cefoxitin and Candidiasis

The recovery of Candida albicans along with bacteria from the abdomen in the setting of peritonitis is becoming increasingly common. It is not known whether the interactions between the fungal and bacterial elements of these infections are synergistic, competitive, or neutral. To study this question, we have examined the effects of both the addition of C. albicans to a solely bacterial infection caused by Escherichia coli and Bacteroides fragilis, and the deletion of various components of this system using directed antimicrobial therapy. In a mixed infection, both C. albicans and bacteria contributed to mortality, since only the combination of cefoxitin and amphotericin B improved survival (from 50% to 90%). The addition of C. albicans to the bacterial inoculum increased the recovery of abscesses, but only to the number seen with fungal infection alone, implying two fairly independent processes. Although the number of bacteria recovered from abscesses at 10 days postinfection was unchanged with the addition of fungi, the deletion of the bacterial component of mixed infections led to the overgrowth of C. albicans. We conclude that this model of mixed C. albicans/E. coli/B. fragilis peritonitis is best characterized as two nonsynergistic, parallel infections with incomplete competition, allowing the survival of all three organisms to eventual abscess formation.

Topics: Abscess; Amphotericin B; Animals; Bacteroides fragilis; Bacteroides Infections; Candida albicans; Candidiasis; Cefotetan; Cefoxitin; Clindamycin; Colony Count, Microbial; Drug Combinations; Escherichia coli; Escherichia coli Infections; Male; Mice; Mice, Inbred BALB C; Peritoneal Diseases; Peritonitis; Survival Rate

The clinical significance of a concomitant, non-specific influence of antibiotics on immune defence mechanisms was studied by evaluating the death rate in mice experimentally infected with highly resistant or primarily resistant microorganisms. It could be shown that the mortality rate of mice infected with Enterobacter cloacae or Candida albicans significantly increased under treatment with cefoxitin, whereas treatment with cefotaxine or lamoxactam either had no effect, or even resulted in a better survival rate in comparison to controls. These results run parallel to an inhibition (cefoxitin) or stimulation (cefotaxime and lamoxactam) of antibody production. The effect of cefoxitin on the course of experimental infections could be compensated for by the concomitant application of sodium-8-chlorotheophyllinate which promotes antibody formation. None of these antibiotics showed any additional effect in animals treated with cyclophosphamide. From these observations it was concluded that the influence of antibiotics on certain immunological parameters assayed in vitro may be reflected in comparable effects on the course of infections in vivo; this implies that under certain clinical conditions, the immunological side-effects of antibiotics may be of practical therapeutic significance.

Topics: Animals; Anti-Bacterial Agents; Antibody Formation; Candidiasis; Cefotaxime; Cefoxitin; Cephamycins; Cyclophosphamide; Drug Therapy, Combination; Enterobacter; Enterobacteriaceae Infections; Infections; Male; Mice; Mice, Inbred BALB C; Moxalactam; Theophylline