Cefoperazone-sulbactam Research Articles

Efficacy of short term versus long term antibiotic therapy in preventing deep wound infections in elective orthopaedic surgeries

<p><strong>Background:</strong> Comparison of the efficacy of short term (up to 48 hours) versus long term (five days) antibiotic therapy in preventing deep wound infections in elective orthopaedic surgeries.</p><p><strong>Methods: </strong>Two hundred patients of all ages and both sexes were divided into two groups of 100 patients. One group received long term antibiotic treatment consisting of 2 days intra-venous cefoperazone sulbactam 1.5 gm twice daily and intra-venous amikacin 500 mg twice daily followed by 3 days of oral amoxicillin clavulunate 625 mg thrice daily. Other group received short term antibiotic of 2 days intra-venous cefoperazone sulbactam 1.5 gm twice daily and intra-venous amikacin 500 mg twice daily. Comparison of SSI was done with age, sex, BMI, pre-operative haemoglobin, TLC, duration of surgery in both the groups.</p><p><strong>Results: </strong>In group I and group II respectively, average duration of surgery in procedures involving implants was 65.02±27.41 and 59.47±20.27 minutes and non implant related procedures was 53.66±23.97 and 53.74±22.40 minutes. Overall incidence of SSI in Group I and Group II was 14% and 10% respectively. Mean infection in the present study was 12%.</p><p><strong>Conclusions: </strong>It was concluded that in clean orthopaedic elective surgeries short term antibiotics regimen is as effective as long term antibiotics regimen. Continuing antibiotics for more than two days is associated with drug related complications like allergic reactions and gastrointestinal upset, adverse interactions in other drugs, development of resistant organisms and it adds to overall cost of treatment.</p>

Clinical Epidemiology and Risk Factors of Candida auris Bloodstream Infection in Trauma Patients

Background: Candidiasis caused by Candida auris is one of the most serious hospital-acquired infection. Initially, Candida auris was reported to cause local infections; later, invasive candidasis was also reported in which the bloodstream, the central nervous system, kidneys, liver eyes, etc, are invaded. In this study, we evaluated the clinical epidemiology and risk factors in patients hospitalized to trauma center. Methods: This study was conducted at JPN Apex Trauma Centre of All India Institute of Medical Sciences, New Delhi, which is a 169-bed hospital. All patients who were identified to have candidemia due to C. auris over a period of 5 years from January 2012 to December 2016 were included. Blood samples were collected in BAC-T-Alert bottles (Bio Merieux, Durham, NC) and isolates were identified up to the species level by the VITEK 2 (version 8.01, BioMerieux). Conventional identification was performed by observing color development on CHROMagar (Becton Dickinson, Franklin Lakes, NJ). The demographic and clinical data of patients were collected from the hospital information system. Results: Over a period of 5 years, 20 patients admitted to our trauma hospital developed candidemia due to Candida auris. Among them, men were predominant (95%), and the mean (SD) age of the patients was 33 (+15) years. Among these patients, 80% were in hospitalized and 20% were follow-up patients. The median of the total length of stay in the hospital was 34 days (range, 7–122). All of the patients were on mechanical ventilation; 65% patients were catheterized and 75% patients had central line placed. Head injury was the major cause of trauma followed by abdomen, chest, and spine. The overall mortality rate was 40%. Most of the patients (65%) who developed Candida auris infection were immunocompromised. The different comorbidities present were hypertension (35%), diabetes (15%), renal disease (10%), and hepatitis C (5%). Broad-spectrum antibiotics were given: amoxicillin-clavulanate was given to 65% of patients; cefoperazone sulbactam was given to 30% of patients; chloroamphenicol, amicillin-sulbactam, or clindamycin was given to 10% of patients. Antifungal agents like fluconazole or caspofungin were given to 5% of patients. Major surgeries like cranioplasty were performed in 58% of patients. Pancreatectomy, laparotomy, and endoscopic necrosectomy were performed in 42% of patients. Conclusions:Candida auris is one of the dreaded and most commonly spread hospital-acquired fungal infections, especially in immunocompromised patients. Broad-spectrum antibiotics use, major surgery, and invasive devices were the most common risk factors for acquiring Candida auris infection.Funding: NoneDisclosures: None

Distribution of pathogenic bacteria in lower respiratory tract infection in lung cancer patients after chemotherapy and analysis of integron resistance genes in respiratory tract isolates of uninfected patients.

BackgroundWe studied the distribution of pathogenic bacteria in lower respiratory tract infection in lung cancer patients after chemotherapy and analyzed the integron resistance genes in respiratory tract isolates of uninfected patients.MethodsRetrospective analysis was used to select sputum samples from 400 lung cancer patients after chemotherapy admitted in Fuyang People’s Hospital from July 2017 to July 2019. Culture, isolation and identification of strains were conducted in accordance with the national clinical examination operating procedures.ResultsA total of 134 strains were identified. In 120 patients with pulmonary infection, 114 strains were cultured. Twenty strains of klebsiella pneumoniae were cultured in 280 patients without pulmonary infection. Among the 134 strains, the detection rate of gram-negative bacteria was 79.10%. The first four strains were Klebsiella pneumoniae, Escherichia coli, Pseudomonas aeruginosa, and Haemophilus influenzae. The gram-positive bacteria detection rate was 4.47%, mainly Staphylococcus aureus and Streptococcus. The fungus detection rate was 16.42%. The drug sensitivity results showed that the resistance rate of gram-negative bacillus to penicillin and cephalosporin was higher, and were more sensitive to carbapenem, piperacillin tazobactam and cefoperazone sulbactam. Gram-positive cocci were resistant to penicillin, macrolide and clindamycin, and sensitive to linezolid, vancomycin and rifampicin. All strains of fungal culture were candida albicans, which were sensitive to common antifungal drugs. Among the 20 strains of klebsiella pneumoniae cultured in sputum specimens of non-infected patients with lung cancer undergoing chemotherapy, 2 strains were integron-positive strains, and all of them were class I integrons.ConclusionsLung cancer patients after chemotherapy have a high resistance to commonly used antimicrobial drugs, so it is necessary to detect the resistance of pathogenic microorganisms in clinical practice. The strains carried by patients with lung cancer without pulmonary infection during chemotherapy can isolate type I integrons, suggesting that the spread of drug resistance at gene level should be closely detected.

Analysis of risk factors and prognosis of cirrhosis combined with bacterial pneumonia

Objective: To study the bacterial pathogen, the optimal plan of antibacterial drugs and the prognostic factors in patients with liver cirrhosis combined with bacterial pneumonia. Methods: Data of 324 cases with liver cirrhosis from the Department of Traditional and Western Medical Hepatology, the Third Hospital of Hebei Medical University were collected, including 217 cases of bacterial pneumonia. Baseline characteristics of the patients, factors affecting the efficacy of antibacterial treatment and prognosis were compared and analyzed. Logistic regression analysis was used to screen and predict the antibacterial efficacy indicators and a prediction model was established. Receiver operating characteristic curve was used to evaluate the value of the established model and Child-Turcortte-Pugh, model for end-stage liver disease, and model for end-stage liver disease combined with serum sodium concentration predict the therapeutic efficacy. Results: Chronic HBV and HCV infections were the main causes of cirrhosis, followed by cryptogenic cirrhosis and alcoholic cirrhosis. Diabetes, cardio-cerebrovascular and chronic obstructive pulmonary disease were susceptible factors for bacterial pneumonia. As infection occurred, the ratio of neutrophils to lymphocytes, serum C-reactive protein, procalcitonin, alanine aminotransferase, and total bilirubin levels had increased significantly. The results of pathogenic analysis showed that the top three pathogenic bacteria were Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa and Staphylococcus aureus. The resistance rate of Klebsiella pneumoniae to ceftriaxone was 50.0%, and that of ceftazidime, cefepime, and cefoperazone sulbactam were 27.8%. Imipenem and piperacillin tazobactam containing β-lactamase inhibitors were the most effective antibacterial therapies. Regression analysis showed that age, procalcitonin, and albumin was significantly correlated with antibacterial effects. The PAA model was established and had predicted the efficacy of Child-Turcortte-Pugh, model for end-stage liver disease, and model for end-stage liver disease combined with serum sodium. The specificity and sensitivity of the PAA was confirmed to be 94.12% and 93.62%, which was significantly higher than other models. Conclusion: The main common pathogenic bacterium of cirrhosis combined with bacterial pneumonia is Klebsiella pneumonia (G-bacilli). In addition, gram positive cocci (Staphylococcus aureus) and other are also visible. The elderly, diabetics and patients using hormones are prone to secondary fungal infections. Age, procalcitonin and serum albumin can accurately predict the antibacterial effect, guide clinical treatment and judge the prognosis of the established PAA model.

Analysis of the microbial species, antimicrobial sensitivity and drug resistance in 2652 patients of nursing hospital

ObjectiveTo understand the microbial species, antimicrobial sensitivity and drug resistance of patients in the nursing hospital, to bring clinical guiding significance to the use of antimicrobial in the nursing hospital. MethodsA retrospective analysis of bacterial and drug sensitivity report of 2652 patients in nursing hospitals. ResultsThere were 2652 cases of bacterial and drug sensitivity results, including 1202 positive cases, 652 females accounted for 54.24%, and 550 males accounted for 45.76%, concentrated in 70–99 years old. There were 57 kinds of bacteria, 303 cases of Gram-positive bacteria accounted for 25.21%, 808 cases of Gram-negative bacteria accounted for 67.22%, and fungi accounted for 7.57%. The positive samples were mainly from urine (35.94%) and sputum (48.59%). The main Gram-positive bacteria in the positive samples were Staphylococcus aureus (53.14%), Enterococcus faecalis (12.87%), Staphylococcus epidermidis (10.23%), Staphylococcus haemolyticus (6.93%), Enterococcus faecium (3.96%). The main Gram-negative bacteria in the positive samples were E. coli (35.27%), Pseudomonas aeruginosa (20.67%), Klebsiella pneumoniae (13.99%), Proteus mirabilis (8.66%), Bowman The main fungi in the positive samples of the bacillus (5.57%) were Candida albicans (59.34%), Candida albicans (16.48%), and Candida glabrata (14.29%). Among the Gram-positive bacteria, Enterococcus faecium and Enterococcus faecalis are easily detected in urine. Staphylococcus haemolyticus and Staphylococcus epidermidis are easily detected in sputum. Staphylococcus aureus is easily detected in sputum and secretions. Among the Gram-negative bacteria, E. coli and Klebsiella pneumoniae are easily detected in sputum and urine. Proteus mirabilis is easily detected in the urine. Pseudomonas aeruginosa and Acinetobacter baumannii are easily detected in sputum. Among the fungi, Candida albicans, Candida bulgaricus, and Candida glabrata are easily detected in sputum. There is a significant statistically difference in the distribution of P. aeruginosa in all age groups. The resistance rate of Staphylococcus aureus to levofloxacin and penicillin are above 90%, the resistance rate to clindamycin and erythromycin are above 80%, the resistance rate to gentamicin is above 70%, and vancomycin and linezolid The sensitivity rate of amine is 100.0%, the sensitivity rate to rifampicin and teicoplanin are above 90%, and the sensitivity to compound sulfamethoxazole and streptomycin are above 80%. Staphylococcus aureus resistant to vancomycin and linezolid are not found this time. The resistance rate of E. coli to compound sulfamethoxazole is above 60%, the resistance rate to cefuroxime, ceftriaxone, levofloxacin, and ciprofloxacin are above 70%, and the resistance rate to cefazolin is above 80%. The resistance rate to ampicillin is above 90%, the sensitivity rate to nitrofurantoin, minocycline and cefoxitin are above 60%, and the sensitivity to cefoperazone sulbactam and piperacillin tazobactam is above 70%. The sensitivity rate of ropamine, imipenem and amikacin are above 80%. The resistance rate of Proteus mirabilis to nitrofurantoin is 100%, the resistance rate to ampicillin are above 90%, and the resistance rate to compound sulfamethoxazole, levofloxacin and ciprofloxacin are above 80%. For cefazolin and gentamicin The rate of resistance is above 70%. The sensitivity rate to cefoxitin, imipenem and amikacin are above 80%, and the sensitivity to meropenem, cefoperazone sulbactam, and piperacillin tazobactam are above 90%. Klebsiella pneumoniae to cefazolin, gentamicin, ampicillin, cefuroxime, ceftazidime, cefoxitin, ceftriaxone, ampicillin sulbactam, compound sulfamethoxazole, levofloxacin, ciprofloxacin The drug resistance rate is above 60%, the sensitivity rate to amikacin is only above 60%, and the sensitivity rate to imipenem and meropenem is only above 50%. Pseudomonas aeruginosa tested resistance to antimicrobial is below 50%, sensitivity to ceftazidime, cefepime, meropenem, imipenem, amikacin are above 60%, sensitivity to polymyxin B is above 90%, the sensitivity rate of tigecycline is 100%. The resistance rate of Candida glabrata to fluorocytosine is above 60%, the sensitivity rate to amphotericin B, fluconazole and itraconazole are above 60%, and the sensitivity rate of voriconazole is above 90%. ConclusionThere is a difference between this data and the bacteria data in Shanghai. It is necessary to understand the bacteria sensitivity rate and resistance rate of antimicrobial in the nursing hospital, and it has certain guiding significance for the clinical of the nursing hospital.

Antibiotic Susceptibility Profiling of Gram-Negative Bacteria Causing Upper Respiratory Tract Infections in Hyderabad, Sindh

Respiratory tract infections (RTIs) are important clinical problems and among the commonest infectious diseases throughout the world. Several factors including gender, age and season have been shown to influence the prevalence rates of RTIs. The current study aimed to isolate and identify bacteria causing of upper respiratory tract (URT) infections and to determine the antibiotic susceptibility patterns of the isolated bacteria. A total of 201 sputum and swab samples were collected from patients from August 2015 to March 2016 and investigated for Gram-negative pathogenic bacteria. The antibiotic sensitivity of isolated bacteria was performed using Kirby Bauer Disc diffusion method. Isolation and identification of the bacteria were carried out using conventional methods including microscopic, cultural and biochemical testing. Out of 201 samples, 29.85% (n=60) yielded bacterial growth in which 20.9% (n=42) belonged to male while 8.96% (n=18) were from female patients. Among the isolates, Pseudomonas aeruginosa was the most frequent bacteria accounting 48.33% (n=29), followed by Klebsiella pneumoniae 45% (n=27) and E. coli 6.67% (n=04). The data of antibiotic susceptibility profiling demonstrated that Cefoperazone sulbactam, Meropenem, Piperacillin Tazobactam and Amikacin were highly effective against all isolated bacteria. However, Ampicillin, Cephradine, Ofloxacin and Co-trimoxazole were found the least effective antibiotics against all isolated bacteria. In summary, an increasing trend in the resistance against antibiotics which are more frequently prescribed, such as Cephradine, Ampicillin and Co-trimoxazole was observed. Therefore, a continuous surveillance of antibiotic resistance trends of pathogens is needed to ensure appropriate recommendations for the treatment of the URTIs.

Haemodialysis Central-Line Associated Bloodstream Infection : Incidence, Risk factor, and Antibiogram

Background The incidence of central-line associated bloodstream infection (CLABSI) is one of the complications of using a temporary HD catheter is one of the causes of HD patient morbidity and mortality. Identifying CLABSI risk factors and causative micro-organisms are important for setting prevention policies. There were no data regarding CLABSI in hemodialysis in Indonesia Objective: This study identified the epidemiology and risk factor of HD CLABSIs and to aid in the choice of empiric antibiotics therapy given to patients with HD CLABSI Method: This study was an analytical observational study with a cross-sectional design conducted at the Inpatient Installation of Dr. Soetomo General Hospital in August 2018 - January 2019. The study population was patients with installed non-tunneled double lumen hemodialysis catheters more than two calendar days established. The inclusion criteria in this study were the patient 18-60 years old and any clinical presentation of fever, chills, and or hypotension. HD patients who presented with other sources of infection were excluded from the study. Data analysis was performed using SPSS v.23. Results: In this study, 42 subjects were included in the composition of male: female 24: 18, with an average age of 49.62 years. The incidence of CLABSI is 11,3 /1000 catheter days. The results of blood cultures by gram-negative bacteria were 51.86%, and gram-positive bacteria were 48.14%. The most bacterial causes of CLABSI were Staphylococcus aureus by 25.9%. The most gram-positive bacteria causing CLABSI Staphylococcus aureus was 53.84%. The most gram-negative bacteria that caused CLABSI was Enterobacter cloacae at 53.84%. Antibiotics that have the highest sensitivity to gram-positive bacteria are Fosfomycin, Teicoplanin, and Chloramphenicol. Antibiotics that have the highest sensitivity to gram-negative bacteria are Cefoperazone Sulbactam, Imipenem, and Meropenem. There was a statistically significant relationship between DM and CLABSI events (OR = 3.896; p 0.037). There was a statistically significant relationship between hypoalbuminemia and the incidence of CLABSI (OR = 4,524; p 0,023). Conclusion: This study found S. aureus was the most common cause of CLABSI. Our study was unusual as a high prevalence of gram-negative bacteremia was found in HD patients. Diabetes mellitus and hypoalbuminemia increase the risk of CLABSI in hemodialysis patients.

Case report: Mycobacterium monacense isolated from the blood culture of a patient with pulmonary infection

BackgroundThe poorly known mycobacterial species Mycobacterium monacense is a rapidly growing non-tuberculous mycobacterium that was first described in 2006 (Reischl et al., Int J Syst Evol Microbiol 56:2575-8, 2006); it has been reported that its isolation is usually associated with skin and lung infections, especially in immunosuppressed patients (Hogardt et al., Jpn J Infect Dis 61:77-8, 2008; Taieb et al., J Hand Surg Am 33:94-6, 2008; Therese et al., Lung India 28:124-6, 2011; Shojaei et al., Ann Lab Med 32:87-90, 2012; Romero et al., New Microbes New Infect 10:112-5, 2016 ). The clinical significance of Mycobacterium monacense is not yet fully understood. Here, we report the first isolation of Mycobacterium monacense from the blood culture of a patient in China with severe pneumonia.Case presentationOn June 26, 2018, a 38-year-old man was admitted to the intensive care unit with breathing difficulty. One day prior, he was discovered with his face immersed in a small pond (non-chlorinated water) and with limb convulsions. He had undergone craniocerebral surgery after trauma 5 years earlier, which left him with epilepsy as a sequela. Bilateral diffuse ground-glass opacity was found in the lungs on chest X ray and chest CT image at admission. The result of the HIV serology test of the patient was negative. The patient was diagnosed with severe pneumonia. Drug-susceptible Klebsiella pneumoniae and Candida glabrata were isolated in the BALF, and yellow-pigmented colonies were isolated from blood cultures of the patient. The strain isolated from blood was identified by 16S rDNA sequencing as Mycobacteria monacense, which is a rapidly growing mycobacterium (RGM). The patient was treated with a combination of cefoperazone sulbactam, linezolid and voriconazole for 10 days, and the symptoms improved. During the one-year follow-up time, the patient did not relapse.ConclusionsWe report the first case of M. monacense isolated from blood cultures in a patient with severe pneumonia, which provided evidence that the environmental microorganism possessed pathogenic characteristics.

The effect of cefoperazone sulbactam and piperacillin tazobactam on mortality in Gram-negative nosocomial infections

Cefoperazone-sulbactam (CS) and piperacillin-tazobactam (TZP) are used in the treatment of Gram-negative nosocomial infections (NIs). We aimed to compare the effects of these two antibiotics on mortality and treatment success. Patients treated with CS or TZP empirically for at least three days with suspicion of NI were included in this retrospective study. In total, 308 (154 patients in both treatment arms) patients were analyzed. Treatment success rate in CS and TZP group respectively (50% vs 51.2%, p = 0.18), 28-day mortality rate (46.1% vs 42.8%, p = 0.56) and antibiotic-related side effects (50.6% vs 46.1%, p = 0.42) were similar except prolonged prothrombin time (19.4% vs 6.4%; p = 0.001). According to this study results, CS and TZP have equal effectivity and safety for the empirical treatment of Gram-negative NIs. CS may be an appropriate alternative to TZP for antibiotic cycling or mixing strategy to reduce antibiotic resistance.

The report of two cases infection with novel coronavirus (2019-ncov) after kidney transplantation and the association literature analyzation/ 中华器官移植杂志

Objective To investigate the clinical experience of patients with novel coronavirus (2019-ncov) infection after kidney transplantation. Method Clinical data of two patients with 2019-nCoV infection after renal transplantationin Jan 2020 Renmin Hospital of Wuhan Universiyt were retrospectively analyzed.Case 1 was a 48-year-old male with CMV pneumonia secondary to 2019-nCoV infection at 4 months after transplantation. CT imaging showed multiple patchy ground-glass images of both lungs. Case 2 was a 59-year-old male, who was screened positive for 2019-nCoV nucleic acid due to fever at 9 days after renal transplantation and showed no clinical manifestations of pneumonia. After diagnosis, case 1 was transferred to a designated hospital for isolation. Treatment regimens: cefoperazone sulbactam sodium + linezolid to resist infection, gamma globulin to enhance immunity function, methylprednisolone to control inflammatory response, antiviral regimens including arbidol tablets + lopina-velitonavir tablets. Case 2 was treated with isolated treatment in a single room. The treatment plan included anti-infection (cefoperazone sulbactam sodium), enhancing immunity function (gamma globulin), antivirus therapy with arbidol and other symptomatic treatment. Result Follow up with 3 weeks, case 1 recovered with renal dysfunction, nucleic acid test with nasopharyngeal swabs turned negative, and pulmonary imaging improved. Case 2 showed no obvious clinical symptoms, and the nucleic acid test of nasopharyngeal swabs turned negative for 3 times. Conclusion Renal transplant recipients should receive fine protection to avoid exposure to high-risk environments. Diagnosis should be defined with combination of clinical manifestations, nucleic acid test and pulmonary imaging. At present, there are no antiviral drugs and symptomatic treatment is the main choice. Key words: 2019-nCov; NCP; Kidney transplant; Level III Protection

In Vitro Antimicrobial Activity of Various Cefoperazone/Sulbactam Products.

This study aims to assess the in vitro activity of different samples of cefoperazone/sulbactam (CFP/SUL) against multidrug-resistant organisms (MDROs). Clinical isolates of extended-spectrum β-lactamase (ESBL)-Escherichia coli, ESBL-Klebsiella pneumoniae, carbapenem-resistant Acinetobacter baumannii (CR-AB), and carbapenem-resistant Pseudomonas aeruginosa (CR-PA) were collected. The minimum inhibitory concentration (MIC) and time-killing methods were used to assess and compare the in vitro activities of different samples of cefoperazone/sulbactam (CFP/SUL) against these MDROs. For ESBL-E. coli, ESBL-K. pneumoniae, and CR-PA, product C had smaller variations than product A and B (p < 0.05). For CR-AB, product B had the largest variation compared to the other two products (p < 0.05). In the time-killing studies, significant differences among the products when used at 16/16 µg/mL were noted for ESBL-E. coli, ESBL-K. pneumoniae, and CR-AB isolates. In conclusion, this study demonstrated the significantly different activity of different products of CFP/SUL against MDROs.

Meta-analysis of randomized controlled trials on effect of Tanreqing Injection combined with Western medicine on acute exacerbation of chronic bronchitis

To systematically review the effectiveness and safety of Tanreqing Injection in treating acute exacerbation of chronic bronchitis( AECB). CNKI,Wan Fang,VIP,CBM,Medline,Cochrane Library,EMbase and Web of Science were retrieved,and randomized controlled trials for the effect of Tanreqing Injection in the treatment of acute exacerbation of chronic bronchitis were screened. The quality of the included studies was evaluated according to the Cochrane Handbook&apos;s evaluation criteria. The data was analyzed by RevMan 5.3. Totally 23 RCTs involving 1 901 patients were included,including 952 in the experimental group and 949 in the control group. The Meta-analysis demonstrated that in terms of the disappearance time of fever,the group of Tanreqing Injection combined with the conventional therapy was superior to conventional therapy group( RR =-1. 03,95%CI[-1. 45,-0. 62],P&lt;0. 000 01); compared with the conventional therapy group,the group of Tanreqing Injection combined with conventional therapy had a higher cure rate for AECB( RR = 1. 17,95% CI[1. 13,1. 23],P &lt; 0. 000 01). The group of Tanreqing Injection combined with levofloxacin had a higher cure rate for AECB than the levofloxacin group( RR = 1. 23,95% CI[1. 08,1. 41],P = 0. 002). The group of Tanreqing Injection combined with cefuroxime had a higher cure rate for AECB than the cefuroxime group( RR = 1. 22,95%CI[1. 05,1. 42],P = 0. 01).The group of Tanreqing Injection combined with cefoperazone sodium and sulbactam sodium had a higher cure rate for AECB than the group of cefoperazone sodium and sulbactam sodium( RR = 1. 22,95% CI[1. 04,1. 44],P = 0. 02). The outcomes of disappearance time of cough and expectoration had a huge heterogeneity,so were used for descriptive analysis. The adverse reactions mainly included skin rash,dizziness,gastrointestinal reactions. Based on the available data and the results of the analysis,the group of Tanreqing Injection combined with Western medicine has a higher cure rate for acute exacerbation of chronic bronchitis,and the effect in reducing symptoms disappearance time. In view of the limited number of included studies,small sample size and low methodological quality,the results of this study need to be confirmed with high-level clinical trials.

2288. Role of Β Lactam-Β Lactamase Inhibitors in Indian Tertiary Care Hospitals: Results from a Nationwide Survey

BackgroundBroad-spectrum antibiotics, particularly third-generation cephalosporins, are routinely used in the treatment of nosocomial infections. The emergence of Extended Spectrum Β-Lactamase (ESBL)-producing pathogens in Indian tertiary care hospitals warrants the need to reassess β-lactam–β-lactamase inhibitors (BL-BLIs) as better alternative treatments.MethodsAn online survey was conducted by Pfizer India to understand the usage of BL-BLIs across Indian hospitals. The survey was administered to 334 clinicians across multiple specialties out of which 195 were from tertiary care hospitals. Results were analyzed using MS-Excel statistical tools.ResultsOne-hundred ninety-five (195) clinicians from tertiary care hospitals completed the survey. About 78% of HCPs revealed the resistance to third-generation cephalosporins (e.g., ceftriaxone, ceftazidime) to be between 10–60% in their clinical settings. BL-BLIs were mostly preferred for treatment based on hospital antibiograms (64%) and used as first-line options for hospitalized adults with mild-moderate severe infections caused by ESBL-producing organisms (71%) and in mild-moderate infections caused by susceptible Gram-negative bacteria such as Enterobacteriaceae (54%). The average duration of IV BL-BLI treatment was 5–7 days (66%). The HCPs considerations while choosing BL-BLIs were mainly based on anti-microbial spectrum (81%), and rationality of BL/BLI combination (63%) and clinical experience with the BL-BLI molecule (63%). Cefoperazone-Sulbactam (CS) and Piperacillin–tazobactam (PT) were most commonly prescribed BL-BLIs and HCPs preferred the latter for pneumonia (67%), skin and soft-tissue infections (57%), bloodstream infections (67%) and cancer-associated febrile neutropenia (64%); while they preferred former for urinary tract infections (64%). CS and PT were preferred for intra-abdominal infections (57% and 64% respectively) and post-surgical infections (56% and 53% respectively).ConclusionCS and PT were the most commonly prescribed BL-BLIs probably due to their wide antimicrobial spectrum, rationality of the BL/BLI combination and the clinical experience with the molecules. BL-BLIs are still a mainstay of treatment for infections due to ESBL producing organisms. Disclosures All authors: No reported disclosures.

694. In vitro Antibacterial Activity of Sulbactam–Durlobactam (ETX2514SUL) Against 121 Recent Acinetobacter baumannii Isolated from Patients in India

BackgroundThe incidence of infections caused by multidrug-resistant Acinetobacter baumannii is increasing at an alarming rate in Southeast Asia and other parts of the world. Sulbactam (SUL) has intrinsic antibacterial activity against A. baumannii; however, the prevalence of β-lactamases in this species has limited its therapeutic use. Durlobactam (ETX2514, DUR) is a novel β-lactamase inhibitor with broad-spectrum activity against Ambler class A, C and D β-lactamases. DUR restores SUL in vitro activity against multidrug-resistant A. baumannii. Against >3,600 globally diverse, clinical isolates from 2012–2017, addition of 4 mg/L DUR reduced the SUL MIC90 from >32 to 2 mg/L. SUL-DUR is currently in Phase 3 clinical development for the treatment of infections caused by carbapenem-resistant Acinetobacter spp.The goal of this study was to determine the activity of SUL-DUR and comparator antibiotics (amikacin (AMK), ampicillin-sulbactam (AMP-SUL), cefoperazone-sulbactam (CFP-SUL) and meropenem (MEM)) against A. baumannii isolated from hospitalized patients in India.MethodsA total of 121 clinical A. baumannii isolates from multiple hospital settings and infection sources were collected between 2016–2019 from six geographically diverse hospitals in India. Species identification was performed by MALDI-TOF. Susceptibility of these isolates to SUL-DUR (10µg/10µg) and comparator antibiotics was determined by disk diffusion using CLSI methodology and interpretive criteria, except for CFP-SUL, for which resistance was defined using breakpoints from the CFP-SUL package insert.ResultsAs shown in Table 1, resistance of this collection of isolates to marketed agents was extremely high. In contrast, based on preliminary breakpoint criteria, only 11.5% of isolates were resistant to SUL-DUR.ConclusionThe in vitro antibacterial activity of SUL-DUR was significantly more potent than comparator agents against multidrug-resistant A. baumannii isolates collected from diverse sites in India. These data support the continued development of SUL-DUR for the treatment of antibiotic-resistant infections caused by A. baumannii. Disclosures All authors: No reported disclosures.

Development and Validation of Stability Indicating HPLC Method for the Determination of Impurities in the Sterile Mixture of Cefoperazone and Sulbactam

Background: Cefoperazone Sulbactam injection is a cephalosporin antibiotic with a β- lactamase inhibitor used in the treatment for intra abdominal infections, Urinary track infections, surgical infections, etc. The combination is not official in any of the pharmacopeia for their content and impurities determination. Introduction: The present study involves the development of a simple, rapid, accurate, sensitive and stability indicating RP-HPLC method for the quantitative estimation of Cefoperazone Sulbactam mixture and its impurities in bulk and pharmaceutical dosage forms. Methods: 0.005 M Tetrabutyl ammonium hydroxide buffer solution pH adjusted to 6.80 and Acetonitrile combination has been used in a gradient programme with a flow rate of 1.0 ml/min. The retention time of Cefoperazone and Sulbactam were observed at around 8.5 and 19.5 minutes respectively. The UV detection was carried out at a wavelength of 230 nm. The chromatographic separation was achieved using Waters xbridge C18-150*4.6 mm, 3.5 µm HPLC column. The method has been validated according to the current International Council for Harmonization (ICH) guidelines for the method validation parameters such as Specificity, linearity, range, accuracy, precision, robustness and sensitivity. Results: The validation results indicate that the method is specific, as the known impurities and other impurities formed during the forced degradation studies were not co-eluting with the main components. Moreover, all these impurities were found to be spectrally pure, proving the stability indicating power of the method. The linearity and range of the method is in the range of 0.01-150%, highly accurate (100.2%), precise (&lt;1%) and robust. Conclusion: The proposed method was accurate and specific for the quantitative analysis of Cefoperazone and Sulbactam and their related impurities in the sterile mixture. Hence the proposed method can be used for the quantification of impurities in routine as well as stability analysis in the development as well as quality control laboratories.

Uropathogens and antibiotic resistance in the community and hospital-induced urinary tract infected children.

In this study, we aimed at identifying community and hospital-induced uropathogens isolated in urinary tract infection (UTI) determining the regional antibiotic resistance and the antibiotic preferences in empirical treatment in Sanliurfa/Turkey. The urinary culture results of the 842 paediatric patients, who were aged between 0 and 18 years, admitted to Department of Pediatrics, Harran University Medi-cal Faculty Hospital, Sanliurfa, Turkey with UTI complaints, diagnosed with UTI and in whose urine cultures production was detected, were retrospectively evaluated. Age, gender, clinical findings and culture results of the patients were examined in terms of reproducing pathogens, the frequency of their being community and hospital induced, Extended Spectrum Beta Lactamase production of reproduced pathogens, sensitivity and resistance to antibiotics. A total of 842 patients, 472 (56.1%) girl were included in the study. According to the results of urine culture, Escherichia coli was detected in (58.9%) of the patients, Klebsiella (17.9%) and Proteus (15.8%). While high resistance to ampicillin (87.3%), cefuroxime (71.6%) and trimethoprim-sulfamethoxazole (60.8%) was found for all microorganisms, the lowest resistance to nitrofurantoin (21.4%), piperacillin/tazobactam (19.1), imipenem (8.6%), meropenem (8.8%), amikacin (6.2%) and cefoperazone/sulbactam (CSL) (4.7%) were determined in descending order. Resistance rates were higher in inpatients with UTI than in outpatients. We think that the most appropriate antibiotic to be chosen for the outpatients for empirical treatment in all age groups in our region, is as oral nitrofurantoin and parenteral amikacin. Also the appropriate parenteral antibiotics that should be selected for the empirical treatment of inpatients UTI in all age groups are the CSL, amikacin and carbapenems.

In vitro Susceptibility Pattern of Major Gram Negative Isolates to Selected Antimicrobial Agents

Background: The choice of choosing right anti-microbial therapy in hospitals depends on the knowledge of local anti-microbial susceptibility profile. This retrospective study was conducted to assess the in vitro susceptibility pattern of different pathogen isolates to various antibiotics including Cefepime-Amikacin-Antibiotic resistant breakers (ARBs)* in various hospitals across the Jaipur City.&#x0D; Methods: To characterize the antimicrobial susceptibility pattern of different isolates from various hospitals across the Jaipur City, a retrospective, observational analysis was done for antibiogram data. A total of 1201 Gram negative isolates collected during the period from January 2017 to December 2017 were included in the study. Antibiotic sensitivity testing was done in accordance with the recommendations of Clinical Laboratory Standard Institute (CLSI) guidelines.&#x0D; Results: Of the total 1201 Gram negative isolates included in this study, 51.6% were from wounds and pus specimens, 40.1% were from respiratory and 8.2% from blood. P. aeruginosa (49.7%) was the most frequently isolated pathogen distantly followed by A. baumannii (21.6%), K. pneumoniae (16.6%) and E. coli (12.1%). The highest susceptibility was reported to polymyxins (100%) including Colistin and Polymyxin B, among all the tested bacteria’s and system wise. Among all the antibiotic tested, (Cefepime-Amikacin-ARBs*) sensitivity ranged for 87.9% to 52% on pathogens (E. coli, K. pneumonia, P. aeruginosa) tested from samples of skin and soft tissue, respiratory tract, blood stream, followed by Meropenem ranged for 78.4% to 55% on pathogens (E. coli, K. pneumonia, P. aeruginosa), followed by ceftazidime-tazobactam ranged for 82.7% to 58% on pathogens (E. coli, K. pneumonia, P. aeruginosa) and 22.7% sensitive for A. baumannii to Cefoperazone sulbactam. Based on pathogen type, E. coli exhibited highest overall susceptibility and the lowest was reported by A. baumannii. The susceptibility of A. baumannii ranged from 1-26% to all the tested antibiotics except polymyxins with 100% susceptibility.&#x0D; Conclusions: This in vitro susceptibility data suggests that Cefepime-Amikacin-ARBs* can serve as important therapeutic option for the treatment of various resistant Gram-negative bacterial infections to relieve the excess pressure on last resort antibiotics, carbapenems and other drugs including Colistin and polymyxin B. Cefepime-Amikacin-ARBs*on the basis of antimicrobial susceptibility data can be considered as an effective therapeutic option for carbapenems in treating gram negative bacterial infections, and could be considered as a broad spectrum antibiotic sparer’s like carbapenem, colistin and Polymyxin B.

Fatal Vitamin K-Dependent Coagulopathy Associated with Cefoperazone/Sulbactam: A Case Report.

This case report describes a suspected and fatal adverse reaction involving vitamin K-dependent coagulopathy that might be associated with cefoperazone/sulbactam (CPZ/SAM), a combined antimicrobial formulation. We reported a patient diagnosed with acute cerebral infarction and secondary pulmonary infection who was treated with an intravenous infusion of CPZ/SAM at 3 g twice daily. After receiving treatment with CPZ/SAM, the patient developed a fatal adverse reaction of CPZ-induced hemorrhage. The Naranjo assessment score in this report was 5, suggesting that the patient’s coagulation function disorder was potentially associated with the use of CPZ/SAM. To prevent vitamin K-dependent coagulopathy caused by CPZ/SAM, it is suggested to avoid cephalosporins in patients with a high risk of bleeding unless the need for cephalosporins is compelling.

In vitro combination of tigecycline with other antibiotics in Stenotrophomonas maltophilia isolates

Background/aim The aim of this study was to determine the usefulness of tigecycline in combination treatment of Stenotrophomonas maltophilia infections by evaluating the in vitro synergistic effects of tigecycline with various antibiotics using the E-test method.Materials and methods Synergy testing by E-test was performed with various antibiotic combinations in 10 S. maltophilia isolates identified as a cause of infection. The antibiotics used in the study included tigecycline (TGC), cefoperazone-sulbactam (CPS), ceftazidime (TZ), levofloxacin (LEV), and trimethoprim-sulfamethoxazole (cotrimoxazole) (TS). Four different combinations (TGC-CPS, TGC-TZ, TGC-LEV, TGC-TS) were studied with the E-test synergy method. ResultsS. maltophilia isolates were found to have the highest level of susceptibility to trimethoprim-sulfamethoxazole, tigecycline, and levofloxacin. The fractional inhibitory concentration (FIC) index was calculated as FIC = MICAB/MICA + MICBA/MICB. The FIC index values were calculated and classified as synergistic (FIC < 0.5), additive (FIC = 0.5–1), indifferent (FIC = 1–4), and antagonistic (FIC > 4). According to FIC index values, synergy was found with the highest rate with TGC-CPS and TGC-LEV combinations (20%). Antagonistic activity was not found in any combination. ConclusionWhen trimethoprim-sulfamethoxazole cannot be used because of resistance or allergy, tigecycline alone or in combination may be included as an alternative option. Although in vitro results are promising, clinical data are required.

Resistance analysis of pathogenic bacteria in chronic obstructive pulmonary disease patients with mechanical ventilation

Objective To investigate the constitution and drug resistance status of the major pathogens in mechanically ventilated patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD), so as to provide evidences for clinical treatment. Methods From patients with AECOPD undergoing mechanical ventilation in EICU or ICU of the Second Affiliated Hospital of Wenzhou Medical University from January 2016 to December 2017, various specimens were collected for identification and drug susceptibility testing of pathogens; the clinical data and test results were analyzed. Results A total of 104 patients were included in the study. Total of 163 strains of pathogens were isolated from the specimens, of which gram-negative pathogens were the most common, accounting for 74.8% of any pathogens. Drug resistance analysis showed that gram-negative pathogens were severely resistant to third generation cephalosporins, and were more sensitive to Sulperazon and carbapenems; gram-positive cocci were more sensitive to vancomycin and linezolid. Fungi were more sensitive to amphotericin B and 5-fluorocytosine. Most of the pathogens were multi-resistant. Conclusions In selecting antibiotics for the treatment of critical patients with AECOPD, emphasis should be placed on bacterial culture and drug susceptibility testing, so as to reduce irrational drug use and the emergence of drug-resistant strains or superinfection. Key words: Chronic obstructive pulmonary disease; Mechanical ventilation; Pathogens; Drug resistance