brl-28500 and Gram-Negative-Bacterial-Infections

To compare the minimum inhibitory concentrations (MIC) of the ceftazidime-avibactam (CZA) combination versus ceftazidime alone (TZ) for Stenotrophomonas maltophilia.. MIC comparison was performed by E-tests. We assumed that CZA was more effective in vitro than TZ alone when CZA led to a category change from "Resistant" with TZ alone to "Susceptible" or "Intermediate" with CZA, or if the MIC of CZA was at least 4-fold lower than the MIC of TZ for TZ-susceptible isolates.. Using CZA for empirical treatments in severe or polymicrobial infections with S. maltophilia seems appropriate.

Topics: Azabicyclo Compounds; Ceftazidime; Clavulanic Acids; Cystic Fibrosis; Drug Combinations; Drug Resistance, Multiple, Bacterial; Gram-Negative Bacterial Infections; Humans; Microbial Sensitivity Tests; Multicenter Studies as Topic; Stenotrophomonas maltophilia; Ticarcillin

Stenotrophomonas maltophilia (S. maltophilia) is an important nosocomial bacterial pathogen. However, the clinical features of children with S. maltophilia infection, the predisposing factors, and the antibiotic susceptibility of the bacteria have not been fully evaluated.In this study, the data of children with S. maltophilia infection from the West China Second University Hospital of Sichuan University (Chengdu, China) between July 2010 and October 2017 were collected and analyzed. The clinical features of enrolled children, the predisposing factors, and the antibiotic susceptibility were reported.In total, infection of S. maltophilia was identified in 128 patients. Most of these patients were under 1 year old (67.2%) and were mainly diagnosed as pneumonia (69%). A large proportion had underlying diseases (45.3%), received immunosuppressive therapy (53.1%), had undergone invasive operations (41.4%), had a history of carbapenem antibiotics use within 7 days before culture acquisition (54.7%), history of intensive care unit (ICU) hospitalization within previous 30 days (34.4%), and other risk factors. In particular, invasive operation (95% confidence interval [CI]: 1.125-14.324, P = .032), especially mechanical ventilation (95% CI: 1.277-20.469, P = .021), and ICU admission (95% CI: 1.743-22.956, P = .005) were independent risk factors for the children to develop severe S. maltophilia infection. As for antibiotic susceptibility, trimethoprim sulfamethoxazole (TMP-SMX), piperacillin tazobactam, ticarcillin clavulanate, and ceftazidime exhibited strong antibacterial activities against S. maltophilia, the susceptibility rates were 97.5%, 86.7%, 92.9%, and 81.5%, respectively.We report the clinical features of children with S. maltophilia infection, the predisposing factors and the antibiotic susceptibility. TMP-SMX can continue to be the first choice for the treatment of S. maltophilia infection. Piperacillin tazobactam, ticarcillin clavulanate, and the third generation cephalosporins can be used as alternative drugs.

Topics: Age Distribution; Anti-Bacterial Agents; Carbapenems; Ceftazidime; Child, Preschool; China; Clavulanic Acids; Comorbidity; Female; Gram-Negative Bacterial Infections; Hospitalization; Humans; Immunosuppressive Agents; Infant; Intensive Care Units, Pediatric; Length of Stay; Male; Piperacillin, Tazobactam Drug Combination; Respiration, Artificial; Retrospective Studies; Risk Factors; Sex Distribution; Stenotrophomonas maltophilia; Surgical Procedures, Operative; Ticarcillin; Trimethoprim, Sulfamethoxazole Drug Combination

The aim of this study was to evaluate the in vitro effects and clinical efficacies of trimethoprim-sulfamethoxazole (SXT) combined with other antimicrobial agents against Stenotrophomonas maltophilia.. In vitro analysis was conducted on 89 S. maltophilia strains isolated from blood and the respiratory tract between June 2012 and October 2014. Levofloxacin (LVX), ticarcillin-clavulanic acid (TIM), and minocycline (MIN) were selected for an examination of their effects when individually combined with SXT by the checkerboard method. In addition, 29 S. maltophilia bacteremia cases were reviewed and the clinical efficacies of SXT-based combination therapies were analyzed.. SXT+LVX showed synergy in 21, no interactions in 61, and antagonism in 7. SXT+TIM showed synergy in 71, and no interactions in 18. SXT+MIN showed synergy in 10, and no interactions in 79. The review of clinical data indicated that a combination of SXT+fluoroquinolone was not associated with improved prognosis compared with monotherapy.. The in vitro data indicated that SXT+TIM had beneficial microbiological effects and was not antagonistic. Our in vitro and clinical data analyses do not support the routine use of SXT+fluoroquinolone combination therapy for S. maltophilia infection.

Topics: Aged; Anti-Bacterial Agents; Bacteremia; Clavulanic Acids; Drug Therapy, Combination; Female; Fluoroquinolones; Gram-Negative Bacterial Infections; Humans; Levofloxacin; Male; Middle Aged; Minocycline; Neoplasms; Stenotrophomonas maltophilia; Ticarcillin; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Blood infections with multidrug-resistant Gram-negative carbapenem-resistant bacilli are particularly dangerous and challenging to treat in organ transplant recipients. Resistance to carbapenems may be acquired, for example, in Enterobacteriaceae, Pseudomonas, or Acinetobacter spp. or innate, for example, in Stenotrophomonas maltophilia. The purpose of this study was to analyze blood infections caused by S maltophilia in organ transplant recipients and to compare drug susceptibility of these bacteria and the same species isolated from the blood of other inpatients.. A total of 26 S maltophilia strains isolated from blood samples of 26 patients (including 14 liver or kidney transplant recipients) hospitalized during 2011 to 2014 were evaluated in this study. Antibiotic susceptibility was determined via E-test and disk diffusion methods.. Stenotrophomonas maltophilia strains isolated from blood exhibited sensitivity to trimethoprim/sulfamethoxazole (100%), levofloxacin (96.2%), ciprofloxacin (92.3%), ticarcillin/clavulanic acid (80.8%), and ceftazidime (53.9%).. Because appropriate antibiotic therapy in the case of S maltophilia differs from the standard empirical therapy administered in the case of most other Gram-negative bacilli, early identification of this pathogen is of particular significance. The use of antibiotics to which this pathogen is sensitive eliminates the infection and helps avoid graft loss.

Topics: Anti-Bacterial Agents; Ceftazidime; Ciprofloxacin; Clavulanic Acids; Drug Resistance, Bacterial; Gram-Negative Bacterial Infections; Hospitals, Teaching; Humans; Levofloxacin; Microbial Sensitivity Tests; Organ Transplantation; Stenotrophomonas maltophilia; Ticarcillin; Transplant Recipients; Trimethoprim, Sulfamethoxazole Drug Combination

Stenotrophomonas maltophilia can present as bacteremia, respiratory tract infection, urinary tract infection, soft tissue and wound infections, bone and joint infections, meningitis, and endocarditis especially in immunosuppressed patients and those with underlying medical conditions. The incidence and impact of S. maltophilia in young children with heart disease are poorly defined. A single center retrospective observational study was conducted in infants <180 days of age with positive S. maltophilia cultures over a period of 5 years. The overall incidence for S. maltophilia infection was 0.8 % (n = 32/3656). Among 32 identified infants, there were 47 episodes of S. maltophilia infection 66 % of infants had prior exposure to broad spectrum antibiotics. 97 % of positive isolates were susceptible to trimethoprim/sulfamethoxazole and 91 % to levofloxacin as well as ticarcillin/clavulanate. Ventilator-free days and absolute lymphocyte count prior to acquiring infection were significantly lower in non-survivors than in survivors. 100 % of survivors had clearance of positive cultures compared to 50 % in non-survivors (p < 0.05). The crude all-cause mortality rate was 37.5 %. All non-survivors had increased length of ICU stay and duration of mechanical ventilation and had delayed clearance of infection and required longer duration of treatment.

Topics: Anti-Bacterial Agents; Clavulanic Acids; Female; Gram-Negative Bacterial Infections; Humans; Incidence; Infant; Infant, Newborn; Intensive Care Units; Levofloxacin; Male; Retrospective Studies; Risk Factors; Stenotrophomonas maltophilia; Ticarcillin; Trimethoprim, Sulfamethoxazole Drug Combination

Aztreonam, cefepime, and ceftazidime are anti-pseudomonal beta-lactam antibiotics which have been previously reported to be administered by continuous infusion (CI) in pediatric CF patients. We present two cases administering intravenous (IV) meropenem and ticarcillin-clavulanate by CI in pediatric CF patients. The delivery of beta-lactam antibiotics via CI should be considered in order to optimize the pharmacodynamics (PD) of beta-lactams in the treatment of acute pulmonary exacerbations (APE).

Topics: Adolescent; Anti-Bacterial Agents; Clavulanic Acids; Cystic Fibrosis; Female; Gram-Negative Bacterial Infections; Humans; Infusions, Intravenous; Meropenem; Pneumonia, Bacterial; Pseudomonas aeruginosa; Pseudomonas Infections; Rhodospirillaceae; Thienamycins; Ticarcillin

Stenotrophomonas maltophilia is an emerging nosocomial pathogen capable of causing healthcare-associated infections, including pneumonia and bacteremia. Intrinsic resistance in S. maltophilia is exhibited towards many broad-spectrum antibiotics, and treatment recommendations are controversial. One of the major causes of antimicrobial resistance is attributed to a robust array of efflux pumps that extrude drug compounds from the cell. Using checkerboard and growth kinetic assays, we evaluated the in vitro activity of a polyclonal antibody raised against an ATP-binding cassette efflux protein in S. maltophilia. Six clinical strains of S. maltophilia and one type strain were challenged with co-trimoxazole, ticarcillin-clavulanate, and ciprofloxacin, alone and in combination with antibody. One clinical strain was tested by growth curve experiments for each antibiotic-antibody combination. The use of antibody resulted in significantly increased susceptibility in 71.4% (15/21) of treatments tested, with 33.3% displaying synergy and 38.1% an additive effect. In growth kinetic studies, synergy was obtained for each antibiotic-antibody combination. Thus, the use of antibody raised against multidrug efflux pumps for the treatment of multidrug-resistant organisms warrants further investigation. Antibody targeting substrate recognition sites, or other functionally important epitopes, may lead to inhibition of multiple efflux pumps that share the same substrate and is an attractive area that should be explored.

Topics: Animals; Anti-Bacterial Agents; Antibodies, Bacterial; ATP-Binding Cassette Transporters; Ciprofloxacin; Clavulanic Acids; Drug Synergism; Gram-Negative Bacterial Infections; Humans; Microbial Sensitivity Tests; Rabbits; Stenotrophomonas maltophilia; Ticarcillin; Trimethoprim, Sulfamethoxazole Drug Combination

To report a case of chronic unilateral conjunctivitis caused by Alcaligenes xylosoxidans.. A previously healthy 47-year-old woman presented with left eye purulent discharge and irritation beginning 3 months earlier. The patient had previously been treated with bacitracin and olopatadine without improvement. Bacterial staining, culture, and antibiotic sensitivities were performed from a conjunctival swab.. The cultures revealed heavy growth of A. xylosoxidans. The organism was resistant to aminoglycosides, fluoroquinolones, and cephalosporins. The patient was started on polytrim, but an allergic reaction forced the use of topical Timentin 2%. After 14 days of treatment, the infection completely resolved.. To our knowledge, this is the first case report of an external ocular infection caused by A. xylosoxidans in a host without predisposing risk factors and the first case report of isolated conjunctivitis caused by A. xylosoxidans. A. xylosoxidans should be considered a rare but potential pathogen capable of producing chronic conjunctivitis in an otherwise healthy host.

Topics: Alcaligenes; Anti-Bacterial Agents; beta-Lactamase Inhibitors; Clavulanic Acids; Conjunctivitis, Bacterial; Female; Gram-Negative Bacterial Infections; Humans; Middle Aged; Ticarcillin

A combination of ticarcillin with clavulanate has been used for more than 12 years in many countries in the treatment of infections caused by Gram-negative microorganisms and a mixed microbe flora, in particular where the presence of beta-lactamase producers can be anticipated. In the Czech Republic it is not very well known, probably more for commercial than medical reasons, and the objective of the present paper to draw attention to this old but still useful antibiotic.. In a simple open trial the therapeutic results in a group of 15 patients treated by the above preparation in 1992-1995 at the unit for septic infections of the Clinic for Infectious Diseases in Prague were summarized and compared with the results of a previous trial conducted in the same department in 1987-91 and with results published in the literature. The mean success of treatment was about 90%.. A combination of ticarcillin, a semisynthetic broad spectrum penicillin with clavulanic acid is an antibiotic which is still very valuable in the treatment of sepsis and other severe forms of bacterial infection, incl. patients with a significantly reduced immunity. The tolerance is very good and an important factor is also the relatively favourable price. The author's results are consistent with experience published by departments abroad.

Topics: Adult; beta-Lactamase Inhibitors; Clavulanic Acids; Drug Therapy, Combination; Female; Gram-Negative Bacterial Infections; Humans; Male; Middle Aged; Ticarcillin