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- HLA-DRA variants predict penicillin allergy in genome-wide fine-mapping genotyping. [JOURNAL ARTICLE]
- J Allergy Clin Immunol 2014 Sep 12.
Immediate reactions to β-lactams are the most common causes of anaphylactic reactions and can be life-threatening. The few known genetic factors influencing these reactions suggest a link with atopy and inflammation.We performed a fine-mapping genome-wide association study of the genetic predictors of β-lactam allergy to better understand the underlying mechanisms.We studied 387 patients with immediate allergic reactions to β-lactams and 1124 paired control subjects from Spain. We replicated the results in 299 patients and 362 paired control subjects from Italy.We found significant associations with the single nucleotide polymorphisms rs4958427 of ZNF300 (c.64-471G>A, P = 9.9 × 10(-9)), rs17612 of C5 (c.4311A>C [p.Glu1437Asp], P = 7.5 × 10(-7)), rs7754768 and rs9268832 of the HLA-DRA | HLA-DRB5 interregion (P = 1.6 × 10(-6) and 4.9 × 10(-6)), and rs7192 of HLA-DRA (c.724T>G [p.Leu242Val], P = 7.4 × 10(-6)) in an allelic model, with similar results in an additive model. Single nucleotide polymorphisms of HLA-DRA and ZNF300 predicted skin test positivity to amoxicillin and other penicillins but not to cephalosporins. A haplotype block in HLA-DRA and the HLA-DRA | HLA-DRB5 interregion encompassed a motif involved in balanced expression of the α- and β-chains of MHC class II, whereas rs7192 was predicted to influence α-chain conformation. HLA-DRA rs7192 and rs8084 were significantly associated with allergy to penicillins and amoxicillin (P = 6.0 × 10(-4) and P = 4.0 × 10(-4), respectively) but not to cephalosporins in the replication study.Gene variants of HLA-DRA and the HLA-DRA | HLA-DRB5 interregion were significant predictors of allergy to penicillins but not to cephalosporins. These data suggest complex gene-environment interactions in which genetic susceptibility of HLA type 2 antigen presentation plays a central role.
- Occurrence of multidrug resistance to oral antibiotics among Escherichia coli urine isolates from outpatient departments in Germany: Extended-spectrum β-lactamases and the role of fosfomycin. [JOURNAL ARTICLE]
- Int J Antimicrob Agents 2014 Jul 16.
The in vitro activities of fosfomycin and seven other antibiotics commonly used for oral treatment of urinary tract infections (UTIs) were evaluated for 499 Escherichia coli isolated from urine samples during a nationwide laboratory-based surveillance study in 2010. Overall, the highest resistance rates were found for amoxicillin (42.9%), followed by amoxicillin/clavulanic acid (32.7%), trimethoprim/sulfamethoxazole (SXT) (30.9%), ciprofloxacin (19.8%), cefuroxime (10.0%), cefpodoxime (8.6%) and cefixime (8.2%). One-half of the isolates (n=252; 50.5%) were fully susceptible to the eight drugs, whilst only 6 strains (1.2%) were resistant to fosfomycin. Combined resistance to amoxicillin, cefuroxime, ciprofloxacin and SXT was detected in 29 isolates (5.8%). Moreover, 40 isolates (8.0%) produced an extended-spectrum β-lactamase (ESBL), including CTX-M-type ESBLs detected in 39/40 isolates (97.5%) and a TEM-52 ESBL in 1 strain (2.5%). The predominant CTX-M-type ESBL was CTX-M-15 (27/39; 69.2%). Of the 27 CTX-M-15 producers, 19 (70.4%) belonged to the clonal lineage E. coli O25b-ST131. All but one ESBL-producing strains were fosfomycin-susceptible. In view of the emergence of multidrug resistance to standard oral antibiotics, these data support that oral fosfomycin (trometamol salt) may represent a valuable option in the treatment of uncomplicated UTIs.
- [Antibiotic prescribing in acute respiratory tract infections in general practice.] [JOURNAL ARTICLE]
- An Pediatr (Barc) 2014 Sep 11.
Antimicrobial resistance is a worldwide threat to public health. Acute respiratory tract infections are the main reason for antibiotic prescribing in the Spanish paediatric population. The aim of the study was to describe the frequency of antibiotic prescription and their pattern of use in acute respiratory tract infections diagnosed in children in Primary Care in Aragón (Spain).A study was conducted over a 1-year period on children between 0 and 14 years-old, recording all episodes of acute otitis, acute pharyngotonsillitis, non-specific upper respiratory infection, and acute bronchitis. The proportion of episodes within each diagnosis receiving an antibiotic prescription was calculated, and the prescribing pattern was determined.Half (50%) of the children in Aragón were diagnosed with a respiratory tract infection during the study period. Non-specific upper respiratory infection was the most frequent diagnosis. An antibiotic was prescribed in 75% of pharyngotonsillitis episodes, 72% of otitis, 27% of bronchitis, and 16% of non-specific upper respiratory infections. Broad spectrum antibiotics, mainly amoxicillin and amoxicillin-clavulanic, were predominantly prescribed.Antibiotic prescribing in respiratory tract infections in children was generally high, and the choice of antibiotics was probably inappropriate in a high percentage of cases. Therefore an improvement in antibiotic prescribing in children appears to be needed.
- Prospective multi-region study on primary antibiotic resistance of Helicobacter pylori strains isolated from Chinese patients. [JOURNAL ARTICLE]
- Dig Liver Dis 2014 Sep 11.
Large-scale multi-region studies are urgently needed to provide comprehensive and up-to-date information on the antibiotic resistance of Helicobacter pylori that is critical for selecting the most optimal eradication regimens.To determine the resistance patterns of Helicobacter pylori strains isolated from dyspeptic patients.This is a prospective, multicentre, cross-sectional, observational study. Helicobacter pylori cultures were successful in 600 patients (never receiving eradication therapy) from Northern, Eastern, Middle, and Southern regions between 2008 and 2012. Resistance to amoxicillin, clarithromycin, metronidazole, levofloxacin, tetracycline, and rifampicin was determined by Epsilometer test.The overall resistance rate was highest for metronidazole (403, 67.2%), followed by clarithromycin (225, 37.5%), levofloxacin (201, 33.5%), rifampicin (85, 14.2%), amoxicillin (41, 6.8%), and tetracycline (21, 3.5%). There were 16.3% isolates susceptible to all tested antibiotics, followed by mono-resistance (34.2%), double resistance (27.0%), triple resistance (16.8%), quadruple resistance (4.7%), quintuple resistance (0.7%) and sextuple resistance (0.3%). Independent factors influencing antibiotic resistance were gender (to levofloxacin), age (to levofloxacin), and endoscopic finding (to clarithromycin, metronidazole, and levofloxacin). Among the clarithromycin-resistant isolates, 75.6% and 48.0% were also resistant to metronidazole and levofloxacin, respectively.Helicobacter pylori resistance to commonly used antibiotics in China is a very serious issue, due to the high resistance rate and general multiple resistance.
- To choose the proper antibiotic regimen between the old and new antimicrobial agents and to determine the optimum dosage with Bi-Digital O-Ring Test. [Journal Article]
- Acupunct Electrother Res 2014; 39(2):183-201.
Bi-Digital O-Ring Test (BDORT) can be used for various purposes for medical and dental diagnosis as well as for treatment purposes by determining the type of medication and the dosage for a patient. In case of infection, BDORT is a fast and non-invasive way to decide what kind of antibiotic and the dosage to be given to patient. If a patient already has been on a certain antibiotic for days, the clinician could use BDORT with diode (with arrow signs of the diode pointing to the patient) to test the same drug. Otherwise without diode, if BDORT result is negative, it could either mean the negative result might be due to resonance phenomenon or it may be because the antibiotic is ineffective. Either way, if O-Ring would be open during testing, the clinician should gradually increase or decrease the dosage of antibiotic to find out if BDORT result begins to become positive. In great majority of cases involving less effective old generation antibiotics, it is usually due to resistant microbia that require increasing dosage of antibiotic to make it become more effective. If increasing dosage would make O-Ring close, then the increased dosage would be effective to the patient. If the result is negative, the clinician should consider switching to another antibiotic regimen that may be tested positive with BDORT. Old generation antibiotics have not necessarily lost usefulness or lack efficacy on those new emerging resistant bacteria. Clinicians may just need to increase the dosage of those older generation antibiotics to make them more effective. In fact, with so many antibiotic-resisting strains of bacteria, clinician often face dilemma whether to switch to newer generation of antibiotics or just to increase the dosage of the older generation of antibiotics that a patient has been taking. When testing antibiotic of penicillin-related medication including amoxicillin, the thymus tablet (bovine source) should also be used for the testing after initially testing without it. Such a double checking system will avoid the false signal from BDORT about the drugs of penicillin family.
- Penicillin and Beta-Lactam Allergy: Epidemiology and Diagnosis. [JOURNAL ARTICLE]
- Curr Allergy Asthma Rep 2014 Nov; 14(11):476.
Penicillin is the most common beta-lactam antibiotic allergy and the most common drug class allergy, reported in about 8 % of individuals using health care in the USA. Only about 1 % of individuals using health care in the USA have a cephalosporin allergy noted in their medical record, and other specific non-penicillin, non-cephalosporin beta-lactam allergies are even rarer. Most reported penicillin allergy is not associated with clinically significant IgE-mediated reactions after penicillin rechallenge. Un-verified penicillin allergy is a significant and growing public health problem. Clinically significant IgE-mediated penicillin allergy can be safely confirmed or refuted using skin testing with penicilloyl-poly-lysine and native penicillin G and, if skin test is negative, an oral amoxicillin challenge. Acute tolerance of an oral therapeutic dose of a penicillin class antibiotic is the current gold standard test for a lack of clinically significant IgE-mediated penicillin allergy. Cephalosporins and other non-penicillin beta-lactams are widely, safely, and appropriately used in individuals, even with confirmed penicillin allergy. There is little, if any, clinically significant immunologic cross-reactivity between penicillins and other beta-lactams. Routine cephalosporin skin testing should be restricted to research settings. It is rarely needed clinically to safely manage patients and has unclear predictive value at this time. The use of alternative cephalosporins, with different side chains, is acceptable in the setting of a specific cephalosporin allergy. Carbapenems and monobactams are also safely used in individuals with confirmed penicillin allergy. A certain predictable, but low, rate of adverse reactions will occur with all beta-lactam antibiotic use both pre- and post-beta-lactam allergy evaluations.
- Antimicrobial susceptibility in bacterial isolates from Norwegian cats with lower urinary tract disease. [JOURNAL ARTICLE]
- J Feline Med Surg 2014 Sep 12.
Studies of feline lower urinary tract disease (FLUTD) among Norwegian cats have shown higher prevalences of bacterial cystitis than most previously published reports. The aims of the present study were to identify bacterial isolates obtained from the urine of Norwegian cats with FLUTD and their susceptibility to antimicrobial agents. Eighty-two bacterial isolates from 72 urine cultures obtained from 71 different cats were included. Escherichia coli, Staphylococcus species, Enterococcus species and Streptococcus species were the most frequently detected. The percentages of isolates susceptible to the included antimicrobial agents were as follows: enrofloxacin - 92%; trimethoprim/sulfonamide - 91%; nitrofurantoin - 89%; tetracycline - 78%; ampicillin - 73%; amoxicillin/clavulanic acid - 72%; trimethoprim - 68%; amoxicillin - 58%; cephalexin - 51%; spiramycin - 39%; penicillin - 34%; fucidic acid - 34%; lincomycin - 27%. Although several tendencies towards increasing antimicrobial resistance were detected among the isolates included, the species of bacteria isolated and their patterns of antimicrobial resistance were, in general, in concurrence with the existing literature. Thus, the results do not fully explain the higher prevalence of bacterial cystitis found in Norwegian cats. Moreover, additional explanatory factors beside the inclusion of primary accession cases rather than referred cases were not found.
- Green Synthesis of Silver Nanoparticles: Structural Features and In Vivo and In Vitro Therapeutic Effects against Helicobacter pylori Induced Gastritis. [Journal Article]
- Bioinorg Chem Appl 2014.:135824.
This study evaluates in vivo and in vitro anti-Helicobacter pylori (H. pylori) efficacy of silver nanoparticles (Ag-NPs) prepared via a cost-effective green chemistry route wherein Peganum harmala L. seeds extract was used as a reducing and capping agent. The structural features, as elucidated by surface plasmon resonance spectrophotometry, transmission electron microscopy, and powder X-ray diffraction spectroscopy, revealed the Ag-NPs synthesized to be polydispersed in nature and spherical in shape with 5-40 nm size. A typical Ag-NPs suspension (S5), with size being 15 nm, when tested in vitro against forty-two local isolates and two reference strains, showed a considerable anti-H. pylori activity. In case of in vivo trial against H. pylori induced gastritis, after oral administration of 16 mg/kg body weight of S5 for seven days, a complete clearance was recorded in male albino rates. In comparative time-killing kinetics, S5 exhibited dose- and time-dependent anti-H. pylori activity that was almost similar to tetracycline and clarithromycin, less than amoxicillin, but higher than metronidazole. Furthermore, S5 was found to be an equally effective anti-H. pylori agent at low (≤4) and high pH with no drug resistance observed even up to 10 repeated exposures while a significant drug resistance was recorded for most of the standard drugs employed. The present results revealed the potential of the synthesized Ag-NPs as safer bactericidal agents for the treatment of H. pylori induced gastritis.
- Antibiotic resistance and resistance genes in Escherichia coli from poultry farms, southwest Nigeria. [Journal Article]
- J Infect Dev Ctries 2014; 8(9):1103-12.
This study investigated the mechanisms of resistance in 36 E. coli isolated from waste, litter, soil and water samples collected from poultry farms in Southwestern Nigeria.Minimum inhibitory concentration (MIC) distributions of the isolates were determined using the methods of the Clinical and Laboratory Standard Institute and resistance genes detected by PCR.A total of 30 isolates (94%) showed resistance to more than one antimicrobial. Percentage resistance was: tetracycline 81%, sulphamethoxazole 67%, streptomycin 56%, trimethoprim 47 %, ciprofloxacin 42%, ampicillin 36%, spectinomycin 28%, nalidixic acid 25%, chloramphenicol 22%, neomycin 14%, gentamicin 8%, amoxicillin-clavulanate, ceftiofur, cefotaxime, colistin, florfenicol and apramycin 0%. Resistance genes found among the isolates include bla-TEM (85%), sul2 (67%), sul3 (17%), aadA (65%), strA (70%), strB (61%), catA1 (25%), cmlA1 (13%), tetA (21%) and tetB (17%). Class 1 and 2 integrons were found in five (14%) and six (17%) isolates, respectively, while one isolate was positive for both classes of integrons. Seven out of eight isolates with resistance to ciprofloxacin and MIC ≤ 32 mg/L to nalidixic acid contained qnrS genes.Our findings provided additional evidence that the poultry production environment in Nigeria represents an important reservoir of antibiotic resistance genes such as qnrS that may spread from livestock production farms to human populations via manure and water.
- [Current care guideline: lower respiratory tract infections in children]. [English Abstract, Journal Article]
- Duodecim 2014; 130(15):1560-1.
All respiratory viruses are capable of causing lower respiratory tract infections. Active testing of influenza viruses during influenza epidemics is recommended. Antitussive medications are ineffective and should not be used. Croup presenting with inspiratory stridor is recommended to be treated with oral corticosteroids and inhaled racemic adrenalin. Corticosteroids and inhaled racemic adrenalin are ineffective for the treatment of bronchiolitis. Inhaled salbutamol administered by a spacer (with a mask) is recommended for wheezy bronchitis. Amoxicillin is recommended for treating pneumonia at home and intravenous penicillin in hospital (combined with macrolide if mycoplasma is suspected). Pertussis is treated with azithromycin or clarithromycin.