Resistance In Intestinal Flora Research Articles

Antibacterial activity of oxytetracycline on microbial ecology of Nile tilapia ( Oreochromis niloticus ) gastrointestinal tract under laboratory condition

The antibacterial effect of oxytetracycline (OTC) on bacterial load, pathogen and possible development of antibiotic resistance in intestinal flora of apparently healthy Nile tilapia (Oreochromis niloticus) was investigated under laboratory condition. OTC, a broad spectrum approved antibiotic widely used in aquaculture, was fed to Nile tilapia through medicated diet at a rate of 2 g/ kg of feed for consecutive 7 days in treatment 1 (T₁) and 30 days in treatment 2 (T₂). Changes in physico‐chemical parameters of water were also recorded where pH and dissolved oxygen influenced bacterial load and coliform count respectively. At the start of the experiment, initial bacterial load in fish intestine was 1.61 ± 2.25 × 10¹⁰ cfu/g, which after OTC treatment decreased significantly (p < .05) to 3.06 ± 2.08 × 10⁸ cfu/g on day 7 and 3.45 ± 4.46 × 10⁷ cfu/g on day 30 when compared with the control group. Among the 10 bacterial genera identified in the intestine, 4 potential public health concern bacteria viz., Salmonella, Escherichia, Enterobacter and Staphylococcaus were predominant. There was a sharp increase in bacterial load on day 18 in T₂ that may be attributed to the development of antibiotic resistance in intestinal bacteria. Antibiotic susceptibility test for isolates against seven antibiotics: amoxycillin, ciprofloxacin, co‐trimoxazole, erythromycin, gentamicin, nitrofurantoin and tetracycline using disc diffusion method revealed significantly increased resistance of Gram‐negative rods (p < .05) that possibly caused increased frequency of OTC‐resistant microorganisms. In conclusion, short‐ and long‐term exposure to OTC treatment affected the distribution of bacterial genera including pathogens in the Nile tilapia gastrointestinal tract and concomitantly influenced their antimicrobial resistance.

Reduction in Hospital Admission Rates Due to Post-Prostate Biopsy Infections After Augmenting Standard Antibiotic Prophylaxis

We evaluated the incidence of infectious complications requiring hospitalization after transrectal ultrasound guided prostate biopsy, comparing an augmented regimen of antibiotic prophylaxis to the standard regimen, and established cost-effectiveness at our center. Our standard antibiotic prophylaxis regimen consisted of 3 days of ciprofloxacin or Bactrim™ DS in the perioperative period. An increase in hospital admissions related to infection after transrectal ultrasound guided biopsy from January 2010 through December 2010 led us to initiate an augmented regimen of 3 days of ciprofloxacin or Bactrim DS in addition to 1 dose of intramuscular gentamicin before biopsy from January 2011 to December 2011. Urine and blood cultures along with bacterial susceptibilities were obtained at admission and compared between the 2 groups. Cost analysis was done to determine the cost-effectiveness of standard and augmented regimens. The rate of hospitalization due to post-biopsy infections was 3.8% (11 patients among 290 biopsies) in 2010, which decreased to 0.6% (2 patients among 310 biopsies) in 2011 (p <0.001). Of the admitted patients who received standard prophylaxis, 73% had fluoroquinolone resistant Escherichia coli urinary infection and/or bacteremia and only 9% had strains resistant to gentamicin. Multivariate analysis showed that the standard regimen was significantly associated with hospital admission due to post-biopsy infection (HR 2.078 ± 0.84, p = 0.013). The augmented regimen resulted in a cost savings of $15,700 per 100 patients compared to the standard regimen. The addition of gentamicin to current prophylactic regimens significantly reduced the rate of hospitalization for post-biopsy infectious complications and was shown to be cost-effective.

Targeted Antimicrobial Prophylaxis Using Rectal Swab Cultures in Men Undergoing Transrectal Ultrasound Guided Prostate Biopsy is Associated With Reduced Incidence of Postoperative Infectious Complications and Cost of Care

We evaluated targeted antimicrobial prophylaxis in men undergoing transrectal ultrasound guided prostate biopsy based on rectal swab culture results. From July 2010 to March 2011 we studied differences in infectious complications in men who received targeted vs standard empirical ciprofloxacin prophylaxis before transrectal ultrasound guided prostate biopsy. Targeted prophylaxis used rectal swab cultures plated on selective media containing ciprofloxacin to identify fluoroquinolone resistant bacteria. Patients with fluoroquinolone susceptible organisms received ciprofloxacin while those with fluoroquinolone resistant organisms received directed antimicrobial prophylaxis. We identified men with infectious complications within 30 days after transrectal ultrasound guided prostate biopsy using the electronic medical record. A total of 457 men underwent transrectal ultrasound guided prostate biopsy, and of these men 112 (24.5%) had rectal swab obtained while 345 (75.5%) did not. Among those who received targeted prophylaxis 22 (19.6%) men had fluoroquinolone resistant organisms. There were no infectious complications in the 112 men who received targeted antimicrobial prophylaxis, while there were 9 cases (including 1 of sepsis) among the 345 on empirical therapy (p=0.12). Fluoroquinolone resistant organisms caused 7 of these infections. The total cost of managing infectious complications in patients in the empirical group was $13,219. The calculated cost of targeted vs empirical prophylaxis per 100 men undergoing transrectal ultrasound guided prostate biopsy was $1,346 vs $5,598, respectively. Cost-effectiveness analysis revealed that targeted prophylaxis yielded a cost savings of $4,499 per post-transrectal ultrasound guided prostate biopsy infectious complication averted. Per estimation, 38 men would need to undergo rectal swab before transrectal ultrasound guided prostate biopsy to prevent 1 infectious complication. Targeted antimicrobial prophylaxis was associated with a notable decrease in the incidence of infectious complications after transrectal ultrasound guided prostate biopsy caused by fluoroquinolone resistant organisms as well as a decrease in the overall cost of care.

PREVALENCE OF ANTIMICROBIAL RESISTANCE IN INTESTINAL FLORA OF PATIENTS UNDERGOING PROSTATIC BIOPSY: IMPLICATIONS FOR PROPHYLAXIS AND TREATMENT OF INFECTIONS AFTER BIOPSY

OBJECTIVE To determine the prevalence of antimicrobial resistance in intestinal flora of patients undergoing transrectal ultrasonography (TRUS)-guided prostate biopsies (TGB) and to examine if this information is useful in selecting appropriate antimicrobial agents for prophylaxis and treatment of biopsy-associated infections. PATIENTS AND METHODS In 2007 and 2008, rectal swabs were cultured from patients before undergoing TGB. Antimicrobial sensitivity of coliforms to amikacin, ciprofloxacin and coamoxiclav was determined. Laboratory records were used to identify patients who had bacteraemia or significant bacteriuria within 30 days of the TGB and the antimicrobial sensitivity pattern of these organisms were compared to those from the rectal swab. RESULTS Of 592 patients who had TGB, 445 (75.1%) had a rectal swab beforehand; 0.2%,10.6% and 13.3% of the coliforms were resistant to amikacin, ciprofloxacin and coamoxiclav, respectively. After TGB, six patients presented with urinary tract infections (UTI) and two with bacteraemia. All the infections were caused by coliforms except one UTI which was caused by ciprofloxacin-sensitive Pseudomonas aeruginosa. The blood culture isolates were sensitive to amikacin but resistant to ciprofloxacin and coamoxiclav. All the coliforms in the urine were resistant to ciprofloxacin but sensitive to coamoxiclav. Urine isolates were not tested for amikacin sensitivity. There was a strong correlation between the antimicrobial sensitivity of the coliforms from the rectal swabs and those cultured from urine or blood in both patients for amikacin, six of eight for ciprofloxacin and seven of eight for coamoxiclav. CONCLUSIONS Our study shows that in the coliforms in the bowel flora of our local population there is a relatively high level of resistance to ciprofloxacin and coamoxiclav, and very low level of resistance to amikacin. As there was a strong correlation between the antimicrobial sensitivity of organisms causing infections after TGB and those isolated from the rectal swabs, we conclude that rectal swab cultures before TGB provide useful evidence for selecting appropriate antimicrobials for prophylaxis and treatment of TGB-associated infections.

1439 TARGETED ANTIMICROBIAL PROPHYLAXIS USING RECTAL SWAB (RS) CULTURES IN MEN UNDERGOING TRANSRECTAL ULTRASOUND GUIDED PROSTATE BIOPSY (TRUSP) SIGNIFICANTLY REDUCES THE INCIDENCE OF POST PROCEDURE INFECTIOUS COMPLICATIONS AND COST OF CARE

You have accessJournal of UrologyInfections/Inflammation of the Genitourinary Tract: Prostate & Genitalia1 Apr 20111439 TARGETED ANTIMICROBIAL PROPHYLAXIS USING RECTAL SWAB (RS) CULTURES IN MEN UNDERGOING TRANSRECTAL ULTRASOUND GUIDED PROSTATE BIOPSY (TRUSP) SIGNIFICANTLY REDUCES THE INCIDENCE OF POST PROCEDURE INFECTIOUS COMPLICATIONS AND COST OF CARE Aisha Taylor, Adam Murphy, John Cashy, Teresa Zembower, Anthony Schaeffer, Robert Nadler, and Elodi Dielubanza Aisha TaylorAisha Taylor Chicago, IL More articles by this author , Adam MurphyAdam Murphy Chicago, IL More articles by this author , John CashyJohn Cashy Chicago, IL More articles by this author , Teresa ZembowerTeresa Zembower Chicago, IL More articles by this author , Anthony SchaefferAnthony Schaeffer Chicago, IL More articles by this author , Robert NadlerRobert Nadler Chicago, IL More articles by this author , and Elodi DielubanzaElodi Dielubanza Chicago, IL More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1351AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES About 90% of urologists use fluoroquinolones (FQ) for empiric prophylaxis prior to TRUSP. The increasing prevalence of infections with FQ resistant bacteria in men undergoing TRUSP suggests that empiric FQ prophylaxis may be injudicious. We evaluated the effectiveness of RS culture derived targeted antimicrobial prophylaxis in men undergoing TRUSP. METHODS From July to October 2010 urologists at our institution used targeted vs. standard empiric antimicrobial prophylaxis prior to TRUSP. Standard empiric prophylaxis included a PO dose of ciprofloxacin 2 hours prior to and 12 hours after the procedure. Targeted prophylaxis was based on RS cultures, which identified FQ resistant bacteria plated on MacConkey agar containing ciprofloxacin. Resistance was defined by ciprofloxacin MIC ≥4 μg/ml. Patients with FQ susceptible organisms received ciprofloxacin prophylaxis while those with FQ resistant organisms received antimicrobials based on susceptibilities from the RS cultures. We identified men with infectious complications within 30 days post-TRUSP using the electronic medical record. RESULTS 213 men underwent TRUSP. Forty-three (20.2%) underwent RS while 170 (79.8%) did not. Six (14.0%) of the 43 men who underwent RS grew a FQ resistant organism (1 Klebsiella sp & 5 Escherichia-coli). All 6 men complied with the targeted antimicrobial prophylaxis approach and none suffered an infectious complication post TRUSP. In contrast, 4 (2.3%) of the 170 men undergoing empiric antibiosis without a RS had infectious complications including 1 with prostatitis, 1 cystitis, 1 fever, and 1 with fever, prostatitis, and bacteremia with FQ resistant E. coli. The risk reduction of infectious complications post TRUSP among patients who underwent RS was statistically significant (p<0.01). The cost of a RS culture was $13. The mean cost of managing the infectious complications for all 4 patients in the empiric group was $2153 (range $618–$5271). We calculate the cost of the targeted and empiric therapy approaches per 100 men undergoing TRUSP, including the Medicare costs for IM antimicrobial administration ($23/administration). The cost per 100 TRUS prostate biopsies for the targeted approach is $1323 vs. $5066 for the empiric approach. CONCLUSIONS Targeted antimicrobial prophylaxis significantly reduced the incidence of post-TRUSP infectious complications caused by FQ resistant organisms, and decreased the overall cost of care. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited bySchaeffer E (2018) Re: Prevalence of Antimicrobial Resistance in Intestinal Flora of Patients Undergoing Prostatic Biopsy: Implications for Prophylaxis and Treatment of Infections After BiopsyJournal of Urology, VOL. 187, NO. 3, (1004-1004), Online publication date: 1-Mar-2012. Volume 185Issue 4SApril 2011Page: e576 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Aisha Taylor Chicago, IL More articles by this author Adam Murphy Chicago, IL More articles by this author John Cashy Chicago, IL More articles by this author Teresa Zembower Chicago, IL More articles by this author Anthony Schaeffer Chicago, IL More articles by this author Robert Nadler Chicago, IL More articles by this author Elodi Dielubanza Chicago, IL More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Prevalence of antimicrobial resistance in intestinal flora of patients undergoing prostatic biopsy: implications for prophylaxis and treatment of infections after biopsy

To determine the prevalence of antimicrobial resistance in intestinal flora of patients undergoing transrectal ultrasonography (TRUS)-guided prostate biopsies (TGB) and to examine if this information is useful in selecting appropriate antimicrobial agents for prophylaxis and treatment of biopsy-associated infections. In 2007 and 2008, rectal swabs were cultured from patients before undergoing TGB. Antimicrobial sensitivity of coliforms to amikacin, ciprofloxacin and coamoxiclav was determined. Laboratory records were used to identify patients who had bacteraemia or significant bacteriuria within 30 days of the TGB and the antimicrobial sensitivity pattern of these organisms were compared to those from the rectal swab. Of 592 patients who had TGB, 445 (75.1%) had a rectal swab beforehand; 0.2%,10.6% and 13.3% of the coliforms were resistant to amikacin, ciprofloxacin and coamoxiclav, respectively. After TGB, six patients presented with urinary tract infections (UTI) and two with bacteraemia. All the infections were caused by coliforms except one UTI which was caused by ciprofloxacin-sensitive Pseudomonas aeruginosa. The blood culture isolates were sensitive to amikacin but resistant to ciprofloxacin and coamoxiclav. All the coliforms in the urine were resistant to ciprofloxacin but sensitive to coamoxiclav. Urine isolates were not tested for amikacin sensitivity. There was a strong correlation between the antimicrobial sensitivity of the coliforms from the rectal swabs and those cultured from urine or blood in both patients for amikacin, six of eight for ciprofloxacin and seven of eight for coamoxiclav. Our study shows that in the coliforms in the bowel flora of our local population there is a relatively high level of resistance to ciprofloxacin and coamoxiclav, and very low level of resistance to amikacin. As there was a strong correlation between the antimicrobial sensitivity of organisms causing infections after TGB and those isolated from the rectal swabs, we conclude that rectal swab cultures before TGB provide useful evidence for selecting appropriate antimicrobials for prophylaxis and treatment of TGB-associated infections.