cefoxitin and Granuloma

The incidence and prevalence of nontuberculous mycobacteria (NTM) infection is on the rise with many cases still going unreported. Given the vague and nonspecific clinical features of NTM infections, it is often missed or mistaken for Mycobacterium tuberculosis. The presumption that NTM infections are benign and do not contribute to morbidity no longer holds true. NTM infections need to be considered in patients with disseminated multisystem disease and in those not responding to standard M. tuberculosis treatment. As NTM infection is associated with granuloma formation, it can result in hypercalcaemia. Interestingly, there is evidence that there may be other mechanisms in play contributing to hypercalcaemia besides the increased calcitriol levels.

Topics: Aged; Anti-Bacterial Agents; Antibodies; Cefoxitin; Ciprofloxacin; Clarithromycin; Doxycycline; Drug Therapy, Combination; Female; Granuloma; Humans; Hypercalcemia; Interferons; Liver; Macrophage Colony-Stimulating Factor; Mycobacterium abscessus; Mycobacterium fortuitum; Mycobacterium Infections, Nontuberculous; Singapore

Mycobacterium fortuitum bacteremia with granulomatous hepatitis complicating home cyclic parenteral nutrition through an indwelling Broviac catheter occurred in a 41-year-old woman. She was successfully treated with intravenous cefoxitin and removal of the indwelling central catheter. The granulomatous hepatitis occurred in the apparent absence of mycobacteria from the liver. Incorrect identification of the organism as Corynebacterium J-K led to a change of antimicrobial therapy and clinical deterioration. It is recommended that acid-fast stains be done on "diphtheroids" when such isolates are suspected pathogens.

Topics: Adult; Catheters, Indwelling; Cefoxitin; Corynebacterium Infections; Diagnosis, Differential; Female; Granuloma; Hepatitis; Humans; Infusions, Parenteral; Mycobacterium Infections; Mycobacterium Infections, Nontuberculous; Nontuberculous Mycobacteria; Parenteral Nutrition; Sepsis

The interaction of cefoxitin and mezlocillin was studied in rats using the granuloma pouch technique. Proteus morganii strains against which cefoxitin and penicillins exhibited antagonistic antibacterial activity were selected for infection of the pouches. Animals were treated with cefoxitin and/or mezlocillin, and bacterial counts, drug levels and beta-lactamase production in the pouch exudate monitored. A significant decrease in bacterial counts was seen after administration of mezlocillin and cefoxitin in combination but not after the drugs administered alone. Drug concentrations of mezlocillin and/or cefoxitin corresponded directly to the rate of induction of beta-lactamase activity. Although both beta-lactam antibiotics induce beta-lactamase activity, administered in combination in vivo they appear to protect each other from being inactivated thus resulting in synergistic antibacterial activity.

Topics: Animals; beta-Lactamases; Cefoxitin; Drug Synergism; Drug Therapy, Combination; Enzyme Induction; Female; Granuloma; Kinetics; Mezlocillin; Penicillins; Proteus; Proteus Infections; Rats