Abrupt changes in antibiotic resistance

McGowan, John E.

doi:10.1016/0195-6701(91)90025-4

Cited by 11 publications

(5 citation statements)

References 30 publications

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“…The major reservoir of these organisms is the human, with some areas of the human body being colonized with upward of 10 7 log 10 CFU/cm 2 . Many studies have examined clinically relevant isolates of coagulasenegative staphylococci to determine their antibiotic resistance patterns or have tracked the emergence of antibiotic-resistant organisms concurrently with the use of either an oral or a topically applied antibiotic (6,10,12,15). In contrast, in the present study we assessed the prevalence and density of antibiotic-resistant organisms at multiple time points including 6 weeks subsequent to the cessation of antibiotic use in order to determine the ecological effects of long-term antibiotic use.…”

Section: Discussionmentioning

confidence: 99%

Effects of topical erythromycin on ecology of aerobic cutaneous bacterial flora

Vowels

Feingold

Sloughfy

et al. 1996

Antimicrob Agents Chemother

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We have demonstrated previously that application of topical erythromycin, an antibiotic commonly used for the treatment of acne, results in an increased density of cutaneous erythromycin-resistant (Emr) coagulase-negative staphylococci; however, it is unknown if this increase results in an overall higher density of total cutaneous staphylococci or if upon cessation of erythromycin use, Emr coagulase-negative staphylococci remain at an increased density compared with the pretreatment density. To investigate this, 2% erythromycin or vehicle was applied to each subject's forehead (n = 225) twice a day by laboratory personnel for a period of 6 weeks. Samples were obtained for culture from the forehead, anterior nares, and back of the subjects at baseline and at weeks 6, 9, and 12 of the study. Cultures were performed on differential media. Plates into which erythromycin was incorporated (8 micrograms/ml) were used to identify Emr coagulase-negative staphylococci. The species of all Emr coagulase-negative staphylococci were determined, and an antibiogram for 16 antibiotics was obtained. The baseline prevalence of Emr coagulase-negative staphylococci on the forehead and nose was about 80% at the two study sites, whereas that on the back was 50%. The baseline density of Emr coagulase-negative staphylococci on the forehead, nose, and back was approximately 20% of the total flora. Following 6 weeks of erythromycin treatment, the prevalence of Emr coagulase-negative staphylococci on the forehead and nose was nearly 100% and the densities were 73 and 62%, respectively; the prevalence and density for the back were 78 and 42%, respectively. The most prevalent erythromycin resistance gene expressed by the Emr coagulase-negative staphylococci was ermC. There was no increase in the numbers of Staphylococcus aureus, gram-negative rods, or yeasts, nor was there increased resistance to any other antibiotic except clindamycin. The density of total aerobic organisms also remained static. There were no changes in the prevalence or density of Emr coagulase-negative staphylococci in the vehicle group. A statistically significant decrease in the prevalence and density of Emr coagulase-negative staphylococci in the erythromycin group was observed within 3 weeks posttreatment and by 6 weeks posttreatment, the prevalence and density returned to baseline values. These data demonstrate that the increased prevalence and density of Emr coagulase-negative staphylococci as a result of topical 2% erythromycin use are transient on both population and individual levels.

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Section: Discussionmentioning

confidence: 99%

Effects of topical erythromycin on ecology of aerobic cutaneous bacterial flora

Vowels

Feingold

Sloughfy

et al. 1996

Antimicrob Agents Chemother

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“…Tracheal aspirate (predominantly one pathogen) (9) or positive urine culture > 106 pathogens/ml or positive culture from normally sterile compartment or positive wound swab in the presence of purulent discharge (10) 2 A diagnostic sepsis workup comprises blood-cultures, differential WBC, C-reactive protein and physical examination3 Prescription of antibiotics other than guideline-directed prophylaxis or increase or change in current medication not indicated by cultures 4 WBC = white blood cell count 5 CRP = C-reactive protein…”

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confidence: 99%

Use of antibiotics in pediatric intensive care and potential savings

Fischer¹,

Ramser²,

Fanconi³

2000

Intensive Care Med

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“…The addition of ciprofloxacin to empirical regimens will expand the spectrum to cover most of the ESBL pathogens described here, and will also cover >50% of the MRSA, although S. aureus has been shown to acquire resistance to ciprofloxacin rapidly. [15] Gentamicin was effective against all non- Salmonella GNRs, but empirical regimens in patients with suspected bacteraemia at MCH (particularly those with AIDS) must cover NTS, given local epidemiology. All GNRs isolated in the course of this study were susceptible to imipenem, which was not consistently available at MCH during the time of this study.…”

Section: Discussionmentioning

confidence: 99%

A prospective observational study of bacteraemia in adults admitted to an urban Mozambican hospital

et al. 2015

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Background Bacteraemia is a common cause of fever among patients presenting to hospitals in sub-Saharan Africa. The worldwide rise of antibiotic resistance makes empirical therapy increasingly difficult, especially in resource-limited settings. Objectives To describe the incidence of bacteraemia in febrile adults presenting to Maputo Central Hospital (MCH), an urban referral hospital in the capital of Mozambique, and characterise the causative organisms and antibiotic susceptibilities. We aimed to describe the antibiotic prescribing habits of local doctors, to identify areas for quality improvement. Methods Inclusion criteria were: (i) ≥18 years of age; (ii) axillary temperature ≥38°C or ≤35°C; (iii) admission to MCH medical wards in the past 24 hours; and (iv) no receipt of antibiotics as an inpatient. Blood cultures were drawn from enrolled patients and incubated using the BacT/Alert automated system (bioMérieux, France). Antibiotic susceptibilities were tested using the Kirby-Bauer disc diffusion method. Results Of the 841 patients enrolled, 63 (7.5%) had a bloodstream infection. The most common isolates were Staphylococcus aureus, Escherichia coli, and non-typhoidal Salmonella. Antibiotic resistance was common, with 20/59 (33.9%) of all bacterial isolates showing resistance to ceftriaxone, the broadest-spectrum antibiotic commonly available at MCH. Receipt of insufficiently broad empirical antibiotics was associated with poor in-hospital outcomes (odds ratio 8.05; 95% confidence interval 1.62 – 39.91; p=0.04). Conclusion This study highlights several opportunities for quality improvement, including educating doctors to have a higher index of suspicion for bacteraemia, improving local antibiotic guidelines, improving communication between laboratory and doctors, and increasing the supply of some key antibiotics.

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Abrupt changes in antibiotic resistance

Cited by 11 publications

References 30 publications

Effects of topical erythromycin on ecology of aerobic cutaneous bacterial flora

Effects of topical erythromycin on ecology of aerobic cutaneous bacterial flora

Use of antibiotics in pediatric intensive care and potential savings

A prospective observational study of bacteraemia in adults admitted to an urban Mozambican hospital

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