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The present report is the original description of bla TEM-176. The mechanisms of resistance to antimicrobial agents were determined in an enterotoxigenic Escherichia coli, determining the susceptibility to 22 antimicrobials classified in 15 different groups by agar diffusion and establishing the phylogenetic group, mechanisms of resistance and presence of Class 1 and 2 integrons. Integrons and β-lactam resistance genes were sequenced. The isolate, belonging to phylogenetic group A, showed the presence of resistance or diminished susceptibility to a ampicillin, amoxicillin plus clavulanic acid, nalidíxic acid, ciprofloxacin, streptomycin, kanamycin, tetracycline, trimethoprim, sulfisoxazole, cotrimoxazole, azithromycin and nitrofurantoin, carrying bla TEM, aadA1/2, aphA1, sul3, tet(A) and a Class 2 integron containing a dfrA1 gene. Quinolone resistance was related to the substitution Ser83Ala. The TEM sequencing showed the presence of the new substitution Ala222Val, which led to the description of the new β-lactamase bla TEM-176.El presente reporte es la descripción original de bla TEM-176. Se caracterizaron los mecanismos de resistencia a antimicrobianos de un aislamiento de Escherichia coli enterotoxigénica, determinándose la resistencia a 22 antimicrobianos categorizados en 15 grupos diferentes mediante difusión en agar, estableciéndose grupo filogenético, mecanismos de resistencia y presencia de integrones de Clase 1 y 2 mediante PCR. Integrones y genes de resistencia a β-lactámicos fueron secuenciados. El aislamiento del grupo filogenético A, mostró resistencia o sensibilidad disminuida a ampicilina, amoxicilina más ácido clavulánico, ácido nalidíxico, ciprofloxacino, estreptomicina, kanamicina, tetraciclina, trimetoprim, sulfisoxazol, cotrimoxazol, azitromicina y nitrofurantoina, detectándose la presencia de bla TEM, aadA1/2, aphA1, sul3, tet(A) y un integron de Clase 2 conteniendo un gen dfrA1. La resistencia a quinolonas se relacionó con la substitución Ser83Ala. La secuencia de TEM mostró la substitución Ala222Val, la cual a la fecha no había sido descrita, reportándose como una nueva β-lactamasa, con el nombre de bla TEM-176.

Background: Cat-scratch disease (CSD) is a zoonotic infection caused by Bartonella henselae and B. clarridgeiae. The typical manifestations of CSD include regional lymphadenitis and fever. However, CSD can have a wide variety of clinical manifestations that can lead to incorrect diagnoses and prolonged hospital stays. Case presentation: We present a case of a 3-year-old boy admitted to the pediatric service due to prolonged fever and abdominal pain. He received empirical antimicrobial treatment due to suspicion of infection. Abdominal ultrasound showed hepatosplenic abscesses. An IFA detected the presence of IgG antibodies against B. henselae (1:256). Patient was successfully treated with azithromycin and discharged after 7 weeks. Conclusions: Hepatosplenic abscesses in CSD are rarely reported, particularly in immunocompetent children, with this, only 36 cases in PubMed, Web of Sciences and Scopus bibliographical databases. High rate of suspicion and serological tests availability are of utmost importance in order to detect it and treat it successfully and promptly. Revisado por pares

A 46-year-old female patient, who presented with a black, crusty lesion on the upper eyelid, was diagnosed with cutaneous anthrax after the detection of Bacillus anthracis in the skin culture. It was determined that the symptoms started after she cooked the meat she bought from a butcher. Anthrax is a disease that should be kept in mind in cutaneous infections even in isolated lesions, especially in endemic areas. (C) 2021 The Author(s). Published by S. Karger AG, Basel

The emergence of carbapenemase-producing Enterobacteriaceae (CPE) is a critical concern worldwide. In Italy, CPE isolates are very frequent, with the KPC enzyme types strongly predominant whereas the New Delhi metallo-β-lactamase (NDM) enzymes are extremely rare. Here we report the first detection of NDM-5-producing Escherichia coli sequence type 167 (ST167) isolates from two patients with urinary tract infection (Ec001 and Ec002 from urines), including one with colonisation (Ec003 from faeces) admitted to the same hospital 2 months apart in 2017. Minimum inhibitory concentrations (MICs) were determined by broth microdilution. The carbapenemase type was identified both by phenotypic and genotypic methods. Isolate genotypes were investigated by phylogenetic typing, multilocus sequence typing (MLST) and pulsed-field gel electrophoresis (PFGE). Next-generation sequencing (NGS) was used to obtain complete sequences of plasmids. The three E. coli isolates carried the blaNDM-5 gene, shared the same resistance phenotype and belonged to ST167. By PFGE, isolates showed the same profile, suggesting that they were the same strain. NGS revealed that the blaNDM-5 gene was located on a 99-kb multireplicon plasmid (designed pNDM-5-IT) with a peculiar scaffold constituted by four replicons of the IncF type (FIA, FIB and two copies of the FII replicon). pNDM-5-IT plasmid harboured multiple resistance and virulence determinants, including the arginine deaminase (ADI) cluster never found associated with plasmids before. Since NDM-5-producing E. coli ST167 has been regarded as a successful epidemic clone in China, the emergence of such a clone carrying a plasmid associated both with multiresistance and virulence could be a public-health threat.

Very old (aged ≥80 years) adults constitute an increasing proportion of the global population. Currently, this subgroup of patients represents an important percentage of patients admitted to the intensive care unit. Community-acquired pneumonia (CAP) frequently affects very old adults. However, there are no specific recommendations for the management of critically ill very old CAP patients. Multiple morbidities, polypharmacy, immunosenescence and frailty contribute to an increased risk of pneumonia in this population. CAP in critically ill very old patients is associated with higher short- and long-term mortality; however, because of its uncommon presentation, diagnosis can be very difficult. Management of critically ill very old CAP patients should be guided by their baseline characteristics, clinical presentation and risk factors for multidrug-resistant pathogens. Hospitalisation in intermediate care may be a good option for critical ill very old CAP patients who do not require invasive procedures and for whom intensive care is questionable in terms of benefit. Publication was funded by Ciber de Enfermedades Respiratorias (CibeRes CB06/06/0028) and the 2009 Support to Research Groups in Catalonia 911, IDIBAPS (CERCA Programme/Generalitat de Catalunya). C. Cillóniz is the recipient of a postdoctoral grant (Strategic Plan for Research and Innovation in Health-PERIS 2016–2020), SEPAR fellowship 2008 and the Fondo de Investigación Sanitaria (grant PI19/00207). Funding information for this article has been deposited with the Crossref Funder Registry

Acute generalized exanthematous pustulosis (AGEP) is a toxic cutaneous reaction pattern that is mostly caused by drug intake and rarely associated with spider bites. We report a case of a female patient, 47 years old, with febrile pustular lesions on an erythematous base at the abdominal region. She had three violaceous erythematous and edematous plaques on the interscapular region, one of which had a necrotic crust at its center. The lesions were compatible with spider bites. By considering histopathological and clinical findings, the patient was diagnosed with AGEP. Since she had no history of drug intake, viral infection or other triggers, a spider bite was thought to have caused the AGEP. © Copyright 2020 by Turkish Society of Dermatology and Venereology Turkderm - Turkish Archives of Dermatology and Venereology published by Galenos Yayınevi., The authors declared that this study has received no financial support.

Background. There is a rapid deterioration in the effectiveness of antibiotics due to the global prevalence of bacterial antimicrobial resistance (AMR). AMR can cause an increase in mortality and morbidity due to treatment failures and a lack of effective therapy. Objective. The purpose of this study was to evaluate the AMR pattern of different bacterial isolates at hospitals and laboratories. Materials and Methods. A cross-sectional study from March 2019 to June 2019 was conducted at different governmental and private hospitals and laboratories in Aden, Yemen. Age, sex, specimen type, bacterial isolates, and antibiotic susceptibility pattern were collected using a data extraction sheet. Descriptive statistics were used for data analysis. Result. Data were recorded for 412 patients from whom 20 clinical specimens were collected and analyzed. The most common bacteria isolated were Staphylococcus spp. (n=172, 41.74%), E. coli (n=164, 39.80%), Pseudomonas spp. (n=37, 8.98%), and Klebsiella pneumoniae (n=18, 4.36%); other bacteria were less common. The overall bacterial resistance was highest against the combination of sulfamethoxazole with trimethoprim (73.12%), followed by amoxicillin and clavulanate (65.19%). The cephalosporin antibiotics also showed high resistance rates. The study also showed moderate bacterial resistance to gentamycin (32.65%), azithromycin (29.92%), cefoxitin (62.65%), and ciprofloxacin (25.60%). Ertapenem (16.67%) and levofloxacin (15.56%) had the lowest resistance rates. Conclusion. There was a high percentage of bacteria resistant to several antibiotics. Antibiotic susceptibility testing is a prerequisite guide for the selection of appropriate antibiotic therapy for bacterial infections. https://orcid.org/0000-0003-1145-860X Badulla Wafa F. S. aden.wf.77@gmail.com 1 Alshakka Mohammed alshakka400@gmail.com 2 https://orcid.org/0000-0001-9757-3574 Mohamed Ibrahim Mohamed Izham mohamedizham@qu.edu.qa 3 Domingo Pere 1 Department of Analytical Chemistry Faculty of Pharmacy Aden University Aden Yemen aden-univ.net 2 Section of Clinical Pharmacy Faculty of Pharmacy Aden University Aden Yemen aden-univ.net 3 Department of Clinical Pharmacy and Practice College of Pharmacy QU Health Qatar University Doha Qatar qu.edu.qa 2020 23 4 2020 2020 11 02 2020 02 04 2020 23 4 2020 2020 Copyright � 2020 Wafa F. S. Badulla et al. This is an open access article distributed under the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The publication of this article was funded by Qatar National Library. Scopus

Background/aim: Community-onset urinary tract infections (UTIs) caused by extended-spectrum ß-lactamase (ESBL)-producing Escherichia coli have increased in many parts of the world. This study aimed to determine the prevalence and risk factors for community-onset UTI caused by ESBL-producing E. coli. Materials and methods: This prospective cohort study was conducted between January 2012 and March 2014 in cases of community-onset UTI caused by E. coli. Patients with UTI due to ESBL-producing E. coli and patients with UTI due to non-ESBL-producing E. coli were compared to identify risk factors for ESBL-producing E. coli in the community. Results: A total of 305 patients (116 males [46.4%]; mean age: 57.76 ± 18.06 years) were included in the study. Among these patients, 154 (50.5%) were infected with ESBL-producing E. coli. In multivariate analysis, the healthcare-associated UTI (odds ratio [OR]: 1.80; 95% confidence interval [CI]: 1.02–3.18; P = 0.041), upper urinary tract infection (OR: 3.05; 95% CI: 1.76–5.29; P < 0.0001), use of antibiotics in the preceding 6 months (OR: 2.28; 95% CI: 1.21–4.30; P = 0.011), and having two or more risk factors (OR: 4.03; 95% CI: 1.73–9.35; P = 0.001) were the significant factors associated with increased risk of community-onset UTIs due to ESBL-producing E. coli. Conclusion: The increasing prevalence of ESBL-producing E. coli makes it difficult to decide the empirical therapy in UTIs, especially in patients with two or more of the risk factors. A better understanding of the epidemiology and risk factors associated with community-onset UTIs due to ESBL-producing E. coli may have significant implications in decision-making for empirical antimicrobial treatment. © TÜBİTAK.

The objective of this study was to determine the phenotypic patterns of antibiotic resistance and the epidemiology of drug-resistant Campylobacter spp. from a low-resource setting., The objective of this study was to determine the phenotypic patterns of antibiotic resistance and the epidemiology of drug-resistant Campylobacter spp. from a low-resource setting. A birth cohort of 303 patients was followed until 5 years of age. Stool samples from asymptomatic children (n = 10,008) and those with diarrhea (n = 3,175) were cultured for Campylobacter. Disk diffusion for ciprofloxacin (CIP), nalidixic acid (NAL), erythromycin (ERY), azithromycin (AZM), tetracycline (TE), gentamicin (GM), ampicillin (AMP), amoxicillin and clavulanic acid (AMC), ceftriaxone (CRO), chloramphenicol (C), and trimethoprim-sulfamethoxazole (TMS) was determined. Antibiotic resistances in Campylobacter jejuni and non-C. jejuni isolates from surveillance and diarrhea samples were compared, and the association between personal macrolide exposure and subsequent occurrence of a macrolide-resistant Campylobacter spp. was assessed. Of 917 Campylobacter isolates, 77.4% of C. jejuni isolates and 79.8% of non-C. jejuni isolates were resistant to ciprofloxacin, while 4.9% of C. jejuni isolates and 24.8% of non-C. jejuni isolates were not susceptible to azithromycin. Of the 303 children, 33.1% had been diagnosed with a Campylobacter strain nonsusceptible to both azithromycin and ciprofloxacin. Personal macrolide exposure did not affect the risk of macrolide-resistant Campylobacter. Amoxicillin and clavulanic acid (94.0%) was one of the antibiotics with the highest rates of susceptibility. There is a high incidence of quinolone- and macrolide-resistant Campylobacter infections in infants under 24 months of age. Given the lack of association between personal exposure to macrolides and a subsequent Campylobacter infection resistant to macrolides, there is a need to evaluate the source of multidrug-resistant (MDR) Campylobacter. This study provides compelling evidence to propose amoxicillin/clavulanic acid as a treatment for campylobacteriosis.

There is a dilemma about usage and selection of the antibiotics following pulmonary contusion. Thus, this study aimed to evaluate pulmonary infection risk in dogs with pulmonary contusion. In total, eleven dogs with pulmonary contusion included in the study. Diagnosis of the pulmonary contusion and its degrees were determined based on the clinical and radiological findings. Under general anesthesia, bronchoscopy and bronchoalveolar lavage (BAL) was applied on 0, 24 and 48(th) h and BAL samples were collected. Cytological examination, culture and antibiotic susceptibility analysis of the BAL samples were performed. Clinically, mild, moderate and severe degree pulmonary contusions were diagnosed, but radiological results pointed out severe degree of pulmonary contusion in all dogs. Bronchoscopy showed the hemoptysis in all dogs except one. Cytologically, all preparations had the inflammatory results at 0(th) hour and these were increased at 24 and 48(th) hours. Additionally, evidence of infection was determined in the cytological preparations of four dogs (case 1, 2, 5 and 8) taken at 0, 24 and 48(th) hours. These cytological results were compatible with microbiological results of case 1, 2, 5 and 8. Pasteurella multocida in case 1 and 2, and Escherichia coli in case 5 and 8 was cultured microorganism from the BAL samples, separately. While P. multocida was resistant to gentamicin, erythromycin and oxytetracycline; E. coli was resistant only sulfamethoxazole/trimethoprim. In conclusion, it may be stated that pulmonary contusion triggers inflammation process, and if there is a pathogenic opportunistic flora in the lower respiratory tracts, the pulmonary infections might accompany with inflammation process. Thus, if it is able, antibiotic usage must be planned considering to the results of BAL culture and antibiogram tests. Pulmoner kontüzyon sonrası antibiyotik kullanımı ve seçimi hakkında bir çelişki vardır. Bu nedenle bu çalışma pulmoner kontüzyonlu köpeklerde pulmoner enfeksiyon riskinin değerlendirmesini amaçladı. Çalışmaya pulmoner kontüzyonlu 11 köpek dahil edildi. Pulmoner kontüzyon tanısı ve derecelendirilmesi klinik ve radyolojik bulgular temelinde belirlendi. Genel anestezi altında, 0, 24 ve 48. saatlerde köpeklerde bronkoskopi ve bronkoalveolar lavaj (BAL) uygulandı ve BAL numunesi alındı. BAL numunelerin sitolojik muayenesi, kültür ve antibiyotik duyarlılık analizleri yapıldı. Klinik olarak hafif, orta ve şiddetli derece pulmoner kontüzyon tanıları konuldu, ancak radyolojik bulgular tüm köpeklerde şiddetli derecede pulmoner kontüzyonu belirtti. Bronkoskopi, biri hariç tüm köpeklerde hemoptiziyi gösterdi. Sitolojik olarak, tüm preparatlar 0. saatte enflamasyon bulgularına sahipti ve bu bulgular 24 ve 48. saatlerde artıyordu. Ek olarak, enfeksiyon varlığı, dört köpeğin (olgu 1, 2, 5 ve 8) 0, 24 ve 48. saatlerde alınan sitoloji preparatlarında belirlendi. Bu sitolojik bulgular olgu 1, 2, 5 ve 8’in mikrobiyolojik bulguları ile uyumluydu. Sırasıyla, Pasteurella multocida olgu 1 ve 2’de, Escherichia coli olgu 5 ve 8’de BAL numunelerinden kültüre edilen mikroorganizmalardı. P. multocida gentamisin, eritromisin ve oksitetrasiklin’e dirençli iken, E. coli sadece sulfametoksazol/ trimetoprim’e dirençliydi. Sonuç olarak, pulmoner kontüzyononun yangısal süreci tetikleyebildiği ve eğer alt solunum yollarında patojenik fırsatçı bir flora var ise akciğerdeki yangısal sürece enfeksiyonun da eşlik edebileceği söylenebilir. Bu yüzden, antibiyotik kullanımı olanaklar elveriyor ise BAL kültür ve antibiyogram sonuçları göz önüne alınarak kurgulanmalıdır.

The purpose of this investigation was to determine the prevalence of plasmid-mediated AmpC (pAmpC) and carbapenemases in Enterobacteriaceae collected from 35 hospitals in Spain and to establish their epidemiological relationships. We conducted a prospective multi-centre study on pAmpC- or carbapenemase-producing Enterobacteriaceae isolates from clinical samples collected from February to July 2009. The strains suspected to carry pAmpC were resistant or showed intermediate susceptibility to co-amoxiclav and second- or third-generation cephalosporins. Strains suspected to carry a carbapenemase were selected because they showed a minimum inhibitory concentration (MIC) to imipenem >1 mg/L. Polymerase chain reaction (PCR) and a sequencing strategy were used to characterise the enzymes. The clonal relationships between isolates was analysed by pulsed field gel electrophoresis (PFGE). Among 100,132 Enterobacteriaceae isolates collected, 1,654 were compatible with the production of pAmpC or carbapenemases. We found a prevalence of 0.64 % of pAmpC (n = 635) and 0.04 % of carbapenemases (n = 43). The most prevalent pAmpC enzymes were CMY-type (78.3 %), DHA-type (19.5 %), ACC-type (1.6 %) and FOX-type (0.6 %). The CMY-type was the most frequent in Escherichia coli and Proteus mirabilis species, whereas the DHA-type was mainly found in Klebsiella spp. The enzymes involved in carbapenem resistance were VIM-1, IMP-22 and the new IMP-28. Nine new bla genes were described: bla CMY-54, bla CMY-55, bla CMY-56, bla CMY-57, bla CMY-96, bla DHA-6, bla DHA-7, bla FOX-8 and bla IMP-28. The prevalence of pAmpC or carbapenemases found is not negligible. The CMY-types were the predominant pAmpC, whereas the VIM or IMP enzymes were the predominant carbapenemases. Furthermore, we observed a great genetic diversity among pAmpC-producing strains and a close clonal relationship between carbapenemase-producing strains.

The objective of this study was to understand the conjugative transmissibility of resistance plasmids present in 205 Salmonella enterica isolates from bovine sources. Polymerase chain reaction (PCR)-based replicon typing was used to type plasmid replicons. Conjugation experiments were preformed in triplicate at 30 degrees C and 37 degrees C on solid medium. PCR mapping of the A/C transfer gene operon was done on 17 Salmonella Newport isolates that were only positive for A/C. Eighty-six percent (n = 177) of the Salmonella isolates were multidrug resistant (MDR) with resistance to 3-12 antimicrobial agents. Of these, 82% (n = 146) were resistant to extended-spectrum cephalosporins and possessed a bla(CMY) gene. A/C was the predominant replicon detected, present in 90% (n = 160) of the MDR isolates. Twenty-three percent (n = 37) of the A/C-positive strains were positive for a second replicon. Replicons coresident with A/C included I1, N, B/O, HI1, and HI2. Only 31% (n = 54) of the MDR isolates produced transconjugants, and most of these donors carried multiple replicons. A/C cotransferred with B/O, N, and I1 at both 30 degrees C and 37 degrees C and with HI2 at 30 degrees C. Seven Salmonella Newport isolates that produced transconjugants possessed only the single A/C replicon and lacked bla(CMY). PCR mapping of the A/C transfer gene operon in ten Salmonella Newport isolates that carried bla(CMY) revealed a bla(CMY) inverted repeat element integrated between the traA and traC genes. These results suggest that A/C may have been a conjugative plasmid before the integration of bla(CMY) into the transfer gene operon. Additionally, transfer deficient A/C replicons may be mobilized in the presence of certain compatible conjugative plasmids.

We determined the complete nucleotide sequences of three plasmids that encode CTX-M extended-spectrum β-lactamases (ESBLs) in pulsed-field gel electrophoresis-defined United Kingdom variants (strains A, C, and D) of the internationally prevalent Escherichia coli O25:H4-ST131 clone. Plasmid pEK499 (strain A; 117,536 bp) was a fusion of type FII and FIA replicons and harbored the following 10 antibiotic resistance genes conferring resistance to eight antibiotic classes: bla CTX-M-15 , bla OXA-1 , bla TEM-1, aac6′-Ib-cr , mph (A), catB4 , tet (A), and the integron-borne dfrA7 , aadA5 , and sulI genes. pEK516 (strain D; 64,471 bp) belonged to incompatibility group IncFII and carried seven antibiotic resistance genes: bla CTX-M-15 , bla OXA-1 , bla TEM-1 , aac6′-Ib-cr , catB4 , and tet (A), all as in pEK499. It also carried aac3-IIa , conferring gentamicin resistance, and was highly related to pC15-1a, a plasmid encoding the CTX-M-15 enzyme in Canada. By contrast, pEK204 (strain C; 93,732 bp) belonged to incompatibility group IncI1 and carried only two resistance genes, bla CTX-M-3 and bla TEM-1 . It probably arose by the transposition of Tn 3 and IS Ecp1 - bla CTX-M-3 elements into a pCOLIb-P9-like plasmid. We conclude that (i) United Kingdom variants of the successful E. coli ST131 clone have acquired different plasmids encoding CTX-M ESBLs on separate occasions, (ii) the bla CTX-M-3 and bla CTX-M-15 genes on pEK204 and pEK499/pEK516 represent separate escape events, and (iii) IncFII plasmids harboring bla CTX-M-15 have played a crucial role in the global spread of CTX-M-15 ESBLs in E. coli .

JUSTIFICATIVA E OBJETIVOS: Com base nos conhecimentos sobre a ação antiinflamatória e antibacteriana dos anestésicos locais (AL) o estudo teve como objetivo determinar o efeito da lavagem peritoneal com solução de bupivacaína na sobrevida de ratos com peritonite fecal por fezes autógenas. MÉTODO: Foram utilizados 48 ratos da linhagem Wistar, com peso entre 300 g e 330 g (311,45 ± 9,67), submetidos à laparotomia seis horas após a indução de peritonite, distribuídos aleatoriamente em quatro grupos: 1 - Controle, nenhum tratamento (n = 12); 2 - Enxugamento da cavidade abdominal (n = 12); 3 - Lavagem da cavidade abdominal com 3 mL de solução fisiológica a 0,9% e enxugamento (n = 12); 4 - Lavagem da cavidade abdominal com 8 mg.kg-1 (± 0,5 mL) de bupivacaína 0,5%, adicionada a 2,5 mL de solução fisiológica a 0,9% e enxugamento (n = 12). Os animais que faleceram foram necropsiados e o horário do óbito foi anotado. Os animais sobreviventes foram mortos no 11° dia do pós-operatório e realizou-se a necropsia. RESULTADOS: Houve 100% de mortalidade nos animais do Grupo 1, em 52 horas, 100% nos animais do Grupo 2, em 126 horas e 50% nos animais do Grupo 3 em 50 horas. Os animais do Grupo 4 sobreviveram. A sobrevida, no 11º dia de pós-operatório, foi maior nos grupos 3 e 4 com relação aos grupos 1 e 2 (p < 0,001) e maior nos Grupo 4 com relação ao Grupo 3 (p < 0,01). CONCLUSÕES: A lavagem peritoneal com solução de bupivacaína diluída em solução fisiológica foi eficaz para evitar o óbito, por 11 dias, em 100% dos animais com peritonite fecal. BACKGROUND AND OBJECTIVES: Based on the knowledge of the anti-inflammatory and anti-bacterial actions of local anesthetics (LA), the objective of this study was to determine the effects of peritoneal lavage with bupivacaine on survival of mice with fecal peritonitis. METHODS: Forty-eight Wistar mice, weighing between 300 and 330 g (311.45 ± 9.67 g), undergoing laparotomy 6 hours after induction of peritonitis were randomly divided in 4 groups: 1 - Control, without treatment (n = 12); 2 - Drying of the abdominal cavity (n = 12); 3 - Lavage with 3 mL NS and posterior drying of the abdominal cavity (n = 12); and 4 - Lavage with 8 mg.kg-1 (± 0.5 mL) of 0.5% bupivacaine added to 2.5 mL of NS followed by drying out of the abdominal cavity (n = 12). Animals that died underwent necropsy and the time of death was recorded. Surviving animals were killed on the 11th postoperative day and underwent necropsy. RESULTS: Group 1 presented a 100% mortality rate in 52 hours, 100% mortality rate in Group 2 in 126 hours, and Group 3 presented a 50% mortality rate in 50 hours. Animals in Group 4 survived. Survival on the 11th day was greater in groups 3 and 4 than in Groups 1 and 2 (p < 0.001) and greater in Group 4 than in Group 3 (p < 0.01). CONCLUSIONS: Peritoneal lavage with a solution of bupivacaine diluted in NS was effective in preventing death for 11 days in 100% of animals with fecal peritonitis. JUSTIFICATIVA Y OBJETIVOS: Basados en los conocimientos sobre la acción antiinflamatoria y antibacteriana de los anestésicos locales (AL), el estudio tuvo el objetivo de verificar el efecto del lavado peritoneal con solución de bupivacaína en la sobrevida de ratones con peritonitis fecal por heces autógenas. MÉTODO: Se usaron 48 ratones de la raza Wistar, con peso entre 300 g y 330 g (311,45 ± 9,67), sometidos a la laparotomía 6 horas después de la inducción de peritonitis, distribuidos aleatoriamente en 4 grupos: 1 - Control, ningún tratamiento (n = 12); 2 - Secado de la cavidad abdominal (n = 12); 3 - Lavado de la cavidad abdominal con 3 mL de solución fisiológica a 0,9% y secado (n = 12); 4 - Lavado de la cavidad abdominal con 8 mg.kg-1 (± 0,5 mL) de bupivacaína 0,5%, adicionada a 2,5 mL de solución fisiológica a 0,9% y secado (n = 12). Los animales que murieron fueron llevados a necropsia y el horario del óbito se anotó. Los animales sobrevivientes se sacrificaron al 11º día del postoperatorio y se realizó la necropsia. RESULTADOS: Hubo un 100% de mortalidad en los animales del Grupo 1 en 52 horas, 100% en los animales del Grupo 2, en 126 horas y un 50% en los animales del Grupo 3 en 50 horas. Los animales del Grupo 4 sobrevivieron. La sobrevida, al 11° día del postoperatorio, fue mayor en los grupos 3 y 4 con relación a los grupos 1 y 2 (p < 0,001) y mayor en los Grupo 4 con relación al Grupo 3 (p < 0,01). CONCLUSIONES: El lavado peritoneal con solución de bupivacaína diluida en solución fisiológica fue eficaz para evitar el óbito, por 11 días, en un 100% de los animales con peritonitis fecal.

Escherichia coli is one of the most-studied microorganisms worldwide but its characteristics are continually changing. Extraintestinal E. coli infections, such as urinary tract infections and neonatal sepsis, represent a huge public health problem. They are caused mainly by specialized extraintestinal pathogenic E. coli (ExPEC) strains that can innocuously colonize human hosts but can also cause disease upon entering a normally sterile body site. The virulence capability of such strains is determined by a combination of distinctive accessory traits, called virulence factors, in conjunction with their distinctive phylogenetic background. It is conceivable that by developing interventions against the most successful ExPEC lineages or their key virulence/colonization factors the associated burden of disease and health care costs could foreseeably be reduced in the future. On the other hand, one important problem worldwide is the increase of antimicrobial resistance shown by bacteria. As underscored in the last WHO global report, within a wide range of infectious agents including E. coli, antimicrobial resistance has reached an extremely worrisome situation that 'threatens the achievements of modern medicine'. In the present review, an update of the knowledge about the pathogenicity, antimicrobial resistance and clinical aspects of this 'old friend' was presented.

Objectives To evaluate the presence of qnr genes among enterobacterial isolates carrying extended-spectrum beta-lactamases (ESBLs) in Barcelona, Spain. Methods Screening for the qnrA, qnrB and qnrS genes was carried out by PCR amplification with specific primers in 305 non-duplicate, clinically relevant ESBL-producing enterobacterial isolates obtained from February 2003 to August 2004. ESBLs from all qnr-positive isolates were characterized by isoelectric focusing, PCR amplification and DNA sequencing. Plasmid analysis was performed by S1 digestion and hybridization with specific probes for the qnr and bla genes. Plasmids containing qnr genes were transferred by conjugation or transformation. The genetic environment of qnrA1 in selected isolates was characterized by cloning experiments. Results Fifteen isolates, each from a different individual, carried qnr. Among them, 14 had qnrA1 (6 Klebsiella pneumoniae, 6 Enterobacter cloacae and 2 Escherichia coli isolates) and 1 had qnrS1 (K. pneumoniae). None of the isolates carried qnrB. Among the qnrA1-carrying isolates, 10 possessed both bla(CTX-M-9) and bla(SHV-12), 2 had both bla(CTX-M-9) and bla(SHV-92) and 2 had bla(CTX-M-9) alone. The isolate with qnrS1 possessed bla(SHV-12). The qnrA1 and ESBL genes were located together on plasmids ranging in size from 40 to 320 kb. qnrS1 and bla(SHV-12) were not located on the same plasmid. Transfer of quinolone resistance was successfully achieved from all but three isolates. The cloned region surrounding qnrA in two K. pneumoniae isolates revealed a novel genetic organization. Conclusions The prevalence of qnr among enterobacterial clinical isolates carrying ESBLs between 2003 and 2004 in Barcelona was 4.9%. qnrA1 was the most prevalent, whereas only one qnrS and no qnrB were detected.

Sporothrix schenckii causes clinical cutaneous forms consisting of lymphangitic, localised, disseminated or extracutaneous forms of sporotrichosis. Cutaneous form caused by the agent entering the body through the skin after trauma is the most frequently seen sporotrichosis form and it progresses in the form of either nodular lymphangitic lesions or localised (fix) lesions (da Rosa AC et al., J Am Acad Dermatol 2005; 52: 451–9; Schamroth JM, Grieve TP, Kellen P. Int J Dermatol 1988; 27: 28–30). Causative agent entering the body through skin causes erythematous, ulcerative or verrucous nodules and lesions generally progress to nodular lymphangitic cutaneous sporotrichosis (Kwon-Chung KJ, Bennett JE. Medical Mycology, Lea & Febiger, Philadelphia–London, 1992: 707–29). Lymphangitic sporotrichosis (nodular lymphangitic cutaneous sporotrichosis) accounts for 70–80% of the total number of the cases (Vismer HF, Hull PR. Mycopathologia 1997; 137: 137–43). The case presented in this paper is that of patient with a sporotrichosis in nodular lymphangitic cutaneous form which developed after the prick of a thorn in hand.

A case of Lemierre's syndrome is reported. Although Fusobacterium species are commonly associated with this presentation, Prevotella bivia was the causative micro-organism identified in this case. The finding that disseminated anaerobic sepsis followed primary EBV infection led to the construction of a hypothetical model of infection. © 2005 The British Infection Society.

Drug therapy in cystic fibrosis is focused on pulmonary infection and inflammation, intestinal obstruction and the substitution of pancreas enzymes. Most morbidity and mortality arises from the pulmonary infection and subsequent tissue destruction and deterioration of lung function. Antibiotic treatment is the mainstay of therapy. Nebulised antibiotics improve lung function and the incidence of acute exacerbations is reduced in patients chronically infected with Pseudomonas. Macrolides play a special role probably due to an antiinflammatory effect. Inhalation of rhDNAse improves lung function and decreases deterioration of lung function. New therapeutics directed at the CFTR defect are not yet available. Pharmacokinetics in CF patients may differ from those in healthy volunteers, probably due to differences in body composition.

Introduction. This study aims to investigate the reasons that discourage the patients affected by OSAS to undergo orthognathic surgery and compares the postoperative discomfort of phase I (soft tissue surgery) and phase II (orthognathic surgery) procedures for treatment of OSAS.Material and Methods. A pool of 46 patients affected by OSAS was divided into two groups: “surgery patients” who accepted surgical treatments of their condition and “no surgery patients” who refused surgical procedures. The “surgery patients” group was further subdivided into two arms: patients who accepted phase I procedures (IP) and those who accepted phase II (IIP). To better understand the motivations behind the refusal of II phase procedures, we asked the patients belonging to both the IP group and “no surgery” group to indicate the main reason that influenced their decision to avoid II phase procedures. We also monitored and compared five parameters of postoperative discomfort: pain, painkiller assumption, length of hospitalization, foreign body sensation, and diet assumption following IP and IIP procedures.Results. The main reason to avoid IIP procedures was the concern of a more severe postoperative discomfort. Comparison of the postoperative discomfort following IP versus IIP procedures showed that the former scored worse in 4 out of 5 parameters analyzed.Conclusion. IIP procedures produce less postoperative discomfort. IIP procedures, namely, orthognathic surgery, should be the first choice intervention in patients affected by OSAS and dentoskeletal malformation.

Objective: To determine risks factors associated with severe sepsis or septic shock (SS) at admission in patients with community-onset bacteraemic urinary tract infection (CO-BUTI) including the impact of multidrug-resistant (MDR) bacteria. Methods: We analysed a prospective cohort of all consecutive episodes of CO-BUTI requiring hospitalisation in 8 tertiary hospitals of Spain between October 2010 and June 2011. Results: Of an overall of 525 CO-BUTI episodes, 175 (33%) presented with SS at admission. MDR bacteria were isolated in 29% (51/175) of episodes with SS and in 33% (117/350) of those without SS (. p=0.32). The main MDR microorganism was Escherichia coli in both groups (25% and 28% respectively). Independent risk factors associated with SS at admission were: having fatal underlying conditions, McCabe score II/III (OR 1.90; 95%CI 1.23-2.92; p=0.004), presence of an indwelling urethral catheter (OR 3.01; 95%CI 1.50-6.03; p=0.002) and a history of urinary tract obstruction (OR 1.56; 95%CI 1.03-2.34; p=0.03). After considering interactions, indwelling urethral catheters were a risk factor only for patients without fatal underlying conditions. Conclusions: SS at hospital admission occurred in a third of CO-BUTI. Mainly host factors, and not the causative microorganisms or antimicrobial resistance patterns had an impact on the presence of SS. © 2014 The British Infection Association.

Cutaneous anthrax is well known, unlike anthrax of the lumbar region, which is not reported elsewhere. We present a case of anthrax of the lumbar region in a 50-year-old man. The infection was characterised by a wide, black eschar and oedema on an erythematous ground. After isolation of the Gram-positive bacilli from the skin lesions, prompt antibiotic treatment (intravenous sulbactam-ampicillin 1.5 g every six hours) was initiated. Following eradication of the bacilli after 14 days of antibiotic treatment, a split-thickness skin graft was applied. A diagnosis of anthrax depends on clinical suspicion. Early diagnosis, antibiotic and surgical treatment can facilitate the treatment and prevent development of complications., NA

Background. Morbidity and mortality for critically ill patients with infections remains a global healthcare problem. We aimed to determine whether α-lactam antibiotic dosing in critically ill patients achieves concentrations associated with maximal activity and whether antibiotic concentrations affect patient outcome.Methods. This was a prospective, multinational pharmacokinetic point-prevalence study including 8 α-lactam antibiotics. Two blood samples were taken from each patient during a single dosing interval. The primary pharmacokinetic/pharmacodynamic targets were free antibiotic concentrations above the minimum inhibitory concentration (MIC) of the pathogen at both 50% (50% f TMIC) and 100% (100% f T MIC) of the dosing interval. We used skewed logistic regression to describe the effect of antibiotic exposure on patient outcome.Results. We included 384 patients (361 evaluable patients) across 68 hospitals. The median age was 61 (interquartile range [IQR], 48-73) years, the median Acute Physiology and Chronic Health Evaluation II score was 18 (IQR, 14-24), and 65% of patients were male. Of the 248 patients treated for infection, 16% did not achieve 50% f TMIC and these patients were 32% less likely to have a positive clinical outcome (odds ratio [OR], 0.68; P =. 009). Positive clinical outcome was associated with increasing 50% f TMIC and 100% f TMIC ratios (OR, 1.02 and 1.56, respectively; P

Background Data mining in spontaneous reporting databases has shown that drug-induced liver injury is infrequently reported in children. Objectives Our objectives were to (i) identify drugs potentially associated with acute liver injury (ALI) in children and adolescents using electronic healthcare record (EHR) data; and (ii) to evaluate the significance and novelty of these associations. Methods We identified potential cases of ALI during exposure to any prescribed/dispensed drug for individuals 1 and in the presence of at least three exposed cases of ALI. Potentially new signals were distinguished from already known associations concerning ALI (whether in adults and/or in the paediatric population) through manual review of published literature and drug product labels. Results The study population comprised 4,838,146 individuals aged < 18 years, who contributed an overall 25,575,132 person-years of follow-up. Within this population, we identified 1,015 potential cases of ALI. Overall, 20 positive drug-ALI associations were detected. The associations between ALI and domperidone, flunisolide and human insulin were considered as potentially new signals. Citalopram and cetirizine have been previously described as hepatotoxic in adults but not in children, while all remaining associations were already known in both adults and children. Conclusions Data mining of multiple EHR databases for signal detection confirmed known associations between ALI and several drugs, and identified some potentially new signals in children that require further investigation through formal epidemiologic studies. This study shows that EHRs may complement traditional spontaneous reporting systems for signal detection and strengthening.

We report expanded-spectrum cephalosporin resistance in Escherichia coli from dogs and cats in Rome, Italy. Three major β-lactamases (CMY-2, SHV-12, and CTX-M-1) are reported for the first time in E. coli from sick and healthy dogs and cats. Molecular characterization suggests the presence of several combinations of β-lactamase genes in E. coli from companion animals.

Cystic fibrosis (CF) is the most common potentially fatal inherited disease in the white population. In patients with CF, abnormal chloride transport across the apical membrane of epithelial cells has been identified, causing inspissated secretions in the airways, pancreas and other organs. Clinical manifestations result from obstruction in ducts or organs followed by tissue destruction and inflammatory response due to viscid secretions. Most morbidity and mortality arises from pulmonary disease. Pulmonary infection usually occurs with Haemophilus influenzae, Staphylococcus aureus and Pseudomonas aeruginosa. Pharmacotherapeutic treatment modalities have been focused on substituting pancras enzymes and suppression of the chronic pulmonary infection. However, in case Burkholderia cepacia is isolated from the airways, this is associated with an increased deterioration of the pulmonary function and a high mortality. There is an urgent need for antibiotics with sufficient activity against B. cepacia. New therapeutic modalities are directed towards the normalization of the ion transport across the membranes and the suppression of the pulmonary inflammatory response. If the pulmonary ion transport could be normalized, it should be possible to treat the pulmonary manifestations of the disease.

Background: The prevalence and type of plasmids, resistance genes and integrons carried by two collections of multiresistant E. coli producing or not extended-spectrum beta-lactamases have been compared. Rep-PCR was used to determine the clonal relationship of the organisms. Plasmids were classified according to their incompatibility. Class 1 and Class 2 integrons and antibiotic resistance genes were analysed by PCR and sequencing. Results: Both collections of organisms contained a large diversity of unrelated strains with some clones distributed in both groups of isolates. Large plasmids were identified in the two groups of organisms. Plasmids with replicons repK and repColE were more frequent among ESBL-producing isolates, while repFIA, repFII and repA/C replicons were more frequent in isolates lacking ESBL. Conjugative plasmids with repK and repA/C replicons coded for CTX-M-14 and CMY-2 beta-lactamases, respectively. No significant differences were observed in the distribution of class 1 and class 2 integrons among multiresistant E. coli producing or not ESBL, and dfrA17-ant(3[prime][prime])-Ie was the cassette arrangement most commonly found. Conclusions: In the concrete temporal and geographical context of this study, multiresistant E. coli producing ESBL or other mechanisms of resistance were largely clonally diverse and present some differences in the types of harboured plasmids. Still, some clones were found in both ESBL-producing and --lacking isolates.

SUMMARYLatin America has a high rate of community-associated infections caused by multidrug-resistant Enterobacteriaceae relative to other world regions. A review of the literature over the last 10 years indicates that urinary tract infections (UTIs) byEscherichia coli, and intra-abdominal infections (IAIs) byE. coliandKlebsiella pneumoniae, were characterized by high rates of resistance to trimethoprim/sulfamethoxazole, quinolones, and second-generation cephalosporins, and by low levels of resistance to aminoglycosides, nitrofurantoin, and fosfomycin. In addition, preliminary data indicate an increase in IAIs by Enterobacteriaceae producing extended-spectrumβ-lactamases, with reduced susceptibilities to third- and fourth-generation cephalosporins. Primary-care physicians in Latin America should recognize the public health threat associated with UTIs and IAIs by resistant Gram-negative bacteria. As the number of therapeutic options become limited, we recommend that antimicrobial prescribing be guided by infection severity, established patient risk factors for multidrug-resistant infections, acquaintance with local antimicrobial susceptibility data, and culture collection.

The blaESBL and blaAmpC genes in Enterobacteriaceae are spread by plasmid-mediated integrons, insertion sequences, and transposons, some of which are homologous in bacteria from food animals, foods, and humans. These genes have been frequently identified in Escherichia coli and Salmonella from food animals, the most common being blaCTX-M-1, blaCTX-M-14, and blaCMY-2. Identification of risk factors for their occurrence in food animals is complex. In addition to generic antimicrobial use, cephalosporin usage is an important risk factor for selection and spread of these genes. Extensive international trade of animals is a further risk factor. There are no data on the effectiveness of individual control options in reducing public health risks. A highly effective option would be to stop or restrict cephalosporin usage in food animals. Decreasing total antimicrobial use is also of high priority. Implementation of measures to limit strain dissemination (increasing farm biosecurity, controls in animal trade, and other general postharvest controls) are also important.

We conducted a prospective multicenter study in Spain to characterize the mechanisms of resistance to amoxicillin-clavulanate (AMC) in Escherichia coli. Up to 44 AMC-resistant E. coli isolates (MIC =32/16 µg/ml) were collected at each of the seven participant hospitals. Resistance mechanisms were characterized by PCR and sequencing. Molecular epidemiology was studied by pulsed-field gel electrophoresis (PFGE) and by multilocus sequence typing. Overall AMC resistance was 9.3%. The resistance mechanisms detected in the 257 AMC-resistant isolates were OXA-1 production (26.1%), hyperproduction of penicillinase (22.6%), production of plasmidic AmpC (19.5%), hyperproduction of chromosomic AmpC (18.3%), and production of inhibitor-resistant TEM (IRT) (17.5%). The IRTs identified were TEM-40 (33.3%), TEM-30 (28.9%), TEM-33 (11.1%), TEM-32 (4.4%), TEM-34 (4.4%), TEM-35 (2.2%), TEM-54 (2.2%), TEM-76 (2.2%), TEM-79 (2.2%), and the new TEM-185 (8.8%). By PFGE, a high degree of genetic diversity was observed although two well-defined clusters were detected in the OXA-1-producing isolates: the C1 cluster consisting of 19 phylogroup A/sequence type 88 [ST88] isolates and the C2 cluster consisting of 19 phylogroup B2/ST131 isolates (16 of them producing CTX-M-15). Each of the clusters was detected in six different hospitals. In total, 21.8% of the isolates were serotype O25b/phylogroup B2 (O25b/B2). AMC resistance in E. coli is widespread in Spain at the hospital and community levels. A high prevalence of OXA-1 was found. Although resistant isolates were genetically diverse, clonality was linked to OXA-1-producing isolates of the STs 88 and 131. Dissemination of IRTs was frequent, and the epidemic O25b/B2/ST131 clone carried many different mechanisms of AMC resistance. Copyright © 2012, American Society for Microbiology. All Rights Reserved.

Contains fulltext : 108207.pdf (Publisher’s version ) (Open Access) Drug-induced liver injury (DILI) is the leading cause of acute liver failure. Currently, no adequate predictive biomarkers for DILI are available. This study describes a translational approach using proteomic profiling for the identification of urinary proteins related to acute liver injury induced by acetaminophen (APAP). Mice were given a single intraperitoneal dose of APAP (0-350 mg/kg bw) followed by 24 h urine collection. Doses of >/=275 mg/kg bw APAP resulted in hepatic centrilobular necrosis and significantly elevated plasma alanine aminotransferase (ALT) values (p

Escherichia coli-associated urinary tract infections (UTIs) are among the most common bacterial infections in humans. UTIs are usually managed with antibiotic therapy, but over the years, antibiotic-resistant strains of uropathogenic E. coli (UPEC) have emerged. The formation of biofilms further complicates the treatment of these infections by making them resistant to killing by the host immune system as well as by antibiotics. This has encouraged research into therapy using bacteriophages (phages) as a supplement or substitute for antibiotics. In this study we characterized 253 UPEC in terms of their biofilm-forming capabilities, serotype, and antimicrobial resistance. Three phages were then isolated (vB_EcoP_ACG-C91, vB_EcoM_ACG-C40 and vB_EcoS_ACG-M12) which were able to lyse 80.5% of a subset (42) of the UPEC strains able to form biofilms. Correlation was established between phage sensitivity and specific serotypes of the UPEC strains. The phages' genome sequences were determined and resulted in classification of vB_EcoP_ACG-C91 as a SP6likevirus, vB_EcoM_ACG-C40 as a T4likevirus and vB_EcoS_ACG-M12 as T1likevirus. We assessed the ability of the three phages to eradicate the established biofilm of one of the UPEC strains used in the study. All phages significantly reduced the biofilm within 2-12 h of incubation. © 2012 by the authors; licensee MDPI, Basel, Switzerland.