Antibiotic Research Articles

Gum Arabic as a potential candidate in quorum quenching and treatment of periodontal diseases.

Periodontal diseases are chronic inflammatory conditions influenced by bacterial biofilm formation and host immune responses, affecting millions worldwide. Traditional treatments like mechanical debridement and systemic antibiotics often face limitations, including biofilm resilience and antibiotic resistance. Gum Arabic (GA), a natural exudate from Acacia trees, presents a promising alternative with its anti-biofilm and anti-inflammatory properties. This review highlights the role of GA in periodontal therapy, particularly its ability to interfere with quorum sensing (QS) pathways, specifically the AI-2 signaling system used by key periodontal pathogens such as Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, and Fusobacterium nucleatum. By disrupting QS, GA inhibits biofilm formation, reduces bacterial virulence, and promotes a balanced oral microbiome. GA's prebiotic properties also encourage the growth of beneficial bacteria, enhancing the host's immune response while preserving the systemic microbiome. Clinical studies demonstrate GA's effectiveness as an adjunct in periodontal therapy, with significant reductions in plaque accumulation, gingival inflammation, and bleeding. This highlights GA's potential as a natural therapeutic agent, offering an effective, antibiotic-sparing option in managing periodontal disease. However, further research is warranted to fully establish GA's role in comprehensive periodontal care and its long-term benefits.

"Sterile hypopyon following pars plana vitrectomy and silicone oil injection".

To report five cases of post-operative sterile endophthalmitis in patients who underwent pars plana vitrectomy with silicone oil injection for retinal detachment. Review of the medical records of five patients who underwent pars plana vitrectomy with silicone oil injection at Southend University Hospital and the Royal Eye Infirmary, Derriford Hospital for rhegmatogenous or tractional retinal detachment. All five patients presented with signs of anterior chamber inflammation exhibiting flare, fibrin and hypopyon in the early or late post-operative period following vitrectomy with silicone oil injection. Treatment with topical antibiotics and steroids was commenced, with rapid resolution of the anterior chamber inflammatory reaction and no further intervention required. The use of silicone oil as a tamponade agent for retinal detachment can rarely induce sterile anterior chamber inflammation with signs resembling infectious endophthalmitis. Onset of symptoms, absence of pain and good response to topical steroids can help differentiate between the two entities.

Gram-Negative Bacteremia: Epidemiology and Antimicrobial Resistance in Qatar

One of the major causes of morbidity and mortality in hospitalised patients is the presence of gram-negative bacteremia (GNB) in blood. The developed resistance among the bacteria poses a significant challenge for treatment. The study aimed to identify the gram-negative patient’s epidemiological risk factors, antimicrobial susceptibility patterns, and clinical outcomes. A retrospective observational study of adult in-patients with gram-negative bacteremia was conducted between January 2019 and December 2020 in the 320-bed general hospital in Qatar. Data on demographics, antimicrobial resistance, source of infection, and treatment were collected. The primary outcomes were patients’ cure, death, or relapse. Total of 357 patients were identified with bacteremia, the most common sources being urinary tract infections (39.6%), intra-abdominal infections (28%), and lower respiratory tract infections (9%). The mean duration of the intravenous and oral antibiotics administration was 14 days. Surgical source control was performed in 35.7% of patients. Common pathogens were Escherichia-coli (47.2%), Klebsiella pneumoniae (16.4%), Salmonella enterica serotype Typhi (10.6%), and Pseudomonas aeruginosa (7.8%). 67.32% fully susceptible strains, 31.56% extended-spectrum beta-lactamase (ESBL) producing bacteria, and 1.11% multidrug-resistant organisms (MDROs) were among the isolates. Most infections (68%) were cured, but 5% had recurrence within 90 days of admission. Infection-related mortality was 8%, and death due to non-infectious causes was 2%. In conclusion, Gram-negative BSIs are severe infections with increasing antimicrobial resistance, primarily caused by ESBL-producing bacteria. High mortality rates are linked to diabetes, age, and hospitalisation, necessitating antibiotic treatment optimisation.

Trigeminal Trophic Syndrome With Herpetic Keratitis.

The aim of this study was to report a rare observation of trigeminal trophic syndrome presenting with concurrent herpetic keratitis. This study was a case report. A 42-year-old male with a remote history of a motor vehicle accident, traumatic brain injury, extensive facial reconstructive surgery, and traumatic optic neuropathy presented with left periorbital swelling. He was found to have extensive periorbital and total hypoesthesia in the cranial nerve V1 distribution and partial hypoesthesia in the V2 distribution. Corneal findings were highly suspicious for herpes simplex keratitis or zoster ophthalmicus. The patient was diagnosed with herpetic epithelial and stromal keratitis with periorbital ulceration secondary to Trigeminal trophic syndrome. The patient was treated broad spectrum intravenous antibiotics, intravenous acyclovir, and topical antibiotics. He was treated with topical steroids upon closure of epithelial defect. Upon discharge, the patient's vision improved from hand-motion to 20/30 at near. The patient was later fit with a custom thermoplastic facial mask to minimize further selfinjurious behavior. To our knowledge, this is the first report of trigeminal trophic syndrome presenting with concurrent herpetic keratitis. Successful treatment requires a multidisciplinary approach to provide the patient insight and create protective equipment.

The Essential Role of Herbal-based Therapies in Combatting Acne Vulgaris

Inflammation, follicular epidermal hyperproliferation, and Propionibacterium acnes (P. acnes) are the primary causes of acne vulgaris, a prevalent skin condition that affects millions of young adults and adolescents. This intricate pathophysiology leads to various acne symptoms, such as whiteheads and blackheads, inflammatory nodules, and scarring. Among the many traditional allopathic acne therapies that often have serious side effects include hormone therapy, hydroxy acids, oral and topical antibiotics, retinoic acid derivatives, and acne medications. Herbal extracts are becoming more and more well-liked as more holistic, kinder substitutes with fewer side effects. Herbal extracts with antibacterial, anti-inflammatory, and antioxidant qualities include Eucalyptus Globulus, Thymus vulgaris (thyme), Melaleuca alternifolia (tea tree), Lavandula angustifolia (lavender), Origanum vulgare (oregano), and Curcuma longa (turmeric). Because of these qualities, they are considered to be viable candidates for treating different elements of acne etiology, including wound healing, inflammation reduction, and P. acnes growth inhibition. Developing herbal remedies is a viable approach to developing efficient and minimally invasive acne treatments. Medicinal plants and essential oils have a long history of traditional use and the potential to attenuate harmful exposures and lessen drug-induced side effects. Their use in dermatological treatments demonstrates their ability to offer comprehensive and natural solutions for the treatment of acne vulgaris, a common and frequently upsetting skin condition.

Unexpected positive cultures in aseptic revision hip and knee arthroplasty.

The outcomes of patients with unexpected positive cultures (UPCs) during revision total hip arthroplasty (THA) and total knee arthroplasty (TKA) remain unknown. The objectives of this study were to establish the prevalence and infection-free implant survival in UPCs during presumed aseptic single-stage revision THA and TKA at mid-term follow-up. This study included 297 patients undergoing presumed aseptic single-stage revision THA or TKA at a single treatment centre. All patients with at least three UPCs obtained during revision surgery were treated with minimum three months of oral antibiotics following revision surgery. The prevalence of UPCs and causative microorganisms, the recurrence of periprosthetic joint infections (PJIs), and the infection-free implant survival were established at minimum five years' follow-up (5.1 to 12.3). Of the 297 patients undergoing aseptic revisions, 37 (12.5%) had at least three UPCs obtained during surgery. The UPC cohort included 23 males (62.2%) and 14 females (37.8%), with a mean age of 71.2 years (47 to 82). Comorbidities included smoking (56.8%), hypertension (48.6%), diabetes mellitus (27.0%), and chronic renal impairment (13.5%). The causative microorganisms included Staphylococcus epidermidis (49.6%), Bacillus species (18.9%), Micrococcus species (16.2%), and Cutibacterium acnes (16.2%). None of the study patients with UPCs developed further PJIs or required further surgical intervention during follow-up. The prevalence of UPCs during presumed aseptic revision THA and TKA was 12.5%. The most common causative microorganisms were of low virulence, and included S. epidermidis, Bacillus species, Micrococcus species, and C. acnes. Microorganism-specific antibiotic treatment for minimum three months' duration of UPCs in presumed aseptic revision arthroplasty was associated with excellent infection-free implant survival at mid-term follow-up.

Risk Factors for Empiric Treatment Failure in US Female Outpatients with Uncomplicated Urinary Tract Infection: an Observational Study.

Treatment failure (TF) in uncomplicated urinary tract infection (uUTI) increases disease burden and risk of antimicrobial resistance. Identification of risk factors for TF could inform empiric treatment decisions and reduce suboptimal outcomes. To evaluate the incidence of TF to empirically prescribed oral antibiotics and identify risk factors for TF in females with uUTI in the United States (US). This retrospective cohort study used Optum's de-identified Electronic Health Record dataset (January 2017-September 2022). Eligible female patients aged ≥ 12years had ≥ 1 diagnosis of urinary tract infection (UTI) in an outpatient ambulatory/emergency department (ED) setting, ≥ 1 empiric oral antibiotic prescription, and no evidence of complicated UTI (cUTI). TF was defined as having a new/repeat oral antibiotic prescription, IV antibiotic administration or acute UTI diagnosis ≤ 28days following initial empiric oral antibiotic prescription​. Risk factors of TF were selected using LASSO and reported using adjusted risk ratios (aRR) and 95% CIs. Of 376,004 patients with uUTI, 62,873 (16.7%) experienced TF. Incidence of TF was highest in patients with history of antibiotic TF (33.9%) or fosfomycin prescription (30.1%). Significant risk factors of TF included ≥ 3 prior antibiotic prescriptions (aRR [95% CI]: 1.60 [1.56-1.64]); fosfomycin prescription (1.60 [1.38-1.86]); uUTI diagnosis in ED (1.49 [1.46-1.52]), Southern US residence (1.37 [1.35-1.40]), age ≥ 75years (1.35 [1.29-1.41]), recurrent UTI (1.12 [1.10-1.14]) and obesity (1.06 [1.04-1.08]). Incidence of TF to empirically prescribed oral antibiotics for uUTI is considerable. Prior infections requiring antibiotic prescription and location of care are key risk factors for TF in female outpatients with uUTI. Knowledge of these TF risk factors can inform shared-decision making and supplement existing guidance on uUTI treatment.

A-253 Antimicrobial Susceptibility Pattern in Escherichia coli Isolated From Community-Acquired Urinary Tract Infections in the era Post-Covid-19

Abstract Background Urinary tract infections (UTI) are one of the most common infectious diseases diagnosed in the community as well as in hospitals. Community-acquired urinary tract infections caused by Escherichia coli represent the largest proportion of infectious diseases affecting women and a significant amount of oral antibiotics are prescribed daily to treat UTI in community outpatient clinics. Having knowledge of regional susceptibility data regarding E. coli is very important for selecting an appropriate empirical antibiotic. This study aimed to report the frequency and antimicrobial susceptibility of E. coli isolated from community-acquired urinary tract infections post-Covid-19 pandemic. Methods This study was a retrospective analysis from January to December 2023 based on the analysis of 24,019 uropathogens isolated from 182 outpatient health centers located in several regions of São Paulo city, Brazil. The urine samples were cultivated onto ChromID™CPS® agar plates by semi-quantitative technique using 1µL disposable loop, incubated at 35-37°C and the colony counting were read after 24h and 48h of incubation. The bacteria identification was performed by MALDI-TOF mass spectrometry (Vitek-MS), and the minimal inhibitory concentrations of antibiotics were determined using the Vitek®2 system, according to the manufacture’s recommendations. Only positive results with one bacterial species and a colony count ≥105 CFU/mL was considered for descriptive analysis. Results Of the 24,019 urine samples tested, 71.44% (17,159/24,019) were identified as Escherichia coli. The major frequency of E. coli infection occurred among women (90.48%) and the main age range was over 60 years (38.57%), while 21-30 comprised 16.5% of cases. The antimicrobial resistance profile for E. coli isolates showed 39.9% (6852/17158) of resistance to ciprofloxacin (MIC, >0.5 mg/L), 34.7% (5,921/17,075) to trimethoprim/sulfamethoxazole (MIC, >0.5 mg/L), 37.5% (6,371/17,002) to Amoxicillin/clavulanate (MIC, >8 mg/L), 8.75% (1,501/17,592) to ceftriaxone (MIC, >1 mg/L), 4.88% (837/17,138) to cefepime (MIC, >4 mg/L), 3.64% (616/16,901) to piperacillin/tazobactam (MIC, >8 mg/L), 11.07% (1,900/17,156) of gentamicin (MIC, >2 mg/L), 0.43% (74/17,158) of amikacin (MIC, >8 mg/L) and 2.23% (377/16,909) of fosfomycin (MIC, >16 mg/L). High-level of susceptibility was detected to carbapenems with 99.94% (10/17159) to ertapenem (MIC, ≤0.5 mg/L) and 99.8% (4/17,159) to meropenem (MIC, ≤2 mg/L). The rate of Extended-spectrum beta-lactamase production was 8.1% (1391/17159). Conclusions This data could be used locally with other related samples, to properly interpret significant resistance patterns and choose the most appropriate antimicrobial for empirical treatment of patients with community-acquired urinary tract infections.

Low incidence of acute kidney injury with combined intravenous and topical antibiotic infusions in periprosthetic joint infection after total knee arthroplasty.

This study aimed to assess the risk of acute kidney injury (AKI) associated with combined intravenous (IV) and topical antibiotic therapy in patients undergoing treatment for periprosthetic joint infections (PJIs) following total knee arthroplasty (TKA), utilizing the Kidney Disease: Improving Global Outcomes (KDIGO) criteria for classification. We conducted a retrospective analysis of 162 knees (162 patients) that received treatment for PJI post-TKA with combined IV and topical antibiotic infusions at a single academic hospital from 1 January 2010 to 31 December 2022. The incidence of AKI was evaluated using the KDIGO criteria, focussing on the identification of significant predictors and the temporal pattern of AKI development. AKI was identified in 9.26% (15/162) of the cohort, predominantly presenting as stage 1 AKI, which was transient in nature and resolved prior to discharge. The analysis highlighted moderate anaemia and lower baseline serum creatinine levels as significant predictors for the development of AKI. Notably, the study found no instances of severe complications such as wound dehiscence, skin erosion, or the need for haemodialysis following treatment. The findings suggest that the combined use of IV and topical antibiotic therapy in the management of PJIs post-TKA is associated with a low incidence of primarily transient stage 1 AKI. This indicates a potentially favourable renal safety profile, advocating for further research to confirm these outcomes and potentially influence treatment protocols in PJI management.

Recent Trends in Therapeutic Drug Monitoring of Peptide Antibiotics.

Antimicrobial peptides take a specific position in the field of antibiotics (ATBs), however, from a large number of available molecules only a few of them were approved and are used in clinics. These therapeutic modalities play a crucial role in the management of diseases caused by multidrug-resistant bacterial pathogens and represent the last-line therapy for bacterial infections. Therefore, there is a demand for a rationale use of such ATBs based on optimization of the dosing strategy to minimize the risk of resistance and ensure the sustainable efficacy of the drug in real clinical practice. Therapeutic drug monitoring, as a measurement of drug concentration in the body fluids or tissues, results in the optimization of the patient´s medication and therapy outcome. This strategy is beneficial and could result in tailored therapy for different types of infection and the prolongation of the use and efficacy of ATBs in hospitals. This review paper provides an actual overview of approved antimicrobial peptides used in clinical practice and covers current trends in their analysis by convenient and advanced methodologies used for their identification and/or quantitation in biological matrices for therapeutic drug monitoring purposes. Special emphasis is given to the methods with perspective clinical outcomes.

Acute Hematogenous Osteomyelitis in Pediatric Patients.

This article focuses on the advancements made in diagnostic techniques and drug interventions of acute hematogenous osteomyelitis. A diagnosis necessitates a combination of factors, including inflammatory markers and imaging findings, as well as the collection of specimens for culture when feasible. Subsequently, treatment should be based on epidemiology, mechanisms of resistance, and susceptibility findings. A brief course of intravenous (IV) antibiotics, followed by oral antibiotics, may be employed for uncomplicated infections if there is improvement in the clinical condition and a decline in C-reactive protein levels. However, for complex infections caused by methicillin-resistant Staphylococcus aureus, prolonged administration of IV antibiotics is recommended, along with surgical intervention if necessary. [Pediatr Ann. 2024;53(10):e392-e395.].

Etiology and Outcomes of Acute Infectious Conjunctivitis in Children

To determine the causes of conjunctivitis and whether clinical presentations and outcomes differ by pathogen. This multicenter, case-control study enrolled 390 children (194 cases, 196 controls) whose conjunctival samples were tested for bacterial and viral pathogens. Caregivers completed surveys tracking symptoms, antibiotic use, school attendance, and adverse events. The outcomes analyzed included the prevalence of microorganisms detected by PCR in cases versus controls, symptoms, rate of resolution by day 5, school/childcare attendance, and parent-reported antibiotic-related adverse incidents. Most cases (148, 76%) and controls (112, 57%) had bacteria identified, although only detection of Haemophilus influenzae was associated with conjunctivitis (aOR 4.59, 95% CI 2.86, 7.37). Purulent discharge was associated with H. influenzae (aOR 2.47, 95% CI 1.23, 5.01) and occurred in 92 (77%) cases in which H. influenzae was detected and 39 (53%) in which H. influenzae was not detected. Improvement (186, 96%) and resolution (166, 86%) were observed by day 5 for most children and did not differ based on ophthalmic antibiotic use. Caregivers reported antibiotic-associated adverse events for 21 (20%) children with 8 (8%) requiring a medical visit. Only H. influenzae was significantly associated with conjunctivitis. Symptoms did not differ in children with or without bacteria detected by PCR. Independent of antibiotic use, most children experienced resolution by day 5, but parents reported adverse events in 20% of children treated with topical antibiotics, underscoring the importance of judicious prescribing.

Intraosseous regional antibiotic prophylaxis in total joint arthroplasty (TJA): Systematic review and meta-analysis

BackgroundA major catastrophic adverse event after total joint arthroplasty surgery (TJA) is the periprosthetic joint infection (PJI). In the recent years, regional antibiotic prophylaxis has gained momentum as a novel infection control strategy in total knee arthroplasty (TKA), with different purported benefits over systemic administration. The current article was planned to comprehensively review the available evidence in literature; as well as compare the safety and effectiveness of intraosseous (IO) antibiotic prophylaxis with systemic prophylaxis in patients undergoing TJA. MethodsAn independent database (5 databases: Pubmed, Scopus, Embase, Web of science and Cochrane library) search was performed (on January 1, 2024) using suitable key words [PROSPERO (registration number: CRD42023458219)]. All randomised controlled trials (RCT), prospective or retrospective studies reporting data on intraosseous vancomycin or other antibiotics during arthroplasty for prophylaxis of PJI were considered. Studies not pertaining to the topic of interest or non-clinical trials were excluded. The evaluated outcome parameters included PJI incidence, systemic antibiotic levels, minimal inhibitory concentrations, local antibiotic concentrations achieved in soft tissues (or fat) and bone; and associated complications. While the “risk of bias” was evaluated using ROB-2 tool and MINORS criteria; LibreOffice version (v)7.5.6 was utilized for data management. OpenMeta-analyst v5.26.14 and RevMan v5.4 software were employed for meta-analysis. ResultsFollowing our literature search, 11 studies (1 prospective series, 6 RCT and 4 retrospective studies) were finally identified. Based on our meta-analysis, there was statistically higher antibiotic concentration in the bone [meandifference(MD):25.12 μg/g;95%CI:10.32,39.91;z=3.33,p = 0.0009] and local fat tissues [MD:22.01 μg/g;95%CI:1.71,32.30;z=4.19,p < 0.0001) following IO prophylaxis, as compared with the systemic drug administration. IO prophylaxis was also associated with a significant reduction in prosthetic joint infections (PJI; April 1633 and 25/2213 patients developed PJI in IO and systemic prophylaxis groups, respectively; p = 0.006). There was significant difference in gram-positive infections between IO and systemic prophylaxis groups (2/1123 and 13/1753 g + ve infections in IO and systemic prophylaxis groups, respectively; p = 0.05). Our review and meta-analysis revealed no substantial difference in complications amongst the groups (p = 0.66). ConclusionIO antibiotic prophylaxis appears to be an effective and safe strategy in patients undergoing TJA. IO access provides substantially enhanced antibiotic elution into the local tissues (bone and soft tissues); and consequently, results in reduced of PJI rates after TJA (in comparison with conventional systemic antibiotic prophylaxis).

Managing Maggots in the Eye: A Case Series

Purpose: To describe the presentation and management of ocular maggots and to identify the factors contributing to their occurrence. Study Design: Retrospective case series. Place and Duration of Study: Department of Ophthalmology Mayo Hospital Lahore from 2015 to 2022. Methods: The study involved retrospective chart analysis of patients who presented with Ophthalmomyasis and managed in the eye department. Data regarding age, gender, occupation, clinical findings, co-morbidities, associations and environmental factors were analyzed.Larvae were removed one by one under microscope. Follow up was done after 1 week, 1 month and 3 months. In patients with orbital myasis having distorted, large ulcerated wounds/socket, turpentine oil was used and larvae were removed mechanically under microscope. Results: There were 15 fifteen patients included in the study. Underlying co-morbidities were present in 60% patients and the most common being basal cell carcinoma (46.6%). Seventy four percent patients had some systemic disease; Diabetes Mellitus, Hypertension, AIDS, Hepatitis C etc. One thirdpatients had external ophthalmo-myasis while two third had orbital myasis. Patients who did not complete follow-up were 33%. Use of suffocating agents like turpentine oil, periodic removal of larvae, topical and systemic antibiotics, topical lavage with copious irrigation with sterile fluids resulted in good outcome in all cases that completed the follow up. Conclusion: The majority of patients came from rural communities and had underlying co-morbidities. Timely management resulted in good outcomes for all patients who completed the follow-up, highlighting the importance of comprehensive and sustained treatment protocols.

CLINICAL ASSESSMENT OF ANTIBIOTICS USED IN CHRONIC KIDNEY DISEASE: A LONGITUDINAL OBSERVATIONAL STUDY

Objective: The study was conducted to clinically evaluate the safety and efficacy of antibiotic drug consumption based on laboratory data, specifically White Blood Cells(WBC) and Glomerular Filtration Rate (GFR) before and after antibiotic use in patients with chronic kidney disease. Methods: This retro-prospective longitudinal study was conducted on 115 patients with Chronic Kidney Disease (CKD) based on 6 mo of data at a tertiary care teaching institute, Geetanjali Medical College and Hospital, in Udaipur, Rajasthan. Inclusion criteria were all the patients who were admitted in the nephrology department and were above 18 y, who were receiving antibiotics, and Creatine Clearance (CrCl) was ≤ 60 ml/min were included into this study. Exclusion criteria patients with renal replacement and lacking information of laboratory data (WBC, CrCl) and those who were below the age of 18 were excluded from the study. The data were analysed using descriptive analysis. Results: The mean age of the CKD patients was 50.10 (standard deviation=17.47) y. Males were found in greater numbers than that of females with 66 (58%) and 49(42%) respectively. Patients admitted with stage 5 CKD (66%) were greater than the patients with stage 4 CKD. 10 different types of antibiotics were provided to CKD patients, of which seven had irrational doses. Piptaz, Meropenem, and Teicoplanin have the highest irrational doses incidence. Conclusion: Patients with CKD Stages 4 and 5 were given systemic antibiotics at unreasonable dosages, most frequently in the forms of piptaz, aztreonam, and meropenem injections. The incidence of irrational antibiotic dosages provided to the CKD patients was still high.

Ocular Manifestations in Paediatric Erythema Multiforme: A Case Report

Erythema multiforme (EM) is a type IV cytotoxic hypersensitivity reaction characterized by classic target lesions on the skin and mucosa, typically affecting the oral, genital, and rarely, ocular mucosa. We describe a 9-year-old girl with widespread rashes, blisters and target lesions on her trunkfor three days. She had eye redness, discomfort, a week-long fever, and a dry cough, without any medication. Ophthalmological examination revealed localized conjunctival injection in her right eye, with no visual impairment or corneal lesions. The diagnosis of EM major (EMM) was based on prior infection, characteristic skin lesions, and mucosal involvement, including ocular manifestation of conjunctival injection. Treatment requires addressing the underlying cause and ophthalmologic consultation for systemic or topical corticosteroids, antibiotics, lubricants, and antihistamines. This case highlights the diagnostic challenges of atypical EM presentations, emphasizing the need for comprehensive evaluation, early recognition, and interdisciplinary collaboration to prevent severe ocular complications and preserve vision.

Retrospective description of the clinical use of chloramphenicol in client-owned cats: 12 cases (2015-2023).

The study aimed to describe the clinical use of chloramphenicol in client-owned cats, examining the patient population, sites of infection, targeted pathogens, prescribed dosing regimen, outcomes and adverse effects. Between 2015 and 2023, a retrospective medical record review was undertaken to identify a case series of cats treated with chloramphenicol. Twelve client-owned cats with complicated infections were treated with chloramphenicol at a median dose of 13.3 mg/kg (range 9.1-34.7) administered orally every 12 h for a median duration of 14.5 days. Within 30 days before starting chloramphenicol, 11/12 cats had received treatment with at least one antibiotic. The sites of infection included skin, urinary tract and multisystemic. Multidrug-resistant pathogens, for which no alternative oral antibiotic therapy was available, were commonly targeted. These included meticillin-resistant Staphylococcus species and multidrug-resistant Enterococcus faecium. Of the 12 cats treated with chloramphenicol, nine effectively achieved either bacteriologic or clinical cure. Chloramphenicol adverse effects were uncommon and limited to gastrointestinal upset, which was self-limiting or manageable with supportive treatment in two cats. In these cats, the decision to treat with chloramphenicol was made because an alternative oral antibiotic was not available to target the multidrug-resistant pathogens. Infections of the skin or urinary tract were common. Overall, chloramphenicol was well tolerated, and treatment success was possible for most cats.

Optimal Pediatric Outpatient Antibiotic Prescribing

In the US, 50% of all pediatric outpatient antibiotics prescribed are unnecessary or inappropriate. Less is known about the appropriateness of pediatric outpatient antibiotic prescribing. To identify the overall percentage of outpatient antibiotic prescriptions that are optimal according to guideline recommendations for first-line antibiotic choice and duration. This cross-sectional study obtained data on any clinical encounter for a patient younger than 20 years with at least 1 outpatient oral antibiotic, intramuscular ceftriaxone, or penicillin prescription filled in the state of Tennessee from January 1 to December 31, 2022, from IQVIA's Longitudinal Prescription Claims and Medical Claims databases. Each clinical encounter was assigned a single diagnosis corresponding to the lowest applicable tier in a 3-tier antibiotic tier system. Antibiotics prescribed for tier 1 (nearly always required) or tier 2 (sometimes required) diagnoses were compared with published national guidelines. Antibiotics prescribed for tier 3 (rarely ever required) diagnoses were considered to be suboptimal for both choice and duration. Primary outcome was the percentage of optimal antibiotic prescriptions consistent with guideline recommendations for first-line antibiotic choice and duration. Secondary outcomes were the associations of optimal prescribing by diagnosis, suboptimal antibiotic choice, and patient- and clinician-level factors (ie, age and Social Vulnerability Index) with optimal antibiotic choice, which were measured by odds ratios (ORs) and 95% CIs calculated using a multivariable logistic regression model. A total of 506 633 antibiotics were prescribed in 488 818 clinical encounters (for 247 843 females [50.7%]; mean [SD] age, 8.36 [5.5] years). Of these antibiotics, 21 055 (4.2%) were for tier 1 diagnoses, 288 044 (56.9%) for tier 2 diagnoses, and 197 660 (39.0%) for tier 3 diagnoses. Additionally, 194 906 antibiotics (38.5%) were optimal for antibiotic choice, 259 786 (51.3%) for duration, and 159 050 (31.4%) for both choice and duration. Acute otitis media (AOM) and pharyngitis were the most common indications, with 85 635 of 127 312 (67.3%) clinical encounters for AOM and 42 969 of 76 865 (55.9%) clinical encounters for pharyngitis being optimal for antibiotic choice. Only 257 of 4472 (5.7%) antibiotics prescribed for community-acquired pneumonia had a 5-day duration. Optimal antibiotic choice was more likely in patients who were younger (OR, 0.98; 95% CI, 0.98-0.98) and were less socially vulnerable (OR, 0.84; 95% CI, 0.82-0.86). This cross-sectional study found that less than one-third of antibiotics prescribed to pediatric outpatients in Tennessee were optimal for choice and duration. Four stewardship interventions may be targeted: (1) reduce the number of prescriptions for tier 3 diagnoses, (2) increase optimal prescribing for AOM and pharyngitis, (3) provide clinician education on shorter antibiotic treatment courses for community-acquired pneumonia, and (4) promote optimal antibiotic prescribing in resource-limited settings.

Soy protein β-conglycinin ameliorates pressure overload-induced heart failure by increasing short-chain fatty acid (SCFA)-producing gut microbiota and intestinal SCFAs

Soybeans and their ingredients have antioxidant and anti-inflammatory effects on cardiovascular diseases. β-Conglycinin (β-CG), a major constituent of soy proteins, is protective against obesity, hypertension, and chronic kidney disease, but its effects on heart failure remain to be elucidated. We tested the effects of β-CG on left ventricular (LV) remodeling in pressure overload-induced heart failure. A transverse aortic constriction (TAC)-induced pressure overload was applied to the heart in 7-week-old C57BL6 male mice that were treated with β-CG, GlcNAc, or sodium propionate. Gut microbiota was analyzed by 16S rRNA sequencing. Fecal short-chain fatty acids (SCFAs) were quantified by GC-MS. The effects of oral antibiotics were examined in β-CG-fed mice. β-CG ameliorated impaired cardiac contractions, cardiac hypertrophy, and myocardial fibrosis in TAC-operated mice. As β-CG is a highly glycosylated protein, we examined the effects of GlcNAc. GlcNAc had similar but less efficient effects on LV remodeling compared to β-CG. β-CG increased three major SCFA-producing intestinal bacteria, as well as fecal concentrations of SCFAs, in sham- and TAC-operated mice. Oral administration of antibiotics nullified the effects of β-CG in TAC-operated mice by markedly reducing SCFA-producing intestinal bacteria and fecal SCFAs. In contrast, oral administration of sodium propionate, one of SCFAs, ameliorated LV remodeling in TAC-operated mice to a similar extent as β-CG. β-CG was protective against TAC-induced LV remodeling, which was likely to be mediated by increased SCFA-producing gut microbiota and increased intestinal SCFAs. Modified β-CG and/or derivatives arising from β-CG are expected to be developed as prophylactic and/or therapeutic agents to ameliorate devastating symptoms in heart failure.

Review - Expert Opinion on Antibiotics and Antibiotic Resistance in Dermatology.

Antibiotic resistance has become a serious, severe problem worldwide. This issue does not only relate to the use of systemic antibiotics but to topical ones as well, like systemic therapies and local treatment of skin and mucosal infections. Antiseptics, an alternative to the topical treatment with antibiotics of wounds and some inflammatory dermatological conditions, tend to be microbicidal and have a broader spectrum of antimicrobial activity than antibiotics. Among these, polyhexanide (PHMB) allows for the control of the infection while avoiding the development of resistance. Recommendations on the rules of good clinical practice for the management of small wounds, burns and post-traumatic ulcerative wounds, impetigo or folliculitis in the initial stages, and acne. Literature review on the principal topical therapies for small wounds, injuries, impetigo, folliculitis, and acne and a proposal of innovative, highly-tolerated treatments. Given the abuse of topical antibiotics in dermatology, for the treatment of small wounds, injuries, localized folliculitis, impetigo, and acne, the use of alternative topical treatments like polyhexanide and Rigenase® is recommended.