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We examined a large panel of C. difficile strains collected in 2006-2008 at the University Hospital of Zurich. We found that the antimicrobial susceptibilities to amoxicillin/clavulanate, piperacillin/tazobactam, meropenem, clindamycin, ciprofloxacin, ceftriaxone, metronidazole and vancomycin were similar to those reported in the literature and that they are similar to those reported in other populations over the last two decades. Antibiotic activity did not prevent CDI. For example, thre use of meropenem, which is highly active against all strains tested, was a clear risk factor for CDI. Most of the antibiotics tested also showed a higher minimum inhibitory concentration distribution than that of EUCAST. All strains were susceptible to metronidazole. One strain was resistant to vancomycin.
The collection comprised 171 C. difficile strains of human (n = 91) and animal (n = 80) origin in Australia in the last decade. The collection encompassed seven different clade 5 PCR ribotypes (RTs; 033, 078, 126, 127, 237, 281 and 288), seven STs and three toxin gene profiles. MICs were determined by agar incorporation methodology.
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Single-dose metronidazole, 2 gm orally, is as effective as 5- to 7-day courses of oral metronidazole, with cure rates in the 80% to 90% range. Oral clindamycin results in more than a 90% clinical cure rate. Intravaginal clindamycin cream 2% and intravaginal metronidazole gel 0.75% are associated with clinical cure rates similar to those for oral metronidazole.
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We obtained 26 patients, 7 in the first 5 years and 19 more in the following years. The mean age at diagnosis was 19 months. Four cases (15%) occurred during the neonatal period. Sixty-seven percent of the cases were diagnosed during spring and summer. Main clinical signs were: erythroderma with blisters and posterior desquamation (100%), perioral fissures (54%), fever (46%), conjunctivitis (42%) and palpebral edema (31%). No significant increases in leukocytes (mean: 11,341/.l) or C-reactive protein (mean: 9 mg/l) were found on blood analysis. Diagnosis was made by clinical findings. S. aureus was isolated in nasal or conjunctival samples on 59% of cases. All strains were sensitive to cloxacillin, clindamycin and vancomycin. The patients were treated with cloxacillin with good progress.
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The resistance of Campylobacter jejuni to fluoroquinolones is increasing globally. This study was performed to delineate those antimicrobial agents that are effective in vitro against ciprofloxacin-resistant C. jejuni isolates and potentially suitable for the treatment of severe disease when fluoroquinolone resistance or multidrug resistance is known or suspected.
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In a retrospective study comparing 526 oocyte donors who received prophylactic antibiotics for oocyte retrieval with a comparable group of 625 who did not, the incidence of infection after retrieval was reduced from 0.4% to 0 in the group receiving antibiotics. Donors take risks but have no medical indication for the procedures that they undergo; our data suggest that prophylactic antibiotics at retrieval should be considered to minimize the risk of infection.
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We have evaluated the KOH test, the antibiotic disk identification test, and the Gram stain reaction for the preliminary grouping of gram-positive and gram-negative anaerobes and have assessed the value of erythromycin 60-micrograms-disk resistance as a predictive index of clindamycin resistance among anaerobes. By testing 931 clinical isolates, 281 gram positive and 650 gram negative, with the KOH test and vancomycin 5-micrograms-disk test, we obtained the following parameters: sensitivity, 89.7 and 97.1%; specificity, 97.5 and 98.3%; positive predictive value, 80.4 and 98.7%; and efficiency, 92.1 and 98% for the KOH test and the vancomycin test, respectively. The KOH reaction incorrectly grouped 42 of 97 Bacteroides bivius and 12 of 50 pigmented Bacteroides strains. The vancomycin test correctly identified 63 of 67 gram-negative strains that had given a negative KOH reaction. The erythromycin disk result correctly predicted clindamycin resistance in gram-negative isolates but had a sensitivity of 85.7%, a specificity of 92.4%, and a positive predictive value of 42.8% for gram-positive isolates. Therefore, the use of these preliminary identification tests can assist in the correct grouping of anaerobes and accurately predict significant clindamycin resistance in gram-negative anaerobic bacteria.
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HIV-infected patients, especially those with AIDS, may develop TEN that shares many similarities with the disease in immunocompetent patients.
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Streptococcus criceti is a cariogenic organism that belongs to the mutans streptococci. Of the four S. criceti strains, strain OMZ 61 has been identified as being resistant to erythromycin. Antimicrobial susceptibility testing showed that strain OMZ 61 is also resistant to azithromycin, josamycin and clindamycin but susceptible to tetracycline and tiamulin. DNA hybridization analysis of the 23S rRNA genes revealed that the hybridization patterns in strain OMZ 61 differed from those in the other three strains. We further analyzed the nucleotide sequences of a ribosomal RNA operon, the rrnD operon, and the rpsJ-rpsQ region including rplC and rplD genes for ribosomal proteins L3 and L4, respectively, in the four strains studied. Nucleotide sequence analysis indicated that strain OMZ 61 contains an A-to-G substitution at nucleotide position 2059, equivalent to Escherichia coli numbering 2058, in a 23S rRNA gene (rrlD) and a G-to-A substitution at nucleotide position 439 in the rplC gene, suggesting an amino acid residue change at position 147 from valine to isoleucine, whereas no mutation in the rplD gene was found. DNA sequencing and polymerase chain reaction-restriction fragment length polymorphism analysis showed that most or all of the 23S rRNA genes in strain OMZ 61 contain the A2059G mutation. These findings suggest that the resistance to erythromycin, azithromycin, josamycin and clindamycin in strain OMZ 61 is conferred by alterations in 23S rRNA and/or ribosomal protein L3. This is the first description of mutations in the 23S rRNA and rplC genes in mutans streptococci.
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Nasal swabs from 168 healthy children with AD and 20 AD children with concurrent skin and soft-tissue infections (SSTI) were collected in 2005-2008. S. aureus strains were further analyzed for and compared with antibiotic susceptibilities.
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Our prospective treatment trial of children aged 3 months to 15 years included 199 cases of S. aureus osteomyelitis, septic arthritis, or their combination. These cases were compared with 66 cases caused by other agents, mainly Haemophilus influenzae type b, Streptococcus pneumoniae, or Streptococcus pyogenes. According to protocol, the treatment was initiated intravenously only for 2 to 4 days and completed orally. Nonstaphylococcal and staphylococcal infections were treated similarly. Primary antibiotics were clindamycin or a first-generation cephalosporin. Follow-up lasted ≥ 12 months posthospitalization.
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The incidence of inducible clindamycin resistance were studied in Milad Hospital of Tehran, Iran. Of 175 isolates of S. aureus 17 (9.7%) isolates showed inducible clindamycin resistance. Of 17 inducible clindamycin isolates of S. aureus, 11 strains were methicillin resistant S. aureus (MRSA) and 6 isolates were methicillin susceptible S. aureus) (MSSA). All isolates were susceptible to vancomycin and linozolide. We conclude that it is necessary to perform D-test for detection of inducible clindamycin in staphylococci in routine laboratory practices.
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The vagina has been studied as a favorable site for the local and systemic delivery of drugs, for female associated conditions. Vaginal preparations, although generally perceived as safer most still associated with number of problems including multiple days of dosing, dripping, leakage and messiness, causing discomfort to users and expulsion due to the self-cleansing action of the vaginal tract. These limitations lead to poor patient compliance and failure of the desired therapeutic effects. For efficient vaginal delivery of drugs, the delivery system should reside at the site of infection for a prolonged period of time. In situ gel formulation which combines advantages of both gels and solution so that an accurate dose can be administered with ease. These formulations remain in solution state before administration and transforms to gel after administration in to vaginal cavity.
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The aim of this study was to assess the antimicrobial susceptibility of a taxonomically diverse set of Bifidobacterium strains to different classes of antimicrobial agents using a recently described medium.
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Our population of pneumococci represents a transition era, soon after the introduction of PCV10. Non-susceptible patterns were found to be associated with classical PCV serotypes (especially serotype 14), which is still highly prevalent, and non-PCV10 ones (19A), which may disseminate, occupying the biological niche left by the vaccine serotypes.
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One hundred macrolide-resistant staphylococcal isolates from clinically relevant infections in Italy during a 19-month period were studied. Four distinct resistance phenotypes were observed using the triple-disk induction test (erythromycin, clindamycin, telithromycin): the cMLS(B) phenotype (24 isolates); the iMLS(B) phenotype (41 isolates); the MS phenotype (three isolates); and the iMTS phenotype (erythromycin-induced telithromycin resistance) (32 isolates). ermC and ermA genes predominated within erythromycin-resistant Staphylococcus aureus isolates with iMLS(B) phenotype and cMLS(B) phenotype, respectively. Among erythromycin-resistant CoNS isolates, half of the strains showed the iMTS or MS/msrA association, and ermC gene predominated among isolates with MLS(B) phenotype. By pulsed-field gel electrophoresis, high genetic heterogeneity was observed among the isolates studied. Both independent acquisition of macrolide resistance genes and spread of specific resistant clones were observed. Association between certain clonal types and specific types of infection could be detected. To our knowledge, this is the first report on characterization of erythromycin-resistant staphylococci in Italy.
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The susceptibility to 21 antimicrobial agents of 214 strains of Erysipelothrix rhusiopathiae isolated from pigs affected with swine erysipelas in Japan between 1988 and 1998 was determined. Ampicillin, cloxacillin, benzylpenicillin, ceftiofur, tylosin, enrofloxacin and danofloxacin were the most active agents [minimum inhibitory concentrations (MICs); < or = 0.025-0.78 microgram/ml], followed by cefazolin, virginiamycin, tiamulin, chloramphenicol, florphenicol and oxolinic acid (MICs; 0.1-25 micrograms/ml). Activity was poor or absent with kanamycin and sulfadimethoxine. Strains resistant to dihydrostreptomycin, erythromycin, clindamycin, lincomycin, oxytetracycline and doxycycline were detected. The susceptibilities to dihydrostreptomycin and oxytetracycline tended to decrease. Investigation of the differences in antimicrobial susceptibility of the 214 strains according to their serotypes, sources, isolation years and regions, showed that the strains resistant to dihydrostreptomycin were most frequently found in the strains of serotype 1a and in strains from septicaemic cases. Strains resistant to oxytetracycline were detected in all serotypes and all sources, and most of the strains resistant to erythromycin were detected in the strains of serotype 2. The frequency of strains resistant to dihydrostreptomycin gradually increased from 1988 to 1996, but then decreased between 1997 and 1998. The frequency of strains resistant to oxytetracycline was remained more than 38% from 1988 to 1998. It was suggested that the strains resistant to dihydrostreptomycin and oxytetracycline were distributed over almost all districts of Japan.
Methicillin-resistant coagulase-negative staphylococci (MR-CNS) are of increasing importance to animal and public health. In veterinary medicine and along the meat and milk production line, only limited data were so far available on MR-CNS characteristics. The aim of the present study was to evaluate the prevalence of MR-CNS, to identify the detected staphylococci to species level, and to assess the antibiotic resistance profiles of isolated MR-CNS strains.
The effectiveness of clinical pharmacists and attending physicians in altering the prescribing of metronidazole and clindamycin by resident physicians was evaluated, and the effect of these changes on antibiotic costs was determined. In July 1983, clinical pharmacists and attending physicians educated resident physicians about the efficacy and cost-effectiveness of substituting metronidazole for clindamycin in the treatment of intraabdominal and pelvic infections. A three-month educational program was implemented, which included distribution of a newsletter and involvement of clinical pharmacists in patient rounds. The use patterns of these drugs were then monitored for a 12-month period. A total of 425 treatment periods for 414 patients were reviewed, representing 91% of all therapy with metronidazole and clindamycin. Metronidazole use increased from 18.2% one month after implementation of the educational program to a plateau of 50% by November. Clindamycin expenditures decreased by more than 50% from the previous fiscal year, resulting in a savings of $33,469 to the pharmacy. The prescribing patterns of resident physicians were altered and cost savings were realized as a result of a comprehensive educational program that focused on substituting metronidazole for clindamycin. The program's success was enhanced because an equally efficacious agent was available and because of the participation of clinical pharmacists in patient rounds.
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To evaluate the in vitro effect of varying concentrations of clindamycin on Lactobocillus spp.
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The therapeutic effect of clindamycin on Eimeria pragensis (E. pragensis) infection in C57BL/6 mice was demonstrated by suppression of oocyst production and the appearance of degenerated endogenous stages of parasite in the intestine. Short-term clindamycin treatment, from 1 to 4 days or 4 to 8 days post infection (pi) at a dose of 800 mg/kg/day was effective to reduce clinical symptoms, oocyst production and schizogonic development. Interestingly, the short-term treatment schedules allowed the development of a measurable degree of protective immunity to challenge infection in the treated mice. In contrast, clindamycin treatment for the full 12 days period, which almost completely inhibited clinical symptoms and oocyst output, prevented the full development of protective immunity in the treated mice. All these data indicate that clindamycin is efficacious as an anti-eimerian agent and that both early and late endogenous developmental stages of E. pragensis exert a deep influence on the development of effective immunity to challenge infection.
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This study was designed to determine the antibiotic susceptibility profile of clinical isolates of group B streptococcus(GBS, Streptococcus agalactiae) and to use the information for formulating appropriate intrapartum antibiotic policy for GBS carriage in pregnancy.