Antibiotics-Basel最新文献

Objectives: This double-blind, randomized clinical trial aimed to evaluate the impact of 2 g of pre-operative amoxicillin on postoperative clinical outcomes and salivary prostaglandin E2 (PGE2) concentration following mandibular third molar removal. Methods: Eighteen healthy adult patients requiring impacted mandibular third molar extraction were randomly assigned to two groups: an experimental group (EG) receiving 2 g of amoxicillin and a placebo group (PG) receiving empty capsules, one hour before the surgery and before taking the first saliva sample. Primary outcomes measured were pain levels at different time points and salivary PGE2 concentrations measured before, 24 h, and 7 days after the surgery, while secondary outcomes included changes in maximum mouth opening (MMO) immediately after the surgery at 1 day and a week post-surgery, and facial swelling at 24 h and 7 days post-surgery. Results: The results showed no significant differences between the EG and PG in terms of pain levels, salivary PGE2 concentration, MMO changes, or facial swelling at different time points (p-values > 0.05). One instance of surgical site infection was noted in the PG in the 7-day follow-up session, but it was not statistically significant (p-value = 0.303). Correlation analyses indicated that a higher number of sutures and a higher difficulty index of surgery were associated with increased pain, while longer surgery duration and osteotomy were linked to more MMO changes and facial swelling (p-values < 0.05). In addition, while longer surgery duration and performing tooth section were correlated with lower PGE2 concentrations, PGE2 concentrations were positively correlated with pain levels (p-values < 0.05). Conclusions: Based on the results of this study, administering 2 g of prophylactic amoxicillin did not significantly affect postoperative clinical or laboratory outcomes in healthy patients undergoing mandibular third molar surgery.

Background/Objectives: Cm-p5 and its cyclic monomeric and dimeric analogues are known for their antifungal, antibacterial, antiviral, and antibiofilm activities. Previously, our cyclization method produced a mixture of peptides that were difficult to separate, which was then improved by a selective synthesis of the parallel dimer and its differentiation from the antiparallel by comparison of the retention times in RP-HPLC. Methods: Here, we developed a more reliable identification method for the Cm-p5 dimer identification, which included chymotrypsin proteolytic digestion and sequencing of the different fragments by ESI-MSMS. We also improved our cyclization methods to specifically produce higher amounts of the desired cyclic variant, either cyclic monomer or dimer. Results: We show that liquid phase oxidation with 20% DMSO or iodine oxidation yields only the cyclic analogue. However, the on-resin oxidation with iodine showed greater efficacy and efficiency. Additionally, liquid phase cyclization yields the antiparallel dimer in high EtOH or peptide concentration, indicating a kinetic control. On the other hand, the parallel dimer was preferentially produced in 5% of TFE and low peptide concentration without the formation of the cyclic analogue indicating a thermodynamic control. Conclusions: In conclusion, we report that chymotryptic digestion combined with ESI-MS and MS/MS allows an unambiguous differentiation of Cm-p5 dimers. Here, we develop more selective and efficient methods for the synthesis of cyclic and dimeric analogues of Cm-p5.

Background: Inappropriate antibiotic use drives antimicrobial resistance and remains a global concern. Evidence suggests antibiotic use may be higher among malaria-negative patients compared to malaria-positive ones, but uncertainty persists, particularly in regions with varying malaria prevalence. This study measured antibiotic residuals in three Tanzanian regions with varying malaria epidemiology and analyzed factors influencing their presence.

Methods: A cross-sectional household survey was conducted in 2015, covering a population of 6000 individuals across three regions of Tanzania. Dried blood spot samples from a subset of participants were analyzed using broad-range tandem mass spectrometry to detect residual antibiotics. Risk factors associated with antibiotic presence, including household healthcare-seeking behaviors, malaria testing, and other relevant variables, were evaluated.

Results: The overall prevalence of residual antibiotics in the study population was 14.4% (438/3036; 95% CI: 11.4-15.8%). Stratified by malaria transmission intensity, antibiotic prevalence was 17.2% (95% CI: 12.9-17.2%) in Mwanza (low), 14.6% (95% CI: 10.6-15.0%) in Mbeya (moderate), and 11.2% (95% CI: 7.9-11.6%) in Mtwara (high). Trimethoprim was the most frequently detected antibiotic (6.1%), followed by sulfamethoxazole (4.4%) and penicillin V (0.001%).

Conclusions: Residual antibiotic prevalence did not directly correlate with malaria endemicity but was influenced by healthcare practices, including co-prescription of antibiotics and antimalarials. The higher antibiotic use in malaria-negative cases highlights the need for improved diagnostics to reduce unnecessary use and mitigate antimicrobial resistance in malaria-endemic areas.

Background: Antimicrobial resistance (AMR) is an escalating global health threat, projected to cause over 40 million deaths by 2050. ESKAPE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp.) are major contributors to nosocomial infections and AMR. We evaluated the epidemiology and AMR prevalence of ESKAPE pathogens at the University Hospital in Palermo between January 2018 and July 2023, analyzing factors associated with mortality in patients with positive blood cultures.

Methods: Microbiological data from all specimen types were collected using the Business Intelligence system Biwer, excluding duplicates. We assessed the prevalence and trends of ESKAPE isolates and AMR over time. Clinical data from hospital discharge forms were used to evaluate factors associated with mortality in patients with ESKAPE-positive blood cultures. Differences in AMR prevalence between blood and non-blood isolates were examined.

Results: A total of 11,607 specimens from 4916 patients were analyzed. Most patients were admitted to Internal Medicine (19.4%), the ICU (13.2%), and General Surgery (9.9%). Additionally, 21.5% of the specimens were collected from ICU-admitted patients. Blood cultures accounted for 14.3% of the specimens, urine for 25.3%, respiratory secretions for 22.1%, and skin and mucosal swabs for 20.9%. The prevalence of all isolates increased progressively, peaking in 2021. The vancomycin-resistant E. faecium prevalence was 19.4%, with a significant upward trend, while oxacillin-resistant S. aureus prevalence was 35.0%, showing a significant decline. A. baumannii exhibited high resistance to all antibiotics tested except for colistin and cefiderocol. Carbapenemase resistance was 55.0% in K. pneumoniae, 20.4% in P. aeruginosa, and 4.6% in Enterobacter spp. P. aeruginosa showed a significant decrease in meropenem resistance. K. pneumoniae and A. baumannii bloodstream infections were linked to higher mortality risk.

Background/objectives: The rise in multidrug-resistant pathogens complicates UTI management, particularly in empirical therapy. This study aimed to develop and describe a Bayesian hierarchical weighted-incidence syndromic combination antibiogram (WISCA) model to optimize antibiotic selection for adult patients with community-onset UTIs.

Methods: A retrospective study was conducted using a Bayesian hierarchical model. Data from microbiology laboratory records and medical databases were analyzed, focusing on age, prior antibiotic exposure, and clinical characteristics. Clinical outcomes, including extended hospital stays and in-hospital mortality, were evaluated before WISCA model development. Unlike traditional antibiograms, a WISCA integrates patient-specific factors to improve antimicrobial coverage estimations. A total of 11 monotherapies and 18 combination therapies were tested against 15 pathogens, with posterior coverage probabilities and 95% highest density intervals (HDIs) used to assess coverage.

Results: Inappropriate final antibiotic treatment was associated with worse outcomes. The Bayesian framework improved estimations, particularly for rare pathogen-antibiotic interactions, increasing model applicability in high-resistance settings. Combination regimens showed superior coverage, especially in MDR cases and older adults.

Conclusions: This study employed a comprehensive methodological approach for WISCA development, enhancing empirical antibiotic selection by incorporating local resistance data and patient-specific factors in a middle-income Latin American country with a high antimicrobial resistance profile. These findings provide a foundation for future clinical applications and antimicrobial stewardship strategies in high-resistance environments.

Background:Staphylococcus aureus is one of the most prevalent pathogens causing mastitis in dairy animals and represents a serious issue of public health concern due to its resistance against multiple antimicrobials. Objectives: This study assessed 101 S. aureus isolates obtained from quarter milk of animals with subclinical mastitis in the Ragusa area (Sicily, Italy). Methods: Antibiotic resistance against nine antibiotics was evaluated using the Kirby-Bauer method, and the Minimum Inhibitory Concentration (MIC) values were measured for oxacillin (OXA) and vancomycin (VA). Additionally, the isolates were genetically characterized through multiplex PCR to identify the presence of spa, mecA, mecC, pvl, vanA, vanB, and vanC genes, along with pulsed-field gel electrophoresis analysis and multi-locus sequence typing (MLST). Results: The highest rates of antibiotic resistance were found against gentamicin (47.5%) and erythromycin (29.7%), with 86.1% of strains exhibiting resistance to at least two antimicrobials and 33.7% showing resistance to three antimicrobial classes. Furthermore, the results indicated that the presence of antibiotic resistance genes was not correlated with phenotypic resistance, and a phylogenetic analysis revealed varying phenotypic resistance profiles even within the same PFGE cluster. Lastly, alongside a new allelic profile ST 9471, MLST analysis identified five additional STs clustered into three CCs, with CC5 originating from human ancestral strains through human-to-animal host transfers, making it the dominant group. Conclusions: This study provided valuable insights into regional trends, allowing for the identification of significant antibiotic-resistant patterns and offering an understanding of bacterial dynamics in these environments, underscoring the importance of routine resistance surveillance in dairy farms.

Background/Objectives: A retrospective study was conducted to evaluate antibiotic resistance among Salmonella strains isolated during human infection using data from the computer database (SIGLA) of the Salmonella Typing Center (Ce.Ti.Sa) of the Istituto Zooprofilattico del Mezzogiorno (IZSM). Methods: From 2010 to 2023, the Ce.Ti.Sa laboratory tested 680 Salmonella strains against the following: amoxicillin/clavulanic acid, ampicillin, azithromycin, cefixime, cefoxitin, cefotaxime, ceftazidime, chloramphenicol, ciprofloxacin, colistin, erythromycin, gentamicin, kanamycin, meropenem, nalidixic acid, pefloxacin, streptomycin, sulfisoxazole, sulfonamides, tetracyclines, tigecycline, and trimethoprim. Results: The most common serovars were S. monophasic Typhimurium (23.2%), S. Enteritidis (16.8%), and S. Typhimurium (16.0%). Nearly all strains were resistant to azithromycin (99.4%) and showed high resistance to sulphonamides, tetracycline, streptomycin, and ampicillin. The study found that 45.8% of strains exhibited multidrug resistance. Resistance to ciprofloxacin increased over time. Serovar-specific resistance varied: S. monophasic Typhimurium was resistant to azithromycin (100.0%), tetracycline (93.0%), and ampicillin (92.4%); S. Enteritidis showed 100.0% resistance to azithromycin; S. Typhimurium had high resistance to azithromycin, streptomycin, and ampicillin; and S. Infantis was resistant to erythromycin, sulfonamides, and azithromycin. Conclusions: The study highlights a troubling prevalence of Salmonella-resistant strains, emphasizing the need for infection prevention, proper antibiotic use in humans and animals, and the development of new antibiotics.

In the original publication [...].

Background/Objectives: Essential oils of Thymbra spicata subsp. spicata are known for their rich phytochemical content and bioactive properties. This study aimed to evaluate the antimicrobial, anti-biofilm and anti-quorum sensing, as well as the cytotoxic activities of T. spicata subsp. spicata essential oils (TS-EO1 and TS-EO2) obtained from two different localities in Türkiye, along with a detailed chemical composition analysis. Methods: TS-EO1 and TS-EO2 were obtained by the hydrodistillation method and analyzed using Gas Chromatography-Mass Spectrometry (GC-MS) to determine their phytochemical profiles. Antimicrobial activities were assessed against Gram-positive and Gram-negative bacteria, and fungal strains were assessed using the broth microdilution method. Anti-biofilm and anti-quorum sensing activities were evaluated using Pseudomonas aeruginosa PAO1 and Chromobacterium violaceum ATCC 12472, respectively. Cytotoxic properties were tested on four cell lines (A549, MCF-7, U87MG, and L929) using the MTT assay. Results: Both essential oil samples were rich in carvacrol (54.3% and 54.1%), followed by p-cymene and γ-terpinene. The essential oils exhibited significant antimicrobial activity, particularly against Staphylococcus aureus (6.25 mg/mL) and Candida parapsilosis (0.20 mg/mL). Sub-MIC concentrations significantly inhibited biofilm formation and quorum sensing. Both samples showed moderate cytotoxic properties against human cancer cell lines, particularly A549 (IC50: 116.3 and 134.4 μg/mL, respectively). Conclusions: This study showed that T. spicata subsp. spicata essential oils have significant antimicrobial, anti-biofilm, and anti-quorum sensing properties against various bacteria and fungi, along with moderate cytotoxic effects, indicating their medicinal and pharmaceutical potentials. This is the first study which revealed anti-biofilm and anti-quorum sensing properties of T. spicata essential oils to our knowledge.

Background: Pakistan is classified as a high-burden country for tuberculosis, and the prescription of antibiotics and fluoroquinolones complicates the detection and treatment of the disease. The existing literature primarily relies on knowledge questionnaires and prescription analyses, which focus on healthcare providers' knowledge rather than their actual clinical practices. Therefore, this study aimed to evaluate the quality of tuberculosis care using standardized patients. Materials and Methods: We conducted a cross-sectional study, recruiting consenting private healthcare practitioners in four cities in Punjab, Pakistan. Standardized patients were engaged from the general public to simulate four cases: two suspected tuberculosis cases (Case 1 and 2), one confirmed tuberculosis case (Case 3), and one suspected multidrug-resistant tuberculosis case (Case 4). The optimal management in Cases 1 and 2 was referral for sputum testing, chest X-ray, or referral to a public facility for directly observed treatment short-courses without dispensing antibiotics, fluoroquinolones, and steroids. In Case 3, treatment with four anti-TB medications was expected, while Case 4 should have prompted a drug-susceptibility test. Descriptive statistics using SPSS version 23 were employed to analyze disparities in referrals, ideal case management, antibiotic use, steroid administration, and the number of medications prescribed. Results: From July 2022 to May 2023, 3321 standardized cases were presented to private healthcare practitioners. Overall, 39.4% of tuberculosis cases were managed optimally, with Case 3 showing the highest rate (56.7%) and Case 4 showing the lowest (19.8%). City-specific analysis revealed that Rawalpindi had the highest management rate (55.8%), while Sialkot had the lowest (30.6%). Antibiotics were most frequently prescribed in Case 1 and least prescribed in Case 4, with a similar pattern for fluoroquinolones. Anti-TB medications were also prescribed in naïve and suspected tuberculosis cases (8.3% in Case 1 and 10.8% in Case 2). Conclusions: The quality of tuberculosis management in actual practice is suboptimal among healthcare providers in Pakistan. Furthermore, the over-prescription of antibiotics, fluoroquinolones, and anti-TB drugs presents a significant risk for the development of drug-resistant tuberculosis.