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Abstract Background Ertapenem is a once-a-day carbapenem and has excellent activity against many gram-positive and gram-negative aerobic, facultative, and anaerobic bacteria. The susceptibility of isolates of community-acquired bacteremia to ertapenem has not been reported yet. The present study assesses the in vitro activity of ertapenem against aerobic and facultative bacterial pathogens isolated from patients with community-acquired bacteremia by determining and comparing the MICs of cefepime, cefoxitin, ceftazidime, ceftriaxone, ertapenem, piperacillin, piperacillin-tazobactam, ciprofloxacin, amikacin and gentamicin. The prevalence of extended broad spectrum β-lactamases (ESBL) producing strains of community-acquired bacteremia and their susceptibility to these antibiotics are investigated. Methods Aerobic and facultative bacteria isolated from blood obtained from hospitalized patients with community-acquired bacteremia within 48 hours of admission between August 1, 2004 and September 30, 2004 in Chang Gung Memorial Hospital at Keelung, Taiwan, were identified using standard procedures. Antimicrobial susceptibility was evaluated by Etest according to the standard guidelines provided by the manufacturer and document M100-S16 Performance Standards of the Clinical Laboratory of Standard Institute. Antimicrobial agents including cefepime, cefoxitin, ceftazidime, ceftriaxone, ertapenem, piperacillin, piperacillin-tazobactam, ciprofloxacin, amikacin and gentamicin were used against the bacterial isolates to test their MICs as determined by Etest. For Staphylococcus aureus isolates, MICs of oxacillin were also tested by Etest to differentiate oxacillin-sensitive and oxacillin-resistant S. aureus. Results Ertapenem was highly active in vitro against many aerobic and facultative bacterial pathogens commonly recovered from patients with community-acquired bacteremia (128/159, 80.5 %). Ertapenem had more potent activity than ceftriaxone, piperacillin-tazobactam, or ciprofloxacin against oxacillin-susceptible S. aureus (17/17, 100%)and was more active than any of these agents against enterobacteriaceae (82/82, 100%). Conclusion Based on the microbiology pattern of community-acquired bacteremia, initial empiric treatment that requires coverage of a broad spectrum of both gram-negative and gram-positive aerobic bacteria, such as ertapenem, may be justified in moderately severe cases of community-acquired bacteremia in non-immunocompromised hosts.

With the improvement of internet technology in health applications, the utilization of internet and social media as new survey methodologies and recruitment source for research participants have been encouraged, yet evidence of the feasibility in people living with HIV (PLHIV) study is still lacking. We conducted a cross-sectional survey to determine whether there are differences among PLHIV recruited from social media networks and health-care systems using an HIV stigma and discrimination questionnaire. The result revealed that PLHIV recruited from social media networks were younger, more sexually active, and had higher educational status and awareness of the country's HIV rights protection laws than those recruited from hospitals. By contrast, participants recruited from hospitals were more diverse regarding key population compositions, had lived with HIV for a longer duration, had a higher prevalence of concomitant physical disabilities than those recruited from social media networks, and fit Taiwan PLHIV characteristics described by 2016 census from Taiwan Centres for Disease Control. We conclude that sampling bias exists when utilizing social media networks for PLHIV studies. [ABSTRACT FROM AUTHOR]

Background This multicenter retrospective cohort study aimed to compare the clinical presentations and evolution of acute hepatitis A (AHA) between human immunodeficiency virus (HIV)–infected patients and HIV-uninfected counterparts during the AHA outbreak. Methods Clinical and laboratory data were collected from the medical records of the patients with AHA at the 14 hospitals around Taiwan between May 2015 and May 2017. Results A total of 297 adult patients with AHA were included during the study period. Their mean age was 31.4 years (range, 19.0–76.1 years); 93.4% were men and 58.6% were men who have sex with men. Of 265 patients with known HIV serostatus, 166 (62.6%) were HIV infected. Compared with HIV-uninfected patients, HIV-infected patients had a lower peak alanine aminotransferase (ALT) level (median, 1312 vs 2014 IU/L, P =.003), less coagulopathy (6.0% vs 16.2%, P =.007), and less hepatomegaly or splenomegaly on imaging studies, but a higher rate of delayed resolution of hepatitis (38.8% vs 21.3%, P =.009). HIV-infected patients with plasma RNA load <1000 copies/mL while receiving combination antiretroviral therapy (cART) had a higher peak ALT level (median, 1420 vs 978 IU/L, P =.006) and less delay in resolution of hepatitis (30.6% vs 48.8%, P =.047) than patients without cART or with plasma RNA load ≥1000 copies/mL. Conclusions During an AHA outbreak, HIV-infected patients had a lower severity, but delayed resolution, of AHA than HIV-uninfected patients. Better viral suppression by cART alleviated the impact of HIV infection on the disease course of AHA in HIV-infected patients. [ABSTRACT FROM AUTHOR]

Background: In recent years, there has been a rapid worldwide emergence of multidrugresistant (MDR) pathogens, especially in cases of nosocomial infections. This study assesses the in vitro activities of ampicillin/sulbactam, cefpirome, colistin, daptomycin, ertapenem, meropenem, teicoplanin, tigecycline and vancomycin against 208 aerobic bacterial pathogens that caused 197 nosocomial infections in 184 patients., Methods: Antimicrobial susceptibility was evaluated by Etest. Broth dilution method was utilized in tigecycline susceptibility testing., Results: Most (140/208, 67%) of the isolates were facultative Gram-negative bacilli. Of the 31 oxacillin-resistant S. aureus (ORSA) isolates, 16 were susceptible to daptomycin (16/31, 51.6%) according to the breakpoint ≤ 1 μg/ml. All 31 ORSA isolates were susceptible to teicoplanin, and vancomycin but MICs of vancomycin for all 31 ORSA isolates were ≥ 1 μg/ml. Of the 21 isolates of A. baumannii that were multiple-drug-resistant, 19 isolates (19/21, 90%) were susceptible to colistin and 18 isolates (18/21, 86%) sensitive to tigecycline. Of the 22 isolates of E. coli with extended-spectrum beta-lactamase (ESBL), the most susceptible antimicrobial agent were colistin (20/22, 91%), ertapenem (21/22, 96%), meropenem and tigecycline (22/22, 100%). Of the 11 isolates of P. aeruginosa, 6 isolates were susceptible to colistin (6/11, 55%) and all isolates were susceptible to meropenem (11/11, 100%)., Conclusion: For nosocomial infections caused by MDR-Acinetobacter baumannii, colistin and tigecycline are usually susceptible according to the result of this study. For nosocomial infections caused by ORSA, ORSA has reduced susceptibility to vancomycin, teicoplanin and daptomycin. For MDR-P. aeruginosa, further study is needed.

Background and Purpose: There is a rapid worldwide emergence of multidrug-resistant pathogens, especially in nosocomial isolates. This study compared the in vitro activities of levofloxacin, ciprofloxacin, ceftazidime, cefepime, imipenem, and piperacillin-tazobactam against 208 aerobic bacterial pathogens that caused 197 nosocomial infections in 184 patients., Methods: Antimicrobial susceptibility was evaluated by E test in accordance with the guidelines of the National Committee for Clinical Laboratory Standards., Results: Most (140/208, 67%) of the isolates were facultative Gram-negative bacilli. Levofloxacin and ciprofloxacin were the most effective (22/22, 100%) against oxacillin-sensitive Staphylococcus aureus. None of the antibiotics tested were found to be effective (0/25) against oxacillin-resistant S. aureus. Of the 11 isolates of Acinetobacter baumannii that were not pandrug-resistant (PDR), only 9 isolates (9/11, 81%) were sensitive to imipenem and 5 isolates (5/11, 45%) were sensitive to levofloxacin, ciprofloxacin, and ceftazidime. Another 22 isolates of A. baumannii that were PDR were completely resistant to all 6 antibiotics. The majority of isolates of Pseudomonas aeruginosa were sensitive to these 6 antimicrobial agents with 10/11 (91%) sensitive to levofloxacin and ciprofloxacin, 9/11 (83%) sensitive to ceftazidime, cefepime and piperacillin-tazobactam, and 8/11 (75%) sensitive to imipenem., Conclusions: The majority of the bacterial isolates causing nosocomial infections were found to be sensitive to the 6 antibiotics tested. Bacterial isolates of nosocomial infections that were completely resistant to these 6 antibiotics were PDR A. baumannii, PDR P. aeruginosa, and oxacillin-resistant S. aureus. More potent antimicrobial agents are needed to treat infections caused by PDR A. baumannii and PDR P. aeruginosa.

Background and Purpose: Carbapenems are considered the drugs of choice for the treatment of serious infections caused by extended-spectrum beta-lactamase (ESBL)-producing Klebsiella and Escherichia coli. However, controversy exists about the antibiotic choice for infections due to ESBL-producing organisms of other genera., Methods: This retrospective study evaluated the risk factors and outcomes of 54 adult patients with bacteremia due to ESBL-producing Enterobacteriaceae other than Klebsiella spp. or E. coli treated at a tertiary care hospital in northern Taiwan from January 2001-December 2003. Patients were categorized into carbapenem (n = 22) and non-carbapenem (n = 32) treatment groups. All patients had at least one positive blood culture together with fever or other clinical features compatible with systemic infection., Results: Higher Acute Physiology and Chronic Health Evaluation II score, glucocorticoid use, and presentation of septic shock were significant risk factors for mortality (p<0.05). Patients treated with a carbapenem had a better 14-day or overall survival rate (i.e., survived to discharge) than those treated with non-carbapenem antibiotics, although this difference was not significant. Among patients in the non-carbapenem group, the overall survival rates of ciprofloxacin, aminoglycoside, and ceftazidime were 70% (14/20), 62.5% (5/8), and 50% (2/4), respectively (p=0.877). The overall survival rates of the carbapenem (72.7%) and ciprofloxacin (70.0%) groups were similar., Conclusions: The results suggest that ciprofloxacin, when indicated based on antimicrobial susceptibility testing, may serve as an alternative choice for infections caused by ESBL-producing Enterobacteriaceae other than E. coli or Klebsiella spp. and may not affect the clinical outcome at discharge.