Ciprofloxacin Therapy Research Articles

Improving Antibiotic Stewardship in a Pediatric Long-term Care Facility.

Antimicrobial stewardship is little studied in pediatric long-term care facilities. We sought to determine whether empirical ciprofloxacin for febrile respiratory illnesses could be safely reduced in our pediatric long-term care facility. All patients living in the 45-bed facility were included. A 1-year educational intervention for antimicrobial stewardship was implemented. Days of ciprofloxacin therapy, infections, microbiology, hospitalizations, other antibiotic use, methicillin-resistant Staphylococcus aureus and Clostridioides difficile infections, and mortality were recorded at regular intervals retrospectively from 5 years before intervention and prospectively for 8 years after intervention. Data were analyzed using statistical process control charts. A majority of patients had tracheostomy tubes (96%) and ventilator dependence (58%). Ciprofloxacin use declined by 76% (17 to 4 days/1000 facility patient days). Antibiotic prescriptions for bacterial tracheitis decreased by 89% (38 to 4 courses per 6-month period). No increases in positive blood or urine cultures, hospitalizations, or need for hospital antibiotics were observed. An antimicrobial stewardship intervention in a pediatric long-term care facility led to decreases in ciprofloxacin use, bacterial tracheitis diagnoses, and overall antibiotic use without increasing negative outcomes.

Socio-Demographic Factors Affecting the Prevalence of Typhoid Fever Among Febrile Patients in Kebbi State, Nigeria

Typhoid fever is a life-threatening public health disease caused by the bacterium Salmonella Typhi. The disease is a significant health concern in underdeveloped and most developing countries, especially in Asia and Africa (including Nigeria). The study was aimed at determining the prevalence and sociodemographic factors associated with typhoid fever among febrile patients attending three selected hospitals in Kebbi State, Nigeria. A hospital based cross sectional study was carried out among 406 febrile patients suspected of typhoid fever aged 1-70 years (mean age 34 years) in three selected health facilities of Kebbi State, Nigeria from February2021 to October, 2021. Approximately 20 ml and 10 ml of venous blood was collected from adults and children respectively. Blood culture and biochemical tests were carried out. Patients were administered structured questionnaires to evaluate the level of knowledge and practice toward the disease. Data obtained from respondents was analysed by descriptive statistics. In this study, the culture identified Salmonella Typhi prevalence of typhoid fever among febrile study subjects in Kebbi State was 6.4%. A higher prevalence was recorded among males (7.5%) than in females (5.0%) participants. Patients within the age range of 11- 20 years had the highest prevalence (14.8%), those with informal education recorded 11.2%. It was observed that rural area dwellers had higher prevalence (9.4%). Out of 26 isolates, 25 were susceptible to cefotaxime, 11 isolates were resistant to cotrimoxazole and amoxicillin-clavulanate antibiotics. Salmonella enterica serovar Typhi is an important and common cause of febrile illness in our population. Lack of good quality drinking water in rural areas has a greater impact on the burden of typhoid fever among study participants. Cefotaxime and ciprofloxacin therapy are suitable treatments for typhoid fever. The identification of sociodemographic characteristics associated with the disease are of great importance in providing holistic preventive approach and control strategies of the disease.

Acidic Urine pH and Clinical Outcome of Lower Urinary Tract Infection in Kidney Transplant Recipients Treated with Ciprofloxacin and Fosfomycin.

Different factors, including antimicrobial resistance, may diminish the effectiveness of antibiotic therapy, challenging the management of post-transplant urinary tract infection (UTI). The association of acidic urine pH with microbiological and clinical outcomes was evaluated after fosfomycin or ciprofloxacin therapy in 184 kidney transplant recipients (KTRs) with UTI episodes by Escherichia coli (N = 115) and Klebsiella pneumoniae (N = 69). Initial urine pH, antimicrobial therapy, and clinical and microbiological outcomes, and one- and six-month follow-up were assessed. Fosfomycin was prescribed in 88 (76.5%) E. coli and 46 (66.7%) K. pneumoniae UTI episodes in the total cohort. When the urine pH ≤ 6, fosfomycin was prescribed in 60 (52.2%) E. coli and 29 (42.0%) K. pneumoniae. Initial urine pH ≤ 6 in E. coli UTI was associated with symptomatic episodes (8/60 vs. 0/55, p = 0.04) at one-month follow-up, with a similar trend in those patients receiving fosfomycin (7/47 vs. 0/41, p = 0.09). Acidic urine pH was not associated with microbiological or clinical cure in K. pneumoniae UTI. At pH 5, the ciprofloxacin MIC90 increased from 8 to >8 mg/L in E. coli and from 4 to >8 mg/L in K. pneumoniae. At pH 5, the fosfomycin MIC90 decreased from 8 to 4 mg/L in E. coli and from 512 to 128 mg/L in K. pneumoniae. Acidic urine is not associated with the microbiological efficacy of fosfomycin and ciprofloxacin in KTRs with UTI, but it is associated with symptomatic UTI episodes at one-month follow-up in E. coli episodes.

Effects of combined ciprofloxacin and Neulasta therapy on intestinal pathology and gut microbiota after high-dose irradiation in mice.

Treatments that currently exist in the strategic national stockpile for acute radiation syndrome (ARS) focus on the hematopoietic subsyndrome, with no treatments on gastrointestinal (GI)-ARS. While the gut microbiota helps maintain host homeostasis by mediating GI epithelial and mucosal integrity, radiation exposure can alter gut commensal microbiota which may leave the host susceptible to opportunistic pathogens and serious sequelae such as sepsis. To mitigate the effects of hematopoietic ARS irradiation, currently approved treatments exist in the form of colony stimulating factors and antibiotics: however, there are few studies examining how these therapeutics affect GI-ARS and the gut microbiota. The aim of our study was to examine the longitudinal effects of Neulasta and/or ciprofloxacin treatment on the gut microbiota after exposure to 9.5 Gy 60Co gamma-radiation in mice. The gut microbiota of vehicle and drug-treated mice exposed to sham or gamma-radiation was characterized by shotgun sequencing with alpha diversity, beta diversity, and taxonomy analyzed on days 2, 4, 9, and 15 post-irradiation. No significant alpha diversity differences were observed following radiation, while beta diversity shifts and taxonomic profiles revealed significant alterations in Akkermansia, Bacteroides, and Lactobacillus. Ciprofloxacin generally led to lower Shannon diversity and Bacteroides prevalence with increases in Akkermansia and Lactobacillus compared to vehicle treated and irradiated mice. While Neulasta increased Shannon diversity and by day 9 had more similar taxonomic profiles to sham than ciprofloxacin-or vehicle-treated irradiated animals. Combined therapy of Neulasta and ciprofloxacin induced a decrease in Shannon diversity and resulted in unique taxonomic profiles early post-irradiation, returning closer to vehicle-treated levels over time, but persistent increases in Akkermansia and Bacteroides compared to Neulasta alone. This study provides a framework for the identification of microbial elements that may influence radiosensitivity, biodosimetry and the efficacy of potential therapeutics. Moreover, increased survival from H-ARS using these therapeutics may affect the symptoms and appearance of what may have been subclinical GI-ARS.

Complication rates of ciprofloxacin alone vs. ciprofloxacin plus fosfomycin for transrectal prostate biopsy.

Infectious complications after transrectal prostate biopsy have been increasing, driven in large part, by rates of antibiotic resistance to conventional prophylaxis, such as ciprofloxacin. This study was designed to compare conventional antibiotic prophylaxis (oral ciprofloxacin) with ciprofloxacin and fosfomycin combination therapy prior to biopsy. This was a retrospective study looking at men between September 2021 and April 2023, who underwent transrectal prostate biopsy at several institutions in Alberta. The primary outcome was infectious complications within 30 days of prostate biopsy. Secondary outcomes included Clostridium difficile infections, urinary retention, gross hematuria, diarrhea, emergency room (ER ) visits, hospital admissions, and intensive care unit (ICU) admissions. Data was collected on resistance patterns and pathogens isolated in culture. During the study period, 2168 men underwent transrectal prostate biopsy. A total of 1216 men received ciprofloxacin alone and 877 received fosfomycin and ciprofloxacin. Infectious complications were significantly higher in the ciprofloxacin alone group (5.8% vs. 0.5%, p<0.0001). Thirty-day complications (7.2% vs. 2.1%, p<0.0001), 30-day ER visits (7.1% vs. 1.8%, p<0.0001), and 30-day hospitalizations (2.7% vs. 0.7%, p<0.001) were all higher in the ciprofloxacin alone group. The most isolated pathogen was E. coli in 54/60 (90%). Ciprofloxacin resistance in the isolated pathogens was high, with 52/60 (87%) showing resistance to ciprofloxacin and 51/54 (94%) E. coli strains resistant. No difference was seen in retention, C. difficile infections, bleeding, or diarrhea. The addition of fosfomycin for antibiotic prophylaxis prior to transrectal prostate biopsy was associated with significant improvement in infectious complications and healthcare utilization.

The Comparative Effectiveness of Ciprofloxacin and Metronidazole for an Initial Episode of Pouchitis: A Propensity-Matched Study.

There is minimal evidence regarding the comparative effectiveness of individual antibiotics in the treatment of pouchitis. We sought to evaluate the comparative effectiveness of ciprofloxacin monotherapy, metronidazole monotherapy, and combination therapy (ciprofloxacin and metronidazole) in the treatment of an initial episode of pouchitis after ileal pouch-anal anastomosis for ulcerative colitis (UC). We performed a retrospective cohort study in TriNetX, a global federated research network of electronic health records. Primary outcomes were failure of initial antibiotic therapy and the development of recurrent pouchitis in the first 12 months after an initial episode of pouchitis. One-to-one propensity score matching was performed for age, sex, race, primary sclerosing cholangitis, nicotine dependence, obesity, and previous exposure to tumor necrosis factor inhibitors between the cohorts. Among 271 patients who developed pouchitis (mean age at ileal pouch-anal anastomosis 35.8 years, male sex 57%) and were treated with ciprofloxacin, metronidazole, or combination therapy, 190 (70%) developed recurrent pouchitis. After propensity score matching, there was no significant difference in the odds of early relapse or nonresponse with ciprofloxacin compared with metronidazole monotherapy (adjusted odds ratio 0.56, 95% confidence interval 0.23-1.34) or when either monotherapy was compared with combination therapy. There was also no significant difference in odds of recurrent pouchitis when comparing patients treated with ciprofloxacin with metronidazole monotherapy (adjusted odds ratio 0.86, 95% confidence interval 0.40-1.84) or either monotherapy with combination therapy. In this retrospective cohort study, we demonstrated no significant difference in the real-world effectiveness of ciprofloxacin, metronidazole, or combination therapy for the initial episode of pouchitis.

Current Trends in the Management of Port-Site Infections: A Case Series and a Review of Published Work.

Introduction Laparoscopic techniques have become standard for many surgeries, offering benefits such as quicker recovery and less pain. However, port-site infections (PSIs) can occur and pose challenges. PSIs can be early (within seven days) or delayed (after three to four weeks), with delayed PSIs often caused by non-tuberculous mycobacteria (NTMs). NTMs are difficult to treat and do not respond well to antibiotics, leading to prolonged and recurrent infections. Guidelines for PSI management are limited. This summary highlights a case series of 10 patients with PSIs, discussing their treatment experience and presenting a treatment algorithm used at our institute. Methods This is a retrospective study (2015-2020) on chronic port-site infections (PSIs) in laparoscopic surgeries. Data were collected on patient demographics, surgery type, prior treatment, and management at the institute. Results The study analyzed 10 patients with chronic PSIs following laparoscopic surgery between 2015 and 2020. Laparoscopic cholecystectomy was the most frequent index surgery. Three patients had a history of treatment with varying durations of anti-tubercular therapy, one of whom had completed anti-tubercular treatment prior to presentation. Complete surgical excision with histopathological examination and fungal, bacterial and mycobacterial cultures were performed. Seven of the 10 patients were treated with oral ciprofloxacin and clarithromycin combination therapy for three months, two were treated with culture-based antibiotics and one was treated with anti-tubercular therapy. All patients improved on treatment.Themean follow-up period was52 ± 9.65 months, with no relapses being reported. Conclusion Port-site infections (PSIs) are troublesome complications of laparoscopic surgery that can erode the benefits of the procedure. Delayed PSIs caused by drug-resistant mycobacteria are difficult to treat. Improved sterilization methods and thorough microbiological work-up are crucial. Radical excision and prolonged oral antibiotics are effective treatments. Clinicians should avoid empirical antibiotic therapy to prevent antimicrobial resistance.

Combined Ganoderma lucidum polysaccharide and ciprofloxacin therapy alleviates Salmonella enterica infection, protects the intestinal barrier, and regulates gut microbiota.

Clinical antibiotics used worldwide could diminish the intestinal barrier, enhance contact with microbiota and intestinal immune cells, and induce inflammation. We found that ciprofloxacin treatment of Salmonella enterica serovar Typhimurium infection resulted in the destruction of the intestinal barrier, with decreased concentrations of MUC2, ZO-1, and occludin in the jejunum and colon. Ganoderma lucidum ethanol extracts (GLE), as a prebiotic food extract, significantly decreased inflammation-related enzymes, including COX-2, MPO, and iNOS, and pro-inflammatory cytokines (IL-6, IL-1β, IL-17, and TNF-α), and protected the intestinal barrier by increasing the concentration of MUC2, ZO-1, and occludin. Meanwhile it significantly increased the abundances of Salmonella, Parabacteroides, Acinetobacter, Enterococcus, and Escherichia-Shigella, which increased the risk of pathogenic bacterial infections. Prebiotic G. lucidum polysaccharide (GLP) provided a significant intestinal barrier, improving the concentration of ZO-1, occludin, and MUC2 in the colon and jejunum. The synergistic effects of GLP and ciprofloxacin were hypothesized to reverse the negative effects resulting from ciprofloxacin alone, as the concentrations of ZO-1, occludin, and MUC2 were significantly increased in the jejunum and colon, especially in the colon. Also, the synergistic effect increased the abundances of probiotic bacteria Lachnospiraceae NK4A136, Ruminococcaceae UGG-014, Lactobacillus, and Parabacteroides. In conclusion, combined GLP and ciprofloxacin therapy against Salmonella infection alleviated the side effects resulting from the clinical application of the antibiotic alone, and increased the probiotic bacterial population.

Short term ciprofloxacin and clindamycin combination antibiotic therapy before and after transrectal ultrasound scan and prostate biopsy: Its impact on major components of gut microbiome

The perturbation of gut microbiome is a risk factor for a number of adverse conditions. Among other factors antibiotic therapy is a common culprit. We characterized the short-term alteration of gut microbiome after antibiotic therapy.Nine patients (age (median [range]): 67 [57–75 years]) were subjected to prostate biopsy. Ciprofloxacin and clindamycin, 500 mg and 150 mg, respectively, were administered twice a day; this combination therapy was started the day before and continued until 5th and 8th day, respectively, following biopsy. 16s RNA sequencing data from fecal swabs taken before antibiotic therapy and 14 days after biopsy were analysed.At phylum level, the abundance of Actinobacteria and Firmicutes decreased, while that of Bacteroides and Proteobacteria increased after antibiotic therapy. The ratio of Firmicutes:Bacteroides inversed (from 2.81 to 0.74, p = 0.035). At order level, the abundance of Bacteroidales and Veillonellales increased, while that of Clostridiales and Coriobacteriales decreased. At genus level the abundance of Bacteroides increased, while those of Roseburia, Faecalibacterium and Collinsella decreased.These findings indicate that short-term antibiotic exposure skews gut microbiome composition. The current level of knowledge does not allow to decide whether this skewness is detrimental and has any long-term effect on disease including prostate pathology.

Undercooked Leghorn Chicken is A Source of Campylobacter Jejuni, An Infectious Agent for Causing Prosthetic Joint Infection and Diarrhea

Campylobacter species commonly cause diarrheal illness. As the Campylobacter species are found in chicken and beef, so utilization of contaminated undercook chicken and unpasteurized milk products is a significant reason for diarrhea. This case report describes a rare prosthetic joint infection caused by Campylobacter jejuni. The patient ate the undercook Leghorn chicken wings, and after 12h of the meal, he started suffering from a diarrheal illness that followed the prosthetic joint infection. The patient had undergone arthroplasty seven years ago. He started copious, watery stool output along with experiencing pain in his left hip and leg. After blood culture and synovial fluid culture trials, results revealed C. jejuni, identified by using MALDI-TOF MS (matrix-assisted laser desorption/ ionization time-of-flight mass spectrometry). The patient recovered after surgery and following a prescription of intravenous and oral ciprofloxacin therapy. This case describes the rare event in medical history that Campylobacter jejuni that may be causing prosthetic joint infection. Therefore, we should focus on destroying such infection-causing strains in a meal before eating chicken and beef

Effectiveness of different eradication treatment protocols for new-onset Pseudomonas aeruginosa in children with cystic fibrosis.

While eradicating new-onset Pseudomonas aeruginosa in children with cystic fibrosis is an important issue, there is no clear evidence about the best treatment approach. This retrospective observational cohort study aims to compare the effectiveness of intravenous therapy versus inhalation with/without oral therapy in the eradication of new-onset P. aeruginosa, determine the factors affecting the treatment success and assess lung function at baseline and posttreatment. Of 399 children, 110 (140 episodes) with either the first P. aeruginosa isolation or a new isolation after at least 1 year free of infectionwere included. Different eradication regimens (intravenous therapy or inhaled tobramycin or inhaled tobramycin plus oral ciprofloxacin) were compared. Eradication success was accepted as remaining free of infection with a negative culture for 12 months. Demographic, clinical, and microbiological characteristics of children, effectiveness of different eradication strategies, time to a new P. aeruginosa isolation, and the relationship between lung function and the type of eradication regimen were determined. Of 140 episodes, intravenous therapy was administered in 53 and inhalation therapy (in combination with or without oral ciprofloxacin) in 87. Total success rate of eradication was 60.7%. Eradication was achieved in 56.6% of children with intravenous therapy, 59.7% with inhaled tobramycin therapy, and 72% with inhaled tobramycin plus oral ciprofloxacin therapy. Success rates of different eradication regimens did not differ significantly (p = 0.419). Lung function by the end of the first year was worse in the intravenous group compared to the inhalation group (p = 0.017 for forced expiratory volume in 1 s, p = 0.015 for forced vital capacity). No advantage of intravenous therapy was demonstrated compared to inhalation therapy in terms of eradication success.

Infective endocarditis of a native aortic valve due to Pseudomonas aeruginosa complicated by progressive multi-drug resistance

Treatment of infective endocarditis secondary to Pseudomonas aeruginosa can be challenging because of this organism's ability to acquire antimicrobial resistance over time. We describe a patient with native aortic valve infective endocarditis due to P. aeruginosa who developed progressive multi-drug resistance while on therapy. The resistance mechanisms were characterized using whole-genome sequencing. We identified two mutations in subsequent isolates (dacB and OprD) that conferred resistance to anti-pseudomonal penicillins, cephalosporins, and carbapenems. The patient was treated with combination high-dose continuous infusion meropenem and ciprofloxacin therapy, in addition to bioprosthetic aortic valve replacement and repair of ventricular septal wall defect. Antibiotics were continued for 6 weeks post-cardiac surgery and the patient remains infection free 18 months post-completion of antibiotic therapy. Clinicians should be aware of the ability of P. aeruginosa to acquire resistance mechanisms in response to selective antibiotic pressures in high-inoculum infections such as infective endocarditis. The mutations identified in this case report correlated well with the evolving antimicrobial resistance profile observed.

Impact of Ciprofloxacin and Coenzyme Q10 on Spermatogenesis in Mice

Background: Ciprofloxacin is commonly used to treat many bacterial infections. There are controversial reports regarding abnormalities in sperm parameters in laboratory animal and human studies after ciprofloxacin administration. Coenzyme Q10 is a fat-soluble vitamin-like substance that is concentrated in sperm mitochondria, where it acts as an antioxidant and an energy promoter. Various studies found that coenzyme Q10 can improve sperm parameters, whereas other studies showed no significant improvement in sperm parameters. This study aimed at investigating the effect of ciprofloxacin and coenzyme Q10 on spermatogenesis and sperm morphology in male mice. Materials and Methods: Twenty eight-week-old male albino mice were randomly divided into four equal groups: control group, group 1 that received ciprofloxacin (102.78 mg/kg), group 2 that was given coenzyme Q10 (20.56 mg/kg), and group 3 that was given both ciprofloxacin and coenzyme Q10. The drugs were given twice daily for 35 days. On day 36, the mice were sacrificed; sperm were harvested, analyzed for sperm morphology, and stained for detection of sperm abnormalities. Testes were taken to evaluate spermatogenesis histopathologically. Data were statistically analyzed, and a P value of ≤ 0.05 was considered significant. Results: Sperm morphology showed no significant alteration in the groups treated with ciprofloxacin, coenzyme Q10, and a combination of ciprofloxacin and coenzyme Q10 compared with the control. However, histopathological lesions showed a mild decrease in spermatogenesis that was accompanied by mild vein congestion in the testicular tissue sections of mice treated with ciprofloxacin only. Conclusion: Ciprofloxacin had no significant negative impact on sperm morphology; however, it induced mild histopathological alterations in testicular tissue that was ameliorated by the coadministration of coenzyme Q10. This effect should be taken into consideration during ciprofloxacin therapy in males.

Evaluation of the Synergistic Effects of Ciprofloxacin and Low-Power Laser on Apoptosis, Cell Viability, and Reactive Oxygen Species Levels in Skin Cancer (A375 Cancer Cells)

Background: Skin cancer is one of the most common diseases. Ciprofloxacin creates free radicals and causes DNA damage, and due to the chromophore nature of this drug, the production of free radicals increases. Low-power laser (LPL) is the inhibition of red and near-infrared light to tissues to repair injuries and lesions created to heal wounds and connective tissue and treat acute and chronic pain. Objectives: The aim of this research was to investigate the synergistic effects of ciprofloxacin and LPL on apoptosis, cell viability, and reactive oxygen species (ROS) levels in skin cancer (A375 cancer cell lines). Methods: The viability rate of A375 cancer cell lines treated with ciprofloxacin and LPL was evaluated by microscopic and MTT methods, and then flow cytometry was used to evaluate their effects on apoptosis and ROS levels. Statistical analysis was done using one-way ANOVA. Results: Treatment of cancer cells with ciprofloxacin (100 μg/mL) and LPL for 30 seconds could prevent the process of cancer cell proliferation after 48 and 72 hours. Also, the combination of these two methods increased the rate of cellular apoptosis by 5% and reduced ROS levels by 0.1%. Conclusions: Because the combination of ciprofloxacin and LPL therapy can stop the proliferation of cancer cells, especially skin cancer cells thus, the use of this treatment can be used to treat cancer in the future.

Pseudoaneurysm of the ascending aorta: case report of a donor-derived Pseudomonas infection in a heart transplant recipient

BackgroundMycotic aortic pseudoaneurysm is a rare complication after heart transplantation (HTX) with remarkable mortality. Intrathoracic infection is a well-documented predisposing factor for this disease. Staphylococcus aureus, Pseudomonas aeruginosa or Candida species are commonly isolated from resected specimens of the pseudoaneurysms. We demonstrate a unique case of mycotic pseudoaneurysm caused by presumably donor-derived Pseudomonas infection in a heart transplant recipient.Case presentationOur 67-year-old male patient treated with diabetes mellitus underwent HTX. The donor suffered from epiglottic abscess and pneumonia with known microorganisms including Pseudomonas, therefore both the donor and recipient received targeted antimicrobial therapy and prophylaxis. Five months after the uneventful HTX, lab test of the asymptomatic patient showed moderate, increasing C-reactive protein level without obviuos source of infection. Chest computed tomography showed a large (90 mm) saccular dilatation of the tubular portion of ascending aorta. Urgent surgical intervention identified a pseudoaneurysm, histological examinations and cultures of the resected aorta verified Pseudomonas aeruginosa aortitis, while all blood cultures remained negative. Retrospective interrogation of other transplanted organs of the donor supported donor-derived infection as the transport fluid of the right kidney grew Pseudomonas. The patient received 3 weeks of ceftazidime followed by 7 months of oral ciprofloxacin therapy. One year after the operation the patient was asymptomatic with normal inflammatory markers.ConclusionsDonor-derived infection is a rare but potential cause of aortitis. Early diagnosis, surgical intervention and adjuvant antibiotic therapy seem to be the keys to successful management of mycotic pseudoaneurysms after HTX.

Ciprofloxacin Chondrotoxicity, A Biochemical Analysis for Serum Magnesium, Calcium, Zinc, and Vitamin E in Wistar Albino Rats

Ciprofloxacin is the most potent fluoroquinolone and was seen active against a broad range of bacteria. Several researchers revealed that ciprofloxacin can cause a chondrotoxic effects and supplementation with magnesium, calcium, zinc or vitamin E can diminish the induced chondrotoxicity. The aim of the present study was to assess the rat’s serum magnesium, calcium, zinc, and vitamin E, after the subcutaneous injections of ciprofloxacin to male Wistar rats. Ten rats were used in the study and divided into two equal groups. On day 32 of age, all the animals in the control group were subcutaneously injected by physiological saline, while the animals in the study group were subcutaneously injected by 600 mg/kg b.w. of ciprofloxacin eight hours apart. On day 34 of age, rats were anesthetized and blood collection by cardiac puncture was taken. The present study revealed that mean serum levels for rat’s magnesium, calcium, and zinc in the control group were 2.258±0.199 mg/dl, 9.416±0.369 mg/dl, and 95.51±1.81 µg/dl respectively, and the mean serum levels for rat’s magnesium, calcium, and zinc in the study group were 2.138±0.257mg/dl, 9.254±0.292 mg/dl, and 94.19±2.929µg/dl respectively; The mean serum levels for vitamin E in the control and study group were 23.772±1.029 and 21.97±1.419 ng/ml, respectively. Statistical analysis showed that ciprofloxacin hydrochloride caused a non-significant decrease in rat’s serum magnesium, calcium, zinc, and vitamin E levels (p>0.05). The research concluded that ciprofloxacin chondrotoxicity was not caused by the decrease in rat’s serum magnesium, calcium, zinc, and vitamin E levels, and other researchers are recommended to measure their levels in the chondroid tissue after ciprofloxacin therapy.

Comparison of antimicrobial resistance patterns in dogs with bacterial keratitis presented to a veterinary teaching hospital over two multi-year time periods (1993-2003 and 2013-2019) in the Southeastern United States.

To report clinical characteristics of dogs with bacterial keratitis, identify the most common bacterial isolates within this population, characterize the bacterial isolates' antimicrobial resistance patterns, and compare those resistance patterns to previously reported resistance patterns. Dogs diagnosed with bacterial keratitis between 2013 and 2019. Data pertaining to breed; Schirmer tear test I results; use of cyclosporine, tacrolimus, or corticosteroids at time of ulcer diagnosis; bacterial genus or species isolated; and resistance to selected antimicrobials as measured by Kirby-Bauer disk diffusion were collected. Resistance patterns were compared to those reported by Tolar et al. (2006). One hundred seventy bacterial isolates were cultured from 138 eyes from 130 dogs. Of these dogs, 45% were brachycephalic, 62% had STT <15mm/min, and 28% were receiving a corticosteroid at the time of examination. The most common isolates were Staphylococcus pseudintermedius (31%), β-hemolytic Streptococcus spp. (28%), and Pseudomonas aeruginosa (18%). Compared to the 1993-2003 study period, there were significant increases in resistance to cephalothin and polymyxin B among S.pseudintermedius isolates. β-hemolytic Streptococcus spp. and P.aeruginosa isolates had no significant changes in resistance to the tested antimicrobials. Isolates of S.pseudintermedius, β-hemolytic Streptococcus spp., and P.aeruginosa had minimal changes in resistance between the two study periods. In this population, monotherapy with ciprofloxacin or combination therapy of tobramycin and a first-generation cephalosporin continue to be appropriate for use in cases of suspected bacterial keratitis while awaiting results of susceptibility testing.

Seven-Year Analysis of Microbial Keratitis Tendency at an Ophthalmology Department in Poland: A Single-Center Study.

This study aimed to analyze the frequency, drug susceptibility, and drug resistance of pathogens causing microbial keratitis (a corneal inflammation) in the Clinical Department of Ophthalmology, Medical University of Silesia, Katowice. Despite intensive treatment, severe inflammation causes irreversible blindness in ∼7% of cases and eye loss (evisceration or enucleation of the eyeball) in ∼1% of cases at our hospital. The choice of a targeted drug depends on the culture result and drug resistance of the microorganism. This was a retrospective observation study. Conjunctival swabs and corneal scrapes were collected between January 1, 2013, and December 31, 2019, in the tertiary reference center for keratitis. The collected data included the type of material received, culture result, and antimicrobial susceptibilities. Of the 2482 samples analyzed, 679 were positive and 1803 were negative. Of the total pathogens isolated, 69.9% were Gram-positive bacteria, 20.8% were Gram-negative bacteria, and 7.1% were fungi. A significant increase in the number of Gram-positive methicillin-resistant Staphylococcus aureus and a partial increase in the number of Gram-negative beta-lactams-resistant bacteria were observed. All fungal species were sensitive to amphotericin B, 82.81% were sensitive to voriconazole, and 56.25% were sensitive to fluconazole. Dual drug therapy (levofloxacin and tobramycin) was the first-line treatment. Drug susceptibility testing of the cultured microorganisms is necessary to initiate targeted treatment. Increased drug resistance was observed in this study. In the present study, most bacteria were sensitive to fluoroquinolones. Ciprofloxacin therapy remains the recommended empirical treatment in microbial keratitis. According to our study, voriconazole remains a first-line antifungal drug, when a fungal infection is suspected.

Effects of Ciprofloxacin on the Dynamics of Biofilm Formation by Staphylococcus Epidermidis Strains Isolated from Implant-Associated Infection

Introduction. The formation of a microbial biofilm in implant-associated infection after arthroplasty of large joints reduces the informative value of traditional microbiological diagnostic methods and limits the range of effective antimicrobial drugs. When prescribing etiotropic therapy for periprosthetic joint infection, it is necessary to take into account not only the antibacterial effect of the drug, but also its effect on biofilm formation. Ciprofloxacin therapy may be a risk factor for the development of biofilm periprosthetic infection caused by multidrug-resistant staphylococcal strains.The aim of research was to study the effect of sub-inhibiting and therapeutic doses of ciprofloxacin on biofilm formation by Staphylococcus epidermidis strains isolated from implant-associated infection.Materials and methods. The authors studied the effect of various concentrations of ciprofloxacin on 15 strains of St. epidermidis isolated from 83 patients with deep periprosthetic joint infection after primary knee arthroplasty, treated at NIITON SSMU in 2018-2019. The effect of the calculated concentrations of ciprofloxacin on the planktonic culture, forming and preformed biofilms was investigated. Biofilm simulation was performed according to the method described by G.D. Christensen under in vitro conditions with determination of the optical density of alcohol eluates of gentian violet in polystyrene microplates.Results. It was demonstrated that ciprofloxacin in a dose 0.01 g/ml inhibits the growth of planktonic forms by 50% and statistically significantly (p = 0.001) stimulates formation of microbial biofilms as compared to the control without antibiotic addition. Concentration of ciprofloxacin equal 0.03 g/ml inhibits the growth of planktonic forms by 90%, statistically significantly (p = 0.001) stimulates formation of biofilms and activates further increase in the mass of pre-formed microbial biofilms. An increase in the concentration of ciprofloxacin to 0.05 g/ml completely inhibits the growth of planktonic forms and statistically significantly stimulates further growth of preformed biofilms.The use of ciprofloxacin at concentrations equal 1-3 g/ml statistically significantly (p = 0.001) inhibits the formation of microbial biofilms, but does not affect the preformed biofilm.Conclusions. Thus, there has been found a dose-dependent effect of ciprofloxacin towards clinical strains of St. epidermidis: subinhibitory and therapeutic concentrations of the drug have a stimulating effect on the formation and further increase in the mass of the preformed microbial biofilms. This fact must be taken into account when prescribing etiotropic therapy for implant-associated complications following large joint replacements.

Acute kidney injury with dark urine: the case of paroxysmal nocturnal hemoglobinuria

In this case report; we describe a patient with severe attack of paroxysmal nocturnal hemoglobinuria (PNH) following Ciprofloxacin therapy. He presented with recurrent abdominal pain, repeated vomiting and dark urine. Physical examination revealed severe pallor and jaundice. Laboratory investigations showed severe intravascular hemolysis with negative Coomb’s test, progressive acute kidney injury (AKI), sterile blood cultures and negative serology for autoimmune diseases. Subsequently, he developed pancytopenia. Ham test was positive and flow cytometry, later on, confirmed PNH. He was supported with multiple transfusions of packed blood cells and hemodialysis. Ciprofloxacin was discontinued and his PNH was treated with Solumedrol 1 g daily for 3 days followed by Prednisone 60 mg/day for 2 months. Two weeks later; his hemolysis abated and his AKI improved. Up to 5 years later, he still has minor PNH clone yet without disease activity. In conclusion; our patient had acute drug-induced hemolytic crisis associated with minor PNH clone. With drug-vigilance; no further relapses were reported and his PNH clone remained stable for 5 years. The case expands the spectrum of PNH phenotypes and its triggering factors.&#x0D; Keywords: AKI, anemia, autoimmune, flow cytometry, hemolysis, PNH.