Empiric Treatment of Foot Infection in Patients with Severe Diabetes

2021 ◽  
Author(s):  
Alexandre Sacchetti Bezerra ◽  
◽  
Flavia Altheman Loureiro ◽  
Carla Maria Pasquareli Vazquez ◽  
Afonso Cesar Polimanti ◽  
...  
Keyword(s):  
Broad Spectrum ◽  
Bacterial Resistance ◽  
Empirical Therapy ◽  
Empirical Treatment ◽  
Diabetic Patients ◽  
Gram Positive ◽  
International Consensus ◽  
Gram Negative ◽  
Severe Diabetes ◽  
High Incidence

Background: Despite being treated with antibiotics of broad spectrum recommended by International Consensus, severe diabetic patients with lower limb infection do not present a positive clinical evolution during empirical treatment. This study’s bacterial profile was analysed and compared with other worldwide hospital centers. Objective: To confirm the need of an individualized empirical treatment for severe diabetic patients with foot infection. Methods: Retrospective analysis of cultures and antibiograms of severe diabetic patients admitted by foot infection. Results: The results were consistent with the socioeconomic realities of developing countries. Gram-negative bacteria (52,11%) were present in most bone cultures. Results presented a high incidence of Enterococcus faecalis in both gram-positive (21,2%) and polymicrobial (34,7%) samples. Bacterial resistance with the use of ordinary antibiotics in the statistical analysis was high. Conclusion: The community infections should undergo broad spectrum empirical therapy combining amikacin (80,43%) or meropenem (72,00%) with gram-negative and vancomycin (100%) or teicoplanin (90,00%) or linezolid (74,19%) with gram-positive.

scholarly journals Kibdelomycin Is a Bactericidal Broad-Spectrum Aerobic Antibacterial Agent

2015 ◽  
Vol 59 (6) ◽  
pp. 3474-3481 ◽  
Author(s):  
Sheo B. Singh ◽  
Priya Dayananth ◽  
Carl J. Balibar ◽  
Charles G. Garlisi ◽  
Jun Lu ◽  
...  
Keyword(s):  
Broad Spectrum ◽  
Bacterial Resistance ◽  
Selective Inhibition ◽  
Cross Resistance ◽  
Topoisomerase Iv ◽  
Gram Positive ◽  
Entry Barrier ◽  
Strong Activity ◽  
Gram Negative ◽  
Content Type

ABSTRACTBacterial resistance to antibiotics continues to grow and pose serious challenges, while the discovery rate for new antibiotics declines. Kibdelomycin is a recently discovered natural-product antibiotic that inhibits bacterial growth by inhibiting the bacterial DNA replication enzymes DNA gyrase and topoisomerase IV. It was reported to be a broad-spectrum aerobic Gram-positive agent with selective inhibition of the anaerobic bacteriumClostridium difficile. We have extended the profiling of kibdelomycin by using over 196 strains of Gram-positive and Gram-negative aerobic pathogens recovered from worldwide patient populations. We report the MIC50s, MIC90s, and bactericidal activities of kibdelomycin. We confirm the Gram-positive spectrum and report for the first time that kibdelomycin shows strong activity (MIC90, 0.125 μg/ml) against clinical strains of the Gram-negative nonfermenterAcinetobacter baumanniibut only weak activity againstPseudomonas aeruginosa. We confirm that well-characterized resistant strains ofStaphylococcus aureusandStreptococcus pneumoniaeshow no cross-resistance to kibdelomycin and quinolones and coumarin antibiotics. We also show that kibdelomycin is not subject to efflux inPseudomonas, though it is inEscherichia coli, and it is generally affected by the outer membrane permeability entry barrier in the nonfermentersP. aeruginosaandA. baumannii, which may be addressable by structure-based chemical modification.

scholarly journals Impact of Culture Sensitivity Reports on the Pattern of Antibiotics use and Cost of Therapy: A Prospective Observational study

2020 ◽  
Author(s):  
Ummara Altaf ◽  
Muhammad Furqan Akhtar ◽  
Bashir Ahmad ◽  
Hassan Mehmood Yasir ◽  
Brian Godman ◽  
...  
Keyword(s):  
Observational Study ◽  
Broad Spectrum ◽  
Prospective Observational Study ◽  
Inappropriate Prescribing ◽  
Empirical Therapy ◽  
Definitive Treatment ◽  
Diffusion Method ◽  
Gram Positive ◽  
Gram Negative ◽  
Culture Sensitivity

Abstract Background: There are concerns with inappropriate prescribing of antibiotics in hospitals especially broad spectrum in Pakistan and the subsequent impact on antimicrobial resistance rates. One recognized way to reduce inappropriate prescribing is for empirical therapy to be adjusted according to the result of culture sensitivity reports.Objective: To find the impact of culture sensitivity reports on the use of antibiotics and cost in a leading tertiary care hospital in Lahore.Methods: This prospective observational study was carried out in Ghurki trust teaching hospital. A total of 465 positive culture patients were taken over an 8 month study period using convenient sampling techniques and immediately sent to the microbiology laboratory for pathogen identification and susceptibility testing using the Kirby-Bauer disc diffusion method. Additional data was collected from the patient medical file which included demographic data, sample type, causative microbe, anti-microbial treatment given in empirical and definitive treatment as well as medicine costs. Results: Total of 497 isolates were detected from the 465 patient samples, which included 309 gram-negative rods and 188 gram-positive cocci. Out of 497 isolates, the most common Gram-positive pathogen isolated was MSSA (28.4%) and Gram-negative was E. coli (23.8%). Most of the gram-negative isolates were found to be resistant to ampicillin and co-amoxiclav. Most of the A. baumannii isolates were resistant to carbapenems. Gram-positive microorganism showed the maximum sensitivity to linezolid and vancomycin. The most widely used antibiotics in empirical therapy were cefoperazone+sulbactam, ceftriaxone, amikacin, vancomycin and metronidazole whereas high use of linezolid, clindamycin, meropenem and piperacillin + tazobactam was evidenced in definitive treatment. Empiric therapy was adjusted in 222 (71.8%) cases of Gram-negative infections and 131 (69.6%) cases of gram-positive infections (p-value <0.0001). Compared with empirical therapy, there was a 13.8% reduction in the number of antibiotics in definitive treatment. The average costs of antibiotics in definitive treatment was less than the empirical treatment (8.2%) and the length of hospitalization also decreased.Conclusion: Culture sensitivity reports helped reduce antibiotic utilization, hospital stay and costs as well as helping select the most appropriate treatment. We also found an urgent need for implementing antimicrobial stewardship programs and the development of hospital antibiotic guidelines within the hospital to reduce future unnecessary prescribing of broad-spectrum antibiotics.

Fusogenic porous silicon nanoparticles as a broad-spectrum immunotherapy against bacterial infections

2021 ◽  
Author(s):  
Byungji Kim ◽  
Qinglin Yang ◽  
Leslie W. Chan ◽  
Sangeeta N. Bhatia ◽  
Erkki Ruoslahti ◽  
...  
Keyword(s):  
Porous Silicon ◽  
Broad Spectrum ◽  
Therapeutic Efficacy ◽  
Bacterial Infections ◽  
Silicon Nanoparticles ◽  
First Line ◽  
Gram Positive ◽  
Gram Negative ◽  
Porous Silicon Nanoparticles

RNAi-mediated immunotherapy provided by fusogenic porous silicon nanoparticles demonstrates superior therapeutic efficacy against both Gram-positive and Gram-negative bacterial infections compared with first-line antibiotics.

scholarly journals NEW INSIGHT ON EPIDEMIOLOGY AND MANAGEMENT OF BACTERIAL BLOODSTREAM INFECTION IN PATIENTS WITH HEMATOLOGICAL MALIGNACIES

2015 ◽  
Vol 7 ◽  
pp. e2015044 ◽  
Author(s):  
Sara Lo Menzo ◽  
Giulia La Martire ◽  
Giancarlo Ceccarelli ◽  
Mario Venditti
Keyword(s):  
Febrile Neutropenia ◽  
Bloodstream Infections ◽  
Multidrug Resistant ◽  
Empirical Treatment ◽  
Rational Approach ◽  
Attributable Mortality ◽  
Low Grade ◽  
Gram Positive ◽  
Adequate Treatment ◽  
Gram Negative

Bloodstream infections (BSI) are an important cause of morbidity and mortality in onco-hematologic patients. The Gram-negative etiology was the main responsible of the febrile neutropenia in the sixties and its impact declined due to the use of fluoroquinolone prophylaxis; this situation was followed by the gradual emergence of Gram-positive bacteria also following of the increased use of intravascular devices and the introduction of new chemotherapeutic strategies. In the last decade the Gram-negative etiology is raising again because of the emergence of resistant strains that make questionable the usefulness of currentstrategies for prophylaxis and empirical treatment. Gram-negative BSI attributable mortality is relevant and the appropriate empirical treatment significantly improves the prognosis; on the other hand the delayed adequate treatment of Gram-positive BSI does not seem to have an high impact on survival. The clinician has to be aware of the epidemiology of his institution and of colonizations of his patients in order to choose the most appropriate empiric therapy. Ina setting of high endemicity of multidrug-resistant infections, even the choice of a targeted therapy can be a challenge, often requiring strategies based on off-label prescriptions and low grade evidences.In this review we summarize the current evidences for the best targeted therapies for difficult to treat bacteria BSIs and future perspectives in this topic. We also provide a flow chart for a rational approach to the empirical treatment of febrile neutropenia in a multidrug resistant high prevalence setting.

Efficacy of some medicated soaps and hand washes available in market

2021 ◽  
Vol 3 (1) ◽  
pp. 047-055
Author(s):  
Pimpliskar Mukesh ◽  
SoumyaGounder ◽  
Rahul Jadhav
Keyword(s):  
Broad Spectrum ◽  
Life Forms ◽  
Small Scale ◽  
Gram Positive ◽  
Consistent Finding ◽  
Gram Negative ◽  
Cross Transmission ◽  
Spectrum Activity ◽  
Significant Measure ◽  
Broad Spectrum Activity

Background: Handwashing is underlined as the absolute most significant measure to forestall cross-transmission of small-scale life forms and consequently to forestall nosocomial contaminations. Be that as it may, under routine emergency clinic practice consistent with this measure is still unsatisfactorily low, under half in many investigations distributed in the previous 20 years. This consistent finding is stressing because ongoing investigations have demonstrated that this degree of consistency won't decrease the danger of transmission of multi- medicate safe microscopic organisms in the emergency clinics. Results: In the present investigation effect of marketed hand washed namely Lifebuoy, Dettol and Savlon were tested on bacteria E. coli, S.aureus, S.pyogen, Klebshiella and, fungi Candida albicans. All the handwash at concentrated level found to be effective but only Dettol hand wash could give inhibitory action at 25ug/ml against Klebshiella while others at50ug/ml. Conclusions: Soapex and Dettol soap had broad spectrum activity as it inhibited the growth of Gram positive (Streptococcus pyogen) and Gram-negative (Escherichia coli). Liquid handwash such as Lifebuoy,Dettol and Savlon showed broad spectrum activity on both Gram-positive and Gram negative test microorganisms.

Evolution of Our Experience in Diagnosis and Therapy for Urinary Infections

2009 ◽  
Vol 76 (2) ◽  
pp. 140-143
Author(s):  
R. Pizzorno ◽  
A. Simonato ◽  
M. Esposito ◽  
T. Montanaro ◽  
M. Mussap ◽  
...  
Keyword(s):  
Enterococcus Faecalis ◽  
Empirical Therapy ◽  
Enterococcus Species ◽  
Bacterial Strains ◽  
Gram Positive ◽  
Gram Negative ◽  
E Coli ◽  
Diagnosis And Therapy ◽  
Urinary Infections ◽  
Spectrum Activity

The therapy for urinary infections is advised according to the antibiogram; the symptoms request an empirical therapy based on urinary infections knowledge and drugs spectrum activity. We considered the urinoculture performed on 3834 patients, 3012 male and 822 female, hospitalized in our Institute in the period between 01/01/2005 and 31/10/2006; 444 of these were positive (12.7 % - 451 bacterial strains). Table 1: bacterial strains isolaed. We reported some evaluations obtained by antibiogram. E. coli strains Ciprofloxacin sensitive resulted in 60% of cases. Enterococcus species and Enterococcus faecalis strains Ampicillin sensitive resulted in 96.4% and 100% of cases, respectively. In this study there is a Gram negative prevalence, whereas we had previously observed an equivalence between Gram negative and Gram positive (p 0.001). These data are useful for empirical therapy.

scholarly journals Bacteraemia and antibiotic susceptibility pattern of isolates from patients visiting a private hospital of Kathmandu

2018 ◽  
Vol 5 ◽  
pp. 39-44
Author(s):  
Nandalal Jaishi ◽  
Pramila Pathak ◽  
Pradeep Kumar Shah ◽  
Puspa Raj Dahal
Keyword(s):  
Antibiotic Susceptibility ◽  
Blood Stream Infection ◽  
Empirical Therapy ◽  
Blood Stream ◽  
Salmonella Typhi ◽  
Diffusion Method ◽  
Microbiological Analysis ◽  
Gram Positive ◽  
Gram Negative ◽  
Causative Agents

Background: Bacteraemia can develop a broad array of complications that may be difficult to recognize initially and can increase morbidity. The study was thus conducted to identify the causative agents of bacteraemia and to assess antibiogram of the isolates among the patients suspected of blood stream infection visiting Everest hospital, New Baneshwor Kathmandu. Methods: Altogether 400 blood cultures were processed during March, 2015 to August, 2015. Standard Operating Procedures (SOPs) was followed during the processing of the specimens. Antibiotic susceptibility testing of bacterial isolates was done by Kirby Bauer disc diffusion method with Muller-Hinton agar using the guidelines and interpretive criteria of the Clinical and Laboratory Standards Institute (CLSI 2013). Result: The positivity of blood culture was found to be 48 (12%). Gram negative bacterial were found to be more predominant 27(56.2%) than gram positive bacteria 21(43.7%) in causing bacteraemia. The most prevalent isolate was Staphylococcus aureus 15 (31.2%) followed by Salmonella Paratyphi A 10 (20.8%) and Salmonella Typhi 8 (16.6%), E. coli & CoNS 4 (8.3%), Pseudomonas aeruginosa 3 (6.2%) and Klebsiella pneumoniae & Streptococcus pneumoniae 2 (4.1%) respectively. All gram-positive isolates were found to be sensitive to Cefoxitin, Ceftriaxone and Vancomycin followed by Ampicillin (90.42%), Erythromycin (85.71%), Ciprofloxacin (83.33%), Doxycycline (75%) and Cephalexin (70.58%) whereas gram negative isolates were sensitive to Ceftriaxone followed by Chloramphenicol (92%), Gentamicin (88.8%), Cefixime (85.71%), Ofloxacin (83.3%) and Amoxycillin and Ciprofloxacin (71.3%) Conclusion: The isolation of etiological agents of blood stream infection should be assessed by proper microbiological analysis and it would be helpful for controlling of the outbreaks of resistance strains through effective empirical therapy.

Microbiology of Ventilator–Associated Pneumonia Compared With That of Hospital-Acquired Pneumonia

2007 ◽  
Vol 28 (7) ◽  
pp. 825-831 ◽  
Author(s):  
David J. Weber ◽  
William A. Rutala ◽  
Emily E. Sickbert-Bennett ◽  
Gregory P. Samsa ◽  
Vickie Brown ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Empirical Therapy ◽  
Ventilator Associated Pneumonia ◽  
Gram Positive ◽  
Similar Frequency ◽  
Gram Negative ◽  
Hospital Acquired Pneumonia ◽  
Hospital Acquired ◽  
Gram Positive Cocci ◽  
Ventilated Patients

Objective.Nosocomial pneumonia is the leading cause of mortality attributed to nosocomial infection. Appropriate empirical therapy has been associated with improved survival, but data are limited regarding the etiologic agents of hospital-acquired pneumonia in non-ventilated patients (HAP). This evaluation assessed whether the currently recommended empirical therapy is appropriate for both ventilator-associated pneumonia (VAP) and HAP by evaluating the infecting flora.Design.Prospectively collected hospitalwide surveillance data was obtained by infection control professionals using standard Centers for Disease Control and Prevention definitions.Setting.A tertiary care academic hospital.Patients.All patients admitted from 2000 through 2003.Results.A total of 588 episodes of pneumonia were reported in 556 patients: 327 episodes of VAP in 309 patients, and 261 episodes of HAP in 247 Patients. The infecting flora in ventilated patients included gram-positive cocci (32.0% [oxacillin-susceptible Staphylococcus aureus {OSSA}, 9.25%; oxacillin-resistant Staphylococcus aureus {ORSA}, 17.75%]), gram-negative bacilli (59.0% {Pseudomonas aeruginosa, 17.50%; Stenotrophomonas maltophilia, 6.75%; Acinetobacter species, 7.75%), and miscellaneous pathogens (9.0%). The infecting flora in nonventilated patients included gram-positive cocci (42.59% [OSSA, 13.33%; ORSA, 20.37%]), gram-negative bacilli (39.63% [P. aeruginosa, 9.26%; S. maltophilia, 1.11%; Acinetobacter species, 3.33%), and miscellaneous pathogens (17.78%).Conclusions.Our data demonstrated that patients with HAP, compared with those with VAP, had a similar frequency of infection with ORSA but less commonly had infections due to P. aeruginosa, Acinetobacter species, and S. maltophilia. However, the overall frequency of infection with these pathogens was sufficiently high to warrant the use of empirical therapy likely to be active against them. Our data supports using the currently recommended empirical therapy for both HAP and VAP.

scholarly journals Potential Assessment of Rumex spp. as a Source of Bioactive Compounds and Biological Activity

2021 ◽  
Vol 12 (2) ◽  
pp. 1824-1834
Keyword(s):  
Antioxidant Activity ◽  
Broad Spectrum ◽  
Pathogenic Bacteria ◽  
Gram Negative Bacteria ◽  
Meoh Extract ◽  
Gram Positive ◽  
Filter Paper Disc ◽  
Gram Negative ◽  
Gram Positive Bacteria ◽  
Antibacterial Performance

Secondary metabolites from the shoots and roots of three Rumex species collected from three different habitats were investigated (Rumex dentatus collected from cultivated land, R. pictus collected from the coastal desert and R. vesicarius collected from the inland desert) and tested for antioxidant activity as well as for anti-microbial activity against some human pathogenic bacteria. The present study indicated that the quantitative analysis of shoot and root extracts of three Rumex spp. were found to be rich in tannins and phenolics composition. The aerial parts of the three plants exhibited the highest significant values compared to the root parts. The MeOH extracts of Rumex species showed adequate antioxidant activity, wherein the IC50 values of the MeOH from the cultivated sample was 41.61 and 31.31 mg mL-1, coastal samples were 34.99 and 23.99 mg mL-1, while the sample of inland showed IC50 value of 41.59 and 31.67 mg mL-1, for root and shoot, respectively. Furthermore, using a filter paper disc assay, the MeOH extracts of the three Rumex species showed a substantial anti-microbial inhibitory effect on the growth of 10 pathogenic bacteria. According to sensitivity, the tested organisms could be sequenced as following: E. coli < K. pneumoniae ˂ S. typhi < P. aeruginosa for Gram-negative bacteria and B. subtilis < S. pneumoniae ˂ L. monocytoyenes < S. epidermis < S. aureus < B. cereus for Gram-positive bacteria. In addition, the antibacterial performance of R. dentatus root and R. vesicarius shoot MeOH extract is 100% broad spectrum against Gram-negative bacteria. A shoot of R. dentatus and R. pictus MeOH extract against Gram-positive bacteria is 83.3% broad spectrum. A further study is recommended for more characterization of the major compounds and assesses their efficiency and biosafety.

Use of Antimicrobials and Toxicity

2019 ◽  
Author(s):  
Armine Sefton
Keyword(s):  
Immune System ◽  
Broad Spectrum ◽  
Therapeutic Index ◽  
Beta Lactam ◽  
Beta Lactams ◽  
Gram Positive ◽  
Gram Negative ◽  
Narrow Spectrum ◽  
Source Of Infection ◽  
Bactericidal Agent

Broad-spectrum antibacterial agents kill most bacteria including gram-positive rods and cocci, gram-negative rods and cocci, and often anaerobes too. Narrow-spectrum agents kill a narrow range of microbes, e.g. benzylpenicillin is mainly active against gram-positive cocci. By and large a narrow-spectrum antimicrobial is less likely to disrupt a patient’s normal flora than a broad-spectrum agent. Hence, if the likely organism is causing an infection it is best to give a narrow-spectrum antimicrobial to treat that specific organism. If a patient presents ‘septic’ and the source of infection is unknown, relevant cultures should be taken followed by broad-spectrum antimicrobial cover. This can later be modified either when the source of infection is found or as a result of microbiology culture results. ● Agents mostly active against gram-positive bacteria include: ■ Penicillin (Also active against Neisseria spp.). ■ Fusidic acid. ■ Macrolides (Also active against Legionella, Campylobacter, Bordetella spp.). ■ Clindamycin. ■ Glycopeptides. ■ Oxazolidinones. ■ Streptogramins. ● Agents mainly active against gram-negative bacteria include: ■ Polymyxin. ■ Trimethoprim. ■ Aminoglycosides (also active against staphylococci and show synergy when combined with beta-lactams against/glycopeptides against streptococci). ■ Monobactams. ■ Temocillin. ● Broad-spectrum antimicrobials include: ■ Beta-lactam plus beta-lactamase inhibitor combinations. ■ Cephalosporins. ■ Carbapenems. ■ Chloramphenicol, Tetracyclines/Glycyclines. A bactericidal agent is a compound that actively kills multiplying bacteria. A bacteriostatic compound inhibits the growth of bacteria. Whether or not an antimicrobial is bactericidal or bacteriostatic depends on a variety of things, including the type of agent, its concentration, and the organism it is being used to treat. It is especially important to try and use a bactericidal agent if the patient’s immune system is impaired or the infection is at a site where it is difficult for the immune system to access, e.g. the heart valves in bacterial endocarditis, the meninges in meningitis. Examples of each are given here: ● Bactericidal agents include beta-lactams, glycopeptides, fluoroquinolones, and aminoglycosides. ● Bacteriostatic agents include macrolides, clindamycin, tetracyclines, trimethoprim, and sulphonamides. The therapeutic index of a drug is the ration of the concentration of drug likely to be toxic to the patient divided by the concentration of drug likely to be clinically effective.

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