reproducible, and quantitative. 9-Fluorenylmethylchloroformate reacts with amines to form derivatives sensitive to both ultraviolet and fluorescence detection. Human serum and urine samples following 50-mg and 500-mg single oral doses of pirlimycin were analyzed. The samples were chromatographed on an RP-18 Spherisorb 5-micron, 250 X 4.6 mm I.D. reversed-phase HPLC column. The eluent for the serum assay was acetonitrile-water (58:42) containing 0.02% acetic acid, and for the urine assay was acetonitrile-methanol-tetrahydrofuran-water (48:2:1:49). Fluoranthene was used as an internal standard. The assay sensitivity by ultraviolet detection (lambda max = 264) was about 5 ng/ml and by fluorescence detection (lambda excitation = 270 nm, lambda emission = 300 nm) was 0.1 ng/ml. Statistical analysis indicates an average drug recovery of 101 +/- 4.2% from serum and 102.0 +/- 2.62% from urine.
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Forty-one periodontal abscess samples were cultivated on selective and non-selective culture media to isolate the oral anaerobes. Their antibiotic susceptibilities to clindamycin, doxycycline, amoxicillin, imipenem, cefradine, cefixime, roxithromycin, and metronidazole were determined using the agar dilution method, and polymerase chain reaction assays were performed to detect the presence of the ermF, tetQ, nim, and cfxA drug resistance genes.
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We studied S. aureus-positive skin swabs (n=583) from the lesional skin of infants, children, and adults who presented to our outpatient clinic with AD from July 2009 to April 2012.
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This study was conducted to investigate the antimicrobial susceptibilities of the strains of coagulase negative Staphylococci (CNS) isolates from urine at Juntendo University Hospital in Tokyo from 1989 to 1994. The susceptibility testing were performed according to the broth dilution method standerdized by the Japan Society of Chemotherapy. The following bacteria were tested; Staphylococcus epidermidis (59 strains), Staphylococcus haemolyticus (42 strains), Staphylococcus saprophyticus (30 strains). The antimicrobial agents tested wre as follows; Oxacillin, Cefazolin, Imipenem, Flomoxef, Gentanicin, Tobramycin, Arbekacin, Clindamycin, Tetracycline, Minicycline, Vancomycin, Sulfamethoxaxole-Trimethoprim and, Ofloxacin. 1. 100% of S. caprae, 62% of S. haemolyticus and 42% of S. epidermidis were resistant to Oxacillin. All strains of S. saprophyticus were sensitive to Oxacillin. 2. S. saprophyticus showed the highest sensitivities to all anti-microbial agents. 3. All strains of S. caprae were resistant to Tobramycin and Clindamycine. 4. Vancomycin and Arbecacin has strong antimicrobial activities to all CNS. S. saprophyticus, which is the pathogen of acute urinary tract infections, showed high sensitivities to many antimicrobial agents. On the other hand, S. haemolyticus and S. caprae, which are the predominate microorganisms of bacteriuria of inpatients, showed high resistance rates to antimicrobial agents.
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The incidence of Clostridium difficile-associated disease (CDAD) has increased over the past few years and more severe cases of CDAD have been reported. This changing epidemiology is possibly a result of the emergence of a more virulent strain of C difficile that is more resistant to fluoroquinolones and is associated with increased morbidity and mortality. Because of advanced age and frequent courses of antibiotic therapy, patients in long-term care facilities are at increased risk of C difficile infection. In addition to beta-lactams and clindamycin, the fluoroquinolones have recently been associated with increased rates of CDAD. Early identification of C difficile infection and prompt initiation of therapy with the most appropriate agent are critical to minimize morbidity and mortality in this era of increasingly severe CDAD. Metronidazole and vancomycin have been the mainstays of therapy, and recent data support the expanding role of vancomycin in the treatment of severe CDAD. Adjunctive therapy with probiotics, intravenous immunoglobulin, or rifampin has been used in refractory or recurrent CDAD. Adherence to the recommended infection control measures and the judicious use of antibiotics should also be part of the global management of CDAD in long-term care facilities.
Childhood acute septic arthritis is most often of hematogenous origin, and usually caused by Staphylococcus aureus. Characteristic symptoms and signs include a swollen, red painful joint, and fever. The diagnosis is confirmed by a joint aspiration. Following a brief 2- to 4-day intravenous phase, the antibiotic course is completed orally to a total of 10 to 14 days. Cephalosporins, clindamycin or staphylococcal penicillins, administered every 6 hours, are recommended as first-line antibiotics because of their appropriate spectrum, excellent penetration, good tolerability in large doses, and moderate price. Operative treatment (arthroscopy, arthrotomy) is not needed routinely, unless the response is tardy.
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In this study we outline a consistent management protocol for type I open pediatric forearm fractures that has not previously been documented in the literature. Our results corroborate the those reported in the literature that pediatric type I open fractures may be managed safely in a non-operative manner. There were no infections in our prospective series of 45 consecutive type I open pediatric forearm fractures using our protocol. Using a protocol of only four doses of intravenous antibiotics (one in the emergency department and three additional doses during a 24-h hospital admission) is a safe and efficient method for managing routine pediatric type I open fractures non-operatively.
To estimate the efficacy of different therapeutic modalities on proven cases of bacterial vaginosis (BV) in patients at high risk of preterm labor and premature rupture of membranes.
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This pilot study provides encouraging evidence of the efficacy and safety of a 3 day course of 2% clindamycin cream in bacterial vaginosis.
Cross-resistance to macrolide, lincosamide, and streptogramin B (MLSB) antibiotics is mainly mediated by the erm (erythromycin ribosome methylation) genes that encode 23S rRNA methylases in enterococi, and various mechanisms are involved in the streptogramin B resistance. Prevalence of MLSB resistance and its genetic mechanisms were analyzed for a total of 159 strains of Enterococcus faecium isolated from clinical specimens in a university hospital in Japan from 1997 to 2006. Resistance to erythromycin (EM) and clindamycin was detected in 88.1% and 89.9% of all the strains examined, respectively, and expression of resistance was totally constitutive. Although none of the strain was resistant to quinupristin/dalfopristin (Q/D), 28 strains (17.6%) showed intermediate resistance to Q/D (MIC: 2 μg/ml). The erm(B) gene was detected in 139 strains (87.4%), and msrC was found in all the strains examined, whereas no other known MLSB resistance genes were identified. The erm(B) regulator region (RR) containing a coding region of the leader peptide was classified into 13 genetic variations (L1-L3, M, S1-S7, D, and R genotypes) in 56 strains. However, no relatedness was identified between the erm(B) RR genotype and EM resistance, or reduced susceptibility to Q/D, although most of Q/D-intermediate strains were assigned to the L1, L2, and S1 genotypes. Q/D-intermediate strains were classified into five multiple-locus variable-number tandem-repeat analysis (MLVA) types, including four types of clonal complex (CC)-C1, five sequence types (STs), including four STs of CC-17, and several resistance gene/virulence factor profiles. The present study revealed the occurrence of Q/D-intermediate E. faecium, which are composed of heterogeneous strains in Japan, and more genetic diversity in the erm(B) RRs than those reported previously.
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Worldwide increase in antibiotic resistance has become one of the major problems. Optimal and rationale use of antibiotic is important to prevent resistance against most of the bacteria including Coagulase-negative Staphylococci (CoNS), which has now been recognized as an important pathogen for nosocomial infections. This study was carried out to determine efficacy of vancomycin and linezolid against CoNS in various clinical specimens.
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This study has shown that inducible clindamycin resistance in staphylococci can be detected by disk testing on sheep blood agar inoculum purity plates used with the bioMerieux VITEK 2. Tests of 150 erythromycin-resistant isolates correlated with standard D-zone tests on Mueller-Hinton agar and with PCR for erm(A), erm(C), and msr(A).
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Antimicrobial stewardship has been shown to reduce unnecessary antibiotic use, but there are few data on the long-term benefits of such a programme. Antimicrobial use over a 13-year period since implementing an antimicrobial stewardship programme (ASP) at our institution was examined. Nosocomial rates of Clostridium difficile infection (CDI) and antimicrobial susceptibility patterns of common nosocomial micro-organisms over the same period were also reviewed. Total antimicrobial use decreased by 62.8% (P<0.0001). There were decreases in use of aminoglycosides (-91.3%; P<0.0001), cephalosporins (-68.3%; P<0.0001), extended-spectrum penicillins (-77.7%; P<0.0001), macrolides (-27.2%; P=0.002), clindamycin (-95.9%; P<0.0001) and quinolones (-78.7%; P<0.0001). Antifungal use decreased by 71.0% (P<0.0001). There were increases in the use of carbapenems (+736%, P<0.0001) and anti-MRSA drugs (+73.3%; P<0.0001). There was a 56.7% (P=0.007) reduction in nosocomial MRSA infections. Nosocomial CDI rates decreased by 42.6% (P=0.005) between 2003 and 2010 and then increased to near baseline levels following implementation of more sensitive testing for detection of CDI in 2011. There were decreases in the rate (-71.9%; P=0.001) and percentage (-51.4%; P<0.0001) of quinolone-resistant Pseudomonas aeruginosa. There were decreases in the rate (P<0.0001) and percentage (P=0.02) of carbapenem-resistant P. aeruginosa following implementation of a policy restricting ciprofloxacin use. We have demonstrated sustained reductions in both antimicrobial use and drug-resistant organisms following implementation of an ASP.
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Group B streptococcus is the leading cause of early-onset neonatal sepsis in the United States. Universal screening is recommended for pregnant women at 35 to 37 weeks' gestation. The Centers for Disease Control and Prevention recently updated its guideline for the prevention of early-onset neonatal group B streptococcal disease. The new guideline contains six important changes. First, there is a recommendation to consider using sensitive nucleic acid amplification tests, rather than just routine cultures, for detection of group B streptococcus in rectal and vaginal specimens. Second, the colony count required to consider a urine specimen positive is at least 104 colony-forming units per mL. Third, the new guideline presents separate algorithms for management of preterm labor and preterm premature rupture of membranes, rather than a single algorithm for both conditions. Fourth, there are minor changes in the recommended dose of penicillin G for intrapartum chemoprophylaxis. Fifth, the guideline provides new recommendations about antibiotic regimens for women with penicillin allergy. Cefazolin is recommended for women with minor allergies. For those at serious risk of anaphylaxis, clindamycin is recommended if the organism is susceptible [corrected] and vancomycin is recommended if there is clindamycin resistance or if susceptibility is unknown. [corrected]. Finally, the new algorithm for secondary prevention of early-onset group B streptococcal disease in newborns should be applied to all infants, not only those at high risk of infection. The algorithm clarifies the extent of evaluation and duration of observation required for infants in different risk categories.
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During the study period nationwide non-prescription sales of antibiotics increased threefold and reached nearly 2% prevalence in 2004. Substantial interregional differences were detected in both the level and the share of non-prescription antibiotics sales. Ten drugs were responsible for 90% of non-prescription antibiotic sales in 2004 (doxycyline, co-amoxiclav, co-trimoxazole, penamecillin, ampicillin, amoxicillin, clindamycin, clarithromycin, norfloxacin, and cefuroxime); of these, doxycycline was the number one nonprescription antibiotic in all five years. A relationship was found between price and non-prescription antibiotic use (R = -0.732, P = 0.016).
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Dihydroartemisinin-piperaquine (DHA-PPQ) is a promising new artemisinin combination treatment. There are no published data on the intentional use of the drug in pregnancy. Between June 2006 and January 2007, 50 Karen pregnant women with recurrent P. falciparum infections, despite 7-day treatments with quinine or artesunate (+/-clindamycin) or both, were treated with DHA-PPQ. This rescue treatment was effective and well tolerated and there was no evidence of toxicity for the mothers or the fetus. The PCR adjusted cure rate by Kaplan Meier analysis at day 63 was 92.2% (95% CI: 76.9-97.4).
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The present study establishes a data compilation on biochemical features and natural antibiotic susceptibilities of Moellerella wisconsensis strains. 17 moellerellae isolated from humans (n = 11), food (n = 5) and water (n = 1) were tested. Identification was carried out using two commercially available systems and conventional tests. MIC determinations of 74 antibiotics were performed applying a microdilution procedure in Cation-adjusted Mueller Hinton broth and IsoSensitest broth. M. wisconsensis was naturally sensitive to doxycycline, minocycline, all tested aminoglycosides, numerous beta-lactams, all fluoroquinolones, folate-pathway inhibitors, chloramphenicol and nitrofurantoin. Natural resistance was found with oxacillin, penicillin G, all tested macrolides, lincomycin, streptogramins, ketolides, glycopeptides, fusidic acid, linezolid and rifampicin. Medium-dependent differences in susceptibility affecting clinical assessment criteria were seen with tetracycline, clindamycin and fosfomycin. From the data of the present study it is possible that some moellerellae are misidentified as Klebsiella pneumoniae subsp. ozaenae.
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It has been widely reported that the incidence and severity of Clostridium difficile infection (CDI) have increased dramatically in North America and Europe. However, little is known about CDI in Mainland China. In this study, we aimed to investigate the incidence of CDI and the main epidemic and drug-resistant strains of C. difficile in Mainland China through meta-analysis of related studies published after the year 2010. A total of 51 eligible studies were included. The pooled incidence of toxigenic C. difficile among patients with diarrhoea was 14% (95% CI = 12-16%). In Mainland China, ST-37 and ST-3 were the most prevalent strains; fortunately, hypervirulent strains, such as ST-1 (BI/NAP1/027) and ST-11 (RT 078), have only occurred sporadically to date. The rates of C. difficile resistance to ciprofloxacin (98.3%; 95% CI = 96.9-99.7%), clindamycin (81.7%; 95% CI = 76.1-87.3%) and erythromycin (80.2%; 95% CI = 73.5-86.9%) are higher than in other counties; however, none of the C. difficile isolates reported in Mainland China were resistant to metronidazole (n/N = 0/960), vancomycin (n/N = 0/960), tigecycline (n/N = 0/41) or piperacillin/tazobactam(n/N = 0/288).
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Samples were taken from the urethra in men and from the cervix and urethra in women by universal swab (Biolab®) into Urea-Myco DUO kit (Bio-Rad®) and were incubated for 48 hours at 37 C°. Antibiotic sensitivity of positive samples was determined in U9 bouillon using SIR Mycoplasma kit (Bio-Rad®).