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We describe a case of Streptomyces atratus bacteremic pneumonia in an otherwise healthy, 77-year-old Spanish man. Streptomyces identified by 16S ribosomal RNA sequencing grew in multiple blood cultures and bronchoalveolar lavage cultures. The infection resolved completely after treatment with imipenem and amoxicillin/clavulanic acid for 2 months.
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Although Campylobacter jejuni is naturally susceptible to fluoroquinolones, the resistance to these antimicrobials has increased rapidly during the recent years. The aim of this study was to compare the activities of various older and newer fluoroquinolones towards C. jejuni, with special attention on ciprofloxacin-resistant strains.
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Gemifloxacin efficiency and tolerance in comparison to the ofloxacin, levofloxacin and gatifloxacin during the intensive phase of the antituberculosis therapy for drug resistant cases was evaluated. 156 drug resistant TB patients were examined in the open, prospective, randomized research, being divided into 2 groups with similar drug resistance profile. The 1st group received gemifloxacin, the 2nd--other fluoroquinolones. Gemifloxacin efficiency in the treatment regimen for the drug resistant TB patients did not differ from the efficiency of the use of other fluoroquinolones of the 4th generation and was significantly higher in comparison to ofloxacin. At the same time the identical level of side effects was registered in the course of treatment with mentioned drugs. Gemifloxacin is effective and safe at treatment of tuberculosis in comparison to other fluoroquinolones that allows considering it as the drug of choice among fluoroquinolones for treatment of drug resistant TB, including multidrug-resistant TB.
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The primary bactericidal classes used therapeutically as single agents, are the quinolones and the cell-wall active agents. In this study, their rates of killing were compared. The des-fluoro(6) quinolone BMS-284756 (T-3811ME), fluoroquinolones (trovafloxacin, levofloxacin) and cell wall-active agents (beta-lactams, vancomycin) were evaluated against Enterobacteriaceae, Staphylococcus aureus, streptococci, and Enterococcus faecalis. Time-kill analysis was done at 10x the MIC, using Mueller-Hinton broth (supplemented with 7% lysed horse blood for Streptococcus pneumoniae and the viridans streptococci), or Brain Heart Infusion broth for beta-haemolytic streptococci. Using a 3-log(10) decrease in viable count as an index of bactericidal activity, BMS-284756 and the fluoroquinolones killed Enterobacteriaceae rapidly, requiring < 2 h versus > or =6 h for beta-lactams. The staphylococcal cell counts generally decreased more rapidly with quinolone exposure, compared with those treated with vancomycin or the beta-lactams. The antimicrobial agents killed streptococci and enterococci more slowly, requiring > 6 h to decrease the viable count by 99.9%. In summary, BMS-284756 killing rates are similar to those of recent fluoroquinolones and are bacterial group-dependent. Overall, the quinolones are more rapidly bactericidal than vancomycin and the beta-lactam antibiotics.
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Haemophilus influenzae is a major respiratory tract pathogen that is becoming increasingly resistant to beta-lactam antibiotics.
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There is a significant correlation between levofloxacin use and the incidence of nosocomial fluoroquinolone-resistant E coli isolates. The incidence of fluoroquinolone-resistant E coli could be reduced by limiting levofloxacin consumption.
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This study compared the efficacy of moxifloxacin and levofloxacin in the treatment of multidrug-resistant tuberculosis (MDR-TB) in Shanghai, China. A retrospective analysis of 158 patients with MDR-TB receiving either moxifloxacin- or levofloxacin-containing regimens was performed. Clinical data from patients were subjected to univariate analysis, stratification and multiple logistic regression to compare the roles of moxifloxacin and levofloxacin in multidrug regimens. In total, 72 patients received 400mg of moxifloxacin once daily and 86 patients received 509.9 ± 79.4 mg (mean ± standard deviation) of levofloxacin once daily together with similar active agents for similar durations. The times to sputum culture conversion were similar. Adverse reactions occurred at comparable rates. The combined treatment success rate was 60.1%, being higher among ofloxacin-susceptible than ofloxacin-resistant cases (67.5% vs. 52.0%; P < 0.05). The success rates for the moxifloxacin group were 65.3% (overall), 77.1% (ofloxacin-susceptible cases) and 54.1% (ofloxacin-resistant cases) in comparison with 55.8%, 60.4% and 50.0%, respectively, for the levofloxacin group. No demographic, clinical, bacteriological or treatment characteristics were independent predictors of favourable outcome. Fourteen patients from the moxifloxacin group and twelve patients from the levofloxacin group had bacteriological relapse after treatment cessation. In conclusion, compared with levofloxacin, moxifloxacin did not show superior efficacy when incorporated into multidrug regimens used for the treatment of MDR-TB.
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Similarities in patient risk factors and resistance patterns of isolates of both community-acquired and nosocomial MRSA suggest healthcare acquisition of most MRSA. Thus, classifying MRSA as either community acquired or nosocomial underestimates the amount of healthcare-associated MRSA.
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The installation of synthetic prosthesis in the repair of the hernial defects of the inguinal region, though it is part of cleaned surgical operations, it needs of an antibacterial prophylaxis for the prevention of the septic complications of the surgical wound and these, compared with complications following hernioplasty by straight suture, have a meaningful morbidity that can outweigh social and economic advantages of the hernioplasties. The Authors' experience is relative to 112 patients submitted to prosthetic hernioplasty by anterior approach (94 cases) and by transabdominal preperitoneal laparoscopy (TAPP) (18 cases) and underwent to "switch prophylaxis" with Levofloxacin using this posologic scheme: 500 mg ev 30 m' before the surgical operation and 500 mg os in seven days following. The evaluation of the surgical wound has never evidenced septic and suppurative complications; only 11 of the 122 surgical wounds (9%) have documented light phlogosis never advanced to evident suppuration. No patients have showed signs of pharmacologic local intolerance; about collateral general effects as sick and diarrhoea are appeared in 5% of patients, but these have been of light entity; an increase of the transaminase, quickly reverted to the suspension of the therapy, has interested 4% of cases. On the basis of these satisfactory results about clinical efficacy on the prophylaxis of the phlogistic complications of the surgical wound, with reduction of the incidence and gravity and in relation to large and complete antibacterial spectrum included Staphylococcus aureus and epidermidis, and about excellent tolerability without collateral effects, the Authors consider to be important the standardized use of this prophylaxis in the prosthetic hernial surgery of the inguinal region. This choice is correlated to the typical pharmacologic characteristics of the Levofloxacin and particularly to the total bioequivalence between endovenous and oral formulation and besides in relation to perseverance, not inferior to 24 hours, of the plasmatic and tissutal concentrations above bactericide IMC on the most part of organic districts, included skin and soft tissue. The assurance of Levofloxacin's employment in the "switch prophylaxis" also is correlated to patient's elevated compliance, above all if he is operated on regimen of "one day surgery", and to a favorable relationship between costs and benefits.
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In this study, 44 isolates of SDSE, recovered from noninvasive infections (37) and from carriage (7), during 2008-2013, were submitted to antimicrobial susceptibility testing, emm typing and pulsed-field gel electrophoresis (PFGE) analysis.
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The frequency of occurrence and antimicrobial susceptibility patterns of 3059 non-enteric Gram-negative bacilli (NGB), other than Pseudomonas aeruginosa and Acinetobacter spp., consecutively collected as part of the SENTRY Antimicrobial Surveillance Program (1997-2003) were reviewed. During this period, a total of 221,084 bacterial isolates were collected from several clinical specimens worldwide, including 25,305 (11.5%) NGB. Acinetobacter spp. and P. aeruginosa accounted for 82.7% of the NGB isolates and have been excluded from this analysis. The antimicrobial susceptibility results of 3509 strains from 13 species/genera have been analysed in this review. The isolates were tested by reference broth microdilution methods in three central laboratories using common reagents and procedures. More than 30 antimicrobial agents were tested and the results for the 18 most active compounds are reported here. Stenotrophomonas maltophilia (2076 strains; 59.2%) was the most frequently isolated pathogen in this group, followed by Aeromonas spp. (385 strain; 11.0%), Burkholderia cepacia (269 strains; 7.7%), Pseudomonas fluorescens/putida (253 strains; 7.2%) and Alcaligenes spp. (236 strains; 6.7%). All other species/genera accounted for less than 3% of the isolates analysed. The antimicrobial agents with the most consistent activity against the NGB evaluated in the present study were the newer fluoroquinolones gatifloxacin and levofloxacin with 84.1 and 84.9% susceptibility overall. Trimethoprim/sulphamethoxazole was active against 85.3% of the isolates tested, but showed reduced activity against P. fluorescens/putida (22.1% susceptibility). Antimicrobial susceptibility varied significantly between species/genera and the geographical regions evaluated. Thus, proper identification and quantitative susceptibility testing will be required for the treatment of NGB infections. Extensive worldwide surveillance programmes remain extremely important to guide empirical antimicrobial therapy for rarely isolated pathogens and also for pathogens that are not routinely tested due to the lack of standardised susceptibility testing methods.
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The mean concentration of levofloxacin in the aqueous humor was higher than the MIC(90) values against some common pathogens of postoperative endophthalmitis, although a great degree of interpatient variability was present.
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Coagulase-negative staphylococci are the most common bacteria isolated from conjunctiva and lid margin.
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Careful monitoring is required when levofloxacin is prescribed for patients who are taking clarithromycin with theophylline.
Preoperative conjunctival isolates of CNS seem to be most sensitive to vancomycin, the aminoglycosides (except neomycin), and levofloxacin.
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The SENTRY antimicrobial surveillance program was established to monitor the occurrence and antimicrobial susceptibility of bacterial pathogens via an international network of sentinel hospitals.
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Sixteen albino rabbits were used in this study, and divided four groups. Levofloxacin in doses of 50, 100, 250 and 500 microg was injected into the midvitreous of rabbit's left eyes. The other eye served as a control and received normal saline solution. Indirect ophthalmoscopy, electroretinography (ERG) and light microscopy were used for retinal toxicity of levofloxacin. ERGs were recorded before injection and at 1(st) day, 1(st), 2(nd) and 4(th) weeks. At the end of follow-up period, the rabbits were killed and the eyes were enucleated for histologic evaluation.
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Antibiotic use per 1000 patient-days and carbapenem, fluoroquinolone and vancomycin use were evaluated pre- and post-implementation of the ASP. Total antimicrobial expenditures were evaluated for the 3 years prior to ASP implementation and three years following implementation.
Poor visual outcome and postoperative complication rates are related to extensive intraocular injury. Delayed IOFB removal with a combination of systemic and topical antibiotic coverage can result in good visual outcome without an apparent increased risk of endophthalmitis or other deleterious side effects.
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Among eight selected antibiotics, the greatest resistance was to levofloxacin (61.2%, n = 19) and the lowest one to imipenem (9.6%, n = 3). All isolates (100%, n = 31) exhibited efflux pump MexAB-OprM genes but different expression was observed in different strains. The result of gene expression indicated that significant differences in expression of MexR (P value = 0.003), OprD (P value < 0.001), and MexB (P value = 0.026) genes. In addition, there was high level of MexR gene expression in bacteria that leads to reduced expression of MexA, MexB, and OprM. The OprD gene was presented in all strains but different expression has been observed.
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The ease with which B. anthracis can be made resistant in vitro suggests that close monitoring of patients treated for anthrax is mandatory.
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The frequency of fluoroquinolone-associated anaphylaxis has been estimated to be 1.8-23 per 10 million days of treatment based on spontaneous reports. It is unknown whether there are differences between the reporting rates of anaphylaxis with individual fluoroquinolones. According to pathophysiology, anaphylaxis may be immune mediated (anaphylactic) or not (anaphylactoid). The latter may occur after first-ever intake since no sensitisation phase is necessary.
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Mycobacterium szulgai is one of the nontuberculous mycobacteria (NTM) and rarely causes diseases in human beings, particularly in immunocompetent patients. Less than 1% of all cases of NTM infection are caused by M szulgai, but the incidence is continuously increasing. Although extrapulmonary infections have been reported, most M szulgai infections are associated with pulmonary diseases. However, to our knowledge, a urinary tract infection caused by M szulgai has never before been reported. Here we report an immunocompetent female who experienced a urinary tract infection caused by M szulgai and was successfully treated with 4 months of isoniazid, rifampin, and levofloxacin.
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Clostridium difficile is a major cause of infectious diarrhea in hospitalized patients. Between August 2003 and January 2004, we experienced an increase in the incidence of C. difficile-associated disease. We describe the investigation into and management of the outbreak in this article.