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Antibiotics: The Need for Innovation
Published in Nathan Keighley, Miraculous Medicines and the Chemistry of Drug Design, 2020
However, there are several drawbacks to methicillin: the absence of an electron-withdrawing group on the acyl side chain means that it is acid sensitive, it has only one-fiftieth the activity of penicillin G against micro-organisms that are sensitive to penicillin G, and shows poor activity against some streptococcal strains and is inactive against gram-negative bacteria. As a result, methicillin is no longer used clinically. Better penicillinase-resistant penicillins have since been developed, but, disconcertingly, a large number of S. aureus strains that can be detected in hospitals have become resistant to methicillin and other penicillinase-resistant antibiotics as a result of mutation of the transpeptidase enzyme. These are termed methicillin-resistant Staphylococcus aureus, or MRSA.
An Overview of Drug-Induced Nephropathies *
Published in Robin S. Goldstein, Mechanisms of Injury in Renal Disease and Toxicity, 2020
Jean Paul Fillastre, Michel Godin
Methicillin-induced interstitial nephritis may be considered as the prototype of the clinical and pathological features associated with all drug-associated acute interstitial nephritis. The incidence of adverse renal reactions to methicillin is estimated between 1 to 2% of all patients taking the drug. Methicillin is now less prescribed and the number of cases of interstitial nephritis has decreased during the past few years. Patients developing this type of nephritis received normal doses of methicillin, and the appearance of renal symptoms ranges from 2 to 60 d. Characteristically, the fever appears after the initial fever caused by the original infection has subsided. Skin rash and eosinophilia associated with high fever are noted in approximately one third of all patients. Acute renal failure is nonoliguric in the majority of cases. The proteinuria is mild, microscopic hematuria is frequent, and gross hematuria is noted in about a third of the cases. In most of the patients examined, the urinary sediment shows eosinophiluria which ranged up to 30% of the urinary leukocytes in some observations.
Cardiac Implantable Device Infections
Published in Firza Alexander Gronthoud, Practical Clinical Microbiology and Infectious Diseases, 2020
Julian Anthony Rycroft, Simon Tiberi
In reflection, empirical antimicrobials should be anti-staphylococcal—vancomycin (or daptomycin) should be used until the sensitivities are known for any isolated organisms. For methicillin-sensitive strains, antibiotics can later be rationalized to anti-staphylococcal penicillin or cefazolin. Gram-negative cover should be included empirically until the organism is identified—piperacillin/tazobactam or an aminoglycoside.
Bacterial dacryoadenitis: clinical features, microbiology, and management of 45 cases, with a recent uptick in incidence
Published in Orbit, 2022
Karen M. Wai, Joseph J. Locascio, Natalie Wolkow
A wide range of bacteria can cause dacryoadenitis. In our study, the most common organisms identified were Streptococcus pneumoniae, Haemophilus influenzae, and Staphylococcus aureus. Although the incidence of Haemophilus influenzae orbital and periorbital infections has decreased since the introduction of the Haemophilus influenza B vaccine,14Haemophilus infleunzae was still a significant pathogen in our study as well as other recent studies on bacterial dacryoadenitis.1,5 Further, both MSSA and MRSA were identified in our study. The incidence of methicillin-resistant strains has been increasing in both pediatric and adult populations in the community setting.15,16 Community acquired MRSA infections can present aggressively with rapid clinical progression or multiple orbital abscesses.15 Considering the rise of MRSA in the community, early clinical suspicion for MRSA-related infections even without traditional risk factors such as recent hospitalization is vital. Interestingly, our single patient with positive MRSA culture by conjunctival swab also had a positive MRSA nasal swab, raising the question of whether there may be correlations between MRSA nasal swabs and MRSA positive ocular cultures.
MRSA Decolonization and the Eye: A Potential New Tool for Ophthalmologists
Published in Seminars in Ophthalmology, 2022
Jeremy B Hatcher, Alex de Castro-Abeger, Richard W LaRue, Melanie Hingorani, Louise Mawn, Sean P Donahue, Paul Sternberg, Christine Shieh
Methicillin-Resistant Staphylococcus Aureus (MRSA) is an opportunistic pathogen resistant to several antibiotics commonly used to treat Staphylococcus aureus. The rise in prevalence of both hospital- and community-acquired MRSA strains in the early twenty-first century is attributed to widespread antibiotic use in prior decades, leading to international challenges with multi-drug resistance.1 The ecologic niche of MRSA in humans is the anterior nares. Healthy individuals may be “colonized” with MRSA but without active clinical infection. However, MRSA colonization plays a key role in the epidemiology and pathogenesis of disease in the body, with patterns of increased persistent nasal carriage in immunocompromised patients.2 MRSA is also readily transmitted between patients. Risk factors for MRSA carriage include advanced age, prior or recent hospital admission, and residence in a nursing home. Once considered a nosocomial pathogen, surveillance studies have noted the increasing prevalence of community-acquired MRSA isolates.2,3 MRSA infections affect the care of patients in all medical settings, complicating medical care in the inpatient setting (particularly the intensive care unit), operating room and the outpatient clinics. Some authors have even gone as far as to call for universal MRSA screening in adults admitted through the Emergency Department.4 Evidence suggests that up to 1/4 of colonized patients may develop an MRSA infection within a year of being identified as MRSA-colonized.5
Antimicrobial resistance of ocular microbes and the role of antimicrobial peptides
Published in Clinical and Experimental Optometry, 2021
Shyam Sunder Tummanapalli, Mark DP Willcox
Antibiotic resistance in ocular microbes was first reported in the 1950s when strains of staphylococci were found to be resistant to penicillin.98,99 In 1959, methicillin, a beta‐lactam antibiotic, was introduced to treat penicillin‐resistant staphylococci.100 However, the emergence of multidrug‐resistant forms of MRSA101 and methicillin‐resistant CoNS (MRSE)101–103 has led to severe forms of ocular infections.101–105 Early (1975–2000) and recent (2002–2017) studies have shown that ocular infections with MRSA and MRSE do respond to topical and intravitreal vancomycin.101–108 Although there have been reports of the emergence of resistance to vancomycin in strains isolated from endophthalmitis.109–111P. aeruginosa is the leading cause of ocular infections during contact lens wear,112,113 and can be isolated from contact lenses.39,113–115P. aeruginosa isolates resistant to the fluoroquinolone ciprofloxacin were isolated from scleral buckle infection in 1998,116 and this was followed by resistant isolates from corneal infection in 1999.117 A previous review article reported there are increasing rates of resistance to fluoroquinolones and beta‐lactams in ocular isolates of both P. aeruginosa and S. aureus.118