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One hundred fifty-six eyes from 139 patients scheduled for anterior segment surgery were enrolled over a 6-month period from August 2001 to February 2002.
Escherichia coli O157:H7 (E. coli O157:H7) is now recognized as a major cause of diarrhoea, hemorrhagic colitis and hemolytic-uremic syndrome worldwide. Consumption of raw or undercooked meat of bovine origin has been the most common means of transmitting this organism.
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Fluoroquinolone-containing regimens have been suggested as an alternate to standard triple therapy for the treatment of Helicobacter pylori infections. To determine the relationship between fluoroquinolone resistance and mutations of GyrA and GyrB in H. pylori, we exchanged the mutations at positions 87 and 91 of GyrA among fluoroquinolone-resistant clinical isolates. GyrB of a strain with no mutations in GyrA was also analyzed to identify mechanisms of resistance to norfloxacin.
The fluoroquinolone antibacterial agent fleroxacin has a broad spectrum of in vitro activity which encompasses most Gram-negative species (particularly Enterobacteriaceae) and a number of Gram-positive organisms, including methicillin-sensitive staphylococci. It is available as oral and intravenous formulations. In clinical trials, fleroxacin has been evaluated in the treatment of uncomplicated urinary tract infections (single or multiple once-daily oral doses of 200 or 400mg), gonorrhoea and chancroid (single oral doses of 200 or 400mg), complicated urinary tract, nonpneumococcal lower respiratory tract and skin and soft tissue infections and typhoid fever (multiple once-daily oral or intravenous regimens, usually 400 mg/day), bacterial enteritis, and traveller's diarrhoea (single or multiple once-daily oral doses of 400mg). Bacteriological cure rates were generally around 90% or higher in complicated and uncomplicated urinary tract infections, uncomplicated gonorrhoea (approximately 100%), pyelonephritis, bacterial enteritis and typhoid fever, and exceeded 80% in lower respiratory tract, and skin and soft tissue infections and chancroid. These cure rates were similar to, or better than, those achieved with standard comparator antibacterial agents such as penicillins, cephalosporins, cotrimoxazole, or other quinolones. Fleroxacin 400mg once daily also achieved bacteriological cure in approximately 80% of patients with bone and joint infections in preliminary studies. In Japanese studies using a lower dosage of 200 or 300 mg/day, fleroxacin was reported to be bacteriologically effective in a range of infections, including urinary tract and upper and lower respiratory tract infections. Fleroxacin has a relatively long elimination half-life, which allows once-daily administration, and it appears to have less propensity for interactions with other medications in comparison to many other fluoroquinolones. Its tolerability profile is typical of this class of compound, with adverse events mostly relating to the gastrointestinal tract, CNS, and skin and appendages (including phototoxicity). Recent pooled tolerability data from worldwide clinical trials indicate that adverse events are reported by approximately 27% of patients receiving 200 mg/day orally or 400 mg/day orally or intravenously, and 17% of those receiving a single oral dose of 400mg. These exceed incidences reported for established fluoroquinolones, possibly indicating recent trends towards increased rates of reported adverse effects with these agents. However, in direct comparative studies with twice-daily fluoroquinolones, fleroxacin 400mg once daily produced a similar incidence of adverse effects to ofloxacin 800 mg/day and a slightly higher incidence than ciprofloxacin 1000 mg/day, while fleroxacin 200mg once daily produced a similar incidence to norfloxacin 800 mg/day.(ABSTRACT TRUNCATED AT 400 WORDS)
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Between the end of November 1996 and the beginning of March 1997, there was an outbreak of Escherichia coli O26:H11 infection in Asahikawa. The strain produced only verotoxin type 1. The minimal inhibitory concentrations (microgram/ml) of the strain under aerobic condition and those of anaerobic were as follows: chloramphenicol (1.56, 0.78), minocycline (12.5, 3.13), kanamycin (3.13, 25), ampicillin (> 100, > 100), fosfomycin (12.5, 1.56), norfloxacin (0.1, 0.1), and cefaclor (6.25, 3.13). Forty-one episodes of antibiotic therapy to 32 children, who were treated in Asahikawa Kosei Hospital, Asahikawa Municipal Hospital, and Asahikawa Red Cross Hospital, were evaluated bacteriologically. In 26 episodes treated with fosfomycin, the pathogen from stools of 19 were eradicated, 4 were not eradicated, and 3 were isolated again within 2 weeks after the cessation of therapy. Eight episodes treated with norfloxacin and 5 episodes in kanamycin were all eradicated.
Activity of six quinolones (nalidixic acid, pipemidic acid, oxolinic acid, pefloxacin, ofloxacin and norfloxacin) against one-hundred and ten Pseudomonas strains was studied in vitro. Five species of Pseudomonas were represented, i.e. aeruginosa, maltophilia, cepacia, stutzeri and paucimobilis. Isolates came from two Paris hospitals. Minimal inhibitory concentrations (MICs) were determined using gelose dilution according to WHO recommendations (Mueller Hinton medium, multiple inoculator, controlled inoculum). Modal CMIs classify activities of the six tested quinolones against P. aeruginosa in the following order: nalidixic acid: 64 mg/l; pipemidic acid: 16-32 mg/l; oxolinic acid: 16 mg/l; pefloxacin: 2 mg/l; ofloxacin: 2 mg/l; norfloxacin: 1 mg/l. The other Pseudomonas species exhibit a variety of resistance phenotypes which are described in detail. High CMIs are found for certain P. aeruginosa strains. Two of these, i.e. DL 55 and DL 59, are highly resistant to all the tested quinolones. Their pattern of resistance is comparable to that of a mutant, PAO 38-02, obtained in vitro in the presence of pefloxacin. This fact suggests that quinolones may induce in vivo selection of resistant P. aeruginosa mutants.
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The prevalence of fecal carriage of ESBL-PE was 4.3% (4/93; 95% CI, 0.2-8.4). Klebsiella pneumoniae (n = 2), Enterobacter cloacae (n = 2), Escherichia coli (n = 1), and Serratia odorifera (n = 1) were the ESBL-producing species. Four (66.7%) of these isolates were multidrug-resistant. The blaSHV-12 (n = 5) was the most frequent ESBL gene detected, followed by blaCTX-M-15 (n = 3).The non-ESBL gene detected was blaTEM-1 (n = 5). One isolate harbored the qnrB1 variant. RESULTS of conjugation experiments indicated that blaSHV-12 + blaTEM-1 + qnrB1 and blaCTX-M-15 + blaTEM-1 genes were co-transferred and that these genes were carried by a conjugative plasmid of high molecular weight (125 kb).
The in vitro activity of pefloxacin, a new fluoroquinolone, was compared with that of 5 other quinolone compounds (nalidixic and pipemidic acids, norfloxacin, ciprofloxacin, and ofloxacin) against 416 strains of Proteae spp. isolated from urine specimens of hospitalized patients with acute urinary tract infections (UTI). Ciprofloxacin was the most active agent. Norfloxacin, ofloxacin, and pefloxacin were similarly active against Proteus strains (MIC90 = 0.39 microgram/ml). Against Providencia spp. pefloxacin and norfloxacin showed similar activity (MIC90 = 3.12 micrograms/ml). There is minimal discrepancy between minimum inhibitory concentrations and minimum bactericidal concentrations exhibited by the quinolones for all urinary tract pathogens tested. Our in vitro studies indicate that pefloxacin is an active antimicrobial agent and suggest that it will prove useful in the treatment of complicated urinary tract infections due to nalidixic acid-resistant Proteae spp.
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A DNA fragment responsible for resistance to antimicrobial agents was cloned from the chromosomal DNA of Enterococcus faecalis ATCC 29212 by using drug-hypersensitive mutant Escherichia coli KAM32 as a host cell. Cells of E. coli KAM32 harboring a recombinant plasmid (pAEF82) carrying the DNA fragment became resistant to many structurally unrelated antimicrobial agents, such as norfloxacin, ciprofloxacin, doxycycline, acriflavine, 4',6-diamidino-2-phenylindole, tetraphenylphosphonium chloride, daunorubicin, and doxorubicin. Since the sequence of the whole genome of E. faecalis is known, we sequenced several portions of the DNA insert in plasmid pAEF82 and identified two open reading frames within the insert. We designated the genes efrA and efrB. A search of the deduced amino acid sequences of EfrA and EfrB revealed that they are similar to each other and that they belong to the ATP-binding cassette (ABC) family of multidrug efflux transporters. Transformed E. coli KAM32 cells harboring efrAB showed energy-dependent efflux of acriflavine. The efflux activity was inhibited by reserpine, verapamil, and sodium-o-vanadate, known inhibitors of ABC efflux pumps.