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Type 4 pili (T4P) are multifunctional filaments involved in adhesion, surface motility, biofilm formation, and horizontal gene transfer. These extracellular polymers are surface-exposed and, therefore, act as antigens. The human pathogen Neisseria gonorrhoeae uses pilin antigenic variation to escape immune surveillance, yet it is unclear how antigenic variation impacts most other functions of T4P. Here, we addressed this question by replacing the major pilin of a laboratory strain with pilins from clinical isolates. We reveal that the resulting strains vary substantially in their attractive forces. Strongly interacting bacteria form microcolonies while weakly interacting bacteria retain a planktonic lifestyle. In mixed microcolonies, different variant strains segregate in agreement with the differential strength of adhesion hypothesis. By combining structural predictions and laser tweezers experiments, we show that the C-terminal region of the pilin is crucial for attraction. Lifestyle affects growth kinetics and antibiotic tolerance. In the presence of ceftriaxone or ciprofloxacin, the killing kinetics indicate strongly increased tolerance of aggregating strains. We propose that pilin antigenic variation produces a mixed population containing variants optimized for growth, colonization, or survivability under external stress. Different environments select different variants, ensuring the survival and reproduction of the population as a whole. Neisseria gonorrhoeae evades immunity by altering its surface structures through antigenic variation. This study shows that this process also modulates bacterial interactions, driving microcolony diversification, aggregation, colony morphology, and antibiotic tolerance. [ABSTRACT FROM AUTHOR]

Ceftriaxone is widely used in clinical practice for its efficacy against infections. However, its increasing association with life-threatening immune hemolytic reactions urge clinicians to enhance recognition and maintain sharp vigilance. This report details a rare and severe case of ceftriaxone-induced hemolytic anemia (CIHA), hemodynamic instability and hemolytic crisis in a 54-year-old woman after intravenous infusion of ceftriaxone following a respiratory infection. Clinicians must promptly identify symptoms suggestive of CIHA, such as fatigue, pallor, nausea, vomiting, and trunk pain, and immediately discontinue ceftriaxone. Laboratory examination can also assist in confirming the diagnosis of CIHA. Effective management measures include rigorous monitoring of vital signs, circulatory support, respiratory support, timely blood transfusion, administration of steroid hormones, IVIG infusion as necessary, plasma exchange, and symptomatic treatment of possible complications. Even after the patient has achieved full recovery, careful consideration should be given to the choice of subsequent antibiotics to prevent recurrence of CIHA. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this study was to investigate the effect of intestinal dysbiosis on the bioavailability of voriconazole and to explore any underlying mechanisms. Method: Sprague-Dawley rats were randomly divided into two groups: a normal control group and a ceftriaxone-associated dysbiotic group. The composition of the intestinal flora was examined using 16S rRNA sequencing analysis. Voriconazole concentrations were determined by high-performance liquid chromatography-tandem mass spectrometry. Outer membrane vesicles (OMVs) of microbes from the different groups were prepared for in vitro study in Caco-2 cells. The Nrf2 pathway and its related proteins involved in modifying P-glycoprotein (P-gp) expression were clarified by a series of immunoblot analyses. Key findings: The diversity and richness of intestinal bacteria, especially the abundance of gram-negative bacteria, were significantly decreased after ceftriaxone treatment. The AUC(0-t) and Cmax of voriconazole were reduced, and greater voriconazole clearance were noted in the dysbiotic group. An in vivo study also indicated that the expression of P-glycoprotein was significantly increased after ceftriaxone treatment, which may be due to the absence of gram-negative bacteria in the intestine. Finally, in vitro findings in Caco-2 cells treated with OMVs from the ceftriaxone-associated dysbiotic group suggested that Nrf2 translocation into the nucleus induced high expression of P-gp. Conclusion: OMVs from intestinal bacterial in the ceftriaxone-associated dysbiotic group induced high P-gp expression by regulating the Nrf2 signalling pathway, which led to an in vivo reduction in the bioavailability of voriconazole due to ceftriaxone-associated dysbiosis. [ABSTRACT FROM AUTHOR]

Introduction: Patients with cerebral hemorrhage often require a tracheal intubation to protect the airway and maintain oxygenation. Due to the use of analgesic and sedative drugs during endotracheal intubation and the opening of the glottis may easily cause aspiration pneumonia. Ceftriaxone is a semi-synthetic third-generation cephalosporin with strong antimicrobial activity against most gram-positive and gram-negative bacteria. It can effectively prevent and treat aspiration pneumonia. Methods and analysis: This is a prospective, randomized, controlled, double-blind clinical study. Patients with intracerebral hemorrhage (ICH) undergoing endotracheal intubation in Dong E Hospital of Shandong Province from April 2023 to April 2025 will be enrolled and randomly assigned to the intervention group or control group. The intervention group will be treated using 100mL 0.9% sodium chloride with 2g ceftriaxone intravenously over the course of one hour beginning within two hours after endotracheal intubation. The control group will be given 100mL 0.9% sodium chloride injection intravenously of the course of one hour beginning within two hours after endotracheal intubation. The primary outcome is the incidence of aspiration pneumonia within 48 hours after endotracheal intubation. Secondary outcomes include: intensity of antimicrobial use, length of hospital stay, duration without mechanical ventilation, and 28-day mortality. Discussion: The primary objective of this study is to explore whether a single dose of ceftriaxone administered during endotracheal intubation in patients with ICH reduced the incidence of pneumonia within 48 hours and provide evidence for the prevention of aspiration pneumonia in patients with ICH with endotracheal intubation. Trial registration: The trial is registered at the Chinese Clinical Trial Registry: ChiCTR2200066837. Registered on December 19, 2022. [ABSTRACT FROM AUTHOR]

Aim Methods Results Conclusion The preferred antibiotic treatment for bacteraemia in infants continues to be debated. We examined the duration of hospital stays as a surrogate for the effectiveness of initial treatment with ceftriaxone versus cefuroxime.This was a retrospective review of the medical records of all infants aged 3–36 months, admitted with suspected occult bacteraemia to the paediatric department at Laniado Hospital, Israel, between 2016 and 2022. The effect of antibiotic treatment, namely ceftriaxone versus cefuroxime, on hospital stays was determined, in both the total study population and population subgroups.We identified 217 patients (59.0% male) with a median age of 13 months and 12.4% had positive blood cultures. Approximately three‐quarters (75.6%) received cefuroxime as their initial treatment for bacteraemia and the other quarter (24.4%) received ceftriaxone. The median length of hospital stay was 3.0 (interquartile range 3.0–4.0), with no statistically significant difference between the two drugs. However, we did notice a statistically significant shorter median length of hospital stay among fully vaccinated infants treated with cefuroxime rather than ceftriaxone (p = 0.055).The length of hospital stay among infants diagnosed with bacteraemia was not affected by whether they initially received ceftriaxone or cefuroxime. Further studies in larger populations are needed. [ABSTRACT FROM AUTHOR]

Purpose Patients with acute decompensated heart failure (ADHF) present similarly to those with respiratory infections, which may lead to administration of unnecessary intravenous (IV) antibiotics. This study was conducted to assess outcomes in patients admitted for ADHF who received IV antibiotics vs those who did not. Methods This retrospective cohort study evaluated adults admitted with ADHF who received IV antibiotics for at least 48 hours or did not receive IV antibiotics. Patients with an active infection were excluded. The primary outcome was hospital length of stay in the unmatched cohort; secondary outcomes included 30-day readmission, all-cause mortality, amount of loop diuretic administered, total sodium and fluids received, Clostridioides difficile infection, IV antibiotic agents administered, and duration of therapy. Results The unmatched cohort included 38 patients who received IV antibiotics and 123 patients who did not receive IV antibiotics, while the matched cohort included 33 patients in each arm. In the unmatched and matched cohorts, patients receiving IV antibiotics had a longer median hospital length of stay (5 vs 3 days; P < 0.01 and 5 vs 4 days; P < 0.01) and received a greater median amount of total sodium (9.22 vs 0.28 g; P < 0.01 and 10.24 vs 0 g; P < 0.01) and median total volume from IV antibiotics and fluids (1,788 vs 50 mL; P < 0.01 and 1,825 vs 0 mL; P < 0.01). No significant differences were found for the other secondary outcomes. Ceftriaxone and azithromycin were the most frequently administered IV antibiotics, with a median duration of therapy of 4 days. Conclusion Use of IV antibiotics in patients with ADHF was associated with longer hospital length of stay and should be avoided in patients without evidence of infection. [ABSTRACT FROM AUTHOR]

Antimicrobial resistance poses a global public health threat, compelling the search for alternative treatments, especially in resource-limited settings. The increasing ineffectiveness of traditional antibiotics has intensified the need to explore medicinal plants as viable therapeutic options. This study sought to compare the efficacy of certain medicinal plants used in Owerri, Nigeria, for treating pathogenic bacteria against traditional commercial antibiotics. We tested graded concentrations (25 mg/ml, 50 mg/ml, 75 mg/ml, and 100 mg/ml) of ethanolic extracts of Awolowo leaf (Chromolaena odorata), Bitter leaf (Vernonia amygdalina), and Lemon grass leaf (Cymbopogon citratus) against Salmonella spp, Klebsiella spp, Escherichia coli, and Staphylococcus aureus employing the agar well diffusion method to measure zones of inhibition. Commercial antibiotics studied included: Pefloxacin, Gentamycin, Ampiclox, Zinnacef, Amoxicillin, Rocephin, Ciprofloxacin, Streptomycin, Septrin and Erythromycin, Sparfloxacin Amoxicillin, Augmentin, and Tarivid. Each experiment was conducted in triplicate to ensure accuracy and reproducibility. Results were analyzed descriptively and presented as mean zones of inhibition and standard deviations. One to three plant species exhibited antibacterial activities (zones of inhibition) across 25–100 mg/ml concentrations. In contrast, some or all antibiotics only exhibited antibacterial activities at 100 mg/ml concentration (none at 25–75 mg/ml concentrations). Zones of inhibition (10.3–14.1 mm) of all three plant species against E.coli and Klebsiella at 100 mg/ml concentration were higher than those of 8–10 antibiotics. C. odorata had shown high zones of inhibition of 11.8 and 11.0 mm against Salmonella spp. and S. aureus at 100 mg/ml concentration, which were higher than those of eight antibiotics. The other two plant species (C. citratus and V. amygdalina) had exhibited low zones of inhibition against Salmonella spp. and S. aureus, which were higher than those of 3 or 4 antibiotics at 100 mg/ml concentration. In general, the antibacterial activities of the three plant species across 25–100 mg/ml concentrations were higher than those of many antibiotics. To a large extent, the efficacy of medicinal plant extracts across different concentrations against bacterial strains was higher than that of many antibiotics. Those plant species have therefore shown some potential to be used as alternative or complementary therapeutics to antibiotics in addressing antibiotic resistance. Since the promising findings were based on an in vitro study, we recommend clinical trials to establish safe and effective doses of those plant extracts in humans. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the effect of pre-biopsy rectal swab and urine screening combined with a risk-adapted antibiotic treatment strategy on reducing post-biopsy infections (PBIs) following multiparametric magnetic resonance imaging (mpMRI)/ transrectal ultrasound (TRUS) fusion-targeted transrectal prostate biopsy (TRPBx). Methods: 1119 Patients undergoing mpMRI-TRUS fusion TRPBx between June 2017 and February 2024 were included. Patients were screened for rectal extended-spectrum beta-lactamase (ESBL)/multi-resistant gram-negative (MRGN) and urinary pathogens. Standard-risk patients (rectal non-ESBL/MRGN-carriers) either received Cefuroxime (2017–2020) or Ceftriaxone (2020–2024) intravenously before biopsy. For high-risk patients (rectal ESBL/MRGN-carriers) intravenous Ertapenem was used. Patients with positive urine cultures received oral targeted prophylaxis. PBIs were the primary outcome of the study. We used uni- and multivariable logistic regression analysis (MLRA) to reveal predictors for the main outcome. Results: Rectal ESBL/MRGN prevalence was 5.5%. For standard-risk patients, PBI-rates were 8.1% and 0.24% for Cefuroxime and Ceftriaxone (p < 0.0001), respectively. Only 1.7% of high-risk patients treated with Ertapenem developed PBI. On MLRA, Cefuroxime (OR 38.7, 95%-CI: 10.9–246), oral Ciprofloxacin (OR 103, 95%-CI: 10.8–994), other oral targeted antibiotics (OR 42.7, 95%-CI: 1.86–496) (reference Ceftriaxone, all p < 0.005) were significant predictors for PBI whereas Ertapenem (OR 7.30 95%-CI: 0.34–77.4, p = 0.11) was not. Conclusion: By integrating rectal swab ESBL/MRGN and urine screening, we developed a tailored antibiotic treatment strategy, resulting in low PBI-rates following TRPBx. Carbapenem-based treatment of high-risk patients is crucial. Ceftriaxone should be considered for routine use in standard-risk patients as it offers very low PBI-rates. [ABSTRACT FROM AUTHOR]

The present study was conducted to evaluate the therapeutic effects of ceftriaxone on colibacillosis-induced infection in broilers. Besides, the effects of both colibacillosis infection and ceftriaxone treatment on the body performance and immune parameters of broilers were evaluated. A total of 200 one-day-old broiler chicks (100 healthy, and 100 experimentally challenged with E. coli) were used in this investigation. Broilers were divided into four equal groups (n= 50/each). Group (G1): healthy broilers were kept as a control group. G2: healthy broilers that received a therapeutic dose of ceftriaxone. G3: broilers were experimentally infected with E. coli with no treatment. G4: broilers were experimentally infected with E. coli and received a therapeutic dose of ceftriaxone. The obtained results revealed that challenged broilers with E. coli showed significant decreases in body weight, weight gain, phagocytic percentage, phagocytic index, total protein, albumin, ß, γ globulin, total globulin, Superoxide dismutase (SOD), and Glutathione peroxidase (Gpx). Besides, insignificant decreases in lymphocytes, basophils, eosinophils, and monocytes coupled with increases in food conversation ratio (FCR), WBCs, heterophils, nitric oxide, and lysosome, A/G ratio, malondialdehyde (MDA) were recorded in comparison to the control broilers. Infected broilers treated with ceftriaxone showed significant improvement in body weight, weight gain, total protein, albumin, γ globulin, and total globulin. Moreover, other parameters such as WBCs, a, and ß globulin, MDA, FCR, heterophils, nitric oxide, lysosome, phagocytic percentage, and phagocytic index, A/G ratio, Tumor necrosis factor a (TNF-a), Interleukin 10 (IL-10), Gpx, and SOD were significantly improved compared with the challenged birds with no treatment. Such results demonstrated the colibacillosisinduced adverse effects on broilers and the use of ceftriaxone as an effective therapeutic candidate. [ABSTRACT FROM AUTHOR]

Ventriculo-meningitis or nosocomial meningitis/ventriculitis is a severe nosocomial infection that is associated with devastating neurological sequelae. The cerebrospinal fluid isolates associated with the infection can be Gram-positive or -negative, while the Enterococcus spp. is rarely identified. We report a case of a 68-year-old woman with a past medical history of insulin-dependent diabetes mellitus, hypertension, and coronary artery disease. She was admitted to the intensive care unit following a scheduled sphenoid wing meningioma resection. Her course was complicated with left middle cerebral artery pseudoaneurysm and hemispheric hemorrhage, and an arterial stent and external ventricular drainage catheter were placed. Neurological evaluation showed a minimal conscious state. She presented high fever on the 35th intensive care unit day. Cerebrospinal fluid was sampled and the external ventricular catheter was removed. Enterococcus faecalis was isolated from the culture specimen. The patient received targeted treatment with an ampicillin plus ceftriaxone combination, and a follow-up culture confirmed the pathogen's eradication. Although she was considered cured, she had a prolonged intensive care unit stay and finally died in the ward two months after the completion of treatment. This case highlights the first reported use of this combination in a severe, non-endocarditis, invasive enterococcal infection, while the review discusses treatment options for nosocomial ventriculitis/meningitis. [ABSTRACT FROM AUTHOR]

Traces of antibiotics in domestic and industrial effluents have toxic effects on human health and the surrounding plants and animals, besides their potential to increase antibiotic resistance of microorganisms. Therefore, this study aims to develop a new adsorbent made from kaolin magnetised with Fe2O3 (Kaolin- Fe2O3) composite and apply it to remove ceftriaxone and cefixime from aqueous solutions. The efficiency of the new adsorbent in removing ceftriaxone and cefixime from solutions was studied under different adsorbent doses, antibiotic concentrations, solution pH values, and contact times. The results indicated the best ceftriaxone and Cefixime removal was attained at pH of 5 and 3, respectively, while the best antibiotic concentration, contact time, and adsorbent dose were 20 mg/L, 60 min, and 0.4 g/250 cc, respectively. It was noticed the adsorption was improved at low temperatures (25 $$^\circ C$$ ∘ C for ceftriaxone and 35 $$^\circ C$$ ∘ C for cefixime). Five types of isotherms matched the equilibrium data, including Langmuir, Freundlich, Temkin, Redlich-Peterson, and Sips. Equilibrium data were also matched with pseudo-first and second-order kinetics, Elovich, and intraparticle diffusion. Freundlich and Sips isotherm models were more consistent with equilibrium data. The positive results of Gibbs free energy and the negative enthalpy obtained from thermodynamic parameters indicate that the adsorption process is spontaneous and the adsorption process is exothermic. In light of the obtained results, the Kaolin-Fe2O3 nanocomposites could be considered an effective and inexpensive adsorbent for removing antibiotics from aqueous solutions. [ABSTRACT FROM AUTHOR]

Salvia officinalis has been used for so many years as a traditional remedy and still used in pharmaceutical, cosmetics, and food industries, which made it an interesting subject for researcher of natural alternatives. Enhancing the value of Moroccan S. officinalis essential oil, which is grown at Sidi Taibi in the Rabat‐Salé‐Kénitra Region, was the goal of this project, through analyzing its chemical composition and assessing its insecticidal and antibacterial activities. This latter was estimated by comparison with the antibiotic ceftriaxone. The main components identified by gas chromatography–mass spectrometry (GC‐MS) were camphor, eucalyptol (1,8‐cineole), α‐thujone, β‐thujone, ledol, and isoterpinolene with values of 19.72%, 15.64%, 15.05%, 9.74%, 7.27%, and 3.24%, respectively. A study of antibacterial activity revealed that while ceftriaxone seemed useless against the bacteria tested (all the bacteria proved resistant to the antibiotic), the essential oil of S. officinalis showed an inhibitory effect on the four bacteria tested, with MIC values ranging from 1/100 to 1/500 and a CMB value of 1/100. Using several dosages of pure essential oils (0, 1, 5, 10, and 20 μL), fumigant toxicity was ascertained. The mortality rate in individuals of Sitophilus oryzae and Rhyzopertha dominica reached a value of 100% when applying a dose of 10.00 μL/L of air to individuals of S. oryzae during 36 h of exposure and 24 h to individuals of R. dominica. The LC50 was determined at 2.51 and 6.02 μL/L for R. dominica and S. oryzae individuals successively, and the LC95 was determined at 5.45 and 12.61 μL/L of air over 12 h for R. dominica and S. oryzae individuals successively. Molecular docking analysis revealed ledol as a potent inhibitor of three key enzymes involved in the insecticidal effect of S. officinalis essential oil, mainly as an inhibitor of acetylcholinesterase (AChE), γ‐aminobutyric acid receptor (GABA), and ryanodine receptor. [ABSTRACT FROM AUTHOR]

Objectives Since June 2022, there has been a rise in the number of ceftriaxone-resistant Neisseria gonorrhoeae cases detected in England (n  = 15), of which a third were XDR. We describe the demographic and clinical details of the recent cases and investigate the phenotypic and molecular characteristics of the isolates. For a comprehensive overview, we also reviewed 16 ceftriaxone-resistant cases previously identified in England since December 2015 and performed a global genomic comparison of all publicly available ceftriaxone-resistant N. gonorrhoeae strains with mosaic penA alleles. Methods All N. gonorrhoeae isolates resistant to ceftriaxone (MIC > 0.125 mg/L) were whole-genome sequenced and compared with 142 global sequences of ceftriaxone-resistant N. gonorrhoeae. Demographic, behavioural and clinical data were collected. Results All cases were heterosexual, and most infections were associated with travel from the Asia-Pacific region. However, some had not travelled outside England within the previous few months. There were no ceftriaxone genital treatment failures, but three of five pharyngeal infections and the only rectal infection failed treatment. The isolates represented 13 different MLST STs, and most had the mosaic penA -60.001 allele. The global genomes clustered into eight major phylogroups, with regional associations. All XDR isolates belonged to the same phylogroup, represented by MLST ST16406. Conclusions Most cases of ceftriaxone-resistant N. gonorrhoeae detected in England were associated with travel from the Asia-Pacific region. All genital infections were successfully treated with ceftriaxone, but there were extragenital treatment failures. Ceftriaxone resistance continues to be associated with the penA -60.001 allele within multiple genetic backgrounds and with widespread dissemination in the Asia-Pacific region. [ABSTRACT FROM AUTHOR]

Background Infective endocarditis (IE) caused by viridans and gallolyticus group streptococci (VGS-GGS) resistant to penicillin (PEN-R; minimum inhibitory concentration ≥4 mg/L) is rare but poses therapeutic challenges. Objectives To describe the characteristics of patients with IE caused by PEN-R VGS-GGS, focusing on antimicrobial management. Methods Retrospective analysis of a prospective cohort of definite IE caused by PEN-R VGS-GGS between 2008 and 2023 in 40 Spanish hospitals. We describe clinical characteristics, management and outcome of the cases, and compare them to IE caused by VGS-GGS with susceptibility or susceptibility with increased exposure to penicillin (PEN-I). Results We identified nine cases of PEN-R VGS-GGS IE in a cohort of 1563 streptococcal IE (0.58%). All isolates belonged to S. mitis group. Three cases died during hospitalization and no relapse occurred at 3 months of follow-up. Compared to cases with susceptibility or PEN-I, PEN-R showed a higher rate of mitral location (78% versus 51%), surgical indication (67% versus 51%), and in-hospital mortality (33% versus 12%). Most cases (86%) showed resistance to third-generation cephalosporins. The preferred antibiotic regimen was beta-lactam-based: ceftriaxone plus gentamicin, penicillin plus gentamicin, ceftriaxone plus levofloxacin, and ceftaroline plus daptomycin. Two cases received a combination of vancomycin plus gentamicin. Levofloxacin was used in two cases in combination with ceftriaxone or daptomycin. All patients that received cardiac surgery were cured at the end of follow-up. Conclusions IE caused by PEN-R VGS-GGS was rare and only affected mitis group streptococci. Antibiotic combination including a beta-lactam seems to be effective in its management. [ABSTRACT FROM AUTHOR]

The article discusses a retrospective study that compared the effects of three days of treatment with ceftriaxone and longer durations of therapy for uncomplicated cystitis in patients admitted to a community teaching hospital. It describes several clinical dilemmas associated with uncomplicated cystitis in the hospital setting, as well as confounding variables affecting the study design. It explores developments in research on the benefits of a shorter duration of antibiotic use in infections.

Antimicrobial resistance is a global crisis that has been exacerbated by the inappropriate use of antibiotics. Drug-resistant bacteria are a major menace to public health and treatment of multidrug resistant bacterial infections is extremely challenging. One major contributor to high antibiotic resistance of bacteria is the increased production of β-lactamases which are responsible for cleavage of β-lactams. Therefore, targeting β-lactamases with potential inhibitors could be one of the important strategies in combating antimicrobial resistance. However, in order to target β-lactamases, we need to have a better understanding of the underlying interactions between the β-lactamases and the β-lactam antibiotics. In this regard, we have performed a molecular docking and MD simulation-based analysis to study interaction between class C β lactamases forming proteins i.e., CMY, ACT, AmpC and FOX with five generations of cephalosporins namely Cefepime, Ceftraoline, Ceftriaxone, Cefuroxime, and Cephalexin. The three-dimensional structure of ACT-1, AmpC, CMY-37, and FOX-1 proteins were modelled and validated, and were subsequently docked with each of the five generations of cephalosporins. Based on the molecular docking and MMGBSA results, ACT-ceftraoline, AmpC-ceftraoline, CMY-ceftraoline, and FOX-cefepime complexes were considered for molecular dynamics simulation, which revealed that among the four complexes, FOX-cefepime was the most stable. Our work provides useful insights towards structure-based drug development against FOX-1, which have an impact on bacterial resistance. The interactions between β-lactamase and cefepime can be exploited to build novel therapeutic treatments against the FOX-1 β-lactamases. Further validation of this is essential, preferably through in vitro and in vivo studies. [ABSTRACT FROM AUTHOR]

Community Acquired Pneumonia (CAP) is caused by pathogenic infections such as bacteria and fungi acquired outside the hospital, the main therapy given to pneumonia patients is antibiotics. The irrationality of antibiotics will lead to antibiotic resistance. This study aims to determine the description and evaluation of the appropriateness of antibiotic use in CAP patients in inpatient a government hospital Batam period January 2023 to December 2023 using the PPAB 2021, IDSA 2019 and PDPI 2021 therapy guidelines. This research method is crosssectional with a retrospective data collection technique using medical records, descriptive data analysis. The results of the study of 34 samples of the description of the use of antibiotics that were most often prescribed were Ceftriaxone at 35.28%. The results of the evaluation of accuracy based on the PPAB 2021, IDSA 2019 and PDPI 2021 guidelines obtained the correct type of antibiotic of 85.3%, the correct dose of 91.2%, the correct route and time of administration of 100% and the correct interval of administration of 82.4%. [ABSTRACT FROM AUTHOR]

The article describes a case of parotitis following endoscopy. Topics include the rarity of parotitis, particularly in children, with causes ranging from viral and bacterial infections to noninfectious factors; the occurrence of post-endoscopy parotitis, a seldom-seen complication that can lead to serious conditions such as osteomyelitis and sepsis; and the clinical case of a 4-year-old girl who developed parotitis after an EGD procedure for Helicobacter pylori gastritis.

Background/Objectives: Neisseria gonorrhoeae is the third most common sexually transmitted infection (STI), which may become untreatable soon if resistance continues to drastically increase. Due to increases in resistance to recommended antibiotics, alternative sources of novel compounds to combat this threat are being explored. Interestingly, marine sponges have proven to produce a plethora of bioactive compounds that display anticancer, antiviral, antifungal, and antibacterial activity. Methods: In this study, the extracts of the sponge collected from Saint Thomas, US Virgin Islands were examined to determine their antibacterial activity against E. coli, S. aureus, and N. gonorrhoeae. Results: The ethyl acetate sponge extracts significantly inhibited growth of N. gonorrhoeae, while none inhibited S. aureus and E. coli. The bioassay-guided purification of the ethyl acetate extract resulted in the isolation of 6-desmethyl-6-ethylspongosoritin A (1) and plakortone B (2). To determine if the pure sponge metabolite could improve the efficacy of ceftriaxone against a high-level ceftriaxone (HTX)-resistant gonococcal strain, an antibiotic checkerboard assay was done by combining various concentrations of either precursor fractions or the purified compound 2 with ceftriaxone. Plakortone B (2) and ceftriaxone acted in synergy against gonococcal strains and inhibited growth by increasing membrane permeability when exposed for 4 h and 24 h. Conclusions: This suggests that marine sponges may serve as a source for novel bioactive compounds against antibiotic-resistant strains of N. gonorrhoeae, as well as improve the efficacy of currently prescribed antibiotics. [ABSTRACT FROM AUTHOR]

Background/Objectives: There has been a lack of a holistic approach to evaluating antibiotic consumption in Kazakhstan over the past few years using an internationally recognized methodology. Therefore, this study aimed to provide a nationwide evaluation of antibiotic consumption in Kazakhstan during the period 2019–2023. Methods: Defined daily doses per 1000 inhabitants per day (DIDs) were calculated for systemic antibiotics (J01 code of the Anatomical Therapeutic Chemical Classification System (ATC)) following the methodology established by the Global Antimicrobial Resistance and Use Surveillance System (GLASS-AMC). The average annual percent change (AAPC) was computed for each chemical agent, pharmacological group, and J01 in general to evaluate past trends in antibiotic consumption. Results: The consumption of J01 antibiotics ranged between 10.869 DIDs (2022) and 14.470 DIDs (2020). There was an increase in antibiotic consumption during 2020 and 2021, but the overall trend was declining, with an AAPC of −2.45%. Azithromycin was the most consumed systemic antibiotic, followed by ceftriaxone and ciprofloxacin. The consumption of "Watch" group antibiotics prevailed in Kazakhstan during the study period, with the number of people consuming the top five "Watch" group antibiotics rising from 72,578 in 2019 to 94,617 in 2023. Conclusions: The findings of this study are crucial for the reorganization of the national antimicrobial stewardship program. [ABSTRACT FROM AUTHOR]

Type I Alexander disease (AxD) presents with paroxysmal neurodegeneration, refractory epilepsy, and encephalopathy in the first years of life and is associated with a poor prognosis. Although there is no treatment, mild symptomatic improvement has been reported in one case of adult Alexander treated with ceftriaxone, given its interaction with the mutant glial fibrillary acid protein (GFAP) responsible for the disease's pathogenesis. We describe a patient presenting with irritability starting at 2 months of age, initially attributed to gastroesophageal reflux. A ventriculoperitoneal shunt was placed at 3 months of age due to hydrocephalus secondary to aqueduct stenosis detected through an MRI scan, but the irritability persisted. At 5 months, a new brain MRI was performed due to irritability worsening, onset of abnormal ocular movements and seizures. In addition genetic testing was performed. AxD was diagnosed due to the mutation c.716G>A (p.Arg239His) in GFAP. Since irritability had worsened and had not responded to levomepromazine, treatment with amoxicillin (80 mg/kg/day) was attempted to modulate glutamate levels. The patient showed a striking improvement of irritability in 48 h that persisted over the next months. The patient had frequent daily seizures which did not respond to valproate, clonazepam, or phenobarbital. Perampanel, a postsynaptic AMPA receptor antagonist, was added to phenobarbital and he was seizure free for more than 3 months. Drugs modulating glutamate levels in the central nervous system, including β‐lactam antibiotics and perampanel, may have an important role in the symptomatic treatment of AxD and other neurodegenerative diseases where glutamatergic excitotoxicity is a pathogenic determinant. Plain Language Summary: Alexander disease is a rare and serious condition that affects the brain, often leading to neurodegeneration (brain damage), seizures, and other problems in early childhood. The disease is caused by a mutation in a gene called GFAP. There is no cure, and current treatments mainly focus on relieving symptoms. This article discusses the case of a baby who showed signs of irritability and seizures from a young age. The baby was diagnosed with Alexander disease after brain scans and genetic testing. Despite treatment with various drugs, the baby continued to experience seizures and irritability. The doctors decided to try amoxicillin, a common antibiotic, because of its potential to help control the disease by affecting a brain chemical called glutamate. Surprisingly, the baby's irritability improved within 2 days of starting amoxicillin, and the improvement lasted for several months. However, the seizures persisted until another medication, perampanel, was added. This combination controlled the baby's seizures for over 3 months. Unfortunately, the baby passed away at 13 months due to complications from the disease. However, doctors believe that drugs like amoxicillin and perampanel could be promising treatments for managing symptoms of Alexander disease and other similar brain conditions in the future, especially where excess glutamate plays a role in the damage. This case suggests that these treatments may help control irritability and seizures, offering hope for better management of this challenging disease. [ABSTRACT FROM AUTHOR]

(1) Background: Alternative antibiotics are needed to treat infective endocarditis (IE) caused by non-faecalis/non-faecium enterococci; we aimed to assess the in vitro activity of ampicillin plus ceftriaxone (AMP + CTR) against these enterococci and to describe its clinical efficacy in IE cases. (2) Methods: Time–kill curves with standard (ISI) and high (IHI) inocula were performed to test VanC isolates [3 E. casseliflavus (ECAS) and 1 E. gallinarum (EGALL)] and non-VanC isolates [1 E. durans (EDUR), 1 E. hirae (EHIR) and 1 E. raffinosus (ERAF)]. The narrative literature review of IE cases treated with AMP + CTR was analyzed alongside three study cases. Clinical outcomes were relapse and death. (3) Results: Ampicillin plus gentamicin (AMP + GEN) showed synergistic and bactericidal activity against most isolates. AMP + CTR was synergistic at ISI for EGALL, EDUR, and EHIR and bactericidal against EHIR. At IHI, indifferent activity was observed for all isolates. In IE cases treated with AMP + CTR, it was only effective for EDUR and EHIR. Clinical information for EGALL IE is lacking. For IE caused by ECAS and ERAF, AMP + CTR seems suboptimal or ineffective, respectively. (4) AMP + CTR cannot be recommended for treating IE due to ECAS/ERAF. In contrast, this combination was effective in IE caused by EDUR/EHIR and could be recommended. [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.

Ceftriaxone (CTX), a beta-lactam antibiotic, is widely used in drug seeking and relapse studies due to its ability to enhance glutamate transporter (GLT-1) expression in the brain. Since increased synaptic glutamate is believed to drive drug seeking and relapse, CTX’s effect on GLT-1 offers potential for treating substance abuse. However, the effect of CTX on the gut microbiome remains unexplored. Mice received CTX at 200 mg/kg per day for 4 d, and its effects on the gut microbiome were assessed. CTX led to increased striatal GLT-1 expression and induced rapid, long-lasting dysbiosis, with females showing a greater response than males. Diversity metrics were significantly altered during the acute phase of CTX treatment. Alpha diversity showed varying recovery levels depending on sex, while beta diversity indicated that CTX-treated mice remained significantly different from controls. CTX caused significant increases in Bacillota and reductions in Bacteroidota. Most taxa were rapidly reduced by CTX, but Enterococcus and Bacillales expanded significantly. Metabolomic analysis revealed significant changes in microbial pathways related to substance use disorders. These findings indicate that CTX causes immediate and persistent alterations in the gut microbiome, highlighting the importance of considering the gut microbiome as a target in substance abuse treatment.

Antimicrobial resistance in Neisseria gonorrhoeae is an urgent global health issue. The objectives of the study were to use a global collection of 12,936 N. gonorrhoeae genomes from the PathogenWatch database to evaluate different machine learning models to predict ceftriaxone susceptibility/decreased susceptibility using 97 mutations known to be associated with ceftriaxone resistance. We found the random forest classifier model had the highest performance. The analysis also reported the relative contributions of different mutations within the ML model predictions, allowing for the identification of the mutations with the highest importance for ceftriaxone resistance. A machine learning model retrained with the top five mutations performed similarly to the model using all 97 mutations. These results could aid in the development of molecular tests to detect resistance to ceftriaxone in N. gonorrhoeae. Moreover, this approach could be applied to building and evaluating machine learning models for predicting antimicrobial resistance in other pathogens.