Tartrazine-containing drugs

Tobramycin, an aminoglycoside antibiotic, was used to treat 52 infections due to gram-negative organisms in 51 patients. Complicated urinary tract infections, bacteremia and pyelonephritis accounted for 80% of the infections. The rate of immediate satisfactory response was 79%. During therapy with tobramycin, resistant organisms emerged in four patients--two Pseudomonas aeruginosa and two Escherichia coli strains. There were four superinfections with tobramycin-resistant Providencia sp. In four seriously ill patients the serum creatinine concentration increased 1 mg/dL or more; in three the increase was transient. No auditory toxicity was noted in the 19 patients in whom serial audiograms were made. In vitro testing of isolates from these patients showed that tobramycin and gentamicin had equal activity against Enterobacteriaceae. Tobramycin was two to four times more active against susceptible P. aeruginosa.     

Mycobacterium avium subspecies paratuberculosis is not associated with Type-2 Diabetes Mellitus

Background

Escherichia coli is the commonest cause of community and nosocomial urinary tract infection (UTI). Antibiotic treatment is usually empirical relying on susceptibility data from local surveillance studies. We therefore set out to determine levels of resistance to 8 commonly used antimicrobial agents amongst all urinary isolates obtained over a 12 month period.

Methods

Antimicrobial susceptibility to ampicillin, amoxicillin/clavulanate, cefalexin, ciprofloxacin, gentamicin, nitrofurantoin, trimethoprim and cefpodoxime was determined for 11,865 E. coli urinary isolates obtained from community and hospitalised patients in East London.

Results

Nitrofurantoin was the most active agent (94% susceptible), followed by gentamicin and cefpodoxime. High rates of resistance to ampicillin (55%) and trimethoprim (40%), often in combination were observed in both sets of isolates. Although isolates exhibiting resistance to multiple drug classes were rare, resistance to cefpodoxime, indicative of Extended spectrum β-lactamase production, was observed in 5.7% of community and 21.6% of nosocomial isolates.

Conclusion

With the exception of nitrofurantoin, resistance to agents commonly used as empirical oral treatments for UTI was extremely high. Levels of resistance to trimethoprim and ampicillin render them unsuitable for empirical use. Continued surveillance and investigation of other oral agents for treatment of UTI in the community is required.     

某三甲医院儿童和成年女性尿培养病原菌分布和耐药性分析

摘要 目的：了解尿路感染儿童和成年女性尿培养病原菌种类和耐药性的差异,为临床合理选用抗菌药物提供依据。方法：分别收集2018年1月~2019年12月期间在我院住院的尿路感染儿童的尿培养标本1618份和尿路感染成年女性的尿培养标本1044份,分析其病原菌的分布和耐药性。结果：1618份儿童尿培养标本中分离出267株病原菌,居首位的病原菌是屎肠球菌,占43.82%（117/267）;1044份成年女性尿培养标本中分离出139株病原菌,居首位的病原菌是粪肠球菌,占28.78%（40/139）。在两种人群尿培养病原菌中大肠埃希菌和肺炎克雷伯菌构成比均分别为第二位和第三位。儿童尿培养屎肠球菌对青霉素G、氨苄西林、环丙沙星等喹诺酮类药物的耐药率高于成年女性尿培养粪肠球菌,对克林霉素、奎奴普丁/达福普汀、四环素的耐药率低于成年女性尿培养粪肠球菌（P＜0.05）;未发现对高浓度庆大霉素、高浓度链霉素、利奈唑胺、万古霉素、替加环素耐药的肠球菌。儿童尿培养大肠埃希菌对氨苄西林/舒巴坦、头孢吡肟的耐药率均高于成年女性尿培养大肠埃希菌（P＜0.05）。儿童尿培养肺炎克雷伯菌对头孢哌酮/舒巴坦、氨苄西林/舒巴坦、哌拉西林/他唑巴坦、氨曲南、厄他培南、亚胺培南、美洛培南、呋喃妥因、头孢唑啉等头孢菌素类药物的耐药率高于成年女性尿培养肺炎克雷伯菌（P＜0.05）。结论：尿路感染儿童和成年女性尿培养病原菌均以肠球菌为主,大肠埃希菌和肺炎克雷伯菌构成比分别为第二位和第三位,两种人群尿培养主要病原菌耐药性均有不同程度的差异,临床医生应根据尿培养和药敏结果合理用药。     

Antibiotic resistance among coliforms and Pseudomonas spp. from bodies of water around Port Harcourt, Nigeria

Samples from municipal waste water, the Bonny River estuary and wells in and around Port Harcourt were examined for bacteriological quality over a 9 month period. A total of 157 Pseudomonas spp., 133 Escherichia coli and 282 other coliforms were isolated and tested for the incidence of resistance to 10 antibiotics. All of the Pseudomonas spp. were resistant to at least one of the antibiotics while 96.2% were resistant to two or more. Most (83.5%) of the E. coli and other coliforms (91.8%) were resistant to at least one antibiotic. All strains were susceptible to gentamicin. Minimal inhibitory concentrations of ampicillin and tetracycline for E. coli ranged from 6.25 to 50 and 6.25 to 12.5 micrograms/ml, respectively. Minimal inhibitory concentrations of ampicillin and tetracycline were 1000 and 25 micrograms/ml for the Pseudomonas strains. The high incidence of bacterial resistance to antibiotics is discussed in relation to the widespread use of antibiotics, and possible public health implications.     

糖尿病患者无乳链球菌尿路感染临床表现及药物敏感性分析

目的了解糖尿病患者无乳链球菌尿路感染的临床表现及耐药状况,为临床用药提供依据。方法回顾性分析温州医学院附属第一医院2003年至2005年糖尿病患者继发尿路感染的临床特点及耐药情况。结果280例送检尿培养的住院糖尿病患者致病菌阳性有169例,共检出无乳链球菌25株,其中女性23例,男性2例。药敏结果显示无乳链球菌对氨曲南、林可霉素、复方新诺明、红霉素、阿米卡星的耐药率高达50%以上,而对头孢唑啉、万古霉素的耐药率为0%,对替考拉宁、青霉素、氨苄西林的耐药率为5.88%、7.69%、10%。结论糖尿病患者无乳链球菌引起尿路感染应引起注意,临床医生需根据药敏结果合理选用抗生素。     

Antibiotic resistance among coliforms and Pseudomonas spp. from bodies of water around Port Harcourt, Nigeria

Samples from municipal waste water, the Bonny River estuary and wells in and around Port Harcourt were examined for bacteriological quality over a 9 month period. A total of 157 Pseudomonas spp., 133 Escherichia coli and 282 other coliforms were isolated and tested for the incidence of resistance to 10 antibiotics. All of the Pseudomonas spp. were resistant to at least one of the antibiotics while 96.2% were resistant to two or more. Most (83.5%) of the E. coli and other coliforms (91.8%) were resistant to at least one antibiotic. All strains were susceptible to gentamicin. Minimal inhibitory concentrations of ampicillin and tetracycline for E. coli ranged from 6.25 to 50 and 6.25 to 12.5 μg/ml, respectively. Minimal inhibitory concentrations of ampicillin and tetracycline were 1000 and 25 μg/ml for the Pseudomonas strains. The high incidence of bacterial resistance to antibiotics is discussed in relation to the widespread use of antibiotics, and possible public health implications.     

Trimethoprim resistance in Finland after five years' use of plain trimethoprim.

A total of 1388 urinary bacterial pathogens were tested for resistance to plain trimethoprim after five years'' use of this drug for prophylaxis against urinary tract infections. Samples were obtained in Turku, Finland, where use of the drug is much greater than in other parts of Finland. Resistance to trimethoprim (greater than 8 mg/l; agar-dilution method) occurred in 20.3% of strains isolated from outpatients and 39.8% of strains isolated from inpatients. Escherichia coli and Micrococcus showed low incidences of resistance (11% and 13% respectively in ouptatients and 23% and 19% respectively in inpatients); Enterobacter, Streptococcus faecalis, and Staphylococcus epidermidis occupied an intermediate position; and Proteus mirabilis and Klebsiella were resistant in 41-76% of cases. Similar incidences of resistance were observed to sulphamethoxazole-trimethoprim, sulphamethoxazole, ampicillin, and nitrofurantoin. These findings together with the rare occurrence of side effects and convenient dosage confirm the usefulness of plain trimethoprim for urinary tract infection.     

Incompatibility group K plasmids in bacteria isolated from a urinary tract infection

Citrobacter freundii and Klebsiella pneumoniae were concurrently isolated from a patient with a urinary tract infection. Transferable drug resistant plasmids were isolated from both strains, pMS434 and pMS435. These plasmids belonged to incompatibility group K and both carried genes governing resistance to various aminoglycoside antibiotics, i.e., kanamycin, gentamicin C complex, streptomycin, and 3',4'-dideoxykanamycin B, in addition to those governing resistance to sulfanilamide and ampicillin. They inactivated kanamycin, gentamicin C complex and 3',4'-dideoxykanamycin by adenylylation and kanamycin by phosphorylation. Electron microscopic observations disclosed that the molecular weights of the plasmids were about 67.8 megadaltons. These results indicated the similarity in genetic constitution of the two plasmids. This was the second isolation of incompatibility group K plasmids, following that reported by Hedges and Datta (Nature 234: 220-221, 1971).     

Resistance of urinary tract infection pathogens and choice of antibacterial therapy in pediatric urologic practice]

The data on antibiotic resistance of the main uropathogens isolated from patients with urinary tract infection in an urologic department (319 isolates) and outpatient and diagnostic units (360 isolates) are presented. It was shown that by the antibiotic resistance the Escherichia coli isolates from the urologic department patients and outpatients did not practically differ: 44.1 and 47.8% of the isolates were resistant to ampicillin, 26.7 and 23.4% were resistant to amoxycillin/clavulanate, 28.9 and 24.9% were resistant to co-trimoxazole and 26.5% was resistance to cefuroxime (outpatients). The basic differences referred to Pseudomonas aeruginosa: resistance to ceftazidime in 38.5% of the isolates and resistance to gentamicin in 36.2% of the isolates. The activity against P. aeruginosa could be arranged as follows in the decreasing order: amikacin = meropenem > imipenem > cefepime = cefoperazone/sulbactam > gentamicin = ceftazidime. Resistance of P. aeruginosa to fluoroquinolones (ciprofloxacin and levofloxacin) remained low (7.4 and 8.0% respectively). No ampicillin resistance was revealed in the isolates of Enterococcus faecalis.     

The structure and antibiotic sensitivity of the causative agents of community-acquired infectious diseases of bacterial origin in children]

Four hundred and forty pediatric patients at the age of 7 days to 15 years with various infections admitted to the Hospital within a month were examined. The biological material was inoculated to blood agar on the first days of the patient admittance to the Hospital and after the growth the organisms were isolated and identified. Antibiotic susceptibility of the isolates was assayed with the disk diffusion method. 479 strains in all were tested. The most frequent cases requiring hospitalization and antibiotic therapy were those of respiratory tract infections (54.09 per cent), urinary tract infections (26.36 per cent), cutaneous and subcutaneous fat diseases, gastrointestinal diseases and others (about 25 per cent of the cases in all). The main pathogens were Streptococcus viridans, S.aureus and S.epidermidis, as well as Enterobacteriaceae (chiefly E.coli) whose frequencies were practically equal (in 25-35 per cent of the cases). The Pneumococcus isolates amounted to 6.3 per cent. Nonfermenting bacteria (Pseudomonas aeruginosa and Acinetobacter) and some representatives of Enterobacteriaceae (Citrobacter, Serratia, Morganella) were isolated from 7 per cent of the patients. The frequency of Klebsiella and Enterobacter was about 11 per cent. The main pathogens were tested for their susceptibility to amoxycillin/clavulanic acid, ampicillin, oxacillin and gentamicin. The least active antibiotic was ampicillin. 88.8 per cent of the E.coli isolates and 100 per cent of the Klebsiella, P.mirabilis, Morganella, Citrobacter, Enterobacter and Serratia isolates were resistant to it. 53.2 per cent of the Streptococcus isolates including 64.5 per cent of the Pneumococcus isolates were as well resistant to ampicillin. 59.5 per cent of the Streptococcus isolates (mainly S.viridans and Enterococcus) was susceptible to oxacillin, 22.2 per cent of them being moderately susceptible. 62.5 per cent of the Pneumococcus isolates and 78.1 per cent of the Staphylococcus isolates were also susceptible to oxacillin. The highest susceptibility of the isolates was that to amoxycillin/clavulanic acid, i.e. 90.1 per cent of the strains, 79.9 per cent of them being highly susceptible. All the isolates of Citrobacter, Serratia and Morganella and some isolates of P.aeruginosa, Acinetobacter, Enterobacter, Klebsiella and E.coli were resistant to amoxycillin/clavulanic acid. As for the latter 5 organisms their susceptibility to amoxycillin/clavulanic acid was comparable with that to gentamicin. The susceptibility of the Streptococcus and Staphylococcus isolates to amoxycillin/clavulanic acid was significantly much higher than that to oxacillin, gentamicin and ampicillin: 93 per cent of the Streptococcus isolates (62.7 per cent of the Pneumococcus isolates) and 90.7 per cent of the Staphylococcus isolates.     

Susceptibility of sixty-five non-oral clinical isolates of the Streptococcus milleri group to seven antimicrobial agents.

Antimicrobial susceptibilities of sixty-five non-oral Streptococcus milleri group clinical isolates to penicillin, gentamicin, lincomycin, ampicillin, chloramphenicol, tetracycline and erythromycin were determined by an agar dilution method. All strains were penicillin-sensitive (MIC < or = 0.031 microgram/ml) and the majority (64/65) were susceptible to erythromycin (MIC < or = 0.125 microgram/ml). Low-level resistance to gentamicin was observed, and the majority of strains possessed an MIC of 8 micrograms/ml. Lincomycin and ampicillin at 0.5 microgram/ml inhibited 52/65 and 61/65 strains, respectively. Of the isolates 92% were inhibited by chloramphenicol at < or = 2 micrograms/ml. Twenty-two S. milleri group strains (of which thirteen were vaginal isolates) were resistant to tetracycline (MIC > or = 8 micrograms/ml).     

Nosocomial urinary infection due to Trichosporon asahii. First two cases in Chile

We present two cases of nosocomial urinary tract infection due to Trichosporon asahii in intensive care unit patients with bladder catheter from two hospitals in Santiago, Chile. Both patients had an several catheters and bacterial infections that required the use of antibiotic therapy. One strain showed in vitro resistance to amphotericin B. Both strains were susceptible to fluconazole, but presented MIC with dose-dependent susceptibility to ketoconazole and itraconazole. This is the first report showing T. asahii as urinary tract infection agent in Chile.     

老年患者阴沟肠杆菌感染的临床特点及耐药性分析

目的了解我院老年患者阴沟肠杆菌感染的临床分布及耐药性变迁,为临床合理用药提供参考依据。方法采用回顾性分析方法,统计临床数据并分析我院2011年9月至2016年4月期间老年患者感染标本中分离出的阴沟肠杆菌的感染现状及耐药性。结果共检出149株阴沟肠杆菌,主要分离于痰液、全血和尿液中,分别占31.54%、24.16%和18.12%。在科室分布中,阴沟肠杆菌感染主要来源于普通外科、重症监护病房和呼吸内科,分别占26.84%、14.10%和14.10%。药敏结果显示阴沟肠杆菌对美罗培南、亚胺培南和阿米卡星具有较好的抗菌活性,敏感率分别为100.00%、96.64%和95.97%,而对阿莫西林/克拉维酸、氨苄西林、头孢替坦、头孢西丁和头孢唑啉的耐药率分别为96.36%、96.36%、97.67%、100.00%和100.00%。结论阴沟肠杆菌易引起呼吸道、泌尿道以及伤口的感染,且其耐药现象较为严重,应加强耐药性的监测,根据药敏结果合理选用抗菌药物,以控制医院感染。     

Drug resistance of Enterococcus species isolated from the urogenital system

Despite low virulence of enterococci, they have become important nosocomial pathogens. This has been correlated with the increased use of broad-spectrum antibiotics, particularly cephalosporins. Many strains of enterococci exhibit multiple drug resistance; the most important being high-level resistance (HLR) to penicillin (MIC > 100 mg/l) and gentamicin (MIC > 500 mg/l and 2000 mg/l) and/or streptomycin (MIC > 2000 mg/l). The investigation was performed on 92 strains, isolated from genito-urinary tract and recognised as Enterococcus sp. All strains were obtained from several microbiological laboratories of Gdańsk, Gdynia and Tczew. On biochemical reaction profiles species of enterococci were identified as: E. faecalis (72.8%), E. faecalis varians (9.8%), E. durans (7.6%) and E. faecium (9.8%). The minimal inhibitory concentration (MICs) of penicillin, ampicillin, azlocillin, imipenem, gentamicin, amicacin, ciprofioxacin and vancomycin were determined by the agar dilution method. None of these 92 enterococcal strains was vancomycin resistant. 22.2% of E. faecium and 7.5% of E. faecalis showed high-level resistance to penicillin. None of these strains were produced beta-lactamase. High-level resistance to streptomycin and gentamicin was detected. Both--high-level resistance to streptomycin and gentamicin--were found in 6% E. faecalis; 11.1% E. faecalis varians and 22.2% E. faecium.     

Survey of antimicrobial resistance in lactic streptococci.

A total of 26 strains of Streptococcus cremoris and 12 strains of Streptococcus lactis were challenged with 18 antimicrobial agents and with nisin in the Bauer-Kirby disk susceptibility test. All strains were susceptible to ampicillin, bacitracin, cephalothin, chloramphenicol, chlortetracycline, erythromycin, penicillin G, tetracycline, and vancomycin. All strains were resistant to trimethoprim, and almost all strains were resistant to sulfathiazole. Variability in resistance to gentamicin, kanamycin, lincomycin, nafcillin, neomycin, nisin, rifampin, and streptomycin was observed. MICs of these substances for the less susceptible strains were determined, and high-level resistance factors could not be detected, except in the case of nisin. S. lactis ATCC 7962 was resistant to at least 40-fold-higher concentrations of nisin (greater than 64 micrograms/ml) than most other strains tested. This strain was a potent nisin producer.     

Survey of antimicrobial resistance in lactic streptococci

A total of 26 strains of Streptococcus cremoris and 12 strains of Streptococcus lactis were challenged with 18 antimicrobial agents and with nisin in the Bauer-Kirby disk susceptibility test. All strains were susceptible to ampicillin, bacitracin, cephalothin, chloramphenicol, chlortetracycline, erythromycin, penicillin G, tetracycline, and vancomycin. All strains were resistant to trimethoprim, and almost all strains were resistant to sulfathiazole. Variability in resistance to gentamicin, kanamycin, lincomycin, nafcillin, neomycin, nisin, rifampin, and streptomycin was observed. MICs of these substances for the less susceptible strains were determined, and high-level resistance factors could not be detected, except in the case of nisin. S. lactis ATCC 7962 was resistant to at least 40-fold-higher concentrations of nisin (greater than 64 micrograms/ml) than most other strains tested. This strain was a potent nisin producer.     

Biochemical and Clinical Characteristics and Antibiotic Susceptibility of Atypical Enterobacter cloacae

The characteristics of an atypical group of the family Enterobacteriaceae resembling Enterobacter cloacae were studied. The urinary tract was the most common source of these organisms, and most strains represented infections of secondary clinical significance. In contrast to typical Enterobacter strains, the atypical strains were highly susceptible to the cephalosporins; otherwise, there was a high degree of susceptibility to five other antibiotics and resistance to ampicillin except in very high concentration.     

大肠埃希菌泌尿系统感染患者临床分布及药物敏感性分析

摘要 目的：探讨大肠埃希菌引起泌尿系统感染患者的临床分布情况及其药物敏感性分析,为临床诊断及合理使用抗菌药物提供理论性依据。方法：选取2015年1月至2020年12月期间诊治的2052例大肠埃希菌泌尿系统感染患者为研究对象,使用MALDI-TOF MS全自动微生物鉴定质谱仪对细菌进行鉴定,应用VITEK 2 Compact全自动微生物鉴定及药敏分析仪进行药物敏感性分析。结果：2052例大肠埃希菌泌尿系统感染患者中泌尿外科患者占比最高,为17.50%,其次为肾病科患者,占12.87%。其中检出803株产ESBLs的大肠埃希菌,泌尿外科占比最高,为18.56%,其次是肾病科占13.95%,内分泌科占11.71%,重症医学科10.09%。2052株大肠埃希菌整体药敏分析结果显示,大肠埃希菌对美罗培南、亚胺培南、阿米卡星、哌拉西林/他唑巴坦、呋喃妥因、米诺环素、头孢西丁等药物敏感率高,均>90%,头孢唑啉、环丙沙星、左氧氟沙星、氨苄西林/舒巴坦、复方新诺明、氨苄西林敏感率低,均<50%,其中氨苄西林敏感率最低,只有28.17%。结论：大肠埃希菌泌尿系统感染主要发生在泌尿外科,产ESBLs大肠埃希菌整体检出率较高,临床应重视泌尿系统感染患者的尿细菌培养及药物敏感性分析,尽量避免仅凭经验性用药,根据药物敏感性结果合理选择抗菌药物。     

Administration of antibiotics in combination. The antibacterial activity of blood serum and urine after a simultaneous administration of aminoglycosides and ampicillin

Blood serum and urine samples collected from a group of volunteers treated with single doses of ampicillin and aminoglycoside preparations given separately or in combination were tested for their antimicrobial activity against the reference strains Staphylococcus aureus SZK 76/69 and ATCC 6538, Pseudomonas aeruginosa SZK 444 and SZK 385, and Escherichia coli SZK 326/71. Out of all antimicrobials and their combinations tested the most powerful was the combination of netilmicin with ampicillin. Of the therapeutic combinations used nowadays in clinical practice the combined use of gentamicin and ampicillin proved also effective. These antibiotic combinations appear thus to be best suited for the treatment of mixed Pseudomonas aeruginosa and Staphylococcus aureus infections and of urinary tract infections caused by bacterial strains exhibiting in the in vitro susceptibility assays a reduced sensitivity to some of the antibiotic preparations used.     

A murine pneumonia model to study pathogenesis of <Emphasis Type="Italic">Stenotrophomonas maltophilia</Emphasis>

Early attempts to develop an animal model of infection appeared to support the hypothesis that Stenotrophomonas maltophilia does not cause serious sepsis when bacteria are intravenously administered to mice. This species has also been implicated in an increasing number of infections such as, bacteremia, endocarditis, ophthalmological syndromes, skin lesions, urinary, respiratory tract and gastrointestinal infections. Despite this clinical importance, the mechanisms involved in the pathogenesis of S. maltophilia infections have not been elucidated and the virulence factors of importance in the pathogenesis of S. maltophilia associated pulmonary infection remain to be characterized. The purpose of this study was to establish an infection model using 5 clinical isolates of S. maltophilia in a mouse pneumonia model. All strains were able to establish themselves in respiratory tract with peak of infection occurring at 24 h post infection. The strains were able to cause neutrophil influx, were taken up and intracellularly killed by alveolar macrophages except Sm2 that persisted for a slightly longer time in the macrophages. All strains were resistant to lytic action of serum and survived in blood confirming their ability to cause bacteremia. The strains were cleared from spleen and liver by 7th and 4th day but caused tissue damage that was measured in terms of lipid peroxidation, lactate dehydrogenase activity and histopathological examination of lung tissue homogenate. All strains caused interstitial pneumonitis in lungs of mice.