Identificación de enterobacterias multirresistentes a antibióticos en muestras de heces de lactantes residentes en Talara, Piura, Perú / Identification of multidrug-resistant enterobacteriaceae in fecal samples from infants residing in Talara, Piura, Peru Arturo

La colonización fecal en lactantes por bacterias resistentes a los antimicrobianos es un potencial riesgo para futuras terapias antibióticas. Nuestro objetivo fue determinar la frecuencia y características sociodemográficas de lactantes portadores fecales de enterobacterias resistentes a ciprofloxacina (PFRC) y sus genes de resistencia asociados. Analizamos muestras fecales de 41 niños lactantes residentes en el distrito de Talara-Piura, Perú, en 2019. Evaluamos la presencia de 3 genes de resistencia a quinolonas: aac(6')-Ib-cr, qnrB y oqxA y 2 de betalactamasas: bla CTX-M, bla PER-2.El 68% de lactantes fueron PFRC, Escherichia coli (83,3%) fue el más frecuente. El análisis genotípico detectó: oqxA (41,1%), qnrB (26,7%) y aac(6')-Ib-cr (20%) y al gen bla CTX-M en el 93,3% de los aislados con betalactamasas. La elevada frecuencia de PFRC nos alertan sobre el potencial riesgo en la pérdida de utilidad de esta familia antibiótica en el área de estudio.

Fecal colonization by antimicrobial-resistant bacteria in infants is a potential risk for future antibiotic therapy. We aimed to determine the sociodemographic characteristics and frequency of infants who were fecal carriers of ciprofloxacin-resistant enterobacteriaceae (FCCRE) and their associated resistance genes. We analyzed fecal samples from 41 infants from the district of Talara, Piura, Peru in 2019. The presence of 3 quinolone resistance genes was evaluated: aac(6')-Ib-cr, qnrB and oqxA as well as of 2 beta-lactamase genes: bla CTX-M,bla PER-2. We found that 68% of infants were FCCRE, Escherichia coli (83.3%) was the most frequent bacteria. The genotypic analysis detected: oqxA (41.1%), qnrB (26.7%), aac(6')-Ib-cr (20%) and the bla CTX-M gene (93.3%) of the isolates with beta-lactamases. The high frequency of FCCRE alerts us of the potential risk of this antibiotic family becoming less useful over time.

Uso de Quinolonas como Factor de Riesgo para Infección Oportunista Severa por Cándida en Pacientes Adultos Críticamente Enfermos

Resumen Introducción: Candida es uno de los microorganismos mayormente aislado de los hemocultivos positivos, mostrando un aumento de su prevalencia a nivel mundial debido a múltiples factores de riesgo siendo unos de los más importantes el uso de antibioticoterapia de espectro ampliado, como las quinolonas usados en pacientes críticos hospitalizados en salas de cuidado intensivo, de los cuales la literatura es tangencial en su relación con el desarrollo de candidiasis invasiva. Materiales y metodos: se realizó una búsqueda exhaustiva en las bases de datos biomédicas MEDLINE, PubMed, ScienceDirect, Scopus, Embase, utilizando la estrategia de búsqueda: "Candidemia AND Quinolones AND Adult" sin embargo también se usaron otras estrategias para aumentar la sensibilidad como: "Invasive candidiasis AND Quinolones" y "Candidemia OR Invasive candidiasis AND risk factors" incluyendo los idiomas inglés, español, francés y portugués, se tuvieron en cuenta artículos tipo: [Randomized Controlled Trial], [Clinical Trial], [Controlled Clinical Trial] y [Review] Resultados: la literatura biomédica es escasa en cuanto a la descripción de la relación entre el uso de quinolinas como factor de riesgo para desarrollar candidiasis invasiva, sin embargo se encontraron ocho estudios con significancia estadística importante que muestran una relación estrecha entre el fenómeno propuesto. Conclusiónes: Las quinolonas de uso sistémico como Ciprofloxacino, son un factor de riesgo confirmado asociado a infecciones invasivas por hongos tipo Candida.

Abstract Introduction: Candida is one of the microorganisms most frequently isolated from positive blood cultures, showing an increase in its prevalence worldwide due to multiple risk factors, one of the most important being the use of extended-spectrum antibiotic therapy, such as quinolones used in critical patients in intensive care wards, of which the literature is tangential in its relationship with the development of invasive candidiasis, Methods: a search of biomedical databases MEDLINE, PubMed, ScienceDirect, Scopus, Embase, was performed using the search strategy: "Candidemia AND Quinolones AND Adult" other strategies were also used to increase sensitivity such as: "Invasive candidiasis AND Quinolones" and "Candidemia OR Invasive candidiasis AND risk factors" including English, Spanish, French and Portuguese languages, articles type were taken into account: [Randomized Controlled Trial], [Clinical Trial], [Controlled Clinical Trial] and [Review]. Results: The biomedical literature is scarce regarding the description of the relationship between the use of quinolones as a risk factor for developing invasive candidiasis; however, eight studies were found with important statistical significance that show a close relationship between the proposed phenomenon. Conclusion: Systemic quinolones such as Ciprofloxacin are a confirmed risk factor associated with invasive fungal infections such as Candida.

Domestic wastewater treatment plants as sources of macrolide-lincosamide-streptogramin B- and penicillin-resistant Staphylococcus aureus in Brazil / Plantas de tratamiento de aguas residuales domésticas como fuentes de Staphylococcus aureus resistente a macrólidos-lincosamida-estreptogramina B- y penicilina en Brasil / Estações de tratamento de águas residuais domésticas como fontes de Staphylococcus aureus resistente a macrolídeo-lincosamida-estreptograma e B- e penicilina no Brasil

SUMMARY Staphylococcus aureus is one of the main bacteria that affect human health. Its reduced susceptibility to beta-lactam antibiotics has driven the clinical use of macrolides and lincosamides. However, the presence of macrolide-lincosamide-streptogramin B (MLSB)-resistant S. aureus strains is increasingly common. Wastewater treatment plants (WWTPs) are the main anthropogenic source of resistance determinants. However, few studies have assessed the importance of this environment on the dissemination of MLSB-resistant S. aureus strains. Thus, we aimed to evaluate the impact of a domestic WWTP on the resistance to MLSB and penicillin in S. aureus in southeast Brazil. Of the 35 isolates tested, 40.6% were resistant to penicillin. Resistance to erythromycin (8.6%) and quinolones (2.8%) was less common. Despite the low rate of resistance to clindamycin (2.8%), many isolates showed reduced susceptibility to this antibiotic (57.1%). Regarding the resistance phenotypes of staphylococci isolates, inducible MLSB resistance (D-test positive) was found in two isolates. In addition, 27 S. aureus isolates showed the ability to produce penicillinase. In this article, we report for the first time the importance of WWTPs in the dissemination of MSLB resistance among S. aureus from southeast Brazil.

RESUMEN Staphylococcus aureus es una de las principales bacterias que afectan la salud humana. Su susceptibilidad reducida a los antibióticos betalactámicos ha impulsado el uso clínico de macrólidos y lincosamidas. Sin embargo, la presencia de cepas resistentes a macrólido-lincosamida-estreptogramina B (MLSB) de S. aureus es cada vez más común. Las plantas de tratamiento de aguas residuales (PTAR) son la principal fuente antropogénica de determinantes de resistencia. Sin embargo, pocos estudios han evaluado la importancia de este entorno en la diseminación de cepas de S. aureus resistentes a MLSB. Nuestro objetivo fue evaluar el impacto de una PTAR doméstica en MLSB y la resistencia a la penicilina en S. aureus en el sureste de Brasil. De los 35 aislamientos analizados, el 40,6% eran resistentes a la penicilina. La resistencia a la eritromicina (8,6%) y quinolonas (2,8%) fue menos común. A pesar de la baja tasa de resistencia a la clindamicina (2,8%), muchos aislamientos mostraron sensibilidad reducida a este antibiótico (57,1%). Con respecto a los fenotipos de resistencia de los aislamientos de estafilococos, la resistencia inducible a MLSB (prueba D positiva) se encontró en dos aislamientos. Además, 27 aislamientos de S. aureus mostraron la capacidad de producir penicilinasa. En este artículo informamos, por primera vez, la importancia de las PTAR en la difusión de la resistencia a MSLB entre S. aureus del sureste de Brasil.

RESUMO O Staphylococcus aureus é uma das principais bactérias que afetam a saúde humana. Sua reduzida suscetibilidade aos antibióticos beta-lactâmicos tem impulsionado o uso clínico de macrolídeos e lincosamidas. No entanto, a presença de cepas de S. aureus resistentes a macrolídeo-lincosamida-estreptogramina B (MLSB) é cada vez mais comum. As estações de tratamento de esgoto (ETEs) são a principal fonte antropogênica de determinantes de resistência. No entanto, poucos estudos avaliaram a importância desse ambiente na disseminação de cepas de S. aureus resistentes ao MLSB. Assim, nosso objetivo foi avaliar o impacto de uma ETE doméstico na resistência ao MLSB e à penicilina em S. aureus no sudeste do Brasil. Dos 35 isolados testados, 40,6% eram resistentes à penicilina. Resistência à eritromicina (8,6%) e quinolonas (2,8%) foi menos comum. Apesar da baixa taxa de resistência à clindamicina (2,8%), muitos isolados apresentaram sensibilidade reduzida a esse antibiótico (57,1%). Em relação aos fenótipos de resistência dos isolados de estafilococos, a resistência induzível ao MLSB (D-teste positivo) foi encontrada em dois isolados. Além disso, 27 isolados de S. aureus mostraram a capacidade de produzir penicilinase. Neste artigo relatamos pela primeira vez a importância das ETEs na disseminação da resistência do MSLB entre S. aureus do sudeste do Brasil.

Irrational Use of Quinolones in Tertiary Care Hospital Karachi, Pakistan

Objective: The antimicrobial drugs especially Quinolones are the top most therapeutics class of drug prescribed in some country like Pakistan in primary and tertiary care hospitals and clinics. The objective of the study was to assess the irrational prescribing practice of quinolones in tertiary care setups of Karachi. Methodology: A prospective observational study was conducted for the period of 04 months from November 2019-February 2020, in Public and Private Sector Tertiary Care setups of Karachi. Data was collected from surgical, medical and emergency wards on the basis of World Health Organization prescribing pattern, to evaluate the prescriptions based on Culture sensitivity tests (CST), empirical, targeted, and/or prophylactic therapies. Results: Out of total 1000 patients 41.6% patients were from Public and 58.4% were from Private Sector Tertiary Care Hospital. 13.7% of the patients from Public and 24.8% from Private Sector Tertiary Hospitals were prescribed Quinolones after performing their Culture Sensitivity Test. However, 79.8% of the patients were prescribed Quinolones without Culture Sensitivity Test. 36.4% patients were prescribed with empirical therapy, 20.2% with De-Escalation therapy, while 43.4% were prescribed with prophylactic therapy of quinolones. Conclusion: Study concluded that some serious efforts are required to avoid the irrational prescribing practice and promote the rational prescribing practice of antibiotics particularly for Quinolones.

Quinolones resistance in Salmonella spp. isolated from broilers and chickens carcasses under federal inspection / Resistência à quinolonas em Salmonella spp. isoladas de frangos vivos e carcaças sob inspeção federal

We analyzed 77 Salmonella spp. strains, from which 20 were isolated from broilers (cloacal swabs) and 57 from chickens from slaughterhouses under federal inspection. The following serotypes were identified: Salmonella Saint Paul (29), Salmonella Heidelberg (27), Salmonella Anatum (9), Salmonella Cerro (5), Salmonella Senftenberg (5), Salmonella enterica (O: 4,5) (1) and Salmonella enterica (O: 9.12) (1). Fifteen strains (19.5%) were resistant to enrofloxacin, six (7.8%) to ciprofloxacin, and 26 (33.8%) to nalidixic acid in the Disk Diffusion Test. The fifteen enrofloxacin resistant strains were selected for the PCR to detect the genes gyrA, gyrB, parC, and parE, and genetic sequencing to identify mutations in these genes. Five strains (33.3%) had point mutations in the gyrA gene, and one (6.7%) presented a point mutation in the parC gene. None of the 15 strains had mutations in the gyrB and parE genes, and none had more than one mutation in the gyrA gene or the other genes. The presence of point mutations in the strains studied corroborates with the phenotypic resistance observed to nalidixic acid. However, it did not explain the resistance to fluoroquinolones found in the 15 strains. Other mechanisms may be related to the fluoroquinolones resistance, highlighting the need for additional mutation screening.(AU)

Foram analisadas neste estudo 77 estirpes de Salmonella spp., 20 isoladas de frangos vivos (suabes de cloaca) e 57 isoladas de carcaças, provenientes de abatedouros frigoríficos sob Inspeção Federal. Foram identificados os seguintes sorotipos: Salmonella Saint Paul (29), Salmonella Heidelberg (27), Salmonella Anatum (9), Salmonella Cerro (5), Salmonella Senftenberg (5), Salmonella enterica (O: 4,5) (1) e Salmonella enterica (O: 9,12) (1). Do total de estirpes estudadas, 15 (19,5%) se mostraram resistentes à enrofloxacina, seis (7,8%) à ciprofloxacina e 26 (33,8%) ao ácido nalidíxico no Teste de Difusão em Disco. Foram selecionadas as 15 estirpes resistentes à enrofloxacina para a realização da PCR para detecção dos genes gyrA, gyrB, parC e parEe para sequenciamento genético do produto da PCR para identificação de mutações nesses genes. Cinco estirpes (33,3%) apresentaram mutações pontuais no gene gyrA e uma (6,7%) apresentou mutação pontual no gene parC. Nenhuma das 15 estirpes apresentou mutações nos genes gyrB e parE e nenhuma apresentou mais de uma mutação no gene gyrA ou nos outros genes. A existência apenas de mutações pontuais em alguns genes das estirpes analisadas está de acordo com a resistência fenotípica observada ao ácido nalidíxico, mas não explica a resistência às fluoroquinolonas encontrada nas 15 estirpes. Outros mecanismos de resistência podem estar relacionados à resistência encontrada às fluoroquinolonas e estudos adicionais são necessários para investigar sua presença.(AU)

Pattern of Ciprofloxacin Prescribing at Outpatient Setting in Al-Kharj

Aim: The study was conducted to demonstrate the pattern of ciprofloxacin prescribing at outpatient Setting in Al-kharj.Methodology:A retrospective study was conducted to demonstrate the pattern of ciprofloxacin prescribing. The Information was collected from electronic prescriptions in a public hospital in Al-Kharj city. The data was processed using Microsoft Exceland the descriptive data was represented as frequencies and percentages.Results:There were 611 ciprofloxacin prescriptions in 2018. Ciprofloxacin is the 5thmost commonly prescribing antibiotics in the outpatient setting in 2018. The majority of the patients were in the age level between 20-39 (53.51%). Out of 773 prescriptions, 162 were excluded (eye or ear drops). There were 608 tablets (99.51%).Conclusion:Ciprofloxacin is one of the common prescribed antibiotics in the outpatient settings. If it is prescribed inappropriately it will lead to increase bacterial resistance rate, increase adverse effects and increase the cost of the treatment. It should be prescribed appropriately and the patients should be monitored frequently during its use

Effect of clove oil combined with quinolones antibiotics on methicillin-resistant Staphylococcus aureus / 中草药

Objective: To investigate the anti-methicillin-resistant Staphylococcus aureus (MRSA) activity of clove oil combined with quinolones antibiotics in vitro, and provide scientific evidences for the treatment of MRSA infection by clove oil combined with quinolones antibiotics. Methods: Minimal inhibitory concentrations (MICs) of clove oil and four quinolones antibiotics (moxifloxacin, levofloxacin, ciprofloxacin and norfloxacin) were determined by microdilution method; Fractional inhibitory concentration (FIC) indexes of clove oil combined with four quinolones antibiotics were determined by chessboard dilution method; Inhibition effect of MRSA by clove oil combined with four quinolones antibiotics was analyzed by growth curve method. MIC changes were analyzed when MRSA standard strain ATCC33591 was induced 30 generations with clove oil. Results: A total of 35 strains of MRSA isolated from clinical patients showed that the highest resistance rate was moxifloxacin (88.57%), followed by ciprofloxacin and levofloxacin (77.14%), and the lowest resistance rate was norfloxacin (74.29%). The results of FIC index analysis showed that the different thesynergistic action effects of clove oil with moxifloxacin, levofloxacin, ciprofloxacin and ornorfloxacin, were 42.86%, 37.15%, 34.28% and 34.28%, respectively; The additive effects of which were 28.57%, 25.71%, 22.86% and 42.86%, respectively; The unrelated effects of that were 28.57%, 20.00%, 42.86% and 22.86%, respectively. Among them, there was partial antagonism in experimental strains when combined with levofloxacin, accounting for 17.14%. The growth curve showed that the combination of clove oil and quinolone antibiotics had a significant synergistic inhibition on MRSA. The results of induced drug resistance test showed that MIC did not change after 30 generations of continuous induction with the clove oil, but increased to 16 times of that of ciprofloxacin under the same condition, which indicated that the clove oil was not easy to make MRSA resistant. Conclusion: Clove oil is not easy to produce drug resistance. They showed different interactions on each other when clove oil combined with quinolones antibiotics, and most strains of MRSA isolated from clinical patients had obvious synergistic and additive inhibition effect. The dosage of quinolones antibiotics could be cut when clove oil combined with quinolones antibiotics for treating MRSA infection.

Marcadores de resistencia plasmídica a quinolonas qnr en aislamientos clínicos de enterobacterias productoras de betalactamasas CTX-M en Lima, Perú / Markers of plasmid resistance to qnr quinolones in clinical isolates of CTX-M beta-lactamases-producing enterobacteria in Lima, Peru

RESUMEN Con el objetivo de reportar marcadores de resistencia plasmídica a quinolonas qnr en aislamientos clínicos de enterobacterias productoras de betalactamasas CTX-M, se realizó un estudio descriptivo, con aislamientos del cepario del proyecto TO-06/09 del Instituto Nacional de Salud del Niño. Se recuperaron 138 aislamientos. La susceptibilidad antimicrobiana se determinó por el método de disco difusión y la identificación de genes por reacción en cadena de la polimerasa. De los 138 aislados, 67 (48,5%) fueron positivos para proteínas qnr por el método genotípico. De los cuales 38 (56,7%) presentaron determinantes qnrB y 48 (71,6%) determinantes qnrS. Ningún aislado presentó determinantes qnrA. Se detectó determinantes qnr en aislamientos que presentaban betalactamasas CTX-M en una población no expuesta.

ABSTRACT Aimed at reporting markers of plasmid resistance to qnr quinolones in clinical isolates of CTX-M beta-lactamase-producing enterobacteria, a descriptive study was conducted with isolates from the strain repository of TO-06/09 project of the National Children´s Health Institute. 138 isolates were recovered. Antimicrobial susceptibility was determined by the diffusion disk method, and gene identification by polymerase chain reaction. Of the 138 isolates, 67 (48.5%) were genotypically positive for qnr proteins; of these, 38 (56.7%) had qnrB determinants and 48 (71.6%) had qnrS determinants. No isolate presented qnrA determinants. qnr determinants were detected in isolates containing CTX-M beta-lactamases in a non-exposed population.

Ruptura espontánea del semitendinoso secundario al uso de una quinolona / Spontaneous semitendinosus rupture secondary to the use of a quinolone

Resumen La ruptura espontánea de un tendón secundario al uso de una quinolona es un efecto adverso poco común, pero que con el paso de los años se ha venido documentado con mayor frecuencia. A pesar de lo anterior, aún no hay estudios clínicos que permitan aclarar su fisiopatología, qué estrategias pueden disminuir el riesgo de desarrollar una ruptura espontánea o a qué dosis de las diferentes quinolonas se aumenta el riesgo de presentar una ruptura espontánea. Adicionalmente, varías guías de práctica clínica incentivan el uso de las quinolonas como primera línea para el manejo de infecciones respiratorias o de vías urinarias sin hacer consideraciones sobre este efecto adverso. Por lo anterior, presentamos a continuación el caso de un paciente de 31 años que posterior al inicio de ciprofloxacina para el manejo de una diarrea aguda presento una ruptura espontánea del tendón del semitendinoso secundario al uso de la quinolona. (Acta Med Colomb 2019; 44: 115-118).

Abstract The spontaneous rupture of a tendon secondary to the use of a quinolone is an uncommon adverse effect, but over the years has been documented more frequently. Despite this, there are still no clini cal studies to clarify its pathophysiology, nor which strategies can reduce the risk of developing a spontaneous rupture or at what dose of the different quinolones the risk of presenting a spontaneous rupture increases. In addition, several clinical practice guidelines encourage the use of quinolones as the first line for the management of respiratory or urinary tract infections without considering this adverse effect. Therefore, the case of a 31 year old patient who after the start of ciprofloxacin for the management of acute diarrhea had spontaneous semitendinosus tendon rupture secondary to the use of quinolone, is presented. (Acta Med Colomb 2019; 44: 115-118).

Cambios en las prescripciones y el consumo de antimicrobianos, luego de la implementación de recomendaciones de uso: experiencia en un hospital universitario / Changes in prescriptions and antibiotic consumption after the implementation of recommendations for use: experience in a university hospital

Resumen Introduccion: Actualmente cerca de la mitad de las prescripciones de antimicrobianos son inadecuadas, lo que aumenta la resistencia bacteriana. Tanto cefalosporinas como fluoroquinolonas se asocian con este fenomeno: aumento de bacterias productoras de β-lactamasas e infecciones por Clostridioides difficile, por lo que las agencias reguladoras buscan racionalizar su uso. Objetivo: Evaluar el efecto de recomendaciones para el uso adecuado de antimicrobianos en la proporcion de prescripciones inadecuadas de ceftriaxona y fluoroquinolonas. Metodologia: Se desarrollo un estudio de antes y despues, prospectivo e intervencional, que comparo la calidad y la cantidad de uso de ceftriaxona y fluoroquinolonas antes y despues de la implementacion de recomendaciones de uso para tratamientos de enfermedades infecciosas adquiridas en la comunidad. Los parametros medidos fueron: proporcion de prescripciones inadecuadas y DDD. Los datos se analizaron por medio del test de χ2, correccion de Fisher y test de Student. Resultados: Se evaluaron 206 pacientes, observandose una disminucion de 35% en las prescripciones inadecuadas, una reduccion del consumo de ceftriaxona y levofloxacina y un aumento significativo de la utilizacion de ampicilina/sulbactam. Conclusiones: La implementacion de recomendaciones de uso basadas en evidencia cientifica y susceptibilidad local, permitieron disminuir la proporcion de prescripciones inadecuadas y reducir el consumo de ceftriaxona y fluoroquinolonas.

Background: Nowadays about half of antibiotic prescriptions are inadequate, increasing bacterial resistance. Both cephalosporins and fluoroquinolones are associated with this phenomenon: increase of β-lactamase producing bacteria and Clostridioides difficile infections, which is why regulatory agencies seek to rationalize their use. Aim: To evaluate the effect of use recommendations on the proportion of inadequate prescriptions of ceftriaxone and fluoroquinolones. Methods: A prospective and interventional study was developed, comparing the quality and quantity of use of ceftriaxone and fluoroquinolones before and after the implementation of use recommendations for treatments of infectious diseases acquired at the community. The outcomes were: proportion of inadequate prescriptions and defined daily dose (DDD). Data were analyzed using the Chi-square test, Fisher's correction and Student's test. Results: A total of 206 patients were evaluated, a 35% decrease in inadequate prescriptions, a decline in the consumption of ceftriaxone and levofloxacin, and a significant increase in the use of ampicillin/ sulbactam was observed. Conclusions: The implementation of use recommendations based on scientific evidence and local susceptibility allowed to reduce the proportion of inadequate prescriptions and to reduce de consumption of ceftriaxone and fluoroquinolones.

Determination of antibiotic resistance genes and virulence factors in Escherichia coli isolated from Turkish patients with urinary tract infection

Abstract INTRODUCTION : Escherichia coli ranks among the most common sources of urinary tract infections (UTI). METHODS: Between November 2015 and August 2016, 90 isolates of E. coli were isolated from patients at Rize Education and Research Hospital in Turkey. Antibiotic susceptibility was determined for all isolates using the Kirby-Bauer disk diffusion method. These E. coli isolates were also screened for virulence genes, β-lactamase coding genes, quinolone resistance genes, and class 1 integrons by PCR. RESULTS: With respect to the antibiotic resistance profile, imipenem and meropenem were effective against 98% and 90% of isolates, respectively. A high percentage of the isolates showed resistance against β lactam/β lactamase inhibitor combinations, quinolones, and cephalosporins. PCR results revealed that 63% (57/90) of the strains carried class 1 integrons. In addition, a high predominance of extended-spectrum β-lactamases (ESBLs) was observed. The qnrA, qnrB, and qnrS genes were found in 24 (26.6%), 6 (6.6%), and 3 (3.3%), isolates, respectively. The most common virulence gene was fim (82.2%).The afa, hly, and cnf1 genes were detected in 16.6%, 16.6%, and 3.3% of isolates, respectively. Moreover, we observed eleven different virulence patterns in the 90 E. coli isolates. The most prevalent pattern was fım, while hly-fım, afa-aer-cnf-fım, aer-cnf, afa-aer, and afa-cnf-fım patterns were less common. CONCLUSIONS: Most of the E. coli virulence genes investigated in this study were observed in E. coli isolates from UTI patients. Virulence genes are very important for the establishment and maintenance of infection.

Efficacy, safety and cost of Qianlieshutong Capsules in the treatment of chronic prostatitis / 中华男科学杂志

Objective@#To comprehensively evaluate the clinical effect, safety and cost of Qianlieshutong Capsules (QC) in the treatment of chronic prostatitis.@*METHODS@#We searched Cochrane Library, PubMed, Springer, ProQuest, CNKI, Wanfang Data and VIP for randomized controlled trials (RCT) on the treatment of chorionic prostatitis with QC published from January 2000 to May 2018. According to the inclusion and exclusion criteria, two researchers independently completed the screening and evaluation of the articles, extraction of information, and meta-analysis of the included RCTs using the RevMan 5.3 software.@*RESULTS@#Totally 10 RCTs involving 1 796 cases were included in this study, in which the chronic prostatitis patients treated by the combination of QC and quinolones all showed a significantly better response than the controls (P < 0.05). QC combined with quinolones cost an average of ¥23 more than quinolones alone with a 1% increase of therapeutic effectiveness, ¥38.39 more with a 1-unit reduction of WBCs, and ¥38.84 more with a 1-point decrease in the NIH-CPSI score.@*CONCLUSIONS@#The combination of QC with quinolones has a better therapeutic efficacy but a higher cost than quinolones alone in the treatment of chronic prostatitis.

Literature Analysis of Hepatotoxicity Induced by Quinolones / 中国药房

OBJECTIVE： To investigate the characteristics and regularity of hepatotoxicity induced by quinolones， and to provide reference for clinical use of drug safely. METHODS： Using “quinolone” “floxacin” “hepatotoxicity” “hepatic injury”as retrieval words， relevant literatures about hepatotoxicity induced by quinolones were retrieved from domestic and foreign databases as CNKI， Wanfang， VIP， PubMed （during database establishment to 31th， Dec. 2017）. Those literatures were summarized and analyzed. RESULTS： A total of 59 valid literatures were collected， including 61 cases of hepatotoxicity induced by quinolones， 8 types of drugs as ciprofloxacin， moxifloxacin， ofloxacin， lomefloxacin， norfloxacin， levofloxacin， gatifloxacin and enoxacin. Ciprofloxacin， levofloxacin， moxifloxacin and ofloxacin were the most common drugs that caused hepatotoxicity， involving 19， 13， 11， 7 cases， respectively； accumulative constitute ratio was 81.97％. The ratio of male to female was 1.54 ∶ 1， and hepatotoxicity always happened at the age of 61 to 80 （30 cases， 49.18％）. Primary diseases of 46 cases were single disease （75.41％）， and mainly were infection of respiratory system and urogenital system. There were 15 cases of combined disease （24.59％）. Thirty-one cases used quinolones alone， most of which was ciprofloxacin. There were 30 cases of drug combination. Thirty-four cases were given drug intravenously and mainly were domestic cases. The hepatotoxicity first occurred within 10 minutes after administration and at the latest 8 weeks after administration. Forty-nine patients suffered from hepatotoxicity within 10 days after medication， accounting for 80.33％. Besides general fatigue， nausea and vomiting， clinical symptoms also included abnormal elevation of alanine aminotransferase， aspartate aminotransferase and total bilirubin，etc. Fifty-four patients were improved after withdrawal or symptomatic treatment， while 7 patients died. The results of causality evaluation of drug-induced hepatic injury showed that there were 4 probably association cases， 45 likely association cases and 12 possible association cases. CONCLUSIONS： The hepatotoxicity caused by quinolones is related to drug variety， patient’s age， primary disease， drug combination and route of administration， and mostly occurs within 10 days after administration. Great importance should be attached to patient’s liver function indexes， strengthen medication monitoring， and carefully combined use of drugs.

Empleo de los antibióticos de segunda línea para el tratamiento de la cistitis aguda no complicada de la mujer: enfoque actual

RESUMEN Fundamento y objetivo: con este estudio pretendemos identificar los antibióticos considerados de segunda línea para el uso en las infecciones de vías urinarias (IVU), específicamente en las cistitis no complicadas de la mujer. Posteriormente nos proponemos presentar la prevalencia de resistencia a los antibióticos de segunda línea de los gérmenes más frecuentemente encontrados en las IVU en el Laboratorio de Microbiología de la Facultad de Ciencias Médicas, de la Universidad Nacional de Asunción. Material y método: se realizó un trabajo observacional, descriptivo, de corte transverso. Resultados: Escherichia coli presenta un resistencia inferior al 20% en promedio para la cefuroxima, que se mantiene en el lapso observado (2010 - 2017). La resistencia a la ampicilina-sulbactam de dicho germen está variando, de una resistencia elevada en los primeros años de la observación, hasta un acercamiento progresivo en los años precedentes al 30% (en promedio 34%). La resistencia a la ciprofloxacina presenta una tasa superior al 25% en los años de estudiados. En cuanto a la resistencia de Klebsiella pneumoniae a los antibióticos de segunda línea, en los últimos dos años de observación, tanto al grupo de las cefalosporinas, de la ampicilina sulbactam y la ciprofloxacina, se encontró una resistencia mayor al 30%. Conclusiones: los datos muestran una importante resistencia de Escherichia coli y Klebsiella pneumoniae aislados en los urocultivos a los antibióticos identificados como de segunda línea para el tratamiento de las cistitis no complicadas de la mujer, por lo que debe otorgársele un gran peso a los resultados de los urocultivos para la utilización apropiada de estos antibióticos.

ABSTRACT Background and objective: With this study we intended to identify the second-line antibiotics to be used in urinary tract infections (UTI), specifically in uncomplicated cystitis of women. Later, we proposed to present the prevalence of resistance to the second-line antibiotics of the germs most frequently found in the UTI in the Microbiology Laboratory of the Faculty of Medical Sciences of the National University of Asunción. Material and method: An observational, descriptive, cross-sectional study was carried out. Results: Escherichia coli has a resistance to cefuroxine lower than 20% on average, which was maintained in the observed period (2010-2017). The resistance to ampicillin-sulbactam of this germ is varying, from a high resistance in the first years of the observation to a progressive approach to 30% in the preceding years (on average 34%). Resistance to ciprofloxacin presents a rate higher than 25% in the studied years. Regarding the resistance of Klebsiella pneumoniae to the second-line antibiotics, a resistance greater than 30% was found for the group of cephalosporins, ampicillin sulbactam and ciprofloxacin in the last two years of observation. Conclusions: The data show an important resistance of Escherichia coli and Klebsiella pneumoniae isolated in urine cultures to the second-line antibiotics for the treatment of uncomplicated cystitis in women. Therefore, a great weight should be given to the results of the urine cultures for the proper use of these antibiotics.

Fecal peritonitis in aging rat model. Therapeutic response to different antibiotic strategies

Abstract Purpose: To evaluate the response of aging rats with sepsis to two different antibiotic regimens. Methods: The study was conducted with 30 aging rats (18 month-old) with autologous feces peritonitis. The animals were divided into three groups: Group 0 received no therapeutic intervention (control), while Group 1 received a single dose of 40 mg/kg meropenem and Group 2 received a single dose of 20 mg/kg moxifloxacin. The intervention in both Groups was made 6 hours after induction of peritonitis. The animals were followed up to 15 days for evaluating morbidity and mortality. The weights at baseline were similar in all groups. Results: At the end of follow-up, weight loss was significantly greater (p=0.0045) in Group 0 (non-intervention controls). Culture from a blood sample at the end of follow-up was positive in all the animals in Group 0, in two animals in Group 1 and in four animals in Group 2. Morbidity/mortality was significantly higher in Group 0 compared to both Groups 1 and 2 (p=0.003) but the scores were not significantly different between Groups 1 and 2 (p=0.6967). Conclusion: Both antibiotic regimens rendered promising results for the treatment of fecal peritonitis.

Disglucemia asociada a fluoroquinolonas: una revisión estructurada / Hypo or hyperglycemia associated with fluoroquinolone use

Fluoroquinolone type antimicrobials can cause hypo or hyperglycemia in certain patients. We performed a structured review about this side effect, searching articles published in English or Spanish with full text access in PubMed/Medline. The following MESH terms were used: Hypoglycemia, Hyperglycemia, Quinolones, Ciprofloxacin, Levofloxacin, Moxifloxacin. Additionally, we evaluated the clinical relevance of potential drug interactions, based on the probability of occurrence and the severity of the interaction effect. We obtained 42 publications about the issue; 22 references were selected, where the severity of the interaction in patients with risk factors was evaluated. Patients receiving antidiabetic medications and with risk factors such as advanced age and renal failure may be more likely to have a severe hypoglycemia. In these patients, this drug interaction should be considered clinically relevant since its risk is high or very high.

Genes qnr en Enterobacteriaceae aisladas en un hospital de Venezuela / qnr genes in Enterobacteriaceae isolated from at a hospital in Venezuela

Resumen Introducción: La resistencia de enterobacterias a quinolonas se ha difundido por el mundo, fenómeno presente también en Venezuela. El mecanismo de esta resistencia pudiera estar mediado por genes incluidos en el cromosoma bacteriano o transmitirse en el interior de plásmidos. Objetivo: Evaluar la resistencia a quino-lonas, codificada por genes qnr, presentes en cepas de enterobacterias, aisladas en el Hospital Universitario de Cumaná, Venezuela. Métodos: A las cepas obtenidas se les realizaron pruebas de susceptibilidad antimicrobiana a quinolonas, β-lactámicos y aminoglucósidos. La presencia del gen qnr se determinó por RPC. Las enterobacterias portadoras del gen qnr fueron sometidas al proceso de conjugación bacteriana para comprobar su capacidad de transferencia. A las transconjugantes obtenidas se les realizó pruebas de susceptibilidad antimicrobiana y RPC para comprobar la transferencia de los genes. Resultados: Se encontraron elevados porcentajes de resistencia antimicrobiana a quinolonas y betalactámicos. El 33,6% de las cepas eran portadoras del gen qnrB, y 0,9% del gen qnrA. Se obtuvieron 23 cepas transconjugantes; de éstas, 20 portaban el gen qnrB, no se observó la presencia de qnrA. Discusión: En conclusión, el elevado porcentaje de genes qnr encontrado en las enterobacterias aisladas, y comprobada la presencia de éstos en plásmidos transferibles, complica la aplicación de tratamientos basados en quinolonas y fluoroquinolonas, por lo que es recomendable el uso racional de estos antimicrobianos, y proponer la rotación de la terapia antimicrobiana, a fin de evitar la selección de cepas resistentes.

Background: Enterobacteria resistant to quinolones is increasing worldwide, including Venezuela. The mechanism for this resistance could be due to genes included in the chromosome or in transmissible plasmids. Aim: To evaluate the resistance to quinolones, coded by qnr genes present in enterobacteria species, isolated in the University Hospital of Cumana, Venezuela. Methods: Antimicrobial susceptibility tests to quinolones, beta-lactams and aminoglycosides were carried out to all the isolates. The presence of qnr genes were determined by PCR. The isolates carrying the qnr genes were used for bacterial conjugation tests to determine the presence of transferable plasmids. Antimicrobial susceptibility tests and PCR were carried out in the transconjugants to verify the transfer of the genes. Results: High levels of antimicrobial resistance to quinolones and beta-lactams were found among the isolates. We found that 33.6% of the isolates carry the qnrB gene and 0.9% qnr A gene. Of the 23 transconjugants, 20 showed to have qnrB gene, but none qnrA. Discussion: We concluded that the high frequency of qnr genes found in the enterobacteria isolates and their presence on transferable plasmids, complicate the use of quinolones for the treatment of bacterial infections, thus, a treatment plan should be designed with the rational use and the rotation of different types of antimicrobials, in order to avoid the selection of increasingly resistant strains.

Actualización en la prescripción de fluoroquinolonas / Update on the prescription of fluoroquinolones

Resumen: Las quinolonas o fluoroquinolonas son un grupo de antibióticos frecuentemente prescritos y de amplio espectro que actúan inhibiendo a las enzimas encargadas de la replicación, transcripción, reparación y recombinación del ADN bacteriano. El objetivo de este artículo es presentar una revisión sistemática de los antecedentes, farmacocinética y actividad microbiológica de las tres fluoroquinolonas más representativas en nuestro medio (ciprofloxacino, levofloxacino y moxifloxacino) en sus tres indicaciones actualmente autorizadas: infecciones de vías respiratorias inferiores, de vías urinarias, de piel y tejidos blandos.

Abstract: Quinolones or fluoroquinolones are a group of commonly prescribed and broad-spectrum antibiotics drugs that act by inhibiting the enzymes responsible for the bacterial DNA replication, transcription, repair and recombination. The aim of this article is to present a systematic review of the three most representative fluoroquinolones in our country (ciprofloxacin, levofloxacin and moxifloxacin) in their three authorized indications: lower respiratory tract infections, urinary tract infections, skin and soft tissues infections.

Application of quinolones in children with severe infection / 中华急诊医学杂志

Objective To analyze the efficacy and safety of quinolones in children with severe infection. Methods Patients with severe infections treated in the Pediatric Intensive Care Unit of Beijing Children's Hospital from November 2016 to January 2018 were enrolled. The clinical data were collected and analyzed. Results Totally 24 children were treated with quinolones, including levofloxacin, ciprofloxacin and moxifloxacin. Patients with poor initial treatment were treated with levofloxacin or ciprofloxacin on the basis of drug sensitivity for bacterial infections. Moxifloxacin was used to treat Mycoplasma pneumoniae infection in patients poorly treated by macrolides antibiotics or macrolide-resistance gene positive. Among the 24 cases, 1 case (4.2 ％) was cured, 19 cases (79.1 ％) treated effectively, 1 case had no response (4.2 ％), and 3 cases (12.5 ％) discharged automatically during treatment, with a response rate of 83.3 ％. The consciousness, skin, joint and gastrointestinal function were closely observed; blood routine test, liver and kidney function were closely monitored. There were no adverse drug reactions during the period of medication. Conclusions Quinolones can improve efficacy and prognosis for pediatric patients with severe infections. There are no drug related adverse reactions, indicating a safe short-term use. The use of quinolones in children is super-instructive, and clinical pharmacists should assist physicians in doing related work and reduce medical risks.

Fluoroquinolone resistance profile of Klebsiella pneumoniae isolates and the mechanisms conferring antibiotic resistance in ST494 strains / 中国感染与化疗杂志

Objective To investigate the resistance profile of Klebsiella pneumoniae isolates in Huashan Hospital, Fudan University. Methods The MICs of fluoroquinolones were determined by agar dilution method against 112 clinical strains of K. pneumoniae. Multilocus sequence typing (MLST) were applied to 48 K. pneumoniae strains. The characteristic sequence type (ST) associated with antibiotic resistance was identified by PCR. Results Lower percentage (＜40％) of K. pneumoniae strains were susceptible to fluoroquinolones. Majority (86.2％) of ciprofloxacin non-susceptible K. pneumoniae strains belonged to CC1 (ST11), ST494 or CC4 (ST15 and ST655), indicating the potential of clonal dissemination. ST494 (18.8％) was the second commonest sequence type, next only to ST11. ST494 strains harbored the genes encoding beta-lactamases, oqxAB, qnrD, aac-(6')-lb-cr and armA and had a single point mutation in gyrA. Therefore, ST494 strains were highly resistant to cephalosporins, fluoroquinolones and aminoglycosides and 22％ of the strains were resistant to carbapenems. However, all the ST494 strains were susceptible to tigecycline and tetracycline. Conclusions ST11 and ST494 are the commonest STs of K. pneumoniae conferring multidrug resistance in this hospital. These STs may contribute to the high resistance rates of K. pneumoniae to fluoroquinolones. The susceptibility of ST494 strains to tigecycline and tetracycline allows us to consider the promising potential of such drugs in managing K. pneumoniae infections.