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In China, antibiotic mycelial residue is categorized as hazardous waste. To achieve the harmless and resourceful disposal of cephalosporin, three types of biochars from cephalosporin mycelia residues, namely non-activated carbon (BC1), ZnCl2-activated carbon (BC2), and KOH-activated carbon (BC3), were respectively fabricated by high-temperature pyrolysis carbonization technology. These three kinds of biochars were characterized via iodine value, FTIR, and SEM, and the adsorption performance of the prepared biochars was investigated using cefuroxime (CXM) as the adsorption target. The results indicated that BC3 biochar possesses the most well-developed pores and the highest iodine value of 1367.41 mg/g; The most suitable dosage is 1.6 g/L, and the lower the pH, the more favorable the adsorption effect. The investigation of adsorption kinetics revealed that it conformed to the kinetic model of pseudo-second order, as well as the process of adsorption was governed by the chemical adsorption mechanism, the rate of adsorption was affected by the collective impact of the quantity of active sites present and the interaction strength between the CXM molecules and the biochar. The exploration of adsorption thermodynamics revealed that it aligned with the Langmuir model, the surface of biochar was relatively uniform, and the adsorption was mainly of low coverage; The calculation of thermodynamic parameters demonstrated that the adsorption was exothermic and spontaneous. [ABSTRACT FROM AUTHOR]

Background: Clinical significance of Eschericia coli is due to its capacity to develop resistance against many antibiotics specially carbapenem by producing carbapenemase which limits treatment options. blaNDM and blaVIM genes are responsible for this multi-drug-resistance. This is an alarming condition for society as well as clinician because they are very difficult to treat due to limited options of antibiotics and its high virulence. Aims and Objectives: The study was conducted to detect antibiogram pattern and prevalence of blaNDM and blaVIM genes among carbapenem resistant E. coli isolates in a tertiary care hospital. Our study will also help to identify molecular basis of Carbapenem resistance including treatment guideline. Materials and Methods: Cross-sectional study was performed during January'2021 to June'2022 time period. Identification of E. coli was followed by standard protocol and antibiotic sensitivity was done by Kirby-Bauer disk-diffusion method following CLSI guideline, using VITEK-2D-SYSTEM. Detection of genes was done by polymerase chain reaction (PCR). Results: Out of 1867 samples, 161 isolates were identified as E. coli, among which 90 were resistant to carbapenem. Among those, 50 (31%) were resistant to all three carbapenems. Among those, 100% were resistant to ampicillin, amoxycillin-clavulanic acid, cefuroxime, cefuroxime-axetil, cefoperazone-sulbactam, ceftriaxone, cefepime, piperacillin-tazobactam, nalidixic acid, ciprofloxacin; 52% were resistant to amikacin; 54% were resistant to gentamicin; 86% were resistant to cotrimoxazole; 22% were resistant to nitrofurantoin and 96% were sensitive to tigecycline; 100% were intermediate sensitive to colistin. blaNDM gene is detected in 17 (34%) isolates and blaVIM gene is detected in 2 (4%) isolates by PCR. Conclusion: E. coli leads to common clinical presentations such as urinary tract infection, blood stream infection, pneumonia, and wound infection. High burden of carbapenem resistant E. coli was associated with urinary indoor samples. Rising incidence of multi-drug-resistance occurs due to lack of infection control measures, irrational use of antibiotics. Continuous surveillance will prevent development of multi-drug-resistance and help to improve treatment guideline. [ABSTRACT FROM AUTHOR]

Low oral bioavailability is a common feature in most drugs, including antibiotics, due to low solubility in physiological media and inadequate cell permeability, which may limit their efficacy or restrict their administration in a clinical setting. Cefuroxime is usually administered in its prodrug form, cefuroxime axetil. However, its preparation requires further reaction steps and additional metabolic pathways to be converted into its active form. The combination of Active Pharmaceutical Ingredients (APIs) with biocompatible organic molecules as salts is a viable and documented method to improve the solubility and permeability of a drug. Herein, the preparations of five organic salts of cefuroxime as an anion with enhanced physicochemical characteristics have been reported. These were prepared via buffer-assisted neutralization methodology with pyridinium and imidazolium cations in quantitative yields and presented as solids at room temperature. Cell viability studies on 3T3 cells showed that only the cefuroxime salts combined with longer alkyl chain cations possess higher cytotoxicity than the original drug, and while most salts lost in vitro antibacterial activity against E. coli, P. aeruginosa and B. subtilis, one compound, [PyC10Py][CFX]2, retained the activity. Cefuroxime organic salts have a water solubility 8-to-200-times greater than the original drug at 37 °C. The most soluble compounds have a very low octanol-water partition, similar to cefuroxime, while more lipophilic salts partition predominantly to the organic phase. [ABSTRACT FROM AUTHOR]

Enterobacteriaceae that produce extended‐spectrum β‐lactamases (ESBLs) can result in severe human infections, contributing to the development of complex diseases. Klebsiella pneumoniae is one of the ESBL‐producing pathogens that helps to set antimicrobial resistance as a major public health problem worldwide. The current study aimed to isolate, identify, and characterize ESBL‐producing K. pneumoniae and their antimicrobial resistance pattern in retail cattle meat samples. A comprehensive set of 225 cattle meat samples was gathered from 13 upazilas within the Sylhet district of Bangladesh. The bacterial isolates were obtained through biochemical and cultural techniques, and the identification of K. pneumoniae was accomplished using polymerase chain reactions (PCRs). Antimicrobial susceptibilities were assessed using disk diffusion in accordance with the Clinical and Laboratory Standards Institute (CLSI, 2020) guidelines. Genes encoding ESBL enzymes were detected by the double‐disk synergy test (DDST) and multiplex PCR. The overall prevalence of Klebsiella spp. was 28.89% (65/225), whereas the positive percentage of K. pneumoniae was 59.2% (29/49) confirmed by PCR. Antimicrobial resistance was observed against 12 antibiotics. According to the phenotypic resistance pattern determined through the disk diffusion method, all isolates (100%) were resistant to ampicillin, amoxicillin, cefuroxime, cefotaxime, and colistin. On the other hand, the highest susceptibility was observed towards gentamicin (97.95%), followed by ciprofloxacin (85.71%), tetracycline (83.67%), and trimethoprim‐sulfamethoxazole (81.63%). Out of the total K. pneumoniae isolates analyzed, ESBL genes were present, and the highest percentage, 82.8% (24/29), tested positive for blaTEM genes. Interestingly, among the nine ESBL genes, six were identified in K. pneumoniae isolates, except for blaOXA, blaCTX‐M‐grp2, and MultiCaseDHA. The study's results reveal the presence of extended‐spectrum β‐lactamase (ESBL)‐producing multidrug‐resistant (MDR) K. pneumoniae in retail cattle meat samples posing a substantial public health threat. [ABSTRACT FROM AUTHOR]

Introduction: Improper protection of an active substance may lead to a loss of its original properties. Many methods can be used to assess the photoprotective properties of drug packaging, including the hemispherical directional reflectance method. The aim of the study is to assess the reflectance value for both the outer and direct packaging containing cefuroxime. Material and methods: Two formulations (Ceroxim and Zinnat) of both expired and unexpired packages were tested with a 410-Solar reflectometer. Three types of measurement areas were analyzed: “white” (white areas of the outer cardboard box), “coloured” (coloured areas of the outer cardboard box) and “blister” (the direct packaging made of aluminium/PVC). Results: The highest reflectance value was found in the 700–1100 nm range for both the unexpired and expired preparations. In the 335–380 nm band, the amount of reflected radiation for the unexpired Ceroxim vs Zinnat packages was as follows: 30% vs 12% from the coloured areas, 39% vs 24% from the white areas and 74% vs 70% from the blisters, respectively. For the expired coloured areas of Ceroxim, the reflectance was significantly higher compared to the unexpired (p < 0.001) in all the spectral bands, except 1700–2500 nm. In contrast, the reflectance of the expired white areas of Ceroxim was higher than the unexpired (p < 0.001) for 480–600 nm, 590–720 nm, 700–1100 nm, and 1700–2500 nm. The blisters of the unexpired Zinnat preparation exhibited greater photoprotective properties than the expired in the 335–380 nm range while the unexpired and expired blisters of Ceroxim did not differ. Conclusions: Based on the reflectance value, blisters and white cardboard packages protect cefuroxime against radiation to a greater extent than coloured packages.

Purpose: to evaluate the variability of cefuroxime concentration for intracameral administration during preparation of ex tempore solutions under conditions of real clinical practice.Materials and methods. Two operating room nurses participated in the study, each prepared 20 samples of cefuroxime solution for intracameral administration according to a uniform dilution protocol. The concentration of antibiotic in the solutions was measured by photocolorimetric method.Results. The experiment modelling the conditions of real clinical practice demonstrated a significant difference of cefuroxime concentrations in solutions prepared ex tempore. The mean antibiotic concentration in samples prepared by 2 nurses was 1.189 [1.075; 1.383] mg/ml and 1.019 [0.984; 1.10] mg/ml, respectively, p = 0.0002. The range of variation was 0.4 mg/ml, or 40.5 % of the minimum recorded value.Conclusion. High variability of cefuroxime concentration during ex tempore preparation may lead to a number of undesirable events. Unintentional overdosing causes the development of serous retinal detachment and anterior chamber toxic syndrome. Low antibiotic content can be considered as one of the reasons for the development of infectious complications caused by cefuroxime-sensitive bacterial strains. Improvement of approaches, substances and routes of administration of antimicrobial agents to improve the safety of cataract surgery in the conditions of changing structure and increasing resistance of ocular microbiota seems to be an urgent scientific task.

Enas M Al-Khlifeh,1 Ibrahim S Alkhazi,2 Majed Abdullah Alrowaily,3 Mansoor Alghamdi,4 Malek Alrashidi,4 Ahmad S Tarawneh,5 Ibraheem M Alkhawaldeh,6 Ahmad B Hassanat5 1Department of Medical Laboratory Science, Al-Balqa Applied University, Al-salt, 19117, Jordan; 2College of Computers & Information Technology, University of Tabuk, Tabuk, 47512, Saudi Arabia; 3Department of Computer Science, College of Computer and Information Sciences, Jouf University, Sakaka, 72341, Saudi Arabia; 4Computer Science Department, Applied College, University of Tabuk, Tabuk, 71491, Saudi Arabia; 5Faculty of Information Technology, Mutah University, Al-Karak, Jordan; 6Faculty of Medicine, Mutah University, Al-Karak, JordanCorrespondence: Enas M Al-Khlifeh, Parasitology laboratory, Department of Medical Laboratory Science, Faculty of Science, Al-Balqa Applied University, Al-Salt (19117), Jordan, Tel +962795856110, Email Al-khlifeh.en@bau.edu.joBackground: The incidence of microorganisms with extended-spectrum beta-lactamase (ESBL) is on the rise, posing a significant public health concern. The current application of machine learning (ML) focuses on predicting bacterial resistance to optimize antibiotic therapy. This study employs ML to forecast the occurrence of bacteria that generate ESBL and demonstrate resistance to multiple antibiotics (MDR).Methods: Six popular ML algorithms were initially trained on antibiotic resistance test patient reports (n = 489) collected from Al-Hussein/Salt Hospital in Jordan. Trained outcome models predict ESBL and multidrug resistance profiles based on microbiological and patients’ clinical data. The results were utilized to select the optimal ML method to predict ESBL’s most associated features.Results: Escherichia coli (E. coli, 82%) was the most commonly identified microbe generating ESBL, displaying multidrug resistance. Urinary tract infections (UTIs) constituted the most frequently observed clinical diagnosis (68.7%). Classification and Regression Trees (CART) and Random Forest (RF) classifiers emerged as the most effective algorithms. The relevant features associated with the emergence of ESBL include age and different classes of antibiotics, including cefuroxime, ceftazidime, cefepime, trimethoprim/ sulfamethoxazole, ciprofloxacin, and gentamicin. Fosfomycin nitrofurantoin, piperacillin/tazobactam, along with amikacin, meropenem, and imipenem, had a pronounced inverse relationship with the ESBL class.Conclusion: CART and RF-based ML algorithms can be employed to predict the most important features of ESBL. The significance of monitoring trends in ESBL infections is emphasized to facilitate the administration of appropriate antibiotic therapy. Keywords: ESBL, machine learning, multidrug-resistant bacteria, E. coli, cefuroxime, CART and RF

Cure rates for pulmonary disease caused by the Mycobacterium avium complex (MAC) are poor. While β-lactam are front line antibiotics against Mycobacterium abscessus pulmonary disease, they have not been used or recommended to treat MAC lung infections. Through a comprehensive screen of oral β-lactams, we have discovered that selected pairs combining either a penem/carbapenem or penicillin with a cephalosporin are strongly bactericidal at clinically achieved concentrations. These dual β-lactam combinations include tebipenem and sulopenem, both in phase 3, and Food and Drug Administration-approved amoxicillin and cefuroxime. They could therefore immediately enter clinical trials or clinical practice. [ABSTRACT FROM AUTHOR]

Purpose: To study the incidence, predictive factors, etiology, and visual consequences of postoperative endophthalmitis (PE) in relation to 3 intracameral (IC) antibiotic regimes. Setting: Swedish National Cataract Register entries from 2011 through 2017. Design: Observational retrospective study. Methods: PE incidence, influencing factors, bacteriology, and visual outcome were analyzed regarding the 3 major prophylactic IC protocols. Results: The overall incidence of PE was 0.023% or 177 cases in 764 513 cataract procedures. Analyzed per IC regime, the rates of PE were 0.024% (126 cases in 514 916 surgeries) for cefuroxime, 0.020% (25 cases in 122 340 surgeries) for moxifloxacin, and 0.017%(20 cases in 121 045 surgeries) for combined cefuroxime-ampicillin. Incidences were not statistically significantly different from one another. Grampositive bacteria caused 89.0% of culture positive cases. Enterococci as pathogens were significantly more frequent with IC cefuroxime than with moxifloxacin, P = .006, or cefuroxime-ampicillin, P < .001, while streptococci other than enterococci were more common with moxifloxacin than with cefuroxime, P < .001. Bacterial susceptibility to the given antibiotics was demonstrated in 21.3% of PE cases treated with cefuroxime, which was statistically significantly lower than proportions found with cefuroxime-ampicillin, 60.0%, P = .015, or with moxifloxacin, 88.2%, P < .001. Visual outcome worse than 20/200 was similar in the groups ranging from 42.0% to 53.7%. Conclusions: No statistically significant differences in PE incidence or visual outcome results between treatment groups were demonstrated. However, differences in etiology and bacterial sensitivity were found between the prophylactic IC treatments. [ABSTRACT FROM AUTHOR]

Background: Multidrug resistant bacterial pathogens employ different mechanisms in evading the action of antibiotics. Multidrug resistance is wide spread among strains of Escherichia coli implicated in several infections including urinary tract infections, gastrointestinal infections, meningitis and bacteraemia. Aim/Objective: This study investigates the antibiotic resistance profile, efflux pump activity and biofilm formation ability of E. coli strains isolated from clinical samples. Methods: A total of 32 E. coli strains isolated from clinical samples were characterized and subjected to antibiotic susceptibility testing using standard methods. Isolates were screened phenotypically for biofilm formation and efflux pump activity. While molecular detection of genes encoding curli fimbriae and efflux pump activity was done by PCR. Results: All 32 (100%) E. coli isolates were resistant to ceftazidime, cefuroxime, cefixime, amoxicillin-clavulanate, ofloxacin and ciprofloxacin. While 30 (93.8%) were resistant to gentamicin, 27 (84.4%) were resistant to cefepime and the least resistance of 15.6% was to imipenem. Efflux pump encoding gene tolC was detected in 13(40.6%) of the isolates, while 1(3.1%) harboured acrA gene. acrB gene was not detected in any of the isolates. Seven (21.9%) of the isolates were strong biofilm formers, while 5 (15.6%) and 20 (62.5%) were moderate and weak biofilm formers respectively. csgA gene was detected in all E. coli isolates. Discussion: High antibiotic resistance of E. coli strains observed in this study is of public health significance.. It is therefore important to scale up efforts in regular monitoring of antibiotic resistance in both community and hospital settings. [ABSTRACT FROM AUTHOR]

In this study, pulsed laser ablation was utilized to produce gold nanoparticles (Au NPs), hydroxyapatite NPs, and then conjugated with cefuroxime as a heteronanocomposite structure targeting Klebsiella pneumoniae. When Klebsiella forms a biofilm, it shows a remarkable resistance against a variety of antibiotics. The heterostructure nanocomposite was characterized using UV/Vis spectrophotometry, X-ray diffraction (XRD), Fourier transform infrared spectroscopy (FTIR), and transmission electron microscopy (TEM). The antibacterial activity of the heteronanocomposite against Klebsiella pneumoniae was assessed and compared with the cefuroxime alone. The inhibitory action of the heteronanocomposite of biofilm in the urinary catheter (Foley's catheter) was examined by atomic force microscopy (AFM). The results of the current study demonstrated that the heteronanocomposite had antimicrobial activity greater than cefuroxime alone to stop the growth of microbial biofilms. This heteronanocomposite has shown a promising result, which could be a reliable therapy against Klebsiella pneumoniae in the future and could be a promising agent for succeeding bacterial biofilm inhibition during a urinary tract infection. [ABSTRACT FROM AUTHOR]

Surgical site infections (SSI) are one of the common complications following spinal fusion surgery. Unfortunately, several studies had shown conflicting results regarding optimal timing of surgical antimicrobial prophylaxis (SAP) administration. Due to limitations in population homogeneity and sample size, these studies have not provided significant statistical correlations or clear practical recommendations. The purpose of the study was to investigate the impact of timing of cefuroxime SAP on the risk of SSI in patients undergoing spinal fusion surgery, and to determine the optimal timing of administration. Retrospective nested case-control study. We retrospectively analyzed consecutive patients who underwent spinal fusion surgery at our institution between October 2011 and October 2021. In the current study, the primary outcome measure was SSI. This was a retrospective nested case-control study. All consecutive patients who underwent spinal fusion surgery at our institution between October 2011 and October 2021 formed a retrospective cohort. For each SSI case, 2 controls free of SSI at the time of the index date of their corresponding case were selected, matched by age, sex, and calendar year. Electronic record and radiographic data were reviewed retrospectively in electronic database. SAP related data included timing of administration, preoperative dose, intraoperative second dose, and postoperative use. To examine the effects of mismatched variables, we further adjusted for possible confounding factors using conditional logistic regression models. Subsequently, subgroup analyses were conducted to assess the robustness of the statistical associations. According to the preplanned statistical scheme and matching factors, we matched 236 controls for these SSI cases, and the subsequent statistical analysis was performed on these 354 patients. After adjusting for confounding factors, the results indicated that the risk of SSI was 70% higher in the group receiving SAP 31 to 60 minutes before incision compared to the group receiving SAP 0 to 30 minutes before incision (OR=1.732, 95%CI 1.031–2.910, p=.038). Additionally, the risk of SSI was 150% higher in the group receiving SAP 61 to 120 minutes before incision compared to the group receiving SAP 0 to 30 minutes before incision (OR=2.532, 95%CI 1.250–5.128, p=.010). In subgroup analysis, this statistical trend persisted for both deformity surgeries and different SSI classifications. Administering cefuroxime SAP within 30 minutes before skin incision significantly reduces the risk of SSI, whether they are deep or superficial, in spinal fusion surgery. This pattern remains consistent among spinal deformity patients. [ABSTRACT FROM AUTHOR]

Background and purpose: The duration of antibiotic coverage in hand tissues during surgery is unknown. We investigated the time the free concentration of cefuroxime was above the minimal inhibitory concentration (fT>MIC) of 4 μg/mL in hand tissues after single and repeated administration. Methods: In a prospective, unblinded randomized study 16 patients (13 female, age range 51–80 years) underwent trapeziectomy. Microdialysis catheters were placed in the metacarpal bone (primary effect parameter), synovial sheath, and subcutaneous tissue. Patients were randomized to postoperative administration of either intravenous single administration of cefuroxime (1,500 mg) (Group 1, n = 8) or repeated dosing (2 x 1,500 mg) with a 4 h interval (Group 2, n = 8). Samples were taken over 8 h. Results: The fT>MIC of 4 μg/mL was found to be significantly longer in the metacarpal bone in Group 2 compared with Group 1 with a mean difference of 199 min (95% confidence interval 158–239). The same trend was evident in the remaining compartments. A concentration of 4 μg/mL was reached in all compartments in both groups within a mean time of 6 min (range 0–27 min). In Group 1, the mean concentrations decreased below 4 μg/mL between 3 h 59 min and 5 h 38 min. Conclusion: The fT>MIC was longer after repeated administration compared with single administration in all compartments. A single administration of cefuroxime 1,500 mg provided antimicrobial hand tissue coverage for a minimum of 3 h 59 min. Cefuroxime administration in hand surgeries should be done minimum 27 min prior to incision to achieve sufficient coverage in all individuals. Cefuroxime readministration should be considered in hand surgeries lasting longer than 4 h from time of administration.

Background: Aminopenicillins are recommended agents for non-invasive Haemophilus influenzae infections. One of the mechanisms of resistance to β-lactams is the alteration of the transpeptidase region of penicillin binding protein 3 (PBP3) which is caused by mutations in the ftsI gene. It was shown that exposure to beta-lactams has a stimulating effect on increase of prevalence of H. influenzae strains with the non-enzymatic mechanism of resistance. Objectives: The aim of our study was to compare the mutational potential of ampicillin and cefuroxime in H. influenzae strains, determination of minimum inhibitory concentration and the evolution of mutations over time, focusing on amino acid substitutions in PBP3. Methods: 30 days of serial passaging of strains in liquid broth containing increasing concentrations of ampicillin or cefuroxime was followed by whole-genome sequencing. Results: On average, cefuroxime increased the minimum inhibitory concentration more than ampicillin. The minimum inhibitory concentration was increased by a maximum of 32 fold. Substitutions in the PBP3 started to appear after 15 days of passaging. In PBP3, cefuroxime caused different substitutions than ampicillin. Conclusions: Our experiment observed differences in mutation selection by ampicillin and cefuroxime. Selection pressure of antibiotics in vitro generated substitutions that do not occur in clinical strains in the Czech Republic.

Background: The aim of this study was to compare the impact of three different types of intraoperative antibiotic prophylaxis on the risk of postoperative surgical site infection (SSI). Material and Methods: Single-center retrospective cohort study. Patients who underwent surgery for osteosynthesis of a tibial plateau fracture (January 2009–November 2018) in Hospital Clinic i Provincial de Barcelona were included. Three types of prophylaxis during the study period were used: group A (cefuroxime single-dose treatment), group B (meropenem + teicoplanin), and group C (ceftriaxone + teicoplanin). Demographics, co-morbidity, type of fracture, need for external fixation, microbiology data, surgical time, and outcome were recorded. Failure was defined as the need for reintervention due to postoperative surgical site infection. Results: From a total of 148 patients included, 20 cases developed SSI, 8 from group A, 8 from group B, and 4 from group C. Higher ASA scores, Schatzker II classification, need for external fixation, and a prolonged surgical time were associated with a significantly (p < 0.005) increased incidence of SSI. Group C showed the overall highest survival and lowest cumulative risk, but differences were not statistically significant. Conclusions: Group C showed the lowest incidence of infection in this sample. It is necessary to confirm these findings with larger studies. [ABSTRACT FROM AUTHOR]

The aim of this study is to investigate the in vitro antimicrobial interaction between Azadirachta indica crude water extract and standard antibiotics (tetracycline, doxycycline, ampicillin, cefuroxime, streptomycin, gentamicin, ciprofloxacin, norfloxacin, and erythromycin). In vitro interactions were evaluated via agar diffusion and Checkerboard techniques against E. coli as the test microorganism. Synergistic interactions were observed between crude extract (0.1 mg/ml or 0.25 mg/ml) and all antibiotics used (p < 0.05). Checkerboard technique revealed fractional inhibitory concentration (FIC) index indicating synergy with tetracycline (1:9). Coadministration of tetracycline, doxycycline, gentamicin, streptomycin, erythromycin, cefuroxime, ciprofloxacin, or norfloxacin with A. indica crude extract may offer clinical benefits in treating E. coli infections. [ABSTRACT FROM AUTHOR]

Mammal bites account for over 5 million visits to Emergency Departments (EDs) annually. NursePractitioners (NPs) need to stay abreast of current guidelines, changes to antibiotic regimens that are now most effective, and understand in what circumstances collaboration with other specialists is indicated. It is not enough to care for the wound, itself, but rather understand in what presentations additional care may be needed despite the fact that there is no clear evidence at the time of evaluation of the need for advanced care. Additionally, NPs should understand what resources are available within their community for wound care that may exceed the scope and ability of the facility in which they practice. Health departments may need to be utilized in the care of ED patients who present with wounds that are suspicious for rabies. Finally understanding what constitutes a high, medium, and low risk bite will aide NPs in delivering optimal care within the communities they serve while also minimizing patient morbidity. [ABSTRACT FROM AUTHOR]

Current investigations aim to develop and validate an accurate, simple, specific, and precise RP‐HPLC method for the detection of cefuroxime axetil, in bulk and tablet dosage forms. Despite extensive literature reviews, no method could be found for estimating the variables mentioned above. The chromatographic separation is achieved on Sunfire C18 column (250 mm × 4.6 mm, 5 µm) of HPLC (Agilent Tech 1100), with 5 µm mobile phase composed of methanol, orthophosphoric acid (0.05%) adjusted to a pH of 3.0 in water, 40:60% v/v triethylamine using isocratic mode of elution, at wavelength 278.0 nm using UV Spectrophotometer, temperature 25 °C, detection is done. The developed method is done as per ICH guidelines. A linear calibration curve is found to be linear in concentrations between 1 and 5 µg mL−1 (r2 = 0.9995). The percentage recoveries of cefuroxime axetil are found to be in the range of 95.68–96.98%. The percentage of relative standard deviations in intraday trials is found to be 0.61, 0.66, and 0.88, respectively, and in interday studies are 0.06, 0.16, and 0.29, respectively, demonstrating good accuracy and little variance. The proposed method is highly sensitive, robust, precise, accurate, and the use of green solvents makes this method safe and efficacious. [ABSTRACT FROM AUTHOR]

Background: Helicobacter pylori infection and its associated diseases represent a significant global health concern. Patients who cannot use amoxicillin pose a therapeutic challenge and necessitate alternative medications. Preliminary research indicates that cefuroxime demonstrates promising potential for eradicating H. pylori infection, and there is a lack of comprehensive review articles on the use of cefuroxime. Materials and Methods: This study conducts a thorough systematic literature review and synthesis. A comprehensive systematic search was conducted in PubMed, Web of Science, EMBASE, China National Knowledge Infrastructure, China Biology Medicine disc, and Wanfang Data up to January 13, 2024. The search strategy utilized the following keywords: (Cefuroxime) AND (Helicobacter pylori OR Helicobacter nemestrinae OR Campylobacter pylori OR Campylobacter pylori subsp. pylori OR Campylobacter pyloridis OR H. pylori OR Hp) for both English and Chinese language publications. Sixteen studies from five different countries or regions were included in final literature review. Results: Analysis results indicate that H. pylori is sensitive to cefuroxime, with resistance rates similar to amoxicillin being relatively low. Regimens containing cefuroxime have shown favorable eradication rates, which were comparable to those of the regimens containing amoxicillin. Regarding safety, the incidence of adverse reactions in cefuroxime‐containing eradication regimens was comparable to that of amoxicillin‐containing regimens or other bismuth quadruple regimens, with no significant increase in allergic reactions in penicillin‐allergic patients. Regarding compliance, studies consistently report high compliance rates for regimens containing cefuroxime. Conclusion: Cefuroxime can serve as an alternative to amoxicillin for the patients allergic to penicillin with satisfactory efficacies, safety, and compliance. [ABSTRACT FROM AUTHOR]

Background: Despite multiple antibiotics being available to manage dental infections (DI), there is lack of data comparing commonly prescribed antibiotics in India. Objectives: The aim of this study was to evaluate the real-world effectiveness and tolerability of cephalexin-clavulanic acid fixed-dose combination (cephalexin CV FDC) in contrast with amoxicillin-clavulanic acid (co-amoxiclav FDC) and cefuroxime among patients with dental infections (odontogenic) in India. Methods: This retrospective, multi-centric, observational, real-world electronic medical record (EMR)-based study was conducted between January 2022 and December 2022. The EMRs of 355 adults with DI receiving oral cephalexin CV, co-amoxiclav, or cefuroxime were categorized into two distinct groups: Group I (Test Group) with patients prescribed cephalexin extended release 375/750 mg along with clavulanic acid 125 mg; and Group II (Comparator Group) with patients prescribed co-amoxiclav 625 mg (500 mg amoxicillin + 125 mg clavulanic acid) or cefuroxime (250 mg/500 mg). Results: Toothache was the most common complaint, reported by 95.5% of patients, followed by swelling (46.8%), tooth sensitivity (35.5%), pus discharge (33.0%), redness and halitosis (30.4% each). Dental caries was observed in 81.1% of patients. Clinical improvement, defined as improvement/partial resolution of infection-related clinical signs and symptoms (composite measure of pain, swelling, fever, requirement of additional antimicrobial therapy) as per dentists' judgment, was recorded in 98.3% of patients with cephalexin CV, 96.8% of patients with co-amoxiclav, and 98.9% of patients treated with cefuroxime within 10 days. Time (days) to clinical improvement was numerically lesser among patients receiving cephalexin CV (4.6 ± 2.0) compared with cefuroxime (4.9 ± 2.1) and co-amoxiclav (5.0 ± 2.6). All treatments were well tolerated. Conclusion: Cephalexin CV was as effective as co-amoxiclav and cefuroxime, with faster clinical improvement and better resolution of certain symptoms. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the effect of inappropriate therapy in adult patients with community-acquired pyelonephritis caused by Escherichia coli receiving empirical treatment with cefuroxime during hospital stay and readmission. A retrospective cohort study was performed. Inappropriate treatment was considered treatment for a nonsusceptible isolate according to the results of the urine culture. Adjustment for confounding factors was performed with propensity score-derived inverse probability of treatment weighting. Between 2013 and 2020, 747 patients were included, 102 (13.7%) of whom received inappropriate therapy. Compared to appropriate therapy, inappropriate therapy was associated with a shorter length of stay in the adjusted analysis (Hazard Ratio = 0.34; 95% CI = 0.23–0.49). After 735 patients were discharged from the hospital, 66 were readmitted in the following 30 days. In comparison with appropriate therapy, inappropriate antimicrobial therapy was not related to readmission (OR 1.47; 95% CI = 0.35–2.79). Inappropriate therapy was not related to a longer hospital stay or readmission due to pyelonephritis after adjusting for confounders and covariates. [ABSTRACT FROM AUTHOR]

Escherichia coli isolates that are resistant to cefixime and amoxicillin/clavulanic acid, but apparently susceptible to cefuroxime, with no ESBL identified, were initially detected in Madrid from urine samples in 2019. Throughout 2020 and 2021, all cases of community UTI by E. coli from six health areas in Madrid were studied. A representative sample of 23 cases was selected for further studies. The broth microdilution method and the agar diffusion method were performed to determine the antibiotic susceptibility. WGS was carried out for phylogeny, resistome and virulome analysis. Community consumption of third-generation oral cephalosporins in Madrid (2017–2021) was analyzed. A total of 582 (1.3%) E. coli isolates had the mentioned resistance profile. The mutation at position –32 (T > A) of the AmpC promoter was found in 21 isolates. No plasmid AmpC- or ESBL-encoding genes were detected. A cluster of 20 ST12 isolates was detected by cgMLST. A 6.2% increase in the consumption of third-generation oral cephalosporins, especially cefixime, was observed in Madrid. Chromosomal AmpC-hyperproducing ST12 E. coli isolates could be implicated in the increase in community UTI cases by cefixime-resistant isolates, which correlates with an increasing trend of cefixime consumption. [ABSTRACT FROM AUTHOR]

Abstract Background The selection of prophylactic antibiotics for preventing post-operative pulmonary infections in smoking patients undergoing video-assisted thoracoscopic lung surgery (VATLS) is not clear. Methods In this retrospective cohort study, the outcomes of 572 smoking patients undergoing VATLS with prophylactic cefazolin/cefuroxime or other antibiotics were analyzed. Patients were classified as cefazolin/cefuroxime group and the control group. A 1:1 propensity score matching was also performed. Results The primary outcome of the incidence of post-operative pulmonary infection did not differ significantly between the two groups (23.7% vs 30.5%, RR = 0.777, 95%CI 0.564 ~ 1.070 p = 0.113). Similarly, secondary outcomes including the incidence of post-operative fever, the white blood cell count and neutrophils on the 3rd day after the surgery, and time for blood routine test recovery were all found without significant difference between the two groups. In the multivariate logistic regression model, no association was found between prophylactic use of cefazolin/cefuroxime and post-operative pulmonary infections after controlling other possible confounding factors (OR = 0.685, 95%CI 0.441 ~ 1.065, p = 0.093). Conclusions Prophylactic use of cefazolin/cefuroxime was not associated with more adverse clinical outcomes among smoking populations undergoing VATLS when compared with broad-spectrum antibiotics and the two drugs are still feasible for peri-operative prophylactic use for smoking population before the surgery.

The method has been proposed for the spectrophotometric determination of antibiotics of the cephalosporin (cefuroxime, ceftriaxone, cefotaxime, cefazolin) and penicillin (amoxicillin) groups using chemometric data processing (method of partial least squares, PLS). The absorption spectra of 24 binary mixtures of “cephalosporin – cephalosporin” and 16 binary mixtures of “cephalosporin – amoxicillin” with various concentrations in the range of 3–27 and 5–140 μg/ml have been recorded. The optimal number of latent variables for each chemometric method (PLS-1 and PLS-2) has been selected, which ranged from 2 to 7 depending on the type of model and the nature of the antibiotics. The smallest root mean square calibration errors (RMSEC) have been found for the ceftriaxone–cefazolin system, which have been 0.09 and 0.08 for PLS-1 and PLS-2, respectively. The smallest root mean square errors of prediction (RMSEP) for the mixture “cefuroxime – amoxicillin” have been 0.07 for both methods (PLS-1 and PLS-2). It has been established that equations of linear relationships “measured-predicted” are characterized by a regression coeffi cient and the square of the approximation coeffi cient close to 1; which indicates the high quality of the models. The relative error of determination in test mixtures has been 0.4–6.2% by the PLS-1 method for “cephalosporin – cephalosporin” mixtures, and 0.07–6.0% by the PLS-2 method. At the same time, there is no signifi cant diff erence in the error in determining the components of the mixture, in contrast to the “cefuroxime – amoxicillin” system, for which the error is 0.1–1.1% for the fi rst component and 2.6–14.7% for the second component using the PLS-1 method and 0.2–1.2% for the fi rst component and 4.3–13.3% for the second component using the PLS-2 method. Thus, it has been shown that the use of chemometric methods ensures high accuracy of the spectrophotometric determination of the studied antibiotics with overlapping absorption bands in their mixtures.

Low oral bioavailability is a common feature in most drugs, including antibiotics, due to low solubility in physiological media and inadequate cell permeability, which may limit their efficacy or restrict their administration in a clinical setting. Cefuroxime is usually administered in its prodrug form, cefuroxime axetil. However, its preparation requires further reaction steps and additional metabolic pathways to be converted into its active form. The combination of Active Pharmaceutical Ingredients (APIs) with biocompatible organic molecules as salts is a viable and documented method to improve the solubility and permeability of a drug. Herein, the preparations of five organic salts of cefuroxime as an anion with enhanced physicochemical characteristics have been reported. These were prepared via buffer-assisted neutralization methodology with pyridinium and imidazolium cations in quantitative yields and presented as solids at room temperature. Cell viability studies on 3T3 cells showed that only the cefuroxime salts combined with longer alkyl chain cations possess higher cytotoxicity than the original drug, and while most salts lost in vitro antibacterial activity against E. coli, P. aeruginosa and B. subtilis, one compound, [PyC10Py][CFX]2, retained the activity. Cefuroxime organic salts have a water solubility 8-to-200-times greater than the original drug at 37 °C. The most soluble compounds have a very low octanol-water partition, similar to cefuroxime, while more lipophilic salts partition predominantly to the organic phase.

Indicator papers with immobilized para-dimethylaminobenzaldehyde are proposed for the visual–colorimetric and colorimetric determination of antibacterial compounds of the cephalosporin group (cephalexin, cefuroxime, cefotaxime, ceftriaxone, cefazolin) using a smartphone camera. The effect of conditions and the type of the photorecording device is assessed. The accuracy of the developed rapid procedures is estimated using the added–found method; the procedures are characterized by the satisfactory reproducibility of results (RSD does not exceed 19%). An analysis of drugs—"Aksosef" tablets and "Cephalexin" capsules—is carried out; the found contents of cephalosporins are consistent with the declared ranges of their contents in the drugs. [ABSTRACT FROM AUTHOR]

Background: The selection of prophylactic antibiotics for preventing post-operative pulmonary infections in smoking patients undergoing video-assisted thoracoscopic lung surgery (VATLS) is not clear. Methods: In this retrospective cohort study, the outcomes of 572 smoking patients undergoing VATLS with prophylactic cefazolin/cefuroxime or other antibiotics were analyzed. Patients were classified as cefazolin/cefuroxime group and the control group. A 1:1 propensity score matching was also performed. Results: The primary outcome of the incidence of post-operative pulmonary infection did not differ significantly between the two groups (23.7% vs 30.5%, RR = 0.777, 95%CI 0.564 ~ 1.070 p = 0.113). Similarly, secondary outcomes including the incidence of post-operative fever, the white blood cell count and neutrophils on the 3rd day after the surgery, and time for blood routine test recovery were all found without significant difference between the two groups. In the multivariate logistic regression model, no association was found between prophylactic use of cefazolin/cefuroxime and post-operative pulmonary infections after controlling other possible confounding factors (OR = 0.685, 95%CI 0.441 ~ 1.065, p = 0.093). Conclusions: Prophylactic use of cefazolin/cefuroxime was not associated with more adverse clinical outcomes among smoking populations undergoing VATLS when compared with broad-spectrum antibiotics and the two drugs are still feasible for peri-operative prophylactic use for smoking population before the surgery. [ABSTRACT FROM AUTHOR]

Introduction: Neutrophil extracellular traps (NETs) have various beneficial and detrimental effects in the body. It has been reported that some bacteria may evade the immune system when entangled in NETs. Thus, the aim of the current study was to evaluate the effects of a combined DNase and antibiotic therapy in a murine model of abdominal sepsis. Methods: C57BL/6 mice underwent a cecum-ligation-and-puncture procedure. We used wild-type and knockout mice with the same genetic background (PAD4-KO and DNase1-KO). Mice were treated with (I) antibiotics (Metronidazol/Cefuroxime), (II) DNAse1, or (III) with the combination of both; mock-treated mice served as controls. We employed a streak plate procedure and 16s-RNA analysis to evaluate bacterial translocation and quantified NETs formation by ELISA and immune fluorescence. Western blot and proteomics analysis were used to determine inflammation. Results: A total of n=73 mice were used. Mice that were genetically unable to produce extended NETs or were treated with DNases displayed superior survival and bacterial clearance and reduced inflammation. DNase1 treatment significantly improved clearance of Gram-negative bacteria and survival rates. Importantly, the combination of DNase1 and antibiotics reduced tissue damage, neutrophil activation, and NETs formation in the affected intestinal tissue. Conclusion: The combination of antibiotics with DNase1 ameliorates abdominal sepsis. Gram-negative bacteria are cleared betterwhen NETs are cleaved by DNase1. Future studies on antibiotic therapy should be combined with anti-NETs therapies. [ABSTRACT FROM AUTHOR]

Environmental conditions can lead to changes in the physical and chemical structures of drug products. In this study, the stability of cefuroxime tablets stored under adverse conditions was evaluated based on total directional–hemispherical reflectance (THR). The THR value was measured before and after the tablets' exposure to stress factors (temperature of 45 °C and UV radiation). Each measurement was performed three times within seven spectral bands at the beginning of the experiment (day 0), and then on days 1, 2, 3, 5, and 7. In addition, hyperspectral profiles (400–1030 nm) were analyzed on days 0 and 7. A significant decrease in THR values in all wavelength ranges was observed when day 7 vs. day 0 were compared, especially for spectral bands of 335–380 nm and 1700–2500 nm (Δ = 0.220, p < 0.001 and Δ = 0.171, p < 0.001, respectively). The hyperspectral analysis confirmed a decrease in the reflectance after the end of stress conditions in the visible light range (400–700 nm) compared to tablets before the experiment. This may indicate that more radiation entered the tablets. In conclusion, the THR of cefuroxime tablets decreases during the exposure to heat and UV radiation, which may result from some physicochemical changes that have occurred during storage. [ABSTRACT FROM AUTHOR]

A frequent and efficient weapon in the fight against infectious diseases is antibiotics. Antimicrobial resistance, however, has emerged as a major concern in public health due to the unintentional, overuse, and improper administration of antibiotics. In the current study, a heterostructure of gold (Au), Hydroxyapatite (HAP) and Cefuroxime was produced using an environmentally friendly pulsed laser ablation technique to improve the antibacterial activity of Cefuroxime against Staphylococcus (S.) saprophyticus. X-ray diffraction (XRD), Fourier transforms infrared spectroscopy, UV/Vis spectrophotometry, and field emission-scanning electron microscopy (FESEM) were used to characterize the heterostructure nanocomposite. The susceptibility of S. saprophyticus to the Au-Hydroxyapatite-Cefuroxime was evaluated in terms of preventing biofilm development in the urinary catheter. This study confirmed the greater antimicrobial activity of hetero nanocomposite of the Hydroxyapatite-Cefuroxime-AuNPs than Cefuroxime alone against S. saprophyticus. The Hydroxyapatite nanoparticles (NPs)-Cefuroxime-Gold nanoparticles (AuNPs) hybrid was developed as an intelligent drug delivery mechanism to prevent the proliferation of S. saprophyticus and to hinder the formation of bacterial biofilm on Foley catheters. The smart hetero nanocomposite has shown a promising result, which could be a reliable therapy against S. saprophyticus in the future and could be used as a promising approach for succeeding bacterial biofilm inhibition during urinary tract infection. [ABSTRACT FROM AUTHOR]

Background and Objective: Physiologically based pharmacokinetic (PBPK) models for pregnant women have recently been successfully used to predict maternal and umbilical cord pharmacokinetics (PK). Because there is very limited opportunity for conducting clinical and PK investigations for fetal drug exposure, PBPK models may provide further insights. The objectives of this study were to extend a whole-body pregnancy PBPK model by multiple compartments representing fetal organs, and to predict the PK of cefuroxime in the maternal and fetal plasma, the amniotic fluid, and several fetal organs. Methods: To this end, a previously developed pregnancy PBPK model for cefuroxime was updated using the open-source software Open Systems Pharmacology (PK-Sim®/MoBi®). Multiple compartments were implemented to represent fetal organs including brain, heart, liver, lungs, kidneys, the gastrointestinal tract (GI), muscles, and fat tissue, as well as another compartment lumping organs and tissues not explicitly represented. Results: This novel PBPK model successfully predicted cefuroxime concentrations in maternal blood, umbilical cord, amniotic fluid, and several fetal organs including heart, liver, and lungs. Further model validation with additional clinical PK data is needed to build confidence in the model. Conclusions: Being developed with an open-source software, the presented generic model can be freely re-used and tailored to address specific questions at hand, e.g., to assist the design of clinical studies in the context of drug research or to predict fetal organ concentrations of chemicals in the context of fetal health risk assessment. [ABSTRACT FROM AUTHOR]

Rationale: Acute otitis media is a common disease in early childhood, and is usually caused by Streptococcus pneumoniae (S. pneumoniae). Acute mastoiditis is a complication of acute otitis media and can involve not only the mucoperiosteum of the middle ear but can also spread to the periosteum by destroying the mastoid bone (acute coalescent mastoiditis). In addition, the infection can extend through the surrounding bones or the emissary veins beyond the mastoid's air cells, leading to subperiosteal abscesses. Patient's Concern: A 16-month-old female patient was hospitalized due to the purulent discharge of the left ear and the symptoms of right mastoiditis (swelling and redness of the skin). Diagnosis: Bilateral acute coalescent mastoiditis caused by S. pneumoniae infection. The computer tomography revealed bilateral bone destruction of the mastoid and abscesses found behind the auricle on both sides. Interventions: The patient underwent intravenous antibiotic therapy and surgical treatment. Outcomes: The patient was discharged 14 days after hospitalization with an improved condition. Lessons: Improperly treated acute coalescent mastoiditis can lead to extracranial and intracranial complications, sometimes serious and even life-threatening. Complications are prevalent in children under 2 years, in whom the disease progresses more rapidly and severely. The vaccination with a 13-valent vaccine may not result in sufficient immunity against S. pneumoniae, a predominant pathogen in children affected by acute coalescent mastoiditis. [ABSTRACT FROM AUTHOR]

Silver and its compounds have long been utilized as antimicrobial agents in medicine. Silver sulfadiazine, a broad-spectrum antibiotic ointment, is widely used and effective against a wide range of bacteria and some yeast. Copper and its alloys possess natural antimicrobial properties. Ancient civilizations recognized and utilized the antimicrobial effects of copper long before the understanding of microbes in the nineteenth century. Mechanochemistry refers to reactions induced by the input of mechanical energy, typically involving solids, such as grinding in ball mills. It is gaining increased attention due to its ability to promote rapid and quantitative reactions between solids, often without the need for additional solvents. Historically, mechanochemistry has been a secondary approach to chemical synthesis, with solution-based methods being the default choice. Building upon our previous research on antibiotic resistance, this paper presents the impact of mechanochemically synthesized copper (II) and silver (I) complexes with cefuroxime on cephalosporin-resistant bacteria. [ABSTRACT FROM AUTHOR]

Colorectal endoscopic mucosal resection (EMR) is associated with the risk of postoperative wound infections, prompting investigations into effective prophylactic measures. This meta‐analysis aimed to evaluate the efficacy of various prophylactic interventions in reducing the incidence of wound infections following EMR. Adhering to PRISMA guidelines, we conducted a comprehensive search across multiple databases for randomized controlled trials (RCTs) and cohort studies from 2015 to 2022. We included studies that compared the efficacy of antibiotic prophylaxis and antiseptic measures, with clear data on post‐procedure infection rates. Eight studies met our inclusion criteria, and data were extracted for meta‐analysis. The risk of bias was assessed using the Cochrane Collaboration tool and the Newcastle‐Ottawa Scale. The meta‐analysis included 3765 patients from eight RCTs. Prophylactic antibiotics (cefixime and cefuroxime) showed moderate to high efficacy, with infection rates as low as 0% and 0.76%. Prophylactic endoscopic closure and clipping showed the highest efficacy, with zero reported infections. The standardized surgical site infection prevention bundle had lower effectiveness, with an infection incidence of 3.83%. The risk of bias assessment indicated potential performance bias due to lack of blinding, but overall evidence quality was upheld by proper random sequence generation and diligent outcome data monitoring. The effectiveness of specific prophylactic measures, notably prophylactic antibiotics and mechanical closure techniques, has been shown in significantly reducing the risk of wound infections following colorectal EMR. [ABSTRACT FROM AUTHOR]

A comparative study of the electroanalytical properties of solid-contact sensors (tubular, planar) in solutions of cefuroxime (Cefur), cefotaxime (Ceftx), cefixime (Cefix), and amoxicillin (Amox) is performed. Associates of tetraalkylammonium—tetradecylammonium (TDA) and dimethyldistearylammonium (DMDSA)—with complex compounds of silver(I) and β-lactam antibiotics [Ag(β-lac)2]TAA and modifiers such as ZnO, polyaniline, and polyaniline nanotubes are used as electrode-active components (EACs). The sensors under study based on [Ag(Cefur)2]TDA and [Ag(Amox)2]DMDSA are characterized by a short response time in solutions of cefotaxime, cefuroxime, cefixime, and amoxicillin: 20–25 and 12–17 s for tubular unmodified and modified, respectively; 20–25 and 10–15 s for planar unmodified and modified, respectively. The linear range of electrode functions in solutions of antibiotics is 1 × 10–4–1 × 10–2 mol/L; the limit of detection is 2.5 × 10–5–8.9 × 10–5 mol/L for unmodified, 5.6 × 10–6–7.5 × 10–5 mol/L for modified, and 4.2 × 10–5–7.2 × 10–5 mol/L for planar sensors. The potential drift is 8–12 mV/day for unmodified and 5–7 mV/day for modified planar sensors; the service life is 1.5–2 months. An advantage of planar sensors is their use in microassay detection, which is relevant in the analysis of biological media. Application of solid-contact sensors for determination of the antibiotics under study in model aqueous solutions, medicinal products, and oral fluid in the case of various infectious diseases is demonstrated. [ABSTRACT FROM AUTHOR]

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