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Vancomycin administration in continuous ambulatory peritoneal dialysis: the risk of ototoxicity

Gendeh BS, Gibb AG, Aziz NS, Kong N, Zahir ZM

Otolaryngol Head Neck Surg, 1998 Apr;118(4):551-8.
PMID: 9560111

A prospective study was undertaken in 16 patients with chronic renal failure on continuous ambulatory peritoneal dialysis, with 22 episodes of peritonitis treated with vancomycin, a known ototoxic agent. Twelve patients had one episode each, and four had recurrent peritonitis. Each treatment course consisted of two infusions of vancomycin (30 mg/kg body weight) in 2 L of peritoneal dialysate administered at 6-day intervals. Serum vancomycin analyzed by enzyme immunoassay showed a mean trough level of 11.00 microg/ml on day 6 and mean serum levels of 33.8 and 38.6 microg/ml about 12 hours after administration on days 1 and 7, respectively. Similar levels, well within the therapeutic range, were encountered with repeated vancomycin therapy for recurrent episodes of peritonitis, suggesting that no changes occurred in the pharmacokinetic profile of the drug. Pure-tone audiometry, electronystagmography, and clinical assessment performed during each course of treatment showed no evidence of ototoxicity even on repeated courses of vancomycin therapy. The results suggest that vancomycin therapy when given in appropriate concentrations as a single therapeutic agent is both effective and safe. We believe, however, that vancomycin administered in combination with an aminoglycoside may produce ototoxic effects that may be greatly aggravated, possibly because of synergism.

Matched MeSH terms: Vancomycin/administration & dosage; Vancomycin/adverse effects*; Vancomycin/pharmacokinetics
Fulltext Virulence genes detection among the antibiotic resistant enterococcus faecalis isolated from bird industry in Borneo

Sui, Sien Leong, Lihan, Samuel, Hwa, Chuan Chia

Pertanika Journal of Science & Technology, 2020;28(2):673-687.
MyJurnal

The abuse of antibiotics usage in bird industry has resulted in the emerging antibiotic resistant Enterococci worldwide which has posed a threat clinically to human health. The present study was to screen and identify the potential virulence agents in antibiotic resistance E. faecalis in bird industry in Borneo. Enterococcus bacteria collected from the birds’ faeces and indoor air inside ten birdhouses were identified to species level and their antibiotic resistance was checked using antibiotic susceptibility discs. Specific primers using PCR assay were intended for the detection of four potential virulence genes (ace, AS, efaA, gelE). Out of the thirty-seven Enterococci faecal bacteria, the prevailing bacteria found were Enterococcus qallinacum (51%), Enterococcus faecalis (35%) and Enterococcus harae (8%). The airborne bacteria were reported as Enterococcus faecalis (5%) and Enterococcus qallinacum (1%). Twenty-seven percent of isolates were reported to have Multiple Antibiotic Resistance (MAR) index ≥ 0.2 with 9 distinct resistance patterns formed. E. faecalis showed higher resistance to vancomycin. Virulence genes were successfully reported in the 15 E. faecalis isolates. Sixty-seven percent of isolates were detected positive for four virulence genes, 27% possessed three (AS, efaA, gelE) genes and 6% possessed two (ace, AS) genes. Antibiotic resistance and virulence genes detection were significantly correlated. These virulence genes or antibiotic resistance genes were important in the pathogenesis of E. faecalis infections.

Matched MeSH terms: Vancomycin
Pericardial abscess: The corollary of disseminated Methicillin-resistant Staphylococcus aureus following diabetic foot ulcer infection

Tan TL, Lim SH, Ruslan Mustapa M, Ganeswary R

Med J Malaysia, 2020 11;75(6):742-744.
PMID: 33219189

Methicillin-resistant Staphylococcus aureus (MRSA) purulent pericarditis, characterised by frank pus collection or microscopic pyogenic effusion in the pericardium represents the most serious form of pericardial infection. The route of MRSA acquisition in pericardial abscess commonly occurs via the blood stream infection and it is more commonly observed among immunocompromised individuals. To date, diabetic foot ulcer infection rarely disseminates and becomes a nidus for pericardial infection. Herein, we report an unusual case of MRSA pericardial abscess in a 44-year-old man who presented at Hospital Seri Manjung, Malaysia with cardiac tamponade. Past medical history indicated that he was recently treated for infected diabetic foot ulcer with MRSA bacteraemia one week earlier. Despite adequate pericardial drainage and extended parenteral vancomycin therapy, this case ended in fatality on day 42 of admission due to nosocomial infection. It is hoped that this report serves to increase the vigilance among clinicians that diabetic foot ulcer infections have the potential to progress to pericardial abscess in the presence of MRSA bacteraemia, although they may appear seemingly innocuous at presentation. Systemic vancomycin must be instituted promptly when MRSA bacteraemia is confirmed in order to circumvent the propagation of MRSA.

Matched MeSH terms: Vancomycin
Fulltext Preliminary Screening of Antibacterial Activity Using Crude Extracts of Hibiscus rosa sinensis

Arullappan S, Zakaria Z, Basri DF

Trop Life Sci Res, 2009 Dec;20(2):109-18.
PMID: 24575183 MyJurnal

Hibiscus rosa sinensis, a member of the Malvaceae family, is widely cultivated in the tropics as an ornamental plant. It is often planted as a fence or hedge plant, and has several forms of flowers with varying colours. It is also used in traditional medicine to induce abortion, ease menstrual cramps, assist in childbirth and relieve headache, fever and inflammation. In this study, we evaluated the antibacterial activity of H. rosa sinesis extract using a disc diffusion method. Crude petroleum ether extract, ethyl acetate extract and methanol extract from the leaves, stems and flowers of the plant were prepared using a cold extraction technique. These extracts were tested at concentrations ranging from 4 mg/disc to 0.017 mg/disc against methicillin-resistant Staphylococcus aureus (MRSA), Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa and Klebsiella pneumonia. The petroleum ether extract from the leaves, stems and flowers and methanol extract from the leaves showed inhibition zones with diameters > 12 mm against MRSA. Overall, the petroleum ether extract from flowers at concentrations of 4 mg/disc and 2 mg/disc displayed the strongest inhibition zones of 18.6 ± 2.85 mm and 18.5 ± 0.29 mm, respectively, as compared to vancomycin (30 μg/ml), which did not differ significantly from the 18.0 ± 0.10 mm size of the vancomycin (30 μg/ml) inhibition zone (p < 0.05). In conclusion, H. rosa sinensis extract is a potential antibacterial agent for treating MRSA infection.

Matched MeSH terms: Vancomycin
Fulltext Antimicrobial stewardship program in a Malaysian district hospital: First year experience

Sing DY, Boo YL, Mukhlis R, Chin PW, Hoo FK

Pak J Med Sci, 2016 Jul-Aug;32(4):999-1004.
PMID: 27648056

Backgrounds & Objective: Antimicrobial resistance is an alarming public health threat that requires urgent global solution. Implementation of antimicrobial stewardship program (ASP) is an essential practice element for healthcare institutions in gate-keeping judicious antimicrobial use. This study highlighted the development, first year experience, and result of the implementation of ASP utilizing persuasive and restrictive approaches in a Malaysian district hospital.
Methods: An observational study was conducted between January 2015 to December 2015 on implementation of ASP among hospitalized inpatients age 12 years old and above.
Results: Recommendations were provided for 60% of cases (110 patients) with the average acceptance rate of 83.33%. Majority of the interventions were to stop the antimicrobial therapy (30.3%), and the most common audited antimicrobials was Piperacillin/Tazobactam (25.5%), followed by Meropenem (11.82%), Amoxicillin/Clavulanate and Vancomycin (8.18%) respectively. The concordance rate towards authorization policy was increased in 2015 (71.59% of cases) as compared before the implementation of ASP in 2014 (60.6% of cases). Restrictive enforcement under ASP had been shown to improve significantly adherence rate towards antimicrobials authorization policy (p-value: 0.004).
Conclusion: ASP was successfully implemented in a district hospital. Future studies on its clinical outcomes are important to evaluate its effectiveness as well as focus on the improvement to the pre-existing strategies and measures.
KEY WORDS: Antimicrobial stewardship, Anti-Infective agents, Drug resistance, Malaysia, Rural hospital

Matched MeSH terms: Vancomycin
Fulltext A review on the effects of probiotics and antibiotics towards Clostridium difficile infections

Hazirah, A., Loong, Y.Y., Rushdan, A.A., Rukman, A.H., Yazid, M.M.

Pertanika Journal of Science & Technology, 2013;21(2):293-302.
MyJurnal

Clostridium difficile can cause severe diseases with significant morbidity and mortality in infected patients.
The rate of Clostridium difficile infection is high in North America and European countries. Metronidazole
and vancomycin have been recommended as the treatments of choice since 1990s. Recurrent infection
due to Clostridium difficile is common after several days of antibiotic administration. Probiotics have
been used in these patients as an adjunct treatment with some successful findings. However, a detailed
investigation on the use of probiotic for infected patients is still needed, particularly for its real efficacy.

Matched MeSH terms: Vancomycin
Fulltext Antibiotic resistance and biosafety of Vibrio cholerae and Vibrio parahaemolyticus from freshwater fish at retail level

International Food Research Journal, 2011;18(4):1523-1530.
MyJurnal

A total of 49 isolates of V. parahaemolyticus and 8 isolates of V. cholerae isolated from freshwater fish of patin (Pangasius hypopthalmus) and red tilapia (Oreochromis sp.) were purchased from different retail level in Selangor, Malaysia. All of the isolates showed a multiple resistances towards all 15 antibiotics tested. Some of the isolates show a high resistance to different antibiotics including bacitracin, vancomycin, tetracycline, furazididone, cephalothin and erythromycin. However, both species was susceptible towards imipenem. Overall antibiotics resistance patterns of all isolates were resistant from 2 to 14 resistance patterns with multiple antibiotic resistance (MAR) index ranging from 0.13 to 0.93 respectively. As the results obtained in the dendrogram produced from both species had indicates that these antibiotics were intensively used whether in the aquaculture farm through feeds during culture or at the hatchery production of seed. Thus, this study will provides an essential information of the MAR index and also the clustering analysis in order to determine the biosafety of Vibrio spp. in freshwater aquaculture fish sold at different retail level in Malaysia.

Matched MeSH terms: Vancomycin
Fulltext Overcoming antibiotic resistance in the hospital: a never ending battle

Ariza Adnan

Medical Health Reviews, 2008;2008(1):29-44.
MyJurnal

The issue of antibiotic resistance has been around ever since the first antibiotic penicillin was introduced to the world. It continues to rise, becoming a major problem across the globe and Malaysia is no exception. Hospital is a critical component of the antibiotic resistance problem worldwide. The problems of antibiotic resistance are typically magnified in a hospital setting due to the common variables in the hospital environment that favour its development. These include a combination of highly susceptible patients, intensive and prolonged antibiotic use, and crossinfection resulting in nosocomial infections with highly resistant bacterial pathogens such as multi-resistant gram-negative rods, vancomycin resistant enterococci (VRE) and methicillinresistant Staphylococcus aureus (MRSA) as well as resistant fungal infections. Transmission of highly resistant bacteria from patient to patient within the hospital environment amplifies the problem of antibiotic resistance and may result in the infection of patients who are not receiving antibiotics. Transmission of antibiotic-resistant strains from hospital personnel to patients or vice versa may also occur. What are the available strategies and what works best in managing antibiotic resistance in the hospital? This review will highlight the seriousness of the resistance problem and identify actions that address it especially in the context of improving the problem in Malaysian hospitals.

Matched MeSH terms: Vancomycin-Resistant Enterococci
Fulltext Evaluation of vancomycin intial dosing anf the resultant trough level in paediatric patients

Liang Ann Lim, Michelle Sze Hui Chin, Denish Kwasso Devan, Jun Hoe Hui, Thamron Keowmani

Malaysian Journal of Pharmaceutical Science, 2014;12(1):67-77.
MyJurnal

This study aims to examine the vancomycin initial dosing and the resultant trough level in paediatric patients. In this retrospective observational study, all therapeutic drug monitoring (TDM) records of paediatric patients admitted to Sabah Women and Children Hospital (SWACH) from January 2011 to September 2013 were reviewed and 116 patients without renal disease were included in the study. Of the total, 38.8% were neonates, 32.8% were infants and 28.4% were children. The majority of the patients were intensive care patients (69.0%) and the most common clinical indication for vancomycin was sepsis (44.8%). The four initial dosing regimens identified were 40 mg/kg/day (38.8%), 30 mg/kg/day (31.0%), 60 mg/kg/day (25.0%) and 45 mg/kg/day (5.2%). The distribution of initial dosing regimen was significantly different between the three age groups (p40 mg/kg/day (p=0.007). The proportions of those who achieved the target therapeutic range (10–20 mg/L) in the 2 dosing groups were 30.9% and 60.0% respectively. In conclusion, the study showed that the initial dosing of >40 mg/kg/day is more likely to achieve the target therapeutic range (10–20 mg/L) compared to the initial dosing of ≤40 mg/kg/day.

Matched MeSH terms: Vancomycin
Fulltext Intraventricular teicoplanin

Shanti, R., Sam, I.C., Hany Ariffin

JUMMEC, 2009;12(1):35-38.
MyJurnal

Following craniotomy for an atypical rhabdoid tumour of the posterior cranial fossa, a fourteen-month-old boy developed a ventriculitis with methicillin resistant Staphylococcus epidermidis (MRSE) which is associated with the use of a ventriculoperitoneal shunt. Treatment with intravenous vancomycin resulted in a severe allergic skin reaction. Substitution with intravenous teicoplanin resulted in negative blood culture and MRSE ventriculitis was successfully eradicated with concomitant use of intraventricular teicoplanin. No signs of recurrent infection or adverse events occurred. Intraventricular teicoplanin is safe and effective for the treatment of staphylococcal neurosurgical shunt infections.

Matched MeSH terms: Vancomycin
Fulltext Contact lens related Elizabethkingia meningoseptica keratitis-a first Southeast ASEAN case report & literature review

Ang, Wen-Jeat, Embong Zunaina, Raja Omar Raja Norliza, Abdul Jalil Fadzillah

Journal of Biomedical and Clinical Sciences, 2017;2(1):1-4.
MyJurnal

We describe the first clinical case of contact lens related corneal ulcer caused by Elizabethkingia meningosepticaregistered in Southeast Asia. A 20-year-old female student who wasa regular soft contact lens wearer, presented with pain, photophobia and blurring of vision of the right eye for 3 days. On slit lamp examination, there was a small paracentral anterior stromal infiltrate with an overlying epithelial defect. Microbiological cultures from corneal scrapings, contact lens and its casing were positive for E.meningoseptica. Due to high likelihood of contact lens contamination causing keratitis, topical fortified gentamicin0.9% and ceftazidime 5% were administered empirically. Topical vancomycin 5% was later added tailoring to the culture and sensitivity of the organism. After 8 weeks of treatment, the keratitis subsided and corneal epithelial defect completely healed with residual corneal opacity. Even though uncommon, contact lens related E.meningosepticakeratitis can occur in healthy immunocompetent individuals with no ocular comorbidities.

Matched MeSH terms: Vancomycin
Fulltext Streptomyces as a Prominent Resource of Future Anti-MRSA Drugs

Kemung HM, Tan LT, Khan TM, Chan KG, Pusparajah P, Goh BH, et al.

Front Microbiol, 2018;9:2221.
PMID: 30319563 DOI: 10.3389/fmicb.2018.02221

Methicillin-resistant Staphylococcus aureus (MRSA) pose a significant health threat as they tend to cause severe infections in vulnerable populations and are difficult to treat due to a limited range of effective antibiotics and also their ability to form biofilm. These organisms were once limited to hospital acquired infections but are now widely present in the community and even in animals. Furthermore, these organisms are constantly evolving to develop resistance to more antibiotics. This results in a need for new clinically useful antibiotics and one potential source are the Streptomyces which have already been the source of several anti-MRSA drugs including vancomycin. There remain large numbers of Streptomyces potentially undiscovered in underexplored regions such as mangrove, deserts, marine, and freshwater environments as well as endophytes. Organisms from these regions also face significant challenges to survival which often result in the production of novel bioactive compounds, several of which have already shown promise in drug development. We review the various mechanisms of antibiotic resistance in MRSA and all the known compounds isolated from Streptomyces with anti-MRSA activity with a focus on those from underexplored regions. The isolation of the full array of compounds Streptomyces are potentially capable of producing in the laboratory has proven a challenge, we also review techniques that have been used to overcome this obstacle including genetic cluster analysis. Additionally, we review the in vivo work done thus far with promising compounds of Streptomyces origin as well as the animal models that could be used for this work.

Matched MeSH terms: Vancomycin
Fulltext Synergistic Interaction of Methanol Extract from Canarium odontophyllum Miq. Leaf in Combination with Oxacillin against Methicillin-Resistant Staphylococcus aureus (MRSA) ATCC 33591

Basri DF, Sandra V

Int J Microbiol, 2016;2016:5249534.
PMID: 27006659 DOI: 10.1155/2016/5249534

Canarium odontophyllum (CO) Miq. has been considered as one of the most sought-after plant species in Sarawak, Malaysia, due to its nutritional and pharmacological benefits. This study aimed to evaluate the pharmacodynamic interaction of crude methanol and acetone extracts from CO leaves in combination with oxacillin, vancomycin, and linezolid, respectively, against MRSA ATCC 33591 as preliminary study has reported its potential antistaphylococcal activity. The broth microdilution assay revealed that both methanol and acetone extracts were bactericidal with Minimum Inhibitory Concentration (MIC) of 312.5 μg/mL and 156.25 μg/mL and Minimum Bactericidal Concentration (MBC) of 625 μg/mL and 312.5 μg/mL, respectively. Fractional Inhibitory Concentration (FIC) indices were obtained via the chequerboard dilution assay where methanol extract-oxacillin, acetone extract-oxacillin, methanol extract-linezolid, and acetone extract-linezolid combinations exhibited synergism (FIC index ≤ 0.5). The synergistic action of the methanol extract-oxacillin combination was verified by time-kill analysis where bactericidal effect was observed at concentration of 1/8 × MIC of both compounds at 9.6 h compared to oxacillin alone. As such, these findings postulated that both extracts exert their anti-MRSA mechanism of action similar to that of vancomycin and provide evidence that the leaves of C. odontophyllum have the potential to be developed into antistaphylococcal agents.

Matched MeSH terms: Vancomycin
Fulltext Bacteriostatic antimicrobial combination: antagonistic interaction between epsilon-viniferin and vancomycin against methicillin-resistant Staphylococcus aureus

Basri DF, Xian LW, Abdul Shukor NI, Latip J

Biomed Res Int, 2014;2014:461756.
PMID: 24783205 DOI: 10.1155/2014/461756

Stilbenoids have been considered as an alternative phytotherapeutic treatment against methicillin-resistant Staphylococcus aureus (MRSA) infection. The combined effect of ε-viniferin and johorenol A with the standard antibiotics, vancomycin and linezolid, was assessed against MRSA ATCC 33591 and HUKM clinical isolate. The minimum inhibitory concentration (MIC) value of the individual tested compounds and the fractional inhibitory concentration index (FICI) value of the combined agents were, respectively, determined using microbroth dilution test and microdilution checkerboard (MDC) method. Only synergistic outcome from checkerboard test will be substantiated for its rate of bacterial killing using time-kill assay. The MIC value of ε -viniferin against ATCC 33591 and johorenol A against both strains was 0.05 mg/mL whereas HUKM strain was susceptible to 0.1 mg/mL of ε-viniferin. MDC study showed that only combination between ε-viniferin and vancomycin was synergistic against ATCC 33591 (FICI 0.25) and HUKM (FICI 0.19). All the other combinations (ε-viniferin-linezolid, johorenol A-vancomycin, and johorenol A-linezolid) were either indifferent or additive against both strains. However, despite the FICI value showing synergistic effect for ε-viniferin-vancomycin, TKA analysis displayed antagonistic interaction with bacteriostatic action against both strains. As conclusion, ε-viniferin can be considered as a bacteriostatic stilbenoid as it antagonized the bactericidal activity of vancomycin. These findings therefore disputed previous report that ε-viniferin acted in synergism with vancomycin but revealed that it targets similar site in close proximity to vancomycin's action, possibly at the bacterial membrane protein. Hence, this combination has a huge potential to be further studied and developed as an alternative treatment in combating MRSA in future.

Matched MeSH terms: Vancomycin/administration & dosage*
Fulltext The presence of heterogeneous vancomycin-lntermediate Staphylococcus aureus (heteroVISA) in a major Malaysian hospital

Norazah A, Law NL, Abd Ghani MK, Salbiah N

Med J Malaysia, 2012 Jun;67(3):269-73.
PMID: 23082415

This study was conducted to detect the presence of heterogenous vancomycin-intermediate Staphylococcus aureus (heteroVISA) among MRSA isolates in a major hospital. Forty-three MRSA isolates with vancomycin MIC 2 microg/ml collected in 2009 was screened for heteroVISA using Etest Glycopeptide Resistance Detection (GRD) and confirmed by population analysis profile-area under curve method. The genetic relatedness of heteroVISA strains with other MRSA was examined by pulsed-field gel electrophoresis (PFGE) method. Two isolates were shown to be heteroVISA and derived from the same clone. This showed that heteroVISA strains were already present among our local strains since 2009 and were genetically related to other susceptible strains.

Matched MeSH terms: Vancomycin Resistance*
Cefepime monotherapy for treatment of febrile neutropenia in children

Ariffin H, Ai CL, Lee CL, Abdullah WA

J Paediatr Child Health, 2006 Dec;42(12):781-4.
PMID: 17096713

Empirical therapy for children with febrile neutropenia has traditionally consisted of combination antibiotics, usually a beta-lactam and an aminoglycoside. However, recent trends and international guidelines have now made monotherapy a feasible option in the management of this group of patients. We prospectively evaluated the efficacy and safety of cefepime monotherapy in our population of paediatric cancer patients with febrile neutropenia.

Matched MeSH terms: Vancomycin/therapeutic use
Phenotypic and genetic characterization of multidrug-resistant Staphylococcus aureus in the tropics of Southeast Asia

Zulkeflle SNM, Yusaimi YA, Sugiura N, Iwamoto K, Goto M, Utsumi M, et al.

Microbiology (Reading), 2016 12;162(12):2064-2074.
PMID: 27902427 DOI: 10.1099/mic.0.000392

Antibiotic resistance has become a major public health problem throughout the world. The presence of antibiotic-resistant bacteria such as Staphylococcus aureus and antibiotic resistance genes (ARGs) in hospital wastewater is a cause for great concern today. In this study, 276 Staph. aureus isolates were recovered from hospital wastewater samples in Malaysia. All of the isolates were screened for susceptibility to nine different classes of antibiotics: ampicillin, ciprofloxacin, gentamicin, kanamycin, erythromycin, vancomycin, trimethoprim and sulfamethoxazole, chloramphenicol, tetracycline and nalidixic acid. Screening tests showed that 100 % of Staph.aureus isolates exhibited resistance against kanamycin, vancomycin, trimethoprim and sulfamethoxazole and nalidixic acid. Additionally, 91, 87, 50, 43, 11 and 8.7 % of isolates showed resistance against erythromycin, gentamicin, ciprofloxacin, ampicillin, chloramphenicol and tetracycline, respectively. Based on these results, 100 % of isolates demonstrated multidrug-resistant (MDR) characteristics, displaying resistance against more than three classes of antibiotics. Of 276 isolates, nine exhibited resistance to more than nine classes of tested antibiotics; these were selected for antibiotic susceptibility testing and examined for the presence of conserved ARGs. Interestingly, a high percentage of the selected MDR Staph.aureus isolates did not contain conserved ARGs. These results indicate that non-conserved MDR gene elements may have already spread into the environment in the tropics of Southeast Asia, and unique resistance mechanisms against several antibiotics may have evolved due to stable, moderate temperatures that support growth of bacteria throughout the year.

Matched MeSH terms: Vancomycin/pharmacology
Susceptibility patterns of anaerobes isolated from clinical specimens in tertiary Hospital, Malaysia

Ishak N, Abdul Wahab Z, Amin Nordin S, Ibrahim R

Malays J Pathol, 2020 Aug;42(2):245-252.
PMID: 32860377

INTRODUCTION: The susceptibility patterns of anaerobes are becoming less predictable due to the emergence of anaerobic resistance trends to antibiotics; hence increasing the importance of the isolation and antimicrobial susceptibility testing of anaerobes.
MATERIALS AND METHODS: This study investigated the isolation of anaerobes from the clinical specimens of Hospital Sungai Buloh, Malaysia, from January 2015 to December 2015. All isolates were identified using the API 20A system (bioMérieux, France). Antimicrobial susceptibility testing was performed using the E-test (bioMérieux, France).
RESULTS: The proportion of obligate anaerobes isolated from the clinical specimens was 0.83%. The Gram-positive anaerobes were most susceptible to vancomycin and imipenem, showing 100% sensitivity to these antimicrobials, followed by clindamycin (86.3%), penicillin (76.7%), and metronidazole (48.9%). Meanwhile, Gram-negative anaerobes were most susceptible to metronidazole (96%) followed by imipenem (89%), clindamycin (79%), and ampicillin (32%). The present study also showed that 3 out of 12 Bacteroides fragilis isolates were resistant to imipenem.
CONCLUSION: This study demonstrated the differences in the susceptibility patterns of anaerobes towards commonly used antimicrobials for the treatment of anaerobic infections. In summary, continuous monitoring of antimicrobial resistance trends among anaerobes is needed to ensure the appropriateness of treatment.

Matched MeSH terms: Vancomycin/pharmacology
Community-acquired vancomycin-resistant Enterococcus faecium: a case report from Malaysia

Raja NS, Karunakaran R, Ngeow YF, Awang R

J Med Microbiol, 2005 Sep;54(Pt 9):901-903.
PMID: 16091445 DOI: 10.1099/jmm.0.46169-0

Vancomycin-resistant enterococci (VRE) are formidable organisms renowned for their ability to cause infections with limited treatment options and their potential for transferring resistance genes to other Gram-positive bacteria. Usually associated with nosocomial infections, VRE are rarely reported as a cause of community-acquired infection. Presented here is a case of community-acquired infection due to vancomycin-resistant Enterococcus faecium. The patient had been applying herbal leaves topically to his cheek to treat a buccal space abscess, resulting in a burn of the overlying skin. From pus aspirated via the skin a pure culture of E. faecium was grown that was resistant to vancomycin with a MIC of >256 microg ml-1 by the E test and resistant to teicoplanin by disc diffusion, consistent with the VanA phenotype. The organism was suspected of contaminating the leaf and infecting the patient via the burnt skin. This case highlights the need for further studies on the community prevalence of VRE among humans and animals to define unrecognized silent reservoirs for VRE, which may pose a threat to public health.

Matched MeSH terms: Vancomycin Resistance*
Activated ADI pathway: the initiator of intermediate vancomycin resistance in Staphylococcus aureus

Tan XE, Neoh HM, Looi ML, Chin SF, Cui L, Hiramatsu K, et al.

Can J Microbiol, 2017 Mar;63(3):260-264.
PMID: 28059579 DOI: 10.1139/cjm-2016-0439

Comparative proteomic profiling between 2 vancomycin-intermediate Staphylococcus aureus (VISA) strains, Mu50Ω-vraSm and Mu50Ω-vraSm-graRm, and vancomycin-susceptible S. aureus (VSSA) strain Mu50Ω revealed upregulated levels of catabolic ornithine carbamoyltransferase (ArcB) of the arginine catabolism pathway in VISA strains. Subsequent analyses showed that the VISA strains have higher levels of cellular ATP and ammonia, which are by-products of arginine catabolism, and displayed thicker cell walls. We postulate that elevated cytoplasmic ammonia and ATP molecules, resulting from activated arginine catabolism upon acquisition of vraS and graR mutations, are important requirements facilitating cell wall biosynthesis, thereby contributing to thickened cell wall and consequently reduced vancomycin susceptibility in VISA strains.

Matched MeSH terms: Vancomycin/pharmacology*

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