Antibiotic Therapy For Bacterial Infections Research Articles

Bacterial Predominance and Antimicrobial Susceptibility Patterns of Blood Culture at a Tertiary Care Hospital, Bangladesh

Background: The problem of widespread resistant bacteria has become a major threat to reduce the effectiveness of antibiotics worldwide. Objective: The aim of this study was to identify the bacterial pathogens from bold culture and determine their antibiotic susceptibility pattern. Methodology: This cross-sectional study was conducted in the department of Microbiology at Monno Medical College, Manikganj, Bangladesh during the period from January 2019 to December 2019 for duration of one year. Blood was collected according to blood collection guidelines and inoculated into BacT/ALERT FA plus and BacT/ALERT PF plus aerobic blood culture bottles respectively. After collection these bottles were immediately incubated in BacT/ALERT 3D (manufactured by bioMerieoux, France) a fully automated blood culture system. Antimicrobial susceptibility test was done for all isolated bacteria by disc diffusion method. Results: A total number of 180 patients were recruited, among them 12 (7%) yielded growth of different bacteria. The most frequently isolated bacteria were Streptococcus Spp 5(42%) followed by Staphylococcus aureus and Escherichia coli which were 4(33%) and 3(25%) respectively. Escherichia Coli which showed highly sensitive to Imipenum, Amikacin, Linezolid, Gentamicin (N=3, 100%). Conclusion: There were a high percentage of bacteria isolated from blood culture and resistant to several antibiotics. For the selection of appropriate antibiotic therapy in bacterial infections the antibiotic susceptibility testing is mandatory. Journal of National Institute of Neurosciences Bangladesh, January 2023;9(1):48-53

Persistence of obligate intracellular pathogens: alternative strategies to overcome host-specific stresses.

In adapting to the intracellular niche, obligate intracellular bacteria usually undergo a reduction of genome size by eliminating genes not needed for intracellular survival. These losses can include, for example, genes involved in nutrient anabolic pathways or in stress response. Living inside a host cell offers a stable environment where intracellular bacteria can limit their exposure to extracellular effectors of the immune system and modulate or outright inhibit intracellular defense mechanisms. However, highlighting an area of vulnerability, these pathogens are dependent on the host cell for nutrients and are very sensitive to conditions that limit nutrient availability. Persistence is a common response shared by evolutionarily divergent bacteria to survive adverse conditions like nutrient deprivation. Development of persistence usually compromises successful antibiotic therapy of bacterial infections and is associated with chronic infections and long-term sequelae for the patients. During persistence, obligate intracellular pathogens are viable but not growing inside their host cell. They can survive for a long period of time such that, when the inducing stress is removed, reactivation of their growth cycles resumes. Given their reduced coding capacity, intracellular bacteria have adapted different response mechanisms. This review gives an overview of the strategies used by the obligate intracellular bacteria, where known, which, unlike model organisms such as E. coli, often lack toxin-antitoxin systems and the stringent response that have been linked to a persister phenotype and amino acid starvation states, respectively.

Procalcitonin for antimicrobial stewardship among cancer patients admitted with COVID-19.

Procalcitonin (PCT) has been used to guide antibiotic therapy in bacterial infections. We aimed to determine the role of PCT in decreasing the duration of empiric antibiotic therapy among cancer patients admitted with COVID-19. This retrospective study included cancer patients admitted to our institution for COVID-19 between March 1, 2020, and June 28, 2021, with a PCT test done within 72 hr after admission. Patients were divided into two groups: PCT <0.25 ng/ml and PCT ≥0.25 ng/ml. We assessed pertinent cultures, antibacterial use, and duration of empiric antibacterial therapy. The study included 530 patients (median age, 62 years [range, 13-91]). All the patients had ≥1 culture test within 7 days following admission. Patients with PCT <0.25 ng/ml were less likely to have a positive culture than were those with PCT ≥0.25 ng/ml (6% [20/358] vs. 17% [30/172]; p<0.0001). PCT <0.25 ng/ml had a high negative predictive value for bacteremia and 30 day mortality. Patients with PCT <0.25 ng/ml were less likely to receive intravenous (IV) antibiotics for >72 hr than were patients with PCT ≥0.25 ng/ml (45% [162/358] vs. 69% [119/172]; p<0.0001). Among patients with PCT <0.25 ng/ml and negative cultures, 30 day mortality was similar between those who received IV antibiotics for ≥72 hr and those who received IV antibiotics for shorter durations (2% [2/111] vs. 3% [5/176], p=0.71). Among cancer patients with COVID-19, PCT level <0.25 ng/ml is associated with lower likelihood of bacterial co-infection and greater likelihood of a shorter antibiotic course. In patients with PCT level <0.25 ng/ml and negative cultures, an antibiotic course of >72 hr may not be necessary. PCT could be useful in enhancing antimicrobial stewardship in cancer patients with COVID-19. This research was supported by the National Institutes of Health/National Cancer Institute under award number P30CA016672, which supports MD Anderson Cancer Center's Clinical Trials Office.

Antimicrobial susceptibility patterns of Bacterial Isolates from patients attending Ear, Nose, and Throat Department of a Tertiary Care Hospital in Burdwan, West-Bengal, India.

Background: The susceptibility of the most common causative pathogens drives empiric initial antibiotic therapy for bacterial infections. This cross-sectional study was conducted to detect the infection trends and antibiotic susceptibility patterns of patients attending the Burdwan medical college and hospital (BMCH), West Bengal.&#x0D; Methodology: A prospective study was conducted for six months, from August 2021 to January 2022, at the department of microbiology (BMCH), West Bengal. Isolation of bacteria and fungus was performed from clinical samples obtained from patients attending the department of the ear, nose, and throat (ENT) of BMCH. A total of 84 samples were collected from patients with suspected ENT infections. Types of samples taken include pus, fluid, tissue, and throat, nasal, and ear swabs.&#x0D; Results: Bacterial growth was observed in 55(65.47%), of which gram-positive and gram-negative bacterial isolates were found in 31(56.36%) and 21(38.18%) samples, respectively. 3(5.45%) gram-positive bacilli were grown, and 14(16.66%) samples were positive for fungal growth. &#x0D; Conclusion: Antibiogram of gram-positive isolates showed maximum susceptibility to vancomycin and least to ciprofloxacin, whereas gram-negative isolates showed maximum susceptibility to amikacin and least to ciprofloxacin.&#x0D;

Streptococcus pneumoniae Coinfection in COVID-19 in the Intensive Care Unit: A Series of Four Cases

Bacterial coinfections in patients infected with SARS-CoV-2 pneumonia are uncommon, when compared to coinfections with other respiratory viruses. For example, the prevalence of bacterial coinfections in hospitalized seasonal influenza patients can exceed 30%, whereas the prevalence of bacterial coinfections in SARS-CoV-2 infection is less than 4%. Bacterial coinfections increase the severity of respiratory viral infections and have been associated with higher mortality and morbidity. Current literature shows that diagnostic testing and antibiotic therapy for bacterial infections are not necessary upon admission in majority of patients with SARS-CoV-2 patients. It is however important for the clinician to be cognizant of these coinfections since missing the diagnosis may pose a substantial risk to vulnerable COVID-19 patients. In that light, we present four cases of Streptococcus pneumoniae coinfections complicating confirmed SARS-CoV-2 infections.

Studying synergy of antibacterial drugs using the “checkerboard” method and the “time-kill” analysis

The use of combinations of antibiotics is a promising area of antibiotic therapy of bacterial infections caused by antibiotic-resistant strains. The main goal of combined antibiotic therapy is to achieve a synergistic effect and to expand a spectrum of antibacterial activity against multi-resistant microorganisms. Due to the presence of various mechanisms of resistance in bacteria, even to drugs of the same group, the microbiological efficacy of antibiotic combinations is difficult to predict. Therefore, to select effective combinations of antibiotics, it is required to conduct a microbiological testing of isolates isolated from a particular patient. Currently, in the Republic of Belarus, the appointment of combined antibiotic therapy is carried out empirically, and in the event of its clinical ineffectiveness, the drugs are replaced. One of the reasons for a limited testing, with the availability of culture media and diagnostic materials, is the lack of regulatory and technical methods for identifying synergy adapted to local microbiological laboratories. The purpose of this publication was to analyze the literature data illustrating the relevance of analyzing the methods for studying the effects of synergy of antibacterial drugs and the possibility of their introduction into practical medicine. As a result of a search for publications in the PubMed database on the topic of increasing the antibacterial effect of antibiotics on the request the “checkerboard” method and the “time-kill” analysis for the period from 2016 to 2021, 947 results were found with an upward trend in research. “Checkerboard” and “time-kill” assays are the most common, reliable in vitro tests that reflect the effects of antibiotic combinations and the effects of antibiotic combinations with other compounds.

First Cases of Candida auris in a Referral Intensive Care Unit in Piedmont Region, Italy.

Candida auris is an emerging healthcare-associated infection that can easily cause dissemination in hospitals through colonizing the skin and contaminating environmental surfaces, especially in Intensive Care Units (ICU). Difficulties with identification of this organism, uncertainty about routes of transmission and antifungals resistance have impacted significantly outbreak detection and management. Here, we describe our experience with colonization/infection of C. auris among critically ill patients, admitted to a referral ICU of a University Hospital, in a transitional period (July 2021–March 2022) between management of non-COVID-19 and COVID-19 patients due to the reconversion of the ICU between two waves. A total of 8 patients presented colonization from C. auris, and two of them developed invasive infection from C. auris. The fungal pathogen was cultured from different sites: the skin (7 isolates), urine (2), respiratory tract (1), blood (1). The median time from admission to first detection is 24 days with 100% of patients requiring mechanical ventilation. All 8 patients received broad-spectrum antibiotic therapy for bacterial infections before identification of C. auris; 62.5% of the patients had prior antifungal exposure; 87.5% received steroids; 37.5% patients used immunomodulatory; and 75% had severe COVID-19 illness prior to C. auris identification. Only two cases (25%) were treated with antifungals as C. auris infections (1 patient for suspected UTI; 1 patient with candidemia). Infection control measures, including rapid microbiological identification, contact isolation, screening of contacts, antisepsis of colonized patients, dedicated equipment, cleaning and disinfection of the environment and subsequent follow-up sampling, remain essential in critically ill patients. Our experience highlights the importance of establishing a multidisciplinary model and bundling of practices for preventing C. auris’ spread.

Pathogenicity of Salmonella During Schistosoma-Salmonella Co-infections and the Importance of the Gut Microbiota.

Antibiotic inefficacy in treating bacterial infections is largely studied in the context of developing resistance mechanisms. However, little attention has been paid to combined diseases mechanisms, interspecies pathogenesis and the resulting impact on antimicrobial treatment. This review will consider the co-infections of Salmonella and Schistosoma mansoni. It summarises the protective mechanisms that the pathophysiology of the two infections confer, which leads to an antibiotic protection phenomenon. This review will elucidate the functional characteristics of the gut microbiota in the context of these co-infections, the pathogenicity of these infections in infected mice, and the efficacy of the antibiotics used in treatment of these co-infections over time. Salmonella-Schistosoma interactions and the mechanism for antibiotic protection are not well established. However, antimicrobial drug inefficacy is an existing phenomenon in these co-infections. The treatment of schistosomiasis to ensure the efficacy of antibiotic therapy for bacterial infections should be considered in co-infected patients.Graphical Co-infections of Salmonella and Schistosoma mansoni confers the protective mechanisms that give ineffetive treatment of salmonella. The functional characteristics of the gut microbiota in the context of these co-infections influence the pathogenicity of the both pathogens thereby drecreasing immunity and brings changes in gut metabolism.

Side effects of antibiotic therapy for bacterial infections

Antibiotics are widely accepted as powerful medications. More and more antibiotics come into the hands of doctors. However, doctors do not always use these drugs on reflection. Often antibiotics are prescribed before the diagnosis is established, without taking into account the sensitivity to the drug of both micro- and macroorganisms, and are prescribed when other drugs can and should be dispensed with.

POS1367 PROCALCITONIN IN RHEUMATOLOGY

Background:The differentiation between infection and aseptic inflammation is difficult and often a challenge in the daily practice of rheumatology.Procalcitonin (PCT) is a preferred marker for bacterial infections that allows the rheumatologist to make an early diagnosis, choose an appropriate antibiotic therapy for bacterial infection, and avoid unnecessary antibiotic therapy for inflammation.Objectives:To study the levels of PCT in various inflammatory states observed in a rheumatology department, and to assess its possible discriminating role in the differentiation of bacterial infection from other inflammatory processes.Methods:This is a preliminary monocentric retrospective study conducted from January 2018 to December 2020 in our rheumatology department. The inclusion criteria were all patients hospitalized in rheumatology for a rheumatic or autoimmune disease or a bone and joint infection.PCT samples from patients were analyzed along with general signs (fever/chills) and with routine assessment (blood count including white blood cell count(WBC), erythrocyte sedimentation rate (ESR)and C reactive protein(CRP)) in patients admitted to hospitalfor a fever or a biological inflammatory syndrome, or both, with a laboratory cut-off value of 0.5 ng/ml.Results:20 patients were included. Their mean age was 46.1 (extremes 19 – 66)and the with sex ratio was 1. Three patients had a history of autoimmune disease, 2 of neoplasia, 1 with chronic terminal kidney failure and hemodialysis, and 4 patients took antibiotics before hospitalization. The mean PCT was 100.01ng/ml (extremes 0.01-200), and Sensitivity at 57.44% and specificity at 100%, PPV: 100%, NPV: 81.25%.The patients were divided according to their final diagnosis into 3 groups: bacterial or fungal infection; inflammatory abacterian disease (autoimmune or rheumatic flare, neoplasia, metabolic, reactive arthritis); infection + inflammatory abacterian disease. Group 1 included 4 patients, their mean PCT was 6.92ng/ml (0.16-26.80),mean CRP was 131.725 mg/L, and mean ESR was 50 mm, and 25% had hyperleukocytosis.2 patients had already taken antibiotics before admission. Group 2 included 13 patients, their mean PCT was 0.025 ng/mL (0.01-0.13), mean CRP was 132.25mg/L, mean ESR was 84.38mm, and 30.77% of them had hyperleukocytosis. Group 3 included 3 patients, their mean PCT was 66.88 ng/mL (0.02-200), mean CRP was 560 mg/L, mean ESR was 107.33 mm, and 33.33% had hyperleucocytosis. The patient with the highest PCT was admitted for a sepsis with uremic encephalopathy that improved after hemodialysis. A control PCT was made in 2 patients with infection who received antibiotics,showing a decrease or negativation compared to the initial value of PCT.Conclusion:Our study showed that PCT levels only increased significantly in bacterial infections. The PCT values were more discriminating than the level of WBC and CRP in differentiating a bacterial infection from another inflammatory process, hence the value of using this marker in case diagnosis doubt.Group 1(n=4)Group 2(n=13)Group 3(n=3)Mean age4546.7744.67Sex ratio M/F2/28/50/3Reason for hospitalizationPhlegmon of the left shoulder and inflammatory gonalgia in a feverish context 25%Multiple vertebral fractures 25%Acute monoarthritis of the left knee 25%Pain in the left hip with functional impairment 25%Inflammatory polyarthralgia15.38%Inflammatory back pain 23.07%Activity of his autoimmune 15.38%diseaseChronic hip pain 7.69%Acute febrile polyarthralgia 30.77%Biarthritis 7.69%Acute febrile polyarthralgia 66.67%Flare of polymyalgia rheumatica 33.33%HistoryNeoplasia 25%Autoimmune disease 23.07%End-stage chronic renal disease with hemodialysis 33.33%PCT indicationSuspected septic arthritis 75%Exploration of inflammatory syndrome 25%Suspicion of arthritis 46.15%Exploration of inflammatory syndrome 53.85%Suspicion of sepsis 33.33%Exploration of inflammatory syndrome 66.67%Mean PCT value (ng/ml)6.920.02566.88fever/chills75%30.77%33.33%Biological parametersHyperleukocytosisESR (mm)CRP (mg/L)25%50131.72530.77 %84.38132.2533.33%107.33560Disclosure of Interests:None declared

Prospective Observational Study to Determine Kinetics of Procalcitonin in Hospitalized Children Receiving Antibiotic Therapy for Non-Critical Acute Bacterial Infections.

IntroductionThe kinetics of procalcitonin in pediatric patients with non-critical acute bacterial infections receiving appropriate antibiotic therapy are not well described.MethodsWe performed a single-center, prospective observational pilot study of children admitted to a tertiary care children’s hospital who were receiving antibiotics for treatment of a non-critical acute bacterial infection, and we prospectively measured serial procalcitonin levels daily for 4 days during hospitalization.ResultsAmong the 46 children with baseline procalcitonin levels enrolled in the study, procalcitonin kinetics followed a half-life of approximately 24 h in most patients. Procalcitonin declined faster than C-reactive protein over the first 48 h of appropriate antibiotic treatment. There was variation in biomarker levels among participants with the same infection type, especially in participants with bacteremia, musculoskeletal infection and skin/soft tissue infection.ConclusionUtility of procalcitonin as a biomarker to follow every 24–48 h in non-critically ill children receiving antibiotic therapy for bacterial infections as an objective measure of clinical improvement is promising.

Antimicrobial Resistance Profiles for Different Isolates in Aden, Yemen: A Cross-Sectional Study in a Resource-Poor Setting.

Background There is a rapid deterioration in the effectiveness of antibiotics due to the global prevalence of bacterial antimicrobial resistance (AMR). AMR can cause an increase in mortality and morbidity due to treatment failures and a lack of effective therapy. Objective The purpose of this study was to evaluate the AMR pattern of different bacterial isolates at hospitals and laboratories. Materials and Methods A cross-sectional study from March 2019 to June 2019 was conducted at different governmental and private hospitals and laboratories in Aden, Yemen. Age, sex, specimen type, bacterial isolates, and antibiotic susceptibility pattern were collected using a data extraction sheet. Descriptive statistics were used for data analysis. Result Data were recorded for 412 patients from whom 20 clinical specimens were collected and analyzed. The most common bacteria isolated were Staphylococcus spp. (n = 172, 41.74%), E. coli (n = 164, 39.80%), Pseudomonas spp. (n = 37, 8.98%), and Klebsiella pneumoniae (n = 18, 4.36%); other bacteria were less common. The overall bacterial resistance was highest against the combination of sulfamethoxazole with trimethoprim (73.12%), followed by amoxicillin and clavulanate (65.19%). The cephalosporin antibiotics also showed high resistance rates. The study also showed moderate bacterial resistance to gentamycin (32.65%), azithromycin (29.92%), cefoxitin (62.65%), and ciprofloxacin (25.60%). Ertapenem (16.67%) and levofloxacin (15.56%) had the lowest resistance rates. Conclusion There was a high percentage of bacteria resistant to several antibiotics. Antibiotic susceptibility testing is a prerequisite guide for the selection of appropriate antibiotic therapy for bacterial infections.

Antibiotic Therapy for ESBL and NDM producing Escherichia coli and Klebsiella pneumoniae isolates in a Tertiary Care Center

Objective: Antibiotic resistance is a global phenomenon wherein&#x0D; physicians face the most challenging decision to make for the right kind of&#x0D; drug, and its combinations, to tackle the ever growing ESBL and NDM on&#x0D; pathogens. The aim of the study is to understand outcome of hospitalized&#x0D; patients undergoing antibiotic therapy for bacterial infections. These patients&#x0D; are from Kamrup District of Assam, India. &#x0D; &#x0D; Materials&#x0D; and methods: A total of 185 clinical isolates of Escherichia coli and Klebsiella&#x0D; pneumoniae were collected from hospitalized patients of a tertiary care&#x0D; centre presenting symptoms of infection. Upon biochemical identification, their&#x0D; antibiotic susceptibility were assessed; isolates resistant to 3rd or 4th&#x0D; generation cephalosporins or carbapenem were phenotypically and genotypically&#x0D; determined for the production of extended spectrum β-lactamase (ESBL) and&#x0D; carbapenemase. PCR was carried out for CTX-M, TEM, SHV, OXA-48 and New Delhi&#x0D; Metallo-β-lactamase (NDM). &#x0D; &#x0D; Results:&#x0D; Bacterial infection is ubiquitous among male and female patients, with high&#x0D; isolation rate of Escherichia coli&#x0D; among female patients with urinary infection. The highest resistance against E. coli isolates was nalidixic acid&#x0D; (82.9%; p≤0.005) and cefixime (81.4%; p≤0.005). The highest resistance against K. pneumoniae was cefotaxime (77.7%;&#x0D; p≤0.005) and ceftazidime (73%; p≤0.005). Imipenem was the most effective&#x0D; antibiotic while ertapenem was the least. Antibiotic therapy included&#x0D; piperacillin (alone or in combination with tazobactam) for both E. coli and K. pneumoniae infections. &#x0D; &#x0D; Conclusions: Ceftriaxone, amikacin, cefepime, ceftriazone and&#x0D; imipenem were chosen as treatment options; isolates showed intermediate to&#x0D; negligible resistance to these drugs. Tigecycline was administered to patients&#x0D; infected with NDM producing pathogens. &amp;nbsp;J Microbiol Infect Dis 2018; 8(4): 153-157.

Combined photothermal and antibiotic therapy for bacterial infection via acidity-sensitive nanocarriers with enhanced antimicrobial performance

Integration of two distinctive bactericides into one platform is a promising strategy to enhance the efficiency of antimicrobial agents. We reported an efficient chemo-photothermal therapeutic platform based on polydopamine (PDA)-coated gold nanorods (PDA@GNRs). Then the PDA@GNRs were further grafted with glycol chitosan (GCS-PDA@GNRs), which became positively charged in the low pH environment of bacterial infection sites, allowing them to accumulate/retain at local infection site as revealed by thermal imaging. The PDA coating acquires high loading efficiency of daptomycin (DAP) and pH-sensitive DAP release ability. The acidity-activated release of DAP could effectively damage the bacterial membrane, causing permeability increase and heat resistance reduction of the cell membrane, leading to large improvement on bactericidal efficiency of photothermal therapy. On the other hand, the hyperthermia could trigger more DAP release, resulting in further improvement on bactericidal efficiency of chemotherapy. Moreover, combined chemo-hyperthermia therapy of DAP loaded GCS-PDA-PDA@GNRs (DAP-GCS-PDA@GNRs) could thoroughly ablate abscess and accelerate wound healing via a synergistic antibacterial effect as well as exhibit negligible biotoxicity in vitro and in vivo. Therefore, our study demonstrates that combining antimicrobial therapy along with a stimulus-responsive moiety represents a feasible way to treat the bacterial-induced skin infection.

The principles of rational chemotherapy of bacterial infections in poultry

Growing levels of microbial resistance to chemotherapeutic agents pose a threat to public health and constitute a global problem. The above can be often attributed to improper and excessive use of antibacterial drugs in veterinary and human medicine, animal breeding, agriculture and industry. To address this problem, veterinary and human health practitioners, animal breeders and the public have to be made aware of the consequences and threats associated with the uncontrolled use of antibacterial preparations. In recent years, many countries have implemented programs for monitoring antibiotic resistance which provide valuable information about the applied antibiotics and the resistance of various bacterial species colonizing livestock, poultry and the environment. Special attention should be paid to the sources and transmission routes of antibiotic resistance. There are no easy solutions to this highly complex problem. The relevant measures should address multiple factors, beginning from rational and controlled use of chemotherapeutic agents in veterinary practice, to biosecurity in animal farms, food production hygiene, and sanitary and veterinary inspections in the food chain. The tissues of treated birds should not contain antibiotic residues upon slaughter. Rational use of antibiotics should minimize the risk of drug resistance and decrease treatment costs without compromising the efficacy of treatment. Therefore, the key principles of antibiotic therapy of bacterial infections in poultry should be the adequate selection and dosage of the administered drug, a sound knowledge of the drug’s pharmacokinetic and pharmacodynamic properties, as well as a knowledge of the differences between bacteriostatic and bactericidal drugs and between time-dependent and concentration-dependent drugs. There is an urgent need to revise the existing approach to the use of chemotherapeutic agents in the treatment of poultry diseases, and to increase the awareness that antibiotics cannot compensate for the failure to observe the fundamental principles of biosecurity in all stages of poultry farming.

Antimicrobial susceptibility of bacterial isolates from patients presenting with ear, nose and throat (ENT) infections in the German community healthcare setting.

Empiric initial antibiotic therapy of bacterial infections is based primarily upon the susceptibility of the most common causative pathogens. The purpose of this study was to provide susceptibility data on six bacterial species known to cause ear, nose and throat (ENT) infections. A total of 1066 isolates collected during a nationwide laboratory-based surveillance study were analysed. All Streptococcus pyogenes isolates were penicillin (PEN)-susceptible, indicating that natural penicillins can still be recommended as the first-line treatment for group A streptococcal tonsillopharyngitis. Of the S. pneumoniae isolates, 92.9% were PEN-susceptible and of the Haemophilus influenzae isolates, 89.7% were amoxicillin-susceptible, retaining aminopenicillins as the first-line treatment for acute otitis media (AOM) and acute rhinosinusitis (ARS), in case antibiotic therapy is considered. In contrast, cefuroxime axetil seems less likely to be suitable for the treatment of AOM or ARS, as all Moraxella catarrhalis and >99% of the H. influenzae isolates were categorised as intermediate or resistant. The susceptibility rates of Pseudomonas aeruginosa were 97-100% for the drugs tested, except for the fluoroquinolones (87.6%). Overall, bacterial isolates from outpatients presenting with ENT infections showed low frequencies of resistance in Germany. However, given the emergence of multidrug resistance to standard antibiotics in Escherichia coli and other pathogens, inappropriate use of broad-spectrum antibiotics for the treatment of ENT infections has to be avoided.

Molecular mechanisms and clinical implications of bacterial persistence.

Any bacterial population harbors a small number of phenotypic variants that survive exposure to high concentrations of antibiotic. Importantly, these so-called 'persister cells' compromise successful antibiotic therapy of bacterial infections and are thought to contribute to the development of antibiotic resistance. Intriguingly, drug-tolerant persisters have also been identified as a factor underlying failure of chemotherapy in tumor cell populations. Recent studies have begun to unravel the complex molecular mechanisms underlying persister formation and revolve around stress responses and toxin-antitoxin modules. Additionally, in vitro evolution experiments are revealing insights into the evolutionary and adaptive aspects of this phenotype. Furthermore, ever-improving experimental techniques are stimulating efforts to investigate persisters in their natural, infection-associated, in vivo environment. This review summarizes recent insights into the molecular mechanisms of persister formation, explains how persisters complicate antibiotic treatment of infections, and outlines emerging strategies to combat these tolerant cells.

Intravenous antibiotic durations for common bacterial infections in children: when is enough enough?

Durations of intravenous antibiotic therapy for bacterial infections in hospitalized children sometimes extend well beyond clinical recovery and are often the primary determinants of length of stay. These durations, however, are not always based on solid evidence. Moreover, fixed durations are invariant to important individual factors. We review guidelines and the available evidence for durations of intravenous antibiotic therapy for meningitis, bacteremia, urinary tract infection, and osteomyelitis, conditions where intravenous antibiotics often extend beyond resolution of clinical symptoms. We propose a framework for the duration of therapy that is intended to serve as a guide when standards of care are either nonexistent, dated, conflicting, or contrary to evidence from published studies. This framework incorporates patient-centered factors such as severity of infection, response to therapy, ease of intravenous access, harms and costs of ongoing intravenous treatment, and family preferences.

Role of Triphala in dentistry.

Ayurveda is considered as the “science of life,” because the ancient Indian system of health care focused views of man and his illness. India has an age-old heritage of traditional herbal medicine. Conventional drugs usually provide effective antibiotic therapy for bacterial infections, but there is an increasing problem of antibiotic resistance and a continuing need for new solutions. Hence, now herbal drugs are being preferred to synthetic antibiotics. ‘Triphala’ is a well-known powdered preparation in the Indian system of medicine (ISM). It consists of equal parts of the Emblica officinalis, Terminalia chebula, and Terminalia belerica. Currently, Triphala is being extensively researched for its various therapeutic effects including its anti-caries, antioxidant, anti-collagenase, and anti-microbial activities. The present review will focus on the comprehensive appraisal of Triphala and its several applications in dentistry.

Syndrome of Inappropriate Antidiuretic Hormone Secretion Concurrent with Liver Disease in a Dog

A 5-year-old female Chihuahua was presented for acute collapse. Laboratory examinations showed markedly elevated levels of hepatobiliary enzymes. Empiric antibiotic therapy for bacterial infection of the liver was ineffective. The clinical signs worsened with the development of hyponatremia with hypoosmolality and elevated urine sodium levels. The dog was suspected of having acute cholangiohepatitis associated with an immune-mediated disease. Subsequently, it was diagnosed with syndrome of inappropriate antidiuretic hormone secretion (SIADH) on the basis of the specific disease criteria. Further tests showed normal function of the adrenal and thyroid glands, and MRI and cerebrospinal fluid (CSF) analysis did not show any intracranial diseases. Immunosuppressive therapy and water restriction resolved the clinical signs and improved the SIADH in this dog. This case indicates that SIADH can occur concurrently with suspected immune-mediated liver disease in dogs.