Comparison of drug susceptibility between Escherichia coli detected in stool cultures of patients undergoing transrectal prostate needle biopsy and Escherichia coli in hospital-wide urine antibiograms

A prostate biopsy is essential for prostate cancer diagnosis. However, infections are one of the biopsy-associated complications, and post-biopsy fever is estimated to occur in approximately 1% of all cases. It may thus be beneficial to perform a rectal swab culture before a transrectal prostate biopsy to confirm the presence of resistant bacteria and select preventive antibacterial agents according to the drug susceptibility results. This study aimed to determine whether there is a difference between the drug susceptibility of bacteria detected in the stool of patients who were scheduled to undergo prostate biopsy and the hospital-wide urine antibiogram. Patients suspected of having prostate cancer who underwent transrectal prostate biopsy via transrectal ultrasonography between August 1, 2016, and June 30, 2020, were included in this study. Stool samples were collected and cultured before biopsy. Overall, 99 patients underwent prostate biopsy, and of these, culture results were available for 81 patients (81.8%). Escherichia coli was detected in 74.0% (60 samples) of the stool culture samples, of which 4 samples were extended-spectrum β-lactamase-producing types. We found greater susceptibility of Escherichia coli to ampicillin, fluoroquinolones, sulfamethoxazole/trimethoprim, and cefixime in the stool culture antibiogram than in the hospital-wide urine antibiogram. We also found a significantly low incidence of ESBL-positive Escherichia coli in the stool culture antibiogram with p-values of 0.009, 0.007, and 0.03 compared to the hospital-wide urine antibiograms for 2017, 2018, and 2019, respectively. Stool culture of prostate cancer patients undergoing biopsy may provide useful information for selecting prophylactic antimicrobial agents.     

Comparison of two exhaled nitric oxide analyzers: the NIOX MINO hand-held electrochemical analyzer and the NOA280i stationary chemiluminescence analyzer

Background and objective: Measurement of the fraction of nitric oxide (FeNO) in exhaled air is useful in the management of asthma. A new hand‐held nitric oxide (NO) analyzer, the NIOX MINO, is simple and easy to use in clinical practice. In this study, FeNO values measured using the NIOX MINO were compared with those obtained using a stationary chemiluminescence analyzer, the Sievers NOA280i. Methods: FeNO was measured in 100 adults, using both the NIOX MINO and the NOA280i. Nine (9.0%) of these subjects had asthma. The first acceptable measurement with the NIOX MINO and the mean of two acceptable measurements with the NOA280i were compared. Results: There was a significant correlation between FeNO concentrations measured with the two devices (r = 0.876, P < 0.001). A Bland–Altman plot showed a high degree of agreement between the two devices: the mean inter‐device difference was 3.3 parts per billion (ppb), and the 95% limits of agreement were ?7.0 and 13.6 ppb. In addition, the mean relative difference was 14.5%, with the 95% limits of agreement being ?33.7 and 62.7%. The mean value (± standard error of the mean) for FeNO as measured with the NIOX MINO (18.8 ± 0.9 ppb) was significantly lower than that measured with the NOA280i (22.1 ± 1.2 ppb, P < 0.001). Conclusions: There was a significant correlation, but only moderate agreement, between FeNO values measured with the NIOX MINO and those measured with the NOA280i, with the NIOX MINO values being significantly lower than the NOA280i values. Significant differences in FeNO values obtained with these two NO analyzers should be considered when interpreting the results of FeNO measurements.     

Reliability of a new hand-held device for the measurement of exhaled nitric oxide

BACKGROUND: Given the importance of airway inflammation in asthma, there has been an effort to incorporate inflammatory markers into its management. Measurement of fractional exhaled nitric oxide (FeNO) is a noninvasive marker of airway inflammation; however, the use of the available FeNO analyzer is limited by several factors including its cost and lack of transportability. The aim of this study was to compare the performance of a new hand-held FeNO measuring device (NIOX MINO) to the current clinical standard - the chemiluminescence FeNO analyzer (NIOX). METHODS: Subjects 6 years and older presenting to an allergy and asthma clinic underwent FeNO evaluation by NIOX and each of three NIOX MINOs. The mean of two acceptable measurements from the NIOX and the first approved measurement from each NIOX MINO were used for analysis. RESULTS: One hundred ten patients aged 6-86 years completed the study. Intrasubject FeNO levels obtained by each of the three NIOX MINOs revealed no significant difference between the measurements (P = 0.59). There was a very strong correlation between FeNO measurements by NIOX and by NIOX MINO (r = 0.98, P < 0.0001). The mean intrasubject FeNO difference between NIOX and NIOX MINO was -0.5 p.p.b. which was not statistically significantly different from zero (P = 0.21). CONCLUSIONS: Fractional exhaled nitric oxide measurements by the NIOX MINO showed a strong correlation and a high degree of agreement with the current standard stationary device. The NIOX MINO may be reliably used in clinical practice.     

Exhaled Nitric Oxide in Pregnant Healthy and Asthmatic Women

Background. Measurement of fractioned exhaled nitric oxide (FE_NO) is useful for monitoring airway inflammation in asthma. Asthma is one of the most common diseases complicating pregnancy, and FE_NO may be helpful for monitoring asthma in pregnancy. However, some physiological alterations of FE_NO may be expected during healthy pregnancy due to vascular nitric oxide production. Until now no study assessed the level of FE_NO in asthmatic pregnant patients. Objective. We aimed to assess the possible use and reproducibility of FE_NO measurements in pregnant asthmatic women. We compared FE_NO concentrations between four groups of subjects: healthy nonpregnant and pregnant females and asthmatic nonpregnant and pregnant patients. We also investigated the relationship between FE_NO values and the level of asthma control in pregnant asthmatic patients. Methods. A total of 102 female subjects (35 healthy nonpregnant and 27 healthy pregnant females; 20 nonpregnant and 20 pregnant asthmatic women) were included in this cross-sectional study. Two FE_NO measurements were performed in each subject using an electrochemical sensor based device (NIOX MINO, Aerocrine, Solna, Sweden). Data are given as median with range. Results. The repeatability of FE_NO measurement was similar in pregnant and nonpregnant subjects. FE_NO levels did not differ significantly between healthy pregnant versus nonpregnant subjects (16.0 [8, 31] vs. 16.0 [9, 35] ppb). FE_NO levels were significantly increased in asthmatic women compared to healthy females (nonpregnant asthmatics: 38 [9, 54] ppb, p < 0.001 vs. healthy nonpregnant; pregnant asthmatic patients: 28 [10, 56] ppb; p < 0.05 vs. healthy pregnant). Conclusions. FE_NO level is not influenced by healthy pregnancy. In pregnant asthmatic patients FE_NO level is elevated compared to healthy pregnant subjects and correlates with the level of asthma control. Further studies are required to assess the use of FE_NO measurement to monitor asthma in this patient group.     

Antimicrobial susceptibility testing of Mycobacteroides (Mycobacterium) abscessus complex,Mycolicibacterium (Mycobacterium) fortuitum,and Mycobacteroides (Mycobacterium) chelonae

The drug susceptibility of rapidly growing mycobacteria (RGM) varies among isolates. Treatment strategies similarly differ depending on the isolate, and for some, no clear strategy has been identified. This complicates clinical management of RGM. Following Clinical and Laboratory Standards Institute standard M24-A2, we assessed the susceptibility of 140 RGM isolates to 14 different antimicrobial drugs by measuring their minimal inhibitory concentrations (MICs). We also investigated the correlation of clarithromycin (CAM) MICs with the erm(41) and rrl gene mutations in the Mycobacteroides (Mycobacterium) abscessus complex, the rrl mutation in Mycobacteroides (Mycobacterium) chelonae, and the erm(39) mutation in Mycolicibacterium (Mycobacterium) fortuitum to determine the contribution of these mutations to CAM susceptibility. The five species and subspecies examined included 48 M. abscessus subsp. abscessus isolates (34.3%), 35 (25.0%) being M. abscessus subsp. massiliense, and two (1.4%) being M. abscessus subsp. bolletii. The M. abscessus complex accounted for 85 isolates (60.7%) in total, whereas 43 isolates (30.7%) were M. fortuitum, and 12 (8.6%) were M. chelonae. Our results demonstrated species-specific susceptibility to antimicrobials. In most cases, susceptibility to CAM could be predicted based on genetic pattern, but since one isolate did not fit that pattern, MIC values needed to be measured. Some isolates also exhibited rates of resistance to other drugs that differed from those previously reported in other locations, indicating that accurate identification of the bacterial isolate and use of the correct method for determining MIC are both important for the diagnosis of RGM.     

Prevalence of antimicrobial resistant genes in Bacteroides spp. isolated in Oita Prefecture,Japan

IntroductionBacteroides spp. are the most common anaerobic bacteria isolated from the human gastrointestinal tract. Several resistant genes are present in Bacteroides spp. However, most studies have focused on the prevalence of the c?A gene in Bacteroides fragilis alone. We assessed the susceptibility to antimicrobial agents and the prevalence of cepA, cfiA, cfxA, ermF, nim, and tetQ genes in Bacteroides strains isolated from clinical specimens in our hospital.MethodsWe isolated 86 B. fragilis and 58 non-fragilis Bacteroides strains from human clinical specimens collected from January 2011 to November 2021. Resistance against piperacillin (PIPC), cefotaxime (CTX), cefepime (CFPM), meropenem (MEPM), clindamycin, and minocycline was determined.ResultsThe resistant rates of penicillins and cephalosporins in non-fragilis isolates were significantly higher than those in B. fragilis isolates. In B. fragilis isolates, the resistant rates of PIPC, CTX, and CFPM in cfxA-positive isolates were significantly higher than those in cfxA-negative isolates (71% vs. 16%, 77% vs. 19%, and 77% vs. 30%, respectively). Thirteen B. fragilis isolates harbored the cfiA gene, two of which were resistant to MEPM. Six of the 13 cfiA-positive B. fragilis isolates were heterogeneously resistant to MEPM.ConclusionIt is important to evaluate the use of MEPM as empirical therapy for Bacteroides spp. infections, considering the emergence of carbapenem resistance during treatment, existence of MEPM-resistant strains, and heterogeneous resistance.