Fluoroquinolone Group Research Articles

Impact of discontinuing routine fluoroquinolone prophylaxis in neutropenic allogeneic haematopoietic stem cell transplant recipients: an observational study.

Uncertainty exists as to the role of fluoroquinolone (FQ) prophylaxis for patients undergoing allogeneic haematopoietic stem cell transplantation (HSCT) in the era of rising antibiotic resistance. We aimed to evaluate rates of bloodstream infections (BSI), resistance patterns and outcomes of patients after discontinuing routine FQ prophylaxis administration. All adult recipients of first HSCT from 2017 to 2020 were retrospectively included and classified according to time of HSCT as FQ group (HSCT January 2017-December 2018) or no FQ group (January 2019-December 2020). The primary outcome was Gram-negative (GN) BSI from day -7 to 30 days post-HSCT. The independent association between the study period and BSI was assessed using survival analysis, and adjusting for confounders. We included 254 patients, 130 (51%) and 124 (49%) in the FQ and no FQ groups, respectively. Compared to the FQ group, no FQ had significantly more GN BSI (21% versus 33%, P = 0.027) and the median time to first GN BSI was significantly shorter [4 (IQR 1-8) days versus 6 (1-10) days, P = 0.009]. Following adjustment, FQ prophylaxis remained associated with lower hazard for GN BSI (hazard ratio 0.57, 95% CI 0.34-0.93). Eighty-two GN BSI episodes had FQ susceptibility testing. More GN BSI episodes were FQ resistant in the FQ group (68.9% versus 41.6%, P = 0.021). No significant difference was found for 30-day mortality, time to first febrile neutropenia and time to first broad-spectrum antibiotics between the groups (P was not significant). FQ prophylaxis is associated with fewer GN BSI in the early post-HSCT period even in high FQ resistance settings, with FQ resistance rates reaching >60% following prophylaxis.

Establishment of an Antimicrobial Stewardship Program to Spare the Use of Oral Fluoroquinolones for Acute Uncomplicated Cystitis in Outpatients.

The increase in fluoroquinolone (FQ)-resistant Escherichia coli (EC) is a serious global problem. In addition, much of acute uncomplicated cystitis (AUC) cases are caused by EC. FQs have been selected for the treatment of cystitis in outpatients, and there is concern about treatment failure. It is therefore necessary to select appropriate antimicrobials to spare FQs. However, there are few reported effective antimicrobial stewardship programs (ASPs) for outpatients. We aimed to establish the effective ASP for outpatients diagnosed with AUC caused by EC, to spare the use of FQs, and to explore optimal oral antimicrobials for AUC. The study subjects were outpatients treated for AUC caused by extended-spectrum β-lactamase-non-producing EC (non-ESBL-EC). Based on the antibiogram results, we recommended cefaclor (CCL) as the initial treatment for AUC, and educated clinical pharmacists who also worked together to advocate for CCL or cephalexin (CEX) prescriptions. FQ usages decreased, and cephalosporin (Ceph) prescriptions increased in all medical departments. The Ceph group (n = 114; CCL = 60, CEX = 54) in the non-FQ group had fewer treatment failures than the FQ group (n = 86) (12.3% vs. 31.4%). Cephs, including CCL and CEX, were effective treatments for AUC caused by non-ESBL-EC. Antimicrobial selection based on antibiogram results and the practice of an ASP in collaboration with clinical pharmacists were useful for optimizing antimicrobial therapy in outpatients.

Effect of FluoRoquinolones on Aortic Growth, aortic stIffness and wave refLEctionS (FRAGILES study).

Background: The widespread use of fluoroquinolones has been associated with the formation, dissection, and rupture of aortic aneurysms. Arterial biomarkers are established predictors of cardiovascular events. The present study was designed to investigate the effect of quinolones on arterial stiffness and aortic size for the first time. Methods: We studied 28 subjects receiving short-term (<15 days) antibiotic therapy involving quinolones and 27 age- and sex-matched subjects receiving an alternative to quinolone antibiotics. The follow-up period was approximately 2 months. The study's primary endpoint was the carotid-femoral pulse wave velocity (cfPWV) difference between the two groups 2 months after therapy initiation. Secondary endpoints were the augmentation index corrected for heart rate (AIx@75) and sonographically assessed aortic diameters 2 months after the initial treatment. Results: Subjects had similar values of arterial biomarkers, blood pressure measurements, and aortic diameters at baseline. At follow-up, no significant change was observed between the two groups regarding the hemodynamic parameters and arterial biomarkers (p > 0.05 for all), i.e., cfPWV (7.9 ± 2.6 m/s for the control group vs. 8.1 ± 2.4 m/s for the fluoroquinolones group; p = 0.79), AIx@75 (22.6 ± 9.0% for the control group vs. 26.6 ± 8.1% for the fluoroquinolones group; p = 0.09), and aortic diameters. Conclusions: To our knowledge, FRAGILES is the first study to provide insights into the possible effects of fluoroquinolones on arterial biomarkers, showing that, at least in the short term, treatment with fluoroquinolones does not affect aortic function and diameter.

Fluoroquinolones and the risk for incidental seizures: a comparative retrospective study.

Over the years, reports have associated fluoroquinolones (FQ) with seizures. The incidence and whether FQ compared to non-epileptogenic antibiotic are associated with increased risk of seizures has yet to be examined. A retrospective observational study of hospitalized patients treated with FQ (ofloxacin, ciprofloxacin, levofloxacin, moxifloxacin) or macrolides (MA: azithromycin or roxithromycin) between January 2009 and January 2021 in a large tertiary academic medical centre. The outcome was the occurrence of a seizure during treatment. The Naranjo scale was used to assess causality between FQ treatment and seizures. Comparative analysis was conducted using propensity score matching to correct for possible bias due to non-random selection, followed by inverse probability weighting (IPW) to estimate the difference in seizure risk between FQ and MA. Overall, 52 722 patients were treated with FQ during a total of 178 982 days. Mean age was 65 (±19) years and 47% were females. Thirty-three patients (0.06%) experienced a seizure, yielding an incidence of 1:5422 treatment days. Causality was deemed probable and possible among 9/33 and 24/33, respectively. The MA group composed of 8522 patients treated during 17 954 treatment days. Mean age was 65 (±21) years, 49% were females. Six (0.07%) patients experienced each a single seizure. IPW estimated OR for seizures among the FQ versus MA group was 1.44 (95%CI 0.59-3.5, P = 0.42). The incidence of FQ associated seizures among hospitalized patients is low and the risk did not significantly exceed that under macrolides. Our results provide evidence for clinicians and decision-makers when balancing fluoroquinolones risks and benefits.

Focus on lomefloxacin: effectiveness and safety

The results of clinical studies on the use of lomefloxacin for various diseases are presented.The purpose of this study was to analyze the effectiveness and safety of lomefloxacin based on the results of clinical studies published in the scientific literature. Extensive clinical experience with the use of fluoroquinolones in millions of patients indicates their high effectiveness in treating infections of various origins and localities. Lomefloxacin, a difluorinate representative of the fluoroquinolone group, is a bactericidal agent with a wide spectrum of antimicrobial activity against gram-negative and gram-positive microorganisms. The most important property of lomefloxacin is its high bioavailability — more than 98 % when administered orally.The effectiveness of oral lomefloxacin against respiratory tract, urinary tract, obstetric, and gynecological infections, joint infections, skin infections, and mouth, ears, nose, throat, and eyes infections has been studied. Moreover, lomefloxacin has been used as an otic solution to treat otitis media and in the form of an ophthalmic solution to treat eye infections.In studies conducted in Western countries, 72 to 94 % of patients with respiratory tract infections treated with lomefloxacin (400 mg once daily) experienced improvement in clinical symptoms: the causative bacteria were eliminated in 80 to 90 % of cases. Lomefloxacin was well tolerated, and most adverse effects were mild to moderate and reversible. The most common adverse events were gastrointestinal symptoms (nausea, diarrhea, pain/discomfort). In addition, headache, dizziness, transient insomnia, skin hypersensitivity reactions, including photosensitivity, were reported in fewer patients.Based on extensive clinical experience with the use of lomefloxacin, it can be argued that the drug has established itself as a drug with proven effectiveness and a known safety profile.

Pregnancy outcomes after first-trimester exposure to fluoroquinolones: Findings based on an integrated database from two Japanese institutions.

Given the paucity of safety data on fluoroquinolone antibiotics in pregnancy, a prospective observational cohort study was conducted in pregnant women who sought help and advice on drug use at two teratology information institutes in Japan. The primary endpoint of the study was the incidence of major congenital anomalies. The study population included pregnant women exposed to (i) fluoroquinolones (fluoroquinolone group), (ii) β-lactams (infectious control group), or (iii) other agents considered to be nonteratogenic in humans (nonteratogenic control group) during the first trimester. The frequency of major congenital anomalies was compared across groups using a logistic regression model that adjusted for maternal age, smoking status, drinking status, facility consulted, and time of consultation. The fluoroquinolone group consisted of 411 women who had 383 children born alive. The infectious control and nonteratogenic control groups consisted of 1416 and 1482 women who had 1322 and 1401 children born alive, respectively. The incidence of major congenital anomalies was 1.5%, 2.0%, and 1.6% in the fluoroquinolone group, infectious control, and nonteratogenic control groups, respectively. Logistic regression showed that fluoroquinolone exposure is not a significant risk factor for major congenital anomalies. In conclusion, first-trimester exposure to fluoroquinolone antibiotics was not associated with increased maternal or fetal risks.

Electrochemical Hydrogen Peroxide Generation and Removal of Moxifloxacin by Electro-Fenton Process

In this study, the removal of moxifloxacin, an antibiotic of the fluoroquinolone group, from aqueous solutions was investigated using the electro-Fenton process. As the efficiency of the electro-Fenton process is highly dependent on the amount of H2O2 produced during process, the formation of H2O2 under acidic conditions was also investigated. In this context, the effects of applied current, cathode type and O2 flow rate on H2O2 production were investigated using boron-doped diamond anode. The highest H2O2 production was achieved using the boron-doped diamond anode and the graphite felt cathode. In addition, the optimum conditions for the applied current and oxygen flow rate for H2O2 production were determined to be 0.25 A and 0.1 L min−1, respectively. The effects of applied current and Fe2+ concentration in the electro-Fenton process on the removal of moxifloxacin were investigated. It was found that the moxifloxacin removal rate increased with increasing applied current. The highest H2O2 accumulation was observed at 0.25 A applied current, and moxifloxacin removal also reached 93.6% after 60 min. The moxifloxacin removal rate reached the highest value at Fe2+ concentration of 0.01 mM. This study provides promising results for the efficient treatment of moxifloxacin-containing wastewater by the electro-Fenton process without the addition of H2O2 using boron-doped diamond anode anode and graphite felt cathode.

Infection risk reduction with povidone-iodine rectal disinfection prior to transrectal prostate biopsy: an updated systematic review and meta-analysis

BackgroundTo prevent infectious complications after transrectal ultrasound-guided prostate biopsy (TRUS-PB), some studies have investigated the efficacy of rectal disinfection using povidone-iodine (PI) and antibiotic prophylaxis (AP).ObjectiveTo summarize available data and compare the efficacy of rectal disinfection using PI with non-PI methods prior to TRUS-PB.Evidence acquisitionThree databases were queried through November 2023 for randomized controlled trials (RCTs) analyzing patients who underwent TRUS-PB. We compared the effectiveness of rectal disinfection between PI groups and non-PI groups with or without AP. The primary outcomes of interest were the rates of overall infectious complications, fever, and sepsis. Subgroups analyses were conducted to assess the differential outcomes in patients using fluoroquinolone groups compared to those using other antibiotics groups.Evidence synthesisWe included ten RCTs in the meta-analyses. The overall rates of infectious complications were significantly lower when rectal disinfection with PI was performed (RR 0.56, 95% CI 0.42–0.74, p < 0.001). Compared to AP monotherapy, the combination of AP and PI was associated with significantly lower risk of infectious complications (RR 0.54, 95% CI 0.40–0.73, p < 0.001) and fever (RR 0.47, 95% CI 0.30–0.75, p = 0.001), but not with sepsis (RR 0.49, 95% CI 0.23–1.04, p = 0.06). The use of fluoroquinolone antibiotics was associated with a lower risk of infectious complications and fever compared to non-FQ antibiotics.ConclusionRectal disinfection with PI significantly reduces the rates of infectious complications and fever in patients undergoing TRUS-PB. However, this approach does not show a significant impact on reducing the rate of sepsis following the procedure.

A Novel Approach for Single-Step Analyte Fractionation of Raw Milk Prior to Antibiotic Residue Trace Analysis as an Alternative to QuEchERS-Based Extraction.

Antibiotic residues in milk are a well-known hazard in the dairy food chain. Detection methods for these residues, such as nonspecific microbiological inhibitor tests or group-specific receptor tests, are relatively inexpensive, easy to use, and widely applied to ensure food safety. In contrast, specific detection by liquid chromatography-tandem mass spectrometry (LC-MS/MS)-although a critical, complimentary method to confirm the results of nonspecific testing-is relatively costly, time-consuming, and laborious. Furthermore, sample processing before LC-MS/MS analysis requires unique preparation procedures for different groups of antibiotic compounds. To simplify and speed up specific antibiotic residue detection, a low-cost, passive, and single-step method to fractionate analytes in raw milk was developed. Untreated raw milk was fractionated into its water and fat/protein phases using a Fractionation of Milk for Trace Analysis of Contaminants and Residues for Antibiotics (FraMiTrACR® AB) fractionation unit. The water fraction was then analyzed by LC-MS/MS. The analyte fractionation method was evaluated against a Quick Easy Cheap Effective Rugged and Safe (QuEChERS)-based method for sample preparation. Our method allows qualitative and quantitative detection of substances from the penicillin, cephalosporin, macrolide, lincosamide, sulfonamide, tetracycline, and fluoroquinolone groups of antibiotics. Detection limits are below the legally prescribed maximum residue levels, allowing reliable, specific, and rapid validation of a positive result in nonspecific microbiological inhibitor tests. Analyte fractionation by FraMiTrACR AB is a faster alternative to QuEChERS-based sample preparation for the detection of antibiotic substances in milk. This method describes a low-cost, environmentally friendly, passive, and single-step milk analyte fractionation. As an alternative to QuEChERS-based preparation, this fractionation method simplifies and speeds up the process for specific antibiotic residue detection.

The addition of doxycycline to fluoroquinolones for bacterial prophylaxis in autologous stem cell transplantation for multiple myeloma.

Bacterial prophylaxis with a fluoroquinolone (FQ) during autologous stem cell transplant (ASCT) is common, although not standardized among transplant centers. The addition of doxycycline (doxy) to FQ prophylaxis was previously linked to reduced neutropenic fever and bacteremia in multiple myeloma (MM) patients undergoing ASCT although several confounders were present. We compared the incidence of neutropenic fever and bacteremia between MM patients variably receiving prophylaxis with FQ alone and FQ-doxy during ASCT. Systematic retrospective chart review of MM patients who underwent ASCT between January 2016 and December 2021. The primary objective was to determine the effect of bacterial prophylaxis on neutropenic fever and bacteremia within 30 days of ASCT. Multivariable logistic regression for neutropenic fever and univariate logistic regression for bacteremia accounted for differences in subject characteristics between groups. Among 341 subjects, 121 received FQ and 220 received FQ-doxy for prophylaxis. Neutropenic fever developed in 67 (55.4%) and 87 (39.5%) subjects in the FQ and FQ-doxy groups, respectively (p=.005). Bacteremia was infrequent, with 5 (4.1%) and 5 (2.3%) cases developing in the FQ and FQ-doxy groups, respectively (p=.337). Among Gram-negative bacteremia events, 7/7 Escherichia coli strains were FQ-resistant, and 5/7 were ceftriaxone-resistant. The FQ-doxy prophylaxis group had fewer cases of neutropenic fever than the FQ group, however, there was no significant difference in bacteremia. High rates of antibiotic resistance were observed. An updated randomized controlled trial investigating appropriate prophylaxis for ASCT in the context of current oncology standards and changing antimicrobial resistance rates is warranted.

Antibiotic subclasses differentially perturb the gut microbiota in kidney transplant recipients.

The impact of antibiotics on the gut microbiota in kidney transplant recipients is not well characterized. In this study, we determine the impact of different subclasses of antibiotics on the gut microbiota in a cohort of 168 kidney transplant recipients. Gut microbiome profiling was performed on 510 fecal specimens using 16S rRNA gene sequencing of the V4-V5 hypervariable region. We classified fecal specimens by antibiotic exposure into 5 categories: Beta-lactam, Fluoroquinolone (FQ), Beta-lactam & FQ Group, Other Antibiotics, and No Antibiotic (No Abx). Mixed-effects regression models were utilized to identify changes in microbial diversity and in the centered log-ratio (CLR) transformed abundance of genera while adjusting for important covariates. Antibiotic administration was associated with a significant decrease in the Shannon alpha diversity index, a decreased abundance of 11 taxa including Eubacterium and Ruminococcus, and an increased abundance of 16 taxa including Enterococcus and Staphylococcus. Exposure to Beta-lactam antibiotics was associated with an increased abundance of 10 taxa including Enterococcus and a decreased abundance of 5 taxa including Eubacterium while exposure to FQ antibiotics was associated with an increased abundance of 3 taxa and a decreased abundance of 4 taxa including Ruminococcus. Beta-lactam antibiotics and FQ antibiotics have a profound impact on the gut microbiota in kidney transplant recipients. Given the link of the gut microbiota to infectious complications, antibiotic associated changes in the microbiota may lead to an increased risk for further infections.

ГЕНЕТИЧЕСКИЕ МЕХАНИЗМЫ УСТОЙЧИВОСТИ БАКТЕРИЙ К ЦИПРОФЛОКСАЦИНУ (ЛИТЕРАТУРНЫЙ ОБЗОР)

Ciprofloxacin, as a member of the fluoroquinolone group, is widely used to treat diseases caused by both grampositive and gram-negative bacteria. However, in recent years there has been an increase in resistance to this drug, which may be associated with the overuse of ciprofloxacin due to its broad spectrum of action. In this regard, in order to develop new and effective drugs against drug-resistant pathogens, there is a need to study and analyze such resistance mechanisms to ciprofloxacin as modification of target molecules, changes in drug penetration and plasmid-mediated quinolone resistance. The article presents up-to-date information on genetic mechanisms of bacterial resistance to antimicrobial drugs belonging to the fluoroquinolone group.

Drift of antimicrobial resistance of bacterial pathogens of the Moraxella group

The multiple resistance of bacteria to antibiotics leads to a decrease in the effectiveness of treatment methods for bacterial diseases, an increase in morbidity and mortality and, in some cases, to prolonged bacterial transmission. In this regard, the search for new antimicrobial agents and the need to improve veterinary approaches in therapeutic and preventive work with bacterioses is currently a priority task. The study is devoted to the assessment of antibiotic resistance in zoopathogenic moraxella pathogens of infectious bovine keratoconjunctivitis. The article analyzes the drug resistance of topical epizootic strains of Moraxella bovis and M. bovoculi. It was found that since the 1982 study and ending with the own results obtained at the present time, there has been a noticeable increase in the resistance of M. bovis and M. bovoculi to antibiotics. However, a still high level of sensitivity in moraxella is detected for antibiotics of the fluoroquinolone and cephalosporin groups, as well as for ampicillin and benzylpenicillin, the studied bacteria were the most sensitive despite the fact that resistance was recorded for oxacillin and methicillin from the same group.

Ретроспективный анализ чувствительности к лекарственным средствам зоопатогенных моракселл – возбудителей инфекционного кератоконъюнктивита крупного рогатого скота

The growth of antibiotic resistance in circulating bacterial pathogens determines the need for improvement in veterinary approaches to the therapeutic and preventive management of bacterial infections. This study is dedicated to investigating the drift of antibiotic resistance in zoopathogenic Moraxella, the causative agents of infectious keratoconjunctivitis in cattle. The article presents a retrospective analysis of primary scientific data from research groups of foreign authors, compared with our own results on the drug resistance of current epizootic strains of Moraxella bovis and M. bovoculi. The analysis showed that since the 1982 study and ending with the own results obtained at the present time, there has been an increase in the resistance of M. bovis and M. bovoculi to antibiotics. However, a still high level of sensitivity in moraxella is detected for antibiotics of the fluoroquinolone and cephalosporin groups, as well as for ampicillin and benzylpenicillin, the studied bacteria were the most sensitive, despite the fact that resistance was recorded for oxacillin and methicillin from the same group.

ОПРЕДЕЛЕНИЕ ЧУВСТВИТЕЛЬНОСТИ МИКРОБИОЛОГИЧЕСКОГО МЕТОДА ОБНАРУЖЕНИЯ АНТИБАКТЕРИАЛЬНЫХ ПРЕПАРАТОВ В РЫБЕ

The article presents experimental data on expanding the spectrum of detectable groups of antibiotics according to GOST R 55481-2013. The sensitivity for the fluoroquinolone group was 100 μg/kg. For the cephalosporin group, sensitivity ranged from 50 to 100 μg/kg, and for the aminoglycoside group, from 50 to 500 μg/kg. The sensitivity of lincosamides, nitrofurans and macrolides is 100 μg /kg. The method is insensitive to the amphenicol group (5000 μg/kg). The advantages of this method are that it is quite inexpensive, accessible and the duration of the analysis is only 6...7 hours.

Abstract 13788: Association Between Floroquinolones and Cardiovascular Outcomes: A Systematic Review and Meta-Analysis

Background: The administration of Fluoroquinolones (FQ) has raised concerns regarding potential adverse cardiovascular outcomes, including severe arrhythmias, myocardial infarction, and even mortality. Nevertheless, a comprehensive evaluation of these outcomes and their real impact on patients receiving these antibiotics is lacking. Objective: We aim to evaluate the association between fluoroquinolones and cardiovascular outcomes.Methods: We systematically searched all electronic databases from inception until 27th May 2023. Odds ratios (OR) with corresponding 95% confidence intervals (CI) were calculated, with a p-value &lt;0.05 considered statistically significant. Results: The final analysis included a total of 11 studies, encompassing a sample size of 6,579,936 individuals (FQ: 2,005,466 and control: 4,574,470). The pooled analysis shows that the FQ group was associated with significantly higher risk arrhythmia (OR: 1.87 (95% CI: 1.22, 2.87), P&lt;0.01, cardiovascular mortality (OR: 1.72 (95% CI: 1.38, 2.14), P&lt;0.0001), and myocardial infarction (OR: 1.33 (95% CI: 1.26, 1.39), P&lt;0.0001). Conclusion: Fluoroquinolones exhibit a significant cardiotoxic effect, contributing to the development of arrhythmias, myocardial infarction, and even mortality. Consequently, caution must be exercised when prescribing this class of antibiotics, with regular follow-up recommended to monitor potential cardiovascular complications.

Lack of association between fluoroquinolone and aortic aneurysm or dissection.

An increased risk of aortic aneurysm and aortic dissection (AA/AD) has been reported with fluoroquinolone (FQ) use. However, recent studies suggested confounding factors by indication. This study aimed to investigate the risk of AA/AD associated with FQ use. This nationwide population-based study included adults aged ≥20 years who received a prescription of oral FQ or third-generation cephalosporins (3GC) during outpatient visits from 2005 to 2016. Data source was the National Health Insurance Service reimbursement database. The primary outcome was hospitalization or in-hospital death with a primary diagnosis of AA/AD. A self-controlled case series (SCCS) and Cox proportional hazards model were used. Self-controlled case series compared the incidence of the primary outcome in the risk period vs. the control periods. A total of 954 308 patients (777 109 with FQ and 177 199 with 3GC use) were included. The incidence rate ratios for AA/AD between the risk period and the pre-risk period were higher in the 3GC group [11.000; 95% confidence interval (CI) 1.420-85.200] compared to the FQ group (2.000; 95% CI 0.970-4.124). The overall incidence of AA/AD among the patients who received FQ and 3GC was 5.40 and 8.47 per 100 000 person-years. There was no significant difference in the risk between the two groups (adjusted hazard ratio 0.752; 95% CI 0.515-1.100) in the inverse probability of treatment-weighted Cox proportional hazards model. Subgroup and sensitivity analysis showed consistent results. There was no significant difference in the risk of AA/AD in patients who were administered oral FQ compared to those administered 3GC. The study findings suggest that the use of FQ should not be deterred when clinically indicated.

Antibiotic ciprofloxacin removal from aqueous solutions by electrochemically activated persulfate process: Optimization, degradation pathways, and toxicology assessment

Ciprofloxacin (CIP) is a commonly used antibiotic in the fluoroquinolone group and is widely used in medical and veterinary medicine disciplines to treat bacterial infections. When CIP is discharged into the sewage system, it cannot be removed by a conventional wastewater treatment plant because of its recalcitrant characteristics. In this study, boron-doped diamond anode and persulfate were used to degrade CIP in an aquatic solution by creating an electrochemically activated persulfate (EAP) process. Iron was added to the system as a coactivator and the process was called EAP+Fe. The effects of independent variables, including pH, Fe2+, persulfate concentration, and electrolysis time on the system were optimized using the response surface methodology. The results showed that the EAP+Fe process removed 94% of CIP under the following optimum conditions: A pH of 3, persulfate/Fe2+ concentration of 0.4 mmol/L, initial CIP concentration 30 mg/L, and electrolysis time of 12.64 min. CIP removal efficiency was increased from 65.10% to 94.35% by adding Fe2+ as a transition metal. CIP degradation products, 7 pathways, and 78 intermediates of CIP were studied, and three of those intermediates (m/z 298, 498, and 505) were reported. The toxicological analysis based on toxicity estimation software results indicated that some degradation products of CIP were toxic to targeted animals, including fathead minnow, Daphnia magna, Tetrahymena pyriformis, and rats. The optimum operation costs were similar in EAP and EAP+Fe processes, approximately 0.54 €/m3.

Comparative Effectiveness of First-Line and Alternative Antibiotic Regimens in Hospitalized Patients With Nonsevere Community-Acquired Pneumonia: A Multicenter Retrospective Cohort Study

There are several antibiotic regimens to treat community-acquired pneumonia (CAP). In patients hospitalized to a non-ICU ward setting with CAP, is there a difference between first-line and alternative antibiotic regimens (β-lactam plus macrolide [BL+M], β-lactam [BL] alone, respiratory fluoroquinolone [FQ], or β-lactam plus doxycycline [BL+D]) in terms of in-hospital mortality? This retrospective cohort study included consecutive patients admitted with CAP at 19 Canadian hospitals from 2015 to 2021. Taking a target trial approach, patients were categorized into the four antibiotic groups based on the initial antibiotic treatment within 48h of admission. Patients with severe CAP requiring ICU admission in the first 48h were excluded. The primary outcome was all-cause in-hospital mortality. Secondary outcome included time to being discharged alive. Propensity score and overlap weighting were used to balance covariates. Of 23,512 patients, 9,340 patients (39.7%) received BL+M, 9,146 (38.9%) received BL, 4,510 (19.2%) received FQ, and 516 (2.2%) received BL+D. The number of in-hospital deaths was 703 (7.5%) for the BL+M group, 888 (9.7%) for the BL group, 302 (6.7%) for the FQ group, and 31 (6.0%) for the BL+D group. The adjusted risk difference for in-hospital mortality when compared with BL+M was 1.5%(95%CI,-0.3%to 3.3%) for BL,-0.9%(95%CI,-2.9%to 1.1%) for FQ, and-1.9%(95%CI,-4.8%to 0.9%) for BL+D. Compared with BL+M, the subdistribution hazard ratio for being discharged alive was 0.90 (95%CI, 0.84-0.96) for BL, 1.07 (95%CI, 0.99-1.16) for FQ, and 1.04 (95%CI, 0.93-1.17) for BL+D. BL+M, FQ, and BL+D had similar outcomes and can be considered effective regimens for nonsevere CAP. Compared with BL+M, BL was associated with longer time to discharge and the CI for mortality cannot exclude a small but clinically important increase in risk.

IDENTIFICATION OF MICRORGANISMS BY USING AUTOMATED MICROBIAL DETECTION SYSTEM IN ADULT PATIENTSSUSPECTED WITH SEPTICAEMIA WITH ITS SUPPLEMENTARY PARAMETERS

Septicaemia is a major cause of mortality in both developed and developing countries. Despite important progress in treatment and prevention of infectious diseases, they are considered as leading cause of death and disability. The purpose of this study was monitoring the spectrum of microorganisms that invade blood stream and to study role of different markers in septicaemia, such data are often used to determine empiric antibiotic therapy, to alert clinicians to emerging pathogens that may pose a threat to community and also help in diagnosing severity of septicaemia. Aims and Objectives: To isolate and study the microorganisms from septicaemiccases, to study antimicrobial susceptibility of microorganisms isolated from septicemic casesandto study role of different markers in septicemic cases. Which help in diagnosing severity of septicaemia. Methodology: The study was conducted from September 2015 to February 2017 in a tertiary care teaching hospital. 1993 samples were collected from patients clinically suspected patients of septicaemia. They were inoculated and then incubated, and gram staining was performed. Antibiotic resistance and susceptibility were measured by the disk diffusion method according to the Clinical and Laboratory standards institute (CSLI) guidelines Result:Out of 1993 patients having, 695(34.87%) were culture positive. Among Gram negative isolates, Klebsiella spp.(14.96%)was commonest followed by Acinetobacter species (13.66%) ,E.coli (7.76%),Pseudomonas aeruginosa (6.76%) and salmonella spp.(1.29%). Among Gram positive organisms in our study CONS was the commonest (14.53%) followed by S. aureus (10.79%) and Enterococcus (6.18%), Streptococcus species (1.72%). It shows that colistin was found to be more sensitive for gram negative organisms followed by aminoglycosides and carbapenem group, while resistance was observed towards fluoroquinolone, 1st and 2nd generation cephalosporine groups. &amp;Vancomycin, Teicoplanin and Linezolide were highly active drugs against Gram positive organisms. Conclusion:Septicaemia is an important cause of morbidity and mortality. The study conducted showed both Gram positive and Gram-negative bacteria were responsible for septicaemia. Most of the strains were multi drug resistant and leaving limited options for treatment. Thus, timely detection and knowledge of most likely pathogens causing septicaemia along with their antibiotic susceptibility pattern will help the clinicians in choosing appropriate antimicrobials for treatment which will reduce the major burden of septicaemia in critically ill patients and will also minimize the further emergence of resistance. Therefore, there should be an intensive surveillance, antibiotic policy formulations and preventive efforts for the effective management and prevention of drug resistance.