The effect of tryptamine on Serratia marcescens, Pseudomonas aeruginosa and Escherichia coli

Aims@#Tryptamine is an amine compound derived from tryptophan by decarboxylation process. This compound can be found in fermented food and beverages, and in human gut and skin as well. This study aims to investigate the effect of tryptamine, on Gram-negative bacteria, namely Escherichia coli, Serratia marcescens and Pseudomonas aeruginosa.@*Methodology and results@#In this study, we used E. coli, S. marcescens and P. aeruginosa due to their relatively observable quorum sensing-regulated phenotype, such as motility, prodigiosin and pyocyanin sequentially. Our results showed that tryptamine started to inhibit the growth and prodigiosin production of S. marcescens at concentration 250 μg/mL, while it inhibits the growth and pyocyanin production of P. aeruginosa at concentration 250 μg/mL and 500 μg/mL, respectively. Tryptamine inhibits both the growth and motility of E. coli at concentration 100 μg/mL. @*Conclusion, significance and impact of study@# These results suggest that tryptamine is able to inhibit the growth of E. coli, S. marcescens and P. aeruginosa at relatively high concentration, thus decreases the quorum sensing-regulated phenotypes. It implies that the growth and quorum sensing of Gram-negative bacteria most likely will not be affected by the low concentration of tryptamine that present in the gut.

Availability and quality of procedural sedation and analgesia in emergency departments without emergency physicians: A national survey in the Netherlands / 世界急诊医学杂志（英文）

BACKGROUND@# Emergency physicians have been successful in implementing procedural sedation and analgesia (PSA) to treat emergency department (ED) patients who need to undergo painful procedures. However, 25% of the EDs in the Netherlands are not staffed by emergency physicians. The aim of this study was to investigate PSA availability and quality in EDs without emergency physicians.@*METHODS@# We performed an exploratory cross-sectional study amongst ED nurses and physicians in all 13 EDs without emergency physicians in the Netherlands. Data were gathered using a standardized questionnaire.@*RESULTS@# The response rate was 34.3% (148/432). Of the respondents, 84/148 (56.8%) provided adult PSA and 30/148 (20.3%) provided paediatric PSA. Main reasons for not providing PSA were insufficient numbers of trained staff to support PSA in the ED and insufficient training and exposure. The providers agreed significantly stronger when reflecting their PSA competencies in adults compared to paediatric patients.@*CONCLUSION@# The key to improve pain management in the ED-setting may lay in investing in continuous training of ED health care professionals and/or acquiring professionals who are both qualified in PSA and available in the ED.

Surveillance for enterotoxigenic & enteropathogenic Escherichia coli isolates from animal source foods in Northwest Iran

Background & objectives: Diarrhoeagenic Escherichia coli strains are common agents of diarrhoea particularly in developing countries. Food products of animal origin are considered as common carriers of E. coli. This study was undertaken to identify enterotoxigenic Escherichia coli (ETEC) and enteropathogenic E. coli (EPEC) pathotypes in animal-source foods (ASF). Methods: A total of 222 ASF samples were investigated. Based on the culture and biochemical tests, 109 E. coli isolates were identified. Duplex-polymerase chain reaction assay was used to detect ETEC and EPEC. The target genes selected for each category were the lt and st for the ETEC, and eae and bfp for the EPEC isolates. Results: The occurrence of E. coli in dairy and meat products was 45 and 52.5 per cent, respectively. Among the E. coli isolates, two ETEC, one typical EPEC and three atypical EPEC were detected in meat samples, whereas only one typical EPEC and one atypical EPEC were detected in dairy samples. Interpretation & conclusions: Our results showed presence of ETEC and EPEC strains in ASFs. The milk without pasteurization and traditional dairy products produced in unhygienic conditions are most likely the main sources of E. coli pathotypes and other zoonotic pathogens and thus can be considered a potential hazard to the health of the community.

Early Vessels Exploration of Pink Pulseless Hand in Gartland III Supracondylar Fracture Humerus in Children: Facts and Controversies

The management of pink pulseless limbs in supracondylar fractures has remained controversial, especially with regards to the indication for exploration in a clinically well-perfused hand. We reviewed a series of seven patients who underwent surgical exploration of the brachial artery following supracondylar fracture. All patients had a non-palpable radial artery, which was confirmed by Doppler ultrasound. CT angiography revealed complete blockage of the artery with good collateral and distal run-off. Two patients were more complicated with peripheral nerve injuries, one median nerve and one ulnar nerve. Only one patient had persistent arterial constriction which required reverse saphenous graft. The brachial arteries were found to be compressed by fracture fragments, but were in continuity. The vessels were patent after the release of obstruction and the stabilization of the fracture. There was no transection of major nerves. The radial pulse was persistently present after 12 weeks, and the nerve activity returned to full function.

Advanced glycation end products (AGEs) and their receptor (RAGE) induce apoptosis of periodontal ligament fibroblasts

Diabetics have an increased prevalence of periodontitis, and diabetes is one of the causative factors of severe periodontitis. Apoptosis is thought to be involved in this pathogenic relationship. The aim of this study was to investigate apoptosis in human periodontal ligament (PDL) fibroblasts induced by advanced glycation end products (AGEs) and their receptor (RAGE). We examined the roles of apoptosis, AGEs, and RAGE during periodontitis in diabetes mellitus using cultured PDL fibroblasts that were treated by AGE-modified bovine serum albumin (AGE-BSA), bovine serum albumin (BSA) alone, or given no treatment (control). Microscopy and real-time quantitative PCR indicated that PDL fibroblasts treated with AGE-BSA were deformed and expressed higher levels of RAGE and caspase 3. Cell viability assays and flow cytometry indicated that AGE-BSA reduced cell viability (69.80±5.50%, P<0.01) and increased apoptosis (11.31±1.73%, P<0.05). Hoechst 33258 staining and terminal-deoxynucleotidyl transferase-mediated nick-end labeling revealed that AGE-BSA significantly increased apoptosis of PDL fibroblasts. The results showed that the changes in PDL fibroblasts induced by AGE-BSA may explain how AGE-RAGE participates in and exacerbates periodontium destruction.

Factores asociados a mayor débito de drenaje tras linfadenectomía axilar por cáncer de mama / Factors associated with greater debit drainage after axillary lymphadenectomy for breast cancer

Introduction: axillary lymph node dissection (ALND) is still a usual procedure in the treatment of breast cancer. A drain is normally placed in the surgical bed and maintained several days until obtaining a daily discharge of 30-50 ml, in order to reduce the appearance of seroma. The aim of this study was to analyze possible factors associated with an increased drainage volume. Patients and Methods: a retrospective study of all the patients undergoing ALND for breasts cancer at our institution between 2011 and 2012 was performed. Results: 40 females were included. There were no complications or mortality. Median hospital stay was 2 days. Median day of drainage removal was the 5th postoperative day. Mean total drainage volume was 298.9 +/- 240.1 ml. High blood pressure associated with an increased drainage volume (550 ml vs 217.5 ml; p = 0.001) and a later removal (8th vs 4th day; p = 0.002). Similar happened with age > 65 years (420.8 ml vs 24.6 ml; p = 0.003) and (7th vs 5th day; p = 0.009). The number of metastatic lymph nodes showed a direct correlation with total drainage volume (Pearson 0.503; p = 0.017) and removal day (Spearman 0.563; p = 0.006), similar to the primary tumour size: total drainage volume (Pearson 0.447; p = 0.042) and removal day (Spearman 0.556; p = 0.009). Conclusion: age over 65 years, high blood pressure, number of metastatic lymph nodes and primary tumour size associated with a higher drainage volume and time to remove the drain.

Introducción: la linfadenectomía axilar (LA) sigue siendo un procedimiento frecuente en el tratamiento del cáncer de mama. Habitualmente se coloca un drenaje en el hueco axilar, que se mantiene varios días, hasta que tiene un débito diario de 30-50 ml, con el fin de reducir la aparición de seroma. El objetivo del presente estudio es analizar posibles factores asociados a un mayor volumen de drenaje. Pacientes y Métodos: realizamos un estudio retrospectivo de todas las pacientes intervenidas de LA por cáncer de mama en nuestro centro durante los años 2011 y 2012. Resultados: incluimos 40 mujeres en el estudio. No hubo complicaciones ni mortalidad. La mediana de estancia hospitalaria fue de 2 días. El día mediano de retirada de drenaje fue el 5° postoperatorio. El volumen medio total del drenaje fue 298,9 +/- 240,1 ml. La hipertensión arterial se asocia a un mayor volumen de drenaje (550 ml vs 217,5 ml; p = 0,001) y a una retirada más tardía del mismo (8° día vs 4° día; p = 0,002). Al igual ocurre con la edad > 65 años (420,8 ml vs 24,6 ml; p = 0,003) y (7° vs 5° día; p = 0,009). El número de ganglios metastásicos también se correlaciona con el volumen total de drenaje (coeficiente de correlación de Pearson 0,503; p = 0,017) y con el día de retirada (Spearman 0,563; p = 0,006), lo mismo que el tamaño del tumor primario: volumen total de drenaje (Pearson 0,447; p = 0,042) y día de retirada (Spearman 0,556; p = 0,009). Conclusión: la edad mayor de 65 años, la hipertensión arterial, el número de ganglios metastásicos y el tamaño del tumor primario se asocian con mayor volumen por el drenaje axilar y días necesarios hasta la retirada.

Application of combination, immunomagnetic separation plus multiplex PCR for the detection and identification of salmonella enterica subspecies enterica serovar typhimurium in bovine diarrhoeic fecal samples

A total of 400 bovine diarrhoeic fecal specimens were obtained and conventional microbial culture, immunomagnetic separation and multiplex PCR were simultaneously carried out on samples. For detection of Salmonella at genus level, inv-A universal primer was selected. In order to identifiing of Salmonella typhimurium, specific primers of Rfbj, Fljb and Flic related to gene sequence of O4, H2:1,2 and H1: i were used, respectively. Results showed, 33[8.5%]were culture positive for Salmonella serotypes. However, Salmonella typhimurium with[66.7%], Salmonella dublin[9.1%], Salmonella virchow[6.1%], Salmonella gloucester[6.1%], Salmonella enteritidis[3%], Salmonella georgia[3%], Salmonella augustenborg[3%]and Salmonella lindenburg[3%], were the most common isolated serovars, respectively. In the IMS+Multiplex PCR four amplified products[663,526,284 and 183 bp] were found in all specimens which had typhimurium serovar[1,4,5,12:i:1,2]from rfbj,fljb,inv-A and flic genes, respectively. Results showed that detection and identification of Salmonella typhimurium using specific primers of O4, H2:1,2 and H1: i antigens can be useful

effect of egg derived specific antibody and probiotic on prevention of salmonella enteritidis infection in broiler chickens

To evaluate the effect of probiotic [Primalac] and Salmonella enteritidis-specific IgY on prevention of Salmonella enteritidis infection in broiler chickens, four 33 week-old Single Comb White Leghorn hens were hyperimmunized with Salmonella enteritidis [SE] whole cell antigens obtained by ultrasonication and administrated at a protein concentration of 500 microg/ml after centrifugation. Primary immunization was performed with 250 micro g of the antigen prepared in equal volume of Freunds complete adjuvant and saline. Booster injections were done each 14 days for twice, using incomplete Freunds adjuvant. Bleedings were performed 20 days after first injection and eggs were collected. The presence of anti-Salmonella antibody IgY and IgG in egg yolk and serum respectively, was monitored by ELISA, during the immunization period. Body weight, feed intake and feed conversation were determined. Then two hundred forty male "Ross "day-old chicks were randomly assigned to 8 groups and 3 replications of 10 birds were grown for 56 days of experiment. Eight experimental groups identified with, S, P, A, SP, SA, AP, SPA, C. Four birds from four challenged groups [S], were orally inoculated with 0.5 Ml of S. enteritids that contained 1X10[6] cfu/ml on day 7. The groups that supplemented with antibody [A], received 15 ml of yolk contained antibody [1.5 ml/bird/day], from day 1 to end of the experiment. The probiotic treated groups [P] were received probiotic, 0.1% of feed and 0.5% of feed, during 1-21 and 22-56 days of experimental period respectively. One group as control [C] did not receive any treatment of probiotic and antibody. The test was completely randomized designed. In this project the SAS statistical program for parameter data and chi[2] test for non- parameter data. The results indicated that high titer polyclonal antibody may be obtained 20 days and 55 days after first immunization, in serum and egg yolk respectively. A-treated, P-treated and A-Ptreated groups had significantly lower fecal shedding [P < 0.01]. The antibody alone and A-P treated groups had a significantly lower concentration of SE cecal colonization. Antibody alone and A-Ptreated groups had a lower isolation of SE from the liver, spleen and ileume. There were no significant differences [P > 0.05] in the mean body weight, mean daily feed intake, feed conversation ratio and mortality rate among the experimental groups at any period of experiment, but in the A-, P-, and A-P treated groups, daily weight gain significantly increased during finisher period and at day 49 [p < 0.05]

Normal Anterior Cruciate Ligament Laxity in the MalaysianPopulation

A study to determine average knee laxity in the Malaysian population and how it affects daily living was conducted at the University Malaya Medical Centre between January and April 2004. Fifty two male and 76 female subjects were recruited for this study, all of whom were healthy volunteers with no ambulatory problems. Side to side knee laxity testing was performed using a KT 1000 arthrometer. Significant differences in knee laxity were noted among different races and between sexes. For instance, overall,

Using magnetoencephalography to investigate brain activity during high frequency deep brain stimulation in a cluster headache patient

Purpose: Treatment-resistant cluster headache can be successfully alleviated with deep brain stimulation (DBS) of the posterior hypothalamus [1]. Magnetoencephalography (MEG) is a non-invasive functional imaging technique with both high temporal and high spatial resolution. However, it is not known whether the inherent electromagnetic (EM) noise produced by high frequency DBS is compatible with MEG. Materials and methods: We used MEG to record brain activity in an asymptomatic cluster headache patient with a DBS implanted in the right posterior hypothalamus while he made small movements during periods of no stimulation, 7 Hz stimulation and 180 Hz stimulation. Results: We were able to measure brain activity successfully both during low and high frequency stimulation. Analysis of the MEG recordings showed similar activation in motor areas in during the patient’s movements as expected. We also observed similar activations in cortical and subcortical areas that have previously been reported to be associated with pain when the patient’s stimulator was turned on or off [2,3]. Conclusion: These results show that MEG can be used to measure brain activity regardless of the presence of high frequency deep brain stimulation.

Bronchoalveolar lavage and bacteriological findings in calf pneumonia

This study was done for identification of bacterial agents in calf pneumonia and determination of their antimicrobial susceptibility. Bronchoalveolar lavage was done on fourteen pneumonic and seven normal Holstein calves between 1-3 month old. In bacteriological examination on the fluid of bronchoalveolar lavage, Mycoplasma spp. were isolated from 4 [28.6%] pneumonic calves and 1 [14.3%] healthy calf. Furthermore, Arcanobacterium pyogenes was isolated from 3 [21.5%] pneumonic calves and 1 [14.3%] healthy calf. However, Fusobacterium necrophorum, Actionobacillus [Pasturella] urea, Neisseria mucosa, Staphylococcus aureus, Cardiobacterium hominis were isolated from one pneumonic calf. This is the first report of Cardiobacterium hominis from the lung of a pneumonic calf. All of the isolated bacteria had the highest susceptibility to florfenicol

application of infection control methods by endoscope centers staffs in hospitals of Tehran university of medical sciences

Nasocomial infection is one of the biggest complications of health care facilities all over the world which involves two millions people with nearly 9 billions dollar in cost in addition to therapeutic expenses each year. This study was carried out in order to determine the application of infection control methods by staff working in endoscope centers affiliated to Tehran University of Medical Sciences in 2004-2005. This research is a descriptive study. All ten endoscope centers staff totally 54 physicians, 27 nurses and 14 workers were chosen for the survey. Data gathering instruments consisted of a questionnaire about demographic characteristic of the participants, 6 checklists for evaluating the characteristics of disinfection solutions that workers used for disinfecting endoscope set, the characteristics of endoscope unit environment, the process of disinfecting the set and its environment, as well as the methods used to protect nurses, physicians and associate nurses. The data were gathered by the researchers using observation. Laboratory kits also were another way of data gathering used to get microbial culture from operating room; endoscope tubes and disinfecting solutions which were handed in to the hospitals laboratory centers to be analyzed. The gathered data were analyzed via SPSS computer software, and descriptive statistics. The study findings related to the application of disinfecting method in the units show that in 30% percent of hospitals were desirable, 50% semi-desirable and 20% undesirable. Results about the method of reprocessing of endoscopes through staffs showed that only one hospital [10%] was desirable, also 30% semi-desirable and 60% undesirable. About the application of disinfection or sterilization in endoscopes through nursing staff the results showed that 20% of hospitals were desirable, 70% semi-desirable and one hospital [10%] undesirable. Also the way used for protecting staff were shown as undesirable in all hospitals. About the kinds of microorganisms grown in the environment, on the equipments as well as disinfection solution it was shown that that the majority of the growth was for Bacillus [3.6%] and minimum for pseudomonas and staphylococci [%1.8]. Totally the results of this study showed that the application of infection control methods through staff of endoscope centers is not suitable. It can result in infectious diseases. Therefore prevention from nosocomial infections in endoscope units based on frequent emphasizes by articles in this regard needs a precise and yearly supervision

Prevalence of orofacial complications in Iranian patients with beta thalassemia major

Major beta-thalassemia is the most common monogenic known disorder in Iran and about 15000 persons are affected. The purpose of this study was to evaluate the prevalence of orofacial complications. In this cross-sectional study during 2003-2004, 300 patients with major beta -thalassemia referring to 8 hospitals for routine examinations, blood infusion and treatment in cities of Tehran, Isfahan, Sari, Zahedan, Shahre Kord and Sanandag were studied. The questionnaires included general information, medical and dental history. The prevalence of orofacial complications in major beta-thalassemia was: saddle nose [67%], maxillary protrusion [49/7%], color change of oral mucosa [41/7%], rodent face [34/7%], deep bite [21/7%], spacing [20/7%], and open bite [8/7%], respectively. There was not any relationship between the complications and sex. Most of the patients [91%] were in the first and second decade of life. Early diagnosis and blood infusion caused less prevalence of rodent face. The most observed type of occlusion was class 1, 2 and 3, respectively. Knowing the prevalence of complication can help the dentists to do properly for these patients to solve their problems and improve knowledge of the parents about their children's dental health

Termination of second and early third trimester pregnancy: comparison of 3 methods

The efficacy and safety of 3 methods used in legal termination of pregnancy in the second and early third trimester was assessed in 258 women in Jordan randomly assigned to receive Foley catheter [with and without traction] or prostaglandin E2 vaginal tablets. The failure rate of termination and the total insertion- to- termination time was higher with Foley catheter without traction [16.5%, 16.5 hours] than with traction [10.0%, 14.2 hours] or prostaglandin [8.0%, 11.5 hours]. However, Foley catheter as a method of termination of pregnancy in second and early third trimester is safe and inexpensive, and its efficacy can be enhanced with the use of traction to give similar results to prostaglandin E2

Role of anterior repositioning splint in management of temporomandibular disorders

Myofascial pain dysfunction and temporomandibular joint dysfunction [TMD] are progressively posing challenges to the dental profession. The aetiology has been traced, [apart.from other factors] to psychosomatic disturbances and occlusal anomalies. The treatment includes behavioural modification, physical therapy, pharmacotherapy,, intra oral appliances and surgery. Early intervention by anterior repositioning splint therapy is a non-surgical management of anterior disc displacement with reduction. The aim of this therapeutic intervention is to re-establish a correct disc-condyle relationship to achieve painless and functional mandibular movements. This therapy must be employed with an awareness of potential objectives in carefully selected subjects. It is recommended that patients should undergo a precise evaluation protocol. Diagnostic imaging technique and long term follow up will avoid complications. Intracapsular disorders must be isolated from the extracapsular diseases. Treatment of the cause cannot be overemphasized. Arthrography can be utilized for more accurate repositioning of the displaced disc onto the condyle. MRI has proved to be a useful aid in diagnosing and controlling therapeutic mandibular position by allowing clear evaluation of disc-condyle-fossa relationship. MRI following insertion of anterior repositioning splints has shown successful recapture of partially displaced disc with reduction. The present report describes detailed diagnosis and management of an example patient exhibiting features of TMD. In addition we have also reviewed the literature of this chronologically progressive condition

Immunogenicity of yeast-derived hepatitis B vaccine in Pakistani adults

A study of the immunogenicity and safety of 20m recombinant DNA yeast derived hepatitis B vaccine was conducted in 153 Pakistani adults. All participants were in good physical condition had negative hepatitis B serological markers [HbsAg, anti HBs, anti-HBc] and normal ALT. Anti-HBs developed in 33 percent, 81 percent and 98 percent of subjects one month after the first, second and third dose respectively. Minor systemind local side-effects were observed in 30 percent of individuals. We conclude that yeast derived hepatitis B vaccine is safe, effective and immunogenic in Pakistani adults

Preoperative chemo-radiotherapy in rectal cancer effect on down staging and possibility of sphincter sparing surgery

This study included 30 patients with rectal carcinoma with either border line respectability or not suitable for primary sphincter sparing surgery. Performance status >/60, adequate bone marrow reserve and adequate hepatic and renal functions. All patients had been staged by radiological studies and endoscopies. All patients were treated by combined chemo-radiation; radiotherapy with dose of 45 Gy in 25 fractions over 5 weeks, chemotherapy with 5-flurouracil 500 mg/m2 i.v. infusion over 2 hours and leucovorin immediately before radiation setting for first 5 days of the first week and the first 5 days of the last week of radiation. Patients were evaluated 4-6 weeks after treatment. Operable patients were subjected to abdominoperineal resection [APR] or low anterior resection [AR]. Toxicity was evaluated using WHO Common Toxicity Criteria. In conclusion, preoperative chemo-radiotherapy is an effective treatment in inducing down-staging of locally advanced rectal cancer patients and enhances curative resection and sphincter preserving procedures

Point surveillance of staphylococcus aureus carriage among medical staff in infectious diseases hospital, Kuwait

To investigate the carriage of Staphylococcus aureus among doctors and nurses in Infectious Diseases Hospital, Kuwait, following the detection of 3 cases of methicillin-resistant S. aureus [MRSA]. Materials and A total of 260 nasal and throat swabs were obtained from 19 doctors and 111 nurses and cultured for the carriage of S. aureus. Forty-three S. aureus were identified based on their growth characteristics on mannitol-salt agar, catalase and tube coagulase and DNA hydrolysis. The isolates were tested for susceptibility to antibacterial agents and typed by phage typing; plasmid analysis and pulsed-field electrophoresis were carried out to determine their relatedness. Of the 19 doctors, 4 [21%] had nasal carriage while only 1 of them had a throat carriage. Sixteen [14.4%] nurses carried S. aureus in their noses and 20 [18%] in their throats. The combined nasal carriage rate for both doctors and nurses was 15.8%, and combined throat carriage was 16.6%. None of them carried MRSA. The isolates were resistant to penicillin G [90%], tetracycline [23.3%], erythromycin [9.3%] and cadmium [100%]. Typing of the isolates showed a variety of phage types, plasmid and pulsed-field gel electrophoresis patterns. Discussion: None of the doctors or nurses carried MRSA. Typing of the methicillin-susceptible strains that they carried demonstrated that the S. aureus were different, indicating an absence of a dominant clone capable of spreading. It is important to maintain a low carriage of S. aureus among health-care workers

Antimicrobial susceptibility, phage typing and plasmid profile of salmonella enterica serotype paratyphi A strains isolated in Kuwait

To determine the antimicrobial susceptibility, phage type and plasmid profile pattern of Salmonella enterica serotype paratyphi A strains isolated in Kuwait. Material and From January 1995 to December 1999, 106 strains of S. enterica serotype paratyphi A isolated from an equal number of cases of enteric fever, attending the Infectious Disease and Mubarak Al-Kabeer Hospitals in Kuwait were investigated. The isolates were tested for antimicrobial susceptibility to 8 commonly used antimicrobial agents. Their phage type and plasmid profile patterns were determined using an international set of phages and Qiagen plasmid mini kit, respectively. All of the isolates were susceptible to ciprofloxacin, cefuroxime, ceftazidime, piperacillin and co-trimoxazole. One hundred isolates were susceptible to ampicillin, 99 to chloramphenicol and 98 to tetracycline. None of the isolates was multidrug resistant. Sixty-six% of the isolates were phage type I, 27.4% phage type II and 6.6% were untypable. All phage type I and untypable strains had 3 plasmids of 2.2, 5 and 20 kb, whereas phage type II strains had only 1 plasmid of 20 kb. The findings indicate that while all of the isolates of the S. enterica serotype paratyphi A were susceptible to 4 of the drugs tested, some were resistant to ampicillin, chloramphenicol or tetracycline, thereby indicating the need for continued surveillance and monitoring of antimicrobial susceptibility of these isolates