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We report on a 41-year-old patient who was taken over from an outside hospital with headache, fever, polydipsy and profound sweating.
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Retrospective, observational case series.
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From March to December 2009, among 118 S. aureus blood isolates in a Taiwanese medical center, 62 MRSA isolates were screened for hVISA by Etest macromethod and further confirmed with modified population analysis profiling method. Molecular typing of hVISA isolates was performed.
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Enterococci are major zoonotic bacteria that cause opportunistic infections in human beings and animals. Moreover, pathogenic strains can be disseminated between human beings and animals, particularly companion animals that come into frequent contact with people. Recently, Enterococcus faecium clonal complex 17 (CC17) has emerged as a pandemic clone. Most CC17 strains are ampicillin resistant and possess virulence genes such as esp and hyl. Despite the possible dissemination of CC17 between human beings and animals, prevalence data about CC17 in animals is limited. In the present study, the phenotypes and genotypes of antimicrobial resistance were compared, as well as virulence gene profiles from 184 enterococci strains isolated from chickens, pigs, companion animals, and human patients in Korea. Ampicillin-resistant E. faecium (AREF) strains were selected, and multilocus sequence typing was performed to investigate the dispersion of CC17 among animals and human beings. The companion animal and human isolates showed high resistance rates to ampicillin and ciprofloxacin, whereas food animal isolates showed high tetracycline and erythromycin resistance rates. Ampicillin-resistant E. faecium was only detected in human (21/21 E. faecium, 100%) and companion animal (3/5 E. faecium, 60%) isolates, and all human AREF strains and 1 canine AREF strain were confirmed as CC17. In conclusion, the occurrence of antimicrobial resistance and virulence genes, and the distribution of enterococcal CC17 in companion animal enterococcal strains were similar to those of human strains rather than to those of food animal strains.
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CXA-101, a novel cephalosporin with good antipseudomonal activity, was evaluated against a consecutive and polyclonal collection of extended-spectrum-β-lactamase (ESBL)-producing Escherichia coli (n = 149) and Klebsiella pneumoniae (n = 20), mainly CTX-M-15- (69%) or CTX-M-14 producing (22%). A total of 41% of the E. coli isolates belonged to the international clone O25b-ST131. Broth microdilution versus CXA-101, CXA-tazobactam 4 and 8 mg/L (CXA-201), ceftazidime-tazobactam (CAT), ceftazidime-clavulanate (CAC), piperacillin-tazobactam (TZP), amoxicillin-clavulanate (ACL), ampicillin-sulbactam (ASU), and other comparators was performed, using EUCAST methodology and breakpoints. Susceptibility to CXA-201 was 96% (tazobactam 8 mg/L, tentative breakpoint S ≤ 1 mg/L), CAT 93%, CAC 95%, ACL 24%, ASU 2%, TZP 58%, ciprofloxacin 25%, levofloxacin 30%, gentamicin 54%, tobramycin 34%, amikacin 90%, and tigecycline 98%. Ninety-four percent of the TZP-resistant and all ACL-resistant isolates were CXA-201 susceptible. CXA-201 has good in vitro activity against ESBL-producing Enterobacteriaceae and might be a future therapeutic option for infections caused by TZP- and ACL-resistant isolates.
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Considering all three species together, there were no differences in outcome between the REClari and RECipro groups. Immunotherapy did not improve outcome. New therapies, optimised management of co-morbid conditions and a more holistic approach must be explored in the hope of improving outcome.
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Within the study period a total of 454 patients received prophylaxis with ciprofloxacin; 11 of these patients (2.4%) developed an infective complication within 4 weeks of the TRUSP Bx. A total of 255 patients received prophylaxis with co-amoxiclav and gentamicin; 33 patients (12.9%) in this group had an infective complication. No cases of Clostridium difficile infection were recorded for any of these patients within 1 month of receiving antibiotics. Re-introduction of the original regimen led to a fall in infective complications.
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There were no unexpected adverse events believed related to the use of the study medication. The rate of withdrawal from the study was low (approximately 7%) and did not differ between groups. Randomization was effective and acceptable to participants. Primary and secondary outcome measures all favoured active treatment, but there were no significant between group differences. The median rate of Pseudomonas isolates was 0/patient/year (interquartile range 0-0.38) in both the active and placebo groups. Kaplan-Meier survival curves showed no significant difference in time to first Pseudomonas isolate between groups.
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To investigate the efficacy, safety, and microbiology of a thermosensitive otic suspension of ciprofloxacin (OTO-201) in children with bilateral middle ear effusion undergoing tympanostomy tube placement.