cefotaxime and Infant--Premature--Diseases

Haemophilus parainfluenzae is an unusual causative organism of invasive bacterial infection in adults and children. Mortality and morbidity secondary to Haemophilus parainfluenzae have been documented in the literature. We present a rare case of a premature infant with early onset sepsis caused by Haemophilus parainfluenzae, who was born to a primigravida with chorioamnionitis. The infant was successfully treated for 10 days with antibiotics with no complications.

Topics: Anti-Bacterial Agents; Cefotaxime; Chorioamnionitis; Drugs, Chinese Herbal; Female; Haemophilus Infections; Haemophilus parainfluenzae; Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Neonatal Sepsis; Pregnancy

Neonatal infection due to Haemophilus influenzae has several clinical similarities to infection by the more common Streptococcus agalactiae (Strep group B). A high frequency of H. influenzae biotype IV in association with genital, maternal and neonatal infections has been reported in the literature, suggesting this biotype has an affinity for the female genital tract. Cefotaxime should be considered as part of the treatment regimen when this organism is suspected because of the emerging resistance of H. influenzae to ampicillin. We present a case of H. influenzae biotype IV infection in a premature (32 weeks) neonate.

Topics: Adolescent; Ampicillin Resistance; Bacterial Typing Techniques; Cefotaxime; Female; Haemophilus Infections; Haemophilus influenzae; Humans; Infant, Newborn; Infant, Premature, Diseases; Pregnancy; Pregnancy Complications, Infectious

Seventeen neonates with clinical signs of infection who would otherwise have received gentamicin with penicillin were treated with cefotaxime (50 mg/kg bd) for a period of 5 days. One hundred eleven bacteriological cultures were collected and those from 6/17 neonates yielded pathogenic or potentially pathogenic bacteria. Biochemical investigations undertaken before, during, and after the treatment revealed no adverse effects on renal or hepatic function associated with cefotaxime therapy. In addition to manual methods, a computer program was used to determine six pharmacokinetic variables. The mean peak serum level was 87.4 +/- 36.2 mg/liter, the mean trough level 8.0 +/- 6.9 mg/liter and the serum half life 3.1 +/- 0.8 hours. All the neonates showed clinical improvement following cefotaxime treatment with no adverse clinical signs and were discharged well from hospital. It is concluded that cefotaxime may be safely used in neonates and is a suitable alternative to gentamicin and penicillin for primary treatment in units that do not have a persistent and serious problem with infections due to Pseudomonas aeruginosa.

Topics: Bacterial Infections; Cefotaxime; Clinical Trials as Topic; Female; Humans; Infant, Low Birth Weight; Infant, Newborn; Infant, Premature, Diseases; Kinetics; Male; Time Factors

Topics: Acidosis; Acidosis, Respiratory; Ampicillin; Anti-Bacterial Agents; Blood Gas Analysis; Bradycardia; Cardiopulmonary Resuscitation; Cefotaxime; Diagnosis, Differential; Exanthema; Fatal Outcome; Female; Fluid Therapy; Gentamicins; High-Frequency Ventilation; Humans; Hypotension; Infant, Low Birth Weight; Infant, Newborn; Infant, Premature, Diseases; Infectious Disease Transmission, Vertical; Listeriosis; Pallor; Pneumothorax

A preterm infant with early onset Morganella morganii sepsis was treated with cefotaxime and gentamicin after confirmation of antimicrobial susceptibility. The infant developed persistent ventriculitis caused by the emergence of a cefotaxime-resistant Morganella variant with derepression of its AmpC beta-lactamase. When choosing antibiotic therapy, the risk of development of resistance to cephalosporins should be considered in infections caused by M. morganii and other Gram-negative organisms with inducible AmpC beta-lactamases.

Topics: Bacteremia; Bacterial Proteins; beta-Lactamases; Cefotaxime; Cephalosporin Resistance; Enterobacteriaceae Infections; Female; Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Meningitis, Bacterial; Microbial Sensitivity Tests; Morganella morganii

Topics: Anti-Bacterial Agents; Cataract; Cefotaxime; Endophthalmitis; Eye Infections, Bacterial; Female; Gestational Age; Humans; Infant, Newborn; Infant, Premature, Diseases; Infant, Very Low Birth Weight; Klebsiella Infections; Klebsiella pneumoniae; Ultrasonography

Neonatal listeriosis is an exceptional disease in Northern Africa. Hence, protocols for maternal-fetal infection treatment include only a third generation cephalosporin and an aminoside. This protocol does not take into account the possibility of Listeria monocytogenes infection. We report a fatal case of neonatal listeriosis in Tunisia. The use of first antibiotics in maternal-foetal infection must be reconsidered when lacking sufficient bacteriological data and include systematically ampicillin in presumptive antibiotic protocols.

Topics: Adult; Amikacin; Ampicillin; Anti-Bacterial Agents; Cefotaxime; Cephalosporins; Clinical Protocols; Fatal Outcome; Female; Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Listeriosis; Male; Penicillins; Respiratory Distress Syndrome, Newborn

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

In this communication, we describe the occurrence of strains of Klebsiella pneumoniae resistant to cephalosporins of all generations and to aztreonam due to their production of Extended Spectrum beta-Lactamases (ESBLs), in two hospitals in Slovakia. They were found to transfer the genetic determinants of resistance of cefotaxime, ceftazidime and aztreonam and of ESBL production to suitable recipient strains of Escherichia coli K-12 No. 3110 and Proteus mirabilis P-38. Six donor K. pneumoniae strains were collected from six prematurely born babies gradually infected with strains of K. pneumoniae resistant to cefotaxime, ceftazidime and aztreonam. All six strains of K. pneumoniae gave an identical pattern in ESBL testing (double-disk diffusion test). The second cycle of transfers to nalidixin-resistant E. coli K-12 No. 185 nal+ also confirmed that all transconjugants were resistant to all beta-lactams tested. We conclude that a single gene was transferred from donor strains which confers 'en bloc' the resistance to the beta-lactams tested. Four strains of K. pneumoniae produced a uniform type of ESBI. Although with different quantitative expression. All transconjugants tested produced identical types of ESBL as did the donor strains of K. pneumoniae. This transfer of an identical pattern of ESBL production was confirmed also in the second cycle of transfers. Cefotaxime, ceftazidime and aztreonam were actively hydrolysed (as shown by the relative rate of hydrolysis [Vmax]) by strains of K. pneumoniae as well as by transconjugant colonies and clavulanate inhibited the hydrolysis of these beta-lactam antibiotics.

Topics: Aztreonam; beta-Lactam Resistance; beta-Lactamases; Cefotaxime; Ceftazidime; Cephalosporin Resistance; Cephalosporins; Conjugation, Genetic; Drug Resistance, Multiple; Escherichia coli; Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Klebsiella Infections; Klebsiella pneumoniae; Microbial Sensitivity Tests; Monobactams; Proteus mirabilis

While there are concerns about the consequences of widespread use of quinolones, there are few reports of quinolone-resistant strains of Salmonella typhi or Salmonella paratyphi from the Indian subcontinent. We present a case report of a newborn with meningitis due to a quinolone-resistant strain of S. paratyphi B presenting to the Aga Khan University Hospital (AKUH).

Topics: Amikacin; Anti-Bacterial Agents; Anti-Infective Agents; Brain Abscess; Cefotaxime; Cephalosporins; Ciprofloxacin; Drug Resistance, Multiple; Drug Therapy, Combination; Female; Histocytochemistry; Humans; Imipenem; Infant, Newborn; Infant, Premature, Diseases; Meningitis, Bacterial; Microbial Sensitivity Tests; Paratyphoid Fever; Salmonella paratyphi B; Thienamycins; Tomography, X-Ray Computed

In-vitro and clinical efficacy of a combination therapy consisting of 3 antibiotic agents was to be assessed in neonatal septicemia.. From 1980 to 1987, 152 newborns with septicemia as proven by blood culture were treated with an initial antibiotic regimen consisting of azlocillin (150 mg/kg bw), cefotaxime (100 mg/kg bw), and tobramycin (5 mg/kg bw).. According to the microbiologic testing, antimicrobic therapy was effective in each of the 152 organisms: 101/152 bacteria were susceptible to all 3 agents; resistance to 1 or 2 of the antibiotics was evident in 33/152 and in 18/152 organisms, respectively. Mortality due to septicemia was 7.2%.. As no difference was observed in the frequency in which one of the three antibiotic substances was the only effective drug, each of the 3 agents seemed to be necessary for clinical effectiveness of this antibiotic combination.

Topics: Azlocillin; Bacteriological Techniques; Cefotaxime; Dose-Response Relationship, Drug; Drug Therapy, Combination; Female; Humans; Infant, Newborn; Infant, Premature, Diseases; Male; Microbial Sensitivity Tests; Risk Factors; Sepsis; Staphylococcal Infections; Streptococcal Infections; Streptococcus agalactiae; Tobramycin

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 21 low birth weight infants with two regimens of antibiotic therapy during the first 3 days of life possible hepatotoxic side effects were studied 8 days after the last administration of the tested drugs. Fourteen of the infants were treated with ampicillin/gentamicin and 7 received cefotaxime/gentamicin. The serum concentrations of total bile acids, the activities of transaminases in serum and the cumulative 15N excretion in urine after administration of 3 mg of 15N-labeled methacetin/kg of body weight were used as markers of hepatotoxic side effects. Neither the concentrations of total bile acids (22.6 +/- 12.1 and 19.4 +/- 10.8 mM, respectively) nor the activities of transaminases (alanine aminotransferase, 0.27 +/- 0.06 vs. 0.30 +/- 0.09 mumol/second/liter; aspartate aminotransferase, 0.46 +/- 0.11 vs. 0.49 +/- 0.10 mumol/second/liter) were different between the two groups. In contrast the cumulative 15N excretion in urine was significantly lower in the group treated with cefotaxime/gentamicin than in the group treated with ampicillin/gentamicin (17.2 +/- 6.4 vs. 33.0 +/- 5.1% of intake; P less than 0.01) and also lower than the reported age-related reference values. On the 28th day of life no differences could be found between the cumulative 15N excretion in the urine of the infants treated with cefotaxime/gentamicin and the reported age-related reference values of this test. The results indicate a limited capacity of the monooxygenase system of the liver of low birth weight infants during the first weeks of life and a specific reversible influence of cefotaxime on this hepatocellular system. Further investigations are required to evaluate the clinical relevance of this drug-specific inhibition of the hepatic monooxygenase pathway.

Topics: Acetamides; Ampicillin; Bile Acids and Salts; Bilirubin; Cefotaxime; Drug Therapy, Combination; Female; Gentamicins; Humans; Infant, Low Birth Weight; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Liver; Male; Nitrogen; Prospective Studies; Sepsis; Transaminases

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

Topics: Bacteroides fragilis; Bacteroides Infections; Cefotaxime; Drug Therapy, Combination; Female; Humans; Infant, Newborn; Infant, Premature, Diseases; Meningitis; Metronidazole

Satisfactory efficacy of cefotaxime in treatment of premature infants with pneumonia during the first month of their life was shown. Dosing of the drug was studied. It was noted that the filtration function of the kidneys in the newborn premature infants influenced the blood levels of cefotaxime and its renal excretion.

Topics: Cefotaxime; Creatinine; Dose-Response Relationship, Drug; Drug Evaluation; Female; Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Kinetics; Male; Pneumonia; Time Factors

A 33-week-gestation infant with respiratory distress syndrome is reported. At five days of age, acute life-threatening tracheal obstruction occurred, which was relieved after removal of a plug during bronchoscopy. Histologic examination of the plug revealed partially necrotic tracheal mucosa, compatible with the diagnosis of necrotizing tracheobronchitis. At 31 days of age, obstruction recurred due to the development of a tracheal stricture, which resolved after tracheal reintubation (to maintain patency) and corticosteroid therapy. Tracheal stricture may be a long-term complication of necrotizing tracheobronchitis, when the initial episode does not lead to death from obstruction.

Topics: Bronchitis; Cefotaxime; Dexamethasone; Drug Therapy, Combination; Female; Humans; Infant, Newborn; Infant, Premature, Diseases; Intubation, Intratracheal; Necrosis; Respiratory Distress Syndrome, Newborn; Tracheitis

On the occasion of clinically indicated lumbar of cisternal punctures in 19 newborn and premature babies treated with Cefotaxime 33 CSF-levels of Cefotaxime (CTX) and it's metabolite Desacetyl-Cefotaxime (D-CTX) were measured by means of HPLC. 6 of the 19 infants suffered from meningitis. The highest CTX-levels were found 2 to 4 hours after the last infusion of CTX (50 or 100 mg/kg within 20 min, each 12 hours). Patients with meningitis showed CTX-levels between 20 mg/l and less than 0.5 mg/l (limit of detection), those without meningitis between 11 mg/l and less than 0.5 mg/l. Because of the widely scattered CTX-levels any dependence from CTX-dosage or from degree of meningeal inflammation is not to be shown. With two exceptions D-CTX-levels ranged from 2 to 20 mg/l. Up to 9 1/2 hours after the last CTX-dose no clear decrease of the D-CTX-concentration in CSF may be seen. On the other hand, D-CTX-levels are also widely scattered. Nevertheless D-CTX apparently stays significantly longer in the CSF than CTX does. An influence of meningeal inflammation on the D-CTX-levels can not be observed. In E. coli- and in Klebsiella-spp. The geometrical means of MIC are found to range below 0.5 mg/l for CTX and below 2 mg/l for D-CTX. Therefore CTX might be recommended for treatment of meningitis caused by these germs. This recommendation may be supported by some reports about good clinical results, from our unit and from the literature as well.

Topics: Bacterial Infections; Cefotaxime; Chromatography, High Pressure Liquid; Humans; Infant, Newborn; Infant, Premature, Diseases; Meningitis

Bacterial infections are frequent events in premature and newborn infants. The reason is a defective specific and nonspecific defence of bacterial organisms. Some immunoglobulins like IgM and IgA including secretory IgA are absent. Premature infants also show a decreased level of IgG. Cellular immunity is anatomically intact but functionally defective. A number of complement factors are lacking, the activation of the alternative pathway is impaired. Newborn infants with perinatal problems like asphyxia or difficult delivery, show defects of leucocyte function like decreased deformability, defective chemotaxis and defective killing of ingested bacteria. Certain diseases, like hypoxia and malformations of immature organ functions in this age group (decreased acid production in the stomach), facilitate bacterial colonization of surface epithelia and the invasion of tissues. Consequences of these pathogenetic mechanisms are an unimpaired propagation of bacterial organisms into the blood and meninges without localization of the infecting organisms at the entry site. Bacterial meningitis is not considered a separate disease entity but a complication of bacteremia and sepsis. Clinical symptoms are nonspecific at the onset of the infection. Fever is frequently absent; decreased appetite, vomiting, a bloated abdomen, diarrhea, tachycardia, tachypnea are early signs of a bacterial infection, a grey mottled appearance, cyanosis, jaundice, petechiae, apneic spells, seizure activity and a metabolic acidosis are symptoms of advanced infection. Successful treatment at this stage is often not possible. Every sign of a decreased well being of a newborn of premature infant warrants laboratory and bacteriologic work up for septicemia.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Aminoglycosides; Anti-Bacterial Agents; Bacterial Infections; Cefotaxime; Cephalosporins; Clindamycin; Drug Therapy, Combination; Enterobacteriaceae Infections; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature; Infant, Premature, Diseases; Meningitis; Metronidazole; Penicillin G; Pseudomonas Infections; Streptococcal Infections

Cefotaxime (CTX) was used in the treatment and prophylaxis of infections in neonates and immature infants. The following results were obtained. 1. Mean serum concentrations (bioassay) 30 minutes after a single intravenous injection of about 20 mg/kg of CTX were 44.5 mcg/ml in neonates and 47.2 mcg/ml in immature infants aged 0-3 days, 45.8 mcg/ml in neonates and 56.4 mcg/ml in an immature infant aged 4-7 days and 40.6 mcg/ml in neonates and 38.1 mcg/ml in immature infants aged 8 or more days. Six hour values were respectively 10.9 mcg/ml, 17.0 mcg/ml, 4.6 mcg/ml, 13.4 mcg/ml, 3.8 mcg/ml and 2.7 mcg/ml. 2. Mean serum concentration half-lives were 3.0 hours in neonates and 3.2 hours in immature infants aged 0-3 days, 1.8 hours in neonates and 3.2 hours in an immature infant aged 4-7 days, and 1.5 hours in neonates and 1.6 hours in immature infants aged 8 or more days. 3. Urinary recovery rates were 0.8-78.0% for 0-6 hours after treatment. 4. Adequate clinical efficacy can be expected by the intravenous injection of CTX in doses of 20 mg/kg 2 times daily, every 12 hours, in neonates and immature infants aged 0-3 days, 20 mg/kg 3 times daily, every 8 hours, in neonates and immature infants aged 4-7 days, and 20 mg/kg 3 to 4 times daily, every 6-8 hours, in neonates and immature infants aged 8 or more days. 5. The clinical efficacy of CTX was good in all 4 cases of sepsis (including suspected case), excellent in 1 case of urinary tract infection, and good in all 4 cases of fever of unknown origin for a cure rate of 100%. 6. Adverse reactions were not noted in any cases.

Topics: Bacterial Infections; Cefotaxime; Drug Evaluation; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature, Diseases; Injections, Intravenous; Male; Premedication

Topics: Age Factors; Bacterial Infections; Cefotaxime; Drug Evaluation; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature, Diseases; Infusions, Parenteral; Injections, Intravenous; Male

Topics: Bacterial Infections; Cefotaxime; Drug Evaluation; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature, Diseases; Male

A strain of Listeria monocytogenes isolated from a case of early onset, generalized, fatal, perinatal listeriosis in a premature infant was found to be tolerant for ampicillin and resistant against cefotaxime. A laboratory control strain of L. monocytogenes and Staphylococcus aureus control strain ATCC 25923 proved tolerant for both beta-lactam antibiotics, respectively. The combinations of ampicillin with gentamicin and cefotaxime with gentamicin resulted in additive bactericidal activity against both strains of L. monocytogenes. Based on these findings and those of the literature, it is suggested that cases of systemic listeriosis be treated with a combination of a beta-lactam antibiotic, preferably ampicillin, with an appropriate aminoglycoside, such as gentamicin.

Topics: Ampicillin; Cefotaxime; Drug Combinations; Gentamicins; Humans; Infant, Newborn; Infant, Premature, Diseases; Listeria monocytogenes; Listeriosis; Microbial Sensitivity Tests; Penicillin Resistance