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The modulation by fresh and spent peritoneal dialysis fluids of antibiotic kinetics directed against Staphylococcus epidermidis biofilms.

The presence of CAPD peritoneal catheters has an association with S. epidermidis infections which are relatively resistant to antibiotic therapy. This resistance has been ascribed to the formation by the bacteria of a protective matrix on the catheter surface enclosing the bacteria to form a bacterial biofilm. The rate of action of 14 antibiotics on standardized S. epidermidis bacterial biofilms over a 5 day exposure period and the modifying effects of fresh and spent peritoneal dialysis fluids were assayed. There were significant differences in the rates of antibiotic action. Fresh dialysis solution markedly augmented rifampin activity, and to a lesser extent, vancomycin, cloxacillin and teicoplanin but antagonized ciprofloxacin. Spent dialysis fluid generally augmented the activity of antibiotics, notably cloxacillin and cephalothin. Rifampin was bactericidal in both fresh and spent dialysis fluids. Fusidic acid was a poor performer in all tests.

Anti-Bacterial Agents↗

AIDS-related complex treated by antiviral drugs and allogeneic bone marrow transplantation following conditioning protocol with busulphan, cyclophosphamide and cyclosporin.

A 26-year-old man with AIDS-related complex (ARC) was treated with high-dose busulphan and cyclophosphamide, followed by allogeneic bone marrow transplantation. For 3 months before transplantation he received a combination of four drugs considered active against human immunodeficiency virus (HIV) to reduce the viral burden: zidovudine, acyloguanosine, fusidic acid and phenylidantoin. Although in reduced doses in coincidence with marrow engraftment, zidovudine therapy was scheduled after transplantation in order to protect donor cells from infection with HIV. Engraftment rapidly occurred and was documented by cytogenetic analyses. The post-transplant course was characterized by severe acute GvHD with irreversible hepatorenal failure. The patient died on day 48 after transplantation. Polymerase chain reaction analyses for detecting HIV DNA showed the persistence of positivity at day +30 and +45 after transplantation. Antibodies to specific HIV proteins evaluated with Western blot testing also persisted at days +21 and +35 after transplantation. Circulating immunocomplexes disappeared on day +31, and an increase in the CD4/CD8 ratio occurred. The short survival of the patient, affected by chronic hepatitis too, does not allow final conclusions about the role of BMT in HIV disease.

AIDS-Related Complex↗

Staphylococcus aureus carriage in selected communities and their antibiotic susceptibility patterns.

The carriage and antibiotic susceptibility patterns of Staphylococcus aureus in the community were determined. Nasal, throat and axillary swabs were taken from 100 healthy adults and 90 disabled nursing home inmates. Antibiotic disc susceptibility testing was conducted following the NCCLS method. Staphylococcus aureus carriage was noted in 29% of healthy adults and 47.7% of nursing home inmates. Out of 79 strains, resistance to antibiotics were as follows; penicillin (92.4%), genetamicin (2.5%), tetracycline (6.3%), fusidic acid (11.3%), erythromycin (3.8%), pefloxacin (5.1%), mupirocin (3.8%), amikacin (3.8%), ciprofloxacin (2.5%) and chloramphenicol (2.5%). Methicillin-resistant Staphylococcus aureus was not isolated. Multiple colonizations and multi-antibiotic resistant Staphylococcus aureus were shown to occur in healthy individuals without risk factors and not previously hospitalized.

Adult↗

[Community-acquired cutaneous infections: causal role of some bacteria and sensitivity to antibiotics].

OBJECTIVE: Identify the bacteria responsible for cutaneous infections observed in private practice and test their sensitivity to currently used antibiotics. PATIENTS AND METHODS: The patients were examined by dermatologists. A bacteriological sample was taken and sent to a central laboratory for identification of the germ and antibiograms were performed and the minimal inhibiting concentrations (MIC) determined. RESULTS: Folliculitis, impetigo and furuncles were the three most frequent primary infections. Four hundred and forty-three patients were included and 442 samples were placed in culture. Cultures were positive in 265 cases (a single bacterial strain in 231 cases). Staphylococcus aureus was isolated in 208 cases, streptococci in 11 and enterobacteria in 3; occasionally several germs were present. Eight strains of staphylococci were meti-R (4 p. 100). All the strains were sensitive to pristinamycin and mupirocin and 90 p. 100 were sensitive to fusidic acid. CONCLUSION: The occurrence and diffusion of resistant strains is a daily concern in hospitals. In general practice, although care must be taken, the problem rarely occurs and the antibiotics used remain effective.

Adolescent↗

[Rhabdomyolysis due to simvastin. Apropos of a case with review of the literature].

A new case of simvastatin-induced acute rhabdomyolysis with heart failure after initiation of treatment with fusidic acid is reported. In most reported instances, statin treatment was initially well tolerated with muscle toxicity developing only after addition of another drug. The mechanism of this muscle toxicity is unelucidated but involvement of a decrease in tissue Co enzyme Q is strongly suspected.

Aged↗

A child with Bartonella henselae osteomyelitis of the right humerus.

We present a case of a 22-month-old child with swollen upper part of the right arm and osteolytic lesion of the right humerus, which resembled a neoplastic process. Epidemiological history revealed no scratch marks on the skin or cutaneous papule or pustule. Presumptive diagnosis of hematogenous osteomyelitis was established, but treatment with fusidic acid was unsuccessful. Histological examination of the bioptic specimen of the soft tissue swelling showed a lymph node morphology, with numerous granulomas with central stellate necrosis. Indirect immunofluorescence assay for Bartonella henselae yielded positive results. New treatment included 15 days of trimetoprime and sulfamethoxazole, followed by azithromycin for 5 days. Four months later, swelling resolved and osteolytic lesion almost completely healed with formation of surrounding sclerosis. In conclusion, cat-scratch disease without positive epidemiological history and primary cutaneous papule or pustule may be a serious diagnostic problem, but can be solved by serological and histological examination.

Animals↗

Facial cellulitis associated with Pseudomonas aeruginosa complicating ophthalmic herpes zoster.

Cellulitis is a rare and severe soft-tissue infection characterized by acute, diffuse, spreading inflammation, often associated with systemic symptoms such as malaise and fever. Surgery of the head and neck, dental infections, sinusitis, upper respiratory tract infections, and trauma are the most common portal of entry for pathogens in facial cellulitis. A very unusual case complicating an ophthalmic herpes zoster in a 74-year-old woman was observed at the department of dermatology, Cagliari University (Italy). Culture of skin swabs showed growth of numerous Gram-negative bacilli, further identified as Pseudomonas aeruginosa. Therapy with intravenous ciprofloxacin was promptly instituted on the basis of the culture and sensitivity report. She was initially treated with daily drainage and twice-daily topical fusidic acid. The lesion completely resolved in 4 weeks, and no general complications or recurrence have been observed for 6 months. Early recognition and management of facial cellulitis is mandatory to avoid serious and generalized complications. Pseudomonas aeruginosa is rarely reported in facial cellulitis; there are apparently no reports of this infection occurring as a complication of ophthalmic herpes zoster. Herpetic damage of the anatomic barrier as well as impairment of defense mechanisms because of decompensated diabetes mellitus may have facilitated the colonization and proliferation of this opportunistic pathogen in our patient.

Aged↗

New strategies for the treatment of infections associated with prosthetic joints.

Treatment of infections associated with orthopedic devices usually requires appropriate surgical intervention combined with a prolonged course of antimicrobial therapy. The choice of optimal management depends on duration and pathogenesis of infection, stability of the implant, antimicrobial susceptibility of the pathogen and condition of the soft tissue. The role of rifampin in combination with quinolones, minocycline, co-trimoxazole or fusidic acid in the treatment of staphylococcal infections is outlined in this review. Increasing antimicrobial resistance requires the use of alternative agents, such as quinupristin-dalfopristin, linezolid and daptomycin, but results of clinical trials are limited. Finally, agents with a potential for treatment or prophylaxis of device-associated infections, such as novel rifamycin derivatives, and compounds acting on bacterial quorum-sensing mechanisms are presented in this review.

Animals↗

Susceptibility of methicillin-resistant Staphylococcus aureus to vancomycin, teicoplanin, linezolid, pristinamycin and other antibiotics.

BACKGROUND: Methicillin-resistant Staphylococcus aureus is a major nosocomial pathogen worldwide. Vancomycin is the traditional drug of choice, but decreasing susceptibility to vancomycin and other glycopeptides has been reported since 1996. OBJECTIVES: To test the in vitro activity of linezolid (oxazolidinone) and other antimicrobial agents against MRSA isolates recovered from hospitalized patients. METHODS: We tested 150 MRSA isolates recovered from hospitalized patients. The minimal inhibitory concentration of vancomycin, teicoplanin, pristinamycin (quinupristin-dalforistin) and linezolid was determined by the Etest method. Susceptibility to other antibiotics was tested by the disk diffusion method. RESULTS: All isolates were sensitive to vancomycin, teicoplanin, pristinamycin, and linezolid. The MIC90 was 2.0 microg/ml for vancomycin and teicoplanin (range 0.5-2.0 microg/ml and 0.125-2.0 microg/ml, respectively), and 0.5 microg/ml for pristinamycin and linezolid (range 0.125-0.75 microg/ml and 0.125-0.5 microg/ml, respectively). Of the other antibiotics, fusidic acid showed the best in vitro activity, with 96.7% susceptibility, associated with trimethoprim/sulfamethoxazole (85.8%) and minocycline (84%). Penicillin was associated with the lowest susceptibility (1.3%), associated with ofloxacin (3%) and erythromycin (14%). An increase in the minimal inhibitory concentration value of vancomycin was associated with a significant decrease in resistance to TMP-SMZ (P < 0.01) and an apparent increase in resistance to other antibiotics. CONCLUSION: The excellent in vitro activity of linezolid and its reported in vivo effectiveness renders it an important therapeutic alternative to vancomycin in the treatment of MRSA infection.

Acetamides↗

Community acquired MRSA infections in a paediatric population in Greece.

We investigated the characteristics of 20 community acquired methicillin resistant Staphylococcus aureus (MRSA) strains isolated in a paediatric hospital in Athens. Eighteen of these, all isolated from skin and soft tissue infections, carried the Panton-Valentine leukocidin (PVL) determinants. They all were found resistant to fusidic acid, tetracycline and kanamycin, and displayed a PFGE pattern identical to that of the well-described ST80 CA-MRSA clone circulating in various European countries.

Child↗

[Comparison of the antibiotic sensitivity of lipophilic Corynebacterium sp. isolated from patients on the day of admission and during hospitalization].

Lipophilic species of Corynebacterium are increasing problem in hospital infections. The aim of this study was to evaluate occurrence of these microorganisms in the materials taken from patients in the day of admission and during the hospitalization as well as comparison of their antibiotic sensitivity. The investigation included 65 strains isolated from hospitalized patients and 48 strains isolated from unchanged skin. Using Api Coryne test 5 species were identified. C. urealyticum dominated, the other were C. subsp. lipophilum and C. jeikeium. Among strains isolated from unchanged diseased skin the most C. jeikeium and C. accolens occurred. All strains were sensitive to glycopeptide, quinupristin/dalphopristin. The strains isolated from hospitalized patients were usually sensitive to fuside acid, doxycycline as well as tetracycline. Strains isolated from unchanged skin were sensitive to almost all tested antibiotics. In the group of 65 strains isolated from hospitalized patients 99.0% were multiresistant. In the group of strains isolated from unchanged skin only two strains were multiresistant. Differences in antibiotic sensitivity among analysed Corynebacterium sp. were confirmed. Majority of the "hospital strains" were characterized by multiresistance. Basing on these results it is possible to suppose, that multiresistance is main factor that favours lipophilic Corynebacterium species in the process of colonization of mucous membranes, skins as well as developing infections.

Anti-Bacterial Agents↗

[Rational use of antibiotics in mucoviscidosis pediatric cases with an account of local microbiological monitoring].

The results of local microbiological monitoring of bronchial secretion in 482 children with mucoviscidosis observed within 2000-2004 in the Republican Centre of Mucoviscidosis are presented. The results provided development of recommendations for rational use of antibiotics in the treatment of infectious processes in pediatric patients with mucoviscidosis. Since the emergence of MRSA in such patients is low, it is recommended to use antistaphylococcal betalactams (oxacillin, cefazolin, amoxycillin/clavulanate) for the treatment of infections due to S. aureus. For the treatment of infections due to some other pathogens, except S. maltophilia, the most active betalactams were carbapenems (imipenem and meropenem). Ciprofloxacin was active against numerous etiological agents causing low respiratory tract infections in children with mucoviscidosis except S. maltophila and A. xylosoxidans subsp. xylosoxidans. For the treatment of infections due to P. aeruginosa, P. aeruginosa muc. and K. pneumoniae the most active aminoglycosides were amikacin and tobramycin (for P. aeruginosa and P. aeruginosa muc.), while gentamicin was not active in such cases. As for antibiotics of other groups, high activity against S. aureus in the treatment of children with mucoviscidosis was recarded with the use of vancomycin, fusidic acid and rifampicin. Azithromycin and co-trimoxazole were active against H. influenzae. Chloramphenicol was active against S. maltophilia, B. cepacia and H. influenzae in the treatment of such patients.

Anti-Bacterial Agents↗

Topical antibiotics for acute bacterial conjunctivitis: Cochrane systematic review and meta-analysis update.

BACKGROUND: Uncertainty remains about the extent to which findings from our previously published systematic review and meta-analysis of double-blind, randomised controlled trials of topical antibiotics compared with placebo in the management of patients with acute bacterial conjunctivitis treated in secondary care outpatient settings are generalisable to the management of the condition in primary care settings. We updated our review, undertaking searches, methodological assessment, data extraction and analysis according to a pre-defined protocol. In addition to the previous three included studies, we identified two additional double-blind primary care trials, one which compares fusidic acid gel with placebo gel and one which compares chloramphenicol eye drops with placebo eye drops in children. Meta-analyses of clinical and microbiological remission data reveal that topical antibiotics are of benefit in improving early (days 2-5) clinical (relative risk [RR] = 1.24, 95% confidence interval [CI] = 1.05 to 1.45) and microbiological (RR = 1.77, 95% CI = 1.23 to 2.54) remission rates; later (days 6-10) data reveal that these early advantages in clinical (RR = 1.11, 95% CI = 1.02 to 1.21) and microbiological cure rates are reduced (RR 1.56, 95% CI = 1.17 to 2.09), but persist. Most cases of acute bacterial conjunctivitis resolve spontaneously. While topical antibiotics are associated with significantly improved rates of early (days 2-5) clinical remission, this benefit is marginal for later remission (days 6-10).

Acute Disease↗

[Resistance of Staphylococcus aureus isolated from burn wounds to antibiotics].

OBJECTIVE: To determine the colonization rate of Staphylococcus aureus in burn wounds and to assess the variation in the resistance of Staphylococcus aureus strains to antibiotics. MATERIAL AND METHODS: A retrospective study of 72 patients with burn wounds was carried out during 1997 and 2003. Specimens taken from burn wounds at first, fifth, and later every seventh day of hospitalization were placed in transport medium. Isolates were grown on mannitol salt agar. Cultures of Staphylococcus aureus were determined using plasmacoagulase and DNA-ase tests. The resistance of Staphylococcus aureus strains to penicillin, oxacillin, ceftazidime, vancomycin, gentamicin, kanamycin, tobramycin, doxycycline, ciprofloxacin, cefepime, fusidic acid, and clindamycin was determined. The isolated strains of Staphylococcus aureus were tested for resistance to methicillin by performing a disc diffusion method using commercial discs (Oxoid) (5 microg methicillin per disk and 1 microg oxacillin per disk). RESULTS: During 1997-2003, a total of 221 Staphylococcus aureus cultures were isolated from burn wounds. More than one-fourth of all isolated Staphylococcus aureus strains (25.3%) were resistant to methicillin; 64% of methicillin-sensitive Staphylococcus aureus strains were resistant to clindamycin and 28-30% - to gentamicin and kanamycin. The resistance rate of methicillin-resistant Staphylococcus aureus strains to doxycycline, clindamycin, oxacillin, tobramycin, gentamicin, and kanamycin was 78.5-98%. Majority of Staphylococcus aureus strains were non-susceptible to ceftazidime (91-100%); the rate of resistance to clindamycin decreased from 99% to 36%, (p<0.05) and to ciprofloxacin - increased from 55-65% to 81% (p<0.05). CONCLUSIONS: Staphylococcus aureus was the most prevalent pathogen isolated from burn wounds. On the first day of hospitalization Staphylococcus aureus isolates were obtained from 25.3% of patients; 12.5% of patients with burn wounds had methicillin-resistant Staphylococcus aureus at the end of the first week of hospitalization and 66% of patients--after two weeks and later. The resistance of methicillin-susceptible Staphylococcus aureus to gentamicin, tobramycin, and clindamycin decreased. The resistance of methicillin-resistant Staphylococcus aureus to clindamycin decreased and to ciprofloxacin--increased.

Anti-Bacterial Agents↗

[Reduced susceptibility to triclosan in methicillin-resistant Staphylococcus aureus].

Susceptibility to triclosan in Staphylococcus aureus was determined. The study was carried out on 200 strains, including 100 resistant (MRSA) and 100 susceptibile (MSSA) to methicillin. The examined strains were isolated from varied clinical samples and patients in 18 medical centers, in majority from hospitals in the region of Gdansk. The susceptibility was estimated by the MIC (minimal inhibitory concentration) using dilution test in Mueller-Hinton agar. The antimicrobial resistance patterns were determined, including resistance to methicillin and mupirocin. The most of MRSA strains (62%) demonstrated reduced susceptibility to triclosan (MIC 2mg/L), while 93% of MSSA strains were highly sensitive to this antibacterial agent (MIC 0,031mg/L). The majority (66,1%) of MRSA strains with reduced susceptibility to triclosan demonstrated the same antimicrobial resistance pattern. Reduced susceptibility to triclosan was observed in 8 from 9 high - level mupirocin resistant strains, but the most of MRSA strains with reduced triclosan susceptibility (91,5%) were found among fusidic acid resistant strains.

Anti-Infective Agents, Local↗

[Epidemic outbreak of methicillin-resistant Staphylococcus aureus in a general hospital. Preliminary report].

The incidence of MRSA infections in Spain had remained in a low level through the years, being MRSA usually less than 1.5% of all S. aureus isolates. Since October 1988, we have detected in our hospital a MRSA outbreak. The epidemic started in the surgical wards, and spread through the rest of the institution. The incidence of cases was higher in the ICU's, areas that act as "multipliers" of the outbreak. In spite of standard control measures, the total number of patients with MRSA was 245 in April 1990. We studied prospectively a sample of 100 MRSA patients: thirty-six percent were colonized and 46% infected. The more common source of infection was the lower respiratory tract and primary bacteremia. The infection-related mortality was 30%. Our MRSA strain belong to phage type III, and shows a characteristic multiple antibiotic resistant pattern, the MRSA strain is sensitive to vancomycin, fusidic acid, phosphomycin and cotrimoxazole. Over the entire outbreak period, the MRSA strain developed resistance to rifampin, imipenem-cilastatin and ciprofloxacin. In spite of all control measures implemented, the outbreak can not have been totally controlled, and MRSA is now an endemic pathogen in our institution. Therefore, major changes in therapeutic approach to nosocomial infections have been since then introduced.

Adult↗

Sensitivity of oral bacteria to imipenem and other antibiotics.

Specimens from a variety of oral and maxillofacial infections were cultured and 88 bacterial isolates belonging to the genera Bacteroides, Actinomyces, Staphylococcus, Veillonella, Eubacterium, Streptococcus and Aerococcus were obtained. These were tested for their sensitivity to imipenem, penicillin, cefuroxime, vancomycin, erythromycin and fusidic acid. Imipenem proved to be the most effective of the antibiotics tested, inhibiting all 88 isolates. Penicillin was the least effective in that it inhibited only 56% of the isolates.

Anti-Bacterial Agents↗

[Drug sensitivity of bacterial strains isolated from clinical specimens during the years 1987-1988].

Sensitivity to selected chemotherapeutics of various bacterial strains was analysed. Bacteria were isolated from the different material collected from patients within 1987-1988, and included: 690 strains of staphylococci, 465 strains of streptococci, 1224 strains of aerobic gram-negative bacilli, and 163 strains of anaerobic micro-organisms. Out of isolated staphylococci, the highest percentage was sensitive to vancomycin, pristinamycin, and fusidic acid. Vancomycin proved the most effective against streptococci followed by chloramphenicol and netilmicin . However, streptococci were highly sensitive to vancomycin within two years whereas their sensitivity to chloramphenicol and netilmicin .

Anti-Bacterial Agents↗