colistin and Urinary-Tract-Infections

The most effective way to control severity and mortality rate of the novel coronavirus disease (COVID-19) is through sensitive diagnostic approaches and an appropriate treatment protocol. We aimed to identify the effect of adding corticosteroid and Tocilizumab to a standard treatment protocol in treating COVID-19 patients with chronic disease through hematological and lab biomarkers.. This study was performed retrospectively on 68 COVID-19 patients with chronic disease who were treated by different therapeutic protocols. The patients were categorized into four groups: control group represented the patients' lab results at admission before treatment protocols were applied; group 1 included patients treated with anticoagulants, Hydroxychloroquine, and antibiotics; group 2 comprised patients treated with Dexamethasone; and group 3 included patients treated with Dexamethasone and Tocilizumab.. The study paves the way into the effectiveness of combining Dexamethasone with Tocilizumab in treatment COVID-19 patients with chronic diseases.. La forma más eficaz de controlar la gravedad y la tasa de mortalidad de la enfermedad del nuevo coronavirus (COVID-19) es mediante enfoques de diagnóstico sensibles y un protocolo de tratamiento adecuado. Nuestro objetivo fue identificar el efecto de agregar corticosteroides y tocilizumab a un protocolo de tratamiento estándar en el tratamiento de pacientes con COVID-19 con enfermedad crónica a través de biomarcadores hematológicos y de laboratorio.. Este estudio se realizó de forma retrospectiva en 68 pacientes COVID-19 con enfermedad crónica que fueron tratados por diferentes protocolos terapéuticos. Los pacientes se clasificaron en cuatro grupos: el grupo de control representaba los resultados de laboratorio de los pacientes en el momento de la admisión antes de que se aplicaran los protocolos de tratamiento; el grupo 1 incluyó a pacientes tratados con anticoagulantes, hidroxicloroquina y antibióticos; el grupo 2 estaba compuesto por pacientes tratados con dexametasona; y el grupo 3 incluyó a pacientes tratados con dexametasona y tocilizumab.. El estudio allana el camino hacia la eficacia de la combinación de dexametasona con tocilizumab en el tratamiento de pacientes con COVID-19 con enfermedades crónicas.. The Child-Mother Index constitutes a potential useful risk factor indicator for statistical analyses on data after birth. The value of the Child-Mother Index based on the estimated fetal weight before birth deserves evaluation.. Six ceria supports synthesized by various synthesis methodologies were used to deposit cobalt oxide. The catalysts were thoroughly characterized, and their catalytic activity for complete methane oxidation was studied. The supports synthesized by direct calcination and precipitation with ammonia exhibited the best textural and structural properties as well as the highest degree of oxidation. The remaining supports presented poorer textural properties to be employed as catalytic supports. The cobalt deposited over the first two supports presented a good dispersion at the external surface, which induced a significant redox effect that increased the number of Co. Some studies show that children with obesity are more likely to receive a diagnosis of depression, anxiety, or attention-deficit hyperactivity disorder (ADHD). But this does not necessarily mean obesity causes these conditions. Depression, anxiety, or ADHD could cause obesity. A child's environment, including family income or their parents' mental health, could also affect a child's weight and mental health. Understanding the nature of these relationships could help scientists develop better interventions for both obesity and mental health conditions. Genetic studies may help scientists better understand the role of the environment in these conditions, but it's important to consider both the child's and their parents’ genetics in these analyses. This is because parents and children share not only genes, but also environmental conditions. For example, families that carry genetic variants associated with higher body weight might also have lower incomes, if parents have been affected by biases against heavier people in society and the workplace. Children in these families could have worse mental health because of effects of their parent’s weight, rather than their own weight. Looking at both child and adult genetics can help disentangle these processes. Hughes et al. show that a child's own body mass index, a ratio of weight and height, is not strongly associated with the child’s mental health symptoms. They analysed genetic, weight, and health survey data from about 41,000 8-year-old children and their parents. The results suggest that a child's own BMI does not have a large effect on their anxiety symptoms. There was also no clear evidence that a child's BMI affected their symptoms of depression or ADHD. These results contradict previous studies, which did not account for parental genetics. Hughes et al. suggest that, at least for eight-year-olds, factors linked with adult weight and which differ between families may be more critical to a child's mental health than a child’s own weight. For older children and adolescents, this may not be the case, and the individual’s own weight may be more important. As a result, policies designed to reduce obesity in mid-childhood are unlikely to greatly improve the mental health of children. On the other hand, policies targeting the environmental or societal factors contributing to higher body weights, bias against people with higher weights, and poor child mental health directly may be more beneficial.. The development of an efficient photocatalyst for C2 product formation from CO. Оценка антиастенического эффекта последовательной терапии левокарнитином (ЛК) и ацетилкарнитином (АЛК) пациентов с артериальной гипертензией и/или ишемической болезнью сердца (ИБС) с астеническим синдромом (АС).. В открытое сравнительное исследование были включены 120 пациентов в возрасте 54—67 лет с артериальной гипертензией и/или ИБС с АС. Пациенты 1-й группы (. У больных 1-й группы отмечено статистически значимое уменьшение различных проявлений АС. Отличия носили достоверный характер по сравнению как с исходным уровнем, так и со 2-й группой. Установлено эндотелийпротективное действие ЛК и АЛК.. Полученные результаты свидетельствуют, что у таких коморбидных пациентов использование ЛК и АЛК уменьшает выраженность проявлений АС, а установленные эндотелиотропные свойства препаратов позволяют рекомендовать их в составе комплексной персонифицированной терапии пациентов с сердечно-сосудистыми заболеваниями.. Naproxen sodium 440 mg/diphenhydramine 50 mg combination demonstrated improvement in sleep maintenance (WASO) vs. naproxen sodium 550 mg and higher efficiency in average daily pain reduction compared with the comparison groups. The treatment was well tolerated There were no serious or unexpected adverse events reported in the study.. Сравнительный анализ эффективности и безопасности новой комбинации напроксена натрия и дифенгидрамина у пациентов с неспецифическим болевым синдромом в пояснично-крестцовом отделе спины (M54.5 «Боль внизу спины») и нарушением сна (G47.0 «Нарушения засыпания и поддержания сна [бессонница]»).. Проведено проспективное многоцентровое рандомизированное открытое сравнительное в параллельных группах клиническое исследование. Пациенты были рандомизированы в 3 группы. Больные 1-й группы получали напроксен натрия (440 мг) и дифенгидрамин (50 мг), 2-й — напроксен натрия (550 мг), 3-й — парацетамол (1000 мг) и дифенгидрамин (50 мг). Исследуемые препараты пациенты принимали однократно перед сном в течение 3 дней. Все пациенты также принимали 275 мг (1 таблетка) напроксена натрия в качестве препарата фоновой терапии. Первичным критерием эффективности было общее время бодрствования после наступления сна (WASO), измеряемое методом актиграфии. Также использовались критерии оценки продолжительности и качества сна и выраженности боли.. Анализ эффективности проведен для ITT популяции (. Применение комбинации напроксена натрия (440 мг) и дифенгидрамина (50 мг) характеризовалось более выраженным поддержанием сна по сравнению с напроксеном натрия 550 мг и более высокой эффективностью в отношении снижения интенсивности боли по сравнению со 2-й и 3-й группами. Отмечена хорошая переносимость препарата, серьезных нежелательных явлений зарегистрировано не было.

Topics: Acetaminophen; Acetylcarnitine; Acetylcholinesterase; Acids; Acinetobacter baumannii; Acinetobacter Infections; Adaptation, Psychological; Adolescent; Adsorption; Adult; Aged; Alcohol Drinking; Alzheimer Disease; Amikacin; Ammonia; Anaerobiosis; Animals; Anorexia; Anti-Bacterial Agents; Anti-Infective Agents; Anti-Inflammatory Agents; Anti-Inflammatory Agents, Non-Steroidal; Antineoplastic Agents; Anxiety; Aptamers, Nucleotide; Asthenia; Attention Deficit Disorder with Hyperactivity; Bacterial Proteins; Beryllium; beta-Lactamases; Biofuels; Biomass; Biosensing Techniques; Bismuth; Blister; Body Mass Index; Body Surface Area; Boronic Acids; Brain; Breast Neoplasms; Butyrylcholinesterase; Cannabis; Carbapenems; Carbonyl Cyanide m-Chlorophenyl Hydrazone; Carboxylic Acids; Carcinoma, Hepatocellular; Cardiovascular Diseases; Carnitine; Case-Control Studies; Catalysis; Cell Cycle Proteins; Cell Line, Tumor; Cell Proliferation; Child; China; Cholinesterase Inhibitors; Clarithromycin; Clostridioides; Clostridioides difficile; Clostridium Infections; Cohort Studies; Colistin; Colitis; Colon; Coloring Agents; Coronary Artery Bypass; Creatinine; Crystalloid Solutions; Cytokines; Depression; Dextran Sulfate; Dextrans; Diabetes Mellitus, Type 2; Diabetic Retinopathy; Diarrhea; Dietary Supplements; Diphenhydramine; Disease Models, Animal; Disease Outbreaks; Double-Blind Method; Doxorubicin; Drosophila; Drug Tapering; Dysbiosis; Electrons; Escherichia coli; Extracellular Vesicles; Fatigue; Female; Fermentation; gamma-Cyclodextrins; Gastrointestinal Microbiome; Glucose; Graft Survival; Graft vs Host Disease; Head and Neck Neoplasms; Heart Arrest, Induced; Hematopoietic Stem Cell Transplantation; High-Intensity Interval Training; Hippocampus; Humans; Hydrogen-Ion Concentration; Hypertension; Incidence; Interferon-gamma; Italy; Kinetics; Klebsiella Infections; Klebsiella pneumoniae; Lab-On-A-Chip Devices; Lactoferrin; Larva; Length of Stay; Lignin; Liver; Liver Neoplasms; Liver Transplantation; Living Donors; Low Back Pain; Lung; Lung Volume Measurements; Macrophages; Male; Melphalan; Men; Mendelian Randomization Analysis; Meropenem; Methane; Mice; Mice, Inbred C57BL; Microbial Sensitivity Tests; Mitochondrial Proteins; Molecular Docking Simulation; Molecular Structure; Mothers; Motivation; Mycoplasma; Mycoplasma hominis; Mycoplasma Infections; NAD; Nanocomposites; Nanoparticles; Nanotubes, Carbon; Naproxen; Neovascularization, Pathologic; Neurons; Nitrates; Nucleolin; Opuntia; Paratyphoid Fever; Phenotype; Phosphatidylinositol 3-Kinases; Phytochemicals; Plant Extracts; Pregnancy; Prevalence; Prospective Studies; Proto-Oncogene Proteins c-akt; Pulmonary Disease, Chronic Obstructive; Rats; Rats, Wistar; Resveratrol; Retrospective Studies; Rifampin; Risk Factors; RNA, Messenger; Selenium; Sleep; Social Behavior; Soil; Soil Pollutants; Squamous Cell Carcinoma of Head and Neck; Staphylococcus aureus; Structure-Activity Relationship; Suicidal Ideation; Suicide; Superoxide Dismutase-1; Surveys and Questionnaires; Swimming; Syndrome; Tannins; Temperature; Transforming Growth Factor beta; Transplantation Conditioning; Treatment Outcome; Triple Negative Breast Neoplasms; Troponin T; Tumor Microenvironment; United Kingdom; Ureaplasma; Ureaplasma urealyticum; Urinary Tract Infections; Viscum; Waste Disposal Facilities; Wastewater; Water; Water Pollutants, Chemical; Wolfiporia; Young Adult

Plazomicin is a novel semisynthetic parenteral aminoglycoside that inhibits bacterial protein synthesis. It was approved by the United States Food and Drug Administration for use in adults with complicated urinary tract infections (cUTI), including pyelonephritis. Plazomicin displays potent in vitro activity against Enterobacteriaceae, including both extended-spectrum β-lactamase-producing and carbapenem-resistant isolates. Plazomicin's enhanced Enterobacteriaceae activity is due to its stability to commonly encountered aminoglycoside-modifying enzymes that compromise the activity of traditional aminoglycosides. Plazomicin resistance in Enterobacteriaceae is via modification of the ribosomal binding site due to expression of 16S rRNA methyltransferases. Plazomicin does not display improved activity over traditional aminoglycosides against other problematic resistant Gram-negative bacteria, namely Pseudomonas aeruginosa and Acinetobacter baumannii. Plazomicin has been assessed in two phase III randomized controlled trials. The EPIC trial compared plazomicin and meropenem for the management of cUTI. In this trial, plazomicin demonstrated superiority in composite cure (81.7% vs 70.1%; difference 11.6%; 95% confidence interval [CI] 2.7-25.7) at the test-of-cure visit, which was driven by enhanced sustained microbiological eradication. The CARE trial compared plazomicin-based and colistin-based combinations in patients with serious infections due to carbapenem-resistant Enterobacteriaceae (CRE). In this analysis, plazomicin-based combinations were associated with numerically decreased mortality or serious disease-related complications when compared with colistin-based combinations (23.5% vs 50%, respectively; 90% CI -0.7 to 51.2). Furthermore, plazomicin was also associated with a lower incidence of nephrotoxicity than colistin. However, small sample sizes limit the interpretation of the findings in the CARE trial. Plazomicin is a novel aminoglycoside that offers clinicians an additional option for the management of CRE infections, with superior activity compared with traditional aminoglycosides and potentially improved efficacy and decreased toxicity compared with colistin.

Topics: Animals; Anti-Bacterial Agents; Carbapenems; Clinical Trials as Topic; Colistin; Dose-Response Relationship, Drug; Drug Approval; Drug Resistance, Multiple, Bacterial; Drug Therapy, Combination; Gram-Negative Bacteria; Gram-Negative Bacterial Infections; Humans; Meropenem; Randomized Controlled Trials as Topic; Sisomicin; United States; United States Food and Drug Administration; Urinary Tract Infections

Data on the efficacy and safety of ceftazidime/avibactam (CAZ-AVI) are limited. A systematic review and meta-analysis was conducted to clarify the role of CAZ-AVI for patients with serious Gram-negative bacterial infections. The PubMed, EMBASE and Cochrane Library databases were searched for randomised controlled trials (RCTs) and cohort studies involving CAZ-AVI. Summary risk ratios (RRs) and 95% confidence intervals (CIs) were calculated using a fixed- or random-effects model. Twelve articles (4951 patients) were included, consisting of nine RCTs and three observational studies comparing CAZ-AVI with other regimens, e.g. carbapenems or colistin. CAZ-AVI showed a comparable clinical response (RR = 0.99, 95% CI 0.96-1.02; I

Topics: Anti-Bacterial Agents; Azabicyclo Compounds; Carbapenems; Ceftazidime; Colistin; Drug Administration Schedule; Drug Combinations; Drug Resistance, Multiple, Bacterial; Gram-Negative Bacteria; Gram-Negative Bacterial Infections; Humans; Microbial Sensitivity Tests; Patient Safety; Randomized Controlled Trials as Topic; Survival Analysis; Treatment Outcome; Urinary Tract Infections

The spread of carbapenemase-producing K. pneumoniae (CPKP) has become a significant problem worldwide. Combination therapy for CPKP is encouraging, but polymyxin resistance to many antibiotics is hampering effective treatment. Combination therapy with three or more antibiotics is being increasingly reported, therefore we performed a systematic review of triple combination cases in an effort to evaluate their clinical effectiveness for CPKP infections.. The PubMed database was searched to identify all published clinical outcomes of CPKP infections treated with triple combination therapy. Articles were stratified into two tiers depending on the level of clinical detail provided. A tier 1 study included: antibiotic regimen, regimen-specific outcome, patient status at onset of infection, and source of infection. Articles not reaching these criteria were considered tier 2.. Thirty-three studies were eligible, 23 tier 1 and ten tier 2. Among tier 1 studies, 53 cases were included in this analysis. The most common infection was pneumonia (31%) followed by primary or catheter-related bacteremia (21%) and urinary tract infection (17%). Different combinations of antibiotic classes were utilized in triple combinations, the most common being a polymyxin (colistin or polymyxin B, 86.8%), tigecycline (73.6%), aminoglycoside (43.4%), or carbapenem (43.4%). Clinical and microbiological failure occurred in 14/39 patients (35.9%) and 22/42 patients (52.4%), respectively. Overall mortality for patients treated with triple combination therapy was 35.8% (19/53 patients).. Triple combination therapy is being considered as a treatment option for CPKP. Polymyxin-based therapy is the backbone antibiotic in these regimens, but its effectiveness needs establishing in prospective clinical trials.

Topics: Aminoglycosides; Anti-Bacterial Agents; Bacteremia; Bacterial Proteins; beta-Lactamases; Carbapenems; Colistin; Drug Combinations; Female; Humans; Klebsiella Infections; Klebsiella pneumoniae; Male; Microbial Sensitivity Tests; Minocycline; Pneumonia; Polymyxin B; Polymyxins; Tigecycline; Treatment Outcome; Urinary Tract Infections

The multiresistant Acinetobacter species bacteria are frequently involved in urinary or respiratory tract infections, and one of the most effective drugs, colistine, is associated with significant nephrotoxicity and neurotoxicity. Given that very high concentrations of colistine into biological fluids are safe for the human organism, attempts have been made at delivering the drug topically, by aerosol, or, occasionally, intratechally or intraventricularly for meningitis. These topical treatments could eradicate the Pseudomonas sp. from the lung of patients with cystic fibrosis or bronchiectasis and the Acinetobacter baumannii from lung and meninges. However, only one case of colistin topic treatment in urinary tract infection is described. We report a case series of three patients successfully undergone colistin bladder instillations for multi drug resistant Acinetobacter urinary tract infection, and we review the literature about colistin topic treatment.

Topics: Acinetobacter baumannii; Acinetobacter Infections; Administration, Intravesical; Aged; Anti-Bacterial Agents; Colistin; Female; Humans; Male; Treatment Outcome; Urinary Tract Infections

We sought to evaluate the effectiveness of the antibiotic treatment administered for infections caused by carbapenemase-producing Enterobacteriaceae. The PubMed and Scopus databases were systematically searched. Articles reporting the clinical outcomes of patients infected with carbapenemase-producing Enterobacteriaceae according to the antibiotic treatment administered were eligible. Twenty nonrandomized studies comprising 692 patients who received definitive treatment were included. Almost all studies reported on Klebsiella spp. In 8 studies, the majority of infections were bacteremia, while pneumonia and urinary tract infections were the most common infections in 12 studies. In 10 studies, the majority of patients were critically ill. There are methodological issues, including clinical heterogeneity, that preclude the synthesis of the available evidence using statistical analyses, including meta-analysis. From the descriptive point of view, among patients who received combination treatment, mortality was up to 50% for the tigecycline-gentamicin combination, up to 64% for tigecycline-colistin, and up to 67% for carbapenem-colistin. Among the monotherapy-treated patients, mortality was up to 57% for colistin and up to 80% for tigecycline. Certain regimens were administered to a small number of patients in certain studies. Three studies reporting on 194 critically ill patients with bacteremia showed individually significantly lower mortality in the combination arm than in the monotherapy arm. In the other studies, no significant difference in mortality was recorded between the compared groups. Combination antibiotic treatment may be considered the optimal option for severely ill patients with severe infections. However, well-designed randomized studies of specific patient populations are needed to further clarify this issue.

Topics: Anti-Bacterial Agents; Bacteremia; beta-Lactam Resistance; Carbapenems; Colistin; Critical Illness; Drug Therapy, Combination; Enterobacteriaceae; Humans; Minocycline; Pneumonia, Bacterial; Survival Analysis; Tigecycline; Urinary Tract Infections

Nitrofurantoin, amikacin, colistin, polymyxin B, doxycycline, and minocycline are antibiotics with proven effectiveness against selected pathogens. These antibiotics have not developed resistance over time. As "low-resistance potential antibiotics" that are effective against an increasing number of infections due to resistant gram-positive or gram-negative pathogens, these antimicrobials remain an important part of the antibiotic armamentarium. They will be used increasingly in the future, as highly resistant organisms continue to be important clinically and therapeutic options remain limited.

Topics: Amikacin; Cell Membrane; Colistin; Doxycycline; Drug Resistance, Microbial; Gram-Negative Bacterial Infections; Humans; Methicillin Resistance; Minocycline; Nitrofurantoin; Polymyxin B; Staphylococcal Infections; Urinary Tract Infections

The literature on the clinical use of rifampicin in combination for the treatment of non-mycobacterial diseases is reviewed. From the published evidence, the most promising associations are, for staphylococcal infections, gentamicin, erythromycin, kanamycin and fusidic acid. In the field of Gram-negative infections, Psuedomonas-induced sepsis in particular, data are not so impressive but promising results have been obtained with the associated use of rifampicin and gentamicin or colistin. Some systemic fungal diseases may be successfully treated with rifampicin in combination with amphotericin-B. Although only few reports are available on this subject, the importance of such an application is stressed in view of the severity of these diseases and of the lack of appropriate treatments.

Topics: Amphotericin B; Cephalosporins; Chloramphenicol; Colistin; Drug Therapy, Combination; Endocarditis, Bacterial; Erythromycin; Gentamicins; Humans; Kanamycin; Lincomycin; Mycoses; Nalidixic Acid; Penicillins; Pseudomonas Infections; Respiratory Tract Infections; Rifampin; Staphylococcal Infections; Sulfamethoxazole; Tetracyclines; Trimethoprim; Urinary Tract Infections; Vancomycin

Topics: Ampicillin; Anti-Bacterial Agents; Bacterial Infections; Biliary Tract Diseases; Carbenicillin; Cephalosporins; Chloramphenicol; Colistin; Endocarditis, Subacute Bacterial; Gentamicins; Humans; Meningitis; Osteomyelitis; Oxacillin; Sepsis; Tetracycline; Urinary Tract Infections

The most effective way to control severity and mortality rate of the novel coronavirus disease (COVID-19) is through sensitive diagnostic approaches and an appropriate treatment protocol. We aimed to identify the effect of adding corticosteroid and Tocilizumab to a standard treatment protocol in treating COVID-19 patients with chronic disease through hematological and lab biomarkers.. This study was performed retrospectively on 68 COVID-19 patients with chronic disease who were treated by different therapeutic protocols. The patients were categorized into four groups: control group represented the patients' lab results at admission before treatment protocols were applied; group 1 included patients treated with anticoagulants, Hydroxychloroquine, and antibiotics; group 2 comprised patients treated with Dexamethasone; and group 3 included patients treated with Dexamethasone and Tocilizumab.. The study paves the way into the effectiveness of combining Dexamethasone with Tocilizumab in treatment COVID-19 patients with chronic diseases.. La forma más eficaz de controlar la gravedad y la tasa de mortalidad de la enfermedad del nuevo coronavirus (COVID-19) es mediante enfoques de diagnóstico sensibles y un protocolo de tratamiento adecuado. Nuestro objetivo fue identificar el efecto de agregar corticosteroides y tocilizumab a un protocolo de tratamiento estándar en el tratamiento de pacientes con COVID-19 con enfermedad crónica a través de biomarcadores hematológicos y de laboratorio.. Este estudio se realizó de forma retrospectiva en 68 pacientes COVID-19 con enfermedad crónica que fueron tratados por diferentes protocolos terapéuticos. Los pacientes se clasificaron en cuatro grupos: el grupo de control representaba los resultados de laboratorio de los pacientes en el momento de la admisión antes de que se aplicaran los protocolos de tratamiento; el grupo 1 incluyó a pacientes tratados con anticoagulantes, hidroxicloroquina y antibióticos; el grupo 2 estaba compuesto por pacientes tratados con dexametasona; y el grupo 3 incluyó a pacientes tratados con dexametasona y tocilizumab.. El estudio allana el camino hacia la eficacia de la combinación de dexametasona con tocilizumab en el tratamiento de pacientes con COVID-19 con enfermedades crónicas.. The Child-Mother Index constitutes a potential useful risk factor indicator for statistical analyses on data after birth. The value of the Child-Mother Index based on the estimated fetal weight before birth deserves evaluation.. Six ceria supports synthesized by various synthesis methodologies were used to deposit cobalt oxide. The catalysts were thoroughly characterized, and their catalytic activity for complete methane oxidation was studied. The supports synthesized by direct calcination and precipitation with ammonia exhibited the best textural and structural properties as well as the highest degree of oxidation. The remaining supports presented poorer textural properties to be employed as catalytic supports. The cobalt deposited over the first two supports presented a good dispersion at the external surface, which induced a significant redox effect that increased the number of Co. Some studies show that children with obesity are more likely to receive a diagnosis of depression, anxiety, or attention-deficit hyperactivity disorder (ADHD). But this does not necessarily mean obesity causes these conditions. Depression, anxiety, or ADHD could cause obesity. A child's environment, including family income or their parents' mental health, could also affect a child's weight and mental health. Understanding the nature of these relationships could help scientists develop better interventions for both obesity and mental health conditions. Genetic studies may help scientists better understand the role of the environment in these conditions, but it's important to consider both the child's and their parents’ genetics in these analyses. This is because parents and children share not only genes, but also environmental conditions. For example, families that carry genetic variants associated with higher body weight might also have lower incomes, if parents have been affected by biases against heavier people in society and the workplace. Children in these families could have worse mental health because of effects of their parent’s weight, rather than their own weight. Looking at both child and adult genetics can help disentangle these processes. Hughes et al. show that a child's own body mass index, a ratio of weight and height, is not strongly associated with the child’s mental health symptoms. They analysed genetic, weight, and health survey data from about 41,000 8-year-old children and their parents. The results suggest that a child's own BMI does not have a large effect on their anxiety symptoms. There was also no clear evidence that a child's BMI affected their symptoms of depression or ADHD. These results contradict previous studies, which did not account for parental genetics. Hughes et al. suggest that, at least for eight-year-olds, factors linked with adult weight and which differ between families may be more critical to a child's mental health than a child’s own weight. For older children and adolescents, this may not be the case, and the individual’s own weight may be more important. As a result, policies designed to reduce obesity in mid-childhood are unlikely to greatly improve the mental health of children. On the other hand, policies targeting the environmental or societal factors contributing to higher body weights, bias against people with higher weights, and poor child mental health directly may be more beneficial.. The development of an efficient photocatalyst for C2 product formation from CO. Оценка антиастенического эффекта последовательной терапии левокарнитином (ЛК) и ацетилкарнитином (АЛК) пациентов с артериальной гипертензией и/или ишемической болезнью сердца (ИБС) с астеническим синдромом (АС).. В открытое сравнительное исследование были включены 120 пациентов в возрасте 54—67 лет с артериальной гипертензией и/или ИБС с АС. Пациенты 1-й группы (. У больных 1-й группы отмечено статистически значимое уменьшение различных проявлений АС. Отличия носили достоверный характер по сравнению как с исходным уровнем, так и со 2-й группой. Установлено эндотелийпротективное действие ЛК и АЛК.. Полученные результаты свидетельствуют, что у таких коморбидных пациентов использование ЛК и АЛК уменьшает выраженность проявлений АС, а установленные эндотелиотропные свойства препаратов позволяют рекомендовать их в составе комплексной персонифицированной терапии пациентов с сердечно-сосудистыми заболеваниями.. Naproxen sodium 440 mg/diphenhydramine 50 mg combination demonstrated improvement in sleep maintenance (WASO) vs. naproxen sodium 550 mg and higher efficiency in average daily pain reduction compared with the comparison groups. The treatment was well tolerated There were no serious or unexpected adverse events reported in the study.. Сравнительный анализ эффективности и безопасности новой комбинации напроксена натрия и дифенгидрамина у пациентов с неспецифическим болевым синдромом в пояснично-крестцовом отделе спины (M54.5 «Боль внизу спины») и нарушением сна (G47.0 «Нарушения засыпания и поддержания сна [бессонница]»).. Проведено проспективное многоцентровое рандомизированное открытое сравнительное в параллельных группах клиническое исследование. Пациенты были рандомизированы в 3 группы. Больные 1-й группы получали напроксен натрия (440 мг) и дифенгидрамин (50 мг), 2-й — напроксен натрия (550 мг), 3-й — парацетамол (1000 мг) и дифенгидрамин (50 мг). Исследуемые препараты пациенты принимали однократно перед сном в течение 3 дней. Все пациенты также принимали 275 мг (1 таблетка) напроксена натрия в качестве препарата фоновой терапии. Первичным критерием эффективности было общее время бодрствования после наступления сна (WASO), измеряемое методом актиграфии. Также использовались критерии оценки продолжительности и качества сна и выраженности боли.. Анализ эффективности проведен для ITT популяции (. Применение комбинации напроксена натрия (440 мг) и дифенгидрамина (50 мг) характеризовалось более выраженным поддержанием сна по сравнению с напроксеном натрия 550 мг и более высокой эффективностью в отношении снижения интенсивности боли по сравнению со 2-й и 3-й группами. Отмечена хорошая переносимость препарата, серьезных нежелательных явлений зарегистрировано не было.

Topics: Acetaminophen; Acetylcarnitine; Acetylcholinesterase; Acids; Acinetobacter baumannii; Acinetobacter Infections; Adaptation, Psychological; Adolescent; Adsorption; Adult; Aged; Alcohol Drinking; Alzheimer Disease; Amikacin; Ammonia; Anaerobiosis; Animals; Anorexia; Anti-Bacterial Agents; Anti-Infective Agents; Anti-Inflammatory Agents; Anti-Inflammatory Agents, Non-Steroidal; Antineoplastic Agents; Anxiety; Aptamers, Nucleotide; Asthenia; Attention Deficit Disorder with Hyperactivity; Bacterial Proteins; Beryllium; beta-Lactamases; Biofuels; Biomass; Biosensing Techniques; Bismuth; Blister; Body Mass Index; Body Surface Area; Boronic Acids; Brain; Breast Neoplasms; Butyrylcholinesterase; Cannabis; Carbapenems; Carbonyl Cyanide m-Chlorophenyl Hydrazone; Carboxylic Acids; Carcinoma, Hepatocellular; Cardiovascular Diseases; Carnitine; Case-Control Studies; Catalysis; Cell Cycle Proteins; Cell Line, Tumor; Cell Proliferation; Child; China; Cholinesterase Inhibitors; Clarithromycin; Clostridioides; Clostridioides difficile; Clostridium Infections; Cohort Studies; Colistin; Colitis; Colon; Coloring Agents; Coronary Artery Bypass; Creatinine; Crystalloid Solutions; Cytokines; Depression; Dextran Sulfate; Dextrans; Diabetes Mellitus, Type 2; Diabetic Retinopathy; Diarrhea; Dietary Supplements; Diphenhydramine; Disease Models, Animal; Disease Outbreaks; Double-Blind Method; Doxorubicin; Drosophila; Drug Tapering; Dysbiosis; Electrons; Escherichia coli; Extracellular Vesicles; Fatigue; Female; Fermentation; gamma-Cyclodextrins; Gastrointestinal Microbiome; Glucose; Graft Survival; Graft vs Host Disease; Head and Neck Neoplasms; Heart Arrest, Induced; Hematopoietic Stem Cell Transplantation; High-Intensity Interval Training; Hippocampus; Humans; Hydrogen-Ion Concentration; Hypertension; Incidence; Interferon-gamma; Italy; Kinetics; Klebsiella Infections; Klebsiella pneumoniae; Lab-On-A-Chip Devices; Lactoferrin; Larva; Length of Stay; Lignin; Liver; Liver Neoplasms; Liver Transplantation; Living Donors; Low Back Pain; Lung; Lung Volume Measurements; Macrophages; Male; Melphalan; Men; Mendelian Randomization Analysis; Meropenem; Methane; Mice; Mice, Inbred C57BL; Microbial Sensitivity Tests; Mitochondrial Proteins; Molecular Docking Simulation; Molecular Structure; Mothers; Motivation; Mycoplasma; Mycoplasma hominis; Mycoplasma Infections; NAD; Nanocomposites; Nanoparticles; Nanotubes, Carbon; Naproxen; Neovascularization, Pathologic; Neurons; Nitrates; Nucleolin; Opuntia; Paratyphoid Fever; Phenotype; Phosphatidylinositol 3-Kinases; Phytochemicals; Plant Extracts; Pregnancy; Prevalence; Prospective Studies; Proto-Oncogene Proteins c-akt; Pulmonary Disease, Chronic Obstructive; Rats; Rats, Wistar; Resveratrol; Retrospective Studies; Rifampin; Risk Factors; RNA, Messenger; Selenium; Sleep; Social Behavior; Soil; Soil Pollutants; Squamous Cell Carcinoma of Head and Neck; Staphylococcus aureus; Structure-Activity Relationship; Suicidal Ideation; Suicide; Superoxide Dismutase-1; Surveys and Questionnaires; Swimming; Syndrome; Tannins; Temperature; Transforming Growth Factor beta; Transplantation Conditioning; Treatment Outcome; Triple Negative Breast Neoplasms; Troponin T; Tumor Microenvironment; United Kingdom; Ureaplasma; Ureaplasma urealyticum; Urinary Tract Infections; Viscum; Waste Disposal Facilities; Wastewater; Water; Water Pollutants, Chemical; Wolfiporia; Young Adult

The emergence of antibiotic-resistant bacteria has driven renewed interest in older antibacterials, including colistin. Previous studies have shown that colistin is less effective and more toxic than modern antibiotics. In vitro synergy studies and clinical observational studies suggest a benefit of combining colistin with a carbapenem. A randomised controlled study is necessary for clarification.. This is a multicentre, investigator-initiated, open-label, randomised controlled superiority 1:1 study comparing colistin monotherapy with colistin-meropenem combination therapy for infections caused by carbapenem-resistant Gram-negative bacteria. The study is being conducted in 6 centres in 3 countries (Italy, Greece and Israel). We include patients with hospital-associated and ventilator-associated pneumonia, bloodstream infections and urosepsis. The primary outcome is treatment success at day 14, defined as survival, haemodynamic stability, stable or improved respiratory status for patients with pneumonia, microbiological cure for patients with bacteraemia and stability or improvement of the Sequential Organ Failure Assessment (SOFA) score. Secondary outcomes include 14-day and 28-day mortality as well as other clinical end points and safety outcomes. A sample size of 360 patients was calculated on the basis of an absolute improvement in clinical success of 15% with combination therapy. Outcomes will be assessed by intention to treat. Serum colistin samples are obtained from all patients to obtain population pharmacokinetic models. Microbiological sampling includes weekly surveillance samples with analysis of resistance mechanisms and synergy. An observational trial is evaluating patients who met eligibility requirements but were not randomised in order to assess generalisability of findings.. The study was approved by ethics committees at each centre and informed consent will be obtained for all patients. The trial is being performed under the auspices of an independent data and safety monitoring committee and is included in a broad dissemination strategy regarding revival of old antibiotics.. NCT01732250 and 2012-004819-31; Pre-results.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Bacteremia; Colistin; Drug Resistance, Multiple, Bacterial; Female; Gram-Negative Bacteria; Greece; Humans; Israel; Italy; Male; Meropenem; Microbial Sensitivity Tests; Middle Aged; Pneumonia, Ventilator-Associated; Research Design; Thienamycins; Treatment Outcome; Urinary Tract Infections; Young Adult

To assess the effectiveness of selective digestive decontamination (SDD) on the control of nosocomial infection (NI) in critically ill pediatric patients.. A prospective, randomized, non-blinded and controlled clinical microbiology study.. The pediatric intensive care unit (PICU) of a tertiary level pediatric university hospital. CRITERIA FOR INCLUSION: Patients 1 month to 14 years old, who underwent some kind of manipulation or instrumentation (mechanical ventilation, vascular cannulation, monitoring of intracranial pressure, thoracic or abdominal drainage, bladder catheterization, peritoneal dialysis, etc.) and/or presented a neurological coma requiring a stay in the PICU of 3 or more days.. Over a period of 2 years, 244 patients met the inclusion criteria; 18 patients were withdrawn because of protocol violation. The treatment group comprised 116 patients and the control group, 110 patients.. The treatment group received a triple therapy of colimycin, tobramycin and nystatin administered orally or via nasogastric tube every 6 hours. All patients with mechanical ventilation or immune-depression received decontamination treatment of the oropharyngeal cavity with hexitidine (Oraldine 0.5 mg/ml) every 6-8 hours in accordance with the PICU's conventional protocol.. Up to 10 types of nosocomial infection were diagnosed following criteria of the Centers for Disease Control (CDC). The severity and manipulation of the patients on admission was assessed using the therapeutic intervention scoring system (TISS) and multi-organ system failure scores (MOSF).. UNIVARIANT ANALYSIS: SDD did not significantly reduce the incidence of NI, antibiotic use, the length of stay, or mortality; although a small percentage of respiratory and urinary tract infections was detected, catheter-related bacteremia was the most common infection. MULTIVARIANT ANALYSIS: Controlling the risk factors for each child through log regression showed that SDD acted as a protective factor for more than 90% of the sample with respect to the appearance of respiratory and urinary tract infections, reducing the risk of such infections to 1/5 and 1/3, respectively.. SDD was effective in controlling respiratory and urinary tract infections in children admitted to the PICU, but it did not reduce the incidence of other types of nosocomial infection.

Topics: Adolescent; Antibiotic Prophylaxis; Child; Child, Preschool; Colistin; Cross Infection; Digestive System; Drug Therapy, Combination; Female; Hexetidine; Humans; Infant; Intensive Care Units, Pediatric; Male; Multiple Organ Failure; Multivariate Analysis; Nystatin; Prospective Studies; Regression Analysis; Respiratory Tract Infections; Severity of Illness Index; Tobramycin; Urinary Tract Infections

To study the effect of enterally administered polymyxin E, tobramycin, and amphotericin B (selective flora suppression) on bacterial colonization, infection, resistance, and mortality rate.. Prospective, consecutive crossover controlled study.. Two surgical ICUs in a university hospital; ICU I with ten beds, ICU II with eight beds.. Two hundred patients entered the 1-yr trial. Fifty of 111 patients received selective flora suppression during the first 6 months in ICU I (test group), while 61 of 111 patients served as the control group in the following 6 months. In ICU II, 49 of 89 patients received no selective flora suppression in the first 6 months (control group), followed by 40 of 89 patients receiving selective flora suppression during the second 6-month period (test group).. The test group got a mixture of nonabsorbable antibiotics (paste and suspension) in the digestive tract. The control group received paste and suspension without antimicrobial agents. All 200 patients received cefotaxime during the first 4 days.. With the use of selective flora suppression, colonization with aerobic Gram-negative bacilli was significantly (p less than .01) reduced. There was also a significant reduction in nosocomial bronchopulmonary (ICU I and II; p less than .001) and urinary tract (ICU II; p less than .001) infections. The difference in mortality was not significant. There was no development of resistance against the antibiotics used during the limited period evaluated.. Selective flora suppression is effective in reducing secondary colonization by aerobic Gram-negative bacilli. Reduction of bronchopulmonary and urinary tract infections most likely occurs with colonization prevention.

Topics: Administration, Oral; Adult; Aged; Amphotericin B; Bacterial Infections; Bronchopneumonia; Colistin; Critical Care; Cross Infection; Female; Gram-Negative Aerobic Bacteria; Humans; Intensive Care Units; Male; Middle Aged; Mortality; Mouth; Ointments; Prospective Studies; Sepsis; Suspensions; Tobramycin; Urinary Tract Infections

The question to be answered in this study was: Is prophylactic selective florasuppression advantageous compared to conventional antibiotic policy as far as microbial colonisation, infection, mortality and development of resistance are concerned? A prospective, consecutive, placebo-controlled study in two ICU's was carried out during four 6-months periods. 200 patients who were intubated for at least 3 days, required intensive care for a minimum of 5 days, and belonged to either class III or IV according to the "Therapeutic Intervention Scoring System" were included in the study. They received either placebo or the prophylaxis regimen described by Stoutenbeek et al., consisting of polymyxin E, tobramycin and amphotericin B. Oropharyngeal, tracheobronchial and rectal colonisation with aerobic gram-negative bacilli markedly decreased in the test groups. The rates of nosocomial bronchopulmonary infections (ICU I and II) and urinary tract infections (ICU II) were significantly reduced. There was no significant reduction in wound infection, septicaemia and mortality rates. No development of resistance and no increase of multi-resistant strains occurred. Selective florasuppression is effective in reducing infection rates in critically ill patients without development of resistant strains.

Topics: Adult; Aged; Amphotericin B; Bacterial Infections; Bronchopneumonia; Clinical Trials as Topic; Colistin; Cross Infection; Drug Therapy, Combination; Female; Humans; Intensive Care Units; Male; Prospective Studies; Risk Factors; Sepsis; Surgical Wound Infection; Tobramycin; Urinary Tract Infections

Topics: Adolescent; Adult; Amphotericin B; Ampicillin; Cadaver; Cephalosporins; Cephradine; Clinical Trials as Topic; Colistin; Drug Therapy, Combination; Humans; Kidney Transplantation; Middle Aged; Postoperative Complications; Urinary Tract Infections

Topics: Adolescent; Adult; Aged; Ampicillin; Carbenicillin; Child; Child, Preschool; Clinical Trials as Topic; Colistin; Escherichia coli Infections; Female; Humans; Injections, Intravenous; Klebsiella Infections; Male; Middle Aged; Nalidixic Acid; Penicillins; Pseudomonas Infections; Sulfonamides; Tetracycline; Urinary Tract Infections; Urine

Topics: Clinical Trials as Topic; Colistin; Humans; Male; Urinary Tract Infections

Topics: Colistin; Humans; Point-of-Care Testing; Polymerase Chain Reaction; Urinary Tract Infections

The co-emergence of mcr and carbapenem resistance genes in Gram-negative bacteria is a serious problem. This study aims to clarify the genetic characteristic of one novel multidrug-resistant Enterobacter kobei EC1382 with mcr-9 causing urinary tract inflammation in an infant.. Antimicrobial drug susceptibility testing was performed for this isolate using the broth microdilution method. Whole-genome sequencing was performed using the Illumina PacBio RS II platform and HiSeq platform, and the antimicrobial resistance genes, mobile elements, and plasmid replicon types were identified. Conjugation analysis was performed using Escherichia coli C600 as recipients.. Enterobacter kobei EC1382 was resistant to carbapenem, aminoglycoside, and cephalosporin. Twenty-five antimicrobial resistance genes were identified, including genes conferring resistance to carbapenem (blaNDM-1), colistin (mcr-9), and aminoglycosides (rmtC). The blaNDM-1 gene, accompanied by bleMBL and rmtC located downstream of an ISCR14 element, was detected in the IncFII(Yp) type plasmid pEC1382-2. Interestingly, although E. kobei EC1382 was susceptible to colistin, it had three identical mcr-9 genes (two in the chromosome and one in the IncHI2-type plasmid pEC1382-1). The backbone (∼12.2-kb genetic fragment) of these mcr-9 (flanked by IS903B and IS481-IS26) regions were conserved in this strain, and they were found to be present in various bacteria as three types, implying a silent distribution.. To the best of our knowledge, this is the first study to demonstrate the coexistence of blaNDM-1, rmtC, and mcr-9 in E. kobei. The silent prevalence of mcr-9 in bacteria may be a threat to public health.

Topics: Anti-Bacterial Agents; beta-Lactamases; Carbapenems; Colistin; Escherichia coli; Escherichia coli Proteins; Humans; Infant; Microbial Sensitivity Tests; Mycobacterium tuberculosis; Urinary Tract Infections

Antibiotic persistence is a phenomenon observed when genetically susceptible cells survive long-term exposure to antibiotics. These 'persisters' are an intrinsic component of bacterial populations and stem from phenotypic heterogeneity. Persistence to antibiotics is a concern for public health globally, as it increases treatment duration and can contribute to treatment failure. Furthermore, there is a growing array of evidence that persistence is a 'stepping-stone' for the development of genetic antimicrobial resistance. Urinary tract infections (UTIs) are a major contributor to antibiotic consumption worldwide, and are known to be both persistent (i.e. affecting the host for a prolonged period) and recurring. Currently, in clinical settings, routine laboratory screening of pathogenic isolates does not determine the presence or the frequency of persister cells. Furthermore, the majority of research undertaken on antibiotic persistence has been done on lab-adapted bacterial strains. In the study presented here, we characterized antibiotic persisters in a panel of clinical uropathogenic

Topics: Anti-Bacterial Agents; Bacteria; Colistin; Escherichia coli Infections; Humans; Meropenem; Urinary Tract Infections; Uropathogenic Escherichia coli

Urinary tract infection is the second-leading reason for consults in primary health care. Bacterial urinary tract infections are the most common, of which. Evaluate community-acquired uropathogenic. Of the 281 isolates, 68.3% (192/281) were resistant to ampicillin, 54.8% (154/281) were resistant to ciprofloxacin, and 49.5% (139/281) were resistant to trimethoprim/sulfamethoxazole. Resistance to colistin was not detected. On the other hand, 14.2% (40/281) were susceptible to the 8 antibiotics we evaluated, 22.1% (62/281) showed resistance to only 1 antibiotic, and 63.7% (179/281) were resistant to 2 or more antibiotics. In the extended-spectrum beta-lactamase determination, 34.5% (97/281) had inhibition zones ≤14 mm with cefazolin. Of those with inhibition zones, 64.9% (63/97) were positive in the phenotype test, and 35.1% (34/97) were negative. In extended-spectrum beta-lactamase-producing bacteria, 1.6% (1/63) were resistant to fosfomycin, and 3.2% (2/63) were resistant to nitrofurantoin. The most common multidrug-resistance pattern (22.9%; 30/131) was to ampicillin/sulbactam, ampicillin, cefazolin, ciprofloxacin, and trimethoprim/sulfamethoxazole.. Uropathogenic

Topics: Ampicillin; Anti-Bacterial Agents; beta-Lactamases; Cefazolin; Ciprofloxacin; Colistin; Cross-Sectional Studies; Cuba; Escherichia coli Proteins; Fosfomycin; Humans; Microbial Sensitivity Tests; Nitrofurantoin; Sulbactam; Sulfamethoxazole; Trimethoprim; Urinary Tract Infections; Uropathogenic Escherichia coli

The Klebsiella pneumoniae (K. pneumoniae) bacterium is responsible for many opportunistic infections such as sepsis, and a multidrug-resistant (MDR) clone sequence type (ST) 307 has recently begun to spread. The objective of this study was to report the first occurrence of this virulent genotype, which was found in the context of a urinary infection in a domestic feline in Brazil. The K. pneumoniae isolate was identified from the urine of a 6-month-old male crossbreed cat using 16S rRNA sequencing. It was then subjected to antimicrobial susceptibility testing, followed by multilocus sequence typing analysis, and PCR detection of virulence and resistance genes. The antimicrobial susceptibility profile demonstrated that the isolate was MDR and associated with the presence of the colistin resistance gene (mcr-1). Genotyping allowed us to classify the isolate as K. pneumoniae ST307 with the presence of wabG, uge, and entB genes. MDR K. pneumoniae is important in human and veterinary medicine because it causes many types of infections. Clonal propagation of virulent or MDR genotypes such as K. pneumoniae ST307 is a global concern. This report of ST307 isolation from a urine sample in a domestic feline is the first in Brazil.

Topics: Animals; Anti-Bacterial Agents; Brazil; Cat Diseases; Cats; Colistin; Drug Resistance, Multiple, Bacterial; Genes, Bacterial; Genotype; Klebsiella Infections; Klebsiella pneumoniae; Male; Microbial Sensitivity Tests; Urinary Tract Infections

Limited therapeutic options exist for treating severe infections caused by multidrug-resistant (MDR) and extensively drug-resistant Gram-negative bacteria (GNB). In this study, the activity of colistin (COL) as monotherapy and in combination with other antibiotics against Acinetobacter baumannii in vitro was investigated. In addition, the efficacy of intravenous colistimethate sodium (CMS) was evaluated in a murine model of urinary tract infection (UTI) induced by MDR Escherichia coli.. Minimum inhibitory concentration (MIC), Monte Carlo simulation, fractional inhibitory concentration index (FICI), time-kill study and erythrocyte lysis assay were applied to evaluate the effect and cytotoxicity of COL, meropenem, imipenem, doripenem (DOR) and sulbactam alone and in combination. For the in vivo experiment, determination of the bacterial burden and histopathological examination were performed to evaluate the efficacy of CMS against UTI.. Of 106 A. baumannii isolates, 104 (98.1%) were susceptible to COL. In the chequerboard assay, COL + DOR showed the highest rate of synergism (60%). No antagonism or cytotoxicity was observed. All COL-based combinations were able to inhibit or slow bacterial re-growth in a time-kill assay. In an in vivo activity study, intravenous CMS reduced not only the bacterial load but also inflammation and maintained structural integrity of infected bladders and kidneys.. The effectiveness of COL alone in vitro and in vivo suggested that intravenous CMS will be an effective and available therapeutic strategy for UTI due to MDR-GNB. In-depth in vitro tests demonstrated that COL + DOR could be an attractive option, especially when the COL MIC is ≥1 μg/mL.

Topics: Acinetobacter baumannii; Administration, Intravenous; Animals; Anti-Bacterial Agents; Biofilms; Colistin; Disease Models, Animal; Doripenem; Drug Resistance, Multiple, Bacterial; Drug Synergism; Drug Therapy, Combination; Escherichia coli; Escherichia coli Infections; Female; Humans; Imipenem; Meropenem; Mice; Microbial Sensitivity Tests; Monte Carlo Method; Sulbactam; Treatment Outcome; Urinary Tract Infections

Topics: Colistin; Humans; Pseudomonas aeruginosa; Sisomicin; Urinary Tract Infections

Topics: Anti-Bacterial Agents; Colistin; Guidelines as Topic; Humans; Microbial Sensitivity Tests; Polymyxin B; Polymyxins; Respiratory Tract Infections; United States; Urinary Tract Infections

The presented study was to compare in vitro biofilm production by bacterial strains from chronic/recurrent and from acute non-complicated UTIs. The activity of gentamicin and colistin on biofilm form of these strains has also been detected, with goal to predict the gentamicin and colistin therapeutic efficacy in the antimicrobial treatment of patients with a suspected presence of biofilm in urinary tract.. The group of 40 bacterial strains repeatedly isolated from patients with chronic or recurrent UTIs was compared with the group of 40 strains from acute UTIs. Both groups contained comparable number of strains of Escherichia coli, Klebsiella spp., Proteus mirabilis and Pseudomonas aeruginosa. Biofilm production was assessed by method in polystyrene microtiter plate. The MIC and MBC values of gentamicin and colistin were detected by broth microdilution assay. The minimal biofilm inhibitory (MBIC) and biofilm eradication concentrations (MBEC) were tested by microdilution method. Non-inactivated biofilm-associated bacteria were detected after overnight incubation in broth medium free of antimicrobials. The statistical analysis of results was performed by Fisher's exact test and by Student's t-test.. Biofilm was produced by 90% strains from chronic UTIs, but only by 52% of strains from acute UTIs (p = 0.0004). In the biofilm producing strains, the MBIC values of gentamicin reached from four to 256 mg/L, the MBIC levels of colistin from two to 64 mg/L. The minimal biofilm eradicating concentrations were even higher: for gentamicin from eight to > 512 mg/L, and for colistin from 32 to > 512 mg/L. The differences between MIC and MBIC/MBEC levels were statistically highly significant (p < 0.0001). Presumably, the therapeutic success of parenterally applied gentamicin or colistin on biofilm-related urinary tract infections would be, without respect to the high concentration of gentamicin or colistin achievable in urine during parenteral application, rather unpredictable. Local intravesical instillation would allow for achieving higher gentamicin and colistin concentrations; however, there is need for interpretation criteria for MBEC values concerning therapy, as well as for clinical studies allowing for application of those values to predict clinical success of therapy.. Laboratory detection of biofilm production and evaluation of the MBIC/MBEC values of antimicrobials for strains producing biofilm might be a valuable complement to the microbiologic diagnostics of chronic and recurrent UTIs. It might provide valuable information for more reliable individualised therapy and so decrease the risk of emergence and selection of multiresistant strains during repeated and non-eradicating therapy of chronic and recurrent UTIs.

Topics: Anti-Bacterial Agents; Bacteria; Bacterial Physiological Phenomena; Biofilms; Chronic Disease; Colistin; Gentamicins; Humans; In Vitro Techniques; Microbial Sensitivity Tests; Urinary Tract Infections

Peptide antibiotics are an abundant and synthetically tractable source of molecular diversity, but they are often cationic and can be cytotoxic, nephrotoxic and/or ototoxic, which has limited their clinical development. Here we report structure-guided optimization of an amphipathic peptide, arenicin-3, originally isolated from the marine lugworm Arenicola marina. The peptide induces bacterial membrane permeability and ATP release, with serial passaging resulting in a mutation in mlaC, a phospholipid transport gene. Structure-based design led to AA139, an antibiotic with broad-spectrum in vitro activity against multidrug-resistant and extensively drug-resistant bacteria, including ESBL, carbapenem- and colistin-resistant clinical isolates. The antibiotic induces a 3-4 log reduction in bacterial burden in mouse models of peritonitis, pneumonia and urinary tract infection. Cytotoxicity and haemolysis of the progenitor peptide is ameliorated with AA139, and the 'no observable adverse effect level' (NOAEL) dose in mice is ~10-fold greater than the dose generally required for efficacy in the infection models.

Topics: Animals; Anti-Bacterial Agents; Antimicrobial Cationic Peptides; Carbapenems; Cell Membrane Permeability; Colistin; Disease Models, Animal; Drug Discovery; Drug Resistance, Multiple, Bacterial; Female; Gram-Negative Bacteria; Helminth Proteins; Humans; Male; Mice; Microbial Sensitivity Tests; Peritonitis; Pneumonia; Urinary Tract Infections

Topics: Aged; Algeria; Anti-Bacterial Agents; Colistin; Drug Resistance, Bacterial; Escherichia coli Infections; Escherichia coli Proteins; Hospitals; Humans; Male; Plasmids; Urinary Tract Infections; Uropathogenic Escherichia coli

Topics: Animals; Anti-Bacterial Agents; Argentina; beta-Lactamases; Cats; Cephalosporins; Colistin; Dogs; Escherichia coli; Escherichia coli Infections; Escherichia coli Proteins; Microbial Sensitivity Tests; Pets; Phylogeny; Plasmids; Urinary Tract Infections

The last few years have seen the emergence of multi-drug resistant (MDR) Gram-negative infections, which are associated with high morbidity and mortality. The indiscriminate use of colistin has led to the development of resistance, which can be diagnosed effectively by broth microdilution. Studies from India are limited, and this study was conducted in order to determine the prevalence and risk factors associated with colistin resistance.. Urine samples from patients admitted with urinary tract infection (UTI), growing MDR Escherichia coli and Klebsiella pneumoniae, were tested for the minimum inhibitory concentration (MIC) of colistin by broth microdilution. Isolates with an MIC >2 µg ml. Two hundred and fifty MDR isolates (E. coli=142/2319 and K.pneumoniae=108/775) from 216 patients were selected from the 25 046 isolates screened. Twenty-five isolates (20 K.pneumoniae and 5 E. coli) were resistant to colistin, with a prevalence of 3.52  % in E. coli and 18.5  % in K. pneumoniae among the MDR isolates. PCR for the mcr1 and mcr2 genes was negative. Multivariate regression showed that multiple episodes of hospitalization, hospital stay >2 weeks, exposure to >three antibiotic classes and abnormality/surgery of the lower urinary tract were the significant risk factors for colistin resistance. Previous use of colistin and colistin resistance had a significant effect on all outcomes.. K. pneumoniae show six times higher prevalence of colistin resistance than E. coli, and the emergence of resistant organisms has led to an increase in morbidity in infected patients.

Topics: Adult; Anti-Bacterial Agents; Bacterial Proteins; Case-Control Studies; Colistin; Drug Resistance, Multiple, Bacterial; Escherichia coli; Escherichia coli Infections; Female; Humans; India; Klebsiella Infections; Klebsiella pneumoniae; Male; Middle Aged; Prevalence; Risk Factors; Urinary Tract Infections; Young Adult

Ceftazidime/avibactam (CAZ-AVI) is a novel, fixed-dose combination antibiotic that has been approved in Europe and the United States for patients with complicated urinary tract infections (cUTIs) based on results of a Phase III, randomized, comparative study (RECAPTURE study). The present analysis evaluated cost-effectiveness of CAZ-AVI as an empirical treatment for hospitalized patients with cUTIs from the Italian publicly funded healthcare (third-party payer) perspective. A sequential, patient-level simulation model was developed that followed the clinical course of cUTI and generated 5000 pairs of identical patients (CAZ-AVI or imipenem as empirical treatment). The model included additional impact of resistant pathogens; patients who did not respond to empirical treatment were switched to second-line treatment of colistin+high dose carbapenem in both groups. The time horizon of the model was five years, with an annual discount rate of 3% applied to both costs and quality-adjusted life-years (QALYs). The analysis demonstrated that an intervention sequence (CAZ-AVI followed by colistin+high dose carbapenem) compared with a comparator sequence (imipenem followed by colistin+high dose carbapenem) was associated with a net incremental cost of €1015 per patient but provided better health outcomes in terms of clinical cure (97.65% vs. 91.08%; ∆ = 6.57%), shorter hospital stays (10.65 vs. 12.55 days; ∆ = 1.90 days), and QALYs gained per patient (4.190 vs. 4.063; ∆ = 0.126). The incremental cost-effectiveness ratio was €8039/QALY, which is well below the willingness-to-pay threshold of €30 000/QALY in Italy. The results showed that CAZ-AVI is expected to be a cost-effective treatment compared with imipenem for cUTI in Italy.

Topics: Anti-Bacterial Agents; Azabicyclo Compounds; Carbapenems; Ceftazidime; Colistin; Cost-Benefit Analysis; Drug Combinations; Europe; Gram-Negative Bacteria; Humans; Imipenem; Length of Stay; National Health Programs; United States; Urinary Tract Infections

The escalation in carbapenem resistance among Enterobacteriaceae has resulted in a lack of effective therapeutic alternatives. Older antimicrobials, fosfomycin, nitrofurantoin and colistin for urinary tract infections (UTIs) caused by carbapenem-resistant Enterobacteriaceae (CRE) may be effective treatment options. The objectives of this study were to evaluate the utility of fosfomycin, nitrofurantoin and colistin in treating UTI caused by CRE and molecular characterization of the plasmid-mediated carbapenem resistance mechanisms.. Consecutive, non-duplicate isolates of CR Escherichia coli and Klebsiella spp. from urine cultures were included (n=150). Minimum inhibitory concentrations (MIC) were determined by E-test (fosfomycin and nitrofurantoin) and broth microdilution (colistin). Efficacy ratios were derived by dividing susceptibility breakpoints by observed MIC values of the drugs for the isolates. Isolates were screened for genes coding for carbapenemases using multiplex PCR. Fosfomycin, nitrofurantoin and colistin-resistant isolates were screened for plasmid-borne resistance genes fos A3, oqx AB and mcr-1, respectively using PCR.. Among E. coli, 98.9, 56 and 95 per cent isolates were susceptible to fosfomycin, nitrofurantoin and colistin, respectively, while 94 and 85 per cent of Klebsiella spp. were susceptible to fosfomycin and colistin, respectively. The efficacy ratios indicated fosfomycin as the drug of choice for UTI caused by CR E. coli and Klebsiella spp., followed by colistin. The bla. With increasing resistance against the current treatment options, older drugs may emerge as effective options. Molecular screening of resistant isolates is essential to prevent the spread of plasmid-borne resistance against these drugs.

Topics: Bacterial Proteins; beta-Lactamases; Carbapenem-Resistant Enterobacteriaceae; Colistin; Enterobacteriaceae Infections; Fosfomycin; Humans; Klebsiella pneumoniae; Microbial Sensitivity Tests; Nitrofurantoin; Urinary Tract Infections

The incidence of carbapenem-resistant Enterobacteriaceae has been steadily rising. The morbidity, mortality and financial implications of such patients are significant. We did a retrospective analysis of the case records of 11 patients who had culture report positive for pan drug-resistant (PDR) organisms. There were total 15 isolates of PDR organisms in 11 patients. These were associated with catheter-associated urinary tract infections (7), tracheitis (4), bacteraemia (2), meningitis (1) and soft-tissue infection (1). Average APACHE II score was 23.72 (range 7-36) indicating patients with multiple co-morbidities and organ dysfunction. The average length of hospital stay was 60.72 (25-123) days. The overall mortality rate was 81.81 per cent, while PDR infection-related mortality was 18.18 per cent. Strict implementation of antibiotic stewardship programme is essential to limit use and prevent abuse of colistin.

Topics: Adult; Aged; Aged, 80 and over; Bacterial Infections; beta-Lactamases; Carbapenems; Colistin; Drug Resistance, Bacterial; Enterobacteriaceae; Female; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Tertiary Care Centers; Urinary Tract Infections

Topics: Adolescent; Aged; Anti-Bacterial Agents; Citrobacter; Colistin; Drug Resistance, Multiple, Bacterial; Enterobacter; Escherichia coli; Female; Gram-Negative Bacteria; Humans; Klebsiella; Microbial Sensitivity Tests; Plasmids; Urinary Tract Infections

Topics: Aged; Aged, 80 and over; Anti-Bacterial Agents; beta-Lactamases; Colistin; Drug Resistance, Bacterial; Escherichia coli; Escherichia coli Infections; Escherichia coli Proteins; Humans; Male; Switzerland; Urinary Tract Infections

The incidence of infections caused by multidrug-resistant Pseudomonas aeruginosa (MDR-Pa) has become a concern of increasing relevance nowadays. Ceftolozane/tazobactam (C/T) is a novel fifth-generation cephalosporin/β-lactamase inhibitor combination with activity against MDR-Pa.. The clinical records of all patients diagnosed from May 2016 to May 2017 with an infection due to a MDR-Pa treated with C/T were retrospectively reviewed.. A total of 23 patients with 24 episodes of infection due to MDR-Pa were included. The minimum inhibitory concentration (MIC) of C/T against MDR-Pa ranged from 0.75-8μg/mL. In 14 cases (58%) the use of C/T was off-label, including 8 respiratory tract infections (RTIs) and 6 skin and soft-tissue infections, whilst in 10 cases the use was for approved indications, including 7 urinary tract infections and 3 intra-abdominal infections. C/T was the first-line therapy in only three cases with a mean±standard deviation treatment duration of 9.3±4 days, and it was associated with another active drug (aminoglycoside or colistin) in 16 cases. The global clinical cure rate was 88% (21/24 episodes), and the 6-week mortality rate was 22% (5/23 patients) being higher in RTIs (37%). In these infections, three patients received 2/1g every 8h (q8h) and were cured without mortality, whilst three (60%) of five patients receiving 1/0.5g q8h died.. C/T had good clinical responses in different types of infection, including both FDA-accepted and off-label indications. The results support the use of higher doses in RTIs.

Topics: Aged; Anti-Bacterial Agents; Cephalosporins; Colistin; Drug Resistance, Multiple, Bacterial; Female; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Pseudomonas aeruginosa; Pseudomonas Infections; Respiratory Tract Infections; Retrospective Studies; Tazobactam; Urinary Tract Infections

Colistin is regarded as one of the last-resort antimicrobials for severe infections. Isolates carrying the plasmid-borne mobile colistin resistance gene mcr-1 were rarely reported in community-acquired infections. Here we report the draft genome sequence of an MCR-1-carrying, extended-spectrum β-lactamase (ESBL)-producing Escherichia coli isolate from community-acquired urinary tract infection.. Antimicrobial susceptibility testing (AST) was performed by the broth microdilution method. Transferability of the mcr-bearing plasmid was determined by filter mating using E. coli EC600 as recipient strain. Multilocus sequence typing (MLST) was undertaken using the E. coli MLST database. The draft genome sequence of isolate LX13 was obtained using an Illumina HiSeq X-Ten platform. The genome was assembled using SOAPdenovo. Acquired antimicrobial resistance genes were identified using ResFinder 2.1.. AST showed that LX13 was resistant to ampicillin, amoxicillin/clavulanic acid, piperacillin/tazobactam, cefazolin, cefepime and polymyxins. MLST showed that isolate LX13 belongs to ST746. The MCR-1-producing plasmid was conjugative and conferred increased resistance to colistin the transconjugant. The draft genome of E. coli LX13 was 4914035bp in size. In silico analysis revealed the presence of eight putative acquired resistance genes, including bla. This study highlights the potential risk of spread of MCR-1-carrying, ESBL-producing E. coli in the community. The genome sequence of E. coli LX13 will facilitate the understanding of colistin resistance mechanisms and genomic features of clinically isolated colistin-resistant E. coli.

Topics: Aged; beta-Lactamases; Colistin; Community-Acquired Infections; Drug Resistance, Multiple, Bacterial; Escherichia coli; Escherichia coli Proteins; Female; Genome, Bacterial; Humans; Microbial Sensitivity Tests; Polymyxins; Urinary Tract Infections; Whole Genome Sequencing

Topics: Acinetobacter baumannii; Acinetobacter Infections; Animals; Anti-Bacterial Agents; Bacterial Proteins; beta-Lactamases; Colistin; Dogs; Drug Resistance, Multiple, Bacterial; Microbial Sensitivity Tests; Serbia; Urinary Tract Infections

Since KPC-2-producing Klebsiella pneumoniae are associated with successful dissemination of a major clone, defined as sequence type 258 (ST258), the aim of this study was to perform whole-genome sequencing (WGS) of the first colistin-resistant K. pneumoniae strain (Kpn666) carrying bla. WGS of strain Kpn666 isolated from an asymptomatic urinary tract infection was performed using Illumina MiSeq, and de novo assembly was performed using SPADES v.3.11. Contigs were re-ordered using the ST258 reference genome NJST258_1 (GenBank CP006923) and were oriented with the MAUVE Contig Mover. Twenty complete genomes of K. pneumoniae identified as ST258 using the Pasteur MLST site were downloaded from GenBank (May 2017). A maximum-likelihood tree was created using MEGA7 based on core single nucleotide polymorphisms (SNPs) from whole-genome alignment obtained with SNP sites (https://github.com/sanger-pathogens/snp-sites).. WGS analysis revealed a genome of 5448179bp (5232 CDS, 108 RNAs). Phylogenetic analysis identified that Kpn666 belonged to clade I lineage of ST258. Further studies also identified IncR, IncFIB(K) and IncFII(K) plasmid replicons and 11 transferable associated antimicrobial resistance genes (ARGs) comprising four drug classes. The mgrB gene involved in colistin resistance was shown to be disrupted by insertion of an IS5-like element.. The first isolate of KPC-2-producing K. pneumoniae detected in Uruguay was sequenced and the results confirm the ability of this bacterium to capture several ARGs. The KPC-2 carbapenemase in Uruguay is likely to have been introduced by the high-risk clone ST258.

Topics: beta-Lactamases; Colistin; Genome, Bacterial; Genomics; Humans; Klebsiella Infections; Klebsiella pneumoniae; Multilocus Sequence Typing; Phylogeny; Urinary Tract Infections; Uruguay

We described 27 polyclonal colistin-resistant Enterobacteriaceae (MIC 4-16 μg/mL) infections (12 pneumonia, 12 urinary tract infection (UTI), two Bacteremia, and one skin/soft tissue infection) in which 74% harbored KPC. The isolates were polyclonal, 6 STs were identified and the colistin resistance was due to chromosome mutations. Eight patients with UTI received monotherapy, and combination therapy was given to 19 patients. Overall mortality was 37%. In vitro synergy using time-kill assay was observed in 14 of 19 (74%) isolates tested; the synergistic effect was observed for almost all isolates for the combination of three drugs: colistin, amikacin, and tigecycline. The Kaplan-Meier survival curve showed no significant difference comparing combination therapy with 2, 3, or more drugs and risk factors associated with death were dialysis and shock. These findings reinforce the fact that colistin in combination with other classes of drugs can be useful in treating infections caused by colistin-resistant CRE.

Topics: Amikacin; Anti-Bacterial Agents; Bacterial Proteins; beta-Lactamases; Colistin; Drug Resistance, Multiple, Bacterial; Drug Synergism; Drug Therapy, Combination; Enterobacteriaceae; Enterobacteriaceae Infections; Female; Humans; Kaplan-Meier Estimate; Male; Microbial Sensitivity Tests; Middle Aged; Minocycline; Pneumonia; Prospective Studies; Soft Tissue Infections; Tigecycline; Urinary Tract Infections

Five strains producing extended-spectrum β-lactamases (ESBL) bacteria, identified as Escherichia coli, were isolated from children with urinary infections hospitalized at Roubaix hospital in the north of France. The DNA genotypes of these non-nosocomial isolates were determined by Random Amplified Polymorphic DNA (RAPD) method. Further, their DNA plasmids content revealed the presence of two distinct plasmids for S1, S2, S3 and one plasmid for S4 and S5. The antibacterial susceptibility of these ESBL bacteria was tested mainly against antibiotics of β-lactams family. The ESBL producing bacteria were resistant to ticarcillin and cefotaxime but the combination of these antibiotics with colistin has dropped the MIC of ticarcillin below its breakpoint (isolates S2, S3 and S4), and has almost reached the breakpoint for cefotaxime (isolate S2). Thus, kill curves analyses carried out with only isolates S1 and S2, strengthened the bactericidal activity of the combinations of colistin-ticarcillin and colistin-cefotaxime against ESBL E. coli. Indeed, reduction of 3 log10 colony count were observed after 24 h of incubation.

Topics: Anti-Bacterial Agents; beta-Lactam Resistance; beta-Lactamases; beta-Lactams; Child; Colistin; DNA, Bacterial; Drug Synergism; Escherichia coli; Escherichia coli Infections; France; Hospitals; Humans; Microbial Sensitivity Tests; Microbial Viability; Molecular Typing; Plasmids; Random Amplified Polymorphic DNA Technique; Urinary Tract Infections

At the Shaare Zedek Medical Center, we have been using colistimethate sodium (CMS) for empiric as well as pathogen-directed treatment. We present our 10-year experience.. We conducted a retrospective case-series analysis of patients admitted from 1 January 2004 through 1 May 2014 who received at least one dose of CMS. Patient characteristics analysed for all admission for which patients received CMS, included: age, number of re-admissions, admission ward, renal function, disposition and microbiology results. Overall trend in defined daily dose (DDD) for CMS and resistant isolates was analysed.. A total of 5603 admissions met inclusion criteria. Patients' mean (±SD) age was 80 ± 14 years, 1162 (48%) of the admissions were from a healthcare facility and 4367 (78%) of the admissions were to general Internal Medicine wards. The median number of hospital admissions per patient was 5, median admission and discharge creatinine (mg/dl) were 1.05 and 1.01, respectively; 2.3% of admissions required first-time dialysis. The discharge rate from the hospital was 58.4%. Excluding intrinsically CMS-resistant gram-negative organisms, bloodstream and urine isolates were 98% and 100% susceptible, respectively. CMS use (DDDs) increased during the study (p for trend = 0.04) without significant increase in incidence of multidrug-resistant organisms.. Colistimethate sodium use at our institution has increased during this 10-year period. Nevertheless, there is no increasing trend in CMS-resistant organisms, 58% of the patients were discharged alive, and we did not observe significant nephrotoxicity in patients prescribed CMS. CMS should be reserved for microbiologically confirmed extensively drug-resistant gram-negative infections.

Topics: Aged, 80 and over; Anti-Bacterial Agents; Colistin; Community-Acquired Infections; Cross Infection; Drug Resistance, Bacterial; Female; Gram-Negative Bacterial Infections; Hospitalization; Humans; Male; Microbial Sensitivity Tests; Respiratory Tract Infections; Retrospective Studies; Urinary Tract Infections

Klebsiella pneumoniae New Delhi metallo-beta-lactamase-1 (NDM-1) strains have recently become a new threat in kidney transplant recipients due to the strains' resistance to almost all antibiotics, including carbapenems.. We present a case series of 3 patients with urinary tract infections (UTIs) caused by multiresistant K pneumoniae NDM-1 strains who were treated with the same protocol. Genotyping sequencing with pulsed-field gel electrophoresis was performed in all cases.. All patients were male and had undergone kidney transplantation 4, 7, and 8 months, respectively, before the admission. Combined antibiotic therapy consisting of imipenem/cilastatin in maximal doses, gentamicin and/or colistin for 21 to 27 days, followed by oral fosfomycin, was used in all cases. There were no further UTI episodes in 2 patients at the 12-month visit. Three months after initial treatment, the third patient presented with leukocyturia with no clinical symptoms and a urine culture positive for K pneumonia NDM-1 strain. Interestingly, the strain was susceptible to trimethoprim/sulfamethoxazole despite resistance in previous urine culture samples. The patient was successfully treated with trimethoprim/sulfamethoxazole 2 × 960 mg/d for 3 weeks followed by 480 mg/d and 3 doses of fosfomycin. Genotyping sequencing revealed identical DNA restriction fragments in bacterial strains from 2 patients. In the third case, although a difference in 2 restriction fragments was observed, the strain was considered related to the others.. In cases of UTI caused by K pneumoniae NDM-1 strains, prolong combined treatment followed by oral fosfomycin prophylaxis can be successful. Strain genotyping should be performed to optimize further treatment protocols in such cases.

Topics: Anti-Bacterial Agents; beta-Lactamases; Cilastatin; Cilastatin, Imipenem Drug Combination; Colistin; Drug Combinations; Drug Resistance, Microbial; Electrophoresis, Gel, Pulsed-Field; Fosfomycin; Genotype; Gentamicins; Humans; Imipenem; Kidney Transplantation; Klebsiella Infections; Klebsiella pneumoniae; Male; Microbial Sensitivity Tests; Transplant Recipients; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Colistin is increasingly used as an antibiotic of last resort for the treatment of carbapenem-resistant Gram-negative infections. The plasmid-borne colistin resistance gene mcr-1 was initially identified in animal and clinical samples from China and subsequently reported worldwide, including in the United States. Of particular concern is the spread of mcr-1 into carbapenem-resistant bacteria, thereby creating strains that approach pan-resistance. While several reports of mcr-1 have involved carbapenem-resistant strains, no such isolates have been described in the United States. Here, we report the isolation and identification of an Escherichia coli strain harboring both mcr-1 and carbapenemase gene blaNDM-5 from a urine sample in a patient without recent travel outside the United States. The isolate exhibited resistance to both colistin and carbapenems, but was susceptible to amikacin, aztreonam, gentamicin, nitrofurantoin, tigecycline, and trimethoprim-sulfamethoxazole. The mcr-1- and blaNDM-5-harboring plasmids were completely sequenced and shown to be highly similar to plasmids previously reported from China. The strain in this report was first isolated in August 2014, highlighting an earlier presence of mcr-1 within the United States than previously recognized.. Colistin has become the last line of defense for the treatment of infections caused by Gram-negative bacteria resistant to multiple classes of antibiotics, in particular carbapenem-resistant Enterobacteriaceae (CRE). Resistance to colistin, encoded by the plasmid-borne gene mcr-1, was first identified in animal and clinical samples from China in November 2015 and has subsequently been reported from numerous other countries. In April 2016, mcr-1 was identified in a carbapenem-susceptible Escherichia coli strain from a clinical sample in the United States, followed by a second report from a carbapenem-susceptible E. coli strain originally isolated in May 2015. We report the isolation and identification of an E. coli strain harboring both colistin (mcr-1) and carbapenem (blaNDM-5) resistance genes, originally isolated in August 2014 from urine of a patient with recurrent urinary tract infections. To our knowledge, this is the first report in the United States of a clinical bacterial isolate with both colistin and carbapenem resistance, highlighting the importance of active surveillance efforts for colistin- and carbapenem-resistant organisms.

Topics: Aged; Anti-Bacterial Agents; beta-Lactamases; Carbapenems; Colistin; DNA, Bacterial; Drug Resistance, Bacterial; Escherichia coli; Escherichia coli Infections; Escherichia coli Proteins; Humans; Male; Plasmids; Sequence Analysis, DNA; Sequence Homology; Travel; United States; Urinary Tract Infections; Urine

Persisters are small populations of quiescent bacterial cells that survive exposure to bactericidal antibiotics and are responsible for many persistent infections and posttreatment relapses. However, little is known about how to effectively kill persister bacteria. In the work presented here, we found that colistin, a membrane-active antibiotic, was highly active against Escherichia coli persisters at high concentrations (25 or 50 μg/ml). At a clinically relevant lower concentration (10 μg/ml), colistin alone had no apparent effect on E. coli persisters. In combination with other drugs, this concentration of colistin enhanced the antipersister activity of gentamicin and ofloxacin but not that of ampicillin, nitrofurans, and sulfa drugs in vitro The colistin enhancement effect was most likely due to increased uptake of the other antibiotics, as demonstrated by increased accumulation of fluorescence-labeled gentamicin. Interestingly, colistin significantly enhanced the activity of ofloxacin and nitrofurantoin but not that of gentamicin or sulfa drugs in the murine model of urinary tract infection. Our findings suggest that targeting bacterial membranes is a valuable approach to eradicating persisters and should have implications for more effective treatment of persistent bacterial infections.

Topics: Animals; Anti-Bacterial Agents; Cell Membrane; Colistin; Disease Models, Animal; Dose-Response Relationship, Drug; Drug Synergism; Escherichia coli Infections; Escherichia coli K12; Female; Gentamicins; Mice, Inbred C3H; Microbial Sensitivity Tests; Urinary Tract Infections; Uropathogenic Escherichia coli

In 2015, scientists reported the emergence of the plasmid-encoded mcr-1 gene conferring bacterial resistance to the antibiotic colistin (1), signaling potential emergence of a pandrug-resistant bacterium. In May 2016, mcr-1-positive Escherichia coli was first isolated from a specimen from a U.S. patient (2) when a Pennsylvania woman was evaluated for a urinary tract infection. The urine culture and subsequent testing identified the gene in an extended-spectrum beta-lactamase (ESBL)-producing E. coli with reduced susceptibility to colistin. The patient had no international travel for approximately 1 year, no livestock exposure, and a limited role in meal preparation with store-bought groceries; however, she had multiple and repeated admissions to four medical facilities during 2016.

Topics: Colistin; Drug Resistance, Bacterial; Escherichia coli; Escherichia coli Infections; Female; Humans; Pennsylvania; Urinary Tract Infections

A 50-year-old woman known to have type 1 diabetes mellitus presented with a rare case of angio-oedema associated with colistin use. The angio-oedema was temporally associated with the use and discontinuation of colistin with the reasonable exclusion of important differential diagnoses. Pseudoallergy may be a probable underlying mechanism. However, we cannot exclude the possibility of hereditary angio-oedema type 2 or 3, or that her concomitant medications (particularly enalapril) and her renal impairment contributed to the risk and severity of her angio-oedema.

Topics: Acinetobacter baumannii; Angioedema; Anti-Allergic Agents; Anti-Bacterial Agents; Colistin; Diagnosis, Differential; Female; Humans; Hydrocortisone; Middle Aged; Promethazine; Sepsis; Treatment Outcome; Urinary Tract Infections; Withholding Treatment

To describe the clinical and microbiological data of carbapenem-resistant Enterobacteriaceae (CRE) infections, the treatment used, hospital- and infection-related mortality, and risk factors for death.. A prospective cohort conducted from March 2011 to December 2012. Clinical, demographic, and microbiological data such as in vitro sensitivity, clonality, carbapenemase gene mortality related to infection, and overall mortality were evaluated. Data were analyzed using Epi Info version 7.0 (CDC, Atlanta, GA, USA) and SPSS (Chicago, IL, USA).. One hundred and twenty-seven patients were evaluated. Pneumonia, 52 (42 %), and urinary tract infections (UTI), 51 (40.2 %), were the most frequent sites of infection. The isolates were polyclonal; the Bla. CRE infection mortality was higher among patients with pneumonia. Infections caused by colistin-resistant isolates did not increase mortality. The use of more than two drugs on combination therapy did not show a protective effect on outcome. The isolates were polyclonal, and the bla

Topics: Adult; Age Factors; Aged; Anti-Bacterial Agents; Bacterial Proteins; beta-Lactamases; Carbapenems; Cohort Studies; Colistin; Drug Resistance, Bacterial; Electrophoresis, Gel, Pulsed-Field; Enterobacteriaceae; Enterobacteriaceae Infections; Female; Hospital Mortality; Humans; Kidney Failure, Chronic; Male; Microbial Sensitivity Tests; Middle Aged; Pneumonia; Polymerase Chain Reaction; Prospective Studies; Renal Dialysis; Risk Factors; Shock, Septic; Urinary Tract Infections

Topics: Administration, Intravesical; Anti-Bacterial Agents; Colistin; Drug Resistance, Multiple, Bacterial; Humans; Male; Middle Aged; Urinary Tract Infections

The emergence of multidrug-resistant (MDR) Gram-negative bacteria has become a major public health problem, eliciting renewed interest in colistin, an old antibiotic that is now routinely used to treat MDR bacterial infections. Here we investigated whether colistin use has affected the prevalence of infections due to intrinsic colistin-resistant bacteria (CRB) in university hospitals in Marseille (France) over a 5-year period. All data from patients infected by intrinsic CRB were compiled from January 2009 to December 2013. Escherichia coli infections were used for comparison. Colistin consumption data were also collected from pharmacy records from 2008 to 2013. A total of 4847 intrinsic CRB infections, including 3150 Proteus spp., 847 Morganella spp., 704 Serratia spp. and 146 Providencia spp., were collected between 2009 and 2013. During this period, the annual incidence rate of hospital-acquired CRB infections increased from 220 per 1000 patients to 230 per 1000 patients and that of community-acquired CRB infections increased from 100 per 1000 patients to 140 per 1000 patients. In parallel, colistin consumption increased 2.2-fold from 2008 to 2013, mainly because of an increase in the use of colistin aerosol forms (from 50 unitary doses to 2926 unitary doses; P<10(-5)) that was significantly correlated with an increase in the number of patients positive for CRB admitted to ICUs and units of long-term care between 2009 and 2013 (r=0.91; P=0.03). The global rise in infections due to intrinsic CRB is worrying and surveillance is warranted to better characterise this intriguing epidemiological change.

Topics: Anti-Bacterial Agents; Colistin; Drug Resistance, Bacterial; France; Gram-Negative Bacterial Infections; Hospitals, University; Humans; Incidence; Retrospective Studies; Urinary Tract Infections

Eravacycline (formerly TP-434) was evaluated in vitro against pre-established biofilms formed by a uropathogenic Escherichia coli strain. Biofilms were eradicated by 0.5 μg/ml eravacycline, which was within 2-fold of the MIC for planktonic cells. In contrast, colistin and meropenem disrupted biofilms at 32 and 2 μg/ml, respectively, concentrations well above their respective MICs of 0.5 and 0.03 μg/ml. Gentamicin and levofloxacin eradicated biofilms at concentrations within 2-fold of their MICs.

Topics: Anti-Bacterial Agents; Biofilms; Colistin; Colony Count, Microbial; Escherichia coli Infections; Gentamicins; Humans; Levofloxacin; Meropenem; Microbial Sensitivity Tests; Tetracyclines; Thienamycins; Urinary Tract Infections; Uropathogenic Escherichia coli

Topics: Adaptation, Physiological; Aged, 80 and over; Anti-Bacterial Agents; Cholecystitis; Colistin; Drug Resistance, Bacterial; Escherichia coli; Escherichia coli Infections; Female; Humans; Male; Microbial Sensitivity Tests; Sepsis; Urinary Tract Infections

To describe the management strategy for a multidrug-resistant (MDR) Klebsiella urinary tract infection (UTI).. A 69-year-old Caucasian woman with a past medical history of recurrent UTIs and a right-lung transplant presented with fever to 101.4°F, chills, malaise, and cloudy, foul-smelling urine for approximately 1 week. She was found to have a MDR Klebsiella UTI that was sensitive to tigecycline and cefepime. To further evaluate the degree of resistance Etest minimum inhibitory concentrations were requested for cefepime, amikacin, meropenem, and ertapenem. The patient received a 14-day course of amikacin, which resulted in resolution of her symptoms. One month later, the patient's UTI symptoms returned. The urine culture again grew MDR Klebsiella, sensitive only to tigecycline. Fosfomycin was initiated and resulted in limited resolution of her symptoms. Colistin was started, however, therapy was discontinued on day 5 secondary to the development of acute kidney injury. Despite the short course of therapy, the patient's symptoms resolved.. The case presented lends itself well to numerous discussion items that are important to consider when determining optimal treatment for MDR Gram-negative bacilli (GNBs). Susceptibility testing is an important tool for optimizing antibiotic therapy, however, automated systems may overestimate the susceptibility profile for a MDR GNB. Treatment strategies evaluated to treat MDR GNB, include combination therapy with a carbepenem and synergy using polymyxin.. We have described the management strategy for a MDR Klebsiella UTI, the consequences of the initial management strategy, and potential strategies to manage these types of infections in future patients.

Topics: Aged; Anti-Bacterial Agents; Colistin; Drug Resistance, Multiple, Bacterial; Female; Humans; Klebsiella; Microbial Sensitivity Tests; Urinary Tract Infections

Colistin (polymyxin E) was developed ~ 60 years ago but was rarely used in clinical practice during the last 20 years because of concerns related to high rates of nephrotoxicity. However, it was recently reintroduced to clinical practice in many parts of the world for the treatment of multi-drug resistant gram-negative bacilli. In the current study, we evaluated the predictive capacity of urine neutrophil gelatinase-associated lipocalin (NGAL) for early diagnosis of acute kidney injury (AKI) in geriatric patients with urinary tract infection (UTI) receiving colistin therapy.. We studied 116 patients aged 80.7 ± 12 treated with colistin who suffered from UTI. Urinary NGAL was measured at baseline and 1 - 2 hours after the second dose of colistin. The primary outcome was AKI. Secondary outcome was in-hospital morbidity and mortality.. 52 patients (44.8%) developed acute tubular necrosis (ATN) (14% of these had underlying CKD), 8 (7%) had prerenal azotemia, 8 (7%) had stable CKD without changes in renal function during hospitalization and the remaining 48 patients (41%) had normal kidney function. The mean duration of colistin therapy was 9.1 ± 4.8 days. At baseline, urine NGAL was 405 ± 452 g/l in ATN, 285 ± 256 g/l in prerenal azotemia, 390 ± 468 g/l in CKD and 347 ± 877 g/l in normal kidney function patients (difference non-significant). We were unable to demonstrate statistically significant increments of urine NGAL following colistin administration in either ATN or non-ATN patient groups. Urine NGAL was not correlated with urinary leukocyte or erythrocyte counts or baseline comorbidities such as CKD, heart failure, or diabetes. For primary outcome (ATN), receiver operating characteristics curve revealed AUC 0.59 (95% CI 0.49 - 0.7) sensitivity 0.65, and specificity 0.62 for a cutoff value of urinary NGAL 140 g/l. Similar results were obtained for secondary outcomes.. Our data suggest limited predictive capacity of urinary NGAL for early diagnosis of AKI in a large clinical setting of geriatric patients hospitalized for UTI and receiving the potentially nephrotoxic colistin. This finding is likely due to the powerful influence of UTI on NGAL levels in both patients with normal kidney function and those with a wide spectrum of acute or chronic kidney diseases.

Topics: Acute Kidney Injury; Acute-Phase Proteins; Aged; Aged, 80 and over; Anti-Bacterial Agents; Biomarkers; Colistin; Early Diagnosis; Female; Humans; Lipocalin-2; Lipocalins; Male; Prospective Studies; Proto-Oncogene Proteins; Urinary Tract Infections

Polymyxins have recently again become important because of multidrug-resistant (MDR) gram-negative pathogens. The aim of this study was to evaluate the clinical and microbiological efficacy and toxicity of different dosages of colistin in patients infected with MDR microorganisms that were sensitive only to colistin. The study was conducted in the 1,200-bed Ankara Numune Training and Research Hospital. Patients with normal renal function who received colistin for 48 h or more were retrospectively evaluated. Clinical response was defined as resolution of fever and clinical and laboratory findings. Microbiological response was defined as bacteriological eradication from the infection site. Nephrotoxicity was defined as at least two consecutive serum creatinine measurements with an increase of 0.5 mg/dl from baseline at least 24 h apart after 2 or more days of colistin therapy. Twenty-four patients were included in the study: total clinical response was obtained in 17 of 24 (70.8 %) patients and microbiological response in 15 of 24 (62.5 %) patients. Patients were grouped according to colistin dosage of 3 × 1 million units (MU) versus 3 × 2 MU. Clinical response rates were 69.2 % and 72.7 %, respectively (p = 0.65). Microbiological response rate was similar (p = 0.62). Nephrotoxicity was revealed in 1 of 13 patients (7.7 %) for the 3 × 1 MU group and 2 of 11 patients (18.2 %) in the 3 × 2 MU group (p = 0.57). The nephrotoxicity rate was greater with higher dosages of colistin, but the difference was not statistically significant. Renal function of patients receiving higher dosages of colistin should be more closely monitored.

Topics: Adult; Aged; Anti-Bacterial Agents; Bacteremia; Colistin; Drug Resistance, Multiple, Bacterial; Female; Gram-Negative Bacteria; Gram-Negative Bacterial Infections; Humans; Male; Middle Aged; Pneumonia, Bacterial; Treatment Outcome; Urinary Tract Infections; Young Adult

The New Delhi metallo-β-lactamase gene (bla(NDM-1)) has emerged as a worldwide concern among isolates of Enterobacteriaceae. Its epidemiology is been strongly associated with travel and healthcare on the Indian Subcontinent. We report two cases of urinary tract infection with Enterobacteriaceae harboring a bla(NDM-1). Both cases presented as infection in community-dwelling individuals in Australia and were associated with travel to the Indian Subcontinent. One isolate of Escherichia coli harbored the previously undescribed enzyme variant bla(NDM-3), differing from bla(NDM-1) by a single nonsynonymous SNP conferring a putative peptide sequence change at the 95th position (ASP→ASN). The second was an Enterobacter cloacae harboring bla(NDM-1). Further genetic characterization included identification of additional β-lactamase and aminoglycoside resistance genes. Legacy antimicrobials were used for treatment. Oral therapy with nitrofurantoin was successful in one case, while combination of colistin and rifampicin was required in the second patient. Such infection, due to extensively drug-resistant pathogens, poses significant challenges in balancing the efficacy and toxicity of potential antimicrobial therapies.

Topics: Adult; Aged; Anti-Bacterial Agents; beta-Lactamase Inhibitors; beta-Lactamases; Colistin; Drug Resistance, Multiple, Bacterial; Enterobacter cloacae; Enterobacteriaceae Infections; Escherichia coli; Female; Humans; Male; Nitrofurantoin; Polymorphism, Single Nucleotide; Rifampin; Urinary Tract Infections

This study describes and analyzes Acinetobacter baumannii antibiotic susceptibly profile in Aleppo, Syria, thus providing vital information for guiding treatment of A baumannii infections. Two hundred sixty nonrepetitive A baumannii isolates were studied over 3.5 years. Resistance rates are at the higher end of globally reported levels. Newer cephalosporins and β-lactamase-resistant agents are becoming practically ineffective. Better activity is limited to carbapenems and colistin, which elicited the highest susceptibility levels.

Topics: Acinetobacter baumannii; Acinetobacter Infections; Adolescent; Adult; Anti-Bacterial Agents; Carbapenems; Child; Child, Preschool; Colistin; Drug Resistance, Multiple, Bacterial; Humans; Infant; Microbial Sensitivity Tests; Prevalence; Respiratory Tract Infections; Retrospective Studies; Syria; Urinary Tract Infections; Young Adult

Fifty Acinetobacter isolates were obtained from urinary tract infections and urinary catheter samples. Analytical profile index assays identified 47 isolates as Acinetobacter baumannii and three as Acinetobacter lwoffii. Six A. baumannii isolates (A1-A6) displayed hydrophobicity indices >70%. Twenty isolates exhibited lectin activity. Biofilm formation by these isolates was compared with those with low hydrophobicity index values (A45-A50). Biofilms on different surfaces were confirmed by light microscopy, epifluorescence microscopy and by obtaining scanning electron microscope images. Biofilm production was maximal at 30 °C, pH 7.0 in a medium with 5.0 g L(-1) NaCl, and its efficiency was reduced on urinary catheter surfaces at sub-minimum inhibitory concentration concentrations of colistin. Plasmid-mediated antibiotic resistance was observed in selected isolates of A. baumannii and experiments of conjugation and transformation showed the occurrence of gene transfer. Plasmid curing was used to examine the function of plasmids. Five plasmids of A. baumannii A3 were cured but no differences were observed between wild-type and plasmid-cured strains with respect to the biofilm formation capabilities. The prevalence of A. baumannii strains with biofilm mode of growth could explain their ability to persist in clinical environments and their role in device-related infections.

Topics: Acinetobacter baumannii; Acinetobacter Infections; Anti-Bacterial Agents; Bacterial Adhesion; Biofilms; Catheters, Indwelling; Colistin; Conjugation, Genetic; Drug Resistance, Bacterial; Humans; Hydrogen-Ion Concentration; Hydrophobic and Hydrophilic Interactions; Lectins; Microbial Sensitivity Tests; Microscopy; Molecular Weight; Plasmids; Temperature; Urinary Catheterization; Urinary Tract Infections

Topics: Acinetobacter baumannii; Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Child; Child, Preschool; Colistin; Drug Resistance, Multiple, Bacterial; Female; Humans; India; Male; Middle Aged; Minocycline; Prospective Studies; Tigecycline; Urinary Tract Infections; Young Adult

There has been an increase in recent years of antimicrobial resistance of Gram negative bacilli (GNB). Carbapenems, the mainstay for the treatment of multidrug resistant GNB infections, are no longer always effective leaving treatment options limited. We present the case of patient with recurrent, complicated urinary tract infections. The current episode was caused by carbapenem-resistant K. pneumoniae and P. aeruginosa and carbapenem-susceptible, but MDR E. cloacae. Resistance to carbapenems of K. pneumoniae was conferred by the production of the class B metallo-beta-lactamase, VIM1. Infection control measures were implemented and following a 2-week course of treatment with colistin, the infection resolved and the patient was discharged. We discuss the changes in the epidemiology, the mechanisms involved and the means of detecting carbapenem resistance in GNB. We would also like to stress the role of infection control measures in limiting patient-to-patient spread of MDR organisms which, are of paramount importance in cases when few treatment options are left available.

Topics: Aged; Anastomosis, Surgical; Anti-Bacterial Agents; beta-Lactam Resistance; Carbapenems; Colistin; Drug Resistance, Multiple, Bacterial; Enterobacter cloacae; Enterobacteriaceae Infections; Humans; Infection Control; Klebsiella Infections; Klebsiella pneumoniae; Male; Nephrolithiasis; Pseudomonas aeruginosa; Pseudomonas Infections; Risk Factors; Treatment Outcome; Urinary Bladder; Urinary Bladder Neoplasms; Urinary Tract Infections

Multidrug resistant Gram-negative rods are emerging as major pathogens and are the cause of difficulty to treat infections. In certain situations colistin is the only active drug.. A retrospective review of the patient's charts admitted at Hôtel-Dieu de France hospital, Beirut, between October 2002 and February 2004 and treated with intravenous colistin.. Fifteen patients were identified; they were suffering from urinary tract infections, cellulitis, osteomyelitis, mediastinitis and intra-abdominal abscess. The microorganisms were resistant to all available antibiotics except colistin. Three strains were also susceptible to aminoglycosides. Pseudomonas aeruginosa was the most frequently isolated pathogen. Colistin was used in monotherapy in 12 patients and combined with amikacin in three patients. At the end of therapy, a 93% rate of favorable clinical outcome was observed. Renal toxicity was encountered among 12 patients. It was severe in only two cases in which creatinine clearance decline surpassed 50% of the baseline value. No neurological toxicity was observed.. Colistin has an important role to play when used for the treatment of infections with multiresistant Gram-negative bacteria. Nephrotoxicity seems much lower than expected and neurotoxicity is minimal.

Topics: Abdominal Abscess; Anti-Bacterial Agents; Colistin; Gram-Negative Bacteria; Humans; Infusions, Intravenous; Kidney; Osteomyelitis; Pseudomonas aeruginosa; Pseudomonas Infections; Pyelonephritis; Retrospective Studies; Urinary Tract Infections

An outbreak of a multidrug resistant Pseudomonas aeruginosa including imipenem resistance occurred in the urology intensive care unit at Charles Nicolle Hospital (Tunis). All isolates presented the same antibiotic resistance pattern and were only susceptible to colistin. The epidemic strain was detected in different sites of this unit. Pulsed-field gel electrophoresis after enzymatic restriction using XbaI was performed in order to establish an epidemiologic link between these infections. Genotypic analysis showed two different patterns and the environmental source was identified in both cases. Although the same antibiotype was harbored by all the isolates, two outbreaks occurring in the same period were identified. The strengthening of hygiene measures allowed to stop the outbreak spreading. Since the hospital environment is the major source of Pseudomonas aeruginosa contamination, a continuous surveillance of the patients and the environmental sources is required for the implementation efficient control measures.

Topics: Colistin; Cross Infection; Disease Outbreaks; Drug Resistance, Bacterial; Drug Resistance, Multiple; Electrophoresis, Gel, Pulsed-Field; Genotype; Pseudomonas aeruginosa; Pseudomonas Infections; Urinary Tract Infections

Current bacteriological data are very useful when making therapeutic decisions in cases of non complicated urinary tract infection. In this article, we present the data gathered by a university hospital laboratory in mid-Tunisia as well as the results of 17,829 urinary cytobacteriological examinations conducted in a multidisciplinary hospital during the year 2000. Urine was sowed on usual agar. All bacterium cultivating at least 10(5) bacteria reported to ml and at 37 degrees C in a normal atmosphere was retained; identification and sensitivity to antibiotics of the bacterium followed the recommendations of the French Society of Microbiology. We collected 2063 non-redundant bacteria of which 82.3% came from female samples. Gram negative rods were distinctly predominant with 92% of the whole bacterium and Escherichia coli represented 67% of the whole of the germs; Staphylococcus saprophyticus with 4.8% and Streptococcus agalactiae with 1% dominated Gram positive bacteria. The susceptibility of bacteria to the principal antibiotics used for the treatment of the urinary tract infection was characterised by the low percentage of sensitivity of the Gram negative rods to amoxicillin (41.2% of sensitivity for Escherichia coli and 22% for the Proteus sp), and by cotrimoxazole which preserved an activity between 63.8% for Escherichia coli and 94.7% for Staphylococcus saprophyticus. The highest percentage of sensitivity was achieved by gentamicine (99.4% of Escherichia coli and 98.9% of Staphylococcus saprophyticus) and fluoroquinolons (97.8% of Escherichia coli and 100% of Staphylococcus saprophyticus are sensible); furadoin was active on almost all Escherichia coli and Staphylococcus saprophyticus. Apart from natural resistance, colistin was constantly active. Escherichia coli and Staphylococcus saprophyticus were the major agents of the urinary tract infection. Gentamicin and fluoroquinolons showed themselves to be constantly active antibiotics. Nitrofurans and colistin deserve a better place in therapeutic choice.

Topics: Anti-Bacterial Agents; Anti-Infective Agents, Urinary; Bacteria; Colistin; Escherichia coli; Female; Gentamicins; Hospitals, University; Humans; Microbial Sensitivity Tests; Nitrofurantoin; Ofloxacin; Pregnancy; Pregnancy Complications, Infectious; Tunisia; Urinary Tract Infections; Urine

Two hundred and seventy eight women undergoing Cesarean section were evaluated retrospectively to determine the value of prophylactic antibiotic treatment on post-operative urinary tract infection morbidity. One hundred eight women who received no prophylactic treatment, and ninety eight treated prophylactically with ampicillin and colistin (colliracin). The effect of various obstetrics parameters including parity, previous Cesarean section, duration of labor and maternal anemia on the rate of infection was studied. Significant difference in the rate of infection after the introduction of prophylactic treatment was found. Morbidity rate was reduced to 6.1% in patients treated with ampicillin and collistin compared to 16.1% in the control group (P less than 0.001). The risk group for developing urinary tract infection were those who stayed more than two hours in the delivery room or with hemoglobin blood level less than 12 gr/D.L.

Topics: Ampicillin; Cesarean Section; Colistin; Female; Humans; Pregnancy; Risk; Urinary Tract Infections

Topics: Animals; Animals, Domestic; Bacterial Infections; Colistin; Dogs; Endotoxins; Humans; Mesylates; Polymyxin B; Polymyxins; Rabbits; Urinary Tract Infections

Topics: Colistin; Humans; Injections, Spinal; Meningitis; Polymyxins; Pseudomonas Infections; Urinary Tract Infections

Topics: Aged; Amikacin; Colistin; Cross Infection; Disease Outbreaks; Drug Administration Schedule; Drug Resistance, Microbial; Female; Humans; Injections, Intramuscular; Injections, Intravenous; Kanamycin; Klebsiella Infections; Klebsiella pneumoniae; Male; Middle Aged; Urinary Tract Infections

Topics: Aminoglycosides; Anti-Bacterial Agents; Cephalosporins; Colistin; Humans; Kidney; Kidney Function Tests; Penicillins; Polymyxins; Sepsis; Tetracyclines; Urinary Tract Infections

Hospitalized patients with urinary tract infections caused by Pseudomonas aeruginosa or other bacterial pathogens are frequently treated with parenteral antibiotics such as gentamicin. Many of these organisms are shown by Kirby-Bauer disk sensitivity testing to be resistant to tetracycline. One hundred seventy-one such tetracycline-resistant bacterial isolates were studied; 84% were found to be sensitive to achievable urinary concentrations of tetracycline. Two patients with long-standing chronic urinary tract infection with Pseudomonas were treated with tetracycline for a year and a half with excellent results. In a pilot clinical trial, eight of 12 hospitalized patients with urinary tract infection were treated successfully with tetracycline without regard to disk sensitivity data. Institution of tetracycline as soon as the microscopic diagnosis of urinary tract infection is made might be an acceptable empiric approach to the treatment of urinary infection in hospitalized patients who do not show evidence of sepsis.

Topics: Bacteriuria; Carbenicillin; Colistin; Gentamicins; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Nephrectomy; Penicillin Resistance; Proteus mirabilis; Pseudomonas aeruginosa; Pseudomonas Infections; Tetracycline; Urinary Tract Infections

The identity of 693 pathogenic bacilli isolated from 2,175 urine specimens cultured during a two-year period in southeastern New Mexico is presented along with results of sensitivity testing by Kirby-Bauer technique. The pattern of infections and sensitivity studies in hospitalized patients is compared with that of office patients and contrasted with results noted in other areas.

Topics: Canada; Citrobacter; Colistin; Drug Evaluation, Preclinical; Epidemiologic Methods; Escherichia coli; Escherichia coli Infections; Female; Gentamicins; Humans; In Vitro Techniques; Klebsiella; Male; Microbial Sensitivity Tests; Minnesota; Nalidixic Acid; New Mexico; Nitrofurantoin; Pennsylvania; Proteus; Pseudomonas; Urinary Tract Infections; Urine

Topics: Ampicillin; Chloramphenicol; Colistin; Conjugation, Genetic; Czechoslovakia; DNA, Bacterial; Escherichia coli; Extrachromosomal Inheritance; Humans; Kanamycin; Microbial Sensitivity Tests; Nalidixic Acid; Penicillin Resistance; Streptomycin; Sulfonamides; Tetracycline; Urinary Tract Infections

Topics: Ampicillin; Cephalexin; Cephaloridine; Child; Child, Preschool; Chloramphenicol; Colistin; Escherichia coli; Female; Humans; Infant; Kanamycin; Klebsiella pneumoniae; Male; Microbial Sensitivity Tests; Minocycline; Nalidixic Acid; Proteus; Streptomycin; Tetracycline; Tetracyclines; Urinary Tract Infections

Topics: Ampicillin; Anti-Bacterial Agents; Bacteria; Bacterial Infections; Bacteriuria; Chloramphenicol; Colistin; Drug Resistance, Microbial; Enterococcus faecalis; Escherichia coli; Escherichia coli Infections; Humans; Hungary; Kanamycin; Klebsiella; Microbial Sensitivity Tests; Nalidixic Acid; Neomycin; Nitrofurantoin; Penicillin Resistance; Polymyxins; Proteus; Proteus Infections; Proteus mirabilis; Pseudomonas aeruginosa; Streptomycin; Tetracycline; Time Factors; Urinary Tract Infections; Urine

Topics: Ampicillin; Antigens, Bacterial; Cephalothin; Child; Chloramphenicol; Colistin; Escherichia coli; Gentamicins; Humans; Immune Sera; Infant; Kanamycin; Meningitis; Neomycin; Penicillin Resistance; Polymyxins; Sepsis; Serotyping; Streptomycin; Tetracycline; Urinary Tract Infections

Topics: Cephalothin; Colistin; Enterococcus faecalis; Escherichia coli Infections; Gentamicins; Humans; Kanamycin; Kidney Failure, Chronic; Kidney Function Tests; Male; Novobiocin; Postoperative Complications; Prostatectomy; Pseudomonas aeruginosa; Pseudomonas Infections; Streptococcal Infections; Urinary Tract Infections; Urologic Diseases

Topics: Ampicillin; Chloramphenicol; Colistin; Female; Humans; Pregnancy; Pregnancy Complications, Infectious; Urinary Tract Infections

Topics: Colistin; Female; Humans; Male; Penicillins; Pregnancy; Pregnancy Complications, Infectious; Urinary Tract Infections

Topics: Aged; Animals; Bordetella; Colistin; Dogs; Female; Humans; Kidney; Kidney Diseases; Male; Middle Aged; Polymyxins; Urinary Tract Infections

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Cephaloridine; Chloramphenicol; Colistin; Erythromycin; Escherichia coli; Female; Gentamicins; Humans; Kanamycin; Lincomycin; Male; Meningitis; Microbial Sensitivity Tests; Middle Aged; Novobiocin; Penicillins; Radiography; Respiratory Tract Infections; Sepsis; Staphylococcus; Streptococcus; Streptomycin; Sulfonamides; Tetracycline; Urinary Tract Infections

Topics: Animals; Anti-Bacterial Agents; Biological Transport; Colistin; Dogs; Hydrogen-Ion Concentration; Injections, Intravenous; Male; Streptomycin; Tetracycline; Urinary Bladder; Urinary Tract Infections

Topics: Colistin; Female; Humans; Kanamycin; Male; Spinal Cord Injuries; Urinary Bladder Diseases; Urinary Catheterization; Urinary Tract Infections

Topics: Australia; Colistin; Female; Humans; Kanamycin; Male; Paraplegia; Prognosis; Quadriplegia; Spinal Cord Injuries; Urinary Bladder, Neurogenic; Urinary Catheterization; Urinary Tract Infections

Topics: Aged; Ampicillin; Carbenicillin; Colistin; Edrophonium; Humans; Male; Medication Errors; Myasthenia Gravis; Neostigmine; Neuromuscular Depolarizing Agents; Primidone; Pseudomonas Infections; Pyridostigmine Bromide; Respiratory Insufficiency; Urinary Tract Infections

Topics: Anti-Bacterial Agents; Colistin; Cross Infection; Disease Outbreaks; Humans; Intensive Care Units; Klebsiella; Klebsiella Infections; Meningitis; Neurosurgery; Respiratory Tract Infections; Sputum; Urinary Tract Infections

Topics: Ampicillin; Bacteria; Cephaloridine; Chloramphenicol; Chromobacterium; Colistin; Drug Synergism; Enterobacteriaceae; Enterococcus faecalis; Escherichia coli; Female; Folic Acid Antagonists; Framycetin; Gentamicins; Humans; Kanamycin; Klebsiella; Male; Microbial Sensitivity Tests; Nalidixic Acid; Nitrofurantoin; Penicillin Resistance; Polymyxins; Proteus; Pseudomonas; Pyrimidines; Staphylococcus; Streptomycin; Sulfamethoxazole; Tetracycline; Urinary Tract Infections

Topics: Candida; Cell Membrane; Colistin; Female; Humans; Microbial Sensitivity Tests; Middle Aged; Polymyxins; Urinary Tract Infections

Topics: Adolescent; Adult; Aged; Bacteriuria; Cephalothin; Chloramphenicol; Chronic Disease; Colistin; Drug Resistance, Microbial; Escherichia coli Infections; Female; Gentamicins; Humans; Kanamycin; Male; Methacycline; Middle Aged; Oxytetracycline; Proteus Infections; Rifampin; Sulfamethoxypyridazine; Urinary Tract Infections

Topics: Aged; Bacteriological Techniques; Colistin; Enterobacteriaceae Infections; Female; Humans; Injections, Intramuscular; Injections, Intravenous; Male; Middle Aged; Pseudomonas Infections; Urinary Tract Infections

Topics: Ampicillin; Cloxacillin; Colistin; Cross Infection; Humans; Intensive Care Units; Klebsiella Infections; Lung Diseases; Neurosurgery; Penicillin Resistance; Urinary Tract Infections

Topics: Adult; Aged; Anti-Bacterial Agents; Bacteria; Cephalothin; Colistin; Female; Humans; Kanamycin; Male; Middle Aged; Pneumonia; Sepsis; Urinary Tract Infections

Topics: Animals; Anti-Infective Agents; Cephalosporins; Colistin; Cystitis; Disease Models, Animal; Gentamicins; Nalidixic Acid; Pyelonephritis; Rats; Sulfadiazine; Urinary Tract Infections

High doses of colistin were used in the treatment of severely ill patients with refractory klebsiella chest and urinary tract infections. At the same time renal function was monitored to determine possible nephrotoxicity. In all patients it produced acute renal failure and in some acute tubular necrosis. Though renal failure contributed to the final cause of death in some cases, in the majority death was due to the primary neurological illness.

Topics: Acute Kidney Injury; Adult; Aged; Colistin; Creatinine; Female; Humans; Kidney; Kidney Function Tests; Klebsiella Infections; Male; Metabolic Clearance Rate; Middle Aged; Respiratory Tract Infections; Urea; Urinary Tract Infections

Topics: Albuminuria; Cholangitis; Chronic Disease; Colistin; Hematuria; Humans; Pyelonephritis; Urinary Tract Infections

Topics: Anti-Infective Agents, Urinary; Cephaloridine; Colistin; Gentamicins; Glomerulonephritis; Humans; Nalidixic Acid; Nitrofurantoin; Pyelonephritis; Sulfadiazine; Urinary Tract Infections

Topics: Acute Kidney Injury; Adolescent; Adult; Aged; Air Microbiology; Ampicillin; Ascitic Fluid; Bacteriocins; Benzalkonium Compounds; Catheterization; Cephaloridine; Chloramphenicol; Colistin; Cross Infection; Ethylene Oxide; Filtration; Gentamicins; Humans; Kanamycin; Lysogeny; Middle Aged; Nalidixic Acid; Peritoneal Dialysis; Pseudomonas aeruginosa; Pseudomonas Infections; Renal Dialysis; Sterilization; Streptomycin; Tetracycline; Ultraviolet Rays; Urinary Tract Infections

Topics: Adult; Child; Child, Preschool; Colistin; Drug Synergism; Gentamicins; Humans; Infant; Middle Aged; Penicillin Resistance; Penicillins; Pseudomonas aeruginosa; Pseudomonas Infections; Urinary Calculi; Urinary Tract Infections; Urogenital Abnormalities

Topics: Colistin; Humans; Pseudomonas aeruginosa; Pseudomonas Infections; Urinary Tract Infections

Topics: Bacteria; Chloramphenicol; Chronic Disease; Colistin; Escherichia coli; Humans; Iodine; Kanamycin; Klebsiella; Proteus; Pseudomonas aeruginosa; Urinary Bladder Calculi; Urinary Tract Infections

Topics: Ampicillin; Anti-Bacterial Agents; Cephalosporins; Child; Cloxacillin; Colistin; Drug Synergism; Dysentery, Bacillary; Endocarditis, Bacterial; Humans; Infections; Lincomycin; Meningitis; Nafcillin; Neomycin; Oxacillin; Penicillin Resistance; Penicillins; Pneumococcal Infections; Polymyxins; Shigella; Streptococcal Infections; Sulfamethoxazole; Tetracycline; Urinary Tract Infections

Topics: Anti-Bacterial Agents; Cephaloridine; Chloramphenicol; Colistin; Escherichia coli; Hydrogen-Ion Concentration; Kanamycin; Nalidixic Acid; Polymyxins; Streptomycin; Sulfonamides; Tetracycline; Urinary Tract Infections

Topics: Adult; Aged; Ampicillin; Anti-Bacterial Agents; Chloramphenicol; Colistin; Cystoscopy; Fever; Humans; Infection Control; Kanamycin; Male; Methods; Middle Aged; Nalidixic Acid; Nitrofurantoin; Penicillin G; Penicillin Resistance; Postoperative Complications; Preoperative Care; Prostatectomy; Streptomycin; Sulfonamides; Tetracycline; Urinary Tract Infections; Urine

Topics: Acute Disease; Colistin; Humans; Pseudomonas Infections; Urinary Tract Infections

Topics: Ampicillin; Anti-Bacterial Agents; Chloramphenicol; Colistin; Humans; Kanamycin; Oxacillin; Oxytetracycline; Renal Dialysis; Streptomycin; Urinary Tract Infections

Topics: Acute Kidney Injury; Adult; Ampicillin; Cephalothin; Chloramphenicol; Chronic Disease; Colistin; Humans; Male; Pyelonephritis; Urinary Tract Infections

Topics: Ampicillin; Biliary Tract Diseases; Chloramphenicol; Colistin; Culture Media; Enterobacter; Erythromycin; Escherichia; Escherichia coli; Humans; Infections; Kanamycin; Klebsiella; Oleandomycin; Oxacillin; Penicillin Resistance; Penicillins; Proteus; Pseudomonas; Staphylococcus; Streptomycin; Sulfisoxazole; Tetracycline; Urinary Tract Infections

Gentamicin was of value in the treatment of chronic urinary tract infections caused by multiresistant bacterial strains for which no atoxic antibiotic was available. The treatment was carried out after alkalinization of the patient's urine. With the dosage given, gentamicin gave a low serum and a relatively high urine concentration. Excretion of active gentamicin in the urine was high even in patients with impaired renal function. The results of treatment of complicated chronic urinary tract infections with initial gentamicin and following long-term therapy showed negative urinary cultures in 12 out of 24 patients within one to 14 months of follow-up time. To reduce the risk of toxic side effects the dosage was adjusted according to the patient's kidney function. No development of resistance was demonstrated in the bacteria.

Topics: Adult; Aged; Chronic Disease; Colistin; Drug Resistance, Microbial; Escherichia coli Infections; Female; Gentamicins; Humans; Kanamycin; Klebsiella Infections; Male; Middle Aged; Proteus Infections; Urinary Tract Infections

Topics: Adolescent; Adult; Colistin; Female; Humans; Male; Middle Aged; Urinary Tract Infections

Topics: Colistin; Creatine; Humans; Pseudomonas Infections; Urinary Tract Infections

Topics: Colistin; Humans; Paraplegia; Urinary Tract Infections

Topics: Colistin; Humans; Urinary Tract Infections

Topics: Anticoagulants; Colistin; Diagnosis; Drug Therapy; Enterobacter; Escherichia coli Infections; Heparin; Hydrocortisone; Kanamycin; Klebsiella; Mannitol; Proteus Infections; Pseudomonas Infections; Sepsis; Streptomycin; Urinary Tract Infections; Urology; Vasodilator Agents

Topics: Colistin; Diagnosis; Drainage; Drug Therapy; Geriatrics; Humans; Intestinal Obstruction; Laparotomy; Postoperative Complications; Pseudomonas Infections; Radiography; Urinary Bladder Diseases; Urinary Catheterization; Urinary Tract Infections; Urination Disorders

Topics: Colistin; Drug Therapy; Injections, Intramuscular; Nalidixic Acid; Proteus; Pseudomonas Infections; Toxicology; Urinary Tract Infections

Colistimethate sodium (Coly-Mycin) was used in the treatment of 17 patients: 13 had urinary tract infections (two of these had positive blood cultures), three had respiratory tract infections, and one patient had both urinary and respiratory tract infections. In nine of the 17 a foreign body-either a carcinoma, a catheter, or a stone-complicated the infection.The dosage used was 1.1-2.3 mg./lb./day with a maximum in one case of 2.4 g. given over an eight-day period. The organisms so treated included Pseudomonas, six; Aerobacter, six and E. coli, two. Both Pseudomonas and Aerobacter were encountered in three cases.On bacteriological grounds, six patients were cured, eight relapsed, and in three the infecting agent was replaced by another organism. The best responses were obtained in those patients with Pseudomonas infection. Side effects included nausea, vomiting, vertigo, paresthesias, and pain at the site of injection.Colistimethate sodium has a place in the treatment of Gram-negative infections excluding Proteus organisms.

Topics: Colistin; Drug Therapy; Enterobacter; Escherichia coli; Escherichia coli Infections; Geriatrics; Humans; Proteus; Pseudomonas Infections; Respiratory Tract Infections; Toxicology; Urinary Tract Infections

Topics: Adolescent; Anti-Bacterial Agents; Colistin; Drug Therapy; Geriatrics; Glomerulonephritis; Humans; Kidney Failure, Chronic; Kidney Function Tests; Pyelonephritis; Toxicology; Urinary Tract Infections

Topics: Anti-Bacterial Agents; Antibiotics, Antitubercular; Blood Chemical Analysis; Colistin; Humans; Kanamycin; Kidney; Polymyxins; Toxicology; Urea; Uremia; Urinary Tract Infections; Urine

Topics: Anti-Bacterial Agents; Bacteriological Techniques; Bacteriuria; Colistin; Enterobacteriaceae; Escherichia coli Infections; Klebsiella; Proteus Infections; Pseudomonas; Pseudomonas Infections; Staphylococcal Infections; Streptococcal Infections; Urinary Tract Infections; Urine

Topics: Anti-Bacterial Agents; Chloramphenicol; Colistin; Drug Resistance, Microbial; Enterobacteriaceae; Humans; Kanamycin; Neomycin; Novobiocin; Streptomycin; Tetracycline; Urinary Tract Infections

Topics: Colistin; Drug Therapy; Humans; Proteus; Proteus Infections; Sulfisoxazole; Urinary Tract Infections

Topics: Alcaligenes; Anti-Bacterial Agents; Chloramphenicol; Colistin; Diabetes Mellitus; Enterobacteriaceae; Escherichia coli Infections; Female; Humans; Kanamycin; Klebsiella; Neomycin; Nitrofurantoin; Novobiocin; Penicillins; Polymyxins; Proteus Infections; Staphylococcal Infections; Streptomycin; Sulfonamides; Tetracycline; Urinary Tract Infections

Topics: Abortion, Septic; Bacteremia; Chloramphenicol; Cholangitis; Colistin; Escherichia coli Infections; Gastroenteritis; Hydrocortisone; Kanamycin; Polymyxins; Prognosis; Sepsis; Shock, Septic; Streptomycin; Urinary Tract Infections

Topics: Abscess; Cellulitis; Colistin; gamma-Globulins; Humans; Infections; Leukemia; Leukemia, Lymphoid; Leukemia, Myeloid; Methicillin; Neoplasms; Pharmacology; Pneumonia; Prednisone; Sepsis; Sinusitis; Statistics as Topic; Urinary Tract Infections

Topics: Anti-Bacterial Agents; Bacitracin; Chloramphenicol; Colistin; Drug Resistance; Drug Resistance, Microbial; Drug Therapy; Erythromycin; Humans; Kanamycin; Neomycin; Nitrofurantoin; Novobiocin; Penicillins; Polymyxins; Streptomycin; Tetracycline; Urinary Tract Infections; Vancomycin; Viomycin

Topics: Aging; Angiotensins; Bacteremia; Bacteroides; Chloramphenicol; Colistin; Drug Therapy; Enterobacter aerogenes; Escherichia coli Infections; Humans; Iatrogenic Disease; Kanamycin; Metaraminol; Polymyxins; Postoperative Complications; Proteus; Pseudomonas Infections; Sepsis; Sex; Streptomycin; Sympatholytics; Tetracycline; Urinary Tract Infections

Topics: Colistin; Drug Therapy; Escherichia coli Infections; Humans; Meningitis; Pseudomonas aeruginosa; Pseudomonas Infections; Urinary Tract Infections

Topics: Colistin; Drug Therapy; Humans; Urinary Tract Infections

Topics: Colistin; Drug Therapy; Humans; Penicillins; Urinary Tract Infections

Topics: Colistin; Enterobacter; Escherichia coli Infections; Klebsiella; Pseudomonas Infections; Urinary Tract Infections

Topics: Colistin; Humans; Pseudomonas Infections; Urinary Tract Infections

Topics: Biomedical Research; Colistin; Humans; Urinary Tract Infections

Topics: Colistin; Humans; Pseudomonas Infections; Urinary Tract Infections

Topics: Colistin; Enterobacter aerogenes; Enterobacteriaceae Infections; Humans; Klebsiella; Paraplegia; Toxicology; Urinary Tract Infections

Topics: Colistin; Enterobacter aerogenes; Enterococcus faecalis; Escherichia coli Infections; Hospitals, General; Humans; Proteus Infections; Pseudomonas aeruginosa; Pseudomonas Infections; Staphylococcal Infections; Streptococcal Infections; Urinary Tract Infections

Topics: Colistin; Cystitis; Escherichia coli Infections; Humans; Male; Prostatic Hyperplasia; Urinary Calculi; Urinary Tract Infections; Urology

Topics: Anti-Bacterial Agents; Colistin; Ethnicity; Gastroenteritis; Humans; Infections; Urinary Tract Infections

Topics: Anti-Bacterial Agents; Colistin; Escherichia coli Infections; Humans; Kidney; Kidney Diseases; Urinary Tract Infections

Topics: Animals; Anti-Bacterial Agents; Colistin; Furunculosis; Otitis Media; Urinary Tract Infections

Topics: Anti-Bacterial Agents; Colistin; Urinary Tract Infections

Topics: Anti-Bacterial Agents; Colistin; Communicable Diseases; Escherichia coli Infections; Humans; Urinary Tract Infections

Topics: Anti-Bacterial Agents; Colistin; Gastrointestinal Diseases; Penicillins; Surgical Procedures, Operative; Urinary Tract Infections

Topics: Anti-Bacterial Agents; Colistin; Female; Genitalia; Genitalia, Female; Gynecology; Humans; Obstetrics; Penicillins; Postoperative Complications; Urinary Tract Infections

Topics: Anti-Bacterial Agents; Colistin; Humans; Urinary Tract Infections; Urology

Topics: Anti-Bacterial Agents; Colistin; Female; Humans; Pregnancy; Pregnancy Complications; Urinary Tract Infections

Topics: Anti-Bacterial Agents; Antibiotics, Antitubercular; Colistin; Gastrointestinal Diseases; Humans; Otitis Media; Urinary Tract Infections

Topics: Anti-Bacterial Agents; Colistin; Humans; Urinary Tract Infections