This study evaluated resistance trends among gram-positive cocci in the US over the past decade and assessed the activity of tigecycline against resistant isolates. The key findings were:
1) Resistance increased substantially for MRSA and VRE between 1998-2008, while PRSP and macrolide-resistant Streptococcus pyogenes fluctuated between 15-22% and 8-11%, respectively.
2) Resistance varied regionally, with higher rates in the South and Southeast US compared to other areas.
3) Tigecycline maintained activity against resistant subpopulations of MRSA, PRSP, VRE and macrolide-resistant S. pyogenes, with MICs within
This document discusses new developments in the treatment of community-onset pneumonia. It notes that mortality from pneumonia has declined due to pneumococcal vaccines, timely administration of appropriate antibiotics, and avoiding overtreatment in low-risk patients. Viruses are now recognized as a common cause of adult pneumonia. Procalcitonin levels may help identify patients at low risk of deterioration who need only extremely short courses of antibiotics. While healthcare-associated pneumonia is associated with drug-resistant pathogens and worse outcomes, inappropriate antibiotics alone do not fully explain increased mortality.
This document discusses optimal strategies for inducing broadly neutralizing antibodies (bnAbs) against highly mutable pathogens like HIV. It presents a computational model of affinity maturation in the presence of multiple variant antigens. The model suggests there is an optimal level of "frustration" between conflicting selection forces from different antigens that maximizes the probability of evolving bnAbs. An intermediate level of frustration allows for cross-reactivity while avoiding overspecialization. The results provide guidance for rational vaccine design and reveal principles at the intersection of immunology and evolutionary biology.
This document summarizes research on drug-induced anaphylaxis in Latin America. Some key findings include:
- Drugs are a leading cause of anaphylaxis in Latin America, reported in 34% of cases in one study. NSAIDs and beta-lactams are among the most common culprits.
- Studies in Latin America found cardiovascular involvement in over 45% of anaphylaxis cases, and was more frequent in elderly patients. Shock and severe reactions were also more common in the elderly.
- A study of over 800 anaphylaxis cases across Latin America found NSAIDs to be the predominant cause in adults, while beta-lactams were more common in children and
- The document discusses chronic granulomatous disease (CGD), an immunodeficiency caused by a defect in the NADPH oxidase complex resulting in recurrent infections.
- It covers the genetics, clinical presentation including infections by bacteria, fungi and mycobacteria, diagnostic testing such as NBT and DHR, and management including antimicrobial prophylaxis and IFN-γ therapy.
- Mendelian susceptibility to mycobacterial disease is also discussed, which is caused by defects in IFN-γ signaling and results in selective predisposition to mycobacterial infections despite otherwise normal health. Causative genes involved in IFN-γ production and response are identified.
Dr. Kurt Stevenson - Antimicrobial Resistance Surveillance and Management in ...John Blue
Antimicrobial Resistance Surveillance and Management in Hospital and Community Settings - Issues for Human Population Medicine - Dr. Kurt Stevenson, The Ohio State University Medical Center, from the 2012 NIAA One Health Approach to Antimicrobial Resistance and Use Symposium, October 26-27, 2012, Columbus, OH, USA.
More presentations at:
http://www.trufflemedia.com/agmedia/conference/2012-one-health-to-approach-antimicrobial-resistance-and-use
This document is a dedication and acknowledgments section from a thesis. It dedicates the thesis to the author's family and thanks various individuals and institutions for their support and contributions to completing the work. It expresses gratitude to God, the author's parents, the thesis advisor, various doctors and laboratories, secretaries, statisticians, participating subjects, and the Faculty of Medicine for their help and assistance during the research and writing process.
This study investigated the nasopharyngeal microbiome of 45 Malawian children who carried Streptococcus pneumoniae. The microbiome was characterized using 16S rRNA gene sequencing. The results showed a shift in microbial diversity with HIV infection, with Moraxella and Streptococcus influencing diversity. Multiple carriage of pneumococcal serotypes did not significantly impact microbial diversity. The major limitation was that only pneumococcal carriers were studied. Further research on non-carriers is recommended to better understand implications on pneumococcal colonization.
This document discusses biomarkers in asthma and the 2020 Mexican consensus on fractional exhaled nitric oxide (FeNO) in asthma. It provides background on the population affected by asthma and the economic burden. Biomarkers can help identify asthma phenotypes and endotypes, guiding treatment. Fractional exhaled nitric oxide (FeNO) is a non-invasive marker of eosinophilic airway inflammation and can help monitor asthma control and response to treatment. The document reviews the use of FeNO and other biomarkers to identify inflammation phenotypes and optimize asthma management.
This document discusses new developments in the treatment of community-onset pneumonia. It notes that mortality from pneumonia has declined due to pneumococcal vaccines, timely administration of appropriate antibiotics, and avoiding overtreatment in low-risk patients. Viruses are now recognized as a common cause of adult pneumonia. Procalcitonin levels may help identify patients at low risk of deterioration who need only extremely short courses of antibiotics. While healthcare-associated pneumonia is associated with drug-resistant pathogens and worse outcomes, inappropriate antibiotics alone do not fully explain increased mortality.
This document discusses optimal strategies for inducing broadly neutralizing antibodies (bnAbs) against highly mutable pathogens like HIV. It presents a computational model of affinity maturation in the presence of multiple variant antigens. The model suggests there is an optimal level of "frustration" between conflicting selection forces from different antigens that maximizes the probability of evolving bnAbs. An intermediate level of frustration allows for cross-reactivity while avoiding overspecialization. The results provide guidance for rational vaccine design and reveal principles at the intersection of immunology and evolutionary biology.
This document summarizes research on drug-induced anaphylaxis in Latin America. Some key findings include:
- Drugs are a leading cause of anaphylaxis in Latin America, reported in 34% of cases in one study. NSAIDs and beta-lactams are among the most common culprits.
- Studies in Latin America found cardiovascular involvement in over 45% of anaphylaxis cases, and was more frequent in elderly patients. Shock and severe reactions were also more common in the elderly.
- A study of over 800 anaphylaxis cases across Latin America found NSAIDs to be the predominant cause in adults, while beta-lactams were more common in children and
- The document discusses chronic granulomatous disease (CGD), an immunodeficiency caused by a defect in the NADPH oxidase complex resulting in recurrent infections.
- It covers the genetics, clinical presentation including infections by bacteria, fungi and mycobacteria, diagnostic testing such as NBT and DHR, and management including antimicrobial prophylaxis and IFN-γ therapy.
- Mendelian susceptibility to mycobacterial disease is also discussed, which is caused by defects in IFN-γ signaling and results in selective predisposition to mycobacterial infections despite otherwise normal health. Causative genes involved in IFN-γ production and response are identified.
Dr. Kurt Stevenson - Antimicrobial Resistance Surveillance and Management in ...John Blue
Antimicrobial Resistance Surveillance and Management in Hospital and Community Settings - Issues for Human Population Medicine - Dr. Kurt Stevenson, The Ohio State University Medical Center, from the 2012 NIAA One Health Approach to Antimicrobial Resistance and Use Symposium, October 26-27, 2012, Columbus, OH, USA.
More presentations at:
http://www.trufflemedia.com/agmedia/conference/2012-one-health-to-approach-antimicrobial-resistance-and-use
This document is a dedication and acknowledgments section from a thesis. It dedicates the thesis to the author's family and thanks various individuals and institutions for their support and contributions to completing the work. It expresses gratitude to God, the author's parents, the thesis advisor, various doctors and laboratories, secretaries, statisticians, participating subjects, and the Faculty of Medicine for their help and assistance during the research and writing process.
This study investigated the nasopharyngeal microbiome of 45 Malawian children who carried Streptococcus pneumoniae. The microbiome was characterized using 16S rRNA gene sequencing. The results showed a shift in microbial diversity with HIV infection, with Moraxella and Streptococcus influencing diversity. Multiple carriage of pneumococcal serotypes did not significantly impact microbial diversity. The major limitation was that only pneumococcal carriers were studied. Further research on non-carriers is recommended to better understand implications on pneumococcal colonization.
This document discusses biomarkers in asthma and the 2020 Mexican consensus on fractional exhaled nitric oxide (FeNO) in asthma. It provides background on the population affected by asthma and the economic burden. Biomarkers can help identify asthma phenotypes and endotypes, guiding treatment. Fractional exhaled nitric oxide (FeNO) is a non-invasive marker of eosinophilic airway inflammation and can help monitor asthma control and response to treatment. The document reviews the use of FeNO and other biomarkers to identify inflammation phenotypes and optimize asthma management.
This document summarizes research on the interrelations between Caveolin-1 and heat shock proteins in cancer. It discusses previous studies that have linked Caveolin-1 with the heat shock protein response. Specifically, it mentions interactions found between beta-catenin, Hsp27, and Caveolin-1 in breast cancer tissues. The document also reports that loss of Caveolin-1 results in oxidative stress and activation of the heat shock protein response in cells. Finally, it summarizes that loss of Caveolin-1 decreases apoptosis in mammary tumors but also decreases the incidence of lung metastases, potentially due to lower levels of heat shock protein Hsp27.
Pearls in Allergy and Immunology, December 2013Juan Aldave
The purpose of this summary is exclusively educational, to provide practical updated knowledge for Allergy/Immunology Physicians. It does not intend to replace the clinical criteria of the physician.
- A study of 204 patients with delayed hypersensitivity to penicillins found that all patients tolerated drug challenges with carbapenems, suggesting an absence of cross-reactivity. Skin tests and graded challenges are still advised for patients needing carbapenems who experienced severe penicillin reactions.
- Anaphylaxis is an acute severe allergic reaction potentially fatal. Most common triggers are foods, drugs, insects. Factors influencing severity include pathogenic mechanism, allergen properties, dose, route of exposure, sensitization level.
This document discusses the development of models for predicting toxicity after radiotherapy for prostate cancer. Early models focused only on dosimetric variables but were limited. Later models incorporated clinical variables and improved predictions. Current research aims to include genetic and biomolecular factors to account for variability in individual radiosensitivity. While some models exist for acute and late rectal toxicity, validation and inclusion of additional variables is still needed. Future multifactorial models integrating dosimetric, clinical, and genetic data may enable more individualized risk assessments and isotoxic treatment planning.
This document summarizes a review article on the genetic, autoimmune, and environmental factors involved in rheumatoid arthritis (RA). It discusses how RA results from an interplay between these factors. Genetically, the HLA-DRB1 gene is a major determinant of RA risk. Over 30 non-MHC genes have also been associated with RA through genome-wide association studies and studies of specific populations, including STAT4, PADI4, and PTPN22. Environmental risks like smoking may interact with genetic susceptibility to increase RA risk. Understanding the roles of disease-associated genes and gene-environment interactions could lead to improved RA treatments and prevention strategies.
Bacterial Profile and Antimicrobial Resistance Pattern of Pus Isolates in Ben...Ahmed Elberry
This study analyzed bacterial culture data from pus samples collected from 2008-2014 at Beni-Suef University Hospital in Egypt to identify the prevalent bacteria and their antibiotic resistance patterns. Pseudomonas spp. was the most commonly isolated bacteria (20.9%), followed by MSSA (14.3%). Gram-negative bacteria like Pseudomonas spp., E. coli, and Klebsiella spp. showed high resistance to many antibiotics but lower resistance to imipenem, amikacin, and meropenem. MSSA was resistant to penicillin and erythromycin but sensitive to vancomycin. The results provide guidance for empiric antibiotic treatment of wound infections in the
PUBLICATIONS in International Scientific Journal1Sana Ceesay
This document lists 24 publications by researchers studying health factors in Gambian communities. The publications cover topics such as: cardiovascular risk factors like hypertension in rural and urban Gambia; the role of family history in hypertension, obesity, and diabetes; prevalence of non-communicable diseases nationwide in Gambia; effects of maternal dietary supplements on birthweight and mortality in Gambia; and assessment of energy expenditure and muscle glycogen using non-invasive techniques. Many of the publications involve collaboration between researchers in Gambia and the UK or other countries.
This document summarizes a study that used multilocus sequence typing (MLST) to analyze the evolutionary history and origins of major methicillin-resistant Staphylococcus aureus (MRSA) clones. The researchers analyzed 912 MRSA and methicillin-susceptible S. aureus isolates from 20 countries. They identified 11 major MRSA clones within 5 groups of related genotypes. Analysis of the methicillin resistance genes and the most parsimonious patterns of descent identified the likely ancestral genotype and MSSA progenitor of each major MRSA clone. Major MRSA clones have repeatedly emerged from successful epidemic MSSA strains through acquisition of the methicillin resistance gene. Isolates with decreased susceptibility to vancomycin,
Role of microorganisms in cancer treatmentHafiz M Waseem
This document summarizes research on the role of microorganisms in cancer treatment. It discusses how bacteria and their extracts/toxins have been used to treat cancer as far back as over 100 years ago. Specific bacteria like Mycobacterium bovis BCG and Salmonella enterica have shown effectiveness against cancers like bladder cancer. Their effectiveness is believed to be due to modulating the immune system and cytokines. Ongoing research continues to explore using bacteria and their biofilms and secretions to target and destroy cancer cells through mechanisms like inhibiting angiogenesis and metastasis.
Cervical cancer prevention current scenarioNilesh Kucha
Cervical cancer prevention requires a multi-pronged approach including screening, vaccination, and treatment. Screening begins at age 30 through pap smears or HPV testing every 5-10 years and helps detect pre-cancerous lesions early. HPV vaccination targets girls aged 9-13 and has shown nearly 100% efficacy against HPV types 16 and 18, which cause 70% of cervical cancers. Treatment of pre-cancerous lesions can prevent progression to invasive cancer. A comprehensive cervical cancer prevention program should include building healthcare infrastructure, increasing screening coverage, assessing impact, and conducting targeted education campaigns.
Epidemiology of antibacterial resistance in Eastern India: An analysisDiganta Dey
This study analyzed trends in antibiotic resistance in Eastern India over two time periods: July 2008-February 2009 and July 2015-September 2015. It found:
1) A marked increase in ESBL-producing bacteria, rising from 15% of E. coli and 21% of K. pneumoniae in 2008-2009 to 32% in community-acquired and 41% in hospital-acquired UTIs in 2015.
2) MRSA infections decreased from 52% in 2008-2009 to 25% in community settings and 37% in hospitals in 2015.
3) Alarmingly, resistance had risen for nearly all classes of antibiotics tested, with high rates of fluoroquinolone and carbapenem resistance observed even
This document provides an overview of drug hypersensitivity during anesthesia. It begins with a brief history of anesthesia practice dating back to ancient civilizations. It then defines anesthesia and introduces the topic of drug hypersensitivity during anesthesia. It discusses the epidemiology, risk factors, pathophysiology, clinical manifestations, diagnosis and treatment of drug hypersensitivity reactions that can occur during anesthesia. It also provides specific information on reactions to common anesthetic agents like neuromuscular blockers, opioids and benzodiazepines. The document includes a case report example and discusses special considerations for conditions like mastocytosis and the alpha-gal syndrome.
Dr. José Antonio Ortega Martell presented on allergic rhinitis (AR) and the role of intranasal corticosteroids (INS) in its treatment. AR is a common condition worldwide that can impair quality of life. While symptoms can be relieved by various medications, INS are the most effective treatment due to their ability to reduce inflammation and prevent exacerbations. INS work both acutely and prevent persistent minimal inflammation. Potential side effects are typically minor and can be reduced by proper administration. INS should be used as the preferred treatment for AR due to their efficacy and ability to alter the disease course over time.
This thesis investigated Tobacco streak virus (TSV), which was found to cause a previously unknown sunflower necrosis disorder in central Queensland, Australia. The research identified two distinct TSV strains (TSV-parthenium and TSV-crownbeard) through genetic characterization. Field studies showed parthenium and crownbeard weed species act as major symptomless hosts of the respective TSV strains. Both strains were found to be seed and thrips-transmitted. The research also evaluated sunflower hybrid tolerance to TSV and found seasonal disease variation correlated with rainfall. This work provides insights into the diversity, epidemiology and management of TSV in Australia.
This document provides summaries of several genetics studies:
1) A study identifies genetic variants in genes related to heat shock and hormone response pathways that influence flowering time in Arabidopsis thaliana under seasonal warming.
2) Research in mice finds that meiotic chromosome dynamics and recombination patterns are influenced by paternal age, though effective elimination of defective cells prevents errors from completing meiosis.
3) A paper revisits the "thrifty gene hypothesis" using data from 65 loci associated with type 2 diabetes susceptibility, finding some evidence of positive selection at a few loci but concluding that the current prevalence cannot be fully explained by this hypothesis.
This editorial summarizes recent research on oncolytic viruses for cancer therapy. It discusses how oncolytic viruses can directly kill tumor cells and induce immune responses. Clinical trials have explored various naturally occurring and engineered viruses to treat cancers like melanoma, hepatocellular carcinoma, and glioblastoma. Recent FDA approval of the first oncolytic virus therapy for melanoma marks progress in the field. However, many questions remain regarding optimal viruses, combinations, dosages and administration methods. The role of the immune system is complex, with barriers and opportunities to leverage. Future work is needed to address challenges and maximize the potential of this innovative cancer treatment approach.
This document summarizes research on the use of adeno-associated virus (AAV) as a vector for gene therapy. AAV is a promising delivery method due to its low immunogenicity, ability to target specific cell types, and lack of pathogenicity. The document discusses how AAV is being used experimentally to treat diseases like cystic fibrosis, cancer, and heart disease by delivering therapeutic genes. While challenges remain, AAV vectors appear safer than other methods and have the potential to treat many currently incurable diseases.
This article summarizes 9 research papers on gene and cell therapy approaches for treating cystic fibrosis. It provides brief summaries of the objectives, methods, and conclusions of each paper to give an overview of the current state of research on developing therapies for cystic fibrosis.
Romsat is a Ukrainian telecommunications company that has been operating for 15 years. It provides digital television and internet services across various technologies, including cable TV, satellite, terrestrial, and IPTV. It offers end-to-end solutions including network design, equipment installation and integration, content delivery, and long-term technical support. Romsat has many government and corporate customers in Ukraine.
A Revolução Industrial começou na Inglaterra no século 18 com a mecanização da produção, impulsionada por fatores como reservas de carvão e ferro, mão-de-obra barata e mercado consumidor em expansão. As condições de trabalho nas fábricas eram precárias e exploratórias, gerando reações dos trabalhadores como os movimentos ludistas e cartistas.
This document summarizes research on the interrelations between Caveolin-1 and heat shock proteins in cancer. It discusses previous studies that have linked Caveolin-1 with the heat shock protein response. Specifically, it mentions interactions found between beta-catenin, Hsp27, and Caveolin-1 in breast cancer tissues. The document also reports that loss of Caveolin-1 results in oxidative stress and activation of the heat shock protein response in cells. Finally, it summarizes that loss of Caveolin-1 decreases apoptosis in mammary tumors but also decreases the incidence of lung metastases, potentially due to lower levels of heat shock protein Hsp27.
Pearls in Allergy and Immunology, December 2013Juan Aldave
The purpose of this summary is exclusively educational, to provide practical updated knowledge for Allergy/Immunology Physicians. It does not intend to replace the clinical criteria of the physician.
- A study of 204 patients with delayed hypersensitivity to penicillins found that all patients tolerated drug challenges with carbapenems, suggesting an absence of cross-reactivity. Skin tests and graded challenges are still advised for patients needing carbapenems who experienced severe penicillin reactions.
- Anaphylaxis is an acute severe allergic reaction potentially fatal. Most common triggers are foods, drugs, insects. Factors influencing severity include pathogenic mechanism, allergen properties, dose, route of exposure, sensitization level.
This document discusses the development of models for predicting toxicity after radiotherapy for prostate cancer. Early models focused only on dosimetric variables but were limited. Later models incorporated clinical variables and improved predictions. Current research aims to include genetic and biomolecular factors to account for variability in individual radiosensitivity. While some models exist for acute and late rectal toxicity, validation and inclusion of additional variables is still needed. Future multifactorial models integrating dosimetric, clinical, and genetic data may enable more individualized risk assessments and isotoxic treatment planning.
This document summarizes a review article on the genetic, autoimmune, and environmental factors involved in rheumatoid arthritis (RA). It discusses how RA results from an interplay between these factors. Genetically, the HLA-DRB1 gene is a major determinant of RA risk. Over 30 non-MHC genes have also been associated with RA through genome-wide association studies and studies of specific populations, including STAT4, PADI4, and PTPN22. Environmental risks like smoking may interact with genetic susceptibility to increase RA risk. Understanding the roles of disease-associated genes and gene-environment interactions could lead to improved RA treatments and prevention strategies.
Bacterial Profile and Antimicrobial Resistance Pattern of Pus Isolates in Ben...Ahmed Elberry
This study analyzed bacterial culture data from pus samples collected from 2008-2014 at Beni-Suef University Hospital in Egypt to identify the prevalent bacteria and their antibiotic resistance patterns. Pseudomonas spp. was the most commonly isolated bacteria (20.9%), followed by MSSA (14.3%). Gram-negative bacteria like Pseudomonas spp., E. coli, and Klebsiella spp. showed high resistance to many antibiotics but lower resistance to imipenem, amikacin, and meropenem. MSSA was resistant to penicillin and erythromycin but sensitive to vancomycin. The results provide guidance for empiric antibiotic treatment of wound infections in the
PUBLICATIONS in International Scientific Journal1Sana Ceesay
This document lists 24 publications by researchers studying health factors in Gambian communities. The publications cover topics such as: cardiovascular risk factors like hypertension in rural and urban Gambia; the role of family history in hypertension, obesity, and diabetes; prevalence of non-communicable diseases nationwide in Gambia; effects of maternal dietary supplements on birthweight and mortality in Gambia; and assessment of energy expenditure and muscle glycogen using non-invasive techniques. Many of the publications involve collaboration between researchers in Gambia and the UK or other countries.
This document summarizes a study that used multilocus sequence typing (MLST) to analyze the evolutionary history and origins of major methicillin-resistant Staphylococcus aureus (MRSA) clones. The researchers analyzed 912 MRSA and methicillin-susceptible S. aureus isolates from 20 countries. They identified 11 major MRSA clones within 5 groups of related genotypes. Analysis of the methicillin resistance genes and the most parsimonious patterns of descent identified the likely ancestral genotype and MSSA progenitor of each major MRSA clone. Major MRSA clones have repeatedly emerged from successful epidemic MSSA strains through acquisition of the methicillin resistance gene. Isolates with decreased susceptibility to vancomycin,
Role of microorganisms in cancer treatmentHafiz M Waseem
This document summarizes research on the role of microorganisms in cancer treatment. It discusses how bacteria and their extracts/toxins have been used to treat cancer as far back as over 100 years ago. Specific bacteria like Mycobacterium bovis BCG and Salmonella enterica have shown effectiveness against cancers like bladder cancer. Their effectiveness is believed to be due to modulating the immune system and cytokines. Ongoing research continues to explore using bacteria and their biofilms and secretions to target and destroy cancer cells through mechanisms like inhibiting angiogenesis and metastasis.
Cervical cancer prevention current scenarioNilesh Kucha
Cervical cancer prevention requires a multi-pronged approach including screening, vaccination, and treatment. Screening begins at age 30 through pap smears or HPV testing every 5-10 years and helps detect pre-cancerous lesions early. HPV vaccination targets girls aged 9-13 and has shown nearly 100% efficacy against HPV types 16 and 18, which cause 70% of cervical cancers. Treatment of pre-cancerous lesions can prevent progression to invasive cancer. A comprehensive cervical cancer prevention program should include building healthcare infrastructure, increasing screening coverage, assessing impact, and conducting targeted education campaigns.
Epidemiology of antibacterial resistance in Eastern India: An analysisDiganta Dey
This study analyzed trends in antibiotic resistance in Eastern India over two time periods: July 2008-February 2009 and July 2015-September 2015. It found:
1) A marked increase in ESBL-producing bacteria, rising from 15% of E. coli and 21% of K. pneumoniae in 2008-2009 to 32% in community-acquired and 41% in hospital-acquired UTIs in 2015.
2) MRSA infections decreased from 52% in 2008-2009 to 25% in community settings and 37% in hospitals in 2015.
3) Alarmingly, resistance had risen for nearly all classes of antibiotics tested, with high rates of fluoroquinolone and carbapenem resistance observed even
This document provides an overview of drug hypersensitivity during anesthesia. It begins with a brief history of anesthesia practice dating back to ancient civilizations. It then defines anesthesia and introduces the topic of drug hypersensitivity during anesthesia. It discusses the epidemiology, risk factors, pathophysiology, clinical manifestations, diagnosis and treatment of drug hypersensitivity reactions that can occur during anesthesia. It also provides specific information on reactions to common anesthetic agents like neuromuscular blockers, opioids and benzodiazepines. The document includes a case report example and discusses special considerations for conditions like mastocytosis and the alpha-gal syndrome.
Dr. José Antonio Ortega Martell presented on allergic rhinitis (AR) and the role of intranasal corticosteroids (INS) in its treatment. AR is a common condition worldwide that can impair quality of life. While symptoms can be relieved by various medications, INS are the most effective treatment due to their ability to reduce inflammation and prevent exacerbations. INS work both acutely and prevent persistent minimal inflammation. Potential side effects are typically minor and can be reduced by proper administration. INS should be used as the preferred treatment for AR due to their efficacy and ability to alter the disease course over time.
This thesis investigated Tobacco streak virus (TSV), which was found to cause a previously unknown sunflower necrosis disorder in central Queensland, Australia. The research identified two distinct TSV strains (TSV-parthenium and TSV-crownbeard) through genetic characterization. Field studies showed parthenium and crownbeard weed species act as major symptomless hosts of the respective TSV strains. Both strains were found to be seed and thrips-transmitted. The research also evaluated sunflower hybrid tolerance to TSV and found seasonal disease variation correlated with rainfall. This work provides insights into the diversity, epidemiology and management of TSV in Australia.
This document provides summaries of several genetics studies:
1) A study identifies genetic variants in genes related to heat shock and hormone response pathways that influence flowering time in Arabidopsis thaliana under seasonal warming.
2) Research in mice finds that meiotic chromosome dynamics and recombination patterns are influenced by paternal age, though effective elimination of defective cells prevents errors from completing meiosis.
3) A paper revisits the "thrifty gene hypothesis" using data from 65 loci associated with type 2 diabetes susceptibility, finding some evidence of positive selection at a few loci but concluding that the current prevalence cannot be fully explained by this hypothesis.
This editorial summarizes recent research on oncolytic viruses for cancer therapy. It discusses how oncolytic viruses can directly kill tumor cells and induce immune responses. Clinical trials have explored various naturally occurring and engineered viruses to treat cancers like melanoma, hepatocellular carcinoma, and glioblastoma. Recent FDA approval of the first oncolytic virus therapy for melanoma marks progress in the field. However, many questions remain regarding optimal viruses, combinations, dosages and administration methods. The role of the immune system is complex, with barriers and opportunities to leverage. Future work is needed to address challenges and maximize the potential of this innovative cancer treatment approach.
This document summarizes research on the use of adeno-associated virus (AAV) as a vector for gene therapy. AAV is a promising delivery method due to its low immunogenicity, ability to target specific cell types, and lack of pathogenicity. The document discusses how AAV is being used experimentally to treat diseases like cystic fibrosis, cancer, and heart disease by delivering therapeutic genes. While challenges remain, AAV vectors appear safer than other methods and have the potential to treat many currently incurable diseases.
This article summarizes 9 research papers on gene and cell therapy approaches for treating cystic fibrosis. It provides brief summaries of the objectives, methods, and conclusions of each paper to give an overview of the current state of research on developing therapies for cystic fibrosis.
Romsat is a Ukrainian telecommunications company that has been operating for 15 years. It provides digital television and internet services across various technologies, including cable TV, satellite, terrestrial, and IPTV. It offers end-to-end solutions including network design, equipment installation and integration, content delivery, and long-term technical support. Romsat has many government and corporate customers in Ukraine.
A Revolução Industrial começou na Inglaterra no século 18 com a mecanização da produção, impulsionada por fatores como reservas de carvão e ferro, mão-de-obra barata e mercado consumidor em expansão. As condições de trabalho nas fábricas eram precárias e exploratórias, gerando reações dos trabalhadores como os movimentos ludistas e cartistas.
This document provides an overview of communication, including its definition, components, types, steps, factors affecting it, and barriers. Communication is defined as the mutual exchange of facts, thoughts, or emotions between a sender and receiver. The key components are the sender, message, medium, receiver, and feedback. Types of communication include speaking-listening, writing-reading, visualizing-observing, and doing-learning. The steps in communication are ideation, encoding, transmission, receiving, decoding, and responding. Factors like the sender's perception and the receiver's readiness can affect communication. Barriers include inaudibility, unfamiliar terms, facilities, language proficiency, environment, and speech speed.
Haiku Deck is a presentation tool that allows users to create Haiku style slideshows. The tool encourages users to get started making their own Haiku Deck presentations which can be shared on SlideShare. In just a few sentences, it pitches the idea of using Haiku Deck to easily create visual presentations.
O Haiti foi a primeira nação da América Latina a se tornar independente em 1804, após uma revolta de escravos liderada por Toussaint L'Ouverture. No entanto, a independência trouxe consequências negativas como dívidas externas e instabilidade política ao longo do século XIX. A família Duvalier instituiu uma ditadura brutal de 1957 a 1986 que empobreceu ainda mais o país.
Online collaboration allows groups to work together in real-time over the Internet on documents and presentations. It enables sharing of resources, ideas, and skills to achieve shared goals. Key features of online collaboration tools include easy setup, security, and functionality like whiteboards for brainstorming or document sharing. Video conferencing provides a video link between people, allowing meetings without travel. While reducing costs, it may not replace in-person discussions. Items needed include a computer, webcam, microphone, speakers and software like Skype.
O documento descreve os principais acontecimentos do Primeiro Reinado no Brasil (1822-1831):
1) Dom Pedro I teve que combater províncias contrárias à independência e controlá-las para legitimar o novo Império;
2) Foi convocada uma Assembleia Constituinte em 1823, mas Dom Pedro dissolveu-a por considerar o projeto constitucional muito liberal;
3) Uma nova Constituição foi outorgada por Dom Pedro em 1824, definindo o poder moderador exclusivo do Imperador.
O artigo descreve a experiência de um ex-escravo chamado Hipólito Xavier Ribeiro que testemunhou importantes eventos da história brasileira como a abolição da escravidão em 1888. No entanto, apesar da liberdade, os descendentes de escravos não conquistaram a cidadania de fato. As elites tentaram apagar o passado escravista e substituíram a discriminação institucionalizada no lugar da escravidão.
capitulo 1: Início da colonização
Capitulo 2: Estado e Religião
Capitulo 3: Economia colonial: açúcar
Capitulo 4: Escravidão e resistência
Capitulo 5 : Domínio Espanhol e Brasil Holandês
Capitulo 6: Expansão territorial da colônia
Capitulo 7: Economia colonial : Mineração
Abstract— Methicillin-resistant Staphylococcus aureus (MRSA) poses a great risk to burn patients with potential to cause significant morbidity and mortality. This study aimed to find out the prevalence of MRSA and its susceptibility, in burn wound infection/colonization in a Tertiary Care Hospital in North India. A retrospective study was conducted among patients admitted in burn ward of our hospital, between January to December 2012. All the patients irrespective of age, sex, duration of hospital stay, percentage and degree of burn were included in our study. Wound swabs from 1294 patients hospitalized in burn ward were analysed for bacteriological examination. Swabs were inoculated on Blood agar, MacConkey agar and Brain heart infusion broth. Isolates were examined for colony characteristics, Gram staining and biochemical tests. Antimicrobial susceptibility testing was done by modified Stokes disc diffusion method. Detection of MRSA was done by cefoxitin (30g) disc diffusion method. Among the Staphylococcus aureus (S.aureus) isolates, 56.7% (80/141) were found to be MRSA while 43.3% (61/141) were Methicillin Susceptible S.aureus (MSSA). All the MRSA isolates were resistant to penicillin, cephalexin and cefazolin. Resistance to erythromycin, clindamycin, ofloxacin, ciprofloxacin, gentamicin, amikacin, rifampicin, chloramphenicol was found to be 74%, 97.4%, 96%, 100%, 97.4%, 84.6%, 11.5%, 10.3%. All MRSA isolates were found to be sensitive to vancomycin and teicoplanin while 1.3% were resistant to linezolid. Although survival rates for burn patients have improved substantially over the years, nosocomial infections still remain a major challenge in burn care. This concludes that there is high prevalence of nosocomial infections specially the presence of multidrug resistant bacteria like Methicillin Resistant Staphylococcus aureus among burn patients suggest continuous surveillance of burn wound infections and development and stringent implementation of antibiotic policy.
This study evaluated the in vitro activity of tigecycline and other antibiotics against Enterobacteriaceae isolates exhibiting common resistance mechanisms in the US from 2006-2009. It found that 12.4% of isolates were multi-drug resistant, and 5-8% exhibited extended-spectrum beta-lactamase or AmpC production. In contrast to other agents, tigecycline maintained high activity against resistant subsets, with consistent MICs and >96% susceptibility regardless of phenotype. Against the rare imipenem-resistant isolates, tigecycline also retained potent activity at 100% susceptibility. The results support tigecycline as an important treatment option for infections involving resistant Enterobacteriaceae.
The document discusses the RTS,S/AS01 malaria vaccine candidate. It provides details on the development of RTS,S from initial designs incorporating the circumsporozoite protein to clinical trials demonstrating safety and efficacy. Phase 3 trials in African children showed RTS,S/AS01 reduced clinical malaria by approximately 50% and severe malaria by approximately 50% over 12 months. While the vaccine provided benefit, it also caused some adverse side effects and deaths. Ongoing research continues to improve vaccine design and development for a highly effective malaria vaccine.
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Emergencias oncológicas (Diplomado UniRemington) Parte 4/6Mauricio Lema
The document discusses oncological emergencies and focuses on hypercalcemia associated with cancer, febrile neutropenia, tumor lysis syndrome, and superior vena cava syndrome. It provides information on the definition, causes, clinical presentation, and treatment recommendations for these oncological emergencies. The timely administration of antibiotics is emphasized for febrile neutropenia, as delays can impact survival. Primary treatment with voriconazole is recommended for invasive pulmonary aspergillosis. Antibacterial and antifungal prophylaxis are only advised for patients expected to have very low neutrophil counts for over seven days.
Dr. Kurt Stevenson - Antimicrobial Resistance Surveillance and Management in ...John Blue
This document summarizes antimicrobial resistance surveillance in hospitals and communities. It discusses the increasing issues of antibiotic resistance over time, with predictions from 1966 that bacterial diseases would be eliminated by 2000 proving inaccurate. The document outlines various multidrug resistant organisms of concern, including MRSA, and the need to track resistance patterns and transmission. It presents a case study describing the identification of the ST-239 strain of MRSA in a surveillance program, which was previously uncommon in the US. Overall it emphasizes the growing challenges of antimicrobial resistance for treatment of infections.
Immergluck- Emory Antibiotic Resistance Center Seminar Poster 8-19-2015-Yun Li
This study aims to determine the prevalence and risk factors of MRSA carriage and infection in children with skin and soft tissue infections (SSTIs). The researchers conducted a prospective case-control study of children presenting to Atlanta hospitals with SSTIs. They found that a history of antibiotic use and previous MRSA SSTIs were associated with MRSA carriage and infection. Children with abscess SSTIs were more likely to be colonized with MRSA USA300 strain than other SSTI types. Recurrence risk was higher for MRSA USA300 SSTI cases. Certain MRSA USA300 virulence genes like lukS/F-PV, agr and bsaB may contribute to carriage and SSTI
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This document discusses several key issues related to the novel A(H1N1) influenza virus pandemic:
1) It proposes new WHO phases for classifying the pandemic that focus on sustained human-to-human transmission.
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1) Rates of invasive disease caused by penicillin-nonsusceptible and multidrug-resistant strains decreased significantly in children under 2 years old and adults over 65.
2) Rates of resistant disease caused by the vaccine serotypes fell sharply.
3) There was an increase in disease caused by non-vaccine serotype 19A.
1) The study tested the effects of increasing concentrations of the antibiotic kanamycin on the bacteria Serratia marcescens.
2) Using a disk diffusion method, the study found that higher concentrations of kanamycin resulted in larger zones of inhibition, indicating greater effectiveness at killing the bacteria.
3) Statistical analysis revealed a strong positive correlation between kanamycin concentration and zone of inhibition, supporting the hypothesis that increased concentrations are more effective against S. marcescens.
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This document summarizes a study on multidrug resistant organisms and their antibiotic resistance patterns among intensive care unit patients in Surat City, India. The study found that Pseudomonas aeruginosa and Klebsiella species were the most common causes of healthcare-associated infections. It also found high resistance of these organisms to cephalosporins but that amikacin and imipenem were the most effective antibiotics. Regular monitoring of resistance patterns was deemed important for guiding empirical treatment of infections in ICU patients.
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characterization of FQ Non-susceptible S. Pyogenescamilomesa22
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Prevalence and Antimicrobial Susceptibility of Methicillin Resistant StaphJoshua Owolabi
This document summarizes a study on the prevalence and antimicrobial susceptibility of methicillin resistant Staphylococcus aureus (MRSA) and coagulase-negative Staphylococci (CoNS) isolated from healthy university students in Nigeria. Swabs were collected from the noses and necks of 100 students. A total of 39 Staphylococcus species were identified, including MRSA and MRCoNS. The MRSA strains showed high resistance to methicillin and several other antibiotics. CoNS also demonstrated moderate to high resistance to several antibiotics tested. This highlights the need for surveillance of antibiotic resistance in the community and policies to prevent the spread of resistant infections.
ICN Victoria presents Professor Oliver Cornely, Professor of Internal Medicine and Director for Clinical Trials at University Hospital, Cologne, Germany. His research interests include invasive fungal diseases in haematology/oncology and in the ICU setting. Dr Cornely is also a clinical infectious diseases consultant at the University Hospital of Cologne.
Professor Cornely gives an entertaining talk on the pervasiveness, invasiveness, diagnosis and treatment of fungal infections in ICU patients.
NZ2114 is a novel antibiotic derived from plectasin that is active against Gram-positive pathogens including resistant strains. Testing showed NZ2114 had minimum bactericidal concentration to minimum inhibitory concentration ratios of ≤2 against staphylococci and streptococci, indicating bactericidal activity regardless of resistance. Time-kill kinetics demonstrated rapid bactericidal activity of NZ2114 within 2-6 hours at concentrations of 2-4 times the MIC against staphylococci including MRSA and VISA, and at concentrations of 2-4 times the MIC against streptococci within 1 hour. These results highlight NZ2114's potential as a treatment for Gram-positive infections.
ICAAC2008-nz2114 GP cocci F1-3962 v4.PPTVenkat Alluru
NZ2114 is a novel antimicrobial being developed to treat infections caused by Gram-positive cocci. It was tested against staphylococcal and streptococcal isolates, including resistant strains. NZ2114 demonstrated potent activity against these pathogens, with MIC50/90 generally unaffected by resistance to oxacillin, penicillin, macrolides, vancomycin, linezolid, or daptomycin. These results support the potential use of NZ2114 for treating infections where resistant staphylococci and streptococci are commonly present.
CXA-101 is a new cephalosporin antibiotic under development that has potent in vitro activity against Pseudomonas aeruginosa. This study evaluated the effect of various testing conditions on the antimicrobial activity of CXA-101 against representative pathogens. Results showed that changes in pH, inoculum size, serum concentration, divalent cations, and testing media had little effect on CXA-101 activity, with some exceptions of lower MICs against single isolates under some conditions. Overall, CXA-101 maintained consistent antimicrobial activity against pathogens under different in vitro test parameters.
CXA-101 is a novel parenteral cephalosporin that demonstrated potent in vitro activity against Pseudomonas aeruginosa and other gram-negative pathogens based on broth microdilution testing of over 1000 clinical isolates. It showed excellent activity against P. aeruginosa, including many ceftazidime-resistant strains, with an MIC50/90 of 1/2 μg/mL. CXA-101 also displayed good activity against Enterobacteriaceae, Haemophilus influenzae, Moraxella catarrhalis, and Streptococcus pneumoniae comparable to ceftazidime and cefepime. Broth microdilution results correlated well with agar dilution for 90% of isolates tested. CXA
CXA-101 is a novel parenteral cephalosporin under development as monotherapy and in combination with tazobactam. This study evaluated disk diffusion testing of CXA-101 and CXA-101/tazobactam against 64 bacterial isolates. Results showed CXA-101 was potent against P. aeruginosa, including resistant isolates, but less active against S. aureus and beta-lactam resistant Enterobacteriaceae. CXA-101/tazobactam improved activity against ESBL producers. Disk diffusion results correlated well with broth microdilution MICs, indicating the evaluated disk masses are suitable for susceptibility testing of CXA-101 and CXA-101/tazobactam against
CXA-101 is a novel cephalosporin antibiotic being studied for the treatment of serious bacterial infections. This study evaluated the in vitro activity of CXA-101 alone and in combination with tazobactam against various Gram-positive and Gram-negative pathogens. CXA-101 showed potent activity against Pseudomonas aeruginosa, including drug-resistant strains. When combined with tazobactam, CXA-101 demonstrated enhanced activity against extended-spectrum beta-lactamase producing Escherichia coli and Klebsiella pneumoniae. Overall, CXA-101 alone or with tazobactam was more active than ceftazidime against several pathogens, indicating potential clinical benefit
1. Resistance Trends among Gram-Positive Cocci across the US and the Activity Profile of Tigecycline against
Resistant Isolates
Background: Due to the prevalence of methicillin
resistant S. aureus (MRSA); vancomycin resistant
enterococci (VRE); and penicillin resistant S. pneu-
moniae (PRSP), agents used to treat gram-positive
infections should maintain activity against these re-
sistant subpopulations. Data from The Surveillance
Network (TSN) were reviewed for rates of MRSA,
VRE and PRSP in the US over the past 10 years.
The impact of resistance on the activity of tigecy-
cline (TIG), used to treat infections where resistant
gram-positives are commonly encountered, was de-
termined.
Methods: Resistant rates were evaluated using data
from TSN, a database of test results from >150 US
hospitals. Also, recent (‘06-‘09) US clinical isolates
of S. aureus (n=4,158), vancomycin susceptible E.
faecalis (VSE; n=256), S. pneumoniae (n=658) and
S. pyogenes (n=741) were centrally tested by broth
microdilution (CLSI; M7-A8) against TIG. TSN
data were used to evaluate TIG MICs for VRE.
Results: MRSA rates increased from 32-53% dur-
ing ’98-‘08. VRE rates increased (E. faecium: 68-
77%; E. faecalis 2.6-3.8%) over this period while
PRSP rates and macrolide resistance among S. pyo-
genes fluctuated between 16-22% and 8-11%, re-
spectively. Regionally, there was a trend towards
higher rates in the South Atlantic and Mid Atlantic
regions and lower rates in the Pacific and Mountain
regions. TIG had MIC50/MIC90s (g/ml) for MRSA
(0.12/0.25), PRSP (0.015/0.03), and macrolide re-
sistant S. pyogenes (0.03/0.06) identical or within 1
doubling dilution compared with the susceptible
subpopulations. The susceptibility rate for TIG for
S. aureus, S. pnuemoniae, and S. pyogenes was
>99.7%. 87.9% of VSE were susceptible to TIG
with an MIC90 of 0.5 g/ml. For VRE, TIG activity
was similar to VSE based on MIC distributions.
Conclusion: Resistant gram-positive organisms are
common, MRSA and VRE rates have increased in
the US in the past 10 years and rates varied region-
ally. TIG maintained its activity profile for these re-
sistant subpopulations showing that current resis-
tance commonly encountered among target GP has
no impact on its in vitro activity.
Mohana K. Torres1
, Deborah C. Draghi1
, Karla Tomfohrde1
, Chris M. Pillar1
, Venkat Alluru1
, Michael J. Dowzicky2
, Daniel F. Sahm1
1
Eurofins Medinet, Chantilly, VA, USA
2
Wyeth Pharmaceuticals, Collegeville, PA, USA
Poster No. C2-1957
Contact Information:
Chris M. Pillar, Ph.D.
Eurofins Medinet
14100 Park Meadow Drive
Chantilly, VA, USA 20151
Tel. 1.703.480.2500
ResultsIntroductionRevised Abstract
Methods
Conclusions
This study was supported by a grant from Wyeth Pharmaceuticals.
Resistance among frequently encountered gram-positive
pathogens continues to be an issue across the US, given the
prevalence of methicillin resistant S. aureus (MRSA), penicil-
lin and multi-drug resistant S. pneumoniae (PRSP, MDRSP),
and vancomycin resistant enterococci (VRE). Tigecycline, a
broad spectrum glycylcycline, is approved for use in the treat-
ment of complicated skin and skin structure infections
(cSSSIs) and community-acquired pneumoniae (CAP) and,
given these indications, it is important to understand tigecy-
cline activity against resistant subpopulations of gram-positive
organisms likely to be encountered with cSSSIs and CAP.
This study evaluates the prevalence of resistance among gram-
positive cocci both across the US and regionally over the past
10 years and reports the current activity profile of tigecycline
against both resistant and susceptible populations of recent
clinical isolates of gram-positive cocci.
Current resistance rates were evaluated using data from The
Surveillance Network®
(TSN), an electronic database of test re-
sults from >150 US hospitals. Also, recent (2006-2009) US
clinical isolates of S. aureus (n=4,158), vancomycin susceptible
E. faecalis (n=256), S. pneumoniae (n=658) and S. pyogenes
(n=741) were collected from 176 hospitals across the nine US
Census Regions (table) and centrally tested at Eurofins Medi-
net by broth microdilution (CLSI M7-A8; CLSI M100-S18)
against tigecycline. Tigecycline activity against gram-positive
cocci from surveillance studies were analyzed by relevant resis-
tance phenotypes. TSN data were used to evaluate tigecycline
MICs for vancomycin resistant enterococci (VRE). Multi-drug
resistant S. pneumoniae (MDRSP) was defined as resistant to
≥2 of the following agents: penicillin, cefuroxime, erythromy-
cin, tetracycline, and
trimethoprim-
sulfamethoxazole. Tigecy-
cline FDA breakpoints were
used to interpret data. S.
aureus with MICs ≤0.5 µg/
mL, S. pneumoniae ≤0.06 µg/
mL, S. pyogenes ≤0.25 µg/
mL, and E. faecalis
(vancomycin susceptible
only) ≤0.25 µg/mL were in-
terpreted as susceptible.
Acknowledgments
Resistance among gram-positive cocci is common in the US with a
large increase in the amount of MRSA over the past decade.
There is variation in the rates of resistance regionally with a general
trend towards increased resistance in the south and south eastern US
relative to other areas, with lower resistance in the western US, in par-
ticular for PRSP and MRSA.
Tigecycline maintains the same activity profile against the evaluated re-
sistant subpopulations of gram-positive cocci (MRSA, PRSP, VRE and
macrolide-resistant S. pyogenes) relative to the respective susceptible
subpopulations.
Due to its broad-spectrum of activity which includes resistant gram-
positive cocci, tigecycline is a valuable therapeutic option for the treat-
ment of cSSSI and CAP, infections where resistant gram-positive iso-
lates are likely to be encountered.
Streptococci
Resistance to penicillin among S. pnuemoniae (PRSP; based on oral penicillin breakpoints) has ranged from between 15-22% over a ten
year period in the US (Table 1). Current prevalence of PRSP vary by region from 11% in the Pacific and New England regions to 20-
25% in the West South Central and South Atlantic regions (Figure 1b).
Tigecycline maintained similar activity profiles against PRSP and MDRSP (MIC50/MIC90 = 0.015/0.03 g/ml, 100%S) relative to PSSP
and non-MDRSP isolates (Table 2). Similar tigecycline MIC distributions were observed between susceptible and resistant S. pneumo-
niae subpopulations (Figure 2b).
Macrolide resistance among S. pyogenes was 11% in the US overall with variation in rates by region (Figure 1c).
All evaluated S. pyogenes were susceptible to tigecycline, and there was no variation in activity based on macrolide resistance either by
MIC50/MIC90 (0.03/0.06 g/ml; Table 2) or MIC distribution (Figure 2c).
Enterococci
Among enterococci, resistance to vancomycin was species dependent, with high resistance rates for E. faecium (77%) relative to E. fae-
calis (4%) currently in the US (Table 1). These rates show an increase in resistance relative to that observed 10 years ago (68% for E.
faecium, 3% for E. faecalis; Table 1).
Regionally, there tended to be higher rates of VRE in the midwest and eastern regions relative to other regions in the US, with
the largest increases in resistance over the past 10 year period observed in the East South Central and South Atlantic regions
(Table 1, Figure 1d).
Against vancomycin susceptible population of E. faecalis, for which tigecycline is indicated, an MIC50/MIC90 of 0.12/0.5 g/
ml and 88% susceptibility rate was observed (Table 2). Results reported from TSN show that TIG has a similar MIC distri-
bution against both vancomycin susceptible and resistant populations of E. faecalis and E. faecium (Figure 2d).
S. aureus
Overall, the prevalence of MRSA in the US rose from 32% in 1998 to 53% in
2008 (Table 1). There was variation in MRSA rates by region, with rates <50%
in the western and northeast regions of the US and higher rates (>60%) in the
south and southeast regions (Figure 1a).
Tigecycline activity against S. aureus was identical by MIC50/MIC90 (0.12/0.25
g/ml; Table 2) and by MIC distribution (Figure 2a) against MRSA and MSSA
subpopulations. Both MSSA and MRSA were >99.8% susceptible to tigecycline.
Source % overall
Lower respiratory tract 15.9
Upper respiratory tract 14.8
Urine 5.0
Blood 13.6
Skin/Wound 47.3
Other 3.4
Region
East North Central 17.7
East Sout Central 9.5
Mid Atlantic 11.7
Mountain 10.4
New England 6.2
Pacific 11.3
South Atlantic 12.2
West North Central 11.4
West South Central 9.6
Strain Diversity from '06-'09 Clinical Isolates
Figure 2. MIC distribution of tigecycline by resistance phenotype
a. S. aureus b. S. pneumoniae
MSSA/ MRSA, methicillin susceptible/ resistant S. aureus PSSP/ PRSP, penicillin susceptible/ resistant S. pneumoniae ; MDR, multi-drug resistant
c. S. pyogenes d. Enterococci from TSN database (2006-2008)
Ery S/ Ery R, erythromycin sysceptible/ resistant VSEfc/ VREfc, vancomycin susceptible/ resistant E. faecalis; VSEfm/ VREfm, vancymycin susceptible/ resistant E. faecium
FDA MIC breakpoints for vancomycin susceptible E. faecalis were used for interpretation
0
10
20
30
40
50
60
≤0.008 0.015 0.03 0.06 0.12 0.25 0.5 1 2 4
MIC (g/mL)
%ofisolatesatMIC
MSSA
MRSA
S NS
0
10
20
30
40
50
60
70
80
≤0.008 0.015 0.03 0.06 0.12 0.25 0.5 1 2 4
MIC (g/mL)
%ofisolatesatMIC
Ery S
Ery R
S NS
0
10
20
30
40
50
60
70
80
90
100
≤0.12 0.25 0.5 1 2 4 >4
MIC (g/mL)
%ofisolatesatMIC
VSEfc
VREfc
VSEfm
VREfm
S NS
0
10
20
30
40
50
60
70
80
90
≤0.008 0.015 0.03 0.06 0.12 0.25 0.5 1 2 4
MIC (g/mL)
%ofisolatesatMIC
PSSP
PRSP
non-MDR
MDR
S NS
Table 2. Tigecycline activity by resistance
phenotypes (2006-2009)
Figure 1. TSN resistance rates in 2008
a. MRSA b. PRSP (in 2007*) c. EryR SPY (in 2006-2008*) d. VREfc / VREfm
MRSA, methicillin resistant S. aureus PRSP, penicillin resistant S. pneumoniae EryR SPY, erythromycin resistant S. pyogenes VREfc/ VREfm, vancomycin resistant E. faecalis / E. faecium
*Data from 2007 interpreted using oral penicillin breakpoints *Due to low reporting, resistance rates determined from 2006-2008
DC
50-59.9%
≤ 40-49.9% R
60% R
43.3%
N=43,538
59.6%
N=11,841
53.1%
N=11,636
62.2%
N=21,521
51.4%
N=17,736
68.8%
N=3,422
58.3%
N=48,621
48.6%
N=25,161
44.3%
N=8,476
DC
15-19.9%
≤ 10-14.9% R
20% R
10.7%
N=1,233
15.5%
N=536
18.0%
N=1,099
20.2%
N=1,284
18.6%
N=908
14.6%
N=233
24.0%
N=1,720
17.8%
N=843
11.0%
N=547
DC
10-14.9%
≤ 5-9.9% R
15% R
11.4%
N=438
9.6%
N=94
13.7%
N=190
17.2%
N=203
7.7%
N=273
9.2%
N=76
15.2%
N=1,272
8.2%
N=608
13.7%
N=612
DC
VREfc: 2.5%, N=4,525
VREfm: 73.4%, N=1,548
VREfc: 1.1%, N=2,884
VREfm: 52.8%, N=430
VREfc: 4.0%, N=1,803
VREfm: 62.2%, N=635
VREfc: 2.0%, N=3,200
VREfm: 79.3%,
N=1,547
VREfc: 9.0%, N=3,730
VREfm: 77.8%, N=1,530
VREfc: 2.2%, N=770
VREfm: 65.5%, N=174
VREfc: 3.3%, N=6,090
VREfm: 81.8%, N=3,372
VREfc: 4.5%, N=3,234
VREfm: 79.8%, N=1,551
VREfc: 4.3%, N=1,288
VREfm: 74.0%, N=308
Table 1. Resistance trends by year and US Census Region
US Census Region 1998 2001 2004 2008 2008-1998 1998 2001 2004 2007* 2007-1998 1998 2001 2004 2008 2008-1998 1998 2001 2004 2008 2008-1998 1998 2001 2004 2008 2008-1998
Overall 32.4 42.9 52.3 52.7 20.3 16.4 22.0 15.5 17.8 1.4 9.3 7.5 10.6 11.0 1.7 2.6 2.9 3.4 3.8 1.2 67.7 71.2 70.1 76.8 9.1
East North Central 34.7 41.6 49.5 51.4 16.7 13.1 18.0 16.6 18.6 5.5 3.2 5.8 6.9 7.1 3.9 4.1 6.0 7.6 9.0 4.9 73.4 80.4 82.0 77.8 4.4
East South Central 46.9 48.5 62.8 68.8 21.9 19.6 27.3 13.9 14.6 -5.0 –
a
– 12.7 – ND 0.9 2.2 4.5 – – ND 31.0 81.7 68.8 65.5 34.5
Mid Atlantic 35 41.9 45.8 48.6 13.6 13.9 18.6 12.4 17.8 3.9 – 10.3 8.8 6.9 ND 4.7 3.7 4.1 4.5 -0.2 76.1 73.4 68.6 79.8 3.7
Mountain 28.9 37 51.1 59.6 30.7 16.1 15.3 10.7 15.5 -0.6 – – 1.6 – ND 1.3 1.5 2.7 1.1 -0.2 71.8 69.7 62.3 52.8 -19.0
New England 21.6 38.4 43.2 44.3 22.7 7.0 30.8 9.9 11.0 4.0 – – – 18.4 ND – – 0.6 – – 4.3 ND – – 62.4 – – 74.0 ND
Pacific 22.6 31 46.2 43.3 20.7 16.4 17.9 14.9 10.7 -5.7 14.4 11.5 10.2 3.8 -10.6 2.1 0.6 1.6 2.5 0.4 74.9 52.0 53.1 73.4 -1.5
South Atlantic 40.2 53.4 56.8 58.3 18.1 20.2 26.8 19.8 24.0 3.8 11.3 3.6 15.8 13.3 2.0 1.6 2.9 2.4 3.3 1.7 55.2 72.0 70.1 81.8 26.6
West North Central 37 42.5 49.7 53.1 16.1 12.2 21.3 14.2 18.0 5.8 – 7.9 6.9 – ND 0.8 1.2 1.4 4.0 3.2 64.9 65.7 68.7 62.2 -2.7
West South Central 29.3 43.1 59.4 62.2 32.9 18.4 26.7 17.1 20.2 1.8 5.5 5.2 13.6 12.1 6.6 3.4 1.5 1.1 2.0 -1.4 66.3 69.6 70.5 79.3 13.0
*2008 data excluded due to reporting on non-meningitis isolates with both parenteral and oral breakpoints during that year
a
Single dashed line (–) indicates that < 50 results were reported; double dashed line (– –) indicates that <100 results were reported
ND - not determined
%R
VREfmMRSA VREfcPRSP EryR SPY
Organism Phenotype
a
Total n Mode MIC5 0 MIC90 (%S) (%I) (%R)
S. aureus MSSA 1,552 0.12 0.12 0.25 (99.9) (0.0) (0.1)
MRSA 2,606 0.12 0.12 0.25 (99.8) (0.0) (0.2)
S. pneumoniae PSSP* 479 0.015 0.015 0.03 (99.6) (0.0) (0.0)
PRSP 56 0.015 0.015 0.03 (100.0) (0.0) (0.0)
non-MDR 555 0.015 0.015 0.03 (99.6) (0.0) (0.0)
MDR 103 0.015 0.015 0.03 (100.0) (0.0) (0.0)
S. pyogenes Ery S 645 0.03 0.03 0.06 (100.0) (0.0) (0.0)
Ery R 96 0.03 0.03 0.06 (100.0) (0.0) (0.0)
E. faecalis VSE 256 0.12 0.12 0.5 (87.9) (0.0) (0.0)
MDR, multi-drug resistant; Ery S/ Ery R, erythromycin susceptible/ resistant; VSE, vancomycin susceptible E. faecalis
*Penicillin (oral penicillin V) CLSI MIC interpretive standard used
MIC (µg/mL)
a
MSSA/ MRSA, methicillin susceptible/ resistant S. aureus ; PSSP/ PRSP, penicillin susceptible/ resistant S.