meropenem and Abscess

Klebsiella pneumoniae infection can induce multiple invasive abscesses, and the invasive infection is severe and life-threatening.. A 69-year-old previously healthy Chinese male presented with fever, chill, backache, and ocular pain.. The blood culture results indicated Klebsiella pneumoniae of the K1 serotype. Multiple invasive abscesses in liver, lung, eye, soft tissue, and central nervous system were identified by imaging examination. Subsequently, the patient experienced right ocular pain accompanied by visual disturbance. Tyndall sign was strongly positive, and lens opacity was observed by the ophthalmologist.. Full-dose and long-term treatment with meropenem was performed. Intraventricular injection of glass and anterior chamber puncture with antibiotics were performed twice. The patient also underwent an evacuation of the brain abscess.. The patient's headache and lumbar backache were relieved, his ophthalmodynia disappeared, and his vision recovered after nearly 3 months of treatment.. Imaging examination is very important for severe Klebsiella pneumoniae infection. The choice of antibiotics is complex, and the antimicrobial regimen should be adjusted according to the assessment of illness and the therapeutic effect. Surgical intervention must be considered for patients with multiple invasive abscesses.

Topics: Abscess; Aged; Anti-Bacterial Agents; Humans; Klebsiella Infections; Klebsiella pneumoniae; Male; Meropenem

Melioidosis is mainly observed in South-East Asia, where Burkholderia pseudomallei is endemic. Cutaneous melioidosis (CM) has rarely been described and in contrast to systemic forms, there are no therapeutic recommendations to guide management.. We reviewed the literature published before January 2018, evaluating: dermatological presentation, natural history, diagnostic methods, and treatment options. We also distinguish between primary and secondary CM in which the infection first started in the skin or came from an extracutaneous localization, respectively, and chronic CM when duration exceeded 2 months. The recommended treatment for systemic forms included ceftazidime or meropenem, followed by oral maintenance therapy with cotrimoxazole or amoxicillin - clavulanic acid.. Forty-three cases were published in 38 articles. Twenty-nine patients (67.4%) were travelers, including 13 (44.8%) returning from Thailand. Thirty-eight patients (88%) had primary CM, including nine (29.9%) with chronic infection. All cases of secondary CM first presented with acute infection. The median incubation time was 3 weeks. The most common presentation was cutaneous abscesses (58%). The recommended treatment was administered in 62.7% cases with 37.2% for maintenance therapy. Sixteen patients (37.2%) underwent surgery. Death was reported in less than 5%.. CM should be considered in travelers returning from or residents of endemic countries, particularly Thailand, presenting with cutaneous abscesses, cellulitis, or ulcerations. Surgery may be necessary in a substantial proportion of patients and follow-up of at least 1 year is essential. Therapeutic recommendations need to be established.

Topics: Abscess; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Ceftazidime; Drug Therapy, Combination; Humans; Infectious Disease Incubation Period; Melioidosis; Meropenem; Skin Diseases, Bacterial; Trimethoprim, Sulfamethoxazole Drug Combination

This report is the first published case of cerebral melioidosis in the western hemisphere. In this paper the authors review the literature on neurological melioidosis and its presentation and treatment in endemic areas, describe the clinical course of this unique case of a presentation of the disease with cranial abscess in the US, review the pathological and radiological findings associated with this seminal case, and put forth recommendations for recognizing and treating possible future instances of the disease within the western hemisphere.

Topics: Abscess; Anti-Bacterial Agents; Burkholderia pseudomallei; Cambodia; Humans; Male; Melioidosis; Meropenem; Middle Aged; Skull; Thienamycins; United States

The incidence of prostatic abscess is 0.5% in relation to all prostate pathologies and usually occurs in patients with diabetes or with some degree of immunosuppression. The case of a male patient, 84 years old, with a history of arterial hypertension and mild renal failure, presenting high fever, prostate syndrome, genital edema and constipation is reported. He was diagnosed with prostate abscess via transrectal ultrasonography (TRUS). Treatment was started with empirical meropenem and a puncture of the abscess was performed transperineally under TRUS guidance placing an 8-Fr nephrostomy tube for 36 h. The patient was discharged 48 h after the puncture with a good prognosis. TRUS-guided transperineal drainage is a safe, adequate and effective treatment for prostate abscess, and allows the placement of drainage for several hours thereby avoiding the communication between the abscessed cavity and the urethra or rectum. Therefore, after having reviewed the literature, we consider this approach suitable for drainage.

Topics: Abscess; Aged, 80 and over; Anti-Bacterial Agents; Antibiotic Prophylaxis; Drainage; Humans; Male; Meropenem; Prostatic Diseases; Punctures; Thienamycins; Treatment Outcome; Ultrasonography, Interventional

Burkholderia gladioli is an unusual organism that has become increasingly responsible for infections in patients who are immunosuppressed, including patients who have undergone solid organ transplantation. This article presents a patient in whom a mediastinal mass due to Burkholderia gladioli developed after lung transplantation. A review of the literature is also presented.

Topics: Abscess; Adult; Anti-Bacterial Agents; Burkholderia gladioli; Burkholderia Infections; Combined Modality Therapy; Cystic Fibrosis; Diagnosis, Differential; Drainage; Drug Therapy, Combination; Humans; Infusions, Intravenous; Lung Transplantation; Male; Mediastinal Diseases; Meropenem; Opportunistic Infections; Postoperative Complications; Thienamycins; Tobramycin; Tomography, X-Ray Computed

Meropenem is a new carbapenem antibiotic shown to resist degradation by renal dehydropeptidase I. In a multicenter, open-label, prospective trial, we compared the efficacy and safety of meropenem with imipenem/cilastatin in patients with skin and soft tissue infections. Patients received either 500 mg of meropenem every 8 hours (n = 184) or 500 mg of imipenem/cilastatin every 6 hours (n = 193), by intravenous infusion for an average of 6 to 7 days. Satisfactory clinical responses were achieved in 120 (98%) of 123 assessable meropenem-treated patients and in 120 (95%) of 126 assessable imipenem/cilastatin-treated patients. Satisfactory bacteriologic responses were achieved in 120 (98%) of 123 assessable meropenem-treated patients and in 120 (95%) of 126 assessable imipenem/cilastatin-treated patients. Satisfactory bacteriologic response rates were high as well: 94% with meropenem and 91% with imipenem/cilastatin. Between-group differences in satisfactory response rates were not significant (95% confidence interval, -2.29 to 6.93 [clinical]; -2.73 to 10.39 [bacteriologic]). Overall pathogen eradication rates (for aerobes and anaerobes) were slightly higher for meropenem. Elevated liver enzymes were the most frequent adverse events in each treatment group. Meropenem was well tolerated and as effective as imipenem/cilastatin in treatment of hospitalized patients with skin and soft tissue infections.

Topics: Abscess; Adolescent; Adult; Aged; Aged, 80 and over; Bacterial Infections; Cellulitis; Cilastatin; Cilastatin, Imipenem Drug Combination; Drug Combinations; Drug Therapy, Combination; Female; Hospitalization; Humans; Imipenem; Infusions, Intravenous; Male; Meropenem; Middle Aged; Prospective Studies; Skin Diseases, Infectious; Soft Tissue Infections; Thienamycins; Ulcer

Topics: Abscess; Adenocarcinoma; Anti-Bacterial Agents; Chemoradiotherapy; Combined Modality Therapy; Drainage; Endoscopic Ultrasound-Guided Fine Needle Aspiration; Esophagoscopy; Humans; Lung Neoplasms; Male; Meropenem; Middle Aged; Neck; Smoking; Streptococcal Infections; Streptococcus anginosus; Subcutaneous Tissue; Superior Vena Cava Syndrome; Thoracic Diseases; Tomography, X-Ray Computed

In Denmark, Q fever has previously been considered a rare and imported disease; however, recent testing of antibodies in cattle as well as humans has indicated that the infection is widespread. A 76-year-old Danish man was diagnosed with infective endocarditis and underwent open surgical aortic valve replacement with insertion of a biological valve. Due to paravalvular leakage, destruction of the aortic annulus, and an aortic root abscess, the patient underwent re-operation 3 weeks later, with replacement of the biological valve and insertion of an aortic prosthetic tube. Despite treatment with various broad-spectrum antibiotic regimes, the patient died 3.5 months after initial hospital admission.. The causative agent was probed by PCR amplification of bacterial DNA on the removed prosthetic aortic valve using broad range primers targeting the variable regions V1-V3 of the 16S RNA gene. After identification of Coxiella burnetii, multispacer sequence typing (MST) was performed by PCR amplification of 10 intergenic sequences.. BLAST analysis of DNA from prosthetic valve material identified a 16S rRNA gene fragment almost identical to the type strain of C. burnetii (462/463 nt). Molecular typing allocated the strain to MST_18.. Molecular methods are increasingly used to characterize isolates and to determine relationships between isolates that cause disease in different contexts and geographical areas. The present case demonstrates that identification and typing of C. burnetii is achievable without access to biosafety level 3 containment and highlights the first molecular characterization of an uncultured strain of C. burnetii causing infective endocarditis.

Topics: Abscess; Aged; Aortic Valve; Coxiella burnetii; Denmark; DNA, Bacterial; Doxycycline; Echinocandins; Endocarditis, Bacterial; Fatal Outcome; Gentamicins; Heart Valve Prosthesis; Humans; Male; Meropenem; Metronidazole; Multilocus Sequence Typing; Rifampin; RNA, Ribosomal, 16S; Vancomycin

Melioidosis is a life-threatening infectious disease that is caused by gram negative bacteria Burkholderia pseudomallei. This bacteria occurs as an environmental saprophyte typically in endemic regions of south-east Asia and northern Australia. Therefore, patients with melioidosis are at high risk of being misdiagnosed and/or under-diagnosed in South Asia.. Here, we report two cases of melioidosis from Nepal. Both of them were diabetic male who presented themselves with fever, multiple abscesses and developed sepsis. They were treated with multiple antimicrobial agents including antitubercular drugs before being correctly diagnosed as melioidosis. Consistent with this, both patients were farmer by occupation and also reported travelling to Malaysia in the past. The diagnosis was made consequent to the isolation of B. pseudomallei from pus samples. Accordingly, they were managed with intravenous meropenem followed by oral doxycycline and cotrimoxazole.. The case reports raise serious concern over the existing unawareness of melioidosis in Nepal. Both of the cases were left undiagnosed for a long time. Therefore, clinicians need to keep a high index of suspicion while encountering similar cases. Especially diabetic-farmers who present with fever and sepsis and do not respond to antibiotics easily may turn out to be yet another case of melioidosis. Ascertaining the travel history and occupational history is of utmost significance. In addition, the microbiologist should be trained to correctly identify B. pseudomallei as it is often confused for other Burkholderia species. The organism responds only to specific antibiotics; therefore, correct and timely diagnosis becomes crucial for better outcomes.

Topics: Abscess; Adult; Anti-Bacterial Agents; Burkholderia pseudomallei; Diabetes Mellitus; Diagnostic Errors; Doxycycline; Fever; Humans; Malaysia; Male; Melioidosis; Meropenem; Middle Aged; Nepal; Travel; Trimethoprim, Sulfamethoxazole Drug Combination

We report an unusual presentation of pulmonary embolism (PE) where a 58-year-old man first developed symptoms of community-acquired pneumonia. Despite antibiotic therapy, he remained unwell with rising inflammatory markers, general malaise and persistent cough. He developed stony dull percussion and absent breath sounds to his left mid to lower zones. Serial chest x-rays showed progression from lobar consolidation to a large loculated left-sided pleural collection. CT chest showed left-sided lung abscess, empyema and bronchopleural fistulation. Incidentally, the scan revealed acute left-sided PE and its distribution corresponded with the location of the left lung abscess and empyema. The sequence of events likely started with PE leading to infarction, cavitation, abscess formation and bronchopleural fistulation. This patient was managed with a 6-month course of rivaroxaban. After completing 2 weeks of intravenous meropenem, he was converted to 4-week course of oral co-amoxiclav and metronidazole and attained full recovery.

Topics: Abscess; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Bronchial Fistula; Disease Progression; Drug Therapy, Combination; Humans; Infarction; Male; Meropenem; Metronidazole; Middle Aged; Pleural Diseases; Pneumonia; Pulmonary Embolism; Radiography, Thoracic; Rivaroxaban; Thienamycins; Treatment Outcome

There have been various reports concerning Helicobacter cinaedi infections. However, few reports have examined central nervous system infections.. A 52-year-old man was transferred from the local hospital because of a persistent headache and suspected intracranial subdural empyema. Neurosurgical drainage was performed via burr holes. Gram staining and results from abscess cultures were negative. The blood culture yielded H. cinaedi. He was given an antibiotic regimen consisting of 2 g of ceftriaxone twice a day, but the size of the abscess was not reduced in size at all after 3 weeks of treatment. Neurosurgical drainage was performed again, and the antimicrobial regimen was switched to 2 g of meropenem 3 times a day. The size of the abscess was reduced after 2 weeks of the second drainage and antimicrobial drug change to meropenem. After 4 weeks treatment with meropenem, the patient was discharged, and his symptoms had completely resolved.. H. cinaedi infection should be considered in the differential diagnosis of subdural empyema cases for which Gram staining and abscess culture results are negative. Meropenem can be a first-line drug of choice or an effective alternative treatment for H. cinaedi central nervous system infections.

Topics: Abscess; Anti-Bacterial Agents; Anti-Infective Agents; Bacteremia; Ceftriaxone; Drainage; Empyema, Subdural; Helicobacter; Helicobacter Infections; Humans; Male; Meropenem; Middle Aged; Thienamycins; Treatment Outcome

Acute appendicitis is an uncommon and challenging disease in infancy. Usually, the clinical presentation in neonates and infants is non-specific and varies depending on the age of the child and duration of the disease. Diagnosis of incomplete and atypical Kawasaki disease (KD) in infants is also a challenging aspect and there is no gold standard for this diagnosis and sometimes fever is the only symptom that could be found. Herein, we report a 6-month infant with a 7 days of fever and bilateral pleural effusion, elevated erythrocyte sedimentation rate, thrombocytosis, hypo-albominemia, normal abdominal ultrasound, and primary diagnosis of KD. Final diagnosis was perforated retrocecal appendicitis and abscess formation. Physicians should be aware of the vague signs and symptoms of acute appendicitis in neonates and infants and consider this diagnosis to prevent delayed diagnosis, inappropriate treatment, and consequent morbidity and mortality.

Topics: Abscess; Acute Disease; Anti-Bacterial Agents; Appendectomy; Appendicitis; Humans; Immunoglobulins; Infant; Meropenem; Rupture, Spontaneous; Thienamycins; Tomography, X-Ray Computed; Treatment Outcome; Vancomycin

Thyroid abscess is a very rare clinical condition. It usually occurs in immunocompromised individuals or those with underlying malignancy. We report a case of multiple thyroid abscesses in the patient with Pre B acute lymphoblastic leukaemia which developed secondary to hematogenous spread from pyomyositis of right calf muscle. The patient developed sepsis-associated disseminated intravascular coagulation, which got resolved after thyroidectomy. He became afebrile after surgical intervention. Unfortunately, all the cultures were negative. Since there are few case series and reports, there are no clear guidelines for management of thyroid abscess. We conclude that though rare, thyroid abscess may be the cause of persistent fever in immunocompromised patients.

Topics: Abscess; Adolescent; Anti-Bacterial Agents; Antineoplastic Combined Chemotherapy Protocols; Clindamycin; Drainage; Fever; Humans; Male; Meropenem; Precursor B-Cell Lymphoblastic Leukemia-Lymphoma; Prednisolone; Pyomyositis; Sepsis; Teicoplanin; Thienamycins; Thyroid Diseases; Thyroid Gland; Thyroidectomy; Treatment Outcome

We report a 60-year-old woman who presented with orbital cellulitis, restricted ocular motility, proptosis, and visual acuity of counting fingers in her left eye 3 days after strabismus surgery. Although she initially responded well to antibiotic and anti-inflammatory therapy, visual acuity in the left eye again decreased on postoperative day 5. Radiographic imaging revealed an intraconal orbital abscess, and she underwent left lateral orbitotomy with abscess drainage, with continued antibiotics and a tapering dose of steroids. To our knowledge, this is the first case of orbital cellulitis and intraconal abscess after strabismus surgery in an adult.

Topics: Abscess; Anti-Bacterial Agents; Ceftriaxone; Clindamycin; Drainage; Drug Therapy, Combination; Eye Infections, Bacterial; Female; Humans; Magnetic Resonance Imaging; Meropenem; Middle Aged; Oculomotor Muscles; Ophthalmologic Surgical Procedures; Orbital Cellulitis; Strabismus; Streptococcal Infections; Thienamycins; Tomography, X-Ray Computed; Visual Acuity

We describe a case of a 66-year-old immunocompetent man affected by Achromobacter denitrificans renal abscess related to renal stones. The patient was treated successfully with meropenem 1 g three times daily for 60 days. To our knowledge, this is the first ever case reported of Achromobacter denitrificans renal abscess.

Topics: Abscess; Achromobacter denitrificans; Aged; Anti-Bacterial Agents; Humans; Kidney Diseases; Male; Meropenem; Thienamycins

The authors report a rare case of piriformis pyomyositis, in a teenage rugby player, who was initially feverish and presented to us with low back pain, sciatica and inability to mobilise due to pain. Subsequent imaging investigations (MRI scan) revealed abscess formation in the piriformis muscle with compression effect on the ipsilateral sciatic nerve. A course of intravenous antibiotic therapy followed by oral antibiotics fully resolved his symptoms and returned inflammatory markers back to normal.

Topics: Abscess; Adolescent; Anti-Bacterial Agents; Floxacillin; Football; Humans; Low Back Pain; Magnetic Resonance Imaging; Male; Meropenem; Pain; Piriformis Muscle Syndrome; Pyomyositis; Rifampin; Sciatica; Staphylococcal Infections; Staphylococcus aureus; Thienamycins; Vancomycin

Topics: Abdominal Wall; Abscess; Anti-Bacterial Agents; Bangladesh; Blood Glucose; Burkholderia pseudomallei; Chills; Clindamycin; Diagnosis, Differential; Fever; Humans; Male; Melioidosis; Meropenem; Middle Aged; Neck; Neck Pain; Saudi Arabia; Thienamycins; Tomography, X-Ray Computed; Travel; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Abscess; Acetamides; Acute Disease; Adult; Anti-Bacterial Agents; Bacterial Toxins; Cellulitis; Drainage; Drug Therapy, Combination; Exotoxins; Fever; Humans; Iraq; Leg; Leukocidins; Linezolid; Magnetic Resonance Imaging; Male; Meropenem; Military Personnel; Oxazolidinones; Staphylococcal Infections; Staphylococcus aureus; Thienamycins; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

We report a case of prostatic abscess in a 22-year-old man with metastatic testicular cancer being treated by BEP (bleomycin, etoposide and cisplatin) chemotherapy. This abscess was successfully treated by surgical drainage with transurethral resection of the prostate (TURP) under the guidance of transrectal ultrasound, allowing the patient to continue be receiving BEP without significant interruption. Drainage TURP is suggested to be a useful strategy for prostate abscess, when prompt control of symptoms caused by prostatic abscess is required.

Topics: Abscess; Adult; Anti-Bacterial Agents; Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Brain Neoplasms; Ceftazidime; Cisplatin; Drainage; Etoposide; Humans; Immunocompromised Host; Lung Neoplasms; Male; Meropenem; Orchiectomy; Prostatic Diseases; Pseudomonas Infections; Testicular Neoplasms; Thienamycins; Transurethral Resection of Prostate

Resistance emergence to carbapenem antibiotics was studied in a rat-thigh abscess model. Abscesses were developed in three groups with a total of 15 P. aeruginosa strains (three rats per strain). Groups were assigned to imipenem or meropenem treatment while one was left antibiotic-free. Test strains were fully susceptible to these antibiotics and the "Mutant Preventing Concentrations" of imipenem and meropenem over these strains were comparable. Antibiotic serum levels, assessed by serum bioassay test, were similar among therats. After four days, rats (n=45) were sacrificed and carbapenem resistant mutants were selected on imipenem (4 mg/L) and meropenem (4 mg/L) supplemented agar plates. Resistant variants of three strains, from four abscesses, were detected; one in the meropenem group, two in the imipenem and one in the untreated group. The MICs of imipenem and meropenem for the mutants were increased fourfold times or even higher of their counterparts. Resistance emergence under antibiotic pressure in P. aeruginosa has been shown in various conditions. To our knowledge, however, resistance emergence in abscess and also the comparison of imipenem and meropenem in this regard has not been studied before.

Topics: Abscess; Animals; Carbapenems; Drug Resistance, Bacterial; Imipenem; Male; Meropenem; Microbial Sensitivity Tests; Pseudomonas aeruginosa; Pseudomonas Infections; Rats; Rats, Wistar; Selection, Genetic; Thienamycins