amphotericin-b and Enterobacteriaceae-Infections

In a prospective randomized study to determine whether prevention of colonization of Gram-negative bacteria results in prevention of Gram-negative bacterial infections, 96 intensive care patients were randomly allocated into a control group and a study group. The study group received oral nonabsorbable antimicrobial agents (i.e., tobramycin, amphotericin B, and polymyxin E) in addition to parenteral antibiotics. Colonization with Gram-negative microorganisms in the oropharynx, and respiratory and digestive tracts increased in the control group during their stay, while the study group did not tend to colonize with Gram-negative bacteria. In the control group, 107 nosocomial infections were diagnosed, vs. 42 nosocomial infections in the study group. Nosocomial infections caused by Gram-negative bacteria were significantly less frequent in the study group. Mortality due to an acquired infection was significantly less frequent in the study group. We conclude that colonization, infection, and subsequent mortality by nosocomial Gram-negative bacteria can be prevented by a regime of topically applied nonabsorbable antibiotics.

Topics: Adult; Aged; Aged, 80 and over; Amphotericin B; Anti-Bacterial Agents; Bacteria; Cefotaxime; Child; Colistin; Cross Infection; Digestive System; Drug Therapy, Combination; Enterobacteriaceae Infections; Female; Humans; Male; Middle Aged; Oropharynx; Prospective Studies; Pseudomonas Infections; Random Allocation; Respiratory System; Tobramycin

In a prospective study the efficacy of two regimens for selective decontamination of the digestive tract was studied in patients with acute leukaemia during remission induction therapy. Seventy-eight patients were randomized to receive either a combination of cotrimoxazole, polymyxin B and nystatin (group A) or a combination of nalidixic acid, polymyxin B, neomycin and nystatin. With both regimens the gastrointestinal tract could be decontaminated equally effectively from potential pathogens. In the oropharyngeal region the decontamination from Enterobacteriaceae was significantly better in group A (P less than 0.01). In both groups less than 10% of the acquired infections were caused by gram-negative bacilli and no gram-negative septicaemia occurred in either group. The median time interval until the first acquired infection was 17 days in group A and 36 days in group B, respectively (P less than 0.05). It is concluded that regimen A might be more effective than regimen B though both regimens prevent reliably severe gram-negative infections.

Topics: Acute Disease; Adolescent; Adult; Aged; Aminoglycosides; Amphotericin B; Anti-Bacterial Agents; Bacterial Infections; Candidiasis; Cephalosporins; Enterobacteriaceae Infections; Female; Flucytosine; Humans; Leukemia; Male; Middle Aged; Oxacillin; Penicillins; Prospective Studies; Staphylococcal Infections; Streptococcal Infections

Topics: Aged; Amphotericin B; Anti-Bacterial Agents; Antifungal Agents; Aortic Aneurysm, Abdominal; Aortitis; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Clostridium Infections; Coccidioidomycosis; Device Removal; Enterobacter cloacae; Enterobacteriaceae Infections; Fluconazole; Humans; Magnetic Resonance Angiography; Male; Pneumonia, Bacterial; Postoperative Complications; Prosthesis-Related Infections

Topics: Amphotericin B; Antifungal Agents; Blepharoptosis; Cellulitis; Diabetes Complications; Diagnosis, Differential; Enterobacter aerogenes; Enterobacteriaceae Infections; Humans; Male; Middle Aged; Mucormycosis; Necrosis; Ophthalmoplegia; Orbit; Orbital Diseases; Rhizopus; Sinusitis; Vision Disorders; Visual Acuity; Zygomycosis

Topics: Abdominal Wall; Amphotericin B; Antifungal Agents; Biopsy; Debridement; Enterobacteriaceae Infections; Fatal Outcome; Heart Transplantation; Humans; Male; Middle Aged; Mucormycosis; Necrosis; Peritonitis; Postoperative Complications; Radiography, Abdominal; Rare Diseases; Superinfection; Tomography, X-Ray Computed

Topics: Adolescent; Adult; Aged; Amphotericin B; Bacterial Infections; Cefotaxime; Child; Child, Preschool; Drug Therapy, Combination; Enterobacteriaceae Infections; Humans; Infant; Middle Aged; Thoracic Injuries; Tobramycin

Eighty-three patients with 117 episodes of candidemia were reviewed to examine the clinically significant variables and the results of treatment for this problem. Mortality was 52%. Patients who had bacteremia either synchronously or metachronously in association with Candida species had poorer survival rates. Staphylococcal and enterococcal species were the most frequently associated bacteria. Patients with Candida parapsilosis had better survival rates than patients with other species. Portals of entry for fungemia were catheters, wounds, the urinary tract, and the peritoneal cavity, but were undefined in 54% of patients. Antifungal chemotherapy could not be identified as affecting the outcome in these patients. It is suggested that candidemia in most patients represents a failure of host defense, and that septicemia of either bacteria or fungi may arise from the gastrointestinal tract in critically ill, immunocompromised patients.

Topics: Adolescent; Adult; Aged; Amphotericin B; Candidiasis; Child; Enterobacteriaceae Infections; Female; Humans; Immunocompetence; Male; Middle Aged; Nystatin; Sepsis; Staphylococcal Infections

Topics: Amphotericin B; Ampicillin; Brain Abscess; Candidiasis; Cryptococcosis; Enterobacteriaceae Infections; Esophagitis; Herpes Simplex; Humans; Infections; Meningitis; Meningitis, Listeria; Mucormycosis; Neoplasms; Pharyngitis; Stomatitis; Toxoplasmosis

Trichosporon cutaneum is a fungus known to cause superficial nodules over the distal third of hair shafts, mainly scalp hair, and to produce a clinical entity known as piedra. This superficial mycosis occurs mostly in temperate and tropical regions and is rarely seen in North America. Trichosporon cutaneum spesis is described here in a 12-year-old boy with acute lymphocytic leukemia in relapse. To our knowledge this is the first case reported in the literature. Emphasis is made of the increasing rate of fungal diseases as well as of "opportunistic" infections in this type of immunosuppressed patient.

Topics: Amphotericin B; Anti-Bacterial Agents; Bleomycin; Child; Cytarabine; Enterobacteriaceae Infections; Flucytosine; Humans; Leukemia, Lymphoid; Male; Mycoses; Sepsis; Vincristine; Yeasts