cefoxitin and Mycobacterium-Infections

Mycobacterium fortuitum is a rarely reported cause of otitis media and mastoiditis. We report such a case recently seen at our institution and review the four previously published cases of this disease entity. Amikacin is recommended in the current medical literature as empirical treatment of disease due to M. fortuitum, but the isolate from our patient showed high-level resistance to amikacin, which is rare in clinical isolates of this species; this resistance was probably related to prior treatment with topical aminoglycosides. Our patient's infection responded to a 12-month course of therapy with clarithromycin and trimethoprim-sulfamethoxazole.

Topics: Adolescent; Amikacin; Anti-Bacterial Agents; Cefoxitin; Clarithromycin; Drug Resistance, Microbial; Drug Therapy, Combination; Female; Humans; Mastoiditis; Mycobacterium Infections; Nontuberculous Mycobacteria; Otitis Media; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Amikacin; Anti-Bacterial Agents; Australia; Cefoxitin; Clarithromycin; Drug Therapy, Combination; Humans; Male; Mycobacterium Infections; Public Health; Tattooing; Young Adult

To evaluate the therapeutic effect and safety of the regimen containing cefoxitin on highly drug-resistant rapidly growing nontuberculous mycobacterial (RGM) pulmonary disease.. From January to December 2007, 16 patients with RGM pulmonary disease, who had been treated for 6-48 months, average (15 ± 11) months but still sputum positive, were included in the study and treated with a new regimen containing cefoxitin, fluoroquinolone, macrolide, and SMZco. Cefoxitin was used in the first 3 months and the total duration of therapy was 18 months. Sputum conversion rate, radiology change and side effects were observed before and after the therapy.. Underlying chronic diseases including COPD (n = 2), tuberculosis (n = 3), bone-marrow transplantation due to chronic leukemia (n = 1) and bronchiectasis (n = 5), were present in 11 patients. Main symptoms before therapy were cough and expectoration. There were multi-focal patchy, small nodular shadows with cavities on CT scans. The 16 clinical strains were highly resistant to anti-tuberculous drugs: 15/16 to streptomycin, 16/16 to isoniazid, 14/16 to rifampin, 13/16 to ethambutol, 14/15 to amikacin, 15/15 to capreomycin and 14/15 to ofloxacin. After treatment, the clinical symptoms improved in all patients. Eight of the 16 patients became sputum negative by 6 months which lasted to the end of the therapy, while another 8 patients remained sputum positive. Six patients showed radiological improvement. No one experienced side effects induced by cefoxitin. The total cure rate was 8/16.. The regimen containing cefoxitin has certain effect on highly drug-resistant nontuberculous mycobacterial pulmonary disease, especially for RGM.

Topics: Adult; Aged; Anti-Bacterial Agents; Cefoxitin; Drug Resistance, Multiple, Bacterial; Female; Humans; Lung Diseases; Male; Middle Aged; Mycobacterium Infections; Nontuberculous Mycobacteria; Retrospective Studies

We evaluated the in vitro activities of tigecycline and 10 other antibiotics against clinical isolates of nonpigmented rapidly growing mycobacteria. Fifteen collection strains and 165 clinical isolates were included in the study. Tigecycline showed the highest activity among all antibiotics studied: all the strains were inhibited by 1 mg/liter.

Topics: Anti-Bacterial Agents; Drug Resistance, Bacterial; Humans; In Vitro Techniques; Microbial Sensitivity Tests; Minocycline; Mycobacterium; Mycobacterium Infections; Pigmentation; Species Specificity; Tigecycline

Topics: Adult; Amikacin; Anti-Bacterial Agents; Bacteremia; Catheterization, Central Venous; Catheters, Indwelling; Cefoxitin; Device Removal; Female; Humans; Leukemia; Lymphoma; Male; Middle Aged; Multiple Myeloma; Mycobacterium; Mycobacterium Infections; Retrospective Studies

Nontuberculous mycobacteria (NTM) are ubiquitous in nature and have been implicated in skin/soft-tissue, pulmonary, middle ear, bone, and surgical/traumatic wound infections. Disseminated disease occurs infrequently and almost exclusively in the immunocompromised. We describe the first 2 reported cases of disseminated Mycobacterium fortuitum infection in teenagers with sickle hemoglobinopathy. Both had central venous catheters (CVCs), frequent admissions for vaso-occlusive painful episode and received hydroxyurea. Diagnosis was confirmed by multiple positive blood cultures and pulmonary dissemination occurred in both. Both had successful treatment after CVC removal and combination drug therapy. Positive cultures persisted in 1 patient due to drug resistance emphasizing the need for accurate susceptibility data. NTM infection should be added to the list of pathogens in sickle cell patients with CVCs and fever. Investigation for disseminated disease should be undertaken based on clinical signs and symptoms. Although some routine blood culture systems can identify NTM, specific mycobacterial blood culture is optimal. Removal of involved CVCs is essential and treatment of NTM must be guided by susceptibilities. As dissemination almost always occurs in those with impaired cellular immunity, human immunodeficiency virus testing should be performed. Hydroxyurea may be a risk factor for dissemination and needs further evaluation.

Topics: Acetamides; Adolescent; Amikacin; Anemia, Sickle Cell; Anti-Bacterial Agents; Cefoxitin; Ciprofloxacin; Clarithromycin; Doxycycline; Drug Therapy, Combination; Female; Humans; Hydroxyurea; Linezolid; Microbial Sensitivity Tests; Mycobacterium fortuitum; Mycobacterium Infections; Oxazolidinones; Treatment Outcome

Topics: Anti-Bacterial Agents; Blood Glucose; Cefoxitin; Ciprofloxacin; Diabetes Mellitus, Type 1; Drug Therapy, Combination; Glycated Hemoglobin; Humans; Injections, Subcutaneous; Insulin; Minocycline; Mycobacterium Infections; Recurrence

Mycobacterium fortuitum is an environmental organism which rarely causes disease. We report the case of a young man in whom this organism caused a soft tissue abscess. The laboratory findings and subsequent management of the case are described.

Topics: Abscess; Adult; Cefoxitin; Ciprofloxacin; Connective Tissue Diseases; Humans; Male; Mycobacterium Infections

A unique case is presented in which disseminated Mycobacterium chelonae ssp. abscessus was found in a normal immunocompetent host after a traumatic injury. Although disseminated disease is known to occur in immunocompromised and postsurgical patients, this case is unusual in that it occurred in a patient with no evidence of immunodeficiency and with a known portal of entry.

Topics: Adult; Amikacin; Cefoxitin; Drug Therapy, Combination; Female; Humans; Immunocompetence; Mycobacterium Infections; Skin; Skin Diseases, Infectious; Wounds, Penetrating

One hundred twenty-three patients with nonpulmonary infections due to Mycobacterium fortuitum or Mycobacterium chelonei were treated by wound debridement and with chemotherapy on the basis of in vitro susceptibilities of the organism. Of 76 patients with infections caused by M. fortuitum, 13 required no therapy or were adequately treated with surgery alone. Patients with active localized disease received single drug therapy (usually with a sulfonamide) for a mean period of 10.6 weeks for cellulitis and seven months for osteomyelitis. Patients with extensive disease received amikacin or amikacin plus cefoxitin (mean, four weeks) followed by a sulfonamide (mean, six months). The 47 patients with infections caused by M. chelonei received no therapy or were treated with surgery alone (6); with amikacin (10), erythromycin (6), doxycycline (3), or cefoxitin (1); or with amikacin plus cefoxitin followed by cefoxitin alone for a total of 10-12 weeks (20); or other multiple-drug regimens (1). Surgery was performed on 74 (60%) patients. Schlichter tests or serum drug levels were determined for 81 (66%) patients. Response to therapy was excellent; 68 (90%) infections with M. fortuitum and 34 (72%) with M. chelonei were successfully treated. Cultures became negative within six weeks of chemotherapy, except for sternal osteomyelitis, for which cultures were not negative until up to 14 weeks. Follow-up for a mean period of 12 months following therapy was possible in 80% of cases. Relapses were rare except in patients with disseminated disease, and drug resistance developed in only one patient. These studies demonstrate the value of routine susceptibility testing of these mycobacterial species and the benefit of chemotherapy on the basis of in vitro susceptibilities.

Topics: Adult; Aged; Amikacin; Anti-Bacterial Agents; Cefoxitin; Drug Combinations; Erythromycin; Female; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Mycobacterium; Mycobacterium Infections; Mycobacterium Infections, Nontuberculous; Nontuberculous Mycobacteria; Sulfamethoxazole; Sulfisoxazole; Sulfonamides; Tetracyclines; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

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

Disseminated disease due to rapidly growing mycobacteria is manifested by positive blood cultures and multiple skin and subcutaneous abscesses. A patient had T-cell lymphoma and disseminated disease; he also had neutropenia intermittently. Single-agent therapy with amikacin sulfate or cefoxitin sodium was not adequate during periods of neutropenia, and combination therapy was necessary to control the infection. Clinical response correlated with detectable serum inhibitory levels of the antimicrobial agents. Surprisingly, the organism was not killed by either amikacin or cefoxitin, a finding that correlated with the absence of serum bactericidal levels. This case suggests that granulocytes may play a role in the host's response to this organism, and determination of serum inhibitory and possible bactericidal levels may be useful in monitoring therapy.

Topics: Adult; Amikacin; Cefoxitin; Drug Resistance, Microbial; Granulocytes; Humans; Kanamycin; Lymphoma; Male; Mycobacterium; Mycobacterium Infections; Mycobacterium Infections, Nontuberculous; Neutropenia; Nontuberculous Mycobacteria; Skin Diseases, Infectious

Mice inoculated intravenously with Mycobacterium fortuitum 18367 were treated subcutaneously with cefoxitin or cefotetan once daily for 4 weeks, beginning 24 h after challenge. Both drugs suppressed spinning disease, and both reduced the severity of renal lesions and the number of organisms in the kidneys and liver but not in the lungs or spleen. These therapeutic effects were dose-dependent.

Topics: Animals; Cefotetan; Cefoxitin; Cephamycins; Female; Kidney Diseases; Mice; Mycobacterium Infections; Mycobacterium Infections, Nontuberculous

This article describes a case of disseminated Mycobacterium chelonei infection in a renal transplant recipient. This patient, who underwent thoracic duct drainage prior to cadaveric renal transplantation, developed M chelonei bacteremia and numerous subcutaneous nodules a few weeks after transplantation. The M chelonei initially responded to amikacin and tetracycline. Because of side effects and bacterial resistance, however, these drugs had to be discontinued. Subsequent treatment with cefoxitin led to reduction in size of subcutaneous nodules, but control of the infection was not achieved until an intravascular nidus of infection at the anastomotic site of an arteriovenous fistula was removed.

Topics: Adult; Cadaver; Cefoxitin; Drug Resistance, Microbial; Female; Humans; Kidney Transplantation; Mycobacterium; Mycobacterium Infections; Postoperative Complications

A case of renal infection with Mycobacterium chelonei is described. The infection probably occurred via haematogenous spread from an infected arteriovenous shunt in a uraemic woman. Prolonged treatment with intravenous cefoxitin combined with oral erythromycin and rifampicin eradicated the organism from the urine. Although renal function stabilised for one year, gradual deterioration to end-stage renal failure occurred.

Topics: Adult; Cefoxitin; Drug Therapy, Combination; Erythromycin; Female; Humans; Kidney Diseases; Mycobacterium Infections; Mycobacterium Infections, Nontuberculous; Rifampin