cefoxitin and Endocarditis--Bacterial

Topics: Arthritis; Bacterial Infections; Cefoxitin; Cephalosporins; Clinical Trials as Topic; Empyema, Tuberculous; Endocarditis, Bacterial; Humans; Lung Abscess; Osteomyelitis; Pneumonia; Sepsis; Urinary Tract Infections

Cefoxitin was administered intravenously to 143 patients, 67% of whom were seriously ill. The rate of cure or improvement was 93%. The study was conducted in two phases; the first was an open, controlled clinical comparison of cefoxitin and cephalothin. In this phase, 28 patients received cefoxitin and 29 received cephalothin. In the second phase, cefoxitin alone was used for the treatment of an additional 115 patients. Twenty bacteremic patients treated with cefoxitin were cured or improved in 95% of cases. The infecting organism was eradicated in all bacteremic patients. All of 14 anaerobic or predominantly anaerobic infections were cured or improved. The infecting anaerobic organism was eliminated in 86% of the cases. Twenty-five patients infected by cephalothin-resistant, cefoxitin-susceptible gram-negative rods were cured. Three patients each with infective endocarditis and osteomyelitis were cured. The incidence of adverse experiences was: 1.4% drug eruption; 2% each asymptomatic serum transaminase elevation and leukopenia; and 2.5% asymptomatic eosinophilia. The incidence of severe thrombophlebitis was 5%. No permanent or serious adverse reactions were encountered. Although the numbers of patients in some categories were too small to permit statistical evaluation, I feel that cefoxitin may be a useful new antibiotic for treatment of infections caused by cehalothin-resistant bacteria and by anaerobic organisms.

Topics: Adult; Bacterial Infections; Cefoxitin; Cephalosporins; Cephalothin; Clinical Trials as Topic; Drug Resistance, Microbial; Endocarditis, Bacterial; Humans; Osteomyelitis; Sepsis

Methicillin-resistant Staphylococcus aureus (MRSA) carrying the mecC gene (mecC-MRSA) exhibited at 37°C MICs of oxacillin close to those of methicillin-susceptible S. aureus (MSSA). We investigated whether at this temperature, mecC-MRSA strains respond to flucloxacillin treatment like MSSA strains, using a rat model of endocarditis. Flucloxacillin (human-like kinetics of 2 g intravenously every 6 h) cured 80 to 100% of aortic vegetations infected with five different mecC-MRSA strains. These results suggest that mecC-MRSA infections may successfully respond to treatment with β-lactams.

Topics: Animals; Anti-Bacterial Agents; Aorta; Cefoxitin; Chromatography, Micellar Electrokinetic Capillary; Endocarditis, Bacterial; Floxacillin; Infusion Pumps; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Oxacillin; Rats; Staphylococcal Infections; Temperature

Propionibacterium acnes, which usually considered as a contaminant, has been found to be an emerging pathogen in human diseases. We describe a case of prosthetic valve related endocarditis caused by P. acnes. Sequencing of the genetic coding of 16S ribosomal RNA was used to identify the pathogen and random amplified polymorphic DNA patterns further confirmed the persistent bacteraemia, which help to determine the diagnosis.

Topics: Anti-Bacterial Agents; Cefoxitin; Clindamycin; Communicable Diseases, Emerging; Endocarditis, Bacterial; Gram-Positive Bacterial Infections; Heart Valve Prosthesis; Humans; Infusions, Intravenous; Male; Middle Aged; Molecular Sequence Data; Penicillin G; Polymerase Chain Reaction; Propionibacterium acnes; Prosthesis-Related Infections; Random Amplified Polymorphic DNA Technique; RNA, Ribosomal, 16S

The effectiveness of penicillin G, fosfomycin, and cefoxitin alone and in combination was studied in vitro and in the treatment of left-sided Streptococcus sanguis endocarditis in rabbits. In vitro, the combinations penicillin G plus fosfomycin, penicillin G plus cefoxitin, and fosfomycin plus cefoxitin were synergistic or partially synergistic for S sanguis. Therapy with the combinations was more effective in eradicating the species from cardiac vegetations that was that with each antibiotic used alone.

Topics: Animals; Anti-Bacterial Agents; Cefoxitin; Drug Synergism; Drug Therapy, Combination; Endocarditis, Bacterial; Female; Fosfomycin; Humans; Penicillin G; Rabbits; Streptococcal Infections; Streptococcus sanguis

30 patients were treated with i.v. cefoxitin (4-8 g/day), of which 20 had documented infections which included endocarditis (5), lung abscess (4), empyema (4), liver and subhepatic abscess (3), osteomyelitis (3), and pancreatic abscess (1). 14 patients had infections caused by anaerobic bacteria and 5 had endocarditis due to aerobic organisms. All but 2 patients with osteomyelitis of the mandible were cured. Adverse reactions were noted in 7 patients, mostly due to drug fever and leukocytosis; one had Coombs'-positive hemolytic anemia. The average serum cefoxitin levels were 24, 16, 12, and 4 microgram/ml at 1, 2, 3 and 4 h, respectively, and the average serum/pleural fluid ratio was 1:0.5 +/- 0.25. All anaerobic and aerobic isolates except one strain of Bacteroides fragilis were susceptible to cefoxitin at less than or equal to 32 microgram/ml. The concentration of cefoxitin in the tissues was measured in 8 rabbits; it was 4 +/- 1 microgram/ml in the heart and 2 +/- 0.5 microgram/ml in the femur and mandibular tissue, suggesting that the lack of response in cases of osteomyelitis could be due to inadequate antibiotic concentration in the bone. Our study suggests that cefoxitin can be used in the treatment of anaerobic infections and endocarditis due to susceptible organisms.

Topics: Abscess; Adult; Animals; Bacterial Infections; Bacteriological Techniques; Cefoxitin; Cephalosporins; Drug Evaluation; Empyema; Endocarditis, Bacterial; Female; Humans; Liver Abscess; Lung Abscess; Male; Osteomyelitis; Pancreatitis; Rabbits; Tissue Distribution