meropenem and Acute-Disease

Pantoea is a Gram-negative, non-encapsulated, non-spore-forming, ubiquitous straight rod which can be isolated from geographical and ecological sources such as plant surfaces, buckwheat seeds, human feces, and the environment. The genus Pantoea is a rare pathogen in a clinical setting, and is divided into 20 different species such as Pantoea agglomerans, Pantoea ananatis, Pantoea deleyi, Pantoea dispersa, Pantoea septica, Pantoea stewartii or Pantoea rwandensis. Pantoea dispersa has been reported to cause other infections, including respiratory infections, neonatal sepsis, and bloodstream infections. We report a case of Pantoea dispersa bacteremia caused by acute cholangitis. This is the first case report of Pantoea dispersa bacteremia caused by acute cholangitis as far as we had searched.. A 38-year-old Japanese woman suffered from acute cholangitis; a blood culture showed that Gram-negative rod was positive. The treatment was successful with intravenously administered meropenem, and it was switched to orally administered levofloxacin according to microbiological susceptibility. The organism was identified as Pantoea dispersa by both genetic investigation by 16S ribosomal RNA and additional biochemical tests. To the best of our knowledge, this is the first case report of Pantoea dispersa bacteremia caused by acute cholangitis.. The epidemiology and clinical features of Pantoea dispersa are still unknown. More cases of infections caused by Pantoea dispersa might be revealed with advancing technical methods, such as matrix-assisted laser desorption/ionization time-of-flight mass spectrometry or 16S ribosomal RNA analysis. Physicians must know that a variety of infections caused by Pantoea dispersa could occur in immunocompromised as well as immunocompetent patients.

Topics: Acute Disease; Adult; Anti-Bacterial Agents; Bacteremia; Bile Ducts; Cholangitis; Enterobacteriaceae Infections; Female; Humans; Immunocompetence; Immunocompromised Host; Levofloxacin; Meropenem; Pantoea

Acute osteomyelitis, which is uncommon in neonates, needs to be quickly diagnosed and treated to avoid devastating sequelae. Therefore, it is important to maintain a high index of suspicion and be aware of the evolving epidemiology and of the emergence of antibiotic resistant and aggressive strains requiring careful monitoring and targeted therapy. The most frequently isolated bacterium in neonates with osteomyelitis is Staphylococcus aureus, while Salmonella is an unusual organism causing osteomyelitis and is exceedingly rare in non-sickle cell disease children.. We report an extremely rare case of neonatal osteomyelitis caused by Salmonella in a neonate, who was previously healthy. We report this case because it was caused by a rare pathogenic germ in newborns and by its non-specific presentation.. Salmonella should be kept in mind in the differential diagnosis of neonatal osteomyelitis. It is important to start antibiotic therapy as soon as possible and to adjust therapy in relation to the susceptibility of the bacterial strain.

Topics: Acute Disease; Anti-Bacterial Agents; Diagnosis, Differential; Fibula; Humans; Infant, Newborn; Magnetic Resonance Imaging; Male; Meropenem; Osteomyelitis; Radiography; Salmonella; Salmonella Infections; Thienamycins; Tibia

The management of acute pancreatitis (AP) is still based on speculative and unproven paradigms in many centers. Therefore, we performed an evidence-based analysis to assess the best available treatment.. A comprehensive Medline and Cochrane Library search was performed evaluating the indication and timing of interventional and surgical approaches, and the value of aprotinin, lexipafant, gabexate mesylate, and octreotide treatment. Each study was ranked according to the evidence-based methodology of Sackett; whenever feasible, we performed new meta-analyses using the random-effects model. Recommendations were based on the available level of evidence (A=large randomized; B=small randomized; C=prospective trial).. None of the evaluated medical treatments is recommended (level A). Patients with AP should receive early enteral nutrition (level B). While mild biliary AP is best treated by primary cholecystectomy (level B), patients with severe biliary AP require emergency endoscopic papillotomy followed by interval cholecystectomy (level A). Patients with necrotizing AP should receive imipenem or meropenem prophylaxis to decrease the risk of infected necrosis and mortality (level A). Sterile necrosis per se is not an indication for surgery (level C), and not all patients with infected necrosis require immediate surgery (level B). In general, early necrosectomy should be avoided (level B), and single necrosectomy with postoperative lavage should be preferred over "open-packing" because of fewer complications with comparable mortality rates (level C).. While providing new insights into key aspects of AP management, this evidence-based analysis highlights the need for further clinical trials, particularly regarding the indications for antibiotic prophylaxis and surgery.

Topics: Acute Disease; Anti-Bacterial Agents; Antibiotic Prophylaxis; Aprotinin; Cholecystectomy; Enteral Nutrition; Evidence-Based Medicine; Gabexate; Gastrointestinal Agents; Humans; Imidazoles; Imipenem; Leucine; Meropenem; Octreotide; Pancreatitis; Pancreatitis, Acute Necrotizing; Platelet Activating Factor; Randomized Controlled Trials as Topic; Serine Proteinase Inhibitors; Sphincterotomy, Endoscopic; Thienamycins

We describe 3 previously healthy Costa Rican children who had Listeria monocytogenes meningitis, an uncommon cause of bacterial meningitis beyond the newborn period in normal subjects. Two of them had initial normal brain computed tomography, but all 3 developed acute hydrocephalus at days 7, 3, and 5, respectively. All required immediate ventriculostomy placement and only 1 of 3 survived. L. monocytogenes should be considered among the etiologies of bacterial meningitis in children who do not respond initially to conventional antimicrobial treatment or who deteriorate rapidly.

Topics: Acute Disease; Amikacin; Cefotaxime; Child; Child, Preschool; Combined Modality Therapy; Costa Rica; Dexamethasone; Drug Resistance; Drug Therapy, Combination; Emergencies; Fatal Outcome; Female; Humans; Hydrocephalus; Male; Meningitis, Listeria; Meropenem; Rifampin; Thienamycins; Tomography, X-Ray Computed; Vancomycin; Ventriculostomy

Topics: Acute Disease; Amikacin; Anemia, Aplastic; Antilymphocyte Serum; Combined Modality Therapy; Cyclosporine; Drug Therapy, Combination; Escherichia coli Infections; Gastric Mucosa; Gastritis; Granulocyte Colony-Stimulating Factor; Immunosuppressive Agents; Meropenem; Methylprednisolone; Necrosis; Neutropenia; Omeprazole; Parenteral Nutrition, Total; T-Lymphocytes; Thienamycins

Febrile neutropenia is often observed in patients with hematologic malignancies, especially in those with acute leukemia. Meropenem has potent and broad antibacterial activity against gram-positive and gram-negative bacteria, and is recommended as first-line empiric therapy for febrile neutropenia. In contrast, the safety and efficacy of doripenem in patients with febrile neutropenia and hematologic malignancies is limited. In this randomized, prospective, cooperative, open-label trial, we compared doripenem (1.0 g every 8 h) to meropenem (1.0 g every 8 h) as first-line empiric antibacterial treatment of febrile neutropenia. To evaluate efficacy and safety, 133 hospitalized patients with acute leukemia or high-risk myelodysplastic syndrome, who developed febrile neutropenia during or after chemotherapy, were randomized to each drug. Resolution of fever within 3 to 5 days without treatment modification (i.e., the primary endpoint) did not significantly differ between the doripenem and meropenem groups (60.0% vs. 45.6%, respectively; P = 0.136). However, resolution of fever within 7 days of treatment was significantly higher in the doripenem group than in the meropenem group (78.4% vs. 60.2%, respectively; P = 0.037). Similar rates of adverse events (grades 1-2) were observed in both groups. Thus, we conclude that both drugs are safe and well-tolerated for the treatment of febrile neutropenia in patients with acute leukemia or high-risk myelodysplastic syndrome, and that the clinical efficacy of doripenem is noninferior to that of meropenem. UMIN Clinical Trial Registry number: 000006124.

Topics: Acute Disease; Adolescent; Adult; Aged; Aged, 80 and over; Chemotherapy-Induced Febrile Neutropenia; Doripenem; Female; Fever; Humans; Leukemia; Male; Meropenem; Middle Aged; Myelodysplastic Syndromes; Prospective Studies

Meropenem-vaborbactam is a combination carbapenem/beta-lactamase inhibitor and a potential treatment for severe drug-resistant gram-negative infections.. To evaluate efficacy and adverse events of meropenem-vaborbactam in complicated urinary tract infection (UTI), including acute pyelonephritis.. Phase 3, multicenter, multinational, randomized clinical trial (TANGO I) conducted November 2014 to April 2016 and enrolling patients (≥18 years) with complicated UTI, stratified by infection type and geographic region.. Eligible patients were randomized 1:1 to receive meropenem-vaborbactam (2g/2g over 3 hours; n = 274) or piperacillin-tazobactam (4g/0.5g over 30 minutes; n = 276) every 8 hours. After 15 or more doses, patients could be switched to oral levofloxacin if they met prespecified criteria for improvement, to complete 10 days of total treatment.. Primary end point for FDA criteria was overall success (clinical cure or improvement and microbial eradication composite) at end of intravenous treatment in the microbiologic modified intent-to-treat (ITT) population. Primary end point for European Medicines Agency (EMA) criteria was microbial eradication at test-of-cure visit in the microbiologic modified ITT and microbiologic evaluable populations. Prespecified noninferiority margin was -15%. Because the protocol prespecified superiority testing in the event of noninferiority, 2-sided 95% CIs were calculated.. Among 550 patients randomized, 545 received study drug (mean age, 52.8 years; 361 [66.2%] women; 374 [68.6%] in the microbiologic modified ITT population; 347 [63.7%] in the microbiologic evaluable population; 508 [93.2%] completed the trial). For the FDA primary end point, overall success occurred in 189 of 192 (98.4%) with meropenem-vaborbactam vs 171 of 182 (94.0%) with piperacillin-tazobactam (difference, 4.5% [95% CI, 0.7% to 9.1%]; P < .001 for noninferiority). For the EMA primary end point, microbial eradication in the microbiologic modified ITT population occurred in 128 of 192 (66.7%) with meropenem-vaborbactam vs 105 of 182 (57.7%) with piperacillin-tazobactam (difference, 9.0% [95% CI, -0.9% to 18.7%]; P < .001 for noninferiority); microbial eradication in the microbiologic evaluable population occurred in 118 of 178 (66.3%) vs 102 of 169 (60.4%) (difference, 5.9% [95% CI, -4.2% to 16.0%]; P < .001 for noninferiority). Adverse events were reported in 106 of 272 (39.0%) with meropenem-vaborbactam vs 97 of 273 (35.5%) with piperacillin-tazobactam.. Among patients with complicated UTI, including acute pyelonephritis and growth of a baseline pathogen, meropenem-vaborbactam vs piperacillin-tazobactam resulted in a composite outcome of complete resolution or improvement of symptoms along with microbial eradication that met the noninferiority criterion. Further research is needed to understand the spectrum of patients in whom meropenem-vaborbactam offers a clinical advantage.. clinicaltrials.gov Identifier: NCT02166476.

Topics: Acute Disease; Adult; Aged; Anti-Bacterial Agents; Boronic Acids; Drug Combinations; Female; Humans; Intention to Treat Analysis; Male; Meropenem; Middle Aged; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination; Practice Guidelines as Topic; Pyelonephritis; Thienamycins; Urinary Tract Infections; Urine

The aim of this study was to evaluate the feasibility and safety of nonoperative treatment of acute nonperforated appendicitis with antibiotics in children.. A pilot randomized controlled trial was performed comparing nonoperative treatment with antibiotics versus surgery for acute appendicitis in children. Patients with imaging-confirmed acute nonperforated appendicitis who would normally have had emergency appendectomy were randomized either to treatment with antibiotics or to surgery. Follow-up was for 1 year.. Fifty patients were enrolled; 26 were randomized to surgery and 24 to nonoperative treatment with antibiotics. All children in the surgery group had histopathologically confirmed acute appendicitis, and there were no significant complications in this group. Two of 24 patients in the nonoperative treatment group had appendectomy within the time of primary antibiotic treatment and 1 patient after 9 months for recurrent acute appendicitis. Another 6 patients have had an appendectomy due to recurrent abdominal pain (n = 5) or parental wish (n = 1) during the follow-up period; none of these 6 patients had evidence of appendicitis on histopathological examination.. Twenty-two of 24 patients (92%) treated with antibiotics had initial resolution of symptoms. Of these 22, only 1 patient (5%) had recurrence of acute appendicitis during follow-up. Overall, 62% of patients have not had an appendectomy during the follow-up period. This pilot trial suggests that nonoperative treatment of acute appendicitis in children is feasible and safe and that further investigation of nonoperative treatment is warranted.

Topics: Abdominal Pain; Acute Disease; Adolescent; Anti-Bacterial Agents; Appendectomy; Appendicitis; Child; Child, Preschool; Ciprofloxacin; Drug Therapy, Combination; Follow-Up Studies; Humans; Meropenem; Metronidazole; Pilot Projects; Recurrence; Thienamycins; Treatment Outcome

The current management of acute cholangitis consists of antibiotic therapy in combination with biliary drainage. However, the optimal duration of antibiotic therapy after the resolution of clinical symptoms by biliary drainage is unclear. We aimed to evaluate whether discontinuing antibiotic therapy for acute cholangitis immediately after the resolution of clinical symptoms, achieved by endoscopic biliary drainage, was safe and effective.. This prospective study included patients with moderate and severe acute cholangitis. Cefmetazole sodium and meropenem hydrate were used as initial antibiotic therapy for patients with moderate and severe acute cholangitis, respectively. All patients underwent endoscopic biliary drainage within 24 h of diagnosis. When the body temperature of < 37 ° C was maintained for 24 h, administration of antibiotics was stopped. The primary endpoint was the recurrence of acute cholangitis within 3 days after the withdrawal of antibiotic therapy.. Eighteen patients were subjected to the final analysis. The causes of cholangitis were bile duct stone (n = 17) and bile duct cancer (n = 1). The severity of acute cholangitis was moderate in 14 patients and severe in 4. Body temperature of < 37 ° C was achieved in all patients after a median of 2 days (range 1-6) following endoscopic biliary drainage. Antibiotic therapy was administered for a median duration of 3 days (range 2-7). None of the patients developed recurrent cholangitis within 3 days after the withdrawal of antibiotics.. Fever-based antibiotic therapy for acute cholangitis is safe and effective when resolution of fever is achieved following endoscopic biliary drainage.

Topics: Acute Disease; Aged; Aged, 80 and over; Anti-Bacterial Agents; Cefmetazole; Cholangiopancreatography, Endoscopic Retrograde; Cholangitis; Drainage; Female; Fever; Humans; Male; Meropenem; Middle Aged; Prospective Studies; Recurrence; Severity of Illness Index; Thienamycins; Treatment Outcome

In the present study, we analyze the efficacy of prophylaxis with meropenem in patients receiving a matched related donor allogeneic transplant. In total, 38 patients were sequentially treated with meropenem starting on the day of the first febrile episode (n=17, group A) vs prophylactic meropenem starting on the first day with <500/mm(3) granulocytes (n=21, group B), and maintained until resolution of fever or after granulocyte count >500/mm(3). Of these, 16 (94%) patients in group A developed fever as compared to 16 (76%) in group B (P=0.02). While only one patient in group A did not require first-line antibiotherapy, there were seven (33%) in group B who did not require it (P=0.01) since fever lasted less than 72 h. In addition, 52% patients in group B did not require second-line antibiotics as compared to 11% among patients in group A (P=0.04). In multivariate analysis prophylaxis with meropenem (HR=2.83, 95% CI (1-8.02); P=0.04) and disease status at transplant (HR for early stage=0.15, 95% CI (0.04-0.62); P=0.04) significantly influenced the development of fever. In conclusion, the current pilot study suggests that the use of prophylaxis with meropenem during the period of neutropenia in patients undergoing allogeneic transplantation favorably affects the morbidity of the procedure by reducing febrile episodes.

Topics: Acute Disease; Adult; Bacterial Infections; Chronic Disease; Cohort Studies; Female; Fever; Hematopoietic Stem Cell Transplantation; Humans; Incidence; Leukemia, Lymphocytic, Chronic, B-Cell; Leukemia, Myeloid; Male; Meropenem; Middle Aged; Pilot Projects; Thienamycins

Topics: Abdomen; Acute Disease; Adult; APACHE; Female; Humans; Male; Meropenem; Middle Aged; Peritonitis; Sepsis; Surgical Procedures, Operative; Thienamycins; Time Factors

Topics: Acute Disease; Adult; Anti-Bacterial Agents; Drainage; Female; Follow-Up Studies; Humans; Meropenem; Pyriform Sinus; Respiratory Tract Fistula; Streptococcal Infections; Streptococcus constellatus; Suppuration; Thyroiditis, Suppurative; Tomography, X-Ray Computed; 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

We present a case report of young man with Type 1 diabetes who developed acute visual loss after initially presenting with diabetic ketoacidosis. The diagnosis of invasive paranasal sinusoidal aspergillosis was made following CT and biopsy. Although uncommon, visual loss is a recognised complication of disseminated aspergillosis and is more likely in immune-compromised patients and those with diabetes. Early investigation with appropriate sinus imaging and involvement of the Ear Nose and Throat team in recommended when patients with diabetes develop acute visual loss in the context of a non-specific infective illness.

Topics: Acute Disease; Amphotericin B; Anti-Bacterial Agents; Antifungal Agents; Aspergillosis; Biopsy; Blindness; Caspofungin; Diabetes Mellitus, Type 1; Diagnosis, Differential; Echinocandins; Emergency Service, Hospital; Fatal Outcome; Humans; Lipopeptides; Magnetic Resonance Imaging; Male; Meropenem; Middle Aged; Paranasal Sinuses; Thienamycins; Tomography, X-Ray Computed; United Kingdom

To date intracranial complication caused by tooth extractions are extremely rare. In particular parietal subdural empyema of odontogenic origin has not been described. A literature review is presented here to emphasize the extreme rarity of this clinical entity.. An 18-year-old Caucasian man with a history of dental extraction developed dysarthria, lethargy, purulent rhinorrhea, and fever. A computed tomography scan demonstrated extensive sinusitis involving maxillary sinus, anterior ethmoid and frontal sinus on the left side and a subdural fluid collection in the temporal-parietal site on the same side. He underwent vancomycin, metronidazole and meropenem therapy, and subsequently left maxillary antrostomy, and frontal and maxillary sinuses toilette by an open approach. The last clinical control done after 3 months showed a regression of all symptoms.. The occurrence of subdural empyema is an uncommon but possible sequela of a complicated tooth extraction. A multidisciplinary approach involving otolaryngologist, neurosurgeons, clinical microbiologist, and neuroradiologist is essential. Antibiotic therapy with surgical approach is the gold standard treatment.

Topics: Acute Disease; Adolescent; Anti-Bacterial Agents; Craniotomy; Diagnosis, Differential; Empyema, Subdural; Follow-Up Studies; Humans; Male; Maxillary Sinus; Meropenem; Metronidazole; Parietal Lobe; Sinusitis; Subdural Space; Thienamycins; Tomography, X-Ray Computed; Tooth Extraction; Treatment Outcome; Vancomycin

Pseudomonas aeruginosa (P. aeruginosa) infections are associated with considerable morbidity and mortality in immunocompromised patients due to antibiotic resistance. Therefore, we investigated the efficacy of the anti-P. aeruginosa serotype O11 lipopolysaccharide monoclonal antibody Panobacumab in a clinically relevant murine model of neutropenia induced by cyclophosphamide and in combination with meropenem in susceptible and meropenem resistant P. aeruginosa induced pneumonia. We observed that P. aeruginosa induced pneumonia was dramatically increased in neutropenic mice compared to immunocompetent mice. First, Panobacumab significantly reduced lung inflammation and enhanced bacterial clearance from the lung of neutropenic host. Secondly, combination of Panobacumab and meropenem had an additive effect. Third, Panobacumab retained activity on a meropenem resistant P. aeruginosa strain. In conclusion, the present data established that Panobacumab contributes to the clearance of P. aeruginosa in neutropenic hosts as well as in combination with antibiotics in immunocompetent hosts. This suggests beneficial effects of co-treatment even in immunocompromised individuals, suffering most of the morbidity and mortality of P. aeruginosa infections.

Topics: Acute Disease; Animals; Anti-Bacterial Agents; Antibodies, Bacterial; Antibodies, Monoclonal; Drug Resistance, Bacterial; Drug Synergism; Female; Lung; Meropenem; Mice; Mice, Inbred C57BL; Neutropenia; Pneumonia; Pseudomonas aeruginosa; Thienamycins

Glanders is a zoonotic infection inducing acute forms of the disease (pneumonia, sepsis) in humans and animals under certain conditions, which even with the use of modern chemotherapy have unfavourable prognosis. Insufficient of efficacy of antibiotics with in vitro low MIC for planktonic bacterial suspension of Burkholderia mallei in chemotherapy of acute forms of glanders was due to the capacity of the pathogen for intracellular survival and formation of biofilms. Under such conditions the susceptibility of B. mallei to antibiotics lowered by several orders of magnitude. Chemotherapy of the glanders acute forms in animals usually provided only an increase of the lifespan, while among the survivors there was recorded a high relapse rate. More favourable outcomes were observed with the use of in vitro effective antibiotics in the form of clathrate compounds or especially liposomal forms. In the experiments with golden hamsters the survival rate reached 100% in 1000 Dlm infection even with the treatment onset by meropenem liposomal form 48 hours after the infection. Chemotherapeutics in the liposomal form significantly lowered resistance of B. mallei in both the experiments with a suspension of planktonic organisms and the use of bacteria interned in eukaryotic cells (Tetrahymena pyriformis).

Topics: Acute Disease; Animals; Anti-Bacterial Agents; Burkholderia mallei; Ceftazidime; Cricetinae; Doxycycline; Female; Fever; Glanders; Liposomes; Male; Meropenem; Mesocricetus; Microbial Sensitivity Tests; Survival Rate; Terpenes; Thienamycins

The identification of the optimal agent for administration via the respiratory tract when treating pneumonia caused by carbapenem-resistant Acinetobacter baumannii (CRAB).. A murine model of acute CRAB pneumonia was established by intratracheal (i.t.) inoculation with 2.5 × 10⁷ colony-forming units (CFU) of A. baumannii strain Ab396 plus 10% porcine mucin. After 4h the infected BALB/c mice were treated intratracheally with 25μl of either 0.85% saline (control group), colistimethate sodium (CMS) (166 666 U/kg, CMS group), imipenem/cilastatin (30/30 mg/kg, imipenem group), or meropenem (20mg/kg, meropenem group), every 8h. The therapeutic efficacy of these agents was examined.. A. baumannii strain Ab396 was susceptible to CMS only. However, meropenem treatment did give a significantly superior survival rate (100%) compared to treatment with imipenem (50%), CMS (33%), or saline (0%) (p<0.001 vs. the control and CMS groups, p=0.006 vs. the imipenem group, by log-rank test). Furthermore, compared to the other groups, the meropenem group demonstrated significantly more favorable results in terms of tissue penetration of the antibiotic, bacterial clearance, normalization of the wet lung-to-body weight ratio, and down-regulation of pro-inflammatory cytokine levels in the lungs.. Administration of meropenem via the respiratory tract proved to have the best therapeutic efficacy among the antibiotics tested when treating advanced murine CRAB pneumonia.

Topics: Acinetobacter baumannii; Acinetobacter Infections; Acute Disease; Animals; Anti-Bacterial Agents; Carbapenems; Cilastatin; Cilastatin, Imipenem Drug Combination; Colistin; Cytokines; Disease Models, Animal; Drug Combinations; Drug Resistance, Bacterial; Female; Imipenem; Meropenem; Mice; Mice, Inbred BALB C; Microbial Sensitivity Tests; Pneumonia, Bacterial; Stem Cells; Thienamycins

Topics: Acute Disease; Anti-Bacterial Agents; Drug Interactions; Drug Therapy, Combination; Humans; Male; Meropenem; Middle Aged; Nephritis, Interstitial; Osteomyelitis; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination; Thienamycins

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 present the first reported case of severe intravascular haemolysis associated with the use of meropenem in a 64 year old man. The report highlights a further possible drug related cause of intravascular haemolysis. The patient, who had a background of dialysis dependent renal failure, epilepsy and learning difficulties, was admitted to the intensive care unit following laparotomy and large bowel resection. His background also included a reported childhood allergy to penicillin. Along with initial haemodynamic and ventilatory support he was treated with cefuroxime, metronidazole and gentamicin without incident. He went on to develop an abdominal collection, for which treatment included meropenem. Associated with the administration of meropenem was the development of severe intravascular haemolysis confirmed by laboratory analysis and microscopy, which resolved on cessation of meropenem therapy. We discuss the possible mechanisms involved in the development of drug induced haemolysis and suggest the most likely cause in this case.

Topics: Acute Disease; Anti-Bacterial Agents; Gram-Negative Bacterial Infections; Hemolysis; Humans; Male; Meropenem; Middle Aged; Severity of Illness Index; Thienamycins

Topics: Acute Disease; Anti-Bacterial Agents; C-Reactive Protein; Humans; Imipenem; Meropenem; Necrosis; Pancreatitis; Thienamycins

To report a probable interaction between meropenem and valproic acid that resulted in the development of epileptic seizures.. A 21-year-old woman presented to our emergency department because of a new-onset, generalized tonic-clonic seizure and was admitted to the intensive care unit. Treatment with valproic acid 1000 mg as a continuous intravenous infusion over 24 hours was initiated. On day 6, the serum concentration of valproic acid was 52.5 microg/mL. On day 13, treatment with intravenous meropenem 1 g 3 times daily was started. On day 15, when the patient was afebrile, numerous myoclonic episodes occurred involving her arms and face; the serum concentration of valproic acid at that time was 42 mug/mL. The valproic acid dose was increased to 2880 mg. Two days later, a generalized tonic-clonic seizure occurred despite the increased dosage, and the plasma concentration of valproic acid fell to 7 microg/mL. The valproic acid dose was increased the following day to 3600 mg; however, the serum concentrations remained <10 microg/mL. On day 19, based on the results of a blood culture and the suspicion of an interaction between meropenem and valproic acid, meropenem therapy was suspended. The serum concentration of valproic acid was 52.4 microg/mL on day 27. Three days later, the patient was asymptomatic and was discharged.. Coadministration of valproic acid and other drugs that are metabolized by the hepatic cytochrome P450 isoenzyme system can lead to clinically relevant interactions by induction or inhibition of enzymes in shared metabolic pathways. In view of studies in experimental models, the interaction between carbapenem antibiotics and valproic acid is at least possible. Use of the Naranjo probability scale indicated a probable relationship between acute seizures and a meropenem-valproic acid interaction in this patient.. This case report provides strong evidence for an interaction between valproic acid and meropenem. Clinicians should be aware of this potential interaction that may be associated with a serious adverse effect as the result of the decrease of the valproic acid serum concentrations.

Topics: Acute Disease; Adult; Anti-Bacterial Agents; Anticonvulsants; Drug Interactions; Epilepsy; Female; Humans; Infusions, Intravenous; Meropenem; Seizures; Thienamycins; Valproic Acid

Results of surgical treatment of 142 patients with acute destructive pancreatitis were analyzed. The treatment of patients was divided into two periods. The first period included 59 (41.5%) patients when active surgical strategy was used. The second period of observations included 83 (53.5%) patients with the optimized strategy of treatment based on intensive therapy, prognosis of the course of the disease, new antibacterial medicines and new technologies of operative treatment. A comparison of the results of treatment has revealed the advantages of using the optimized strategy and allowed the postoperative lethality to be reduced from 59.3 to 32.5%.

Topics: Acute Disease; Anti-Bacterial Agents; Cephalosporins; Fluoroquinolones; Gastrointestinal Agents; Humans; Meropenem; Octreotide; Pancreatectomy; Pancreatitis; Postoperative Complications; Preoperative Care; Prognosis; Risk Factors; Thienamycins; Time Factors; Ultrasonography

A case of acute generalized exanthematous pustulosis (AGEP) is presented. The case is notable for the recurrent episodes of AGEP, caused by three beta-lactam antibiotics (piperacillin, ceftazidime, and meropenem) in septicemic patient. The case represents the first report of the reaction developing in response to these three antibiotics. The report is also notable for the spontaneous resolution of the rash in all the three episodes.

Topics: Acute Disease; Anti-Bacterial Agents; Bacteremia; Ceftazidime; Diabetes Mellitus; Diagnosis, Differential; Exanthema; Hepatitis, Alcoholic; Humans; Male; Meropenem; Middle Aged; Piperacillin; Pseudomonas aeruginosa; Pseudomonas Infections; Recurrence; Thienamycins

Recent data from the experimental clinical studies suggest that antibiotics having good penetration to pancreas may reduce mortality by preventing pancreatic infection, which is the most important prognostic factor in acute pancreatitis (AP). Deferoxamine is an active free oxygen radical scavenger, which has been shown to have a protective role in development of acute pancreatitis.. To determine the effects of combination of deferoxamine and meropenem in acute necrotizing pancreatitis.. One hundred male Sprague-Dawley rats were randomly divided into 5 groups. All rats underwent laparotomy with cannulation of biliopancreatic duct. Group 1 received intraductal saline injection. Acute necrotizing pancreatitis was induced in group 2, 3, 4, and 5 by intraductal injection of 3% taurocholate. Group 1 (sham operated) and group 2 were injected with saline of 0.3 mL/kg intraperitoneally (i.p). Group 3 was injected with meropenem 60 mg/kg/d i.p, group 4 with deferoxamine 80 mg/kg/d s.c and group 5 with combination of these 2 agents at the same doses. While meropenem was started 2 hours later, all treatments were started immediately after the induction of pancreatitis. All rats were killed at the 48th hour of the treatment and blood and tissue samples were collected for amylase determinations, pathologic examinations, and culture.. There was no difference in serum amylase levels between AP induced groups (P > 0.05). Pancreatic histology scores were significantly low in rats treated with deferoxamine (group 4), and combination regimen (group 5) (P < 0.001). Meropenem significantly reduced the incidence of pancreatic infection. Although combination of deferoxamine with meropenem showed better effects than meropenem alone in terms of pancreatic infection, the difference did not reach to statistical significance.. Meropenem treatment reduces secondary pancreatic infections in acute pancreatitis. Treatment with deferoxamine and meropenem combination may be more beneficial than single therapies in reducing the severity of pancreatitis. Further studies investigating the effects of this combination on survival are needed.

Topics: Acute Disease; Animals; Bacteria; Bacterial Infections; Catheterization; Deferoxamine; Drug Therapy, Combination; Laparotomy; Male; Meropenem; Pancreatitis, Acute Necrotizing; Rats; Rats, Sprague-Dawley; Thienamycins

Topics: Acute Disease; Anti-Bacterial Agents; Anti-Inflammatory Agents; Bacteremia; Cerebrospinal Fluid; Clarithromycin; Dexamethasone; Drug Therapy, Combination; Female; Humans; Infant; Infusions, Intravenous; Meningitis, Pneumococcal; Meropenem; Microbial Sensitivity Tests; Otitis Media; Streptococcus pneumoniae; Thienamycins