Highlights Earlier use of tocilizumab in COVID-19 infection is beneficial for survival, length of hospitalization and duration of oxygen support Administration of tocilizumab is based on an increase in requirements of oxygen support, progression of thoracic CT, elevation of inflammation IL-6, CRP, ferritin, d -dimer, and decrease in % lymphocytes Among the inflammation parameters, the earliest changes were detected at the levels of CRP, IL-6 and % lymphocytes
Our aim was to evaluate the prevalence of fosfomycin-resistant strains among ESBL-producing Escherichia coli isolates recovered from community patients in Switzerland. A total of 1225 ESBL-producing E. coli isolates were collected between 2012 and 2013 from a private and community laboratory. Fosfomycin resistance was assessed by using the novel rapid fosfomycin/E. coli NP test and agar dilution method. Resistant isolates were further investigated for acquired resistance genes fosA1-7 by PCR and sequencing. Pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST) were performed to evaluate the clonal relationship among fosA3-carrying isolates. Out of the 1225 ESBL-producing E. coli isolates analyzed in this study, 1208 were fosfomycin susceptible while 17 were fosfomycin resistant. No discrepancy was observed between the rapid fosfomycin/ E. coli NP test and the agar dilution method taken as the gold standard. Five out of the 17 resistant isolates carried a fosA-like gene. No clonal relationship was observed among those isolates. Here, the prevalence of fosfomycin resistance among ESBLproducing E. coli isolates in the community is reported for the first time in Switzerland, being ca. 1.4%. Among the five isolates carrying a fosA gene, four encoded the FosA3 enzyme, being the most prevalent fosfomycin-resistant determinant. An excellent correlation was observed between minimum inhibitory concentration-based susceptibility categorization and results of the rapid fosfomycin/E. coli NP test, further indicating the excellent sensitivity and specificity of this recently developed rapid test whose results are obtained in less than 2 h.
ÖZETElizabethkingia meningosepticum, özellikle yenidoğanlar ve immün süpresif hastalarda hayatı tehdit eden hastane kaynaklı enfeksiyonlara yol açabilen gram-negatif bir fırsatçı patojendir. Değişik bir antibiyotik duyarlılık paternine sahip olan E.meningosepticum, gram-negatif bakterilerin duyarlı olduğu birçok antibiyotiğe dirençli olup, vankomisin ve kotrimoksazol (SXT) gibi gram-pozitif bakterilere etkili olan antibiyotiklere duyarlılık gösterir. Bu nedenle E.meningosepticum enfeksiyonlarında tedavinin başarısı, etkenin doğru tanımlanmasına bağlıdır. Bu raporda, birçok organı etkileyen genetik bir bozukluk olan Bardet-Biedl sendromuna bağlı kronik böbrek yetmezliği gelişen ve diyaliz kateteri bulunan bir hastada görülen kateter ile ilişkili E.meningosepticum bakteriyemisi sunulmaktadır. Bardet-Biedl sendromlu femoral kateteri olan 25 yaşında erkek hasta acil servise bir gündür var olan yüksek ateş ve titreme şikayetleriyle başvurmuştur. Başvuru sırasında alınan kan kültürlerinin her ikisi, iki gün sonra pozitif sinyal vermiş; kanlı agar besiyerine yapılan pasajda 37°C'de 16 saatlik inkübasyon sonunda gram-negatif bakteri kolonilerine benzeyen düzgün kenarlı, iri, gri koloniler ürerken, MacConkey agara yapılan pasajda beş gün sonunda üreme olmamıştır. Bakteri kolonileri KOH, oksidaz, katalaz, üreaz, eskülin, MOI (Motility Indole Ornithine) testleriyle pozitif; sitratla negatif sonuç vermiş; Gram boyamada zayıf boyanan, gram-negatif, ince basiller izlenmiştir. İzolat, Vitek ® 2 sistemi (bioMérieux, ABD) ile E.meningosepticum olarak tanımlanmış ve tanı PCR ile 16S RNA gen bölgesinin amplifikasyonu ve dizi analizi yapılarak doğrulanmıştır. İzolatın antibiyotik duyarlılığı Vitek 2 sistemiyle belirlenmiş, vankomisin duyarlılığı ise Kirby-Bauer disk difüzyon testiyle değerlendirilmiştir. İzolatın, ampisilin/sulbaktam piperasilin/tazobaktam, seftazidim, sefepim, meropenem, imipenem, amikasin, gentamisin, netilmisin, levofloksasin, tetrasiklin, kolistin ve rifampisine dirençli; tigesiklin ve tetrasikline orta duyarlı; sefoperazon/sulbaktam, siprofloksasin, levofloksasin, SXT Geliş Tarihi
The rising prevalence of vancomycin-resistant enterococci (VRE) is a matter of concern in hospital settings across Europe without a distinct geographical pattern. In this scoping review, we compared the epidemiology of vancomycin-resistant Enterococcus spp. in hospitals in the Netherlands and Germany, between 1991 and 2022. We searched PubMed and summarized the national antibiotic resistance surveillance data of the two countries. We included 46 studies and summarized national surveillance data from the NethMap in the Netherlands, the National Antimicrobial Resistance Surveillance database in Germany, and the EARS-Net data. In total, 12 studies were conducted in hospitals in the Netherlands, 32 were conducted in German hospitals, and an additional two studies were conducted in a cross-border setting. The most significant difference between the two countries was that studies in Germany showed an increasing trend in the prevalence of VRE in hospitals, and no such trend was observed in studies in the Netherlands. Furthermore, in both Dutch and German hospitals, it has been revealed that the molecular epidemiology of VREfm has shifted from a predominance of vanA towards vanB over the years. According to national surveillance reports, vancomycin resistance in Enterococcus faecium clinical isolates fluctuates below 1% in Dutch hospitals, whereas it follows an increasing trend in German hospitals (above 20%), as supported by individual studies. This review demonstrates that VRE is more frequently encountered in German than in Dutch hospitals and discusses the underlying factors for the difference in VRE occurrence in these two neighboring countries by comparing differences in healthcare systems, infection prevention control (IPC) guidelines, and antibiotic use in the Netherlands and Germany.
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