amoxicillin-potassium-clavulanate-combination and Prostatic-Neoplasms

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

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

To prospectively trial ertapenem prophylaxis in patients with known risk factors of sepsis undergoing transrectal biopsy of the prostate.. In this prospective audit, patients were identified as having a low- or high-risk of sepsis based on a questionnaire about established risk factors: previous biopsy; recurrent urine infections; receiving ciprofloxacin in the 12 months prior; travel to South-East Asia or South America in the previous 6 months; or diabetes, immune system impairment or receipt of immunosuppressant drugs. All received ciprofloxacin and amoxicillin-clavulanate and high-risk patients additionally received ertapenem. Sepsis requiring hospital admission was recorded. Data was analysed using a two-tailed Fisher's exact test.. In all, 80 men were identified as high risk of sepsis and 90 as low risk during the audit period. Six patients in the low-risk group (6.7%, 95% confidence interval 2.1-11.3) and none in the high-risk group developed sepsis (P = 0.03). Of the six developing sepsis, two grew ciprofloxacin-resistant organisms, two had no growth and two grew a ciprofloxacin-sensitive organism, although one of these grew extended-spectrum β-lactamase-producing Escherichia coli.. The addition of ertapenem to standard prophylaxis is effective at reducing sepsis after prostate biopsy. Risk stratification is not effective at identifying those men at low risk of sepsis, as these men still have a high sepsis rate. Ertapenem prophylaxis for all patients undergoing prostate biopsy is likely to be the most effective strategy in our population group.

Topics: Aged; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Antibiotic Prophylaxis; beta-Lactams; Biopsy; Ciprofloxacin; Drug Therapy, Combination; Ertapenem; Escherichia coli Infections; Humans; Male; Middle Aged; Patient Selection; Prospective Studies; Prostatic Neoplasms; Rectum; Risk Assessment; Risk Factors; Sepsis; Surveys and Questionnaires; Treatment Outcome; Ultrasonography, Interventional

To evaluate whether changing antibiotic prophylaxis from quinolone to penicillin antibiotics has affected infectious complication rates in those men undergoing transrectal ultrasound-guided prostate biopsy (TRUSgpb).. This interventional study was designed to determine whether changing antibiotic prophylaxis had any bearing on developing serious infectious complications after taking TRUSgpb. As a secondary aim, we also investigated Clostridium difficile (C. difficile) rates in the same groups of men undergoing TRUSgpb. Men historically received ciprofloxacin 500 mg orally 1 h before their procedure followed by a 3-day course of 500 mg given twice daily (group A). Due to increasing local patterns of antimicrobial resistance to quinolones and concerns regarding potential antibiotic induced C. difficile infection, antibiotic prophylaxis was changed to a penicillin-based regimen comprising of co-amoxiclav 625 mg given orally 1 h before TRUSgpb followed by a three times daily course for 3 days (group B). Excluded from the study were those men given an alternative antibiotic prophylaxis than those given within the two distinct groups due to reasons of previous hypersensitivity reactions and/or clinical decision by the attending Urologist. Comparisons were made between the groups using two-tailed Fisher's exact tests.. In all, 119 and 110 men were identified in groups A and B, respectively. Two men in group A (1.68%) developed sepsis after TRUSgpb requiring hospital admission and intravenous antibiotic treatment. The sepsis rate in group B was significantly higher than that of group A (eight of 110, 7.27%; P = 0.036). Escherichia coli was the only organism isolated from our cohort of patients. There were no incidences of C. difficile infections in either antibiotic prophylaxis groups.. Ciprofloxacin appears to provide superior prophylaxis than co-amoxiclav in men undergoing TRUSgpb and was not associated with an increased risk of quinolone induced C. difficile infections. Changing antibiotic prophylaxis from a quinolone-based regime may therefore be putting our patients at an increased risk of serious infectious complications after TRUSgpb.

Topics: Aged; Aged, 80 and over; Amoxicillin-Potassium Clavulanate Combination; Anti-Infective Agents; Antibiotic Prophylaxis; Biopsy; Ciprofloxacin; Epidemiologic Methods; Humans; Male; Middle Aged; Penicillins; Prostate; Prostatic Neoplasms; Rectum; Treatment Outcome; Ultrasonography, Interventional

To report a case of death due to Augmentin-induced cholestatic hepatitis and discuss a possible drug interaction between Augmentin and oestrogenic steroids.. An 81-year-old man, on oestrogen therapy for prostatic malignancy, presented with obstructive jaundice one week after completing a four-week course of Augmentin for recurrent urinary tract infection. Liver biopsy showed features of a drug-induced cholestatic hepatitis with bile duct injury. His clinical course was marked by progressive deterioration with increasing jaundice and the development of hepatic encephalopathy. A course of prednisolone did not result in any improvement and he died nine weeks after the onset of jaundice.. The cholestatic hepatitis induced by Augmentin is usually reversible but may be progressive, leading to death. The concurrent administration of ethinyloestradiol, a potentially cholestatic agent, may have altered the susceptibility and/or course of the reaction in this patient.

Topics: Aged; Aged, 80 and over; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Chemical and Drug Induced Liver Injury; Cholestasis; Clavulanic Acids; Drug Interactions; Estradiol Congeners; Humans; Male; Prostatic Neoplasms; Urinary Tract Infections