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Pneumocystis carinii pneumonia (PCP) is the most common illness associated with the acquired immunodeficiency syndrome (AIDS) in the United States and also occurs in immunocompromised persons not infected with the human immunodeficiency virus.. Several advances have taken place in the treatment and prophylaxis of PCP, with most clinical trials conducted in patients with AIDS. Treatment of choice is trimethoprim-sulfamethoxazole (TMP-SMX). Desensitization regimens are available for those who have a fever or rash associated with the agent. Patients with severe PCP who cannot tolerate TMP-SMX may be treated successfully with pentamidine or trimetrexate. Those with mild to moderate disease may receive dapsone-trimethoprim, clindamycin-primaquine, or atovaquone if they cannot take TMP-SMX. Adjunctive therapy with corticosteroids improves the outcome in patients with AIDS and severe PCP.
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A detailed microbiological analysis was made of the antibiotic resistant coagulase-negative staphylococcal flora of facial skin of 64 untreated individuals. The flora was quantified at primary isolation using both non-selective and selective media (each containing one of seven different antibiotics). The isolates obtained were tested against 18 antibiotics for multiple resistance and biotyped to species level. The incidence of the seven primary antibiotic resistance markers among the staphylococcal flora of 64 untreated subjects was: tetracycline 87.5%, erythromycin 68.8%, fusidic acid 56.3%, trimethoprim 42.4%, chloramphenicol 25%, clindamycin 9.4% and gentamicin 4.7%. In addition, penicillin resistant staphylococci were isolated from 98% of subjects. Multiply resistant strains were carried by 62.5% of individuals, with 27.9% carrying more than 100 multiply resistant staphylococci/cm2 skin. Analysis of the frequency distributions of the size of resistant staphylococcal populations revealed considerable individual variation, with many individuals carrying greater than 10(3) resistant staphylococci/cm2 skin. Multiply resistant staphylococci usually comprised less than 10% of the total staphylococcal flora, although this often represented a large number of multiply resistant organisms. Three people carried greater than 10(4) multiply resistant staphylococci/cm2 skin. Most of the singly and multiply resistant isolates were identified as strains of Staphylococcus epidermidis, which was found to carry up to eight resistances per isolate. In contrast, S. capitis, a common resident of human facial skin, was never found to carry more than two resistances per isolate. S. aureus was rarely detected on intact facial skin and the strains were not multiply resistant. Resistance to the major antistaphylococcal antibiotics was infrequent (gentamicin, methicillin) or absent (rifampicin, vancomycin, cephalothin). It was concluded that untreated individuals carry a significant pool of singly and multiply resistant staphylococci of sufficient size to be readily disseminated by direct contact and desquamation.
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Although polymorphonuclear leukocytes (PMNs) are powerfully anti-Aspergillus, transfusion therapy remains controversial, with conflicting results, and experimental support has been lacking. We devised a pulmonary infection model in neutropenic BALB/c mice, used an antibacterial regimen to prevent confounding sepsis, and optimized PMN induction, purifications, and dose. Mice were given 150 mg/kg cyclophosphamide every 4 days and a gentamicin-vancomycin-clindamycin-imipenem regimen daily beginning 4 days before intranasal challenge with 5 × 10(5) Aspergillus conidia. This regimen produced leukopenia (~10% of normal white blood cell [WBC] count; ≤ 10% PMNs) for 10 days, without bacterial superinfection. PMN donors given 100 μg/kg recombinant murine granulocyte colony-stimulating factor (G-CSF) for 10 days yielded 11 × 10(7) to 13.6 × 10(7) WBC/ml (81 to 87% PMNs). Infected mice were given PMN transfusions intravenously. In 2 experiments with up to 70% mortality of neutropenic controls, transfusion of 10(7) PMNs 1 and 4 days after challenge had negligible effects on peripheral WBC counts but improved survival (P = 0.007, 0.02), decreased lung CFU (P = 0.03, 0.005), and cleared infection in 28 to 50% of survivors. Transfusion of 5 × 10(6) PMNs showed partial protection. Transfusions given every other day did not improve protection. Our present results provide an experimental basis for enthusiasm for PMN transfusions in the therapy of aspergillosis in humans.
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A total of 82 (43%) MRSA were isolated from various clinical samples. Pattern of first line antistaphylococcal antibiotics is changing. Antimicrobial susceptibility testing is crucial in the treatment of these patients.
We performed a retrospective cohort study of GBS-colonized, penicillin-allergic women delivering at term receiving intrapartum antibiotic prophylaxis during labor. Scheduled cesarean deliveries were excluded. The primary outcome was the proportion of women who received appropriate antibiotic coverage, defined as penicillin or cefazolin. Secondary outcomes included neonatal outcomes such as Apgar score, blood draws, antibiotic use, length of hospital stay, and composite morbidity.
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Active macrolide efflux is a major mechanism of macrolide resistance in Streptococcus pneumoniae in many parts of the world, especially North America. In Canada, this active macrolide efflux in S. pneumoniae is predominantly due to acquisition of the mef(E) gene. In the present study, we assessed the mef(E) gene sequence as well as mef(E) expression in variety of low- and high-level macrolide-resistant, clindamycin-susceptible (M-phenotype) S. pneumoniae isolates (erythromycin MICs, 1 to 32 microg/ml; clindamycin MICs, < or = 0.25 microg/ml). Southern blot hybridization with mef(E) probe and EcoRI digestion and relative real-time reverse transcription-PCR were performed to study the mef(E) gene copy number and expression. Induction of mef(E) expression was analyzed by Etest susceptibility testing pre- and postincubation with subinhibitory concentrations of erythromycin, clarithromycin, azithromycin, telithromycin, and clindamycin. The macrolide efflux gene, mef(E), was shown to be a single-copy gene in all 23 clinical S. pneumoniae isolates tested, and expression post-macrolide induction increased 4-, 6-, 20-, and 200-fold in isolates with increasing macrolide resistance (erythromycin MICs 2, 4, 8, and 32 microg/ml, respectively). Sequencing analysis of the macrolide efflux genetic assembly (mega) revealed that mef(E) had a 16-bp deletion 153 bp upstream of the putative start codon in all 23 isolates. A 119-bp intergenic region between mef(E) and mel was sequenced, and a 99-bp deletion was found in 11 of the 23 M-phenotype S. pneumoniae isolates compared to the published mega sequence. However, the mef(E) gene was fully conserved among both high- and low-level macrolide-resistant isolates. In conclusion, increased expression of mef(E) is associated with higher levels of macrolide resistance in macrolide-resistant S. pneumoniae.
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A simple chemiluminescence (CL) method using flow injection has been developed for the determination of clindamycin, based on the inhibitory effect of clindamycin on the CL generated from the luminol-K(3)Fe(CN)(6) system in alkaline medium. It was found that the decrement of CL intensity was linear with the logarithm of clindamycin concentration over the range 0.7-1000 ng/mL. The detection limit was 0.2 ng/mL with a relative standard deviation (RSD) of <5.0% (n = 7). At a flow rate of 3.0 mL/min, a complete analytical process could be performed within 0.5 min, including sampling and washing. The proposed procedure was applied successfully to the determination of clindamycin in pharmaceutical preparations and human urine without pretreatment.
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For patients with a true penicillin allergy, we recommend broader gram-negative coverage with alternative antibiotics, such as cefuroxime, when undergoing free tissue transfer in the head and neck.
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Twenty consecutive patients, mean age 71 years, with a peroperative diagnosis of diffuse peritonitis were treated with clindamycin and tobramycin. The aim of this open prospective study was to correlate bacterial findings at operation to the duration of illness. The effectiveness of the treatment was also evaluated. The number of aerobic strains from peritoneal cultures outnumbered anaerobes when duration of illness was less than three days, while the opposite was evident when duration was longer. All isolates were fully susceptible to the antibiotic combination except for four anaerobic strains with MIC greater than 1 mg/l for clindamycin. The response to treatment was good in 18 patients, fair in one and poor in one.
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to determine the spa-types and assigned MLST clonal complexes (CCs) among all 98 MRSA-Tet(R) strains recovered during 2011-2012 (from different patients) in a Spanish Hospital, analyzing the possible correlation with livestock-contact of the patients. All 98 strains were assigned to 9 CCs: CC398 (60.2%), CC1 (19.4%), CC5 (12.2%), and other CCs (8.2%). The 98 patients were classified into three groups: (A) contact with livestock-animals (n=25); (B) no-contact with livestock-animals (n=42); (C) no information about animal contact (n=31). A significant higher percentage of CC398 strains was obtained in group A (76%) than in group B (50%) (p<0.05), being the percentage in group C of 61.3%. Most of MRSA-Tet(R)-CC398 strains presented a multi-resistance phenotype, including erythromycin, clindamycin, and ciprofloxacin, and the most prevalent detected genes were tet(M) and erm(C). Three strains presented the phenotype macrolide-susceptibility/lincosamide-resistance and contained the vga(A) gene. MRSA-CC1 strains showed higher percentages of erythromycin/clindamycin resistance (95%/89%) than MRSA-CC398 strains (58%/63%), and this resistance was usually mediated by erm(C) gene. Most of MRSA-CC5 strains showed resistance to ciprofloxacin, tobramycin/kanamycin and erythromycin. None of the strains presented the genes lukF/lukS-PV, tsst-1, eta, etb or etd. All MRSA-CC398 strains lacked the genes of the immune-evasion-cluster, but MRSA-CC1 strains carried these genes (type E). In conclusion, although MRSA CC398 is detected in a significant higher proportion in patients with livestock-contact; its detection in people without this type of contact also indicates its capacity for human-to-human transmission.
To review our results with the use of non-vascularised rib grafts for maxillofacial reconstruction.
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The annual number of cases of S. pneumoniae infection decreased from 218 in 2000 to 86-130 during the period 2002-2007, with the number of cases involving invasive strains decreasing from 96 to 18-35. For 1999 versus 2005-2007, the annual incidence of vaccine serotypes decreased by 92% (95% confidence interval [CI], -96.3% to -87.0%), whereas that of vaccine-related and nonvaccine serotypes increased 207.4% (95% CI, 135.0%-297.7%) and 18.4% (95% CI, -10.0% to 52.3%), respectively. Serotypes 19A, 6C, and 22F and serogroup 15 accounted for most of these increases. For the period 2005-2007, antimicrobial susceptibility testing revealed that ceftriaxone was the most active parenteral beta-lactam for both meningeal and nonmeningeal infections (72% and 88% of isolates, respectively, were susceptible to this agent); only 52% were susceptible to penicillin G at the meningeal breakpoint, whereas 77% were susceptible at the new nonmeningeal breakpoint of 2 microg/mL. Amoxicillin was the most active oral beta-lactam (72% of isolates were susceptible), whereas 53% of isolates were susceptible to azithromycin, 69% to clindamycin, 63% to trimethoprim-sulfamethoxazole, and 100% to levofloxacin.