Combination Of Ampicillin Research Articles

Antibiotic Usage and its Sensitivity Pattern in the NICU

Sepsis is a major cause of mortality and morbidity in newborns affecting both developed and developing countries accounting a quarter around one million deaths per annum. This study was aimed to assess the prevalence of neonatal sepsis, culture isolates, pattern, antibiotic sensitivity and drug prescribing pattern. In present prospective study, 48 neonates admitted in pediatric ward from January to March 2011 of Dhulikhel Hospital were included. The gestation age, onset of sepsis, culture isolates, antibiotic sensitivity pattern and drug prescribing pattern were studied. Environmental air sampling of NICU (Neonatal Intensive Care Unit) was done by settle plate method for microbial examination. Among 48 neonates, 23 (47.92%) neonates were culture positive with predominant isolates of Klebsiella oxytoca 11(47.83%), Pseudomonas sp. 4(17.39%), Methicillin Resistant Staphylococcus Aureus (MRSA) 3(13.04%) and single case of Enterobacter spp. In environmental samples, K. oxytoca and Enterobacter sp. were isolated. Amikacin, Imepeneum and Ciprofloxacin were sensitive whereas Ampicillin in combination with Cloxacillin, Ampicillin, Aztreonam were resistant for Klebsiella. oxytoca. Amikacin, Ceftazidime and Imipenuem were sensitive to Enterobacter spp. The single or combinations of resistant antibiotics were found to be prescribed. The emerging antibiotic resistances among the culture isolates and coherence with environmental samples were observed. Hence, special measures are imperative for reducing environmental contamination and the rational usage of antibiotics for preventing the infection and emerging antibiotic resistance. The study recommends need of the antibiotic policy to curb the present scenario.

Antimicrobial prescription and usage in the neonatal intensive care units of a Caribbean country: A prospective observational study

To study the prescribing patterns and usage of antimicrobials in the Neonatal Intensive Care Units (NICU) of Trinidad & Tobago. A 3-month prospective observational study was conducted at the three NICUs at the major public hospitals. Data included antimicrobials prescribed, route of administration, culture and sensitivity reports, leukocyte count, length of stay and outcome of patients. 353 patients were studied, 57.5% of the patients were males. Mean birth weight was 2.96 ± 0.94 (Standard Deviation) kg. Admission diagnoses included meconium stained liquor, preterm, respiratory distress, sepsis, etc. Length of stay ranged between 1 to 76 days, (median 4, Interquartile Range 1-8). The mean leukocyte count was 15.7 ± 8.5 × 103 per μL. Overall, 645 culture specimens were sent; umbilical swab (27.6%), throat swab (27.0%) and blood (16.4%) being the most common specimens. 310 (48.1%) showed no bacterial growth. Overall, 16 different antimicrobials were used. First line antibiotic of choice was a combination of ampicillin and gentamicin (85.8 %). Second line antibiotic of choice was cefotaxime. The overall mortality was 7.6%. The choice of antimicrobials in the NICUs of major public hospitals is mostly empirical and not primarily dictated by the culture and sensitivity reports, emphasizing the need for antibiotic stewardship programme in Trinidad & Tobago.

Studies on in vitro interaction of ampicillin and fresh garlic extract against Staphylococcus aureus by checkerboard method.

Objective:Staphylococcus aureus has largely developed resistance to the multiple antimicrobial agents. Garlic (Allium sativum) is claimed to retard development of resistance and produce synergy with conventional antimicrobial agents. The aim of the present study was to evaluate the effect of combination of ampicillin with fresh garlic extract (FGE) against S. aureus by using in vitro method.Materials and Methods:Antimicrobial activity of FGE was studied by well diffusion and broth dilution methods. The effect of combination of ampicillin with FGE was studied by using checkerboard method against the clinical isolates of S. aureus. The organisms were exposed to individual antimicrobial as well the different combinations of the two agents and minimum inhibitory concentration was measured.Results:Synergistic interaction was observed by the combination of FGE with ampicillin for all the strains of S. aureus. Mean minimum inhibitor concentration (MIC) of ampicillin per se was 24 μg/ml. Addition of 30-60 mg/ml of FGE reduced MIC of ampicillin to <2 μg/ml.Conclusion:This in vitro study indicates synergism between FGE and ampicillin against S. aureus. Evaluation of these combinations in vivo may be warranted.

EVALUATION OF IN VITRO SYNERGY BETWEEN AMIPICILLIN AND KANAMYCIN AGAINST STAPHYLOCOCCUS AUREUS

ABSTRACT The emergence of antibiotic resistance in bacteria is threatening as in case of Staphylococcus aureus and is well known for causing nosocomial infections in humans. In this study a total of 50 isolates of S.aureus were isolated from clinical samples collected from wound, boils, abscesses, ulcers and post operative infections (POI). The isolate exhibiting multi-antibiotic resistance was subjected for test of synergism. Synergism can be best achieved by checkerboard or Fractional Inhibitory Concentration (FIC). A combination of ampicillin and kanamycin were used for the checkerboard method. From the checkerboard, the MIC of ampicillin and kanamycin alone were 160µg/ml and 80µg/ml respectively. However a combination of both antibiotics required were just 10µg/ml and 20µg/ml of ampicillin and kanamycin with a FIC index of 0.562 indicating their synergistic effect. Thus from this study it can be concluded that antibiotic combination therapy is the best way to achieve synergy when the causal organism is a multi-antibiotic resistant one. Key words: Staphylococcus aureus, Antibiotic resistance, Checker board and Synergy test.

In vitro activities of antimicrobial cationic peptides; melittin and nisin, alone or in combination with antibiotics against Gram-positive bacteria

The in vitro activities of two antimicrobial cationic peptides, melittin and nisin alone and in combination with frequently used antibiotics (daptomycin, vancomycin, linezolid, ampicillin, and erythromycin), were assessed against clinical isolates of methicillin-susceptible Staphylococcus aureus, methicillin-resistant S. aureus and Enterococcus faecalis. Using the broth microdilution method, minimum inhibitory concentration (MIC) ranges of melittin and nisin against all strains were 2–8 μg/ml and 2–32 μg/ml respectively. In combination studies performed with the microdilution checkerboard method using a fractional inhibitory concentration index of ⩽0·5 as borderline, synergistic interactions occurred more frequently with nisin–ampicillin combination against MSSA and nisin–daptomycin combination against E. faecalis strains. The results of the time-killing curve analysis demonstrated that the concentration dependent rapid bactericidal activity of nisin, and that synergism or early synergism was detected in most strains when nisin or melittin was used in combination with antibiotics even at concentrations of 0·5×MIC.

Prevalence, pattern, sensitivity and resistance to antibiotics of different bacteria isolated from port site infection in low risk patients after elective laparoscopic cholecystectomy for symptomatic cholelithiasis at tertiary care hospital of Kashmir.

The aim of this study was to determine specific pattern of port site microbial colonisation, sensitivity and resistance to different antibiotics of bacteria isolated from port site infection (PSI) in low risk patients after elective laparoscopic cholecystectomy in surgical wards at tertiary care hospital of Kashmir. This is a prospective study. The study included 675 consecutive patients of postoperative PSI after elective laparoscopic cholecystectomy for symptomatic cholelithiasis over a period of 12 months. Culture swabs were taken from port sites with signs of PSI and transported to the microbiology laboratory. The positive swab cultures were subjected to antibiotic susceptibility test. The data obtained was analysed by using appropriate statistical analytical tests. The incidence of PSI after elective laparoscopic cholecystectomy is 6·7%. The commonest organism responsible for PSI is pseudomonas, 19 (42·2%) cases. Most of the strains of organisms isolated were resistant to commonly used antibiotics in the hospital,pseudomonas was found 100% resistant to the combination of ampicillin + sulbactum and ceftriaxone and it was sensitive to imipenem, amikacin and vancomycin in 89·47,57 and 52·63% of cases respectively. Our study will be helpful in choosing effective empirical prophylactic antibiotic therapy in cases of elective laparoscopic cholecystectomy and will have a great impact on morbidity and mortality in them because of PSI.

Pharmacokinetics of Ampicillin/Sulbactam in Critically Ill Patients with Acute Kidney Injury undergoing Extended Dialysis

The fixed antibacterial combination of ampicillin and sulbactam is frequently used for various infections. Intact kidneys eliminate approximately 71% of ampicillin and 78% of sulbactam. Patients on thrice-weekly low-flux hemodialysis exhibit an ampicillin t(1/2) of 2.3 hours on and 17.4 hours off dialysis. Despite its frequent use in intensive care units, there are no available dosing recommendations for patients with AKI undergoing renal replacement therapy. The aims of this study were to evaluate the pharmacokinetics of ampicillin/sulbactam in critically ill patients with AKI undergoing extended dialysis (ED) and to establish a dosing recommendation for this treatment method. Twelve critically ill patients with anuric AKI being treated with ED were enrolled in a prospective, open-label, observational pharmacokinetic study. Pharmacokinetics after a single dose of ampicillin/sulbactam (2 g/1 g) was obtained in 12 patients. Multiple-dose pharmacokinetics after 4 days of twice-daily ampicillin/sulbactam (2 g/1 g) was obtained in three patients. The mean dialyzer clearance for ampicillin/sulbactam was 80.1 ± 7.7/83.3 ± 12.1 ml/min. The t(1/2) of ampicillin and sulbactam in patients with AKI undergoing ED were 2.8 ± 0.8 hours and 3.5 ± 1.5 hours, respectively. There was no significant accumulation using a twice-daily dosage of 2 g/1 g ampicillin/sulbactam. Our data suggest that in patients treated with ED using a high-flux dialyzer (polysulphone, 1.3 m(2); blood and dialysate flow, 160 ml/min; treatment time, 480 minutes), a twice-daily dosing schedule of at least 2 g/1 g ampicillin/sulbactam, with one dose given after ED, should be used to avoid underdosing.

Childhood Bacterial Meningitis Trends in Japan from 2009 to 2010

We conducted a pediatric survey of bacterial meningitis epidemiology from January 2009 to December 2010 in Japan, and obtained the following results for 314 cases (186 boys, 124 girls, and 4 with gender not reported). Children younger than one year old accounted for the majority of cases (51.2%, 161/314), and the incidence decreased with increasing age. Haemophilus influenzae (in children aged 1 month to 5 years old) was the most common cause of infection (53.2%), followed by Streptococcus pneumoniae (1 month to 12 years, 24.2%), Streptococcus agalactiae (0-4 months, 7.6%), and Escherichia coli (0-3 months, 3.2%). Susceptibility tests showed that 50.1% (78/153) of the H. influenzae isolates and 63.0% (46/73) of the S. pneumoniae isolates were drug-resistant. Combinations of ampicillin and cephem or carbapenem and other beta-lactams were mainly used as the initial antibiotics for patients under 4 months of age (77.8%, 42/54), and a carbapenem and other beta-lactam combination was used for patients aged 4 months and older (76.4%, 198/259). The final antibiotics for H. influenzae and S. pneumoniae were mainly cefotaxime (CTX) or ceftriaxone (CTRX) and carbapenem, respectively. The overall fatality rate was 2.0% (6/305). Since the Haemophilus influenzae type b vaccine (Hib vaccine) and the 7 valent pneumococcal conjugate vaccine (PCV7) are not widely used in Japan, only 5 patients in our cohort (all with meningitis not caused by H. influenzae) had been immunized with the Hib vaccine, and none had been immunized with the PCV7 vaccine. No remarkable changes in the characteristics of pediatric meningitis have been observed for several years in Japan.

Effect of the Formulation on the Bioequivalence of Sultamicillin: Tablets and Suspension

Sultamicillin (CAS 76497-13-7) is a pro-drug of a combination of ampicillin and sulbactam linked as a double ester. The aim of the present studies, performed in two different groups of volunteers, was to compare the bioavailability of 750 mg sultamicillin tablets (Duobaktam 750 mg tablets, study 1) and sultamicillin 250 mg/5mL suspensions (Duobaktam 250 mg/5mL, study 2). Each study was conducted according to an open, randomized, single-dose, two-period cross-over design in 24 healthy volunteers with a wash-out period from 7 to 14 days. Blood samples were taken up to 12 h post dosing, and concentrations of ampicillin and sulbactam were determined by a HPLC-UV method. In the first study, the 90% confidence interval for intra-individual ratios of AUC0-t and Cmax of ampicillin and sulbactam were between 1.01-1.18 and 0.95-1.09 (AUC0-t) as well as between 0.87-1.04 and 0.80-0.96 (Cmax), respectively, and thus within the acceptance ranges. The 90% confidence interval for intra-individual ratios of AUC0-t and Cmax of sultamicillin suspensions (2nd study) were between 0.94-1.16 (ampicillin) and 0.92-1.14 (sulbactam) for AUC0-t and between 0.96-1.23 (ampicillin) and 0.97-1.24 (sulbactam) for Cmax. These values were also within the acceptance range for bioequivalence studies. Concerning the secondary parameter tmax the 90%-confidence interval for the intra-individual differences for both ampicillin and sulbactam were between 0.00-0.50 in the first and between -0.17-0.00 in the second study, respectively. In the light of the present studies it can be concluded that the sultamicillin test formulations, i.e. tablet and suspension are bioequivalent to the respective reference formulations.

Bio equivalence Study of Sultamicillin Suspensions

Sultamicillin (CAS 76497-13-7) is a prodrug combination of ampicillin (CAS 69-53-4) and sulbactam (CAS 68373-14-8), with the antibiotic ampicillin and the beta-lactamase inhibitor sulbactam chemically linked as double ester. The present study was performed to investigate the relative bioavailability and to assess the bioequivalence of two different sultamicillin suspensions (Devasid 250 mg/5 ml as test preparation and 375 mg/7.5 ml of the originator product as reference preparation). Twenty-four healthy male volunteers received equal doses of the sultamicillin preparations according to an open, randomised, single-dose, two-period cross-over design with a wash-out phase of 7 days. Blood samples for pharmacokinetic profiling were taken up to 8 h post-dose, and ampicillin and sulbactam plasma concentrations were determined with a validated LC-MS/MS method. Maximum plasma concentrations (C(max)) of 11,267.4 ng/ml (ampicillin, test), 10,864.4 ng/ml (ampicillin, reference), 6,360.6 ng/ml (sulbactam, test and 6,410.7 ng/ml (sulbactam, reference) were achieved. Areas under the plasma concentration-time curve (AUC(0-infinity) of 17,512.9 ng x h/ml (ampicillin, test), 18,388.0 ng x h/ml (ampicillin, reference), 10,971.7 ng ng x h/ml (sulbactam, test) and 11,181.2 ng x h/ml (sulbactam, reference) were calculated. The median t(max) was 0.69 h (ampicillin, test), 0.85 h (ampicillin, reference), 0.72 h (sulbactam, Devasid) and 0.83 h (sulbactam, reference). Plasma elimination half-lives (t(1/2)) of 1.04 h (ampicillin, test), 1.03 h (ampicillin, reference), 1.26 h (sulbactam, Devasid) and 1.00 h (sulbactam, reference) were determined. Both primary target parameters AUC(0-infinity) and C(max) of ampicillin and sulbactam were tested parametrically by analysis of variance (ANOVA) and the 90% confidence intervals were between 84.58%-117.80% (AUC(0-infinity), ampicillin), 92.37%-119.93% (C(max), ampicillin), 85.81%-120.50% (AUC(0-infinity), sulbactam) and 88.41%-117.57% (C(max), sulbactam). Bioequivalence between test and reference preparation was demonstrated since for both parameters AUC and C(max) the 90% confidence intervals of the T/R-ratios of logarithmically transformed data were in the generally accepted range of 80%-125%.

Resistance to antimicrobial drugs in Ghana

BackgroundAntimicrobial drug resistance is a global issue that affects health, economic, and social development. The problem has been attributed to misuse of antimicrobial agents.PurposeTo identify the agents of bacterial infection in Ghana, determine their antibiogram, and the possibility of setting up a surveillance program.Patients and methodsA prospective quantitative study set in various hospitals including two teaching hospitals, seven regional hospitals, and two district hospitals in Ghana. A total of 5099 bacterial isolates from various clinical specimens were collected over a period of 1 year, including data related to the patients. Susceptibility of the isolates was determined by the Kirby–Bauer method. In addition, the minimum inhibitory concentration (MIC) of multidrug-resistant isolates of epidemiological significance was also determined using the E-test.ResultsA wide range of bacterial isolates were identified in both teaching and regional hospitals. High percentage of resistance was observed for tetracycline (82%), cotrimoxazole (73%), ampicillin (76%), and chloramphenicol (75%). Multidrug resistance was observed to a combination of ampicillin, tetracycline, chloramphenicol, and cotrimoxazole. On the other hand, a lower percentage of resistance was observed for ceftriaxone (6.3%), ciprofloxacin (11%), and amikacin (9.9%).ConclusionGenerally, the prevalence of multidrug resistance was widespread among the various isolates. Some multidrug-resistant strains of Staphylococcus aureus, Salmonella typhi, and non-typhoidal Salmonella (NTS) had high MIC to cefuroxime (>256), gentamicin (>256), and ciprofloxacin (>32).

Synergistic Effects and Physiological Responses of Selected Bacterial Isolates from Animal Feed to Four Natural Antimicrobials and Two Antibiotics

In this study, 20 samples from three different sources of animal feed were investigated and six bacterial isolates were identified. The susceptibility of four natural antimicrobials, namely, eugenol, cinnamaldehyde, thymol, and carvacrol, against six of these isolates was determined. Carvacrol and eugenol showed better inhibitory effects with larger zones of inhibition. The minimal inhibitory concentration for a range of antibiotics on the susceptibility of two isolates (namely, Sphingomonas paucimobilis and Klebsiella oxytoca) was investigated using the VITEK® 2 microbiological identification system. Both isolates showed a variety of resistance to 18 antibiotics. The minimal inhibitory concentration and fractional inhibitory concentration index of those two isolates for ampicillin and nitrofurantoin in combination with four phenolic compounds was determined. Synergistic interactions were found for most antimicrobial/antibiotic combinations; thymol and carvacrol were very effective (fractional inhibitory concentration ≤0.5) in combination with all antibiotics tested against S. paucimobilis and K. oxytoca, respectively. Ultra performance liquid chromatography techniques were used to investigate the physiological effects of the four natural antimicrobials against those two isolates. Two identical peaks were found to be systematically different between cinnamaldehyde-treated and -untreated cells. The identity of the peaks is unknown and further investigation is needed.

Antimicrobial susceptibilities of Listeria monocytogenes human strains isolated from 1970 to 2008 in Brazil

Listeria monocytogenes is the causative agent of listeriosis, a foodborne illness that affects mainly pregnant women, the elderly and immunocompromised patients. The primary treatment is a combination of ampicillin with an aminoglycoside, in addition to a second-choice drug represented by chloramphenicol, erythromycin, tetracycline and rifampicin. The aim of this study was to analyze the antimicrobial susceptibility profile of strains isolated from human sources in the last four decades. Sixty-eight strains were selected from the culture collection of the Laboratory of Bacterial Zoonoses/LABZOO/FIOCRUZ isolated in different regions of Brazil from 1970 to 2008 and primarily isolated from cerebrospinal fluid and blood culture. Susceptibility tests to antimicrobials drugs were evaluated using the criteria established by Soussy using the Kirby-Bauer method and E-Test strips were used to determine the minimum inhibitory concentration (MIC). Among the strains tested, serovar L4b (60.3%) was the most prevalent, followed by serovar 1/2a (20.6%), 1/2b (13.2%) and the more uncommon serovars 1/2c, 3b and 4ab (5.9%). All strains were susceptible to ampicillin, cephalothin, erythromycin, gentamicin, teicoplanin and vancomycin. Only one strain (1.5%) showed resistance to rifampin, and two (3%) were resistant to trimethoprim-sulfamethoxazole. MICs with values up to 2 μg/ml reinforce the need for microbiological surveillance. The study demonstrated low prevalence of strains resistant to the antimicrobial drugs indicated in the treatment of human listeriosis. Monitoring antimicrobial resistance profile is still very important to determine adequate treatment, especially in immunocompromised patients.

Serious bacterial infections in hospitalized febrile infants aged 90 days or younger: The traditional combination of ampicillin and gentamicin is still appropriate

A change in the bacterial epidemiology of infantile serious bacterial infection (SBI) has raised concerns regarding the appropriate empirical antibiotic therapy. To describe the epidemiological features of SBI in febrile infants in order to elucidate the appropriate empirical regimens. From 2005 to 2009, clinical and laboratory data were prospectively collected for all infants aged ≤ 90 days who were hospitalized for fever. Of the 1584 febrile infants who met the study criteria, 149 (9.4%) had a culture-proven SBI: urinary tract infection in 128 (86%), urinary tract infection with bacteraemia in 11 (7%), bacteraemia in 7 (5%), enteritis with bacteraemia in 2 (1.3%), and meningitis in 1 (0.7%). Ninety-one percent of cases were caused by Gram-negative bacteria, mostly Escherichia coli (72%). Among the causative Gram-positive bacteria were Enterococcus spp. (4%) and group B Streptococcus (0.7%); no cases of Listeria monocytogenes infection were identified. Sixty-one percent of the causative bacteria were resistant to ampicillin. According to in vitro susceptibility testing, the combination of ampicillin and gentamicin provided appropriate antibiotic coverage. Despite changes in the epidemiology of infantile SBI, the traditional combination of ampicillin and gentamicin is still appropriate for empirical treatment of febrile infants aged ≤ 90 days.

Bacterial Isolates and Antibiotic Sensitivity among Gambian Children with Severe Acute Malnutrition

Background. Establishing the pattern of infection and antimicrobial sensitivities in the local environment is critical to rational use of antibiotics and the development of management algorithms. Methods. Morbidity history and physical examination of 140 children with severe acute malnutrition were recorded. Their blood, stool, and urine samples were cultured and antibiotic sensitivity patterns determined for any bacterial pathogens isolated. Results. Thirty-eight children had a pathogen isolated from blood culture, 60% of which were considered contaminants. Coagulase negative staphylococcus was the predominant contaminant, while the major causes of bacteraemia were nontyphoidal Salmonella (13%), S. pneumoniae (10%), and E. coli (8%). E. coli accounted for 58% of the urinary isolates. No pathogen was isolated from stool. In vitro sensitivity by disk diffusion showed that 87.5% of the isolates were sensitive to ampicillin and/or gentamicin and 84.4% (27/32) to penicillin and/or gentamicin. Conclusions. A combination of ampicillin and gentamicin provides adequate antibiotic cover for severely malnourished children in The Gambia.

The Emergence ofClostridium difficileInfection among Peripartum Women: A Case-Control Study of aC. difficileOutbreak on an Obstetrical Service

Objective. An outbreak of 20 peripartum Clostridium difficile infections (CDI) occurred on the obstetrical service at the University of Washington Medical Center (UWMC) between April 2006 and June 2007. In this report, we characterize the clinical manifestations, describe interventions that appeared to reduce CDI, and determine potential risk factors for peripartum CDI. Methods. An investigation was initiated after the first three peripartum CDI cases. Based on the findings, enhanced infection control measures and a modified antibiotic regimen were implemented. We conducted a case-control study of peripartum cases and unmatched controls. Results. During the outbreak, there was an overall incidence of 7.5 CDI cases per 1000 deliveries. Peripartum CDI infection compared to controls was significantly associated with cesarean delivery (70% versus 34%; P = 0.03 ), antibiotic use (95% versus 56%; P = 0.001), chorioamnionitis (35% versus 5%; P = 0.001), and the use of the combination of ampicillin, gentamicin, and clindamycin (50% versus 3%; P < 0.001 ). Use of combination antibiotics remained a significant independent risk factor for CDI in the multivariate analysis. Conclusions. The outbreak was reduced after the implementation of multiple infection control measures and modification of antibiotic use. However, sporadic CDI continued for 8 months after these measures slowed the outbreak. Peripartum women appear to be another population susceptible to CDI.

A ONE‐SHOT SOLUTION TO BACTERIAL AND FUNGAL CONTAMINATION IN THE GREEN ALGA CHLAMYDOMONAS REINHARDTII CULTURE BY USING AN ANTIBIOTIC COCKTAIL1

Keeping sterile stocks or cultures of microalgae is fundamental to microalgae biotechnology as well as basic scientific research. However, contamination by bacteria and/or fungi in microalgae cultures or stocks is often a problem. Here, we have developed a strategy for reducing or eliminating bacterial and fungal contamination by using a cocktail of antibiotics. Chlamydomonas reinhardtii P. A. Dang., a widely used unicellular green alga, has been used as a testing organism. A combination of ampicillin, cefotaxime, and carbendazim removed or reduced contamination by three different bacteria and two different fungi tested. A step‐by‐step procedure is provided, which is simple, economical, and effective.

Airway microbial culture and susceptibility patterns in dogs and cats with respiratory disease of varying severity

To compare airway microbiological culture and susceptibility results in 2 groups of dogs and cats: 1 with respiratory failure requiring positive pressure ventilation (PPV) and 1 with respiratory disease. Retrospective study. University teaching hospital. Fifty-two dogs and cats requiring PPV that had an airway microbiologic culture submitted from October 1, 2003 to October 31, 2008 were included. One hundred and four airway microbiologic cultures from dogs and cats with respiratory disease not requiring PPV were randomly sampled for comparison. None. Patients with respiratory failure were more likely to have a gram-negative enteric isolate identified (P<0.001), while patients with respiratory disease were more likely to have a gram-negative nonenteric isolate (P<0.001) or anaerobic isolate (P<0.001) identified. Aerobic bacterial isolates from patients with respiratory failure were less likely to be susceptible to ampicillin (P=0.006), amoxicillin/clavulonate (P<0.001), chloramphenicol (P=0.004), enrofloxacin (P<0.001), ticarcillin/clavulonate (P=0.004), and the combination of ampicillin with enrofloxacin (P<0.001) than were aerobic bacterial isolates from patients with respiratory disease. Canine and feline patients with respiratory failure severe enough to require PPV exhibit a different pattern of bacterial isolates cultured from their airways when compared with isolates from patients with respiratory disease that has not resulted in ventilator dependence. These isolates are more likely to be resistant to commonly used antimicrobials/antimicrobial combinations than patients in the respiratory disease group. These findings suggest that in canine and feline patients with infectious lower respiratory tract disease, consideration of the severity of the pulmonary insult may allow for better prediction of likely isolates and their antimicrobial susceptibilities. Further prospective studies with a standardized collection technique are warranted.

A guideline for the inpatient care of children with pyelonephritis

BACKGROUND AND OBJECTIVES:Febrile urinary tract infections and pyelonephritis are common in children and frequently lead to hospitalization for management, especially in the child who appears toxic. The American Academy of Pediatrics (AAP) practice parameter on the diagnosis, treatment and evaluation of the initial urinary tract infection in febrile infants and young children provides experience and evidence-based guidelines for the practitioner caring for children between the ages of 2 months to 2 years. No established guideline exists for older children and the AAP guideline does not specifically focus on inpatient care.METHODS:We conducted a comprehensive review of recently published literature and practice guidelines to develop a consensus on the inpatient diagnosis and management of children with pyelonephritis.RESULTS:Eight recommendations are proposed for the diagnosis and management, including revised guidelines for the imaging studies postpyelonephritis on the basis of current best evidence.CONCLUSION:Proper diagnosis of pyelonephritis, timely initiation of appropriate therapy and identification of children at risk for renal injury will help to reduce immediate as well as long-term complications due to chronic kidney disease.

Trends in antimicrobial resistance in Shigella species in Karachi, Pakistan

Shigellosis is a common cause of morbidity, especially in the very young and old, in developing countries. The disease is treated with antibiotics. Surveillance of antimicrobial resistance trends is essential owing to the global emergence of antimicrobial resistance. The study involved 1,573 isolates of Shigella species (1996-2007) that were analyzed for trends in antimicrobial resistance. The majority of the specimens (1046; 66.5%) were from the pediatric population, and of these 887 (84.8%) were under 5 years of age (p = 0.001). S. flexineri was the most frequent species (54.5%) isolated. Isolation of S. sonnei increased from 15.4 % (1996) to 39% (2007) (p = 0.001). Although none of the isolates was found sensitive to all the antibiotics tested, 58% (n =9 07) were resistant to ampicillin and 85% (n = 1,338) were resistant to trimethoprim-sulfamethoxazole (TMP-SMX). Out of a total of 198 (12.6%) nalidixic acid resistant isolates, 6 (3.0%) were also resistant to ofloxacin. Overall 1.7 % of isolates were resistant to ofloxacin, 2.4% to ceftriaxone and 2.3% were resistant to combination of ampicillin, nalidixic acid and TMP-SMX. Ofloxacin is still an effective drug for treatment of acute shigellosis in Pakistan. Emergence of resistance to ceftriaxone in Shigella may have grave implications in treatment of severe shigellosis in very young patients.