Continuous Antibiotic Treatment Research Articles

Giant vascular malformations invading the skull: A case report

BACKGROUND Vascular malformations (VMs) arise as a result of errors in the process of angiogenesis and are usually present at birth, but may not become apparent until after birth. However, giant VMs of the head and face are uncommon, with few reported cases, and the prognosis for their surgical intervention is unclear. CASE SUMMARY A 12-year-old girl was admitted to the hospital with findings of an enlarged right temporal scalp. After admission, computed tomography (CT) angiography of cerebral ateries showed a right occlusal gap and a right temporal artery venous malformation. Furthermore, cerebral angiography showed a right temporal lobe VM with multiple vessels supplying blood. The patient underwent surgery to remove the malformed vessels and the eroded skull. Two hours after the surgery, the patient's right pupil was dilated, and an urgent CT scan of the skull showed a right subdural haematoma under the incision, which was urgently removed by a second operation. After surgery, we gave continuous antibiotic anti-infection treatment, and the patient recovered well and was discharged two weeks later. CONCLUSION Surgical removal of giant haemangiomas is risky and adequate preoperative (including interventional embolisation) and intraoperative preparations should be made.

N07 JAKne: JAK inhibitor associated acne, a real-life single-center experience

Abstract Background Three Janus kinase (JAK) inhibitors, tofacitinib (TFC), filgotinib (FIL) and upadacitinib (UPA), have been approved for treatment of Crohn’s disease (CD) and/or ulcerative colitis (UC). During the IBD registrational trials, acne was reported as adverse event (AE) in 5-7% of UPA treated patients, but not in the FIL and TFC programs. Hence, we assessed the prevalence of JAK inhibitor associated acne in a real-life cohort. Methods All patients initiating JAK inhibitors for active moderate-to-severe CD or UC at our center were included. Patients were prospectively monitored at prespecified timepoints, and specifically assessed for AEs including acne. Affected patients completed a visual analogue scale (VAS) to assess the impact of acne on their quality of life. All pictures of skin lesions were assessed by a dermatologist specialized in inflammatory skin diseases. Results In total, 46 patients initiated TFC, 40 FIL and 79 UPA. None of the TFC or FIL treated patients reported new onset of acne. Instead, 17 (21.5%) patients (9 CD, 8 UC; median [IQR] age 28.2 [25.2-45.0]; 47.1% female) spontaneously reported acne during UPA therapy. Most (89.5%) reported new onset of acne, while 2 (10.5%) mentioned a deterioration of existing acne during UPA induction. Previous acne during adolescence was reported by 46.2%. Lesions were present in the face (82.3%), back (23.5%), chest (23.5%) and scalp (11.8%). The acne phenotype included inflammatory papules in all patients, but also pustules (66.7%), nodules (33.3%), cysts (11.1%) and comedones (11.1%) were observed. A median VAS score of 5.5 [5.0-7.0] highlighted the impact on the patient’s quality of life, though no patient interrupted UPA due to acne. Six (35.2%) patients were referred to a dermatologist for acne. Most patients (82.4%) received topical skin therapy during UPA induction based on a standard operation procedure approved by the dermatologist and communicated via the IBD nurses. Three patients (17.6%) received antibiotics during UPA induction because of acne. During UPA maintenance, 5 patients (29.4%) reported resolution of skin problems with only 1 requiring continued skin therapy. Ten patients (58.7%) continued topical skin therapy during maintenance, with 4 of them requiring continued antibiotic treatment for at least 3 months. A single patient was deescalated from UPA 30mg to 15mg QD because of severe acne, with little improvement. Conclusion In this real-world experience, JAK inhibitor associated acne was uniquely linked to UPA, occurring in one fifth of patients. This is more prevalent than observed in the registrational trials. Awareness and patient education are therefore important, as well as early referral to the dermatologist for appropriate treatment.

Maintaining beneficial alga-associated bacterial communities under heat stress: insights from controlled co-culture experiments using antibiotic-resistant bacterial strains.

Brown algae, like many eukaryotes, possess diverse microbial communities. Ectocarpus-a model brown alga-relies on these communities for essential processes, such as growth development. Controlled laboratory systems are needed for functional studies of these algal-bacterial interactions. We selected bacterial strains based on their metabolic networks to provide optimal completion of the algal metabolism, rendered them resistant to two antibiotics, and inoculate them to establish controlled co-cultures with Ectocarpus under continuous antibiotic treatment. We then monitored the stability of the resulting associations under control conditions and heat stress using 16S metabarcoding. Antibiotics strongly reduced bacterial diversity both in terms of taxonomy and predicted metabolic functions. In the inoculated sample, 63%-69% of reads corresponded to the inoculated strains, and the communities remained stable during temperature stress. They also partially restored the predicted metabolic functions of the natural community. Overall, the development of antibiotic-resistant helper cultures offers a promising route to fully controlled laboratory experiments with algae and microbiota and thus represents an important step towards generating experimental evidence for specific host-microbe interactions in the systems studied. Further work will be required to achieve full control and progressively expand our repertoire of helper strains including those currently 'unculturable'.

Increased piglet losses upon exudative epidermitis - a case report

A massive outbreak of exudative epidermitis (EE) occurred on a Western German piglet producing farm with 350 productive sows. Gilts are produced on site. In one group of piglets, more than 50% of suckling and nursery piglets were clinically affected; furthermore, gilts as well as sows showed localized blackish-squamous skin lesions in the neck area. Generalized infection in suckling and nursery piglets resulted in mortality rates of up to 10% per weaning group. Swabs of moist, affected areas of skin taken on the farm in addition to swab and organ samples collected during necropsy were examined via bacterial cultivation. Both Staphylococcus (St.) hyicus and St. chromogenes strains were detected in affected skin lesions, with St. hyicus also present in systemic localizations. Further characterization of the St. hyicus strains identified ExhA and SHETA as toxins involved, and isolates showed resistance to penicillin and aminopenicillin. In the short term, antibiotic treatment with trimethoprim-sulfadiazine of the whole age group combined with individual treatment of severely affected animals as well as washing with an iodine-containing solution improved the clinical signs. In order to reduce the antibiotic use, an autogenous vaccine against the isolated St. hyicus and St. chromogenes strains for gilts and sows was produced and applied as a basic immunization twice before farrowing. In addition, external and internal biosecurity was evaluated and adjusted using an objective questionnaire (Bio-check.UGentTM). The combination of taken measures resulted in a long-term improvement of the overall health status. Several months after the severe EE outbreak, the sporadic occurrence of new EE cases in individual piglets could be controlled by the adjustment of the autogenous vaccine with an additional St. hyicus isolate. The case report illustrates how the combination of continuous monitoring, individual and group antibiotic treatment, biosecurity evaluation, and the use of appropriate immune prophylaxis can improve the clinical picture of EE.

Scorpionfish BPI is highly active against multiple drug-resistant Pseudomonas aeruginosa isolates from people with cystic fibrosis.

Chronic pulmonary infection is a hallmark of cystic fibrosis (CF) and requires continuous antibiotic treatment. In this context, Pseudomonas aeruginosa (Pa) is of special concern since colonizing strains frequently acquire multiple drug resistance (MDR). Bactericidal/permeability-increasing protein (BPI) is a neutrophil-derived, endogenous protein with high bactericidal potency against Gram-negative bacteria. However, a significant range of people with CF (PwCF) produce anti-neutrophil cytoplasmic antibodies against BPI (BPI-ANCA), thereby neutralizing its bactericidal function. In accordance with literature, we describe that 51.0% of a total of 39 PwCF expressed BPI-ANCA. Importantly, an orthologous protein to human BPI (huBPI) derived from the scorpionfish Sebastes schlegelii (scoBPI) completely escaped recognition by these autoantibodies. Moreover, scoBPI exhibited high anti-inflammatory potency towards Pa LPS and was bactericidal against MDR Pa derived from PwCF at nanomolar concentrations. In conclusion, our results highlight the potential of highly active orthologous proteins of huBPI in treatment of MDR Pa infections, especially in the presence of BPI-ANCA.

Effectiveness of Platelet-Rich Plasma Injections as Prophylaxis for Recurrent Urinary Tract Infection in Women.

To investigate the therapeutic efficacy of intravesical platelet-rich plasma (PRP) injections as prophylaxis for adult women with recurrent urinary tract infection (rUTI). This proof-of-concept study enrolled 63 women with rUTI in PRP treatment and control groups after achieving control of the most recent urinary tract infection (UTI) episode. The treatment group included 34 women who received 4 monthly intravesical PRP injections. The control group was made up of 30 women who received continuous antibiotic treatment for 3 months. After the completion of PRP or antibiotic treatment, outpatient follow-up was continued for up to 12 months. Treatment was considered successful if ≤2 UTI episodes occurred during a period of 12 months or ≤1 UTI episode within 6 months; otherwise, the outcome was considered a treatment failure. The frequency of symptomatic UTI episodes before and after PRP treatment was compared with that of the controls. Regression analysis was used to determine the association between potential predictors for a failed treatment outcome. At the study endpoint, 33 PRP and 25 control group patients were available for analysis. After four PRP injections, the frequency of rUTI episodes per month was significantly decreased compared with baseline (0.46 ± 0.27 vs. 0.28 ± 0.30, p = 0.047). The PRP treatment success rate was 51.5% (17 of 33) for the PRP group versus 48% (12 of 25) for the control group. The PRP treatment success group had significantly higher voided volume, lower post-void residual volume, and higher voiding efficiency than the PRP treatment failure group. A higher baseline voiding efficacy ≥0.71 was significantly associated with a successful outcome (OR 16.56; p = 0.049). The study results revealed that repeat intravesical PRP injections decreased the recurrence rate of UTI within 1 year in women with rUTI. The treatment success rate with intravesical PRP injections for rUTI was about 51.5%, whereas for women with prolonged antibiotic treatment, it was 48.0%. A baseline VE ≥ 0.71 was associated with a better treatment outcome with PRP injections.

Pulmonary Fat Embolism Syndrome: A Case Report and Literature Review

Background: Fat embolism syndrome (FES) is caused by a systemic inflammatory response arising from embolized fat particles that block blood vessels and disrupt blood supply, particularly in the respiratory microcirculation. Despite its high morbidity and mortality, FES is still challenging to diagnose due to its versatile symptoms. Case Presentation: In this article, we describe case reports of two patients with pulmonary FES from Zhongnan Hospital of Wuhan University, Wuhan, China. The two patients were diagnosed based on their detailed medical histories, such as a history of liposuction surgery, low oxygen saturation, dyspnea, and chest computed tomography (CT). Both of them received continuous oxygen inhalation therapy and antibiotic treatment. The first patient received additional anti-inflammation and anticoagulation treatment. The symptoms and CT improved after treatments. They were discharged and completely cured. Literature Review: We obtained and analyzed the clinical manifestations, treatments, and prognosis data of 206 patients diagnosed with pulmonary FES between January 1900 and July 2021 from the China National Knowledge Infrastructure database. Conclusion: The analysis of our two cases and the literature review suggest that patients with symptoms (such as respiratory system symptoms, nervous system symptoms, cardiovascular system symptoms, and mucocutaneous bleeding) combined with a history of fracture and other risk factors should be considered pulmonary FES cases. Furthermore, respiratory support and glucocorticoid treatment may be effective in preventing the death of pulmonary FES patients.

Aerobic exercise training-induced alteration of gut microbiota composition affects endurance capacity.

This study aimed to clarify whether aerobic exercise training-induced alterations in the gut microbiota affect physiological adaptation with endurance exercise capacity. In study 1, ICR mice were randomly divided into three groups: vehicle intake + sedentary (V+S), vehicle intake + exercise training (V+Ex) and antibiotic intake + exercise training (AB+Ex). In the exercise training groups, treadmill running was performed for 8weeks. During the exercise training intervention, the antibiotic-intake group freely drank water containing antibiotics. In study 2, ICR mice were randomly divided into three groups: Sham, transplantation of caecum microbiota from sedentary mice (Sed-CMT) and exercise training mice (Ex-CMT). In study 1, the treadmill running time to exhaustion, an index of maximal aerobic capacity, after aerobic exercise training in the V+Ex group was significantly longer than that in the V+S and AB+Ex groups. Gastrocnemius muscle citrate synthase (CS) activity and PGC-1α protein levels in the V+Ex group were significantly higher than in the V+S and AB+Ex groups. The bacterial Erysipelotrichaceae and Alcaligenaceae families were positively correlated with treadmill running time to exhaustion. In study 2, the treadmill running time to exhaustion after transplantation was significantly higher in the Ex-CMT group than in the Sham and Sed-CMT groups. Furthermore, CS activity and PGC-1α protein levels in the gastrocnemius muscle were significantly higher in the Ex-CMT group than in the Sham and Sed-CMT groups. Thus, gut microbiota altered by aerobic exercise training may be involved in the augmentation of endurance capacity and muscle mitochondrial energy metabolism. KEY POINTS: Aerobic exercise training changes gut microbiota composition, and the Erysipelotrichaceae and Alcaligenaceae families were among the altered gut bacteria. The gut microbiota was associated with endurance performance and metabolic regulator levels in skeletal muscle after aerobic exercise training. Continuous antibiotic treatment attenuated the increase in endurance performance, citrate synthase activity and PGC-1α levels in skeletal muscle induced by aerobic exercise training. Gut microbiota transplantation from exercise-trained mice improved endurance performance and metabolic regulator levels in recipient skeletal muscle, despite the absence of aerobic exercise training.

Cerebral Nocardiosis: a diagnostic challenge

uncertain if this represented post-surgical change, residual neoplasm, radiation reaction, or infection. One-year after the brain mass resection, the patient presented to the hospital with new-onset expressive aphasia and focal weakness in the left lower extremity. Repeat MRI showed 3 new ring- enhancing lesions within the left cerebellum, left temporo-parietal junction, and left para-median superior parietal lobe (Figure 1). There was persistent irregular enhancement within the right cerebellum, now extending to the right middle cerebellar peduncle. Aspiration biopsy revealed a large amount of Nocardia farcinica, which was resistant to ceftriaxone, imipenem, clarithromycin, tobramycin, doxycycline, and minocycline. The patient was started on trimethoprim- sulfamethoxasole 400 mg three times/day, but despite continued antibiotic treatment, she became bacteremic. This was complicated by acute toxic

Consider this tool to reduce antibiotic-associated adverse events in patients with sepsis

Predictive biomarker procalcitonin can aid clinical decision-making on continued antibiotic treatment in this patient population.

Diagnostic and therapeutic management of vesico-ureteral reflux in pediatric kidney transplantation-Results of an online survey on behalf of the European Society for Paediatric Nephrology.

Vesico-ureteral reflux (VUR) is considered to be a risk factor for recurrent febrile urinary tract infections and impaired renal transplant survival. An online survey supported by the European Society for Paediatric Nephrology was designed to evaluate current management strategies of VUR in native and transplanted kidneys of recipients aged <18 years. Seventy-three pediatric transplant centers from 32 countries contributed to the survey. All centers performed urological evaluation prior to pediatric kidney transplantation (KTx) with subsequent interdisciplinary discussion. Screening for VUR in native kidneys (30% in all, 70% in selected patients) led to surgical intervention in 78% (11% in all, 89% in selected patients) with a decided preference of endoscopic intervention over ureterocystoneostomy. Following KTx, continuous antibiotic prophylaxis was applied in 65% of the patients and screening for allograft VUR performed in 93% of selected patients. The main management strategies of symptomatic allograft VUR were continuous antibiotic prophylaxis (83%) and surgical treatment (74%) (endoscopic intervention 55%, redo ureterocystoneostomy 26%). This survey demonstrates the high variability in the management of VUR in pediatric KTx recipients, points to knowledge gaps, and might serve as a starting point for improving the care for patients with VUR in native and transplanted kidneys.

Incidence of UTI and Stent-related Symptoms in Patients with Peri-interventional Antibiotic Prophylaxis Only vs Low-dose Continuous Antibiotic Treatment among Double J Stented Patients: A Randomised Clinical Trial

Introduction: Endourological surgeries like Percutaneous Nephrolithotripsy (PCNL) and Ureteroscopic Lithotripsy (URSL) is the standard of care for upper urinary tract urolithiasis. Placement of Double J stent (DJ stent) is a routine practice, following these surgical interventions. Though endourological surgeries are less invasive, these are not without complications. Main postoperative complications following these procedures, which hamper daily activities are Urinary Tract Infection (UTI) and Stent Related Symptoms (SRS). There is a lack of literature, about appropriate postoperative antibiotic strategy following uncomplicated endourological surgery for upper urinary tract stone disease in patients, who are on DJ stent. Aim: To evaluate the incidence of UTI and SRS in patients given, a peri-interventional antibiotic prophylaxis only versus a continuous low-dose antibiotic treatment for entire stent indwelling time. Materials and Methods: This was a randomised clinical study conducted in the Department of Urology, SDM Medical College and Hospital, Dharwad, Karnataka, India from january 2020- march 2021. A total of 70 patients following uncomplicated endourological surgery were randomised, to either receive periinterventional antibiotic prophylaxis only (group A=31) or low-dose antibiotic treatment for entire stent indwelling time (group B=39). Randomisation was done to allocate sample into two groups using computer randomisation program. All patients received cefotaxime injection 1 gm at the time of anaesthesia induction as peri intervention prophylaxis. Patients in group B, in addition received nitrofurantoine 100 mg tablet at bedtime for entire stent indwelling time. Patients were evaluated for incidence of UTI and SRSs. Statistical analysis was done using Chi-square and Yates corrected Chi-square for analysis of association between attributes. Independent t-test was used for comparison of two groups with numerical variables. Results: The incidence of UTI was not significantly different between the two groups {group A- 4 (12.9%) and group B- 6 (15.38%)}. UTI was more common following URSL compared to PCNL {group A 24 (77.42%) and group B 29 (74.36%)}, and more common in those with diabetes mellitus. Similarly the incidence and severity of SRSs was very similar in both the groups {group A 28 (90.32%) and group B 37 (94.87%)}. Conclusion: According to the present study findings, continuous low-dose antibiotic treatment during entire stent indwelling time does not reduce the incidence of UTI and has no effect on SRSs.

Intermittent antibiotic treatment accelerated the development of colitis in IL-10 knockout mice

Background and aimsMany epidemiological studies suggest an association between antibiotic exposure and the development of inflammatory bowel disease [IBD]. However, the majority of these studies are observational and still the question remains, “Does the specific antibiotic administration regimen play a role in the development of colitis?” This study aimed to compare the possible effects of continuous and intermittent antibiotic exposure on the development of colitis using a colitis-susceptible IL-10 knockout [IL-10–/–] mouse model. MethodsIL-10–/– mice [C57BL/6] were randomly assigned to a non-antibiotic group, continuous antibiotic group and intermittent antibiotic group, and observed for 30 weeks. The antibiotic cocktail was given via the drinking water. The differential response to antibiotics was assessed. ResultsIntermittent antibiotic treatment resulted in severe colitis with early disease onset in IL-10–/– mice. Higher unit colon weight and spleen weight were observed in intermittent antibiotic-treated mice but not in the continuous antibiotic group. Moreover, intermittent antibiotic treatment aggravated epithelial damage and colonic inflammation, mucosal barrier dysfunction and colonic allergic sensitization in IL-10–/– mice, whereas continuous antibiotic treatment ameliorated these symptoms. Male IL-10–/– mice with intermittent antibiotic exposure were more susceptible to colonic inflammation and allergic response than females. ConclusionsIn summary, intermittent antibiotic exposure accelerated the development of severe colitis more than continuous antibiotic exposure in IL-10–/– male mice. In addition to the colonic damage and impaired barrier function, stimulation of allergic response may play a role in accelerating the development of colitis in genetically susceptible mice.

Dysbiosis of the gut microbiome impairs mouse skeletal muscle adaptation to exercise.

There is emerging evidence of a gut microbiome-skeletal muscle axis. The purpose of this study was to determine if an intact gut microbiome was necessary for skeletal muscle adaptation to exercise. Forty-two 4-month-old female C57BL/6J mice were randomly assigned to untreated (U) or antibiotic-treated (T) non-running controls (CU or CT, respectively) or progressive weighted wheel running (PoWeR, P) untreated (PU) or antibiotic-treated (PT) groups. Antibiotic treatment resulted in disruption of the gut microbiome as indicated by a significant depletion of gut microbiome bacterial species in both CT and PT groups. The training stimulus was the same between PU and PT groups as assessed by weekly (12.35 ± 2.06 vs. 11.09 ± 1.76km/week, respectively) and total (778.9± 130.5 vs. 703.8 ± 112.9km, respectively) running activity. In response to PoWeR, PT showed less hypertrophy of soleus type 1 and 2a fibres and plantaris type 2b/x fibres compared to PU. The higher satellite cell and myonuclei abundance of PU plantaris muscle after PoWeR was not observed in PT. The fibre-type shift of PU plantaris muscle to a more oxidative type 2a fibre composition following PoWeR was blunted in PT. There was no difference in serum cytokine levels among all groups suggesting disruption of the gut microbiome did not induce systemic inflammation. The results of this study provide the first evidence that an intact gut microbiome is necessary for skeletal muscle adaptation to exercise. KEY POINTS: Dysbiosis of the gut microbiome caused by continuous antibiotic treatment did not affect running activity. Continuous treatment with antibiotics did not result in systemic inflammation as indicated by serum cytokine levels. Gut microbiome dysbiosis was associated with blunted fibre type-specific hypertrophy in the soleus and plantaris muscles in response to progressive weighted wheel running (PoWeR). Gut microbiome dysbiosis was associated with impaired PoWeR-induced fibre-type shift in the plantaris muscle. Gut microbiome dysbiosis was associated with a loss of PoWeR-induced myonuclei accretion in the plantaris muscle.

Similar periprosthetic joint infection rates after and before a national infection control program: a study of 45,438 primary total knee arthroplasties

Background and purpose — Strenuous efforts to minimize postoperative infection rates have been made, including the Swedish nationwide initiative Prosthesis Related Infections Shall be Stopped (PRISS). This study calculated the incidence rate of periprosthetic joint infection (PJI) following primary total knee arthroplasty (TKA) before and after PRISS. Patients and methods — All 45,438 primary TKAs registered in the Swedish Knee Arthroplasty Register (SKAR) during 2007–2008 and 2012–2013 were included. Matched data on antibiotic prescriptions were obtained from the Swedish Prescribed Drug Register (SPDR). All patients with ≥ 28 days of continuous antibiotic treatment within 2 years of primary surgery had their medical charts reviewed to identify cases of PJI. The incidence rate was calculated by dividing the number of PJIs by the total time at risk during each time period and presented as percentages with 95% confidence interval (CI). Results — 644 PJIs were identified, equaling a 2-year incidence rate of 1.45% (CI 1.34–1.57). The incidence rate was 1.44% (CI 1.27–1.61) before PRISS and 1.46% (CI 1.31–1.61) after. Diagnosis was made within 30 days of primary TKA in 52%, and within 90 days in 73% of cases. 603 cases were reoperated on or revised. Median time from operation to diagnosis was 29 days (1–716), for both time periods. Debridement with exchange of the insert was performed in 32% and 63% of cases before and after PRISS, respectively. Interpretation — We found similar incidence rates before and after the PRISS initiative without any statistically significant difference. Time to diagnosis was similar during both time periods. The project may have contributed to increased compliance with treatment protocols.

Evaluation of biofilm colonization on multi-part dental implants in a rat model

BackgroundPeri-implant mucositis and peri-implantitis are highly prevalent biofilm-associated diseases affecting the tissues surrounding dental implants. As antibiotic treatment is ineffective to fully cure biofilm mediated infections, antimicrobial modifications of implants to reduce or prevent bacterial colonization are called for. Preclinical in vivo evaluation of the functionality of new or modified implant materials concerning bacterial colonization and peri-implant health is needed to allow progress in this research field. For this purpose reliable animal models are needed.MethodsCustom made endosseous dental implants were installed in female Sprague Dawley rats following a newly established three-step implantation procedure. After healing of the bone and soft tissue, the animals were assigned to two groups. Group A received a continuous antibiotic treatment for 7 weeks, while group B was repeatedly orally inoculated with human-derived strains of Streptococcus oralis, Fusobacterium nucleatum and Porphyromonas gingivalis for six weeks, followed by 1 week without inoculation. At the end of the experiment, implantation sites were clinically assessed and biofilm colonization was quantified via confocal laser scanning microscopy. Biofilm samples were tested for presence of the administered bacteria via PCR analysis.ResultsThe inner part of the custom made implant screw could be identified as a site of reliable biofilm formation in vivo. S. oralis and F. nucleatum were detectable only in the biofilm samples from group B animals. P. gingivalis was not detectable in samples from either group. Quantification of the biofilm volume on the implant material revealed no statistically significant differences between the treatment groups. Clinical inspection of implants in group B animals showed signs of mild to moderate peri-implant mucositis (4 out of 6) whereas the mucosa of group A animals appeared healthy (8/8). The difference in the mucosa health status between the treatment groups was statistically significant (p = 0.015).ConclusionsWe developed a new rodent model for the preclinical evaluation of dental implant materials with a special focus on the early biofilm colonization including human-derived oral bacteria. Reliable biofilm quantification on the implant surface and the symptoms of peri-implant mucositis of the bacterially inoculated animals will serve as a readout for experimental evaluation of biofilm-reducing modifications of implant materials.

Management of Modular Mega-Implant Infection of the Lower Extremity.

Revision arthroplasty involving mega-implants is associated with a high complication rate. In particular, infection is a serious complication of revision arthroplasty of hip and knee joints and has been reported to have an average rate of 18%, and for mega-implants, the range is from 3 to 36%. This study was designed to analyze the strategy of treatment of infection of mega-endoprostheses of the lower extremities in our patient cohort, particularly the management of chronic infection. This was a retrospective study that focused on the results of the treatment of periprosthetic infections of mega-implants of the lower extremities. We identified 26 cases with periprosthetic infections out of 212 patients with 220 modular mega-endoprostheses of the lower extremities who were treated in our department between September 2013 and September 2019. As a reinfection or recurrence, we defined clinical and microbiological recurrences of local periprosthetic joint infections after an antibiotic-free period. In this study, 200 cases out of 220 were investigated. The average follow-up period was approximately 18 months (6 months to 6 years). Endoprosthesis infections after implantation of mega-implants occurred in 26 cases (13%). This group comprised 2 early infections (within the first 4 weeks) and 24 chronic infections (between 10 weeks and 6 years after implantation). Nineteen cases out of the identified 26 cases with infection (73.1%) belong to the group of patients who were operated on due to major bone loss following explantation of endoprosthetic components due to previous periprosthetic joint infection. The remaining seven cases with infection comprised four cases following management of periprosthetic fracture, two cases following treatment of aseptic loosening, and one case following tumor resection. All infections were treated surgically. In all cases, the duration of continuous antibiotic treatment did not exceed 6 weeks. Both cases with early infection were treated by exchanging polyethylene inlays and performing debridement with lavage (two cases). In two (7.7%) cases with chronic infection, one-stage surgery was performed. In all remaining cases with chronic infection (22 cases; 84.6%), explantation of all components and temporary implantation of cement spacers were carried out prior to reimplantation. There is still no gold standard therapeutic regimen for the management of periprosthetic infection of mega-implants, though radical surgical debridement and lavage accompanied by systemic antibiotic therapy are the most important therapeutic tools in all cases of periprosthetic infections, regardless of the time of onset. Further studies are needed to standardize management strategies of such infections. Nevertheless, it is not uncommon for compromises to be made based on the particular condition of the individual.

Risk factors for respiratory Aspergillus fumigatus in German Cystic Fibrosis patients and impact on lung function

Airway inflammation and chronic lung infections in cystic fibrosis (CF) patients are mostly caused by bacteria, e.g. Pseudomonas aeruginosa (PA). The role of fungi in the CF lung is still not well elucidated, but evidence for a harmful and complex role is getting stronger. The most common filamentous fungus in CF is Aspergillus fumigatus (AF). Age and continuous antibiotic treatment have been discussed as risk factors for AF colonisation but did not differentiate between transient and persistent AF colonisation. Also, the impact of co-colonisation of PA and AF on lung function is still under investigation. Data from patients with CF registered in the German Cystic Fibrosis Registry database in 2016 and 2017 were retrospectively analysed, involving descriptive and multivariate analysis to assess risk factors for transient or persistent AF colonisation. Age represented an independent risk factor for persistent AF colonisation. Prevalence was low in children less than ten years, highest in the middle age and getting lower in higher age (≥ 50 years). Continuous antibiotic lung treatment was significantly associated with AF prevalence in all age groups. CF patients with chronic PA infection had a lower lung function (FEV1%predicted), which was not influenced by an additional AF colonisation. AF colonisation without chronic PA infection, however, was significantly associated with a lower function, too. Older age up to 49 years and continuous antibiotic use were found to be the main risk factors for AF permanent colonisation. AF might be associated with decrease of lung function if not disguised by chronic PA infection.

Outcome of Continuous Low Dose Antibiotic Treatment in Comparison With Periintervention Antibiotic Prophylaxsis in Double J Stenting

Objective: To determine the outcome of antibiotic treatment regime in patient with indwelling DJ stenting having a per-interventional antibiotic prophylaxis compared with those of a continuous low-dose antibiotic treatment.&#x0D; Methods: A hospital based prospective experimental study was conducted in the Department of Urology of Dhaka Medical College Hospital, Dhaka from July 2012 to June 2014, to evaluate the antibiotic treatment regime in patient with indwelling DJ stenting, the benefits and disadvantages of a peri-interventional antibiotic prophylaxis compared with those of a continuous low-dose antibiotic treatment by enrolling a total number of 60 subjects in the department of Urology, Dhaka Medical College, Dhaka. Among 60 subjects 30 subjects were Group A comprised of subjects treated with continuous low dose antibiotic and Group B with 30 subjects treated with peri-interventional antibiotic. The patients would undergo temporary D J stent placement due to upper tract urolilhiasis who meet the inclusion criteria and exclusion criteria. Informed written consent would be taken from all patients. Urine samples would be analysed conventional antibiotic susceptibility and resistance was determined. All analyses was conducted at department of Microbiology, Dhaka medical college hospital. All patients who received peri-interventional antibiotic prophylaxis with 1g ceftriaxon was given l.v. at anaesthesia induction to obtain a peak concentration at the time of highest risk during the procedure.According to the pathogens profile and susceptibility, the antimicrobial agent of choice for continuous low-dose treatment was Cefixim 200mg twice daily. All stents placements were performed under sterile conditions applying a retrograde technique or antregrade in PCNL and open procedure under spinal or general anaesthesia. Patients were prescribed ketorolac (10mg) or Tramadol (50mg), while none of the patient received alpha blocker agents or anti-cholinergic drugs. Evaluations for UTI were performed before stent insertion and consecutively after 1, 2 and 4 weeks and/or at stent withdrawal. Statistical analysis of the result was obtained by using window based computer software devised with statistical packages for social science (SPSS-20 IBM) (SPSS inc, Chicago, IL, USA). The result was presented in tables, figures, and diagrams. Statistical test was done by Chi square test and Z test for qualitative data and t test for quantitative data. A p-value &lt;0.05 is considered as level of significance.&#x0D; Results: To evaluate the antibiotic treatment regime in patient with indwelling DJ stenting, the benefits and disadvantages of a peri-interventional antibiotic prophylaxis compared with those of a continuous low-dose antibiotic treatment, a total number of 60 subjects were enrolled in this present study in the department of Urology, Dhaka Medical College, Dhaka. Among 60 subjects 30 subjects were Group A comprised of subjects treated with continuous low dose antibiotic and Group B with 30 subjects treated with periinterventional antibiotic only. Outcome of these two treatment techniques were studied. For urinary tract infection rate the concept of a peri-interventional antibiotic prophylaxis during DJ stent implantation is known to be better antibiotic coverage and is therefore recommended by the European Association of Urology. However, there is a lack of evidence concerning the exact antibiotic strategy for the entire stent-indwelling time. In clinical routine, it is an applied practice among urologists to continue antibiotic treatment in a low-dose fashion, even after previous uncomplicated implantations.&#x0D; Conclusion: In case of indwelling DJ stenting, subjects with continuous low dose antibiotic regimen had significantly less proportion of UTI, dysuria and frequency of micturition than those with peri-interventional antibiotic. So, if haematuria, skin rash and GIT disturbance is carefully managed then continuous low dose antibiotic regimen is better treatment option than peri-interventional regimen for with indwelling DJ stenting in different cases.&#x0D; Bangladesh Journal of Urology, Vol. 21, No. 2, July 2018 p.127-136

The Interaction of Gut Microbiota Composition and Dietary Starch Form on Gut Health in Aged Mice

Abstract Objectives A high glycemic diet has been shown to increase gut permeability, which is associated with increased disease risk. Our objective was to evaluate the role of gut microbiota in mediating the relationship between dietary starch composition and gut health. Methods A high (HG) or low glycemic (LG) diet was fed in equal amounts to male mice from 12 to 24 months of age. The diets differed only by starch composition, which was 100% rapidly-digested amylopectin in the HG diet or 30% amylopectin/70% amylose in the LG diet. Within each diet, mice were assigned to one of three treatment conditions: continuous broad-spectrum antibiotic treatment (ampicillin and neomycin; HGabx or LGabx), weekly fecal microbiota transplants (FMT) from donor control mice fed the alternate diet (HG[tLG] or LG[tHG]), or a control group receiving no additional treatment. Feces were collected for microbiome analysis. Colon sections were collected for histology. Results The diet affected gut microbiota composition, with significantly greater abundance of Clostridium, Ruminococcus, and Coprobacillus in the HG-fed control animals compared with LG-fed controls. Antibiotic treatment in HG-fed animals resulted in elimination of Bacteroidetes and most Firmicutes and a proliferation of Proteobacteria, whereas LG-fed animals were able to maintain Bacteroidetes and a lower abundance of Proteobacteria. Fecal microbiota transplants altered the gut microbiome and recipients differed from their donors. Histological evaluation of colons showed increased intestinal disease in HG-fed animals across all treatments, including increased inflammatory cell infiltration and abnormal villi. Antibiotic treatment in HG-fed animals resulted in the most severe disease phenotype, and most animals died within 4–6 months on treatment and presented with an enlarged and hemorrhagic cecum upon necropsy. Conclusions The high glycemic diet altered the gut microbiome and increased the prevalence of pathological intestinal morphology, which was further exacerbated with antibiotic treatment. Our work suggests that dietary starch form has a substantial effect on the gut health outcomes, particularly in the context of antibiotic treatment or fecal microbiota transplants. Funding Sources BrightFocus Foundation, USDA/NIFA AFRI, USDA, Stanley N. Gershoff Scholarship, NIH RO1, Thome Memorial Foundation.