we prospectively evaluated the prevalence of resistance to penicillins, cephalosporins, carbapenem, quinolones, aminoglycosides, and trimethoprim-sulfamethoxazole (SXT) in 320 Escherichia coli isolates isolated from hospitalized patients with acute urinary tract infections (UTIs). We also studied for these strains risk factors for resistance to amoxicillin-clavulanic acid (AMC), fluoroquinolones (FQs), and SXT. Resistance rates were consistent with those from major recent studies reported in the literature. Multivariate analyses selected the following factors as being significantly associated with E. coli resistance: (i) for resistance to AMC, prior (1 year) UTI (odds ratio [OR] ؍ 2.71, P ؍ 0.006), prior (1 year) urinary catheter (OR ؍ 2.98, P ؍ 0.0025), and prior (6 months) antibiotic exposure (OR ؍ 2.68, P ؍ 0.005); (ii) for resistance to FQs male sex (OR ؍ 3.87, P ؍ 0.03), with a trend toward significance for age >65 years (OR ؍ 7.67, P ؍ 0.06) and prior (1 year) UTI (OR ؍ 2.98, P ؍ 0.07); and (iii) for resistance to SXT, male sex (OR ؍ 1.91, P ؍ 0.046), hospitalization in an intermediate-term-care unit (OR ؍ 2.18, P ؍ 0.008), and prior (1 year) UTI (OR ؍ 2.03, P ؍ 0.03). Ours results suggest that prior UTI is a common risk factor for resistance to the different antibiotics tested. Although few studies on risk factors for E. coli resistance to antibiotics have been published, careful interpretation of their findings, taking into consideration the population, infection site, and period studied, should contribute to the formulation of a better strategy that can be used to overcome antibiotic resistance.Escherichia coli, the most common member of the family Enterobacteriaceae implicated in human infectious diseases, has not been spared acquisition of antibiotic resistance, a complex therapeutic problem (7,15,38). The evolution of this microorganism's antibiotic resistance patterns identified from clinical isolates has been reported in many studies on amoxicillin (AMZ), amoxicillin-clavulanic acid (AMC), fluoroquinolones (FQs), and trimethoprim-sulfamethoxazole (SXT). Also, the intimate mechanisms of E. coli antibiotic resistance have been studied and explained in numerous publications (23,24,26,35,39). Unfortunately, few analyses of the demographic, epidemiological, and clinical data for patients with E. coli infection for determination of risk factors for resistance to antimicrobial agents have been reported (1,10,13,17,27,31).To evaluate the prevalence of resistance to a panel of antibiotics, including penicillins, cephalosporins, carbapenem, quinolones, aminoglycosides, and SXT, of E. coli strains isolated from hospitalized patients with acute urinary tract infections (UTIs) and to identify the risk factors for E. coli resistance to AMC, FQs, and SXT, which are routinely used to treat these infections, we conducted a prospective study in our hospital over a 3-month period. We discuss our observations, taking into consideration the most recent major studies on E. coli resist...
Among the six species characterized within the genus Ochrobactrum, Ochrobactrum anthropi and Ochrobactrum intermedium are currently reported as opportunistic pathogens in humans. Since the species identification is mainly based on 16S rDNA analysis, the aim of this study was to search for other characteristics useful for Ochrobactrum species discrimination. Ribotyping, morphological and biochemical analyses, and antimicrobial susceptibility testing were performed for a panel of 35 clinical isolates, first identified to the species level using 16S rDNA sequencing. Type and reference strains of five Ochrobactrum species were comparatively analysed. Commercial identification systems such as API 20NE and VITEK 2 were tested for their ability to identify Ochrobactrum anthropi and to detect other members of the genus Ochrobactrum. An improved protocol for the identification of Ochrobactrum spp. by routine medical microbiology practices is proposed: isolation of a non-fastidious non-fermenting oxidase-positive Gram-negative rod resistant to all â-lactams except imipenem indicates the genus Ochrobactrum, and the API 20NE system confirms the genus identification for most strains, whereas the VITEK 2 system using ID-GNB cards was less powerful. Urease activity, the mucoidy of the colonies, growth at 45 8C on tryptic soy agar, and susceptibility to colistin, tobramycin and netilmicin should be considered as differential characteristics for identification of O. anthropi and O. intermedium to the species level. However, definitive identification depends on genotyping methods.
Twelve cases of infections caused by extended-spectrum beta-lactamase (ESBla)-producing Klebsiella pneumoniae were reported between August 1991 and March 1993 in the Geriatric Department of the Nimes University Hospital, where these bacteria had not been previously isolated. Restriction profiles of total genomic DNAs cleaved byXMal and Spel were compared by pulsed-field gel electrophoresis. The strains that were tested included the 12 isolates from K. pneumoniae-infected patients, strains recovered from rectal swabs of asymptomatic patients in the same ward, and strains isolated in other hospitals in Nimes at the same time. The restriction profiles of the 12 isolates and those recovered from asymptomatic patients in the same ward were very similar. Over a period of more than 1 year, extended-spectrum beta-lactamases were not detected in K. pneumoniae isolates with restriction patterns different from that of the epidemic strain. It seems, therefore, that there was no transfer of a plasmid or a gene coding for ESBla to strains of K. pneumoniae that were different from the epidemic strain. At the same time, ESBla-producing K. pneumoniae isolates exhibiting restriction endonuclease proffles very different from that of the epidemic strain were isolated from other hospitals in Nimes. None of these strains caused an outbreak. Pulsed-field gel electrophoresis, which allows precise characterization of strains beyond the species level, is a useful tool for studying the ESBla-producing K. pneumoniae strains involved in nosocomial outbreaks.
This is, to our knowledge, the first example of a small molecule inhibitor of this interaction.
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