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136461. Criteria of time and antibiotic susceptibility in the elimination of duplicates when calculating resistance frequencies. Full Text available with Trip Pro

Criteria of time and antibiotic susceptibility in the elimination of duplicates when calculating resistance frequencies. We studied the effects of various systems of eliminating repeat isolates on the absolute number and susceptibility of Pseudomonas aeruginosa, Acinetobacter baumannii and Staphylococcus aureus isolates over a 2 year period. The criterion of time is objective and reproducible, whereas that of variation in antibiotic susceptibility detects variations in the susceptibility (...) of microorganisms that acquire resistance during treatment, but may be affected by methodological errors in determining the antibiotic susceptibility. These tools are useful in the control of multi-resistant bacteria and enable the true situation regarding antibiotic resistance in each geographical area to be determined.

2003 Journal of Antimicrobial Chemotherapy

136462. Antibiotic susceptibilities of Gram-positive anaerobic cocci: results of a sentinel study in England and Wales. Full Text available with Trip Pro

Antibiotic susceptibilities of Gram-positive anaerobic cocci: results of a sentinel study in England and Wales. A sentinel study was carried out to determine the antimicrobial susceptibilities of Gram-positive anaerobic cocci (GPAC) freshly isolated from clinical material in diagnostic laboratories in England and Wales.A total of 113 GPAC isolates consisting predominantly of current or former members of the genus Peptostreptococcus was obtained from 17 sentinel laboratories in England and one (...) in Wales. Minimum inhibitory concentrations (MICs) of 10 antimicrobial agents were determined by the Etest method. The agents tested were: penicillin, tetracycline, erythromycin, cefoxitin, clindamycin, chloramphenicol, imipenem, co-amoxiclav, piperacillin/tazobactam and metronidazole. MIC50 and MIC90 values for each drug-species combination were calculated whenever suitable numbers of each species were obtained.Excellent spectra of activity (0% resistance) against GPAC were seen for metronidazole

2003 Journal of Antimicrobial Chemotherapy

136463. The European ban on growth-promoting antibiotics and emerging consequences for human and animal health. Full Text available with Trip Pro

The European ban on growth-promoting antibiotics and emerging consequences for human and animal health. Following the ban of all food animal growth-promoting antibiotics by Sweden in 1986, the European Union banned avoparcin in 1997 and bacitracin, spiramycin, tylosin and virginiamycin in 1999. Three years later, the only attributable effect in humans has been a diminution in acquired resistance in enterococci isolated from human faecal carriers. There has been an increase in human infection (...) necrotic enteritis in broilers. A directly attributable effect of these infections is the increase in usage of therapeutic antibiotics in food animals, including that of tetracycline, aminoglycosides, trimethoprim/sulphonamide, macrolides and lincosamides, all of which are of direct importance in human medicine. The theoretical and political benefit of the widespread ban of growth promoters needs to be more carefully weighed against the increasingly apparent adverse consequences.

2003 Journal of Antimicrobial Chemotherapy

136464. Antibiotic resistance and clinical significance of Haemophilus influenzae type f. Full Text available with Trip Pro

Antibiotic resistance and clinical significance of Haemophilus influenzae type f. Little is known about the antibiotic susceptibility and clinical significance of non-type b capsulated Haemophilus influenzae. We studied the antibiotic resistance patterns, plasmid carriage and clinical features of H. influenzae type f infections in Spain during 1996-2002.Forty-nine H. influenzae type f recovered from Spanish hospitals were analysed at a central laboratory where full microbiological and molecular (...) epidemiological studies were carried out. Antimicrobial susceptibility testing was performed in accordance with NCCLS guidelines.Twelve strains (24.5%) were resistant to ampicillin and 22 (44.9%) to co-trimoxazole. Decreased susceptibility to clarithromycin, tetracycline, chloramphenicol and rifampicin was found in 16.3%, 12.2%, 14.3% and 2% of strains, respectively. Multidrug resistance was present in nine (18.4%) of the 49 isolates. The most prevalent resistance phenotype was ampicillin/tetracycline/co

2003 Journal of Antimicrobial Chemotherapy

136465. High levels of multiple antibiotic resistance among 938 Haemophilus influenzae type b meningitis isolates from Cuba (1990-2002). Full Text available with Trip Pro

High levels of multiple antibiotic resistance among 938 Haemophilus influenzae type b meningitis isolates from Cuba (1990-2002). A national surveillance study to determine antimicrobial susceptibility in Haemophilus influenzae type b isolated from cerebrospinal fluid was carried out in Cuba from 1990 to 2002.Susceptibility to ampicillin, co-amoxiclav, cefotaxime, ceftriaxone, co-trimoxazole, tetracycline, chloramphenicol and rifampicin was tested by the microdilution method according (...) . An increase in the prevalence of resistance to these antibiotics was observed from 1990 to 2000 in the range 40.7%-54.8% for ampicillin, 40.1%-51.6% for chloramphenicol, 45.4%-58.1% for co-trimoxazole and 23%-45.2% for tetracycline.In Cuba, the widespread vaccination against Haemophilus influenzae type b prevented a large number of meningitis cases in children caused by strains resistant to multiple antibiotics.

2003 Journal of Antimicrobial Chemotherapy

136466. Impact of a multidisciplinary approach to the control of antibiotic prescription in a general hospital. (Abstract)

Impact of a multidisciplinary approach to the control of antibiotic prescription in a general hospital. We examined the impact of a rational antibiotic prescription programme based on a multidisciplinary consultative approach in a 600-bed hospital. The programme involved four measures: (1). drawing up of a local prescribing consensus with all prescribers; (2). a restricted prescriptions policy for the most expensive antibiotics; (3.assessment of the prescription of these antibiotics by regular (...) audits; and (4). institutional training and information for prescribers. The impact of the programme was assessed by comparing actual prescriptions with the criteria of the local consensus, compliance with the restrictive prescription policy, changes in the average daily cost of antibiotic therapy per inpatient and changes in the local ecology of methicillin-resistant Staphylococcus aureus (MRSA), Enterobacteriaceae producing extended-spectrum beta-lactamases (EPESB) and ceftazidime-resistant

2003 Journal of Hospital Infection

136467. Correlation between candiduria and departmental antibiotic use. (Abstract)

Correlation between candiduria and departmental antibiotic use. The incidence of candiduria is increasing in teaching hospitals. We examined the hypothesis that this trend was correlated with the amount of departmental antibiotic consumption. In the setting of a large teaching hospital in Israel, the correlation coefficient between departmental intravenous antibiotic consumption (expressed as daily defined dose (DDD)/1000 patient-days) and the incidence of candiduria per 1000 patient-days (...) was 0.47 (P=0.03). For broad-spectrum antibiotics, the corresponding correlation coefficient was 0.66 (P=0.001). The strongest correlation with candiduria was shown for the use of meropenem (r=0.79, P<0.001) and ceftazidime (r=0.66, P=0.001). This is the first time that departmental habits of antibiotic use have been shown to be strongly correlated with the incidence of candiduria in hospitalized patients. These results add an important new dimension to the strategy of restricting broad-spectrum

2003 Journal of Hospital Infection

136468. Antibacterial activity and endotoxin-binding capacity of Actisorb Silver 220. (Abstract)

Antibacterial activity and endotoxin-binding capacity of Actisorb Silver 220. Actisorb Silver 220 wound dressing demonstrated a high in vitro endotoxin-binding capacity combined with a marked bactericidal activity without releasing Pseudomonas aeruginosa endotoxins into the environment, and so may be beneficial in the treatment of infected wounds, particularly colonization by Gram-negative bacteria.

2003 Journal of Hospital Infection

136469. Impact of changes in antibiotic policy on Clostridium difficile-associated diarrhoea (CDAD) over a five-year period in a district general hospital. (Abstract)

Impact of changes in antibiotic policy on Clostridium difficile-associated diarrhoea (CDAD) over a five-year period in a district general hospital. The impact of changes in antibiotic policy on Clostridium difficile-associated diarrhoea (CDAD), over a five-year period between 1995 and 2000, were studied in the Preston Acute Hospitals Trust. In 1996 the policy was changed in the Preston Acute Hospitals Trust from cefotaxime to ceftriaxone for initial treatment of severe sepsis or pneumonia

2003 Journal of Hospital Infection

136470. Clostridium difficile infections related to antibiotic use and infection control facilities in two university hospitals. (Abstract)

Clostridium difficile infections related to antibiotic use and infection control facilities in two university hospitals. We investigated whether a reduction in antibiotic use at the Aker University Hospital (Aker) led to a reduction in Clostridium difficile-associated diarrhoea (CDAD). We compared the incidence of CDAD in Aker and Tromsoe University Hospitals (Tromsoe) and related it to antibiotic use and facilities for infection control between 1993-2001. For this purpose we also performed (...) point prevalence studies. Total antibiotic use was the same in the two hospitals. In spite of a reduction in the use of broad-spectrum antibiotics in Aker the incidence of CDAD increased during 1993-1999. In Tromsoe the use of broad-spectrum antibiotics and clindamycin was two to three times higher than in Aker, but until 1999 the incidence of CDAD remained constant and only half that of Aker. After 1999 the incidence of CDAD was halved in Aker, and increased three-fold in Tromsoe. Point prevalence

2003 Journal of Hospital Infection

136471. Development of bacterial resistance to several biocides and effects on antibiotic susceptibility. (Abstract)

Development of bacterial resistance to several biocides and effects on antibiotic susceptibility. The aims of this study were to investigate the development of bacterial resistance to eugenol, thymol, trichlorocarbanalide (TCC), didecyldimethylammonium chloride (DDDMAC) and C10-16-alkyldimethyl, N-oxides (ADMAO) and subsequent effects on antibiotic susceptibility. An agar minimum inhibitory concentration (MIC) method was used to assess the activity of the biocides against standard bacterial (...) strains and laboratory mutants. A range of techniques including disk diffusion and gradient plate experiments were used to attempt to develop bacterial 'resistance' or tolerance to the biocides. The mutants produced were examined for cross-resistance to the other biocides and to antibiotics via disk diffusion and gradient plate MIC methods. Outer membrane proteins of the mutants were extracted and examined using sodium dodecyl sulphate polyacrylamide gel electrophoresis (SDS-PAGE). Escherichia coli

2003 Journal of Hospital Infection

136472. Principles of good use of antibiotics in hospitals. (Abstract)

Principles of good use of antibiotics in hospitals. Rational use of antimicrobials is a key element for a successful strategy against development of resistance to antimicrobials. The physician should establish the need and the reason for therapy, select the appropriate antimicrobial agent, and then decide on the optimum dose and dosing interval, duration, as well as route of administration. In a particular hospital, the present status of antimicrobial use should be determined, and a strategy

2003 Journal of Hospital Infection

136473. A pseudo-outbreak of nosocomial infections associated with the introduction of an antibiotic management programme. (Abstract)

A pseudo-outbreak of nosocomial infections associated with the introduction of an antibiotic management programme. An abrupt and persistent 30% increase in the rate of nosocomial infections was detected at a university teaching hospital after a prolonged period with a relatively constant nosocomial infection rate. Demographic data, risk factors for nosocomial infection, features of reported cases of nosocomial infection, and policy and procedure changes were evaluated for the periods of 1 (...) January 1997 to 30 April 1998 (endemic period) and 1 May to 31 December 1998 (epidemic period). An extensive outbreak investigation revealed no evidence of a true outbreak of nosocomial infection. The apparent outbreak involved all four major body sites, began during the same month that an antibiotic management programme was started, involved the same adult medical and surgical units where antibiotics were being controlled, and occurred months before any significant change in antibiotic usage

2003 Journal of Hospital Infection

136474. Empirical antibiotic choice for the seriously ill patient: are minimization of selection of resistant organisms and maximization of individual outcome mutually exclusive? Full Text available with Trip Pro

Empirical antibiotic choice for the seriously ill patient: are minimization of selection of resistant organisms and maximization of individual outcome mutually exclusive? Mortality related to serious infections in intensive care units (ICUs) is highest if empirical therapy is not active against the organism causing the infection. However, excessive empirical therapy undoubtedly contributes to bacterial resistance to antibiotics, in turn potentially contributing to poor patient outcome. We have (...) reviewed 3 strategies that are increasingly practiced to reduce the hazards of broad empirical therapy, while aiming to ensure that empirical therapy is adequate. The most widely practiced strategy is discontinuation or streamlining of empirical therapy when culture results are available. The second approach is to withdraw certain antibiotic classes (most notably, third-generation cephalosporins) from the ICU antibiotic armamentarium. The third strategy employed is antibiotic cycling. Although this has

2003 Clinical Infectious Diseases

136475. Streptococcus pneumoniae bacteremia: duration of previous antibiotic use and association with penicillin resistance. Full Text available with Trip Pro

Streptococcus pneumoniae bacteremia: duration of previous antibiotic use and association with penicillin resistance. Previous antibiotic exposure is one of the most important predictors for acquisition of penicillin-nonsusceptible Streptococcus pneumoniae (PNSP) infection. To determine the impact of duration of exposure to different antibiotic classes, a study of 303 patients with S. pneumoniae bacteremia was undertaken. Ninety-eight cases of bacteremia (32%) were caused by a penicillin (...) result were independent risk factors (P<.05). Risk for acquiring PNSP infection depends on both the class of antibiotic to which the patient was exposed and the duration of therapy.

2003 Clinical Infectious Diseases

136476. Clostridium difficile-associated diarrhea: epidemiological data from Western Australia associated with a modified antibiotic policy. Full Text available with Trip Pro

Clostridium difficile-associated diarrhea: epidemiological data from Western Australia associated with a modified antibiotic policy. The incidence of Clostridium difficile-associated diarrhea (CDAD) has increased dramatically in hospitals worldwide during the past 2 decades. In Western Australia, this increase was most obvious during the 1980s, when there was also an increase in the use of third-generation cephalosporin antibiotics. A study of the epidemiology of CDAD and the use of third

2002 Clinical Infectious Diseases

136477. Addition of a macrolide to a beta-lactam-based empirical antibiotic regimen is associated with lower in-hospital mortality for patients with bacteremic pneumococcal pneumonia. Full Text available with Trip Pro

Addition of a macrolide to a beta-lactam-based empirical antibiotic regimen is associated with lower in-hospital mortality for patients with bacteremic pneumococcal pneumonia. To assess the association between inclusion of a macrolide in a beta-lactam-based empirical antibiotic regimen and mortality among patients with bacteremic pneumococcal pneumonia, 10 years of data from a database were analyzed. The total available set of putative prognostic factors was subjected to stepwise logistic (...) regression, with in-hospital death as the dependent variable. Of the 409 patients analyzed, 238 (58%) received a beta-lactam plus a macrolide and 171 (42%) received a beta-lactam without a macrolide. Multivariate analysis revealed 4 variables to be independently associated with death: shock (P<.0001), age of >or=65 years (P=.02), infections with pathogens that have resistance to both penicillin and erythromycin (P=.04), and no inclusion of a macrolide in the initial antibiotic regimen (P=.03

2003 Clinical Infectious Diseases

136478. Serotype distribution, antibiotic susceptibility, and genetic relatedness of Neisseria meningitidis strains recently isolated in Italy. Full Text available with Trip Pro

Serotype distribution, antibiotic susceptibility, and genetic relatedness of Neisseria meningitidis strains recently isolated in Italy. The availability of new polysaccharide-protein conjugate vaccines against Neisseria meningitidis serogroup C prompted European National Health authorities to carefully monitor isolate characteristics. In Italy, during 1999-2001, the average incidence was 0.4 cases per 100,000 inhabitants. Serogroup B was predominant and accounted for 75% of the isolates

2003 Clinical Infectious Diseases

136479. Combination antibiotic therapy for infective endocarditis. Full Text available with Trip Pro

Combination antibiotic therapy for infective endocarditis. Despite the availability of new and potent antibiotics, modern echocardiography, and advanced surgical techniques, infective endocarditis (IE) is still associated with high morbidity and mortality rates. Use of synergistic antibiotic combinations is an appealing way to optimize therapy for IE. This review focuses on evidence-based recommendations for combination antimicrobial therapy for IE due to the most common etiologic pathogens

2003 Clinical Infectious Diseases

136480. Epidemiology and risk factors for gram-positive coccal infections in neutropenia: toward a more targeted antibiotic strategy. Full Text available with Trip Pro

Epidemiology and risk factors for gram-positive coccal infections in neutropenia: toward a more targeted antibiotic strategy. The objective of this study was to evaluate the risk of acquiring gram-positive coccal infections in febrile neutropenic patients and to develop risk indexes for gram-positive and streptococcal infections. This prospective, multicenter study included 513 patients. The prevalence of gram-positive coccal infections was 21% (14% were staphylococcal infections and 7.8% were

2003 Clinical Infectious Diseases

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