Routine Antibiotics Research Articles

Susceptibility Profile and Clinical Response of Fosfomycin and Other Antibiotics against Multidrug Resistant Gram Negative Urinary Isolates: A Cross-sectional Study

Introduction: Irrational use of antibiotics to treat Urinary Tract Infections (UTI) has led to the development of Multidrug Resistant (MDR) bacteria in both community as well as the hospital settings. Fosfomycin has emerged as a novel therapeutic option to treat these UTI patients along with empirically used routine antibiotics. Aim: To assess the sensitivity, molecular resistance mechanisms and clinical response of fosfomycin along with other urinary antibiotics like nitrofurantoin, colistin, and imipenem. Materials and Methods: It was a cross-sectional observational study from July 2018 to June 2019 in SGPGIMS, Lucknow, India. Stream urine samples of 24,782 patients were collected with clinical suspicion of UTI. The antibiotics were tested by disc diffusion and Minimum Inhibitory Concentration (MIC) methods. Genotypic analysis was done for testing resistance mechanisms in fosfomycin resistant isolates. Statistical tests were performed using Statistical Package for the Social Sciences (SPSS) software for Windows version 14.0. Results: Out of the 24,782 urine samples, 2,776 (11.2%) showed significant growth of pathogens ,with 334 drug resistant isolates among them. Gram negative bacilli 1846 (66.50%) was the most predominantly isolated pathogen in the cultures. Among the 334 drug resistant specimens, Escherichia coli {124 (37.13%)} were maximum in number. Total 79.6% (266/334) of the isolates were sensitive to fosfomycin including 89% (110/ 124) of E. coli, and 91.3% (105/115) of K.pneumoniae isolates. Colistin showed sensitivity in 87% (108/124) of the E.coli isolates; followed by Imipenem in 49% (61/124) and nitrofurantoin in 37% (46/124) of the isolates. Fos A genes were found to be the most prevalent in Fosfomycin resistant. About 41% of the patients showed favourable outcome and were cured with initiation of treatment as per sensitivity pattern. Conclusion: Fosfomycin has emerged as a safer option in MDR urinary isolates as compared to other urinary antibiotics including colistin. The drug needs to be more widely studied for its possible pharmacokinetics and dynamics as well as it’s possible implications in health care settings and patient management.

Eliminated routine postorthotopic liver transplant antibiotics in uncomplicated patients leads to equivalent safety outcomes.

The purpose of this retrospective study was to evaluate safety and efficacy end points of a postoperative antibiotic prophylaxis protocol in liver transplant (LT) patients, which was revised to limit antibiotic use. In the routine antibiotics group (RA), patients routinely received prophylactic antibiotics for around 3 days postoperatively for a variety of rationales, versus the limited antibiotics group (LA), in which patients received antibiotics for the treatment of secondary peritonitis. Patients were included if they were 18 or older and underwent liver transplant between January 2016 and September 2019. In total, 216 patients remained after exclusion: 118 patients in the RA group and 98 patients in the LA group. We detected a significant difference in the primary end point of postoperative antibiotic days of therapy. The median days of therapy was 2 for the RA group and 0 for the LA group (P < 0.005). Significantly fewer patients received only intraoperative antibiotics in the RA group versus the LA group: 42 (35.6%) versus 76 (73.5%) respectively (P < .005). There was no significant difference in secondary or safety outcomes, including surgical site infections. This study provides evidence that limiting the duration of prophylactic antibiotics postoperatively and treating most patients with only intraoperative antibiotics is safe.

Primary Lower-Limb Arterial Stent Infection Managed with Resection and in Situ Bovine Pericardial Revascularization

Peripheral arterial stent infection is a rare but morbid condition. We present the case of a patient with primary stent infection of his superficial femoral artery (SFA) and popliteal artery, managed with surgical explant and in situ reconstruction using rifampicin-soaked bovine pericardial tube graft. A 69-year-old man presented with a 3-day history of left groin pain. He had had stents placed into his SFA and popliteal artery in 6 months prior. Duplex ultrasound demonstrated a pseudoaneurysm of the common femoral artery (CFA), with ying-yang flow. A computed tomography angiogram confirmed this pseudoaneurysm, which had a thick rind of nonenhancing soft tissue. Blood cultures were positive for methicillin-sensitive Staphylococcus aureus. The patient was taken to the operating theater, and the CFA, profunda femoris artery, and SFA were exposed. After heparinization and clamp control, the pseudoaneurysm was incised, which revealed that the proximal SFA had been completely eroded. All infected tissues were resected. In situ arterial reconstruction was undertaken using a rifampicin-soaked bovine pericardium tube graft. A subsequent positron emission tomography scan revealed high fluorodeoxyglucose uptake around the patients remaining distal SFA and popliteal artery stents. These were explanted in the same manner described above. There is limited evidence regarding the prevention of infection when placing peripheral arterial stents. The Society of Interventional Radiology does not recommend routine prophylactic antibiotics when placing peripheral stents. In situ reconstruction using bovine pericardium is a well-described technique in the management of aortic graft infections, but there is limited experience in its use in a peripheral setting.

Risk Factors and Bacterial Profile of Abdominal Surgical Incisions- Changing Trends

Introduction: Surgical Site Infections (SSIs) remain a significant postoperative complication after abdominal surgeries, even with the advancement of infection control practices. The emergence of drug resistance to routine antibiotics was a challenge to infected wound management. Aim: To analyse the host risk factors and bacterial flora associated with abdominal surgical site infections and to evaluate the changes in the prevalence and antibiotic susceptibility pattern over the years. Materials and Methods: A cross-sectional study was done among 150 abdominal surgery cases admitted to a Government Medical College Thrissur, (referral hospital) in Kerala, India for one year, from September 2010 to August 2011. Host risk factors were analysed by clinical details and preoperative investigations. Samples were collected from the wound site on the third day of surgery using sterile swabs for bacteriological analysis. Repeated samples were taken in case of suspected wound infection to identify the types of pathogen if any. Statistical analysis was done using Microsoft excel and open Epi software. The results were compared with the similar studies conducted in this institution during 2015-2016 and 2016-2017 to know the changes in prevalence and antimicrobial sensitivity. Result: Out of 150 cases higher infection rate was found in patients &gt;60 years 5 (17.2%), emergency surgeries 16 (21.6%), large intestinal surgeries 4 (44.4%), with diabetes 5 (26.32%), patients on steroids and obese 3 (37.5%). Colonisers were present in 34.7% abdominal surgical wounds. Infection rate of 14.7% in abdominal surgeries was reduced to 11.2% and 10% between the years 2015-16 and 2016-17 respectively. Higher infection rate was noticed in patients with premorbid risk factors. When compared with the similar studies conducted in the same institute, Pseudomonas and Acinetobacter with E. coli and S. aureus were found to be most common wound pathogens and resistance to ciprofloxacin and ceftriaxone were increased. Amikacin, piperacillin tazobactam and imipenem were useful but decreasing in sensitivity were noticed. Conclusion: Bacterial colonisation with endogenous flora was the primary source of SSIs. Good infection control practices, early identification of the pathogen and treatment with an appropriate antibiotics can reduce the development of resistant organisms and cross infection. The use of antimicrobials for prophylaxis and treatment needed to be modified according to the antimicrobial sensitivity report and local susceptibility pattern.

Comparison between outcome of single dose of prophylactic antibiotic versus postoperative antibiotic in inguinal hernia surgery.

Objectives:To compare the outcome prophylactic antibiotics and routine pre-surgical and post-surgical in terms of incidence of surgical site infection (SSI) and to explore the effect of various factors such as duration of surgery and patient characteristics (if any).Methods:A double-blinded prospective analysis of a total of 60 patients with the primary inguinal hernia was conducted from 24th August 2020 to 24th August 2021 at the Surgical Department of Nishtar Medical University & Hospital, Multan. The participants of the study were categorized into two groups such that 30 consecutive patients were placed in the study group who were administered with a single dose of prophylactic antibiotic 30 minutes before to mesh repair surgery and the remaining 30 patients were placed in the control group who were administered routine antibiotics pre and post-operatively. The effects in patients were observed till 30 days following surgery for any sign of infection. All the collected data were analyzed through SPSS (version 19).Results:The rate of infection in both groups was noted. The incidence of infection in the study group (13.3%) was higher as compared to the control group (10%). No patient underwent mesh removal and no significant difference in terms of post-operative complications was observed in the results of both groups.Conclusion:Both the treatments, prophylactic antibiotics and routine pre-surgical and post-surgical were equally effective. However, we recommend the administration of prophylactic since they are cost-effective and prevent bacterial drug resistance.

Implementing the Protocol of Perioperative Narrow-spectrum Antibiotic Prophylaxis in the Surgical Wards of Mofid Children’s Hospital in 2019 - 2020, A Comparative Study

Background: Surgical procedures may be complicated by post-surgical infections. This study investigates the role of administering perioperative narrow-spectrum antibiotic prophylaxis in preventing post-surgical infections as compared to routine broad-spectrum antibiotic usage in the surgical ward. Methods: Narrow-spectrum perioperative antibiotic prophylaxis, in accordance with CDC guidelines, was implemented in our hospital in October 2019. In this quasi-experimental study, all the children (one month to fifteen years old) who underwent surgery from April to September 2019 and had received broad-spectrum antibiotics for various durations, as well as those operated after the implementation of the perioperative narrow-spectrum antibiotic prophylaxis plan (October 2019 to March 2020) were enrolled. Surgical wound type (clean, clean/contaminated, contaminated, and dirty), type and site of the infection, and the patient’s age and sex were recorded. Cases with postoperative infections were followed up in the two groups during hospitalization and for 30 days (or 90 days if a prosthetic material was implanted) after discharge. The rate of post-surgical infections was compared between the two groups by the Mann-Whitney and chi-squared tests. Results: In total, 4308 cases were enrolled in the first six months and 3650 in the second six months of the study. The rate of post-surgical infections in the first group was 31/4380 (23.7%) as compared to 22/3650 (20%) in the second group (P-value = 0.3365) Conclusions: There was no increase in the frequency of post-surgical infections after the implementation of the perioperative narrow-spectrum antibiotic prophylaxis protocol. Reducing the use of antibiotics before surgery shrinks costs and antibiotic resistance without any effect on the post-surgical infection rate.

Decreasing Unnecessary Antibiotic Usage in Patients Admitted With Bronchiolitis.

Bronchiolitis is a viral syndrome that occurs in children aged <2 years and is a common reason for admission to children's hospitals. The American Academy of Pediatrics bronchiolitis guideline discourages routine antibiotic therapy for bronchiolitis. Despite this, there is high use of antibiotics in this patient population. We performed a retrospective chart review of all patients aged ≤2 years admitted to our tertiary care center with bronchiolitis during 2 subsequent respiratory seasons. Between the 2 seasons, we provided an intervention to our hospital medicine group, which included a didactic review of American Academy of Pediatrics bronchiolitis guideline followed by subsequent, ongoing reinforcement from antibiotic stewardship weekday rounds. We were able to achieve a 40% decrease in overall antibiotic use between the 2 study periods (25% vs 15%, P < .001). Provider education, along with focused antibiotic stewardship audits with real-time feedback, resulted in decreased use of antibiotics in patients admitted with bronchiolitis.

Ongoing Outbreak of Extensively Drug-Resistant Campylobacter jejuni Infections Associated With US Pet Store Puppies, 2016-2020

Extensively drug-resistant Campylobacter jejuni infections cannot be treated with any commonly recommended antibiotics and pose an increasing public health threat. To investigate cases of extensively drug-resistant C jejuni associated with pet store puppies and describe the epidemiologic and laboratory characteristics of these infections. In August 2017, health officials identified, via survey, patients with C jejuni infections who reported contact with puppies sold by pet stores. In conjunction with state and federal partners, the Centers for Disease Control and Prevention investigated cases of culture-confirmed C jejuni infections in US patients with an epidemiologic or molecular association with pet store puppies between January 1, 2016, and February 29, 2020. Available records from cases occurring before 2016 with genetically related isolates were also obtained. Patients were interviewed about demographic characteristics, health outcomes, and dog exposure during the 7 days before illness onset. Core genome multilocus sequence typing was used to assess isolate relatedness, and genomes were screened for resistance determinants to predict antibiotic resistance. Isolates resistant to fluoroquinolones, macrolides, and 3 or more additional antibiotic classes were considered to be extensively drug resistant. Cases before 2016 were identified by screening all sequenced isolates submitted for surveillance using core genome multilocus sequence typing. A total of 168 patients (median [interquartile range] age, 37 [19.5-51.0] years; 105 of 163 female [64%]) with an epidemiologic or molecular association with pet store puppies were studied. A total of 137 cases occurred from January 1, 2016, to February 29, 2020, with 31 additional cases dating back to 2011. Overall, 117 of 121 patients (97%) reported contact with a dog in the week before symptom onset, of whom 69 of 78 (88%) with additional information reported contact with a pet store puppy; 168 isolates (88%) were extensively drug resistant. Traceback investigation did not implicate any particular breeder, transporter, distributer, store, or chain. Strains of extensively drug-resistant C jejuni have been circulating since at least 2011 and are associated with illness among pet store customers, employees, and others who come into contact with pet store puppies. The results of this study suggest that practitioners should ask about puppy exposure when treating patients with Campylobacter infection, especially when they do not improve with routine antibiotics, and that the commercial dog industry should take action to help prevent the spread of extensively drug-resistant C jejuni from pet store puppies to people.

The Effects of Zinc Sulfate on Sepsis Outcomes in Neonates: A Blind Clinical Trial

Background: The present study aimed at assessing the effects of zinc sulfate supplementation on sepsis outcomes in neonates. Methods: This randomized double-blind clinical trial was performed on neonates suffering neonatal sepsis. They were hospitalized in NICU ward at Hajar hospital in Shahrekord, Iran, in 2018. The patients were randomly assigned into two groups receiving a combined therapy of oral zinc sulfate (3mg/kg/day) and antibiotic for ten days (the intervention group, n=30) or routine anti-sepsis antibiotic therapy for the same time (the control group, n=30). The intervention and control groups were matched for baseline variables including gestational age, patients' age, time for beginning the first feeding and baseline anthropometric parameters. Height, weight, head circumference, feeding tolerance time, number of days of oxygenation, number of days hospitalized, NEC, duration of TPN reception, and time at feeding completion in the two groups were compared. Results: In total, 37 males and 23 females participated in this study, 21.7% of whom were born by natural vaginal delivery and others by cesarean section. There was a significant difference between the intervention and control groups in terms of neonates' weight and height, the rate of receiving TPN, Apgar score and nutrition tolerance. The use of zinc sulfate resulted in a significant increase in body weight and height, requiring less TPN use, and also shorter time to achieve nutritional tolerance (P<0.05). Conclusion: The use of oral zinc sulfate (3 mg/kg/day divided for 10 days) in neonates suffering from sepsis improves sepsis-related clinical outcomes, leading to improvements in linear growth and nutrition tolerance, along with shortening the time for TPN

Asymptomatic full-term infants born to women with chorioamnionitis may not need routine antibiotics.

While infants with early-onset sepsis require antibiotics, there is little evidence to support their routine use in asymptomatic infants exposed to maternal chorioamnionitis. We aimed to ascertain the incidence of culture-proven sepsis in full-term infants exposed to chorioamnionitis and to determine whether asymptomatic infants need routine antibiotic treatment. This study was retrospective. Included were all full-term infants admitted to our neonatal intensive care unit between 1January 2017 and 31May 2018 who were given intravenous antibiotics for maternal chorioamnionitis. After identifying eligible infants, relevant maternal and infant data were collected from our medical records and the Neonatal Intensive Care Units Database. We selected 167 term infants from 7736 deliveries. The incidence of chorioamnionitis was 21 per 1000 deliveries. The mean gestational age was 39weeks (range 37-41), and 57% infants were male. Asymptomatic infants (76%) received intravenous antibiotics for an average of 2days compared to 4days in the symptomatic group (24%), p<0.001. No infant died or developed culture-positive sepsis. The risk of early-onset sepsis in well-appearing term infants of mothers with chorioamnionitis is low. Further studies are mandatory to determine whether asymptomatic infants of mothers with clinical chorioamnionitis need antibiotic treatment.

Routine antibiotics may not be needed to treat uncomplicated right diverticulitis: A retrospective cohort study.

We aimed to investigate whether antibiotic administration is necessary for patients with uncomplicated right colonic diverticulitis. Data from patients diagnosed with uncomplicated right colonic diverticulitis, who received inpatient treatment at a single center between January 2019 and January 2021, were retrospectively examined. The patients were divided into two groups according to whether antibiotics were administered. The patients were matched between groups using propensity score matching in a 1:1 ratio using logistic regression with the nearest-neighbor method. The primary study outcome was the length of hospital stay, and the secondary outcomes were time to the introduction of sips of water and a soft diet. The study included 138 patients who received antibiotics and 59 who did not. After propensity score matching, 55 patients were assigned to each treatment group. There was no significant difference between the two groups in terms of age (p = 0.772), sex (p>0.999), body mass index (p = 0.121), prehospital symptom duration (p = 0.727), initial body temperature (p = 0.661), white blood cell count (p = 0.688), or C-reactive protein level (p = 0.337). There was also no statistically significant difference in the length of hospital stay between the no antibiotic and antibiotic groups (3.1±0.7 days vs. 3.0±1.0 days, p = 0.584). Additionally, no significant difference was observed between the no antibiotic and antibiotic groups with respect to time to sips of water (2.1±0.7 days vs. 1.8±0.9 days, p = 0.100) and time to the introduction of a soft diet (2.4±0.8 days vs. 2.1±0.9 days, p = 0.125). The findings suggest that routine antibiotics may be not required for treating patients with uncomplicated right colonic diverticulitis.

Subconjunctival antibiotics: an alternative to intracameral antibiotics for endophthalmitis prophylaxis in cataract surgery

Background: There has been an increase in the use of routine intracameral antibiotics for endophthalmitis prophylaxis in cataract surgery. However, this can be associated with serious adverse events. Previously, subconjunctival antibiotics were the preferred route but there is minimal literature directly comparing the two. Hence, the safest and most efficacious route of prophylactic antibiotic administration remains controversial. Purpose: To evaluate the efficacy and safety of subconjunctival with intracameral antibiotics for postoperative endophthalmitis (POE) prophylaxis in patients undergoing uncomplicated cataract surgery. Methods: A literature review was conducted in Cochrane and PubMed for studies that compared the efficacy of prophylactic subconjunctival and intracameral antibiotics for post-cataract endophthalmitis. Searches were not limited to English or study design. Results: Three observational studies showed that subconjunctival and intracameral antibiotics both reduced POE rates. Intracameral antibiotics demonstrated a high efficacy (OR = 0.25, 95% CI 0.13-0.46, p < 0.0001) but was also associated with increased potential complications. All studies were conducted in a sequential nature during which cataract surgery techniques and instrumentation have improved in recent years. Conclusion: In institutions with a high incidence of endophthalmitis, routine intracameral antibiotic use would be more appropriate. However, in facilities with lower rates of POE, the subconjunctival route of delivery can be an alternative due to its better safety profile.

Postoperative antibiotic use in patients with unilateral purulent chronic rhinosinusitis.

ObjectivesTo describe our experience with the use of postoperative antibiotics in the management of unilateral chronic rhinosinusitis (CRS) patients with active infection at the time of surgery, and to evaluate the need for routine postoperative antibiotic administration in this population.MethodsThis retrospective chart review analyzed the medical records of all patients who underwent endoscopic sinus surgery for unilateral purulent CRS between November 2013 and September 2019 at a tertiary care center and who were not prescribed routine postoperative antibiotics. Duration of time until normalization of sinus cavities and whether antibiotics were ultimately prescribed for persistent infectious signs and symptoms were recorded. Patient characteristics and findings were analyzed to determine if any of the evaluated parameters were associated with the need for postoperative antibiotics.ResultsSixty‐nine patients were included in the study. Thirty‐three (47.8%) did not require antibiotics during the postoperative period. The average time to sinus normalization was 8.1 weeks (range 1‐24 weeks) for patients who received antibiotics and 5.7 weeks (range 1‐16 weeks) for those who did not receive antibiotics (P = .066). No evaluated variables were associated with antibiotic use on univariate or multivariate analysis.ConclusionPostoperative antibiotics were not necessary to normalize infected sinus cavities for nearly half of patients with unilateral purulent CRS in this series. Further studies are needed to better delineate which patients would derive benefit from postoperative antibiotics.Level of EvidenceLevel IV.

Prospective study to analyze clinico-epidemiological profile of patients presenting with liver abscess at tertiary care centers

Background: Liver abscess is an ancient disease bothering mankind since ages and continues to be a common health problem in India. Both of its subtypes i.e., amoebic and pyogenic, continues to pose serious challenge to the Indian health care system.Aims and objectives: To determine the demographic profile of patients, to assess type of liver abscess prevalent in the region and to assess etiological factors of the disease.Methods: Study was conducted in two tertiary care and referral hospitals in the Indian national capital region and a govt. hospital in Punjab from 01 July 2016 to 31 December 2019 and the patients were followed up till June 2020 with the last recruited patient getting a six month follow up. Diagnosis was confirmed by sonography and examination of aspirate. Positive routine bacteriological culture of the pus and a positive response to routine antibiotics made up for the pyogenic liver abscess category.Results: Liver abscess commonly affects middle aged males of low socioeconomic status. Diabetics and alcohol (both Indian made foreign liquor and the local country liquor) are biggest risk factors. Majority have raised leukocyte counts while Alkaline phosphatase is the most commonly deranged liver function test marker, raised to more than twice of the normal range in most cases. Right lobe involvement, right sided pleural effusion and raised right hemidiaphragm are seen in plain chest X-ray. Fever and pain abdomen are the most common presenting complaints. USG abdomen is an effective diagnostic modality that also serves to guide intervention procedures.Conclusions: Early diagnosis and timely intervention produces best results.International Journal of Human and Health Sciences Vol. 05 No. 04 October’21 Page: 473-477

Routine Postoperative Antibiotics After Tissue Expander Placement Postmastectomy Does Not Improve Outcome.

In an attempt to reduce the incidence of infectious complications after tissue expander-based breast reconstruction, the routine administration of postoperative antibiotics regimen is common in many practices. In recent years, there has been a plethora of reports scrutinizing the prophylactic use of postoperative antibiotics in this setting. The aim of this study was to determine the efficacy of prolonged administration of postoperative antibiotics compared with perioperative-only antibiotic administration for prophylaxis after tissue expander placement for immediate mastectomy reconstruction. A retrospective chart review of all patients who underwent immediate tissue expander placement after mastectomy at our institution from June 2005 to September 2018 was performed. All patients in the study received perioperative intravenous antibiotics 30 to 60 min preoperatively and for 24 hours postoperatively. Patients were divided into 2 groups. Patients in group A did not receive antibiotics beyond the perioperative period. Patients in group B received oral antibiotics for at least 7 days postoperatively in addition to the perioperative intravenous antibiotics. The 2 groups were compared for demographics and prevalence of risk factors such as radiation, chemotherapy, smoking, and diabetes. The incidence of complications such as infection, wound complications, hematoma, seroma, capsular contracture, loss of tissue expander, and reoperations was assessed. A total of 529 patients were included in the study, of which 241 were in group A and 288 were in group B. The total number of breasts reconstructed in group A was 398, whereas in group B, it was 466 breasts. Patients were followed up to 5 months postoperatively in each group. There were no statistically significant differences in the demographic and patient characteristics among the 2 groups. The incidence of infection in group A was 23.24% and in group B was 21.53% (P = 0.412). The incidence of other complications follows the same trend when comparing group A versus B. This retrospective study shows that the routine use of postoperative antibiotics after tissue expander placement for immediate mastectomy reconstruction does not result in reduction in the incidence of common complications or improvement of clinical outcomes.

Spectrum of surgical site infection on the surgical floor; Increasing resistance to routine antibiotics

Objective: To know the spectrum of surgical site infections in general surgical patients so that specific strategies can be developed to decrease the morbidity caused by these infections.Material and Methods: All the patients who underwent general surgical operations on an emergency basis at the surgical unit of the District headquarters teaching hospital Rawalpindi from 01-01-2016 to 31-12-2017 were evaluated for surgical site infections. Surgical site infections suspected clinically were confirmed by culture and sensitivity. Involved flora and their sensitivity to various antibiotics were also determined.Results: Among 2202 emergency operated patients, two hundred and thirty-seven patients (10.76%) had surgical site infection confirmed on culture and sensitivity (C/S) report. About sixty-five percent of patients were male. Of two hundred and thirty-seven positive patients, the twenty-nine patient underwent laparotomy for penetrating and blunt abdominal trauma. Staph aureus was present in one hundred and forty-five (79.67%) patients. E.coli was the commonest Gram-ve micro-organism (70.95%). Forty-six patients (19.40%) were sensitive to Cefoperazone sodium followed by twenty patients (8.43%) to Piperacillin sodium and twenty-one (8.86%) each to Amikacin and Linezolid.Conclusion: Surgical site infection causes a significant rise in morbidity on the surgical floor. Most of the causative microorganisms are becoming resistant to routine antibiotics. Sensitivity to the broader spectrum of antibiotics like Cefoperazone and Linezolid is increasing.

Pathogen isolation and antibiogram analysis in dairy cows with clinical mastitis in Adana region, Turkey

The aim of this study was to investigate the pathogen types in milk samples of cows with clinical mastitis and the sensitivity of isolated bacteria to various antibacterial drugs, in Adana region, Turkey. The study was carried out on 103 milk samples collected from dairy cows with clinical mastitis. Microbiological identification and isolation were performed to identify gram negative and gram positive bacteria, Mycoplasma bovis and fungi. Then, bacteria isolated from infected milks were subjected to in vitro antibiotic sensitivity testing, using 27 antimicrobials agents. As a result, a total of 146 microorganisms isolates were obtained from 103 milk samples. The predominant pathogen isolates recovered were fungi (21.9%), Escherichia coli (19.9%) and Staphylococcus aureus (13.7%), followed by Mycoplasma bovis (8.2%) and Streptococcus uberis (6.8%). The mixed predominant pathogen was fungi, (75%) the majority of which mixed with gram positive bacteria. Ampicillin, imipenem, Chloramphenicol and Streptomycin were the least effective antimicrobial agents, while the most effective antibiotics were Florfenicol, followed by Amikacin and Kanamycin / Cefalexin. In conclusion, the types of microorganisms that cause mastitis and the antibiogram results of the bacteria isolated varied. Most importantly, fungal mastitis is a serious problem, should always be considered before routine antibiotic therapy.

Role of minimal antibiotic therapy and routine long term post-operative therapy in elective surgery: an evaluation

Background: Antibacterial drugs are powerful agents to prevent infections but excess use of antibiotics led to increase of resistance towards the antibiotics used and thus has risen the expense in medical support.Methods: A total of 250 patients were included in the study. The patients were divided randomly into 2 groups, each containing 125 patients. Group I patients received. Three dosage of injectable ceftriaxone 1 gram intravenous peri-operatively, first dose twelve hour before surgery and second dose half hour before surgical incision and third dose twelve hours after surgery. Group II patients were given injectable ceftriaxone 1 gram intravenous peri-operatively, first dose twelve hour before surgery and second dose half hour before surgical incision and then followed by injection (conventional dose) ceftriaxone 1 gram/day I.V twice daily for the first 5-7 days post-operatively. Using Southampton wound grading system. The wound was inspected on the 3rd, 5th and 7th postoperative day days post operatively.Results: In group I, 15 (12%) cases had grade 2 SSI and in group II, 11 (8.8%) cases had grade 2 SSI. There was no statistical significance: p value is 0.83 and c2 0.048.Conclusions: A minimal dose antibiotic prophylaxis is equally efficient and has added advantage of reducing the duration of hospital stay and cost of medicines for the patients. Hence minimal dose antibiotic is better than a routine long term antibiotics therapy.

Human Urine Alters Methicillin-Resistant Staphylococcus aureus Virulence and Transcriptome.

Gram-positive methicillin-resistant Staphylococcus aureus (MRSA) is an emerging cause of hospital-associated urinary tract infections (UTI), especially in catheterized individuals. Despite being rare, MRSA UTI are prone to potentially life-threatening exacerbations such as bacteremia that can be refractory to routine antibiotic therapy. To delineate the molecular mechanisms governing MRSA urinary pathogenesis, we exposed three S. aureus clinical isolates, including two MRSA strains, to human urine for 2 h and analyzed virulence characteristics and changes in gene expression. The in vitro virulence assays showed that human urine rapidly alters adherence to human bladder epithelial cells and fibronectin, hemolysis of sheep red blood cells (RBCs), and surface hydrophobicity in a staphylococcal strain-specific manner. In addition, transcriptome sequencing (RNA-Seq) analysis of uropathogenic strain MRSA-1369 revealed that 2-h-long exposure to human urine alters MRSA transcriptome by modifying expression of genes encoding enzymes catalyzing metabolic pathways, virulence factors, and transcriptional regulators. In summary, our results provide important insights into how human urine specifically and rapidly alters MRSA physiology and facilitates MRSA survival in the nutrient-limiting and hostile urinary microenvironment. IMPORTANCE Methicillin-resistant Staphylococcus aureus (MRSA) is an uncommon cause of urinary tract infections (UTI) in the general population. However, it is important to understand MRSA pathophysiology in the urinary tract because isolation of MRSA in urine samples often precedes potentially life-threatening MRSA bacteremia. In this report, we describe how exposure to human urine alters MRSA global gene expression and virulence. We hypothesize that these alterations may aid MRSA in acclimating to the nutrient-limiting, immunologically hostile conditions within the urinary tract leading to MRSA UTI.

Use of Lactobacillus plantarum (strains 22F and 25F) and Pediococcus acidilactici (strain 72N) as replacements for antibiotic-growth promotants in pigs

The lactic acid bacteria (LAB) Lactobacillus plantarum (strains 22F and 25F) and Pediococcus acidilactici (strain 72N) have appeared promising as replacements for antibiotics in in vitro studies. Microencapsulation, especially by the spray-drying method, has been used to preserve their numbers and characteristics during storage and digestion. This study compared the efficacy of these strains and their microencapsulated form with antibiotic usage on growth performance, faecal microbial counts, and intestinal morphology in nursing-finishing pigs. A total of 240 healthy neonatal pigs were treated on days 0, 3, 6, 9, and 12 after cross-fostering. Sterile peptone water was delivered orally to the control and antibiotic groups. Spray-dried Lactobacillus plantarum strain 22F stored for 6-months was administered to piglets in the spraydry group. Three ml of each the three fresh strains (109 CFU/mL) were orally administered to piglets in each group. All pigs received the basal diets, but these were supplemented with routine antibiotic for the antibiotic group. Pigs in all the probiotic supplemented groups exhibited a better average daily gain and feed conversion ratio than those of the controls in the nursery and grower phases. Probiotic supplementation increased viable lactobacilli and decreased enterobacterial counts. Antibiotic additives reduced both enterobacterial and lactobacilli counts. Villous height and villous height:crypt depth ratio were greater in probiotic and antibiotic supplemented pigs comparing to the controls, especially in the jejunum. The results demonstrated the feasibility of using these strains as a substitute for antibiotics and the practicality of the microencapsulation protocol for use in swine farms.