meropenem and Cellulitis

Infection with Campylobacter species is a predominant cause of food-borne gastroenteritis in the industrialized world. Bacteremia is detected in <1% of patients with diarrhea, mainly in immunocompromised hosts or those in the extremes of age. Reported here is the case of a 78-year-old, immunocompromised male patient with Campylobacter jejuni subsp. jejuni bacteremia complicated by cellulitis. The infection was characterized by a protracted course with several recurrences and refractoriness to multiple antibiotic regimens, responding only to a prolonged course of meropenem treatment. The frequency of cellulitis as reflected in previously reported series of Campylobacter bacteremia and the clinical characteristics of this difficult-to-treat infection are reviewed.

Topics: Aged; Bacteremia; Campylobacter Infections; Campylobacter jejuni; Cellulitis; Drug Therapy, Combination; Follow-Up Studies; Humans; Immunocompromised Host; Male; Meropenem; Myelodysplastic Syndromes; Recurrence; Risk Assessment; Roxithromycin; Severity of Illness Index; Thienamycins; Treatment Outcome

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

Sphingobacterium spiritivorum is a glucose non-fermenting Gram-negative rod, formerly classified as one of the Flavobacterium species. It is characterized by a large number of cellular membrane sphingophospholipids. Sphingobacterium species are ubiquitous and isolated from natural environments, such as soil and water. However, they rarely cause infections in humans. Only a limited number of cases have been reported in elderly and immunocompromised patients with underlying diseases and predisposing factors.. An 80-year-old Japanese man with chronic obstructive pulmonary disease and congestive heart failure visited the Kariya Toyota General Hospital, Aichi, Japan with the chief complaint of fever accompanied by chills and left leg pain. At initial presentation, he was distressed and dyspneic. He was febrile (38.8 °C), and his left foot was swollen with reddening and tenderness. We diagnosed him as having cellulitis, and he was hospitalized for antibiotic therapy. Initially, he was treated with intravenously administered cefazolin, but after the isolation of a glucose non-fermenting Gram-negative rod from blood cultures, we decided to switch cefazolin to intravenously administered meropenem on day 4, considering the antibiotic resistance of the causative organism. The causative organism was identified as S. spiritivorum on day 6. His condition gradually stabilized after admission. Meropenem was switched to orally administered levofloxacin on day 12. He was discharged on day 16 and treated successfully without any complications.. Although S. spiritivorum is rare, with limited cases isolated from cellulitis, it should be considered as a causative organism in elderly and immunocompromised patients with cellulitis. Blood cultures are the key to correct diagnosis and appropriate treatment.

Topics: Aged, 80 and over; Anti-Bacterial Agents; Cellulitis; Gram-Negative Bacterial Infections; Heart Failure; Humans; Levofloxacin; Male; Meropenem; Pulmonary Disease, Chronic Obstructive; Shock, Septic; Sphingobacterium; Thienamycins; Treatment Outcome

Serratia marcescens is a Gram-negative bacillus belonging to the Enterobacteriaceae family. Cutaneous infection with Serratia is rare, and usually occurs in immunocompromised individuals. Primary cutaneous infections are uncommon, but they are typically severe and are associated with significant morbidity and mortality. The pathogenetic factors leading to S. marcescens infection are not fully understood, but contributing virulence factors include proteases, secreted exotoxins, and the formation of biofilm. We report a case of cellulitis occurring in a splenectomized patient, which led to multiple wound debridements and a transmetatarsal amputation. This dramatic case led us to review the published literature on soft tissue infections caused by S. marcescens.

Topics: Aged; Amputation, Surgical; Anti-Bacterial Agents; Biopsy; Cellulitis; Ciprofloxacin; Debridement; Fasciitis, Necrotizing; Foot Dermatoses; Humans; Male; Meropenem; Serratia Infections; Serratia marcescens; Skin Diseases, Vesiculobullous; Splenectomy; Thienamycins; Treatment Outcome

Topics: Abdominal Abscess; Anti-Bacterial Agents; Cellulitis; Clindamycin; Combined Modality Therapy; Common Variable Immunodeficiency; Debridement; Drug Substitution; Female; Humans; Immunoglobulin G; Immunoglobulins, Intravenous; Infusions, Subcutaneous; Meropenem; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Necrosis; Pyoderma Gangrenosum; Reoperation; Staphylococcal Infections; Thienamycins; Vancomycin; Wound Infection

A 69-year-old man developed motor aphasia and right hemiparesis with severe headache, during the treatment of cellulitis and sepsis due to cat bites. Brain CT showed a low density, crescent-shaped lesion in the left subdural space, which was hypointense on brain diffusion-weighted imaging (DWI). One week later, when his neurological symptoms had worsened, the signal of the subdural lesion had changed to hyperintense on DWI. The lesion was capsule-shaped when enhanced by Gadolinium. The signal changes on DWI of the lesion indicated the existing hematoma had changed to an empyema, or so-called infected subdural hematoma, due to a hematogenous bacterial infection. Pasteurella multocida, a resident microbe in the oral cavity of cats, could be the responsible pathogen in this case. The patient recovered completely after treatment with intravenous high dose antibiotics. This is an important case report describing the transformation from a chronic subdural hematoma into a subdural empyema by DWI.

Topics: Aged; Animals; Anti-Bacterial Agents; Bites and Stings; Cats; Ceftriaxone; Cellulitis; Diffusion Magnetic Resonance Imaging; Disease Progression; Drug Therapy, Combination; Empyema, Subdural; Headache; Hematoma, Subdural, Chronic; Humans; Male; Meropenem; Paresis; Pasteurella Infections; Pasteurella multocida; Sepsis; Thienamycins; Treatment Outcome

A 64-year-old man presented with epigastralgia and nausea after an acute exacerbation of chronic pancreatitis. Abdominal computed tomography revealed remarkable thickening of the gastric wall and intramural hypodense areas. Esophagogastroduodenoscopy showed a large gastric ulcer surrounded by an edematous mucosa and mucopus. The results of a culture from a biopsy of the lesion indicated phlegmonous gastritis. The patient was successfully treated with an antibiotic without gastrectomy.

Topics: Anti-Bacterial Agents; Cellulitis; Endoscopy, Digestive System; Gastritis; Humans; Male; Meropenem; Middle Aged; Omeprazole; Pancreatitis, Chronic; Proton Pump Inhibitors; Thienamycins; Tomography, X-Ray Computed; Treatment Outcome

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

To describe a case of severe cellulitis, successfully treated with high-dose daptomycin plus continuous infusion meropenem, in a patient with morbid obesity and renal failure, in whom drug exposure over time was optimized by means of real-time therapeutic drug monitoring (TDM).. A 63-year-old man with morbid obesity (body mass index 81.6 kg/m²) and renal failure was admitted to the emergency department because of severe cellulitis. The patient had an admission Laboratory Risk Indicator for Necrotizing Fasciitis score of 9, and broad-spectrum antimicrobial therapy with daptomycin and meropenem was started. Because of rapidly changing renal function, dosage adjustments were guided by an intensive program of TDM (daptomycin ranging from 1200 mg every 48 hours over 30 minutes to 1200 mg every 36 hours over 30 minutes; meropenem ranging from 0.25 g every 8 hours over 6 hours to 500 mg every 4 hours by continuous infusion). Clinical response was observed within 72 hours. However, a sudden increase of serum creatine kinase (SCK) raised questions about the need for discontinuation of daptomycin. The drug concentrations were not toxic; therefore, we decided to continue therapy. Significant clinical improvement, with SCK normalization, was observed within a few days. Antimicrobial therapy was switched on day 29 to amoxicillin/clavulanate plus levofloxacin, and then discontinued at discharge on day 53.. High-dose daptomycin plus continuous infusion meropenem may ensure adequate empiric antimicrobial coverage in patients with possible early necrotizing fasciitis. However, in patients with morbid obesity and changing renal function, significant challenges may arise because of the hydrophilic nature of these drugs and the inaccuracy of standard methods of estimating renal function.. Real-time TDM may represent an invaluable approach in optimizing drug exposure with high-dose daptomycin plus continuous infusion meropenem in patients with severe cellulitis, morbid obesity, and changing renal function.

Topics: Anti-Bacterial Agents; Cellulitis; Creatine Kinase; Daptomycin; Drug Monitoring; Drug Therapy, Combination; Fasciitis, Necrotizing; Humans; Male; Meropenem; Middle Aged; Obesity, Morbid; Renal Insufficiency; Severity of Illness Index; Thienamycins; Treatment Outcome

Patients with Waldenström's macroglobulinemia may manifest several types of skin lesions. We present our experience with a patient with the disease that adds to the literature on the topic.. A 57-year-old man with history of multiple sclerosis and Waldenström's macroglobulinemia was admitted to the intensive care unit in shock. His family members reported that the patient had complained of fever and the gradual development of gangrenous, hemorrhagic, bullous cellulitis lesions on the abdomen and lower extremities for 7 days prior to his admission to the hospital. Pseudomonas aeruginosa was isolated from fluid specimens collected from the cutaneous lesions. Appropriate antimicrobial treatment including continuous intravenous administration of meropenem (6 g every 24 h) led to the cure of the infection.. We postulate that the underlying Waldenström's macroglobulinemia contributed to the pathophysiology of the development of the rare skin manifestations of the infection observed in our patient.

Topics: Anti-Bacterial Agents; Cellulitis; Humans; Infusions, Intravenous; Male; Meropenem; Middle Aged; Pseudomonas aeruginosa; Pseudomonas Infections; Thienamycins; Waldenstrom Macroglobulinemia

Acinetobacter baumannii is rarely encountered as a pathogen causing community-acquired skin and soft tissue infection. A 79-year-old man had a fever for 3 days accompanied by pain and swelling over the left leg around an old scar caused by a dog bite 10 years ago. Two sets of blood cultures and a wound culture all yielded A. baumannii. The patient's condition deteriorated initially but recovered completely after 3 weeks of meropenem treatment. This case suggests that A. baumannii should be included among pathogens with the potential to cause complicated skin infection in the community.

Topics: Acinetobacter baumannii; Acinetobacter Infections; Aged; Cellulitis; Community-Acquired Infections; Humans; Leg; Male; Meropenem; Thienamycins