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Infections caused by methicillin-resistant Staphylococcus aureus (MRSA) is frequent among hemodialysis patients and lead to increased morbidity and mortality rates. It is known that nasal colonization plays an important role for the development of MRSA infections. The aim of this study was to determine the prevalence and risk factors for MRSA colonization among outpatients undergoing hemodialysis. A total of 466 adult patients (199 female, 267 male; age range: 18-89 years, mean age: 55.8 ± 15.1 years) who were under hemodialysis between September-December 2008 in different health centers at Pamukkale/ Denizli region, Turkey, were included in the study. Swab samples obtained from anterior nares of patients were cultivated on sheep-blood agar and mannitol-salt agar media. The isolates were identified by conventional bacteriological methods. S.aureus strains were isolated from 204 (43.8%) patients and 34 (16.7%) were found methicillin-resistant. Thus the rate of MRSA colonization in hemodialysis patients was detected as 7.3% (34/466). All of the MRSA strains were found susceptible to vancomycin, linezolid and tigecycline, while the resistance rates for the other antimicrobial agents were as follows: 70.6% to azithromycin and claritromycin; 64.7% to erythromycin; %58.8 to clindamycin, gentamicin and trimethoprim-sulfamethoxazole; 55.9% to ciprofloxacin; 44.1% to tetracycline and rifampin; 5.9% to chloramphenicol. Inducible clindamycin resistance in MRSA isolates was %23.5 (8/34), and multidrug resistance rate was 76.5% (26/34). Multivariate analysis revealed that the history of previous hospitalization within a year [odds ratio (OR), 3.426; 95% confidence interval (CI), 1.595-7.361, p= 0.002] and the presence of chronic obstructive lung disease (OR, 5.181; 95% CI, 1.612-16.648, p= 0.006) were independent risk factors for MRSA colonization in this population. A better understanding of the prevalence and risk factors for nasal MRSA colonization among hemodialysis population may hold significant implications for both the treatment strategies and prevention of MRSA infections to establish appropriate infection control measures.
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The genus Clostridium includes major human pathogens and species important to cellulose degradation, the carbon cycle, and biotechnology. Small RNAs (sRNAs) are emerging as crucial regulatory molecules in all organisms, but they have not been investigated in clostridia. Research on sRNAs in clostridia is hindered by the absence of a systematic method to identify sRNA candidates, thus delegating clostridial sRNA research to a hit-and-miss process. Thus, we wanted to develop a method to identify potential sRNAs in the Clostridium genus to open up the field of sRNA research in clostridia. Using comparative genomics analyses combined with predictions of rho-independent terminators and promoters, we predicted sRNAs in 21 clostridial genomes: Clostridium acetobutylicum, C. beijerinckii, C. botulinum (eight strains), C. cellulolyticum, C. difficile, C. kluyveri (two strains), C. novyi, C. perfringens (three strains), C. phytofermentans, C. tetani, and C. thermocellum. Although more than one-third of predicted sRNAs have Shine-Dalgarno (SD) sequences, only one-sixth have a start codon downstream of SD sequences; thus, most of the predicted sRNAs are noncoding RNAs. Quantitative reverse transcription-PCR (Q-RT-PCR) and Northern analysis were employed to test the presence of a randomly chosen set of sRNAs in C. acetobutylicum and several C. botulinum strains, leading to the confirmation of a large fraction of the tested sRNAs. We identified a conserved, novel sRNA which, together with the downstream gene coding for an ATP-binding cassette (ABC) transporter gene, responds to the antibiotic clindamycin. The number of predicted sRNAs correlated with the physiological function of the species (high for pathogens, low for cellulolytic, and intermediate for solventogenic), but not with 16S rRNA-based phylogeny.
To assess the efficacy of a 10-week course of combination clindamycin 300 mg twice daily and rifampicin 300 mg twice daily in the treatment of HS.
A total of 182 patients were screened for eligibility; 41 patients were enrolled (21 DEX; 20 PLAC). At 24 hours, those receiving DEX reported lower pain scores (1.4 vs. 5.1; P = .009); however, these differences disappeared by 48 hours (P = .22) and 7 days (P = .4). At 24 hours, more patients receiving DEX returned to normal activities (33% vs. 11%) and dietary intake (38% vs 25%); however, these differences were not significant and disappeared by 48 hours and 7 days. Side effects were rare and did not differ between groups (P > .05).
The South Swedish Pneumococcal Intervention Project (SSPIP) was started in 1995 with the aim of limiting the spread of penicillin-non-susceptible pneumococci (PNSP) in Skåne County, Sweden. As part of the SSPIP, eradication therapy with rifampicin in combination with 1 more antibiotic was considered on a social indication after prolonged carriage of 2-3 months.
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Summary Atlantoaxial subluxation is a rare complication of the upper neck inflammatory processes of head and neck region. Grisel's syndrome is a non-traumatic subluxation of the atlanto axial joint. It is not associated with trauma or bone disease. It typically occurs in children after serious infection in the head and neck region. Several theories have been proposed to explain the pathogenesis of inflammatory subluxation. The primary treatment of Grisel's syndrome is medical. We report a case of atlantoaxial rotatory subluxation treated with external fixation and antibiotic therapy.
Although some of these trends, such as the dramatic increase in fluoroquinolone and cephalosporin resistance in E. coli, can be attributed to the emergence and global spread of resistant clones (e.g. ST131 E. coli), others remain unexplained. However, recognizing these trends remains important to guide changes in empirical antimicrobial therapy and drug development.
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Clostridium difficile colitis is a disabling complication in critically ill patients who commonly receive broad-spectrum antibiotics and liquid diets. To date, there is no experimental model specifically designed to investigate the effects of liquid diets on this type of colitis. The addition of fiber to liquid diets normalizes gut structure and improves absorptive function in selected conditions of intestinal dysfunction. The purposes of this study were the following: (1) to develop a reproducible model to examine the interaction of acute C difficile-induced colitis and liquid diets, (2) to determine whether the addition of soy fiber to a liquid diet improves disease, and (3) to investigate possible mechanisms of fiber-mediated disease improvement. Syrian hamsters were pair-fed with either a polymeric liquid diet or the same diet with 1.4% soy fiber for 10 days. Animals were given either clindamycin and C difficile (to produce ileocecitis), or equivalent volumes of saline. Mean survival time and systematic stool examinations for C difficile toxin positivity, liquidity, and percent water were performed to determine the effect of soy fiber on disease. Survival time was prolonged by 34% (p < .05), and C difficile toxin positivity and stool liquidity were significantly reduced (p < .05) with fiber. Additional animals were studied to determine possible mechanisms for improved survival in fiber-supplemented animals. Cecal histology, colonic water absorption, cecal microflora, and gastric to anus transit time were measured in these animals. Colonic water absorption and gastric to anus transit time were significantly increased (p < .05) and decreased (p < .05) with fiber, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)
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After a successful cardiac transplantation, routine endomyocardial biopsies showed severe infiltrates comparable with myocarditis. Polymerase chain reaction analysis of native myocardial samples revealed infection with Paracoccus yeei, and the clinical condition of the patient deteriorated. After administration of ciprofloxacin, his clinical condition improved, and further biopsies showed no infiltrates in the cardiac specimens. To our knowledge this is the first documented case of P. yeei infection in a heart transplant patient.