amphotericin-b and Streptococcal-Infections

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

Gastrointestinal (GI) mucormycosis is a rare and often deadly form of mucormycosis. Delayed diagnosis can lead to an increased risk of death. Here, we report a case of GI mucormycosis following streptococcal toxic shock syndrome in a virologically suppressed HIV-infected patient.. A 25-year-old Thai woman with a well-controlled HIV infection and Grave's disease was admitted to a private hospital with a high-grade fever, vomiting, abdominal pain, and multiple episodes of mucous diarrhea for 3 days. On day 3 of that admission, the patient developed multiorgan failure and multiple hemorrhagic blebs were observed on all extremities. A diagnosis of streptococcal toxic shock was made before referral to Siriraj Hospital - Thailand's largest national tertiary referral center. On day 10 of her admission at our center, she developed feeding intolerance and bloody diarrhea due to bowel ischemia and perforation. Bowel resection was performed, and histopathologic analysis of the resected bowel revealed acute suppurative transmural necrosis and vascular invasion with numerous broad irregular branching non-septate hyphae, both of which are consistent with GI mucormycosis. Peritoneal fluid fungal culture grew a grayish cottony colony of large non-septate hyphae and spherical sporangia containing ovoidal sporangiospores. A complete ITS1-5.8S-ITS2 region DNA sequence analysis revealed 100% homology with Rhizopus microsporus strains in GenBank (GenBank accession numbers KU729104 and AY803934). As a result, she was treated with liposomal amphotericin B. However and in spite of receiving appropriate treatment, our patient developed recurrent massive upper GI bleeding from Dieulafoy's lesion and succumbed to her disease on day 33 of her admission.. Diagnosis of gastrointestinal mucormycosis can be delayed due to a lack of well-established predisposing factors and non-specific presenting symptoms. Further studies in risk factors for abdominal mucormycosis are needed.

Topics: Adult; Amphotericin B; Antifungal Agents; DNA, Fungal; Fatal Outcome; Female; Gastrointestinal Tract; Graves Disease; HIV Infections; Humans; Mucormycosis; Rhizopus; Shock, Septic; Streptococcal Infections; Streptococcus pyogenes; Syndrome; Thailand

Bloodstream infection (BSI) after allogeneic hematopoietic stem cell transplantation (HSCT) is a well-known complication during the pre-engraftment phase. Knowledge of trends in etiology and antibiotic susceptibility of BSI is important as the time to effective antibiotic treatment is closely associated with survival in bacteremic patients with septic shock.. BSI during the pre-engraftment phase was studied retrospectively in 521 patients undergoing HSCT at our center in 2001-2008. Incidence, risk factors, outcome, and microbiology findings were investigated and compared with BSI in a cohort transplanted during 1975-1996.. The incidence of at least 1 episode of BSI was 21%, the total attributable mortality of BSI was 3.3%, and crude mortality at day 120 after transplantation was 21%. The rate of gram-positive and gram-negative BSI was 80% and 13%, respectively. Gram-negative BSI was more frequent both in 2001-2004 and in 2005-2008 compared with 1986-1996 (P = 0.023 for 2001-2004, P = 0.001 for 2005-2008), with fluoroquinolone-resistant Escherichia coli as the predominant finding. BSI with viridans streptococci and E. coli occurred significantly earlier after HSCT than BSI with Enterococcus species, with median time of 4, 8, and 11 days, respectively (P < 0.01 both for viridians streptococci vs. Enterococcus species, and E. coli vs. Enterococcus species). Risk factors for BSI in multivariate analysis were transplantation from unrelated donor and cord blood as stem cell source, whereas peripheral blood as stem cell source was protective.. Despite low attributable mortality of BSI, crude mortality at day 120 after transplantation was 21%, indicating an association between BSI and other risk factors for death. The risk of gram-negative BSI increased over time in parallel with an increased rate of quinolone resistance. However, the incidence and attributable mortality of gram-negative BSI remained low. Thus, prophylaxis with ciprofloxacin is still deemed appropriate, but continued assessments of the risk and benefits of fluoroquinolone prophylaxis must be performed.

Topics: Adolescent; Adult; Aged; Amphotericin B; Anti-Infective Agents; Bacteremia; Candidiasis; Child; Child, Preschool; Ciprofloxacin; Cohort Studies; Enterococcus; Female; Fluconazole; Fungemia; Gram-Negative Bacterial Infections; Gram-Positive Bacterial Infections; Hematopoietic Stem Cell Transplantation; Humans; Incidence; Infant; Male; Middle Aged; Multivariate Analysis; Neutropenia; Retrospective Studies; Risk Factors; Staphylococcal Infections; Streptococcal Infections; Time Factors; Transplantation, Homologous; Viridans Streptococci; Young Adult

A 46-year-old previously healthy woman was diagnosed with acute lymphoblastic leukaemia. The induction phase was complicated by alpha-haemolytic streptococcal bacteremia which responded to antibacterial therapy. Subsequently, the patient developed pneumonie due to Chlamydiapneumoniae which responded to macrolides. Following this infection the patient developed recurrent fever and new pulmonary infiltrates were noted. Bronchoscopy was performed and treatment was administered with liposomal amphotericin B (L-AmB, AmBisome) for two days, but was complicated by acute renal failure. Aspergillus fumigatus was cultured from bronchoalveolar lavage fluid [corrected] L-AmB was discontinued and voriconazole and caspofungin were administered. Despite aggressive antifungal therapy the patient developed progressive invasive infection, with central nervous system involvement as well as lesions appearing in the kidneys and liver. The patient died one week following the diagnosis of aspergillosis.

Topics: Acute Kidney Injury; Amphotericin B; Anti-Bacterial Agents; Antifungal Agents; Antineoplastic Combined Chemotherapy Protocols; Aspergillosis; Bacteremia; Caspofungin; Chlamydophila Infections; Chlamydophila pneumoniae; Doxorubicin; Drug Resistance, Multiple, Fungal; Drug Therapy, Combination; Echinocandins; Fatal Outcome; Female; Humans; Immunocompromised Host; Lipopeptides; Liposomes; Lung Diseases, Fungal; Medical Futility; Methotrexate; Middle Aged; Neuroaspergillosis; Peptides, Cyclic; Pneumonia, Bacterial; Precursor B-Cell Lymphoblastic Leukemia-Lymphoma; Pyrimidines; Streptococcal Infections; Triazoles; Vincristine; Voriconazole

Topics: Acute Disease; Adult; Amphotericin B; Candidiasis; Cefuroxime; Cephalosporins; Humans; Infusions, Intravenous; Male; Parotitis; Streptococcal Infections; Streptococcus pyogenes

Sixty four episodes of bacteraemia that appeared during antimicrobial prophylaxis with an oral quinolone plus an azole in neutropenic cancer patients were compared with 128 cases of bacteraemia in a cohort of controls matched for age, sex, underlying disease, neutropenia and vascular catheter in situ to assess differences in aetiology, cost of therapy and outcome. Patients who received prophylaxis had breakthrough bacteraemias of a different aetiology compared with the control group: they had significantly fewer multiply-resistant strains (21.9 vs. 51.5, P < 0.04) and a longer afebrile neutropenic period (9.55 days vs. 4.1, P < 0.001). Patients who received prophylaxis also had bacteraemias that were significantly more frequently caused by viridans streptococci (9.4%, vs. 1.7%, P < 0.01), enterococci (15.6% vs. 7.2%, P < 0.05) and Stenotrophomonas maltophilia (17.2% vs. 3.4%, P < 0.01). The cost of antimicrobial therapy per case (37401 SKK (1091 USD) vs. 31808 SKK (899 USD), P < 0.05) was also significantly higher in cases than controls; however, the number of administered antibiotics (4.18 vs. 3.21 per case, P = NS) was similar in both groups. There were no differences in outcome between both groups. However patients who received prophylaxis had significantly longer periods of afebrile neutropenia (9.55 days vs. 4.1, P < 0.001) and bacteraemia developed later than in controls. Also, the incidence of polymicrobial bacteraemia caused by multiresistant strains was lower among cases (21.9 vs. 51.5, P < 0.04).

Topics: Amikacin; Amphotericin B; Antibiotic Prophylaxis; Bacteremia; Bacterial Infections; Case-Control Studies; Catheters, Indwelling; Ceftazidime; Drug Therapy, Combination; Enterococcus; Female; Fluconazole; Gram-Negative Bacterial Infections; Gram-Positive Bacterial Infections; Humans; Male; Neoplasms; Neutropenia; Ofloxacin; Retrospective Studies; Streptococcal Infections; Treatment Outcome; Vancomycin; Xanthomonas

Topics: Acute Disease; Adult; Agranulocytosis; Amphotericin B; Antineoplastic Combined Chemotherapy Protocols; Ciprofloxacin; Combined Modality Therapy; Drug Evaluation; Drug Therapy, Combination; Humans; Leukemia; Roxithromycin; Sepsis; Streptococcal Infections

Two adult patients with CSF shunts contracted Candida albicans meningitis. In both patients, these infections were either preceded by or occurred simultaneously with bacterial meningitis. Treatment with antimicrobials alone failed to sterilize the CSF. Cure was obtained only after removal of the shunt tubes. The simultaneous or subsequent development of Candida meningitis should be considered in selected patients who do not make appropriate recovery from a bacterial meningitis, especially one that complicates shunt placement.

Topics: Acinetobacter Infections; Adult; Aged; Amphotericin B; Candidiasis; Cerebrospinal Fluid Shunts; Enterococcus faecalis; Female; Humans; Male; Meningitis; Postoperative Complications; Streptococcal Infections

Cellulitis of the scrotum and penis is caused, in the majority of instances, by a beta hemolytic streptococci without a discernible portal of entry. Clostridium, occasionally, will result in this disease as a manifestation of a perirectal abscess. In either instance, fluid accumulates rapidly in the closed space between Colles' and Buck's fascia, producing intense swelling of the scrotum. If this compartment is not immediately decompressed by linear incisions, devascularization of the scrotal and penile skin will often occur, resulting in gangrene. Immediate treatment of the bacterial infection with penicillin also is essential. If gangrene does develop, radical debridement of the necrotic tissue as well as a wide margin of adjacent inflamed skin must be undertaken. Continual monitoring of the microflora of the debrided would is essential for the selection of the appropriate antibiotic against any secondary intruders. Coverage of the granulating would is accomplished when the would bacterial count is below 10-5 per gram of tissue.

Topics: Amphotericin B; Anti-Bacterial Agents; Antistreptolysin; Candida albicans; Candidiasis; Cellulitis; Debridement; Gangrene; Genital Diseases, Male; Humans; Immunity; Male; Middle Aged; Penile Diseases; Scrotum; Skin Diseases; Skin Transplantation; Streptococcal Infections; Transplantation, Autologous

Topics: Acute Kidney Injury; Adolescent; Adult; Amphotericin B; Anti-Bacterial Agents; Bacterial Infections; Colistin; Deafness; Endocarditis, Bacterial; Female; Humans; Kanamycin; Kidney; Kidney Function Tests; Male; Middle Aged; Pseudomonas Infections; Sepsis; Staphylococcal Infections; Streptococcal Infections; Urea; Vancomycin

Topics: Age Factors; Amphotericin B; Anti-Bacterial Agents; Cryptococcus; Escherichia coli Infections; Humans; Injections, Intravenous; Injections, Spinal; Intracranial Pressure; Leptospira; Meningitis; Meningitis, Haemophilus; Meningitis, Listeria; Meningitis, Meningococcal; Meningitis, Pneumococcal; Meningitis, Viral; Microbial Sensitivity Tests; Penicillins; Staphylococcal Infections; Streptococcal Infections; Streptomycin; Sulfonamides; Tuberculosis, Meningeal

Topics: Amphotericin B; Anti-Bacterial Agents; Antibiotic Prophylaxis; Enterobacter aerogenes; Escherichia coli Infections; Humans; Infant, Newborn; Proteus Infections; Pseudomonas Infections; Spinal Dysraphism; Staphylococcal Infections; Streptococcal Infections; Tetracycline

Topics: Amphotericin B; Anti-Bacterial Agents; Bacitracin; Chloramphenicol; Cross Infection; Drug Hypersensitivity; Drug Resistance; Drug Resistance, Microbial; Erythromycin; Kanamycin; Methicillin; Mycoses; Penicillins; Staphylococcal Infections; Streptococcal Infections; Tetracycline; Toxicology; Vancomycin

Topics: Amphotericin B; Anti-Bacterial Agents; Chloramphenicol; Colistin; Drug Resistance; Drug Resistance, Microbial; Endocarditis; Endocarditis, Bacterial; Enterobacter aerogenes; Enterobacteriaceae; Erythromycin; Escherichia coli Infections; Kanamycin; Penicillin G; Penicillins; Proteus Infections; Pseudomonas Infections; Ristocetin; Staphylococcal Infections; Streptococcal Infections; Streptomycin; Tetracycline; Vancomycin

Topics: Amphotericin B; Anti-Bacterial Agents; Candidiasis; Chloramphenicol; Endocarditis; Endocarditis, Bacterial; Humans; Kanamycin; Penicillins; Staphylococcal Infections; Streptococcal Infections; Streptomycin; Tetracycline; Vancomycin

Topics: Adolescent; Amphotericin B; Child; Diphtheria; Enterovirus Infections; Escherichia coli Infections; Humans; Infant; Otolaryngology; Phosphates; Pneumococcal Infections; Pseudomonas Infections; Staphylococcal Infections; Streptococcal Infections; Tetracycline