phenylephrine-hydrochloride and Enterobacteriaceae-Infections

Topics: Adult; Cellulitis; Community-Acquired Infections; Enterobacter cloacae; Enterobacteriaceae Infections; Female; Humans; Nose

The draft genome sequences of two Enterobacter aerogenes strains (HN503E2II and PN108E5IIB) isolated from two Cameroonian abattoirs are reported.. Bacterial genomic DNA of the two isolates was sequenced using an Illumina MiSeq platform. Generated reads were de novo assembled using CLC Genomics Workbench and SPAdes. The assembled contigs were annotated, and antibiotic resistance genes, virulence factors and plasmids were identified.. Whole-genome sequencing revealed that both strains were similar, with genomes of 4878638bp and 4794257bp, encoding several resistance genes associated with resistance to β-lactams, fluoroquinolones, aminoglycosides, fosfomycin, phenicols, sulphonamides, trimethoprim, macrolides and tetracycline. In silico analysis also revealed chromosomal integration of one plasmid in the genome of PN108E5IIB.. The genome sequences reported here will provide useful information for a better understanding of the genetic structure of E. aerogenes in Africa.

Topics: Abattoirs; Animals; Anti-Bacterial Agents; beta-Lactamases; Cameroon; DNA, Bacterial; Drug Resistance, Multiple, Bacterial; Enterobacter aerogenes; Enterobacteriaceae Infections; Female; Genome, Bacterial; Humans; Microbial Sensitivity Tests; Nose; Plasmids; Swine; Virulence Factors; Whole Genome Sequencing

Methicillin-resistant Staphylococcus aureus (MRSA) and extended-spectrum β-lactamase (ESBL) producing enterobacteria (ESBL-E) have emerged in livestock. This study prospectively investigates the prevalence of MRSA and ESBL-E on pig farms and in nasal and stool samples from farmers and compares molecular characteristics of these ESBL-E isolates. In 2014, samples were derived at 51 pig farms in Germany. Per farm, five dust and five fecal samples were collected; one nasal and one stool sample were retrieved from farmers. ESBL-E isolates from humans and environmental isolates from the respective farms were characterized using whole genome sequencing for classical multilocus sequence typing (MLST), determination of ESBL-encoding genes and an ad hoc core genome MLST (cgMLST) analysis. MRSA and ESBL-E were detected on 49 (96%) and 31 (61%) of the farms, respectively; in most cases (59%) simultaneously. Nasal MRSA carriage was detected in 72 of 85 (84.7%) farmers and five of 84 (6.0%) farmers carried ESBL-E. ESBL-Escherichia coli isolates from farmers belonged to MLST STs/ESBL-genes ST10/CTX-M-1, ST196/TEM-52, ST278/TEM-52, ST410/CTX-M-15 and ST453/CTX-M-1. In one case, the human ESBL-E isolate was clonally identical to isolates from the farm environment; in the other four cases typing results indicated potential exchange of resistance determinants between human and environmental isolates, but, comparing the isolates within a minimum spanning tree indicated differences in cgMLST-patterns between the farms (p=0.076). This study demonstrated rectal ESBL-E carriage rates among farmers, which were similar to those in the general population. Molecular typing suggested that cross-transmission between the farmers and the farm environment is possible.

Topics: Animals; Bacterial Typing Techniques; beta-Lactamases; Enterobacteriaceae; Enterobacteriaceae Infections; Escherichia coli; Farmers; Farms; Feces; Female; Germany; Humans; Male; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Multilocus Sequence Typing; Nose; Prospective Studies; Staphylococcal Infections; Swine; Swine Diseases

Inflammatory bowel disease (IBD) patients may be at increased risk of acquiring antibiotic-resistant organisms (ARO). We sought to determine the prevalence of colonization of methicillin-resistant Staphylococcus aureus (MRSA), Enterobacteriaceae containing extended spectrum beta-lactamases (ESBL), and vancomycin-resistant enterococi (VRE) among ambulatory IBD patients.. We recruited consecutive IBD patients from clinics (n=306) and 3 groups of non-IBD controls from our colon cancer screening program (n=67), the family medicine clinic (n=190); and the emergency department (n=428) from the same medical center in Toronto. We obtained nasal and rectal swabs for MRSA, ESBL, and VRE and ascertained risk factors for colonization.. Compared to non-IBD controls, IBD patients had similar prevalence of colonization with MRSA (1.5% vs. 1.6%), VRE (0% vs. 0%), and ESBL (9.0 vs. 11.1%). Antibiotic use in the prior 3 months was a risk factor for MRSA (OR, 3.07; 95% CI: 1.10-8.54), particularly metronidazole. Moreover, gastric acid suppression was associated with increased risk of MRSA colonization (adjusted OR, 7.12; 95% CI: 1.07-47.4). Predictive risk factors for ESBL included hospitalization in the past 12 months (OR, 2.04, 95% CI: 1.05-3.95); treatment with antibiotics it the past 3 months (OR, 2.66; 95% CI: 1.37-5.18), particularly prior treatment with vancomycin or cephalosporins.. Ambulatory IBD patients have similar prevalence of MRSA, ESBL and VRE compared to non-IBD controls. This finding suggests that the increased MRSA and VRE prevalence observed in hospitalized IBD patients is acquired in-hospital rather than in the outpatient setting.

Topics: Adult; Aged; Ambulatory Care; Anti-Bacterial Agents; beta-Lactamases; Carrier State; Cephalosporins; Enterobacteriaceae; Enterobacteriaceae Infections; Enterococcus; Female; Histamine H2 Antagonists; Hospitalization; Humans; Inflammatory Bowel Diseases; Logistic Models; Male; Methicillin-Resistant Staphylococcus aureus; Metronidazole; Middle Aged; Nose; Prevalence; Proton Pump Inhibitors; Rectum; Risk Factors; Staphylococcal Infections; Vancomycin; Vancomycin Resistance; Young Adult

The risk of acquisition of antibiotic resistant-bacteria during or shortly after antibiotic therapy is still unclear and it is often confounded by scarce data on antibiotic usage.Primary objective of the study is to compare rates of acquisition of methicillin-resistant Staphylococcus aureus and extended spectrum beta-lactamase-producing Enterobacteriaceae in hospitalised patients, after starting antibiotic therapy.. The study, running in three European hospitals, is a multicenter, prospective, longitudinal, observational cohort study funded from the European Community's Seventh Framework Programme [FP7/2007-2013] within the project 'Impact of Specific Antibiotic Therapies on the prevalence of hUman host ResistaNt bacteria' (acronym SATURN). Nasal and rectal screening for methicillin-resistant Staphylococcus aureus and extended spectrum beta-lactamase-producing Enterobacteriaceae will be obtained at hospital admission, discharge, at antibiotic start (t0, within one hour) and at the following intervals: day 3 (t1), 7 (t2), 15 (t3), and 30 (t4). Two nested case-control studies will be performed. The objective of the first study will be to define individual level of risk related to specific antibiotics. Patients acquiring methicillin-resistant Staphylococcus aureus and extended spectrum beta-lactamase-producing Enterobacteriaceae (cases) will be compared with patients not acquiring antibiotic-resistant strains after starting antibiotic therapy (controls; ratio 1:4). To define the impact of antibiotics on new acquisition of target antibiotic-resistant bacteria, a second nested case-control study will be done (ratio 1:4). Control group will be selected among patients not receiving antibiotics, admitted in the same ward on the day of the corresponding case, with negative cultures at admission. Epidemiological, clinical and microbiological data will be prospective collected.. The rationale of this study is to better understand the impact of antibiotic use on acquisition, selection and transmission of antimicrobial resistant-bacteria in European hospitals.. ClinicalTrials.gov NCT01208519.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; beta-Lactamases; Case-Control Studies; Child; Child, Preschool; Cross Infection; Drug Utilization; Enterobacteriaceae; Enterobacteriaceae Infections; Europe; Feces; Female; Hospitals; Humans; Infant; Infant, Newborn; Longitudinal Studies; Male; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Nose; Prevalence; Prospective Studies; Staphylococcal Infections; Young Adult

To determine the rates of and risk factors for carriage and acquisition of extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae during hospitalization.. Cohort study.. Shaare Zedek Medical Center, a 550-bed teaching hospital.. During a 5-month period (February 1-June 30, 2004), 167 (8%) of 1,985 newly admitted general medical patients were enrolled in our study. Nasal, oropharyngeal, and rectal swab specimens were obtained at admission and every 2-3 days until hospital discharge or death. Enterobacteriaceae isolates were tested for ESBL, and Staphylococcus aureus isolates were tested for methicillin resistance.. Of the 167 patients enrolled in our study, 15 (9%) were identified as nasal carriers of methicillin-resistant S. aureus (MRSA) at admission, and 13 (8%) were rectal carriers of ESBL-producing Enterobacteriaceae at admission. Univariate risk factors for rectal carriage of ESBL-producing Enterobacteriaceae included female sex (odds ratio [OR], 11 [95% confidence interval {CI}, 1.4-238]; P < .05), nursing home residence (OR, 6.9 [95% CI, 1.8-27]; P < .01), recent antibiotic treatment (OR, 9.8 [95% CI, 1.7-74]; P < .05), and concomitant nasal carriage of MRSA and/or ESBL-producing Enterobacteriaceae (OR, 5.8 [95% CI, 1.2-26]; P < .01). Multivariate risk factors were female sex and recent antibiotic treatment. During hospitalization, 35 (21%) of 167 patients had acquired rectal carriage of ESBL-producing Enterobacteriaceae (P = .002, for trend analysis). Of the 12 patients who were still in the hospital 2 weeks after admission, 4 (33%) were carriers of ESBL-producing Enterobacteriaceae. Univariate risk factors for acquisition included an age of older than 65 years (P < .005), nursing home residence (OR 2.6, [95% CI, 0.98-2.6]), impaired cognition (OR, 4.8 [95% CI, 1.9-12]), recent antibiotic treatment (OR, 2.7 [95% CI, 0.9-8.3]), respiratory assistance (OR, 4.2 [95% CI, 1.2-14]), and prolonged hospitalization. Multivariate risk factors were an age of older than 65 years and broad-spectrum antibiotic therapy.. Rectal carriage of ESBL-producing Enterobacteriaceae occurred in 13 (8%) of 167 patients at admission to the medical departments of our hospital and in 4 (33%) of 12 patients still remaining in our hospital after 2 weeks.

Topics: Aged; Aged, 80 and over; Anti-Bacterial Agents; beta-Lactamases; Carrier State; Enterobacteriaceae; Enterobacteriaceae Infections; Female; Hospitalization; Humans; Israel; Male; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Nose; Rectum; Risk Factors; Staphylococcal Infections

We performed a prospective observational cohort study of the epidemiology and etiology of nosocomial pneumonia in 358 medical ICU patients in two university-affiliated hospitals. Protected bronchoscopic techniques (protected specimen brush and bronchoalveolar lavage) were used for diagnosis to minimize misclassification. Risk factors for ventilator-associated pneumonia were identified using multiple logistic regression analysis. Twenty-eight cases of pneumonia occurred in 358 patients for a cumulative incidence of 7.8% and incidence rates of 12.5 cases per 1, 000 patient days and 20.5 cases per 1,000 ventilator days. Staphylococcus aureus, Streptococcus pneumoniae, Pseudomonas aeruginosa, and Hemophilus species made up 65% of isolates from the lower respiratory tract, whereas only 12.5% of isolates were enteric gram-negative bacilli. Daily surveillance cultures of the nares, oropharynx, trachea, and stomach demonstrated that tracheal colonization preceded ventilator-associated pneumonia in 93.5%, whereas gastric colonization preceded tracheal colonization for only four of 31 (13%) eventual pathogens. By multiple logistic regression, independent risk factors for ventilator- associated pneumonia were admission serum albumin <= 2.2 g/dl (odds ratio [OR] 5.9; 95% confidence interval [CI] 2.0-17.6; p = 0.0013), maximum positive end-expiratory pressure >= 7.5 cm H2O (OR, 4.6; 95% CI, 1.4 to 15.1; p = 0.012), absence of antibiotic therapy (OR, 6.7; 95% CI, 1.8 to 25.3; p = 0.0054), colonization of the upper respiratory tract by respiratory gram-negative bacilli (OR, 3.4; 95% CI, 1.1 to 10.1; p = 0.028), pack-years of smoking (OR, 2.3 for 50 pack-years; 95% CI, 1. 2 to 4.2; p = 0.012), and duration of mechanical ventilation (OR, 3. 4 for 14 d; 95% CI, 1.5 to 7.8; p = 0.0044). Several of these risk factors for ventilator-associated pneumonia appear amenable to intervention.

Topics: Anti-Bacterial Agents; Bronchoalveolar Lavage; Bronchoscopes; Bronchoscopy; Cohort Studies; Confidence Intervals; Critical Care; Cross Infection; Enterobacteriaceae; Enterobacteriaceae Infections; Haemophilus Infections; Humans; Incidence; Logistic Models; Nose; Odds Ratio; Oropharynx; Pneumonia, Bacterial; Pneumonia, Pneumococcal; Pneumonia, Staphylococcal; Positive-Pressure Respiration; Prospective Studies; Pseudomonas aeruginosa; Pseudomonas Infections; Risk Factors; Serum Albumin; Smoking; Stomach; Tennessee; Time Factors; Trachea; Ventilators, Mechanical

Augmentation rhinoplasty has become a popular plastic operation in Asia. In Korea most surgeons prefer using silicone rubber prosthesis instead of autogenous material. The authors have used the standard shaped silicone prosthesis, boat-shaped and also L-shaped prostheses. The standard shape prosthesis has less extrusion and fixation problems. In over 1,500 cases, there were 357 complications (20.8%). All the complications were due to the silicone prosthesis acting as a foreign body or failure in design of implant or unskillful operative technique. In order to minimise complications, care should be taken to use the proper size of prosthesis, the correct shape of implant and to ensure that there is adequate undermining and meticulous closure technique. To minimise the overlying skin tension at the tip and on the dorsum of the nose, the cutting of the depressor septi nasi muscle and transverse part of the nasalis muscle are recommended. In this review, we report the types and incidence of complications by analysing the cases seen during the past 10 years in our Unit and offer a few solutions to overcome these complications.

Topics: Asian People; Cerebrospinal Fluid Rhinorrhea; Enterobacteriaceae Infections; Epistaxis; Erythema; Humans; Korea; Nose; Postoperative Complications; Prostheses and Implants; Rhinoplasty; Serratia marcescens; Silicone Elastomers; Staphylococcal Infections; Staphylococcus aureus; Surgical Wound Infection; Time Factors

Nasal swabs from 62 villagers of Kalauna, Goodenough Island were cultured. Streptococcus pneumoniae was isolated from 16 of 25 adults (64%) and 36 of 37 children (97%). Significant regional clustering of prevalent pneumococcal serotypes were seen among families in core hamlets. Five of 20 adults (20%) and 30 of 37 children (81%) grew Haemophilus influenzae all of which were biotypable. A variety of faecal Gram negative bacilli comprising enterobacteria, Alcaligenes species and an aeromonad were isolated from 30 of 62 (48%) swabs.

Topics: Alcaligenes; Bacterial Infections; Carrier State; Enterobacteriaceae Infections; Haemophilus Infections; Haemophilus influenzae; Humans; Nose; Papua New Guinea; Pneumococcal Infections

Topics: Adolescent; Adult; Aged; Enterobacteriaceae Infections; Escherichia coli; Female; Humans; Male; Middle Aged; Nose; Paranasal Sinuses; Proteus; Sinusitis; Staphylococcal Infections; Staphylococcus; Streptococcal Infections; Streptococcus pyogenes

In order to elucidate some of the factors responsible for the high rate of nosocomial infection associated with neonatal intensive care, we studied bacterial colonization in 63 infants admitted to a neonatal intensive care unit. In a six-month period, cultures of nose, throat, umbilicus, and stool were obtained on admission and every three days from all infants staying in the NICU greater than or equal to 3 days. Study infants did not develop "normal" aerobic flora. Forty-eight percent of infants grew Escherichia coli from stool, but 52% had stool colonization with Klebsiella, Enterobacter, or Citrobacter, the only other Enterobacteriaceae encountered. KEC were also isolated from throat, nose, and umbilicus in 22%, 22%, and 24% of patients, respectively. The risk of stool colonization with KEC increased with duration of hospitalization: 2% of infants were colonized on admission, 60% after 15 days, and 91% after 30 days. Stool colonization with E. coli seemed to protect infants from colonization with other gram-negative bacilli. Thirteen of 20 infants, however, developed pharyngeal GNB colonization in spite of pre-existing abundant growth of alpha streptococci. Antibiotic therapy for greater than 3 days was associated with the isolation of KEC in stool and GNB in the throat, but birth weight less than 2,500 gm and lack of breast milk feedings were not.

Topics: Boston; Citrobacter; Cross Infection; Enterobacter; Enterobacteriaceae Infections; Escherichia coli; Feces; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Intensive Care Units; Klebsiella; Nose; Pharynx; Pregnancy; Umbilicus