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Background:Approximately 10% of patients report allergies to penicillin, yet >90% of these allergies are not clinically significant. Patients reporting penicillin allergies are often treated with second-line, non–β-lactam antibiotics that are typically broader spectrum and more toxic. Orders for β-lactam antibiotics for these patients trigger interruptive alerts, even when there is electronic health record (EHR) data indicating prior β-lactam exposure.Objective:To describe the rate that interruptive penicillin allergy alerts display for patients who have previously had a β-lactam exposure.Design:Retrospective EHR review from January 2013 through June 2018.Setting:A nonprofit health system including 1 large tertiary-care medical center, a smaller associated hospital, 2 emergency departments, and ˜250 outpatient clinics.Participants:All patients with EHR-documented of penicillin allergies.Methods:We examined interruptive penicillin allergy alerts and identified the number and percentage of alerts that display for patients with a prior administration of a penicillin class or other β-lactam antibiotic.Results:Of 115,081 allergy alerts that displayed during the study period, 8% were displayed for patients who had an inpatient administration of a penicillin antibiotic after the allergy was noted, and 49% were displayed for patients with a prior inpatient administration of any β-lactam.Conclusions:Many interruptive penicillin allergy alerts display for patients who would likely tolerate a penicillin, and half of all alerts display for patients who would likely tolerate another β-lactam.

Group B Streptococcus is a gram-positive coccal bacterium which produces an arrow zone of blood hemolysis on blood agar. Group B Streptococcus is the most common cause of invasive bacterial illness in neonates, including sepsis, meningitis, septicemia, and pneumonia. For the first time, such a study of Streptococcus agalactiae has been conducted in hospitals of Anbar Governorate .All Streptococcus agalactiae identified by conventianal methods , automated methods using Vitek-2 system , and molecular methods by conventional PCR. All isolates gave a positive result as 16S rRNA. Distribution of resistance ratio for Streptococcus agalactiae were Penicillin 20% , Clindamycin 68% , Chloramphenicol % 46 , Tetracycline 82% , Erythromycin % 100 ,Imipenem % 12 , and Ciprofloxacillin 26.47%. The Cyl E and bibA genes were detected by conventional PCR and the result showed (72%) strains positive, but in case of bla Cyl E gene (53.48%) of strains harbored bla bibA genes , while 48.83 of Streptococcus agalactiae contain Spb1 gene . This approach showed the coexistence of bla Cyl E , Spb 1 and bibA genes in 48.83% strains of Streptococcus agalactiae.

Aim: Streptococcus pyogenes (Group A Beta-hemolytic streptococci, GABHS) is one of the important bacterial pathogens in clinical microbiology. It often causes upper respiratory tract infections such as tonsillitis, pharyngitis, and laryngitis. It also leads to complications such as acute rheumatic fever and post-streptococcal glomerulonephritis. Early diagnosis and treatment of these bacterial infections will prevent suppurative and non-suppurative complications, the transmission of infection to other people, and chronic carriage. Today, the treatment of streptococcal infections relies entirely on chemotherapy. Beta hemolytic group A streptococci and generally other beta-hemolytic streptococci in groups B (GBBHS), C, and G are generally sensitive to many chemotherapeutics, especially Penicillin and Erythromycin. In patients with penicillin allergy, erythromycin, amoxicillin-clavulanate, or oral cephalosporins are used instead of penicillin. However, it has recently been understood that there are strains resistant to Erythromycin in GABHS and are increasing. In this study, the situation in our region of Erythromycin resistance, which is used as an alternative for people allergic to Penicillin in the treatment of streptococcal infections, was investigated. Material and Method: In our study, throat swab samples were taken from 150 pharyngitis patients and 94 GABHS were obtained by applying the Bacitracin-SXT test with the culture method, and antibiotic susceptibility tests were performed on these 94 GABHS by Kirby-Bauer agar disc diffusion method. Result: GABHS was found susceptible to Bacitracin and resistant to SXT. GBBHS is resistant to Bacitracin and SXT. other beta-hemolytic streptococci were resistant to Bacitracin and susceptible to SXT. Conclusion: In this study, Erythromycin’s resistance was found to be 19.1%. it is observed that Erythromycin resistance has increased over the years when compared to previous studies. Erythromycin should not be used empirically in treatment. An antibiotic susceptibility test should be performed and the antibiotic should be selected according to the results of the antibiogram test.

Actinomycosis is a subacute-to-chronic bacterial infection caused by gram-positive, filamentous, non-acid-fast, facultative anaerobic bacteria. It is a normal commensal bacterium found in the oral cavity and the lower reproductive tract of women. We present a case of primary actinomycosis of the breast. A postmenopausal woman, complicated by penicillin allergy, presented with a left breast lump clinically simulating malignancy. The first line of treatment for actinomycosis is penicillin. Due to a penicillin allergy, the patient was initially treated with doxycycline. However, doxycycline was discontinued due to tremors, and was replaced by clindamycin. The patient had a good clinical response with resolution of the abscess.

Background Internationally, clinical and economic advantages of low-risk penicillin delabeling have been explored, supporting changes to healthcare delivery systems where penicillin delabeling is embedded into inpatient usual care. Aim To determine if economic advantages of low-risk inpatient penicillin delabeling, described in the international literature, are realised in the Australian context. Methods This explorative economic evaluation had prospective patient data collection between January and August 2019, across two Australian health services. Part-1: Determine the cost per effectively delabeled patient for Penicillin Allergy Delabeling Program inpatients (PADP cohort) compared to Outpatient Antibiotic Allergy Testing Service outpatients (OAATS cohort). Part-2: A cost analysis to compare hospital costs for inpatients with low-risk penicillin allergy who did (PADP cohort) and did not (usual care cohort) undergo PADP delabeling. Results Part-1: The PADP (n=350) and OAATS (n=27 patients, n=36 individual visits) cohorts were comparable. In PADP, costs/proportion delabeled was $20.10/0.98, equating to $20.51 per effectively delabeled patient; in OAATS, it was $181.24/0.50, equating to $362. Compared to OAATS, PADP was associated with savings of $341.97 per effectively delabeled patient; indicating the outpatient testing was the dominated strategy, being more costly and less effective. Part-2: The PADP (n=218) and usual care (n=32) cohorts were comparable. Significantly favouring the delabeled PADP cohort, mean difference per patient was -4.41 days (95%CI -7.64, -1.18) and -$9,467.72 (95%CI -$15,419.98, -$3,515.46). Conclusions Consistent with international literature, delabeling low-risk penicillin allergies in the inpatient setting had economic advantages in the Australian context. Fully powered economic evaluations are urgently required to consolidate these findings. This article is protected by copyright. All rights reserved.

Background: The presence of biofilm formation exoU gene is significant challenge to infection control management in hospitals and exposure by Pseudomonas aeruginosa may lead to further spread and development of antimicrobial resistance. Methods: Out of 227 samples 40 clinical isolates of P. aeruginosa were collected from patients attending public hospitals ( Rizgary, Teaching hospital, Laboratory center, Raparin, Nanakaly hospitals)in Erbil city/Iraq over a period during 2018 to march 2019 and fully characterized by standard bacteriological procedures and antimicrobial susceptibility test and ESBL has been carried out by Vitek 2 compact system and. by Vitek 2 compact system. The identification has been verified by all isolates as P. aeruginosa by using 16S rDNA with product size (956pb). Results: A high rate of resistance was seen against Penicillin and lincomycin and Piperacillin and chloramphenicol and rifampicin (100 %), whereas Imipenem (5%) were found to be the most effective antimicrobial drugs. Of all P. aeruginosa isolates, 30 (75% %) were identified as MDR, approximately 9(22.5%) of isolates were resistant to 9 drugs in burn samples. Quantitative biofilm determination using the Congo red method revealed that 28 isolates (70%) produced biofilm, biofilm production was significantly higher among MDR P. aeruginosa isolates while coproduction of Extended Spectrum β-lactamase (ESBL) together with Metallo β-lactamase (MBL) ESBLs MBLs recorded in (52.5%) of the isolates. Altogether 40 isolates were processed for analysis by PCR assays and showed that 26(70%) of P. aeruginosa isolates harboured the exoU encoding gene with product size (204) pb was more commonly seen in isolates obtained from burn isolates. In addition, exo U gene was significantly associated with the higher MDR (80%), 8 isolates (76.9%)had exoU gene with ESBL and( 65%) had MBL and the same for MDR (80.8%) in samples for burning. Conclusion: Our results showed surveillance of P. aeruginosa resistance against antimicrobial and ESBL and MBL is fundamental to monitor trends in susceptibility patterns and appropriately guide clinicians in choosing empirical or directed therapy.

Background To investigate antibiotic resistance of pathogens responsible for neonatal invasive bacterial infections (IBIs) in China. Methods Cross-sectional study of neonates with IBI evaluated in nine hospitals in China (January 2012–August 2019). Antibiotic resistance patterns of pathogens responsible for neonatal IBIs were analyzed. Results Of 3770 full-term neonates who were subjected to lumbar puncture and a blood culture, IBIs were diagnosed in 460 neonates (12.2%). Escherichia coli and Group B Streptococcus (GBS) were the leading pathogens, followed by Enterococcus spp, and Staphylococcus aureus. E. coli expressed high resistance to ampicillin (72.0%) and third-generation cephalosporins (cefotaxime, 34.8%; ceftriaxone, 38.1%). The prevalence of extended spectrum beta-lactamase (ESBL)-producing E. coli was 34.1%. The proportions of E. spp resistant to penicillin and ampicillin were 60% and 54.1%. All S. aureus showed resistance to ampicillin and penicillin. The resistance rate of S. aureus to methicillin was 50%. Although all GBS were susceptible to penicillin and ampicillin, the proportions of GBS resistant to erythromycin and clindamycin were 75.9% and 77.3%. Antibiotic susceptibility appeared to improve in 2019. Susceptibility of E. coli to ampicillin, cefotaxime, and ceftriaxone improved to 42.9%, 76.9%, and 71.4% in 2019, compared with 12.5%, 37.5%, and 50% in 2012. The prevalence of ESBL-producing E. coli declined to 20% in 2019, lower than 100% in 2012. Susceptibility of GBS to erythromycin and clindamycin improved from 0% in 2012 to 28.6% and 25% in 2019. Conclusions The prevalence of antibiotic resistance is high in neonates in China, although there is a favorable declining trend in recent years.

Despite the escalating burden of antimicrobial resistance (AMR), the global response has not sufficiently matched the scale and scope of the issue, especially in low- and middle-income countries (LMICs). While many countries have adopted national action plans to combat AMR, their implementation has lagged due to resource constraints, dysfunctional multisectoral coordination mechanisms and, importantly, an under-recognized lack of technical capacity to adapt evidence-based AMR mitigation interventions to local contexts. AMR interventions should be tailored, context-specific, cost-effective and sustainable. The implementation and subsequent scale-up of these interventions require multidisciplinary intervention-implementation research (IIR). IIR involves both quantitative and qualitative approaches, occurs across a three-phase continuum (proof of concept, proof of implementation and informing scale-up), and across four context domains (inner setting, outer setting, stakeholders and the implementation process). We describe the theoretical underpinnings of implementation research (IR), its various components, and how to construct different IR strategies to facilitate sustainable uptake of AMR interventions. Additionally, we provide real-world examples of AMR strategies and interventions to demonstrate these principles in practice. IR provides a practical framework to implement evidence-based and sustainable AMR mitigation interventions. Despite the escalating burden of antimicrobial resistance (AMR), the global response has not sufficiently matched the scale and scope of the issue, especially in low- and middle-income countries (LMICs). While many countries have adopted national action plans to combat AMR, their implementation has lagged due to resource constraints, dysfunctional multisectoral coordination mechanisms and, importantly, an under-recognized lack of technical capacity to adapt evidence-based AMR mitigation interventions to local contexts. AMR interventions should be tailored, context-specific, cost-effective and sustainable. The implementation and subsequent scale-up of these interventions require multidisciplinary intervention-implementation research (IIR). IIR involves both quantitative and qualitative approaches, occurs across a three-phase continuum (proof of concept, proof of implementation and informing scale-up), and across four context domains (inner setting, outer setting, stakeholders and the implementation process). We describe the theoretical underpinnings of implementation research (IR), its various components, and how to construct different IR strategies to facilitate sustainable uptake of AMR interventions. Additionally, we provide real-world examples of AMR strategies and interventions to demonstrate these principles in practice. IR provides a practical framework to implement evidence-based and sustainable AMR mitigation interventions.

Corynebacterium macginleyi has long been associated with ocular infections and has more recently been rarely implicated in systemic infections. There is a paucity of literature regarding the rate of C. macginleyi co-infection with other bacterial and viral pathogens and regarding the incidence of C. macginleyi infection in the paediatric population. In this study, we report 30 isolates of C. macginleyi of ocular origin from 26 patients, identified using matrix-assisted laser desorption ionisation-time of flight mass spectrometry (MALDI-TOF MS). The rates of co-isolation with bacterial and viral pathogens were 62% (n=16/26) and 39% (n=5/13), respectively, in this study. Of these, 13 patients had molecular testing performed as requested by treating clinicians for either the Chlamydia trachomatis/Neisseria gonorrhoeae PCR or herpes/enterovirus/adenovirus multiplex PCR. All isolates tested susceptible to linezolid, vancomycin and ciprofloxacin, with variable resistance to tetracycline, clindamycin and penicillin using EUCAST breakpoints.

Background Fusobacterium species are obligately anaerobic, gram-negative bacilli. Especially, F. nucleatum and F. necrophorum are highly relevant human pathogens. We investigated clinical differences in patients infected with Fusobacterium spp. and determined the antimicrobial susceptibility of Fusobacterium isolates. Methods We collected clinical data of 86 patients from whom Fusobacterium spp. were isolated from clinical specimens at a tertiary-care hospital in Korea between 2003 and 2020. In total, 76 non-duplicated Fusobacterium isolates were selected for antimicrobial susceptibility testing by the agar dilution method, according to the Clinical and Laboratory Standards Institute guidelines (M11-A9). Results F. nucleatum was most frequently isolated from blood cultures and was associated with hematologic malignancy, whereas F. necrophorum was mostly prevalent in head and neck infections. Anti-anaerobic agents were more commonly used to treat F. nucleatum and F. varium infections than to treat F. necrophorum infections. We observed no significant difference in mortality between patients infected with these species. All F. nucleatum and F. necrophorum isolates were susceptible to the antimicrobial agents tested. F. varium was resistant to clindamycin (48%) and moxifloxacin (24%), and F. mortiferum was resistant to penicillin G (22%) and ceftriaxone (67%). β-Lactamase activity was not detected. Conclusions Despite the clinical differences among patients with clinically important Fusobacterium infections, there was no significant difference in the mortality rates. Some Fusobacterium spp. were resistant to penicillin G, ceftriaxone, clindamycin, or moxifloxacin. This study may provide clinically relevant data for implementing empirical treatment against Fusobacterium infections.

Background There is a theoretical concern, unconfirmed by population-based challenge data, that clinically-significant immunologically-mediated hypersensitivity occurs between beta-lactams sharing side chains. Objective Determine the population-based “allergy” incidence associated with the use of beta-lactams sharing exact R1 side chains, [ampicillin, cephalexin, and cefaclor (ACC)], with or without a current ACC “allergy” or a sulfonamide antibiotic “allergy” for comparison. Methods All courses of ACC and trimethoprim-sulfamethoxazole, used by any Kaiser Permanente California members in 2017 and 2018, with follow-up through January 2019, were identified along with their preexisting antibiotic “allergy” status and all new antibiotic-specific “allergies” reported within 30 days of course initiation. Results There were 1,167,713 courses of ACC administered to individuals with no sulfonamide antibiotic or ACC “allergy” and 4,771 (0.41%) new ACC “allergies” were reported. There were 130,032 courses of ACC administered to individuals with a sulfonamide antibiotic “allergy” and no ACC “allergy” and 904 (0.70%) new ACC “allergies” were reported. There were 5,958 courses of ACC administered to individuals with an ACC “allergy”, 2,341 who also had sulfonamide antibiotic “allergy”, and 52 (0.87%) new ACC “allergies” were reported. Conclusion The incidence of new ampicillin, cephalexin, or cefaclor “allergy” reports is minimally and non-specifically increased when a preexisting ACC or sulfonamide antibiotic “allergy” exists over the baseline incidence in the population. This argues against clinically-significant immunologically-mediated cross-reactivity between beta-lactams sharing exact side chains in individuals with pre-existing, but unconfirmed, beta-lactam “allergy”. Any previously reported, even unrelated, antibiotic “allergy” appears to be a risk factor for reporting a new antibiotic “allergy”.

The challenge of delabeling amoxicillin allergy is an important issue for patients and clinicians, especially when anaphylaxis is reported. A recent study has proposed a clinical decision rule, PEN-FAST, to identify low-risk penicillin allergies.To validate the PEN-FAST clinical decision rule in a population with high risk of suspected immediate amoxicillin allergy and to identify clinical predictive factors of amoxicillin immediate hypersensitivity.We retrospectively analyzed medical records of patients with a suspected immediate amoxicillin allergy who carried out an allergologic evaluation by a specialist in the Allergy Unit of Strasbourg University Hospital from 2015 to 2020.A total of 142 adult patients (88 women [62.0%]; median age, 52 [interquartile range, 40.3-62.0] years) were analyzed. Most of them reported anaphylaxis (68.8%). Internal validation of PEN-FAST score revealed a good discrimination with area under the curve of 0.86 (95% confidence interval, 0.79-0.92). A cutoff of less than 3 points for PEN-FAST was used to classify 29 from 142 patients at low risk of allergy, of whom only 2 (6.9%) received positive results of allergy testing. The negative predictive value for successful delabeling was 0.93 (95% confidence interval, 0.77-0.99). Predictive clinical features for immediate amoxicillin hypersensitivity were time since reaction (P.001), time elapsed between drug intake and first symptom (P.001), severity grade reaction (P.001), and treatment or hospitalization required (P.001).PEN-FAST has been validated to identify low-risk penicillin allergies in our European cohort of patients mainly reporting anaphylaxis. This is the first reported external validation of a penicillin allergy clinical decision rule internationally.

A 179-day-old calf, which was weak and stunted, showed neurological signs and was euthanized. Postmortem examination revealed extensive and severe cloudy area in the meninges, and pleural pneumonia. Gram-positive cocci were isolated from systemic organs. Biochemical and 16S rRNA gene sequence analyses identified the isolate as Streptococcus gallolyticus, and its subspecies was suggested to be gallolyticus (SGG). The isolate was classified as a novel sequence type (ST115) by the multilocus sequence typing scheme for SGG and showed susceptibility to penicillin, ampicillin, amoxicillin, florfenicol, sulfamethoxazole-trimethoprim, and chloramphenicol. Histopathologically, suppurative meningoencephalitis and perineuritis were detected. As SGG has been isolated solely from a cow with mastitis in Japan, this is the first SGG infection in a calf with suppurative meningoencephalitis and perineuritis in this country.

Objectives The aim of this study was to investigate the genomic epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) in China to identify predominant lineages and their associations with clinical data and antimicrobial resistance profiles. Methods We performed a national prevalence study of patients with S. aureus infections in 22 tertiary hospitals in China from 2015 to 2017. Clinical data from patients and the antimicrobial phenotypes were collected for each isolate. Genome sequencing was performed on a proportion of isolates and a phylogenetic analysis was undertaken. Genotypic and phenotypic β-lactam susceptibilities were compared. Results A total of 1900 patients with S. aureus infections were included, of which 40% involved MRSA. Community-associated MRSA (CA-MRSA) infections were 24% of the total isolates. Genomic data showed that more than three-quarters of the MRSA were from three dominant lineages CC239 (25%, 116/471), CC5 (21%, 96/471) and CC59 (33%, 154/471) with CC59 accounting for more than half of the CA-MRSA isolates. Penicillin susceptibility genomic features were observed in 53% (251/470) of MRSA, including almost all of the CC59 (152/154) lineage, and 96% (242/251) of these isolates demonstrated in vitro susceptibility to penicillin or amoxicillin combined with clavulanic acid. Phylogenetic analysis indicated that the CC59 lineage can be divided into six lineages with all Asian CC59 isolates likely arising from an ancestral Mainland China lineage. Conclusions This study showed a high prevalence of CA-MRSA in China, largely due to the widespread presence of CC59. As almost all isolates in this lineage possess genetic variants leading to increased β-lactam susceptibility, we suggest that to improve antibiotic stewardship combinations of penicillins and β-lactamase inhibitors should be included in the antibiotic susceptibility testing panels used to inform treatment decisions and research undertaken on this combination therapy.

Purpose The non-invasive pneumococcal disease (NIPD) is a common infection during childhood. We aimed to define the clonal spread of pediatric non-invasive isolates recovered during the PCV10-period in Bulgaria concerning the serotype and antimicrobial susceptibility. Materials and methods Serogrouping/serotyping were performed using latex agglutination and capsular swelling reaction. Serogroup 6 strains were subjected to serotype-specific PCR's. The antibiotic susceptibilities were assessed by broth microdilution. MLST was performed to define the clonal composition. Results We analyzed 154 pediatrics non-invasive S. pneumoniae isolates. The PCV10-vaccinated children were 94.1%. We disclosed 88% non-vaccine serotypes (NVTs) and 12% PCV10 - serotypes. All common serotypes among PCV10-vaccinated children (n ​= ​145) were non-vaccine types (NVTs): 19A (13.8%), 6C (11.7%), 3 (9.6%), 15A (8.3%) and 23A (5.5%). Antimicrobial non-susceptibility showed highest levels in erythromycin (50.0%), oral penicillin (49.4%), clindamycin (45.4%), trimethoprim-sulfamethoxazole (43.5%), tetracycline (42.2%), and ceftriaxone (14.3%). The multidrug-resistant strains (MDR) were 51.3%. MDR-serotypes were 6C (20.2%), 19A (17.7%), 15A (11.4%), 19F (10.1%), and 23A (8.9%). MLST presented 17 clonal complexes (CCs) with prevalence of CC320, CC386, CC505, CC8029 and CC2613 clustered 83% MDR isolates. Conclusions All emergent pediatric non-invasive serotypes in our geographic area during the studied PCV10-period were NVTs (19A, 6C, 3, 15A, and 23A). The fifth widespread CCs: CC320, CC386, CC505, CC8029 and CC2613 clustered 83% MDR isolates. Future surveillance of vaccine-induced changes in the clonality and the antimicrobial resistance of the pneumococcal population is needed.

BACKGROUND Chronic oroantral fistulae (OAF) with secondary sinusitis can occur following repulsion of cheek teeth in horses. CASE REPORT An 8-year-old Andalusian cross gelding presented with an iatrogenic clinical crown fracture of tooth 209, which underwent repulsion of its apical portion (day 0). The horse was treated with intramuscular penicillin and intravenous gentamicin (5 days), followed by oral trimethoprim-sulphonamide (10 days) and then oral doxycycline (14 days). The acute iatrogenic OAF created during the initial repulsion persisted; a chronic OAF was identified on day 24. On day 48, septic sinusitis with multidrug-resistant (MDR) Escherichia coli was confirmed. Although susceptible to enrofloxacin in vitro, 30 days of therapy was unsuccessful. Subsequent serial cultures grew multiple MDR and extensively drug-resistant (XDR) gram-negative microorganisms. Whole-genome sequencing (WGS) revealed multiple sequence types of E. coli, with a range of resistance and virulence genes. The orientation of the OAF, regional osteomyelitis and septic sinusitis were confirmed with computed tomography on day 70. On day 74, enteral nutrition was provided through a cervical oesophagostomy tube for 3 months for prevention of oral feed contamination. The OAF was treated with various alternative therapeutics, including apple cider vinegar, propolis and amikacin impregnated products, until resolution on day 116. CONCLUSION These non-conventional therapeutics, antimicrobials and long-term oesophagostomy contributed to the successful treatment of a complicated OAF. In the future, WGS may be useful to inform antimicrobial selection when MDR or XDR organisms are identified.

Cephalosporins play an indispensable role against bacterial infections. Deacetyloxycephalosporin C synthase (DAOCS), also called expandase, is a key enzyme in cephalosporin biosynthesis that epoxides penicillin to form the hexavalent thiazide ring of cephalosporin. DAOCS in fungus Acremonium chrysogenum was identified as a bifunctional enzyme with both ring expansion and hydroxylation, whereas two separate enzymes in bacteria catalyze these two reactions. In this review, we briefly summarize its source and function, improvement of the conversion rate of penicillin to deacetyloxycephalosporin C through enzyme modification, crystallography features, the prediction of the active site, and application perspective.

Objectives To provide evidence based guidance on the optimum prophylactic antibiotic prescribing regimens in the treatment of fractured mandibles to protect against surgical site infections. Material and methods OVID and Pubmed databases were searched for articles published between 1946 and 2020. Inclusion criteria was for articles to be in English, involve adult patients aged 14 and over, and involve patients treated with oral or IV antibiotics preoperatively, perioperatively or postoperatively during treatment of open or closed fractures of the mandible. Exclusion criteria included infected fractures on presentation, immunocompromised patients, fractures resulting from gunshot and pathological fractures. Results A number of retrospective and prospective, randomised, double blind placebo-controlled trials were identified as suitable for inclusion. The age range within these trials was 14–77 years old. The numbers of patients contained within each trial ranged from 30 to 642. The most commonly prescribed antibiotics were penicillin, administered orally or intravenously. Duration of administration ranged from hospital admission to five days postoperatively. Analysis of these studies failed to demonstrate a statistical difference on the number of surgical site infections and the duration of antibiotic course. Conclusions The available evidence reveals no statistical difference in infection rates whether antibiotics are prescribed pre, peri, or postoperatively. The duration of antibiotics therapy also appears not to be important. Current evidence does not support the recommendation of an optimum antibiotic prescribing regimen. Additional prospective studies looking at the duration and timing of antibiotics during the management of fractured mandibles are required to identify the optimum prescribing regimen.

Background: The antimicrobial susceptibility of isolates of Neisseria meningitidis to agents used for chemoprophylaxis and to penicillin G was determined. Methods: Fifty N. meningitidis strains detected in Nova Scotia between 2004 and 2018 were included. The isolates were originally isolated from sites that might prompt chemoprophylaxis (27 blood, 18 cerebrospinal fluid [CSF], 3 CSF–blood, and 2 conjunctiva). Minimal inhibitory concentrations (MICs) were determined to azithromycin, ciprofloxacin, minocycline, rifampin, trimethoprim–sulfamethoxazole, and penicillin G, using a diffusion gradient strip on Mueller–Hinton agar with 5% sheep blood in 5% CO2 for 20–24 hours. Results: All isolates remained susceptible to azithromycin, ciprofloxacin, minocycline, and rifampin, but there was 26% resistance to trimethoprim–sulfamethoxazole. There was a rise in penicillin MIC of the isolates over the study period. Conclusion: In our province, N. meningitidis isolates causing invasive infection remain susceptible to commonly used antimicrobial agents used for chemoprophylaxis. Significant resistance to trimethoprim–sulfamethoxazole is present and the degree of susceptibility to penicillin G is lessening.

Study objective To study the bacteria and fungi causing vulvovaginitis in prepubertal girls. Design Swabs from vaginal introitus were collected from patients with vulvovaginitis in 2018, and cultured for the identification of microorganisms with standard microbiological techniques. Setting A children's hospital in Hangzhou, East China. Participants A total of 1235 Chinese prepubertal girls diagnosed with vulvovaginitis. Main Outcome Measure Bacteria or fungi in pure cultures or as the predominant organism were defined as pathogens. Results A total of 1235 cases were diagnosed as vulvovaginitis, and 515 isolates were identified from 494 patients (40%, 494/1235). The most common pathogen was Streptococcus pyogenes (27.6%,142/515), followed by Haemophilus influenzae (27.2%,140/515), Candida albicans (22.3%,115/515), Staphylococcus aureus (5.8%, 30/515) and Escherichia coli (4.7%,24/515). All S pyogenes isolates were sensitive to penicillin, whereas 53.7% (73/136) of H influenzae isolates were sensitive to ampicillin, and 70.4% (19/27) of S aureus isolates were sensitive to oxacillin. Conclusion S pyogenes and H influenzae were the 2 most commonly identified pathogenic bacteria found in prepubertal girls with vulvovaginitis. Vulvovaginitis in prepubertal girls caused by C albicans may be more common in older children.

The purpose of this overview was to assess different antibiotic regimens used in orthognathic surgery and to establish an evidence-based protocol so that beneficial and adverse effects can be determined. A comprehensive literature search for systematic reviews and/or meta-analyses was conducted in MEDLINE (PubMed), EMBASE, and the Cochrane Library until March 2020. Grey literature was investigated in Google Scholar, and a manual search was done of references lists. Two meta-analyses and four systematic reviews met the inclusion criteria. The AMSTAR-2-tool was used to ascertain the potential risk of bias in the included studies, which presented moderate to high methodological quality. Lower infection rates were associated with long-term therapies of penicillin, cefazolin-cephalexin, and amoxicillin-clavulanic-acid, with rates varying from 0% - 3.13%. Higher rates were reported in placebo groups (52.6%) and short-term penicillin therapy (60%). Side effects were reported with cefazolin, clindamycin, and penicillin therapies, including nausea, pain, swelling, headache, vomiting, and skin rash. Evidence suggests that long-term antibiotics can reduce the risk of a surgical site infection (SSI) in orthognathic surgery, but there is uncertainty regarding the effects of one dose of antibiotics preoperatively versus short-term antibiotics. In the same way, intravenous penicillin, cefazolin, clindamycin, and amoxicillin-clavulanic acid kept the infection rates associated with bimaxillary procedures under 3.5%.

Platform tests are usually simple and rapid quality control tests which serve as a basis for accepting, setting aside or rejecting raw milk. Some of the rapid antibiotic residues test kits available in the Kenyan market include: Delvo test Fast BL, Delvo Sulphadiazine Penicillin No Tablet (SPNT), Mtusbio Beta-lactam BLQ Rapid Test Kit and Ringbio beta-lactam, tetracycline, sulfa drugs, BTS 3 in 1 TriTest S. Ndungu Antibiotic residues (NAR) is a colour comparison test that is simple, rapid and does not require electric power in its analysis procedure. This study compared these four rapid antibiotics tests with novel NAR test method in terms of sensitivity and specificity. A total of 28 samples were prepared; 8 milk samples without residues were spiked with milk known to have beta-lactam residues while 10 had no residues and 10 had known beta-lactam (benzyl penicillin) residues. The four analysis methods were carried out as described in their technical bulletins and manuals. For the NAR test, 50 mg of its active ingredient was mixed with 3 ml of milk and colour change observations made. The sensitivity and specificity of the NAR test was found to be 66.7 and 100% respectively while for all the other four tests, sensitivity and specificity was established to be 100% for each. The Kappa coefficient was 0.5882 which indicates moderate agreement, between NAR test method and the other test methods, according to Landis-Koch scale. The odds ratio exhibited positive association between the NAR test and the four methods. NAR test is best applicable at the milk collection routes or farm level before bulking for transportation. Key words: Antibiotic residues, rapid test kit, beta-lactam, beta-lactamase, NAR test.

Beta-lactam antibiotics are the most commonly reported drug allergy in adults and children. More than 95% of those with reported allergy labels to beta lactams are not confirmed when subjected to allergy testing. Beta lactam antibiotics are associated with a wide spectrum of immediate and delayed drug hypersensitivity reactions. The latency period to symptoms and clinical presentation aids in the causality assessment. Risk stratification based on diagnosis and timing then allows for appropriate management and evaluation. Skin prick testing, intradermal testing and oral challenge are well established for evaluation of immediate reactions. Delayed intradermal testing, patch testing and oral challenge can also be considered for evaluation of mild to moderate delayed reactions. Cross-reactivity between beta-lactams appears to be driven most commonly by a shared R1 side-chain. Standardized algorithms, protocols and pathways are needed for widespread implementation of a pragmatic and effective approach to patients reporting beta lactam allergy.

Fresh Milk Bar (FMB), an emerging dairy retail franchise, is used to instantly produce and sell pasteurized milk and other dairy products in China. However, the quality and safety of pasteurized milk in FMB have received little attention. The objective of this study was to investigate the prevalence, antimicrobial resistance, and virulence genes of Escherichia coli, Staphylococcus aureus, and Streptococcus in 205 pasteurized milk samples collected from FMBs in China. Four (2.0%) isolates of E. coli, seven (3.4%) isolates of S. aureus, and three (1.5%) isolates of Streptococcus agalactiae were isolated and identified. The E. coli isolates were resistant to amikacin (100%), streptomycin (50%), and tetracycline (50%). Their detected resistance genes include aac(3)-III (75%), blaTEM (25%), aadA (25%), aac(3)-II (25%), catI (25%), and qnrB (25%). The S. aureus isolates were mainly resistant to penicillin G (71.4%), trimethoprim-sulfamethoxazole (71.4%), kanamycin (57.1%), gentamicin (57.1%), amikacin (57.1%), and clindamycin (57.1%). blaZ (42.9%), mecA (28.6%), ermB (14.3%), and ermC (14.3%) were detected as their resistance genes. The Streptococcus strains were mainly resistant to tetracycline (66.7%) and contained the resistance genes pbp2b (33.3%) and tetM (33.3%). The virulence genes eae and stx2 were only found in one E. coli strain (25%), sec was detected in two S. aureus strains (28.6%), and bca was detected in one S. agalactiae strain (33.3%). The results of this study indicate that bacteria with drug resistance and virulence genes isolated from the pasteurized milk of FMB are a potential risk to consumers' health.

It is now well-established that avoiding β-lactam antibiotics, when they are the drugs of choice, results in significantly worse long-term global outcomes for patients. Much of this avoidable morbidity has been caused by widespread warnings in electronic health care record systems not to use cephalosporins in the setting of penicillin allergy. High rates, up to 1000-fold higher than now seen, of immunologically mediated reactions were associated with early impure penicillin preparations. This instilled a rational fear of β-lactam-associated anaphylaxis in generations of physicians. In the late 1970s, several editorial comments regarding a potential increased risk to patients given cephalosporins who had a history of a penicillin allergy resulted in the warning that became imbedded in the culture of medicine. Over the past 40 years, compelling data have been developed that refute this warning and showed that the risks of avoiding cephalosporins outweighed the benefits. In late 2017, Kaiser Permanente Southern California completely removed all warnings not to use cephalosporins in the setting of a penicillin allergy. The results have recently been published in JAMA Network Open. This Rostrum article provides some of the backstory on the establishment and removal of this warning for physicians who trained over the past 30 years.

Adverse drug reactions are frequently reported in pediatric patients. In this review article, the authors discuss pediatric drug allergies with emphasis on the most common culprits, beta-lactam antibiotics and non-steroidal anti-inflammatory drugs. The authors also discuss reactions to non-beta-lactam antibiotics and chemotherapeutics. Skin testing has not yet been validated for many drugs, although notable exceptions include penicillin and carboplatin. The gold standard for diagnosis in most cases remains drug challenge, and the need for penicillin skin testing prior to oral provocation challenge has been questioned in recent studies. Successful desensitizations have also been reported with several drugs.

Staphylococcus aureus is an important pathogen causing a wide variety of diseases such as skin infections, food poisoning, pneumonia and septicemia in humans and animals. Among the bacterial agents of food poisoning, S. aureus is the most common agent worldwide. The aim of this study was to assess prevalence of SEA, SEB enterotoxin producing S. aureus isolated from foodborne outbreaks in Iran. In this study, 313 diarrheal samples from 120 outbreaks were collected from December 2017 to August 2018. Isolates were identified using classical methods. The antimicrobial resistance patterns of the S. aureus isolates were assessed using standard disk-diffusion and E-test methods. Presence of sea and seb genes was investigated using polymerase chain reaction (PCR). Data were analyzed using SPSS and Excel Software as well as statistical tests. In this study, 55 samples (17.6%) from an overall number of 313 samples from food outbreaks were identified as S. aureus, which were assessed for their antimicrobial susceptibility. The highest contamination belonged to Yazd (50.9%) and Semnan (29.1%) Provinces. However, no contaminations of S. aureus were seen in Zanjan Province. The S. aureus was more common in females (50.9%) than males. Furthermore, S. aureus isolates were mostly resistant to penicillin (81.8%) and completely susceptibile to vancomycin. Of 55 isolates of S. aureus, four isolates (7.3%) were positive for sea and one (1.8%) for seb genes. The current study has shown that S. aureus food infection is one of the most common foodborne diseases, caused by the ingestion of staphylococcal enterotoxins produced by enterotoxigenic strains of staphylococci. Therefore, further screening and monitoring programs are suggested for the prevention of staphylococcal infections. Key words: Staphylococcus aureus, foodborne outbreaks, antibiotic resistance, sea, seb.

The mastitis causing microorganisms resist beta-lactam antibiotics by releasing beta-lactamase and the enzyme can be traced in raw milk. This study was aimed at developing a novel platform test to detect beta-lactam antibiotics residues in raw milk based on the Hardy Diagnostic Beta-lactamase Test (HDBT) reagent. The HDBT ingredients modified were penicillin, sodium chloride, trisodium citric acid, trisodium phosphate and phenol red dissolved in distilled water. Pooled raw milk samples were obtained from 3 Friesians and 3 Ayrshires lactating cows identified to have subclinical mastitis and treated using beta-lactam antibiotics. The appropriate mixing ratios were investigated at nine levels. Investigation on the effect of breeds on the test method results was also carried out. Evaluations to determine the colour differences between beta-lactam positive and negative raw milk samples for all the experiments were carried out using trained panelists. The results indicate that gradual addition of trisodium phosphate and phenol red in the reagent showed significant difference (P ≤ 0.05) between a beta-lactam positive and negative raw milk sample. Ratio 5:5 was selected as the best and had significant difference (P ≤ 0.05) from the others. Conversely, the test method indicated no significant difference (P ≤ 0.05) between the Friesians and Ayrshires raw milk samples. This method can be used along the raw milk collection routes to accept, set aside or reject raw milk suspected to have residues. The colour observed for a beta-lactam negative sample was fuchsia purple while peach or pink signified a positive sample. Key words: Raw milk, antibiotic residues, beta-lactam, beta-lactamase enzyme, trisodium phosphate

Background:Clostridium perfringens, a rapid-growing pathogen known to secrete an arsenal of >20 virulent toxins, has been associated with intestinal diseases in both animals and humans throughout the past century. Gas gangrene is synonymous with myonecrosis and is a highly lethal infection of deep soft tissue, caused by Clostridium species, with Clostridium perfringens being the most common. Clostridium perfringens is one of the most common cause’s gas gangrene that is associated with broadspectrum antibiotic treatment. The objectives of the present article were focusing on the diagnosis of Clostridium perfringens from wound swabs from patients suffering from gas gangrene associated with antibiotics treatment and determining the best antibiotics that can inhibit the growth of Clostridium perfringens.Materials and methods: Four hundred isolates were collected from Fever Abbassia hospital in Cairo, Egypt. Clinical samples were collected from swab wounds of limbs. Samples were taken during the period of the first of Oct 2017 till the end of Oct 2018. From four hundred cases collected, Two hundred twenty-eight identified as gas gangrene (57%), One hundred twenty-eightidentified as Clostridium perfringens type(A) (56.1%) confirmed by biochemical tests (Gram stain, Catalase test, Motility test, Skim milk test, Urease test, Indole test, Nagler reaction.) and Multiplex PCR. In this study, we are used different media such as (Thioglycalate broth, Reinforced Clostridial Agar, Blood agar, TryptoseSulfiteCycloserine Agar, Robertson's cooked meat media). The antibiotic sensitivity against CL.perfringens is assayed by two methods, disc diffusion Method and Determination of (MIC) using E-Test by following the reference standards established by the Clinical and Laboratory Standards Institute ( CLSI) and British Society for Antimicrobial Chemotherapy (BSAC). The antimicrobial susceptibility test was performed for all of the isolates (128) by disc diffusion method using antibiotics (Chloramphenicol (30 μg /disc), Cefoxitin (10 μg /disc), Clindamycin (2 μg /disc), Metrondiazole (5 μg /disc), Tetracyclin (30 μg /disc), Rifampin (5 μg /disc), Penicillin (10 μg /disc) and Piperacillin (30 μg /disc) and by E- test (MIC) (0.016- 256µg/1ml) method using antibiotics (Chloramphenicol, Cefoxitin, Clindamycin, Penicillin G, Tetracycline and Piperacillin) on blood agar and incubate anaerobically in Anaerobic jar for 24 hrs. at 37 ˚C. As Rifampin and Metrondiazole breakpoints (E-Test) for Clostridium perfringenhave not yet been established by either EUCAST or CLSI.Results and conclusion: In this study, isolates Clostridium perfringens from selective media TSC Agar or Blood agar and doing biochemical tests, the antibiotics susceptibility test showing that disc diffusion method and MIC method give the same result. Susceptibility tests were done on (128) isolates of CL.perfringens by E-Test to determine MIC.Our results revealed that the percentage of sensitivity of CL.perfringens to( Chloramphenicol , Cefoxitin, Clindamycin, Rifampin, Penicillin G, Metrondiazole and Tetracyclin) are (53.9% , 53.1% , 52.3 % , 41.4 % , 35.9 % , 21.1 % , 14.1 % ) respectively . On the other hand, the data revealed that CL.perfringens was resistant to PRL ( 100%). Future advanced research should participate in the prevention of C. perfringens gas gangrene outbreaks

Adolescent deep neck space infection is an important pathology that often requires hospitalization for antimicrobial therapy. The aim of the study was to identify the inciting organisms and their resistance profiles in the adolescent population of patients with deep neck space infection. We performed a single-center cross-sectional retrospective analysis of patients between 10 and 16 years of age, with deep neck space infections. From the 319 cases of deep neck space infections that presented over the study period, nine patients met the criteria to be included in the study. The mean age being 11.8 years. The microbiology of the specimens revealed mainly Staphylococcus and Streptococcus species and in some patients microscopy and culture showed no predominant bacteria. There was an overall 86% resistance of organisms to penicillin and ampicillin but most organisms were sensitive to amoxicillin-clavulanic acid Deep neck space infections in adolescents can initially be managed with amoxicillin-clavulanic acid, source control and surgical drainage if required. Culture directed therapy can be initiated after microbiology results. The spaces involved are similar to adults with 44% of patients having deep neck abscess secondary odontogenic infection. The microbiology however is similar to that of children with Streptococcus and staphylococcus species being the most predominant.

Utilizing the pathology and microbiology found in tissue from patients with documented Alzheimer’s disease (AD), the pathogenesis of this fateful disorder has been made clear. Borrelia burgdorferi and Treponema denticola spirochetes enter the brain, mostly via neuronal pathways and the entorhinal circulation. These organisms easily pass through the blood-brain barrier and have an affinity for neural tissue. Once in the brain, the spirochetes make intra- and extracellular biofilms, and it is the biofilms that create the pathology. Specifically, it is the intracellular biofilms that are ultimately responsible for neurofibrillary tangles and dendritic disintegration. The extracellular biofilms are responsible for the inflammation that initially is generated by the first responder, Toll-like receptor 2. The hypothesis that arises from this work is two-pronged: one is related to prevention; the other to treatment. Regarding prevention, it is very likely possible that AD could be prevented by periodic administration of penicillin (PCN), which would kill the spirochetes before they made biofilms; this would prevent the disease and would not allow any of the above deleterious changes generated by the biofilms to occur. As regards treatment, it may be possible to slow or prevent further decline in early AD by administration of PCN together with a biofilm disperser. The disperser would disrupt the biofilm coating and enable the PCN to kill the spirochetes. This protocol could be administered in a trial with the control arm utilizing the current treatment. The progress of the treatment could be evaluated by one of the current blood tests that is semi-quantitative. The specific protocols are listed.

Syphilis is a sexually transmitted infection caused by the bacterium Treponema pallidum (T. Palladium). Human Immunodeficiency Virus (HIV) is a virus that attacks the body's immune system, decreased the number of CD4 cells that makes the immune system decrease, and facilitates syphilis infection. Syphilis increased the risk of spreading HIV infection with skin barrier destruction. The diagnosis of syphilis is made based on a complete history, including sexual history, clinical manifestations, and examination. The treatment of syphilis with HIV and without HIV similar, penicillin is still the gold standard for syphilis treatment with HIV. Prevention of syphilis with HIV are educated, screening for syphilis and other sexually transmitted infections, as well as early detection and therapy of partners. The prognosis for syphilis in HIV is worse than for syphilis without HIV.

Viability of probiotics in the foods and human bodies is important, because a certain minimum count of bacteria is necessary to impose health promoting effects. In the present work, we encapsulated Lactobacillus reuteri within whey protein isolate (WPI), soy protein isolate (SPI), WPI + inulin (WPI4I), and SPI + inulin (SPI4I) through spray drying method and investigated the efficiency of the microcapsules on the protection of the cells under different conditions (heat, salt, bile salt, penicillin, pH, simulated gastrointestinal condition, and storage). The particle size of the samples was in the range of 195.2–358.1 nm. The sensitivity of unencapsulated bacteria to heat was considerably higher than that to the encapsulated bacteria, so that, at 80°C, no growth (of unencapsulated type) was observed. At 60°C and 40°C, the cell count of free bacteria decreased to 5.81 and 8.04 log CFU/mL, respectively. The bacteria encapsulated within SPI4I showed the highest viability at these temperatures. A comparison between the effects of different pH values showed pH 1.5 more lethal than 2.5 and 7. The effect of NaCl at 4% concentration on decreasing the bacterial count was more notable than 2%. However, the used wall materials in all conditions resulted in higher viability of the cells compared to the free cells. Among different types of wall materials, it was observed that WPI4I imposed the best protective effect. The higher viability of cells within WPI4I wall material was also observed during the storage time. The viability of encapsulated cells decreased from 10.35 to 10.40 log CFU/g in the first week and to 8.93–9.23 log CFU/g in the last week of storage.

Objectives: Acute tonsillitis is an inflammatory process of tonsil tissue and is usually infectious. Acute tonsillitis starts suddenly and usually disappears within one to two weeks. This study aims to isolate bacteria from patients with infectious tonsillitis and determine the antibacterial activity of Mentha piperita L, Citrus aurantium, banana peel extract and antibiotics including penicillin, ampicillin, oxacillin, meropenem, tobramycin, gentamicin, levofloxacin, and clarithromycin against bacteria. Methods: Were Collected 60 clinical samples of sputum and throat swabs from patients with tonsillitis admitted to AL-Furat Alawsait Hospital in Najaf. The samples were cultured in blood, MacConkey agar, and incubated at 37°C for 24 hours, and then the Vitek2 system was used for diagnosis to detect G + ve and G-ve bacteria. Results: It was found that out of 60 sputum samples and throat swabs, 15 cases were gram positive bacteria, while 45 gram negative bacteria. As revealed by the in vitro agar well diffusion method, it was found that the aqueous extracts of these plants, especially Mentha piperita, have strong antibacterial activity against a variety of pathogens. The results show that Mentha is very effective at all concentrations used in this study (125, 250, 500, 1000) mg / ml in all bacteria isolated from tonsillitis. The zone of greatest inhibition of Mentha, Citrus anrantium and banana peel extract was 30, 28, 25 mm at concentrations of 1000 mg / ml respectively. Used eight selected antibiotics, including (penicillin, ampicillin, oxacillin, meropenem, tobramycin, gentamicin, levofloxacin, and clarithromycin). To shows the susceptibility of all bacteria isolates used in this study, the best antibiotics to sensitive for all bacteria (Meropenem and Levofloxacin ), while the resistance to oxacillin. Conclusion: The selected commonly used aqueous extracts have been tested for their antibacterial activity against multi drug-resistant bacteria, and it is believed that their extracts can be used for multi drug-resistant bacteria that can cause nosocomial and community-acquired infections.

Penicillin allergies are reported by 8% to 15% of the US population, but up to 95% of these allergies do not correspond to a true allergy when tested. Recent studies have demonstrated that having a penicillin allergy label (PAL) results in a 50% increased odds of surgical site infection among patients reporting a penicillin allergy entirely attributable to the use of a beta-lactam alternative antibiotic (primarily clindamycin or vancomycin). This study provides a review of the prevalence of PAL, the cross-reactivity with cefazolin, immunogenic components of cefazolin and penicillin, and current guidelines for preoperative antibiotic selection in patients with PALs. On understanding these principles, a new set of guidelines and a risk stratification tool are proposed for assessing allergies and determining appropriate antibiotic choice, dosage, and timing in the orthopaedic preoperative setting.

BACKGROUND Patients who report a penicillin allergy are often given second-line antibiotic prophylaxis during total joint arthroplasty (TJA), with only a minority of patients undergoing additional consultations and allergy testing. In an effort to increase the use of cephalosporin prophylaxis in TJA, the present study aimed to assess the effectiveness of a simple, protocol-driven penicillin allergy screening program without the need for additional work-up. METHODS Following implementation of a questionnaire-based screening protocol in May 2019, all patients scheduled for primary TJA were risk-stratified into low or high-risk categories. The low-risk cohort received cefazolin, and the high-risk cohort received non-cefazolin antibiotics. Patients were monitored prospectively, and data on antibiotic usage and adverse outcomes were documented. The protocol group (n = 2,078) was propensity score matched 1:1 with a control group that included patients who underwent TJA in the same institution prior to implementation of the protocol. The primary end point was the efficacy of the protocol in reducing unnecessary use of non-cephalosporin antibiotics for prophylaxis. Secondary outcomes included the rate of surgical site infections and allergic reactions to the administered antibiotic. RESULTS A total of 357 patients (17.2%) reported a penicillin allergy in the protocol group compared with 310 patients (14.9%) with a recorded allergy in the control group (p = 0.052). The number of patients who received non-cephalosporin antibiotics was significantly lower in the protocol group (5.7% compared with 15.2% in the control group; p < 0.001), whereas there was no difference in the rate of total allergic reactions (0.8% compared with 0.7%, respectively; p = 0.857). Of the 239 low-risk patients (66.9%) in the protocol group, only 3 (1.3%) experienced a mild cutaneous reaction following cefazolin administration. There were no differences in the rates of superficial wound, deep periprosthetic, or Clostridioides difficile infections between the protocol and control groups. CONCLUSIONS A simple screening protocol allowed two-thirds of patients with a self-reported allergy to receive cefazolin without the need for additional consultations or testing. We believe this protocol can be safely implemented to increase the rate of cefazolin usage without a corresponding increase in the number of allergic reactions. LEVEL OF EVIDENCE Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

BackgroundMultidrug-resistant Enterobacterales (MDR-E) are important pathogens. People living with human immunodeficiency virus (HIV; PLWH) may be at greater risk for MDR-E infection given relatively high antibiotic exposure and burden of comorbidities.MethodsWe analyzed data from 36 521 patients in a healthcare system in North Carolina who had a clinical culture with growth of an Enterobacterales species from 2000 to 2018; 440 were PLWH. We used generalized linear models to estimate prevalence ratios and differences, contrasting PLWH and people not living with HIV (PNLWH) for resistance to individual antibiotic classes, as well as MDR-E. We assessed trends in prevalence over time by calculating the 5-year moving average and fitting restricted cubic spline models.ResultsThe overall prevalence of MDR-E was higher among PLWH (21.5%; 95% confidence interval [CI], 18.2%–25.1%) vs PNLWH (16.5%; 95% CI, 16.2%–16.9%), with an adjusted prevalence ratio of 1.38 (95% CI, 1.14–1.65). PLWH had higher rates of antimicrobial resistance than PNLWH for all antibiotic classes analyzed, including penicillins, penicillin/beta lactamase inhibitor combinations, and sulfonamides. MDR-E prevalence was 3 to 10 percentage points higher among PLWH than PNLWH throughout the study period based on the 5-year moving average.ConclusionsIn a large clinical study population in the southeastern United States from 2000 to 2018, the prevalence of antibacterial resistance among Enterobacterales was consistently higher among PLWH than PNLWH. These data highlight the importance of identifying and mitigating the factors that contribute to antimicrobial resistance in PLWH, given the potential clinical consequences of these resistant pathogens.

Background Pneumococcal serotypes differ in antimicrobial susceptibility. However, patterns and causes of this variation are not comprehensively understood. Methods We undertook a systematic review of epidemiologic studies of pneumococci isolated from carriage or invasive disease among children globally from 2000–2019. We evaluated associations of each serotype with nonsusceptibility to penicillin, macrolides, and trimethoprim/sulfamethoxazole. We evaluated differences in the prevalence of nonsusceptibility to major antibiotic classes across serotypes using random-effects meta-regression models and assessed changes in prevalence of nonsusceptibility after implementation of pneumococcal conjugate vaccines (PCVs). We also evaluated associations between biological characteristics of serotypes and their likelihood of nonsusceptibility to each drug. Results We included data from 129 studies representing 32 187 isolates across 52 countries. Within serotypes, the proportion of nonsusceptible isolates varied geographically and over time, in settings using and those not using PCVs. Factors predicting enhanced fitness of serotypes in colonization as well as enhanced pathogenicity were each associated with higher likelihood of nonsusceptibility to penicillin, macrolides, and trimethoprim/sulfamethoxazole. Increases in prevalence of nonsusceptibility following PCV implementation were evident among non-PCV serotypes, including 6A, 6C, 15A, 15B/C, 19A, and 35B; however, this pattern was not universally evident among non-PCV serotypes. Postvaccination increases in nonsusceptibility for serotypes 6A and 19A were attenuated in settings that implemented PCV13. Conclusions In pneumococci, nonsusceptibility to penicillin, macrolides, and trimethoprim/sulfamethoxazole is associated with more frequent opportunities for antibiotic exposure during both prolonged carriage episodes and when serotypes cause disease. These findings suggest multiple pathways leading to resistance selection in pneumococci.

Listeriosis is an infective complication that primarily affects pregnant women, patients at extremes of age or those with weakened immune systems. Ingestion of food contaminated with Listeria monocytogenes is the most common source of infection, causing self-limiting illness in immunocompetent hosts but associated with invasive infection and high mortality in high-risk patient groups. Milder illness presents as gastroenteritis with fever, diarrhoea, nausea and vomiting common in the 7 days post exposure. Invasive infection, characterised by bacteraemia and encephalitis, can develop in high-risk patients. Fetal loss is a major complication of listeriosis during pregnancy. Penicillin-based therapy (high dose penicillin or amoxicillin) in combination with gentamicin is advised for invasive infection; co-trimoxazole may be considered for patients intolerant to penicillin. Vulnerable individuals, notably pregnant women, should be counseled on appropriate preventative strategies including avoiding foods commonly contaminated with L. monocytogenes, such as soft ripened cheeses, pate, cooked chilled meats, unpasteurised milk, and ready to eat poultry unless thoroughly cooked.

Staphylococcus aureus has been recognized as an important foodborne pathogen. However, knowledge about the epidemiology and genetic characteristics of S. aureus in the meat production chain from farm to market is limited. The aim of this study was to investigate the genetic characteristics of S. aureus in animal samples isolated from Xinjiang province farms and farmer' markets, by determining staphylococcal protein A (spa) repeat region and virulence factor typing, and by assessment of antimicrobial resistance. Out of 1324 samples, 128 (9.7%) were positive for S. aureus, 26 (2.0%) of them were identified as methicillin-resistant S. aureus (MRSA) and 88 (6.6%) of them were identified as vancomycin-resistant S. aureus (VRSA). Antimicrobial resistance was determined using the disk diffusion method. S. aureus isolates showed resistance to penicillin G (98.4%), clarithromycin (69.5%), erythromycin (69.5%), vancomycin (68.8%), and tetracycline (67.2%). A total of 80.4% of isolates showed resistance to three or more antimicrobial classes. PCR was used to detect ten virulence genes such as the enterotoxin (sea, seb, and sec), hemolysin (hla and hlb), clumping factor (clfA), and fibronectin-binding proteins A and B (fnbA and fnbB). Our study showed that isolates harbored two or seven virulence genes. All strains encode hla and clfA, and half of them encode hlb and enterotoxin genes. The spa typing results showed that the 128 isolates were grouped into 32 spa types. The main spa types were t127 (22.7%), t2592 (12.5%), t437 (10.9%), and t2616 (10.9%). Notably, isolates of t437 type accounted for 46.2% of the MRSA. Our data indicate that meats in the slaughterhouse and farmers' markets were contaminated with S. aureus. S. aureus virulence genes and spa types were diverse, and its antibiotic resistance was serious. The presence of MRSA and VRSA represents potential public health risks and warrants further investigation regarding the driving factors of such resistance and their transmission to humans.

The quality and composition of meat and its derivatives are influenced by many factors namely physicochemical, organoleptic factors and microbial contamination. The aim of this study was to evaluate kpakouma consumption risk through its chemical and microbiological contaminants. The methodological approach was composed of (i) observation of selling environment, (ii) pesticides and antibiotics residues quantification by HPLC, and (iii) microbiological analysis using selective media and biochemical tests. The data shows that aminoglycosides, penicillin and nitrofuran were not determined both in the black and the white kpakouma. Macrolides (0.094±0.004) and beta lactams (0.016±0.0036) are noted only with white kpakouma. Lindane (0.215±0.003) and HCH (1.0003±0.003) were only detected among some samples whereas chlorpyrifos, malathion and parathion were not detected in all the tested samples. Concerning the microbial contaminants, according to the European Regulation, all kpakouma samples were highly contaminated with Staphylococcus species, Escherichia coli and Salmonella. The isolated Staphylococcus spp. were mostly (90%) resistant to vancomycin, no Staphylococcus spp. resistance was recorded for ciprofloxacin. E. coli and Salmonella were all resistant to oxytetracycline, no resistant isolate of E. coli was recorded for ciprofloxacin but Salmonella strains were at 25% resistant to ciprofloxacin. These results show the non-compliance with the hygiene rules during the sale of kpakouma and reaffirm the potentially critical role that can be played by commensals in public health. Key words: Environment, bacteria, pesticide and antibiotics residues, kpakouma, Cotonou.

A cross-sectional study was carried out in and around Sebeta town dairy farms, Finfinne special zone, Ethiopia, from December 2019 to May 2020 to isolate, identify, and test antimicrobial susceptibility profile of Staphylococcus aureus from clinical mastitis. A total of 116 milk samples were purposively collected from 57 lactating cows with clinical mastitis. Isolation and identification of Staphylococcus aureus were carried out by using primary and secondary biochemical tests. Besides, Biolog was used for microbial identification systems. To know if the isolates develop resistance to antibiotics, the antimicrobial susceptibility test (ATS) was performed on Mueller-Hinton agar by the disk diffusion method. From a total of 57 lactating cows and 116 teat quarters examined, 21.05% (12/57) and 15.52% (18/116) were positive for S. aureus from clinical mastitis, respectively. From a total of 116 milk samples collected, 15.52% (18/116) Staphylococcus aureus were isolated, and from 11 farms surveyed, about 72.72% (8/11) overall farm prevalence of clinical mastitis due to S. aureus was recorded. All the 18 Staphylococcus aureus isolates were found susceptible to sulphamethoxazole/trimethoprim, erythromycin, gentamicin, ciprofloxacin, and chloramphenicol. However, high level of resistance was observed to common drugs such as penicillin (88.89%, 16/18) and tetracycline (61.11%, 11/18). The observed high level of resistance to penicillin and tetracycline also indicates the need to visit our treatment guidelines for mastitis caused by Staphylococcus aureus. Therefore, improved management and early treatment of the cases with drug of choice after the antimicrobial susceptibility test for each specific case can reduce chance of further development of resistance and are imperative to tackle clinical mastitis occurring at Sebeta and other similar farms in Ethiopia.

Beta-lactam antibiotic resistance can occur in ESBL-producing bacteria such as E.coli and K.pneumoniae, which can cause UTI. One of the risk factors for infection is the non-intensive care space density level. The objective of this study was to determine the sensitivity pattern of ESBL-producing bacteria in urine specimens of patients in the non-intensive care of Ulin General Hospital, Banjarmasin, in the period of 2016-2018. A descriptive study with a cross-sectional design using data results of urine culture and antibiotic susceptibility patterns data in non-intensive care patients at Ulin General Hospital from 2016 to 2018. The urine test results showed 96 positive isolates of ESBL-producing bacteria, consisting of ESBL-E.coli (69.8%) and ESBL-K.pneumonia (30.2%). Antibiotics with low sensitivity tests were Penicillin, Cephalosporin, Monobactam, and Penicillin/beta-lactam inhibitor combinations. Contrastingly, antibiotics with high sensitivity were Aminoglycoside, Carbapenem, and Glycylcycline. It was concluded from this study that the ESBL-producing bacteria in urine specimens for non-intensive care patients of Banjarmasin Ulin General Hospital in the period of 2016-2018 showed varying sensitivity to antibiotics

In this research study, a novel deep eutectic solvent was synthetized and used for rapid and simple ultrasound-assisted dispersive liquid–liquid microextraction based on solidification of floating organic drop (USA-DLLME-SFO) method. The proposed method was applied for simultaneous separation and preconcentration of penicillin G, ampicillin, and amoxicillin prior to their analysis by high-performance liquid chromatography with photodiode array detection (HPLC–PDA). Benzyl triethylammonium chloride (as hydrogen bond acceptor (HBA)) and decanoic acid (as hydrogen bond donor (HBD)) (1:3 mol ratio)) were synthetized and used as hydrophobic deep eutectic solvent (HP-DES) in USA-DLLME-SFO process. Important parameters including pH, DES volume, dispersive solvent type and volume, sonication time, sample volume, and ionic strength were investigated. Under the optimum conditions, the LODs of 0.18–0.35 µg kg−1 for aqueous solutions, 2.8–3.5 µg kg−1 for chicken meat, 1.16–2.35 µg kg−1 for honey, and 2.73–5.08 µg kg−1 for egg were acquired for penicillin G, ampicillin, and amoxicillin. The suitable linearity of 3.0–500 µg kg−1 for penicillin G and amoxicillin and 7.5–750 µg kg−1 for ampicillin was attained for all real samples. The inter-day precision (the relative standard deviations (RSDs %)) below 4.2% was also acquired for three concentrations of 50, 100, and 200 µg kg−1 of analytes within seven replications. In order to consider the reproducibility, the analytical process was carried out at optimum conditions within 4 days and each day for three times. The reproducibility values of 3.1, 2.6, and 3.5% were achieved for penicillin G (Pen. G), ampicillin (Amp.), and amoxicillin (Amox.) (100 µg kg−1), respectively. The proposed method was successfully applied for determination of the target antibiotics in chicken meat, egg, and honey with the relative recoveries over 97.0% which confirms high capability of the method for application in complex matrices.

The present study aimed to assess the correlation between ambient air pollutants and Streptococcus pneumoniae (S. pneumoniae)-induced pneumonia in children and retrospectively reviewed the daily data regarding S. pneumoniae from children with pneumonia in a tertiary hospital of Hangzhou City, between January 1st, 2018, and December 31st, 2018. The excess risk (ER) of NO2 with regard to the daily number of S. pneumoniae isolates obtained from the respiratory tract specimens of children with pneumonia was 13.31% (95% confidence interval [CI]: 3.12–24.51%, P = 0.010) in the single-pollutant model. An increase of 10 μg/m3 in NO2 exposure was associated with a 23.30% increased risk for the acquisition of S. pneumoniae-induced pneumonia in children (95% CI: 2.02–49.02%; P = 0.031) according to the multi-pollutant model. The ER of NO2 with regard to the daily number of S. pneumoniae isolates (1 μg/ml ≤ minimum inhibitory concentration (MIC) to penicillin ≤ 2 μg/ml) obtained from the respiratory tract specimens of children with pneumonia was 15.80% (95% CI: 2.02–31.45%; P = 0.024) in the single-pollutant model. According to the multi-pollutant model, the ER of NO2 with regard to the daily number of S. pneumoniae isolates (1 μg/ml ≤ MIC to penicillin ≤ 2 μg/ml) obtained from the respiratory tract specimens of children with pneumonia was 37.09% (95% CI: 5.70–77.81%; P = 0.018). In conclusion, ambient NO2 is associated with S. pneumoniae-induced pneumonia in children. More importantly, NO2 exposure is associated with the increased MICs of penicillin against S. pneumoniae from children with pneumonia.

Objective: To describe the impact of pharmacy driven penicillin allergy assessments on de-labeling penicillin allergies and antibiotic streamlining opportunities for hospitalized patients. Design: Multi-center, retrospective case-series study. Setting: A health system of 4 non-teaching hospitals. Participants: Patients aged 18 years and older with a physician order for a pharmacist penicillin allergy assessment. Exclusion criteria consisted of patients with anaphylaxis or a type II penicillin allergy, anaphylaxis of any cause within 4 weeks, refusal of penicillin allergy skin test (PAST), antihistamine use within 24 hours, penicillin intolerance, immunosuppression or immunosuppressive medications, or skin conditions that could interfere with PAST. Interventions: The primary endpoint evaluated the number of de-labeled penicillin allergies after pharmacists provided penicillin allergy assessments. Secondary endpoints evaluated the percent of patients with antibiotics deescalated to beta-lactam antibiotics and classification of notable interventions made by pharmacists. Measurements and Main Results: There were 35 patients who met inclusion criteria. Twenty-four patients underwent both penicillin allergy skin testing and oral (PO) amoxicillin challenge. Five patients had allergies de-labeled only after a pharmacist interview. Four patients received only the PO amoxicillin challenge and 2 patients received only PAST. Penicillin allergies were de-labeled from the electronic health record (EHR) in 31 (89%) patients despite all testing negative for a penicillin allergy from PAST or a PO amoxicillin challenge. Four patients had the allergy re-added to the chart on subsequent admissions. No patients experienced a reaction from PAST, PO amoxicillin challenge, or subsequent beta-lactam antibiotics. Twenty-eight (80%) patients had their antibiotic therapy changed as a result of the allergy assessment. Seventeen patients were de-escalated onto beta-lactam antibiotics and aztreonam was stopped in 6 patients. Conclusion: Results from this study suggests that pharmacists expanding their scope of practice with PAST is a safe and effective allergy de-labeling tool. Pharmacist-driven penicillin allergy assessments could provide antibiotic cost savings and avoid aztreonam use. The study supports the need to emphasize education for patients and caretakers regarding allergy testing results to avoid relabeling in future hospital visits.

We describe a case of recurrent catheter-related blood stream infections (BSI) with Staphylococcus aureus, in which the first isolate tested susceptible to penicillin, while subsequent isolates were resistant. Phenotypic susceptibility correlated with the absence/presence of the blaZ gene. The in vitro stability of penicillin resistance was investigated by subculturing single colonies. In two out of five colonies, phenotypical resistance was lost after a single subculture, which correlated with loss of the blaZ gene. This in vitro phenomenon probably resulted in a very major error in the microbiology report of the first BSI, where penicillin had been recommended as treatment.

Background and Rationale: Enterococci have long been recognised as low virulence bacteria occurring as commensals in the human intestine. However in the last two decades they emerged as one of the leading causes of nosocomial infections with the development of resistance to antibiotics. So appropriate identification and characterization and antimicrobial susceptibility testing of Enterococcal species is necessary for management and prevention of these infections. Materials and Methods: 150 isolates of Enterococcal species were obtained from various clinical samples. Characterisation was done by standard Microbiological methods and antibiotic susceptibility testing was done by Kirby- Bauer disc diffusion method and Vancomycin MIC tested by E- test. Results: Out of 150 isolates from various clinical samples like urine 93(62%), pus 45(30%), blood 7(4.6%) and other body fluids 5(3%), E.faecalis 131(87.3%) was the predominant isolate followed by E.faecium 14(9.3%), E.avium 2(1.3%), E.raffinosus 2(1.3%) and E.durans 1(0.6%). All isolates were sensitive to Vancomycin, Teicoplanin and Linezolid. Sensitivity to High level Gentamicin was 92%. Rate of resistance to Penicillin 150(100%), Tetracycline 95(63.3%), Ciprofloxacin 103(68.6%) and Ampicillin 67(44.6%). Conclusions: Even though no Vancomycin resistant strains were isolated from our study, there is incidence of Vancomycin resistant Enterococci are emerging as potent pathogen. So methods for characterization, antimicrobial susceptibility testing and MIC of Vancomycin should be done routinely for Enterococcal species. Keywords: Enterococcus, Efaecalis, Efaecium, High level Gentamicin, Vancomycinresistant Enterococci

Discovery of penicillin marked a turning point in the history of infection therapy which also led to the emergence of bacterial resistance. It is now 100 years to fight with ever-muted variants of pathogens by developing more and more antibiotics. Since 1987 to todate, no successful class of antibiotic was introduced; this three decade period is known as "the discovery void" period. While, the clinically approved antibiotics are gradually dying in front of bacterial resistance due to which bacterial infections are appearing leading cause of death and disability. Nuclear medicine imaging technique is the strongest modality to diagnose and follow-up of deep-seated and complicated infections. However, the selection of radiolabeled antimicrobial agents plays critical role in gaining sensitivity and specificity of the imaging results. This review comprises of two main sections; first section explains antibiotic targets, and second section explains the imaging efficacy of 99m Tc-labeled antimicrobial agents against bacterial infection along with the emphasis on progress and update of 99m Tc-labeled antibiotics as infection imaging probes. The review, in conclusion, could be an acceleration for radiopharmaceutical chemists for designing and developing 99m Tc-labeled antimicrobial agents to improve infection imaging quality.