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Abdelbagi Elfadil,1,2 Ahmad Mandeel Alzahrani,1 Hani Abdullah,1 Hamoud Alsamhan,3– 5 Turki S Abujamel,6,7 Hafsa Elawd Ahmed,8 Asif Jiman-Fatani1 1Department of Clinical Microbiology and Immunology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia; 2Center of Research Excellence for Drug Research and Pharmaceutical Industries, King Abdulaziz University, Jeddah, Saudi Arabia; 3Department of Pharmaceutical Care, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia; 4Department of Infectious Disease Research, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; 5Department of Pharmacy Practice, College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; 6Vaccines and Immunotherapy Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia; 7Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia; 8Department of Medicine, King Abdulaziz University Hospital, Jeddah, Saudi ArabiaCorrespondence: Ahmad Mandeel Alzahrani, Department of Clinical Microbiology and Immunology, Faculty of Medicine, King Abdulaziz University, P.O. Box 80205, Jeddah, 21589, Saudi Arabia, Tel +966 54 095 9911, Email amsalzahrani4@kau.edu.saBackground: While the frequency of methicillin-resistant Staphylococcus aureus (MRSA) continues to rise globally, there is a fear regarding an increase in vancomycin resistance among S. aureus strains. As far back as the 1960s, MRSA was one of the world’s most prevalent antibiotic-resistant bacteria. Among hospitalized patients and community members, MRSA is the cause of a significant number of infections. As a result of its resistance to classical beta-lactam and, in some cases, vancomycin antibiotics, efforts must be made as soon as feasible to find a new approach to fighting MRSA.Purpose: This study is designed to evaluate the antibacterial activity of quinoxaline derivative compound against MRSA in comparison with vancomycin as a reference drug.Methods: Sixty MRSA isolates were subjected to susceptibility testing by broth microdilution method for quinoxaline derivative compound and vancomycin. Each drug’s minimal inhibitory concentration (MIC) was determined and compared.Results: Among the sixty MRSA isolates, most of the quinoxaline derivative compound MIC findings (56.7%) were 4 μg/mL compared to vancomycin MIC values (63.3%) of 4 μg/mL. In comparison, 20% of quinoxaline derivative compound MIC readings were 2 μg/mL, while the vancomycin MIC results were 6.7%. However, the overall proportion of MIC readings at ≤ 2 μg/mL for both antibacterial agents was equal (23.3%). None of the isolates were resistant to vancomycin.Conclusion: This experiment revealed that most MRSA isolates were associated with low MICs (1– 4 μg/mL) for quinoxaline derivative compound. Overall, the susceptibility of the quinoxaline derivative compound signifies a promising efficacy against MRSA and may set a novel treatment approach.Keywords: antibiotic resistance, drug discovery, methicillin-resistant Staphylococcus aureus, minimum inhibitory concentration, quinoxaline, vancomycin

Maja Johanne Søndergaard Knudsen,1,* Ingrid Maria Cecilia Rubin,1,* Andreas Munk Petersen1– 3 1Department of Clinical Microbiology, Copenhagen University Hospital – Amager and Hvidovre, Hvidovre, Denmark; 2Department of Gastroenterology, Copenhagen University Hospital – Amager and Hvidovre, Hvidovre, Denmark; 3Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark*These authors contributed equally to this workCorrespondence: Maja Johanne Søndergaard Knudsen, Email mjsk@dadlnet.dkIntroduction: The aim of this systematic review of randomized clinical trials (RCTs) was to examine the efficacy, safety, and tolerability of vancomycin for treatment of recurrent Clostridioides difficile infection (rCDI).Methods: The PubMed database was searched from inception to August 23, 2022. An initial screening was performed followed by a full-text evaluation of the papers. Inclusion criteria were RCTs investigating vancomycin for treatment of rCDI.Results: A total of six studies and 269 patients were included in the review. Three studies used a fixed dose regimen of vancomycin, one study used pulse regimen, one study used a taper-and-pulse regimen, and one study used a taper-and-pulse regimen for the participants with two or more recurrences. The resolution of infection varied from 19% to 58.3% in five of six studies reporting this as an outcome. Four out of six studies reported new episodes of rCDI as an intervention outcome, in those studies 50– 63% of participants experienced rCDI. Regarding the safety and tolerability of vancomycin treatment for rCDI, one study described several adverse events regarding gastrointestinal discomfort along with fatigue and skin rash. There were no records of serious adverse events in the included studies.Conclusion: While oral vancomycin is mostly safe and well tolerated in the RCTs reviewed here, the efficacy for treating rCDI varies greatly from 19– 58.3%, and 50– 63% of participants experienced new episodes of rCDI.Keywords: Clostridioides difficile, infection, diarrhoea, recurrent, vancomycin

Local prophylaxis with antibiotic-loaded bone cement is a successful method to prevent post-operative infections in patients receiving orthopaedic implants. No comparable method is available for uncemented implants. Therefore, a hydrogel consisting of hyaluronic and polylactic acids was evaluated in a rabbit model for delivery of antimicrobial agents to prevent post-operative infections. In a pilot study, the suitability of the in vivo model was assessed by testing the hydrogel as carrier material for antimicrobial agents.In the main study, the antimicrobial-agent-loaded hydrogel was evaluated for infection prophylaxis. Rabbits received a titanium rod intramedullary in the tibia after contamination with Staphylococcus aureus. The rods were coated with unloaded hydrogel (Gel), hydrogel loaded with 2 % (Van2) or 5 % vancomycin (Van5), bioactive glass (BAG) or N-acetyl-L-cysteine (NAC). To analyse the infection severity after 28 d, histopathological, bacteriological, micro-computed tomographic and haematological analyses were performed. In the pilot study, the Van5 group had less infection (0/6 infected) as compared to the Gel group (5/5, p = 0.000) and the in vivo model was deemed suitable. In the main study, in the Van2 and Van5 groups, the number of infected animals was lower [1/6 (p = 0.006) and 2/6 (p = 0.044) infected, respectively]. In contrast, BAG and NAC groups showed no infection reduction (5/6 both groups, p = 0.997). The hydrogel can be used as a local carrier of vancomycin for prophylaxis of implant-related infections.The present study showed promising results for local delivery of antibacterial agents by hydrogel to prevent implant-related infections.

Background and purpose: Vancomycin is a glycopeptide antibiotic which is the drug of choice against methicillin-resistant Staphylococcus aureus. It has a narrow therapeutic index, and thus therapeutic drug monitoring (TDM), and clinical pharmacokinetic assessment are necessary in order to prevent adverse drug reactions such as nephrotoxicity. In this study, we aimed to develop a simple and validated HPLC method for vancomycin assay in order to establish a TDM center for patients admitted to the ICU of Nemazee Hospital in southern Iran. Experimental approach: In this study, a brief review of different parameters and variables which could affect the sensitivity, selectivity of the validated HPLC method for vancomycin determination were considered. According to the previous studies a simple, fast, and the relatively low-cost method was established for vancomycin determination in plasma samples. Findings/Results: The developed HPLC assay indicated a calibration curve with R-square of > 0.999, acceptable selectivity, the accuracy of 90-105%, CV% of less than 15%, the limit of quantification of 1 μg/mL, and limit of detection of 300 ng/mL. Vancomycin trough level, the area under the curve, renal clearance, the volume of distribution,, and elimination constant were measured in patients using this validated method. Conclusion and implications: Validated method for assay of vancomycin plasma levels was used to quantify vancomycin levels of four patients who were admitted to the ICU of Nemazee Hospital. According to the results, two of these patients showed lower levels than recommended therapeutic purposes while one of them showed a toxic level. According to the results, the TDM assessment of vancomycin is strongly recommended for patients who are hospitalized in ICU.

In this study which was conducted in Alzahra University Hospital (Isfahan, I.R. Iran), the therapeutic drug monitoring of vancomycin focused on determining area under the concentration-time curve at dosing interval (τ) at steady state/minimum inhibitory concentration (AUCτ/MIC) was carried out in chronic kidney disease (CKD) patients. The study population was selected from patients with the history of CKD (stages 3 or 4) treated by intravenous vancomycin. To determine vancomycin AUCτ, blood samples were taken at four different occasions (trough-1, peak, random, trough-2) between the fourth and fifth doses of vancomycin. Drug concentration was determined by fluorescence polarization technique, and the E-TEST technique was used to determine the MIC. Nineteen patients were included. For 8 (42%), 7 (37%), and 4 (21%) patients, trough concentration levels were found to be less than 10 mg/L, 10-20 mg/L, and more than 20 mg/L, respectively. The mean value of AUCτ for studied patients was 470.7 ± 228.3 mg.h/L and the mean MIC values was 1.04 ± 0.43 mg/L. Ten patients (53%) and 9 patients (47%) had the AUCτ/MIC ratios above 400 and below 400, respectively, with the average of 519.4 ± 391.3 h. Vancomycin dosing based on patient glomerular filtration rate (GFR), as a traditional method, is not accurate enough to gain the most desired vancomycin concentration in patients with decreased or changing kidney function. Measuring drug concentration and observing its therapeutic effects accordingly is inevitable in susceptible populations receiving vital drugs such as vancomycin.

Introducción La infección posquirúrgica en la columna lumbar es desafortunadamente común, multifactorial y una complicación potencialmente devastadora, que se asocia a un incremento de la morbilidad y la necesidad de futuras cirugías, y en última instancia, puede ser mortal. Con la intención de disminuir la morbilidad posquirúrgica, la medicación y los días de internación, comenzamos a utilizar aloinjerto fresco congelado de cabeza femoral de donantes vivos, en la artrodesis lumbar corta. El objetivo de este estudio fue comparar el índice de infección en la artrodesis lumbar corta en pacientes con aloinjerto fresco congelado y con autoinjerto. Materiales y Métodos Estudio retrospectivo de 153 pacientes divididos en dos grupos: grupo A: 84 pacientes con autoinjerto de cresta ilíaca y grupo B: 69 pacientes con aloinjerto fresco congelado, desde marzo de 2009 hasta enero 2014, sometidos cirugía instrumentada de fusión espinal lumbar posterolateral. Resultados Tres de los 153 pacientes operados se perdieron en el seguimiento (2 del grupo A y 1 del grupo B) y la muestra incluyó 150 pacientes (82 del grupo A y 68 del grupo B). Se produjeron tres infecciones por Staphylococcus aureus sensible a la meticilina, todas en el grupo A (4,5%). Ningún paciente de los dos grupos necesitó transfusión. Conclusiones El uso de aloinjerto fresco congelado en las cirugías de columna lumbar posterolateral de causa degenerativa no se asocia a un aumento en la tasa de infección. Consideramos que el aloinjerto fresco congelado es una excelente alternativa, porque disminuye el tiempo quirúrgico y de hospitalización.

Background and Objectives: With increasing use of vancomycin antibiotic, vancomycin-resistant Enterococcus (VRE), is considered as a major cause of nosocomial infections. In this study, the pattern of antibiotic resistance and prevalence of vancomycin resistant enterococcus faecium, were investigated. Methods: In this descriptive study, after isolation and identification of 690 strains of Enterococcus from clinical and environmental specimens in different wards of Lorestan hospitals, the pattern of antibiotic resistance of these strains to common antibiotics, were investigated using dick diffusion and agar dilution methods. The antibiotic resistance genes (vanA, vanB, pbp5, pbpZ, and blaZ), were detected by PCR technique. Results: Among 690 studied Enterococcus isolates, 439 isolates (64%), were Enterococcous feacalis, 228 isolates (33%) Enterococcous faecium, and 23 isolates (3%), were other Enterococci. Based on the antibiogram test by disk diffusion method, the highest resistance was to penicillin with 446 isolates (67%) and the lowest resistance was to linezolid with 0 isolate (0%). In the evaluation of resistance using minimum inhibitory concentration (MIC), the antibiotic resistance rate was obtained to be 58% for ampicillin, 59% for penicillin, and 23% for vancomycin. Resistance genes, including vanA, vanB, pbp5, pbpZ, and blaZ, were detected in 84 (72%), 26 (22%), 87 (74%), 63 (53%), and 0 (0%) of the isolates. Conclusion: Based on the results of this study, resistance to vancomycin in Enterococcus strains is also found in Lorestan province like other parts of the world. Therefore, application of control and preventive measures are necessary. Furthermore, to prescribe appropriate antibiotic, it is recommended to perform antibiogram test for each patient before the treatment.

Toxic epidermal necrolysis is a potentially life threatening dermatologic disorder characterized by widespread erythema, necrosis and bullas, detachment of epidermis and mucous membrane resulting in exfoliation, possible sepsis and even death. This is the first case report in Nepal of toxic epidermal necrolysis in puerperium. We present a case of a 28-years-old, P1L1 on fourth postoperative day following emergency lower segment caesarean section for cephalopelvic disproportion in latent phase of labour with uneventful antenatal period. She developed fever followed by rashes all over the body with hypotension, tachypnea and shortness of breath. Initially, she was diagnosed as a case of septic shock and transferred to intensive care unit from postnatal ward. She was managed with broad spectrum antibiotics and inotropes. Later on, it was found to be the case of Toxic epidermal necrolysis and managed with vancomycin and corticosteroids under the supervision of gynecology, dermatology and medicine team.

Introduction: In recent years, enterococci have become important nosocomial pathogens. Indiscriminate use of antibiotics, prolonged hospital stay, severity of illness and immunosuppression are responsible for nosocomial acquisition of drug resistant enterococci. Aim: To determine the prevalence and anti-microbial resistance pattern of enterococci in blood samples. Materials and Methods: This retrospective study was carried out in the Department of Microbiology, Shri M. P. Shah Government Medical College, Jamnagar, Gujarat from January 2014 to June 2014. A total of 540 blood samples were tested. The isolates were identified by grams staining, colony characteristics, catalase test, black color on bile esculin agar and tolerance to 6.5% NaCl. Antibiotic susceptibility test was done by Kirby-Bauer disc diffusion method for Penicillin (10 units), Azithromycin (30 mcg), Gentamicin (10 mcg), Ciprofloxacin (5 mcg), Tetracycline (30 mcg), Linezolid (30 mcg) and Vancomycin (30 mcg). Results: The prevalence rate of enterococci in blood samples was 6.48%. Antibiotic susceptibility tests showed high level resistance to commonly used antibiotics like Penicillin (100%), Azithromycin (85.71%), Gentamicin (100%), Ciprofloxacin (82.85%) & Tetracycline (77.14%) and spread to newer drugs like Linezolid (5.71%) and Vancomycin (8.57%). Conclusion: We conclude that enterococcal strains with high level of resistance to penicillin aminoglycosides and fluoroquinolones group of drugs. So there is urgent need for more rational and restricted use of antimicrobials and continuous monitoring, in order to minimize the selection and to prevent hospital spread of such strains.

As the field of interventional pain management (IPM) grows, the risk of surgical site infections (SSIs) is increasing. SSI is defined as an infection of the incision or organ/space that occurs within one month after operation or three months after implantation. It is also common to find patients with suspected infection in an outpatient clinic. The most frequent IPM procedures are performed in the spine. Even though primary pyogenic spondylodiscitis via hematogenous spread is the most common type among spinal infections, secondary spinal infections from direct inoculation should be monitored after IPM procedures. Various preventive guidelines for SSI have been published. Cefazolin, followed by vancomycin, is the most commonly used surgical antibiotic prophylaxis in IPM. Diagnosis of SSI is confirmed by purulent discharge, isolation of causative organisms, pain/tenderness, swelling, redness, or heat, or diagnosis by a surgeon or attending physician. Inflammatory markers include traditional (C-reactive protein, erythrocyte sedimentation rate, and white blood cell count) and novel (procalcitonin, serum amyloid A, and presepsin) markers. Empirical antibiotic therapy is defined as the initial administration of antibiotics within at least 24 hours prior to the results of blood culture and antibiotic susceptibility testing. Definitive antibiotic therapy is initiated based on the above culture and testing. Combination antibiotic therapy for multidrug-resistant Gram-negative bacteria infections appears to be superior to monotherapy in mortality with the risk of increasing antibiotic resistance rates. The never-ending war between bacterial resistance and new antibiotics is continuing. This article reviews prevention, diagnosis, and treatment of infection in pain medicine.

Background: CONS are the major nosocomial pathogens. These undoubtedly need more recognition. Susceptibility testing should be done on any isolate considered to be a pathogen as multidrug resistance is common among them. Aims: · Isolation, identification and speciation of CONS. · To identify their pathogenicity markers, antibiogram with special emphasis on methicillin resistance. Settings and Design: This cross sectional study was conducted at a government tertiary healthcare teaching center for a period of one year. Material and Methods: Totally 2361 clinical specimens were processed. All specimens were subjected to gram's staining and cultured for isolation. The organisms were identified and speciated by standard biochemical reactions. Antibiogram was formed by Kirby-Bauer disk diffusion method. Statistical Analysis: The data entry was carried out using Microsoft office Excel worksheet and was statistically analyzed by WINKS SDA6 software. Results: A total of 150 strains of CONS were isolated from 2361 clinical specimens. Majority of CONS were isolated from urine (44.67%), followed by exudates (33.33%), and blood (22%). Most common species isolated was S.epidermidis (50.67%), followed by S.saprophyticus (22%) and S.hemolyticus (18%). Slime production (38.67%) and methicillin resistance (54.67%) was detected respectively. Vancomycin and amikacin were the most effective antibiotics. Conclusion: S.epidermidis can cause a number of human infections and should no longer be considered as a harmless commensal. S.saprophyticus is proven pathogen in man. The antibiotic resistance pattern in CONS is a great threat to clinicians combating such infections. [ABSTRACT FROM AUTHOR]

x. vilanova, a. manero, m. cerdà-cuéllar and a.r. blanch. 2003. The changes in structure and composition of faecal coliforms and enterococcal populations in sewage from different treatment plants, and the elimination of vancomycin- and erythromycin-resistant enterococci (VRE and ERE, respectively) in these treatment plants was analysed to determine any selective reduction. Faecal coliforms, enterococci, VRE, ERE and spores of sulphite-reducing bacteria were enumerated using standard methods. Samples were enriched where necessary in order to isolate antibiotic resistant strains. The structure and composition of these bacterial populations were determined by biochemical fingerprinting and clustering analysis. High diversity and similarity indexes were detected among all the bacterial populations in raw and treated sewage, independently of their origin and the treatment processes employed. Antibiotic resistant strains were detected in all sewage tested and no selective reduction was observed. The faecal coliforms and enterococci populations did not differ in the sewage samples studied. The vancomycin and erythromycin resistances of the enterococcal populations were similar in the sewage samples. Resistance to both antibiotics persisted after the treatment process independently of raw sewage flow, faecal origin or size of the human population contributing to sewage. However, sewage of mixed origin (human and animal) presented a lower similarity index for the two bacterial populations compared with that of the other human sewage analysed. Although a significant reduction in bacterial populations was observed, the persistence of VRE and ERE strains in the same proportions in sewage suggests that there is no selective elimination of bacterial populations during the treatment processes. The ability of antibiotic resistance strains to survive sewage treatment systems should be considered in certain water reuse programmes. [ABSTRACT FROM AUTHOR]

Background: Current guidelines recommend the use of vancomycin for the initial treatment of Clostridioides difficile Infection (CDI). Cadazolid, an experimental drug, has been utilized and compared in several studies with varying results., Methods: A systematic literature search was performed using electronic databases [Medline, Google Scholar and Cochrane] for eligible studies. Randomized Controlled Trials (RCTs) comparing cadazolid with vancomycin for CDI treatment were included. Demographic variables and outcomes (CDI resolution, CDI recurrence, and adverse events) were collected. The primary outcome was clinical cure rate defined as the resolution of CDI at the end of a 10-day course., Results: Two studies with three RCTs met the inclusion criteria with a total of 1283 patients with CDI who received either cadazolid 250 mg twice daily (624 patients) or vancomycin 125 mg four times daily (659 patients). Clinical cure rate at the end of the treatment was not statistically significant (pooled OR= 0.82; 95% CI = 0.61 to 1.11; p=0.20; I2= 0%). Sustained clinical response at clinical follow-up was also not significantly different (pooled OR = 1.14; 95% CI = 0.91 to 1.43; p=0.27; I2 = 0 %). Cadazolid had a lower recurrence rate than vancomycin (pooled OR = 0.71; 95% CI = 0.52 to 0.98; p=0.04; I2 = 13 %)., Conclusion: Cadazolid is non-inferior to vancomycin and offers a promising alternative for the treatment of CDI. More studies including RCTs and longitudinal studies with large and diverse patient population are needed to further confirm this. Furthermore, cadazolid should also be compared with fidaxomicin in a head-to-head trial to evaluate their efficacy for CDI., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Background: The use of indwelling Central Venous Access Devices (CVADs) is associated with the development of bloodstream infections. When CVADs are used to administer systemic antibiotics, particularly second- or higher-generation cephalosporins, there is a particular risk of developing Clostridium difficile infection. The overall bloodstream infection rate is estimated to be around 1.74 per 1000 Central Venous Catheter (CVC)-days., Objective: We hypothesised that daily oral administration of the anion-binding resin colestyramine (cholestyramine) would help prevent infections in those receiving intravenous antibiotic treatment via CVADs., Method: A small case series is described of adult patients who received regular intravenous antibiotic treatment (ceftriaxone, daptomycin or vancomycin) for up to 40 weeks via indwelling CVADs; this represented a total of 357 CVC-days. In addition to following well-established strategies to prevent C. difficile infection, during the course of the intravenous antibiotic treatment the patients also received daily oral supplementation with 4 g colestyramine., Results: There were no untoward infectious events. In particular, none of the patients developed any symptoms or signs of C. difficile infection, whereas approximately one case of a bloodstream infection would have been expected., Conclusion: It is suggested that oral colestyramine supplementation may help prevent such infection through its ability to bind C. difficile toxin A (TcdA) and C. difficile toxin B (TcdB); these toxins are able to gain entry into host cells through receptor-mediated endocytosis, while anti-toxin antibody responses to TcdA and TcdB have been shown to induce protection against C. difficile infection sequelae., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Implementation of a guideline for the management of hospitalized adults with uncomplicated skin and soft-tissue infections may decrease unnecessary antibiotic use. For cellulitis, treatment with vancomycin and broad-spectrum antibiotics decreased significantly. For cutaneous abscess, treatment with broad-spectrum antibiotics decreased significantly. There were no differences in rates of treatment failure, recurrence, or adverse events.

Vancomycin is an increasingly important option for the treatment of Clostridium difficile infection, but economic barriers to its use remain significant in the outpatient setting. Generic vancomycin capsules are still inexplicably expensive and not universally covered by insurers. This report highlights the potential adverse consequences of cost-related nonadherence to vancomycin therapy and the challenges that clinicians face when prescribing oral vancomycin.