cefotaxime and Gram-Negative-Bacterial-Infections

Eikenella corrodens is a facultatively anaerobic gram-negative rod bacterium in the oropharynx and respiratory tract. It is a member of HACEK (Haemophilus spp., Aggregatibacter spp., Cardiobacterium hominis, E. corrodens, and Kingella kingae) group commonly associated with endocarditis and craniofacial infections. It is usually susceptible to penicillin, second and third-generation cephalosporins, and carbapenem, but has variable susceptibility to first-generation cephalosporin. We herein provide a description of the first case of pediatric acute dacryocystitis caused by E. corrodens. The patient did not respond to oral cephalexin and required surgical drainage followed by intravenous cefotaxime. Also provided is a brief review of the current literature.

Topics: Acute Disease; Aggregatibacter; Anti-Bacterial Agents; Cardiobacterium; Cefotaxime; Cephalexin; Child, Preschool; Dacryocystitis; Drug Administration Routes; Eikenella corrodens; Female; Gram-Negative Bacterial Infections; Haemophilus; Humans; Kingella; Microbial Sensitivity Tests; Tomography, X-Ray Computed; Treatment Outcome

Recent studies have shown that spontaneous bacterial peritonitis (SBP) is more common than previously thought among patients admitted to the hospital with cirrhotic ascites. Other recent studies have clarified which antibiotic regimens are most successful for treatment and prevention, often shortening the duration of treatment. Still, the prognosis is poor and recurrence of SBP is common.

Topics: Anti-Bacterial Agents; Antibiotic Prophylaxis; Ascites; Ascitic Fluid; Cefotaxime; Gram-Negative Bacterial Infections; Humans; Incidence; Lactams; Liver Cirrhosis; Peritonitis; Time Factors

Capnocytophaga canimorsus causes dog-bite wound induced sepsis in adults, but infection may follow mucous membrane exposure. Systemic infection in children is extremely rare. A neonate with frequent exposure to a family dog and no cutaneous infection developed C. canimorsus meningitis. Suspicion of this pathogen requires laboratory consultation. Parental counseling can limit the risk of pet acquired infections.

Topics: Ampicillin; Animals; Capnocytophaga; Cefotaxime; Dogs; Drug Therapy, Combination; Female; Follow-Up Studies; Gentamicins; Gram-Negative Bacterial Infections; Humans; Infant, Newborn; Infusions, Intravenous; Meningitis, Bacterial; Risk Assessment; Treatment Outcome

Topics: Acute Disease; Anti-Bacterial Agents; Cefotaxime; Evidence-Based Medicine; Female; Gram-Negative Bacterial Infections; Humans; Middle Aged; Ofloxacin; Peritonitis; Randomized Controlled Trials as Topic

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Cefotaxime; Ceftriaxone; Cephalosporins; Female; Gram-Negative Bacterial Infections; Humans; Male; Middle Aged; Randomized Controlled Trials as Topic; Respiratory Tract Infections

Topics: Anti-Bacterial Agents; Blood-Brain Barrier; Cefotaxime; Cephalosporins; Gram-Negative Bacterial Infections; Gram-Positive Bacterial Infections; Humans; Microbial Sensitivity Tests; Respiratory Tract Infections

Spontaneous bacterial peritonitis in liver cirrhosis is due to the passage of intestinal bacteria into intestinal lymph vessels, systemic circulation and ascitic fluid. It may occur in patients with severe portal hypertension and hepatic failure, impaired reticuloendothelial phagocytic activity and low ascitic fluid opsonic activity. Spontaneous bacterial peritonitis is a monomicrobial infection usually caused by gram-negative bacteria. The treatment of choice of spontaneous bacterial peritonitis is cefotaxime. Several subgroups of cirrhotic patients have been shown to be predisposed to develop spontaneous bacterial peritonitis, including cases with gastrointestinal hemorrhage, patients with high serum bilirubin and low ascitic fluid protein concentration (< 1 g/dl), and patients who had recovered from an episode of spontaneous bacterial peritonitis. Since spontaneous bacterial peritonitis is associated with a relatively high in-hospital mortality rate (20-40%), prophylactic measures to prevent this infection are required. Short-term and long-term selective intestinal decontamination with oral norfloxacin has proved highly effective in preventing bacterial infection and spontaneous bacterial peritonitis in bleeding cirrhotic patients as well as recurrence of spontaneous bacterial peritonitis.

Topics: Cefotaxime; Gram-Negative Bacterial Infections; Humans; Liver Cirrhosis; Peritonitis; Probability; Recurrence

Ceftriaxone has a higher biliary elimination than cefotaxime (40% versus 10%), which may result in a more pronounced impact on the intestinal microbiota. We performed a monocenter, randomized open-label clinical trial in 22 healthy volunteers treated by intravenous ceftriaxone (1 g/24 h) or cefotaxime (1 g/8 h) for 3 days. We collected fecal samples for phenotypic analyses, 16S rRNA gene profiling, and measurement of the antibiotic concentration and compared the groups for the evolution of microbial counts and indices of bacterial diversity over time. Plasma samples were drawn at day 3 for pharmacokinetic analysis. The emergence of 3rd-generation-cephalosporin-resistant Gram-negative enteric bacilli (

Topics: Adolescent; Adult; Anti-Bacterial Agents; Cefotaxime; Ceftriaxone; Cephalosporins; Feces; Female; Gastrointestinal Microbiome; Gram-Negative Bacteria; Gram-Negative Bacterial Infections; Healthy Volunteers; Humans; Male; Middle Aged; RNA, Ribosomal, 16S; Young Adult

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

The objective of this multicentre, randomized, prospective and comparative study was to evaluate and compare the efficacy and safety of 1 g intravenous ceftriaxone (active ingredient of Rocephin), 3 g intravenous cefoiaxime (active ingredient of clafron), and 2.25 g intavenous cefuroxime (active ingredient of Zinacef).. In this multicentre, randomized, prospective and comparative study, patients received 1 g of ceftriaxone intravenously once a day (group A), or 1 g of cefotaxime intravenously three times a day (group B), or 0.75 g of cefuroxime intravenously three time a day (group C). 197 patients were enrolled in the study, and in 142 (48 in group A, 46 in group B and 48 in group C) we were able to make an evaluation.. The overall efficacy (bacteriological eradication plus clinical cure or clear improvement) of ceftriaxone, cefotaxime and cefuroxime were 81%, 83%, 79% respectively (P > 0.05). The eradication rate for three groups were 80%, 78%, 75% (P > 0.05). No adverse events occured.. Data obtained in our study indicate that for the majority of patients with lower respiratory tract infections, 1 g ceftriaxone, 3 g cefotaxime and 2.25 g cefuroxime are effective and safe, and 7 days therapy is enough, but the use of 1 g ceftriaxone is more convenient.

Topics: Adolescent; Adult; Aged; Bronchitis; Cefotaxime; Ceftriaxone; Cefuroxime; Cephalosporins; Female; Gram-Negative Bacterial Infections; Humans; Injections, Intravenous; Male; Middle Aged; Pneumonia; Prospective Studies

In a randomized comparative study, adult patients suffering from Gram-negative septicemia or pyemia were treated either with a single daily dose of 1.5g of ceftriaxone in most patients or 6g of cefotaxime divided into four daily doses. K. pneumoniae and E. coli were commonly isolated in both groups. Altogether 17 patients treated with ceftriaxone and 14 with cefotaxime completed the treatment with a success rate of 88.2% and 85.6% respectively. There were two deaths in patients treated with ceftriaxone (12%) and one with cefotaxime (7.2%). Despite the severity of the disease, antibiotic treatment was relatively short: 7 patients (41%) were treated with ceftriaxone for only 7 days, 2 with cefotaxime for 7 days, 5 for 10 days. Others were treated for a longer period with a maximum duration of 22 days. This study confirms in Asian patients the previous reports that a single daily dose of ceftriaxone is as efficacious as four daily doses with cefotaxime in treating patients with severe infections.

Topics: Adult; Aged; Bacteremia; Cefotaxime; Ceftriaxone; Chi-Square Distribution; Drug Administration Schedule; Female; Gram-Negative Bacterial Infections; Humans; Male; Middle Aged; Suppuration

Infection is the immediate cause of death in many patients with cancer. Traditionally, combinations of modern beta-lactam antibiotics and aminoglycosides are empirically used in the treatment of patients with neutropenia and presumed infection. However, the new quinolones appear to have become potent combination partners for beta-lactams. Eighty-seven patients with presumed serious infection were blindly randomised to receive either 2 g cefotaxime i.v. plus 200 mg ofloxacin twice daily (group 1) or 2 g cefotaxime i.v. twice daily plus tobramycin i.v. three times daily with dosage adjustment according to renal function and body weight (group 2). The response rate was significantly higher in group 1 (71%) compared to group 2 (47%). The cefotaxime/ofloxacin combination proved to be safe and represented a considerable reduction of workload on the nursing staff.

Topics: Administration, Oral; Cefotaxime; Drug Synergism; Drug Therapy, Combination; Gram-Negative Bacterial Infections; Gram-Positive Bacterial Infections; Humans; Infusions, Intravenous; Neoplasms; Neutropenia; Ofloxacin; Tobramycin

Multidrug resistance (MDR) is a major clinical problem in tertiary hospitals in Tanzania and jeopardizes the life of neonates in critical care units (CCUs). To better understand methods for prevention of MDR infections, this study aimed to determine, among other factors, the role of MDR-Gram-negative bacteria (GNB) contaminating neonatal cots and hands of mothers as possible role in transmission of bacteremia at Bugando Medical Centre (BMC), Mwanza, Tanzania.. This cross-sectional, hospital-based study was conducted among neonates and their mothers in a neonatal intensive care unit and a neonatology unit at BMC from December 2018 to April 2019. Blood specimens (n = 200) were sub-cultured on 5% sheep blood agar (SBA) and MacConkey agar (MCA) plates. Other specimens (200 neonatal rectal swabs, 200 maternal hand swabs and 200 neonatal cot swabs) were directly inoculated on MCA plates supplemented with 2 μg/ml cefotaxime (MCA-C) for screening of GNB resistant to third generation cephalosporins, r-3GCs. Conventional biochemical tests, Kirby-Bauer technique and resistance to cefoxitin 30 μg were used for identification of bacteria, antibiotic susceptibility testing and detection of MDR-GNB and screening of potential Amp-C beta lactamase producing GNB, respectively.. The prevalence of culture confirmed bacteremia was 34.5% of which 85.5% were GNB. Fifty-five (93.2%) of GNB isolated from neonatal blood specimens were r-3GCs. On the other hand; 43% of neonates were colonized with GNB r-3GCs, 32% of cots were contaminated with GNB r-3GCs and 18.5% of hands of neonates' mothers were contaminated with GNB r-3GCs. The prevalences of MDR-GNB isolated from blood culture and GNB r-3GCs isolated from neonatal colonization, cots and mothers' hands were 96.6, 100, 100 and 94.6%, respectively. Significantly, cyanosis (OR[95%CI]: 3.13[1.51-6.51], p = 0.002), jaundice (OR[95%CI]: 2.10[1.07-4.14], p = 0.031), number of invasive devices (OR[95%CI]: 2.52[1.08-5.85], p = 0.031) and contaminated cot (OR[95%CI]: 2.39[1.26-4.55], p = 0.008) were associated with bacteremia due to GNB. Use of tap water only (OR[95%CI]: 2.12[0.88-5.09], p = 0.040) was protective for bacteremia due to GNB.. High prevalence of MDR-GNB bacteremia and intestinal colonization, and MDR-GNB contaminating cots and mothers' hands was observed. Improved cots decontamination strategies is crucial to limit the spread of MDR-GNB. Further, clinical presentations and water use should be considered in administration of empirical therapy whilst awaiting culture results.

Topics: Bacteremia; Beds; Cefotaxime; Cross-Sectional Studies; Female; Gram-Negative Bacteria; Gram-Negative Bacterial Infections; Hand; Humans; Infant, Newborn; Intensive Care, Neonatal; Intestines; Male; Mothers; Prevalence; Tanzania; Tertiary Care Centers

Topics: Ampicillin; Anti-Bacterial Agents; Bacteremia; Capnocytophaga; Cefotaxime; Female; Gentamicins; Gram-Negative Bacterial Infections; Humans; Infant, Newborn; Intensive Care Units, Neonatal; Placenta; Pregnancy

Topics: Aged; Anti-Bacterial Agents; Cefotaxime; Cholangiopancreatography, Endoscopic Retrograde; Gallstones; Gram-Negative Anaerobic Bacteria; Gram-Negative Bacterial Infections; Humans; Male; Metronidazole; Microbial Sensitivity Tests; RNA, Ribosomal, 16S; Sequence Analysis, DNA; Tomography, X-Ray Computed

Antibiotic adjuvant therapy represents an exciting opportunity to enhance the activity of clinical antibiotics by co-dosing with a secondary small molecule. Successful adjuvants decrease the concentration of antibiotics used to defeat bacteria, increase activity (in some cases introducing activity against organisms that are drug resistant), and reduce the frequency at which drug-resistant bacteria emerge. We report that 5-alkyloxytryptamines are a new class of broad-spectrum antibacterial agents with exciting activity as antibiotic adjuvants. We synthesized 5-alkyloxytryptamine analogs and found that an alkyl chain length of 6-12 carbons and a primary ammonium group are necessary for the antibacterial activity of the compounds, and an alkyl chain length of 6-10 carbons increased the membrane permeability of Gram-positive and Gram-negative bacteria. Although several of the most potent analogs also have activity against the membranes of human embryonic kidney cells, we demonstrate that below the minimum inhibitory concentration (MIC)-where mammalian cell toxicity is low-these compounds may be successfully used as adjuvants for chloramphenicol, tetracycline, ciprofloxacin, and rifampicin against clinical strains of Salmonella typhimurium, Acinetobacter baumannii and Staphylococcus aureus, reducing MIC values by as much as several logs.

Topics: Acinetobacter baumannii; Alkylation; Anti-Bacterial Agents; Gram-Negative Bacteria; Gram-Negative Bacterial Infections; Gram-Positive Bacteria; Gram-Positive Bacterial Infections; HEK293 Cells; Humans; Salmonella typhimurium; Staphylococcus aureus; Tryptamines

Cefotaxime is one of the most frequently prescribed antibiotics for the treatment of Gram-negative bacterial sepsis in neonates. However, the dosing regimens routinely used in clinical practice vary considerably. The objective of the present study was to conduct a population pharmacokinetic study of cefotaxime in neonates and young infants in order to evaluate and optimize the dosing regimen. An opportunistic sampling strategy combined with population pharmacokinetic analysis using NONMEM software was performed. Cefotaxime concentrations were measured by high-performance liquid chromatography-tandem mass spectrometry. Developmental pharmacokinetics-pharmacodynamics, the microbiological pathogens, and safety aspects were taken into account to optimize the dose. The pharmacokinetic data from 100 neonates (gestational age [GA] range, 23 to 42 weeks) were modeled with an allometric two-compartment model with first-order elimination. The median values for clearance and the volume of distribution at steady state were 0.12 liter/h/kg of body weight and 0.64 liter/kg, respectively. The covariate analysis showed that current weight, GA, and postnatal age (PNA) had significant impacts on cefotaxime pharmacokinetics. Monte Carlo simulations demonstrated that the current dose recommendations underdosed older newborns. A model-based dosing regimen of 50 mg/kg twice a day to four times a day, according to GA and PNA, was established. The associated risk of overdose for the proposed dosing regimen was 0.01%. We determined the population pharmacokinetics of cefotaxime and established a model-based dosing regimen to optimize treatment for neonates and young infants.

Topics: Anti-Bacterial Agents; Body Weight; Cefotaxime; Chromatography, High Pressure Liquid; Computer Simulation; Drug Administration Schedule; Drug Dosage Calculations; Female; Gestational Age; Gram-Negative Bacterial Infections; Humans; Infant; Infant, Newborn; Intensive Care Units; Male; Models, Statistical; Monte Carlo Method; Sepsis; Tandem Mass Spectrometry

To evaluate resistances mediated by extended-spectrum β-lactamases (ESBLs) and AmpC β-lactamases among Gram-negative bacteria recovered from ocular infections.. As per the Clinical Laboratory Standards Institute M100-S-16 document, a total of 135 Gram-negative bacilli were recovered from ocular specimens and were subjected to phenotypic confirmation for ESBL production by the double-disc synergy test, cephalosporin and clavulanate combination disc test and E test, and, for AmpC β-lactamase, the modified double-disc approximation method and AmpC disc test.. In the double-disc synergy test, 21 (15.5%) isolates showed positive results against the cefpodoxime disc, 19 (14%) against cefpodoxime and cefotaxime, 15 (11%) against cefpodoxime, cefotaxime and ceftriaxone and 10 (7%) isolates were against cefpodoxime, cefotaxime, ceftriaxone and ceftazidime discs. In the cephalosporin/clavulanate combination disc test, 19 (14%) isolates showed positive results against cefotaxime with clavulanic acid and 10 (7%) isolates against ceftazidime with clavulanic acid. In the E test, 10 (7%) isolates displayed positive results against ceftazidime and 19 (14%) against cefotaxime. In the AmpC disc test for phenotypic confirmation, indentations were observed in 15 (11%) isolates with flattening also occurring in 10 (7%) isolates.. The incidences of ESBL- and AmpC β-lactamase-mediated resistances are found to be 7 and 18.5% among ocular isolates, respectively, and are more prevalent among the strains of Escherichia coli and Klebsiella pneumoniae.

Topics: Anti-Bacterial Agents; Bacterial Proteins; beta-Lactamases; Cefotaxime; Cefpodoxime; Ceftazidime; Ceftizoxime; Ceftriaxone; Cephalosporin Resistance; Cephalosporins; Drug Resistance, Multiple, Bacterial; Eye Infections, Bacterial; Gram-Negative Bacteria; Gram-Negative Bacterial Infections; Humans; Microbial Sensitivity Tests; Prospective Studies

Although extended-spectrum-β-lactamase (ESBL)-producing aeromonads have been increasingly reported in recent years, most of them were isolates from case reports or environmental isolates. To investigate the prevalence of ESBL producers among Aeromonas blood isolates and the genes encoding ESBLs, consecutive nonduplicate Aeromonas blood isolates collected at a medical center in southern Taiwan from March 2004 to December 2008 were studied. The ESBL phenotypes were examined by clavulanate combination disk test and the cefepime-clavulanate ESBL Etest. The presence of ESBL-encoding genes, including bla(TEM), bla(PER), bla(CTX-M), and bla(SHV) genes, was evaluated by PCR and sequence analysis. The results showed that 4 (2.6%) of 156 Aeromonas blood isolates, 1 Aeromonas hydrophila isolate and 3 Aeromonas caviae isolates, expressed an ESBL-producing phenotype. The ESBL gene in two A. caviae isolates was bla(PER-3), which was located in both chromosomes and plasmids, as demonstrated by Southern hybridization. Of four patients with ESBL-producing Aeromonas bacteremia, two presented with catheter-related phlebitis and the other two with primary bacteremia. Three patients had been treated with initial noncarbapenem β-lactams for 5 to 10 days, and all survived. In conclusion, ESBL producers exist among Aeromonas blood isolates, and clinical suspicion of ESBL production should be raised in treating infections due to cefotaxime-resistant Aeromonas isolates.

Topics: Academic Medical Centers; Aeromonas caviae; Aeromonas hydrophila; Aged; Aged, 80 and over; Anti-Bacterial Agents; Bacteremia; beta-Lactamases; Cefotaxime; Child, Preschool; Drug Resistance, Bacterial; Female; Gram-Negative Bacterial Infections; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Polymerase Chain Reaction; Prevalence; Taiwan

The Capnocytophaga sputigena isolate NOR, responsible for septicemia, was resistant to amoxicillin and narrow-spectrum cephalosporins. In a cloning experiment, a new gene, bla(CSP-1), was identified; this gene encodes a novel extended-spectrum beta-lactamase (ESBL) that shares only 52% and 49% identities with the CME-1 and VEB-1 beta-lactamases, respectively. The G+C content of this gene, its genetic environment, the absence of conjugation transfer, and its detection in two reference strains suggested that it was an intrinsic resistance gene located on the chromosome.

Topics: Amino Acid Sequence; Amoxicillin; Anti-Bacterial Agents; beta-Lactam Resistance; beta-Lactamases; Capnocytophaga; Cephalosporins; Gram-Negative Bacterial Infections; Humans; Microbial Sensitivity Tests; Molecular Sequence Data; Sepsis

Of 3,004 gram-negative bacilli collected from intra-abdominal infections in the Asia-Pacific region during 2007, 42.2% and 35.8% of Escherichia coli and Klebsiella spp., respectively, were extended-spectrum beta-lactamase (ESBL) positive. Moreover ESBL rates in India for E. coli, Klebsiella pneumoniae, and Klebsiella oxytoca were 79.0%, 69.4%, and 100%, respectively. ESBL-positive E. coli rates were also relatively high in China (55.0%) and Thailand (50.8%). Ertapenem and imipenem were the most active drugs tested, inhibiting over 90% of all species, including ESBL-positive isolates with the exception of Pseudomonas aeruginosa isolates (<90% susceptible to all study drugs) and ESBL-positive Klebsiella pneumoniae isolates (<90% susceptible to all study drugs except imipenem). Quinolones achieved 90% inhibition levels only against ESBL-negative K. pneumoniae and ESBL-negative K. oxytoca. A decline in ampicillin-sulbactam activity was noted, with only 34.5% of all Enterobacteriaceae inhibited in this study.

Topics: Anti-Bacterial Agents; beta-Lactamases; beta-Lactams; China; Drug Resistance, Bacterial; Ertapenem; Escherichia coli; Gram-Negative Bacteria; Gram-Negative Bacterial Infections; Imipenem; India; Klebsiella; Quinolones; Thailand

Sinusitis can rarely be latent and present directly with intracranial complications. We present the case of an 11-year-old girl who presented with typical features of meningitis. She underwent neuroimaging because of slow improvement and concern for a brain abscess. Despite no history or examination findings suggestive of sinusitis, she was found to have pansinusitis with intracranial extension causing meningitis and epidural abscess.

Topics: Bacteroidaceae Infections; Cefotaxime; Ceftriaxone; Child; Combined Modality Therapy; Consciousness Disorders; Diagnostic Imaging; Drug Therapy, Combination; Eikenella; Emergencies; Endoscopy; Epidural Abscess; Female; Fusobacterium Infections; Gram-Negative Bacterial Infections; Gram-Positive Bacterial Infections; Humans; Meningitis, Bacterial; Metronidazole; Otorhinolaryngologic Surgical Procedures; Peptostreptococcus; Prevotella intermedia; Sinusitis; Staphylococcal Infections; Vancomycin

Brachyspira pilosicoli BM4442, isolated from the feces of a patient with diarrhea at the Hospital Saint-Michel in Paris, was resistant to oxacillin (MIC > 256 microg/ml) but remained susceptible to cephalosporins and to the combination of amoxicillin and clavulanic acid. Cloning and sequencing of the corresponding resistance determinant revealed a coding sequence of 807 bp encoding a new class D beta-lactamase named OXA-63. The bla OXA-63 gene was chromosomally located and not part of a transposon or of an integron. OXA-63 shared 54% identity with FUS-1 (OXA-85), an oxacillinase from Fusobacterium nucleatum subsp. polymorphum, and 25 to 44% identity with other class D beta-lactamases (DBLs) and contained all the conserved structural motifs of DBLs. Escherichia coli carrying the bla OXA-63 gene exhibited resistance to benzylpenicillin and amoxicillin but remained susceptible to amoxicillin in combination with clavulanic acid. Mature OXA-63 consisted of a 31.5-kDa polypeptide and appeared to be dimeric. Kinetic analysis revealed that OXA-63 exhibited a narrow substrate profile, hydrolyzing oxacillin, benzylpenicillin, and ampicillin with catalytic efficiencies of 980, 250, and 150 mM(-1) s(-1), respectively. The enzyme did not apparently interact with oxyimino-cephalosporins, imipenem, or aztreonam. Unlike FUS-1 and other DBLs, OXA-63 was strongly inhibited by clavulanic acid (50% inhibitory concentration [IC50] of 2 microM) and tazobactam (IC50 of 0.16 microM) and exhibited low susceptibility to NaCl (IC50 of >2 M). OXA-63 is the first DBL described for the anaerobic spirochete B. pilosicoli.

Topics: Amino Acid Sequence; Anti-Bacterial Agents; Base Sequence; beta-Lactamases; Brachyspira; Cloning, Molecular; Diarrhea; Feces; Gram-Negative Bacterial Infections; Humans; Kinetics; Molecular Sequence Data; Oxacillin; Penicillin Resistance; Sequence Analysis, DNA

All 198 Salmonella isolates (58.6% of isolates were resistant to tetracycline), 92 Vibrio isolates (4.4% of isolates were resistant to tetracycline), and 200 of 201 Aeromonas isolates (39.3% of isolates were resistant to tetracycline; 1 A. caviae isolate had a tigecycline MIC of 4 mug/ml) in our study were susceptible to tigecycline, by U. S. Food and Drug Administration criteria for Enterobacteriaceae.

Topics: Aeromonas; Anti-Bacterial Agents; Gram-Negative Bacterial Infections; Humans; In Vitro Techniques; Microbial Sensitivity Tests; Minocycline; Salmonella; Salmonella Infections; Taiwan; Tetracycline Resistance; Tigecycline; Vibrio; Vibrio Infections

We report an unusual case of a 6-year-old boy with a sinus tract terminating with an intramedullary dermoid cyst and holocord central lesion, presenting with tetraparesis secondary to intramedullary abscess. Total excision of dermal sinus tract, dermoid cyst, and the intramedullary abscess by means of a L2-S3 laminectomy, followed by antibiotic therapy resulted in good functional recovery. Strengths of the upper extremities have fully recovered, and a remarkable improvement was detected in the muscles of the lower extremities. Postoperative magnetic resonance imaging (MRI) of the spine showed complete removal of the dermoid cyst, decreased inflamed granulation tissue over the medullary conus, and disappearance of the holocord high intensity lesion. The pathomechanism of holocord central lesion is discussed herein.

Topics: Abscess; Cefotaxime; Child; Dermoid Cyst; Drug Therapy, Combination; Follow-Up Studies; Gram-Negative Bacterial Infections; Humans; Laminectomy; Lumbar Vertebrae; Magnetic Resonance Imaging; Male; Metronidazole; Neurologic Examination; Postoperative Care; Postoperative Complications; Quadriplegia; Sacrum; Spina Bifida Occulta; Spinal Cord; Spinal Cord Neoplasms; Vancomycin

Ceftazidime and cefotaxime are beta-lactam antibiotics with dose-related affinities for penicillin-binding protein (PBP)-3 and PBP-1. At low concentrations, these antibiotics inhibit PBP-3, leading to filament formation. Filaments are long strands of non-dividing bacteria that contain enhanced quantities of endotoxin molecules. Higher concentrations of ceftazidime or cefotaxime cause inhibition of PBP-1, resulting in rapid bacterial lysis, which is associated with low endotoxin release. In the present study, 37 isolates of Escherichia coli, Klebsiella spp., Pseudomonas aeruginosa and Acinetobacter spp. were studied over a 4-h incubation period in the presence of eight concentrations of ceftazidime or cefotaxime. As resistance of Gram-negative bacteria is an emerging problem in clinical practice, 14 isolates of E. coli and Klebsiella pneumoniae that produced extended-spectrum beta-lactamases (ESBLs) were also investigated. Morphological changes after exposure to the beta-lactam antibiotics revealed recognisable patterns in various bacterial families, genera and isolates. In general, all isolates of Enterobacteriaceae produced filaments within a relatively small concentration range, with similar patterns for E. coli and K. pneumoniae. Pseudomonas and Acinetobacter spp. produced filaments in the presence of clinically-relevant concentrations of both antibiotics as high as 50 mg/L. In all genera, filament-producing capacity was clearly related to the MIC. Ceftazidime induced filament production in more isolates and over wider concentration ranges than did cefotaxime. Interestingly, ESBL-producing isolates were not protected against filament induction. The induction of filament production may lead to additional risks during empirical treatment of severe infections.

Topics: Acinetobacter; Anti-Bacterial Agents; beta-Lactam Resistance; beta-Lactams; Cefotaxime; Ceftazidime; Colony Count, Microbial; Dose-Response Relationship, Drug; Endotoxins; Enterobacteriaceae; Gram-Negative Bacteria; Gram-Negative Bacterial Infections; Humans; Microbial Sensitivity Tests; Pseudomonas

To describe the changes in antibiotic susceptibility patterns of common intensive care unit pathogens with time from the medical intensive care unit of a tertiary care hospital.. A prospective observational study was conducted in the medical intensive care unit (MICU) of a 2100 bed tertiary care hospital in South India. All data regarding patient characteristics, disease characteristics, infective agents, identified along with their antibiotic sensitivity patterns and patient outcomes were prospectively recorded in MICU data base. Various bacterial pathogen antibiotic sensitivity patterns from August 2004 to May 2005 were prospectively documented. During this period 491 patients were admitted to the MICU. Data were analyzed using excel spreadsheets.. Ceftazidime resistance reduced in Klebsiella spp. while cefotaxime resistance increased. In E. coli however, ceftazidime and cefotaxime resistance increased. Klebsiella resistance to cefotaxime and ceftazidime ranged from 25-50% and 14-91%, while E. coli resistance to these antibiotics ranged from 50-70% and 50 to 80% respectively. In Pseudomonas and the non-fermenting gram-negative bacteria (NFGNB) ceftazidime resistance decreased. Third generation cephalosporin resistance seemed to be reducing in the NFGNB, however, carbapenem resistance appeared to be increasing, possibly due to their increasing use.. This study demonstrates the trend in antibiotic susceptibility pattern (AST) of common gram negative infections seen in intensive care units. It demonstrates the changes seen especially after a change in the protocol antibiotic. Changes in the AST patterns of Klebsiella, E. coli, Pseudomonas and non-fermenting gram negative bacteria were seen. The data on the changing antibiotic susceptibility trends we believe is an important pillar in our efforts at infection control especially in intensive care settings.

Topics: Carbapenems; Cefotaxime; Ceftazidime; Cephalosporins; Drug Resistance, Bacterial; Gram-Negative Bacteria; Gram-Negative Bacterial Infections; Humans; India; Intensive Care Units; Microbial Sensitivity Tests

A 52-year-old man with a gastric signet-ring cell carcinoma but without acute symptoms was admitted for reconstructive surgery of the gastrointestinal tract.. Before the present surgery all functional and radiological tests merely confirmed the previously known disease. Except for mild anemia and abnormal electrolytes all laboratory tests were within normal limits. COURSE, DIAGNOSIS AND TREATMENT: The patient underwent reconstructive surgery of the gastrointestinal tract, namely an ascending sigmoidostomy and resection of an enterocutaneous fistula. For a few days the postoperative development was as expected and the drain, placed during surgery, was removed at the expected time. 9 days postoperatively the patient developed signs of an infection (fever up to 38.8 degrees C, increased WBC and raised C-reactive protein levels). Computed tomography (CT) of the abdomen revealed an epigastric tumor measuring 6 x 5 cm. CT-guided needle aspiration of this lesion showed macroscopic signs of an infected hematoma. A pigtail catheter was successfully implanted for continuous drainage. Both the fluids obtained from CT-guided aspiration and the pigtail drain grew Aeromonas veronii biovar sobria when cultured on standard blood agar. Administration of both cefotaxim and metronidazole for 10 days produced a decrease in the inflammatory parameters. The abdominal CT at that time showed a noticeable regression of the epigastric mass so that the patient was discharged from hospital 3 weeks after surgery.. This case emphasizes the importance of adequately dosed antibiotic therapy, also for unusual bacteria such as species of Aeromonas.

Topics: Aeromonas; Anti-Bacterial Agents; Carcinoma, Signet Ring Cell; Cefotaxime; Gram-Negative Bacterial Infections; Hematoma; Humans; Male; Metronidazole; Middle Aged; Postoperative Complications; Stomach Diseases; Stomach Neoplasms; Treatment Outcome

Myonecrosis due to Aeromonas spp is exceptional. We report the case of a diabetic patient with liver cirrhosis who developed a rapidly progressive myonecrosis by Aeromonas veronii biotype sobria. The portal of entry was an injury after falling down in an irrigation canal. The outcome was not favourable and surgical amputation of left leg was performed in spite of antibiotic treatment with cefotaxime and tobramicin. Aeromonas spp can be very aggressive and this microorganism should be considered in the differential diagnosis of skin and soft tissue infections with myonecrosis, specially after posttraumatic wound infections with a history of freshwater exposure.

Topics: Aeromonas; Aged, 80 and over; Anti-Bacterial Agents; Cefotaxime; Gram-Negative Bacterial Infections; Humans; Male; Muscular Diseases; Necrosis

Ventriculoperitoneal shunts were routinely used in the past in children with posterior fossa tumors and hydrocephalus. They can, however, cause a multitude of problems.. This report highlights a previously unencountered phenomenon of a pyogenic abscess forming within a posterior fossa ependymoma as a result of shunt infection. The shunt was exteriorized and the child treated with antibiotics before surgery was done. Only a partial excision of the tumor was possible, as the inflammatory response caused by the abscess had obliterated tissue planes.

Topics: Amikacin; Brain Abscess; Cefotaxime; Cerebellar Neoplasms; Child, Preschool; Combined Modality Therapy; Cranial Fossa, Posterior; Cranial Irradiation; Drug Therapy, Combination; Ependymoma; Gram-Negative Bacterial Infections; Humans; Hydrocephalus; Male; Neoplasm, Residual; Postoperative Complications; Prosthesis-Related Infections; Radiotherapy, Adjuvant; Skull Base Neoplasms; Ventriculoperitoneal Shunt

Gold-standard treatment of spontaneous bacterial peritonitis currently involves 3rd generation cephalosporins. To evaluate the efficacy of ofloxacin in this infection, we compared a combined therapy with intravenous and oral ofloxacin to intravenous cefotaxime.. Thirty cirrhotic patients with spontaneous bacterial peritonitis were assigned to receive either intravenous (1 g/12 h) cefotaxime for 7 days (n=17) or intravenous (200 mg/12 h) ofloxacin for 2 days followed by oral (200 mg/12 h) ofloxacin for 5 days (n=13). All cases had community-acquired spontaneous bacterial peritonitis.. The infection resolution rate on the 7th day of therapy was 82.4% in the cefotaxime group and 92.3% in the ofloxacin group. Hospital survival rates were 82.4% and 100%, respectively.. Oral ofloxacin after a short course of intravenous ofloxacin is effective in the treatment of uncomplicated spontaneous bacterial peritonitis. This regimen may allow physicians to treat these patients as outpatients as soon as their intravenous therapy is completed.

Topics: Adult; Aged; Analysis of Variance; Cefotaxime; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Follow-Up Studies; Gram-Negative Bacterial Infections; Gram-Positive Bacterial Infections; Humans; Liver Cirrhosis; Male; Middle Aged; Ofloxacin; Peritonitis; Probability; Prospective Studies; Severity of Illness Index; Statistics, Nonparametric; Treatment Outcome

Intrapartum antibiotic prophylaxis against group B Streptococcus (GBS) has reduced the occurrence of serious bacterial infections (SBI) in young infants caused by GBS. Recommendations for initial antibiotic therapy for the febrile infant 1 to 90 days old were developed when infections with GBS were common and antibiotic resistance was rare.. To document the pathogens responsible for SBI in recent years in febrile infants 1 to 90 days old and the antibiotic susceptibility of these organisms.. The results of bacterial cultures from infants 1 to 90 days old evaluated for fever at Primary Children's Medical Center in Salt Lake City, Utah, between July 1999 and April 2002 were analyzed. Antibiotic susceptibility profiles were collected and patient records were reviewed to determine if initial antibiotic therapy was changed following the identification of the organism.. Of 1298 febrile infants enrolled from the Primary Children's Medical Center emergency department, 105 (8%) had SBI. The mean age of the infants with SBI was 39 days (range 2-82 days) and 2 (2%) were <7 days. SBI included urinary tract infection (UTI; 67%), bacteremia (16%), bacteremia and UTI (6%), bacteremia and meningitis (5%), meningitis (2%), abscess (2%), meningitis and UTI (1%), and meningitis and gastroenteritis (1%). Eighty-three (79%) of 105 episodes of SBI were caused by Gram-negative bacteria, including 92% of UTI, 54% of bacteremia, and 44% of meningitis cases. The most common pathogen was Escherichia coli (61%). Other Gram-negative pathogens were responsible for 19% of SBI. Staphylococcus aureus was the most common Gram-positive pathogen, causing 8% of SBI. GBS accounted for 6% of SBI. Of the 105 pathogens, 56 (53%) were resistant to ampicillin. Of the pathogens causing meningitis, UTI, and bacteremia, 78%, 53%, and 50%, respectively, were resistant to ampicillin. Antibiotic therapy was changed in 54% of cases of SBI following identification of the organism.. In Utah, ampicillin-resistant Gram-negative bacteria are the most common cause of SBI in febrile infants <90 days old. This finding impacts antibiotic selection, especially in cases of meningitis. Local surveillance of pathogens and antibiotic susceptibility patterns is critical to determine appropriate antibiotic therapy.

Topics: Ampicillin Resistance; Bacteremia; Bacterial Infections; Cefotaxime; Drug Resistance, Bacterial; Fever; Gastroenteritis; Gentamicins; Gram-Negative Bacteria; Gram-Negative Bacterial Infections; Health Planning Guidelines; Health Status; Humans; Infant; Infant, Newborn; Meningitis; Microbial Sensitivity Tests; Urinary Tract Infections

Comamonas testosteroni, a lesser-known member of the genus, has shown little apparent capacity for causing infections in humans. We here present a case of purulent meningitis due to C. testosteroni, which occurred in a patient who had recurrent cholesteatoma. Ceftriaxone treatment was not effective in this patient even though in vitro the bacteria were susceptible to the drug. The patient responded well to meropenem therapy.

Topics: Anti-Bacterial Agents; Cefotaxime; Cholesteatoma; Comamonas testosteroni; Gram-Negative Bacterial Infections; Humans; Male; Meningitis, Bacterial; Meropenem; Middle Aged; Thienamycins

Aeromonas hydrophila, an uncommon human pathogen, can cause invasive infections in immunocompromised individuals. As the fluoroquinolones have been shown to be active in vitro against mesophilic aeromonads and clinical experience with the use of fluoroquinolones to treat aeromonads infections is limited, the antimicrobial activities of five selected drugs (ciprofloxacin, gatifloxacin, levofloxacin, lomefloxacin, and moxifloxacin) against A. hydrophila were studied in vitro and in mice. The MICs of the fluoroquinolones (except lomefloxacin), cefotaxime, and minocycline for 90% of 64 clinical isolates of A. hydrophila tested by the agar dilution method were

Topics: Aeromonas hydrophila; Animals; Anti-Bacterial Agents; Anti-Infective Agents; Aza Compounds; Cefotaxime; Ciprofloxacin; Fluoroquinolones; Gatifloxacin; Gram-Negative Bacterial Infections; Humans; In Vitro Techniques; Levofloxacin; Mice; Mice, Inbred BALB C; Microbial Sensitivity Tests; Minocycline; Moxifloxacin; Ofloxacin; Quinolines; Quinolones

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: Amoxicillin; Cefotaxime; Drug Resistance, Bacterial; Drug Therapy, Combination; Enterobacter; Enterobacteriaceae Infections; Escherichia coli; Escherichia coli Infections; Gram-Negative Bacteria; Gram-Negative Bacterial Infections; Humans; Infant, Newborn; Intensive Care Units, Neonatal; Length of Stay; Molecular Epidemiology; Penicillins; Risk Factors; Tobramycin

The activities of cefotaxime and minocycline against Aeromonas hydrophila were investigated. Cefotaxime (4 times the MIC) plus minocycline (0.75 times the MIC) elicited an inhibitory effect for 48 h in a time-kill study, and more infected mice treated with both drugs survived (91%) than survived after treatment with cefotaxime (9%) or minocycline (44%) alone, suggesting that cefotaxime and minocycline act synergistically against A. hydrophila.

Topics: Aeromonas hydrophila; Animals; Anti-Bacterial Agents; Cefotaxime; Cephalosporins; Drug Synergism; Drug Therapy, Combination; Gram-Negative Bacterial Infections; Kinetics; Mice; Microbial Sensitivity Tests; Minocycline; Survival Analysis

Eikenella corrodens is a gram-negative, facultative anaerobic rod that frequently exists as part of normal human flora in the upper respiratory tract and gastrointestinal tract. Recently, E. corrodens is reported as a rare causative agent of empyematic lesion. We report a case of 10-year-old girl with acute subdural abscess. She developed a high grade fever, swelling of the left periorbital area, right sided partial seizure and hemiplegia. Brain CT and MRI showed left parietal subdural abscess. Because intravenous antibiotic therapy was not effective enough and her neurological symptoms progressed, surgical drainage was performed in order to decompress the brain and to determine the causative agents. Through careful bacterial cultures, E. corrodens and Streptococcus constellatus were detected from the subdural abscess. After the drainage operation and a three week course of appropriate chemotherapy, the abscess completely disappeared and no sequela remained.

Topics: Acute Disease; Brain; Cefotaxime; Cephalosporins; Child; Eikenella corrodens; Empyema, Subdural; Female; Gram-Negative Bacterial Infections; Humans; Magnetic Resonance Imaging; Streptococcal Infections

The aim of this retrospective study was to evaluate the clinical efficacy in terms of mortality and long-term morbidity of third generation cephalosporins and amikacin in combination for the treatment of gram-negative bacterial meningitis in a homogeneous group of neonates. A 15-year experience (1983-1997) with 72 term neonates without central nervous system anomalies and with gram-negative organisms grown in their cerebrospinal fluid treated with the above combination of antibiotics is presented. All isolated organisms were sensitive to cefotaxime or ceftazidime and to amikacin but 80% were resistant to ampicillin. The predominant infecting organism was Escherichia coli (68.0%) which was sensitive to both cefotaxime and amikacin in all cases but resistant to ampicillin in 48% of cases. Survival at discharge was 97.2% but ultimate survival was reduced to 94.4%, as 2 patients died a few months following discharge of conditions unrelated to meningitis. Ventriculitis was diagnosed in 10 neonates (13.8%). Among survivors, 1 neonate (1.3%) developed hydrocephalus needing shunting and 1 neonate (1.3%) with Proteus mirabilis developed a brain abscess with relapse of meningitis which was successfully treated with a 6-week course of chloramphenicol. At follow-up at an age greater than 6 months, 91.1% of the surviving infants were normal, while 92.3% of survivors at an age greater than 6 years were normal and attended normal school. These results, despite any reservations due to the nature of the study (retrospective, uncontrolled study), strongly support the use of third generation cephalosporins and amikacin in combination for the treatment of neonatal gram-negative bacterial meningitis.

Topics: Amikacin; Anti-Bacterial Agents; Cefotaxime; Ceftazidime; Cephalosporin Resistance; Cephalosporins; Drug Therapy, Combination; Female; Gram-Negative Bacteria; Gram-Negative Bacterial Infections; Greece; Humans; Infant, Newborn; Male; Meningitis, Bacterial; Morbidity; Retrospective Studies

Fear of infection in neonatal intensive care units (NICUs) often leads to early use of empiric broad-spectrum antibiotics, a strategy that selects for resistant bacteria. We investigated whether the emergence of resistant strains could be halted by modifying the empiric antibiotic regimens to remove the selective pressure that favours resistant bacteria.. Two identical NICUs were assigned to different empiric antibiotic regimens. On unit A, penicillin G and tobramycin were used for early-onset septicaemia, flucloxacillin and tobramycin were used for late-onset septicaemia, and no broad-spectrum beta-lactam antibiotics, such as amoxicillin and cefotaxime were used. In unit B, intravenous amoxicillin with cefotaxime was the empiric therapy. After 6 months of the study the units exchanged regimens. Rectal and respiratory cultures were taken on a weekly basis.. There were 436 admissions, divided equally between the two regimens (218 in each). Three neonates treated with the penicillin-tobramycin regimen became colonised with bacilli resistant to the empirical therapy used versus 41 neonates on the amoxicillin-cefotaxime regimen (p<.0001). The relative risk for colonisation with strains resistant to the empirical therapy per 1000 patient days at risk was 18 times higher for the amoxicillin-cefotaxime regimen compared with the penicillin-tobramycin regimen (95% CI 5.6-58.0). Enterobacter cloacae was the predominant bacillus in neonates on the amoxicillin-cefotaxime regimen, whereas Escherichia coli predominated in neonates on the penicillin-tobramycin regimen. These colonisation patterns were also seen when the units exchanged regimens.. Policies regarding the empiric use of antibiotics do matter in the control of antimicrobial resistance. A regimen avoiding amoxicillin and cefotaxime restricts the resistance problem.

Topics: Amoxicillin; Cefotaxime; Cephalosporins; Cross-Sectional Studies; Drug Resistance, Microbial; Gram-Negative Bacteria; Gram-Negative Bacterial Infections; Humans; Infant, Newborn; Intensive Care Units, Neonatal; Organizational Policy; Penicillins; Prospective Studies; Sepsis

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

Topics: Alcaligenes; Cefotaxime; Cephalosporins; Female; Gentamicins; Gram-Negative Bacterial Infections; Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Meningitis, Bacterial; Respiratory Distress Syndrome, Newborn

Topics: Bacteremia; Cefotaxime; Cephalosporins; Female; Gram-Negative Bacteria; Gram-Negative Bacterial Infections; Humans; Immunocompetence; Infant

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

To highlight an unusual organism causing a unilateral endophthalmitis by transplacental spread.. We report a case of Plesiomonas shigelloides endophthalmitis, presenting in a newborn, with co-existing septicaemia and meningitis. There was a significant maternal history of diarrhoea associated with the ingestion of oysters 2 weeks prior to delivery.. The endophthalmitis was treated with parenteral antibiotics and topical mydriatics with complete resolution, although subsequent assessment of the affected eye suggests a poor visual outcome.. Endophthalmitis in the newborn is an unusual clinical finding and usually presents with other manifestations of bacteraemia. Plesiomonas shigelloides is fortunately an infrequent cause of neonatal infection, but is associated with a high degree of morbidity and mortality. We postulate that this neonate acquired P. shigelloides via the transplacental route, and suggest that this organism be included in the list of 'other' causes of transplacental infection that has been abbreviated to 'O' in the acronym 'TORCH'.

Topics: Animals; Bacteremia; Cefotaxime; Cephalosporins; Cyclopentolate; Endophthalmitis; Eye Infections, Bacterial; Female; Food Microbiology; Gram-Negative Bacterial Infections; Humans; Infant, Newborn; Male; Maternal-Fetal Exchange; Meningitis, Bacterial; Mydriatics; Ostreidae; Plesiomonas; Pregnancy; Pregnancy Complications, Infectious

Of the 43 Aeromonas spp. isolated from various clinical samples 94% isolates were Beta-lactamase producers. The isolates were tested for sensitivity by disc diffusion method which is commonly used in Pakistan. MIC was determined by using Epsilometer test (E-test) method. More than 80% isolates were sensitive to cephalosporins and quinolones. However, resistance to commonly used antibiotics was very high, 94% isolates were resistant to ampicillin which corresponds to the betalactamase production. More than 60% of the isolates were resistant to cotrimoxazole and 40% to chloramphenicol, hence quinolones and cephalosporins appear to be the drugs of choice for treating serious Aeromonas infections. The MIC range of Aeromonas was best for cefotaxime < 0.06 - 1.0 ug/ml. MIC 90 for cefotaxime was 0.50 ug/ml, for imipenem 0.25 ug/ml and for ciprofloxacin 2.0 ug/ml.

Topics: Aeromonas; Ampicillin Resistance; Anti-Bacterial Agents; beta-Lactamases; Cefotaxime; Cephalosporins; Chloramphenicol; Ciprofloxacin; Drug Resistance, Microbial; Gram-Negative Bacterial Infections; Humans; Imipenem; Microbial Sensitivity Tests; Pakistan; Thienamycins; Trimethoprim, Sulfamethoxazole Drug Combination

To investigate the distribution and drug-resistance of gram-negative bacilli in respiratory ward.. (1) Drug-resistance was tested by Kirby-Bauer disk sensitivity method and MIC by agar doubling dilution. (2) beta-lactanase was tested by nitrocephin. (3) ESBLs was tested by E test.. (1) Among 345 strains gram-negative bacillus, klebsiella pneumoniae and pseudomonas aeruginoea was about 39.7%, 17.4%, respectively. (2) Drug-resistance rate of cefotaxime dropped from 42.9% (6 years ago) to 8.2%. (3) beta-lactamase positive rate of 345 strains bacilli was 54.5%. (4) ESBLs was negative.. (1) Klebsiella pneumoniae and pseudomonas aerugries were the main pathogens in lower respiratory tract infection in hospital. (2) Although we didn't find the evidence of ESBLs, we should pay more attention to it in the future.

Topics: Bronchiectasis; Cefotaxime; Cephalosporins; Drug Resistance, Microbial; Gram-Negative Bacteria; Gram-Negative Bacterial Infections; Humans; Klebsiella pneumoniae; Lung Diseases, Obstructive; Pseudomonas aeruginosa; Respiratory Tract Infections

Topics: Adult; AIDS-Related Opportunistic Infections; Ampicillin; Cefotaxime; Ciprofloxacin; Drug Therapy, Combination; Endocarditis, Bacterial; Gentamicins; Gram-Negative Bacterial Infections; Heart Valve Prosthesis; Humans; Male; Prosthesis-Related Infections

Topics: Aeromonas hydrophila; Bacteremia; Cefotaxime; Cephalosporins; Chronic Disease; Female; Gram-Negative Bacterial Infections; Humans; Liver Cirrhosis; Middle Aged; Peritonitis

Capnocytophaga sp. is a gram-negative bacilli, scarcely documented as the cause of bacteremias. Two cases of bacteremia caused by Capnocytophaga sp, one of them with endocarditis, are reported here. A review of previous published cases is also presented. One of the patients was immunocompromised, because of chemotherapy, the other, suffered from a rheumatic-cardiopathy which was complicated with endocarditis. Both patients developed an alteration of the oral mucosa. Antibiotic therapy proved to be effective with two patients.

Topics: Adult; Aged; Amikacin; Anti-Bacterial Agents; Bacteremia; Capnocytophaga; Cefotaxime; Ceftazidime; Cephalosporins; Endocarditis, Bacterial; Female; Gram-Negative Bacterial Infections; Humans; Male

Spontaneous bacterial peritonitis is a well known complication in cirrhotic patients with ascites. The etiological spectrum is broad. We report a case of spontaneous bacterial peritonitis due to Plesiomonas shigelloides.

Topics: Cefotaxime; Gram-Negative Bacterial Infections; Humans; Liver Cirrhosis, Alcoholic; Male; Middle Aged; Peritonitis; Plesiomonas

Topics: Animals; Anti-Bacterial Agents; Cefotaxime; Ceftazidime; Cephalosporins; Gram-Negative Bacteria; Gram-Negative Bacterial Infections; Gram-Positive Bacteria; Gram-Positive Bacterial Infections; Male; Mice; Mice, Inbred ICR; Microbial Sensitivity Tests

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

A case of cellulitis of the leg caused by Aeromonas hydrophila in a cirrhotic patient is reported. The starting point of the infection could not be determined with certainty, but a direct local inoculation during foot-baths was suspected. Because of clinical signs suggestive of erysipelas, the disease was initially treated without success with penicillin G, which raises questions concerning the choice of the initial antibiotic therapy for cellulitis of the leg in immunocompromised patients, pending the bacteriological results. A purely medical treatment (adequate antibiotic therapy) resulted in complete cure of this patient, despite the fact that his lesions were necrotizing.

Topics: Aeromonas hydrophila; Aged; Cefotaxime; Cellulitis; Drug Therapy, Combination; Gram-Negative Bacterial Infections; Humans; Leg Dermatoses; Male; Netilmicin

A case is reported of splenic abscess due to Eikenella corrodens, a gram-negative rod which is found as part of normal flora in human mucous surfaces. A 64-year-old man presented with fever, chills, anorexia and abdominal pain. Abdominal ultrasound examination showed a perisplenic fluid collection which was considered to be either blood or a subcapsular spleen abscess. The presence of a splenic abscess was later confirmed during surgery and a splenectomy was performed. Splenic purulent material and blood cultures yielded Eikenella corrodens. The patient received cefotaxime for 19 days and was discharged asymptomatic.

Topics: Abscess; Cefotaxime; Eikenella corrodens; Gram-Negative Bacterial Infections; Humans; Male; Middle Aged; Spleen; Splenectomy; Splenic Diseases

Increasing use of medicinal leeches has been accompanied by increasing numbers of reports of Aeromonas hydrophila infections after leech application on or near damaged tissue. We examined the enteric contents of postprandial leeches after their application to patients receiving antibiotics. We found measurable levels of antibiotic in the leech enteric contents, and in leeches applied to patients receiving an antibiotic effective against Aeromonas hydrophila, there was a significant decrease in positive Aeromonas enteric cultures. Suppression of leech enteric bacteria by antibiotic administration to the patient may be an effective strategy to prevent invasive infection by Aeromonas hydrophila as well as bacterial colonization of devitalized tissue that could be the source of late infection. Clinical studies will be required to clarify whether suppression of leech enteric flora results in a decrease in infections associated with leech use.

Topics: Aeromonas hydrophila; Animals; Cefazolin; Cefotaxime; Fingers; Gram-Negative Bacterial Infections; Humans; Leeches; Premedication; Replantation; Surgical Wound Infection

Topics: Cefotaxime; Cephalothin; Gram-Negative Bacteria; Gram-Negative Bacterial Infections; Gram-Positive Bacteria; Gram-Positive Bacterial Infections; Humans; Microbial Sensitivity Tests