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Abstract The efficacy of converting to oral fluoroquinolones after initial intravenous antibiotics for the treatment of acute pyelonephritis (APN) caused by the third‐generation cephalosporin resistant Enterobacteriaceae (3‐GCrEC) needs to be investigated. The objective was to compare the clinical and bacteriological outcome of oral prulifloxacin with intravenous ertapenem for the treatment of APN caused by 3‐GCrEC. A pilot, randomized controlled trial of patients with APN caused by 3‐GCrEC was conducted at two hospitals from August 2015 to December 2020. Any intravenous antimicrobial drug was initially permitted for empirical therapy. On day 4, adult patients (aged >18 years) with either non‐bacteremic or bacteremic APN were eligible for the study if their infection was caused by 3‐GCrEC susceptible to the study drugs. The patients were randomly assigned to receive either oral prulifloxacin or intravenous ertapenem. The total duration of antimicrobial therapy was 14 days. Of the 21 enrolled patients, 11 were treated with prulifloxacin, and 10 were treated with ertapenem. At the test of cure visit, there was no statistically significant difference between the patients with overall clinical success who were treated with prulifloxacin (90.9%) and those treated with ertapenem (100%, p = 0.999). In addition, there was no statistically significant difference in microbiological eradication between the prulifloxacin and ertapenem groups (100% vs. 100%, p = 0.999). The converting to oral prulifloxacin after intravenous antibiotics therapy appears to be an alternative option for treatment of APN caused by 3‐GCrEC. A further large randomized controlled trial should be investigated.

The emergence in Southeast Asia of invasive group B Streptococcus (GBS) infections in adults by sequence type (ST) 283 is suggested to be associated with fish consumption. Genotyping of 55 GBS clinical isolates revealed that 33/44 invasive isolates belonged to ST283/capsular polysaccharide type (CPS) III. This included 15/16 isolates recovered from younger adults aged 16–36 years. Seven ST283/CPSIII isolates from the blood, cerebrospinal fluid, or joint fluid were selected by the patient’s age at random to perform interaction studies with intestinal epithelial Caco-2 monolayers. The invasion efficiency profiles from this study classified these isolates into two groups; a higher invasion efficiency group 1 recovered from patients aged between 23 and 36 years, and a lower invasion efficiency group 2 recovered from the elderly and neonate. Intracellular survival tests revealed that only group 1 members could survive inside Caco-2 cells up to 32 h without replication. Additionally, all isolates tested were able to traverse across polarized Caco-2 monolayers. However, the timing of translocation varied among the isolates. These results indicated the potential of GBS invasion via the gastrointestinal tract and showed phenotypic variations in invasiveness, intracellular survival, and translocation efficiency between genetically closely related ST283 isolates infecting young adults and those infecting the elderly.

Objective: To determine the number of isolates and drug susceptibility testing of Acinetobacter baumannii at Taksin Hospital. Materials and Methods: A 3-year retrospective descriptive study was conducted between January 2019 and December 2021. Drug susceptibility testing of isolates to 13 drugs, which included amikacin, gentamycin, piperacillin/tazobactam, cefotaxime, ceftazidime, cefepime, three carbapenem drugs that were imipenem, meropenem, and doripenem, ciprofloxacin, trimethoprim-sulfamethoxazole, colistin, and tigecycline, were evaluated by standard disk diffusion method and automated microdilution method. Results: One thousand six hundred sixty-five non-duplicate A. baumannii isolates from different patients were detected and included 535 in 2019, 500 in 2020, and 630 in 2021. The patients' ages ranged from three days to 100 years. The median age of patients was 70 years with an interquartile range of 56 to 80 years. A. baumannii was mostly found in patients aged older than 50 years old at 83.6%. They were isolated from sputum in 72.3%, urine in 9%, pus in 6.3%, tissue in 6.3%, and blood in 5.2%. Overall, A. baumannii demonstrated 91.5% and 79.8% susceptibility to colistin and tigecycline, respectively, but less susceptible to other drugs tested, with a range of 0.4% to 32.6%. Drug susceptibility to carbapenem such as imipenem, meropenem, and doripenem were 19.5%, 20%, and 20.9%, respectively. The carbapenem-resistant A. baumannii (CRAB) was found at 77.6%, 80%, and 79.1% in 2019, 2020, and 2021, respectively. For total isolates tested, the mean of CRAB was 78.9±1.2%. Conclusion: The present study results suggested the importance of monitoring A. baumannii at a hospital in Bangkok. Colistin and tigecycline had the high percentages of drug susceptibility rates in vitro. The antibiogram of susceptibility helps provide guidelines for clinician to consider empirical treatment. [ABSTRACT FROM AUTHOR]

Methicillin-resistant Staphylococcus aureus (MRSA) is a common pathogen in human diseases. Thirtyseven clinical clones from different patients were tested for a molecular study of the mecA gene and multilocus sequence types (ST). Total genomic extraction, followed by a polymerase chain reaction (PCR) for DNA amplification with specific primers for mecA, and specific primers for various ST were used. Molecular typing for the study of genetic relationships among clones was performed by enterobacterial repetitive intergenic consensus (ERIC)-PCR. Antimicrobial susceptibility testing for all clones to 9 drugs was performed by the disk diffusion and vancomycin Etest. The presence of mecA was detected in all clones. The most common ST was MRSA-ST30, accounting for 81.1% of all MRSA tested, followed by MRSA-ST8/ST97/ST779 (8.1%), MRSA-ST239 (2.7%) and MRSA-nontypeable clones (8.1%). Molecular typing by ERIC-PCR demonstrated DNA fingerprints with corresponding results with sequence types. All clones were susceptible (70-100%) to fosfomycin, fusidic acid, gentamicin, tetracycline, trimethoprimsulfamethoxazole and vancomycin [minimal inhibitory concentration (MIC) range, MIC50 and MIC90 were 0.25-1.0, 0.5 and 0.75 µg/ml, respectively by using E-test] but resistant to ciprofloxacin, clindamycin and erythromycin. Inducible macrolide, lincosamide-type B streptogramin resistance (iMLSB) phenotype was 5.4% while constitutive MLSB phenotype was 91.9%. For MRSA-ST30 clones, 96.7% were multi-drug resistant (MDR) with the most common pattern being resistant to ciprofloxacin, clindamycin and erythromycin. These results suggest the importance of MRSA in the field of epidemiology at a hospital in Thailand. [ABSTRACT FROM AUTHOR]