Diarrhoea caused by Clostridium difficile in patients with postoperative subhepatic abscess

Background. Toxigenic strains of Clostridium difficile in the majority of cases cause disease of the intestinal tract of hospitalized patients. For a long time, Clostridium difficile was considered to produce both types of toxins (A+/B+ strain), however, the investigations conducted in the last ten years point to the existence of clinically significant isolates which produce only toxin B, i.e. toxin A negative / toxin B positive (A-/B+ strain) Clostridium difficile. Case report. We presented the case of a patient admitted to the Surgery Clinic, Clinical Center Nis due to the presence of calculus in the ductus choledochus. Twenty-four hours after the surgical intervention for calculus removal, the first signs of the operative wound infection began to appear. In the course of infection treatment, different antibiotics were administered (cefuroxine, ciprofloxacin, vancomycin, imipenem). After making etiological microbiological diagnosis and application of antibiotics according to antibiogram results, the signs of the operative wound infection began to withdraw, but the patient reported the abdominal pain and liquid stools with traces of blood (up to 17 stools per day). By microbiological examination, Clostridium difficile was cultivated and the presence of toxin B was detected in the stool samples. The patient was sent to the Clinic for Infectious Diseases, where the causal therapy of mitronidazol was administered. Liquid and electrolytes were made up by substitution therapy. After the eight-day-treatment, the patient felt much better, and diarrheas stopped on the 10th day of the therapy application. Conclusion. Our results have shown that toxingen strains Clostridium difficile are present in our country so this bacterium sort have to be considered in differential causal diagnosis of diarrhoea syndrom. Considering that it can cause difficult form of the disease, it is an obligation to establish the presence of some toxins of Clostridium difficile in stool samples of patients and/or production of some toxins in liquid culturate of isolates to provide data for the presence of strains which produce only toxin B

PRESENCE OF RESISTANCE IN CAMPYLOBACTER JEJUNI AND CAMPYLOBACTER COLI

There are 18 species belonging to the genus of Campylobacter (rRNK group I), of which thermophilic ones are the following: Campylobacter jejuni, Campylobacter coli, Campylobacter lari and Campylobacter upsaliensis. The aim of our research was to determine the sensitivity of Campylobacter species, isolated from human feces, to antibiotics being used in practice. The study involved 50 human strains of C. jejuni/coli isolated from feces in the Center for Microbiology in the Public Health Institute Nis. Sensitivity was tested by applying the disk diffusion method on seven antibiotics (erythromycin, gentamicin, tetracycline, ciprofloxacin, hloramphenicol, cephalexin and nalidixic acid). Our results showed low resistance to erythromycin, gentamicin and tetracycline (2%), which corresponds to the studies conducted in the world. Moreover, these findings indicate that erythromycin may be considered the drug of choice in the treatment of Campylobacter diarrhea in this region. Resistance to fluoroquinolone and nalidixic acid was 44%, and C. coli showed higher resistance compared to C. jejuni, though statistical significance was not proved

Antimicrobial susceptibility profiles of thermophilic campylobacters isolated from patients in the town of Niš

Background/Aim. In some clinical forms of human Campylobacter infections, such as prolonged diarrhea or associated with postinfections sequels, antibacterial treatment is necessary. The aim of the present study was to evaluate the antimicrobial susceptibility of thermophilic Campylobacter strains isolated from patients with diarrhea, as well as from patients with diarrhea followed by postinfections sequels, to drugs used in the therapy of enterocolitis, and to nalidixic acid used in laboratory identification and differentiation of thermophilic Campylobacter spp. Methods. We studied the antimicrobial susceptibility profiles of 131 Campylobacter strains isolated from patients with diarrhea (122 strains), diarrhea associated with rheumatic disorders (8 strains), and one strain isolated from a patient with Guillain-Barré Syndrome following Campylobacter enterocolitis. Susceptibility testing to erythromycin, gentamicin, tetracycline, chloramphenicol, ciprofloxacin and nalidixic acid was performed by the agar dilution method. Results. In the strains we investigated, resistance to gentamicin and chloramphenicol was not recorded, whereas a low rate of strains resistant to erythromycin (2.4%), a higher prevalence of strains resistant to tetracycline (9.9%), and a high level of resistance to ciprofloxacin (29.8%) and nalidixic acid (33.3%) were registered. All strains resistant to nalidixic acid were also resistant to ciprofloxacin. In addition, there was no difference in the occurrence of resistance between strains isolated from patients with diarrhea as compared to those isolated from patients with diarrhea followed by postinfection disorders. Conclusion. The fact that the most of Campylobacter strains were sensitive to erythromycin and all to gentamicin, makes erythromycin an antibiotic of choice in the treatment of Campylobacter diarrhea and gentamicin when parenteral therapy should be administered. Resistance to tetracycline and, especially, ciprofloxacin, necessitates antibiotic susceptibility testing

Successful isolation of Helicobacter pylori after prolonged incubation: A case report of prolonged incubation for H. pylori

The culture of Helicobacter pylori from a gastric biopsy is the “gold standard” in the diagnosis of H. pylori infection. However, the primary isolation of H. pylori from gastric biopsies is rather demanding. The duration of incubation for the isolation of H. pylori has been recommended to be five to seven days: in the present case, we found that a prolonged incubation period allowed the successful isolation of H. pylori from a patient with ulcus ventriculi. Biopsies were placed directly into transport medium and processed for culture within two hours. On day 14, one suspected H. pylori-like colony appeared on one of the plates. The isolate was confirmed to be H. pylori based on its typical colony morphology, negative Gram stain, and positive urease, catalase and oxidase tests. The isolate, requiring 14 days recovery, later exhibited the normal growth characteristics of H. pylori strains, indicating its unusually long incubation requirement was a temporary predicament

High-density cervical ureaplasma urealyticum colonization in pregnant women

Background/aim: Ureaplasma urealyticum, a common commensal of the female lower genital tract, has been observed as an important opportunistic pathogen during pregnancy. The aims of this study were to determine the degree of cervical colonization with U. urealyticum in pregnant women with risk pregnancy and in pregnant women with normal term delivery and to evaluate the correlation between high-density cervical U. urealyticum colonization and premature rupture of membranes (PROM) as well. Methods. This research was conducted on the samples comprising 130 hospitalized pregnant women with threatening preterm delivery and premature rupture of membranes. The control group consisted of 39 pregnant women with term delivery without PROM. In addition to standard bacteriological examination and performing direct immunofluorescence test to detect Chlamydia trachomatis, cervical swabs were also examined for the presence of U. urealyticum and Mycoplasma hominis by commercially available Mycofast Evolution 2 test (International Microbio, France). Results. The number of findings with isolated high-density U. urealyticum in the target group was 69 (53.08%), while in the control group was 14 (35.90%). Premature rupture of membranes (PROM) occurred in 43 (33.08%) examinees: 29 were pPROM, and 14 were PROM. The finding of U.urealyticum ≥104 was determined in 25 (58.14%) pregnant women with rupture, 17 were pPROM, and 8 were PROM. There was statistically significant difference in the finding of high-density U. urealyticum between the pregnant women with PROM and the control group (χ² = 4.06, p < 0.05). U. urealyticum was predominant bacterial species found in 62.79% of isolates in the PROM cases, while in 32.56% it was isolated alone. Among the 49 pregnant women with preterm delivery, pPROM occurred in 29 (59.18%) examinees, and in 70.83% of pregnant women with findings of high-density U. urealyticum pPROM was observed. Conclusion. Cervical colonization with U. urealyticum ≥ 104 is more frequent in pregnant women with risk pregnancy than in pregnant women with normal term delivery. High-density cervical U. urealyticum colonization should be observed as a possible etiological factor for PROM

An Investigation into the Influence of Experimental Conditions on In Vitro Drug Release from Immediate-Release Tablets of Levothyroxine Sodium and Its Relation to Oral Bioavailability

The aim of this study was to investigate the influence of experimental conditions on levothyroxine sodium release from two immediate-release tablet formulations which narrowly passed the standard requirements for bioequivalence studies. The in vivo study was conducted as randomised, single-dose, two-way cross-over pharmacokinetic study in 24 healthy subjects. The in vitro study was performed using various dissolution media, and obtained dissolution profiles were compared using the similarity factor value. Drug solubility in different media was also determined. The in vivo results showed narrowly passing bioequivalence. Considering that levothyroxine sodium is classified as Class III drug according to the Biopharmaceutics Classification System, drug bioavailability will be less sensitive to the variation in its dissolution characteristics and it can be assumed that the differences observed in vitro in some of investigated media probably do not have significant influence on the absorption process, as long as rapid and complete dissolution exists. The study results indicate that the current regulatory criteria for the value of similarity factor in comparative dissolution testing, as well as request for very rapid dissolution (more than 85% of drug dissolved in 15 min), are very restricted for immediate-release dosage forms containing highly soluble drug substance and need further investigation. The obtained results also add to the existing debate on the appropriateness of the current bioequivalence standards for levothyroxine sodium products

Prevalence of antimicrobial resistance in Campylobacter spp.: A review of the literature

Campylobacter spp. are commensal organisms in the intestinal tract of food producing and companion animals. There is an increasing trend of human campylobacteriosis worldwide, including complicated cases that request treatment by antibiotics. Prevalence of resistance continually increases, especially to fluoroquinolones and tetracyclines. There are many reports on multiresistant strains of Campylobacter spp. In this work we present the available information about the prevalence and antimicrobial resistance of Campylobacter spp. worldwide, as well as studies from Serbia published in last two decades. Campylobacter strains isolated from animal samples in Serbia showed increased prevalence of antimicrobial resistance to all clinically relevant antibiotics. Preliminary data (2014 2019) from Reference laboratory for Campylobacter and Helicobacter at the Institute of Public Health of Nis, Serbia show high resistance rates to ciprofloxacin (90%) and to tetracycline (50%) but low resistance to erythromycin (<5%) in human Campylobacter isolates

In vitro evaluation of antimicrobial activity of nano composite biomaterials based on hydroxyapatite

Antimicrobial materials based on hydroxyapatite are potentially attractive in a wide variety of medical and stomatological applications. The objective of this paper is to examine antimicrobic activity of cobalt-substituted calcium hydroxyapatite nanopowders and biphased calciumphosphate/ poli-lactide-co-glicolide. The antimicrobial effects of these substances (powders) against two pathogen bacterial strains- Escherichia coli (ATCC 25922) and Staphylococcus aureus (ATCC 25923) were tested by disc diffusion method and quantitative antimicrobial test in liquid medium. It was noted that the inhibition zone of the bacterial cells S. aureus around the sample of the Ca/Co- HAp, was a lot bigger compared to the inhibition zone of bacterial cells E. coli around the sample of the mentioned biomaterial, which means that this material has bigger antimicrobic activity on S. aureus, in relation to E. coli. Quantitative antimicrobial test in liquid medium demonstrate that cobalt-substituted calcium hydroxyapatite samples show viable cells reduction of both tested microorganisms. It may be concluded that nanoparticles of cobalt-substituted calcium hydoxyapatite nano-powders has a satisfactory antimicrobic activity according to the tested bacteria strain

SALMONELLA ENTERITIDIS – PHENOTYPIC AND GENOTYPIC

Today, Salmonella enterica subspecies enterica serovar Enteritidis (S. Enteritidis) represents one of the most common serotypes that causes enterocolitis. Since S. enteritidis identification methods are advanced permanently, the following phenotyping methods could be applied for this purpose: biotyping, phagotyping (phage typing – PT), and resistotyping. From methods for genotyping of S. Enteritidis, plasmid profile analysis (PP), restriction analysis of the virulence plasmid, ribotyping, pulsed field gel electrophoresis (PFGE), insertion sequences, polymerase chain reaction (PCR), random amplified polymorphic DNA analysis (RAPD) could be applied. On the one hand, S. Enteritidis expresses clearly homogenous structure which is reflected by domination of few phagotypes, presence of one plasmid profile in most of strains, merely three clonal lines, as well as a large number of electrophoretic types in a single dendrogram line. Insufficient discrimination of typing systems of S. Enteritidis suggests the introduction of new typing methods as well as improvement of the old ones

Survival of Campylobacter jejuni in chicken meat at frozen storage temperatures

The aim of this study was to determine the survival of Campylobacter jejuni in chicken meat samples at frozen temperatures and given length of incubation and to determine the impact of aerobic bacteria on the survival of C. jejuni. The chicken meat samples were inoculated with C. jejuni NCTC 11351 suspensions and stored in bags at temperatures of −20°C and −70°C. The mean value of C. jejuni from meat samples decreased from 7.52 log10 CFU/g after 30 minutes of incubation at ambient temperature, to 3.87 log10 CFU/g on the eighth week of incubation at −20°C, and to 3.78 log10 CFU/g at incubation at −70°C after the same incubation period. Both freezing temperatures, −20°C and −70°C, decreased the number of campylobacters. The presence of aerobic mesophilic bacteria did not influence the survival of C. jejuni in chicken meet samples. Keeping poultry meat at freezing temperatures is important for the reduction of C. jejuni, which has a strong influence on the prevention of occurrence of campylobacteriosis in humans