dibekacin and Bacteremia

A 50-year-old woman was admitted to our hospital because of MRSA septicemia caused by a contaminated permanent pacemaker lead. A pacemaker system was successfully removed under cardiopulmonary bypass support. Postoperative antibiotics was administered for 7 weeks. Total removal of a pacemaker system under cardiopulmonary bypass support is the treatment of choice in a case with pacemaker infection associated with MRSA septicemia.

Topics: Aminoglycosides; Anti-Bacterial Agents; Bacteremia; Cardiopulmonary Bypass; Dibekacin; Drug Therapy, Combination; Female; Humans; Methicillin Resistance; Middle Aged; Minocycline; Pacemaker, Artificial; Staphylococcal Infections; Staphylococcus aureus; Treatment Outcome; Vancomycin

Availability of arbekacin (ABK) was analyzed in the chemotherapy of 24 MRSA-infected patients with symptoms of pneumonia (12), sepsis (6) and others (6). Most patients had background diseases such as malignant tumors or cerebrovascular disorders. 47% (7/15) of them were immunologically abnormal. 17 of them had been previously treated with cephems, imipenem, minocycline or fosfomycin. The ABK therapy was performed with doses ranging 50-400 mg a day, divided into 1-3 times (mostly 100 mg x 2), and for 5-24 days. (18 patients were treated between 5 and 14 days). 14 patients (58%) received combined therapy with other antibiotics (mostly with beta-lactams, 12). The clinical efficacy rate of the ABK therapy was 62% (good, 13; fair, 4; ineffective, 4; unknown, 3). The bacteriological efficacies were: eradicated, 7 (44%); decreased, 4; no change, 5; unknown, 8. Side effects were found in 3 patients (oliguria, 2; eruption due to drug, 1) and one case resulted in serious renal disorder. Abnormal laboratory data were found in 7 cases. Above results have indicated that ABK is a useful antibiotic in chemotherapy of MRSA-infections.

Topics: Adult; Aged; Aged, 80 and over; Aminoglycosides; Anti-Bacterial Agents; Bacteremia; Dibekacin; Drug Therapy, Combination; Female; Humans; Kidney; Male; Methicillin Resistance; Middle Aged; Pneumonia, Staphylococcal; Staphylococcal Infections; Staphylococcus aureus

A clinical investigation was carried out to evaluate arbekacin, an aminoglycoside, in the treatment of MRSA infections (pneumonia, septicemia, etc.) of pediatric patients. The obtained results are summarized as follows. 1.. Excluding those patients who met the present exclusion criteria and withdrawal cases from a total of 18 patients, 10 patients (3, 6, and 1 cases of septicemia, pneumonia, and urinary tract infection, respectively) were subjected to clinical evaluation. These were composed of 1, 1, 6, and 2 cases of neonate, infants, pre- and school age children, respectively. Excellent, good and fair results were obtained in 5, 2, and 3 patients, respectively; thus, the efficacy rate was 70.0%. The efficacy rate by disease was 100%, 50.0% and 100% in septicemia, pneumonia, and urinary tract infection, respectively. The bacteriological eradication were obtained in 70.0% of the total patients; by disease, these rates were 100% and 50.0% in septicemia/urinary tract infection and in pneumonia, respectively. The MIC50 as well as the MIC80 against MRSA strains isolated from 9 patients were 0.39 microgram/ml and 1.56 micrograms/ml, respectively. No adverse reactions were observed in the 15 patients, while in laboratory test values, one case each out of 12 patients examined showed gamma-GTP elevation, proteinuria, and hematuria. 2. Pharmacokinetics: The pharmacokinetics of the agent was investigated in a total of 9 patients, which included 1 neonate and 4 cases each of pre- and school age children. The Cmax, 4.85-8.83 micrograms/ml, was observed immediately after the termination of the instillation. The T1/2's were 4.96 hours, 1.24-2.54 hours, and 1.78-1.88 hours in the neonate, the pre- and the school age children, respectively; in the neonate the half-life was longer. When 1.92-2.7 mg/kg were administered to 3 each of the pre- and school age children, urinary excretion rates in the first 6-8 hours were 40.1-56.5% of the dosages administered. In all cases, the urinary concentrations were highest in the first 2 hours, after the administration, and then gradually decreased. These results suggest that arbekacin is a useful antibiotic for treating MRSA infections in the pediatric field.

Topics: Adolescent; Aminoglycosides; Anti-Bacterial Agents; Bacteremia; Child; Child, Preschool; Dibekacin; Female; Humans; Infant; Infant, Newborn; Male; Methicillin Resistance; Pneumonia, Staphylococcal; Staphylococcal Infections; Staphylococcus aureus; Urinary Tract Infections

We examined the peck concentration (Cmax)/minimal inhibitory concentration (MIC) and the clinical efficacy in methicillin-resistant Staphylococcus aureus (MRSA) pneumonia and Gram-positive cocci bacteremia. We evaluated arbekacin (ABK) on 22 cases of pneumonia and 10 cases of bacteremia in Aichi Medical University Hospital between August 2008 and July 2011, retrospectively. In pneumonia cases, Cmax/MIC was 16.4 +/- 2.8 in the effective group, and was 17.6 +/- 4.5 in the not effective group, the significant differences were not accepted (p = 0.8). The dosage of ABK was 4.7 +/- 1.4 mg/kg/dose in the effective group and was 4.3 +/- 0.7 mg/kg/dose in the not effective group. In bacteremia cases, Cmax/MIC was 24.2 +/- 13.9 in the effective group and 12.9 +/- 3.9 in the not effective group about clinical efficacy, and the high tendency was accepted by the effective group (p < 0.05). The dosage of ABK was 3.4 +/- 1.1 mg/kg/dose in the effective group, and 3.0 +/- 0.6 mg/kg/dose in the not effective group. In this examination, the significant difference was not observed in clinical efficacy and Cmax/MIC in the pneumonia cases. Although it was reported that clinical efficacy of ABK was given Cmax/MIC at eight or more, in this examination, all cases was eight or more at Cmax/MIC, and the clinical effect was 40.9%. On Cmax/MIC of ABK, clinical effective group was higher than not effective group in bacteremia cases, it was suggested that the administration design should make that Cmax/MIC at least about 14 or more would be necessary.

Topics: Aged; Aged, 80 and over; Anti-Infective Agents; Bacteremia; Dibekacin; Gram-Positive Cocci; Humans; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Middle Aged; Pneumonia, Staphylococcal

It was reported that some methicillin-resistant Staphylococcus aureus (MRSA) show resistance to vancomycin (VCM) and beta-lactam antibiotics; thus, they are termed beta-lactam antibiotic-induced VCM-resistant MRSA (BIVR). The VCM resistance of MRSA is induced by the administration of beta-lactam antibiotics, but this phenomenon can be difficult to detect in the clinical laboratory. We detected the BIVR strain in a 64-year-old man who had had a ventilator tube inserted directly into the windpipe during long-term VCM therapy. The patient was diagnosed with MRSA pneumonia and septicemia on July 5, 2007, and sulbactam/ampicillin (SBT/ABPC) was administered for 5 days. However, the fever recurred, and administration of VCM was resumed for 7 days from July 19. Fever developed again, and VCM was administered again for 14 days from September 30. BIVR and VCM-low-sensitive MRSA were isolated from blood on October 18 and 22, although the VCM trough concentration was 10.2 microg/ml. On October 27, we changed to a combination of fosfomycin (FOM) and arbekacin (ABK), and thereafter the fever quickly decreased and the clinical symptoms abated. We isolated five MRSA strains from the blood of the patient, three strains of VCM-sensitive MRSA, one strain of BIVR, and one strain of a VCM-low-sensitive MRSA. The DNA band patterns determined by pulsed-field gel electrophoresis were completely identical except for the VCM-low-sensitive MRSA, which was missing one band. Furthermore, the VCM-low-sensitive MRSA became sensitive to beta-lactam antibiotics. Our results indicate the possibility that long-term VCM therapy is one of the factors that allow BIVR or VCM-low-sensitive MRSA to emerge, and this allows VCM therapy for MRSA to fail.

Topics: Anti-Bacterial Agents; Bacteremia; beta-Lactam Resistance; beta-Lactams; Dibekacin; Drug Therapy, Combination; Fosfomycin; Humans; Male; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Middle Aged; Pneumonia, Bacterial; Staphylococcal Infections; Time Factors; Vancomycin; Vancomycin Resistance

Aiming at measuring the antimicrobial activities of arbekacin (ABK) against the strains of methicillin-resistant Staphylococcus aureus (MRSA), isolated from pediatrics patients in 1992, the minimum inhibitory concentration (MIC) of 8 antibiotics including ABK was determined and the coagulase types of those strains were also examined. The obtained results are summarized as follows. 1. Among coagulase types of a total of 78 strains, Type II, Type IV and Type VII were 84.6%, 12.8% and 2.6%, respectively. No clear difference in coagulase types were observed among their origins of isolation. 2. MIC90 of ABK against 42 strains isolated from the air passage of suspected pneumoniae patients and 36 strains isolated from the blood of suspected septicemia patients were 1.56 micrograms/ml and 3.13 micrograms/ml, respectively, and MIC90 of ABK against the 78 strains was 1.56 micrograms/ml, which was equal to that of vancomycin (VCM). 3. Most of these strains exhibited resistance against multiple antibiotic agents including cefmetazole (CMZ), imipenem (IPM), fosfomycin (FOM) and minocycline. Strains isolated from the blood were mostly resistant to multiple agents, and most of them were especially highly resistant to CMZ and IPM. ABK, however, showed potent antimicrobial activities even to those strains. These results were similar to the results obtained several years ago. 4. Considering the fact that ABK demonstrates not only potent antimicrobial activities against MRSAs isolated from the pediatric patients, but also shows remarkable clinical effects with concomitant use with beta-lactams or FOM, the prospect of ABK use in MRSA infectious diseases of children is excellent.

Topics: Aminoglycosides; Anti-Bacterial Agents; Bacteremia; Child; Dibekacin; Humans; Kanamycin Resistance; Methicillin Resistance; Pneumonia; Respiratory System; Staphylococcal Infections; Staphylococcus aureus

Topics: Aminoglycosides; Anti-Bacterial Agents; Bacteremia; Dibekacin; Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Methicillin Resistance; Staphylococcal Infections; Staphylococcus aureus; Vancomycin