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From January 2007 to December 2009, an annual Canadian national surveillance study (CANWARD) tested 2,943 urinary culture pathogens for antimicrobial susceptibilities according to Clinical and Laboratory Standards Institute guidelines. The most frequently isolated urinary pathogens were as follows (number of isolates, percentage of all isolates): Escherichia coli (1,581, 54%), enterococci (410, 14%), Klebsiella pneumoniae (274, 9%), Proteus mirabilis (122, 4%), Pseudomonas aeruginosa (100, 3%), and Staphylococcus aureus (80, 3%). The rates of susceptibility to trimethoprim-sulfamethoxazole (SXT) were 78, 86, 84, and 93%, respectively, for E. coli, K. pneumoniae, P. mirabilis, and S. aureus. The rates of susceptibility to nitrofurantoin were 96, 97, 33, and 100%, respectively, for E. coli, enterococci, K. pneumoniae, and S. aureus. The rates of susceptibility to ciprofloxacin were 81, 40, 86, 81, 66, and 41%, respectively, for E. coli, enterococci, K. pneumoniae, P. mirabilis, P. aeruginosa, and S. aureus. Statistical analysis of resistance rates (resistant plus intermediate isolates) by year for E. coli over the 3-year study period demonstrated that increased resistance rates occurred only for amoxicillin-clavulanate (from 1.8 to 6.6%; P < 0.001) and for SXT (from 18.6 to 24.3%; P = 0.02). For isolates of E. coli, in a multivariate logistic regression model, hospital location was independently associated with resistance to ciprofloxacin (P = 0.026) with higher rates of resistance observed in inpatient areas (medical, surgical, and intensive care unit wards). Increased age was also associated with resistance to ciprofloxacin (P < 0.001) and with resistance to two or more commonly prescribed oral agents (amoxicillin-clavulanate, ciprofloxacin, nitrofurantoin, and SXT) (P = 0.005). We conclude that frequently prescribed empirical agents for urinary tract infections, such as SXT and ciprofloxacin, demonstrate lowered in vitro susceptibilities when tested against recent clinical isolates.
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At the day 28 visit, risk of penicillin-nonsusceptible pneumococcal carriage was significantly lower in the short-course, high-dose group (24%) compared with the standard-course group (32%); relative risk (RR), 0.77; 95% confidence interval (CI), 0.60-0.97; P =.03; risk of trimethoprim-sulfamethoxazole nonsusceptibility was also lower in the short-course, high-dose group (RR, 0.77; 95% CI, 0.58-1.03; P =.08). The protective effect of short-course, high-dose therapy was stronger in households with 3 or more children (RR, 0.72; 95% CI, 0.52-0.98). Adherence to treatment was higher in the short-course, high-dose group (82% vs 74%; P =.02).
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We conducted a multicenter, open-label, randomized trial comparing daily atovaquone (1500-mg suspension) with daily dapsone (100 mg) for the prevention of P. carinii pneumonia among patients infected with the human immunodeficiency virus who could not tolerate trimethoprim-sulfamethoxazole. The median follow-up period was 27 months.
Most routines for handling of prostate biopsies, antibiotic prophylaxis, local anaesthesia and number of cores were uniform. However, there is still a need for standardization of the performance of ultrasound-guided biopsies. Although the method used to specify biopsy location varied greatly, most urologists would prefer a national standardized system.
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The antibacterial activity of fleroxacin was evaluated in 427 gram-positive and gram-negative strains, all isolated recently from clinical specimens and compared to that of ofloxacin, ciprofloxacin and co-trimoxazole. The activity of fleroxacin resembled to that of ofloxacin; its excellent activity against Haemophilus influenzae on the one hand and its lack of activity against beta-hemolytic streptococci on the other hand have to be mentioned. Selection frequencies for resistant clones were evaluated for clinical E. coli and Serratia marcescens isolates and the quinolones. With respect to clinical E. coli and Serratia marcescens isolates selection frequencies ranged from 10(-7) to 10(-9) in the presence of 2-fold or 8-fold the MIC. The outer membrane proteins of E. coli and Serratia marcescens wild-type strains were compared with those of their quinolone-resistant mutants. No discrepancies could be observed in E. coli, whereas some of the resistant Serratia marcescens mutants exhibited an increased expression of 31 kdal protein linked with a decrease of a 37 kdal major outer membrane protein. As these alterations could not be observed in each of the resistant mutants, it cannot be decided at present whether such alterations may provide an explanation for the resistance observed.
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A patient who developed toxic epidermal necrolysis secondary to a sulfonamide derivative is presented. Treatment consisted of fluid resuscitation and silver nitrate soaks to the affected areas. Silver nitrate was selected over silver sulfadiazine (Silvadene) and mafenide in view of the nature of the offending agent. Tissue biopsy helps in the differentiation of toxic epidermal necrolysis from staphylococcal scalded skin syndrome. A biopsy is especially useful if the offending agent is not known so that appropriate treatment can be started promptly. The mortality associated with toxic epidermal necrolysis is in the neighborhood of 30%. The priniciples of burn wound management are the key to treatment of this disease. The wound usually heals by epithelialization without the need of skin grafting.
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Children (age 1 to 15 years) with acute leukemia during maintenance chemotherapy or post-bone marrow transplantation (BMT) receiving prophylaxis for Pneumocystis carinii pneumonia (PCP) with TMP/SMX received AP following prolonged neutropenia or allergy to TMP/SMX. Patients received 300 mg of AP monthly (children < 4 years received 150 mg) dissolved in 5 mL of distilled water over 20 to 30 minutes.