cefotaxime and Cross-Infection

Pneumonia complicates the course of 50% of patients on mechanical ventilation, requiring three or more days of mechanical ventilation and potentially increasing the relative risk of mortality by 20-40%. The predominant potentially pathogenic micro-organisms are Streptococcus pneumoniae, Staphylococcus aureus (sensitive to methicillin in the previously healthy host), Pseudomonas aeruginosa (aerobic gram-negative bacilli), and methicillin-resistant Staphylococcus aureus in the host with underlying disease. Approximately 85% of pneumonias are endogenous, caused by bacteria present in the patient's oropharyngeal flora. Bacteria present on admission cause primary endogenous pneumonia (55%), whereas bacteria acquired in the unit lead to supercarriage or secondary carriage and subsequently secondary endogenous pneumonia (30%). The remaining 15% are exogenous, ie the bacteria causing pneumonia are not carried by the patient. The diagnosis is usually based on clinical, radiological, and microbiological criteria, using the non-invasive method of tracheal aspirate, which yields >/=10(5) micro-organisms. Seven randomized trials have evaluated three non-antibiotic prophylactic maneuvers: hygiene (1 trial), subglottic drainage (4 trials), and semirecumbent position (2 trials). The impact on pneumonia was mixed, whereas mortality was unchanged. Selective digestive decontamination, using parenteral and enteral antimicrobials to control the three types of pneumonia, has been evaluated in 54 trials and showed an absolute mortality reduction of 8%. The therapy of pneumonia relies on six basic principles: (a) surveillance and diagnostic cultures to identify micro-organisms; (b) immediate and adequate antibiotic treatment to sterilize the lower airways, (c) the source of potential pathogens requires elimination for recovery of the original infection and prevention of relapses and/or superinfections; (d) aerosolized antimicrobials; (e) removal or replacement of the endotracheal tube; and (f) surveillance samples are indispensable to monitor efficacy of treatment. The aim of our review was to evaluate up to date facts regarding control of bacterial pneumonias during mechanical ventilation in intensive care unit settings.

Topics: Amphotericin B; Anti-Bacterial Agents; Cefotaxime; Chemoprevention; Cross Infection; Equipment Contamination; Humans; Hygiene; Intensive Care Units; Length of Stay; Pneumonia, Bacterial; Polymyxin B; Respiration, Artificial; Tobramycin

Selective decontamination of the digestive tract (SDD) is a strategy designed to prevent or minimize the impact of infections by potentially pathogenic micro-organisms in critically ill patients requiring long-term mechanical ventilation. SDD is a four-component protocol to control the three types of infections occurring in intensive care patients: (a) a parenteral antibiotic, cefotaxime, for a few days to prevent primary endogenous infections that generally occur 'early'; (b) the topical antimicrobial drugs colistine (polymyxin E), tobramycin and amphotericin B (together: PTA) used throughout the stay in the intensive care unit (ICU) to prevent secondary endogenous infections developing in general 'late'; (c) a high standard of hygiene to prevent exogenous infections that may occur throughout the ICU stay; (d) surveillance samples of throat and rectum to distinguish between the three types of infection, to monitor compliance and efficacy of treatment and to detect emergence of resistance at an early stage. The most recent and rigorous meta-analysis examined 33 randomized SDD trials involving 5727 patients. It shows significant reductions, in overall mortality by 20% and in the incidence of lower airway infections by 65%. It failed to detect any report on the emergence of resistance and associated superinfections and/or out-breaks in the 33 studies covering a period of more than 10 years. Using the criterion of cost-per-survivor, four recent randomised trials showed that it is cheaper to produce a survivor using SDD than with the traditional approach.

Topics: Amphotericin B; Bacterial Infections; Cefotaxime; Clinical Protocols; Colistin; Critical Care; Critical Illness; Cross Infection; Decontamination; Digestive System; Drug Therapy, Combination; Female; Humans; Intensive Care Units; Male; Survival Rate; Tobramycin

Clostridium difficile diarrhoea is an increasingly important nosocomial infection. Clostridium difficile infection is associated with antibiotic use. The elderly are at greatest risk. We reported an outbreak associated with the use of cefotaxime, a third-generation cephalosporin. We review the extent of this association, putative causal mechanisms and suggest an integrated approach to the control of C difficile infection which focuses on both limiting environmental contamination and reducing patient susceptibility. Future developments are also considered, especially the potential for vaccination.

Topics: Aged; Cefotaxime; Cephalosporins; Clostridioides difficile; Cross Infection; Diarrhea; Enterocolitis, Pseudomembranous; Forecasting; Humans; Risk Factors

The use of the broad-spectrum cephalosporin, cefotaxime, in internal medicine is well-established, particularly in the treatment of moderately severe to severe community- and hospital-acquired infections. It is particularly useful for infections of the lower respiratory tract, urinary and biliary systems, skin and soft tissue, and in serious conditions, such as meningitis, particularly in pediatric patients. Knowledge of the pharmacokinetic and pharmacodynamic properties of cefotaxime supports the view that low dose (1-2 g), low frequency (12-hourly) dosage regimens are applicable to many mild-to-moderately severe infections, including community-acquired pneumonia, caused by susceptible organisms.

Topics: Adolescent; Adult; Cefotaxime; Cephalosporins; Child; Clinical Trials as Topic; Community-Acquired Infections; Cross Infection; Humans; Microbial Sensitivity Tests; Middle Aged

The "third-generation" cephalosporins (3GC) have emerged as one of the most significant therapeutic entities in the last 15 years. These 3GC compounds (using cefotaxime as a model) have generally maintained their potency and spectrum of activity against important pathogens. However, the continuing popularity of this class associated with local, regional, or national-level use or abuse has led to efficacy reduction against some organism populations associated with selection of Class I cephalosporinase, stably derepressed mutants predominantly among Citrobacter and Enterobacter spp.; emergence of extended-spectrum beta-lactamase producing Enterobacteriaceae (usually Klebsiella spp.), as well as some isolates mimicking Class I-type resistance patterns; and lastly, altered PBP-mediated resistances among pneumococci, Haemophilus influenzae and pathogenic Neisseria spp. Some of these resistance patterns had been present prior to the clinical introduction of 3GCs and have only significantly threatened their use in the last 5 years. Prudent application of these 3GC drugs should be the goal for this decade as follows: 1) use as monotherapy at appropriate doses and frequencies only for organisms with low potential for mutational events; 2) use combination therapy routinely for organisms such as Citrobacter, Enterobacter, some indole-positive protease and Pseudomonas aeruginosa, to minimize emerging resistance clones; 3) use conservatively in high risk patients to minimize "super-colonization" by emerging problem bacteria (e.g. vancomycin-resistant enterococci, Xanthomonas maltophilia etc.); 4) use only those agents among 3GCs that have documented safety, broad clinical applications to all age groups, acceptable pharmacokinetic features and clear cost-saving potential; and 5) use in prophylaxis (surgical procedure, selective decontamination), should be focused toward single-dose or short-course regimens to reduce total hospital-wide exposure to broad-spectrum beta-lactam drugs.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Cefotaxime; Cephalosporin Resistance; Clinical Trials as Topic; Cross Infection; Humans; Microbial Sensitivity Tests; Multicenter Studies as Topic

All 324 patients admitted over sixteen months to a general intensive therapy unit (ITU) were prospectively studied to assess the effect of a novel prophylactic antibiotic regimen on the incidence of acquired infection. Consecutive control (161 patients) and test (163 patients) groups were analyzed. In the control group, antibiotic administration was determined by clinical and microbiological evidence of infection. In the test group, treatment consisted of a triple regimen of selective decontamination of the digestive tract (polymyxin E, tobramycin, and amphotericin B) administered throughout the ITU stay, systemic cefotaxime administered for the initial four days, and regular microbiological screening of multiple sites. The test group showed a striking and consistent reduction in colonisation of the digestive tract with aerobic gram-negative bacilli, and there was a substantial reduction in the incidence of acquired infection (24% to 10%). Mortality in certain categories of patients was also reduced. There is now a considerable body of evidence to justify the more widespread use of this selective parenteral and enteral anti-sepsis regimen (SPEAR) in general intensive care practice.

Topics: Adult; Aged; Anti-Bacterial Agents; Cefotaxime; Cross Infection; Digestive System; Disinfection; Drug Combinations; Humans; Intensive Care Units; Length of Stay; Middle Aged; Postoperative Complications; Prospective Studies; Pseudomonas; Pseudomonas Infections; Respiratory Tract Diseases; Sterilization; Yeasts

Nosocomial aspiration pneumonia and infections of soft tissue are most often caused by mixed aerobic and anaerobic pathogens. Single-agent therapy with a beta-lactam antibiotic is tending to replace combination therapy because it is as effective and less toxic. Important considerations in choosing among the beta-lactam antibiotics include a long pharmacologic half-life, permitting less frequent administration, and cost per gram.

Topics: Cefazolin; Cefotaxime; Ceftizoxime; Cost Control; Cross Infection; Diabetes Complications; Half-Life; Humans; Pneumonia, Aspiration; Skin Ulcer

Topics: Administration, Intravenous; Aged; Amphotericin B; Anti-Bacterial Agents; Cefotaxime; Cluster Analysis; Colistin; Critical Care; Cross Infection; Cross-Over Studies; Decontamination; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Gastrointestinal Tract; Hospital Mortality; Humans; Intensive Care Units; Intubation, Gastrointestinal; Male; Middle Aged; Netherlands; Odds Ratio; Oropharynx; Primary Prevention; Survival Analysis; Tobramycin; Treatment Outcome

Selective digestive decontamination (SDD) and selective oropharyngeal decontamination (SOD) are effective in improving survival in patients under intensive care. In this study possible differential effects in surgical and non-surgical patients were investigated.. This was a post hoc subgroup analysis of data from a cluster-randomized multicentre trial comparing three groups (SDD, SOD or standard care) to quantify effects among surgical and non-surgical patients. The primary study outcome was 28-day mortality rate. Duration of mechanical ventilation, duration of intensive care unit (ICU) and hospital length of stay, and bacteraemia rates were secondary outcomes.. The subgroup analyses included a total of 2762 surgical and 3165 non-surgical patients. Compared with standard care, adjusted odds ratios (ORs) for mortality were comparable in SDD-treated surgical and non-surgical patients: 0·86 (95 per cent confidence interval 0·69 to 1·09; P = 0·220) and 0·85 (0·70 to 1·03; P = 0·095) respectively. However, duration of mechanical ventilation, ICU stay and hospital stay were significantly reduced in surgical patients who had SDD. SOD did not reduce mortality compared with standard treatment in surgical patients (adjusted OR 0·97, 0·77 to 1·22; P = 0·801); in non-surgical patients it reduced mortality (adjusted OR 0·77, 0·63 to 0·94; P = 0·009) by 16·6 per cent, representing an absolute mortality reduction of 5·5 per cent with number needed to treat of 18.. Subgroup analysis found similar effects of SDD in reducing mortality in surgical and non-surgical ICU patients, whereas SOD reduced mortality only in non-surgical patients. The hypothesis-generating findings mandate investigation into mechanisms between different ICU populations.

Topics: Administration, Oral; Amphotericin B; Anti-Bacterial Agents; Antibiotic Prophylaxis; Bacteremia; Cefotaxime; Cluster Analysis; Colistin; Critical Care; Cross Infection; Decontamination; Digestive System Diseases; Drug Combinations; Female; Hospital Mortality; Humans; Infusions, Intravenous; Intubation, Gastrointestinal; Length of Stay; Male; Middle Aged; Oropharynx; Pharyngeal Diseases; Respiration, Artificial; Tobramycin

Selective digestive tract decontamination aims to eradicate gram-negative bacteria in both the intestinal tract and respiratory tract and is combined with a 4-day course of intravenous cefotaxime. Selective oropharyngeal decontamination only aims to eradicate respiratory tract colonization. In a recent study, selective digestive tract decontamination and selective oropharyngeal decontamination were associated with lower day-28 mortality, when compared to standard care. Furthermore, selective digestive tract decontamination was associated with a lower incidence of intensive care unit-acquired bacteremia caused by gram-negative bacteria. We quantified the role of intestinal tract carriage with gram-negative bacteria and intensive care unit-acquired gram-negative bacteremia.. Data from a cluster-randomized and a single-center observational study.. Intensive care unit in The Netherlands.. Patients with intensive care unit stay of >48 hrs that received selective digestive tract decontamination (n = 2,667), selective oropharyngeal decontamination (n = 2,166) or standard care (n = 1,945).. Selective digestive tract decontamination or selective oropharyngeal decontamination.. Incidence densities (episodes/1000 days) of intensive care unit-acquired gram-negative bacteremia were 4.5, 3.0, and 1.4 during standard care, selective oropharyngeal decontamination, and selective digestive tract decontamination, respectively, and the daily risk for developing intensive care unit-acquired gram-negative bacteria bacteremia increased until days 36, 33, and 31 for selective digestive tract decontamination, standard care, and selective oropharyngeal decontamination and was always lowest during selective digestive tract decontamination. Rectal colonization with gram-negative bacteria was present in 26% and 71% of patient days during selective digestive tract decontamination and selective oropharyngeal decontamination, respectively (p < .01). Irrespective of interventions, incidence densities of intensive care unit-acquired gram-negative bacteremia was 4.5 during patient days with both intestinal and respiratory tract gram-negative bacteria carriage. These incidence densities reduced with 33% (to 3.1) during days with intestinal gram-negative bacteria carriage only and with another 45% (to 1.0) during days without gram-negative bacteria carriage at both sites.. Respiratory tract decolonization was associated with a 33% and intestinal tract decolonization was associated with a 45% reduction in the occurrence of intensive care unit-acquired gram-negative bacteremia.

Topics: Bacteremia; Cefotaxime; Cluster Analysis; Colony Count, Microbial; Cross Infection; Decontamination; Drug Administration Schedule; Female; Follow-Up Studies; Gastroenteritis; Gastrointestinal Tract; Gram-Negative Bacteria; Gram-Negative Bacterial Infections; Humans; Incidence; Infusions, Intravenous; Intensive Care Units; Intestines; Male; Netherlands; Oropharynx; Proportional Hazards Models; Prospective Studies; Respiratory Tract Infections; Risk Assessment; Standard of Care; Treatment Outcome

Rates of Clostridium difficile diarrhoea have recently been rising, with the elderly being at highest risk.. To compare the incidence of C. difficile colonization and diarrhoea in elderly patients treated for presumed infection with either empirical cefotaxime (CTX) or piperacillin-tazobactam (PT).. A prospective, ward-based, crossover study was carried out on two well-matched care of the elderly wards at a UK tertiary care hospital, in patients requiring empirical broad-spectrum antibiotic treatment.. There was a highly significant increased incidence of C. difficile colonization (26/34 vs. 3/14, P=0.001) and diarrhoea (18/34 vs. 1/14, P=0.006) in patients who received CTX as opposed to PT. DNA fingerprinting suggested that most infections arose from strains acquired from the hospital environment.. Elderly patients are significantly less likely to develop C. difficile diarrhoea after treatment with PT than after CTX. The source of C. difficile appears to be predominantly from the ward environment.

Topics: Aged; beta-Lactamase Inhibitors; Cefotaxime; Clostridioides difficile; Cross Infection; Cross-Over Studies; Diarrhea; Drug Combinations; Enterocolitis, Pseudomembranous; Enzyme Inhibitors; Female; Humans; Male; Opportunistic Infections; Penicillanic Acid; Piperacillin; Prospective Studies; Tazobactam

To determine whether selective decontamination of the digestive tract exerts any long-term effects on antimicrobial resistance patterns.. A surveillance and interventional study comparing the antimicrobial sensitivity patterns of clinically important bacterial isolates the year before a 2-yr, double-blind, randomized, controlled study of selective decontamination of the digestive tract, and for the year thereafter when no use of the regimen was made.. A ten-bed respiratory intensive care unit (ICU) in a 1,200-bed teaching hospital.. All 1,528 patients admitted to the ICU over the 4-yr study period were included. There were 406 patients admitted in the year before the study of decontamination of the digestive tract (65% medical, 23% surgical, and 12% trauma), of whom 76% required mechanical ventilation. There were 719 patients admitted during the 2-yr study of selective decontamination (55% medical, 28% surgical, and 17% trauma), of whom 79.6% required mechanical ventilation. There were 403 patients admitted in the subsequent year (61% medical, 25% surgical, and 14% trauma), of whom 76.9% required mechanical ventilation.. We performed daily clinical monitoring to detect nosocomial infection, with microbiological investigation when clinically indicated, as well as twice-weekly routine microbiological surveillance sampling. Antimicrobial susceptibility testing using standard laboratory methods was also performed. Selective decontamination of the digestive tract included parenteral cefotaxime and oral and enteral polymyxin E, amphotericin B, and tobramycin.. The occurrence rate of nosocomial infection was 20.6%, 16.6%, and 25.3%, respectively, in the three study periods. In the year after selective decontamination, there was an increase in the occurrence rate of infection (p = .005), with an-associated increase in infections caused by the Enterobacteriaceae, while a reduction in the level of resistance to the third-generation cephalosporins were found (p = .07). There was a progressive increase in the occurrence rate of infections caused by Acinetobacter species (p = .05). Only 11 infections over the 4 yrs were caused by Enterococcus species. Staphylococcal infections were uncommon (5.7% of admissions), and the level of methicillin resistance did not change. No increase in aminoglycoside resistance occurred.. No long-term effects on antimicrobial resistance or the spectrum of nosocomial pathogens could be attributed to the use of selective decontamination of the digestive tract over a 2-yr period in a respiratory ICU admitting all categories of patients.

Topics: Adult; Amphotericin B; APACHE; Bacteria; Cefotaxime; Colistin; Cross Infection; Digestive System; Double-Blind Method; Drug Resistance, Microbial; Drug Therapy, Combination; Female; Humans; Intensive Care Units; Male; Prospective Studies; Respiration, Artificial; Tobramycin

The role of selective decontamination of the digestive tract (SDD) for the prevention of nosocomial infection in critically ill patients remains controversial, and the efficacy of this technique in patients who are already infected on presentation to the intensive care unit has not previously been assessed. We performed a double-blind randomized placebo controlled trial of SDD (parenteral cefotaxime, six-hourly oral and enteral polymyxin E, tobramycin, and amphotericin B vs placebo) for all infected patients presenting to the ICU requiring mechanical ventilation for more than 48 hours and ICU stay of more than 5 days. Daily clinical and microbiological monitoring for secondary infection was undertaken until hospital discharge. In all, 59 selective decontamination and 76 placebo fully comparable patients fulfilled criteria for enrollment and analysis (APACHE II 15.2 vs 15.1). The number of patients receiving SDD who developed nosocomial infections was significantly reduced (P = 0.048), and there were no infections caused by the enterobacteriaceae or Candida spp in this group. No difference in ICU (17.5 vs 18.8 days) or hospital stay (32.7 vs 34.2 days) or mortality (17% vs 22.3%) was shown. Critically ill, primarily infected patients are protected from nosocomial infection by the use of SDD.

Topics: Administration, Oral; Adult; Amphotericin B; Cefotaxime; Colistin; Critical Care; Critical Illness; Cross Infection; Digestive System; Double-Blind Method; Drug Therapy, Combination; Female; Humans; Intensive Care Units; Length of Stay; Male; Middle Aged; Placebos; Prospective Studies; Respiration, Artificial; Survival Rate; Tobramycin

To evaluate the efficacy of the technique of selective decontamination of the digestive tract (SDD) in preventing secondary infections in patients with neurologic diseases requiring intensive care.. Randomized, double-blind, placebo-controlled trial using amphotericin B, polymyxin E, and tobramycin applied to the oropharynx and enterally; all patients received intravenous cefotaxime for 72 h.. Respiratory ICU.. Forty patients with neurologic diseases requiring ventilation for > 48 h and ICU stay > 5 days. Neurologic diagnosis included acute inflammatory demyelinating neuropathy (15), meningoencephalitis (10), status epilepticus (6), tetanus (6), and myasthenia gravis (3).. Microbiologic surveillance samples of oropharyngeal and tracheal secretions, gastric aspirates, stool, urine, and any other potentially infected sites were taken at the time of ICU admission and twice weekly thereafter until 3 days after discharge from the unit. The SDD was applied every 6 h to the oropharynx and enterally.. Effective decontamination of the gastrointestinal tract was achieved in the patients receiving the active regimen; however, there was no reduction in the incidence of infections (11 in the active group vs 10 in placebo), and duration of ICU stay (30.1 +/- 22.5 vs 20.6 +/- 17.7 days) and hospital stay (49.3 +/- 31.9 vs 40 +/- 33.4 days) were unaffected as was the mortality (15 percent vs 15 percent).. SDD did not reduce the incidence of secondary infection in patients with neurologic disease, nor did it affect morbidity or mortality; however, it adds considerably to the cost of patient care.

Topics: Administration, Oral; Adult; Cefotaxime; Cross Infection; Digestive System; Double-Blind Method; Drug Therapy, Combination; Female; Humans; Intensive Care Units; Intubation, Gastrointestinal; Male; Nervous System Diseases; Premedication; Respiration, Artificial; Respiratory Insufficiency; Severity of Illness Index

Hospital-acquired infections still represent a serious threat to the surgical patient. A nationwide survey of 259 Italian surgical wards involving 11,343 patients was conducted in October 1988. Hospital-acquired infections were recorded in 565 (5%) patients: the microorganisms most commonly involved were gram-negative rods (60% of all isolates), 41% of the infected patients presented one or more intrinsic predisposing factor, and 65% had undergone some invasive procedure. The studied group represented 23% of all surgical patients in the country on the days of the survey. Following the epidemiologic survey, an open multicenter study was conducted in the same wards to evaluate the efficacy and tolerability of cefotaxime (1 g, 2 or 3 times per day) in the treatment of nosocomial surgical infections. Among 3,032 evaluable patients, 1,295 intra-abdominal, 610 wound and soft tissue, 554 urinary, and 367 respiratory infections were observed. Treatment was judged to be clinically effective in 94% of patients, and side effects, mostly involving the gastrointestinal tract, were observed in 1.4% of patients; but interruption of the treatment was required only in 19 patients (0.6%). This study confirms that cefotaxime, after over a decade of use, retains high efficacy in the treatment for nosocomial infections and induces a low rate of side effects.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Cefotaxime; Child; Child, Preschool; Cross Infection; Female; Humans; Infant; Italy; Male; Middle Aged; Postoperative Complications; Premedication; Risk Factors; Surgical Procedures, Operative

Four hundred and seventy patients who had undergone neurosurgical operations were studied prospectively. After defining post-operative infection so that is included all the infective complications irrespective of location occurring after surgery, the overall infection rate was 17%. The infection rate in 413 cases without pre-existing infection was 15%. Wound infection was recorded in 5% and meningitis in 6%. Risk factors which lead to a significant increase in the incidence of postoperative infection were found to be altered sensorium, multiple operations, pre-existing infection, emergency surgery, duration of surgery more than 4 hours, urinary catheterisation, cerebrospinal fluid leak, and ventilatory support.

Topics: Administration, Oral; Bacterial Infections; Cefotaxime; Central Nervous System Diseases; Cephalexin; Cerebrospinal Fluid Shunts; Cross Infection; Female; Gentamicins; Humans; Injections, Intramuscular; Male; Meningitis, Bacterial; Middle Aged; Penicillins; Premedication; Prospective Studies; Risk Factors; Surgical Wound Infection

The aim of prophylactic antibiotic therapy in urological surgery is the prevention of local or systemic infections. The authors treated 100 patients prophylactically; 62 were treated with amikacin and 38 with cefotaxime. Of the 62 patients treated with amikacin, 18 had infectious complications. Of the 38 patients treated with cefotaxime, ten had infectious complications. We conclude that in the Hospital do Desterro the incidence of infectious complications is high, despite antibiotic prophylaxis.

Topics: Amikacin; Cefotaxime; Clinical Protocols; Cross Infection; Humans; Portugal; Postoperative Complications; Premedication; Risk Factors; Urinary Catheterization; Urology

A multicenter Canadian study enrolled 74 persons to compare low-dose cefotaxime at 1 g every 8 hr to ceftriaxone 1 g every 12 hr in patients with nosocomial pneumonia. Of 57 evaluable patients (30 cefotaxime and 27 ceftriaxone) in this preliminary report, 93% responded to therapy in both groups. Ceftriaxone patients tended to have more side effects (14.2%). This study is continuing to accrue patients to achieve 100 evaluable patients. Interim data, however, support the continued use of low-dose cefotaxime as an appropriate alternative for clinically effective and cost-effective management of nosocomially acquired pneumonia.

Topics: Adult; Aged; Aged, 80 and over; Cefotaxime; Ceftriaxone; Cross Infection; Female; Humans; Injections, Intravenous; Male; Middle Aged; Pneumonia

To evaluate the use of selective decontamination of the digestive tract (SDD) (polymyxin, amphotericin, tobramycin, and intravenous cefotaxime) in a mixed intensive care unit, we performed a stratified, randomized, prospective study. The 331 patients were recruited over an 18-month period, with 256 patients remaining more than 48 hours. Stratification by acute physiology and chronic health evaluation (APACHE II) preceded randomization to control (standard antibiotic therapy) or treatment (SDD) groups. Nosocomial infection was significantly reduced in the SDD group (16.7%; 21 of 126 patients) compared with the control group (30.8%; 40 of 130 patients; p = 0.008). No difference was found in overall mortality rate or length of stay between the two groups. Those patients with admission APACHE II scores 10 to 19 demonstrated the most significant reduction in nosocomial infection (23 of 70 control vs 13 of 76 SDD; p = 0.03) and mortality (15 of 70 control vs 8 of 76 SDD; p = 0.07). Emergence of multiresistant microorganisms was not a clinical problem, but a definite change occurred in the ecology of environmental and colonizing bacteria. With the exception of cefotaxime, a reduction was noted in systemic antibiotic usage in the SDD group. We conclude that SDD is useful in selected patients in a mixed intensive care unit.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Amphotericin B; Bacterial Infections; Cefotaxime; Cost-Benefit Analysis; Critical Care; Cross Infection; Digestive System; Drug Therapy, Combination; Female; Humans; Length of Stay; Male; Middle Aged; Polymyxins; Prospective Studies; Tobramycin

In a multicentre clinical trial involving 32 hospitals, 588 adult patients diagnosed with nosocomial pneumonia and not receiving mechanical ventilation were treated randomly with monotherapy with cefotaxime or the antibiotic combination routinely used in each particular hospital. Both groups of patients were similar regarding demographic data, concurrent diseases, additional therapies and causative organism. Protocol violations were recorded in 40 patients, and these patients were excluded from the evaluation of treatment efficacy. The cure rate was 79% in the cefotaxime group and 71% in the group receiving antibiotic combinations; this difference is statistically significant (p = 0.03, Fisher's two-tailed test). In the patients receiving combinations of cephalosporins having activity predominantly against gram-positive organisms plus aminoglycosides, the cure rate obtained was very low. The frequency of serious adverse reactions was significantly higher in the group treated with antibiotic combinations. It is concluded that monotherapy with cefotaxime is the regimen that offers better results for the empirical treatment of nosocomial pneumonia.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Cefotaxime; Cross Infection; Drug Administration Schedule; Drug Therapy, Combination; Humans; Middle Aged; Pneumonia; Prospective Studies

In a multicentre non-randomized open prospective study, 124 patients hospitalized in medical infectious disease or intensive care units, with severe community and hospital-acquired bacterial infections were treated with 15 mg/kg body weight amikacin in a once-daily dose given as a 30 min iv infusion, combined with other antibiotics. Infections were bacteriologically proven in 101 patients. The clinical responses showed 83.1% primary success and 83.9% definitive cure predominantly in intensive care patients with hospital-acquired infections and pneumonia. Bacteriological eradication was achieved in 67.3%. Bacteria associated with true failures and colonizations were predominantly Pseudomonas, Acinetobacter and Staphylococcus spp. The risk of nephrotoxicity may be decreased with such a regimen of amikacin, but no conclusions could be drawn with regard to ototoxicity. In summary, a once-daily dosing regimen of amikacin 15 mg/kg is practical and probably efficacious and safe in severely infected patients.

Topics: Adult; Aged; Amikacin; Bacterial Infections; Cefotaxime; Ceftazidime; Cross Infection; Drug Administration Schedule; Drug Therapy, Combination; Female; Gram-Negative Bacteria; Gram-Positive Bacteria; Humans; Imipenem; Male; Middle Aged; Ofloxacin; Piperacillin; Prospective Studies

181 patients undergoing resection of the oesophagus for carcinoma were randomised to receive selective decontamination (test group) or conventional perioperative antibiotic prophylaxis (controls). 114 patients were finally included in the study: 12 of 56 test patients had 18 infections, whereas 32 of 58 controls acquired 51 infections. Colonisation with aerobic gram-negative microorganisms, and the number of postoperative respiratory tract infections were significantly lower in the test patients. The postoperative therapeutic use of antibiotics was significantly lower in the test group. No endogenous infections were caused by gram-negative bacilli in the test group. Selective decontamination reduces colonisation with gram-negative bacilli and postoperative infections after resection of the oesophagus.

Topics: Adult; Aged; Cefotaxime; Chi-Square Distribution; Cross Infection; Drug Administration Schedule; Drug Evaluation; Esophageal Neoplasms; Female; Follow-Up Studies; Gram-Negative Aerobic Bacteria; Humans; Length of Stay; Male; Metronidazole; Middle Aged; Premedication; Prospective Studies; Randomized Controlled Trials as Topic; Respiratory Tract Infections; Surgical Wound Infection

The combination aztreonam + cefotaxime (AZ + CE) was compared to amikacin + cefotaxime (AM + CE) in the treatment of nosocomial pneumonia acquired at the intensive-care unit. This study included a total of 33 patients fulfilling criteria for nosocomial pneumonia. 16 of them were randomly allocated to the AZ + CE group and 17 to the AM + CE group. The empirical treatment was effective for 78% of AZ + CE cases and 92% of AM + CE cases (p = NS). Clinical care was observed in 77% of cases (10 out of 13 evaluable) in the AZ group and in 75% of the group treated with AM (12 cases out of 16 evaluable; p = NS). In the evaluable cases, treatment failure was associated with injections due to the following organisms: Acinetobacter calcoaceticus (1) and Pseudomonas aeruginosa (1) in the AZ group and A. calcoaceticus (1) in the AM group. Superinfections were observed only in the AM group P. aeruginosa. A. calcoaceticus, Streptococcus viridans, Candida albicans, Aspergillus fumigatus and Serratia marcescens. Both the peak and through serum concentrations of AZ and AM were maintained within normal ranges. Finally, an impairment of renal tubular function was observed in the group of patients treated with AM, as measured by urinary levels of N-acetyl-beta-D-glucosaminidase and leucine aminopeptidase sequentially during the treatment. These changes in renal functions alterations mentioned were not observed in the AZ group. It is concluded that the AZ + CE combination is an effective empirical and active antibiotic treatment against severe nosocomial pneumonia. Aztreonam has no renal toxicity, which is an advantage to take into account in patients with altered renal function.

Topics: Adult; Aged; Amikacin; Aztreonam; Cefotaxime; Clinical Trials as Topic; Cross Infection; Drug Therapy, Combination; Female; Humans; Intensive Care Units; Male; Middle Aged; Pneumonia; Random Allocation

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

93 patients were enrolled into a prospective randomised study to determine the efficacy and safety of netilmicin, cefotaxime or their combination in the treatment of sepsis caused by susceptible strains of Enterobacteriaceae or staphylococci. 83 patients were evaluable for safety, 74 for clinical efficacy and 63 for microbiological response including 36 patients (57%) with positive blood cultures. There were significantly more clinical failures with cefotaxime than with netilmicin even when urinary tract sepsis was excluded. Microbiological failures occurred more frequently in the cefotaxime arm and were associated with Klebsiella and Enterobacter spp. Four cefotaxime failures were subsequently successfully treated with netilmicin. More mixed infections were however enrolled by chance into the cefotaxime arm. The statistical difference between netilmicin and cefotaxime is not significant if mixed infections are excluded. There was no difference in efficacy between the netilmicin and combination groups although superinfection was seen in the latter group. The incidence of nephrotoxicity was greater in the netilmicin group but not significantly so. Only one minor case of ototoxicity was detected in the 41 patients receiving netilmicin who had serial audiograms. The results suggest that netilmicin is a more effective agent than cefotaxime for treating life-threatening infections with susceptible Enterobacteriaceae or staphylococci particularly with infections in non-urinary tract sites. If dosage of netilmicin is closely monitored by measuring serum concentrations, toxicity is minimal.

Topics: Adolescent; Adult; Bacterial Infections; Cefotaxime; Cross Infection; Drug Therapy, Combination; Enterobacteriaceae Infections; Humans; Netilmicin; Random Allocation; Sepsis; Staphylococcal Infections

The minimal inhibitory concentrations (MICs) of aztreonam and cefotaxime were determined against 400 isolates from urological in-patients with complicated and/or hospital acquired urinary tract infections (UTI). Against the Gram-negative rods the activities of both antibiotics were comparable except for higher activity of aztreonam against Pseudomonas aeruginosa. The pharmacokinetic study in nine elderly patients showed a prolonged plasma half life of aztreonam (2.7 h) as compared to younger volunteers (1.6-1.9 h). In a prospective randomized study 39 urological patients with complicated and/or hospital acquired UTI were treated with 1 g aztreonam or cefotaxime iv twice daily for 4 to 15 days. Cure was obtained in 5 out of 18 patients in the aztreonam and 7 out of 20 patients in the cefotaxime group. There were 3 superinfections, 7 relapses and 3 reinfections in the aztreonam group and 1 failure, 1 superinfection, 6 relapses and 5 reinfections in the cefotaxime group. There was no significant difference in therapeutic efficacy between the two antibiotics. Both antibiotics were tolerated well and seem to be equally effective in the treatment of complicated UTI caused by sensitive organisms.

Topics: Adult; Aged; Aztreonam; Cefotaxime; Cross Infection; Female; Gram-Negative Bacteria; Gram-Positive Bacteria; Humans; Inulin; Iothalamic Acid; Kinetics; Male; Microbial Sensitivity Tests; Middle Aged; Random Allocation; Urinary Tract Infections

Nephrotoxicity frequently complicates the use of aminoglycosides in severely compromised acute care patients. Therefore, an open clinical trial was initiated to determine if cefmenoxime alone is useful in serious nosocomial pneumonias. Thirty consecutive patients were entered in the trial, and 28 patients with an average age of 66 years were evaluable. Most were malnourished at entry, with serum albumin averaging 2.8 g/dl and prognostic nutritional index values over 70 percent (normal less than 40 percent). One-half the patients had severe chronic obstructive pulmonary disease and 68 percent required ventilators. Fifty-seven percent had concomitant cardiac disease, and 79 percent had previously been treated with antibiotics. Pneumonia was proven to be present by new infiltrate on chest x-ray, new fever, elevated white blood cell count, and gram-negative rods on gram stain and in cultures of tracheal aspirates or sputum. Patients were given cefmenoxime 1 to 2 g every six hours an average of 12 days. Cefmenoxime peak (one hour) and trough concentrations were measured by high pressure liquid chromatography and averaged 58 and 7 micrograms ml, respectively. Pharmacokinetic data in 18 patients were determined from serum profiles. Gram-positive organisms, Escherichia coli, Klebsiella, and Hemophilus influenzae were usually eradicated. Persistence was noted for some Enterobacter, Pseudomonas, Serratia, and Acinetobacter. Persistence in patients with good clinical response was considered colonization rather than superinfection. Overall, a satisfactory clinical response rate was noted in 78.6 percent of evaluable patients, whereas four patients responded satisfactorily with recurrence and two treatments had an unsatisfactory response. No serious adverse effects were observed. Cefmenoxime is a promising agent in the treatment of susceptible pneumonias in critical care patients.

Topics: Aged; Bacteria; Blood Proteins; Cefmenoxime; Cefotaxime; Chromatography, High Pressure Liquid; Clinical Trials as Topic; Critical Care; Cross Infection; Female; Humans; Kinetics; Lung; Male; Middle Aged; Pneumonia; Protein Binding; Radiography; Recurrence

Ceftriaxone, a broad-spectrum cephalosporin with a markedly extended half-life, was administered to 100 patients with 56 bone and 44 soft tissue infections. Sixty-eight received 1 g twice daily, and 32 received 2 g once daily intravenously. Overall, 91% had a satisfactory clinical response, with similar efficacies in both treatment regimens. In six patients, failure to achieve a cure correlated well with the development of resistance to ceftriaxone during therapy in Enterobacter and Pseudomonas species (two cases) and with superinfection with Bacteroides fragilis (four cases). In 41 patients, intravenous drug therapy was continued after discharge from the hospital. In this group, 1,093 patient-days of hospitalization were saved, amounting to $150,020 in cost savings. The prolonged half-life facilitated the administration of ceftriaxone in this setting.

Topics: Adolescent; Adult; Aged; Bacterial Infections; Bone Diseases; Cefotaxime; Ceftriaxone; Child; Child, Preschool; Costs and Cost Analysis; Cross Infection; Female; Humans; Male; Middle Aged; Skin Diseases, Infectious

The objectives were to determine the risk factors for recurrent healthcare facility-associated Clostridioides difficile infection (HCF-CDI) in a high CDI incidence, low antibiotic use setting and to determine if length of cefotaxime exposure is a risk factor for recurrent HCF-CDI.. The risk factors for recurrent HCF-CDI were evaluated with a retrospective nested case control study based on chart reading. The risk factors were evaluated univariately and multivariately. Length of risk antibiotic exposure was evaluated further in a subanalysis.. Risk factors for recurrent HCF-CDI were renal insufficiency (25.4% of cases compared to 15.4% of controls p = 0.006) and metronidazole treatment of initial CDI episode (88.4% compared to 71.7% p = 0.01). Exposure to cefotaxime and risk for recurrent CDI showed a dose-dependent relationship (linear by linear p = 0.028).. Renal insufficiency and metronidazole treatment were independent risk factors for recurrent HCF-CDI in our setting. The relationship between cefotaxime exposure and risk for recurrent HCF-CDI, dose-dependent, could be evaluated further in a setting with high cefotaxime use.

Topics: Anti-Bacterial Agents; Case-Control Studies; Cefotaxime; Clostridioides difficile; Clostridium Infections; Cross Infection; Delivery of Health Care; Humans; Metronidazole; Retrospective Studies; Risk Factors; Sweden

To analyse the genome sequences of four archival Acinetobacter nosocomialis clinical isolates (designated AC13, AC15, AC21 and AC25) obtained from Terengganu, Malaysia in 2011 to determine their genetic relatedness and basis of antimicrobial resistance.. Antimicrobial susceptibility profiles of the A. nosocomialis isolates were determined by disk diffusion. Genome sequencing was performed using the Illumina NextSeq platform.. Genome sequencing of A. nosocomialis isolates led to the discovery of two novel plasmids, one of which encodes the tetA(39) tetracycline-resistant gene in a mobile pdif module. The high degree of genetic relatedness among the three tetracycline-resistant A. nosocomialis isolates is indicative of nosocomial transmission.

Topics: Acinetobacter; Acinetobacter Infections; Anti-Bacterial Agents; Cefotaxime; Cross Infection; Genomics; Humans; Malaysia; Nucleotides; Phylogeny; Plasmids; Tetracycline

In preterm and term infants who require intermediate or intensive care Methicillin-resistant Staphylococcus aureus (MRSA) infection can lead to significant morbidity. In this study MRSA colonization and infection were assessed in a mixed tertiary neonatal intensive and intermediate care unit in Germany over an 8-year period (2013-2020). We investigated patient-related factors, associated with nosocomial MRSA acquisition, and we discuss our infection control concept for MRSA. Of 3488 patients treated during the study period, 24 were MRSA positive patients, corresponding to 26 patient hospital stays. The incidence was 0.7 MRSA patients per 100 patients. The incidence density was 0.4 MRSA patient hospital stays per 1000 patient days. Twelve patients (50%) acquired MRSA in the hospital. One patient developed a hospital acquired MRSA bloodstream infection 9 days after birth (i.e., 0.03% of all patients on the ward during the study period). A total of 122 patients had to be screened to detect one MRSA positive patient. In a logistic regression model, the use of 3rd generation intravenous cephalosporin (cefotaxim) was associated with nosocomial MRSA acquisition compared with matched control patients who did not acquire MRSA. In sum, the burden of MRSA colonization and infection in the ward was low during the study period. A comprehensive infection control concept that included microbiologic colonization screening, prospective infection surveillance together with isolation and emphasis on basic hygiene measures is essential to handle MRSA in this specialized setting.

Topics: Cefotaxime; Cephalosporins; Cross Infection; Humans; Infant; Infant, Newborn; Infection Control; Methicillin-Resistant Staphylococcus aureus; Prospective Studies; Retrospective Studies; Staphylococcal Infections

Epidemiological data of cephalosporin-resistant Enterobacterales in Sub-Saharan Africa is still restricted, and in particular in Mozambique. The aim of this study was to detect and characterize extended-spectrum β-lactamase (ESBL) - and plasmid-mediated AmpC (pAmpC)-producing clinical strains of Escherichia coli at Maputo Central Hospital (MCH), a 1000-bed reference hospital in Maputo, Mozambique.. A total of 230 clinical isolates of E. coli from urine (n = 199) and blood cultures (n = 31) were collected at MCH during August-November 2015. Antimicrobial susceptibility testing was performed by the disc diffusion method and interpreted according to EUCAST guidelines. Isolates with reduced susceptibility to 3rd generation cephalosporins were examined further; phenotypically for an ESBL-/AmpC-phenotype by combined disc methods and genetically for ESBL- and pAmpC-encoding genes by PCR and partial amplicon sequencing as well as genetic relatedness by ERIC-PCR.. A total of 75 isolates with reduced susceptibility to cefotaxime and/or ceftazidime (n = 75) from urine (n = 58/199; 29%) and blood (n = 17/31; 55%) were detected. All 75 isolates were phenotypically ESBL-positive and 25/75 (33%) of those also expressed an AmpC-phenotype. ESBL-PCR and amplicon sequencing revealed a majority of bla. We have observed a high prevalence of MDR pAmpC- and/or ESBL-producing clinical E. coli isolates with FOX/MOX and CTX-Ms as the major β-lactamase types, respectively. ERIC-PCR analyses revealed genetic diversity and some clusters indicating within-hospital spread. The overall findings strongly support the urgent need for accurate and rapid diagnostic services to guide antibiotic treatment and improved infection control measures.

Topics: Anti-Bacterial Agents; Bacterial Proteins; beta-Lactamases; Cefotaxime; Ceftazidime; Cross Infection; Drug Resistance, Multiple, Bacterial; Escherichia coli; Escherichia coli Infections; Humans; Microbial Sensitivity Tests; Mozambique; Phenotype; Plasmids; Prevalence

Klebsiella pneumoniae is a major pathogen implicated in nosocomial infections. Extended-spectrum β-lactamase (ESBL)-producing K. pneumoniae isolates are a public health concern. We aim to characterize the type of β-lactamases and the associated resistance mechanisms in ESBL-producing K. pneumoniae isolates obtained from blood cultures in a Portuguese hospital, as well as to determine the circulating clones. Twenty-two cefotaxime/ceftazidime-resistant (CTX/CAZR) K. pneumoniae isolates were included in the study. Identification was performed by MALDI-TOF MS and the antimicrobial susceptibility testing by disk-diffusion. The screening test for ESBL-production was performed and ESBL-producer isolates were further characterized. The presence of different beta-lactamase genes (blaCTX-M, blaSHV, blaTEM, blaKPC, blaNDM, blaVIM, blaOXA-48, blaCMY-2, blaDHA-1, blaFOX, blaMOX, and blaACC) was analyzed by PCR/sequencing in ESBL-producer isolates, as well as the presence of other resistance genes (aac(6')-Ib-cr, tetA/B, dfrA, qnrA/B/S, sul1/2/3) or integron-related genes (int1/2/3). Multilocus-sequence-typing (MLST) was performed for selected isolates. ESBL activity was detected in 12 of the 22 CTX/CAZR K. pneumoniae isolates and 11 of them carried the blaCTX-M-15 gene (together with blaTEM), and the remaining isolate carried the blaSHV-106 gene. All the blaCTX-M-15 harboring isolates also contained a blaSHV gene (blaSHV-1, blaSHV-11 or blaSHV-27 variants). Both blaSHV-27 and blaSHV-106 genes correspond to ESBL-variants. Two of the CTX-M-15 producing isolates carried a carbapenemase gene (blaKPC2/3 and blaOXA-48) and showed imipenem resistance. The majority of the ESBL-producing isolates carried the int1 gene, as well as sulphonamide-resistance genes (sul2 and/or sul3); the tetA gene was detected in all eight tetracycline-resistant isolates. Three different genetic lineages were found in selected isolates: ST348 (one CTX-M-15/TEM/SHV-27/KPC-2/3-producer isolate), ST11 (two CTX-M-15/TEM/SHV-1- and CTX-M-15-TEM-SHV-11-OXA-48-producer isolates) and ST15 (one SHV-106/TEM-producer isolate). ESBL enzymes of CTX-M-15 or SHV-type are detected among blood K. pneumoniae isolates, in some cases in association with carbapenemases of KPC or OXA-48 type.

Topics: Anti-Bacterial Agents; beta-Lactamases; Cefotaxime; Ceftazidime; Cross Infection; Drug Resistance, Multiple, Bacterial; Humans; Klebsiella Infections; Klebsiella pneumoniae; Microbial Sensitivity Tests; Multilocus Sequence Typing; Sepsis; Sequence Analysis, DNA

The aim of this study was to characterise metallo-β-lactamase (MBL)-harbouring plasmids, their change in copy number in respect to different antibiotic pressure, and the efficiency of different curing agents in eliminating these resistance plasmids from nosocomial Pseudomonas aeruginosa isolates.. Plasmids were extracted from four isolates harbouring bla. Conjugatively transferable MBL genes (bla. The spread of multidrug resistance plasmids has been noted as a key factor associated with increasing carbapenem resistance. Successful curing of resistance plasmids can reverse the bacterial phenotype back to susceptible. This study revealed that different antibiotic pressure induces a change in copy number of MBL-encoding plasmids. SDS can be successfully used as an eliminating agent for these resistance determinants, although therapeutic application of this agent is not possible due to its high toxicity and mutagenic nature.

Topics: Anti-Bacterial Agents; Aztreonam; beta-Lactamases; Cefotaxime; Cross Infection; DNA Copy Number Variations; Drug Resistance, Multiple, Bacterial; Ertapenem; Gene Expression Regulation, Bacterial; Humans; Imipenem; Meropenem; Microbial Sensitivity Tests; Plasmids; Pseudomonas aeruginosa; Pseudomonas Infections; Sodium Dodecyl Sulfate; Suppuration; Urine

Concern about Haemophilus influenzae infection has been increasing over recent decades. Given the emergence of H. influenzae with severe drug resistance, we assessed the prevalence of as well as risk factors and potential therapies for extensively drug-resistant (XDR) H. influenzae infection in Taiwan.. In total, 2091 H. influenzae isolates with disk diffusion-based antibiotic susceptibility testing from 2007 to 2018 were enrolled. H. influenzae strains resistant to ampicillin, chloramphenicol, levofloxacin, and trimethoprim-sulfamethoxazole tended to be isolated from patient wards (≧41%), whereas those resistant to amoxicillin-clavulanate, cefotaxime, and cefuroxime were more likely to be isolated from intensive care units (approximately 50%). XDR H. influenzae was first identified in 2007, and its incidence did not significantly change thereafter. Overall prevalence of single, multiple, and extensively drug-resistant H. influenzae over 2007-2018 was 21.5% (n = 450), 26.6% (n = 557), and 2.5% (n = 52), respectively. A stepwise logistic regression analysis revealed that blood culture (odds ratio: 4.069, 95% confidence intervals: 1.339-12.365, P = 0.013) was an independent risk factor for XDR H. influenzae infection. No nosocomial transmission of XDR H. influenzae observed. Antibiotic susceptibility testing results demonstrated that cefotaxime was effective against 78.8% (n = 41) of the XDR strains.. The presence of XDR H. influenzae strains was identified in Taiwan, and cefotaxime was efficacious against most of these strains.

Topics: Ampicillin; Anti-Bacterial Agents; Cefotaxime; Cefuroxime; Chloramphenicol; Cross Infection; Drug Resistance, Bacterial; Female; Haemophilus Infections; Haemophilus influenzae; Humans; Incidence; Intensive Care Units; Levofloxacin; Logistic Models; Male; Microbial Sensitivity Tests; Taiwan; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Anti-Bacterial Agents; beta-Lactamases; Cefotaxime; Ceftriaxone; Cross Infection; Enterobacteriaceae; Enterobacteriaceae Infections; Humans; Intensive Care Units; Microbial Sensitivity Tests

This study aimed to evaluate the antibiofilm potential of phytol and cefotaxime combinations (PCCs) against Acinetobacter baumannii and to elucidate the molecular mechanism of their antibiofilm potential through the transcriptomic approach.. The obtained results of this study indicate that PCCs have potent antibiofilm activity and downregulate the biofilm-related virulence genes expression in A. baumannii.. To the best of our knowledge, this is the pioneering study, which shows the antibiofilm effect of PCCs against A. baumannii along with their molecular mechanism. The antibiofilm effect of PCCs could be a successful strategy for eradicating infections related to A. baumannii biofilms in nosocomial settings.

Topics: Acinetobacter baumannii; Anti-Bacterial Agents; Biofilms; Cefotaxime; Cross Infection; Gene Expression Regulation, Bacterial; Genes, Bacterial; Humans; Phytol; Spectroscopy, Fourier Transform Infrared

The aim of the current study was to compare community-acquired acute pyelonephritis (CA-APN) with health care-associated acute pyelonephritis (HCA-APN), describe the outcomes, and identify variables that could predict antimicrobial susceptibility. We conducted an observational study that included all consecutive episodes of acute pyelonephritis (APN) in adults during 2014 at a Spanish university hospital. From each episode, demographic data, comorbidities, clinical presentation, microbiological data, antimicrobial therapy, and outcome were recorded. A multivariable logistic regression model was performed to define the variables associated with antimicrobial resistance. A total of 607 patients, 503 (82.9%) with CA-APN and 104 (17.1%) with HCA-APN, were included in the study. Patients with HCA-APN were older than patients with CA-APN (70.4 versus 50.6 years;

Topics: Acute Disease; Adult; Aged; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Cefotaxime; Cefuroxime; Ciprofloxacin; Cohort Studies; Community-Acquired Infections; Cross Infection; Drug Resistance, Bacterial; Empirical Research; Escherichia coli; Escherichia coli Infections; Female; Hospitals, University; Humans; Logistic Models; Male; Microbial Sensitivity Tests; Middle Aged; Pyelonephritis; Risk Factors; Spain; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

The objective of the present study was to evaluate the prevalence of intestinal colonization with extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae (ESBL-E) and carbapenemase-producing Enterobacteriaceae (CPE) in non-selected hospitalized and non-hospitalized patients from the same geographic area of Madrid.. A total of 501 fecal samples were screened. Diluted samples in saline were cultured in MacConkey agar plates with ceftazidime, cefotaxime, imipenem and meropenem disks. Colonies growing within the inhibition zone of either disk were selected. Characterization of ESBLs and CPEs were performed by PCR and sequencing. The Wider system was used for the bacterial identification. In addition, clonal analysis was carried out for species predominant among the fecal carriage.. Among the 501 patients enrolled, 43 (8.6 %) carried ESBL-E and 8 (1.6 %) patients exhibited CPE. The main intestinal colonizer among ESBL-E was CTX-M-producing Escherichia coli isolates in both settings (community and hospital). ST131 clonal complex was the most common among faecal ESBL-producing E. coli. All gut carriers of CPE were hospitalized patients, Klebsiella pneumoniae being the most prevalent species. Two OXA-48-producing K. pneumoniae isolates belonging to ST15 were detected.. Present study reveals that faecal carriage of ESBL is common among inpatients and outpatients, whereas carbapenemase producers are only present in the hospital setting. Therefore, active surveillance will be useful for reducing transmission of antimicrobial-resistant bacteria and preventing infection.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bacterial Proteins; beta-Lactamases; Carrier State; Cefotaxime; Ceftazidime; Child; Child, Preschool; Cross Infection; Culture Media; Drug Resistance, Multiple, Bacterial; Escherichia coli; Feces; Female; Gastrointestinal Microbiome; Hospitalization; Humans; Imipenem; Infant; Intestines; Klebsiella pneumoniae; Male; Meropenem; Microbial Sensitivity Tests; Middle Aged; Spain; Thienamycins; Young Adult

The increasing prevalence of multidrug-resistant (MDR) bacteria is a serious global challenge. Here, we studied prospectively whether bacterial whole-genome sequencing (WGS) for real-time MDR surveillance is technical feasible, returns actionable results, and is cost-beneficial. WGS was applied to all MDR isolates of four species (methicillin-resistant Staphylococcus aureus [MRSA], vancomycin-resistant Enterococcus faecium, MDR Escherichia coli, and MDR Pseudomonas aeruginosa) at the University Hospital Muenster, Muenster, Germany, a tertiary care hospital with 1,450 beds, during two 6-month intervals. Turnaround times (TAT) were measured, and total costs for sequencing per isolate were calculated. After cancelling prior policies of preemptive isolation of patients harboring certain Gram-negative MDR bacteria in risk areas, the second interval was conducted. During interval I, 645 bacterial isolates were sequenced. From culture, TATs ranged from 4.4 to 5.3 days, and costs were €202.49 per isolate. During interval II, 550 bacterial isolates were sequenced. Hospital-wide transmission rates of the two most common species (MRSA and MDR E. coli) were low during interval I (5.8% and 2.3%, respectively) and interval II (4.3% and 5.0%, respectively). Cancellation of isolation of patients infected with non-pan-resistant MDR E. coli in risk wards did not increase transmission. Comparing sequencing costs with avoided costs mostly due to fewer blocked beds during interval II, we saved in excess of €200,000. Real-time microbial WGS in our institution was feasible, produced precise actionable results, helped us to monitor transmission rates that remained low following a modification in isolation procedures, and ultimately saved costs.

Topics: Anti-Bacterial Agents; Cefotaxime; Ciprofloxacin; Cross Infection; Enterococcus faecium; Escherichia coli; Escherichia coli Infections; Genome, Bacterial; Gram-Positive Bacterial Infections; High-Throughput Nucleotide Sequencing; Humans; Infection Control; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Piperacillin; Prospective Studies; Pseudomonas aeruginosa; Pseudomonas Infections; Sequence Analysis, DNA; Staphylococcal Infections; Vancomycin-Resistant Enterococci

Group B Streptococcus is a primary source of pneumonia, which is a leading cause of death worldwide. During the last few decades, there has been news of growing antibiotic resistance in group B streptococci to penicillin and different antibiotic agents. This clinical study retrospectively analyzes antimicrobial resistance in inpatients who were diagnosed with group B streptococcal pneumonia.. All of the required information from inpatients who were identified to have group B streptococcal pneumonia was sourced from the database at the Department of Internal Medicine of HELIOS Clinic Wuppertal, Witten/Herdecke University, in Germany, from 2004-2014. Antimicrobial susceptibility testing was performed for the different antimicrobial agents that were regularly administered to these inpatients.. Sixty-six inpatients with a mean age of 63.3 ± 16.1 years (45 males [68.2%, 95% CI 60.0%-79.4%] and 21 females [31.8%, 95% CI 20.6%-43.0%]) were detected to have group B streptococcal pneumonia within the study period from January 1, 2004, to August 12, 2014. Group B Streptococcus had a high resistance rate to gentamicin (12.1%), erythromycin (12.1%), clindamycin (9.1%), and co-trimoxazole (3.0%), but it was not resistant to penicillin, cefuroxime, cefotaxime, or vancomycin (P < 0.0001).. No resistance to penicillin, cefuroxime, cefotaxime, or vancomycin was detected among inpatients with pneumonia caused by group B streptococci.

Topics: Aged; Cefotaxime; Cefuroxime; Cephalosporin Resistance; Cross Infection; Drug Resistance, Bacterial; Female; Germany; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Penicillin Resistance; Pneumonia, Bacterial; Pneumonia, Pneumococcal; Retrospective Studies; Streptococcal Infections; Streptococcus agalactiae; Vancomycin Resistance

Proteus mirabilis is a common cause of urinary tract infection. Wild-type P. mirabilis strains are usually susceptible to penicillins and cephalosporins, but occurrences of P. mirabilis producing extended-spectrum β-lactamases (ESBLs) have been recently reported. Here, we surveyed the prevalence of cefotaxime resistance among P. mirabilis strains at seven different hospitals in Kanagawa Prefecture, Japan, and investigated their molecular epidemiology to explain the mechanism of their spread. The prevalence of cefotaxime resistance among P. mirabilis increased annually, from 10.1 % in 1998 to 23.1 % in 2003, and increased drastically in 2004, exceeding 40 %. We collected 105 consecutive and non-duplicate cefotaxime-resistant P. mirabilis isolates (MIC 16 to >256 µg ml(-1)) from these hospitals from June 2004 to May 2005 and characterized their profile. PCR and sequence analysis revealed that all resistant strains produced exclusively CTX-M-2 β-lactamase. PFGE analysis identified 47 banding patterns with 83 % or greater similarity. These results indicated that a regional outbreak of P. mirabilis producing CTX-M-2 β-lactamase has occurred in Japan and suggest that the epidemic spread occurred within and across hospitals and communities by extended clonal strains. Plasmid analysis revealed that 44.8 % of plasmids harboured by bla(CTX-M-2) isolates had common profiles, encoding ISEcp1, IS26 and Int1, and belonged to incompatibility group T. Spread of the resistant isolates in Japan resulted from dissemination of narrow-host-range plasmids of the IncT group encoding bla(CTX-M-2). These findings indicate the rapidly developing problem of treating the species to prevent dissemination of ESBL producers.

Topics: Anti-Bacterial Agents; beta-Lactamases; Cefotaxime; Cross Infection; Disease Outbreaks; DNA, Bacterial; Humans; Japan; Microbial Sensitivity Tests; Molecular Epidemiology; Plasmids; Proteus Infections; Proteus mirabilis

In 2007, the Robert Koch Institute established the infrastructure for the national Antimicrobial Resistance Surveillance (ARS) system. Laboratories submit data of routine susceptibility testing of clinical samples from hospitals as well as from outpatient care settings in a standardized format to the Robert Koch Institute for central processing. The database for the period 2008-2011 comprises data of about 1.3 million samples from patients in hospital care and almost 800,000 samples from outpatients. Based on SIR interpretations of susceptibility, the trends of methicillin resistance of Staphylococcus aureus (MRSA) and cefotaxime non-susceptibility as an indicator of extended-spectrum beta-lactamases (ESBL) of Escherichia coli and Klebsiella pneumoniae were analyzed for four care settings or categories: hospital care, outpatient care, intensive care units, and isolates from blood cultures. After constant high levels of above 20%, the proportion of MRSA isolates showed a decline for the first time from 2010 to 2011 in hospital care overall, in intensive care units as well as in blood cultures; in outpatient care, MRSA proportions of about 13% were observed. Within the observed period, non-susceptibility to cefotaxime as an indicator of ESBL in E. coli showed an increasing trend in hospital care at a level above 10% in intensive care units, while cefotaxime non-susceptibility in K. pneumoniae was more frequent but without any trend. In outpatient care, the proportions of cefotaxime non-susceptibility increased year by year in both species resulting in nearly a doubling to 6%.

Topics: Bacteremia; beta-Lactamases; Cefotaxime; Community-Acquired Infections; Cross Infection; Cross-Sectional Studies; Drug Resistance, Bacterial; Escherichia coli; Escherichia coli Infections; Germany; Humans; Intensive Care Units; Klebsiella Infections; Klebsiella pneumoniae; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Sentinel Surveillance; Staphylococcal Infections

Extended-spectrum β-lactamase (ESBLs) production is still the most frequent mechanism of resistance to cephalosporins in gram-negative bacteria. The aim of the study was to identify the types of ESBL-producing Enterobacteriaceae clinical isolates causing nosocomial infections in Mexico.. ESBL production was performed using a disk diffusion method. The MIC for several antibiotics was performed by agar dilution on Mueller-Hinton. PFGE typing was carried out on all enterobacteria assayed. The β-lactamase pattern was obtained by IEF and bioassay. Genes of β-lactamases were amplified by PCR with specific primers and products were sequenced and analyzed using informatics programs. Plasmid isolation and conjugation experiments were carried out using standard methodologies.. There were 134 isolates of Enterobacteriaceae included from a retrospective and multicenter study that included eight Mexican hospitals from 1999 to 2005. The most prevalent species were K. pneumoniae (56%), Enterobacter cloacae (29%), and Escherichia coli (15%). Molecular analysis identified the underlying endemic and polyclonal spread of enterobacterials in each hospital. The most frequent ESBLs identified were SHV-type (84%), TLA-1 (11%), and CTX-M-15 (5%). Successful matings were detected in 68.4% (71/104) isolates.. ESBL-producer K. pneumoniae remains the most frequent bacterial species obtained in nosocomial infections. The SHV-type and TLA-1 ESBLs were disseminated in most hospitals analyzed and CTX-M-15 was emerging in one of the studied hospitals. This work highlights the proper use of antibiotics to avoid the selection of these types of multiresistant bacteria.

Topics: Anti-Bacterial Agents; beta-Lactamases; Cefotaxime; Congresses as Topic; Cross Infection; Drug Resistance, Bacterial; Enterobacteriaceae; Enterobacteriaceae Infections; Humans; Isoelectric Point; Mexico; Microbial Sensitivity Tests; R Factors; Retrospective Studies

In vitro activities of colistin and other drugs were tested against 221 Klebsiella pneumoniae isolates that were collected between 2006 and 2007 in nine tertiary care South Korean hospitals from patients with bacteremia. The clonality of colistin-resistant K. pneumoniae (CRKP) isolates was assessed by multilocus sequence typing (MLST). We found that 15 isolates (6.8%) were resistant to colistin. MLST showed that CRKP isolates were nonclonal, with colistin resistance in K. pneumoniae occurring independently and not by clonal spreading.

Topics: Anti-Bacterial Agents; Bacteremia; Colistin; Cross Infection; Drug Resistance, Bacterial; Humans; Klebsiella Infections; Klebsiella pneumoniae; Microbial Sensitivity Tests; Population Surveillance; Republic of Korea

The resistance mechanism of 49 Enterobacteriaceae isolates with decreased susceptibility to carbapenems collected from 2004 to 2008 at 16 teaching hospitals in China was investigated. Moderate- to high-level carbapenem resistance in most isolates was more closely associated with loss or decreased expression of both major porins combined with production of AmpC or extended-spectrum beta-lactamase enzymes, while KPC-2, IMP-4, and IMP-8 carbapenemase production may lead to a low to moderate level of carbapenem resistance in Enterobacteriaceae in China.

Topics: Anti-Bacterial Agents; Bacterial Outer Membrane Proteins; Bacterial Proteins; beta-Lactamases; Carbapenems; China; Cross Infection; Drug Resistance, Bacterial; Electrophoresis, Gel, Pulsed-Field; Enterobacteriaceae; Enterobacteriaceae Infections; Genotype; Integrons; Microbial Sensitivity Tests; Phenotype; Population Surveillance; Porins; Reverse Transcriptase Polymerase Chain Reaction

A Pseudomonas aeruginosa isolate recovered in Belgium produced a novel extended-spectrum ss-lactamase, BEL-2, differing from BEL-1 by a single Leu162Phe substitution. That modification significantly altered the kinetic properties of the enzyme, increasing its affinity for expanded-spectrum cephalosporins. The bla(BEL-2) gene was identified from a P. aeruginosa isolate clonally related to another bla(BEL-1)-positive isolate.

Topics: Belgium; beta-Lactamases; Cephalosporinase; Cephalosporins; Cross Infection; Escherichia coli; Genes, Bacterial; Humans; Kinetics; Microbial Sensitivity Tests; Pseudomonas aeruginosa; Pseudomonas Infections

Extracorporeal membrane oxygenation (ECMO) is used to temporarily sustain cardiac and respiratory function in critically ill infants but can cause pharmacokinetic changes necessitating dose modifications. Cefotaxime (CTX) is used to prevent and treat infections during ECMO, but the current dose regimen is based on pharmacokinetic data obtained for non-ECMO patients. The objective of this study was to validate the standard dose regimen of 50 mg/kg of body weight twice a day (postnatal age [PNA], <1 week), 50 mg/kg three times a day (PNA, 1 to 4 weeks), or 37.5 mg/kg four times a day (PNA, >4 weeks). We included 37 neonates on ECMO, with a median (range) PNA of 3.3 (0.67 to 199) days and a median (range) body weight of 3.5 (2.0 to 6.2) kg at the onset of ECMO. Median (range) ECMO duration was 108 (16 to 374) h. Plasma samples were taken during routine care, and pharmacokinetic analysis of CTX and its active metabolite, desacetylcefotaxime (DACT), was done using nonlinear mixed-effects modeling (NONMEM). A one-compartment pharmacokinetic model for CTX and DACT adequately described the data. During ECMO, CTX clearance (CL(CTX)) was 0.36 liter/h (range, 0.19 to 0.75 liter/h), the volume of distribution of CTX (V(CTX)) was 1.82 liters (0.73 to 3.02 liters), CL(DACT) was 1.46 liters/h (0.48 to 5.93 liters/h), and V(DACT) was 11.0 liters (2.32 to 28.0 liters). Elimination half-lives for CTX and DACT were 3.5 h (1.6 to 6.8 h) and 5.4 h (0.8 to 14 h). Peak CTX concentration was 98.0 mg/liter (33.2 to 286 mg/liter). DACT concentration varied between 0 and 38.2 mg/liter, with a median of 10 mg/liter in the first 12 h postdose. Overall, CTX concentrations were above the MIC of 8 mg/liter over the entire dose interval. Only 1 of the 37 patients had a sub-MIC concentration for over 50% of the dose interval. In conclusion, the standard cefotaxime dose regimen provides sufficiently long periods of supra-MIC concentrations to provide adequate treatment of infants on ECMO.

Topics: Anti-Bacterial Agents; Bacteremia; Cefotaxime; Critical Illness; Cross Infection; Extracorporeal Membrane Oxygenation; Female; Humans; Infant; Infant, Newborn; Male; Medical Records; Models, Biological; Nonlinear Dynamics; Respiration, Artificial

From 2002 to 2008, there was a significant increase in extended-spectrum beta-lactamase (ESBL)-positive Escherichia coli isolates in European intra-abdominal infections, from 4.3% in 2002 to 11.8% in 2008 (P < 0.001), but not for ESBL-positive Klebsiella pneumoniae isolates (16.4% to 17.9% [P > 0.05]). Hospital-associated isolates were more common than community-associated isolates, at 14.0% versus 6.5%, respectively, for E. coli (P < 0.001) and 20.9% versus 5.3%, respectively, for K. pneumoniae (P < 0.01). Carbapenems were consistently the most active drugs tested.

Topics: Abdomen; Anti-Bacterial Agents; beta-Lactamases; Carbapenems; Cross Infection; Escherichia coli; Escherichia coli Infections; Humans; Klebsiella Infections; Klebsiella pneumoniae

Hospital-associated invasive pneumococcal disease (HA-IPD) is infrequently reported. A retrospective surveillance of IPD in a medical centre in Taiwan was conducted from 2000 to 2008 to compare the clinical and microbiological characteristics of HA-IPD and community-associated IPD (CA-IPD). HA-IPD was identified in 37 patients, comprising 12.3% of the 302 hospitalised patients with IPD. Patients with HA-IPD were more likely to have solid-organ cancer (40.5% vs. 16.6%; P=0.001) or to have received immunosuppressive therapy (56.8% vs. 26.8%; P<0.001). The 30-day mortality rate of HA-IPD was significantly higher than that of CA-IPD (40.5% vs. 16.2%; P=0.001). Age >or=65 years [odds ratio (OR)=2.10; P=0.033], HA-IPD (OR=2.90; P=0.009) and liver cirrhosis (OR=3.19; P=0.009) were independent predictors of 30-day mortality. No significant differences in serotype distribution or in susceptible rates to penicillin (18.2% vs. 32.6%; P=0.14) and cefotaxime (60.6% vs. 67.8%; P=0.53) were found between HA-IPD and CA-IPD isolates. Similar prevalences of the serotypes included in the pneumococcal vaccines were found in isolates from patients with HA-IPD and CA-IPD. Among patients with HA-IPD and CA-IPD, 26 (78.8%) and 172 (73.2%) (P=0.45) had isolates of serotypes included in the 7-valent pneumococcal conjugate vaccine, and 30 (90.9%) and 224 (95.3%) (P=0.96) had isolates of serotypes included in the 23-valent pneumococcal polysaccharide vaccine, respectively. In summary, this study found that HA-IPD and CA-IPD were not significantly different with regard to serotype distribution and antimicrobial susceptibility in Taiwan. Patients with HA-IPD have a higher mortality rate, and pneumococcal vaccination for patients at increased risk for HA-IPD should be encouraged.

Topics: Adult; Age Factors; Aged; Anti-Bacterial Agents; Cefotaxime; Community-Acquired Infections; Cross Infection; Female; Humans; Immunosuppressive Agents; Liver Cirrhosis; Male; Neoplasms; Penicillins; Pneumococcal Infections; Pneumococcal Vaccines; Retrospective Studies; Risk Factors; Serotyping; Streptococcus pneumoniae; Taiwan; Treatment Outcome; Vaccines, Conjugate

Within the last decade, human infections caused by enterobacteria which produce the Klebsiella pneumoniae carbapenemase (KPC) became a serious therapeutic and epidemiological problem worldwide. The KPC producing strains of K. pneumoniae broadly disseminated in the USA then spread to Europe. Recently, the KPC-2 was found in Poland. In the presented study we tested 11 ertapenem resistant isolates of K. pneumoniae. The isolates were obtained from 10 patients of a regular hospital (RH) and from one patient of a palliative care hospital (PH) in Warsaw, Poland. Expression of the KPC was confirmed in all the tested isolates by the positive result of phenotypic test with boronic acid. All the isolates were also shown to harbour the bla(KPC) gene by PCR with primers targeting the core 372 bp fragment of the gene, and all but two were resistant to imipenem and meropenem as determined by the disc-diffusion method. The DNA sequence analysis of the complete bla(KPC) gene from representative isolate DM0269 revealed variant 2 of KPC (KPC-2). Tested isolates were subjected to genotyping by the PFGE with XbaI. Dendrogram based on the PFGE profiles was composed of two main branches with 82,3% of similarity. Branch A encompassed 9 isolates (93,2%), including the one from the PH-patient, while the two remaining isolates (86,5%) were located in branch B. Five isolates of the branch A were indistinguishable by the PFGE. The high genetic similarity of the branch A isolates strongly suggests the intra-hospital dissemination of epidemic K. pneumoniae KPC+ sensu stricto strain. Most probably, the strain was also transferred to the palliative care hospital. In contrast, the branch B isolates appear to belong to the distinct sensu stricto strain, that has acquired the bla(KPC) gene via horizontal transfer. This is the first report on the intra-hospital dissemination of the KPC producing K. pneumoniae in Poland. It is noteworthy, all the tested strains were also resistant to cefotaxime, ceftazidime, aztreonam, ciprofloxacin and sulphonamides, but sensitive to colistin.

Topics: Adult; Aged; Aztreonam; Bacterial Proteins; beta-Lactamases; Cefotaxime; Ceftazidime; Ciprofloxacin; Colistin; Cross Infection; Drug Resistance, Multiple, Bacterial; Female; Genotype; Humans; Klebsiella Infections; Klebsiella pneumoniae; Male; Middle Aged; Poland; Species Specificity

Patients infected with bacteria producing extendedspectrum beta-lactamases (ESBL) are at higher risk of mortality and morbidity. Several mutations in genes encoding SHV, tem and CTX-M beta-lactamases have been associated with ESBL activity. This paper describes a new SHV mutation in ESBL-producing strains of Klebsiella pneumoniae isolated in Kuwait. The study included 13 K. penumoniae strains isolated from patients admitted to the Amiri hospital of Kuwait. The production of ESBL in all strains was confirmed by Vitek system and E-test. All the ESBL genes were amplified by PCR and examined by DNA sequencing. All these ESBL-positive isolates were resistant to ceftazidime and cefotaxime. DNA sequencing revealed an A815G point mutation in the bla (SHV )gene causing an asparagine (AAT) to aspartic acid (GAT) mutation at position 253 of the enzyme. This new mutation was assigned the unique number SHV-112, and the Genebank accession number EU477409. This study reports a new mutation in the SHV gene in K. pneumoniae with ESBL capability. There could be other mutations still to be found in ESBL genes of K. pneumoniae in Kuwait and probably in other middle eastern countries, and researchers in the region should make use of molecular techniques to look for more novel mutations in ESBL-producing strains of K. pneumoniae.

Topics: Amino Acid Sequence; Anti-Bacterial Agents; Base Sequence; beta-Lactam Resistance; beta-Lactamases; Cefotaxime; Ceftazidime; Conjugation, Genetic; Cross Infection; Disease Outbreaks; DNA, Bacterial; Drug Resistance, Multiple, Bacterial; Electrophoresis, Gel, Pulsed-Field; Humans; Klebsiella Infections; Klebsiella pneumoniae; Kuwait; Microbial Sensitivity Tests; Molecular Sequence Data; Mutation; Polymorphism, Single Nucleotide; Retrospective Studies

A cefotaxime-resistant Klebsiella pneumoniae ML4313 was obtained from a patient from intensive care unit of Military hospital in Tunisia. This strain was resistant to beta-lactams, aminoglycosides, quinolones and phenicols, and tetracyclines. It was identified as producer of extended-spectrum beta-lactamases (ESBL) by double-disk synergy test between amoxicillin-clavulanate and cefotaxime, ceftriaxone, ceftazidime and aztreonam. The ESBL was identified as CTX-M-28 by sequencing of PCR products and by isoelectric focusing. The ESBL resistance was transferred by a 50kb plasmid. CTX-M-28 is closely related to CTX-M-15. This is the first description of this enzyme in Tunisia.

Topics: Amino Acid Sequence; Amino Acid Substitution; Bacterial Proteins; beta-Lactam Resistance; beta-Lactamases; Cefotaxime; Cross Infection; DNA, Bacterial; Drug Resistance, Multiple, Bacterial; Hospitals, Military; Humans; Intensive Care Units; Klebsiella Infections; Klebsiella pneumoniae; Molecular Sequence Data; Mutation, Missense; R Factors; Sequence Alignment; Sequence Analysis, DNA; Sequence Homology, Amino Acid; Tunisia

Asymptomatic excretion of group B streptococcus (GBS) in breast milk may be an underrecognized cause of neonatal and recurrent infection. We report the case of late-onset and recurrent infection in newborn twins resulting from ingestion of maternal breast milk infected with GBS. Genetic analysis of isolates is equally presented.

Topics: Amoxicillin; Anti-Bacterial Agents; Breast Feeding; Cefotaxime; Cross Infection; Diseases in Twins; Female; Humans; Infant, Newborn; Infant, Premature; Milk, Human; Polymerase Chain Reaction; Recurrence; Streptococcal Infections; Streptococcus agalactiae

Multiresistant, extended spectrum beta lactamase (ESBL)-producing pathogens are an increasing problem in daily clinical life. This paper summarizes the development of resistance as well as epidemiology, diagnostics, and treatment of ESBL-producing micro-organisms. We analyzed microbiological data collected at the Grosshadern Clinic in Germany between 1996 and 2007, in order to assess the importance of these micro-organisms to medical practice and surgical care units.. Pathogens were isolated from 28,894 patients with Escherichia coli and 10,903 with Klebsiella pneumoniae pathogens between 1996 and 2006 and tested for ESBL production. For the year 2007 we have analyzed the complete spectrum of ESBL-producing pathogens and their distribution to different departments of the clinic. The agar diffusion test with five cephalosporins and an automated detection system (BD Phoenix) were used for screening purposes. Positive results were verified with the E- and double-disc agar diffusion tests.. The most important pathogens isolated from patients were E. coli and K. pneumoniae. Analysis of ESBL-producing E. coli pathogens from 1996 to 2006 showed the prevalence increasing from 0% to 4.1%. For ESBL-producing K. pneumoniae, we also found a prevalence rising from 0.3% in 1996 to 6.6% in 2006. For the year 2007 a further increase in ESBL-producing pathogens was detected, reaching 182 cases, with 118 of ESBL-producing E. coli (5.7 %) and 39 of ESBL-producing K. pneumoniae (7.4%). Of these, 24 cases with E. coli and nine with K. pneumoniae were surgery patients (20% and 23%, respectively).. The results show an increasing prevalence of ESBL-producing pathogens in hospitalized patients and in surgical departments. The resulting rise in treatment costs and patient risk require thorough knowledge of risk factors, therapy, and preventive measures.

Topics: Anti-Bacterial Agents; beta-Lactam Resistance; Cefotaxime; Ceftriaxone; Cross Infection; Cross-Sectional Studies; Drug Resistance, Multiple, Bacterial; Escherichia coli Infections; Europe; Humans; Intensive Care Units; Klebsiella Infections; Klebsiella pneumoniae; Microbial Sensitivity Tests; Retrospective Studies; Risk Factors; Surgical Wound Infection

The MICs of imipenem, meropenem, piperacillin-tazobactam, cefotaxime, polymixin B and tigecycline against 80 isolates of Acintobacter baumanii from 6 hospitals were determined. A multiplex-PCR was used to detect the genes encoding carbapenemases. Field Inversion Gel Electrophoresis (FIGE) was then used to investigate the genetic relationships among the carbapenem-resistant isolates. Only 7 isolates were resistant to polymixin B and tigecycline (MIC = 16). All isolates were positive for at least 2 carbapenemase genes. At least 10 distinct clones were detected by FIGE. A dominant pattern designated as pulsotype A consisting of 23 isolates was detected from 4 hospitals. The majority of isolates in this pulsotype had a bla(OXA-51/23-like) and bla(OXA-51/24-like) carbapenemase genes and cultured from the patients at burns and ICU. The pan drug resistant isolates belonged to different FIGE patterns. Nosocomial infections with different clones of Acintobacter baumanii occur at Tehran hospitals. However, inter-hospital transmission with certain pulsotypes is likely.

Topics: Acinetobacter baumannii; Acinetobacter Infections; Anti-Bacterial Agents; Bacterial Proteins; beta-Lactamases; Carbapenems; Cefotaxime; Cross Infection; Drug Resistance, Multiple, Bacterial; Electrophoresis, Gel, Pulsed-Field; Genes, Bacterial; Hospitals; Humans; Imipenem; Iran; Meropenem; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination; Thienamycins

Topics: Acinetobacter baumannii; Acinetobacter Infections; Anti-Bacterial Agents; beta-Lactamases; Carbapenems; Chromosomes, Bacterial; Cross Infection; Disease Outbreaks; DNA, Bacterial; Drug Resistance, Bacterial; Edetic Acid; Greece; Humans; Imipenem; Integrons; Isoelectric Focusing; Microbial Sensitivity Tests; Molecular Sequence Data; Sequence Analysis, DNA

The oxacillinase gene was reported to confer limited resistance to carbapenem in Acinetobacter baumannii. In this study, we have demonstrated that an A. baumannii clinical isolate harboring a plasmid, pTVICU53, has 11,037 bp encoding 13 open reading frames. A bla(OXA-58) gene with an upstream insertion of truncated ISAba3 (DeltaISAba3) and IS1008 was found in this plasmid. DeltaISAba3and IS1008 provided two independent promoters for the transcription control of the bla(OXA-58) gene. The transformation of pTVICU53 or a shuttle vector bearing IS1008-DeltaISAba3-bla(OXA-58) to different A. baumannii recipients can increase their MICs of carbapenem 64- to 256-fold. The deletion of promoters provided by IS1008 resulted in dramatic decreases in bla(OXA-58) transcription and a 32- to 64-fold reduction in the carbapenem MIC. These findings highlight that A. baumannii might develop carbapenem resistance with a single transformation step, taking up a plasmid containing a genetic construct with a potentially high level of transcription of the bla(OXA-58) gene.

Topics: Acinetobacter baumannii; Acinetobacter Infections; Base Sequence; beta-Lactam Resistance; beta-Lactamases; Carbapenems; Cross Infection; DNA Primers; DNA Transposable Elements; DNA, Bacterial; Genes, Bacterial; Humans; Microbial Sensitivity Tests; Molecular Sequence Data; Plasmids; Promoter Regions, Genetic; Transformation, Genetic

The first outbreak of carbapenem-resistant Klebsiella pneumoniae isolates producing the plasmid-encoded carbapenem-hydrolyzing oxacillinase OXA-48 is reported. The 39 isolates belonged to two different clones and were collected at the University Hospital of Istanbul, Turkey, from May 2006 to February 2007, and they coproduced various beta-lactamases (SHV-12, OXA-9, and TEM-1 for clone A and CTX-M-15, TEM-1, and OXA-1 for clone B).

Topics: Bacterial Proteins; beta-Lactamases; Carbapenems; Cross Infection; Drug Resistance, Bacterial; Electrophoresis, Gel, Pulsed-Field; Humans; Klebsiella Infections; Klebsiella pneumoniae; Microbial Sensitivity Tests; Models, Genetic; Turkey

A Klebsiella pneumoniae strain resistant to third-generation cephalosporins was isolated in the eastern Netherlands. The strain was found to carry a novel extended-spectrum beta-lactamase, namely, SHV-31. The combination of the two mutations by which SHV-31 differs from SHV-1, namely, L35Q and E240K, had previously only been described in association with one or more additional mutations.

Topics: Anti-Bacterial Agents; beta-Lactamases; Cross Infection; Disease Outbreaks; Drug Resistance, Multiple, Bacterial; Humans; Intensive Care Units; Isoelectric Focusing; Klebsiella Infections; Klebsiella pneumoniae; Microbial Sensitivity Tests; Molecular Sequence Data; Netherlands; Plasmids

Of the 181 unduplicated Escherichia coli strains isolated in nine different hospitals in three Portuguese regions, 119 were extended-spectrum beta-lactamase (ESBL)-CTX-M producers and were selected for phenotype and genotype characterization. CTX-M producer strains were prevalent among community-acquired infections (56%), urinary tract infections (76%), and patients >/=60 years old (76%). In MIC tests, all strains were resistant to cefotaxime, 92% were resistant to ceftazidime, 93% were resistant to quinolones, 89% were resistant to aminoglycoside, and 26% were resistant to trimethoprim-sulfamethoxazole; all strains were sensitive to carbapenems, and 92% of the strains had a multidrug resistance phenotype. Molecular methods identified 109 isolates harboring a bla(CTX-M-15) gene, 1 harboring the bla(CTX-M-32) gene (first identification in the country), and 9 harboring the bla(CTX-M-14) gene. All isolates presented the ISEcp1 element upstream from the bla(CTX-M) genes; one presented the IS903 element (downstream of bla(CTX-M-14) gene), and none had the IS26 element; 85% carried bla(TEM-1B), and 84% also carried a bla(OXA-30). Genetic relatedness analysis based on pulsed-field gel electrophoresis defined five clusters and indicated that 76% of all isolates (from cluster IV) corresponded to a single epidemic strain. Of the 47 strains from one hospital, 41 belonged to cluster IV and were disseminated in three main wards. CTX-M-producing E. coli strains are currently a problem in Portugal, with CTX-M-15 particularly common. This study suggests that the horizontal transfer of bla(CTX-M) genes, mediated by plasmids and/or mobile elements, contributes to the dissemination of CTX-M enzymes to community and hospital environments. The use of extended-spectrum cephalosporins, quinolones, and aminoglycosides is compromised, leaving carbapenems as the therapeutic option for severe infections caused by ESBL producers.

Topics: Aged; Anti-Bacterial Agents; beta-Lactamases; Community-Acquired Infections; Cross Infection; Drug Resistance, Bacterial; Escherichia coli; Escherichia coli Infections; Escherichia coli Proteins; Humans; Microbial Sensitivity Tests; Middle Aged; Portugal

Bloodstream infections (BSI) caused by extended-spectrum beta-lactamase (ESBL)-producing organisms markedly increase the rates of treatment failure and death. We conducted a retrospective cohort analysis to identify risk factors for mortality in adult in-patients with BSI caused by ESBL-producing Enterobacteriaceae (ESBL-BSI). Particular attention was focused on defining the impact on the mortality of inadequate initial antimicrobial therapy (defined as the initiation of treatment with active antimicrobial agents >72 h after collection of the first positive blood culture). A total of 186 patients with ESBL-BSI caused by Escherichia coli (n = 104), Klebsiella pneumoniae (n = 58), or Proteus mirabilis (n = 24) were identified by our microbiology laboratory from 1 January 1999 through 31 December 2004. The overall 21-day mortality rate was 38.2% (71 of 186). In multivariate analysis, significant predictors of mortality were inadequate initial antimicrobial therapy (odds ratio [OR] = 6.28; 95% confidence interval [CI] = 3.18 to 12.42; P < 0.001) and unidentified primary infection site (OR = 2.69; 95% CI = 1.38 to 5.27; P = 0.004). The inadequately treated patients (89 of 186 [47.8%]) had a threefold increase in mortality compared to the adequately treated group (59.5% versus 18.5%; OR = 2.38; 95% CI = 1.76 to 3.22; P < 0.001). The regimens most commonly classified as inadequate were based on oxyimino cephalosporin or fluoroquinolone therapy. Prompt initiation of effective antimicrobial treatment is essential in patients with ESBL-BSI, and empirical decisions must be based on a sound knowledge of the local distribution of pathogens and their susceptibility patterns.

Topics: Adult; Aged; Anti-Bacterial Agents; Bacteremia; beta-Lactamases; Cross Infection; Drug Resistance, Bacterial; Enterobacteriaceae; Enterobacteriaceae Infections; Escherichia coli; Female; Humans; Klebsiella pneumoniae; Male; Microbial Sensitivity Tests; Middle Aged; Predictive Value of Tests; Proteus mirabilis; Risk Factors; Survival Analysis; Treatment Outcome

Clinical isolates of Acinetobacter baumannii (n = 470) were collected during a 7-year period and investigated for the genetic determinants of resistance to expanded-spectrum beta-lactams. Thirty-one isolates produced the TEM-92 extended-spectrum beta-lactamase (ESBL) and were clonally related. This is the first report of A. baumannii producing a TEM-type ESBL.

Topics: Acinetobacter baumannii; Acinetobacter Infections; Anti-Bacterial Agents; beta-Lactam Resistance; beta-Lactamases; beta-Lactams; Cross Infection; Humans; Italy; Microbial Sensitivity Tests

A prospective observational study was conducted to identify factors associated with bloodstream infections (BSIs) caused by integron-carrying Enterobacteriaceae and to evaluate the clinical significance of integron carriage. Consecutive patients with Enterobacteriaceae BSIs were identified and followed up until discharge or death. Identification of blood isolates and susceptibility testing were performed by the Wider I automated system. int-1-specific PCR, conserved-segment PCR, and DNA sequencing were used to determine the presence, length, and content of integrons. The relatedness among the isolates was examined by pulsed-field gel electrophoresis. Two hundred fifty episodes of Enterobacteriaceae BSI occurred in 233 patients; 109 (43.6%) were nosocomial, 82 (32.8%) were community acquired, and 59 (23.6%) were health care associated. Integrons were detected in 11 (13.4%) community-acquired, 24 (40.7%) health care-associated, and 46 (42.2%) nosocomial isolates. Integron-carrying organisms were more likely to exhibit resistance to three or more classes of antimicrobials (odds ratio [OR], 9.84; 95% confidence interval [95% CI], 5.31 to 18.23; P < 0.001) or to produce extended-spectrum beta-lactamases (OR, 5.75; 95% CI, 2.38 to 13.89; P < 0.001) or a VIM-type metallo-beta-lactamase (P, 0.003). Inter- or intraspecies integron transfer and cross-transmission of integron-carrying clones were observed. Use of cotrimoxazole (OR, 4.77; 95% CI, 1.81 to 12.54; P < 0.001) and a nosocomial or other health care setting (OR, 3.07; 95% CI, 1.30 to 7.22; P, 0.01) were independently associated with BSIs caused by integron-carrying Enterobacteriaceae. Patients with a nonurinary source of bacteremia (OR, 9.46; 95% CI, 2.77 to 32.32; P < 0.001) and a Pitt bacteremia score of > or =4 (OR, 23.36; 95% CI, 7.97 to 68.44; P < 0.001) had a significantly higher 14-day mortality rate, whereas integron carriage did not affect clinical outcomes. These findings may have implications affecting antibiotic policies and infection control measures.

Topics: Bacteremia; Community-Acquired Infections; Cross Infection; DNA, Bacterial; Drug Resistance, Multiple, Bacterial; Electrophoresis, Gel, Pulsed-Field; Enterobacteriaceae Infections; Gene Transfer, Horizontal; Humans; Infectious Disease Transmission, Professional-to-Patient; Integrons; Microbial Sensitivity Tests; Nucleic Acid Amplification Techniques; Polymerase Chain Reaction; Prospective Studies; Risk Factors; Sequence Analysis, DNA; Treatment Outcome

Risk factors, therapy and outcome of 15 cases of nosocomial meningitis due to Pseudomonas aeruginosa is reviewed. No difference in risk factors was found, however mortality for Ps. aeruginosa was significantly higher (33.3 vs 15.1% p<0.04).

Topics: Adolescent; Anti-Bacterial Agents; Cefotaxime; Ceftazidime; Chi-Square Distribution; Child, Preschool; Chloramphenicol; Cross Infection; Drug Therapy, Combination; Female; Gentamicins; Humans; Infant; Infant, Newborn; Male; Meningitis, Bacterial; Meropenem; Pseudomonas Infections; Retrospective Studies; Risk Factors; Survival Analysis; Thienamycins

Klebsiella pneumoniae has long been a prominent cause of nosocomial infections and outbreaks have been observed in the intensive care units and in high risk groups. We present here a brief report on an outbreak of Klebsiella pneumoniae which occurred in a neonatal intensive care unit in our teaching hospital. As neonates are at highest risk for acquisition of Klebsiella pneumoniae producing extended spectrum beta-lactamase, infection control policies and procedures should be strictly followed to prevent such outbreaks.

Topics: Anti-Bacterial Agents; beta-Lactamases; Cefotaxime; Ceftazidime; Ceftriaxone; Cephalosporin Resistance; Cross Infection; Disease Outbreaks; Hospitals, Teaching; Humans; India; Infant, Low Birth Weight; Infant, Newborn; Intensive Care Units, Neonatal; Klebsiella Infections; Klebsiella pneumoniae

Neonatal osteoarticular infections remain rare, with an estimated incidence of 1 to 3 cases per 1000 admissions to Neonatal Intensive Care Units. It usually results from bacteraemia and may thus be induced by IV catheters. More rarely it is due to direct inoculation secondary to cutaneous damage, or extension of soft tissue infection. The particularity of bone vascularization in the newborn explains the frequency of abscess formation in the periosteum or in soft tissues. The main pathogen involved is S. aureus (3/4 of cases), followed by group B streptococci and enterobacteriacae. Infection consists mainly of localised and slowly progressing abscesses. However, multifocal and severe infection is possible, in particular when caused by an IV catheter. Ultrasonography is the best initial investigation, possibly leading to surgical care. Medical treatment must include 2 synergistic antistaphyloccocal antibiotics, possibly associated with cefotaxime. The outcome is generally favorable, but orthopaedic consequences may emerge if the growth plate is involved. Rare specific causes, such as syphilis or tuberculosis, should also be evoked, but the clinical context is generally helpful for the diagnosis.

Topics: Age Factors; Anti-Bacterial Agents; Bacterial Infections; Catheterization; Cefotaxime; Cross Infection; Drug Therapy, Combination; Enterobacteriaceae; Escherichia coli Infections; Humans; Incidence; Infant, Newborn; Intensive Care Units, Neonatal; Osteoarthritis; Staphylococcal Infections; Staphylococcus aureus; Streptococcal Infections; Streptococcus agalactiae; Treatment Outcome

There are numerous types of extended spectrum beta-lactamases (ESBLs), of which TEM and SHV are predominant among Klebsiella pneumoniae strains. Nosocomial infections with strains of K. pneumoniae are common in healthcare centers in Iran. However, no information is available on the prevalence of different phenotypes of ESBL strains in Tehran hospitals.. To determine the resistance of K. pneumoniae to beta-lactam antibiotics in Tehran hospitals, 145 isolates were tested using the disk diffusion method. The MICs for ceftazidime were also determined using microbroth dilution assay. Isolates showing MIC >/=4 for ceftazidime were subjected to PCR to target the bla(SHV) and bla(TEM) genes and screened for ESBL production by the phenotypic confirmatory method.. All strains were susceptible to imipenem. Resistance to ceftazidime and cefotaxime were 31% and 32%, respectively. Fifty-six isolates showed MIC >/=4 microg/ml for ceftazidime, of which 50 were positive for ESBL in the phenotypic confirmatory test. The prevalence of bla(SHV) and bla(TEM) among these isolates was 69.6% (n=39) and 32.1% (n=18), respectively. Resistance to ciprofloxacin was found among 32% of the ESBL strains.. SHV is the dominant enzyme among the ESBL-producing strains of Klebsiella pneumoniae in Iran. The high rate of co-resistance to ceftazidime and ciprofloxacin is a matter of concern and treatment requires further attention to the results of susceptibility.

Topics: Base Sequence; beta-Lactamases; Cefotaxime; Ceftazidime; Cross Infection; DNA Primers; DNA, Bacterial; Drug Resistance, Bacterial; Genes, Bacterial; Humans; Iran; Klebsiella Infections; Klebsiella pneumoniae; Microbial Sensitivity Tests; Polymerase Chain Reaction

The aim of this study was to determine the prevalence of extended-spectrum beta-lactamases (ESBLs) in nosocomial bacteremia isolates of Escherichia coli, Klebsiella pneumoniae and Klebsiella oxytoca at Hacettepe University Adult Hospital in Ankara, Turkey. A total of 344 blood culture isolates of E. coli (n=244), K. pneumoniae (n=86) and K. oxytoca (n=34) were included in the study from January 2003 to November 2005. Only one isolate from one patient was tested in the study. The isolates with ceftazidime and/or cefotaxime MIC values > or =1 microg/ml were tested by ceftazidime-ceftazidime/clavulanic acid and cefotaxime-cefotaxime/clavulanic acid Etest (AB Biodisk Solna, Sweden) strips and evaluated as ESBL positive if the ratio was > or =8. Of the isolates, 33% (74/224) of E. coli, 31.4% (27/86) of K. pneumoniae and 47% (16/34) of K. oxytoca were detected as ESBL producers by any kind of two strips. However, 5.4% (4/74) of E. coli, 3.7% (1/27) of K. pneumoniae and 43.1% (7/16) of K. oxytoca ESBL-producing isolates could be detected only by cefotaxime-cefotaxime/clavulanic acid strips. It is important to use cefotaxime-cefotaxime/clavulanic acid as well as ceftazidime-ceftazidime/clavulanic acid ratio for detection of ESBL types that preferentially hydrolyze cefotaxime. Since prevalence of ESBL production is high in nosocomial E. coli and Klebsiella spp. isolates in our hospital, surveillance of antibiotic susceptibility patterns is important for the empirical treatment of bacteremic patients.

Topics: Anti-Bacterial Agents; Bacteremia; beta-Lactamases; Cefotaxime; Ceftazidime; Clavulanic Acid; Cross Infection; Drug Combinations; Enzyme Inhibitors; Escherichia coli; Escherichia coli Infections; Humans; Klebsiella; Klebsiella Infections; Klebsiella oxytoca; Klebsiella pneumoniae; Microbial Sensitivity Tests; Prevalence; Turkey

During a survey of the prevalent subtypes of extended-spectrum beta -lactamases in a university hospital in Korea, a nosocomial outbreak of Escherichia coli producing CTX-M-15 and OXA-30 beta -lactamases was detected. The outbreak comprised various infections, including bloodstream infections and colonization, and persisted for several months in various areas of the hospital.

Topics: beta-Lactamases; Cefotaxime; Ceftazidime; Cross Infection; Disease Outbreaks; Escherichia coli; Escherichia coli Infections; Humans; Klebsiella Infections; Klebsiella pneumoniae; Korea; Prevalence

A total of 151 Escherichia coli strains resistant to cefotaxime and ceftazidime were isolated during a prospective surveillance study. These strains were characterized by clinical, microbiological, and molecular analyses and were distributed into four clusters of 103, 11, 6, and 5 isolates, along with 25 unrelated strains. The principal cluster was isolated from urine, wound, blood, and other samples in three hospitals, eight nursing homes, and a community healthcare center. This cluster was associated with both nosocomial (65%) and community-acquired (35%) infections. Most strains were resistant to ciprofloxacin, gentamicin, tobramycin, cefepime, amoxicillin-clavulanic acid, and trimethoprim-sulfamethoxazole but were susceptible to imipenem. All isolates from the four clusters expressed the extended-spectrum beta-lactamase (ESBL) CTX-M-15. This enzyme was also present in 8 (30.8%) of the 26 unrelated isolates. The other ESBLs, CTX-M-14 and CTX-M-32, were detected in five and seven cases, respectively, but they were detected in individual E. coli isolates only. In three clusters, blaCTX-M-15 alleles were linked to an ISEcp1-like element, while in eight strains of cluster II an IS26 element preceded the blaCTX-M-15 allele. An additional pool of resistance genes included tetA, drfA14 or dfrA17, sul1 or sul2, aac(6')Ib, and aac(3)IIb. All except one of the 27 isolates tested for genetic virulence markers harbored the same three virulence genes: iutA and fyuA (siderophores), and traT (serum survival factor). Epidemic or occasional isolates of cefotaxime- and ceftazidime-resistant E. coli can spread between distinct health facilities including hospitals, community health centers, and long-term care centers.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Bacterial Outer Membrane Proteins; beta-Lactam Resistance; beta-Lactamases; Blood; Cefotaxime; Ceftazidime; Cluster Analysis; Community-Acquired Infections; Cross Infection; DNA Transposable Elements; Escherichia coli; Escherichia coli Infections; Escherichia coli Proteins; Female; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Molecular Epidemiology; Receptors, Cell Surface; Spain; Urine; Virulence; Wounds and Injuries

Spontaneous bacterial peritonitis (SBP) is an ascitic fluid infection as a complication of end stage liver disease. The outcome is related to the severity of hepatorenal function, gastrointestinal bleeding, and many others; however it is not well known whether the infection acquisition sites have an effect on the prognosis of SBP. In order to identify the prognostic significance of the acquisition sites, we studied 106 patients who were diagnosed as culture positive SBP between October 1998 and August 2003. Thirty-two episodes were nosocomial and 74 were community acquired. Gram-negative bacilli such as Escherichia coli were dominant in both of the nosocomial and community-acquired SBPs. Despite significantly higher resistance to cefotaxime in nosocomial isolates compared to community-acquired isolates (77.8% vs. 13.6%, p=0.001), no difference was found regarding short or long term prognosis. Infection acquisition sites were not related to short or long term prognosis either. Shock, gastrointestinal bleeding and renal dysfunction were related to short term prognosis. Only Child-Pugh class C was identified as an independent prognostic factor of long-term survival.

Topics: Aged; Anti-Bacterial Agents; Bacterial Infections; Cefotaxime; Ciprofloxacin; Community-Acquired Infections; Cross Infection; Drug Resistance, Bacterial; Escherichia coli; Female; Gastrointestinal Hemorrhage; Humans; Kidney Diseases; Klebsiella pneumoniae; Male; Middle Aged; Multivariate Analysis; Peritonitis; Prognosis; Shock; Survival Rate; Time Factors

Antimicrobial resistance of isolates and risk factors for mortality were retrospectively investigated in 71 adult patients with Serratia marcescens bacteremia. During the 4-year study period, 78 clinically significant episodes of S. marcescens bacteremia occurred in 71 patients. The mean age of the patients was 65 years (range, 25-86 years) with a male predominance (45 patients, 63%). Most of the bacteremic episodes were nosocomial (78%), and 34% were polymicrobial. The overall mortality rate within 2 weeks after the onset of bacteremia was 41%. The presence of malignancy and critical illness at initial presentation were independent risk factors for mortality. By disk susceptibility test, 72 isolates were resistant to cefotaxime (92%) but susceptible to ceftazidime (99%). All isolates were susceptible to meropenem. Among the 47 patients with monomicrobial S. marcescens bacteremia, the mortality rate within 5 days of onset in patients receiving appropriate empirical antimicrobial therapy was lower than that in patients receiving inappropriate therapy although this difference was not significant (14% vs 28%, p = 0.27). Among the patients with cefotaxime-resistant but ceftazidime-susceptible S. marcescens bacteremia treated with ceftazidime, 6 of 7 patients (86%) survived for more than 2 weeks, suggesting the potential effectiveness of ceftazidime in the treatment of cefotaxime-resistant Serratia infections. Further clinical studies are required to delineate the clinical role of ceftazidime therapy for infections caused by S. marcescens with this resistant phenotype.

Topics: Adult; Aged; Anti-Bacterial Agents; Bacteremia; Cefotaxime; Ceftazidime; Critical Illness; Cross Infection; Drug Resistance, Bacterial; Female; Humans; Male; Meropenem; Middle Aged; Neoplasms; Retrospective Studies; Risk Factors; Serratia Infections; Serratia marcescens; Taiwan; Thienamycins

Thirty-four clinical isolates of Serratia marcescens nonsusceptible to cefotaxime were collected from a medical center in middle Taiwan. Confirmatory tests for extended-spectrum beta-lactamases (ESBLs) by cefotaxime and ceftazidime +/- clavulanic acid using Etest ESBL Screen identified only one ESBL producer; the remaining 33 isolates revealed nondeterminable results, because of off-scale minimum inhibitory concentration (MIC) levels for cefotaxime +/- clavulanic acid. Agar microdilution method using broader MIC ranges confirmed 21 ESBL-producers and one non-determinable result, achieving a highly predicting value compared to golden standard by PCR and DNA sequencing analysis, which identified 22 (65%) isolates containing blaCTX-M-3 genes. Only one strain carried concurrent CTX-M-3 and SHV-5 conferring high-level MICs to both cefotaxime (128 microg/mL) and ceftazidime (64 microg/mL). Other enzymatic mechanisms, such as chromosome-encoded AmpC including a novel SRT-2 enzyme, may confer resistance to cefotaxime on the remaining 12 isolates without ESBL bla genes. Thus, it is unreliable to predict the resistance mechanism by antibiogram, and current Etest ESBL Screen tests. Our study highlights expanding efforts to detect ESBLs in S. marcescens are urgently needed in Taiwan.

Topics: Anti-Bacterial Agents; Base Sequence; beta-Lactamases; Cefotaxime; Cross Infection; Data Collection; DNA, Bacterial; Drug Resistance, Bacterial; Female; Hospitals, University; Humans; Male; Microbial Sensitivity Tests; Molecular Sequence Data; Polymerase Chain Reaction; Sensitivity and Specificity; Serratia Infections; Serratia marcescens; Taiwan

Three strains of cefotaxime (CTX)-resistant Acinetobacter baumannii, FM0209680, FM0300106, and FM0301433, were isolated from transtracheal aspirate cultures of three patients with probable nosocomial infections in a neurosurgery ward in Japan. The CTX MICs for these isolates were greater than 128 microg/ml but were drastically reduced in the presence of 4 microg of clavulanic acid per ml. These strains were also resistant to ceftriaxone, cefpodoxime, and aztreonam but were susceptible to ceftazidime and imipenem. The profile of resistance to various broad-spectrum beta-lactams was transferred by conjugation. Strain FM0209680 was not eradicated from case patient 1 by administration of imipenem, ceftazidime, and levofloxacin, even after a 6-month hospitalization period. Strains FM0300106 and FM0301433 were isolated from case patients 2 and 3 during the sixth week following admission, respectively, and then each patient was colonized for 3 weeks. Eradication of FM0300106 was successfully obtained from case patient 2 by imipenem treatment, while administration of imipenem was continued to prevent pneumonia. Prophylactic antimicrobial therapy was discontinued in case patient 3 because of the lack of pneumonic symptoms, and FM0301433 disappeared after the discontinuation of antimicrobial chemotherapy. All three strains carried the bla(CTX-M-2) gene, and the appearance of colonies in the growth-inhibitory zones around disks of CTX and aztreonam in double-disk synergy tests suggested inducible beta-lactamase production in these A. baumannii strains. The ribotyping investigation suggested that all these strains belong to the same clonal lineage. The plasmids harbored by A. baumannii had the same restriction profile as those harbored by Proteus mirabilis strains previously isolated in a urology ward of the Funabashi Medical Center.

Topics: Acinetobacter baumannii; Acinetobacter Infections; Base Sequence; Cefotaxime; Cross Infection; DNA Primers; Drug Resistance, Bacterial; Humans; Microbial Sensitivity Tests; Polymerase Chain Reaction

Enterobacter species have become increasingly important nosocomial pathogens. However, resistance to cephalosporins often complicates the treatment of Enterobacter infection. This study was conducted to evaluate the predictors of mortality and the impact of cephalosporin resistance on outcome in patients with Enterobacter bacteremia.. A total of 183 patients with Enterobacter bacteremia were retrospectively analyzed. Broad-spectrum cephalosporin resistance was defined as in vitro resistance to cefotaxime or ceftazidime. The main outcome measure was the 30-day mortality rate.. Of 183 patients, 86 (47%) had bacteremia caused by broad-spectrum cephalosporin-resistant Enterobacter species, and their infections were classified as resistant. The 30-day mortality rate of patients with resistant infections (the resistant group) was significantly higher than that of patients with susceptible infections (the susceptible group) (33.7% vs. 18.6%; P=.021). When the 30-day mortality rates were compared according to the primary sites of infection and underlying conditions, the 30-day mortality rates of the resistant group were significantly higher than those of the susceptible group, in patients with an unknown primary site of infection, or in patients with septic shock. Multivariate analysis showed that broad-spectrum cephalosporin resistance was one of the independent risk factors associated with 30-day mortality (odds ratio [OR], 3.69; 95% confidence interval [CI], 1.01-13.52; P=.049). Presentation with septic shock and an increasing Acute Physiology and Chronic Health Evaluation II score were also independent risk factors for mortality (OR, 59.91 [95% CI, 14.93-240.15; P<.001] and 1.52 [95% CI, 1.24-1.86; P<.001], respectively).. Broad-spectrum cephalosporin resistance adversely affects the outcome of patients with Enterobacter bacteremia, especially those with an unknown primary site of infection and those with septic shock.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; APACHE; Bacteremia; Cefotaxime; Ceftazidime; Cephalosporin Resistance; Cross Infection; Enterobacter; Enterobacteriaceae Infections; Female; Humans; Male; Middle Aged; Retrospective Studies; Risk Factors; Survival Analysis

Over a 22-month period, there was an unusual upsurge in the incidence of cefotaxime-resistant Escherichia coli among hospitalized patients in three geriatric hospitals in the same district. Sixteen highly cefotaxime-resistant strains were obtained from clinical specimens during the period January 1996 through October 1997. All strains were characterized by antibiotic resistance pattern analysis, the detection of the TEM- and Toho-type beta-lactamase or CTX-M-type beta-lactamase gene by polymerase chain reaction (PCR), plasmid profiling, Southern hybridization analysis, and pulsed-field gel electrophoresis (PFGE). Antibiotic resistance analysis showed that all strains were highly resistant to ampicillin, piperacillin, carbenicillin, cephaloridine, and cefotaxime; intermediately resistant to cefoxitin; moderately susceptible to moxalactam and ceftazidime; and susceptible to imipenem. Detailed analysis of beta-lactamase content revealed that all cefotaxime-resistant strains harbored a plasmid that mediated an extended-spectrum beta-lactamase of the Toho-type or CTX-M-type by PCR and Southern hybridization analysis. PCR detection showed that all the E. colistrains, except for strains TUM1023, TUM1101, TUM1227, and TUM1229, also possessed bla(TEM) genes. Furthermore, Southern hybridization analysis showed that all strains, except for TUM1102, gave a similar signal with the Toho probe. The PFGE profiles of the E. colistrains obtained with XbaI showed four patterns that correlated well with the plasmid profiles. The Dice value of 15 strains, including Toho-2 producer (TUM1083), for their PFGE patterns indicated a similarity of 80% or more. Our results suggest that 15 of the 17 Toho type beta-lactamase-producing E. coli strains (including strain TUM1083) studied belong to a single epidemic strain, while the other two strains are different from them, and the Toho-type or CTX-M-type beta-lactamase encoding gene may be acquired by plasmid conjugation or a mobile element.

Topics: Aged; Aged, 80 and over; beta-Lactamases; Cefotaxime; Cephalosporin Resistance; Cross Infection; Disease Outbreaks; Electrophoresis, Gel, Pulsed-Field; Escherichia coli; Female; Humans; Male; Microbial Sensitivity Tests; Polymerase Chain Reaction

The combination of cefotaxime and fosfomycin (CTX-FOS) has been proposed in France for the empirical treatment of postoperative nosocomial meningitis since the late 1980s. The purpose of this work was to evaluate this strategy today, as well as other possible treatments.. Each patient undergoing a neurosurgical procedure was prospectively included in a database designed for the surveillance of surgical site infection (SSI). For each meningitis detected, we analysed the in vitro susceptibility of the causative micro-organisms to cefotaxime alone (CTX), cefotaxime-fosfomycin (CTX-FOS), vancomycin (VAN) and cefotaxime-vancomycin (CTX-VAN) combinations. The patient population was divided into two groups according to the presence or absence of CSF shunting material.. 116 patients had had a postoperative meningitis/ventriculitis during the last 36 months, among 6447 patients undergoing neurosurgery in our department (1.8%). Ten patients had aseptic meningitis (8.6%). Overall sensitivity to CTX was 69.8%, as compared to 77.3% with CTX-FOS combination (NS). This result was due to a large proportion of fosfomycin resistant cocci in our population. The CTX-VAN combination increased the overall in vitro susceptibility up to 91.5%, but the benefit of this combination was only significant in CSF shunting material patients. In these latter patients, VAN was as effective as CTX-FOS combination.. CTX-FOS combination is no longer the best choice for empirical treatment of post neurosurgical meningitis. CTX alone can be safely used in patients without a CSF shunt; in those with either a ventriculostomy or a CSF shunt associated ventriculitis, a CTX-VAN combination could improve treatment efficacy, provided that high doses of vancomycin are used to ensure correct CSF diffusion.

Topics: Adult; Aged; Cefotaxime; Central Nervous System Diseases; Cerebrospinal Fluid Shunts; Craniotomy; Cross Infection; Dose-Response Relationship, Drug; Drug Therapy, Combination; Female; Fosfomycin; Humans; Male; Meningitis, Aseptic; Meningitis, Bacterial; Methicillin Resistance; Microbial Sensitivity Tests; Middle Aged; Prospective Studies; Staphylococcal Infections; Surgical Wound Infection; Treatment Outcome; Vancomycin

To determine the distribution and antimicrobial drug resistance in bacterial pathogens causing nosocomial infections, surveillance data on nosocomial infections documented from 1981 to 1999 at National Taiwan University Hospital were analyzed. During this period, 35,580 bacterial pathogens causing nosocomial infections were identified. Candida species increased considerably, ranking first by 1999 in the incidence of pathogens causing all nosocomial infections, followed by Staphylococcus aureus and Pseudomonas aeruginosa. Candida species also increased in importance as bloodstream infection isolates, from 1.0% in 1981-1986 to 16.2% in 1999. The most frequent isolates from urinary tract infections were Candida species (23.6%), followed by Escherichia coli (18.6%) and P. aeruginosa (11.0%). P. aeruginosa remained the most frequent isolates for respiratory tract and surgical site infections in the past 13 years. A remarkable increase in incidence was found in methicillin-resistant S. aureus (from 4.3% in 1981-1986 to 58.9% in 1993-1998), cefotaxime-resistant E. coli (from 0% in 1981-1986 to 6.1% in 1993-1998), and cefotaxime-resistant Klebsiella pneumoniae (from 4.0% in 1981-1986 to 25.8% in 1993-1998). Etiologic shifts in nosocomial infections and an upsurge of antimicrobial resistance among these pathogens, particularly those isolated from intensive care units, are impressive and alarming.

Topics: Anti-Bacterial Agents; Anti-Infective Agents; Candida; Candidiasis; Cefotaxime; Cross Infection; Drug Resistance, Bacterial; Drug Resistance, Fungal; Escherichia coli Infections; Humans; Methicillin Resistance; Microbial Sensitivity Tests; Pseudomonas aeruginosa; Pseudomonas Infections; Staphylococcus aureus; Taiwan

Infections caused by Gram-negative bacteria with resistance to extended-spectrum cephalosporins require the identification of effective alternative antimicrobial therapy. To determine the role of other pre-existing or currently available antimicrobial agents in treating infections caused by these multidrug-resistant pathogens, we evaluated the in vitro susceptibilities of these agents in 411 non-duplicate isolates of extended-spectrum cephalosporin-resistant Gram-negative bacteria recovered between January 1999 and December 1999 in a major teaching hospital in Taipei, Taiwan. These isolates included cefotaxime-resistant (MICs > or = 2 mg/L) Escherichia coli (66 isolates) and Klebsiella pneumoniae (77 isolates); cefotaxime-resistant (MICs > or = 64 mg/L) Enterobacter cloacae (59 isolates), Serratia marcescens (52 isolates) and Citrobacter freundii (52 isolates); and ceftazidime-resistant (MICs > or = 64 mg/L) Pseudomonas aeruginosa (50 isolates) and Acinetobacter baumannii (55 isolates). Overall, carbapenems (imipenem and meropenem) had good activity against the cefotaxime-resistant Enterobacteriaceae tested (>90% of isolates were susceptible). However, carbapenems had limited activity against the ceftazidime-resistant P. aeruginosa (only 4% of isolates were susceptible) and A. baumannii (51-56% of isolates were susceptible). Among the E. coli and K. pneumoniae isolates tested, 33.3% and 58.4%, respectively, exhibited extended-spectrum beta-lactamase phenotype, determined by the double disc method. Over 80% of cefotaxime-resistant E. cloacae and C. freundii were susceptible to cefepime, but this agent had limited activity against other bacteria tested. Susceptibilities of these isolates to ciprofloxacin varied, ranging from 25% for A. baumannii to 92% for E. cloacae. Newer fluoroquinolones (moxifloxacin and trovafloxacin) had equal or less activity against these organisms, except for A. baumannii for which their MIC(90)s (8-16 mg/L) were four- to 16-fold less than that of ciprofloxacin (MIC(90) 128 mg/L).

Topics: Cefotaxime; Ceftazidime; Cephalosporin Resistance; Cephalosporins; Cross Infection; Drug Prescriptions; Drug Resistance, Microbial; Gram-Negative Bacterial Infections; Hospitals, University; Humans; Taiwan

Topics: Cefotaxime; Cross Infection; Drug Therapy, Combination; Female; Humans; Infant, Newborn; Infant, Premature; Sepsis; Staphylococcal Infections; Vancomycin

To compare the efficacy of gentamicin, nebulised via the endotracheal tube (ET), with that of parenteral cefotaxime or parenteral cefuroxime in preventing the formation of ET biofilm.. General intensive care units in two university teaching hospitals.. The microbiology of ET biofilm from 36 ICU patients eligible to receive antibiotic prophylaxis was examined. Peak and trough tracheal concentrations of gentamicin, cefotaxime or cefuroxime were measured in each patient group, on the 2nd day of intubation.. Twelve patients received gentamicin (80 mg) nebulised in 4 ml normal saline every 8 h, 12 cefotaxime (1 g, 12 hourly) and 12 cefuroxime (750 mg, 8 hourly). Prophylaxis was continued for the duration of intubation.. Samples of tracheal secretions were taken on the 2nd day of ventilation for determination of antibiotic concentrations. Following extubation, ETs were examined for the presence of biofilm. Pathogens considered to be common aetiological agents for VAP included Staphylococcus aureus, enterococci, Enterobacteriaceae and pseudomonads. While microbial biofilm was found on all ETs from the cephalosporin group, microbial biofilm of these micro-organisms was found on 7 of the 12 ET tubes from patients receiving cefotaxime [ S. aureus (4), pseudomonads (1), Enterobacteriaceae (1), enterococcus (1)] and 8 of the 12 ET tubes from patients receiving cefuroxime [Enterobacteriaceae (6), P. aeruginosa (1) and enterococcus (1)]. While microbial biofilm was observed on five ETs from patients receiving nebulised gentamicin, none of these were from pathogens for ventilator-associated pneumonia (VAP). Tracheal concentrations of both cephalosporins were lower than those needed to inhibit the growth of pathogens recovered from ET tube biofilm. The median (and range) concentrations for cefotaxime were 0.90 (<0.23-1.31) mg/l and 0.28 (<0.23-0.58) mg/l for 2 h post-dose and trough samples, respectively. Two hours post-dose concentrations of cefuroxime (median and range) were 0.40 (0.34-0.83) mg/l, with trough concentrations of 0.35 (<0.22-0.47) mg/l. Tracheal concentrations (median and range) of gentamicin measured 1 h post-nebulisation were 790 (352-->1250) mg/l and then, before the next dose, were 436 (250-1000) mg/l.. Nebulised gentamicin attained high concentrations in the ET lumen and was more effective in preventing the formation of biofilm than either parenterally administered cephalosporin and therefore may be effective in preventing this complication of mechanical ventilation.

Topics: Administration, Inhalation; Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Antibiotic Prophylaxis; Biofilms; Cefotaxime; Cefuroxime; Cephalosporins; Cross Infection; Female; Gentamicins; Humans; Infusions, Parenteral; Intubation, Intratracheal; Male; Middle Aged; Pneumonia, Bacterial; Statistics, Nonparametric

To determine patterns of use of ceftriaxone and cefotaxime (CEFX) in Victorian hospitals and to identify areas for improvement.. A concurrent, observational evaluation of CEFX use in patients commencing a course of these drugs between 8 and 14 September, 1999, in 51 Victorian hospitals.. Proportion of patients treated with CEFX; indications; duration of use; concordance with recommendations of national antibiotic guidelines (Therapeutic guidelines: antibiotic, 10th edition [AG10]).. 671 patients were treated with CEFX. The overall rate of use was 43 patients per 1000 inpatient separations. Treatment of respiratory tract infection accounted for 352 patients (52%) and surgical prophylaxis for 99 patients (15%). Treatment of skin/soft tissue, urinary tract and gastrointestinal tract infections accounted for about 7% of patients each. The median duration of CEFX courses was 3.0 days. The overall rate of concordance with indications recommended in AG10 was 27%. The rate of concordance for empirical treatment of respiratory tract infection was 24%. Of the 195 patients treated empirically with CEFX for community-acquired respiratory tract infection and assessed as non-concordant, 64% did not have radiological evidence of pneumonia, and a further 30% did not fulfill the criteria for severe pneumonia. All courses given for surgical prophylaxis were non-concordant.. CEFX is widely used in Victorian hospitals, mostly to treat lower respiratory tract infection and in surgical prophylaxis of infection. The rate of concordance with AG10 is low. Potential areas for intervention include empirical treatment of respiratory tract infection and use in surgical prophylaxis.

Topics: Bacterial Infections; Cefotaxime; Ceftriaxone; Cephalosporins; Cross Infection; Drug Utilization Review; Guideline Adherence; Hospitals; Hospitals, Teaching; Humans; Logistic Models; Practice Guidelines as Topic; Victoria

Data on the incidence of Enterobacter infections in neonates over prolonged periods of time are scant. We determined the epidemiology of Enterobacter sepsis and/or meningitis and the trends of infection in a neonatal unit.. Retrospective review of sepsis and/or meningitis in inborn neonates admitted to Son Dureta University Hospital during a 22-year period. Molecular study by ribotyping of the Enterobacter strains isolated from 1995 to 1997.. There were 513 cases of culture-proved sepsis and/or meningitis in neonates. In late onset infections Klebsiella pneumoniae and Staphylococcus epidermidis were the most frequent isolates in the period 1977 through 1991. Enterobacter was the most common isolate in the period 1992 through 1998. During this latter period Candida infections also increased, and the resistance rate of Enterobacter to cefotaxime was higher (59.2%). Decrease in early onset infections and increase in late onsets (4.6/1,000 live births) were observed in the second period. From 1977 to 1998, 45 episodes of sepsis and/or meningitis by Enterobacter species were identified in 44 patients (8.7% of all neonatal bacteremias). Three patients with Enterobacter bacteremia died (6.6%, 0.03/1,000 live births). During 1995 through 1997 5 different clones causing sepsis were identified and 3 were predominant. In 1997 there was an outbreak of Enterobacter disease. After cleaning, cohort nursing and hygiene reinforcement, Enterobacter was not isolated in the next 2 years. No change in the antibiotic policy was made.. We observed a resurgence of Enterobacter infections in our neonatal intensive care unit. The sudden disappearance of this microorganism after reinforcement of hygienic measures, without withdrawing cefotaxime, confirms the importance of patient-to-patient transmission of this nosocomial infection. Further studies are needed to establish the role of antibiotics in the emergence of microorganisms in neonatal intensive care units.

Topics: Cefotaxime; Cross Infection; Drug Resistance, Bacterial; Enterobacter; Enterobacteriaceae Infections; Female; Humans; Hygiene; Infant, Newborn; Intensive Care Units, Neonatal; Longitudinal Studies; Male; Meningitis, Bacterial; Retrospective Studies; Ribotyping; Sepsis

Afer twenty years of commercial availability of cefotaxime, the objective of this study was to know the reasons and modes of use, administration dosage as well as its effectiveness and tolerance in critically ill patients admitted to Intensive Care Units (ICU) in our country.. Open, prospective, observational, multicenter study.. All patients who had cefotaxime administered in monotherapy or in combination with other antibiotics were included as cases in this study.. A total of 624 patients were included in 44 ICUs (average 14 cases). Cefotaxime was indicated for therapy of 274 community-acquired infections (43.9%), 194 prophylaxis (31.1%), and 156 nosocomial infections (25.0%). Both community-acquired pneumonia (149, 34.7%) and mechanical ventilation associated pneumonia (62, 14.4%) predominated, followed by trachebronchitis (60, 13.9%) and central nervous system infections (42, 9.8%). Over half of infections (222, 51.6%) presented as systemic inflammatory response syndrome (SIRS), 133 (30.9%) as severe sepsis, and 75 (17.4%) as septic shock. In 374 (87.0%) out of the 430 cases of infection treatment, cefotaxime wan prescribed on an empirical basis and in 150 of them (40.1%) a further confirmation of the causative agent was obtained. In 120 (27.9%) cases, cefotaxime was administered as monotherapy and in the remaining cases in association with one or more antibiotics.The use of cefotaxime as prophylaxis was evaluated as failure in 31 (16.0%) of the cases, whereas in treatment it was considered as failure in 98 (22.8%) of the 430 cases, 51 community-acquired infections, 27 (27.3%) of ICU-acquired infections, and 20 (35.1%) nosocomial infections acquired outside the ICU. In 127 (29.5%) of the 430 infection treatments the initial treatment was changed. The reasons for the change included clinical failure (36, 28.3%), recovery of an uncovered pathogen with the antibiotic (40, 31.5%), emergence of multi-resistant pathogens (28, 22.0%), to decrease the therapeutic spectrum (7, 5.5%), and other reasons (16). Cefotoxime was also changed in 21 (6.0%) of the 194 cases in which it was used as prophylaxis. In 32 (5.1%) patients 37 adverse effects were noted which were associated with a possible or likely use of cefotaxime. Most notably, diarrhoea in 15 (2.4%) occasions and skin rash in 6 cases (1.0%).. Cefotaxime is still one of the therapies of choice for community-acquired and nosocomial infections as well as in different prophylactic modes. It is mostly used on an empirical basis and associated with other antibiotics. Clinical and microbiological efficiency is high whereas adverse effects related to its use have been scarce.

Topics: Antibiotic Prophylaxis; Cefotaxime; Cephalosporins; Community-Acquired Infections; Critical Illness; Cross Infection; Drug Utilization; Humans; Intensive Care Units; Prospective Studies; Spain

The aim of this study was to determine the prevalence of primary Helicobacter pylori resistance, and to investigate the relationship with factors such as age and sex. During 1998, 106 H. pylori strains collected from dyspeptic patients who had had no previous H. pylori treatment were studied. The minimun inhibitory concentrations of metronidazole, amoxicillin, clarithromycin, tetracycline, azithromycin, clindamycin, cefotaxime and ciprofloxacin were determined by E-test.((R)). The overall prevalence of primary metronidazole resistance was 40.6%. Although it was more frequent in women than in men (44.4% vs. 37.7%), the difference was significant only in the women who were under 45 years of age. For the rest of the antibiotics, the primary resistance rates were the following: clarithromycin 9.5%, azithromycin 10.3%, clindamycin 13.1%, and ciprofloxacin 7.9%. No resistance to tetracycline and b-lactam antibiotics was found. Clarithromycin and amoxicillin were the most active compounds of the macrolides and b-lactams studied, respectively.

Topics: Adult; Aged; Amoxicillin; Azithromycin; Cefotaxime; Ciprofloxacin; Clarithromycin; Clindamycin; Cross Infection; Drug Resistance; Female; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Male; Metronidazole; Microbial Sensitivity Tests; Middle Aged; Prevalence; Pyloric Antrum; Spain; Tetracycline

A prospective study conducted among Jordanian ICU patients in 1997 using Etest identified resistance rates among isolates of E. coli (25%-44%), Enterobacter spp. (54%-62%), and Klebsiella spp. (30%-80%) to extended-spectrum B-lactams (ESBLs): ceftazidime, cefotaxime, ceftriaxone, and aztreonam. All these isolates were susceptible to imipenem and showed low resistance rate to ciprofloxacin (5%-19%) and amikacin (13%-18%). Higher and significant resistance rates of Klebsiella isolates to ceftazidime (80%) and aztreonam (65%) were observed in 1997 compared with a previous study performed in 1994. The majority of Klebsiella pneumoniae (70%) express different ESBL phenotypes that were almost resistant to aztreonam and ceftazidime but susceptible or resistant to cefotaxime and/or ceftriaxone. This prospective study strongly suggests that ESBL production of Klebsiella pneumoniae isolates have been highly disseminated among ICU patients during 1997.

Topics: Aztreonam; beta-Lactam Resistance; Cefotaxime; Ceftazidime; Ceftriaxone; Cross Infection; Gram-Negative Bacteria; Humans; Incidence; Intensive Care Units; Jordan; Klebsiella Infections; Klebsiella pneumoniae; Lactams; Microbial Sensitivity Tests; Prospective Studies; Sensitivity and Specificity

Fifty-two strains of Klebsiella pneumoniae producing an AmpC-type plasmid-mediated beta-lactamase were isolated from 13 patients in the same intensive care unit between March 1998 and February 1999. These strains were resistant to ceftazidime, cefotaxime and ceftriaxone, but susceptible to cefoxitin, cefepime and aztreonam. Plasmid content and genomic DNA restriction pattern analysis suggested dissemination of a single clone. Two beta-lactamases were identified, TEM-1 and ACC-1. We used internal bla(ACC-1) primers, to sequence PCR products obtained from two unrelated strains of Hafnia alvei. Our results show that the ACC-1 beta-lactamase was derived from the chromosome-encoded AmpC-type enzyme of H. alvei.

Topics: Amino Acid Sequence; Aztreonam; Bacterial Proteins; Base Sequence; beta-Lactamases; Cefepime; Cefotaxime; Cefoxitin; Ceftazidime; Ceftriaxone; Cephalosporins; Cephamycins; Cloning, Molecular; Cross Infection; Disease Outbreaks; Drug Resistance, Microbial; Electrophoresis, Gel, Pulsed-Field; France; Hafnia; Humans; Klebsiella Infections; Klebsiella pneumoniae; Microbial Sensitivity Tests; Molecular Sequence Data; Monobactams; Plasmids; Polymerase Chain Reaction

Aeromonas bacteraemia is not a common infectious disease, but can cause a grave outcome in infected cases. In this study, clinical presentations and prognostic factors of cases of monomicrobial Aeromonas bacteraemia were analysed. Also, the impact of beta-lactam and aminoglycoside in combination and of emerging cephalosporin-resistance during therapy was discussed.. From 1989 to 1998 in a medical centre in southern Taiwan, those cases with monomicrobial Aeromonas bacteraemia were included for study.. A total of 104 episodes of monomicrobial Aeromonas bacteraemia, accounting for 74% of all Aeromonas bacteraemia, were encountered. The infections usually occurred in the patients with hepatic cirrhosis (54%) or malignancy (21%) and were community-acquired (74%). Cases of community-acquired bacteraemia were more likely to have cirrhosis, a high severity score at onset, and a worse prognosis than those of nosocomial bacteraemia did and nosocomial isolates were less susceptible to cefoxitin and cefotaxime. Forty-three percent of cases had a concomitant infection focus, such as primary peritonitis, invasive cellulitis or necrotizing fasciitis, biliary tract or burn wound infections. Crude fatality rate within 2 weeks after the onset was 30%. Secondary bacteraemia and a higher severity score ( > or = 4) for illness at the first presentation were independently associated with a fatal outcome. The therapeutic superiority of beta-lactam and aminoglycoside in combination cannot be demonstrated in patients with Aeromonas bacteraemia. Cefotaxime resistance emerged in 3.4% of 58 patients treated with a cephalosporin for at least 72 h. None of the community-acquired isolates, but one-quarter of the nosocomial isolates, were resistant to cefotaxime.. Aeromonas bacteraemia usually occurred in patients with liver cirrhosis or malignancy, and heralded a poor prognosis, especially while associated with a relevant infectious source or with a higher severity score at presentation. The superiority of aminoglycoside and beta-lactam in combination cannot be demonstrated while treating those patients, and the emergence of antimicrobial resistance to cephalosporin was a rare event during cephalosporin therapy. Thus, a broad-spectrum cephalosporin remains one of the antimicrobial alternatives for invasive community-acquired Aeromonas infections.

Topics: Adolescent; Adult; Aeromonas; Aged; Aminoglycosides; Anti-Bacterial Agents; Bacteremia; Cefotaxime; Cephalosporin Resistance; Cephalosporins; Community-Acquired Infections; Cross Infection; Drug Therapy, Combination; Female; Gram-Negative Bacterial Infections; Humans; Lactams; Male; Middle Aged; Prognosis; Risk Factors

To analyse clinical characteristics of endocarditis for the last 10 years, treatment difficulties and how to overcome them.. 135 patients with infectious endocarditis (IE) were examined according to the routine scheme using modern methods of diagnosis and therapy control: transthoracic and transesophageal echo-CG, test for antibiotics sensitivity of the microflora, etc. Immediate results were assessed in all the patients, some of them were followed up for maximum 5 years.. Last decade was marked for growing difficulties in the treatment of IE related to its polyetiology. It can be caused by such therapy-resistant microbes as Staphylococcus aureus, Pseudomonas aeruginosa, anaerobic infection, nosocomial infection, injections of narcotic drugs, etc.. Current course of IE dictates the necessity of fighting resistant microflora especially in case of nosocomial disease. Recurrences become more frequent. Indications to surgery did not change for the last decade. The best treatment results are achieved after antibacterial treatment of the valve.

Topics: Adult; Amoxicillin-Potassium Clavulanate Combination; Ampicillin; Anti-Bacterial Agents; Anti-Infective Agents; Cefotaxime; Cephalosporins; Ciprofloxacin; Cross Infection; Drug Therapy, Combination; Echocardiography; Endocarditis, Bacterial; Follow-Up Studies; Gentamicins; Humans; Male; Oxacillin; Plasmapheresis; Recurrence; Time Factors

In 1995, changes in our hospital formulary were made to limit an outbreak of vancomycin-resistant enterococci and resulted in decreased usage of cephalosporins, imipenem, clindamycin, and vancomycin and increased usage of beta-lactam/beta-lactamase-inhibitor antibiotics. In this report, the effect of this formulary change on other resistant pathogens is described. Following the formulary change, there was a reduction in the monthly number (mean +/- SD) of patients with methicillin-resistant Staphylococcus aureus (from 21.9 +/- 8.1 to 17.2 +/- 7.2 patients/1,000 discharges; P = .03) and ceftazidime-resistant Klebsiella pneumoniae (from 8.6 +/- 4.3 to 5.7 +/- 4.0 patients/1,000 discharges; P = .02). However, there was an increase in the number of patients with cultures positive for cefotaxime-resistant Acinetobacter species (from 2.4 +/- 2.2 to 5.4 +/- 4.0 patients/1,000 discharges; P = .02). Altering an antibiotic formulary may be a possible mechanism to contain the spread of selected resistant pathogens. However, close surveillance is needed to detect the emergence of other resistant pathogens.

Topics: Acinetobacter; Anti-Bacterial Agents; Cefotaxime; Ceftazidime; Cross Infection; Drug Resistance, Microbial; Drug Therapy, Combination; Formularies, Hospital as Topic; Humans; Klebsiella Infections; Klebsiella pneumoniae; Methicillin Resistance; Staphylococcal Infections; Staphylococcus aureus

Evaluate the influence of the anti-anaerobic antimicrobial therapy in the outcome of patients with nosocomial pneumonia.. The population study included 53 intensive care unit patients with nosocomial pneumonia in whom, using a protected specimen brush, anaerobic bacteria were isolated, which were associated or not with aerobes. Current and empirical antibiotherapies were retrospectively analyzed, regarding their efficacy against anaerobic bacteria. Since it was debated, sensitivity to cefotaxime, ceftazidime, and ciprofloxacin was determined in 38 strains of Prevotella species. Outcome was evaluated 10 days after the day of protected specimen brushes. Improvement was defined as a decrease of Murray score or ventilator weaning.. The most frequently isolated bacteria were Prevotella species, which were more frequently resistant to cefotaxime (37%), ceftazidime (50%), and ciprofloxacine (32%) than usually reported in the literature. Sixty-six percent of these strains produced beta-lactamase. The effect of empirical anti-anaerobic antibiotherapy on the outcome at day 10 was evaluable in 39 patients. Twenty-nine patients were improved and 10 patients worsened. Interestingly, patients who had received well-adapted antibiotics against anaerobes had a better outcome after 10 days (P < .02).. This study suggests that specific antianaerobic therapy may be considered in the choice of empirical antibiotherapy in patients with nosocomial pneumonia.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Infective Agents; Bacteria, Anaerobic; Cefotaxime; Ceftazidime; Cephalosporins; Ciprofloxacin; Cross Infection; Drug Resistance, Microbial; Female; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Pneumonia, Bacterial; Prevotella; Retrospective Studies; Treatment Outcome

Topics: Adult; Aminoglycosides; Anti-Bacterial Agents; Cefotaxime; Ceftriaxone; Child; Child, Preschool; Community-Acquired Infections; Cross Infection; Drug Hypersensitivity; Drug Resistance, Microbial; Drug Resistance, Multiple; Enterococcus; Gram-Negative Bacteria; Humans; Infant, Newborn; Macrolides; Meningitis, Bacterial; Neutropenia; Penicillin Resistance; Penicillins; Pneumonia, Bacterial; Sepsis; Systemic Inflammatory Response Syndrome; Urinary Tract Infections

Topics: Administration, Oral; Anti-Bacterial Agents; Cefotaxime; Ceftazidime; Cephalosporins; Community-Acquired Infections; Costs and Cost Analysis; Cross Infection; Drug Resistance, Microbial; Drug Resistance, Multiple; Enterococcus; Gram-Negative Bacterial Infections; Gram-Positive Bacteria; Humans; Macrolides; Meningitis, Bacterial; Meningitis, Meningococcal; Meningitis, Pneumococcal; Microbial Sensitivity Tests; Neutropenia; Pneumococcal Infections; Pneumonia, Bacterial; Systemic Inflammatory Response Syndrome; Urinary Tract Infections

Two successive outbreaks of colonization and infection with Enterobacter cloacae resistant to third generation cephalosporins (cephalosporin-resistant E. cloacae, CREC) and involving 15 infants occurred within 12 months in a neonatal special care unit. Isolates of clinical significance were obtained from four infants (urine 2 cases, blood, pleural drainage). According to epidemiological typing using computerized biochemical fingerprinting and pulsed-field gel electrophoresis (PFGE) the same CREC strain was found in both outbreaks. The origin of the strain and its reservoir between the two outbreaks remained unknown. Emphasizing strict barrier nursing of the infants had little or no impact on the presence and transmission of the strain in the unit. In contrast, replacing ampicillin plus cefotaxime as standard empiric therapy with penicillin G plus netilmicin plus consequent cohorting of newborns and staff promptly halted both the outbreaks. During a 5-y follow-up after the last episode, the choice of antibiotics for empirical treatment has varied, and no further outbreaks of CREC have been seen, with the exception of two sporadic cases.

Topics: Ampicillin; Cefotaxime; Cephalosporin Resistance; Cephalosporins; Cross Infection; Disease Outbreaks; Enterobacter cloacae; Enterobacteriaceae Infections; Female; Gentamicins; Humans; Infant; Infant, Newborn; Intensive Care Units, Neonatal; Male; Penicillin G; Penicillins; Sweden

Topics: Aminoglycosides; Anti-Bacterial Agents; Bacteria; Bacterial Infections; Cefotaxime; Cephalosporins; Child; Child, Preschool; Cross Infection; Drug Hypersensitivity; Drug Resistance, Microbial; Drug Resistance, Multiple; Enterococcus; Erythromycin; Gram-Negative Bacteria; Humans; Infant; Infant, Newborn; Meningitis, Bacterial; Neutropenia; Penicillins; Pneumonia, Mycoplasma; Pneumonia, Staphylococcal; Systemic Inflammatory Response Syndrome; Urinary Tract Infections

In the last decade were in SR documented new problems in resistance to the newer antibiotics that with regard to their structure and antibacterial properties resisted to the known mechanism of bacterial resistance. The emergence of multiple drug resistance to the new betalactams is connected both with frequent application of these drugs in the hospitals and transfer of R plasmids.. We studied composition and transferability of resistance to newer betalactam antibiotics in strains of Acinetobacter sp., Enterobacter sp, and Citrobacter sp. isolated during one month in patients from two teaching University Hospitals. All strains studied were resistant to cefotaxime (CTX), ceftazidime (CAZ) and aztreonam (ATM) but Acinetobacter strains, although resistant also to CAZ and ATM transferred the resistance to CTX only. Thus, resistance to CAZ and ATM has a chromosomal origin in these strains. A strain of Citrobacter sp., resistant to CTX, CAZ and ATM, produced a ESBL betalactamase detectable in a double-disk diffusion method (Fig. 1). An Enterobacter cloacae strain transfers directly the resistance to all new betalactams indicated. Their hydrolysis by these strains points to their production of new types of extended-spectrum beta-lactamases ESBL).. We strongly recommend to be strictly rational in the use of new betalactams of CTX, CZA or ATM type because it is suspected that, especially in so-called empirical prophylaxis or treatment, they exert a strong selective pressure toward the prevalence of mutants with transferable ESBL-producing nosocomial bacteria resistant to these drugs.

Topics: Acinetobacter; Aztreonam; Cefotaxime; Ceftazidime; Cephalosporins; Citrobacter; Cross Infection; Drug Resistance, Microbial; Drug Resistance, Multiple; Enterobacter; Hospitals, University; Humans; Monobactams; R Factors

One hundred eighty consecutive, unduplicate isolates of Haemophilus influenzae from clinical specimens collected from November 1994 through February 1995 in nine general hospitals throughout Belgium were examined for beta-lactamase production using a nitrocefin-based test, and for their in vitro susceptibilities to ampicillin, amoxycillin/clavulanate, cefaclor, cefuroxime, cefotaxime, clarithromycin and azithromycin by means of the NCCLS agar dilution test. The isolates were all from respiratory tract specimens. The prevalence of capsular type b was 1.1%, and the overall rate of beta-lactamase production 16.7%. Rates of beta-lactamase production were higher in isolates from children (22.0%) than in those from adults (15.3%), and in isolates from upper respiratory tract specimens (22.0%) than in those from the lower respiratory tract (15.1%). Beta-lactamase-negative ampicillin resistance amounted to 1.1%. Cefotaxime had the highest activity on a weight basis [MIC (minimal inhibitory concentration) for 50% of the isolates tested (MIC50) < or = 0.06 microgram/ml], followed by ampicillin (MIC50 of 0.25 microgram/ml), amoxycillin/clavulanate and cefuroxime (MIC50 of 0.5 microgram/ml), azithromycin (MIC50 of 2 micrograms/ml), cefaclor (MIC50 of 4 micrograms/ml), and clarithromycin (MIC50 of 8 micrograms/ml). Cefotaxime was also the most active drug in terms of susceptibility rates of the isolates (100.0%), followed by amoxycillin/clavulanate and azithromycin (98.9%), cefuroxime (97.2%), cefaclor (89.4%), clarithromycin (82.8%), and ampicillin (82.2%). In conclusion, amoxycillin/clavulanate and cefuroxime retain an excellent activity against H. influenzae, while cefaclor lost some of its activity. The rate of susceptibility to azithromycin was markedly higher than that to clarithromycin; however, its ability to accumulate intracellularly while concentrations in serum and interstitial fluid remain low, should be considered, as it may represent a major drawback to its use in H. influenzae infections.

Topics: Adolescent; Adult; Aged; Amoxicillin; Anti-Bacterial Agents; Azithromycin; Cefaclor; Cefotaxime; Cefuroxime; Child; Child, Preschool; Clarithromycin; Clavulanic Acids; Cross Infection; Haemophilus Infections; Haemophilus influenzae; Humans; In Vitro Techniques; Microbial Sensitivity Tests; Middle Aged

Ceftizoxime and cefotaxime demonstrate very similar activities in vitro against a broad range of bacteria. To reduce costs, our hospital pharmacy implemented an automatic substitution policy whereby ceftizoxime was dispensed and administered whenever cefotaxime was ordered. This policy was modified when penicillin-resistant Streptococcus pneumoniae isolates were found to be markedly less susceptible to ceftizoxime than to cefotaxime, of concern considering the prevalence and virulence of this pathogen. We compared clinical findings among 179 adult patients treated with ceftizoxime for any indication during the substitution months with 200 patients treated with cefotaxime during the previous year. The ceftizoxime group had a shorter mean length of stay, which paralleled a hospital-wide trend toward more efficient discharge planning. After adjusting for this trend, we observed no significant difference in duration of study drug, number of other intravenous antibiotics, likelihood of receiving additional antibiotics after study drug completion, or patient survival. Fortuitously, no penicillin-resistant pneumococcal infections were documented in ceftizoxime-treated patients. This study suggests that cefotaxime and ceftizoxime are comparable. The choice of one versus the other may be dictated by price, provided ceftizoxime is not used for proven or suspected penicillin-resistant pneumococcal infections.

Topics: Adult; Cefotaxime; Ceftizoxime; Cephalosporin Resistance; Cephalosporins; Costs and Cost Analysis; Cross Infection; Female; Humans; Length of Stay; Male; Middle Aged; Pneumococcal Infections; Streptococcus pneumoniae; Treatment Outcome

Topics: Base Sequence; Cefotaxime; Cephalosporins; Cross Infection; DNA Primers; DNA, Bacterial; Drug Therapy, Combination; Female; Gentamicins; Humans; Infant; Meningitis, Pneumococcal; Molecular Sequence Data; Penicillin Resistance; Polymerase Chain Reaction; Polymorphism, Restriction Fragment Length; Streptococcus pneumoniae; Treatment Failure; Vancomycin

Transferable resistance to cefotaxime was demonstrated in 21 nosocomial strains of Klebsiella pneumoniae and Escherichia coli subsequently isolated from patients in two large University clinics. Using the double-disk diffusion test, we could detect, in each such strain, as well as in E. coli 3110 K-12 transconjugants after the transfer, the production of an Extended Spectrum Beta-Lactamase (ESBL). Ceftibuten was demonstrated to be effective against the majority of strains studied.

Topics: beta-Lactamases; Cefotaxime; Ceftibuten; Cephalosporins; Conjugation, Genetic; Cross Infection; Drug Resistance, Microbial; Escherichia coli; Escherichia coli Infections; Humans; Hydrolysis; Klebsiella Infections; Klebsiella pneumoniae; Microbial Sensitivity Tests; Slovakia

Topics: Cefotaxime; Ceftazidime; Cephalosporins; Cross Infection; Drug Resistance, Microbial; Humans; Infant, Newborn; Infection Control; Intensive Care Units, Neonatal

Ninety-four percent of 336 strains of Klebsiella pneumoniae were resistant to ampicillin, while less than 10% were resistant to cefotaxine and ceftazidine. Among all the aminoglycosides tested, amikacin had the strongest activity on K. pneumoniae. The resistant rate of nosocomial strains was higher than that of community strains. The results of susceptibility test showed that 42% (119/280) of K. pneumoniae strains were gentamicin-resistant. Based on the resistant pattern of K. pneumoniae, the aminoglycoside-modifying enzymes produced by the organisms were inferred. Among them 90% of 119 strains produced aminoglycosides-modifying enzymes AAC (3)-V, 8% (10/119) AAC (3)-V together with AAC (6')-Ib, AAC (6')-V or ANT (2"). The resistance of two strains was assumed to be permeability change. Besides, 58% (161/280) were sensitive strains without producing any aminoglycoside-modifying enzymes. Bacteria typing done by phage typing or Klebcin in 27 strains showed that most strains were from different origins with few exceptions. The results show the significance for controlling the nosocomial infections and reasonable use of antibiotics.

Topics: Acetyltransferases; Amikacin; Ampicillin Resistance; Cefotaxime; Cross Infection; Drug Resistance, Microbial; Humans; Klebsiella pneumoniae

During a nosocomial epidemic of Salmonella mbandaka in Algeria, 99 strains were isolated from specimens. Study of 22 of them revealed minimum inhibiting concentrations ranged from 4 to 32 micrograms/ml for cefotaxime, 2 to 32 micrograms/ml for ceftazidime and 2 to 16 micrograms/ml for ceftriaxione. The mechanism underlying resistance was enzymatic with production of broad-spectrum beta-lactamase enzyme. Clavulinic acid at a dose of 2 micrograms/ml restored the activity of hydrolyzed beta-lactamases. Resistance to all antibiotics including cefotaxime was due to a single plasmid structure. The plasmid did not belong to any known compatibility group. All strains studied contained a plasmid of 26MDa and produced TEM-1 and TEM-2 beta-lactamases. Strains resistant to cefotaxime also synthetized a broad-spectrum beta-lactamase derived from TEM.

Topics: Algeria; Anti-Bacterial Agents; beta-Lactamase Inhibitors; beta-Lactamases; Cefotaxime; Ceftazidime; Ceftriaxone; Cephalosporin Resistance; Child; Child, Preschool; Clavulanic Acid; Clavulanic Acids; Cross Infection; Disease Outbreaks; DNA, Bacterial; Enzyme Inhibitors; Humans; Infant; Infant, Newborn; Plasmids; Salmonella; Salmonella Infections

To investigate at what time the peak level should be determined under conventional thrice daily (t.i.d.) administration of the aminoglycoside netilmicin and to study its serum concentrations under once daily (od) treatment to define the required daily dose and to gain information about convenient drug monitoring.. The design of the study was a consecutive sample trial.. The study took place in a university hospital.. 41 intubated patients of a surgical ICU who received netilmicin as a short-term infusion over 30 min for life-threatening infections were included in the study.. In 21 patients netilmicin was administered t.i.d. The virtual peak levels which had been determined by pharmacokinetic dosage calculation were compared with the serum concentrations obtained directly after the administration as well as after 15, 30, 60 and 180 min. In 20 patients the netilmicin serum concentrations during od treatment were determined directly before and immediately after the application as well as 0.5, 1, 3, 7 and 12 h later. To achieve a virtual peak level of 25 mg/l and a trough level of 0.5 mg/l individual adjustment of the dosage based on pharmacokinetic calculations was performed.. In t.i.d. treatment the serum concentration measured after 30 min was closest to the virtual peak level; therefore, this is the best time to determine the peak level. In od treatment the required daily dose was 7.86 mg/kg body weight (median) in patients with normal renal function. During od dosing the trough level was extremely important in drug monitoring, whereas determination of the high peak level was of doubtful value.. The peak level should be determined during t.i.d. administration at 30 min. In od treatment the initial daily dose should be 7 mg/kg body weight; in drug monitoring the trough level is very important.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Cefotaxime; Cross Infection; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Fosfomycin; Gram-Negative Bacterial Infections; Humans; Infusions, Intravenous; Intensive Care Units; Male; Metabolic Clearance Rate; Metronidazole; Middle Aged; Netilmicin; Piperacillin; Respiration, Artificial; Staphylococcal Infections; Teicoplanin

Topics: Cefotaxime; Critical Care; Cross Infection; Digestive System; Humans

During an 8-month period, Klebsiella pneumoniae resistant to cefotaxime and ceftazidime were isolated from 18 elderly patients in two closely-situated UK hospitals. Amongst these 18 patients, the organisms were isolated from urine samples of 17, from blood cultures of two and from a wound swab of one. The infected patients were located in nine different wards and several of the patients had been transferred between wards, within and between the two hospitals. All the bacterial isolates belonged to serotype K62, were non-typable or reacted only weakly with bacteriophage, showed similar plasmid profiles and were resistant to tetracycline and trimethoprim, thus indicating they were the same strain. Resistance to cefotaxime and ceftazidime was inhibited by clavulanic acid suggesting the involvement of extended-spectrum beta-lactamase (ESBL) enzyme activity. This was confirmed by analytical isoelectric focusing, which showed that isolates each produced two beta-lactamases with isoelectric points of 7.0(SHV-3) and 7.6 (SHV-1/2) respectively.

Topics: beta-Lactamases; Cefotaxime; Ceftazidime; Cross Infection; Disease Outbreaks; Drug Resistance, Microbial; Humans; Klebsiella Infections; Klebsiella pneumoniae; Microbial Sensitivity Tests; Species Specificity; United Kingdom

During a 3-week period, nine babies in the neonatal unit of a large teaching hospital in Durban were infected or colonized with Klebsiella pneumoniae resistant to a range of antimicrobial agents including amikacin and cefotaxime. Resistance to cefotaxime was reduced by clavulanic acid in vitro suggesting production of extended-spectrum beta-lactamase activity. All the isolates had the same antibiotic resistance profile, belonged to the same serotype (K17), were non-typable with bacteriophages, and had identical plasmid profiles indicating that they belonged to the same strain. During a 1-day microbiological survey of the ward, the outbreak strain was isolated from the nose and hands of a doctor based in the nursery and from the hands of a nurse and the mother of an infected baby. The strain was also isolated from nine of 67 environmental samples. Investigation revealed that infection control practices which had been instituted following a previous outbreak in the nursery with multi-resistant methicillin-resistant Staphylococcus aureus (MRSA) were not being adhered to. The re-introduction and strict enforcement of these procedures under the supervision of an Infection Control Nurse resulted in the abrupt end of the outbreak.

Topics: Amikacin; Carrier State; Cefotaxime; Cross Infection; Disease Outbreaks; Drug Resistance, Microbial; Hospitals, Teaching; Humans; Infant; Infant, Newborn; Infection Control; Klebsiella Infections; Klebsiella pneumoniae; Methicillin Resistance; Microbial Sensitivity Tests; Nurseries, Hospital; South Africa

Topics: Adult; Aged; Cefotaxime; Cross Infection; Haemophilus Infections; Haemophilus influenzae; Humans; Male; Pneumonia; Sputum

In a Tunisian hospital 27 babies, including 12 who were premature, in a single intensive care unit suffered acute gastroenteritis in the period from January to May 1988. The mean age at the onset of gastroenteritis was 8.4 days; nine babies died. Salmonella wien was isolated from stools (all babies) and blood (4 babies). It was also isolated from the stools of one nurse and from a mattress. Twelve of the babies had received cefotaxime, which was successfully replaced by oral colimycin. The outbreak was stopped by the implementation of infection control measures. All isolates of Salmonella wien were of the same biotype, and had the same antibiotic resistance pattern (third generation cephalosporins, monobactams, aminoglycosides, chloramphenicol, trimethoprim and sulphonamides) and plasmid DNA restriction pattern. The isolates were all susceptible to a combination of cefotaxime and clavulanic acid (a beta-lactamase inhibitor), which displayed synergy, suggesting the presence of a beta-lactamase (geometric mean MICs 11.24 micrograms/ml for cefotaxime alone and 0.24 micrograms/ml in combination with 0.1 micrograms/ml potassium clavulanate). All isolates produced TEM-1 and SHV-2 beta-lactamase which was not transferable to Escherichia coli by conjugation. The presence of the SHV-2 enzyme in Salmonella wien may allow it to adapt to newer beta-lactams which is a cause for concern in this hospital.

Topics: Acute Disease; beta-Lactamases; Cefotaxime; Clavulanic Acid; Clavulanic Acids; Colistin; Cross Infection; Disease Outbreaks; Drug Resistance, Microbial; Drug Synergism; Feces; Gastroenteritis; Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Intensive Care Units, Neonatal; Microbial Sensitivity Tests; Salmonella; Salmonella Infections; Tunisia

In a retrospective study carried out at Norrköping Central Hospital, the incidence of Clostridium difficile-associated diarrhoea and colitis was found to be correlated to in-patient consumption (in terms of defined daily doses) of the implicated anti-microbial agents. The third generation cephalosporin, cefotaxime, was implicated 38 times more often than small spectrum penicillins. In general, the cephalosporins were predominantly responsible, accounting for 46 per cent (67/147) of the episodes but only 12 per cent of overall consumption of antibiotics at the hospital. These findings are in accord with data previously published in the nationwide report by the Medical Product Agency, Uppsala.

Topics: Adolescent; Adult; Aged; Cefotaxime; Cephalosporins; Clostridioides difficile; Colitis; Cross Infection; Diarrhea; Drug Utilization; Humans; Middle Aged; Retrospective Studies; Sweden

Topics: Cefotaxime; Cross Infection; Digestive System; Drug Resistance, Microbial; Humans; Injections, Intravenous; Sterilization

All cases of bacterial meningitis in the neonatal unit at King Edward VIII Hospital, Durban for the period 1 January 1981 to 31 December 1987 were reviewed. In particular, we looked at the impact of cefotaxime on mortality rates and amikacin on the incidence of hospital-acquired Gram-negative bacillary (GNB) meningitis. Klebsiella was found to be the commonest cause of neonatal meningitis, followed by Escherichia coli and Streptococcus agalactiae. Eighty-four per cent of all cases of GNB meningitis presented more than 3 days after birth, with the vast majority being caused by gentamicin-resistant Klebsiella. A decline in the incidence of meningitis from 1.27/1000 live births in 1981 and 0.95/1000 for the period 1981-1986 to 0.22/1000 live births in 1987, with no cases of Klebsiella meningitis being seen in that year, coincided with the exclusive use of amikacin as the parenteral aminoglycoside in place of gentamicin in the unit after August 1986. The initial decline in the incidence of meningitis from 0.93/1000 in 1985 to 0.46/1000 in 1986 was attributed to the introduction in 1985 of strict hand disinfection measures to prevent cross-infection in the unit. The case mortality rate (CMR) fell from 0.65 for the period 1981-1984 to 0.42 for the period 1985-1987, and we believe this was largely a result of the introduction of cefotaxime in 1984 as first-line therapy for GNB meningitis, together with better patient care facilities.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Amikacin; Cefotaxime; Cross Infection; Humans; Infant, Newborn; Meningitis; South Africa

The in vitro antibacterial activity of aztreonam was compared with that of cefoperazone, cefotaxime, ceftazidime, gentamicin, latamoxef, and ticarcillin against 140 clinical isolates of gram-negative bacteria. The activity of aztreonam against Enterobacteriaceae is similar to that of cefotaxime and ceftazidime but greater than that of gentamicin, latamoxef, and ticarcillin. The 90% minimum inhibitory concentration (MIC90) of most of these isolates ranges between 0.8 and 1.6 micrograms/ml. The activity of aztreonam against Pseudomonas aeruginosa is similar to that of cefotaxime and cefoperazone, more active than that of latamoxef, and less active than that of ceftazidime. The minimum bactericidal concentration of aztreonam is equal to or twice the MIC for most strains tested. Time-kill studies of selected strains demonstrated rapid killing when they were exposed to 2-4 times the MIC of aztreonam. The selective spectrum of action of aztreonam makes this drug a useful agent in the therapy of a variety of gram-negative infections.

Topics: Aztreonam; Cefoperazone; Cefotaxime; Ceftazidime; Cross Infection; Gentamicins; Gram-Negative Bacteria; Moxalactam; Ticarcillin

In Klebsiella pneumoniae 86-4, cefotaxime resistance was due to a transferable broad-spectrum beta-lactamase, SHV-3. The plasmid-borne gene encoding SHV-3 has been cloned, and the primary structure of the enzyme was deduced from its nucleotide sequence. SHV-3 differs from SHV-1 in two positions. The extended substrate profile of SHV-3 probably results from the substitution of Ser-213 for Gly, as in SHV-2, whereas replacement of Arg-180 by Leu resulted in a decrease in the pI from 7.6 to 7.0. The blashv-3 gene is highly homologous (92% DNA sequence identity) with the chromosomal gene coding for LEN-1 beta-lactamase of K. pneumoniae, suggesting that the origin of the SHV-encoding genes now present on many plasmids may be chromosomal.

Topics: Base Sequence; beta-Lactamases; Cefotaxime; Cloning, Molecular; Cross Infection; Culture Media; Drug Resistance, Microbial; Electrophoresis, Agar Gel; Escherichia coli; Klebsiella Infections; Klebsiella pneumoniae; Molecular Sequence Data; Plasmids; Restriction Mapping

Topics: Anti-Bacterial Agents; Cefotaxime; Cross Infection; Digestive System; Disinfection; Humans; Intensive Care Units; Oropharynx; Respiratory Tract Infections; Sterilization

Melioidosis, caused by Pseudomonas pseudomallei, occurs in tropical areas and is diagnosed mostly in adults. In Khon Kaen, a province of northeast Thailand, five cases of infantile melioidosis were managed at Srinagarind Hospital. The patient's specimens were submitted to microbiologic and serologic examination for P. pseudomallei demonstrated by indirect hemagglutination. Possible modes of transmission such as environment, perinatal exposure and venereal transmission were investigated.

Topics: Cefotaxime; Cross Infection; Diseases in Twins; Female; Humans; Infant, Newborn; Infant, Premature, Diseases; Male; Melioidosis; Thailand

Klebsiella pneumoniae strains that were resistant to third-generation cephalosporins and amikacin were recovered from 62 of 395 patients (15.7%) during 1986. 25 isolates (40%) caused urinary tract infections. The outbreak involved three intensive care units (54 isolates), and spread from one unit to another and then to four wards (8 isolates). K pneumoniae of various serotypes and strains of different Enterobacteriaceae demonstrating the same antibiotic resistance pattern were isolated, which suggests dissemination of an R-factor. The isolates had low-level resistance to third-generation cephalosporins (mode minimum inhibitory concentration of cefotaxime, 2 mg/l) but remained sensitive to cephamycins. Cefotaxime was effective in cases of uncomplicated urinary tract infection, but failed in major infections at other sites. 1-5 mg/l of the beta-lactamase inhibitors clavulanic acid or sulbactam restored normal activity to cefotaxime against the multiresistant strains. Resistance to third-generation cephalosporins was mediated by a new broad-spectrum enzyme of isoelectric point 6.3. Resistance to beta-lactams and aminoglycosides was transferable to Escherichia coli. The emergence of transferable enzymatic resistance to newer beta-lactams in K pneumoniae strains indicates a major risk of spread of such resistance to otherwise sensitive strains.

Topics: Amikacin; beta-Lactamases; Cefotaxime; Cephalosporins; Cross Infection; Disease Outbreaks; Drug Resistance, Microbial; Enterobacteriaceae; Escherichia coli; Humans; Klebsiella Infections; Klebsiella pneumoniae; Paris; Recurrence; Urinary Tract Infections

Cefixime, a broad-spectrum, orally active cephalosporin, was more active in vitro than ampicillin, cefaclor, cephalothin, and trimethoprim/sulfamethoxazole against 194 nosocomial pathogens of the family Enterobacteriaceae. Activity was especially good against Klebsiella spp, Proteus spp, Serratia spp, and Providencia stuartii. Although gentamicin had equivalent or better activity against Citrobacter spp, Enterobacter spp, Escherichia coli, and Morganella morganii, all 23 of the gentamicin-resistant strains studied were susceptible to cefixime. Isolates tested were from urinary tract infections, abdominal infections, wounds, vascular infections, and respiratory infections; they were sequentially collected nosocomial pathogens from a single institution. This orally active cephalosporin should be considered for therapy of a variety of nosocomial infections involving gram-negative bacillary pathogens.

Topics: Ampicillin; Anti-Bacterial Agents; Cefaclor; Cefixime; Cefotaxime; Cephalothin; Cross Infection; Drug Combinations; Enterobacteriaceae; Enterobacteriaceae Infections; Gentamicins; Humans; Microbial Sensitivity Tests; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Cefotaxime; Child; Child, Preschool; Cross Infection; Female; Fosfomycin; Humans; Infant; Infant, Newborn; Intensive Care Units; Male; Sepsis; Staphylococcal Infections

The MICs and MBCs of ciprofloxacin were determined for clinical isolates of antibiotic-resistant aerobic bacteria. Decreased susceptibility to ciprofloxacin of cefotaxime- and amikacin-resistant Serratia marcescens and amikacin-resistant Pseudomonas aeruginosa strains were noted. The data suggest that ciprofloxacin susceptibility should be carefully monitored in treating patients with hospital-acquired bacterial infections.

Topics: Amikacin; Cefotaxime; Ciprofloxacin; Cross Infection; Gram-Negative Bacteria; Humans; Kanamycin; Methicillin; Penicillin Resistance; Quinolines; Staphylococcus

In order to investigate the frequency of the emergence of resistance during treatment, 1,403 episodes of lower respiratory infection were studied in a General Hospital with three departments of Chest Medicine in a period of four years. In 650 episodes the pathogen was isolated and in 82 of those failure of therapy was accompanied by emergence of resistance to the agent used. Factors associated with this phenomenon were: intensive care, tracheostomy, involvement of Pseudomonas aeruginosa, Enterobacter spp., Serratia marcescens, Staphylococcus aureus or Acinetobacter calcoaceticus, use of antipseudomonas penicillins, cefotaxime (especially when used in P. aeruginosa infections) and co-trimoxazole and monotherapy as opposed to appropriate combination therapy in patients with nosocomial pneumonia.

Topics: Acinetobacter; Anti-Bacterial Agents; Bacteria; Cefotaxime; Cross Infection; Drug Combinations; Drug Therapy, Combination; Drug Utilization; Enterobacteriaceae; Humans; Intensive Care Units; Penicillin Resistance; Penicillins; Pneumonia; Pseudomonas aeruginosa; Respiratory Tract Infections; Retrospective Studies; Staphylococcus aureus; Sulfamethoxazole; Tracheotomy; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

The in vitro activity of aztreonam, leader of a new class of antibiotics, the monobactams, has been investigated. The effectiveness of the new molecule on 1990 strains of Gram-negative clinical isolates has been compared to that of some other drugs widely utilized for the treatment of nosocomial infections. Aztreonam has shown the highest activity against all the tested strains, with a geometrical mean of MICs (MG) of 0.37 and a MIC 90 of 8 micrograms/ml.

Topics: Aztreonam; Cefotaxime; Ceftazidime; Cross Infection; Gentamicins; Gram-Negative Bacteria; Humans; In Vitro Techniques; Microbial Sensitivity Tests; Piperacillin; Structure-Activity Relationship

Minimal inhibitory concentrations (MICs) of cefodizime were evaluated by agar dilution for 746 bacterial strains isolated in two hospitals. For enterobacteriaceae MICs ranged from 0.008 micrograms/ml to more than 128 micrograms/ml (mode MIC: 0.25); mode MICs varied across species, ranging from 0.016 micrograms/ml for Proteus mirabilis to 1 microgram/ml for Citrobacter; MICs ranged from 0.12 to 8 for most Enterobacter and from 1 to 64 for Serratia. The rare cefotaxime-resistant strains, most of which were Citrobacter or Enterobacter, also showed resistance to cefodizime. Cefodizime was noticeably less active against Pseudomonas aeruginosa and Acinetobacter, with MICs ranging from 32 to more than 128. Haemophilus sp. and Gonococci, regardless of beta-lactamase-production status, as well as Neisseria meningitidis, were highly susceptible (MIC less than or equal to 0.008-0.016). Cefodizime was moderately active against methicillin-susceptible Staphylococci (MIC: 2 to 16 micrograms/ml) and failed to inhibit methicillin-resistant strains. Enterococci were slightly susceptible or resistant. Whereas the other Streptococci and Pneumococci had low MICs (0.03-0.12). A fairly wide range of MICs was found for anaerobes, with lower values for Clostridium (0.008 to 1) than for Bacteroids (8 to 128 mu g/ml). Our results show that cefodizime has the same properties as other third-generation cephalosporins: cefotaxime-resistant Enterobacteriaceae strains also exhibit resistance to cefodizime.

Topics: Bacteria; Cefotaxime; Cross Infection; Humans; Microbial Sensitivity Tests

Acinetobacter calcoaceticus, a nosocomial pathogenic agent, is isolated with increasing frequency from hospitalized patients. Acinetobacter is one of the most resistant pathogens to currently available antibiotics, particularly beta-lactam antibiotics. Beta-lactamases (TEM penicillinase and cephalosporinase) and problems of permeability are the most frequent mechanisms of resistance. The authors compared the in vitro activity of ceftizoxim, ceftazidim and imipenem against 82 clinical isolates of Acinetobacter calcoaceticus. Ceftizoxim, structurally similar to cefotaxim, was highly active in vitro; MIC 50%, 90% and geometric mean were respectively 6.28, 15 and 6.9 micrograms/ml. A significant difference was observed between the anitratum and lwoffi varieties. The lwoffi variety was more susceptible to tested drugs than the anitratum variety. Ceftazidim activity was comparable with MIC 50 of 6.5 micrograms/ml and MIC 90 of 26.2 micrograms/ml. A good bactericidal activity was observed against susceptible strains (MIC less than or equal to 4 micrograms/ml). Imipenem showed the greatest activity since 0.47 microgram/ml of the drug inhibited 90% of Acinetobacter calcoaceticus.

Topics: Acinetobacter; Acinetobacter Infections; Cefotaxime; Ceftazidime; Ceftizoxime; Cross Infection; Humans; Imipenem; Thienamycins

Mortality due to serious infections is significantly higher among elderly patients than among younger patients. This differential is particularly striking in some subsets of patients; for example, the mortality rate among older patients with afebrile bacteremia is 65 percent, compared with 25 to 35 percent in younger patients. Although serious underlying disease is an important reason for older patients' difficulties with infection, other problems of these patients include a tendency to deny the presence of disease and some obstacles to interaction with the health care system. Older patients with infection are less likely to present with typical symptoms, which makes early recognition difficult for physicians. For example, typical findings of sepsis (mental obtundation, tachycardia, and fever) may be absent in an elderly patient; the only clue may be the patient's failure to eat. Once sepsis is recognized, its source must be identified. Urinary tract infection is the most common cause of sepsis in the elderly and responds best to antibiotic therapy. Pneumonia is the next most common cause and leads to the highest mortality in this age group; rapid (sometimes invasive) methods must be utilized to identify the etiologic agent. In this life-threatening infection, initial antibiotic therapy should include an aminoglycoside, such as amikacin, to ensure the broadest coverage against the common pathogens. Supportive measures should be instituted for patients with sepsis, including careful monitoring of fluid intake and output and special attention to adequate oxygenation. Fluid volume replacement must be carried out in patients with septic shock, and hemodynamic monitoring with a Swan-Ganz catheter should be performed frequently. Careful consideration should be given to the use of corticosteroids and inotropic agents. After appropriate cultures have been obtained, antibiotics should be started; the time from initial presentation to the administration of the first dose of antibiotic should not exceed one hour. Important considerations in antibiotic selection include the patient's history and environment (community, nursing home, or hospital), anatomic location of the infection, and the pathogen. In our institution, initial empiric antibiotic therapy consists of a combination of amikacin and cefotaxime. When older patients are treated, adjustments in dosing should be based on estimates of kidney function.

Topics: Aged; Amikacin; Aminoglycosides; Anti-Bacterial Agents; Bacterial Infections; Cefotaxime; Cross Infection; Drug Therapy, Combination; Female; Humans; Male; Pneumonia; Risk; Shock, Septic; Urinary Tract Infections

Topics: Bacteria; Cefamandole; Cefonicid; Cefotaxime; Cefoxitin; Cephaloridine; Cephalosporins; Cross Infection; Humans; Microbial Sensitivity Tests

An outbreak of serious infections due to gentamicin-resistant Klebsiella pneumoniae occurred in a neonatal intensive care unit in which the combination of gentamicin sulfate and ampicillin sodium had been used for standard initial therapy for suspected sepsis for nearly 11 years. After institution of control measures that included the substitution of cefotaxime sodium for gentamicin in the standard regimen, the outbreak promptly subsided. Nevertheless, a second outbreak of serious infections due to cefotaxime-resistant Enterobacter cloacae began ten weeks later. Sequential stool cultures from patients in the unit confirmed the disappearance of gentamicin-resistant K pneumoniae and the emergence of cefotaxime-resistant E cloacae after the change in antibiotic policy. These observations suggest that routine use of newer cephalosporins for therapy of suspected sepsis may lead to the emergence of drug-resistant microorganisms more rapidly than has occurred with the aminoglycosides.

Topics: Ampicillin; Cefotaxime; Cross Infection; Disease Outbreaks; Drug Therapy, Combination; Enterobacter; Enterobacteriaceae Infections; Gentamicins; Humans; Infant, Newborn; Intensive Care Units, Neonatal; Klebsiella Infections; Klebsiella pneumoniae; Microbial Sensitivity Tests; Penicillin Resistance; South Carolina; Time Factors

One hundred sequential Gram-negative rod isolates from patients with hospital-acquired bloodstream infections were tested against seven new cephalosporins. Duplicate broth microdilution tests indicated superior activity for ceftazidime with 97% of strains susceptible to 16 mg/l. Less in-vitro activity was demonstrated cefotaxime (91% susceptible to 16 mg/l, P = 0.07), latamoxef (moxalactam) (90%, P = 0.04), cefoperazone (90%, P = 0.04), ceftriaxone (87%, P = 0.008), cefmenoxime (80%, P = 0.0001), and ceftizoxime (79%, P less than 0.0001). With the exception of cefoperazone, the newer drugs had mean MICs of less than or equal to 0.6 mg/l against Enterobacteriaceae. Ceftazidime and cefoperazone had highest activities against Pseudomonas aeruginosa with MIC90S of 4 and 16 mg/l, respectively. A comparison of recently published data shows important geographic differences in MIC90 data for the new cephalosporins against specific species.

Topics: Cefmenoxime; Cefoperazone; Cefotaxime; Ceftazidime; Ceftizoxime; Ceftriaxone; Cephalosporins; Cross Infection; Enterobacteriaceae; Enterobacteriaceae Infections; Gram-Negative Bacteria; Humans; Microbial Sensitivity Tests; Pseudomonas aeruginosa; Pseudomonas Infections; Sepsis

A disturbed microbiological ecosystem of the gut flora is frequently seen as a consequence of antibiotic therapy. Because this impact on the physiological balance is known to be causative for severe nosocomial infections and is mainly seen with antibiotics that are massively excreted via the bile (e.g. broadspectrum penicillins, ceftriaxone and cefoperazone), we investigated cefotaxime (CTX), cefotiam (CTM), cefmenoxime (CMX), ceftazidime (CAZ), ceftizoxime (CZX) and cefazolin + netilmicin (CEZ + NTL) in healthy volunteers. The respective daily i.v. doses, days of medication and numbers of volunteers were: CTX 3 g, 1 d, n = 8; CTM 6 g, 3 d, n = 15; CMX 4 g, 3 d, n = 15; CAZ 4 g, 1 d, n = 8; CZX 4 g, 1 d, n = 8; CEZ + NTL 2 X 3 g + 1 X 3 mg/kg/day, 4 d, n = 15. CTX was also investigated in 11 selected hospitalized patients. One or two stool specimens were taken before, during and several days after medication. The microorganisms were also tested for ampicillin and CEZ resistance on selective media. Ampicillin and CEZ resistance was much higher in hospitalized patients than in volunteers (mainly Proteus and Serratia sp.): 90% vs. 42% and 63.6% vs. 43%, respectively. CTX did not affect the anaerobes (Bacteroides sp. and lactobacilli) that are antagonistic to clostridia and Candida. No selection of strains resistant to ampicillin or CEZ occurred. In hospitalized patients, the level of resistance to these drugs was lower after treatment than before.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Bacteria; Bile; Cefotaxime; Cephalosporins; Cross Infection; Digestive System; Hospitalization; Humans; Injections

Nephrotoxicity frequently complicates the use of aminoglycosides in severely compromised acute care patients. Therefore, we initiated an open clinical trial to determine if cefmenoxime alone is useful for serious Gram-negative pneumonias in this population. Thirty consecutive patients were studied. Average age was 66 years. Most were malnourished at entry, with serum albumin averaging 2.8 g/dl and prognostic nutritional index values over 70% (normal less than 40%). One-half of the patients had severe COPD and 67.9% were on ventilators. Fifty-seven per cent suffered concomitant cardiac disease, and 78.6% had been previously treated with antibiotics. Pneumonia was proven by new infiltrates on chest X-ray, new fever, elevated WBC count and Gram-negative rods on Gram's stain and in cultures of tracheal aspirate or sputum. Patients were given cefmenoxime 1-2 g every 6 h for an average of 12 days. Cefmenoxime peak (1 h) and trough concentrations were measured by HPLC and averaged 58 and 7 mg/l respectively. Gram-positive organisms, Escherichia coli, Klebsiella spp. and Haemophilus influenzae were usually eradicated. Persistence was noted for Enterobacter, Pseudomonas and Acinetobacter spp. Persistence in patients with good clinical response was considered colonization rather than superinfection. Overall, satisfactory clinical response rate was noted in 78.6%, while four patients responded satisfactorily with recurrence, and two treatments were unsatisfactory. No serious adverse effects were observed. Cefmenoxime is a promising agent for treatment of susceptible pneumonias in critical care patients.

Topics: Aged; Cefmenoxime; Cefotaxime; Critical Care; Cross Infection; Female; Humans; Male; Middle Aged; Pneumonia; Radiography

Cefmenoxime concentration/effect relationships were retrospectively explored for gram-negative bacteria isolated from 14 critical care patients treated for nosocomial pneumonia. The effects of cefmenoxime concentrations on in vitro growth kinetics of 21 isolated pathogens were studied using the Abbott MS-2 Research System, from which a dynamic response concentration was derived. Serum pharmacokinetic profiles were obtained in each patient. These data were used to calculate the in vivo total area under the curve over dynamic response concentration and the time that cefmenoxime concentrations exceeded the dynamic response concentration for each bacteria. The same determinations were made in 18 patients prospectively treated, except that dosage was optimized on the basis of previous mathematical relations to achieve bacterial eradication in four days. This method of dosage optimization is termed dual individualization. Serial cultures of infected tissues were evaluated to determine the number of days to the eradication of bacteria, and the pharmacokinetic and pharmacodynamic variables were used to describe the bacteriologic response of the original pathogen isolated in pretreatment culture. Bacterial eradication rates could be described from cefmenoxime pharmacokinetics in the patient and from the relation between concentration and bacterial inhibition. Patients who were prospectively treated using these retrospectively derived relationships had a predictable day of bacterial eradication. This, in turn, was associated with a shorter duration of treatment (p less than 0.05). The success of prospective dual individualization is encouraging and suggests that more precise optimization of antibiotic dosage can yield a predictable rate of bacterial eradication from the infection site.

Topics: Aged; Cefmenoxime; Cefotaxime; Computers; Cross Infection; Female; Gram-Negative Bacteria; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Pneumonia; Prospective Studies; Retrospective Studies

19 patients received an intravenous 5-min bolus injection of 2 g ceftriaxone at various times before thoracic surgery. Lung tissue concentrations of 31.8 micrograms/g could be maintained for at least 5 h. Serum and lung tissue concentrations of ceftriaxone are high enough to inhibit most organisms causing nosocomial and community-acquired respiratory tract infections.

Topics: Cefotaxime; Ceftriaxone; Cross Infection; Humans; Injections, Intravenous; Lung; Middle Aged; Premedication; Respiratory Tract Infections; Thoracic Surgery

MIC of ceftriaxone, moxalactam and cefotaxime is determined for 827 strains of Enterobacteriaceae isolated in the Central Laboratory of the Pitié-Salpêtrière Hospital between december 1981 and september 1982. Results are distributed according to the species involved and the pattern of sensitivity (S) and resistance (R) to ampicillin (A), carbenicilline (Ca) and cephalotin (Ct). Among the strains ASCaSCtS and ARCaRCtS cefotaxime and ceftriaxone have the lowest MICs. Among the most sensitive strains ARCaSCtR and ARCaRCtR cefotaxime, ceftriaxone and moxalactam have the similar MICs, whereas among the less sensitive ones moxalactam has the lowest MICs. The latter might be the cephalosporin of choice for the treatment of serious infection due to the less sensitive Enterobacteriaceae. On the other hand, cefotaxime and ceftriaxone might be the cephalosporins of choice for the treatment of serious infections due to the most sensitive Enterobacteriaceae.

Topics: Anti-Bacterial Agents; Cefotaxime; Ceftriaxone; Cross Infection; Enterobacteriaceae; Enterobacteriaceae Infections; Humans; Microbial Sensitivity Tests; Moxalactam; Phenotype

617 clinical isolates were tested, 592 of which were from hospital source. The minimal inhibitory concentrations of cefmenoxime were determined by a microtiter dilution method, using Mueller-Hinton broth. The results obtained give a 92% agreement with the reference agar-dilution method. Cefmenoxime shows a potent activity against Enterobacteriaceae (n = 420): the modal MIC is less than or equal to 0,03 mg/l, and 90% of them are inhibited by 1 mg/l. Some isolates require a higher concentration, above 32 mg/l: Enterobacter (8%), indole-positive Proteus (13%), Serratia (3%), Citrobacter (3%). Pseudomonas (n = 71) and Acinetobacter (n = 62) appear to be less susceptible than Enterobacteriaceae. The modal MIC is 16 mg/l and the concentration inhibiting 90% of the isolates is above 32 mg/l. The modal MIC of cefmenoxime against Staphylococcus aureus (n = 64) is 1 mg/l, and 90% of the strains belonging to this species are inhibited by 32 mg/l.

Topics: Acinetobacter; Bacteria; Cefmenoxime; Cefotaxime; Cross Infection; Enterobacteriaceae; Humans; Microbial Sensitivity Tests; Pseudomonas; Staphylococcus aureus

The in vitro activity of a new cephalosporin, cefmenoxime, was tested by an agar dilution procedure against 616 strains of Gram negative rods resistant to various beta-lactams and was compared with that of cefotaxime, lamoxactam, ceftazidime (and cefsulodin against P. aeruginosa). A high activity was demonstrated on many species of tested Enterobacteriaceae including E. coli, K. pneumoniae, S. marcescens, E. cloacae resistant to the first generation cephalosporins, Proteus sp., Providencia and C. freundii, with MIC geometric mean values from 0,028 to 0,33 microgram by ml. These values were nearly similar to those given by cefotaxime or lamoxactam and inferior to those given by ceftazidime. Cefmenoxime however showed a low activity (MIC geometric means from 19,5 to 25,5 micrograms by ml) against E. cloacae resistant to second generation cephalosporins (the better agent was lamoxactam), A. calcoaceticus (the better agent was ceftazidime) and carbenicillin-resistant P. aeruginosa (here ceftazidime and cefsulodin gave better performances).

Topics: Anti-Bacterial Agents; Bacteria; Cefmenoxime; Cefotaxime; Ceftazidime; Cephalosporins; Cross Infection; Drug Resistance, Microbial; Enterobacteriaceae; Humans; Moxalactam

This work reports a multicenter study of antibacterial activity of cefatiolene (RP 42 980), a new third generation cephalosporin, in comparison with cefotaxime and lamoxactam. On the basis of MIC, activity of the three products is similar or Gram negative rods, but cefotaxime is a little more active on Enterobacteriaceae. The activity against Staphylococci requires further studies, indeed the determination of IC 50 of some strains showed a better activity of cefatiolene, but this was not observed by determination of MIC. As cefotaxime and contrary to lamoxactam, cefatiolene is active at low concentrations on other Streptococci than Enterococci, but a little on Bacteroides.

Topics: Bacteria; Cefotaxime; Cephalosporins; Cross Infection; Drug Resistance, Microbial; Humans; Microbial Sensitivity Tests; Moxalactam; Staphylococcus aureus

The flora in the throat and the stools of 10 patients receiving chemotherapy for malignant diseases in a laminar air-flow room was studied during the prophylactic administration of ceftazidime. Ten percent of aerobic gram-negative bacilli, 41% of aerobic gram-positive organisms, 59% of anaerobes, and 70% of fungi persisted in stool specimens during ceftazidime administration. This drug had a less pronounced effect on the throat flora; 66% of organisms persisted during antibiotic administration. The throat and fecal flora of another eight patients were studied during the prophylactic administration of ceftriaxone. This antibiotic had a profound effect on the fecal flora; none of the gram-negative bacilli, only 24% of aerobic gram-positive organisms, and only 10% of anaerobes persisted during ceftriaxone administration. Like ceftazidime, ceftriaxone had a less marked effect on the throat flora; 59% of organisms persisted during antibiotic administration. The results show that new, expanded-spectrum cephalosporins can have a major suppressive effect on patients' endogenous microbial flora.

Topics: Adult; Aged; Bacterial Infections; Bacteroides; Candidiasis; Cefotaxime; Ceftazidime; Ceftriaxone; Cephalosporins; Cross Infection; Drug Resistance, Microbial; Enterobacteriaceae; Feces; Female; Humans; Male; Middle Aged; Neoplasms; Pharynx; Staphylococcus; Streptococcus

An outbreak of colonisation and infection with a netilmicin resistant strain of Serratia marcescens occurred in a special care baby unit. S marcescens was isolated from a total of 13 babies; significant infection occurred in five, of whom two died. Epidemiological investigation failed to detect a common source but gastrointestinal colonisation of babies formed a prolonged and possibly important reservoir for infection. Containment proved difficult until the unit was closed to new admissions, and even then spread to a temporary unit ensued. O Serotyping and bacteriophage typing disclosed a single epidemic strain. This produced an aminoglycoside acetylating enzyme (AAC(6')) conferring resistance to netilmicin and tobramycin and moderate resistance to amikacin. Use of gentamicin resulted in the isolation of serratia with increased resistance to all aminoglycosides, and, similarly, increased resistance to third generation cephalosporins emerged with their use.

Topics: Acetyltransferases; Amikacin; Cefotaxime; Cross Infection; Disease Outbreaks; Drug Resistance, Microbial; Enterobacteriaceae Infections; Gentamicins; Humans; Infant, Newborn; Netilmicin; Nurseries, Hospital; Serratia marcescens; Tobramycin

Our clinical experience with new antibiotics giving special consideration to the individual cephalosporin groups is discussed. Although newer cephalosporins from cefamandol and cefoxitin to cefotiam and cefoperazon already showed increased effectiveness (for example, cefoxitin in bacteroides infection) in comparison to older ones, the real breakthrough regarding enterobacteriaceae was only made with cephalosporins of the cefotaxime group. This group's main indication is non-specific initial therapy of severe nosocomial infections, especially processes in which the presence of resistant enterobacteriaceae must be assumed. Because of its broad spectrum of action, cefotaxime can to a large extent replace the combinations with aminoglycosides which were used previously. When required, cefotaxime proves to be a good partner for combinations with pseudomonas antibiotics.

Topics: Bacteroides Infections; Cefotaxime; Cefoxitin; Cephalosporins; Cross Infection; Drug Therapy, Combination; Enterobacteriaceae Infections; Gentamicins; Humans; Pseudomonas Infections; Staphylococcal Infections; Structure-Activity Relationship

Topics: Anti-Bacterial Agents; Cefotaxime; Cross Infection; Digestive System; Drug Resistance, Microbial; Drug Therapy, Combination; Humans; Intensive Care Units; Polymyxins; Respiratory Tract Infections; Sepsis; Tobramycin

Topics: Bacterial Infections; Cefotaxime; Cross Infection; Female; Humans; Male; Resuscitation

Thirty-five patients underwent 38 treatment courses with cefotaxime. Documented infections included 11 bacteremias, 7 cases of nosocomial pneumonia, 6 surgical wound infections, 3 bone infections, 1 biliary infection, and 1 urinary tract infection. Granulocytopenic patients with fever received 15 courses of empiric cefotaxime therapy alone; in 8 courses, no definite site of infection or pathogen was isolated. Broad-spectrum antibiotics had been administered to 23 patients before cefotaxime. Thirty-seven bacterial pathogens were isolated from 25 patients. Three such pathogens were resistant to cefotaxime and required alternative therapies. Pathogenic isolates included 13 Serratia marcescens, 12 Pseudomonas aeruginosa, 4 Escherichia coli, 2 Klebsiella pneumoniae, 2 Providencia stuartii, 1 Enterobacter cloacae, 1 Haemophilus influenzae, 1 Enterococcus, and 1 Staphylococcus aureus. Of the treatment courses, 25 of 38 resulted in a favorable response to cefotaxime, including 9 of 15 in granulocytopenic patients. Superinfection was seen in one patient. The emergence of resistance was documented in another patient. Of 15 patients with multiply resistant pathogens, 12 improved with cefotaxime. Of 12 patients with Pseudomonas aeruginosa, 6 favorably responded. Possible complications of cefotaxime were observed in 14 of 42 treatment courses. Cefotaxime is most useful in treatment of infections due to multiply resistant, gram-negative pathogens other than Pseudomonas aeruginosa.

Topics: Adolescent; Adult; Aged; Bacteria; Bacterial Infections; Cefotaxime; Cross Infection; Female; Humans; Male; Middle Aged; Sepsis

Acinetobacter calcoaceticus is recognized as one of the most resistant nosocomial pathogens. Clinical isolates of Acinetobacter are usually resistant to most beta-lactam antibiotics. The objective of this study was to evaluate the in vitro activity of ceftazidime, a new broad spectrum highly potent beta-lactam antibiotic, able to inhibit especially Pseudomonas and Providencia. Its activity against 96 clinical strains of Acinetobacter was compared with the activity of 5 recent beta-lactam antibiotics which are resistant to beta-lactamase degradation (cefoxitine, Cefotaxime, moxalactam, cefotiam, cefamandole). The results of this comparative study of the in vitro activity of the 6 beta-lactam antibiotics exhibit a higher activity of ceftazidime: 50 p. cent of the strains were inhibited at a concentration of 4 micrograms/ml while the other drugs inhibited 50 p. cent of the strains at concentrations superior to 10 micrograms/ml; the geometric mean was 7 micrograms/ml for ceftazidime while for the other drugs it was more than 10 micrograms/ml and for 3 of them, the geometric mean was more than 40 micrograms/ml. Otherwise one could notice a bimodal distribution of the strains which suggests the presence of 2 populations of Acinetobacter, respectively inhibited with 4 micrograms/ml (susceptible) and 64 or 128 micrograms/ml (resistant). Finally this study shows that ceftazidime is one of the most active compounds against clinical isolates of Acinetobacter calcoaceticus among the 3rd generation of cephalosporins.

Topics: Acinetobacter; beta-Lactamases; Cefotaxime; Ceftazidime; Cephalosporins; Cephamycins; Cross Infection; Drug Resistance, Microbial; Humans

All aminoglycoside-resistant gram-negative bacilli isolated during 1 year at a community hospital were tested for in vitro sensitivity to cefotaxime, moxalactam, cefoperazone, and piperacillin. The majority of Enterobacteriaceae were susceptible to all four antibiotics. Cefoperazone and piperacillin were the most active for pseudomonas aeruginosa, and activity for other nonfermentative gram-negative bacilli was variable.

Topics: Aminoglycosides; Anti-Bacterial Agents; Bacteria; Cefoperazone; Cefotaxime; Cephalosporins; Cephamycins; Cross Infection; Humans; Moxalactam; Penicillin Resistance; Penicillins; Piperacillin

The inhibitory and bactericidal activity of N-formimidoyl-thienamycin in vitro against 131 clinical isolates selected for their gentamicin resistance was compared with that of cefotaxime and moxalactam. All strains were inhibited by N-formimidoyl-thienamycin concentrations within a range of 0.12-4 mg/l. N-formimidoyl-thienamycin was less active than cefotaxime and moxalactam against Escherichia coli and Klebsiella spp., and more active than all other antibiotics tested against Serratia spp., Enterobacter cloacae, Pseudomonas aeruginosa and Acinetobacter spp. In contrast to the other antibiotics N-formimidoyl-thienamycin showed a narrow margin of difference between minimal inhibitory and minimal bactericidal concentrations. N-formimidoyl-thienamycin is a promising antibiotic for the treatment of hospital infections with multi-resistant organisms.

Topics: Acinetobacter; Bacteria; Cefotaxime; Cephalosporins; Cephamycins; Cross Infection; Drug Resistance, Microbial; Enterobacter; Escherichia coli; Gentamicins; Imipenem; Klebsiella; Microbial Sensitivity Tests; Moxalactam; Pseudomonas aeruginosa; Serratia; Thienamycins

Topics: Adult; Aged; Bacterial Infections; Cefotaxime; Ceftizoxime; Critical Care; Cross Infection; Drug Resistance, Microbial; Female; Humans; Male; Microbial Sensitivity Tests; Middle Aged

Topics: Adolescent; Adult; Aged; Bacterial Infections; Cefotaxime; Ceftizoxime; Cross Infection; Endocarditis, Bacterial; Female; Humans; Male; Middle Aged; Pneumonia; Pyelonephritis; Sepsis; Urinary Tract Infections

Topics: Anti-Bacterial Agents; Cefotaxime; Cross Infection; Humans

Topics: Adolescent; Adult; Aged; Bacterial Infections; Cefotaxime; Cephalosporins; Cross Infection; Drug Resistance, Microbial; Female; Humans; Male; Middle Aged