International Medical Publisher Journals (iMedPub)
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Cefotaxime vs Ceftriaxone for the Prolongation of Latency Period in Preterm Premature Rupture of Membranes
Get PDFIntroduction: Antibiotics are well known and recommended as the main therapy for preterm premature rupture of membranes (PPROM.) But the research on antibiotics other than the recommended macrolides regimens is still lacking. This research aims to evaluate whether there are effects differences of cefotaxime and ceftriaxone given on pregnancy with PPROM by comparing the duration of the latency period and the infants outcomes.
Material and Methods: Data was taken retrospectively through medical records at Dr. Soetomo Surabaya General Hospital, Indonesia during the period of January-December 2017. The inclusion criteria were a history of PPROM in pregnancy <37 weeks, given cefotaxime or ceftriaxone therapy, and have labor data. The analysis was performed by the Mann-Whitney comparison test for the latency period and Fisher's exact test for infant outcomes.
Results: There were 52 samples obtained. The antibiotics used were cefotaxime 3x1gr (A) and ceftriaxone 2x1gr (B). The results of the analysis showed that there were no significant differences between the types of antibiotics with the length of the latency period, with a value of p = 0,601 (p>0,05), where group A had a median of 52,67 hours and group B was 34,17 hours. Group A was found to be more able to extend the latency period for >48 hours with a percentage of 57,8%, whereas in group B only 42,9%. There are no significant differences in infant outcomes; infant birth weight and Apgar score among the two therapies used.
Conclusion: Cefotaxime was more preferably to be used in the Dr. Soetomo Surabaya General Hospital. Nevertheless, ceftriaxone can still be a good choice for PPROM therapy since both cephalosporins have succeeded in preventing infections in women with PPROM
Hepatitis B Screening Prior to Chemotherapy in the Middle East: A Retrospective Cohort Study
Get PDFBackground: Hepatitis B virus (HBV) reactivation can be asymptomatic or manifest as fatal fulminant hepatitis. Most international guidelines recommend screening patients prior to immunosuppressive therapy.
Aims: To determine HBV screening rates and modalities in patients receiving chemotherapy at the American University of Beirut Medical Center.
Methods: A retrospective cohort review of electronic health records of adult patients who received chemotherapeutic agents, between June 2015 and June 2016. Patients clinical characteristics were documented. Adequate screening was defined as performing all: HBsAg, HBs Abs, and anti HBc Abs(total).
Results: A total of 1547 patients were initially assessed. 45.6% were males with a mean age of 56. 382(30%) had hematologic malignancies, of whom 111 underwent HSCT. Of those included, 303(24%) patients were screened by at least one test for HBV and 42(3.3%) for HBsAg, anti HBc Abs and HBs Abs.
Patients who were appropriately screened were significantly younger(p=0.008) and more likely to have hematologic malignancies (n=35, 83.3%, p<0.0001). Among patients with hematologic malignancies, appropriately screened patients (n=35) were younger (p=0.042) and had a history of HSCT(n=19, 54.3%, p=0.001).
Conclusion: Rates of screening for HBV prior to chemotherapy at our medical center are low, and not always complete or adequate. There is an urgent need to implement a better screening policy
Impact of the inpatient infectious disease consultations at a tertiary care university hospital
Get PDFBACKGROUND: The role of the infectious disease specialist continues to evolve. The purpose of this study is to demonstrate the value of infectious disease consultation in the inpatient setting.
METHODS: This is a prospective cohort study that took place in a tertiary care university hospital. During the period from April to June 2016, 224 cases of patients receiving antibiotics in the hospital with the request of an infectious diseases’ consultation, were evaluated. The following variables were assessed: the referring department, purpose of the consultation, the antibiotic used before requesting the infectious diseases consultation, the antibiotic modifications after the infectious disease’s visit, whenever the antibiotic usage was switched to a mono or bi-therapy.
RESULTS: The most frequent requesting departments were Oncology (23.2%) and Urology (21.4%). The purpose of the consultations was diagnosis (29%), therapy (41%), both diagnosis and therapy (21%), and prophylaxis (9%). An infectious diseases consultation was given at a rate of 4.9 consultations per 100 hospitalized patients. Antibiotic was discontinued in 14.7% of cases. There was no indication for the antibiotic treatment in 11.6% of cases. Modifying the antibiotic therapy was done in 25.4% of cases. Adjusting the antibiotic dosage was done in only one case. Carbapenem antibiotics were discontinued in 31.6 % of cases and Quinolones discontinuation accounted for 22.7% of cases.
CONCLUSION: Infectious disease consults contributed to the optimization of the diagnostic and therapeutic approaches for suspected or confirmed infections in hospitalized patients
Evidence-Based Progressive Passage to Reopening American Societies Post COVID-19
Get PDFIn the United States, the total number of confirmed reported cases of Covid-19 had reached 1.36 million with a total death of 80,574 and a total confirmed recoveries of 210,000 cases. Significant efforts have been invested to flatten the curve and control new cases appearing in the societies. Meanwhile, the governments has imposed a lockdown with the objective of controlling the transmission of the virus. The re-opening of societies is challenging and might involve threats, many of them remain unseen. We describe here a dynamic scenario to un-locking and re-opening societies using an evidence-based design, suggested by an algorithm of screening using RT-PCR and antibodies in a large population
Trends of antimicrobial resistance in Escherichia coli isolates from urine cultures of women in Jordan: A 10-year retrospective study
Get PDFBackground: Urinary tract infection (UTI) is a common medical condition among women. E.coli is the most common causative organism. Appropriate understanding of the development of antimicrobial resistance over the past helps to establish efficient treatment strategies in the future. The study aims to discover antimicrobial resistance trends exhibited by E.coli strains isolated from women urine cultures over the past 10 years.
Methods: A total of 1874 affected urine samples over the years 2009 to 2018 were collectively reviewed and classified according to the response they showed to 24 different antimicrobial disks in the laboratory. Relations between time and resistance evolutionary profiles were calculated.
Results: Gentamicin (p value =0.039), Augmentin (p value =0.017), Cefoxitin (p value =0.001), Cefixime (p value =0.026) fulfilled satisfactory figures in terms of average resistance, regression of resistance, speed of resistance evolution, steadiness of performance, side effects, spectrum range and cost with high significance.
Conclusion: Drugs that showed satisfactory figures are recommended for future treatment protocols in Jordan.
 
Molecular characterization of Pseudomonas aeruginosa isolates from various clinical specimens in Khartoum/Sudan: Antimicrobial resistance and virulence genes
Get PDFBackground: Pseudomonas aeruginosa is a pathogenic organism responsible for frequent wound and nosocomial infections worldwide. Its infections are difficult to control since the organism is known to rapidly develop antibiotic resistance and becomes multidrug-resistant (MDR) during treatment of patients.
Aim of the study: This study was intended to investigate the occurrence of certain important types of (ESBL) and (MBL) enzymes in association with important specific virulence factors associated with P. aeruginosa clinical isolates from Khartoum, Sudan.
Methods: This study investigated 70 P. aeruginosa isolates which were collected from patients admitted to four major hospitals in Khartoum (Fedail, Ribat, Ibn Sina and Soba hospitals). These isolates were recovered from 40 wound swabs (57.1%), 27 urine samples (38.6%), and 3 pleural fluid samples (4.3%) of patients. Higher numbers of isolates were recovered from males 42 (60%) than in females 28 (40%). All P. aeruginosa isolates were first confirmed by conventional biochemical and second using molecular PCR tests. PCR methods were also used for detecting the presence of the virulence genes ToxA, AlgD, LasB, exoS, exoU, CTX, GES-1, and genes of VIM, IMP, KPC, CTX, VEB-1 and SHV-1.
Results: Antimicrobial susceptibility testing of P. aeruginosa isolates showed a high resistance to azetronam 49 (70%), followed by ceftazidime 32 (45.7%), 16 ciprofloxacin (22.9%), gentamicin 13 (18.6 %), piperacillin-tazobactam 11 (15.7%), amikacin 9 (12.9 %), and imipenem 6 (8.6%) showed the least resistance. All isolates were positive for algD and lasB (100%), followed by toxA (90%), exoS (34.3), exoU (24.3%), respectively. The rates of detected ESBL genes blaTEM, blaCTX-m, blaSHV-1,GES-1, were 3.3%, 6.6%, 10%, 3.3%,10%, respectively, but all isolates were negative for bla-KPC and bla- VIM and IMP . The percentages of pigment production were 61.4% for pyocyanin, 37.1% for pyoverdin and 1.4% for pyorubin.
Conclusion: The study demonstrated high rates of antimicrobial resistance markers to most commonly used antibiotics in treatment of P. aeruginosa infections. The majority of the isolates from urine and wound samples carried at least three potential virulence factor genes of algD, lasB and toxA and without any significant relation to their antimicrobial resistance markers.
 
A Ten Years Study of The Rates and Resistance Trends of the ESKAPE Bacteria Isolated from Sterile Body Sites (2010 – 2019) at a Single Hospital
No full textBackground
To assess the rates and trends of resistance among ESKAPE pathogens during 2010 – 2019.
Methods
A retrospective, single-center study between 2010 –2019, non-duplicate isolates from six sterile sources were studied. Pathogens were processed through the automated VITEK-2. The Clinical Laboratory Standards Institute (CLSI) breakpoints were referenced. The aim was to detect the rates and resistance trends of the ESKAPE pathogens, the rates of ESBL-producing K. pneumoniae, and the carbapenem-resistant (CR)-K. pneumoniae, CRAb, CRPa, VRE, and MRSA for the inpatients. Trends for the prevalence and resistance rates were analyzed by linear regression. Missing values were averaged based on the neighboring values. Data analysis was by SPSS version 25, and statistical significance is considered for one-tailed P < 0.05.
Results
The ESKAPE bacteria (4286 isolate) comprised (45.57%) of the inpatients' isolates, the sterile sources consisted of 1421 (33.15%): K. pneumonia 272 isolates, the ESBL-producing K. pneumoniae significantly declined (Pearson R - 0.877, P = 0.001), CR-K. pneumoniae showed no significant trends (P = 0.475). P. aeruginosa 202 isolates; resistance to carbapenem (CRPa) averaged 42%. S. aureus 198 isolates; MRSA rates averaged 45%. A. baumannii 165 isolates; carbapenem-resistance (CRAb) average 93%. Vancomycin-resistant (VR)E. Faecium = 33%, and VRE. faecalis = 15% with a weighted average 17%. Enterobacter spp. resistance rates were: Amikacin 3.6%, Third and fourth generation cephalosporines 28% and 20% respectively, Quinolones 27% ± 3%, Piperacillin/tazobactam resistance 29%, Imipenem 15%, and Meropenem 27.
Conclusion
The ESKAPE pathogens were highly resistant, making treatment more complicated, and compromise the initial empiric treatment.
 
Overuse of antibiotics as a key driver to antibiotic resistance in Morocco: A short review with potential solutions
Get PDFAntimicrobial resistance is a global public health challenge, which has accelerated by the overuse of antibiotics worldwide. Increased antimicrobial resistance is the cause of severe infections, complications, longer hospital stays and increased mortality. Steps must be taken to reverse the damage that has already been done and prevent further resistance from developing. This work will examine the context and societal situations that led to this acceptance of antibiotic overuse and misuse seen in both health care professionals and the public, the biochemical and genetic pathways that allow a microbe to develop drug resistance, the consequences that could follow if this trend of antibiotic overuse is allowed to continue and the various methods and solutions that have been suggested to prevent and reverse this problem
Biofilm Formation and Methicillin Resistance of Staphylococcus aureus Isolated from Clinical Samples
Get PDFBackground: Staphylococcus aureus including methicillin resistant S. aureus (MRSA) is one of the most effective biofilm-forming organisms, biofilm contribute in protecting the microorganism from host defenses and prevent the effective penetration of antimicrobial agents. Biofilm formation is considered as an important contributing factor for the initiation and establishment of chronic infection by S. aureus and known as a major obstacle in the treatment of S. aureus infections is their ability to develop resistance to antimicrobials.
Aims : To screen clinical Staphylococcus aureus including MRSA isolates for their biofilm forming abilities and their association with antimicrobial resistance.
Methods: A total of 196 clinical isolates of S. aureus were obtained from different sample sources using standard microbiological techniques from three major hospitals in Gaza strip. Biofilm formation of these isolates was determined by tissue culture plate (TCP) method and tube adherence method (TM). Antimicrobial susceptibility test was performed using the modified Kirby–Bauer disk diffusion method as per Clinical and Laboratory Standards Institute guidelines. MRSA was detected using the cefoxitin disk test.
Results: Biofilm formation was observed in 174 (88.8 %) and in 145 (74.0%) isolates of S. aureus via TCP method and TM, respectively. The highest resistance percent was for penicillin (92.9%), followed by cefoxitin (80.6%) and oxacillin (67.9%), while the lowest resistance percent was for linezolid and ceftaroline (1%). Among the 196 isolates 71.4% (N=140) were classified as MDR with a MAR index (≥ 0.2).
A total of 158 isolates (80.6%) were identified as MRSA distributed as 90.4%, 79.4% and 70.9% from Al-Shifa, Al-Nasser pediatrics and Al-Aqsa hospitals respectively. Large proportions (82.1%) of biofilm producers were identified as MRSA. Biofilm-producing MRSA exhibited a higher percent (90.5%) when compared with the biofilm non-producer MRSA (9.5%). Importantly, 89.2% of biofilm-producing S. aureus were multidrug resistant.
Conclusions: S. aureus isolates possessed high biofilm-forming ability. Biofilm-producing strains have very high tendency to exhibit antimicrobial resistance, multidrug resistance and methicillin resistance. Regular surveillance of biofilm formation by S. aureus and their antimicrobial resistance profile may lead more success in treating S. aureus infections.
Keywords: Biofilm, MDR, MRSA, TCP, TM, Gaza strip, Palestine
Assessment of Urinalysis Reflex to Culture Criteria: Impact on Antimicrobial Usage
Get PDFObjectives: To assess the predictive value of the urinalysis (UA) reflex criteria’s parameters and to evaluate the criteria’s impact on antimicrobial usage
Methods: A prospective study using laboratory data was conducted on inpatient urine samples with orders placed for Urinalysis Reflex Culture (UARC) in a 400-bed acute care hospital. A total of 4016 urine samples were collected and examined between February and April 2020. The UA results were then subjected to the laboratory UA reflex criteria for reflecting UA to culture. Multivariable logistic regression was utilized in evaluating the effectiveness of the criteria’s parameters to predict positive urine cultures
Results: The total number of the positive UA reflex samples was 1539, which accounted for 38.3% of all the UA samples. Moreover, those positive UA samples were reflexed to urine cultures. Among the urine samples that were cultured, 45.1% (n = 694) were negative urine cultures while 54.9% (n = 845) were positive urine cultures. The UA reflex criterion was associated with positive predictive values for positive urine cultures between 26.30% and 92.96%.
Conclusions: The current Laboratory UA reflex criterion is not highly effective in predicting positive urine culture, thus potentially leading to the inappropriate antimicrobial usage.