Chemotherapy with cefotaxime: how to avoid selection of Pseudomonas aeruginosa.
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Biomedical subjects
Publications and source records attributed to A Bauernfeind.
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In addition to carbenicillin, the newer beta-lactam antibiotics such as ticarcillin and azlocillin are now available for the chemotherapy of Pseudomonas aeruginosa infections. We investigated the in vitro effect of these antibiotics on 233 isolates from clinical material. We were particularly careful, when choosing the experimental material, to exclude copies of the same individual strain, and we achieved this by combining various epidemiological typing procedures. A comparison of carbenicillin, ticarcillin and azlocillin according to the concentrations at which half of the 233 strains were inhibited showed the ticarcillin values to be higher than those of azlocillin by a factor of 2.1, and carbenicillin values to be higher than those of azlocillin by a factor of 4.9. Individual strains also occurred in which the inhibitory concentration for azlocillin was higher than that of carbenicillin (5 strains) or ticarcillin (11 strains). In 17 out of the 233 isolates no therapeutic success would have been within reach even with the newer beta-lactam antibiotics. The use of ticarcillin and azlocillin permits an extension of the indications for therapy with beta-lactam antibiotics in P. aeruginosa infections, from hitherto 76%, to 90% of the cases. If one includes the aminoglycosides gentamycin, tobramycin, sisomycin and amikacin in the therapeutic armoury, then the proportion of in vitro sensitive strains of P. aeruginosa in the material submitted for examination rises to 98%.
After bacteria are mechanically removed from solid media, the remaining viable cells can be killed by exposure to chloroform vapors. Until recently, the applicability of this procedure was restricted to glass petri dishes. Here a procedure is described in which plastic petri dishes are used and remain stable in the presence of chloroform vapors.
The Procedure for pyocin typing of Pseudomonas aeruginosa isolations as proposed by GILLIES and GOVAN has been modified in the following aspects: strains are arranged in a symmetrical way, with a central producer zone and radial indicator streaks, optimal size of inocula for both producer (300 x 10(6)/ml) and indicators (50 X 10(6)/ml) was determined, unsupplemented Tryptic Soy Agar is used giving identical results to those when TSA is supplemented with 5% horse blood. The typing results obtained with this simplified and standardized procedure were identical with those from the cross streak method.
The minimal inhibition concentration of Tetracycline was tested in 177 strains of gram positive and gram negative species of bacteria from the vagina which were found to be resistant to Tetracycline in the Agardiffusion Test. 170 of the 177 strains (96%) were inhibited with a Tetracycline concentration of 512 microgram/ml. Six Klebsiella-enterobacter strains and one proteus morgaini strain needed a minimal inhibition concentration of 1024 microgram/ml. For a successful local treatment of vaginitis by Tetracycline against species highly resistant to Tetracycline local Tetracycline levels of 1000 microgram/ml or better have to be obtained. Concomitant preventive treatment of fungi for instance, with amphotericin containing drugs such as mysteclin is indicated.
Out of urine samples from 170 male patients strains of the genus Proteus with atypical biochemical characteristics and extensive corresponding multiresistance were isolated. Their significance as causative agents in urinary tract infection looks to be established as well as their ability of transfer by cross infection. Because of this we are concerned with the epidemiological occurrence of a special biotype of Proteus rettgeri as a causative agent in urinary tract infections.
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Susceptibility in vitro of 179 staphylococcal strains from 107 cystic fibrosis patients against 31 antibiotics indicates that only teicoplanin, vancomycin and netilmicin were active against all strains. The use of betalactam antibiotics is impaired by 11.7% of methicillin-resistant strains. The bactericidal kinetics of cephalexin and flucloxacillin as determined in a pharmacodynamic model demonstrates the killing of strains resistant to cephalexin (MIC 8 mg/l to 32 mg/l) by flucloxacillin. For the rational selection of antistaphylococcal antibiotics for cystic fibrosis patients, both the MIC of the isolates and the concentration of the antibiotics in cystic fibrosis patients have to be considered.
Strains of Escherichia coli resistant to ceftazidime but susceptible to other third generation cephalosporins were detected in three patients at two different locations (München, Bremen). The resistance was self-transmissible to other E. coli strains. Resistance against ampicillin, kanamycin, chloramphenicol and sulfonamide was co-transferred. The isoelectric point (pI) of the beta-lactamase was similar to the pI of the AER-1 and LCR-1 beta-lactamases. These enzymes, however, do not confer resistance to ceftazidime. Therefore the beta-lactamase described is the first example for a ceftazidimase.