Search

We report a case of a white man in his 80s presenting with reduced vision, 1 day following uncomplicated cataract surgery. Optical coherence tomography scan showed evidence of a large collection of subretinal and intraretinal fluid. There was no ocular abnormality of note to explain these macular findings. The findings were presumed to be caused by cefuroxime toxicity despite a standard intraoperative dose of 1 mg/0.1 mL injected into the anterior chamber. We have postulated that the process of discarding excess cefuroxime onto the corneal wound or surface may inadvertently lead to a higher dose entering the eye than intended. This patient was treated with topical prednisolone 1%, ketorolac 0.5% and chloramphenicol 0.5% in place of the standard Maxitrol (dexamethasone 0.1% with neomycin) prescribed as a postoperative regimen in our unit. There was complete resolution of the retinal changes with restoration of normal vision at 3-week follow-up.

OBJECTIVE Postoperative infections in pediatric spinal surgery commonly occur and necessitate reoperation(s). However, pediatric-specific infection prophylaxis guidelines are not available. This network meta-analysis compares perioperative prophylaxis methods including Betadine irrigation, saline irrigation, intrawound vancomycin powder, combination therapy (Betadine, vancomycin, gentamicin, and cefuroxime), Betadine irrigation plus vancomycin powder, and no intervention to determine the most efficacious prevention method. METHODS A systematic review was performed by searching the PubMed, EBSCO, Scopus, and Web of Science databases for peer-reviewed articles published prior to February 2022 comparing two or more infection prophylaxis methods in patients younger than 22 years of age. Data were extracted for treatment modalities, patient demographics, and patient outcomes such as total number of infections, surgical site infections, deep infections, intraoperative blood loss, operative time, follow-up time, and postoperative complications. Quality and risk of bias was assessed using National Institutes of Health tools. A network meta-analysis was performed with reduction of infections as the primary outcome. RESULTS Overall, 10 studies consisting of 5164 procedures were included. There was no significant difference between prophylactic treatment options in reduction of infection. However, three treatment options showed significant reduction in total infection compared with no prophylactic treatment: Betadine plus vancomycin (OR 0.22, 95% CI 0.09–0.54), vancomycin (OR 3.26, 95% CI 1.96–5.44), and a combination therapy (Betadine, vancomycin, gentamicin, and cefuroxime) (OR 0.24, 95% CI 0.07–0.75). P-Score hierarchical ranking estimated Betadine plus vancomycin to be the superior treatment to prevent total infections, deep infections, and surgical site infections (P-score 0.7876, 0.7175, and 0.7291, respectively). No prophylaxis treatment–related complications were reported. CONCLUSIONS The results of this network meta-analysis show the strongest support for Betadine plus vancomycin as a method to reduce infections following pediatric spinal surgery. There was heterogeneity among studies and inconsistent outcome reporting; however, three effective treatment options are identified.

Background Following the invasion of eukaryotic cells, Salmonella enterica serovar Typhimurium replaces PBP2/PBP3, main targets of β-lactam antibiotics, with PBP2SAL/PBP3SAL, two homologue peptidoglycan synthases absent in Escherichia coli. PBP3SAL promotes pathogen cell division in acidic environments independently of PBP3 and shows low affinity for β-lactams that bind to PBP3 such as aztreonam, cefepime, cefotaxime, ceftazidime, ceftriaxone, cefuroxime and cefalotin. Objectives To find compounds with high affinity for PBP3SAL to control Salmonella intracellular infections. Methods An S. Typhimurium ΔPBP3 mutant that divides using PBP3SAL and its parental wild-type strain, were exposed to a library of 1520 approved drugs in acidified (pH 4.6) nutrient-rich LB medium. Changes in optical density associated with cell filamentation, a read-out of blockage in cell division, were monitored. Compounds causing filamentation in the ΔPBP3 mutant but not in wild-type strain—the latter strain expressing both PBP3 and PBP3SAL in LB pH 4.6—were selected for further study. The bactericidal effect due to PBP3SAL inhibition was evaluated in vitro using a bacterial infection model of cultured fibroblasts. Results The cephalosporin cefotiam exhibited higher affinity for PBP3SAL than for PBP3 in bacteria growing in acidified LB pH 4.6 medium. Cefotiam also proved to be effective against intracellular Salmonella in a PBP3SAL-dependent manner. Conversely, cefuroxime, which has higher affinity for PBP3, showed decreased effectiveness in killing intracellular Salmonella. Conclusions Antibiotics with affinity for PBP3SAL, like the cephalosporin cefotiam, have therapeutic value for treating Salmonella intracellular infections.

The benefit of antibiotic prophylaxis is uncertain when performing transperineal prostate biopsies. Judicious use of antibiotics is required as antimicrobial resistance increases worldwide. We aimed to assess whether antibiotic prophylaxis can be omitted when performing transperineal prostate biopsies under local anaesthesia as an outpatient procedure.In this randomised, open-label, non-inferiority trial, we aimed to enrol all patients with a suspicion of prostate cancer undergoing transperineal prostate biopsies at two hospitals in Norway and Germany. Patients with a high risk of infection or ongoing infection were excluded. Patients were randomised (1:1) to receive intramuscular (in Norway) or intravenous (in Germany) 1·5 g cefuroxime antibiotic prophylaxis or not. Follow-up assessments were done after 2 weeks and 2 months. The primary outcome was rate of sepsis or urinary tract infections requiring hospitalisation within 2 months. The secondary outcome was the rate of urinary tract infections not requiring hospitalisation. These outcomes were assessed in all eligible randomly allocated participants with a prespecified non-inferiority margin of 4%. Biopsies were performed using an MRI-transrectal ultrasound fusion transperineal technique under local anaesthesia. Patients with a positive MRI underwent 2-4 biopsies per target; in addition, 8-12 systematic biopsies were performed in biopsy naive and MRI-negative patients. This study is registered with ClinicalTrials.gov, NCT04146142.Between Nov 11, 2019, and Feb 23, 2021, 792 patients were referred for biopsy, of whom 555 (70%) were randomly allocated to treatment groups. 277 (50%) patients received antibiotic prophylaxis and 276 (50%) did not; two (lt;1%) patients were excluded after randomisation because of unknown allergy to study drug. Sepsis or urinary tract infections requiring hospitalisation occurred in no patients given antibiotic prophylaxis (0%, 95% CI 0 to 1·37) or not given antibiotic prophylaxis (0%, 0 to 1·37; difference 0% [95% CI -1·37 to 1·37]). Urinary tract infections not requiring hospitalisation occurred in one patient given antibiotic prophylaxis (0·36%, 95% CI 0·01 to 2·00) and three patients not given antibiotic prophylaxis (1·09%, 0·37 to 3·15; difference 0·73% [95% CI -1·08 to 2·81]). The number needed to treat with antibiotic prophylaxis to avoid one infection was 137.The non-inferiority margin of 4% was not exceeded, suggesting rates of infections were not higher in patients not receiving antibiotic prophylaxis before transperineal prostate biopsy than in those receiving it. Therefore, antibiotic prophylaxis might be omitted in this population.Oslo University Hospital, Oslo, Norway and Vivantes Klinikum Am Urban, Berlin, Germany.

BACKGROUND CONTEXT: Surgical site infection following spine surgery is associated with increased morbidity and mortality. Perioperative antibiotic prophylaxis is a key factor in lowering the risk of acquiring an infection. Previous studies have assessed perioperative cefuroxime concentrations in the anterior column of the cervical spine with an anterior surgical approach. However, the majority of surgeries are performed in the posterior column and many surgeries involve the lumbar spine.PURPOSE: The objective of this study was to compare the perioperative tissue concentrations of cefuroxime in the anterior and posterior column during lumbar spine surgery with a posterior surgical approach.STUDY DESIGN: In vivo experimental pharmacokinetics study of cefuroxime concentrations in an acute preclinical porcine model.METHODS: The lumbar vertebral column was exposed from L1 to L5 in 8 female pigs. Microdialysis catheters were placed for sampling in the anterior column (vertebral body) and posterior column (posterior arch) within the same vertebra (L5). Cefuroxime (1.5 g) was administered intravenously. Microdialysates and plasma samples were continuously obtained over 8 hours. Cefuroxime concentrations were quantified by Ultra High Performance Liquid Chromatography Tandem Mass Spectrometry. The primary endpoint was the time above cefuroxime clinical breakpoint minimal inhibitory concentration (T>MIC) for Staphylococcus aureus of 4 µg/mL. The secondary endpoint was tissue penetration (AUCtissue/AUCplasma).RESULTS: Mean T>MIC 4 µg/mL (95% confidence interval) was 123 min (105-141) in plasma, 97 min (79-115) in the anterior column and 93 min (75-111) in the posterior column. Tissue penetration (95% confidence interval) was incomplete for both the anterior column 0.48 (0.40-0.56) and posterior column 0.40 (0.33-0.48).CONCLUSIONS: T>MIC was comparable between the anterior and posterior column. Mean cefuroxime concentrations decreased below the clinical breakpoint minimal inhibitory concentration for S. aureus of 4 µg/mL after 123 min (plasma), 97 min (anterior column) and 93 min (posterior column). This is shorter than the duration of most lumbar spine surgeries, and therefore alternative dosing regimens should be considered in posterior open lumbar spine surgeries lasting more than 1.5 hours.CLINICAL SIGNIFICANCE: Open lumbar spine surgery often involves extensive soft tissue dissection, stripping and retraction of the paraspinal muscles which may impair the local blood flow exposing the lumbar vertebra to postoperative infections. A single intravenous administration of 1.5 g cefuroxime only provided sufficient prophylactic target tissue concentrations in the vertebrae of the lumber spine for up to 1.5 hours.

Pneumonia is one of the significant causes of death in developing countries, including Indonesia. As the capital of West Java, Bandung is one of the cities with the highest pneumonia cases in this province. The objective of this study was to conduct cost-minimization analysis of pneumonia treatment in Indonesia by using one of the private hospitals in Bandung as a reference case. The use of cefuroxime and ceftizoxime was considered in adult hospitalized patients. In addition, ampicillin-sulbactam and ceftriaxone usage was compared in pediatric hospitalized patients. A cross-sectional descriptive study was applied by collecting data retrospectively from medical records of adult and pediatric patients who met the inclusion criteria at one of the private hospitals in Bandung from January 2017 to December 2018. We applied the following inclusion criteria: (i) adult (> 20 years old) and pediatric (0–5 years old) patients who were diagnosed with pneumonia; and (ii) adult patients who received cefuroxime or ceftizoxime antibiotic therapy and pediatric patients who received ampicillin-sulbactam or ceftriaxone antibiotic therapy. We excluded patients who were diagnosed with any other co-morbidities and who did not complete the treatment. The result showed that drug cost was the primary contributor to total treatment cost in adult and pediatric patients. We calculated the average total treatment cost with ceftizoxime and cefuroxime in adult patients at $149.39 and $193.05, respectively, and the average total treatment cost with ampicillin-sulbactam and ceftriaxone in pediatric patients at $202.83 and $192.77, respectively. We also estimated the LoS in a group of ceftizoxime and cefuroxime in adult patients at 3.8 and 4.1 days, respectively, and the LoS in a group of ampicillin-sulbactam and ceftriaxone in pediatric patients at 3.9 and 5.3 days, respectively. In conclusion, using ceftizoxime to treat hospitalized pneumonia in adult patients would require less cost and yield shorter LoS than cefuroxime. Using ampicillin-sulbactam to treat hospitalized pneumonia in pediatric patients would require higher costs and yield shorter LoS than ceftriaxone.

Cesarean scar defect (CSD) is a long-term outcome of cesarean section (CS) and associated with numerous gynecological and obstetric problems. Previous studies indicate that infection may be a risk factor for CSD. Adjunctive azithromycin was shown to reduce the risk of postoperative infection in patients undergoing non-elective primary cesarean delivery in labor or after the rupture of membranes compared with standard antibiotic prophylaxis. This study investigated the protective effect of adjunctive azithromycin in combination with single-dose cephalosporin against CSD in women undergoing non-elective cesarean delivery.A randomized, double-blind, controlled clinical trial was conducted in a University hospital in Shanghai, China. A total of 242 women who underwent their first non-elective CS were randomly assigned to receive 1500 mg cefuroxime sodium plus 500 mg intravenous azithromycin (n = 121; experimental group) or 1500 mg cefuroxime sodium plus a placebo (n = 121; placebo group). The primary outcome was CSD prevalence, as determined by transvaginal ultrasound and saline infusion sonohysterography within 6 months of delivery. Secondary outcomes were changes in infectious indicators (eg hypersensitive C-reactive protein and procalcitonin), postoperative morbidity, and use of postoperative antibiotics. We also examined the operative procedure, pathogenic microorganism cultures, and fetal outcomes. Outcomes were compared between groups with the chi-squared test, Fisher's exact test, or Student's t test.Between May 2018 and May 2021, 121 women were randomized to each arm. Because the sonographic follow up was disrupted by the coronavirus disease 2019 pandemic and strict management policies, we merged the follow-up time points (6 weeks and 6 months) into a single time period (6 weeks to 6 months); 104 and 108 women in the experimental and placebo groups, respectively, completed the first sonographic follow up. CSD was diagnosed by sonography in 34/104 (32.7%) and 50/108 (46.3%) patients in the experimental and placebo groups, respectively (relative risk 0.71, 95% confidence interval 0.50-0.99; p = 0.043). Characteristics of CSD and short-term infection outcomes did not differ between groups.A single dose of intravenous 500 mg azithromycin adjunctive to single-dose cefuroxime prophylaxis significantly reduced the incidence of CSD in women undergoing non-elective CS.

Fosfomycin tromethamol (FT) was reintroduced as an option for the treatment of low urinary tract infection (UTI) in children. In this study, we described the antibiotic sensitivity and mechanisms of resistance to fosfomycin in isolates from children older than 6 years with UTI. Urine culture and antibiotic susceptibility study were performed. In fosfomycin resistant strains, PCR for fos, blaCTX-M was performed followed by classification by phylogenetic group and sequencetyping. Escherichia coli was the most frequent etiological agent (89.2%). The susceptibility percentages were: fosfomycin 97.9%; amoxicillin-clavulanate 92.7%; cefuroxime and ceftriaxone 99%; nitrofurantoin 94.4%. An E. coli strain (ST69, phylogenetic group D) was resistant to fosfomycin (MIC 256mg/l) and carried the blaCTX-M-14 and fosA3 genes in a 45kb IncN-type plasmid. Resumen La fosfomicina-trometamol (FT) se reintrodujo como una opción para el tratamiento de la infección del tracto urinario (ITU) baja en niños. En este estudio describimos la sensibilidad antibiótica y los mecanismos de resistencia a FT en aislamientos de niños mayores de 6 anos con ITU. Se realizaron urocultivos y estudios de sensibilidad antibiótica. En las cepas resistentes a fosfomicina se realizó la técnica de PCR para fos, blaCTX-M, y su identificación según su grupo filogenéticoy secuenciotipo. Escherichiacoli fue el agente etiológico más frecuente (89,2%). Los porcentajes de sensibilidad fueron: fosfomicina 97,9%; amoxicilina-clavulánico 92,7%; cefurox-ima y ceftriaxona 99%; nitrofurantoína 94,9%. Una cepa de E. coli (ST69, grupo filogenético D) fue resistente a fosfomicina (CIM 256mg/l) y portaba los genes blaCTX-M-14 y fosA3 en un plás-mido de 45 kb del tipo IncN. Este es el primer reporte de E. coli ST69 con blaCTX-M-14/fosA3 de origen humano.

Surgical site infections (SSIs) are serious postoperative complications reported globally, which lead to perioperative antibiotics use during routine practice in surgical procedures. Selection of appropriate antibiotic/s for prophylaxis is a vital step in the management and care of invasive surgical procedures. This expert opinion review was developed based on expert discussion and literature search on scientific databases with special emphasis on cefuroxime in surgical prophylaxis for general surgeries. Cephalosporins are globally considered to be the drugs of choice for surgical prophylaxis in general surgeries owing to good safety, bactericidal activity, penetration to critical tissues, and proven efficacy in clinical trials. Cefuroxime, a 2nd generation cephalosporin, is an effective, safe and low-cost antibiotic for surgical prophylaxis in general surgeries, in particular for patients who need sequential antibiotic therapy. Cefuroxime can be administered alone or in combination with other classes of antibiotics based on clinical characteristics of individual patients and surgeon’s discretion to reduce the risk of postoperative SSIs, abscess, septicemia, and microbial growth. Key Messages: Cefuroxime can be administered alone or in combination with other classes of antibiotics based on clinical characteristics of individual patients and surgeon’s discretion to reduce the risk of postoperative SSIs, abscess, septicemia, and microbial growth. Keywords: Cefuroxime, Surgical wound infection, Cross infection, Anti­bacterial agents, Abscess, Sepsis.

Rational use of antibiotics implies appropriate choice of an antibiotic administered at correct dose, frequency, and duration using the most suitable route of administration. Irrational antibiotics use is associated with antimicrobial resistance, drug failure, and high mortality in the critical care units (CCUs). This study sought to establish rational use of antibiotics and determinants of clinical outcomes of patients admitted to the CCUs at the Kenyatta National Hospital (KNH). The findings would guide policy formulation of antibiotics use in hospital CCUs in Kenya and the region.Retrospective review of 220 admissions to the KNH CCUs over the period February 2018-February 2020 was conducted. Participants' sociodemographics, clinical characteristics, antibiotics therapy, and outcome of admission were extracted from patient files and analyzed using STATA version 23. Determinants of irrational antibiotic use and covariates of clinical outcomes were computed at 95% confidence.The prevalence of rational use of antibiotics was only 18.5%. Inappropriate choice of antibiotics (51.0%) and incorrect duration (32.3%) were the most common irrational practices. Flucloxacillin (100%), cefuroxime (93.3%), cefazolin (85.7%), and ceftriaxone (83.0%) were the most irrationally used antibiotics. Irrational use of ceftriaxone was significantly associated with clinical diagnosis (p = 0.012), while that of amoxiclav was associated with patient risk category (p = 0.039). Mortality in the CCUs was 10%, and the odds of dying were almost six times among intubated patients compared to those who were not (AOR 5.5, 95% CI = 1.1-28.1, p = 0.042).Irrational antibiotics prescribing is high in the KNH CCUs, attributable largely to incorrect choice and wrong duration of antibiotic use. Mortality was significantly associated with intubation. Intensification of management in critical care settings should be directed toward intubated patients while ensuring appropriate choice of antibiotics administered for the correct duration. Future studies should explore factors that could promote rational antibiotics use in critical care settings.Antibiotics are important in the management of infections. Therefore, they should be used properly as guided by the 5Rs of antimicrobials use, namely, right choice of antibiotic for a particular disease, administered at the right dose, for the right duration, at the right frequency via the right route of administration.We sought to establish the extent to which the use of antibiotics adheres to the established guidelines in the treatment and prevention of infections among patients admitted to intensive care units (ICUs) of Kenyatta National Hospital (KNH), Kenya.We reviewed and analyzed medical records of 220 patients admitted in the KNH ICUs in the period between February 2018 and February 2020.Antibiotics were used properly in only 18.5% of the cases. Unsuitable choice of antibiotics (51.0%) and incorrect duration (32.3%) were the major contributors to improper use. Flucloxacillin (100%), cefuroxime (93.3%), cefazolin (85.7%), and ceftriaxone (83.0%) were the most inappropriately used antibiotics. Approximately 10% of those admitted to the ICU died. Further, the probability of dying was almost six times among intubated patients compared to those who were not.The use of antibiotics in the KNH CCUs is not in tandem with established guidelines, owing to inappropriate selection and wrong duration of use. Though death was associated with intubation, more studies are needed to find out factors promoting appropriate antibiotics use in the ICUs so that clinicians can follow them in the treatment of patients.

Concerns over maternal and fetal drug exposures highlight the need for a better understanding of drug distribution into the fetus through the placental barrier. This study aimed to predict maternal and fetal drug disposition using physiologically based pharmacokinetic (PBPK) modeling. The detailed maternal-placental-fetal PBPK model within the Simcyp Simulator V20 was used to predict the maternal and fetoplacental exposure of cefazolin, cefuroxime, and amoxicillin during pregnancy and at delivery. The mechanistic dynamic model includes physiologic changes of the maternal, fetal, and placental parameters over the course of pregnancy. Placental kinetics were parametrized using permeability parameters determined from the physicochemical properties of these compounds. Then, the PBPK predictions were compared with the observed data. Fully bottom-up fetoplacental PBPK models were developed for cefuroxime, cefazolin, and amoxicillin without any parameter fitting. Predictions in nonpregnant subjects and in pregnant subjects fall within 2-fold of the observed values. Predictions matched observed pharmacokinetic data reported in nine maternal (five fetoplacental) studies for cefuroxime, 10 maternal (five fetoplacental) studies for cefazolin, and six maternal (two fetoplacental) studies for amoxicillin. Integration of the fetal and maternal system parameters within PBPK models, together with compound-related parameters used to calculate placental permeability, facilitates and extends the applications of the maternal-placental-fetal PBPK model. The developed model can also be used for designing clinical trials and prospectively used for maternal-fetal risk assessment after maternally administered drugs or unintended exposure to environmental toxicants. SIGNIFICANCE STATEMENT: This study investigates the performance of an integrated maternal-placental-fetal PBPK model to predict maternal and fetal tissue exposure of renally eliminated antibiotics that cross the placenta through a passive diffusion mechanism. The transplacental permeability clearance was predicted from the drug physicochemical properties. Results demonstrate that the PBPK approach can facilitate the prediction of maternal and fetal drug exposure simultaneously at any gestational age to support its use in the maternal-fetal exposure assessments.

Background and Purpose: Optimal antibiotic prophylaxis is crucial to prevent postoperative infection in spinal surgery. Sufficient time above the minimal inhibitory concentration (fT > MIC) for relevant bacteria in target tissues is required for cefuroxime. We assessed cefuroxime concentrations and fT > MIC of 4 μg·ml−1 for Staphylococcus aureus in the intrathecal (spinal cord and cerebrospinal fluid, CSF) and extrathecal (epidural space) compartments of the lumbar spine. Experimental Approach: Eight female pigs were anaesthetized and laminectomized at L3–L4. Microdialysis catheters were placed for sampling in the spinal cord, CSF, and epidural space. A single dose of 1500 mg cefuroxime was administered intravenously over 10 min. Microdialysates and plasma were obtained continuously during 8 h. Cefuroxime concentrations were determined by ultra-high-performance liquid chromatography. Key Results: Mean fT > MIC (4 μg·ml−1) was 58 min in the spinal cord, 0 min in the CSF, 115 min in the epidural space, and 123 min in plasma. Tissue penetration was 32% in the spinal cord, 7% in the CSF, and 63% in the epidural space. Conclusion and Implications: fT > MIC (4 μg·ml−1) and tissue penetration for cefuroxime were lower in the intrathecal compartments (spinal cord and CSF) than in the extrathecal compartment (epidural space) and plasma, suggesting a significant effect of the blood–brain barrier. In terms of fT > MIC, a single dose of 1500 mg cefuroxime seems inadequate to prevent intrathecal infections related to spinal surgery for bacteria presenting with a MIC target of 4 μg· ml−1 or above.

Pneumonia is one of the significant causes of death in developing countries, including Indonesia. As the capital of West Java, Bandung is one of the cities with the highest pneumonia cases in this province. The objective of this study was to conduct cost-minimization analysis of pneumonia treatment in Indonesia by using one of the private hospitals in Bandung as a reference case. The use of cefuroxime and ceftizoxime was considered in adult hospitalized patients. In addition, ampicillin-sulbactam and ceftriaxone usage was compared in pediatric hospitalized patients. A cross-sectional descriptive study was applied by collecting data retrospectively from medical records of adult and pediatric patients who met the inclusion criteria at one of the private hospitals in Bandung from January 2017 to December 2018. We applied the following inclusion criteria: (i) adult (> 20 years old) and pediatric (0–5 years old) patients who were diagnosed with pneumonia; and (ii) adult patients who received cefuroxime or ceftizoxime antibiotic therapy and pediatric patients who received ampicillin-sulbactam or ceftriaxone antibiotic therapy. We excluded patients who were diagnosed with any other co-morbidities and who did not complete the treatment. The result showed that drug cost was the primary contributor to total treatment cost in adult and pediatric patients. We calculated the average total treatment cost with ceftizoxime and cefuroxime in adult patients at $149.39 and $193.05, respectively, and the average total treatment cost with ampicillin-sulbactam and ceftriaxone in pediatric patients at $202.83 and $192.77, respectively. We also estimated the LoS in a group of ceftizoxime and cefuroxime in adult patients at 3.8 and 4.1 days, respectively, and the LoS in a group of ampicillin-sulbactam and ceftriaxone in pediatric patients at 3.9 and 5.3 days, respectively. In conclusion, using ceftizoxime to treat hospitalized pneumonia in adult patients would require less cost and yield shorter LoS than cefuroxime. Using ampicillin-sulbactam to treat hospitalized pneumonia in pediatric patients would require higher costs and yield shorter LoS than ceftriaxone.

O índice da resistência antimicrobiana (RAM) cresce progressivamente no mundo e acaba limitando a eficácia de tratamento de doenças comuns, como a infecção do trato urinário (ITU). Além disso, na atualidade, a RAM é apontada como um dos principais problemas de saúde pública. Diante do exposto, o objetivo do presente estudo foi avaliar a resistência bacteriana frente aos antibióticos orais mais comumente utilizados para o tratamento das ITU em pacientes ambulatoriais, bem como a identificação das bactérias isoladas. Foi realizado um estudo observacional experimental com abordagem quantitativa no período de janeiro a maio de 2019, desenvolvido em um hospital privado de alta complexidade localizado na cidade do Recife, PE. Foram incluídas no estudo todas as uroculturas positivas de pacientes adultos atendidos no ambulatório do referido hospital, onde foi utilizado, para a identificação bacteriana, o equipamento MALDI – TOF (Matrix Associated Laser Desorption-Ionization – Time of Flight). Foram analisadas um total de 379 amostras positivas de uroculturas, das quais 16 (4,2%) representavam espécies sem interesse clínico, pois obtiveram uma porcentagem de frequência muito baixa, bem como 327 (86,3%) pertenciam a três espécies de bactérias Gram-negativas: Escherichia coli (72,8%), Klebsiella pneumoniae (16,2%) e Proteus mirabilis (11%). Enquanto nas 36 (9,5%) amostras foram identificadas duas espécies Gram-positivas: Staphylococcus saprophyticus (66,7%) e Enterococcus faecalis (33,3%). Foi possível observar que o antibiótico oral com maior percentual de resistência foi o sulfametoxazol + trimetoprima com 24,5% seguido da ciprofloxacina com 22,1%, cefuroxima (16,7%), amoxicilina + clavulanato (13,0%) e nitrofurantoína (8,1%). De acordo com recomendação, é excluído o uso de antibióticos que apresentarem resistência acima de 20%, desta forma os únicos antibióticos por via oral que possui perfil terapêutico adequado para o tratamento empírico dos pacientes adultos com ITU na região do presente estudo são cefuroxima, amoxicilina + clavulanato e nitrofurantoína.

Publisher Copyright: © 2021 John Wiley & Sons Ltd Objectives Postoperative infection is the most common complication after septoplasty. Pre- or postoperative prophylactic antibiotics are commonly used, although no official guidelines exist. Design We retrospectively collected data on postoperative infections from 772 septoplasties performed in 2015, 2016 and 2018, and classified the infections according to surgical site infection (SSI) criteria by the Centers for Disease Control and Prevention (CDC). We evaluated the infections according to antibiotic use (preoperative or postoperative, both, or none) and accounted for patient and surgical confounding factors. We compared the results with three previous studies from our department to find out the trend in the occurrence of postoperative infections and in the use of antibiotics. Results Twenty-nine cases (3.8%) fulfilled CDC infection criteria. Any kind of antibiotic prophylaxis reduced the risk of SSI (p = .018). One dose of intravenous cefuroxime before incision was the most effective preventive measure (p = .045). We found no significant effect of postoperative antibiotics. However, postoperative antibiotics lowered the infection rate to 1.8% compared to 6.1% among those not treated with any antibiotics. The only other factor reducing the risk of SSI was local anaesthesia compared with general anaesthesia. Conclusion Preoperative antibiotic prophylaxis effectively reduced postoperative infection rate after septoplasty.

Dextran/Sulfodextran-graft-polyacrylamide- and polyacrylamide-based hydrogels were synthesized by radical polymerization and loaded with cefuroxime to obtain antimicrobial wound dressings. Antibiotic release from the antibiotic-loaded hydrogels into an aqueous solution was studied by the HPLC-UV method. It is shown that cefuroxime-loaded Dextran/Sulfodextran-graft-polyacrylamide hydrogels release the antibiotic more slowly compared to polyacrylamide hydrogel with the same density of cross-links. Antibacterial activity of the synthesized materials was tested in vitro against wild strains of S. aureus, E. coli, and Klebsiella spp. The possibility of using the obtained antimicrobial hydrogels for the treatment of infected wounds was confirmed in vivo in a rat model.

Intracameral cefuroxime has been associated with postoperative macular edema and sub-retinal fluid. To date, nearly all published cases are attributed to errors in antibiotic dilution, leading to administration of supratherapeutic doses. We report three cases of postoperative macular edema and subretinal fluid following a standard dose of 1 mg/0.1 mL of cefuroxime at the end of cataract surgery. Distinguishing features of these cases were intraoperative zonular instability and history of vitrectomy. We hypothesize that certain factors may increase the risk of cefuroxime-associated retinal toxicity, including history of vitrectomy, zonular compromise, posterior capsular break, surgery for a secondary intraocular lens, and unicameral state. [ Ophthalmic Surg Lasers Imaging Retina . 2021;52:615–618.]

Deodorants are substances formulated for the purpose of eliminating armpit odor but not perspiration. They typically consist of alcohol. When applied, they make the skin acidic, preventing the proliferation of bacteria. This study was carried out with the aim of evaluating the effects of deodorant on microflora of the armpit. The study lasted for one month which was divided into two phases; Phase one consist of two weeks without deodorant usage and phase two consist of two weeks of deodorant usage. Axillae swabs were collected from 20 female students of the University of Benin. Samples were cultured and incubated at 37 °C both aerobically and anaerobically for 24 - 48 hours on Chocolate, Blood and MacConkey agars. The brand of deodorant used was 'Bouquet Deodorant'. Antibiotic susceptibility test was done on nutrient agar using the disc diffusion method of Bauer and Kirby. The isolates identified consist of Staphylococcus albus which was the predominant organism and accounted for 52.4 % and 50 % of the bacteria isolates for the first and second weeks respectively. Other bacteria isolated include Staphylococcus aureus (42.9 % and 46.1 %) and Klebsiella spp. (4.7 % and 3.9 %) respectively for the successive two weeks. All the isolates showed some degree of susceptibility to impenem, gentamycin, ofloxacin, erythromycin, cloxacilin, amoxilillin and clavulanate. Staphylococcus aureus and Klebsiella showed some degree of susceptibility to cefuroxime while Staphylococcus albus was resistant. All the isolated showed some degree of susceptibility to ciprofloxicin while Staphylococcus aureus was resistant. The axillary microflora, predominantly Gram-positive cocci showed a sustained reduction during two weeks usage of deodorant and Gram-negative bacteria were, in general, eliminated.

On the first of January 2019, the European Committee on Antimicrobial Susceptibility Testing, EUCAST, introduced the concept of "area of technical uncertainty" (ATU). The aim was to report on the incidence of ATU test results in a selection of common bacterial species and the subsequent impact on antimicrobial resistance categorization and workload. A retrospective analysis of clinical samples collected from February 2019 until November 2019 was performed. Susceptibility to amoxicillin-clavulanic acid and piperacillin-tazobactam in Enterobacterales (Escherichia spp., Klebsiella spp., Proteus spp.), piperacillin-tazobactam in Pseudomonas aeruginosa, and amoxicillin-clavulanic acid and cefuroxime in Haemophilus influenzae was studied. Disk diffusion antibiotic susceptibility testing was read and interpreted by ADAGIO 93400 automated system (Bio-Rad, France). In case of an inhibition zone in the ATU, strains were retested using gradient minimal inhibitory concentration method (Etest, BioMerieux, France). Overall, 14,164 isolate-antibiotic combinations were tested in 7922 isolates, resulting in 1204 (8.5%) disk zone diameters in the ATU region. Retesting of ATUs with Etest resulted in a category change from S to R for amoxicillin-clavulanic acid in 63/498 (12.7%) of Escherichia spp., 2/58 (3.4%) of Klebsiella spp., 2/37 (5.4%) of Proteus spp., and 6/125 (4.8%) of Haemophilus influenzae. For piperacillin-tazobactam, a category change from S to R was found in 33/92 (35.9%) of Pseudomonas aeruginosa. We conclude that ATU testing has a substantial impact on the correct interpretation of antimicrobial resistance, at the expense of turn-around time and with the cost of additional workload.

Background: The upper respiratory infections cause considerable morbidity mainly in children due to the fact that they mainly affect children. Accordingly, a study was conducted on antibiotics to compare the effectiveness of clarithromycin, cefuroxime, and levofloxacin for treating upper respiratory tract infections (URTI) in children. Methods: A prospective observational study for a period of 6 months was conducted in the pediatrics department of RVM hospital. Outpatients under the age of 14 years given antibiotics for the treatment of URTI were included in the study. A total of 99 study subjects were included in the study, divided into three groups each containing 33 sample sizes (clarithromycin, cefuroxime, and levofloxacin). Patient data was collected using a form and verbal consent was obtained from patients/patient representatives, and drugs were given using the lottery method. Follow-up was done and noted for the 3rd, 5th, 7th day through telephonic calls, and the collected data were evaluated using statistical analysis. Results: Pool data from 99 patients shows that many patients belong to 0–5 years age groups (age distribution), and males were more than female (gender distribution). Clarithromycin (cure rate 3 days) and cefuroxime (cure rate 5 days) showed an equal rate of cure percentage (94%), while levofloxacin for 3–5 days with a 3% failure rate. A significant difference of p

BACKGROUND Diagnosis and treatment of influenza patients are often provided across several medical specialties. We compared patient outcomes at an infectious diseases (ID), a rheumatology (Rheu) and a pulmonology (Pul) department. MATERIAL AND METHODS In this prospective observational multicenter study we included all influenza positive adults who were hospitalized and treated at flu isolation wards in three hospitals in Vienna during the season 2018/2019. RESULTS A total of 490 patients (49% female) with a median age of 73 years (interquartile range [IQR] 61-82) were included. No differences regarding age, sex and most underlying diseases were present at admission. Frequencies of the most common complications differed: acute kidney failure (ID 12.7%, Rheu 21.2%, Pulm 37.1%, p

Background and purpose - Tourniquet is widely used in orthopedic surgery to reduce intraoperative bleeding and improve visualization. We evaluated the effect of tourniquet application on peri- and postoperative cefuroxime concentrations in subcutaneous tissue, skeletal muscle, calcaneal cancellous bone, and plasma. The primary endpoint was the time for which the free cefuroxime concentration was maintained above the clinical breakpoint minimal inhibitory concentration (T > MIC) for Staphylococcus aureus (4 mu g/mL). Patients and methods - 10 patients scheduled for hallux valgus or hallux rigidus surgery were included. Microdialysis catheters were placed for sampling of cefuroxime concentrations bilaterally in subcutaneous tissue, skeletal muscle, and calcaneal cancellous bone. A tourniquet was applied on the thigh of the leg scheduled for surgery (tourniquet duration time [range]: 65 minutes [58-77]). Cefuroxime (1.5 g) was administered intravenously 15 minutes prior to tourniquet inflation, followed by a second dose 6 hours later. Dialysates and venous blood samples were collected for 12 hours. Results - A cefuroxime concentration of 4 mu g/mL was reached within 23 minutes in all compartments and patients. For cefuroxime the T > MIC (4 mu g/mL) ranged between 4.8 and 5.4 hours across compartments, with similar results for the tourniquet and non-tourniquet leg. Comparable T > MIC and penetration ratios were found for the first and second dosing intervals. Interpretation - Administration of cefuroxime (1.5 g) 15 minutes prior to tourniquet inflation is safe in order to achieve tissue concentrations above 4 mu g/mL throughout surgery. A tourniquet application time of approximately 1 hour did not affect the cefuroxime tissue penetration in the following dosing interval.

Objectives Compared to cephalosporin-based prophylaxis, ertapenem prophylaxis lowers the risk of surgical site infection among carriers of extended-spectrum β-lactamase-producing Enterobacterales (ESBL-PEs) undergoing colorectal surgery. We aimed to determine whether ertapenem prophylaxis leads to increased postoperative colonization with carbapenem-resistant Enterobacterales (CREs) and third-generation-cephalosporin-resistant Enterobacterales (3GCR-Es). Methods This study was nested within a quality improvement study of prophylaxis for ESBL-PE carriers undergoing colorectal surgery. Patients were screened 4–6 days after surgery for carriage of ESBL-PEs or other 3GCR-Es and CREs. When CREs were detected, pre- and postsurgical clones were compared using Fourier-transform infrared (FT-IR) spectroscopy. Results The sample consisted of 56 patients who carried ESBL-PEs before surgery and received cefuroxime/metronidazole prophylaxis (Group 1), 66 who carried ESBL-PEs before surgery and received ertapenem (Group 2), and 103 ESBL-PE non-carriers who received cefuroxime/metronidazole prophylaxis (Group 3). CRE carriage was detected postoperatively in one patient (1.5%) in Group 2 versus eight patients (14.3%) in Group 1 (RD –12.8%; 95%CI –22.4% to –3.1%). For seven out of nine patients, preoperative ESBL-PE and postoperative CRE isolates were compared; in five of them, the pre- and postoperative clones were identical. Postoperative 3GCR-E carriage was detected in 37 patients (56.1%) in Group 2 versus 46 patients in Group 1 (82.1%) (aRD –20.7%, 95%CI –37.3% to –4.1%). Conclusions Among ESBL-PE carriers undergoing colorectal surgery, detection of short-term postsurgical colonization by CREs and 3GCR-Es was significantly lower among patients who received ertapenem prophylaxis than those who received cephalosporin–metronidazole prophylaxis. Resistance development in a colonizing bacterial clone, rather than carbapenemase acquisition, was the major mechanism of carbapenem resistance.

Purpose This study set out to determine the antimicrobial resistance trends of Haemophilus influenzae isolates from pediatric hospitals in Mainland China, which would provide basis for clinical treatment. Methods The Infectious Disease Surveillance of Pediatrics (ISPED) collaboration group conducted this study. H. influenzae strains isolated from nine pediatric hospitals in Mainland China were included. Disk diffusion method was used for antimicrobial susceptibility test. Cefinase disc was used for detection of β-lactamase. Results In total, 13810 H. influenzae isolates were included during 2017–2019: 93.17% of which were from respiratory tract specimens, 4.63% from vaginal swabs, 1.10% from secretion, and 1.10% from others. Of all strains, 63.32% isolates produced β-lactamase; 8.22% isolates were β-lactamase-negative and ampicillin-resistant (BLNAR). The resistance to sulfamethoxazole-trimethoprim was 70.98%, followed by resistance to ampicillin (69.37%), cefuroxime (51.35%), ampicillin-sulbactam (38.82%), azithromycin (38.21%), amoxicillin-clavulanate (35.28%). More than 90% of H. influenzae isolates were susceptible to ceftriaxone, cefotaxime, meropenem, levofloxacin and chloramphenicol. The resistance rate of ampicillin and azithromycin in H. influenzae showed an increasing trend through the years. Statistically significant differences in antibiotic-resistance rates of all the antibiotics except chloramphenicol were found in different regions. The major Multi-Drug Resistance pattern was resistant to β-lactams, macrolides, and sulfonamides. Conclusions There is a rising trend of resistance rate of ampicillin and azithromycin in H. influenzae. Antimicrobial resistance of H. influenzae deserves our ongoing attention. Third-generation cephalosporin could be the preferred treatment option of infections caused by ampicillin-resistant H. influenzae.

Background and Objectives: Acinetobacter baumannii, a notorious opportunistic pathogen known to seriously affect debilitated individuals especially intensive care unit (ICU) patients and others with underlying illness, have consistently jeopardized many antibiotics. This study was therefore aimed to ascertain the antimicrobial susceptibility profile and molecularly identify A. baumannii pathogens in Alex Ekwueme-Federal University Teaching Hospital, Abakaliki, Nigeria. Methodology: A total of 385 clinical samples were collected aseptically from debilitated patients and analyzed following standard microbiological procedures. Acinetobacter species was confirmed by Gram staining reaction and biochemical tests. All bacterial isolates were phenotypically screened for multidrug resistance using the Kirby–Bauer disc diffusion technique and results interpreted as per CLSI criteria. A. baumannii isolates were finally confirmed using 16S rRNA sequencing. Results: A total of 23(6%) A. baumannii isolates were recovered from 385 clinical samples collected from 87 patients comprising 48 males and 39 females admitted in various hospital wards of AE-FETHA. The age of the patients varied from 20–79 years. The commonest sites for isolation of A. baumannii pathogen were catheter urine (8/8%) and wound sores (7/8%). The highest percentage resistance was observed with cefuroxime (96%), tetracycline (96%), sulfamethoxazole/trimethoprim (96 %), and ofloxacin (91%) while meropenem (91%) and imipenem (78%) were the most effective antibiotics against A. baumannii. The isolated A. baumannii was re-confirmed genotypically by 16S rRNA gene amplification. Variations were observed in the gene sequence of all the isolated A. baumannii. Conclusion: Catheter urine, wound sores, and respiratory fluids were the more easily colonized samples. Also, high frequency of multidrug resistance observed in this study further established A. baumannii as a notorious opportunistic pathogen.

У роботі розглядаються проблеми етіології інфекцій сечовивідної системи в дітей, а також антибактеріальної резистентності клінічних штамів збудників даної патології. Встановлено, що основними збудниками інфекцій сечовивідної системи в дітей виступали грамнегативні палички роду Enterobacteriaceae. Проведений аналіз антибіотикограм показав, що на сучасному етапі стартовим антибактеріальним препаратом для емпіричної терапії інфекцій сечовивідної системи в дітей є цефало­спорини ІІ покоління.

Methicillin-resistant Staphylococcus aureus (MRSA) strains pose major treatment challenges due to their innate resistance to most β-lactams under standard

BACKGROUND AND PURPOSE: Minimally invasive spine surgery has continuously evolved for specific surgical procedures and patient populations to lower morbidity and the risk of postoperative bacterial infection. Perioperative antibiotic prophylaxis is an important preventive measure and local tissue concentrations can be quantified with microdialysis. Insertion of spinal implants induces tissue trauma and inflammation, which may affect antibiotic proximate implant concentrations. We compared perioperative cefuroxime concentrations inside a cannulated pedicle screw used in minimally invasive spine surgery with the opposite non-instrumented vertebral pedicle.MATERIALS AND METHODS: Microdialysis catheters were placed inside a cannulated pedicle screw and in the opposite non-instrumented vertebral pedicle of the same vertebra (L1) in 8 female pigs through a posterior lumbar surgical approach. Following a single-dose intravenous cefuroxime administration (1.5 g), dialysates and plasma were dynamically sampled over 8 hours. The primary endpoint was time above the cefuroxime clinical breakpoint minimal inhibitory concentration for Staphylococcus aureus of 4 μg/mL (T>MIC4).RESULTS: Median T>MIC4 was 0 h (range 0-0) inside the cannulated pedicle screw, 1.6 h (range 1.1-2.4) in non-instrumented vertebral pedicle, and 1.9 h (range 1.9-2.9) in plasma.CONCLUSION: A single-dose intravenous cefuroxime administration provided low and subtherapeutic concentrations for prevention of infection inside a cannulated pedicle screw in the lumbar spine. Therapeutic concentrations were achieved in the opposite non-instrumented vertebral pedicle up to 1.5-2 h. Therefore, additional prophylactic strategies may be considered in cannulated instrumented spine surgery, especially in high-risk patients. Alternative dosing regimens seem relevant in lumbar spine surgery lasting longer than 1.5 h.

To reveal optimal antibiotic prophylactic regimen for postoperative endophthalmitis (POE), we conducted systematic review and network meta-analysis. A total of 51 eligible original articles, including two randomized controlled trials, were identified. In total, 4502 POE cases occurred in 6,809,732 eyes (0.066%). Intracameral injection of vancomycin had the best preventive effect (odds ratio [OR] 0.03, 99.6% confidence interval [CI] 0.00–0.53, corrected P-value = 0.006, P-score = 0.945) followed by intracameral injection of cefazoline (OR 0.09, 99.6% CI 0.02–0.42, corrected P-value

Introduction. Peritonsillar abscess (PTA) is a common infection which requires surgical intervention and suitable antibiotic therapy. Hypotheses/Gap Statement. Beside Streptococcus pyogenes and Fusobacterium necrophorum several other mostly anaerobic bacteria can be cultured from the properly taken pus samples of PTA, the clinical significance of which is still not fully understood. Aim. This study focused on the culture-based microbiological evaluation of PTA cases, compared to surgical intervention and empirical antibiotic management. Methodology. A retrospective analysis of PTA cases was performed between 2012 and 2019. Data about the aerobic and anaerobic culture results of the samples taken during different surgical interventions were summarized and the coverage of the empirically selected antibiotics was evaluated. The patient’s history, the development of complications and the recurrence rate were also evaluated. Results. The microbiological culture results were available for 208 of 320 patients with clinically diagnosed PTA. Incision and drainage (I and D) and immediate tonsillectomy were the leading surgical interventions. Ninety-five Fusobacterium species (including 44 Fusobacterium necrophorum ), 52 Actinomyces species and 47 Streptococcus pyogenes were obtained from PTA samples alone or together with polymicrobial flora. S. pyogenes (33.7 %, n=28) and F. necrophorum (22.9 %, n=19) were the dominating pathogens in the 83 monobacterial PTA samples. In >60 % of the patients polymicrobial infection was demonstrated, involving a great variety of anaerobic bacteria. In 22 out of 42 cases where intravenous cefuroxime was empirically started, the therapy should be changed to properly cover the culture-proven anaerobic flora. There were no serious complications, abscess recurrence was detected in two cases (0.96 %). Conclusion. PTAs are often polymicrobial infections including a great variety of anaerobes. Targeted antibiotic therapy, in conjunction with adequate surgical drainage eliminating the anaerobic milieu, can accelerate the healing process and radically reduce the complication and recurrence rate.

Bioactive forms of oral β-lactams were screened in vitro against Mycobacterium abscessus with and without the bioactive form of the oral β-lactamase inhibitor avibactam-ARX1796. Sulopenem was equally active without avibactam, while tebipenem, cefuroxime and amoxicillin required avibactam for optimal activity. Systematic pairwise combination of the four β-lactams revealed strong bactericidal synergy for each of sulopenem, tebipenem and cefuroxime combined with amoxicillin in the presence of avibactam. These all-oral β-lactam combinations warrant clinical evaluation.

With the emergence of the new SARS-CoV-2 virus, drug repurposing studies have gained substantial importance. Combined with the efficacy of recent improvements in ligand- and target-based virtual screening approaches, virtual screening has become faster and more productive than ever. In the current study, an FDA library of approved drugs and compounds under clinical investigation were screened for their antiviral activity using the MetaCoreTM/MetaDrugTM (https://portal.genego.com) platform's antiviral therapeutic activity binary QSAR model. In the 6733-compound collection, we found 370 compounds with a normalized therapeutic activity value greater than a cutoff of 0.75. Only these selected compounds were used for molecular docking studies against the SARS-CoV-2 Main Protease (Mpro). After initial short (10 ns) molecular dynamics (MD) simulations with the top-50 docked compounds and following Molecular Mechanics Generalized Born Surface Area (MM/GBSA) calculations, top-10 compounds were subjected to longer (100 ns) MD simulations and end-point MM/GBSA estimations. Our virtual screening protocol yielded Cefuroxime pivotexil, an ester prodrug of second-generation cephalosporin antibiotic Cefuroxime, as being a considerable molecule for drug repurposing against the SARS-CoV-2 Mpro.

Background Narrow-spectrum antibiotics are recommended as the first-line therapy for management of children hospitalized with community-acquired pneumonia (CAP). There are limited data evaluating the antibiotic prescription patterns for CAP in Saudi Arabia. The goal of this study to report on the antibiotic patterns in children hospitalized with CAP. Methods A prospective cross-sectional study was conducted in children aged 1 month to 13 years who were hospitalized with a diagnosis of CAP at King Khalid Hospital in Majmaah, Saudi Arabia, between January 2019 and January 2020. Results Data from 233 patients were collected. The majority of patients received amoxicillin clavulanate (57.9%), followed by ceftriaxone (30%), azithromycin (20.6%), cefuroxime (6%), ampicillin (2.1%), and piperacillin-tazobactam (2.1%). None of our patients were started on narrow-spectrum therapy. The younger age group (1-3 months) and patients with severe pneumonia were more likely to receive broad-spectrum cephalosporin and have a longer hospital stay (P = .000 and P = .002, respectively). However, the 4 months to 5 years age group was more likely to receive amoxicillin clavulanate (P = .001). Male gender was a significate risk factor for patients with severe pneumonia (P=.013) Conclusions We demonstrated the inappropriate use of broad-spectrum therapy in children hospitalized with CAP. Further large multicenter studies are necessary to evaluate the patterns of antibiotic use and implement antimicrobial stewardship programs or quality-improvement projects to improve adherence to guidelines.

BACKGROUND: The purpose of the study was to investigate the effects of cefuroxime axetil combined with Xingpi Yanger granules on the treatment of upper respiratory tract infection accompanied by diarrhea and on serum gastrin (GAS), motilin (MOT), and somatostatin (SS) levels in children. METHODS: In total, 124 children with upper respiratory tract infection accompanied by diarrhea admitted to the department of pediatrics in our hospital from May 2019 to May 2020 were selected and divided into a study group (n=62) and a reference group (n=62), according to admission number. The reference group children received routine treatment, while the children in the study group were treated with cefuroxime axetil combined with Xingpi Yanger granules. After treatment, each clinical index of the children in both groups was detected to evaluate the clinical efficacy of the different treatment methods. RESULTS: There were no significant differences in gender ratio, average age, mean body temperature, mean duration of diarrhea, average weight, or place of residence between the 2 groups (P>0.05); the total clinical effective rate after treatment in the study group was significantly higher than that in the reference group (P

Objective: This study was carried out to evaluate the efficacy and prescribing pattern of antibiotics in the skin and skin structure infections (SSTIs) at tertiary care teaching hospital. Methods: In this prospective observational study, an attempt was made to evaluate the efficacy and prescribing pattern of antibiotics. Subjects were selected according to the inclusion and exclusion criteria and patient case sheets were analyzed for patient demographic details, results of physical examination and laboratory parameters, and prescription pattern. Results: Cellulitis was the most common skin and skin structure infection among the subjects, followed by an ulcer. Few patients showed discomforts such as pain, swelling, and purulent discharge. Surgical procedure has been done in 76 patients. Out of 99 patients, 11 patients showed a prolonged length of stay (LOS) (≥16 d), which is an indication of the poor efficacy of antibiotics. Intravenous to oral antibiotic therapy switch was seen in 47 patients, which indicates that the patient’s condition was improved. The mean length of hospital stay was 8.79 d. The majority of patients have been discharged within 15 d. Cephalosporins were the most frequently prescribed class of antibiotics in patients with skin and soft tissue infections. Metronidazole was the most frequently used antibiotic as monotherapy followed by cefuroxime. Piperacillin+Tazobactam was the most frequently used combination antibiotic. This study finds that the antibiotic treatment was efficacious in the majority of the patients. Conclusion: This study finds that the antibiotic treatment was efficacious in the majority of the patients.

Approved, basic and taken a toll successful spectroscopic strategies (spectrophotometric and spectrofluorimetric) were created for the measure of seven cephalosporins to be specific; cefpiramide (I), cefuroxime (II), cefoxitin (III), ceftazidime (IV), cefpirome (V), ceftabiprole (VI) and ceftriaxone (VII). The most guideline of these strategies is twofold complex arrangement through the response of the drugs amino bunch with Eosin Y (EY). The examined drugs were decided spectrophotometrically at 542-550 nm in acetic acid derivation buffer. The examined drugs were encourage decided spectrofluorimetrically by measuring their extinguishing impact on the EY local fluorescence at 545 nm after excitation at 305 nm. The absorbance-concentration charts were rectilinear over the ranges of (20-100), (10-130), (20-220), (30-230), (10-210), (20-180) and (10-130) μg mL-1 for I, II, III, IV, V, VI and VII, individually. The fluorescence-concentration charts were rectilinear over the ranges (0.5-1.5), (0.1-0.9), (0.3-1.5), (0.5-2.5), (0.1-0.9), (0.5-2.5) and (0.1-1.0) μg mL-1 for I, II, III, IV, V, VI and VII, respectively. The recommended comes about have been certified concurring to ICH controls and were connected for examination of the considered drugs in dose shapes and human plasma tests. The approved comes about were acknowledged compared to reference strategies.

The aim of this study was to evaluate the antimicrobial activity of twenty-five Plastoquinone analogs synthesized previously in a panel of seven bacterial strains (three Gram-positive and four Gram-negative bacteria) and three fungi. PQ1, which does not contain any substituent(s) on the phenyl ring, was the most potent compound against Staphylococcus epidermidis (8-fold more potent than Cefuroxime, MIC = 1.22 μg/mL). The antifungal profile of all Plastoquinone analogs indicated that three analogs (PQ1, PQ2, and PQ7) displayed the best antifungal activity against Candida albicans, which was about the same activity with the reference standard (MIC = 4.88 μg/mL). The structure-activity relationship study was also carried out to reveal important chemical features. After probing twenty-five Plastoquinone analogs for a potential antimicrobial lead structure, two analogs (PQ1 and PQ25) were selected for further investigation for biofilm evaluation. Based on the tests performed, there was a significant positive correlation between inhibition of the biofilm attachment and time. The results showed that both analogs (PQ1 and PQ25) are able to reduce biofilm mass. Finally, these findings endorse us further efforts to optimize two phenotypes of the Plastoquinone analogs (PQ1 and PQ25) to develop potential antimicrobial drug candidates.

The aim of this study was to determine the resistance patterns and ESBLs production among clinical isolates of Escherichia coli and Klebsiella pneumoniae in two government hospitals of Delta State, Nigeria. Urine, blood and wound samples were aseptically collected from hospitalized patients, bacteriologically processed and isolates identified using standard protocols. Antimicrobial susceptibility testing was determined by disc diffusion method. The plasmid DNA of Multidrug resistance (MDR) isolates were extracted by alkaline lysis method. Phenotypic ESBL production of the MDR isolates was done by Double Disc Synergy Test (DDST) while PCR was used to detect blaCTX-M, blaSHV and blaTEM among isolates. A total of 217 isolates were obtained, of which 161(74.2%) and 56(25.8%) were Escherichia coli and Klebsiella pneumoniae respectively. The antimicrobial resistance varied from one location to another. All isolates obtained from blood of general hospital Warri (GHW) were 100% resistant to amoxicillin clavulanic acid and the cephalosporins (ceftazidime, cefotaxime, and cefuroxime). Isolates from General hospital Agbor (GHA) showed high resistance of 75.0% to cefotaxime, 93.8% to each of ceftazidime and cefuroxime. Overall low resistance to nitrofurantoin was observed in E. coli isolates obtained from urine of GHW (27.5%) and GHA (20.8%). Out of 217 isolates, 75.1% (163/217) were MDR, of which 36.8% and 39.3% produced ESBL by DDST and PCR respectively. The most common ESBL gene was blaCTX-M expressed by 28(17.2%) of the isolates. The high prevalence of MDR and ESBL underscores the need for a continuous local monitoring of antibiotic resistance.

Bloodstream infections (BSIs) adversely affect clinical outcome in children with cancer. Over 1 decade, this retrospective cohort study describes pathogen distribution in BSIs and antimicrobial susceptibility against empirical antibiotics frequently prescribed in children with cancer. The antibiotic efficacy was evaluated through the determination of minimal inhibitory concentrations for piperacillin-tazobactam and meropenem and by disk diffusion for remaining antibiotics. From 2004 to 2013, 398 BSIs occurred in 196 children with cancer (median age: 5.4 y), resulting in 457 bacteria. Overall, 266 (58.2%) were gram-positive, and 191 (41.8%) were gram-negative with a significant gram-positive increase over time (P=0.032). Coagulase-negative staphylococci (74, 16.2%), viridans group streptococci (67, 14.7%), Escherichia coli (52, 11.4%), and Staphylococcus aureus (39, 8.5%) were the most common pathogens. Susceptibility to piperacillin-tazobactam (95.9%, P=0.419) and meropenem (98.9%, P=0.752) was stable over time, and resistance was observed among viridans group streptococci against piperacillin-tazobactam (18%) and meropenem (7%) and among Enterobacterales against piperacillin-tazobactam (3%). Vancomycin showed 98% gram-positive activity, gentamicin 82% gram-negative activity and ampicillin, cefotaxime, and cefuroxime were active in 50%, 72%, and 69% of pathogens, respectively, and BSI-related mortality was 0%. In conclusion, over 1 decade, we report an increase in gram-positive BSIs, and stable, low-resistance rates against currently recommended empirical antibiotics, piperacillin-tazobactam and meropenem.

Ertapenem, cefepime, imipenem, ofloxacin, ceftazidime, clarithromycin, cefaclor, levofloxacin, linezolid, moxifloxacin, azithromycin, piperacillin–tazobactam, trimethoprim–sulfamethoxazole, metronidazole, ciprofloxacin, and cefuroxime are known to be associated with delirium. Other antibiotics may also lead to delirium, but no study has systemically compared delirium associations for many available antibiotics. The objective of this study was to evaluate the association between delirium and antibiotics using the FDA Adverse Event Reporting System (FAERS). FAERS reports from January 1, 2004 to December 31, 2018 were included in the study. Reporting odds ratios (RORs) and corresponding 95% confidence intervals (95% CI) for the association between antibiotics and delirium were calculated. An association was considered to be statistically significant when the lower limit of the 95% CI was greater than 1.0. A total of 10,015,622 reports (including 16,982 delirium reports) were considered, after inclusion criteria were applied. Statistically significant delirium RORs (95% CI) for antibiotics were: ertapenem 21.07 (16.38–27.10), cefepime 9.8 (6.37–15.09), imipenem 9.68 (6.75–13.89), ofloxacin 7.73 (4.00–14.92), ceftazidime 6.09 (2.73–13.62), clarithromycin 5.34 (4.37–6.53), cefaclor 5.32 (1.71–16.58), ampicillin–sulbactam 4.49 (2.13–9.45), levofloxacin 4.47 (3.88–5.16), linezolid 4.33 (3.28–5.72), moxifloxacin 3.51 (2.81–4.38), azithromycin 2.76 (2.09–3.64), piperacillin–tazobactam 2.41 (1.47–3.93), trimethoprim–sulfamethoxazole 2.36 (1.61–3.47), metronidazole 1.85 (1.31–2.60), ciprofloxacin 1.83 (1.44–2.33), and cefuroxime 1.81 (1.03–3.20). This study found statistically significant increased risk of reporting delirium with ertapenem, cefepime, imipenem, ofloxacin, ceftazidime, clarithromycin, cefaclor, ampicillin–sulbactam, levofloxacin, linezolid, moxifloxacin, azithromycin, piperacillin–tazobactam, trimethoprim–sulfamethoxazole, metronidazole, ciprofloxacin, and cefuroxime.

Background Oral beta-lactam antimicrobials are not routinely tested against Streptococcus pneumoniae due to presumed susceptibility based upon penicillin minimum inhibitory concentration (MIC) testing. Currently, Clinical and Laboratory Standards Institute provides comments to use penicillin MIC ≤0.06 to predict oral cephalosporin susceptibility. However, no guidance is provided when cefotaxime MIC is known, leading to uncertainty with interpretation. The purpose of this study was to evaluate cefotaxime and penicillin MICs and their respective correlation to oral beta-lactam categorical susceptibility patterns. Methods 249 S. pneumoniae isolates were identified by matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-ToF) and then tested by broth microdilution method to penicillin, cefotaxime, amoxicillin, cefdinir, cefpodoxime, and cefuroxime. Results Using Clinical and Laboratory Standards Institute (CLSI) non-meningitis breakpoints for cefotaxime, 240/249 isolates were classified as susceptible. Of the cefotaxime susceptible isolates, 23% of the isolates are misrepresented as cefdinir susceptible. Amoxicillin correlated well with penicillin MIC breakpoints with only 1 discordant isolate out of 249. Conclusion The correlation between amoxicillin and penicillin creates a very reliable predictor to determine categorical susceptibility. However oral cephalosporins were not well predicted by either penicillin or cefotaxime leading to the possible risk of treatment failures. Caution should be used when transitioning to oral cephalosporins in cefotaxime susceptible isolates, especially with higher cefotaxime MICs.

Purpose To estimate the association of cefuroxime and moxifloxacin in relation to the occurrence of endophthalmitis following phacoemulsification cataract surgery. Design Retrospective clinical cohort study. Methods We studied patients with noncomplex phacoemulsification cataract surgery in Kaiser Permanente Northern California during 2014-2019. Data were obtained for acute, postoperative endophthalmitis within 90 days of phacoemulsification, including culture and antibiogram results, intracameral and topical antibiotic agent, and dose. In a post hoc analysis, we also examined preoperative anterior chamber depth (ACD) and postoperative anterior chamber volume (ACV). Results Of 216,141 surgeries, endophthalmitis occurred in 0.020% of moxifloxacin-injected eyes and 0.013% of cefuroxime eyes (relative risk 1.62 with 95% CI 0.82-3.20, P = .16). Of the 34 (0.016%) cases of endophthalmitis, cefuroxime 1 mg was injected into 13 eyes and moxifloxacin 0.1% into 21 eyes. Organisms with antibiograms were identified in 12 (35%) cases. Of these, bacteria recovered from cefuroxime-injected eyes were resistant to cefuroxime in all cases (4/4), with Enterococcus comprising half of these. In eyes injected with moxifloxacin 0.1%, 6 out of 7 organisms were sensitive to moxifloxacin injected with 0.1 mL and in 1 eye injected with 1 mL. Streptococcus was the most common organism recovered (6/9) in moxifloxacin-injected eyes. Preoperative ACD and postoperative calculated ACV were higher in eyes injected with moxifloxacin. Conclusions Endophthalmitis cases with positive cultures were generally related to organism resistance in cefuroxime eyes but to sensitive organisms in moxifloxacin eyes. Moxifloxacin doses may have been insufficient in eyes with larger ACV.

Antimicrobial resistance is a hidden threat lurking behind the COVID-19 pandemic which has claimed thousands of lives prior to the emergence of the global outbreak. With a pandemic on the scale of COVID-19, antimicrobial resistance has the potential to become a double-edged sword with the overuse of antibiotics having the potential of taking us back to the pre-antibiotic era. Antimicrobial resistance is majorly attributed to widespread and unnecessary use of antibiotics, among other causes, which has facilitated the emergence and spread of resistant pathogens. Our study aimed to conduct a rapid review of national treatment guidelines for COVID-19 in 10 African countries (Ghana, Kenya, Uganda, Nigeria, South Africa, Zimbabwe, Botswana, Liberia, Ethiopia, and Rwanda) and examined its implication for antimicrobial resistance response on the continent. Our findings revealed that various antibiotics, such as azithromycin, doxycycline, clarithromycin, ceftriaxone, erythromycin, amoxicillin, amoxicillin-clavulanic acid, ampicillin, gentamicin, benzylpenicillin, piperacillin/tazobactam, ciprofloxacin, ceftazidime, cefepime, vancomycin, meropenem, and cefuroxime among others, were recommended for use in the management of COVID-19. This is worrisome in that COVID-19 is a viral disease and only a few COVID-19 patients would have bacterial co-infection. Our study highlighted the need to emphasize prudent and judicious use of antibiotics in the management of COVID-19 in Africa.

Purpose To evaluate the clinical characteristics and investigate the role of surgical antibiotic prophylaxis (SAP) in acute endophthalmitis cases after cataract surgery. Design Retrospective, consecutive case series. Participants A total of 126 patients referred to a tertiary center from 2007 to 2015 for acute endophthalmitis after unilateral cataract surgery. Methods All patients who underwent a vitreous biopsy were included. Clinical and microbiology data were reviewed, and associations with visual outcome were analyzed using multivariate logistic regression. Data regarding SAP via intracameral injection were also retrieved. Main Outcome Measures Bacterial culture results and visual acuity outcome. Results Bacterial growth was observed in 92 of 126 cases (73%). Among these positive cultures, 49 (53.3%), 29 (31.5%), and 13 (14.1%) were coagulase-negative staphylococci, other gram-positive, and gram-negative bacteria, respectively. Among the 77 gram-positive strains tested, 76 (98.7%) were vancomycin-sensitive; among the 12 gram-negative strains tested, all 12 (100%) were ceftazidime-sensitive. Best achieved visual acuity outcome was ≥20/40 Snellen in 77 of 114 cases (67.5%). On multivariate analysis, we found an association between visual outcome of worse than 20/40 Snellen and a positive culture of more virulent bacteria (gram-negative and other gram-positive groups) and presentation with light perception or worse, with an odds ratio of 3.3 and 3.0, respectively. A subgroup of 25 cases (19.8%) developed endophthalmitis despite receiving a SAP by cefuroxime at the end of cataract surgery. Conclusions Two-thirds of the patients in this endophthalmitis cohort experienced a visual outcome of ≥20/40 Snellen. Efficacy of primary treatment with vancomycin combined with ceftazidime is supported by this study. A subgroup treated prophylactically with cefuroxime demonstrated that SAP alone does not prevent endophthalmitis. This highlights the importance of surgical factors in the prevention of postoperative endophthalmitis.

It is important for clinicians to consider exposure to toxic substances and nutritional deficiencies when diagnosing and managing cases of vision loss. In these cases, physiologic damage can alter the function of key components of the visual pathway before morphologic changes can be detected by traditional imaging methods. Electrophysiologic tests can aid in the early detection of such functional changes to visual pathway components, including the retina or optic nerve. This review provides an overview of various electrophysiologic techniques, including multifocal electroretinogram (mfERG), full-field ERG (ffERG), electrooculogram (EOG), pattern electroretinogram (PERG), and visual evoked potential (VEP) in monitoring the retinal and optic nerve toxicities of alcohol, amiodarone, cefuroxime, cisplatin, deferoxamine, digoxin, ethambutol, hydroxychloroquine, isotretinoin, ocular siderosis, pentosane, PDE5 inhibitors, phenothiazines (chlorpromazine and thioridazine), quinine, tamoxifen, topiramate, vigabatrin, and vitamin A deficiency.

Increasing trends in antimicrobial resistance among uropathogens call for rational use of empirical antibiotics for managing uncomplicated urinary tract infections (UTIs). In Ghana, standard treatment guidelines (STGs) for UTI recommend oral ciprofloxacin or cefuroxime for 5–7 days in females and 10–14 days in males. We conducted a cross-sectional audit using electronic medical records (EMR) to assess compliance to the STGs among adults (≥18 years) with uncomplicated UTIs diagnosed in a primary health facility between October 2019 and October 2021. Among 3717 patients, 71% were females and all had complete prescription details in the EMR. Of all the patients, 83% were prescribed empirical antibiotics, of whom 88% received oral ciprofloxacin or cefuroxime. Only 68% were prescribed antibiotics for the correct duration, which was significantly lower among males (10%) compared to females (90%). Among patients who received antibiotics, 60% were prescribed in line with the STGs. The results call for feedback to physicians about poor compliance to STGs with duration of antibiotic prescribed. Recommendations on 10–14 days duration of antibiotics for males needs to be reassessed and necessary amendments to STGs can be made. Leveraging the well-established EMR system, a real-time audit-feedback mechanism can be instituted to improve compliance with STGs.

Background:Diseases contracted through consuming contaminated water present health challenges globally, hence this study aimed to assess occurrence and antibiogram of bacteria isolated from various brands of sachet drinking water sold in Gombe metropolis.Methods:Twenty brands of samples were collected randomly, serially diluted, and cultured on nutrient agar (NA). Isolates were identified morphologically and biochemically, with antibiogram determined using Clinical and Laboratory Standards Institute (CLSI) guidelines.Results:All the 20 samples produced positive bacterial growths with counts ranging from 1.0x103to 9.8x103CFU/ml with identified colonies ofEscherichia coli (E. coli),Staphylococcus aureus ( S. aureus),Pseudomonas aeruginosa (P. aeruginosa),andKlebsiella pneumoniae(K. pneumoniae).Antibiogram revealed the isolates were all resistant to augmentin, cefixime, cefuroxime and ceftazidime, butE. coliandS. aureuswere also resistant to gentamicin.Conclusion:The samples were contaminated with potentially pathogenic bacteria that were resistant to some antibiotics. Hence there is need for enforcement of drinking water standards to avoid consequences of unsafe drinking water, thus improving the health of the population.

We report a case of brucellosis-induced severe neutropenia in a 2-year-old girl who presented with a 2-week history of fever. On clinical examination, the patient was febrile with mild aphthous stomatitis. However, her general condition was stable, and systemic examination did not show involvement of any other organ. Laboratory test results revealed severe neutropenia, mild anemia, and an elevated serum C-reactive protein level. Flow cytometry of peripheral blood leukocytes revealed no malignancy, and blood film morphology was unremarkable except for mild microcytosis and hypochromia. Antineutrophil antibody and Coombs test results were negative. We administered intravenous cefuroxime; however, therapy was switched to meropenem plus clarithromycin because fever persisted for 5 days, despite treatment. On the 10th day after admission, Brucella serology tests showed positive results, and trimethoprim-sulfamethoxazole plus rifampicin therapy was prescribed for 8 weeks. The fever defervesced, and the child was discharged in a good state of health. Neutropenia persisted for several months but gradually resolved. Neutropenia, defined as an absolute neutrophil count (ANC)1.5 cells × 10 9 /L beyond the first year of life, is a benign transient condition associated with an intercurrent infection (usually viral illnesses or infections) in immunocompetent children. However, severe neutropenia (ANC0.5 × 10 9 /L) associated with fever necessitates hospitalization and administration of broad-spectrum antibiotics to avoid the high risk of sepsis, particularly in children. Brucellosis is rarely associated with hematologic abnormalities such as neutropenia. Early diagnosis of hematologic complications of brucellosis is essential for prompt initiation of specific and aggressive treatment.

Background Few studies have investigated the differences in clinical features of patients with mastitis following Corynebacterium kroppenstedtii infection, and most focused on the bacterial antimicrobial susceptibility, detection methods and therapy. Methodology There were 133 patients with mastitis infected by C. kroppenstedtii between August 2016 and September 2019. C. kroppenstedtii was identified using mass spectrometry. The demographics, clinical diagnosis, laboratory test results of different types of mastitis combined with bacillus infection, and the effects of different treatments in reducing recurrence were compared. Results The incidence of pus following C. kroppenstedtii infection was higher in patients with non-granulomatous lobular mastitis (NGLM; 56.6%) than in those with granulomatous lobular mastitis (GLM; 33.3%; χ2 = 7.072, p = 0.008). While C-reactive protein (CRP) was higher in the GLM group (12.50 mg/L) than in the NGLM group (6.05 mg/L; Z = − 2.187, p = 0.029). Treatment with local lavage (triamcinolone acetonide) and antibiotics (cefuroxime) showed a recurrent rate of 25.9% in C. kroppenstedtii infection. Conclusion Increased pus, large masses, and an elevated CRP level may occur in patients with mastitis infected by C.kroppenstedtii. These clinical features may guide the determination of the bacterial infection in patients with mastitis. Combining an antibiotic with a triamcinolone acetonide lavage, preferably cefuroxime, may reduce the recurrence.