[An analysis of the outbreak situation and background risk factors for drug-resistant urinary tract infection in nursing homes].

AIM: The present study clarified the outbreak situation and background risk factors for drug-resistant bacteria infection in nursing homes. METHODS: Subjects were 48 elderly individuals with urinary tract infections in 3 nursing homes during the 12-month period from January to December 2020. We analyzed the drug resistance of cultured bacteria using medical records. RESULTS: Escherichia coli was the most frequently cultured bacteria (37.1%), and extended-spectrum ß-lactamase (ESBL) -producing E. coli accounted for 26.1% of specimens. E. coli susceptibility to levofloxacin (LVFX) was seen in 47.8%, resistance in 47.8%, and intermediate response in 4.4%. E. coli susceptibility to ceftriaxone (CTRX) was seen in 73.9%, and resistance in 26.1%. E. coli susceptibility to sulfamethoxazole trimethoprim (ST) mixture was seen 81.8%, while resistance was seen in 18.2%. In addition, among ESBL-producing E. coli, susceptibility to LVFX was seen in 0% and resistance in 83.3%, and an intermediate response was seen in 16.7%, while susceptibility to ST mixture was seen in 83.3% and resistance in 16.7%. No marked differences in background risk factors were seen between the groups with LVFX-resistant and LVFX-susceptible E. coli. However, the body mass index was significantly lower (p=0.0389), and significantly more patients were treated with antimicrobial agents during the 1-year period preceding the sample acquisition and analysis (p=0.0418) in the group with CTRX-resistant E. coli than in the group with CTRX-susceptible E. coli. CONCLUSION: In the nursing homes examined, LVFX-resistant E. coli were highly prevalent, and ESBL-producing bacteria were also common. When we treat urinary tract infections, refraining from the use of LVFX is desirable, and antimicrobials should be chosen with care.

Enantioselective Bromolactonization of Trisubstituted Olefinic Acids Catalyzed by Chiral Pyridyl Phosphoramides.

Enantioselective bromolactonization of trisubstituted olefinic acids producing synthetically useful chiral lactones with two contiguous asymmetric centers has remained mainly unexplored except for the 6-exo cyclization mode. In this work, the 5-exo- and 6-endo modes of bromocyclization of trisubstituted olefinic acids were enabled for the first time using N-bromosuccinimide and a pyridyl phosphoramide catalyst. The utility of the resulting bromolactones was demonstrated by transformations harnessing reactive alkyl bromide moieties without losing stereochemical information. Optimization studies and control experiments revealed that the basicity of pyridine moieties and presence of N-H protons in the phosphoramide species strongly affected both the reactivity and enantioselectivity parameters.