ABSTRACT
Background: Urinary tract infection (UTI), a common bacterial infection managed in general practice, is the second most common cause for antibiotic use in primary care setting. Antibiotic prescription is mostly empirical in UTI and it is imperative to choose one highly sensitive drug against the common pathogens. Aims and Objectives: In this study, it has been tried to find out the magnitude of community-acquired UTI in a rural population of West Bengal, its causative agents, and the sensitivity pattern of urinary isolates to reduce the development of antibiotic resistance. Materials and Methods: This is an observational, cross-sectional study over 1 year in a rural tertiary care hospital in West Bengal. Culture and sensitivity reports generated from diagnosed UTI patients from the different OPDs of the hospital were analyzed. Results: Out of 603 reports analyzed, culture-positive reports were 463. Escherichia coli was identified to be the most predominant (61.7%) followed by Staphylococcus aureus (17.3%). The sensitivity report of the empirically given antibiotics shows that among the oral antibiotics, nitrofurantoin was the most sensitive one (92%) followed by ciprofloxacin (83.1%) and ofloxacin (66%). Among the injectables, amikacin (84.5%) and ceftazidime (81.8%) were the antibiotics having the highest sensitivity. Conclusion: The sensitivity among the uropathogens to the commonly used antibiotics shows higher resistance rate toward norfloxacin, cephalexin, cotrimoxazole, ampicillin, amoxicillin, co-amoxiclav, and cefuroxime. Oral antibiotics such as nitrofurantoin and ciprofloxacin and parenteral antibiotic amikacin have found to be of higher sensitivity among all organisms identified clubbed together.
ABSTRACT
Resumen OBJETIVO: Determinar la prevalencia de bacteriuria asintomática, su adecuado tratamiento con base en el reporte del antibiograma de pacientes embarazadas que acudieron a control prenatal en una clínica privada. MATERIALES Y MÉTODOS: Estudio retrospectivo de una serie de casos, descriptivo y transversal efectuado en mujeres embarazadas que acudieron a control prenatal en la consulta externa del Hospital Fray Juan de San Miguel de Uruapan, Michoacán, entre el 1 de enero de 2019 y el 31 de diciembre de 2021. Variables de estudio: edad de las madres, semanas de embarazo, embarazos, bacteriuria, agente causal, antibiótico indicado y respuesta al tratamiento. Para interpretar los resultados obtenidos se aplicaron estadística descriptiva, medidas de tendencia central y de frecuencias simples. RESULTADOS: Se estudiaron 227 embarazadas; de ellas, 49 tuvieron un urocultivo positivo. La prevalencia de bacteriuria asintomática fue de 21.59. Escherichia coli fue el agente causal más reportado. De los urocultivos de control 36 de 37 resultaron negativos y solo 1 de 37 fue positivo. CONCLUSIÓN: La prevalencia de bacteriuria asintomática de este estudio fue de 21.59% y el principal agente etiológico asilado E. coli en la mayoría de los casos, con sensibilidad a nitrofurantoína en la mayoría de los casos.
Abstract OBJECTIVE: To determine the prevalence of asymptomatic bacteriuria, its adequate treatment based on the antibiogram report of pregnant patients who attended prenatal control in a private clinic. MATERIALS AND METHODS: Retrospective study of a case series, descriptive and cross-sectional carried out in pregnant women who attended prenatal control in the outpatient clinic of the Hospital Fray Juan de San Miguel de Uruapan, Michoacán, between January 1, 2019 and December 31, 2021. Study variables: mothers' age, weeks of pregnancy, pregnancies, bacteriuria, causative agent, indicated antibiotic and response to treatment. Descriptive statistics, measures of central tendency and simple frequencies were used to interpret the results obtained. RESULTS: A total of 227 pregnant women were studied; 49 of them had a positive urine culture. The prevalence of asymptomatic bacteriuria was 21.59. Escherichia coli was the most reported causative agent. Of the control urine cultures 36 of 37 were negative and only 1 of 37 was positive. CONCLUSION: The prevalence of asymptomatic bacteriuria in this study was 21.59% and the main etiologic agent was E. coli in most cases, with sensitivity to nitrofurantoin in most cases.
ABSTRACT
Background: Urinary pathogens develop lesser resistance against Nitrofurantoin than other antimicrobials such as Fluoroquinolones, Cotrimoxazole, and Carbapenems. Aim and Objective: The objective of this study was to estimate the sensitivity pattern of the urinary isolates against Nitrofurantoin in uncomplicated Urinary tract infection (UTI). Materials and Methods: The descriptive cross-sectional study was performed from January 1, 2020, to June 30, 2020, with 759 cases with signs and symptoms of uncomplicated UTI. Aseptically collected midstream urine was inoculated on Nutrient Agar Media, MacConkey’s Agar media, and Blood Agar media for bacterial isolation. Antimicrobial susceptibility testing was done by disk diffusion technique on Mueller Hinton Agar (Kirby Bauer technique) as per Clinical Laboratory Standards Institute guidelines. Results: Out of total of 759 urine samples, in 165 cases bacterial pathogens were isolated (21.73%). Only 17 were resistant to Nitrofurantoin (10.30%) whereas resistance to Fluoroquinolone (Ciprofloxacin) was in 58 isolates (35.15%) and Cotrimoxazole, in 37 isolates (22.42%). Resistance against Carbapenem antibiotics (Imipenem and Meropenem) was found in 29 isolates (17.57%). All the Nitrofurantoin resistant isolates were Gram-negative. Majority of the Nitrofurantoin resistant isolates were Klebsiella pneumonia (8 out of 17, i.e, 47.05%). All Nitrofurantoin resistant isolates were sensitive to Colistin and Tigecycline. Five out of 17 Nitrofurantoin resistant isolates were sensitive to Meropenem and Imipenem (29.41%). The Fischer exact test reveals that Nitrofurantoin is effective against the isolates resistant to Fluoroquinolones, Cotrimoxazole, and Carbapenems. Conclusion: Nitrofurantoin, even today, remains a good choice for empirical therapy for uncomplicated UTI.
ABSTRACT
Background: Urinary tract infections (UTIs) are one of the most common infections. For treatment of UTIs, there are limited antibiotics due to increased resistance among uropathogens. Two older antibiotics; Nitrofurantoin and Fosfomycin have become novel oral therapeutic options against uropathogens. Aim of the study was to identify UTI causing micro-organisms and evaluate in-vitro activity of nitrofurantoin and fosfomycin against most common isolated organism (E. coli).Methods: Results of urine samples culture and susceptibility testing over a period of 1 year were analysed and included in this study.Results: Micro-organisms were isolated from 568 urine samples. Most commonly isolated organism was Escherichia coli (40.50%), followed by Klebsiella spp. (20.07%) and Staphylococcus spp. (17.07%). Susceptibility of E. coli to nitrofurantoin and fosfomycin was 91.74% and 65.65% respectively. Conclusion: Good activity of nitrofurantoin and fosfomycin against E. coli indicates that these two drugs are potential therapeutic alternatives for urinary tract infections.
ABSTRACT
Resumen Introducción: La Hipertensión Intracraneal Idiopática (HICI) es un síndrome neurológico caracterizado por un aumento de la presión intracraneal en ausencia de lesión estructural o hidrocefalia. Los síntomas incluyen cefalea, tinnitus pulsátil, oscurecimientos visuales transitorios y pérdida visual. Dentro de los signos destacan diplopía por parálisis del VI par, edema de papila y disminución de la agudeza visual. Los pacientes no tienen compromiso de conciencia ni signos neurológicos focales. La principal complicación es la pérdida visual que puede ser irreversible. La asociación entre HICI y nitrofurantoína (NTF) se reportó en 1974. Caso clínico: Mujer de 42 años, con sobrepeso, que desarrolló una HICI aproximadamente 18 meses posterior al inicio de nitrofurantoína profiláctica. Consultó por cefalea frontal, opresiva que aumentaba con la maniobra de Valsalva, asociada a disminución fluctuante de la agudeza visual y episodios de oscurecimiento. Al examen destacó edema de papila bilateral, sin déficit neurológico focal. La presión del líquido cefalorraquídeo (LCR) fue de 25,5 cm de agua. La resonancia magnética mostró signos de aumento de la presión del LCR, sin lesiones estructurales ni hidrocefalia. El cuadro se recuperó concomitantemente a la suspensión de la NTF y el uso de topiramato. No se constató daño visual permanente. Conclusiones: Se debe sospechar la HICI en mujeres en edad fértil con sobrepeso. Dentro de los gatillantes del síndrome destacan varios fármacos, entre ellos la NTF. El principal objetivo del tratamiento de la HICI es preservar la función visual.
Abstract Introduction: Idiopathic intracranial hypertension (IIH) is a syndrome characterized by increased intracranial pressure without a space occupying lesion or hydrocephalus. The symptoms are headache, pulsatile tinnitus, transient visual obscurations, and visual loss. Signs are diplopia caused by sixth cranial nerve paresis and papilledema with its associated loss of sensory visual function. The patient maintains an alert and oriented mental state, but has no localizing neurologic findings. The only major morbidity with IIH is visual loss. The association between IIH and nitrofurantoin was reported in 1974. Case: A 42 years old female, overweighed, who developed IIH 18 months after the start of prophylactic nitrofurantoin. She had frontal oppressive headache that increased with the Valsalva maneuver, fluctuant visual loss and transient visual obscurations. She had bilateral papilledema without localizing neurologic findings. The cerebrospinal fluid (CSF) pressure was 25.5 cm H2O. Magnetic resonance imaging showed signs of increased CSF pressure without structural lesions or hydrocephalus. IIH recovered with the withdrawal of nitrofurantoin and the use of topiramate. There was not permanent visual loss. Conclusions: It is recommendable to suspect IIH in obese women in the childbearing years. There are several drugs associated with IIH including nitrofurantoin. The main objective of treatment is to prevent visual loss.
Subject(s)
Humans , Female , Adult , Paralysis , Pseudotumor Cerebri , Intracranial Pressure , Headache , NitrofurantoinABSTRACT
Nitrofurantoin is effective against many urinary tract pathogens. It acts as bacteriostatic and/or bactericidal by inhibiting DNA-RNA protein& cell wall synthesis. Nanostructured Lipid Carriers (NLCs) of NFT was prepared by Hot Homogenization Process. Glyceryl Monostearate and Miglyol 812 were heated at 80ºC temperature on hot plate. In the melted lipid, drug was added with continuous stirring at high speed homogenization. Formulation NLC12B has % Entrapment efficiency 89.1 ± 0.5, PDI 0.11 ± 0.01 and mean particle size 237 ± 7nm represents narrow particle size distribution. Spherical feature of NLCs with better uniformity without aggregation of Nitrofurantoin loaded NLC was confirmed by TEM. Moreover, efficient miscibility of drug in lipids was confirmed by the absence of intense and characteristic peak of NFT in XRPD. After 6 month storage at 2-8°C there was no significant changes in the PDI as well as mean particle size.
ABSTRACT
Urinary tract infections (UTI) are one of the most common causes for patients to seek medical attention and also for prescription of antibiotics. Escherichia coli is the most common pathogen isolated from both complicated and uncomplicated UTI. Frequent and inappropriate use of antibiotics has led to antimicrobial resistance in the organisms. Multidrug resistance and carbapenem resistance are posing greater challenges to the clinicians. With only few antibiotics expected to be in the pipeline in the continuing five to ten years, the options that we are left with today are prudent use of antibiotics and re-exploration of old and forgotten antibiotics like nitrofurantoin, fosfomycin to help in combating the development of further resistance.METHODSThis study was conducted in the Department of Microbiology, of our tertiary care hospital from March 2019 to June 2019. Retrospective analysis of results of urine culture was done. Isolates resistant to one antibiotic in at least three classes were considered as multidrug resistant. Susceptibility to fosfomycin and Nitrofurantoin among the MDR and non-MDR isolates were comparedRESULTSEscherichia coli (66.67 %) was the most common Enterobacteriaceae to be isolated, followed by Klebsiella pneumoniae (25.49 %). A very high susceptibility was noted to fosfomycin and Nitrofurantoin, with only 2.91 % and 14.04 % of the isolates being resistant to fosfomycin and nitrofurantoin respectively. Highest resistance was noted against ampicillin with 485 (83.05 %) being resistant followed by ciprofloxacin (65.75 %), norfloxacin (62.84 %), cotrimoxazole (47.09 %) and amoxicillin-clavulanic acid (36.99 %). About 49.14 % of the isolates were found to be multi-drug resistant. There was no significant difference in the resistance rates to fosfomycin among the MDR (3.83 %) and non-MDR isolates (2.02 %), while 20.55 % of the MDR isolates and 7.74 % of non-MDR isolates were resistant to nitrofurantoin.CONCLUSIONSDue to emergence of resistance to commonly used oral antibiotics in UTI, among the two older drugs- Nitrofurantoin and Fosfomycin, the latter can be used for treatment of acute cystitis, especially in cases due to MDR Escherichia coli, as Fosfomycin is equally effective against both MDR and non-MDR Escherichia coli isolated from urine samples while nitrofurantoin may be less effective against the MDR strains.
ABSTRACT
Nitrofurantoin is a broad-spectrum bactericidal antibiotic that affects both Gramnegative and Gram-positive bacteria. Nitrofurantoin exhibits bacteriostatic or bactericidaleffects by inhibiting the synthesis of DNA, RNA, protein and cell wall synthesis. Nanocrystals ofNFT were prepared by Cold High Pressure Homogenization Technique. NFT was dispersed inaqueous surfactant solution containing Poloxamer 188, PVPK 30 and HPMC E3 undercontinuous stirring. Poloxamer 188 was used as a surfactant for the preparation of the NCsFormulation NC9B3 have mean particle size 231 ± 9nm with Polydispersity index 0.09 ± 0.02which indicates very narrow particle size distribution. % Entrapment efficiency was 98.3± 0.7Slow drug release profile indicates the homogeneous dispersion of NFT in lipid matrix. NCshave crystalline nature with rough surfaces which has been confirmed using SEM analysis.XRPD spectra show the reduction in crystalline behaviour of the drug and the lipid afterformation of the NCs. There was no significant change in the mean particle size andPolydispersity index after 6 month storage at 25°C/60% RH
ABSTRACT
Background & objectives: The escalation in carbapenem resistance among Enterobacteriaceae has resulted in a lack of effective therapeutic alternatives. Older antimicrobials, fosfomycin, nitrofurantoin and colistin for urinary tract infections (UTIs) caused by carbapenem-resistant Enterobacteriaceae (CRE) may be effective treatment options. The objectives of this study were to evaluate the utility of fosfomycin, nitrofurantoin and colistin in treating UTI caused by CRE and molecular characterization of the plasmid-mediated carbapenem resistance mechanisms. Methods: Consecutive, non-duplicate isolates of CR Escherichia coli and Klebsiella spp. from urine cultures were included (n=150). Minimum inhibitory concentrations (MIC) were determined by E-test (fosfomycin and nitrofurantoin) and broth microdilution (colistin). Efficacy ratios were derived by dividing susceptibility breakpoints by observed MIC values of the drugs for the isolates. Isolates were screened for genes coding for carbapenemases using multiplex PCR. Fosfomycin, nitrofurantoin and colistin-resistant isolates were screened for plasmid-borne resistance genes fos A3, oqx AB and mcr-1, respectively using PCR. Results: Among E. coli, 98.9, 56 and 95 per cent isolates were susceptible to fosfomycin, nitrofurantoin and colistin, respectively, while 94 and 85 per cent of Klebsiella spp. were susceptible to fosfomycin and colistin, respectively. The efficacy ratios indicated fosfomycin as the drug of choice for UTI caused by CR E. coli and Klebsiella spp., followed by colistin. The blaNDM gene was most common, followed by blaOXA48-like. Plasmid-borne genes encoding resistance to fosfomycin, nitrofurantoin and colistin were absent. Interpretation & conclusions: With increasing resistance against the current treatment options, older drugs may emerge as effective options. Molecular screening of resistant isolates is essential to prevent the spread of plasmid-borne resistance against these drugs.
ABSTRACT
Aims@#Urinary Tract Infection (UTI) is one of the common infections in clinical practice. Increasing incidence of Multi Drug Resistant (MDR) uropathogens limited the therapeutic options; thereby prompted the interest in old drugs like Fosphomycin. The current study was undertaken for the comparative evaluation of vitro activity of Fosphomycin and Nitrofurantoin against ESBL producing and carbapenem resistant uropathogens. We also tried to compare the coexistence of resistance of both the drugs with another commonly used oral drug for UTI, i.e. Flouroquinolone. @*Methodology and results@#A total 101 MDR uropathogens were tested for ESBL production, carbapenem resistance, Fosphomycin susceptibility and Nitrofurantoin susceptibility as per the CLSI guidelines. Fosphomycin susceptibility testing was carried out by disc diffusion test. Klebsiella pneumoniae was the commonest MDR uropathogen followed by Pseudomonas aeruginosa and Escherichia coli. Susceptibility to Fosphomycin among the ESBL producer and carbapenem resistant uropathogen was found uniformly higher (91.8%, 90.1%) in comparison to Nitrofurantion (27.5%, 21.3%). Coexistence of resistance to Fosphomycin was much less than Nitrofurantoin in presence of resistance to Flouroquinolone. @*Conclusion, significance and impact of study@#Fosphomycin showed excellent in vitro susceptibility against both ESBL producing and carbapenem resistant MDR uropathogens. Fosphomycin has excellent in vitro action of Fosphomycin against ESBL producing and carbapenem resistance uropathogen in comparison to Nitrofurantoin, hence will be useful for the treatment of drug resistsant uropathogens.
ABSTRACT
Background: Urinary tract infections (UTI) are commonly seen in adults, Urinary tract infection and asymptomatic bacteriuria in adults are a significant health care burden. In a developing country it is necessary to minimize the cost of therapy while giving maximum health benefits to the patient. Appropriate antimicrobial selection is clearly important, as treatment failures will increase the cost of care and result in additional morbidity for patients. Empirical treatment of urinary tract infection is common at tertiary health care center, authors conducted a pharmacoeconomic study to evaluate cost effectiveness of the empirical treatment.Methods: Patients with similar symptoms suffering from UTI were divided into 5 groups with 10 patients in each group. Each group was subdivided into two subgroups with subgroup A having five patients receiving tab nitrofurantoin and subgroup B having 5 patients receiving inj ceftriaxone. Out of the total cost of therapy, percentage of cost attributed to tab nitrofurantoin was compared with inj ceftriaxone. Most cost-effective antibiotic was analysed. Average number of admission days for groups of UTI patients receiving tab nitrofurantoin and inj ceftriaxone were calculated and compared. Group of UTI patients receiving antibiotic with least number of admission days was calculated.Results: Percentage of cost attributed to Nitrofurantoin therapy out of total cost in urinary tract infection patient was less than percentage of cost attributed to inj Ceftriaxone in all five groups of patients and was found to be statistically significant (p <0.05). However, there was no statistically significant difference in average number of admission (IPD) days between groups of patients receiving tab nitrofurantoin and inj ceftriaxone (p>0.05).Conclusions: In current study authors found tab nitrofurantoin to be more cost effective than inj ceftriaxone as an empirical therapy in UTI patients.
ABSTRACT
RESUMEN Introducción: la práctica de la Medicina enfrenta frecuentemente al manejo de pacientes del sexo femenino con infección de vías urinarias no complicada, en las que se necesita iniciar un tratamiento empírico para Escherichia coli, basado en la identificación de los llamados antibióticos de primera línea para dicho germen y en el conocimiento de la resistencia local a los mismos. Objetivos: analizar los textos de Medicina Interna, Nefrología, Microbiología, guías internacionales y otras publicaciones recientes para identificar los antibióticos como los de primera línea para el tratamiento de la cistitis aguda no complicada en la mujer: nitrofurantoína, fosfomicina, cotrimoxazol (trimetoprim-sulfametoxazol) y pivmecillinam. Resultados: de los antibióticos mencionados sólo están disponibles en el país la nitrofurantoína y el cotrimoxazol. En un estudio que hemos publicado recientemente se encontró que la resistencia de Escherichia coli a la nitrofurantoína fue 4% y al cotrimoxazol fue del 35%. Conclusión: de los antibióticos considerados de primera línea para el tratamiento empírico de la cistitis aguda no complicada en la mujer, solo tenemos disponible en el país la nitrofurantoína y el cotrimoxazol, siendo baja (4%) la resistencia local de Escherichia coli a la nitrofurantoina y elevada (35%) al cotrimoxazol.
ABSTRACT Introduction: The practice of medicine frequently faces the management of female patients with uncomplicated urinary tract infection, in which an empirical treatment for Escherichia coli is needed, based on the identification of the so-called first-line antibiotics for this germ and in the knowledge of local resistance to them. Objectives: To analyze the texts of Internal Medicine, Nephrology, Microbiology, international guidelines and other recent publications to identify the following antibiotics as those of first line for the treatment of uncomplicated acute cystitis in women: nitrofurantoin, fosfomycin, cotrimoxazole (trimethoprim -sulfamethoxazole) and pivmecillinam. Results: Of the above mentioned antibiotics, only nitrofurantoin and cotrimoxazole are available in Paraguay. In a study we recently published it was found that the resistance of E. coli to nitrofurantoin was 4% and to cotrimoxazole 35%. Conclusion: Of the antibiotics considered as of first line for the empirical treatment of uncomplicated acute cystitis in women, only nitrofurantoin and cotrimoxazole are available in the country, being low (4%) the local resistance of E. coli to nitrofurantoin and high (35%) to cotrimoxazole.
ABSTRACT
Resumen Objetivo: Describir la prevalencia de infección de la vía urinaria en mujeres que finalizaron el embarazo en una clínica privada (nivel II-2) de Lima, Perú, además de conocer el perfil microbiológico e identificar la resistencia a los antibióticos. Materiales y métodos: Estudio retrospectivo, observacional y transversal efectuado en pacientes que finalizaron el embarazo en la Clínica Jesús del Norte del distrito de Independencia de Lima, Perú, entre enero de 2016 y diciembre del 2017. Criterio de inclusión: pacientes con al menos seis citas médicas de control prenatal en la clínica. Se obtuvo el resultado de los urocultivos y el de resistencia a los antibióticos. Se buscaron medidas de tendencia central como promedios, desviación estándar y frecuencias. Resultados: Se registraron 1455 pacientes que cumplieron con el criterio de inclusión; de éstas 108 (7.4%) tuvieron infección de la vía urinaria con urocultivo positivo. El microorganismo aislado con más frecuencia fue Escherichia coli en 70 (63.6%) casos, con resistencia a ampicilina (60.8%), ciprofloxacina (34.7%) y norfloxacina (34.7%), y sensibilidad a amikacina, nitrofurantoína y cefuroxima. En 13 (11.8%) pacientes también se identificó Escherichia coli y enterobacterias productoras de betalactamasas de espectro extendido resistentes a cefalosporinas. Conclusión: La prevalencia de infección de la vía urinaria estuvo dentro del valor de referencia expresado en los reportes internacionales (7.4%). Los microorganismos aislados con mayor frecuencia fueron E. coli y E. coli productora de betalactamasas de espectro extendido.
Abstract Objective: To describe the prevalence of urinary tract infections (UTI) and their microbiological profile in pregnant women attended in a private clinic of level II-2 of Lima, Peru. Materials and methods: An analytical cross-sectional observational study was conducted, in women they had their delivery in a private clinic during January 2016 to December 2017. Inclusion criteria were those who had at least 06 prenatal care. Results of urocultures and their respective antibiotic resistance were obtained. In the statistical analysis, central tendency measures such as averages, standard deviation and frequencies were found. Results: 1455 met the selection criteria. We found 108 patients (7.4%) with UTI with a positive urine culture. The 70 cases (63.6%) were Escherichia coli resistant to antibiotics such as: ampicillin (57.6%), ciprofloxacin (30.7%) and norfloxacin (30.7%), and sensitive to: amikacin, nitrofurantoin and cefuroxime. However, was is found that 13 (11.8%) had Escherichia coli BLEE resistant to cephalosporins. Conclusion: The prevalence of urinary infection was within what was expected in relation to international reports. The most commonly isolated uropathogen was Escherichia coli, followed by Escherichia coli BLEE.
ABSTRACT
INTRODUCCIÓN: Las crecientes tasas de resistencia que muestran los patógenos urinarios representan un grave problema. El objetivo de este estudio ha sido realizar un seguimiento de la etiología de las infecciones urinarias, de adquisición comunitaria, de la resistencia a los antimicrobianos de primera línea y la presencia de Betalactamasas de Espectro Extendido en bacilos gram negativos (BLEE). MATERIAL Y MÉTODOS: El estudio fue realizado entre enero de 2011 y diciembre de 2015 con datos del Laboratorio Microbiología del Hospital de Clínicas de la Universidad Nacional de Asunción. RESULTADOS: Se obtuvieron 1957 uropatógenos en mujeres. Escherichia coli fue el gérmen más frecuentemente aislado (57%), seguido de Klebsiella pneumoniae (11%) y Streptococcus agalactiae, Staphylococcus saprophyticus y Proteus mirabilis (2%). El promedio de resistencia de Escherichia coli fue para trimetoprim-sulfametoxazol 43 %, ciprofloxacina 32%, ampicilina-sulbactam 32%, cefotaxima 13%, piperacilina tazobactam 8%, nitrofurantoína 2% y meropenem no presentaba resistencia alguna en este lapso. El 11% de las cepas de Escherichia coli y el 30 % de Klebsiella pneumoniae produjo betalactamasas de espectro extendido. CONCLUSIONES: Las tasas de resistencia y de resistencias cruzadas que se evidencian en este estudio representan un grave problema que obliga a evaluar permanentemente el tratamiento empírico de las infecciones urinarias en nuestro hospital
INTRODUCTION: The growing resistance rates of urinary pathogens represent a serious problem. The aim of this study was to analyze the etiology of community-acquired urinary tract infections, their first-line antimicrobial resistance and the presence of extended-spectrum beta-lactamases (ESBL) in gram negative bacilli. METHODS: The study was conducted between January 2011 and December 2015 using data from the Microbiology Laboratory at the teaching hospital Hospital de Clínicas, which belongs to the National University of Asunción. RESULTS: A total of 1957 urinary pathogens were found in women. Escherichia coli was the most commonly isolated bacterium (57%), followed by Klebsiella pneumoniae (11%) and Streptococcus agalactiae (2%), Staphylococcus saprophyticus (2%) and Proteus mirabilis (2%). The resistance rates of Escherichia coliwere the following: to trimetoprim-sulfametoxazol, 43%; to ciprofloxacin, 32%; to ampicilin/sulbactam, 32%; to cefotaxime, 13 %; to piperacillin/tazobactam, 8%; nitrofurantoin, 2%, whereas it did not show resistance to meropenem during this period. Extended-spectrum beta-lactamases were produced by 11% of the E. coliisolates and 30% of the Klebsiella pneumoniae isolates. CONCLUSIONS: The resistance and cross-resistance rates found in this study pose a serious problem which compels the continuous assessment of the empirical therapy for urinary tract infections at this hospital
Subject(s)
Humans , Female , Urinary Tract Infections , Drug Resistance, Microbial , Nitrofurantoin , Bacteria/drug effectsABSTRACT
The aim and objectives of this study were to determine the etiological pathogens of the Urinary Tract Infection and to determine their antibiotic sensitivity pattern in Bangladesh. This study was carried out on clinically suspected UTI patient in a Private Diagnostic Centre, Bangladesh from May 2015 to November 2015. From total 200 urine samples, pathogens were isolated and identified and their antibiotic susceptibility was observed by standard microbiological procedures. Out of 200 urine samples 124 (62%) patients tested positive for culture. In gram negative bacteria, the most predominant was the E. coli (48.39%) followed by Klebsiella spp (14.52%), Pseudomonas spp (3.23%) and Acinetobacter spp (3.23%). In the gram positive bacteria Staphylococcus aureus (13.71%) and Enterococcus spp (11.29%) were found. Occasionally Candida spp. (5.65%) was found. Gram-negative bacteria were more sensitive to Imipenem, Amikacin and Nitrofurantoin. On the otherhand Gram-positive bacteria showed their sensitivity to Amoxicillin-clavulinic acid and Linezolid and Vancomycin showed 100% sensitivity. UTI has become difficult to treat due to appearance of pathogens with increasing resistance to antimicrobial agents. This study showed that pathogens responsible for UTI showed increasing resistance to the commonly prescribed drugs that in turn leaves very few alternative options for the treatment of UTIs.
ABSTRACT
Toxoplasma gondii is an important opportunistic pathogen that causes toxoplasmosis, which has very few therapeutic treatment options. The most effective therapy is a combination of pyrimethamine and sulfadiazine; however, their utility is limited because of drug toxicity and serious side effects. For these reasons, new drugs with lower toxicity are urgently needed. In this study, the compound, (Z)-1-[(5-nitrofuran-2-yl)methyleneamino]-imidazolidine-2,4-dione (nitrofurantoin), showed anti-T. gondii effects in vitro and in vivo. In HeLa cells, the selectivity of nitrofurantoin was 2.3, which was greater than that of pyrimethamine (0.9). In T. gondii-infected female ICR mice, the inhibition rate of T. gondii growth in the peritoneal cavity was 44.7% compared to the negative control group after 4-day treatment with 100 mg/kg of nitrofurantoin. In addition, hematology indicators showed that T. gondii infection-induced serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels, biochemical parameters involved in liver injury, were reduced by nitrofurantoin significantly. Moreover, nitrofurantoin exerted significant effects on the index of antioxidant status, i.e., malondialdehyde (MDA) and glutathione (GSH). The nitrofurantoin-treated group inhibited the T. gondii-induced MDA levels while alleviating the decrease in GSH levels. Thus, nitrofurantoin is a potential anti-T. gondii candidate for clinical application.
Subject(s)
Animals , Female , Humans , Mice , Alanine Transaminase , Aspartate Aminotransferases , Drug-Related Side Effects and Adverse Reactions , Glutathione , HeLa Cells , Hematology , Liver , Malondialdehyde , Mice, Inbred ICR , Nitrofurantoin , Peritoneal Cavity , Pyrimethamine , Sulfadiazine , Toxoplasma , ToxoplasmosisABSTRACT
Infections caused by antibiotic resistant pathogens are of significant concern and are associated with higher mortality and morbidity. Nitrofurantoin is a broad-spectrum bactericidal antibiotic and is effectively used to treat urinary tract infections (UTIs) caused by E. coli, Klebsiella sp., Enterobacter sp., Enterococcus sp. and Staphylococcus aureus. It interfere with the synthesis of cell wall, bacterial proteins and DNA of both Gram positive and Gram negative pathogens. Nitrofurantoin has been used successfully for treatment and prophylaxis of acute lower urinary tract infections. With the emergence of antibiotic resistance, nitrofurantoin has become the choice of agent for treating UTIs caused by multi-drug resistant pathogens.
ABSTRACT
Introduction: UTIs are the second most common bacterial infection in present population. Women are more prone to UTI than Male. Uropathogenic Escherichia coli is responsible for >80% of community acquired UTIs. Aims: The present study was carried out to compare sensitivity / Resistance between Ofloxacin and Nitrofurantoin in UTI patients. Methods: This was a prospective, cross-sectional, observatory study conducted on patients (n = 200) suffering from Urinary Tract Infection from March 2014 to February 2015 at the Department of Microbiology and Department of Pharmacology, Teerthanker Mahaveer Medical College and Research Centre (TMMC & RC), at a tertiary care teaching hospital, in Moradabad, Uttar Pradesh, India. Results: UTI was much more common in females (61%, n=122) than in males (39%, n=78). The most common organism isolated was E. coli, 47%(n=94), followed by Klebsiella 34.5%(n=69), staphylococcus 7.5%(n=15), Proteus, pseudomonas 4%(n=8) and enterococcus 3%(n=6). E. coli was highly sensitive to the Ofloxacin 18% (n=36). Conclusion: Sensitivity pattern of the antimicrobial was found to be more in Nitrofurantoin (57%) was found to be more sensitive than Ofloxacin (40.5%) for the treatment of UTI.
ABSTRACT
La enfermedad hepática inducida por drogas es un fenómeno multifacético y su espectro morfológico es muy variado imitando cualquier patrón de daño hepático, tanto en pacientes expuestos en forma aguda o crónica, en aquellos susceptibles en forma idiosincrática a una dosis terapéutica o por toxicidad intrínseca, a su vez puede estar afectada por otros factores como son los genéticos, la edad o el sexo, el estado nutricional, la exposición a otros fármacos o la existencia de una enfermedad de base; puede ser la única manifestación clínica del efecto adverso de una droga o estar acompañado de manifestaciones sistémicas o de otros órganos, e incluso puede llegar a ser fatal (1). Su incidencia no está bien definida, algunos estudios afirman que la incidencia global es variable encontrándose entre 1-15 x 100.000 personas/año, en USA ocurren 20 nuevos casos x 100.000 habitantes/año. Se han descrito como causantes de lesión hepática más de 900 drogas, productos herbales, homeopáticos, suplementos dietéticos o toxinas, sean productos naturales o de la industria farmacéutica, utilizados o no en dosis terapéuticas, que son las responsables de aproximadamente 15% de consultas y hospitalizaciones por ictericia, hepatitis aguda o crónica; en la población adulta, por encima de los 50 años, llega a 40% de todos los casos de hepatitis. Es también la causante de 11-50% de casos de falla hepática aguda. Los datos publicados indican que los antibióticos son responsables entre un 27-46% de los casos, seguidos por medicamentos para enfermedades del sistema nervioso central entre 13-17%, antiinflamatorios y analgésicos de 5-17% y los productos herbales 9%. Nuevos biomarcadores y el uso de microRNA se están estudiando y serán prometedores en un futuro cercano para identificar pacientes que puedan presentar hepatotoxicidad inducida por medicamentos. Son tantos los tipos de lesión hepática atribuidos a estos agentes que solo podremos dar algunos ejemplos en este artículo, basados en los patrones de daño hepático y enfatizando la importancia de una adecuada y profunda correlación clínica (2, 3).
Drug-induced liver disease is a multifaceted phenomenon which has a varied morphological spectrum that mimics other patterns of liver damage both in cases of acute drug exposure and in cases of chronic exposure to drugs. Those patients who are idiosyncratically susceptible at the therapeutic dose or to intrinsic toxicity may also be affected by other factors including genetic factors, age, sex, nutritional status, exposure to other drugs and the existence of an underlying disease. The only clinical manifestation of the disease may be the adverse effect of a drug, but it can also be accompanied by systemic manifestations and manifestations in other organs, and it can even be fatal (1). The incidence of drug-induced liver disease is not well defined, but some studies claim that its overall annual incidence varies between 1/100,000 people and 15/100,000 people. In the United States, twenty new cases per 100,000 inhabitants occur every year. More than 900 natural and pharmaceutical drugs, herbal medicines, homeopathic products, dietary supplements and toxins have been reported to cause liver damage. This can occur whether or not they are used at normal therapeutic doses. These cases are responsible for about 15% of consultations and hospitalizations for jaundice, acute hepatitis, and chronic hepatitis in adults above the age of 50, and in up to 40% of all cases of hepatitis. Drug-induced liver disease also accounts for 11% to 50% of all cases of acute liver failure. Published data indicate that antibiotics are responsible for between 27% and 46% of cases, that drugs for diseases of the central nervous system are responsible for between 13% and 17%, anti-inflammatory and analgesic agents are responsible for between 5% and 17%, and herbal products are responsible for 9%. New biomarkers and the use of microRNA are being studied and may become promising alternatives in the near future for identifying patients susceptible to drug-induced hepatotoxicity. There are so many types of liver damage attributed to these agents that only give some examples can be provided in this article. These examples have been chosen on the basis ofn the patterns of liver damage with emphasis on the importance of proper and thorough clinical correlation (2, 3).
Subject(s)
Humans , Biopsy , Chemical and Drug Induced Liver Injury , Chlorpromazine , Cholestasis , Contraceptives, Oral , Liver , Non-alcoholic Fatty Liver Disease , SteroidsABSTRACT
The aim of this study was to investigate in vitro the antimicrobial effect and diffusion against E. faecalis of new intracanal medications on the external root surface. The medications tested were a placebo gel (PC); the new formulations with either 3% nitrofurantoin (NIT) or 3% doxycycline hydrochloride (DX) and 2% chlorhexidine (CHX) gel as positive control. The new formulations were tested using the traditional agar diffusion test (ADT) and an adapted agar diffusion method (AADM), where the teeth were filled with the medications and left to diffuse on agar surface seeded with E. faecalis. In the ADT, the larger zones of microbial growth inhibition were seen in DX, followed by CHX and NIT. In the AADM test only DX and CHX showed antimicrobial effect. Statistically significant differences between groups were observed by the Kruskal-Wallis test (2=47.126; p<0.001). The new intracanal formulations with DX and NIT have demonstrated antimicrobial effect against E. faecalis, but only DX was able to diffuse through the dentinal tubules and exert antimicrobial effect outside the roots.
O objetivo deste estudo foi investigar, in vitro, o efeito antibacteriano e a difusão frente ao E. faecalis, de novas medicações intracanal na superfície externa da raiz. As medicações testadas foram um gel placebo (PC), as novas formulações quer com nitrofurantoína a 3% (NIT) ou hidrocloridrato de doxiciclina a 3%(DX) e um gel de clorexidina a 2% (CHX) como controle positive. As novas formulações foram testadas usando o tradicional teste de difusão em agar (ADT) e um método de difusão adaptado (AADM), onde os dentes foram preenchidos com as medicações e deixados a difundir numa superfície de agar semeada com E. faecalis. No ADT, a maior área de inibição foi registada para DX, seguida por CHX e NIT. No teste AADM, apenas DX e CHX demonstraram ação antimicrobiana. Foram observadas diferenças significativas entre os grupos através do teste Kruskal-Wallis (X2=47.126; p<0.001). As novas formulações intracanais contendo DX e NIT demonstraram ação antimicrobiana quando em contacto com E. faecalis, mas apenas DX teve capacidade de difundir através dos túbulos dentinários e exercer ação antimicrobiana fora das raízes.