colistin and Staphylococcal-Infections

A two-stage approach to total knee arthroplasty (TKA) using an antibiotic-impregnated articulating cement spacer is an option for an infected arthritic knee. Vancomycin combined with broad-spectrum antibiotics can be used to make an antibiotic-impregnated articulating cement spacer. Causative organisms are sometimes not confirmed before surgery. Joint infections of multidrug-resistant organisms are increasing. Therefore, routine combinations of antibiotics may not be effective.. We present a case of a patient who developed vancomycin-resistant Pseudomonas aeruginosa infection in an arthritic knee. A 71-year-old man was initially diagnosed with pyogenic arthritis caused by Staphylococcus aureus. He underwent arthroscopic debridement elsewhere. However, the infection persisted. He was referred to our hospital, and we performed a two-stage TKA using a vancomycin-based antibiotic-impregnated articulating cement spacer. Vancomycin-resistant P. aeruginosa was identified after surgery. Intravenous colistin was added. However, this failed, either because vancomycin was not effective against P. aeruginosa, or because insufficient systemic colistin due to colistin-induced acute kidney injury. Therefore, debridement was repeated, and colistin-loaded cement spacer was inserted. The spacer delivered high concentrations of colistin to the infected joint with decreased systemic effects. Thus, less systemic colistin was used. The infection was controlled without recurrent acute kidney injury. One year after surgery, conversion to TKA was successfully performed.. A two-stage approach to TKA using a colistin-loaded articulating cement spacer can be used for an arthritic knee infected by vancomycin-resistant P. aeruginosa. Furthermore, local administration of colistin using a cement spacer can reduce the systemic side effects of colistin.

Topics: Aged; Anti-Bacterial Agents; Arthritis, Infectious; Arthroplasty, Replacement, Knee; Bone Cements; Colistin; Debridement; Humans; Male; Pseudomonas aeruginosa; Pseudomonas Infections; Reoperation; Staphylococcal Infections; Vancomycin Resistance

The global spread of multi-drug resistant organisms (MDRO) is a major threat to public health. Fighting MDRO spread requires a multi-faceted approach as summarized in the German Antibiotic Resistance Strategy (DART). In the hospital, this includes antibiotic stewardship concepts and strict infection control measures. Treatment of MDRO is sophisticated. Within the last years, several antibiotics with activity against MRSA were launched and facilitate an individual therapy according to site of infection and co-morbidities. In contrast, novel antibiotics against carbapenemase producing Gram-negatives are still lacking. Current studies have shown, that a colistin-based combination treatment can improve the prognosis in these patients. The following article reviews MDRO definitions, burden of disease, treatment options and general strategies against MDRO.

Topics: Anti-Bacterial Agents; Bacterial Infections; Colistin; Cost of Illness; Cross Infection; Drug Resistance, Multiple, Bacterial; Drug Therapy, Combination; Gram-Negative Bacterial Infections; Humans; Methicillin-Resistant Staphylococcus aureus; Staphylococcal Infections

Nitrofurantoin, amikacin, colistin, polymyxin B, doxycycline, and minocycline are antibiotics with proven effectiveness against selected pathogens. These antibiotics have not developed resistance over time. As "low-resistance potential antibiotics" that are effective against an increasing number of infections due to resistant gram-positive or gram-negative pathogens, these antimicrobials remain an important part of the antibiotic armamentarium. They will be used increasingly in the future, as highly resistant organisms continue to be important clinically and therapeutic options remain limited.

Topics: Amikacin; Cell Membrane; Colistin; Doxycycline; Drug Resistance, Microbial; Gram-Negative Bacterial Infections; Humans; Methicillin Resistance; Minocycline; Nitrofurantoin; Polymyxin B; Staphylococcal Infections; Urinary Tract Infections

One hundred and fifty-nine cases of clinical Staphylococcus aureus mastitis were analyzed to detect factors associated with bacteriological cure after therapy. On 100 Dutch dairy farms, data were collected from four clinical trials with five intramammary treatment regimes designed to treat beta-lactamase-positive pathogens. Infected quarters were treated three times, with a 12-h interval between treatments. Treatment was extended for 2 d if results of the trial treatment were, according to the owner, not satisfactory. The overall bacteriological cure rate was 52%. The bacteriological cure rate of clinical beta-lactamase-negative S. aureus mastitis was significantly higher than that of clinical beta-lactamase-positive S. aureus mastitis. Bacteriological cure was also significantly higher if somatic cell count of the cow was low at the milk recording prior to the onset of the clinical mastitis. The bacteriological cure rate of clinical beta-lactamase-negative S. aureus mastitis was also significantly higher after an extended treatment compared with no extended treatment. The seriousness of the various clinical symptoms and the bacteriological cure rate of clinical S. aureus mastitis were not associated.

Topics: Ampicillin; Animals; Antibiotics, Antitubercular; beta-Lactam Resistance; Cattle; Cefazolin; Cephalosporins; Cloxacillin; Colistin; Double-Blind Method; Female; Mastitis, Bovine; Milk; Penicillins; Rifampin; Staphylococcal Infections; Staphylococcus aureus; Trimethoprim

The literature on the clinical use of rifampicin in combination for the treatment of non-mycobacterial diseases is reviewed. From the published evidence, the most promising associations are, for staphylococcal infections, gentamicin, erythromycin, kanamycin and fusidic acid. In the field of Gram-negative infections, Psuedomonas-induced sepsis in particular, data are not so impressive but promising results have been obtained with the associated use of rifampicin and gentamicin or colistin. Some systemic fungal diseases may be successfully treated with rifampicin in combination with amphotericin-B. Although only few reports are available on this subject, the importance of such an application is stressed in view of the severity of these diseases and of the lack of appropriate treatments.

Topics: Amphotericin B; Cephalosporins; Chloramphenicol; Colistin; Drug Therapy, Combination; Endocarditis, Bacterial; Erythromycin; Gentamicins; Humans; Kanamycin; Lincomycin; Mycoses; Nalidixic Acid; Penicillins; Pseudomonas Infections; Respiratory Tract Infections; Rifampin; Staphylococcal Infections; Sulfamethoxazole; Tetracyclines; Trimethoprim; Urinary Tract Infections; Vancomycin

Topics: Anti-Bacterial Agents; Cephalosporins; Chloramphenicol; Colistin; Drug Hypersensitivity; Enterobacteriaceae Infections; Erythromycin; Female; Gonorrhea; Humans; Kidney Diseases; Mycoplasma Infections; Pelvic Inflammatory Disease; Salpingitis; Staphylococcal Infections; Streptococcal Infections; Streptomycin; Tetracycline; Thrombophlebitis; Tuberculosis, Female Genital; Wound Infection

Topics: Anti-Bacterial Agents; Cephalosporins; Chloramphenicol; Colistin; Drug Hypersensitivity; Erythromycin; Gentamicins; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature, Diseases; Infections; Intestinal Absorption; Kanamycin; Neomycin; Odontogenesis; Oleandomycin; Penicillin Resistance; Penicillins; Polymyxins; Staphylococcal Infections; Streptomycin; Tetracycline

Topics: Acremonium; Anti-Bacterial Agents; Chemical Phenomena; Chemistry; Colistin; Fusidic Acid; Penicillin G; Penicillin Resistance; Penicillins; Pharmacology; Polymyxins; Staphylococcal Infections; Steroids; Tetracycline; Toxicology

Topics: Amphotericin B; Anti-Bacterial Agents; Antifungal Agents; Cephalothin; Colistin; Cycloserine; Demeclocycline; Erythromycin; Gentamicins; Griseofulvin; Humans; Kanamycin; Methicillin; Novobiocin; Oxacillin; Paromomycin; Penicillin V; Penicillins; Pharmacology; Ristocetin; Staphylococcal Infections; Toxicology; Troleandomycin; Vancomycin

Despite optimal medical therapy and endoscopic sinus surgery there still remains a group of unfortunate patients suffering from exacerbations of recalcitrant chronic sinusitis. We have performed a pilot study in order to determine whether nebulized topical antibiotic therapy improves sinusitis symptoms more than saline-based placebo in patients with recalcitrant chronic rhinosinusitis.. A randomized, placebo-controlled, double-blind, cross-over pilot study was conducted in 14 patients with recalcitrant CRS. Nasal irrigation with bacitracin/colimycin or placebo using the RhinoFlow nebulizer twice daily was administered in combination with oral levofloxacin. Severity of a diversity of symptoms was measured using the VAS score, a Disease-Specific Symptom Score and the SF-36 questionnaire. Nasal endoscopic findings were also assessed.. For most VAS items and Disease-Specific Symptom Scores, a reduction in severity of symptoms was noted in both the bacitracin/colimycin and the placebo group. No significant difference was found between the 2 arms (bacitracin/colimycin vs. placebo). Most SF-36 items improved, compared with the situation before treatment in both groups. However no significant difference was found between the verum and placebo arm. Endoscopic findings did not reveal significant differences when comparing the 2 treatments.. The outcome of this study suggests a beneficial effect of nebulizing the nose with saline. This study again shows that adding antibiotics to local saline is not effective. Although the placebo-controlled studies looking at the effect of local antibiotics are all small they all point to the same direction: no effect. Definite conclusions however need a large randomized, multicenter study.

Topics: Administration, Inhalation; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Bacitracin; Chronic Disease; Colistin; Cross-Over Studies; Double-Blind Method; Drug Therapy, Combination; Female; Humans; Levofloxacin; Male; Middle Aged; Nebulizers and Vaporizers; Ofloxacin; Pilot Projects; Rhinitis; Sinusitis; Staphylococcal Infections; Staphylococcus aureus

One hundred and fifty-nine cases of clinical Staphylococcus aureus mastitis were analyzed to detect factors associated with bacteriological cure after therapy. On 100 Dutch dairy farms, data were collected from four clinical trials with five intramammary treatment regimes designed to treat beta-lactamase-positive pathogens. Infected quarters were treated three times, with a 12-h interval between treatments. Treatment was extended for 2 d if results of the trial treatment were, according to the owner, not satisfactory. The overall bacteriological cure rate was 52%. The bacteriological cure rate of clinical beta-lactamase-negative S. aureus mastitis was significantly higher than that of clinical beta-lactamase-positive S. aureus mastitis. Bacteriological cure was also significantly higher if somatic cell count of the cow was low at the milk recording prior to the onset of the clinical mastitis. The bacteriological cure rate of clinical beta-lactamase-negative S. aureus mastitis was also significantly higher after an extended treatment compared with no extended treatment. The seriousness of the various clinical symptoms and the bacteriological cure rate of clinical S. aureus mastitis were not associated.

Topics: Ampicillin; Animals; Antibiotics, Antitubercular; beta-Lactam Resistance; Cattle; Cefazolin; Cephalosporins; Cloxacillin; Colistin; Double-Blind Method; Female; Mastitis, Bovine; Milk; Penicillins; Rifampin; Staphylococcal Infections; Staphylococcus aureus; Trimethoprim

113 patients being treated for acute non-lymphoblastic leukaemia were investigated to determine the effect of suppression of body microbial flora on prevention of infection. They were randomly allocated to a control group or a group which received non-absorbed antibiotics by mouth and topical applications of cutaneous and mucosal antiseptic preparations. The group receiving oral non-absorbed antibiotics had significantly few infections, fewer deaths from infection, fewer pyrexial episodes, and consequently received less systemic antibiotic therapy than the controls.

Topics: Acute Disease; Administration, Oral; Administration, Topical; Adolescent; Adult; Antineoplastic Agents; Bacterial Infections; Bacteroides Infections; Chlorhexidine; Colistin; Drug Combinations; Enterobacteriaceae Infections; Framycetin; Humans; Leukemia; Nystatin; Remission, Spontaneous; Sepsis; Staphylococcal Infections; Staphylococcus aureus; Streptococcal Infections

Low- and middle-income countries bear a disproportionate burden of antimicrobial resistance (AMR) but often lack adequate surveillance to inform mitigation efforts. Colonization can be a useful metric to understand AMR burden. We assessed the colonization prevalence of Enterobacterales with resistance to extended-spectrum cephalosporins, carbapenems, colistin, and methicillin-resistant Staphylococcus aureus among hospital and community dwellers.. Between April and October 2019, we conducted a period prevalence study in Dhaka, Bangladesh. We collected stool and nasal specimens from adults in 3 hospitals and from community dwellers within the hospitals' catchment area. Specimens were plated on selective agar plates. Isolates underwent identification and antibiotic susceptibility testing using Vitek 2. We performed descriptive analysis and determined population prevalence estimates accounting for clustering at the community level.. The majority of both community and hospital participants were colonized with Enterobacterales with resistance to extended-spectrum cephalosporins (78%; 95% confidence interval [95% CI], 73-83; and 82%; 95% CI, 79-85, respectively). Thirty-seven percent (95% CI, 34-41) of hospitalized patients were colonized with carbapenems compared with 9% (95% CI, 6-13) of community individuals. Colistin colonization prevalence was 11% (95% CI, 8-14) in the community versus 7% (95% CI, 6-10) in the hospital. Methicillin-resistant Staphylococcus aureus colonization was similar in both community and hospital participants (22%; 95% CI, 19-26 vs 21% (95% CI, 18-24).. The high burden of AMR colonization observed among hospital and community participants may increase the risk for developing AMR infections and facilitating spread of AMR in both the community and hospital.

Topics: Adult; Anti-Bacterial Agents; Bangladesh; Carbapenems; Cephalosporins; Colistin; Drug Resistance, Microbial; Hospitals; Humans; Methicillin-Resistant Staphylococcus aureus; Prevalence; Staphylococcal Infections

In 2016, very high rates of methicillin-resistant Staphylococcus aureus (MRSA)-ST398 (99%) were found in Portuguese pig farms that used colistin, amoxicillin, and zinc oxide as feed additives. Since then, farms A and B banned the use of colistin, and farm C banned the use of both antibiotics.. The aim of the present study was to evaluate the impact of the ban of colistin and amoxicillin on pig MRSA carriage rates, clonal types and antimicrobial resistance, compared to the results obtained in 2016.. In 2018, 103 pigs (52 from farm B using amoxicillin only as a feed additive and 51 from farm C where no antibiotics were included in the feed regimen) were nasally swabbed for MRSA colonization. Isolates were tested for antimicrobial susceptibility, and characterised by spa typing, SCCmec typing and MLST. Whole genome sequencing (WGS) was performed for representative isolates.. Overall, 96% of the pigs swabbed in 2018 carried MRSA, mostly ST398-SCCmec V-spa types t011/t108. MRSA from pigs not receiving antibiotics in the feed regimen showed susceptibility to a higher number of antibiotics, namely erythromycin, ciprofloxacin, gentamicin, and chloramphenicol. Notably, most of these isolates (n = 52) presented an unusual erythromycin-susceptibility/clindamycin-resistance phenotype. WGS showed that these isolates lacked the erm and the lnu genes encoding resistance to macrolides and lincosamides, respectively, but carried the vgaALC gene encoding resistance to lincosamides, which is here firstly identified in S. aureus ST398.. After two years the ban of colistin and amoxicillin as feed additives had no significant impact on the MRSA nasal carriage rates. Nevertheless, the MRSA strains circulating in those farms showed resistance to a lower number of antibiotic classes.

Topics: Amoxicillin; Animal Feed; Animals; Anti-Bacterial Agents; Carrier State; Colistin; Drug Resistance, Multiple, Bacterial; Farms; Methicillin-Resistant Staphylococcus aureus; Nose; Portugal; Staphylococcal Infections; Swine; Swine Diseases; Whole Genome Sequencing

The use of colistin for multi-drug resistant (MDR) infections has led to an increase of colistin-associated acute kidney injury (AKI). Nevertheless, information on long-term renal prognosis is scarce. We aimed to determine the predictors of chronic kidney disease (CKD) in survivors of MDR-infections with colistin-associated AKI.. A retrospective cohort of patients with colistin-associated AKI was compared with controls (survivors of severe infections who developed AKI matched by age, sex, diabetes, vancomycin exposure, and baseline kidney function). The primary outcome was the development of CKD after 6months of follow-up.. From 2011 to 2015, 122 patients with MDR infections received colistin. Among 72 survivors, 29 (40%) had colistin-associated AKI. After 6months, 22 of them (75%) progressed to CKD (G3 in 21/22) compared with 16 (27%) in 58 controls (P<0.001). Independent predictors of progression to CKD were colistin use [odds ratio (OR): 8.86; 95% CI: 2.8-27.8] and age (OR: 1.04, 95% CI: 1.01-1.07). In patients exposed to colistin, a total dose of colistin >5g was an independent predictor of progression to CKD (OR: 14.1, 95% CI: 2.6-75.7).. Colistin-associated AKI had a substantial risk for the latter development CKD, and consequently, these patients should be tightly monitored.

Topics: Acute Kidney Injury; Adult; Aged; Anti-Bacterial Agents; Cohort Studies; Colistin; Female; Humans; Male; Methicillin-Resistant Staphylococcus aureus; Mexico; Middle Aged; Prevalence; Renal Insufficiency, Chronic; Retrospective Studies; Risk Factors; Staphylococcal Infections; Survivors; Young Adult

Biofilms are the preferred environment of micro-organisms on various surfaces such as catheters and heart valves, are associated with numerous difficult-to-treat and recurrent infections, and confer an extreme increase in antibiotic tolerance to most compounds. The aim of this study was to evaluate how colistin affects both the extracellular biofilm matrix and the embedded bacteria in biofilms of methicillin-resistant Staphylococcus aureus (MRSA), a species with intrinsic resistance to colistin, and colistin-susceptible Escherichia coli. Biofilms of MRSA and E. coli were treated with different concentrations of colistin. The minimum biofilm eradication concentration (MBEC) and the effectiveness of colistin at reducing the planktonic fraction were defined as the remaining viable bacteria measured as CFU/mL. In addition, biofilm-embedded cells were LIVE/DEAD-stained and were analysed by confocal laser scanning microscopy (CLSM). Quantification of the biofilm CLSM images was conducted using an open-access in-house algorithm (qBA). In contrast to MRSA, E. coli biofilms and planktonic cells were significantly reduced by colistin in a concentration-dependent manner. Nevertheless, colistin has been shown to exert a matrix-reducing effect following treatment both in laboratory strains and clinical isolates of MRSA and E. coli. Because exposure to colistin rapidly triggered the emergence of highly resistant clones, monotherapy with colistin should be applied with caution. These results suggest that colistin destabilises the biofilm matrix structure even in species with intrinsic colistin resistance, such as S. aureus, leading to the release of planktonic cells that are more susceptible to antibiotics.

Topics: Anti-Bacterial Agents; Biofilms; Colistin; Colony Count, Microbial; Escherichia coli; Escherichia coli Infections; Humans; Methicillin-Resistant Staphylococcus aureus; Microbial Viability; Microscopy, Confocal; Staining and Labeling; Staphylococcal Infections

Resistance of Staphylococcus aureus to beta-lactam antibiotics has led to increasing use of the glycopeptide antibiotic vancomycin as a life-saving treatment for major S. aureus infections. Coinfection by an unrelated bacterial species may necessitate concurrent treatment with a second antibiotic that targets the coinfecting pathogen. While investigating factors that affect bacterial antibiotic sensitivity, we discovered that susceptibility of S. aureus to vancomycin is reduced by concurrent exposure to colistin, a cationic peptide antimicrobial employed to treat infections by Gram-negative pathogens. We show that colistin-induced vancomycin tolerance persists only as long as the inducer is present and is accompanied by gene expression changes similar to those resulting from mutations that produce stably inherited reduction of vancomycin sensitivity (vancomycin-intermediate S. aureus [VISA] strains). As colistin-induced vancomycin tolerance is reversible, it may not be detected by routine sensitivity testing and may be responsible for treatment failure at vancomycin doses expected to be clinically effective based on such routine testing.. Commonly, antibiotic resistance is associated with permanent genetic changes, such as point mutations or acquisition of resistance genes. We show that phenotypic resistance can arise where changes in gene expression result in tolerance to an antibiotic without any accompanying genetic changes. Specifically, methicillin-resistant Staphylococcus aureus (MRSA) behaves like vancomycin-intermediate S. aureus (VISA) upon exposure to colistin, which is currently used against infections by Gram-negative bacteria. Vancomycin is a last-resort drug for treatment of serious S. aureus infections, and VISA is associated with poor clinical prognosis. Phenotypic and reversible resistance will not be revealed by standard susceptibility testing and may underlie treatment failure.

Topics: Anti-Bacterial Agents; Bacterial Proteins; Colistin; Humans; Staphylococcal Infections; Staphylococcus aureus; Vancomycin; Vancomycin Resistance

Topics: Anti-Bacterial Agents; Colistin; Humans; Staphylococcal Infections; Staphylococcus aureus; Vancomycin; Vancomycin Resistance

Topics: Anti-Bacterial Agents; Colistin; Humans; Staphylococcal Infections; Staphylococcus aureus; Vancomycin; Vancomycin Resistance

Topics: Anti-Bacterial Agents; Colistin; Humans; Staphylococcal Infections; Staphylococcus aureus; Vancomycin; Vancomycin Resistance

Topics: Anti-Bacterial Agents; beta-Lactamases; Coinfection; Colistin; Drug Resistance, Multiple, Bacterial; Drug Therapy, Combination; Enterobacteriaceae; Enterobacteriaceae Infections; Humans; Male; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Middle Aged; Pyoderma; Skin Transplantation; Staphylococcal Infections

Prosthetic joint infections are severe complications of joint implants. Further complications arise when polymicrobial and/or multidrug-resistant microorganisms are involved. Currently, there are limited data on the management of these infections and on the tolerability of long-term treatment with daptomycin, ceftazidime and colistin.. A 55-year-old Caucasian woman who had a right hip prosthesis removed 1 year prior because of infection was admitted for prosthesis reimplantation. On admission at our hospital, anamnesis regarding etiology and management of prosthesis infection was not available. On clinical, laboratory findings and imaging studies infection was not suspected. A hip prosthesis was reimplanted. At surgery, histopathological and microbiological investigations were not taken. Three weeks after reimplantation, surgical site infection due to Enterobacter cloacae was diagnosed and oral ciprofloxacin was prescribed. Four days later, a periprosthesis fluid collection was evidenced and a percutaneous needle aspirate grew Staphylococcus epidermidis and S. haemolyticus. Enterobacter genome was also detected from the same sample. Teicoplanin and meropenem were added to ciprofloxacin without clinical improvement. Moreover, acetabular cup dislocation was documented. She underwent prosthesis explantation, debridement, and positioning of an antimicrobial mixed spacer. From the intraoperatory cultures S. epidermidis and Acinetobacter baumannii were grown. Daptomycin, ceftazidime, colistin and rifampin were administered. Four days later, rifampin was stopped due to a suspected liver toxicity. While undergoing therapy she presented recurrent episodes of wound dehiscence and on the 22nd week of treatment a further surgical debridement was performed, upon which the spacer was removed. At this time, intraoperative cultures resulted negative. Three months later, after a total of 8 months, antimicrobials were interrupted. Subsequently, a femoral transcondylar traction was positioned, and 3 weeks later a new prosthesis was reimplanted. At over 1 year after reimplantation she is well.. Our findings suggest that microbiologic investigations are mandatory even when prosthetic joint infection is not suspected. Molecular methods for identification of microorganisms can be used in addition to conventional cultures especially when patients are under antibiotic treatment. Daptomycin, ceftazidime and colistin can be administered for several months without side effects. Guidelines specifically addressing the diagnosis and the management of polymicrobial, multidrug-resistant prosthetic joint infections need to be developed.

Topics: Acinetobacter baumannii; Acinetobacter Infections; Anti-Bacterial Agents; Ceftazidime; Coinfection; Colistin; Daptomycin; Drug Resistance, Multiple, Bacterial; Drug Therapy, Combination; Enterobacter cloacae; Enterobacteriaceae Infections; Female; Hip Prosthesis; Humans; Middle Aged; Prosthesis-Related Infections; Recurrence; Reoperation; Staphylococcal Infections; Staphylococcus epidermidis; Staphylococcus haemolyticus; Treatment Outcome

The effect of antibiotic therapy on the intestinal flora was studied qualitatively and quantitatively in 41 infants. The results have been compared with 27 normal children of the same age and background. Antibiotics were responsible for the suppression of sensitive strains and for their replacement by resistant organisms but above all to a rapid multiplication of the intestinal flora. Colistin and pristinamycin caused these changes when given orally. Ampicillin when given both orally and parenterally but Colistin and the aminoglycosides when given parenterally did not have any effect. Fourteen cases of secondary septicaemia due to resistant organisms were observed but other factors were also important, namely the young age of the patients and intestinal problems (stasis and diarrhoea).

Topics: Age Factors; Ampicillin; Anti-Bacterial Agents; Bacterial Infections; Child; Child, Preschool; Colistin; Feces; Follow-Up Studies; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Intestinal Diseases; Intestines; Klebsiella Infections; Penicillin Resistance; Proteus Infections; Sepsis; Staphylococcal Infections

Serious complications occurred in 29 of 887 children with puncture wounds of the feet treated over a four-year period at the Dr. Charles A. Janeway Child Health Centre. Osteomyelitis in one of the small bones of the foot was the commonest complication and occurred when a cartilaginous surface (physeal plate or articular cartilage) had been violated. Although systemic signs of osteomyelitis frequently are absent, this infectious process is refractory to medical management. The combined surgical and medical management of this complication is outlined. Management of puncture wounds in the emergency room should include a thorough history concisely recorded, tetanus prophylaxis, and cleansing, debridement, and probing of the wound. Antimicrobial agents are not routinely required but should be reserved for patients presenting late with cellulitis or an established infection. A semisynthetic penicillinase-penicillin appears to be the agent of choice until the results of microbiologic studies are available.

Topics: Adolescent; Cellulitis; Child; Child, Preschool; Colistin; Erythromycin; Female; Foot Injuries; Humans; Klebsiella Infections; Lincomycin; Male; Osteomyelitis; Penicillins; Pseudomonas Infections; Staphylococcal Infections; Streptococcal Infections; Tetracyclines; Wounds, Penetrating

Topics: Adult; Blood; Carbenicillin; Cephalothin; Colistin; Drug Synergism; Drug Therapy, Combination; Endocarditis, Bacterial; Female; Gentamicins; Heart Valve Prosthesis; Heroin Dependence; Humans; Male; Mesylates; Polymyxins; Pseudomonas aeruginosa; Pseudomonas Infections; Sepsis; Staphylococcal Infections; Tricuspid Valve

Topics: Ampicillin; Anti-Bacterial Agents; Carbenicillin; Cephalothin; Chloramphenicol; Colistin; Dicloxacillin; Escherichia coli Infections; Gentamicins; Humans; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature, Diseases; Pseudomonas Infections; Sepsis; Staphylococcal Infections; Streptococcal Infections

Subphrenic abscess is still a significant hazard which complicates surgical procedures as well as certain abdominal catastrophes. This is a report of 88 patients with subphrenic abscess at St. Vincent's Hospital and Medical Center of New York from 1954 through 1971. There were 46 males and 42 females, ranging from 2 to 88 years. Operations on the stomach, duodenum and biliary tract were the major causes. The causative organisms in order of frequency were: E coli (41.6%), Staphylococcus (41.6%), Aerobacter aerogenes (23.3%), Proteus (20%), Streptococci (18.3%) and Pseudomonas (8.3%). Penicillin and tetracycline, the antibiotics most commonly chosen on an empiric basis, proved effective in only 38% of cases. On the other hand, kanamycin, chloramphenicol and cephalothin were effective in 90%, 85% and 70% of cases respectively. The overall mortality rate was 15%. Nine of the 21 patients (42.8%) treated with antibiotics alone died while 11 of 67 patients (10.6%) treated with antibiotics and surgical drainage died. Some of the latter deaths occurred in patients treated with prolonged antibiotic therapy and operated on only as a last resort. In this series subphrenic abscess was best treated by early surgical drainage combined with the use of appropriate antibiotics.

Topics: Abdominal Injuries; Adolescent; Adult; Aged; Anti-Bacterial Agents; Child; Child, Preschool; Chloramphenicol; Colistin; Drug Resistance, Microbial; Escherichia coli Infections; Female; Humans; Infant; Kanamycin; Male; Microbial Sensitivity Tests; Middle Aged; Postoperative Complications; Radiography; Staphylococcal Infections; Subphrenic Abscess; Surgical Procedures, Operative

Topics: Acute Disease; Age Factors; Ampicillin; Anti-Bacterial Agents; Child, Preschool; Chloramphenicol; Colistin; Erythromycin; Haemophilus; Haemophilus Infections; Humans; Infant; Infant, Newborn; Microbial Sensitivity Tests; Otitis Media; Penicillins; Pneumococcal Infections; Staphylococcal Infections; Staphylococcus; Streptococcal Infections; Streptococcus pneumoniae; Streptococcus pyogenes; Streptomycin; Tetracycline

Topics: Acute Kidney Injury; Adolescent; Adult; Amphotericin B; Anti-Bacterial Agents; Bacterial Infections; Colistin; Deafness; Endocarditis, Bacterial; Female; Humans; Kanamycin; Kidney; Kidney Function Tests; Male; Middle Aged; Pseudomonas Infections; Sepsis; Staphylococcal Infections; Streptococcal Infections; Urea; Vancomycin

Topics: Animals; Anti-Bacterial Agents; Bacteria; Blood Proteins; Colistin; Culture Media; Drug Resistance, Microbial; Escherichia coli Infections; Gentamicins; Hydrogen-Ion Concentration; Kanamycin; Klebsiella Infections; Male; Mice; Mice, Inbred Strains; Microbial Sensitivity Tests; Protein Binding; Pseudomonas aeruginosa; Pseudomonas Infections; Staphylococcal Infections; Staphylococcus; Streptomycin

Topics: Acute Disease; Anti-Bacterial Agents; Chloramphenicol; Cholecystitis; Chronic Disease; Colistin; Escherichia coli Infections; Penicillins; Staphylococcal Infections; Streptococcal Infections; Streptomycin

Topics: Animals; Chloramphenicol; Colistin; Drug Synergism; Escherichia coli Infections; Female; Mice; Staphylococcal Infections

Topics: Albuminuria; Colistin; Eczema; Edema; Fever; gamma-Globulins; Humans; Infant; Kanamycin; Kaposi Varicelliform Eruption; Male; Neurologic Manifestations; Oxacillin; Smallpox Vaccine; Staphylococcal Infections; Thiosemicarbazones; Vaccinia virus

Topics: Adult; Aged; Ampicillin; Anti-Bacterial Agents; Chloramphenicol; Chronic Disease; Colistin; Depression, Chemical; Drug Synergism; Erythromycin; Escherichia coli Infections; Female; Follow-Up Studies; Humans; Kanamycin; Klebsiella Infections; Male; Middle Aged; Nitrofurantoin; Oleandomycin; Oxacillin; Penicillins; Polymyxins; Proteus Infections; Pyelonephritis; Staphylococcal Infections; Stimulation, Chemical; Streptococcal Infections; Streptomycin; Sulfonamides; Tetracycline

The effect of early bilateral pyelonephritis on urinary concentrating ability was studied in rats injected intravenously with enterococci or Staphylococcus aureus and in rats inoculated with Escherichia coli into the medullae of both kidneys. The mean maximum urinary osmolality of normal rats was 2352 mOsm/kg of water. Inoculation of E. coli caused reversible pyelonephritis with sterilization of the kidneys within 12 wk. By 1 day after injection the mean maximum urinary osmolality had decreased to about 1100 mOsm. remained at this level for 3 wk, and then rose to normal by 12 wk. After injection of enterococci and staphylococci, the mean maximum urine osmolality decreased over 3-4 days to about 1000 and 800 mOsm respectively. In the enterococcal infection (which is chronic) the maximum urine osmolality remained about 1200 mOsm for at least 12 wk whereas in the staphylococcal infection (which is reversible) the osmolality gradually rose. Antimicrobial therapy of E. coli renal infection with colistimethate sodium and S. aureus infection with ampicillin rapidly reduced bacterial titers in the kidneys with an associated rise in maximum urinary osmolality. Therapy of enterococcal renal infection with ampicillin produced less impressive decreases in bacterial titers in the kidneys and little or no improvement in urinary concentrating ability. With antimicrobial therapy or with the self-limited infections, the rate of increase in concentrating ability was directly correlated with the rate of decrease of bacterial titers. However, there was poor correlation between histological findings in the kidneys and urinary concentrating ability. These studies demonstrate that early experimental pyelonephritis is associated with a concentrating defect that can be rapidly reversed and therefore is not related to permanent renal damage.

Topics: Ampicillin; Animals; Anti-Bacterial Agents; Colistin; Creatinine; Escherichia coli Infections; Kidney; Kidney Concentrating Ability; Male; Osmolar Concentration; Pyelonephritis; Rats; Staphylococcal Infections; Streptococcal Infections; Vasopressins

Topics: Acute Disease; Animals; Anti-Bacterial Agents; Antitoxins; Chloramphenicol; Colistin; Drug Synergism; gamma-Globulins; Mice; Oleandomycin; Oxacillin; Penicillin Resistance; Penicillins; Staphylococcal Infections; Tetracycline; Time Factors

Topics: Abscess; Ampicillin; Anti-Bacterial Agents; Bacteriological Techniques; Cellulitis; Cephalothin; Chloramphenicol; Colistin; Erythromycin; Escherichia coli; Escherichia coli Infections; Hand; Humans; Infections; Kanamycin; Lincomycin; Methicillin; Penicillin Resistance; Penicillins; Polymyxins; Staphylococcal Infections; Staphylococcus; Streptococcal Infections; Streptococcus; Streptomycin; Tetracycline; Wound Infection

Topics: Adult; Burns; Burns, Electric; Candidiasis, Cutaneous; Child; Child, Preschool; Colistin; Escherichia coli Infections; Female; Gentamicins; Humans; Male; Patient Isolators; Penicillins; Polymyxins; Proteus Infections; Pseudomonas Infections; Sepsis; Silver Nitrate; Staphylococcal Infections; Streptococcal Infections; Sulfonamides; Toluene

Topics: Administration, Oral; Adolescent; Adult; Aged; Blood Sedimentation; C-Reactive Protein; Child; Chloramphenicol; Chronic Disease; Cloxacillin; Colistin; Female; Fistula; Humans; Injections; Male; Middle Aged; Osteomyelitis; Probenecid; Prognosis; Recurrence; Staphylococcal Infections; Staphylococcus

Topics: Adolescent; Adult; Aged; Animals; Anti-Bacterial Agents; Bacteria; Child; Child, Preschool; Colistin; Cornea; Corneal Ulcer; Dogs; Drug Resistance, Microbial; Drug Synergism; Edema; Eye Diseases; Female; Humans; Infant; Male; Middle Aged; Ophthalmic Solutions; Panophthalmitis; Pseudomonas; Pseudomonas Infections; Rats; Staphylococcal Infections; Staphylococcus

Topics: Adrenal Cortex Hormones; Adult; Anti-Bacterial Agents; Burns; Candida; Chlortetracycline; Colistin; Erythromycin; Erythromycin Ethylsuccinate; gamma-Globulins; Humans; Male; Neomycin; Nystatin; Penicillin Resistance; Penicillins; Ristocetin; Staphylococcal Infections; Staphylococcus; Streptomycin; Tetracycline; Wound Infection

Topics: Adult; Anti-Bacterial Agents; Carrier State; Child; Chloramphenicol; Chlortetracycline; Colistin; Erythromycin; Erythromycin Ethylsuccinate; Humans; Oxytetracycline; Penicillin Resistance; Penicillins; Pneumonia, Staphylococcal; Russia; Staphylococcal Infections; Staphylococcus; Streptomycin; Tetracycline

Topics: Anti-Bacterial Agents; Carrier State; Chloramphenicol; Chlortetracycline; Colistin; Erythromycin; Erythromycin Ethylsuccinate; Georgia (Republic); Humans; Novobiocin; Oleandomycin; Oxytetracycline; Penicillin Resistance; Penicillins; Ristocetin; Staphylococcal Infections; Staphylococcus; Streptomycin; Tetracycline; Vancomycin

Topics: Animals; Aqueous Humor; Biological Assay; Blindness; Colistin; Dogs; Eye Diseases; Inflammation; Oxytetracycline; Perfusion; Pseudomonas aeruginosa; Pseudomonas Infections; Staphylococcal Infections; Staphylococcus; Uveitis; Vitreous Body

Topics: Abortion, Criminal; Adult; Anti-Bacterial Agents; Chloramphenicol; Colistin; Dexamethasone; Drug Synergism; Electrocardiography; Endocarditis, Bacterial; Female; Humans; Penicillins; Staphylococcal Infections; Tricuspid Valve Stenosis

Topics: Adult; Cellulitis; Chloramphenicol; Colistin; Cystitis; Humans; Male; Methicillin; Prednisone; Prostatitis; Staphylococcal Infections

Topics: Aged; Catheterization; Chloramphenicol; Clostridium perfringens; Colistin; Dextrans; Enterobacter; Erythromycin; Escherichia coli Infections; Female; Humans; Hydrocortisone; Isoproterenol; Kanamycin; Klebsiella; Male; Methicillin; Middle Aged; Ointments; Penicillins; Sepsis; Staphylococcal Infections; Streptomycin; Strongyloides; Veins

Topics: Adult; Bacteria; Chloramphenicol; Chlortetracycline; Colistin; Erythromycin; Escherichia coli; Escherichia coli Infections; Female; Humans; In Vitro Techniques; Infections; Kanamycin; Male; Middle Aged; Penicillin G; Penicillin Resistance; Pseudomonas aeruginosa; Staphylococcal Infections; Staphylococcus; Streptococcus; Streptomycin; Surgical Wound Infection; Tetracycline

Topics: Acetates; Anti-Infective Agents, Local; Bandages; Cellulose; Colistin; Copper; Drug Resistance, Microbial; Hexachlorophene; Iodine; Silver; Staphylococcal Infections; Staphylococcus; Surgical Wound Infection

Topics: Anti-Bacterial Agents; Antibiotics, Antineoplastic; Chloramphenicol; Chlortetracycline; Colistin; Drug Resistance, Microbial; Erythromycin; Flavonoids; Humans; In Vitro Techniques; Novobiocin; Penicillin Resistance; Ristocetin; Staphylococcal Infections; Staphylococcus; Streptomycin; Tyrothricin; Vancomycin

Topics: Bacitracin; Child; Colistin; Drug Therapy; Endocarditis; Endocarditis, Bacterial; Enterobacter aerogenes; Escherichia coli Infections; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Infections; Klebsiella; Liver Abscess; Oxacillin; Penicillins; Pseudomonas Infections; Staphylococcal Infections; Streptococcal Infections; Toxicology

Topics: Colistin; Immunity; Protective Factors; Research; Staphylococcal Infections

Topics: Anti-Bacterial Agents; Chloramphenicol; Colistin; Cornea; Corneal Transplantation; Debridement; Diathermy; Eye Burns; Eye Injuries; Geriatrics; Humans; Injections, Intra-Arterial; Iontophoresis; Lidocaine; Ophthalmology; Polymyxins; Pseudomonas Infections; Staphylococcal Infections; Streptomycin; Tetracycline; Therapeutic Irrigation; Ulcer

Topics: Anti-Bacterial Agents; Bacteriological Techniques; Bacteriuria; Colistin; Enterobacteriaceae; Escherichia coli Infections; Klebsiella; Proteus Infections; Pseudomonas; Pseudomonas Infections; Staphylococcal Infections; Streptococcal Infections; Urinary Tract Infections; Urine

Topics: Acinetobacter; Biomedical Research; Colistin; Enterobacter aerogenes; Escherichia coli Infections; Hydrocortisone; Klebsiella; Neomycin; Otitis Externa; Proteus Infections; Pseudomonas aeruginosa; Pseudomonas Infections; Staphylococcal Infections

Topics: Adolescent; Anti-Bacterial Agents; Antibiotic Prophylaxis; Burns; Child; Chloramphenicol; Colistin; Erythromycin; Escherichia coli Infections; gamma-Globulins; Humans; Immune Sera; Infant; Infant, Newborn; Kanamycin; Novobiocin; Polymyxins; Proteus Infections; Pseudomonas Infections; Salmonella Infections; Sepsis; Serum Albumin; Shigella; Sodium Chloride; Solutions; Staphylococcal Infections; Streptococcal Infections; Tetracycline; Vancomycin

Topics: Amphotericin B; Anti-Bacterial Agents; Chloramphenicol; Colistin; Drug Resistance; Drug Resistance, Microbial; Endocarditis; Endocarditis, Bacterial; Enterobacter aerogenes; Enterobacteriaceae; Erythromycin; Escherichia coli Infections; Kanamycin; Penicillin G; Penicillins; Proteus Infections; Pseudomonas Infections; Ristocetin; Staphylococcal Infections; Streptococcal Infections; Streptomycin; Tetracycline; Vancomycin

Topics: Anti-Bacterial Agents; Arthritis; Chloramphenicol; Colistin; Humans; Infections; Kanamycin; Methicillin; Oxacillin; Oxytetracycline; Penicillin G; Staphylococcal Infections; Streptomycin; Tetracycline

Topics: Abscess; Amphotericin B; Brain Abscess; Candidiasis; Carrier State; Child; Chloramphenicol; Colistin; Deoxyribonucleases; DNA; Empyema; Enteritis; Humans; Kanamycin; Meningitis; Methicillin; Penicillins; Peritonitis; Phlebitis; Pneumonia; Pneumothorax; Pseudomonas Infections; Sepsis; Staphylococcal Infections; Sulfadiazine; Troleandomycin

Topics: Colistin; Diagnosis, Differential; Enterobacter; Escherichia coli Infections; Glomerulonephritis; Kanamycin; Prognosis; Proteus Infections; Pseudomonas Infections; Pyelonephritis; Staphylococcal Infections

Topics: Adolescent; Anti-Bacterial Agents; Antibiotics, Antitubercular; Child; Colistin; Drug Therapy; Enterobacteriaceae; Geriatrics; Humans; Hydrocortisone; Infant; Infections; Neomycin; Otitis Externa; Pseudomonas; Staphylococcal Infections

Topics: Abscess; Adolescent; Animals; Child; Colistin; Cornea; Corneal Ulcer; Corynebacterium; Dacryocystitis; Drug Therapy; Geriatrics; Humans; Hydrogen-Ion Concentration; Infant; Ophthalmology; Orbit; Osmosis; Pseudomonas Infections; Rabbits; Research; Staphylococcal Infections; Streptococcal Infections; Ulcer; Uveitis

Topics: Alcaligenes; Anti-Bacterial Agents; Chloramphenicol; Colistin; Diabetes Mellitus; Enterobacteriaceae; Escherichia coli Infections; Female; Humans; Kanamycin; Klebsiella; Neomycin; Nitrofurantoin; Novobiocin; Penicillins; Polymyxins; Proteus Infections; Staphylococcal Infections; Streptomycin; Sulfonamides; Tetracycline; Urinary Tract Infections

Topics: Aerosols; Bronchiectasis; Bronchitis; Colistin; Humans; Lung Diseases; Lung Neoplasms; Pneumococcal Infections; Proteus Infections; Staphylococcal Infections; Streptococcal Infections; Suppuration

Topics: Colistin; Enterobacter aerogenes; Enterococcus faecalis; Escherichia coli Infections; Hospitals, General; Humans; Proteus Infections; Pseudomonas aeruginosa; Pseudomonas Infections; Staphylococcal Infections; Streptococcal Infections; Urinary Tract Infections

Topics: Colistin; Humans; Kidney Function Tests; Male; Pharmacology; Pseudomonas Infections; Pyelonephritis; Radioisotopes; Radionuclide Imaging; Staphylococcal Infections; Urography; Vasopressins

Topics: Acid-Base Equilibrium; Colistin; Hydrocortisone; Neomycin; Otitis Externa; Pseudomonas Infections; Staphylococcal Infections

Topics: Anti-Bacterial Agents; Bacitracin; Chloramphenicol; Colistin; Culture Media; Cycloserine; Drug Resistance, Microbial; Erythromycin; Fusidic Acid; Kanamycin; L Forms; Methicillin; Neomycin; Novobiocin; Penicillin G; Penicillin Resistance; Research; Ristocetin; Staphylococcal Infections; Staphylococcus; Staphylococcus aureus; Staphylococcus Phages; Streptomycin; Sulfonamides; Tetracycline; Vancomycin

Topics: Anti-Bacterial Agents; Candidiasis; Chloramphenicol; Colistin; Colitis, Ulcerative; Erythromycin; Escherichia coli Infections; Gastrointestinal Hemorrhage; Humans; Intestines; Penicillins; Peptic Ulcer Perforation; Polyps; Proteus Infections; Staphylococcal Infections; Streptomycin; Tetracycline

Topics: Anti-Bacterial Agents; Antibiotics, Antitubercular; Bacteria; Colistin; Dermatologic Agents; Lymph Nodes; Pharmacology; Rats; Research; Staphylococcal Infections

Topics: Adolescent; Anti-Bacterial Agents; Child; Colistin; Colitis; Drug Therapy; Enterocolitis; Erythromycin; Escherichia coli Infections; Gastroenteritis; Oxytetracycline; Staphylococcal Infections

Topics: Biliary Tract; Chloramphenicol; Chlortetracycline; Cholangitis; Cholecystitis; Colistin; Drug Resistance; Drug Resistance, Microbial; Duodenum; Escherichia coli Infections; Oxytetracycline; Penicillins; Pneumococcal Infections; Staphylococcal Infections; Streptomycin

Topics: Anti-Infective Agents; Colistin; Lymph Nodes; Lymphadenitis; Penicillins; Staphylococcal Infections

Topics: Anti-Bacterial Agents; Colistin; Focal Infection; Humans; Staphylococcal Infections; Streptococcus pneumoniae

Topics: Anti-Bacterial Agents; Colistin; Staphylococcal Infections; Vitamins