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PubMedDate not supplied

[Neonatal shigellosis].

BACKGROUND: Neonatal shigellosis is rare and is usually encountered in unsanitary countries. It is occasionally responsible for manifestations of bacteremia such as septic shock and rash. CASE REPORT: A boy was born at 40 weeks of gestational age, while the end of labor was marked by temperature at 38 degrees C. His weight was 3,640 g and his height was 49.5 cm. The temperature of the newborn was 38 degrees C at 1 hour of life. He had hepatomegaly and X-rays showed abdominal distension. Gastric aspirates taken at that time showed Gram-negative bacilli and Gram-positive cocci. The patient was given amoxicillin intravenously and netilmicin intramuscularly. The infant still had a fever at 33 hours of life and produced aqueous stools containing blood and mucus. At H40, he developed shock requiring infusion of human albumin. He was given cefotaxime and was admitted to the intensive care unit, where a hepatosplenomegaly was also noted. He was given respiratory support, albumin infusion, dobutamine and dopamine. Antibiotics included cefotaxime, gentamicin and metronidazole. His total white cell count was 2,400/mm3, with 71% mature neutrophils; his platelet count was 190,000/mm3. Stool cultures showed the presence of Shigella flexneri, but blood cultures did not grow. A generalized rash was seen 4 days later; this persisted for less than 24 hours, while the platelet count was 25,000/mm3. The patient was then given ceftriazone and gentamicin. His stool cultures contained Shigella flexneri on the 4th and 9th day, but not on the 14th day. His mother had diarrhea 7 weeks before delivery, but stool cultures before and after delivery did not grow. CONCLUSION: Diagnosis of neonatal shigellosis is difficult. Cutaneous manifestations, possibly indicating bacteremia, have been seen in older children but never in the neonates.

Diarrhea, Infantile↗
PubMedDate not supplied

Lactobacillus casei endocarditis in an intravenous heroin drug addict: a case report.

A 24-year-old HIV negative unemployed intravenous heroin addict with teeth in poor condition was admitted to hospital with left hemiparesis; CT scan of the brain revealed a hypodense area in the right parietal region. He was apyrexial with marked leukocytosis and raised ESR, had an aortic diastolic murmur and an echocardiogram showed marked aortic insufficiency with possible small vegetations on the anterior leaflet of the mitral valve. Lactobacillus Casei was isolated from repeated blood cultures. Therapy with penicillin G together with netilmicin for 6 weeks led to improvement of his clinical status and an echocardiogram on discharge showed clear improvement. Regression of the cerebral lesions was also demonstrated on CT scan. We conclude that lactobacillus species should be sought in all haemoculture negative endocarditis in the presence of tooth disease.

Adult↗
PubMed1993

Randomized comparative trial of imipenem/cilastatin versus aminoglycoside plus amoxycillin plus clindamycin in the treatment of severe intra- and post-operative infections.

In a prospective, randomized, controlled study, clinical and bacteriological efficacy of imipenem/cilastatin (I/C) was compared with a standard combination of aminoglycoside + amoxycillin + clindamycin (C) in patients (pts) with severe intra- and postoperative infections. A total of 84 pts were randomly separated into two groups of 42 pts. Diagnoses were pneumonia n = 21 (14 in I/C group and 7 in C), peritonitis n = 45 (16 in I/C group and 29 in C), septicaemia n = 12 (9 in I/C group and 3 in C), and 7 other infections (3 in I/C group and 4 in C). Doses used were imipenem/cilastatin 1 g q 8 h and amoxycillin 2 g q 8 h plus clindamycin 0.6 g q 6 h, plus netilmicin according to serum concentrations. Success rates were 85.4% (n = 35: 34 cured and one improved) in the I/C group and 83.3% (n = 35: 30 cured and five improved) in the C group. Six pts in group I/C and 7 in group C failed to respond to treatment. One patient in the I/C group was not assessable. 62% of the bacterial isolates were eradicated in the I/C group and 55% in group C. 7% were suppressed in I/C and 5% in C. It is concluded that imipenem/cilastatin is an effective and well-tolerated alternative to antibiotic combinations in severe intra- and post-operative infections. It offers the advantages of fewer drug doses and less renunciation of serum drug concentration monitoring.

Aminoglycosides↗
PubMed1994

[Endocarditis caused by Cardiobacterium hominis].

The incidence of endocarditis due to Cardiobacterium hominis is probably underestimated because clinical presentations vary greatly and culture of this Gram negative germ is difficult. A 48-year-old man with a past history of post-streptococcic aortic regurgitation was hospitalized twice within 1 week for fever (38 degrees C) and junctional tachycardia which responded to amiodarone. Subsequently, infero-apical necrosis was documented. Based on the result of the laboratory tests, coronary embolism was suspected although 12 blood cultures were negative. The patient recovered well with a standard antibiotic treatment. Fifteen days later, the blood cultures revealed Cardiobacterium hominis. Antibiotic therapy was adapted and aortic valve replacement was programmed. Two months later the patient died from uncontrollable left heart failure. A 63-year-old man who had had mitral valve replacement 10 years earlier for Streptococcus mitis endocarditis was hospitalized for fever (38 degrees C) and a painful left calf. Phlebocavography eliminated deep vein thrombosis and a complete cardiac work-up was inconclusive. Endocarditis was suspected although blood cultures were negative. The patient was given oral penicillin and discharged after one week. Three months later, the patient was again febrile (38 degrees C) and suffered a cerebral vascular event. Fourteen days after blood sampling, cultures revealed Cardiobacterium hominis. The patient's haemodynamic status worsened and valve replacement with atrioplasty was performed. Outcome after 4 years follow-up has been favourable. Endocarditis due to Cardiobacterium hominis, a saprophitic germ of the upper airway and the female genital tract, has been reported in 64 cases in the literature. The clinical picture is often limited to fever and a heart murmur and laboratory tests show an accelerated erythrocyte sedimentation rate and hyperleukocytosis. Inflammatory type anaemia is often found due to the latency of the endocarditis. Complications are frequent and can be fatal due to massive pulmonary emboli, cerebral vascular events or irreversible heart failure. C. hominis is sensitive to amoxycillin and netilmicin. Surgical treatment of the valvulopathy is indicated.

Anti-Bacterial Agents↗
PubMed1993

The antimicrobial activity of imipenem/cilastatin and its treatment in critical ill patients with polymicrobial and mixed infection.

The antimicrobial activity of imipenem/cilastatin (IPM/CS) was determined for a broad spectrum of 7,157 organisms isolated from the Clinical Microbiology Laboratory of Chang Gung Memorial Hospital, Linkou Medical Center, between April 1 and June 30, 1988. Ninety eight point one percent of 4,389 gram negative aerobes, 95.8% of 2391 gram positive rods, and 95.9% of 507 anaerobes, were shown to be sensitive to IPM/CS. Ninety nine point two percent of 837 Pseudomonas aeruginosa isolates were sensitive to this antibiotic. This study also disclosed that this agent was much more active against Pseudomonas aeruginosa than any other tested aminoglycosides (gentamicin, amikacin, netilmicin) or third generation cephalosporins (cefotaxime, latamoxef, ceftazidime). Twelve critically ill patients with polymicrobial and mixed infection were recruited into this trial. All patients received IPM/CS 500 mg intravenously every six hours except one patient with poor renal function had 250 mg every six hours. The average duration of therapy was 12.5 days. All patients were evaluated according to the selection criteria. IPM/CS achieved favorable clinical response in 83.7 percent. The antibiotic was well tolerated. One patient discontinued treatment because of jaundice. One patient had superinfection of fungemia. The results suggested that IPM/CS is very useful in the treatment of patients with mixed infections due to gram positive, gram negative, and anaerobic bacteriae, even when empirical therapy with other antibiotics fails.

Adult↗
PubMed1993

Aminoglycoside cochlear ototoxicity.

The aminoglycoside antibiotics streptomycin, kanamycin, neomycin, gentamicin, tobramycin, amikacin, and netilmicin are discussed in this article on cochlear toxicity of aminoglycosides. Topics discussed include pharmacokinetics, comparative studies on toxicity, toxicity in neonates and children, histopathology, and aminoglycoside monitoring.

Aminoglycosides↗
PubMed1993

[The effect of the inoculum concentration on the in vitro sensitivity of Pseudomonas aeruginosa].

Using a broth microtiter dilution method, the minimum inhibitory concentrations of antipseudomonal antibiotics were determined against 19 P. aeruginosa isolates. Two different concentration of inoculum, 10(5) and 10(8), were used to show the inoculum concentration effect of in vitro antibiotic susceptibility tests. On the basis of the MIC values and using Howard B.J. (1) breakpoints, the effect of inoculum density was most prominent for amikacin and aztreonam, intermediate for mezlocillin, ticarcillin, piperacillin, cefotaxime, cefoperazone, netilmicin, tobramycin, gentamicin, and least apparent for ciprofloxacin and carbenicillin respectively.

Anti-Bacterial Agents↗
PubMed1993

[Antimicrobial susceptibility patterns of the Proteeae in Japan, 1989].

We discussed the antimicrobial susceptibilities of Proteeae isolated in Japan, 1989. Eight hundred six clinical isolates were collected from 47 hospitals. These were comprised of 431 strains of Proteus mirabilis, 155 Proteus vulgaris, 154 Morganella morganii, 44 Providencia rettgeri and 22 Providencia stuartii. Antibiotics tested in this study were 2 penicillins, 5 cephems, 1 carbapenem and 2 aminoglycosides. The MIC's were determined using the standard method of the Japan Society of Chemotherapy. Susceptibilities of the above strains to these antibiotics are described below; 1. Latamoxef, ceftizoxime and imipenem had excellent activities with no evident differences among the species of Proteeae. 2. Ampicillin and cefazolin were less active against Indol-positive Proteeae. 3. Piperacillin and cefmetazole were also strongly active drugs against P. mirabilis, P. vulgaris and P. stuartii, and cefotiam against P. mirabilis and P. stuartii. 4. Gentamicin and netilmicin showed excellent activities against M. morganii.

Anti-Bacterial Agents↗
PubMed1995

Antimicrobial therapy in Plesiomonas shigelloides-associated diarrhea in Thai children.

A retrospective case-controlled study was performed in 36 Thai children with Plesiomonas shigelloides (P. shigelloides)-associated diarrhea admitted to the Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University from August 1990 to December 1992. Nineteen cases received antibiotics while seventeen did not receive any. The two groups were comparable in age, sex, duration of fever, duration and severity of diarrhea and medical treatment. The antibiotics given were norfloxacin, wintomylon, colistin, gentamicin, ceftriaxone, co-trimoxazole and ampicillin. In our study, 100% of P. shigelloides isolates were susceptible to quinolones and cephalosporins, while only 9% were susceptible to ampicillin. Co-trimoxazole, gentamicin, netilmicin, chloramphenicol and nalidixic acid showed high susceptibility. The duration of fever and diarrhea after treatment was not significantly different between treatment and control groups (p > 0.05). Therefore, we conclude that antibiotics did not change the duration of fever and diarrhea in Thai children with P. shigelloides-associated diarrhea.

Anti-Bacterial Agents↗
PubMed1995

The changing nature of aminoglycoside resistance mechanisms and the role of isepamicin--a new broad-spectrum aminoglycoside. The Aminoglycoside Resistance Study Groups.

Aminoglycoside resistance mechanisms from recent studies were compared with those found in earlier studies in the USA and Europe for three pathogen groups. Among Citrobacter-Enterobacter-Klebsiella, four single mechanisms (AAc(3)-II, AAC(3)-I, ANT(2")-I and AAC(6')-I were found in all studies, but the most recent studies showed a significant increase in combinations of AAC(6')-I with the other common mechanisms. Since AAC(6')-I confers resistance to tobramycin, netilmicin and amikacin, combinations of it with the other gentamicin modifying enzymes conferred broad-spectrum resistance to all clinically available aminoglycosides except isepamicin. Similar changes occurred in Escherichia-Morganella-Proteus-Salmonella-Shigella except that the frequency of combinations was much lower and two additional single mechanisms - AAC(3)-IV and permeability - were also found frequently. Among aminoglycoside-resistant Pseudomonas, three mechanisms, AAC(6')-II, ANT(2")-I and permeability, were always common and remained common. However, combinations of the three mechanisms with each other and with other mechanisms were more common in the recent surveys. Different genes which produce different proteins with the same aminoglycoside-modifying activity are now known. The results of hybridisation studies with two aac(3)-I, 2 aac(6')-II and 4 aac(6')-I gene probes are presented. The most commonly occurring genes were: aac(3)-Ia, aac(3)-IIa, aac(6')-IIa, aac(6')-Ib and, in Serratia, aac(6')-Ic. The activity of isepamicin against amikacin resistant strain which produce AAC(6')-I can be related to differences in the structure of these two similar aminoglycosides at Position 3". Amikacin may form a stable complex with AAC(6')-I enzymes via binding interaction at Position 3 and 3". Isepamicin, which has a secondary amino group at Position 3", may only be able to interact at Position 3 and enzyme-isepamicin complexes are likely to be less stable.

Acetyltransferases↗
PubMed1995

In vitro activity of imipenem and six other beta-lactam antibiotics against aminoglycoside resistant gram-negative bacilli.

The in vitro activity of imipenem and six other beta-lactams (ampicillin, cefamandole, cefoxitin, ceftriaxone, ceftazidime, cefotaxime) against twenty Gram-negative bacilli resistant to clinically important aminoglycosides was studied. The bacterial strains showed high resistance (R) to gentamicin, tobramycin (R 100%), netilmicin (R 75%) and to the beta-lactams ampicillin (R 100%), cephamandole (R 90%) and cefoxitin (R 75%). The strains were susceptible to isepamicin (R 10%) and imipenem (R 10%) as well as susceptible to at least third generation cephalosporin. Three Pseudomonas aeruginosa strains were resistant to the majority of antibiotics, except for imipenem.

Aminoglycosides↗
PubMed1996

[Aminoglycosides in pediatrics].

The aminoglycosides continue to be needed in hospital pediatrics. Their advantage is high predictability of both efficacy and toxicity. This review focuses on the background to the aminoglycosides and defines their present role in antibiotic therapy of pediatric patients. Both the beneficial and unfavourable characteristics of these antimicrobial agents are discussed. The clinical uses of aminoglycoside antibiotics and their possible modes of administration are also commented on. The author attempts to compare the currently available aminoglycosides gentamicin, tobramycin, amikacin and netilmicin in the light of their antibacterial activity in vitro, their clinical efficacy, and their ototoxic and nephrotoxic potential. For the future it is important not to lose sight of these backup drugs where appropriately and safely used. A possible renaissance of the aminoglycosides would require either a molecular miracle (new aminoglycosides with decreased toxicity and an increased spectrum of activity) or a bacterial revolt (rapid emergence of resistance of many gram-negative enteric bacilli to other antibiotic classes).

Aminoglycosides↗
PubMed1995

Antibiotic resistance of Acinetobacter calcoaceticus strains isolated from patients treated in intensive care units.

The distribution according to specimens and susceptibility to antimicrobial agents of 481 Acinetobacter calcoaceticus strains isolated from patients treated in intensive care units were studied. They occurred most frequently in tracheal specimens and pus. Using disk diffusion test the strains proved to be multiple resistant to ampicillin (86.3%), azlocillin (86.7%), mezlocillin (84.0%), cefamandole (99.7%), cefoxitin (94.1%), cefuroxime (90.6%), cefoperazone (84.9%), cefotaxime (82.0%), ceftriaxone (81.0%), tobramycin (71.2%), gentamicin (86.2%), chloramphenicol (90.5%) and tetracycline (89.8%). Based on the lowest incidence of resistant strains imipenem (0%), netilmicin (2.6%), amikacin (4.9%), ampicillin+sulbactam (8.9%), amoxicillin+clavulanic acid (29.4%), pefloxacin (26.2%), ciprofloxacin (30.1%), ofloxacin (34.3%), cotrimoxazole (41.6%), carbenicillin (41.2%) or ceftazidime (55.4%) may be the drug of choice in nosocomial A. calcoaceticus infections.

Acinetobacter calcoaceticus↗
PubMed1996

Pharmacokinetics of antimicrobial agents in anuric patients during continuous venovenous haemofiltration.

BACKGROUND: The optimal drug dosing in anuric patients undergoing continuous haemofiltration is a difficult task. More pharmacokinetic data is needed to derive practical guidelines for dosage adjustments. METHODS: Drug elimination of various antimicrobial agents (amikacin, amoxycillin, ceftazidime, ciprofloxacin, flucloxacillin, imipenem, netilmicin, penicillin G, piperacillin, sulphamethoxazole, tobramycin, vancomycin) was studied in 24 patients with acute renal failure treated by pump-assisted continuous venovenous haemofiltration (CVVH). Concentrations of serial blood and ultrafiltrate samples were determined by HPLC or by fluorescence polarization immunoassay. Total body clearance (CL) and haemofilter clearance (CLf) rates were determined by standard model-independent equations. Data from published literature on fractions not bound to proteins (fu), non-renal drug clearance fractions (Qo), and normal clearance values (CLn) were used to derive a pharmacokinetic model, taking into account drug removal by ultrafiltration and by non-renal clearance. RESULTS: A total of 37 treatment periods was studied. Blood flow through the haemofilters was 100 ml/min resulting in an average ultrafiltrate flow rate (UFR) of 13.2 +/- 4.6 (range 3.2-22.1) ml/min. Acceptable correlations of calculated and measured haemofilter clearances and total body clearances were obtained. CONCLUSIONS: Total body clearance in anuric patients during CVVH is predictable from drug properties, which are generally known. The individual dosage requirements may be calculated by multiplying Qo + fu.UFR/CLn with the dose considered appropriate in the absence of renal impairment.

Acute Kidney Injury↗
PubMed1996

The spectrum of antimicrobial resistance among methicillin resistant Staphylococcus aureus (MRSA) in a tertiary care centre in India.

Methicillin-resistant Staphylococcus aureus (MRSA) is a major nosocomial pathogen globally, including India. Staph. aureus strains isolated from pus or blood of patients during January 1993 to November 1994 were tested for antimicrobial susceptibility using Kirby-Bauer disc diffusion technique. Among 1382 isolates of Staph. aureus, 332 (24%) were MRSA. Among the latter, 97 per cent were resistant to trimethoprim-sulphamethoxazole; 85.5 per cent to gentamicin and 45 per cent to amikacin. While over 90 per cent were resistant to norfloxacin and ciprofloxacin, only 53 per cent were resistant to ofloxacin. Fifty seven per cent were susceptible to rifampicin and 87 per cent to netilmicin. All tested strains were susceptible to vancomycin. Therefore, when antimicrobials other than vancomycin are considered for therapy, their choice requires the results of in vitro susceptibility testing of every isolate of MRSA.

Anti-Bacterial Agents↗
PubMed1997

[Nationwide survey of susceptibilities of clinical isolates to antibacterial agents in 1992].

This study was conducted to investigate susceptibilities of clinical isolates to imipenem (IPM) and other antibacterial agents in 144 hospital laboratories throughout Japan from September to December of 1992. In this study, the isolates were identified and susceptibility tests were performed at individual laboratories. The susceptibility tests were performed using the disk dilution method recommended by NCCLS. S. aureus (including MRSA) strains were highly susceptible to arbekacin (ABK) and netilmicin (NTL). S. pneumoniae and H. influenzae were susceptible to most of the agents tested. E. faecalis were highly susceptible to penicillins and imipenem (IPM). P. aeruginosa showed high susceptibility to ceftazidime (CAZ), IPM and amikacin (AMK). Annual changes in antimicrobial susceptibility patterns over 5 years (1988-1992) were examined. The frequency of sensitive strains of S. aureus to methicillin (DMPPC) has slightly increased from 1991 to 1992. A moderate increases of PCG-insensitive S. pneumoniae was observed. B. fragilis group showed a slight increase in sensitivity to minocycline (MINO) but no yearly changes in IPM sensitivity was observed.

Anti-Bacterial Agents↗
PubMed1997

Emerging bacterial drug resistance in hospital practice.

The growing multiple drug resistance among bacteria in hospital practice is posing a serious threat to the successful antimicrobial therapy. Our data on the bacterial drug resistance at a tertiary care centre during 1995-1996 has been alarming with an incidence of 73 to 99% resistance to the common antibiotics like ampicillin, chloramphenicol, cotrimoxazole and first generation cephalosporins among the gram negative isolates. The resistance to gentamicin and ciprofloxacin ranged from 53 to 79%. Resistance to amikacin, netilmicin and the third generation cephalosporins ranged from 30 to 73%. The frightening observation was the emergence of resistant isolates which were sensitive only to two drugs, sensitive only to one drug and resistant to all the available antibiotics (2.64, 17.6 and 11.5% respectively) during 1994 to 1996. Resistance among the gram positive bacteria was much less but the increase in methicillin resistant Staphylococci (52-65%) was a serious matter. The data were an eye opener and the infection control measures could bring marginal improvement in the situation in 1996. It is vehemently appealed that the national antibiotic policies be formed and be stringently implemented before we are thrown back to the pre-antibiotic era.

Anti-Bacterial Agents↗
PubMed1998

[Status febrilis and jaundice].

A 49 year old patient was admitted with fever and jaundice. Laboratory evaluation showed leukocytosis, elevated values for C-reactive protein, transaminases, bilirubin and alkaline phosphatase. Ultrasound and subsequent CT-scan revealed multiple liver lesions and a liquid mass in the bursa omentalis. A CT-guided catheter-drainage was performed and streptococcus milleri isolated from the abscess and one blood culture. After empiric broad spectrum treatment with Piperacillin/Tazobactam (Tazobac) and Netilmicin (Netromycin), Ceftriaxon (Rocephin) was given for a total treatment time of 10 days. Further evaluation revealed a perforated peptic ulcer as possible etiology for the described localized infectious complication.

Abdominal Abscess↗