amoxicillin-potassium-clavulanate-combination and Acquired-Immunodeficiency-Syndrome

Rhodococcus equi is an emerging opportunistic pathogen of HIV-I infected patients. It is an aerobic, Gram-positive coryneform bacterium which acts as a facultative intracellular micro-organism, multiplying in the phagosome of macrophages. Eighteen cases of R. equi infection in HIV-I positive patients have now been reported. Sixteen of these had pneumonia, of which 12 had cavitating lung lesions. A history of contact with farm animals, which are the primary hosts of R. equi, was found in only three patients. There was a delay in establishing a definite diagnosis in most cases as this depended upon the isolation of R. equi from sputum, bronchoalveolar lavage fluid, or blood. Treatment included surgical resection in five patients and erythromycin with a second antibiotic in 13 cases, but II of the 18 patients died from the infection. In this report we describe our experience of R. equi pneumonia in two AIDS patients and review the published cases of the disease in man.

Topics: Acquired Immunodeficiency Syndrome; Actinomycetales Infections; Adult; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Clavulanic Acids; Doxycycline; Drug Therapy, Combination; HIV Seropositivity; HIV-1; Humans; Male; Microbial Sensitivity Tests; Pneumonia; Rhodococcus equi; Rifampin

Severe non-AIDS bacterial infections (SBIs) are among the leading causes of hospital admissions among persons with human immunodeficiency virus (PWH) in regions with high antiretroviral therapy coverage.. This large prospective cohort study of PWH examined the types of infections, bacterial documentation, and evolution of antibiotic resistance among PWH hospitalized with SBIs over an 18-year period.. Between 2000 and 2017, 459 PWH had at least 1 SBI with bacterial documentation. Among the 847 SBIs, there were 280 cases of bacteremia, 269 cases of pneumonia, and 240 urinary tract infections. The 1025 isolated bacteria included Enterobacteriaceae (n = 394; mainly Escherichia coli), Staphylococcus aureus (n = 153), and Streptococcus pneumoniae (n = 82). The proportion of S. pneumoniae as the causative agent in pneumonia and bacteremia decreased sharply over time, from 34% to 8% and from 21% to 3%, respectively. The overall antibiotic resistance of S. aureus and S. pneumoniae decreased progressively but it increased for Enterobacteriaceae (from 24% to 48% for amoxicillin-clavulanate, from 4% to 18% for cefotaxime, and from 5% to 27% for ciprofloxacin). Cotrimoxazole prophylaxis was associated with higher nonsusceptibility of S. pneumoniae to amoxicillin and erythromycin, higher nonsusceptibility of Enterobacteriaceae to β-lactams and fluoroquinolones, and a higher risk of extended-spectrum β-lactamase-producing Enterobacteriaceae.. The bacterial resistance pattern among PWH between 2014 and 2017 was broadly similar to that in the general population, with the exception of a higher resistance profile of Enterobacteriaceae to fluoroquinolones. The use of cotrimoxazole as prophylaxis was associated with an increased risk of antibiotic resistance.

Topics: Acquired Immunodeficiency Syndrome; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bacteremia; Bacteria; beta-Lactamases; Drug Resistance, Bacterial; Enterobacteriaceae; Escherichia coli; Fluoroquinolones; HIV; Humans; Microbial Sensitivity Tests; Prospective Studies; Staphylococcal Infections; Staphylococcus aureus; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Acquired Immunodeficiency Syndrome; Amoxicillin-Potassium Clavulanate Combination; Diagnostic Errors; Drug Eruptions; Eosinophilia; Exanthema; Humans; Hypergammaglobulinemia; Leukopenia; Lung Diseases, Interstitial; Male; Middle Aged

Topics: Acquired Immunodeficiency Syndrome; Adult; Ambulatory Care; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Clavulanic Acids; Drug Combinations; Humans; Klebsiella Infections; Klebsiella pneumoniae; Male; Sepsis