A clinical view of vancomycin in 1990.
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Journal Article↗
Biomedical subjects
W T Siebert
Publications and source records attributed to W T Siebert.
Ticarcillin plus clavulanic acid versus moxalactam therapy of osteomyelitis, septic arthritis, and skin and soft tissue infections.
A controlled, randomized study to compare the efficacy and safety of ticarcillin plus clavulanic acid with moxalactam was carried out in 25 evaluable patients with bone, joint, and skin or skin structure infections. Of the 13 patients in the ticarcillin plus clavulanic acid-treated group, nine had osteomyelitis, two had septic arthritis, one had cellulitis, and one had a wound infection. Four of the 12 moxalactam-treated patients had osteomyelitis, one had septic arthritis, and the other seven had cellulitis and/or infected ulcers. A total of 21 causative organisms were isolated in the group treated with ticarcillin plus clavulanic acid: Enterobacteriaceae (10), Pseudomonas aeruginosa (five), obligate anaerobes (three), Staphylococcus aureus (two), and Acinetobacter species (one). Cultures in the moxalactam-treated group yielded 23 pathogens: Enterobacteriaceae (seven), S. aureus (six), group B streptococci (four), P. aeruginosa (two), obligate anaerobes (two), Streptococcus pyogenes (one), and Aeromonas species (one). A cure or satisfactory response was achieved in 12 of the 13 (92 percent) patients who received ticarcillin plus clavulanic acid and in 10 of the 12 (83 percent) patients who received moxalactam. One patient with septic arthritis who received ticarcillin plus clavulanic acid had a relapse during therapy, as did one moxalactam-treated patient with a post-surgical wound infection. The other patient in whom moxalactam treatment failed had a wound infection that became reinfected. Some abnormalities in laboratory parameters occurred in each group, but none was severe enough to warrant discontinuation of treatment.
Adult↗
Primary meningococcal arthritis.
We have reported a case of primary meningococcal arthritis of the left ankle in a previously healthy man. Although primary meningococcal arthritis clinically resembles gonococcal arthritis, prolonged antibiotic therapy and open joint drainage are often required. Even with prompt appropriate antibiotic and surgical therapy, primary meningococcal arthritis may lead to permanent joint damage.
Ankle Joint↗
Gonococcal endocarditis with initially negative blood cultures.
This case of gonococcal endocarditis in a young man highlights the recognized capacity of Neisseria gonorrhoeae to destroy an infected valve, and illustrates that emergency valve replacement in the presence of congestive heart failure may be life-saving. The utility of the echocardiogram and the reportedly low yield of positive blood cultures in this disease are represented.
Adult↗
Primary Pseudomonas pneumonia.
We have described a patient who had primary Pseudomonas pneumonia, without evidence of an underlying disease state. Although uncommon, Pseudomonas pneumonia may occur in a normal host and should be treated, if the diagnosis is confirmed by appropriate Gram stain and culture of sputum.
Adult↗
Synergy of vancomycin plus cefazolin or cephalothin against methicillin-resistance Staphylococcus epidermidis.
The in vitro activity of cephalothin, cefazolin, and vancomycin against 25 isolates of methicillin-resistant Staphylococcus epidermidis was determined by means of a broth dilution technique with two sizes of inoculum. The size of the inoculum had a marked effect on the minimal inhibitory concentrations and the minimal bactericidal concentrations of all three antibiotics. With a small inoculum, 100% of the isolates were inhibited by 3.12 micrograms of vancomycin/ml, 76% by 12.5 micrograms of cephalothin/ml, and 64% by 12.5 micrograms of cefazolin/ml. With a large inoculum 100% of the isolates were inhibited by 200 micrograms of vancomycin/ml, 40% by 12.5 micrograms of cephalothin/ml, and 12% by 12.5 micrograms of cefazolin/ml. As determined by a tube dilution checkerboard technique for both sizes of inoculum, the combination of vancomycin plus cephalothin was synergistic against methicillin-resistant S. epidermidis in 45 of 50 cases, and the combination of vancomycin plus cefazolin was synergistic in 39 or 50 cases. These data from in vitro studies suggest that these antibiotic combinations should be evaluated clinically in patients with severe infections caused by methicillin-resistant S. epidermidis.
Cefazolin↗
Blastomycosis of paranasal sinuses.
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Amphotericin B↗
Methicillin-resistant Staphylococcus epidermidis.
Staphylococcus epidermidis is frequently associated with infection of prosthetic heart valves, prosthetic orthopedic devices, and neurosurgical shunts. Penicillinase-resistant semisynthetic penicillins, such as methicillin, have been the therapeutic and prophylactic agents of choice for S epidermidis infection. However, more S epidermidis isolates are now resistant to methicillin and other penicillins. In our laboratory 41% of S epidermidis isolates were resistant to methici-lin. All of the methicillin-susceptible isolates and 82% of the methicillin-resistant isoates were susceptible to cephalothin. Cephalothin should replace methicillin as the prophylactic and therapeutic agent of choice in institutions with a high percentage of methicillin-resistant S epidermidis.
Cephalothin↗
Prosthetic valve endocarditis.
PVE is increasingly frequent and often lethal. The classic features of infective endocarditis may be absent early in the course of the illess. Therefore, patients with prosthetic heart valves and fever must be considered candidates for this infection until another cause for the fever can be established. Five to six blood cultures will document the persistent bacteremia of PVE in most cases. Treatment consists of parenteral penicillins for sensitive organisms plus valvular re-replacement for intractable heart failure mechanical malfunction of the valve, persistent sepsis, or multiple major emboli. In spite of aggressive therapy, the mortality remains high. Therefore, appropriate prophylaxis is warranted in patients with prosthetic valves who must undergo procedures that might lead to bacteremia.
Anti-Bacterial Agents↗
Resistance to gentamicin: a growing concern.
Gentaminic was introduced in 1969 as a broad-spectrum aminoglycoside effective in vitro against a majority of aerobic gram-negative bacilli. In recent years gentamicin-resistant clinical isolates have become more prevalent. In our laboratory in 1975, 32% of Pseudomonas sp and 44% of indole-negative Proteus sp isolates were resistant to gentamicin. Resistance to tobramycin is also increasing; 24% of Escherichia coli and 28% of indole-negative Proteus sp isolates were found to be tobramycin-resistant. In addition, isolation of previously uncommon gentamicin-resistant species, ie, Proteus rettgeri and other indole-positive Proteus sp, from clinical specimens has increased dramatically in the past five years. This increase in gentamicin and tobramycin-resistant gram-negative bacilli serves as a constant stimulus for the development of new antimicrobial agents.
Drug Resistance, Microbial↗
Practical ways to avoid hospital acquired infections.
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Cross Infection↗
Chronic consumption coagulopathy accompanying abdominal aortic aneurysm.
Each of two patients harboring a stable abdominal aortic aneurysm manifested severe recurrent bleeding consequent to chronic consumption coagulopathy (CCC). Both underwent successful aneurysmectomy, but in only one patient did bleeding cease and depressed clotting factors return to normal activity. In the other patient, subsequent observations suggested that his coagulopathy actually resulted from occult pancreatic carcinoma. We propose here criteria for establishing stable aneurysm as the cause of CCC and demonstrate the efficacy of heparin in reversing the coagulation defect prior to surgical intervention. These cases also illustrate that the discovery of CCC accompanying stable aneurysm may signal the presence of another underlying disorder.
Aged↗
Comparison of thrombophlebitis associated with three cephalosporin antibiotics.
A double-blind study with volunteers was performed to determine the incidence and severity of thrombophlebitis associated with cephalothin, cephapirin, cefamandole, and a water control. Although there were no statistical differences in the incidence of thrombophlebitis, cephalothin resulted in significantly more severe thrombophlebitis compared with the other agents.
Cephalosporins↗
Antimicrobial susceptibility of clinical isolates of gram-negative bacilli.
No one can doubt the increased incidence of gram-negative bacillary infections and the importance of an awareness of this increase. Today's hospital, where one finds aggressive surgery, patients with multiple indwelling polyethylene lines and Foley catheters, and widespread use of prophylactic antibiotics, serves as a haven for resistant gram-negative bacilli. Twenty-five strains of Escherichia coli, Klebsiella sp, Enterobacter sp, Pseudomonas sp, indole-negative Proteus sp, indole-positive Proteus sp, and Serratia sp from hospitalized patients were tested for susceptibility to eight commonly used antibiotics using an inocula replicating method. Gentamicin proved to be the most effective antibiotic against the majority; most strains were inhibited by 3.12mug/ml or less. Other antibiotics, although not so active against all species, were effective against selected species.
Administration, Oral↗
Combined effects of ticarcillin and cefazolin on blood coagulation and platelet function.
Combined intravenous infusions of ticarcillin and cefazolin given to normal volunteers resulted in a functional platelet defect which appeared to be determined primarily by the dose and duration of treatment with the penicillin component. No effect on soluble blood coagulation factors was evident. Acute administration of corticosteroids did not influence the prolonged bleeding times induced by extended ticarcillin infusions.
Blood Coagulation↗
Case report. Pseudomonas puncture wound osteomyelitis in adults.
Pseudomonas osteomyelitis following a puncture wound is commonly reported in children, but very few cases have been recorded in adults. We describe ten adult patients with well documented Pseudomonas aeruginosa osteomyelitis consequent to puncture wounds. The disease in adults is similar to that in children with respect to bone involved, clinical features, and preferred antibiotic therapy; however, the prognosis for complete recovery without permanent sequelae seems much better in adults.
Adolescent↗