Antibiotic-treated Group Research Articles

The urinary antigen tests have high sensitivity in diagnosis of Pneumococcus caused community-acquired pneumonia posterior to antimicrobial therapy.

Antibiotic treatment before microbiological test significant reduces the positive rate of culture methods of Streptococcus pneumoniae. The Binax NOW S. pneumoniae immunochromatographic test (ICT) has become a more commonly used procedure to diagnose S. pneumoniae from community-acquired pneumonia in adults. However, performance of this test after empirical antimicrobial therapy is uncertain. Therefore, in this prospective study, we evaluate the impact of antimicrobial therapy on sensitivity of ICT test in 487 hospitalized adult patients. The results showed that 192 (39.4 %) and 295 (60.6 %) specimens were collected before (Group 1) or after antibiotic treatment (Group 2), respectively. S. pneumoniae was detected by ICT in 21 (10.9 %) patients in the Group 1 and 39 (13.2 %) in the Group 2 and their positive rates were not different (P > 0.05). However, The positive rate of blood and pleural fluid was declined from 5.7 to 2.7 % and sputum, from 9.9 to 4.7 % after the antibiotic treatment, respectively. This study confirmed that the ICT urinary antigen test remained to have a high sensitivity for diagnosis of pneumococcal infection after empiric antibiotic treatment was started. The ICT urinary antigen test would have a potential to guide the right choice of therapy for pneumonia in adults earlier.

Su1663 An Open-Labeled, Randomized Controlled Trial Comparing Between Short Duration and Standard 14 Days Antibiotic Treatments for Acute Cholangitis in Patients With Common Bile Duct Stone After Successful Endoscopic Biliary Drainage. a Preliminary Report

On each line: pCLE image representative of a query video (framed image on the left), followed by 3 pCLE images representative of the 3 atlas videos which have been automatically recognized by the Smart Atlas software as the most visually similar to the query video. Each pCLE video is annotated with final diagnosis. Su1663 An Open-Labeled, Randomized Controlled Trial Comparing Between Short Duration and Standard 14 Days Antibiotic Treatments for Acute Cholangitis in Patients With Common Bile Duct Stone After Successful Endoscopic Biliary Drainage. a Preliminary Report Duangswang Limmathurotsakul*, Nisa Netinatsunton, Siriboon Attasaranya, Bancha Ovartlarnporn Medicine, Faculty of Medicine, Prince of Songkla university, Division of gastroenterology, Hatyai, Thailand; NKC institute of Gastroenterology and Hepatology, Hatyai, Thailand Background: Acute cholangitis is generally treated with endoscopic biliary drainage (EBD) and systemic antibiotics. The traditional duration of antibiotic treatment varied from 7-14 days after endoscopic biliary drainage. Data regarding short duration of antibiotic treatment after EBD are limited. Aims. To compare the efficacy and safety of short duration with standard fourteen days antibiotic treatment in patients with acute cholangitis due to common bile duct stone (CBDS) after successful endoscopic biliary drainage. Methods: A prospective randomized study of patients with mild to moderate acute cholangitis due to CBDS with symptoms duration! 48 hours were randomized at the time of ERCP to a short duration (group A) or standard fourteen days antibiotic treatment (group B) from February 2013 to November 2013. Ceftriaxone was used for antibiotic therapy. The endoscopic drainage by ERCP was done within 72 hours after admission. Endoscopic drainage was defined as complete when all the CBDSs were removed and as incomplete when some residual stones were present with stent insertion done. In the short duration treatment group, antibiotic was stopped when the patient was afebrile for 72 hours. The study protocol was approved by local Ethics Committee. Results: 14 patients with 6 female and 8 male and the mean age 70.2+16.2 years were recruited. 7 were in group A and 7 in group B. The demographic data, the abdominal pain intensity, LFT and number of CBDS were not significantly different between the 2 groups. The clinical response including duration of fever, abdominal pain, improvement of LFT, and the number of patient with incomplete drainage after treatment were similar between group A and B. The mean duration + SD of antibiotic treatment in group A was 5 +1.8 days with a range of 4-9 days. There were 3 patients with bacteremia in each group but none of patients in both groups developed recurrent cholangitis after 2 months of follow-up. Conclusions: Our preliminary data suggested that short duration antibiotic therapy for acute CBDS cholangitis after successful endoscopic biliary drainage was safe and effective as the standard fourteen days antibiotic treatment. Baseline characteristic data AB358 GASTROINTESTINAL E Group A (Treatment) NDOSCOPY Vo Group B (Control) lume 79, No. P Value Total patient 7 7 Sex (male/female), n 4/3 5/2 Age (y), mean (SD) 72.9(17.2) 67.6(16.2) 0.564 Abdominal pain score before ERCP (0-10), mean (SD) 9.29(1.89) 8.71(1.60) 0.554 5S : 2014 Group A (Treatment) Group B (Control)

Vulvo-vaginitis in Prepubertal Girls: New Ways of Administering Old Drugs

Study ObjectiveTo evaluate the effectiveness and safety of local vs systemic antibiotic treatment in the management of recurrent vulvovaginitis in children. DesignRandomized treatment and follow-up of 90 cases of persistent vulvovaginitis. SettingThe Department of Medicine and Health Sciences, Institute of Gynecology and Obstetrics, University of Molise, Italy. MethodsBetween January 2009 and December 2012, 90 prepubertal girls (Tanner Stage I) aged 6–12 years, with recurrent discharge not responding to common hygienic measures and not suspected of being sexually abused, were treated, 45 patients with oral antibiotic treatment (group 1) and 45 patients with a local antibiotic treatment (group 2). Vaginal cultures were prepared before treatment and follow-ups were made after 3 months. ResultsBacterial pathogens were isolated in vaginal secretions of 84/90 (93%) girls. There were 6 girls receiving antibiotic treatment who had persistent discharge and repetitive isolations of Escherichia coli. Administration type was selected at random. Symptoms and signs were resolved in all girls, but we observed 1 recurrence (2.22%) in group 2 vs 6 recurrences (13.33%) in group 1 (P = .049). In group 1 we observed 3 cases (6.67%) of gastro-intestinal side effects vs no cases in group 2 (P = .079). ConclusionTopical medication based on netilmicin, associated with Benzalkonium-Chloride, showed a clinical and microbiological effectiveness in first-line treatment of bacterial vulvovaginitis in children, comparable to conventional drugs; so local treatment may be a good alternative to systemic treatment decreasing the use of oral antibiotics in young people and related risks of bacterial resistances.

The influence of antibiotic treatment of bitches in oestrus on their attractiveness to males during mating

The aim of this study was to evaluate the influence of the antibiotic treatment, including the mode of drugs administration, on bitches' attractiveness to the stud dogs during mating. Moreover, we tried to estimate the possibility of aversive effect of the drug vehicle on the male behavior. In experiment I, four bitches in oestrus without antibiotic treatment (group A), four bitches treated with intravaginal antibiotic (group B) and four bitches treated with intramuscular antibiotic (group C) were presented to four stud dogs. In experiment II, bitches in oestrus (n = 5) were presented to the males (n = 2) before and after the application to the females' vulva the antibiotic carrier--Miglyol 840 (Sasol, Germany). In both experiments the presence of the typical sexual behavior of the males (sniffing, licking the vulva and anal region, mating attempts) was evaluated. In experiment III the reaction of the males to the samples containing oestrual discharge from the bitches untreated and treated with antibiotics was evaluated. In the last part of study the aversion reaction to the samples containing antibiotic and the antibiotic carrier was evaluated. The results of experiments showed that females treated with the antibiotics were less attractive to males than untreated females, regardless of the method of administration. We did not observe adverse effect of the antibiotic carrier but samples from the bitches treated with antibiotics were significantly less attractive to the males. We concluded that the reason for reduced attractiveness of the bitches in oestrus after antibiotic treatment was the changes in semiochemical signal emitted by treated females as a consequence of elimination of the vaginal bacterial flora, which seems to be involved in creation of the typical, recognizable by the stud dogs, oestrual signal but also by the possible covering effect of used drugs.

TSPO expression in brain tissue of vibrio vulnificus sepsis rats and the effects of antibacterial agents

Objective To investigate the potential role and changes of translocator protein 18 kDa (TSPO) in brain tissue of vibrio vulnifwus (VV) septic rats and effects of Cefoperazone Sodium combined with Levofloxacin.Methods One hundred SD rats were divided randomly (random number) into four groups:normal control group (A,n =10),VV sepsis model group (B,n =40),antibiotics treatment group (C,n =40),and antibiotics control group (D,n =10).Septic model was replicated by injection with VV (6 × 108 cfu/ml,0.1 ml/100 g) in the left posterior leg of rats.The antibacterials were given intraperitoneally with Cefoperazone sodium (180 mg/ kg) combined with Levofloxacin (18 mg/kg).The level of TSPO and pro-and anti-Inflammatory cytokines in rattish brain at 6,12,24,48 h after infection were observed by RT-PCR,Western blotting,immunohistochemisty and ELISA.Then pathological change in brain tissue was detected by electron microscope.Results Compared with group A,the expression of TSPO in brain tissue was significantly increased in group B (P ＜ 0.05),and reached the peak at 24 h.The TSPO expression in group C was significantly decreased compared with that in group B at 12,24,48 h (P ＜0.05).The levels of TNF-α,IL-6,IL-10 in brain tissue of group B were significantly higher than those in group A (P ＜ 0.05).Compared with group B,the TNF-α expression in group C was siginificantly decreased at 6,12,24 h (P ＜0.05),while the IL-6 expression was siginificantly decreased at 12,24,48 h (P ＜0.05) and IL-10 level was significantly increased at 6,12,24,48 h (P ＜ 0.05).Immunohistochemical tests showed brownish yellow particles (TSPO protein) in the brain tissue of group B were more dense than those in group C.Electron microscope showed the nerve cells and organelles were swelling intensively and the neuronal nucleus were dissolved and disappear in group B.But the neuronal nucleus were dissolved partly and the swelling were alleviative in group C.Conclusions TSPO expression is markedly increased in accord with brain tissue injury and inflammation,which makes it suited for assessing brain injury as a sensitive biomarker in VV sepsis.Effective antibiotics can inhibit the inflammatory and injury and reduce the level of TSPO in septic brain. Key words: Vibro vulnificus ; Sepsis encephalopathy; Translocator protein (TSPO) ; Antibacterials ; Rat

The effect of continuous renal replacement therapy on the outcome of severe pneumonia in patients receiving long-term immunosuppressants

To investigate the effect of continuous renal replacement therapy (CRRT) on the outcome of severe pneumonia in patients receiving long-term immunosuppressants. Thirty-four patients, who had been treated with long-term immunosuppressants, were admitted for severe pneumonia. After admission, the dose of immunosuppressants including glucocorticoids was decreased, and the patients were divided into 2 groups: antibiotic treatment group (n = 16) and antibiotic + CRRT treatment group (n = 18). Before and after treatment, the changes of the patients' condition, chest CT and blood gas analysis were monitored. Biomarkers including C-reactive protein (CRP), interferon-γ (IFN-γ), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), interleukin-8(IL-8), white blood cell and neutrophil counts were determined. After treatment, the levels of CRP[(109 ± 24) vs (40 ± 13) mg/L], IFN-γ [(151 ± 28) vs (42 ± 12) ng/L], TNF-α [(301 ± 45) vs (118 ± 28) pg/L], IL-6 [(214 ± 45) vs (76 ± 23) pg/L], IL-8[(590 ± 121) vs (159 ± 60) pg/L], white blood cell count [(14.3 ± 5.7)×10⁹/L vs (8.5 ± 2.7)×10⁹/L], and neutrophil percentage [(91.3 ± 3.1)% vs (75.3 ± 2.6)%] decreased significantly in the antibiotic + CRRT group (P < 0.05) as compared to the antibiotic treatment group. In the antibiotic + CRRT group, blood gas showed significant improvement in pH [(7.30 ± 0.12) to (7.37 ± 0.18)], SaO₂ [(80.6 ± 7.6)% to (91.9 ± 7.3)%] and PaO₂ (41 ± 6) mm Hg (1 mm Hg = 0.133 kPa) to (71 ± 9) mm Hg. The patients' condition and chest CT abnormalities also improved more rapidly in the antibiotic + CRRT group. The 6-month survival was increased by 12.9% in the antibiotic + CRRT group as compared to the antibiotic group (P < 0.05). CRRT is effective in clearance of inflammatory mediators and may increase survival of severe pneumonia patients receiving long-term treatment of immunosuppressants.

Identification and Antimicrobial Susceptibility of Enterococci Isolated from Dogs and Cats Subjected to Differing Antibiotic Pressures

The purpose of the present study was to determine the prevalence of antibiotic-resistant enterococci in dogs and cats subjected to differing antibiotic pressures, and the prevalence of vancomycin resistance genes in isolates from these animals. Enterococci were isolated from fecal samples of 65 healthy dogs and 29 healthy cats brought to animal hospitals, from rectal swabs of 73 puppies and 15 kittens from five breeders and two pet shops, and from fecal samples of 20 dogs and 9 cats that were treated with antibiotics in Nippon Veterinary and Life Science University Animal Medical Center. The rates of resistance to ampicillin among isolates from the kitten-puppy group and healthy dog-cat group were 6.8 and 4.3%, respectively. In contrast, the rates of resistance to ampicillin in enterococci from the treatment group under antibiotic pressure were 37.5%. There was a significant difference between the antibiotic-treated group and the untreated group (P<0.01). Similarly, in the treatment group, the rate of resistance to enrofloxacin was extremely high (75.0%). In comparison, in the healthy group and kitten-puppy group, the rates of resistance to enrofloxacin were 23.4 and 12.1%, respectively. Among these groups, a significant difference was also observed in the apparent resistance rates (P<0.01). Vancomycin-resistant enterococci (VRE) harboring vanA or vanB were not detected in any groups. Therefore, contamination of VRE in dogs and cats is still considered to be minimal in Japan.

Antisense inhibition of secretory and cytosolic phospholipase A2 reduces the mortality in rats with sepsis*

Phospholipase A(2) has been implicated to play a pivotal role in the pathogenesis of sepsis syndrome. The two major forms of phospholipase A(2) isoenzymes, secretory phospholipase A(2) and cytosolic phospholipase A(2), are overexpressed during sepsis. The objective of this study was to test the hypothesis that inhibition of the overexpressed secretory phospholipase A(2) and cytosolic phospholipase A(2) during sepsis benefits the disease's eventual outcome. Short-chain antisense oligonucleotide molecules were designed with the aid of computer software programs, and their in vitro efficacies were assessed in cell culture systems based on inhibition of target protein expression. The in vivo efficacies were determined in intact sepsis rats using 35-day survival rate as a primary efficacy end point. Animal research laboratory at a university. Male Sprague-Dawley rats (180-200 g). Sepsis was induced by cecal ligation and puncture. Antibiotics were administered subcutaneously once daily at 12 mg/kg, for 20 days. Oligonucleotides (antisense or mismatch) were administered intravenously once daily at 2 mg/kg to 0.8 mg/kg in a decreasing order, for 20 days. In cell culture systems, 21 of the 105 antisense constructs were found to be efficacious in inhibiting secretory phospholipase A(2) IIa and cytosolic phospholipase A(2) IVa protein expression. In sepsis rats, antisense oligonucleotides were capable of reducing their target protein expression by 18%-61% in major organs such as liver, heart, and kidney. In animal experiments, sepsis without any treatment (Group 1) had a median survival time of 2 days and a zero (0) percent survival rate at day 14. Sepsis with antibiotic treatment (Group 2) had a median survival time of 6 days and a 35-day survival rate of 28%. Sepsis with cotreatment of antibiotics and antisense oligonucleotides (one against secretory phospholipase A2 IIa and the other against cytosolic phospholipase A(2) IVa) (Group 4) increased the median survival time from 6 to 35 days and the 35-day survival rate from 28% to 58.8% as compared with antibiotics alone (Group 4 vs. Group 2; p <.05). Sepsis with cotreatment of antibiotics and mismatch oligonucleotides (Group 3) did not affect the median survival time and the 35-day survival rate as compared to antibiotics alone (Group 3 vs. Group 2; p >.05). The results demonstrate that antisense strategy against secretory phospholipase A(2) IIa and cytosolic phospholipase A(2) IVa can inhibit their target protein expression in major organs and greatly improve the clinical outcome, i.e., an absolute reduction in 35-day mortality of 30.8%, in rats with sepsis. Our studies, thus, provide an improved method for the treatment of sepsis by targeting multiple forms of phospholipase A(2) isoenzymes with DNA antisense oligomers.

Excretion of Antibiotic Resistance Genes by Dairy Calves Fed Milk Replacers with Varying Doses of Antibiotics

Elevated levels of antibiotic resistance genes (ARGs) in soil and water have been linked to livestock farms and in some cases feed antibiotics may select for antibiotic resistant gut microbiota. The purpose of this study was to examine the establishment of ARGs in the feces of calves receiving milk replacer containing no antibiotics versus subtherapeutic or therapeutic doses of tetracycline and neomycin. The effect of antibiotics on calf health was also of interest. Twenty-eight male and female dairy calves were assigned to one of the three antibiotic treatment groups at birth and fecal samples were collected at weeks 6, 7 (prior to weaning), and 12 (5 weeks after weaning). ARGs corresponding to the tetracycline (tetC, tetG, tetO, tetW, and tetX), macrolide (ermB, ermF), and sulfonamide (sul1, sul2) classes of antibiotics along with the class I integron gene, intI1, were monitored by quantitative polymerase chain reaction as potential indicators of direct selection, co-selection, or horizontal gene transfer of ARGs. Surprisingly, there was no significant effect of antibiotic treatment on the absolute abundance (gene copies per gram wet manure) of any of the ARGs except ermF, which was lower in the antibiotic-treated calf manure, presumably because a significant portion of host bacterial cells carrying ermF were not resistant to tetracycline or neomycin. However, relative abundance (gene copies normalized to 16S rRNA genes) of tetO was higher in calves fed the highest dose of antibiotic than in the other treatments. All genes, except tetC and intI1, were detectable in feces from 6 weeks onward, and tetW and tetG significantly increased (P < 0.10), even in control calves. Overall, the results provide new insight into the colonization of calf gut flora with ARGs in the early weeks. Although feed antibiotics exerted little effect on the ARGs monitored in this study, the fact that they also provided no health benefit suggests that the greater than conventional nutritional intake applied in this study overrides previously reported health benefits of antibiotics. The results suggest potential benefit of broader management strategies, and that cost and risk may be avoided by minimizing incorporation of antibiotics in milk replacer.

Synergistic effects of antibiotics and an N-acyl homoserine lactone analog on Porphyromonas gingivalis biofilms

To investigate the effects of the combined application of an N-acyl homoserine lactone (HSL) analog and antibiotics on biofilms of Porphyromonas gingivalis, a major pathogen of periodontal disease. Antibiotics used were cefuroxime, ofloxacin and minocycline. A flow-cell model was used for biofilm formation. Samples were divided into four groups: control, analog-treated, antibiotic-treated and combined application groups. Biofilm cell survival was determined using adenosine triphosphate (ATP) bioluminescence and confocal laser microscopy (CLSM). In the combined application group, the ATP count in biofilm cells was significantly decreased compared with the antibiotic-treated group (Games-Howell test, P < 0·05). A combination of cefuroxime and the analog was most effective against the P. gingivalis biofilm. CLSM observations revealed that the proportion of dead cells was highest in the combined application group. The combined application of the N-acyl HSL analog and antibiotics was effective at reducing the viability of P. gingivalis cells in biofilms. The combined application of the N-acyl HSL analog and antibiotics may be successful for eradicating infections involving bacterial biofilms, such as periodontitis.

A Pilot Study Validating the Use of a Neonatal Early Warning Score

Background: A Neonatal Early Warning Score (NEWS) is currently not used consistently, and screening for sepsis can be a subjective decision. NEWS may help to alert clinicians as to which infants are sick or at risk of impending illness. Aims: To demonstrate usefulness of NEWS signs and consequent actions in confirmed and suspected cases of neonatal sepsis. Methods: A retrospective analysis of infants with either a positive blood culture or who received antibiotics with negative blood culture from July 2007 to June 2009. A ‘traffic light’ NEWS proforma was designed based on colour coded alert signs & symptoms according to severity. Data from the NEWS proforma was collated in Excel and analysed using simple statistical methods and percentage calculations. Results: 15 case notes in the positive blood culture group were reviewed; 23 case notes in the antibiotic treatment group were reviewed. This gave a total of 38 case notes. 58% infants had one or more 'red alert' signs and were transferred to SCBU 47% infants had one or more ‘amber alert’ signs and had a senior review 39% infants had one or more ‘green alert’ signs and had a review within one hour Some of the babies had more than 1 alert. Conclusions: This NEWS would have highlighted all the infants with confirmed or suspected sepsis. Given the majority of junior trainees with relative inexperience it is helpful to have a validated proforma.

Adjuvant Anti-Tumor Necrosis Factor Therapy for Staphylococcal Arthritis and Sepsis: A Cautionary Note

Although etanercept, a dimeric fusion protein linking two 75-kDa tumor necrosis factor (TNF)–a receptor molecules to the Fc portion of immunoglobulin G1, is clearly effective for inhibiting TNF-mediated synovial inflammation and joint destruction in patients with rheumatoid arthritis [1, 2], the role of anti-TNF adjuvant therapy for septic arthritis is far from certain. Because proinflammatory mediators such as TNF-a play an important role in the pathogenesis of septic arthritis [3], there is reason to believe that antiTNF therapy in combination with antibiotics may be beneficial. Two other studies have demonstrated that systemic corticosteroids or a nonsteroidal antiinflammatory drug administered in combination with antibiotics was superior to antibiotics alone in animal studies of Staphylococcus aureus septic arthritis [4, 5]. A double-blind, placebocontrolled randomized clinical trial also demonstrated that short-course dexamethasone adjuvant therapy significantly reduced symptom duration and joint dysfunction in children with hematogenous septic arthritis, including those with S. aureus infection [6]. In this issue of the Journal, Fei et al [7] provide evidence suggesting that anti-TNF adjuvant therapy may also be beneficial in S. aureus septic arthritis and sepsis. Using a murine hematogenous infection model, they demonstrated significant reduction in both clinical severity (arthritic index) and bone destruction (histopathologic index) after combination treatment with cloxacillin and etanercept, compared with cloxacillin alone. Furthermore, overall mortality at 14 days was reduced in mice treated with the combination. However, this study also raises a number of questions. Is this animal model relevant to human disease? Is the favorable response of etanercept specific to the strain of S. aureus used in their animal model? Is there sufficient evidence to warrant further studies of etanercept by randomized clinical trials in patients with S. aureus septic arthritis? What about safety concerns with etanercept? An important but unexplained observation in their murine model of S. aureus septic arthritis is the high early mortality rate in mice receiving antibiotics alone ( 65% within 2 days after treatment). In contrast, mice receiving phosphate-buffered saline (PBS) had a more gradual death rate ( 45% at 10 days after infection). Fei et al suggested that this early mortality in the antibiotic treatment group could be due to the release of cell wall components after exposure to bactericidal antibiotics. This is certainly a possibility, because peptidoglycan and lipoteichoic acid are released from grampositive cell wall during antibiotic exposure, and are known to activate a cascade of proinflammatory cytokines, including TNF-a, interleukin-1, and interleukin-6 [8, 9]. However, whether release of these bacterial cell wall components contributes to early mortality after antibiotic treatment during experimental S. aureus infection is unknown. An alternative and equally attractive proposition is that this early mortality was due to the release of superantigen exotoxins from the infecting strain of S. aureus after treatment with bactericidal antibiotics [10], because LS-1, the S. aureus strain used in the experimental model of septic arthritis, is known to produce toxic shock syndrome toxin 1 (TSST-1) [11, 12]. TSST1 was found to be both arthritogenic and lethal in this murine model, because TSST-1–deficient mutants were significantly less arthritogenic and produced less severe disease than their isogenic parental strains [13]. Thus, the beneficial effect of etanercept in this animal model was probably derived from its anti-TNF effect on TSST-1–mediated lethality, as confirmed by its protective Received 9 March 2011; accepted 14 March 2011. Potential conflicts of interest. none reported. Correspondence: Anthony W. Chow, MD, 769 Burley Pl, West Vancouver, BC, CanadaV7T 2A2 (tonychow@interchange.ubc.ca). The Journal of Infectious Diseases 2011;204:332–34 The Author 2011. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals. permissions@oup.com 0022-1899 (print)/1537-6613 (online)/2011/2043-0002$14.00 DOI: 10.1093/infdis/jir272

Inhaled antibiotics for long-term therapy in cystic fibrosis

Inhaled antibiotics are commonly used to treat persistent airway infection that contributes to lung damage in people with cystic fibrosis (CF). To examine the evidence that inhaled antibiotic treatment in people with CF reduces frequency of exacerbations of infection, and improves lung function, quality of life and survival. To examine adverse effects of inhaled antibiotic treatment. Trials were identified from the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register.Last search: 31 January 2011. Trials were selected if inhaled antibiotic treatment was used for at least four weeks in people with CF, treatment allocation was randomised or quasi-randomised, and there was a control group (either placebo, no placebo or another inhaled antibiotic). Two authors independently selected trials, judged the risk of bias and extracted data from these trials. The searches identified 176 citations to 78 trials. Nineteen trials, with 1724 participants, met the inclusion criteria. Adequate meta-analysis was not possible because of the variability of study design and reporting of results. Seventeen trials with 1562 participants compared an inhaled antibiotic with placebo or usual treatment for a duration between 1 and 32 months. Inhaled tobramycin was studied in eight trials. Lung function (measured as forced expired volume in one second) was higher and exacerbations of lung infection (by different measures) were less in the antibiotic-treated group. Resistance to antibiotics increased more in the antibiotic-treated group than in placebo group when results were reported. No auditory or renal impairment was found; analysis showed tinnitus, voice alteration, hemoptysis and cough were more frequent with tobramycin than placebo. One trial, compared tobramycin with colistin in 115 participants, after one month the mean difference in forced expiratory volume at one second was 6.33 (95% confidence interval -0.04 to 12.70) favouring tobramycin. Inhaled antibiotic treatment probably improves lung function and reduces exacerbation rate, but a pooled estimate of the level of benefit is not possible. The best evidence is for inhaled tobramycin. More evidence, from trials of longer duration, is needed to determine whether this benefit is maintained and to determine the significance of development of antibiotic-resistant organisms.

Risk factors associated with the antimicrobial resistance of staphylococci in canine pyoderma

This study reports the susceptibility to antimicrobial agents of staphylococci (n=105) isolated from dogs, and the factors associated with this resistance. The study animals were 23 healthy dogs (group A), 24 with first-time pyoderma (group B), and 27 with recurrent pyoderma that had undergone long-term antibiotic treatment (group C). Staphylococci were more commonly isolated from the pyoderma-affected than the healthy dogs (p<0.0001).Some 78% of the isolates were resistant to at least one antimicrobial agent. Resistance to amoxicillin–clavulanate, cephalosporins (OR 4.29, 95% CI [1.15, 16.3] respectively), enrofloxacin (OR 9.47, 95% CI [1.53, 58.5]) and ciprofloxacin (OR 79.7 95% CI [3.26, 1947.4]) was more common among group C isolates. Some 32% of all the isolates were multiresistant (MR) and 10.4% were methicillin-resistant (MRS). The probability of isolating MRS staphylococci in group C increased by a factor of four (95% CI [1.18, 17.9]) compared to A plus B. Multi-resistant (MR) isolates were obtained more commonly from urban than rural dogs (OR 3.79, 95% CI [1.09, 13.17]). All the MRS staphylococci encountered were obtained from urban dogs and more commonly from male dogs (p=0.07).This study shows that dogs bred in urban habitat, with a history of antibiotic therapy in the past year represents significant risk of being carriers of isolates resistant to methicillin (MRS) and other antimicrobials. These factors should be considered before applying an antimicrobial treatment in veterinary clinics.

Quercetin의 급여가 육계 다리육의 산화 안정성에 미치는 영향

본 연구는 quercetin의 급여가 닭고기 다리육의 지방산패 억제 효과에 미치는 영향을 구명하고자 실시하였다. 1일령 Ross 320마리 육계 병아리를 8처리군으로 나누어 대조군(T1), 항생제 처리군(T2), 비타민 E 20 ppm 처리군(T3), 비타민 E 200 ppm 처리군(T4), quercetin 20 ppm(T5), quercetin 200 ppm(T6), methoxylated quercetin 20ppm(T7), methoxylated quercetin 200 ppm(T8) 처리구로 나누어 35일간 급여하였다. 급여 후 36일째 도계하여 다리육만 분리하였고, 0, 3, 7일 냉장 저장 기간 동안의 단백질 변패도(VBN), 지방산패도(TBARS), 지방산 조성 변화, 미생물학적 특성을 조사하였다. 저장 3일에는 대조군보다 항생제처리군(T2), 비타민 E처리군(T3, T4)와 quercetin 20 ppm 처리군(T5)에서 유의적인 감소를 나타내어 quercetin 20 ppm의 높은 단백질 산패 억제 효과를 보였다(P<0.05). 도계 직후 다리살의 지방산패도는 대조군보다 비타민 E 200 IU 급여한 T4에서 가장 낮은 값을 나타내었으며, 이 값은 항생제 처리구인 T2, quercetin 200 ppm 첨가구인 T5와 유의적인 차이를 나타내지 않아, 비타민 E 200 IU와 유사한 항산화력을 나타냄을 보여주었다(p<0.05). 그러나 저장 7일에 quercetin 20 ppm 처리군(T5)과 200 ppm 처리군(T6)은 항생제 처리군보다도 낮은 총 균수를 나타내어 높은 항균력을 나타내었다(P<0.05). 대장균군은 도계 직후부터 냉장 저장 7일까지 quercetin 처리에 의한 유의적인 감소 효과는 없었다. This study was carried out to determine the effect of dietary supplementation of quercetin and methoxylated quercetin extracted from onions on oxidation of chicken thigh during cold storage. For 35 days, 1-day-old 320 broiler chicks (Ross) were divided into 8 groups and supplemented the diet; basal diet only (T1), T1 with antibiotics (T2), vitamin E 20 IU (T3), vitamin E 200 IU (T4), quercetin 20 ppm (T5), quercetin 200 ppm (T6), methoxylated quercetin 20 ppm (T7), methoxylated quercetin 200 ppm (T8). After slaughtering the broilers, thigh meats were collected and analyzed the oxidation stability during storage at <TEX>$4^{\circ}C$</TEX> for 7 days. Volatile basic nitrogen (VBN) was ranged from 10.98~15.37 mg% until day 3 and quercetin 20 ppm (T5) significantly reduced (p<0.05) the VBN value of thigh as much as antibiotics treatment group (T2). The supplementation of quercetin at a 200 ppm level significantly reduced 2-thiobarbituric acid reactive substances value when compared with the control. Supplementation of 20 ppm quercetin also affected fatty acid composition of chicken thigh and resulted in increase of C18:1w9 and decrease of C18:2w6 on day 3. In microbes of chicken thigh during storage, supplementation of 20 ppm quercetin significantly reduced total microbes compare to control on day 7 (p<0.05). There was no effect on the number of coliforms in thigh with quercetin diet. From these results, the dietary supplementation of 20 ppm of quercetin may have effects on enhancing oxidation stability.

Alta exposición a antibióticos en la población y sus diferencias por género y edad

Purpose To determine antibiotic use and its distribution by age and gender, as well as the most prescribed therapeutic group. Design Observational descriptive with retrospective data. Settings and participants Population from the Lleida (Spain) Health Region receiving antibiotic prescriptions from 2002 to 2007. Measurements Daily Dose Per Inhabitant (DID) was calculated, as well as the number of patients under treatment. The study variables were: age, gender, number of patients under antibiotic treatment and pharmacological group. Results Mean prevalence of patients receiving antibiotics was 36.93% (33.51% in men and 40.42% in women). The DID in Lleida during 2007 is 23.52. The majority (56%) had received antibiotics once a year. The antibiotic consumption prevalence has a “V” shape with higher values among children and old people. There is an annual exposure to antibiotics in 58.8% of the 0 to 4 years-old age group. The most prescribed antibiotic is amoxicillin/clavulanic. Conclusions We observe a high antibiotic prescription rate among children and older people, the high consumption in childhood being of note. There is also a higher use of antibiotics among women and changing of prescription towards broad spectrum antibiotics.

774 Antibiotics Therapy in Mild Nontyphoid Salmonellosis Children Prolonged Hospitalization and Fecal Excretion Time-A Preliminary Report

Objective: Antibiotics for nontyphoid salmonellosis has long been a controversial matter. Most studies didn't claβify the salmonellosis with severity of disease. The purposes of the study were to investigate the outcomes of the mild nontyphoid salmonellosis children with antibiotics therapy. Material and methods: This is a prospective observational study. Between 2005 and 2008, all pediatric patients with nontyphoid salmonellosis admitted to Kaohsiung Veterans General Hospital, Taiwan, were claβified with severity score. The severity score is composed of three parameters: Score greater than 3, 2 or 3 and ≤ 1 was considered severely, moderately and mildly ill respectively. Mildly ill salmonellosis patients treated with or without antibiotics were collected. All patients were followed until two consecutive rectal swabs were negative for Salmonella. The demographic data, clinical manifestations, laboratory data, response to treatment and duration of fecal excretion of Salmonella were recorded. Results: Fifteen patients were enrolled into the study and six patients were in antibiotics treatment group. The demographic data, clinical manifestations and laboratory data were comparable between two groups. Significantly longer days of fever after admiβion, longer hospitalization days and longer days of fecal excretion in the antibiotics treatment group. Conclusions: Antibiotics are not mandatory for the subset of nontyphoid salmonellosis children with low severity score.

1388 Assessment of a Series of Markers as Diagnostic Tools of Early-Onset Neonatal Sepsis

Aim: The aim of the research was to evaluate the usefulness of Toll-like receptors 2(TLR-2) and 4(TLR-4), interleukine-6(IL-6), tumor necrosis factor-alpha(TNF- α) and C-reactive protein(CRP) in diagnosis of early neonatal sepsis on preterm babies with premature rupture of membranes.Material and Methods:A prospective study has carried out between jan.2007-jan.2008 at Neonatology Department of the Cluj District University Hospital.Diagnosis of sepsis was done according to International Sepsis Definitions Criteria. Study group involved 21 newborns with symptoms suggestive of systemic infection, requiring sepsis evaluation, antibiotic treatment and control group represented by healthy newborns. We determined in the first day of life TLR-2, TLR-4, IL-6, TNF-α and CRP and in the third day the same without TLR. We used latex agglutination test for CRP, Elisa technique for TNF-α and IL-6 and flow cytometry for TLR. Data were analyzed using Statistica 6.0.Results: Sepsis group presented in the 1st day: TNF-α (pg/ml)= 14,7[5,0-24,3]; IL6 (pg/ ml)=153,7[82,3-225,1]; CRP (mg%)= 0,83[0,54- 1,12]; and the expression(%) of TLR2 = 42,5 [29,5- 55,4]; and TLR4 = 2,2[1,26-3,15]. TNF- α was correlate significantly and negative with TLR2. TLR2 was correlated significantly and positive with TLR4. In the 3-rd day the values were: TNF-α (pg/ml)= 10,1[5,1-15,1]; IL6(pg/ml)=46,5[16,3-76,7]; CRP (mg%)= 1,2[0,6-1,81]. Control group presented: TLR2(%) = 5,69 (p= 0,00006) and TLR4(%) = 0,67(p = 0,037).Conclusions: IL-6 and TNF-α can be considered markers of early-onset neonatal sepsis. TLR-2 and TLR-4 could be promising markers for neonatal sepsis. CRP revealed not to be a useful marker in diagnosis of early-onset sepsis.

Clinical Trial Report: Eradication of Helicobacter pylori Reduces the Risk for Subsequent Gastric Cancer

Curr Gastroenterol Rep (2010) 12:427–430 DOI 10.1007/s11894-010-0138-8 CLINICAL TRIAL REPORT Clinical Trial Report: Eradication of Helicobacter pylori Reduces the Risk for Subsequent Gastric Cancer Joseph R. Pisegna & Bijal Surti & David R. Scott Published online: 22 September 2010 # The Author(s) 2010. This article is published with open access at Springerlink.com Fuccio L, Zagari RM, Eusebi LH, et al.: Meta-analysis: can Helicobacter pylori eradication treatment reduce the risk for gastric cancer? Ann Intern Med 2009, 151:121– Aims The study’s purpose is to examine whether eradication of H. pylori infection can reduce the risk for the development of gastric cancer. Rating Methods •Of importance. The authors examined the results of seven studies that met inclusion criteria by using relevant clinical trials. Relevant trials were identified through searching PubMed, Embase, Google Scholar, and the Cochrane Library. To be eligible to include subjects in this analysis, the randomized clinical trials were required to compare an eradication treatment group to an untreated group and to provide an analysis of the number of gastric cancers occurring during follow-up evaluation. Introduction Helicobacter pylori is a carcinogen and has been associated with the development of gastric cancer. The hypothesis to be tested in this meta-analysis is to determine whether eradication of this organism is associated with a long-term reduction in the risk for development of gastric cancer. Results A total of seven studies were considered adequate to meet the inclusion criteria. One of the studies was excluded after further analysis. Overall, 27 of 3388 (1.1%) treated patients in the H. pylori antibiotic treatment group were identified as having gastric cancer, compared to 56 of 3307 (1.7%) in those subjects who did not undergo treatment. The authors identified the relative risk for gastric cancer as 0.65 (95% CI, 0.43–0.98). J. R. Pisegna : B. Surti : D. R. Scott CURE: Digestive Diseases Research Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA J. R. Pisegna : B. Surti : D. R. Scott Department of Medicine, University of California, Los Angeles, Los Angeles, CA 90073, USA J. R. Pisegna (*) Division of Gastroenterology and Hepatology, VA Greater Los Angeles Healthcare System, 11301 Wilshire Boulevard, Los Angeles, CA 90073, USA e-mail: jpisegna@ucla.edu Discussion The authors conclude that eradication of H. pylori reduces gastric cancer risk.

Prophylactic Antibiotics in Endoscopic Sinus Surgery: A Short Follow-Up Study

The study was designed to assess the usefulness of postoperative antibiotics in patients undergoing endoscopic sinus surgery (ESS). The effects of antibiotics in the postoperative period of ESS patients were evaluated in a prospective, randomized, double-blind, placebo-controlled study. Fifty patients were treated with amoxicillin/clavulanate for 2 weeks after ESS, while the other half received placebo. Preoperatively, the symptom, endoscopic, and CT scores were recorded. In the postoperative period, symptom and endoscopic scores were recorded on the 5th, 12th, 21st, and 30th days. In estimating the length of the blood crust formation episode, a Kaplan-Meier plot was used. Seventy-five patients completed the study: forty in the antibiotic-treated group and thirty-five in the placebo group. On the 5th day, nasal obstruction and drainage were significantly better in the antibiotic-treated group. In addition, a statistically significant difference in the endoscopic scores was noted between the treatment and placebo groups on days 5 and 12. The use of an antibiotic (amoxicillin/clavulanate) in the postoperative period is able to improve the outcome in the early blood crust healing phase: nasal obstruction and drainage are reduced and the endoscopic score objectively showed a faster recovery.