Rapid determination of colistin resistance in Klebsiella pneumoniae by MALDI-TOF peak based machine learning algorithm with MATLAB.

INTRODUCTION: To date, limited data exist on demonstrating the usefulness of machine learning (ML) algorithms applied to MALDI-TOF in determining colistin resistance among Klebsiella pneumoniae. We aimed to detect colistin resistance in K. pneumoniae using MATLAB on MALDI-TOF database. MATERIALS AND METHODS: A total of 260 K. pneumoniae isolates were collected. Three ML models, namely, linear discriminant analysis (LDA), support vector machine, and Ensemble were used as ML algorithms and applied to training data set. RESULTS: The accuracies for the training phase with 200 isolates were found to be 99.3%, 93.1%, and 88.3% for LDA, support vector machine, and Ensemble models, respectively. Accuracy, sensitivity, specificity, and precision values for LDA in the application test set with 60 K. pneumoniae isolates were 81.6%, 66.7%, 91.7%, and 84.2%, respectively. CONCLUSION: This study provides a rapid and accurate MALDI-TOF MS screening assay for clinical practice in identifying colistin resistance in K. pneumoniae.

Prevalence of carbapenemases in Enterobacterales from urine specimens in an university hospital in Istanbul, Turkey.

We aimed to investigate the prevalence of carbapenemases in Enterobacterales strains isolated from urine specimens between July 2019 and July 2020.CIM and modified CIM tests were applied as well as detection of blaOXA-48, blaNDM, blaVIM, blaKPC and blaIMP genes was performed by multiplex PCR.One hundred fifty of 3,242 Enterobacterales strains were found to be carbapenem resistant and 46 were included in the study. Forty five (98%) of the 46 strains included in the study were Klebsiella spp. and one (2%) of them was Escherichia coli. Susceptibility to ceftazidime-avibactam, amikacin and gentamicin was 97%, 11% and 9%, respectively. Forty three (94%) isolates were found positive at 2 and 4 h with CIM test. Forty four (97%) strains were found positive at 4 h and 43 (94%) strains were found positive at 2 h with modified CIM test.While blaOXA-48, blaNDM and blaOXA-48 with blaNDM association were found in Klebsiella spp. isolates in 55%, 27% and 11%, respectively, blaVIM, blaKPC, blaIMP were not found. Only blaOXA-48 and blaNDM-1 were detected in the E. coli strain.None of the investigated genes were detected in three Klebsiella strains but with whole genome analysis the combination of blaOXA-534, blaCMY-99 and blaKPC-3 was found in the first strain, blaOXA-370 in the second strain and no resistance gene was found in the third strain.Ceftazidime-avibactam was found to be active against 97% of strains, and the most common resistance genes were blaOXA-48 and blaNDM-1. Previously undetected resistance genes have been identified in our country.

Molecular Mechanisms of Colistin Resistance Among Klebsiella Pneumoniae Strains.

BACKGROUND: The increasing rate of infections caused by multiple drug resistant gram-negative bacteria has led to resuscitation of colistin. As a result, colistin resistance, mainly among Klebsiella pneumoniae strains has also been increased. The aim of this study was to investigate molecular mechanisms behind colistin resistance. METHODS: Twenty colistin-resistant K. pneumoniae strains isolated from clinical samples of different patients were involved in this study. VITEK2 automated ID/AST system (Biomeriux, France) was used for the identification and also the susceptibility testing for antibiotics other than colistin. Colistin susceptibility was determined by broth microdilution method. To identify the mechanisms of resistance, mutations on mgrB genes, expression levels of pmrA, pmrB, pmrC, pmrD, pmrE, pmrK, phoQ, and phoP genes, and the presence of plasmid mediated colistin resistance genes, mcr-1 and mcr-2 were investigated. RESULTS: As a result of the study, increased expression levels of the pmrA, pmrB, pmrD, pmrK, phoP, and phoQ genes were observed. All colistin resistant strains were found wild type for the mgrB gene which is thought to be esponsible for colistin resistance. Also, no mcr-1 or mcr-2 genes which are the causes of plasmid mediated colistin resistance have been detected in any of the strains. CONCLUSIONS: Among the colistin resistant K. pneumoniae strains included in our study, increased expression Levels of the genes responsible for cell membrane modifications related with colistin resistance were the most common mechanisms.

Antibacterial, Antitubercular and Antiviral Activity Evaluations of Some Arylidenehydrazide Derivatives Bearing Imidazo[2,1-b]thiazole Moiety.

OBJECTIVES: The aim of this study was to determine the probable antibacterial, antitubercular, and antiviral activities of some N2 -arylidene-(6-(4-chlorophenyl)imidazo[2,1-b]thiazol-3-yl) acetic acid hydrazides (3a-j). Further structural optimization of the identified lead structures can lead us to new more active potential antibacterial, antitubercular, and antiviral agents. MATERIALS AND METHODS: Antibacterial activities of the title compounds against Staphylococcus aureus ATCC 29213, Pseudomonas aeruginosa ATCC 27853 and Escherichia coli ATCC 25922. These molecules were also evaluated for their in vitro antitubercular activity against Mycobacterium tuberculosis H37Rv (ATCC 27294) using the BACTEC 460 radiometric system and BACTEC 12B medium. Moreover, all the compounds (3a-j) were also evaluated against some DNA and RNA viruses in Madin-Darby Canine Kidney, Crandell-Rees Feline Kidney (CRFK), Vero, human embryonic lung (HEL) and HeLa cells. RESULTS: Among the tested compounds, 3i displayed the highest efficacy against S. aureus and E. coli. Compound 3j, 5-nitro-2-furfurylidene derivative showed the highest antituberculosis activity (IC50: 6.16 µg/mL and IC90: 14.390 µg/mL). Compound 3i showed the most potent antiviral activity against feline corona virus in CRFK cell cultures (antiviral EC50: 7.5 µM and SI>13). Furthermore, compounds 3c and 3g displayed activity against herpes simplex virus-1 and vaccinia virus in HEL cell cultures (antiviral EC50 values of 9; 16 and 20; 14 µM, respectively). CONCLUSION: On the basis of aforementioned results, it can be conluded that imidazo[2,1-b]thiazole derivatives bearing hydrazone moieties serve as promising chemical probes to design therapeutic agents with antibacterial, antitubercular, and antiviral properties.

Determination of clinical significance of coagulase-negative staphylococci in blood cultures.

The aim of this study was to investigate the criteria used to distinguish coagulase-negative staphylococci (CoNS) bacteremia from contamination. We evaluated 162 adult patients with CoNS-positive blood cultures (BCs). Of the 162 patients, 35 (21.6%) had at least 2 positive BCs and 127 (78.4%) had a single positive BC. According to the Laboratory-Confirmed Bloodstream Infection (LCBI) criteria, 24 (14.8%) patients with the same species of CoNS had true bacteremia, and 138 (85.2%) patients had contaminants. Despite the detection of the same CoNS species, 9 of the 24 patients had different CoNS genotypes. Using clinical assessments, only 20 patients were diagnosed with true bacteremia, 8 of them had a single positive BC. We concluded that only using the LCBI criteria or clinical evaluations of a patient were not sufficient to distinguish CoNS bacteremia from contamination. Molecular identification should also be performed as a diagnostic laboratory parameter for CoNS bacteremia.

Synthesis, characterization, and antimicrobial evaluation of some new hydrazinecarbothioamide, 1,2,4-triazole and 1,3,4-thiadiazole derivatives.

In this work, we reported the synthesis and evaluation of antibacterial and antifungal activities of three new compound series obtained from 6-(phenyl/4-chlorophenyl)imidazo[2,1-b]thiazole-3-acetic acid hydrazide: 2-{[6-(phenyl/4-chlorophenyl)imidazo[2,1-b]thiazol-3-yl]acetyl}-N-alkyl/arylhydrazinecarbothioamides (2a-d), 4-alkyl/aryl-2,4-dihydro-5-{[6-(phenyl/4-chlorophenyl)imidazo[2,1-b]thiazol-3-yl]methyl}-3H-1,2,4-triazole-3-thiones (3a-n), and 2-alkyl/arylamino-5-{[6-(phenyl/4-chlorophenyl)imidazo[2,1-b]thiazol-3-yl]methyl}-1,3,4-thiadiazoles (4a-g). The newly synthesized compounds were characterized by IR, (1)H NMR, (13)C NMR (APT), mass and elemental analysis. Their antibacterial and antifungal activities were evaluated against Staphylococcus aureus ATCC 29213, Pseudomonas aeruginosa ATCC 27853, Escherichia coli ATCC 25922, Candida albicans ATCC 10231, C. parapsilosis ATCC 22019, C. krusei ATCC 6258, Trichophyton mentagrophytes var. erinacei NCPF 375, Microsporum gypseum NCPF 580, and T. tonsurans NCPF 245. 3c, 3f, 3m, 3n, and 4e showed the highest antibacterial activity. Particularly 3c, 3f, 3g, 3k, 3n, 4a, 4e, and 4g showed the highest antifungal activity against tested fungi.

[Antibiotic susceptibility rates and beta-lactam resistance mechanisms of Pseudomonas aeruginosa strains]. / Pseudomonas aeruginosa Suslarinda Antibiyotik Duyarlilik Oranlari ve Beta-Laktam Direnç Mekanizmalarinin Tiplendirilmesi.

Pseudomonas aeruginosa is a well-known cause of severe and potentially life-threatening infections including bacteremia, skin and wound infections, pulmonary disease, especially among individuals with cycstic fibrosis, nosocomial urinary tract infections, endocarditis and meningitis. The mechanism of resistance to broad-spectrum beta-lactams in P.aeruginosa are overexpression of cephalosporinases and/or class A, B and D beta-lactamases. Recently PER-1 type beta-lactamase has been reported from Turkey, France, Italy, Romania, Hungary, Belgium, Russia, South Korea and India. OXA beta-lactamases have increasingly been reported in clinical strains of P.aeruginosa from various geographical origins. This study was aimed to investigate the antibiotic susceptibility of various P.aeruginosa clinical strains and to define the beta-lactamase enzymes leading to resistance. In this study, a total of 100 P.aeruginosa strains isolated from various clinical specimens (37 urine, 21 blood, 10 sputum, 5 bronchoalveolar lavage, 5 abscess, 5 wound swabs, 4 endotracheal aspirate, 3 throat swabs, 2 catheter tips, one of each pleural and peritoneal fluid) were included. According to Clinical and Laboratory Standards Institute (CLSI) recommendations, susceptibilities of isolates to various antibiotics were investigated by disk diffusion and agar dilution method, and beta-lactamase enzymes were detected by isoelectric focusing (IEF) method. PSE, PER-1, OXA-10-like beta-lactamase genes and MEX-R genes of isolates were investigated by polymerase chain reaction (PCR). According to MIC90 values, the most effective antibiotics were found to be imipenem (8 µg/ml). The MIC90 values of amikacin, ciprofloxacin, cefepime, cefpirome, piperacillin + tazobactam, piperacillin, ceftazidime, ticarcilin, aztreonam and ticarcilin + clavulanic acid were 32, 64, 64, 64, 128/4, 512, 512, 512, 512 and 512/2 µg/ml, respectively. Seven of the isolates were found to be ESBL positive by double-disk synergy method. It was detected that 10% of the isolates were imipenem-susceptible and 9% were intermediate susceptible. Phenotypical investigation of metallo-beta-lactamase enzyme in these strains by MBL E-test method did not reveal a positive result. PER-1 and OXA-10 like beta-lactamases were detected each in 11% of the isolates, and co-presence of PER-like and OXA-10 like enzymes were shown in 4% of the isolates. PSE gene was not found in any of the strains. The MEXR gene was identified in 52% of the isolates. Antibiotic resistance mechanisms in P.aeruginosa strains seems to be complex. Determination of the resistance mechanisms and antibiotic susceptibility rates in P.aeruginosa will guide the proper antimicrobial therapy, reducing the emergence of resistant strains.

The role of latent toxoplasmosis in the aetiopathogenesis of schizophrenia--the risk factor or an indication of a contact with cat?

We assessed IgG antibody to Toxoplasma gondii in 300 inpatients with schizophrenia (SG), 150 outpatients with anxiety and depressive disorders (PCG), and 150 healthy blood donors (HCG). Seropositivity rates were 60.7% for SG, 36.7% for PCG, and 45.3% for HCG (p<0.001). The seropositivity rate for anti-Toxoplasma IgG antibodies in SG was significantly higher that in PCG (chi2 = 23.11, OR = 2.66, p = 0.001) and HCG (chi2 = 9.52, OR = 1.86, p = 0.002). Among SG, 85% of those who reported close cat contact had IgG antibodies to T. gondii. Close cat contacts were reported by 59% of SG, 6% of PCG, and 9% of HCG (p<0.001). There was a nonsignificant positive association between toxoplasmosis and schizophrenia for people with a contact with a cat (OR = 2.221, p = 0.127, CI95 = 0.796-6.192), and significant negative association between toxoplasmosis and schizophrenia for people without contact with a cat (OR = 0.532, p = 0.009, CI95 = 0.332-0.854). Close cat contact (OR = 2.679, p<0.001), 51-65-year age group (OR = 1.703, p<0.001) and education [illiterate+primary (OR = 6.146, p<0.001) and high school (OR = 1.974, p = 0.023)] were detected as independent risk factors in multivariate logistic regression. The effect of toxoplasmosis on risk of schizophrenia disappeared in the complex model analyzed with multivariate logistic regression. In conclusion, our data suggest that the toxoplasmosis has no direct effect on the risk of schizophrenia in Turkey but is just an indication of previous contacts with a cat.

Synthesis and antimicrobial evaluation of new 3-alkyl/aryl-2-[((alpha,alpha-diphenyl-alpha-hydroxy)acetyl)hydrazono]-5-methyl-4-thiazolidinones.

New 4-thiazolidinone derivatives of benzilic acid (alpha,alpha-diphenyl-alpha-hydroxyacetic acid) have been synthesized and evaluated for antibacterial and antifungal activities. The reaction of 1- (alpha,alpha-diphenyl-alpha-hydroxy)acetyl-4-alkyl/arylthiosemicarbazides with ethyl 2-bromopropionate gave 3-alkyl/aryl-2-[((alpha,alpha-diphenyl-alpha-hydroxy)acetyl)hydrazono]-5-methyl-4-thiazolidinone derivatives. Their antibacterial and antifungal activities were evaluated against S. aureus ATCC 29213, P. aeruginosa ATCC 27853, E. coli ATCC 25922, C. albicans ATCC 10231, C. parapsilosis ATCC 22019, C. krusei ATCC 6258, T. mentagrophytes var. erinacei NCPF 375, M. gypseum NCPF 580 and T. tonsurans NCPF 245. 3e, 3f, 3g and 3h showed the highest antibacterial activity. Particularly 3a and 3e showed the highest antifungal activities against C. parapsilosis ATCC 22019, T. tonsurans NCPF 245 and M. gypseum NCPF 580.

Synthesis and antimicrobial activity evaluation of new 1,2,4-triazoles and 1,3,4-thiadiazoles bearing imidazo[2,1-b]thiazole moiety.

A series of 4-alkyl/aryl-2,4-dihydro-5-((6-(4-bromophenyl)imidazo[2,1-b]thiazol-3-yl)methyl)-3H-1,2,4-triazole-3-thiones (3a-i) and 2-alkyl/arylamino-5-((6-(4-bromophenyl)imidazo[2,1-b]thiazol-3-yl)methyl)-1,3,4-thiadiazoles (4a-c) were synthesized starting from 6-(4-bromophenyl)imidazo[2,1-b]thiazole-3-acetic acid hydrazide. The newly synthesized compounds were characterized by IR, (1)H NMR, mass and elemental analysis. All compounds were tested for antibacterial and antifungal activities. The antimicrobial activities of the compounds were assessed by the microbroth dilution technique. The compounds were also evaluated for antituberculosis activity against Mycobacterium tuberculosis H37Rv (ATCC 27294). The preliminary results revealed that some of the compounds exhibited promising antimicrobial activities.

Prevalence and antimicrobial resistance patterns of extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae isolated from blood cultures in an Istanbul University Hospital.

Between January 2001 and September 2006, a total of 459 Escherichia coli and 226 Klebsiella pneumoniae strains were isolated from blood samples of patients with bacteremia who were hospitalized at the Istanbul University Cerrahpasa Medical Faculty. Blood cultures were analyzed with the Bactec 9120 system (Becton Dickinson, USA). Antimicrobic resistance of the E. coli or K. pneumoniae strains was determined by the disk diffusion method according to the Clinical and Laboratory Standards Institute criteria. Extended spectrum beta-lactamase (ESBL) production was examined with the double-disk synergy test. The percentage of ESBL was 40% (182/459) for E. coli and 49% (111/226) for K. pneumoniae. ESBL-producing E. coli and K. pneumoniae were highly resistant to trimethoprim/sulfamethoxazole (60 and 40.5%), amoxicillin/clavulanic acid (56.5 and 48.6%), ciprofloxacin (57.6 and 35%) and gentamicin (38 and 40.5%), respectively; however, lower resistance rates were found for amikacin (19.7 and 16%) and piperacillin/tazobactam (29.6 and 24%). None of the strains were resistant to imipenem. Our data indicated that prevalence of ESBL-producing E. coli and K. pneumoniae strains isolated from blood cultures is high and antimicrobial resistance increases. Considerable effort should be made to decrease the ESBL-positive organisms.

Comparison of in vitro activities of tigecycline with other antimicrobial agents against Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis in two university hospitals in Istanbul, Turkey.

BACKGROUND: We compared the in vitro activities of tigecycline with those of other agents against 97 Streptococcus pneumoniae, 140 Haemophilus influenzae and 54 Moraxella catarrhalis strains isolated in two large university hospitals in Istanbul. METHODS: For analysis, the agar dilution method was used. RESULTS: For S. pneumoniae isolates, 32% were not susceptible to penicillin (28.9% intermediate and 3.1% resistant). Cefotaxime, telithromycin, moxifloxacin and linezolid were fully active. Tigecycline had a 90% minimum inhibitory concentration (MIC(90)) of 0.12 microg/ml. For H. influenzae, 8.57% were not susceptible to ampicillin, among which 8 possessed beta-lactamase (5.7%). Four (2.87%) H. influenzae isolates with beta-lactamase-negative and ampicillin-resistant phenotype were found. All isolates were susceptible to ceftriaxone, azithromycin, ciprofloxacin, levofloxacin and moxifloxacin. MIC(90) for tigecycline was 0.5 microg/ml. Of 54 M. catarrhalis isolates, 88.9% possessed beta-lactamase. Tigecycline and fluoroquinolones were highly active (MIC(90) < or =0.12 microg/ml). CONCLUSIONS: Linezolid, telithromycin, newer fluoroquinolones and tigecycline all have excellent in vitro activities against the 3 respiratory pathogens.

Higher prevalence of toxoplasmosis in victims of traffic accidents suggest increased risk of traffic accident in Toxoplasma-infected inhabitants of Istanbul and its suburbs.

Reflexes of drivers who have toxoplasmosis have been shown to deteriorate from the actions of the parasitic cysts. The cysts can change the level of the neurotransmitters such as dopamine in the brain and by doing so extend the muscle response time and change personality profiles. In this study, we aimed to determine the frequency of the latent toxoplasmosis (LT) in the driver population who were either injured or died in traffic accidents reported in Istanbul and its suburbs. We compared the results with a control group and discussed the relationship between the LT and the traffic accidents. We included 218 (89.7%) non-fatal, 25 (10.3%) fatal cases in our study as study groups. A total 243 subjects, 234 (96%) male, 9 (4%) female (who were alcohol negative) compared with 191 (95.5%) male and 9 (4.5%) female subjects (control group) who had a traffic accident before but no history of toxoplasmosis were studied. Serologic tests, enzyme immunoassay (EIA) for IgG and IgM, and microimmunoflorescence (MIF) for IgG were used as the reference test, the Sabin-Feldman Dye test (SFDT) was used. According to serologic test results, LT seroprevalence in the study groups was 130 (53.5%) and in the control group 56 (28%) (p<0.0001). A LT was present in 126 out of 234 (53.8%) males in the study groups, and 54 out of 191 (28.3%) males in the control group (p<0.0001). In the 31-44 year age group, there was a significant difference with regard to toxoplasmosis between the study subjects and control groups (p<0.0001). This difference was statistically very significant in (recent and former) cases with middle-aged men (31-44 years old). The results of this retrospective study suggest that LT in drivers, especially those who are between 31 and 44 years might increase the risk for getting involved in a car accident. In a prospective study, Toxoplasma positive and negative subjects can be monitored before they are involved in a traffic accident to clarify the cause and result relationship.

The influence of glucose added urine on the in vitro antimicrobial activity of various antibiotics.

BACKGROUND & OBJECTIVE: Factors associated with the medium, including calcium and magnesium ion concentration and pH have been shown to affect the results of susceptibility testing but very little is known about glycosuria and the effect of glucose on the antimicrobial effect of antibiotics. In this study we assessed the influence of glucose added urine on the in vitro activities of various antibiotics by the microbroth dilution method. METHODS: Sixteen Escherichia coli isolates from patients with urinary infections were used in this study. Nine antibiotics were tested for their antimicrobial activity. Minimum inhibitory concentrations (MICs) were performed by the microbroth dilution method parallel in Mueller Hinton broth and glucose added urine. RESULTS: MICs of nearly all antibiotics were higher in glucose added urine than MICs in broth. MIC(90) against ampicillin was 32-fold higher in glucose added urine than MIC(90) in broth. MIC(90)s against ampicillin-sulbactam, cephalothin, cefuroxime, ceftriaxone and ciprofloxacin in glucose added urine were significantly (P<0.05) higher than MIC(90) in broth. Equal MIC(90) in glucose added urine and broth were obtained for amikacin, sulphamethoxazole and trimethoprime. INTERPRETATION & CONCLUSION: Our findings demonstrated that MICs of antibiotics are influenced by the glucose added urine.

Implant-related infection model in rat spine.

OBJECTIVE: The rate of postoperative infections is approximately 1% in spine surgery. However, when metal implants are used, postoperative infection rates significantly increase and were reported between 2.1 and 8.5%. This study aim to set up an infection model in the rat spine with a metal implant. MATERIALS AND METHODS: Forty white male Sprague Dawley rats were randomly divided in four groups. In all rats, under operation microscope, a 3 mm titanium microscrew was implanted in the thoracolumbar area (T10-L1) after laminar decortication. In Group I (control group), sterile isotonic solution and in other three groups, different concentrations of Staphylococcus aureus [Group II: (10(2)), Group III: (10(3)), Group IV: (10(6))] were squirted on the decorticated lamina site. All animals were sacrificed after 2 weeks, and then blood cultures and cultures from fascia, muscle and bone were obtained. Bacterial number in each tissue was measured as colony-forming unit per gram tissue. Titanium microscrews were placed in 0.5 ml tryptic soy broth and vortexed than plated on trypticase soy agar to determine bacterial growth. Two animals from each group were subjected to histological examination. RESULTS: Blood cultures obtained by intra-atrial puncture after 2 weeks were negative in all groups indicating no systemical infection developed. Bacterial cultures were negative in all specimens of Group I (control group). A significant osseous infection was confirmed in Groups II, III and IV. Comparison of bacterial counts in bone cultures showed no significant difference between Group III (10(3) CFU/10 microl) and Group IV (10(6) CFU/10 microl) (P > 0.05), while both groups had significantly higher counts than Group II (10(2) CFU/10 microl) (P > 0.05). Microscopic findings of supurrative inflammation were present only in Group IV (10(6) CFU/10 microl). CONCLUSIONS: This study shows that inoculation of S. aureus in 10(6) CFU/10 microl concentration at the decorticated lamina after implantation of a titanium screw in rat spine is a reproducible model for spinal infection and can be used for the animal model of prophylaxis and treatment and of postoperative infection.

Susceptibilities of Neisseria gonorrhoeae and Ureaplasma urealyticum isolates from male patients with urethritis to several antibiotics including telithromycin.

BACKGROUND: The minimal inhibitory concentrations (MICs) of erythromycin, azithromycin, clarithromycin, telithromycin, tetracycline, doxycycline, ciprofloxacin, ofloxacin, norfloxacin, levofloxacin, gemifloxacin and moxifloxacin against 78 Neisseria gonorrhoeae and 31 Ureaplasma urealyticum strains, which were isolated from patients with urethritis in Istanbul, were determined and compared. Additionally, the activities of penicillin and ceftriaxone against N. gonorrhoeae strains were explored. METHODS: MICs were determined by agar and broth dilution methods for N. gonorrhoeae and U. urealyticum, respectively. RESULTS: The susceptibility rates for penicillin and tetracycline in N. gonorrhoeae strains were 35.9 and 24.3%, respectively. All gonococcal strains were susceptible to ceftriaxone, with very low MICs (MIC90 0.008 microg/ml). Telithromycin was highly active against N. gonorrhoeae and U. urealyticum strains (MIC90 0.25 microg/ml for both). Ciprofloxacin was the most active quinolone against N. gonorrhoeae (MIC90 0.008 microg/ml) while quinolone resistance was detected in a single strain (1.3%). CONCLUSIONS: Tetracycline and penicillin should not be the option in empirical treatment of N. gonorrhoeae infections due to the very low susceptibility rates. Ceftriaxone continues to be the first choice antibiotic in the treatment of gonococcal urethritis.

The influence of urine on the in vitro antimicrobial activity of various antibiotics against different Escherichia coli phenotypes.

BACKGROUND: The influence of urine on the in vitro activities of various antibiotics used in the therapy of urinary tract infections was assessed by the microbroth dilution method in this study. METHODS: Thirty Escherichia coli strains were used: 10 E. coli strains susceptible to ampicillin, 10 strains resistant to ampicillin and ampicillin+sulbactam and ten extended spectrum beta-lactamase producer strains. The minimum inhibitory concentrations (MICs) of ampicillin, ampicillin + sulbactam, cephalothin, cefuroxime, ceftriaxone, amikacin, ciprofloxacin, sulfamethoxazole and trimethoprim were performed parallel in Mueller-Hinton broth and human urine by the microbroth dilution method. RESULTS: The MIC(90) of all antibiotics except cephalothin were higher in the urine. MICs performed in the urine were found significantly higher than those performed in broth. CONCLUSIONS: This study demonstrated that MICs of antibiotics are influenced by the human urine and that MICs of some antibiotics used in the treatment of urinary tract infections may be overestimated by the standard antibiotic testing methods.

The effects of streptozotocin-induced diabetes on brucellosis of rats.

It is believed that an infection is more common and runs a more protracted course in people with diabetes. In clinical practice, it is important to be aware of these associations, as the prognosis is often dependent upon prompt recognition and appropriate treatment. To show the course of brucellosis in the diabetic state, a model of Brucella melitensis infection was used in the setting of streptozotocin-induced diabetes in rat. B. melitensis infection proceeded more severely in diabetic rats and the severity of diabetes affected the prognosis. However, no association was found between B. melitensis and insulin using in vitro and in vivo experiments. Our study illustrates that B. melitensis infection in diabetes should be taken seriously.

In vitro activity of telithromycin compared with macrolides and fluoroquinolones against Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis.

The in vitro activity of telithromycin was compared with erythromycin A, azithromycin, clarithromycin, moxifloxacin, gemifloxacin, levofloxacin, ciprofloxacin, penicillin G, ampicillin, cefuroxime and ceftriaxone against 336 consecutive strains (83 Streptococcus pneumoniae, 168 Haemophilus influenzae and 85 Moraxella catarrhalis) isolated from patients with community-acquired respiratory tract infections. Telithromycin (MIC(90), 0.008 mg/l) was the most active drug against S. pneumoniae. Telithromycin was also highly active against M. catarrhalis (MIC(90), 0.06 mg/l), but less active against H. influenzae (MIC(90), 4 mg/l).