cefotaxime and Escherichia-coli-Infections

Topics: Anthrax; Biopsy; Cefotaxime; Combined Modality Therapy; Drainage; Escherichia coli Infections; Humans; Infant; Kidney Diseases; Male; Ultrasonography; Urography

In this double-blind multicentre study, using the intention-to-treat approach, a total of 293 patients with fever (> or = 38.5 degrees C), symptoms of sepsis and signs of pneumonia or pyelonephritis were randomly assigned to treatment with ampicillin and mecillinam (A+M) or cefotaxime followed by cefadroxil. In the febrile phase, treatment was given intravenously twice daily, either with 1,200 mg ampicillin together with 600 mg mecillinam or with 2 g cefotaxime alone. When the patients stayed afebrile, the intravenous administration was replaced by oral treatment twice daily for 14 days, either with 500 mg pivampicillin and 400 mg pivmecillinam or 1 g cefadroxil. In the A+M group, 33% (48/144) of the patients did not complete the full course of treatment as compared with 32% (47/149) in the cephalosporin group, the reasons being treatment failure in 27 and 29, respectively, or adverse effects (n = 16 in both groups). The median duration of fever was 47 h in the A + M group and 50 h in the cephalosporin group. Of 135 patients with pneumonia, 68% were completely cured in the A + M group, and 65% in the cephalosporin group, the main reasons for treatment failure being Mycoplasma pneumonia or ornithosis. Of 136 patients with pyelonephritis, 63% were cured in each group. The main reason for failure was bacteriological relapse. Side-effects were reported by 32 patients (22%) of the A+M group, as compared with 41 (28%) of the cephalosporin group. Epigastric complaints were equally frequent in both groups, but there was a tendency for a higher frequency of exanthema in the A+M group, and for antibiotic-associated diarrhoea and fungal superinfections in the cephalosporin group.

Topics: Amdinocillin; Ampicillin; Cefadroxil; Cefotaxime; Cephalosporins; Double-Blind Method; Drug Therapy, Combination; Escherichia coli Infections; Female; Fever; Humans; Male; Middle Aged; Penicillins; Pneumonia, Bacterial; Pyelonephritis

In a prospective, open clinical trial 21 patients suffering from lower respiratory tract infections were treated with the new oral cephalosporin cefixime. The antibiotic was given at a dosage of 200 mg b. i. d. for seven to eleven days. Seventeen of 18 evaluable patients were cured or distinctly improved at the end of therapy as well as two days after the end of treatment. Clinical results correlated well with the results of the lung function tests, especially with the significant decrease of resistance. At the end of therapy all initially isolated pathogens were eradicated. The tolerability of cefixime was good, only in two patients treated mild and transient side effects were noticed (1 x diarrhea, 1 x epigastric pain).

Topics: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Bacterial Infections; Bronchitis; Bronchopneumonia; Cefixime; Cefotaxime; Citrobacter; Drug Resistance, Microbial; Drug Tolerance; Enterobacteriaceae Infections; Escherichia coli Infections; Female; Haemophilus Infections; Humans; Male; Middle Aged; Pneumonia; Pneumonia, Pneumococcal; Prospective Studies; Proteus Infections

In a prospective, open clinical study, 50 urological patients with acute pyelonephritis were treated with the oral cephalosporin cefixime. The medication (2 x 200 mg/day) was given for seven to ten days. Clinical, bacteriological as well as hematological examinations were carried out prior to, during and immediately after therapy. A late check-up was performed five to nine days after the end of therapy. 46 of the 50 cases were evaluable for efficacy, and all 50 patients were included in safety evaluation. The most frequent pathogens isolated prior to therapy were Escherichia coli (34 times), Proteus mirabilis (six times), Klebsiella pneumoniae (twice) and coagulase-negative staphylococci (twice). Immediately after the end of therapy the pathogens were eradicated in 44 (97.5%) patients. At the late check-up the urine was sterile in 29 (63%) patients. A relapse was observed in 11 patients, a reinfection in four and the initially isolated pathogens had persisted in two. Immediately after the end of therapy 44 (95.7%) patients were clinically cured and two patients had improved. At the late check-up 41 patients were classified as clinically cured, three showed improvement, and two improvement with relapse. Adverse reactions (one case nausea and exanthem, and one case of meteorism) occurred in two patients. No changes in the blood counts or in the liver and kidney functions were observed. In the study described here cefixime proved to be an effective and well tolerated antibiotic for the treatment of upper urinary tract infections; it is of particular interest that 16 of the 50 patients presented with underlying disease favoring infection.

Topics: Acute Disease; Adult; Aged; Aged, 80 and over; Anti-Infective Agents, Urinary; Body Temperature; Cefixime; Cefotaxime; Drug Tolerance; Escherichia coli Infections; Female; Humans; Klebsiella Infections; Leukocyte Count; Male; Middle Aged; Prospective Studies; Proteus Infections; Pyelonephritis; Recurrence; Staphylococcal Infections

A prospective, randomized clinical trial was conducted to compare the efficacy and tolerance of a single dose of 1 g ceftriaxone i.v. daily with 3 doses of 1 g cefotaxime i.v. daily for obstetric and gynecologic infections. Both agents are characterized by a wide spectrum and potent activity. Furthermore, ceftriaxone has an outstanding serum half-life of 8 h. 41 patients with pelvic inflammatory disease, pelvic or wound infections after vaginal or abdominal hysterectomy, endomyometritis and urinary-tract infection were included. Patients were monitored clinically by routine laboratory methods (erythrocyte sedimentation rate, white blood cell count and cross-reacting protein) and bacteriologically. Clinical parameters of infection were fever, local pain and/or tenderness, a sactosalpinx or pyosalpinx at palpation and cervical secretion. Clinical cure was achieved in 77.3% in the ceftriaxone and in 78.9% in the cefotaxime group, improvement in 3 (13.6%) and 4 patients (21.0%), respectively. 2 clinical failures were seen in the ceftriaxone group. One was a severe pelvic infection following vaginal hysterectomy, which responded to the addition of metronidazole, the other was due to a chlamydial salpingitis, which was cured with a 10-day course of doxycycline. Both antibiotics were well tolerated. Our results suggest that for obstetric and gynecologic infections a single 1-gram dose of ceftriaxone is equally effective as three 1-gram doses of cefotaxime.

Topics: Cefotaxime; Ceftriaxone; Endometritis; Escherichia coli Infections; Female; Humans; Hysterectomy; Pelvic Inflammatory Disease; Prospective Studies; Randomized Controlled Trials as Topic; Surgical Wound Infection

One hundred six patients with acute, uncomplicated lower urinary tract infections participated in a randomized study that compared cefixime (one 400-mg tablet once daily) with trimethoprim (160 mg)/sulfamethoxazole (800 mg) (one tablet every 12 hours). Two cefixime recipients and 3 patients given trimethoprim/sulfamethoxazole had courses that were not evaluable for efficacy. At five to nine days post-therapy, 98 percent of the patients in each treatment group had clinical cure and bacteriologic eradication. At four to six weeks post-therapy, 87 percent (34/39) of the cefixime-treated patients and 83 percent (33/40) of those given trimethoprim/sulfamethoxazole had clinical cure and 90 percent (35/39) and 93 percent (37/40) of the patients in the respective treatment groups had bacteriologic eradication. Adverse clinical experiences or changes in the results of laboratory tests were few. Thus, a once-daily dose of cefixime was as safe and as effective as a twice-daily regimen of trimethoprim/sulfamethoxazole.

Topics: Anti-Infective Agents, Urinary; Cefixime; Cefotaxime; Drug Administration Schedule; Escherichia coli Infections; Female; Humans; Klebsiella Infections; Klebsiella pneumoniae; Male; Middle Aged; Randomized Controlled Trials as Topic; Time Factors; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Administration, Oral; Adult; Aged; Aged, 80 and over; Bacteroides fragilis; Bacteroides Infections; Cefotaxime; Colon; Drug Therapy, Combination; Erythromycin; Escherichia coli Infections; Female; Humans; Injections, Intravenous; Male; Middle Aged; Neomycin; Prospective Studies; Random Allocation; Rectum; Surgical Wound Infection

The combination of beta-lactam antibiotics and new quinolones is a form of broad spectrum antibiotic therapy rapidly bactericidal in vitro which could be an alternative to the classical combination of beta-lactam antibiotics and aminoglycosides in the first line treatment of febrile episodes in patients with neutropenia. The treatment of 37 initial febrile episodes (12 cases of septicemia, 7 infectious sites and 38 cases of fever of unknown origin) in 33 neutropenic patients (PMN leucocytes less than 500/mm3) using the combination of a third generation cephalosporin (cefotaxime or ceftazidime) and a new quinolone (pefloxacin) resulted in an 86% immediate success rate (32 cases/37). Results and course during treatment were similar in both groups (cefotaxime or ceftazidime). A second febrile episode occurred in 11 cases (4 superinfections, 2 chest infections, 5 fevers of unknown origin). Clinical acceptability was satisfactory in both groups. Minimal and transient changes in liver function tests were observed in 19% of the successfully treated patients. Study of quantitative aerobic stool cultures revealed the emergence of resistant bacterial strains, essentially Pseudomonas sp. (6 cases). More extensive trials should provide a better view of the role of this new combination in the first line treatment of febrile episodes in the neutropenic patient.

Topics: Agranulocytosis; Anti-Infective Agents; Cefotaxime; Ceftazidime; Drug Evaluation; Drug Therapy, Combination; Escherichia coli Infections; Feces; Fever; Focal Infection; Humans; Leukemia; Neutropenia; Norfloxacin; Pefloxacin; Pseudomonas Infections; Sepsis; Staphylococcal Infections

Rapid eradication of bacteria in bloodstream is critical for the outcome in neonatal bacterial sepsis. Two groups of neonates with E. coli K1 sepsis without purulent meningitis were studied. Group I (n = 14) received cefotaxime IV (100 mg.kg-1 D-1) plus netilmicin (4 mg.kg-1 D-1); group II (n = 8) received amoxicillin/clavulanic acid IV (100/10 mg.kg-1 D-1) plus netilmicin (4 mg.kg-1 D-1). Both groups were identical. For all strains MICs of cefotaxime, amoxicillin/clavulanic acid, netilmicin were less than 0.2, 4 and 1 mg/l respectively. Serum bactericidal activity (SBA) was determined for each patient (peak sample). The SBA was defined as the greatest dilution in which 99,99% of the inoculum was killed. Time-kill curves were performed with 1:16 dilutions of peak serum samples to measure the kinetic of bacterial killing. The minimal bactericidal time of serum (MBTS) was defined as the minimal time required to observe a decrease of more than 4 log CFU/ml of the bacterial inoculum. Samples (10 microliters) were taken at 1 h intervals over a 6 h period and at 24 h for quantitative culture. All patients cured. Median SBA were respectively 1/128 and 1/64 for group I and II. However, mean MBTS for groups I and II were respectively 1.2 h +/- 0.8 and 3.9 h +/- 1.4. Killing was more rapid in group I (p less than 0.01). The MBTS may be a clinically useful adjunctive test when optimal therapy would be expected.

Topics: Amoxicillin; Blood Bactericidal Activity; Cefotaxime; Clavulanic Acids; Drug Therapy, Combination; Escherichia coli Infections; Humans; Infant, Newborn; Netilmicin; Sepsis; Time Factors

Single-dose antibiotic therapy for urinary tract infections in which no underlying structural or neurologic lesions are present holds the promise of greater patient compliance and convenience. We present the results of a study comparing a single intramuscular dose of a long-acting, third-generation cephalosporin, ceftriaxone, with a standard, five-day regimen of trimethoprim-sulfamethoxazole (TMS). Fifty-two patients were entered into the study. After randomization, 26 were assigned to the TMS group and 26 were assigned to the ceftriaxone group. Of the patients who completed the study, 13 of the TMS group had positive cultures at the time of initial presentation, and 20 of the ceftriaxone group had positive cultures. There was no statistical difference between the groups in symptoms of dysuria, hematuria, frequency, flank pain, and nocturia (alpha = .05). The physical parameters of age, blood pressure, pulse, and temperature were similar in the two groups (alpha = .05), as were the types of infecting organisms (alpha = .05). When comparing the two regimens, the ceftriaxone group cure rate (18 of 20, 90%) was not found to be significantly different from that of the TMS-treated control group (13 of 13) (alpha = .05).

Topics: Administration, Oral; Cefotaxime; Ceftriaxone; Drug Combinations; Drug Evaluation; Escherichia coli Infections; Female; Humans; Injections, Intramuscular; Random Allocation; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

In a prospective, randomized, double-blind study, we compared cefotaxime with nafcillin plus tobramycin in the treatment of serious bacterial infections. Of 195 patients with suspected or proven infections who were not neutropenic, definite bacterial infections were identified in 81; 34 of 38 patients given cefotaxime and 26 of 43 given nafcillin plus tobramycin (p less than 0.01) responded to treatment. The difference in response rates occurred primarily in patients with rapidly fatal underlying disease or with an infection outside the urinary tract. A logistic regression analysis showed that treatment with cefotaxime was still associated with a higher response rate after adjusting for several potential confounding factors. Among patients treated for 3 days or more, our criteria for nephrotoxicity were met in 2 of 68 (2.9%) given cefotaxime and 16 of 57 (28.1%) given nafcillin plus tobramycin (p less than 0.001). Prolongation of the prothrombin time and enterococcal colonization did not occur more frequently with cefotaxime. We conclude that cefotaxime may be more effective and less toxic than nafcillin plus tobramycin for patients with serious bacterial infections.

Topics: Adult; Aged; Bacterial Infections; Cefotaxime; Clinical Trials as Topic; Double-Blind Method; Drug Therapy, Combination; Enterobacter; Enterobacteriaceae Infections; Escherichia coli Infections; Female; Humans; Infusions, Parenteral; Kidney Diseases; Male; Middle Aged; Nafcillin; Penicillin Resistance; Prognosis; Pseudomonas Infections; Random Allocation; Tobramycin; Urinary Tract Infections

Seventy-seven patients with acute bacterial infections were treated with ceftriaxone (1 gm administered intravenously every 12 hours). The 58 patients evaluable for efficacy had 60 infections, including 39 of the respiratory tract, 14 of the urinary tract, and seven of soft tissue. Five patients were bacteremic. The mean duration of ceftriaxone treatment was eight days for patients with respiratory and urinary tract infections and 13 days for patients with other types of infections. A satisfactory clinical response occurred in 56 (93%) of the infections. Eighty-four (94%) of the 89 pretherapy pathogens were bacteriologically eradicated. Included were all 19 isolates of Haemophilus influenzae, all 15 of Streptococcus pneumoniae, all 12 of Escherichia coli, 22 of the 23 isolates of other Enterobacteriaceae species, three of five isolates of Pseudomonas aeruginosa, and three of four isolates of Staphylococcus aureus. Two cases of superinfection (one with bacteremia) occurred with P aeruginosa. There were two cases each of reinfection and colonization with Streptococcus faecalis. One patient developed manifestations of culture-documented S pneumoniae meningitis eight hours after the first dose was administered. Peak and trough plasma levels of ceftriaxone were 142 and 64 micrograms/ml. Ceftriaxone achieved therapeutic levels in infected cerebrospinal fluid and in the abscess fluid of selected patients. Adverse effects, which were mild, included diarrhea in 4% of the patients and elevated transaminase levels in 10%.

Topics: Adult; Aged; Alanine Transaminase; Bacterial Infections; Cefotaxime; Ceftriaxone; Clinical Trials as Topic; Connective Tissue Diseases; Diarrhea; Escherichia coli Infections; Female; Haemophilus Infections; Haemophilus influenzae; Humans; Male; Middle Aged; Pneumococcal Infections; Respiratory Tract Infections; Sepsis; Streptococcus pneumoniae; Time Factors; Urinary Tract Infections

The activities of azlocillin, cefotaxime, and amikacin alone and in combination were evaluated in in vitro checkerboard studies, in infected neutropenic mice, and in human volunteers. The combination of cefotaxime plus amikacin was more synergistic in vitro than the others against the Enterobacteriaceae tested, and the combination of azlocillin plus amikacin was more synergistic against Pseudomonas aeruginosa and Staphylococcus aureus. Survival of neutropenic mice infected with Escherichia coli and Klebsiella pneumoniae, respectively, was greater with azlocillin plus amikacin (24 of 40 and 11 of 40) and with cefotaxime plus amikacin (21 of 40 and 17 of 40) than with azlocillin plus cefotaxime (22 of 40 and 3 of 40; P less than 0.05). Median serum bactericidal activity in volunteers receiving these antibiotics alone and in combination was greater than or equal to 1:8 with most agents and with all combinations tested against 10 strains each of E. coli, K. pneumoniae, P. aeruginosa, and S. aureus. These data suggest that clinical trials with combinations of azlocillin or cefotaxime plus amikacin deserve further study in febrile neutropenic patients.

Topics: Amikacin; Animals; Anti-Bacterial Agents; Azlocillin; Cefotaxime; Enterobacteriaceae; Escherichia coli; Escherichia coli Infections; Humans; In Vitro Techniques; Klebsiella; Klebsiella Infections; Mice; Mice, Inbred BALB C; Penicillins; Pseudomonas aeruginosa; Serratia; Staphylococcus aureus

The global increase of antimicrobial resistance (AMR) is a major public health concern. An effective AMR surveillance tool is needed to track the emergence and spread of AMR. Wastewater surveillance has been proposed as a resource-efficient tool for monitoring AMR carriage in the community. Here, we performed genomic surveillance of antimicrobial-resistant Escherichia coli obtained from fecal sludge and sewage in Uganda to gain insights into E. coli epidemiology and AMR burden in the underlying population. Selective media containing different antibiotic combinations (cefotaxime, ciprofloxacin, cefotaxime + ciprofloxacin + gentamicin) were used to obtain antimicrobial-resistant E. coli from fecal sludge and sewage. Short-read sequencing was performed for the obtained isolates, and a subset of isolates (selected from predominant sequence types (STs)) was also subjected to long-read sequencing. Genomic analysis of the obtained E. coli isolates (n = 181) revealed the prevalence of clonal complex 10, including ST167 (n = 43), ST10 (n = 28), ST1284 (n = 17), and ST617 (n = 4), in both fecal sludge and sewage, irrespective of antibiotics used for selection. We also detected global high-risk clones ST1193 (n = 10) and ST131 (n = 2 clade A, n = 3 subclade C1-M27, and n = 1 subclade C2). Diverse AMR determinants, including extended-spectrum β-lactamase genes (mostly bla

Topics: Anti-Bacterial Agents; beta-Lactamases; Cefotaxime; Ciprofloxacin; Escherichia coli; Escherichia coli Infections; Genomics; Humans; Microbial Sensitivity Tests; Plasmids; Sewage; Uganda; Wastewater; Wastewater-Based Epidemiological Monitoring

Whole genome sequencing (WGS) enables detailed characterization of bacteria at single nucleotide resolution. It provides data about acquired resistance genes and mutations leading to resistance. Although WGS is becoming an essential tool to predict resistance patterns accurately, comparing genotype to phenotype with WGS is still in its infancy. Additional data and validation are needed. In this retrospective study, we analysed 234 E. coli isolates from positive blood cultures using WGS as well as microdilution for 11 clinically relevant antibiotics, to compare the two techniques. We performed whole genome sequencing analyses on 234 blood culture isolates (genotype) to detect acquired antibiotic resistance. Minimal inhibitory concentrations (MIC) for E. coli were performed for amoxicillin, cefepime, cefotaxime, ceftazidime, meropenem, amoxicillin/clavulanic acid, piperacillin/tazobactam, amikacin, gentamicin, tobramycin, and ciprofloxacin, using the ISO 20776-1 standard broth microdilution method as recommended by EUCAST (phenotype). We then compared the two methods for statistical 'agreement'. A perfect (100%) categorical agreement between genotype and phenotype was observed for gentamicin and meropenem. However, no resistance to meropenem was observed. A high categorical agreement (> 95%) was observed for amoxicillin, cefepime, cefotaxime, ceftazidime, amikacin, and tobramycin. A categorical agreement lower than 95% was observed for amoxicillin/clavulanic acid, piperacillin/tazobactam, and ciprofloxacin. Most discrepancies occurred in isolates with MICs within ± 1 doubling dilution of the breakpoint and 22.73% of the major errors were samples that tested phenotypically susceptible at higher antibiotic exposure and were therefore considered as 'not resistant'. This study shows that WGS can be used as a valuable tool to predict phenotypic resistance against most of the clinically relevant antibiotics used for the treatment of E. coli bloodstream infections.

Topics: Amikacin; Amoxicillin; Anti-Bacterial Agents; Cefepime; Cefotaxime; Ceftazidime; Ciprofloxacin; Clavulanic Acid; Escherichia coli; Escherichia coli Infections; Genotype; Gentamicins; Humans; Meropenem; Microbial Sensitivity Tests; Phenotype; Piperacillin; Retrospective Studies; Tazobactam; Tobramycin; Whole Genome Sequencing

While most detailed analyses of antibiotic resistance plasmids focus on those found in clinical isolates, less is known about the vast environmental reservoir of mobile genetic elements and the resistance and virulence factors they encode. We selectively isolated three strains of cefotaxime-resistant Escherichia coli from a wastewater-impacted coastal wetland. The cefotaxime-resistant phenotype was transmissible to a lab strain of E. coli after one hour, with frequencies as high as 10

Topics: Anti-Bacterial Agents; beta-Lactamases; Cefotaxime; Escherichia coli; Escherichia coli Infections; Humans; Microbial Sensitivity Tests; Plasmids; Virulence Factors; Wetlands

Urinary tract infection (UTI) is one of the most prevalent infectious diseases with worldwide health threatening. Antimicrobial resistant strains of Escherichia coli (E. coli) are a common cause of UTI which were identified as a treatment challenge. This study aimed to assay the prevalence of common β-lactam resistance genes including bla. The prevalence of resistance genes were 89.6% for bla. This study's results confirmed an explosion of antibiotic resistance amongst E. coli isolates from UTI against β-lactams and fluoroquinolones. Findings explain the necessity of deep changes in quantity and quality of drug resistance diagnosis and antibiotic therapy strategies. More studies are suggested to better and confident evaluations.

Topics: Anti-Bacterial Agents; Aztreonam; beta-Lactam Resistance; beta-Lactamases; Cefotaxime; Ceftazidime; Ciprofloxacin; Escherichia coli; Escherichia coli Infections; Fluoroquinolones; Humans; Iran; Phylogeny; Prevalence; Urinary Tract Infections

In this study, 370 strains of. The overall resistance rate was 82.68%, with the highest rate of methicillin/sulfamethoxazole (55.68%) followed by cefotaxime (46.22%). Multiple resistance rate was 36.74%, 132 strains (35.68%) had extended-spectrum β-lactamase (ESBL) phenotype and 5 strains (1.35%) had insensitivity to the tested carbapenem antibiotics. The resistance of. Substantial proportions of neonatal

Topics: Anti-Bacterial Agents; beta-Lactamases; beta-Lactams; Cefotaxime; China; Escherichia coli; Escherichia coli Infections; Humans; Infant, Newborn; Intensive Care Units, Neonatal; Microbial Sensitivity Tests; Multilocus Sequence Typing

Bacterial infections in COVID-19 patients, especially those caused by multidrug-resistant gram-negative strains, are associated with increased morbidity, hospital stay and mortality. However, there is limited data on the epidemiology of extended-spectrum β-lactamase (ESBL)-producing bacteria in COVID-19 patients. Here, we assessed the prevalence and the factors associated with ESBL-producing gram-negative bacterial (GNB) infections among severely ill COVID-19 patients admitted in Kenyatta National Hospital (KNH), Kenya.. We adopted a descriptive cross-sectional study design for patients admitted between October 2021 and February 2022, purposively recruiting 120 SARS-CoV- 2 infected participants based on clinical presentation. Demographics and clinical characteristics data were collected using structured questionnaires and case report forms. Clinical samples were collected and analyzed by standard microbiological methods in the KNH Microbiology laboratory and the Centre for Microbiology Research, Kenya Medical Research Institute.. GNB infections prevalence was 40.8%, majorly caused by ESBL-producers (67.3%) predominated by Klebsiella pneumoniae (45.5%). Generally, 73% of the ESBL producers harboured our target ESBL genes, mainly CTX-M-type (59%, 17/29) in K. pneumoniae (76.9%, 20/26). GNB harbouring TEM-type (83%, 10/12) and SHV-type (100%, 7/7) genes showed ESBLs phenotypes and inhibitor resistance, mainly involving clavulanate, but most of them remained susceptible to tazobactam (60%, 6/10). SHV-type genes carrying ESBL producers showed resistance to both cefotaxime (CTX) and ceftazidime (CAZ) (K. pneumoniae), CAZ (E. coli) or CTX (E. cloacae complex and K. pneumoniae). About 87% (20/23) of isolates encoding CTX-M-type β-lactamases displayed CTX/ceftriaxone (CRO) resistance phenotype. About 42% of isolates with CTX-M-type β-lactamases only hydrolyzed ceftazidime (CAZ). Isolates with OXA-type β-lactamases were resistant to CTX, CAZ, CRO, cefepime and aztreonam. Patients with comorbidities were 10 times more likely to have an ESBL-producing GNB infection (aOR = 9.86, 95%CI 1.30 - 74.63, p = 0.003).. We report a high prevalence of ESBL-GNB infections in severely ill COVID-19 patients, predominantly due to Klebsiella pneumoniae harbouring CTX-M type ESBL genes. The patient's underlying comorbidities increased the risk of ESBL-producing GNB infection. In COVID-19 pandemic, enhanced systematic and continuous surveillance of ESBL-producing GNB, strict adherence to infection control measures and antimicrobial stewardship policies are warranted in the current study setting.

Topics: Anti-Bacterial Agents; beta-Lactamases; Cefotaxime; Ceftazidime; COVID-19; Cross-Sectional Studies; Escherichia coli; Escherichia coli Infections; Hospitals; Humans; Kenya; Klebsiella Infections; Klebsiella pneumoniae; Microbial Sensitivity Tests; Pandemics; Referral and Consultation

Urinary tract infection (UTI) caused by Escherichia coli is a significant health issue in children. Today especially E.coli O25b/ST131, defined as a pandemic clone, is a serious public health problem due to its high virulence and antimicrobial resistance rates. In this study, a total of 200 (100 first and 100 recurrent UTI-causing) E.coli isolates from urine samples sent to the Ankara University School of Medicine Cebeci Training and Research Hospital Central Laboratory between January and September 2021 with the preliminary diagnosis of UTI in pediatric patients aged three to 18 years were analyzed for antimicrobial resistance rates, phylogenetic group distributions, virulence factor frequencies and whether they belong to the O25b/ST131 clone. It is aimed in this study that, the obtained data will shed light on new studies for diagnosis, treatment and prophylaxis options that can be developed for more effective UTI management by contributing to the surveillance studies in our country. Antimicrobial susceptibility of E.coli isolates identified by conventional methods was evaluated by Kirby-Bauer disc diffusion method and extended spectrum beta-lactamase (ESBL) production was evaluated by double disc synergy test. Polymerase chain reaction (PCR) was used for the investigation of phylogenetic grouping, the O25b/ST131 clone, virulence genes and the molecular level classification of the isolates detected as uropathogenic E.coli (UPEC). Pulsed-field gel electrophoresis (PFGE) was performed with the isolates collected at different times from the same patient. The highest antimicrobial resistance rates observed were against ampicillin (n= 100, 50%), cefazolin (n= 99, 49.5%), trimethoprim-sulfamethoxazole (n= 55, 27.5%), amoxicillin-clavulanic acid (n= 43, 21.5%) and cefotaxime (n= 43, 21.5%). In recurrent UTI agents, resistance rates were higher for cefotaxime (n= 29, 29%), trimethoprim-sulfamethoxazole (n= 35, 35%) and cefepime (n= 25, 25%) and in O25b/ST131 isolates (n= 67) the rates were higher for amikacin (n= 3, 4.5%), gentamicin (n= 10, 14.9%) and ciprofloxacin (n= 17, 25.4%) when compared to the first UTI agents and non-O25b/ ST131 isolates (p< 0.05). It was found that 29% (n = 58) of the isolates were multidrug resistant (MDR) and 19% (n = 38) produced ESBL.The rate of recurrent UTI agents was found to be higher among ESBL producing isolates and/or MDR isolates (n= 36, 62% and n= 27, 71%, respectively, p< 0.05). It was found that 45.5% (n= 91) of the iso

Topics: Anti-Bacterial Agents; Anti-Infective Agents; beta-Lactamases; Cefotaxime; Child; Clone Cells; Escherichia coli; Escherichia coli Infections; Humans; Phylogeny; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Virulence Factors

Piperacillin-tazobactam (TZP) is a frequently prescribed antibiotic in hospital settings. Reports suggest in vivo efficacy of TZP, despite in vitro resistance of isolates susceptible to cephalosporins. Escherichia coli (E. coli) isolates hyperproducing TEM-1 β-lactamase possess this phenotype. This study investigated the influence of tazobactam (TAZ) concentration on piperacillin (PIP) inhibition of such isolates and compared the in vivo efficacy of TZP with cefotaxime (CTX) in an infection model.. The PIP MICs for E. coli isolates, either hyperproducing TEM-1 because of promoter substitutions (n = 4) or because of gene amplification (n = 2) or producing an inhibitor-resistant TEM-35 (IRT) (n = 1), were determined using increasing concentrations of TAZ in a checkerboard setup. Furthermore, the efficacy of TZP and CTX against the isolates was investigated in a mouse peritonitis model using antibiotic exposures mimicking human conditions. Isolates producing either OXA-48 or CTX-M-15 β-lactamases were included as controls.. Using TAZ concentrations ≤ 64 mg/L, one isolate hyperproducing TEM-1 had a PIP MIC of 8 at TAZ 16 mg/L and two additional isolates at TAZ 64 mg/L. In the mouse peritonitis infection model, reduction of bacterial load in the peritoneum was larger for TZP than CTX only for the CTX-M-15-producing isolate. Larger reductions in bacterial load were observed after CTX treatment than TZP treatment for seven of the eight remaining test isolates.. Piperacillin-tazobactam treatment of E. coli isolates hyperproducing TEM-1 was less effective than CTX treatment and may, for some isolates, be comparable with TZP treatment of isolates producing established resistance markers as IRT or OXA-48.

Topics: Animals; Anti-Bacterial Agents; Antigens, CD; beta-Lactamases; Cefotaxime; Escherichia coli; Escherichia coli Infections; Mice; Microbial Sensitivity Tests; Neoplasm Proteins; Peritonitis; Piperacillin; Piperacillin, Tazobactam Drug Combination; Tazobactam

In the Netherlands, antimicrobial resistance (AMR) is monitored in commensal indicator Escherichia coli from healthy broilers at slaughter as part of a European monitoring programme. In a separate programme for poultry health, AMR is monitored in veterinary pathogens from diseased broilers. So far, it is unknown how the outcomes of these two AMR monitoring approaches in the same animal population are associated.. This study aims to investigate the association between the outcomes of monitoring non-wildtype susceptibility (using epidemiological cut-off values, ECOFF, as prescribed by EU legislation) in commensal E. coli isolated from healthy broilers (i.e. active surveillance) with the outcomes of monitoring clinical resistance (using clinical breakpoints, to determine susceptibility for antibiotic treatment in veterinary practice) in E. coli isolated from diseased broilers (i.e. passive surveillance).. Data acquired by broth microdilution was analysed for commensal indicator E. coli and clinical E. coli from the Netherlands, 2014-2019. A generalized linear multivariable model (Poisson regression) was used to determine time trends and identify differences in mean resistant proportions.. Observed resistant proportions of the monitored commensal E. coli and clinical E. coli were similar with overlapping confidence intervals for most time points for ampicillin, gentamicin, cefotaxime, tetracycline, colistin and trimethoprim/sulfonamide. The statistical analysis showed that only for cefotaxime and tetracycline, mean resistant proportions were different. In commensal E. coli, a decrease of resistant proportions over time was observed, except for gentamicin. In clinical E. coli, no time trend was detected in resistant proportions, except for cefotaxime and colistin.. Generally, the resistant proportions monitored in commensal and clinical E. coli were similar. However, some relevant differences were found, which can be explained by the type of monitoring approach, i.e. active or passive surveillance. The random sample of commensal E. coli isolated from healthy animals (active surveillance), was more suitable to monitor AMR time trends. The sample of clinical isolates from diseased animals (passive surveillance), resulted in a higher chance to detect low-prevalent resistance: i.e. cefotaxime and colistin. The clinical E. coli data showed more fluctuation over time, and data from a longer period of time would be needed to determine the association. This study shows the value of both an active and a passive surveillance component for AMR monitoring.

Topics: Animals; Anti-Bacterial Agents; Cefotaxime; Chickens; Colistin; Drug Resistance, Bacterial; Escherichia coli; Escherichia coli Infections; Gentamicins; Microbial Sensitivity Tests; Tetracyclines

Topics: Animals; Anti-Bacterial Agents; Anti-Infective Agents; Bacterial Proteins; beta-Lactamases; Cefotaxime; Escherichia coli; Escherichia coli Infections; Goats; Jordan; Milk; Sheep

Topics: Ampicillin; Animals; Anti-Bacterial Agents; beta-Lactam Resistance; beta-Lactamases; Biofilms; Cefotaxime; Dogs; Escherichia coli; Escherichia coli Infections; Humans; Livestock; Molecular Docking Simulation; Phylogeny; Sheep

Topics: Amoxicillin; Anti-Bacterial Agents; beta-Lactamases; Carbapenems; Cefotaxime; Ceftazidime; Ciprofloxacin; Clavulanic Acid; Escherichia coli; Escherichia coli Infections; Escherichia coli Proteins; Extraintestinal Pathogenic Escherichia coli; Gentamicins; Hospitals; Humans; Iron; Mozambique; Piperacillin; Tazobactam; Trimethoprim, Sulfamethoxazole Drug Combination

Fosfomycin has become a therapeutic option in urinary tract infections. Our objective was to evaluate the in vitro activity of fosfomycin against Escherichia coli isolated from urine samples in 2013, 2018 and 2021. We also determined a putative association between fosfomycin resistance and extended-spectrum β-lactamases (ESBL) production. Fosfomycin activity was evaluated against 7367, 8128 and 5072 Escherichia coli urinary isolates in 2013, 2018 and 2021, respectively. We compare the prevalence of fosfomycin-resistant strains among the ESBL- and non-ESBL-producing isolates. MICs of fosfomycin, cefotaxime, and cefotaxime-clavulanate were determined by a microdilution method. 302 ESBL-producers were selected to determine MICs of fosfomycin by agar dilution and genes encoding ESBLs were detected by PCR. Among the total of ESBL-producing strains, 14.3%, 20.8% and 20% were resistant to fosfomycin in 2013, 2018 and 2021, respectively, whereas fosfomycin resistance in non-ESBL producers was 3.5%, 4.05% and 5.53% for each year (P ≤ 0.001). In the 302 selected ESBL-producing isolates, CTX-M was the main ESBL (228 isolates), being 50.7% CTX-M-15. Resistance to fosfomycin among these ESBL-producing strains was associated (P = 0.049) with isolates that produced the CTX-M type. Our data show that fosfomycin resistance is increasing in Escherichia coli urinary isolates and it is related to ESBL-production. A follow-up of fosfomycin resistance is required.

Topics: Anti-Bacterial Agents; beta-Lactamases; Cefotaxime; Escherichia coli; Escherichia coli Infections; Fosfomycin; Humans; Microbial Sensitivity Tests; Urinary Tract Infections

Escherichia coli is a common pathogen causing invasive bacterial infections in neonates. In recent years, clinical antimicrobial susceptibility testing has demonstrated an increased rate of drug-resistant E. coli infections. This study aimed to analyse the resistance characteristics of E. coli against common antimicrobial agents, and perform multilocus sequence typing (MLST) in clinical strains of E. coli collected from Chinese neonates.. Culture-positive specimens of E. coli were collected from neonates in seven class A tertiary hospitals located in seven cities across different provinces in China between November 2019 and October 2020. E. coli isolated from these specimens were subjected to antimicrobial susceptibility testing (by broth microdilution method), extended-spectrum β-lactamase (ESBL) detection, and MLST.. A total of 223 E. coli strains were isolated, with an overall resistance rate of 87.4%, an ESBL-positive rate of 48.0%, and a multidrug resistance rate of 42.2%. Among the 20 antimicrobial agents tested, E. coli strains showed the highest resistance rates against cefotaxime (59.2%), trimethoprim/sulfamethoxazole (56.5%), doxycycline (39.9%), ciprofloxacin (36.8%), and aztreonam (31.0%). The resistance rates of E. coli strains isolated from children's hospitals against piperacillin/tazobactam, cefotaxime, ciprofloxacin, trimethoprim/sulfamethoxazole, and carbapenems, were significantly higher than those of strains isolated from maternity and child health hospitals. The primary E. coli multilocus sequence types were ST1193, ST95, ST73, ST410, and ST131. The ESBL production rates and multidrug resistance rates of ST1193, ST410, and ST131 were significantly higher than those of ST95 and ST73. Significantly, more strains of E. coli ST1193 and ST410 were isolated from children's hospitals than from maternity and child health hospitals.. The rates of antimicrobial agent resistance in E. coli isolates from hospitalised neonates in China were high. The increased number of strains of E. coli ST1193 and ST410 was the reason for higher resistance rates to multiple antimicrobial agents in E. coli from children's hospitals compared with those from maternal and child health hospitals.

Topics: Anti-Bacterial Agents; Aztreonam; beta-Lactamases; Carbapenems; Cefotaxime; Child; Ciprofloxacin; Doxycycline; Drug Resistance; Escherichia coli; Escherichia coli Infections; Female; Humans; Infant, Newborn; Microbial Sensitivity Tests; Multilocus Sequence Typing; Piperacillin; Pregnancy; Tazobactam; Tertiary Care Centers; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Animals; Anti-Bacterial Agents; beta-Lactamases; Cefotaxime; Cephalosporins; Drug Resistance, Bacterial; Escherichia coli; Escherichia coli Infections; Humans; Japan; Microbial Sensitivity Tests; Monobactams; Raccoon Dogs

Epidemiological data of cephalosporin-resistant Enterobacterales in Sub-Saharan Africa is still restricted, and in particular in Mozambique. The aim of this study was to detect and characterize extended-spectrum β-lactamase (ESBL) - and plasmid-mediated AmpC (pAmpC)-producing clinical strains of Escherichia coli at Maputo Central Hospital (MCH), a 1000-bed reference hospital in Maputo, Mozambique.. A total of 230 clinical isolates of E. coli from urine (n = 199) and blood cultures (n = 31) were collected at MCH during August-November 2015. Antimicrobial susceptibility testing was performed by the disc diffusion method and interpreted according to EUCAST guidelines. Isolates with reduced susceptibility to 3rd generation cephalosporins were examined further; phenotypically for an ESBL-/AmpC-phenotype by combined disc methods and genetically for ESBL- and pAmpC-encoding genes by PCR and partial amplicon sequencing as well as genetic relatedness by ERIC-PCR.. A total of 75 isolates with reduced susceptibility to cefotaxime and/or ceftazidime (n = 75) from urine (n = 58/199; 29%) and blood (n = 17/31; 55%) were detected. All 75 isolates were phenotypically ESBL-positive and 25/75 (33%) of those also expressed an AmpC-phenotype. ESBL-PCR and amplicon sequencing revealed a majority of bla. We have observed a high prevalence of MDR pAmpC- and/or ESBL-producing clinical E. coli isolates with FOX/MOX and CTX-Ms as the major β-lactamase types, respectively. ERIC-PCR analyses revealed genetic diversity and some clusters indicating within-hospital spread. The overall findings strongly support the urgent need for accurate and rapid diagnostic services to guide antibiotic treatment and improved infection control measures.

Topics: Anti-Bacterial Agents; Bacterial Proteins; beta-Lactamases; Cefotaxime; Ceftazidime; Cross Infection; Drug Resistance, Multiple, Bacterial; Escherichia coli; Escherichia coli Infections; Humans; Microbial Sensitivity Tests; Mozambique; Phenotype; Plasmids; Prevalence

Recent findings on Antibiotic Resistance (AR) have brought renewed attention to the comparison of data on AR from human and animal sectors. This is however a major challenge since the data is not harmonized. This study performs a comparative analysis of data on resistance combinations in Escherichia coli (E. coli) from different routine surveillance and monitoring systems for human and different animal populations in Germany. Data on E. coli isolates were collected between 2014 and 2017 from human clinical isolates, non-clinical animal isolates from food-producing animals and food, and clinical animal isolates from food-producing and companion animals from national routine surveillance and monitoring for AR in Germany. Sixteen possible resistance combinations to four antibiotics-ampicillin, cefotaxime, ciprofloxacin and gentamicin-for these populations were used for hierarchical clustering (Euclidian and average distance). All analyses were performed with the software R 3.5.1 (Rstudio 1.1.442). Data of 333,496 E. coli isolates and forty-one different human and animal populations were included in the cluster analysis. Three main clusters were detected. Within these three clusters, all human populations (intensive care unit (ICU), general ward and outpatient care) showed similar relative frequencies of the resistance combinations and clustered together. They demonstrated similarities with clinical isolates from different animal populations and most isolates from pigs from both non-clinical and clinical isolates. Isolates from healthy poultry demonstrated similarities in relative frequencies of resistance combinations and clustered together. However, they clustered separately from the human isolates. All isolates from different animal populations with low relative frequencies of resistance combinations clustered together. They also clustered separately from the human populations. Cluster analysis has been able to demonstrate the linkage among human isolates and isolates from various animal populations based on the resistance combinations. Further analyses based on these findings might support a better one-health approach for AR in Germany.

Topics: Animals; Anti-Bacterial Agents; Cefotaxime; Ciprofloxacin; Cluster Analysis; Drug Resistance, Bacterial; Escherichia coli; Escherichia coli Infections; Germany; Humans; Microbial Sensitivity Tests; Poultry; Swine

A large number of antimicrobials are used for the treatment of bacterial infections, and the emergence of antimicrobial-resistant Escherichia coli (E. coli) in livestock and the transfer of resistant isolates to humans poses a serious potential risk to public health. In particular, broiler parent stock produce thousands of eggs for commercial broiler chickens and can transfer antimicrobial-resistant bacteria and drug-resistance genes to chicks. This study was conducted to investigate the prevalence and characteristics of third-generation cephalosporin-resistant and extended-spectrum β-lactamases (ESBL)-producing E. coli isolated from the broiler parent stock in Korea. Among 51 cefotaxime-resistant E. coli isolates, 45 (88.2%) isolates were identified as multidrug resistant and 21 isolates showed phenotypic and genotypic characteristics of CTX-M-producing E. coli. The CTX-M genes CTX-M-14, CTX-M-15, CTX-M-1, and CTX-M-1 were detected in 10, 7, 3, and 1 isolates, respectively. ISEcp1 or IS26 + ISEcp1 were identified upstream of all CTX-M-type genes, and orf477 and IS903 were detected downstream of 9 and 10 CTX-M-type genes, respectively. Thirteen (61.9%) of the 21 CTX-M-producing E. coli isolates harbored class 1 integrons with 4 different gene cassette arrangements. Among the plasmid replicons, CTX-M-1 was located on I1, F, and FIB; CTX-M-14 on F and FII; CTX-M-15 on FII, FIA, and FIB; and CTX-M-65 on FIB. This is the first study to investigate the presence and distribution of third-generation cephalosporin-resistant and CTX-M-producing E. coli isolated from the broiler parent stock level in Korea, and the results indicate that comprehensive surveillance and persistent monitoring systems in broiler parent stock farms are necessary to prevent the dissemination of resistant isolates.

Topics: Animals; Anti-Bacterial Agents; beta-Lactamases; Cefotaxime; Chickens; Drug Resistance, Microbial; Escherichia coli; Escherichia coli Infections; Feces; Ovum; Poultry Diseases; Republic of Korea

Escherichia coli (E. coli) is an indicator of antimicrobial resistance, and some strains of E. coli cause infectious diseases. E. coli sequence type 131 (ST131) - a global antimicrobial-resistant pandemic E. coli clone - is frequently detected in clinical specimens. Antimicrobial-resistant bacteria are monitored via national surveillance in clinical settings; however, monitoring information in non-clinical settings is limited. This study elucidated antimicrobial resistance trends of E. coli and dissemination of ST131 among healthy people in non-clinical settings.. This study collected 517 E. coli isolates from healthy people in Osaka, Japan, between 2013 and 2019. It analysed antimicrobial susceptibility of the isolates and detected the bla and mcr genes in ampicillin-resistant and colistin-resistant isolates, respectively, and the ST131 clone.. Antimicrobial resistance rates of the bacteria isolated from healthy people in non-clinical settings were lower than for those in clinical settings. The resistance of the isolates to cefotaxime (4.4%) and ciprofloxacin (13.5%) gradually increased during the study period. In 23 cefotaxime-resistant isolates, the most frequent bla genes belonged to the bla. Both ciprofloxacin resistance and O25b-ST131 clone frequency increased during the study period. Antimicrobial-resistant bacteria gradually spread in healthy people in non-clinical settings; one reason behind this spread was dissemination of global antimicrobial-resistant pandemic clones.

Topics: Ampicillin; Anti-Bacterial Agents; beta-Lactamases; Carrier State; Cefotaxime; Ciprofloxacin; Colistin; DNA, Bacterial; Drug Resistance, Multiple, Bacterial; Epidemiological Monitoring; Escherichia coli; Escherichia coli Infections; Escherichia coli Proteins; Feces; Humans; Japan; Microbial Sensitivity Tests; Polymerase Chain Reaction; Prevalence

Cefotaxime (CTX) is a third-generation cephalosporin (3GC) commonly used to treat infections caused by

Topics: Anti-Bacterial Agents; Bacterial Proteins; beta-Lactamases; Cefotaxime; Drug Resistance, Bacterial; Escherichia coli; Escherichia coli Infections; Genome, Bacterial; Heteroplasmy; Humans; Microbial Sensitivity Tests; Mutation; Plasmids; Promoter Regions, Genetic

Third-generation cephalosporin-resistant Escherichia coli from community-acquired urinary tract infections are increasingly reported worldwide. We sought to determine and characterize the mechanisms of cefotaxime resistance employed by urinary E. coli obtained from primary care, over 12 months, in Bristol and surrounding counties in South-West England.. Cefalexin-resistant E. coli isolates were identified from GP-referred urine samples using disc susceptibility testing. Cefotaxime resistance was determined by subsequent plating onto MIC breakpoint plates. β-Lactamase genes were detected by PCR. WGS was performed on 225 isolates and analyses were performed using the Center for Genomic Epidemiology platform. Patient information provided by the referring general practices was reviewed.. Cefalexin-resistant E. coli (n=900) isolates were obtained from urines from 146 general practices. Following deduplication by patient approximately 69% (576/836) of isolates were cefotaxime resistant. WGS of 225 isolates identified that the most common cefotaxime-resistance mechanism was blaCTX-M carriage (185/225), followed by plasmid-mediated AmpCs (pAmpCs) (17/225), AmpC hyperproduction (13/225), ESBL blaSHV variants (6/225) or a combination of both blaCTX-M and pAmpC (4/225). Forty-four STs were identified, with ST131 representing 101/225 isolates, within which clade C2 was dominant (54/101). Ciprofloxacin resistance was observed in 128/225 (56.9%) of sequenced isolates, predominantly associated with fluoroquinolone-resistant clones ST131 and ST1193.. Most cefalexin-resistant E. coli isolates were cefotaxime resistant, predominantly caused by blaCTX-M carriage. The correlation between cefotaxime resistance and ciprofloxacin resistance was largely attributable to the high-risk pandemic clones ST131 and ST1193. Localized epidemiological data provide greater resolution than regional data and can be valuable for informing treatment choices in the primary care setting.

Topics: Aged; Anti-Bacterial Agents; Bacterial Proteins; beta-Lactamases; Cefotaxime; Community-Acquired Infections; Drug Resistance, Bacterial; England; Escherichia coli; Escherichia coli Infections; Female; Humans; Male; Middle Aged; Multilocus Sequence Typing; Primary Health Care; Urinary Tract Infections; Whole Genome Sequencing

To determine the prevalence of Escherichia coli STs and associated resistance mechanisms carried by the community in North-East India.. E. coli (108) were isolated from sewage collected from 19 sites across the city of Silchar by plating on MacConkey agar with/without selection (50 mg/L cefotaxime). Species identification was confirmed by MALDI-TOF MS for 82 isolates. Common resistance mechanisms were determined by WGS of pooled E. coli isolates. PFGE combined with specific probes determined the presence of common resistance mechanisms in all isolates. Phylotypes, multilocus STs, core-genome multilocus STs, resistance genes and virulence genes were determined by in silico analysis of 38 genomes.. Analysis of isolates collected without selection (n=33) indicated that cefotaxime resistance in E. coli was 42% (14/33) and estimated meropenem resistance at 9%. The remaining 58% (19/33) were additionally susceptible to ampicillin, trimethoprim, ciprofloxacin and aminoglycosides. The most common ST among the cefotaxime-resistant E. coli was ST167 (29%), followed by ST410 (17%) and ST648 (10%). E. coli ST131 was absent from the collection. Sixty-three isolates were resistant to cefotaxime and harboured blaCTX-M-15 [54% (34/63)] or blaCMY-42 [46% (29/63)], of which 10% (6/63) harboured both genes. Carbapenem resistance was due to blaNDM-5, found in 10/63 cefotaxime-resistant isolates, and/or blaOXA-181, found in 4/63 isolates. NDM-5 was encoded by IncX3 and/or IncFII plasmids and CMY-42 was mostly encoded by IncI plasmids. NDM-5 appears to have replaced NDM-1 in this region and CMY-42 appears to be in the process of replacing CTX-M-15.

Topics: Anti-Bacterial Agents; Bacterial Proteins; beta-Lactamases; Carrier State; Cefotaxime; Drug Resistance, Multiple, Bacterial; Electrophoresis, Gel, Pulsed-Field; Escherichia coli; Escherichia coli Infections; Genome, Bacterial; Humans; India; Microbial Sensitivity Tests; Multilocus Sequence Typing; Phylogeny; Prevalence; Sewage

Topics: Abattoirs; Animals; Anti-Bacterial Agents; Bacterial Proteins; beta-Lactamases; Cefotaxime; Chickens; Culture Media; Drug Resistance, Multiple, Bacterial; Escherichia coli; Escherichia coli Infections; Farmers; Genotype; Humans; Intestines; Italy; Poultry Diseases; Prevalence

Emerging virulent and antibiotic-resistant pathogens present a global public health risk. Routine monitoring of prevalence within the clinical, environmental and food production setting is vital. Quantitative real-time PCR (qPCR) coupled with melting curve analysis can rapidly and accurately characterize pathogens. We evaluated commercial qPCR mixes based on SYBR Green l and EvaGreen for developing an assay for simultaneously detecting antibiotic resistance (extended-spectrum beta-lactamase, ESBL and bla

Topics: Anti-Bacterial Agents; beta-Lactamases; Cefotaxime; Drug Resistance, Bacterial; Escherichia coli; Escherichia coli Infections; Escherichia coli Proteins; Foodborne Diseases; Fresh Water; Humans; Nucleic Acid Denaturation; Real-Time Polymerase Chain Reaction; Vegetables; Virulence

Shiga toxin-producing Escherichia coli (STEC) is a major source of food-borne illness around the world. E. coli O157 has been widely reported as the most common STEC serogroup and has emerged as an important enteric pathogen. Cattle, in particular have been identified as a major E. coli O157:H7 reservoir of human infections; however, the prevalence of this organism in camels, sheep, and goats is less understood. The aim of this study was to evaluate the occurrence and concentration of E. coli serotype O157 in the feces of healthy camels (n = 140), cattle (n = 137), sheep (n = 141) and goats (n = 150) slaughtered in United Arab Emirates (UAE) for meat consumption between September 2017 and August 2018. We used immunomagnetic separation coupled with a culture-plating method to detect E. coli O157. Non-sorbitol fermenting colonies were assessed via latex-agglutination testing, and positive cultures were analyzed by performing polymerase chain reactions to detect genes encoding attaching and effacing protein (eaeA), hemolysin A (hlyA, also known as ehxA) and Shiga toxin (stx1 and stx2), and E. coli O157:H7 specific genes (rfb O157, uidA, and fliC). All E. coli O157 isolates were analyzed for their susceptibility to 20 selected antimicrobials.. E. coli O157 was observed in camels, goats, and cattle fecal samples at abundances of 4.3, 2, and 1.46%, respectively, but it was undetectable in sheep feces. The most prevalent E. coli O157 gene in all STEC isolates was stx. To our knowledge, this is the first report on the occurrence of E. coli O157 in slaughter animals in the UAE. Our results clearly demonstrate the presence of E. coli O157 in slaughtered animals, which could possibly contaminate meat products intended for human consumption.

Topics: Animals; Anti-Bacterial Agents; Camelus; Cattle; Cefotaxime; Chloramphenicol; Ciprofloxacin; Escherichia coli Infections; Escherichia coli Proteins; Feces; Female; Food Microbiology; Goats; Male; Microbial Sensitivity Tests; Norfloxacin; Polymyxin B; Prevalence; Ruminants; Sheep; Shiga-Toxigenic Escherichia coli; United Arab Emirates; Virulence Factors

In recent decades, the number of studies on the occurrence of resistant strains in wildlife animals has increased significantly, but data are still fragmentary. The aim of this study was to evaluate drug resistance of

Topics: Ampicillin; Animals; Anti-Bacterial Agents; beta-Lactamases; Cefotaxime; Chloramphenicol; Drug Resistance, Multiple, Bacterial; Epidemiological Monitoring; Escherichia coli; Escherichia coli Infections; Ferrets; Gene Expression; Genes, Bacterial; Kanamycin; Microbial Sensitivity Tests; Mink; Mustelidae; Nalidixic Acid; Plasmids; Poland; Raccoon Dogs; Streptomycin; Sulfamethoxazole; Tetracycline

In this visual case of Strongyloides stercoralis disseminated infection with Enterobacteriaceae-related invasive infection, we demonstrated the in-host S. stercoralis circulation with DNA found in different fluids and specimens, but also in cerebrospinal fluid (CSF), supporting the role of migrant larvae in the Enterobacteriaceae-related invasive and central nervous system infection.

Topics: Aged; Animals; Anti-Bacterial Agents; Anti-HIV Agents; Antiparasitic Agents; Cefotaxime; DNA, Protozoan; Escherichia coli; Escherichia coli Infections; Feces; Ganciclovir; HIV Infections; Humans; Ivermectin; Male; Strongyloides stercoralis; Strongyloidiasis

Small-scale farming may have large impacts on the selection and spread of antimicrobial resistance to humans. We conducted an observational study to evaluate antibiotic-resistant

Topics: Agriculture; Animals; Anti-Bacterial Agents; beta-Lactam Resistance; beta-Lactamases; Cefotaxime; Chickens; Drug Resistance, Multiple, Bacterial; Ecuador; Escherichia coli; Escherichia coli Infections; Escherichia coli Proteins; Gene Expression; Humans; Microbial Sensitivity Tests; Poultry; Poultry Diseases; Prevalence

Topics: Animals; Animals, Suckling; Anti-Infective Agents; Bacterial Shedding; beta-Lactamases; Cattle; Cefotaxime; Czech Republic; Escherichia coli; Escherichia coli Infections; Farms; Feces; Female; Mastitis, Bovine; Plasmids; Virulence Factors; Whole Genome Sequencing

Sequence type 1193 (ST1193) is a new emerging global clone of Escherichia coli. The main goal of this study was to determine the prevalence and molecular characteristics of ST1193 among clinical isolates of extended-spectrum β-lactamase (ESBL)-producing E. coli from University Hospital of Erlangen, Germany.. Between November 2015 and February 2016, all consecutive non-duplicate clinical E. coli isolates showing resistance to cefotaxime or ceftazidime were further analysed for ESBL production by the combined disk method. ESBL genes were identified by PCR and sequencing. Bacterial strain typing was performed by PCR-based phylogrouping, MLST and whole-genome sequencing.. ESBL production was confirmed in 51 isolates. The globally dominant ST131 occurred at a frequency of 37.3% (n=19). Major non-ST131 sequence types were ST38 (n=4; 7.8%), ST10 (n=3; 5.9%) and ST1193 (n=3; 5.9%). Among the ESBL-producing E. coli ST1193, two expressed CTX-M-14 and one expressed CTX-M-15 ESBL type. All three ST1193 isolates belonged to serogroup O75:H5, phylogroup B2, and harboured IncFIA and IncFIB plasmids and the virulence factors genes iha, sat, gad, vat and senB. Moreover, they showed ciprofloxacin resistance and exhibited a set of four conserved mutations defining quinolone resistance (gyrA S83L, gyrA D87N, parC S80I and parC L416F).. This study revealed for the first time in Germany the occurrence of ST1193 among clinical isolates of ESBL-producing E. coli. Further national or regional multicentre studies are needed to assess the effective relevance of ESBL-producing E. coli ST1193 as a nosocomial pathogen in Germany.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; beta-Lactamases; Cefotaxime; Ceftazidime; Child; Child, Preschool; Ciprofloxacin; Drug Resistance, Multiple, Bacterial; Escherichia coli; Escherichia coli Infections; Escherichia coli Proteins; Female; Germany; Humans; Infant; Infant, Newborn; Male; Microbial Sensitivity Tests; Middle Aged; Molecular Epidemiology; Multilocus Sequence Typing; Plasmids; Polymerase Chain Reaction; Prevalence; Quinolones; Serogroup; Virulence Factors; Young Adult

Antimicrobial resistance (AR) is a worldwide concern. Up to a 160% increase in antibiotic usage in food animals is expected in Latin American countries. The poultry industry is an increasingly important segment of food production and contributor to AR. The objective of this study was to evaluate the prevalence, AR patterns and the characterization of relevant resistance genes in Extended Spectrum β-lactamases (ESBL) and AmpC-producing E. coli from large poultry farms in Ecuador. Sampling was performed from June 2013 to July 2014 in 6 slaughterhouses that slaughter broilers from 115 farms totaling 384 flocks. Each sample of collected caeca was streaked onto TBX agar supplemented with cefotaxime (3 mg/l). In total, 176 isolates were analyzed for AR patterns by the disk diffusion method and for blaCTX-M, blaTEM, blaCMY, blaSHV, blaKPC, and mcr-1 by PCR and sequencing. ESBL and AmpC E. coli were found in 362 flocks (94.3%) from 112 farms (97.4%). We found that 98.3% of the cefotaxime-resistant isolates were multi-resistant to antibiotics. Low resistance was observed for ertapenem and nitrofurantoin. The most prevalent ESBL genes were the ones belonging to the blaCTX-M group (90.9%), specifically the blaCTX-M-65, blaCTX-M-55 and blaCTX-M-3 alleles. Most of the AmpC strains presented the blaCMY-2 gene. Three isolates showed the mcr-1 gene. Poultry production systems represent a hotspot for AR in Ecuador, possibly mediated by the extensive use of antibiotics. Monitoring this sector in national and regional plans of AR surveillance should therefore be considered.

Topics: Animals; beta-Lactam Resistance; Cefotaxime; Chickens; Ecuador; Escherichia coli; Escherichia coli Infections; Escherichia coli Proteins; Poultry Diseases

Topics: Animals; Anti-Bacterial Agents; Bacterial Proteins; beta-Lactamases; Cattle; Cattle Diseases; Cefotaxime; Cefoxitin; Clavulanic Acid; Dairying; Drug Resistance, Multiple, Bacterial; Escherichia coli; Escherichia coli Infections; Feces; Female; Netherlands; Prevalence

The spread of extended-spectrum β-lactamases (ESBLs) in Escherichia coli is a major public health issue and ESBL-producing bacteria are frequently reported in livestock. For the assessment of the role of the foodborne transmission pathway in Germany, detailed data on the prevalence and characteristics of isolates of food origin are necessary. The objective of this study was to describe the prevalence of cefotaxime resistant E. coli as well as ESBL/pAmpC-producing E. coli and their characteristics in foods in Germany. Out of 2256 food samples, the highest prevalence of cefotaxime resistant E. coli was observed in chicken meat (74.9%), followed by turkey meat (40.1%). Prevalence in beef, pork and minced meat was considerably lower (4.2-15.3%). Whereas 18.0% of the raw milk samples, collected at farm level were positive, this was true only for few cheese samples (1.3%). In one out of 399 vegetable samples a cefotaxime-resistant E. coli was isolated. ESBL resistance genes of the CTX-M-group (10.1% of all samples) were most frequently detected, followed by genes of the pAmpC (2.6%), SHV (2.0%) and TEM (0.8%) families. Distribution of ESBL/AmpC-encoding E. coli resistance genes and E. coli phylogroups was significantly different between the chicken related food samples and all other food items. Our study results reflect that consumers might get exposed to ESBL/pAmpC-producing E. coli through several food chains. These results together with those collected at primary production and in the human population in other studies will allow more detailed analysis of the foodborne pathways, considering transmission from livestock populations to food at retail and to consumers in Germany.

Topics: Animals; Anti-Bacterial Agents; Bacterial Proteins; beta-Lactamases; Cefotaxime; Drug Resistance, Bacterial; Escherichia coli; Escherichia coli Infections; Escherichia coli Proteins; Food Microbiology; Germany; Livestock; Meat; Poultry; Prevalence; Red Meat; Vegetables

A rapid and highly sensitive ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) assay was developed for quantification of 7 antibiotics in low sample volumes (50 μL): amoxicillin, azithromycin, cefotaxime, ciprofloxacin, meropenem, metronidazole and piperacillin, for both routine monitoring and pharmacokinetic studies. After protein precipitation by acetonitrile, the antibiotics were separated on an Acquity UPLC HSS T3 column (run time, 4 min). The mobile phase consisted of a mixture of (A) ammonium acetate (pH 2.4; 5 mM) and (B) acetonitrile acidified with 0.1% formic acid, delivered at 500 μl/min in a gradient elution mode. Total time run was 2.75 min. Ions were detected in the turbo-ion-spray-positive and multiple-reaction-monitoring modes. The assay was accurate and reproductible for the quantification of the seven antibiotics in serum samples over large concentration ranges.

Topics: Adolescent; Amoxicillin; Anti-Bacterial Agents; Azithromycin; Blood Chemical Analysis; Calibration; Cefotaxime; Child; Child, Preschool; Chromatography, High Pressure Liquid; Ciprofloxacin; Escherichia coli Infections; Humans; Infant; Infant, Newborn; Leukemia, Myeloid, Acute; Limit of Detection; Male; Meropenem; Metronidazole; Pediatrics; Piperacillin; Reproducibility of Results; Tandem Mass Spectrometry

Topics: Cefotaxime; Cefpodoxime; Ceftizoxime; Drug Resistance, Multiple, Bacterial; Escherichia coli; Escherichia coli Infections; Microbial Sensitivity Tests; Multilocus Sequence Typing; Sewage; Wastewater; Whole Genome Sequencing

The incidence of infections caused by antimicrobial-resistant Enterobacteriaceae in Thailand is increasing and human intestinal flora is an important reservoir for these organisms. This study was carried out to determine the intestinal carriage of bla

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Bacterial Proteins; beta-Lactamases; Cefotaxime; DNA, Bacterial; Drug Resistance, Multiple, Bacterial; Escherichia coli; Escherichia coli Infections; Escherichia coli Proteins; Feces; Female; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Multilocus Sequence Typing; Polymerase Chain Reaction; Prevalence; Thailand; Young Adult

Topics: Ampicillin; Anti-Bacterial Agents; Cefotaxime; Epididymitis; Escherichia coli Infections; Humans; Infant, Newborn; Male; Orchitis; Remission Induction; Scrotum; Suppuration

Extended-spectrum β-lactamase-producing Escherichia coli (ESBL-E) are becoming increasingly widespread in Vietnam. Antibiotics are detected in many Vietnamese foods; however, the effect of ESBL-E and antibiotic consumption on intestinal bacteria has not been studied sufficiently. Here, we investigated the effect of oral administration of ESBL-E (TB19) and cefotaxime on luminescence-emitting cefotaxime-sensitive E. coli (X14). Mice were given water containing TB19 and then received three injections of 1.0 × 108 CFU of X14 harboring a luciferase gene. The mice were administered 100 μg of cefotaxime and luminescent bacteria were monitored over 24 h, following which luminescent bacteria were isolated from mouse feces. Luminescence continued to be detected in mice administered TB19 24 h after cefotaxime ingestion. Fecal analysis revealed two types of luminescent colonies: cefoxitin-resistant E. coli (X14-R) and Pseudomonas aeruginosa. Pulse-field gel electrophoresis confirmed that X14-R was a clonal strain of X14, suggesting that X14 survived using ESBLs originating from TB19 and acquired cefoxitin resistance due to cefotaxime consumption. Moreover, in vitro analysis of X14 indicated that expression of the ampC gene was upregulated by cefotaxime. Overall, ESBL-E and cefotaxime promoted the expansion of cefoxitin-resistant E. coli in the absence of plasmid-mediated gene transfer.

Topics: Animals; Anti-Bacterial Agents; Bacterial Proteins; beta-Lactam Resistance; beta-Lactamases; Cefotaxime; Escherichia coli; Escherichia coli Infections; Feces; Gene Expression; Luminescence; Mice, Inbred C57BL; Microbial Sensitivity Tests; Microbial Viability

Antimicrobial-resistant bacteria may be transmitted between farm workers and livestock. This study aimed to determine and compare the prevalence and the genetic determinants of cefotaxime-resistant and ESBL-producing Escherichia coli in faecal isolates from workers and pigs at 100 farms in northern Vietnam.. Farmers were interviewed about antimicrobial usage in livestock. Escherichia coli isolated on MacConkey agar containing 2 mg/l of cefotaxime (CTX) were tested for susceptibility to different cephalosporins by disc diffusion and screened for occurrence of ESBL-encoding genes by PCR.. Antimicrobial usage was widespread and included classes regarded of critical or high importance in human medicine. Dosages were 0.5-2 times higher than recommended, and antimicrobials were often administered right until slaughter. Prevalence of CTX-resistant E. coli was 86% in farm workers and 89% in pigs. In 76% of farms, CTX-resistant E. coli were shared by pigs and farm workers. ESBL-producing E. coli were detected from pigs and workers at 66 and 69 farms, respectively. The ESBL phenotype was mainly mediated by CTX-M and to a lesser extent by TEM. Occurrence of bla. The high occurrence of ESBL-producing E. coli in pig farmers and pigs could present a risk for spillover of these bacteria from pig farms into the community. Genomic studies are needed to elucidate reservoirs and transmission routes of ESBL-producing E. coli at livestock farms.

Topics: Animal Husbandry; Animals; Anti-Bacterial Agents; beta-Lactam Resistance; beta-Lactamases; Cefotaxime; Cephalosporins; Disease Reservoirs; Escherichia coli; Escherichia coli Infections; Farmers; Farms; Humans; Livestock; Microbial Sensitivity Tests; Occupational Exposure; Phenotype; Polymerase Chain Reaction; Surveys and Questionnaires; Swine; Zoonoses

The present study was conducted to evaluate the susceptibility, multidrug resistance and genetic characteristics of Escherichia coli (E. coli) strains, isolated from clinical samples from Jazan Hospital, Jazan, Saudi Arabia. A total of 95 samples were recruited from wound, urine, stool and blood. The isolates were assessed for their antibiotic susceptibilities and the presence of class II and III integrons was studied using PCR technique. Integron II-positive PCR products were further confirmed using partial sequencing. Ampicillin (84.2%) was found to be the most resistant antibiotic followed by ciprofloxacin (57.9%), gentamicin (56.8%), nalidixic acid (50.5%), cefotaxim (49.5%), ofloxacin (45.3%), amikacin (26.3%) and imipenem (16.8%), respectively. Seventy-six isolated strains were designated as multidrug resistant (MDR), while non-MDR was found in 19 strains (20.0%). Out of 76 MDR E. coli isolates, 41 (53.9%) were identified as positive for class II and 5 (6.5%) were positive for class III integron. Bioinformatics' analysis have shown that the sequences of our samples aligned along with many published sequences of integron II. Our findings further strengthen the significance of hospital-based and community E. coli strains on rising the burden of antimicrobial resistance.

Topics: Amikacin; Ampicillin; Anti-Bacterial Agents; Base Sequence; Cefotaxime; Ciprofloxacin; Drug Resistance, Multiple, Bacterial; Escherichia coli; Escherichia coli Infections; Gene Expression Regulation, Bacterial; Gentamicins; Hospitals; Humans; Imipenem; Integrons; Microbial Sensitivity Tests; Nalidixic Acid; Ofloxacin; Phylogeny; Polymerase Chain Reaction; Prevalence; Saudi Arabia; Sequence Alignment

Topics: Age Factors; Animals; Anti-Bacterial Agents; Cefotaxime; Chickens; Drug Resistance, Bacterial; Escherichia coli; Escherichia coli Infections; Farms; Infectious Disease Transmission, Vertical; Ovum; Poultry Diseases; Prevalence

Resistance to β-lactam antibiotics, including third-generation cephalosporins, is of major concern for animal and human health. In this study, extended-spectrum β-lactamase (ESBL) / plasmid-mediated AmpC (pAmpC) β-lactamase -producing Escherichia coli isolates from German livestock farms were characterised and associations of these isolate characteristics with farm-related factors were investigated across different types of livestock. A total of 469 isolates originating from 150 farms (34 broiler farms, 38 fattening pig farms, 43 dairy cattle farms, 35 beef cattle farms) was included in the analyses. ESBL-gene family, phylogroup and phenotypic antimicrobial susceptibility for several antimicrobial agents were determined. This data was used to define different profiles characterising the isolates. Multivariate analyses using a distance-based non-parametric approach were performed to investigate associations between the profiles of the isolates and farm-related factors (e.g. management, husbandry, and environment of the farms). Co-occurrence of ESBL-gene families were not found in any of the isolates analysed. Sixty-eight percent of the isolates carried bla

Topics: Animals; Anti-Bacterial Agents; Bacterial Proteins; beta-Lactamases; Cattle; Cattle Diseases; Cefotaxime; Chickens; Cross-Sectional Studies; Drug Resistance, Bacterial; Escherichia coli; Escherichia coli Infections; Farms; Humans; Livestock; Plasmids; Poultry Diseases; Swine; Swine Diseases

The emergence of Escherichia coli sequence type 131 (ST131) as a multidrug-resistant and virulent pathogen represents a major challenge to public health globally. Recently, the O25b/ST131 E. coli producing CTX-M-15 with high virulence potential has been reported worldwide, but has received little attention in Iran. This study is the first in Iran to specifically determine the spread of the O25b/ST131 clone producing CTX-M-15 among E. coli isolates belonging to the B2 phylogenetic group. ST131 clone in phylogenetic group B2 was detected based on PCR detection of ST131-specific single-nucleotide polymorphisms in mdh and gyrB. O25b/ST131 E. coli clone was confirmed utilizing O25b/ST131 clone allele-specific PCR for the pabB gene. All group B2 E. coli isolates were characterized based on antibiotic susceptibility, extended-spectrum β-lactamase (ESBL) enzymes, and virulence traits. Our results demonstrated that 38 out of the 154 B2 group isolates (24.7%) were identified as belonging to the ST131 clone. Furthermore, of these, 28 isolates (73.6%) were detected as O25b/ST131 clone. Antibiotic resistance of ST131 E. coli isolates to ciprofloxacin, gentamicin, cefotaxime, and aztreonam was significantly higher than non-ST131 isolates. Almost all of the O25b/ST131 isolates with the ability for ESBL production were reported as CTX-M-15 producing (95.5%). Our results showed that the most prevalent virulence trait in ST131 clone was ompT (94.7%). This study is the first to report the prevalence of the CTX-M-15-producing O25b/ST131 E. coli in Iran. Our findings reinforce the surveillance of dissemination of ST131 E. coli clone as a major drug-resistant pathogen and an important new public health threat.

Topics: Anti-Bacterial Agents; Aztreonam; beta-Lactamases; Cefotaxime; Ciprofloxacin; Clone Cells; Drug Resistance, Multiple, Bacterial; Escherichia coli; Escherichia coli Infections; Gene Expression; Gentamicins; Humans; Iran; Microbial Sensitivity Tests; Multilocus Sequence Typing; Phylogeny; Polymorphism, Single Nucleotide; Prevalence; Virulence Factors

The resistance mechanisms, molecular type and plasmid content of cefotaxime-resistant Escherichia coli isolated from faecal samples of healthy volunteers in Puebla, Mexico, were characterised.. Cefotaxime-resistant E. coli were recovered from 11 (18%) of 60 healthy volunteers. The isolates (one per sample) were characterised as multidrug-resistant and phenotypically extended-spectrum β-lactamase (ESBL)-producing strains. Genes encoding resistance to β-lactams (bla. This study reports the detection of E. coli ST131-B2-O25:H4-H30-Rx subclone in healthy humans in Mexico, highlighting its dissemination in the community setting.

Topics: Adolescent; Adult; Anti-Bacterial Agents; beta-Lactamases; Carrier State; Cefotaxime; Escherichia coli; Escherichia coli Infections; Feces; Female; Genotype; Healthy Volunteers; Humans; Male; Mexico; Middle Aged; Plasmids; Surveys and Questionnaires; Young Adult

Resistance to third-generation cephalosporins and other beta-lactam antibiotics is of major concern for animal and human health. Knowledge of the prevalence of resistant bacteria in primary production is an important element to estimate transmission along the stages in the food production chain and the exposure of the human population. The primary objective of this study was to determine the prevalence of cefotaxime-resistant commensal E. coli in dairy and beef cattle production units throughout Germany. Secondarily, the association between management factors and the presence of cefotaxime resistance was investigated. In total, 60 beef cattle and 52 dairy cattle production units all over Germany were included. Cefotaxime-resistant E. coli were isolated from at least one sample in 70% (95% CI: 58-83%) of the farms keeping beef cattle and 85% (95% CI: 75-94%) of the farms keeping dairy cattle. The sample prevalence was 35% (161/455; 95% CI: 31-40%) and 48% (156/323; 95% CI: 43-54%), respectively. Most factors associated with resistance to cefotaxime indicate that less intensive production results in a lower number of positive samples. For beef cattle, antimicrobial treatment of the whole animal group was significantly associated with an increased proportion of samples containing cefotaxime resistant E. coli. In addition, our results indicate that better hygiene management could improve the resistance situation on cattle farms.

Topics: Animals; Anti-Bacterial Agents; Cattle; Cattle Diseases; Cefotaxime; Cross-Sectional Studies; Drug Resistance, Bacterial; Escherichia coli; Escherichia coli Infections; Farms; Germany; Prevalence

The aim of the current study was to compare community-acquired acute pyelonephritis (CA-APN) with health care-associated acute pyelonephritis (HCA-APN), describe the outcomes, and identify variables that could predict antimicrobial susceptibility. We conducted an observational study that included all consecutive episodes of acute pyelonephritis (APN) in adults during 2014 at a Spanish university hospital. From each episode, demographic data, comorbidities, clinical presentation, microbiological data, antimicrobial therapy, and outcome were recorded. A multivariable logistic regression model was performed to define the variables associated with antimicrobial resistance. A total of 607 patients, 503 (82.9%) with CA-APN and 104 (17.1%) with HCA-APN, were included in the study. Patients with HCA-APN were older than patients with CA-APN (70.4 versus 50.6 years;

Topics: Acute Disease; Adult; Aged; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Cefotaxime; Cefuroxime; Ciprofloxacin; Cohort Studies; Community-Acquired Infections; Cross Infection; Drug Resistance, Bacterial; Empirical Research; Escherichia coli; Escherichia coli Infections; Female; Hospitals, University; Humans; Logistic Models; Male; Microbial Sensitivity Tests; Middle Aged; Pyelonephritis; Risk Factors; Spain; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

European starlings (Sturnus vulgaris) have been implicated in the dispersal of zoonotic enteric pathogens. However, their role in disseminating antimicrobial-resistant organisms through their home range has not been clearly established. The aim of this study was to determine whether starling night roosts served as foci for spreading organisms with reduced susceptibility to antimicrobials among dairy cattle farms. Bovine faecal pats were collected from 150 dairy farms in Ohio. Each farm was visited twice (in summer and fall) between 2007 and 2009. A total of 1490 samples (10 samples/farm over two visits) were tested for Escherichia coli with reduced susceptibility to cefotaxime and ciprofloxacin. Using a spatial scan statistic, focal scans were conducted to determine whether clusters of farms with a high prevalence of organisms with reduced susceptibility to cefotaxime and ciprofloxacin surrounded starling night roosts. Faecal pats 13.42% and 13.56% of samples carried Escherichia coli with reduced susceptibility to cefotaxime and ciprofloxacin, respectively. Statistically significant (P < 0.05) spatial clusters of faecal pats with high prevalence of Escherichia coli showing reduced susceptibility to cefotaxime and ciprofloxacin were identified around these night roosts. This finding suggests that the risk of carriage of organisms with reduced susceptibility to antimicrobials in cattle closer to starling night roosts was higher compared to cattle located on farms further from these sites. Starlings might have an important role in spreading antimicrobial-resistant E. coli to livestock environments, thus posing a threat to animal and public health.

Topics: Animals; Anti-Bacterial Agents; Cattle; Cattle Diseases; Cefotaxime; Ciprofloxacin; Cluster Analysis; Dairying; Drug Resistance, Multiple, Bacterial; Escherichia coli; Escherichia coli Infections; Farms; Ohio; Starlings

Topics: Bacterial Proteins; Bacterial Typing Techniques; beta-Lactamases; Bulgaria; Carbapenem-Resistant Enterobacteriaceae; Carbapenems; Cefotaxime; Drug Resistance, Multiple, Bacterial; Escherichia coli; Escherichia coli Infections; Female; Humans; Imipenem; Microbial Sensitivity Tests; Phylogeny; Plasmids

Topics: Animals; Anti-Bacterial Agents; Bacterial Proteins; beta-Lactamases; Bird Diseases; Cefotaxime; Ciprofloxacin; Crows; Electrophoresis, Gel, Pulsed-Field; Escherichia coli; Escherichia coli Infections; Escherichia coli Proteins; Humans; Microbial Sensitivity Tests; Multilocus Sequence Typing; Plasmids; United States

This study sought to compare the antimicrobial susceptibility rates between acute uncomplicated cystitis patients with failed initial antimicrobial treatment, who were considered unresolved cases, and newly presenting acute uncomplicated cystitis patients without recent antimicrobial use within 3 months and to determine whether different treatment strategies should be applied according to recent antimicrobial exposure (RAE). Female acute uncomplicated cystitis patients with Escherichia coli growth, who visited our hospital's urology department from 2010 to 2014, were divided according to RAE. The antimicrobial susceptibility of E. coli was compared between the group with RAE and the group with no antimicrobial exposure (NAE) within 3 months. The total number of acute uncomplicated cystitis patients with E. coli growth was 259: 40 patients comprised the RAE group and 219 patients formed the NAE group. The mean age was significantly older and previous recurrent cystitis history was higher in the RAE group (p < 0.05). Furthermore, the antimicrobial susceptibility of E. coli to amoxicillin-clavulanic acid, cefotaxime, cefoxitin, ciprofloxacin, and trimethoprim-sulfamethoxazole was significantly lower in the RAE group, with susceptibility results of 64.7%/88.0% (RAE/NAE), 77.5%/89.0%, 79.4%/95.3%, 31.3%/64.2%, and 42.5%/70.6%, respectively. RAE was an independent factor for antimicrobial resistance. This study showed that antimicrobial susceptibilities were significantly lower in acute uncomplicated cystitis patients with failed initial antimicrobial treatment, who are defined as unresolved cases. Our results suggest that first-line antimicrobials might show poor efficacy in cases of unresolved, acute uncomplicated cystitis and alternative or secondary antimicrobials should be considered in these cases.

Topics: Acute Disease; Adult; Aged; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Cefotaxime; Cefoxitin; Ciprofloxacin; Cystitis; Drug Resistance, Multiple, Bacterial; Escherichia coli; Escherichia coli Infections; Female; Humans; Microbial Sensitivity Tests; Middle Aged; Recurrence; Treatment Failure; Trimethoprim, Sulfamethoxazole Drug Combination

In this investigation the farm prevalence of cefotaxime-resistant Escherichia coli (CREC) in German broiler farms was evaluated. In total, 59 flocks on 34 broiler farms were sampled in four agricultural regions of Germany. Per broiler flock, three faecal samples, a pair of boot swabs and one dust sample were taken and examined for the presence of CREC. After pre-enrichment of sample material in Luria-Bertani-broth, the broth was streaked onto MacConkey agar containing 1mg/l cefotaxime (CTX). CREC isolates were detected in at least one sample from each flock resulting in a farm prevalence of 100%. The proportion of positive samples was high in all three sample types. Of 177 collective faecal samples 81.9% were positive, of 59 boot swabs and 59 dust samples 79.7% and 62.7% were positive. In conclusion, the prevalence of broiler farms with cefotaxime-resistant E. coli in Germany is very high. We suggest that the analysis of collective faecal samples is sufficient to determine the CREC farm status. In addition to other studies our study supports the finding that cefotaxime resistance is a good proxy for the presence of ESBL- or plasmidic AmpC-beta-lactamases.

Topics: Animals; Anti-Bacterial Agents; beta-Lactam Resistance; Cefotaxime; Chickens; Cross-Sectional Studies; Escherichia coli; Escherichia coli Infections; Germany; Poultry Diseases; Prevalence

To determine the occurrence of bacterial pathogens responsible for diarrhea and to engender information regarding the effectiveness of commonly used antibiotic against diarrhea.. This cross-sectional study was conducted between April and July 2014. Samples were collected from the Divisional Headquarter and Allied Hospital, Faisalabad, Pakistan. The differential and selective media were used to isolate bacterial pathogens, which were identified through cultural characteristics, microscopy, and biochemical tests. Disc diffusion assay was carried out using Muller Hinton agar medium, and minimum inhibitory concentration was determined using broth dilution method against isolated pathogens.. One hundred and forty-one (100%) samples were positive for some bacteria. Frequency of occurrence was Bacillus cereus (B. cereus) (66%), Escherichia coli (E.coli) (48.5%), Salmonella typhi (S. Typhi) (27.7%), Pseudomonas aeruginosa (P. aeruginosa) (8.5%), and Staphylococcus aureus (S. aureus) (4.3%). Single pathogen was detected in 20 (14.2%) samples whereas combinations were found in 121 (85.8%) samples. Bacillus cereus and E.coli were the most frequently detected pathogens followed by the S. Typhi, P. aeruginosa, and Staph. aureus. The percentage occurrence of isolated pathogens was 31% in B. cereus, 31% in E. coli, 18% in S. Typhi, 5% in P. aeruginosa, and 3% in Staph. aureus.. Pseudomonas aeruginosa showed resistance against Amoxicillin and Cefotaxime, whereas S. aureus was found resistant against Cefotaxime. Statistical analysis using one way Analysis of Variance revealed that Ofloxacin and Gentamicin had significant (p less than 0.05) differences against all isolates as compared with other antibiotics used in this study.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Amoxicillin; Anti-Bacterial Agents; Bacillus cereus; Cefotaxime; Child; Child, Preschool; Cross-Sectional Studies; Diarrhea; Drug Resistance, Bacterial; Escherichia coli; Escherichia coli Infections; Female; Gentamicins; Gram-Positive Bacterial Infections; Humans; Infant; Infant, Newborn; Male; Microbial Sensitivity Tests; Middle Aged; Ofloxacin; Pakistan; Pseudomonas aeruginosa; Pseudomonas Infections; Salmonella typhi; Staphylococcal Infections; Staphylococcus aureus; Typhoid Fever; Young Adult

Bacterial pathogens producing CTX-M beta-lactamases are emerging around the world as a source of resistance to oxyimino cephalosporins such as cefotaxime. In this study, we have investigated the prevalence of blaCTX-M genes among clinical isolates of Escherichia coli and Klebsiella pneumoniae. Of the double-disk synergy test-positive E. coli (n = 94) and Kl. pneumoniae (n = 73) strains isolated during the study period, 41 (44·08%) E. coli and 32 (43·24%) Kl. pneumoniae isolates were found to be positive for blaCTX-M genes. Twenty-two integrons (13 for E. coli and 9 for Kl. pneumoniae) were detected whose sizes ranged from 600 bp to 1·5 kb. All these integrons were found to be of Class1 type and were invariably PCR positive for int1 and sul1 genes. Marker transfer experiments demonstrated plasmid-mediated transfer of cefotaxime and ceftazidime resistance markers. In addition, analysis of the enterobacterial repetitive intergenic consensus (ERIC)-PCR typing of the blaCTX-M -carrying isolates showed that they were genetically diverse and heterogeneous suggesting that multiple subtypes of the species were involved in infection.. A high frequency of blaCTX-M -resistant marker has been found in Escherichia coli and Klebsiella pneumoniae isolates of clinical origin. Analysis of the ERIC-PCR typing of the blaCTX-M -carrying isolates showed that they were genetically diverse and heterogeneous suggesting that multiple subtypes of the species were involved in infection.

Topics: beta-Lactamases; Cefotaxime; Drug Resistance, Multiple, Bacterial; Escherichia coli; Escherichia coli Infections; Escherichia coli Proteins; Humans; Integrons; Klebsiella Infections; Klebsiella pneumoniae; Molecular Sequence Data; Molecular Typing; Prevalence

The objective of this study was to determine whether antibiotic exposure is associated with extended-spectrum-beta-lactamase- or AmpC-producing Escherichia coli or Klebsiella pneumoniae infections in children. We collected extended-spectrum-beta-lactamase- or AmpC-producing E. coli or K. pneumoniae isolates and same-species susceptible controls from normally sterile sites of patients aged ≤21 years, along with associated clinical data, at four free-standing pediatric centers. After controlling for potential confounders, the relative risk of having an extended-spectrum-beta-lactamase-producing isolate rather than a susceptible isolate was 2.2 times higher (95% confidence interval [CI], 1.49 to 3.35) among those with antibiotic exposure in the 30 days prior to infection than in those with no antibiotic exposure. The results were similar when analyses were limited to exposure to third-generation cephalosporins, other broad-spectrum beta-lactams, or trimethoprim-sulfamethoxazole. Conversely, the relative risk of having an AmpC-producing versus a susceptible isolate was not significantly elevated with any antibiotic exposure in the 30 days prior to infection (adjusted relative risk ratio, 1.12; 95% CI, 0.65 to 1.91). However, when examining subgroups of antibiotics, the relative risk of having an AmpC-producing isolate was higher for patients with exposure to third-generation cephalosporins (adjusted relative risk ratio, 4.48; 95% CI, 1.75 to 11.43). Dose-response relationships between antibiotic exposure and extended-spectrum-beta-lactamase-producing or AmpC-producing isolates were not demonstrated. These results reinforce the need to study and implement pediatric antimicrobial stewardship strategies, and they indicate that epidemiological studies of third-generation cephalosporin-resistant E. coli and K. pneumoniae isolates should include resistance mechanisms when possible.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Aztreonam; Bacterial Proteins; beta-Lactamases; Cefepime; Cefotaxime; Ceftazidime; Ceftriaxone; Cephalosporins; Child; Child, Preschool; Drug Resistance, Multiple, Bacterial; Escherichia coli; Escherichia coli Infections; Female; Humans; Infant; Infant, Newborn; Klebsiella Infections; Klebsiella pneumoniae; Male; Microbial Sensitivity Tests; Prospective Studies; Young Adult

The increasing prevalence of multidrug-resistant (MDR) bacteria is a serious global challenge. Here, we studied prospectively whether bacterial whole-genome sequencing (WGS) for real-time MDR surveillance is technical feasible, returns actionable results, and is cost-beneficial. WGS was applied to all MDR isolates of four species (methicillin-resistant Staphylococcus aureus [MRSA], vancomycin-resistant Enterococcus faecium, MDR Escherichia coli, and MDR Pseudomonas aeruginosa) at the University Hospital Muenster, Muenster, Germany, a tertiary care hospital with 1,450 beds, during two 6-month intervals. Turnaround times (TAT) were measured, and total costs for sequencing per isolate were calculated. After cancelling prior policies of preemptive isolation of patients harboring certain Gram-negative MDR bacteria in risk areas, the second interval was conducted. During interval I, 645 bacterial isolates were sequenced. From culture, TATs ranged from 4.4 to 5.3 days, and costs were €202.49 per isolate. During interval II, 550 bacterial isolates were sequenced. Hospital-wide transmission rates of the two most common species (MRSA and MDR E. coli) were low during interval I (5.8% and 2.3%, respectively) and interval II (4.3% and 5.0%, respectively). Cancellation of isolation of patients infected with non-pan-resistant MDR E. coli in risk wards did not increase transmission. Comparing sequencing costs with avoided costs mostly due to fewer blocked beds during interval II, we saved in excess of €200,000. Real-time microbial WGS in our institution was feasible, produced precise actionable results, helped us to monitor transmission rates that remained low following a modification in isolation procedures, and ultimately saved costs.

Topics: Anti-Bacterial Agents; Cefotaxime; Ciprofloxacin; Cross Infection; Enterococcus faecium; Escherichia coli; Escherichia coli Infections; Genome, Bacterial; Gram-Positive Bacterial Infections; High-Throughput Nucleotide Sequencing; Humans; Infection Control; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Piperacillin; Prospective Studies; Pseudomonas aeruginosa; Pseudomonas Infections; Sequence Analysis, DNA; Staphylococcal Infections; Vancomycin-Resistant Enterococci

Although the dairy farm environment is a known source of extended-spectrum β-lactamase (ESBL)-producing bacteria, surveillance data on ESBL in the milk production chain are still scarce. This study aimed at estimating the dimensions of the problem for public health and animal welfare by surveying ESBL-producing Enterobacteriaceae in raw bulk tank milk in Germany. Samples from 866 dairy farms, comprising about 1% of the total number of dairy farms in Germany, were first screened for presence of cefotaxime-resistant bacteria by selective enrichment. Suspect colonies were identified phenotypically and further characterized by biochemical and molecular methods, including analysis of resistance genes and clonal diversity in ESBL-producing isolates. Bulk tank milk from 82 (9.5%) farms yielded Enterobacteriaceae with confirmed ESBL-production. The most frequent ESBL-producing species was Escherichia coli (75.6%), followed by Citrobacter spp. (9.6%), Enterobacter cloacae (6.1%), and Klebsiella oxytoca (3.7%), a few isolates belonged to other species within the genera Hafnia, Raoutella and Serratia. The majority of isolates (95.1%) harbored the β-lactamase blaCTX-M gene, which has gained increased importance among ESBL-producing strains worldwide; the CTX-M group 1 was found to be the dominating (88.4%) phylogenetic group. All ESBL-positive Escherichia coli isolates were clonally heterogeneous, as determined by pulsed-field gel electrophoresis. The results from this survey demonstrate that ESBL-producing bacteria are distributed widely in the dairy farm environment in Germany. Therefore, raw milk is a potential source of exposure for the consumer, which is of increasing importance considering the trend of farmer-to-consumer direct marketing. Furthermore, dairy farm staff have an increased likelihood of exposure to ESBL-producing bacteria. Finally, ESBL-producing bacteria may also be transferred via waste milk to calves, thus further spreading antibiotic resistance in the farm environment.

Topics: Animals; beta-Lactamases; Cattle; Cefotaxime; Citrobacter; Dairying; Drug Resistance, Bacterial; Electrophoresis, Gel, Pulsed-Field; Enterobacter cloacae; Enterobacteriaceae; Escherichia coli; Escherichia coli Infections; Escherichia coli Proteins; Farms; Food Microbiology; Geography; Germany; Humans; Klebsiella oxytoca; Microbial Sensitivity Tests; Milk; Phylogeny

The aim of this study was to identify the presence of group CTX-M-9 extended spectrum beta-lactamases (ESBL) in clinical Escherichia coli isolates from pediatric patients. A total of 404 non-repeated positive ESBL E. coli isolates were collected from documented clinical infections in pediatric patients over a 2-year period. The identification and susceptibility profiles were determined using an automated system. Isolates that suggested ESBL production based on their resistance profiles to third and fourth generation cephalosporin and monobactam were selected. ESBL production was phenotypically confirmed using a diffusion method with cefotaxime and ceftazidime discs alone and in combination with clavulanic acid. blaESBL gene identification was performed through PCR amplification and sequencing. Pulsed Field Gel Electrophoresis (PFGE) and Multilocus Sequence Typing (MLST) were performed to establish the clonal relationships of the E. coli isolates. CTX-M-9-type ESBLs were detected in 2.5% of the isolates. The subtypes corresponded to blaCTX-M-14 (n = 4) and blaCTX-M-27 (n = 6). Additionally, coexistence with other beta-lactamases was observed. A clonal relationship was established in three isolates; the rest were classified as non-related. We found seven different sequence type (ST) in CTX-M-9- producing E. coli isolates. ST38 was the most frequent. This study is the first report in Mexico to document the presence of group CTX-M-9 ESBLs in E. coli isolates from pediatric patients.

Topics: Adolescent; beta-Lactamases; Cefotaxime; Ceftazidime; Cephalosporin Resistance; Child; Child, Preschool; Disk Diffusion Antimicrobial Tests; Escherichia coli; Escherichia coli Infections; Escherichia coli Proteins; Female; Humans; Infant; Infant, Newborn; Male; Mexico

CTX-M-15 is the dominant type of extended-spectrum β-lactamase in clinical isolates. This enzyme constitutes the most widespread enzymes in Tunisia. In this study, we were interested to understand the causes of the evolutionary success of CTX-M-15 in a Tunisian university hospital.. A total of of 72 cefotaxime-resistant Enterobacteriaceae were isolated from newborn patients at the hospital Taher sfar Mahdia in Tunisia and characterized their genetic support by means of molecular techniques.. Isolates were clustered into various clonal groups, although most isolates belonged to sequence types ST39 (Klebsiella pneumoniae) and ST131 (Escherichia coli). F replicons (FIA, FIB, and FII) were the most frequently detected replicon types in our collection (91.66%).. This is the first report of QnrB- and CTX-M-15-encoding large IncF-type conjugative plasmids in Tunisia.

Topics: Academic Medical Centers; beta-Lactamases; Cefotaxime; Drug Resistance, Bacterial; Enterobacteriaceae; Escherichia coli; Escherichia coli Infections; Evolution, Molecular; Genetic Variation; Humans; Infant, Newborn; Klebsiella Infections; Klebsiella pneumoniae; Microbial Sensitivity Tests; Molecular Epidemiology; Plasmids; Tunisia

Extended-spectrum β-lactamases (ESBLs) pose a threat to public health because of their ability to confer resistance to extended-spectrum cephalosporins such as cefotaxime. The CTX-M β-lactamases are the most widespread ESBL enzymes among antibiotic resistant bacteria. Many of the active site residues are conserved between the CTX-M family and non-ESBL β-lactamases such as TEM-1, but the residues Ser237 and Arg276 are specific to the CTX-M family, suggesting that they may help to define the increased specificity for cefotaxime hydrolysis. To test this hypothesis, site-directed mutagenesis of these positions was performed in the CTX-M-14 β-lactamase. Substitutions of Ser237 and Arg276 with their TEM-1 counterparts, Ala237 and Asn276, had a modest effect on cefotaxime hydrolysis, as did removal of the Arg276 side chain in an R276A mutant. The S237A:R276N and S237A:R276A double mutants, however, exhibited 29- and 14-fold losses in catalytic efficiency for cefotaxime hydrolysis, respectively, while the catalytic efficiency for benzylpenicillin hydrolysis was unchanged. Therefore, together, the Ser237 and Arg276 residues are important contributors to the cefotaximase substrate profile of the enzyme. High-resolution crystal structures of the CTX-M-14 S70G, S70G:S237A, and S70G:S237A:R276A variants alone and in complex with cefotaxime show that residues Ser237 and Arg276 in the wild-type enzyme promote the expansion of the active site to accommodate cefotaxime and favor a conformation of cefotaxime that allows optimal contacts between the enzyme and substrate. The conservation of these residues, linked to their effects on structure and catalysis, imply that their coevolution is an important specificity determinant in the CTX-M family.

Topics: Amino Acid Substitution; Anti-Bacterial Agents; beta-Lactamases; Cefotaxime; Crystallography, X-Ray; Drug Resistance, Microbial; Escherichia coli; Escherichia coli Infections; Humans; Hydrolysis; Models, Molecular; Mutagenesis, Site-Directed

Megalocytic interstitial nephritis is a rare form of kidney disease caused by chronic inflammation. We report a case of megalocytic interstitial nephritis occurring in a 45-yrold woman who presented with oliguric acute kidney injury and acute pyelonephritis accompanied by Escherichia coli bacteremia. Her renal function was not recovered despite adequate duration of susceptible antibiotic treatment, accompanied by negative conversion of bacteremia and bacteriuria. Kidney biopsy revealed an infiltration of numerous histiocytes without Michaelis-Gutmann bodies. The patient's renal function was markedly improved after short-term treatment with high-dose steroid.

Topics: Acute Disease; Acute Kidney Injury; Anti-Bacterial Agents; Azithromycin; Bacteremia; Cefotaxime; Creatinine; Escherichia coli; Escherichia coli Infections; Female; Humans; Kidney; Methylprednisolone; Middle Aged; Nephritis, Interstitial; Pyelonephritis; Renal Dialysis; Shock, Septic

The objective of this study was to characterize plasmids coharboring 16S rRNA methylases, blaCTX-M and virulence-associated genes in Escherichia coli and Klebsiella pneumoniae isolates from chickens in China. A total of 32 positive transconjugants exhibited coresistance to amikacin and cefotaxime in E. coli (24/281) and K. pneumoniae (8/93), and were identified by conjugation experiments and S1-pulsed-field gel electrophoresis. Polymerase chain reaction amplification assay detecting resistance genes showed that rmtB or armA gene accompanied with different blaCTX-M genes coexisted on 32 transferred plasmids. The blaCTX-M-98b gene was identified in chicken-derived E. coli and K. pneumoniae for the first time. The association between resistance genes and virulence genes was observed in the transferred plasmids; 68.8% (22/32) transferred resistance plasmids coharboring various virulence genes including traT, iutA, fyuA, msbB, and vagC genes with diverse proportions. Genetic stability tests revealed that 93.8% (30/32) transferred plasmids continued to exist in the host strain after continuous passage of 30 times in 15 days. Furthermore, 87.5% (28/32) conjugants showed no significant differences in growth rates compared with E. coli J53. Results of the growth competition assay showed that conjugants have low fitness cost, which indicated that there were no obvious negative effects on the host's growth. The combination of blaCTX-M-98b-rmtB-traT on 85-kb transferred IncF plasmids in E. coli, and blaCTX-M-14-rmtB-traT on 95-kb transferred IncF plasmids in K. pneumoniae were first identified in this study. These features of plasmids may contribute to the successful spread of resistance and virulence among pathogens of different sources and geographical origins.

Topics: Amikacin; Animals; Anti-Bacterial Agents; Bacterial Proteins; Bacteriocin Plasmids; beta-Lactamases; Cefotaxime; Chickens; China; Conjugation, Genetic; Drug Resistance, Bacterial; Electrophoresis, Gel, Pulsed-Field; Escherichia coli; Escherichia coli Infections; Escherichia coli Proteins; Klebsiella Infections; Klebsiella pneumoniae; Methyltransferases; Microbial Sensitivity Tests; Polymerase Chain Reaction; RNA, Ribosomal, 16S; tRNA Methyltransferases; Virulence Factors

Quantitative data on faecal shedding of antimicrobial resistant bacteria are crucial to assess the risk of transmission from dogs to other animals as well as humans. In this study we investigated prevalence and concentrations of β-lactam-resistant Escherichia coli and enterococci in the faeces of 108 dogs presenting at a veterinary hospital in Denmark. The dogs had not been treated with antimicrobials for 4 weeks prior to the study. Total E. coli and enterococci were quantified by counts on MacConkey and Slanetz-Bartley, respectively. Resistant E. coli and enterococci were counted on the same media containing relevant antibiotic concentrations, followed by species identification using MALDI-TOF. Ampicillin- and cefotaxime-resistant E. coli were detected in 40% and 8% of the dogs, respectively, whereas approximately 15% carried ampicillin-resistant enterococci, mainly Enterococcus faecium. In the faeces of the carriers, the proportion of resistant strains in the total bacterial species population was on average 15% for both ampicillin-resistant E. coli (median faecal load 3.2×10(4)cfu/g) and E. faecium (5.8×10(2) cfu/g), and 4.6% for cefotaxime-resistant E. coli (8.6×10(3) cfu/g). Cefotaxime resistance was associated with the presence of blaCTX-M-1 (n=4), blaCMY-2 (n=4) or multiple mutations in the promoter and coding region of chromosomal ampC (n=1). Altogether the results indicate that the risks of zoonotic transmission of β-lactam-resistant bacteria via human exposure to canine faeces greatly vary amongst individual dogs and are influenced by unidentified factors other than recent antimicrobial use.

Topics: Ampicillin; Animals; Anti-Bacterial Agents; Bacterial Shedding; beta-Lactams; Cefotaxime; Denmark; Dogs; Drug Resistance, Bacterial; Enterococcus faecium; Escherichia coli; Escherichia coli Infections; Feces; Female; Humans; Male; Microbial Sensitivity Tests; Prevalence

Retail meat products could serve as an important medium for the transfer of multidrug resistant isolates from food-producing animals to the community. In this study, the prevalence and characteristics of cefotaxime and ciprofloxacin co-resistant Escherichia coli isolates were investigated in retail chicken and ground pork samples from four provinces of China. The isolates were subjected to phylogenetic group typing and antimicrobial susceptibility testing. All isolates were further characterized by pulsed-field gel electrophoresis to determine the genetic relatedness. These isolates were also screened for beta-lactamase genes, quinolone resistance determinants by PCR, and followed by DNA sequence analysis. Cefotaxime and ciprofloxacin co-resistant E. coli isolates with diverse genetic origins were recovered in 31.9% (106/332) of retail meat samples. E. coli isolates of phylogenetic group A were dominant (59.4%, 63/106), and all isolates showed multidrug resistant profiles. The dominant resistant profiles were AMP-CAZ-CTX-CIP-CHL-GEN-SXT-TET (n=43) and AMP-CAZ-CTX-CIP-CHL-SXT-TET (n=43). Point mutations in quinolone resistance determination regions of topoisomerases were identified in all the isolates, and most of the isolates accumulated three (n=78) or four (n=21) point mutations. Plasmid-mediated quinolone-resistant determinants were identified in 68 isolates, including oqxAB (n=66), qnrS1 (n=7), qnrS2 (n=4), and aac(6')-Ib-cr (n=9). Eight subtypes of bla(CTX-M) were identified in 103 E. coli isolates, and blaCTX-M-55 (n=90) was dominant. This study highlights that retail meat could serve as an important reservoir of cefotaxime and ciprofloxacin co-resistant E. coli isolates. It is necessary to evaluate their contribution in the community and hospital infections.

Topics: Animals; Anti-Bacterial Agents; Bacterial Typing Techniques; beta-Lactam Resistance; beta-Lactamases; Cefotaxime; Chickens; China; Ciprofloxacin; Disease Reservoirs; Drug Resistance, Multiple, Bacterial; Electrophoresis, Gel, Pulsed-Field; Escherichia coli; Escherichia coli Infections; Humans; Meat Products; Phylogeny; Plasmids; Polymerase Chain Reaction; Prevalence; Swine

The aim of our study was to characterize the phylogenetic groups of Escherichia coli, antibiotic resistance, and containment of class 1 integrons in the first attack of pyelonephritis and in subsequent recurrences in young children. Altogether, 89 urine E. coli isolates from 41 children with urinary tract infection (UTI) were studied for prevalence and persistence of phylogenetic groups by pulsed-field gel electrophoresis (PFGE), antibacterial resistance by minimal inhibitory concentrations (MIC) and class 1 integrons by PCR. Phylogenetic group B2 was most common (57%), followed by D (20%), A (18%) and B1 (5%). Overall resistance to betalactams was 61%, trimethoprim-sulfamethoxazole 28%, and was not associated with phylogenetic groups. According to PFGE, the same clonal strain persisted in 77% of patients. The persistence was detected most often in phylogenetic group B2 (70%). Phylogenetic group B2 more often contained class 1 integrons than group A. Integron positive strains had higher MIC values of cefuroxime, cefotaxime, and gentamicin. In conclusion, phylogenetic group B2 was the most common cause of the first episode of pyelonephritis, as well as in case of the persistence of the same strain and contained frequently class 1 integrons in childhood recurrent UTI. An overall frequent betalactam resistance was equally distributed among phylogenetic groups.

Topics: Anti-Bacterial Agents; Bacterial Typing Techniques; Cefotaxime; Cefuroxime; Child; Child, Preschool; Drug Resistance, Multiple, Bacterial; Electrophoresis, Gel, Pulsed-Field; Escherichia coli; Escherichia coli Infections; Female; Gentamicins; Humans; Integrons; Male; Microbial Sensitivity Tests; Phylogeny; Recurrence; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

The characterization of extended-spectrum beta-lactamases , plasmidic AmpC (pAmpC), and associated plasmid-mediated quinolone resistance (PMQR) determinants in cefotaxime-resistant coliforms isolated from hospital effluent in Algiers showed blaCTX-M genes in 89%, blaTEM-1 in 79·8%, and pAmpC genes (blaCIT) in 2·7% isolates. Association of ISEcp1B with blaCTX-M was found in all CTX-M+ isolates, and 97·2% harboured class 1 integrons. Sequencing showed blaCTX-M-15, blaCTX-M-3, and blaCMY-4 genes. blaCTX-M-3 and blaCTX-M-15 were located in Inc L/M conjugative plasmids. The PMQR determinants identified were qnrB1, qnrB2, qnrB9, qnrB19, qnrS2, and aac(6')-Ib-cr. qnrB2, qnrB9, qnrB19, and blaCMY-4 are described for the first time in Algeria and qnrB19 for the first time in non-clinical environments. This study highlights the major potential role of hospital effluents as providers of resistance genes to natural environments.

Topics: Algeria; Anti-Bacterial Agents; beta-Lactamases; Cefotaxime; Drug Resistance, Multiple, Bacterial; Escherichia coli; Escherichia coli Infections; Hospitals; Humans; Plasmids; Quinolones

The aim of this study was to characterize plasmid-mediated AmpC (pAmpC)-producing Escherichia coli clinical isolates. A total of 101 strains with AmpC-susceptibility pattern were prospectively included. All isolates were tested by multiplex PCR to detect different bla genes. Phylogenetic groups were determined by a multiplex PCR assay. Antimicrobial susceptibility was tested by a microdilution commercial method. Presence of blapAmpC was detected in 79 (78.2%) of the strains; in these pAmpC-producing isolates, blaTEM was detected in 41 (51.9%) strains, blaSHV in 5 (6.3%) strains, blaOXA in 3 (3.8%) strains, and blaCTX-M in 3 (3.8%) strains. blaVIM and blaKPC were detected in one strain. Sixteen strains belonged to phylogroup A, 27 to B1, 20 to B2, and 16 to D. As conclusion, the majority of the strains of E. coli with AmpC-susceptibility pattern are pAmpC positive, although the association of extended-spectrum beta-lactamases (ESBL) and pAmpC is unusual.

Topics: Anti-Bacterial Agents; Bacterial Proteins; beta-Lactam Resistance; beta-Lactamases; Cefotaxime; Cefoxitin; Ceftazidime; Drug Resistance, Multiple, Bacterial; Escherichia coli; Escherichia coli Infections; Humans; Microbial Sensitivity Tests; Plasmids; Prospective Studies

High rates of antimicrobial resistance in Escherichia coli isolated from patients with urinary tract infections have been reported worldwide. The aim of this study was to identify risk factors for resistance to ciprofloxacin (CIP) and cefotaxime (CTX) in E. coli isolated from patients with acute pyelonephritis (APN).. We prospectively identified women over 18 y of age who visited the emergency department of one of 10 hospitals with APN and whose urine culture grew E. coli. The study was conducted from April 16 to June 10, 2012.. Of the 229 patients identified, 173 (75.5%) had community-associated (CA) infections and 56 (24.5%) had healthcare-associated (HCA) infections. Sixty-seven isolates (29.3%) were resistant to CIP, 45 (19.7%) to CTX, and 29 (12.7%) to both CIP and CTX. Multivariate analyses revealed that hematologic disease, chronic kidney disease, a bed-ridden state, indwelling urinary catheter, antibiotic treatment in the preceding 3 months, and isolation of CIP-resistant E. coli in the urine within the preceding 3 months, were significantly associated with resistance to both CIP and CTX.. Chronic conditions and healthcare-associated factors were related to resistance to both fluoroquinolones and third-generation cephalosporins in women with APN. Continued and vigilant surveillance is necessary to monitor the dissemination of antimicrobial resistance in uropathogens.

Topics: Acute Disease; Aged; Anti-Bacterial Agents; Cefotaxime; Ciprofloxacin; Drug Resistance, Multiple, Bacterial; Emergency Service, Hospital; Escherichia coli; Escherichia coli Infections; Female; Fluoroquinolones; Humans; Middle Aged; Multivariate Analysis; Prospective Studies; Pyelonephritis; Republic of Korea

Antibiotic resistance in Gram-negative bacteria, especially Enterobacteriaceae, can be conferred by a large number of different acquired resistance genes, although it appears that relatively few dominate. A previous survey of Escherichia coli and Klebsiella pneumoniae isolates from Sydney, Australia, revealed that a limited set of genes could reliably predict resistance to third-generation cephalosporins (3GCs) and aminoglycosides. Here we tested E. coli and K. pneumoniae isolates with a cefotaxime, ceftriaxone and/or ceftazidime minimum inhibitory concentration of ≥ 2 μg/mL from China and Singapore, with significantly higher resistance rates than Australia, as well as the USA. Few targets were needed to predict non-susceptibility to 3GCs (95/95; 100%) and gentamicin (47/51; 92%). The gene types detected here are consistent with previous surveys in similar countries with similar resistance rates, where the majority of 3GC resistance can be explained by blaCTX-M genes. This study identified a limited set of genes capable of predicting resistance to 3GC and aminoglycoside antibiotics and implies a restriction in the global resistance gene pool that can be exploited for diagnostic purposes.

Topics: Anti-Bacterial Agents; Cefotaxime; Ceftazidime; Ceftriaxone; China; Drug Resistance, Bacterial; Escherichia coli; Escherichia coli Infections; Genes, Bacterial; Gentamicins; Humans; Klebsiella Infections; Klebsiella pneumoniae; Microbial Sensitivity Tests; Singapore; United States

In 2009, CTX-M Enterobacteriaceae and Salmonella isolates were recovered from a UK pig farm, prompting studies into the dissemination of the resistance and to establish any relationships between the isolates.. PFGE was used to elucidate clonal relationships between isolates whilst plasmid profiling, restriction analysis, sequencing and PCR were used to characterize the CTX-M-harbouring plasmids.. Escherichia coli, Klebsiella pneumoniae and Salmonella 4,5,12:i:- and Bovismorbificans resistant to cefotaxime (n = 65) were recovered and 63 were shown by PCR to harbour a group 1 CTX-M gene. The harbouring hosts were diverse, but the group 1 CTX-M plasmids were common. Three sequenced CTX-M plasmids from E. coli, K. pneumoniae and Salmonella enterica serotype 4,5,12:i:- were identical except for seven mutations and highly similar to IncI1 plasmid ColIb-P9. Two antimicrobial resistance regions were identified: one inserted upstream of yacABC harbouring ISCR2 transposases, sul2 and floR; and the other inserted within shfB of the pilV shufflon harbouring the ISEcp1 transposase followed by blaCTX-M-1.. These data suggest that an ST108 IncI1 plasmid encoding a blaCTX-M-1 gene had disseminated across multiple genera on this farm, an example of horizontal gene transfer of the blaCTX-M-1 gene.

Topics: Animals; Anti-Bacterial Agents; Base Sequence; beta-Lactamases; Cefotaxime; Drug Resistance, Multiple, Bacterial; Escherichia coli; Escherichia coli Infections; Gene Transfer, Horizontal; Klebsiella Infections; Klebsiella pneumoniae; Microbial Sensitivity Tests; Mutation; Plasmids; Salmonella enterica; Salmonella Infections, Animal; Sequence Analysis, DNA; Swine; United Kingdom

To characterize a novel CTX-M chimera, CTX-M-137, from Escherichia coli clinical isolates in China.. Isolates were collected from five hospitals between 22 February 2009 and 20 December 2011. Resistance genes were investigated by PCR. blaCTX-M-137 was cloned and purified for kinetic measurements. Conjugation experiments, S1-PFGE and Southern blotting were performed to study the plasmid harbouring blaCTX-M-137. The genetic environment of blaCTX-M-137 was determined by genomic cloning and sequencing.. A total of 247 cephalosporin-resistant E. coli were identified. blaCTX-M group genes were the most prevalent extended-spectrum β-lactamase (ESBL) genes, with 71 isolates harbouring blaCTX-M-1 group genes and 137 isolates harbouring blaCTX-M-9 group genes. A novel chimera of CTX-M-14-like and CTX-M-15-like ESBLs, designated CTX-M-137, was identified from a 60-year-old man with a urinary tract infection. The N-terminus of CTX-M-137 matched CTX-M-14 and the C-terminus matched CTX-M-15. CTX-M-137 conferred resistance to ceftazidime, cefotaxime and aztreonam. Purified CTX-M-137 showed good hydrolytic activity against ceftazidime and cefotaxime, and was inhibited by clavulanic acid. The blaCTX-M-137 was carried on an ∼83 kb IncI1 plasmid. blaCTX-M-137 was carried on a complete transposition unit ISEcp1-blaCTX-M-137-Δorf477 inserted into yagA, which is part of the IncI1 plasmid backbone.. We identified a novel CTX-M chimera, CTX-M-137, with a CTX-M-14-like N-terminus and a CTX-M-15-like C-terminus. Our findings suggest an ongoing diversification of CTX-M-type ESBLs through recombination events.

Topics: Anti-Bacterial Agents; Aztreonam; beta-Lactam Resistance; beta-Lactamases; Cefotaxime; Ceftazidime; Clavulanic Acid; DNA, Bacterial; Escherichia coli; Escherichia coli Infections; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Molecular Sequence Data; Mutant Chimeric Proteins; Plasmids; Urinary Tract Infections

A cross-sectional study concerning farm prevalence and risk factors for the count of cefotaxime resistant Escherichia coli (E. coli) (CREC) positive samples per sampling group on German fattening pig farms was performed in 2011 and 2012. Altogether 48 farms in four agricultural regions in the whole of Germany were investigated. Faecal samples, boot swabs and dust samples from two sampling groups per farm were taken and supplemental data were collected using a questionnaire. On 85% of the farms, at least one sample contained cefotaxime resistant E. coli colonies. Positive samples were more frequent in faeces (61%) and boot swabs (54%) than in dust samples (11%). Relevant variables from the questionnaire were analysed in a univariable mixed effect Poisson regression model. Variables that were related to the number (risk) of positive samples per sampling group with a p-value <0.2 were entered in a multivariable model. This model was reduced to statistically significant variables via backward selection. Factors that increased the risk for positive samples involved farm management and hygienic aspects. Farms that had a separate pen for diseased pigs had a 2.8 higher mean count of positive samples (95%-CI [1.71; 4.58], p=0.001) than farms without an extra pen. The mean count was increased on farms with under-floor exhaust ventilation compared to farms with over floor ventilation (2.22 [1.43; 3.46], p=0.001) and more positive samples were observed on farms that controlled flies with toxin compared to farms that did not (1.86 [1.24; 2.78], p=0.003). It can be concluded, that CREC are wide spread on German fattening pig farms. In addition the explorative approach of the present study suggests an influence of management strategies on the occurrence of cefotaxime resistant E. coli.

Topics: Animals; Anti-Bacterial Agents; beta-Lactam Resistance; Cefotaxime; Colony Count, Microbial; Cross-Sectional Studies; Escherichia coli; Escherichia coli Infections; Germany; Prevalence; Risk Factors; Swine; Swine Diseases

A Shiga toxin 2 producing enterohemorrhagic Escherichia coli (EHEC) O121: H19 was isolated from a 2-year-old child who attending a nursery. An EHEC O121 outbreak in two nurseries (A, B), involving a total of 17 infected persons including 12 children, was revealed through contact investigation. The symptoms of all infected persons were almost all mild, and no one developed the hemolytic uremic syndrome. The combination use of desoxycholate-hydrogen sulfide-lactose (DHL) and CHROMagar STEC as selective isolation media was employed for efficient fecal examination. Nursery A and nursery B were combined as one group after the outbreak in nursery A was confirmed. As a result, EHEC O121 infected persons were also detected in children from nursery B. The 17 strains of EHEC O121 obtained from the total population showed almost the same pulsed-gel electrophoresis (PFGE) pattern, suggesting that these strains were very closely related. However, 13 of these 17 strains obtained from nursery A were susceptible to cefotaxime, whereas the remaining 4 strains obtained from nursery B showed cefotaxime resistance. A cefotaxime resistant Escherichia coli (E. coli) O86 strain was isolated in the stool specimen from a child who had been infected with the cefotaxime resistant EHEC O121. Both the cefotaxime resistant EHEC O121 and E. coli O86 had the same drug resistant gene (bla(CTX-M-1) group). The child was the index case of these 4 later cases and had received no antibiotics therapy prior to the laboratory examination. These findings suggested the possibility that an EHEC O121 strain had acquired a drug resistant gene from E. coli O86 in the digestive tract of the child.

Topics: Anti-Bacterial Agents; Cefotaxime; Child, Preschool; Disease Outbreaks; Disease Susceptibility; Escherichia coli; Escherichia coli Infections; Feces; Female; Humans; Male; Nurseries, Infant

To investigate the prevalence and characteristics of cefotaxime in co-resistant Escherichia coli isolates in retail chicken samples and provide or the risk assessment and evaluation of new control measures of multi-drug i isolates in retail chicken products.. Whole chicken carcasses re collected from Shanxi (n = 91), Guangdong (n = 63) and Inner 53) from April to December in 2011, cefotaxime and ciprofloxacin co- li isolates were recovered and subjected to phylogenetic group typing and usceptibility testing. All isolates were further characterized by screening for genes, quinolone resistance determinants by PCR and followed by DNA sis.. Cefotaxime and ciprofloxacin co-resistant E. coli isolates in 35.7% (73/207) of retail chicken carcasses. E. coli isolates of oup A were dominant (61.6%, 45/73) and all the isolates showed tant profiles. The dominant resistant profiles were AMP-CAZ-CTX-CIP- (n =34) and AMP-CAZ-CTX-CIP-CHL-GEN-SXT-TET (n = 24). Point and ciprofloxac mutations in quinolone resistance determination, regions of topoisomerases were identified in all the isolates and most of the isolates accumulated three (n = 56) or four (n = 12) point mutations. Plasmid mediated quinolone resistant determinants were identified in 50 isolates, including oqxAB (n = 48) , aac(6')-Ib-cr (n = 5) , qnrS1 (n = 5) and qnrS2 (n = 3). Six subtypes of blaCTX-M were identified in 72 E. coli isolates and blaCTX-M-55 (n = 62) was dominant.. Retail chicken could serve as an important reservoir of cefotaxime and ciprofloxacin co-resistant E. coli isolates.

Topics: Animals; Anti-Bacterial Agents; Cefotaxime; Chickens; Ciprofloxacin; Drug Resistance, Multiple, Bacterial; Escherichia coli; Escherichia coli Infections; Escherichia coli Proteins; Humans; Meat; Phylogeny; Plasmids; Polymerase Chain Reaction; Prevalence; Quinolones; Risk Assessment

To evaluate the prevalence of extended-spectrum cephalosporin (ESC)-resistant Enterobacteriaceae in broiler chickens, 41 rectal samples taken from 4 commercial farms were examined. Desoxycholate hydrogen sulfide lactose agars, supplemented with either 4 μg/ml cefotaxime or 16 μg/ml ceftazidime, were used to screen ESC-resistant bacteria. ESC-resistant bacteria were isolated from all samples. Of the 164 ESC-resistant bacteria (included 4 isolates per a sample), 163 were Escherichia coli, while 1 isolate was identified as Enterobacter cloacae. Extended-spectrum β-lactamase (ESBL) genes and plasmid-mediated AmpC β-lactamase genes in the isolates were determined by PCR and sequencing. One AmpC β-lactamase gene, bla(CMY-2) (66%), and 4 ESBL genes, bla(CTX-M-1) (26%), bla(CTX-M-55) (10%), bla(SHV-5) (4%) and bla(CTX-M-2) (3%), were detected in the E. coli isolates. The epidemiological relationship of the CMY-2 and CTX-M β-lactamase-producing isolates among the farms was analyzed by pulsed-field gel electrophoresis using the XbaI restriction enzyme. Forty-one (Y1-Y41) and 14 (X1-X14) clusters were found in the CMY-2 and CTX-M-carrying E. coli isolates, respectively. Some clusters included isolates derived from more than 1 farm, indicating some cross-contamination of clonal strains and spread of CMY-2 AmpC β-lactamase or CTX-M ESBL among the farms.

Topics: Animals; Base Sequence; beta-Lactamases; Cefotaxime; Ceftazidime; Chickens; DNA Primers; Electrophoresis, Gel, Pulsed-Field; Escherichia coli; Escherichia coli Infections; Escherichia coli Proteins; Japan; Molecular Sequence Data; Polymerase Chain Reaction; Poultry Diseases; Prevalence; Sequence Analysis, DNA; Species Specificity

Vaginal Escherichia coli is a reservoir along the fecal-vaginal-urinary/neonatal course of transmission in extraintestinal E. coli infections. They also causes genital tract infections especially vaginitis, so that detection of their antibiotic resistance is an important approach to control these infections. One important mechanism of resistance is ESBL production by Enterobacteriaceae especially Klebsiella spp. and Escherichia coli, which is now a worldwide problem that limits therapeutic options.. Sixty one vaginal E. coli isolates from pregnant and non-pregnant women, were detected phenotypically and genotypically for ESBL production.. Most of pregnant and non-pregnant women's isolates, were resistant to cefotaxime (100% vs. 81.5%, respectively) and more than half of them to ceftazidime (56.5% vs. 71.0%, respectively). One hundred percent each, 52.1% vs. 68.4%, and 73.9% vs. 60.5%%, were ESBL producers by screening, confirmatory, and PCR tests, respectively. Pregnant women's isolates had: CTX-M- (69.5%), SHV- and OXA-type (each 4.3%) ESBLs. Only one isolate (4.3%) had two types of ESBLs. All 16 CTX-M-positive (100%) isolates had CTX-M-1. Non-pregnant women's isolates were predominated by SHV and CTX-M -type (44.7% vs. 39.4%, respectively), followed by OXA- (15.7%), and TEM-type (2.6%). Of these isolates, 42.1% had two types of ESBL genes. All 15 CTX-M-positive (100%) isolates had CTX-M-1. Pregnant and non-pregnant women's isolates differed significantly (P≤ 0.05) regarding the expression of SHV- (4.3% vs. 44.7%, respectively) and CTX-M-type (69.5% vs. 39.4%, respectively) ESBLs. In both, CTX-M-1 was the predominant CTX-M group (each 100%). All of the isolates were susceptible to imipenem and meropenem, while the highest rate of resistance was against β-lactams. Multidrug resistance was noted in 56.2% of ESBL-producing isolates.. Ggenital tracts of pregnant and non-pregnant women represent different environments for propagation of ESBL-producing E. coli. In Iraq, nationwide study is required to make a precise estimation of this widespread of ESBL-producing bacteria.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Bacterial Load; Bacterial Typing Techniques; beta-Lactamases; Cefotaxime; Ceftazidime; Disk Diffusion Antimicrobial Tests; Drug Resistance, Multiple, Bacterial; Escherichia coli; Escherichia coli Infections; Female; Genes, Bacterial; Genotype; Humans; Middle Aged; Phenotype; Pregnancy; Pregnancy Complications, Infectious; Vagina; Young Adult

The presence of ESBL/AmpC-producing E. coli in cattle has been reported previously, however information on veal calves is limited. This study describes the prevalence and molecular characteristics of E. coli with non-wild type susceptibility to cefotaxime in veal calves at slaughter.. Faecal samples from 100 herds, 10 individual animals per herd, were screened for E. coli with non-wild type susceptibility for cefotaxime. Molecular characterization of ESBL/AmpC genes and plasmids was performed on one isolate per herd by microarray, PCR and sequence analysis.. 66% of the herds were positive for E. coli with non-wild type susceptibility for cefotaxime. Within-herd prevalence varied from zero to 90%. 83% of E. coli producing ESBL/AmpC carried bla(CTX-M) genes, of which bla(CTX-M-1), bla(CTX-M-14) and bla(CTX-M-15) were most prevalent. The dominant plasmids were IncI1 and IncF-type plasmids.. A relatively high prevalence of various bla(CTX-M) producing E. coli was found in veal calves at slaughter. The genes were mainly located on IncI1 and IncF plasmids.

Topics: Abattoirs; Animals; Bacterial Proteins; beta-Lactamases; Cattle; Cefotaxime; Cross-Sectional Studies; Drug Resistance, Bacterial; Escherichia coli; Escherichia coli Infections; Genes, Bacterial; Microbial Sensitivity Tests; Netherlands; Plasmids; Prevalence

Cloacal swabs from carcasses of Dutch wild birds obtained in 2010 and 2011 were selectively cultured on media with cefotaxime to screen for the presence of extended-spectrum β-lactamase (ESBL)/AmpC-producing Escherichia coli. Subsequently, all cefotaxime-resistant E. coli isolates were tested by broth microdilution and microarray. The presence of ESBL/AmpC and coexisting plasmid-mediated quinolone resistance (PMQR) genes was confirmed by PCR and sequencing. To determine the size of plasmids and the location of ESBL and PMQR genes, S1 pulsed-field gel electrophoresis (PFGE) was performed on transformants, followed by Southern blot hybridization. The study included 414 cloacal swabs originating from 55 different bird species. Cefotaxime-resistant E. coli isolates were identified in 65 birds (15.7%) from 21 different species. In all, 65 cefotaxime-resistant E. coli ESBL/AmpC genes were detected, mainly comprising variants of blaCTX-M and blaCMY-2. Furthermore, PMQR genes [aac(6')-lb-cr, qnrB1, and qnrS1] coincided in seven cefotaxime-resistant E. coli isolates. Overall, replicon typing of the ESBL/AmpC-carrying plasmids demonstrated the predominant presence of IncI1 (n = 31) and variants of IncF (n = 18). Our results indicate a wide dissemination of ESBL and AmpC genes in wild birds from The Netherlands, especially among aquatic-associated species (waterfowl, gulls, and waders). The identified genes and plasmids reflect the genes found predominantly in livestock animals as well as in humans.

Topics: Animals; Anti-Bacterial Agents; beta-Lactam Resistance; Birds; Cefotaxime; Cloaca; Electrophoresis, Gel, Pulsed-Field; Escherichia coli; Escherichia coli Infections; Microarray Analysis; Microbial Sensitivity Tests; Molecular Typing; Netherlands; Plasmids; Polymerase Chain Reaction; Sequence Analysis, DNA

The aim of this study was to investigate the prevalence and types of plasmid-mediated AmpC (pAmpC) beta-lactamase enzymes in Escherichia coli and Klebsiella pneumoniae strains isolated from blood cultures of hospitalized patients in Dokuz Eylul University Hospital between 2007 and 2012. A total of 261 isolates which consisted of 184 E.coli (70.5%) and 77 K.pneumoniae (29.5%) were included in the study. All isolates were resistant to cefotaxime and/or ceftazidime but susceptible to imipenem. Cefoxitin resistance was investigated as an indicator of AmpC type enzymes. A total of 57 (21.8%) isolates which were cefoxitin-resistant (32 E.coli, 25 K.pneumoniae), were screened for pampC genes by a multiplex polymerase chain reaction (PCR) assay. Additionally, 10 of each cefoxitin susceptible isolates per year were chosen randomly and screened by the same PCR assay to detect the presence of ACC enzymes, which can not hydrolyze cefoxitin. Positive PCR results were confirmed by sequence analysis. Plasmid analysis and macrorestriction analysis were performed for pampC-positive isolates. The presence of pAmpC enzymes has been shown in 9.4% (3/32) of cefoxitin-resistant E.coli, and 8% (2/25) of cefoxitin-resistant K.pneumoniae strains. It was noted that there were no strains producing this enzyme isolated in 2007 and 2008, however the prevalence of pAmpC was detected as 1.6% in 2009 (one ACT-1 producing K.pneumoniae), increasing to 4.8% in 2011 (one ACT-1 producing K.pneumoniae) and 6.4% in 2012 (three CMY-2 producing E.coli). These enzymes were found to be carried on 81 kb size plasmids in K.pneumoniae isolates and on a 9 kb size plasmid in E.coli isolates. Macrorestriction analysis indicated that two of the three CMY-2 producing E.coli had the same PFGE (Pulsed-field gel electrophoresis) pattern. If these two strains are considered as identical, it can be concluded that the prevalence of pAmpC was low in the strains isolated between 2007-2012 (4/261; 1.5%) in our institution. On the other hand, the increasing prevalence of pAmpC in 2011 and 2012 should be considered as a warning for the implementation of infection control measures and monitorization of the prevalence in order to prevent the dissemination of pAmpC. As far as the current literature is concerned, this is the first study that demonstrated the presence of the ACT-1 enzyme in K.pneumoniae isolates in Turkey.

Topics: Anti-Bacterial Agents; Bacteremia; Bacterial Proteins; beta-Lactamases; Cefotaxime; Cefoxitin; Ceftazidime; Drug Resistance, Multiple, Bacterial; Escherichia coli; Escherichia coli Infections; Humans; Imipenem; Klebsiella Infections; Klebsiella pneumoniae; Plasmids

Current knowledge on extended-spectrum beta-lactamases (ESBLs) in animals is based largely on cross-sectional studies and qualitative data. The aim of this longitudinal study was to elucidate carriage proportions and fecal counts of ESBL-producing Escherichia coli in pigs during the production cycle. At each of three ESBL-positive single-sited farrow-to-finisher pig farms (farms A, B, and C) included in the study, individual fecal samples were taken from 17 to 20 sows 1 week before farrowing and from 2 piglets of each sow's litter four times from birth to slaughter (as piglets, weaners, and finishers). Cefotaxime (CTX)-resistant coliforms in feces were counted on MacConkey agar containing 2 μg/ml CTX and characterized for the presence of ESBL-encoding genes by PCR and sequencing. CTX-M-positive pigs were detected in all age groups at farms A (bla(CTX-M-9) group, compatible with bla(CTX-M-14/17)) and B (bla(CTX-M-1) group, compatible with bla(CTX-M-1/61)), whereas only three weaners were positive at farm C (bla(CTX-M-1) group, compatible with bla(CTX-M-1/61)). A significant decrease in carriage was detected during the production cycle, with on average 50% carriage immediately after birth, 58% just before weaning, 29% during weaning, and 12% during finishing. The observed reduction in numbers of CTX-M-positive pigs was accompanied by a significant reduction in mean fecal counts of CTX-resistant coliforms from ~10(7) CFU/g in piglets to ~10(3) CFU/g in finishers (P < 0.001). These findings provide novel information about the epidemiology of ESBLs at the farm level and have important implications for assessments of risks of meat contamination during slaughter.

Topics: Animals; Anti-Bacterial Agents; Bacterial Load; beta-Lactam Resistance; beta-Lactamases; Carrier State; Cefotaxime; Culture Media; DNA, Bacterial; Escherichia coli; Escherichia coli Infections; Feces; Longitudinal Studies; Polymerase Chain Reaction; Prevalence; Sequence Analysis, DNA; Swine

The burden of neonatal bacterial infections continues. They remain a significant cause of death and morbidity, despite recommendations for prevention. The epidemiology of these infections has changed. Currently the two most causative pathogens for early-onset neonatal sepsis and for late-onset sepsis in term infants are Group B streptococci (GBS) and Escherichia coli. E. coli's role is increasingly important since the widespread use of intrapartum antibiotic prophylaxis. In late-onset infections, one of the suggested pathophysiological mechanisms is microbial translocation in the gut secondary to digestive colonization, particularly when E. coli is isolated in blood cultures. This can occur either before or after birth. Bacterial sepsis can be associated with various non-specific peripheral manifestations involving skin and soft tissues. We report the case of a full-term, 26-day-old newborn admitted to the hospital for fever. She presented with dermohypodermitis of the left trunk and was diagnosed with E. coli septicemia. She was discharged in good condition after appropriate intravenous antibiotic therapy.

Topics: Abdomen; Amikacin; Amoxicillin; Anti-Bacterial Agents; Bacteremia; Bacterial Translocation; Cefotaxime; Escherichia coli; Escherichia coli Infections; Feces; Female; Fever; Humans; Infant, Newborn; Infant, Newborn, Diseases; Skin Diseases; Thorax; Treatment Outcome

To characterize the diversity of extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli isolates recovered within the faecal microbiota of Iberian lynx. The identification of other associated resistance genes and the analysis of clonal relationship were also focused in this study.. From 2008 to 2010, 128 faecal samples of Iberian lynx (wild and captive animals) were collected. Eleven tested samples contained cefotaxime-resistant E. coli isolates (all belonging to captive animals) and 10 ESBL-producing isolates were showed. CTX-M-14 and SHV-12 ESBL-types were detected and seven different patterns were identified by pulsed-field gel electrophoresis analysis.. The occurrence of unrelated multiresistant E. coli in faecal flora of captive specimens of Iberian lynx, including the presence of ESBLs, resistant genes in integrons and virulence determinants was showed in this study.. The results obtained in this study highlight the environmental problem as future reintroductions of Iberian lynx could lead to a spread of resistant bacteria. Additionally, ESBL-producing bacteria can represent a health problem for this endangered species.

Topics: Animals; beta-Lactamases; Cefotaxime; Conservation of Natural Resources; Drug Resistance, Bacterial; Electrophoresis, Gel, Pulsed-Field; Endangered Species; Escherichia coli; Escherichia coli Infections; Feces; Integrons; Lynx; Spain

We investigated the performance of cefotaxime for the detection of extended-spectrum β-lactamase (ESBL) or plasmid-mediated AmpC β-lactamase (pAmpC) and the clinical characteristics of cefotaxime-non-susceptible Escherichia coli or Klebsiella pneumoniae (CTXNS-EK) bacteraemia. All of the consecutive bloodstream isolates between 2005 and 2010 in a Japanese university hospital were characterised using polymerase chain reaction (PCR). Risk factors and outcomes of CTXNS-EK were analysed by multivariate logistic regression analysis. We identified 58 CTXNS-EK (15.6%) from 249 E. coli and 122 K. pneumoniae. Cefotaxime with a minimum inhibitory concentration (MIC) of >1 μg/mL had a sensitivity of 98.3% and a specificity of 99.7% for the detection of ESBL or pAmpC. CTXNS-EK had increased from 4.5% in 2005 to 23% in 2009. Risk factors for CTXNS-EK were previous isolation of multidrug-resistant bacteria, use of oxyimino-cephalosporins or fluoroquinolones, and high Sequential Organ Failure Assessment (SOFA) score. Patients with CTXNS-EK bacteraemia less frequently received appropriate empirical therapy than patients with cefotaxime-susceptible EK bacteraemia (81% vs. 97%, p<0.001) and died within 30 days (21% vs. 5%, p=0.001). Using the current breakpoints of the Clinical and Laboratory Standards Institute (CLSI) or the European Committee on Antimicrobial Susceptibility Testing (EUCAST), cefotaxime alone can identify ESBL or pAmpC producers. CTXNS-EK is an important and increasingly prevalent bacteraemia pathogen.

Topics: Aged; Anti-Bacterial Agents; Bacteremia; beta-Lactamases; Cefotaxime; Cohort Studies; DNA, Bacterial; Escherichia coli; Escherichia coli Infections; Female; Hospitals, University; Humans; Japan; Klebsiella Infections; Klebsiella pneumoniae; Male; Microbial Sensitivity Tests; Middle Aged; Polymerase Chain Reaction; Retrospective Studies; Risk Factors; Sensitivity and Specificity; Treatment Outcome

An 80-year-old woman with hilar cholangiocarcinoma was hospitalized due to sudden-onset abdominal pain. Computed tomography revealed hepatic necrosis accompanied with emphysematous change in the superior segment of the right liver (S7/S8), implying spontaneous rupture, based on the presence of perihepatic free air. Although urgent percutaneous drainage was performed, neither pus nor fluids were drained. These findings suggest emphysematous hepatitis with a hepatic mass. Despite the application of intensive care, the patient's condition deteriorated rapidly, and she died 3 days after admission to hospital. Liver gas has been reported in some clinical diseases (e.g., liver abscess) to be caused by gas-forming organisms; however, emphysematous hepatitis simulating emphysematous pyelonephritis is very rare. The case reported here was of fatal emphysematous hepatitis in a patient with hilar cholangiocarcinoma.

Topics: Aged, 80 and over; Anti-Bacterial Agents; Bile Duct Neoplasms; Bile Ducts, Intrahepatic; Cefotaxime; Cholangiocarcinoma; Clostridium Infections; Clostridium perfringens; Emphysema; Escherichia coli; Escherichia coli Infections; Female; Hepatitis; Humans; Metronidazole; Pneumoperitoneum; Tomography, X-Ray Computed

Extended-spectrum β-lactamase (ESBL)-producing bacteria coexpressing AmpC type β-lactamase (ACBL) are associated with the laboratory issue of false susceptibility to third-generation cephalosporins. This study was to evaluate laboratory tests and clinical significance of bacteremic isolates of Escherichia coli and Klebsiella pneumoniae with both ESBL and ACBL [dual-type lactamases (DTL)].. From 2006 to 2009, 78 E coli and 12 pneumoniae bacteremic isolates with reduced susceptibility to cefotaxime (CTX) or ceftazidime (CAZ) were identified and relevant patients' data were collected for analysis. Phenotypic and genotypic characterizations of these selected isolates were determined by inhibitor-based assays and polymerase chain reaction-based genetic analyses, respectively.. Among the 90 isolates, 47 had DTL production. There was an increasing annual prevalence from 29% in 2006 to 56% in 2009 (p=0.02). Phenotypic assays had a sensitivity and specificity of 57% (43/76) and 93% (13/14) for ESBL detection and 95% (58/61) and 34% (10/29) for ACBL, respectively. Among the DTL-producing isolates, phenotypic assays yielded a higher false negative rate of ESBL detection than that of ACBL detection (70% versus 6%), while all false negative ESBL results were associated with ESBL genes other than bla(CTx-M). The majority of the DTL-producing isolates were in the category of resistance to CTX (47/47, 100%) and CAZ (44/47, 94%) by the Clinical and Laboratory Standards Institute (CLSI) 2010 interpretive criteria, of which many were considered intermediate or fully susceptible to CTX (25/47, 53%) and CAZ (15/47, 32%) by the previous ones (CLSI-2009). The DTL-producing isolates exhibited a lower susceptibility rate to fluoroquinolones, aztreonam, and β-lactam/lactamase inhibitors than those with either ESBL or ACBL alone. The use of indwelling catheters or nasogastric tubes was associated with bacteremia due to the DTL isolates, but the mortality rates were not different among those due to isolates with ESBL, ACBL, or both. By multivariate analysis, Pittsburg bacteremia score and Charlson comorbidity index were the significant predictors for all-cause mortalities.. Bacteremic episodes due to DTL-producing E coli and K pneumoniae became increasingly prevalent and were often associated with coresistance to antibiotics other than β-lactams, but they were not associated with a worse prognosis than those due to ESBL- or ACBL-producing bacteria.

Topics: Aged; Analysis of Variance; Anti-Bacterial Agents; Bacteremia; Bacterial Proteins; beta-Lactamases; Cefotaxime; Ceftazidime; Chi-Square Distribution; Drug Resistance, Bacterial; Escherichia coli; Escherichia coli Infections; False Negative Reactions; Female; Humans; Klebsiella Infections; Klebsiella pneumoniae; Male; Microbial Sensitivity Tests; Middle Aged; Phenotype; Prevalence; Risk Factors; Sensitivity and Specificity

Red-legged partridges (Alectoris rufa) are a significant part of the culture, diet and income for many people in central and southern Spain. Due to declining populations in the wild, intensive farming is common and 4 million juvenile partridges are released each autumn. Intensive management and high densities result in high prevalence of enteric disease and the use of antimicrobials as preventive measures on partridge farms and prior to restocking in the wild. We determined the occurrence of avian pathogenic Escherichia coli (APEC), and screened phenotypic resistance of E. coli against enrofloxacin, gentamicin and cefotaxim in farmed, restocked and wild partridges. Prevalence of APEC in farmed and restocked red-legged partridges was significantly higher than in natural populations. Phenotypic resistance against both gentamicin and enrofloxacin was significantly more frequent in farmed (75%) and restocked (43%) partridges than in wild partridges, while most E. coli isolated from natural populations were susceptible to all three antimicrobials tested (65%). This indicates that farmed and restocked partridges carry APEC that could be a reason for disease outbreaks on farms, and that E. coli carried by farmed and restocked partridges can acquire resistance to frequently used antimicrobials, thus being a concern for the environment, wild birds and consumers. Management in farms and restocking procedures may create a hazard not only for spreading APEC, but also as a potential source of resistant E. coli in the environment.

Topics: Animal Husbandry; Animals; Animals, Domestic; Animals, Wild; Anti-Bacterial Agents; Bird Diseases; Cefotaxime; Drug Resistance, Bacterial; Electrophoresis, Gel, Pulsed-Field; Enrofloxacin; Escherichia coli; Escherichia coli Infections; Feces; Fluoroquinolones; Galliformes; Gentamicins; Humans; Microbial Sensitivity Tests; Phenotype; Prevalence; Spain

We characterized 67 Escherichia coli isolates with reduced susceptibility to cefotaxime obtained from 136 samples of healthy broilers housed in 36 Tunisian farms. All these isolates harboured blaCTX-M-1 and/or blaCMY-2 genes located mostly on self-conjugative IncI1 plasmids. qnrS1, qnrA6 and aac(6')-Ib-cr were detected in six isolates. Considerable genetic diversity was detected among isolates from different farms. To our knowledge, this is the first detailed documentation of a high occurrence of blaCTX-M-1 and blaCMY-2 in E. coli at the poultry farm level in Tunisia as well as the first description of plasmid-mediated quinolone resistance in food animals in Tunisia which may contribute to the dissemination of these genes throughout Tunisia.

Topics: Animals; beta-Lactamases; Cefotaxime; Chickens; Drug Resistance, Multiple, Bacterial; Escherichia coli; Escherichia coli Infections; Escherichia coli Proteins; Feces; Microbial Sensitivity Tests; Plasmids; Quinolones; Tunisia

In 2007, the Robert Koch Institute established the infrastructure for the national Antimicrobial Resistance Surveillance (ARS) system. Laboratories submit data of routine susceptibility testing of clinical samples from hospitals as well as from outpatient care settings in a standardized format to the Robert Koch Institute for central processing. The database for the period 2008-2011 comprises data of about 1.3 million samples from patients in hospital care and almost 800,000 samples from outpatients. Based on SIR interpretations of susceptibility, the trends of methicillin resistance of Staphylococcus aureus (MRSA) and cefotaxime non-susceptibility as an indicator of extended-spectrum beta-lactamases (ESBL) of Escherichia coli and Klebsiella pneumoniae were analyzed for four care settings or categories: hospital care, outpatient care, intensive care units, and isolates from blood cultures. After constant high levels of above 20%, the proportion of MRSA isolates showed a decline for the first time from 2010 to 2011 in hospital care overall, in intensive care units as well as in blood cultures; in outpatient care, MRSA proportions of about 13% were observed. Within the observed period, non-susceptibility to cefotaxime as an indicator of ESBL in E. coli showed an increasing trend in hospital care at a level above 10% in intensive care units, while cefotaxime non-susceptibility in K. pneumoniae was more frequent but without any trend. In outpatient care, the proportions of cefotaxime non-susceptibility increased year by year in both species resulting in nearly a doubling to 6%.

Topics: Bacteremia; beta-Lactamases; Cefotaxime; Community-Acquired Infections; Cross Infection; Cross-Sectional Studies; Drug Resistance, Bacterial; Escherichia coli; Escherichia coli Infections; Germany; Humans; Intensive Care Units; Klebsiella Infections; Klebsiella pneumoniae; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Sentinel Surveillance; Staphylococcal Infections

Escherichia coli and the antimicrobial pressure exerted on this microorganism can be modulated by factors dependent on the host. In this paper, we describe the distribution of antimicrobial resistance to amikacin, tobramycin, ampicillin, amoxicillin clavulanate, cefuroxime, cefoxitin, cefotaxime, imipenem, ciprofloxacin, fosfomycin, nitrofurantoin, and trimetoprim-sulfametoxazole in more than 100,000 E. coli isolates according to culture site and patient age, gender, and location. Bayesian inference was planned in all statistical analysis, and Markov chain Monte Carlo simulation was employed to estimate the model parameters. Our findings show the existence of a marked difference in the susceptibility to several antimicrobial agents depending on from where E. coli was isolated, with higher levels of resistance in isolates from medical devices, the respiratory system, and the skin and soft tissues; a higher resistance percentage in men than in women; and the existence of a clear difference in antimicrobial resistance with an age influence that cannot be explained merely by means of an increase of resistance after exposure to antimicrobials. Both men and women show increases in resistance with age, but while women show constant levels of resistance or slight increases during childbearing age and greater increases in the premenopausal age, men show a marked increase in resistance in the pubertal age. In conclusion, an overwhelming amount of data reveals the great adaptation capacity of E. coli and its close interaction with the host. Sex, age, and the origin of infection are determining factors with the ability to modulate antimicrobial resistances.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Amikacin; Ampicillin; Anti-Bacterial Agents; Cefotaxime; Child; Child, Preschool; Ciprofloxacin; Drug Resistance, Multiple, Bacterial; Escherichia coli; Escherichia coli Infections; Female; Fosfomycin; Humans; Imipenem; Infant; Male; Middle Aged; Nitrofurantoin; Retrospective Studies; Tobramycin; Young Adult

The aim of this prospective study was to assess the extent of dissemination of extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae at the hospital level in the United Arab Emirates (UAE).. A total of 662 Escherichia coli and Klebsiellapneumoniae samples were collected from three UAE hospitals between January and December 2008. ESBL screening and confirmatory test for ESBL phenotype were conducted using the VITEK system. Molecular typing was performed using specific primers and then sequencing.. A total of 240 (36%) samples were identified as ESBL producers, including both E. coli (n = 150) and K. pneumoniae (n = 90). All of these isolates were resistant to cefazoline and cefotaxime, but remained susceptible to imipenem. Molecular analysis revealed that, of the 240 ESBL producers, 228 carried the ESBL bla genes. A majority of the strains 199 (87%) expressed the CTX-M-15 gene. The SHV-28 gene was detected in 29 (13%) of the strains.. The present study highlighted the emergence and dissemination of CTX-M-15-producing E. coli and K. pneumoniae in the UAE. This is the first report of SHV-28-producing Enterobacteriaceae in the country.

Topics: Adolescent; Adult; Anti-Bacterial Agents; beta-Lactamases; Cefazolin; Cefotaxime; Child; Child, Preschool; Drug Resistance, Multiple, Bacterial; Enterobacteriaceae; Escherichia coli Infections; Female; Humans; Klebsiella Infections; Klebsiella pneumoniae; Male; Microbial Sensitivity Tests; Middle Aged; Molecular Typing; Prospective Studies; United Arab Emirates; Young Adult

To investigate the effect of sub-inhibitory concentrations of cefotaxime on adherence to siliconized latex urinary catheters of uropathogenic Escherichia coli strains from pregnant and non pregnant patients.. Using random sampling, 30 E. coli strains were selected from hospitalized patients with catheter associated urinary tract infection, 12 from pregnant women and 18 from men and non-pregnant women. The strains were categorized on the basis of cefotaxime susceptibility, adhesion and biofilm production capacity, cell surface hydrophobicity and expression of adhesins and fimbriae in vitro.. The overall results indicated that sub-inhibitory concentrations of cefotaxime could reduce the adhesiveness, the biofilm production and hence, potentially, the infection rate associated with indwelling urinary catheters.. Based on our results, we propose that this reduction is due to decreasing exopolysaccharide production and increasing cell surface hydrophobicity of E.coli strains.

Topics: Anti-Bacterial Agents; Bacterial Adhesion; Biofilms; Catheter-Related Infections; Cefotaxime; Cell Membrane; Escherichia coli Infections; Female; Fimbriae, Bacterial; Humans; Hydrophobic and Hydrophilic Interactions; Latex; Male; Osmolar Concentration; Pregnancy; Pregnancy Complications, Infectious; Silicone Elastomers; Surface Properties; Urinary Tract Infections; Uropathogenic Escherichia coli

Of forty-seven extended-spectrum cephalosporin-resistant Escherichia coli isolates, collected from children at the Children's Hospital in 2006 (Tunis, Tunisia), we analyzed 32 isolates that were genotypically different by enterobacterial repetitive intergenic consensus -polymerase chain reaction. For all isolates, the double-disk diffusion test revealed synergy between clavulanate and cefotaxime and/or ceftazidime, suggesting the production of extended-spectrum beta-lactamases. Polymerase chain reaction experiments, performed on plasmid DNA, and sequencing revealed the presence of bla(TEM-1B) (26 isolates, 81%), bla(TEM-34(IRT-6)) (3 isolates, 9%), bla(SHV-12) (2 isolates, 6%), and bla(CTX-M-15) (31 isolates, 97%). Further, the insertion sequence ISEcp1 was found upstream from the bla(CTX-M-15) gene in 11 isolates. The bla genes were found alone or in various combinations in a single isolate. bla(TEM-1B) and bla(CTX-M-15) genes were detected in 26 out of the 32 isolates. Three isolates harbored both bla(TEM-34(IRT-6)) and bla(CTX-M-15). bla(SHV-12) was identified either alone or with bla(CTX-M-15) in a single isolate. Our investigation showed the dominance of CTX-M-type extended-spectrum beta-lactamases, with CTX-M-15 particularly common, and to our best knowledge, this is the first report of the coexistence of CTX-M-15 and IRT-6 in E. coli isolates from children in Tunisia.

Topics: Anti-Bacterial Agents; Bacterial Typing Techniques; beta-Lactamases; Cefotaxime; Ceftazidime; Child; Clavulanic Acid; Disk Diffusion Antimicrobial Tests; DNA Transposable Elements; DNA, Bacterial; DNA, Intergenic; Drug Resistance, Bacterial; Escherichia coli; Escherichia coli Infections; Feces; Humans; Plasmids; Polymerase Chain Reaction; Tunisia

The purpose of this study was to investigate the molecular epidemiology of CTX-M-14-producing Escherichia coli clinical isolates from Korea.. A total of 138 non-duplicate E. coli clinical isolates showing reduced susceptibility or resistance to ceftazidime and/or cefotaxime were included in the study. Resistance genes, genetic environment, R plasmid size and replicon type, sequence type (ST) and XbaI-macrorestriction patterns were determined.. Among 138 isolates, 35 were found to carry the bla(CTX-M-14) gene. The ISEcp1 element was identified in the upstream region of the bla(CTX-M-14) gene in 32 isolates. The bla(CTX-M-14) gene was located on an IncF plasmid in 21 isolates, on an IncA/C plasmid in 1 isolate, on the chromosome in 8 isolates and on both the chromosome and an IncF plasmid in 5 isolates. The most prevalent ST was ST405 (n = 8), followed by ST354 (n = 4), ST38 (n = 3), ST69 (n = 3) and the intercontinental ST, ST131 (n = 3). PFGE and multilocus sequence typing experiments demonstrated no major clonal relationship among the CTX-M-14-producing isolates.. The bla(CTX-M-14) gene was probably mobilized by IncF plasmids, which can readily spread in E. coli, causing horizontal dissemination of the resistance gene in Korea.

Topics: Anti-Bacterial Agents; Bacterial Typing Techniques; beta-Lactam Resistance; beta-Lactamases; Cefotaxime; Ceftazidime; Deoxyribonucleases, Type II Site-Specific; DNA, Bacterial; Escherichia coli; Escherichia coli Infections; Gene Transfer, Horizontal; Korea; Molecular Epidemiology; Molecular Sequence Data; Molecular Typing; Plasmids; Polymorphism, Restriction Fragment Length; Sequence Analysis, DNA

Relative to the cefotaxime-gentamicin combination, the moxifloxacin-cefotaxime combination significantly reduced microglial activation and immature oligodendrocyte cell death and delayed myelination in the developing white matter of neonatal rats with experimental Escherichia coli sepsis. These neuroprotective effects were not due to differences in in vivo bactericidal activities or in the systemic inflammatory responses and could be related to the intrinsic immunomodulatory properties of moxifloxacin. Molecular mechanisms underlying the neuroprotective effect of moxifloxacin remain to be elucidated.

Topics: Animals; Animals, Newborn; Anti-Bacterial Agents; Aza Compounds; Cefotaxime; Escherichia coli Infections; Fluoroquinolones; Gentamicins; Leukoencephalopathies; Moxifloxacin; Quinolines; Rats; Rats, Sprague-Dawley; Sepsis

It is crucial that nephrologists correctly identify acute focal bacterial nephritis, as timely and adequate treatment with appropriate antibiotics can prevent unnecessary investigations, invasive surgical procedures, and renal complications such as renal abscess or renal scar. An urgent kidney ultrasonography should be performed if there is a delayed response to appropriate antibiotic treatment in patients with urinary tract infection. Serial kidney ultrasonography plays a significant role in confirming the diagnosis and monitoring the progression of acute focal bacterial nephritis. We presented a patient with acute focal bacterial nephritis and showed that a serial kidney ultrasonography could prevent the use of invasive investigations and inappropriate surgical procedures.

Topics: Acute Disease; Cefotaxime; Child, Preschool; Ciprofloxacin; Disease Progression; Drug Therapy, Combination; Escherichia coli; Escherichia coli Infections; Female; Follow-Up Studies; Humans; Monitoring, Physiologic; Nephritis; Risk Assessment; Severity of Illness Index; Treatment Outcome; Ultrasonography, Doppler

We characterized 67 Escherichia coli isolates with reduced susceptibility to cefotaxime or ceftiofur obtained from healthy broilers housed in five Italian farms. The bla(CTX-M-1), bla(CTX-M-32) and bla(SHV-12) beta-lactamase genes were identified on IncI1, IncN, or IncFIB plasmids. Considerable genetic diversity was detected among the extended-spectrum beta-lactamase (ESBL)-producing isolates, and we identified indistinguishable strains in unrelated farms and indistinguishable plasmids in genetically unrelated strains. The detection of highly mobile plasmids suggests a potential animal reservoir for beta-lactamase genes.

Topics: Amplified Fragment Length Polymorphism Analysis; Animals; beta-Lactamases; Cephalosporin Resistance; Chickens; Disease Reservoirs; Escherichia coli; Escherichia coli Infections; Escherichia coli Proteins; Genes, Bacterial; Genetic Variation; Humans; Italy; Microbial Sensitivity Tests; Plasmids

Extended-spectrum AmpC beta-lactamase (ESAC) Escherichia coli producers were investigated over a 5-year period. Eleven isolates presenting a strong ampC promoter and different strategic AmpC mutations, including two newly described modifications (A292V and an L-A-A insertion at 295), were characterized. All the isolates belonged to phylogenetic group A and to the ST23 complex.

Topics: Bacterial Proteins; beta-Lactam Resistance; beta-Lactamases; Cefepime; Cefotaxime; Ceftazidime; Cephalosporins; Escherichia coli; Escherichia coli Infections; Escherichia coli Proteins; France; Hospitalization; Humans; Molecular Sequence Data; Mutation; Phylogeny; Promoter Regions, Genetic

From 2002 to 2008, there was a significant increase in extended-spectrum beta-lactamase (ESBL)-positive Escherichia coli isolates in European intra-abdominal infections, from 4.3% in 2002 to 11.8% in 2008 (P < 0.001), but not for ESBL-positive Klebsiella pneumoniae isolates (16.4% to 17.9% [P > 0.05]). Hospital-associated isolates were more common than community-associated isolates, at 14.0% versus 6.5%, respectively, for E. coli (P < 0.001) and 20.9% versus 5.3%, respectively, for K. pneumoniae (P < 0.01). Carbapenems were consistently the most active drugs tested.

Topics: Abdomen; Anti-Bacterial Agents; beta-Lactamases; Carbapenems; Cross Infection; Escherichia coli; Escherichia coli Infections; Humans; Klebsiella Infections; Klebsiella pneumoniae

The aim of this research is to evaluate the recent changes in microorganisms causing spontaneous bacterial peritonitis in cirrhotic patients, antibiotic resistance, and response to empirical cephalosporin therapy. A total of 218 patients with ascites secondary to cirrhosis were enrolled. Parenteral cefotaxime or cefepime was given to patients who had a neutrophil count of 250/mm(3) or more or a positive bacterial culture of ascitic fluid. Antibiotic failure was defined by an absence of clinical improvement and an insufficient decrease in neutrophil count of ascites (<25% of initial value) by the third day of therapy. Of all the patients, 44.6% had culture-negative neutrocytic ascites, 24.8% had spontaneous bacterial peritonitis, and 10.1% had monomicrobial nonneutrocytic bacterascites. Growth in culture was observed in 76 patients (34.9%). The two most common isolated bacteria were Escherichia coli (33.8%) and coagulase-negative Staphylococcus (CoNS; 19.7%). The two cephalosporins were effective against E. coli (82%) and but not against CoNS (44%), while levofloxacin showed reasonable activity against both E. coli (71%) and CoNS (90%) in vitro. We confirmed a recent increased incidence of spontaneous bacterial peritonitis caused by Gram-positive bacteria. Levofloxacin seems to be a good alternative treatment for patients with uncomplicated spontaneous ascites infections.

Topics: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Ascitic Fluid; Bacterial Infections; Cefepime; Cefotaxime; Cephalosporins; Drug Resistance, Bacterial; Enterococcus; Escherichia coli Infections; Female; Humans; Infusions, Intravenous; Klebsiella Infections; Klebsiella pneumoniae; Leukocyte Count; Levofloxacin; Liver Cirrhosis; Male; Microbial Sensitivity Tests; Middle Aged; Neutrophils; Ofloxacin; Peritonitis; Pneumococcal Infections; Pseudomonas aeruginosa; Pseudomonas Infections; Staphylococcal Infections

The Shiga toxin-producing Escherichia coli (STEC) is an emerging foodborne pathogen. The proportion of cases attributed to STEC in an episode of diarrhea in the Faisalabad region of Pakistan was investigated. In addition, as increase in Shiga toxin (Stx) release after exposure to various antimicrobial agents is widely reported, we also elucidated the in vitro effects of three commonly used antibiotics (ampicillin, gentamicin, and cefotaxime) on Stx release. Isolation and detection of STEC was done using enzyme-linked immunosorbent assay and polymerase chain reaction, followed by phenotypic characterization. In vitro Stx release from isolated STEC was determined using enzyme-linked immunosorbent assay, and Stx-induced verocytotoxicity was quantified using cytotoxicity detection assay. STEC was detected in 5 (21.7%) of 23 patients. Exposure to minimum inhibitory concentration (MIC) of ampicillin, gentamicin, and cefotaxime resulted in a considerable decrease in toxin release and level of cytotoxicity in most of the STEC isolates when compared with control (without antibiotic exposure). Exposure to sub-MIC of ampicillin resulted in a relative increase in Stx release and cytotoxicity (p

Topics: Adhesins, Bacterial; Ampicillin; Animals; Anti-Bacterial Agents; Cefotaxime; Child; Child, Preschool; Chlorocebus aethiops; Disease Outbreaks; Dysentery; Escherichia coli Infections; Escherichia coli Proteins; Gentamicins; Hemolysin Proteins; Humans; Microbial Sensitivity Tests; Pakistan; Phenotype; Shiga Toxins; Shiga-Toxigenic Escherichia coli; Vero Cells; Virulence

The study aimed at (i) characterizing the mode of transmission of bla(CTX-M) and bla(TEM-1) among extended-spectrum-beta-lactamase (ESBL)-producing Escherichia coli strains isolated from infected diabetic foot ulcers, and (ii) identifying the risk factors for "sex-associated multidrug resistant Gram-negative bacterial (MDRGNB)-infection status" of the ulcers.. Seventy-seven diabetic patients having clinically infected foot ulcers were studied in a consecutive series. The E. coli strains isolated from the ulcers were screened for bla(CTX-M), bla(TEM-1), armA, rmtA and rmtB during the 2-year study-period. PCR amplified bla(CTX-M) genes were cloned and sequenced. Enterobacterial repetitive intergenic consensus (ERIC)-PCR was used for the analysis of genetic relatedness of the ESBL-producers. Risk factors for "sex-associated MDRGNB-infection status" of ulcers were assessed. Modeling was performed using Swiss-Model-Server and verified by Procheck and verify3D programmes. Discovery Studio2.0 (Accelrys) was used to prepare Ramachandran plots. Z-scores were calculated using 'WHAT IF'-package. Docking of cefotaxime with modeled CTX-M-15 enzyme was performed using Hex5.1.. Among 51 E. coli isolates, 14 (27.5%) ESBL-producers were identified. Only 7 Class1 integrons, 2 bla(CTX-M-15), and 1 bla(TEM-1) were detected. Ceftazidime and cefotaxime resistance markers were present on the plasmidic DNA of both the bla(CTX-M-15) positive strains and were transmissible through conjugation. The residues Asn132, Glu166, Pro167, Val172, Lys234 and Thr235 of CTX-M-15 were found to make important contacts with cefotaxime in the docked-complex. Multivariate analysis proved 'Glycemic control at discharge' as the single independent risk factor.. Male diabetic patients with MDRGNB-infected foot ulcers have poor glycemic control and hence they might have higher mortality rates compared to their female counterparts. Plasmid-mediated conjugal transfer, albeit at a low frequency might be the possible mechanism of transfer of bla(CTX-M-15) resistance marker in the present setting. Since the docking results proved that the amino acid residues Asn132, Glu166, Pro167, Val172, Lys234 and Thr235 of CTX-M-15 (enzyme) make important contacts with cefotaxime (drug) in the 'enzyme-drug complex', researchers are expected to duly utilize this information for designing more potent and versatile CTX-M-inhibitors.

Topics: Anti-Bacterial Agents; beta-Lactam Resistance; beta-Lactamases; Blood Glucose; Cefotaxime; Ceftazidime; Conjugation, Genetic; Diabetic Foot; Escherichia coli; Escherichia coli Infections; Female; Humans; India; Male; Microbial Sensitivity Tests; Molecular Sequence Data; Plasmids; Risk Factors

Extended spectrum beta-lactamases (ESBLs) are cephalosporinases that confer resistance to a wide variety of oxyimino cephalosporins and create serious therapeutic problems. In addition, the quinolone resistance qnr genes are becoming increasingly prevalent in clinical isolates, some of which also produce ESBL. This study was designed to evaluate the occurrence and genotypic distribution of ESBL producing Escherichia coli (E. coli) and Klebsiella pneumoniae (K. pneumoniae) as well as the prevalence and distribution of qnr genes in ESBL-producing isolates in a tertiary care hospital in Korea.. We tested a total of 111 ESBL-producing isolates of E. coli and K. pneumoniae, which were collected at Kyung Hee Medical Center from November 2006 to June 2008. ESBL production was determined by the Clinical and Laboratory Standards Institute (CLSI) ESBL confirmatory test. The cefotaxime and ceftazidime resistance of the ESBL-producers were transferred to azide-resistant E. coli J53 by conjugation. The presence and identity of ESBL and qnr genes were determined by polymerase chain reaction (PCR) and nucleotide sequencing.. The prevalence of ESBLs was 17.7% (297/1,680) of E. coli and 26.5% (240/904) of K. pneumoniae in our hospital during the study periods. Of the 111 collected isolates, 69 isolates were E. coli and 42 isolates were K. pneumoniae. The most prevalent ESBL genotype was CTX-M15. Among the ESBL-producing isolates, 4 E. coli (5.8%) and 17 K. pneumoniae (40.5%) contained qnr genes. qnrB4 was the most frequent type in both E. coli and K. pneumoniae.. CTX-M15 was the most frequently encountered ESBL. In addition, a high prevalence of qnr genes among ESBL-producing K. pneumoniae was identified in this study.

Topics: Azides; Bacterial Proteins; beta-Lactamases; Cefotaxime; Ceftazidime; Drug Resistance, Multiple, Bacterial; Escherichia coli; Escherichia coli Infections; Escherichia coli Proteins; Humans; Klebsiella Infections; Klebsiella pneumoniae; Korea; Microbial Sensitivity Tests; Polymerase Chain Reaction

A combination of phenotypic and genotypic methods was used to investigate 70 unique Escherichia coli clinical isolates identified as producing extended-spectrum beta-lactamases (ESBLs) at a medical center in Pittsburgh, PA, between 2007 and 2008. Fifty-seven isolates (81%) produced CTX-M-type ESBLs, among which CTX-M-15 was predominant (n = 46). Isolates producing CTX-M-2, -9, -14, and -65 were also identified. One CTX-M-producing isolate coproduced CMY-2 cephalosporinase. Ten isolates (14%) produced SHV-type ESBLs, either SHV-5 or SHV-7. Two isolates produced only CMY-2 or -32. Pulsed-field gel electrophoresis revealed the presence of two major clusters of CTX-M-15-producing E. coli isolates, one in phylotype B2 (n = 15) and the other in phylotype A (n = 19). Of four phylotype B2 isolates that were able to transfer the bla(CTX-M-15)-carrying plasmids, three showed fingerprints related (>60%) to those of plasmids from phylotype A isolates. In phylotype B2, all CTX-M-15-producing isolates, as well as three isolates producing CTX-M-14, two producing SHV-5, and one producing SHV-7, belonged to the international epidemic clone defined by serotype O25:H4 and sequence type 131. The plasmids from eight of nine CTX-M-15-producing E. coli isolates of phylotype A that were examined were highly related to each other and were also found in two isolates belonging to phylotype D, suggesting horizontal transfer of this bla(CTX-M-15)-carrying plasmid between phylotypes. Our findings underscore the need to further investigate the epidemiology and virulence of CTX-M-producing E. coli in the United States.

Topics: beta-Lactamases; Drug Resistance, Bacterial; Electrophoresis, Gel, Pulsed-Field; Escherichia coli; Escherichia coli Infections; Gene Transfer, Horizontal; Humans; Microbial Sensitivity Tests; Plasmids

Multiresistant, extended spectrum beta lactamase (ESBL)-producing pathogens are an increasing problem in daily clinical life. This paper summarizes the development of resistance as well as epidemiology, diagnostics, and treatment of ESBL-producing micro-organisms. We analyzed microbiological data collected at the Grosshadern Clinic in Germany between 1996 and 2007, in order to assess the importance of these micro-organisms to medical practice and surgical care units.. Pathogens were isolated from 28,894 patients with Escherichia coli and 10,903 with Klebsiella pneumoniae pathogens between 1996 and 2006 and tested for ESBL production. For the year 2007 we have analyzed the complete spectrum of ESBL-producing pathogens and their distribution to different departments of the clinic. The agar diffusion test with five cephalosporins and an automated detection system (BD Phoenix) were used for screening purposes. Positive results were verified with the E- and double-disc agar diffusion tests.. The most important pathogens isolated from patients were E. coli and K. pneumoniae. Analysis of ESBL-producing E. coli pathogens from 1996 to 2006 showed the prevalence increasing from 0% to 4.1%. For ESBL-producing K. pneumoniae, we also found a prevalence rising from 0.3% in 1996 to 6.6% in 2006. For the year 2007 a further increase in ESBL-producing pathogens was detected, reaching 182 cases, with 118 of ESBL-producing E. coli (5.7 %) and 39 of ESBL-producing K. pneumoniae (7.4%). Of these, 24 cases with E. coli and nine with K. pneumoniae were surgery patients (20% and 23%, respectively).. The results show an increasing prevalence of ESBL-producing pathogens in hospitalized patients and in surgical departments. The resulting rise in treatment costs and patient risk require thorough knowledge of risk factors, therapy, and preventive measures.

Topics: Anti-Bacterial Agents; beta-Lactam Resistance; Cefotaxime; Ceftriaxone; Cross Infection; Cross-Sectional Studies; Drug Resistance, Multiple, Bacterial; Escherichia coli Infections; Europe; Humans; Intensive Care Units; Klebsiella Infections; Klebsiella pneumoniae; Microbial Sensitivity Tests; Retrospective Studies; Risk Factors; Surgical Wound Infection

Three clinical strains of Escherichia coli (p168, p517 and p667) were collected in 2006 from three hospitals in Anhui Province (China). PCR and DNA sequencing revealed that E. coli p168 carried a novel extended-spectrum beta-lactamase (ESBL), which was designated CTX-M-87. The extended-spectrum beta-lactamase which was carried by E. coli p517 and E. coli p667 was previously named CTX-M-65. The deduced amino acid sequence of CTX-M-87, with pI 9.1, differed from that of CTX-M-14 by the substitutions Ala77-->Val and Pro167-->Leu. Like CTX-M-14, CTX-M-87 had a more potent hydrolytic activity against cefotaxime than against ceftazidime and had high affinity for cefuroxime and cefotaxime. These data show that mutations at position 167 in CTX-M do not always affect catalytic activity and substrate preference.

Topics: Amino Acid Substitution; Anti-Bacterial Agents; beta-Lactamases; Cefotaxime; China; Cloning, Molecular; Conjugation, Genetic; Escherichia coli; Escherichia coli Infections; Humans; Kinetics; Microbial Sensitivity Tests; Molecular Sequence Data; Plasmids; Polymerase Chain Reaction; Sequence Analysis, DNA

Topics: Administration, Intranasal; Anti-Bacterial Agents; Antidiuretic Agents; Cefotaxime; Deamino Arginine Vasopressin; Diabetes Insipidus; Escherichia coli Infections; Female; Gentamicins; Humans; Hydrocephalus; Infant, Newborn; Infant, Premature; Injections, Intravenous; Magnetic Resonance Imaging; Meningitis, Escherichia coli; Ventriculostomy

About 408 Escherichia coli were isolated from sick farm animals and pets during 2003-2006. Of these isolates, four strains showed resistance to third-generation cephalosporins. The bla(CTX-M-14) gene was encountered in three E. coli strains, each of which were isolated from two cows and a dog, respectively, and bla(CTX-M-15) was identified in an E. coli isolated from a pig. All bla(CTX-M) genes were found to be transferred. The pulsed-field gel electrophoresis pattern indicated that the CTX-M-type beta-lactamase-producing E. coli isolates were genetically diverse. This study shows the emergence of CTX-M-type beta-lactamase-producing E. coli in animals for the first time in Korea. Study results suggest the need for awareness and comprehensive monitoring of extended-spectrum beta-lactamases in animals because gene transfer can occur between animals as well as humans.

Topics: Animals; Anti-Bacterial Agents; beta-Lactamases; Cattle; Cefotaxime; Ceftazidime; Conjugation, Genetic; DNA, Bacterial; Dogs; Drug Resistance, Multiple, Bacterial; Escherichia coli; Escherichia coli Infections; Korea; Microbial Sensitivity Tests; Swine

Topics: Ambulatory Care; Aminoglycosides; Anti-Bacterial Agents; beta-Lactamases; Cephalosporins; Drug Resistance, Bacterial; Escherichia coli; Escherichia coli Infections; Escherichia coli Proteins; Female; Humans; Methyltransferases; Microbial Sensitivity Tests; Molecular Sequence Data; Plasmids; RNA, Ribosomal, 16S; Sequence Analysis, DNA; United States

Seven hundred fifty-one Escherichia coli clinical isolates collected from 140 Japanese hospitals between 2002 and 2006 were screened for the qepA and qnr genes. Two E. coli isolates (0.3%) harbored qepA, but no qnr was identified. The results suggested a low prevalence of E. coli harboring qepA or qnr in Japan.

Topics: Anti-Bacterial Agents; Conjugation, Genetic; Drug Resistance, Bacterial; Electrophoresis, Gel, Pulsed-Field; Escherichia coli; Escherichia coli Infections; Escherichia coli Proteins; Fluoroquinolones; Hospitals; Humans; Japan; Microbial Sensitivity Tests; Plasmids; Prevalence

Extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli and Klebsiella pneumoniae have rapidly spread worldwide and pose a serious threat for health care-associated (HA) infection. We conducted molecular detection and characterization of ESBL-related bla genes, including bla(TEM), bla(SHV), bla(CTX-M), bla(VEB), bla(OXA), bla(PER), and bla(GES), among 362 isolates of ESBL-producing E. coli (n = 235) and ESBL-producing K. pneumoniae (n = 127) collected from patients who met the definition of HA infection at two major university hospitals in Thailand from December 2004 to May 2005. The prevalence of ESBL-producing E. coli and ESBL-producing K. pneumoniae, patient demographics and the susceptibilities of these bacteria to various antimicrobial agents were described. A total of 87.3% of isolates carried several bla genes. The prevalence of bla(CTX-M) was strikingly high: 99.6% for ESBL-producing E. coli (CTX-M-14, -15, -27, -40, and -55) and 99.2% for ESBL-producing K. pneumoniae (CTX-M-3, -14, -15, -27, and -55). ISEcp1 was found in the upstream region of bla(CTX-M) in most isolates. Up to 77.0% and 71.7% of ESBL-producing E. coli and ESBL-producing K. pneumoniae, respectively, carried bla(TEM); all of them encoded TEM-1. ESBL-producing K. pneumoniae carried bla(SHV) at 87.4% (SHV-1, -2a, -11, -12, -27, -71, and -75) but only at 3.8% for ESBL-producing E. coli (SHV-11 and -12). bla genes encoding VEB-1 and OXA-10 were found in both ESBL-producing E. coli (8.5% and 8.1%, respectively) and ESBL-producing K. pneumoniae (10.2% and 11.8%, respectively). None of the isolates were positive for bla(PER) and bla(GES). Pulsed-field gel electrophoresis analysis demonstrated that there was no major clonal relationship among these ESBL producers. This is the first study to report CTX-M-3, CTX-M-27, CTX-M-40, SHV-27, SHV-71, and SHV-75 in Thailand and to show that CTX-M ESBL is highly endemic in the country.

Topics: Adult; Bacterial Proteins; beta-Lactamases; DNA, Bacterial; Drug Resistance, Multiple, Bacterial; Electrophoresis, Gel, Pulsed-Field; Endemic Diseases; Escherichia coli; Escherichia coli Infections; Female; Humans; Klebsiella Infections; Klebsiella pneumoniae; Male; Middle Aged; Polymerase Chain Reaction; Sequence Analysis, DNA; Thailand

Two clinical strains of Escherichia coli (2138) and Enterobacter cloacae (7506) isolated from the same patient in France and showing resistance to extended-spectrum cephalosporins and low susceptibility to imipenem were investigated. Both strains harbored the plasmid-contained bla(TEM-1) and bla(KPC-2) genes. bla(KLUC-2), encoding a mutant of the chromosomal beta-lactamase of Kluyvera cryocrescens, was also identified at a plasmid location in E. cloacae 7506, suggesting the ISEcp1-assisted escape of bla(KLUC) from the chromosome. Determination of the KPC-2 structure at 1.6 A revealed that the binding site was occupied by the C-terminal (C-ter) residues coming from a symmetric KPC-2 monomer, with the ultimate C-ter Glu interacting with Ser130, Lys234, Thr235, and Thr237 in the active site. This mode of binding can be paralleled to the inhibition of the TEM-1 beta-lactamase by the inhibitory protein BLIP. Determination of the 1.23-A structure of a KPC-2 mutant in which the five C-ter residues were deleted revealed that the catalytic site was filled by a citrate molecule. Structure analysis and docking simulations with cefotaxime and imipenem provided further insights into the molecular basis of the extremely broad spectrum of KPC-2, which behaves as a cefotaximase with significant activity against carbapenems. In particular, residues 104, 105, 132, and 167 draw a binding cavity capable of accommodating both the aminothiazole moiety of cefotaxime and the 6 alpha-hydroxyethyl group of imipenem, with the binding of the former drug being also favored by a significant degree of freedom at the level of the loop at positions 96 to 105 and by an enlargement of the binding site at the end of strand beta 3.

Topics: Aged; Base Sequence; beta-Lactam Resistance; beta-Lactamases; beta-Lactams; Catalytic Domain; Cephalosporin Resistance; Crystallography, X-Ray; DNA Primers; DNA, Bacterial; Enterobacter cloacae; Enterobacteriaceae Infections; Escherichia coli; Escherichia coli Infections; France; Genes, Bacterial; Humans; Imipenem; Kinetics; Male; Models, Molecular; Mutation

One hundred twenty-one extended-spectrum beta-lactamse-producing enterobacterial clinical isolates were screened for the qepA gene. A single CTX-M-15-positive Escherichia coli isolate (0.8%) that produced the putative pump QepA2 was identified. This qepA2 gene was located onto a 90-kb mobilizable plasmid that conferred reduced susceptibility to hydrophilic fluoroquinolones.

Topics: Aged; Base Sequence; DNA Primers; DNA, Bacterial; Drug Resistance, Bacterial; Escherichia coli; Escherichia coli Infections; Escherichia coli Proteins; Female; Fluoroquinolones; France; Genes, Bacterial; Humans; Models, Genetic; Molecular Sequence Data; Plasmids

beta-Lactamases produced by urine isolates from patients in long-term care facilities (LTCFs), outpatient, clinics, and one hospital in a U.S. community were characterized. A total of 1.3% of all Escherichia coli and Klebsiella pneumoniae isolates collected from patients in 30 LTCFs and various outpatient clinics produced extended-spectrum beta-lactamases (ESBLs) and/or imported AmpC beta-lactamases.

Topics: Bacterial Proteins; beta-Lactamases; Community-Acquired Infections; Disease Reservoirs; Escherichia coli; Escherichia coli Infections; Humans; Klebsiella Infections; Klebsiella pneumoniae; Population Surveillance; United States

Characterisation of extended-spectrum beta-lactamase (ESBL) genes and their genetic environments as well as the presence of integrons were analysed in nine Klebsiella pneumoniae and two Escherichia coli ESBL-positive isolates recovered in the Centre of Bone Marrow Transplantation of Tunisia. All strains harboured the bla(CTX-M-15) gene and presented minimum inhibitory concentrations for cefotaxime and ceftazidime of 256-1024 mg L(-1) and 16-512 mg L(-1), respectively, and eight of them showed different pulsed-field gel electrophoresis patterns. The bla(OXA-1) and bla(TEM-1) genes were detected in eight and ten strains, respectively. In addition, bla(SHV-1), bla(SHV-11) and bla(SHV-27) were found in six, one and one K. pneumoniae strains, respectively. The new variant bla(SHV-103) was characterised in one K. pneumoniae strain. The intI1 gene was detected in eight K. pneumoniae strains and the dfrA5+ereA2 and aadA gene cassettes were found in one and five strains, respectively. All strains harboured a 70 kb plasmid, and its transference in addition to bla(CTX-M-15), bla(TEM-1b) and bla(OXA-1) genes was demonstrated from three K. pneumoniae to E. coli. ISEcp1 and orf477 were located upstream and downstream, respectively, of the bla(CTX-M-15) gene in 10 strains. The occurrence of the bla(CTX-M-15) gene in unrelated strains might have originated from the dissemination of mobile genetic elements in which ISEcp1 may have played an important role.

Topics: Anti-Bacterial Agents; beta-Lactamases; Cefotaxime; Ceftazidime; Cephalosporin Resistance; Escherichia coli; Escherichia coli Infections; Hospitalization; Humans; Klebsiella Infections; Klebsiella pneumoniae; Microbial Sensitivity Tests; Plasmids; Stem Cell Transplantation; Tunisia

The CTX-M-1 group was found in 86.8% of the Escherichia coli isolates from Istanbul. A subset study revealed all isolates carrying bla(CTX-M-15) genes flanked by the insertion element ISEcp1. Plasmid typing of transconjugates carrying bla(CTX-M-15) showed that most isolates belonged to the Inc/rep FII group but that one isolate also belonged to the FI group.

Topics: Anti-Bacterial Agents; beta-Lactam Resistance; beta-Lactamases; Cefotaxime; Ceftazidime; Conjugation, Genetic; Escherichia coli; Escherichia coli Infections; Escherichia coli Proteins; F Factor; Hospitals, University; Humans; Microbial Sensitivity Tests; Plasmids; Polymerase Chain Reaction; Prevalence; Random Amplified Polymorphic DNA Technique; Turkey

The algorithms included in most automated systems used for antimicrobial susceptibility testing (e.g., Vitek 2) consider that Escherichia coli isolates resistant to cefoxitin are AmpC-hyperproducers and, consequently, resistant also to amoxycillin-clavulanate. However, a recent study revealed that 30% of E. coli clinical isolates resistant to cefoxitin remained susceptible in vitro to amoxycillin-clavulanate. The aim of the present study was to evaluate the in-vivo efficacy of amoxycillin-clavulanate in the treatment of an experimental model of pneumonia, using two clonally related isolates (with identical repetitive extragenic palindromic sequence (REP)-PCR patterns) of AmpC-non-hyperproducing and OmpF-lacking E. coli (Ec985 and Ec571) that were resistant to cefoxitin and susceptible to cefotaxime and amoxycillin-clavulanate. MICs were determined using a microdilution technique, and in-vitro bactericidal activity was tested using time-kill assays. The in-vivo efficacy of amoxycillin, amoxycillin-clavulanate and cefotaxime against both isolates was tested in a murine pneumonia model using immunocompetent C57BL/6 mice. Ec571 (a TEM-1/2 producer) was resistant to amoxycillin, whereas Ec985 (a TEM-1/2 non-producer) was susceptible. Amoxycillin, amoxycillin-clavulanate and cefotaxime were bactericidal for Ec985, and amoxycillin-clavulanate and cefotaxime were bactericidal for Ec571 at different concentrations and time-points, as determined using time-kill assays. Treatment with amoxycillin, amoxycillin-clavulanate and cefotaxime reduced the bacterial lung concentration of Ec985 compared with non-treated controls (p <0.05), whereas amoxycillin-clavulanate and cefotaxime showed efficacy against Ec571 when compared with the control and amoxycillin groups (p <0.05). Regardless of the exact underlying mechanism(s) of resistance, amoxycillin-clavulanate was effective in the experimental murine model in the treatment of pneumonia caused by AmpC-non-hyperproducing strains of E. coli resistant to cefoxitin.

Topics: Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Animals; Anti-Bacterial Agents; Bacterial Proteins; beta-Lactam Resistance; beta-Lactamase Inhibitors; beta-Lactamases; Cefotaxime; Cefoxitin; Drug Therapy, Combination; Escherichia coli; Escherichia coli Infections; Female; Lung; Mice; Mice, Inbred C57BL; Microbial Sensitivity Tests; Pneumonia, Bacterial; Specific Pathogen-Free Organisms

Of the 181 unduplicated Escherichia coli strains isolated in nine different hospitals in three Portuguese regions, 119 were extended-spectrum beta-lactamase (ESBL)-CTX-M producers and were selected for phenotype and genotype characterization. CTX-M producer strains were prevalent among community-acquired infections (56%), urinary tract infections (76%), and patients >/=60 years old (76%). In MIC tests, all strains were resistant to cefotaxime, 92% were resistant to ceftazidime, 93% were resistant to quinolones, 89% were resistant to aminoglycoside, and 26% were resistant to trimethoprim-sulfamethoxazole; all strains were sensitive to carbapenems, and 92% of the strains had a multidrug resistance phenotype. Molecular methods identified 109 isolates harboring a bla(CTX-M-15) gene, 1 harboring the bla(CTX-M-32) gene (first identification in the country), and 9 harboring the bla(CTX-M-14) gene. All isolates presented the ISEcp1 element upstream from the bla(CTX-M) genes; one presented the IS903 element (downstream of bla(CTX-M-14) gene), and none had the IS26 element; 85% carried bla(TEM-1B), and 84% also carried a bla(OXA-30). Genetic relatedness analysis based on pulsed-field gel electrophoresis defined five clusters and indicated that 76% of all isolates (from cluster IV) corresponded to a single epidemic strain. Of the 47 strains from one hospital, 41 belonged to cluster IV and were disseminated in three main wards. CTX-M-producing E. coli strains are currently a problem in Portugal, with CTX-M-15 particularly common. This study suggests that the horizontal transfer of bla(CTX-M) genes, mediated by plasmids and/or mobile elements, contributes to the dissemination of CTX-M enzymes to community and hospital environments. The use of extended-spectrum cephalosporins, quinolones, and aminoglycosides is compromised, leaving carbapenems as the therapeutic option for severe infections caused by ESBL producers.

Topics: Aged; Anti-Bacterial Agents; beta-Lactamases; Community-Acquired Infections; Cross Infection; Drug Resistance, Bacterial; Escherichia coli; Escherichia coli Infections; Escherichia coli Proteins; Humans; Microbial Sensitivity Tests; Middle Aged; Portugal

Topics: Aged, 80 and over; Anti-Bacterial Agents; beta-Lactamases; Conjugation, Genetic; Escherichia coli; Escherichia coli Infections; Humans; Male; Microbial Sensitivity Tests; Plasmids; Recombination, Genetic

This work identifies an ISCR1-related bla(CTX-M-14) gene, which has never been reported before, from a clinical isolate of Escherichia coli. The bla(CTX-M-14) gene was preceded by an ISCR1 element that was followed by a class 1 integron containing three different insert gene cassettes, i.e., dfrA12, orfF, and aadA2.

Topics: Adult; Anti-Bacterial Agents; Base Sequence; beta-Lactamases; DNA Transposable Elements; Drug Resistance, Bacterial; Escherichia coli; Escherichia coli Infections; Escherichia coli Proteins; Humans; Integrons; Male; Microbial Sensitivity Tests; Molecular Sequence Data; Pneumonia, Bacterial; Sequence Analysis, DNA

A clinical isolate of Escherichia coli LBT04 was found to have a high-level resistance to broad-spectrum beta-lactams. Analysis of this strain by the disk diffusion test revealed synergies between clavulanic acid and ceftazidime, cefotaxime. Clavulanic acid decreased the MICs of ceftazidime, cefotaxime, and ceftriaxone, which suggested that LBT04 produced an extended-spectrum beta-lactamase. These resistances were carried by a 1080-bp chromosomal gene that encoded a beta-lactamase with a pI of 6.3. Cloning and sequencing experiments showed that this beta-lactamase revealed identity with the bla(TEM-1) gene encoding the TEM-1 beta-lactamase, except for a replacement of the Glu residue at position 104 by Lys, and of the Gly residue at position 238 by Ser. These two mutations were encountered in TEM-15 beta-lactamase, but this is the first description of this enzyme in the E. coli species in Tunisian hospitals.

Topics: Anti-Bacterial Agents; beta-Lactamases; Blotting, Southern; Cefotaxime; Ceftazidime; Disease Outbreaks; DNA, Viral; Drug Resistance, Bacterial; Escherichia coli; Escherichia coli Infections; Gene Amplification; Humans; Inpatients; Microbial Sensitivity Tests; Polymerase Chain Reaction; Tunisia

Topics: Ampicillin; Cefotaxime; Diagnosis, Differential; Escherichia coli Infections; Fever of Unknown Origin; Humans; Infant, Newborn; Infusions, Intravenous; Male; Referral and Consultation; Urinary Tract Infections

Neonatal osteoarticular infections remain rare, with an estimated incidence of 1 to 3 cases per 1000 admissions to Neonatal Intensive Care Units. It usually results from bacteraemia and may thus be induced by IV catheters. More rarely it is due to direct inoculation secondary to cutaneous damage, or extension of soft tissue infection. The particularity of bone vascularization in the newborn explains the frequency of abscess formation in the periosteum or in soft tissues. The main pathogen involved is S. aureus (3/4 of cases), followed by group B streptococci and enterobacteriacae. Infection consists mainly of localised and slowly progressing abscesses. However, multifocal and severe infection is possible, in particular when caused by an IV catheter. Ultrasonography is the best initial investigation, possibly leading to surgical care. Medical treatment must include 2 synergistic antistaphyloccocal antibiotics, possibly associated with cefotaxime. The outcome is generally favorable, but orthopaedic consequences may emerge if the growth plate is involved. Rare specific causes, such as syphilis or tuberculosis, should also be evoked, but the clinical context is generally helpful for the diagnosis.

Topics: Age Factors; Anti-Bacterial Agents; Bacterial Infections; Catheterization; Cefotaxime; Cross Infection; Drug Therapy, Combination; Enterobacteriaceae; Escherichia coli Infections; Humans; Incidence; Infant, Newborn; Intensive Care Units, Neonatal; Osteoarthritis; Staphylococcal Infections; Staphylococcus aureus; Streptococcal Infections; Streptococcus agalactiae; Treatment Outcome

The aim of this study was to determine the prevalence of extended-spectrum beta-lactamases (ESBLs) in nosocomial bacteremia isolates of Escherichia coli, Klebsiella pneumoniae and Klebsiella oxytoca at Hacettepe University Adult Hospital in Ankara, Turkey. A total of 344 blood culture isolates of E. coli (n=244), K. pneumoniae (n=86) and K. oxytoca (n=34) were included in the study from January 2003 to November 2005. Only one isolate from one patient was tested in the study. The isolates with ceftazidime and/or cefotaxime MIC values > or =1 microg/ml were tested by ceftazidime-ceftazidime/clavulanic acid and cefotaxime-cefotaxime/clavulanic acid Etest (AB Biodisk Solna, Sweden) strips and evaluated as ESBL positive if the ratio was > or =8. Of the isolates, 33% (74/224) of E. coli, 31.4% (27/86) of K. pneumoniae and 47% (16/34) of K. oxytoca were detected as ESBL producers by any kind of two strips. However, 5.4% (4/74) of E. coli, 3.7% (1/27) of K. pneumoniae and 43.1% (7/16) of K. oxytoca ESBL-producing isolates could be detected only by cefotaxime-cefotaxime/clavulanic acid strips. It is important to use cefotaxime-cefotaxime/clavulanic acid as well as ceftazidime-ceftazidime/clavulanic acid ratio for detection of ESBL types that preferentially hydrolyze cefotaxime. Since prevalence of ESBL production is high in nosocomial E. coli and Klebsiella spp. isolates in our hospital, surveillance of antibiotic susceptibility patterns is important for the empirical treatment of bacteremic patients.

Topics: Anti-Bacterial Agents; Bacteremia; beta-Lactamases; Cefotaxime; Ceftazidime; Clavulanic Acid; Cross Infection; Drug Combinations; Enzyme Inhibitors; Escherichia coli; Escherichia coli Infections; Humans; Klebsiella; Klebsiella Infections; Klebsiella oxytoca; Klebsiella pneumoniae; Microbial Sensitivity Tests; Prevalence; Turkey

A highly cefotaxime- and cefepime-resistant but ceftazidime-sensitive Escherichia coli isolate was recovered from a community-acquired urinary infection of a Greek patient. Susceptibility testing, transfer assays, plasmid analysis as well as PCR and sequencing techniques were used to investigate the underlying mechanism of resistance. The isolate carried a new variant of the bla(CTX-M-3) gene that possessed a T instead of A at nt position 663. Cefotaxime resistance was transferable and carried on a 60 kb plasmid. The bla(CTX-M-3) variant was located downstream of an ISEcp1B element. The emergence of this new derivative indicates further evolution of the worldwide-distributed bla(CTX-M-3) gene.

Topics: Anti-Bacterial Agents; beta-Lactamases; Cefepime; Cefotaxime; Cephalosporin Resistance; Cephalosporins; Child, Preschool; Community-Acquired Infections; Escherichia coli; Escherichia coli Infections; Female; Genetic Variation; Greece; Humans; Microbial Sensitivity Tests; Polymerase Chain Reaction; Urinary Tract Infections

During a survey of the prevalent subtypes of extended-spectrum beta -lactamases in a university hospital in Korea, a nosocomial outbreak of Escherichia coli producing CTX-M-15 and OXA-30 beta -lactamases was detected. The outbreak comprised various infections, including bloodstream infections and colonization, and persisted for several months in various areas of the hospital.

Topics: beta-Lactamases; Cefotaxime; Ceftazidime; Cross Infection; Disease Outbreaks; Escherichia coli; Escherichia coli Infections; Humans; Klebsiella Infections; Klebsiella pneumoniae; Korea; Prevalence

Extended-spectrum beta-lactamase (ESBL)-mediated resistance is of considerable importance in human medicine. Recently, such enzymes have been reported in bacteria from animals. We describe a longitudinal study of a dairy farm suffering calf scour with high mortality rates. In November 2004, two Escherichia coli isolates with resistance to a wide range of beta-lactams (including amoxicillin-clavulanate and cefotaxime) were isolated from scouring calves. Testing by PCR and sequence analysis confirmed the isolates as being both bla(CTX-M14/17) and bla(TEM-35) ((IRT-4)) positive. They had indistinguishable plasmid and pulsed-field gel electrophoresis (PFGE) profiles. Transferability studies demonstrated that bla(CTX-M) was located on a conjugative 65-MDa IncK plasmid. Following a farm visit in December 2004, 31/48 calves and 2/60 cows were positive for E. coli with bla(CTX-M). Also, 5/48 calf and 28/60 cow samples yielded bla(CTX)- and bla(TEM)-negative E. coli isolates that were resistant to cefotaxime, and sequence analysis confirmed that these presented mutations in the promoter region of the chromosomal ampC gene. Fingerprinting showed 11 different PFGE types (seven in bla(CTX-M)-positive isolates). Six different PFGE clones conjugated the same bla(CTX-M)-positive IncK plasmid. One clone carried a different-sized, bla(CTX-M)-positive, transformable plasmid. This is the first report of bla(CTX-M) from livestock in the United Kingdom, and this report demonstrates the complexity of ESBL epidemiology. Results indicate that horizontal plasmid transfer between strains as well as horizontal gene transfer between plasmids have contributed to the spread of resistance. We have also shown that some clones can persist for months, suggesting that clonal spread also contributes to the perpetuation of resistance.

Topics: Animals; Bacterial Proteins; beta-Lactam Resistance; beta-Lactamases; Cattle; Cattle Diseases; Cefotaxime; DNA, Bacterial; Escherichia coli; Escherichia coli Infections; Feces; Genes, Bacterial; Humans; Longitudinal Studies; Mutation; Polymerase Chain Reaction; Promoter Regions, Genetic; United Kingdom

A total of 151 Escherichia coli strains resistant to cefotaxime and ceftazidime were isolated during a prospective surveillance study. These strains were characterized by clinical, microbiological, and molecular analyses and were distributed into four clusters of 103, 11, 6, and 5 isolates, along with 25 unrelated strains. The principal cluster was isolated from urine, wound, blood, and other samples in three hospitals, eight nursing homes, and a community healthcare center. This cluster was associated with both nosocomial (65%) and community-acquired (35%) infections. Most strains were resistant to ciprofloxacin, gentamicin, tobramycin, cefepime, amoxicillin-clavulanic acid, and trimethoprim-sulfamethoxazole but were susceptible to imipenem. All isolates from the four clusters expressed the extended-spectrum beta-lactamase (ESBL) CTX-M-15. This enzyme was also present in 8 (30.8%) of the 26 unrelated isolates. The other ESBLs, CTX-M-14 and CTX-M-32, were detected in five and seven cases, respectively, but they were detected in individual E. coli isolates only. In three clusters, blaCTX-M-15 alleles were linked to an ISEcp1-like element, while in eight strains of cluster II an IS26 element preceded the blaCTX-M-15 allele. An additional pool of resistance genes included tetA, drfA14 or dfrA17, sul1 or sul2, aac(6')Ib, and aac(3)IIb. All except one of the 27 isolates tested for genetic virulence markers harbored the same three virulence genes: iutA and fyuA (siderophores), and traT (serum survival factor). Epidemic or occasional isolates of cefotaxime- and ceftazidime-resistant E. coli can spread between distinct health facilities including hospitals, community health centers, and long-term care centers.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Bacterial Outer Membrane Proteins; beta-Lactam Resistance; beta-Lactamases; Blood; Cefotaxime; Ceftazidime; Cluster Analysis; Community-Acquired Infections; Cross Infection; DNA Transposable Elements; Escherichia coli; Escherichia coli Infections; Escherichia coli Proteins; Female; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Molecular Epidemiology; Receptors, Cell Surface; Spain; Urine; Virulence; Wounds and Injuries

The UK, like other countries worldwide, has a growing problem with CTX-M beta-lactamase-producing Escherichia coli. Five major clonally related strains have been identified among CTX-M-15 producers. We characterize here the plasmids from clonal strains A and D.. Plasmids were extracted and transformed into E. coli DH5alpha; conjugative mating was attempted on agar. MICs were determined by agar dilution. beta-Lactamases were typed by isoelectric focusing; antibiotic resistance genes and integrons were identified by PCR and sequenced. Plasmid incompatibility groups were determined by replicon PCR.. bla(CTX-M-15) was carried by a 150 kb plasmid in strain A and a 70 kb plasmid in strain D. Conjugative transfer of cefotaxime resistance was only achieved from strain D; plasmids from both strains were transferred by transformation. The plasmid from strain A additionally carried bla(TEM-1) (variably), bla(OXA-1), aac(6')-Ib-cr and tet(A), as well as a class 1 integron with the gene cassettes aadA5 and dfr(17); the plasmid from strain D carried bla(TEM-1) consistently, also bla(OXA-1), aac(6')-Ib-cr, aac3-IIa and tet(A). Both plasmids belonged to incompatibility group FII.. bla(CTX-M-15) was plasmid-mediated in both strains A and D and was linked to other antibiotic resistance genes including aac(6')-Ib-cr, which encodes an acetyltransferase, not previously found in Europe, acting on both aminoglycosides and some fluoroquinolones. Although the plasmids from the two strains differed in size, both were related and conferred similar multi-drug resistance phenotypes, suggesting that they may share a similar genetic scaffold. Both shared features with plasmids encoding CTX-M-15 beta-lactamases in E. coli from Canada and India.

Topics: Anti-Bacterial Agents; beta-Lactamases; Cefotaxime; Drug Resistance, Bacterial; Escherichia coli; Escherichia coli Infections; Genes, Bacterial; Humans; Isoelectric Focusing; Microbial Sensitivity Tests; Molecular Sequence Data; Plasmids; United Kingdom

Bacterial infection of a cephalhaematoma is rare and has been associated with needle aspiration of the haematoma, placement of scalp electrodes and systemic sepsis. Clinical diagnosis of infected cephalhaematoma is difficult without obvious evidence of local infection. The role of imaging in differentiating infected from non-infected cephalhaematoma has not been clearly established. Needle aspiration is considered mandatory for suspected cases. In this report, we present the magnetic resonance imaging (MRI) findings of a 23-day-old neonate with an infected cephalhaematoma. Cephalhaematoma is a subperiosteal accumulation of blood, thus the diagnosis of infected cephalhaematoma was made as the MRI showed an accumulation of blood under thick, contrast-enhancing periosteum in the presented case. Without a diagnostic puncture, the decision for surgical intervention was made before complicating osteomyelitis developed. Early intervention with simple incision and drainage resulted in prompt improvement.

Topics: Anti-Bacterial Agents; Cefotaxime; Escherichia coli; Escherichia coli Infections; Head; Hematoma; Humans; Infant, Newborn; Magnetic Resonance Imaging; Male; Suction

To characterize CTX-M-12 extended-spectrum beta-lactamase (ESBL) produced by clinical Escherichia coli isolates and to investigate its genetic environment.. Antimicrobial susceptibilities were determined by disc diffusion and agar dilution methods, and the double-disc synergy test was carried out. Detection of genes encoding class A beta-lactamases was performed by PCR amplification, and the genetic environments of the bla(CTX-M-12) genes were investigated by PCR and sequencing of the regions surrounding the genes. Kinetic parameters were determined from purified CTX-M-12.. Sequence data for the CTX-M-1 cluster from three clinical E. coli isolates indicated the presence of CTX-M-12. An ISEcp1 insertion sequence was located 49 bp upstream of bla(CTX-M-12) in all three E. coli isolates. CTX-M-12 had a more potent hydrolytic activity against cefotaxime than against ceftazidime and was encoded on a self-transferable approximately 18 kbp plasmid.. This work shows that CTX-M-12, which confers high-level resistance to cefotaxime but not to ceftazidime, has emerged in Korea. The bla(CTX-M-12) gene was associated with an upstream ISEcp1 insertion sequence.

Topics: Anti-Bacterial Agents; beta-Lactamases; Cefotaxime; Ceftazidime; DNA Transposable Elements; DNA, Bacterial; Escherichia coli; Escherichia coli Infections; Escherichia coli Proteins; Humans; Kinetics; Korea; Microbial Sensitivity Tests; Molecular Sequence Data; Plasmids; Polymerase Chain Reaction; Sequence Analysis, DNA; Substrate Specificity

Topics: Aged; Anti-Bacterial Agents; Cefotaxime; Diarrhea; Endocarditis, Bacterial; Escherichia coli; Escherichia coli Infections; Female; Gentamicins; Humans; Pacemaker, Artificial

Epididymitis, or epididymo-orchitis, and infected hydrocele are unusual in the neonatal period. It is critical to differentiate them rapidly from testicular torsion to salvage the affected testis and avoid unnecessary surgical exploration. Escherichia coli is an important gram-negative bacteria causing diverse neonatal infections and is also the common bacteria causing epididymo-orchitis from an ascending route. We report the case of a preterm infant affected with epididymo-orchitis and infected hydrocele caused by early-onset E. coli sepsis. We highlight the importance of sampling proper cultures and using suitable antibiotics after excluding testicular torsion in a neonate with an acute scrotum.

Topics: Acute Disease; Bacteremia; Cefotaxime; Diagnosis, Differential; Epididymitis; Escherichia coli Infections; Humans; Infant, Newborn; Infant, Premature; Male; Orchitis; Scrotum; Sepsis; Spermatic Cord Torsion; Testicular Hydrocele; Tomography, X-Ray Computed; Ultrasonography

A search of the computerized database at the National Taiwan University Hospital was made for cefotaxime-resistant and cefmetazole-susceptible isolates of Escherichia coli and Klebsiella pneumoniae (which may be extended-spectrum beta-lactamase-producing strains) in pediatric wards and intensive care units between 1999 and 2001. Fourteen infectious episodes attributed only to study bacteria were identified, including 7 episodes of bacteremia. Nine patients (64.3%) had underlying medical conditions: 3 were premature babies, 3 were immunodeficient, 2 had malignancy, and 2 had a congenital heart disease with active heart failure even after surgery. Among the 7 patients with bacteremias, 5 may be catheter-related; 6 were treated with carbapenems and 1 was treated with cefmetazole successfully, with or without the removal of the catheter. Before the acquisition of the infection, a history of stay in an intensive care unit within 4 weeks was noted in 10 cases (71.4%); a history of use of extended-spectrum cephalosporins within 4 weeks was also noted in 6 cases (42.9%). Cefmetazole, with or without an aminoglycoside, was clinically effective in 6 cases (42.8%). Except for 1 episode of pneumonia that ended in mortality, all of the infectious episodes were successfully treated. The mortality rate was 7.1%.

Topics: Adolescent; Anti-Bacterial Agents; Bacteremia; Carbapenems; Catheterization; Cefmetazole; Cefotaxime; Child; Child, Preschool; Drug Resistance, Bacterial; Escherichia coli; Escherichia coli Infections; Female; Heart Defects, Congenital; Humans; Immunologic Deficiency Syndromes; Infant; Inpatients; Klebsiella Infections; Klebsiella pneumoniae; Male; Neoplasms; Premature Birth; Taiwan

During a survey of extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae in Bulgaria in 2001-2002, three isolates from Sofia (two Escherichia coli, one Klebsiella pneumoniae) showed cefotaxime MICs that were decreased in the presence of clavulanate and were 2-8-fold higher than those of ceftazidime. Resistance was transferred to a sensitive recipient strain of E. coli. Both wild-type and transconjugant strains produced a cefotaxime-hydrolysing beta-lactamase of pI 8.8. Sequencing of the PCR product obtained with oligonucleotide primers binding outside the coding region identified this beta-lactamase as CTX-M-15. To our knowledge, this is the first report of CTX-M-15 in Bulgaria.

Topics: Anti-Bacterial Agents; beta-Lactamases; Bulgaria; Cefotaxime; Drug Resistance, Bacterial; Escherichia coli; Escherichia coli Infections; Female; Humans; Infant; Klebsiella Infections; Klebsiella pneumoniae; Male; Microbial Sensitivity Tests; Middle Aged; Polymerase Chain Reaction

To identify the ESBL gene and the prevalence in Escherichia coli and Klebsiella pneumoniae strain isolated from Huashan Hospital, Shanghai.. Isolates were confirmed as an ESBL producing strain by double-disk synergy test and NCCLS Confirmatory Test. Antibiotic susceptibilities were determined by standard agar dilution procedure on Mueller-Hinton agar. To determine whether the resistance was transferable, the conjugation experiment was performed; plasmids were isolated from clinical isolates and transcojugants. The partial bla(gene) of ESBL producing isolates and their transcojugants were detected by PCR using universal primers for TEM, SHV, CTX-M-1group, Toho-1group, CTX-M-13group respectively. The entire bla(CTX-M-13) group were amplified by PCR using the primers outside the Open Reading Frame (ORF) of CTX-M-13group beta-lactamases; the PCR products of entire bla(CTX-M-13)group were cloned into vector and the recombinant plasmids were transformed into the recipient strain for expression; the PCR products were also directly sequenced and analyzed; the clinical isolates of ESBL producers were detected by PFGE.. ESBL producers were resistant to most beta-lactams and non-beta-lactams. Most transconjugants were obtained at frequency of 10(-4) approximately 10(-5) and resistance to non-beta-lactams was cotransferred with the ESBL activity to the transconjugant. A plasmid of about > 23.1 kb was obtained from each tansconjugant by plasmid extraction. Partial gene amplification products of CTX-M-13 group gene were obtained from isolates and their transconjugants. The bla(CTX-M-13)group from 4 transconjugants were identified as bla(CTX-M-14), and other six were bla(CTX-M-24); those ESBLs were mediated by plasmids (> 23.1 kb); the transformants producing CTX-M-14 or CTX-M-24 were resistant to most beta-lactams, which were much more resistant to cefotaxime than to ceftazidine; PFGE patterns of those isolates were different.. clinical isolate of Escherichia coli and Klebsiella pneumoniae isolated from Huashan Hospital, Shanhai produced CTX-M-14 or CTX-M-24, which caused the isolate resistant to most beta-lactams; no clone spread in those isolates was found.

Topics: Anti-Bacterial Agents; beta-Lactam Resistance; beta-Lactamases; Cefotaxime; DNA, Bacterial; Drug Resistance, Bacterial; Escherichia coli; Escherichia coli Infections; Genes, Bacterial; Humans; Klebsiella Infections; Klebsiella pneumoniae

To describe the antibiotic resistant mode of extended-spectrum beta-lactamases(ESBLs) producing Escherichia coli (E. coli.) and Klebsiella pneumoniae (KPn) in surgical intensive care unit(SICU), and to implore the molecular epidemiology of ESBLs coding genes of these strains.. The minimal inhibitory concentrations (MICs) at antibiotics were examined by agar dilution method. The ESBLs coding genes were amplified by TEM, SHV and CTX-M specific primers. Amplicons of such genes with conjugates' plasmids as templates were sequenced.. In vitro susceptibility tests of ESBLs producing strains showed a high level of resistance to most of the beta-lactam biotics, especially cefotaxime. 93.5% of these ESBLs positive strains contained CTX-M group genes,and 38.7% of the strains contained SHV genes. By sequencing, some genotype were determined: TEM-1, CTX-M-1,3,14,22.. ESBLs producing strains were resistant to most of the beta-lactam biotics. The most prevalent ESBLs genotype of ESBLs produced by E coli and KPn in SICU was CTX-M subgroup. The most probable reason might be the extensive use of cefotaxime.

Topics: Anti-Bacterial Agents; beta-Lactamases; Cefotaxime; Cephalosporin Resistance; China; Drug Resistance, Multiple, Bacterial; Escherichia coli; Escherichia coli Infections; Humans; Intensive Care Units; Klebsiella Infections; Klebsiella pneumoniae; Microbial Sensitivity Tests

Topics: Anti-Bacterial Agents; Bursitis; Cefotaxime; Escherichia coli; Escherichia coli Infections; Humans; Liver Cirrhosis; Male; Middle Aged; Treatment Outcome

Spontaneous infection of ascitic fluid with Salmonella typhimurium is very rare and exhibits uncommon features.. A Child-Pugh C cirrhotic 47 year-old woman was hospitalised for fever and coma. Norfloxacin 400 mg per day had been introduced three months earlier as secondary prophylaxis for spontaneous bacterial peritonitis. A spontaneous bacterial peritonitis was diagnosed, and an intravenous broad-spectrum antibiotic therapy was started (cefotaxime 1 g/8h). Bacteriologic samples isolated Salmonella typhimurium in ascites, blood and stools; Escherichia coli sensitive to norfloxacin in blood and Escherichia coli resistant to norfloxacin but sensitive to cefotaxime in urine. Despite the initial regression of the hepatic encephalopathy and the decrease in fever, the patient died twenty days after admission to hospital.. This observation is exceptional because of the simultaneous presence of Salmonella typhimurium in ascites, blood and stools. It underlines the features of spontaneous Salmonella bacterial peritonitis: rare, occurring in immuno-suppressive diseases, virulent despite sensitivity to third generation cephalosporines and of often poor prognosis. Compliance to norfloxacin prophylaxis in cirrhotic patients is a real problem, since in the case of poor compliance such patients are exposed both to sensitive norfloxacin bacteria, and to resistant norfloxacin bacteria selected by the norfloxacin prophylaxis.

Topics: Anti-Bacterial Agents; Anti-Infective Agents; Antibiotic Prophylaxis; Ascitic Fluid; Blood; Cefotaxime; Drug Resistance, Bacterial; Escherichia coli; Escherichia coli Infections; Feces; Female; Humans; Liver Cirrhosis, Alcoholic; Middle Aged; Norfloxacin; Peritonitis; Salmonella Infections; Salmonella typhimurium; Time Factors; Urine

To determine the distribution and antimicrobial drug resistance in bacterial pathogens causing nosocomial infections, surveillance data on nosocomial infections documented from 1981 to 1999 at National Taiwan University Hospital were analyzed. During this period, 35,580 bacterial pathogens causing nosocomial infections were identified. Candida species increased considerably, ranking first by 1999 in the incidence of pathogens causing all nosocomial infections, followed by Staphylococcus aureus and Pseudomonas aeruginosa. Candida species also increased in importance as bloodstream infection isolates, from 1.0% in 1981-1986 to 16.2% in 1999. The most frequent isolates from urinary tract infections were Candida species (23.6%), followed by Escherichia coli (18.6%) and P. aeruginosa (11.0%). P. aeruginosa remained the most frequent isolates for respiratory tract and surgical site infections in the past 13 years. A remarkable increase in incidence was found in methicillin-resistant S. aureus (from 4.3% in 1981-1986 to 58.9% in 1993-1998), cefotaxime-resistant E. coli (from 0% in 1981-1986 to 6.1% in 1993-1998), and cefotaxime-resistant Klebsiella pneumoniae (from 4.0% in 1981-1986 to 25.8% in 1993-1998). Etiologic shifts in nosocomial infections and an upsurge of antimicrobial resistance among these pathogens, particularly those isolated from intensive care units, are impressive and alarming.

Topics: Anti-Bacterial Agents; Anti-Infective Agents; Candida; Candidiasis; Cefotaxime; Cross Infection; Drug Resistance, Bacterial; Drug Resistance, Fungal; Escherichia coli Infections; Humans; Methicillin Resistance; Microbial Sensitivity Tests; Pseudomonas aeruginosa; Pseudomonas Infections; Staphylococcus aureus; Taiwan

Topics: Amoxicillin; Cefotaxime; Drug Resistance, Bacterial; Drug Therapy, Combination; Enterobacter; Enterobacteriaceae Infections; Escherichia coli; Escherichia coli Infections; Gram-Negative Bacteria; Gram-Negative Bacterial Infections; Humans; Infant, Newborn; Intensive Care Units, Neonatal; Length of Stay; Molecular Epidemiology; Penicillins; Risk Factors; Tobramycin

A cefotaxime-resistant, ceftazidime-susceptible Escherichia coli isolate was obtained from a patient with sepsis in 1997, from which a beta-lactamase with a pI of 8.1 was cloned. Cephaloridine and cefotaxime relative hydrolysis rates were 167 and 81, respectively (penicillin G rate = 100), whereas ceftazidime hydrolysis was not detected. The nucleotide sequence revealed a bla gene related to that coding for CTX-M-3. Despite 21 nucleotide substitutions, only 2 determined amino acid changes (Ala27Val and Arg38Gln). The amino acid sequence identity between this enzyme, designated CTX-M-10, and the chromosomal beta-lactamase of Kluyvera ascorbata was 81%.

Topics: beta-Lactamases; Cefotaxime; Cephaloridine; Cephalosporins; DNA, Bacterial; Drug Resistance, Microbial; Escherichia coli; Escherichia coli Infections; Genes, Bacterial; Humans; Kinetics; Microbial Sensitivity Tests; Molecular Sequence Data

The disk screening methods for extended-spectrum beta-lactamase-producing strains were evaluated. The confirmatory work is reduced significantly in settings such as those in this study, by changing the cefpodoxime breakpoint to < or =20 mm and by not testing cefoxitin-resistant isolates. Cefotaxime and ceftazidime disk screening is reliable, and the laboratory-prepared cefotaxime- and ceftazidime-clavulanic acid disks are stable at -20 degrees C for 12 weeks.

Topics: Anti-Bacterial Agents; beta-Lactamases; Cefotaxime; Ceftazidime; Clavulanic Acid; Drug Stability; Escherichia coli; Escherichia coli Infections; Hospitals; Humans; Klebsiella Infections; Klebsiella pneumoniae; Microbial Sensitivity Tests; Prevalence

Secondary infection of pancreatic necrotic tissue and peripancreatic fluid is a serious complication of acute pancreatitis resulting in significant morbidity and mortality. The aim of this study was to find out the spectrum of bacterial infections, and their antibiotic sensitivity pattern in patients with acute pancreatitis.. All consecutive patients with acute pancreatitis were studied prospectively. Detailed investigations were carried out to identify bacterial infections and their antibiotic sensitivities in patients with suspected infection. These investigations included cultures of various body fluids, throat swabs, indwelling cannula and catheter tips. Pancreatic tissue was obtained by using needle aspiration or at surgery for Gram's stain, culture and sensitivity. All cultures were repeated until the presence of infection was confirmed or excluded.. A total of 169 patients with acute pancreatitis were studied during the period between January 1997 and June 2000 (mean age 41.3 years; 116 males and 53 females). Of the 169 patients, 63 had infections at various sites. A total of 80 cultures were positive, and 12 different bacterial isolates were cultured from samples taken from these 63 patients. Polymicrobial infection was seen in 32% of patients. Twenty-four patients had a confirmed pancreatic infection. Blood cultures had a growth of organisms in 19 patients, with evidence of ongoing or worsening pancreatitis, thus raising a strong suspicion of infected necrosis in them. The commonest organisms were Escherichia coli from 20 cultures and Pseudomonas aeruginosa from 18 cultures. The antibiotic sensitivity pattern showed that most bacteria were sensitive to third generation cephalosporins and quinolones; notably among them were cefotaxime, ceftazidime, and ciprofloxacin.. Bacterial infections were seen in 37% of patients with acute pancreatitis. The commonest organisms were Pseudomonas aeruginosa and Escherichia coli. Most bacterial isolates were sensitive to third generation cephalosporins and quinolones.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Bacterial Infections; Cefotaxime; Ceftazidime; Ciprofloxacin; Escherichia coli Infections; Female; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Pancreatitis, Acute Necrotizing; Pseudomonas Infections

Escherichia coli R170, isolated from the urine of an infected patient, was resistant to expanded-spectrum cephalosporins, aztreonam, ciprofloxacin, and ofloxacin but was susceptible to amikacin, cefotetan, and imipenem. This particular strain contained three different plasmids that encoded two beta-lactamases with pIs of 7.0 and 9.0. Resistance to cefotaxime, ceftazidime, aztreonam, trimethoprim, and sulfamethoxazole was transferred by conjugation from E. coli R170 to E. coli J53-2. The transferred plasmid, RZA92, which encoded a single beta-lactamase, was 150 kb in length. The cefotaxime resistance gene that encodes the TLA-1 beta-lactamase (pI 9.0) was cloned from the transconjugant by transformation to E. coli DH5alpha. Sequencing of the bla(TLA-1) gene revealed an open reading frame of 906 bp, which corresponded to 301 amino acid residues, including motifs common to class A beta-lactamases: (70)SXXK, (130)SDN, and (234)KTG. The amino acid sequence of TLA-1 shared 50% identity with the CME-1 chromosomal class A beta-lactamase from Chryseobacterium (Flavobacterium) meningosepticum; 48.8% identity with the VEB-1 class A beta-lactamase from E. coli; 40 to 42% identity with CblA of Bacteroides uniformis, PER-1 of Pseudomonas aeruginosa, and PER-2 of Salmonella typhimurium; and 39% identity with CepA of Bacteroides fragilis. The partially purified TLA-1 beta-lactamase had a molecular mass of 31.4 kDa and a pI of 9.0 and preferentially hydrolyzed cephaloridine, cefotaxime, cephalothin, benzylpenicillin, and ceftazidime. The enzyme was markedly inhibited by sulbactam, tazobactam, and clavulanic acid. TLA-1 is a new extended-spectrum beta-lactamase of Ambler class A.

Topics: Amino Acid Sequence; Base Sequence; beta-Lactamases; Cefotaxime; Cephalosporins; Cloning, Molecular; Conjugation, Genetic; Escherichia coli; Escherichia coli Infections; Humans; Isoelectric Focusing; Kinetics; Mexico; Microbial Sensitivity Tests; Molecular Sequence Data; Plasmids

We investigated the effect of seven antibacterial antibiotics: kanamycin, gentamicin, tetracycline, minocycline, ampicillin, piperacillin and cefotaxime, on survival of mice infected sequentially with a lethal dose of Candida albicans and a sublethal dose of Escherichia coli. The mortality of C. albicans-infected mice was facilitated by the superinfection with E. coli. When administered to mice with C. albicans/E. coli complex infection, aminoglycosides and tetracyclines significantly prolonged the survival period as compared with the infected and untreated controls. The recovery of viable counts of E. coli from the renal tissues was rapidly reduced by the treatment with gentamicin or minocycline, compared to the untreated control. Thus it was concluded that nullification by the treatment with aminoglycosides or tetracyclines of the enhancing effect of E. coli superinfection on the lethality of C. albicans-infected mice is due to early elimination of E. coli from the kidney.

Topics: Ampicillin; Animals; Anti-Bacterial Agents; Candida albicans; Candidiasis; Cefotaxime; Escherichia coli; Escherichia coli Infections; Female; Gentamicins; Kanamycin; Kidney; Mice; Mice, Inbred ICR; Minocycline; Piperacillin; Tetracycline

Acute changes in the electrophysiology and ultrastructure of the organ of Corti were studied after microperfusion of c. 5 x 10(6) CFU of serotype 2 Streptococcus pneumoniae D39 or Escherichia coli K-12 directly into the scala tympani of guinea pigs. Hearing loss was assessed by recording the auditory nerve compound action potential response to a 10 kHz tone pip. Mean hearing loss 3 h after pneumococcal perfusion (n = 4) was 44 dB, compared to 6 dB after E. coli perfusion (n = 4) (P<0.001). After pneumococcal perfusion, scanning electron microscopy revealed damage to hair cell stereocilia and cratering of the apical surface of supporting cells. Intraperitoneal injection of 100 mg/kg cefotaxime (n = 4) or 100 mg/kg amoxycillin (n = 4) 30 min before perfusion of pneumococci significantly reduced mean hearing loss to 23 dB (P=0.01) or 20 dB (P=0.01), respectively, and diminished ultrastructural damage. The data suggest that if pneumococci invade the inner ear during meningitis, cochlear deafness may rapidly ensue.

Topics: Amoxicillin; Animals; Antibiotic Prophylaxis; Cefotaxime; Cephalosporins; Ear Diseases; Electrophysiology; Escherichia coli; Escherichia coli Infections; Guinea Pigs; Hair Cells, Auditory; Hearing Loss, Central; Microscopy, Electron, Scanning; Penicillins; Pneumococcal Infections; Scala Tympani; Streptococcus pneumoniae

Complement component C9 is required for rapid complement-mediated killing of Escherichia coli. In this report, the influence of supplemental C9 on the bactericidal and protective effects of beta-lactam antibiotics in neonates was assessed. By rocket immunoelectrophoresis, the intrinsic C9 concentrations of pooled serum from both human and rat neonates was less than 20% of adult levels. Supplemental C9 purified from human plasma enhanced the capacity of ampicillin-treated serum from human neonates to impair the survival of E coli O7:K1:NM (P < 0.02). Similarly, supplemental C9 enhanced the capacity of cefotaxime-treated neonatal rat serum to impair the survival of E coli O1:K1:NM (P < 0.05). Moreover, the intraperitoneal administration of C9 enhanced the survival of cefotaxime-treated neonatal rats that were septic with E coli (P < 0.05). These observations may contribute to the development of new strategies, such as augmentation of complement component serum concentrations, to reduce the morbidity and mortality of neonatal E coli sepsis.

Topics: Adult; Ampicillin; Animals; Animals, Newborn; Anti-Bacterial Agents; Bacteremia; Blood Bactericidal Activity; Cefotaxime; Complement C9; Escherichia coli; Escherichia coli Infections; Female; Fetal Blood; Humans; In Vitro Techniques; Infant, Newborn; Pregnancy; Rats; Rats, Sprague-Dawley; Sepsis

Topics: Anus, Imperforate; Cefixime; Cefotaxime; Cephalosporins; Escherichia coli Infections; Humans; Infant; Male; Orchitis; Recurrence; Ultrasonography, Doppler, Color

A case of retroperitoneal pulmonary fistula caused by a neonatal adrenal abscess is reported. The adrenal abscess was diagnosed by means of needle aspiration which guided the choice of antibiotic therapy. The fistula was demonstrated by direct injection of contrast medium into the adrenal abscess. Treatment by needle aspiration of the adrenal abscess and intravenous antibiotics was successful.

Topics: Abscess; Adrenal Gland Diseases; Anti-Bacterial Agents; Bronchial Fistula; Cefotaxime; Cephalosporins; Contrast Media; Escherichia coli Infections; Fistula; Gentamicins; Humans; Infant, Newborn; Injections, Intravenous; Lung Diseases; Male; Needles; Netilmicin; Suction; Tomography, X-Ray Computed

Enrichment culture in modified buffered peptone water followed by immunomagnetic separation (IMS) with magnetic beads coated with an antibody against Escherichia coli O157 was compared with direct culture on cefixime rhamnose sorbitol MacConkey agar (CR-SMAC) and cefixime tellurite sorbitol MacConkey agar (CT-SMAC) for the isolation of E. coli O157 from human faeces. In total, 690 samples were examined; E. coli O157 was isolated from 25 samples by IMS but from only 15 and 12 by direct culture on CT-SMAC and CR-SMAC, respectively. The difference in sensitivity of detection was at its most marked on screening repeat faecal samples from known cases and samples from asymptomatic contacts, when of 12 strains of E. coli O157 isolated by IMS, only five were isolated by direct culture. IMS is a sensitive and simple technique for the isolation of E. coli O157 from human faecal samples and should prove useful in elucidating further the epidemiology of this micro-organism.

Topics: Acute Disease; Animals; Anti-Bacterial Agents; Bacterial Toxins; Bacteriophage Typing; Cefixime; Cefotaxime; Chlorocebus aethiops; Culture Media; Cytotoxins; Diarrhea; DNA Probes; DNA, Bacterial; Escherichia coli; Escherichia coli Infections; Feces; Gastrointestinal Hemorrhage; Humans; Immunomagnetic Separation; Plasmids; Rhamnose; Shiga Toxin 1; Sorbitol; Vero Cells

To investigate the influence of different classes and doses of antibiotics on endotoxin release in gram-negative infection in a rat model of intra- abdominal infection.. Immediately after intraperitoneal inoculation of Escherichia coli (5 x 10(7) colony-forming units/kg), anesthetized Wistar rats were treated with a single intravenous dose of an antimicrobial agent: cefotaxime (40 mg/kg), ciprofloxacin (3 mg/kg or 6 mg/kg), imipenem (7 mg/kg or 14 mg/kg), or gentamicin (5 mg/kg). An untreated control group received 0.9% sodium chloride instead of antibiotic. Plasma endotoxin activity, blood bacteria count, and mean arterial pressure were monitored at 60-minute intervals for 5 hours. At the end of the experiment, lavage was performed to determine the bacteria count in the peritoneal cavity.. In the untreated group, the blood bacteria count increased rapidly. Five hours after therapy, the plasma endotoxin activity in the cefotaxime group was higher by a factor of 3.6 than in the untreated group. Compared with the cefotaxime group, endotoxin activity was approximately 26% lower in the ciprofloxacin (3 mg/kg) group, 35% lower in the imipenem groups, and 38% lower in the gentamicin group. The lowest endotoxin levels were in the high-dose ciprofloxacin group. Bacteria counts in the peritoneal cavity were lowest in the gentamicin and high-dose ciprofloxacin groups. Except in the high-dose ciprofloxacin group, the endotoxin increase in the therapy groups was associated with a significant (P < .05) decrease in mean arterial pressure.. In the early phase of therapy, antibiotic-induced endotoxin release is influenced by the mode of action of the agent class. This is not the sole influence in every class. With quinolones, this effect is also influenced considerably by dosage, ie, by pharmacodynamics.

Topics: Animals; Anti-Bacterial Agents; Anti-Infective Agents; Bacteremia; Blood Pressure; Cefotaxime; Cephalosporins; Ciprofloxacin; Colony Count, Microbial; Disease Models, Animal; Endotoxins; Escherichia coli; Escherichia coli Infections; Gentamicins; Imipenem; Male; Peritoneal Diseases; Peritoneum; Rats; Rats, Wistar; Thienamycins

Topics: Anti-Bacterial Agents; Cefazolin; Cefotaxime; Emphysema; Endocarditis; Endophthalmitis; Escherichia coli Infections; Fatal Outcome; Gentamicins; Humans; Male; Middle Aged; Oxacillin; Sepsis; Urinary Tract Infections

The in vitro and in vivo antibacterial activities of sulopenem (CP-70,429),a new parenteral penem antibiotic, were compared with those of imipenem (IPM), flomoxef, cefuzonam (CZON) and cefotaxime. Sulopenem possessed broad-spectrum activities against Gram-positive bacteria and Gram-negative bacteria. Antibacterial activities of sulopenem against methicillin-sensitive Staphylococcus aureus, Staphylococcus epidermidis, Enterococcus faecalis, Streptococcus pyogenes and Streptococcus pneumoniae were equivalent to or somewhat superior to those of IPM. Against members of the family Enterobacteriaceae, sulopenem was 4- to 260-fold more active than reference antibiotics with broad-spectra. In a killing kinetics study for Haemophilus influenzae, sulopenem showed a 99.9% decrease of viable cells after 8 hours at a concentration of 0.20 micrograms/ml. This effect was obtained at a concentration 8-fold lower than that of IPM. The protective effects of sulopenem in murine experimental systemic infections were superior to those of imipenem/cilastatin. In murine experimental mixed infection with Escherichia coli and Bacteroides fragilis, sulopenem had lower ED50, in other words stronger antimicrobial activities than IPM. The therapeutic effect of sulopenem are related well with its MIC value. In guinea pigs experimental lung infection with Klebsiella pneumoniae, sulopenem was more effective than CZON or cefotiam.

Topics: Animals; Anti-Bacterial Agents; Bacteroides fragilis; Bacteroides Infections; beta-Lactam Resistance; Cefotaxime; Ceftizoxime; Cephalosporins; Escherichia coli Infections; Gram-Negative Bacteria; Gram-Positive Bacteria; Guinea Pigs; Imipenem; Klebsiella Infections; Lactams; Lung Diseases; Mice; Mice, Inbred ICR; Thienamycins

Topics: Adult; Bacteremia; Cefotaxime; Cloxacillin; Drug Resistance, Microbial; Drug Therapy, Combination; Endocarditis, Bacterial; Escherichia coli; Escherichia coli Infections; Fatal Outcome; Female; HIV Infections; Humans; Injections, Intravenous; Male; Substance Abuse, Intravenous; Tobramycin; Urinary Tract Infections

The MIC is the main microbiologic parameter used to predict the efficacies of antibiotics. However, it is well known that MICs may vary according to the inoculum size used (inoculum effect), especially with some beta-lactam antibiotics. In order to correlate the pharmacologic and microbiologic properties of some beta-lactams, an experimental model of intraperitoneal infection caused by Escherichia coli in nonneutropenic and neutro-penic mice was developed. The animals were treated with three different doses of either ampicillin, piperacillin, aztreonam, cefazolin, or cefotaxime. The linear regression analysis obtained in our model shows a better correlation between in vitro activity and efficacy when the MICs considered were those obtained with a large inoculum (ca. 1 x 10(8) CFU/ml) instead of the standard inoculum (5 x 10(5) CFU/ml). The correlations for the MICs obtained with the large inoculum were 0.78 for log2 maximum concentration of drug in serum (Cmax)/ MIC, 0.72 the time that the concentrations exceeded the MIC, and 0.79 for log2 area under the serum concentration-time curve (AUC)/MIC at 24 h in nonneutropenic mice. The corresponding values in neutropenic mice, also for the MICs obtained with the large inoculum, were 0.54, 0.68, and 0.64, respectively, at 24 h. A good correlation was also obtained for the same parameters in nonneutropenic mice at 48 h. The values of Cmax, AUC, and the time that the concentrations exceeded the MIC were parallel among the antibiotics studied, and our study confirms that the time that the levels in serum exceed the MIC is a significant parameter determining the efficacies of beta-lactam antibiotics, but the correlation is much better when the MICs obtained with the large inoculum instead of those obtained with the standard (low) inoculum are considered.

Topics: Ampicillin; Animals; Anti-Bacterial Agents; Aztreonam; Cefazolin; Cefotaxime; Disease Models, Animal; Escherichia coli Infections; Male; Mice; Peritoneal Diseases; Piperacillin

Transferable resistance to cefotaxime was demonstrated in 21 nosocomial strains of Klebsiella pneumoniae and Escherichia coli subsequently isolated from patients in two large University clinics. Using the double-disk diffusion test, we could detect, in each such strain, as well as in E. coli 3110 K-12 transconjugants after the transfer, the production of an Extended Spectrum Beta-Lactamase (ESBL). Ceftibuten was demonstrated to be effective against the majority of strains studied.

Topics: beta-Lactamases; Cefotaxime; Ceftibuten; Cephalosporins; Conjugation, Genetic; Cross Infection; Drug Resistance, Microbial; Escherichia coli; Escherichia coli Infections; Humans; Hydrolysis; Klebsiella Infections; Klebsiella pneumoniae; Microbial Sensitivity Tests; Slovakia

Topics: Antigens, Bacterial; Bacterial Proteins; Blood Bactericidal Activity; Cefotaxime; Escherichia coli; Escherichia coli Infections; Humans; Microbial Sensitivity Tests; Urinary Tract Infections

An investigation examined the efficacy of antibiotics in a novel feline model of pancreatic infection in acute pancreatitis. Acute pancreatitis was induced in cats using an established technique. In control animals (no pancreatitis) and cats with pancreatitis, Escherichia coli (10(4) in 0.1 ml) was placed in the pancreatic duct. Reoperation was performed after 24 h in six controls and six cats with pancreatitis. E. coli was cultured from the pancreas in five control animals and five cats with pancreatitis. Reoperation was performed after 1 week in ten controls, in 11 cats with pancreatitis and in nine with pancreatitis that were treated with cefotaxime (50 mg/kg intramuscularly three times daily) started 12 h after the induction of pancreatitis and administration of E. coli. Pancreatic infection developed in eight cats with pancreatitis compared with none of the cefotaxime-treated animals and none of the controls (P < 0.05). Cefotaxime reached bactericidal levels in pancreatic tissue and juice. In conclusion, ductal administration of E. coli caused pancreatic infection only in cats with acute pancreatitis. Early administration of an appropriate antibiotic was effective in treating pancreatic infection in acute pancreatitis.

Topics: Acute Disease; Animals; Cats; Cefotaxime; Disease Models, Animal; Escherichia coli; Escherichia coli Infections; Opportunistic Infections; Pancreas; Pancreatitis

In a rabbit Escherichia coli meningitis model, endotoxin liberation and concentrations of leukocytes, tumor necrosis factor (TNF), and lactate were compared after a single intravenous dose of cefotaxime, cefpirome, meropenem, chloramphenicol, or gentamicin. These antibiotics caused a 2- to 10-fold increase in cerebrospinal fluid concentrations of free (filterable) endotoxin within 2 h of starting treatment. By contrast, free endotoxin concentrations increased almost 100-fold in untreated animals 4 h later as bacteria continued to multiply. An initial enhancement of inflammation in the central nervous system occurred in all treatment groups compared with untreated controls. No significant differences were observed between treatment groups except for lower TNF concentrations in chloramphenicol-treated animals. Antibiotic therapy in E. coli meningitis, irrespective of the agent used, may result in an increase in free endotoxin and enhancement of inflammation, but the amount of endotoxin liberated is considerably smaller than that shed by untreated bacteria.

Topics: Animals; Anti-Bacterial Agents; Cefotaxime; Cefpirome; Cephalosporins; Chloramphenicol; Endotoxins; Escherichia coli Infections; Gentamicins; Inflammation; Male; Meningitis, Bacterial; Meropenem; Rabbits; Thienamycins

The in vivo efficacy of ofloxacin was compared with those of cefotaxime and doxycycline in a rat model of epididymitis due to Escherichia coli. Treatment was started 24 h after infection and was continued for 7 days. Ofloxacin reduced the numbers of E. coli organisms in the epididymides significantly more than the other therapeutic regimens and cured the infection more frequently. Histopathological changes in the epididymides of ofloxacin-treated animals were significantly less severe than those observed in untreated animals. Doxycycline was less effective than ofloxacin but significantly reduced the titers of organisms in rat epididymides. In contrast, despite excellent in vitro activity, cefotaxime failed to reduce the magnitude of infection. The results of this study suggest that ofloxacin may be a very effective antimicrobial agent for the treatment of epididymitis due to E. coli.

Topics: Animals; Cefotaxime; Doxycycline; Epididymitis; Escherichia coli; Escherichia coli Infections; Male; Microbial Sensitivity Tests; Ofloxacin; Rats; Rats, Wistar

Experimental endophthalmitis was treated with single intravitreous administrations of cefotaxime (claforan) and gentamicin. It was found that a single administration of cefotaxime to the vitreous body prevented development of endophthalmitis in rabbits previously infected with Staphylococcus aureus, E. coli and Pseudomonas aeruginosa. Vitrectomy in the treatment of endophthalmitis was shown to be promising and provide satisfactory anatomical and functional results.

Topics: Animals; Cefotaxime; Endophthalmitis; Escherichia coli Infections; Gentamicins; Pseudomonas Infections; Rabbits; Staphylococcal Infections; Vitrectomy; Vitreous Body

In acute life-threatening surgical infections requiring immediate institution of antimicrobial therapy before bacteriological results are available, antibiotic treatment must be empiric. For best efficacy a more sophisticated form of empiric therapy is offered, termed calculated antibiotic therapy (CAT). Calculated antibiotic therapy requires consideration of a) typical bacterial spectrum; b) bacterial pathogenicity and synergism; c) antibacterial concentrations at the site of infection; d) toxicity and adverse effects; e) interaction with immune response; and f) results of properly conducted trials. Intraabdominal infections are used as an example here to assess the efficacy of clinically used cephalosporins and penicillins for determination of calculated antibiotic therapy. CAT identifies Escherichia coli and Bacteroides fragilis as the most important pathogens for intraabdominal infections and determines the most effective antibiotics at the tissue breakpoint, which is defined as the minimal concentration maintained for more than 90% of the dosage interval period at the infected tissues. At the tissue breakpoint calculated antibiotic therapy identifies cefotaxime-generation cephalosporins to be fully (100%) active against the most important aerobic pathogen E. coli and metronidazole as fully active against the important obligate anaerobe B. fragilis. Calculated antibiotic therapy becomes relatively important, since impeccably controlled clinical therapeutic trials as a foundation for therapy are rarely published.

Topics: Abdomen; Anti-Bacterial Agents; Bacterial Infections; Bacteroides fragilis; Bacteroides Infections; Cefotaxime; Escherichia coli Infections; Humans; Metronidazole; Premedication; Surgical Wound Infection; Time Factors

Fifty-nine patients were operated or punctured in 60 incidents of brain abscess from 1963-1989, twice as many in men as in women. The number of cases tripled in 1980 to an incidence of 3.6 per million inhabitants per year, supposedly due to the advent of computerized tomography. Simultaneously, the aetiology changed from staphylococci and Gram negative rods to dominance of streptococci and Haemophilus aphrophilus. Apart from temporal abscesses, there was no correlation between localisation in the brain and the bacterial species isolated. Ninety-five per cent of the specimens from untreated patients gave growth, but so did specimens from six of 18 patients treated with relevant antibiotics up to 11 days before puncture. Therefore, we recommend removal of pus by excision or puncture.

Topics: Adolescent; Adult; Aged; Ampicillin; Bacteroides Infections; Brain Abscess; Cefotaxime; Child; Child, Preschool; Chloramphenicol; Denmark; Escherichia coli Infections; Female; Gram-Positive Bacterial Infections; Haemophilus Infections; Humans; Infant; Infant, Newborn; Male; Methicillin; Metronidazole; Middle Aged; Penicillins; Retrospective Studies; Streptomycin; Sulfonamides

Sorbitol-MacConkey medium has become widely used for the isolation of verotoxigenic (VT+) Escherichia coli O157. However, many organisms other than VT+ E. coli O157, especially other serogroups of E. coli and Proteus spp., may not ferment sorbitol, and thus may be confused initially with VT+ E. coli O157. Rhamnose is not fermented by VT+ E. coli O157, but is by most sorbitol non-fermenting E. coli of other serogroups. Cefixime is a cephalosporin antibiotic that is more active against Proteus spp. than against E. coli. Inclusion of rhamnose and cefixime in sorbitol-MacConkey agar improves its selectivity for the isolation of VT+ E. coli O157.

Topics: Anti-Infective Agents, Urinary; Bacterial Toxins; Cefixime; Cefotaxime; Culture Media; Diarrhea; Escherichia coli; Escherichia coli Infections; Feces; Microbial Sensitivity Tests; Rhamnose; Shiga Toxin 1

Stimulation of nonspecific immunity as an additional modality for therapy of sepsis that cannot be cured by antibiotics alone was investigated. SDZ MRL 953, a novel monosaccharidic lipid A analog as a prototype immunostimulant, and cefotaxime or gentamicin were administered to normal or myelosuppressed mice in a state of advanced sepsis caused by Escherichia coli or Staphylococcus aureus. In this novel model, antibiotic therapy was initiated when the infected mice appeared moribund. At this stage, neither pretreatment with the immunostimulant nor therapy with high doses of cefotaxime or gentamicin was effective in protecting the animals from fatal sepsis. However, pretreatment with a single dose of SDZ MRL 953 1 day prior to microbial inoculation dramatically improved the curative effects of the antibiotics. Hence, long-term survival was significantly enhanced with increasing doses of the immunostimulant in the combined therapy. Peritoneal macrophages from SDZ MRL 953-pretreated animals were primed for enhanced production of microbicidal reactive oxygen metabolites in vitro. In conclusion, the results of the present study indicate that SDZ MRL 953 is a potential candidate for use in a clinical setting as an adjunct to antimicrobial therapy for infections that cannot be treated successfully with appropriate antibiotics alone.

Topics: Animals; Cefotaxime; Drug Synergism; Escherichia coli Infections; Female; Gentamicins; Lipid A; Lipopolysaccharides; Mice; Staphylococcal Infections

According to the generally accepted mechanism by which bacterial enzymes react with cephalosporins, opening of the beta-lactam ring can lead to the expulsion of a 3'-substituent. A series of dual-action cephalosporins was prepared in which antibacterial quinolones were linked to the cephalosporin 3'-position through an ester bond in the expectation that, in addition to exerting their own beta-lactam activity, these cephalosporins would act as prodrugs for the second antibacterial agent. Compared to parent cephalosporins in which the 3'-substituent was acetoxy, the bifunctional cephalosporins exhibited a broadened antibacterial spectrum, suggesting that a dual mode of action may indeed be operative.

Topics: Animals; Anti-Infective Agents; Cefotaxime; Cephalosporins; Chemical Phenomena; Chemistry; Ciprofloxacin; Enterobacter; Escherichia coli Infections; Fleroxacin; Fluoroquinolones; Hydrolysis; Mice; Molecular Structure; Pneumococcal Infections; Prodrugs; Quinolones; Rats; Staphylococcus aureus; Structure-Activity Relationship

In 1983 our antibiotic regimen for suspected neonatal septicemia was changed from amoxicillin-gentamicin to cefotaxime-amoxicillin. During the subsequent 5-year period we studied the effect of this change in regimen on the bacterial flora of the infants in the unit and the occurrence of serious infections. This was done with bacteriologic surveillance and analysis of the positive blood cultures from 1978 through 1987. A change in the relative numbers of isolated pathogens was observed; Klebsiella sp. and Escherichia coli decreased whereas Enterobacter sp. increased. The susceptibility of the Enterobacter isolates to cefamandole decreased from 85.3% in 1982 to 52.9% in 1983. The susceptibility of these bacteria to cefotaxime was 55.2% in 1983 and 55.0% in 1987. No change in susceptibilities to cefotaxime, amoxicillin or gentamicin was found in other pathogens. Although colonization with Enterobacter strains has increased and the susceptibility of these bacteria to the cephalosporins has decreased, the incidence of serious infections with Gram-negative bacteria decreased.

Topics: Amoxicillin; Cefotaxime; Drug Resistance, Microbial; Enterobacter; Enterobacteriaceae Infections; Escherichia coli Infections; Female; Gentamicins; Humans; Infant, Newborn; Intensive Care Units, Neonatal; Klebsiella Infections; Male; Sepsis

Pseudomeningitis is the demonstration of microorganisms from the cerebrospinal fluid by stain or culture in a patient with symptoms suggesting meningitis. This is a report of fungal pseudomeningitis superimposed on a case of nosocomial Escherichia coli meningitis resulting from a neurosurgical procedure. Critical care personnel need to be aware of the possibility of pseudomeningitis with or without associated meningitis in the appropriate setting.

Topics: Cefotaxime; Escherichia coli Infections; Female; Fungi; Humans; Meningitis; Middle Aged

An experimental model in Wistar rats, of osteomyelitis caused by Escherichia coli, was used to evaluate the efficacy of cefotaxime in two treatment regimens of different durations. Four groups of rats were set up: a group of rats receiving short-term treatment (14 days) with subcutaneous cefotaxime (100 mg bd), killed after 56 days; a control group receiving no treatment, killed after 56 days; a group of rats undergoing long-term treatment (28 days) with subcutaneous cefotaxime as above, killed after 70 days and a control group of rats receiving no treatment, killed after 70 days. Analysis of histopathological and microbiological findings revealed significantly better results in the long-term treatment group. No side-effects were observed during treatment or afterwards.

Topics: Animals; Cefotaxime; Chronic Disease; Disease Models, Animal; Escherichia coli Infections; Female; Osteomyelitis; Rats; Rats, Inbred Strains

We reviewed cases of Gram-negative enteric bacillary meningitis in infants and children treated with cefotaxime at Texas Children's Hospital from January, 1984, through June, 1989. Seventeen of 20 children had an underlying condition predisposing to the development of meningitis. The etiologic organisms in these 20 children (2 days to 12 years old; median, 12 days old) were Klebsiella sp, 9; Escherichia coli, 4; Enterobacter cloacae, 3; Citrobacter diversus, 2; other, 2. With the exception of one isolate of Acinetobacter, all isolates were susceptible to cefotaxime. In addition to cefotaxime 17 children received an aminoglycoside intravenously. Children with meningitis caused by Klebsiella sp. or non-Klebsiella organisms received cefotaxime for 31 +/- 14 and 37 +/- 17 days, respectively. Aminoglycosides were administered for 16 +/- 10 days in both groups. Five children in each group also received intraventricular doses (1 to 25) of an aminoglycoside (9) or colistimethate (1). The mean durations of positive lumbar, ventricular cerebrospinal fluid or brain abscess cultures were 5.8 +/- 4.7 and 7.2 +/- 5.0 days after start of therapy in the Klebsiella and non-Klebsiella meningitis patients, respectively. Only three children were normal at the time of discharge or follow-up. Gram-negative enteric meningitis remains difficult to treat despite the excellent in vitro activity of cefotaxime against Gram-negative enterics, in part as a result of the predisposing conditions resulting in the development of this infection.

Topics: Aminoglycosides; Anti-Bacterial Agents; Cefotaxime; Child; Child, Preschool; Citrobacter; Drug Therapy, Combination; Enterobacter; Enterobacteriaceae Infections; Escherichia coli Infections; Humans; Infant; Infant, Newborn; Klebsiella Infections; Meningitis; Retrospective Studies

In systemic and local infections, the therapeutic efficacy of cefpirome was compared to that of imipenem and cefotaxime. Murine septicemia induced with methicillin-sensitive and methicillin-resistant Staphylococcus aureus strains responded well to cefpirome and imipenem therapy, the ED50 values ranged from 0.8 to 28.40 mg/kg and 0.5 to 15.58 mg/kg, respectively. The carbapenem also displayed high efficacy against Enterococci and was more potent than cefpirome. Cefotaxime, however, exhibited lower activity or proved to be inactive against these strains. With ED50 values of 0.03 to 31.33 mg/kg, cefpirome was the most active of the three antibiotics in protecting mice challenged with Enterobacteriaceae. The corresponding ED50 values of imipenem and cefotaxime ranged from 0.72 to 70.95 mg/kg and 0.06 to 66.30 mg/kg, respectively. Despite distinctly lower in vitro activity against the infecting organism, cefpirome showed efficacy similar to imipenem in the treatment of subcutaneous S. aureus abscesses in mice. It was more effective than imipenem and cefotaxime against experimental Klebsiella pneumonia in mice and the Escherichia coli infected granuloma pouch in rats.

Topics: Abscess; Animals; Bacterial Infections; Cefotaxime; Cefpirome; Cephalosporins; Enterobacteriaceae Infections; Escherichia coli Infections; Female; Granuloma; Imipenem; Male; Mice; Mice, Hairless; Mice, Inbred C3H; Pneumonia; Rats; Rats, Inbred Strains; Sepsis; Staphylococcal Skin Infections; Staphylococcus aureus; Streptococcal Infections

This epidemiological Study is held in Sağlik Sosyal Yardim Bakanliği--Hacettepe Universitesi Tip Fakültesi Cubuk Research and Training area to find out the prevalence of urinary tract infections and to determine the antibiotic susceptibility of the causitive organisms. The prevalence of urinary tract infections in the area is 10%. E. coli is the most frequently isolated bacterium (40%). Amikacin, Cephotaxime, and Ofloxacine are the most effective antibiotics.

Topics: Adolescent; Adult; Amikacin; Anti-Bacterial Agents; Bacteria; Cefotaxime; Escherichia coli; Escherichia coli Infections; Female; Humans; Male; Middle Aged; Ofloxacin; Prevalence; Turkey; Urinary Tract Infections

The possibility that beta-lactamase-producing strains of Bacteroides fragilis can protect Escherichia coli from cefotaxime was studied in an in-vivo model of peritoneal infection in rats. The protective effect of cefotaxime, aztreonam and gentamicin in peritonitis induced by E. coli alone or combined with B. fragilis was evaluated by analysing mortality at 24 and 48 h after bacterial inoculation and treating the animals with two doses of each antibiotic. Comparisons, by drugs, at 24 and 48 h revealed that a statistically significant high mortality rate was obtained at 48 h when mixed infections were treated with cefotaxime, a drug very active in the infection caused by E. coli alone. Infections by mixed flora or E. coli alone treated with aztreonam or gentamicin did not show any significant difference in mortality rate analysed at 24 or 48 h. These in-vivo results confirm previous in-vitro studies and suggest that cefotaxime could be inactivated in mixed infections if a beta-lactamase-producing strain, such as B. fragilis, is involved in a clinical infection.

Topics: Animals; Aztreonam; Bacteroides fragilis; Bacteroides Infections; Cefotaxime; Escherichia coli Infections; Female; Gentamicins; Microbial Sensitivity Tests; Peritonitis; Rats; Rats, Inbred Strains

Relationships between concentration and antimicrobial effect (AME) of sisomicin (SMN) and cefotaxime (CTX) were established by simulating their pharmacokinetic profiles in an in vitro dynamic model. The AME duration (TE, time shift between the curves of bacteria heat output in the presence and absence of the antibiotics) or intensity (IE, area between the above curves) for both the antibiotics depended in the same way on the area under the concentration/time curve (AUC, mimicing of intravenous administration of the antibiotics in various doses). At low and moderate values of the AUC the dependences of IE or TE vs the AUC (the bacteriostatic phase of the AME development) were of the sigmoid shape while at high values of the AUC there was a marked increase in IE or TE (the bactericidal phase). The patterns of the IE or TE vs AUC curves in impaired antibiotic elimination were analogous. At the same time the IE or TE vs AUC curves for both the antibiotics under simulation of normal elimination (T 1/2, SMN-2.1 h, T 1/2, CTX-1.2 h) and impaired one (T 1/2, SMN-8.3 h, T 1/2, CTX-4.6 h) did not match. In the first case the AMESMN was on the whole higher and the AMECTX was lower than in the second case. Therefore, in patients with renal failure the efficient concentration of the aminoglycoside in blood can be higher and that of the cephalosporin on the contrary can be lower than the normal.

Topics: Cefotaxime; Dose-Response Relationship, Drug; Escherichia coli; Escherichia coli Infections; Humans; In Vitro Techniques; Metabolic Clearance Rate; Sisomicin

A significant decrease in resistance to infections caused by gramnegative pathogens was observed in mice with neutropenia induced by cytostatics. Efficacy of schemes for combined chemotherapy with beta-lactams, aminoglycosides and a novel peptide antibiotic was studied on model infections in mice with neutropenia. In the neutropenic mice with sepsis caused by Pseudomonas the peptide antibiotic administered parenterally in a single dose of 50 micrograms/kg provided high therapeutic activity. In combination with azlocillin, cefotaxime and amikacin the peptide antibiotic has a synergistic therapeutic action.

Topics: Agranulocytosis; Amikacin; Animals; Azlocillin; Cefotaxime; Drug Synergism; Drug Therapy, Combination; Escherichia coli Infections; Immune Tolerance; Klebsiella Infections; Mice; Neutropenia; Opportunistic Infections; Pseudomonas Infections

The activity of amoxycillin/clavulanic acid was compared with that of cefuroxime and cefotaxime, alone and combined with metronidazole, in preventing the development of infections in the mouse caused by subcutaneous injection of a beta-lactamase-producing strain, Escherichia coli E96, or a mixed inoculum of E. coli E96 and Bacteroides fragilis VPI 8908. Amoxycillin/clavulanic acid, cefuroxime and cefotaxime were equally efficacious in preventing development of the E. coli E96 monoinfection at clinically achievable concentrations. However, the activity of cefuroxime against E. coli E96 in the mixed infection was markedly reduced as was, to a lesser extent, that of cefotaxime. Co-administration of metronidazole improved slightly the activity of cefuroxime against E. coli E96 in the mixed infection, but had no such enhancing effect on cefotaxime. In contrast, amoxycillin/clavulanic acid effectively prevented development of the mixed infection in all treated mice. Results of in-vitro studies showed that cefuroxime and cefotaxime were stable in a culture of E. coli E96, and were rapidly bactericidal against this strain. In contrast, both cephalosporins were hydrolysed in a mixed culture of E. coli E96/Bact. fragilis VPI 8908, which resulted in diminished bactericidal activity, particularly of cefuroxime, which was not restored by addition of metronidazole. Amoxycillin/clavulanic acid was stable in the mixed culture and caused a significant reduction in numbers of both organisms. These in-vitro data explain the findings of the in-vivo studies, and establish that the beta-lactamase activity of Bact. fragilis VPI 8908 was responsible for the diminished activity of cefuroxime and cefotaxime, combined with metronidazole, against a mixed E. coli/Bact. fragilis infection.

Topics: Amoxicillin; Animals; Bacteroides fragilis; Bacteroides Infections; beta-Lactamases; Cefotaxime; Cefuroxime; Cephalosporins; Clavulanic Acids; Escherichia coli; Escherichia coli Infections; Female; Metronidazole; Mice; Microbial Sensitivity Tests

In order to assess the in vivo antibacterial activity of two cephalosporins of third generation, cefotaxime and ceftriaxone, we used the model of experimental bacteremia in chickens we had developed for a few years. 93 chickens were inoculated with 10(7) E. coli K1 coming from a meningitis in a new-born baby. 19 chickens were used as a control group; 29 were given ceftriaxone (50 mg/kg); 28 cefotaxime (50 mg/kg) and 17 cefotaxime (100 mg/kg). The antibiotics were injected 4 hours after the inoculation. The bacterial concentrations found in capillaries by using quantitative blood cultures, were significantly lower in the 3 groups of chickens which were given antibiotics than in the control group, at 24, 48 and 72 hours after inoculation. At 24 hours after the inoculation, the bacterial concentration in the chickens treated by ceftriaxone (50 mg/kg) was significantly lower than that found in chickens treated by cefotaxime (50 mg/kg). At 48 or 72 hours the differences of bacterial concentration in the three groups of chickens were not significant. Over 72 hours following inoculation, 4 control and only one treated chickens died. The efficient clearance of E. coli K1 by a single dose of ceftriaxone, found at 24 hours after inoculation, confirms the possibility of using ceftriaxone once daily for serious infections.

Topics: Animals; Cefotaxime; Ceftriaxone; Chickens; Escherichia coli Infections; Injections, Intravenous; Microbial Sensitivity Tests; Models, Biological; Sepsis; Time Factors

25 patients of acute urinary tract infection with E. coli received Omnatax, 1 gm. b.d. 80% patients had bacteriologic cure on second day and 96% on fourth day of treatment. When assessed in light of the disappearance or decrease in pyuria and bacteriuria, 72% patients showed excellent response and 28% moderate response at the end of treatment. Clinical cure was achieved in 84% of patients. Mean number of days required for the patients to become symptom-free was 3.5 and mean time to achieve complete bacterial elimination was 1.96 days.

Topics: Acute Disease; Adult; Cefotaxime; Cystitis; Escherichia coli; Escherichia coli Infections; Female; Humans; Male; Urinary Tract Infections

Cefixime (CFIX) was administered orally in the treatment of 59 cases of urinary tract infection (UTI). According to the response criteria defined by the Japanese UTI committee, the rate of clinical efficacy for 26 cases of uncomplicated cystitis was 96.2%. The rate of clinical effectiveness of five patients with complicated UTI and five with uncomplicated pyelonephritis was 80.0%. In the other 23 cases which did not meet the response criteria, the efficacy rate was also high. The results indicated that CFIX was an effective drug for the treatment of UTI.

Topics: Anti-Infective Agents, Urinary; Cefixime; Cefotaxime; Drug Evaluation; Escherichia coli Infections; Humans; Urinary Tract Infections

It is well known that some antibiotics are particularly nephrotoxic. In the present study we investigated kidney function and AAP excretion (as an index of nephrotoxicity) in patients with urinary tract infection treated with CAZ or CTX plus TOB. The main cause of infection was E. coli in both treated groups. After 10 days of treatment similar beneficial effects were stated in both groups. At the end of treatment urinary AAP excretion in both groups was higher than before treatment. Despite a significant increase in urinary AAP in only one patient of each group, the serum creatinine level rose by more than 45 mumol/l. Monitoring of urinary AAP may be useful in early detection of nephrotoxicity caused by antibiotics.

Topics: Adult; Aminopeptidases; CD13 Antigens; Cefotaxime; Ceftazidime; Clinical Enzyme Tests; Creatinine; Drug Therapy, Combination; Escherichia coli Infections; Female; Humans; Kidney Function Tests; Male; Tobramycin; Urinary Tract Infections

We studied the effect of a nonsteroidal anti-inflammatory drug, diclofenac, in rabbits on the kinetics of three cephalosporins: cefotiam, cefmenoxime and ceftriaxone, and compared the antibacterial effect of these antibiotics, given alone or with diclofenac, in experimental endocarditis. Diclofenac significantly increased (P less than .05) the area under the curve in tissue-cage fluid of ceftriaxone and cefotiam-treated animals, and the terminal half-life of ceftriaxone in their sera (3.45 +/- 0.4 vs. 2.8 +/- 0.5 hr). Diclofenac reduced urinary excretion of cefotiam only. Cefmenoxime pharmacokinetics remained unchanged by diclofenac. The alteration of ceftriaxone kinetics appeared to be due to nonrenal mechanisms and could suggest reduction of biliary excretion. In Escherichia coli endocarditis, diclofenac enhanced the concentration (P less than .05) of cefotiam (23 +/- 16 vs. 8.9 +/- 5 micrograms/g) and ceftriaxone (13.2 +/- 3 vs. 8.5 +/- 4 micrograms/g) in infected vegetations, but not that of cefmenoxime. The antibacterial effect of ceftriaxone increased with diclofenac (5.5 +/- 1 vs. 7.2 +/- 1 log10 colony forming unit/g of vegetation). In vitro, neither protein binding to rabbit serum proteins nor intrinsic activity on the E. coli strain of each antibiotic was modified by diclofenac. These results suggest that anti-inflammatory drugs could increase antibiotic efficacy by altering their pharmacokinetics. The renal and nonrenal site of interaction may be involved for drugs belonging to the same class. Results obtained in tissue-cage fluid were predictive of the interference at the infected site.

Topics: Animals; Cefmenoxime; Cefotaxime; Cefotiam; Ceftriaxone; Diclofenac; Drug Synergism; Endocarditis, Bacterial; Escherichia coli Infections; Injections, Intramuscular; Microbial Sensitivity Tests; Rabbits

The minimum dosage of antibiotics which reduced mortality in rats intraperitoneally inoculated with an Escherichia coli isolate was determined. Low mortality rates (0-10%) were obtained when antibiotics with minimal or no inoculum effect (cefoxitin, cefmetazole and gentamicin) were administered to yield serum levels 3 to 20 times the MIC, while antibiotics with a pronounced inoculum effect (cefotaxime and aztreonam) had to be administered to yield serum levels 200 to 1,000 times the MIC determined with a standard (low) inoculum. Thus, it seems that the inoculum effect observed in vitro with some antibiotics for Escherichia coli may have clinical significance.

Topics: Animals; Anti-Bacterial Agents; Aztreonam; Cefmetazole; Cefotaxime; Cefoxitin; Cephamycins; Drug Resistance, Microbial; Escherichia coli; Escherichia coli Infections; Female; Gentamicins; Microbial Sensitivity Tests; Rats; Rats, Inbred Strains

To determine the influence of in vitro activity, pharmacokinetic properties, and therapeutic regimen on the antibacterial effect in vivo, we compared three cephalosporins, cefotiam, cefmenoxime, and ceftriaxone, in a rabbit model of experimental Escherichia coli endocarditis after 4 days of treatment. The MBCs of cefotiam, cefmenoxime, and ceftriaxone for the E. coli strain were 0.5, 0.125, and 0.06 microgram/ml, respectively. Killing curves at 10 times the MBC were similar for the three cephalosporins. In serum, the elimination half-life of ceftriaxone was twice as much as the elimination half-life of cefotiam or cefmenoxime (2.8 +/- 0.45 versus 1.4 +/- 0.25 or 1.3 +/- 0.4 h, respectively). Ceftriaxone was much more effective than cefotiam. The bacterial titer in the vegetations (log10 CFU per gram of vegetation) was 7.56 +/- 1 with cefotiam and 2.41 +/- 2.6 with ceftriaxone, as their concentrations were 18 and 466 times higher, respectively, than their MBCs. Although ceftriaxone and cefmenoxime exhibited a similar rate of killing and percentage of protein binding, ceftriaxone was more effective than cefmenoxime at the same regimen of 15 mg/kg twice a day (3.08 +/- 1.1 versus 4.82 +/- 3.2 log10 CFU/g of vegetation). When antibiotic was given as a single daily injection of 30 mg/kg, the antibacterial effect persisted for ceftriaxone, but not for cefmenoxime. The longer elimination half-life and the higher local concentration/MBC ratio of ceftriaxone explained these results. The bacterial titer measured 24 h after the fourth injection of 30 mg of ceftriaxone per kg confirmed that this regimen prevented regrowth of bacteria. These results suggest that the local antibiotic level/MBC ratio roughly correlated with the antibacterial effect and could represent an adequate basis to explain the differences observed between the drugs in vivo. They also demonstrate that, provided that the dose is sufficient, a long-acting broad-spectrum cephalosporin may be effective in severe gram-negative infections, even when given at relatively long dosing intervals, in contrast with a rapidly cleared drug with the same intrinsic activity.

Topics: Animals; Cefmenoxime; Cefotaxime; Cefotiam; Ceftriaxone; Drug Evaluation, Preclinical; Endocarditis, Bacterial; Escherichia coli; Escherichia coli Infections; Kinetics; Rabbits

We investigated the effect of cefotaxime and chloramphenicol on endotoxin concentrations in cerebrospinal fluid (CSF) and on the development of brain edema in rabbits with Escherichia coli meningitis. Both antibiotics were similarly effective in reducing bacterial titers. Cefotaxime, but not chloramphenicol, induced a marked increase of endotoxin in CSF, from log10 1.5 +/- 0.8 to log10 2.8 +/- 0.7 ng/ml (P less than .01). This result was associated with an increase in brain water content (405 +/- 12 g of water/100 g of dry weight compared with 389 +/- 8 g in untreated controls; P less than .01), whereas in animals treated with chloramphenicol, brain water content was identical to controls. The cefotaxime-induced increase in endotoxin concentration and brain edema were both neutralized by polymyxin B, which binds to the lipid A moiety of endotoxin, or by a monoclonal antibody to lipid A. These results indicate that treating gram-negative bacillary meningitis with selected antibiotics induces increased endotoxin concentrations in CSF that are associated with brain edema.

Topics: Animals; Anti-Bacterial Agents; Antibodies, Monoclonal; Brain Edema; Cefotaxime; Chloramphenicol; Endotoxins; Escherichia coli; Escherichia coli Infections; Lipid A; Meningitis; Polymyxin B; Rabbits

Endotoxin and monocyte thromboplastin activity were evaluated in rats with gram-negative septicaemia induced by caecal perforation or intravenous Escherichia coli challenge and treated with antibiotics or placebo. Endotoxin burst was not detected in either form of septicaemia during antibiotic treatment. Thromboplastin synthesis in monocytes is known to be stimulated by endotoxin, but the rats showed no increase of monocyte thromboplastin activity after antibiotic treatment, which constituted further evidence against the concept of massive endotoxin liberation during antibiotic therapy for gram-negative septicaemia.

Topics: Animals; Anti-Bacterial Agents; Cefotaxime; Endotoxins; Escherichia coli Infections; Gentamicins; Male; Monocytes; Rats; Rats, Inbred Strains; Sepsis; Thromboplastin; Tinidazole

The cefotiam (CFT) penetration in infected ascitic fluid was investigated in 12 cirrhotic patients. CFT (1 g every 8 h) was given intravenously and measured by HPLC in plasmatic and ascitic samples. The mean ascitic concentrations (+/- SEM), 1 h, 3 h and 8 h after the first injection (J1) were 14.6 +/- 4.6, 11.8 +/- 3 and 8.4 +/- 2.9 micrograms/ml respectively. These values were 38, 62 and 88% of the corresponding mean plasmatic concentrations and higher than the MIC's for the organisms most commonly involved. The mean plasmatic and ascitic concentrations, a few days later (4.5 or 6 days) (Jn) were not significantly different from the corresponding values at J1. A significant decrease of polymorphonuclear cell count was observed between J1 and Jn. These results suggest that CFT diffusion into ascitic fluid is independent of inflammation and CFT is an adequate antibiotic in cirrhotic patients with infected ascitic fluid.

Topics: Adult; Aged; Ascitic Fluid; Bacterial Infections; Cefotaxime; Cefotiam; Diffusion; Escherichia coli; Escherichia coli Infections; Female; Humans; Male; Middle Aged; Pneumococcal Infections; Staphylococcal Infections; Staphylococcus aureus; Streptococcus pneumoniae; Yersinia enterocolitica; Yersinia Infections

Two groups of rats were treated for epididymitis in an experimental study. The developing infection of E. coli was treated effectively by a single dose of cephalosporin in one group of rats. In the other group, where abscess formation had taken place, no effect of up to 9 days of treatment could be demonstrated, indicating the importance of early antibiotic treatment in bacterial epididymitis.

Topics: Abscess; Animals; Cefotaxime; Epididymitis; Escherichia coli Infections; Male; Rats; Time Factors

Ciprofloxacin was tested in the acute and chronic experimental E.coli pyelonephritis in rats. Its therapeutic efficacy was compared with that of cefotaxime. In the acute pyelonephritis increasing doses resulted in increasing elimination of bacteria from the kidneys. Ciprofloxacin and cefotaxime showed no difference in the efficiency in therapy of the acute pyelonephritis. In chronic pyelonephritis ciprofloxacin proved to be more effective than cefotaxime in spite of identical in vitro activity. Pharmacokinetic data showed that ciprofloxacin was eliminated more slowly than cefotaxime. The long serum half-life and the high volume of distribution could be responsible for the high therapeutic efficacy and could outweigh the disadvantage of metabolic instability.

Topics: Acute Disease; Animals; Anti-Infective Agents, Urinary; Cefotaxime; Chronic Disease; Ciprofloxacin; Escherichia coli Infections; Female; Pyelonephritis; Quinolines; Rats; Rats, Inbred Strains

Information on 62 bacteriologically confirmed cases of bacterial meningitis treated with cefotaxime in this country was obtained retrospectively from infectious disease consultants. This series of cases differed markedly from the world cumulative case data thus far presented. One of the two most common organisms treated was the pneumococcus (allergy to penicillin or misdiagnosis of the Gram stain results were the major reasons given). The other organism was Klebsiella. Unanticipated bacteriologic successes were noted in two cases of staphylococcal meningitis secondary to parameningeal foci. The bacteriologic cure rate and survival rate were about 85 percent. Failure of monotherapy was seen in one case of Pseudomonas meningitis, as well as in three of five cases of Enterobacter meningitis. In addition, two cases of Escherichia coli meningitis in which moxalactam therapy inexplicably failed were cured with cefotaxime. Close analysis of killing kinetics appeared to explain the Enterobacter and E. coli failures. Thus, overall not all gram-negative species and not all isolates of any particular species that cause meningitis can be successfully treated by cephalosporins. Data obtained during the investigative trials do not appear to be entirely predicative of what occurred during the free clinical use of an antibiotic. Post-investigatory follow-up and surveillance of all newly introduced therapeutic agents are needed.

Topics: Adult; Aged; Bacterial Infections; Cefotaxime; Escherichia coli; Escherichia coli Infections; Humans; Infant, Newborn; Klebsiella Infections; Male; Meningitis; Meningitis, Pneumococcal; Microbial Sensitivity Tests; Middle Aged; Moxalactam

The therapeutic efficacy of the fluoroquinolone pefloxacin mesylate was compared with those of cefotaxime and chloramphenicol in a rabbit model of Escherichia coli meningitis. The mean percent penetration (+/- the standard deviation) of pefloxacin (range, 1 to 30 mg/kg per h) into cerebrospinal fluid of infected rabbits was 51.3 +/- 14.0 compared with 11.1 +/- 1.0 for cefotaxime (100 mg/kg per h) and 22.3 +/- 1.5 for chloramphenicol (60 mg/kg per h). The rate of bacterial killing (delta log10 CFU/ml per h) did not change over a dosage range of 1 to 15 mg/kg per h (-0.37 +/- 0.15, 20% sterile). At 30 mg/kg per h, the rate achieved (-0.77 +/- 0.18, 100% sterile) was comparable to that of cefotaxime (-0.88 +/- 0.23, 100% sterile) and superior to that of chloramphenicol (-0.10 +/- 0.14, 0% sterile).

Topics: Animals; Anti-Infective Agents; Cefotaxime; Chloramphenicol; Escherichia coli Infections; Humans; Meningitis; Microbial Sensitivity Tests; Norfloxacin; Pefloxacin; Rabbits; Time Factors

Combinations of SF-2103A with cefotaxime, cefoperazone or cefazolin showed synergistic efficacy at a wide range of combination ratios against experimental infection in mice due to Proteus vulgaris GN76/C-1, producing type Ic cephalosporinase, Escherichia coli No. 29/36 RGN823, producing type IIIa (TEM-2) penicillinase and E. coli GN206, producing type Ib cephalosporinase. These effects by SF-2103A were greater than those seen with sulbactam. The in vitro and in vivo synergistic activities were roughly correlated. Potent in vivo activity of SF-2103A was related to good pharmacokinetic properties, with blood half-life of 30 minutes and urinary recovery of 55.2% after parenteral administration to rats. Furthermore, SF-2103A was stable to rat kidney homogenate. The high stability of SF-2103A in aqueous and biological media was correlated with the sulfonate group at C-3.

Topics: Animals; Anti-Bacterial Agents; beta-Lactamase Inhibitors; Carbapenems; Cefoperazone; Cefotaxime; Cephalosporins; Drug Stability; Drug Synergism; Drug Therapy, Combination; Escherichia coli Infections; Kinetics; Proteus Infections; Rats; Rats, Inbred Strains; Structure-Activity Relationship

In the course of a study to determine the nature and type of secondary bacterial infection in dracunculiasis. The most common organisms cultured from lesions were Escherichia coli, Enterobacter and Staphylococcus aureus. E. coli and Enterobacter which were found to carry high morbidity were sensitive to Gentamycin, Claforan and Septrin.

Topics: Cefotaxime; Dracunculiasis; Drug Combinations; Enterobacter; Enterobacteriaceae Infections; Escherichia coli; Escherichia coli Infections; Female; Gentamicins; Humans; Skin Diseases, Infectious; Skin Ulcer; Staphylococcal Skin Infections; Staphylococcus aureus; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

An experimental wound model was used to evaluate the effectiveness of cefazolin, cefamandole, and cefotaxime in the prevention of wound infection. Incisions were contaminated with Staphylococcus aureus, Escherichia coli, or a standardized fecal suspension. Regardless of the contaminant employed, the prophylactic use of either cefazolin, cefamandole, or cefotaxime yielded lower concentrations of bacteria in the wounds and fewer infections compared with treatment with saline solution. Within the context of this experimental model, cefazolin proved equally as effective as the newer and more expensive cephalosporins, cefamandole and cefotaxime.

Topics: Animals; Cefamandole; Cefazolin; Cefotaxime; Cephalosporins; Escherichia coli Infections; Feces; Female; Mice; Staphylococcal Infections; Surgical Wound Infection

In the E. coli pyelonephritis, induced in female Wistar rats by retrograde infection (high pressure reflux), we investigated the influence of 1) the time of commencement of therapy, 2) the renal bacterial counts, i.e. the inflammatory activity of the pyelonephritis after endovesical instillation of cultures with different bacterial concentrations, and 3) the level of infection resistance of the experimental animal strain on the therapeutic response of the model infection with single doses of cefoxitin (150 mg/ml) and cefotaxime (5 mg/ml). Early commencement of therapy post inoculation was therapeutically advantageous provided the intrarenal multiplication of the infective organisms was not delayed or the initial bacterial concentrations were not too high. The mild form of pyelonephritis with lower renal bacterial concentrations and poor inflammatory activity after endovesical instillation of a low inoculum (10(4) cfu/ml) was less amenable to treatment than the inflammatory active pyelonephritis with high renal bacterial counts, using a high inoculum (10(7) cfu/ml). High renal bacterial counts after retrograde inoculation of an E. coli culture of 10(8) cfu/ml resulted in significant reduction of bacterial counts 48, 72 and 96 h post infectionem, with i.m. application of cefoxitin 12 h prior. For Wistar rat strain Bor:WIST, which showed a stronger infection resistance with lower renal bacterial concentrations and a stronger tendency to spontaneous healing, application of a single dose of cefotaxime (5 mg/ml) was therapeutically ineffective, whereas, in contrast, with Han: WIST rats the acute phase of E. coli pyelonephritis could be treated effectively.

Topics: Animals; Cefotaxime; Cefoxitin; Disease Models, Animal; Escherichia coli; Escherichia coli Infections; Female; Kidney; Pyelonephritis; Rats; Rats, Inbred Strains

Cefmenoxime, a new semisynthetic cephalosporin structurally similar to cefotaxime, was evaluated for its activities in vitro and in vivo against a K1 Escherichia coli strain in comparison with activities of cefotaxime and ampicillin. In vitro the MICs and MBCs of both cefmenoxime and cefotaxime were the same, 1/16th and 1/32nd those of ampicillin, respectively. The efficacies of cefmenoxime and cefotaxime against experimentally induced E. coli bacteremia and meningitis in newborn rats were similar and significantly better than that of ampicillin as judged by bactericidal titers of blood and cerebrospinal fluid, rapidity of clearance of bacteria from blood and cerebrospinal fluid, and incidence of meningitis in animals with bacteremias. The efficacy of cefmenoxime or cefotaxime measured by impact on mortality was influenced by the size of bacterial populations. The mortality was significantly greater in rats with bacterial counts before therapy of greater than or equal to 10(6) CFU/ml of blood than in animals with lower counts. Overall, the in vivo efficacy of cefmenoxime was similar to that of cefotaxime; thus it could be useful in the therapy of neonatal E. coli infection.

Topics: Ampicillin; Animals; Cefmenoxime; Cefotaxime; Escherichia coli Infections; Meningitis; Microbial Sensitivity Tests; Rats; Sepsis

In a search for more effective antimicrobial therapy of neonatal Escherichia coli infection, newer beta-lactam antibiotics, cefotaxime and imipenem, were evaluated for their activities against a K1 E. coli strain in vitro and in vivo, and the results were compared with those of conventional therapeutic regimens for neonatal E. coli infection: ampicillin-gentamicin and ampicillin-chloramphenicol. Measured by MICs and MBCs, cefotaxime and imipenem were 8- to 512-fold more active in vitro than the older agents. For in vivo studies, the following daily doses were used: 50 mg/kg for each of imipenem and cilastatin; 100 mg/kg for each of cefotaxime, ampicillin, and chloramphenicol; and 10 mg/kg for gentamicin. At these doses, the mean bactericidal titers in blood and cerebrospinal fluid were significantly greater with newer agents than with ampicillin-gentamicin and ampicillin-chloramphenicol. However, at the doses used, the newer agents were not more effective in vivo than the older agents. This was shown by the similarities in clearance of bacteria from blood and cerebrospinal fluid, incidences of meningitis in bacteremic animals, and mortality rates. Thus, although these two newer antibiotics are more active in vitro and produce greater bactericidal titers in vivo, they do not appear to be superior to conventional regimens for treatment of neonatal E. coli bacteremia and meningitis.

Topics: Ampicillin; Animals; Animals, Newborn; Cefotaxime; Chloramphenicol; Cilastatin; Cyclopropanes; Dose-Response Relationship, Drug; Drug Therapy, Combination; Escherichia coli Infections; Gentamicins; Imipenem; Meningitis; Rats; Sepsis; Thienamycins

Cefotaxime has a good meningeal diffusion and is effective at low concentrations on many bacteria, especially ampicillin resistant Enterobacteriaceae and Hemophilus influenzae. We have therefore used cefotaxime (150 mg/kg/24 h, continuous infusions lasting 30 minutes q. 6 h.) in meningitis due to gram negative bacilli. Twenty eight infants and children have been treated within 4 years. The 13 Hemophilus influenzae meningitis (including 2 beta-lactamase producers) have been cured without immediate sequelae. The duration of treatment could be reduced from 3 weeks to 2 weeks. The 7 infants with Enterobacteria meningitis (6 E. coli and 1 Serratia) have been cured of their infection with a 21 to 28 days treatment. The C.S.F. was sterile 2-3 days after treatment except a case of E. coli persisting during 7 days in C.S.F. contrasting with a normal ventricular fluid. A case of relapse with E. coli remaining sensitive was cured with a new course of the same treatment. Five meningitis complicated with hydrocephalus needed external drainage: the fluid was sterile 1 day after treatment in 4 of them. Two superinfections of ventriculo-peritoneal shunt due to Enterobacteriaceae have been cured. To obtain a good result, the need for a careful drug monitoring must be emphasized.

Topics: Cefotaxime; Child; Child, Preschool; Escherichia coli Infections; Female; Humans; Infant; Infant, Newborn; Male; Meningitis; Meningitis, Haemophilus

We have evaluated the efficacy of cefotaxime and latamoxef against a Kl Escherichia coli strain in vitro and in vivo. In vitro, the minimal inhibitory concentrations (MICs) were close to the minimal bactericidal concentrations (MBCs) for both antibiotics (less than or equal to 2 dilutions). However, with an inoculum of 10(7) CFU/ml, MIC and MBC were significantly greater than those with inocula of 10(3) and 10(5). In vivo study with an infant rat model of bacteremia and meningitis revealed that both cefotaxime and latamoxef penetrated well into the cerebrospinal fluid (CSF), both drugs were bactericidal in blood and CSF, both were effective in prevention of the development of meningitis in bacteremic animals, and the mortality rates were significantly less in the treated than in the control group (p less than 0.001). However, even with cefotaxime or latamoxef treatment, the mortality was significantly greater (p less than 0.001) in rats whose bacterial counts before therapy were greater than or equal to 10(6) CFU/ml of blood. These findings suggest that the effects of cefotaxime and latamoxef may be directly correlated with the size of the bacterial population exposed to these agents and that this variable may be an important factor to influence the therapeutic outcome.

Topics: Animals; Animals, Newborn; Blood Bactericidal Activity; Cefotaxime; Escherichia coli Infections; Female; Meningitis; Microbial Sensitivity Tests; Moxalactam; Rats; Rats, Inbred Strains; Sepsis

Topics: Cefotaxime; Ceftriaxone; Drug Resistance, Microbial; Escherichia coli Infections; Female; Humans; Meningitis; Middle Aged; Tobramycin

We treated 12 adult patients who had gram-negative bacillary meningitis with cefotaxime administered intravenously at a dose of 2 g every 4 hours. The etiological organisms included Haemophilus influenzae (3 cases), Serratia marcescens (3 cases), Klebsiella pneumoniae (3 cases), Escherichia coli (2 cases), and Enterobacter (1 case). The infection followed a neurosurgical procedure in 6 cases. The mean inhibitory and bactericidal concentrations of cefotaxime for the isolates ranged from 0.125 to 0.25 microgram/ml. The cerebrospinal fluid (CSF) concentrations of cefotaxime ranged from 5.0 to 15.2 micrograms/ml, and the CSF bactericidal titers were 1:64 to 1:128. The CSF in all patients was sterilized within 96 hours. All 12 patients recovered, and there were no relapses.

Topics: Adult; Bacterial Infections; Cefotaxime; Enterobacteriaceae Infections; Escherichia coli Infections; Humans; Klebsiella Infections; Klebsiella pneumoniae; Meningitis; Meningitis, Haemophilus; Middle Aged; Serratia marcescens

Topics: Animals; Anti-Bacterial Agents; Cefotaxime; Ceftriaxone; Escherichia coli; Escherichia coli Infections; Kinetics; Mice; Microbial Sensitivity Tests; Pseudomonas aeruginosa; Pseudomonas Infections; Ticarcillin

Three cases of meningitis with E. coli and H. influenzae are reported. They illustrate the recrudescence and relapse in bacterial meningitis. After the failure of initial antibiotic therapy, the treatment by Cefotaxime allowed a good outcome in all the cases. On account of the bacteriological, pharmacological and clinical data the authors advise using Cefotaxime in first purpose in meningitis with common gram negative bacilli.

Topics: Bacterial Infections; Cefotaxime; Escherichia coli Infections; Female; Gram-Negative Bacteria; Humans; Infant; Infant, Newborn; Kinetics; Male; Meningitis; Meningitis, Haemophilus; Recurrence

A new mouse model of anaerobic infection with Bacteroides fragilis alone or in a mixed infection with Escherichia coli is described. It is established by implantation under the skin of a filter paper disk saturated with the appropriate bacterial suspension. The penetration of antibiotics into the implantation site can be detected by assaying the disk. The local infection can be both standardized and evaluated by determining the bacterial count on the disk. The antimicrobial efficacy of ceftizoxime was compared with other commercially available antibiotics administered in a single dose, 40 mg/kg subcutaneously, one hour after implantation of the disk. Using such a regimen ceftizoxime was found to be superior to a clindamycin-gentamicin combination and equal to or superior to cefoxitin in these models.

Topics: Animals; Bacteroides fragilis; Bacteroides Infections; Cefotaxime; Cefoxitin; Ceftizoxime; Clindamycin; Cyclophosphamide; Escherichia coli Infections; Gentamicins; Mice

The therapeutic efficacy and pharmacokinetics of the cephalosporins ceftazidime, ceftizoxime, cefotaxime and HR 221 were studied in animal experiments. The animal model used was experimental estrogen-induced or non-induced chronic Escherichia coli pyelonephritis in rats. The animals were treated with 5 mg cephalosporin/kg twice daily for one week. Each of the cephalosporins tested led to a significant decrease in renal bacterial counts, in spite of the low doses given. Ceftazidime was significantly more active than HR 221 in both experimental models, although the serum levels of HR 221 were higher and were maintained for a longer period of time than those of ceftazidime. Differences in pharmacokinetic properties (influenced by metabolic stability and protein binding) could be the reason for the differences in therapeutic activity, since the in vitro antimicrobial activity of each of the cephalosporins tested was very similar against the test strain.

Topics: Animals; Cefotaxime; Ceftazidime; Ceftizoxime; Cephalosporins; Chronic Disease; Drug Evaluation, Preclinical; Escherichia coli Infections; Pyelonephritis; Rats

Topics: Bacterial Infections; Cefotaxime; Ceftriaxone; Escherichia coli Infections; Gonorrhea; Humans; Pseudomonas Infections

Ceftriaxone was highly active in eliminating Escherichia coli from the cerebrospinal fluid of rabbits infected with experimental meningitis. However, concentrations equal to or greater than 10 times the minimal bactericidal concentration had to be achieved to ensure optimal efficacy (rate of kill, 1.5 log10 CFU/ml per h). In contrast to other beta-lactams studied in this model, ceftriaxone concentrations in cerebrospinal fluid progressively increased, whereas serum steady state was obtained by constant infusion. The percent penetration was 2.1% after 1 h of therapy, in contrast to 8.9% after 7 h (P less than 0.001). In vitro time-kill curves done in cerebrospinal fluid or broth more closely predicted the drug concentrations required for a maximum cidal effect in vivo than that predicted by determinations of minimal inhibitory or bactericidal concentrations.

Topics: Animals; Cefotaxime; Ceftriaxone; Escherichia coli; Escherichia coli Infections; Kinetics; Meningitis; Rabbits; Time Factors

Cefamandole resistance in five patients was studied. Microorganisms emerged resistant to cefamandole during therapy with the drug in three patients with complicated infections. This resistance was associated with an enhanced production of beta-lactamase and/or with a change in the substrates and the isoelectric focusing patterns of the enzymes. Cross-resistance to other beta-lactam antibiotics developed concurrently in isolates from these patients. Disk diffusion tests did not detect resistance to cefamandole in the pretreatment isolate from the fourth patient; this isolate produced inactivating enzymes, and resistance was detected only in broth dilution tests. In the fifth patient, infection with a cefamandole-resistant Enterobacter developed during postoperative therapy with the drug. Resistance to cefamandole in the isolate from this patient was unstable and was associated with inducible beta-lactamase activity. These examples emphasize the need for close monitoring of patients who are given cefamandole and for thorough in vitro evaluation of isolates from the patients both before and after treatment.

Topics: Adult; Aged; Bacteroides Infections; beta-Lactamases; Cefamandole; Cefotaxime; Cefoxitin; Cephalosporins; Cephamycins; Enterobacteriaceae Infections; Escherichia coli Infections; Female; Humans; Isoelectric Focusing; Male; Middle Aged; Moxalactam; Penicillin Resistance; Penicillins

A transpapillary indwelling catheter was inserted to prevent stone impaction in six female patients who were suffering from choledocholithiasis. The bile withdrawn via the catheter was infected on six occasions with Escherichia coli. In one of these cases Klebsiella sp. and in another Salmonella sp. were also identified. All bacteria were sensitive to ceftizoxime (the MIC was between 0.007 and 0.06 mg/l). The bacterial counts in the bile were determined before and during treatment by means of membrane filtration. In all six cases there was a rapid decline in the colony count. The concentration of ceftizoxime in bile samples was several times higher than the MIC of ceftizoxime for the corresponding pathogens. Overall, the therapeutic results with ceftizoxime were good. Three of eight pathogens were eliminated from the bile within eight to 24 hours. In one case a change of pathogen was seen after 24 hours. Forty-eight hours after beginning treatment, four of eight pathogens had been eliminated from the bile. After 72 hours the colony count in six patients was less than 10 pathogens/ml. In two patients a change of pathogen occurred; in one patient treatment had to be stopped after the first injection because of urticaria.

Topics: Aged; Bile; Bile Duct Diseases; Cefotaxime; Ceftizoxime; Cholestasis; Enterobacteriaceae Infections; Escherichia coli Infections; Female; Gallstones; Humans; Middle Aged

We conducted an experimental study using rats to investigate the timing of prophylactic antibiotics in urological surgery and to evaluate the benefit from a single, prophylactic injection of an antibiotic. Another objective was to examine the growth and kill rates of Escherichia coli 06 in operated urinary tract organs. We were unable to demonstrate a short decisive period for the antibiotic treatment; it seems to vary with respect to the infecting organism and the infected organ. Administration of a single dose of antibiotic was sufficient to lower the rate of infection in the kidney and epididymis 24 hours after the operation and to eliminate bacteria completely from the prostate. The rate of growth and kill of E. coli 06 depended on the specific organs in which the infection took place.

Topics: Animals; Anti-Bacterial Agents; Cefotaxime; Escherichia coli; Escherichia coli Infections; Humans; Male; Premedication; Rats; Sepsis; Time Factors; Urogenital System; Urologic Diseases

We have tested the effectiveness of several antibiotic regimens, using a rat model of Escherichia coli experimental pyelonephritis that mimics the conditions of severe renal infections in man because the infection is acquired by the ascending route. We found that ceftriaxone, when given for 5 days to rats with severe exudative pyelonephritis, was as effective as the combination ceftriaxone + gentamicin or the reference combination ampicillin + gentamicin. This effectiveness in vivo of the antibiotic alone was achieved despite a marked synergism between the combinations of antibiotics in vitro. This observation suggests that a new and extremely active cephalosporin is as effective in vivo when used alone as when given in combination with an aminoglucoside and provides rationale for testing the use of single antibiotic therapy for clinical situations for which combinations of antibiotics are currently recommended.

Topics: Ampicillin; Animals; Anti-Bacterial Agents; Cefotaxime; Ceftriaxone; Drug Therapy, Combination; Escherichia coli Infections; Gentamicins; Kidney; Male; Pyelonephritis; Rats; Rats, Inbred Strains

Two models of pneumonia--the experimental E. coli-pleuropneumonia and "intrapulmonary" E. coli-pneumonia--were employed in these studies. Only fosfomycin was effective in both models even at the low dosage of 100 mg/kg/d. The comparative drugs cefotaxime and cefoxitin, however, were not able to reduce the bacteria in both lungs even at very high dosages of 900 mg/kg and 300 mg/kg per day respectively over 6 days.

Topics: Animals; Anti-Bacterial Agents; Cefotaxime; Cefoxitin; Cephalosporins; Dose-Response Relationship, Drug; Escherichia coli Infections; Female; Fosfomycin; Kinetics; Pleuropneumonia; Rats