cefoxitin and Cross-Infection

The different patterns of pneumonia are classified and show the various manifestations of the disease, indicating the necessary specific diagnostic procedures. Only by description and recognition of the possible pathogenic agents, an adequate therapy can be initiated as described in the last chapter.

Topics: Aminoglycosides; Amoxicillin; Anti-Bacterial Agents; Antibodies, Bacterial; Antibody Specificity; Biopsy; Cefoxitin; Cephalosporins; Clindamycin; Cross Infection; Erythromycin; Humans; Legionnaires' Disease; Lung; Metronidazole; Penicillin G; Pneumonia; Radiography, Thoracic; Serologic Tests; Sputum; Tetracycline

Today, however aminoglycosides are nearly indispensable owing to their broad antibacterial spectrum and genuine bactericidal effect as well as the possible synergic effect with beta-lactam preparations. The new cephalosporins are distinguished by a high beta-lactam stability and are active against the majority of pathogens causing nosocomial infections. An exceptional position is held by cefotaxim with its generally outstanding antibacterial potency, and by cefoxitin with its activity against Bacteroides fragilis. The ureidopenicillin azlocillin is superior to the Pseudomonas penicillins so far used. It acts against enterococci and H. influenzae as reliably as does mezlocillin.

Topics: Aminoglycosides; Anti-Bacterial Agents; Bacteroides; beta-Lactamases; Cefoxitin; Cephalosporins; Cross Infection; Drug Resistance, Microbial; Enterobacteriaceae; Haemophilus influenzae; Humans; Surgical Wound Infection

In a randomized multicenter clinical trial on antibiotic prophylaxis, 1,319 patients in 23 ICUs were enrolled over a 4-month period. The end-point of the study was the prevention of early onset pneumonia (EOP), defined as acquired pneumonia diagnosed within 4 days of ICU admission; this accounted for greater than 50% of overall pneumonia. Patients eligible for the study were divided into three groups which received either cefoxitin (2 g iv for three doses/8 h), penicillin G (2 million U iv for four doses/6 h), or no antibiotic (control group). In the overall population, the incidence of EOP was 6.1% in the prophylaxis recipients vs. 7.2% in the control group (a 15.3% reduction). No statistically different rates of pneumonia or death were found among the groups. Patients with impaired reflexes on admission or prolonged ventilatory support were noted to have a lower incidence of EOP and an improved outcome when treated with cefoxitin.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Cefoxitin; Child; Child, Preschool; Clinical Trials as Topic; Cross Infection; Female; Humans; Infant; Intensive Care Units; Male; Middle Aged; Multicenter Studies as Topic; Penicillin G; Pneumonia; Premedication; Random Allocation

Two hundred eighty-seven women were treated in a multicenter, randomized, comparative study to compare the safety and efficacy of cefotetan every 12 hours with that of cefoxitin every 6 or 8 hours in the treatment of acute obstetric and gynecologic pelvic infections. The most frequent primary diagnoses in both groups were endometritis and pelvic inflammatory disease; 24 of these patients were also bacteremic. The mean duration of treatment was 5.2 and 5.4 days for the cefotetan and cefoxitin groups, respectively, and the total doses administered were 18.1 and 32.1 gm, respectively. The rate of clinical failure for the cefotetan group was 8.5% and 12.2% for the cefoxitin group. Laboratory and clinical adverse reactions were infrequent and none was serious; both antimicrobials were well tolerated. These results suggest the administration of cefotetan provided adequate clinical and bacteriologic effectiveness in the treatment of hospital- and community-acquired, polymicrobial obstetric and gynecologic pelvic infections.

Topics: Acute Disease; Adult; Bacterial Infections; Cefotetan; Cefoxitin; Cephamycins; Clinical Trials as Topic; Cross Infection; Endometritis; Female; Genital Diseases, Female; Humans; Pelvic Inflammatory Disease; Random Allocation

The Authors illustrate the results obtained in treatment of various types of infection in patients hospitalised in an intensive care surgical department with cephoxitin, a new semisynthetic antibiotic derivate of the cephalosporin group. In view of the severity of the treated cases, the Authors consider the results obtained to be satisfactory.

Topics: Adult; Aged; Bacterial Infections; Cefoxitin; Clinical Trials as Topic; Cross Infection; Female; Humans; Intensive Care Units; Male; Middle Aged; Postoperative Complications; Respiratory Tract Infections; Surgical Wound Infection; Urinary Tract Infections

Methicillin-resistant Staphylococcus aureus (MRSA) is a significant pathogen causing both healthcare-associated and community-acquired infection. Rapid and accurate detection of this pathogen is crucial for the use of appropriate antimicrobial therapy and the control of nosocomial spread.. A total of 107 S. aureus strains were assayed for methicillin resistance: Vitek2® (bioMérieux), CHROMagarTM MRSA II (BD Becton Dickinson), disk diffusion in agar for cefoxitin 30 μg and immunochromatography PBP2a SA Culture Colony Test (AlereTM). The results of conventional tests were compared with the "gold standard" PCR test for mecA gene.. Sensitivity and specificity were: disk diffusion for cefoxitin 100% and 100% respectively, Vitek2® 100 and 100%, CHROMagarTM MRSA II 100 and 96%, and ICPBP2a detection 98,25% and 100%.. ICPBP2a Culture Colony Test (AlereTM) is fast, efficient and economical technique for detection of penicillin binding protein 2a (PBP2a) from isolates. This assay is a useful tool for the management of hospital outbreaks.

Topics: Anti-Bacterial Agents; Bacterial Proteins; Bacteriological Techniques; Cefoxitin; Community-Acquired Infections; Cross Infection; Culture Media; Disk Diffusion Antimicrobial Tests; Humans; Immunoassay; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Penicillin-Binding Proteins; Polymerase Chain Reaction; Sensitivity and Specificity

The emergence of extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) infections requires re-assessment of therapeutic choices. Here we report the efficacy of cefoxitin-based antibiotic therapy for ESBL-E prostatitis. A prospective study including patients with ESBL-E prostatitis resistant to trimethoprim/sulfamethoxazole and fluoroquinolones from January 2014 to March 2016 was conducted. Cefoxitin was administered by continuous infusion for 3 weeks in the case of acute bacterial prostatitis or 6 weeks in the case of chronic bacterial prostatitis (CBP), with intravenous fosfomycin for the first 5 days. Urological investigations were performed to diagnose underlying urinary tract pathology. Clinical and microbiological efficacy were evaluated 3 months (M3) and 6 months (M6) after the end of therapy. A total of 23 patients were included in the study. The median patient age was 74 years (range 48-88 years). Of the 23 infections, 14 (61%) were CBP and 12 (52%) were healthcare-associated infections. The bacteria involved were Escherichia coli in 11 cases, Klebsiella pneumoniae in 10 cases and Klebsiella oxytoca in 2 cases. Clinical cure was observed in 19/23 patients (83%) at M3 and in 17/22 patients (77%) at M6. Urocultures were sterile in 13/23 patients (57%) at M3 and in 9/19 patients (47%) and M6. Urinary colonisation was observed in 6/19 patients (32%) with clinical cure at M3 and 5/14 patients (36%) with clinical cure at M6. No resistance to cefoxitin was detected. Surgical treatment was required for 7/23 patients (30%). In conclusion, cefoxitin-based antibiotic therapy is suitable for difficult-to-treat ESBL-E infections such as prostatitis.

Topics: Aged; Aged, 80 and over; Anti-Bacterial Agents; beta-Lactamases; Cefoxitin; Cross Infection; Escherichia coli; Escherichia coli Infections; Fluoroquinolones; Fosfomycin; Humans; Klebsiella Infections; Klebsiella oxytoca; Klebsiella pneumoniae; Male; Microbial Sensitivity Tests; Middle Aged; Pilot Projects; Prospective Studies; Prostatitis; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Here, 210 healthy participants including community personnel (70), clinical students (68), and healthcare workers (HCWs) (72) from the eastern region of Saudi Arabia were studied. Sixty-three

Topics: Adult; Anti-Bacterial Agents; Cefoxitin; Cross Infection; Female; Health Personnel; Humans; Male; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Middle Aged; Nasal Cavity; Saudi Arabia; Staphylococcal Infections; Students; Young Adult

β-lactam antibiotics target penicillin-binding proteins (PBPs) preventing peptidoglycan synthesis and this inhibition is circumvented in methicillin resistant Staphylococcus aureus (MRSA) strains through the expression of an additional PBP, named PBP2A. This enzyme is encoded by the mecA gene located within the Staphylococcal Chromosome Cassette mec (SCCmec) mobile genetic element, of which there are 12 types described to date. Previous investigations aimed at analysing the synergistic activity of two β-lactams, oxacillin and cefoxitin, found that SCCmec type IV community-acquired MRSA strains exhibited increased susceptibility to oxacillin in the presence of cefoxitin, while hospital-acquired MRSA strains were unaffected. However, it is not clear if these differences in β-lactam resistance are indeed a consequence of the presence of the different SCCmec types. To address this question, we have exchanged the SCCmec type I in COL (HA-MRSA) for the SCCmec type IV from MW2 (CA-MRSA). This exchange did not decrease the resistance of COL against oxacillin and cefoxitin, as observed in MW2, indicating that genetic features residing outside of the SCCmec element are likely to be responsible for the discrepancy in oxacillin and cefoxitin synergy against these MRSA strains.

Topics: Cefoxitin; Community-Acquired Infections; Cross Infection; DNA, Bacterial; Drug Resistance, Bacterial; Drug Synergism; Humans; Interspersed Repetitive Sequences; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Oxacillin; Sequence Analysis, DNA; Staphylococcal Infections

To describe the epidemiology and susceptibility of pathogens (including ESBL producers) from hospital-acquired (HA) versus community-acquired (CA) urinary tract infections (UTIs) and ICU- versus non-ICU-associated intra-abdominal infections (IAIs) in Turkey as a part of the SMART study.. : For this report, Gram-negative pathogens (363 from UTIs and 458 from IAIs) were collected in 2011 and 2012 at six hospitals in Turkey. HA versus CA UTIs and ICU- versus non-ICU-associated IAIs were compared for the species isolated, percentage of ESBL-positive isolates by species and susceptibility for overall and individual Gram-negative species.. : Escherichia coli was the most common pathogen identified in HA (40.2%) and CA (73.9%) UTIs and ICU-associated (25.8%) and non-ICU-associated (43.3%) IAIs. The rate of ESBL-positive E. coli was significantly higher in HA than in CA UTIs (50.5% versus 38.2%, P  <   0.001) and in non-ICU-associated than in ICU-associated IAIs (52.5% versus 29.2%, P  = 0.029). Of the drugs studied, only amikacin was active against ≥90% of pathogens in UTIs, while ertapenem, imipenem and amikacin were active against ≥90% of E. coli ; and imipenem, amikacin and cefoxitin were active against ≥90% of Klebsiella pneumoniae in IAIs.. Our findings demonstrated that E. coli continues to be the principal pathogen of UTIs and IAIs in Turkey. Along with a high rate of ESBL-positive isolates, high antimicrobial resistance among Gram-negative bacilli from either UTIs or IAIs was noted particularly in the case of HA UTIs and ICU-associated IAIs, with a higher likelihood of carbapenem- or amikacin-based therapy to provide the broadest activity against bacterial pathogens.

Topics: Amikacin; Anti-Bacterial Agents; beta-Lactams; Carbapenems; Cefoxitin; Community-Acquired Infections; Cross Infection; Enterobacteriaceae; Ertapenem; Escherichia coli; Humans; Imipenem; Intensive Care Units; Intraabdominal Infections; Klebsiella pneumoniae; Microbial Sensitivity Tests; Turkey; Urinary Tract Infections

To evaluate the antimicrobial susceptibility of Gram-negative bacilli that caused hospital-acquired and community-acquired intra-abdominal infections (IAIs) in China between 2012 and 2013, we determined the susceptibilities to 12 antimicrobials and the extended-spectrum β-lactamase (ESBL) statuses of 3,540 IAI isolates from seven geographic areas in China in a central laboratory using CLSI broth microdilution and interpretive standards. Most infections were caused by Escherichia coli (46.3%) and Klebsiella pneumoniae (19.7%). Rates of ESBL-producing E. coli (P = 0.031), K. pneumoniae (P = 0.017), and Proteus mirabilis (P = 0.004) were higher in hospital-acquired IAIs than in community-acquired IAIs. Susceptibilities of enterobacteriaceae to ertapenem, amikacin, piperacillin-tazobactam, and imipenem were 71.3% to 100%, 81.3% to 100%, 64.7% to 100%, and 83.1% to 100%, respectively, but imipenem was ineffective against P. mirabilis (<20%). Although most ESBL-positive hospital-acquired isolates were resistant to third- and fourth-generation cephalosporins, the majority were susceptible to cefoxitin (47.9% to 83.9%). Susceptibilities of ESBL-positive isolates to ampicillin-sulbactam (<10%) were low, whereas susceptibilities to ciprofloxacin (0% to 54.6%) and levofloxacin (0% to 63.6%) varied substantially. The prevalences of cephalosporin-susceptible E. coli and K. pneumoniae were higher in the northeastern and southern regions than in the central and eastern regions, reflecting the ESBL-positive rates in these areas, and were lowest in the Jiangsu-Zhejiang (Jiang-Zhe) area where the rates of carbapenem resistance were also highest. Ertapenem, amikacin, piperacillin-tazobactam, and imipenem are the most efficacious antibiotics for treating IAIs in China, especially those caused by E. coli or K. pneumoniae. Resistance to cephalosporins and carbapenems is more common in the Jiang-Zhe area than in other regions in China.

Topics: Amikacin; Ampicillin; Anti-Bacterial Agents; beta-Lactamases; beta-Lactams; Cefoxitin; China; Ciprofloxacin; Community-Acquired Infections; Cross Infection; Drug Resistance, Multiple, Bacterial; Enterobacteriaceae; Enterobacteriaceae Infections; Ertapenem; Gene Expression; Humans; Imipenem; Intraabdominal Infections; Levofloxacin; Microbial Sensitivity Tests; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination; Sulbactam

Community and nosocomial infections by Pseudomonas aeruginosa still create a major therapeutic challenge. The resistance of this opportunist pathogen to β-lactam antibiotics is determined mainly by production of the inactivating enzyme AmpC, a class C cephalosporinase with a regulation system more complex than those found in members of the Enterobacteriaceae family. This regulatory system also participates directly in peptidoglycan turnover and recycling. One of the regulatory mechanisms for AmpC expression, recently identified in clinical isolates, is the inactivation of LMM-PBP4 (Low-Molecular-Mass Penicillin-Binding Protein 4), a protein whose catalytic activity on natural substrates has remained uncharacterized until now.. We carried out in vivo activity trials for LMM-PBP4 of Pseudomonas aeruginosa on macromolecular peptidoglycan of Escherichia coli and Pseudomonas aeruginosa. The results showed a decrease in the relative quantity of dimeric, trimeric and anhydrous units, and a smaller reduction in monomer disaccharide pentapeptide (M5) levels, validating the occurrence of D,D-carboxypeptidase and D,D-endopeptidase activities. Under conditions of induction for this protein and cefoxitin treatment, the reduction in M5 is not fully efficient, implying that LMM-PBP4 of Pseudomonas aeruginosa presents better behaviour as a D,D-endopeptidase. Kinetic evaluation of the direct D,D-peptidase activity of this protein on natural muropeptides M5 and D45 confirmed this bifunctionality and the greater affinity of LMM-PBP4 for its dimeric substrate. A three-dimensional model for the monomeric unit of LMM-PBP4 provided structural information which supports its catalytic performance.. LMM-PBP4 of Pseudomonas aeruginosa is a bifunctional enzyme presenting both D,D-carboxypeptidase and D,D-endopeptidase activities; the D,D-endopeptidase function is predominant. Our study provides unprecedented functional and structural information which supports the proposal of this protein as a potential hydrolase-autolysin associated with peptidoglycan maturation and recycling. The fact that mutant PBP4 induces AmpC, may indicate that a putative muropeptide-subunit product of the DD-EPase activity of PBP4 could be a negative regulator of the pathway. This data contributes to understanding of the regulatory aspects of resistance to β-lactam antibiotics in this bacterial model.

Topics: Anti-Bacterial Agents; Bacterial Proteins; beta-Lactam Resistance; beta-Lactams; Carboxypeptidases; Cefoxitin; Cross Infection; DNA, Bacterial; Endopeptidases; Enzyme Activation; Escherichia coli; Escherichia coli Proteins; Models, Molecular; Penicillin-Binding Proteins; Peptidoglycan; Pseudomonas aeruginosa; Recombinant Proteins

Topics: Acinetobacter; Bacterial Proteins; beta-Lactamases; Cefoxitin; Cross Infection; Disk Diffusion Antimicrobial Tests; Drug Resistance, Bacterial; Humans

Staphylococcus aureus infections are increasingly reported from both health institutions and communities around the world. In particular, infections due to methicillin-resistant Staphylococcus aureus (MRSA) strains have been detected worldwide. If MRSA becomes the most common form of S. aureus in a community, it makes the treatment of common infections much more difficult. But, report on the current status of community acquired MRSA in the study area is scanty.. Community-based cross sectional study was conducted to evaluate the current prevalence and antibiotic susceptibility pattern of MRSA among primary school children and prisoners in Jimma town. MRSA was detected using Cefoxitin (30μg) disc; and epidemiologic risk factors were assessed using pre-designed questionnaires distributed to the children's parents and prisoners. A total of 354 nasal swabs were collected from primary school children and prisoners from December 2010 to March 2011 following standards microbiological methods.. A total of 169 S. aureus isolates were recovered. The overall prevalence of MRSA among the study population was 23.08 % (39/169). Specifically, the prevalence of MRSA among primary school children and prisoners were 18.8% (27/144) and 48% (12/25), respectively. The isolated S. aureus and MRSA displayed multiple drug resistance (MDR) to 2 to 10 antibiotics. The most frequent MDR was Amp/Bac/Ery/Pen/Fox (resistance to Ampicillin, Bacitracin, Erythromycin, Penicillin, and Cefoxitin).. The present study revealed that MRSA could be prevalent in the healthy community, transmitted from hospital to the community. The high distribution of MRSA could be favored by potential risk factors. Thus, for comprehensive evaluation of the current prevalence of MRSA and design control measures, consideration need to be given to the healthy community besides data coming from health institutions.

Topics: Adolescent; Adult; Ampicillin; Anti-Bacterial Agents; Carrier State; Cefoxitin; Child; Child, Preschool; Cross Infection; Cross-Sectional Studies; Drug Resistance, Multiple, Bacterial; Ethiopia; Female; Humans; Male; Methicillin Resistance; Methicillin-Resistant Staphylococcus aureus; Prevalence; Prisoners; Risk Factors; Schools; Staphylococcal Infections; Students; Surveys and Questionnaires; Young Adult

In vitro studies demonstrate that oxacillin minimal inhibitory concentrations (MICs) of methicillin-resistant S. aureus (MRSA) strains USA300 and 400 decrease in the presence of cefoxitin. The aim of this study was to characterize the activity of cefoxitin plus β-lactams against a collection of MRSA isolates. We assessed the in vitro antimicrobial activity of a selection of β-lactams alone and together with subinhibitory concentrations of cefoxitin against a collection of MRSA, methicillin-susceptible S. aureus (MSSA), and vancomycin-intermediate S. aureus (VISA) isolates using MICs and time kill assays. For community-associated (CA) MRSA strains USA300 and USA400, MICs of nafcillin, cefazolin, cephalexin, cefuroxime, ceftriaxone and cefotaxime decreased by 8- to 64-times in the presence of 10 μg/ml cefoxitin. In contrast, for hospital-associated (HA) strains COLn, N315, and Mu50, there was no change in any β-lactam MIC in the presence of cefoxitin. When combined with cefoxitin, the cephalexin MIC decreased for eight CA-MRSA and five MSSA sequence types but did not change for seven HA-MRSA sequence types. β-lactam/cefoxitin combinations were synergistic against CA- but not HA-MRSA strains in time kill assays. Cefoxitin combined with a variety of β-lactams enhances their activity against CA-MRSA strains in vitro. Further studies of combination β-lactam therapy may provide insight into β-lactam biology, penicillin binding protein cooperativity, and novel therapeutic strategies against MRSA.

Topics: beta-Lactams; Cefoxitin; Community-Acquired Infections; Cross Infection; Drug Synergism; Humans; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Staphylococcal Infections

Topics: Aged; Anti-Bacterial Agents; Bacteremia; Bacterial Proteins; beta-Lactam Resistance; beta-Lactamases; Catheter-Related Infections; Cefoxitin; Cross Infection; Diarrhea; Drug Resistance, Multiple, Bacterial; Drug Therapy, Combination; Enterococcus faecalis; Glycopeptides; Humans; Klebsiella Infections; Klebsiella pneumoniae; Male; Pancreatic Neoplasms; Pneumonia, Bacterial; Postoperative Complications; Prostatitis; Substrate Specificity; Urinary Catheterization

Plasmid mediated AmpC β-lactamase (PMABL) resistance in Escherichia coli and Klebsiella spp. is an emerging problem worldwide. Phenotypic methods are commonly used for detection of PMABL production in Gram-negative isolates, but molecular data about the prevalence of plasmid-mediated AmpC-type resistance at the national level are needed. Hence, a prospective study was undertaken to determine the occurrence of PMABL gene and its types among clinical isolates of E. coli and K. pneumoniae obtained from six different hospitals in India.. A total of 241 nosocomial isolates of K. pneumoniae (n=109) and E.coli (n=132) from six geographically distant hospitals in India were included. These were screened for cefoxitin resistance. AmpC disk test and modified three dimensional extraction test were used for phenotypic detection of PMABL production. Molecular types were determined by a multiplex PCR.. Among the 241 isolates, 187 (77.5%) were found to be cefoxitin resistant (K. pneumoniae n=83, E. coli n=104). AmpC activity was detectable in 153 (63.4%) isolates, (K. pneumoniae n=69, E. coli n=84). By PCR, the plasmid encoded AmpC genes were found in 92 (38.1%) isolates and the molecular types of the genes detected predominantly were DHA, CIT followed by MOX and ACC types.. A high percentage of plasmid-encoded AmpC enzymes was noted in E. coli and K. pneumonia isolates obtained from different parts of the country. Phenotypic methods alone may not reflect the true number of PMABL producers. Genotypic methods need to be employed in national surveillance studies.

Topics: Anti-Bacterial Agents; Bacterial Proteins; beta-Lactam Resistance; beta-Lactamases; Cefoxitin; Cross Infection; Escherichia coli; Hospitals; Humans; India; Klebsiella pneumoniae; Plasmids

The dynamics of isolation of staphylococci and enterococci from clinical material of patients and their antibiotic susceptibility within a 5-year period (2005-2009) was analysed. 5990 isolates were tested: 1250 isolates of Staphylococcus aureus, 3268 isolates of S. epidermidis, 1005 isolates of Enterococcus faecalis and 467 isolates of E. faecium. Grampositive infections were shown to be prevailing within the last 2-3 years, the nosocomial epidermal staphylococci more and more replacing S. aureus (the ratio of S. epidermidis and S. aureus in 2009 was 3.3). The isolation rate of E. faecalis significantly increased (by 3.5 times) and the ratio of E. faecalis and E. faecium in 2009 was 4.3. The microflora composition with respect to the isolation source was analysed and its clinical significance was estimated. The study of the antibiotic susceptibility showed that oxacillin had its own specific niche, while antibiotics active against resistant grampositive cocci, such as rifampicin, fusidic acid, fluoroquinolones (moxifloxacin), cefoxitin, as well as amoxicillin/clavulane in infections due to E. faecalis, might be considered as the drugs of choice. In the treatment of nosocomial infections, when the etiological role of MRSA or VRE is suspected or confirmed, the complex therapy should obligatory include the most active antibiotics (vancomycin or linezolid among them).

Topics: Acetamides; Amoxicillin; Anti-Bacterial Agents; Cefoxitin; Cross Infection; Drug Resistance, Microbial; Enterococcus; Fluoroquinolones; Fusidic Acid; Gram-Positive Bacterial Infections; Humans; Linezolid; Methicillin-Resistant Staphylococcus aureus; Moscow; Oxacillin; Oxazolidinones; Rifampin; Surgery, Plastic; Vancomycin

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

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

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

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

CXA-101, previously designated FR264205, is a new antipseudomonal cephalosporin. We evaluated the activity of CXA-101 against a highly challenging collection of beta-lactam-resistant Pseudomonas aeruginosa mutants selected in vitro and after antipseudomonal treatment of intensive care unit (ICU) patients. The in vitro mutants investigated included strains with multiple combinations of mutations leading to several degrees of AmpC overexpression (ampD, ampDh2, ampDh3, and dacB [PBP4]) and porin loss (oprD). CXA-101 remained active against even the AmpD-PBP4 double mutant (MIC = 2 microg/ml), which shows extremely high levels of AmpC expression. Indeed, this mutant showed high-level resistance to all tested beta-lactams, except carbapenems, including piperacillin-tazobactam (PTZ), aztreonam (ATM), ceftazidime (CAZ), and cefepime (FEP), a cephalosporin considered to be relatively stable against hydrolysis by AmpC. Moreover, CXA-101 was the only beta-lactam tested (including the carbapenems imipenem [IMP] and meropenem [MER]) that remained fully active against the OprD-AmpD and OprD-PBP4 double mutants (MIC = 0.5 microg/ml). Additionally, we tested a collection of 50 sequential isolates that were susceptible or resistant to penicillicins, cephalosporins, carbapenems, or fluoroquinolones that emerged during treatment of ICU patients. All of the mutants resistant to CAZ, FEP, PTZ, IMP, MER, or ciprofloxacin showed relatively low CXA-101 MICs (range, 0.12 to 4 microg/ml; mean, 1 to 2 microg/ml). CXA-101 MICs of pan-beta-lactam-resistant strains ranged from 1 to 4 microg/ml (mean, 2.5 microg/ml). As described for the in vitro mutants, CXA-101 retained activity against the natural AmpD-PBP4 double mutants, even when these exhibited additional overexpression of the MexAB-OprM efflux pump. Therefore, clinical trials are needed to evaluate the usefulness of CXA-101 for the treatment of P. aeruginosa nosocomial infections, particularly those caused by multidrug-resistant isolates that emerge during antipseudomonal treatments.

Topics: Anti-Bacterial Agents; Bacterial Proteins; beta-Lactam Resistance; beta-Lactamases; Cephalosporins; Cross Infection; Humans; Intensive Care Units; Microbial Sensitivity Tests; Mutation; Pseudomonas aeruginosa; Pseudomonas Infections

Methicillin-Resistant Staphylococcus aureus (MRSA) is one of the most common and important causes of nosocomial infections. Rapid detection of this pathogen is important for conducting good and swift infection control. This prospective study evaluates two chromogenic media for the detection of MRSA. New colony characteristics were noticed during this evaluation: (i) a yellow/golden colouration on a pipette after streaking the colonies of the chromogenic culture could eventually be used as a supplementary identification test to identify the MRSA strains, and (ii) some MRSA strains do not metabolise the chromogens and therefore are not coloured on chromogenic agars. However, they have a typical yellow/golden colony aspect usually observed amongst S. aureus.

Topics: Bacterial Typing Techniques; Cefoxitin; Chromogenic Compounds; Cross Infection; Culture Media; Humans; Methicillin-Resistant Staphylococcus aureus; Phenotype; Predictive Value of Tests; Prospective Studies; Staphylococcal Infections

The aim of this study was to determine the molecular epidemiology of cefoxitin-resistance Escherichia coli identified in cattle entering feedlots and determine if there were any similarities to E. coli causing human infections in Canadian hospitals. A total of 51 E. coli were isolated from a total of 2483 cattle entering four feedlots in southern Alberta, Canada. DNA fingerprinting using pulsed-field gel electrophoresis revealed thirty-two unique patterns with two major clusters observed comprised of Cluster A (11 strains) and Cluster B (7 strains). PCR and sequence analysis revealed 38 isolates (74.5%) harboured bla(CMY-2), whereas the remainder were found to contain mutations in the promoter region of the chromosomal ampC gene, which has been previously associated with cefoxitin resistance. No resistance to nalidixic acid, ciprofloxacin, or amikacin was observed in the clinical isolates. bla(CMY-2) harbouring plasmids were transferred to E. coli DH10B. All of the plasmids carrying bla(CMY-2) contained the A/C replicon and also harboured other resistance genes. Plasmid fingerprinting using BglII revealed 17 unique patterns with all but one clustering within 70% similarity. Comparison of the plasmid fingerprints to those isolated from human clinically significant E. coli in Canada during a similar time period [Mulvey, M.R., Bryce, E., Boyd, D.A., Ofner-Agostini, M., Land, A.M., Simor, A.E, Paton, S., 2005. The Canadian Hospital Epidemiology Committee, and The Canadian Nosocomial Infection Surveillance Program, Health Canada. Molecular characterization of cefoxitin resistant Escherichia coli from Canadian hospitals. Antimicrob. Agents Chemother. 49, 358-365] revealed four strains that harboured bla(CMY-2) A/C replicon type plasmid with fingerprint similarities of greater than 90% to the ones identified in E. coli from the cattle in this study. These findings highlight the potential linkage of multidrug resistant organisms in food producing animals and human infections in Canadian hospitals. The plasmids conferred resistance to multiple antibiotics which could limit options for the treatment of infections caused by these strains.

Topics: Animals; Anti-Bacterial Agents; Canada; Cattle; Cefoxitin; Cross Infection; Drug Resistance, Bacterial; Escherichia coli; Escherichia coli Infections; Humans; Molecular Epidemiology; Phylogeny; Plasmids

The aim of this study was to investigate the prevalence and diversity of plasmid-mediated AmpC cephalosporinases (PAcBLs) in clinical isolates of Enterobacteriaceae collected between 2003 and 2007 from three Algiers hospitals. Antibiograms were determined on Mueller-Hinton agar plates using the disk diffusion method, and minimum inhibitory concentrations were determined by Etest. Isolates resistant to cefoxitin or ceftazidime were screened for bla(CMY), bla(DHA), bla(FOX) and bla(ACC) as well as extended-spectrum beta-lactamase (ESBL) genes by polymerase chain reaction (PCR). PCR products were sequenced by the Sanger method. Plasmid incompatibility grouping was conducted by PCR-based replicon typing. The prevalence of PAcBLs was 2.18% (11/505), comprising 8 CMY-2 and 3 DHA-1 enzymes. CTX-M-15 was co-produced with CMY-2 in three isolates and with DHA-1 in one isolate; the two remaining DHA-1-producers co-expressed SHV-12 ESBL. This is the first report of plasmid-mediated AmpC from Algeria, with the first detection of DHA-1 in Enterobacter cloacae.

Topics: Algeria; Anti-Bacterial Agents; Bacterial Proteins; beta-Lactam Resistance; beta-Lactamases; Cefoxitin; Ceftazidime; Cross Infection; Enterobacteriaceae; Enterobacteriaceae Infections; Hospitals; Humans; Microbial Sensitivity Tests; Plasmids; Polymerase Chain Reaction; Prevalence

Topics: Anti-Bacterial Agents; beta-Lactamases; Cefoxitin; Ceftazidime; Cephalosporin Resistance; Critical Care; Cross Infection; Electrophoresis, Gel, Pulsed-Field; Female; Humans; Isoelectric Focusing; Klebsiella Infections; Klebsiella pneumoniae; Male; Microbial Sensitivity Tests; Middle Aged; Phenotype; Retrospective Studies; Taiwan

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

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

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

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

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

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

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

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

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

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

Topics: Acinetobacter; Acinetobacter baumannii; Acinetobacter Infections; Bacterial Proteins; beta-Lactamases; Cross Infection; Humans; Plasmids; Portugal

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

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

Fifteen isolates of Klebsiella pneumoniae producing extended-spectrum beta-lactamases (ESBLs) isolated during a nosocomial outbreak were studied. The strains belonged to the same clonal type, as shown by pulsed-field gel electrophoretic analysis of chromosomal DNA. All the isolates were resistant to extended-spectrum cephalosporins, aztreonam, gentamicin, and fluoroquinolones and were susceptible to carbapenems, tobramycin, netilmicin, and amikacin. None of the isolates expressed the OmpK36 porin. Eight isolates, for which the MICs of cefoxitin were > or = 64 micrograms/ml, showed a diminished level or no expression of a 35-kDa porin. The MICs of meropenem, cefotaxime, and cefpirome were three to eight times higher for porin-deficient isolates than for isolates expressing the 35-kDa porin, but the MICs of imipenem increased two times for porin-deficient isolates compared to those for isolates expressing the porin. This MIC increase reverted to a level similar to that for the parental strain when porin-deficient isolates were transformed with the gene coding for the K. pneumoniae porin OmpK36. It is concluded that the high level of resistance to cefoxitin and the increase in the MICs of meropenem, cefotaxime, and cefpirome for the ESBL-producing K. pneumoniae isolates studied are associated with porin deficiency.

Topics: Bacterial Typing Techniques; beta-Lactamases; Carbapenems; Cefoxitin; Cephalosporins; Cephamycins; Cross Infection; Disease Outbreaks; Humans; Klebsiella Infections; Klebsiella pneumoniae; Microbial Sensitivity Tests; Porins; Spain

During a 3-month period, six Klebsiella pneumoniae isolates resistant to cefoxitin and penicillin-inhibitor combinations were derived from patients in the intensive care unit of a hospital in Athens, Greece. Enterobacterial repetitive intergenic consensus PCR and pulsed-field gel electrophoresis provided evidence of the clonal origin of the isolates. Conventional techniques and ribotyping were inadequate in proving that the isolates were related. Resistance was due to a plasmidic class C beta-lactamase.

Topics: Bacterial Typing Techniques; beta-Lactamases; Cefoxitin; Cephalosporin Resistance; Cross Infection; Disease Outbreaks; Drug Resistance, Microbial; Greece; Hospitals, General; Humans; Intensive Care Units; Klebsiella Infections; Klebsiella pneumoniae; Polymerase Chain Reaction; R Factors

The effectiveness of cycloserine-cefoxitin-fructose agar (CCFA) and taurocholate-CCFA (TCCFA) in isolating Clostridium difficile from swabs of the rectum or stools from 184 hospitalized patients who were monitored weekly and when they had diarrhea was compared. The number of surveillance time points ranged from two to eight per patient over a period of 4 to 34 days per patient, totalling 621 comparisons of the media. C. difficile was isolated more frequently by TCCFA than CCFA at seven of eight surveillance points, a significant trend (O'Brien test, p = 0.002). This difference reached statistical significance at the second surveillance time point when the prevalence of C. difficile was sufficiently high. At the second surveillance point, C. difficle was isolated only by TCCFA in 7 of 184 comparisons of the media, only by CCFA in none of the comparisons, and by both media in 19 comparisons (p = 0.016). C. difficle was first isolated at an earlier surveillance time point on TCCFA in 11 of 36 patients and on CCFA first only once (p = 0.005). Use of TCCFA media increased the rapidity and sensitivity of culture for C. difficle when doing patient surveillance but did not increase sensitivity when diagnosing patients with diarrhea.

Topics: Antibiotics, Antitubercular; Cefoxitin; Cephamycins; Cholagogues and Choleretics; Clostridioides difficile; Cross Infection; Culture Media; Cycloserine; Diarrhea; Feces; Fructose; Humans; Prospective Studies; Rectum; Surgical Stomas; Taurocholic Acid

Cefoxitin resistance in Klebsiella pneumoniae from Escherichia coli strains isolated in Greek hospitals was found to be due to the acquisition of similar plasmids coding for group 1 beta-lactamases. The plasmids were not self-transferable but were mobilized by conjugative plasmids. These elements have also been spread to Enterobacter aerogenes. The most common enzyme was a Citrobacter freundii-derived cephalosporinase (LAT-2) which differed from LAT-1 by three amino acids.

Topics: Amino Acid Sequence; Base Sequence; Cefoxitin; Cephamycins; Citrobacter freundii; Conjugation, Genetic; Cross Infection; Drug Resistance, Microbial; Enterobacter; Enterobacteriaceae; Escherichia coli; Greece; Microbial Sensitivity Tests; Molecular Sequence Data; Penicillinase; Plasmids

Clostridium difficile and/or toxin B were isolated from the faeces of 3 (1.6%) of 184 patients within the first two days of hospitalisation in the University of Tübingen, Gynaecological Clinic. With following stool samples from a total of 117 patients the isolation rate of C. difficile was examined in relation to the treatment with antibiotics. From the first group of 61 patients, who had had gynaecological operations and were not treated with any antibiotic, the isolation rate of C. difficile rose statistically but not significantly from 0% at the time of admission up to 3.3% during hospitalisation. Amongst the second group of 17 patients, who had had gynaecological operations and were treated with various antibiotics for at least three days, the isolation rate was also found to rise insignificantly from 0 to 11.8% (p < 0.1). The third group of 33 patients, who had had gynaecological operations and perioperative prophylaxis with cefoxitin (one to three doses 2 g each), the isolation rate rose significantly from 0 to 12.1% (p < 0.05). The result of this study shows that the bacterial flora of the gut was probably altered even after a very brief application of cefoxitin. In two environmental examinations on the wards of the patients of this study, C. difficile was not isolated in any case.

Topics: Adult; Aged; Anti-Bacterial Agents; Bacterial Proteins; Bacterial Toxins; Bacteriological Techniques; Cefoxitin; Clostridioides difficile; Cross Infection; Dose-Response Relationship, Drug; Drug Administration Schedule; Enterocolitis, Pseudomembranous; Feces; Female; Genital Diseases, Female; Humans; Middle Aged; Premedication; Surgical Wound Infection

Nosocomial bloodstream infections add to the morbidity, mortality and length of hospitalization that is attributed to the underlying diseases alone. We have compared the in vitro potency of fifteen antibiotics against 136 isolates from clinically significant nosocomial gram-negative bacteraemias. Ciprofloxacin was the most potent antibiotic and had the broadest spectrum of activity (98% of isolates susceptible, MIC90 range: 0.06-0.5 micrograms ml-1). We subjected all isolates to beta-lactamase induction but antibiotic susceptibility was unaffected by this procedure.

Topics: Anti-Bacterial Agents; Bacterial Infections; beta-Lactamases; Cefoxitin; Ciprofloxacin; Cross Infection; Drug Resistance, Microbial; Gram-Negative Bacteria; Microbial Sensitivity Tests

In an increasing number of cases of the Caesarean delivery of small premature babies (length of gestation less than 32 weeks or an estimated weight of less than 1501 g) between April 1983 and March 1987, the uterus was opened by an isthmo-corporeal longitudinal section if the lower uterine segment appeared too narrow for a gentle delivery via an isthmian transverse incision. A comparison of 67 Caesarean deliveries of this type with 116 Caesarean deliveries of the same small premature babies using an isthmian transverse incision did not reveal any difference with regard to postoperative infections, feverish standard morbidity, or other noninfectious complications. In comparison with Caesarean deliveries of older babies, the Caesarean deliveries of small premature babies had significantly more infectious and noninfectious complications, such as cases of phlebitis of the arm owing to intravenous application (2.7% as against 1.0%), posthemorrhaging and hematomas (3.8% as against 0.8%), and blood transfusions (3.3% as against 0.8%). The number of infectious complications was significantly reduced by a perioperative antibiotics prophylaxis. The question of late complications as a result of the isthmo-corporeal longitudinal section, especially the danger of rupture of the uterine scar in the event of a subsequent vaginal delivery, has not yet been resolved.

Topics: Birth Weight; Cefoxitin; Cesarean Section; Cross Infection; Female; Humans; Infant, Newborn; Infant, Premature, Diseases; Obstetric Labor, Premature; Pregnancy; Premedication; Puerperal Infection; Risk Factors; Surgical Wound Infection; Suture Techniques

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

Among 185 patients with nonneutropenic, community-acquired gram-negative bacillary bacteremias, clinical risk factors for cefoxitin resistance included any antibiotic taken within the last three weeks (25.6% cefoxitin resistance), long-term bladder catheterization or surgical urinary diversion (23.3%), hospitalization within the last 30 days (22.9%), and nursing home residence before admission (20.8%). Patients with none of these risk factors were less likely to have cefoxitin-resistant bacteremias (0.9%). When these risk factors were examined in the subgroups of urinary tract and non-urinary tract sources of community-acquired gram-negative bacillary bacteremia, they were also helpful in predicting sensitivity to trimethoprim-sulfamethoxazole and gentamicin. The presence of one or more of the risk factors identified may be a useful adjunct in determining initial empiric antimicrobial therapy for community-acquired gram-negative bacillary bacteremia.

Topics: Cefoxitin; Child; Clindamycin; Cross Infection; Drug Combinations; Drug Resistance, Microbial; Gentamicins; Gram-Negative Bacteria; Humans; Retrospective Studies; Risk; Sepsis; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Catheterization; Urinary Diversion; Urinary Tract Infections

The activity of cefbuperazone against 266 strains of anaerobic bacteria was determined by the agar dilution method and compared with cefoxitin, moxalactam, piperacillin, and clindamycin. All strains were recent clinical isolates from community hospitals. All agents tested showed good activity against Bacteroides fragilis, Fusobacterium spp., Propionibacterium spp., Clostridium septicum, Clostridium perfringens, and the anaerobic, gram-positive cocci and gram-negative cocci. Cefbuperazone, cefoxitin, and moxalactam had poor activity against Bacteroides thetaiotaomicron, Bacteroides ovatus, and Bacteroides distasonis. The susceptibility of other Clostridium spp., Lactobacillus spp., and Eubacterium lentum was variable. Our community hospital isolates showed a difference in susceptibility patterns from those reported from university and research centers. This supports the recommendation that clinical microbiology laboratories, including those in community hospitals, need to perform susceptibility testing on representative clinical isolates.

Topics: Bacteria, Anaerobic; Cefoxitin; Cephamycins; Clindamycin; Cross Infection; Hospitals, Community; Humans; Microbial Sensitivity Tests; Moxalactam; Piperacillin

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

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

Topics: Aged; Cefoxitin; Cephalosporins; Cross Infection; Drug Evaluation; Drug Resistance, Microbial; England; Female; Humans; Klebsiella Infections; Klebsiella pneumoniae; London; Male; Urinary Tract Infections

Topics: Adult; Brazil; Cefamandole; Cefoxitin; Cross Infection; Drug Resistance, Microbial; Escherichia coli; Escherichia coli Infections; Humans; Israel; Male; Proteus Infections; Providencia; South Africa; Transients and Migrants

Topics: Cefoxitin; Cephalosporins; Cross Infection; Drug Resistance, Microbial; Escherichia coli Infections; Humans; Intensive Care Units; Urinary Tract Infections