dibekacin and Postoperative-Complications

The frequency of infection by methicillin-resistant Staphylococcus aureus (MRSA) is high in Japan and control of such strains is urgently needed. Arbekacin (ABK), a semisynthetic aminoglycoside, has potent activity against S. aureus, including resistant strains, and against Gram-negative bacteria as well. For this reason, in surgical infections (which are often caused by more than one bacterium), this drug might be particularly effective. We calculated the MIC and the decrease in the MIC when cultures of 59 resistant strains of S. aureus isolated in our wards at Osaka City University Hospital, contained arbekacin in the medium. We also used the drug to treat 12 infections caused by resistant strains of S. aureus. The MICs of vancomycin had a single peak at 0.5 microgram/ml, and those for ABK had double peaks at 0.5 and 4.0 micrograms/ml. The effect of arbekacin in lowering the MIC of minocycline (MINO) was slight because of the low MIC of MINO. Effects on fosfomycin (FOM), ampicillin, clavulanic acid/ticarcillin, cefotiam, cefuzonam, flomoxef, and imipenem/cilastatin were strong; the peaks were lowered by 1/2(7)-1/2(11). When 1.0 micrograms/ml ABK was present in the medium, the efficacy of FOM was increased enough that, by prediction from the pharmacokinetics of FOM (blood level when given at the usual dose), all but one (2%) of the 47 resistant strains would be eradicated clinically. If 2.0 micrograms/ml ABK were in the medium, all strain would be eradicated, by our calculations. We treated 11 infections and one colonization by resistant strains of S. aureus with ABK and evaluated the response in these cases of infection. Four infections were treated with FOM as well. The clinical efficacy was good in four infections (three patients), fair in four, and poor in three, for an efficacy rate of 36%. All presumed causative bacteria were eradicated in two (18%) of the 11 infections and S. aureus strains were eradicated in three (27%) of the 11 infections. No symptoms of side effects were reported, but blood urea nitrogen and creatinine rose in a 72-year-old woman with duodenal perforation and peritonitis. The MIC levels of ABK were satisfactory, but clinical efficacy for staphylococcal infections caused by resistant strains was unsatisfactory.

Topics: Adult; Aged; Aged, 80 and over; Aminoglycosides; Anti-Bacterial Agents; Dibekacin; Drug Therapy, Combination; Female; Fosfomycin; Humans; Male; Methicillin Resistance; Microbial Sensitivity Tests; Middle Aged; Postoperative Complications; Staphylococcal Infections; Staphylococcus aureus

Empyema is a well-known complication following lung resection. In particular, empyema caused by methicillin-resistant Staphylococcus aureus (MRSA) is difficult to treat. Here, we present our experience of MRSA empyema treated with local irrigation using arbekacin.. Six patients consisted of 4 males and 2 females with an average age of 65.7 years. They developed MRSA empyema following lung resection and were treated at our institution between 2007 and 2011. Cases comprised four primary and one metastatic lung cancer, and 1 patient was a living lung transplantation donor. The surgical procedure consisted of four lobectomies, one segmentectomy and one wedge resection. After diagnosis of MRSA empyema, anti-MRSA drugs were administered intravenously in all cases. In addition, arbekacin irrigation at a dose of 100 mg dissolved in saline was performed after irrigation with saline only.. The average number of postoperative days for the diagnosis of MRSA empyema was 13 (range 4-19). The period of irrigation ranged from 6 to 46 days. Arbekacin irrigation did not induce nephrotoxicity or other complications, and no bacteria resistant to arbekacin was detected in the thoracic cavity. We re-operated on 1 case because he had pulmonary fistula and severe wound infection. At the time of removing the thoracic catheter, MRSA in the pleural effusion disappeared completely in 3 patients. The period until MRSA concentration in the pleural effusion became negative after starting arbekacin irrigation ranged from 4 to 9 days. In the remaining cases, in which MRSA did not disappear, the catheter was removed because of no inflammatory reaction after stopping irrigation and clamping the catheters. All patients were discharged from our institution without thoracic catheterization and no patients had relapsed during the follow-up period ranging from 6 to 44 months.. Irrigation of the thoracic cavity with arbekacin proved to be an effective, safe and readily available method for treating MRSA empyema following lung resection.

Topics: Aged; Aged, 80 and over; Anti-Infective Agents; Dibekacin; Empyema, Pleural; Female; Follow-Up Studies; Humans; Male; Methicillin Resistance; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Pneumonectomy; Postoperative Complications; Retrospective Studies; Staphylococcal Infections; Therapeutic Irrigation; Thoracic Cavity; Treatment Outcome

We report here two cases of MRSA sepsis following craniotomy. In case 1, a petroclival meningioma was subtotally removed and lumbar drainage was inserted postoperatively to prevent cerebrospinal fluid leakage. Ventriculo-peritoneal shunt was performed after meningitis was treated with vancomycin and panipenem/betamipron. Two weeks after the procedure, the patient revealed continuous spiking fevers related to MRSA sepsis, which did not improve with vancomycin and arbekacin administration. The focus of infection was found by scintigraphy and CT by 67Ga to be spondylo-diskitis at the level of L2-L3. The lesion was removed and bone from the iliac crest grafted. In case 2, seven days after surgery for multiple meningioma, the patient exhibited spiking fevers and swelling in the left leg. The central venous catheter was removed from the left femoral vein and MRSA was found from blood culture. The patient was treated with arbekacin (200 mg/day). Venous thrombosis diagnosed by CT was treated with heparin. Symptoms related to the infection and laboratory data did not improve because the concentration of arbekacin in the blood did not reach an effective level. The symptoms markedly improved when the dose of arbekacin was doubled (400 mg/day).

Topics: Adult; Aged; Alanine; Aminoglycosides; Ampicillin; Anti-Bacterial Agents; Craniotomy; Dibekacin; Drug Therapy, Combination; Female; Humans; Male; Meningeal Neoplasms; Meningioma; Methicillin Resistance; Postoperative Complications; Sepsis; Staphylococcal Infections; Sulbactam; Thienamycins; Treatment Outcome; Vancomycin

We examined the clinical features of 14 men (mean age 72 years) with postoperative enteritis caused by methicillin-resistant Staphylococcus aureus (MRSA). The patients had all undergone surgery for the treatment of digestive diseases and had received antibiotic prophylaxis consisting of an extended-spectrum cephem. Diarrhea appeared a mean of 3.3 days postoperatively and lasted for 5 days on average. In severe cases organ insufficiency was involved. Coagulate-positive staphylococci were the predominant organisms isolated from watery diarrhea. In 13 of 14 patients, coagulase type II isolates producing enterotoxins A, C and toxic shock syndrome toxin-1 (TSST-1) with enterotoxin A, C, and 1st genes were isolated. These strains were sensitive to vancomycin and arbekacin; however, they were highly resistant to many other antibiotics. We also investigated the effects of a glucocorticoid hormone and gamma globulin on production of tumor necrosis factor-alpha (TNF-alpha) and interleukin-2 (IL-2) obtained from healthy volunteers. TNF-alpha and IL-2 production was enhanced by TSST-1 and the supernatant of Iscove-modified dulbecco medium, in which coagulase type II isolates producing enterotoxins A, C and TSST-1 with enterotoxin A, C were cultured for 24 h. Both glucocorticoid hormone and gamma globulin suppressed TNF-alpha and IL-2 production, thus suggesting that these drugs may be effective in treating postoperative MRSA enteritis.

Topics: Aged; Aged, 80 and over; Anti-Bacterial Agents; Dibekacin; Digestive System Diseases; Enteritis; Enterotoxins; Glucocorticoids; Humans; Immunoglobulin G; In Vitro Techniques; Interleukin-2; Male; Methicillin Resistance; Middle Aged; Postoperative Complications; Shock, Septic; Staphylococcal Infections; Staphylococcus aureus; Tumor Necrosis Factor-alpha; Vancomycin

We experienced successful treatment of postoperative severe pneumonia of Methicillin-resistant Staphylococcus aureus (MRSA) with combination therapy of Arbekacin (ABK) and Fosfomycin (FOM) in three lung cancer patients. Case 1 was a advanced age of seventy-nine man who had had right upper lobectomy. Case 2 was a 61-year-old man who had had left lower lobectomy and extended bilateral mediastinal lymph-node dissection through the median sternotomy. And case 3 was a 59-year-old man who had suffered from pulmonary embolism after right pneumonectomy and partial resection of left atrium and superior vena cava. All cases were immuno-compromised patients and super-infected with Gram-negative rods, and Pseudomonas aeruginosa in case 1 and case 3. Clinical symptoms were improved after the start of administration of ABK and FOM inspite of ineffectiveness of prior treatment with other antibiotics. We added staggered chemotherapy of Sulbactam/Cefoperazone (SBT/CPZ) and Ceftazidime (CAZ) for case 1 and case 3 respectively. Thus, the combination therapy of ABK and FOM might be useful for severe pneumonia of MRSA in the immunocompromised patients, and the combined staggered chemotherapy of beta-lactum agents and above would be the first choice in the treatment for the case involving Pseudomonas aeruginosa.

Topics: Aged; Aminoglycosides; Anti-Bacterial Agents; Dibekacin; Drug Therapy, Combination; Fosfomycin; Humans; Immunocompromised Host; Lactams; Lung Neoplasms; Male; Methicillin Resistance; Middle Aged; Pneumonia, Bacterial; Postoperative Complications; Pseudomonas Infections; Staphylococcal Infections; Staphylococcus aureus

Susceptibilities to antibiotics were determined in 36 strains of methicillin-resistant Staphylococcus aureus (MRSA) isolated from clinical specimens from 1990 to 1992. Rates of resistance to arbekacin and minocycline were 31% and 53%, respectively. However, all MRSA isolates were susceptible to vancomycin. MRSA was found in 12 out of 35 cases. Three infections caused by MRSA included enterocolitis (3), abscess (5), pneumonia (1), cholangitis (1), peritonitis (1) and catheter related sepsis (1). In two cases patients died with bacteremia within two years after the onset of MRSA infections.

Topics: Aged; Aged, 80 and over; Aminoglycosides; Anti-Bacterial Agents; Dibekacin; Female; Humans; Male; Methicillin Resistance; Microbial Sensitivity Tests; Middle Aged; Minocycline; Postoperative Complications; Staphylococcal Infections; Staphylococcus aureus; Vancomycin

The clinical efficacy of a new aminoglycoside antibiotic, arbekacin (ABK), was studied in surgical patients who had been infected with methicillin-resistant Staphylococcus aureus (MRSA). Six cases of pneumonia, 2 of wound infections and 2 of intra-abdominal infections were treated by ABK alone or ABK together with beta-lactam antibiotics such as imipenem/cilastatin or cefotiam. The overall clinical efficacies against these MRSA infections were excellent in one case, good in 6 and poor in 3. In six cases treated by ABK alone, good clinical responses were obtained in 4 cases. Among 4 cases that received combination therapy with ABK, good responses were obtained in 3 cases. No adverse reactions were found in ABK monotherapy or in combined therapy. These data suggested that ABK is an effective antibiotic on surgical infections caused by MRSA.

Topics: Aged; Aged, 80 and over; Aminoglycosides; Anti-Bacterial Agents; Cefotiam; Cilastatin; Dibekacin; Drug Evaluation; Drug Therapy, Combination; Female; Humans; Imipenem; Male; Methicillin Resistance; Postoperative Complications; Staphylococcal Infections; Staphylococcus aureus; Surgical Wound Infection

From January 1991 to July 1993, 58 patients with MRSA infections in our clinic at Wakayama Medical College and six affiliated hospitals were administered with arbekacin (ABK). The clinical results were as follows: 1. The clinical efficacy rates of ABK were 84% in pneumonia, 100% in both wound infections and hepatobiliary tract infections, and 85% in total. The bacteriological efficacy rate was 83%. 2. Regarding the administration route, the clinical efficacy rates were 60-79% by the intravenous treatment and inhalation therapy. Especially by the local administration with ABK, MRSA was eradicated in all cases. 3. The sufficient efficacy was obtained by the treatment of ABK alone (89%) and by the combined treatment with ABK (82%) and another antibiotics. From these results, it is concluded that ABK is useful for the treatment of MRSA infections after gastrointestinal surgery.

Topics: Administration, Inhalation; Administration, Topical; Aminoglycosides; Anti-Bacterial Agents; Dibekacin; Drug Evaluation; Drug Therapy, Combination; Gastrointestinal Diseases; Humans; Infusions, Intravenous; Methicillin Resistance; Postoperative Complications; Staphylococcal Infections; Staphylococcus aureus; Surgical Wound Infection

We experienced 20 cases of methicillin-resistant Staphylococcus aureus (MRSA) infection from April 1991 to September 1992. Of them, 9 showed substantial morbidity and their clinical courses are herein reported. The clinical presentations of these cases were wound infection and enterocolitis. Although in 8 cases MRSA was eradicated in 14 to 160 days by effective antibiotics administration, one had a fatal outcome. All strains isolated showed similar drug-sensitivity pattern suggesting hospital infection. Sensitivity to vancomycin and arbekacin, however, remained high and these drugs were effective clinically. It should be stressed that treatment strategy of MRSA infection should consist of isolation of patients with MRSA from other patients, use of disposable equipment and products, and serious and continuing concerns of medical personal on communicability of MRSA.

Topics: Aged; Aminoglycosides; Anti-Bacterial Agents; Dibekacin; Enterocolitis; Female; Humans; Immunocompromised Host; Male; Methicillin Resistance; Middle Aged; Postoperative Complications; Staphylococcal Infections; Staphylococcus aureus; Urinary Bladder Neoplasms; Vancomycin

Major abdominal surgery often involves severe postoperative infections with various pathogens: enterobacteriaceae, staphylococcus and anaerobic bacteria. For this reason a strong antibiotherapy can be necessary in the case of an infectious disease. Dibekacin was administered at a daily dose of 3 mg/kg to 22 patients suffering from very severe postoperative infection. In all the cases dibekacin was combined with a beta-lactamine and in some with nitro-imidazole derivative. The results were especially favourable in all of these cases and a good tolerance was observed.

Topics: Abdomen; Adult; Aged; Bacterial Infections; Dibekacin; Female; Humans; Kanamycin; Male; Middle Aged; Postoperative Complications