Suboptimal clinical response to ciprofloxacin in patients with enteric fever due to Salmonella spp. with reduced fluoroquinolone susceptibility: a case series

BACKGROUND: Salmonella spp. with reduced susceptibility to fluoroquinolones have higher than usual MICs to these agents but are still considered "susceptible" by NCCLS criteria. Delayed treatment response to fluoroquinolones has been noted, especially in cases of enteric fever due to such strains. We reviewed the ciprofloxacin susceptibility and clinical outcome of our recent enteric fever cases. METHODS: Salmonella enterica Serotype Typhi (S. Typhi) and Serotype Paratyphi (S. Paratyphi) blood culture isolates (1998–2002) were tested against nalidixic acid by disk diffusion (DD) and agar dilution (AD) and to ciprofloxacin by AD using NCCLS methods and interpretive criteria. Reduced fluoroquinolone susceptibility was defined as a ciprofloxacin MIC of 0.125–1.0 mg/L. The clinical records of patients treated with ciprofloxacin for isolates with reduced fluoroquinolone susceptibility were reviewed. RESULTS: Seven of 21 (33%) S. Typhi and S. Paratyphi isolates had reduced susceptibility to fluoroquinolones (MIC range 0.125–0.5 mg/L). All 7 were nalidixic acid resistant by DD (no zone) and by AD (MIC 128- >512 mg/L). The other 14 isolates were nalidixic acid susceptible and fully susceptible to ciprofloxacin (MIC range 0.015–0.03 mg/L). Five of the 7 cases were treated initially with oral ciprofloxacin. One patient remained febrile on IV ciprofloxacin until cefotaxime was added, with fever recurrence when cefotaxime was discontinued. Two continued on oral or IV ciprofloxacin alone but had prolonged fevers of 9–10 days duration, one was switched to IV beta-lactam therapy after remaining febrile for 3 days on oral/IV ciprofloxacin and one was treated successfully with oral ciprofloxacin. Four of the 5 required hospitalization. CONCLUSIONS: Our cases provide further evidence that reduced fluoroquinolone susceptibility of S. Typhi and S. Paratyphi is clinically significant. Laboratories should test extra-intestinal Salmonella spp. for reduced fluoroquinolone susceptibility

Fungaemia due to Cryptococcus laurentii and a review of non- neoformans cryptococcaemia

Cryptococcus laurentii is one of several non- neoformans cryptococci that have rarely been associated with human infection. The spectrum of clinical infection due to non- neoformans species ranges from skin lesions to fungaemia. Most cases of non- neoformans fungaemia have been noso-comially acquired and have been associated with indwelling intravascular catheters and neutropenia. Limited data on in vitro susceptibilities of non- neoformans cryptococci show these species to be more resistant to fluconazole and flucytosine than most Cr. neoformans. Two such cases are presented here. Zusammenfassung . Cryptococcus laurentii ist eine von mehreren nicht- neofomans-Cryptococcus -Arten, die selten mit Krankheiten am Menschen in Zusammenhang gebracht werden. Das Spektrum durch Nicht- neoformans -Arten bedingter klinischer Infektionen reicht von HautlÄsionen bis zur FungÄmie. Die Mehrzahl der FÄlle von nicht- neoformans -FungÄmie waren nosokomial bedingt und mit intravasalen Dauerkathetern und Neutropenie assoziiert. Die wenigen Daten Über In-vitro-SuszeptibilitÄt von Non- neoformans -Arten fÜr Fluconazol und Flucytosin sprechen dafÜr, daß diese Arten resistenter als die meisten Cr. neoformans-StÄmme sind. Zwei solcher FÄlle werden vorgestellt.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/72398/1/j.1439-0507.1998.tb00338.x.pd

Guidelines on fibrinogen assays

No abstract available

Antimicrobial and antioxidant screening of curcumin and pyrocatechol in the prevention of biodiesel degradation: oxidative stability

Owing to its hygroscopicity biodiesel may accumulate water during storage, which becomes favorable to the growth of microorganisms. In order to control microbial contamination, use of various chemical biocides has been studied. However, the addition of a natural substance simultaneously with antioxidant and microbial growth inhibition could prove advantageous in the prevention of biodiesel oxidation and microbial contamination. Curcumin and pyrocatechol are antioxidant agents, which also exhibit microbial growth inhibition abilities. This research effort aimed at evaluating the addition of curcumin and pyrocatechol to biodiesel produced from various vegetable sources (waste frying oil, soybean oil, cottonseed oil, sesame oil, macaúba almond oil and microalgae oil). The combined addition of 1% (w/w) water and curcumin (viz. 0.2% (w/w) for biodiesel from spent frying oil, 0.5% (w/w) for biodiesel from soybean oil, 0.1% (w/w) for biodiesel from cotton seed oil, 0.5% (w/w) for biodiesel from sesame seed oil, 0.2% (w/w) for biodiesel from macaúba almond oil, and 0.2% (w/w) for biodiesel from microalgae oil) were those processing variables that promoted the best fungistatic and antioxidant effects, allowing maintenance of an unfavorable environment for microbial growth in biodiesel inoculated with the ubiquitous filamentous mold Paecilomyces variotii Bainier.Project funding by CNPq (National Council for Scientific and Technological Development - Brazil) (CNPq Ref. No. 404808/ 2013-1, Project ‘Studies on Biodiesel: Development of analytical methods for the characterization and quality control, and research of new natural additives to improve the quality of this biofuel’), is hereby gratefully acknowledged. This work received support from CNPq, National Council for Scientific and Technological Development Brazil, in the form of Research Productivity (PQ) fellowships granted to Victor M. Balcão (Ref. No. 306113/2014-7) and Marco V. Chaud (Ref. No. 309598/2014-1). The authors have no conflicts of interest whatsoever to declare

Frequency of antimicrobial resistance among invasive and colonizing Group B Streptococcal isolates

BACKGROUND: Group B Streptococcus (GBS) remains susceptible to penicillin, however, resistance to second-line antimicrobials, clindamycin and erythromycin, has increased since 1996. We describe the age-specific antibiotic susceptibility profile and capsular type distribution among invasive and colonizing GBS strains. METHODS: We tested 486 invasive GBS isolates from individuals of all ages collected by a Wisconsin surveillance system between 1998 and 2002 and 167 colonizing strains collected from nonpregnant college students during 2001 in Michigan. Antimicrobial susceptibility testing was performed by disk diffusion or Etest and capsular typing was performed using DNA dot blot hybridization RESULTS: 20.0% (97/486) of invasive and 40.7% (68/167) of colonizing isolates were resistant to clindamycin (P < .001) and 24.5% (119/486) of invasive and 41.9% (70/167) of colonizing isolates were resistant to erythromycin (P < .001). Similarly, 19.8% (96/486) of invasive and 38.3% (64/167) of colonizing isolates were resistant to both antimicrobial agents (P < .001). 29.4% (5/17) of invasive isolates from persons 18–29 years of age and 24.3% (17/70) of invasive isolates from persons 30–49 years of age were resistant to clindamycin. Similarly, 35.3% (6/17) of invasive isolates from persons 18–29 years of age and 31.4% (22/70) of invasive isolates from persons 30–49 years of age were resistant to erythromycin. 34.7% (26/75) of invasive isolates from persons < 1 year of age were capsular type Ia, whereas capsular type V predominated among isolates from adults. CONCLUSION: Clindamycin and erythromycin resistance rates were high among isolates colonizing nonpregnant college students and invasive GBS isolates, particularly among the colonizing isolates. Susceptibility profiles were similar by age although the proportion of clindamycin and erythromycin resistance among invasive isolates was highest among persons 18–49 years of age. Increasing antimicrobial resistance has implications for GBS disease treatment and intrapartum prophylaxis among penicillin intolerant patients

In vitro activity of tigecycline against methicillin-resistant Staphylococcus aureus, including livestock-associated strains

The in vitro activity of tigecycline was determined using a well-defined collection of methicillin-resistant Staphylococcus aureus (MRSA) isolates (n = 202), including 33 livestock-associated strains. Susceptibility testing was performed using the Etest system. Among the 202 MRSA strains, three (1.5%) had a minimum inhibitory concentration (MIC) value for tigecycline greater than 0.5 mg/l, which are considered to be resistant. When these strains were tested using Iso-Sensitest medium, the MICs were substantially lower and no resistance was found. This discrepancy warrants further investigations into the preferred test conditions for tigecycline. In conclusion, tigecycline showed good activity against MRSA strains in vitro

Three Cases of Moraxella osloensis Meningitis: A Difficult Experience in Species Identification and Determination of Clinical Significance

We had three cases of Moraxella osloensis meningitis. The species identification was impossible by conventional and commercial phenotypic tests. However, we could identify the species using the 16S rRNA gene sequencing. Determination of clinical significance was difficult in one patient. All three patients recovered by appropriate antimicrobial therapy

State of malaria diagnostic testing at clinical laboratories in the United States, 2010: a nationwide survey

<p>Abstract</p> <p>Background</p> <p>The diagnosis of malaria can be difficult in non-endemic areas, such as the United States, and delays in diagnosis and errors in treatment occur too often.</p> <p>Methods</p> <p>A nationwide survey of laboratories in the United States and its nine dependent territories was conducted in 2010 to determine factors that may contribute to shortcomings in the diagnosis of malaria. This survey explored the availability of malaria diagnostic tests, techniques used, and reporting practices.</p> <p>Results</p> <p>The survey was completed by 201 participants. Ninety percent reported that their laboratories had at least one type of malaria diagnostic test available on-site. Nearly all of the respondents' laboratories performed thick and thin smears on-site; approximately 50% had access to molecular testing; and only 17% had access to rapid diagnostic tests on-site. Seventy-three percent reported fewer than five confirmed cases of malaria in their laboratory during the 12-month period preceding the survey. Twenty-eight percent stated that results of species identification took more than 24 hours to report. Only five of 149 respondents that performed testing 24 hours a day, 7 days a week complied with all of the Clinical and Laboratory Standards Institute (CLSI) guidelines for analysis and reporting of results.</p> <p>Conclusion</p> <p>Although malaria diagnostic testing services were available to a majority of U.S. laboratories surveyed, very few were in complete compliance with all of the CLSI guidelines for analysis and reporting of results, and most respondents reported very few cases of malaria annually. Laboratories' difficulty in adhering to the rigorous CLSI guidelines and their personnel's lack of practice and proficiency may account for delays and errors in diagnosis. It is recommended that laboratories that infrequently process samples for malaria seek opportunities for practice and proficiency training annually and take advantage of available resources to assist in species identification.</p

Prognostic Significance of Infection Acquisition Sites in Spontaneous Bacterial Peritonitis: Nosocomial versus Community Acquired

Spontaneous bacterial peritonitis (SBP) is an ascitic fluid infection as a complication of end stage liver disease. The outcome is related to the severity of hepatorenal function, gastrointestinal bleeding, and many others; however it is not well known whether the infection acquisition sites have an effect on the prognosis of SBP. In order to identify the prognostic significance of the acquisition sites, we studied 106 patients who were diagnosed as culture positive SBP between October 1998 and August 2003. Thirty-two episodes were nosocomial and 74 were community acquired. Gram-negative bacilli such as Escherichia coli were dominant in both of the nosocomial and community-acquired SBPs. Despite significantly higher resistance to cefotaxime in nosocomial isolates compared to community-acquired isolates (77.8% vs. 13.6%, p=0.001), no difference was found regarding short or long term prognosis. Infection acquisition sites were not related to short or long term prognosis either. Shock, gastrointestinal bleeding and renal dysfunction were related to short term prognosis. Only Child-Pugh class C was identified as an independent prognostic factor of long-term survival