scholarly journals Clinical and microbiological investigations of typhoid fever in an infectious disease hospital in Kuwait

2007 ◽  
Vol 56 (4) ◽  
pp. 538-544 ◽  
Author(s):  
Tsonyo Dimitrov ◽  
Eded E. Udo ◽  
Ossama Albaksami ◽  
Shehab Al-Shehab ◽  
Abdal Kilani ◽  
...  
Keyword(s):  
Typhoid Fever ◽  
Nalidixic Acid ◽  
Treated Group ◽  
Multidrug Resistant ◽  
Diffusion Method ◽  
Microbiological Characteristics ◽  
The Mean ◽  
Disease Hospital ◽  
Mean Time ◽  
Level Resistance

A retrospective analysis of 135 typhoid cases was conducted to review the clinical, epidemiological and microbiological characteristics of enteric fever cases diagnosed and treated at the Infectious Diseases Hospital, Kuwait, from 2002 to 2005. Diagnosis of patients was based on clinical features, serology and blood culture. The susceptibility testing of the isolates to ampicillin, chloramphenicol, trimethoprim–sulfamethoxazole, ceftriaxone, ciprofloxacin and nalidixic acid was performed by the disc diffusion method, and MICs of ceftriaxone and ciprofloxacin were determined by Etest. Of 135 typhoid fever patients, 108 (88 %) were treated with ceftriaxone and 27 (20 %) were treated with ciprofloxacin. The mean time for fever defervescence with ciprofloxacin therapy was 8 days and 6.3 days for those treated with ceftriaxone. Of the 135 Salmonella enterica serotypes Typhi and Paratyphi A isolated from patients, 50 (37 %) were multidrug resistant (MDR) and 94 (69.6 %) isolates of both serotypes were nalidixic acid resistant (NAR). Between 90 and 100 % of MDR and NAR strains had decreased susceptibility to ciprofloxacin (0.125–1 μg ml−1). Low-level resistance to ciprofloxacin (MIC 0.125−1 μg ml−1) was also detected in 13.8 and 33.3 % of nalidixic acid-susceptible isolates of S. Typhi and S. Paratyphi A, respectively. All isolates were susceptible to ceftriaxone. Two relapses occurred in the ciprofloxacin-treated group. MDR strains and strains resistant to ciprofloxacin and ceftriaxone are a major threat in the developing world. A situation is fast approaching where the emergence of highly resistant Salmonella isolates is quite likely. Proper steps must be taken to avoid a pandemic spread of MDR S. Typhi strains.

scholarly journals Randomized Controlled Comparison of Ofloxacin, Azithromycin, and an Ofloxacin-Azithromycin Combination for Treatment of Multidrug-Resistant and Nalidixic Acid-Resistant Typhoid Fever

2006 ◽  
Vol 51 (3) ◽  
pp. 819-825 ◽  
Author(s):  
Christopher M. Parry ◽  
Vo Anh Ho ◽  
Le Thi Phuong ◽  
Phan Van Be Bay ◽  
Mai Ngoc Lanh ◽  
...  
Keyword(s):  
Typhoid Fever ◽  
Nalidixic Acid ◽  
Salmonella Enterica ◽  
Clinical Cure Rate ◽  
Controlled Trial ◽  
Multidrug Resistant ◽  
Cure Rate ◽  
Randomized Controlled ◽  
Fever Clearance Time ◽  
The Mean

ABSTRACT Isolates of Salmonella enterica serovar Typhi that are multidrug resistant (MDR, resistant to chloramphenicol, ampicillin, and trimethoprim-sulfamethoxazole) and have reduced susceptibility to fluoroquinolones (nalidixic acid resistant, Nar) are common in Asia. The optimum treatment for infections caused by such isolates is not established. This study compared different antimicrobial regimens for the treatment of MDR/Nar typhoid fever. Vietnamese children and adults with uncomplicated typhoid fever were entered into an open randomized controlled trial. Ofloxacin (20 mg/kg of body weight/day for 7 days), azithromycin (10 mg/kg/day for 7 days), and ofloxacin (15 mg/kg/day for 7 days) combined with azithromycin (10 mg/kg/day for the first 3 days) were compared. Of the 241 enrolled patients, 187 were eligible for analysis (186 S. enterica serovar Typhi, 1 Salmonella enterica serovar Paratyphi A). Eighty-seven percent (163/187) of the patients were children; of the S. enterica serovar Typhi isolates, 88% (165/187) were MDR and 93% (173/187) were Nar. The clinical cure rate was 64% (40/63) with ofloxacin, 76% (47/62) with ofloxacin-azithromycin, and 82% (51/62) with azithromycin (P = 0.053). The mean (95% confidence interval [CI]) fever clearance time for patients treated with azithromycin (5.8 days [5.1 to 6.5 days]) was shorter than that for patients treated with ofloxacin-azithromycin (7.1 days [6.2 to 8.1 days]) and ofloxacin (8.2 days [7.2 to 9.2 days]) (P < 0.001). Positive fecal carriage immediately posttreatment was detected in 19.4% (12/62) of patients treated with ofloxacin, 6.5% (4/62) of those treated with the combination, and 1.6% (1/62) of those treated with azithromycin (P = 0.006). Both antibiotics were well tolerated. Uncomplicated typhoid fever due to isolates of MDR S. enterica serovar Typhi with reduced susceptibility to fluoroquinolones (Nar) can be successfully treated with a 7-day course of azithromycin.

ANTIMICROBIAL SUSCEPTIBILITY IN CULTURE POSITIVE ENTERIC FEVER

2019 ◽  
Vol 3 (7) ◽  
Author(s):  
Dr. Manish Kulshrestha ◽  
Dr. Anjali Kulshrestha
Keyword(s):  
Bone Marrow ◽  
Blood Culture ◽  
Nalidixic Acid ◽  
Antimicrobial Susceptibility ◽  
Salmonella Enterica ◽  
Enteric Fever ◽  
Multidrug Resistant ◽  
Bone Marrow Culture ◽  
Diffusion Method ◽  
Culture Positive

INTRODUCTION: Enteric fever includes typhoid and paratyphoid fever. Peak incidence is seen in children 5–15 years of age; but in regions where the disease is highly endemic, as in India, children younger than 5 years of age may have the highest infection rates. There are about 22 million new typhoid cases occur each year. Young children in poor, resource limited areas, who make up the majority of the new cases and there is a mortality figures of 215,000 deaths annually. A sharp decline in the rates of complications and mortality due to typhoid fever is observed as a result of introduction of effective antibiotic therapy since 1950s. MDR-ST became endemic in many areas of Asia, including India soon after multidrug-resistant strains of Salmonella enterica serotype typhi (MDR-ST) that were resistant to all the three first-line drugs then in use, namely chloramphenicol, amoxycillin and co-trimoxazole emerged in early 1990s. MATERIAL AND METHODS: Only blood culture or bone marrow culture positive cases were included. The patients with culture isolated enteric fever were included in the study. Antimicrobial susceptibility testing was carried out by disk diffusion method using antibiotic discs. The analysis of the antimicrobial susceptibility was carried out as per CLSI interpretative guidelines. RESULTS: A total of 82 culture positive cases were included in the present study. 80 culture isolates were from blood culture and 2 from the bone marrow culture. Salmonella entericasubspecies enterica serovartyphi (S typhi) was isolated from 67 (81.70%) patients while Salmonella enterica subspecies entericaserovarparatyphi (S paratyphi A) was isolated from 13 (15.85%) cases and 2 (2.44%) were Salmonella enterica subspecies entericaserovarschottmuelleri (S paratyphi B). Of the 82 cases 65(79.3%) isolates were resistant to ciprofloxacin, 17 (20.7%) were resistant to nalidixic acid, one (1.2%) case each was resistant to Cefotaxime and ceftriaxone, 2 (2.4%) were resistant to chloramphenicol, 10 (12.2%) were resistant and to cotrimoxazole 3 (3.7%) were resistant. CONCLUSION: In a culture positive cases 65(79.3%) isolates were resistant to ciprofloxacin and 17 (20.7%) were resistant to nalidixic acid. Multidrug resistant isolates were 65(79.3%).

scholarly journals Sensitivity of Acinetobacter baumannii and Pseudomonas aeruginosa Microorganisms to Colistin Antibiotic by MIC (E-test) in Patients Admitted to the Intensive Care Unit of Firoozgar Hospital

2020 ◽  
Author(s):  
Mahin Jamshidi Makiani ◽  
Maryam Farasatinasab ◽  
Sam Bemani ◽  
Hoda Namdari Moghadam ◽  
Fatemeh Sheibani ◽  
...  
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Acinetobacter Baumannii ◽  
Antibiotic Sensitivity ◽  
Cross Sectional Study ◽  
Diffusion Method ◽  
Disk Diffusion Method ◽  
Cross Sectional ◽  
Hospitalization Period ◽  
The Mean ◽  
Mean Time

Background: Nosocomial infections are associated with increased morbidity, mortality, and medical burdens. Pseudomonas aeruginosa and Acinetobacter baumannii are not-fermentative gram-negative bacteria that considered as the most important nosocomial infection. In the current study, we have aimed to evaluate the sensitivity of Acinetobacter baumannii and Pseudomonas aeruginosa microorganisms to the colistin antibiotic. Methods: In this descriptive cross-sectional study, patients admitted to the ICU ward of Firoozgar Hospital from July 2018 to March 2019 were evaluated, and 169 Patients infected with Acinetobacter baumannii, and Pseudomonas aeruginosa were included. Acinetobacter baumannii and Pseudomonas aeruginosa were isolated, and antibiotic sensitivity was determined by the disk diffusion method according to Clinical & Laboratory Standards Institute (CLSI) criteria. E test was also used to determine MIC-50 and MIC-90 of colistin. Results: Acinetobacter baumannii was around 8 times more frequent than Pseudomonas aeruginosa. Colistin resistance was detected in only 4(2.4%). The mean age of patients infected by Acinetobacter baumannii was significantly higher than those infected with Pseudomonas aeruginosa. Moreover, the mean time of the hospitalization period did not show any significant differences in the different groups. Conclusion: Our findings indicated that the majority of isolated Pseudomonas aeruginosa and Acinetobacter baumannii were sensitive to Colistin. Therefore, it could be effectively used for patients with a confirmed diagnosis of Pseudomonas aeruginosa and Acinetobacter baumannii.

scholarly journals Clinical and Microbiological Characteristics of Culture-Positive, Influenza-Associated Pulmonary Aspergillosis: A Single-Center Study in Southern Taiwan, 2016–2019

2022 ◽  
Vol 8 (1) ◽  
pp. 49
Author(s):  
Chi-Jung Wu ◽  
Cong-Tat Cia ◽  
Hsuan-Chen Wang ◽  
Chang-Wen Chen ◽  
Wei-Chieh Lin ◽  
...  
Keyword(s):  
Medical Center ◽  
Pulmonary Aspergillosis ◽  
Microbiological Characteristics ◽  
Single Center Study ◽  
All Cause Mortality ◽  
Southern Taiwan ◽  
The Mean ◽  
Antifungal Use ◽  
Mean Time ◽  
Culture Positive

This study delineated the characteristics of 24 (11.2%) culture-positive, influenza-associated pulmonary aspergillosis (IAPA) patients out of 215 patients with severe influenza during 2016–2019 in a medical center in southern Taiwan. Twenty (83.3%) patients did not have EORTC/MSG-defined host factors. The mean time from influenza diagnosis to Aspergillus growth was 4.4 days, and 20 (83.3%) developed IAPA within seven days after influenza diagnosis. All patients were treated in intensive care units and all but one (95.8%) received mechanical ventilation. Aspergillus tracheobronchitis was evident in 6 (31.6%) of 19 patients undergoing bronchoscopy. Positive galactomannan testing of either serum or bronchoalveolar lavage was noted in all patients. On computed tomography imaging, IAPA was characterized by peribronchial infiltrates, multiple nodules, and cavities superimposed on ground-glass opacities. Pure Aspergillus growth without bacterial co-isolation in culture was found in 17 (70.8%) patients. A. fumigatus (15, 62.5%), A. flavus (6, 25.0%), and A. terreus (4, 16.7%) were the major causative species. Three patients had mixed Aspergillus infections due to two species, and two had mixed azole-susceptible and azole-resistant A. fumigatus infection. All patients received voriconazole with an all-cause mortality of 41.6%. Of 14 survivors, the mean duration of antifungal use was 40.5 days. In conclusion, IAPA is an early and rapidly deteriorating complication following influenza that necessitates clinical vigilance and prompt diagnostic workup.

scholarly journals Pharmacokinetics of oral and intravenous ofloxacin in children with multidrug-resistant typhoid fever.

1996 ◽  
Vol 40 (9) ◽  
pp. 2167-2172 ◽  
Author(s):  
D B Bethell ◽  
N P Day ◽  
N M Dung ◽  
C McMullin ◽  
H T Loan ◽  
...  
Keyword(s):  
Oral Administration ◽  
Typhoid Fever ◽  
Apparent Volume ◽  
Salmonella Typhi ◽  
Multidrug Resistant ◽  
Volume Of Distribution ◽  
Systemic Clearance ◽  
Time To Peak ◽  
The Mean ◽  
Intravenous And Oral Administration

The pharmacokinetics of oral and intravenous ofloxacin (7.5 mg.kg of body weight-1 given over 30 min) were studied in an open crossover study of 17 Vietnamese children, aged between 5 and 14 years, with acute uncomplicated typhoid fever. Following oral administration, the median (95% confidence interval [CI]) time to peak concentration of ofloxacin in serum (Cmax) was 1.7 h (1.4 to 1.9 h) and the mean (95% CI) Cmax was 5.5 mg.liter-1 (4.7 to 6.3 mg.liter-1) compared with a Cmax of 8.7 mg.liter-1 (7.6 to 9.7 mg.liter-1) following the intravenous infusion. The median (95% CI) total apparent volume of distribution following the first intravenous dose, 1.35 liter.kg-1 (1.17 to 1.73 liter.kg-1), was significantly larger than that following the second dose, 0.99 liter.kg-1 (0.86 to 1.17 liter.kg-1; P < 0.0005), although the estimates for systemic clearance were similar: 0.255 liter.kg-1 h-1 (0.147 to 0.325 liter.kg-1 h-1) compared with 0.172 liter.kg-1 h-1 (0.127 to 0.292 liter.kg-1 h-1; P = 0.14). The mean residence times (95% CI) following intravenous and oral administration were similar: 5.24 h (4.84 to 6.58 h) and 6.24 h (5.32 to 7.85 h), respectively. The mean (95% CI) oral bioavailability was 91% (74 to 109%). The peak concentrations in serum were 10 to 100 times higher than the maximum MICs for ofloxacin against multidrug-resistant Salmonella typhi isolated in this area. Although the systemic clearance values were higher than those reported previously for adults, these data overall suggest that weight-or area-adjusted dose regimens for the treatment of typhoid in older children should be the same as those for adults.

scholarly journals Effect of LH on circulating oestradiol and follicular fluid factor concentrations during follicle deviation in cattle

Reproduction ◽  
2001 ◽  
pp. 103-110 ◽  
Author(s):  
OJ Ginther ◽  
DR Bergfelt ◽  
MA Beg ◽  
K Kot
Keyword(s):  
Growth Factor ◽  
Follicular Fluid ◽  
Plasma Concentrations ◽  
Treated Group ◽  
Transient Increase ◽  
Insulin Like Growth Factor ◽  
Fluid Factor ◽  
Igf I ◽  
The Mean ◽  
Mean Time

Progesterone was used to reduce LH concentrations starting at the time when the largest follicle was > or = 5.7 mm in diameter or well before the expected start of follicle deviation (largest follicle > or = 8.5 mm in diameter). Plasma concentrations of LH, FSH and oestradiol were determined at 4 h intervals in control and progesterone-treated heifers (n = 8 per group). Concentrations of LH were lower (P < 0.05) in the progesterone-treated group, reflecting an absence of the transient increase in LH concentrations that encompasses follicle deviation. An increase in oestradiol and a continued decrease in FSH occurred at the start of follicle deviation in the control cows but not in the treated heifers. In a second experiment, follicular fluid of the two largest follicles of control and progesterone-treated heifers was sampled at the expected start of deviation (n = 8--10 per group). The concentrations of oestradiol, but not androstenedione and free insulin-like growth factor I (IGF-I), in follicular fluid were higher (P < 0.001) in the largest follicle than in the second largest follicle. Progesterone treatment reduced (P < or = 0.02) the concentrations of all three factors in follicular fluid and increased (P < 0.05) the concentrations of insulin-like growth factor binding protein 2 (IGFBP-2). These results confirm that oestradiol contributes to the continued decrease in FSH concentrations after the start of follicle deviation. Prevention of the transient LH increase, the oestradiol increase and the continued FSH decrease did not significantly alter the mean time or follicle diameters characteristic of expected follicle deviation. However, in some treated individuals (three of eight), the observed follicle deviation was delayed. In addition, these results indicate that the secretion of oestradiol into the circulation and the increase in oestradiol and IGF-I and decrease in IGFBP-2 concentrations in the follicular fluid at the start of deviation are functions of the transient increase in LH concentrations that encompasses follicle deviation.

scholarly journals Multidrug-resistant Escherichia coli and Salmonella spp. isolated from pigeons

2020 ◽  
Vol 13 (10) ◽  
pp. 2156-2165
Author(s):  
Shah Jungy Ibna Karim ◽  
Mahfuzul Islam ◽  
Tahmina Sikder ◽  
Rubaya Rubaya ◽  
Joyanta Halder ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Nalidixic Acid ◽  
Multidrug Resistant ◽  
Diffusion Method ◽  
Resistant Bacteria ◽  
Biochemical Tests ◽  
Salmonella Spp ◽  
Disk Diffusion Method ◽  
Significant Positive Association ◽  
E Coli

Background and Aim: Pigeon rearing has been gaining popularity for recent years. They are reared remarkably very close to the house of the owner. This activity, therefore, may pose potential threats for humans as well as other animals as pigeons may carry and spread different pathogens including drug-resistant bacteria. This study was conducted to explore the prevalence of Escherichia coli and Salmonella spp. as well as their antibiogram profile along with an association analysis. Materials and Methods: Forty swab samples were collected from 20 pigeons during the study. E. coli and Salmonella spp. were isolated and identified on various types of agars, including MacConkey, Eosin methylene blue, Brilliant green, and Salmonella-Shigella agar. Biochemical tests such as the carbohydrate fermentation test, the triple sugar iron agar slant reaction, the indole test, the methyl red test, the catalase test, as well as the Voges–Proskauer test were also performed. Besides, the presence of E. coli was further confirmed by polymerase chain reaction (PCR). Moreover, antimicrobial susceptibility testing of the isolates was performed against nine antibiotics from seven classes on the Mueller-Hinton agar based on the Kirby–Bauer disk diffusion method. Results: The overall prevalence of E. coli and Salmonella spp. was 52.5 and 27.5%, respectively. The prevalence of the pathogenic E. coli was 61.90%. The antibiogram profile of 21 E. coli as well as 11 Salmonella spp. revealed that all isolates, except one, were resistant to one to six antibiotics. Around 61.90%, 71.43%, 23.81%, 61.90%, 23.81%, 19.05%, and 52.38% of E. coli showed resistance against amoxicillin, ampicillin, azithromycin, erythromycin, nalidixic acid, gentamicin, and tetracycline, respectively. Furthermore, E. coli resistance was not observed in case of ciprofloxacin and levofloxacin. Similarly, around 36.36%, 27.27%, 27.27%, 45.45%, 81.82%, 100%, and 18.18% of the Salmonella spp. showed resistance against amoxicillin, ampicillin, azithromycin, erythromycin, nalidixic acid, tetracycline, and levofloxacin, respectively. However, all Salmonella spp. (100%) were found to show sensitivity against ciprofloxacin and gentamicin. Multidrug-resistant (MDR) E. coli (23.80%) and Salmonella spp. (54.54%) were also isolated. Furthermore, both positive (odds ratio [OR] >1) and negative (OR <1) drug resistance associations, with a higher frequency of positive associations, were found in E. coli. A significant positive association was observed between ampicillin and amoxicillin (OR: 81.67, 95% confidence interval: 2.73-2447.57, p=0.01). Conclusion: Pigeon carrying MDR E. coli and Salmonella spp. may contribute to the transmission and spread of these microorganisms. Therefore, strict hygienic measures should be taken during the farming of pigeons to decrease the potential transmission of E. coli and Salmonella spp. from pigeon to humans as well as other animals. So far, this is the first report of the PCR-based identification of pathogenic E. coli from pigeons in Bangladesh.

Predicting Daily Maintenance Dose of Fluindione, an Oral Anticoagulant Drug

1996 ◽  
Vol 75 (05) ◽  
pp. 731-733 ◽  
Author(s):  
V Cazaux ◽  
B Gauthier ◽  
A Elias ◽  
D Lefebvre ◽  
J Tredez ◽  
...  
Keyword(s):  
Effective Dose ◽  
Maintenance Dose ◽  
Successive Approximations ◽  
Hemorrhagic Complication ◽  
Simple Method ◽  
Individual Variations ◽  
Anticoagulant Drug ◽  
The Mean ◽  
Mean Time ◽  
Daily Maintenance Dose

SummaryDue to large inter-individual variations, the dose of vitamin K antagonist required to target the desired hypocoagulability is hardly predictible for a given patient, and the time needed to reach therapeutic equilibrium may be excessively long. This work reports on a simple method for predicting the daily maintenance dose of fluindione after the third intake. In a first step, 37 patients were delivered 20 mg of fluindione once a day, at 6 p.m. for 3 consecutive days. On the morning of the 4th day an INR was performed. During the following days the dose was adjusted to target an INR between 2 and 3. There was a good correlation (r = 0.83, p<0.001) between the INR performed on the morning of day 4 and the daily maintenance dose determined later by successive approximations. This allowed us to write a decisional algorithm to predict the effective maintenance dose of fluindione from the INR performed on day 4. The usefulness and the safety of this approach was tested in a second prospective study on 46 patients receiving fluindione according to the same initial scheme. The predicted dose was compared to the effective dose soon after having reached the equilibrium, then 30 and 90 days after. To within 5 mg (one quarter of a tablet), the predicted dose was the effective dose in 98%, 86% and 81% of the patients at the 3 times respectively. The mean time needed to reach the therapeutic equilibrium was reduced from 13 days in the first study to 6 days in the second study. No hemorrhagic complication occurred. Thus the strategy formerly developed to predict the daily maintenance dose of warfarin from the prothrombin time ratio or the thrombotest performed 3 days after starting the treatment may also be applied to fluindione and the INR measurement.

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