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Fonton P, Hassoun-Kheir N, Harbarth S. Epidemiology of Citrobacter spp. infections among hospitalized patients: a systematic review and meta-analysis. BMC Infect Dis 2024; 24:662. [PMID: 38956542 PMCID: PMC11221093 DOI: 10.1186/s12879-024-09575-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 06/27/2024] [Indexed: 07/04/2024] Open
Abstract
BACKGROUND Infections due to Citrobacter species are increasingly observed in hospitalized patients and are often multidrug-resistant. Yet, the magnitude and burden of Citrobacter spp. resistance in the hospital setting have not been reported. We aimed to evaluate the epidemiology of Citrobacter spp. infections among hospitalized patients, their main resistance patterns and Citrobacter spp. involvement in hospital outbreaks. METHODS We conducted a systematic review and meta-analysis of published literature (PROSPERO registration Jan-2023, CRD42023390084). We searched Embase, Medline and grey literature for studies on hospitalized patients diagnosed with Citrobacter spp. infections, and nosocomial outbreaks due to Citrobacter spp. published during the years 2000-2022. We included observational, interventional, surveillance studies and outbreak reports. Outcomes of interest were the frequency of Citrobacter spp. infections among hospitalized patients and 3rd generation cephalosporin and/or carbapenem resistance percentages in these infections. We used random-effects models to generate pooled outcome estimates and evaluated risk of bias and quality of reporting of outbreaks. RESULTS We screened 1609 deduplicated publications, assessed 148 full-texts, and included 41 studies (15 observational, 13 surveillance and 13 outbreak studies). Citrobacter spp. urinary tract- and bloodstream infections were most frequently reported, with Citrobacter freundii being the main causative species. Hospital-acquired infection occurred in 85% (838/990) of hospitalized patients with Citrobacter infection. After 2010, an increasing number of patients with Citrobacter spp. infections was reported in observational studies. Pooled frequency estimates for Citrobacter spp. infections could not be generated due to lack of data. The pooled prevalence of ESBL and carbapenemase producers among Citrobacter isolates were 22% (95%CI 4-50%, 7 studies) and 18% (95%CI 0-63%, 4 studies), respectively. An increased frequency of reported Citrobacter outbreaks was observed after 2016, with an infection/colonization ratio of 1:3 and a case-fatality ratio of 7% (6/89 patients). Common outbreak sources were sinks, toilets, contaminated food and injection material. Implemented preventive measures included environmental cleaning, isolation of positive patients and reinforcement of hand hygiene. Only seven out of 13 outbreaks (54%) were definitively controlled. CONCLUSION This review highlights the clinical importance of endemic and epidemic Citrobacter spp. in healthcare settings. As an emerging, multidrug‑resistant nosocomial pathogen it requires heightened awareness and further dedicated surveillance efforts.
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Affiliation(s)
- Pérince Fonton
- Infection Control Program, Geneva University Hospitals and Faculty of Medicine, WHO Collaborating Center, Rue Gabrielle-Perret-Gentil 4, CH-1205, Geneva, Switzerland
| | - Nasreen Hassoun-Kheir
- Infection Control Program, Geneva University Hospitals and Faculty of Medicine, WHO Collaborating Center, Rue Gabrielle-Perret-Gentil 4, CH-1205, Geneva, Switzerland
| | - Stephan Harbarth
- Infection Control Program, Geneva University Hospitals and Faculty of Medicine, WHO Collaborating Center, Rue Gabrielle-Perret-Gentil 4, CH-1205, Geneva, Switzerland.
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Kao PHN, Ch'ng JH, Chong KKL, Stocks CJ, Wong SL, Kline KA. Enterococcus faecalis suppresses Staphylococcus aureus-induced NETosis and promotes bacterial survival in polymicrobial infections. FEMS MICROBES 2023; 4:xtad019. [PMID: 37900578 PMCID: PMC10608956 DOI: 10.1093/femsmc/xtad019] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 09/09/2023] [Accepted: 10/10/2023] [Indexed: 10/31/2023] Open
Abstract
Enterococcus faecalis is an opportunistic pathogen that is frequently co-isolated with other microbes in wound infections. While E. faecalis can subvert the host immune response and promote the survival of other microbes via interbacterial synergy, little is known about the impact of E. faecalis-mediated immune suppression on co-infecting microbes. We hypothesized that E. faecalis can attenuate neutrophil-mediated responses in mixed-species infection to promote survival of the co-infecting species. We found that neutrophils control E. faecalis infection via phagocytosis, ROS production, and degranulation of azurophilic granules, but it does not trigger neutrophil extracellular trap formation (NETosis). However, E. faecalis attenuates Staphylococcus aureus-induced NETosis in polymicrobial infection by interfering with citrullination of histone, suggesting E. faecalis can actively suppress NETosis in neutrophils. Residual S. aureus-induced NETs that remain during co-infection do not impact E. faecalis, further suggesting that E. faecalis possess mechanisms to evade or survive NET-associated killing mechanisms. E. faecalis-driven reduction of NETosis corresponds with higher S. aureus survival, indicating that this immunomodulating effect could be a risk factor in promoting the virulence polymicrobial infection. These findings highlight the complexity of the immune response to polymicrobial infections and suggest that attenuated pathogen-specific immune responses contribute to pathogenesis in the mammalian host.
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Affiliation(s)
- Patrick Hsien-Neng Kao
- School of Biological Sciences, Nanyang Technological University, Singapore 637551
- Singapore Centre for Environmental Life Sciences Engineering, Nanyang Technological University, Singapore 637551
| | - Jun-Hong Ch'ng
- Department of Microbiology and Immunology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117545
- Singapore Centre for Environmental Life Sciences Engineering, National University of Singapore, Singapore 117456
- Department of Surgery Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597
- Infectious Disease Translational Research Program, National University Health System, Singapore 117545
| | - Kelvin K L Chong
- Singapore Centre for Environmental Life Sciences Engineering, Nanyang Technological University, Singapore 637551
| | - Claudia J Stocks
- Singapore Centre for Environmental Life Sciences Engineering, Nanyang Technological University, Singapore 637551
| | - Siu Ling Wong
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 636921
- Tan Tock Seng Hospital, National Healthcare Group, Singapore 308433
| | - Kimberly A Kline
- School of Biological Sciences, Nanyang Technological University, Singapore 637551
- Singapore Centre for Environmental Life Sciences Engineering, Nanyang Technological University, Singapore 637551
- Department of Microbiology and Molecular Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland 1211
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Aguirre-Sánchez JR, Quiñones B, Ortiz-Muñoz JA, Prieto-Alvarado R, Vega-López IF, Martínez-Urtaza J, Lee BG, Chaidez C. Comparative Genomic Analyses of Virulence and Antimicrobial Resistance in Citrobacter werkmanii, an Emerging Opportunistic Pathogen. Microorganisms 2023; 11:2114. [PMID: 37630674 PMCID: PMC10457828 DOI: 10.3390/microorganisms11082114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 08/11/2023] [Accepted: 08/13/2023] [Indexed: 08/27/2023] Open
Abstract
Citrobacter werkmanii is an emerging and opportunistic human pathogen found in developing countries and is a causative agent of wound, urinary tract, and blood infections. The present study conducted comparative genomic analyses of a C. werkmanii strain collection from diverse geographical locations and sources to identify the relevant virulence and antimicrobial resistance genes. Pangenome analyses divided the examined C. werkmanii strains into five distinct clades; the subsequent classification identified genes with functional roles in carbohydrate and general metabolism for the core genome and genes with a role in secretion, adherence, and the mobilome for the shell and cloud genomes. A maximum-likelihood phylogenetic tree with a heatmap, showing the virulence and antimicrobial genes' presence or absence, demonstrated the presence of genes with functional roles in secretion systems, adherence, enterobactin, and siderophore among the strains belonging to the different clades. C. werkmanii strains in clade V, predominantly from clinical sources, harbored genes implicated in type II and type Vb secretion systems as well as multidrug resistance to aminoglycoside, beta-lactamase, fluoroquinolone, phenicol, trimethoprim, macrolides, sulfonamide, and tetracycline. In summary, these comparative genomic analyses have demonstrated highly pathogenic and multidrug-resistant genetic profiles in C. werkmanii strains, indicating a virulence potential for this commensal and opportunistic human pathogen.
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Affiliation(s)
- José R. Aguirre-Sánchez
- Laboratorio Nacional para la Investigación en Inocuidad Alimentaria, Centro de Investigación en Alimentación y Desarrollo A.C. (CIAD), Coordinación Regional Culiacán, Culiacan 80110, Mexico;
| | - Beatriz Quiñones
- Produce Safety and Microbiology Research Unit, Western Regional Research Center, Agricultural Research Service, U.S. Department of Agriculture, Albany, CA 94710, USA; (B.Q.); (B.G.L.)
| | - José A. Ortiz-Muñoz
- Parque de Innovación Tecnológica de la Universidad Autónoma de Sinaloa, Culiacan 80040, Mexico; (J.A.O.-M.); (R.P.-A.); (I.F.V.-L.)
| | - Rogelio Prieto-Alvarado
- Parque de Innovación Tecnológica de la Universidad Autónoma de Sinaloa, Culiacan 80040, Mexico; (J.A.O.-M.); (R.P.-A.); (I.F.V.-L.)
| | - Inés F. Vega-López
- Parque de Innovación Tecnológica de la Universidad Autónoma de Sinaloa, Culiacan 80040, Mexico; (J.A.O.-M.); (R.P.-A.); (I.F.V.-L.)
| | - Jaime Martínez-Urtaza
- Departament de Genètica i de Microbiologia, Universitat Autờnoma de Barcelona, 08193 Bellaterra, Spain;
| | - Bertram G. Lee
- Produce Safety and Microbiology Research Unit, Western Regional Research Center, Agricultural Research Service, U.S. Department of Agriculture, Albany, CA 94710, USA; (B.Q.); (B.G.L.)
| | - Cristóbal Chaidez
- Laboratorio Nacional para la Investigación en Inocuidad Alimentaria, Centro de Investigación en Alimentación y Desarrollo A.C. (CIAD), Coordinación Regional Culiacán, Culiacan 80110, Mexico;
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Abid Khan RM, Dodani SK, Nadeem A, Jamil S, Zafar MN. Bacterial isolates and their antimicrobial susceptibility profile of superficial and deep-seated skin and soft tissue infections. ASIAN BIOMED 2023; 17:55-63. [PMID: 37719324 PMCID: PMC10505063 DOI: 10.2478/abm-2023-0045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
Background Skin and soft tissue infections (SSTIs) are caused by microbial invasion of healthy or damaged skin. SSTIs are difficult to manage and contribute to chronicity and emergence of antimicrobial resistance. Objectives To ascertain the prevalence of bacteria causing SSTIs and their antimicrobial susceptibility patterns. Methods A prospective study between November 2020 and May 2021. A total of 447 samples from SSTIs were analyzed. Results A total of 347 samples revealed mono-bacterial growth, of which 67% were male. SSTIs are common among patients aged 21-50 years with the dominance (78%) of gram-negative rods (GNRs). Escherichia coli (36%), Klebsiella spp. (22%), Staphylococcus aureus (16%), and Pseudomonas aeruginosa (11%) were predominant organisms. GNRs were highly resistant (>65%) to ciprofloxacin and trimethoprim-sulfamethoxazole. For injectable antibiotics, the highest resistance was determined against ceftriaxone, and the least resistance was determined against amikacin. Resistance against carbapenem was the highest among P. aeruginosa (53%) and Klebsiella spp. (32%). S. aureus showed the highest resistance against ciprofloxacin, and the least resistance was determined against clindamycin. Of 57 S. aureus isolates, 86% isolates were methicillin-resistant Staphylococcus aureus (MRSA). All isolates of P. aeruginosa and S. aureus were sensitive to polymyxin B and vancomycin, respectively. The prevalence of multidrug-resistant E. coli and Klebsiella spp. was higher among deep-seated SSTIs (dSSTIs). Conclusions The predominant etiology of SSTIs is GNR. Currently, there is very high resistance against oral antibiotics. Antimicrobial resistance against carbapenem has also increased. Moreover, there is a high frequency of MRSA. MDR E. coli and Klebsiella spp. isolates are frequently involved in dSSTIs.
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Affiliation(s)
- Rao Muhammad Abid Khan
- Department of Microbiology, Sindh Institute of Urology and Transplantation, Karachi74200, Pakistan
| | - Sunil Kumar Dodani
- Department of Infectious Diseases, Sindh Institute of Urology and Transplantation, Karachi74200, Pakistan
| | - Ali Nadeem
- Department of Microbiology, Sindh Institute of Urology and Transplantation, Karachi74200, Pakistan
| | - Sana Jamil
- Department of Microbiology, Sindh Institute of Urology and Transplantation, Karachi74200, Pakistan
| | - Mirza Naqi Zafar
- Department of Biochemistry, Sindh Institute of Urology and Transplantation, Karachi74200, Pakistan
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Yimana M, Tesfaye J. Isolation, identification and antimicrobial profile of methicillin‐resistant
Staphylococcus aureus
from bovine mastitis in and around Adama, Central Ethiopia. Vet Med Sci 2022; 8:2576-2584. [DOI: 10.1002/vms3.902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Muhabaw Yimana
- Addis Ababa University College of Veterinary Medicine, Department of Veterinary public health Debrezeit Ethiopia
- Sekota Agricultural Bureau, Animal health case team Sekota Ethiopia
| | - Juhar Tesfaye
- Ethiopian Institute of Agricultural Research Werer Agricultural Research Center, Animal health research department Werer Ethiopia
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Bendre RS, Patil RD, Patil PN, Patel HM, Sancheti RS. Synthesis and characterization of new Schiff-bases as Methicillin resistant Staphylococcus aureus (MRSA) inhibitors. J Mol Struct 2022. [DOI: 10.1016/j.molstruc.2021.132152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Luisetto M, Legrand A, Vandromme E, Boulares S, Delahaut O. Morel-Lavallée lesion associated with atypical skin damage: a case report. Acta Orthop Belg 2021; 87:751-754. [PMID: 35172443 DOI: 10.52628/87.4.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A Morel-Lavallée lesion is a post-traumatic, soft tissue lesion that is little known and for which there is no standard treatment. This report describes the case of a 51-year-old man who presented with a large Morel-Lavallée lesion on the left calf that was not diagnosed on two visits to the emergency department. Given the deteriorating condition of the skin, we performed surgical drainage of the effusion because the skin was showing signs of major damage. Complications occurred following surgery, with cellulitis in the lower limb caused by Citrobacter Koseri, a gram-negative bacillus that is rarely implicated in soft tissue infections, and wound dehiscence. The purpose of our article is to present the difficulty involved in choosing the right treatment from among the many proposed in the literature, and to inform any practitioner working in an emergency setting about the existence of this often overlooked condition.
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Topaz M, Athamna A, Ashkenazi I, Shpitz B, Freimann S. In-vitro model for bacterial growth inhibition of compartmentalized infection treated by an ultra-high concentration of antibiotics. PLoS One 2021; 16:e0252724. [PMID: 34101731 PMCID: PMC8186763 DOI: 10.1371/journal.pone.0252724] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 05/20/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Pseudomonas aeruginosa (P. aeruginosa), Escherichia coli (E. coli), and Staphylococcus aureus (S. aureus) are common pathogens encountered in infected cardiovascular-implantable electronic device (CIED). Continuous, in-situ targeted, ultra-high concentration antibiotic (CITA) treatment is a novel antibiotic treatment approach for localized infections. CITA provides sufficient local antibiotic concentrations to heavily infected cavities while avoiding systemic toxicity. AIM In-vitro confirmation of the efficacy of the CITA treatment approach in simulated compartmentalized infections. MATERIALS AND METHODS A rapid automated bacterial culture analyzing system) Uro4 HB&L™ (was applied to compare the efficacy of selected antibiotics at a standard minimal inhibitory concentration (1MIC), 4MIC, and CITA at 103MIC, for growth inhibition of high bacterial loads (106 colony-forming-units/ml) of ATCC strains of P. aeruginosa, E. coli, and S. aureus. RESULTS The addition of gentamicin and amikacin at 1MIC concentrations only temporarily inhibited the exponential growth of E. coli and P. aeruginosa. 4MIC level extended the delay of exponential bacterial growth. Increasing concentrations of vancomycin similarly temporarily delayed S. aureus growth. All tested antibiotics at CITA of 103MIC totally inhibited the exponential growth of the tested bacteria through 72 hours of exposure. (P<0.001). CONCLUSION In this in-vitro model, CITA at 103MIC effectively inhibited exponential bacterial growth of high loads of P. aeruginosa, E. coli, and S. aureus. This model offers preliminary laboratory support for the benefit of the in-situ antibiotic treatment, providing ultra-high concentrations directly at the compartmentalized infection site, not achievable by the conventional intravenous and oral routes.
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Affiliation(s)
- Moris Topaz
- Clinical Microbiology Laboratory, Hillel Yaffe Medical Center, Hadera, Israel
| | - Abed Athamna
- Clinical Microbiology Laboratory, Hillel Yaffe Medical Center, Hadera, Israel
| | | | - Baruch Shpitz
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Sarit Freimann
- Clinical Microbiology Laboratory, Hillel Yaffe Medical Center, Hadera, Israel
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Tesfaye K, Gizaw Z, Haile AF. Prevalence of Mastitis and Phenotypic Characterization of Methicillin-Resistant Staphylococcus aureus in Lactating Dairy Cows of Selected Dairy Farms in and Around Adama Town, Central Ethiopia. ENVIRONMENTAL HEALTH INSIGHTS 2021; 15:11786302211021297. [PMID: 34103935 PMCID: PMC8165823 DOI: 10.1177/11786302211021297] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 05/11/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND The emergence of Methicillin resistant Staphylococcus aureus (MRSA) poses a serious public health threat. Strains of Staphylococcus aureus resistant to β-lactam antibiotics are known as MRSA. MRSA has gained attention as community pathogen. MRSA has been increasingly reported as emerging problem in veterinary medicine. However, little is known in Ethiopia. This study was, therefore, conducted to identify MRSA, to determine its drug susceptibility patterns, and mastitis infection in dairy cattle in and around Adama town, Central Ethiopia. METHODS A cross-sectional study was conducted to estimate the occurrence of MRSA in mastitic dairy cows in and around Adama town, central Ethiopia. A total of 384 lactating cows were included from the conveniently selected dairy farms in the study area. Approximately 10 ml of milk was aseptically collected from clinical and subclinical mastitic cows into sterile universal bottles after discarding the first 3 milking streams. Then, Staphylococcus aureus was isolated using the conventional bacteriological procedure. Resistance to methicillin was detected using the Kirby-Bauer disc diffusion antibiotic susceptibility method. Oxacillin disc was used to detect methicillin resistant Staphylococcus aureus strains. Antimicrobial susceptibility test was conducted against MRSA strains using streptomycin (S, 10 µg), amoxicillin (Am, 25 µg), kanamycin (k, 30 µg), nalidixic acid (NA, 30 µg), oxytetracycline (OT, 30 µg) sulphonamide (S, 300 µg) and ceftriazole (CRO, 30 µg). RESULTS The study found that the prevalence of mastitis was 121(31.5%). Among this 37(30.6%) were clinical mastitis and 84 (69.4%) of them were sub-clinical mastitis. Of 121 mastitis cases, Staphylococcus aureus was isolated in 37 (30.6%) of mastitic cow milk samples. The prevalence of mastitis was significantly affected by breed, age, floor type and hygienic status of the milkers (P < .05). Moreover, 32.4% of Staphylococcus aureus isolates were resistant to oxacillin. A total of 75% percent of MRSA isolates were resistant to amoxicillin, 66.7% were resistant to oxytetracycline, and 50% were resistant to sulphonamide. However, 75% of MRSA isolates were susceptible to kanamycin, 58.3% were susceptible to streptomycin, and 50% were susceptible to nalidixic acid. CONCLUSION The study revealed that relatively high number of strains are resistant to the antibiotics commonly used in the therapeutic protocol of many human and animal infections. Therefore, antimicrobial susceptibility test should be carried out at a regular basis and proper hygienic practices should be introduced at farm level. Creating public awareness about transmission, prevention and control of MRSA should also be considered.
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Affiliation(s)
- Kaleab Tesfaye
- College of Veterinary Medicine and Agriculture, Addis Ababa University, Addis Ababa, Ethiopia
| | - Zemichael Gizaw
- Department of Environmental and Occupational Health and Safety, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Aklilu Feleke Haile
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
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Yao W, Kuan EC, Grundfest WS, St John MA. Safety of laser-generated shockwave treatment for bacterial biofilms in a cutaneous rodent model. Lasers Med Sci 2020; 36:1403-1410. [PMID: 33106990 DOI: 10.1007/s10103-020-03171-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 10/21/2020] [Indexed: 10/23/2022]
Abstract
Bacterial biofilms are often found in chronically infected wounds. Biofilms protect bacteria from antibiotics and impair wound healing. Surgical debridement is often needed to remove the biofilm from an infected wound. Laser-generated shockwave (LGS) treatment is a novel tissue-sparing treatment for biofilm disruption. Previous studies have demonstrated that LGS is effective in disrupting biofilms in vitro. In this study, we aim to determine the safety threshold of the LGS technology in an in vivo rodent model. To understand the in vivo effects of LGS on healthy cutaneous tissue, the de-haired dorsal skin of Sprague-Dawley rats were treated with LGS at three different peak pressures (118, 296, 227 MPa). These pressures were generated using a 1064 nm Nd/YAG laser (pulse duration 5 ns and laser fluence of 777.9 mJ) with laser spot size diameters of 2.2, 3.0, and 4.2 mm, respectively. Following treatment, the animals were observed for 72 h, and a small subset was euthanized at 1-h, 24-h, and 72-h post-treatment and assessed for tissue injury or inflammation under histology. Each treatment group consisted of 9 rats (n = 3/time point for 1-h, 24-h, 72-h post-treatment). An additional 4 control (untreated) rats were included in the analysis, for a total of 31 animals. Gross injuries occurred in 21 (77%) animals and consisted of minor erythema, with prevalence positively correlated with peak pressure (p < 0.05). Of injuries under gross observation, 94% resolved within 24 h. Under histological analysis, the injuries and tissue inflammation were found to be localized to the epidermis and superficial dermis. LGS appears to be well tolerated by cutaneous tissue for the laser energy settings shown to be effective against bacterial biofilm in vitro. All injuries incurred, at even the highest peak pressures, were clinically mild and resolved within 1 day. This lends further support to the overall safety of LGS and serves to translate LGS towards in vivo efficacy studies.
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Affiliation(s)
- William Yao
- Department of Bioengineering, University of California, Los Angeles (UCLA) Henry Samueli School of Engineering and Applied Science, Los Angeles, CA, USA
| | - Edward C Kuan
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, CA, 92868, USA.
| | - Warren S Grundfest
- Department of Bioengineering, University of California, Los Angeles (UCLA) Henry Samueli School of Engineering and Applied Science, Los Angeles, CA, USA
| | - Maie A St John
- Department of Head and Neck Surgery, UCLA Medical Center, Los Angeles, CA, USA.,UCLA Head and Neck Cancer Program, Los Angeles, CA, USA
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Sarwar A, Butt MA, Hafeez S, Danish MZ. Rapid emergence of antibacterial resistance by bacterial isolates from patients of gynecological infections in Punjab, Pakistan. J Infect Public Health 2020; 13:1972-1980. [PMID: 32605779 DOI: 10.1016/j.jiph.2020.06.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 09/16/2019] [Accepted: 06/03/2020] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND PROBLEM Antibiotic resistance is considered a global problem, where highly emerging antibacterial resistance is posing a great threat to treat infections. OBJECTIVES The present study is aimed to highlight emerging resistance of bacteria to commonly used antibiotics in Pakistan. METHODS The samples for bacterial culture were obtained using high vaginal swabs (HVS) from female genitalia. The specimens were incubated and identified for subsequent pathogenic bacterial growth. There were 370 bacterial isolates from 520 females provisionally diagnosed for gynecological infections. RESULTS Out of total 9 isolated bacteria, Escherichia coli were most common isolates (41.6%) followed by Staphylococcus aureus (15.4%), and coagulase negative staphylococci (12.2%). E. coli exhibited maximum susceptibility to meropenem (98.2%) and imipenem (97.7%) and least to amoxicillin (9.8%) and ampicillin (9.6%). The highest incidence of bacterial infection was found in age group of 26-35 years. Among Gram-positive bacteria, 98.7%, 88.2% and 81.3% were susceptible to vancomycin, cefuroxime and linezolid respectively. For Gram-negative bacteria, 94.3%, 93.6% were susceptible to cefoperazone/sulbactam and meropenem respectively. Recurrence of infection developed among 3.27% of the patients, while two patients died with the infection. CONCLUSION Maximum resistance was shown by co-trimoxazole (81.4%), followed by amoxicillin (80.2%). After identifying the causative strain, the susceptible antibiotic should be administered to reduce antibiotic resistance and better control of gynecological infections in female Pakistani population.
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Affiliation(s)
- Ammar Sarwar
- Institute of Pharmaceutical Sciences, University of Veterinary & Animal Sciences, Lahore, Pakistan; University College of Pharmacy, University of the Punjab, Lahore, Pakistan; Xi'an Jiaotong University, Xi'an, PR China.
| | - Mobasher A Butt
- Institute of Pharmacy, Gulab Devi Educational Complex, Lahore, Pakistan.
| | - Saira Hafeez
- Institute of Pharmacy, Gulab Devi Educational Complex, Lahore, Pakistan; University College of Pharmacy, University of the Punjab, Lahore, Pakistan
| | - Muhammad Z Danish
- University College of Pharmacy, University of the Punjab, Lahore, Pakistan
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Sunderkötter C, Becker K, Eckmann C, Graninger W, Kujath P, Schöfer H. Calculated initial parenteral treatment of bacterial infections: Skin and soft tissue infections. GMS INFECTIOUS DISEASES 2020; 8:Doc11. [PMID: 32373436 PMCID: PMC7186924 DOI: 10.3205/id000055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
This is the ninth chapter of the guideline "Calculated Parenteral Initial Therapy of Adult Bacterial Disorders - Update 2018" in the 2nd updated version. The German guideline by the Paul-Ehrlich-Gesellschaft für Chemotherapie e.V. (PEG) has been translated to address an international audience. The chapter contains the first German S2k guidelines for bacterial skin and soft tissue infections. They encompass recommendations on diagnosis and treatment of the defined entities erysipelas (caused by beta-hämolytic streptococci), limited superficial cellulitis (S. aureus), severe cellulitis, abscess, complicated skin and soft tissue infections, infections of feet in diabetic patients ("diabetic foot"), necrotizing soft tissue infection and bite injuries.
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Affiliation(s)
- Cord Sunderkötter
- Universitätsklinik und Poliklinik für Dermatologie und Venerologie, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Germany
| | - Karsten Becker
- Institut für Med. Mikrobiologie, Universitätsklinikum Münster, Germany
| | - Christian Eckmann
- Klinik für Allgemein-, Viszeral- und Thoraxchirurgie, Klinikum Peine, Germany
| | | | - Peter Kujath
- Chirurgische Klinik, Medizinische Universität Lübeck, Germany
| | - Helmut Schöfer
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Frankfurt/Main, Germany
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Sunderkötter C, Becker K, Eckmann C, Graninger W, Kujath P, Schöfer H. S2k guidelines for skin and soft tissue infections Excerpts from the S2k guidelines for "calculated initial parenteral treatment of bacterial infections in adults - update 2018". J Dtsch Dermatol Ges 2020; 17:345-369. [PMID: 30920735 DOI: 10.1111/ddg.13790] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
These first German S2k guidelines for bacterial skin and soft tissue infections were developed as one chapter of the recommendations for "calculated initial parenteral treatment of bacterial infections" issued under the auspices of the Paul-Ehrlich Society, of which the main part is presented here. Well-calculated antibiotic therapies require precise diagnostic criteria. Erysipelas is defined as non-purulent infection considered to be caused by beta-hemolytic strepto-cocci. It is diagnosed clinically by its bright-red erythema and early fever or chills at disease onset. Penicillin is the treatment of choice. Limited soft tissue infection (cellulitis) is usually caused by Staphylococcus (S.) aureus, frequently originates from chronic wounds and presents with a more violaceous-red hue and only rarely with initial fever or chills. Treatment consists of first- or second--generation cephalosporins or flucloxacillin (IV). Severe cellulitis is a purulent, partially necrotic infection which extends through tissue boundaries to fascias and requires surgical management in addition to antibiotics. Moreover, it frequently fulfills the criteria for "complicated soft tissue infections", as previously defined by the Food and Drug Administration for use in clinical trials (they include comorbidities such as uncontrolled diabetes, peripheral artery disease, neutropenia). It requires antibiotics which besides S. aureus target anaerobic and/or gramnegative bacteria. The rare so-called necrotizing skin and soft tissue infections represent a distinct entity. They are characterized by rapid, life-threatening progression due to special bacterial toxins that cause ischemic necrosis and shock and need rapid and thorough debridement in addition to appropriate antibiotics. For cutaneous abscesses the first-line treatment is adequate drainage. Additional antibiotic therapy is required only under certain circumstances (e.g., involvement of the face, hands, or anogenital region, or if drainage is somehow complicated). The present guidelines also contain consensus-based recommendations for higher doses of antibiotics than those approved or usually given in clinical trials. The goal is to deliver rational antibiotic treatment that is both effective and well-tolerated and that exerts no unnecessary selection pressure in terms of multidrug resistance.
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Affiliation(s)
- Cord Sunderkötter
- Department of Translational Dermatoinfectiology, Medical Faculty of the University of Münster, and Department of Dermatology and Venereology, University Medical Center, Martin Luther University of Halle-Wittenberg, Halle, Germany
| | - Karsten Becker
- Institute of Medical Microbiology, Münster University Medical Center, Münster, Germany
| | - Christian Eckmann
- Department of General, Visceral and Thoracic Surgery, Peine Medical Center, Peine, Germany
| | - Wolfgang Graninger
- Medical University of Vienna, Department of Internal Medicine I, Division of Infectious Diseases and Tropical Medicine, Vienna General Hospital, Vienna, Austria
| | - Peter Kujath
- Department of Visceral, Vascular and Thoracic Surgery, Heide Medical Center, Heide, Germany
| | - Helmut Schöfer
- Department of Dermatology, Venereology, and Allergology, University hospital Frankfurt, Goethe-university, Frankfurt am Main, Germany
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Activity of dalbavancin against gram-positive cocci isolated from skin and soft tissue infections in Poland. Diagn Microbiol Infect Dis 2019; 95:114881. [DOI: 10.1016/j.diagmicrobio.2019.114881] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 06/06/2019] [Accepted: 07/29/2019] [Indexed: 11/23/2022]
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Eed EM, Ghonaim MM, Khalifa AS, Alzahrani KJ, Alsharif KF, Taha AA. Prevalence of mupirocin and chlorhexidine resistance among methicillin-resistant coagulase-negative staphylococci isolated during methicillin-resistant Staphylococcus aureus decolonization strategies. Am J Infect Control 2019; 47:1319-1323. [PMID: 31204092 DOI: 10.1016/j.ajic.2019.05.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 05/07/2019] [Accepted: 05/07/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND The widespread of methicillin-resistant Staphylococcus aureus (MRSA) antimicrobial decolonization in the clinical setting may lead to an increase in the prevalence of multiresistance to coagulase-negative staphylococci (CoNS) owing to their selection. This study aimed to investigate the impact of MRSA decolonization strategies, using mupirocin and chlorhexidine, on their CoNS susceptibility. METHODS A total of 312 CoNS isolates were collected before starting the decolonization protocols "baseline strains" (BLS) group, 330 isolates were collected after application of the targeted decolonization protocol "targeted decolonization strains" group, and 355 isolates were collected after application of the universal decolonization protocol "universal decolonization strains" group. Methicillin-resistant CoNS (MR-CoNS) were identified and tested for mupirocin and chlorhexidine susceptibilities. Heptaplex polymerase chain reaction assay was applied for simultaneous screening for chlorhexidine (CHX-R) and mupirocin resistance (Mu-R) genes. RESULTS Mu-R prevalence of MR-CoNS among the BLS group was considered moderate (9.1%); however, CHX-R in the BLS group was 5.8%, the rate of which significantly increased among the universal decolonization strains group. DISCUSSION Both MRSA decolonization strategies have an additional benefit in reducing the prevalence of MR-CoNS. The prevalence Mu-R rate didn't change significantly during either of the MRSA decolonization practices that may be due to the local nature of mupirocin application on the nasal mucosa only. In contrast CHX-R that was found to be significantly higher among the UDS group. CONCLUSIONS Our findings indicate that both MRSA decolonization strategies have an additional benefit in reducing the prevalence of MR-CoNS. Although the universal MRSA decolonization has superior efficacy in decolonization of CoNS, it may increase the risk of selecting CHX-R and Mu-R. In addition, other potential resistance genes should be studied.
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Affiliation(s)
- Emad M Eed
- Department of Medical Microbiology and Immunology, College of Medicine, Menoufia University, Menoufia, Egypt; Clinical Laboratory Department, College of Applied Medical Sciences, Taif University, Taif, Saudi Arabia.
| | - Mabrouk M Ghonaim
- Department of Medical Microbiology and Immunology, College of Medicine, Menoufia University, Menoufia, Egypt; Clinical Laboratory Department, College of Applied Medical Sciences, Taif University, Taif, Saudi Arabia
| | - Amany S Khalifa
- Department of Clinical Pathology, College of Medicine, Menoufia University, Menoufia, Egypt; Department of Clinical Pathology, College of Pharmacy, Taif University, Taif, Saudi Arabia
| | - Khalid J Alzahrani
- Clinical Laboratory Department, College of Applied Medical Sciences, Taif University, Taif, Saudi Arabia
| | - Khalaf F Alsharif
- Clinical Laboratory Department, College of Applied Medical Sciences, Taif University, Taif, Saudi Arabia
| | - Aza A Taha
- Department of Public Health and Community Medicine, College of Medicine, Menoufia University, Menoufia, Egypt; Department of Family and Community Medicine, College of Medicine, Taif University, Saudi Arabia
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Collin SM, Shetty N, Guy R, Nyaga VN, Bull A, Richards MJ, van der Kooi TI, Koek MB, De Almeida M, Roberts SA, Lamagni T. Group B Streptococcus in surgical site and non-invasive bacterial infections worldwide: A systematic review and meta-analysis. Int J Infect Dis 2019; 83:116-129. [DOI: 10.1016/j.ijid.2019.04.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 04/15/2019] [Accepted: 04/18/2019] [Indexed: 12/15/2022] Open
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Sunderkötter C, Becker K, Eckmann C, Graninger W, Kujath P, Schöfer H. S2k‐Leitlinie Haut‐ und WeichgewebeinfektionenAuszug aus „Kalkulierte parenterale Initialtherapie bakterieller Erkrankungen bei Erwachsenen – Update 2018“. J Dtsch Dermatol Ges 2019; 17:345-371. [DOI: 10.1111/ddg.13790_g] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Cord Sunderkötter
- Abteilung für translationale DermatoinfektiologieMedizinische Fakultät Universität Münster und Universitätsklinik und Poliklinik für Dermatologie und VenerologieMartin‐Luther‐Universität Halle‐Wittenberg Halle (Saale)
| | - Karsten Becker
- Institut für Medizinische Mikrobiologie des Universitätsklinikums Münster
| | - Christian Eckmann
- Klinik für Allgemein‐Viszeral‐ und Thoraxchirurgie Klinikum Peine Peine
| | - Wolfgang Graninger
- Medizinische Universität WienUniversitätsklinik für Innere Medizin IKlinische Abteilung für Infektionen & TropenmedizinAllgemeines Krankenhaus Wien Wien Österreich
| | - Peter Kujath
- Klinik für Viszeral‐Gefäß‐ und ThoraxchirurgieWestküstenklinikum Heide Deutschland
| | - Helmut Schöfer
- Klinik für DermatologieVenerologie und AllergologieUniversitätsklinikum Frankfurt, Goethe‐Universität Frankfurt am Main
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Carijo JH, Courtney PM, Goswami K, Groff H, Kendoff D, Matos J, Sandiford NA, Scheper H, Schmaltz CAS, Shubnyakov I, Tan TL, Wouthuyzen-Bakker M. Hip and Knee Section, Pathogen Factors: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34:S381-S386. [PMID: 30343968 DOI: 10.1016/j.arth.2018.09.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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Kaspar U, von Lützau A, Schlattmann A, Roesler U, Köck R, Becker K. Zoonotic multidrug-resistant microorganisms among small companion animals in Germany. PLoS One 2018; 13:e0208364. [PMID: 30532196 PMCID: PMC6285998 DOI: 10.1371/journal.pone.0208364] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 11/15/2018] [Indexed: 01/08/2023] Open
Abstract
Antimicrobial multidrug-resistant microorganisms (MDRO) can be transmitted between companion animals and their human owners. Aim of this study was to determine the prevalence of extended spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-E) and Staphylococcus aureus including methicillin-resistant S. aureus (MRSA) in different companion animal species. Dogs (n = 192), cats (n = 74), and rabbits (n = 17), treated in a veterinary practice and hospital or living in an animal shelter and private households, were sampled. All facilities were located in a region characterized by a high density of pig production. Nasal, buccal and perianal swabs were enriched and cultured on solid chromogenic selective media. A subgroup of 20 animals (13 dogs, 3 cats, 4 rabbits) was analyzed for the presence of staphylococci other than S. aureus. Amongst all animals (n = 283), twenty dogs (10.4%) and six cats (8.1%) carried S. aureus. MRSA was found in five dogs (2.6%) and two cats (2.7%). Isolates were of spa types t011, t034, t108 (all mecA-positive, ST398), and t843 (mecC-positive, ST130), typical for livestock-associated (LA)-MRSA. Except for one dog, MRSA-positive animals did not have direct contact to husbandry. ESBL-Escherichia coli (blaCTX-M/blaTEM/blaSHV genes) were present in seven dogs (3.6%), one cat (1.4%) possessed a cefotaxime-resistant Citrobacter freundii isolate (blaTEM/blaCMY-2 genes). MDRO carriage was associated with animals from veterinary medical settings (p<0.05). One dog and one rabbit carried methicillin-resistant coagulase-negative staphylococci. The exclusive occurrence of MRSA lineages typically described for livestock stresses the impact of MDRO strain dissemination across species barriers in regional settings. Presence of ESBL-E and LA-MRSA among pets and probable dissemination in clinical settings support the necessity of a “One Health” approach to address the potential threats due to MDRO-carrying companion animals.
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Affiliation(s)
- Ursula Kaspar
- Institute of Medical Microbiology, University Hospital Münster, Münster, Germany
| | - Alexa von Lützau
- Institute of Medical Microbiology, University Hospital Münster, Münster, Germany
| | - Andreas Schlattmann
- Institute of Medical Microbiology, University Hospital Münster, Münster, Germany
| | - Uwe Roesler
- Institute for Animal Hygiene and Environmental Health, FU Berlin, Department of Veterinary Medicine, Berlin, Germany
| | - Robin Köck
- Institute of Medical Microbiology, University Hospital Münster, Münster, Germany
| | - Karsten Becker
- Institute of Medical Microbiology, University Hospital Münster, Münster, Germany
- * E-mail:
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Esposito S, Ascione T, Pagliano P. Management of bacterial skin and skin structure infections with polymicrobial etiology. Expert Rev Anti Infect Ther 2018; 17:17-25. [PMID: 30518267 DOI: 10.1080/14787210.2019.1552518] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Skin and Soft Tissue Infections (SSTIs) are some of the most commonly occurring bacterial infections, with a wide range of possible etiological pathogens and a considerable variety of clinical presentations and severity; from mild to severe life-threatening infections. Several classifications have been proposed based on a specific variable, such as anatomical localization, skin extension, progression rate, clinical presentation, severity, and etiological agent. Areas covered: The last criteria allows the differentiation of SSTIs as monomicrobial and polymicrobial. Among them, especially those infections with a long lasting or chronic course can be sustained by multiple microbial etiology. Most polymicrobial SSTIs can be included in the following: diabetes foot infections (DFIs), pressure ulcers infection, burn infection, and infected chronic ulcers. Expert commentary: The medical management of these infections comprises the administration of wide a spectrum antibiotic, taking into consideration the frequent occurrence of multidrug resistant microorganisms as responsible agents. An appropriate deep tissue specimen for microbiological examination is a very important issue, especially for polymicrobial infections, sometimes permitting the distinction between real pathogens and contaminants avoiding more complex antibiotic treatments. This aspect must be strongly emphasized, as frequently superficial swabs remain the specimen of choice because they are easy to obtain.
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Affiliation(s)
- Silvano Esposito
- a Departement of Infectious Diseases , University of Salerno , Salerno , Italy
| | - Tiziana Ascione
- b Department of Infectious Diseases , AORN dei Colli , Naples , Italy
| | - Pasquale Pagliano
- b Department of Infectious Diseases , AORN dei Colli , Naples , Italy
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Brun P, Bernabè G, Marchiori C, Scarpa M, Zuin M, Cavazzana R, Zaniol B, Martines E. Antibacterial efficacy and mechanisms of action of low power atmospheric pressure cold plasma: membrane permeability, biofilm penetration and antimicrobial sensitization. J Appl Microbiol 2018; 125:398-408. [PMID: 29655267 DOI: 10.1111/jam.13780] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 03/15/2018] [Accepted: 04/04/2018] [Indexed: 12/22/2022]
Abstract
AIM The objective of this study was to determine the efficacy and mechanisms of inactivation of two clinically relevant ESKAPE bacteria namely Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus by atmospheric pressure cold plasma. METHODS AND RESULTS Plasma was generated between two brass grids by applying a radiofrequency electric field to a flow of helium. Intracellular generation of reactive species, alterations in cell membrane, and inactivation of bacteria in planktonic or biofilm growth were studied. Results were compared with commonly used antimicrobial drugs. Plasma exposure generated reactive oxygen and nitrogen species in bacteria, disrupted membrane integrity and reduced bacterial load. The efficacy in bacterial inactivation was comparable to antibiotics but exhibited a quicker killing rate. The antibacterial effect of plasma synergistically increased in association with antibiotics and did not diminish over repeated exposures, suggesting no development in bacterial resistance. CONCLUSIONS Through generation of reactive species, cold plasma altered cell membrane and effectively inactivated clinically important bacteria, both in suspension and in biofilms. SIGNIFICANCE AND IMPACT OF THE STUDY As cold plasma damages different targets in bacterial cells, it emerges as an effective strategy used alone or in combination with antimicrobial drugs to control microbial infections and prevent the selection of resistant bacterial strains.
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Affiliation(s)
- P Brun
- Department of Molecular Medicine, University of Padova, Padova, Italy
| | - G Bernabè
- Department of Molecular Medicine, University of Padova, Padova, Italy
| | - C Marchiori
- Department of Molecular Medicine, University of Padova, Padova, Italy
| | - M Scarpa
- Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
| | - M Zuin
- Consorzio RFX, Padova, Italy
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Ultrasonography for the diagnosis of patients with clinically suspected skin and soft tissue infections: a systematic review of the literature. Eur J Emerg Med 2018; 24:162-169. [PMID: 26485694 DOI: 10.1097/mej.0000000000000340] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND In patients presenting with skin and soft tissue infections (SSTI), the use of ultrasound may lead to a more accurate distinction between cellulitis and abscess compared with clinical assessment alone. OBJECTIVES This systematic review aims to determine the diagnostic accuracy of ultrasound for detecting skin abscesses. In addition, it aims to assess the impact of using ultrasound on management decisions in patients with SSTI. METHODS We searched relevant electronic databases for primary studies including MEDLINE, EMBASE, and CINAHL. We searched conference proceedings, checked references of retrieved articles, and contacted field experts. Two reviewers assessed the quality of each full-text publication using a modified QUADAS-2 tool. RESULTS Five studies (n=710) fulfilled our inclusion criteria. Four studies compared the diagnostic accuracy of ultrasound with clinical examination alone (n=584). Most studies reported an improvement in diagnostic accuracy. The sensitivity of ultrasound ranged from 89 to 98% and the specificity ranged from 64 to 88%. However, the sensitivity of clinical assessment ranged from 75 to 90% and the specificity ranged from 55 to 83%; most of these results did not reach statistical significance. Sensitivity was further improved in cases of indeterminate clinical assessment. Two studies (n=176) examined the impact of ultrasound on management decisions. Use of ultrasound has led to significant and appropriate changes in management decisions in 16 to 39% of patients. CONCLUSION The use of ultrasound could potentially improve diagnostic accuracy and lead to improved management decisions in patients with SSTI, especially in cases of indeterminate clinical assessment. Most of our findings did not achieve statistical significance. Further research is required to confirm these findings.
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Konappa NM, Siddaiah CN, Krishnamurthy S, Singh B, Ramachandrappa NS. Phytochemical Screening and Antimicrobial Activity of Leaf Extracts ofAmomum nilgiricum(Thomas) (Zingiberaceae)from Western Ghats, India. ACTA ACUST UNITED AC 2017. [DOI: 10.1080/22311866.2017.1357502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Narasimha Murthy Konappa
- Department of Studies in Biotechnology, University of Mysore, Manasagangothri, Mysore - 570 006, Karnataka, India
| | - Chandra Nayaka Siddaiah
- Department of Studies in Biotechnology, University of Mysore, Manasagangothri, Mysore - 570 006, Karnataka, India
| | - Soumya Krishnamurthy
- Department of Studies in Biotechnology, University of Mysore, Manasagangothri, Mysore - 570 006, Karnataka, India
| | - Brijesh Singh
- Department of Studies in Biotechnology, University of Mysore, Manasagangothri, Mysore - 570 006, Karnataka, India
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Takimoto K, Wang Q, Suzuki D, Katayama M, Hayashi Y. Clinical efficacy of piperacillin/tazobactam in the treatment of complicated skin and soft tissue infections. Expert Opin Pharmacother 2017. [PMID: 28627952 DOI: 10.1080/14656566.2017.1341491] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Complicated skin and soft tissue infections (cSSTIs) are skin and soft tissue infections (SSTIs) that involve deep soft tissue. cSSTIs often require surgical intervention and/or hospitalization. cSSTIs are associated with significant mortality and morbidity, and carry a significant burden on health care systems. Piperacillin/tazobactam has been regarded as a standard treatment for cSSTIs because of its antibiotic spectrum, safety and clinical efficacy. Several antibiotics, as compared to piperacillin/tazobactam, have been evaluated in the treatment of cSSTIs. Areas covered: This review summarizes randomized controlled trials (RCTs) evaluating the clinical efficacy of piperacillin/tazobactam for the treatment of cSSTIs. Expert opinion: Piperacillin/tazobactam, which covers most causative organisms in cSSTIs, is the drug of choice for the treatment of cSSTIs. Other options such as ertapenem and moxifloxacin may be reasonable where multiple daily dosing or intravenous administration is inappropriate. But in general, they should be avoided as an empirical treatment because of their highly association with resistant bacteria, which are becoming a global threat. Therefore, piperacilin/tazobactam is appropriate as an empirical therapy for the treatment of SSTIs and should be de-escalated as soon as causative organisms are identified, their drug-sensitivity results are available, and clinical condition becomes stable.
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Affiliation(s)
- Kohei Takimoto
- a Department of Intensive Care Medicine , Kameda Medical Center , Kamogawa , Japan
| | - Qianzhi Wang
- b Postgraduate Education Center , Kameda Medical Center , Kamogawa , Japan
| | - Daisuke Suzuki
- c Department of Infectious Diseases , Kameda Medical Center , Kamogawa , Japan
| | - Mitsuya Katayama
- d Department of General Internal Medicine , Kameda Medical Center , Kamogawa , Japan
| | - Yoshiro Hayashi
- a Department of Intensive Care Medicine , Kameda Medical Center , Kamogawa , Japan
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Torres J, Avalos N, Echols L, Mongelluzzo J, Rodriguez RM. Low yield of blood and wound cultures in patients with skin and soft-tissue infections. Am J Emerg Med 2017; 35:1159-1161. [PMID: 28592371 DOI: 10.1016/j.ajem.2017.05.039] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Accepted: 05/26/2017] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Current guidelines recommend blood cultures in skin and soft-tissue infection (SSTI) patients only with signs of systemic toxicity and wound cultures for severe purulent infections. Our objectives were to determine: 1) blood and wound culture yields in patients admitted with SSTIs; 2) whether injection drug users (IDUs) and febrile patients had higher blood culture yields; and 3) whether blood and wound cultures grew organisms sensitive to typical SSTI empiric antibiotics. METHODS We prospectively enrolled adult patients admitted from the ED with SSTIs at an urban hospital. We recorded patient characteristics, including IDU, comorbidities and temperatures, and followed admitted patients throughout their hospital course. RESULTS Of 734 SSTI patients enrolled, 246 (33.5%) were admitted. Of 86 (35.0%) patients who had blood cultures, six had positive cultures (yield=7.0%; 95% confidence intervals [CIs] 3.2-14.4); 4 were methicillin sensitive Staphylococcus aureus (MSSA) and 2 were methicillin resistant (MRSA). Of 29 febrile patients, 1 had a positive culture (yield=3.5%; 95% CI 0.6-17.2). Of 101 admitted IDU patients, 46 (46%) received blood cultures, and 4 had positive cultures (yield=8.7%; 95% CI 3.4-20.3). Of 89 patients with purulent wounds, 44 (49.4%) patients had ED wound cultures. Thirteen had positive cultures (yield=29.6%; 95% CI 18.2-44.2%). Most were MRSA, MSSA, and group A Streptococcus species - all sensitive to Vancomycin. CONCLUSIONS Febrile and IDU patients had low yields of blood cultures similar to yields in non-IDU and afebrile patients. All blood and wound culture species were adequately covered by currently recommended empiric antibiotic regimens.
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Affiliation(s)
- Jesus Torres
- Department of Emergency Medicine, University of California, San Francisco, CA, United States
| | - Nathaniel Avalos
- Department of Emergency Medicine, University of California, San Francisco, CA, United States
| | - Lamarr Echols
- Department of Emergency Medicine, University of California, San Francisco, CA, United States
| | - Jillian Mongelluzzo
- Department of Emergency Medicine, University of California, San Francisco, CA, United States
| | - Robert M Rodriguez
- Department of Emergency Medicine, University of California, San Francisco, CA, United States.
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Yao W, Kuan EC, Francis NC, St John MA, Grundfest WS, Taylor ZD. Laser-generated shockwaves enhance antibacterial activity against biofilms in vitro. Lasers Surg Med 2017; 49:539-547. [PMID: 28333393 DOI: 10.1002/lsm.22627] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2016] [Indexed: 01/23/2023]
Abstract
BACKGROUND AND OBJECTIVES Bacterial biofilm formation within chronic wound beds, which provides an effective barrier against antibiotics, is a known cause of recalcitrant infections and a significant healthcare burden, often requiring repeated surgical debridements. Laser-generated shockwaves (LGS) is a novel, minimally invasive, and nonthermal modality for biofilm mechanical debridement which utilizes compressive stress waves, generated by photonic absorption in thin titanium films to mechanically disrupt the biofilm. Prior studies have demonstrated LGS monotherapy to be selectively efficacious for biofilm disruption and safe for host tissues. In this study, we sought to determine if LGS can enhance the antimicrobial activity and biofilm disruption capability of topical antibiotic therapy. STUDY DESIGN/MATERIALS AND METHODS Staphylococcus epidermidis biofilms grown in vitro on glass were treated with topical gentamicin (31, 62, and 124 μg/ml) with and without LGS (n = 3-11/treatment group). Mechanical shockwaves were generated with a 1,064 nm Nd:YAG laser (laser fluence 110.14 mJ/mm2 , pulse duration 5 ns, spot size 3 mm). Following a 24-hour incubation period, bacterial viability was assessed by determining the number of colony-forming units (CFU) via the Miles and Misra method. Residual biofilm bioburden was analyzed using the crystal violet biofilm assay. RESULTS With gentamicin monotherapy, CFU density (CFU/mm2 ) at 31, 62, and 124 μg/ml were (282 ± 84) × 104 , (185 ± 34) × 104 , and (113 ± 9) × 104 , respectively. With LGS and gentamicin therapy, CFU density decreased to (170 ± 44) × 104 , (89 ± 24) × 104 , and (43 ± 3) × 104 , respectively (P = 0.1704, 0.0302, and 0.0004 when compared with gentamicin alone). Biofilm burden as measured by the assay in the gentamicin 31, 62, and 124 μg/ml groups was reduced by 80%, 95%, and 98% when LGS was added (P = 0.0102, >0.0001, and 0.0001 for all groups when compared with gentamicin alone). Furthermore, samples treated with LGS saw an increase in susceptibility to gentamicin, in terms of reduced biofilm bioburden and CFU densities. CONCLUSION LGS enhances the efficacy of topical antibiotics in an in vitro model. This has significant implications for clinical applications in the management of chronic soft tissue infections and recalcitrant chronic rhinosinusitis. Lasers Surg. Med. 49:539-547, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- William Yao
- Department of Bioengineering, Henry Samueli School of Engineering and Applied Science, University of California (UCLA), Los Angeles, California
| | - Edward C Kuan
- Department of Head and Neck Surgery, UCLA Medical Center, Los Angeles, California
| | - Nathan C Francis
- Department of Bioengineering, Henry Samueli School of Engineering and Applied Science, University of California (UCLA), Los Angeles, California
| | - Maie A St John
- Department of Head and Neck Surgery, UCLA Medical Center, Los Angeles, California
| | - Warren S Grundfest
- Department of Bioengineering, Henry Samueli School of Engineering and Applied Science, University of California (UCLA), Los Angeles, California
| | - Zachary D Taylor
- Department of Bioengineering, Henry Samueli School of Engineering and Applied Science, University of California (UCLA), Los Angeles, California
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Abetz JW, Adams NG, Newnham H, Smit DV, Mitra B. Transfer of care and overstay in the management of cellulitis in the emergency short stay unit: A retrospective cohort study. Emerg Med Australas 2017; 29:143-148. [DOI: 10.1111/1742-6723.12731] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 12/01/2016] [Accepted: 12/15/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Jeremy W Abetz
- Emergency and Trauma Centre; The Alfred Hospital; Melbourne Victoria Australia
- Department of Epidemiology and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences; Monash University; Melbourne Victoria Australia
- National Trauma Research Institute; The Alfred Hospital; Melbourne Victoria Australia
| | - Nicholas G Adams
- Emergency and Trauma Centre; The Alfred Hospital; Melbourne Victoria Australia
| | - Harvey Newnham
- General Medicine Unit; The Alfred Hospital; Melbourne Victoria Australia
| | - De Villiers Smit
- Emergency and Trauma Centre; The Alfred Hospital; Melbourne Victoria Australia
| | - Biswadev Mitra
- Emergency and Trauma Centre; The Alfred Hospital; Melbourne Victoria Australia
- Department of Epidemiology and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences; Monash University; Melbourne Victoria Australia
- National Trauma Research Institute; The Alfred Hospital; Melbourne Victoria Australia
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Dadashi L, Dehghanzadeh R. Investigating incidence of bacterial and fungal contamination in shared cosmetic kits available in the women beauty salons. Health Promot Perspect 2016; 6:159-63. [PMID: 27579260 PMCID: PMC5002883 DOI: 10.15171/hpp.2016.25] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Accepted: 04/26/2016] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Rich texture of cosmetics can provide a suitable medium for growth of pathogenic microorganisms. In addition, skin microflora of anyone is unique which might be harmful to another person. Skin and eye pathogenicity could be communicated by sharing cosmetics in beauty saloons. The main objective of this study was to evaluate microbial contamination of in-use skin and eye cosmetics which are available as public make-up kits for women in the beauty salons. METHODS Fifty-two in-use skin and eye cosmetics were included in this cross sectional study.The specimens from all the cosmetics were collected following the owner's informed consent, and then about 1 g of the cosmetics was added to nine ml of liquid Eugon LT100 broth medium,two for each product. Ten beauty salons randomly selected from different regions of Tabriz city between June and August 2016. Cosmetics were sampled and carried to the laboratory in sterile condition and then examined to determine bacterial and fungal species in the samples. RESULTS All of in-use cosmetic were contaminated with bacteria (95% CI = 93.1%-100.0%) and about 19.2% by fungus and yeast (95% CI = 10.8%-31.9%). Streptococcus spp., Pseudomonas spp., Acinetobacter, Bacillus spp., Staphylococcus spp., Escherichia coli, Salmonella, Klebsiella,Citrobacter, Rhodotorula and Candida were dominant species which were isolated from the cosmetics. Powders with 38.5% (95% CI = 17.7%-64.5%) and eyeliners with 30.0% (95%CI = 6.7%-65.2%) were the most fungal contaminated products. CONCLUSION Shared cosmetics in beauty salons are almost contaminated by bacteria and fungus.Therefore, it is suggested to avoid sharing cosmetics by women and prevent use of public cosmetics in toilet saloons.
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Affiliation(s)
- Leila Dadashi
- Department of Environmental Health Engineering, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Reza Dehghanzadeh
- Department of Environmental Health Engineering, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
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Rehab ME, Dina ER, Shaymaa HAR. Toxin gene profile and antibiotic resistance of Staphylococcus aureus isolated from clinical and food samples in Egypt. ACTA ACUST UNITED AC 2016. [DOI: 10.5897/ajmr2015.7927] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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The importance of source control in the management of severe skin and soft tissue infections. Curr Opin Infect Dis 2016; 29:139-44. [DOI: 10.1097/qco.0000000000000240] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Eckmann C, Heizmann W, Bodmann KF, von Eiff C, Petrik C, Loeschmann PA. Tigecycline in the Treatment of Patients with Necrotizing Skin and Soft Tissue Infections Due to Multiresistant Bacteria. Surg Infect (Larchmt) 2015; 16:618-25. [PMID: 26115414 DOI: 10.1089/sur.2014.089] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Necrotizing skin and soft tissue infections (NSTI) form a group of aggressive diseases that require radical debridement for infection control. Simultaneously, a high-dose broad spectrum antibiotic regimen needs to be initiated with control of septic complications in the intensive care setting. The aim of this work is to analyze the efficacy and safety of tigecycline in a subpopulation of hospitalized, severely ill surgical NSTI patients who were documented in a large multicenter non-interventional study on tigecycline use in routine clinical practice. METHODS A total of 1,025 patients with severe infections including complicated skin and soft-tissue infections (cSSTI, n=163; 15,9%) were enrolled in a prospective multi-center non-interventional study. Patients were to receive an initial intravenous dose of 100 mg tigecycline, followed by 50 mg twice daily. Prospectively documented parameters included clinical findings, APACHE II score, microbiological and standard laboratory assessments, surgical measures, and clinical outcomes including adverse events. RESULTS Of 163 patients were treated for cSSTI, with the largest subgroup being NSTI patients (n=50, 30.7% of all cSSTI, mean age 61 y, median APACHE II score 20). Forty-eight NSTI patients (96%) had at least one comorbidity. In 80% of patients, the treatment was started after previous antibiotic treatment had failed and in 34% resistant pathogens were isolated (28% methicillin resistant Staphyloccocus aureus [MRSA], 4% extended-spectrum-beta-lactamase (ESBL)-producing bacteria, and 2% vancomycin-resistant Enterococci (VRE). Tigecycline was administered as a single agent in 32 patients; 17 received combination regimens. Data from one patient were not reported. Rates of clinical cure or improvement with tigecycline treatment were 90.2%. Two patients (4%) had drug related adverse events (one thrombocytopenia and one fever/chills); 10 patients (20%) died. CONCLUSIONS Tigecycline alone or in combination therapy was an effective and safe antibiotic treatment in critically ill and antimicrobially pre-treated patients with NSTI frequently caused by resistant pathogens.
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Affiliation(s)
- Christian Eckmann
- 1 Department of General, Visceral and Thoracic Surgery, Klinikum Peine Academic Hospital of Medical University Hannover , Germany
| | | | - Klaus-Friedrich Bodmann
- 3 Klinikum Barnim GmbH, Werner Forßmann Hospital , Clinic of Medical Intensive Care and Interdisciplinary Emergency Care, Eberswalde, Germany
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Kim YS, Kim SK, Cho IC, Ko JS, Lee GI, Min SK. Change of Antibiotic Resistance to the Causative Organisms of Pelvic Wound Infection for Recent 5 Years. ACTA ACUST UNITED AC 2015. [DOI: 10.14777/uti.2015.10.2.112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Yoo Seok Kim
- Department of Urology, National Police Hospital, Seoul, Korea
| | - Soon Ki Kim
- Department of Urology, National Police Hospital, Seoul, Korea
| | - In-Chang Cho
- Department of Urology, National Police Hospital, Seoul, Korea
| | - Jin Soo Ko
- Department of Plastic Surgery, National Police Hospital, Seoul, Korea
| | - Gyeong In Lee
- Department of Laboratoy Medicine, National Police Hospital, Seoul, Korea
| | - Seung Ki Min
- Department of Urology, National Police Hospital, Seoul, Korea
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Abstract
The definition of the heterogeneous group of coagulase-negative staphylococci (CoNS) is still based on diagnostic procedures that fulfill the clinical need to differentiate between Staphylococcus aureus and those staphylococci classified historically as being less or nonpathogenic. Due to patient- and procedure-related changes, CoNS now represent one of the major nosocomial pathogens, with S. epidermidis and S. haemolyticus being the most significant species. They account substantially for foreign body-related infections and infections in preterm newborns. While S. saprophyticus has been associated with acute urethritis, S. lugdunensis has a unique status, in some aspects resembling S. aureus in causing infectious endocarditis. In addition to CoNS found as food-associated saprophytes, many other CoNS species colonize the skin and mucous membranes of humans and animals and are less frequently involved in clinically manifested infections. This blurred gradation in terms of pathogenicity is reflected by species- and strain-specific virulence factors and the development of different host-defending strategies. Clearly, CoNS possess fewer virulence properties than S. aureus, with a respectively different disease spectrum. In this regard, host susceptibility is much more important. Therapeutically, CoNS are challenging due to the large proportion of methicillin-resistant strains and increasing numbers of isolates with less susceptibility to glycopeptides.
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Affiliation(s)
- Karsten Becker
- Institute of Medical Microbiology, University Hospital Münster, Münster, Germany
| | - Christine Heilmann
- Institute of Medical Microbiology, University Hospital Münster, Münster, Germany
| | - Georg Peters
- Institute of Medical Microbiology, University Hospital Münster, Münster, Germany
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Bassetti M, Baguneid M, Bouza E, Dryden M, Nathwani D, Wilcox M. European perspective and update on the management of complicated skin and soft tissue infections due to methicillin-resistant Staphylococcus aureus after more than 10 years of experience with linezolid. Clin Microbiol Infect 2014; 20 Suppl 4:3-18. [DOI: 10.1111/1469-0691.12463] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Amaral LFB, Moriel P, Foglio MA, Mazzola PG. Caryocar brasiliense supercritical CO2 extract possesses antimicrobial and antioxidant properties useful for personal care products. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2014; 14:73. [PMID: 24565304 PMCID: PMC3940022 DOI: 10.1186/1472-6882-14-73] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Accepted: 01/10/2014] [Indexed: 11/24/2022]
Abstract
Background The cosmetic and pharmaceutical industries have an increasing interest in replacing synthetic antimicrobials in dermatological products due to increased microbial resistance to conventional antimicrobial agents. Pequi (Caryocar brasiliense) is a native fruit tree of the Brazilian Cerrado, specifically used in cosmetics, in the food industry, and for medicinal purposes. Leishmanicidal and antifungal activities have been reported previously. This study was designed to evaluate the antimicrobial and antioxidant activities of a C. brasiliense extract obtained by supercritical CO2 extraction. Methods The minimum inhibitory concentrations (MICs) against Escherichia coli, Pseudomonas aeruginosa, and Staphylococcus aureus were determined by the classical microdilution method. Antiseptic activity against these organisms was evaluated by the plate diffusion method. The antioxidant potential of the extract was evaluated using a method based on the oxidation of 2,2′-azino-bis(3-ethylbenzothiazoline-6-sulphonic acid) (ABTS). The extract’s chemical profile was analyzed for the presence of alkaloids, saponins, anthraquinones, steroids, tannins, flavonoids, and phenolic compounds according to standard colorimetric methods. Results The C. brasiliense supercritical CO2 extract exhibits antimicrobial activity against all bacteria tested. It also possesses antioxidant activity, when compared to a vitamin E standard. Conclusions The C. brasiliense supercritical CO2 extract may be useful for the development of personal care products, primarily for antiseptic skin products that inactivate, reduce, prevent, or arrest the growth of microorganisms with the inherent intent to mitigate or prevent disease as well as products that minimize damage caused by free radicals.
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Curcio D. Resistant pathogen-associated skin and skin-structure infections: antibiotic options. Expert Rev Anti Infect Ther 2014; 8:1019-36. [DOI: 10.1586/eri.10.87] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Atshan SS, Nor Shamsudin M, Lung LTT, Sekawi Z, Pei Pei C, Karunanidhi A, Jeevajothi Nathan J, Mateg Ali A, Ghaznavi-Rad E, Abduljaleel SA, Awang Hamat R. Genotypically different clones of Staphylococcus aureus are diverse in the antimicrobial susceptibility patterns and biofilm formations. BIOMED RESEARCH INTERNATIONAL 2013; 2013:515712. [PMID: 24455699 PMCID: PMC3886620 DOI: 10.1155/2013/515712] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 10/04/2013] [Indexed: 11/21/2022]
Abstract
This study evaluated whether genotypically different clinical isolates of S. aureus have similar susceptibilities to individual antibiotics. It further aims to check the impact of biofilm on the in vitro activity of vancomycin, daptomycin, linezolid, and tigecycline against S. aureus clones. The study used a total of 60 different clinical MSSA and MRSA isolates. Susceptibilities were performed in planktonic cultures by macrobroth dilution and epsilon-test (E test) system. Biofilm production was determined using an adherent plate assay. The efficacy of antimicrobial activities against biofilms formation was checked using confocal laser scanning microscopy (CLSM). The study found that similar and different spa, MLST, and SCCmec types displayed high variation in their susceptibilities to antibiotics with tigecycline and daptomycin being the most effective. The biofilms were found resistant to high concentrations of most antibiotics tested with daptomycin being the most effective drug used in adhesive biofilms. A considerable difference exists among similar and various clone types against antibiotics tested. This variation could have contributed to the degree of virulence even within the same clonal genotype and enhanced heterogeneity in the infection potential. Thus, the development of a rapid and precise identification profile for each clone in human infections is important.
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Affiliation(s)
- Salman Sahab Atshan
- Laboratory of Medical Microbiology and Parasitology, Faculty of Medicine and Health Science, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia
- Department of Medical Microbiology, Basrah University, Basrah, Iraq
| | - Mariana Nor Shamsudin
- Laboratory of Medical Microbiology and Parasitology, Faculty of Medicine and Health Science, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia
- Laboratory of Marine Science and Aquaculture, Institute of Bioscience, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia
| | - Leslie Than Thian Lung
- Laboratory of Medical Microbiology and Parasitology, Faculty of Medicine and Health Science, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia
| | - Zamberi Sekawi
- Laboratory of Medical Microbiology and Parasitology, Faculty of Medicine and Health Science, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia
| | - Chong Pei Pei
- Department of Biomedical Sciences, Faculty of Medicine and Health Science, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia
| | - Arunkumar Karunanidhi
- Laboratory of Medical Microbiology and Parasitology, Faculty of Medicine and Health Science, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia
| | - Jayakayatri Jeevajothi Nathan
- Laboratory of Medical Microbiology and Parasitology, Faculty of Medicine and Health Science, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia
| | - Alreshidi Mateg Ali
- Department of Biomedical Sciences, Faculty of Medicine and Health Science, Al Bukacyriyah, Saudi Arabia
| | | | | | - Rukman Awang Hamat
- Laboratory of Medical Microbiology and Parasitology, Faculty of Medicine and Health Science, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia
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Teras J, Gardovskis J, Vaasna T, Kupcs U, Pupelis G, Dukart G, Dartois N, Jouve S, Cooper A. Overview of Tigecycline Efficacy and Safety in the Treatment of Complicated Skin and Skin Structure Infections - A European Perspective. J Chemother 2013; 20 Suppl 1:20-7. [DOI: 10.1179/joc.2008.20.supplement-1.20] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Waldenburger S, Vogel U, Goebeler M, Kolb-Mäurer A. Community-acquired skin infections caused by Staphylococcus aureus: What is the role of the Panton-Valentine leukocidin toxin? J Dtsch Dermatol Ges 2013; 12:59-66. [PMID: 24393315 DOI: 10.1111/ddg.12228] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2013] [Accepted: 08/27/2013] [Indexed: 11/24/2022]
Abstract
BACKGROUND The data concerning frequency and relevance of the toxin Panton-Valentine leukocidin (PVL) in skin infections caused by Staphylococcus aureus is controversial. The objective of the study was the identification of the role of the toxin in community-acquired skin infections caused by S. aureus. PATIENTS AND METHODS We performed a retrospective analysis of 112 patients with the diagnosis of skin infections caused by S. aureus. Frequency of PVL was investigated by PCR for the lukSF gene. Risk factors and severity of the disease were analyzed. Furthermore, spa typing was done in 55 of the isolated S. aureus. RESULTS PVL occurred in 45 % of patients with skin infections caused by methicillin-susceptible S. aureus; methicillin-resistant strains were positive in 63 %. Mean age was 30.9 years in PVL-positive infections and thus statistically highly significantly lower than in PVL-negative infections. There was no correlation between presence of PVL and severity and course of skin infections or presence of special risk factors. The spa types showed a high variability in PVL-positive as well as in PVL-negative strains. CONCLUSIONS In our study the PVL status of S. aureus isolated from skin infections was neither correlated with methicillin-resistance nor with the severity of disease. Remarkably, PVL-positive S. aureus strains appeared to be more frequent in younger than in older patients. Our results demonstrate that routine determination of PVL status is not required since the outcome has no diagnostic or therapeutic consequences in daily dermatological practice.
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Affiliation(s)
- Stefanie Waldenburger
- Department of Dermatology, Venereology and Allergology, University Clinic of Würzburg, Germany
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Karaküçük-İyidoğan A, Mercan Z, Oruç-Emre EE, Taşdemir D, İşler D, Kılıç İH, Özaslan M. Synthesis, Characterization, and Biological Evaluation of Some Novel Thiosemicarbazones as Possible Antibacterial and Antioxidant Agents. PHOSPHORUS SULFUR 2013. [DOI: 10.1080/10426507.2013.844139] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Ayşegül Karaküçük-İyidoğan
- Department of Chemistry, Faculty of Arts and Sciences, Gaziantep University, Universite Bulvari, 27310 Gaziantep, Turkey
| | - Zeliha Mercan
- Department of Chemistry, Faculty of Arts and Sciences, Gaziantep University, Universite Bulvari, 27310 Gaziantep, Turkey
| | - Emine Elçin Oruç-Emre
- Department of Chemistry, Faculty of Arts and Sciences, Gaziantep University, Universite Bulvari, 27310 Gaziantep, Turkey
| | - Demet Taşdemir
- Department of Chemistry, Faculty of Arts and Sciences, Gaziantep University, Universite Bulvari, 27310 Gaziantep, Turkey
| | - Derya İşler
- Department of Biology, Faculty of Arts and Sciences, Gaziantep University, Universite Bulvari, 27310 Gaziantep, Turkey
| | - İbrahim Halil Kılıç
- Department of Biology, Faculty of Arts and Sciences, Gaziantep University, Universite Bulvari, 27310 Gaziantep, Turkey
| | - Mehmet Özaslan
- Department of Biology, Faculty of Arts and Sciences, Gaziantep University, Universite Bulvari, 27310 Gaziantep, Turkey
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Garau J, Ostermann H, Medina J, Ávila M, McBride K, Blasi F. Current management of patients hospitalized with complicated skin and soft tissue infections across Europe (2010–2011): assessment of clinical practice patterns and real-life effectiveness of antibiotics from the REACH study. Clin Microbiol Infect 2013; 19:E377-85. [DOI: 10.1111/1469-0691.12235] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Revised: 03/01/2013] [Accepted: 03/25/2013] [Indexed: 01/22/2023]
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Alhariri M, Azghani A, Omri A. Liposomal antibiotics for the treatment of infectious diseases. Expert Opin Drug Deliv 2013; 10:1515-32. [PMID: 23886421 DOI: 10.1517/17425247.2013.822860] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Liposomal delivery systems have been utilized in developing effective therapeutics against cancer and targeting microorganisms in and out of host cells and within biofilm community. The most attractive feature of liposome-based drugs are enhancing therapeutic index of the new or existing drugs while minimizing their adverse effects. AREAS COVERED This communication provides an overview on several aspects of liposomal antibiotics including the most widely used preparation techniques for encapsulating different agents and the most important characteristic parameters applied for examining shape, size and stability of the spherical vesicles. In addition, the routes of administration, liposome-cell interactions and host parameters affecting the biodistribution of liposomes are highlighted. EXPERT OPINION Liposomes are safe and suitable for delivery of variety of molecules and drugs in biomedical research and medicine. They are known to improve the therapeutic index of encapsulated agents and reduce drug toxicity. Recent studies on liposomal formulation of chemotherapeutic and bioactive agents and their targeted delivery show liposomal antibiotics potential in the treatment of microbial infections.
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Affiliation(s)
- Moayad Alhariri
- Laurentian University, The Novel Drug & Vaccine Delivery Systems Facility, Department of Chemistry and Biochemistry , Sudbury, ON, P3E 2C6 , Canada +1 705 675 1151 ext. 2190 ; +1 705675 4844 ;
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McGregor JC, Bearden DT, Townes JM, Sharp SE, Gorman PN, Elman MR, Mori M, Smith DH. Comparison of antibiograms developed for inpatients and primary care outpatients. Diagn Microbiol Infect Dis 2013; 76:73-9. [PMID: 23541690 DOI: 10.1016/j.diagmicrobio.2013.01.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Revised: 11/30/2012] [Accepted: 01/24/2013] [Indexed: 10/27/2022]
Abstract
To support antimicrobial stewardship, some healthcare systems have begun creating outpatient antibiograms. We developed inpatient and primary care outpatient antibiograms for a regional health maintenance organization (HMO) and academic healthcare system (AHS). Antimicrobial susceptibilities from 16,428 Enterococcus, Staphylococcus aureus, Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa cultures from 2010 were summarized and compared. Methicillin susceptibility among S. aureus was similar in inpatients and primary care outpatients (HMO: 61.2% versus 61.9%, P = 0.951; AHS: 62.9% versus 63.3%, P > 0.999). E. coli susceptibility to trimethoprim/sulfamethoxazole was also similar (HMO: 81.8% versus 83.6%, P = 0.328; AHS: 77.2% versus 80.9%, P = 0.192), but ciprofloxacin susceptibility differed (HMO: 88.9% versus 94.6%, P < 0.001; AHS: 81.2% versus 90.6%, P < 0.001). In the HMO, ciprofloxacin-susceptible P. aeruginosa were more frequent in primary care outpatients than in inpatients (91.4% versus 79.0%, P = 0.007). Comparison of cumulative susceptibilities across settings yielded no consistent patterns; therefore, outpatient primary care antibiograms may more accurately inform prudent empiric antibiotic prescribing.
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Affiliation(s)
- Jessina C McGregor
- Department of Pharmacy Practice, College of Pharmacy, Oregon State University/Oregon Health & Science University, Portland, OR 97239, USA.
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Fu J, Ye X, Chen C, Chen S. The efficacy and safety of linezolid and glycopeptides in the treatment of Staphylococcus aureus infections. PLoS One 2013; 8:e58240. [PMID: 23484002 PMCID: PMC3590119 DOI: 10.1371/journal.pone.0058240] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Accepted: 02/01/2013] [Indexed: 01/22/2023] Open
Abstract
To assess the effectiveness and safety of linezolid in comparison with glycopeptides (vancomycin and teicoplanin) for the treatment of Staphylococcus aureus infections, we conducted a meta-analysis of relevant randomized controlled trials. A thorough search of Pubmed and other databases was performed. Thirteen trials on 3863 clinically assessed patients were included. Linezolid was slightly more effective than glycopeptides in the intent-to-treat population (odds ratio [OR], 1.05; 95% confidence interval [CI], 1.01–1.10), was more effective in clinically assessed patients (OR 95% CI: 1.38, 1.17–1.64) and in all microbiologically assessed patients (OR 95% CI: 1.38, 1.15–1.65). Linezolid was associated with better treatment in skin and soft-tissue infections (SSTIs) patients (OR 95% CI: 1.61, 1.22–2.12), but not in bacteraemia (OR 95% CI: 1.24, 0.78–1.97) or pneumonia (OR 95% CI: 1.25, 0.97–1.60) patients. No difference of mortality between linezolid and glycopeptides was seen in the pooled trials (OR 95% CI: 0.98, 0.83–1.15). While linezolid was associated with more haematological (OR 95% CI: 2.23, 1.07–4.65) and gastrointestinal events (OR 95% CI: 2.34, 1.53–3.59), a significantly fewer events of skin adverse effects (OR 95% CI: 0.27, 0.16–0.46) and nephrotoxicity (OR 95% CI: 0.45, 0.28–0.72) were recorded in linezolid. Based on the analysis of the pooled data of randomized control trials, linezolid should be a better choice for treatment of patients with S. aureus infections, especially in SSTIs patients than glycopeptides. However, when physicians choose to use linezolid, risk of haematological and gastrointestinal events should be taken into account according to the characteristics of the specific patient populations.
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Affiliation(s)
- Jinjian Fu
- Department of Epidemiology, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, Guangdong, China
- Guangdong Key Laboratory of Molecular Epidemiology, Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, Guangdong, China
- Department of Laboratory Medicine, Liuzhou Municipal Maternity and Child Healthcare Hospital, Liuzhou, Guangxi, China
| | - Xiaohua Ye
- Department of Epidemiology, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, Guangdong, China
- Guangdong Key Laboratory of Molecular Epidemiology, Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, Guangdong, China
| | - Cha Chen
- Department of Laboratory Medicine, Guangzhou High Education Mega Centre Hospital, Branch of Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou, Guangdong, China
| | - Sidong Chen
- Guangdong Key Laboratory of Molecular Epidemiology, Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, Guangdong, China
- * E-mail:
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Garcia MC, Finola MS, Marioli JM. Bioassay Directed Identification of Royal Jelly’s Active Compounds against the Growth of Bacteria Capable of Infecting Cutaneous Wounds. ACTA ACUST UNITED AC 2013. [DOI: 10.4236/aim.2013.32022] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Matthews P, Alpert M, Rahav G, Rill D, Zito E, Gardiner D, Pedersen R, Babinchak T, McGovern PC. A randomized trial of tigecycline versus ampicillin-sulbactam or amoxicillin-clavulanate for the treatment of complicated skin and skin structure infections. BMC Infect Dis 2012; 12:297. [PMID: 23145952 PMCID: PMC3560230 DOI: 10.1186/1471-2334-12-297] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2011] [Accepted: 11/01/2012] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Complicated skin and skin structure infections (cSSSIs) frequently result in hospitalization with significant morbidity and mortality. METHODS In this phase 3b/4 parallel, randomized, open-label, comparative study, 531 subjects with cSSSI received tigecycline (100 mg initial dose, then 50 mg intravenously every 12 hrs) or ampicillin-sulbactam 1.5-3 g IV every 6 hrs or amoxicillin-clavulanate 1.2 g IV every 6-8 hrs. Vancomycin could be added at the discretion of the investigator to the comparator arm if methicillin-resistant Staphylococcus aureus (MRSA) was confirmed or suspected within 72 hrs of enrollment. The primary endpoint was clinical response in the clinically evaluable (CE) population at the test-of-cure (TOC) visit. Microbiologic response and safety were also assessed. The modified intent-to-treat (mITT) population comprised 531 subjects (tigecycline, n = 268; comparator, n = 263) and 405 were clinically evaluable (tigecycline, n = 209; comparator, n = 196). RESULTS In the CE population, 162/209 (77.5%) tigecycline-treated subjects and 152/196 (77.6%) comparator-treated subjects were clinically cured (difference 0.0; 95% confidence interval [CI]: -8.7, 8.6). The eradication rates at the subject level for the microbiologically evaluable (ME) population were 79.2% in the tigecycline treatment group and 76.8% in the comparator treatment group (difference 2.4; 95% CI: -9.6, 14.4) at the TOC assessment. Nausea, vomiting, and diarrhea rates were higher in the tigecycline group. CONCLUSIONS Tigecycline was generally safe and effective in the treatment of cSSSIs. TRIAL REGISTRATION ClinicalTrials.gov NCT00368537.
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Affiliation(s)
- Peter Matthews
- Department of Family Medicine, Department of Health, Mpumalanga, Middelburg, 1050, South Africa
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Hao H, Dai M, Wang Y, Huang L, Yuan Z. Key genetic elements and regulation systems in methicillin-resistant Staphylococcus aureus. Future Microbiol 2012; 7:1315-29. [DOI: 10.2217/fmb.12.107] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA), popularly known as a type of superbug, has been a serious challenge for animal and human health. S. aureus has developed methicillin resistance mainly by expression of β-lactamase and PBP2a, which is regulated by the blaZ–blaI–blaR1 and mecA–mecI–mecRI systems. Other genetic elements, including murE and femA, also participate in expression of methicillin resistance, but the mechanism remains unclear. The evolution of the staphylococcal cassette chromosome mec determines the epidemiological risk of MRSA. The plasmid-located gene cfr might contribute to multiresistance and transmission of MRSA. Some virulence factors, including Panton–Valentine leukocidin, phenol-soluble modulin, arginine catabolic mobile element and other toxin elements enhance the pathogenesis and fitness of MRSA. Two-component regulation systems (agr, saeRS and vraRS) are closely associated with pathogenesis and drug resistance of MRSA. The systematic exploration of key genetic elements and regulation systems involved in multidrug resistance/pathogenesis/transmission of MRSA is conclusively integrated into this review, providing fundamental information for the development of new antimicrobial agents and the establishment of reasonable antibiotic stewardship to reduce the risk of this superbug.
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Affiliation(s)
- Haihong Hao
- National Reference Laboratory of Veterinary Drug Residues (HZAU) & MOA Key Laboratory for the Detection of Veterinary Drug Residues in Foods, Huazhong Agricultural University, Wuhan, Hubei 430070, China
| | - Menghong Dai
- National Reference Laboratory of Veterinary Drug Residues (HZAU) & MOA Key Laboratory for the Detection of Veterinary Drug Residues in Foods, Huazhong Agricultural University, Wuhan, Hubei 430070, China
| | - Yulian Wang
- National Reference Laboratory of Veterinary Drug Residues (HZAU) & MOA Key Laboratory for the Detection of Veterinary Drug Residues in Foods, Huazhong Agricultural University, Wuhan, Hubei 430070, China
| | - Lingli Huang
- National Reference Laboratory of Veterinary Drug Residues (HZAU) & MOA Key Laboratory for the Detection of Veterinary Drug Residues in Foods, Huazhong Agricultural University, Wuhan, Hubei 430070, China
| | - Zonghui Yuan
- National Reference Laboratory of Veterinary Drug Residues (HZAU) & MOA Key Laboratory for the Detection of Veterinary Drug Residues in Foods, Huazhong Agricultural University, Wuhan, Hubei 430070, China
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Dalhoff A. Global fluoroquinolone resistance epidemiology and implictions for clinical use. Interdiscip Perspect Infect Dis 2012; 2012:976273. [PMID: 23097666 PMCID: PMC3477668 DOI: 10.1155/2012/976273] [Citation(s) in RCA: 212] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2012] [Accepted: 06/26/2012] [Indexed: 12/22/2022] Open
Abstract
This paper on the fluoroquinolone resistance epidemiology stratifies the data according to the different prescription patterns by either primary or tertiary caregivers and by indication. Global surveillance studies demonstrate that fluoroquinolone resistance rates increased in the past years in almost all bacterial species except S. pneumoniae and H. influenzae, causing community-acquired respiratory tract infections. However, 10 to 30% of these isolates harbored first-step mutations conferring low level fluoroquinolone resistance. Fluoroquinolone resistance increased in Enterobacteriaceae causing community acquired or healthcare associated urinary tract infections and intraabdominal infections, exceeding 50% in some parts of the world, particularly in Asia. One to two-thirds of Enterobacteriaceae producing extended spectrum β-lactamases were fluoroquinolone resistant too. Furthermore, fluoroquinolones select for methicillin resistance in Staphylococci. Neisseria gonorrhoeae acquired fluoroquinolone resistance rapidly; actual resistance rates are highly variable and can be as high as almost 100%, particularly in Asia, whereas resistance rates in Europe and North America range from <10% in rural areas to >30% in established sexual networks. In general, the continued increase in fluoroquinolone resistance affects patient management and necessitates changes in some guidelines, for example, treatment of urinary tract, intra-abdominal, skin and skin structure infections, and traveller's diarrhea, or even precludes the use in indications like sexually transmitted diseases and enteric fever.
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Affiliation(s)
- Axel Dalhoff
- Institute for Infection-Medicine, Christian-Albrechts Univerity of Kiel and University Medical Center Schleswig-Holstein, Brunswiker Straße 4, 24105 Kiel, Germany
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Medel N, Panchal N, Ellis E. Postoperative care of the facial laceration. Craniomaxillofac Trauma Reconstr 2012; 3:189-200. [PMID: 22132257 DOI: 10.1055/s-0030-1268516] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
The purpose of this investigation is to examine factors involved in the postoperative care of traumatic lacerations. An evidence-based comprehensive literature review was conducted. There are a limited number of scientifically proven studies that guide surgeons and emergency room physicians on postoperative care. Randomized controlled trials must be conducted to further standardize the postoperative protocol for simple facial lacerations.
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Daka D, G/Silassie S, Yihdego D. Antibiotic-resistance Staphylococcus aureus isolated from cow's milk in the Hawassa area, South Ethiopia. Ann Clin Microbiol Antimicrob 2012; 11:26. [PMID: 25927182 PMCID: PMC3549789 DOI: 10.1186/1476-0711-11-26] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2012] [Accepted: 08/20/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Quarter milk samples from cows were examined to determine the prevalence of Staphylococcus aureus (SA) and different antibiotic resistant pattern were determined in a cross-sectional study design. OBJECTIVE The objective of this study was to isolate Staphylococcus aureus from samples of cow's milk obtained from Hawassa area and to determine their antibiotic susceptibility patterns. METHOD A total of 160 milk (CCP1-CCP5) samples were collected and screened for the presence of S. aureus. Gram staining, oxidase, catalase, DNase, haemolysis and coagulase tests were employed for bacterial identification. RESULTS All the samples were contaminated with S. aureus. A total of 78 S. aureus isolates were obtained during this study. The levels of contamination with S. aureus were higher in milk obtained from CCP1, CCP2, CCP3, CCP4 and CCP5 at Hawassa area farms (18.0%, 25.6%, 27.0%, 21.8% and 7.7%) respectively. A large percentage of the S. aureus isolates (25.6% and 27.0%) were from CCP2 and CCP3. All strains were resistant to Penicillin G (PG) (10 μg), Ampicillin (AP) (10 μg), Amoxicillin-Clavulanic acid (AC) (30 μg), Ciprofloxacin (CIP) (5 μg), Erythromycin (E) (15 μg), Ceftriaxone (CRO) (30 μg), Trimethoprime-Sulfamethoxazole (TMP-SMZ) (25 μg) Oxacillin (Ox) (1 μg) and Vancomycin (V) (30 μg), 67.9%, 70.9%, 30.9%, 0%, 32.1%, 23.1%, 7.7%, 60.3% and 38.5% respectively. CONCLUSION The proportion of isolates resistant to CIP, TMP-SMZ, CRO, AC, E and V were low compared to AP, PG and Ox. S. aureus is normally resident in humans; therefore, the S. aureus present in the cow's milk may have resulted from transmission between the two species, emphasizing the need to improve sanitary conditions in the milking environment.
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Affiliation(s)
- Deresse Daka
- Hawassa University College of Medicine and Health sciences, Hawassa, Ethiopia.
| | | | - Dawit Yihdego
- Hawassa University College of Medicine and Health sciences, Hawassa, Ethiopia.
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