In vitro effects of various antimicrobials alone and in combinations against imipenem-resistant Pseudomonas aeruginosa

Imipenem-resistant Pseudomonas aeruginosa (IRPA) infection is a serious problem in hospitals. Combination therapy is an alternative treatment for this infection. In this study, the in vitro activities of amikacin, aztreonam, ceftazidime, ciprofloxacin, colistin, imipenem, and piperacillin/tazobactam alone and in various combinations were determined by E-test for 38 imipenem-resistant P. aeruginosa isolates obtained from a Thai hospital. Of the 38 IRPA isolates, 9 (24%) were low-level IRPA (defined as MICs of imipenem 8-32 μg/mL) and 29 (76%) were high-level IRPA (defined as MICs of imipenem >32 μg/mL). The high-level IRPA isolates were susceptible to colistin (90%), piperacillin/tazobactam (72%), and amikacin (52%). The low-level IRPA isolates were susceptible to colistin (100%) and all other antimicrobials tested (78%-89%). The MIC50 value of colistin against both the high-level and low-level IRPA isolates was 1.5 μg/mL. Of all the antimicrobial combinations tested, ceftazidime plus ciprofloxacin displayed the highest percentages of synergistic effects against IRPA isolates (26%, 10/38 isolates) and a high percentages of synergistic effects against high-level IRPA isolates (21, 6/29 isolates), with no antagonistic effects detected. Colistin had the greatest activity against most IRPA isolates among all of the antimicrobials tested, while ceftazidime plus ciprofloxacin showed promise in treating infections caused by IRPA isolates including high-level IRPAs

Route of Infection in Melioidosis

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Post-licensure, phase IV, safety study of a live attenuated Japanese encephalitis recombinant vaccine in children in Thailand

AbstractBackgroundJapanese encephalitis is a mosquito-borne viral disease endemic in most countries in Asia. A recombinant live, attenuated Japanese encephalitis virus vaccine, JE-CV, is licensed in 14 countries, including Thailand, for the prevention of Japanese encephalitis in adults and children.MethodsThis was a prospective, phase IV, open-label, multicentre, safety study of JE-CV conducted from November 2013 to April 2015, to evaluate rare serious adverse events (AEs). JE-CV was administered to 10,000 healthy children aged 9months to <5years in Thailand as a primary (Group 1) or booster (Group 2) vaccination. Serious AEs (SAEs), including AEs of special interest, up to 60days after administration were evaluated. Immediate Grade 3 systemic AEs up to 30min after JE-CV administration were also described.ResultsThe median age of participants was 1.1years in Group 1 and 3.8years in Group 2. SAEs were reported in 204 (3.0%) participants in Group 1 and 59 (1.9%) participants in Group 2. Among a total of 294 SAEs in 263 participants, only three events occurring in two participants were considered related to vaccination. All three cases were moderate urticaria, none of which met the definition of AEs of special interest for hypersensitivity. AEs of special interest were reported in 28 (0.4%) participants in Group 1 and 4 (0.1%) participants in Group 2; none were considered related to vaccination. Febrile convulsion was the most frequently reported AE of special interest: 25 (0.4%) participants in Group 1; and 2 (<0.1%) in Group 2. There were no cases of Japanese encephalitis reported. No Grade 3 immediate systemic AEs were reported after any JE-CV vaccination.ConclusionsOur study did not identify any new safety concerns with JE-CV and confirms its good safety profile.This study was registered on www.clinicaltrials.gov (NCT01981967; Universal Trial Number: U1111-1127-7052)