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Necrotizing fasciitis in children is a frequently misdiagnosed condition; early identification of the necrotizing process can improve the outcome of this life-threatening disease. Surgical debridement and antibiotics were the most important therapeutic measures.
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We evaluated 450 FDE patients to determine the causative drugs.
Distribution according to species and genus and resistance to antibacterial agents was studied with 420 bacterial isolates cultured from the wound excretion of 282 burned-infected patients. Of the isolates 68.2% was Gram-positive and 31.8% Gram-negative. This latter high rate may be due to fecal infection as 21% of the burned patients was between the age of 0-4 years. Of the total isolates 38.3% was Staphylococcus aureus, 16.7% coagulase-negative staphylococcus, 10.7% Pseudomonas strain, 6.9% Escherichia coli and 4.8% Klebsiella. Vancomycin resistant Staphylococcus strain was not found. On the other hand 30-35% of the strains was cross-resistant to methicillin- oxacillin-cefuroxim-clindamycin though these agents are the most potent following the vancomycine. Ceftazidime is the most effective agent for Pseudomonas strains being followed by amikacin, carbenicillin, tobramycin and ceftriaxon. Other Gram-negative bacteria showed strongest sensitivity to ceftazidime and ceftriaxone and these are followed by amikacin.
A total of 387 S aureus isolates were analyzed between January 1, 2005, and June 30, 2011, from adult and pediatric patients.
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In recent years, novel fluoroquinolones with improved activity against gram-positive organisms have been introduced into clinical practice. These drugs may be of potential benefit for the treatment of pneumococcal otitis media, including infections caused by organisms resistant to conventional drugs.
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One hundred and seventy-nine strains of Staphylococcus aureus were isolated from wound excretion, blood, and sputum samples of patients that were admitted to ICU or public wards of our Department of Burns and Plastic Surgery from September 2012 to September 2013. Among them, 68 strains were from ICU and 111 strains from public wards. The MRSA phenotype of Staphylococcus aureus was detected with cefoxitin K-B disk diffusion method, and the isolation rates of MRSA in ICU and public wards were compared. Genotyping of SCCmec was performed by PCR in strains of MRSA. In the meantime, the identification result of MRSA by K-B method was verified through detecting methicillin-resistant determinant mecA. The antimicrobial resistance of MRSA and methicillin-sensitive Staphylococcus aureus (MSSA) to 23 kinds of commonly used antibiotics in clinic were detected by K-B disk diffusion method. Except for the antibiotics to which the resistant rates of MRSA were 100.0% or 0, the resistant rates of SCCmecIII MRSA and non-SCCmec III MRSA to the rest of antibiotics were compared. Data were processed with Pearson chi-square test or corrected chi-square test.
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Ninety-seven patients underwent 100 reconstructions (61 free flap reconstructions, 39 pedicled/local flap reconstructions) and all received a combination of intravenous (IV) antibiotic agents designed to cover oral flora. There were 23 (23%) recipient-site complications, which included cellulitis (9%), mucocutaneous fistula (5%), abscess (5%), and wound dehiscence (4%). Duration of antibiotic prophylaxis, defined as less than 48 hours (short-course) or greater than 48 hours (long-course), was not a significant predictor of recipient-site complication. Significant risk factors for recipient-site complications were clindamycin prophylaxis (P < 0.008), increased duration of surgery (P < 0.047), and advanced age (P < 0.034). Recipient-site complication was found to be a significant predictor of both increased length of hospital stay (P < 0.001) and increased time to the resumption of enteral feeds (P < 0.035).
Among 328 strains, 19F (36.3%), 19A (13.4%), 6A (11.9%), 23F (11.0%), 14 (5.8%), 6B (5.2%), and 15B/C (4.3%) were the most common serotypes. The coverage rates of 7-, 10-, and 13-valent conjugate vaccines (PCV7, PCV10, and PCV13) were 58.2%, 58.2%, and 84.1%, respectively. Out of the isolates, 26 (7.9%) strains were penicillin resistant. Most of the strains displayed high resistance rate to macrolides (98.5% to erythromycin, 97.9% to azithromycin, and 97.0% to clindamycin).
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From October 2005 to September 2006, we collected the specimen from 366 patients with lower respiratory tract infections in 12 institutions in Japan, and investigated the susceptibilities of isolated bacteria to various antibacterial agents and patients' characteristics. Of 411 strains that were isolated from specimen (mainly from sputum) and assumed to be bacteria causing in infection, 406 strains were examined. The isolated bacteria were: Staphylococcus aureus 70, Streptococcus pneumoniae 85, Haemophilus influenzae 78, Pseudomonas aeruginosa (non-mucoid) 46, P. aeruginosa (mucoid) 14, Klebsiella pneumoniae 21, and Moraxella subgenus Branhamella catarrhalis 40. Of 70 S. aureus strains, those with 2 microg/ml or less of MIC of oxacillin (methicillin-susceptible S. aureus: MSSA) and those with 4 microg/ml or more of MIC of oxacillin (methicillin-resistant S. aureus: MRSA) were 38 (54.3%) and 32 (45.7%) strains, respectively. Against MSSA, imipenem had the most potent antibacterial activity and inhibited the growth of 37 strains (97.4%) at 0.063 microg/ml or less. Against MRSA, arbekacin and vancomycin showed the most potent activity and inhibited the growth of all the strains at 1 microg/ml. Carbapenems showed the most potent activities against S. pneumoniae and in particular, panipenem inhibited the growth of all the strains at 0.063 microg/ml or less. Faropenem also had a preferable activity and inhibited the growth of all the strains at 0.25 microg/ml. In contrast, there were high-resistant strains (MIC: over 128 microg/ml) for erythromycin (38.1%) and clindamycin (22.6%). Against H. influenzae, levofloxacin showed the most potent activity and its MIC90 was 0.063 microg/ml or less. Meropenem showed the most potent activity against P. aeruginosa (mucoid) and its MIC90 was 0.5 microg/ml. Against P. aeruginosa (non-mucoid), arbekacin had the most potent activity and its MIC90 was 8 microg/ml. Against K. pneumoniae, cefozopran was the most potent activity and inhibited the growth of all the strains at 0.063 microg/ml or less. Also, all the antibacterial agents except ampicillin generally showed a potent activity against M. (B.) catarrhalis and the MIC90 of them were 2 microg/ml or less. The approximately half the number (53.6%) of the patients with respiratory infection were aged 70 years or older. Bacterial pneumonia and chronic bronchitis accounted for 44.3% and 29.8% of all the respiratory infection, respectively. The bacteria frequently isolated from the patients with bacterial pneumonia were S. aureus (15.4%), S. pneumoniae (23.4%), and H. influenzae (21.3%). S. aureus (25.4%) and S. pneumoniae (18.0%) also were frequently isolated from the patients with chronic bronchitis. Before the drug administration, the bacteria frequently isolated from the patients were S. pneumoniae (22.0%) and H. influenzae (21.4%). The bacteria frequently isolated from the patients treated with macrolides were S. pneumoniae and P. aeruginosa, and their isolation frequencies were each 35.3%.
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Among the 373 clinical isolates of Staphylococci which were studied, 134 isolates showed a discordant resistance pattern. Among these discordant strains, 45 (33.6%) isolates were D-test positive, which had inducible clindamycin resistance and belonged to the inducible macrolide lincosamide streptogramin- B phenotype (MLSBi). 89 (66.4%) isolates were D-test negative and they belonged to the macrolide streptogramin phenotype (MS). Among the MLSBi phenotypes, 6 (13.3%) isolates were methicillin-resistant Staphylococcus aureus (MRSA), 13 (28.9%) were Methicillin-sensitive S.aureus (MSSA) and 26 (57.8%) were coagulase negative staphylococci (CONS).
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Soft tissue infections in the maxillofacial region are mainly caused by Staphylococcus aureus, Pseudomonas aeruginosa, and Escherichia coli but also by members of the genera Enterococcus, Klebsiella, and Enterobacter, respectively.
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The GBS colonization rate in our study was low. No resistance to penicillin or clindamycin was seen, while the majority of the isolates were resistant to tetracycline.
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The objective was to collect recent data on the antibiotic susceptibility of clinically significant anaerobes in Belgium. A total of 333 anaerobic clinical isolates from various body sites were prospectively collected between 2005 and 2007 at two tertiary care hospitals in Belgium. The minimal inhibitory concentrations (MICs) were determined using the E-test method for nine anti-anaerobic antibiotics. Sixty-one percent of the isolates were beta-lactamase producers, which explains the poor activity of penicillin. Amoxicillin/clavulanic acid, piperacillin/tazobactam, metronidazole and meropenem were very active against most anaerobes, but around 10% of the Bacteroides fragilis group strains were non-susceptible to the two beta-lactam/beta-lactamase inhibitors. No resistance was observed to metronidazole, while 3% of the Bacteroides spp. had decreased susceptibility to meropenem (MIC > or = 4 mg/L). Cefoxitin, clindamycin and moxifloxacin were less active, with 33%, 52% and 57% of the B. fragilis group being non-susceptible respectively. Tigecycline showed consistently good activity against most anaerobes with MIC(50) and MIC(90) of 0.25 and 2 mg/L. Metronidazole, amoxicillin/clavulanate, piperacillin/tazobactam and meropenem remain good empirical choices when anaerobes are expected in our setting. Because of the occurrence of resistance to most classes of current anti-anaerobic antibiotics, it is recommended that the antimicrobial resistance patterns be monitored regularly in order to guide empirical therapy.
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In these strains, antibiotypes resistant to oxacillin, gentamicin, erythromycin, and tobramycin predominated (50%). The greater percentage of MRSA strains isolated from health personnel as well as two neonates were described as pulse types Ia and Ib, belonging to phage group II, containing type IV SCCmecA and resistant to macrolides and aminoglycosides and sensitive to clindamycin and trimethoprim-sulfamethoxazole.
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CA-MRSA is well established in this pediatric population. Although no discernable changes in CA- or HA-MRSA case characteristics were documented during the study period, significant changes were observed in CA-MRSA isolate characteristics, indicating that this pathogen continues to evolve.
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Resistance to erythromycin was 21.7% [95% confidence interval (CI) 16.5-26.3]. The resistance to azithromycin was 21.5%, whereas the resistance to miocamycin and to clindamycin was 6.6% (95% CI 3.0-8.9). Thirty-one (5.8%) of the isolates were resistant to telithromycin. Of the 115 erythromycin-resistant isolates, 67.8% had the M phenotype, representing 14.7% of all the isolates tested. Thirty-five isolates (30.5% of the erythromycin-resistant strains and 6.6% of all the isolates) had the MLS(B) constitutive phenotype. There was a high prevalence of resistance to telithromycin (88.6%) among the 35 strains with the MLS(B) constitutive phenotype. When we compared these results with those from previous studies (1998 and 2001), we found a significant increase in the MLS(B) constitutive phenotype (P < 0.001), and a significant decrease in the M phenotype (P < 0.005) was noted.
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The pathophysiologic mechanism of acute hematogenous osteomyelitis in children has been further elucidated. Investigations revealed, that certain strains of staphylococcus aureus, responsible for the majority of infections, can resist intracellular killing after phagocytosis. Beta-lactam-antibiotics don't penetrate well into phagocytes and are unable to eradicate staphylococci surviving intracellularly. Fosfomycin, clindamycin and combinations of these antibiotics with beta-lactam-antibiotics are able to eradicate staphylococci also in phagocytic vacuoles. In a therapeutic investigation 36 patients have been treated with fosfomycin in combination with cefamandole intravenously for 10-14 days followed by clindamycin orally for 3-6 weeks. With this treatment schedule the therapeutic outcome was superior to previously employed therapeutic regimen.
This study aimed to detect inducible clindamycin (iCLI) resistance in Staphylococcus pseudintermedius isolated from dogs in Thailand using D-zone testing. Strains that were iCLI-resistant were characterized by molecular typing and antibiogram and were detected in 10/200 S. pseudintermedius isolates (5%) from 7/41 dogs (17%). All were methicillin-resistant S. pseudintermedius (MRSP) and demonstrated multidrug resistance. The iCLI-resistant MRSP contained erm(B) and had identical or closely related DNA fingerprint patterns by pulsed-field gel electrophoresis. All iCLI-resistant MRSP strains belonged to the same clonal complex 112 (sequence types 111 and 112) by multilocus sequence typing. To avoid misinterpretation of clindamycin susceptibility, D-zone testing is recommended to promote rational antimicrobial selection and limit the clonal expansion of multidrug resistant bacteria.
To compare the rates of cure of septic abortion and pelvic inflammatory disease using a daily dose of clindamycin with gentamicin versus divided doses, we conducted a retrospective cohort study, where the electronic records of 661 patients who used clindamycin 1 × , 3 × or 4 ×/day (groups 1, 3 and 4, respectively) between September 2002 and August 2010 were analysed. Major outcomes included rates of cure and failure according to the clinical records. Secondary endpoints were percentage of adverse effects related to medication regimen and the prevalence of positive VDRL and HIV. Similar conditions were observed in all groups - septic abortion: 167/116/123; pelvic inflammatory disease: 73/95/87 (groups 1, 3 and 4, respectively). No significant difference was found among groups for age or for rate of cure. Rates of cure (cure/total [rate (95%CI)]) in groups 1, 3 and 4 were 236/240 [0.983 (0.957-0.993)], 205/211 [0.971 (0.939-0.986)], 203/210 [0.966 (0.932-0.983)], respectively. Days of use of clindamycin was significantly reduced in group 1, compared to groups 3 and 4 (2.6 ± 1.3 vs. 3.5 ± 2.5 vs. 3.3 ± 1.9-mean ± SD; p < 0.0001 - ANOVA), but this may be due to differences in how length of therapy was measured and not the effect on clinical cure.
Bacteriological and clinical studies were carried out on 280 strains of Staphylococcus aureus isolated in clinics and hospitals in the Fukuoka city area from September 1990 to March 1991. The percentage of methicillin-resistant S. aureus (MRSA) strains studied was 41.4% (116 of 280). Of 116 MRSA strains, 48 (41.3%) produced coagulase VII and 21 (18.1%) produced coagulase II. The mean age of the patients who harboured MRSA, 70.5 +/- 16.9 years, was significantly higher than that of patients with methicillin-sensitive S. aureus (MSSA), 44.2 +/- 29.3 years (P < 0.001). MRSA was detected more frequently than MSSA in sputum (P < 0.01), while MSSA was detected more frequently than MRSA in pus (P < 0.01). Ninety (89.1%) of 101 strains of MRSA were isolated from inpatients and 98 (71.0%) of 130 strains of MSSA were isolated from outpatients. Similar number of MRSA strains were recovered in a variety of hospitals, indicating that there was no relationship between hospital size (number of beds) and the incidence of MRSA. As for drug susceptibility, coagulase VII-producing MRSA strains were more sensitive to clidamycin (P < 0.01) and more resistant to minocycline (P < 0.01) than were other MRSA strains.
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Colitis associated with antibiotics, particularly with lincomycin and clindamycin, is a well established entity. The colitis may be clinically and radiologically very difficult to distinguish from inflammatory bowel disease, including Crohn's disease and ulcerative colitis. A wide spectrum of pathological features is described with various antibiotics. However, the pathological picture in the pseudomembranous form is quite distinctive. The most important histological findings include a "mushroom-like" or "explosive" appearance of the pseudomembrane with a sudden transition to normal mucosa adjacent to the lesion. Rectal biopsy is both an accurate and a rapid method of establishing the diagnosis.
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From a sample size of 188 patients, an overall review was obtained for 80.3% of patients. When departmental guidelines were followed all reviewed patients achieved a successful outcome. An overall antibiotic prescribing rate of 2.9% was achieved for adult patients attending the emergency department in pain.
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Of the 252 patients, 209 were male, and 43 were female. The mean age was 41.4 years, and 70.2% were alcoholic. Cough, expectoration, fever and overall poor health were seen over 97% of patients. Chest pain was reported by 64%, 30.2% presented digital clubbing, 82.5% had dental disease, 78.6% reported having lost consciousness at least once, and 67.5% presented foul smelling sputum. In 85.3% of the patients, the lung lesions were located either in the posterior segments of the upper lobe or in the superior segments of the lower lobe, and 96.8% were unilateral. Concomitant pleural empyema was seen in 24 (9.5%) of the patients. Mixed flora was identified in the bronchopulmonary or pleural secretions of 182 patients (72.2%). All patients were initially treated with antibiotics (mainly penicillin or clindamycin), and postural drainage was performed in 98.4% of cases. Surgical procedures were performed in 52 (20.6%) of the patients (drainage of empyema in 24, pulmonary resection in 22 and drainage of the abscess in 6). Cure was obtained in 242 patients (96.0%), and 10 (4.0%) died.
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Carbapenem-sparing agents are particularly suitable for antimicrobial stewardship strategy. The new long-acting lypoglycopeptides are very effective in treating necrotizing fasciitis and are uttermost attractive for patients requiring short hospital stays and early discharge.
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Three different antibiotic regimens (trospectomycin plus azteonam, clindamycin plus azteonam, and triple antibiotics-ampicillin plus clindamycin plus gentamicin) were all effective in treating patients with postcesarean endometritis. Patients are frequently cured clinically despite the fact that the offending organisms may be isolated in post-treatment cultures. Treatment of postcesarean endometritis without obtaining endometrial cultures is acceptable gynecologic practice. Obtaining post-treatment cultures is clearly not cost effective nor clinically beneficial. Drug treatment efficacy should be evaluated by clinical response. This communication is the first to report the new antibiotic, trospectomycin, in the treatment of postcesarean endometritis. Further clinical trials are currently underway.
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The study was conducted in an NICU in a large urban university-affiliated hospital. Retrospective review was performed of all infants and health care workers in the NICU, especially those either colonized or infected with GAS during the outbreak and the prospective surveillance period (July through September 1994). Prospective epidemiologic investigation, including cultures of throat, umbilicus, and anorectum (infants), or throat and anus (NICU personnel), identified a possible common source of the disease in case infants. Antimicrobial susceptibility testing and serotyping of all GAS strains were performed; M serotype 1 isolates were examined by DNA analysis with restriction fragment length polymorphism. The M-1 GAS isolates were tested for streptococcal pyrogenic exotoxin (SPE) A and SPE B production. A retrospective chart review and analysis of infants with GAS infection or colonization was conducted.
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A model was developed to permit direct assessment of antibiotic efficacy against Enterococcus species in experimental intra-abdominal abscess. Abscesses yielded Enterococcus faecalis in pure culture. Antimicrobials were delivered by precisely controlled continuous intravenous infusion. After five days of therapy, ampicillin alone or in combination with gentamicin reduced residual bacterial titers from 7.93 +/- 1.05 (untreated) to 3.51 +/- 1.07 and 3.52 +/- 0.81 log10 colony forming units per gram, respectively. Both the clindamycin and gentamicin combination (6.49 +/- 1.33) and metronidazole and gentamicin combination (6.79 +/- 0.90) significantly suppressed the growth of enterococci (p less than 0.01). Combined clindamycin and aztreonam was ineffective, as were any of the agents used alone (except ampicillin). These results may explain, in part, the clinical efficacy of certain drug combinations against the enterococcal component of polymicrobial abscesses despite the apparent lack of in vitro activity of individual agents.
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The study was registered on ClinicalTrials.gov:NCT01572532 on December 15, 2011. The study was funded by NICHD: R01HD066156 .
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In an analysis of 4766 consecutive strains of Streptococcus pneumoniae isolated from cultures of blood from 1979 to 1986 and of 1157 isolates from cerebrospinal fluid (CSF), resistance was found in 380 (8%) of blood and 107 (9.2%) of CSF isolates to one or more of the following antibiotics: penicillin, tetracycline, erythromycin, clindamycin, rifampin, and chloramphenicol. Resistance increased from 3.8% to 14.1% among isolates from blood and from 6.8% to 14.1% among CSF isolates during this period. Comparing 1979-1982 with 1983-1986, we found that significant increases (P less than .01) have occurred in penicillin resistance alone, rifampin resistance alone, and in strains showing multiple resistance. Resistance was found in 15 different serogroups and/or serotypes, although 92.2% of resistant strains belonged to serogroups 6 or 19 or to serotype 14. Of the serogrouped or serotyped strains, 97.4% are represented in the 23-valent vaccine by a vaccine or vaccine-related strain.