Search

Severe community-acquired and nosocomial infections require aggressive support measures and appropriate antimicrobial therapy. Nosocomial infections in particular are associated with high mortality rates, extended hospital stays, and a dramatic increase in overall costs. The prevention, diagnosis, and treatment of these infections depend on how knowledgeable health care professionals are about nosocomial infections. Hospital-acquired infections usually are caused by multiresistant bacteria. The hospital environment is a breeding ground for bacterial resistance. Inappropriate antibiotic use in hospitalized patients is responsible for the development of multiple resistance mechanisms and for the transmission of these mechanisms from resistant bacteria to sensitive bacteria. However, even though resistance is a problem, third-generation cephalosporins continue to be of value in the treatment of severe communityacquired and selected nosocomial infections.

Twenty-five patients with urinary tract infection were treated with norfloxacin, a fluoroquinolone antibacterial with a wide spectrum of activity for an oral agent. Of 22 patients who were evaluable, 20 had complicated urinary tract infection; infection was cured in 19 patients at one week after treatment. Optimal alternative treatments were also selected in norfloxacin's stead, based on each patient's characteristics and the results of susceptibility testing for each isolated pathogen. Direct costs for alternative treatment ranged from $7 to $970. The results indicated that for those patients with suspected or proven urinary tract infection caused by multiresistant bacteria, therapy with norfloxacin may represent a cost-effective choice.

A long-term endemic caused by Klebsiella pneu-moniae occurred in the period 1966 to 1970 among patients in an urological unit. The multiresistant bacteria which were uniformly resistant to sulfonamides, ampicillin, and tetracyclines, were responsible for asymptomatic significant bacteriuria or overt urinary tract infection in 93 patients during an observation period covering one year (1967). Septicemia developed in 12 patients and 6 of the patients eventually succumbed. The endemic was provoked by two different types of Klebsiella: a chloramphenicol-sensitive and kanamycin-resistant one of capsular type 35, and a chloramphenicol-resistant and kanamycin-sensitive one of capsular type 7. Each of the two serotypes possessed their distinct phage pattern. Aseptic as well as antiseptic procedures were reviewed, but no flaws of any importance were disclosed either in the operating theatres or in the wards. A search for the Klebsiella throughout the environment was futile except in one locality, namely in a soile...

Imipenem is a new carbapenem antibiotic that has an extremely broad spectrum of antibacterial activity. It has been used to treat a variety of serious infections and an increasing volume of literature documents its value in infections due to multiresistant bacteria. This article reviews the antibacterial activity, pharmacology, and clinical uses of imipenem.

Sixty patients were treated with ciprofloxacin: 19 received only intravenous ciprofloxacin, 41 received intravenous followed by oral ciprofloxacin. The mean duration of therapy was 28 days in the intravenous only group and 10 days intravenously and 80 days orally in the intravenous/oral group. Ten (17 percent) patients received 200 mg intravenously every 12 hours and 49 (82 percent) 300 mg every 12 hours. The overall clinical response was 85 percent, with a bacteriologic response of 70 percent. The lowest bacteriologic response (38 percent) occurred in the 13 patients treated for Pseudomonas respiratory infection. Clinical response occurred in 24 of 26 patients with soft-tissue infection, and 10 of 13 patients with respiratory infection. Of three patients with endocarditis, therapy failed in two with resistance developing in Pseudomonas aeruginosa and Staphylococcus aureus. Overall, 19 percent of 26 P. aeruginosa isolates developed resistance to ciprofloxacin. Toxicity was minor, with phlebitis and nausea most commonly reported. Intravenously administered ciprofloxacin or intravenous followed by oral ciprofloxacin is a safe, effective therapy for serious infections due to multiply resistant gram-negative bacteria, including P. aeruginosa and S. aureus.

The correlation between aminoglycoside consumption patterns and the occurrence of aminoglycoside-resistant bacteria from 12 different countries was analyzed. Regional and national data were collected retrospectively and compared. There was evidence of a wide variation of the national aminoglycoside consumption patterns in the different countries. There was a striking correlation of gentamicin resistance and the total national aminoglycoside and national gentamicin consumption. In addition, there was a clear correlation between bacterial resistance inside and outside the hospital to the total amount of aminoglycoside, particularly gentamicin, consumption in hospitals. In a number of countries, an increase in the frequency of gentamicin-resistant bacterial strains could be noticed. For amikacin, only a correlation of staphylococcal resistance in hospitalized patients to the total amount of national aminoglycoside and amikacin consumption could be found.

El objetivo del estudio fue determinar el genotipo BLEE de 15 cepas de enterobacterias resistentes a betalactámicos, aisladas de superficies inanimadas y caracterizadas fenotípicamente como productoras de betalactamasas de espectro extendido. Previa evaluación y tamizaje de las cepas bacterianas, se hizo un PCR para amplificar fragmentos de 1078 pb y 544 pb correspondientes a BLEE tipo TEM y CTX-M. Once cepas presentaron ambos fragmentos a la vez y tres presentaron solamente blaCTX-M. En conclusión, se demostró la presencia de genes BLEE en cultivos de origen ambiental, algunos de los cuales podrían pertenecer a más de un tipo; esta información podría servir de base para implementar medidas de prevención que eviten la trasmisión de bacterias multirresistentes desde superficies inanimadas a los pacientes, principalmente en áreas hospitalarias críticas The aim of the study was to determine the genotype of 15 ESBL strains of Enterobacteriaceae resistant to beta-lactams, isolated from inanimate surfaces and phenotypically characterized as producing extended-spectrum beta-lactamase. After evaluation and screening of the bacterial strains, a PCR was conducted to amplify fragments of 1078 bp and 544 bp corresponding to type TEM and CTX-M ESBL. Eleven strains presented both fragments at the time and only three had blaCTX-M. In conclusion, the presence of ESBL genes in cultures from the environment was demonstrated, some of which may belong to more than one type. This information could serve as a basis for implementing preventive measures to prevent the transmission of multiresistant bacteria from inanimate surfaces to patients, mainly in critical hospital areas

International audience; Since the introduction in the 1940s of antibiotics as drugs against bacterial infections in human and then veterinary medicine, two major events have caused a shift in the antibiotherapy era: (1) the emergence of resistant bacteria and (2) the awareness of the limits of new drug development. It rapidly became urgent to set up measures in order to evaluate the importance of resistant bacteria and their origin as well as to limit the dissemination of resistant vectors (bacteria and bacterial genes). This led to the establishment of guidelines and regulatory rules necessary for risk assessment and clearly dependent upon monitoring and research organisations. At a veterinary level, the possible dissemination of multiresistant bacteria from animals to humans, through feeding, urged various national European and international institutions to give general recommendations to monitor and contain the emergence and diffusion of resistant strains. This paper gives an overview of the evolution of regulatory rules and monitoring systems dealing with multiresistant bacteria.; Nouvelles tendances concernant la législation et la surveillance de la résistance aux antibiotiques chez les bactéries d'origine animale. Depuis l'introduction, dans les années 1940, des antibiotiques comme médicaments antibactériens en médecine humaine puis vétérinaire, deux événements majeurs ont marqué l'ère de l'antibiothérapie : l'émergence de bactéries résistantes et la prise de conscience des possibilités limitées de développement de nouvelles molécules. Il est apparu rapidement urgent d'établir des mesures pour évaluer l'importance des résistances et leur origine ainsi que pour limiter la dissémination des vecteurs de résistance (bactéries et/ou gènes bactériens). Ceci a conduit à l'élaboration de guides et réglementations nécessaires à la gestion du risque et dépendant des systèmes de surveillance et de recherche. Au niveau vétérinaire, la possible dissémination de souches multirésistantes des animaux vers l'homme à travers l'alimentation a conduit différentes instances nationales, européennes et mondiales à émettre des recommandations générales pour surveiller et limiter l'émergence et la diffusion de ces résistances. Ce texte présente un état des lieux de l'évolution des textes réglementaires et des systèmes de surveillance des bactéries multirésistantes aux antibiotiques.

Objective This study aimed to investigate the association of anesthetists’ academic and educational status with self-confidence, self-rated knowledge and objective knowledge about rational antibiotic application. Therefore, anesthetists in Germany were asked about their self-confidence, self-rated knowledge and objective knowledge on antibiotic therapy via the Multiinstitutional Reconnaissance of practice with Multiresistant bacteria (MR2) survey. Other analysis from the survey have been published elsewhere, before. Results 361 (52.8%) questionnaires were completed by specialists and built the study group. In overall analysis the Certification in Intensive Care (CIC) was significantly associated with self-confidence (p

The emergence of multiresistant bacteria has increased the need for new antibiotics or modifications of older antibiotics. One promising agent might be the everninomicin SCH 27899, an oligosaccharide antibiotic recently developed by Schering Plough. However, another oligosaccharide, avilamycin, that is structurally very similar has been used as a growth promoter for food animals in the EU for several years, and a very frequent occurrence of resistance to avilamycin has been found among Enterococcus faecium isolates from broilers in Denmark. This study was conducted to investigate whether the resistance to avilamycin was associated with decreased susceptibility to everninomicin. From broilers, a total of 31 avilamycin susceptible and 55 avilamycin resistant (MIC >16 microg/mL) E. faecium isolates were selected. From pigs, 21 avilamycin-susceptible and eight avilamycin-resistant Enterococcus faecalis and 50 avilamycin-susceptible and two avilamycin-resistant E. faecium isolates were selected. All isolates were tested for susceptibility to everninomicin by E-test. The avilamycin-susceptible enterococci isolates had MICs to everninomicin from 0.064 to 0.75 microg/mL (MIC50 = 0.38 microg/mL) and the avilamycin-resistant isolates had MICs from 1.5 to 16 microg/mL (MIC50 = 3 microg/mL). Complete agreement between decreased susceptibility to avilamycin and everninomicin was found. This study showed that the use of avilamycin as a growth promoter for broilers and pigs has created a reservoir of E. faecium and E. faecalis isolates with decreased susceptibility to everninomicin among food animals already before this antibiotic have been finally developed for human use.

Staphylococcus spp. are bacteria involved in human and animal infections. They are resistant to antimicrobials and have become a major public health concern. In recent years, there has been a significant increase in methicillin-resistant Staphylococcus strains and vancomycin is the drug of choice for the treatment of such isolates. However, the minimum inhibitory concentration (MIC) of vancomycin necessary to combat this microorganism has been showing an increase. The aim of the present study was to determine the susceptibility profile of the Staphylococcus spp. of domestic and wild animals to vancomycin, using the microdilution in broth and E-test® techniques, as well as comparing the results of both tests. Of the 50 isolates tested, 47 (94 %) were sensitive to vancomycin in the microdilution and 43 (86 %) were sensitive to vancomycin in the E-test®. Seven (14 %) isolates had an intermediate result showing a risk to public health since the detection of these isolates may precede the occurrence of isolates resistant to vancomycin. In addition, the mecA gene was detected in 78 % of the tested samples. Six of the seven isolates with intermediate resistance to vancomycin were carriers of the mecA gene, showing that these isolates had a potential risk of becoming resistant. Thus, control measures must be taken to prevent the spread of these isolates with intermediate resistance and preserve the effectiveness of this antimicrobial for the treatment of infections caused by multiresistant Staphylococcus spp. RESUMO: Staphylococcus spp. são bactérias envolvidas em infecções de humanos e animais, resistentes a antimicrobianos e tem se tornado uma grande preocupação em saúde pública. Nos últimos anos houve um aumento significativo de Staphylococcus resistentes à meticilina e a vancomicina é a droga de escolha para o tratamento desses isolados, porém vem apresentando elevação nos valores de Concentração Inibitória Mínima (CIM) necessários para combater este microrganismo. O objetivo do presente trabalho foi determinar o perfil de suscetibilidade à vancomicina para isolados de Staphylococcus spp. de animais domésticos e silvestres pelas técnicas de Microdiluição em caldo e E-test®, bem como comparar os resultados de ambos os testes. Dos 50 isolados testados 47 (94%) foram sensíveis à vancomicina na Microdiluição e 43 (86%) foram sensíveis à vancomicina no E-test®. Sete (14%) isolados tiveram resultado intermediário demonstrando um risco à saúde pública visto que a detecção destes isolados pode preceder a ocorrência de isolados resistentes à vancomicina. Ademais o gene mecA foi detectado em 78% das amostras testadas, sendo que dos sete isolados com resistência intermediária à vancomicina, seis eram portadores do gene mecA, evidenciando que esses isolados possuem potencial risco de se tornarem resistentes. Dessa forma medidas de controle devem ser tomadas para evitar a propagação destes isolados com resistência intermediária e preservar a eficácia deste antimicrobiano para o tratamento de infecções causadas por Staphylococcus multirresitentes.

Bacterial infections are very common and represent one of the most important reasons of progression of liver failure, development of liver-related complications, and mortality in patients with cirrhosis. In fact, bacterial infections may be a triggering factor for the occurrence of gastrointestinal bleeding, hypervolemic hyponatremia, hepatic encephalopathy, kidney failure, and development of acute-on-chronic liver failure. Moreover, infections are a very common cause of repeated hospitalizations, impaired health-related quality of life, and increased healthcare costs in cirrhosis. Bacterial infections develop as a consequence of immune dysfunction that occurs progressively during the course of cirrhosis. In a significant proportion of patients, infections are caused by gram-negative bacteria from intestinal origin, yet gram-positive bacteria are a frequent cause of infection, particularly in hospitalized patients. In recent years, infections caused by multidrug-resistant bacteria are becoming an important clinical problem in many countries. The reduction of the negative clinical impact of infections in patients with cirrhosis may be achieved by a combination of prophylactic measures, such as administration of antibiotics, to reduce the occurrence of infections in high-risk groups together with early identification and management of infection once it has developed. Investigation on the mechanisms of altered gut microflora, translocation of bacteria, and immune dysfunction may help develop more effective and safe methods of prevention compared to those that are currently available. Moreover, research on biomarkers of early infection may be useful in early diagnosis and treatment of infections. The current manuscript reports an in-depth review and a position statement on bacterial infections in cirrhosis., Journal Article, Research Support, Non-U.S. Gov't, info:eu-repo/semantics/published

Corynebacterium group JK is described as the aetiologic agent of a second episode of peritonitis which occurred after a period of antibiotic treatment for likely endogenous peritonitis. Inclusion of vancomycin is suggested for treatment of continuous ambulatory peritoneal dialysis (CAPD) peritonitis in patients colonized by these multiresistant bacteria.