Risk Factors for and Impact of Ambulatory Urinary Tract infections Caused by High Mic-Fluoroquinolone Susceptible E. Coli in Women

Coincident with the increasing use of fluoroquinolones (FQs) as the first-line agent for treatment of urinary tract infections (UTIs) in adults, the prevalence of high MIC fluoroquinolone susceptible E. coli (high MIC-FQSEC) which are the E. coli isolates with reduced susceptibility to FQs has increased substantially. The high MIC-FQSEC strains may serve as an important reservoir for FQ resistance in that treatment of these organisms with a FQ has been associated with future emergence of resistance. To establish an effective program for controlling emergence of FQ resistance, it is necessary to understand the risk factors for, and impact of infection caused by high MIC-FQSEC. To identify risk factors for high MIC-FQ susceptibility, we conducted a case-control study of female subjects with UTIs caused by FQSEC at outpatient services within University of Pennsylvania Health System, Philadelphia. A total of 1836 subjects with low MIC-FQSEC UTI (CASE) and 165 subjects with high MIC-FQSEC UTIs (CONTROL) were enrolled into our study. Independent risk factors for high MIC-FQ included Asian race, having renal diseases and previous exposure to nitrofurantoin. To determine the impact of high MIC-FQ susceptibility, we conducted a retrospective cohort study of female subjects with ambulatory FQSEC UTIs who were treated with FQ therapy. We enrolled 246 subjects into the low MIC (unexposed) group and 29 subjects into the high MIC (exposed) group. Study subjects with high MIC-FQSEC-UTIs were approximately 8 times more likely to experience treatment failure when received FQ therapy when comparing to those with low MIC FQSEC-UTIs. The last dissertation project was a simulation study aiming to quantitatively compare the conventional case-control (CC) approach and the novel case-case-control (CCC) approach in investigating risk factors for infection caused by FQ-resistant pathogen. Our study confirmed that the CC approach almost always overestimates the effect of previous antibiotic exposure. The difference is more pronounced if the study is to be conducted among healthy population with a lower rate of colonization and protective effect of exposure on mechanism of harboring FQ-susceptible pathogen does not exist

High-Dose, Extended-Interval Colistin Administration in Critically Ill Patients: Is This the Right Dosing Strategy? A Preliminary Study

In critically ill patients with otherwise untreatable nosocomial infection due to gram-negative bacteria susceptible only to colistin, a high-dose, extended-interval colistin dosing regimen is, according to the pharmacokinetic/pharmacodynamic behavior of the drug, associated with low renal toxicity and high efficacy

Renal and neurological side effects of colistin in critically ill patients

Colistin is a complex polypeptide antibiotic composed mainly of colistin A and B. It was abandoned from clinical use in the 1970s because of significant renal and, to a lesser extent, neurological toxicity. Actually, colistin is increasingly put forward as salvage or even first-line treatment for severe multidrug-resistant, Gram-negative bacterial infections, particularly in the intensive care setting. We reviewed the most recent literature on colistin treatment, focusing on efficacy and toxicity issues. The method used for literature search was based on a PubMed retrieval using very precise criteria

Management of multidrug resistant Gram-negative bacilli infections in solid organ transplant recipients: SET/GESITRA-SEIMC/REIPI recommendations

Solid organ transplant (SOT) recipients are especially at risk of developing infections by multidrug resistant (MDR) Gram-negative bacilli (GNB), as they are frequently exposed to antibiotics and the healthcare setting, and are regulary subject to invasive procedures. Nevertheless, no recommendations concerning prevention and treatment are available. A panel of experts revised the available evidence; this document summarizes their recommendations: (1) it is important to characterize the isolate´s phenotypic and genotypic resistance profile; (2) overall, donor colonization should not constitute a contraindication to transplantation, although active infected kidney and lung grafts should be avoided; (3) recipient colonization is associated with an increased risk of infection, but is not a contraindication to transplantation; (4) different surgical prophylaxis regimens are not recommended for patients colonized with carbapenem-resistant GNB; (5) timely detection of carriers, contact isolation precautions, hand hygiene compliance and antibiotic control policies are important preventive measures; (6) there is not sufficient data to recommend intestinal decolonization; (7) colonized lung transplant recipients could benefit from prophylactic inhaled antibiotics, specially for Pseudomonas aeruginosa; (8) colonized SOT recipients should receive an empirical treatment which includes active antibiotics, and directed therapy should be adjusted according to susceptibility study results and the severity of the infection.J.T.S. holds a research contract from the Fundación para la Formación e Investigación de los Profesionales de la Salud de Extremadura (FundeSalud), Instituto de Salud Carlos III. M.F.R. holds a clinical research contract “Juan Rodés” (JR14/00036) from the Spanish Ministry of Economy and Competitiveness, Instituto de Salud Carlos III

Rat bite fever caused by Streptobacillus notomytis mimicking pyogenic polyarthritis: A case report

We report the world’s sixth case of rat bite fever caused by Streptobacillus notomytis that mimicked pyogenic polyarthritis and required surgical debridement in combination with prolonged antibiotic therapy. This case report highlights the higher severity of rat bite fever caused by S. notomytis compared to S. moniliformis

Real-World Effectiveness and Optimal Dosage of Favipiravir for Treatment of COVID-19: Results from a Multicenter Observational Study in Thailand

Favipiravir is a broad-spectrum oral antiviral agent that shows in vitro activity against SARS-CoV-2. Presently, data on the real-world effectiveness and optimal dosage of favipiravir for treating COVID-19 are limited. We conducted a retrospective observational study of hospitalized adult patients with COVID-19 at five tertiary care hospitals in Thailand. We reviewed patient charts to obtain all necessary data. Among 247 COVID-19 patients, 63 (23.0%) received ≥1 dose of favipiravir. Of these 63 patients, 61.9% were male with a median age of 48 years (range 22–85 years), 27.0% required an O2 nasal cannula, 9.5% required non-invasive ventilation and/or high-flow O2 therapy, and 6.4% required invasive mechanical ventilation and/or ECMO. The median baseline NEWS2 score was 5 (0–16). The Day-7 clinical improvement rate [95%CI] was 66.7% [53.7–78.0%] in all patients, 92.5% [75.7–99.1%] in patients who did not require O2 supplementation, and 47.2% [0.4–64.5%] in patients who required O2 supplementation. No life-threatening adverse events were identified. The 28-day mortality rate was 4.8%. A multivariate analysis revealed three poor prognostic factors for Day-7 clinical improvement (odds ratio (95%CI); p-value): older age (0.94 (0.89–0.99); p = 0.04), a higher baseline NEWS2 score (0.64 (0.47–0.88); p = 0.006), and a lower favipiravir loading dose (≤45 mg/kg/day) (0.04 (0.005–0.4); p = 0.006). In conclusion, our study reports the promising effectiveness of favipiravir for treating COVID-19 patients. In addition to older age and a high baseline NEWS2 score, a low loading dose of favipiravir (≤45 mg/kg/day) was also identified as a poor prognostic factor for early clinical improvement. Further studies to explore the optimal dose and the optimal timing of drug initiation for favipiravir should be performed