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PubMed1989

[Clinico-etiological observation of 13 cases of mycobacterial keratitis].

We report a series of 13 cases of atypical mycobacterial keratitis encountered in 1986 and 1987. The ratio of mycobacterial keratitis to the total number of corneal ulcer cases increased recently from 1% in 1984 to 8% in 1988 at our clinic. The diagnosis was established by a positive acid-fast stain of smear and a Löwenstein-Jensen media culture. Of the 13 cases, 12 were diagnosed within one week after the first presentation. All cases had a history of corneal trauma; there was foreign body injury in 10 cases, pterygium surgery in 2 cases and penetrating keratoplasty in one case. The clinical pictures of mycobacterial keratitis mostly included anterior stromal infiltrate (100%), necrotic abscess (69.2%), migration lesion (69.2%) and Descemet's folding (61.5%), showing resemblances to fungal keratitis in their characteristics. Species identification showed 11 cases of Mycobacterium fortuitum and 2 cases of Mycobacterium chelonei. On the sensitivity test Rifampin (12 cases, mean 19 mm), Kanamycin (11 cases, mean 29 mm), Ethambutol (11 cases, mean 28 mm), Amikacin (11 cases, mean 19 mm), Netilmicin (9 cases, mean 20 mm) and Tobramycin (8 cases, mean 20 mm) were more effective. Ten of the 13 cases completely healed after treatment and remained quiet during the follow up period of more than one year. In the other 3 cases there was no follow up. We emphasize that the recognition of the clinical features of the corneal findings will facilitate an early diagnosis of this disease and is of essential importance for the salvage of the eye.

Adult↗
PubMedDate not supplied

[Sensitivity profile of 147 strains of S. aureus isolated from patients in continuous ambulatory peritoneal dialysis].

Staphylococcus aureus is reported to be the most common organism to cause peritonitis in continuous ambulatorial peritoneal dialysis (CAPD). Staphylococcal nasal carriage is frequently seen in these patients. The authors studied the sensitivity of S. aureus strains isolated from CAPD patients and some close family contacts. Susceptibility of 147 strains of S. aureus to 23 antimicrobial agents were determined based on 348 samples. All strains tested were susceptible to vancomycin. Penicillin resistance was found in nearly all strains. Resistance to rifampicin was seen in just 5% of the strains. A high rate of resistance to ampicillin, amoxicillin, tetracycline, and also to cotrimoxazole, gentamicin, and tobramycin were observed. Cephalosporins and some aminoglycosides (amicacin and netilmicin) have a good in vitro bactericidal activity anti-S. aureus. Knowledge of the susceptibility profile of bacteria frequently isolated at a given hospital ward will provide the basis for a more effective empirical antibiotic treatment in such ward.

Humans↗
PubMed1989

Isolation of Eikenella corrodens from a liver abscess. Case report.

Eikenella corrodens was isolated from a posttraumatic liver abscess in a man with previous hemicolectomy for sigmoid adenocarcinoma. Escherichia coli was the initial isolate, but sepsis persisted after its eradication by cefuroxime and metronidazole. A second specimen yielded E. corrodens which responded promptly to combined ampicillin and netilmicin. The patient died of disseminated cancer 6 months later.

Athletic Injuries↗
PubMed1989

[Sensitivity of Salmonella strains to Augmentin and new generation cephalosporins and aminoglycosides].

The authors evaluated the sensitivity of Salmonella rods to augmentin (amoxicilin and clavulanic acid) and 23 antibiotics routinely used in antibiograms. Salmonella strains were isolated in the years 1987-88 from the faeces of children and adults. It was found that 94% of strains were sensitive to augmentin. Among cephalosporins the most effective were cefotaxime and cephtriaxone (100% of sensitive strains) and among aminoglycosides--amikacin (100%) and netilmicin (93%). S. typhimurium revealed greater resistance to antibiotics than S. enteritidis, which points to the need of making antibiograms before starting a therapy of infections induced by S. typhimurium.

Adult↗
PubMed1989

[Resistance of enterobacteria and Pseudomonas to old and new antimicrobial agents].

Antibiotic sensitivity to eight common use antibiotics for 9,538 enterobacteria and Pseudomonas strains isolated from hospitalized children was studied using the serial dilution plate technique. Minimum inhibitory concentration to seven new antibiotics for 310 strains was also determined. Enterobacteria showed high resistance (50-80%) to ampicillin, carbenicillin, sulbenicillin, chloramphenicol and trimethoprim/sulfamethoxazole; resistance to piperacillin, gentamicin, tobramycin, and netilmicin was moderate (15-45%), and resistance to amikacin, cefotaxime, moxalactam and aztreonam was low (2-10%). Pseudomonas strains showed less than 20% resistance to carbenicillin, piperacillin, amikacin and aztreonam. Enterobacteria isolated from urine samples showed low resistance to nitrofurantoin and nalidixic acid (15%). Therapeutic recommendation for most frequent infections caused by these etiologic agents based on the resistance values found were elaborated.

Anti-Bacterial Agents↗
PubMed1989

[Treatment of superinfections caused by pyocyanic bacillus in patients with mucoviscidosis. Efficacy of cefsulodin in combination with an aminoglycoside].

UNLABELLED: Cefsulodin is a third generation cephalosporin with specific antipseudomonas activity. We used cefsulodin in combination with aminoglycosides in 15 cystic fibrosis patients treatments. There were 13 children or adolescents, 4 to 19 years old with chronic Pseudomonas aeruginosa lung infections: 9 patients had acute exacerbations of infection with occasionally important respiratory insufficiency and 5 patients had a regimen of regular treatment every 3 months. Cefsulodin was given after record of bacterial sensitivity to antibiotics, at the mean posology of 100 mg/kg, IV, tid. The combination with aminoglycosides was systematic: tobramycin (6 mg/kg/day), netilmicin (6 mg/kg/day) or amikacin (30 mg/kg/day). Duration of treatment was 9 to 15 days. RESULTS: --clinical improvement in all patients, important in 13 patients and moderate in 2 patients;--respiratory function improvement in 11 patients;--pulmonary radiography improvement in 10 patients;--Pseudomonas were eradicated in 8 patients but temporarily and were found after treatment in 7 patients, 5 with lower number, 2 with higher number. Clinical and biological tolerance was excellent. The present study shows the interest of cefsulodin use in combination with aminoglycosides in this pathology.

Adolescent↗
PubMed1989

[In vivo bactericidal effect of ciprofloxacin, ofloxacin and pefloxacin against Staphylococcus aureus].

The bactericidal activity of ciprofloxacin, ofloxacin, pefloxacin, against methicillin sensitive S. aureus (2 different strains) was studied on a model of infected fibrin clots inserted subcutaneously in rabbit. The quinolones were delivered intravenously, as a single daily dose of 100 mg/kg/day. The bactericidal activity was evaluated by determining for various time points (1 h, 2 h, 6 h, 12 h, and 24 h after the infusion of the antibiotics), viable organisms in the dissolved clots. This study shows that: 1) No significant difference appears between the quinolones studied. 2) The in vivo early bactericidal activity of quinolones against S. aureus appears to be better than oxacillin but lesser than oxacillin-netilmicin combination.

Animals↗
PubMed1989

[Why is peroperative antibiotic prophylaxis of infectious complications most effective?].

The concentrations of oxacillin, azlocillin, temocillin, amoxycillin, cefoperazone, cefazoline, netilmicin, clindamicin, ofloxacine in serum and coagulum take a parallel course but their content in the coagulum is ten times lower than in serum--with the exception of doxycycline which reached a 40% value of the serum level in the coagulum. From this ensues that most effective are those antibiotics which can be administered in large doses and which have a long half-life. Unfavourable are antibiotics with a narrow therapeutic range and those with a short half-life. Preoperative application of such doses which create sufficiently high and prolonged levels is the optimal method of antibiotic prophylaxis of infectious complications during surgical operations.

Anti-Bacterial Agents↗
PubMed1989

The pathogenesis of low pleural fluid glucose in acidotic malignant pleural effusions.

To clarify the pathogenesis of low glucose concentrations in acidotic pleural fluid of malignant effusion, simultaneous studies of 1) serial plasma-pleural fluid glucose, pH, PCO2, gentamicin, tobramycin and netilmicin in vivo, and 2) serial in vitro incubation of pleural fluid pH and PCO2 were conducted in 19 cases. In all effusion samples, the pleural fluid pH and PO2 levels were lower and the CO2 levels were higher than those of arterial blood, respectively. The pleural fluid aminoglycoside levels increased gradually, reaching the maximum values after about four to seven hours, thereafter, it gradually decreased. There were three types of serial pleural fluid-plasma glucose concentrations, of which types 2 and 3 showed either a delayed rise or no rise in pleural fluid glucose concentrations, respectively. Serial pleural fluid pH and PCO2 levels remained stable during the in vitro incubation study, especially during the first three hours. The pleural fluid kinetics of the three aminoglycosides followed a large reservoir model without any relationships to pleural fluid pH, PCO2, fluid-volume and no significant differences of the kinetics among the three aminoglycosides. This indicated that the diffusion block of the antibiotics did not depend on molecular weight nor pH, PCO2 dependent. Since the molecular weight of three aminoglycosides is greater than that of glucose, lactic acid, CO2 and O2, it may be concluded, therefore, that an over utilization of glucose and O2 with an over production of lactic acid and CO2 by the pleura, rather than glucose transport defect, results in a low glucose concentration in malignant effusions.

Adult↗
PubMed1988

Evaluation of in vitro activity of teicoplanin against recent clinical isolates.

The in vitro antibacterial activity of teicoplanin, a new glycopeptide antibiotic, previously named teichomycin A2, has been compared to that of five other chemoantibiotics: netilmicin, clindamycin, rifampicin, enoxacin and vancomycin. The minimum inhibitory concentration (MIC) values against 588 gram-positive strains, 561 facultative aerobes and 27 anaerobes, recently isolated from clinical specimens, were evaluated. Teicoplanin showed the highest activity against all the tested strains, with a geometrical mean of the MICs (GMM), a MIC50 and MIC90 of 0.123, 0.12 and 0.5 micrograms/ml respectively.

Anti-Bacterial Agents↗
PubMed1988

[Plasmid resistance to 3d generation cephalosporins].

Beta-lactamases still play an important part in medical bacteriology, as shown by the emergence, since 1983, of plasmid-mediated beta-lactamases with an enlarged spectrum (SHV-2, CTX-1, etc.). Such enzymes are only produced by enterobacteria and, more specifically, by Klebsiella pneumoniae. This phenomenon, described in Europe and in Africa, is certainly more widespread than it would appear, as some strains are now known to be less sensitive to third generation cephalosporins (MIC 1 to 4 mg/l). Despite differences in behaviour (cefotaximase and ceftazidimase phenotypes), resistance to amino-, carboxy- and ureido-penicillins is associated with reduced sensitivity or resistance to oxyimino beta-lactams (cefotaxime, ceftriaxone, ceftazidime, aztreonam), but cefamycins and imipenem are untouched. Being sensitive to enzyme inhibitors (e.g. clavulanic acid), these beta-lactamases can easily be detected and some infections (notably urinary tract infections) can probably be treated using these inhibitors. These enzymes show modified kinetic constants (better affinity and quicker hydrolysis) against penicillins, third generation aminothiazolimino-cephalosporins and aztreonam. The producing strains are mutants, with aminoacid 1 to 2 substitutions, of those which produce the usual plasmid-borne and transposable beta-lactamases (TEM or SHV). Because these beta-lactamases are plasmid-mediated, enzyme production mechanisms are spreading among enterobacteria species in relation to other resistance markers (tobramycin, netilmicin, amikacin). Strains which produce these new enzymes are mainly isolated from patients treated in intensive care units.

Cell Membrane Permeability↗
PubMed1988

Characterization of multiply resistant Proteus mirabilis isolates in Hungary.

According to a survey on tendencies of antibiotic resistance in Hungary (1974-1983), the emergence of multiresistant (MR) Proteus mirabilis isolates is a new phenomenon. A total of 60 strains resistant to 11-16 antibiotics were collected from various specimens and geographical locations. Except for cefoperazone, third generation cephalosporins, amikacin, netilmicin and ofloxacin were effective in vitro against multiply resistant P. mirabilis isolates. Out of them 62% belonged to O18, a serogroup not shown in early studies in Hungary; moreover, in serogroup-distribution the present collection differed sharply from isolates examined in 1956. All but two strains produced the same aminoglycoside-modifying enzyme ANT (2"), and all of them proved beta-lactamase positive in nitrocephin test. All multiresistant strains harboured 2-4 plasmids, whereas the sensitive isolates had no plasmids. The presence of two plasmids (62 and 22 Mdal) occurring in 85% of the isolates was a characteristic feature of the multiresistant P. mirabilis isolates. In contrast to these plasmids some other ones (17.5, 103 and 113 Mdal) could be transferred to Escherichia coli recipient. There was no relationship between plasmid profiles, serogroups and resistance patterns.

Drug Resistance, Microbial↗
PubMed1986

Survey of aminoglycoside resistance patterns.

We studied the susceptibility of 545 gram-negative clinical isolates to six aminoglycosides: gentamicin, tobramycin, netilmicin, amikacin, 2'-N-ethylnetilmicin, and 6'-N-ethylnetilmicin. The resistant strains (359) have been classified into aminoglycoside resistance (patterns) phenotypes (AGRPs) corresponding to known resistance mechanisms. The results clearly demonstrated that most strains of Proteus spp., Klebsiella spp., Escherichia coli and Pseudomonas aeruginosa appeared to be able to adenylate the 2'-hydroxyl group (ANT(2'')) of aminoglycosides. Of the AGRPs reflecting acetylating activity, the AAC(3)-II and AAC(3)-I predominated. The AGRP AAC(2') was limited mainly to Proteus and Providencia isolates. It is noteworthy that permeability type resistance (PTR) was observed only among P. aeruginosa strains. Statistical evaluation of the results, using a discriminant regression analysis showed that PTR P. aeruginosa strains were isolated less often from urine than from other clinical sources (P less than 0.05). On the contrary the ANT(2'') Proteus strains were more common isolates from urinary infections as compared to those from other sources (P less than 0.05). Other correlations between frequency of AGRPs, bacterial groups, and various clinical sources were not statistically significant. However such differences in the frequency of occurrence of AGRPs among diverse bacterial groups were noted in relation to hospitals.

Amikacin↗
PubMed1986

Comparison of effectiveness of aminoglycosides and cephalosporins in gram-negative rods.

Aminoglycosides and cephalosporins belong among antimicrobials with a pronounced effect on most gram-negative rods. In vitro susceptibility and resistance to gentamicin, tobramycin, amikacin, netilmicin, cefoxitin, cefotaxime, cefsulodin, cefoperazone in Klebsiella pneumoniae, Enterobacter spp., Proteus mirabilis, Escherichia coli and Pseudomonas aeruginosa was tested by the quantitative dilution micromethod. Selected, highly susceptible strains of the above species were furthermore compared for minimal inhibitory concentration (MBC) and minimal bactericidal concentration (MBC) values. Aminoglycosides tended to be the most effective drugs for susceptible strains. In view of their relative toxicity possibly optimal combinations of individual aminoglycosides with individual cephalosporins are discussed.

Aminoglycosides↗
PubMed1986

[Present status of the sensitivity of Pseudomonas aeruginosa to aminoglycosides in France].

9,119 strains of P. aeruginosa were collected from 10 French hospitals from 1981 to 1984. The MIC of gentamicin (GM), sisomicin (SIS), tobramycin (TOB), dibekacin (DBK), netilmicin (NET), amikacin (AMK), and habekacin (HBK) was determined by the two fold microdilution method. 81% of the strains were susceptible to the 4 aminoglycosides. The MICs (geometric mean, mg/l) for these susceptible strains were: GM: 1.69, SIS: 1.58, TOB: 1.06, DBK: 1.12, NET: 2.73, AMK: 4.16, HBK: 2.70. 19% of the 9 119 strains were resistant to SIS, 18% to GM, 16% to TOB and DBK, 11% to NET, 3% to AMK and HBK. Among the 1 758 strains resistant to one or several aminoglycosides, the frequency of the resistance phenotypes was GM-SIS: 11%, GM-SIS-NET: 4.95%, GM-SIS-TOB-DBK: 32.7%, GM-SIS-TOB-DBK-NET: 34.45%, SIS-TOB-DBK-NET: 2.5%, SIS-TOB-DBK-NET-AMK-HBK: 2.39%, GM-SIS-TOB-DBK-NET-AMK-HBK: 11.61%. The mechanism of resistance of the phenotypes 1 to 6 is enzymatic. The mechanism of resistance of the phenotype 7 (resistance to the six aminoglycosides) is either enzymatic or due to decreased uptake or penetration of antibiotic. HBK and AMK are the aminoglycosides most frequently active against P. aeruginosa. The patterns of resistance to both antibiotics are the same. On a weight-for-weight basis, HBK is more active than AMK.

Aminoglycosides↗
PubMed1986

Nosocomial consequences of antibiotic usage.

In 1979, seven years after introduction of gentamicin into the greek market, resistance in Pseudomonas aeruginosa rose in Laiko General Hospital to an incidence of 55% of the isolates. Gentamicin then was the first line antibiotic. In 1983, three years after amikacin was brought onto the market and while it represented 3/5 of all aminoglycoside consumption, resistance against it in strains of Pseudomonas rose suddenly to 23%. However, amikacin prescription was not restricted and, in 1985, resistance rate, including all aminoglycosides and the 3rd generation cephalosporins, exceeded 50%. By analysing all available data, it was evident that: Urine predominates in the isolation of multiresistant strains, while in 1/2 of bacteraemias amikacin-resistant strains are implicated. The ICU is the most common source of isolation and similar strains are spread in all hospital wards. Multiresistant strains are virulent since they were incriminated for a 11% death rate. In 60% of amikacin resistant strains AAC (6') I was detected. Among multiresistant strains serotype O:12 predominated. From the hospital pharmacy data, it was evident that antibiotic consumption refers to greater than 60% of hospital admissions, and amikacin, netilmicin and newer cephalosporins are the first line antibiotics. It is evident that urgent changes are needed in the antibiotic policies in the Laiko General Hospital.

Amikacin↗
PubMed1987

N-acetylcysteine and 2-mercaptoethane sulphonate inhibit anti-pseudomonas activity of antibiotics in vitro.

The in vitro activity against Pseudomonas aeruginosa was investigated for serial dilutions of eight anti-Pseudomonas antibiotics in combination with serial dilutions of N-acetylcysteine (NAC) and 2-mercaptoethane sulphonate (MES). The results indicated that addition of NAC and MES to the antibiotics increased the MIC values for tobramycin, netilmicin, piperacillin, azlocillin, cefsulodin, ceftazidime and imipenem but not for colistin. The decrease of MIC found in high concentrations of NAC and MES was probably due to the bacteriostatic effect of the drugs per se and not to synergism with the antibiotics.

Acetylcysteine↗
PubMed1987

[In vitro activities of 9 aminosides against of 250 strains of Neisseria gonorrhoeae].

We compared the in vitro activities of 9 aminoglycosides including trospectomycin sulfate against 250 selected strains of Neisseria gonorrhoeae according to their penicillin resistance (penicillinase production), streptomycin resistance, spectinomycin resistance. Trospectomycin sulfate inhibited all spectinomycin-sensible strain at a concentration of 4 mg/l but the spectinomycin-resistant strain needed 32 mg/l for its inhibition. Among the other aminoglycosides tested netilmicin had the most in vitro effectiveness. Its minimal inhibitory concentrations were comparable to that of trospectomycin sulfate: furthermore this compound demonstrated in vitro activity against the spectino-resistant strain.

Aminoglycosides↗