Effective Antimicrobial Treatment Research Articles

Postexposure Prophylaxis and Treatment of Bacillus anthracis Infections: A Systematic Review and Meta-analyses of Animal Models, 1947-2019.

Anthrax is endemic to many countries, including the United States. The causative agent, Bacillus anthracis, poses a global bioterrorism threat. Without effective antimicrobial postexposure prophylaxis (PEPAbx) and treatment, the mortality of systemic anthrax is high. To inform clinical guidelines for PEPAbx and treatment of B. anthracis infections in humans, we systematically evaluated animal anthrax treatment model studies. We searched for survival outcome data in 9 scientific search engines for articles describing antimicrobial PEPAbx or treatment of anthrax in animals in any language through February 2019. We performed meta-analyses of efficacy of antimicrobial PEPAbx and treatment for each drug or drug combination using random-effects models. Pharmacokinetic/pharmacodynamic relationships were developed for 5 antimicrobials with available pharmacokinetic data. Monte Carlo simulations were used to predict unbound drug exposures in humans. We synthesized data from 34 peer-reviewed studies with 3262 animals. For PEPAbx and treatment of infection by susceptible B. anthracis, effective monotherapy can be accomplished with fluoroquinolones, tetracyclines, β-lactams (including penicillin, amoxicillin-clavulanate, and imipenem-cilastatin), and lipopeptides or glycopeptides. For naturally occurring strains, unbound drug exposures in humans were predicted to adequately cover the minimal inhibitory concentrations (MICs; those required to inhibit the growth of 50% or 90% of organisms [MIC50 or MIC90]) for ciprofloxacin, levofloxacin, and doxycycline for both the PEPAbx and treatment targets. Dalbavancin covered its MIC50 for PEPAbx. These animal studies show many reviewed antimicrobials are good choices for PEPAbx or treatment of susceptible B. anthracis strains, and some are also promising options for combating resistant strains. Monte Carlo simulations suggest that oral ciprofloxacin, levofloxacin, and doxycycline are particularly robust choices for PEPAbx or treatment.

Incidence and Clinical Characteristics of Anaerobic Bacteremia at a University Hospital in Hungary: A 5-Year Retrospective Observational Study.

Strict anaerobes have been reported to account for 0.5–13% of episodes of bacteremia in the adult population, with a growing awareness among clinicians regarding anaerobic bacteremia, especially in patients with specific predisposing factors. The aim of our present study was to assess the incidence and clinical characteristics of anaerobic bacteremia during a 5-year period (2016–2020) at a tertiary care teaching hospital, and to compare our findings with other studies in Hungary. Overall, n = 160 strict anaerobes were detected, out of which, 44.4% (n = 71; 0.1% of positive blood cultures, 0.1/1000 hospitalizations, 3.3/100,000 patient days) were clinically significant, while Cutibacterium spp. accounted for 55.6% (n = 89) of isolates. Among relevant pathogens, the Bacteroides/Parabacteroides spp. group (32.4%; n = 23), Clostridium spp. (22.5%; n = 16) and Gram-positive anaerobic cocci (15.5%; n = 11) were the most common. The mean age of patients was 67.1 ± 14.1 years, with a male majority (59.2%; n = 42). A total of 38.0% of patients were affected by a malignancy or immunosuppression, while an abscess was identified in 15.5% of cases. A total of 74.7% (n = 53) of patients received antibiotics prior to blood culture sampling; in instances where antimicrobials were reported, anaerobic coverage of the drugs was appropriate in 52.1% (n = 37) of cases. The 30-day crude mortality rate was 39.4% (n = 28); age ≥ 75 years was a significant predictor of 30-day mortality (OR: 5.0; CI: 1.8–14.4; p = 0.003), while malignancy and immunosuppression, lack of anti-anaerobic coverage or female sex did not show a significant relationship with the mortality of these patients. Early recognition of the role played by anaerobes in sepsis and timely initiation of adequate, effective antimicrobial treatment have proven efficient in reducing the mortality of patients affected by anaerobic bacteremia.

Association Between Time to Appropriate Antimicrobial Treatment and 30-day Mortality in Patients With Bloodstream Infections: A Retrospective Cohort Study.

Effective antimicrobial treatment is key for survival in bloodstream infection (BSI), but the impact of timing of treatment remains unclear. Our aim was to assess the association between time to appropriate antimicrobial treatment and 30-day mortality in BSI patients. This was a retrospective cohort study using electronic health record data from a large academic center in Sweden. Adult patients admitted between the years 2012 and 2019, with onset of BSI at the emergency department or general wards, were included. Pathogen-antimicrobial drug combinations were classified as appropriate or inappropriate based on reported in vitro susceptibilities. To avoid immortal time bias, the association between appropriate therapy and mortality was assessed with multivariable logistic regression analysis at pre-specified landmark times. We included 10 628 BSI-episodes, occurring in 9192 unique patients. The overall 30-day mortality was 11.8%. No association in favor of a protective effect between appropriate therapy and mortality was found at the 1, 3 and 6 hours landmark after blood culture collection. At 12 hours, the risk of death increased with inappropriate treatment (adjusted odds ratio 1.17 [95% confidence interval {CI}, 1.01-1.37]) and continued to increase gradually at 24, 48, and 72 hours. Stratifying by high or low SOFA score generated similar odds ratios, with wider confidence intervals. Delays in appropriate antimicrobial treatment were associated with increased 30-day mortality after 12 hours from blood culture collection, but not at 1, 3, and 6 hours, in BSI. These results indicate a benchmark for providing rapid microbiological diagnostics of blood cultures.

Photodynamic Antimicrobial Therapy Based on Conjugated Polymers.

Pathogenic microorganisms have been a serious threat to human life and have become a public health problem of global concern. However, in the actual treatment there is a lack of efficient antimicrobial strategies which do not easily develop drug resistance; this can lead to inaccurate drug treatment that worsens the infection and even threatens life. With the emergence of a variety of drug-resistant bacteria and fungi, photodynamic therapy has gradually become one of the most promising treatment methods for drug-resistant bacteria infection; this is because it is controllable, non-invasive, and not prone to cause the development of drug resistance. Organic conjugated polymers that possess high fluorescence intensity, a large molar extinction coefficient, excellent light stability, an adjustable energy band, easy modification, good biocompatibility, and the ability to photosensitize oxygen to produce reactive oxygen species have been widely used in the fields of solar cells, highly sensitive detection systems, biological imaging, and anti-cancer and anti-microbial treatment. Photodynamic therapy is non-invasive and has high temporal and spatial resolution and is a highly effective antimicrobial treatment that does not easily induce drug resistance; it has also stimulated the scientific research enthusiasm of researchers and has become a research hotspot in the antimicrobial field. In this review, the photodynamic antibacterial applications of conjugated polymers with different structure types are summarized, and their development directions are considered.

The epidemiology, clinical characteristics, and macrolide susceptibility of Mycoplasma pneumoniae pneumonia in children in Southern Taiwan, 2019-2020.

Since the global use of the pneumococcal conjugate vaccine, Mycoplasma pneumoniae (MP) has become the most common bacterial cause of lower respiratory tract infections among children. Monitoring the changing epidemiology and antimicrobial resistance rates of this organism is important for MP clinical management. This study characterizes key features of MP during the 2019-2020 epidemic in children in Taiwan. The cohort included all hospitalized children under 18 years of age with polymerase chain reaction (PCR)-confirmed community-acquired mycoplasma pneumonia (CAMP) in southern Taiwan. Macrolide resistance was identified by mutations in domain V of MP 23S rRNA. Severe disease referred to symptoms warranting oxygen therapy, septic shock, or intensive care unit admission. Among 495 LRTI patients, 195 (39.4%) had CAMP, of which 106 (54.4%) had concurrent serological evidence of MP infection. The diagnostic sensitivity of IgM in the acute phase was 65.6%. CAMP case numbers were highest from July 2019 to January 2020. The most common clinical presentations of CAMP were fever (99.0%), cough (99.0%), and coryza (31.8%). Despite a high rate of macrolide resistance (88.1%), macrolide-resistant MP (MRMP) did not differ from macrolide-sensitive MP (MSMP) in clinical course or severity. Delayed administration of effective antimicrobial treatment was also associated with severe disease (p<0.05). Early diagnosis and determination of MRMP are needed for effective management of MP infection.

Antibacterial treatment for exotic species, backyard ruminants and small flocks: a narrative review highlighting barriers to effective and appropriate antimicrobial treatment

Antimicrobial resistance is a complex One Health issue that exists in both human and veterinary medicine. To mitigate this ever-growing problem, efforts have been made to develop guidelines for appropriate antimicrobial use (AMU) across sectors. In veterinary medicine, there are notable literature gaps for proper AMU in minor species. We conducted a structured narrative review covering the years of July 2006 – July 2021 to find antimicrobial treatments for common bacterial infections in exotic (birds, rodents, reptiles, and others), small flock (chickens, turkeys, and other fowl), and backyard small ruminant (sheep and goats) species. We retrieved a total of 4728 articles, of which 21 articles met the criteria for our review. Studies were grouped according to species, syndrome, and body system affected. Other data extracted included the bacterial pathogen(s), treatment (active ingredient), and geographical origin. Body systems reported included: intra-oral (n = 4), gastrointestinal (n = 1), respiratory (n = 2), reproductive (n = 1), skin (n = 3), aural (n = 1), ocular (n = 4), and other/multisystem (n = 5). By species, our search resulted in: rabbit (n = 5), rat (n = 2), guinea pig (n = 1), chinchilla (n = 1), guinea pig and chinchilla (n = 1), avian species (n = 1), psittacine birds (n = 2), loris and lorikeets (n = 1), turtles (n = 2), lizards (n = 1), goats (n = 2) and sheep (n = 2). The results of our findings identified a distinct gap in consistent antimicrobial treatment information for commonly encountered bacterial conditions within these species. There is a persisting need for clinical trials that focus on antibacterial treatment to strengthen the evidence base for AMU within exotic, small flock, and backyard small ruminant species.

ALA_PDT Promotes Ferroptosis-Like Death of Mycobacterium abscessus and Antibiotic Sterilization via Oxidative Stress.

Mycobacterium abscessus is one of the common clinical non-tuberculous mycobacteria (NTM) that can cause severe skin infection. 5-Aminolevulinic acid photodynamic therapy (ALA_PDT) is an emerging effective antimicrobial treatment. To explore whether ALA_PDT can be used to treat M. abscessus infections, we conducted a series of experiments in vitro. We found that ALA_PDT can kill M. abscesses. Mechanistically, we found that ALA_PDT promoted ferroptosis-like death of M. abscesses, and the ROS scavenger N-Acetyl-L-cysteine (NAC) and ferroptosis inhibitor Ferrostatin-1 (Fer-1) can mitigate the ALA_PDT-mediated sterilization. Furthermore, ALA_PDT significantly up-regulated the transcription of heme oxygenase MAB_4773, increased the intracellular Fe2+ concentration and altered the transcription of M. abscessus iron metabolism genes. ALA_PDT disrupted the integrity of the cell membrane and enhanced the permeability of the cell membrane, as evidenced by the boosted sterilization effect of antibiotics. In summary, ALA_PDT can kill M. abscesses via promoting the ferroptosis-like death and antibiotic sterilization through oxidative stress by changing iron metabolism. The study provided new mechanistic insights into the clinical efficacy of ALA_PDT against M. abscessus.

Direct antimicrobial resistance prediction from clinical MALDI-TOF mass spectra using machine learning.

Early use of effective antimicrobial treatments is critical for the outcome of infections and the prevention of treatment resistance. Antimicrobial resistance testing enables the selection of optimal antibiotic treatments, but current culture-based techniques can take up to 72 hours to generate results. We have developed a novel machine learning approach to predict antimicrobial resistance directly from matrix-assisted laser desorption/ionization-time of flight (MALDI-TOF) mass spectra profiles of clinical isolates. We trained calibrated classifiers on a newly created publicly available database of mass spectra profiles from the clinically most relevant isolates with linked antimicrobial susceptibility phenotypes. This dataset combines more than 300,000 mass spectra with more than 750,000 antimicrobial resistance phenotypes from four medical institutions. Validation on a panel of clinically important pathogens, including Staphylococcus aureus, Escherichia coli and Klebsiella pneumoniae, resulting in areas under the receiver operating characteristic curve of 0.80, 0.74 and 0.74, respectively, demonstrated the potential of using machine learning to substantially accelerate antimicrobial resistance determination and change of clinical management. Furthermore, a retrospective clinical case study of 63 patients found that implementing this approach would have changed the clinical treatment in nine cases, which would have been beneficial in eight cases (89%). MALDI-TOF mass spectra-based machine learning may thus be an important new tool for treatment optimization and antibiotic stewardship.

Sepsis in Burns-Lessons Learnt from Developments in the Management of Septic Shock.

After surviving the acute phase of resuscitation, septic shock is the cause of death in the majority of burn patients. Therefore, the management of septic shock is a cornerstone in modern burn care. Whereas sepsis therapy in general has undergone remarkable developments in the past decade, the management of septic shock in burn patients still has a long way to go. Instead, the differences of burn patients with septic shock versus general patients have been emphasized and thus, burn patients were excluded in every sepsis study which are the basis for modern sepsis therapy. However, due to the lack of evidence in burn patients, the standards of procedure for general sepsis therapy have been adopted in burn care. This review identifies the differences of burn patients with sepsis versus other septic patients and summarizes the scientific basis for modern sepsis therapy in general ICU patients and burn patients. Consequently, the results in general sepsis research should be transferred to burn care, which means the implementation of effective screening, early resuscitation, and efficient antimicrobial treatment. Therefore, on the basis of past developments and in the light of the current update of the Surviving Sepsis Campaign guidelines, this review introduces the “Burn SOFA score” and the “3 H’s of burn sepsis” as a screening tool for early sepsis recognition in burn patients.

The in vitro efficacy of neutral electrolysed water and povidone-iodine against CRS-associated biofilms.

Despite best medical and surgical practice, some cases of chronic rhinosinusitis (CRS) can remain recalcitrant. Bacterial biofilms have been associated with the recalcitrance of sinonasal inflammation. Biofilms are highly resistant to commonly prescribed antibiotics. Accordingly, more effective antimicrobial treatment options are needed to treat refractory CRS. The aim of this study was to determine the in vitro efficacy of neutral electrolysed water (NEW) and povidone-iodine (PVI) against CRS-associated Staphylococcus aureus biofilms. Mature S. aureus biofilms were grown in a Centre for Disease Control (CDC) biofilm reactor. The antimicrobial activity of NEW, PVI and doxycycline was determined for both planktonic and biofilm cultures of a clinical S. aureus isolate using minimum inhibitory concentration (MIC), minimum bactericidal concentration (MBC) and minimum biofilm eradication concentration (MBEC) assays. MICs and MBCs were determined for all antimicrobials. MBC values were similar to MICs for both antiseptics, but doxycycline MBCs were significantly higher than the associated MICs. Biofilms were highly resistant to NEW and doxycycline. The MBEC for doxycycline was between 500 and 1000 Â#181;g/mL. NEW was ineffective against biofilms and no MBEC could be determined. In contrast, a concentration of 10% of the commercial PVI solution (10 mg/mL PVI) led to effective eradication of mature biofilms. In this study, only PVI showed promising antibiofilm activity at physiological concentrations. The in vivo efficacy of PVI warrants further investigation of its potential as a treatment for recalcitrant CRS.

A retrospective analysis of the impact of a hospital pharmacist-led procalcitonin protocol.

Procalcitonin is a precursor hormone to calcitonin that increases in response to systemic inflammation, especially of bacterial origin, and is otherwise undetectable in healthy states. Studies have shown that following effective antimicrobial treatment, procalcitonin levels steadily decline. To be utilized however, procalcitonin levels determinations must be ordered at specific times during a patient's antimicrobial treatment. A retrospective medication-use evaluation of patients was performed at Medical Center Hospital and showed that in 70% of patients, initial procalcitonin levels were ordered inappropriately and procalcitonin levels were trended inconsistently during antibiotic treatment. A pharmacist-led procalcitonin protocol was developed and presented to medical staff committees for approval. Data was collected from patients presenting with suspected or confirmed sepsis or lower respiratory tract infections for whom procalcitonin levels were utilized. Patient outcomes before and after protocol implementation were compared. A total of 400 patients were included in the study. The primary outcome of appropriate ordering of initial procalcitonin levels was improved in the postprotocol group relative to the preprotocol group (28% of patients [n = 56] vs 72% of patients [n = 144]; P < 0.001). Patients in the postprotocol group had a procalcitonin level checked at discontinuation more frequently (8% [n = 16] vs 37% [n = 74], P < 0.001) and had a higher rate of appropriate discontinuation of antibiotics (12% [n = 21] vs 46% [n = 77]; P < 0.001). The postprotocol group also had fewer mean days of antibiotic therapy (9.17 vs 6.01; P < 0.001). Studies have shown the usefulness of procalcitonin levels for antimicrobial stewardship, but for procalcitonin testing to be properly utilized it must be ordered at the correct times during the patient's therapy. The implementation of a hospital-wide pharmacist-led protocol resulted in an increase in appropriate ordering of baseline procalcitonin levels.

Rapid Identification and Antimicrobial Susceptibility of Gram Negative Bacteria Detected in Positive Blood Culture Bottles

Abstract Background Blood stream infection (BSI) is one of the most serious situations in infectious disease .Accurate and timely identification of the causative agent and determination of its antimicrobial susceptibility profile are essential for guiding targeted and effective antimicrobial treatment. Current methods involve culturing of blood in a liquid medium and subsequently subculturing of signal positive bottles on solid media in order to obtain isolated colonies that can be further used in identification and susceptibility testing of the isolates. The standard method requires additional 48-72hours following the appearance of a positive signal in order to provide a reliable patient report. On the other hand, rapid identification of the causative agent and determination of its susceptibility profile by direct inoculation of the biochemical test media with the blood-broth mixtures from signal positive bottles and performing primary susceptibility testing might help reducing the time needed for provision of results compared to the standard isolated-colony based method and hence would help the rapid initiation of effective and targeted antimicrobial therapy and reduce the bacteremia-related morbidity and mortality. Objective The aim of the present study was to determine the accuracy and precision of the non-standard methods (direct identification and susceptibility testing using the blood/broth mixture) by comparing its results to those of the standard isolate-based identification and susceptibility testing methods. Material and method The study included 52 signal blood culture bottles yielding gram negative isolates. Bottles were selected amongst blood culture bottles submitted to the Main Microbiology laboratory, Ain Shams University hospital, for culture and antimicrobial susceptibility testing during the period between May 2018 and October 2018. a portion of the blood-broth mixture was aspirated from positive blood culture bottles, after being well mixed, and was subcultured onto agar media for the isolation of the causative agent and subsequently determination of its antimicrobial susceptibility profile was performed. Another part of the aspirated blood-broth mixture was diluted with sterile saline, its turbidity was adjusted against a 0.5McFarland standard and was used to inoculate directly the biochemical test media panel used for the identification of gram negative organisms as well as to perform direct (primary) antimicrobial susceptibility. Results The present study revealed there was 100% categorical agreement between the results of the direct biochemical inoculation method and those of the standard isolate-based inoculation method regarding the identification of the causative agent. The results of the direct biochemical identification method were also consistent giving rise to a 100% withinrun precision categorical agreement and a 100% between-run precision categorical agreement. The overall categorical agreement between the results of the standard isolate-based AST method and the results of the direct (primary susceptibility) AST method was 96.3% for the signal blood culture media. The major error rate was 0.5% whereas the minor error rate was 3.3% . Consistent results were also obtained for the AST done directly from the signal blood culture bottles since the between-run and within-run precision categorical agreement were 96.3% and 98.6%, respectively. Conclusion the overall performance of the AST done directly from positive blood culture bottles fulfilled the acceptable performance criteria specified in the Cumitech 31A so the direct method can be used for the earlier determination of AST and identification of Gram negative bacteria and thus to reduce the time for early initiation of appropriate antibiotic

Pulsed Ultraviolet Light Treatment of Chicken Parts

With increasing production and consumption of chicken, it is appropriate to investigate the functionality and effectiveness of microbial reduction interventions and the qualitative effects they have on food. The effectiveness of pulsed ultraviolet (PUV) light applied to chicken on a moving conveyor was evaluated for inactivation of Escherichia coli on the surface of raw boneless/skinless (B/S) chicken breasts, B/S chicken thighs, and bone-in/skin-on chicken thighs. The conveyor height (distance from the flashlamp) and speed were set to deliver total energy fluences of 5, 10, 20, and 30 J/cm2 to the surface of the products. The product type by energy fluence interaction was significant (P = 0.015) for microbial reduction of E. coli. Exposure to PUV light for 5 and 30 J/cm2 resulted in Log10 reductions of 0.29 and 1.04 for B/S breasts, 0.34 and 0.94 for B/S thighs, and 0.10 and 0.62 for bone-in/skin-on thighs, respectively. Lipid oxidation and changes in color of chicken samples were evaluated after 30 J/cm2 of PUV light treatment. Lipid oxidation was measured at 0, 24, 48, and 120 h after the treatment. PUV light treatment did not produce significant (P &amp;gt; 0.05) changes in lipid oxidation values for each product type. International Commission on Illumination L*, a*, and b* parameters were used to report lightness and color of samples before and after treatment for B/S breasts and thighs and bone-in/skin-on thighs. Color parameters were not significantly (P &amp;gt; 0.05) affected by PUV light treatments. In conclusion, this study indicates that PUV light applied to the surface of raw chicken parts on a moving conveyor is an effective surface antimicrobial treatment while inducing minimal change in quality of the product over a 5-d storage period under aerobic conditions.

Antisense yycG modulates the susceptibility of Staphylococcus aureus to hydrogen peroxide via the sarA

BackgroundThe infectious pathogen Staphylococcus aureus (S. aureus) is primarily associated with osteomyelitis. Hydrogen peroxide drainage is an effective antimicrobial treatment that has been adopted to combat S. aureus infections. Previous investigations have indicated that the antisense RNA (asRNA) strategy negatively modulates S. aureus YycFG TCS, and it significantly disrupts biofilm formation. However, the effects of the antisense yycG RNA (ASyycG) strategy on the susceptibility of biofilm-producing S. aureus to hydrogen peroxide and the mechanisms underlying this effect have not been elucidated to date.ResultsOverexpression of ASyycG inhibited the transcription of biofilm formation-related genes, including sarA and icaA. Additionally, the CFU counts and the live bacterial ratios of ASyycG biofilm-producing S. aureus treated with H2O2 were notably reduced across the groups. Notably, the predicted promoter regions of the sarA and icaA genes were directly regulated by YycF.ConclusionsASyycG was observed to sensitize biofilm-producing S. aureus to H2O2 intervention synergistically via the sarA and thus may represent a supplementary strategy for managing osteomyelitis. However, future in-depth studies should attempt to replicate our findings in animal models, such as the rat osteomyelitis model.

Light‐Activated Conjugated Polymers for Antibacterial Photodynamic and Photothermal Therapy

With the growing crisis of the availability of effective antimicrobial treatments, the use of phototherapy has gained increasing interest as an alternative to traditional antibiotic therapy. Even though phototherapy is already used in the clinic, there is an emerging interest in new materials with enhanced antimicrobial activity triggered by light. Among the different light‐responsive materials, conjugated polymers are emerging candidates with successful application in the field of antimicrobial photodynamic and photothermal therapy. Due to their organic composition, easy processability, tailorability of physicochemical properties, and capability of reactive oxygen species (ROS) and heat generation, their use as photoresponsive agents against bacteria has greatly expanded. Conjugated polymers have been designed to interact with specific bacterial targets, and their chemical composition has been optimized to enhance ROS and/or heat generation and new cationic polymers have been developed for augmented water solubility and increased interaction with negatively charged bacteria. Herein, the use of conjugated polymers in the field of phototherapy is discussed, focusing on the different approaches that have improved their performance against bacteria and their current preclinical safety assessment.

Intrapartum and Postpartum Management of Intra-amniotic Infection.

Intra-amniotic infection (IAI) is a common condition with potentially devastating maternal and neonatal complications. However, there are incomplete data regarding the most effective antimicrobial treatment regimen for this condition. This article aims to review the current evidence and recommendations for intrapartum and postpartum management of IAI. Original research articles, review articles, and guidelines on IAI were reviewed. Numerous known risk factors for IAI exist, some of which are modifiable. Serious neonatal complications can result from exposure to IAI including increased risk of preterm birth and neonatal death. Possible maternal complications include increased risk of cesarean delivery, postpartum hemorrhage, and postpartum endometritis. Antibiotics are the mainstay of treatment for IAI for both mothers and neonates, although there is no consensus on which antimicrobial agents are best and the appropriate duration of therapy. Monitoring patients for signs of IAI, proper treatment, and communication of the diagnosis with the pediatric team are essential for preventing maternal and neonatal complications of IAI. More research is needed to determine the proper treatment regimens for both mothers diagnosed with IAI and their neonates.

Bacteria Associated with Clinically Suspected Respiratory Disease in Snakes and Effective Antimicrobial Treatment Options

Captive snakes often suffer from pneumonia. Factors contributing to this problem include husbandry issues, nutrition, and hygiene. Infectious agents are particularly important, and bacteria can be primary or secondary drivers of disease processes. If these are not treated, they can lead to life-threatening problems. Bacteria were isolated from the lower respiratory tracts of 25 snakes with clinical signs of pneumonia. Antibiograms were made for the isolated bacteria against antibiotics commonly used to treat respiratory disease in small animals as well as macrolides and phenicols used to treat respiratory disease in cattle. Three hundred fifty snakes with clinical respiratory disease were then treated with one of the macrolides or the phenicol and monitored by bioassay for antibiotic activity in the blood and for clinical recovery. A total of 47 different bacteria, all Gram negative, were isolated from the tracheal washes of the 25 snakes. The highest sensitivity rates (>80%) were found against enrofloxacin and marbofloxacin, trimethoprim/sulfamethoxazole, the macrolides tularthromycin, tilmicosin, tildipirosin, and gamithromycin, and the phenicol flurofenicol. Of the snakes treated with tularthromycin, tilmicosin, gamithromycin, tildipirosin, or florfenicol, 89.4% recovered clinically within 2–3 wk of treatment.

Etiological factors and Risk stratification of sepsis among septicemia patients – A Review

Infections represents a frequent medical concern in the individuals of all age group. Typically, the initial treatment given is adequate thus little treatment if required further. However, in some cases inadequate initial treatment is given to patients as response toward the infections which lead to the organ failure, this condition led to the sepsis. Sepsis happened when a dysregulated host reacted toward infection that causes a life-threatening organ dysfunction.It is generally brought about by microbes’growths,bacterial disease, or infections and at present there is no particular treatment; and lead to 30% mortality rate, causing millions of deaths per year worldwide. Recent definitions have been distributed for clinical practices and exploration. Efficacious administration requires a brief acknowledgment, rapid clinical assessment, antimicrobial treatment, source control and steady treatment. Early, and effective antimicrobial treatment is related with endurance from sepsis and increases the survival rate from the disease. Early diagnosis and management of source of infection (e.g., puss removal) plays a vital role in lowering the incidence rate of disease in many individuals. The early management of risk factors associated with sepsis can be managed by “sepsis six” heap of care among septicemia patients.This article audits key components of sepsis the board, zeroing in on finding, biomarkers and treatment. The super late development in treatment is the procedure of customized medication, in light of an exact methodology utilizing biomarkers to recognize explicit people who are probably going to profit from more customized consideration.

1607. Dual Therapy with Aztreonam &amp; Ceftazidime/Avibactam Against Multi-Drug Resistant Stenotrophomonas maltophilia on Tricuspid Valve Endocarditis

BackgroundAntimicrobial resistance in Stenotrophomonas maltophilia is one of the most complex among Gram-negatives. Presence of regulating non-specific antimicrobial class efflux pumps and chromosomal encoded L1 metallo-betalactamase (Ambler Class B) and L2 betalactamase (Ambler Class A) are responsible for few clinically active antimicrobials and pan-drug resistant strains.MethodsA 38 year old male with a history of IV drug use, chronic hepatitis C, and recent MSSA endocarditis was admitted with sepsis. Workup revealed tricuspid valve endocarditis with pulmonary septic emboli due to S. maltophilia. Initial antibiotics were levofloxacin (LVX), metronidazole, and piperacillin-tazobactam (TZP) followed by LVX and minocycline (MIN). He had valve replacement on day 6. Repeat blood cultures and valve tissue culture revealed pan-resistant S. maltophilia (resistant: ceftazidime (CAZ), LVX, MIN, TMP/SMX, chloramphenicol; intermediate: MIN; eravacycline MIC 8 μg/mL; tigecycline MIC 16 μg/mL). Microbiology Department was consulted for additional antimicrobial options. In vitro testing for aztreonam (ATM) with ceftazidime/avibactam (CZA) was recommended.ResultsSynergy testing between ATM and CZA was performed by positioning ATM strip over the area where CZA had been previously been placed and removed after 10 minutes of incubation. The interception of the growth with the ATM strip was read. In presence of avibactam, ATM MIC was 4 μg/mL, 6 two-fold dilutions lower than ATM without CZA. MIC for ATM (256 μg/mL), CAZ (256 μg/mL) and CZA (32 μg/mL) were tested individually. ATM with CZA was recommended as a salvage treatment based on in vitro result. Patient completed 6 weeks of ATM with CZA along with MIN. He achieved microbiologic clearance and clinical recovery from infection. At the end of treatment, he experienced episodes of refractory ascites. With complex comorbidities, patient was not a transplant candidate and transitioned to hospice two weeks later.ConclusionAlthough the surgical excision was key, treatment with ATM and CZA provided effective antimicrobial treatment in the setting of persistent positive blood culture. ATM with CZA should be considered for cases of pan-drug resistant S. maltophilia with limited treatment options.Disclosures All Authors: No reported disclosures

Spectrum, and Pathophysiology of Sepsis

Infections represents a frequent medical concern in the individuals of all age group. It happened whenpatients’system responses toward any infections which causes a condition called sepsis which further led to the organmalfunctioning. When a dysregulated host reacted toward infection that causes a life-threatening organ dysfunction that can led to the state of critical chronic illness accompanied by catabolism and severe immune dysfunction.It is generally brought about by microbes’ growths, bacterial disease, or infections and at present there is no particular treatment; and lead to 30% mortality rate, causing millions of deaths per year worldwide. It is more common among elder age individuals as compared to young individuals. Recent definitions have been distributed for clinical practices and exploration of sepsis and contributed toward early diagnosis of the disease. Early, and effective antimicrobial treatment is related with endurance from sepsis and increases the survival rate from the disease.