Previous Antibiotic Use Research Articles

Multidrug-resistant Acinetobacter: Risk factors and outcomes in veterans with spinal cord injuries and disorders

Multidrug-resistant (MDR) Acinetobacter is a growing concern and has been identified as a serious threat by the Centers for Disease Control and Prevention. However, there is little information on MDR Acinetobacter in individuals with spinal cord injuries and disorders (SCI/Ds). Therefore, the objective of this study was to identify risk factors for, and assess outcomes of, MDR Acinetobacter in veterans with SCI/Ds. This was a retrospective cohort study from January 1, 2012-December 31, 2013, using national Veterans Affairs medical encounter and microbiology data. A total of 773 Acinetobacter cultures were identified in 571 patients, of which 58.9% were MDR. Inpatient culture, sputum and other specimen type, receipt of antibiotics within 90 days before culture date, and pressure ulcers were identified as independent predictors of MDR Acinetobacter. Highest odds of MDR Acinetobacter were seen with previous antibiotic use (odds ratio, 7.27; 95% confidence interval, 2.59-20.54). Thirty-day mortality was 5.3% in this study. Multidrug resistance, previous mechanical ventilation 90 days before the culture, and cancer were all independent risk factors for 30-day mortality. There should be increased efforts to highlight the importance of antimicrobial stewardship to improve infection control to help limit spread of Acinetobacter in health care settings.

Decision making about antibiotic use: examining the role of antibiotic resistance knowledge, concern, and previous inappropriate antibiotic use

ABSTRACTAntibiotic resistance has become a major public health threat due, in part, to inappropriate antibiotic use. The aim of the present study was to examine the role of antibiotic resistance knowledge, concern, and previous antibiotic misuse in decision making about antibiotic use. Participants (n = 548) recruited through Amazon Mechanical Turk were asked to read four hypothetical scenarios about health conditions (head cold, urinary tract infection, leg wound and respiratory infection). They responded to each scenario regarding their likelihood of engaging in antibiotic use behaviors including (a) whether they would seek an antibiotic prescription from a physician, and (b) whether they would take old antibiotics. Participants also completed questions regarding their knowledge and concern about antibiotic resistance, and previous antibiotic use. Logistic regressions were employed to examine the role of previous antibiotic use for the cold or flu, antibiotic resistance knowledge, and antibiotic resistance concern in the likelihood of antibiotic use. The three variables were predictive of both appropriate and inappropriate antibiotic use in relation to the hypothetical scenarios. Individual-level factors play a role in decision making about antibiotic use. In addressing the issue of antibiotic resistance, it will be necessary to not only increase antibiotic resistance knowledge in the general population, but also to increase antibiotic resistance concern. Past inappropriate antibiotic use should also be considered a risk factor for future antibiotic misuse; therefore, both broad public health campaigns and individually-tailored programs (e.g. in appointments at doctors’ offices) should be considered in curbing inappropriate antibiotic use.

Antibiotic Prophylaxis Is Associated with Subsequent Resistant Infections in Children with an Initial Extended-Spectrum-Cephalosporin-Resistant Enterobacteriaceae Infection.

The objective of this study was to assess the association between previous antibiotic use, particularly long-term prophylaxis, and the occurrence of subsequent resistant infections in children with index infections due to extended-spectrum-cephalosporin-resistant Enterobacteriaceae We also investigated the concordance of the index and subsequent isolates. Extended-spectrum-cephalosporin-resistant Escherichia coli and Klebsiella spp. isolated from normally sterile sites of patients aged <22 years were collected along with associated clinical data from four freestanding pediatric centers. Subsequent isolates were categorized as concordant if the species, resistance determinants, and fumC-fimH (E. coli) or tonB (Klebsiella pneumoniae) type were identical to those of the index isolate. In total, 323 patients had 396 resistant isolates; 45 (14%) patients had ≥1 subsequent resistant infection, totaling 73 subsequent resistant isolates. The median time between the index and first subsequent infections was 123 (interquartile range, 43 to 225) days. In multivariable Cox proportional hazards analyses, patients were 2.07 times as likely to have a subsequent resistant infection (95% confidence interval, 1.11 to 3.87) if they received prophylaxis in the 30 days prior to the index infection. In 26 (58%) patients, all subsequent isolates were concordant with their index isolate, and 7 (16%) additional patients had at least 1 concordant subsequent isolate. In 12 of 17 (71%) patients with E. coli sequence type 131 (ST131)-associated type 40-30, all subsequent isolates were concordant. Subsequent extended-spectrum-cephalosporin-resistant infections are relatively frequent and are most commonly due to bacterial strains concordant with the index isolate. Further study is needed to assess the role prophylaxis plays in these resistant infections.

Perfiles de resistencia y factores de riesgo de microorganismos resistentes en bacteriemia de origen abdominal

ObjectiveThe presence of resistant microorganisms is a major cause of failure in initial empirical antimicrobial therapy. The objectives of this study are to determine the resistance profile of microorganisms that cause bacteraemia of abdominal origin and to identify whether the previous use of antibiotics and the place of acquisition of bacteraemia are risk factors associated with the presence of resistant organisms. Material and methodsA clinical, observational, epidemiological, retrospective cohort study was conducted with all the adult patients admitted to a university hospital from 2011-2013. Antimicrobial resistance profiles were described and a 95% confidence interval chi-square test was used to determine whether the variables studied were risk factors in the isolation of resistant microorganisms. ResultsOf the 1245 patients with bacteraemia, 212 (17%) presented bacteraemia of abdominal origin. The resistance profile highlights the incidence of methicillin resistant Staphylococcus aureus (50%), coagulase-negative staphylococci resistant to linezolid (20.58%), enterococci resistant to vancomycin (3.12%), Escherichia coli resistant to third-generation cephalosporins (9.9%) and fluoroquinolones (35.64%), Klebsiella pneumoniae resistant to third-generation cephalosporins (8.33%), Pseudomonas aeruginosa resistant to fluoroquinolones and carbapenem (25% and 25% respectively) and Acinetobacter baumanii resistant to fluoroquinolones and carbapenem (100% and 100% respectively), Candida albicans resistant to fluconazole (11.11%), single Candida krusei isolate resistant to fluconazole and Candida parapsilosis resistant to echinocandins (12.5%). In our study, previous use of antibiotics had a statistically significant association with the isolation of resistant microorganisms (P=.013) but not the place of acquisition of bacteraemia (P=.239). ConclusionEstablishing the incidence of resistant organisms can improve empirical antimicrobial therapy in patients with bacteraemia of abdominal origin. Previous use of antibiotics was statistically significantly related to the isolation of resistant microorganisms.

Prevalência de infecção por Helicobacter pylori em uma comunidade indígena em São Paulo e fatores associados: estudo transversalPrevalence of Helicobacter pylori infection in an indigenous community in São Paulo and associated factors: cross-sectional study.

The prevalence of Helicobacter pylori infection is unevenly distributed among different populations. The aim here was to evaluate the factors associated with Helicobacter pylori infection among children up to five years of age living in a high-risk community. Cross-sectional study in an indigenous community of Guarani Mbya ethnicity, Tekoa Ytu and Tekoa Pyau villages, Jaraguá district, city of São Paulo (SP), Brazil. 74 children aged 0.4 to 4.9 years (mean 2.9 ± 1.3 years; median 3.1), and 145 family members (86 siblings, 43 mothers and 16 fathers) were evaluated for Helicobacter pylori infection using the validated 13C-urea breath test. Clinical and demographic data were collected. The prevalence was 8.3% among children aged 1-2 years and reached 64.3% among those aged 4-5 years (P = 0.018; overall 31.1%). The prevalence was 76.7% among siblings and 89.8% among parents. There was a negative association with previous use of antibiotics in multivariate analysis adjusted for age (odds ratio, OR: 0.07; 95% confidence interval, CI: 0.01 to 0.66; P = 0.02). The prevalence was higher among males (OR: 1.55), and was associated with maternal infection (OR: 1.81), infection of both parents (OR: 1.5), vomiting (OR: 1.28), intestinal parasitosis (OR: 2.25), previous hospitalization (OR: 0.69) and breastfeeding (OR: 1.87). The prevalence was high among subjects older than three years of age, thus suggesting that the incidence of infection was higher over the first three years of life. Previous use of antibiotics was inversely associated with current Helicobacter pylori infection.

Su2004 - Outcomes of Gastrointestinal Perforations among Medicare Beneficiaries with Previous Antibiotic Use

Su2004 - Outcomes of Gastrointestinal Perforations among Medicare Beneficiaries with Previous Antibiotic Use

ICU Acquisition Rate, Risk Factors, and Clinical Significance of Digestive Tract Colonization With Extended-Spectrum Beta-Lactamase-Producing Enterobacteriaceae: A Systematic Review and Meta-Analysis.

To evaluate the acquisition rate, identify risk factors, and estimate the risk for subsequent infection, associated with the colonization of the digestive tract with extended-spectrum beta-lactamase-producing Enterobacteriaceae during ICU-hospitalization. PubMed, EMBASE, and reference lists of all eligible articles. Included studies provided data on ICU-acquired colonization with extended-spectrum beta-lactamase-producing Enterobacteriaceae in previously noncolonized and noninfected patients and used the double disk synergy test for extended-spectrum beta-lactamase-producing Enterobacteriaceae phenotypic confirmation. Studies reporting extended-spectrum beta-lactamase-producing Enterobacteriaceae outbreaks or data on pediatric population were excluded. Two authors independently assessed study eligibility and performed data extraction. Thirteen studies (with 15,045 ICUs-patients) were evaluated using a random-effect model and a meta-regression analysis. The acquisition rate of digestive tract colonization during ICU stay was 7% (95% CI, 5-10) and it varies from 3% (95% CI, 2-4) and 4% (95% CI, 2-6) in the Americas and Europe to 21% (95% CI, 9-35) in the Western Pacific region. Previous hospitalization (risk ratio, 1.57 [95% CI, 1.07-2.31]) or antibiotic use (risk ratio, 1.65 [95% CI, 1.15-2.37]) and exposure to beta-lactams/beta-lactamase inhibitors (risk ratio, 1.78 [95% CI, 1.24-2.56]) and carbapenems (risk ratio, 2.13 [95% CI, 1.49-3.06]) during the ICU stay were independent risk factors for ICU-acquired colonization. Importantly, colonized patients were more likely to develop an extended-spectrum beta-lactamase-producing Enterobacteriaceae infection (risk ratio, 49.62 [95% CI, 20.42-120.58]). The sensitivity and specificity of prior colonization to predict subsequent extended-spectrum beta-lactamase-producing Enterobacteriaceae infection were 95.1% (95% CI, 54.7-99.7) and 89.2% (95% CI, 77.2-95.3), respectively. The ICU acquisition rate of extended-spectrum beta-lactamase-producing Enterobacteriaceae ranged from 5% to 10%. Previous use of beta-lactam/beta-lactamase or carbapenems and recent hospitalization were independent risk factors for extended-spectrum beta-lactamase-producing Enterobacteriaceae colonization, and colonization was associated with significantly higher frequency of extended-spectrum beta-lactamase-producing Enterobacteriaceae subsequent infection and increased mortality.

Maternal Chorioamnionitis and Postneonatal Respiratory Tract Infection in Ex-Preterm Infants

To assess whether exposure to histologically confirmed chorioamnionitis (ie, histologic chorioamnionitis [HCA]) is associated with altered risk of infection-related hospitalization (IRH) during the first 24 months of life in very preterm infants. This single-center retrospective cohort study analyzed data on 1218 infants born at <30 weeks gestational age (GA). Semiquantitative placental histology, obstetric, and neonatal data were extracted from hospital databases and linked with discharge diagnoses on rehospitalization until age 24 months from statewide statutory data. The associations between HCA and overall and clinical categories of IRH were analyzed by Cox proportional hazards regression with left-truncated failure times. Mean GA was 27 weeks, and HCA was present in 577 placentas (47.4%). Among the 1088 infants surviving until the birth-related discharge, 684 (62.9%) of had at least 1 IRH by age 24 months, of whom 287 included a diagnosis of acute lower respiratory tract infection (ALRTI). Following adjustment for sex, birth weight z-score, GA, early-onset sepsis, late-onset sepsis, previous antibiotic use, age at birth-related discharge, and chronic lung disease, HCA was associated with a 32% increased risk of hospitalization with ALRTI (HR, 1.32; 95% CI, 1.02-1.70; P = .033). There was no association with infection overall or with other infection categories. HCA is associated with a significantly increased risk of hospitalization with ALRTI that is independent of known risk factors, including chronic lung disease.

Antibiotic susceptibility patterns of isolates from children with urinary tract infection in Isfahan, Iran: Impact on empirical treatment.

The aim of this study was to identify the antibiotic susceptibility of bacteria causing urinary tract infections (UTIs) in children in Isfahan, Iran. Retrospective and prospective analyses were conducted on isolates from children with UTIs in a referral teaching hospital of Isfahan during 2013-2015. Findings were compared between first episode versus recurrent, nosocomial versus community-acquired, previous antibiotic use versus no previous antibiotic use, and febrile versus afebrile cases. Among 364 patients, 68.1% had no previous UTI, 19.7% has received antibiotics prior to infection and 96.2% were infected outside the hospital. Escherichia coli was the leading cause of UTI (68.1%), followed by Enterobacter (9.3%), Klebsiella (8.8%) and other bacteria (13.7%). Most isolates were relatively highly susceptible to imipenem (79.2%), ciprofloxacin (78.0%) and nitrofurantoin (70.8%), whereas sensitivity to cefotaxime (53%), cefalexin (39.8%) and trimethoprim/sulfamethoxazole (SXT) (26.1%) was low. Resistance to imipenem, cefotaxime and cefalexin was more prevalent in recurrent cases as well as in patients consuming antibiotics prior to UTI. Resistance of nosocomial cases to nitrofurantoin and cefotaxime was higher. In addition, afebrile patients had isolates that were more resistant to imipenem, ciprofloxacin and cefotaxime. Significant cross-resistance was found between most of the studied antibiotics. Urinary pathogens showed low susceptibility to cefalexin, SXT and cefotaxime and high susceptibility to imipenem, ciprofloxacin and nitrofurantoin. Therefore, use of imipenem and ciprofloxacin should be considered in hospitalised children with severe or complicated disease. In addition, nitrofurantoin is a good option in afebrile cases and for UTI chemoprophylaxis in this area.

Host and Pathogen Biomarkers for Severe Pseudomonas aeruginosa Infections.

Pseudomonas aeruginosa is among the leading causes of severe nosocomial infections, particularly affecting critically ill and immunocompromised patients. Here we review the current knowledge on the factors underlying the outcome of P. aeruginosa nosocomial infections, including aspects related to the pathogen, the host, and treatment. Intestinal colonization and previous use of antibiotics are key risk factors for P. aeruginosa infections, whereas underlying disease, source of infection, and severity of acute presentation are key host factors modulating outcome; delayed adequate antimicrobial therapy is also independently associated with increased mortality. Among pathogen-related factors influencing the outcome of P. aeruginosa infections, antibiotic resistance, and particularly multidrug-resistant profiles, is certainly of paramount relevance, given its obvious effect on the chances of appropriate empirical therapy. However, the direct impact of antibiotic resistance in the severity and outcomes of P. aeruginosa infections is not yet well established. The interplay between antibiotic resistance, virulence, and the concerning international high-risk clones (such as ST111, ST175, and ST235) still needs to be further analyzed. On the other hand, differential presence or expression of virulence factors has been shown to significantly impact disease severity and mortality. The likely more deeply studied P. aeruginosa virulence determinant is the type III secretion system (T3SS); the production of T3SS cytotoxins, and particularly ExoU, has been well established to determine a worse outcome both in respiratory and bloodstream infections. Other relevant pathogen-related biomarkers of severe infections include the involvement of specific clones or O-antigen serotypes, the presence of certain horizontally acquired genomic islands, or the expression of other virulence traits, such as the elastase. Finally, recent data suggest that host genetic factors may also modulate the severity of P. aeruginosa infections.

The Use of Quinacrine in Nitroimidazole-resistant Giardia Duodenalis: An Old Drug for an Emerging Problem.

There is little evidence regarding the management of refractory giardiasis after treatment with nitroimidazoles. This study estimates the proportion of persistent giardiasis in 3 hospitals in Barcelona, describes associated risk factors and genotype, and evaluates the efficacy rate of quinacrine in those with persistent giardiasis. A clinical, prospective, observational study was conducted in patients with giardiasis treated with nitroimidazoles. Those with persistent giardiasis were provided quinacrine. Molecular characterization of Giardia isolates was performed by polymerase chain reaction amplification of a fragment of tpi and bg genes. Seventy-seven patients were recruited and treated with nitroimidazoles, and in 14 of 71 (20%) of patients followed up, Giardia persisted. Refractory giardiasis was associated with malaise (P = .007) and anorexia (P = .02), with previous giardiasis (P = .03), and with previous antibiotic (P = .02) or antiparasitic(P = .04) use. Quinacrine had an effectiveness rate of 100% in refractory giardiasis (n = 13; 95% confidence interval = 75-100). Molecular characterization showed that 17 (25%) Giardia isolates belonged to assemblage A, and 31 (43%) belonged to assemblage B. In refractory giardiasis, assemblage A and B were found responsible in 4 and 6 cases, respectively. Almost 20% of patients presented persistent giardiasis, belonging to both assemblages A and B, after nitroimidazole. Short course of quinacrine was effective in treating refractory cases. Further controlled studies should evaluate its efficacy and safety.

Antibiotic therapy prior to hospital admission is associated with reduced septic shock and need for mechanical ventilation in patients with community-acquired pneumonia

A subgroup of patients admitted to the hospital with a diagnosis of community-acquired pneumonia (CAP) have received antibiotic therapy prior to admission for the current episode of pneumonia. The objective of this study was to assess the clinical course of patients receiving antibiotics prior to admission, compared to patients not previously treated. An observational cohort of 3364 CAP patients consecutively admitted to our hospital, and prospectively included, were studied. We collected clinical, microbiological and biochemical parameters, focusing on recent antibiotics received prior to admission. 610 (18%) patients received antibiotics prior to hospital admission for the current CAP episode. Patients with previous antibiotic use developed septic shock less frequently (4% vs. 7%, p=0.007) and required invasive ventilation less often (3% vs. 6%, p=0.002). After adjustment by different covariate factors and propensity score, antibiotic therapy was still independently associated with a lower incidence of septic shock at admission (OR 0.54 [95% CI 0.31-0.95], p=0.03) and less need for invasive ventilation (OR 0.38 [95% CI 0.16-0.91], p=0.03). In this cohort, recent use of antibiotics before hospital admission in CAP seems to be associated with a lower incidence of septic shock on admission and a lower need for invasive ventilation.

Prevalence of CTX-M beta-Lactamases in Escherichia coli from community-acquired urinary tract infections and associated risk factors among women in Cameroon

Background: In recent years, a worldwide dissemination of CTX-M beta-lactamase-type in Escherichia coli strains isolates from community-acquired urinary tract infections (CA-UTI) has been observed. However little is known on the prevalence and risk factors of this global threat in developing countries. Objective: The aim of this study was to study the prevalence and risk factors for CA-UTI in Yaoundé, Cameroon. Methods: Eighty six patients with urinary E.coli infection recruited from 10 health structures in the town of Yaoundé, Cameroon. After taking the first urine, faeces were collected from the patients for the study of the intestinal flora. The sample collection of faeces was done on a selected gel of enterobacteria resistant to third generation of cephalosporin. The molecular typing of extended-spectrum -lactamase (ESBL) was carried out. Results: Eighty-six strains of E. coli from 86 patients were included. We found that 39 (45.3%) strains produced an extendedspectrum beta-lactamase. Among risk factors, previous use of antibiotic and the dry season were associated with the presence of an ESBL-producing strain in the urine. All ESBL were identified as CTX-M. The production of CTX-M was found to be significantly associated with resistance to fluoroquinolones, aminoglycosides and to the association of trimethoprim-sulfamethazole. Conclusions: The prevalence of CTX-M ESBL in Yaoundé, Cameroon, provides new evidence on the global dissemination of CTX-M and the extent of this phenomenon in developing countries.

Skin and soft tissue infections in the intensive care unit: a retrospective study in a tertiary care center.

ObjectiveTo identify factors that may influence outcomes in patients with severe skin and soft tissue infections in the intensive care unit.MethodsA retrospective observational study was conducted in a cohort of 1,123 critically ill patients admitted to an intensive care unit with a primary or secondary diagnosis of severe skin and soft tissues infection between January 2006 and December 2014.ResultsThirty patients were included, 20 (66.7%) of whom were diagnosed with necrotizing fasciitis; in these patients, perineal area involvement was most commonly identified. Abscess was diagnosed in 8 (26.7%) patients, most commonly involving the cervical area. Risk factors such as immunosuppression and previous surgical trauma were commonly observed in this population. The most commonly isolated microorganism was Escherichia coli. Multidrug resistant microorganisms were commonly detected, even in the absence of traditional risk factors; among these patients, previous use of antibiotics was the most common risk factor for drug resistance. The rate of mortality was significantly higher in patients with necrotizing fasciitis (55%, p = 0.035) and associated with disease severity, presence of septic shock, cardiac arrest and leucocytosis.ConclusionDifferent risk factors and etiologies of severe skin and soft tissue infections were identified. Necrotizing fasciitis and drug-resistant bacteria were significant predictors of mortality, even in the absence of traditional risk factors. Obtaining a better understanding of trends in the risk factors and microorganisms associated with severe skin infections may help in the determination of prompt treatment and antibiotic choices.

Risk factors for carbapenem-resistant bacterial infection or colonization: A case control study

IntroductionWorldwide, there has been a documented increase in carbapenemase-producing bacteria, and the high incidence in Latin America has led to different research groups to focus on the phenotypic and genotypic characterization of these microorganisms. The aim of this study was to determine the risk factors for colonization or infection with carbapenem-resistant bacteria in a third level Hospital in Chía, Colombia. MethodologyPatients hospitalized in Clínica Universidad de La Sabana from January 2010 until September 2013 were identified retrospectively according to culture results from any biological sample as being colonized or infected by a carbapenem-resistant microorganism. Twenty-four variables were analyzed. ResultsEighty-five patients met the inclusion criteria in the study (44 cases, 41 controls). However, since three osteomyelitis cases by Pseudomonas aeruginosa did not have controls, only eighty-two cases were analyzed. Twenty-four variables were included as possible risk factors, of which five were statistically significant: use of carbapenem, beta-lactamase inhibitor and first generation cephalosporin antibiotics (OR 10.5, Mc Nemar 15.7; OR 4.8, Mc Nemar 9.8 and OR 3, Mc Nemar 5 respectively), previous hospitalizations (ICU or general ward) within a three-month period (OR 7.5, Mc Nemar 9.9), and use of a central catheter of peripheral insertion (Mc Nemar 11). ConclusionsThis is the first Colombian study to determine the risk factors associated with colonization or infection by carbapenem-resistant bacteria. Five risk factors were identified and the main one was previous antibiotic use during a patient's hospitalization period.

Worrisome high frequency of extended-spectrum beta-lactamase-producing Escherichia coli in community-acquired urinary tract infections: a case–control study

There has been a sustained and dramatic increase in community-acquired urinary tract infections (CA-UTI) caused by extended-spectrum beta-lactamase (ESBL)-producing bacteria over recent years. Despite this, no studies have been performed in low- or middle-income countries. The main objective of this case-control study was to describe ESBL CA-UTI and its risk factors. Outpatients with CA-UTI seen at the Hospital Cayetano Heredia during 2015 were identified. Patients were contacted by telephone. After consent had been obtained, a questionnaire concerning previously identified risk factors was applied. Univariate and multivariate analyses were conducted using Stata version 13. The overall frequency of ESBL-producing Escherichia coli was 40.85%. Sixty-seven cases and 105 controls were included in this study. The following main risk factors were identified on multivariate analysis: previous antibiotic use (odds ratio (OR) 3.09), previous hospitalization (OR 2.92), and previous surgery (OR 2.75). Chronic corticosteroid use (OR 24.32, 95% confidence interval 2.39-246.92) was also identified as a risk factor. ESBL E. coli accounted for more than 40% of CA-UTIs during 2015. A history of previous hospitalization, surgery, and antibiotic use should be considered when treating this type of infection. Action should be taken to confirm these worrisome results and avoid the major consequences for public health.

Clostridium difficile infection in children: epidemiology and risk of recurrence in a low-prevalence country.

Clostridium difficile infection (CDI) is increasingly found in children worldwide, but limited data are available from children living in southern Europe. A 6-year retrospective study was performed to investigate the epidemiology, clinical features, treatment, and risk of recurrence in Italy. Data of children with community- and hospital-acquired CDI (CA-CDI and HA-CDI, respectively) seen at seven pediatric referral centers in Italy were recorded retrospectively. Annual infection rates/10,000 hospital admissions were calculated. Logistic regression was used to investigate risk factors for recurrence. A total of 177 CDI episodes was reported in 148 children (83 males, median age 55.3months), with a cumulative infection rate of 2.25/10,000 admissions, with no significant variability over time. The majority of children (60.8%) had CA-CDI. Children with HA-CDI (39.2%) had a longer duration of symptoms and hospitalization (p = 0.003) and a more common previous use of antibiotics (p = 0.0001). Metronidazole was used in 70.7% of cases (87/123) and vancomycin in 29.3% (36/123), with similar success rates. Recurrence occurred in 16 children (10.8%), and 3 (2%) of them presented a further treatment failure. The use of metronidazole was associated with a 5-fold increase in the risk of recurrence [odds ratio (OR) 5.18, 95 % confidence interval (CI) 1.1-23.8, p = 0.03]. Short bowel syndrome was the only underlying condition associated with treatment failure (OR 5.29, 95 % CI 1.17-23.8, p = 0.03). The incidence of pediatric CDI in Italy is low and substantially stable. In this setting, there is a limited risk of recurrence, which mainly concerns children treated with oral metronidazole and those with short bowel syndrome.

Diabetic Foot Infections: Antibiotic Susceptibility Patterns and Determination of Antibiotic Cross-Resistance in Clinical Isolates of Enterococcus Species During 2012 - 2014 in Shiraz, Iran

Background: Diabetic foot infections (DFIs) are an increasingly common public health problem and are associated with mortality and morbidity. The incidence of Enterococci in DFIs, a leading cause of hospital admission in Iran, has been increasing, possibly due to previous antibiotic use. Objectives: The aims of this study were 1) isolation of bacteria from diabetic patients with foot ulceration, 2) characterization of the isolated bacteria, 3) confirmation of Enterococci and their genus, 4) determination of the susceptibility profile of the isolates, and 5) survey of the cross-resistance among Enterococcus spp. Methods: A total of 86 diabetic patients with foot ulceration were investigated during 2012 - 2014 in Nemazee hospital (Shiraz, Iran). Swabs were collected from diabetic ulcers. For the isolation of bacteria, microbiological media were used. Colonies were further characterized using various biochemical tests (e.g., catalase test, oxidase reaction, growth on bile esculine [BE] agar, growth in the presence of 6.5% NaCl, growth at 45°C, motility, pyrrolidonyl arylamidase [PYR], yellow pigment, arginine dihydrolase [ADH], and sugars fermentation). Antibiotic susceptibility testing was done by standard disc diffusion method, according to the CLSI protocols. Detection of vancomycin-resistant Enterococcus (VRE) was performed by BHI agar screen plate. Results: In the current study, a total of 86 diabetic patients were investigated. Enterococcus spp. were isolated from 34 (39.5%) patients consisting of 20 males (59%) and 14 females (41%). Twenty-five (73.5%) patients received antibiotic treatment on admission. Fifty (44.1%) cases had random blood sugar ranging between 130 - 300, and 19 (55.9%) had blood sugar of 300 - 450. Of the 34 patients, 15 (44.1%) had type 1 diabetes and 19 (55.9%) had type 2 diabetes. Enterococcus faecalis was the most common isolated Enterococcus spp. (50%). Linezolid was the most effective antibiotic against Enterococcus isolates, and ciprofloxacin was the least effective. Conclusions: Our data showed that resistance to vancomycin among Enterococcus spp. isolates is emerging. Knowledge of the causative microorganisms in DFIs and their antibiotic susceptibility profiles is essential for proper treatment and infection eradication. Keywords: Enterococcus spp.; Diabetic Foot Infections; Antibiotic Susceptibility; Antibiotic Cross-Resistance

Nasal Carriage of Methicillin-resistant Staphylococcus aureus among Elderly People in Lagos, Nigeria

Objectives: Staphylococcus aureus is a lethal opportunistic pathogen capable of causing a wide range of infections, especially in debilitated hosts such as the elderly. Nasal carriers of this organism have an increased risk of becoming infected with the pathogen. The purpose of this study was to assess the prevalence of S. aureus nasal carriage, to determine the probable risk factors, and to examine the frequency of methicillin-resistant S. aureus (MRSA) among elderly people in hospital and nursing home settings in Lagos, Nigeria. Methods: Two hundred thirty nasal samples were collected from the anterior nares of individuals aged 65 years and older. Possible risk factors were assessed using well-structured questionnaires, and the samples were subjected to standard bacteriological procedures. Antibiotic susceptibility of the isolates was determined with the disk diffusion method. Detection of methicillin resistance was done with the disk diffusion test using cefoxitin 30 µg, and confirmed with OXOID MRSA CHROMagar. Results: Fifty (21.7%) S. aureus strains were identified among the samples, and antibiotic susceptibility testing showed that multidrug resistance was common. Approximately 20% were resistant to gentamicin, ofloxacin, and mupirocin. Cloxacillin, amoxicillin/clavulanate, and ceftazidime showed the least anti-staphylococcal activity, and almost half of the isolates were resistant to ceftriaxone and cefuroxime. The MRSA nasal carriage rate was 10% and colonization was favored by previous antibiotic use, hypertension, and tuberculosis. Conclusions: The occurrence of multidrug-resistant S. aureus in the elderly cohort indicates their capacity to serve as reservoirs for these strains, which could facilitate the dissemination of MRSA into the community. Therefore, decolonization and the implementation of measures to prevent the spread of this organism are necessary.

Daptomycin-Vancomycin-Resistant Enterococcus faecium Native Valve Endocarditis: Successfully Treated With Off-Label Quinupristin-Dalfopristin.

Multidrug-resistant enterococcal nosocomial invasive infections are a rising concern faced by the medical community. Not many options are available to treat these highly virulent organisms. Risk factors for developing these highly resistant organisms include prolonged hospital stay, previous antibiotic use, and immunosuppression. In this article, we report a case of daptomycin-resistant enterococcal native infective endocarditis treated with off-label use of quinupristin-dalfopristin.