Meropenem versus piperacillin-tazobactam for definitive treatment of bloodstream infections due to ceftriaxone non-susceptible Escherichia coli and Klebsiella spp (the MERINO trial): study protocol for a randomised controlled trial

BACKGROUND: Gram-negative bacteria such as Escherichia coli or Klebsiella spp. frequently cause bloodstream infections. There has been a worldwide increase in resistance in these species to antibiotics such as third generation cephalosporins, largely driven by the acquisition of extended-spectrum beta-lactamase or plasmid-mediated AmpC enzymes. Carbapenems have been considered the most effective therapy for serious infections caused by such resistant bacteria; however, increased use creates selection pressure for carbapenem resistance, an emerging threat arising predominantly from the dissemination of genes encoding carbapenemases. Recent retrospective data suggest that beta-lactam/beta-lactamase inhibitor combinations, such as piperacillin-tazobactam, may be non-inferior to carbapenems for the treatment of bloodstream infection caused by extended-spectrum beta-lactamase-producers, if susceptible in vitro. This study aims to test this hypothesis in an effort to define carbapenem-sparing alternatives for these infections.

METHODS/DESIGN: The study will use a multicentre randomised controlled open-label non-inferiority trial design comparing two treatments, meropenem (standard arm) and piperacillin-tazobactam (carbapenem-sparing arm) in adult patients with bacteraemia caused by E. coli or Klebsiella spp. demonstrating non-susceptibility to third generation cephalosporins. Recruitment is planned to occur in sites across three countries (Australia, New Zealand and Singapore). A total sample size of 454 patients will be required to achieve 80% power to determine non-inferiority with a margin of 5%. Once randomised, definitive treatment will be for a minimum of 4 days, but up to 14 days with total duration determined by treating clinicians. Data describing demographic information, antibiotic use, co-morbid conditions, illness severity, source of infection and other risk factors will be collected. Vital signs, white cell count, use of vasopressors and days to bacteraemia clearance will be recorded up to day 7. The primary outcome measure will be mortality at 30 days, with secondary outcomes including days to clinical and microbiological resolution, microbiological failure or relapse, isolation of a multi-resistant organism or Clostridium difficile infection.

Antibacterial activity of stevioside towards food-borne pathogenic bacteria

This study determines the inhibitory effect of Stevia rebaudiana leaf extracts and its purified bioactive compound ‘stevioside’ against food-related pathogens. The S. rebaudiana solvent extracts (1000 μg/mL) displayed antibacterial activity to Serratia marcescens, Klebsiella pneumoniae, Bacillus cereus, Pseudomonas aeruginosa, B. subtilis, Alcaligenes denitrificans and Salmonella typhimurium. Of the six solvents, ethanol and acetone extracts displayed the highest zone of inhibition. The bioactive compound from S. rebaudiana was purified by solvent extraction, thin-layer chromatography followed by structural characterization by spectroscopy evidence. Purified stevioside prevented the growth of tested bacterial species, i.e. B. subtilis, K. pneumoniae and S. typhimurium. Significant zone of inhibition (12 mm) was observed against B. cereus which proposes potential application of stevioside in foods to increase their shelf life.

In vitro comparative study of Bougainvillea spectabilis "stand" leaves and Bougainvillea variegata leaves in terms of phytochemicals and antimicrobial activity

Aim: To study the qualitative analysis of phytochemicals and antibacterial activity of the ethanolic and methanolic extracts of Bougainvillea spectabilis and Bougainvillea variegata leaves. Methods: Phytochemical constituents were determined qualitatively by the Harborne method, while antimicrobial activities were determined by measuring the zone of inhibition on Mueller Hinton Agar. Results: The maximum inhibitory effects were obtained against the Gram positive microbe Staphylococcus aureus for the methanolic extracts of both B. spectabilis [(28.54 ± 0.18) mm] and B. variegata [(21.97 ± 0.06) mm]. The Gram negative microbes Proteus vulgaris [(16.00 ± 0.15) mm] and Serratia marcescens [(16.00 ± 0.06) mm] gave maximum inhibitory effects for the ethanolic extracts of B. variegata, while Salmonella typhimurium [(17.26 ± 0.12) mm] gave a maximum zone of inhibition for the methanolic extract of B. spectabilis. No inhibitory effects were observed for the extracts of B. spectabilis or B. variegate against Enterococcus faecalis, Vibro cholera or Klebsiella pneumoniae. Conclusion: Both B. spectabilis and B. variegata possess significant antimicrobial activity that, following additional studies, could replace commercially known antibiotics. © 2012 China Pharmaceutical University.