meropenem and Rupture--Spontaneous

Meropenem (MP), a new carbapenem antibiotic, has excellent antimicrobial activity against the enteric flora commonly encountered in acute appendicitis. Although similar to imipenem, it may have clinical advantages.. We compared patients with advanced appendicitis (gangrenous or perforated) treated with 1,000 mg MP every eight hours with those given the combination of tobramycin 5 mg/kg/day at eight hour intervals and clindamycin 900 mg every eight hours. Both treatments were given intravenously. Patients were randomized to either group of the double-blind study.. Of 129 evaluable cases, 63 received MP and 66 received both tobramycin and clindamycin (T/C). The two groups were similar in age, sex, and severity of disease. The mean number of days of postoperative fever (MP = 3.1 +/- 1.7 SD compared to T/C = 4.4 +/- 2.2 SD, p < or = 0.01), days of antibiotic therapy (MP = 6.1 +/- 1.6 SD compared to T/C = 7.3 +/- 2.2 SD, p = 0.01), and therefore hospital stay (MP = 8.0 +/- 3.5 SD compared to T/C = 9.4 +/- 2.6 SD, p < 0.01) were significantly better for patients treated with MP. No difference was found between the numbers of failures in each group (MP = 5 compared to T/C = 6).. This study demonstrates a small but significant reduction (approximately one day) in post-operative fever, duration of antibiotic treatment, and hospital stay for patients treated with MP compared to those treated with T/C.

Topics: Adult; Anti-Bacterial Agents; Appendicitis; Clindamycin; Double-Blind Method; Drug Administration Schedule; Drug Therapy, Combination; Female; Humans; Intestinal Perforation; Length of Stay; Male; Meropenem; Rupture, Spontaneous; Thienamycins; Time Factors; Tobramycin

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

A 27-year-old woman was admitted to the emergency department with fever and a petechial rash on suspicion of meningitis. Shortly after arriving she developed cardiac arrest. Blood work up showed severe lactate acidosis, anaemia and thrombocytopenia. A focused assessment with sonography in trauma scan showed free intraperitoneal fluid and an emergency laparotomy revealed massive bleeding from a ruptured spleen. The patient was successfully resuscitated. She proved to be infected with cytomegalovirus causing idiopathic thrombocytopenic purpura, splenomegaly and splenic rupture. She was treated for 14 days with ganciclovir and meropenem and discharged on recovery. Atraumatic splenic rupture caused by viral infection is a rare condition although well described. In the case of our patient, thrombocytopenia added to the severity of the splenic rupture. A multidisciplinary team approach was essential for the management and the eventual recovery of the patient.

Topics: Adult; Antiviral Agents; Cytomegalovirus; Cytomegalovirus Infections; Emergencies; Female; Ganciclovir; Heart Arrest; Humans; Meropenem; Rupture, Spontaneous; Splenectomy; Splenic Rupture; Thienamycins; Thrombocytopenia; Treatment Outcome

A 48-year-old man with a history of a penetrating brain injury was referred with a presumptive diagnosis of bacterial meningitis. Examination revealed a brain abscess in addition to meningitis. Blood and cerebrospinal fluid (CSF) cultures were negative for bacteria, and empirical IV antibiotic therapy with vancomycin (VCM) and meropenem was initiated. Despite initial improvement, however, his condition rapidly deteriorated into coma following intraventricular rupture of the abscess and hydrocephalus. Thereafter, an emergency ventriculostomy was performed and the abscess was evacuated. Bacterial cultures of the pus were negative. To manage the hydrocephalus, 150-200 ml of CSF were drained daily. Intraventricular administration of VCM (20 mg q.d.) was added to the IV antibiotic therapeutic regimen after surgery. Although the primary abscess rapidly decreased in size, ependymitis developed in the fourth ventricle. This new lesion, which resulted from CSF dissemination from the primary abscess, was refractory to treatment, and eventually disappeared after the intraventricular VCM dosage was increased from 20 to 30 mg and continued for 30 days. A possible reason for the development of fulminant ependymitis and why it was refractory to treatment despite the shrinkage of the primary lesion may be that physiological CSF flow from the lateral to the fourth ventricle was lost due to CSF drainage, and the stagnant CSF flow coupled with an insufficient VCM level in the fourth ventricle facilitated the rapid growth of pathogens. Although intraventricular antibiotic administration is efficacious for treating ruptured brain abscesses, it may be associated with the unexpected development of secondary lesions.

Topics: Anti-Bacterial Agents; Brain Abscess; Cerebrospinal Fluid Shunts; Ependyma; Humans; Hydrocephalus; Male; Meningitis, Bacterial; Meropenem; Middle Aged; Rupture, Spontaneous; Thienamycins; Vancomycin

Topics: Adult; Anti-Bacterial Agents; Antiprotozoal Agents; Digestive System Fistula; Drainage; Gastric Fistula; Humans; Liver Abscess, Amebic; Liver Diseases; Male; Meropenem; Metronidazole; Rupture, Spontaneous; Thienamycins