cefoxitin and Sepsis

Topics: Administration, Oral; Cefoxitin; Clinical Trials as Topic; Colectomy; Colonic Diseases; Drug Administration Schedule; Humans; Injections, Intravenous; Neomycin; Nitroimidazoles; Postoperative Complications; Prospective Studies; Random Allocation; Rectal Diseases; Sepsis; Surgical Wound Infection; Tinidazole

Ninety patients at the Wilmington Medical Center were enrolled in a comparative study to evaluate the efficacy and toxicity of ticarcillin plus clavulanic acid in the treatment of a variety of infections. Forty-seven women with obstetric or gynecologic infections were randomly assigned to receive ticarcillin plus clavulanic acid or cefoxitin. Forty-three patients with gram-negative septicemia or lower respiratory tract infection were given ticarcillin plus clavulanic acid or tobramycin plus piperacillin in a randomized fashion. Of the 47 women with obstetric or gynecologic infections, 23 were randomly assigned to receive ticarcillin plus clavulanic acid, and 24 were randomly assigned to receive cefoxitin. Several patients in each group had underlying diseases such as diabetes, obesity, and hypertension. Of the 27 pathogens isolated in the group receiving ticarcillin plus clavulanic acid, 26 (96 percent) were eradicated, including all three ticarcillin-resistant pathogens. In the cefoxitin-treated group, 31 of the 33 (94 percent) pathogens were eliminated, including all four ticarcillin-resistant organisms. Three reinfections or superinfections occurred, and cefoxitin therapy failed to eliminate an enterococcus isolate from the endometrium in one patient. The clinical response in both treatment groups was excellent. Either cure or clinical improvement was achieved for all 18 sites of infection in the ticarcillin plus clavulanic acid-treated group and for all 22 sites in the cefoxitin-treated group. There were no systemic drug reactions in either treatment group. In one patient in the cefoxitin-treated group, local phlebitis developed at the infusion site. This reaction responded to local therapy. There were no local reactions among the patients receiving ticarcillin plus clavulanic acid. Of the 43 patients with gram-negative septicemia or lower respiratory tract infection, 21 were randomly assigned to receive ticarcillin plus clavulanic acid and 22 were assigned to receive tobramycin plus piperacillin. Thirty-six patients had gram-negative sepsis, and seven patients had lower respiratory tract infection. Nine of the 36 patients suspected of having gram-negative sepsis were not evaluable because no pathogen was isolated prior to treatment. Twenty-two of the 27 patients treated for septicemia had good clinical and microbiologic responses. Three of the seven patients with pneumonia were not evaluable. Of the four evaluable patients, two had pneumococcus pneum

Topics: Adolescent; Adult; Aged; Bacterial Infections; Cefoxitin; Clavulanic Acid; Clavulanic Acids; Drug Combinations; Female; Gram-Negative Bacteria; Hospitalization; Humans; Male; Penicillins; Piperacillin; Respiratory Tract Infections; Sepsis; Ticarcillin; Tobramycin

We performed a randomized, double-blind trial on a relatively low-risk population comparing the use of three doses of cefoxitin vs. placebo in the prevention of infection following primary cesarean section. Major site-related morbidity (endometritis, wound infection and septicemia) was significantly reduced in the cefoxitin group (8.9% vs. 27.8%; p = 0.017). Febrile morbidity alone tended to occur in the cefoxitin group (15.6% vs. 3.7%; p = 0.091), and all five urinary tract infections occurred in the cefoxitin group as well. Total morbidity was therefore not significantly different (cefoxitin, 35.6%; placebo, 31.5% [not significant]). Duration of hospitalization (mean, 6.0 days) and need for further postoperative antibiotic therapy were similar in the two groups. Our study demonstrated a modest benefit from the perioperative use of antibiotics in relatively low-risk patients undergoing primary cesarean section. Issues that need further study include definition of the optimal prophylactic regimen and of high-risk populations for whom prophylaxis would be most helpful.

Topics: Adult; Cefoxitin; Cesarean Section; Clinical Trials as Topic; Double-Blind Method; Endometritis; Female; Fever; Humans; Placebos; Postoperative Complications; Pregnancy; Premedication; Sepsis; Surgical Wound Infection; Urinary Tract Infections

Cefoxitin (CFX) at a daily dose of 3 to 12 grams was administered to patients who had hematopoietic disorders as underlying diseases and having severe infections. Efficacy and safety of the drug were evaluated. The underlying diseases in the 64 patients included in the evaluation of efficacy were acute myelocytic leukemia (30 cases), acute lymphocytic leukemia (9), acute promyelocytic leukemia (3), acute monocytic leukemia (2), chronic myelocytic leukemia-blastic crisis (10), erythroleukemia (2), malignant lymphoma (2), aplastic anemia (2), and others (4). The infections were septicemia in 3 patients, suspected septicemia in 47, respiratory tract infections in 7, oral infections in 3, urinary tract infections in 2, and others in 2. The clinical efficacy of CFX was 'excellent' in 13 patients, 'good' in 26, 'fair' in 6, 'poor' in 19 for an efficacy rate of 60.9%. The efficacy rate classified according to infections was 66.7% in septicemia, 66.0% in suspected septicemia, 42.9% in respiratory tract infections and 66.7% in oral infection. The organisms isolated from the patients with septicemia were E. coli in 2 patients and B. cereus in 1. B. cereus was not susceptible to CFX. The efficacy rate was 60.0% in the 10 patients whose causative organisms were identified and 61.1% in the 54 patients whose causative organisms were not identified. There was no significant difference in the efficacy rate between the patients who had failed to respond to prior antibiotic therapy and those treated with CFX from the beginning. The efficacy rates for the former group (23 patients) and for the latter group (41 patients) were 56.5% and 63.4%, respectively. The efficacy rate in patients with an initial neutrophil count less than 500/mm3 (35 cases) and from 501 to 1,000/mm3 (13 cases) were 57.1% and 76.9%, respectively. Side effects which might have been caused by CFX were skin eruptions in 2 patients (2.6%) and transient elevation of GOT and GPT in 1 patient (1.3%) among 76 patients who were evaluated for safety. CFX was considered to be a markedly useful and safe drug in the treatment of patients with hematopoietic disorders who developed severe infections.

Topics: Adolescent; Adult; Aged; Anemia, Aplastic; Cefoxitin; Child; Clinical Trials as Topic; Female; Humans; Leukemia; Lymphoma; Male; Middle Aged; Respiratory Tract Infections; Sepsis

To determine the efficacy of perioperative cefoxitin in preventing infections after primary cesarean section, a randomized placebo-controlled, double-blind clinical trial was performed. Among 266 participants, those who received three perioperative 2 gm doses of cefoxitin (138) had significantly fewer serious infections (19.5% vs. 4.3%), fewer urinary tract infections (10.7% vs. 4.4%), less standard febrile morbidity (9.4% vs. 3.6%), and fewer courses of antibiotics postoperatively (23.4% vs. 11.6%). There was no reduction in the length of hospitalization. Use of perioperative cefoxitin umbilical cord is clamped are safe and efficacious in preventing infection after primary cesarean section.

Topics: Cefoxitin; Cesarean Section; Clinical Trials as Topic; Endometritis; Female; Fever; Humans; Infant, Newborn; Intraoperative Care; Postoperative Care; Pregnancy; Prospective Studies; Puerperal Infection; Random Allocation; Sepsis; Urinary Tract Infections

Topics: Adolescent; Adult; Aged; Bacterial Infections; Cefoxitin; Cephalosporins; Child; Clinical Trials as Topic; Drug Therapy, Combination; Female; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Respiratory Tract Infections; Sepsis; Urinary Tract Infections

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

Despite improvements in perioperative mortality, the incidence of postoperative surgical site infection (SSI) remains high after pancreatoduodenectomy. The effect of broad-spectrum antimicrobial surgical prophylaxis in reducing SSI is poorly understood.. To define the effect of broad-spectrum perioperative antimicrobial prophylaxis on postoperative SSI incidence compared with standard care antibiotics.. Pragmatic, open-label, multicenter, randomized phase 3 clinical trial at 26 hospitals across the US and Canada. Participants were enrolled between November 2017 and August 2021, with follow-up through December 2021. Adults undergoing open pancreatoduodenectomy for any indication were eligible. Individuals were excluded if they had allergies to study medications, active infections, chronic steroid use, significant kidney dysfunction, or were pregnant or breastfeeding. Participants were block randomized in a 1:1 ratio and stratified by the presence of a preoperative biliary stent. Participants, investigators, and statisticians analyzing trial data were unblinded to treatment assignment.. The intervention group received piperacillin-tazobactam (3.375 or 4 g intravenously) as perioperative antimicrobial prophylaxis, while the control group received cefoxitin (2 g intravenously; standard care).. The primary outcome was development of postoperative SSI within 30 days. Secondary end points included 30-day mortality, development of clinically relevant postoperative pancreatic fistula, and sepsis. All data were collected as part of the American College of Surgeons National Surgical Quality Improvement Program.. The trial was terminated at an interim analysis on the basis of a predefined stopping rule. Of 778 participants (378 in the piperacillin-tazobactam group [median age, 66.8 y; 233 {61.6%} men] and 400 in the cefoxitin group [median age, 68.0 y; 223 {55.8%} men]), the percentage with SSI at 30 days was lower in the perioperative piperacillin-tazobactam vs cefoxitin group (19.8% vs 32.8%; absolute difference, -13.0% [95% CI, -19.1% to -6.9%]; P < .001). Participants treated with piperacillin-tazobactam, vs cefoxitin, had lower rates of postoperative sepsis (4.2% vs 7.5%; difference, -3.3% [95% CI, -6.6% to 0.0%]; P = .02) and clinically relevant postoperative pancreatic fistula (12.7% vs 19.0%; difference, -6.3% [95% CI, -11.4% to -1.2%]; P = .03). Mortality rates at 30 days were 1.3% (5/378) among participants treated with piperacillin-tazobactam and 2.5% (10/400) among those receiving cefoxitin (difference, -1.2% [95% CI, -3.1% to 0.7%]; P = .32).. In participants undergoing open pancreatoduodenectomy, use of piperacillin-tazobactam as perioperative prophylaxis reduced postoperative SSI, pancreatic fistula, and multiple downstream sequelae of SSI. The findings support the use of piperacillin-tazobactam as standard care for open pancreatoduodenectomy.. ClinicalTrials.gov Identifier: NCT03269994.

Topics: Adult; Aged; Anti-Bacterial Agents; Cefoxitin; Humans; Male; Pancreatic Fistula; Pancreaticoduodenectomy; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination; Sepsis; Surgical Wound Infection

This experiment was carried out to provide a basis for the treatment of clinical bloodstream infections by analyzing the drug resistance characteristics and integrated gene distribution of Escherichia coli in bloodstream infections in elderly patients. For this aim, E. coli were collected for bacterial identification and drug sensitivity testing from bloodstream infections in elderly patients in the hospital from January 2016 to December 2019. ESBLs positive strains were assayed for genotypes and their integron carriage rates by PCR amplification. The characteristics and differences of various genotype rates were compared and analyzed. Results showed that a total of 230 E. coli strains were isolated. The detection rate of ESBLs-producing bacteria was 37.39 %. ESBLs-producing E. coli showed a high rate of resistance to cefepime, levofloxacin, cotrimoxazole, and ticarcillin/clavulanic acid (>40%). The resistance rate of 230 strains of E. coli to meropenem, minocycline, amikacin, gentamicin and cefoxitin was less than 20%. Among the ESBLs-producing E. coli in bloodstream infections in elderly patients, CTX-M-9 accounted for 27.91%, CTX-M-2 for 17.44%, and SHV for 13.95%. The detection rate of type I integrated genes was 41.30%, and type II and III integrated genes were not detected. ESBLs-producing genotyping-positive bacteria were detected with more than 50% of type I integrated genes. It was concluded that type I integrated genes in ESBLs-producing E. coli isolated from elderly patients carried resistance genes such as CTX-M-9 and CTX-M-2 aggravating multi-drug resistance in bacteria.

Topics: Aged; Amikacin; Anti-Bacterial Agents; beta-Lactamases; Cefepime; Cefoxitin; Clavulanic Acid; Drug Resistance; Escherichia coli; Escherichia coli Infections; Gentamicins; Humans; Integrons; Levofloxacin; Meropenem; Microbial Sensitivity Tests; Minocycline; Sepsis; Ticarcillin; Trimethoprim, Sulfamethoxazole Drug Combination

Pediatric sepsis due to Staphylococcus aureus (S. aureus) is associated with high morbidity and mortality. Accessory-Gene-Regulator (agr) has a role in the pathogenesis of S. aureus through controlling and regulating the expression of virulence genes. Therefore, the aim of the present study was to investigate the prevalence of genotypes of the agr system in S. aureus isolated from children with sepsis and to assess their relationship to biofilm formation and antibiotic resistance.. The study was a retrograde cross-sectional study that included 131 children with health care associated sepsis due to S. aureus. The isolated S. aureus was investigated for their ability to form biofilm by microplate method, antibiotic susceptibility pattern by disc diffusion method, and molecular determination of agr genotypes by polymerase chain reaction (PCR).. Methicillin resistant S. aureus (MRSA) was defined by resistance to cefoxitin antibiotic disc in 70 (53.4%) of the isolates and biofilm formation was positive in 67 (58%) of the isolates. Molecular study of the agr genes revealed that 54 (41.2%), 40 (30.5%), 27 (20.6%), and 10 (7.5%) of the studied isolates had agr I, agr II, agr III, and agr IV, respectively. In comparison between MRSA and methicillin sensitive S. aureus (MSSA), there was a signif-icant increase in biofilm formation among MRSA (65.7%, p = 0.01) compared to MSSA (34.3%) and an increase in agr genotype I among MRSA (68.6%, p = 0.001) compared to agr I in MSSA (9.8%). There was a significant association with the presence of a central venous catheter (51.4%, p = 0.001) and urinary tract catheter (81.4%, p = 0.001) in children with MRSA compared to children with MSSA (21.3%, OR = 3.9, 95% CI = 1.8 - 8.5 and 36.1%, OR = 7.8, 95% CI 3.5 - 17.3, respectively).. There was an increase in the biofilm formation among S. aureus isolated from pediatric patients with sepsis with a significant increase in MRSA. The agr group I was the main agr gene among the isolated S. aureus. Moreover, agr I was the predominant gene in MRSA isolates and was significantly associated with biofilm formation.

Topics: Anti-Bacterial Agents; Cefoxitin; Child; Cross-Sectional Studies; Humans; Methicillin; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Sepsis; Staphylococcal Infections; Staphylococcus aureus

Some strains of Bacteroides fragilis species are associated with diarrhea as a result of enterotoxin production (bft or fragilysin). Fragilysin is activated by C11 protease (fpn) and together with C10 protease (bfp) play a significant role in its invasiveness. The objectives of this study were to investigate the proportion of clinical isolates from extra-intestinal sources that are toxin producers and characterize the genes mediating toxin production. Clinical isolates submitted to our reference laboratory over the last 13 years were screened for toxin production using PCR technique. All stool isolates were excluded. The isolates were tested for their susceptibility to 8 antimicrobial agents by E test. Carbapenem resistance gene cfiA was detected by PCR.. A total of 421 B. fragilis isolates were viable. Out of these, bft was detected in 210 (49.9%) isolates. Of the 210 bft-positive isolates, 171 (81.4%), 33 (15.7%) and 6 (2.8%) harbored bft-1, bft-2, and bft-3 genes, respectively. Twenty (9.5%) of the bft-positive strains originated from bloodstream infections. Twenty-five, 20 and 9 strains harbored bfp-1, bfp-2 and bfp-3 gene, respectively. Two, 3, 4 bfp isotypes were detected simultaneously in some of strains. The resistance rates against amoxicillin-clavulanic acid was 32%, clindamycin 62%, cefoxitin 26%, imipenem 11%, meropenem 17%, metronidazole 4%, piperacillin 61% and tigecycline 14%. A chromosomally located cfiA gene that encode metallo-β-lactamase was identified in only 34 isolates (16.2%).. The prevalence of enterotoxin-producing B. fragilis was high among the extra-intestinal isolates. Metronidazole was the most active agent against all isolates. There was no statistically significance difference between resistance rates among bft-positive and bft-negative isolates except for clindamycin.

Topics: Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bacterial Toxins; Bacteroides fragilis; Bacteroides Infections; Cefoxitin; Clindamycin; Drug Resistance, Bacterial; Feces; Female; Humans; Imipenem; Kuwait; Male; Meropenem; Metronidazole; Microbial Sensitivity Tests; Piperacillin; Prevalence; Prospective Studies; Respiratory Tract Infections; Sepsis; Tigecycline; Wound Infection

The Capnocytophaga sputigena isolate NOR, responsible for septicemia, was resistant to amoxicillin and narrow-spectrum cephalosporins. In a cloning experiment, a new gene, bla(CSP-1), was identified; this gene encodes a novel extended-spectrum beta-lactamase (ESBL) that shares only 52% and 49% identities with the CME-1 and VEB-1 beta-lactamases, respectively. The G+C content of this gene, its genetic environment, the absence of conjugation transfer, and its detection in two reference strains suggested that it was an intrinsic resistance gene located on the chromosome.

Topics: Amino Acid Sequence; Amoxicillin; Anti-Bacterial Agents; beta-Lactam Resistance; beta-Lactamases; Capnocytophaga; Cephalosporins; Gram-Negative Bacterial Infections; Humans; Microbial Sensitivity Tests; Molecular Sequence Data; Sepsis

In a retrospective study comparing 526 oocyte donors who received prophylactic antibiotics for oocyte retrieval with a comparable group of 625 who did not, the incidence of infection after retrieval was reduced from 0.4% to 0 in the group receiving antibiotics. Donors take risks but have no medical indication for the procedures that they undergo; our data suggest that prophylactic antibiotics at retrieval should be considered to minimize the risk of infection.

Topics: Adult; Anti-Infective Agents, Local; Antibiotic Prophylaxis; Cefoxitin; Clindamycin; Female; Humans; Oocyte Donation; Oocyte Retrieval; Pelvic Infection; Postoperative Complications; Reproductive Techniques, Assisted; Retrospective Studies; Sepsis; Triclosan; Young Adult

Tumour necrosis factor (TNF) alpha and interleukin (IL) 1 beta are produced in the lung after peritonitis and may contribute to neutrophil-mediated organ injury. It was hypothesized that, during experimental peritonitis, continuous rather than intermittent antibiotic therapy would reduce lung expression of TNF-alpha and IL-1 beta messenger RNA (mRNA) and neutrophil sequestration.. After caecal ligation and puncture, mice received either intermittent or continuous cefoxitin, or continuous metronidazole or aztreonam. Cytokine mRNAs were determined by reverse transcription differential polymerase chain reaction and lung neutrophil content by myeloperoxidase (MPO) assay.. Continuous cefoxitin reduced median (interquartile range (i.q.r.)) lung IL-1 beta mRNA expression ((ratio to beta-actin): continuous 0.18 (0.14-0.34), intermittent 0.46 (0.44-0.49), saline 0.43 (0.38-0.53), P < 0.05) and median (i.q.r.) lung MPO content (continuous 22.5 (9.7-40), intermittent 65 (57.5-76), saline 47 (41-64), P < 0.05) compared with intermittent therapy and saline controls. Continuous infusion was also associated with reduced bacteraemia (P < 0.05) but not serum TNF-alpha or endotoxin levels. Both continuous metronidazole and aztreonam reduced lung MPO concentration (P < 0.05) and TNF-alpha and IL-1 beta mRNA expression (P < 0.05) compared with those in saline controls. These effects were dependent on a reduction in the number of susceptible bacteria rather than serum TNF-alpha or endotoxin levels.. The stimulus for organ inflammatory cytokine production and neutrophil sequestration during peritonitis is the level of bacteraemia present, which is more effectively controlled with continuous antibiotic therapy.

Topics: Animals; Anti-Bacterial Agents; Aztreonam; Cefoxitin; Cephamycins; Cytokines; Endotoxins; Interleukin-1; Metronidazole; Mice; Peroxidase; Sepsis; Tumor Necrosis Factor-alpha

The plasma and peritoneal fluid pharmacokinetic parameters obtained after the intravenous administration of free and liposomal cefoxitin were studied in a porcine model of intraabdominal sepsis. No prior assumptions were made to predict the number of compartments pertaining to drug clearance from the administration of either cefoxitin formulation. The experimental data obtained were applied to fit mathematical models of multiexponential drug clearance and the pharmacokinetic data were found to best fit a two-compartment open model. Liposomal encapsulation significantly altered the plasma drug distribution pattern resulting in changes in the magnitude of a number of pharmacokinetic parameters examined. The mean post-distributive half-life of liposomal cefoxitin was substantially longer than that of free cefoxitin by at least 3 times. The peritoneal cavity appeared to provide a reservoir for the initial distributive phase of rapid drug clearance from the plasma compartment followed by a less-rapid post-distributive phase. The cumulative drug level, as determined by the area under the concentration curve (AUC) as a function of time, in the plasma of animals treated with liposomal cefoxitin was about 3-4 fold as high as that of animals treated with free cefoxitin. The differences in pharmacokinetic parameters appeared to account for the improved therapeutic efficacy of liposomal cefoxitin in this animal model.

Topics: Abdomen; Animals; Area Under Curve; Ascitic Fluid; Cefoxitin; Cephamycins; Disease Models, Animal; Drug Carriers; Half-Life; Injections, Intravenous; Liposomes; Male; Sepsis; Swine

The bactericidal effect of free versus liposomal cefoxitin was evaluated in the major reticuloendothelial organs in a porcine model of intra-abdominal sepsis. Yorkshire Landrace pigs were inoculated with 3.2 x 10(10) (n = 5) or 1.4 x 10(11) (n = 7) cfu of Escherichia coli mixed in sterile feces/animal. Two treatment groups inoculated with 1.4 x 10(11) cfu were established: free cefoxitin (n = 9) and liposomal cefoxitin (n = 9). All animals were maintained under anesthesia and euthanized after 24 h. The number of E. coli recovered in the liver, lungs, and spleen was significantly affected by inoculum size (p < .05). The liver had significantly higher numbers of bacteria (p < .05) compared with the other organs, regardless of the inoculum size. The liver and the lung of the liposomal cefoxitin-treated group showed significantly lower numbers of E. coli (5.0 x 10(4) and 6.3 x 10(2), respectively) compared with the untreated (liver, 6.3 x 10(7); lung, 2.0 x 10(6)) and free cefoxitin (liver, 5.0 x 10(6); lung, 7.9 x 10(4))-treated groups (p < .05). At 2 h following the injection of free and liposomal cefoxitin, the decrease of E. coli in peritoneal fluid compared with the nontreated septic group was significant (p < .05). No growth was observed from blood cultures taken 24 h after sepsis induction. All control experiments yielded negative cultures. The results of these experiments demonstrated that liposomal cefoxitin exerts an enhanced bactericidal effect in liver and lungs during Gram-negative sepsis.

Topics: Analysis of Variance; Animals; Cefoxitin; Cephamycins; Disease Models, Animal; Escherichia coli; Liposomes; Male; Sepsis; Swine

Topics: Anti-Bacterial Agents; Bacteria, Aerobic; Bacteria, Anaerobic; Body Temperature; Cefotetan; Cefoxitin; Gallbladder Diseases; Half-Life; Humans; Sepsis; Shock, Septic

Topics: Aged; Antibiotic Prophylaxis; Biliary Tract Surgical Procedures; Cefotetan; Cefoxitin; Controlled Clinical Trials as Topic; Female; Humans; Male; Postoperative Complications; Risk Factors; Sepsis; Surgical Wound Infection

The local application of antibiotics to treat intraperitoneal contamination has been used with variable results. Liposomes are not rapidly absorbed from the peritoneal cavity, offering a potential delivery system for intraperitoneal antibiotics. The effects of liposome-incorporated antibiotic administration in a fecal peritonitis model were compared with the effects of conventional intraperitoneal and intramuscular antibiotics. Rats were divided into four groups: untreated, intramuscular cefoxitin, intraperitoneal cefoxitin, and intraperitoneal liposome-incorporated cefoxitin. Quantitative blood cultures were drawn at 4 and 24 hours. Liposome delivery of cefoxitin significantly reduced mortality and bacteremia at 4 and 24 hours compared with control subjects and conventional antibiotic groups. Peritoneal abscess formation tended to decrease in the liposome antibiotic group (mean +/- SEM, 6.86 +/- 0.79) compared with the group receiving free intraperitoneal administration of antibiotics (10.33 +/- 1.63). We conclude that liposomal delivery significantly enhances the effectiveness of cefoxitin in this model of peritonitis.

Topics: Animals; Bacteria; Cefoxitin; Drug Carriers; Injections, Intramuscular; Injections, Intraperitoneal; Leukocyte Count; Liposomes; Peritonitis; Rats; Rats, Inbred Strains; Sepsis; Tobramycin

This study was done to test the effectiveness of calcium antagonists on survival in a bacteremic model. Swiss albino mice were injected intraperitoneally with live Escherichia coli at an LD90 dose. When antibiotic treatment was delayed for 3 hr after E coli challenge, there was a mortality range of 30-50% for the gentamicin-treated mice and 40-60% for the cefoxitin-treated mice. A calcium antagonist, either nifedipine or verapamil, was added to this model in different dosages and at different time intervals. Nifedipine yielded a significantly lower mortality both with gentamicin and with cefoxitin. Verapamil did not affect mortality with cefoxitin but did improve survival with gentamicin. Effective dosages occur within a narrow range. The results are encouraging and call for further studies with calcium antagonists to ascertain their prospective usefulness as additives to septic shock treatment.

Topics: Animals; Cefoxitin; Drug Therapy, Combination; Escherichia coli Infections; Gentamicins; Mice; Nifedipine; Sepsis; Time Factors; Verapamil

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

Cefoxitin (CFX) was administrated to a total of 12 hospitalized patients with digestive diseases, in combination with aminoglycosides. The following results were obtained: Clinical effects of CFX on 12 cases were "excellent" in 4 cases, "good" in 5, "fair" in 1 and "unknown" in 2, with the efficacy rate of 75%. All 4 cases who developed septicemia with underlying severe diseases showed "excellent" effect to CFX. Clinical results of 8 cases with hepatic biliary tract infections were "good" in 5, "fair" in 1 and "unknown" in 2, with the efficacy rate in 62.5%. As for side effects, an allergic reaction was observed in 1 case, and it is suggested renal function should be monitored carefully in a case of combination use with aminoglycosides.

Topics: Aged; Bacterial Infections; Biliary Tract Diseases; Cefoxitin; Cholecystitis; Dibekacin; Digestive System Diseases; Drug Therapy, Combination; Female; Gallstones; Gentamicins; Humans; Liver Abscess; Male; Middle Aged; Sepsis

Patients undergoing splenectomy have increased operative morbidity and mortality, especially when associated with gastrointestinal surgery or injury. This present study was designed to assess the effect of splenectomy on mortality in a polymicrobial fecal peritonitis model and evaluate therapy with antibiotic (cefoxitin) or immunomodulation (glucan). Human stool-barium (0.15 cc) was placed in the peritoneum of Sprague-Dawley rats at the time of splenectomy or sham surgery. Splenectomy animals were then treated with 5% dextrose, cefoxitin (60 mg im q 6 hr), glucan (7.5 mg ip prior to surgery), or cefoxitin plus glucan. Splenectomy resulted in decreased survival (5% vs 30%, P less than 0.05). Treatment with cefoxitin (90%) or glucan (47%) significantly improved survival. Combined glucan-cefoxitin therapy had no improvement over cefoxitin alone. Peritoneal and blood cultures were performed 12 hr postoperatively. There were no significant differences in growth of bacteria between sham and splenectomy animals. Cefoxitin treatment resulted in lower growth of bacteria from both blood and peritoneum (P less than 0.05). Glucan treatment caused a significant decrease in the number of bloodborne bacteria (P less than 0.05). Intravascular colloidal carbon clearance and leucocyte counts were performed at 12 hr postoperatively. Presence of peritonitis significantly enhanced intravascular clearance, while splenectomy had no effect. Addition of glucan or cefoxitin therapy to splenectomy animals did not enhance intravascular clearance. Leucocyte counts were significantly lower (P less than 0.05) when splenectomy was added to peritonitis animals. Glucan and cefoxitin therapy did not increase leucocyte counts. Based on these studies we conclude that (1) splenectomy increases mortality in fecal peritonitis, (2) antibiotic and immunomodulator afford some protection, and (3) exact mechanism of protection remains unclear.

Topics: Adjuvants, Immunologic; Animals; Bacteria; Cefoxitin; Glucans; Leukocyte Count; Male; Peritonitis; Phagocytosis; Rats; Rats, Inbred Strains; Sepsis; Splenectomy

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 novel beta-lactam, L-640,876, exhibited excellent therapeutic activity when administered parenterally but not orally to mice infected with a variety of pathogenic bacteria. In this respect, the compound was as potent as cefotaxime against representative Gram-positive and Gram-negative organisms, in most cases, equal to or more potent than cefoxitin, and more effective than mecillinam. When administered subcutaneously to normal mice at dose levels ranging from 10 to 50 mg/kg, L-640,876 provided an adequate dose response, recovery of ca. 45% of biological activity in the urine, and excellent distribution at the highest dose level into liver, lung, kidney, heart muscle, but not brain.

Topics: Amdinocillin; Animals; Anti-Bacterial Agents; Cefotaxime; Cefoxitin; Cephalosporins; Gram-Negative Bacteria; Kinetics; Mice; Microbial Sensitivity Tests; Penicillanic Acid; Sepsis; Tissue Distribution

One hundred fifty-five patients with 157 febrile episodes were treated with amdinocillin or amdinocillin and cefoxitin as second-line therapy, or amdinocillin and ticarcillin or carbenicillin as initial therapy in three separate studies. Overall responses were 57 percent, 55 percent, and 54 percent for amdinocillin, amdinocillin-cefoxitin, and amdinocillin-ticarcillin or amdinocillin-carbenicillin, respectively. In all three studies, patients with septicemia responded less often than patients with other infections. Most patients were profoundly neutropenic at the initiation of therapy, and both the initial neutrophil level and neutrophil trend during therapy influenced response. A significant number of superinfections occurred when amdinocillin alone was used. Although amdinocillin, alone or in combination with cefoxitin, appeared effective as second-line therapy in infections with organisms shown sensitive in vitro, the combination of amdinocillin and ticarcillin or carbenicillin was only moderately effective in initial therapy for neutropenic, febrile, cancer patients.

Topics: Acute Disease; Adolescent; Adult; Aged; Amdinocillin; Bacterial Infections; Carbenicillin; Cefoxitin; Drug Therapy, Combination; Female; Humans; Leukemia; Leukocyte Count; Male; Middle Aged; Neutrophils; Penicillanic Acid; Penicillins; Sepsis; Ticarcillin

Topics: Amikacin; Cefoxitin; Computers; Drug Therapy, Combination; Humans; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature, Diseases; Metabolic Clearance Rate; Penicillin G; Sepsis

Ten patients with sepsis and pneumonia complicated by leukemia or lung cancer were treated with cefoxitin (CFX) at daily dose of 6 g. The following results were obtained. 1. Clinical effects of CFX were good in 5 patients, fair in 2 and poor in 3 with effective rate of 50%. 2. Out of 8 patients with sepsis, 5 showed good response to CFX and effective rate was 62.5%. 3. Bacteriological outcomes were eradicated in 1, unchanged in 1, replaced in 2 and unknown in 6 cases. 4. Diarrhea was observed in 1 patient but this was not considered related to CFX therapy. 5. No abnormal laboratory finding due to CFX was observed. 6. It should be considered that 6 g or more of CFX is given in case of severe infections, such as sepsis or pneumonia complicated by serious underlying diseases.

Topics: Adult; Aged; Cefoxitin; Drug Evaluation; Female; Humans; Infusions, Parenteral; Leukemia; Lung Neoplasms; Male; Middle Aged; Pneumonia; Sepsis

The ability of cefoxitin to antagonize the in vivo efficacy of cefamandole and carbenicillin as predicted by in vitro assays was analyzed in experimental infections in mice. Cefoxitin was administered in a nonprotective dose either at the time of challenge or simultaneously with the protective drug, 1 and 3.5 h postchallenge. In mice infected with Enterobacter cloacae, median 50% protective doses of cefamandole and carbenicillin were markedly increased by cefoxitin, especially when the latter was given at the time of challenge. The antagonistic effect was also associated with increased numbers of challenge bacteria present in animal heart blood within a 6.5-h period after infection. In infections with Pseudomonas aeruginosa, cefoxitin antagonized carbenicillin; however, the effect was less dramatic than that seen with E. cloacae. Antagonism in this model was pronounced with simultaneous administration of antagonizing and protective drugs. The antagonistic effects observed in all in vivo tests were not due to the selection of stable resistance to the protective drugs, but appeared to be due to a reversible induction of beta-lactamases by cefoxitin.

Topics: Animals; Bacterial Infections; Carbenicillin; Cefamandole; Cefoxitin; Cephalosporins; Lactams; Male; Mice; Penicillin Resistance; Sepsis

Eleven paediatric patients ranging in age from 7 weeks to 7 years were treated with intravenous cefoxitin for a variety of moderate or severe infections. All identifiable pathogens were sensitive to cefoxitin and the clinical outcome for every patient was regarded as a cure. Cefoxitin was well tolerated by all patients, the institution of therapy being associated in many cases with a rapid improvement in clinical condition.

Topics: Bacterial Infections; Cefoxitin; Child; Child, Preschool; Drug Tolerance; Female; Humans; Infant; Male; Microbial Sensitivity Tests; Sepsis

An investigation conducted on healthy volunteers showed that cefoxitin quickly reaches high plasma concentrations, and is almost completely excreted via the urine within 6 hours. In a series of 21 cases treated with 2 g i.v. in 100 ml of a 5% glucose solution two or three times a day, a clinical cure was achieved in 20, and marked improvement in the remaining patient.

Topics: Bacillus subtilis; Bronchitis; Bronchopneumonia; Cefoxitin; Cholangitis; Cystitis; Drug Evaluation; Drug Tolerance; Gas Gangrene; Herpes Zoster; Humans; Kinetics; Osteomyelitis; Sepsis

Topics: Adolescent; Blood Coagulation Tests; Cefoxitin; Clostridium Infections; Disseminated Intravascular Coagulation; Drug Therapy, Combination; Female; Gentamicins; Heparin; Humans; Sepsis

Pneumonia due to Escherichia coli (E. coli) has a reported mortality of up to 70 per cent. Most infections are associated with underlying disease, and follow bacteraemia from a genitourinary or gastrointestinal source. This report describes two patients with bacteraemic E. coli pneumonia, presumed secondary to aspiration of E. coli from the oropharynx. Both patients presented a rapidly progressive illness with hypotension. Response of the pneumonia to early, appropriate antimicrobial therapy, was complete. Our cases are discussed with particular reference to clinical features of the infection and choice of antimicrobial therapy.

Topics: Cefoxitin; Cephalothin; Drug Therapy, Combination; Escherichia coli Infections; Gentamicins; Humans; Lung; Male; Middle Aged; Pneumonia, Aspiration; Radiography; Sepsis

In basic pharmacological studies, sodium cefoxitin has proved to possess the following features: a broad action spectrum, resistance to bacterial beta-lactamase, activity against anaerobic species, rapid distribution, rapid serum and bile concentration, rapid, elevated excretion in the urine in active form, and low local and general toxicity. Patients in an Emergency Surgery Department often present the following conditions: highly compromised general situation, serious, often polymicrobic sepsis with aerobic and anaerobic flora, prior treatment without result with various cycles of chemo-antibiotic treatment. The theoretical conditions therefore exist to assess the effectiveness of sodium cefoxitin in patients admitted to an emergency surgery department and presenting serious post-surgical or post-traumatic sepsis, or sepsis due to pathology that can be corrected surgically. A study of 14 patients (3 g i.v. or i.m. for 6 days) showed 71% complete cure, 21% definite improvements and one death (treatment commenced 36 hours prior to death). It is therefore maintained that sodium cefoxitin is particularly indicated as first-choice antibiotic in emergency surgery situations.

Topics: Bacterial Infections; Cefoxitin; Emergency Service, Hospital; Humans; Sepsis; Surgical Procedures, Operative; Wounds and Injuries

Topics: Adolescent; Adult; Aged; Cefoxitin; Drug Evaluation; Female; Hematologic Diseases; Humans; Infections; Infusions, Parenteral; Male; Middle Aged; Sepsis

Laboratory studies of CFX were performed on susceptibility of 123 strains isolated from 72 patients with septicemia by disc sensitivity method in comparison with CER and ABPC. Antibacterial activity of CFX was superior against Escherichia coli, Klebsiella, Serratia marcescens and Proteus than that of CER and ABPC, especially against Serratia marcescens and Bacteroides which were mostly resistant to CER and ABPC. CFX was administrated to 8 patients with septicemia. Clinical effects were obtained, excellent and good in 5 patients and poor in 3, and effective rate was 63%. No side effects were observed. The above results indicate that CFX is mainly useful in the treatment of infections caused by Gram-negative bacilli, especially resistant to penicillins, cephalosporins, and Bacteroides.

Topics: Adolescent; Adult; Aged; Bacteria; Cefoxitin; Drug Evaluation; Drug Resistance, Microbial; Female; Humans; Male; Middle Aged; Sepsis

Procedures for evaluating the efficacy of chemotherapeutic agents in an infant rat model of Haemophilus influenzae meningitis were developed. The results of efficacy studies with ampicillin, chloramphenicol, cefamandole, cefoxitin, and SQ 13,426 were compared to activity in vitro. While most of the drugs tested were very active against the two strains of H. influenzae used in vitro, this activity was not in all cases translated into efficacy in vivo. Pharmacokinetic studies using ampicillin or chloramphenicol demonstrated the presence of each antibiotic at the foci of infection in concentrations found to be bactericidal in vitro.

Topics: Ampicillin; Animals; Cefamandole; Cefoxitin; Cephalosporins; Chloramphenicol; Drug Evaluation, Preclinical; Haemophilus influenzae; Meningitis, Haemophilus; Microbial Sensitivity Tests; Rats; Sepsis

To compare the in vitro activity of cefamandole with ampicillin, cefoxitin, and gentamicin, each antimicrobial was tested against 419 bacteria isolated from the blood of patients with proved sepsis. Cefamandole was active against all gram-positive cocci except the enterococci. Most Enterobacteriaceae were inhibited by both cefamandole and cefoxitin. Cefamandole showed an activity similar to ampicillin against Haemophilus influenzae. The percent of blood culture isolated considered susceptible to the drugs tested were as follows: cefamandole 79%, cefoxitin 78%, ampicillin 55% and gentamicin 81%. None of the drugs tested would be adequate alone for treatment of sepsis of unknown etiology based on in vitro susceptibility data.

Topics: Ampicillin; Anti-Bacterial Agents; Bacteria; Cefamandole; Cefoxitin; Gentamicins; Humans; Microbial Sensitivity Tests; Sepsis