cefepime and Respiratory-Tract-Infections

These studies were designed to assess the efficacy and safety of cefepime, a fourth generation cephalosporin, for the treatment of serious infections, including lower respiratory tract infections (LRTI) in children.. Four clinical trials of cefepime for the treatment of serious bacterial infections enrolled 259 children with LRTI. In 3 trials cefepime was compared with ceftazidime (n = 166), cefotaxime (n = 16) or cefuroxime (n = 12). One trial was noncomparative (n = 65).. Treatment with cefepime 50 mg/kg/ dose administered every 8 to 12 h produced a satisfactory clinical response (clinical signs of infection resolved or improved with no evidence of recurrent infection at posttreatment follow-up) in 88 to 100% of patients, comparable with comparator therapy. In children from whom a causative pathogen was identified, bacteriologic eradication was comparable between cefepime and comparator therapy. Cefepime was as safe and well-tolerated as comparator therapy. Few treatment-related clinical or laboratory adverse events were noted and were equivalent to comparator in all studies.. Cefepime is as effective, safe and well-tolerated for the empiric treatment of children with LRTI as comparator agents but offers the advantage of an enhanced spectrum of activity for Gram-positive and Gram-negative pathogens compared with second or third generation cephalosporins.

Topics: Adolescent; Cefepime; Cefotaxime; Ceftazidime; Cefuroxime; Cephalosporins; Child; Child, Preschool; Clinical Trials as Topic; Humans; Infant; Recurrence; Respiratory Tract Infections; Safety; Treatment Outcome

The author reviews the comparative and non-comparative studies of cefepime and cefpirome, from which it is evident that both cephalosporins are extremely effective both clinically and bacteriologically. Success rates of about 90% have been reported for both drugs as therapy for complicated urinary tract infections, lower respiratory tract infections of the community as well as of nosocomial origin, including a large number of penicillin-resistant Streptococcus pneumoniae infections, skin and soft-tissue infections, surgical infections, as well as therapy for infections in neutropenic hosts. Cure rates are similar to or better than those obtained with ceftazidime, cefotaxime and ceftriaxone. The author also points out the various precautions necessary in utilizing these two antimicrobial agents.

Topics: Bacterial Infections; Cefepime; Cefpirome; Cephalosporins; Clinical Trials as Topic; Humans; Respiratory Tract Infections; Urinary Tract Infections

This study aims to evaluate the clinical efficacy and safety of intravenous Cefoselis injection for the treatment of acute moderate and severe bacterial infections.. A multicenter, double-blind, randomized clinical trial was carried out using Cefepime as control. Patients received 1.0 g of either Cefoselis or Cefepime for moderate infections or 2.0 g for severe infections at an interval of 12 hours for 7 to 14 days. A total of 276 patients (138 with Cefoselis, 138 with Cefepime) with respiratory or urinary tract infections were enrolled in the study. Up to 137 and 124 patients receiving Cefoselis and 132 and 125 patients receiving Cefepime were eligible for the ITT (intent to treat) and PP (per protocol) analyses, respectively.. At the end of the treatment, the cure rates and effective rates were 59.68% (74/124) and 93.55% (116/124) with Cefoselis, and 56.00% (74/124) and 90.40% (116/124) with Cefepime. The bacterial eradication rates of the two groups were 90.32% and 93.85%, respectively. No statistical differences were observed on the above-mentioned parameters between the two groups (all p > 0.05). Adverse events, mainly mild aminotransferase elevation and mild leukopenia, were observed in 11.59% (16/138) and 13.77% (19/138) of patients with Cefoselis and Cefepime, respectively (p > 0.05).. Cefoselis is an effective and safe choice against acute moderate and severe respiratory infections and UTI (urinary tract infection).

Topics: Acute Disease; Anti-Bacterial Agents; Bacterial Infections; Cefepime; Ceftizoxime; Cephalosporins; Double-Blind Method; Female; Humans; Male; Respiratory Tract Infections; Urinary Tract Infections

Various dosing strategies for cefepime have been developed in an effort to maximize pharmacodynamic exposure of this agent against gram-negative infections. An assessment of cefepime dosing strategies is warranted given recent reports of poorer treatment outcomes associated with cefepime compared with other antibiotics, particularly in patients infected with gram-negative organisms with elevated MICs.. The aims of this study were to compare the efficacy of cefepime IV at a dose of 1 g q8h (adjusted based on renal function) with those of other appropriate antimicrobials in the treatment of gramnegative pulmonary and bloodstream infections and to identify risk factors for treatment failure.. This single-center, open-label, prospective, observational study was conducted at a tertiary care center (Barnes-Jewish Hospital, St. Louis, Missouri). Isolates from infections in adult patients with bacteremia or pulmonary infection caused by Pseudomonas aeruginosa, Enterobacter aerogenes, Enterobacter cloacae, or Citrobacter freundii were assessed in a noninterventional manner. Infections were identified using an electronic notification system. Patients receiving appropriate monotherapy against the studied isolate within 24 hours of culture attainment were stratified into 1 of 3 cohorts according to treatment outcome, as follows: treatment success (resolution of initial fever or elevated white blood cell count to normal values plus the presence of repeat negative cultures from the initial site or below the quantitative definition for infection), improvement (treatment success without repeat negative cultures), or treatment failure (persistent or repeat positive cultures for the original organism at the infected site despite appropriate and adequate antimicrobial therapy, lack of resolution in fever or leukocytosis, switch to an alternative antibiotic, or the addition of another antibiotic with gram-negative coverage after > or =3 days of the initial regimen, relapse of infection within 14 days, or mortality attributable to the index infection). Multivariate regression analysis was used to examine risk factors associated with treatment failure.. Data from 120 patients (56.7% male; mean age, 62.2 years) were analyzed. Treatment failure occurred in 48.6% (36/74) of patients who received cefepime versus 32.6% (15/46) of those who received other antibiotics; this difference was not statistically significant. The proportion of patients with markers of increased severity of illness (intensive care unit [P = 0.005] and mechanical ventilation [P = 0.002]) was significantly greater in the cefepime group compared with the group that received other antibiotics. Multivariate logistic regression identified infection with Pseudomonas aeruginosa (adjusted odds ratio [AOR], 1.40 [95% CI, 1.01-2.00]) and mechanical ventilation (AOR, 7.08 [95% CI, 1.80-31.3]) as being associated with treatment failure in patients who received cefepime. Mechanical ventilation (AOR, 3.97 [95% CI, 1.47-11.1]) and neutropenia (AOR, 5.26 [95% CI, 1.28-20.0]) were independent predictors of treatment failure among all patients studied.. Based on these results in this small cohort, the efficacy of this cefepime dosing strategy (1 g q8h) appeared to be similar to that of other antimicrobials.

Topics: Anti-Bacterial Agents; Bacteremia; Cefepime; Cephalosporins; Citrobacter freundii; Enterobacter; Enterobacteriaceae Infections; Female; Humans; Logistic Models; Male; Microbial Sensitivity Tests; Middle Aged; Prospective Studies; Pseudomonas aeruginosa; Pseudomonas Infections; Respiratory Tract Infections; Risk Factors; Severity of Illness Index; Treatment Outcome

The objective of the study was to compare the safety and efficacy of cefepime and ceftazidime in the treatment of community acquired lower respiratory tract infections of moderate intensity. Eighty-six patients were randomized at a 2:1 ratio to receive respectively cefepime 1 g b.i.d. or ceftazidime 1 g t.i.d. The drugs were well tolerated and the occurrence of adverse events in each group was comparable. The rates of satisfactory clinical response were 96% (49/51) for cefepime and 89% (24/27) for ceftazidime. A total of 73 pathogens were isolated and pathogen eradication rates were 98% and 96% respectively for the cefepime and ceftazidime treatment groups. In conclusion, the data confirmed that cefepime could be a good alternative to ceftazidime.

Topics: Aged; Cefepime; Ceftazidime; Cephalosporins; Community-Acquired Infections; Female; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Respiratory Tract Infections

Since infection develops in significant numbers of hospitalized patients, the problem of resistance to third-generation cephalosporins is of increasing concern. We evaluated the efficacy of cefepime 1 g bd as treatment for acute, moderately severe bacterial infection in 239 hospitalized patients (mean age 60 years). Of these patients, 204 were evaluated clinically for urinary tract infection (UTI) (n = 90), lower respiratory tract infection (LRTI) (n = 70), skin and soft tissue infection (S/STI) (n = 12) and bacteraemia which was associated with either UTI or LRTI (n = 32) but not included in the previously mentioned UTI and LRTI groups. Amongst the pathogens isolated (36 Gram-positive, 150 Gram-negative), the most predominant species were Escherichia coli in UTI and bacteraemia (n = 81), Streptococcus pneumoniae in LRTI and bacteraemia (n = 23), Haemophilus influenzae in LRTI (n = 16), Pseudomonas aeruginosa (n = 4) and Enterobacter cloacae (n = 2) in S/STI. The mean duration of treatment was 8.5 days and was the same for the 204 clinically evaluable patients. Overall, the clinical cure rate for cefepime was 94% (191/204). Pathogen eradication was achieved in 93% (185/199) of infections. Of the patients with associated bacteraemia, the clinical cure rate was 97% (31/32) and 94% (16/17) of the pathogens were eradicated. Cefepime therapy was well-tolerated. Treatment was discontinued in eight patients (3%) because of local intolerance and in five patients (2%) because of drug-related adverse events (rash, headache and pruritus). Cefepime 1 g bd is as safe and effective as other parenteral cephalosporins for the treatment of acute bacterial UTI, LRTI and S/STI, including those cases with associated bacteraemia. The bd dosing schedule and reported lack of cross-resistance with other cephalosporins against some species of aerobic Gram-negative bacilli make cefepime an attractive treatment option in hospitalized patients.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bacteremia; Bacteria; Bacterial Infections; Cefepime; Cephalosporins; Female; Freeze Drying; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Powders; Respiratory Tract Infections; Skin Diseases, Infectious; Therapeutic Equivalency; Urinary Tract Infections

Multi-resistant strains of Gram-negative bacteria are rapidly emerging as a frequent cause of serious bacterial infection in the hospital environment. Effective treatment must include an antibiotic with activity against these organisms. In an open multicentre study, cefepime was evaluated as empirical therapy in 156 hospitalized patients (mean age 57 years) with serious infection of the urinary tract (n = 43), lower respiratory tract (n = 101) and skin and soft tissue (n = 12). In 18 patients, septicaemia/bacteraemia was also diagnosed. Cefepime, 2 g bd, was administered for a maximum of 16 days (mean 8). Of 98 pathogens isolated, 75 were Gram-negative and 23 were Gram-positive species. Ninety-four of the pathogens were susceptible to cefepime, including multi-resistant isolates such as Pseudomonas aeruginosa and Enterobacter cloacae. The overall clinical cure rate, excluding septicaemia/bacteraemia, was 92% (94/102); the corresponding bacterial eradication rate was 95% (52/55). In patients with septicaemia/bacteraemia, the clinical cure rate was 87% (13/15) despite eradication of 100% (11/11) of the assessable pathogens. Cefepime was well-tolerated, although 14 (9%) patients experienced local intolerance at the infusion site. Other drug-related adverse events were reported in six (4%) patients and included diarrhoea, pruritus, rash and urticaria. Cefepime is safe and effective as empirical treatment for serious infections commonly found in the hospital setting. Clinical cure and bacterial eradication can be achieved with a convenient bd dosing schedule.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bacteria; Bacterial Infections; Cefepime; Cephalosporins; Female; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Respiratory Tract Infections; Risk Factors; Sepsis; Skin Diseases, Infectious; Urinary Tract Infections

Antibiotic treatment for community-acquired pneumonia must target Gram-positive pathogens, especially frequently isolated organisms such as Streptococcus pneumoniae. The severity of community-acquired pneumonia is often related to underlying factors. Occasionally it may be complicated by staphylococcal or Gram-negative bacillary infection. We have compared the safety and efficacy of cefepime 1 g bd with ceftazidime 1 g tds as empirical treatment in adults with community-acquired lower respiratory tract infections (LRTIs). One hundred and thirty-one patients with moderate to severe LRTIs were randomized to two treatment groups: 87 received cefepime and 44 received ceftazidime. The treatment groups were comparable with regard to sex, age and treatment duration. Of the 116 pathogens isolated, 57 were Gram-positive (46 strains of S. pneumoniae) and 59 were Gram-negative (33 strains of Haemophilus influenzae). Of the 111 patients evaluated, clinical cure rates were 87% (65/75) in the cefepime group and 86% (31/36) in the ceftazidime group. Pathogen eradication rates were 95% (74/78 and 36/37, respectively) in both groups. Both drugs were well tolerated and the incidence of adverse events in each group was comparable. Cefepime 2 g per day (1 g bd) was as safe and effective as ceftazidime 3 g per day (1 g tds) in the treatment of community-acquired LRTIs.

Topics: Adult; Aged; Aged, 80 and over; Bacteria; Cefepime; Ceftazidime; Cephalosporins; Community-Acquired Infections; Female; Follow-Up Studies; Humans; Injections, Intramuscular; Injections, Intravenous; Male; Middle Aged; Radiography; Respiratory Tract Infections

Patients with lower respiratory tract infection (LRTI) were randomized 2:1 to receive either cefepime 2 g i.v. bd or cefotaxime 2 g i.v. tds. Bronchopneumonia alone or associated with another LRTI was diagnosed in 30 of 37 cefepime recipients and in 11 of 18 cefotaxime recipients; other diagnoses included bronchitis, lobar pneumonia and aspiration pneumonia. The mean duration of treatment was 5.9 days in the cefepime group and 5.4 days in the cefotaxime group. There were no significant differences between the two groups with regard to clinical or bacteriological outcome. Treatment was associated with a satisfactory clinical response in 27 (73%) of 37 evaluable cefepime patients and in 10 (56%) of 18 evaluable cefotaxime patients. Treatment resulted in eradication of 33 (89%) of 37 pathogens in the cefepime group, including 13 of 15 strains of Staphylococcus aureus, and of 16 (73%) of 22 pathogens in the cefotaxime group, including eight of ten strains of S. aureus. Two Pseudomonas aeruginosa strains persisted in the cefotaxime group. The sole clinical adverse event reported was a rash in one cefepime patient which did not require discontinuation of treatment. No clinically relevant changes in laboratory test results were attributed to either agent. Cefepime twice daily and cefotaxime three times daily were of comparable safety and efficacy in the treatment of bronchopneumonia and other LRTIs.

Topics: Adult; Aged; Aged, 80 and over; Bronchopneumonia; Cefepime; Cefotaxime; Cephalosporins; Female; Humans; Injections, Intravenous; Male; Middle Aged; Respiratory Tract Infections; Treatment Outcome

Patients in intensive care units (ICUs) are at increased risk of developing nosocomial infections. This is of special concern in the immunocompromised patient, particularly with regard to multiresistant pathogens. We evaluated the effectiveness of cefepime 2 g bd in combination with amikacin 7.5 mg/kg bd for the treatment of severe bacterial infection in 118 ICU patients, including 113 patients with nosocomial lower respiratory tract infections (LRTI) (mean age, 51 years). Ninety-six per cent (108/113) of the LRTI patients required respiratory assistance and 12% (14/113) had associated septicaemia/bacteraemia. Eighty-four per cent (95/113) had clinical signs of sepsis and 35% (39/113) had features of septic shock. The mean Simplified Acute Physiologic Score (SAPS) was 12 at inclusion. Seventy-nine patients with LRTI were clinically and bacteriologically evaluable. The causative pathogens were representative of those usually isolated in ICUs: Staphylococcus aureus (19%); Pseudomonas aeruginosa (14%); and Klebsiella, Enterobacter and Serratia spp. (17%). The clinical cure rate was 86% (68/79) while the pathogen eradication rate was 91% (107/117). Of the patients with associated septicaemia/bacteraemia, 89% (8/9) of the pathogens were eliminated. Cefepime-amikacin combination therapy was well tolerated; two patients discontinued treatment due to rashes. Combination therapy with cefepime 2 g bd and amikacin 7.5 mg/kg bd appears safe and effective for the treatment of nosocomial pneumonia in patients hospitalized in ICUs. Further comparative controlled studies are justified.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Amikacin; Bacteremia; Bacterial Infections; Cefepime; Cephalosporins; Critical Care; Cross Infection; Drug Therapy, Combination; Female; Follow-Up Studies; France; Humans; Male; Middle Aged; Respiratory Tract Infections; Shock, Septic

In order to determine the optimal dose of cefepime (CFPM) for respiratory tract infections, a dose finding study was conducted in patients with chronic respiratory tract infections, and the clinical properties of the drugs were compared with those of ceftazidime (CAZ). Each drug was administered by intravenous drip infusion at the dose of 2 g/day of CFPM, 4 g/day of CFPM or 2 g/day of CAZ for 14 days. 1. The overall efficacy rates evaluated by the committee were 82.6% (19/23) for the CFPM 2 g/day group, 85.0% (17/20) for the 4 g/day group and 79.3% (23/29) for the CAZ 2 g/day group, with no statistically significant difference among the three groups. 2. The overall efficacy rates evaluated by the attending physicians were 91.3% (21/23) for the CFPM 2 g/day group, 78.9% (15/19) for the CFPM 4 g/day group and 75.9% (22/29) for the CAZ 2 g/day group, with no significant difference among the three groups. 3. Bacteriological eradication rates were 88.2% (15/17) for the CFPM 2 g/day group, 68.8% (11/16) for the CFPM 4 g/day group and 63.2% (12/19) for the CAZ 2 g/day group, with no statistically significant difference among the three groups. 4. The incidences of adverse reactions were 3.8% (1/26) for the CFPM 2 g/day group, 9.1% (2/22) for the CFPM 4 g/day group and 3.4% (1/29) for the CAZ 2 g/day group, with no significant difference among the three groups. The incidences of abnormal laboratory findings were 37.5% (9/24) for the CFPM 2 g/day group, 15.0% (3/20) for the CFPM 4 g/day group and 3.4% (1/29) for the CAZ 2 g/day group. There was a significant difference among the three groups. 5. Utility rates assessed by the committee were 81.8% (18/22) for the CFPM 2 g/day group, 76.2% (16/21) for the CFPM 4 g/day group and 75.9% (22/29) for the CAZ 2 g/day group. Utility rates assessed by attending physicians were 90.9% (20/22), 78.9% (15/19) and 72.4% (21/29), respectively. There was no significant difference among the three groups. From the above results, it is concluded that the optimal dosage of CFPM is 2 g/day for chronic respiratory tract infections.

Topics: Adolescent; Adult; Aged; Bacteria; Cefepime; Ceftazidime; Cephalosporins; Chronic Disease; Dose-Response Relationship, Drug; Female; Humans; Male; Middle Aged; Respiratory Tract Infections

The clinical efficacy, safety and usefulness of Cefepime (CFPM), a new cephem antibiotics, in chronic respiratory infections were evaluated in a comparative study against Ceftazidime (CAZ). Each drug was administered by intravenous drip infusion at a dose of 1.0 g (nominal potency), twice daily for 14 days, and the following results were obtained: 1. A total of 170 cases were enrolled in this study. Efficacy rates ("good" or better responses) as evaluated by the subcommittee were 86.2% (56/65) in the CFPM group and 84.5% (60/71) in the CAZ group, with no significant difference between the two groups. 2. Efficacy rates ("good" or better responses) as evaluated by attending physicians were 83.3% (55/66) in the CFPM group and 84.5% (60/71) in the CAZ group with no significant difference between the two groups. 3. Bacteriologically, eradication rates were 83.3% (40/48) in the CFPM group and 88.2% (45/51) in the CAZ group, with no significant difference between the two groups. 4. Side effects occurred in none of the patients in the CAZ group and in 4 of the 66 patients in the CFPM group. There was a significant difference between the two groups (Fisher's test p = 0.0489). The incidence of abnormal laboratory findings were 17.6% (12/68) in the CFPM group and 21.1% (16/76) in the CAZ group. There was no significant difference between the two groups. 5. The utility rates evaluated by the subcommittee were 81.8% (54/66) in the CFPM group and 84.5% (60/71) in the CAZ group with no significant difference between the two groups. Only in the incidence of side effects, there was a significant difference between the two groups (Fisher's test p = 0.0489), but there was no significant difference in other items of efficacy, safety and usefulness between the two groups. These results indicate that CFPM is useful for the treatment of chronic respiratory tract infections.

Topics: Adolescent; Adult; Aged; Bacteria; Cefepime; Ceftazidime; Cephalosporins; Chronic Disease; Female; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Respiratory Tract Infections

To measure first-dose and steady-state plasma, urine, and sputum concentrations of cefepime and make preliminary assessments of the clinical efficacy of cefepime in patients with cystic fibrosis.. Open noncomparative clinical trial.. Memorial Miller Children's Hospital of Long Beach, Calif.. Twelve patients, aged 4 to 41 years, with a confirmed diagnosis of cystic fibrosis and chronic bronchopulmonary infections.. Patients received cefepime at 50 mg/kg per dose (maximum dose, 2 g per dose) given intravenously every 8 hours. Clinical evaluations, pulmonary function tests, quantitative sputum cultures, and sensitivity testing were performed before, at the end of, and 2 weeks after therapy.. Mean (+/- SD) peak plasma concentrations after the first dose were 148.2 (36.6) mg/L; the following other values were included: half-life, 1.59 (0.46) hours; area under the curve, 292 (94) microgram/h per milliliter; total-body clearance, 3.01 (1.46) mL/min per kilogram; volume of distribution at steady state, 0.32 (0.10) L/kg; and percent of dose recovered in urine, 52% (27%). Steady-state and first-dose values were similar. Trough levels varied from 6.4 to 7.2 mg/L. Mean (+/- SD) sputum concentrations at steady state varied from 6.3 (5.4) to 4.8 (2.3) mg/L. At completion of therapy, nine of 10 patients' conditions were improved as indicated by clinical scores (greater than 10 points), forced vital capacity (greater than 10%), and a greater than or equal to 1 log decrease in sputum bacterial concentration. Cefepime was well tolerated in 10 patients, but rash and light-headedness developed in two patients. Pseudomonas aeruginosa minimum inhibitory concentration90 increased from the start (64 mg/L) to the end of therapy (256 mg/L) and was unchanged 2 weeks later.. Based on these data and the potential advantage of a single agent for the treatment of mixed infections (Staphylococcus aureus and P aeruginosa), comparative clinical trials of cefepime and standard therapy for bronchopulmonary exacerbations in patients with cystic fibrosis appear to be warranted.

Topics: Adolescent; Adult; California; Cefepime; Cephalosporins; Child; Child, Preschool; Chronic Disease; Cystic Fibrosis; Female; Hospitals, Pediatric; Humans; Infusions, Intravenous; Male; Metabolic Clearance Rate; Microbial Sensitivity Tests; Respiratory Tract Infections; Severity of Illness Index; Sputum; Tissue Distribution; Vital Capacity

The safety and efficacy of cefepime, a new broad-spectrum, semisynthetic parenteral cephem antibiotic, were evaluated in an open trial at a single hospital. Seventy patients were treated with cefepime: 44 had lower respiratory tract infections, 4 had urinary tract infections, and 22 had skin or soft tissue infections. Of 65 clinically evaluable patients, 64 (98%) had satisfactory responses. No mortality or superinfections occurred. Of 57 respiratory and urinary tract pathogens, 54 (95%) were eradicated and 3 (5%) persisted after therapy. Five bacteremias (two with Streptococcus pneumoniae and one each with Staphylococcus aureus, Proteus mirabilis, and a coagulase-negative staphylococcus) were eradicated. MICs ranged from 1 to 8 micrograms/ml for 13 S. aureus and 9 Pseudomonas aeruginosa isolates and were less than or equal to 0.125 micrograms/ml for 10 streptococcal isolates. Adverse effects occurred in two patients: transient diarrhea and Clostridium difficile toxin in the stool in one patient and loose bowel movements and increased transaminases in the other patient. Cefepime appeared to be well tolerated in humans and was effective against a wide range of isolates, including S. aureus and P. aeruginosa.

Topics: Cefepime; Cephalosporins; Clinical Trials as Topic; Follow-Up Studies; Hospitalization; Humans; Infections; Lung; Microbial Sensitivity Tests; Respiratory Tract Infections; Skin; Skin Diseases, Infectious; Urinary Tract Infections; Urine

To investigate the drug-resistance rate of community-acquired respiratory tract pathogens isolated from class B hospitals in China during 2013 and 2014.. A total of 860 strains (S.pneumoniae 299, K. pneumoniae 221, H. influenzae 185, S. aureus 116, and M. catarrhalis 39) of non-duplicated community-acquired respiratory tract pathogens were isolated from 10 class B hospitals in 9 cities. The minimal inhibitory concentration (MIC) of antibacterial agents was determined by the broth microdilution method. The sensitive rates and MIC range of the antibiotics were analyzed by the WHONET-5.6 software.. Only 19.7%(59/299) S. pneumoniae was sensitive to oral penicillin. The sensitive rates of S. pneumoniae to second-generation cephalosporins(cefuroxime and cefaclor), amoxicillin with clavulanic acid, ceftriaxone, and macrolides (erythromycin, azithromycin and clarithromycin) were 25.6% (77/299), 33.4% (100/299), 63.5% (190/299), and 4.4% (13/299), respectively. About 93.5% (280/299)and 98.0% (293/299)of S. pneumoniae isolates were sensitive to levofloxacin and moxifloxacin.All of the K. pneumoniae isolates were sensitive to ertapenem and imipenem. The sensitive rates of K. pneumoniae to ceftriaxone, cefotaxime, ceftazidime, cefepime, and cefoxitin were about 85.0%, 93.2% (206/221), and 90.3% (200/221)of K. pneumoniae isolates were sensitive to levofloxacin and moxifloxacin.The mean prevalence of ESBL-producing K. pneumoniae was 8.1% (18/221). No S. aureus isolates resistant to vancomycin were detected in this study.The sensitive rates of S. aureus to levofloxacin, moxifloxacin, trimethoprim/sulfamethoxazole, and rifampin were 83.5% (97/116), 82.8% (96/116), 89.6% (104/116) and 83.5% (97/116), respectively. 37.4% (43/116) and 34.8% (40/116)of S. aureus isolates were sensitive to erythromycin and chloramphenicol.All of the H. influenzae and M. catarrhalis isolates were sensitive to amoxicillin with clavulanic acid, ceftriaxone, levofloxacin and moxifloxacin. The sensitive rates of H. influenza and M. catarrhalis to ampicillin, cefuroxime, cefaclor, erythromycin, azithromycin, and clarithromycin were from 80% to 100%.. Penicillins, second-generation cephalosporins (cefuroxime and cefaclor) and amoxicillin with clavulanic acid showed low antimicrobial activity to S. pneumoniae, but a higher sensitive rate to ceftriaxone. The macrolides exhibited a high activity against H. influenza and M. catarrhalis, but low antimicrobial activity against S. pneumoniae and S. aureus. The antimicrobial activity of fluoroquinolones such as levofloxacin and moxifloxacin against most of the respiratory pathogens was high.

Topics: Anti-Bacterial Agents; Aza Compounds; Cefepime; Cephalosporins; China; Clarithromycin; Community-Acquired Infections; Drug Resistance, Bacterial; Fluoroquinolones; Haemophilus influenzae; Humans; Klebsiella pneumoniae; Levofloxacin; Macrolides; Microbial Sensitivity Tests; Moraxella catarrhalis; Moxifloxacin; Penicillins; Respiratory Tract Infections; Staphylococcus aureus; Streptococcus pneumoniae

Antibiotics not only support to alleviate the infections but also facilitate to avert the multiplication of microbes. Due to the irrational use of antibiotics, the resistance of antibiotics has been augmented which results may increase in morbidity and mortality with the span of time. World renowned regulatory bodies like Food and Drug Administration (FDA), Center of Disease Control and Prevention (CDC), and World Health Organization (WHO) vigorously advocate the surveillance of the resistance of antibiotics. During the present study by Kirby-Bauer disk diffusion method 141 clinical isolates of Staphylococcus aureus (n=47, 33.34%), Escherichia coli (n=54, 38.3%), Proteus species (n=26, 18.4%), and Klebsiella pneumoniae (n=14, 9.92%) are evaluated against cefepime and cefpirome which comes of fourth generation cephalosporin. It has been found that cefpirome has better bactericidal activity than cefepime against E. coli and K. pneumoniae while cefepime has been possessed better antibacterial activity against S. aureus and Proteus species which were isolated from respiratory tract infections, blood stream infection, intra-abdominal and urinary tract infections, and skin and soft tissue infections. K. pneumoniae, E. coli, Proteus species, and S. aureus were 34.8%, 26.3%, 11.3%, and 37.7% resistance against cefepime respectively. S. aureus, E. coli, K. pneumoniae, Proteus species has shown 41.4%, 21.7%, 17.6%, and 8.9% resistance against cefpirome correspondingly.

Topics: Anti-Bacterial Agents; Bacteremia; Cefepime; Cefpirome; Cephalosporins; Drug Resistance, Bacterial; Escherichia coli; Escherichia coli Infections; Humans; In Vitro Techniques; Intraabdominal Infections; Klebsiella Infections; Klebsiella pneumoniae; Microbial Sensitivity Tests; Pakistan; Proteus; Proteus Infections; Respiratory Tract Infections; Skin Diseases, Bacterial; Soft Tissue Infections; Staphylococcal Infections; Staphylococcus aureus; Urinary Tract Infections

The results of the microbiological diagnosis of infective inflammatory complications in patients with iatrogenic esophageotracheal fistula and the tactics of their antibacterial prophylaxis and therapy within a 9-year observation period (2003-2011) were analysed. The main organisms colonizing the tracheobronchial tree in the patients were S. epidermidis, S. aureus, enteric bacteria, P. aeruginosa and Candida. An increase of the S. epidermidis resistance to rifampicin, moxifloxacin and especially ciprofloxacin was observed. The resistance of S. aureus did not significantly change. Within the observation period, high susceptibility of all the Staphylococcus isolates to vancomycin and linezolid remained stable. Among the nonfermenting gramnegative bacteria, the P. aeruginosa isolates were the most frequent and characterized by a lower portion of the isolates with preserved susceptibility to the agents (except polymyxin B) known earlier as antipyocyanic antibiotics, i.e. to imipenem and cefepim. Since the proportion of P. aeruginosa in the etiology of pyoinflammatory processes in the region of esophageotracheal fistula ranged within 9.3 to 17.5%, the fact should be considered in the antibiotic therapy. There was observed an increase in the frequency of infectious complications due to other nonfermenting gramnegative bacteria (acinetobacters) and first of all A.baumannii. Various Candida isolates were characterized by dependence of the susceptibility on the selective pressure of irrational therapy, as well as their species (the presence of such species as C. Krusei and C. glabrata with natural resistance), that required not only the species identification but also determination of the Candida isolates resistance in every particular case.

Topics: Acetamides; Anti-Bacterial Agents; Candida; Cefepime; Cephalosporins; Ciprofloxacin; Drug Resistance, Microbial; Enterobacteriaceae; Follow-Up Studies; Gram-Negative Bacteria; Gram-Positive Bacteria; Humans; Iatrogenic Disease; Imipenem; Intubation, Intratracheal; Linezolid; Microbial Sensitivity Tests; Monitoring, Physiologic; Oxazolidinones; Polymyxin B; Pseudomonas aeruginosa; Respiratory Tract Infections; Staphylococcus aureus; Staphylococcus epidermidis; Tracheoesophageal Fistula; Vancomycin

Topics: Aged; Anti-Bacterial Agents; Aphasia; Cefepime; Cephalosporins; Comorbidity; Female; Humans; Kidney; Kidney Failure, Chronic; Male; Middle Aged; Myoclonus; Pulmonary Edema; Renal Dialysis; Respiratory Tract Infections

Despite the increasing prevalence of multiple-drug-resistant (MDR) Pseudomonas aeruginosa, the factors predictive of MDR have not been extensively explored. We sought to examine factors predictive of MDR among patients with P. aeruginosa respiratory tract infections and to develop a tool to estimate the probability of MDR among such high-risk patients. This was a single-site, case-control study of patients with P. aeruginosa respiratory tract infections. Multiple-drug resistance was defined as resistance to four or more antipseudomonal antimicrobial classes. Clinical data on demographics, antibiotic history, and microbiology were collected. Classification and regression tree analysis (CART) was used to identify the duration of antibiotic exposure associated with MDR P. aeruginosa. Log-binomial regression was used to model the probability of MDR P. aeruginosa. Among 351 P. aeruginosa-infected patients, the proportion of MDR P. aeruginosa was 35%. A significant relationship between prior antibiotic exposure and MDR P. aeruginosa was found for all of the antipseudomonal antibiotics studied, but the duration of prior exposure associated with MDR varied between antibiotic classes; the shortest prior exposure duration was observed for carbapenems and fluoroquinolones, and the longest duration was noted for cefepime and piperacillin-tazobactam. Within the final model, the predicted MDR P. aeruginosa likelihood was most dependent upon length of hospital stay, prior culture sample collection, and number of CART-derived prior antibiotic exposures. A history of a prolonged hospital stay and exposure to antipseudomonal antibiotics predicts multidrug resistance among patients with P. aeruginosa respiratory tract infections at our institution. Identifying these risk factors enabled us to develop a prediction tool to assess the risk of resistance and thus guide empirical antibiotic therapy.

Topics: Adult; Anti-Bacterial Agents; Case-Control Studies; Drug Resistance, Multiple, Bacterial; Female; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Predictive Value of Tests; Pseudomonas aeruginosa; Pseudomonas Infections; Respiratory Tract Infections; Retrospective Studies; Risk; Risk Factors

Nonconvulsive status epilepticus is an unusual complication of cephalosporin therapy, with only a few isolated cases reported.. We reviewed the clinical and electroencephalographic (EEG) characteristics of 10 patients with renal failure in whom developed alteration of consciousness without convulsions associated with continuous epileptiform EEG activity while being treated with cephalosporins.. Nonconvulsive status epilepticus developed in 5 men and 5 women, with a mean (+/- SD) age of 69 +/- 14 years, while receiving intravenous cephalosporins (ceftriaxone, 2 patients; ceftazidime, 2; and cefepime, 6). All patients had renal failure; 1 also had hepatic failure. Patients presented with progressive disorientation or agitation, sometimes associated with mild facial or limb myoclonus, that had begun 1 to 10 days (mean, 5 +/- 2 days) after starting cephalosporin treatment. The EEG showed continuous or intermittent bursts of generalized, high-voltage, 1 to 2 Hz sharp wave activity or sharp and slow wave activity that resembled, but could be differentiated from, the triphasic waves seen in metabolic encephalopathies. Intravenous clonazepam suppressed the epileptiform activity completely in 5 patients and partially in the other 5. Cephalosporins were withdrawn, and antiepileptic therapy was started for all patients. All patients improved, 2 in less than 24 hours and the remainder within 2 to 7 days.. Cephalosporins can cause nonconvulsive status epilepticus in patients with renal failure. The clinical picture is difficult to differentiate from a that of metabolic encephalopathy unless an EEG is obtained. Physicians should be aware of this potentially dangerous complication.

Topics: Adult; Aged; Aged, 80 and over; Brain; Cefepime; Ceftazidime; Ceftriaxone; Cephalosporins; Electroencephalography; Female; Humans; Infusions, Intravenous; Male; Meningitis, Bacterial; Middle Aged; Osteomyelitis; Renal Insufficiency; Respiratory Tract Infections; Status Epilepticus

The steady-state pharmacokinetics of cefepime were evaluated in 10 middle-aged and elderly patients with acute lower respiratory tract infections who were receiving 1 g intravenously every 12 h. One preinfusion and 15 postinfusion serum samples and total urine output were collected over one dosing interval between days 3 and 8 of therapy. Cefepime concentrations in serum over time exhibited a multicompartmental profile. Peak and trough concentrations in serum determined by a validated high-performance liquid chromatography method were 71.2 +/- 17.2 (mean +/- standard deviation) and 6.0 +/- 4.9 mg/liter, respectively. The steady-state volume of distribution was 0.22 +/- 0.05 liter/kg. Elimination half-lives ranged from 1.93 to 6.04 h (3.92 +/- 1.28 h), and total body clearances ranged from 36.9 to 102 ml/min per 1.73 m2 (73.0 +/- 19.7 ml/min per 1.73 m2). The disposition of cefepime at steady state in patients was comparable to previous observations in healthy elderly volunteers. The predictive performance of regression equations derived from single-dose studies in volunteers relating creatinine clearance with total body and renal clearances of cefepime exhibited slight biases (mean predictive errors, -9.7 and 2.1 ml/min per 1.73 m2, respectively) and similar precisions. Predicted and observed total body clearances (63.3 +/- 25.1 versus 73.0 +/- 19.7 ml/min per 1.73 m2, respectively) and renal clearances (51.3 +/- 24.4 versus 49.3 +/- 19.6 ml/min per 1.73 m2, respectively) were not significantly different. The pharmacokinetics of cefepime in infected patients appeared to be unaltered by illness, and the steady-state disposition of cefepime was predictable from data derived from single-dose studies in volunteers.

Topics: Aged; Aged, 80 and over; Cefepime; Cephalosporins; Female; Humans; Infusions, Intravenous; Male; Metabolic Clearance Rate; Middle Aged; Respiratory Tract Infections