meropenem and Opportunistic-Infections

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

The purpose of this article is to review the safety and tolerance of two carbapenems (imipenem/cilastatin and meropenem) in order to establish their possible use in different clinical settings. The tolerance and safety profile of both carbapemens in intravenous and intramuscular formulation is good. With imipenem/cilastatin, nausea and vomiting can constitute a practical problem requiring prolonged times of perfusion and high dilutions. The possibility of administering meropenem in intravenous infusion or bolus injection with lower volumes of fluid, without increasing the incidence of these adverse reactions, may have practical advantages in special situations. The possible neurotoxicity of the imipenem/cilastatin presents limitations of the use in high risk circumstances such as meningitis, previous alterations of CNS, renal insufficiency and concomitant administration of other drugs with neurotoxic profiles and when high doses of administration are needed. The meropenem, by the contrary, can be used in patients with infections of the CNS and other risk factors, at high doses, without increased risk of seizures.

Topics: Animals; Cilastatin; Drug Interactions; Epilepsy; Humans; Imipenem; Injections, Intramuscular; Kidney; Meropenem; Nausea; Opportunistic Infections; Thienamycins; Vomiting

Invasive fungal infection (IFI) is a serious complication of chemotherapy for hematological malignancies and autologous/allogeneic hematopoietic stem cell transplantation in children and shows a high mortality rate. We performed a randomized trial comparing micafungin (MCFG), a new anti-fungal agent, with fosfluconazole, a prodrug of fluconazole (FF) conventionally used as a prophylactic agent, for prophylaxis against IFI. Cefpirome was administered as prophylaxis against bacterial infection, and meropenem+minocycline as an empiric window therapy for febrile neutropenia. MCFG 2 mg/kg/day (max 100 mg/day) and FF 10 mg/kg/day (max 400 mg/day) were both safe and effective (event free ratio of IFI, MCFG 94.4% vs FF 94.3%) without significant difference. Thus, MCFG is safe and can be used for prophylaxis against IFI in children.

Topics: Adolescent; Child; Child, Preschool; Drug Therapy, Combination; Echinocandins; Female; Fluconazole; Hematopoietic Stem Cell Transplantation; Humans; Infant; Lipopeptides; Male; Meropenem; Micafungin; Minocycline; Mycoses; Neutropenia; Opportunistic Infections; Organophosphates; Prodrugs; Thienamycins

We report on 232 patients undergoing autologous haematopoietic stem cell transplantation (ASCT) entered into a multicentre, randomised trial comparing the efficacy and tolerability of meropenem (MPM) with that of piperacillin/tazobactam (P/T) as empirical antimicrobial first-line therapy for febrile neutropenia. In 27.6% of patients in the MPM group and 22.4% in the P/T group, therapy was initially supplemented with a glycopeptide for venous catheter infection or bacteraemia because of coagulase-negative staphylococci. Complete response rate after 72 h was 63.8% in the MPM group and 49.6% in the P/T group (P = 0.034). Overall complete response rate after treatment modification was 94.0% in the MPM group and 93.1% in the P/T group. Median time to defervescence was 2 d in the MPM group and 3 d in the P/T group. The most frequently isolated pathogens were Gram-positive cocci. Treatment was well tolerated in both groups. One patient (0.4%) died from infection. Empirical first-line therapy with MPM as well as with P/T is safe and effective in febrile episodes emerging after ASCT. Higher response rates to primary treatment can be achieved with MPM.

Topics: Adolescent; Adult; Aged; Antineoplastic Agents; Drug Therapy, Combination; Female; Fever; Hematopoietic Stem Cell Transplantation; Humans; Male; Meropenem; Middle Aged; Neoplasms; Neutropenia; Opportunistic Infections; Penicillanic Acid; Piperacillin; Prospective Studies; Tazobactam; Thienamycins

In this Swedish multicentre study we compared the efficacy of meropenem with ceftazidime for treatment of febrile neutropenia. 192 patients were randomized and the number of evaluable patients was 92 in the meropenem group and 95 in the ceftazidime group. 40 (43%) patients in the meropenem arm and 49 (52%) in the ceftazidime arm had acute leukaemia. 56 (61%) and 52 (55%) patients respectively had a neutrophil count of < 0.1 x 10(9)/l at randomization and the median duration of neutropenia was 6.5 and 8 d, respectively. Thirty-one (34%) and 28 (29%) patients had a microbiologically defined infection, 14 (15%) and 17 (18%) a clinically defined infection and the remaining 47 (51%) and 50 (53%) had unexplained fever. After 72 h of treatment, 46 (50%) patients in the meropenem arm and 53 (56%) patients in the ceftazidime arm were alive on unmodified monotherapy. 42 (46%) and 47 (49%) of these completed the study on monotherapy alone. Only 2 patients (2%) in each arm had to stop treatment owing to allergic reactions. None of the observed differences were statistically significant and we therefore conclude that meropenem was an effective and safe alternative to ceftazidime for empiric treatment of fever during neutropenia.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Ceftazidime; Cephalosporins; Female; Fever; Humans; Male; Meropenem; Middle Aged; Neutropenia; Opportunistic Infections; Thienamycins; Treatment Outcome

Topics: Adult; Anti-Bacterial Agents; Bacteriological Techniques; Female; Granulomatosis with Polyangiitis; Humans; Immunocompromised Host; Immunosuppressive Agents; Magnetic Resonance Imaging; Meropenem; Nocardia Infections; Opportunistic Infections; Pseudomonas Infections; Sepsis; Treatment Outcome

Topics: Biopsy, Needle; Drug Therapy, Combination; Follow-Up Studies; Humans; Immunocompromised Host; Immunologic Deficiency Syndromes; Lung Neoplasms; Magnetic Resonance Imaging; Male; Meropenem; Middle Aged; Myasthenia Gravis; Nocardia; Nocardia Infections; Opportunistic Infections; Radiography, Thoracic; Risk Assessment; Severity of Illness Index; Syndrome; Thienamycins; Thymoma; Thymus Neoplasms; Tomography, X-Ray Computed; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

We present a 64-year-old man who was treated with R-CHOP (rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisolone) chemoimmunotherapy for mantle cell lymphoma and developed purulent meningitis, probably caused by Leuconostoc sp. The patient had severe hypogammaglobulinemia, which is a possible complication of rituximab therapy. To our knowledge and after reviewing the available medical literature, this is the first described case of purulent meningitis caused by Leuconostoc sp. in a patient with mantle cell lymphoma that appeared after treatment with the R-CHOP protocol. The diagnosis of purulent meningitis was based on clinical, laboratory and cytological cerebrospinal fluid findings, in addition to blood culture results in which we isolated Leuconostoc sp. The patient was treated with meropenem with full recovery.. Burada mantle hücreli lenfoma tanısı ile R-CHOP (rituksimab, siklofosfamid, doksorubisin, vinkristin, prednizolon) kemoimmünoterapisi ile tedavi edilen ve muhtemelen Leuconostoc cinsi etkene bağlı pürülan menenjit gelişen 64 yaşında bir erkek hastayı sunuyoruz. Hastanın rituksimab tedavisinin olası komplikasyonlarından biri olan ağır hipogammaglobulinemisi bulunmakta olup, bildiğimiz kadarı ile ve mevcut tıbbi literatürün taranması sonrasında, olgumuz R-CHOP protokolü ile tedavi sonrası Leuconostoc cinsi etkene bağlı pürülan menejit gelişen mantle hücreli lenfoma tanılı ilk hastadır. Pürülan menenjit tanısı klinik bulgular, laboratuvar ve beyin-omurilik sıvısının sitolojik bulguları ve Leuconostoc izole ettiğimiz kan kültürünü temel alıyordu. Hasta meropenem tedavisi ile tamamen iyileşti.

Topics: Anti-Bacterial Agents; Antineoplastic Combined Chemotherapy Protocols; Drug Resistance, Multiple, Bacterial; Gram-Positive Bacterial Infections; Humans; Leuconostoc; Lymphoma, Mantle-Cell; Male; Meningitis, Bacterial; Meropenem; Middle Aged; Opportunistic Infections; Rituximab; Thienamycins

The patient presented with increasing fatigue and dyspnoea. The patient had medical history of rheumatoid arthritis for which she had been taking methotrexate for the past 15 years and etanercept for the past 6 years. Initial diagnosis was cardiac failure but further investigation by echocardiogram revealed a large pericardial effusion. Empirical piperacillin-tazobactam was started due to moderately raised inflammatory markers. Four hundred millilitre of frank pus was aspirated from the pericardial sac and antimicrobial treatment was changed to meropenem. Gram positive cocci were seen in the initial Gram stain, but conventional cultures remained negative. However, 16S ribosomal RNA gene sequencing of the pus sample detected the presence of Parvimonas micra genome. Reaccumulation of the effusion required further drainage where again P micra was detected by 16S ribosomal RNA gene sequencing. Two weeks of meropenem was completed followed by treatment with benzylpenicillin and metronidazole.

Topics: Aged; Anti-Bacterial Agents; Antirheumatic Agents; Arthritis, Rheumatoid; Drug Therapy, Combination; Etanercept; Female; Gram-Positive Bacteria; Humans; Immunoglobulin G; Meropenem; Metronidazole; Opportunistic Infections; Penicillin G; Pericarditis; Receptors, Tumor Necrosis Factor; Risk Factors; Thienamycins

Opportunistic infections contribute to morbidity and mortality of patients undergoing hematopoietic stem cell transplantation and treatment for malignancies. Rothia mucilaginosa, a gram-positive bacterium, is responsible for rare, but often fatal meningitis in severely immunocompromised patients. We describe two cases of meningitis from discrete strains of R. mucilaginosa on our pediatric bone marrow transplant unit, summarize the published cases of R. mucilaginosa meningitis in oncology and stem cell transplant patients, and provide updated recommendations regarding the use of antibiotic therapy in this patient population.

Topics: Actinomycetales Infections; Adolescent; Anti-Bacterial Agents; Ceftazidime; Cerebrospinal Fluid Shunts; Child; Cord Blood Stem Cell Transplantation; Drug Therapy, Combination; Fatal Outcome; Female; Humans; Immunocompromised Host; Leukemia, Megakaryoblastic, Acute; Male; Meningitis, Bacterial; Meropenem; Micrococcaceae; Opportunistic Infections; Postoperative Complications; Rifampin; Sepsis; Thienamycins; Vancomycin

The aim of this retrospective study was to evaluate the clinical effectiveness of meropenem in immunocompromised children. Between January 1998 and December 2002 in the hemato-oncological units of our hospital meropenem was used in 87 febrile events diagnosed in 55 patients, and 328 bacterial cultures were evaluated. Microorganisms were detected and identified in 64 of the 328 hemocultures; there was a predominance of gram-positive strains (67%). In 49.4% the infection was documented microbiologically. In 16 additional cases the infection was proven clinically and 32.2% of the episodes were considered to be fever of unknown origin. The success rate of the meropenem therapy-excluding the proven fungal or coagulase-negative Staphylococcus infections--was 72.9% and for the whole cohort 49.4%. The results demonstrate that meropenem is effective and well-tolerated when used for the treatment of neutropenic cancer children.

Topics: Adolescent; Adult; Bacteria; Child; Child, Preschool; Drug Evaluation; Female; Fever; Humans; Immunocompromised Host; Infant; Male; Meropenem; Neutropenia; Opportunistic Infections; Retrospective Studies; Thienamycins; Treatment Outcome

Topics: Amikacin; Anemia; Anti-Bacterial Agents; Female; Filgrastim; Granulocyte Colony-Stimulating Factor; Humans; Immunocompromised Host; Meropenem; Middle Aged; Neutropenia; Opportunistic Infections; Prednisone; Recombinant Proteins; Sjogren's Syndrome; Thienamycins; Thrombocytopenia; Treatment Failure

Acinetobacter baumannii is an opportunistic pathogen associated with numerous nosocomial infections. In recent years it has shown extraordinary ease in developing resistance to most antimicrobial agents, which is a serious problem as it makes these infections difficult to treat. We determined the in vitro activity of eight quinolones, five betalactam agents and colistin in 160 clinical isolates of A. baumannii. In general, we observed a high rate of resistance to the quinolones (90%), excluding clinafloxacin (25%), and to ampicillin-sulbactam (61.25%) and imipenem (50%). Colistin is the agent with least resistance (13.125%), although its toxicity limits its therapeutic use. Clinafloxacin may be a good option to treat A. baumannii infections, especially in cases of therapeutic failure with other antimicrobial agents.

Topics: Acinetobacter; Acinetobacter Infections; Ampicillin; Anti-Infective Agents; Aza Compounds; Cefepime; Cephalosporins; Ciprofloxacin; Colistin; Fluoroquinolones; Gatifloxacin; Humans; Imipenem; Meropenem; Microbial Sensitivity Tests; Moxifloxacin; Nalidixic Acid; Naphthyridines; Norfloxacin; Ofloxacin; Opportunistic Infections; Quinolines; Sulbactam; Thienamycins