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PubMed2002

[Indicators for early diagnosis of enterohemorrhagic Escherichia coli infection and methods for final diagnosis].

Bloody diarrhea, abdominal cramp, history of barbecued beef for dinner at a restaurant and evidence of outbreak are important signs of Enterohemorrhagic Escherichia coli (EHEC) infections. Although early antibiotics therapy, such as fosfomycin and fluoroquinolones, is considered to be effective in Japan, stool cultures before antibiotics are essential for final diagnosis. In cases of hemorrhagic colitis or hemolytic uremic syndrome, when cultures are negative, detection of anti O-type specific lipopolysaccharides IgM antibodies is useful for estimate of causative EHEC. In our hospital, non-O157 EHECs increase in number as the causes of pediatric HUS since 1999.

Biomarkers↗

PubMed2002

[TVT procedure--the critical analysis of clinical effectiveness and complications among first 100 cases].

RATIONALE: Since its clinical debut in 1996 TVT procedure has been offering an excellent clinical tool both for patients and surgeons to treat SUI suffering women. Since the learning curve is an important factor influencing the rate of surgical complications as well as the clinical outcome of any new surgical technique we decided to analyse the first 100 cases of SUI women treated with TVT technique. AIM OF THE STUDY: To analyse clinical effectiveness and complications among first 100 consecutive cases of TVT procedures. MATERIAL AND METHODS: One hundred women aged from 30 to 89 years (old mean 55.6) were hospitalised in our Department from September 1999 to November 2000 because of SUI as confirmed by the complete urogynecologic assessment including history and physical examinations, catheterised residual volume determination, and multichannel urodynamic testing. TVT procedure was performed as originally described by Ulmsten et al. except the fact that 43 operations were performed not under local but epidural anesthesia. For 80 patients TVT was offered as the primary surgery for SUI treatment whereas for 14 it was the second and for 6 the third or more attempt. RESULTS: Operation was performed without any technical difficulties in all cases (mean time 25 min). Bladder injury (treated by 1 or 2 days catheterization) occurred in 9 cases, urinary retention in 13 (in 6 cases after 10-14 days tape was cut). Urinary tract infections occurred in 4 women despite intraoperative 2.0 g i.v. piperacillin prophylactics and fosfomycin trometamol 3.0 g p.o. in first postoperative day. Subsequent urge incontinence developed in 4 patients. Clinical efficacy based on medical history, cough test and Gaudenz questionnaire was 95% (observation period 3 to 16 months, mean 8 months). CONCLUSIONS: In our opinion TVT procedure is an operation of choice to treat SUI in women regardless of their age because of its excellent clinical effectiveness accompanied by its technical simplicity, reproducibility and low percentage of serious complications. Previous urogenital surgery is a risk factor for bladder perforation during TVT procedure.

Adult↗

PubMedDate not supplied

[A new technic for determination of antibiotics in the renal parenchyma].

The determination of antibiotics in the renal tissue is of real value only if the blood and the residue urine are removed from the kidney. The Authors report a new technique dealing with the washing of the organ "in situ" by means of an artery-vein perfusion succeeded by the sucking of the residue urine from the ureter. The experiments were carried on male albino rats with the following antibiotics: indanylcarbenicillin, tobramycin, fosfomycin and cefazolin.

Animals↗

PubMed2003

[A prospective, descriptive study on the practice of management of urinary tract infections by general practitioners in Italy: clinical pathways (Part II)].

OBJECTIVES: The aim of this prospective, descriptive study was to draw the picture of the diagnostic and therapeutic pathways of general practitioners (GPs) in the practice of management of urinary tract infections (UTIs) in Italy. The study results are published in two separate papers. We report here the clinical pathways followed by GPs to diagnose and treat UTIs. MATERIALS AND METHODS: A total of 2.696 GPs were requested to fulfill a questionnaire on their perception of the prevalence of UTIs and their habits in the management of patients either before (IVU1 study, 1.111 GPs) or after (IVU2 study, 1.585 GPs) a specific training course. The clinical management pathway was analysed. RESULTS: GPs turned out to share an appropriate management of UTIs, even though some discrepancies between the clinical habits and UTIs guidelines were focused. After the training course the discrepancies were partly amended (IVU2 study). Urinalysis and urine culture are nearly always requested by GPs, frequently including blood examinations. Older and newer fluoroquinolones are mostly prescribed for UTIs, followed by fosfomycin tromoetamol. Lifestyle recommendations for UTIs containment and prevention are released to patients by GPs. CONCLUSION: The clinical results of this study contribute to assess the habits of Italian GPs in diagnosing and treating UTIs. These data may be helpful for urologists in the management of community-acquired UTIs.

Adult↗

PubMed1992

Susceptibility of methicillin-resistant Staphylococcus aureus clinical isolates to various antimicrobial agents. II. Isolation of arbekacin-resistant strain.

Resistance patterns against 24 antimicrobial agents were examined for 50 strains of methicillin-resistant Staphylococcus aureus (MRSA) isolated at Hiroshima University Hospital during the period October 1990 and July 1991. Overall resistance (the percentage of highly and moderately resistant strains) to the antimicrobial agents is summarized as follows: methicillin 100%, flomoxef 100% (beta-lactams); kanamycin 94%, tobramycin 94%, amikacin 100%, isepamicin 94%, gentamicin 80%, dibekacin 94%, arbekacin 2% (basic oligosaccharide group/aminocyclitols); ofloxacin 96%, temafloxacin 96%, levofloxacin 96% (fluoroquinolones); erythromycin 98%, clarithromycin 98%, josamycin 30% (macrolides); vancomycin 0% (glycopeptide); tetracycline 94%, minocycline 94% (tetracyclines); fosfomycin 100%; mikamycin B 30%, nosiheptide 0% (peptide); rifampicin 2% (ansamycin); streptomycin 2% (basic oligosaccharide group); chloramphenicol 2%. Arbekacin resistance was observed in one case: the cross resistance was complete among the aminocyclitol antibiotics tested in this study and streptomycin, probably due to the ribosomal alteration.

Aminoglycosides↗

PubMed2003

Antimicrobial resistance of Listeria monocytogenes.

Listeria monocytogenes is an opportunistic pathogen that causes rare but frequently fatal infections, termed listerioses. In general, strains of L. monocytogenes are susceptible to a wide range of antibiotics, except for the cephalosporins, fluorochinolones and fosfomycin (Hof, 1991). The current therapy of choice is a combination of ampicillin and aminoglycoside, usually gentamicin (Lorber, 1997). In cases when it is not possible to use a beta-lactam antibiotic, second-choice therapy involves the use of an association of trimethoprim with a sulfonamide, such as in co-trimoxazole, in which the more active in the combination seems trimethoprim, synergized by the sulfa compound. Other second line agents for listeriosis include erythromycin and vancomycin (Temple and Nahata, 2000). The first strains of L. monocytogenes resistant to antibiotics were reported in 1988 (Poyart-Salmeron et al. 1990) The present paper reviews the current state of affairs with regard to the resistance of L. monocytogenes isolated from food products and clinical material to different antibiotics, with particular emphasis on those used in the therapy of listeriosis.

Animals↗

PubMed1992

[Bacteriological evaluation of ofloxacin otic solution].

Clinical trials of ofloxacin (OFLX) otic solution, such as an early phase II study, a dose-finding study, a phase III double-blind comparative study and open studies, were conducted in the period from February 1988 to October 1989. In these studies, organisms were isolated from secretions of middle ear in patients with chronic otitis media and acute exacerbation of chronic otitis media, and from secretions of external ear in patients with external otitis. These organisms were subjected to identification, followed by determination of susceptibilities to OFLX and the other antibacterials. Results obtained are summarized as follows: 1. In total, 746 organisms were defined as the presumable causative organisms in 439 patients with otitis media and 80 with external otitis. Among the isolates, aerobic Gram-positive organisms were most prevalent, with an isolation rate of 66.9%, followed by aerobic Gram-negative organisms (32.4%), and obligate anaerobes (0.7%). Staphylococcus aureus and Pseudomonas aeruginosa were the organisms isolated most frequently among aerobic Gram-positive and Gram-negative bacteria, respectively. 2. The MIC90 of OFLX against the above 746 strains was 6.25 micrograms/ml. At this level, OFLX was 8 times more potent than cefmenoxime (CMX), and 32 times more potent than fosfomycin (FOM) and fradiomycin (FRM). It was postulated that OFLX retained higher local level than the MIC90 of the drug at 2 hours after topical adaptation of the otic solution, and had enough "above the MIC" and "time above MIC". 3. The MIC90 of OFLX against glucose-nonfermentative Gram-negative rods (GNF-GNR) including P. aeruginosa, which were isolated in 32.6% of the 519 patients, was superior to those of CMX, FOM, and FRM. The well-balanced antibacterial activity of OFLX was thought to be one of the properties of OFLX otic solution. 4. Previously-reported post antibiotic effect of OFLX was thought to be another property of OFLX otic solution. In conclusion, OFLX otic solution appeared to be clinically useful, because it possessed advantageous properties beyond other clinically-available otic solutions.

Bacteria↗

PubMed1992

[MRSA respiratory tract infection].

Sputum isolates of MRSA have been on the increase, recently. Preventive measures against MRSA nosocomial infections have become important in Japanese hospitals. Clinical study was performed on 29 patients from whom MRSA was isolated more than 10(7) cfu/ml using the quantitative sputum culture method. All had a history of admission, therefore nosocomial infections caused by MRSA could very often occur. MRSA was determined as a causative organism in 3 on the basis of symptoms, laboratory data, chest X-rays, and effect of antimicrobial agents. These three patients improved by a single or combined administration of minocycline, arbekacin and/or fosfomycin. In 15 patients, MRSA was frequently isolated, but was thought to be colonized. In 3 patients, MRSA was not isolated without administration of antimicrobial agents thereafter. It was supposed that most of MRSA isolates from sputum were not the causative organism of the respiratory tract infection.

Anti-Bacterial Agents↗

PubMedDate not supplied

Beta-haemolytic streptococci in acute pharyngitis.

To determine the role and importance of beta-haemolytic streptococci in acute pharyngitis and its relative susceptibility to antibiotics, we cultured samples from 143 patients (age range: 3-72 years) who presented over a 5-month period in 2001 at three primary health care centres in Sousse, Tunisia. The cultures yielded 80 beta-haemolytic streptococci (59 group A streptococci and 21 non-group A streptococci). All strains were susceptible to benzylpenicillin, amoxicillin, chloramphenicol, rifampicin and pristinamycin. Susceptibility was variable in erythromycin, tetracycline, fosfomycin, telithromycin and levofloxacin. Minimum inhibitory concentrations were determined by E-test for penicillin, erythromycin and levofloxacin. Our results confirm that penicillin is still the reference treatment for acute pharyngitis. However, to minimize the potential for complications arising from its use, continued vigilance is required.

Acute Disease↗

PubMed1992

[Septic granulomatosis (chronic granulomatous disease = CGD) in the jaw area. A case report].

A rare case of chronic granulomatous disease with manifestation in the mandible is presented. A 10-year-old boy showed the clinical picture of osteomyelitis without paresthesia (Vincent syndrome). Diagnosis was done by the nitroblue tetrazolium test (NBT) and by demonstration of a complete cytochrome-b deficiency of the granulocytes. In septic granulomatosis a continuous application of Sulfamethoxazol-Trimetoprim is recommended for prophylaxis of infection. For treatment of infection further antibiotics who pass into the granulocytes like rifampicin and fosfomycin are necessary. Oral surgical procedures request a careful tissue handling and a tight wound closure.

Child↗

PubMed2005

Analysis of three phenotyping methods and pulsed-field gel electrophoresis for differentiation of methicillin resistant Staphylococcus aureus isolated from two hospitals in Thailand.

Methicillin resistant Staphylococcus aureus (MRSA) is an important hospital and community-acquired pathogen. Rapid and reliable epidemiologic typing is necessary for controlling the spread of MRSA outbreak. The objective of this study was to compare the phenotyping with the genotyping method to differentiate MRSA isolates obtained from the two hospitals in Thailand (central and northeastern). Seventy-four MRSA isolates were randomly collected and confirmed by the presence of mecA gene. Antibiogram, phage typing and enterotoxin production were used for the phenotyping analysis. Pulsed-field gel electrophoresis (PFGE) with Smal digestion of chromosomal DNA was used for the genotyping analysis. We found 17 distinct profiles by the 3 phenotypic typing methods and 18 PFGE types designated as 5 major types (A-E) and 13 subtypes. The most frequent PFGE types and their related subtypes found in both hospitals were A and C, comprising 54 and 27%, respectively. The antibiogram could differentiate 6 different types. All isolates were resistant to the majority of antimicrobial agents tested, but were susceptible to vancomycin and fosfomycin. Ten (13.5%) MRSA isolates produced enterotoxin A. Nontypable phage and phage type 77 were found predominantly in MRSA isolated from the northeast and central hospital, respectively. A significant correlation was found between the phenotyping and the genotyping methods and there was a good correlation between antibiogram and PFGE. Antibiogram typing alone can be used as a useful epidemiological marker for practical purposes. PFGE types A and C were the common endemic MRSA clones in both hospitals in Thailand.

Electrophoresis, Gel, Pulsed-Field↗

PubMed2005

Bacteriological urinalysis in patients after renal transplantation.

The study consisted of microbiological urinalysis performed in 269 patients after renal transplantation who remained under medical care at the Outpatient Service of the Transplantation Institute in Warsaw. The patients enrolled into the study had undergone renal transplantation 6 to 72 months before urine samples were collected. 304 urinalysis were performed. In the group of 269 patients, 42 individuals had bacteria in their urine what was confirmed in 47 urine cultures. Cases of bacteriuria were divided into 5 groups: 5 cases of symptomatic urinary tract infection (5 individuals--2% of all studied patients), 27 cases of asymptomatic bacteriuria in 22 individuals (8% of all studied patients), 5 cases of insignificant bacteriuria in 5 patients (2%), 10 cases of involuntary urine contamination in 10 cases (4%). Eventually, urinary tract infection (UTI) was established in 27 patients (5 cases of symptomatic UTI and 22 cases of asymptomatic UTI) what makes out for 10% of all studied patients. In cases where urinalysis showed significant bacteriuria, following pathogens were detected in urine cultures: Escherichia coli: 22 strains, Enterococcus faecalis--4 strains, Enterobacter cloacae--2 strains and 1 strains of Ralstonia picketii, Streptococcus uberis, Pseudomonas aeruginosa and Proteus mirabilis. Over 90% of Gram-negative bacteria were susceptible to ceftriaxone and ceftazidime, as well as to amikacin and aztreonam which are the drugs usually administered intravenously in hospitalized patients. The only drug of similar efficacy, which could be administered orally in outpatients was fosfomycin.

Adult↗

PubMedDate not supplied

Prevalence of asymptomatic bacteriuria in pregnant women in Sharjah, United Arab Emirates.

To determine the prevalence of asymptomatic bacteriuria in pregnancy, midstream urine samples from 505 pregnant women in Sharjah, United Arab Emirates, were screened using urine culture and urinalysis. Urine cultures showed heavy growth (> or = 10(5) colony forming units/mL) in 4.8% (24/505) of the samples; 16/24 (66.7%) of these isolates were Escherichia coli. Microscopic examination had the highest sensitivity (67%), while nitrite dipstick testing showed the highest specificity and positive predictive value (99% and 57% respectively). Antibiotic sensitivity tests carried out on the positive culture samples showed high sensitivity to gentamicin, amoxicillin-clavulanic acid and fosfomycin.

Adolescent↗

PubMed1991

Susceptibility of methicillin-resistant Staphylococcus aureus clinical isolates to various antimicrobial agents.

Resistance patterns against 23 antimicrobial agents were examined for 42 strains of methicillin-resistant Staphylococcus aureus (MRSA). Thirty-four strains were isolated at Hiroshima University Hospital during 1984-1990 and 8 strains were collected in Tokushima city in 1986. Overall resistance to the antimicrobial agents in clinical use is summarized as follows: methicillin 100%, flomoxef 93% (beta-lactams); kanamycin 98%, tobramycin 88%, amikacin 83%, isepamicin 81%, gentamicin 60%, dibekacin 64%, arbekacin 0% (aminocyclitol aminoglycosides); ofloxacin 31%, TA-167 33% (fluoroquinolones); erythromycin 100%, clarithromycin 100%, josamycin 71% (macrolides); vancomycin 0% (glycopeptide); tetracycline 43%, minocycline 31% (tetracyclines); fosfomycin 93%. The MRSA strains remained susceptible to the non-clinical peptide group of antibiotics except for mikamycin B: mikamycin A 2%, mikamycin B 69%, nosiheptide 0%, bottromycin A2 0%, bottromycin D-1 0%, bottromycin D-2 0%. Since April 1990, the MRSA strains isolated at Hiroshima University Hospital showed a tendency to acquire resistance to tetracyclines and fluoroquinolones and to lose mikamycin B-resistance. As of August 1990, none of the MRSA strains isolated at Hiroshima University Hospital was resistant to vancomycin and arbekacin.

Drug Resistance, Microbial↗

PubMed1991

[Clinicopathological study of methicillin-resistant Staphylococcus aureus detected by pulmonary microbial culture in autopsied cases].

Microbial culture of lung specimens from 569 autopsied cases from 1986 to 1989 revealed methicillin-resistant Staphylococcus aureus (MRSA) in 28 cases, which were subsequently analyzed clinicopathologically. The number of MRSA positive cases has markedly increased in recent years (2 cases in 1986, 2 in 1987, 6 in 1988, 18 in 1989). The most frequent underlying disease was neoplasm, which was seen in 17 cases. Of non-neoplastic diseases, liver cirrhosis and diffuse panbronchiolitis were prevalent. Twenty-four cases had received a course of antibiotic therapy. Antibiotics frequently administered were third-generation Cephem and Imipenem/cilastatin sodium (used in 20 cases). Antibiotics o which MRSA was sensitive were administered in only one case (minocycline). Sputum culture was performed in only 10 cases, 5 of which were MRSA positive. MRSA had acquired resistance to fosfomycin and ofloxacin. Histological examination revealed complication by pneumonia in 19 cases. In 7 of these 19 cases, MRSA was the only pathogen detected. Pulmonary MRSA infection detected at autopsy is frequently seen in patients with terminal stage cancer, but it is frequently not diagnosed and is undertreated. This may be a factor responsible for the recent marked increase in the proportion of MRSA in pathogens causing infection within medical institutions.

Cross Infection↗

PubMed1991

Determination of the synergy of antibiotic combinations by an overlay inoculum susceptibility disc method.

A method involving an overlay inoculum agar and antibiotic susceptibility discs in the determination of synergy of gentamicin and disc antibiotics against clinical isolates of Pseudomonas aeruginosa has been described. Gentamicin combinations with carbenicillin showed synergism against all test isolates. Combinations containing fosfomycin had indifferent effects. Netilmicin, ceftriaxone and ampicillin, respectively, produced interisolate variations in the synergy of their combinations with gentamicin. In all cases synergy was determined on the basis of correlations between inhibition zone diameter (IZD) increments and fractional inhibitory concentration (FIC) indices. An IZD increment of 19% or more predominantly corresponded with synergy. Cases showing less than 19% increase in IZD produced additive effects, while cases showing no variations in IZD had indifferent effects.

Anti-Bacterial Agents↗

PubMedDate not supplied

[Lyophilized cartilage--an antibiotic carrier].

Human lyophilized bruised costal cartilage was tested in vitro for its ability to act as a carrier medium for antibiotics. A remarkable capacity of accumulating streptomycin, gentamicin, tobramycin, vancomycin and ciprofloxacin was observed; whereas beta-lactum antibiotics and fosfomycin were released at a high rate. This release pattern was not influenced by the sterilization procedure, but rather by the size of the cartilage granula. Lyophilized cartilage--rehydrated in antibiotic-solutions--be helpful adjunct in the surgical management of osseous infections.

Anti-Bacterial Agents↗

PubMed1990

[New treatments for urogenital toxicity of anti-neoplastic chemotherapy].

Renal dysfunction and urinary disorders are the most troublesome adverse reaction to anticancer agents such as cisplatin (CDDP) and ifosfamide (IFM). A number of antidotes such as sodium thiosulfate (STS), WR-2721, thiourea, diethyldithiocarbamate and bismuth subnitrate have been tested to reduce the nephrotoxicity of CDDP. One notable method previously reported by Baba et al. and Pfeifle et al involves the i.v. administration of STS to prevent the nephrotoxicity of CDDP given locally. Since STS has been proven clinically effective in reducing such side effects, we initiated a study of STS in patients with advanced non-small-cell lung carcinoma who were given a combination of CDDP and vindesine (VDS) systemically. Urinary levels of beta 2-microglobulin (BMG) and N-acetyl-beta-D-glucosaminidase (NAG) were measured as an index of proximal tubular function. Analysis of both levels indicated that STS suppressed CDDP nephrotoxicity to a minimal level. Therefore, the present study clearly demonstrates that systemic administration of STS reduces the side effects of CDDP to a minimal level without impairing its antitumor activity and that STS treatment is applicable in a repeated chemotherapy using CDDP alone or in combination with other antitumor agents. Furthermore, it has been reported that urinastatin and fosfomycin may exert potent effects to reduce untoward nephrotoxicity of CDDP. IFM causes urinary disorders such as hematuria, reducing its clinical usefulness, Sodium 2-mercaptoethane sulfonate (mesna) is the thiol compound which binds specifically to the urinary toxic metabolites of IFM, and thereby decreases the undesirable effect of IFM on the lower urinary tract, especially on the bladder. Recently, it was reported by a Osaka mesna study group that mesna is useful for the prevention of IMF-induced urinary disorders. It was considered that above new treatments were required in repeating chemotherapy which induced urogenital toxicity.

Antidotes↗