Antibiotic Era Research Articles

Clinical course of preterm prelabor rupture of membranes in the era of prophylactic antibiotics

BackgroundPreterm prelabor rupture of membrane (PPROM) causes maternal and neonatal complications. Prophylactic antiobiotics were used in the management of PPROM. The objectives of this retrospective study were to compare clinical course and outcome of PPROM managed expectantly with prophylactic antibiotics and antenatal corticosteroids with those without prophylactic antibiotics and antenatal corticosteroids.ResultsA total of 170 cases of singleton pregnant women with gestational age between 28–34 weeks suffering from PROM during January 1998 to December 2009 were included; 119 cases received prophylactic antibiotics and antenatal corticosteroids while 51 cases did not received prophylactic antibiotics and antenatal corticosteroids. Median latency period in the study group was significantly longer than in the control group (89.8 vs. 24.3 hours, P < 0.001). The percentage of patients who did not deliver within 48 hours and within 7 days in the study group were also significantly higher than in control group (64.7 vs. 31.4%, P < 0.001 and 29.4 vs. 7.8%, P = 0.002, respectively). Maternal infectious morbidity was comparable between groups (17.6% vs. 13.7%, P = 0.52). Neonatal infectious morbidity was significantly lesser in study group than control group (21% vs. 35.3%, p = 0.04).ConclusionsLatency period of PPROM after using prophylactic antibiotics and antenatal corticosteroids increased while neonatal infectious morbidity was low. But maternal infectious morbidity was not increased. This retrospective study confirms the benefit of prophylactic antibiotics and antenatal corticosteroids in management of PPROM.

Targeting antibiotic resistance mechanisms in Mycobacterium tuberculosis: recharging the old magic bullets

Tuberculosis (TB) is an ancient disease. This ‘White Plague’ came and went throughout the history of mankind as unavoidable visits from Death until the recent era of antibiotics, starting some 80 years ago. The discovery of these ‘magic bullets’ brought a sudden great vic -tory to our battle against the TB etiologi -cal agent,

Temporal Myositis with Middle Fossa Epidural Abscess as the Complications of Acute Otitis Media

Acute otitis media is an inflammatory process involving the mucoperiosteum of the middle ear cleft. The clinical spectrum can be extended from a self-limiting benign condition to a complicated disease with intracranial involvement. Intracranial and extracranial complications of acute otitis media is still occur in the modern antibiotic era and has potentially serious consequences with high mortality rate. We report a case of acute otitis media with temporal myositis and middle fossa epidural abscess which is rarely seen as the complications from the disease. DOI: http://dx.doi.org/10.3329/bjms.v11i2.8472 Bangladesh Journal of Medical Science Vol. 11 No. 02 April 2012: 126-128

A massively spectacular view of the chemical lives of microbes.

Knowledge that microbes lead fascinating chemical lives is as old as microbiology itself. Observations in the late 19th century by Burdon-Sanderson (1) that were elaborated on by Pasteur and Joubert (2) gave rise to the idea that compounds secreted by some microbes could have remarkable effects on the lives of others. The accretion of such knowledge continued steadily through the early years of the 20th century until the quantum leap emanating from Fleming’s seminal discovery of penicillin (3). Chain and Florey’s subsequent development of penicillin as a therapeutic agent ushered in not only the golden era of antibiotics but an entire pharmaceutical industry based largely on small-molecule natural products. Since those days, the chemical lives of microbes have been studied largely through labor-intensive and time-consuming approaches that addressed one molecule at a time. Although this time-honored approach has yielded much new knowledge, the rate of discovery slowed down dramatically in recent decades. Perhaps all there was to discover about small-molecule natural products had been discovered. The advent of genomics put a halt to that idea; genomes revealed a great potential diversity of secreted microbial products waiting to be found (4). However, progress in realizing that potential has been slow (5). In PNAS, Watrous et al. offer a brand new way of viewing secreted microbial products that holds great promise in providing the next quantum leap in understanding the fascinating world of microbial chemical ecology (6).

Rethinking antibiotic research and development: World War II and the penicillin collaborative.

Policy leaders and public health experts may be overlooking effective ways to stimulate innovative antibiotic research and development. I analyzed archival resources concerning the US government's efforts to produce penicillin during World War II, which demonstrate how much science policy can differ from present approaches. By contrast to current attempts to invigorate commercial participation in antibiotic development, the effort to develop the first commercially produced antibiotic did not rely on economic enticements or the further privatization of scientific resources. Rather, this extremely successful scientific and, ultimately, commercial endeavor was rooted in government stewardship, intraindustry cooperation, and the open exchange of scientific information. For policymakers facing the problem of stimulating antibiotic research and development, the origins of the antibiotic era offer a template for effective policy solutions that concentrate primarily on scientific rather than commercial goals.

Multidrug Resistant Bacteria: The Fatal Menace in Healthcare

The “antibiotic era” saw the discovery of a lot of wonder drugs which killed pathogenic bacteria without significantly harming the host. Never before had nature and sickness seemed so much within the control of mankind. The hopes soon died down with the reports of antibiotic resistant bacteria. The extensive overuse and misuse of antibiotics by human beings coupled with the alarming rate of spread of resistance genes to other bacteria by horizontal and lateral gene transfer has given the problem a larger dimension in that now we have superbugs resistant to a variety of antibiotics. People need to be informed of the dangers of antibiotics and educated on the forms of illnesses that antibiotics cannot treat.

Bactericidal activity against meticillin-resistant Staphylococcus aureus of a novel eukaryotic therapeutic recombinant antimicrobial peptide

Antimicrobial peptides (AMPs) are one of several potential antibacterial agents in the current era of antibiotics facing severe challenges. In this study, the bactericidal activity and stability of two eukaryotic AMPs were determined. Both AMPs showed specific antibacterial activity in a HEK293T cell model infected with meticillin-resistant Staphylococcus aureus. The recombinant eukaryotic AMP pVAX1/hBD3-CBD showed better bactericidal activity and stability than the eukaryotic AMP pVAX1/hBD3. These results illustrate that this peptide, designed and used with eukaryotic expression and recombinant methods, should be studied and applied in further AMP research and trials.

A Lemierre syndrome variant caused by Klebsiella pneumoniae

Lemierre syndrome is an extremely rare disease characterized by oropharyngeal infection, septicemia, internal jugular vein thrombosis, and skip lesions. The most common causative pathogen is Fusobacterium necrophorum. We reported a 45-year-old woman who presented with left neck painful swelling and septicemia. Magnetic resonance imaging of the head and neck demonstrated venous thrombosis extending from the left internal jugular vein to the sigmoid sinus. During admission we discovered that the patient had uncontrolled diabetes mellitus. We also found a metastatic lesion through chest radiography. Klebsiella pneumoniae was cultivated from both blood samples and pus from deep neck spaces. Surgical drainage, early and adequate antibiotic treatment, anticoagulation, and strict control of blood glucose led to the patient's complete recovery. Because Lemierre syndrome is a forgotten disease in the era of antibiotics, awareness of the signs and symptoms of this disease is important because of its associated high mortality rate. This case illustrated that the presence of K pneumoniae can lead to Lemierre syndrome.

Treatment costs of Mycobacterium ulcerans in the antibiotic era

Mycobacterium ulcerans infection results in significant disfiguring morbidity, and treatment is expensive. To estimate the cost of treatment in the antibiotic era, a retrospective study of 71 patients diagnosed and treated for M. ulcerans in the Bellarine Peninsula (Victoria, Australia) between 1998 and 2006 was performed. Patients were categorised into minor single episode infection, major single episode infection and recurrent disease. Data were collected on each treatment cost component. To determine the change from costs in the pre-antibiotic era, mean direct costs were compared with those from a study in a nearby region between 1991 and 1998. All costs were in Australian dollars in 2006-2007 prices. The mean overall cost was $6181 per episode, with the highest cost components being hospitalisation (mean $3977; 63%) and surgeon fees ($949; 12%). Treatment costs per episode increased significantly from minor infection ($2235) to major infection ($6338) to recurrent disease ($13 372). Compared with the pre-antibiotic era, costs have significantly decreased, with a 52% reduction in overall cost per episode, driven mainly by a reduction in hospitalisation costs. Therefore, earlier diagnosis and treatment of M. ulcerans, including the use of outpatient-based oral antibiotic regimens, has the potential to reduce the cost of treatment.

Genomic and SNP Analyses Demonstrate a Distant Separation of the Hospital and Community-Associated Clades of Enterococcus faecium

Recent studies have pointed to the existence of two subpopulations of Enterococcus faecium, one containing primarily commensal/community-associated (CA) strains and one that contains most clinical or hospital-associated (HA) strains, including those classified by multi-locus sequence typing (MLST) as belonging to the CC17 group. The HA subpopulation more frequently has IS16, pathogenicity island(s), and plasmids or genes associated with antibiotic resistance, colonization, and/or virulence. Supporting the two clades concept, we previously found a 3–10% difference between four genes from HA-clade strains vs. CA-clade strains, including 5% difference between pbp5-R of ampicillin-resistant, HA strains and pbp5-S of ampicillin-sensitive, CA strains. To further investigate the core genome of these subpopulations, we studied 100 genes from 21 E. faecium genome sequences; our analyses of concatenated sequences, SNPs, and individual genes all identified two distinct groups. With the concatenated sequence, HA-clade strains differed by 0–1% from one another while CA clade strains differed from each other by 0–1.1%, with 3.5–4.2% difference between the two clades. While many strains had a few genes that grouped in one clade with most of their genes in the other clade, one strain had 28% of its genes in the CA clade and 72% in the HA clade, consistent with the predicted role of recombination in the evolution of E. faecium. Using estimates for Escherichia coli, molecular clock calculations using sSNP analysis indicate that these two clades may have diverged ≥1 million years ago or, using the higher mutation rate for Bacillus anthracis, ∼300,000 years ago. These data confirm the existence of two clades of E. faecium and show that the differences between the HA and CA clades occur at the core genomic level and long preceded the modern antibiotic era.

"Golden Era of Antibiotics" - Coming to an end !!!

"Golden Era of Antibiotics" - Coming to an end !!!

Clostridium difficile Linked to Disrupted Gut Microbiota

That excerpt comes from an editorial that accompanied a 1953 report describing postoperative, antibiotic-associated enterocolitis, which emerged early during the antibiotic era. Yet, those 60-year-old comments are apropos to our current challenge from the toxigenic anaerobe Clostridium difficile, which also causes antibiotic-associated diarrhea. That challenge is leading us to better understand the importance of the gastrointestinal microbiota to human health and disease.

Antimycobacterials from natural sources: ancient times, antibiotic era and novel scaffolds.

Mycobacteria are a group of aerobic, non-motile, acid fast bacteria that have a characteristic cell wall composed of a mycolyl-arabinogalactan-peptidoglycan complex. They display different phenotypic attributes in their growth, color and biochemistry. Tuberculosis (TB) is defined as the infection with Mycobacterium tuberculosis complex and was declared a global health emergency principally because of the appearance of multidrug-resistant strains and the associated risk of infection in immune-compromised population. There is an urgent clinical need for novel, potent and safe anti-TB drugs. Natural products have been used since antiquity for treating diverse complaints and novel pharmacophores are discovered every year. Two of the most potent used antimycobacterials, the rifamycins and streptomycin, were first detected in Streptomyces bacteria. Plants are also the source of an exquisite variety of antimicrobials that can lead to useful therapeutics in the future. In this review, natural preparations used since antiquity for treating tuberculosis are described, together with a rapid view of the 20th century antibiotic development against TB. Finally a summary of the most potent recent natural antimycobacterials is displayed.

A Case of Acute Purulent Pericarditis Complicated by Severe Left Ventricular Systolic Dysfunction and Cardiac Tamponade

An 85-year-old male visited our hospital because of dyspnea. Chest radiography showed marked cardiomegaly and pneumonic infiltration. Transthoracic echocardiography showed moderate pericardial effusion, which resulted in effusive constrictive pericarditis and severe left ventricular systolic dysfunction. During the hospital course, the patient developed cardiogenic shock and was treated with an inotropic agent and intra-aortic balloon pump. The patient’s vital signs were stabilized after pericardiocentesis and drainage. A yellowish purulent pericardial effusion was drained and Streptococcus pneumoniae was isolated. Bacterial purulent pericarditis was not uncommon before the antibiotics era, but it is extremely rare nowadays. Here, we report a case of purulent bacterial pericarditis presenting with severe left ventricular systolic dysfunction and cardiac tamponade. (Korean J Med 2012;82:221-226)

Gonorrhoea presenting as red eye: Rare case

Gonorrhoea is a sexually transmitted disease marked by urethritis in males; it may also be transmitted to other organs through contact with infected genital secretions or urine, although rare in this era of modern antibiotics and rapid diagnostic tools. It could pose a difficult situation when we encounter emerging resistant strains. This paper reports a male who presented initially with unilateral gonococcal conjunctivitis contracted via autoinoculation and was found out to be suffering from gonococcal urethritis.

Perforation of nasal septum secondary to lupus vulgaris: A rare entity

Lupus vulgris (LV) is a chronic, progressive, and destructive form of cutaneous tuberculosis. This occurs in moderate- to high-immunity patients against Mycobacterium tuberculosis, which a shows strongly positive Mantoux test. We present a case of LV located on the nose of a 14-year-old girl that led to nasal septal perforation. In this modern era of antibiotics, septal perforation secondary to LV is very rare.

Antibiotic Prophylaxis in Gynecology, Oncology and Surgical Procedures a Brief up-to Date

Infectious complications in Gynecology Oncology surgical procedures are related with significant morbidity and potential mortality. Several infectious complications may be confronted in gynecology oncology practice and these encompass intra abdominal infections, infections of the vaginal cuff, endometritis, wound infections, subcutaneous cellulitis, perineal infections, port site infections in laparoscopic and endoscopic interventions, cystitis etc. The hospitalization of the patient is prolonged and the health care costs are increased hence causing alertness to health trust services. Since the initiation of the antibiotic era administration, an enormous amount of studies and trials have been conducted leading the clinician to uncertainties which regimen to apply, what dose to give, when to give and for how long?

Late-onset neonatal infections: incidences and pathogens in the era of antenatal antibiotics

Widespread use of intrapartum antimicrobial prophylaxis has significantly reduced the incidence of early-onset neonatal infection (EONI); however, little is known about the effects of increased maternal exposure to antibiotics on late-onset neonatal infection (LONI). This study aims to evaluate LONI epidemiology in our region after the application of French recommendations and to determine whether LONI-causing organisms and their antibiotic susceptibility are influenced by peripartum antibiotic exposure. We performed a prospective epidemiologic study of 139 confirmed and possible cases of bacterial LONI in patients treated with antibiotics for at least 5 days of the 22,458 infants born in our region in the year 2007. The overall incidence of LONI caused by all pathogens, Group B streptococcus (GBS) and Escherichia coli (E. coli) were 6.19, 0.36 and 2.72, respectively, per 1,000 live births. Our findings revealed three major types of LONI: E. coli-induced urinary tract infection (UTI) among term infants, coagulase negative Staphylococcus septicemia affecting preterm infants, and GBS infections with severe clinical presentation. Univariable analysis revealed that maternal antibiotic exposure was significantly associated with the risk of amoxicillin-resistant E. coli infection (p = 0.01). Postnatal antibiotic exposure was associated with an increased risk of E. coli LONI (p = 0.048). This link persisted upon multivariable analysis; however, no additional risk factors were identified for LONI caused by antibiotic-resistant E. coli. Our findings confirm that despite the benefits of antenatal antibiotics, this treatment can increase the risk of antibiotic-resistant cases of LONI. National and international surveillance of LONI epidemiology is essential to assess benefits and potential negative consequences of perinatal antibiotic exposure.

Syphilitic aneurysm of the ascending aorta

Syphilitic aortic aneurysm is a rare occurrence in the antibiotic era, making the diagnose assumption even more infrequent. Nonetheless, this pathology can appear and should be suspected in patients with aortic aneurysm. We report a case of a 57-year old patient who presents with neurosyphilis and, in the following study, a large ascending aorta aneurysm is identified. The authors discuss the diagnostic challenge, the epidemiologic concerns, surgical indication and treatment and subsequent follow-up.

A Study of the Bacteriological Profile of Chronic Suppurative Otitis Media in Agartala

Chronic suppurative otitis media (CSOM) is one of the most commonly encountered diseases in otolaryngology practice. Even in this era of powerful antibiotics, CSOM still consumes considerable medical expenditure, especially in the poorer sections of the society. The present prospective study was conducted at the IGM Hospital, Agartala, in North East India towards clinico-microbiologic evaluation of chronic suppurative otitis media. The focus was mainly on aerobic bacteria, involved in active CSOM in adults as well as children. An attempt was made, despite resource and man power constraints, to have a glimpse of the current antibiotic sensitivity pattern, with special reference to ciprofloxacin. However, the main aim of this study is to see the types of aerobic bacteria involved in CSOM, in our region. Aural swabs were collected from 100 ears, from 97 patients complaining of ear discharge, continuous or intermittent, with a non- intact tympanic membrane for at least 12weeks. Swabs were sent to the hospitals microbiology laboratory for culture and sensitivity tests. Bacteria could be isolated in 53 cases and 47 swabs were culture negative. The commonest bacteria isolated was pseudomonas (20) followed by Staphylococcus aureus (11), E. coli (11), proteus (9) and klebseilla (2). Three patients had bilateral ear discharge of which one had proteus in both ear swabs, one grew proteus in one ear and no growth in the other, and one patient showed no aerobic bacteria in any of his ear swabs. Among the culture positive cases (n=53) gram negative bacteria were isolated in 79.24% (n=42) and S. aureus in 11(20.75%) cases. Among 97 patients number of male and female patients was 50 and 47, respectively. Pseudomonas, E. coli, Bacilli proteus and S. aureus were the predominant bacteria involved in CSOM. Out of the 53 positive isolates ciprofloxacin could be tested against 35 i.e., 66%. Ciprofloxacin was sensitive in 26 isolates, intermediately sensitive in 4 and resistant in only five isolates. It is concluded that, gram negative bacteria especially pseudomonas is the commonest bacteria involved in CSOM in this part of north east India. Ciprofloxacin is an important tool in the management of active CSOM as it is cheap, less ototoxic and widely available as topical preparations.