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Sękowska A, Bogiel T. The Evaluation of Eazyplex® SuperBug CRE Assay Usefulness for the Detection of ESBLs and Carbapenemases Genes Directly from Urine Samples and Positive Blood Cultures. Antibiotics (Basel) 2022; 11:antibiotics11020138. [PMID: 35203741 PMCID: PMC8868433 DOI: 10.3390/antibiotics11020138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 01/15/2022] [Accepted: 01/18/2022] [Indexed: 01/10/2023] Open
Abstract
Increasing antimicrobial resistance of Gram-negative rods is an important diagnostic, clinical and epidemiological problem of modern medicine. Therefore, it is important to detect multi-drug resistant strains as early on as possible. This study aimed to evaluate Eazyplex® SuperBug CRE assay usefulness for beta-lactamase gene detection among Gram-negative rods, directly from urine samples and positive blood cultures. The Eazyplex® SuperBug CRE assay is based on a loop-mediated isothermal amplification of genetic material and allows for the detection of a selection of genes encoding carbapenemases, KPC, NDM, VIM, OXA-48, OXA-181 and extended-spectrum beta-lactamases from the CTX-M-1 and CTX-M-9 groups. A total of 120 clinical specimens were included in the study. The test gave valid results for 58 (96.7%) urine samples and 57 (95.0%) positive blood cultures. ESBL and/or carbapenemase enzymes genes were detected in 56 (93.3%) urine and 55 (91.7%) blood samples, respectively. The Eazyplex® SuperBug CRE assay can be used for a rapid detection of the genes encoding the most important resistance mechanisms to beta-lactams in Gram-negative rods also without the necessity of bacterial culture.
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Cama J, Leszczynski R, Tang PK, Khalid A, Lok V, Dowson CG, Ebata A. To Push or To Pull? In a Post-COVID World, Supporting and Incentivizing Antimicrobial Drug Development Must Become a Governmental Priority. ACS Infect Dis 2021; 7:2029-2042. [PMID: 33606496 PMCID: PMC7931625 DOI: 10.1021/acsinfecdis.0c00681] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The COVID-19 pandemic has refocused attention worldwide on the dangers of infectious diseases, in terms of both global health and the effects on the world economy. Even in high income countries, health systems have been found wanting in dealing with the new infectious agent. However, the even greater long-term danger of antimicrobial resistance in pathogenic bacteria and fungi is still under-appreciated, especially among the general public. Although antimicrobial drug development faces significant scientific challenges, the gravest challenge at the moment appears to be economic, where the lack of a viable market has led to a collapse in drug development pipelines. There is therefore a critical need for governments across the world to further incentivize the development of antimicrobials. Most incentive strategies over the past decade have focused on so-called "push" incentives that bridge the costs of antimicrobial research and development, but these have been insufficient for reviving the pipeline. In this Perspective, we analyze the current incentive strategies in place for antimicrobial drug development, and focus on "pull" incentives, which instead aim to improve revenue generation and thereby resolve the antimicrobial market failure challenge. We further analyze these incentives in a broader "One Health" context and stress the importance of developing and enforcing strict protocols to ensure appropriate manufacturing practices and responsible use. Our analysis reiterates the importance of international cooperation, coordination across antimicrobial research, and sustained funding in tackling this significant global challenge. A failure to invest wisely and continuously to incentivize antimicrobial pipelines will have catastrophic consequences for global health and wellbeing in the years to come.
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Affiliation(s)
- J. Cama
- Living
Systems Institute, University of Exeter, Stocker Road, Exeter EX4 4QD, U.K.
- College
of Engineering, Mathematics and Physical Sciences, University of Exeter, Exeter EX4 4QF, U.K.
- ,
| | - R. Leszczynski
- Polygeia,
Global Health Student Think Tank, London, U.K.https://www.polygeia.com/
| | - P. K. Tang
- Polygeia,
Global Health Student Think Tank, London, U.K.https://www.polygeia.com/
- Faculty
of Life Sciences and Medicine, King’s
College London, Great
Maze Pond, London SE1 1UK, U.K.
| | - A. Khalid
- Polygeia,
Global Health Student Think Tank, London, U.K.https://www.polygeia.com/
- School
of Clinical Medicine, University of Cambridge, Cambridge CB2 0SP, U.K.
| | - V. Lok
- Polygeia,
Global Health Student Think Tank, London, U.K.https://www.polygeia.com/
- School of
Biological and Chemical Sciences, Queen
Mary University of London, Mile End Road, London E1 4NS, U.K.
| | - C. G. Dowson
- School
of Life Sciences, Gibbet Hill Campus, University
of Warwick, Coventry CV4 7AL, U.K.
- Antibiotic
Research U.K., Genesis 5, York Science Park, Heslington, York YO10 5DQ, U.K.
| | - A. Ebata
- Institute
of Development Studies, Library Road, Brighton BN1 9RE, U.K.
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周 慧, 许 昱. [Reasonable application of antibiotics in pediatric acute rhinosinusitis]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2021; 35:752-755. [PMID: 34304540 PMCID: PMC10127806 DOI: 10.13201/j.issn.2096-7993.2021.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Indexed: 11/12/2022]
Abstract
The incidence of upper respiratory tract infection in children is extremely high, and some of them are prone to develop to acute rhinosinusitis. Antibiotics are the first-line medication to alleviate bacterial infections. However, due to the lack of practical and accurate objective indicators for the diagnosis of acute rhinosinusitis, it is difficult to distinguish the acute bacterial rhinosinusitis subgroup, leading to the overuse of antibiotics. In recent years, the form of antibiotic resistance has become more severe, and the application conditions of antibiotics have become more stringent. In addition, the physiological conditions of children are different from adults. Chinese and foreign studies are controversial about the rational application of antibiotics in children with acute rhinosinusitis. The relevant researches of antibiotic treatment in children with acute rhinosinusitis are now reviewed, with a view to providing clinical reference for the rational use of antibiotics in this group of people.
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Affiliation(s)
- 慧琴 周
- 武汉大学人民医院耳鼻咽喉头颈外科(武汉,430060)
| | - 昱 许
- 武汉大学人民医院耳鼻咽喉头颈外科(武汉,430060)
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Tu B, Zhang Y, Bi J, Xu Z, Shi L, Zhang X, Zhao P, Zhang D, Yang G, Qin E. Microbiological Characteristics and Antibiotic Sensitivity in Patients with Nosocomial Spontaneous Bacterial Peritonitis Caused by Escherichia coli: A Multicenter Study. INFECTIOUS MICROBES & DISEASES 2020; 2:167-172. [PMID: 38630105 PMCID: PMC7769054 DOI: 10.1097/im9.0000000000000035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 07/13/2020] [Accepted: 07/23/2020] [Indexed: 11/26/2022]
Abstract
Escherichia coli is a prevalent causative pathogen of spontaneous bacterial peritonitis (SBP). In this retrospective study, we investigated the microbiological characteristics and antibiotic susceptibility of E. coli clinical isolates obtained from liver cirrhosis patients suffering from nosocomial SBP. Our results showed that extended-spectrum β-lactamase (ESBL)-producing E. coli accounted for 47% of the cases, while 62% of the isolates were multi-drug resistant (MDR) pathogens. ESBL-producing and MDR isolates showed high incidences of resistance to third-generation cephalosporins, but they displayed susceptibility to carbapenems, β-lactamase inhibitors, and aminoglycosides. Importantly, liver cirrhosis patients with MDR E. coli SBP showed a significantly higher death rate than patients with non-MDR infections (P = 0.021). The 30-day mortality of nosocomial SBP was independently correlated with female gender [odds ratio (OR) = 5.200, 95% confidence interval (CI) = 1.194-22.642], liver failure (OR = 9.609, 95% CI = 1.914-48.225), hepatocellular carcinoma (OR = 8.176, 95% CI = 2.065-32.364), hepatic encephalopathy (OR = 8.176, 95% CI = 2.065-32.364), model of end-stage liver disease score (OR = 1.191, 95% CI = 1.053-1.346), white blood cell count (OR = 0.847, 95% CI = 0.737-0.973), and ascites polymorphonuclear (OR = 95.903, 95% CI = 3.410-2697.356). In conclusion, third-generation cephalosporins may be inappropriate for empiric treatment of nosocomial SBP caused by E. coli, due to the widespread presence of ESBLs and high incidence of MDR pathogens.
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Affiliation(s)
- Bo Tu
- Department of Infectious disease, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
- Bo Tu, Yuening Zhang, and Jingfeng Bi contributed equally to this work
| | - Yuening Zhang
- Center of Hepatology and Gastroenterology, Beijing Capital Medical University You’an Hospital, China
- Bo Tu, Yuening Zhang, and Jingfeng Bi contributed equally to this work
| | - Jingfeng Bi
- Department of Clinical and Translational Medicine, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
- Bo Tu, Yuening Zhang, and Jingfeng Bi contributed equally to this work
| | - Zhe Xu
- Department of Infectious disease, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Lei Shi
- Department of Infectious disease, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Xin Zhang
- Department of Infectious disease, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Peng Zhao
- Department of Infectious disease, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Dawei Zhang
- Department of Infectious disease, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Guang Yang
- Department of Infectious disease, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Enqiang Qin
- Department of Infectious disease, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
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Abstract
PURPOSE OF REVIEW The purposes of the review are as follows: (1) to define acute rhinosinusitis (ARS) and their phenotypes, (2) to highlight the ARS management according to international guidelines, (3) to compare the physicians' management with the ARS guideline recommendations, and (4) to report ARS socioeconomic burden. RECENT FINDINGS Bacterial and non-bacterial ARS have similar symptoms, although they can be discriminated by using a combination of specific signs and symptoms. The prescription of antibiotics should be limited to clearly suspected bacterial ARS. There is an overuse of diagnosis tools and treatment prescriptions. The total cost per ARS episode in Europe is over €1000. ARS is mainly an inflammatory disease triggered by viral infection, and few cases end up developing bacterial infection. In most of the cases, it is a self-resolving disease which diagnosis is mainly clinical and the treatment symptomatic. The incidence of complications is low and independent of antibiotic use. There is a high socioeconomic burden associated to ARS.
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Affiliation(s)
- Francesca Jaume
- Servei d'Otorrinolaringologia, Hospital Comarcal d'Inca, Carretera Vella de Llubí, 07300, Inca, Illes Balears, Spain.
| | - Meritxell Valls-Mateus
- Servei d'Otorrinolaringologia, Hospital Universitari Son Espases, Palma, Illes Balears, Spain
| | - Joaquim Mullol
- Unitat de Rinologia i Clínica de l'Olfacte, Servei d'Otorinolaringologia, Hospital Clínic, Universitat de Barcelona, Barcelona, Catalonia, Spain.
- Immunoal.lèrgia Respiratòria Clínica i Experimental, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain.
- Centro de Investigación Biomédica En Red en Enfermedades Respiratorias (CIBERES), Madrid, Spain.
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Kofteridis DP, Andrianaki AM, Maraki S, Mathioudaki A, Plataki M, Alexopoulou C, Ioannou P, Samonis G, Valachis A. Treatment pattern, prognostic factors, and outcome in patients with infection due to pan-drug-resistant gram-negative bacteria. Eur J Clin Microbiol Infect Dis 2020; 39:965-970. [PMID: 31933017 DOI: 10.1007/s10096-019-03784-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 11/28/2019] [Indexed: 12/19/2022]
Abstract
The present study investigated the clinical course, treatment pattern, prognostic factors, and outcome of patients with pun-drug resistant (PDR) infections. This was a retrospective single-center cohort study including consecutive eligible patients with a PDR infection hospitalized at the University Hospital of Heraklion, Crete, Greece, between January 2010 and June 2018. In total, 65 patients with infections due to PDR gram-negative pathogens were identified. The median age was 64 years (interquartile range, IQR: 45.5-74.5) and the median Charlson comorbidity index 3.0 (IQR: 1.0-5.75). Of the 65 PDR isolates, 31 (48%) were Klebsiella pneumoniae, 28 (43%) Acinetobacter baumannii, and 6 (9%) Pseudomonas aeruginosa. The most common empirical therapy was colistin-based combination (n = 32; 49%), followed by non-colistin, non-tigecycline combination (n = 25; 39%), and carbapenemes + tigecycline (n = 8; 12%). The empirical therapy was effective in 50%, 37.5%, and 8% of patients receiving colistin combination, carbapenemes - tigecycline, and non-colistin, non-tigecycline combination, respectively (p value = 0.003). The infection-related in-hospital mortality was 32% (95% confidence interval, CI: 21-45%). Three factors were significantly associated with infection-related in-hospital mortality in multivariate analysis: Charlson comorbidity index (odds ratio, OR: 1.5, 95% CI: 1.0-2.3, p value = 0.030), prior steroid use (OR: 4.1, 95% CI: 1.0-17.0, p value = 0.049), and empirical treatment with non-colistin, non-tigecycline combination (OR: 7.5; 95% CI: 1.7-32.8, p value = 0.008). Infections due to PDR pathogens are associated with considerable mortality. Our results support the use of colistin and/or tigecycline-based combinations as empirical therapy when infection due to PDR pathogens is suspected.
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Affiliation(s)
- Diamantis P Kofteridis
- Department of Internal Medicine, University Hospital of Heraklion, Heraklion, Crete, Greece.
| | - Angeliki M Andrianaki
- Department of Internal Medicine, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - Sofia Maraki
- Department of Clinical Microbiology, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - Anna Mathioudaki
- Department of Internal Medicine, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - Marina Plataki
- Department of Internal Medicine, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - Christina Alexopoulou
- Department of Intensive Care Unit, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - Petros Ioannou
- Department of Internal Medicine, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - George Samonis
- Department of Internal Medicine, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - Antonis Valachis
- Department of Oncology, Faculty of Medicine and Health, Örebro University, SE 70182, Örebro, Sweden
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Miller R, Pywell S, Chan J, McCluney S, Halsey T. Seasonal Variation in Hand and Upper Limb Soft Tissue Infections. J Hand Surg Asian Pac Vol 2019; 24:189-194. [DOI: 10.1142/s2424835519500255] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Hand and upper limb soft tissue infections result in significant disability and loss of productivity. Many infections have been shown to follow a seasonal variation, however little is known about this is the context of upper limb soft tissue infections. We aimed to evaluate seasonal variation in acute bacterial, hand and upper limb skin and soft-tissue infections, and correlate findings with key environmental variables. Methods: Hand and upper limb soft tissue infection cases from 2006–2016 were retrieved from a single UK center. Cases were reviewed for microbiology culture and sensitivity. Correlation between cases and season, temperature and humidity was assessed. Results: 206 cases were identified for inclusion. Specimens were sent for microbiology in 76.4% of cases. Of these 78.9% were culture positive, 47.6% exhibited antibiotic resistance and 16.9% were multi-resistant. There was a significant difference between season and culture positive cases, with significantly more culture positive cases in the summer vs. winter on post-hoc analysis (p = 0.004). There was a significant positive correlation between higher temperatures and number of culture positive cases (r = 0.75). There was no significant correlation between temperature and antibiotic resistance (r = 0.5) or between humidity and culture positive cases (r = −0.42). Conclusions: This study demonstrates a seasonal variation in hand and upper limb infections, with a significant correlation between infection rates and ambient temperature. Appreciating seasonal variability of these infections could prove beneficial for surgical planning, public health recommendations and antibiotic guidelines. However, further international data is needed to understand potential mechanisms involved.
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Affiliation(s)
- Robert Miller
- Hand and Plastic Surgery Unit, Chelsea and Westminster Hospital, London, UK
| | - Sarah Pywell
- Hand and Plastic Surgery Unit, Chelsea and Westminster Hospital, London, UK
| | - James Chan
- Department of Plastic Surgery, Oxford University Hospital NHS Trust, Oxford, UK
| | - Simon McCluney
- Hand and Plastic Surgery Unit, Chelsea and Westminster Hospital, London, UK
| | - Tim Halsey
- Hand and Plastic Surgery Unit, Chelsea and Westminster Hospital, London, UK
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Roope LSJ, Smith RD, Pouwels KB, Buchanan J, Abel L, Eibich P, Butler CC, Tan PS, Walker AS, Robotham JV, Wordsworth S. The challenge of antimicrobial resistance: What economics can contribute. Science 2019; 364:364/6435/eaau4679. [DOI: 10.1126/science.aau4679] [Citation(s) in RCA: 197] [Impact Index Per Article: 39.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
As antibiotic consumption grows, bacteria are becoming increasingly resistant to treatment. Antibiotic resistance undermines much of modern health care, which relies on access to effective antibiotics to prevent and treat infections associated with routine medical procedures. The resulting challenges have much in common with those posed by climate change, which economists have responded to with research that has informed and shaped public policy. Drawing on economic concepts such as externalities and the principal–agent relationship, we suggest how economics can help to solve the challenges arising from increasing resistance to antibiotics. We discuss solutions to the key economic issues, from incentivizing the development of effective new antibiotics to improving antibiotic stewardship through financial mechanisms and regulation.
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Development, Characterization, and Evaluation of Novel Broad-Spectrum Antimicrobial Topical Formulations from Cymbopogon martini (Roxb.) W. Watson Essential Oil. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2018; 2018:9812093. [PMID: 30275867 PMCID: PMC6151366 DOI: 10.1155/2018/9812093] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 08/19/2018] [Indexed: 12/13/2022]
Abstract
Background Skin infections were the most frequently encountered of all infections and the 4th leading cause of nonfatal disease burden. Topical drugs have been used for the management of skin infections. The growing concern of drug resistance to the topical agents has warned the need for continuous development of novel drug. Essential oils are the best candidate for new drug with different mode of action and target as they are rich in chemical constituents. Objective To evaluate and develop safe and effective topical antimicrobial formulations from essential oil of Cymbopogon martini. Method. Essential oil was extracted using hydrodistillation aerial part C. martini and topical formulations were prepared in five different semisolid bases. In vitro antimicrobial investigations were performed on essential oil and topical formulations. Skin sensitizations of the formulations were evaluated using guinea pig maximization. Results The essential oil of C. martini has shown broad-spectrum antimicrobial potency against all tested organisms with MIC value ranging from 0.65 to 10 μg/ml. Absolute inhibitions of growth of fungi were observed against Trichophyton mentagrophytes and Trichophyton rubrum at concentrations above 1% of oil and against Microsporum canis and Trichophyton verrucosum at a concentration of 4% oil. Among topical formulations, the highest antimicrobial activity was recorded in hydrophilic ointment followed by macrogol blend ointment. The antimicrobial activity of oil was higher in fungal pathogen compared to bacteria. Gram positive bacteria were more sensitive than gram negative bacteria. Hydrophilic and macrogol blend ointment containing 5% oil did not produce any skin sensitization on guinea pigs. Conclusion In conclusion, topical formulations of C. martini essential oil can be alternative topical agents with safe broad-spectrum activity for the treatment of skin disorder. Further studies should focus on shelf life study and clinical study of the product.
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Khan I, Sivasankaran N, Nagarjuna R, Ganesan R, Dutta JR. Extracellular probiotic lipase capped silver nanoparticles as highly efficient broad spectrum antimicrobial agents. RSC Adv 2018; 8:31358-31365. [PMID: 35548221 PMCID: PMC9085599 DOI: 10.1039/c8ra05999c] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Accepted: 08/24/2018] [Indexed: 11/21/2022] Open
Abstract
The microbial resistance to different drugs due to excessive usage of antibiotics in various domains has become a serious environmental threat in recent years. This gave the impetus to researchers to find alternatives that do not lead to multi-drug resistant microbes. In this backdrop, silver nanoparticles (Ag NPs) have become a popular choice due to their potential broad spectrum of antimicrobial attributes. Recent literature caution that about 400 metric tons of Ag NPs are synthesized annually all over the world that could cause environmental hazards when used at higher concentrations than the toxicity limit. However, most of the literature reports use higher concentrations of Ag NPs and exposure to such concentrations may lead to environmental and health hazards. In this study, a series of Ag NPs have been synthesized using a lipase derived from a probiotic source Lactobacillus plantarum as the stabilizing agent. The Ag NPs synthesized through different combinations of lipase and AgNO3 are characterized using various techniques such as UV-visible spectroscopy, FT-IR, ED-XRF, DLS and HR-TEM. The lipase capped Ag NPs have been studied for their antimicrobial activity against representative microbes such as Pseudomonas putida, Staphylococcus aureus and Aspergillus niger. Our initial results reveal that the lipase capped Ag NPs possess high potential towards broad spectrum antimicrobial applications at concentrations much lower than the toxicity limit of the standard model, zebra fish.
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Affiliation(s)
- Imran Khan
- Department of Biological Sciences, BITS Pilani, Hyderabad Campus Jawahar Nagar, Kapra Mandal Hyderabad - 500078 Telangana India +91 40 6630 3542
| | - Nivetha Sivasankaran
- Department of Biological Sciences, BITS Pilani, Hyderabad Campus Jawahar Nagar, Kapra Mandal Hyderabad - 500078 Telangana India +91 40 6630 3542
| | - Ravikiran Nagarjuna
- Department of Chemistry, BITS Pilani, Hyderabad Campus Jawahar Nagar, Kapra Mandal Hyderabad - 500078 Telangana India +91 40 6630 3602
| | - Ramakrishnan Ganesan
- Department of Chemistry, BITS Pilani, Hyderabad Campus Jawahar Nagar, Kapra Mandal Hyderabad - 500078 Telangana India +91 40 6630 3602
| | - Jayati Ray Dutta
- Department of Biological Sciences, BITS Pilani, Hyderabad Campus Jawahar Nagar, Kapra Mandal Hyderabad - 500078 Telangana India +91 40 6630 3542
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Tadesse G, Tessema TS, Beyene G, Aseffa A. Molecular epidemiology of fluoroquinolone resistant Salmonella in Africa: A systematic review and meta-analysis. PLoS One 2018; 13:e0192575. [PMID: 29432492 PMCID: PMC5809059 DOI: 10.1371/journal.pone.0192575] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 01/25/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Wide-ranging evidence on the occurrence of fluoroquinolone (FQ) resistance genetic determinants in African Salmonella strains is not available. The main objectives of this study were to assess the heterogeneity, estimate pooled proportions and describe the preponderance of FQ-resistance determinants in typhoidal and non-typhoidal Salmonella (NTS) isolates of Africa. METHODS Genetic and phenotypic data on 6103 Salmonella isolates were considered. Meta- and frequency analyses were performed depending on the number of studies by category, number of isolates and risks of bias. A random effects model was used to assess heterogeneity and estimate pooled proportions. Relative and cumulative frequencies were calculated to describe the overall preponderance of FQ-resistance determinants in quinolone resistant isolates. RESULTS The pooled proportion of gyrA mutants (Salmonella enterica serovar Typhi, Salmonella enterica serovar Typhimurium, and Salmonella enterica serovar Enteritidis) was estimated at 5.7% (95% Confidence interval (CI) = 2.6, 9.8; Tau squared (T2) = 0.1105), and was higher in S. Typhi than in S. Typhimurium (odds ratio (OR) = 3.3, 95%CI = 2, 5.7). The proportions of each of gyrB and parC mutants, and strains with Plasmid Mediated Quinolone Resistance genes (qnrA, qnrB and qnrS) were low (≤ 0.3%). Overall, 23 mutant serotypes were identified, and most strains had mutations at codons encoding Ser83 and Asp87 of gyrA (82%, 95%CI = 78, 86). CONCLUSIONS Mutations at gyrA appear to account for ciprofloxacin non-susceptibility in most clinical Salmonella strains in Africa. The estimates could be harnessed to develop a mismatch-amplification mutation-assay for the detection of FQ-resistant strains in Africa.
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Affiliation(s)
- Getachew Tadesse
- Department of Biomedical Sciences, College of Veterinary Medicine and Agriculture, Addis Ababa University, Debre Zeit, Ethiopia
| | - Tesfaye S. Tessema
- Institute of Biotechnology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Getenet Beyene
- Department of Medical Laboratory Sciences, Faculty of Health Sciences, Jimma University, Jimma, Ethiopia
| | - Abraham Aseffa
- Armauer Hansen Research Institute (AHRI), ALERT Campus, Addis Ababa, Ethiopia
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12
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Pouwels KB, Dolk FCK, Smith DRM, Robotham JV, Smieszek T. Actual versus 'ideal' antibiotic prescribing for common conditions in English primary care. J Antimicrob Chemother 2018; 73:19-26. [PMID: 29490060 PMCID: PMC5890776 DOI: 10.1093/jac/dkx502] [Citation(s) in RCA: 130] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objectives Previous work based on guidelines and expert opinion identified 'ideal' prescribing proportions-the overall proportion of consultations that should result in an antibiotic prescription-for common infectious conditions. Here, actual condition-specific prescribing proportions in primary care in England were compared with ideal prescribing proportions identified by experts. Methods All recorded consultations for common infectious conditions (cough, bronchitis, exacerbations of asthma or chronic obstructive pulmonary disease, sore throat, rhinosinusitis, otitis media, lower respiratory tract infection, upper respiratory tract infection, influenza-like illness, urinary tract infection, impetigo, acne, gastroenteritis) for 2013-15 were extracted from The Health Improvement Network (THIN) database. The proportions of consultations resulting in an antibiotic prescription were established, concentrating on acute presentations in patients without relevant comorbidities. These actual prescribing proportions were then compared with previously established 'ideal' proportions by condition. Results For most conditions, substantially higher proportions of consultations resulted in an antibiotic prescription than was deemed appropriate according to expert opinion. An antibiotic was prescribed in 41% of all acute cough consultations when experts advocated 10%. For other conditions the proportions were: bronchitis (actual 82% versus ideal 13%); sore throat (actual 59% versus ideal 13%); rhinosinusitis (actual 88% versus ideal 11%); and acute otitis media in 2- to 18-year-olds (actual 92% versus ideal 17%). Substantial variation between practices was found. Conclusions This work has identified substantial overprescribing of antibiotics in English primary care, and highlights conditions where this is most pronounced, particularly in respiratory tract conditions.
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Affiliation(s)
- Koen B Pouwels
- Modelling and Economics Unit, National Infection Service, Public Health England, London, UK
- PharmacoTherapy, -Epidemiology & -Economics, Department of Pharmacy, University of Groningen, Groningen, The Netherlands
- MRC Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, Imperial College School of Public Health, London, UK
| | - F Christiaan K Dolk
- Modelling and Economics Unit, National Infection Service, Public Health England, London, UK
- PharmacoTherapy, -Epidemiology & -Economics, Department of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - David R M Smith
- Modelling and Economics Unit, National Infection Service, Public Health England, London, UK
| | - Julie V Robotham
- Modelling and Economics Unit, National Infection Service, Public Health England, London, UK
| | - Timo Smieszek
- Modelling and Economics Unit, National Infection Service, Public Health England, London, UK
- MRC Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, Imperial College School of Public Health, London, UK
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Jaume F, Quintó L, Alobid I, Mullol J. Overuse of diagnostic tools and medications in acute rhinosinusitis in Spain: a population-based study (the PROSINUS study). BMJ Open 2018; 8:e018788. [PMID: 29391364 PMCID: PMC5878244 DOI: 10.1136/bmjopen-2017-018788] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 10/16/2017] [Accepted: 11/23/2017] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES Acute rhinosinusitis (ARS) has a high incidence. Diagnosis is clinical, and evolution is mostly self-limited. The aim of this study was to describe the sociodemographic characteristics and use of diagnostic tools and medications in patients with ARS. DESIGN This is a prospective observational study in real-life clinical practice. SETTING Patients with clinical diagnosis of ARS (n=2610) were included from ear, nose and throat clinics in Spain. A second visit at resolution was done. PARTICIPANTS Patients were classified according to the duration of symptoms: viral ARS (≤10 days), postviral ARS (>10 days, ≤12 weeks) and chronic rhinosinusitis (>12 weeks). MAIN OUTCOME MEASURES Sociodemographic characteristics, symptoms, disease severity, quality of life (Sino-Nasal Outcome Test-16), used diagnostic tools and medications, and the management performed by primary care physicians (PCPs) and by otorhinolaryngologists (ORLs) were assessed. RESULTS Of the patients 36% were classified as having viral ARS, 63% postviral ARS and 1% as chronic rhinosinusitis. Working in a poorly air-conditioned environment was a risk factor (OR: 2.26, 95% CI 1.27 to 4.04) in developing postviral ARS. A higher number of diagnostic tools (rhinoscopy/endoscopy: 80% vs 70%; plain X-ray: 70% vs 55%; CT scan: 22% vs 12%; P<0.0001) were performed in postviral than viral cases. PCPs performed more X-rays than ORLs (P<0.0001). Patients, more those with postviral than viral ARS, received a high number of medications (oral antibiotics: 76% vs 62%; intranasal corticosteroids: 54% vs 38%; antihistamines: 46% vs 31%; mucolytic: 48% vs 60%; P<0.0001). PCPs prescribed more antibiotics, antihistamines and mucolytics than ORLs (P<0.0068). More patients with postviral than viral ARS reported symptoms of potential complications (1.5% vs 0.4%; P=0.0603). Independently of prescribed medications, quality of life was more affected in patients with postviral (38.7±14.2 vs 36.0±15.3; P=0.0031) than those with viral ARS. ARS resolution was obtained after 6.04 (viral) and 16.55 (postviral) days, with intranasal corticosteroids being associated with longer (OR: 1.07, 95% 1.02 to 1.12) and phytotherapy with shorter (OR: 0.95, 95% CI 0.91 to 1.00) duration. CONCLUSIONS There is a significant overuse of diagnostic tools and prescribed medications, predominantly oral antibiotics, by PCPs and ORLs, for viral and postviral ARS.
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Affiliation(s)
- Francesca Jaume
- Unitat de Rinologia i Clínica de l’Olfacte, Servei d’Otorinolaringologia, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
- Immunoal·lèrgia Respiratòria Clínica i Experimental, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Llorenç Quintó
- Institut de Salut Global de Barcelona (ISGlobal) de Recerca en Salut Internacional de Barcelona (CRESIB), Barcelona, Spain
- Centro de Investigación Biomédica En Red en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Isam Alobid
- Unitat de Rinologia i Clínica de l’Olfacte, Servei d’Otorinolaringologia, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
- Immunoal·lèrgia Respiratòria Clínica i Experimental, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica En Red en Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| | - Joaquim Mullol
- Unitat de Rinologia i Clínica de l’Olfacte, Servei d’Otorinolaringologia, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
- Immunoal·lèrgia Respiratòria Clínica i Experimental, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica En Red en Enfermedades Respiratorias (CIBERES), Barcelona, Spain
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