History Of Antibiotic Treatment Research Articles

Urinary tract infection and associated risk factors among pregnant women at a tertiary care hospital.

Objective: To determine prevalence of UTI in pregnant women and its associated risk factors at a tertiary care hospital. Study Design: Cross Sectional study. Setting: Department of Gynae & Obstetrics Independent University Hospital, Faisalabad. Period: 1-10-2022 to 31-3-2023. Methods: All pregnant patients visiting gynae OPD (5280) were enrolled for study. Mid-stream urine sample was taken and analyzed. UTI was diagnosed if >10 pus cells / HPF were seen. Inclusion Criteria: All pregnant females attending antenatal clinic during study period. Exclusion Criteria: Women with chronic renal disease. History of antibiotic treatment in last one week, Congenital renal abnormality. Patients on immuno suppressive therapy. Results: The prevalence of UTI in our study was 28%. In this study 593 patients (40%) were <20 years of age, 258(17%) were in 21-30 years age group, 246 (16%) were 31-40 years and 381(26%) were >40 years of age. In our study 526 (35%) were primigravidas, 249(17%) were G2, 272(18%) were G3 and 431 (29%) were G4 or above. In this study 698 (47%) patients were in first trimester, 320(22%) were in second trimester, 460(31%) in third trimester. Among risk factors 245 patients (16%) were anemic and 421(28%) were diabetic. Conclusion: The Prevalence of UTI in pregnant female of independent university hospital Faisalabad is quite high. Anemia and diabetes are major associated risk factors. Owing to its association with a number of complications, UTI needs to be diagnosed and treated promptly to lessen perinatal and maternal morbidity and mortality.

Preliminary investigation of the significance of cavitary lesions in recurrent hemoptysis following bronchial artery embolization for nontuberculous mycobacterial pulmonary disease

BackgroundNontuberculous mycobacterial pulmonary disease (NTM-PD) varies widely in clinical presentation, and some patients experience hemoptysis. Bronchial artery embolization (BAE) is a treatment option for hemoptysis caused by NTM-PD. However, the association between post-BAE rebleeding risk and the presence of cavitary lesions has not been fully elucidated. MethodsA retrospective observational study was conducted on patients with NTM-PD who had undergone BAE at our institution. Patients were classified into Cavitary and Non-cavitary groups, and baseline characteristics and clinical outcomes were compared. ResultsAmong the 155 BAE cases between 2013 and 2023, 18 were included in the analysis, and four experienced rebleeding. The Cavitary group tended to have a higher rebleeding rate 24 months after BAE (37.5% vs. 10.0%, p=0.27). Furthermore, the Cavitary group showed a significantly higher number of non-bronchial arteries involved (median number: 1.5 vs. 0.0, p=0.02), a higher proportion of patients with a prior antibiotic treatment history (100% vs. 20%, p=0.001), and longer duration from diagnosis to BAE (median year: 9.0 vs. 0.6, p=0.02). The Kaplan-Meier curves showed a tendency for shorter rebleeding-free survival in the Cavitary group (p=0.10). ConclusionsCavitary lesions in patients with NTM-PD may predict higher rebleeding rates after BAE. Further research with larger cohorts is needed to better understand rebleeding risk factors in BAE for NTM-PD.

Characterization of antimicrobial resistance profiles in Escherichia coli isolated from captive mammals in Ecuador.

This study focuses on the AMR profiles in E. coli isolated from captive mammals at EcoZoo San Martín, Baños de Agua Santa, Ecuador, highlighting the role of wildlife as reservoirs of resistant bacteria. The aim of this research is to investigate the antimicrobial resistance profiles of E. coli strains isolated from various species of captive mammals, emphasizing the potential zoonotic risks and the necessity for integrated AMR management strategies. A total of 189 fecal samples were collected from 70 mammals across 27 species. These samples were screened for E. coli, resulting in 90 identified strains. The resistance profiles of these strains to 16 antibiotics, including 10 β-lactams and 6 non-β-lactams, were determined using the disk diffusion method. Additionally, the presence of Extended-Spectrum Beta-Lactamase (ESBL) genes and other resistance genes was analyzed using PCR. Significant resistance was observed, with 52.22% of isolates resistant to ampicillin, 42.22% to ceftriaxone and cefuroxime, and 27.78% identified as ESBL-producing E. coli. Multiresistance (resistance to more than three antibiotic groups) was found in 35.56% of isolates. Carnivorous and omnivorous animals, particularly those with prior antibiotic treatments, were more likely to harbor resistant strains. These findings underscore the role of captive mammals as indicators of environmental AMR. The high prevalence of resistant E. coli in these animals suggests that zoos could be significant reservoirs for the spread of antibiotic-resistant bacteria. The results align with other studies showing that diet and antibiotic treatment history influence resistance profiles. The study highlights the need for an integrated approach involving veterinary care, habitat management, and public awareness to prevent captive wildlife from becoming reservoirs of antibiotic-resistant bacteria. Improved waste management practices and responsible antibiotic use are crucial to mitigate the risks of AMR in zoo environments and reduce zoonotic threats.

P137 Salivary calprotectin: a potential biomarker in inflammatory bowel disease?

Abstract Background Background: Biomarkers are used frequently for evaluation and monitoring of IBD. Fecal calprotectin (FCP) is an already established biomarker in IBD, nevertheless patients often do not feel comfortable with stool manipulation. A saliva sample collection is particularly interesting due to its noninvasiveness and readiness of collection. We aimed to assess if salivary calprotectin (SCP) could be used as a new biomarker to assess disease activity. Methods In this observational cohort study, saliva was collected through the passive drool technique from adult IBD patients. All patients were submitted to a previous oral examination performed by a dentist. Recent history of antibiotic treatment (within the preceding month), proton pump inhibitors or non-steroidal anti-inflammatory drugs were exclusion criteria. Determination of FCP and SCP levels was accomplished using Elia Stool Extraction Kit and Elia Calprotectin 2 test. Intestinal disease activity was assessed with fecal calprotectin levels and the Harvey-Bradshaw Index (HBI) or Partial Mayo score (PMS). Ethical approval was obtained. Results 92 patients (56 with CD and 36 with UC) were included. Clinical characteristics are presented in Table 1. Patients had a median FCP of 45 mg/Kg and a median SCP of 206.5 mg/Kg. No significant correlations between SCP and FCP, CRP (C-reactive protein), ferritin and ESR (erythrocyte sedimentation rate) were found. However, there was a significant correlation between fecal calprotectin and CRP (p<0.001) and ESR (p=0.011). Disease activity scores did not correlate significantly with SCP, although there was a significant correlation between FCP and PMS (p=0.006). IBD patients were stratified based on a composite criterion for inactive disease HBI score <5 for CD or a PMS ≤ 2 for UC, and FCP cutoff value of 150 mg/Kg), with no significant difference in SCP between the two groups, despite the significant difference in FCP (p<0.001). No significant differences between different treatments groups or no treatment in salivary calprotectin concentration were found using Kruskal–Wallis H tests (CD (χ2(4) = 6.211, p = 0.184; UC group (χ2(3) = 1.201, p = 0.753)). 77% of patients with IBD do not have periodontal health. Nonetheless, there was no significant difference in the median SCP value between patients with or without periodontal health. Although the median SCP value was higher in patients with UC without periodontal health, the difference was not statistically significant (0.484). Conclusion SCP does not correlate with FCP and do not represent a reliable biomarker to distinguish disease activity in patients with IBD patients. Moreover, according to our results, it cannot be used as a marker of lack of oral health, namely periodontitis.

THE STUDY ON THE PREVALENCE AND SOME FACTORS RELATED TO ANTIBIOTIC RESISTANCE OF PROPIONIBACTERIUM ACNES AT CAN THO HOSPITAL OF DERMATO-VENEREOLOGY

Background: Acne is an inflammatory disease of the hair follicles. There are many treatments from medication to non-medication in which antibiotics are a widely used and effective group. However, the recent overuse of antibiotics has led to an increase in resistance to drugs by P. acnes. Therefore, this study is extremely necessary. Objectives: To determine the antibiotic resistance rate and a number of factors related to Propionibacterium acnes antibiotic resistance rate in acne patients at Can Tho Hospital of Dermato-Venereology. Materials and methods: the cross-sectional descriptive study was carried out on of 43 acne patients at Can Tho Hospital of Dermato-Venereology. Results: resistance rates for antibiotics were cefuroxime (91.7%), ceftriaxone (87.5%), cefotaxime (87.5%), trimethoprim (85.4%), clindamycin (66.7%), ofloxacin (41.7%), ciprofloxacin (25%), levofloxacin (20.8%), tetracycline (16.7%). All patients participating in the study were resistant to at least 2 or more antibiotics of which the highest resistance level was 6 antibiotics (37.5%). Some related factors such as the history of antibiotic treatment accounted for 35.4%. Severity levels were classified into mild acne 60.1%, average 27.1% and severity 12.5%; there were two clinical forms in our study including acne vulgaris (77.1%) and cystic acne (22.9%). However, when examining the relationship between these factors and antibiotic resistance, this difference is not statistically significant. Conclusion: P. acnes are increasingly resistant to many antibiotics, making treatment more difficult, a number of factors related to this condition for example antibiotic use, level of severity of acne.

An Artificial Microbiome Consortium Prevents Recurrence of Clostridioidesdifficile Infection: Paving the Way for Fecal Microbiota Transplantation 2.0

Feuerstadt P, Louie TJ, Lashner B, et al. SER-109, an oral microbiome therapy for recurrent Clostridioides difficile infection. N Engl J Med 2022;386:220–229. Increasing evidence suggests that fecal microbiota transplantation (FMT) is more effective than antibiotics in treating and preventing recurrent Clostridioides difficile infection (rCDI). However, FMT carries a risk of transmission of burdensome pathogens. Feuerstadt et al assessed the efficacy of SER-109, an experimental microbiome therapeutic made of live purified Firmicutes bacterial spores, in reducing the risk of rCDI. One hundred eighty-two patients with rCDI were randomized 1:1 to receive SER-109 or placebo (4 capsules daily for 3 days). They were subsequently followed up over the next 8 weeks to assess recurrence of CDI. Rates of CDI recurrence were significantly lower in the SER-109 group than in the placebo group (12% vs 40%; relative risk, 0.32; 95% CI, 0.18–0.58); these findings were seen regardless of age stratification (younger than 65 years or older than 65 years) or type of antibiotic used in previous episodes of CDI (vancomycin or fidaxomicin). There were no serious adverse events related to SER-109. Engraftment of SER-109 dose species started by week 1 and gradually increased and persisted through to week 8. Microbiome changes in the treatment group showed declines in proinflammatory Enterobacteriaceae and increases in favorable Firmicutes (eg, Lachnospiraceae), the latter known to produce secondary bile acids that inhibit C difficile spore germination. The main study limitations include the low representation of minority patients, as nearly 90% of enrolled patients were White, and the absence of pre-antibiotic microbiome samples, which prevents assessment of the effect of SER-109 in patients without recent history of antibiotic treatment. However, this randomized controlled trial provides further evidence that artificial microbial consortia may be a promising approach to treating rCDI. Targeted manipulation of the gut microbiome with microbial consortia may overcome issues related to donor safety and shortages associated with classical FMT. Given that these approaches are likely to be more expensive, it would be important for future studies to compare synthetic microbial consortia with standard FMT. If these are better or equivalent to classical FMT, then this will herald the era of FMT 2.0.

International Multicentre Study of Candida auris Infections.

Background:Candida auris has emerged globally as a multi-drug resistant yeast and is commonly associated with nosocomial outbreaks in ICUs. Methods: We conducted a retrospective observational multicentre study to determine the epidemiology of C. auris infections, its management strategies, patient outcomes, and infection prevention and control practices across 10 centres from five countries. Results: Significant risk factors for C. auris infection include the age group of 61–70 years (39%), recent history of ICU admission (63%), diabetes (63%), renal failure (52%), presence of CVC (91%) and previous history of antibiotic treatment (96%). C. auris was commonly isolated from blood (76%). Echinocandins were the most sensitive drugs. Most common antifungals used for treatment were caspofungin (40%), anidulafungin (28%) and micafungin (15%). The median duration of treatment was 20 days. Source removal was conductedin 74% patients. All-cause crude mortality rate after 30 days was 37%. Antifungal therapy was associated with a reduction in mortality (OR:0.27) and so was source removal (OR:0.74). Contact isolation precautions were followed in 87% patients. Conclusions: C. auris infection carries a high risk for associated mortality. The organism is mainly resistant to most azoles and even amphotericin-B. Targeted antifungal therapy, mainly an echinocandin, and source control are the prominent therapeutic approaches.

Predictor Factors of Delay Tuberculosis Diagnosis based on Antibiotic Treatment History, Thoracic Radiography And Microbiological Examination

Predictor Factors of Delay Tuberculosis Diagnosis based on Antibiotic Treatment History, Thoracic Radiography And Microbiological Examination

The nasopharyngeal microbiota of preweaned dairy calves with and without ultrasonographic lung lesions

The primary objective of this cross-sectional study was to identify associations between the diversity and composition of the nasopharyngeal (NP) microbiota and pneumonia status, as diagnosed by ultrasonography (US), in preweaned dairy calves. Characteristics of the NP microbiota were compared between calves with and without pneumonia, as diagnosed by US. Secondary objectives were to compare the composition of the NP microbiota between calves by age, clinical respiratory score (CRS), and previous antibiotic therapy. Holstein heifer calves (n = 50) from a southern Wisconsin dairy were enrolled at either 3 or 6 wk of age; 4 calves were sampled at both time points. Antibiotic treatment history was also collected for the 30 d before enrollment. For the purpose of this study, pneumonia was defined as having lobar pneumonia, as diagnosed by US, in at least 1 lung lobe. Following examination by CRS and US, a deep nasopharyngeal swab was obtained for 16S rRNA amplicon sequencing. Alpha diversity was reduced in calves that were CRS positive, and beta diversity tended to be different in calves previously treated with antibiotics and in calves that were CRS positive. Microbial diversity was not different between calves with and without pneumonia. The most dominant genus identified was Mycoplasma spp.; however, there was no association between relative abundance (RA) and pneumonia status. The median RA of Mycoplasma spp. was increased by 25 (95% confidence interval, CI: 3, 40) in calves at 3 wk of age compared with 6 wk of age. The median RA of Pasteurella spp. was increased by 1.5 (95% CI: 0.1, 3) in calves with pneumonia, as diagnosed by US, compared with calves without pneumonia. Additionally, Pasteurella spp. was increased by 2.3 (95% CI: 0, 9) in CRS-positive calves compared with CRS-negative calves. The median RA of Psychrobacter spp. was increased by 2 (95% CI: 0, 12) and median RA of Chryseobacterium spp. was increased by 0.15 (95% CI: 0, 2) in calves that were not treated previously with antibiotics compared with calves previously treated with antibiotics.

Co-seasonality and co-detection of respiratory viruses and bacteraemia in children: a retrospective analysis

ObjectivesThe aim of this study was to assess the co-seasonality and co-detection of respiratory viral infections and bacteraemia in children since the introduction of the 13-valent pneumococcal conjugate vaccine (PCV13). MethodsChildren <18 years old were eligible for inclusion if they had a respiratory infection and a positive PCR-based assay for respiratory viruses as well as a positive blood culture between 2010 and 2018 at a single referral centre in the United States, regardless of their underlying medical condition or antibiotic treatment history. Monthly incidence rates of respiratory viruses and bacteraemia were analysed with a seasonal-trend decomposition procedure based on loess (STL) and cross-correlation functions using time series regression modelling. ResultsWe identified 7415 unique positive respiratory virus tests, including 2278 respiratory syncytial virus (RSV) (31%), 1825 influenza viruses (24%), 1036 parainfluenza viruses (14%), 1017 human metapneumovirus (hMPV) (14%), 677 seasonal coronaviruses (9%), and 582 adenoviruses (8%), together with a total of 11 827 episodes of bacteraemia. Significant co-seasonality was found between all-cause bacteraemia and RSV (OR = 1.76, 95%CI 1.50–2.06, p < 0.001), influenza viruses (OR = 1.38, 95%CI 1.13–1.68, p 0.002), and seasonal coronaviruses (OR = 1.18, 95%CI 1.09–1.28, p < 0.001), respectively. Analysis of linked viral–bacterial infections in individual children indicated that the rate ratio (RR) of bacteraemia associated with hMPV (RR = 2.73, 95%CI 1.12–6.85, p 0.019) and influenza (RR = 2.61, 95%CI 1.21–6.11, p 0.013) were more than double that of RSV. Staphylococcus aureus and Streptococcus pneumoniae were the most commonly identified pathogens causing bacteraemia. ConclusionsThere is a significant association between hMPV and influenza viruses and bacteraemia of all causes in hospitalized children at a single paediatric centre in the United States. Large multicentre studies are needed to confirm these findings and to elucidate the mechanisms by which hMPV potentiates the virulence and invasive capacity of diverse bacteria.

&amp;lt;i&amp;gt;Helicobacter pylori&amp;lt;/i&amp;gt; Infection (&amp;lt;i&amp;gt;Hp&amp;lt;/i&amp;gt;) among Children in the Northern Benin in 2018

Background: Hp infection is the most common chronic bacterial infection in developing countries and is contracted especially in childhood where it remains silent. Because of its involvement in the genesis of certain cancers, the WHO has classified Hp in the category of carcinogen class I. The aim of this study was to determine the prevalence of Hp infection among children from a District in Northern Benin, and to identify the factors associated with it. Patients and methods: This scientific investigation is a cross-sectional, descriptive, and analytical study based on a prospective collection of data carried out from July to September 2018. Recruitment was probabilistic; it was based on the WHO cluster sampling technique implemented among children aged 3 to 10 years without recent history of antibiotic treatment and proton pump inhibitors. Hp infection was diagnosed during the search for bacteria antigen in the feces through a quick Elisa test which proved positive. Results: We included 250 children in the study. Among them, 151 (60.4%) had Hp infection. 79 (52.3%) out of the 151 infected children were female, i.e. a sex ratio of 0.91. Mean age for those infected children was 6 ± 2.3 years. Among the 151 children infected with Hp, 98 (64.9%) were asymptomatic. Factors associated with that infection were: children’s age > 5 years (p = 0.0461), use of contaminated drinking water (p = 0.0001), meals away from home (p = 0.0039), mothers’ low educational status (p = 0.0137) and low monthly income (p = 0.0116) as well as household size > 3 (p = 0.0002). Conclusion: Hp infection is common among children aged 3 to 10 years in Northern Benin. Often asymptomatic, it is facilitated and exacerbated by unsanitary conditions and low socioeconomic status.

What rationale do GPs use to choose a particular antibiotic for a specific clinical situation?

BackgroundMany studies have investigated the ways in which physicians decide whether to prescribe antibiotics, but very few studies have focused on the reasons for which general practitioners (GPs) choose to prescribe a particular antibiotic in a specific clinical situation. Improvements in our understanding of the rationale behind GPs’ decisions would provide insight into the reasons for which GPs do not always prescribe the antibiotic recommended in clinical practice guidelines and facilitate the development of appropriate interventions to improve antibiotic prescription.The objective of the study was to understand the rationale used by GPs to decide which antibiotic to prescribe in a specific clinical situation, and to propose a model representing this rationale.MethodsWe used a three-step process. First, data were collected from interviews with 20 GPs, and analysed according to the grounded theory approach. Second, data were collected from publications exploring the factors used by GPs to choose an antibiotic. Third, data were used to develop a comprehensive model of the rationale used by GPs to decide which antibiotic to prescribe.ResultsThe GPs considered various factors when choosing antibiotics: factors relating to microbiology (bacterial resistance), pharmacology (adverse effects, efficacy, practicality of the administration protocol, antibiotic class, drug cost), clinical conditions (patient profile and comorbid conditions, symptoms, progression of infection, history of antibiotic treatment, preference), and personal factors (GP’s experience, knowledge, emotion, preference).ConclusionsVarious interventions, targeting all the factors underlying antibiotic choice, are required to improve antibiotic prescription. GP-related factors could be improved through interventions aiming to improve the GPs’ knowledge of antibiotics (e.g. continuing medical education). Factors relating to microbiology, pharmacology and clinical conditions could be targeted through the use of clinical decision support systems in everyday clinical practice.

The History of Antibiotic Treatment of Osteomyelitis

Antibiotic treatment of osteomyelitis has evolved substantially over the past 80 years. Traditional teachings (eg, that antimicrobials must be given parenterally, selected based upon ratios of achieved bone vs serum drug levels, and continued for 4–6 weeks) are supported by limited data. New studies are challenging this dogma, however. In this review, we seek to contextualize the discussion by providing a narrative, chronologic review of osteomyelitis treatment spanning the pre-antibiotic era through the present day and by describing the quality of evidence supporting each component of traditional osteomyelitis therapy.

Small cell lung cancer in the young: Characteristics, diagnosis and outcome data.

Patients with small cell lung cancer (SCLC) younger than 40years are limited in number. Our research aimed to assess the characteristics, diagnosis and outcomes of this patient population. Records of patients under the age of 40 with SCLC at the Chinese Academy of Medical Sciences between January 2006 and December 2015 were reviewed and evaluated. One hundred and three patients (67.0% limited stage, 33.0% extensive stage) were included, along with 54 (52.4%) never-smokers. The median diagnostic interval and the median survival time (MST) were 51.0days and 24.0months, respectively. A total of 41 (39.8%) patients claimed to have undergone antibiotic treatment before diagnosis, with a median duration of 2weeks. In univariate analysis, survival was better for the limited stage group than the extensive stage group (MST, 28.0 vs. 13.0months, P<0.0001). Also, patients who received concurrent radiochemotherapy had better survival than those who received chemotherapy alone (MST, 29.0 vs. 18.0months, P=0.001). Patients with antibiotic treatment before SCLC diagnosis have worse prognosis than those without (MST, 21.0 vs. 27.0months, P=0.008). Moreover, a timely diagnosis (≤1month) exerted a positive impact on the overall survival in limited stage patients (48.0 vs. 26.0months, P=0.047) and on progression-free survival in extensive stage patients (6.0 vs. 3.0months, P=0.030). Multivariate analysis suggested that disease stage, history of antibiotic treatment before SCLC diagnosis and performance status independently correlated with survival. Our study identified distinct characteristics and prognostic factors of SCLC patients under 40years. More timely care may improve patient prognosis.

1046. Clinical and Microbiological Characteristics of Patients With Septicemia Caused by IMP-1-Producing Enterobacteriaceae in a Tertiary Hospital in Japan

BackgroundCarbapenemase-producing Enterobacteriaceae (CPE) infection has become a great threat to public health worldwide. Although KPC and OXA-48 infections have mostly described, IMP-1 producing Enterobacteriaceae (IMP1-E) are not well studied. We investigated the clinical and microbiological characteristics of septicemia due to the IMP1-E.MethodsThis observational study of inpatients who developed IMP-1E septicemia was conducted in a Japanese tertiary hospital from April 2013 to March 2017. IMP1-E was defined as a decreased susceptibility to meropenem (minimum inhibitory concentration, ≥2 mg/L), as well as a positive sodium mercaptoacetic acid test, and polymerase chain reaction for blaIMP genes. Clinical data were collected from medical charts. Antimicrobial susceptibilitly was determined by the MicroScan Walkway. We performed total genomic analysis, plasmid analysis, and multilocus sequence typing (MLST) using whole genome sequencing data.ResultsIn total, six patients were identified (median age: 55 years). All had severe underlying disease on admission, and five were admitted to the intensive care unit. The sources of IMP1-E septicemia were as follows: two catheter-related BSI, one pyelonephritis, one cholangitis, one bacterial peritonitis, and one unknown focus. Four isolates were Enterobacter cloacae and two were Klebsiella pneumoniae. All patients had a previous history of antibiotic treatment and long-term hospitalization. All patients were treated with either levofloxacin (LVFX) only or LVFX and aminoglycoside (AG). Follow-up blood culture was negative for all patients. All-cause 30-day mortality rate was 50%. Although no isolates were resistant to LVFX and AG, they harbored aac(6’)-Ⅱc, sul1, and tet(B) genes.Two isolates harbored the qnrB6 gene. There was a high probability that blaIMP-1 was carried by IncHI2 plasmids. MLST sequence type of E. cloacae isolates comprised three ST78, and one ST997; K. pneumonia isolates comprised ST134, and ST252.ConclusionThis study showed that IMP1-E septicemia was isolated in patients with severe disease and long-term hospitalization. Selection of antibiotics therapy based on antimicrobial susceptibility induced microbiological cure, but clinical response was dependent on the underlying diseases.Disclosures All authors: No reported disclosures.

Efficacy of bismuth containing quadruple therapies on Helicobacter pylori eradication in patients with history of antibiotic treatment

To investigate the efficacy of bismuth containing quadruple therapies on Helicobacter pylori (Hp) eradication in patients with history of antibiotic treatment. Methods: Hp infected patients (n=327) were allocated into 3 groups. Group A (n=52), patients had no antibiotic history and they took medicine of proton pump inhibitors (PPI) and livzon triple (clarithromycin, tinidazole, and bismuth); group B (n=80), patients had the antibiotic history except for amoxicillin and clarithromycin, and they were treated with PPI, amoxicillin, clarithromycin, and bismuth; group C (n=195), patients suffered failures of Hp therapy or with history of antibiotic abuse, and they were treated with PPI, doxycycline, furazolidone, and bismuth. Results: Both the intention-to-treat (ITT) analysis (group A 63.5%, group B 76.2%, group C 82.6%, P<0.05) and the pre-protocol (PP) analysis (group A 76.7%, group B 92.4%, group C 96.4%, P<0.05) showed significant difference among the 3 groups, revealing higher elimination in group B and C. The side-effects (20.2%) were mild and tolerable (group A, 28.0%; group B, 10.7%; group C, 22.0%). Conclusion: Proton pump inhibitors together with the livzon triple regimen have a low rate of Hp eradication and a higher incidence of adverse reactions. The quadruple therapy containing clarithromycin and metronidazole drugs can achieve the satisfactory outcomes based on patient's antibiotic history. For patients with multiple antibiotics, the quadruple therapy containing furazolidone and doxycycline may achieve the satisfactory outcomes, but the adverse resction would be relatively higher.

Comparison of treatment history and antimicrobial sensitivity results of common bovine respiratory disease bacterial pathogens from cases submitted to the ISU-VDL from 2013-2015

Summarized susceptibility results from diagnostic laboratory cases are often used to evaluate trends in antibiotic resistance. The objective of this retrospective study was to evaluate summarized antimicrobial susceptibility data from bovine respiratory disease cases submitted to the Iowa State University Veterinary Diagnostic Laboratory in the context of reported antibiotic treatment history.

Risk Factors for Clinician-Diagnosed Lyme Arthritis, Facial Palsy, Carditis, and Meningitis in Patients From High-Incidence States.

Clinical features of Lyme disease (LD) range from localized skin lesions to serious disseminated disease. Information on risk factors for Lyme arthritis, facial palsy, carditis, and meningitis is limited but could facilitate disease recognition and elucidate pathophysiology. Patients from high-incidence states treated for LD during 2005-2014 were identified in a nationwide insurance claims database using the International Classification of Diseases, Ninth Revision code for LD (088.81), antibiotic treatment history, and clinically compatible codiagnosis codes for LD manifestations. Among 88022 unique patients diagnosed with LD, 5122 (5.8%) patients with 5333 codiagnoses were identified: 2440 (2.8%) arthritis, 1853 (2.1%) facial palsy, 534 (0.6%) carditis, and 506 (0.6%) meningitis. Patients with disseminated LD had lower median age (35 vs 42 years) and higher male proportion (61% vs 50%) than nondisseminated LD. Greatest differential risks included arthritis in males aged 10-14 years (odds ratio [OR], 3.5; 95% confidence interval [CI], 3.0-4.2), facial palsy (OR, 2.1; 95% CI, 1.6-2.7) and carditis (OR, 2.4; 95% CI, 1.6-3.6) in males aged 20-24 years, and meningitis in females aged 10-14 years (OR, 3.4; 95% CI, 2.1-5.5) compared to the 55-59 year referent age group. Males aged 15-29 years had the highest risk for complete heart block, a potentially fatal condition. The risk and manifestations of disseminated LD vary by age and sex. Provider education regarding at-risk populations and additional investigations into pathophysiology could enhance early case recognition and improve patient management.

Optimized In Vitro Antibiotic Susceptibility Testing Method for Small-Colony Variant Staphylococcus aureus.

Staphylococcus aureus small-colony variants (SCVs) emerge frequently during chronic infections and are often associated with worse disease outcomes. There are no standardized methods for SCV antibiotic susceptibility testing (AST) due to poor growth and reversion to normal-colony (NC) phenotypes on standard media. We sought to identify reproducible methods for AST of S. aureus SCVs and to determine whether SCV susceptibilities can be predicted on the basis of treatment history, SCV biochemical type (auxotrophy), or the susceptibilities of isogenic NC coisolates. We tested the growth and stability of SCV isolates on 11 agar media, selecting for AST 2 media that yielded optimal SCV growth and the lowest rates of reversion to NC phenotypes. We then performed disk diffusion AST on 86 S. aureus SCVs and 28 isogenic NCs and Etest for a subset of 26 SCVs and 24 isogenic NCs. Growth and reversion were optimal on brain heart infusion agar and Mueller-Hinton agar supplemented with compounds for which most clinical SCVs are auxotrophic: hemin, menadione, and thymidine. SCVs were typically nonsusceptible to either trimethoprim-sulfamethoxazole or aminoglycosides, in accordance with the auxotrophy type. In contrast, SCVs were variably nonsusceptible to fluoroquinolones, macrolides, lincosamides, fusidic acid, and rifampin; mecA-positive SCVs were invariably resistant to cefoxitin. All isolates (both SCVs and NCs) were susceptible to quinupristin-dalfopristin, vancomycin, minocycline, linezolid, chloramphenicol, and tigecycline. Analysis of SCV auxotrophy type, isogenic NC antibiograms, and antibiotic treatment history had limited utility in predicting SCV susceptibilities. With clinical correlation, this AST method and these results may prove useful in directing treatment for SCV infections.

Marked increase in incidence for bloodstream infections due to Escherichia coli, a side effect of previous antibiotic therapy in the elderly.

We conducted a survey including 3334 bloodstream infections (BSIs) due to E. coli diagnosed in 2005–2014 at a stable cohort of hospitals. Marked increases in incidence were observed for community-acquired (CA) BSIs in patients aged >75 years, CA-BSIs of digestive origin in patients aged 60–74 years, healthcare-associated BSIs, and BSIs associated with ESBL (extended-spectrum B-lactamase)-producing E. coli (ESBLEc). Using MLST, we studied the genetic diversity of 412 BSI isolates recovered during the 2014 survey: 7 major sequence type complexes (STCs) were revealed in phylogenetic group B2, 3 in group A/B1 and 2 in group D. Among the 31 ESBLEc isolates, 1/3 belonged to STC 131. We searched for possible associations between clonal groups, clinical determinants and characteristics of BSIs: isolates from groups B2 (except STC 131) and D were susceptible to antibiotics and associated with BSIs of urinary origin in patients <60 years. STC 131 and group A/B1 isolates were multi-drug resistant and associated with CA-BSIs of digestive origin in patients aged 60–74 with a recent history of antibiotic treatment. STC 131 isolates were associated with HCA-BSIs in patients with recent/present hospitalization in a long-stay unit. We provide a unique population-based picture of the epidemiology of E. coli BSI. The aging nature of the population led to an increase in the number of cases caused by the B2 and D isolates generally implicated in BSIs. In addition, the association of a trend toward increasing rates of gut colonization with multi drug-resistant isolates revealed by the rise in the incidence of BSIs of digestive origin caused by STC 131 and A/B1 (STCs 10, 23, and 155) isolates, and a significant increase in the frequency of BSIs in elderly patients with recent antibiotic treatment suggested that antibiotic use may have contributed to the growing incidence of BSI.