meropenem and Postoperative-Complications

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

We report a case of a nosocomial Capnocytophaga spp. DF-1 pneumonia in an intubated 56-year-old man following coronary artery bypass grafting. We review Capnocytophaga spp., including the infections they produce and antibiotic susceptibilities.

Topics: Anti-Bacterial Agents; Capnocytophaga; Coronary Artery Bypass; Cross Infection; Gram-Negative Bacterial Infections; Humans; Immunocompetence; Male; Meropenem; Middle Aged; Pneumonia, Bacterial; Postoperative Complications; Respiration, Artificial; Thienamycins

Topics: Adolescent; Bacterial Infections; Carbapenems; Child; Child, Preschool; Clinical Trials as Topic; Humans; Imipenem; Infant; Infant, Newborn; Meropenem; Postoperative Complications; Thienamycins

Meropenem is important for management of postneurosurgical meningitis, but the data about its penetration into cerebrospinal fluid (CSF) are inadequate. This prospective, open-label study investigated the pharmacokinetic profile of meropenem in patients with postneurosurgical meningitis, especially its CSF penetration.. A total of 82 patients with postneurosurgical meningitis were included to receive meropenem intravenously according to a regimen of 2 g every 8 hours, 1 g every 8 hours, or 1 g every 6 hours. After infusion of 4 doses, blood and CSF samples were collected simultaneously at predefined time points. The high-performance liquid chromatography ultraviolet method was used to determine the concentration of meropenem.. The peak meropenem concentration in blood and CSF was 43.2 ± 5.3 and 2.4 ± 0.3 mg/L in the group who received 2 g every 8 hours; 28.9 ± 2.7 and 1.2 ± 0.2 mg/L in the group who received 1g every 8 hours; and31.5 ± 3.4 and 1.6 ± 0.2 mg/L in the group who received 1g every 6 hours. The maximal percent penetration into CSF was 17.6% ± 7.3%, 14.3% ± 1.7%, and 30.9% ± 24.2%, respectively.. Dosing regimens of meropenem 1 g every 6 hours and 2 g every 8 hours provided higher CSF penetration than 1 g every 8 hours. A higher dose and shorter dosing interval of meropenem may be more useful for clearance of pathogens.

Topics: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Area Under Curve; Female; Gram-Negative Bacteria; Gram-Negative Bacterial Infections; Humans; Male; Meningitis, Bacterial; Meropenem; Microbial Sensitivity Tests; Middle Aged; Neurosurgical Procedures; Postoperative Complications; Prospective Studies; Thienamycins; Treatment Outcome

Meropenem is used to manage postneurosurgical meningitis, but its population pharmacokinetics (PPK) in plasma and cerebrospinal fluid (CSF) in this patient group are not well-known. Our aims were to (i) characterize meropenem PPK in plasma and CSF and (ii) recommend favorable dosing regimens in postneurosurgical meningitis patients. Eighty-two patients were enrolled to receive meropenem infusions of 2 g every 8 h (q8h), 1 g q8h, or 1 g q6h for at least 3 days. Serial blood and CSF samples were collected, and concentrations were determined and analyzed via population modeling. Probabilities of target attainment (PTA) were predicted via Monte Carlo simulations, using the target of unbound meropenem concentrations above the MICs for at least 40% of dosing intervals in plasma and at least of 50% or 100% of dosing intervals in CSF. A two-compartment model plus another CSF compartment best described the data. The central, intercentral/peripheral, and intercentral/CSF compartment clearances were 22.2 liters/h, 1.79 liters/h, and 0.01 liter/h, respectively. Distribution volumes of the central and peripheral compartments were 17.9 liters and 3.84 liters, respectively. The CSF compartment volume was fixed at 0.13 liter, with its clearance calculated by the observed drainage amount. The multiplier for the transfer from the central to the CSF compartment was 0.172. Simulation results show that the PTAs increase as infusion is prolonged and as the daily CSF drainage volume decreases. A 4-hour infusion of 2 g q8h with CSF drainage of less than 150 ml/day, which provides a PTA of >90% for MICs of ≤8 mg/liter in blood and of ≤0.5 mg/liter or 0.25 mg/liter in CSF, is recommended. (This study has been registered at ClinicalTrials.gov under identifier NCT02506686.).

Topics: Adult; Aged; Anti-Bacterial Agents; Brain Injuries, Traumatic; Brain Neoplasms; Drug Administration Schedule; Female; Gram-Negative Bacteria; Humans; Infusions, Intravenous; Male; Meningitis, Bacterial; Meropenem; Microbial Sensitivity Tests; Middle Aged; Monte Carlo Method; Neurosurgery; Postoperative Complications; Prospective Studies; Thienamycins

To determine which carbapenem (imipenem/cilastatin or meropenem) was the preferable empiric antibiotic monotherapy in pre-engrafted pediatric bone marrow transplant (BMT) patients in terms of patient tolerance, therapeutic efficacy, and cost.. We prospectively analyzed 16 pediatric BMT patients who received meropenem, and retrospectively analyzed 16 matched patients who had received imipenem/cilastatin for BMT procedures during the prior 2-year period. We evaluated the patients for evidence of bacterial infection, necessity for concurrent antibiotics, vomiting episodes, duration of concurrent total parenteral nutrition (TPN), and cost of therapy.. We found no differences in the number of culture proven or clinically suspected breakthrough bacterial infections or the need for concurrent additional antibiotics between the groups. Our analysis found that patients who received meropenem experienced significantly less vomiting than those in the imipenem/cilastatin cohort. Our data showed both direct and indirect cost savings for the meropenem group. The statistical and clinical differences in the number of vomiting episodes between these groups impacted other aspects of patient care, antiemetic use, and TPN duration.. By switching to meropenem, we reduced the cost of antiemetic therapy per patient treatment course, and also showed a trend toward reduced duration of TPN. We found that meropenem provided both clinical and fiscal advantages over imipenem/cilastatin as empiric antibiotic monotherapy in neutropenic pediatric BMT patients.

Topics: Adolescent; Bacterial Infections; Bone Marrow Transplantation; Carbapenems; Child; Child, Preschool; Cilastatin; Drug Costs; Female; Humans; Imipenem; Male; Meropenem; Postoperative Complications; Prospective Studies; Protease Inhibitors; Thienamycins; Vomiting

To describe the first case of endophthalmitis caused by. An 83-year-old patient, affected by open-angle glaucoma and with a previous surgery of combined cataract extraction and Xen gel stent implantation, developed endophthalmitis 1 month after bleb needle revision with 5-fluorouracil injection. At presentation, best corrected visual acuity was hand movement, hypopyon was evident into the anterior chamber and a flat bleb with no sign of leakage was present over the Xen gel implant.. Immediate pars plana vitrectomy was performed, with intravitreal antibiotic administration and silicon oil tamponade.

Topics: Administration, Ophthalmic; Aged, 80 and over; Anti-Bacterial Agents; Cataract Extraction; Ceftazidime; Endophthalmitis; Eye Infections, Bacterial; Glaucoma Drainage Implants; Glaucoma, Open-Angle; Gram-Negative Bacterial Infections; Humans; Infusions, Intravenous; Intraocular Pressure; Intravitreal Injections; Male; Meropenem; Postoperative Complications; Reoperation; Sphingobacterium; Stents; Tonometry, Ocular; Visual Acuity; Vitrectomy; Vitreous Body

Topics: Adult; Antibiotic Prophylaxis; Central Nervous System Bacterial Infections; Cerebral Intraventricular Hemorrhage; Drainage; Humans; Lateral Ventricles; Meropenem; Middle Aged; Postoperative Complications

Topics: Aged; Anti-Bacterial Agents; Craniotomy; Drug Resistance, Multiple, Bacterial; Empyema; Enterobacteriaceae Infections; Humans; Male; Meningeal Neoplasms; Meropenem; Piperacillin, Tazobactam Drug Combination; Postoperative Complications; Seizures; Spinal Puncture; Staphylococcal Infections; Surgical Wound Infection; Treatment Outcome; Vancomycin

Although open chest management optimizes hemodynamics after cardiac surgery, it increases postoperative infections and leads to increased mortality. Despite the importance of antibiotic prophylaxis during open chest management, no specific recommendations exist. We aimed to compare the occurrence rates of bloodstream infection and surgical site infection between the different prophylactic antibiotic regimens for open chest management after pediatric cardiac surgery.. Retrospective, single-center, observational study.. PICU at a tertiary children's hospital.. Consecutive patients younger than or equal to 18 years old with open chest management after cardiac surgery followed by delayed sternal closure, between January 2012 and June 2018.. None.. We compared the composite occurrence rate of postoperative bloodstream infection and surgical site infection within 30 days after cardiac surgery between three prophylactic antibiotic regimens: 1) cefazolin, 2) cefazolin + vancomycin, and 3) vancomycin + meropenem. In 63 pediatric cardiac surgeries with open chest management, 17 bloodstream infections, and 12 surgical site infections were identified postoperatively. The composite occurrence rates of bloodstream infection and surgical site infection were 10 of 15 (67%), 10 of 19 (53%), and nine of 29 (31%) in the cefazolin, cefazolin + vancomycin, and vancomycin + meropenem regimens, respectively (p = 0.07). After adjusting for age, open chest management duration, extracorporeal membrane oxygenation use, and nasal methicillin-resistant Staphylococcus aureus colonization in multivariable analysis, there was no significant difference between the cefazolin and the cefazolin + vancomycin regimens (p = 0.19), while the vancomycin + meropenem regimen had a lower occurrence rate of bloodstream infection and surgical site infection than the cefazolin regimen (odds ratio, 0.0885; 95% CI, 0.0176-0.446; p = 0.003).. In this study, a lower occurrence rate of postoperative bloodstream infection and surgical site infection was observed among patients with broad-spectrum antibiotic regimen after pediatric cardiac surgery with open chest management. Further studies, ideally randomized controlled studies investigating the efficacy of broad-spectrum antibiotics and their complications, are warranted before routine implementation of broad-spectrum prophylactic antibiotic regimen.

Topics: Age Factors; Antibiotic Prophylaxis; Bacteremia; Cardiac Surgical Procedures; Cefazolin; Drug Therapy, Combination; Extracorporeal Membrane Oxygenation; Female; Hospitals, Pediatric; Humans; Infant; Infant, Newborn; Intensive Care Units, Pediatric; Male; Meropenem; Postoperative Complications; Retrospective Studies; Surgical Wound Infection; Vancomycin

Raoultella Ornithinolytica (RO) is an encapsulated, Gram- negative, nonmotile aerobic rob which was reclassified from Klepsiella genus belonging in the family of Enterobacteriaceae. It is a rare human infection and few cases have been reported in post thoracotomy patients. Here we present a case of a left lower lobectomy patient that was complicated by pleural effusion and high fever with positive sputum cultures of Raoultella Ornithinolytica and positive pleural fluid cultures of Staphylococcus hominis. It is related with aquatic life poisoning. There are few cases reported and even fewer postoperatively. The infection is rare in human therefore the bacteria is still underreported.

Topics: Aged; Anti-Bacterial Agents; Carcinoma, Non-Small-Cell Lung; Ciprofloxacin; Enterobacteriaceae; Enterobacteriaceae Infections; Humans; Male; Meropenem; Pleural Effusion; Postoperative Complications; Sputum; Staphylococcal Infections; Staphylococcus hominis; Treatment Outcome

Topics: Adult; Anti-Bacterial Agents; Antibiotic Prophylaxis; Carbapenems; Drug Resistance, Multiple, Bacterial; Ertapenem; Female; Fosfomycin; Humans; Intestines; Kidney Transplantation; Klebsiella Infections; Klebsiella pneumoniae; Meropenem; Postoperative Complications; Precision Medicine

Topics: Adult; Anti-Bacterial Agents; Anticonvulsants; Drug Interactions; Epilepsy; Female; Fructose; Humans; Meropenem; Peritonitis; Postoperative Complications; Thienamycins; Topiramate; Valproic Acid

Caulobacter spp. are Gram-negative bacteria that have rarely been found to be pathogenic in humans.. This report describes the first case, to our knowledge, of meningitis in an adult patient caused by Caulobacter spp. A 75-year-old man was operated for a glioblastoma with no evident signs of primary infection in the wound site. Eight days after surgery, the patient developed signs and symptoms of meningitis. Caulobacter was then isolated on 3 separate occasions in the patient's cerebrospinal fluid. Thereafter, specific antibiotic therapy began. After 2 weeks of therapy, the patient was discharged with complete resolution of any related symptoms.. Caulobacter spp. can cause adult meningitis even where there is no evidence of surgical site infection.

Topics: Aged; Brain Neoplasms; Caulobacter; Cerebrospinal Fluid; Glioblastoma; Gram-Negative Bacterial Infections; Humans; Male; Meningitis, Bacterial; Meropenem; Microbial Sensitivity Tests; Postoperative Complications; Thienamycins; Virulence

In this case report we describe a boy with extrahepatic biliary atresia who underwent a Kasai hepatoportoenterostomy at six weeks of age. Beginning several weeks post-op, he had recurrent cholangitis inadequately controlled by various antibiotic prophylaxis regimens. Imaging revealed the development of several bile lakes in the liver hilum. Due to the recurrent nature of his cholangitis, and some evidence of acutely impaired biliary drainage, he underwent a refashioning of his portoenterostomy with resultant improved drainage. However, shortly thereafter, the patient developed ongoing fever and anemia. Culture of the bile lake aspirate grew multiresistant Klebsiella and a 6 week course of parenteral meropenume controlled his fever and his anemia improved. Following treatment cessation his fever and anemia returned. A biliary drain was inserted into his larger bile lake and following another course of parenteral antibiotics he has remained free of clinically detected cholangitis despite ongoing contamination of drained bile fluid. The development of bile lakes after Kasai hepatoportoenterostomy is not an uncommon finding. This have been associated with worse prognosis including increased incidence of cholangitis. Often, conservative treatment with prophylactic antibiotics suffices, however, in rare cases, more aggressive intervention may be considered including percutaneous bile drainage or surgical management. The benefit of these management strategies must be balanced with the potential gain regarding quality of life and delaying transplant, on an individual basis.

Topics: Anti-Bacterial Agents; Bile; Biliary Atresia; Cholangitis; Drug Resistance, Multiple, Bacterial; Humans; Infant; Klebsiella Infections; Male; Meropenem; Portoenterostomy, Hepatic; Postoperative Complications; Thienamycins

Most post-neurosurgical meningitis research has been focused on large cohorts with numerous cases followed over several years. However, the characteristics of post-neurosurgical meningitis in an entire single year are still unclear, and knowledge of these characteristics might influence the selection of appropriate antibiotics and therapeutic strategies for the successful management of this disease. Our aim is to obtain a better understanding of post-neurosurgical meningitis over a single entire year.. Patients with positive meningitis cultures after neurosurgical operations in our hospital during the entire year of 2012 were included in the analysis. We report demographic characteristics, morbidity during different seasons, clinical and bacteriological profiles, sensitivity to antibiotics and causes of the post-neurosurgical meningitis infections in our cohort.. Of the 6407 patients who underwent neurosurgical procedures during the study period, 146 developed post-neurosurgical meningitis and the overall incidence of meningitis was 2.28%. The incidence of meningitis was significantly higher in patients who underwent surgery in the autumn and winter than spring or summer (p=0.000). The most common organisms causing meningitis were Gram-positive bacteria, followed by the Klebsiella and Baumannii species. Compound sulfamethoxazole (52.6%) and vancomycin (10.5%) were the most active antibiotics against Gram-positive bacteria strains, whereas meropenem (43.8%) and polymyxin (18.8%) were active against Gram-negative bacillus strains.. Post-neurosurgical meningitis usually occurs in the autumn and winter of the year in our hospital. Gram-positive organisms, which are sensitive to compound sulfamethoxazole and vancomycin, are the most common causative pathogens of post-neurosurgical meningitis in the northern mainland of China.

Topics: Acinetobacter Infections; Adolescent; Adult; Aged; Anti-Bacterial Agents; Child; Child, Preschool; China; Drug Resistance, Bacterial; Escherichia coli Infections; Female; Humans; Klebsiella Infections; Male; Meningitis, Bacterial; Meropenem; Middle Aged; Neurosurgical Procedures; Polymyxins; Postoperative Complications; Pseudomonas Infections; Retrospective Studies; Seasons; Staphylococcal Infections; Sulfamethoxazole; Thienamycins; Vancomycin; Young Adult

Topics: Animals; Anti-Bacterial Agents; Bone Marrow Transplantation; Capnocytophaga; Disease Progression; Dog Diseases; Dogs; Female; Graft vs Host Disease; Gram-Negative Bacterial Infections; Humans; Leukemia, Myeloid, Acute; Meropenem; Middle Aged; Postoperative Complications; Saliva; Sepsis; Spleen; Thienamycins; Thrombocytosis; Treatment Outcome; Vancomycin

The purpose of this study is to investigate the prevalence of postoperative bacteriuria, pyuria and urine culture in patients with an orthotopic sigmoid colon neobladder replacement. Urine samples for bacteriuria, pyuria and urine culture, if necessary, were collected at 1, 3, 6, 9 and 12 months after surgery and the presence of blood culture and antibiotic-resistant strains, and their treatments on positive urine culture cases were investigated. Of 209 for bacteriuria and 207 for pyuria urine samples with evaluable data, 95 (45.5%) were positive for bacteriuria and 76 (36.7%) had pyuria (10 or more white blood cells per high-power field). Totally, 30 bacteria were isolated from urine culture of urinary tract infection (UTI) and Klebisiella pneumoniae, Escherichia coli, Staphylococcos aureus and Enterococcus spp. strains were representatively isolated. The incidence of pyuria significantly decreased over time (P=0.041) but that of bacteriuria did not (P=0.107). In them, there were six bacteria (20.7%) with antibiotic-resistant strains. The antibiotics used for their treatments representatively were levofloxacin in five cases, tazobactam/piperacillin in three cases and sulfamethoxazole/trimethoprim and cefepime, meropenem in two cases, respectively. In conclusion, these findings suggest that physicians taking care of sigmoid colon neobladder patients need to be aware of these high ratios of bacteriuria, pyuria and UTI, including bacteremia.

Topics: Aged; Anti-Bacterial Agents; Bacteriuria; Cefepime; Cephalosporins; Colon, Sigmoid; Cystectomy; Drug Resistance, Multiple, Bacterial; Enterococcus; Escherichia coli; Female; Humans; Klebsiella pneumoniae; Leukocyte Count; Levofloxacin; Male; Meropenem; Middle Aged; Penicillanic Acid; Piperacillin; Postoperative Complications; Prevalence; Pyuria; Staphylococcus aureus; Sulfamethoxazole; Tazobactam; Thienamycins; Trimethoprim; Urinary Diversion; Urinary Tract Infections

Pneumomediastinum is a clinical event characterized by the presence of air in the mediastinum. Often a result of physical trauma, this condition results from air escaping from the respiratory airway and moving into the mediastinal cavity. Although rare, it can also develop following abdominal laparoscopic surgical procedures. Diagnosis is commonly made by visualizing a radiolucent airline in the mediastinum and/or surrounding the heart following a chest X-ray radiography or a thoracic CT scan. This case study describes the diagnosis, treatment and follow-up of a 51 years old female patient who developed pneumomediastinum following a laparoscopic cholecystectomy.

Topics: Anti-Bacterial Agents; Cholecystectomy, Laparoscopic; Cholelithiasis; Female; Humans; Mediastinal Emphysema; Mediastinum; Meropenem; Middle Aged; Postoperative Complications; Radiography, Thoracic; Teicoplanin; Thienamycins; Tomography, X-Ray Computed; Treatment Outcome; Ultrasonography

Topics: Adult; Allografts; Anastomosis, Surgical; Aneurysm, Infected; Gout; Humans; Hyperuricemia; Iliac Artery; Inflammation; Kidney Diseases; Kidney Failure, Chronic; Kidney Transplantation; Male; Meropenem; Postoperative Complications; Renal Artery; Teicoplanin; Thienamycins; Treatment Outcome

The objective of this study was to explore independent risk factors for the isolation of multidrug-resistant (MDR) Pseudomonas aeruginosa in a Japanese university hospital between January 1997 and December 2010. MDR P. aeruginosa was defined when the organism was resistant or intermediately susceptible to all five antimicrobials tested. In all, 159 patients with MDR P. aeruginosa were identified over the 14-year period. Multivariate logistic regression analysis revealed that prolonged hospital stay, prior exposure to meropenem and fluoroquinolones, and patients suffering from diabetes mellitus or receiving surgery were predictive risk factors for the isolation of MDR P. aeruginosa.

Topics: Anti-Bacterial Agents; Diabetes Complications; Drug Resistance, Multiple, Bacterial; Fluoroquinolones; Hospitals, University; Humans; Japan; Length of Stay; Meropenem; Postoperative Complications; Pseudomonas aeruginosa; Pseudomonas Infections; Risk Factors; Thienamycins

Topics: Acinetobacter Infections; Anti-Bacterial Agents; Drug Resistance, Multiple, Bacterial; Humans; Lumbar Vertebrae; Male; Meropenem; Military Personnel; Postoperative Complications; Rifampin; Spinal Fractures; Spinal Fusion; Thienamycins; Young Adult

Massive hemolysis secondary to sepsis caused by Clostridium perfringens is a rare entity but appears fairly often in the literature. In nearly all published reports, the clinical course is rapid and fatal. We describe the case of a 75-year-old woman with diabetes who was admitted with symptoms consistent with acute cholecystitis. Deteriorating hemodynamics and laboratory findings were consistent with intravascular hemolysis, coagulation disorder, and renal failure. Gram-positive bacilli of the Clostridium species were detected in blood along with worsening indicators of hemolysis. In spite of antibiotic and surgical treatment, hemodynamic support and infusion of blood products, the patient continued to decline and died in the postoperative recovery unit 14 hours after admission. Mortality ranges from 70% to 100% in sepsis due to Clostridium perfringens, and risk of death is greater if massive hemolysis is present, as in the case we report. Only a high degree of clinical suspicion leading to early diagnosis and treatment can improve the prognosis. This bacterium should therefore be considered whenever severe sepsis and hemolysis coincide.

Topics: Acute Kidney Injury; Aged; Anemia, Hemolytic; Anti-Bacterial Agents; Bacteremia; Blood Component Transfusion; Cholecystectomy; Cholecystitis; Clindamycin; Clostridium perfringens; Combined Modality Therapy; Delayed Diagnosis; Diabetes Complications; Emergencies; Fatal Outcome; Female; Gas Gangrene; Hemofiltration; Humans; Meropenem; Norepinephrine; Postoperative Complications; Shock, Septic; Thienamycins

In this report, we present a case of postneurosurgical meningitis due to Providencia stuartii, which was treated successfully with meropenem therapy lasting 21 days.

Topics: Adult; Anti-Bacterial Agents; Enterobacteriaceae Infections; Humans; Male; Meningitis, Bacterial; Meropenem; Postoperative Complications; Providencia; Thienamycins; Treatment Outcome

Clostridium difficile (CD) infection is almost always confined to the colon causing a spectrum of illness ranging from diarrhoea to fulminant colitis. CD infection of the small intestine has been described but the identification of CD toxin in the stoma effluent of a patient with an end ileostomy is rare. We describe a 91-year-old woman, with a history of proctocolectomy for ulcerative colitis, presenting with profuse ileostomy diarrhoea after a course of antibiotics. Ileostomy effluent was positive for CD toxin but the patient died despite appropriate treatment. This suggests that the small intestine is susceptible to CD infection in antibiotic-treated patients many years after a colectomy. CD enteritis should be considered in all patients with increased ileostomy diarrhoea despite the absence of a colon.

Topics: Aged, 80 and over; Anti-Bacterial Agents; Bacteremia; Colectomy; Colitis, Ulcerative; Enterocolitis, Pseudomembranous; Fatal Outcome; Female; Humans; Ileostomy; Infusions, Intravenous; Intestine, Small; Meropenem; Postoperative Complications; Staphylococcal Infections; Thienamycins

The case of a 57-year-old woman who suffered a fall is presented. After a polymethyl malacrylate revision cranioplasty, she presented with signs, symptoms, and intraoperative findings consistent with postneurosurgical infection. Dural foreign-body reaction was diagnosed, and parenteral antibiotic therapy was discontinued successfully.

Topics: Anti-Bacterial Agents; Brain Diseases; Craniotomy; Female; Foreign Bodies; Foreign-Body Reaction; Humans; Infections; Meropenem; Middle Aged; Postoperative Complications; Thienamycins; Time Factors; Vancomycin

Meropenem (MEM; 2 g/8 hr; minimum inhibitory concentration [MIC] = 256 mg/L) plus sulbactam (SUL; 1 g/8 hr; MIC = 128 mg/L) (two-drug-therapy period), and subsequent additional intravenous colistin (COL; 2.5 mg/kg/12 hr) and intraventricular (COL, 5 mg/day; MIC = 1 mg/L) (three-drug-therapy period) were sequentially used in a patient with postneurosurgery bacteremic meningitis due to a multidrug-resistant Acinetobacter baumannii (MDRAB) isolate (AB(1)). We detected 4- to 32-fold increases in peak or trough cerebrospinal fluid bactericidal titer and serum bactericidal titer in three-drug-therapy period when comparing to those in two-drug-therapy period. The time-kill study with MEM, SUL, and COL alone or varied combinations (all at 1 x MIC) against AB(1) and another genetically nonrelated MDRAB isolate (AB(134) [MICs of MEM = 64 mg/L, SUL = 16 mg/L, and COL = 1 mg/L]) was performed. The two-drug combinations (MEM + SUL, MEM + COL, and SUL + COL) each elicited different inhibitory effect on AB(1) and AB(134) at 6 hr. Bacterial regrowth at 24 hr was observed in the experiments in which the MDRAB isolate was inhibited earlier by COL alone (AB(1) and AB(134)), by MEM plus SUL (AB(1)), and by MEM plus COL (AB(134)), but not in SUL plus COL, and MEM + SUL + COL. Combined use of COL with MEM and/or SUL may provide good therapeutic options, even though MEM and SUL are in vitro resistance to the MDRAB.

Topics: Acinetobacter baumannii; Acinetobacter Infections; Aged; Anti-Bacterial Agents; Bacteremia; Colistin; Drug Resistance, Multiple, Bacterial; Drug Therapy, Combination; Humans; Male; Meningitis, Bacterial; Meropenem; Microbial Sensitivity Tests; Neurosurgical Procedures; Postoperative Complications; Sulbactam; Thienamycins; Time Factors

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

Topics: Acinetobacter baumannii; Adolescent; Adult; Aged; Amikacin; Anti-Bacterial Agents; Carbapenems; Cefepime; Cefoperazone; Cephalosporins; Ciprofloxacin; Drug Resistance, Bacterial; Female; Gram-Negative Bacteria; Gram-Negative Bacterial Infections; Humans; Imipenem; Male; Meningitis, Bacterial; Meropenem; Microbial Sensitivity Tests; Middle Aged; Neurosurgical Procedures; Postoperative Complications; Thienamycins; Turkey

A 15-year-old girl developed a persistent bacteraemia with Klebsiella pneumoniae accompanied by systemic symptoms including high fever and rigors after appendectomy. Extensive laboratory and imaging work-up, including tests for an intra-vascular source of infection, did not reveal the origin of the persistent bacteraemia. The Klebsiella pneumoniae isolates were susceptible to gentamicin and colistin and intermediately susceptible to meropenem. The septicaemia persisted despite the intravenous administration of meropenem 1 g and later 2 g every 8 h in combination with intravenous gentamicin and later colistin. The patient was cured only after the continuous intravenous administration of meropenem of 6 g/d.

Topics: Adolescent; Anti-Bacterial Agents; Appendectomy; Appendicitis; Drug Therapy, Combination; Female; Fever; Gentamicins; Humans; Infusions, Intravenous; Klebsiella Infections; Klebsiella pneumoniae; Meropenem; Microbial Sensitivity Tests; Postoperative Complications; Sepsis; Thienamycins

We report a case of pyogenic spondylitis caused by Enterobacter cloacae as a rare complication of transurethral resection of the prostate (TURP). A 79-year-old man underwent TURP. Immediate after removal of urethral catheter on postoperative day (POD) 7, he developed high fever > 40 degrees C with increased acute inflammatory reaction. Urine and blood culture detected E. cloacae and methicillin-resistant Staplylococcus aureus. He complained of lumbago since POD 9. Two-week administration of imipenem and teicoplanin resulted in resolution of fever as well as laboratory data, so intravenous antibiotics were changed to oral gatifloxacin. However, his lumbago worsened and gait disturbance appeared. On POD 39, diagnosis of pyogenic spondylitis was finally obtained by Ga-scintigraphy and magnetic resonance imaging. Aspiration of the intervertebral disk (L4-5) revealed E. cloacae as the causative organism of pyogenic spondylitis. His condition improved after conservative treatment with teicoplanin, meropenem and ciplofloxacin for 9 weeks.

Topics: Aged; Anti-Bacterial Agents; Anti-Infective Agents; Ciprofloxacin; Enterobacter cloacae; Enterobacteriaceae Infections; Humans; Male; Meropenem; Postoperative Complications; Spondylitis; Suppuration; Teicoplanin; Thienamycins; Transurethral Resection of Prostate

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

Topics: Anti-Bacterial Agents; Drug Resistance, Bacterial; Drug Therapy, Combination; Gram-Negative Bacteria; Humans; Meropenem; Peritonitis; Postoperative Complications; Recurrence; Retrospective Studies; Thienamycins

Topics: Aged; Blood-Brain Barrier; Cefepime; Cefotaxime; Cephalosporins; Cerebrospinal Fluid; Cerebrospinal Fluid Shunts; Drug Resistance, Microbial; Drug Therapy, Combination; Humans; Hydrocephalus; Male; Meningitis, Bacterial; Meropenem; Postoperative Complications; Pseudomonas aeruginosa; Pseudomonas Infections; Thienamycins

Intraabdominal infections are severe with a high morbidity and mortality which may be produced by multiple causes: perforation of the empty viscera, intestinal inflammatory processes, vascular pictures, abdominal traumatisms as a consequence of surgery. From a microbiologic point of view, different types of gram positive and gram negative aerobes such as anaerobe microorganisms or fungi may be isolated as causes. Polymicrobial infections are usually observed. The main treatment policy is to correctly eliminate the causing foci of the bacterial contamination whether surgically of by percutaneous drainage. Parallelly, it is essential for the surgeon to use appropriate antibiotic treatment. Meropenem, a carbapenem, has a wide spectrum antibacterial activity which cover gram positive and gram negative aerobes in addition to anaerobes leading to scarce adverse reactions. All the above leads meropenem to be a very effective alternative in both the treatment of these infections as monotherapy and for initiating empiric therapy.

Topics: Abdomen; Bacterial Infections; Cilastatin; Drug Combinations; Humans; Imipenem; Meropenem; Postoperative Complications; Thienamycins