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PubMed1996

[A case of toxic shock syndrome induced by MRSA after sinus surgery].

We present a case of toxic shock syndrome (TSS) induced by MRSA after sinus surgery. The patient was a 64-year-old woman who had undergone sinus surgery because of chronic sinusitis. Nine days after the surgery, she began to have sore throat, fever, and diffuse erythroderma followed by severe hypotension and renal dysfunction. Culture of sputum, nasal discharge and stool showed MRSA. Blood culture was negative. She was treated with intravenous fluids, catecholamines and antibiotics (vancomycin and fosfomycin). Continuous hemodiafiltration was started because of oliguria. Her condition improved gradually and she was discharged about a month after the onset of her illness. We should recognize that TSS can occur as a fatal complication after nasal surgery.

Chronic Disease↗
PubMed1997

[The drug susceptibility pattern of the presumed etiologic agents of infectious enteritis including verotoxin-producing Escherichia coli O-157].

The drug susceptibility patterns were investigated for verotoxin-producing Escherichia coli (VTEC) including O-157, Salmonella spp., Vibrio parahaemolyticus and Campylobacter jejuni subsp. jejuni that were obtained in and after July 1996. The results are summarized as follows; 1. We found highly resistant strains of VTEC to tetracycline (TC) and ampicillin (ABPC). Minimum inhibitory concentrations (MIC) of some of the drugs against VTEC in an aerobic condition were significantly different from those in an anaerobic condition. For example, aerobic.anaerobic MIC ranges of the drugs tested were as follows: chroramphenicol (CP): 1.56-3.13 micrograms/ml.0.78-1.56 micrograms/ml, TC: 1.56-> 100 micrograms/ml.0.78-> 100 micrograms/ml, minocycline (MINO): 1.56-12.5 micrograms/ml.0.78-3.13 micrograms/ml, kanamycin (KM): 3.13-6.25 micrograms/ml.25-100 micrograms/ml, fosfomycin (FOM): 3.13-25 micrograms/ml.0.78-6.25 micrograms/ml, norfloxacin (NFLX): < or = 0.025-0.2 microgram/ml.< or = 0.025-0.2 microgram/ml, ABPC: 1.56-> 100 micrograms/ml.0.78-> 100 micrograms/ml and cefaclor (CCL): 1.56-25 micrograms/ml.56-12.5 micrograms/ml. MICs of CP and tetracyclines (TCs) in an anaerobic condition were lower by twofold and the MIC of FOM was lower by fourfold, but the variabilities of MIC-ranges of NFLX, ABPC and CCL were small. The MIC of KM was high. 2. We observed that some of Salmonella spp. were highly resistant to CP, TCs and MINO, and some were moderately resistant to NFLX. 3. The detection frequency of TC-resistant strains and NFLX-insensitive or resistant strains were high among C. jejuni subsp. jejuni. 4. Strains of V. parahaemolyticus and C. jejuni subsp. jejuni were mostly resistant to ABPC and CCL, MICs of which were in high ranges. 5. Fecal concentrations in MINO, KM, FOM and NFLX reported in literatures are high enough to have some antimicrobial activities, leed dose of ABPC and CCL are quite low.

Aerobiosis↗
PubMed1997

[Predictive factors for development of hemolytic uremic syndrome (HUS) and early intensive treatments for prevention of HUS enterohemorrhagic Escherichia coli infection].

Predictive factors for the development of hemolytic uremic syndrome (HUS) were evaluated in 88 inpatients who suffered from enterohemorrhagic E. coli infections in the outbreak in Sakai, 1996. All in- and outpatients received oral or intravenous fosfomycin within acute phase of hemorrhagic colitis, and HUS complicated 1.4% of them. Persistence of bloody stools and diarrhea were longer in HUS patients than in non-HUS patients, but persistence of abdominal pain was not different in either group. Leukocytosis with leukocyte counts over 15,000/microliters and/or elevated CRP level over 2.0 mg/dl at admission, and fever and/or vomiting in the course of hemorrhagic colitis were more frequent in HUS patients than in non-HUS patients. Early intensive treatments including gammaglobulin, urinastatin, aspirin, and dipyridamole were employed in 34 high risk patients for prevention of HUS. These patients were estimated to be at risk of developing HUS because of incomplete HUS, nephropathy, elevated LDH level, thrombocytopenia, or age younger than two years old. These treatments were clinically effective.

Abdominal Pain↗
PubMed1996

Preoperative administration of antibiotics in patients with suspected acute appendicitis.

The effectiveness of administering antibiotics preoperatively to patients with suspected appendicitis was evaluated over a 2-year period in 105 consecutive patients who presented with right lower quadrant (RLQ) tenderness and a white blood cell (WBC) count of over 10,000/mm3 or a temperature of over 37 degrees C. All the patients were preoperatively administered cefazolin (CEZ), cefotiam (CTM), or fosfomycin (FOM) except those with apparent peritonitis, which resulted in the recovery of 41 patients (39%). Of the remaining 64 patients, 14 (13%) had catarrhal appendicitis, 34 (32%), phlegmonous appendicitis, and 16 (15%), gangrenous appendicitis. Preoperatively, there were no significant differences among these groups in the WBC count or temperature. Following the administration of antibiotics, both these parameters decreased significantly in the patients with catarrhal appendicitis, although a slight RLQ tenderness persisted; in those with phlegmonous appendicitis, the WBC count decreased significantly, but the temperature remained elevated, with slight rebound tenderness in the RLQ; and in those with gangrenous appendicitis, there were no significant differences between the pre- and postoperative data in WBC count or temperature, and the abdominal symptoms did not change. These results show the value of administering antibiotics within 24h of the onset of symptoms indicative of acute appendicitis to allow time to evaluate the patients' condition, decide the operative indications, and prevent unnecessary laparotomy.

Acute Disease↗
PubMed1982

Cefsulodin pharmacokinetics and otitis media.

The pharmacokinetics of cefsulodin in the fluids of the ear and eye as well as in serum were studied after intramuscular administration of 200 and 400 mg/kg to eight groups of six guinea pigs. A retention of cefsulodin in the inner ear-similar to that of the aminoglycoside antibiotics - was observed. As the measured perilymph concentrations of cefsulodin and gentamicin are comparable on a weight for weight basis and as the clinical dosage of cefsulodin is much higher than that of gentamicin, the perilymph concentrations of cefsulodin reached in man are probably much higher than those of gentamicin. The results obtained are compared to those of mezlocillin, azlocillin and fosfomycin, Finally, the importance of the cefsulodin perilymph concentrations in the treatment and prophylaxis of infectious inner ear complications due to the most common pathogens of chronic otitis media as well as in the treatment of certain eye infections is discussed.

Animals↗
PubMed1989

Complement-derived polypeptide C3adesArg as a mediator of inflammation at the blood-brain barrier in a new experimental cat model.

The effect of the complement-derived polypeptide C3adesArg as a mediator of inflammation in the central nervous system was examined. Twenty-five anesthetized cats received 4 mg of this polypeptide by intraventricular injection, 20 cats who served as controls received saline. Cerebrospinal fluid (CSF) was sampled 3 h after intraventricular injection and the brains were removed. For assessment of the permeability of the blood-brain barrier the CSF penetration of four antibiotics, which were given intravenously was measured. Five control animals were employed for each antibiotic (tobramycin, ampicillin, imipenem, fosfomycin), whereas six C3adesArg-treated animals were used for each antibiotic and seven for tobramycin. Besides CSF levels of glucose, the prostanoids 6-keto-prostaglandin F1 alpha, thromboxane B2 and prostaglandin E2 were measured. The morphological examinations in the CSF sediments and histological brain sections in the C3adesArg-treated animals disclosed a distinct inflammation with leptomeningeal and perivascular infiltration of polymorphonuclear granulocytes compared to normal findings in the controls. The CSF/serum ratios of all of the antibiotics were markedly elevated compared to controls, indicating a blood-brain barrier disruption. The levels of all prostanoids were significantly higher in the treatment group than in the control group, whereas the glucose levels were lower. These findings are in accordance with a granulocytic meningitis as seen in some infections at the acute stage. It is concluded that C3adesArg acts as a mediator of inflammation in the central nervous system.

6-Ketoprostaglandin F1 alpha↗
PubMed1988

Antibiotic susceptibilities of Listeria: in vitro studies.

Although Listeria is a rather susceptible bacterium, most antibiotics exert a bacteriostatic effect on Listeria monocytogenes. Except for fosfomycin, antibiotic susceptibilities are similar among the species of the genus Listeria. In vitro, bactericidal effect is often achieved by the use of antibiotic combinations. The most commonly used combinations are ampicillin with aminoglycosides. Up until now, there has been no trend towards reduced susceptibility of Listeria to antibiotics.

Anti-Bacterial Agents↗
PubMedDate not supplied

Haematogenous Serratia marcescens endophthalmitis in an HIV-infected intravenous drug addict.

A case of haematogenous Serratia marcescens endophthalmitis in an HIV-infected intravenous drug addict is described. The patient was admitted with fever, ocular pain and visual loss in the right eye following an i.v. injection of pulverized buprenorphine. A vitreous humor culture grew S. marcescens. The patient was treated with i.v. ceftriaxone (2 g b. i. d.), i.v. amikacin (500 mg b. i. d.) and p. o. fosfomycin (1 g q. i. d.) for three weeks. The ocular infection was cured, although the visual function was lost, leading to blindness. To our knowledge, this is the second case in the reviewed Anglo Saxon literature of S. marcescens endophthalmitis in parenteral drug addicts.

Adult↗
PubMedDate not supplied

Activity of 18 antimicrobial agents against multi-resistant strains of Staphylococcus aureus isolated from intensive care patients.

During an outbreak of infections with multiple-resistant Staphylococcus aureus, 22 strains were isolated from 12 patients between November 1983 and March 1984 on two surgical intensive care units at Kiel University Hospital. Susceptibility of all strains was tested with the disc diffusion method and a microdilution test using different inocula of 10(2) and 10(5) cfu/ml. All strains were resistant to beta-lactam antibiotics, including thienamycin as well as to gentamicin, clindamycin, doxycycline, erythromycin and fosfomycin. Rifampicin was the most active substance in terms of w/v, followed by fusidic acid, ciprofloxacin, vancomycin, and trimethoprim/sulfamethoxazole. Netilmicin and chloramphenicol showed only moderate activity in relation to the antibiotic breakpoint, but were considered sensitive according to the disc diffusion test. Caution should be reserved for the use of imipenem against multiply-resistant staphylococci.

Anti-Bacterial Agents↗
PubMed1992

Short-term treatment of urinary tract infections: the French concept.

The indications for short-term treatment to cure urinary tract infections (UTIs) have been recently clarified in France by a "Consensus Conference". Short-term treatment essentially concerns young, non-pregnant women with symptomatic uncomplicated lower UTI of less than three days duration, with no other underlying severe illness or previous uro-nephrological history, and who accept the idea of clinical and possibly bacteriological control after treatment. Only antibiotics with prolonged urinary excretion are recommended, i.e. co-trimoxazole, fluoroquinolones or fosfomycin-trometamol. In pregnancy, in children, or in the elderly, indications for short-term treatment still remain controversial. As compared with conventional therapeutic strategies using urine cultures, the use of test strips for nitrite and leukocyte esterase for deciding on treatment and assessing its efficacy should allow considerable financial savings.

Anti-Infective Agents, Urinary↗
PubMed1994

Methicillin-resistant Staphylococcus aureus endocarditis following patch closure of a ventricular septal defect: report of a case.

We report herein the case of a 5-month-old infant who, after developing methicillin-resistant Staphylococcus aureus (MRSA) endocarditis following patch closure of a ventricular septal defect (VSD), was successfully treated by replacement of the Dacron patch with an autogenous pericardial patch. Initially, a large perimembranous VSD was repaired with a Dacron patch and after an uneventful recovery of 1 week, he began to spike intermittent fevers from 38 degrees C to 39 degrees C. Two blood cultures grew MRSA and a two-dimensional echocardiogram performed 16 days after surgery showed an irregular mass attached to the right ventricular aspect of the Dacron patch. At reoperation, a large vegetation attached to the Dacron patch was confirmed, but there was no patch dehiscence. Following removal of the patch, the VSD was repaired with an autogenous pericardial patch, soon after which the fever rapidly subsided. Imipenem, 125 mg every 6 h, and fosfomycin, 300 mg every 6 h, were administered for a total of 24 days after reoperation. The child remains well 12 months after his second operation.

Endocarditis, Bacterial↗
PubMed1992

In vitro and in vivo effect of antibiotics on catheters colonized by staphylococci.

An in vitro model was used to study whether and how catheter infections can be cured. Silastic catheters were "infected" with Staphylococcus aureus ATCC 25923 and Staphylococcus epidermidis KH11 and V2; these "infections" were then treated with 24, 48 and 96 h continuous infusions of various antimicrobial agents administered both as monotherapy and in combination. The Staphylococcus aureus strain was considerably more difficult to eliminate from catheters than were the Staphylococcus epidermidis strains. This experience gained in the laboratory was then applied in vivo to 16 episodes of catheter sepsis in seven children. Treatment for at least six days with imipenem/cilastatin combined with fosfomycin or an aminoglycoside successfully eliminated the pathogens isolated from 11 of the 16 episodes of infection. The broad-spectrum combination was chosen because it could not be assumed that individual pathogens would be sensitive to a single substance. Nine of the infected catheters could be retained in the patients. This experience suggests that it may be possible to successfully eliminate the colonization of central venous catheters by coagulase-negative staphylococci using the antimicrobial agents employed here.

Anti-Bacterial Agents↗
PubMed2000

Management of biofilm infections in the urinary tract.

Bacterial biofilms develop on a number of living and inert surfaces within the urinary tract, producing chronic intractable infections. The role of exopolysaccharides in producing a variety of extracellular polymeric substances according to the infection site and bacterial species and the clinical features of the resulting biofilm infections were reviewed. Although fluoroquinolone shows a considerable killing effect against bacterial biofilm, no commercially available drugs are sufficiently active against the cells in a mature biofilm. Combination therapy of fluoroquinolone and macrolide or fluoroquinolone and fosfomycin may be the most effective regimen available at present. Nevertheless, management of the local urinary condition and removal of the local underlying disease are the most effective approaches to treating urinary biofilm infection.

Biofilms↗
PubMed2004

Antibiotic resistance rates and phenotypes among isolates of Enterobacteriaceae in French extra-hospital practice.

Antibiotic resistance among members of the family Enterobacteriaceae was prospectively surveyed by eight French private laboratories over a 5-month period in 1999. A total of 2,599 consecutive and nonduplicate strains were collected, mainly (60.9%) from patients in the community. Most strains (82.9%) derived from urine. Escherichia coli was the predominant (73.9%) organism isolated. The overall rates of antibiotic resistance were as follows: amoxicillin, 53.4%; amoxicillin-clavulanic acid, 27.3%; ticarcillin, 44.2%; piperacillin-tazobactam, 3.2%; cephalothin, 29.2%; cefuroxime, 14.7%; cefoxitin, 11.5%; ceftazidime, 3.6%; cefotaxime, 2.8%; cefepime, 0.3%; imipenem, 0.1%; gentamicin (G), 3.8%; tobramycin (T), 5.0%; netilmicin (Nt), 3.7%; amikacin (A), 0.7%; nalidixic acid, 14.3%; ofloxacin, 10.4%; cotrimoxazole, 21.1%; nitrofurantoin, 12.7%; fosfomycin, 5.2%; tetracycline, 50.1%; and colistin, 12.5%. Beta-lactam resistance phenotypes essentially comprised penicillinase production (33.9%), overexpression of chromosomal cephalosporinase (4.6%), and synthesis of inhibitor-resistant TEM/OXA enzymes (1.5%) or extended-spectrum beta-lactamases (1.5%). Aminoglycoside resistance phenotypes consisted of GTNt (93 strains), TNtA (68 strains), GTNtA (14 strains), T (4 strains), GT (3 strains), G (1 strain), and reduced uptake/permeability (3 strains). Most of the nalidixic acid-resistant strains were resistant to ofloxacin (72.8%). Antibiotic resistance rates and phenotypes varied widely according to the bacterial group and the source of the strains. Significantly higher rates were observed in private healthcare centers than in the community, due to a higher proportion of both resistant species and resistant strains. However, multidrug-resistant isolates, including five extended-spectrum beta-lactamase-producing strains, were also recovered from the community.

Ambulatory Care↗
PubMed1998

Strain-specific differences in the amount of Shiga toxin released from enterohemorrhagic Escherichia coli O157 following exposure to subinhibitory concentrations of antimicrobial agents.

There is no consensus regarding the benefit versus harm of antibiotic therapy for treatment of disease due to enterohemorrhagic Escherichia coli O157. The effects in vitro of subinhibitory concentrations of 13 antimicrobial agents on the release of Shiga toxin (Stx) by three different Escherichia coli O157 strains expressing Stx 1 or Stx 2 either alone or in combination were investigated. The Stx-induced cell death of Vero cells was determined using a colorimetric assay based on the measurement of lactate dehydrogenase (LDH) released into the supernatant from the cytosol of damaged cells. Growth of all O157 strains in broth cultures containing subinhibitory concentrations of cotrimoxazole, trimethoprim, azithromycin, or gentamicin was accompanied by a marked increase in the release of Stx. Exposure to cefixime, ceftriaxone, or erythromycin caused a marked increase in the release of Stx by the O157 strain producing Stx 2 alone, but decreased toxin production was observed with the Stx 1 producer and the strain producing Stx 1 and Stx 2. Exposure to ampicillin caused increased Stx release in the Stx 2-producing strain but had no effect on Stx production in the other two test isolates. Exposure to penicillin G, streptomycin, ciprofloxacin, fosfomycin, or sulfamethoxazole caused an increase in toxin production in two of the three test strains in each case, while decreases were observed for the other isolates. The response of Escherichia coli O157 isolates to subinhibitory concentrations of antibiotics seems to be highly dependent on the nature of the strain involved.

Animals↗
PubMed2000

Antibiotic susceptibility of bacterial strains isolated from patients with community-acquired urinary tract infections in France. Multicentre Study Group.

The aim of this study was to determine the distribution and antibiotic susceptibility patterns of bacterial strains isolated from adults with community-acquired urinary tract infections (UTI) in France. From December 1996 to March 1997, each of 15 private laboratories in France consecutively collected about 80 non-duplicate strains isolated from adult outpatients with UTI, including patients receiving care at home, and tested their susceptibility by the disk diffusion test. A total of 1160 strains were collected: 1031 gram-negative bacilli, including Escherichia coli (n = 865), Proteus mirabilis (n = 68) and Klebsiella spp. (n = 40), and 129 gram-positive cocci, including Staphylococcus aureus (n = 16), other staphylococci (n = 25), group B streptococci (n = 25) and enterococci (n = 63). In the case of 430 bacterial isolates, the patients had either been hospitalised in the last 6 months or received antibiotic treatment in the last 3 months. The antibiotic susceptibility rates for Escherichia coli were: amoxicillin (58.7%), amoxicillin-clavulanic acid (63.3%), ticarcillin (61.4%), cephalothin (66.8%) cefuroxime (77.6%), cefixime (83.6%), cefotaxime (99.8%), ceftazidime (99%), nalidixic acid (91.9%), norfloxacin (96.6%), ofloxacin (96.3%), ciprofloxacin (98.3%), cotrimoxazole (78.2%), fosfomycin (99.1%) and gentamicin (98.4%). Of the Enterobacteriaceae, five strains produced an extended-spectrum beta-lactamase. Methicillin resistance was detected in nine Staphylococcus aureus isolates. The most important findings were two extended-spectrum, beta-lactamase-producing and three methicillin-resistant Staphylococcus aureus strains isolated from patients who had not been hospitalised in the last 6 months or taken antibiotics in the last 3 months. The findings indicate that these strains can spread within the community; therefore, monitoring antibiotic susceptibility of bacteria isolated in the community appears to be mandatory.

Adolescent↗
PubMed2001

Natural antibiotic susceptibility of recently established coryneform bacteria.

The natural susceptibility of 20 strains each of Brevibacterium casei (formerly CDC coryneform groups B-1 and B-3), Dermabacter hominis (formerly CDC coryneform groups 3 and 5), and Turicella otitidis (formerly coryneform group ANF-1-like) isolated from clinical specimens to 71 antibiotics was investigated. Susceptibility testing was carried out with a microdilution procedure using H medium. All three species were naturally sensitive to tetracyclines, most aminoglycosides, carbapenems, macrolides, lincosamides, glycopeptides, and rifampin. Susceptibility patterns indicating natural resistance to pipemidic acid, sulfamethoxazole, and cotrimoxazole also were found for all three species. Species-dependent discrepancies in susceptibility leading to completely different categorizations (changing from sensitive to resistant or vice versa) were found for some penicillins (e.g., oxacillin and amoxicillin), a few cephalosporins (e.g., ceftibutene), aztreonam, tobramycin, norfloxacin, fleroxacin, trimethoprim, nitrofurantoin, fosfomycin, and fusidic acid. For the majority of antibiotics, Brevibacterium casei was the least susceptible species and Turicella otitidis the most susceptible taxon. The present study describes a database on the natural susceptibility of Brevibacterium casei, Dermabacter hominis, and Turicella otitidis to a wide range of antibiotics. This database can be applied for the validation of susceptibility testing results of these recently established coryneform bacteria.

Actinomycetales↗
PubMed2006

Neutralizing activity of bovine colostral antibody against verotoxin derived from enterohemorrhagic Escherichia coli O157:H7 in mice.

The neutralization efficacy of bovine colostral antibody against verotoxin (VT) 1 and 2 was investigated. Cows were immunized with VT1 or VT2 fourteen times at 7-day intervals. A colostral antibody exhibiting high titers was obtained from immunized cows. Survival rates were evaluated in mice administered VT1 or VT2, and those infected with Escherichia coli (E. coli) O157:H7 producing VT1 or VT2. Survival rates after VT1 administration were 100% in the single-administration group, 90% in the repeat-administration group, and 78.6% in the control group. Survival rates after VT2 were 75.0% in the single-administration group, and 100% in the repeat-administration group. All mice in the control group died. Colostral antibody and fosfomycin (FOM) in the colostral antibody group and FOM and skim milk in the control group were administered three times per day for 5 days to mice infected with E. coli O157:H7 producing VT1 or VT2. Survival rates after inoculation with E. coli O157:H7 producing VT1 were 80.0% in the colostral antibody group, and 63.6% in the control group. Survival rates after inoculation with E. coli O157:H7 producing VT2 were 83.3% in the colostral antibody group, and 20.0% in the control group. The survival rate in mice without treatment following inoculation with E. coli O157:H7 producing VT2 was 88.2%. The survival rates in mice infected with E. coli O157:H7 strains producing VT1 or VT2 improved after administration of this colostral antibody, which exhibited neutralization efficacy against VT.

Animals↗