amoxicillin-potassium-clavulanate-combination and Enterobacteriaceae-Infections

Recurrent urinary tract infections are difficult to manage in patients with a history of kidney transplant and may contribute to graft loss. Few cases describe recurrent urinary tract infections due to Raoultella planticola in this population. We describe the management of recurrent urinary tract infections due to R planticola in a kidney transplant recipient and review other case reports of urinary tract infections due to this organism.

Topics: Adult; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Cephalexin; Drug Administration Schedule; Drug Resistance, Bacterial; Drug Therapy, Combination; Enterobacteriaceae; Enterobacteriaceae Infections; Female; Humans; Kidney Transplantation; Microbial Sensitivity Tests; Recurrence; Treatment Outcome; Urinary Tract Infections

Ewingella americana (family Enterobacteriaceae) was isolated separately from both eyes of a 30-year-old woman. Clinical signs and symptoms included adhesive eyelids, itching and edematous upper and lower lids. Therapy with amoxicillin-clavulanate resulted in the relief of symptoms. Ewingella americana can be isolated worldwide, but seems to be a rare pathogen.

Topics: Adult; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Clavulanic Acids; Conjunctivitis, Bacterial; Drug Therapy, Combination; Enterobacteriaceae; Enterobacteriaceae Infections; Female; Humans

Intranasal septal splints are often used in nasal septal surgeries. Routine use of postoperative antibiotics is an accepted practice, although data regarding its efficacy in preventing postsurgical complications are limited. This study aimed to examine bacterial colonization on septal splints following prophylactic antibiotic therapy and the association with postoperative infections.. Fifty-five patients underwent septoplasty by a single surgeon between March 2015 and April 2016. All had intranasal septal splints and were given antibiotic prophylaxis for 7 days until removal of splints. Nasal cultures were taken before surgery, and septal splints were examined for bacterial colonization following their removal.. Thirty-six patients (65%) had positive nasal culture prior to surgery. The most common isolates were. Increased bacterial growth and emergence of resistant strains were observed on intranasal septal splints despite prophylactic antibiotic treatment. Nonetheless, this did not translate into clinical infection. Thus, considering antibiotics overuse and increasing bacterial resistance, further research is needed to determine the role of antibiotic prophylaxis in the setting of intranasal splints.

Topics: Adolescent; Adult; Aged; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Antibiotic Prophylaxis; Cephalexin; Culture Techniques; Drug Resistance, Bacterial; Drug Resistance, Multiple, Bacterial; Enterobacteriaceae; Enterobacteriaceae Infections; Female; Humans; Male; Middle Aged; Nasal Cavity; Nasal Septum; Nasal Surgical Procedures; Splints; Staphylococcal Infections; Staphylococcus aureus; Surgical Wound Infection; Young Adult

Topics: Adult; Aged; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Ciprofloxacin; Clarithromycin; Comorbidity; Crohn Disease; Enterobacteriaceae Infections; Female; Hafnia alvei; Humans; Immunocompromised Host; Male; Pneumonia, Bacterial; Pulmonary Disease, Chronic Obstructive; Rare Diseases; Treatment Outcome; Young Adult

A 72-year-old gentleman with significant cardiac history and a pacemaker in situ initially presented to the emergency department 5 days after he had his pacemaker-unit batteries changed. He had deranged vital signs, productive cough and fever. His chest plain radiograph did not show evidence of infection; however, he had right basal crackles on auscultation, which suggested a lower respiratory tract infection. He was treated with intravenous co-amoxiclav and supportive therapy, which led to his improvement. The patient was discharged but had to be readmitted a total of four times over the span of 4 months due to recurrent fever and associated symptoms. Transthoracic and transoesophageal echocardiograms and CT of the neck/thorax/abdomen/pelvis were done to look for endocarditis, pacemaker-unit infection and other sources of infection. However, these did not show any evidence of infection. He did have persistent raised inflammatory markers and two blood cultures growing

Topics: Aged; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Blood Culture; Device Removal; Enterobacter cloacae; Enterobacteriaceae Infections; Fever of Unknown Origin; Fluorodeoxyglucose F18; Hospitalization; Humans; Male; Pacemaker, Artificial; Patient Readmission; Positron-Emission Tomography; Prosthesis-Related Infections; Radiopharmaceuticals

Topics: Aged, 80 and over; Amoxicillin-Potassium Clavulanate Combination; beta-Lactamase Inhibitors; Citrobacter koseri; Enterobacteriaceae Infections; Facial Dermatoses; Humans; Male

The study investigated 110 Enterobacteriaceae isolates from broiler chickens isolated from Sharkia poultry farms and analyzed the isolates antimicrobial resistance and the presence of integrons as a potential basis for this resistance. Antibiotic susceptibilities against 12 different antibiotics were determined by the disk diffusion method. Prevalences and classes of integrons were then detected in multi-drug resistant (MDR) strains using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) followed by sequencing of the variable parts. Fifty-three isolates were MDR (resistant to three or more antimicrobial agents). High resistance was detected for rifamycin (82.7%), erythromycin (67.2%), and amoxicillin-clavulanic acid (63%). Classes 1 and 2 integrons were detected in 38 of 53 MDR Enterobacteriaceae isolates of which the most common were Salmonella species (n=19), followed by Escherichia coli (12), Klebsiella pneumoniae (3), Proteus species (3), and Citrobacter freundii (1). Three isolates only harbored class 1 integrons while the remaining 35 isolates carried class 2.  All class 1 integron positive isolates exhibited the same gene cassettes arrangements: 1.) dfrA12-orfF-aadA27 (1.6 kbp); 2.) aadA23 (1.0 kbp); and 3.) dfrA15 (0.8 kbp). Moreover, four different gene cassettes were identified within class 2 integrons: 1.) dfrA1-sat2-aadA30 (2 kbp) in all isolates; 2.) sat2-aadA1 (1.7 kbp) in only one isolate; 3.) catB2 (0.9 kbp) in four isolates; and 4.) a new variant of sat2 (0.65 kbp) in three isolates. Efforts should be made to introduce surveillance programs for monitoring antimicrobial resistance that could potentially be transmitted from broiler chickens to human via integrons.

Topics: Amoxicillin-Potassium Clavulanate Combination; Animals; Anti-Bacterial Agents; Chickens; Drug Resistance, Bacterial; Egypt; Enterobacteriaceae; Enterobacteriaceae Infections; Erythromycin; Farms; Gene Expression Regulation, Bacterial; Genes, Bacterial; Integrons; Microbial Sensitivity Tests; Molecular Epidemiology; Polymerase Chain Reaction; Polymorphism, Restriction Fragment Length; Poultry; Poultry Diseases; Rifamycins

Topics: Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bacterial Proteins; beta-Lactamase Inhibitors; beta-Lactamases; beta-Lactams; Carbapenem-Resistant Enterobacteriaceae; Cefotaxime; Ceftazidime; Disk Diffusion Antimicrobial Tests; Enterobacteriaceae Infections; Ertapenem; Fluoroquinolones; Humans; Nigeria; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination

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

In 2010, our hospital, in line with National guidance, changed advice on antibiotic prescribing for UTI to reduce use of cephalosporins in favour of penicillins. We hypothesized that this change in policy would have no impact on the pattern of antibiotic resistance of the organisms causing UTI.. Audit review of all urine samples sent to BWH from 2009 to 2013 and positive cultures showing Enterobacteriaceae were then tested for antibiotic susceptibility.. There has been an increase in the resistance of both Co-amoxiclav and Ciprofloxacin since 2009. Co-amoxiclav and trimethoprim now have similar resistance rates. Ciprofloxacin resistance has risen fairly quickly in the last four years from 1% to 8%. Resistance to nitrofurantoin has remained low. Gentamicin resistance remained stable and very low, second best to meroponem.. The results have been fed back to commissioners and internally and are being used as part of the guideline updating process.. Hospital protocols for treating infections should be reviewed and updated based on accurate local data. These data should be used for formulating regional specific protocols. Our results suggest that meroponem and ciprofloxacin should be reserved for microbiologically proven resistance to other antibiotics.

Topics: Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Ciprofloxacin; Clinical Audit; Drug Resistance, Bacterial; England; Enterobacteriaceae; Enterobacteriaceae Infections; Female; Gentamicins; Health Policy; Humans; Meropenem; Microbial Sensitivity Tests; Nitrofurantoin; Practice Guidelines as Topic; Thienamycins; Trimethoprim; Urinary Tract Infections

The case of a diabetic foot infection caused by Raoultella ornithinolytica is reported.. A 68-year-old Caucasian man arrived at the hospital with a fever (38.5 °C) and a foul-smelling pressure ulcer on his left foot and was admitted for treatment of a moderate diabetic foot infection. The patient's medical history included type II diabetes mellitus, hypertension, chronic kidney disease, dyslipidemia, cataract surgery, and total hip arthroplasty. A tissue biopsy of the diabetic foot lesion was performed, and a blood sample was cultured. Empirical antimicrobial treatment consisting of amoxicillin-clavulanate 1.2 g (of amoxicillin) i.v. every 12 hours and ciprofloxacin 200 mg i.v. every 12 hours was initiated to target aerobic gram-positive and gram-negative and anaerobic microorganisms. After 48 hours, the results of the blood culture were negative, but the left ankle wound culture grew R. ornithinolytica. Although the isolated R. ornithinolytica was relatively sensitive, showing resistance only to cefazolin and ampicillin, the antibiotic regimen was not changed. The patient showed clinical and laboratory improvement during his 5-day hospitalization. Subsequently, i.v. antibiotics were discontinued, and the patient was discharged on oral amoxicillin-clavulanate 1 g (of amoxicillin) twice daily and oral ciprofloxacin 750 mg twice daily for an additional 9 days to complete a total duration of 14 days of treatment, after which the infection was completely resolved.. A 68-year-old man diagnosed with a diabetic foot infection caused by R. ornithinolytica was successfully treated with amoxicillin-clavulanate and ciprofloxacin.

Topics: Aged; Amoxicillin-Potassium Clavulanate Combination; Diabetes Mellitus, Type 2; Diabetic Foot; Enterobacteriaceae; Enterobacteriaceae Infections; Humans; Male

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

The first case of Ewingella americana conjunctivitis in an otherwise healthy child is reported. Cultures of the conjunctival purulent exudate taken from both eyes grew E. americana. The infection resolved completely after successful treatment with amoxicillin/clavulanate. E. americana should be considered a rare but potential pathogen causing conjunctivitis.

Topics: Acute Disease; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Child, Preschool; Conjunctivitis, Bacterial; Enterobacteriaceae; Enterobacteriaceae Infections; Humans; Male

We determined minimum inhibitory concentrations of rifampicin, nitrofurantoin, amoxicillin-clavulanic acid, and cefdinir, plus a combination of amoxicillin-clavulanic acid and cefdinir by broth microdilution for mainly wound isolates of Escherichia coli and Klebsiella pneumoniae. E. coli and K. pneumoniae susceptibilities increased by combining amoxicillin-clavulanic acid and cefdinir.

Topics: Administration, Oral; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Cefdinir; Cephalosporins; Drug Resistance, Multiple, Bacterial; Enterobacteriaceae Infections; Escherichia coli; Humans; Klebsiella pneumoniae; Microbial Sensitivity Tests; Nitrofurantoin; Rifampin; Wound Infection

We report a case of pneumonia due to multi-drug resistant Ewingella americana in a young patient admitted in the Intensive Care Unit of Hera General Hospital, Makkah, Saudi Arabia with severe head injury in a road traffic accident. He was an Indonesian pilgrim who had traveled to the Kingdom of Saudi Arabia to perform Hajj in December 2007. Ewingella americana was identified to be the pathogen of pneumonia with clinical signs and symptoms along with positive radiological findings.

Topics: Adult; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Drug Resistance, Multiple, Bacterial; Enterobacteriaceae; Enterobacteriaceae Infections; Humans; Male; Pneumonia, Bacterial

Ampicillin-sulbactam (A/S) and amoxicillin-clavulanic acid (AUG) are thought to be equally efficacious clinically against the Enterobacteriaceae family. In this study, the in vitro activities of the A/S and AUG were evaluated and compared against Escherichia coli and Klebsiella spp. Antimicrobial susceptibility tests were performed by standard agar dilution and disc diffusion techniques according to the Clinical and Laboratory Standards Institute (CLSI). During the study period, 973 strains were isolated. Of the 973 bacteria isolated, 823 were E. coli and 150 Klebsiella spp. More organisms were found to be susceptible to AUG than A/S, regardless of the susceptibility testing methodology. The agar dilution results of the isolates that were found to be sensitive or resistant were also compatible with the disc diffusion results. However, some differences were seen in the agar dilution results of some isolates that were found to be intermediately resistant with disc diffusion. In E. coli isolates, 17 of the 76 AUG intermediately resistant isolates (by disc diffusion), and 17 of the 63 A/S intermediately resistant isolates (by disc diffusion) showed different resistant patterns by agar dilution. When the CLSI breakpoint criteria are applied it should be considered that AUG and A/S sensitivity in E. coli and Klebsiella spp. strains may show differences.

Topics: Amoxicillin-Potassium Clavulanate Combination; Ampicillin; Colony Count, Microbial; Diffusion Chambers, Culture; Drug Resistance, Multiple, Bacterial; Enterobacteriaceae Infections; Escherichia coli; Escherichia coli Infections; Humans; Klebsiella; Sulbactam

Resistance to beta-lactams and quinolones in two isogenic Enterobacter cloacae isolates was studied. One was susceptible to cefoxitin and amoxicillin-clavulanate. The other one showed its natural beta-lactam resistance pattern. Both isolates had a nonfunctional AmpR regulator. However, within the second one, the presence of a plasmid carrying ampR and qnrA1 allowed reversion to the wild-type beta-lactam resistance phenotype and decreased susceptibility to fluoroquinolones.

Topics: Amoxicillin-Potassium Clavulanate Combination; Bacterial Proteins; beta-Lactam Resistance; Cefoxitin; Enterobacter cloacae; Enterobacteriaceae Infections; Humans; Microbial Sensitivity Tests; Plasmids; Polymerase Chain Reaction; Quinolones

Nontyphoidal salmonellae are among the most common causes of bacterial gastroenteritis worldwide. They are also notable causes of extraintestinal infections, including bacteremia and vascular infections. Salmonella enterica serotype Choleraesuis is typically associated with invasive infections. We report a patient who had an infected intra-abdominal aortic aneurysm due to an unusually mucoid strain of Salmonella enterica serotype Choleraesuis. The isolate was erroneously identified as Hafnia alvei by the Vitek GNI+ card system. A blood culture isolate taken from the same patient 9 months earlier was also identified as H. alvei by the Vitek GNI+ card system. Despite an apparent cure with intravenous amoxicillin-clavulanic acid at that time, the Salmonella infection had not been cleared and manifested as a ruptured infected abdominal aortic aneurysm. Repeated passage of the strain yielded nonmucoid colonies, which were correctly identified by the API and PHOENIX systems. The isolates from the aneurysm and the former bacteremic episode were found to be identical using pulsed field gel electrophoresis. The fallibility of automated bacterial identification systems is highlighted. Such errors are especially important for isolates in which in vitro antibiotic susceptibility testing does not correlate with the clinical success of treatment, as illustrated by Salmonella infections.

Topics: Aged; Amoxicillin-Potassium Clavulanate Combination; Aortic Aneurysm, Abdominal; Bacteriological Techniques; Blood; Diagnostic Errors; DNA Fingerprinting; DNA, Bacterial; Electrophoresis, Gel, Pulsed-Field; Enterobacteriaceae Infections; Hafnia alvei; Humans; Male; Salmonella enterica; Salmonella Infections

Routine susceptibility data for urinary coliform isolates from community practice were analysed in comparison with dispensed antibiotic prescriptions for all conditions and social deprivation data for Bro Taf and North Wales Health Authorities for financial years 1996--1998. Prescribing rates and resistance rates varied widely between practices. Among isolates from practices with high usage of an antibiotic, rates of resistance to that antibiotic tended to be high, and usage correlated significantly with resistance between practice population units. Cross-correlations were found between usage of one antibiotic and resistance to another, particularly for trimethoprim and ampicillin. Usage, particularly of trimethoprim, was associated with multi-resistance to up to four antibiotics. Resistance was more frequent in isolates from males, children and the elderly. Ampicillin resistance correlated with social deprivation. Analyses including or excluding potential repeat isolates yielded closely similar results. Indices reflecting sampling behaviour (laboratory coliform positivity rates, positivity per 1000 registered patients, specimens submitted per 1000 registered patients) varied widely between surgeries, suggesting lack of consensus on urine sampling policies. These indices showed only weak correlations with usage or resistance. Associations between resistance and usage were compared for isolates from two patient subsets that were likely to differ in their proportions of non-Escherichia coli isolates: female patients aged 16--55 years; and males, children and patients aged >55 years. The latter showed higher base levels of resistance, but the associations of resistance with usage were statistically indistinguishable for the two populations. The results suggest that usage of antibiotics in a practice population may affect the rate of urinary infection caused by resistant coliform organisms in that population.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Amoxicillin-Potassium Clavulanate Combination; Ampicillin; Anti-Bacterial Agents; Cephalexin; Cephradine; Child; Child, Preschool; Ciprofloxacin; Community-Acquired Infections; Drug Resistance, Microbial; Enterobacteriaceae; Enterobacteriaceae Infections; Female; Humans; Infant, Newborn; Male; Microbial Sensitivity Tests; Middle Aged; Trimethoprim; Urinary Tract Infections

Topics: Adolescent; Adult; Aged; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; beta-Lactamases; Clavulanic Acids; Drug Combinations; Enterobacteriaceae; Enterobacteriaceae Infections; Female; Humans; Male; Middle Aged; Urinary Tract Infections

Synergism between amoxicillin and clavulanic acid was not expected against cephalosporinase-producing bacterial strains because clavulanic acid has little inhibitory action on cephalosporinases. However, in a clinical trial of BRL 25000 (amoxicillin-clavulanic acid), excellent results were obtained in complicated urinary tract infections caused by Serratia marcescens, Enterobacter cloacae, and Citrobacter freundii strains which produced cephalosporinase and were highly resistant to amoxicillin alone. The good clinical efficacy of BRL 25000 in such urinary tract infections was probably due to the fact that the urinary concentration of clavulanic acid was higher than its minimal inhibitory concentrations for these strains.

Topics: Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Citrobacter; Clavulanic Acids; Drug Combinations; Enterobacter; Enterobacteriaceae Infections; Female; Humans; Male; Microbial Sensitivity Tests; Serratia marcescens; Urinary Tract Infections