amoxicillin-potassium-clavulanate-combination and Staphylococcal-Infections

The aim of this study was to determine the pooled estimate of Staphylococcus aureus and coagulase negative staphylococci and their antimicrobial-resistance in patients with wound infection.. Literature searches were carried out in the electronic biomedical databases and indexing services such as PubMed/MEDLINE, EMBASE, Science Direct, Web of Science and Google Scholar. Original records of research articles, available online from 1988 to March 2020, addressing the rates and antimicrobial-resistance pattern of staphylococcus aureus (S. aureus) and coagulase negative staphylococci (CoNS) in patients with wound infection were identified and screened. Endnote citation manager software version X9 for windows was utilized to collect and organize search outcomes and for removal of duplicate articles. The relevant data were extracted from included studies using a format prepared in Microsoft Excel and exported to STATA 14.0 software for the outcome measures analyses and subgrouping.. The electronic databases search yielded 378 studies, of which 39 met predefined inclusion criteria and included in the final analyses. The pooled estimate of wound infection was 36% [95% CI: 23-50%) for S. aureus and 12% [95% CI: 9-14%) for CoNS. S. aureus exhibited a higher rate of resistance to penicillin (84%), ampicillin (83%), amoxicillin (67%), methicillin (50%), cotrimoxazole (50%), tetracycline (61%), doxycycline (58%), chloramphenicol (49%) and erythromycin (45%). However, relative lower resistant rate was observed to Augmentin (amoxicillin-clavulanic acid) (35%), gentamicin (33%), norfloxacin (23%), ciprofloxacin (26%), ceftriaxone (36%), vancomycin (29%) and clindamycin (40%). Similarly, for CoNS there was high resistance to methicillin, 52% [95% CI: 26-78%]) and other antibiotics, but lower resistance to clindamycin, 15% [95% CI: 6-24]) and vancomycin, 22% [95% CI: 2-41%]). Ceftriaxone resistance was observed with prevalence of 36% [95% CI: 21-50%] for S. aureus and 42% [95% CI: 29-55%] for CoNS.. There was high resistance of staphylococci bacterial species to commonly used antimicrobials in the clinical settings in Ethiopia. It is a high time to implement multitude strategies to contain the threat. Further research focusing on factors promoting resistance and the effect of resistance on treatment outcome studies on these virulent organisms are warranted.

Topics: Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Anti-Infective Agents; Ceftriaxone; Clindamycin; Coagulase; Ethiopia; Humans; Methicillin; Microbial Sensitivity Tests; Staphylococcal Infections; Staphylococcus; Staphylococcus aureus; Vancomycin; Wound Infection

Suppurative parotidis is an uncommon disease in newborns, with limited information available on its pathogenesis and management: approximately 50 cases have been reported in the literature. Diagnosis is based on clinical signs. The predominant organism is Staphylococcus aureus. The administration of empiric antimicrobial therapy is an essential part of the management in very young patients. Prognosis is good and recurrence of the disease is unusual. We describe a 21-day-old newborn who presented with fever and unilateral swelling of the parotid region, and provide a literature review.

Topics: Acute Disease; Amoxicillin-Potassium Clavulanate Combination; Drug Therapy, Combination; Female; Follow-Up Studies; Gentamicins; Humans; Infant, Newborn; Parotitis; Staphylococcal Infections; Suppuration; Ultrasonography

Risk of methicillin-resistant Staphylococcus aureus (MRSA) infection after surgery is generally low, but affects up to 33% of patients after certain types of surgery. Postoperative MRSA infection can occur as surgical site infections (SSIs), chest infections, or bloodstream infections (bacteraemia). The incidence of MRSA SSIs varies from 1% to 33% depending upon the type of surgery performed and the carrier status of the individuals concerned. The optimal prophylactic antibiotic regimen for the prevention of MRSA after surgery is not known.. To compare the benefits and harms of all methods of antibiotic prophylaxis in the prevention of postoperative MRSA infection and related complications in people undergoing surgery.. In March 2013 we searched the following databases: The Cochrane Wounds Group Specialised Register; The Cochrane Central Register of Controlled Trials (CENTRAL); Database of Abstracts of Reviews of Effects (DARE) (The Cochrane Library); NHS Economic Evaluation Database (The Cochrane Library); Health Technology Assessment (HTA) Database (The Cochrane Library); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid EMBASE; and EBSCO CINAHL.. We included only randomised controlled trials (RCTs) that compared one antibiotic regimen used as prophylaxis for SSIs (and other postoperative infections) with another antibiotic regimen or with no antibiotic, and that reported the methicillin resistance status of the cultured organisms. We did not limit our search for RCTs by language, publication status, publication year, or sample size.. Two review authors independently identified the trials for inclusion in the review, and extracted data. We calculated the risk ratio (RR) with 95% confidence intervals (CI) for comparing binary outcomes between the groups and planned to calculated the mean difference (MD) with 95% CI for comparing continuous outcomes. We planned to perform meta-analysis using both a fixed-effect model and a random-effects model. We performed intention-to-treat analysis whenever possible.. We included 12 RCTs, with 4704 participants, in this review. Eleven trials performed a total of 16 head-to-head comparisons of different prophylactic antibiotic regimens. Antibiotic prophylaxis was compared with no antibiotic prophylaxis in one trial. All the trials were at high risk of bias. With the exception of one trial in which all the participants were positive for nasal carriage of MRSA or had had previous MRSA infections, it does not appear that MRSA was tested or eradicated prior to surgery; nor does it appear that there was high prevalence of MRSA carrier status in the people undergoing surgery.There was no sufficient clinical similarity between the trials to perform a meta-analysis. The overall all-cause mortality in four trials that reported mortality was 14/1401 (1.0%) and there were no significant differences in mortality between the intervention and control groups in each of the individual comparisons. There were no antibiotic-related serious adverse events in any of the 561 people randomised to the seven different antibiotic regimens in four trials (three trials that reported mortality and one other trial). None of the trials reported quality of life, total length of hospital stay or the use of healthcare resources. Overall, 221/4032 (5.5%) people developed SSIs due to all organisms, and 46/4704 (1.0%) people developed SSIs due to MRSA.In the 15 comparisons that compared one antibiotic regimen with another, there were no significant differences in the proportion of people who developed SSIs. In the single trial that compared an antibiotic regimen with placebo, the proportion of people who developed SSIs was significantly lower in the group that received antibiotic prophylaxis with co-amoxiclav (or cefotaxime if allergic to penicillin) compared with placebo (all SSI: RR 0.26; 95% CI 0.11 to 0.65; MRSA SSI RR 0.05; 95% CI 0.00 to 0.83). In two trials that reported MRSA infections other than SSI, 19/478 (4.5%) people developed MRSA infections including SSI, chest infection and bacteraemia. There were no significant differences in the proportion of people who developed MRSA infections at any body site in these two comparisons.. Prophylaxis with co-amoxiclav decreases the proportion of people developing MRSA infections compared with placebo in people without malignant disease undergoing percutaneous endoscopic gastrostomy insertion, although this may be due to decreasing overall infection thereby preventing wounds from becoming secondarily infected with MRSA. There is currently no other evidence to suggest that using a combination of multiple prophylactic antibiotics or administering prophylactic antibiotics for an increased duration is of benefit to people undergoing surgery in terms of reducing MRSA infections. Well designed RCTs assessing the clinical effectiveness of different antibiotic regimens are necessary on this topic.

Topics: Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Antibiotic Prophylaxis; Carrier State; Cefotaxime; Humans; Methicillin-Resistant Staphylococcus aureus; Postoperative Complications; Randomized Controlled Trials as Topic; Staphylococcal Infections; Surgical Wound Infection

Non surgical wounds include chronic ulcers (pressure or decubitus ulcers, venous ulcers, diabetic ulcers, ischaemic ulcers), burns and traumatic wounds. The prevalence of methicillin-resistant Staphylococcus aureus (MRSA) colonisation (i.e. presence of MRSA in the absence of clinical features of infection such as redness or pus discharge) or infection in chronic ulcers varies between 7% and 30%. MRSA colonisation or infection of non surgical wounds can result in MRSA bacteraemia (infection of the blood) which is associated with a 30-day mortality of about 28% to 38% and a one-year mortality of about 55%. People with non surgical wounds colonised or infected with MRSA may be reservoirs of MRSA, so it is important to treat them, however, we do not know the optimal antibiotic regimen to use in these cases.. To compare the benefits (such as decreased mortality and improved quality of life) and harms (such as adverse events related to antibiotic use) of all antibiotic treatments in people with non surgical wounds with established colonisation or infection caused by MRSA.. We searched the following databases: The Cochrane Wounds Group Specialised Register (searched 13 March 2013); The Cochrane Central Register of Controlled Trials (CENTRAL) (Issue 2); Database of Abstracts of Reviews of Effects (2013, Issue 2); NHS Economic Evaluation Database (2013, Issue 2); Ovid MEDLINE (1946 to February Week 4 2013); Ovid MEDLINE (In-Process & Other Non-Indexed Citations, March 12, 2013); Ovid EMBASE (1974 to 2013 Week 10); EBSCO CINAHL (1982 to 8 March 2013).. We included only randomised controlled trials (RCTs) comparing antibiotic treatment with no antibiotic treatment or with another antibiotic regimen for the treatment of MRSA-infected non surgical wounds. We included all relevant RCTs in the analysis, irrespective of language, publication status, publication year, or sample size.. Two review authors independently identified the trials, and extracted data from the trial reports. We calculated the risk ratio (RR) with 95% confidence intervals (CI) for comparing the binary outcomes between the groups and planned to calculate the mean difference (MD) with 95% CI for comparing the continuous outcomes. We planned to perform the meta-analysis using both fixed-effect and random-effects models. We performed intention-to-treat analysis whenever possible.. We identified three trials that met the inclusion criteria for this review. In these, a total of 47 people with MRSA-positive diabetic foot infections were randomised to six different antibiotic regimens. While these trials included 925 people with multiple pathogens, they reported the information on outcomes for people with MRSA infections separately (MRSA prevalence: 5.1%). The only outcome reported for people with MRSA infection in these trials was the eradication of MRSA. The three trials did not report the review's primary outcomes (death and quality of life) and secondary outcomes (length of hospital stay, use of healthcare resources and time to complete wound healing). Two trials reported serious adverse events in people with infection due to any type of bacteria (i.e. not just MRSA infections), so the proportion of patients with serious adverse events was not available for MRSA-infected wounds. Overall, MRSA was eradicated in 31/47 (66%) of the people included in the three trials, but there were no significant differences in the proportion of people in whom MRSA was eradicated in any of the comparisons, as shown below.1. Daptomycin compared with vancomycin or semisynthetic penicillin: RR of MRSA eradication 1.13; 95% CI 0.56 to 2.25 (14 people).2. Ertapenem compared with piperacillin/tazobactam: RR of MRSA eradication 0.71; 95% CI 0.06 to 9.10 (10 people).3. Moxifloxacin compared with piperacillin/tazobactam followed by amoxycillin/clavulanate: RR of MRSA eradication 0.87; 95% CI 0.56 to 1.36 (23 people).. We found no trials comparing the use of antibiotics with no antibiotic for treating MRSA-colonised non-surgical wounds and therefore can draw no conclusions for this population. In the trials that compared different antibiotics for treating MRSA-infected non surgical wounds, there was no evidence that any one antibiotic was better than the others. Further well-designed RCTs are necessary.

Topics: Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Diabetic Foot; Humans; Methicillin-Resistant Staphylococcus aureus; Randomized Controlled Trials as Topic; Staphylococcal Infections

One of the most dreaded complications after cochlear implantation is infection. These infections are a challenge due to lack of any data regarding optimal methods of investigation and management. More often than not, these patients have to undergo explantation and revision surgery. This paper presents a case report and literature review which focuses on the role of antibiotics and the need for early explantation in most biofilm-related infections of cochlear implants.

Topics: Administration, Oral; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Biofilms; Child, Preschool; Cochlear Implants; Device Removal; Humans; Infusions, Intravenous; Male; Prosthesis-Related Infections; Recurrence; Reoperation; Rifampin; Rupture, Spontaneous; Staphylococcal Infections; Surgical Flaps; Tomography, X-Ray Computed

Topics: Administration, Oral; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bronchitis; Double-Blind Method; Drug Therapy, Combination; Haemophilus Infections; Haemophilus influenzae; Humans; Moraxella catarrhalis; Multicenter Studies as Topic; Neisseriaceae Infections; Pneumonia; Pneumonia, Pneumococcal; Randomized Controlled Trials as Topic; Respiratory Tract Infections; Staphylococcal Infections; Staphylococcus aureus; Streptococcus pneumoniae

Topics: Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bacterial Proteins; beta-Lactamase Inhibitors; Carrier Proteins; Clavulanic Acids; Drug Therapy, Combination; Hexosyltransferases; Methicillin; Microbial Sensitivity Tests; Muramoylpentapeptide Carboxypeptidase; Oxacillin; Penicillin-Binding Proteins; Penicillinase; Peptidyl Transferases; Staphylococcal Infections

The experimental and clinical values of amoxycillin/clavulanate in severe Staphylococcus aureus infections are reviewed. Experimentally, amoxycillin/clavulanate was highly effective in the treatment of acute endocarditis due to methicillin-sensitive isolates of S. aureus (MSSA) in rats. In addition, high doses of amoxycillin/clavulanate also cured experimental endocarditis due to methicillin-resistant strains of S. aureus (MRSA) in the animal model. In the clinical setting, a review of 86 patients with either community- or hospital-acquired bacteraemia due to MSSA showed that intravenous treatment with amoxycillin/clavulanate was adequate for empirical (and apparently also long-term) therapy of such severe infections. However, the retrospective nature of the analysis did not allow assessment of the relative efficacy of amoxycillin/clavulanate as compared with standard anti-staphylococcal drugs, such as flucloxacillin or vancomycin. Further prospective studies are warranted to address this issue. Thus, amoxycillin/clavulanate appears to be a good candidate for empirical treatment of severe infections that may be caused by MSSA. Usage of amoxycillin/clavulanate against MRSA is, however, still experimental and is not currently advocated for the treatment of MRSA infections in humans.

Topics: Adult; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Animals; Clavulanic Acids; Drug Therapy, Combination; Endocarditis, Bacterial; Humans; Male; Methicillin Resistance; Models, Biological; Rats; Staphylococcal Infections; Staphylococcus aureus

A 26-year-old woman in her third trimester of pregnancy had stridor. Epiglottitis was diagnosed by fiberoptic laryngoscopy. Staphylococcus aureus was the predominant organism isolated from the laryngeal aspirate. Early intubation proved effective in managing this potentially life-threatening disease. Although pharyngitis is the most common cause of sore throat in the adult, acute epiglottitis must be considered in the differential diagnosis when there is unrelenting throat pain and minimal objective signs of pharyngitis. An early diagnosis with aggressive airway management can be life saving to both mother and fetus.

Topics: Adult; Airway Obstruction; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Clavulanic Acids; Drug Therapy, Combination; Epiglottitis; Female; Humans; Intubation, Intratracheal; Pregnancy; Pregnancy Complications, Infectious; Staphylococcal Infections

Topics: Administration, Oral; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bacterial Infections; Clinical Trials as Topic; Humans; Staphylococcal Infections; Streptococcal Infections

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

Eumycetoma is a chronic progressive disabling and destructive inflammatory disease which is commonly caused by the fungus Madurella mycetomatis. It is characterized by the formation of multiple discharging sinuses. It is usually treated by antifungal agents but it is assumed that the therapeutic efficiency of these agents is reduced by the co-existence of Staphylococcus aureus co-infection developing in these sinuses. This prospective study was conducted to investigate the safety, efficacy and clinical outcome of combined antibiotic and antifungal therapy in eumycetoma patients with superimposed Staphylococcus aureus infection. The study enrolled 337 patients with confirmed M. mycetomatis eumycetoma and S. aureus co-infection. Patients were allocated into three groups; 142 patients received amoxicillin-clavulanic acid and ketoconazole, 93 patients received ciprofloxacin and ketoconazole and 102 patients received ketoconazole only. The study showed that, patients who received amoxicillin-clavulanic acid and ketoconazole treatment had an overall better clinical outcome compared to those who had combined ciprofloxacin and ketoconazole or to those who received ketoconazole only. In this study, 60.6% of the combined amoxicillin-clavulanic acid/ketoconazole group showed complete or partial clinical response to treatment compared to 30.1% in the ciprofloxacin/ketoconazole group and 36.3% in the ketoconazole only group. The study also showed that 64.5% of the patients in the ciprofloxacin/ketoconazole group and 59.8% in the ketoconazole only group had progressive disease and poor outcome. This study showed that the combination of amoxicillin-clavulanic acid and ketoconazole treatment is safe and offers good clinical outcome and it is therefore recommended to treat eumycetoma patients with Staphylococcus aureus co-infection.

Topics: Adolescent; Adult; Aged; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Antifungal Agents; Child; Ciprofloxacin; Coinfection; Drug Therapy, Combination; Female; Humans; Ketoconazole; Madurella; Male; Middle Aged; Mycetoma; Prospective Studies; Staphylococcal Infections; Treatment Outcome; Young Adult

Assessment of the usefulness of antibiotic prophylaxis in inguinal hernioplasty.. This prospective randomized double blind study was conducted on 98 patients. Group A (50 patients) received a single dose of intravenous amoxicillin and clavulanic acid, and Group P (48 patients) received an equal volume of normal saline placebo by intravenous bolus 30 min before the induction of anesthesia. Hernioplasty was performed with polypropylene mesh. Skin was closed using skin staples that were removed after complete wound healing. The surgical site infection was diagnosed according to APIC, CDC criteria ( http://www.apic.org ).. The mean operative time was 38.8  ± 10.8 min in group A versus 40.9 ± 11.1 min in group P (P  = 0.34). The mean hospitalization time was 1.3 ± 0.463 days in group A versus 1.25 ± 0.438 days in group P (P = 0.58). Four patients (2%) in group A and 6 patients (2.88%) in group P had wound infections (P = 0.47). Group A had 3 superficial infections and 1 deep infection while group P had 5 superficial infections and 1 deep infection. Antibiotic treatment of the wound infection was successful in all patients. Wound culture showed Staphylococcus aureus infection in 1 patient each group, Streptococcus pyogenes in 1 group A patient and Pseudomonas aeruginosa in 1 group P patient. Cultures in other patients in both groups were reported to be sterile.. Prophylactic antibiotic usage in patients undergoing tension free inguinal hernioplasty did not show any statistically significant beneficial effects in reduction of surgical site infection.

Topics: Adult; Aged; Amoxicillin-Potassium Clavulanate Combination; Antibiotic Prophylaxis; Double-Blind Method; Female; Hernia, Inguinal; Humans; Male; Middle Aged; Odds Ratio; Pseudomonas Infections; Staphylococcal Infections; Streptococcal Infections; Surgical Mesh; Surgical Wound Infection; Young Adult

Perioperative antibiotic prophylaxis has significantly reduced wound infection rates in clean-contaminated head and neck surgical procedures but controversy still remains regarding the optimal antibiotic regime.. To examine the efficacy of different antibiotics in head and neck oncological surgery prophylaxis.. In this prospective, double-blind clinical trial, 189 patients with carcinoma of the upper aerodigestive tract were randomized to receive amoxicillin-clavulanate or cefazolin intravenously up to 1h before surgery and at 8-h intervals for an additional three doses.. An overall wound infection rate of 22% was observed. The infection rate in patients receiving cefazolin was 24% (22/92) vs. 21% (20/97) in those receiving amoxicillin-clavulanate; the difference was not statistically significant. Postoperative overall non-wound infection developed in 12% (22/189) patients; the rate of infection was 9.8% (9/92) in patients receiving cefazolin vs. 13.4% (13/97) in those receiving amoxicillin-clavulanate, without a statistically significant difference between the two groups. Gram-negative bacteria were more often isolated with Pseudomonas aeruginosa as the dominant species. The risk of postoperative infection was more influenced by the type of surgical procedure than by disease stage.. In clean-contaminated head and neck oncologic surgery amoxicillin-clavulanate prophylaxis was at least as efficient as cefazolin. However, when taking into account the fact that beta-lactamase containing strains have recently been spreading, amoxicillin-clavulanate should be the logical first choice.

Topics: Amoxicillin-Potassium Clavulanate Combination; Antibiotic Prophylaxis; Bronchitis; Carcinoma, Squamous Cell; Cefazolin; Double-Blind Method; Head and Neck Neoplasms; Humans; Injections, Intravenous; Laryngeal Neoplasms; Mouth Neoplasms; Pharyngeal Neoplasms; Pneumonia, Bacterial; Postoperative Complications; Prospective Studies; Pseudomonas aeruginosa; Pseudomonas Infections; Staphylococcal Infections; Streptococcal Infections; Surgical Wound Infection; Tracheitis

In an open, randomized study of 60 patients with acute or recurrent sinusitis, the bacteriological and clinical efficacy of roxithromycin 150 mg bd were compared with those of po co-amoxiclav (625 mg) tds. Of 52 patients who underwent sinus puncture for isolation of causative organisms, 48 had pathogens sensitive to both antibiotics. Satisfactory clinical response was obtained in 93.1% (27/29) evaluable patients receiving roxithromycin and 88.8% (24/27) receiving co-amoxiclav. Tolerability was significantly better in the roxithromycin group, with 1/29 (3.4%) patients in this group experiencing gastrointestinal side-effects, compared with 7/27 (25.9%) patients in the co-amoxiclav group (P < 0.05). Although the study had limited power to detect differences, roxithromycin demonstrated clinical, bacteriological and overall efficacy similar to that of co-amoxiclav, but with better tolerability. Roxithromycin thus appears to be an effective and well-tolerated drug for the treatment of acute and recurrent sinusitis.

Topics: Adolescent; Adult; Aged; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bacteroides fragilis; Bacteroides Infections; Drug Therapy, Combination; Female; Haemophilus Infections; Haemophilus influenzae; Humans; Male; Middle Aged; Moraxella catarrhalis; Neisseriaceae Infections; Pneumococcal Infections; Roxithromycin; Sinusitis; Staphylococcal Infections; Streptococcus pneumoniae

We undertook a prospective double-blind controlled study to compare the efficacy of a drug that usually has no antistaphylococcal activity (amoxicillin trihydrate) with the efficacy of the same drug with an addition of a beta-lactamase inhibitor (amoxicillin plus clavulanic acid [Augmentin]) in the treatment of nonbullous impetigo. Fifty-one culture-positive patients, aged 6 months to 9 years, were included, 26 in the amoxicillin group and 25 in the Augmentin group. The study groups were clinically and bacteriologically comparable at the start of the study. Staphylococcus aureus was isolated from all patients and beta-hemolytic streptococcus from 14 (29%). All staphylococci were sensitive to Augmentin but resistant to amoxicillin. Forty-nine patients completed the study. The clinical response was significantly better among the Augmentin recipients (marked improvement in 71% and 95% of patients after 2 and 5 days, respectively; no new lesions during the treatment course) than among the amoxicillin recipients (marked improvement in 44% and 68% of patients after 2 and 5 days, respectively; new lesions appeared in 20% of patients). Recurrence within 3 weeks occurred in 12 (26%) of 49 patients, and no difference was observed between the two groups. We conclude that S aureus is common in nonbullous impetigo, and that at least in some cases it plays an important role in the course of the disease that can be altered by specific therapy.

Topics: Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Child; Child, Preschool; Clavulanic Acids; Clinical Trials as Topic; Double-Blind Method; Drug Therapy, Combination; Humans; Impetigo; Infant; Prospective Studies; Staphylococcal Infections; Staphylococcus aureus

The efficacy of clavulanate-potentiated amoxycillin was compared with amoxycillin alone in experimental staphylococcal infection in dogs and in a controlled trial in clinical cases of skin infection in dogs and cats. The experimental infection was produced by subdermal inoculation with beta-lactamase producing (amoxycillin resistant) staphylococci absorbed in cotton dust. This produced discrete, localised lesions with no systemic involvement. In a cross over study, six animals were randomly allocated to treatment with either amoxycillin alone (10 mg/kg, dosed twice daily) or a formulation of clavulanate-potentiated amoxycillin (12.5 mg/kg, of a 1:4 ratio, dosed twice daily). The lesions of the animals treated with clavulanate-potentiated amoxycillin resolved more quickly than those treated with amoxycillin alone. The difference was significant (P less than 0.05) for both lesion diameter and inflammation score after day 6 of treatment. A trial was carried out in clinical cases of skin disease which were randomly allocated to twice daily treatment with either amoxycillin alone (10 or 20 mg/kg), or with clavulanate-potentiated amoxycillin (12.5 or 25 mg/kg of a 1:4 ratio). The required duration of treatment was shorter (P less than 0.5) for the potentiated amoxycillin treatments, and the success rate (judged by cure or substantial improvement) was higher (P less than 0.05) for this group, especially (P less than 0.01) where amoxycillin resistant organisms were isolated. It was concluded that clavulanate-potentiated amoxycillin was an effective treatment of skin infections both under experimental and clinical conditions.

Topics: Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Animals; Cat Diseases; Cats; Clavulanic Acids; Clinical Trials as Topic; Dog Diseases; Dogs; Drug Combinations; Random Allocation; Skin Diseases, Infectious; Staphylococcal Infections

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

Methicillin-resistant Staphylococcus pseudintermedius (MRSP) lineages harbouring staphylococcal cassette chromosome (SCC) mec types IV, V and ΨSCCmec57395 usually display low oxacillin MICs (0.5-2 mg/L).. To evaluate how oxacillin MICs correlate with PBP mutations and susceptibility to β-lactams approved for veterinary use.. Associations between MICs and PBP mutations were investigated by broth microdilution, time-kill and genome sequence analyses in 117 canine MRSP strains harbouring these SCCmec types. Clinical outcome was retrospectively evaluated in 11 MRSP-infected dogs treated with β-lactams.. Low-level MRSP was defined by an oxacillin MIC <4 mg/L. Regardless of strain genotype, all low-level MRSP isolates (n = 89) were cefalexin susceptible, whereas no strains were amoxicillin/clavulanate susceptible according to clinical breakpoints. Exposure to 2× MIC of cefalexin resulted in complete killing within 8 h. High (≥4 mg/L) oxacillin MICs were associated with substitutions in native PBP2, PBP3, PBP4 and acquired PBP2a, one of which (V390M in PBP3) was statistically significant by multivariable modelling. Eight of 11 dogs responded to systemic therapy with first-generation cephalosporins (n = 4) or amoxicillin/clavulanate (n = 4) alone or with concurrent topical treatment, including 6 of 7 dogs infected with low-level MRSP.. Oxacillin MIC variability in MRSP is influenced by mutations in multiple PBPs and correlates with cefalexin susceptibility. The expert rule recommending that strains with oxacillin MIC ≥0.5 mg/L are reported as resistant to all β-lactams should be reassessed based on these results, which are highly clinically relevant in light of the shortage of effective antimicrobials for systemic treatment of MRSP infections in veterinary medicine.

Topics: Amoxicillin-Potassium Clavulanate Combination; Animals; Anti-Bacterial Agents; Cephalexin; Dog Diseases; Dogs; Methicillin Resistance; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Oxacillin; Retrospective Studies; Staphylococcal Infections

To provide an update on the microbiology, sensitivity rates and antibiotic prescribing patterns for superficial neck lymph node abscesses at Scotland's largest paediatric tertiary centre. Findings were compared to historical data from our institution.. A retrospective case series was conducted of paediatric patients undergoing incision and drainage of a superficial neck lymph node abscess at the Royal Hospital for Children in Glasgow, from 2018 to 2021.. Thirty-nine abscesses were identified. Methicillin-susceptible. There was a significant change in causative micro-organisms, including a decrease in

Topics: Abscess; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Child; Drainage; Humans; Neck; Retrospective Studies; Staphylococcal Infections; Staphylococcus aureus

To determine the antibiotypes and frequency of toxin genes in methicillin-resistant Staphylococcus pseudintermedius (MRSP), 281 nasal swab samples were collected from dogs and dog guardians in Abakaliki, Southeastern Nigeria. Antimicrobial susceptibility testing was determined by disc diffusion technique while detection of toxin genes was carried out by PCR. Exactly 41 (28.7 %) and 6 (4.3 %) MRSP were obtained from dogs and dog guardians respectively. Isolates exhibited resistance (100-16.7 %) to amoxicillin-clavulanic acid, cephalosporins, fluoroquinolones, and carbapenems. Sec

Topics: Amoxicillin-Potassium Clavulanate Combination; Animals; Anti-Bacterial Agents; Anti-Infective Agents; Carbapenems; Cephalosporins; Dog Diseases; Dogs; Fluoroquinolones; Humans; Methicillin Resistance; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Nigeria; Staphylococcal Infections; Staphylococcus

Topics: Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Animals; Anti-Bacterial Agents; Cattle; Endometritis; Enrofloxacin; Female; Genomics; Gentamicins; Methicillin-Resistant Staphylococcus aureus; Metronidazole; Microbial Sensitivity Tests; Phylogeny; Staphylococcal Infections; Staphylococcus aureus

Bacterial infections pose a global threat, especially in the pediatric population. Antimicrobials that are used to treat such infections continuously show reduced efficacy, and empirical therapy is a major treatment option in Rwanda. This study aimed to determine the resistance rate of commonly used antibiotics in pediatric patients. The study was conducted from June 1, 2018 to May 30, 2019, and microbiological samples were collected from 712 children with suspected bacterial infections. Antimicrobial sensitivity testing was performed on 177 positive cultures (24%) that were considered for data analysis. The findings show that the major bacterial isolates were Klebsiella pneumoniae (n = 50, 28.2%), Escherichia coli (n = 47, 26.5%), and Staphylococcus aureus (n = 38, 21.4%). In general, the greatest antibiotic resistance rate was observed in ampicillin (n = 125, 86.2%), amoxicillin-clavulanic acid (n = 84, 82.4%), amoxicillin (n = 64, 79%), cefadroxil (n = 83, 69.2%), tetracycline (n = 72, 59.7%), ceftazidime (n = 42, 55.3%), and cefuroxime (n = 14, 53.8%). More specifically, Klebsiella pneumoniae was 100% resistant to amoxicillin-clavulanic acid, cefuroxime, trimethoprim-sulfamethoxazole, ceftazidime, erythromycin, and clindamycin. Staphylococcus aureus was 86.7% resistant to ampicillin, and Escherichia coli was 91.7% resistant to tetracycline, 90.6% resistant to ampicillin, 83.3% resistant to amoxicillin-clavulanic acid, 79.3% resistant to cefadroxil, and 78.6% resistant to ceftazidime. Moreover, Klebsiella pneumoniae from blood and urine was 96.8% and 100% sensitive, respectively, to meropenem. Staphylococcus aureus from blood was 100% sensitive to vancomycin, whereas Escherichia coli from urine was sensitive to clindamycin (100%), nitrofurantoin (80.6%), and ciprofloxacin (72.7%). In conclusion, our findings show a high resistance rate to commonly used antibiotics, which suggests precaution in empirical therapy and continued surveillance of antimicrobial resistance.

Topics: Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bacteria; Cefadroxil; Ceftazidime; Cefuroxime; Child; Clindamycin; Drug Resistance, Bacterial; Escherichia coli; Hospitals, Teaching; Humans; Klebsiella pneumoniae; Microbial Sensitivity Tests; Rwanda; Staphylococcal Infections; Staphylococcus aureus; Tetracyclines; Universities

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

Staphylococcus pseudintermedius is a common pathogen in dogs and methicillin resistance has emerged over recent decades. According to the current guidelines, S. pseudintermedius displaying oxacillin resistance should be reported as resistant to all β-lactams.. To identify possible associations between β-lactam resistance levels and clonal complexes (CCs) and/or staphylococcal cassette chromosome mec (SCCmec) types in methicillin-resistant S. pseudintermedius (MRSP).. MICs of oxacillin, penicillin, ampicillin, amoxicillin/clavulanic acid and cefalotin were determined by broth microdilution for 86 clinical canine MRSP isolates from Denmark and the Netherlands. PCR and sequencing were used for SCCmec typing and MLST.. Isolates belonged to CC71 (n = 36), CC258 (n = 33), CC45 (n = 11), CC68 (n = 1) and five singleton STs. SCCmecII-III was exclusively found in CC71 and SCCmecIV was significantly associated with CC258. SCCmecV and non-typeable SCCmec types occurred in 4 and 14 isolates, respectively. SCCmecIV was associated with lower MICs of oxacillin (<2 mg/L), ampicillin (<8 mg/L) and amoxicillin/clavulanic acid (<4 mg/L) and with susceptibility to cefalotin (<4 mg/L). All isolates harbouring SCCmecV were susceptible to cefalotin as well.. SCCmec types were associated with different CCs and with either high- or low-level resistance to different β-lactams. The finding of amoxicillin/clavulanic acid (20%) and cefalotin (70%) in vitro susceptibility across all CCs might have clinical implications, since amoxicillin/clavulanic acid and first-generation cephalosporins are first-choice antibiotics for treatment of S. pseudintermedius infections. Pharmacokinetic/pharmacodynamic and clinical outcome studies are warranted to evaluate the in vivo efficacy of these β-lactams for treatment of MRSP infections.

Topics: Amoxicillin-Potassium Clavulanate Combination; Animals; Anti-Bacterial Agents; Cephalothin; Chromosomes; Dog Diseases; Dogs; Methicillin Resistance; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Multilocus Sequence Typing; Netherlands; Staphylococcal Infections; Staphylococcus

Bacterial infection of the urinary tract is among the common reasons for seeking medical attention in the community. Rapidly increasing antibiotic resistance of uropathogens is resulting in limited treatment options. Therefore, knowledge of the current uropathogens and their antibiotic susceptibility is important for better treatment of urinary tract infection.. A cross-sectional study design was conducted from February to September thirty, 2017 among students who came to Mekelle University student's clinics with symptomatic urinary tract infection during the study period.. Mid-stream urine specimens were collected from 341individuals with suspected urinary tract infection for bacteriological identification and antimicrobial susceptibility testing. Data on socio-demographic, clinical and risk factors were also collected using a structured questionnaire.. Among the 341 study participants, 72(21.1%) showed significant bacteriuria. Escherichia coli (48.6%), Coagulase-negative staphylococci (23%), Staphylococcus aureus (13.5%), and Klebsiella spp. (8.1%) were common bacterial isolates. Resistance to ampicillin (81-100%), amoxicillin/clavulanic acid (77-93.6%), co- trimoxazole (55 72.3%), nalidixic acid (57.4%) and tetracycline (46-55.5%) was seen by most isolates. Multidrug resistance was observed in 73% of the bacterial isolates, and 25.5% of the Gram-negative isolates were extended-spectrum beta-lactamase producers. Being female, a history of urinary tract infection, a history of catheterization and frequent sexual activity were found to be statistically associated with urinary tract infection.. Urinary tract infection is a problem among university students with a prevalence of 21.1%. All isolates have developed resistance to most of the commonly used antibiotics. Therefore, health education on the transmission and causes of urinary tract infection are recommended for the students.

Topics: Adolescent; Adult; Amoxicillin-Potassium Clavulanate Combination; Ampicillin; Anti-Bacterial Agents; Bacteriuria; Cross-Sectional Studies; Drug Resistance, Multiple, Bacterial; Escherichia coli; Escherichia coli Infections; Ethiopia; Female; Humans; Microbial Sensitivity Tests; Prevalence; Risk Factors; Staphylococcal Infections; Staphylococcus aureus; Students; Trimethoprim, Sulfamethoxazole Drug Combination; Universities; Young Adult

Topics: Acyclovir; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Antiviral Agents; Herpes Zoster Ophthalmicus; Humans; Male; Middle Aged; Ofloxacin; Photography; Staphylococcal Infections

This quasi-experimental study investigated the effect of an antibiotic cycling policy based on time-series analysis of epidemiologic data, which identified antimicrobial drugs and time periods for restriction. Cyclical restrictions of amoxicillin/clavulanic acid, piperacillin/tazobactam, and clarithromycin were undertaken over a 2-year period in the intervention hospital. We used segmented regression analysis to compare the effect on the incidence of healthcare-associated Clostridioides difficile infection (HA-CDI), healthcare-associated methicillin-resistant Staphylococcus aureus (HA-MRSA), and new extended-spectrum β-lactamase (ESBL) isolates and on changes in resistance patterns of the HA-MRSA and ESBL organisms between the intervention and control hospitals. HA-CDI incidence did not change. HA-MRSA incidence increased significantly in the intervention hospital. The resistance of new ESBL isolates to amoxicillin/clavulanic acid and piperacillin/tazobactam decreased significantly in the intervention hospital; however, resistance to piperacillin/tazobactam increased after a return to the standard policy. The results question the value of antibiotic cycling to antibiotic stewardship.

Topics: Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Antimicrobial Stewardship; beta-Lactamases; Clostridioides difficile; Clostridium Infections; Cross Infection; Drug Resistance, Bacterial; Hospitals; Humans; Incidence; Methicillin-Resistant Staphylococcus aureus; Northern Ireland; Staphylococcal Infections

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

Topics: Acute Disease; Aged; Aged, 80 and over; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Antibiotic Prophylaxis; Cefazolin; Clinical Decision-Making; Combined Modality Therapy; Debridement; Female; Floxacillin; Hip Prosthesis; Humans; Knee Prosthesis; Male; Microbial Sensitivity Tests; Middle Aged; Netherlands; Practice Patterns, Physicians'; Prosthesis-Related Infections; Retrospective Studies; Staphylococcal Infections

Topics: Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Child, Preschool; Female; Furunculosis; Humans; Mupirocin; Nose Diseases; Staphylococcal Infections; Staphylococcus aureus; Treatment Outcome

Antimicrobial resistance in staphylococci, often associated with treatment failure, is increasingly reported in veterinary medicine. The aim of this study was to investigate patterns and predictors of antimicrobial resistance among Staphylococcus spp. isolates from canine samples submitted to the bacteriology laboratory at the University of Pretoria academic veterinary hospital between 2007 and 2012. Retrospective data of 334 Staphylococcus isolates were used to calculate the proportion of samples resistant to 15 antimicrobial agents. The Cochran-Armitage trend test was used to investigate temporal trends and logistic regression models were used to investigate predictors of antimicrobial resistance in Staphylococcus aureus and Staphylococcus pseudintermedius.. Results show that 98.2% (55/56) of the S. aureus isolates were resistant to at least one drug while 42.9% were multidrug resistant. Seventy-seven percent (214/278) of the S. pseudintermedius isolates were resistant to at least one drug and 25.9% (72/278) were multidrug resistant. Resistance to lincospectin was more common among S. aureus (64.3%) than S. pseudintermedius (38.9%). Similarly, resistance to clindamycin was higher in S. aureus (51.8%) than S. pseudintermedius (31.7%) isolates. There was a significant (p = 0.005) increase in S. aureus resistance to enrofloxacin over the study period. Similarly, S. pseudintermedius exhibited significant increasing temporal trend in resistance to trimethoprim-sulphamethoxazole (p = 0.004), clindamycin (p = 0.022) and orbifloxacin (p = 0.042). However, there was a significant decreasing temporal trend in the proportion of isolates resistant to doxycycline (p = 0.041), tylosin (p = 0.008), kanamycin (p = 0.017) and amoxicillin/clavulanic acid (p = 0.032).. High levels of multidrug resistance and the increasing levels of resistance to sulphonamides, lincosamides and fluoroquinolones among Staphylococcus spp. isolates in this study are concerning. Future studies will need to investigate local drivers of antimicrobial resistance to better guide control efforts to address the problem.

Topics: Amoxicillin-Potassium Clavulanate Combination; Animals; Anti-Bacterial Agents; Ciprofloxacin; Clindamycin; Dog Diseases; Dogs; Doxycycline; Drug Resistance, Bacterial; Drug Resistance, Multiple, Bacterial; Enrofloxacin; Female; Fluoroquinolones; Hospitals, Animal; Kanamycin; Lincomycin; Male; Retrospective Studies; South Africa; Spectinomycin; Staphylococcal Infections; Staphylococcus; Trimethoprim, Sulfamethoxazole Drug Combination; Tylosin

Staphylococcus lugdunensis, a strain of coagulase-negative staphylococci, is part of the normal flora of human skin but can cause multiple infections at various sites. This microorganism has emerged as a major human pathogen. However, no study has reported primary lung abscess caused by S. lugdunensis. A 54-year-old alcoholic man without relevant past medical history was admitted because of primary lung abscesses. Empirical amoxicillin/clavulanate therapy was initially administered; however, the patient had persistent pleuritic chest pain and fever. He subsequently underwent resection of the lung abscess and removal of exudative pleural effusion on the fourth hospital day. Histopathologic examination confirmed the diagnosis of lung abscess, and colonies of gram-positive bacteria were identified. The culture specimen from the abscess was positive for S. lugdunensis, which was susceptible to amoxicillin/clavulanate, cefazolin, ciprofloxacin, clindamycin, erythromycin, oxacillin, teicoplanin, tetracycline, and vancomycin. Following resection and 3 weeks of amoxicillin/clavulanate therapy, the patient eventually recovered well without relapse. This case report is the first to describe S. lugdunensis as a cause of primary lung abscess; this microorganism should be considered a potential monomicrobial pathogen in primary lung abscess.

Topics: Alcoholics; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Chest Pain; Humans; Lung Abscess; Male; Middle Aged; Pleural Effusion; Pneumonectomy; Radiography; Staphylococcal Infections; Staphylococcus lugdunensis

Staphylococcus aureus (S. aureus) is a major pathogen implicated in skin and soft tissue infections, abscess in deep organs, toxin mediated diseases, respiratory tract infections, urinary tract infections, post-surgical wound infections, meningitis and many other diseases. Irresponsible and over use of antibiotics has led to an increased presence of multidrug resistant organisms and especially methicillin resistant Staphylococcus aureus (MRSA) as a major public health concern in Afghanistan. As a result, there are many infections with many of them undiagnosed or improperly diagnosed. We aimed to establish a baseline of knowledge regarding the prevalence of MRSA in Kabul, Afghanistan, as well as S. aureus antimicrobial susceptibility to current available antimicrobials, while also determining those most effective to treat S. aureus infections.. Samples were collected from patients at two main Health facilities in Kabul between September 2016 and February 2017. Antibiotic susceptibility profiles were determined by the disc diffusion method and studied using standard CLSI protocols.. Out of 105 strains of S. aureus isolated from pus, urine, tracheal secretions, and blood, almost half (46; 43.8%) were methicillin-sensitive Staphylococcus aureus (MSSA) while 59 (56.2%) were Methicillin-resistant Staphylococcus aureus (MRSA). All strains were susceptible to vancomycin. In total, 100 (95.2%) strains were susceptible to rifampicin, 96 (91.4%) susceptible to clindamycin, 94 (89.5%) susceptible to imipenem, 83 (79.0%) susceptible to gentamicin, 81(77.1%) susceptible to doxycycline, 77 (77.1%) susceptible to amoxicillin + clavulanic acid, 78 (74.3%) susceptible to cefazolin, 71 (67.6%) susceptible to tobramycin, 68 (64.8%) susceptible to chloramphenicol, 60 (57.1%) were susceptible to trimethoprim-sulfamethoxazole, 47 (44.8%) susceptible to ciprofloxacin, 38 (36.2%) susceptible to azithromycin and erythromycin, 37 (35.2%) susceptible to ceftriaxone and 11 (10.5%) were susceptible to cefixim. Almost all (104; 99.05%) were resistant to penicillin G and only 1 (0.95%) was intermediate to penicillin G. Interestingly, 74.6% of MRSA strains were azithromycin resistant with 8.5% of them clindamycin resistant. Ninety-six (91.4%) of the isolates were multi-drug resistant.. There was a high rate of Methicillin resistance (56.2%) among S. aureus strains in the samples collected and most (91.4%) were multidrug resistant. The most effective antibiotics to treat Staph infections were vancomycin, rifampicin, imipenem, clindamycin, amoxicillin-clavulanic acid, cefazolin, gentamicin and doxycycline. The least effective were azithromycin, ceftriaxone, cefixim and penicillin. We recommend that, where possible, in every case of S. aureus infection in Kabul, Afghanistan, Antibiotic susceptibility testing (AST) should be performed and responsible use of antibiotics should be considered.

Topics: Adolescent; Adult; Afghanistan; Aged; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Child; Child, Preschool; Clindamycin; Erythromycin; Female; Health Facilities; Humans; Infant; Longitudinal Studies; Male; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Middle Aged; Staphylococcal Infections; Staphylococcus aureus; Trimethoprim, Sulfamethoxazole Drug Combination; Vancomycin

Topics: Abscess; Adolescent; Amoxicillin-Potassium Clavulanate Combination; Anti-Infective Agents; beta-Lactamase Inhibitors; Choroid Diseases; Diagnosis, Differential; Drug Therapy, Combination; Fluorescein Angiography; Humans; Lacrimal Apparatus Diseases; Male; Metronidazole; Staphylococcal Infections; Staphylococcus epidermidis; Tomography, X-Ray Computed; Ultrasonography

Ecthyma gangrenosum (EG) is an anatomoclinical syndrome commonly associated with Pseudomonas aeruginosa cutaneous infection. Other microorganisms have also been incriminated on occasion, with other viral, fungal and bacterial agents potentially causing EG. In this report, we present an extremely rare case of an EG caused by methicillin-sensitive Staphylococcus aureus (MSSA) infection. This case, highly characteristic of EG both clinically and histologically, calls into question the physiopathological mechanisms of the disease and provides a reminder that it may be caused by a variety of organisms.. A 62-year-old woman, followed for HIV seropositivity at the AIDS stage, developed a painful purpuric skin rash evolving towards necrotic nodules characteristic of ecthyma gangrenosum. Skin biopsy confirmed the diagnosis of EG due to methicillin-sensitive S. aureus (MSSA) infection without toxins or bacteraemia.. To the best of our knowledge, this is the first case in the literature in which MSSA is reported as the underlying cause of such lesions.

Topics: Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bacterial Toxins; Blood; Confusion; Ecthyma; Exotoxins; False Negative Reactions; Female; HIV Infections; Humans; Leukocidins; Methicillin; Methicillin Resistance; Middle Aged; Skin; Staphylococcal Infections; Staphylococcus aureus

Topics: Adult; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Cheilitis; Diagnostic Errors; Edema; Herpes Simplex; Humans; Immunocompetence; Male; Staphylococcal Infections

We aimed to identify the causative organisms and sensitivities in community-acquired paediatric empyema at Starship Children's Hospital and Christchurch Hospital and to determine if current antibiotic recommendations are appropriate.. Retrospective analysis was undertaken of all cases with clinical, radiological, and microbiological evidence of empyema at Starship Children's Hospital and Christchurch Hospital between June 2009 and March 2013 (3.8 years), and January 2009 and May 2014 (5.4 years) respectively.. Ninety-eight children were managed with empyema at Starship Children's Hospital and 30 children at Christchurch Hospital. Staphylococcus aureus was the most common pathogen identified at both sites followed by Streptococcus pneumoniae. A significant proportion had no pathogen identified. Amongst S.aureus isolates, 1/5th were methicillin-resistant, contributing 8% of all culture positive empyema cases. Māori and Pacific groups were over-represented. Cases occurred more often in boys and those <5 years. Blood cultures and S.pneumoniae pleural antigen were important in diagnosis.. Our audit confirms the important role of S.aureus in paediatric empyema in New Zealand and a high rate of this disease, particularly in the North Island. Antimicrobial susceptibilities of the pathogens of empyema demonstrate current initial antibiotic recommendation.

Topics: Adolescent; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Cefotaxime; Cefuroxime; Child; Child, Preschool; Cohort Studies; Community-Acquired Infections; Empyema, Pleural; Ethnicity; Female; Floxacillin; Hospitals, Pediatric; Hospitals, Urban; Humans; Infant; Infant, Newborn; Male; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; New Zealand; Pneumococcal Infections; Practice Guidelines as Topic; Retrospective Studies; Seasons; Staphylococcal Infections; Staphylococcus aureus; Streptococcal Infections; Streptococcus pneumoniae; Streptococcus pyogenes

Infection after head and neck oncological surgery is relatively frequent, and is associated with significant morbidity and mortality.. The primary objective of this prospective study was to determine risk factors for Surgical Site Infection (SSI) in major head and neck cancer surgery.. A population of 137 head and neck cancer patients, of the Portuguese Institute of Oncology Francisco Gentil (Lisbon, Portugal), was prospectively studied in order to ascertain the correlation between 31 known risk factors and the presence of SSI.. The rate of SSI was 10.9%, with all of the infections being of the deep incisional type. A discriminant analysis and multiple logistic regression methods identified pre-surgical tracheostomy (p < 0.001), previous surgery (p = 0.001) and length of pre-operative hospital stay (p < 0.001) as the most significant risk factors for surgical site infections.. In order to minimize the risk of post-operative SSI in the context of head and neck cancer patients, particular attention should be paid to patients submitted to tracheostomy before surgery, to those submitted to previous oncological surgery, and to patients who are forced to remain in the hospital for prolonged periods of time before surgery.

Topics: Adult; Aged; Aged, 80 and over; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Anti-Infective Agents, Local; Antibiotic Prophylaxis; Debridement; Disinfection; Drainage; Female; Forecasting; Head and Neck Neoplasms; Humans; Length of Stay; Male; Middle Aged; Neoadjuvant Therapy; Povidone-Iodine; Preoperative Care; Prospective Studies; Reoperation; Risk Factors; Staphylococcal Infections; Surgical Wound Infection; Tracheostomy

A 33-year-old woman presented with a three-day history of an abscess in the left alar region, four weeks after drainage of a breast abscess. The later infection was confirmed to be due to Panton-Valentine leukocidin positive, methicillin-resistant Staphylococcus aureus. This report aims to raise awareness of such infections, and to advise when Panton-Valentine leukocidin toxin testing is appropriate.. Case report and discussion.. Although superficial Panton-Valentine leukocidin positive Staphylococcus aureus infections are relatively benign, more serious infections can be potentially life-threatening. Clinicians should be able to identify the features of potential Panton-Valentine leukocidin positive Staphylococcus aureus infection, in order to implement appropriate therapy.. Clinicians need to be aware of Panton-Valentine leukocidin positive Staphylococcus aureus infections, and should ask specific questions when investigating the clinical history of patients with recurrent abscesses, as this bacterial strain is not routinely assessed by microbiology departments. If such an infection is suspected, clinicians should be aware of local protocols regarding toxin testing, antibiotic choice and decolonisation agents.

Topics: Abscess; Adult; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bacterial Toxins; Breast Diseases; Drainage; Exotoxins; Female; Humans; Leukocidins; Methicillin-Resistant Staphylococcus aureus; Nasal Cartilages; Nose Diseases; Polymerase Chain Reaction; Recurrence; Risk Factors; Staphylococcal Infections

Pasteurella multocida is a bacterial organism that commonly causes cellulitis after animal bites, especially cat bites. We report an unusual vesiculopustular infection of the hand following a domestic cat bite. Pasteurella multocida and Staphylococcus aureus were cultured from the wound and the patient was treated with amoxicillin-clavulanate potassium. Further history revealed that the patient's cat had nibbled on her hand. Pasteurella usually is resistant to many of the typical empiric antibiotics used to treat skin infections. Amoxicillin-clavulanate potassium (500 mg 3 times daily) is the treatment of choice for patients who have an infected cat or dog bite with no known bacterial cause. A thorough patient history is needed to promptly arrive at a proper diagnosis for an atypical presentation of a common disease.

Topics: Adult; Amoxicillin-Potassium Clavulanate Combination; Animals; Animals, Domestic; Anti-Bacterial Agents; Bites and Stings; Cats; Drug Resistance, Bacterial; Female; Humans; Pasteurella Infections; Pasteurella multocida; Staphylococcal Infections; Staphylococcus aureus

Methicillin-resistant Staphylococcus aureus (MRSA) has emerged to be one of the most important pathogens both in health care and in community-onset infections. Daptomycin (DAP) is a cyclic anionic lipopeptide recommended for treatment of skin infections, bacteremia, and right-sided endocarditis caused by MRSA. Resistance to DAP (DAP(r)) has been reported in MRSA and is mostly accompanied by a parallel decrease in oxacillin resistance, a process known as the "seesaw effect." Our study provides evidence that the seesaw effect applies to other β-lactams and carbapenems of clinical use, including nafcillin (NAF), cefotaxime (CTX), amoxicillin-clavulanic (AMC), and imipenem (IMP), in heterogeneous DAP(r) MRSA strains but not in MRSA strains expressing homogeneous β-lactam resistance. The antibacterial efficacy of DAP in combination with β-lactams was evaluated in isogenic DAP-susceptible (DAP(s))/Dap(r) MRSA strains originally obtained from patients that failed DAP monotherapy. Both in vitro (MIC, synergy-kill curve) and in vivo (wax worm model) approaches were used. In these models, DAP and a β-lactam proved to be highly synergistic against both heterogeneous and homogeneous clinical DAP(r) MRSA strains. Mechanistically, β-lactams induced a reduction in the cell net positive surface charge, reverting the increased repulsion provoked by DAP alone, an effect that may favor the binding of DAP to the cell surface. The ease of in vitro mutant selection was observed when DAP(s) MRSA strains were exposed to DAP. Importantly, the combination of DAP and a β-lactam prevented the selection of DAP(r) variants. In summary, our data show that the DAP-β-lactam combination may significantly enhance both the in vitro and in vivo efficacy of anti-MRSA therapeutic options against DAP(r) MRSA infections and represent an option in preventing DAP(r) selection in persistent or refractory MRSA infections.

Topics: Amoxicillin-Potassium Clavulanate Combination; Animals; Anti-Bacterial Agents; beta-Lactams; Cefotaxime; Daptomycin; DNA; Drug Resistance, Bacterial; Drug Synergism; Imipenem; Insecta; Larva; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Mutation; Nafcillin; Oxacillin; Staphylococcal Infections

To determine the susceptibility of lower respiratory tract (LRT) isolates of Streptococcus pneumoniae, Staphylococcus aureus and Haemophilus influenzae to antimicrobial agents recommended by UK guidelines for treatment of pneumonia associated with influenza-like illness.. Analysis of antimicrobial susceptibility data from sentinel microbiology laboratories in England, Wales and Northern Ireland was carried out. Subjects comprised patients who had an LRT specimen taken in a general practitioner surgery or hospital outpatient setting between January 2007 and March 2010. The main outcome measurements were antimicrobial susceptibility trends of LRT isolates over time, between patient age groups and in different geographical regions.. Susceptibility to tetracyclines or co-amoxiclav was high. Of the 70,288 and 45,288 isolates with susceptibility results for tetracyclines or co-amoxiclav, 96% and 92%, respectively, were susceptible. Overall susceptibility to ciprofloxacin, ampicillin/amoxicillin and macrolides was lower than for tetracyclines or co-amoxiclav and varied markedly by organism. There were few clinically relevant variations in susceptibility to doxycycline or co-amoxiclav over time, geographically or between age groups.. The data support the use of doxycycline or co-amoxiclav as appropriate empiric treatment for LRT infection caused by the pathogens investigated, for patients in primary care.

Topics: Adult; Age Factors; Aged; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Databases, Factual; Female; Haemophilus Infections; Haemophilus influenzae; Humans; Influenza, Human; Male; Microbial Sensitivity Tests; Middle Aged; Opportunistic Infections; Pneumonia, Bacterial; Pneumonia, Pneumococcal; Primary Health Care; Staphylococcal Infections; Staphylococcus aureus; Streptococcus pneumoniae; Tetracyclines

Acute bacterial parotitis is a rare infectious disease in infants under 3 months of age.. To describe the clinical characteristics and the course of acute bacterial parotitis in infants less than 3 months old.. Infants under 3 months of age, hospitalized at Robert Debré university hospital, Paris, France, between January 2005 and December 2009 for acute bacterial parotitis, were included in a retrospective study.. Five infants less than 3 months of age were included in this study, for a frequency of 2.5/1000 hospitalizations in this age group. All were born at term, 4 of 5 were male. Three of the 5 patients had specific clinical signs of parotitis on admission. One patient had septic shock on admission. The ultrasound confirmed the parotitis in all cases. No parotid abscess was demonstrated on imaging. All patients had at least one abnormal inflammatory biological test (WBC, CRP, PCT). Bacteria were identified in 4 of 5 cases: Staphylococcus aureus was isolated in the pus culture of the Stenon duct in 2 patients and a group B Streptococcus was isolated from blood culture of 2 other patients. The duration of intravenous antibiotic therapy varied from 4 to 13 days, and the total duration of antibiotic therapy was between 10 and 16 days. No surgical procedures were needed.. Acute bacterial parotitis in infants under 3 months of age might be associated with localized infections due to S. aureus, but also with a more severe clinical presentation due to group B streptococcus infection. Early diagnosis and appropriate antibiotic therapy might prevent the progression to serious complications.

Topics: Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Female; Hospitals, Pediatric; Hospitals, University; Humans; Infant; Male; Parotitis; Retrospective Studies; Staphylococcal Infections; Staphylococcus aureus; Streptococcal Infections; Streptococcus agalactiae; Treatment Outcome

Community-acquired methicillin-resistant Staphylococcus aureus is emerging as an important pathogen. However, methicillin-resistant Staphylococcus aureus rarely causes nasal septal abscess.. We present a case of severe, community-acquired, methicillin-resistant Staphylococcus aureus infection causing rapidly progressing sinusitis, nasal septal abscess and facial cellulitis.. This report serves to remind the clinician of the expanding spectrum of severe infections caused by methicillin-resistant Staphylococcus aureus, all requiring prompt diagnosis and appropriate medical and/or surgical management.

Topics: Abscess; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Cellulitis; Drainage; Facial Dermatoses; Female; Humans; Methicillin-Resistant Staphylococcus aureus; Nasal Septum; Radiography; Sphenoid Sinusitis; Staphylococcal Infections; Vancomycin; Young Adult

Topics: Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Antibiotic Prophylaxis; Humans; Staphylococcal Infections; Surgical Wound Infection; Varicose Veins

The increasing number of infections caused by drug-resistant bacteria has spurred efforts to develop new therapeutic strategies. When applied locally, exogenous antibiotics work in an environment rich in endogenous antibacterial molecules such as the cathelicidin peptide LL-37, which has increased expression at infection sites because of the stimulatory effects of bacterial wall products on neutrophils and other cell types. To test for possible additive effects of exogenous and endogenous antibacterial agents, we evaluated the minimal inhibitory concentration (MIC) to assess the antibacterial activity of amoxicillin with clavulanic acid (AMC), tetracycline (T), erythromycin (E) and amikacin (AN) against different clinical isolates of Staphyloccocus aureus in combination with synthetic LL-37. These studies revealed that the antibacterial activity of AMC was strongly potentiated when added in combination with LL-37. However, in the presence of LL-37, we did not observe any decrease in the MIC values of T and E, particularly against methicillin-resistant S. aureus and macrolide-lincosamide-streptogramin B (MLS(B))(+)/β-lactamase (+) strains, indicating a lack of synergistic action between these molecules. Interaction between exogenous antibiotics and host antibacterial molecules should be considered to provide optimal treatment, especially in cases of topical infections accompanied by increasing expression of host antibacterial molecules.

Topics: Amikacin; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Antimicrobial Cationic Peptides; Cathelicidins; Drug Synergism; Erythromycin; Humans; Methicillin Resistance; Microbial Sensitivity Tests; Staphylococcal Infections; Staphylococcus aureus; Tetracycline

Septic-embolic diseases are life threatening; survival critically depends on rapid diagnosis. Clinically, cutaneous manifestations like Janeway lesions are infrequently occurring but highly characteristic. In contrast, histological features are not clearly defined. We report the case of a 59-year-old male patient in deteriorating general condition and fever of unknown origin with lesions suggestive for Janeway lesions. Histology showed dilated blood vessels and extravasated erythrocytes throughout the dermis. Only serial sections revealed single, deep dermal vessels occluded by fibrin thrombi. Computed tomography scan identified multiple pulmonary round masses. Blood cultures showed growth of Staphylococcus aureus and Enterococcus faecalis. The knowledge of the described subtle histological features and a clinical-pathological correlation is essential for the diagnosis of certain cases of septic-embolic conditions.

Topics: Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Blood Vessels; Embolism; Enterococcus faecalis; Gram-Negative Bacterial Infections; Humans; Male; Middle Aged; Sepsis; Skin; Skin Diseases; Staphylococcal Infections

The empiric choice of initial antibiotherapy in osteoarticular infections in infants and children must take into consideration the actual epidemiology of principal pathogens, their respective antibiotic sensitivity profile, their pharmacokinetic and pharmacodynamic properties and the results of efficacy clinical studies. After a review of recent data concerning these four major points, the Paediatric Infectious Diseases Group of the French Society of Paediatrics (GPIP) has proposed guidelines for initial recommended schemes of antimicrobial therapy in acute and non complicated osteoarticular infections in infants and children.

Topics: Administration, Oral; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bacteria; Bacterial Infections; Bone Diseases, Infectious; Child; Community-Acquired Infections; Cross Infection; Drug Resistance, Bacterial; Fluoroquinolones; Humans; Infant; Joint Diseases; Kingella kingae; Methicillin Resistance; Methicillin-Resistant Staphylococcus aureus; Neisseriaceae Infections; Penicillins; Pneumococcal Infections; Pristinamycin; Rifampin; Staphylococcal Infections; Staphylococcus aureus; Treatment Outcome

Pediatric neck infections are frequently treated by Otolaryngologists, Head and Neck surgeons. The relative role of medical versus surgical treatment of pediatric neck infections is debated. The aims of this study are to analyze the management of pediatric neck infections with respect to clinical assessment, radiological assessment and treatment.. Medical records from January 1999 to June 2005 were reviewed and analyzed.. Two hundred and five children with lateral neck infections were included in the study. The clinical diagnosis correlated with the radiology finding in 73.6% with a sensitivity of 28% and a specificity of 92% for lateral neck abscess recognition. The ultrasound finding correlated with the surgical finding in 65.2% with a sensitivity of 70% and a specificity of 33%. When an ultrasound scan was used it changed the intended treatment plan in 10.5% of children.. Accurate clinical assessment of lateral neck infections is poor, generally under estimating suppuration. However, when an abscess is diagnosed clinically this correlates highly with the surgical finding. Radiological assessment has inaccuracy in identifying suppuration and this should be borne in mind when being used as a diagnostic tool for neck infections.

Topics: Abscess; Adolescent; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Cellulitis; Child; Child, Preschool; Drainage; Female; Humans; Infant; Infant, Newborn; Length of Stay; Lymphadenitis; Male; Outcome Assessment, Health Care; Predictive Value of Tests; Retrospective Studies; Sensitivity and Specificity; Staphylococcal Infections; Staphylococcus aureus; Tomography, X-Ray Computed

In 2003, 18% of all admissions to our vascular ward were colonised by MRSA, with an MRSA infection rate of 10.6%. Standard practice was to segregate patients with proven MRSA from the rest of the patient pool. After a prospective audit, regression analysis was used to identify factors that could stratify patients into high and low risk for MRSA colonisation. A change in isolation policy was introduced that segregated patients according to their risk of MRSA acquisition, and isolated all patients undergoing prosthetic vascular reconstruction. Antibiotic policy was also altered. This audit reports the impact of these changes on MRSA colonisation and infection rates.. The MRSA status of patients during 777 in-patient episodes was prospectively recorded during three time spans; period 1 (November 2002-April 2003) before the change in isolation and antibiotic policy and, periods 2 (August-December 2003) and 3 (October 2004-January 2005) after the change in policy.. Hospital acquired MRSA colonisation was reduced from 10.6% in period 1, to 1.1 and 1.4% in periods 2 and 3, respectively (p<0.001). Similarly, MRSA infection rates fell from 10.6 to 2.9 and 0.9% over the same time frame (p<0.001). The most dramatic changes in MRSA infection rates occurred in patients undergoing aneurysm repair (MRSA infection 30.1% in period 1 vs. 3.9 and 2.9% in periods 2 and 3) and lower limb revascularization (31 vs. 0 vs. 4.2%). Stepwise regression analysis revealed that the system of isolation was a significant factor reducing MRSA infection and colonisation rates (p<0.001).. These data demonstrate that a change in infection control policy can significantly reduce MRSA infection in a vascular unit.

Topics: Amoxicillin-Potassium Clavulanate Combination; Antibiotic Prophylaxis; Carrier State; Cross Infection; Hospital Units; Humans; Infection Control; Medical Audit; Methicillin Resistance; Patient Isolation; Risk Factors; Staphylococcal Infections; Staphylococcus aureus; Surgical Wound Infection; Vancomycin; Vascular Surgical Procedures

To describe a case of orbital cellulitis arising in a patient treated with an anti-TNFalpha agent.. Single interventional case report.. A 42-year-old man developed severe unilateral orbital cellulitis while receiving infliximab (Remicade, Centocor) treatment for Ankylosing spondylitis (AS) as part of the open-label phase of a trial conducted at our tertiary referral center. Cultures grew Staphylococcus aureus.. Infliximab treatment was stopped and the patient made a full recovery after receiving appropriate antibiotic therapy. Infliximab therapy was resumed after three weeks.. Clinical vigilance is warranted when treating patients with anti-TNFalpha agents as these are associated with a diverse and growing number of ophthalmic complications. Resolved infection does not preclude the use of such agents.

Topics: Adult; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Antibodies, Monoclonal; Cefotaxime; Cellulitis; Drug Therapy, Combination; Eye Infections, Bacterial; Humans; Infliximab; Male; Microbial Sensitivity Tests; Orbital Diseases; Randomized Controlled Trials as Topic; Spondylitis, Ankylosing; Staphylococcal Infections; Staphylococcus aureus; Tumor Necrosis Factor-alpha

We recommend amoxacillin/clavulanate, cephalosporins and macrolides rather than penicillin as the first-line drug in chronic sinusitis with nasal polyps. In cases where there is no improvement of symptoms, cultures should be taken from the middle meatus, followed by appropriate selection of second-line antibiotics according to the sensitivity test results.. To investigate the causative bacteria and the antimicrobial susceptibility in patients with chronic sinusitis and nasal polyps in Korea.. The bacteriology and antimicrobial susceptibility of maxillary sinus aspirates from 81 patients were evaluated.. Aerobes were isolated from 58.0% of the cultures from the middle meatus and from 48.1% of those from the maxillary sinus. Staphylococcus aureus, Haemophilus influenzae, and Streptococcus pneumoniae were the most prevalent aerobic pathogens. Anaerobes were isolated from 8.6% of the cultures from the middle meatus and from 18.5% of the cultures from the maxillary sinus. The predominant anaerobic organisms were Prevotella and Peptostreptococcus in adults but none of them were cultured in children. A high rate of concordance of the middle meatus and maxillary sinus was noted. Monomicrobial infection was most commonly observed. Ampicillin-resistant H. influenzae isolates were cultured in 46% of the cases. Penicillin resistance rates were 93% for Staph. aureus; 25% of Strep. pneumoniae were intermediate and 25% were resistant.

Topics: Adolescent; Adult; Amoxicillin-Potassium Clavulanate Combination; Anti-Infective Agents; Bacteria, Anaerobic; Bacterial Infections; Bacteriological Techniques; Cephalosporins; Child; Chronic Disease; Female; Haemophilus Infections; Humans; Macrolides; Male; Maxillary Sinus; Maxillary Sinusitis; Microbial Sensitivity Tests; Nasal Mucosa; Nasal Polyps; Penicillin Resistance; Pneumococcal Infections; Staphylococcal Infections; Statistics as Topic; Treatment Outcome

Topics: Adolescent; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bacterial Toxins; Enterotoxins; Female; Humans; Receptors, Antigen, T-Cell, alpha-beta; Shock, Septic; Staphylococcal Infections; Staphylococcus aureus; Superantigens; T-Lymphocytes; Tampons, Surgical

Topics: Acute Disease; Aged; Amoxicillin-Potassium Clavulanate Combination; Blood Vessel Prosthesis; Cellulitis; Cloxacillin; Confusion; Diabetes Mellitus, Type 2; Diabetic Foot; Drug Therapy, Combination; Femoral Artery; Hallucinations; Humans; Ischemia; Leg; Male; Popliteal Artery; Prosthesis-Related Infections; Radiography; Staphylococcal Infections; Vitamin B 12 Deficiency

The growing resistance of Streptococcus pneumoniae to penicillin can be overcome by increasing the dose of the penicillin administered. This generated the recommendation that the adult dose of amoxicillin for the treatment of acute maxillary sinusitis (AMS) be increased from 1.5 g/day to 4.0 g/day. The objective of this study was to investigate whether the higher dose of amoxicillin is more effective than the previously recommended dose in eradicating S. pneumoniae from the nasopharynx of patients who present with AMS. Nasopharyngeal cultures obtained from 58 patients with AMS were studied: 30 received amoxicillin 1.5 g/day given in divided doses three times a day for 10 days (amoxicillin/clavulanic acid 4:1 formulation) and 28 were treated with amoxicillin 4.0 g/day given in divided doses twice a day for 10 days (amoxicillin/clavulanic acid 16:1 formulation). Seventy-one potentially pathogenic organisms were isolated: S. pneumoniae (27 isolates), Haemophilus influenzae non-type b (25), Moraxella catarrhalis (5), Streptococcus pyogenes (5) and Staphylococcus aureus (9). The number of S. pneumoniae isolates in the 1.5 g/day group was reduced from 14 to 9 (2 intermediately resistant and 3 highly resistant). In contrast, the number of S. pneumoniae isolates in the 4.0 g/day group was reduced from 13 to 2 (1 highly resistant) (P<0.05). No differences were noted in the eradication rate of other groups of isolates, which were all susceptible to amoxicillin/clavulanic acid. These data illustrate the superiority of 4.0 g/day amoxicillin/clavulanic acid compared with 1.5 g/day amoxicillin/clavulanic acid in the eradication of S. pneumoniae from the nasopharynx.

Topics: Acute Disease; Adolescent; Adult; Aged; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bacterial Infections; Dose-Response Relationship, Drug; Female; Haemophilus Infections; Haemophilus influenzae; Humans; Male; Maxillary Sinusitis; Middle Aged; Moraxella catarrhalis; Moraxellaceae Infections; Nasopharynx; Pneumococcal Infections; Staphylococcal Infections; Streptococcal Infections; Streptococcus pyogenes

Mupirocin and amoxicillin-clavulanate were synergistic against 9 of 49 (18%) strains of methicillin-resistant and methicillin-susceptible Staphylococcus aureus and coagulase-negative staphylococci (CNS). A pattern of enhanced killing was also found using time-kill studies. Time-kill assays were more discriminatory than chequerboard titration assays in demonstrating synergy. These results suggest that combinations of amoxicillin-clavulanate and mupirocin may have therapeutic benefits in prophylaxis against staphylococcal infections.

Topics: Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Coagulase; Drug Synergism; Drug Therapy, Combination; Humans; Methicillin Resistance; Microbial Sensitivity Tests; Mupirocin; Staphylococcal Infections; Staphylococcus; Staphylococcus aureus

A 43-year-old female with Staphyloccocus-induced perianal abscess, was admitted to hospital because of a clinical picture of acute renal failure and thrombotic microangiopathy. Schistocytes, thrombopenia, a negative Coombs test and no detectable plasma haptoglobin were diagnostic for thrombotic microangiopathy. Antibiotics, surgical drainage, plasmapheresis and fresh frozen plasma were given with a favourable evolution. We review the prognostic factors determining recovery of renal function and hematological abnormalities.

Topics: Abscess; Acute Kidney Injury; Adult; Amoxicillin-Potassium Clavulanate Combination; Anal Canal; Debridement; Drug Therapy, Combination; Female; Hemolytic-Uremic Syndrome; Humans; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination; Plasma; Plasmapheresis; Staphylococcal Infections; Thrombocytopenia

The in vitro activity of CA(1-7)M(2-9)NH(2), a 15-residue synthetic hybrid peptide derived from the sequences of cecropin A and melittin, alone and in combination with amoxicillin-clavulanate, imipenem, clarithromycin, ciprofloxacin, rifampin, and vancomycin, was investigated against 40 nosocomial isolates of methicillin-resistant Staphylococcus aureus. Antimicrobial activity of CA(1-7)M(2-9)NH(2) was measured by minimal inhibitory concentration, MBC, and time-kill studies. All isolates were inhibited at concentrations of 1 to 16 microg/mL. Combination studies performed with S. aureusATCC 43300 demonstrated synergy only when CA(1-7)M(2-9)NH(2) was combined with amoxicillin-clavulanate and imipenem. Our findings show that CA(1-7)M(2-9)NH(2) is active against methicillin-resistant S. aureusand that its activity is enhanced when it is combined with several antimicrobial agents.

Topics: Amoxicillin-Potassium Clavulanate Combination; Cross Infection; Drug Interactions; Female; Humans; Imipenem; Male; Melitten; Methicillin Resistance; Microbial Sensitivity Tests; Sensitivity and Specificity; Staphylococcal Infections; Staphylococcus aureus

Individualized optimization of amoxicillin/clavulanate (AMC) antimicrobial therapy in diabetic foot infection.. Pharmacokinetic analysis of individual steady-state plasma amoxicillin concentrations was done both in the i.v. infusion phase and in the oral phase of AMC, administered on the basis of the quantitative susceptibility of the detected microbe(s). The in vitro growth/killing dynamic parameters on model of Staphylococcus aureus as the most frequent isolate were evaluated. Therapeutic protocol optimization, leading to prediction of the earliest time to reduce the number of viable bacteria to 10-6 as a surrogate criterion of efficacy, was performed.. Based on individual plasma amoxicillin oscillations in 17 patients suffering from infected diabetic foot ulcers and the model microbial dynamic parameters, the reduction of the number of viable bacteria was reached significantly earlier after the administration of continuous i.v. AMC infusion than after the same daily AMC dose administered intermittently. In case of highly susceptible staphylococcal strain, highly frequent oral therapy of AMC (not longer than 8 hrs dosing interval) was also sufficiently effective. Decreasing plasma amoxicillin concentrations exponentially extended the time required for effective reduction of microbes.. Individualized optimization of amoxicillin/clavulanate dosage on the basis of growth/killing microbial dynamic parameters and antibiotic concentration/time fluctuations may enhance the antimicrobial effect and the treatment of infected non-critical ischemic diabetic foot ulcers.

Topics: Amoxicillin-Potassium Clavulanate Combination; Diabetic Foot; Drug Therapy, Combination; Female; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Staphylococcal Infections; Staphylococcus aureus

The spore-forming anaerobic bacterium Clostridium difficile has become a serious enteropathogen. Oral and parenteral administration of antibiotics can cause ecological disturbances in the normal intestinal microflora. Suppression of the normal microflora may lead to reduced colonization resistance with subsequent overgrowth by pre-existing, naturally resistant microorganisms, such as C. difficile. C. difficile infection shows a range of clinical presentations between an asymptomatic carrier state, light diarrhea without inflammatory changes, and pseudomembranous colitis. C. difficile infection is acquired by the fecal-oral or environmental-oral routes. From March 2000 through March 2001 we assessed 48 cases of nosocomial antibiotic-associated diarrhea (AAD). Of these, 21 were due to C. difficile (CDAD). Cephalosporin was the agent most commonly associated with CDAD. Avoidance of cephalosporins, strict use of "single shot" prophylaxis, isolation of infected, symptomatic patients in single-bed rooms, improved hygiene and complete room disinfection lead to a rapid decrease of CDAD. The etiology, prognosis and prophylaxis are discussed in this paper.

Topics: Aged; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Cefuroxime; Clostridioides difficile; Colectomy; Colonoscopy; Combined Modality Therapy; Diarrhea; Enterocolitis, Pseudomembranous; Fatal Outcome; Hematoma; Humans; Intestinal Mucosa; Male; Postoperative Complications; Staphylococcal Infections; Superinfection

Combined parenteral and intramammary treatment of mastitis caused by Staphylococcus aureus was compared to parenteral treatment only. Cows with clinical mastitis (166 mastitic quarters) caused by S. aureus treated by veterinarians of the Ambulatory Clinic of the Faculty of Veterinary Medicine during routine farm calls were included. Treatment was based on in vitro susceptibility testing of the bacterial isolate. Procaine penicillin G (86 cases due to beta-lactamase negative strains) or amoxycillin-clavulanic acid (24 cases due to beta-lactamase positive strains) was administered parenterally and intramammarily for 5 days. Efficacy of treatments was assessed 2 and 4 weeks later by physical examination, bacteriological culture, determination of CMT, somatic cell count and NAGase activity in milk. Quarters with growth of S. aureus in at least one post-treatment sample were classified as non-cured. As controls we used 41 clinical mastitis cases caused by penicillin-susceptible S. aureus isolates treated with procaine penicillin G parenterally for 5 days and 15 cases due to penicillin-resistant isolates treated with spiramycin parenterally for 5 days from the same practice area. Bacteriological cure rate after the combination treatment was 75.6% for quarters infected with penicillin-susceptible S. aureus isolates, and 29.2% for quarters infected with penicillin-resistant isolates. Cure rate for quarters treated only parenterally with procaine penicillin G was 56.1% and that for quarters treated with spiramycin 33.3%. The difference in cure rates between mastitis due to penicillin-susceptible and penicillin-resistant S. aureus was highly significant. Combined treatment was superior over systemic treatment only in the beta-lactamase negative group.

Topics: Amoxicillin-Potassium Clavulanate Combination; Animals; Anti-Bacterial Agents; beta-Lactam Resistance; Cattle; Female; Mastitis, Bovine; Milk; Penicillin G Procaine; Penicillin Resistance; Staphylococcal Infections; Staphylococcus aureus; Treatment Outcome

Sixty-three Staphylococcus aureus isolates with a wide distribution in quantitative beta-lactamase production were tested in vitro against amoxycillin and penicillin in combination with clavulanic acid to establish the influence of total amount of beta-lactamase present on the ability of clavulanic acid to protect against beta-lactamase degradation. The beta-lactamase stability of cefuroxime and dicloxacillin was also evaluated. MIC was determined by agar dilution using Mueller-Hinton agar with both a conventional as well as a 100 times higher inoculum. The strains were tested both with and without induction of the beta-lactamase production. Clavulanic acid was highly effective in protecting against beta-lactamase degradation of both penicillin and amoxycillin. Even when using a high inoculum of strains with induced beta-lactamase production, all strains had MICs below the NCCLS breakpoint of 4/2 mg/l for amoxycillin-clavulanic acid. Both cefuroxime and dicloxacillin were highly stable against staphylococcal beta-lactamase degradation. This study encourages further in vivo evaluation of amoxycillin-clavulanic acid for severe staphylococcal infections.

Topics: Amoxicillin-Potassium Clavulanate Combination; beta-Lactamases; Cefuroxime; Dicloxacillin; Drug Therapy, Combination; Humans; Microbial Sensitivity Tests; Penicillins; Staphylococcal Infections; Staphylococcus aureus; Statistics, Nonparametric

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

Topics: Amoxicillin-Potassium Clavulanate Combination; Animals; Anti-Bacterial Agents; Cat Diseases; Cats; Dermatitis, Allergic Contact; Diagnosis, Differential; DNA, Bacterial; Ectoparasitic Infestations; Electrophoresis, Gel, Pulsed-Field; Female; Insecticides; Pruritus; Pyrazoles; Siphonaptera; Staphylococcal Infections; Staphylococcus

A rat model was used to investigate the efficacy of mupirocin in the prevention of vascular prosthetic graft infections. The effect of mupirocin-soaked Dacron was compared with the effect of rifampin-soaked, collagen-sealed Dacron in the rat model of graft infection caused by methicillin-susceptible Staphylococcus aureus and methicillin-resistant S. aureus. Graft infections were established in the back subcutaneous tissue of 195 adult male Wistar rats by implantation of 1-cm(2) Dacron prostheses followed by topical inoculation with 5 x 10(7) colony-forming units of S. aureus. The study included a control group (no graft contamination), two contaminated groups that did not receive any antibiotic prophylaxis, two contaminated groups in which perioperative intraperitoneal amoxicillin clavulanate prophylaxis (50 mg/kg) was administered, four contaminated groups that received mupirocin- or rifampin-soaked graft, and four contaminated groups that received mupirocin- or rifampin-soaked graft and perioperative intraperitoneal amoxicillin clavulanate prophylaxis (50 mg/kg). The grafts were sterilely removed 7 days after implantation and the infection was evaluated by using sonication and quantitative agar culture. Data analysis showed that the efficacy of mupirocin against both strains was significantly different from that of the untreated control. In addition, mupirocin was more effective than rifampin against the methicillin-resistant strain. Finally, only the combination of mupirocin and amoxicillin clavulanate produced complete suppression of growth of all strains.

Topics: Amoxicillin-Potassium Clavulanate Combination; Animals; Anti-Bacterial Agents; Antibiotics, Antitubercular; Blood Vessel Prosthesis; Collagen; Drug Therapy, Combination; Male; Methicillin Resistance; Mupirocin; Polyethylene Terephthalates; Rats; Rats, Wistar; Rifampin; Staphylococcal Infections; Staphylococcus aureus

Antibiotic prophylaxis in clean surgery with implantation of prosthetic material is widely accepted, although there are no studies on its use in abdominal incisional hernia repair. The objective was to evaluate antibiotic chemoprophylaxis in incisional herniorrhaphy with the implantation of prosthetic material. A prospective non-randomized study (1990-1998) was conducted to analyse 216 patients undergoing surgery for abdominal incisional hernia who required a prosthesis (polypropylene) in the reconstruction and who met the criteria for clean surgery. Risk factors were observed in 31.5%, the most frequent being diabetes and obesity. The incisional hernia was located mostly in the abdominal midline and in 64.4% measured over 10 cm. Antibiotic prophylaxis was administered in 140 patients (64.8%) via the systemic route, the antibiotics being first- or second-generation cephalosporins or amoxicillin-clavulanic acid. Surgical wound infection occurred in 39 patients (18.1%), 19 who had received antibiotic prophylaxis (13.6%) and 20 who had not (26.3%). In multivariate analysis using logistic regression, the variables with statistical significance for local septic infection were antibiotic prophylaxis and number of risk factors. We can conclude therefore that antibiotic chemoprophylaxis is useful in abdominal incisional herniorrhaphy surgery with implantation of prosthetic material for reducing local septic complications.

Topics: Aged; Amoxicillin-Potassium Clavulanate Combination; Antibiotic Prophylaxis; Drug Therapy, Combination; Female; Hernia, Ventral; Humans; Logistic Models; Male; Middle Aged; Multivariate Analysis; Prospective Studies; Prostheses and Implants; Risk Factors; Staphylococcal Infections; Streptococcal Infections; Surgical Mesh; Surgical Wound Infection

In a retrospective study, 131 Staphylococcus intermedius strains isolated from apparently healthy dogs, and 187 Staphylococcus intermedius strains isolated from dog pyodermas in the clinical microbiology laboratory at the National Veterinary School in Nantes, during three successive periods: 1986-87, 1992-93 and 1995-96, were investigated and compared for their antimicrobial susceptibility. Results indicated that 60% to 65% of the strains were susceptible to Chloramphenicol and Doxycyclin, 65% to 80% of the strains were susceptible to macrolides (Erythromycin, Lincomycin and Clindamycin) and to Trimethoprim/Sulfonamide association. More than 95% of the strains were susceptible to three betalactamins tested: Oxacillin, Amoxycillin/Clavulanic acid, Cephalexin, to Gentamicin, to Fucidic Acid and to two quinolones: Enrofloxacin and Marbofloxacin. This last group is made up of choice antibacterials for the treatment of dog pyoderma. Many different resistance patterns were observed in each period with no really predominant profile, because of low plasmidic vs chromosomal balance of the genetic basis of antibacterial resistance in Staphylococcus intermedius. However, the proportion of multiresistant (> or = 3 drugs) strains increased from 10.8% in the first period, to 28% in the third period. This increased frequency of resistance suggests strongly that, as in Staphylococcus aureus human infections, the prescription of antibiotic compounds increases the prevalence of resistant strains.

Topics: Aminoglycosides; Amoxicillin-Potassium Clavulanate Combination; Animals; Anti-Bacterial Agents; Cephalexin; Chloramphenicol; Dog Diseases; Dogs; Drug Combinations; Drug Resistance, Microbial; Drug Resistance, Multiple; Drug Therapy, Combination; Fluoroquinolones; France; Fusidic Acid; Macrolides; Microbial Sensitivity Tests; Oxacillin; Pyoderma; Retrospective Studies; Sentinel Surveillance; Staphylococcal Infections; Staphylococcus; Sulfadiazine; Tetracyclines; Trimethoprim

A rat model of Staphylococcus aureus osteomyelitis was used to compare treatment with co-amoxiclav, flucloxacillin and clindamycin. Co-amoxiclav (amoxycillin/clavulanic acid 200/50 mg/kg), flucloxacillin (200 mg/kg) and clindamycin (50 mg/kg) were injected subcutaneously tds for 28 days, commencing 14 days after infection. Eight days after cessation of treatment, high numbers of staphylococci were recovered from the infected tibiae of all control rats. All treatments, at clinically achievable concentrations, significantly (P < 0.05) reduced the bone bacterial titres. However, 50% of tibiae from co-amoxiclav-treated animals were sterile, compared with 17% and 25% from flucloxacillin- or clindamycin-treated animals respectively. Histopathological examination of tibiae reflected the bacteriological results, and showed that the severity of the osteomyelitis was greatly reduced in antibiotic-treated animals compared with non-treated controls. Twenty-eight days after cessation of therapy, bacterial counts from co-amoxiclav and clindamycin-treated animals remained significantly (P < 0.05) lower than those of non-treated controls, although the gross and microscopic appearance of clindamycin and flucloxacillin-treated tibiae suggested that recrudescence of the infection may have occurred. The results of this study demonstrated that co-amoxiclav was as effective as flucloxacillin and clindamycin in the treatment of an experimental chronic staphylococcal osteomyelitis.

Topics: Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Animals; Clavulanic Acids; Clindamycin; Disease Models, Animal; Drug Therapy, Combination; Floxacillin; Male; Osteomyelitis; Rats; Staphylococcal Infections; Staphylococcus aureus; Tibia

Topics: Adult; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; beta-Lactam Resistance; Clavulanic Acids; Humans; Male; Periapical Abscess; Root Canal Therapy; Staphylococcal Infections; Staphylococcus aureus

This study compared co-amoxiclav, vancomycin and teicoplanin with and without netilmicin or amikacin for treating experimental subcutaneous fibrin-clot infection in rabbits due to a clinical beta-lactamase-positive methicillin- and gentamicin-resistant Staphylococcus epidermidis strain (MGRSE). MICs (mg/L) for this strain were: oxacillin 125, gentamicin 32, vancomycin 4, teicoplanin 8, netilmicin 1, amikacin 4, amoxycillin 64 with clavulanate at 2 mg/L. In rabbits treated with a single-dose i.v. regimen (netilmicin 8 mg/kg, amikacin 20 mg/kg, vancomycin 30 mg/kg, teicoplanin 15 mg/kg, co-amoxiclav 150-30 mg/kg), the bacterial count 24 h post-dose was reduced whatever the combination used (ANOVA, P < or = 0.001). Regimens were statistically classified in decreasing order of efficacy as follows: co-amoxiclav combined with netilmicin > vancomycin either alone or combined with either netilmicin or amikacin, teicoplanin with netilmicin > netilmicin and co-amoxiclav alone > teicoplanin or co-amoxiclav combined with amikacin, and teicoplanin alone > amikacin > no drug. From these findings, it is concluded that: co-amoxiclav could be useful for the treatment of beta-lactamase-positive and methicillin-resistant S. epidermidis infection; some enzyme-resistant aminoglycoside could be considered for treating gentamicin-resistant but netilmicin/amikacin-sensitive S. epidermidis infection; the combination of co-amoxiclav with netilmicin was synergistic and more rapidly bactericidal than vancomycin in this animal model.

Topics: Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Animals; Clavulanic Acids; Drug Combinations; Drug Resistance, Microbial; Gentamicins; Methicillin Resistance; Models, Biological; Netilmicin; Rabbits; Staphylococcal Infections; Staphylococcus epidermidis

The efficacy of amoxycillin/clavulanic acid was compared with that of flucloxacillin, vancomycin and amoxycillin in an experimental model of Staphylococcus aureus endocarditis. Doses of the antibiotics were selected to produce peak concentrations in rat serum similar to those achievable in man after administration of parenteral therapeutic doses. Amoxycillin clavulanic acid was more effective than amoxycillin alone against endocarditis caused by beta-lactamase producing strains of Staph. aureus, illustrating the beta-lactamase inhibitory activity of clavulanic acid in vivo. Amoxycillin/clavulanic acid was as effective as flucloxacillin in these infections whereas vancomycin was generally less active. These results illustrate the clinical potential of amoxycillin/clavulanic acid in the prophylaxis, or in the therapy of severe staphylococcal infections.

Topics: Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Animals; Clavulanic Acids; Drug Therapy, Combination; Endocarditis, Bacterial; Floxacillin; Male; Rats; Species Specificity; Staphylococcal Infections; Staphylococcus aureus; Time Factors; Vancomycin

Susceptibility of 327 S. aureus strains isolated in 1988 from various materials obtained from patients hospitalized in various hospitals of Wrocław city has been studied. Antibiograms were made by the use of diffusion-disc method for 21 antibiotics, including augmentin. Penicillin and oxytetracycline showed weak action on the strains studies; percentage of sensitive strains was 8.6% and 27.6%, respectively. Efficacious effects, more than 90% of strains, showed vancomycin, rifampicin, netilmicin, cefamandole++, amikacin and cefalotin. Susceptibility for augmentin was equal to 89.3%, and for other 12 antibiotics 50 to 89%. Multiresistant strains presented 19.6% of all specimen studied: large percentage of that strains was isolated from Department of Anesthesiology and Intensive Therapy (56.8%) and pediatry departments (26.4%). Most frequently they occur in the urine (33.3%). They showed high susceptibility to vancomycin (100%), rifampicin (98.4%), netilmicin (93.8%) and cefamandole++ (85.9%). Susceptibility to augmentin was 54.7%.

Topics: Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bacteriuria; Clavulanic Acids; Cross Infection; Drug Resistance, Microbial; Drug Therapy, Combination; Humans; In Vitro Techniques; Microbial Sensitivity Tests; Respiratory Tract Infections; Sputum; Staphylococcal Infections; Staphylococcus aureus

Topics: Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Animals; Clavulanic Acids; Cloxacillin; Drug Therapy, Combination; Endocarditis, Bacterial; Female; Methicillin; Microbial Sensitivity Tests; Penicillin Resistance; Rats; Rats, Inbred Strains; Staphylococcal Infections; Staphylococcus aureus; Vancomycin

The response of Streptococcus pyogenes to amoxicillin or amoxicillin-clavulanic acid (Augmentin; Beecham Group) therapy of a mixed streptococcal-staphylococcal infection was studied in a surgical wound in mice. A superficial wound was produced on the backs of anesthetized mice, and a suture infected with S. pyogenes, Staphylococcus aureus, or a mixed inoculum of both organisms was inserted. Oral therapy was started 4 h after infection and continued for 3 days. Both amoxicillin and amoxicillin-clavulanic acid were effective in eliminating the streptococci from the pure wound infection. In contrast, amoxicillin failed to eliminate the streptococci from a mixed infection in which a beta-lactamase-producing strain of S. aureus was also present, wound counts reaching 10(7) streptococci per wound by 80 h, whereas amoxicillin-clavulanic acid reduced the count to less than 33 streptococci per wound by 24 h. Numbers of S. aureus were also reduced by amoxicillin-clavulanic acid therapy, controlling the infection, whereas amoxicillin was ineffective. Also of significance was the fact that successful therapy was achieved with blood and tissue concentrations of amoxicillin and clavulanic acid of the same order as those measured in humans. These results show that amoxicillin therapy failed to eliminate S. pyogenes from a wound infection in the presence of a beta-lactamase-producing strain of S. aureus and suggest the potential of amoxicillin-clavulanic acid in the treatment of mixed bacterial skin infections involving beta-lactamase-producing organisms.

Topics: Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Animals; Clavulanic Acid; Clavulanic Acids; Drug Combinations; Male; Mice; Microscopy, Electron, Scanning; Staphylococcal Infections; Staphylococcus aureus; Streptococcal Infections; Streptococcus pyogenes; Time Factors; Wound Infection

Topics: Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Clavulanic Acids; Drug Combinations; Humans; Staphylococcal Infections

Thirty-two patients with skin infections were treated with Augmentin, a combination of amoxycillin with the beta-lactamase inhibitor clavulanic acid. These infections were primary skin sepsis (7), infected eczema (11), infected trauma (10) and leg ulcers (4). The majority of cases were caused by amoxycillin-resistant Staphylococcus aureus either alone or in combination with Streptococcus pyogenes. Thirty patients (94%) responded to treatment with only one withdrawal (for side effects). Side effects were limited to nausea (9%) diarrhoea (9%) and rash (3%). No patient with diarrhoea showed evidence of Clostridium difficile toxin production in the stools. Augmentin appears to be a safe, useful, effective antibiotic for the treatment of skin infections in general practice and in hospital. It may prove of particular value when mixed infections of penicillin-resistant staphylococci and Streptococcus pyogenes are present.

Topics: Adult; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Child; Drug Combinations; Humans; Microbial Sensitivity Tests; Skin Diseases, Infectious; Staphylococcal Infections; Staphylococcus aureus