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Purpose: Outpatient parenteral antimicrobial therapy (OPAT) offers several key advantages, including enhanced patient quality of life, reduced healthcare costs, and a potential reduction of nosocomial infections. It is acknowledged for its safety and effectiveness. This study provides the first systematic clinical data for Germany, where OPAT has not yet been widely adopted. The aim is to establish a foundational reference point for further research and integration of OPAT into the German healthcare system. Methods: This prospective observational study descriptively analyses data obtained from a cohort of patients receiving OPAT. Both in- and outpatients from all medical specialties could be recruited. Patients administered the anti-infective medications themselves at home using elastomeric pumps. Results: 77 patients received OPAT, with a median duration of 15 days and saving 1782 inpatient days. The most frequently treated entities were orthopaedic infections (n = 20, 26%), S. aureus bloodstream infection (n = 16, 21%) and infectious endocarditis (n = 11, 14%). The most frequently applied drugs were flucloxacillin (n = 18, 23%), penicillin G (n = 13, 17%) and ceftriaxone (n = 10; 13%). Only 5% of patients (n = 4) reported to have missed more than one outpatient dose (max. 3 per patient). Only one catheter-related adverse event required medical intervention, and there were no catheter-related infections. Conclusion: The study demonstrates that OPAT can be safely conducted in Germany. In preparation for its broader implementation, crucial next steps include creating medical guidelines, fostering interdisciplinary and inter-sectoral communication, as well as creating financial and structural regulations that facilitate and encourage the adoption of OPAT. Trial registration number: NCT04002453. [ABSTRACT FROM AUTHOR]

Acute cholecystitis is a leading cause of individuals seeking medical attention in the emergency department due to right upper quadrant pain. Common complications associated with this clinical condition, which is frequently encountered in daily practice, include gangrenous cholecystitis, pericholecystic abscess, cholangitis, and gallbladder perforation. It is important to also consider the rare but potentially severe complication of cystic artery pseudoaneurysm. This case report details the development of a cystic artery pseudoaneurysm secondary to acute cholecystitis and its subsequent endovascular treatment in a 59-year-old male patient with no known underlying medical conditions, in accordance with existing literature. [ABSTRACT FROM AUTHOR]

Antimicrobial resistance poses a significant threat to global public health, especially for Enterobacterales. In this study, we investigated the distribution and antimicrobial resistance of Enterobacterales in children in the China Antimicrobial Surveillance Network (CHINET) in 2015–2021. In total, 81,681 strains isolated from children were collected in this period, accounting for 50.1% of Gram-negative organisms. The most frequently isolated Enterobacterales were Escherichia coli, Klebsiella spp., Salmonella spp., and Enterobacter spp. The main sources of the isolates were urine and the respiratory tract, accounting for 29.3% and 27.7% of isolates, respectively. The proportions of E. coli, Klebsiella pneumoniae, and Proteus mirabilis expressing extended-spectrum β-lactamase were 48.8%–57.6%, 49.3%–66.7%, and 23.1%–33.8%, respectively. The prevalence of carbapenem-resistant Enterobacterales was 5.7%–9.5%, which showed a decreasing trend from 2015 to 2021. The detection rates of carbapenem-resistant Klebsiella spp., carbapenem-resistant Enterobacter spp., and carbapenem-resistant E. coli were 14.1%–22.6%, 7.1%–15.7% and 2.0%–3.4%, respectively. In Enterobacterales, the resistance rates to ciprofloxacin were higher than to levofloxacin. However, the Enterobacterales strains were highly susceptible to amikacin, polymyxin B, and tigecycline. The resistance rate of Salmonella spp. to ampicillin was > 70%, whereas their resistance rate to ceftriaxone was < 30%. These findings indicate that the resistant rates of some Enterobacterales isolates in children to common antimicrobial agents show decreasing trends. Continuous monitoring of bacterial resistance should be strengthened to prevent and control the spread of drug-resistant bacteria. [ABSTRACT FROM AUTHOR]

Pneumonia is a common infection in patients of all ages. Determining its etiology and selecting antibiotic therapy are challenging for physicians in both private practice and hospitals. Moreover, the coronavirus disease pandemic revealed the importance of prevention and treatment of secondary bacterial pneumonia in patients hospitalized with viral respiratory infections. This review focuses on the types of bacteria that cause pneumonia and provides new insights into antibiotic therapy for bacterial pneumonia. Moreover, it also reviews the current state of knowledge regarding secondary bacterial pneumonia. [ABSTRACT FROM AUTHOR]

Background: Deep neck infections (DNIs) can compromise the airway and are associated with high morbidity and mortality rates. Diabetes mellitus (DM) is a metabolic disorder characterized by chronic hyperglycemia that is associated with several comorbidities. We compared the clinical characteristics of DNI patients with and without DM. Methods: This study recorded the relevant clinical variables of 383 patients with DNIs between November 2016 and September 2022; of those patients, 147 (38.38%) had DM. The clinical factors between DNI patients with and without DM were assessed. Results: Patients with DM were older (p < 0.001), had higher white blood cell counts (p = 0.029) and C-reactive protein levels (CRP, p < 0.001), had a greater number of deep neck spaces (p = 0.002) compared to patients without DM, and had longer hospital stays (p < 0.001). Klebsiella pneumoniae was cultured more frequently from patients with DM than those without DM (p = 0.002). A higher CRP level (OR = 1.0094, 95% CI: 1.0047–1.0142, p < 0.001) was a significant independent risk factor for DM patients with prolonged hospitalization. The lengths of hospital stays in patients with poorly controlled DM were longer than those with well-controlled DM (p = 0.027). Conclusions: DNI disease severity and outcomes were worse in patients with DM than those without DM. Antibiotics effective against Klebsiella pneumoniae should be used for DNI patients with DM. DNI patients with DM and high CRP levels had more prolonged hospitalizations. Appropriate blood glucose control is essential for DNI patients with DM. [ABSTRACT FROM AUTHOR]

Objectives The quality of amoxicillin capsules, ceftriaxone for injection, and ciprofloxacin tablets was evaluated to determine whether there is any difference in quality when comparing the country of origin. This was undertaken because it has been claimed that antibiotics manufactured in Europe are of superior quality to those originating from Africa or Asia. Methods Samples of amoxicillin capsules, ceftriaxone for injection, and ciprofloxacin tablets were collected from three randomly selected wholesale pharmacies in each city, namely Arusha, Dar es Salaam and Mwanza, Tanzania. The collected samples of collected brands were subjected to quality control testing as per their respective pharmacopoeial monographs. Amoxil 250 mg capsules (Glaxo Wellcome, Mayenne, France), Rocephin (Roche, Switzerland) and Cipro-Denk 500 (Allphamed Pharbil Arzneimittel GmbH, Gottingen, Germany) were used as reference brands for the other generic brands of amoxicillin, ceftriaxone and ciprofloxacin, respectively. Results A total of 31 brands (10 different brands of amoxicillin capsules, 9 of ceftriaxone sodium injections, and 12 of ciprofloxacin tablets) were collected from the targeted regions and subjected to quality control testing. All samples of collected brands complied with the requirements of their respective pharmacopoeial monographs. Conclusions There was no significant difference in quality between brands of amoxicillin capsules, ceftriaxone for injection, and ciprofloxacin tablets manufactured in Africa and Asia against those manufactured in Europe in terms of compliance with the respective pharmacopoeial monographs. [ABSTRACT FROM AUTHOR]

Background and Aim: There is an increasing rate of antibiotic resistance in Neisseria gonorrhoeae (N. gonorrhoeae). Several obstacles affect the culture and susceptibility testing of N. gonorrhoeae. This study was aimed to determine the antimicrobial susceptibility pattern and molecular characteristics in multidrug-resistant (MDR) N. gonorrhoeae in Jakarta, Indonesia. Materials and Methods: Forty-one endocervical specimens were streaked onto the chocolate agar and then gently rolled onto a glass object. The suspected colonies were identified by Gram staining, oxidase testing, and biochemical identification using VITEK® 2 NH cards. The antimicrobial susceptibility testing was performed using the disk diffusion or E-test method. Molecular detection of N. gonorrhoeae was carried out using the SYBR green real-time PCR targeting the opa gene. The multiplex real-time PCR with high-resolution melting (HRM) was also conducted to analyze the gene mutations in penA and 23S rRNA. DNA sequencing was used to confirm penA and 23S rRNA mutations. Results: SYBR green real-time PCR against the opa gene on direct specimens detected N. gonorrhoeae with higher positivity rate (49%) compared to the culture (34%). Susceptibility testing detected 11.1% N. gonorrhoeae resistant to cefixime, whereas resistance to azithromycin and ceftriaxone was 0%. The resistance of N. gonorrhoeae to levofloxacin and kanamycin was 33.3% and 88.9%, respectively. All isolates were resistant to penicillin, tetracycline and ciprofloxacin. There were no mutations in the penA genes Ala501, Gly545Ser, 23S rRNA A2059G and C2611T. Conclusion: Cefixime resistance was found in our samples. This resistence was not correlated with penA gene mutations. All isolates were still susceptiblle to azithromycin, which was in line with its molecular characteristics. The SYBR green real-time PCR targeting the opa gene successfully detected the DNA extracted from endocervical swabs as N. gonorrhoeae. [ABSTRACT FROM AUTHOR]

Background and Aim: Pseudomonas aeruginosa (P. aeruginosa) is a common environmental bacterium linked to the serious hospital-acquired infections. Chlorhexidine (CHX), a widely used antiseptic in hospitals, can create selection pressure that contributes to the cross-antibiotic resistance and the emergence of multidrug-resistant (MDR) strains. This study aimed to investigate the prevalence of tolerance to CHX and the presence of the pslA, pelA, qacE, and qacΔE1 genes among P. aeruginosa isolates in Shiraz, Southwest Iran. Materials and Methods: From October 2020 to July 2021, 120 P. aeruginosa isolates were collected from hospitalized patients at Nemazee Hospital in Shiraz, Southwest Iran. The Kerby-Bauer disk diffusion method was employed for the antimicrobial susceptibility testing. The susceptibility to CHX was evaluated using the microbroth dilution method. Finally, the prevalence of the pelA, pslA, qacE, and qacΔE1 genes was assessed among all P. aeruginosa isolates. Results: The highest resistance rate was observed against ceftriaxone and ceftazidime, with frequencies of 97.120 (80.8%) and 96.120 (80%), respectively. In contrast, the lowest resistance rates were noted for amikacin (5.120, or 4.2%), ofloxacin (7.120, or 5.8%), and meropenem (10.120, or 8.3%). Among the 120 P. aeruginosa isolates, 33 (27.5%) were CHX-tolerant, and 22 (18.3%) were MDR. There was a highly significant correlation between the rates of MDR and CHX-tolerant P. aeruginosa isolates (P<0.005). Conclusion: A positive association between the percentages of MDR strains and CHX-tolerant P. aeruginosa isolates has reinforced the hypothesis that exposure to CHX may contribute to developing cross-resistance. Thus, concise monitoring of CHX susceptibility seems essential in the hospital and clinical settings. [ABSTRACT FROM AUTHOR]

The high mortality rate in cattle and buffalo is a concern, especially in developing countries, such as Egypt. Under conditions of global change in climatic conditions, has caused the activation of some opportunistic microbes, causing deaths in cattle and buffalo farms. As a result of environmental stressors which lead to the activation of some bacterial agents which is the main reason for the increase in mortality in this article, we reported special spots on some bacterial agents causing sudden death in cattle and buffalo. Fecal and nasal discharge samples were collected for bacteriological examination from (60 diseased cattle and buffalo showing clinical signs of respiratory and diarrheic symptoms 30 from each of different ages and sexes (first group) and 40, slaughtered or dead animals (cattle and buffalo) from ruminal contents, tissue samples from liver, spleen, and lung 20 from each (second group). We collected samples from many locations at Assiut Governorate and were sent to the laboratory. The results of the first group indicated that (50) 30 cattle and 20 buffalo were positive for bacterial infection however 10 showed negative results of bacterial infection in buffalo. The incidence of bacterial infection in the first group was 83.5%, whereas the second group indicated that 100% (40) (20 cattle and 20 buffalo) were positive for bacterial infection. Bacteriological investigations of first group revealed that the isolated organisms were: Clostridium perfringens (46.7%), Pasteurella multocida (33.3%), Escherichia coli (13.3%), Salmonella sp.(6.7%) in cattle but in buffalo recorded that Clostridium perfringens (33.3%), Pasteurella multocida (23.3%), Escherichia coli (6.7%), Salmonella sp.( 3.3%), On other hand, bacteriological investigations of second group revealed that the isolated organisms were: Clostridium perfringens (50%), Pasteurella multocida (30%), Escherichia coli (15%) and, Salmonella sp.(5%) in cattle whereas in buffalo showed that Clostridium perfringens (40%), Pasteurella multocida (25%), Escherichia coli (25%), Salmonella sp.(10%), A total of 42 isolates of Clostridium perfringens isolated from first and second group 12 isolates examined for type of toxin by using of Multiscreen Ag ELISA Enterotoxemia The main often occurring toxin type was type A (buffaloes: 5/50; cows: 7/50) Out of 14 isolates of E coli from first and second group examined samples were serologically positive to O111, 0104, O26, O113, O91,0103 and O126. PCR results showed that ten strains from 28 isolates, from the first and second group, were isolates and some of them have Kmt1, BlaROB1, and tetH genes. Antibiogram was applied upon the isolated bacterial pathogens and found that Ofloxacin - oxytetracycline - Aztreonam (Clostridium perfringens) Gentamycin, Ceftriaxone, and Norfloxacin (Pasteurella multocida) garamycin and oxytetracycline (Escherichia coli) and ciprofloxacin and ceftriaxone were the most effective antibiotic against salmonella sp. were the drug of choice for treatment of infected animals. [ABSTRACT FROM AUTHOR]

In a 12-year single-center quasi-experimental study, a switch from ciprofloxacin to ceftriaxone prophylaxis for transrectal ultrasound-guided prostate biopsy procedures was associated with a significant reduction in 30-day postprocedure urinary tract infection, urinary tract infection–related hospitalizations, antibiotic prescriptions, and isolation of fluoroquinolone-resistant organisms from urine or blood cultures. [ABSTRACT FROM AUTHOR]

The aim of the present study was to evaluate the anti-pyelonephritis activity of naringenin alone or combined with ceftriaxone in a rat model. In all, 35 Wistar rats were randomly divided into five equal groups. Groups 2 – 5 underwent surgery and were infected with E. coli to induce pyelonephritis. Groups 1 and 2 were treated with normal saline and groups 3, 4, and 5 received ceftriaxone (60 mg/kg), naringenin (20 mg/kg), and ceftriaxone+naringenin, respectively for 1 week. Subsequently, the disc diffusion method and bacterial colony counting were performed. After six weeks, MDA and GSH levels, TOS, TAC, activities of GPx, CAT and SOD, and histopathological analyses were evaluated in the kidneys. A week after the ceftriaxone treatment and two weeks after the naringenin exposure, negative urinary bacterial colonies were observed. The combination of these drugs caused negative colonies during the first week. Naringenin alone or in combination with ceftriaxone significantly decreased renal MDAand TOS but increased TAC, GSH and activities of GPx, CAT and SOD compared with the pyelonephritic group. This combination revealed histopathological changes in the kidneys. Our data suggest synergism between naringenin and ceftriaxone in alleviating pyelonephritis-induced complications. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the pattern of dispensing antibiotics without a prescription in a community pharmacy in Baghdad, as well as to understand the factors influencing the dispensing of antibiotics without a prescription. A cross-sectional study was conducted among community pharmacists to describe the dispensing of antibiotics in community pharmacies. The convenience sampling method was applied to select the required sample from a community pharmacy in Baghdad. A self-administered questionnaire was used to obtain the data from the participants. The majority of community pharmacists (94.2%) dispensed antibiotics without a prescription in their community pharmacy. Most of them (59.6%) reported that oral antibiotics were the most common form dispensed without a prescription. In addition, 23.6% of participants reported that they also dispensed parenteral antibiotics without a prescription. The highest percent of antibiotics dispensed without prescription were for UTIs (94.2%), sore throat (70.9%), and earache (70.3%). The most common dispensed antibiotics without prescription were Amoxicillin (96.9%) Amoxicillin/Clavulanate (88.2%), Cephalexin (70.6%), Ceftriaxone (61.2%), Cefixime (67.7%), Ciprofloxacin (87.4%), Azithromycin (94.2%), and Metronidazole (85.6%). This study showed that community pharmacists were commonly dispensing antibiotics without a prescription at community pharmacies. Therefore, rigorous rules are needed to control the sale of antibiotics in community pharmacies. [ABSTRACT FROM AUTHOR]

Low-velocity penetrating brain injury (LVPBI) is a class of brain injury where a foreign object violates the skull and damages the brain. Such injuries are rare and consequently understudied. As such, we report an illustrative case of a 29-year-old female with a dense, plastic spike penetrating her right orbit and into her midbrain. After assessment with a CT scan and angiography, the object was removed with careful attention to possible vascular injury. The patient had an uncomplicated post-operative course and received antibiotic and antiepileptic prophylaxis. She was discharged on post-operative day 5, experiencing only mild left-sided weakness. Common concerns regarding LVPBI include infection, post-traumatic epilepsy, and vascular injury. A review of published LVPBI cases over the past 20 years demonstrated that most cases (55.2%) are due to accidents. Of patients undergoing surgery, 43.4% underwent a craniotomy, and 22.8% underwent a craniectomy. Despite the grave nature of LVPBI, only 13.5% of the patients died. Additionally, 6.5% of patients developed an infection over their clinical course. In all, more reported cases further paint a picture of the current state of management and outcomes regarding LVPBI, paving the way for more cohesive guidelines to ensure the best possible patient outcomes. [ABSTRACT FROM AUTHOR]

The article focuses on considering liver abscess as a potential etiology for prolonged fever without an obvious cause in pediatric patients, especially those with acute changes in appetite, abdominal symptoms, or recent abdominal trauma. Topics include typical bacteria associated with liver abscesses, such as Staphylococcus aureus and Escherichia coli, as well as parasitic etiologies like Amebiasis and Human Echinococcosis, based on exposure history.

The article offers information on the increasing incidence of sinogenic and otogenic intracranial empyemas following the COVID-19 pandemic, reviewing their presentation, imaging, and treatment. Topics include the severe complications of bacterial rhinosinusitis or otomastoiditis leading to cerebritis and brain abscesses, the polymicrobial nature involving gram-positive, gram-negative, and anaerobic bacteria, with a focus on Streptococcus anginosus group infections.

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With the increasing use of invasive, interventional, indwelling, and implanted medical devices, healthcare-associated infections caused by pathogenic biofilms have become a major cause of morbidity and mortality. Herein, we present the fabrication, characterization, and in vitro evaluation of biocompatibility and anti-biofilm properties of new coatings based on Fe3O4 nanoparticles (NPs) loaded with usnic acid (UA) and ceftriaxone (CEF). Sodium lauryl sulfate (SLS) was employed as a stabilizer and modulator of the polarity, dispersibility, shape, and anti-biofilm properties of the magnetite nanoparticles. The resulting Fe3O4 functionalized NPs, namely Fe3O4@SLS, Fe3O4@SLS/UA, and Fe3O4@SLS/CEF, respectively, were prepared by co-precipitation method and fully characterized by XRD, TEM, SAED, SEM, FTIR, and TGA. They were further used to produce nanostructured coatings by matrix-assisted pulsed laser evaporation (MAPLE) technique. The biocompatibility of the coatings was assessed by measuring the cell viability, lactate dehydrogenase release, and nitric oxide level in the culture medium and by evaluating the actin cytoskeleton morphology of murine pre-osteoblasts. All prepared nanostructured coatings exhibited good biocompatibility. Biofilm growth inhibition ability was tested at 24 h and 48 h against Staphylococcus aureus and Pseudomonas aeruginosa as representative models for Gram-positive and Gram-negative bacteria. The coatings demonstrated good biocompatibility, promoting osteoblast adhesion, migration, and growth without significant impact on cell viability or morphology, highlighting their potential for developing safe and effective antibacterial surfaces. [ABSTRACT FROM AUTHOR]

Background: Tolerance enables bacteria to survive intermittent antibiotic exposure without an increase in antimicrobial susceptibility. In this study, we investigated the presence of tolerance to three antimicrobials, ceftriaxone, azithromycin and ciprofloxacin, in clinical isolates and the WHO (World Health Organization) reference panel of Neisseria gonorrhoeae. Methods: We used the modified tolerance disk (TD test) to assess for tolerance to ceftriaxone, azithromycin and ciprofloxacin in 14 WHO reference strains and 62 N. gonorrhoeae clinical isolates—evenly divided between anorectal and urogenital infections. The isolates underwent a three-step incubation process wherein the isolates were exposed to an antibiotic disk for 20 h of incubation (Step I), followed by the replacement of the antibiotic disk with a nutrient disk for overnight incubation (Step II) and additional overnight incubation with extra nutrients (Step III). Results: A total of 4 of the 62 clinical anorectal isolates and none of the urogenital isolates exhibited tolerance to azithromycin (p = 0.033). Tolerance to ceftriaxone and ciprofloxacin was observed in eight and four isolates, respectively, with no difference between infection sites. Tolerance was also detected in 8 (K, M, N, O, P, U, V, W) out of the 14 WHO reference strains, with varying patterns of tolerance to ceftriaxone (n = 8), ciprofloxacin (n = 2) and azithromycin (n = 1). Conclusions: This study identified ceftriaxone, azithromycin and ciprofloxacin tolerance in clinical and WHO reference N. gonorrhoeae isolates. Azithromycin tolerance was more common in anorectal than urogenital infections. [ABSTRACT FROM AUTHOR]

Drug-induced hemolytic anemia (DIHA) is a rare but significant condition characterized by the premature destruction of red blood cells (RBCs) triggered by certain medications. Ceftriaxone, a commonly used antibiotic, has been linked to DIHA, presenting diagnostic challenges due to its diverse clinical manifestations. This study examines three cases of DIHA caused by ceftriaxone therapy at our center. The patients presented with symptoms such as fatigue, jaundice, and dark urine following ceftriaxone therapy. Laboratory tests indicated hemolytic anemia with decreased hemoglobin, elevated lactate dehydrogenase, and positive direct antiglobulin tests. Immunohematological workups confirmed ceftriaxone-induced antibodies targeting RBCs and guided management strategies, including discontinuation of ceftriaxone, supportive therapy, and corticosteroids. Timely diagnosis and collaboration between clinicians and laboratory specialists are crucial for optimal patient outcomes. [ABSTRACT FROM AUTHOR]

Background: The number of patients with diarrheal diseases admitted to the hospital was reduced during the COVID-19 lockdown. Following the relaxation of the lockdown, admissions of nontyphoidal Salmonella (NTS) infection showed a two-fold rise compared to pre-COVID-19 years. This retrospective study aimed to detect the incidence of NTS in the pre-COVID-19 and post-COVID-19 outbreak periods, along with describing the antibiogram and comorbid conditions of the patients. Materials and Methods: Using a retrospective design, from January 2015 to December 2022, we studied stool samples for the presence of NTS. Antibiogram with ampicillin, co-trimoxazole, ceftriaxone, chloramphenicol, and ciprofloxacin were studied. The presence of comorbid conditions was noted. Results: We examined 2312 and 937 stool samples collected during the pre-COVID-19 and post-COVID-19 outbreak period, respectively. The number of samples collected during the outbreak (2020) was 273. During the pre-COVID-19 period (2015–2019), the average annual isolation rate of NTS was 5.63%. During the lockdown of 2020, the corresponding rate was 5.49%. The isolation rate showed a significant rise (11.45%) during the relaxation of the lockdown (P < 0.001). No significant change in resistance to antibiotics other than ciprofloxacin was noted in the present study. Malignancy was the leading comorbid condition (11.91%) followed by chronic liver diseases (10.31%). Conclusions: A significant rise in NTS diarrheal cases was detected following the COVID-19 outbreak. During this period, people were attending more celebrations and feasts. No significant change in antibiotic resistance was noted when comparing pre-COVID-19 and COVID-19 periods. Malignancy was the leading comorbid condition. [ABSTRACT FROM AUTHOR]

Background: Clinical conditions such as actinomycosis, midline lethal granulomatosis, and fulminant fungal infections are associated with severe mid-line orofacial tissue destruction. This study aims to present our experience in the diagnostic and therapeutic challenges associated with the management of central orofacial destructive conditions. Materials and Methods: This was a retrospective analysis of the records of 15 patients managed for mid-line orofacial destructive conditions over a period of 3 years (June 2020–July 2023). Record of demographics, history, examination, investigations, treatment, and outcome were recorded and analyzed using IBM SPSS version 25. Results: There were 10 (66.7%) males and 5 (33.3%) females in the age range of 14–62 years with a mean ± standard deviation of 34.53 ± 13.66 years. Anemia was present in 12 (80%) patients, and nine (60%) patients had normal total protein and albumin levels. Histopathological examination revealed chronic nonspecific inflammation in 14 (93.3%) patients. The majority of the patients nine (60%) were negative for fungal studies. All patients received intravenous antibiotics (ceftriaxone 1 g twice daily and metronidazole 500 mg 3 times daily) at presentation. Antifungal drugs (itraconazole 500 mg twice daily) were administered in six (40%) patients after positive microbiological studies. A total of eight (53.3%) patients recovered from the acute stage of the disease, four (26.7%) patients died during the course of management, and three (20%) patients absconded. Conclusion: Destructive midfacial conditions often present diagnostic and therapeutic challenges. Only eight (53.3%) of the patients in this study were diagnosed and successfully treated. Multidisciplinary approach could enhance early diagnosis and proper treatment of these conditions. [ABSTRACT FROM AUTHOR]

Background: This study aimed to understand the clinical characteristics of pulmonary abscess caused by Streptococcus constellatus infection. Methods: The clinical manifestations, laboratory examination, drug sensitivity, chest CT manifestations, and treatment and prognosis of patients with pulmonary abscess caused by Streptococcus constellatus infection were retrospectively collected and analyzed. Results: A total of 9 cases of pulmonary abscess caused by Streptococcus constellatus infection were confirmed; one case was confirmed by traditional cultures, while metagenomic next-generation sequencing (mNGS) confirmed the other 8 cases. All of the 9 patients had different degrees of cough, sputum, fever, chest pain, and/or dyspnea, and the physical examination showed fast breathing, reduced respiratory sound, or moist rales on the affected side. In laboratory tests, 8 patients had elevated white blood cells and hypoproteinemia upon admission. Blood gas analysis showed an oxygenation index < 300. The antimicrobial susceptibility testing results in 1 patient with cultureconfirmed pathogen diagnosis showed that Streptococcus constellatus was susceptible to ampicillin, penicillin G, cefotaxime, ceftriaxone, cefepime, meropenem, chloramphenicol, linezolid, levofloxacin, and vancomycin and resistant to tetracycline and clindamycin. Relevant antibiotic resistance genes were not detected by mNGS in the 8 patients with negative culture and positive mNGS results. A chest CT showed lung consolidation or cavity formation in 9 patients admitted to the hospital, and 5 patients had pleural effusion. 3 cases were admitted to the respiratory intensive care unit (RICU) and 6 cases were admitted to the general ward. There were 3 cases of nasal catheter oxygen inhalation, 1 case of mask oxygen inhalation, and 5 cases of non-invasive ventilator assisted ventilation. All patients received penicillin or respiratory quinolones anti-infection therapy, and 3 cases were treated with a thoracic closed drainage tube. All patients were discharged from the hospital after improvement, and the hospital stay was 15 - 23 days. Conclusions: Patients with pulmonary abscess caused by Streptococcus constellatus infection have an urgent condition and rapid progression. It is helpful to use mNGS combined with traditional culture as soon as possible to identify the pathogenic bacteria. Penicillin antibiotics should be the first choice for pulmonary abscess caused by a suspected Streptococcus constellatus infection. If a patient´s condition worsens during the treatment, especially for patients who have lesions involving the interlobar fissure or pleura, compressive atelectasis caused by pleural fluid formation or an increase in the amount of pleural effusion needs to be highly suspected. [ABSTRACT FROM AUTHOR]

Introduction: Urinary tract infection (UTI) is the most common infection of the pediatric age group. Several factors linked to higher prevalence include poor personal hygiene, improper sanitation, lower socioeconomic status, and malnourishment. In addition to having a worse quality of life, the 1.8 million children who live in Karachi's Korangi district are routinely exposed to such factors. Objectives: The study aims to evaluate the frequency of UTI and distribution of uropathogens along with their antimicrobial susceptibility pattern in patients presenting to a pediatric tertiary care center in the Korangi district of Karachi, Pakistan. Design: The study employed an observational cross-sectional design. Methods: The study was conducted at the Microbiology laboratory of Sindh Institute of Child Health and Neonatology, Karachi, Pakistan from 1st January to 15th August 2023. Urine samples of patients 1 to 16 years of age were collected via midstream clean catch method and of patients from birth up to 1 year were collected in urine collection bags. The samples were cultured on Cystine Lactose Electrolyte Deficient (CLED) agar and antibiotic susceptibility testing was performed using the Kirby-Bauer Disc Diffusion method. Results: A total of 457 urine samples were collected, of which 90 (19.7%) were positive for significant uropathogens. With a mean age of 4.6 years, majority of the culture-positive patients were female (n = 72; 80%). Enterobacterales were the most frequently isolated (n = 88; 95.6%), of which Escherichia coli was the most common (73.9%; n = 68). Citrobacter (n = 7; 7.6%), Klebsiella (n = 6; 6.5%), Serratia (n = 4; 4.3%), Proteus (n = 2; 2.2%), Salmonella (n = 2; 2.2%), and Enterobacter (n = 1; 1.1%) were among the other Enterobacterales isolated. Meropenem and imipenem were the most effective in isolates from Enterobacterales (n = 88) followed by amikacin (n = 84), ciprofloxacin (n = 75), and piperacillin-tazobactam (n = 70). Ceftriaxone and cefixime exhibited moderate susceptibility (n = 69 and 52) whereas, amoxicillin-clavulanate was the least susceptible (n = 3). Conclusion: We report high frequency of UTI in our pediatric population with uropathogens and associated antimicrobial susceptibility pattern confirming to the existing trends of pediatric UTIs in Pakistan. In addition to valuable insights for treating patients under similar conditions, our study serves as a catalyst for further multi-center research in this area. [ABSTRACT FROM AUTHOR]

Purpose Intravenous push antibiotics can serve as an alternative to intravenous piggyback antibiotics while providing the same pharmacodynamics and adverse effect profile, easing shortage pressures and decreasing order to administration time, as well as representing a potential cost savings. The purpose of this study was to determine whether intravenous push antibiotics could decrease the time from an order to the start of administration compared to piggyback antibiotics in emergency departments. This study also measured the cost savings of antibiotic preparation and administration and assessed nursing satisfaction when using intravenous push antibiotics. Methods Sample instances of use of intravenous push and piggyback antibiotics were identified. Patients were included if they were 18 years of age or older and received at least a single dose of intravenous push or piggyback ceftriaxone, cefepime, cefazolin, or meropenem in one of the institution's emergency departments. The primary outcome of the study was to compare the time from the order to the start of administration of intravenous push vs piggyback antibiotics. The secondary outcome was to compare the cost of antibiotic preparation for the 2 methods. Results The intravenous push and piggyback groups each had 43 patients. The time from the order to the start of administration decreased from 74 (interquartile range, 29-114) minutes in the piggyback group to 31 (interquartile range, 21-52) minutes in the push group (P = 0.003). When the estimated monthly cost savings for ceftriaxone, cefepime, and meropenem were added together, across the emergency departments, an estimated $227,930.88 is saved per year when using intravenous push antibiotics. Conclusion Intravenous push antibiotics decrease the time from ordering to the start of administration and result in significant cost savings. [ABSTRACT FROM AUTHOR]

The article focuses on an 18-year-old male presenting with acute altered mental status to an emergency room, detailing his medical history and initial symptoms. Topics include severe microcytic anemia prompting further investigation, empirical treatment for potential infections, and additional symptoms discovered during hospital admission.

Background Clinical trials of treatments for serious infections commonly use the primary endpoint of all-cause mortality. However, many trial participants survive their infection and this endpoint may not truly reflect important benefits and risks of therapy. The win ratio uses a hierarchical composite endpoint that can incorporate and prioritize outcome measures by relative clinical importance. Methods The win ratio methodology was applied post hoc to outcomes observed in the MERINO trial, which compared piperacillin-tazobactam with meropenem. We quantified the win ratio with a primary hierarchical composite endpoint, including all-cause mortality, microbiological relapse, and secondary infection. A win ratio of 1 would correspond to no difference between the 2 antibiotics, while a ratio <1 favors meropenem. Further analyses were performed to calculate the win odds and to introduce a continuous outcome variable in order to reduce ties. Results With the hierarchy of all-cause mortality, microbiological relapse, and secondary infection, the win ratio estimate was 0.40 (95% confidence interval [CI],.22–.71]; P =.002), favoring meropenem over piperacillin-tazobactam. However, 73.4% of the pairs were tied due to the small proportion of events. The win odds, a modification of the win ratio accounting for ties, was 0.79 (95% CI,.68–.92). The addition of length of stay to the primary composite greatly minimized the number of ties (4.6%) with a win ratio estimate of 0.77 (95% CI,.60–.99; P =.04). Conclusions The application of the win ratio methodology to the MERINO trial data illustrates its utility and feasibility for use in antimicrobial trials. [ABSTRACT FROM AUTHOR]

Background A small proportion of Escherichia coli and Klebsiella pneumoniae demonstrate in vitro non-susceptibility to piperacillin/tazobactam but retain susceptibility to ceftriaxone. Uncertainty remains regarding how best to treat these isolates. Objectives We sought to compare clinical outcomes between patients with piperacillin/tazobactam-non-susceptible but ceftriaxone-susceptible E. coli or K. pneumoniae bloodstream infection receiving definitive therapy with ceftriaxone versus an alternative effective antibiotic. Methods We retrospectively identified patients with a positive blood culture for piperacillin/tazobactam-non-susceptible but ceftriaxone-susceptible E. coli or K. pneumoniae between 1 January 2013 and 31 December 2022. Patients were divided into one of two definitive treatment groups: ceftriaxone or alternative effective antibiotic. Our primary outcome was a composite of 90 day all-cause mortality, hospital readmission, or recurrence of infection. We used Cox proportional hazards models to compare time with the composite outcome between groups. Results Sixty-two patients were included in our analysis. Overall, median age was 63 years (IQR 49.5–71.0), the most common source of infection was intra-abdominal (25/62; 40.3%) and the median total duration of therapy was 12.0 days (IQR 9.0–16.8). A total of 9/22 (40.9%) patients in the ceftriaxone treatment group and 18/40 (45.0%) patients in the alternative effective antibiotic group met the composite endpoint. In an adjusted time-to-event analysis, there was no difference in the composite endpoint between groups (HR 0.67, 95% CI 0.30–1.50). The adjusted Bayesian posterior probability that the HR was less than or equal to 1 (i.e. ceftriaxone is as good or better than alternative therapy) was 85%. Conclusions These findings suggest that ceftriaxone can be used to effectively treat bloodstream infections with E. coli or K. pneumoniae that are non-susceptible to piperacillin/tazobactam but susceptible to ceftriaxone. [ABSTRACT FROM AUTHOR]

Pyocyanin is a blue-green phenazine pigment and one of the most virulent factors produced by the opportunistic pathogen Pseudomonas aeruginosa. It has a redox activity and a toxic impact on living cells, as it interacts with oxygen to produce reactive oxygen species (ROS). Using antibiotics at a sub-lethal dose has an unexpected influence on the expression of pyocyaninproducing genes. In this study, qPCR technique was performed to identify the effect of eight antibiotics (cefotaxime, ampicillin, amoxiclav, ceftazidime, ceftriaxone, chloramphenicol, kanamycin and tetracycline) on the gene expression level of pyocyanin synthetic genes in P. aeruginosa isolated from different clinical sources of a few hospitals in Mosul, Iraq using qPCR technique. It was found that when P. aeruginosa was grown in media containing cefotaxime (CTX 30 µg/mL), ampicillin (AM 25 µg/mL) or amoxiclav (AMC 30 µg/mL), up-regulated the expression of pyocyanin producing genes belonging to different operons thereby increased pyocyanin production. Overexpression occurred in (CTX) treatment in PhzA1 operon with 235.56 fold change and phzM and phzS genes with 340.14, 280.13 fold change, respectively. Lower expression levels showed in tetracycline (TE 30 µg/mL) treatment, which was a (1.44) fold change for phzA1 and a (1.64, 1.08) fold change for phzM and phzS genes. More caution should be considered when delivering antibiotics to treat P. aeruginosa infections, as using drugs that the bacteria resists or at sub-lethal concentrations may trigger up-regulation of virulence factors, aiding in the spread of the disease. [ABSTRACT FROM AUTHOR]

Zusammenfassung: Hintergrund: Bei Patienten mit nosokomialer bakterieller Pneumonie ist die Mortalität am höchsten bei denjenigen, die so weit dekompensieren, dass eine mechanische Beatmung (vHABP) nötig wird, gefolgt von denen mit beatmungsassoziierter Pneumonie (VABP) und nicht beatmungsassoziierter, im Krankenhaus erworbener Pneumonie (nvHABP). Die Ziele dieser Studie waren die Identifizierung von Risikofaktoren, die mit der Entwicklung und der Mortalität von vHABP assoziiert sind, und die Bewertung der Antibiotikabehandlung. Methoden: Eine multizentrische retrospektive Kohortenstudie wurde bei erwachsenen hospitalisierten Patienten mit nosokomialer Pneumonie zwischen 2014 und 2019 durchgeführt. Die Gruppen wurden nach vHABP, nvHABP und VABP stratifiziert und hinsichtlich demografischer Daten, klinischer Merkmale, Behandlung und Ergebnissen verglichen. Mithilfe von maschinellem Lernen wurden multivariate Modelle erstellt, um Risikofaktoren für die Progression zur vHABP und die Mortalität durch Pneumonie für jede Kohorte zu identifizieren. Ergebnisse: 457 Patienten (32% nvHABP, 37% vHABP und 31% VABP) wurden untersucht. Die vHABP- und die nvHABP-Gruppe waren ähnlich alt (medianes Alter 66,4 Jahre), 77% wiesen mehrere Komorbiditäten auf, aber mehr vHABP-Patienten hatten eine Lebererkrankung (18,2% vs. 7,7%; p = 0,05) und eine Alkoholkonsumstörung (27% vs. 7,1%; p < 0,001) und waren in den vorausgehenden 30 Tagen im Krankenhaus gewesen (30,4% vs. 19,5%; p = 0,02). 70% der vHABP-Patienten benötigten am Tag der Diagnose eine sofortige Beatmung. Die Mortalität war in der vHABP-Gruppe am höchsten, gefolgt von der VABP- und der nvHABP-Gruppe (44,6% vs. 36% vs. 14,3%; p < 0,0001). Fast alle (96%) vHABP-Patienten hatten positive Kulturen, wobei Gram-negative Erreger 58,8% ausmachten und 33,0% resistent gegen β-Laktame mit breitem Wirkungsspektrum (ESBL), Ceftriaxon (17,5%), Fluorchinolone (20,6%) und Carbapeneme (12,4%) waren. Bis zur Hälfte der vHABP-Patienten mit ESBL-Enterobacteriaceae oder Pseudomonas aeruginosa erhielten keine wirksame empirische Therapie. Bei Patienten, bei denen eine wirksame Therapie erst nach dem Tag der Pneumoniediagnose begonnen wurde, war die Mortalität um mehr als 50% erhöht. Risikofaktoren, die mit der Entwicklung einer vHABP assoziiert waren, waren Alkoholkonsumstörung, APACHE-II-Score, eine Vasopressortherapie vor der Infektion und eine positive Kultur für ESBL-Enterobacteriales, während eine Krankenhausaufnahme in den letzten 30 Tagen, eine aktive maligne Erkrankung, die Isolierung von Ceftriaxon-resistenten Erregern oder P. aeruginosa und eine Vasopressortherapie Risikofaktoren für eine vHABP-assoziierte Mortalität waren. [ABSTRACT FROM AUTHOR]

Among 15 strains of Listeria monocytogenes tested, a synergy between amoxicillin and ceftriaxone was observed in 14 (93%) according to minimal inhibitory concentration strips and 12 (80%) per the checkerboard methods, as well as for 2 of the 3 strains tested by the time-killing curve. This association may be an alternative treatment for listeriosis in the future. [ABSTRACT FROM AUTHOR]

In this work, new substituted drugs polymerized as new homogenous polymers with study their medicinal properties to extend the controlled drug. The first step includes the preparation of compound N-(4-hydroxyphenyl) maleimide (D1) via a reaction of maleic anhydride with 4-aminophenol. Then compound (D1) was converted to maleimide phenol acetic acid ether (D2) which converted to its corresponding acyl chloride derivative which reacted with amino drugs (Ceftriaxone, Ciprofloxacin) afforded monomers (D3 and D4). Homogeneous polymers (D5 and D6) were prepared via free radical polymerization reaction of the monomers (D3, and D4) under nitrogen using Benzoyl peroxide (Bpo) as initiator. All these prepared monomers and polymers were characterized by FT-IR and 1H-NMR, 13C-NMR techniques and C.H.N.S. Study of the drug release behavior in acidic and basic media as well as the swelling ratio were achieved. The antibacterial activity and physical properties of all monomers and polymers were studied. [ABSTRACT FROM AUTHOR]

Objective: Ceftriaxone and metronidazole (CEF/MET) combination therapy is commonly used in the empirical therapy of intra-abdominal infections (IAIs). We aimed to evaluate the treatment response in patients started on empirical CEF/MET therapy and contribute current treatment data on IAIs. Methods: A retrospective analysis was conducted on patients receiving parenteral antibiotic therapy in the general surgery department between 2016 and 2018. Patients aged 18 and older who received CEF/MET therapy for more than 24 hours with a diagnosis of IAI were included. Patient characteristics, antibiotic use and/or surgical history in the last three months, infection source, need for surgical intervention, and clinical and laboratory data were evaluated. Treatment response was analyzed in groups of patients with or without treatment changes. Results: 10,649 patients were evaluated; 591 (5.5%) received CEF/MET therapy, and 297 (50.2%) met the study criteria. Among them, 243 (81.8%) received only CEF/MET treatment (Group 1), while 54(18.2%) received additional antibiotics (median day 5) (Group 2). There was a statistically significant correlation between malignancy, antibiotic use in the last three months and history of surgical intervention and treatment change (p=0.001). The gallbladder (63%) or the biliopancreatic tract (12.1%) were the infection foci in 75.1% of all patients. Treatment was modified in 9.6% of the patients with an infection focused on the gallbladder and 55.6% of the patients with an infection focused on the biliopancreatic tract (p=0.001). Patients with treatment modification had more extended hospital stays and higher mortality rates (p=0.001). Conclusion: Empirical CEF/MET initiation is appropriate for IAIs with a gallbladder focus, yielding a favourable response in four out of five patients. However, CEF/MET therapy may be insufficient in patients with a biliopancreatic tract focus, a history of antibiotic use, malignancy, or surgical intervention, despite source control. Therefore, learning the source of infection and patient characteristics will contribute to the determination of the antibiotic to be selected in empirical treatment, increase treatment success, shorten the hospitalization period, and reduce mortality. [ABSTRACT FROM AUTHOR]

Background & Objective: Antimicrobial resistance is a worldwide issue. According to United Kingdom Government Commissioned Review on Antimicrobial Resistance, antimicrobial resistance might cause mortality of 10 million people each year by 2050. Microbes developed resistance to antimicrobial agents, largely due to irrational antibiotic use. The presence of a certified pharmacist, as well as prescriber's level of education and experience, are all linked to proper medication use. We aimed to find the differentiation in knowledge, attitude and practices of the pharmacists regarding the differences in experience, education level, graduation institute and working sector. Another area of our study was to ascertain the commonly prescribed antibiotics. Methodology: It was a quantitative, cross-sectional and multicenter study performed in Lahore, Pakistan. The sample size for prescriptions was 324, calculated by Daniel’s equation and 230 for questionnaires by convenient sampling. Questionnaires were administered to clinical, community, industrial and academic pharmacists with consent. A data collection form was utilized for finding prescription patterns. Results: According to 72% community, 71% clinical, 53% industrial, and 69% academic pharmacists, samples for culture and sensitivity must be taken before starting antibiotics. Contrarily, 28% community, 19 % clinical, 10% industrial and 23% academic pharmacists disagreed upon the use of broad-spectrum antibiotics, where narrow spectrum antibiotics were effective. The most commonly prescribed antibiotic was ceftriaxone (38.7%), followed by ciprofloxacin (6.8%) and meropenem (5.8%). Conclusion: The study found good knowledge, attitude and practices among pharmacists regarding antibiotic use. Negligible significant differences were observed in scores among pharmacists working under various set-ups. Irrational prescribing can be avoided by introducing training for physicians and pharmacists. [ABSTRACT FROM AUTHOR]

Background: Infectious diseases (ID) pharmacists are pivotal members of antimicrobial stewardship teams. Prospective audit and feedback is a strong recommendation by The Infectious Diseases Society of America Guidelines for Antimicrobial Stewardship Programs (ASP). Utilizing customized ASP intervention documentation tools known as "ivents" in Epic, we aimed to assess the impact of interventions by measuring outcomes that were accepted compared to those that were rejected in a multihospital health system over 5 years. Methods: A multicenter, retrospective cohort study was conducted to compare clinical outcomes among intensive care unit (ICU) and non-ICU patients with accepted and rejected ASP interventions over 5 years from October 2015 to December 2020. Outcomes measured included antibiotic days of therapy per 1000 patient days (DOT/1000 PD), antibiotic doses per 1000 patient days (doses/1000 PD), hospital length of stay (LOS), in-hospital mortality, hospital-acquired Clostridioides difficile infection (HA-CDI), community-onset C. difficile infection (CO-CDI) within 30 days, and hospital readmission within 30 days. Coarsened exact matching (CEM) was used as a non-parametric matching method to balance covariates between groups and to control for confounding. Results: ASP recommendations by ID pharmacists were well-received by providers in a multihospital system over 5 years as evidenced by an overall acceptance rate of 92%. Acceptance of ASP interventions was associated with substantial reductions in antibiotic utilization without adversely affecting mortality or hospital readmissions. While high-risk C. difficile antibiotic use increased significantly due to frequent de-escalation to ceftriaxone among non-ICU patients with accepted interventions, rates of HA-CDI and CO-CDI within 30 days did not worsen. Furthermore, hospital LOS was notably shorter by an average of 1 day for non-ICU patients with accepted interventions, which resulted in substantial cost avoidance of $7 631 400. Conclusion: Collaboration with ID pharmacists to optimize antimicrobial stewardship was associated with significant reductions in antibiotic utilization, costs, and hospital LOS without worsening patient outcomes. [ABSTRACT FROM AUTHOR]

A selective amperometric sensor was developed to detect the antibiotic ceftriaxone (CEF) using a composite film of poly(β‐cyclodextrin) and a metal‐organic framework (MOF). The sensor was obtained by electro‐polymerizing β‐cyclodextrin (β‐CD) onto a glassy carbon electrode (GCE) previously coated with a MIL‐101(Cr) MOF film. This design prevents MOF particles' loss during extended electrode use. The MOF was structurally characterized using scanning electron microscopy, X‐ray diffraction, N2 adsorption‐desorption isotherms (BET method) and FTIR spectroscopy. Electrochemical impedance spectroscopy and cyclic voltammetry were used to assess the GCE/MIL‐101(Cr)‐pβ‐CD sensor, revealing reduced charge transfer resistance and enhanced sensitivity to CEF. Differential pulse voltammetry was then employed for CEF determination. Under optimized conditions, the sensor exhibited high sensitivity, a broad linear working range of 0.5 to 6 μM (R2=0.991), and a low detection limit of 0.34±0.02 μM (0.19±0.01 mg L−1). The selectivity of the sensor was evaluated in the presence of potential interferences such as organic acids, antibiotics and selected ions expected to affect the CEF signal. In an application to quantify a pharmaceutical formulation, the sensor displayed an impressive recovery rate of 98.3 % compared to results obtained using high‐performance liquid chromatography. [ABSTRACT FROM AUTHOR]

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Drug addiction is considered a worldwide concern and one of the most prevailing causes of death globally. Opioids are highly addictive drugs, and one of the most common opioids that is frequently used clinically is fentanyl. The potential harmful effects of chronic exposure to opioids on the heart are still to be elucidated. Although β-lactam antibiotics are well recognized for their ability to fight bacteria, its protective effect in the brain and liver has been reported. In this study, we hypothesize that β-lactam antibiotic, ceftriaxone, and the novel synthetic non-antibiotic β-lactam, MC-100093, are cardioprotective against fentanyl induced-cardiac injury by upregulating xCT expression. Mice were exposed to repeated low dose (0.05 mg/kg, i.p.) of fentanyl for one week and then challenged on day 9 with higher dose of fentanyl (1 mg/kg, i.p.). This study investigated cardiac histopathology and target genes and proteins in serum and cardiac tissues in mice exposed to fentanyl overdose and β-lactams. We revealed that fentanyl treatment induced cardiac damage as evidenced by elevated cardiac enzymes (troponin I). Furthermore, fentanyl treatment caused large aggregations of inflammatory cells and elevation in the areas and volumes of myocardial fibers, indicating hypertrophy and severe cardiac damage. Ceftriaxone and MC-100093 treatment, However, induced cardioprotective effects as evidenced by marked reduction in cardiac enzymes (troponin I) and changes in histopathology. Furthermore, ceftriaxone and MC-100093 treatment decreased the levels of hypertrophic genes (α-MHC & β-MHC), apoptotic (caspase-3), and inflammatory markers (IL-6 & NF-κB). This study reports for the first time the cardioprotective effect of β-lactams against fentanyl-induced cardiac injury. Further studies are greatly encouraged to completely identify the cardioprotective properties of ceftriaxone and MC-100093.

We describe a particularly severe case of drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome with hemodynamic instability, erythroderma, profound eosinophilia, and severe organ dysfunction. We attribute the severity in part to a delay in diagnosis due to patient's skin of color, as the erythroderma was not noticed until a dermatologist was consulted. This case highlights how even severe skin disease can present less conspicuously in patients with darker skin types. We outline several strategies that can help clinicians to recognize DRESS and other skin disease phenotypes in patients of color, thereby avoiding delays in diagnosis as seen in this case.

MYCN proto‐oncogene, bHLH transcription factor (MYCN) amplification is associated with aggressive retinoblastoma (RB) and neuroblastoma (NB) cancer recurrence that is resistant to chemotherapies. Therefore, there is an urgent need to identify new therapeutic tools. This study aimed to evaluate the potential repurposing of ceftriaxone for the treatment of MYCN‐amplified RB and NB, based on the clinical observations that the drug was serendipitously found to decrease the volume of the MYCN‐driven RB subtype. Using patient‐derived tumor organoids and tumor cell lines, we demonstrated that ceftriaxone is a potent and selective growth inhibitor targeting MYCN‐driven RB and NB cells. Profiling of drug‐induced transcriptomic changes, cell‐cycle progression, and apoptotic death indicated cell‐cycle arrest and death of drug‐treated MYCN‐amplified tumor cells. Drug target identification, using an affinity‐based proteomic and molecular docking approach, and functional studies of the target proteins revealed that ceftriaxone targeted DEAD‐box helicase 3 X‐linked (DDX3X), thereby inhibiting translation in MYCN‐amplified tumors but not in MYCN‐nonamplified cells. The data suggest the feasibility of repurposing ceftriaxone as an anticancer drug and provide insights into the mechanism of drug action, highlighting DDX3X as a potential target for treating MYCN‐driven tumors.

A quiz is presented about the case of a 25-year-old male who immigrated to New York City from Ecuador one year ago, and with no known past medical history, who presented to the emergency department after an episode of syncope.

The article discusses a rare case of Streptococcus suis meningitis, which caused vision loss, deafness, and ataxia in a patient in India. Topics include the clinical presentation of Streptococcus suis infection, the complications of meningitis, and the importance of awareness in regions with limited reports of this pathogen.

Purpose: The goal of this study is to describe the clinical and laboratory outcomes of patients with syphilitic uveitis treated with 2 g intravenous Ceftriaxone daily on an outpatient treatment basis for 14 days, in the setting of the COVID pandemic and lack of hospitalization availability. Methods: This study included a review of the clinical records from patients from January 2020 to December 2021 and who were then followed for 6 months at the Research Laboratory of Infectious Diseases in Ophthalmology of the National Institute of Infectious Diseases Evandro Chagas (INI) FIOCRUZ, Rio de Janeiro, Brazil. Conclusion: This study showed that almost all of the 15 patients were well treated for ocular syphilis with Ceftriaxone without any signs of therapeutic failure with documented clinical improvement and satisfactory decreasing VDRL titers. [ABSTRACT FROM AUTHOR]