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Viral, bacterial and parasitic etiology of pediatric diarrhea in Gaza, Palestine.
Med Princ Pract. 2008; 17(4): 296-301
Abu-Elamreen FH, Abed AA, Sharif FA
OBJECTIVES: To determine the etiology of acute diarrhea in Palestinian children under 5 years of age and to improve knowledge of the etiology of gastrointestinal pathogens using traditional and molecular diagnostic techniques. MATERIALS AND METHODS: Various common enteropathogens (viral, bacterial and parasites) associated with diarrhea were investigated by conventional and molecular techniques (PCR) in 150 children less than 5 years of age admitted to the Central Pediatric Hospital, Gaza Strip, Palestine. RESULTS: The occurrence of enteropathogens identified was as follows: rotavirus 42/150 (28%), Entamoeba histolytica/dispar 23/150 (15%), Shigella spp. 9/150 (6%), Campylobacter coli/jejuni and Escherichia coli O157:H7 7/150 (5%) each, Salmonella spp. 3/150 (2%), Giardia intestinalis 1/150 (1%), and Strongyloides stercoralis 1/150 (1%) of the samples. Shigella and Salmonella isolates were tested for their susceptibility to common antimicrobial agents and most of the isolates were resistant to ampicillin and trimethoprim/sulfamethoxazole. CONCLUSION: This study demonstrated that rotavirus, E. coli O157:H7 and Campylobacter, which are not routinely screened for in Gaza Strip, were significant enteropathogens. The results highlight the value of using a combination of traditional and PCR techniques in the diagnosis of enteropathogens related to gastroenteritis.
J Infect. 2008 Jun; 56(6): 446-53
de Boer MG, Brunsveld-Reinders AH, Salomons EM, Dijkshoorn L, Bernards AT, van den Berg PC, van den Broek PJ
OBJECTIVE: A four-fold increase in the incidence of Serratia marcescens occurred in a cardio-thoracic ICU within a 13-month period. Clinical, epidemiological and molecular characteristics were analysed to elucidate the outbreak's origin. METHODS: Epidemiological data were analysed by mapping clustered cases; isolates were genotyped by AFLP analysis. A case-control study was performed to identify risk factors for the acquisition of S. marcescens. Data were obtained from files and electronic databases of the ICU and Department of Medical Microbiology. The adherence to hygiene protocols on the ICU was reviewed by a medical audit. RESULTS: Genotyping showed 16 distinct S. marcescens strains. Twenty-one cases and 39 controls were enrolled in the case-control study. Significant differences found by univariate analysis included the duration of surgery, APACHE-II-score on ICU admission, length of ICU stay, duration of mechanical ventilation, tube feeding and the sum of the number of days per invasive device. In a multivariate logistic regression model, the length of ICU stay and tube feeding were independent risk factors. Outbreak strains were not more frequently resistant to gentamicin, ciprofloxacin, meropenem or trimethoprim-sulfamethoxazole as compared to a reference group. Hygiene protocols, including hand washing, were insufficiently practiced by the ICU's medical staff. CONCLUSIONS: The heterogeneity of the strains points to transmission from various sources. This outbreak of S. marcescens was most probably caused by reduced hand washing and other breaks in infection prevention protocols in combination with the presence of the identified risk factors, which act by affecting the number and intensity of potential transmission events.
Stenotrophomonas maltophilia bacteraemia in Turkish children.
Ann Trop Paediatr. 2008 Jun; 28(2): 129-36
Güriz H, Ciftçi E, Ayberkin E, Aysev D, Ince E, Arsan S, Yavuz G, Doğru U
BACKGROUND: Stenotrophomonas maltophilia is an important cause of life-threatening nosocomial infection. AIM: To evaluate the clinical features, antibiotic treatment and prognosis of S. maltophilia bacteraemia. METHODS: Patients with blood cultures positive for S. maltophilia at the Children's Hospital, Ankara University Medical School between 1995 and 2005 were evaluated retrospectively. The results were compared with those of a case-control group of patients with Pseudomonas aeruginosa bacteraemia (n=33). Antibiotic susceptibilities of S. maltophilia strains were determined by disc diffusion. Susceptibility to ciprofloxacin was also determined by broth dilution. RESULTS: Thirty-six (2.2%) blood cultures were positive for S. maltophilia. Neutropenia was more common in the P. aeruginosa group (p=0.001). Breakthrough bacteraemia developed more commonly during carbapenem treatment in the S. maltophilia group (p=0.02). Ciprofloxacin and trimethoprim-sulfamethoxazole in combination with/without an aminoglycoside were the antibiotics most commonly selected to treat S. maltophilia bacteraemia. Mortality was more common in the P. aeruginosa (13/33) than in the S. maltophilia (2/33) group (p=0.001). According to susceptibility, determination by the disk diffusion method, beta-lactam antibiotics, aminoglycosides and chloramphenicol had little or no effect, whereas trimethoprim-sulfamethoxazole, doxycycline and fluoroquinolones were more active against S. maltophilia strains. However, ciprofloxacin susceptibility results were quite different when determined by disk diffusion (97% isolates susceptible) and broth dilution (49% isolates susceptible). CONCLUSIONS: Although S. maltophilia bacteraemia is rare in children, antibiotic resistance to these strains is an important problem. Tetracyclines, trimethoprim-sulfamethoxazole and fluoroquinolones are the most active agents against S. maltophilia strains.
Vet Microbiol. 2008 May 20;
Zhang C, Ning Y, Zhang Z, Song L, Qiu H, Gao H
Streptococcus suis is an important pathogen in the swine industry. Because transmission is generally thought to occur between healthy carrier sows and their offspring, it is important to understand which antimicrobial agents are likely to be effective against the strains isolated. This study is the first to report on the antimicrobial susceptibility of S. suis isolated from clinical healthy sows. From 2005 to 2007 a total of 421 S. suis isolates were recovered from sows in China and subjected to antimicrobial susceptibility testing in accordance with the Clinical and Laboratory Standards Institute (CLSI) standards. High-level resistance were found with tetracycline (91.7%) and sulfisoxazole (86.7%), followed by clindamycin (68.4%), erythromycin (67.2%), tilmicosin (66.7%) and trimethoprim/sulfamethoxazole (59.1%). These six antimicrobial agents presented the highest MIC(50) values and the antibiogram (19.2%) most frequently observed. Lower resistance rates among the beta-Lactams support their use as the primary drugs to treat the infection of S. suis. However, appropriate dosing or combination antibiotic therapeutic regimens should be adhered to in view of the resistant and intermediate strains to penicillin (9.5% and 42.3%), ampicillin (4.0% and 29.9%) and ceftiofur (22.1% and 37.3%), respectively.
BMC Public Health. 2008; 8: 169
Harambat J, Fassinou P, Becquet R, Touré P, Rouet F, Dabis F, Msellati P, Blanche S, Timité-Konan M, Salamon R, Leroy V,
OBJECTIVE: To assess the 18-month field effectiveness on severe events of a pediatric package combining early HIV-diagnosis and targeted cotrimoxazole prophylaxis in HIV-infected children from age six-week before the antiretroviral era, in Abidjan, Côte d'Ivoire. METHODS: Data from two consecutive prevention of HIV mother-to-child transmission programs were compared: the ANRS 1201/1202 Ditrame-Plus cohort (2001-2005) and the pooled data of the ANRS 049a Ditrame randomized trial and its following open-labeled cohort (1995-2000), used as a reference group. HIV-infected pregnant women > or = 32-36 weeks of gestation were offered a short-course peri-partum antiretroviral prophylaxis (ZDV in Ditrame, and ZDV +/- 3TC+single-dose (sd) NVP in Ditrame-Plus). Neonatal prophylaxis was provided in Ditrame-Plus only: 7-day ZDV and sdNVP 48-72 h after birth. A 6-week pediatric HIV-RNA diagnosis was provided on-line in the Ditrame-Plus while it was only oriented on clinical symptoms in Ditrame. Six-week HIV-infected children received a daily cotrimoxazole prophylaxis in Ditrame-Plus while no prophylaxis was provided in Ditrame. The determinants of severe events (death or hospitalization > 1 day) were assessed in a Cox regression model. RESULTS: Between 1995 and 2003, 98 out of the 1121 live-births were diagnosed as HIV-infected in peri-partum: 45 from Ditrame-Plus and 53 from Ditrame. The 18-month Kaplan-Meier cumulative probability of presenting a severe event was 66% in Ditrame-Plus (95% confidence interval [95%CI]: 50%-81%) and 77% in Ditrame (95%CI: 65%-89%), Log Rank test: p = 0.47. After adjustment on maternal WHO clinical stage, maternal death, 6-week pediatric viral load, birth-weight, and breastfeeding exposure, the 18-month risk of severe event was lower in Ditrame-Plus than in Ditrame (adjusted Hazard Ratio (aHR): 0.55, 95%CI: 0.3-1.1), although the difference was not statistically significant; p = 0.07). Maternal death was the only variable determinant of the occurrence of severe events in children (aHR: 3.73; CI: 2.2-11.2; p = 0.01). CONCLUSION: Early cotrimoxazole from 6 weeks of age in HIV-infected infants seemed to reduce probability of severe events but the study lacked statistical power to prove this. Even with systematic cotrimoxazole prophylaxis, infant morbidity and mortality remained high pointing towards a need for early pediatric HIV-diagnosis and antiretroviral treatment in Africa.
Lymphocutaneous nocardiosis and cutaneous pheohyphomycosis in a liver transplant recipient.
Int J Dermatol. 2008 Jun; 47(6): 571-4
Parra IH, Galimberti R, Galimberti G, Guanella B, Kowalczuk A
BACKGROUND: Infections are the leading cause of morbidity and mortality in transplanted patients. The increasing number of immunocompromised patients has not only augmented infections by specific pathogens, but also by opportunistic microbial agents. METHODS: A mixed cutaneous infection caused by Nocardia brasiliensis and Exophiala jeanselmei is reported in a liver transplant patient. RESULTS: The cutaneous lesions were painful nodules which drained purulent material. They were located on the right lower limb, with lymphadenopathies in the groin. CONCLUSIONS: The patient was treated with itraconazole (600 mg/day) plus trimethoprim (1600 mg/day)-sulfamethoxazole (320 mg/day) for 8 weeks, with complete remission of the lesions.
Microb Drug Resist. 2008; 14(2): 93-9
Gionechetti F, Zucca P, Gombac F, Monti-Bragadin C, Lagatolla C, Tonin E, Edalucci E, Vitali LA, Dolzani L
Mediterranean herring gulls (Larus cachinnans) were investigated as a possible reservoir of antibiotic resistant bacteria and of cassette-borne resistance genes located in class 1 integrons. Two hundred and fourteen isolates of the family Enterobacteriaceae were collected from cloacal swabs of 92 chicks captured in a natural reserve in the North East of Italy. They showed high percentages of resistance to ampicillin and streptomycin. High percentages of resistance to trimethoprim/sulfamethoxazole were found in Proteus and Citrobacter and to chloramphenicol in Proteus. Twenty-two (10%) isolates carried the intI1 gene. Molecular characterization of the integron variable regions showed a great diversity, with the presence of 11 different cassette arrays and of one integron without integrated cassettes. The dfrA1-aadA1a and aadB-aadA2 cassette arrays were the most frequently detected. Also the estX cassette, alone or in combination with other cassettes, was detected in many isolates. From this study it is concluded that the enteric flora of Mediterranean herring gulls may act as a reservoir of resistant bacteria and of resistance genes. Due to their feeding habits and their ability to fly over long distances, these free-living birds may facilitate the circulation of resistant strains between waste-handling facilities, crops, waters, and urban areas.
J Microbiol Immunol Infect. 2008 Apr; 41(2): 130-6
Tuo MH, Tsai YH, Tseng HK, Wang WS, Liu CP, Lee CM
BACKGROUND AND PURPOSE: Nocardia is an uncommon pathogen in humans, and most patients with nocardiosis are immunocompromised, with variable etiologies. To understand the incidence, clinical characteristics, treatment and outcome of pulmonary and bloodstream nocardiosis, we conducted a retrospective study in two tertiary care hospitals in northern Taiwan. METHODS: We reviewed laboratory culture reports and clinical records of 29 adult patients with lower respiratory tract or bloodstream nocardiosis (21 and 8 patients, respectively) in two tertiary care hospitals, over a period of 5 years. The risk factors, clinical manifestations, response to therapy, outcome and recurrence rate were compared between these two groups. RESULTS: The most common underlying conditions in pulmonary nocardiosis were chronic lung disease and long-term steroid usage. For nocardemia, underlying malignancy and steroid administration are common. Fourteen of 21 patients with pulmonary nocardiosis ever transferred to an intensive care unit and 9 of them had concomitant infection. In patients with and without coexisting isolates during hospital course, the mean days from admission to specific therapy for nocardiosis were 26.4 and 11.9 days, respectively. Patients with nocardemia showed great variation in clinical manifestations and disease severity; central venous catheter implantation was noted in 6 of them. Only one patient with nocardemia had documented recurrence. Twenty four patients were treated with antimicrobials (trimethoprim-sulfamethoxazole, 83%; imipenem or meropenem, 25%). Treatment failure occurred in 7 of 20 patients treated with trimethoprim-sulfamethoxazole alone or in combination. CONCLUSIONS: Pulmonary or disseminated nocardiosis is rare but may be fatal as an opportunistic infection in an immunocompromised host with chronic lung disease, underlying malignancy or long-term steroid usage. The significance of primary nocardemia needs careful evaluation. Concomitant infection was the probable predisposing factor for intensive care unit admission for pulmonary nocardiosis in our study (p=0.019) and might obscure the isolation of nocardiae organisms and delay effective treatment. For critical patients with nocardiae infection, initial therapy with a combination antimicrobial regimen is recommended.
Considering the benefits of disease-specific interventions on overall public health.
Lancet Infect Dis. 2008 May; 8(5): 278
Boyd M, Byakwaga H
Clin Infect Dis. 2008 Apr 1; 46(7): 985-91
Gasasira AF, Kamya MR, Achan J, Mebrahtu T, Kalyango JN, Ruel T, Charlebois E, Staedke SG, Kekitiinwa A, Rosenthal PJ, Havlir D, Dorsey G
BACKGROUND: Artemisinin-based combination therapies are rapidly being adopted for the treatment of malaria in Africa; however, there are limited data on their safety and efficacy among human immunodeficiency virus (HIV)-infected populations. METHODS: We compared malaria treatment outcomes between cohorts of HIV-infected and HIV-uninfected children in Uganda who were observed for 18 and 29 months, respectively. Malaria was treated with artesunate plus amodiaquine, and outcomes were assessed using standardized guidelines. HIV-infected children received trimethoprim-sulfamethoxazole prophylaxis and antiretroviral therapy in accordance with current guidelines. RESULTS: Twenty-six HIV-infected participants experiencing 35 episodes of malaria and 134 HIV-uninfected children experiencing 258 episodes of malaria were included in the study. Twelve HIV-infected children were receiving antiretroviral therapy, 11 of whom were receiving zidovudine. Malaria treatment was highly efficacious in both the HIV-infected and HIV-uninfected cohorts (28-day risk of recrudescence, 0% and 3.6%, respectively); however, there was a trend towards increased risk of recurrent malaria among the HIV-uninfected children (2.9% vs. 13.2%; p = .08). Importantly, the risk of neutropenia 14 days after initiation of treatment with artesunate plus amodiaquine was higher among HIV-infected children than among HIV-uninfected children (45% vs. 6%; p < .001). The severity of all episodes of neutropenia in HIV-uninfected children was mild to moderate, and 16% of episodes of neutropenia in the HIV-infected cohort were severe or life-threatening (neutrophil count,