Acute bacterial prostatitis after transrectal prostate needle biopsy: clinical analysis

We investigated the incidence and characteristics of acute bacterial prostatitis after transrectal prostate biopsy, based on urine and blood cultures, treatment method, and outcome. Four hundred and fifty-seven patients who underwent transrectal prostate biopsy in our hospital between November 2003 and October 2006 were reviewed. These patients were treated with 200 mg levofloxacin orally twice daily for 4 days, beginning 12 h before biopsy, and with 200 mg isepamicin sulfate given intravenously just before the biopsy. In patients who developed acute prostatitis urine and blood cultures were checked. All organisms isolated in urine or blood cultures were tested for antibiotic susceptibility of the 457 patients, first-biopsy was performed in 371 and re-biopsy was done in 86. Acute bacterial prostatitis developed in 6 patients (1.3%). Acute prostatitis developed after a first-biopsy in 2 patients (0.5%) and after re-biopsy in 4 patients (4.7%), showing a significant difference. All of the urine and blood cultures yielded levofloxacin-resistant Escherichia coli. Immediate intravenous cephalosporin or carbapenem was effective for all of these patients. We concluded that the use of levofloxacin could be a risk factor for acute bacterial prostatitis after transrectal prostate biopsy, due to an increase in fluoroquinolone-resistant E. coli in the rectum. The incidence of prostatitis was higher in re-biopsy patients. We consider that patients should receive levofloxacin for a shorter period before biopsy to avoid generating fluoroquinolone-resistant strains. Treatment with cephalosporin or carbapenem is recommended for patients with acute prostatitis after prostate biopsy.     

Ocular infections caused by non-tuberculous mycobacteria: update on epidemiology and management

Background: To provide an update on the frequency, distribution, risk factors and in vitro susceptibility of ocular infections caused by non‐tuberculous mycobacteria. Design: Retrospective study of university clinic patients. Participants: One hundred thirty‐nine patients with culture confirmed non‐tuberculous mycobacteria infections seen at Bascom Palmer Eye Institute from January 1980 to July 2007. Methods: Chart review of data collected included patients' demographics, risk factors, microbiological profiles and clinical outcomes. Main Outcome Measures: Frequency, distribution, risk factors and in vitro susceptibility of ocular infections caused by non‐tuberculous mycobacteria. Results: A total of 183 non‐tuberculous mycobacteria isolates from 142 eyes were identified, with a fourfold increase in the number of eyes infected with non‐tuberculous mycobacteria from 1980–1989 (13.4%) to 2000–2007 (56.3%). Eighty‐three percent of non‐tuberculous mycobacteria isolates were identified as M. abscessus/chelonae. The majority (91%) of isolates were recovered within 10 days. Common diagnoses included keratitis (36.6%), scleral buckle infections (14.8%) and socket/implant infections (14.8%). Identifiable risk factors were presence of biomaterials (63.1%), ocular surgery (24.1%) and steroid exposure (77%). The median time from diagnosis of culture positive non‐tuberculous mycobacteria infection to resolution was 13 to 24 weeks. Combination therapy was used to treat 80% of infected eyes. In vitro susceptibility of non‐tuberculous mycobacteria isolates were: amikacin, 81%; clarithromycin, 93%; and moxifloxacin, 21%. Conclusions: The incidence of ocular infections caused by non‐tuberculous mycobacteria has increased within the last 8 years, with a high number of biomaterial associated infections among this group. Clinical diagnosis and microbiological confirmation of non‐tuberculous mycobacteria infections remains challenging. Patient outcomes may be improved by early diagnosis, appropriate therapy and removal of biomaterials.     

Magnetic resonance imaging may be an asset to diagnose and classify fluoroquinolone-associated Achilles tendinitis

Summary— The aim of this study was to document the accuracy of magnetic resonance imaging (MRI) during fluoroquinolone- associated Achilles tendinitis. Fourteen Achilles tendons were examined by MRI (T1 and T2 or T2*-weighted sequences) in nine patients with typical tendinopathy (13 cases of tendinitis and 1 rupture) during fluoroquinolone therapy. Tendinous involvement was classified according to the prominence of intra- or peritendinous changes. The most typical feature was the presence of intratendinous changes, longitudinal or transversal, detected on T1 or T2-weighted sequences. Peritendinitis was most visible in two cases and nodular involvement in three cases. It was concluded that MRI appears a helpful and accurate method in identifying and classifying such iatrogenic tendinitis. In addition, MRI indicates orthopedic management when detecting risk of rupture.     

氟喹诺酮类药物氟含量测定方法比较

用药典比色法和络合滴定法对几个氟喹诺酮类药物氟含量的测定作了比较，认为滴定法优于比色法，因其称样量小，含氟０．４～２ｍｇ时精度可达±０．３％。     

The Intestinal Transport Mechanism of Fluoroquinolones: Inhibitory Effect of Ciprofloxacin,an Enoxacin Derivative,on the Membrane Potential-Dependent Uptake of Enoxacin

Purpose. To clarify the absorption-structure relationship for the fluoroquinolones from the point of view of inhibitory behavior. Methods. The inhibitory effects of ciprofloxacin on the transport process of enoxacin across the rat intestinal brush-border membrane was examined. Results. Ciprofloxacin, which has a similar structure to enoxacin, exhibited a pH-dependent interference with enoxacin absorption from rat jejunal loops. The uptake experiments using BBM vesicles showed that ciprofloxacin significantly reduced not only the initial binding of enoxacin to the membrane surface, but also the K ⁺ - or H⁺-diffusion potential-dependent transport across the membrane. Furthermore, an H ⁺-diffusion potential (interior negative) also exhibited a stimulative uptake of ciprofloxacin. Conclusions. These results suggest that the inhibition behavior of ciprofloxacin from the jejunal loop was closely related to the ionic diffusion potential-dependent uptake of enoxacin across the brush-border membrane.     

刃天青显色法测定氟喹诺酮对结核杆菌的最小抑菌浓度

目的：用刃天青显色法快速测定4种氟喹诺酮对结核分枝杆菌的最小抑菌浓度（MIC）,探讨不同氟喹诺酮对结核分枝杆菌的作用和可能的交叉耐药性。方法：用65株对氧氟沙星敏感的菌株（包括42株MDR-TB）和60株氧氟沙星耐药的菌株为试验菌株,在96孔酶标板中,用Middle brook 7H9液体培养基将药物进行连续对倍稀释后,加入一定浓度菌液,用显色法测定MIC。结果：氧氟沙星通过ROC曲线分析所确定的折点浓度为2μg/ml,敏感度为98.3%,特异度为96.9%,准确度为97.6%。加替沙星和莫西沙星对结核分枝杆菌的MIC50和MIC90比氧氟沙星、环丙沙星要低4～8倍,具有比氧氟沙星和环丙沙星更好的抗结核分枝杆菌活性。结论：新一代氟喹诺酮加替沙星和莫西沙星具有比第3代氟喹诺酮氧氟沙星和环丙沙星更低的MIC,更好的抗菌活性,有可能用于低度氧氟沙星耐药MDR-TB的治疗。     

Seropositivity of human herpesvirus-8 in patients with uveitis

Purpose: To explore the role of human herpesvirus-8 (HHV-8) in the pathogenesis of uveitis and other forms of ocular inflammation. Methods: Serum antibody titers to HHV-8 were measured in 76 patients with uveitis from various causes and other types of ocular inflammation in either the acute phase, the convalescent phase, or both. Results: Only one 21-year-old male patient in the convalescent phase of unilateral pars planitis showed a positive titer for HHV-8. His serum was negative for human immunodeficiency virus-1. Conclusions: Although the seropositive rate in the patient population was higher than that in the general population, the increased incidence was not statistically significant. The role of HHV-8 in the pathogenesis of intraocular inflammation appears to be limited.     

Prevalence and natural history of colonization with fluoroquinolone-resistant gram-negative bacilli in community-dwelling people with spinal cord dysfunction

OBJECTIVES: To estimate the prevalence of colonization with fluoroquinolone-resistant gram-negative bacilli (GNB) and to assess risk factors for and define the natural history of colonization. DESIGN: Cross-sectional study with follow-up of up to 1 year. SETTING: Multiple outpatient sites. PARTICIPANTS: Eighty-four community-dwelling adults with spinal cord dysfunction. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Colonization of perineum with fluoroquinolone-resistant GNB. RESULTS: Overall, 24% of this community-dwelling cohort was colonized with fluoroquinolone-resistant GNB with resistance to both levofloxacin and gatifloxacin. The use of any antibiotic in the last 90 days was most strongly associated with an increased risk of colonization with fluoroquinolone-resistant GNB (relative risk, 2.3; 95% confidence interval, 1.1-4.8; P=.05). Incontinence was significantly more common among those with fluoroquinolone-resistant GNB colonization. Among the participants with incontinence (n=42), the use of intermittent catheterization (vs suprapubic, urethral, or condom catheters or overflow incontinence) was significantly protective. Colonization was not associated with an increase in urinary tract infection and was often transient. CONCLUSIONS: Fluoroquinolone resistance among GNB colonizing community-dwelling people with spinal cord dysfunction is common. Colonization is more common among those receiving antibiotics and less common among those continent of urine. Among those with incontinence, those using intermittent catheterization have less colonization.     

Evolution of fluoroquinolone resistance among Escherichia coli urinary tract isolates from a French university hospital: application of the dynamic regression model

Escherichia coli urinary tract isolates were collected in 1997-2003 from Nimes University Hospital in order to investigate long-term trends in antibiotic resistance and to explore the relationship between antibiotic use and the emergence of resistance. Time-series analysis (ARIMA models) and dynamic regression models were used to investigate relationships between antibiotic use and resistance to ofloxacin and ciprofloxacin. Significant increases were seen in the frequency of ofloxacin (8.9 to 16.7%) and ciprofloxacin resistance (6.2 to 10.1%) (p < 0.001). Using multivariate dynamic regression analysis, it was found that an increased use of one defined daily dose (DDD)/1000 patient-days for ofloxacin, ciprofloxacin and norfloxacin induced average increases of 0.81%, 0.65% and 0.53% in E. coli ofloxacin resistance (p < 0.01), with average delays of 4, 4 and 6 months, respectively. An increase of 1 DDD/1000 patient-days of ciprofloxacin, ofloxacin and norfloxacin use induced increases of 0.73%, 0.82% and 0.63% in E. coli ciprofloxacin resistance (p < 0.01), with average delays of 4, 4 and 5 months, respectively. The use of nalidixic acid was not associated significantly with an increase in resistance to fluoroquinolones by multivariate analysis.     

环丙氟喹诺酮C3/C7双腙的合成及抗肿瘤活性

用酰腙及腙分别作为抗菌氟喹诺酮类药物环丙沙星C3羧基和C7哌嗪基的等排体,设计合成了10个未见文献报道的双腙1-环丙基-6-氟-3-(取代苯叉肼酰基)-7-(取代苯叉肼基)-喹啉-4(1H)-酮(3a～3j)新化合物。体外抗肿瘤活性实验发现,双腙化合物对L1210、HL60和CHO 3种肿瘤细胞抑制活性远高于母体环丙沙星。这表明C3羧基和C7哌嗪基不是抗肿瘤活性所必需的药效团,可被其电子等排体取代,进一步扩展了结构修饰的范围。