cefepime and Pneumococcal-Infections

The aim of this research is to evaluate the recent changes in microorganisms causing spontaneous bacterial peritonitis in cirrhotic patients, antibiotic resistance, and response to empirical cephalosporin therapy. A total of 218 patients with ascites secondary to cirrhosis were enrolled. Parenteral cefotaxime or cefepime was given to patients who had a neutrophil count of 250/mm(3) or more or a positive bacterial culture of ascitic fluid. Antibiotic failure was defined by an absence of clinical improvement and an insufficient decrease in neutrophil count of ascites (<25% of initial value) by the third day of therapy. Of all the patients, 44.6% had culture-negative neutrocytic ascites, 24.8% had spontaneous bacterial peritonitis, and 10.1% had monomicrobial nonneutrocytic bacterascites. Growth in culture was observed in 76 patients (34.9%). The two most common isolated bacteria were Escherichia coli (33.8%) and coagulase-negative Staphylococcus (CoNS; 19.7%). The two cephalosporins were effective against E. coli (82%) and but not against CoNS (44%), while levofloxacin showed reasonable activity against both E. coli (71%) and CoNS (90%) in vitro. We confirmed a recent increased incidence of spontaneous bacterial peritonitis caused by Gram-positive bacteria. Levofloxacin seems to be a good alternative treatment for patients with uncomplicated spontaneous ascites infections.

Topics: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Ascitic Fluid; Bacterial Infections; Cefepime; Cefotaxime; Cephalosporins; Drug Resistance, Bacterial; Enterococcus; Escherichia coli Infections; Female; Humans; Infusions, Intravenous; Klebsiella Infections; Klebsiella pneumoniae; Leukocyte Count; Levofloxacin; Liver Cirrhosis; Male; Microbial Sensitivity Tests; Middle Aged; Neutrophils; Ofloxacin; Peritonitis; Pneumococcal Infections; Pseudomonas aeruginosa; Pseudomonas Infections; Staphylococcal Infections

The global emergence of Streptococcus pneumoniae resistance to fluoroquinolones is alarming and has grown to be a cause for significant concern worldwide. We report the first three cases of levofloxacin resistant S. pneumoniae isolates in a tertiary medical center in Beirut, Lebanon. Judicious use of antimicrobial agents is imperative to limit the spread of such resistant strains.

Topics: Aged; Anti-Bacterial Agents; Cefepime; Ceftazidime; Cephalosporins; Clarithromycin; Drug Resistance, Multiple, Bacterial; Humans; Imipenem; Lebanon; Levofloxacin; Male; Ofloxacin; Pneumococcal Infections; Pneumonia, Pneumococcal; Streptococcus pneumoniae; Vancomycin

This study aimed to evaluate the antimicrobial susceptibility profiles of 364 Streptococcus pneumoniae isolates and studied the genotypes of S. pneumoniae with high level beta-lactam resistance in Taiwan. Clonal complexes related to Spain(23F)-1, Taiwan(19F)-14, and Taiwan(23F)-15 were responsible for the spread of isolates with high beta-lactam resistance.

Topics: Anti-Bacterial Agents; beta-Lactam Resistance; beta-Lactams; Genotype; Humans; Microbial Sensitivity Tests; Pneumococcal Infections; Serotyping; Streptococcus pneumoniae; Taiwan

Topics: Amoxicillin; Anti-Bacterial Agents; Cefotaxime; Ceftaroline; Cephalosporin Resistance; Cephalosporins; Drug Resistance, Multiple, Bacterial; Humans; In Vitro Techniques; Microbial Sensitivity Tests; Penicillin Resistance; Penicillins; Pneumococcal Infections; Streptococcus pneumoniae

A large international collection of Streptococcus pneumoniae (21605 strains) was analyzed to determine the comparative activity of selected oral (cefuroxime and cefpodoxime) and parenteral (ceftriaxone and cefepime) cephalosporins when tested against different antimicrobial resistance phenotypes including penicillin-resistant strains and strains displaying additional resistances to other agents (erythromycin, clindamycin, tetracycline, and trimethoprim/sulfamethoxazole). The multidrug-resistant (MDR) rate ranged from 17.6% (penicillin- and erythromycin-resistant only) to 5.7% (resistance to all 5 drugs). The parenteral cephalosporins retained wider activity for all MDR phenotypes studied with the resistance rates (minimum inhibitory concentration > or = 4 mug/mL) being lower for cefepime (1.3-1.9%) when compared with ceftriaxone (3.0-4.4%) or the orally administered cephalosporins, cefpodoxime (64.4-74.1%), and cefuroxime (69.3-79.1%). Our findings confirm that the parenteral cephalosporins, cefepime, and ceftriaxone possess significant activity against those MDR pneumococci responsible for an increasing number of serious respiratory tract infections.

Topics: Administration, Oral; Cefepime; Ceftriaxone; Cephalosporin Resistance; Cephalosporins; Cohort Studies; Drug Resistance, Multiple, Bacterial; Female; Humans; Infusions, Intravenous; International Cooperation; Male; Microbial Sensitivity Tests; Pneumococcal Infections; Sensitivity and Specificity; Streptococcus pneumoniae

MICs of 21 beta-lactams were determined by agar dilution against 283 penicillin-susceptible (pen-S), 122 intermediate (pen-I) and 23 fully penicillin-resistant (pen-R) pneumococci. MICs of all beta-lactams increased with increasing MICs of penicillin. Clometocillin was the most active penicillin against pen-I or pen-R pneumococci. All oral cephalosporins except cefuroxime and cefpodoxime were less active than penicillin and none was satisfactory against pen-I or pen-R pneumococci. The parenteral third- and fourth-generation cephalosporins (except ceftazidime) were similar in activity to penicillin against pen-S isolates. Cefpirome showed the lowest mean MICs against pen-I and pen-R strains.

Topics: Amoxicillin; Ampicillin; Anti-Bacterial Agents; beta-Lactams; Carbapenems; Cefaclor; Cefadroxil; Cefatrizine; Cefepime; Cefixime; Cefotaxime; Cefpirome; Cefpodoxime; Ceftazidime; Ceftibuten; Ceftizoxime; Ceftriaxone; Cefuroxime; Cephalosporins; Cephradine; Drug Resistance, Microbial; Drug Resistance, Multiple; Humans; Microbial Sensitivity Tests; Penicillin Resistance; Penicillins; Piperacillin; Pneumococcal Infections; Serotyping; Species Specificity; Streptococcus pneumoniae

The purpose of this study was to compare the effect, both in vitro and in vivo, of cefepime with those of four other cephalosporins, namely ceftriaxone, cefotaxime, cefuroxime and cephalothin, against penicillin-resistant pneumococci. One hundred pneumococcal strains, 31 penicillin-susceptible, 30 penicillin-intermediate-resistant and 39 penicillin-resistant pneumococci, were used in MIC studies. Time-kill experiments were carried out for four strains. In the mouse peritonitis model, the dose that gave protection to 50% of mice challenged with a lethal dose of pneumococci (ED50) was determined for three pneumococci and five cephalosporins. The MICs of all five cephalosporins and penicillin correlated significantly with each other. In vitro, the most potent cephalosporins against pneumococci were cefotaxime, ceftriaxone and cefepime, followed by cefuroxime and cephalothin. In time-kill experiments, carried out for four pneumococci, no differences were found in the killing effect of these five cephalosporins in relation to MICs. In the mouse peritonitis model, there was no significant correlation between log(MIC) and log(ED50) for the five cephalosporins against three pneumococci (Spearman's rho = 0.39, P = 0.16). However, if the values for cefepime against the three pneumococci were excluded, there was a significant correlation for the remaining four cephalosporins (Spearman's rho = 0.62, P = 0.04). For all three pneumococci, the ED50s of cefepime were lower than expected from the MICs. It was not possible to explain this beneficial difference in the effect of cefepime in terms of in-vitro bactericidal activities, serum protein binding or pharmacodynamic parameters.

Topics: Animals; Blood Proteins; Cefepime; Cephalosporins; Half-Life; Mice; Mice, Inbred Strains; Microbial Sensitivity Tests; Penicillin Resistance; Peritonitis; Pneumococcal Infections; Streptococcus pneumoniae; Time Factors

Using the national surveillance programme of USA hospitals, we selected 162 strains of Streptococcus pneumoniae for sensitivity testing using the NCCLS breakpoints for benzylpenicillin and the oxacillin discs screen test. Included in the group of isolates were 85 relatively penicillin-resistant and 33 penicillin-resistant strains. The activity of cefepime, a new cephalosporin, was compared with other cephalosporins and penicillins as well as some non-beta-lactam antimicrobials. Imipenem was the most active agent but, cefepime, cefotaxime, ceftriaxone and ciprofloxacin were only slightly less active. The least active agents were ceftazidime, cefuroxime, piperacillin/tazobactam and ticarcillin/clavulanate. Cefepime is a potential alternative treatment to penicillin, particularly when penicillin-resistant and relatively penicillin-resistant S. pneumoniae are encountered. The clinical importance of screening for penicillin resistance by the use of the oxacillin disc is emphasized.

Topics: Anti-Bacterial Agents; Cefepime; Cephalosporins; Humans; Microbial Sensitivity Tests; Oxacillin; Penicillin Resistance; Pneumococcal Infections; Streptococcus pneumoniae