Published data on antimicrobial resistance are lacking for the United Arab Emirates (UAE). Knowledge of local patterns of resistance is essential to optimize guidelines for empirical antimicrobial treatment. Awareness of susceptibility patterns in other parts of the world may be important for determining empirical antimicrobial therapy for travelers or patients transferred from abroad. Antibiograms from unique isolates of common hospital and community bacteria are described in a tertiary referral hospital in the UAE, which had no antimicrobial restrictions and limited resources. Antimicrobial resistance rates were unpredictable and were high for Gram-negative organisms, such as Escherichia coli, Shigella sonnei, Campylobacter spp, and also Streptococcus pneumoniae. In contrast, methicillin-resistant Staphylococcus aureus (MRSA) comprised less than 5% of S. aureus isolates and glycopeptide-resistant enterococci (GRE) were not detected during the surveillance period. Our results provide data on antimicrobial resistance for the UAE and highlight the need for resources for surveillance of antimicrobial resistance.
In this double-blind multicentre study, using the intention-to-treat approach, a total of 293 patients with fever (> or = 38.5 degrees C), symptoms of sepsis and signs of pneumonia or pyelonephritis were randomly assigned to treatment with ampicillin and mecillinam (A+M) or cefotaxime followed by cefadroxil. In the febrile phase, treatment was given intravenously twice daily, either with 1,200 mg ampicillin together with 600 mg mecillinam or with 2 g cefotaxime alone. When the patients stayed afebrile, the intravenous administration was replaced by oral treatment twice daily for 14 days, either with 500 mg pivampicillin and 400 mg pivmecillinam or 1 g cefadroxil. In the A+M group, 33% (48/144) of the patients did not complete the full course of treatment as compared with 32% (47/149) in the cephalosporin group, the reasons being treatment failure in 27 and 29, respectively, or adverse effects (n = 16 in both groups). The median duration of fever was 47 h in the A + M group and 50 h in the cephalosporin group. Of 135 patients with pneumonia, 68% were completely cured in the A + M group, and 65% in the cephalosporin group, the main reasons for treatment failure being Mycoplasma pneumonia or ornithosis. Of 136 patients with pyelonephritis, 63% were cured in each group. The main reason for failure was bacteriological relapse. Side-effects were reported by 32 patients (22%) of the A+M group, as compared with 41 (28%) of the cephalosporin group. Epigastric complaints were equally frequent in both groups, but there was a tendency for a higher frequency of exanthema in the A+M group, and for antibiotic-associated diarrhoea and fungal superinfections in the cephalosporin group.
An enzyme immunoassay for serogroup specific immunological diagnosis of salmonella infections has been developed. Antigens representing salmonella O-antigens 4 (serogroup B) and 9 (serogroup D) were prepared by periodate oxidation of phenol-water extracted lipopolysaccharides from S. typhimurium and S. enteritidis respectively. Applied for seroepidemiological studies of S. typhimurium infections such chemically modified antigens showed a superior specificity compared to native lipopolysaccharides. The antibody titres against O-antigen 4 measured by the enzyme-linked immunosorbent assay (ELISA) were detectable during the second week and increased during the first 3--4 weeks of S. typhimurium infection. High titres persisted for at least 2--3 months and in some cases for more than 3 years. For reliable serodiagnosis a significant increase of the titre between acute and convalescent samples is necessary . Determination of ratio between IgG and IgM antibody titres against the pathogen may, however, be used on single serum samples to indicate whether the observed antibody titre is of recent or longstanding origin.
In the middle of October 1982 a large number of people living at Mjövik, a small community in the south-east of Sweden, fell ill after drinking municipal water contaminated with waste water. The epidemic curve showed one single outbreak without secondary cases. No pathogenic agents could be isolated from the water or sick persons. From some persons who fell ill again or did not recover new samples were taken and Giardia lamblia was then isolated from persons with remaining symptoms and previously affected persons. No parasite was found in persons without gastroenteritis. The outbreak at Mjövik was caused by at least 2 agents, 1 unidentified, with a short incubation time, contracted by 557 persons, and Giardia lamblia, with a longer incubation time, contracted by at least 56 persons.
This randomised, double-blind, multicenter study compared the safety and efficacy of lomefloxacin and norfloxacin in adult female outpatients with uncomplicated urinary tract infections. Patients were randomly assigned to one of 3 treatment groups: 400 mg lomefloxacin once daily for 3 days (L3), 400 mg lomefloxacin once daily for 7 days (L7), or 400 mg norfloxacin twice daily for 7 days (N7). A total of 703 patients (age 17-75 years) were enrolled at 21 investigative sites in southern Sweden. Clinical and microbiological evaluations were conducted at the start, 5-9 days and 3-4 weeks post therapy. Patients with quantitative urine cultures of > or = 10(4) CFU/ml of a susceptible pathogen were considered evaluable for efficacy. Escherichia coli and Staphylococcus saprophyticus were the most commonly isolated pathogens. In both L3 and L7 groups, 196 patients and in the N7 group 195 patients met the criteria for efficacy evaluation. At the 5-9 day post-treatment evaluation, 88% of the pathogens were eradicated in the L3 group, 93% in the L7 group and 93% in the N7 group. At the 3-4 week post-treatment evaluation, 81%, 82%, and 85% of urine cultures remained negative in the L3, L7, and N7 groups, respectively. No statistically significant differences between the 3 treatment groups were noted with the exception of eradication of S. saprophyticus, for which the 7 day courses were more effective at 4-9 days post treatment. No persistent pathogen developed resistance to the study drugs. All 3 treatment regimens were equally well tolerated, except for photosensitivity reactions, which were more frequently reported in patients in the lomefloxacin groups.
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