amoxicillin-potassium-clavulanate-combination and Bacteremia

Carnobacterium species are lactic acid-producing Gram-positive bacteria that have been approved by the US Food and Drug Administration and Health Canada for use as a food bio-preservative. The use of live bacteria as a food additive and its potential risk of infections in immunocompromised patients are not well understood.. An 81-year-old male with a history of metastatic prostate cancer on androgen deprivation therapy and chronic steroids presented to our hospital with a 2-week history of productive cough, dyspnea, altered mentation, and fever. Extensive computed tomography imaging revealed multifocal pneumonia without other foci of infection. He was diagnosed with pneumonia and empirically treated with ceftriaxone and vancomycin. Blood cultures from admission later returned positive for Carnobacterium inhibens. He achieved clinical recovery with step-down to oral amoxicillin/clavulanic acid for a total 7-day course of antibiotics.. This is the fourth reported case of bacteremia with Carnobacterium spp. isolated from humans. This case highlights the need to better understand the pathogenicity and disease spectrum of bacteria used in the food industry for bio-preservation, especially in immunocompromised patients.

Topics: Aged, 80 and over; Amoxicillin-Potassium Clavulanate Combination; Androgen Antagonists; Anti-Bacterial Agents; Bacteremia; Blood Culture; Canada; Carnobacterium; Ceftriaxone; Food Microbiology; Gram-Positive Bacterial Infections; Humans; Immunocompromised Host; Male; Pneumonia, Bacterial; Prostatic Neoplasms; Vancomycin

Postdental procedure bacteremia is common and troublesome. The comparative efficacy of multiple prophylactic interventions is unclear. We compared the efficacy of interventions for the prevention of postdental procedure bacteremia. We conducted a review of ClinicalKey, Cochrane CENTRAL, Embase, ProQuest, PubMed, ScienceDirect, Web of Science, and ClinicalTrials.gov from inception to December 4, 2018. Randomized controlled trials that evaluated prophylactic interventions for the prevention of postdental procedure bacteremia were eligible. The primary outcome was the incidence of postdental procedure bacteremia. A total of 24 trials were included with 2,147 participants. Our network meta-analysis demonstrated that intravenous administration of 1,000/200 mg of amoxicillin/clavulanate provided the least incidence of postdental procedure bacteremia among all the prophylactic interventions (odds ratio = 0.03, 95% CI = 0.00 to 0.63) as compared with the placebo/controls. Oral 3 g of amoxicillin had the least incidence of postdental procedure bacteremia among all oral or topical forms of prophylactic interventions (odds ratio = 0.10, 95% CI = 0.02 to 0.44) as compared with the placebo/controls. No serious adverse events, such as anaphylactic shock, mortality, and the development of antibiotic-resistant bacteria, were reported. None of the included subjects were of high risk of infectious endocarditis. Our network meta-analysis demonstrates that intravenous amoxicillin/clavulanate and oral amoxicillin might be the best prophylactic interventions in preventing postdental procedure bacteremia among all the oral/topical forms of interventions for the overall populations.

Topics: Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Antibiotic Prophylaxis; Bacteremia; Dentistry; Humans; Network Meta-Analysis; Randomized Controlled Trials as Topic

Atopobium vaginae is an anaerobic Gram-positive bacterium recognized as a causative agent of bacterial vaginosis and associated with preterm delivery. Invasive infection and bacteremia have been rarely reported. We describe the case of a woman expecting her firstborn child who presented with a A. vaginae bacteremia during labor. Identification was performed using 16S rRNA gene sequencing. Both maternal and fetal outcomes were favorable due to the maternal treatment with amoxicillin-clavulanic acid. We identified three other cases in the literature with different fetal outcome. The genetic diversity of A. vaginae should be further explored in order to reveal potential strains with differential pathogenic potential.

Topics: Actinobacteria; Adult; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bacteremia; beta-Lactamase Inhibitors; DNA, Bacterial; DNA, Ribosomal; Female; Gram-Positive Bacterial Infections; Humans; Pregnancy; Pregnancy Complications, Infectious; RNA, Ribosomal, 16S; Sequence Analysis, DNA; Treatment Outcome

Leptospirosis is an anthropozoonose, an animal disease transmissible to humans, caused by a spirochete of the genus Leptospira that lives mainly among rodents but also in wetlands. It occurs worldwide, particularly in Asia, Latin America and Africa. In Europe, the incidence is small (except in France and Great Britain, where its frequency has increased in recent years) but the frequency may be underestimated. Some areas overseas are particularly affected. In France, the potential epidemic of leptospirosis is subject to climatic variations, justifying a constant monitoring of the disease provided by the National Reference Centre (CNR) of leptospires. Transmission to humans primarily occurs through contact with environments contaminated by the urine of infected animals. The disease can affect the liver and kidneys (hepatonephritis) as cytolysis, cholestasis and renal failure associated with fever. A coagulopathy usually accompanies the clinical table. Its diagnosis is difficult because of the clinical polymorphism. Early diagnosis of leptospirosis allows effective medical care, improving patient outcomes. This is currently based on gene amplification (PCR) or serology positive by the microscopic agglutination test (MAT), which is the reference method. Its evolution is usually favorable with appropriate antibiotic treatment (aminopenicillin). However 5-10% of symptomatic patients have a severe multisystem defaillance. Nearly a century after the discovery of the causative agent, this zoonosis remains a public health problem, zoonosis priority in terms of virulence, its reporting is mandatory in our country. We report the case of a severe form of hepatonephritis due to water contaminated with Leptospira observed in Northern France.

Topics: Acute Kidney Injury; Adult; Amoxicillin-Potassium Clavulanate Combination; Animal Husbandry; Animals; Anti-Bacterial Agents; Bacteremia; Disease Progression; Doxycycline; Fever; France; Humans; Immunologic Tests; Jaundice; Leptospira interrogans serovar icterohaemorrhagiae; Male; Occupational Diseases; Ofloxacin; Rats; Renal Dialysis; Sheep; Species Specificity; Water Microbiology; Water Pollution; Weil Disease; Zoonoses

Vibrio cholerae is a serious public health problem worldwide, but in the UK, V. cholerae infections are rare. Here, we report a case of V. cholerae bacteraemia in an elderly patient. To our knowledge, this is the first non-travel-related V cholerae bacteraemia in the UK.

Topics: Aged; Amoxicillin-Potassium Clavulanate Combination; Bacteremia; Cholera; Diarrhea; Feces; Humans; Male; Travel; United Kingdom; Vibrio cholerae

Bacterial infections are well described complications of cirrhosis that greatly increase mortality rates. Two factors play important roles in the development of bacterial infections in these patients: the severity of liver disease and gastrointestinal haemorrhage. The most common infections are spontaneous bacterial peritonitis, urinary tract infections, pneumonia and sepsis. Gram-negative and gram-positive bacteria are equal causative organisms. For primary prophylaxis, short-term antibiotic treatment (oral norfloxacin or ciprofloxacin) is indicated in cirrhotic patients (with or without ascites) admitted with gastrointestinal haemorrhage (variceal or non-variceal). Administration of norfloxacin is advisable for hospitalized patients with low ascitic protein even without gastrointestinal haemorrhage. The first choice in empirical treatment of spontaneous bacterial peritonitis is the iv. III. generation cephalosporin; which can be switched for a targeted antibiotic regime based on the result of the culture. The duration of therapy is 5-8 days. Amoxicillin/clavulanic acid and fluoroquinolones--patients not on prior quinolone prophylaxis--were shown to be as effective and safe as cefotaxime. In patients with evidence of improvement, iv. antibiotics can be switched safely to oral antibiotics after 2 days. In case of renal dysfunction, iv albumin should also be administered. Long-term antibiotic prophylaxis is recommended in patients who have recovered from an episode of spontaneous bacterial peritonitis (secondary prevention). For "selective intestinal decontamination", poorly absorbed oral norfloxacin is the preferred schedule. Oral ciprofloxacin or levofloxacin (added gram positive spectrum) all the more are reasonable alternatives. Trimethoprim/sulfamethoxazole is only for patients who are intolerant to quinolones. Prophylaxis is indefinite until disappearance of ascites, transplant or death. Long-term prophylaxis is currently not recommended for patients without previous spontaneous bacterial peritonitis episode, not even when refractory ascites or low ascites protein content is present.

Topics: Administration, Oral; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Ascites; Bacteremia; Bacterial Infections; Cefotaxime; Cephalosporins; Ciprofloxacin; Fluoroquinolones; Gastrointestinal Hemorrhage; Humans; Infusions, Intravenous; Liver Cirrhosis; Norfloxacin; Peritonitis; Pneumonia, Bacterial; Primary Prevention; Severity of Illness Index; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Although controversy exists regarding the efficacy of antibiotic prophylaxis for patients at risk of infective endocarditis, expert committees continue to publish recommendations for antibiotic prophylaxis regimens. This study aimed to evaluate the efficacy of four antimicrobial regimens for the prevention of bacteraemia following dental extractions.. The study population included 266 adults requiring dental extractions who were randomly assigned to the following five groups: control (no prophylaxis); 1000/200 mg of amoxicillin/clavulanate intravenously; 2 g of amoxicillin by mouth; 600 mg of clindamycin by mouth; and 600 mg of azithromycin by mouth. Venous blood samples were collected from each patient at baseline and at 30 s, 15 min and 1 h after dental extractions. Samples were inoculated into BACTEC Plus culture bottles and processed in the BACTEC 9240. Conventional microbiological techniques were used for subcultures and further identification of the isolated bacteria. The trial was registered at ClinicalTrials.gov with ID number NCT02115776.. The incidence of bacteraemia in the control, amoxicillin/clavulanate, amoxicillin, clindamycin and azithromycin groups was: 96%, 0%, 50%, 87% and 81%, respectively, at 30 s; 65%, 0%, 10%, 65% and 49% at 15 min; and 18%, 0%, 4%, 19% and 18% at 1 h. Streptococci were the most frequently identified bacteria. The percentage of positive blood cultures at 30 s post-extraction was lower in the amoxicillin/clavulanate group than in the amoxicillin group (P < 0.001). The incidence of bacteraemia in the clindamycin group was similar to that in the control group.. Bacteraemia following dental extractions was undetectable with amoxicillin/clavulanate prophylaxis. Alternative antimicrobial regimens should be sought for patients allergic to the β-lactams.

Topics: Administration, Intravenous; Adolescent; Adult; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Antibiotic Prophylaxis; Bacteremia; Bacteriological Techniques; beta-Lactamase Inhibitors; Blood; Female; Humans; Male; Middle Aged; Prospective Studies; Tooth Extraction; Treatment Outcome; Young Adult

To study the effect of prophylactic antibiotics on the incidence of bacteraemia following hysteroscopic surgery.. Prospective randomized study.. Aberdeen Royal Infirmary.. One hundred and sixteen women about to undergo either endometrial laser ablation (ELA) or transcervical resection of the endometrium (TCRE).. Fifty-five women were randomised to receive 1.2 g of Augmentin (co-amoxiclav) i.v. at induction of anaesthesia. Sixty-one women received no antibiotic prophylaxis. Blood cultures were obtained at the end of the surgical procedure.. Incidence of bacteraemia in the non-antibiotic group (16%) was significantly higher than that in the antibiotic group (2%) (95% confidence interval for difference from 5% to 25%). The majority of organisms were of dubious clinical significance and contamination could not be excluded in 7 cases out of 10.. There is no convincing evidence that antibiotics are of value in this clinical setting.

Topics: Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Antibiotic Prophylaxis; Bacteremia; Clavulanic Acids; Drug Therapy, Combination; Endometrium; Female; Humans; Hysteroscopy; Laser Therapy; Menorrhagia; Prospective Studies

This prospective multicenter study was conducted to define more clearly clinical and laboratory criteria that predict a strong probability of occult bacteremia and to evaluate the effect of empiric broad spectrum antimicrobial treatment of these children. Children 3 to 36 months old with fever > or = 40 degrees C (104 degrees F) or, > or = 39.5 degrees C (103 degrees F) with white blood cells (WBC) > or = 15 x 10(9)/liter, and no focus of infection had blood cultures obtained and were randomized to treatment with oral amoxicillin/potassium clavulanate or intramuscular ceftriaxone. Sixty of 519 (11.6%) study patients had positive blood cultures: Streptococcus pneumoniae, 51; Haemophilus influenzae b, 6; Neisseria meningitidis, 2; and Group B Streptococcus, 1. Subgroups of high risk were identified as fever > or = 39.5 degrees C and WBC > or = 15 x 10(9)/liter, 55 of 331 or 16.6% positive with increasing incidence of positive culture with increasing increments of degrees of leukocytosis to WBC > or = 30 x 10(9)/liter where 9 of 21 or 42.9% were positive. Subgroups of significantly lower risk were identified as fever > or = 39.5 degrees C and WBC < 15 x 10(9)/liter, 5 of 182 or 2.7% positive and those with WBC < 10 x 10(9)/liter, 0 of 99 or 0.0% positive. Children with positive cultures who received ceftriaxone were nearly all afebrile after 24 hours whereas a significant number who received amoxicillin/potassium clavulanate remained febrile. In the 459 culture-negative children more amoxicillin/potassium clavulanate-treated children developed diarrhea and had less improvement in clinical scores after 24 hours than ceftriaxone-treated children.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Administration, Oral; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bacteremia; Ceftriaxone; Child, Preschool; Clavulanic Acids; Drug Therapy, Combination; Female; Fever; Follow-Up Studies; Haemophilus Infections; Humans; Infant; Injections, Intramuscular; Leukocytosis; Male; Meningococcal Infections; Multivariate Analysis; Pneumococcal Infections; Prospective Studies; Regression Analysis; Treatment Outcome

This study aimed to evaluate the effectiveness of oral amoxicillin/clavulanate (AMX-CL) for the prevention of bacteremia following dental extractions. The study group (AMX-CLG) comprised 40 adults requiring dental extractions under general anesthesia who were administered a prophylactic regimen of 1875/125 mg of AMX-CL orally 1-2 h prior to the surgery. Venous blood samples were collected from each patient at baseline and at 30 s and 15 min after dental extractions. Samples were inoculated into BACTEC Plus culture bottles and processed in the BACTEC 9240. Conventional microbiological techniques were used for subcultures and further identification of the isolated bacteria. The results for the AMX-CLG were compared with those of a control group (CG; no prophylaxis) and an amoxicillin group (AMXG; 2 g of amoxicillin orally), consisting of randomly selected patients from among those participating in two clinical trials that we have previously published. The prevalence of bacteremia in the CG, AMXG, and AMX-CLG was 97%, 50%, and 15%, respectively, at 30 s after completing the extractions, and 67%, 10%, and 4% at 15 min, respectively, after the last extraction. The prevalence of bacteremia in the AMXG and the AMX-CLG at 30 s and at 15 min after completing the extractions was significantly lower than that in the CG (p < 0.001 and p < 0.001, respectively; Fisher's exact test). The prevalence of bacteremia in the AMX-CLG at 30 s after completing the extractions was significantly lower than that in the AMXG (p < 0.001; Fisher's exact test). Based in the results of this preliminary study, oral AMX-CL could be an excellent option for preventing bacteremia secondary to dental procedures in patients at risk.

Topics: Adult; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bacteremia; Bacteria; Humans; Tooth Extraction

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: Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bacteremia; Drug Resistance, Bacterial; Drug Resistance, Multiple, Bacterial; Escherichia coli; Escherichia coli Infections; Humans; Microbial Sensitivity Tests

To estimate the prevalence and antibiotic resistance profile of community- and hospital-acquired bacteremia among hospitalized children with severe acute malnutrition in Niger.. A descriptive, longitudinal study was conducted in an intensive nutritional rehabilitation center in Madarounfa, Niger. Children aged 6 to 59 months admitted for inpatient treatment of complicated severe acute malnutrition (n=2187) had blood specimens drawn at admission to assess prevalence of community-acquired bacteremia. Subsequent specimens were drawn per physician discretion to assess incidence of hospital-acquired bacteremia. Antibiotic susceptibility testing was performed on positive blood cultures.. The prevalence of community-acquired bacteremia at admission was at least 9.1% (95% confidence interval [CI]: 8.1, 10.4%), with non-typhoid Salmonella identified in over half (57.8%) of cases. The cumulative incidence of hospital-acquired bacteremia was estimated at 1.2% (95% CI: 0.8, 1.7%), among which the most common organisms were Klebsiella pneumoniae (19.4%), Acinetobacter baumannii (16.1%), Enterococcus faecalis (12.9%), and Escherichia coli (12.9%). In community-acquired bacteremia, 58% cases were resistant to amoxicillin-clavulanate; 100% of hospital-acquired bacteremia cases were resistant to amoxicillin and amoxicillin-clavulanate. Mortality risk was elevated among children with hospital-acquired bacteremia (risk ratio [RR] = 9.32) and community-acquired bacteremia (RR = 2.67).. Bacteremia was a significant contributor to mortality. Antibiotic resistance poses a challenge to effective clinical management of severe acute malnutrition.

Topics: Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bacteremia; Child; Community-Acquired Infections; Drug Resistance, Microbial; Escherichia coli; Hospitals; Humans; Longitudinal Studies; Niger; Severe Acute Malnutrition

Reported bacteraemia outcomes following inactive empirical antibiotics (based on in vitro testing) are conflicting, potentially reflecting heterogeneity in causative species, MIC breakpoints defining resistance/susceptibility, and times to rescue therapy.. We investigated adult inpatients with Escherichia coli bacteraemia at Oxford University Hospitals, UK, from 4 February 2014 to 30 June 2021 who were receiving empirical amoxicillin/clavulanate with/without other antibiotics. We used Cox regression to analyse 30 day all-cause mortality by in vitro amoxicillin/clavulanate susceptibility (activity) using the EUCAST resistance breakpoint (>8/2 mg/L), categorical MIC, and a higher resistance breakpoint (>32/2 mg/L), adjusting for other antibiotic activity and confounders including comorbidities, vital signs and blood tests.. A total of 1720 E. coli bacteraemias (1626 patients) were treated with empirical amoxicillin/clavulanate. Thirty-day mortality was 193/1400 (14%) for any active baseline therapy and 52/320 (16%) for inactive baseline therapy (P = 0.17). With EUCAST breakpoints, there was no evidence that mortality differed for inactive versus active amoxicillin/clavulanate [adjusted HR (aHR) = 1.27 (95% CI 0.83-1.93); P = 0.28], nor of an association with active aminoglycoside (P = 0.93) or other active antibiotics (P = 0.18). Considering categorical amoxicillin/clavulanate MIC, MICs > 32/2 mg/L were associated with mortality [aHR = 1.85 versus MIC = 2/2 mg/L (95% CI 0.99-3.73); P = 0.054]. A higher resistance breakpoint (>32/2 mg/L) was independently associated with higher mortality [aHR = 1.82 (95% CI 1.07-3.10); P = 0.027], as were MICs > 32/2 mg/L with active empirical aminoglycosides [aHR = 2.34 (95% CI 1.40-3.89); P = 0.001], but not MICs > 32/2 mg/L with active non-aminoglycoside antibiotic(s) [aHR = 0.87 (95% CI 0.40-1.89); P = 0.72].. We found no evidence that EUCAST-defined amoxicillin/clavulanate resistance was associated with increased mortality, but a higher resistance breakpoint (MIC > 32/2 mg/L) was. Additional active baseline non-aminoglycoside antibiotics attenuated amoxicillin/clavulanate resistance-associated mortality, but aminoglycosides did not. Granular phenotyping and comparison with clinical outcomes may improve AMR breakpoints.

Topics: Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bacteremia; Electronic Health Records; Escherichia coli; Escherichia coli Infections; Humans; Microbial Sensitivity Tests

Topics: Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Appendectomy; Appendicitis; Bacteremia; Child; Comamonas testosteroni; Drainage; Gram-Negative Bacterial Infections; Humans; Male; Microbial Sensitivity Tests; Morocco; Treatment Outcome

Topics: Aged, 80 and over; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bacteremia; Chromatiaceae; Female; Gram-Negative Bacterial Infections; Humans; Leg Injuries; Rubus; Skin; Soil Microbiology; Wound Infection

Outside areas of S. aureus strains resistant to methicillin (MRSA) in the community, no studies showed a relationship between the treatment for erysipelas or cellulitis and the outcome. We aimed to measure the impact of an internal therapeutic protocol, based on national guidelines on patients' outcome. This study was based on the dashboard of the infectious diseases department, which prospectively includes 28 parameters for all admitted patients. We included community-acquired erysipelas and cellulitis; exclusion criteria were abscesses at admission; ear, nose, throat, or dental cellulitis; pyomyositis; and length of stay ≤ 2 days. Adherence to guidelines was defined by the use of amoxicillin, amoxicillin/clavulanic acid, clindamycin, or pristinamycin, alone or in combination or successively. A poor outcome was defined by surgical procedure or intensive care requirement or death occurring after 5 days or more of antibiotic therapy. From July 2005 to June 2017, 630 cases of erysipelas or cellulitis were included. Blood cultures performed in 567 patients (90%) were positive in 39 cases (6.9%). Adherence rate to guidelines was 65% (410 cases). A poor outcome was recorded in 54 (8.5%) patients, less frequently in case of adherence to guidelines: 26/410 (6.3%) vs 28/220 (12.7%), p = 0.007. In logistic regression analysis, two risk factors were associated with a poor outcome: peripheral arterial disease, AOR 4.80 (2.20-10.49); and bacteremia, AOR 5.21 (2.31-11.76), while guideline adherence was the only modifiable protective factor, OR 0.48 (0.26-0.89). In erysipelas and cellulitis, adherence to guidelines was associated with a favorable outcome.

Topics: Aged; Aged, 80 and over; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bacteremia; Blood Culture; Cellulitis; Clindamycin; Erysipelas; Female; France; Guideline Adherence; Hospitalization; Humans; Logistic Models; Male; Middle Aged; Retrospective Studies; Risk Factors; Staphylococcal Infections; Staphylococcus aureus; Treatment Outcome

Diagnostic uncertainty is common in the emergency room and multidrug-resistant bacteria emerge in the community setting, implying to establish the most efficient empirical antibiotic therapy (eEAT). Our aim was to identify such eEAT, considering that in case of DU with severe clinical presentation, most prescribers would propose an empiric combination (EC). The medical dashboard of our ward records prospectively 28 characteristics of each hospitalization including hospitalization motive, final diagnosis, and all antibiotics prescribed. All patients with community-acquired bacteremia (CAB) were included. DU was defined by a discrepancy between suspected diagnosis in the emergency room and final diagnosis. eEAT was defined by in vitro activity of at least one prescribed compound. Finally, independently from the dashboard, we retrospectively compared 2 CTs: amoxicillin/clavulanic acid (AMC)+gentamicin (G) and cefotaxime (3GC)+G. One thousand thirty-four patients with a final diagnosis of CAB were identified from July 2005 to June 2018, including 357 DU (35%) at baseline. eEAT (n = 553) was associated with a trend towards a lower death rate compared to inefficient therapies: 5.4 vs 10.0% (p = 0.053), and effective antibiotic reassessment was the most protective factor against an unfavorable outcome: 0.34 (0.16-0.71). Bacteria involved in case of UD were resistant to AMC+G and to 3GC+G in 8.1% and 12.8% of patients, respectively. Diagnostic uncertainty was a frequent event requiring antibiotic reassessment. As the latter was not systematically realized, the best eEAT is required and AMC+aminoglycoside should be considered.

Topics: Adult; Aged; Aged, 80 and over; Aminoglycosides; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bacteremia; Bacteria; Community-Acquired Infections; Drug Resistance, Multiple, Bacterial; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Retrospective Studies; Risk Factors; Treatment Outcome; Uncertainty

Topics: Actinomyces; Actinomycosis; Adult; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bacteremia; Ceftazidime; Cerebellar Neoplasms; Daptomycin; Humans; Male; Medulloblastoma

To identify plasmid-mediated colistin resistance in clinical Enterobacteriaceae isolates in Oman, where this resistance mechanism has not been encountered yet.. Twenty-two colistin-resistant Enterobacteriaceae clinical isolates collected between July 2014 and June 2016 in a tertiary care hospital in Muscat were screened by PCR for the mcr-1 and mcr-2 genes. The strain identified as mcr-1 positive was genotyped and its antibiotic susceptibility was established. The mcr-1 containing plasmid was mobilized into Escherichia coli K-12 and its sequence was determined.. A single E. coli isolate (OM97) carrying mcr-1 gene was identified, while no strains carrying the mcr-2 gene was found. E. coli OM97 was isolated in June 2016 from blood culture of a male patient with multiple comorbidities. It belonged to ST10. Beyond colistin, it was resistant to amoxicillin-clavulanic acid, piperacillin-tazobactam, amikacin, ciprofloxacin, tetracycline, and cotrimoxazole. The mcr-1 gene was located on a conjugative IncI2-type plasmid of 63722 bp size, which did not harbor any further resistance genes. The genetic surrounding of the mcr-1 gene lacked the ISApl1 element.. Although colistin resistance caused by the mcr-1 gene is not common in our collection of clinical isolates, the occurrence of the plasmid-mediated colistin resistance in an E. coli ST10 strain is of concern as this clonal group was already shown to spread ESBL genes and quinolone resistance worldwide. It is especially worrisome that as the mcr-1 gene occurred in a non-ESBL, carbapenem-susceptible E. coli strain, current susceptibility testing algorithms may not detect its presence.

Topics: Amikacin; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bacteremia; Ciprofloxacin; Colistin; Drug Resistance, Bacterial; Escherichia coli; Escherichia coli Infections; Escherichia coli Proteins; Gene Expression; Humans; Membrane Proteins; Microbial Sensitivity Tests; Oman; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination; Plasmids; Protein Isoforms; Tetracycline; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Aged; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bacteremia; Cholecystectomy; Diabetes Mellitus, Type 2; Gram-Positive Bacterial Infections; Humans; Lacticaseibacillus paracasei; Liver Abscess, Pyogenic; Male; Treatment Outcome

Escherichia coli bloodstream infections are increasing in the UK and internationally. The evidence base to guide interventions against this major public health concern is small. We aimed to investigate possible drivers of changes in the incidence of E coli bloodstream infection and antibiotic susceptibilities in Oxfordshire, UK, over the past two decades, while stratifying for time since hospital exposure.. In this observational study, we used all available data on E coli bloodstream infections and E coli urinary tract infections (UTIs) from one UK region (Oxfordshire) using anonymised linked microbiological data and hospital electronic health records from the Infections in Oxfordshire Research Database (IORD). We estimated the incidence of infections across a two decade period and the annual incidence rate ratio (aIRR) in 2016. We modelled the data using negative binomial regression on the basis of microbiological, clinical, and health-care-exposure risk factors. We investigated infection severity, 30-day all-cause mortality, and community and hospital amoxicillin plus clavulanic acid (co-amoxiclav) use to estimate changes in bacterial virulence and the effect of antimicrobial resistance on incidence.. Increases in E coli bloodstream infections in Oxfordshire are primarily community associated, with substantial co-amoxiclav resistance; nevertheless, we found little or no change in mortality. Focusing interventions on primary care facilities, particularly those with high co-amoxiclav use, could be effective in reducing the incidence of co-amoxiclav-resistant E coli bloodstream infections, in this region and more generally.. National Institute for Health Research.

Topics: Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bacteremia; Drug Resistance, Bacterial; Electronic Health Records; Escherichia coli Infections; Humans; Incidence; Time Factors; Urinary Tract Infections

A 5-month-old baby presented with a low-grade fever and tachypnoea and was found to have right upper lobe consolidation on chest radiograph. He was admitted with the diagnosis of bronchopneumonia and the treatment protocol for pneumonia was initiated. Blood culture samples were collected, and he was started on a course of intravenous amoxicillin-clavulanate. Blood culture results displayed pansensitive

Topics: Administration, Intravenous; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bacteremia; Gemella; Gram-Positive Bacterial Infections; Humans; Infant; Lung; Male; Pneumonia, Bacterial

Gardnerella vaginalis is a facultative anaerobic bacterium that inhabits the genitourinary tract of both healthy women and those with bacterial vaginosis. We report a case of G. vaginalis bacteremia associated with severe toxic encephalopathy in a young woman. Anaerobic blood cultures yielded pure growth of small gram-variable rods later identified as G. vaginalis by both rapid biochemical tests and 16S rRNA gene sequencing. The patient recovered after treatment with amoxicillin-clavulanate according to the in vitro susceptibility testing. The complete genome of G. vaginalis isolate from blood cultures was determined. In vitro G. vaginalis isolate produced elevated amounts of a pore-forming toxin vaginolysin compared to control G. vaginalis isolates. We hypothesize that this toxin, if produced in high amounts in blood, is able to disrupt the blood-brain barrier and exert a toxic activity on brain cells.

Topics: Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bacteremia; Bacterial Proteins; Bacterial Toxins; Bacterial Typing Techniques; Brain Diseases; Cluster Analysis; DNA, Bacterial; DNA, Ribosomal; Female; Gardnerella vaginalis; Gram-Positive Bacterial Infections; Humans; Phylogeny; RNA, Ribosomal, 16S; Sequence Analysis, DNA; Treatment Outcome; Young Adult

Although antibiotic de-escalation is regarded as a measure that reduces selection pressure, adverse drug effects and costs, evidence supporting this practice in community-acquired pneumococcal pneumonia (CAPP) is lacking.. We carried out a retrospective analysis of prospectively collected data of a cohort of hospitalized adults with CAPP. Pneumococcal aetiology was established in patients with one or more positive cultures for Streptococcus pneumoniae obtained from blood, sterile fluids or sputum, and/or a positive urinary antigen test. De-escalation therapy was considered when the initial antibiotic therapy was narrowed to penicillin, amoxicillin or amoxicillin/clavulanate within the first 72 h after admission. The primary outcomes were 30 day mortality and length of hospital stay (LOS). Adjustment for confounders was performed with multivariate and propensity score analyses.. Of 1410 episodes of CAPP, antibiotic de-escalation within the first 72 h after admission was performed in 166 cases. After adjustment, antibiotic de-escalation was not associated with a higher risk of mortality (OR = 0.83, 95% CI = 0.24-2.81), but it was found to be a protective factor for prolonged LOS (above the median) (OR = 0.46, 95% CI = 0.30-0.70). Similar results were found in patients classified into high-risk pneumonia severity index classes (IV-V), those with clinical instability and those with bacteraemia. No significant differences were documented in adverse drug reactions or readmission (<30 days).. Antibiotic de-escalation seems to be safe and effective in reducing the duration of LOS, and did not adversely affect outcomes of patients with CAPP, even those with bacteraemia and severe disease, and those who were clinically unstable.

Topics: Aged; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bacteremia; Community-Acquired Infections; Female; Hospitalization; Humans; Length of Stay; Male; Middle Aged; Penicillins; Pneumonia, Pneumococcal; Prospective Studies; Retrospective Studies; Streptococcus pneumoniae; Treatment Outcome

To compare results of amoxicillin/clavulanate susceptibility testing using CLSI and EUCAST methodologies and to evaluate their impact on outcome in patients with bacteraemia caused by Enterobacteriaceae.. A prospective observational cohort study was conducted in 13 Spanish hospitals. Patients with bacteraemia due to Enterobacteriaceae who received empirical intravenous amoxicillin/clavulanate treatment for at least 48 h were included. MICs were determined following CLSI and EUCAST recommendations. Outcome variables were: failure at the end of treatment with amoxicillin/clavulanate (FEAMC); failure at day 21; and 30 day mortality. Classification and regression tree (CART) analysis and logistic regression were performed.. Overall, 264 episodes were included; the urinary tract was the most common source (64.7%) and Escherichia coli the most frequent pathogen (76.5%). Fifty-two isolates (19.7%) showed resistance according to CLSI and 141 (53.4%) according to EUCAST. The kappa index for the concordance between the results of both committees was only 0.24. EUCAST-derived, but not CLSI-derived, MICs were associated with failure when considered as continuous variables. CART analysis suggested a 'resistance' breakpoint of > 8/4 mg/L for CLSI-derived MICs; it predicted FEAMC in adjusted analysis (OR = 1.96; 95% CI: 0.98-3.90). Isolates with EUCAST-derived MICs >16/2 mg/L independently predicted FEAMC (OR = 2.10; 95% CI: 1.05-4.21) and failure at day 21 (OR= 3.01; 95% CI: 0.93-9.67). MICs >32/2 mg/L were only predictive of failure among patients with bacteraemia from urinary or biliary tract sources.. CLSI and EUCAST methodologies showed low agreement for determining the MIC of amoxicillin/clavulanate. EUCAST-derived MICs seemed more predictive of failure than CLSI-derived ones. EUCAST-derived MICs >16/2 mg/L were independently associated with therapeutic failure.

Topics: Aged; Aged, 80 and over; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bacteremia; beta-Lactamase Inhibitors; Enterobacteriaceae; Enterobacteriaceae Infections; Escherichia coli; Escherichia coli Infections; Female; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Prospective Studies

Early review of antimicrobial prescribing decisions within 48 h is recommended to reduce the overall use of unnecessary antibiotics, and in particular the use of broad-spectrum antibiotics. When parenteral antibiotics are used, blood culture results provide valuable information to help decide whether to continue, alter or stop antibiotics at 48 h. The objective of this study was to investigate the frequency of parenteral antibiotic use, broad spectrum antibiotic use and use of blood cultures when parenteral antibiotics are initiated in patients admitted via the Emergency Department.. We used electronic health records from patients admitted from the Emergency Department at University Hospital Birmingham in 2014.. Six percent (4562/72939) of patients attending the Emergency department and one-fifth (4357/19034) of those patients admitted to hospital were prescribed a parenteral antimicrobial. More than half of parenteral antibiotics used were either co-amoxiclav or piperacillin-tazobactam. Blood cultures were obtained in less than one-third of patients who were treated with a parenteral antibiotic.. Parenteral antibiotics are frequently used in those admitted from the Emergency Department; they are usually broad spectrum and are usually initiated without first obtaining cultures. Blood cultures may have limited value to support prescribing review as part of antimicrobial stewardship initiatives.

Topics: Aged; Amoxicillin-Potassium Clavulanate Combination; Anti-Infective Agents; Bacteremia; Cross-Sectional Studies; Emergency Service, Hospital; Female; Hospitals, University; Humans; Male; Microbiological Techniques; Penicillanic Acid; Piperacillin; Retrospective Studies; Tazobactam

Respiratory anthrax is a fatal disease in the absence of early treatment with antibiotics. Rabbits are highly susceptible to infection with Bacillus anthracis spores by intranasal instillation, succumbing within 2 to 4 days postinfection. This study aims to test the efficiency of antibiotic therapy to treat systemic anthrax in this relevant animal model. Delaying the initiation of antibiotic administration to more than 24 h postinfection resulted in animals with systemic anthrax in various degrees of bacteremia and toxemia. As the onset of symptoms in humans was reported to start on days 1 to 7 postexposure, delaying the initiation of treatment by 24 to 48 h (time frame for mass distribution of antibiotics) may result in sick populations. We evaluated the efficacy of antibiotic administration as a function of bacteremia levels at the time of treatment initiation. Here we compare the efficacy of treatment with clarithromycin, amoxicillin-clavulanic acid (Augmentin), imipenem, vancomycin, rifampin, and linezolid to the previously reported efficacy of doxycycline and ciprofloxacin. We demonstrate that treatment with amoxicillin-clavulanic acid, imipenem, vancomycin, and linezolid were as effective as doxycycline and ciprofloxacin, curing rabbits exhibiting bacteremia levels of up to 10(5) CFU/ml. Clarithromycin and rifampin were shown to be effective only as a postexposure prophylactic treatment but failed to treat the systemic (bacteremic) phase of anthrax. Furthermore, we evaluate the contribution of combined treatment of clindamycin and ciprofloxacin, which demonstrated improvement in efficacy compared to ciprofloxacin alone.

Topics: Amoxicillin-Potassium Clavulanate Combination; Animals; Anthrax; Anti-Bacterial Agents; Bacillus anthracis; Bacteremia; Ciprofloxacin; Clarithromycin; Disease Models, Animal; Doxycycline; Drug Combinations; Drug Synergism; Humans; Imipenem; Linezolid; Male; Microbial Sensitivity Tests; Rabbits; Respiratory Tract Infections; Rifampin; Spores, Bacterial; Survival Analysis; Vancomycin

Leclercia adecarboxylata is being increasingly diagnosed as a causative agent of infection due to the availability of rapid molecular diagnostic techniques Few cases of bacteraemia in subjects with underlying medical conditions have been reported. We report a case of L. adecarboxylata bacteraemia in an immunocompromised patient with metabolic syndrome.

Topics: Amoxicillin-Potassium Clavulanate Combination; Bacteremia; Body Mass Index; Debridement; Diabetes Mellitus, Type 2; Enterobacteriaceae; Enterobacteriaceae Infections; Female; Humans; Hypertension; Immunocompromised Host; Leg; Metabolic Syndrome; Middle Aged; Risk Factors; Treatment Outcome

Two hundred twelve patients with colonization/infection due to amoxicillin-clavulanate (AMC)-resistant Escherichia coli were studied. OXA-1- and inhibitor-resistant TEM (IRT)-producing strains were associated with urinary tract infections, while OXA-1 producers and chromosomal AmpC hyperproducers were associated with bacteremic infections. AMC resistance in E. coli is a complex phenomenon with heterogeneous clinical implications.

Topics: Adolescent; Adult; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bacteremia; beta-Lactam Resistance; Child; Cross-Sectional Studies; Escherichia coli; Escherichia coli Infections; Female; Humans; Male; Middle Aged; Multicenter Studies as Topic; Urinary Tract Infections; Young Adult

Topics: Actinomycetaceae; Actinomycetales Infections; Aged; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bacteremia; Bacteroides fragilis; Bacteroides Infections; Catheter-Related Infections; Coinfection; Female; Gardnerella vaginalis; Gram-Positive Bacterial Infections; Humans; Klebsiella Infections; Klebsiella oxytoca; Leg Ulcer; Pressure Ulcer; Skin; Soft Tissue Infections; Species Specificity; Urinary Catheterization; Urinary Tract Infections

Topics: Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bacteremia; beta-Lactamase Inhibitors; Escherichia coli Infections; Female; Humans; Male; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination

Extended-spectrum ß-lactamase-producing Escherichia coli (ESBL-EC) is an important cause of invasive infections. Alternatives to carbapenems--considered the drugs of choice--are needed because of the emergence of carbapenemase-producing enterobacteria. The efficacy of ß-lactam/ß-lactam inhibitors (BLBLI) in such infections is controversial.. The authors performed a post hoc analysis of patients with bloodstream infections due to ESBL-EC from 6 published prospective cohorts. Mortality and length of hospital stay in patients treated with an active BLBLI (amoxicillin-clavulanic acid [AMC] and piperacillin-tazobactam [PTZ]) or carbapenem were compared in 2 cohorts: the empirical therapy cohort (ETC) and the definitive therapy cohort (DTC). Confounding was controlled by multivariate analysis; for patients in the ETC, a propensity score for receiving carbapenem was also used.. The ETC included 103 patients (BLBLI, 72; carbapenem, 31), and the DTC included 174 (BLBLI, 54; carbapenem, 120). Mortality rates at day 30 for those treated with BLBLI versus carbapenems were 9.7% versus 19.4% for the ETC and 9.3% versus 16.7% for the DTC, respectively (P > .2, log-rank test). After adjustment for confounders, no association was found between either empirical therapy with BLBLI (adjusted hazard ratio [HR], 1.14; 95% confidence interval [CI], .29-4.40; P = .84) or definitive therapy (adjusted HR, 0.76; 95% CI, .28-2.07; P = .5) and increased mortality. Furthermore, BLBLI therapy, with respect to carbapenem, was not found to influence length of hospital stay.. These results suggest that AMC and PTZ are suitable alternatives to carbapenems for treating patients with bloodstream infections due to ESBL-EC if active in vitro and would be particularly useful as definitive therapy.

Topics: Aged; Aged, 80 and over; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bacteremia; beta-Lactam Resistance; beta-Lactamase Inhibitors; Escherichia coli; Escherichia coli Infections; Female; Humans; Male; Middle Aged; Multivariate Analysis; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination; Proportional Hazards Models; Prospective Studies; Spain

The incidence of infection following TEVAR is low. To the best of our knowledge, this is the first case report of post thoracic endovascular aortic repair (TEVAR) with Streptococcus viridans graft infection. A 54-year-old male underwent TEVAR for dissecting thoracic aneurysm with spinal ischaemia. He had an eventful recovery with prolonged period of stay in intensive care unit. Three months later, he presented with persistent chest discomfort and fever. Computed tomography (CT) of the thorax revealed evidence of graft infection and the blood culture grew Streptococcus viridans. The rarity of TEVAR graft infection due to Streptococcus viridans and its management are being discussed.

Topics: Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Aortic Aneurysm, Thoracic; Aortic Dissection; Bacteremia; Blood Vessel Prosthesis Implantation; Endovascular Procedures; Esophageal Fistula; Fever; Humans; Ischemia; Male; Middle Aged; Myocardial Infarction; Paraplegia; Penicillins; Postoperative Complications; Prosthesis-Related Infections; Radiography; Spinal Cord; Streptococcal Infections; Vascular Fistula; Viridans Streptococci

Topics: Aged; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bacteremia; Ciprofloxacin; Clostridium; Enterocolitis, Pseudomembranous; Female; Humans; Immunocompetence; Metronidazole; Species Specificity; Ulcer

To determine trends in ciprofloxacin resistance and co-resistance to other antibiotic classes in blood isolates of Escherichia coli, and to investigate if there is an ecological relationship to the community use of fluoroquinolones and other antibiotics.. Forty-two Spanish hospitals of the European Antimicrobial Resistance Surveillance Network collected ciprofloxacin and other antibiotic susceptibility data for non-duplicate consecutive E. coli isolates from patients with bacteraemia between 2001 and 2009. The nationwide ambulatory use of antibiotics between 1997 and 2008 was determined by WHO methods, and the co-evolution of both parameters was further analysed.. Of the 28 307 E. coli blood isolates, 27.9% were ciprofloxacin non-susceptible (CIPNS), increasing from 17.6% in 2001 to 32.7% in 2009. A continuous increase was observed between CIPNS and other resistances, including cephalosporin resistance due to the production of extended-spectrum β-lactamases (ESBLs) and non-susceptibility to both amoxicillin/clavulanic acid and tobramycin. Although the total use of antibiotics did not increase, community use of levofloxacin, moxifloxacin and amoxicillin/clavulanic acid increased by 307.2%, 62.6% and 70.1%, respectively. Yearly rates of CIPNS E. coli strongly correlated with the use of levofloxacin, moxifloxacin and amoxicillin/clavulanic acid (r(2 )> 0.80; P < 0.005 in all cases).. The rapid increase in CIPNS E. coli causing bacteraemia was closely related to the increase in resistance to amoxicillin/clavulanic acid, production of ESBLs and resistance to aminoglycosides. Community use of fluoroquinolones (mainly moxifloxacin and levofloxacin) and of amoxicillin/clavulanic acid represents a significant driver in the progression of fluoroquinolone resistance in bacteraemic E. coli.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Amoxicillin-Potassium Clavulanate Combination; Aza Compounds; Bacteremia; Drug Resistance, Bacterial; Drug Utilization; Escherichia coli; Escherichia coli Infections; Female; Fluoroquinolones; Hospitals; Humans; Levofloxacin; Male; Middle Aged; Moxifloxacin; Ofloxacin; Quinolines; Spain; Young Adult

Topics: Amoxicillin-Potassium Clavulanate Combination; Anemia, Sickle Cell; Anti-Bacterial Agents; Bacteremia; Bordetella; Bordetella Infections; Child; Disease Susceptibility; DNA, Bacterial; Drug Resistance, Multiple, Bacterial; Female; Fever; Humans; Ribotyping; Sequence Homology, Nucleic Acid

We report the first case of Gordonibacter pamelaeae bacteremia, identified by phenotypic tests and 16S rRNA sequencing in a patient with disseminated rectosigmoid carcinoma and responsive to amoxicillin-clavulanate. The bacterium was a nonsporulating, anaerobic, gram-positive, nonmotile, coccobacillus that was catalase, arginine dihydrolase, and arginine acrylamidase positive. The gastrointestinal tract is probably its reservoir.

Topics: Actinobacteria; Aged, 80 and over; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bacteremia; Bacterial Typing Techniques; DNA, Bacterial; DNA, Ribosomal; Gram-Positive Bacterial Infections; Humans; Male; Molecular Sequence Data; Rectal Neoplasms; RNA, Ribosomal, 16S; Sequence Analysis, DNA

Topics: Aged, 80 and over; Aging; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bacteremia; Comorbidity; Female; France; Humans; Immunocompromised Host; Meningococcal Infections; Neisseria meningitidis, Serogroup W-135; Pneumonia, Bacterial

To determine the evolution and trends of amoxicillin-clavulanic acid resistance among Escherichia coli isolates in Spain, we tested 9,090 blood isolates from 42 Spanish hospitals and compared resistance with trends in outpatient consumption. These isolates were collected by Spanish hospitals that participated in the European Antimicrobial Resistance Surveillance System network from April 2003 through December 2006.

Topics: Adolescent; Adult; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bacteremia; Drug Resistance, Multiple, Bacterial; Escherichia coli; Escherichia coli Infections; Female; Humans; Male; Middle Aged; Odds Ratio; Risk Factors; Spain

Recently published guidance from NICE highlights that antibiotic prophylaxis is no longer required for patients with structural heart disease at risk of infective endocarditis. The American Heart Association has published similarly less interventive guidance. Individuals with pulmonary arteriovenous malformations and hereditary haemorrhagic telangiectasia are at risk of brain abscess from dental bacteraemias. In this article we explore why these patients do not fall into the groups considered by NICE and provide recommendations to reduce their risks of dental bacteraemias, including optimising dental hygiene and use of antibiotic prophylaxis prior to dental procedures.

Topics: Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Antibiotic Prophylaxis; Arteriovenous Malformations; Bacteremia; Brain Abscess; Dental Care for Chronically Ill; Drug Combinations; Humans; Practice Guidelines as Topic; Pulmonary Artery; Pulmonary Veins; Telangiectasia, Hereditary Hemorrhagic

In this paper, we report 21 cases of Campylobacter fetus bloodstream infection observed in our institution over a 9-year period. The median age of the patients was 78 years. Most of them (62%) had a significant underlying disease, such as diabetes, immunodeficiency or cardiovascular disease. The main clinical features were fever with (62% of cases) or without (38%) extra-intestinal symptoms. These included mycotic aneurysm of the abdominal aorta (24%) and cellulitis (19%). Antibiotic treatment was mainly based on amoxicilline-clavulanate (57%) or imipenem (21%), for a median duration of 28 days. A favourable outcome was observed in 72% of cases. Death directly attributable to infection was observed for three patients, due to the rupture of an infected aneurysm or relapsing bloodstream infection with septic shock. All patients initially treated with imipenem had a favourable outcome. This report adds evidence that C. fetus bloodstream infection should be suspected in elderly patients with fever, immunodeficiency and cardiovascular damages. Imipenem seems to be the most active drug, especially in severe cases.

Topics: Adult; Age Factors; Aged; Aged, 80 and over; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bacteremia; Campylobacter fetus; Campylobacter Infections; Cardiovascular Diseases; Diabetes Complications; Female; Humans; Imipenem; Immunocompromised Host; Male; Risk Factors; Treatment Outcome

Few attempts have been made to compare bacteremic and non-bacteremic pneumococcal pneumonia, mainly because it is difficult to gain agreement on which cases represent non-bacteremic pneumococcal pneumonia. Recently, an immunochromatographic assay for the detection of Streptococcus pneumoniae urinary antigen has been successfully evaluated for the diagnosis of pneumococcal pneumonia. The aim of our study was to examine and compare clinical and radiological features, risk factors, and outcome associated with bacteremic and non-bacteremic groups.. A retrospective study (1995-2003) analyzing the clinical records of patients diagnosed with pneumococcal pneumonia in our institution was performed. S. pneumoniae were identified by blood cultures (bacteremic group) and detection of urinary antigen (non-bacteremic group).. There were 82 patients (57 bacteremic and 25 non-bacteremic). In seven non-bacteremic cases, another etiology was detected, i.e., Legionella (n=1) and Chlamydia pneumoniae (n=6). Bacteremic patients were significantly younger (p=<0.001), more likely to have liver disease (p=0.028), current smokers (p=0.024), alcohol and intravenous drug abusers (p=0.014 and p<0.001, respectively), and infected with HIV (p<0.001). Non-bacteremic patients were more likely to have congestive heart failure (p=0.004), chronic obstructive pulmonary disease (p=0.033) and to be former smokers (p=0.004). Bacteremic cases needed more prolonged intravenous antibiotic treatment (6 days vs. 4.5 days; p=0.006) than non-bacteremic cases and their length of stay was also longer.. In our study, smoking was the leading risk factor for pneumococcal pneumonia. However, current smokers have an increased risk of bacteremic forms and former smokers and patients with COPD developed non-bacteremic forms more frequently. Bacteremic patients need more prolonged intravenous antibiotic treatment than non-bacteremic patients.

Topics: Adult; Aged; Aged, 80 and over; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Antigens, Bacterial; Bacteremia; Cephalosporins; Community-Acquired Infections; Female; Fluoroquinolones; Humans; Length of Stay; Macrolides; Male; Microbial Sensitivity Tests; Middle Aged; Pneumonia, Pneumococcal; Retrospective Studies; Streptococcus pneumoniae; Treatment Outcome

Topics: Aged; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bacteremia; Cefotaxime; Esophageal and Gastric Varices; Gentamicins; Humans; Ligation; Liver Cirrhosis, Alcoholic; Male

We sought to determine whether the bacteria in complicated rhinosinusitis were the typical acute rhinosinusitis triad of Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. We also compared the difference in yield between infection sites and blood cultures.. We performed a retrospective review of all patients who had required surgical intervention for rhinosinusitis complications over 7 years at a tertiary care pediatric hospital.. There were a total of 28 patients during the review period. Twenty-five organisms were isolated from 21 patients, of which Streptococcus viridans formed 44% of the isolates (11 of the 25). The typical triad of bacteria only formed 20% of the isolates (5 of the 25), and none of these bacteria were found in the group with intracranial complications. Infection site cultures had a superior yield compared to blood cultures (p < .001). Ninety-six percent of the bacteria were sensitive to a combination of amoxicillin-clavulanate and cloxacillin.. In distinction to the typical bacteria of acute rhinosinusitis, S. viridans is the leading cause of rhinosinusitis complications. It is not merely a commensal organism of the upper respiratory tract.

Topics: Adolescent; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bacteremia; Child; Child, Preschool; Cloxacillin; Female; Humans; Male; Retrospective Studies; Rhinitis; Sinusitis; Viridans Streptococci

Emphysematous pyelonephritis is a necrotizing renal infection characterized by bacterial gas production in the renal and perirenal area. It is a rare infection diagnosed in diabetic patients in most cases. Emphysematous pyelonephritis has a high mortality rate. We herein report one case of bilateral emphysematous pyelonephritis managed by medical therapy alone.

Topics: Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Back Pain; Bacteremia; Bacteriuria; Consciousness Disorders; Diabetes Mellitus, Type 2; Emphysema; Female; Fever; Humans; Klebsiella Infections; Middle Aged; Pyelonephritis; Remission Induction

Extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli, particularly those producing CTX-M types of ESBL, are emerging pathogens. Bacteremia caused by these organisms represents a clinical challenge, because the organisms are frequently resistant to the antimicrobials recommended for treatment of patients with suspected E. coli sepsis.. A cohort study was performed that included all episodes of bloodstream infection due to ESBL-producing E. coli during the period from January 2001 through March 2005. Data on predisposing factors, clinical presentation, and outcome were collected. ESBLs were characterized using isoelectric focusing, polymerase chain reaction, and sequencing.. Forty-three episodes (8.8% of cases of bacteremia due to E. coli) were included; 70% of the isolates produced a CTX-M type of ESBL. The most frequent origins of infection were the urinary (46%) and biliary tracts (21%). Acquisition was nosocomial in 21 cases (49%), health care associated in 14 cases (32%), and strictly community acquired in 8 cases (19%). Thirty-eight percent and 25% of patients had obstructive diseases of the urinary and biliary tracts, respectively, and 38% had recently received antimicrobials. Nine patients (21%) died. Compared with beta-lactam/beta-lactamase-inhibitor and carbapenem-based regimens, empirical therapy with cephalosporins or fluoroquinolones was associated with a higher mortality rate (9% vs. 35%; P=.05) and needed to be changed more frequently (24% vs. 78%; P=.001).. ESBL-producing E. coli is a significant cause of bloodstream infection in hospitalized and nonhospitalized patients in the context of the emergence of CTX-M enzymes. Empirical treatment of sepsis potentially caused by E. coli may need to be reconsidered in areas where such ESBL-producing isolates are present.

Topics: Adult; Aged; Aged, 80 and over; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bacteremia; beta-Lactamases; Cephalosporins; Cohort Studies; Community-Acquired Infections; Cross Infection; Drug Resistance, Multiple, Bacterial; Escherichia coli; Escherichia coli Infections; Female; Fluoroquinolones; Humans; Male; Middle Aged; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination

Topics: Adult; Amoxicillin-Potassium Clavulanate Combination; Ascites; Bacteremia; Carcinoma, Hepatocellular; Comorbidity; Drug Combinations; Drug Therapy, Combination; Female; Gonorrhea; Hepatitis C, Chronic; HIV Infections; Humans; Ileus; Liver Neoplasms; Multiple Organ Failure; Ofloxacin; Pelvic Infection; Peritonitis

Topics: Aged; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bacteremia; Drug Resistance, Bacterial; Drug Therapy, Combination; Humans; Macrolides; Methyltransferases; Pneumococcal Infections; Streptococcus pneumoniae; Treatment Failure

A Gram-negative rod was isolated from the blood cultures of an 84-year-old man with foot cellulitis. The bacterium was first identified as Sphingobacterium spiritivorum on the basis of standard assimilation tests. However, sequencing analysis of its 16S rRNA genes and whole genome hybridization studies with other related bacteria showed that this isolate belongs to a so far undescribed species of Sphingobacterium, close to S. mizutae. This bacterium was susceptible to most of the antibiotics tested, including glycopeptides, but was resistant to aminoglycosides and polymyxins. Treatment with amoxicillin-clavulanate cured the infection.

Topics: Aged; Aged, 80 and over; Amoxicillin-Potassium Clavulanate Combination; Bacteremia; Cellulitis; Drug Therapy, Combination; Gram-Negative Bacterial Infections; Humans; Male; Microbial Sensitivity Tests; Sphingobacterium

We report a case of Anaerobiospirillum succiniciproducens bacteremia in a young child who had no underlying disease. The case should alert microbiologists and physicians to an uncommon organism that is very often resistant to antibiotics normally prescribed empirically for infections caused by organisms of similar morphology and characteristics such as Campylobacter species.

Topics: Amoxicillin-Potassium Clavulanate Combination; Bacteremia; Chloramphenicol; Female; Gammaproteobacteria; Humans; Infant

This report describes a case of severe pneumonia associated with Mycoplasma pneumoniae infection and Moraxella catarrhalis bacteraemia in a 44-y-old woman with undiagnosed breast carcinoma. M. pneumoniae is increasingly recognized as a co-pathogen but to the authors' knowledge this is the first reported case of M. catarrhalis bacteraemia associated with M. pneumoniae infection.

Topics: Adult; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bacteremia; Breast Neoplasms; Clarithromycin; Drug Therapy, Combination; Enzyme Inhibitors; Female; Gram-Negative Bacterial Infections; Humans; Moraxella catarrhalis; Mycoplasma pneumoniae; Pneumonia, Mycoplasma

A 34-year-old woman presented two weeks after a visit to Burma with fever peaking up to 39 degrees C, chills, non-productive cough, headache, muscle pain, shortness of breath and a painful swelling on the left lower leg. She was treated immediately with intravenous amoxycillin-clavulanic acid. The Gram negative causative agent of melioidosis, Burkholderia (previously Pseudomonas) pseudomallei, was cultured from samples taken beforehand. The patient then received ceftazidime. She recovered. In view of the risk of relapse she was treated with amoxycillin-clavulanic acid for a further six months. Melioidosis is endemic in Southeast Asia and Northern Australia. It is rarely seen outside these areas. The clinical spectrum of the disease is wide and varies from fulminating sepsis to a subclinical disease and may affect any organ system, usually the lungs. The mortality of the septicaemic form after adequate treatment is 40%. Surviving patients have a high relapse rate (4-20%). Melioidosis can become chronic with formation of abscesses or can remain subclinical for many years, probably because the microorganism can survive within phagocytic cells with a risk of reactivation at moments of immunosuppression. The optimal treatment consists of ceftazidime intravenously for at least two weeks followed by an eradication phase consisting of oral antibiotics for at least 3 months.

Topics: Adult; Amoxicillin-Potassium Clavulanate Combination; Bacteremia; Drug Therapy, Combination; Female; Humans; Melioidosis; Prognosis; Secondary Prevention

A gram-negative alkaline phosphatase- and pyrrolidone peptidase-positive rod-shaped bacterium (CCUG 45702) was isolated from two aerobic blood cultures from a female cancer patient. No identification could be reached using phenotypic techniques. Amplification of the tRNA intergenic spacers revealed fragments with lengths of 116, 133, and 270 bp, but no such pattern was present in our reference library. Sequencing of the 16S rRNA gene revealed its identity as Moraxella atlantae, a species isolated only rarely and published only once as causing infection. In retrospect, the phenotypic characteristics fit the identification as M. atlantae (formerly known as CDC group M-3). Comparative 16S rRNA sequence analysis indicates that M. atlantae, M. lincolnii, and M. osloensis might constitute three separate genera within the MORAXELLACEAE: After treatment with amoxicillin-clavulanic acid for 2 days, fever subsided and the patient was dismissed.

Topics: Adenocarcinoma; Adult; Amoxicillin-Potassium Clavulanate Combination; Bacteremia; Base Sequence; DNA, Bacterial; DNA, Ribosomal; Female; Genes, Bacterial; Humans; Molecular Sequence Data; Moraxella; Neisseriaceae Infections; Opportunistic Infections; Rectal Neoplasms; RNA, Bacterial; RNA, Ribosomal, 16S; Sequence Homology, Nucleic Acid; Species Specificity

The recommended treatment for severe melioidosis is ceftazidime or a combination of ceftazidime and trimethoprim-sulfamethoxazole (TMP/SMX). Amoxicillin-clavulanate has been shown to be an effective alternative therapy. In patient who is allergic to penicillin and cephalosporin, imipenem an alternative drug may be used. We described a 10 year-old boy who was diagnosed as septicemic melioidosis and type 1 diabetes mellitus. He developed fever and rash while being given ceftazidime and TMP/SMX. The fever recurred when amoxicillin-clavulanate was administered orally. He was successfully treated with imipenem.

Topics: Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bacteremia; Ceftazidime; Cephalosporins; Child; Diabetes Complications; Drug Therapy, Combination; Humans; Imipenem; Male; Melioidosis; Thienamycins

Topics: Amoxicillin-Potassium Clavulanate Combination; Bacteremia; Drug Therapy, Combination; Humans; Male; Methylprednisolone; Middle Aged; Retropharyngeal Abscess; Streptococcal Infections; Streptococcus agalactiae

Escherichia coli has seldom been reported to cause pseudobacteremia. The investigation of an outbreak of amoxycillin-clavulanic acid-resistant E. coli pseudobacteremia is described. Seventeen cases occurred over a five-day period. The source of the E. coli was traced to the blood culture specimen of a patient (index patient) with genuine bacteremia as a result of urinary tract infection. The other 16 case-patients had pseudobacteremia which was found to be the result of cross-contamination during subculture of blood specimens. The E. coli strain was carried over from the culture bottle of the index patient, through the contaminated gloved hands of a technician to the culture bottles of the other 16 cases. Although the pseudobacteremia occurred over a five-day period, they all resulted from cross-contamination during blood culture processing within one day. An early outbreak investigation was prompted by the unusual finding of amoxycillin-clavulanic acid resistance in the case E. coli isolates in a short period. The relatedness of the E. coli strains from the 17 cases was confirmed by arbitrary-primed polymerase chain reaction. Clinicians should be alerted to the possibility of a blood E. coli isolate being a contaminant despite its predominant role as a true pathogen.

Topics: Amoxicillin-Potassium Clavulanate Combination; Ampicillin Resistance; Bacteremia; Bacteriological Techniques; Culture Media; Diagnostic Errors; Escherichia coli

Primary peritonitis caused by Streptococcus pneumoniae is a rare but serious complication of childbirth. We present here three cases of young women who developed abdominal pain after childbirth. All of the patients had fever with abdominal pain, diarrhea and clinical signs of peritonitis. In two cases a laparotomy was performed to remove pus. Cultures taken were positive for Streptococcus pneumoniae. Culture of vaginal swabs and blood cultures were also positive for the same pathogen. For the third patient, both vaginal swabs and blood cultures were positive for Streptococcus pneumoniae, antibiotic therapy only was administered. Outcome was favorable for all. We discuss the pathogenesis, clinical presentation, management and the usefulness for systematic search "for" Streptococcus pneumoniae in vaginal swabs.

Topics: Abdominal Pain; Adult; Amikacin; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bacteremia; Cilastatin; Diarrhea; Drug Therapy, Combination; Female; Fever; Humans; Imipenem; Laparotomy; Penicillins; Peritonitis; Pneumococcal Infections; Protease Inhibitors; Puerperal Infection; Thienamycins; Treatment Outcome; Vagina

A blood-culture isolate of Bacteroides fragilis, taken from a woman after elective laparotomy, was resistant to metronidazole and had reduced susceptibility to imipenem and co-amoxiclav. After treatment with imipenem, pus drained from the pleural cavity yielded an identical isolate that had become highly resistant to imipenem and co-amoxiclav. Emergence of full resistance to the beta-lactam antibiotics was accompanied by a tenfold rise in the specific activity of a metallo-beta-lactamase. Clinicians need to be alert to simultaneous resistance to metronidazole, co-amoxiclav, and imipenem and development of high-level resistance to imipenem in B fragilis during treatment with this agent.

Topics: Adult; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Bacteremia; Bacteroides fragilis; Bacteroides Infections; Clavulanic Acids; Drug Resistance, Microbial; Drug Resistance, Multiple; Drug Therapy, Combination; Empyema, Pleural; Female; Humans; Imipenem; Metronidazole