cefotaxime and Streptococcal-Infections

Group A streptococcus is an uncommon cause of meningitis in children. We report a single case of Group A streptococcus meningitis, in an apparently healthy 6-week-old infant. Twenty-five cases in the English-language literature in the last 25 years and our case are reviewed. The commonest associated illness was otitis media. Of the 25 patients, 24 survived. Antibiotic therapy, which consisted of penicillin in the majority of patients, was effective. Ceftriaxone was an alternative agent. Neurological sequelae were not uncommon. This report emphasizes the fact that Group A streptococcus can cause meningitis in healthy children without apparent recognizable foci of infection.

Topics: Amoxicillin; Anti-Bacterial Agents; Cefotaxime; Dexamethasone; Drug Therapy, Combination; Female; Humans; Infant; Infusions, Intravenous; Meningitis, Bacterial; Penicillins; Streptococcal Infections; Streptococcus pyogenes; Treatment Outcome

A case of meningitis caused by Streptococcus Equisimilis and cerebrospinal fluid rhinorrhea, in which the head trauma occurred 16 years before, is presented. To the best of the author's knowledge this is the first case reported with such characteristics. Several precipitating factors could be responsible for the unusually late reopening of the fistula Streptococci equisimilis is an uncommon cause of the bacteremia. An appropriate antimicrobrial therapy against S. Equisimilis followed by surgical dural repair were performed.

Topics: Brain Injuries; Cefotaxime; Cerebrospinal Fluid Rhinorrhea; Drug Therapy, Combination; Frontal Lobe; Humans; Magnetic Resonance Imaging; Male; Meningitis, Bacterial; Middle Aged; Neurosurgical Procedures; Sphenoid Sinus; Streptococcal Infections; Streptococcus; Time Factors; Tomography, X-Ray Computed; Vancomycin

Group C streptococci are a common cause of epidemic bacterial infection in animals. These organisms are a rare but frequently fatal cause of meningitis in humans. We report the case of a 13-year-old girl with meningitis caused by a group C Streptococcus (Streptococcus zooepidemicus) successfully treated with vancomycin and third generation cephalosporins. We also review cases of group C streptococcal meningitis reported previously.

Topics: Adolescent; Anti-Bacterial Agents; Cefotaxime; Cephalosporins; Drug Therapy, Combination; Female; Humans; Meningitis, Bacterial; Streptococcal Infections; Streptococcus equi; Vancomycin

A case of group A streptococcal meningitis is reported and the 51 cases reported in the literature since 1966 reviewed. A total of 24 men and 24 women were included in the study; the mean age (+/-SD) was 20.9+/-25.5 years. Fifty-eight percent of the patients had comorbid conditions, 80% had a distant focus of infection, and 65.8% had blood cultures positive for group A streptococci. Seventy-five per cent of the patients were treated with penicillin. The overall case-fatality rate was 12% (6 patients). Sequelae were more prevalent among children (44%) than among adults (7.7%) (OR=9.43; 95% CI, 1.02-438.95; P=0.03). Group A streptococcus is a rare cause of pyogenic meningitis, affecting mainly children or adults with comorbidity. Although the case-fatality rate is relatively low, neurological sequelae are frequent among survivors, especially children.

Topics: Adult; Aged; Cefotaxime; Cephalosporins; Female; Follow-Up Studies; Humans; Male; Meningitis, Bacterial; Streptococcal Infections; Streptococcus pyogenes; Treatment Outcome

Topics: Amikacin; Anesthesia, General; Anti-Bacterial Agents; Cefotaxime; Cephalosporins; Child, Preschool; Drug Therapy, Combination; Female; Humans; Infant; Male; Retropharyngeal Abscess; Streptococcal Infections; Suction

In an open, controlled, randomized multicenter study, 160 children suffering from pharyngitis and/or tonsillitis were treated with either 8 mg cefixime/kg body weight once daily for 5 days or 20,000 I.U. penicillin V/kg body weight t.i.d. for 10 days. One hundred fifty-one children were evaluable for clinical efficacy. In the cefixime group, 65 (86.7%) children were cured, seven (9.3%) were significantly improved, one (1.3%) relapsed and in two (2.7%) therapy failed. Of the patients treated with penicillin V, 69 (90.8%) were cured, five (6.6%) improved, one (1.3%) relapsed and in one (1.3%) therapy failed. Elimination of initial pathogens occurred in 57 (82.6%) patients treated with cefixime and in 60 (88.2%) treated with penicillin V. At 3 to 4 weeks after the end of treatment, six relapses were seen in the cefixime group and eight in the penicillin V group. Mild-to-moderate adverse events that were possible related to the medication were seen in four children treated with cefixime and in five treated with penicillin V.

Topics: Cefixime; Cefotaxime; Cephalosporins; Child; Child, Preschool; Female; Humans; Infant; Male; Penicillin V; Penicillins; Pharyngitis; Streptococcal Infections; Tonsillitis

Therapy to eradicate pharyngeally carried group A streptococci (GAS) has increasingly been used in the management of institutional outbreaks and is now recommended for household contacts of patients with streptococcal toxic shock syndrome. In this randomized, controlled trial, contacts of patients with GAS infections were screened for pharyngeal GAS colonization. Those whose cultures were positive were randomized to receive either cefixime (8 mg/[kg.d]; maximum 400 mg) or rifampin (20 mg/kg; maximum, 600 mg) once a day for 4 days. Two to five days following completion of therapy, repeated cultures were negative for 13 (38%) of 34 rifampin recipients and 71 (77%; 95% CI, 69%-85%) of 97 cefixime recipients. At 10-14 days after treatment, only 53% of cefixime recipients remained culture-negative. Rates of successful clearance improved with increasing age (P < .01); among 17 adults who received cefixime, the success rate was 94%. Four days of therapy with rifampin is not effective for eradication of pharyngeally carried GAS. Four days of therapy with cefixime may be effective for adults, but further studies are needed.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Cefixime; Cefotaxime; Child; Drug Administration Schedule; Humans; Pharyngitis; Rifampin; Streptococcal Infections; Streptococcus pyogenes

An open label randomized trial conducted in rural Kentucky compared the efficacy and safety of cefixime (CFX), 8 mg/kg once daily, with those of penicillin V (PEN), 250 mg 3 times daily, in 110 pediatric patients with Group A beta-hemolytic streptococcal pharyngitis. Forty-eight CFX and 47 PEN patients were evaluable for efficacy. At the end of therapy bacteriologic eradication was 45 of 48 (94%) and 36 of 47 (77%) in the CFX and PEN V groups, respectively (P < 0.05). Up to 6 weeks posttherapy 10 (21%) CFX patients and 21 (45%) PEN patients had positive Group A beta-hemolytic Streptococcus cultures (P < 0.05). Concordant serotypes were identified from 4 of 7 CFX and 15 of 17 PEN patients with positive repeat cultures. All discordant serotypes (5 of 31) were identified at greater than 19 days posttherapy. Symptomatic treatment failures (concordant serotypes) occurred in 1 (2%) CFX and 8 (17%) PEN patients (P < 0.05). Drug-related adverse experiences consisted of 2 cases of mild diarrhea and loose stools in the CFX group and none in the PEN group. No clinically significant laboratory test abnormalities occurred in either group. CFX, once daily, was as safe as and significantly more effective than PEN given 3 times daily for the treatment of Group A beta-hemolytic streptococcal pharyngitis.

Topics: Adolescent; Cefixime; Cefotaxime; Child; Child, Preschool; Female; Humans; Male; Penicillin V; Pharyngitis; Streptococcal Infections; Streptococcus pyogenes

Seventy-nine children were enrolled in a study to compare seven vs ten days of ceftriaxone therapy for bacterial meningitis. On the basis of a computer-generated list of therapy assignments, 35 children with Haemophilus, pneumococcal, or group B streptococcal meningitis each were assigned to seven- or ten-day treatment regimens; nine children with meningococcal meningitis received seven days of therapy. The population characteristics and etiologic agents were similar for the two treatment groups, as were also the findings on examination and culture of cerebrospinal fluid at completion of therapy. There were no significant differences in the frequency and types of neurological complications between the two treatment groups; four patients in each group had two or more neurological abnormalities. The rates of nosocomial infections and prolonged and secondary fever were similar in those who received seven days of therapy compared with patients treated for the conventional ten days. Diarrhea occurred in 44% of those receiving the drug. Patients treated with the seven-day regimen were discharged from the hospital approximately two days earlier than those with the ten-day regimen.

Topics: Bacterial Infections; Cefotaxime; Ceftriaxone; Child, Preschool; Female; Humans; Infant; Male; Meningitis; Meningitis, Haemophilus; Meningitis, Meningococcal; Streptococcal Infections; Streptococcus agalactiae

Topics: Cefotaxime; Ceftriaxone; Clinical Trials as Topic; Endocarditis, Bacterial; Humans; Streptococcal Infections

Ceftriaxone effectively inhibited 332 out of 452 (73.45%) bacterial strains in vitro tests. 291 out of 365 (79.69%) gram negative and 41 out of 87 (47.12%) gram positive strains were inhibited. The tests showed ceftriaxone to be more effective than cephalothin, cephotaxime, cephuroxime, cephamandol and cephoxitin. Kinetic tests showed that cephtriaxone has a plasmatic half life of 7.25 hrs. 24 hours after administration of a 1000 mg venous bolus the drug was still present in the blood. Urinary elimination over a 24 hr. period amounted to means 486.8 mg (48.68%). The drug has liquor transfer capacity. 37 of the 38 patients treated showed complete clinical or clinicobacteriological cure. Improvement was noted in the 38th.

Topics: Adolescent; Adult; Aged; Cefotaxime; Ceftriaxone; Child; Child, Preschool; Clinical Trials as Topic; Female; Gram-Negative Bacteria; Gram-Positive Bacteria; Half-Life; Humans; Kinetics; Klebsiella Infections; Male; Meningitis; Middle Aged; Respiratory Tract Infections; Staphylococcal Infections; Streptococcal Infections

Group B Streptococcus (GBS) is an important cause of invasive infection in neonates and infants. Cerebrospinal fluid (CSF) findings and culture may not show evidence of infection early in GBS meningitis. Next-generation sequencing (NGS) has the potential to detect microbial genetic material in patients with infectious diseases. We report two cases of infantile sepsis of GBS meningitis with negative results for CSF culture tests, but positive results for NGS analysis.. Patient 1 was a 22-day-old male infant diagnosed with sepsis and meningitis. His CSF findings showed pleocytosis, decreased glucose, and increased protein levels. However, CSF and blood culture results at admission were negative. He received a total of 3 weeks of treatment with ampicillin and cefotaxime, and showed clinical improvement. GBS was detected through NGS analysis of CSF collected at admission. Patient 2 was a 51-day-old male infant with sepsis. CSF findings on admission were normal, and blood and CSF cultures were also negative. Intravenous ampicillin and cefotaxime treatment were initiated. Treatment was de-escalated to ampicillin alone because Enterococcus faecalis was cultured from urine. He was discharged after a total of 1 week of antibiotic treatment. Six days after discharge, he was re-hospitalized for sepsis. Blood and CSF cultures were negative, and E. faecalis was again cultured from urine. He received a total of 3 weeks of ampicillin treatment for enterococcal-induced nephritis and did not relapse thereafter. NGS pathogen searches were retrospectively performed on both blood and CSF collected at the first and second admission. GBS was detected in the CSF collected at the first admission, but no significant pathogen was detected in the other samples. Inadequate treatment for GBS meningitis at the first admission may have caused the recurrence of the disease.. Infantile sepsis may present bacterial meningitis that is not diagnosed by either culture testing or CSF findings. NGS analysis for CSF may be useful for confirming the diagnosis of bacterial meningitis.

Topics: Ampicillin; Anti-Bacterial Agents; Cefotaxime; Cerebrospinal Fluid; Enterococcus faecalis; High-Throughput Nucleotide Sequencing; Humans; Infant; Infant, Newborn; Male; Meningitis, Bacterial; Retrospective Studies; Sepsis; Streptococcal Infections; Streptococcus agalactiae; Urine

Topics: Blindness; Cefotaxime; Endocarditis; Endophthalmitis; Humans; Intravitreal Injections; Male; Meningitis; Middle Aged; Pneumonia; Sepsis; Streptococcal Infections; Streptococcus pneumoniae

We have previously identified group B Streptococcus (GBS) clinical isolates with reduced penicillin susceptibility (PRGBS) that were non-susceptible to cefotaxime; however, the rates of cefotaxime and ceftriaxone non-susceptibility among PRGBS isolates have never been reported. Therefore, we first determined the MICs of 22 antibacterial drugs/compounds for 74 PRGBS isolates and then determined the rates of cefotaxime and ceftriaxone non-susceptibility among these isolates.. We used 74 clinical PRGBS isolates, previously collected in Japan and confirmed to harbour relevant amino acid substitutions in PBP2X. We also used 80 penicillin-susceptible GBS (PSGBS) clinical isolates as controls. The MICs of 22 antibacterial drugs/compounds for all 154 GBS isolates were determined via microdilution and/or agar dilution methods, as recommended by the CLSI.. The rates of non-susceptibility/resistance to ampicillin, cefotaxime, ceftriaxone and levofloxacin for the 80 PSGBS isolates were 0%, 0%, 0% and 30%, respectively, but were 15% (P = 0.0003), 28% (P < 0.0001), 36% (P < 0.0001) and 93% (P < 0.0001) for the 74 PRGBS isolates, respectively. No PRGBS isolates were identified to be non-susceptible to meropenem, doripenem, vancomycin, quinupristin/dalfopristin, daptomycin or linezolid.. We found that cefotaxime- and ceftriaxone-non-susceptible PRGBS isolates occur at relatively high rates in Japan. Importantly, this finding suggests that the range of drugs likely to be effective in treating PRGBS infections may be limited compared with those available for PSGBS infections; therefore, clinicians should exercise care when considering drug choice and efficacy for PRGBS infections.

Topics: Anti-Bacterial Agents; beta-Lactam Resistance; Cefotaxime; Ceftriaxone; Humans; Japan; Microbial Sensitivity Tests; Mutation, Missense; Penicillin-Binding Proteins; Penicillins; Prevalence; Streptococcal Infections; Streptococcus agalactiae

Common etiological agents of neonatal meningitis include group B Streptococcus, Escherichia coli, and Staphylococcus aureus. Here we report a rare pathogen - Streptococcus bovis - causing meningitis in a premature neonate with Down syndrome.. A 26-day-old Asian male neonate with Down syndrome presented with a history of high-grade fever, poor sucking, poor cry, and reduced activity. On admission, he was febrile and had features of circulatory collapse. A cerebrospinal fluid examination confirmed bacterial meningitis and blood culture isolated the causative organism: group D Streptococcus, which was verified as Streptococcus bovis biotype 2. An echocardiogram did not show evidence of infective endocarditis.. This is probably the first report of neonatal meningitis due to Streptococcus bovis in a child with Down syndrome. Although our patient did not show features of overt immunodeficiency, subtle abnormalities in his immune system would have predisposed him to infection with this unusual organism. This case highlights the need for considering unusual pathogens when managing serious infections in children with Down syndrome.

Topics: Administration, Intravenous; Anti-Bacterial Agents; Cefotaxime; Down Syndrome; Humans; Infant, Newborn; Infant, Premature; Male; Meningitis, Bacterial; Penicillin G; Rare Diseases; Streptococcal Infections; Streptococcus bovis

Topics: Acute Disease; Adult; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Cefotaxime; Ciprofloxacin; Combined Modality Therapy; Drainage; Drug Therapy, Combination; Female; Humans; Metronidazole; Parotitis; Self Medication; Streptococcal Infections; Tomography, X-Ray Computed; Viridans Streptococci

Topics: Amoxicillin; Anti-Bacterial Agents; Bacteremia; Cefotaxime; Humans; Infant, Newborn; Male; Neonatal Sepsis; Streptococcal Infections; Streptococcus pyogenes

To analyze the clinical characteristics of blood stream infection caused by Streptococcus agalactiae in children and the drug-resistance of the isolates.. All cases with Streptococcus agalactiae growth in blood or cerebrospinal fluid cultures from January 1, 2011 to December 31, 2015 were enrolled by checking the laboratory information system (LIS) from 7 Class 3 Grade A hospitals (4 in Zhejiang, 2 in Shanghai and 1 in Chongqing). Clinical data were collected for analysis. χ(2) test, t test and non parametric test were used in the study.. One hundred and eighty-one pediatric cases of blood stream infection caused by Streptococcus agalactiae were included in current study. Eighty-six cases (47.5%) were male, and with age range from one day to 9 years (media 13 days). Thirty cases (16.6%) were premature infants and 127 cases (70.2%) were born via vaginal delivery. Seventy-one cases (39.2%) had early onset (<7 d) infections, and 106 cases (58.6%) had late onset (7-89 d) infections. Seventy-eight cases (43.1%) were complicated with purulent meningitis. Incidences of vaginal delivery(81.7%(58/71) vs. 62.3%(66/106)), shortness of breath moaning (43.7%(31/71) vs. 15.1%(16/106)) and preterm premature rupture of membranes (25.4%(18/71) vs. 3.8%(4/106)) were higher in the early onset infection group compared with the late onset group(P all<0.05). However, the number of cases who had fever(25.4%(18/71)vs.85.8%(91/106)) and complicated with purulent meningitis (29.6%(21/71) vs. 53.8%(57/106)) in early onset infections group was less than that in the late onset group(P both<0.05). The blood cultures of most patients (87.8%) were performed before the use of antibiotics. Drug-resistant tests showed that the sensitive rates to penicillin G, ceftriaxone and cefotaxime were 98.9%, 99.0% and 99.0% respectively. All strains were sensitive to vancomucine. The rates of resistance to clindamycin and erythromycin were 68.0% and 34.0%, respectively. Only 39 cases (22.0%) were treated with single antibiotics of either penicillins or cephalosporins, 80 cases (45.2%) were treated with antibiotics containing β lactamase inhibitor, 61 cases (34.5%) were treated with either meropenem or cefoperazone-sulbactam. One hundred and fifty-four cases were cured, while 19 died (including 13 complicated with purulent meningitis) and 8 lost to follow up after giving up of treatment.. The incidence and mortality of blood stream infection caused by Streptococcus agalactiae complicated with purulent meningitis are high in children. Penicillin is the first choice in treatment. Antibiotics should be selected accorrding to the drug-resistance test.

Topics: Anti-Bacterial Agents; Bacteremia; Cefotaxime; Ceftriaxone; Cephalosporins; Child; China; Clindamycin; Drug Resistance, Bacterial; Erythromycin; Female; Humans; Infant; Infant, Newborn; Male; Meningitis, Bacterial; Penicillins; Retrospective Studies; Streptococcal Infections; Streptococcus agalactiae

To study the clinical characteristics, pathogenic bacteria, and antibiotics resistance of neonatal purulent meningitis in order to provide the guide for early diagnosis and appropriate treatment.. A retrospective review was performed and a total of 112 cases of neonatal purulent meningitis (male 64, female 58) were identified in the neonatal intensive care unit of Yuying Children's Hospital of Wenzhou Medical University seen from January 1, 2004 to December 31, 2013. The clinical information including pathogenic bacterial distribution, drug sensitivity, head imageology and therapeutic outcome were analyzed. Numeration data were shown in ratio and chi square test was applied for group comparison.. Among 112 cases, 46 were admitted from 2004 to 2008 and 66 from 2009 to 2013, 23 patients were preterm and 89 were term, 20 were early onset (occurring within 3 days of life) and 92 were late onset meningitis (occurring after 3 days of life). In 62 (55.4%) cases the pathogens were Gram-positive bacteria and in 50 (44.6%) were Gram-negative bacteria. The five most frequently isolated pathogens were Escherichia coli (32 cases, 28.6%), coagulase-negative staphylococcus (CNS, 20 cases, 17.9%), Streptococcus (18 cases, 16.1%, Streptococcus agalactiae 15 cases), Enterococci (13 cases, 11.6%), Staphylococcus aureus (9 cases, 8.0%). Comparison of pathogenic bacterial distribution between 2004-2008 and 2009-2013 showed that Gram-positive bacteria accounted for more than 50% in both period. Escherichia coli was the most common bacterium, followed by Streptococcus in last five years which was higher than the first five years (22.7% (15/66) vs. 6.5% (3/46), χ(2) = 5.278, P < 0.05). Klebsiella pneumoniae was more common isolate in preterm infants than in term infants (13.0% (3/23) vs. 1.1% (1/89), χ(2) = 7.540, P < 0.05). Streptococcus (most were Streptococcus agalactiae) was the most common bacteria in early onset meningitis and higher than those in late onset meningitis (35.0% (7/20) vs. 12.0% (11/92), χ(2) = 4.872, P < 0.05). Drug sensitivity tests showed that all the Gram-positive bacterial isolates were sensitive to linezolid. Staphylococci were resistant to penicillin, and most of them were resistant to erythromycin, oxacillin and cefazolin; 77.8%of CNS isolates were methicillin-resistant staphylococcus. No Streptococcus and Enterococcus faecalis was resistant to penicillin. None of enterococci was resistant to vancomycin. Among the Gram-negative bacterial isolates, more than 40% of Escherichia coli were resistant to commonly used cephalosporins such as cefuroxime, cefotaxime and ceftazidime, and all of them were sensitive to amikacin, cefoperazone sulbactam and imipenem. Isolates of Klebsiella pneumoniae were all resistant to ampicillin, cefuroxime, cefotaxime and ceftazidime, but none of them was resistant to piperacillin tazobactam and imipenem. Of the 112 patients, 69 were cured, 23 improved, 9 uncured and 11 died. There were 47 cases (42.0%) with poor prognosis, they had abnormal head imageology, severe complications and some cases died, 13 of 18 (72.2%) patients with meningitis caused by Streptococcus died.. Escherichia coli, CNS and Streptococcus are the predominant pathogens responsible for neonatal purulent meningitis over the past ten years. There were increasing numbers of cases with Streptococcus meningitis which are more common in early onset meningitis with adverse outcome, therefore careful attention should be paid in clinic. Linezolid should be used as a new choice in intractable neonatal purulent meningitis cases caused by gram positive bacteria.

Topics: Anti-Bacterial Agents; Cefotaxime; Child; Drug Resistance, Bacterial; Female; Gram-Negative Bacteria; Gram-Positive Bacteria; Humans; Imipenem; Infant; Infant, Newborn; Infant, Newborn, Diseases; Intensive Care Units, Neonatal; Male; Meningitis, Bacterial; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Penicillins; Retrospective Studies; Staphylococcus; Staphylococcus aureus; Streptococcal Infections; Streptococcus; Streptococcus agalactiae

We aimed to identify the causative organisms and sensitivities in community-acquired paediatric empyema at Starship Children's Hospital and Christchurch Hospital and to determine if current antibiotic recommendations are appropriate.. Retrospective analysis was undertaken of all cases with clinical, radiological, and microbiological evidence of empyema at Starship Children's Hospital and Christchurch Hospital between June 2009 and March 2013 (3.8 years), and January 2009 and May 2014 (5.4 years) respectively.. Ninety-eight children were managed with empyema at Starship Children's Hospital and 30 children at Christchurch Hospital. Staphylococcus aureus was the most common pathogen identified at both sites followed by Streptococcus pneumoniae. A significant proportion had no pathogen identified. Amongst S.aureus isolates, 1/5th were methicillin-resistant, contributing 8% of all culture positive empyema cases. Māori and Pacific groups were over-represented. Cases occurred more often in boys and those <5 years. Blood cultures and S.pneumoniae pleural antigen were important in diagnosis.. Our audit confirms the important role of S.aureus in paediatric empyema in New Zealand and a high rate of this disease, particularly in the North Island. Antimicrobial susceptibilities of the pathogens of empyema demonstrate current initial antibiotic recommendation.

Topics: Adolescent; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Cefotaxime; Cefuroxime; Child; Child, Preschool; Cohort Studies; Community-Acquired Infections; Empyema, Pleural; Ethnicity; Female; Floxacillin; Hospitals, Pediatric; Hospitals, Urban; Humans; Infant; Infant, Newborn; Male; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; New Zealand; Pneumococcal Infections; Practice Guidelines as Topic; Retrospective Studies; Seasons; Staphylococcal Infections; Staphylococcus aureus; Streptococcal Infections; Streptococcus pneumoniae; Streptococcus pyogenes

A nationwide laboratory-based surveillance study of invasive S. pyogenes infections was conducted in Germany. Invasive isolates (n = 1,281) were obtained between 2003 and 2013. All isolates were susceptible to penicillin, cefotaxime and vancomycin. Tetracycline showed the highest rate of resistant or intermediate resistant isolates with 9.8%, followed by macrolides (4.0%), trimethoprim/sulfamethoxazole (SXT) (1.9%), levofloxacin (1.3%), chloramphenicol (0.9%) and clindamycin (0.7%). The most prominent trends were the appearance of levofloxacin non-susceptible isolates since 2011, and an increase of SXT non-susceptibility since 2012.

Topics: Anti-Bacterial Agents; Cefotaxime; Chloramphenicol; Clindamycin; Epidemiological Monitoring; Germany; Humans; Levofloxacin; Macrolides; Microbial Sensitivity Tests; Penicillins; Streptococcal Infections; Streptococcus pyogenes; Tetracycline; Trimethoprim, Sulfamethoxazole Drug Combination; Vancomycin

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

Acute osteomyelitis of the clavicle accounts for less than 3% of osteomyelitis cases, with its usual location in the middle third. It may be hematogenous, due to contiguity, or secondary to catheterization of the subclavian vein or neck surgery. The diagnosis is often delayed, and clinical symptoms may simulate obstetric brachial plexus palsy in young children. We report a new case of osteomyelitis of the clavicle in a 30-day-old newborn.

Topics: Abscess; Administration, Oral; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Catheterization, Central Venous; Cefotaxime; Clavicle; Female; Fever of Unknown Origin; Follow-Up Studies; Fosfomycin; Fractures, Spontaneous; Haemophilus Infections; Haemophilus influenzae; Humans; Infant; Infant, Newborn; Infectious Disease Transmission, Vertical; Infusions, Intravenous; Male; Osteomyelitis; Pregnancy; Pregnancy Complications, Infectious; Radionuclide Imaging; Sepsis; Streptococcal Infections; Ultrasonography

Topics: Alcoholism; Cefotaxime; Communicable Diseases, Emerging; Disease Susceptibility; Drug Resistance, Multiple, Bacterial; Environmental Exposure; Humans; Immunocompromised Host; Male; Meningitis, Bacterial; Middle Aged; Rural Health; Spain; Streptococcal Infections; Streptococcus suis

Odontogenic infections are quite common and, in unusual cases, can extend beyond the oral cavity with potentially life-threatening complications.. A 35-year-old woman, G3P0020, underwent extraction of an infected left maxillary third molar tooth at 19 3/7 weeks of gestation and later presented with mental status changes. Computed tomography revealed left pterygoid muscle abscess, which progressed to brain abscess. She underwent multiple partial lobectomies to drain her recurrent brain abscess. The pregnancy continued until term, and she underwent a cesarean delivery.. Brain abscess is a rare but life-threatening complication of pregnancy. This case illustrates the potential complications after extraction of an infected tooth in pregnancy.

Topics: Adult; Anti-Bacterial Agents; Anticonvulsants; Brain Abscess; Cefotaxime; Cesarean Section; Dexamethasone; Drug Therapy, Combination; Female; Focal Infection, Dental; Humans; Infant, Newborn; Levetiracetam; Male; Meningoencephalitis; Metronidazole; Molar, Third; Piracetam; Pregnancy; Pregnancy Complications, Infectious; Radiography; Streptococcal Infections; Tooth Extraction; Treatment Outcome; Ultrasonography, Prenatal; Viridans Streptococci

Topics: Anti-Bacterial Agents; Antidiuretic Agents; Cefotaxime; Deamino Arginine Vasopressin; Diabetes Insipidus, Neurogenic; Drug Therapy, Combination; Gentamicins; Humans; Infant, Newborn; Male; Meningitis, Bacterial; Streptococcal Infections; Streptococcus agalactiae; Treatment Outcome

We describe 66 ciprofloxacin-nonsusceptible Streptococcus pyogenes isolates recovered from colonized and infected children. The ParC S79A substitution was frequent and associated with the emm6/sequence type 382 (emm6/ST382) lineage. The ParC D83G substitution was detected in two isolates (emm5/ST99 and emm28/ST52 lineages). One isolate (emm89/ST101) had no quinolone resistance-determining region codon substitutions or other resistance mechanisms. Five of 66 isolates were levofloxacin resistant. Although fluoroquinolones are not used in children, they may be putative disseminators of fluoroquinolone-nonsusceptible strains in the community.

Topics: Amino Acid Substitution; Anti-Bacterial Agents; Antigens, Bacterial; Bacterial Outer Membrane Proteins; Bacterial Typing Techniques; Carrier Proteins; Child; Ciprofloxacin; Drug Resistance, Bacterial; Humans; Molecular Epidemiology; Norfloxacin; Point Mutation; Portugal; Streptococcal Infections; Streptococcus pyogenes

Group A streptococcus (GAS) is a major bacterial pathogen affecting children globally. Approximately 15% of school-age children experience a symptomatic episode of GAS culture-positive pharyngitis each year. Although the incidence of invasive GAS disease under these circumstances is low (0.5%-2%), an increasing number of invasive GAS cases have been reported over the last 2 decades. This report describes a 7-year-old boy who, after being treated for GAS pharyngitis, developed a fatal streptococcal toxic shock syndrome.

Topics: Acute Kidney Injury; Anti-Bacterial Agents; Cefotaxime; Child; Clindamycin; Drug Therapy, Combination; Emergencies; Fatal Outcome; Fluid Therapy; Hemorrhage; Humans; Hypotension; Intubation, Intratracheal; Male; Pharyngitis; Respiration, Artificial; Respiratory Distress Syndrome; Shock, Septic; Streptococcal Infections; Streptococcus pyogenes

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

Viridans group Streptococcus (VGS) is a leading cause of bacteremia in pediatric oncology patients, primarily in children with acute myeloid leukemia or after hematopoietic stem cell transplantation. We retrospectively identified all positive blood cultures in oncology patients at the British Columbia Children's Hospital for a period of 54 months. VGS was the second most commonly isolated pathogen, present in 19% of all the positive blood cultures. Susceptibility analysis of 46 VGS isolates from that period was performed using the Etest method for penicillin, cefotaxime, ceftazidime, and piperacillin/tazobactam. The geometric mean minimal inhibitory concentration for ceftazidime was found to be 9 to 12-fold higher than for any other beta-lactam antibiotic. Penicillin resistance was of 13% with an additional 20% of samples with intermediate susceptibility. The study underscores the prevalence of VGS bacteremia in pediatric patients, especially with acute myeloid leukemia or postallogeneic hematopoietic stem cell transplantation, and the in vitro inferiority of ceftazidime compared with other beta-lactams in that context. We conclude that monotherapy with ceftazidime, or its use along with an aminoglycoside, is not an optimal therapy in pediatric oncology patients with febrile neutropenia.

Topics: Aminoglycosides; Anti-Bacterial Agents; Bacteremia; beta-Lactam Resistance; Cefotaxime; Ceftazidime; Child; Drug Therapy, Combination; Humans; In Vitro Techniques; Leukemia, Myeloid, Acute; Microbial Sensitivity Tests; Penicillanic Acid; Penicillins; Piperacillin; Piperacillin, Tazobactam Drug Combination; Retrospective Studies; Streptococcal Infections; Viridans Streptococci

Group B streptococci (GBS; Streptococcus agalactiae) are the leading cause of neonatal invasive diseases and are also important pathogens for adults. Penicillins are the drugs of first choice for the treatment of GBS infections, since GBS have been regarded to be uniformly susceptible to penicillins so far. Here we characterize the first strains of GBS with reduced penicillin susceptibility (PRGBS) identified in Japan. Fourteen PRGBS strains were clinically isolated from the sputa of elderly patients from 1995 to 2005; and the MICs of penicillin, oxacillin, and ceftizoxime ranged from 0.25 to 1 microg/ml, 2 to 8 microg/ml, and 4 to 128 microg/ml, respectively. Moreover, some strains were also insusceptible to ampicillin, cefazolin, cefepime, and cefotaxime. All the PRGBS isolates tested possessed a few amino acid substitutions adjacent to the conserved SSN and KSG motifs (amino acids 402 to 404 and 552 to 554, respectively) of PBP 2X, and the amino acid substitutions could be classified into two types, Q557E and V405A. Western blotting analysis of the 14 clinical isolates with anti-PBP 2X-specific serum suggested that the amount of PBP 2X among the 14 PRGBS isolates was reduced, although the 2 ATCC strains produced a significant amount of PBP 2X. The introduction of PRGBS-derived PBP 2X genes into penicillin-susceptible strains through allelic exchange elevated their penicillin insusceptibility, suggesting that these altered PBP 2X genes are responsible for the penicillin insusceptibility in PRGBS strains. In this study, we characterized for the first time PRGBS strains on a molecular basis, although several reports have so far mentioned the existence of beta-lactam-insusceptible GBS from a phenotypic standpoint.

Topics: Amino Acid Sequence; Amino Acid Substitution; Ampicillin; Anti-Bacterial Agents; Bacterial Proteins; Blotting, Western; Cefepime; Cefotaxime; Ceftizoxime; Cephalosporins; Electrophoresis, Gel, Pulsed-Field; Humans; Japan; Microbial Sensitivity Tests; Molecular Sequence Data; Oxacillin; Penicillin Resistance; Penicillin-Binding Proteins; Penicillins; Sequence Analysis, DNA; Sequence Homology, Amino Acid; Streptococcal Infections; Streptococcus agalactiae

Topics: Adult; Anti-Bacterial Agents; Aortic Valve; Cefotaxime; Endocarditis, Bacterial; Humans; Male; Streptococcal Infections; Streptococcus constellatus; Treatment Outcome

There is a paucity of data regarding the treatment of endocarditis caused by penicillin-resistant viridans group streptococci (PR-VGS). We report a 16-year-old girl who had native-valve endocarditis due to PR-VGS which was identified as Streptococcus mitis. She also had unusual reactions to vancomycin. Eighteen hours after initiation of 50 mg/kg/day vancomycin, she developed a maculopapular rash, then at 48 hours she developed an intermittent high fever and a progressive decrease in peripheral leukocytes and platelets. She developed hypotension on Day 8. Her serum C-reactive protein and procalcitonin levels were high. All reactions improved after vancomycin was discontinued and oral prednisolone was started. This unusual combination of reactions to vancomycin was likely caused by immune and nonimmune mechanisms. Her endocarditis was successfully treated with cefotaxime 200 mg/kg/ day for 4 weeks.

Topics: Adolescent; Anti-Bacterial Agents; Cefotaxime; Endocarditis, Bacterial; Female; Glucocorticoids; Humans; Penicillin Resistance; Prednisolone; Streptococcal Infections; Streptococcus mitis; Vancomycin

Topics: Anti-Bacterial Agents; Cefotaxime; Child; Female; Humans; Injections, Intravenous; Orbital Pseudotumor; Pharyngitis; Streptococcal Infections; Streptococcus agalactiae

Since the mid-1980s, an increase in incidence of invasive disease caused by group A streptococci has been noted among adults and children. The characteristic clinical and laboratory features of the streptococcal toxic shock syndrome include deep-seated infection associated with shock, skin manifestation, and multiorgan failure. However, bullous impetigo is invariably considered to be a staphylococcal disease. Staphylococcus aureus produces an epidermolytic toxin, assumed to be the cause of bullous formation in the skin. Here, we present a case of bullous impetigo in an infant with streptococcal toxic shock syndrome. This is a rare presentation of bullous impetigo caused by group A streptococcus.

Topics: Anti-Bacterial Agents; Cardiotonic Agents; Cefotaxime; Clindamycin; Colloids; Combined Modality Therapy; Disseminated Intravascular Coagulation; Female; Humans; Impetigo; Infant; Plasma; Respiration, Artificial; Shock, Septic; Skin Diseases, Vesiculobullous; Streptococcal Infections; Streptococcus pyogenes; Vancomycin; Vitamin K

Streptococcus intermedius is increasingly being recognised as an aetiological agent in central nervous system infections. Primary ventriculitis caused by this organism has not been reported so far. We present a case of primary ventriculitis, which resulted in adhesions and multiloculated hydrocephalus, necessitating numerous surgical procedures to control it. No predisposing factor(s) could be identified. Although the organism could not be cultured from CSF, as he was already on antibiotic treatment, it could, however, be identified by 16S rDNA polymerase chain reaction on the CSF sample. It appears important to recognise this condition and to treat it aggressively to prevent complications such as adhesions and multiloculated hydrocephalus.

Topics: Anti-Infective Agents; Cefotaxime; Cerebral Ventricles; Encephalitis; Endoscopy; Glasgow Coma Scale; Humans; Hydrocephalus; Male; Metronidazole; Middle Aged; Rifampin; Streptococcal Infections; Streptococcus intermedius; Tomography, X-Ray Computed

Our objective is to determine in vitro efficiency of moxifloxacin (MXF) alone or in combination with cefotaxime (CTX) on Group B streptococcus (GBS).. For 21 strains of GBS isolated from newborn invasive infections (6 meningitis and 15 bacteraemia), the bacterial growth in Mueller Hinton broth with MXF and/or CTX leaded to the determination of MIC and MBC, the determination of tolerance for CTX and the evaluation of the bacteriostatic action of these antibiotics combination by calculating the FIC index. Time-kill studies were conducted for MXF and CTX alone or in combination for the first four hours, with concentrations likely reached in CSF.. Study of GBS growth with crossed concentrations of MXF and CTX showed no resistant strains, no tolerant strains, and no antagonism between MXF and CTX. Killing curves demonstrated that MXF is ten-fold more active than CTX in the first four hours.. MXF is an interesting antibiotic for its good activity on the GBS, suggesting that MXF is a good candidate for further evaluation in GBS meningitis in animal model.

Topics: Anti-Bacterial Agents; Aza Compounds; Bacteremia; Cefotaxime; Drug Therapy, Combination; Fluoroquinolones; Humans; Infant, Newborn; Meningitis, Bacterial; Microbial Sensitivity Tests; Moxifloxacin; Quinolines; Serotyping; Streptococcal Infections; Streptococcus agalactiae

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

We report a 54 year old female whose successful treatment of cerebral lupus with rituximab was complicated by the development of streptococcus intermedius, on valves damaged by Libman-Sacks endocarditis more than 20 years previously.

Topics: Anti-Bacterial Agents; Antibiotic Prophylaxis; Antibodies, Monoclonal; Antibodies, Monoclonal, Murine-Derived; Antirheumatic Agents; Cefotaxime; Endocarditis, Bacterial; Female; Humans; Lupus Erythematosus, Systemic; Middle Aged; Penicillin G; Rituximab; Streptococcal Infections; Streptococcus intermedius

We evaluated the efficacy of cefotaxime in the management of brain abscesses caused by Streptococcus milleri. Twenty two patients with a S. milleri brain abscess were treated with metronidazole and cefotaxime, in accordance with recent recommendations by the British Society Of Antimicrobial Chemotherapy (BSAC). Seven patients who had Glasgow Coma Scales < or =11 also received rifampicin and high dose cefotaxime. The clinical response of the patients was determined.. A retrospective study at the Queen Elizabeth Hospital, Birmingham covering the period April 1996-March 2004 was carried out. Neurosurgical and anti-microbial therapeutic approaches were reviewed. Any evidence of improvement of clinical features and radiological disappearance of brain abscesses were determined.. Outcome was assessed using the Glasgow Outcome Score (GOS) at 3 and 6 months from the time of surgical intervention. Eighteen patients (82%) had a good outcome by 6 months, with an outcome score of 4-5. Thirteen patients resumed normal life despite minor deficits (GOS 5), while a further five patients had moderate disability though remained independent (GOS 4). One patient had a GOS of 3 and there were three deaths (14). The minimum time to radiological resolution of the abscess was within 1 month in six cases (27) These all represented solitary lesions that required a single drainage procedure in conjunction with 4 weeks of intravenous cefotaxime and metronidazole. Ten cases (45%) had resolution within 4 months and a further three cases took at least 6 months from the time of surgery to show radiological clearance.. This cohort of patients responded favourably to the guidelines recommended by the BSAC. This was confirmed by the Glasgow Outcome Score (GOS 4-5) at 6 months review. Cefotaxime at a higher dose with rifampicin was prescribed for patients presenting with a decreased conscious level (GCS 8-11), subsequent failure of anticipated clinical improvement or clinical deterioration. There was no clinically significant difference in GOS between the two treatment groups. An algorithm for management of brain abscess is presented, based on our clinical experience and review of the literature.

Topics: Adolescent; Adult; Aged; Algorithms; Anti-Infective Agents; Brain Abscess; Causality; Cefotaxime; Cohort Studies; Drainage; Female; Glasgow Outcome Scale; Humans; Male; Metronidazole; Middle Aged; Retrospective Studies; Rifampin; Risk Factors; Streptococcal Infections; Streptococcus milleri Group; Time Factors; Treatment Outcome

To present a case of acute septic arthritis due to Streptococcussanguis, a member of the viridans group streptococci.. A 73-year-old woman presented with fever and increasing swelling and pain of the right knee several weeks after she had been treated for severe periodontal disease. Arthrocentesis yielded purulent synovial fluid. S. sanguis was isolated in synovial fluid cultures, and the patient was treated with intravenous cefotaxime for 3 weeks and repeated aspiration of the knee joint with gradual resolution of fever, joint swelling and effusion.. Although S. sanguis is believed to be a rare cause of septic arthritis in native joints, it should be considered in the differential diagnosis of this disorder, especially in patients with recent treatment of severe dental caries and periodontal disease.

Topics: Acute Disease; Aged; Anti-Bacterial Agents; Arthritis, Infectious; Cefotaxime; Female; Greece; Humans; Knee Joint; Streptococcal Infections; Streptococcus sanguis

A 5-year-old girl was hospitalised for fever, abdominal and lumbar pain, associated with general impairment state and a whitlow. One of the blood cultures and CSF grew A beta haemolytic Streptococcus, muscular echography and MRI showed paravertebral myositis, which was complicated by an epidural abscess. The outcome was good with medical treatment alone.. Streptococcal myositis is a rare and severe skeletal muscle infection caused by A beta haemolytic Streptococcus. It is characterized by a muscle necrosis, without abscess formation. It has to be distinguished from pyomyositis, usually caused by Staphylococcus aureus, where a muscle abscess occurs, which must be treated by surgical drainage and antibiotics. Prognosis of this infection is poorer than other muscle infections such as pyomyositis, with a high mortality rate. The diagnosis is difficult and often delayed. Practitioners should keep in mind this diagnosis, even if symptoms are non specific, in front of an undetermined infectious syndrome associated with pain, and make an echography or nuclear magnetic resonance imaging to confirm the diagnosis.

Topics: Administration, Oral; Amoxicillin; Anti-Bacterial Agents; Cefotaxime; Child, Preschool; Drug Therapy, Combination; Epidural Abscess; Female; Follow-Up Studies; Fosfomycin; Humans; Magnetic Resonance Imaging; Myositis; Streptococcal Infections; Streptococcus pyogenes; Time Factors; Treatment Outcome; Ultrasonography

Fournier gangrene is a necrotizing fasciitis of the perineal and genital region, which almost exclusively affects men. The cause is a polymicrobial infection associated with superficial trauma, urological diseases and operations, as well as colorectal diseases. Diabetes mellitus, alcoholism, immunosuppression and other severe illnesses are frequent co-factors. Immediate administration of systemic broad-spectrum antibiotic therapy with coverage of both gram-positive and gram-negative bacteria combined with surgical debridement and intensive medical care can lower the high mortality rate of this condition.

Topics: Adult; Cefotaxime; Combined Modality Therapy; Drug Therapy, Combination; Emergencies; Follow-Up Studies; Fournier Gangrene; Genital Diseases, Male; Humans; Male; Metronidazole; Necrosis; Penile Diseases; Scrotum; Skin; Streptococcal Infections; Streptococcus pyogenes; Tobramycin

Topics: Acute Kidney Injury; Adult; Bacteremia; Cefotaxime; Cellulitis; Clindamycin; Combined Modality Therapy; Cyanosis; Debridement; Disseminated Intravascular Coagulation; Drug Therapy, Combination; Erythema; Fatal Outcome; Female; Gentamicins; Hemofiltration; Humans; Multiple Organ Failure; Shock, Septic; Streptococcal Infections; Streptococcus pyogenes; Teicoplanin; Vulvitis

Occasionally, trivial odontogenic infections may develop into complex diseases. This may even result in an unrestrained phlegmonous spread causing life-threatening complications. These problems have decreased since the introduction of antibiotics and also due to improved oral hygiene and improved diagnostic measures resulting in optimized medical treatment. However, life-threatening forms are still seen, in particular if infections spread along the cervical fascial sheaths down towards to the mediastinum. Over the past decade the number of critical infections has increased in other medical specialties. This is usually explained by the development of multiresistant pathogens in the context of nosocomial infections.. We reviewed the patients' records of the past 15 years at the Department of Oral and Maxillofacial Surgery of the University Hospital Kiel to assess a possible increase of odontogenic infections with life-threatening complications. From 1990 to 2004, four patients with odontogenic infections exhibiting critical phlegmonous spread were treated in the intensive care unit. Two patients developed bacterial mediastinitis which could be controlled by intravenous antibiotics only. One patient progressed to general septic mediastinitis and eventually died of cardiorespiratory arrest. The last patient also had septic mediastinitis and developed right pleural empyema. Several operations were necessary before the disease could be controlled. This patient's case report is presented in detail.. The prognosis of patients with mediastinitis crucially depends on (a) early diagnosis including computed tomography of the neck and thorax, (b) early radical surgical intervention, and (c) optimized pathogen-oriented antibiotic treatment.

Topics: Abscess; Ampicillin; Cefotaxime; Cellulitis; Combined Modality Therapy; Critical Care; Disease Progression; Empyema, Pleural; Follow-Up Studies; Humans; Male; Mediastinitis; Middle Aged; Neck; Reoperation; Shock, Septic; Staphylococcal Infections; Staphylococcus epidermidis; Streptococcal Infections; Sulbactam; Therapeutic Irrigation; Thoracotomy; Tomography, X-Ray Computed; Vancomycin

From January 1993 to December 2002, 28 patients with nutritionally variant streptococci (NVS) infections were treated at a university hospital in Taiwan. Twelve (43%) of these patients had various underlying malignancies, and 7 (25%) had underlying valvular heart diseases. Nine patients (32%) had infective endocarditis, and 9 (32%) had primary bacteremia. The deaths of 7 patients (25%) were directly related to NVS infection. Among the 28 isolates recovered from these patients, 50% were not susceptible to penicillin, 33% were not susceptible to cefotaxime, and 93% were not susceptible to azithromycin.

Topics: Adolescent; Adult; Aged; Azithromycin; beta-Lactam Resistance; Cefotaxime; Child; Drug Resistance, Bacterial; Female; Hospitals, University; Humans; Macrolides; Male; Microbial Sensitivity Tests; Middle Aged; Streptococcal Infections; Streptococcus; Taiwan

In January 2003, the National Committee for Clinical Laboratory Standards (NCCLS) finalized new breakpoints for defining the susceptibility of Streptococcus pneumoniae isolates to cefotaxime and ceftriaxone. The former breakpoints were based on attainable concentrations of these antibiotics in cerebrospinal fluid (CSF) and the level at which it was thought that meningitis treatment failed because of elevated minimum inhibitory concentrations (MICs). The new breakpoints differ for S. pneumoniae isolates causing meningitis and those causing nonmeningeal clinical syndromes. To assess the effect of these new criteria on reporting of nonsusceptible S. pneumoniae isolates, CDC analyzed cefotaxime MIC data from the Active Bacterial Core Surveillance (ABCs) of the Emerging Infections Program (EIP) Network during 1998-2001. This report summarizes the results of that analysis, which indicated that after the new criteria were applied, the number of isolates defined as nonsusceptible to cefotaxime decreased 52.1%-61.2% for each year. Laboratory reports for clinicians should include interpretations using the new breakpoints for meningitis and nonmeningeal syndromes for all non-CSF isolates.

Topics: Anti-Bacterial Agents; Cefotaxime; Drug Resistance, Bacterial; Humans; Microbial Sensitivity Tests; Streptococcal Infections; Streptococcus pneumoniae; United States

With antibiotics and an increasing dental care and hygiene, the profound neck spaces infections have decreased their incidence. Nevertheless we can found them in the clinical practice, and they present a big morbidity and severe complications. We present in this paper a case of profound cervical abscess in a diabetic patient, discussing the clinical and therapeutics aspects.

Topics: Abscess; Aged; Anti-Bacterial Agents; Cefotaxime; Diabetes Complications; Diabetes Mellitus; Enterobacteriaceae Infections; Humans; Male; Streptococcal Infections; Submandibular Gland Diseases; Tomography, X-Ray Computed

Streptococcus agalactiae or group B streptococcus, GBS, is the leading cause of neonatal and maternal infections and an opportunistic pathogen in adults with underlying disease. In the last decade, a dramatic increase in the resistance of this microorganism to erythromycin and clindamycin has been observed.. To determine the serotype distribution and antimicrobial susceptibility of isolates of S. agalactiae collected from infections and colonization and to assess the genetic mechanisms of macrolide and clindamycin resistance.. A total of 100 GBS isolates were collected between 1998 and 2002, in Santiago, Chile. They were isolated from the amniotic fluid from patients with premature rupture of membranes (7 isolates), blood from neonatal sepsis (10 isolates), neonate colonizations (2 strains), skin and soft tissue infections (7 isolates), urinary tract infections (5 isolates), genital infections (3 isolates), articular fluid (one isolate), and 65 strains were recovered from vaginal colonization55.. Serotypes Ia, II and III were the predominant serotypes identified in our study, accounting for 90 (90%) of the strains. Five isolates belonged to serotypes Ib (5%) and two (2%) to serotype V respectively; no strains belonging to serotype IV were found. All strains were susceptible to penicillin G, ampicillin and cefotaxime, and four isolates (4%) were resistant to both erythromycin (MIC >64 microg/ml) and clindamycin (MIC >64 microg/ml). The strains had a constitutive macrolide-lincosamide-streptogramin (cMLSB) resistance phenotype and the erm(A) gene was present in the four isolates.. Serotypes Ia, II and III were the predominant serotypes in this study. All strains were susceptible to penicillin G, ampicillin and cefotaxime, and four (4%) strains were resistant to both erythromycin and clindamycin. The cMLSB resistance phenotype, and the erm(A) gene was detected in resistant strains.

Topics: Adult; Ampicillin; Anti-Bacterial Agents; Cefotaxime; Clindamycin; Drug Resistance, Bacterial; Erythromycin; Female; Humans; Infant; Infant, Newborn; Microbial Sensitivity Tests; Phenotype; Pregnancy; Sepsis; Serotyping; Streptococcal Infections; Streptococcus agalactiae; Tetracycline

We present a case of nonbullous impetigo neonatorum associated with late onset group B streptococcal meningitis in a 12-day-old infant. Both skin lesions and meningitis resolved with antibiotic therapy. This is the first reported case of meningitis during the course of this skin disease.

Topics: Anti-Bacterial Agents; Cefotaxime; Humans; Impetigo; Infant, Newborn; Male; Meningitis, Bacterial; Streptococcal Infections

A total of 105 clinical strains of Group C and Group G streptococci were examined for their susceptibility to penicillin, cefotaxime, erythromycin, meropenem and vancomycin using a broth microdilution method. Minimum bactericidal concentrations of the antimicrobial agents and phenotypes of strains resistant to erythromycin were also evaluated. No resistance to penicillin, cefotaxime, meropenem and vancomycin was found in years 1995-2002, but there was 6.7% resistance to erythromycin. No tolerance was seen for penicillin and vancomycin, but there were strains tolerant to cefotaxime, erythromycin and meropenem. The resistance phenotypes of erythromycin-resistant isolates were determined by the double disc test with erythromycin and clindamycin which showed inducible MLS (57.1%) and M phenotype (42.8%) resistance. This in vitro finding shows that classical antimicrobial agents used for the treatment of GCS and GGS have good activity against clinically significant isolates, but the presence of macrolide resistance and tolerant isolates suggests that careful surveillance of the streptococcal isolates should be carried out.

Topics: Anti-Bacterial Agents; Cefotaxime; Cephalosporin Resistance; Drug Resistance, Bacterial; Erythromycin; Humans; In Vitro Techniques; Meropenem; Microbial Sensitivity Tests; Penicillin Resistance; Phenotype; Streptococcal Infections; Streptococcus; Thienamycins; Turkey; Vancomycin Resistance

Topics: Adult; Cefotaxime; Cellulitis; Cephalosporins; Combined Modality Therapy; Disease Susceptibility; Exophthalmos; Female; Fever; Graves Disease; Headache; Humans; Ophthalmoplegia; Orbital Diseases; Sinusitis; Streptococcal Infections; Tomography, X-Ray Computed

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

From January 1996 to December 1997, we evaluated the in vitro activity of 8 antimicrobials (penicillin, amoxycillin, amoxycillin/clavulanate, cefuroxime, ceftazidime, cefepime, cefotaxime, and imipenem) against 350 Streptococcus pneumoniae clinical isolates collected from two hospitals. Imipenem, cefepime and cefotaxime were the most active antibiotics against penicillin-intermediate (PI) and highly penicillin-resistant (PR) S. pneumoniae with MICs 2- to 8-fold lower than penicillin. Against PI and PR pneumococci amoxycillin and amoxycillin/clavulanate were 2-times less active than cefepime and cefotaxime, while cefuroxime was 4-8-times less active. The majority of strains of serotypes 6B, 23F, 14, 9 and 19 were penicillin-resistant, both intermediate (68%) and highly resistant (32%).

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

Antibiotic susceptibility profiles were analyzed for 119 invasive and 227 colonizing strains of group B streptococci isolated from neonates at 6 US academic centers. All strains were susceptible to penicillin, vancomycin, chloramphenicol, and cefotaxime. The rate of resistance to erythromycin was 20.2% and to clindamycin was 6.9%. Resistance to erythromycin increased in 1997. Type V strains were more resistant to erythromycin than were type Ia (P=.003) and type Ib (P=.004) strains and were more resistant to clindamycin than were type Ia (P<.001), type Ib (P=.01), and type III (P=.001) strains. Resistance rates varied with geographic region: in California, there were high rates of resistance to erythromycin and clindamycin (32% and 12%, respectively), and low rates in Florida (8.5% and 2.1%, respectively). Penicillin continues to be the drug of choice for treatment of group B streptococcus infection. For women who are penicillin intolerant, however, the selection of an alternative antibiotic should be guided by contemporary resistance patterns observed in that region.

Topics: Anti-Bacterial Agents; Bacterial Capsules; Cefotaxime; Chloramphenicol; Clindamycin; Drug Resistance, Microbial; Erythromycin; Female; Humans; Infant, Newborn; Microbial Sensitivity Tests; Ofloxacin; Penicillins; Sepsis; Serotyping; Streptococcal Infections; Streptococcus agalactiae; Tetracycline; Vancomycin

Topics: Abscess; Acute Disease; Cefotaxime; Cephalosporins; Combined Modality Therapy; Disease Progression; Exudates and Transudates; Female; Humans; Infant; Injections, Intravenous; Mastoiditis; Middle Ear Ventilation; Streptococcal Infections; Streptococcus pneumoniae; Suction; Tomography, X-Ray Computed; Treatment Outcome

Group B streptococci (GBS) are the major cause of neonatal sepsis and meningitis. GBS infection in neonates is usually treated with a combination of penicillin and gentamicin. According to consensus guidelines, pregnant women at risk receive intrapartum prophylaxis with either ampicillin or penicillin or, in case of allergy, with erythromycin or clindamycin. We investigated the susceptibility patterns of 190 GBS strains from neonates isolated from 1993-1999 and 150 GBS strains collected from adult women in 1997 and 1999. All isolates were susceptible to penicillin, ampicillin and cefotaxime. Erythromycin resistance among all isolates from neonates and from adult women in 1997 was 4.7% and 6%, respectively. In contrast, 12% of the isolates from adult women in 1999 were resistant to erythromycin and 7% were resistant to clindamycin. These findings show an increasing macrolide resistance in recent GBS strains and indicate the need for further surveillance.

Topics: Adult; Anti-Bacterial Agents; Antibiotic Prophylaxis; Cefotaxime; Clindamycin; Drug Resistance, Multiple, Bacterial; Erythromycin; Female; Gentamicins; Germany; Humans; Infant; Infant, Newborn; Microbial Sensitivity Tests; Penicillins; Pregnancy; Pregnancy Complications, Infectious; Streptococcal Infections; Streptococcus agalactiae

Topics: Anti-Inflammatory Agents; Brain Abscess; Cefotaxime; Cephalosporins; Female; Haemophilus Infections; Humans; Magnetic Resonance Spectroscopy; Methylprednisolone; Middle Aged; Streptococcal Infections

Topics: Ampicillin; Cefotaxime; Drug Therapy, Combination; Female; Humans; Infant, Newborn; Meningitis, Bacterial; Streptococcal Infections; Streptococcus agalactiae

Topics: Amoxicillin; Anti-Bacterial Agents; Antibiotic Prophylaxis; Cefotaxime; Cephalosporin Resistance; Endocarditis, Bacterial; Gentamicins; Humans; Male; Middle Aged; Penicillin Resistance; Streptococcal Infections; Vancomycin

To study the factors implicated in the infectious process (host, microorganism and antibiotic) of a newborn early sepsis by S. agalactiae that suffered a reactivation at day five from discharge.. Description of two episodes of newborn sepsis by S. agalactiae corresponding to the same patient and microbiologic study of the isolated strain: typing by "genomic macrorestriction" and antibiotic tolerance by "timed killing curves".. It was demonstrated that both strains of S. agalactiae type la/c belonged to the same clone as well as the tolerance to ampicillin of the strain.. This sort of infections processes in the newborn are very serious and there is possibility of relapse. Thus, it is important to study the ethiologic agent and its relationship with antibiotics, in order to stablish the best treatment regimes, avoiding the possibility of relapses as the case we have described.

Topics: Adult; Ampicillin; Ampicillin Resistance; Bacteremia; Cefotaxime; Drug Therapy, Combination; Female; Gentamicins; Humans; Infant, Newborn; Male; Meningitis, Bacterial; Pharynx; Pregnancy; Pregnancy Complications, Infectious; Recurrence; Streptococcal Infections; Streptococcus agalactiae; Vagina

Varicella is a common viral infection which is generally benign in infancy and has a good outcome. It may sometimes be complicated by severe group A streptococcal superinfection.. Three days after the beginning of varicella, a previously healthy 2-year-old girl presented with left leg pain, lameness and edema of all four limbs. Toxic shock syndrome occurred, due to beta-hemolytic group A Streptococcus grown from blood culture. Computerized tomography (CT) scan showed a mild effusion involving both hips. Cefotaxim was administered, but the week after magnetic resonance imaging (MRI) showed a necrotizing fasciitis and a lesion of the left leg leading to a patchy femoral diaphysis consistent with osteomyelitis. Joint aspirate culture did not grow. The left leg was immobilized in plaster for 6 weeks and the child was given cefotaxim and fosfomycin parenterally during 30 days, then followed by 45 days of oral amoxicillin. She recovered without sequelae.. Group A Streptococcus infection is a dangerous complication of varicella. It must be considered in case of any joint pain occurring during or just after this disease. The choice of the best treatment needs full collaboration between surgeons, radiologists and pediatricians.

Topics: Cefotaxime; Chickenpox; Child, Preschool; Drug Therapy, Combination; Female; Fosfomycin; Humans; Shock, Septic; Streptococcal Infections; Streptococcus pyogenes

An increasing number of clinical failures has been noted after treatment of upper respiratory tract infection and acute otitis media with conventional antibiotics. At present, Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis and group A beta-hemolytic streptococcus (GABHS) are the bacterial pathogens most frequently responsible for these infections. Although GABHS has so far not developed penicillin resistance, the frequency of bacteriological failures with either benzathine penicillin or penicillin V has increased. Firstly, a number of hypotheses have been put forward to explain this, including poor patient compliance and inactivation by beta-lactamase-producing oropharyngeal flora. Secondly, this has added to the demand for new agents to treat resistant streptococci. Cefixime, an orally active third-generation cephalosporin, has attracted considerable attention following the results of numerous clinical studies. Comparative studies between cefixime and conventional antibiotics for the treatment of upper respiratory tract infections and otitis media are summarized.

Topics: Cefixime; Cefotaxime; Cephalosporins; Humans; Otitis Media; Patient Compliance; Penicillin Resistance; Respiratory Tract Infections; Streptococcal Infections; Treatment Outcome

Streptococci continue to be prevalent causes of mild as well as of serious, life-threatening infections. Furthermore, some species harbor antimicrobial resistances (pneumococcus, viridans gr. streptococci) that compromise effective chemotherapy with beta-lactam drugs or other antimicrobial classes. In this study, the potency and spectrum of 12 beta-lactams was assessed versus 274 contemporary isolates of viridans group and beta-haemolytic streptococci using reference methods. Cefotaxime and ceftriaxone (MIC90s, 0.015 to 2 micrograms/ml, 84 to 100% susceptible) were consistently most potent among the agents tested. Ceftazidime (MIC90s, 0.25 to 8 micrograms/ml) and ticarcillin (MIC90s, 0.5 to > 32 micrograms/ml) were least active among the cephalosporins and penicillins, respectively. When 25% pooled serum was added to the reference test medium, ceftriaxone activity decreased fourfold, and cefotaxime remained highly active. As penicillin/beta-lactam-resistant streptococci with altered penicillin-binding protein target sites become more prevalent, only a few "third-generation" cephems seem to have sustained activity when used alone or possibly with a carefully selected co-drug. Routine testing of these species against beta-lactams and alternative drugs should be encouraged to detect emerging resistance patterns.

Topics: Ampicillin; Anti-Bacterial Agents; Cefotaxime; Ceftazidime; Ceftriaxone; Cephalosporins; Drug Resistance, Microbial; Microbial Sensitivity Tests; Penicillins; Streptococcal Infections; Streptococcus; Ticarcillin

Highly penicillin- and cephalosporin-resistant Streptococcus mitis and Streptococcus oralis were isolated in Spain, Hungary, and Berlin. With chromosomal DNA of these strains, resistant transformants of Streptococcus pneumoniae were obtained that expressed low-affinity variants of penicillin-binding proteins (PBPs) 2x, 1a, 2a, and 2b in different combinations, depending on the selective conditions. The transformants had cefotaxime MICs of up to 6 microg/mL, and those with a low-affinity PBP 2b were highly deficient in penicillin-induced lysis. Sequence analysis of the pbp2x genes confirmed the presence of a global gene pool of penicillin resistance determinants shared by commensal and pathogenic streptococci.

Topics: Amino Acid Sequence; Base Sequence; Berlin; Carrier Proteins; Cefotaxime; Cephalosporin Resistance; Cephalosporins; DNA, Bacterial; Drug Resistance, Microbial; Gene Expression; Gene Transfer Techniques; Genes, Bacterial; Humans; Hungary; Microbial Sensitivity Tests; Molecular Epidemiology; Molecular Sequence Data; Penicillin Resistance; Penicillin-Binding Proteins; Sequence Alignment; Sequence Analysis, DNA; Sequence Homology, Amino Acid; Sequence Homology, Nucleic Acid; Spain; Streptococcal Infections; Streptococcus; Streptococcus oralis; Streptococcus pneumoniae; Transformation, Genetic

A retrospective study of infants with bacterial meningitis admitted to our hospital during 1949-52, highlighted the lack of 'classical' signs of meningitis in these infants. We carried out a similar review of 44 infants aged less than three months, admitted during 1982-91. We also determined the causative organisms and their antibiotic sensitivities. Symptoms and signs were similar in the two series. Forty infants in the later series were either febrile, irritable or had seizures on the day of admission. Overall mortality fell from 30% to 11%. Between 1982 and 1991 Group B Streptocococcus and Neisseria meningitidis were the commonest causes of meningitis. All organisms, except one, were sensitive to ampicillin and/or cefotaxime. Bacterial meningitis should be suspected in young infants who are febrile, irritable or having seizures. Initial treatment with ampicillin and cefotaxime is appropriate.

Topics: Ampicillin; Cefotaxime; Fever; Humans; Infant; Infant, Newborn; Meningitis, Bacterial; Meningitis, Meningococcal; Retrospective Studies; Seizures; Streptococcal Infections; Streptococcus agalactiae

Topics: Ampicillin; Cefotaxime; Cephalothin; Female; Humans; Penicillin G; Pregnancy; Streptococcal Infections; Streptococcus agalactiae

To our knowledge, we report the first failure of cefotaxime in the treatment of meningitis due to relatively resistant Streptococcus pneumoniae (MICs of penicillin and cefotaxime, 1 microgram/mL). Cure was achieved with a 14-day course of intravenous and intrathecal vancomycin. We recommend that in cases of meningitis caused by strains of S. pneumoniae for which MICs are > or = 1 microgram/mL, cefotaxime should be used with caution; however, if therapeutic failure is suspected therapy should be changed to intravenous and intrathecal vancomycin.

Topics: Adult; Cefotaxime; Drug Resistance, Microbial; Humans; Injections, Intravenous; Injections, Spinal; Male; Meningitis, Bacterial; Penicillin Resistance; Streptococcal Infections; Streptococcus pneumoniae; Vancomycin

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

Necrotizing fasciitis is a potentially fatal, acute bacterial infection characterized by extensive fascial and subcutaneous tissue necrosis. Four factors that contribute significantly to the morbidity and mortality of necrotizing fasciitis are: 1) delayed treatment, due to difficulty in recognizing the condition; 2) inappropriate treatment; 3) host debilitation; and 4) a polymicrobial infection.

Topics: Adult; Bacteroides Infections; Candidiasis; Cefotaxime; Clindamycin; Cloxacillin; Fasciitis; Female; Focal Infection, Dental; Gentamicins; Humans; Metronidazole; Multiple Organ Failure; Neck Muscles; Necrosis; Penicillin G; Periapical Abscess; Shock, Septic; Staphylococcal Infections; Streptococcal Infections; Superinfection

In systemic and local infections, the therapeutic efficacy of cefpirome was compared to that of imipenem and cefotaxime. Murine septicemia induced with methicillin-sensitive and methicillin-resistant Staphylococcus aureus strains responded well to cefpirome and imipenem therapy, the ED50 values ranged from 0.8 to 28.40 mg/kg and 0.5 to 15.58 mg/kg, respectively. The carbapenem also displayed high efficacy against Enterococci and was more potent than cefpirome. Cefotaxime, however, exhibited lower activity or proved to be inactive against these strains. With ED50 values of 0.03 to 31.33 mg/kg, cefpirome was the most active of the three antibiotics in protecting mice challenged with Enterobacteriaceae. The corresponding ED50 values of imipenem and cefotaxime ranged from 0.72 to 70.95 mg/kg and 0.06 to 66.30 mg/kg, respectively. Despite distinctly lower in vitro activity against the infecting organism, cefpirome showed efficacy similar to imipenem in the treatment of subcutaneous S. aureus abscesses in mice. It was more effective than imipenem and cefotaxime against experimental Klebsiella pneumonia in mice and the Escherichia coli infected granuloma pouch in rats.

Topics: Abscess; Animals; Bacterial Infections; Cefotaxime; Cefpirome; Cephalosporins; Enterobacteriaceae Infections; Escherichia coli Infections; Female; Granuloma; Imipenem; Male; Mice; Mice, Hairless; Mice, Inbred C3H; Pneumonia; Rats; Rats, Inbred Strains; Sepsis; Staphylococcal Skin Infections; Staphylococcus aureus; Streptococcal Infections

Topics: Adolescent; Cefotaxime; Child; Child, Preschool; Haemophilus Infections; Haemophilus influenzae; Humans; Infant; Infant, Newborn; Pneumonia; Pneumonia, Pneumococcal; Streptococcal Infections; Streptococcus pyogenes

Cefmenoxime, a new semisynthetic cephalosporin, was evaluated in vitro and in vivo in comparison with penicillin G against a type III group B streptococcal strain. In vitro, the minimal inhibitory and minimal bactericidal concentrations of the two drugs were very close (less than or equal to 2 dilutions). In-vivo studies using experimental bacteraemia and meningitis in newborn rats revealed that despite similar drug levels, cefmenoxime had significantly greater bactericidal titres in blood at 6-7 h after administration and bacterial clearance from blood was significantly faster with cefmenoxime than with penicillin G at the end of one day of treatment. In addition, all animals with cefmenoxime therapy had bactericidal titres in cerebrospinal fluid greater than or equal to 1:8 at 1-2 h after administration, whereas most (67%) animals receiving penicillin G had titres less than 1:8. However, overall efficacy of cefmenoxime was similar to that of penicillin G. These findings suggest that cefmenoxime may be an effective alternative against group B streptococcal infection.

Topics: Animals; Cefmenoxime; Cefotaxime; Meningitis, Pneumococcal; Microbial Sensitivity Tests; Penicillin G; Rats; Sepsis; Streptococcal Infections; Streptococcus agalactiae

Intraperitoneal inoculation in mice of a S. pneumoniae type 3 in beef broth resulted in immediate growth in vivo as evidenced by bacterial counts in peritoneal washings and in blood. Treatment with penicillin 1 hour after inoculation reduced the bacterial counts in vivo; however, different doses of penicillin-G showed a similar effect as measured by bacterial counts, in spite of differences in their effect upon survival of the mice. Therefore, the effect of antibiotics in vivo in this model was better correlated with death/survival of the animals. For comparative purposes the ED50, i.e. the 50% effective dose, should be determined. The effect of cephalosporins, i.e. cefuroxime and cefotaxime, in this model highly depended upon timing of the antibiotic administration as related to inoculation.

Topics: Animals; Anti-Bacterial Agents; Cefotaxime; Cefuroxime; Dose-Response Relationship, Drug; Female; Injections, Intraperitoneal; Mice; Penicillin G; Peritoneal Cavity; Sepsis; Streptococcal Infections; Streptococcus pneumoniae; Time Factors

We evaluated the activity of BMY-28142 against a K1 E. coli strain and a type III group B streptococcal strain in vitro and in vivo and compared the results with those of cefotaxime and penicillin G, respectively. In vitro, the MICs and MBCs of BMY-28142 were close to those of cefotaxime (less than or equal to 2-fold difference) for E. coli and fourfold less than those of penicillin G for group B streptococci. In vivo studies with an experimental bacteremia and meningitis model in newborn rats revealed that the mean penetration of BMY-28142 into the cerebrospinal fluid was 15% that of concomitant levels in serum and that significantly greater bactericidal titers were achieved in blood and cerebrospinal fluid for both test organisms with BMY-28142 than with cefotaxime and penicillin G. However, the overall efficacy of BMY-28142 was similar to that of cefotaxime for the E. coli infection and that of penicillin G for the group B streptococcal infection. This was shown by similar rates of bacterial clearance from blood and cerebrospinal fluid and similar mortality rates. These findings indicate that the activity of BMY-28142 is bactericidal in vitro and in vivo against E. coli and group B streptococci, suggesting that this agent may be a suitable alternative for the therapy of E. coli and group B streptococcal bacteremia and meningitis.

Topics: Animals; Cefepime; Cefotaxime; Cephalosporins; Escherichia coli; Female; Meningitis; Microbial Sensitivity Tests; Penicillin G; Pregnancy; Rats; Rats, Inbred Strains; Sepsis; Streptococcal Infections; Streptococcus agalactiae

Cefotaxime has little antimicrobial activity in vitro against most strains of enterococci, as measured by conventional MICs and MBCs. However, the MICs of cefotaxime against many enterococci are markedly reduced by the addition of serum to the test medium. To assess the relevance of this observation in vivo, we examined the efficacy of cefotaxime in experimental Streptococcus faecalis endocarditis. Since response to antimicrobial agents may vary with the degree of vegetation development, therapeutic efficacy was assessed both in rabbits with newly formed vegetations and in rabbits with well-developed endocardial lesions. Peak serum levels of cefotaxime (50.1 +/- 20.0 micrograms/ml) exceeded the MIC in medium supplemented with serum (4 micrograms/ml), but not in Mueller-Hinton broth alone (greater than 64 micrograms/ml). After 4 days of therapy, animals with newly formed lesions (therapy initiated 1 h after infection, transvalvular catheters removed) had lower mean vegetation bacterial titers than did untreated controls. Among animals with mature vegetations (therapy initiated 12 h after infection, catheters indwelling), the rate of mortality was significantly reduced by cefotaxime therapy. However, no difference in vegetation titers was observed. Thus, cefotaxime demonstrated antienterococcal activity within newly formed vegetations, but did not inhibit bacterial proliferation within well-established vegetations.

Topics: Animals; Cefotaxime; Endocarditis, Bacterial; Enterococcus faecalis; Heart Valve Diseases; Microbial Sensitivity Tests; Rabbits; Streptococcal Infections

Topics: Cefotaxime; Child, Preschool; Chloramphenicol; Humans; Male; Meningitis; Penicillin Resistance; Streptococcal Infections; Streptococcus pneumoniae

The third-generation cephalosporins as a group are characterized by spectra of activity that are the broadest of the currently available antibiotics (Farber and Moellering, 1982). These agents provide excellent coverage of infections due to Enterobacteriaceae. They also exhibit good (but variable) activity against a number of "nonfermentors" such as Pseudomonas aeruginosa, and many of them are likewise active against anaerobes, including Bacteroides fragilis (Farber and Moellering, 1982). As a class, the third generation cephalosporins are less active against gram-positive organisms, but in spite of this they have been clinically effective against infections due to S. aureus and many other gram-positive cocci (Saito, 1982). Enterococci, however, have proven to be a difficult organism for the third-generation cephalosporins. None of the presently available compounds exhibits very good activity against these organisms in vitro (Fass, 1983). Given this fact and the broad spectrum of activity of these compounds against other organisms, there is a significant potential for enterococcal superinfection in patients treated with the third-generation cephalosporins. Indeed, serious enterococcal infection has clearly been documented in patients treated with some third-generation cephalosporins (Moellering, 1982; Yu, 1981). Although none of the presently available third-generation cephalosporins exhibits therapeutically useful activity against enterococci, currently available data suggest that there may be differences among these compounds in their ability to cause (or prevent) this complication. For instance, there are more published reports of enterococcal superinfection in patients treated with moxalactam than in patients receiving the other third-generation cephalosporins.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Blood; Cefotaxime; Culture Media; Drug Resistance, Microbial; Humans; Microbial Sensitivity Tests; Streptococcal Infections; Streptococcus

The in vivo activity of cefodizime (HR 221) was compared with that of cefotaxime (CTX), cefmenoxime, latamoxef, cefazolin and cefmetazole (CMZ). The protective effects of HR 221 on experimental infections in mice caused by Staphylococcus aureus Smith, Escherichia coli C-11, Proteus vulgaris GN-76 and Serratia marcescens No. 2 were directly related to its in vitro activity against these strains. In contrast, the compound showed the smallest ED50 values, among the 5 antibiotics tested (not including CMZ), for Klebsiella pneumoniae 3K-25 and Pseudomonas aeruginosa PI 67 against which it had relatively low in vitro activity, and its ED50 for Citrobacter freundii GN-346 was as small as 1.821 mg/mouse in spite of its MIC of greater than 100 micrograms/ml. HR 221 exerted potent bactericidal activity against Streptococcus pneumoniae Sp-1 inoculated into the mouse lung; the duration of action was prolonged. When tested against the E. coli Ec-89 infection induced in the rat uterus, the activity of HR 221 given to rats once daily was equal to that of CTX or CMZ given at the same dose twice daily.

Topics: Animals; Cefmetazole; Cefotaxime; Cephamycins; Klebsiella Infections; Male; Mice; Mice, Inbred ICR; Rats; Rats, Inbred Strains; Staphylococcal Infections; Streptococcal Infections

The in vitro activity of new cephalosporins, oxacephems and penicillins against pathogens involved in respiratory and gastrointestinal tract infections is practically equivalent. However, in experimental infections with the same pathogens the superior efficacy of ceftriaxone over all comparative cephems and penicillins, expressed in low 50% effective doses after multiple and particularly after single dosage schedules, and caused by a longer maintenance of blood and tissue levels can be demonstrated. Although mice have an altered pharmacokinetics these experimental results reflect the observed clinical advantage of ceftriaxone in human infections: long plasma half-life, low dosage and single daily administration.

Topics: Animals; Anti-Bacterial Agents; Bacteria; Cefotaxime; Ceftriaxone; Dose-Response Relationship, Drug; Haemophilus Infections; Metabolic Clearance Rate; Mice; Microbial Sensitivity Tests; Salmonella Infections; Streptococcal Infections

The efficacy of ceftriaxone against group B streptococci was studied in vitro and in vivo with an infant rat model of group B streptococci bacteraemia and meningitis. Twenty-four strains demonstrated minimal inhibitory concentrations of ceftriaxone of 0 . 05-0 . 1 mg/l and minimal bactericidal concentrations of 0 . 1-0 . 4 mg/l. Four strains were selected to induce bacteraemia and meningitis in infant rats by intraperitoneal inoculation. All 45 bacteraemic animals with or without meningitis that were treated with ceftriaxone 2 mg/kg/dose every eight hours for five doses survived, while all 12 control animals died (P less than 0 . 001). When recultured 54 h after the last dose of ceftriaxone, both CSF and blood remained sterile in all treated animals. These results indicate group B streptococci to be sensitive to ceftriazone in vitro and that, in the low dosage used, ceftriaxone effectively eradicates group B streptococcal bacteraemia and meningitis in infant rats.

Topics: Animals; Animals, Newborn; Cefotaxime; Ceftriaxone; Meningitis; Microbial Sensitivity Tests; Rats; Rats, Inbred Strains; Sepsis; Streptococcal Infections; Streptococcus agalactiae

Aortic valve endocarditis due to a penicillin G (PNC) and ceftizoxime (CZ)-sensitive group B streptococcus (GBS) was induced in 72 rabbits. Animals received either procaine PNC (300 mg/kg per day) or CZ (150 mg/kg/day) for 3, 6, or 9 days. PNC rapidly sterilized blood cultures (less than or equal to 3 days) and significantly reduced vegetation GBS titers versus controls at all three sacrifice times (p less than 0.0005). In contrast, CZ exerted a slow in vivo bactericidal effect with vegetation titers not significantly different from controls until day 9 of therapy. By day 9 of therapy, 65/89 (73%) of vegetations were sterilized by PNC versus only 24/94 (26%) sterilized by CZ (p less than 0.0005). This marked in vitro-in vivo disparity in CZ-treated animals occurred despite 100% of individual serum bactericidal titers greater than or equal to 1:32 and 100% of individual CZ serum levels greater than or equal to 100 times the GBS MBC. The suboptimal CZ in vivo effect was not related to: (1) development of CZ resistance on therapy; (2) CZ inactivation, or (3) inoculum-growth phase effect.

Topics: Animals; Cefotaxime; Ceftizoxime; Endocarditis, Bacterial; Female; Microbial Sensitivity Tests; Penicillin G; Rabbits; Streptococcal Infections; Streptococcus agalactiae; Time Factors

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

From 1979 to 1982, a large number of freshly isolated strains of bacteria were investigated at our institute with regard to their sensitivity to cefotaxime in comparison to other antibiotics. The isolates came from 42 clinics in the Rhine-Main region. The results of the investigations demonstrate that cefotaxime, due to its high stability against beta-lactamases, has advantages over to older cephalosporins, and even cefoperazon and cefoxitin. Despite increased use of cefotaxime, there was no change in the sensitivity of the organisms from 1979 to 1982.

Topics: Cefotaxime; Cefoxitin; Cephalosporins; Enterobacteriaceae; Enterobacteriaceae Infections; Humans; In Vitro Techniques; Microbial Sensitivity Tests; Moxalactam; Penicillin Resistance; Penicillins; Streptococcal Infections; Streptococcus

We studied the pharmacokinetics and efficacy of cefotaxime in 32 neonates with severe gram-negative infections. Many of these patients had been treated unsuccessfully with combinations of antibiotics. Eighty-one percent of these patients were cured, 6% improved, and 13% had treatment failures; there were three deaths. Eighteen patients received cefotaxime alone; 16 were cured and two improved. These data indicate an efficacy of cefotaxime sufficient to warrant more rigorous future trials. The elimination half-life of cefotaxime ranged from 2.0 +/- 0.4 hours in term neonates more than one week of age to 5.7 +/- 0.8 hours in preterm neonates less than one week of age. A volume of distribution of approximately 0.63 L was similar for all infants irrespective of age and maturity. These kinetic data can be used in design of future therapeutic regimens in more rigidly controlled trials assessing indications for cefotaxime therapy in neonates. We recommend dosing as follows, using a dose of 25 mg/kg: every 12 hours for preterm infants less than one week of age, every 8 hours for preterm infants one to four and term infants less than one week of age, and every 6 hours for term infants more than one week of age.

Topics: Bacterial Infections; Cefotaxime; Enterobacteriaceae Infections; Humans; Infant, Newborn; Infant, Newborn, Diseases; Kinetics; Models, Biological; Pseudomonas Infections; Staphylococcal Infections; Streptococcal Infections

Topics: Aged; Cefotaxime; Drug Resistance, Microbial; Female; Humans; Meningitis; Streptococcal Infections; Streptococcus pyogenes

Thirty-nine patients, 17 to 80 years old, were admitted to a pneumology department. The diagnosis was acute serious or severe respiratory tract infection in 25 patients, exacerbation of chronic bronchopulmonary infection in 6, purulent pneumonia in 4, purulent bronchitis in 4. 28 infecting organisms were identified: Gram-positive cocci (Pneumococcus: 6, Streptococcus: 8. Staphylococcus: 1) and 6 Haemophilus influenzae (3 of which were associated with 1 Pneumococcus) 7 Enterobacteria (isolated or associated). Local, biological and systemic tolerance was generally very good in the majority of patients. Cefotaxime at a daily dose of 2 g intramuscularly for 12 days, showed very good efficacy in the treatment of various bacterial infections of the lower respiratory tract. The activity was evident against a variety of organisms in respiratory infections. The in vitro results of the antibiogram which indicated a superiority of cefotaxime in some cases on other antibiotics currently used in these indications were confirmed by the clinical results.

Topics: Adolescent; Adult; Aged; Bronchitis; Cefotaxime; Cephalosporins; Enterobacteriaceae Infections; Female; Haemophilus Infections; Humans; Male; Middle Aged; Pneumonia; Staphylococcal Infections; Streptococcal Infections

The activities of moxalactam and cefotaxime, alone and combined with ampicillin or penicillin, against 40 isolates of group B streptococci were assessed by using the microtiter broth dilution, checkerboard, and time-kill techniques. Penicillin and cefotaxime were bactericidal for all isolates at concentrations of 0.06 micrograms/ml or less. Ampicillin was slightly less active. Moxalactam was bactericidal for all strains at concentrations of 4 to 8 micrograms/ml. The ampicillin- moxalactam combination was partially synergistic for 60% of the isolates tested; the ampicillin-cefotaxime combination was partially synergistic for 35% of these isolates. No instances of antagonism were observed. In time-kill evaluations, ampicillin (3.0 micrograms/ml) and penicillin (0.75 micrograms/ml) effected 2.5 to 3.5 log10 reductions in numbers of colony-forming units. The addition of 4 micrograms of cefotaxime per ml or 8 to 16 micrograms of moxalactam per ml to penicillin or ampicillin did not alter killing kinetics. Moxalactam and cefotaxime neither enhanced nor decreased the activity of ampicillin or penicillin against group B streptococci.

Topics: Ampicillin; Cefotaxime; Cephalosporins; Cephamycins; Drug Synergism; Humans; Moxalactam; Penicillin G; Penicillin Resistance; Streptococcal Infections; Streptococcus agalactiae