amoxicillin-potassium-clavulanate-combination and Gram-Positive-Bacterial-Infections

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

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

We present a case of recurrent subdural post-surgical empyema by Proprionibacterium acnes after a first drained empyema in which no microbiological diagnosis was reached. P. acnes is a gram-positive anaerobic organism which is part of the saprophytic flora of the skin and others parts of the body. However, it can cause infections, as in the central nervous system, especially post-surgical infections in which can be the second more frequent organism after Staphylococcus aureus. P. acnes grows slowly and shows better growth in liquid anaerobic media. It is usually resistant to metronidazol and sensitive to penicillin. In postoperative central nervous system infections we must take into account the possibility of this organism, process the sample properly and keep touch with the Microbiology Department.

Topics: Aged; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Combined Modality Therapy; Decompressive Craniectomy; Drainage; Drug Resistance, Microbial; Empyema, Subdural; Gram-Positive Bacterial Infections; Humans; Male; Meningeal Neoplasms; Meningioma; Metronidazole; Postoperative Complications; Propionibacterium acnes; Recurrence; Surgical Wound Dehiscence; Surgical Wound Infection

Lower urinary tract infection remains frequent particularly in women, despite improvement in therapeutic means. It seems likely to revisit bacterial epidemiology and therapeutic available strategies. To analyze elements in presence i.e. infecting bacteria and antibiotics still active or identification of acquired resistance mechanisms should permit to establish the evolution during the last 10 years. The study shows that bacterial epidemiology in urinary tract infection has not changed significantly, despite antibiotic selective pressure expected from overused antibiotics. However few enterobacteriaceae more resistant than Escherichia coli have emerged, but the latter remains predominant. Development of resistance has concerned Negram, amoxicillin and Augmentin, but several active molecules such as ciprofloxacin, Monuril remain available. Duration of treatments are still discussed but there is a tend toward short durations and even mono-doses. The control of lower urinary tract infections remains relatively easy provided that a good therapeutic choice is based on well documented bacteriologic data (infecting species susceptible to the available antibiotics).

Topics: Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Anti-Infective Agents; Ciprofloxacin; Drug Resistance, Bacterial; Escherichia coli; Escherichia coli Infections; Female; Fosfomycin; Gram-Positive Bacterial Infections; Humans; Male; Microbial Sensitivity Tests; Proteus Infections; Proteus mirabilis; Time Factors; Urinary Tract Infections

By the 1960s and 1970s, problems in the antibacterial treatment of infections had begun to emerge. Previously active antibacterials were being compromised by the development of resistance. Beta-lactamase production was identified in isolates of staphylococci, and, amongst others, in Escherichia coli, Proteus mirabilis, Haemophilus influenzae and Moraxella catarrhalis. The discovery of the potent beta-lactamase inhibitor clavulanic acid, and its protective effect on amoxicillin, a semi-synthetic penicillin with good oral absorption and potent broad-spectrum antimicrobial activity, was thus of great importance in the treatment of bacterial disease. Following preliminary clinical studies in bronchitis and urinary tract infections, amoxicillin/clavulanate therapy was investigated in a wide range of infections and proved to demonstrate a high level of clinical efficacy. These results supported the launch of amoxicillin/clavulanate (Augmentin) in 1981 for use in upper and lower respiratory tract infections, urinary tract infections, skin and soft tissue infections and obstetric, gynaecological and intra-abdominal infections.

Topics: Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bacterial Infections; beta-Lactam Resistance; beta-Lactamase Inhibitors; Community-Acquired Infections; Gram-Negative Bacterial Infections; Gram-Positive Bacterial Infections; History, 20th Century; History, 21st Century; Humans

The combination of amoxicillin/clavulanate and metronidazole is a widely-accepted empirical regimen for infections of the odontogenic spaces. Once adequate drainage has been established micro-organisms are less likely to grow and multiply, particularly anaerobes. This may obviate the need for anaerobic coverage after drainage in healthy hosts. We studied 60 patients in this randomised prospective study, the objective of which was to evaluate metronidazole as part of an empirical antibiotic regimen after drainage of infections of the odontogenic spaces. Samples of pus were sent for culture and testing for sensitivity. Amoxicillin/clavulanate and metronidazole were given to all patients. After incision and drainage the patients were randomly allocated to two groups. In the first group both antibiotics were continued, and in the second metronidazole was withdrawn. The groups were compared both clinically and microbiologically. There were no significant differences between the groups in the resolution of infection. Thirteen patients (n=6 in the 2-antimicrobial group, and n=7 in the amoxicillin/clavulanate group) showed no improvement during the 48 h postoperatively. Overall there was need to substitute another antibiotic for amoxicillin/clavulanate in only 6 cases. Six patients in the amoxicillin/clavulanate group required the addition of metronidazole after drainage. We conclude that in healthy subjects metronidazole is not necessary in the period after drainage, but its prescription should be based on assessment of clinical and laboratory markers of infection.

Topics: Adult; Amoxicillin-Potassium Clavulanate Combination; Anti-Infective Agents; Bacteriological Techniques; beta-Lactamase Inhibitors; Double-Blind Method; Drainage; Empirical Research; Focal Infection, Dental; Follow-Up Studies; Gram-Positive Bacterial Infections; Humans; Metronidazole; Microbial Sensitivity Tests; Middle Aged; Mouth Diseases; Peptostreptococcus; Pharyngeal Diseases; Prospective Studies; Staphylococcal Infections; Streptococcal Infections; Suppuration; Young Adult

Outpatient oral therapy is infrequently used in pediatric low-risk febrile neutropenia (LRFN) as there is insufficient data regarding its equivalence as compared with parenteral therapy.. This is a single institutional, randomized control trial in pediatric LRFN aged 2 to 15 years, in which 123 episodes in 88 patients were randomized to outpatient oral ofloxacin 7.5 mg/kg 12 hourly and amoxycillin-clavulanate 12.5 mg/kg 8 hourly or outpatient intravenous (IV) ceftriaxone 75 mg/kg and amikacin 15 mg/kg once daily after blood cultures.. Out of 119 evaluable episodes, one-third were leukemia patients in maintenance and rest were solid tumors. Success was achieved in 55/61 (90.16%) and 54/58 (93.1%) in oral and IV arms, respectively, (P=0.56). There were 3 hospitalizations but no mortality. Median days to resolution of fever, absolute neutrophil count >500/mm(3) and antibiotic use were 3, 5, and 6 days in both arms. There were 5 blood culture isolates (3 gram-positive and 2 gram-negative bacteria). Failure of outpatient therapy was associated with perianal infections, bacteremia, febrile neutropenia onset before day 9 of chemotherapy in solid tumors and Vincristine, actinomycin-D, and cyclophosphamide chemotherapy for rhabdomyosarcoma. All gram-positive isolates were successes, whereas both gram-negative isolates were failures. Diarrhea in IV arm and Vincristine, actinomycin-D, and cyclophosphamide chemotherapy in the oral arm predicted failure in subgroup analysis.. Outpatient therapy is efficacious and safe in pediatric LRFN. There was no difference in outcome in oral versus IV outpatient therapy. Amoxycillin-clavulanate and ofloxacin may be the oral regimen of choice.

Topics: Administration, Oral; Adolescent; Ambulatory Care; Amikacin; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Antineoplastic Combined Chemotherapy Protocols; Ceftriaxone; Child; Child, Preschool; Drug Therapy, Combination; Female; Fever; Gram-Negative Bacterial Infections; Gram-Positive Bacterial Infections; Humans; Injections, Intravenous; Male; Neoplasms; Neutropenia; Ofloxacin; Treatment Outcome

To compare the safety and efficacy of sequential intravenous (IV) to oral (PO) moxifloxacin treatment against a standard antimicrobial regimen of IV piperacillin-tazobactam followed by PO amoxicillin-clavulanate for the treatment of adults with complicated intra-abdominal infection (cIAI).. cIAIs are commonly due to mixed aerobic and anaerobic bacteria and require both source control and broad-spectrum antibiotic therapy.. A prospective, double-blind, randomized, phase III comparative trial. Patients with cIAI were stratified by disease severity (APACHE II score) and randomized to either IV/PO moxifloxacin (400 mg q24 hours) or comparator (IV piperacillin-tazobactam [3.0/0.375 g q6 hours] +/- PO amoxicillin-clavulanate [800 mg/114 mg q12 hours]), each for 5 to 14 days. The primary efficacy variable was clinical cure rate at the test-of-cure visit (days 25-50). Bacteriologic outcomes were also determined.. : Of 656 intent-to-treat patients, 379 (58%) were valid to assess efficacy (183 moxifloxacin, 196 comparator). Demographic and baseline medical characteristics were similar between the 2 groups. Clinical cure rates at test-of-cure were 80% (146 of 183) for moxifloxacin versus 78% (153 of 196) for comparator (95% confidence interval, -7.4%, 9.3%). The clinical cure rate at test-of-cure for hospital-acquired cIAI was higher with moxifloxacin (82%, 22 of 27) versus comparator (55%, 17 of 31; P = 0.05); rates were similar for community-acquired infections (80% [124 of 156] versus 82% [136 of 165], respectively). Bacterial eradication rates were 78% (117 of 150) with moxifloxacin versus 77% (126 of 163) in the comparator group (95% confidence interval, -9.9%, 8.7%).. Once daily IV/PO moxifloxacin monotherapy was as least as effective as standard IV piperacillin-tazobactam/PO amoxicillin-clavulanate dosed multiple times daily for the treatment of cIAIs.

Topics: Abdominal Abscess; Administration, Oral; Adult; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Appendicitis; Aza Compounds; Bacterial Infections; Cross Infection; Double-Blind Method; Female; Fluoroquinolones; Gram-Negative Bacterial Infections; Gram-Positive Bacterial Infections; Humans; Injections, Intravenous; Intestinal Perforation; Male; Middle Aged; Moxifloxacin; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination; Prospective Studies; Quinolines; Safety; Stomach Rupture; Treatment Outcome

Eggerthella lenta is a Gram-positive anaerobic bacillus that is an important cause of bloodstream infections. This study aims to test the susceptibility of Eggerthella lenta blood culture isolates to commonly used antibiotics for the empirical treatment of anaerobic infections.. In total, 49 positive blood cultures for Eggerthella lenta were retrospectively included from patients hospitalised at the Universitair Ziekenhuis Brussel, Belgium, between 2004 and 2018. Identification was done by matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) system. Antimicrobial susceptibility testing was performed using the reference agar dilution method according to Clinical and Laboratory Standards Institute (CLSI) guidelines with Brucella agar supplemented with 5 μg/mL hemin, 1 μg/mL vitamin K1 and 5% laked sheep blood. The minimal inhibitory concentrations were interpreted using the EUCAST breakpoints. Clinical characteristics were collected by reviewing the patient's medical records.. All isolates were susceptible to amoxicillin-clavulanate, metronidazole and meropenem. Eighty-eight % of them were susceptible to clindamycin and 94% (20% S, 74% I) were susceptible to piperacillin-tazobactam. The mean age of the patients was 64 (±20) and they showed a 30-day mortality of 27%. The source of infection was in 65.3% of the cases abdominal, 20.4% were sacral pressure ulcers and 14.3% were unknown causes. While all isolates were fully susceptible at standard dosing regimen to amoxicillin-clavulanate, most were only susceptible at increased exposure or resistant to piperacillin-tazobactam.. Our results suggest to be careful with the use of piperacillin-tazobactam and clindamycin in the empirical treatment of Eggerthella lenta infections.

Topics: Actinobacteria; Adult; Aged; Aged, 80 and over; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bacteria, Anaerobic; Belgium; Blood; Clindamycin; Female; Gram-Positive Bacteria; Gram-Positive Bacterial Infections; Hospitals, University; Humans; Male; Meropenem; Metronidazole; Middle Aged; Piperacillin, Tazobactam Drug Combination; Retrospective Studies

Topics: Abscess; Actinomycetaceae; Adult; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Arcanobacterium; Breast Diseases; Drug Resistance, Bacterial; Female; Gram-Positive Bacterial Infections; Humans; Microbial Sensitivity Tests; Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization

An 84 year-old woman was referred for evaluation of a painless swelling with small purulent discharge in her left upper canaliculus, and an associated epiphora of one-month duration. The patient was diagnosed with acute primary canaliculitis. She was treated with topical and oral antibiotics, as well as topical corticoids for three months, with little response. Surgical treatment with left upper canaliculotomy and curettage was then performed, and Gemella haemolysans was identified from the curetted material. The patient had no recurrence of the disease two months after the surgery.. This is the first time that Gemella haemolysans is described as unique agent causing primary canaliculitis.

Topics: Aged, 80 and over; Amoxicillin-Potassium Clavulanate Combination; Canaliculitis; Combined Modality Therapy; Curettage; Dexamethasone; Female; Gemella; Gram-Positive Bacterial Infections; Humans; Ofloxacin; Tobramycin

Topics: Adenocarcinoma; Amoxicillin-Potassium Clavulanate Combination; Bacteria, Anaerobic; Ceftriaxone; Combined Modality Therapy; Drainage; Drug Resistance, Microbial; Fever; Firmicutes; Gram-Positive Bacterial Infections; Gram-Positive Cocci; Humans; Lymph Node Excision; Lymphocele; Male; Middle Aged; Postoperative Complications; Prostatectomy; Prostatic Neoplasms

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

A frequent complication during hospital stay of patients with urinary tract infections (UTIs) is a re-infection of the urinary tract after the initial improvement. In this study, we investigated the impact of two empirical antibiotic therapies on the outcomes of complicated bacterial UTIs. We retrospectively evaluated 325 adult patients hospitalized during 6 years period with a diagnosis of complicated bacterial UTIs. The patients were classified into two groups according to the antibiotic therapy: ceftriaxone- and co-amoxiclav+gentamicin-treated group. Clinical data were collected from the patient records into a designed form. Output data included information on the treatment outcome, length of stay (LOS), development of complications, and cause of re-infections. The patients treated with ceftriaxone had significantly longer LOS (p = 0.012), as well as higher occurrence of complications (p = 0.023) and urinary tract re-infections (p < 0.001), compared to co-amoxiclav+gentamicin-treated group. No significant difference was observed in the treatment outcome between the two groups (p = 0.137). The most common complication in both investigated groups were re-infections of the urinary tract, and Enterococcus spp. was detected as the cause of re-infections only in patients from ceftriaxone-treated group (40/69 patients). Out of the 40 ceftriaxone-treated patients with enterococcal urinary tract re-infections, 35 patients had one or more chronic diseases and 29 patients had urinary catheter inserted. Ceftriaxone therapy should be considered carefully in patients with complicated UTIs due to the possibility of enterococcal re-infection and consequent prolonged hospital stay.

Topics: Aged; Aged, 80 and over; Amoxicillin-Potassium Clavulanate Combination; Anti-Infective Agents, Urinary; Ceftriaxone; Cross Infection; Enterococcus; Female; Gentamicins; Gram-Positive Bacterial Infections; Hospitalization; Humans; Length of Stay; Male; Middle Aged; Retrospective Studies; Risk Factors; Treatment Outcome; 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

Finegoldia magna is a Gram-positive anaerobic coccus involved in a wide variety of infections. We report a unusual case of breast abscess in a non-puerperal patient. A 46-year-old woman presented with pain and a nodular lesion in the left breast. Culture of abscess drainage resulted in isolation of F. magna. Initial treatment with clindamycin was changed to a definitive treatment with amoxicillin-clavulanate for 10 days due to resistance to clindamycin, and improvement of this infection was documented.

Topics: Abscess; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Breast; Breast Diseases; Clindamycin; Drainage; Female; Firmicutes; Gram-Positive Bacterial Infections; Humans; Middle Aged; Treatment Outcome

Slackia exigua (S. exigua) is an obligatory anaerobic coccobacillus under the family of Coriobacteriaceae. It is a rare cause of pyogenic extraoral infections. We report a 58-year-old lady with good past health presented with fulminant community-acquired pneumonia causing acute respiratory distress syndrome caused by S. exigua requiring veno-venous extra-corporeal membrane oxygenation (VV-ECMO). Bacterial identification can be challenging and often require 16 S rRNA and MALDI-TOF MS. The patient was treated with amoxicillin-clavulanic acid according to sensitivity and made significant recovery.

Topics: Actinobacteria; Amoxicillin-Potassium Clavulanate Combination; Community-Acquired Infections; Empyema; Extracorporeal Membrane Oxygenation; Female; Gram-Positive Bacterial Infections; Humans; Middle Aged; Pneumonia; Respiratory Distress Syndrome; Treatment Outcome

We report a case of bypass graft infection and bacteremia caused by Anaerostipes caccae. A review of the literature shows no reported human infection caused by this microorganism to date. The patient was initially treated with vancomycin and piperacillin-tazobactam on admission and with amoxicillin-clavulanate upon discharge. The slow-growing organism was subsequently found to be susceptible to metronidazole and ertapenem.

Topics: Adult; Amoxicillin-Potassium Clavulanate Combination; Anastomosis, Surgical; Anti-Bacterial Agents; beta-Lactams; Blood Culture; Clostridiales; Ertapenem; Female; Gram-Positive Bacterial Infections; Humans; Metronidazole; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination; Surgical Wound Infection; Vancomycin

Topics: Aggregatibacter aphrophilus; Alcoholism; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Chest Tubes; Coinfection; Drainage; Drug Therapy, Combination; Empyema, Pleural; Gram-Positive Bacterial Infections; Humans; Imipenem; Linezolid; Male; Middle Aged; Pasteurellaceae Infections; Peptostreptococcus; Pulmonary Atelectasis; Risk Factors; Smoking

Topics: Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Cervical Vertebrae; Clindamycin; Drug Therapy, Combination; Embolism; Female; Gram-Positive Bacterial Infections; Headache; Humans; Lemierre Syndrome; Myalgia; Peptostreptococcus; Retropharyngeal Abscess; Rifampin; Spondylitis; Tomography, X-Ray Computed; Young Adult

Topics: Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bone Diseases; Edema; Female; Gram-Positive Bacterial Infections; Humans; Intervertebral Disc; Intervertebral Disc Displacement; Low Back Pain; Lumbar Vertebrae; Male; Propionibacterium acnes

Susceptibility to beta-lactamic agents has changed among anaerobic isolates from acute endodontic infections. The aim of the present study was to determine the prevalence of the cfxA/cfxA2 gene in Prevotella spp., Porphyromonas spp., and Parviomonas micra strains and show its phenotypic expression.. Root canal samples from teeth with acute endodontic infections were collected and Porphyromonas, Prevotella, and Parvimonas micra strains were isolated and microbiologically identified with conventional culture techniques. The susceptibility of the isolates was determined by the minimum inhibitory concentration of benzylpenicillin, amoxicillin, and amoxicillin + clavulanate using the E-test method (AB BIODISK, Solna, Sweden). The presence of the cfxA/cfxA2 gene was determined through primer-specific polymerase chain reaction. The nitrocefin test was used to determine the expression of the lactamase enzyme.. Prevotella disiens, Prevotella oralis, Porphyromonas gingivalis, and P. micra strains were susceptible to benzylpenicillin, amoxicillin, and amoxicillin + clavulanate. The cfxA/cfxA2 gene was detected in 2 of 29 isolates (6.9%). Simultaneous detection of the cfxA/cfxA2 gene and lactamase production was observed for 1 Prevotella buccalis strain. The gene was in 1 P. micra strain but was not expressed. Three strains were positive for lactamase production, but the cfxA/cfxA2 gene was not detected through polymerase chain reaction.. There is a low prevalence of the cfxA/cfxA2 gene and its expression in Porphyromonas spp., Prevotella spp., and P. micra strains isolated from acute endodontic infections. Genetic and phenotypic screening must be performed simultaneously to best describe additional mechanisms involved in lactamic resistance for strict anaerobes.

Topics: Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bacteroidaceae Infections; beta-Lactam Resistance; beta-Lactamase Inhibitors; beta-Lactamases; Cephalosporins; Dental Pulp Diseases; Gram-Positive Bacterial Infections; Humans; Indicators and Reagents; Microbial Sensitivity Tests; Penicillin G; Peptostreptococcus; Phenotype; Porphyromonas; Porphyromonas endodontalis; Porphyromonas gingivalis; Prevotella; Prevotella intermedia; Prevotella nigrescens

Topics: Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bone Diseases; Edema; Female; Gram-Positive Bacterial Infections; Humans; Intervertebral Disc; Intervertebral Disc Displacement; Low Back Pain; Lumbar Vertebrae; Male; Propionibacterium acnes

Topics: Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bone Diseases; Edema; Female; Gram-Positive Bacterial Infections; Humans; Intervertebral Disc; Intervertebral Disc Displacement; Low Back Pain; Lumbar Vertebrae; Male; Propionibacterium acnes

Topics: Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bone Diseases; Edema; Female; Gram-Positive Bacterial Infections; Humans; Intervertebral Disc; Intervertebral Disc Displacement; Low Back Pain; Lumbar Vertebrae; Male; Propionibacterium acnes

Topics: Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bone Diseases; Edema; Female; Gram-Positive Bacterial Infections; Humans; Intervertebral Disc; Intervertebral Disc Displacement; Low Back Pain; Lumbar Vertebrae; Male; Propionibacterium acnes

Topics: Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bone Diseases; Edema; Female; Gram-Positive Bacterial Infections; Humans; Intervertebral Disc; Intervertebral Disc Displacement; Low Back Pain; Lumbar Vertebrae; Male; Propionibacterium acnes

Topics: Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bone Diseases; Edema; Female; Gram-Positive Bacterial Infections; Humans; Intervertebral Disc; Intervertebral Disc Displacement; Low Back Pain; Lumbar Vertebrae; Male; Propionibacterium acnes

Topics: Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bone Diseases; Edema; Female; Gram-Positive Bacterial Infections; Humans; Intervertebral Disc; Intervertebral Disc Displacement; Low Back Pain; Lumbar Vertebrae; Male; Propionibacterium acnes

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

Enterococcus faecalis may contribute to periodontal breakdown in heavily infected subgingival sites, particularly in patients responding poorly to mechanical forms of periodontal therapy. Because only limited data are available on the antimicrobial sensitivity of enterococci of subgingival origin, this study evaluates the in vitro antibiotic susceptibility of E. faecalis isolated from periodontitis patients in the United States.. Pure cultures of 47 subgingival E. faecalis clinical isolates were each inoculated onto specially prepared broth microdilution susceptibility panels containing vancomycin, teicoplanin, and six oral antibiotics of potential use in periodontal therapy. After incubation in ambient air for 18 to 20 hours, minimal inhibitory drug concentrations were determined using applicable Clinical and Laboratory Standards Institute criteria and interpretative guidelines. The organisms were additionally evaluated for in vitro resistance to metronidazole at 4 μg/mL.. Periodontal E. faecalis exhibited substantial in vitro resistance to tetracycline (53.2% resistant), erythromycin (80.8% resistant or intermediate resistant), clindamycin (100% resistant to 2 μg/mL), and metronidazole (100% resistant to 4 μg/mL). In comparison, the clinical isolates were generally sensitive to ciprofloxacin (89.4% susceptible; 10.6% intermediate resistant) and 100% susceptible in vitro to ampicillin, amoxicillin/clavulanate, vancomycin, and teicoplanin.. Tetracycline, erythromycin, clindamycin, and metronidazole revealed poor in vitro activity against human subgingival E. faecalis clinical isolates, and would likely be ineffective therapeutic agents against these species in periodontal pockets. Among orally administered antibiotics, ampicillin, amoxicillin/clavulanate, and ciprofloxacin exhibited marked in vitro inhibitory activity against periodontal E. faecalis, and may be clinically useful in treatment of periodontal infections involving enterococci.

Topics: Adult; Aged; Amoxicillin-Potassium Clavulanate Combination; Ampicillin; Anti-Bacterial Agents; Anti-Infective Agents; Bacteriological Techniques; Chronic Periodontitis; Ciprofloxacin; Clindamycin; Dental Plaque; Drug Resistance, Bacterial; Enterococcus faecalis; Erythromycin; Female; Gingiva; Gram-Positive Bacterial Infections; Humans; Male; Metronidazole; Microbial Sensitivity Tests; Middle Aged; Periodontal Pocket; Periodontitis; Teicoplanin; Tetracycline Resistance; Vancomycin

Alloiococcus otitidis is a slow growing organism which has been isolated in a few studies on patients with otitis media with effusion (OME). According to the literature review, there is no study about the molecular typing of A. otitidis. In this study, the characteristics of A. otitidis isolates from patients with OME were investigated via Pulsed-Field Gel Electrophoresis (PFGE) typing method.. A total of 50 children with OME, who underwent myringotomy or who had an insertion of a ventilation tube, were included in this study. The isolates were identified to the species level as A. otitidis using standard biochemical methods, following which the amplification and sequencing of the 16S rRNA gene were carried out. The molecular characteristic of A. otitidis was investigated by PFGE technique.. Fifteen isolates of A. otitidis were identified in the middle ear fluid of the patients. All the isolates were susceptible to ampicillin, amoxicillin/clavulanate and fluoroquinolones. All of the 15 isolates were typed by PFGE method and were found to include 13 different PFGE types.. The current study, being the first reports on the molecular typing of A. otitidis by PFGE method, shows that A. otitidis is a heterogenic organism in Iranian children who have OME.

Topics: Amoxicillin-Potassium Clavulanate Combination; Ampicillin; Anti-Bacterial Agents; Child; Child, Preschool; Electrophoresis, Gel, Pulsed-Field; Female; Fluoroquinolones; Gram-Positive Bacteria; Gram-Positive Bacterial Infections; Humans; Male; Middle Ear Ventilation; Otitis Media with Effusion; RNA, Ribosomal, 16S

Although polymicrobial infections, such as peri-implantitis or periodontitis, were postulated in the literature to be caused by synergistic effects of bacteria, these effects remain unclear looking at antibiotic susceptibility. The aim of this study is to compare the antibiotic susceptibilities of pure cultures and definite cocultures.. Laboratory strains of Aggregatibacter actinomycetemcomitans (Aa) (previously Actinobacillus actinomycetemcomitans), Capnocytophaga ochracea (Co), and Parvimonas micra (Pm) (previously Peptostreptococcus micros) were cultivated under anaerobic conditions, and their susceptibilities to 10 antibiotics (benzylpenicillin G, ampicillin, amoxicillin, ampicillin/sulbactam, amoxicillin/clavulanic acid, minocycline, metronidazole, linezolid, azithromycin, and moxifloxacin) were tested using the Epsilometertest. Cocultures, each consisting of two or three bacteria, were treated analogously.. All four cocultures showed lower susceptibilities to azithromycin and minocycline than to pure cultures. The coculture Aa-Co showed a lower susceptibility to moxifloxacin as did the coculture Aa-Pm to benzylpenicillin G; the coculture Co-Pm showed a lower susceptibility to amoxicillin, amoxicillin/clavulanic acid, metronidazole, and benzylpenicillin G. However, the coculture Co-Pm showed a higher susceptibility to ampicillin, linezolid and moxifloxacin as did Aa-Pm and Aa-Co-Pm to linezolid.. In addition to established in vitro assays, it was demonstrated that antimicrobial cocultures caused antibiotic susceptibilities that differed from those of pure cultures. Bacterial cocultures frequently showed lowered susceptibilities to antibiotics.

Topics: Acetamides; Actinobacillus Infections; Aggregatibacter actinomycetemcomitans; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Ampicillin; Anti-Bacterial Agents; Anti-Infective Agents; Aza Compounds; Azithromycin; Capnocytophaga; Coculture Techniques; Coinfection; Drug Resistance, Bacterial; Fluoroquinolones; Gram-Negative Bacterial Infections; Gram-Positive Bacterial Infections; Humans; Linezolid; Metronidazole; Microbial Interactions; Minocycline; Moxifloxacin; Oxazolidinones; Penicillin G; Peptostreptococcus; Peri-Implantitis; Periodontitis; Quinolines; Sulbactam

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

Daptomycin is bactericidal against meticillin-resistant Staphylococcus aureus (MRSA), glycopeptide-intermediate-resistant S. aureus (GISA) and vancomycin-susceptible and -resistant enterococci. However, selection for daptomycin-resistant derivatives has occasionally been reported during therapy in humans. Here we evaluate whether selection for daptomycin-resistant S. aureus or enterococci could be prevented in vitro by combining daptomycin with amoxicillin/clavulanic acid, ampicillin, gentamicin or rifampicin. Six strains of S. aureus (four MRSA and two GISA) and four strains of enterococci (two Enterococcus faecalis and two Enterococcus faecium) were serially exposed in broth to two-fold stepwise increasing concentrations of daptomycin alone or in combination with a fixed concentration [0.25x minimum inhibitory concentration (MIC)] of either of the second agents. The daptomycin MIC was examined after each cycle. Exposure to daptomycin alone gradually selected for S. aureus and enterococci with an increased MIC. Gentamicin did not prevent the emergence of daptomycin-resistant bacteria. Rifampicin was also unable to prevent daptomycin resistance, although resistance was slightly delayed. In contrast, amoxicillin/clavulanic acid or ampicillin prevented or greatly delayed the selection of daptomycin-resistant mutants in S. aureus and enterococci, respectively. Addition of amoxicillin/clavulanic acid or ampicillin to daptomycin prevents, or greatly delays, daptomycin resistance in vitro. Future studies in animal models are needed to predict the utility of these combinations in humans.

Topics: Amoxicillin-Potassium Clavulanate Combination; Ampicillin; Anti-Bacterial Agents; Daptomycin; Drug Resistance, Bacterial; Enterococcus; Gram-Positive Bacterial Infections; Humans; Microbial Sensitivity Tests; Mutation; Selection, Genetic; Staphylococcus aureus

An 11-month-old female dog was evaluated because of a 3- to 4-day history of stranguria and hematuria.. Rectal and vaginal examination and abdominal radiography revealed a large (4 x 2 cm), firm, ovoid object in the area of the pelvic inlet, between the vagina and colon.. Surgical exploration revealed an abscess and moderate amount of seropurulent fluid in the left caudal abdominal quadrant. A large urethrolith (3.7 x 2.0 x 1.5 cm) was evident in the proximal portion of the urethra. The urethrolith was associated with a 3 x 1-cm area of necrosis in the ventral aspect of the proximal portion of the urethra and a 3 x 3-cm area of necrosis in the area of the bladder trigone. The necrotic areas were débrided, and the defect was repaired with an axial pattern flap constructed from the rectus abdominis muscle. During a follow-up examination 2.5 years after surgery, the dog was clinically normal with no history of urinary incontinence. During rigid cystoscopy, the ure-thral mucosa appeared grossly normal, and there was no evidence of stricture.. Findings suggested that axial pattern flaps constructed from the rectus abdominis muscle flap may be useful in reconstructing large urinary bladder and urethral defects.

Topics: Abdominal Abscess; Amoxicillin-Potassium Clavulanate Combination; Animals; Anti-Bacterial Agents; Dog Diseases; Dogs; Enterococcus faecalis; Female; Fluid Therapy; Gram-Positive Bacterial Infections; Rectus Abdominis; Surgical Flaps; Treatment Outcome; Urethral Diseases; Urolithiasis

A 63-year-old female patient was admitted to the department of neurology following an acute ischemic infarction of the right medial cerebral artery. She developed fever, respiratory failure, and hypotension and had to be transferred to the intensive care unit (ICU) for intubation and mechanical ventilation. Chest X-ray showed increased density of the complete right hemi-thorax, indicative of massive pleural effusion. Chest tube drainage produced 1.5 l of pus in 1 h. Cultures revealed growth of Enterococcus faecalis. The patient was treated with amoxicillin and clavulanic acid with good clinical response. Enterococci very rarely cause spontaneous pleural empyema. The natural resistance of enterococci to several types of antibiotics can lead to selection of enterococci as seen in other clinical studies and may lead to this unusual clinical consequence.

Topics: Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Cerebral Infarction; Empyema; Enterococcus faecalis; Female; Gram-Positive Bacterial Infections; Humans; Middle Aged; Radiography, Thoracic

In this investigation, the urine samples obtained in a single oral-dose pharmacokinetic study were examined for their bactericidal activity against a range of relevant urinary tract pathogens.. Six healthy volunteers received a single oral dose of ten oral antibiotics available in Croatia. Urine samples were taken every 2 h during the whole dosing interval of the particular antibiotic. The urinary bactericidal activity was tested by determination of urinary bactericidal titers.. All antibiotics showed a significant urinary bactericidal activity against non-extended spectrum beta-lactamase Escherichia coli and Proteus mirabilis. Fluoroquinolones displayed high and persisting levels of urinary bactericidal activity against all gram-negative bacteria and Staphylococcus saprophyticus.. Average urinary bactericidal activity can be predicted from in vitro susceptibility testing, but we expect that there will be patients with a low level of urinary bactericidal activity.

Topics: Acetamides; Administration, Oral; Adult; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Anti-Infective Agents, Urinary; beta-Lactamases; Biomarkers; Cefadroxil; Ceftibuten; Cefuroxime; Cephalexin; Cephalosporins; Ciprofloxacin; Disk Diffusion Antimicrobial Tests; Female; Gram-Negative Bacteria; Gram-Negative Bacterial Infections; Gram-Positive Bacteria; Gram-Positive Bacterial Infections; Humans; Linezolid; Middle Aged; Norfloxacin; Oxazolidinones; Time Factors; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Aged; Amoxicillin-Potassium Clavulanate Combination; Drug Therapy, Combination; Female; Gram-Positive Bacterial Infections; Humans; Streptococcaceae; Urinary Tract Infections

The successful management of multi-space orofacial odontogenic infections involves identification of the source of the infection, the anatomical spaces encountered, the predominant microorganisms that are found during the various stages of odontogenic fascial space infection, the impact of the infectious process on defense systems, the ability to use and interpret laboratory data and imaging studies, and a thorough understanding of contemporary antibiotic and supportive care. The therapeutic goals, when managing multi-space odontogenic infections, are to restore form and/or function while limiting patient disability and preventing recurrence. Odontogenic infections are commonly the result of pericoronitis, carious teeth with pulpal exposure, periodontitis, or complications of dental procedures. The second and third molars are frequently the etiology of these multi-space odontogenic infections. Of the two teeth, the third molar is the more frequent source of infection. Diagnostic imaging modalities are selected based on the patient's history, clinical presentation, physical findings and laboratory results. Periapical and panoramic x-rays are reliable initial screening instruments used in determining etiology. Magnetic resonance imaging and computed tomography are ideal imaging studies that permit assessment of the soft tissue involvement to include determining fluid collections, distinguishing abscess from cellulitis, and offering insight as to airway patency. Antibiotics are administered to assist the host immune system's effort to control and eliminate invading microorganisms. Early infections, first three (3) days of symptoms, are primarily caused by aerobic streptococci which are sensitive to penicillin. Amoxicillin is classified as an extended spectrum penicillin. The addition of clavulanic acid to amoxicillin (Augmentin) increases the spectrum to staphylococcus and other anaerobes by conferring beta-lactamase resistance. In late infections, more than three (3) days of symptoms, the predominant microorganisms are anaerobes, predominantly Peptostreptococcus, Fusobacterium, or Bacteroides, that are resistant to penicillin. Clindamycin is an attractive alternative drug for first line therapy in the treatment of these infections. The addition of metronidazole to penicillin is also an excellent treatment choice. Alternatively, Unasyn (Ampicillin/Sublactam), should be considered. The mainstay of management of these infections remains appropriate culture for

Topics: Abscess; Adult; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Debridement; Diagnostic Imaging; Disease Progression; Drainage; Drug Therapy, Combination; Focal Infection, Dental; Gram-Positive Bacterial Infections; Humans; Male; Mandibular Diseases; Masticatory Muscles; Neck Muscles; Staphylococcal Infections; Staphylococcus epidermidis; Streptococcal Infections; Tooth Diseases

We have observed by using MicroScan automatic system discrepancies in susceptibility results of Enterococcus faecium strains to ampicillin and amoxicillin/clavulanic acid.. Seventy-six strains of E. faecium were studied with MicroScan; 98.7% of them were inhibited by 16 mg/l of amoxycillin-clavulanic acid versus 60.5% inhibited by the same concentration of ampicillin. We have evaluated the susceptibility to ampicillin, amoxicillin and amoxicillin-clavulanic acid of 7 strains of E. faecium by both MicroScan and standard microdilution assay. MIC values of ampicillin were similar by both methods but MIC values of amoxicillin/clavulanic acid obtained by MicroScan (< or = 4/2 mg/l in 6 strains) were considerably lower than those obtained by standard microdilution (> or = 16/8 in 6 strains). This phenomenon was not dependent of betalactamase production or bacterial inocula.. When using MicroScan, E. faecium strains resistant to ampicillin (betalactamase non producers) must be also considered resistant to amoxicillin/clavulanic acid without considering the values obtained by this system.

Topics: Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Bacterial Proteins; beta-Lactamases; Clavulanic Acids; Dose-Response Relationship, Drug; Drug Resistance, Microbial; Enterococcus faecium; False Positive Reactions; Gram-Positive Bacterial Infections; Humans; Microbial Sensitivity Tests; Retrospective Studies