ABSTRACT
As current levels of antimicrobial resistance are alarming, the World Health Organization urged the development of new antimicrobials to fight infections produced by multidrug resistant bacteria. Antibiotics impose severe selective pressure for the development of resistance, and currently bacteria resistant to all of them exist. In this review, we discuss the release and development of new antibacterial drugs and their properties as well as the current advances in the development of alternative approaches to combat bacterial infections, including the repurposing of drugs, anti-virulence therapies, the use of photosensitizers, phage therapy, and immunotherapies, with an emphasis on what is currently known about the possible development of bacterial resistance against them.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Bacterial Infections/drug therapy , Drug Resistance, Bacterial , Animals , Drug Utilization , HumansABSTRACT
BACKGROUND: The prosthetic joint infection is the most feared and catastrophic complication for cause severe physical damage to patients and, generates high economic costs. OBJECTIVES: To describe the microbiological characteristics and to determine the resistance pattern in prosthetic joint infections in a reference hospital in Mexico. MATERIAL AND METHODS: Patients whose prosthetic devices were withdrawn due to suspicion of septic and aseptic loosening were included. Cultures were performed to identify microorganisms and susceptibility analysis. RESULTS: Of the 111 patients included, 55% were diagnosed with prosthetic joint infection, with the most frequent prosthesis being of the hip (43%). Positive cultures were obtained in 97% of the infected cases, of which 75% were monomicrobial infections. The most frequent bacterial species isolated were: Staphylococcus epidermidis (31%), Enterococcus faecalis (16%), Staphylococcus aureus (13%), and Escherichia coli (8%). The resistance patterns for the Staphylococcus genus were: oxacillin (79%), erythromycin (45%) and ciprofloxacin (37%). Enterococcus faecalis showed a high percentage of resistance to erythromycin and clindamycin (86%), and fluoroquinolones (43%). The large majority (86%) of Escherichia coli were extended spectrum beta-lactamases positive, in addition to having high resistance to fluoroquinolones (86%), trimethoprim/sulfamethoxazole (86%) and gentamicin (72%). CONCLUSION: The microbiological characteristics found in prosthetic joint infections vary according to the hospitals. In this series, a high proportion of coagulase-negative Staphylococci and Enterococcus spp. were found, as well as a high bacterial resistance.
Subject(s)
Drug Resistance, Multiple, Bacterial , Elbow Prosthesis/adverse effects , Hip Prosthesis/adverse effects , Knee Prosthesis/adverse effects , Prosthesis-Related Infections/microbiology , Academies and Institutes/statistics & numerical data , Adult , Aged , Aged, 80 and over , Anti-Bacterial Agents/pharmacology , Cross Infection/epidemiology , Cross Infection/microbiology , Cross-Sectional Studies , Device Removal , Drug Resistance, Multiple, Fungal , Enterobacteriaceae Infections/epidemiology , Enterobacteriaceae Infections/microbiology , Female , Gram-Positive Bacterial Infections/epidemiology , Gram-Positive Bacterial Infections/microbiology , Humans , Male , Mexico/epidemiology , Middle Aged , Mycoses/epidemiology , Mycoses/microbiology , Prosthesis Failure/etiology , Prosthesis-Related Infections/epidemiology , Rehabilitation Centers/statistics & numerical data , Tertiary Care Centers/statistics & numerical dataABSTRACT
We report a case of femorotibial osteomyelitis due to Nocardia brasiliensis. Nocardia spp are a rare cause of bone infections, and the majority of such cases are associated with the spine. This type of osteomyelitis is uncommon, and in the immunocompetent host, is more often related to a chronic evolution following direct inoculation of the microorganism.
Subject(s)
Nocardia Infections/drug therapy , Nocardia/isolation & purification , Osteomyelitis/drug therapy , Osteomyelitis/microbiology , Administration, Intravenous , Amikacin/therapeutic use , Anti-Bacterial Agents/therapeutic use , Ceftriaxone/therapeutic use , Female , Humans , Imipenem/therapeutic use , Nocardia Infections/complications , Osteomyelitis/complications , Osteomyelitis/surgery , Phylogeny , Specimen Handling , Sulfamethoxazole/therapeutic use , Trimethoprim/therapeutic use , Young AdultABSTRACT
OBJECTIVE: To compare the epidemiology, clinical variables, outcome and molecular characteristics between methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-susceptible S. aureus (MSSA) bloodstream infections (BSI) of patients from a tertiary-care center. METHODS: We conducted a five-year retrospective cohort analysis of all patients with at least one peripherally-drawn blood culture positive for S. aureus. Patient characteristics, clinical data and outcome were analyzed, as well as microbiologic data. RESULTS: We included 444 isolates derived from 172 patients. The highest rate of MRSA BSI was observed in 2005 (4.9 cases per 1,000 patients). MRSA BSIs were more likely to be originated from a skin and soft tissue infection (OR 2.44, CI 95% 1.05-5.67, p = 0.03). The only significant risk factor for MRSA BSI was the mean length of hospital stay (OR 1.01; CI 95% 1.00-1.02, p = 0.002). A difference in inadequate initial treatment was noticed in MRSA BSI (OR 8.35 CI 95% 1.55-8.39, p = 0.002); but it had no impact on mortality. All MRSA isolates were SCCmec type II, and we did not find any resistance to vancomycin or linezolid. CONCLUSION: MRSA BSIs were associated with a prolonged hospital stay. We did not observe any difference in mortality between MRSA and MSSA BSIs. During the study period, we only identified SCCmec type II in MRSA isolates, which suggests that this infection was hospital- acquired.
