Cotrimoxazole for community-acquired urinary tract infections leads to more adverse effects than fluoroquinolones.

BACKGROUND: For several years, we applied an internal guideline for community-acquired urinary tract infections (cUTI), targeting the reduction of fluoroquinolone use (FQ) and thereby favouring cotrimoxazole (CTM) prescription. Our aim was to report adverse effects (AE) and outcome for patients presenting with cUTI and treated with these compounds. METHODS: This cohort study was based on the dashboard of our department, bringing together 28 parameters for all patients, including diagnosis, microbiological data, antibiotic therapy, AE, length of hospital stay (LHS) and outcome. We included all patients with cUTI due to Enterobacteriaeae treated with CTM or FQ, and compared these 2 groups on in-hospital AE, LHS, and unfavourable outcome defined as intensive care requirement or death. RESULTS: From June 2008 to June 2019, 640 cUTI due to Enterobacteriaeae were observed, among which 295 (46%) treated with CTM and 345 (54%) with a FQ. There were 25 AE (3.9%): 17 (5.7%) in the CTM group, and 8 (2.3%) in the FQ group (P=0.025). Adverse effects were associated with increased LHS compared to patients without AE: 11±6 vs. 7±4 days respectively, P<0.001, 11.4±6.2 days in the CTM group vs. 9.2±5.8 in the FQ group (relative LHS increase of 73.5% and 29.5%, respectively). Unfavorable outcome occurred for 1 patient (0.3%) in the CTM group, and 5 (1.4%) in the FQ group, P=0.297. CONCLUSION: Favouring cotrimoxazole for cUTI due to Enterobacteriaceae was associated compared to FQ with more AE and prolonged LHS. A cost-effectiveness analysis to validate such therapeutic strategy is warranted.

Antibiotic guidelines coupled with selective reporting of antibiograms.

OBJECTIVES: We reported the impact of internal guidelines coupled with selective reporting of antibiotic susceptibility tests (srAST) on antibiotic adequacy in healthcare facilities. METHODS: This prospective study involved clinicians from three clinics with medical and surgical activities employing a full-time infectious disease (ID) specialist. Internal guidelines were updated in 2016. The clinics were working with the same laboratory, which delivered the srAST introduced in March 2017. Two weeks per month over a 6-month period, all isolated bacterial specimens, empirical antibiotic therapies (EAT) and the documented ones were analyzed. An EAT listed in the guidelines and a documented therapy mentioned in the srAST defined their adequacy. RESULTS: A total of 257 positive bacterial samples were analyzed in 199 patients, for which 106 infections were studied. Of these, 32% were urinary tract infections, 15% were primary bloodstream infections, 11% were bone infections, and 42% were other types of infection. The three main bacteria were Escherichia coli (27%), Staphylococcus aureus (24%), and Enterococcus faecalis (14%). The total number of antibiotic prescriptions was 168, with 75 (45%) EATs and 93 (55%) documented therapies. There were 35/75 (47%) adequate EATs and 86/93 (92%) adequate documented therapies. The ID specialist was not involved in 90/168 (53.5%) prescriptions, of which 43/90 (48%) were adequate, with 21/35 (60%) EATs and 22/86 (25%) documented therapies. There was a statistical correlation between compliance of the EATs with guidelines and of the documented therapy with srAST (p=0.02). CONCLUSION: Combining internal guidelines and srAST led to a high rate of antibiotic adequacy.

Effects of peach palm oil on performance, serum lipoproteins and haemostasis in broilers.

1. An experiment was conducted to study the comparative effects of peach palm oil (PPO, Bactris gasipaes H.B.K), crude palm oil (CPO, Elaeis guinenesis), maize oil (MO) and beef tallow (BT) on serum total and lipoprotein cholesterol levels and haemostatic factors in broiler chickens. 2. Four experimental diets were formulated to be isocaloric (14·2 MJ AME(N)/kg) and isonitrogenous (230 g CP/kg). PPO was extracted from the whole dry fruit with hexane. Each fat was added to the diet in an amount equivalent to 25% of total dietary calories. Six replicate groups of eight male broiler chicks were assigned randomly to each dietary treatment. Diets were fed on ad libitum basis. The experiment lasted 42 d. 3. At 42 d, birds were fasted overnight and three chickens/dietary treatment were utilised to draw blood for lipoprotein separation. Various haemostatic factors were determined in thrombocyte-poor plasma. Thrombocyte aggregation was assayed in whole blood. 4. No significant differences were detected in body-weight gain or feed efficiency between the chickens fed on the PPO diet and those receiving the CPO, MO or BT diets. Total serum cholesterol (TC), very low density lipoprotein cholesterol and low density lipoprotein cholesterol (LDL(C)) were not significantly affected after consuming the PPO, CPO and MO diets. Serum high density lipoprotein cholesterol (HDL(C)) was reduced only by the MO diet. Birds fed on the PPO diet had a significantly lower [corrected] LDLC/HDLC ratio compared with other dietary treatments 5. Thrombocyte count and thrombin time were not significantly affected by the experimental diets. Dietary oils significantly affected prothrombin time, fibrinogen concentration and thrombocyte aggregation. PPO and MO diets elicited the lowest fibrinogen levels compared to the CPO and BT diets. Thrombocyte aggregation in broilers fed on the PPO diet was similar to that of the CPO, MO and BT diets. 6. The results suggest that PPO might efficiently provide up to 25% of dietary energy in broiler diets. Additionally, PPO elicited a more favourable LDL(C)/HDL(C) ratio and haemostatic pattern in broiler chickens. These findings may be of general interest to the food industry.

Effects of concanavalin A on intestinal brush border enzyme activity in broiler chickens.

1. The effects of Concanavalin A (Con A) on enzymes from the intestinal brush border were studied using membrane vesicles (BBMV) prepared from 3- and 6-week-old broiler chickens. 2. Maltase, sucrase, phytase, alkaline phosphatase and leucine aminopeptidase activities were assayed in BBMV in the absence (T0) or presence (T1) of Con A, or in the presence of casein (T2). Disaccharidase specific activities were assayed in the presence of Con A that had been pre-incubated with the enzyme (T3) or with the substrate (T4). 3. Con A significantly affected maltase and sucrase activities in 3-week-old broiler chicken intestinal BBMV. Pre-incubation of the lectin with the maltase or its substrate had no effect on enzyme activity. Pre-incubation of Con A with sucrose reduced enzyme activity. 4. Con A did not affect phytase, alkaline phosphatase or leucine aminopeptidase activities. 5. Maltase, alkaline phosphatase and leucine aminopeptidase activities were lower in 6-week-old than in 3-week-old broilers.

L-canavanine inhibits L-arginine uptake by broiler chicken intestinal brush border membrane vesicles.

1. Intestinal brush border membrane vesicles (BBMV) were prepared from 3-week-old broiler chickens. 2. Electron microscopy of the BBMV fraction showed single membrane vesicles of different sizes with no electron dense material inside. No other organelles were observed. The sucrase and maltase activities were enriched by factors of 16 and 18, respectively, in the BBMV fraction in comparison with the homogenate. On the other hand, the Na+/K+-ATPase sensitivity to ouabain was increased by a factor of 0.8. 3. The BBMV showed a maximum L-[14C]-arginine uptake (944.9 +/- 22.9 pmoles/mg protein) at 45 s and thereafter it declined slowly. In the presence of 0.5 mM L-canavanine, the L-[14C]-arginine uptake by BBMV was reduced by 43.6% at 45 s. 4. It is concluded that L-canavanine inhibits L-arginine Na+-dependent transport across the enterocyte apical membrane in a highly purified intestinal BBMV from broiler chickens.

[Morphological characterization of annatto fruits 9bixa orellana L.) and its correspondence with protein and isoenzym patterns]. / Caracterización morfológica de frutos de onoto (Bixa orellana L.) y su correspondencia con patrones de proteínas e isoenzimas.

A group of 32 annatto genotypes collected in five Venezuelan regions (Oriente, Centro, Llanos, Andes and Amazonas) and in Brazil were used for morphological studies. The fruit variables with the greatest discriminatory power in the formation of groups were capsule size, spinosity and seed size. On the other hand, an association group among the variables spinosity, spine length, dehiscence and apex shape were formed, also a proportional association between capsule and seed size, and between dehiscent capsule and brown coloured seeds. Additionally, in order to discriminate morphological variables behaviour in respond to electrophoretic variables, a group of protein and isozyme bands associated with fruit characteristics were established. Therefore, a classification system of this species was possible using morphological studies of the capsules, even though a determined association relating morphological and molecular patterns was not found.

[Identification and genetic variability of annatto genotypes (Bixa orellana L.) by means of hydrosoluble proteins and isoenzymes]. / Identificación y variabilidad genética de genotipos de onoto (Bixa orellana L.) mediante el uso de proteínas hidrosolubles e isoenzimas.

In order to identify and to determine the genetic variability of 36 annatto genotypes (Bixa orellana L.) collected in five Venezuelan regions (Oriente, Centro, Llanos, Andes and Amazonas) and in Brazil, hydrosoluble protein patterns as well as specific isozyme patterns (alpha-esterase, beta-esterase and peroxidase) were studied using extracts of germinated annatto seeds with radicles of 10 to 15 mm long. Each electrophoretic system allowed genotype discrimination by means of unique banding patterns: both the hydrosoluble protein and the electrophoretic system of beta-esterase with nine banding patterns each; whilst alpha-esterase and peroxidase discriminated eight and three genotypes, respectively. On the other hand, a combination of all the systems permitted a greater discrimination since 34 out of 36 genotypes could be distinguished. Eight mayor groups were formed that showed high levels of genetic diversity (40 to 60%) with no association between geographic and genetic distances, probably because of human influence in the aleatory distribution of this crop. Results obtained indicated that using electrophoretic banding patterns, a classification system could be established for identification and genetic variability purposes in this species.

Effects of Concanavalin A, fed as a constituent of Jack bean (Canavalia ensiformis L.) seeds, on the humoral immune response and performance of broiler chickens.

An experiment was conducted to investigate the effects of the lectin, Concanavalin A (Con A), contained in raw Jack bean (JB) (Canavalia ensiformis, L.) seeds on the immunological response of broilers. A maize-soybean meal basal diet was prepared to which either 2.5, 5, or 10% of ground raw Jack bean (RJB) seeds was added. The RJB seeds contained 24 g Con A/kg on a dry matter basis, as measured by rocket immunoelectrophoresis. Similar diets were prepared by using the same levels of JB after toasting at 190 C for 16 min. In addition, the basal diet was pair-fed to groups of chicks at the level of feed intake of chicks fed the 10% RJB diet. Each diet was fed to six groups of six chicks for 6 wk. At 5 wk, 15 of chicks from each diet were immunized against Brucella abortus (BA) and the anti-BA antibody titers were determined 1 wk later by ELISA. Antibody production against Con A was also measured by the same method. Binding of Con A to intestinal villi and subsequent endocytosis were confirmed by microscopic examination using a specific peroxidase-antiperoxidase-staining technique. Performance was recorded weekly. Feed intake and weight gain were reduced (P < 0.05) only by the diet containing 10% RJB, indicating that broiler chicks can tolerate daily intakes of 100 mg of Con A over 6 wk without affecting growth. Toasted JB diets supported adequate chick performance. The antibody response to BA did not differ with dietary treatment. Serum from chicks fed raw JB also contained antibodies against Con A. The bursa of Fabricius, thymus, spleen, and pancreas dry weights, as a percentage of dry body weight, were not affected by the experimental diets. The data indicated that Con A binds to the cells of the gastrointestinal tract, passes into the general circulation and, eventually, elicits an immunological response without affecting the production of antibodies to BA.

[Effects of sugar cane molasses on the nutritive value of Canavalia ensiformis seeds for broiler chicks]. / Efectos de la melaza de caña sobre el valor nutricional de los granos de Canavalia ensiformis en pollos de engorde.

Three experiments were conducted to determine the efficacy of sugar cane molasses to improve performance of broiler chicks fed a diet containing 30% raw or autoclaved Canavalia ensiformis seeds (Jack beans). For this latter purpose, canavalia seeds were ground and autoclaved at 120 degrees C and 15 psi during 60 min. Day-old male chicks (Cobb x Cobb) were used throughout the study. In Experiment 1, adding 10% molasses to a control diet devoided of jack beans seeds significantly (p < 0.05) increased chick feed intake. However, neither the addition of 10% molasses nor of 5% glucose, sucrose, fructose, xylose or corn starch to the 30% raw canavalia ration allowed feed intakes similar to that shown by the control diet (Experiment 2). Broiler performance was evaluated in Experiment 3 in response to diets containing 30% raw or autoclaved jack bean meal. Ten-percent molasses was also added to both diets which along with the control diet were fed to chiks had free access to diets. Growth was depressed when the Jack bean containing diets were pair-fed to chicks. The results indicated that the use of molasses does not overcome the deleterious effects on chick performance due to the presence of 30% raw or autoclaved jack bean meal in the diets.

[Nutritional value and antinutritional factor content of precooked flours prepared from Canavalia ensiformis]. / Valor nutricional y contenido de factores antinutricionales de harinas precocidas de granos de Canavalia ensiformis.

Precooked flours obtained five Canavalia ensiformis varieties were prepared by dehydration in double drums. On a dry matter basis, significant differences (P < 0.05) among varieties were detected for crude protein content (25 to 30%), starch (36 to 40%) and dietary fiber (13 to 15%). Hemagglutinins were eliminated as result of the high temperature (146 degrees C/4 min) employed during the drying process. Similar results were not obtained for trypsin inhibitors and canavanine considering that small amounts of these compounds remained in the precooked flours prepared from canavalia seeds. A 10% decrease in available lysine was observed. Biological assays yielded Protein Efficiency Ratio (PER) values of 0, 8-1 and Neat Proteic Relation (NPR) values of 2-3-2.6. True digestibility of protein values were improved from 87 to 90%. All cultivars had similar starch digestive utilization coefficient (96%) and starch fraction (4%) resistant to enzymatic hydrolysis in the rat digestive tract.

L-canavanine influences feed intake, plasma basic amino acid concentrations and kidney arginase activity in chicks.

L-Canavanine [2-amino-4-(guanidinooxy) butyric acid], a non-protein amino acid that is structurally analogous to arginine, has been proposed as a major antinutritional factor responsible for the toxic effects induced by raw Canavalia ensiformis (L.) seeds in chicks. We investigated the effects of L-canavanine on performance and select metabolic responses of growing chicks. Canavanine was added to a control diet, in an amount equivalent to that provided by 300 g raw canavalia seeds/kg diet (10 g free base canavanine/kg diet). Growth, plasma basic amino acids and kidney arginase, activity were measured. The incorporation of canavanine into a nutritionally balanced diet for growing chicks depressed feed intake and growth by approximately 25% (P < 0.01) compared with the control diet. Performance was unaffected by equimolar amounts of arginine. Canavanine exerted its growth-depressing effect exclusively by reducing feed intake, because this effect was not observed in a pair-feeding experiment. Chicks fed a diet containing 473 mmol canavanine sulfate/kg for 11 d were given an intracrop dose of 946 mmol of canavanine sulfate or arginine hydrochloride. In both cases, plasma histidine and lysine concentrations were significantly decreased compared with a placebo group dosed with water. Plasma arginine concentration was unaffected by the canavanine sulfate dose but, as expected, was significantly increased by the arginine hydrochloride dose. Free base canavanine significantly (P < 0.05) reduced kidney arginase activity. No overt toxic effects were observed at any point during the study. These data indicate that, although canavanine is not the principal antinutritional factor in Canavalia ensiformis seeds, its presence in the diet precludes optimum performance of chicks.

Immunity to diphtheria in a sample of adult population from central Italy.

A sample of 643 healthy subjects from central Italy aged 20 to 80, were screened for diphtheria antitoxin. Serum diphtheria antitoxin was assayed by a new passive haemagglutination technique using turkey red blood cells sensitized with diphtheria toxoid, after having performed a correlation study between this technique and the reference in vivo neutralization test. Of the studied population 26.7% showed a lack of serum antitoxin titres considered to be protective. The rate of susceptible subjects increased with age, showing the highest value (38.9%) in the sixth decade of age. Males proved less protected than females; 53.2% of the male population aged 50-59 were lacking a protective anti-diphtheria immunity. On the basis of present results, a periodical revaccination of the entire adult population with reduced doses of diphtheria toxoid would be advisable.

Immunity to diphtheria, six to 15 years after a basic three-dose immunization schedule.

The results of a study of the immunity to diphtheria of 283 girls (9-18 years of age) vaccinated at the age of two years with three doses of vaccine, are reported. The rabbit skin test was used to determine the titre of serum diphtheria antitoxin. 55.8% of the subjects were found to be protected (titre greater than or equal to 0.1 IU/ml), 38.9% were only relatively immune (titre greater than or equal to 0.01- less than 0.01 IU/ml), and 5.3% were unprotected (titre less than 0.01 IU/ml). The antitoxin titres showed a tendency to decrease with time. Even so, 6-15 years after vaccination, the percentages of protected and partially protected subjects were still high (95%).