In vitro antimicrobial susceptibility of staphylococci isolated from dogs with otitis externa

Multifaktöriyel bir hastalık olan otitisin etiyolojisinde, çeşitli bakteriler de rol oynamaktadır. Hastalığın etkin tedavisinde etiyolojinin bilinmesi ve antimikrobiyal duyarlılık testleri önem arz etmektedir. Bu çalışmada, otitis eksternalı köpeklerden alınan örneklerde stafilokok türlerinin izolasyonu ve izolatların çeşitli antimikrobiyal maddelere in vitro duyarlılıklarının saptanması amaçlandı. Yaşları 3 ay ile 10 yıl arasında değişen, 12 farklı köpek ırkına ait 13’ü (%31.7) dişi, 28’i (%68.3) erkek olmak üzere toplam 41 adet köpekten alınan 82 adet kulak svap örneği materyal olarak kullanıldı. Köpeklerin 30 (%73.17) adetinden bakteriyel bir etken izole edilirken, 11 (%26.83) adet köpeğe ait örneklerde ise üreme olmadı. Kültür pozitif 30 adet köpeğin 24 (%80) adetinden stafilokok cinsine ait bakteriler izole edildi. Bu hayvanların 7 (%29.1) adetinden Staphylococcus aureus, 6 (%25) adetinden S. schleiferi subsp. schleiferi, 5 (%20.8) adetinden koagulaz negatif stafilokoklar (KNS), 4 (%16.6) adetinden S. haemolyticus ve 2 (%8.3) adetinden ise S. epidermidis izole edildi. İzolatların antimikrobiyal duyarlılıkları değerlendirildiğinde, S. aureus suşlarının tamamının sefoperazon/sulbaktam ve sefolatine karşı duyarlı olduğu, S. schleiferi subsp. schleiferi suşlarının ise %83.3’ünün tobramisine dirençli olduğu belirlendi. İzolatlarının %40’ında çoklu antibiyotik dirençliliği belirlenirken, %44’ünde ise metisilin dirençliliği saptandı. Sonuç olarak bu çalışmada, i) S. schleiferi subsp. schleiferi’nin köpeklerdeki otitis eksterna vakalarının primer bakteriyel etkenlerinden biri olabileceği, ii) otitis eksternalı köpeklerin insanlar, hayvanlar ve çevreye gerek çoklu antibiyotik dirençli gerekse metisilin dirençli stafilokok türlerini bulaştırma potansiyeline sahip olabilecekleri düşünüldü.Otitis is a multifactorial disease and various bacteria play role in its etiology. It is important to determine the etiologic agents and perform antimicrobial susceptibility tests for the effective treatment of the disease. In this study, it was aimed to isolate Staphylococcus species from ear samples taken from dogs with otitis externa and to determine their in vitro antimicrobial susceptibility to various antimicrobial agents. A total of 82 ear swap samples from 41 dogs, 13 (31.7%) females and 28 (68.3%) males, belonging to 12 different dog breeds, aged between 3 months and 10 years, were used. While a bacterial agent was isolated from 30 (73.17%) dogs, there was no growth in 11 (26.83%). Staphylococcus species were isolated from 24 (80%) out of 30 culture positive dogs. From those 24 dogs, Staphylococcus aureus from 7 (29.1%), S. schleiferi subsp. schleiferi from 6 (25%), coagulase negative staphylococcus (CNS) from 5 (20.8%), S. haemolyticus from 4 (16.6%) and S. epidermidis from 2 (8.3%) were isolated. In vitro antimicrobial susceptibility of the isolates obtained in the study was evaluated, and it was determined that all S. aureus strains were susceptible to cefoperazone/sulbactam and cephalothin, and 83.3% of S. schleiferi subsp. schleiferi strains were resistant to tobramycin. Multi-antibiotic resistance was determined in 40% of Staphylococcus species, while methicillin resistance was found to be 44%. As a result of the study, i) S. schleiferi subsp. schleiferi may be the primary bacterial agents of otitis externa cases in dogs, ii) dogs with otitis externa have the potential to transmit both multi-antibiotic resistant and methicillin resistant Staphylococcus species to humans, other animals and the environment

Spontaneous Breathing in Early Acute Respiratory Distress Syndrome: Insights From the Large Observational Study to UNderstand the Global Impact of Severe Acute Respiratory FailurE Study

OBJECTIVES: To describe the characteristics and outcomes of patients with acute respiratory distress syndrome with or without spontaneous breathing and to investigate whether the effects of spontaneous breathing on outcome depend on acute respiratory distress syndrome severity. DESIGN: Planned secondary analysis of a prospective, observational, multicentre cohort study. SETTING: International sample of 459 ICUs from 50 countries. PATIENTS: Patients with acute respiratory distress syndrome and at least 2 days of invasive mechanical ventilation and available data for the mode of mechanical ventilation and respiratory rate for the 2 first days. INTERVENTIONS: Analysis of patients with and without spontaneous breathing, defined by the mode of mechanical ventilation and by actual respiratory rate compared with set respiratory rate during the first 48 hours of mechanical ventilation. MEASUREMENTS AND MAIN RESULTS: Spontaneous breathing was present in 67% of patients with mild acute respiratory distress syndrome, 58% of patients with moderate acute respiratory distress syndrome, and 46% of patients with severe acute respiratory distress syndrome. Patients with spontaneous breathing were older and had lower acute respiratory distress syndrome severity, Sequential Organ Failure Assessment scores, ICU and hospital mortality, and were less likely to be diagnosed with acute respiratory distress syndrome by clinicians. In adjusted analysis, spontaneous breathing during the first 2 days was not associated with an effect on ICU or hospital mortality (33% vs 37%; odds ratio, 1.18 [0.92-1.51]; p = 0.19 and 37% vs 41%; odds ratio, 1.18 [0.93-1.50]; p = 0.196, respectively ). Spontaneous breathing was associated with increased ventilator-free days (13 [0-22] vs 8 [0-20]; p = 0.014) and shorter duration of ICU stay (11 [6-20] vs 12 [7-22]; p = 0.04). CONCLUSIONS: Spontaneous breathing is common in patients with acute respiratory distress syndrome during the first 48 hours of mechanical ventilation. Spontaneous breathing is not associated with worse outcomes and may hasten liberation from the ventilator and from ICU. Although these results support the use of spontaneous breathing in patients with acute respiratory distress syndrome independent of acute respiratory distress syndrome severity, the use of controlled ventilation indicates a bias toward use in patients with higher disease severity. In addition, because the lack of reliable data on inspiratory effort in our study, prospective studies incorporating the magnitude of inspiratory effort and adjusting for all potential severity confounders are required

Identifying associations between diabetes and acute respiratory distress syndrome in patients with acute hypoxemic respiratory failure: an analysis of the LUNG SAFE database

Background: Diabetes mellitus is a common co-existing disease in the critically ill. Diabetes mellitus may reduce the risk of acute respiratory distress syndrome (ARDS), but data from previous studies are conflicting. The objective of this study was to evaluate associations between pre-existing diabetes mellitus and ARDS in critically ill patients with acute hypoxemic respiratory failure (AHRF). Methods: An ancillary analysis of a global, multi-centre prospective observational study (LUNG SAFE) was undertaken. LUNG SAFE evaluated all patients admitted to an intensive care unit (ICU) over a 4-week period, that required mechanical ventilation and met AHRF criteria. Patients who had their AHRF fully explained by cardiac failure were excluded. Important clinical characteristics were included in a stepwise selection approach (forward and backward selection combined with a significance level of 0.05) to identify a set of independent variables associated with having ARDS at any time, developing ARDS (defined as ARDS occurring after day 2 from meeting AHRF criteria) and with hospital mortality. Furthermore, propensity score analysis was undertaken to account for the differences in baseline characteristics between patients with and without diabetes mellitus, and the association between diabetes mellitus and outcomes of interest was assessed on matched samples. Results: Of the 4107 patients with AHRF included in this study, 3022 (73.6%) patients fulfilled ARDS criteria at admission or developed ARDS during their ICU stay. Diabetes mellitus was a pre-existing co-morbidity in 913 patients (22.2% of patients with AHRF). In multivariable analysis, there was no association between diabetes mellitus and having ARDS (OR 0.93 (0.78-1.11); p = 0.39), developing ARDS late (OR 0.79 (0.54-1.15); p = 0.22), or hospital mortality in patients with ARDS (1.15 (0.93-1.42); p = 0.19). In a matched sample of patients, there was no association between diabetes mellitus and outcomes of interest. Conclusions: In a large, global observational study of patients with AHRF, no association was found between diabetes mellitus and having ARDS, developing ARDS, or outcomes from ARDS. Trial registration: NCT02010073. Registered on 12 December 2013

Epidemiology and patterns of tracheostomy practice in patients with acute respiratory distress syndrome in ICUs across 50 countries

Background: To better understand the epidemiology and patterns of tracheostomy practice for patients with acute respiratory distress syndrome (ARDS), we investigated the current usage of tracheostomy in patients with ARDS recruited into the Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG-SAFE) study. Methods: This is a secondary analysis of LUNG-SAFE, an international, multicenter, prospective cohort study of patients receiving invasive or noninvasive ventilation in 50 countries spanning 5 continents. The study was carried out over 4 weeks consecutively in the winter of 2014, and 459 ICUs participated. We evaluated the clinical characteristics, management and outcomes of patients that received tracheostomy, in the cohort of patients that developed ARDS on day 1-2 of acute hypoxemic respiratory failure, and in a subsequent propensity-matched cohort. Results: Of the 2377 patients with ARDS that fulfilled the inclusion criteria, 309 (13.0%) underwent tracheostomy during their ICU stay. Patients from high-income European countries (n = 198/1263) more frequently underwent tracheostomy compared to patients from non-European high-income countries (n = 63/649) or patients from middle-income countries (n = 48/465). Only 86/309 (27.8%) underwent tracheostomy on or before day 7, while the median timing of tracheostomy was 14 (Q1-Q3, 7-21) days after onset of ARDS. In the subsample matched by propensity score, ICU and hospital stay were longer in patients with tracheostomy. While patients with tracheostomy had the highest survival probability, there was no difference in 60-day or 90-day mortality in either the patient subgroup that survived for at least 5 days in ICU, or in the propensity-matched subsample. Conclusions: Most patients that receive tracheostomy do so after the first week of critical illness. Tracheostomy may prolong patient survival but does not reduce 60-day or 90-day mortality. Trial registration: ClinicalTrials.gov, NCT02010073. Registered on 12 December 2013

Hyperoxemia and excess oxygen use in early acute respiratory distress syndrome : Insights from the LUNG SAFE study

Publisher Copyright: © 2020 The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Background: Concerns exist regarding the prevalence and impact of unnecessary oxygen use in patients with acute respiratory distress syndrome (ARDS). We examined this issue in patients with ARDS enrolled in the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study. Methods: In this secondary analysis of the LUNG SAFE study, we wished to determine the prevalence and the outcomes associated with hyperoxemia on day 1, sustained hyperoxemia, and excessive oxygen use in patients with early ARDS. Patients who fulfilled criteria of ARDS on day 1 and day 2 of acute hypoxemic respiratory failure were categorized based on the presence of hyperoxemia (PaO2 > 100 mmHg) on day 1, sustained (i.e., present on day 1 and day 2) hyperoxemia, or excessive oxygen use (FIO2 ≥ 0.60 during hyperoxemia). Results: Of 2005 patients that met the inclusion criteria, 131 (6.5%) were hypoxemic (PaO2 < 55 mmHg), 607 (30%) had hyperoxemia on day 1, and 250 (12%) had sustained hyperoxemia. Excess FIO2 use occurred in 400 (66%) out of 607 patients with hyperoxemia. Excess FIO2 use decreased from day 1 to day 2 of ARDS, with most hyperoxemic patients on day 2 receiving relatively low FIO2. Multivariate analyses found no independent relationship between day 1 hyperoxemia, sustained hyperoxemia, or excess FIO2 use and adverse clinical outcomes. Mortality was 42% in patients with excess FIO2 use, compared to 39% in a propensity-matched sample of normoxemic (PaO2 55-100 mmHg) patients (P = 0.47). Conclusions: Hyperoxemia and excess oxygen use are both prevalent in early ARDS but are most often non-sustained. No relationship was found between hyperoxemia or excessive oxygen use and patient outcome in this cohort. Trial registration: LUNG-SAFE is registered with ClinicalTrials.gov, NCT02010073publishersversionPeer reviewe

Geoeconomic variations in epidemiology, ventilation management, and outcomes in invasively ventilated intensive care unit patients without acute respiratory distress syndrome: a pooled analysis of four observational studies

Background: Geoeconomic variations in epidemiology, the practice of ventilation, and outcome in invasively ventilated intensive care unit (ICU) patients without acute respiratory distress syndrome (ARDS) remain unexplored. In this analysis we aim to address these gaps using individual patient data of four large observational studies. Methods: In this pooled analysis we harmonised individual patient data from the ERICC, LUNG SAFE, PRoVENT, and PRoVENT-iMiC prospective observational studies, which were conducted from June, 2011, to December, 2018, in 534 ICUs in 54 countries. We used the 2016 World Bank classification to define two geoeconomic regions: middle-income countries (MICs) and high-income countries (HICs). ARDS was defined according to the Berlin criteria. Descriptive statistics were used to compare patients in MICs versus HICs. The primary outcome was the use of low tidal volume ventilation (LTVV) for the first 3 days of mechanical ventilation. Secondary outcomes were key ventilation parameters (tidal volume size, positive end-expiratory pressure, fraction of inspired oxygen, peak pressure, plateau pressure, driving pressure, and respiratory rate), patient characteristics, the risk for and actual development of acute respiratory distress syndrome after the first day of ventilation, duration of ventilation, ICU length of stay, and ICU mortality. Findings: Of the 7608 patients included in the original studies, this analysis included 3852 patients without ARDS, of whom 2345 were from MICs and 1507 were from HICs. Patients in MICs were younger, shorter and with a slightly lower body-mass index, more often had diabetes and active cancer, but less often chronic obstructive pulmonary disease and heart failure than patients from HICs. Sequential organ failure assessment scores were similar in MICs and HICs. Use of LTVV in MICs and HICs was comparable (42\ub74% vs 44\ub72%; absolute difference \u20131\ub769 [\u20139\ub758 to 6\ub711] p=0\ub767; data available in 3174 [82%] of 3852 patients). The median applied positive end expiratory pressure was lower in MICs than in HICs (5 [IQR 5\u20138] vs 6 [5\u20138] cm H2O; p=0\ub70011). ICU mortality was higher in MICs than in HICs (30\ub75% vs 19\ub79%; p=0\ub70004; adjusted effect 16\ub741% [95% CI 9\ub752\u201323\ub752]; p&lt;0\ub70001) and was inversely associated with gross domestic product (adjusted odds ratio for a US$10 000 increase per capita 0\ub780 [95% CI 0\ub775\u20130\ub786]; p&lt;0\ub70001). Interpretation: Despite similar disease severity and ventilation management, ICU mortality in patients without ARDS is higher in MICs than in HICs, with a strong association with country-level economic status. Funding: No funding

The role of FNR like proteins (FLP) in Lactococcus lactis

Available from British Library Document Supply Centre- DSC:DXN057029 / BLDSC - British Library Document Supply CentreSIGLEGBUnited Kingdo

Expression of dar gene in lactic acid bacteria and effect on metabolite formation in feta-type cheese quality

The dar gene from Lactococcus lactis subsp. cremoris MG1363, encoding the enzyme diacetyl reductase (DAR) was cloned into the expression vector pMG36e under the control of the P32 promoter, and Lc. lactis MG1363 was transformed with this recombinant plasmid by electroporation. Metabolic end products (e. g., pyruvate, lactate, formate, acetoin) of this strain grown in glucose medium were analyzed by HPLC. The overexpression of the plasmid-encoded dar gene in Lc. lactis MG1363 led to the shift from homolactic to mixed acid fermentation and the production of a high level of acetoin, confirming the overexpression of the diacetyl reductase. In addition, the strains overexpressing dar gene and wild type were used as starter cultures in cheese. Different levels of metabolic end products were detected in cheese during the two weeks of ripening compared to the wild type strain