Long-term Antimicrobial Treatment Research Articles

Effectiveness of outpatient parenteral antimicrobial therapy (OPAT) for patients with cranial infection.

Outpatient parenteral antimicrobial therapy (OPAT) is a well-established and cost-effective method for improving the efficient use of healthcare resources. However, only a few centres in Germany perform it. Here we analysed OPAT for the treatment of patients with cranial infections in our neurosurgical department. This retrospective study analysed patients with cranial infections and the need for intravenous (i.v.) antimicrobial treatment between 2018 and 2021.All diagnosed intracranial infections were defined into two infection categories such as long-term antimicrobial treatment and short-term antimicrobial treatment. All included patients were discharged with a peripherally inserted central catheter (PICC) line. Prior to discharge, all patients received training in the safe administration of their medications via the PICC line. The duration of OPAT and the rate of readmission after OPAT were analysed. We identified a total of 45 patients treated with OPAT for cranial infections. Intradural involvement was present in 40 cases (88.9%). The average length of hospital stay for this cohort after surgical treatment was 45 ± 15 days. 5 patients were treated for soft tissue/skin infection. Surgery was not required in this cohort. The mean hospital stay for this cohort was 8 ± 6 days. Gram-positive organisms were isolated in most cases (53.3%). The most common pathogens were Staphylococcus aureus followed by other Staphylococcus species. For all included patients, OPAT was performed after discharge for an average of 43.1 ± 14 days. There were five cases of readmission due to treatment failure. No serious adverse events or complications of OPAT were observed. OPAT enables better patient-centred healthcare close to home. The length of hospital stay can be reduced and adverse events due to prolonged hospitalisation can be avoided.

In Situ Polymerization of Methylene Blue on Bacterial Cellulose for Photodynamic/Photoelectricity Synergistic Inhibition of Bacterial Biofilm Formation.

In the context of long-term antimicrobial treatment, the emergence of bacterial resistance poses a significant challenge. Therefore, there is a pressing need to develop novel antimicrobial materials and methods that can effectively and safely combat microbial infections. This study focuses on the synthesis of bacterial cellulose-polymethylene blue (BC-PMB) with integrated photodynamic and photoelectric antimicrobial properties. The polymerization of methyl blue (MB) onto bacterial celluloses (BC) was achieved, and through comprehensive computational analyses using density functional theory (DFT) and molecular dynamics simulations, it was confirmed that this polymerization greatly enhanced the binding efficiency between methylene blue and BC. Additionally, polymethylene blue (PMB) exhibited superior photoexcitation efficiency and conductivity compared to its precursor. When BC-PMB was exposed to a 30 mW 660 nm light source for 30 min, the material demonstrated a remarkable antimicrobial efficacy of 93.99% against Escherichia coli and 98.58% against Staphylococcus aureus. Furthermore, the synergistic effect of photodynamic and photoelectric antimicrobial mechanisms exhibited long-term inhibitory capabilities against bacterial biofilms.

Case Studies and Literature Review of Francisella tularensis–Related Prosthetic Joint Infection

Tularemia is a zoonotic infection caused by Francisella tularensis. Its most typical manifestations in humans are ulceroglandular and glandular; infections in prosthetic joints are rare. We report 3 cases of F. tularensis subspecies holarctica-related prosthetic joint infection that occurred in France during 2016-2019. We also reviewed relevant literature and found only 5 other cases of Francisella-related prosthetic joint infections worldwide, which we summarized. Among those 8 patients, clinical symptoms appeared 7 days to 19 years after the joint placement and were nonspecific to tularemia. Although positive cultures are typically obtained in only 10% of tularemia cases, strains grew in all 8 of the patients. F. tularensis was initially identified in 2 patients by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry; molecular methods were used for 6 patients. Surgical treatment in conjunction with long-term antimicrobial treatment resulted in favorable outcomes; no relapses were seen after 6 months of follow-up.

Rifampicin in periprosthetic joint infections: where do we stand and where are we headed?

ABSTRACT Introduction A periprosthetic joint infection (PJI) is a major complication of arthroplasty. Treatment of PJI consists of surgical debridement with or without the exchange of the implant and long-term antimicrobial treatment. Rifampicin is regarded as one of the cornerstones of antimicrobial treatment for staphylococcal PJI, but the exact role of rifampicin for PJI in different clinical scenarios remains to be elucidated. Areas covered In this perspective article, an overview is provided of in vitro, in vivo and clinical studies that were the basis of the current guidelines and recommendations for rifampicin use in daily practice for PJI. Controversial issues on indication, dosing, timing, duration, and antibiotic drug interactions will be addressed. Finally, the most urgent clinical questions on rifampicin use that need answering in the nearby future will be formulated. Expert Opinion Many inquiries remain concerning the exact indications and clinical use of rifampicin in PJI. Randomized controlled trials are needed to answer these questions.

Safety and feasibility of outpatient parenteral antimicrobial therapy for patients with spinal infection

Outpatient parenteral antimicrobial therapy (OPAT) is a cost-effective method of administering intravenous antimicrobial therapy. Although OPAT is well established in the UK and US healthcare systems, few centres in Europe perform it. Here we analysed OPAT for the treatment of patients with spinal infections at our institution. In this retrospective study, patients with spinal infection who required intravenous (i.v.) antimicrobial treatment between 2018 and 2021 were analysed. The duration of short-term antimicrobial treatment for skin and soft tissue infections and complex infections requiring long-term antimicrobial treatment, such as spinal bone or joint infections, were analysed. All patients were discharged with a peripherally inserted central catheter (PICC) line. Prior to discharge, all patients received training in the safe administration of their medications via the PICC line. The duration of OPAT and the rate of readmission after OPAT were analysed. For this study a total of 52 patients who were treated via OPAT due to spinal infections were analyzed. In 35 cases (69.2%) complex spinal infection was reason for i.v. antimicrobial therapy. Surgery was required in 23 of these 35 patients (65.7%). The average hospital stay for these patients was 12 ± 6 days. The remaining 17 patients were treated for an infection of the soft tissue or the skin and hospital stay for these patients was on average 8 ± 4 days. Gram-positive organisms were isolated in 64.4%. Staphylococcus aureus followed by other Staphylococcus species, was the most common detected organism. After discharging i.v. antimicrobial treatment was given for an average of 20 ± 14 days. The duration of antimicrobial treatment for soft tissue was 10.8 ± 8 days, and for complex infections 25.1 ± 18 days. The mean follow-up was 21 ± 14 months. There was one case of readmission due to treatment failure. There were no difficulties encountered in implementing OPAT. OPAT is a feasible and effective option for delivering intravenous antimicrobial therapy to patients with spinal infections who can be managed without hospitalisation. OPAT offers patient-centred treatment at home while avoiding the risks associated with hospitalisation, with high levels of patient satisfaction.

Impact of Treatment on Long-Term Survival of Patients With Mycobacterium avium Complex Pulmonary Disease.

Whether antimicrobial treatment improves long-term survival in patients with Mycobacterium avium complex pulmonary disease (MAC-PD) is unclear. We analyzed survival in patients aged ≥18 years who were treated for MAC-PD at a tertiary referral center in South Korea between 1 January 2009 and 31 December 2020. Treatment exposure was divided into 4 time intervals: <6, ≥6 to <12, ≥12 to <18, and ≥18 months. Time-varying multivariable Cox proportional hazards models were used to calculate the all-cause mortality risk in each time interval. The model was adjusted for major clinical factors related to mortality including age, sex, body mass index, presence of cavities, erythrocyte sedimentation rate, positive acid-fast bacilli (AFB) smear, clarithromycin resistance, and comorbid conditions. A total of 486 patients treated for MAC-PD were included in the analysis. A significant inverse correlation was observed between mortality and duration of treatment (P for trend = .007). Long-term treatment (≥18 months) was significantly associated with reduced mortality (adjusted hazard ratio, 0.32 [95% confidence interval, .15-.71]). In subgroup analyses, patients with cavitary lesions (adjusted hazard ratio, 0.17 [95% confidence interval, .05-.57]) or positive AFB smears (0.13 [.02-.84]) at baseline maintained this significant inverse relationship between treatment duration and mortality. Long-term antimicrobial treatment should be actively considered in patients with progressive MAC-PD, especially in the presence of cavities or positive AFB smears indicative of high mycobacterial burden.

ANTIMICROBIAL APPROACHES FOR TEXTILES

The use of textile materials with antimicrobial treatment is one of the ways to effectively protect a person from exposure to various pathogens. The article is devoted to the topical issue of the development of innovative textile materials with prolonged antimicrobial treatment. To establish the possibility and features of obtaining innovative textile materials with long-term antimicrobial treatment. To prepare this article, many materials were considered, as well as ready-made solutions that were publicly available.Despite the fact that research on this topic was conducted, in order to obtain a prolonged effect, special attention needs to be paid to the problem of fixing the antimicrobial drug.To establish the technological features of applying a prolonged action antimicrobial treatment to textile material. The main tasks are to determine the composition of the composition and the peculiarities of the processing of the textile material; to investigate the influence of the polymer carrierand the fixing agent on the permanence of the final treatment and the stability of the antimicrobial effect.In order to obtain a prolonged antimicrobial effect, the problem of fixing the antimicrobial drug on the textile material was solved by using the developed preparation composition. The proposed finishing compound contains carboxymethylated starch, decamethoxine as a bactericidal drug and an agent for fixing them on the textile material -potassium iodide. The effect of the finishing components on the sorption of modified starch by cotton fabric was studied and a significant increase in its content on the fabric was revealed during simultaneous impregnation. The detected phenomenon is proposed to be explained by the formation of an ionic bond between carboxymethyl groups and decamethoxin. The technological features of applying a long-acting antimicrobial treatment to a textile material, which consists in the use of a one-stage technology, have been clarified.The influence of the polymer carrier and the fixing agent on the permanence of the final treatment and the stability of the antimicrobial effect is shown. The results of antimicrobial tests of prepared samples processed by various technological methods are presented. It was found that the fabric prepared according to the proposed technological regimes has an antimicrobial effect that is resistant to multiple washings. The developed technology is promising and can be implemented on the equipment of finishing factories

A case of late-onset spondylodiscitis within the longest duration: 9 years after posterior instrumentation

BackgroundSpondylodiscitis is infections of the intervertebral disc and adjacent vertebral body with insidious onset. These infections are primarily haematogenous in origin. Early spinal infections after posterior spinal instrumentation usually occur within 3 months after surgery, whereas late infections may occur up to 8 years after surgery but are rare with an incidence of 1.9%.Case presentationWe describe the case of a 66-year-old woman who complained of febrile back pain and developed late-onset spondylodiscitis 9 years after pedicle screw fixation, which is the longest-onset case. She was treated with surgical instrument removal and thorough debridement of the infected tissue with long-term antimicrobial treatment, with excellent results.ConclusionsIf there is radiculopathy and fever associated with spinal surgery in the history, it should be remembered that evaluation of lumbar spine MRI and acute phase reactions is crucial, and spondylodiscitis should also be considered in the preliminary diagnosis even after 9 years.

A transferrable IncL/M plasmid harboring a gene encoding IMP-1 metallo-\u03b2-lactamase in clinical isolates of Enterobacteriaceae

BackgroundThe worldwide spread of carbapenemase-producing Enterobacteriaceae (CPE) has reduced the clinical utility of carbapenems. Plasmids often play an important role in the spread of genes encoding drug-resistance factors, especially in the horizontal transfer of these genes among species of Enterobacteriaceae. This study describes a patient infected with three species of CPE carrying an identical transferrable IncL/M plasmid.MethodsClinical isolates of CPE were collected at St. Luke’s International Hospital, Tokyo, Japan, from 2015 to 2019. Three species of CPE isolates, Enterobacter cloacae, Klebsiella aerogenes and Serratia marcescens, were isolated from a patient who developed severe gallstone pancreatitis associated with bloodstream infection, with all three isolates producing IMP-1 metallo-β-lactamase. The complete sequences of the plasmids of the three isolates were determined by both MiSeq and MinION. The medical chart of this patient was retrospectively reviewed conducted to obtain relevant clinical information.ResultsThe three CPE species carried an IncL/M plasmid, pSL264, which was 81,133 bp in size and harbored blaIMP-1. The genetic environment surrounding blaIMP-1 consisted of int1-blaIMP-1-aac(6’)-IIc-qacL-qacEdelta1-sul1-istB-IS21. Conjugation experiments showed that S. marcescens could transmit the plasmid to E. cloacae and K. aerogenes. In contrast, pSL264 could not transfer from E. cloacae or K. aerogenes to S. marcescens.ConclusionThe IncL/M plasmid pSL264 harboring blaIMP-1 was able to transfer among different species of Enterobacteriaceae in a patient receiving long-term antimicrobial treatment. The worldwide emergence and spread of IncL/M plasmids harboring carbapenemase-encoding genes among species of Enterobacteriaceae is becoming a serious public health hazard.

Focus on patients receiving long-term antimicrobial treatments for lyme borreliosis: No lyme but mostly mental disorders

ObjectivesOverdiagnosis of lyme borreliosis leads to unnecessary and increasingly common antimicrobial treatments. We aimed to evaluate patients receiving long-term antimicrobial treatment for lyme borreliosis. MethodsWe included patients referred to a Parisian teaching hospital between January 1st, 2014 and June 30th, 2019, with a presumed diagnosis of lyme borreliosis for which they were treated with antimicrobials for at least 6 months. ResultsFifteen patients were included (11 women and mean age 44 years). The mean antimicrobial treatment duration was 476 days (180–942). The mean number of antimicrobials was 6.8 per patient (1–18). None of the 15 patients had lyme borreliosis. Nine patients were diagnosed with a mental disorder. ConclusionOverdiagnosis and overtreatment of lyme borreliosis put patients at risk of undiagnosed illnesses and multiple adverse effects of unjustified treatments. The clinical management of such patients requires a comprehensive approach including expertise in mental disorders.

Genome Sequencing Verifies Relapsed Infection of Helicobacter cinaedi.

BackgroundRecurrent infections of Helicobacter cinaedi are often reported, and long-term antimicrobial treatment is empirically recommended to prevent such infections. However, there have been no studies examining whether recurrent infections are relapses of former infections or reinfections with different clones.MethodsA 69-year-old woman presented with recurrent H cinaedi bacteremia-associated cellulitis after a 51-day interval. We isolated 10 colonies from the blood cultures obtained during each of the 2 episodes and subjected them to whole-genome sequencing (WGS). High-confidence single-nucleotide polymorphisms (SNPs) were identified by an assembly based method. Heterogeneous SNP sites were identified by read mapping. The susceptibility of a representative isolate to 14 antimicrobials was also examined.ResultsWhole-genome sequence analysis revealed only 6 SNP sites among the 20 isolates at the whole-genome level. Based on the 6 SNPs, 5 within-host variants (referred to as genotypes) were identified. All 5 genotypes were detected in the first infection; however, only 2 genotypes were detected in the second infection. Although the H cinaedi clone showed a higher minimum inhibitory concentration to fluoroquinolones and macrolides and responsible mutations were identified, none of the 6 SNPs appeared related to additional resistance.ConclusionsThe second infection analyzed here was a relapse of the first infection. A certain level of within-host genomic heterogeneity of the H cinaedi clone was already present in the first infection. Our results suggest the importance of longer treatment courses to eradicate H cinaedi for preventing the relapse of its infection.

Clinical outcome and laboratory markers for predicting disease activity in patients with disseminated opportunistic infections associated with anti-interferon-γ autoantibodies.

BackgroundClinical courses and treatment outcomes are largely unknown in patients with adult-onset immunodeficiency associated with anti-interferon-gamma autoantibodies due to the fact that it was recently recognized and anti-IFN-γ auto-Abs detection is not widely available.Methods and findingsNon-HIV-infected adult patients with detectable anti-IFN-γ auto-Abs diagnosed and followed at Siriraj Hospital, Bangkok, Thailand during January 2013 to November 2016 were prospectively studied. At each follow-up visit, patients were classified as stable or active disease according to symptoms and signs, and all proven OIs were recorded. Laboratory parameters, including erythrocyte sedimentation rate, C-reactive protein, and anti-IFN-γ auto-Abs level, were compared between active and stable disease episodes. We identified 80 patients with this clinical syndrome and followed them up during study period. Seventy-nine patients developed overall 194 proven opportunistic infections. Mycobacterium abscessus (34.5%) and Salmonella spp. (23.2%) were the two most common pathogens identified among these patients. Sixty-three patients were followed for a median of 2.7 years (range 0.6–4.8 years). Eleven (17.5%) patients achieved the drug-free remission period for at least 9 months. Four patients died. Anti-IFN-γ auto-Abs concentration was significantly lower at baseline and decreased over time in the drug-free remission group compared to another group (p = 0.001). C-reactive protein, erythrocyte sedimentation rate and white cell count were found to be useful biomarkers for determining disease activity during follow-up.ConclusionsReinfection or relapse of OIs is common despite long-term antimicrobial treatment in patients with anti-IFN-γ auto-Abs. Treatment to modify anti-IFN-γ auto-Abs production may improve long-term outcomes in this patient population.

Chronic prostatitis caused by extended-spectrum β-lactamase-producing Escherichia coli managed using oral fosfomycin—A case report

Prostatitis is a clinical condition of difficult management and with limited antimicrobial options, especially in the setting of antimicrobial resistance. Recurrences are frequent and can be severe. Limited reports support the use of fosfomycin for chronic prostatitis by ESBL-producing bacteria. We reported a case of a patient with chronic prostatitis caused by ESBL-producing Escherischia coli with several relapses after prolonged periods of treatment with broad-spectrum intravenous antibiotic therapy and with recurring urinary symptoms after transuretheral prostatic resection. After resolution of the last infection, we performed a long-term eradication antimicrobial treatment with 3 g of fosfomycin once daily, altered to 3 g every 48 h after 10 days due to diarrhea (which resolved with the dose change). After three months with this dosage, fosfomycin was switched to a once-weekly regimen which was maintained for further 9 months. After 9 months of follow-up without antimicrobial treatment, the patient has remained free of urinary symptoms. Experience with fosfomycin for chronic prostatitis caused by ESBL-producing E. coli is limited to three case reports and two case series. Intraprostatic measurements have shown adequate penetration of fosfomycin into prostatic tissue. Accordingly, our report suggests that fosfomycin can be used as eradication therapy in a patient with a prior history of chronic prostatitis by ESBL-producing bacteria with recurring urinary infections after surgical treatment.

Stability of benzylpenicillin potassium and ampicillin in an elastomeric infusion pump.

Some infectious diseases, such as infective endocarditis, osteomyelitis, and abscesses, require treatment with long-term intravenous antimicrobial treatment. Therefore, the patient is required to stay in the hospital to receive therapy, which lowers their quality of life. Establishing an outpatient parenteral antimicrobial therapy (OPAT) by continuous infusion pump is desired in Japan to overcome these issues. However, the 24-h stability of antimicrobial agents dissolved in infusion solutions is unclear. Thus, we investigated the stability of antimicrobial agents in five different infusion solutions in a clinical setting. Benzylpenicillin potassium (PCG) and ampicillin (ABPC) were dissolved separately in five different infusion solutions and kept at 25 or 31.1°C for 24h. The residual ratios were determined by high-performance liquid chromatography (HPLC). Dissolved PCG in acetate ringer solution remained stable for 24h at temperatures of 25 and 31.1°C (101.7±1.4% and 92.9±1.3%, respectively). In addition, the PCG solution did not adsorb onto the elastomeric infusion pump after 24h at 31.1°C. PCG dissolved in acetate ringer solution was also stable for 10 days after being kept in an elastomeric infusion pump at 4°C (99.7±0.5%). ABPC was unstable in all of the tested infusion solutions and temperatures. Based on our results, PCG in acetate ringer solution can be used in OPAT with continuous infusion pumps.

Nocardia paucivorans brain abscess. Clinical and microbiological characteristics.

Nocardia paucivorans brain abscesses are unusual in humans. Sixteen cases of this infection have been reported in the world medical literature. There is precise clinical information available from nine patients. All of these patients recovered or were cured from their brain disease with long-term antimicrobial treatment. Surgical drainage was performed in four patients.

Treatment of mandibular osteomyelitis in two red-necked wallabies (Macropus rufogriseus) by means of intensive long-term parenteral drug administration and serial computed tomographic monitoring

CASE DESCRIPTION 2 female red-necked wallabies (Macropus rufogriseus) were evaluated because of sudden-onset mandibular swelling, ptyalism, and hyporexia. CLINICAL FINDINGS Physical examination revealed a mandibular swelling with a fluctuant center in both wallabies. Hematologic analysis revealed leukocytosis with a mature neutrophilia and monocytosis in one wallaby (case 1) and a slight neutrophilia, hyperglobulinemia, and high serum alanine aminotransferase activity in the other (case 2). Cytologic examination of the swelling revealed a uniform population of gram-negative rods in case 1 and neutrophilic inflammation in case 2. Radiography revealed a soft tissue mandibular swelling with osteolucency around mandibular incisor roots in both wallabies. Computed tomography revealed changes consistent with chronic active mandibular osteomyelitis and reactive bone formation, but also sequestra formation not appreciable via radiography. TREATMENT AND OUTCOME Long-term antimicrobial treatment was initiated with clindamycin (17 to 21 mg/kg [7.7 to 9.5 mg/lb], IV, q 12 h for 40 to 55 days) and high-dose benzathine penicillin G (80,000 U/kg [36,364 U/lb], SC, q 12 h for 150 days). Serial CT was performed to evaluate response to treatment and resolution of disease. A CT scan 18 months after the initial evaluation revealed complete resolution of osteomyelitis and sequestra. CLINICAL RELEVANCE Advanced imaging and long-term treatment and management were integral to the successful outcome for these wallabies, given that the osseous changes visible on CT images were not visible on standard radiographs, guiding therapeutic decision-making. This report provides new therapeutic and diagnostic monitoring information to assist clinicians with similar cases.

Host-Guest Self-Assembly Toward Reversible Thermoresponsive Switching for Bacteria Killing and Detachment.

A facile method to construct reversible thermoresponsive switching for bacteria killing and detachment was currently developed by host-guest self-assembly of β-cyclodextrin (β-CD) and adamantane (Ad). Ad-terminated poly(N-isopropylacrylamide) (Ad-PNIPAM) and Ad-terminated poly[2-(methacryloyloxy)ethyl]trimethylammonium chloride (Ad-PMT) were synthesized via atom transfer radical polymerization, and then assembled onto the surface of β-CD grafted silicon wafer (SW-CD) by simply immersing SW-CD into a mixed solution of Ad-PNIPAM and Ad-PMT, thus forming a thermoresponsive surface (SW-PNIPAM/PMT). Atomic force microscopy (AFM), X-ray photoelectron spectrometry (XPS), and water contact angle (WCA) analysis were used to characterize the surface of SW-PNIPAM/PMT. The thermoresponsive bacteria killing and detachment switch of the SW-PNIPAM/PMT was investigated against Staphyloccocus aureus. The microbiological experiments confirmed the efficient bacteria killing and detachment switch across the lower critical solution temperature (LCST) of PNIPAM. Above the LCST, the Ad-PNIPAM chains on the SW-PNIPAM/PMT surface were collapsed to expose Ad-PMT chains, and then the exposed Ad-PMT would kill the attached bacteria. While below the LCST, the previously collapsed Ad-PNIPAM chains became more hydrophilic and swelled to cover the Ad-PMT chains, leading to the detachment of bacterial debris. Besides, the proposed method to fabricate stimuli-responsive surfaces with reversible switches for bacteria killing and detachment is facile and efficient, which creates a new route to extend the application of such smart surfaces in the fields requiring long-term antimicrobial treatment.

Curcumin rescues Caenorhabditis elegans from a Burkholderia pseudomallei infection.

The tropical pathogen Burkholderia pseudomallei requires long-term parenteral antimicrobial treatment to eradicate the pathogen from an infected patient. However, the development of antibiotic resistance is emerging as a threat to this form of treatment. To meet the need for alternative therapeutics, we proposed a screen of natural products for compounds that do not kill the pathogen, but in turn, abrogate bacterial virulence. We suggest that the use of molecules or compounds that are non-bactericidal (bacteriostatic) will reduce or abolish the development of resistance by the pathogen. In this study, we adopted the established Caenorhabditis elegans-B. pseudomallei infection model to screen a collection of natural products for any that are able to extend the survival of B. pseudomallei infected worms. Of the 42 natural products screened, only curcumin significantly improved worm survival following infection whilst not affecting bacterial growth. This suggested that curcumin promoted B. pseudomallei-infected worm survival independent of pathogen killing. To validate that the protective effect of curcumin was directed toward the pathogen, bacteria were treated with curcumin prior to infection. Worms fed with curcumin-treated bacteria survived with a significantly extended mean-time-to-death (p < 0.0001) compared to the untreated control. In in vitro assays, curcumin reduced the activity of known virulence factors (lipase and protease) and biofilm formation. To determine if other bacterial genes were also regulated in the presence of curcumin, a genome-wide transcriptome analysis was performed on curcumin-treated pathogen. A number of genes involved in iron acquisition and transport as well as genes encoding hypothetical proteins were induced in the presence of curcumin. Thus, we propose that curcumin may attenuate B. pseudomallei by modulating the expression of a number of bacterial proteins including lipase and protease as well as biofilm formation whilst concomitantly regulating iron transport and other proteins of unknown function.

Shorter treatments for vertebral osteomyelitis

Vertebral osteomyelitis is a particular infection of bone and surrounding tissues that tends to affect elderly patients more than younger patients. It has been increasing in incidence in the past few years, in line with the general ageing of the population and the resulting increase in chronic diseases, and with the greater availability of MRI. 1 Zimmerli W Vertebral osteomyelitis. N Engl J Med. 2010; 362: 1022-1029 Crossref PubMed Scopus (365) Google Scholar , 2 Lew DP Waldvogel FA Osteomyelitis. Lancet. 2004; 364: 369-379 Summary Full Text Full Text PDF PubMed Scopus (1268) Google Scholar , 3 Mylona E Samarkos M Kakalou E Fanourgiakis P Skoutelis A Pyogenic vertebral osteomyelitis: a systematic review of clinical characteristics. Semin Arthritis Rheum. 2009; 39: 10-17 Summary Full Text Full Text PDF PubMed Scopus (358) Google Scholar Although related mortality is low, the frequency of sequelae and associated morbidity is a concern in this group of patients. Overall, a high proportion of patients with vertebral osteomyelitis are cured, usually after receiving long-term antimicrobial treatment and no concomitant surgery, by contrast with other types of osteomyelitis. 1 Zimmerli W Vertebral osteomyelitis. N Engl J Med. 2010; 362: 1022-1029 Crossref PubMed Scopus (365) Google Scholar , 2 Lew DP Waldvogel FA Osteomyelitis. Lancet. 2004; 364: 369-379 Summary Full Text Full Text PDF PubMed Scopus (1268) Google Scholar , 3 Mylona E Samarkos M Kakalou E Fanourgiakis P Skoutelis A Pyogenic vertebral osteomyelitis: a systematic review of clinical characteristics. Semin Arthritis Rheum. 2009; 39: 10-17 Summary Full Text Full Text PDF PubMed Scopus (358) Google Scholar However, current recommendations on the most appropriate antibiotics, route of administration, and length of therapy are mainly based on expert opinion and extrapolation from observational studies, 1 Zimmerli W Vertebral osteomyelitis. N Engl J Med. 2010; 362: 1022-1029 Crossref PubMed Scopus (365) Google Scholar , 4 Stengel D Bauwens K Sehouli J Ekkernkamp S Porzsolt F Systematic review and meta-analysis of antibiotic therapy for bone and joint infections. Lancet Infect Dis. 2001; 1: 175-188 Summary Full Text Full Text PDF PubMed Scopus (238) Google Scholar and randomised controlled trials are scarce. Antibiotic treatment for 6 weeks versus 12 weeks in patients with pyogenic vertebral osteomyelitis: an open-label, non-inferiority, randomised, controlled trial6 weeks of antibiotic treatment is not inferior to 12 weeks of antibiotic treatment with respect to the proportion of patients with pyogenic vertebral osteomyelitis cured at 1 year, which suggests that the standard antibiotic treatment duration for patients with this disease could be reduced to 6 weeks. Full-Text PDF

Complications of Fungal Cystitis

Fungal infection of the urinary tract is a relatively rare condition. The incidence ranges from 1-2.2 %. Patients who are critically ill, on long-term antimicrobial treatment, who have an indwelling catheter or suffer from diabetes mellitus, are more susceptible to getting fungal infection. Complications of fungal infection of the bladder include emphysematous cystitis, fungus balls (Bezoars and mycetomas), obstructive uropathy, pyelonephritis, papillary necrosis, intrarenal and perinephric abscesses, prostatitis and epididymo-orchitis. The main treatment includes antifungal agents such as fluconazole and surgical intervention.