Penicillinase-resistant Penicillins Research Articles

The association between drugs and vaccines commonly prescribed to older people and bullous pemphigoid: a case-control study.

Bullous pemphigoid (BP) is an autoimmune skin disease that affects mainly older people. Numerous drugs have been previously associated with BP based on case series and small hospital-based studies. More reliable and precise estimates of associations between a broad selection of drugs/vaccines and BP will enable greater awareness of potential increased risk of BP following certain medicines and help identify clinical, histological and genomic characteristics of drug-induced BP for different types of culprit drugs. Greater awareness could lead to earlier recognition or suspicion of BP and referral to a dermatologist for diagnosis. Earlier diagnosis may lead to less aggressive treatment and improved well-being. To determine the association between drugs/vaccines commonly prescribed to older people and BP risk. We conducted a population-based nested case-control study between 1998-2021 using electronic primary care records from the Clinical Practice Research Datalink. We matched BP cases with up to 5 controls. Exposures were drugs/vaccines commonly prescribed to older people. We used multivariable conditional logistic regression adjusting for multiple drug use. For antibiotics, we considered prescriptions may be prescribed for undiagnosed symptoms of BP which resemble skin infection (protopathic bias) in a sensitivity analysis. Antibiotics were the therapeutic group associated with the highest risk of BP (OR: 4.60; 95%CI 4.40-4.80). However, after adjusting for protopathic bias, the OR reduced to 2.08 (95%CI 1.99-2.17). After adjusting for protopathic bias, of all antibiotic classes and subclasses, penicillins and penicillinase-resistant penicillins had the strongest associations with BP risk (OR: 3.44; 95%CI 3.29-3.60; sensitivity analysis OR; 1.74; 1.66-1.84 and OR: 7.56; 95%CI 7.15-8.00; sensitivity analysis OR: 2.64; 95%CI 2.45-2.85, respectively). Other drugs strongly associated with increased risk were gliptins (OR: 2.77; 95% CI 2.37-3.23), and second-generation antipsychotics (OR: 2.58; 95%CI 2.20-3.03). Healthcare professionals need to be aware of BP risk in older people particularly when prescribing penicillinase-resistant penicillins, gliptins, and second-generation antipsychotic drugs to recognise and manage BP early. Due to the low prevalence of disease, we do not suggest avoidance of drugs/vaccines to prevent BP. Further research should consider recency, dosage, and duration of antibiotic treatments.

A review of staphylococcal scalded skin syndrome

Staphylococcal scalded skin syndrome (SSSS) is characterized by widespread epithelial necrosis and/or superficial blistering of the skin following infection by some toxigenic strains of Staphylococcus aureus. The disease primarily affects children under the age of 5 years, but it can also occur in adults. Due to the recent increase in reported cases of SSSS, we have reviewed the epidemiology, pathogenesis, clinical features, diagnosis, treatment, and prevention, including the development of vaccines for S. aureus infections. Electronic databases including PubMed, Google Scholar and websites of the Center for Disease Prevention and Control (CDC), and the World Health Organization (WHO), were searched for publications on SSSS written in English language. Our review showed that SSSS is more common in children, amongst whom it carries a mortality rate of <5%, as opposed to mortality rate of >50% in affected adults. Penicillinase-resistant penicillins are recommended for the treatment of SSSS, and administration of fresh frozen plasma (FFP) may aid early recovery. Important staphylococcal vaccine candidates are also highlighted in the review.

005 Association between prescription drugs and vaccines commonly prescribed to older people and bullous pemphigoid: a UK population-based study

Abstract Bullous pemphigoid (BP) is the most common autoimmune blistering skin disease, manifested by painful itching of the skin and mucous membranes. Despite high mortality, poor quality of life and increasing incidence in older people, BP can be overlooked due to its rarity in the general population. The cause of BP is unknown, but there are reports of drug-induced BP and remission after the withdrawal of suspected drugs. Systematic reviews have found prescription drugs such as gliptins and loop diuretics to be associated with BP. However, previous studies did consider multiple drug exposures and had selected populations. Our UK population-based study aimed to determine whether drugs/vaccines prescribed between 1998 and 2021 for common conditions in older people are associated with BP. We conducted a population-based nested case–control study using the UK Clinical Practice Research Datalink (representing 8% of the UK population). Each person with BP (case) was matched by age, sex and general practice to up to five controls at the diagnosis time of their case. Multivariable conditional logistic regression was used to determine adjusted odds ratios (aOR) of developing BP within 1 year of taking at least one prescription for the following therapeutic groups: antibiotics, antidiabetics and insulin, antihypertensives, antithrombotics, lipid modifiers, analgesics, dementia drugs, antiepileptics, antipsychotics, antidepressants and influenza vaccine. Where possible, we report results for classes of drugs or subclasses. The results were adjusted for multiple exposures and corrected for multiple testing. We also explored potential confounders: ethnicity, deprivation, stroke, Parkinson disease and dementia. Six months of antibiotics prescriptions before the BP diagnosis was excluded to account for treating undiagnosed BP symptoms. We identified 16 844 patients with BP and 79 493 controls (mean age 76 years; 44% male). The drugs associated with an increased risk of BP were penicillinase-resistant penicillins [aOR 2.6, 95% confidence interval (CI) 2.4–2.8]; macrolides (aOR 1.5, 95% CI 1.4–1.7); gliptins (aOR 2.8, 95% CI 2.4–3.3); centrally acting anticholinesterases (aOR 2.3, 95% CI 2.0–2.7); N-methyl-D-aspartate receptor antagonists (aOR 2.2, 95% CI 1.7–2.9); antiepileptics (aOR 2.4, 95% CI 2.3–2.6); influenza vaccine (aOR 1.4, 95% CI 1.4–1.5) and loop diuretics (aOR 1.3, 95% CI 1.2–1.4). Reduced BP risk was associated with nonsteroidal anti-inflammatory drugs (aOR 0.8, 95% CI 0.8–0.9) and opioids (aOR 0.8, 95% CI 0.8–0.9). Potential confounders did not affect odds ratio estimates. All P values were < 0.001. No association was found for broad-spectrum penicillins, lipid-modifying drugs, anticoagulants, beta blockers, calcium channel blockers and potassium-sparing diuretics with another diuretic. Clinicians need to be aware of BP risk in older people following administration of penicillinase-resistant penicillins, gliptins, dementia and epilepsy drugs, in order to recognize BP early and consider withdrawal of the suspect drug.

The most common medications dispensed to lactating persons: An electronic health record-based approach.

Using a novel, electronic health record (EHR)-based approach, to estimate the prevalence of prescription medication use at 2, 4, and 6 months postpartum among lactating individuals. We utilized automated EHR data from a US health system that records infant feeding information at well-child visits. We linked mothers who received prenatal care to their infants born May 2018-June 2019, and we required infants to have ≥1 well-child visit between 31 and 90 days of life (i.e., 2-month well-child visit with a ±1 month window). Mothers were classified as lactating at the 2-month well-child visit if their infant received breast milk at the 2-month well-child visit. For subsequent well-child visits at 4 and 6 months, mothers were considered lactating if their infant was still receiving breast milk. We identified 6013 mothers meeting inclusion criteria, and 4158 (69.2%) were classified as lactating at the 2-month well-child visit. Among those classified as lactating, the most common medication classes dispensed around the 2-month well-child visit were oral progestin contraceptives (19.1%), selective serotonin reuptake inhibitors (8.8%), first generation cephalosporins (4.3%), thyroid hormones (3.5%), nonsteroidal anti-inflammatory agents (3.4%), penicillinase-resistant penicillins (3.1%), topical corticosteroids (2.9%), and oral imidazole-related antifungals (2.0%). The most common medication classes were similar around the 4 and 6-month well-child visits although prevalence estimates were often lower. Progestin-only contraceptives, antidepressants, and antibiotics were the most dispensed medications among lactating mothers. With routine collection of breastfeeding information, mother-infant linked EHR data may overcome limitations in previous studies of medication utilization during lactation. These data should be considered for studies of medication safety during lactation given the need for human safety data.

Demographic characteristics, clinical features, and optimal management of hospitalized patients with staphylococcal scalded skin syndrome.

Optimal management of staphylococcal scalded skin syndrome (SSSS) has not been established. Clindamycin may benefit patients via inhibition of ribosomal toxin production, but resistance patterns suggest penicillinase-resistant penicillins or cephalosporins should be the first line. Our goal was to describe demographic and clinical characteristics of SSSS patients at our institution, delineate bacterial resistance patterns, and examine outcomes of varying therapeutic strategies in SSSS. We performed a retrospective review of patients under the age of 18 with confirmed clinical SSSS diagnosis by the dermatology consult team at the University of North Carolina (UNC) Hospitals from January 2008 to April 2017. Median hospital and ICU length of stay (LOS) were compared using a Wilcoxon Rank Sum Test. We found 59 SSSS patients. Coverage with clindamycin and vancomycin versus absence of that combination was associated with shorter ICU LOS. Although trending toward reduced hospital LOS, this was not significantly altered with the use of vancomycin and clindamycin after adjustment for multiple comparisons. Individual use of either clindamycin or vancomycin did not significantly alter overall hospital or ICU LOS. Among 24 patients with a pathogen identified on culture, 18 (75.0%) revealed resistance to clindamycin, and 2 (8.3%) revealed MRSA. Clindamycin resistance is more prevalent in hospitalized SSSS patients compared to our pediatric outpatient population. The combination of vancomycin and clindamycin results in shorter ICU LOS. Individual use of clindamycin or vancomycin does not significantly reduce hospital or ICU LOS after adjustment for multiple comparisons.

Prevalence and Antibiotic Resistance Pattern of Staphylococcus aureus isolates from Clinical samples at a Tertiary Care Hospital, North India

Background: Staphylococcus aureus (S. aureus) is a well recognized nosocomial and community acquired pathogen which is implicated in causing a wide spectrum of superficial, deep pyogenic infections and toxin mediated illnesses. Localized infections sometimes progress to systemic infections, while ‘spontaneous’ bacteraemia also occur without an evident septic focus, particularly in chronic debilitated immunocompromised patients. Emergence of drug resistance to penicillins and penicillinase-resistant penicillins (i.e., oxacillin and methicillin) is a globally recognized problem. Methicillin Resistant Staphylococcus aureus isolates are also important with respect to the range of nosocomial infections it causes, leading to an increase in the hospital expenditure and mortality or morbidity rate. The increased prevalence of such resistant strains has narrowed down the list of available therapeutic options. Therefore, information regarding the prevalence of S. aureus infections in a health care setting and determining its current antibiotic resistance profile becomes crucial in selecting appropriate treatment regime. Therefore, the current study was done in the department of Microbiology to determine the prevalence of S. aureus infections and the antibiotic resistance pattern of S. aureus isolates from various clinical specimens at our tertiary care hospital in North India. Materials and Methods: A one year prospective study was carried out in the Department of Microbiology, at a tertiary care hospital in North India where non-duplicate strains of S. aureus isolated from various clinical specimens received in the Microbiology laboratory were studied. All S. aureus isolates were subjected to Antibiotic Susceptibility Testing using Kirby Bauer’s disk diffusion method on Mueller Hinton Agar plates in accordance to CLSI guidelines. The antibiotics tested included Penicillin (10U), Amoxicillin-clavulanic acid (20/10μg), Sulphamethoxazole-trimethoprim (1.25/23.75μg), Ciprofloxacin (5μg), Erythromycin (15μg), Clindamycin (2μg), Vancomycin (30μg), Teicoplanin (30μg) and Linezolid (30μg). Results: A total of 23,699 clinical specimens were processed in the laboratory while conducting this study, from which 1233 clinical isolates of S. aureus were identified and processed further. Among all clinical specimens, pyogenic samples (63.1%) yielded maximum number of S. aureus strains followed by blood samples (29.9%) and urine samples (4.8%). S. aureus infection was more evident in hospitalized 71.2% patients than in OPD patients 28.8%. Seasonal variation was also seen in isolation of S. aureus, with a higher percentage of isolates obtained during summer season than during winter season. On antibiotic susceptibility testing, 49.6% strains were Methicillin Resistant. Majority of the isolates were found resistant to Penicillin (92.1%), followed by Erythromycin (59%). Almost half of the total isolates were resistant to Sulphamethoxazole-Trimethoprim (49.3%) followed by Amoxicillin- Clavulanic acid (47.8%), Ciprofloxacin (43.4%) and Clindamycin (18.4%). Antibiotics to which all isolates showed 100% susceptibility included Vancomycin, Teicoplanin, Linezolid. Conclusion: Given the high prevalence of resistance to antibiotics seen in this study, effective treatment of infections caused by multidrug resistant Staphylococcal strains may become challenging. Drugs like Vancomycin, Teicoplanin and Linezolid promise to work as miracle drugs against the multidrug resistant MRSA strains but we need to warrant judicious use of these wonder drugs to conserve them for future use.

Dysbiosis in Parkinson’s disease might be triggered by certain antibiotics

Parkinson’s disease (PD) is a neurodegenerative amyloid disorder with debilitating motor symptoms due to the loss of dopamine-synthesizing, basal ganglia-projecting neurons in the substantia nigra. An interesting feature of the disease is that most of PD patients have gastrointestinal problems and bacterial dysbiosis, years before the full expression of motor symptoms. We hypothesized that antibiotic consumption might be a contributing factor of gut microbiome dysbiosis in PD, favoring curli-producing Enterobacteria. Curli is a bacterial α-synuclein (αSyn) which is deposited first in the enteric nervous system and amyloid deposits are propagated in a prion like manner to the central nervous system. In addition, antibiotics result in a low-grade systemic inflammation, which also contributes to damage of neurons in enteric- and central nervous system. To support our hypothesis, by comparing PD prevalence change with antibiotic consumption data in EU countries, we found significant positive correlation between use narrow spectrum penicillin + penicillinase resistant penicillin and increased prevalence of the disease.

Antibiotic sensitivity and clinical outcomes in staphylococcal scalded skin syndrome.

Staphylococcal scalded skin syndrome causes widespread skin denudation primarily in infants<1 year old. Selection of empiric therapy is complicated by rising rates of antibiotic resistance in community-acquired staphylococcal infections. Consistent with a previous study, this retrospective review found that SSSS-associated isolates were more likely to be clindamycin-resistant and less likely to be methicillin-resistant compared to overall staphylococcal infections. We favor cephalosporins and penicillinase-resistant penicillins (eg, oxacillin) for empiric management of SSSS, with consideration of adding MRSA coverage in communities with high MRSA prevalence or failure to improve following several days of treatment.

The formation and properties of polypyrrole doped with an immobile antibiotic

Oxacillin, a semisynthetic penicillinase-resistant penicillin, was incorporated as a dopant within polypyrrole. The oxacillin-doped polymer was deposited at gold, platinum and the biocompatible substrate, titanium. A doping level of 0.12 was obtained during the early stages of polymer formation. Smooth polymer films were deposited, but more structure was observed in the cross sections of the polymer. This was attributed to a reduction in the concentration of the anionic oxacillin as the interfacial pH decreased due to the electropolymerisation reaction, shifting the equilibrium in favour of the undissociated oxacillin, HOx. Although HOx has poor solubility and may precipitate at the polymer solution interface during formation of the polymer, there was no evidence of any reduction in the conducting properties of the polymer. High charging capacitance values of 12 to 15 mF cm−2 were estimated for the oxidised polymer. These conducting properties were attributed to a slow rate of electropolymerisation that prevented significant acidification at the electrode interface, preventing the build-up of HOx. The oxacillin-doped polypyrrole showed cation exchange properties. Oxacillin was maintained within the polymer, as the polymer was cycled between its oxidised and reduced states to give an immobilised antibiotic with very little oxacillin detected in the solution phase. The application of a layer of chitosan gave rise to a slight reduction in the charging capacitance of PPyOx. However, improved adhesion was observed for the reduced PPyOx with the application of the chitosan layer.

Antibiotic susceptibility among under-fives with severe pneumonia: a prospective study

Background: In underdeveloped countries, lower respiratory tract infection (LRTI) remains the leading cause of under-five mortality. Judicious use of antibiotics prevents the emergence of multidrug resistant organisms, but appropriate selection is vital in the child requiring intensive care.Methods: The study in conducted prospectively in the paediatric wards and intensive care unit, Rajah Muthiah Medical College and Hospital, Chidambaram. Fifty children were enrolled in the study using simple random sampling. Data regarding the demographic details, mean duration of stay, antibiotics given, immunisation status, intensive care unit admission and complications were collected. Statistical analysis is done using the Microsoft excel 2010.Results: The complications (n=3) is more among the female children (n=2) belonging to the age group one to two years (n=2) with mean duration of stay of more than seven days (n=2) and non-immunized for age children (n=3).Conclusions: The gram positive and atypical pneumonia in Chidambaram is found to be sensitive to aminopenicillin with penicillinase resistant penicillin and macrolide respectively.

Antimicrobial use and suitability in long-term care facilities: A retrospective cross-sectional study

Background: Antimicrobial stewardship is the promotion of responsible antimicrobial use to reduce antimicrobial resistance, antimicrobial toxicity and cost, and to reduce the incidence of nosocomial infections. Our objectives were to measure antibiotic use rate in 10 long-term care facilities (LTCF) during a 1-year period, and to determine the appropriateness of antimicrobial prescriptions. Methods: Antibiotic prescriptions from 10 long-term care facilities, between January 2015 and January 2016, were collected from a pharmacy database. A sample of500 prescriptions was randomly selected for chart review to determine the appropriateness of the prescribed antibiotic based on published guidelines. Results: We analyzed 3,148 prescriptions for 1,313 residents (2.40 prescriptions/patient/year, median duration 7 days). Antibiotic use rate was 21.16 Defined Daily Doses/1,000 patient-days/year, or 5.42 antibiotic days/1,000 patient-days/month. Of the 500 randomly selected prescriptions, 448 were analyzed for appropriateness. Mean age of included residents was 82.5 (SD 12.1 years). 288/448 (64.3%) were female, with an average activities of daily living (ADL) score of 19.3 (SD 8.5). Urinary tract infection was the most common indication for antibiotics (177/448, 39.5%), followed by lower respiratory tract infection (144/448, 32.1%) and skin and soft-tissue infection (76/448, 17.0%). 259/448 (57.8%) of prescriptions were inappropriate, including 115/163 (70.5%) given for urinary tract infection, 78/140 (55.7%) given for lower respiratory tract infection, and 15/68 (22.0%) given for skin and soft-tissue infection. Inappropriateness varied by long-term care facility (LTCF) between 18/41 (43.9%) and 15/21 (71.4%), and by drug class between 0/5 (0%) among penicillinase-resistant penicillins and 29/38 (76.3%) among macrolides. Conclusions: Antimicrobial use rate is high, and 57.8% of prescriptions are inappropriate. The least appropriate prescriptions are given for urinary tract infections. Appropriateness is highly variable by LTCF, indication, and drug class.

Pharmacoeconomic analysis of hospital antimicrobial therapy of community-acquired pneumonia using DDD and DU90% methods

This study was designed to compare results of pharmacoepidemiological analysis of antibacterial therapy in patients with community-acquired pneumonia (CAP) admitted to hospitals of Nizhniy Novgorod. Methods . Data for analysis were obtained from medical records of all patients with CAP (n = 117; 51.3% were males) admitted to two city hospitals in 2015 and 2016. Therapy of CAP was in agreement with corresponding standards. We analyzed real drug utilization using the defined daily dose (DDD) and drug utilization accounting for 90% of the total amount of DDD prescribed (DU90%). Results . Penicillinase-resistant penicillins, the 3rd generation cephalosporins and fluoroquinolones were the most often prescribed antibiotics in hospitals. The highest number of DDD was for ceftriaxone (376.0 g) in the hospital 1 and levofloxacin (468.16 g) in the hospital 2. The drugs constituting 90% of the prescription volume for inpatient therapy of CAP were ceftriaxone (46.09%), levofloxacin (20.0%), azythromycin (9.19%), and ciprofloxacin (9.19%) in the hospital 1 and ceftriaxone (16.50%), levofloxacin (71.19%), and ertapenem (4.70%) in the hospital 2. In the hospital 1, the cost of one DDD in DU10% segment (982.12 RUB) was 4-fold higher than that in DU90% segment (200.0 RUB); this suggests that inexpensive drugs were predominantly used in the hospital 1. In the hospital 2, DU10% consisted of two drugs accounting 24.56% of the total prescriptions. The cost of one DDD in DU90% segment (6 022.88 RUB) was 1.9-fold higher than that in DU10% segment (3 166.73 RUB); this suggests that more expensive antibiotics were widely used in the hospital 2. Conclusion . The strategy used in the hospital 2 is recommended according to the study results. The initial therapy with a single antibiotic could significantly reduce the drug load for the patient. Addition of the second antibiotic to the treatment was needed in 15% only, though patients were admitted to a hospital after the treatment failure both in ambulatory settings and in other hospitals.

Biology and management of methicillin resistant Staphylococcus aureus in cystic fibrosis.

Staphylococcus aureus is one of the earliest bacteria isolated from the respiratory tract in people with cystic fibrosis (CF). Its methicillin resistant form, MRSA, has gained attention due to the rapid increase in the last decades and worse outcomes with chronic infection. In the United States, prevalence of MRSA in CF is around 27%, but is much lower (3-18%) in most other countries. Methicillin is typically genetically encoded by the mecA gene, which encodes for an alternative penicillin binding protein (PRBa). This PRBa has low affinity to β-lactams, thereby enabling growth of S. aureus in the presence of penicillinase resistant penicillins and most other β-lactams. Non-mecA positive strains of MRSA, so-called borderline resistant (BORSA) have also been described. In addition to production of toxins, the virulence of S. aureus is conferred by its adaptability allowing persistence in face of antibiotic therapies and host defense. These adaptive growth mechanisms include small colony variants, biofilms, and growth under anaerobic conditions. Several reports have described successful eradication of MRSA, yet only two randomized trials of eradication during early infection have been conducted. A list of MRSA specific antibiotics with dosing relevant to CF patients is presented here. Many of these require special dosing in people with CF. Novel antibiotics are in trials for skin and soft tissue infections and it is unclear if and when those might be available for lung infections. Thus the best strategies for MRSA would be primary prevention.

Antibiotic resistance of &amp;lt;italic&amp;gt;Staphylococcus aureus&amp;lt;/italic&amp;gt; colonized in children with staphylococcal scalded skin syndrome

Objectives Systemic antibiotic therapy with semisynthetic penicillinase-resistant penicillin or vancomycin and clindamycin are recommended for the treatment of staphylococcal scalded skin syndrome (SSSS). This study assessed the rate of antibiotic resistance of Staphylococcus aureus isolated from the anterior nares or skin of children diagnosed with SSSS. Methods A retrospective review of the medical records of 25 patients with SSSS between July 2010 and October 2014 was conducted. The clinical characteristics of patients were collected and the antibiotic susceptibility of S. aureus were analyzed using automated systems. Results The median age of the patients was 22 months (range: 2-95). Ninety-two percent of patients were less than 5 years of age. Nasal swab samples of all patients and skin swab samples of 17 patients were cultured to isolate S. aureus . Twenty-one (84%) of 25 patients were colonized with methicillin-resistant S. aureus (MRSA). The results of swab samples of the other four patients were no growth or isolation of bacteria other than S. aureus . Among 20 strains isolated from the anterior nares, 1 strain (5%) was methicillin-susceptible S. aureus . All 15 strains isolated from the skin were MRSA. All 21 strains isolated from anterior nares or skin were found to be resistant to clindamycin upon evaluation using automated systems. Conclusions The rates of methicillin and clindamycin resistance in S. aureus colonized in children with SSSS were very high. Further studies evaluating proper antibiotic regimens and the effectiveness of systemic antibiotic therapy are needed.

The Evaluation and Management of Toxic Shock Syndrome in the Emergency Department: A Review of the Literature

BackgroundToxic shock syndrome (TSS) is a severe, toxin-mediated illness that can mimic several other diseases and is lethal if not recognized and treated appropriately. ObjectiveThis review provides an emergency medicine evidence-based summary of the current evaluation and treatment of TSS. DiscussionThe most common etiologic agents are Staphylococcus aureus and Streptococcus pyogenes. Sources of TSS include postsurgical wounds, postpartum, postabortion, burns, soft tissue injuries, pharyngitis, and focal infections. Symptoms are due to toxin production and infection focus. Early symptoms include fever, chills, malaise, rash, vomiting, diarrhea, and hypotension. Diffuse erythema and desquamation may occur later in the disease course. Laboratory assessment may demonstrate anemia, thrombocytopenia, elevated liver enzymes, and abnormal coagulation studies. Diagnostic criteria are available to facilitate the diagnosis, but they should not be relied on for definitive diagnosis. Rather, specific situations should trigger consideration of this disease process. Treatment involves intravenous fluids, source control, and antibiotics. Antibiotics should include a penicillinase-resistant penicillin, cephalosporin, or vancomycin (in methicillin-resistant S. aureus prevalent areas) along with either clindamycin or linezolid. ConclusionTSS is a potentially deadly disease requiring prompt recognition and treatment. Focused history, physical examination, and laboratory testing are important for the diagnosis and management of this disease. Understanding the evaluation and treatment of TSS can assist providers with effectively managing these patients.

Borderline oxacillin-resistant Staphylococcus aureus (BORSA) - a more common problem than expected?

Borderline oxacillin-resistant Staphylococcus aureus (BORSA) represents a quite poorly understood and inadequately defined phenotype of methicillin resistance. BORSA strains show low, borderline resistance to penicillinase-resistant penicillins (PRPs), with oxacillin MICs typically equal to 1-8 µg ml-1, and in contrast to methicillin-resistant S. aureus (MRSA), do not have an altered penicillin-binding protein, PBP2a, encoded by the mecA or mecC gene. Their resistance is typically associated with hyperproduction of beta-lactamases or, in some cases, point mutations in PBP genes. BORSA cannot be classified as either truly methicillin-resistant or truly methicillin-susceptible strains. However, they are frequently misidentified, which poses an obvious epidemiological and therapeutic threat. BORSA strains are commonly isolated from humans and animals, and are found both in hospitals and in a community setting. The epidemiology and clinical presentation of BORSA infections seem to be similar to those for MRSA; these infections are usually more severe than those caused by methicillin-sensitive S. aureus (MSSA). Treatment of severe infections caused by BORSA may be ineffective, even with larger doses of oxacillin. The available evidence suggests that BORSA represent a frequently neglected problem, and their emergence in new environments implies that they need to be monitored and accurately distinguished from MSSA and MRSA.

Aetiology and clinical features of facial cellulitis: a prospective study

Background: In the early 20th century, the face was the predominant site of cellulitis. Despite a relative decrease in the incidence of facial cellulitis, it is still common. There are few studies on this condition during the last decades. The aim of this study was to describe contemporary aetiological and clinical characteristics of patients admitted to hospital with non-suppurative facial cellulitis.Methods: Patients were included prospectively. Clinical details, comorbidities and biochemistry results were recorded. Investigations included cultures of skin swab and blood and tests for streptococcal antibodies during the acute and convalescent stages.Results: Sixty-five patients were included. Serology, cultures and response to penicillin monotherapy identified probable or confirmed β-haemolytic streptococci (BHS) aetiology in 75% (49/65) of cases. Significant comorbidities were present in 54% (35/65). Fever, chills or rigors before or at admission was noted in 91% (59/65). Patients presented most often with sharply demarcated erythema and raised borders (54/64). Penicillin or penicillinase-resistant penicillin alone or in combination cured 68% (44/65) of the patients. Supplementary clindamycin was used in 28% (18/65), most often only for 1–3 days. Only four patients needed a second course of antibiotics. Clinical failure was more often seen in patients with non-BHS aetiology (p = .037). Few complications were noted; 14.5% (9/62) experienced transient diarrhoea, and only one had confirmed Clostridium difficile infection. No patients developed cerebral venous sinus thrombosis, and there were no fatalities.Conclusions: Our findings indicate that BHS are the leading cause of facial cellulitis. Most patients exhibit sharply demarcated lesions and systemic symptoms. Narrow-spectrum β-lactam antibiotics and short hospital stay appear sufficient. Few complications and low recurrence rates were seen.

Recommendations for approaches to meticillin-resistant staphylococcal infections of small animals: diagnosis, therapeutic considerations and preventative measures.: Clinical Consensus Guidelines of the World Association for Veterinary Dermatology.

Multiple drug resistance (MDR) in staphylococci, including resistance to the semi-synthetic penicillinase-resistant penicillins such as meticillin, is a problem of global proportions that presents serious challenges to the successful treatment of staphylococcal infections of companion animals. The objective of this document is to provide harmonized recommendations for the diagnosis, prevention and treatment of meticillin-resistant staphylococcal infections in dogs and cats. The authors served as a Guideline Panel(GP) and reviewed the literature available prior to September 2016. The GP prepared a detailed literature review and made recommendations on selected topics. The World Association of Veterinary Dermatology (WAVD) provided guidance and oversight for this process. A draft of the document was presented at the 8th World Congress of Veterinary Dermatology (May 2016) and was then made available via the World Wide Web to the member organizations of the WAVD for a period of threemonths. Comments were solicited and posted to the GP electronically. Responses were incorporated by the GP into the final document. Adherence to guidelines for the diagnosis, laboratory reporting, judicious therapy (including restriction of use policies for certain antimicrobial drugs), personal hygiene, and environmental cleaning and disinfection may help to mitigate the progressive development and dissemination of MDR staphylococci.

Identification of Penicillinase-Resistant Penicillins in Human Urine by RPLC Method

Identification of Penicillinase-Resistant Penicillins in Human Urine by RPLC Method

Prevalence and Characterization of Multi‐Resistant Staphylococcus SPP. Isolated from Poultry Liver

AbstractThe objective of this study was to determine the prevalence and to characterize multi‐resistant Staphylococcus spp. in raw poultry liver intended for human consumption. Staphylococcus was isolated from 116 of 120 raw liver samples (96.7%; CI 95% ± 3.2). One hundred and thirty‐six isolates (73.1% CI 95% ±7.93) were resistant to at least one antimicrobial while 30 isolates (25.9% CI 95% ±7.97) were resistant to at least three antimicrobial agents. Nine species of staphylococci were identified among the multi‐resistant isolates. Ten out of 30 multi‐resistant isolates were resistant to methicillin, including four MRSA strains. The most common multi‐resistance combination was toward tetracycline, ciprofloxacin and macrolides/lincosamides. All Staphylococcus isolates from poultry liver remain susceptible to vancomycin, linezolid, daptomycin, rifampin, sulfamethoxazole‐trimethoprim and streptogramins. The most prevalent genes encoding resistance were tetK, tetM (tetracyclines), blaZ, mecA (beta‐lactams), ermB, ermC, msrA (macrolides and lincosamides) and aac(6′)‐Ie‐aph(2″)‐Ia (aminoglycosides).Practical ApplicationsStaphylococcus spp. frequently contaminates raw poultry liver sold in retail markets. Multi‐resistant staphylococci are potential hazard for consumers as they often are resistant to critically important antimicrobials for humans including beta‐lactams (cefalosporins and penicillinase resistant penicillins), macrolides and fluoroquinolones.Hygienic measures in raw food‐production should be strongly enforced. Personal hygiene during marketing is also very important since multi‐resistant bacteria could easily spread among salespersons and consumers. More stringent requirements for sanitary standards in retail markets need to be set, and the existing requirements should be more strongly enforced on a daily basis.