Notes

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INTRODUCTION In most resource-poor settings, amikacin is normally co-administered with aminophylline among preterm newborns with infection and apnea of prematurity. There is the likelihood of an interaction between concurrently administered amikacin that is excreted almost solely via kidneys, and aminophylline, which is known to increase filtration fraction. The aim of this study was to evaluate the effect of aminophylline on the pharmacokinetics of amikacin using an animal model. METHODOLOGY Twelve male Sprague-Dawley rats (7 - 8 weeks old) were put into 2 equal groups. The test group received amikacin (10 mg/kg/day) with aminophylline (5 mg/kg/day) via the intraperitoneal route, and the control group received only amikacin (10 mg/kg/day) via the same route. On Day 4, after daily administration of drugs, tail vein blood samples were collected at different time points. Serum samples at each time point for each group were pooled and analyzed by fluorescence polarization immunoassay. Non-compartment pharmacokinetic analysis was used to estimate pharmacokinetic parameters. Area under the concentration-time curves (AUCs) were extrapolated from time 0 to infinity (AUC0→∞). Elimination rate constant (Ke) and elimination half-life (t1/2e) were also estimated. RESULTS Pharmacokinetic parameters of the control group (amikacin only) vis-a-vis the test group were as follows Cmax; 42.4 μmol/L vs 19.0 μmol/L, AUC0→∞; 84.9 μmol/L/h vs 41.4 μmol/L/h, Ke; 0.12 hours-1 vs 0.24 hours-1, and t1/2; 5.87 hours vs 2.88 hours, respectively. CONCLUSION This study suggests possible interaction between aminophylline and amikacin. However, further studies need to be conducted in humans to ascertain this finding. Copyright (c) 2019 Kwabena Frimpong-Manso Opuni, Seth Kwabena Amponsah, Kwabena Aboagye Antwi, Victor Pouzuing Kunkpeh.INTRODUCTION Tigecycline Evaluation and Surveillance Trail (TEST) study is an on-going global surveillance. The study was performed to determine the susceptibility of common pathogens to tigecycline and comparator antibiotics by broth microdilution (BMD) at two tertiary care centres in India from 2015 to 2017. METHODOLOGY Total of 989 isolates collected from various clinical specimens between January 2015 and September 2017 from two centres in India were included. BMD was performed to determine the minimum inhibitory concentration (MIC) for tigecycline and comparator antibiotics. RESULTS Among Gram-negative bacteria, susceptibility to tigecycline was lowest among Klebsiella spp. being 84% while others such as E. OSI-774 molecular weight coli, Enterobacter spp., Serratia spp. and H. influenzae showed susceptibility of 98%, 95%, 98% and 100% respectively. Overall, 99 isolates among Enterobacteriaceae (E. coli, Klebsiella spp. and Enterobacter spp.) were ESBL producers, susceptible to tigecycline. Among the 101 meropenem resistant Enterobacteriaceae, 85 were susceptible to tigecycline (84%). Among the Gram-positive bacteria, S. aureus and Enterococcus spp. were 99% and 98% susceptible to tigecycline respectively. link2 Among 68 MRSA isolates in the study, 66 (97%) were susceptible to tigecycline. Seven vancomycin resistant E. faecalis were isolated and all were susceptible to tigecycline. CONCLUSION Tigecycline has retained activity over both Gram-positive and Gram-negative organisms with MIC values comparable to global reports. About 98% of the MDR Gram-positive and Gram-negative bacteria in the study are susceptible to tigecycline. With increased incidence of extensively drug resistant organisms, tigecycline is a potential reserve drug. Copyright (c) 2019 Balaji Veeraraghavan, Aruna Poojary, Chaitra Shankar, Anurag Kumar Bari, Seema Kukreja, Bhuvaneswari Thukkaram, Ramya Gajaraj Neethimohan, Yamuna Devi Bakhtavachalam, Shweta Kamat.INTRODUCTION In the classic treatment of Trichomonas vaginalis infection, although metronidazole has been used since the 1960s, there has been an increase in MTZ-resistant T. vaginalis strains and failure in the treatment of trichomoniasis causes serious concerns. Therefore, the present study aimed to investigate the in vitro antitrichomonal activities of extracts (ethanol and total alkaloid) and pure compounds (chrysosplenetin, dictamnine, gamma-Fagarine, skimmianine) of H. myrtifolium against T. vaginalis. METHODOLOGY H. myrtifolium was collected from the town of Honaz in Denizli, located in the Aegean region of Turkey, and preparation of extracts and isolation and structure elucidation of pure compounds were performed. Later, different concentrations of extracts and pure compounds were incubated with T. vaginalis trophozoites isolated from Turkey, which are known to be sensitive to metronidazole. RESULTS It was found that ethanol extract caused a more effective lysis on T. vaginalis trophozoites compared with total alkaloid extract (P less then 0.05). No compounds except for furoquinoline alkaloid skimmianine prepared above 37.5 µg/mL were found to have any inhibitory effect on T. vaginalis trophozoites. CONCLUSION The ethanol extract of H. myrtifolium and skimmianine can be considered as potential candidates for antitrichomonal drug development. Copyright (c) 2019 Aysegul A Gokmen, Hüseyin Can, Hüseyin Can, Hüsniye KAYALAR, Bayram Pektaş, Selçuk Kaya.INTRODUCTION After a large outbreak of dengue virus (DENV) serotype-3 in Saint Kitts and Nevis (SKN) in 2008, we performed a cross-sectional study to determine the prevalence of anti-DENV immunoglobulin G (IgG) antibodies in expatriate and local persons affiliated with an American veterinary school there. METHODOLOGY This campus community comprised mostly expatriate students and faculty and Kittitian administrative staff. In 2009, a stratified random sample of students, faculty and staff was invited to complete an electronic survey to assess risk factors for DENV and provide blood for testing for anti-DENV IgG antibodies by an enzyme-linked immunosorbent assay. IgG-positive specimens were also tested by a 90% plaque reduction neutralization test (PRNT90) to determine immunoreactivity to DENV (1-4) serotypes and West Nile virus. Risk factors for anti-DENV IgG seropositivity were determined using simple and adjusted logistic regression. RESULTS Of the 118 participants, the overall prevalence of DENV IgG antibodies was 44.1% (95% confidence interval [CI] 35.1-53.0%), ranging from 30.1% in students, 100.0% in staff and 57.9% in faculty (p less then 0.001). Duration of residence in St. Kitts was the only variable significantly associated with seropositivity on multiple logistic regression (adjusted odds ratio [95% CI] 1.21 [1.07-1.37]). The serotype of DENV was determined in 11 persons DENV-1 (n = 4), DENV-2 (n = 3), and DENV-3 (n = 4). CONCLUSIONS Expatriate students and faculty moving to St. Kitts from non-endemic areas were at high risk of DENV infection. There is a need for increased emphasis on pre-travel mosquito-borne virus prevention education for persons moving to St. Kitts to study and work. Copyright (c) 2019 Hamish Mohammed, Mary H Hayden, Elise Lee, Luis Manuel Santiago, Rosina C Krecek, Floyd Revan, Elizabeth Hunsperger.INTRODUCTION We aimed to evaluate the effects of 7-valent pneumococcal conjugate vaccine on nasopharyngeal carriage of Streptococcus pneumoniae and antibiotic resistance in children in a well-child clinic in a tertiary children's hospital in Turkey. METHODOLOGY We collected nasopharyngeal (NP) specimens from 557 two-month-old babies before vaccination. After the study population had received PCV7, NP samples were obtained from 135 babies. Antimicrobial susceptibility testing and serotyping were performed. link3 RESULTS S. pneumoniae colonized in 48 (8.6%) of the 557 two-month-old babies before vaccination. The follow-up cohort consisted of 135 subjects. The prevalence of PCV7 strain decreased from 33.3% to 19.3% after vaccination. However, non-PCV7 types increased from 66.6% to 80.6% (p = 0.02). Of PCV7 serotypes, 19F was the most frequent serotype before and after vaccination. There was an increase in 6A and 15 of non-PCV7 serotypes after vaccination. Penicillin non-susceptible increased from 56.3% to 80.6% after vaccination (p =0.03). Serotypes 14, 18C, 9V and 6B, which were identified before vaccination, never colonized afterwards. Number of siblings and having sibling with older age of five were determined to be significant effective factors for SP colonization presence after vaccination and antibiotic use was negatively associated with pneumococcal carriage but associated with penicillin non-susceptibility. CONCLUSIONS Nasopharyngeal carriage rate of S. pneumoniae dropped after PCV7 vaccination, and replacement by NVT pneumococci were also observed. Risk factors for nasopharyngeal carriage included household crowding and having a sibling age five years or older. Penicillin non-susceptibility increased in both VT and NVT strains. Copyright (c) 2019 Basak Kaya Gursoy, Ufuk Beyazova, Melahat Melek Oguz, Filiz Demirel, Secil Ozkan, Nedim Sultan, Selin Nar Otgun.INTRODUCTION Diagnosis and management of urinary tract infection (UTI) are complex, and do not always follow guidelines. The aim of this study was to determine adherence to the 2014 Malaysian Ministry of Health guidelines for managing suspected UTI in a Malaysian primary care setting. METHODOLOGY We retrospectively reviewed computerized medical records of adults with suspected UTI between July-December 2016. Excluded were consultations misclassified by the search engine, duplicated records of the same patient, consultations for follow-up of suspected UTI, patients who were pregnant, catheterised, or who had a renal transplant. Records were reviewed by two primary care physicians and a clinical microbiologist. RESULTS From 852 records, 366 consultations were a fresh episode of possible UTI. Most subjects were female (78.2%) with median age of 61.5 years. The major co-morbidities were hypertension (37.1%), prostatic enlargement in males (35.5%) and impaired renal function (31.1%). Symptoms were reported in 349 (95.4%) consultations. Antibiotics were prescribed in 307 (83.9%) consultations, which was appropriate in 227/307 (73.9%), where the subject had at least one symptom, and leucocytes were raised in urine full examination and microscopic examination (UFEME). In 73 (23.8%) consultations antibiotics were prescribed inappropriately, as the subjects were asymptomatic (14,4.6%), urine was clear (17,5.5%), or UFEME did not show raised leucocytes (42,13.7%). In 7 (2.3%) consultations appropriateness of antibiotics could not be determined as UFEME was not available. CONCLUSION Several pitfalls contributed to suboptimal adherence to guidelines for diagnosis and management of suspected UTI. This illustrates the complexity of managing suspected UTI in older subjects with multiple co-morbidities. Copyright (c) 2019 Sajaratulnisah Othman, Alison A Jackson, Aqtab Mazhar Alias, Pauline Siew Mei Lai, Nadia Atiya, Siti Nurkamilla Ramdzan, Tun Firzara Abdul Malik, Fadzilah Hanum Mohd Mydin, Haireen Abd Hadi.INTRODUCTION Surgical site infections (SSI) continue to be a major problem for thoracic surgery patients. We aimed to determine incidence rate (IR) and risk factors for SSI in patients with thoracic surgical procedures. METHODOLOGY During 12 years of hospital surveillance of patients with thoracic surgical procedures, we prospectively identified SSI. Patients with SSI were compared with patients without SSI. RESULTS We operated 3,370 patients and 205 (6.1%) developed SSI postoperatively. We detected 190 SSI among open thoracic surgical procedures (IR 7.1%) and 15 SSI after video-assisted thoracic surgery (IR 2.1%). Five independent risk factors for SSI were identified wound contamination (p = 0.013; relative risk (RR) 2.496; 95%, confidence interval (CI) 1.208-5.156), American Society of Anesthesiologist (ASA) score (p = 0.012; RR 1.795; 95% CI 1.136-2.834), duration of drainage (p less then 0.001; RR 1.117; 95% CI 1.085-1.150), age (p = 0.036; RR 1.018; 95% CI 1.001-1.035) and duration of operation (p less then 0.
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