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Ofloxacin versus trimethoprim/sulfamethoxazole in the treatment of uncomplicated urinary tract infection.

A multicenter randomized study was conducted to compare the efficacy and safety of ofloxacin with that of trimethoprim/sulfamethoxazole (TMP/SMX) in the treatment of uncomplicated urinary tract infection in adults. Patients were randomized to receive either oral ofloxacin 200 mg daily for three days (102 patients), or oral TMP/SMX 160 mg/800 mg twice daily for seven days (100 patients). The pathogen was eradicated in 73 (97.3%) of the 75 evaluable patients receiving ofloxacin and in 66 (97.1%) of the 68 evaluable patients receiving TMP/SMX. The most frequently isolated pathogens were Escherichia coli, Klebsiella pneumoniae, and Proteus mirabilis. More urinary pathogens were susceptible to ofloxacin than to TMP/SMX, although this difference was not statistically significant. The clinical cure rate for patients receiving ofloxacin was 93.3%, with 4% improved and 2.7% failed. For patients receiving TMP/SMX, the clinical cure rate was 86.4%, with 12.1% improved and 1.5% failed. Side effects were reported by 29.7% of the patients receiving ofloxacin and by 40.4% of the patients receiving TMP/SMX. Drug-related adverse experiences, as determined by the investigators, occurred in 5% of the ofloxacin patients and in 15.2% of the TMP/SMX patients, a statistically significant difference. No patients receiving ofloxacin, compared with three patients receiving TMP/SMX, discontinued therapy because of an adverse reaction. These results indicate that short-course ofloxacin is as effective as TMP/SMX in the treatment of uncomplicated urinary tract infection. Ofloxacin therapy is also better tolerated than TMP/SMX.

Adolescent↗

Role of viruses in febrile convulsions.

A disseminated viral illness was demonstrated by isolating a virus from the CSF, blood or urine in 27% of 73 children who were admitted to hospital after a first febrile convulsion. However, a viral aetiology could be implicated for 86% of the children after combining results of tissue culture, electron microscopy, mouse inoculation, complement fixation tests, and interferon assay. Parallel bacterial cultures showed a possible pathogen in 29% of children, but in only 4% was the pathogen isolated from the CSF, blood, or urine. No correlation was found between the nature of the pathogen (or evidence of its dissemination) and the severity of the convulsion, degree of fever, CSF protein, CSF white cells, or the WBC. The results suggest that a febrile convulsion could be a response to invasion of the blood stream or central nervous system by a micro-organism which is usually a virus. Invasion may be of such brief duration that successful isolation of the virus from the blood, CSF, or urine in not more commonly achieved.

Child↗

Comparative pathogenicity of Trichomonas vaginalis isolated from symptomatic and asymptomatic cases.

Pathogenicity of 19 isolates of Trichomonas vaginalis obtained from vaginal specimens were studied in the murine model by intraperitoneal inoculation. Sixteen isolates were recovered from the females with various clinical conditions and 3 isolates were from normal healthy females. Pathogenicity level of these isolates were studied by inoculating 5 mice per isolate through intraperitoneal route and the animals were sacrificed on the 10th day post-inoculation. In general, all the isolates recovered produced infection in mice. On comparison with the reference strain obtained from Hoechst India Ltd., seven isolates recovered from symptomatic cases and one strain from healthy females produced severe infection in mice. Though variation in the pathogenicity level was observed among the isolates, a definite correlation between the clinical picture in the natural host and pathogenicity in mice was not observed.

Animals↗

Sieve analysis: methods for assessing from vaccine trial data how vaccine efficacy varies with genotypic and phenotypic pathogen variation.

A key component in the evaluation of efficacy of a vaccine to protect against disease caused by an antigenically diverse infectious pathogen in a preventative vaccine trial is assessing how vaccine-induced protection depends on genotypic and phenotypic variations of the exposing pathogen. This assessment is made by comparing pathogen isolates between infected vaccinated subjects and infected unvaccinated subjects. A survey of efficacy trial reports reveals a lack of systematic, quantitative investigation in this question. Analysis tools for testing if vaccine protection against disease is superior against some pathogen strains, and for estimating the magnitude of this differential vaccine protection, are described. The broad applicability of the methods is illustrated through analysis of isolates taken from persons infected while participating in vaccine trails for cholera, HIV-1, hepatitis B, rotavirus, and pneumococcus. These analyses reveal intriguing trends for Genentech's monovalent rgp120 HIV-1 vaccine, for two whole-killed-cell oral cholera vaccines, and for other vaccines.

Cholera↗

Urinary tract infection trends in Latin American hospitals: report from the SENTRY antimicrobial surveillance program (1997-2000).

Urinary tract infections (UTI) are one of the most common infectious diseases diagnosed in outpatients as well as in hospitalized patients. The objective of this study was to report the frequency of occurrence and antimicrobial susceptibility of uropathogens collected in Latin America between 1997 to 2000 through the SENTRY Antimicrobial Surveillance Program. Antimicrobial susceptibility testing was performed and results interpreted using reference broth microdilution methods. In the 4 year period, a total of 1961 urine isolates from hospitalized patients were included. The patients' mean age was 51.3 years and most of the infections occurred among women (65.6%). Esherichia coli was the most frequent pathogen isolated followed by Klebsiella spp., Pseudomonas aeruginosa, and Proteus mirabilis. Among the E. coli isolates, piperacillin/tazobactam, aztreonam, extended-spectrum cephalosporins, carbapenems and amikacin constitute reasonable therapeutic options for treatment of serious UTI in Latin America (91.0-100.0% susceptible). High resistance rates to fluoroquinolones (17.5-18.9%) and trimethoprim/sulfamethoxazole (>45.0%) were observed among the E. coli. In contrast, nitrofurantoin displayed susceptibility rate of > 87.0%. Against Klebsiella spp. infections, the only effective therapeutic option would be the carbapenems due to the high number of isolates (>30.0%) producing extended-spectrum beta-lactamases (ESBL). Even the new fluoroquinolones showed limited activity against Klebsiella spp. (72.1-88.6% susceptible) and the P. aeruginosa isolates showed high resistance rates to most antimicrobial agents tested. The results of this survey endorse the importance of Enterobacteriaceae as cause of UTI in Latin America. Our results also demonstrate that the uropathogens isolated in the Latin American medical centers exhibit high resistance to various classes of antimicrobial agents. Carbapenem-resistant P. aeruginosa, ciprofloxacin-resistant E. coli, ESBL-producing K. pneumoniae constitute serious problem in this geographic region.

Adolescent↗

A new plating medium for the isolation of enteric pathogens. I. hektoen enteric agar.

A new agar plating medium for the isolation of enteric pathogens is described. This medium contains greater quantities of peptone to offset the inhibitory effects of bile salts. Additional carbohydrates and larger quantities of those previously used have also been incorporated into the medium to differentiate pathogens from some of the slow lactose fermenters. The use of an indicator system never used before in a differential plating medium opens new possibilities for improvement over traditional and newer selective media. Known strains from the various genera of Enterobacteriaceae have been tested for colonial differentiation as well as for possible inhibitory effects. The results show the medium to be highly selective for the shigellae as well as for other enteric pathogens.

Agar↗

[Incidence of selected bacterial pathogens of the respiratory tract in patients with bronchial asthma].

Chronic bacterial infections intensify the reactivity of bronchi and aggravate the course and the control of asthma. They cause the disorders of both function and the structure of respiratory epithelium. Not only structural elements of bacteria but also their toxins intensify the release of mediators of the inflammatory reaction (leucotriens, histamine, IL1, IL4, IL6, IL8, TNF alpha). The aim of our research is to determine the prevalence of microorganisms, which can have an influence on the course of asthma. Moraxella catarrhalis has been the most frequent isolated pathogen (23.7%) in patients with bronchial asthma. We have received only individual isolations of Streptococcus pneumoniae and Haemophilus influenzae strains. Bacterial flora of the upper respiratory tract in patients with bronchial asthma has been more diverse in comparison with microflora of airways in healthy subjects. The significant percentage of Candida isolation in asthmatics (over 30% in bronchial tree secretion) poses the high risk of incidence of mycotic complications of inhaled steroids. In patients with asthma bronchial tree secretion is more valuable diagnostic material than pharyngeal swab.

Asthma↗

Nosocomial bacterial infections among children with severe protein energy malnutrition.

The incidence of hospital acquired acute bacterial infections among 164 severely malnourished children admitted to the paediatric wards at the Muhimbili Medical Centre in Dar es Salaam were studied. On admission, ninety two per cent of the patients had at least one form of bacterial infection. During the subsequent two weeks hospital stay, 49% of the patients acquired a new infection. Septicaemia and urinary tract infection (UTI) were the commonest infections. Staphylococcus aureus was the commonest organism in the former, while gram negative organisms, Escherichia coli and Klebsiella species, were predominant in the latter. Pathogens similar to those found from patients were cultured from random samples taken from the floor, beds, towels, sinks and antiseptic containers in the wards. Sensitivity patterns of isolated pathogens to antimicrobial agents showed that S. aureus was highly sensitive to cloxacillin, erythromycin, and gentamicin, while the gram negative organisms were highly sensitive to gentamicin. Our study shows that the problem of nosocomial infection in paediatric wards requires urgent attention. There is a need to institute preventive measures including provision of proper nursing care, maintenance of sterile environment, and reduction of duration of hospital stay.

Academic Medical Centers↗

[Identification and characteristics of the conjugative R plasmids of conditionally pathogenic E. coli isolated from chronic pyelonephritis patients].

The study on 63 strains of conditionally pathogenic E. coli isolated from patients with chronic pyelonephritis showed that the bacteria of the 47 strains (74.6%) were resistant to one or several antibiotics. 7 strains of such bacteria carried R-plasmids capable of transferring into the cells of E. coli K-12 during conjugation. Most of the identified 9 R-plasmids belonged to the class of the F-like plasmids and were characterized by similar lots of antibiotic resistance markers. DNA of the detected R-plasmids were treated with endonuclease (restrictase) EcoRI. After that the fragments were analysed by means of electrophoresis in agarose gel. On the basis of the restrictogrames it was concluded that the plasmids studied were not identical. A possibility of detecting complexes consisting of different plasmids carrying similar lots of antibiotic resistance markers in the cells of the same strain was shown.

Chemical Phenomena↗

Klebsiella pneumoniae fascial space infections of the head and neck in Taiwan: emphasis on diabetic patients and repetitive infections.

OBJECTIVES: To assess the epidemiological features, clinical characteristics, treatment, and outcome of head and neck infections caused by Klebsiella pneumoniae. METHODS: We reviewed records of four common aerobic pathogens isolated by the microbiological laboratory of a teaching hospital in Taiwan from July 1995 to December 1999. Patients aged 14 or older with community-acquired fascial space infections of head and neck were identified by review of medical records and included in the study. RESULTS: A total of 100 cases were identified, and K. pneumoniae was the most common pathogen of monomicrobial infections (48%), followed by viridans streptococci (15%). Polymicrobial infections were noted in 35 cases. In comparison with patients with infections not caused by K. pneumoniae, those with monomicrobial K. pneumoniae infections were older (P = 0.04) and had a higher prevalence of diabetes mellitus (P < 0.001), a longer duration of antimicrobial therapy (P = 0.007), a longer hospital stay (P = 0.001), and more repetitive infections (P = 0.001). All but one of K. pneumoniae isolates were susceptible to first generation cephalosporins and aminoglycosides. CONCLUSIONS: K. pneumoniae is an important endemic pathogen of fascial space infections of head and neck in Taiwan, especially among diabetics. Physicians should be aware of the tendency of this organism to cause repetitive infection.

Adult↗

Eradication of common pathogens at days 2, 3 and 4 of moxifloxacin therapy in patients with acute bacterial sinusitis.

BACKGROUND: Acute bacterial sinusitis (ABS) is a common infection in clinical practice. Data on time to bacteriologic eradication after antimicrobial therapy are lacking for most agents, but are necessary in order to optimize therapy. This was a prospective, single-arm, open-label, multicenter study to determine the time to bacteriologic eradication in ABS patients (maxillary sinusitis) treated with moxifloxacin. METHODS: Adult patients with radiologically and clinically confirmed ABS received once-daily moxifloxacin 400 mg for 10 days. Middle meatus secretion sampling was performed using nasal endoscopy pre-therapy, and repeated on 3 consecutive days during treatment. Target enrollment was 30 bacteriologically evaluable patients (pre-therapy culture positive for Streptococcus pneumoniae, Haemophilus influenzae or Moraxella catarrhalis and evaluable cultures for at least Day 2 and Day 3 during therapy visits), including at least 10 each with S. pneumoniae or H. influenzae. RESULTS: Of 192 patients enrolled, 42 were bacteriologically evaluable, with 48 pathogens isolated. Moxifloxacin was started on Day 1. Baseline bacteria were eradicated in 35/42 (83.3%) patients by day 2, 42/42 (100%) patients by day 3, and 41/42 (97.6%) patients by day 4. In terms of individual pathogens, 12/18 S. pneumoniae, 22/23 H. influenzae and 7/7 M. catarrhalis were eradicated by day 2 (total 41/48; 85.4%), and 18/18 S. pneumoniae and 23/23 H. influenzae were eradicated by day 3. On Day 4, S. pneumoniae was isolated from a patient who had negative cultures on Days 2 and 3. Thus, the Day 4 eradication rate was 47/48 (97.9%). Clinical success was achieved in 36/38 (94.7%) patients at the test of cure visit. CONCLUSION: In patients with ABS (maxillary sinusitis), moxifloxacin 400 mg once daily for 10 days resulted in eradication of baseline bacteria in 83.3% of patients by Day 2, 100% by Day 3 and 97.6% by Day 4.

Journal Article↗

[Molecular biological analysis of Tinea faciei caused by a clinically anomalous strain of Trichophyton mentagrophytes].

We report a case of Trichophyton mentagrophytes infection. A 27-year-old female dairy worker visited our hospital in August 2001 for evaluation of an erythematous lesion near her right eye. The patient had been treated with antibiotics and an anti-allergic drug at another clinic with no effect on the lesion. KOH preparation of the scale revealed mycelia and T. mentagrophytes was isolated from the culture. The isolated pathogen was identified as T. mentagrophytes animal type 1 by the classification system based on the cluster analysis of nuclear ribosomal internal transcribed spacer 1 (ITS1) DNA sequences. The oral administration of terbinafine at 125 mg/day and antifungal cream was effective. T. mentagrophytes is one of the most common dermatophytes isolated from humans and animals. We should be aware that animals may carry this kind of fungal pathogen.

Administration, Oral↗

[Bacterial epidemiological study of acute otitis media in children observed at home in the Nord Pas-de-Calais region].

BACKGROUND: The aim of this work is the study of the bacteriologic epidemiology of acute otitis media in infants observed at home in Nord Pas-de-Calais area, and the analysis of bacteria associated to recurrent otitis and clinical failure. OBSERVATIONS: A total of 295 specimens of ear pus specimens were collected from children (mean age: 18 months; average: one month-12 years). Pneumococcus strains were isolated from 52% of samples and 80% of these showed resistance to penicillin. H. influenzae was found in 35% of specimens and the half produced a beta lactamase. Pneumococcus is the predominant pathogen isolated in prolonged otitis media, while H. influenzae is preferentially found during recurrent otitis media. The main bacteriologic cause of failure traitement was penicillin-intermediate or -resistant pneumococci. The therapy administered 48 to 72 hours before collection of ear pus sample in therapeutic failure was ineffective (oral cephalosporins or macrolides), or administered to low dosage (50 mg/kg/j). CONCLUSION: Our results demonstrate, in opposition to other studies, Streptococcus pneumoniae as the most frequent pathogen in acute otitis media. They also show the excellent correlation between antibiotic therapy and clinical failures.

Bacterial Infections↗

Efficacy and safety of cefpirome (HR810).

Sixty adult patients with suspected systemic bacterial infections were treated with cefpirome 1 g or 2 g twice daily for 5-22 days. Forty-seven patients were evaluable for clinical efficacy. Diagnoses in evaluable patients were urinary tract infections (20), pneumonia (10), soft tissue infections (17), and bone and joint infections (4); four patients had two infections each. Nine patients were bacteraemic and all were cured; the responsible bacteria were Escherichia coli (6), Streptococcus pneumoniae (1), Pseudomonas aeruginosa (1), and Haemophilus influenzae (1). One patient with a soft tissue infection failed to respond clinically to cefpirome. Bacteriologically, 41 of 48 isolated pathogens (85%) were eradicated. In wound cultures, three strains of Staphylococcus aureus and one each of Ps. aeruginosa and Str. faecalis persisted. One Enterobacter sp. relapsed in urine. Of isolated strains, only Str. faecalis and methicillin resistant Staph, epidermidis were resistant to cefpirome. Staph, aureus strains were inhibited in vitro by 0.25 to 2 mg/l of cefpirome in agar dilution. Adverse effects, probably or possibly related to cefpirome, were skin reactions (3), fever (1), Clostridium difficile diarrhoea (2), and disturbed taste sensation (1). Tolerance was good. Cefpirome is suitable for large-scale comparative trials.

Adult↗

Efficacy, safety and tolerability of azithromycin versus roxithromycin in the treatment of acute lower respiratory tract infections.

In an open, multicentre study, the clinical and bacteriological efficacy, safety and tolerance of azithromycin and roxithromycin were compared in a total of 204 adults with acute lower respiratory tract infections (LRTIs) [acute bronchitis, acute infectious exacerbations of chronic bronchitis (AIECBs), or pneumonia]. Following treatment with 500 mg/day azithromycin administered orally once daily for 3 days, a satisfactory clinical response of cure or improvement was recorded in 91/99 (91.9%) evaluable patients at the post-therapy evaluation (day 10-14). Of the 94 evaluable patients treated with roxithromycin (150 mg given orally twice daily for 10 days), 82 (87.2%) were classified as cured or improved at post-therapy. The main pathogens isolated before treatment were Staphylococcus aureus, Streptococcus pneumoniae, Streptococcus species, Haemophilus influenzae and Moraxella catarrhalis. In the 46 azithromycin-treated patients evaluated both clinically and bacteriologically, 92.0% of pathogens were eradicated; H. influenzae persisted in one azithromycin-treated patient with acute bronchitis who was classed as clinically improved. In the roxithromycin group, 81.1% of the pathogens were eradicated in 35 patients; S. aureus persisted in one clinically cured patient with acute bronchitis, and H. influenzae persisted in one patient with AIECB and one with pneumonia, and Haemophilus species in one with AIECB, who were all classified as clinically improved. Azithromycin was well tolerated with a lower incidence of adverse events than that recorded in the roxithromycin treatment group. Treatment was not discontinued due to adverse events in any of the azithromycin-treated patients, whereas two roxithromycin-treated patients were withdrawn from treatment due to vomiting and/or dyspepsia.

Acute Disease↗

Antibiotic resistance among respiratory pathogens in preschool children.

OBJECTIVE: To determine the prevalence of antibiotic resistance among common respiratory pathogens circulating in the community. DESIGN: Survey of common respiratory pathogens isolated from nasal discharges. SETTING: 117 childcare centres and kindergartens in metropolitan Melbourne between May and July 1991-1993 and 42 from sociodemographically matching suburbs in Sydney between May and July, 1993. SUBJECTS: Children aged six years and under with nasal discharge. OUTCOME MEASURES: Resistance to penicillins, erythromycin and tetracycline among isolates of Haemophilus influenzae, Streptococcus pneumoniae, Moraxella (Branhamella) catarrhalis and Staphylococcus aureus. RESULTS: A total of 2286 nasal discharge swabs were collected. Amoxycillin resistance was detected in 99 of 711 isolates of H. influenzae (13.9%) and penicillin resistance in 781 of 834 isolates of M. catarrhalis (93.6%), 342 of 375 isolates of S. aureus (91.2%), and 30 of 781 isolates of S. pneumoniae (3.9%). Of 86 strains of H. influenzae type b isolated, 20 (23.3%) produced beta-lactamase. Penicillin resistance tended to become more common among isolates of H. influenzae and S. pneumoniae during the three-year period. CONCLUSION: Antibiotic resistance, mediated by beta-lactamase or altered penicillin-binding proteins, among respiratory pathogens carried by preschool children was significant and possibly increasing. This highlights the impact of prescribed antibiotics in the community and the folly of prescribing the limited store of antibiotics for viral infections.

Bacteria↗

[Enterobacterial sensitivity to beta-lactam antibiotics].

The susceptibility to betalactams of 868 enteric bacteria isolated from the patients at the hospital was studied. The isolated pathogens included: E. coli (549), Klebsiella sp. (195), Serratia sp. (124). Ampicillin and cefazoline demonstrated the lowest activity. Cefotaxime, ceftazidime and imipenem were active against 90 per cent of isolates. Among E. coli isolates the susceptibility to the above mentioned drugs was the following: 95.1, 96.9, 99.3 per cent, among Klebsiella sp.--89.7, 88.7, 97.9 per cent, among Proteus sp.--89.5, 90.3, 91.9 per cent respectively. Thus cefotaxime may be used in antibacterial empiric therapy if Pseudomonas aeruginosa infection is excluded.

Anti-Bacterial Agents↗

Travelers' diarrhea among United States military personnel during joint American-Egyptian armed forces exercises in Cairo, Egypt.

A study was conducted of travelers' diarrhea in a United States military population on deployment in Cairo, Egypt, during July and August 1987. Acute diarrhea requiring medical attention developed in 183 (4%) of 4,500 troops. A possible etiologic agent was identified in 49% of all diarrhea cases. Enteric pathogens associated with cases of diarrhea included: Enterotoxigenic Escherichia coli (17% ST-producers, 13% LT-producers, and 3% LT/ST-producers); Shigella (9%); Campylobacter spp. (2%); Salmonella (2%); and Vibrio cholerae non-01 serogroup (2%). Other enteric pathogens isolated from one episode each of diarrhea included Aeromonas hydrophila group, Plesiomonas shigelloides, and Bacillus cereus. Yersinia enterocolitica, enteroinvasive E. coli, intoxications by Clostridium perfringens and Clostridium difficile, and pathogenic enteric parasites were not found in any of the 183 patients with diarrhea. A survey of military personnel not requesting medical care indicated that up to 40% of troops may have had diarrhea during this deployment. Acute gastroenteritis is a potential cause of substantial morbidity in U.S. military personnel deployed to Egypt.

Adolescent↗