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Frontiers in Cellular and Infection... 2024The increasing incidence of Klebsiella pneumoniae and carbapenem-resistant Klebsiella pneumoniae (CRKP) has posed great challenges for the clinical anti-infective...
INTRODUCTION
The increasing incidence of Klebsiella pneumoniae and carbapenem-resistant Klebsiella pneumoniae (CRKP) has posed great challenges for the clinical anti-infective treatment. Here, we describe the molecular epidemiology and antimicrobial resistance profiles of K. pneumoniae and CRKP isolates from hospitalized patients in different regions of China.
METHODS
A total of 219 K. pneumoniae isolates from 26 hospitals in 19 provinces of China were collected during 2019-2020. Antimicrobial susceptibility tests, multilocus sequence typing were performed, antimicrobial resistance genes were detected by polymerase chain reaction (PCR). Antimicrobial resistance profiles were compared between different groups.
RESULTS
The resistance rates of K. pneumoniae isolates to imipenem, meropenem, and ertapenem were 20.1%, 20.1%, and 22.4%, respectively. A total of 45 CRKP isolates were identified. There was a significant difference in antimicrobial resistance between 45 CRKP and 174 carbapenem-sensitive Klebsiella pneumoniae (CSKP) strains, and the CRKP isolates were characterized by the multiple-drug resistance phenotype.There were regional differences among antimicrobial resistance rates of K. pneumoniae to cefazolin, chloramphenicol, and sulfamethoxazole,which were lower in the northwest than those in north and south of China.The mostcommon sequence type (ST) was ST11 (66.7% of the strains). In addition, we detected 13 other STs. There were differences between ST11 and non-ST11 isolates in the resistance rate to amikacin, gentamicin, latamoxef, ciprofloxacin, levofloxacin, aztreonam, nitrofurantoin, fosfomycin, and ceftazidime/avibactam. In terms of molecular resistance mechanisms, the majority of the CRKP strains (71.1%, 32/45) harbored blaKPC-2, followed by blaNDM (22.2%, 10/45). Strains harboring blaKPC or blaNDM genes showed different sensitivities to some antibiotics.
CONCLUSION
Our analysis emphasizes the importance of surveilling carbapenem-resistant determinants and analyzing their molecular characteristics for better management of antimicrobial agents in clinical use.
Topics: Klebsiella pneumoniae; Humans; China; Klebsiella Infections; Microbial Sensitivity Tests; Anti-Bacterial Agents; Molecular Epidemiology; Multilocus Sequence Typing; Drug Resistance, Multiple, Bacterial; Male; Carbapenem-Resistant Enterobacteriaceae; Female; Middle Aged; Aged; Hospitalization; Adult; Carbapenems
PubMed: 38817445
DOI: 10.3389/fcimb.2024.1380678 -
Therapeutic Advances in Respiratory... 2024Ukraine remains a high World Health Organization priority country for drug-resistant tuberculosis (TB). Rifampicin-resistant TB (RR-TB) has a more protracted, more... (Observational Study)
Observational Study
Impact of line probe assay-based molecular testing on individualized treatment in patients with rifampicin-resistant tuberculosis: data from the prospective INNOVA4TB cohort study in Ukraine.
BACKGROUND
Ukraine remains a high World Health Organization priority country for drug-resistant tuberculosis (TB). Rifampicin-resistant TB (RR-TB) has a more protracted, more complicated, and more expensive treatment. In 2021, Ukraine reported 4025 RR-TB cases - 5.4 times more (751) than all 30 European Union/ European Economic Area countries together.
OBJECTIVES
The objective of the study was to determine the diagnostic accuracy of line probe assay (LPA), AID Autoimmun Diagnostika GmbH, for detecting resistance to anti-TB drugs and its clinical application for selecting treatment regimens.
DESIGN
A prospective observational cohort study.
METHODS
From May 2019 to June 2020, we consecutively enrolled patients with active TB hospitalized at the Regional Phthisiopulmonology Center (Vinnytsia, Ukraine), aged between 18 and 82 years. The LPA was performed in the Genetic Research Laboratory at National Pirogov Memorial Medical University, Vinnytsia, Ukraine.
RESULTS
A total of 84 clinical specimens and 97 culture isolates from 126 TB patients were tested during the study. Accuracy (95% confidence interval) of LPA for clinical samples in comparison with phenotypic drug susceptibility test (DST) was 80.1 (68.5-89.0) for isoniazid (H), 74.7 (62.4-84.6) for rifampicin (R), 74.4 (62.5-84.1) for ethambutol, 71.4 (41.9-91.6) for streptomycin, 84.6 (62.4-96.5) for prothionamide/ethionamide, and 84.6 (73.6-92.3) for levofloxacin (Lfx), respectively. We found a significantly higher sensitivity of LPA for H, R, and Lfx for the culture isolates compared to clinical specimens ( < 0.05). LPA detected different mutations in 6 out of 17 (35.5%) patients susceptible to R by Xpert. A shorter treatment regimen with an injectable agent demonstrated a low suitability rate of 5% (8/156) in a cohort of RR-TB patients from Ukraine.
CONCLUSION
Initial LPA testing accurately identifies resistance to anti-TB drugs and facilitates the selection of an appropriate treatment regimen, minimizing exposure to empirical therapy.
Topics: Humans; Prospective Studies; Adult; Ukraine; Rifampin; Male; Middle Aged; Tuberculosis, Multidrug-Resistant; Female; Mycobacterium tuberculosis; Young Adult; Aged; Adolescent; Antitubercular Agents; Microbial Sensitivity Tests; Aged, 80 and over; Antibiotics, Antitubercular; Predictive Value of Tests; Precision Medicine; Reproducibility of Results
PubMed: 38817020
DOI: 10.1177/17534666241249841 -
Journal of Infection and Chemotherapy :... May 2024Legionella pneumonia is one of the major causes of severe pneumonia, in which treatment delay might lead to a poor prognosis. Therefore, as far as possible, early...
Legionella pneumonia is one of the major causes of severe pneumonia, in which treatment delay might lead to a poor prognosis. Therefore, as far as possible, early diagnosis and treatment of Legionella pneumonia is essential. Regarding the antimicrobials for Legionella pneumonia, fluoroquinolones, such as levofloxacin, or macrolides, such as azithromycin (AZM), are recommended in Japan and other countries. Lascufloxacin (LSFX), the newest fluoroquinolone developed in Japan, has been in use in daily clinical practice since January 2020. However, there are only few reports of Legionella pneumonia cases treated with LSFX. Here, we report three cases of hospitalized Legionella pneumonia patients that were successfully treated using LSFX. All three patients were admitted to the medical ward on admission, although one patient was subsequently transferred to the ICU for mechanical ventilatory management due to worsening of the pneumonia on day 3. All patients improved and were discharged following LSFX treatment (the patient admitted to the ICU was treated using LSFX + AZM combination therapy) without any severe adverse events. LSFX might be considered to be the first antibiotic choice for Legionella pneumonia, similar to levofloxacin. However, further data regarding the treatment of Legionella pneumonia cases using LSFX are needed to evaluate its efficacy and safety.
PubMed: 38815654
DOI: 10.1016/j.jiac.2024.05.011 -
Alternative Therapies in Health and... May 2024This study aimed to evaluate the clinical efficacy of third-generation cephalosporins combined with Levofloxacin in treating community-acquired pneumonia (CAP) among...
OBJECTIVE
This study aimed to evaluate the clinical efficacy of third-generation cephalosporins combined with Levofloxacin in treating community-acquired pneumonia (CAP) among elderly patients.
METHODS
A retrospective analysis was conducted, and a total of 200 elderly patients with CAP were included in the study. We included elderly patients aged 55 and above diagnosed with CAP at our hospital between January 2019 and June 2021. Patients were categorized into two groups: a control group receiving Levofloxacin alone and an observation group receiving a combination of third-generation cephalosporins and Levofloxacin. Each group consisted of 100 patients. The control group received intravenous levofloxacin hydrochloride injection (0.5 g in 250 mL) once daily, while the observation group received the same dose of Levofloxacin along with intravenous ceftriaxone sodium (80 mg/kg/day) once daily. Outcome measures included levels of inflammatory markers, pulmonary function tests, clinical indices, adverse events, and overall clinical efficacy.
RESULTS
Baseline characteristics were similar between the two groups. After treatment, the observation group demonstrated significantly lower levels of procalcitonin (PCT) and C-reactive protein (CRP) compared to the control group (P < .01). Additionally, the combination therapy group exhibited reduced levels of inflammatory markers (P < .05), improved pulmonary function (P < .01), higher clinical efficacy (P < .01), and a lower incidence of adverse events (4.00%) compared to the levofloxacin-alone group (23.00%) (P < .01). Furthermore, the combination of third-generation cephalosporins with Levofloxacin enhanced clinical efficacy when compared to Levofloxacin alone (P < .05).
CONCLUSION
The combination of third-generation cephalosporins with Levofloxacin proved effective in reducing adverse events, improving lung function, and decreasing inflammatory markers in elderly patients with CAP. However, further clinical trials are warranted to validate these findings before widespread clinical implementation.
PubMed: 38814600
DOI: No ID Found -
Antimicrobial Stewardship & Healthcare... 2024Levofloxacin prophylaxis reduces bloodstream infections in neutropenic patients with acute myeloid leukemia or relapsed acute lymphoblastic leukemia. A retrospective,...
Levofloxacin prophylaxis reduces bloodstream infections in neutropenic patients with acute myeloid leukemia or relapsed acute lymphoblastic leukemia. A retrospective, longitudinal cohort study compares incidence of bacteremia, multidrug-resistant organisms (MDRO), and (CDI) between time periods of levofloxacin prophylaxis implementation. Benefits were sustained without increasing MDRO or CDI.
PubMed: 38807931
DOI: 10.1017/ash.2024.81 -
Frontiers in Pediatrics 2024infection of the bloodstream and intestine is a rare and severe opportunistic infection in immunocompromised people. In Southwest China, we first reported a case of...
infection of the bloodstream and intestine is a rare and severe opportunistic infection in immunocompromised people. In Southwest China, we first reported a case of bloodstream and intestinal infection with multidrug-resistant (MDR) in a 4-year-old child with T-cell acute lymphoblastic leukemia. Blood and stool cultures were used to identify the infection. The selection of antibiotics was based on clinical expertise and medication sensitivity tests. We used linezolid, levofloxacin, and polymyxin B to treat the patient aggressively. infection is uncommon in juvenile acute lymphoblastic leukemia. Doctors should be aware of the likelihood of opportunistic infection during the post-chemotherapy bone marrow suppression period. We further conducted a review of the literature and performed a detailed analysis of s infection in pediatric leukemia. It is becoming increasingly apparent that antibiotic is abused domestically and abroad, resulting in the sharp increase of MDR bacteria. In general, most of the isolates are susceptible to third- or fourth-generation cephalosporins, aminoglycosides, quinolones, and carbapenem, but drug-resistant strains are being reported increasingly. We summarized the drug resistance rate of s caviae and in China in the last 10 years. Early recognition and effective treatment will improve prognosis and reduce mortality.
PubMed: 38803640
DOI: 10.3389/fped.2024.1233600 -
JAC-antimicrobial Resistance Jun 2024Antimicrobial resistance (AMR) is a growing public health concern globally, and misuse of antibiotics is a major contributor.
Antibiotic utilization patterns in Tanzania: a retrospective longitudinal study comparing pre- and intra-COVID-19 pandemic era using Tanzania Medicines and Medical Devices Authority data.
BACKGROUND
Antimicrobial resistance (AMR) is a growing public health concern globally, and misuse of antibiotics is a major contributor.
OBJECTIVE
This study investigated antibiotic utilization patterns before and during the COVID-19 pandemic in Tanzania using data from the Tanzania Medicines and Medical Devices Authority (TMDA).
METHODS
This retrospective longitudinal study analysed secondary data. The study compared antibiotics consumption in defined daily doses per 1000 inhabitants per day (DID) in two distinct eras: 2018-2019 as the pre-COVID-19 era and 2020-2021 as the intra-COVID-19 era. A sample -test was conducted using Statistical Package for the Social Sciences.
RESULTS
The study analysed 10 614 records and found an overall increase in antibiotics consumption from 2018 to 2021. We found that the consumption was 61.24 DID in the intra-COVID-19 era and 50.32 DID in the pre-COVID-19 era. Levofloxacin had the highest percentage increase in use, with a 700% increase in DID during the intra-COVID-19 era. Azithromycin had a 163.79% increase, while cefotaxime had a 600% increase. By contrast, some antibiotics exhibited a decrease in usage during the intra-COVID-19 era, such as nalidixic acid, which had a 100% decrease, and cefpodoxime, which had a 66.67% decrease.
CONCLUSIONS
Increased antibiotic consumption during the COVID-19 pandemic highlights the importance of implementing effective antimicrobial stewardship strategies to prevent AMR, especially during pandemics.
PubMed: 38803386
DOI: 10.1093/jacamr/dlae081 -
Zhongguo Dang Dai Er Ke Za Zhi =... May 2024To investigate the risk factors for (HP) infection in children with primary duodenogastric reflux (DGR) and its impact on gastritis and antibioticresistance.
OBJECTIVES
To investigate the risk factors for (HP) infection in children with primary duodenogastric reflux (DGR) and its impact on gastritis and antibioticresistance.
METHODS
A retrospective analysis was performed on the clinical data of 2 190 children who underwent upper gastrointestinal endoscopy in Wuxi Children's Hospital from January 2019 to February 2022, among whom 308 children were diagnosed with primary DGR. According to the presence or absence of HP infection, the children were classified to HP infection group (53 children) and non-HP infection group (255 children). The risk factors for HP infection and its impact on the incidence rate and severity of gastritis were analyzed. According to the presence or absence of primary DGR, 331 children with HP infection were classified to primary DGR group (29 children) and non-primary DGR group (302 children), and then the impact of primary DGR with HP infection on antibiotic resistance was analyzed.
RESULTS
The HP infection group had a significantly higher age than the non-HP infection group (<0.05), and there was a significant difference in the age distribution between the two groups (<0.05), while there were no significant differences in the incidence rate and severity of gastritis between the two groups (>0.05). The multivariate logistic regression analysis showed that older age was a risk factor for HP infection in children with DGR (<0.05). Drug sensitivity test showed that there were no significant differences in the single and combined resistance rates of metronidazole, clarithromycin, and levofloxacin between the primary DGR group and the non-primary DGR group (>0.05).
CONCLUSIONS
Older age is closely associated with HP infection in children with DGR. Primary DGR with HP infection has no significant impact on gastritis and antibiotic resistance in children.
Topics: Humans; Helicobacter Infections; Gastritis; Helicobacter pylori; Male; Female; Child; Retrospective Studies; Child, Preschool; Drug Resistance, Bacterial; Duodenogastric Reflux; Anti-Bacterial Agents; Risk Factors; Adolescent; Infant; Logistic Models
PubMed: 38802910
DOI: 10.7499/j.issn.1008-8830.2311086 -
RSC Advances May 2024An advanced form of magnesium-rich hydroxyapatite (Mg·HAP) was modified with two types of biopolymers, namely chitosan (CH/Mg·HAP) and β-cyclodextrin (CD/Mg·HAP),...
Characterization of chitosan- and β-cyclodextrin-modified forms of magnesium-doped hydroxyapatites as enhanced carriers for levofloxacin: loading, release, and anti-inflammatory properties.
An advanced form of magnesium-rich hydroxyapatite (Mg·HAP) was modified with two types of biopolymers, namely chitosan (CH/Mg·HAP) and β-cyclodextrin (CD/Mg·HAP), producing two types of bio-composites. The synthesized materials were developed as enhanced carriers for levofloxacin to control its loading, release, and anti-inflammatory properties. The polymeric modification significantly improved the loading efficiency to 281.4 mg g for CH/Mg·HAP and 332.4 mg g for CD/Mg·HAP compared with 218.3 mg g for Mg·HAP. The loading behaviors were determined using conventional kinetic and isotherm models and mathematical parameters of new equilibrium models (the monolayer model of one energy). The estimated density of effective loading sites ( = 88.03 mg g (Mg·HAP), 115.8 mg g (CH/Mg·HAP), and 138.5 mg g (CD/Mg·HAP)) illustrates the markedly higher loading performance of the modified forms of Mg·HAP. Moreover, the loading energies (<40 kJ mol) in conjunction with the capacity of each loading site ( > 1) and Gaussian energies (<8 kJ mol) signify the physical trapping of LVX molecules in vertical orientation. The addressed materials validate prolonged and continuous release behaviors. These behaviors accelerated after the modification procedures, as the complete release was identified after 160 h (CH/Mg·HAP) and 200 h (CD/Mg·HAP). The releasing behaviors are regulated by both diffusion and erosion mechanisms, according to the kinetic investigations and diffusion exponent analysis (>0.45). The entrapping of LVX into Mg·HAP induces its anti-inflammatory properties against the generation of cytokines (IL-6 and IL-8) in human bronchial epithelia cells (NL20), and this effect displays further enhancement after the integration of chitosan and β-cyclodextrin.
PubMed: 38799215
DOI: 10.1039/d4ra02144d -
Microorganisms May 2024() poses a significant threat to food safety due to its ability to cause severe human illness and its resistance to various antibiotics and environmental conditions....
() poses a significant threat to food safety due to its ability to cause severe human illness and its resistance to various antibiotics and environmental conditions. This study investigated the prevalence, serotype distribution, virulence gene profiles, and antimicrobial resistance patterns of in ready-to-eat (RTE) food products from Romania. A total of 8151 samples were analyzed, including various processed dairy, bovine, poultry, pork, and fish products. Bacterial isolation was conducted using the classical standard method, followed by confirmation through biochemical and molecular testing. Among the isolated strains, serotypes 1/2a, 1/2b, and 1/2c were identified, with a prevalence of 75% for serotype 1/2a. Additionally, virulence genes specific to listeriolysin O (A) and regulatory factor A (A) were detected in all isolates. Antimicrobial susceptibility testing revealed varying resistance patterns among the strains. Trimethoprim-sulfamethoxazole and oxacillin showed the highest prevalence of resistance at 26.92% and 23.07%, respectively. However, all strains remained susceptible to ciprofloxacin, levofloxacin, and moxifloxacin. Notably, 23.07% of the isolates exhibited multidrug resistance, with the most common pattern being resistance to oxacillin, penicillin, and tetracycline. Analysis of antimicrobial resistance genes identified tetracycline resistance genes, particularly (C), (M), and (K), in a significant proportion of isolates. The presence of C and D genes was also notable, indicating potential mechanisms of resistance. These results emphasize the necessity for ongoing surveillance of in RTE foods and emphasize the importance of thorough monitoring of antimicrobial resistance to guide public health strategies within the European Union.
PubMed: 38792784
DOI: 10.3390/microorganisms12050954