meropenem and Streptococcal-Infections

A 39-year-old previously healthy man was referred to our hospital because of acute onset of fever and consciousness disturbance. Neurological examinations revealed deteriorated consciousness, nuchal rigidity and Kernig's sign. A lumbar puncture yielded clouded fluid with a WBC 1,012/μl (polynuclear cell 96%), 147.3 mg/dl of protein, 44 mg/dl of glucose and Gram positive cocci. At first, he was treated with ceftriaxon and ampicillin. At Day 2, meropenem was added. Streptococcus agalactiae was isolated from blood and cerebrospinal fluid. He responded promptly to antimicrobial therapy, and within 2 days, he became lucid and afebrile. S. agalactiae was sensitive to ceftriaxone, ampicillin and meropenem. After Day 3, he was treated with meropenem only. We diagnosed his condition as S. agalactiae meningitis and was discharged from our hospital at Day 18. Many cases of S. agalactiae meningitis are known to occur in neonates, pregnant women, elderly, and persons with underlying disease such as diabetes, malignant disorders, liver dysfunction. But cases occurring in a previously healthy adult are rare. Neurologists should be aware that S. agalactiae may be cause bacterial meningitis in a previously healthy adults.

Topics: Adult; Ampicillin; Anti-Bacterial Agents; Ceftriaxone; Consciousness Disorders; Drug Therapy, Combination; Fever; Humans; Immunocompetence; Male; Meningitis, Bacterial; Meropenem; Streptococcal Infections; Streptococcus agalactiae; Treatment Outcome

Pharmacokinetic and clinical evaluations in pediatrics were made on meropenem (SM-7338, MEPM), a new parenteral dehydropeptidase-1 stable carbapenem used without any inhibitors, at 33 medical institutions. The results are summarized as follows. 1. Pharmacokinetic studies. MEPM at a dose of 10, 20, or 40 mg/kg was administered to 53 children by 30-minute drip infusion. Peak plasma concentrations (Cmax's) and plasma half-lives (T1/2's) of these doses were 28.5, 47.2 and 130.0 micrograms/ml, and 0.80, 0.93 and 0.94 hours, respectively. A clear dose response was observed in Cmax's and T1/2 values were quite similar to those observed in adults. In the first 6 hours after administration, 54.4 to 68.1% of the administered drug was recovered in urine. The cerebrospinal fluid (CSF) levels of MEPM in patients with purulent meningitis were 0.13 microgram/ml at a dose of 6 mg/kg, and 0.64 to 4.22 micrograms/ml at a dose of 29 to 44 mg/kg within day 4 of onset. The penetration rate of MEPM showed an intermediate value among those for other cephalosporin antibiotics. 2. Clinical study. Clinical efficacies of MEPM were evaluated in 389 cases. The most common doses used were 10 to 20 mg/kg/once, 2 to 3 times a day. The maximum dose was 173 mg/kg/day q.i.d. MEPM gave "excellent" or "good" responses in 242 (97.6%) out of 248 cases in which causative organisms were documented and in 134 (95.0%) out of 141 cases in which causative organisms were not identified. Clinical efficacy rates were 100% in 11 patients with purulent meningitis, 85.7% in 7 with septicemia, 98.8% in 173 with pneumonia, and 100% in 65 with UTI. Bacteriologically, 260 strains (96.7%) out of 269 strains were eradicated by MEPM treatment. Eradication rates were 89.2% for Staphylococcus aureus (37 strains) and 100% for Streptococcus pneumoniae (35 strains). The overall eradication rate for Gram-positive bacteria was 94.6%. Among Gram-negative bacteria, 98.3% out of 172 strains were eradicated. The eradication rate of Haemophilus influenzae (73 strains) was 98.6% and Pseudomonas aeruginosa (11 strains) was 90.9%, and all of Branhamella catarrhalis (15 strains), Escherichia coli (42 strains), and Klebsiella pneumoniae (6 strains) were eradicated. Out of 84 cases for which previous antibiotic therapies of 3 days or longer were not successful, MEPM gave "excellent" or "good" responses in 77 cases (91.7%) and excellent bacteriological responses (95.7%).(ABSTRACT TRUNCATED AT 400 WORDS)

Topics: Bacterial Infections; Child; Child, Preschool; Escherichia coli Infections; Female; Haemophilus Infections; Haemophilus influenzae; Humans; Infant; Klebsiella Infections; Klebsiella pneumoniae; Male; Meropenem; Moraxella catarrhalis; Neisseriaceae Infections; Pseudomonas Infections; Staphylococcal Infections; Streptococcal Infections; Thienamycins

The authors report three trials of B-lactams and carbapenems for soft tissue infections treated on a surgical service: 1) cefmetazole versus cefoperazone, n = 44; 2) cefotetan versus cefoxitin, n = 24; and 3) meropenem versus imipenem, n = 44. A total of 138 hospitalized patients were enrolled with 112 meeting evaluability criteria. Four hundred twenty-three isolates were cultured (mean, three/patient) of which 67 per cent were aerobes and 33 per cent anaerobes. Cure rates for each trial were: 1) 93 per cent; 2) 92 per cent; 3) 100 per cent. Failures were caused by resistant organisms (Streptococcus group D, Bacteroides fragilis and Pseudomonas) appearing in incompletely drained infection sites. Three patients receiving meropenem had adverse effects (headache, nausea) and one receiving cefoxitin (truncal rash). Operative drainage and debridement remain the critical elements in therapy. Agents with longer half lives allowing twice daily dosing (cefmetazole and cefotetan) were as effective and less expensive than multiple doses of short-acting agents. The extended spectrum carbapenems are most useful for severe infections or resistant organisms.

Topics: Adult; Aged; Bacterial Infections; Carbapenems; Cefmetazole; Cefoperazone; Cefotetan; Cefoxitin; Cephalosporins; Drug Combinations; Drug Resistance, Microbial; Escherichia coli Infections; Female; Humans; Imipenem; Male; Meropenem; Middle Aged; Prospective Studies; Remission Induction; Skin Diseases, Infectious; Staphylococcal Infections; Streptococcal Infections; Thienamycins

The coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread worldwide. Bacterial co-infections are associated with unfavourable outcomes in respiratory viral infections; however, microbiological and antibiotic data related to COVID-19 are sparse. Adequate use of antibiotics in line with antibiotic stewardship (ABS) principles is warranted during the pandemic. We performed a retrospective study of clinical and microbiological characteristics of 140 COVID-19 patients admitted between February and April 2020 to a German University hospital, with a focus on bacterial co-infections and antimicrobial therapy. The final date of follow-up was 6 May 2020. Clinical data of 140 COVID-19 patients were recorded: The median age was 63.5 (range 17-99) years; 64% were males. According to the implemented local ABS guidelines, the most commonly used antibiotic regimen was ampicillin/sulbactam (41.5%) with a median duration of 6 (range 1-13) days. Urinary antigen tests for Legionella pneumophila and Streptococcus peumoniae were negative in all cases. In critically ill patients admitted to intensive care units (n = 50), co-infections with Enterobacterales (34.0%) and Aspergillus fumigatus (18.0%) were detected. Blood cultures collected at admission showed a diagnostic yield of 4.2%. Bacterial and fungal co-infections are rare in COVID-19 patients and are mainly prevalent in critically ill patients. Further studies are needed to assess the impact of antimicrobial therapy on therapeutic outcome in COVID-19 patients to prevent antimicrobial overuse. ABS guidelines could help in optimising the management of COVID-19. Investigation of microbial patterns of infectious complications in critically ill COVID-19 patients is also required.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Ampicillin; Anti-Bacterial Agents; Antifungal Agents; Antimicrobial Stewardship; Aspergillosis; Azithromycin; Bacterial Infections; Cohort Studies; Coinfection; COVID-19; Enterobacteriaceae Infections; Escherichia coli Infections; Female; Germany; Humans; Klebsiella Infections; Linezolid; Male; Meropenem; Middle Aged; Piperacillin, Tazobactam Drug Combination; Practice Patterns, Physicians'; Retrospective Studies; SARS-CoV-2; Staphylococcal Infections; Streptococcal Infections; Sulbactam; Vancomycin; Young Adult

Topics: Abdomen; Adult; Anti-Bacterial Agents; Clindamycin; Coinfection; Debridement; Diabetes Mellitus, Type 2; Fasciitis, Necrotizing; Female; Fluid Therapy; Humans; Meropenem; Methicillin-Resistant Staphylococcus aureus; Obesity; Renal Insufficiency, Chronic; Resuscitation; Staphylococcal Infections; Streptococcal Infections; Streptococcus pyogenes; Vancomycin

Topics: Abscess; Adenocarcinoma; Anti-Bacterial Agents; Chemoradiotherapy; Combined Modality Therapy; Drainage; Endoscopic Ultrasound-Guided Fine Needle Aspiration; Esophagoscopy; Humans; Lung Neoplasms; Male; Meropenem; Middle Aged; Neck; Smoking; Streptococcal Infections; Streptococcus anginosus; Subcutaneous Tissue; Superior Vena Cava Syndrome; Thoracic Diseases; Tomography, X-Ray Computed

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

Topics: Aged; Anti-Bacterial Agents; Ceftazidime; Cohort Studies; Community-Acquired Infections; Drug Therapy, Combination; Female; Humans; Klebsiella Infections; Male; Melioidosis; Meropenem; Middle Aged; Mortality; Pneumonia, Bacterial; Pneumonia, Pneumococcal; Proportional Hazards Models; Retrospective Studies; Severity of Illness Index; Streptococcal Infections

Dermacoccus spp. have rarely been reported as human pathogens. We describe a case of a 4-year-old boy with congenital heart disease who was diagnosed with a brain abscess. The abscess was drained and the sample grew Streptococcus intermedius, Aggregatibacter aphrophilus and Dermacoccus sp.. Dermacoccus grew after 5 days of incubation and the patient was treated with meropenem.

Topics: Actinobacteria; Aggregatibacter aphrophilus; Anti-Bacterial Agents; Brain Abscess; Child, Preschool; Coinfection; Drainage; Heart Defects, Congenital; Humans; Male; Meropenem; Pasteurellaceae Infections; Streptococcal Infections; Streptococcus intermedius; Treatment Outcome

Phlegmonous gastritis is a rapidly progressive bacterial infection of the stomach wall. It has a high mortality rate and aggressive treatment, either with antibiotics or surgical resection, is required. Here, we report an extremely rare case of phlegmonous gastritis associated with advanced esophageal cancer. A 65-year-old Japanese man was urgently admitted to the hospital due to pyrexia and gastrointestinal symptoms. Abdominal computed tomography revealed widespread diffuse thickening of the gastric wall. On endoscopic examination, an ulcerative mass was detected at the lower thoracic esophagus, and a markedly elevated submucosal lesion was present in the middle of the stomach body. Biopsy specimens taken endoscopically from the esophageal tumor confirmed a diagnosis of squamous cell carcinoma. Gastric biopsy cultures were positive for Streptococcus viridans, leading to a diagnosis of phlegmonous gastritis associated with esophageal cancer. After the patient's condition improved with preoperative antibiotic administration, we performed a thoracoscopic esophagectomy, a total gastrectomy and a reconstruction of the gastrointestinal tract using a pedicled right colon. Histological examination of the resected specimen confirmed that the gastric mass was compatible with a phlegmon.

Topics: Aged; Anti-Bacterial Agents; Carcinoma, Squamous Cell; Esophageal Neoplasms; Esophagectomy; Gastrectomy; Gastritis; Humans; Male; Meropenem; Streptococcal Infections; Thienamycins; Viridans Streptococci

Hemolytic streptococcus gangrene is a life threatening invasive bacterial infection. Hemolytic streptococcus gangrene in the danger triangle of the face is too lethal to operate. A case of the confirmed hemolytic streptococcus gangrene in the danger triangle of the face caused by Group A beta-hemolytic streptococcus (GAS) in 20-months old boy is presented to draw attention of clinicians to this uncommon but frequently fatal infection.. Previously healthy 20 months old boy suddenly developed paranasal gangrene on the left side of the danger triangle of the face, followed by rapidly progressive thrombocytopenia and hepatitis. The clinical features, liver function, and hematological and serological parameters resembled to a description of streptococcal toxic shock syndrome (STSS). Aggressive antibiotics, substitutional and supportive therapy were conducted without surgical debridement of facial tissues. Prompt diagnosis and aggressive timely treatment completely cured the disease in 28 days.. The present case report demonstrates prompt diagnosis and timely treatment as a strategy to cure the fatal hemolytic streptococcus gangrene located in too risky body part to operate.

Topics: Anti-Bacterial Agents; Drug Resistance, Bacterial; Early Diagnosis; Face; Gangrene; Hepatitis; Humans; Infant; Male; Meropenem; Penicillin G; Streptococcal Infections; Streptococcus pyogenes; Thrombocytopenia; Vancomycin

Spontaneous bacterial peritonitis (SBP) can be life threatening in patients with liver cirrhosis. In contrast to community-acquired SBP, no standard treatment has been established for healthcare-related and nosocomial SBP.. We prospectively collected healthcare-related and nosocomial SBP cases from March 2012 till February 2016 at the Department of Internal Medicine I of the University of Bonn and analysed the prevalence of antibiotic resistance among the isolated bacteria. SBP was diagnosed according to international guidelines. Ciprofloxacin, ceftriaxone and meropenem were used as reference substance for resistance to quinolones, third-generation cephalosporins and carbapenems, respectively.. Ninety-two SBP episodes in 86 patients were identified: 63 episodes (69%) were nosocomial. Escherichia coli, Klebsiella species, enterococci and streptococci were most frequently isolated. Frequencies of these microorganisms were comparable for healthcare-related and nosocomial SBP (14% vs. 11%, 14% vs. 8%, 14% vs. 5% and 10% vs. 6%, respectively). In general, antibiotic resistance was higher in isolates from nosocomial than from healthcare-related SBP (50% vs. 18% for quinolones, 30% vs. 11% for piperacillin-tazobactam; P > 0·05), but comparable concerning third-generation cephalosporins (30% vs. 33%). All microorganisms were sensitive to carbapenems apart from nosocomial infections with Enterococcus faecium (n = 3) and Candida albicans (n = 1) due to intrinsic resistance or lack of microbiological efficacy, respectively. No multidrug-resistant microorganisms were detected. Resistance to initial antibiotic treatment affected 30-day survival negatively (18% vs. 68%; P = 0·002).. Resistance to initial antibiotic treatment was associated with increased mortality. With resistance to cephalosporins being frequent, piperacillin-tazobactam or carbapenems might be preferred as treatment of SBP.

Topics: Aged; Anti-Bacterial Agents; Bacterial Infections; Ceftriaxone; Ciprofloxacin; Cross Infection; Drug Resistance, Bacterial; Enterococcus; Escherichia coli Infections; Female; Gram-Positive Bacterial Infections; Humans; Klebsiella Infections; Liver Cirrhosis; Male; Meropenem; Middle Aged; Peritonitis; Prospective Studies; Streptococcal Infections; Thienamycins

We report the case of a patient with multiple empyema present throughout his body, including chronic sinusitis and chronic suppurative otitis media, as well as subsequent epidural empyema, all caused by Streptococcus intermedius. A 38-year-old man presented with chief complaints of headache, left ear discharge, and nasal congestion. Imaging studies revealed pansinusitis, soft tissue signs in the mastoid cells, and otitis media. The patient was treated with meropenem hydrate, 6g/day. While clinical findings indicated improvement of the sinusitis, his headache did not improve. Further examination with contrast computerized tomography (CT) 'a chest radiography' blood cultures were performed, and the patient was diagnosed with multiple empyema (with an epidural empyema, pulmonary suppuration) caused by S. intermedius. Subsequent burr hole drainage was implemented to drain the epidural empyema. Long-term administration was required to treat pulmonary suppuration. While they remain rare, there has been a recent upward trend in the frequency of cases in which a young, previously healthy patient has developed multiple empyema throughout their body despite the absence of complicating diseases that pose an immune deficiency risk, such as diabetes or infection with the human immunodeficiency virus (HIV). In order to properly diagnose and treat patients presenting with multiple empyema infection with S. intermedius should be included in the differential diagnosis.

Topics: Adult; Anti-Bacterial Agents; Chronic Disease; Drainage; Epidural Abscess; Humans; Male; Meropenem; Otitis Media, Suppurative; Radiography, Thoracic; Sinusitis; Streptococcal Infections; Streptococcus intermedius; Thienamycins; Tomography, X-Ray Computed

We report a 60-year-old woman who presented with orbital cellulitis, restricted ocular motility, proptosis, and visual acuity of counting fingers in her left eye 3 days after strabismus surgery. Although she initially responded well to antibiotic and anti-inflammatory therapy, visual acuity in the left eye again decreased on postoperative day 5. Radiographic imaging revealed an intraconal orbital abscess, and she underwent left lateral orbitotomy with abscess drainage, with continued antibiotics and a tapering dose of steroids. To our knowledge, this is the first case of orbital cellulitis and intraconal abscess after strabismus surgery in an adult.

Topics: Abscess; Anti-Bacterial Agents; Ceftriaxone; Clindamycin; Drainage; Drug Therapy, Combination; Eye Infections, Bacterial; Female; Humans; Magnetic Resonance Imaging; Meropenem; Middle Aged; Oculomotor Muscles; Ophthalmologic Surgical Procedures; Orbital Cellulitis; Strabismus; Streptococcal Infections; Thienamycins; Tomography, X-Ray Computed; Visual Acuity

A Pott's puffy tumour is a subperiosteal abscess and osteomyelitis of the frontal bone secondary to frontal sinusitis. Intracranial complications are seen in approximately 40 per cent of cases and are potentially life-threatening; such complications have not previously been reported in pregnancy.. A 21-year-old woman at 35 weeks' gestation presented with a history of frontal headaches and swelling, periorbital oedema, pain and chemosis. Imaging confirmed Pott's puffy tumour with right-sided epidural empyema and periorbital cellulitis. A multidisciplinary team was involved in the patient's management. Intravenous antibiotics were commenced and initial percutaneous drainage through the frontal sinus skin was performed, followed by endoscopic sinus drainage. A caesarean section was performed 3 days later. Complete resolution of the sinus and intracranial collections was noted on imaging performed six weeks later.. This case highlights the challenges of managing rare intracranial complications of sinusitis in pregnancy, and the importance of multidisciplinary care.

Topics: Anti-Bacterial Agents; Catheterization; Ceftriaxone; Cesarean Section; Drainage; Drug Therapy, Combination; Endoscopy; Female; Frontal Sinusitis; Headache; Humans; Magnetic Resonance Imaging; Meropenem; Orbital Cellulitis; Patient Care Team; Pott Puffy Tumor; Pregnancy; Pregnancy Complications, Infectious; Streptococcal Infections; Thienamycins; Treatment Outcome; Vancomycin; Young Adult

Topics: Aged; Anti-Bacterial Agents; Cervical Vertebrae; Clindamycin; Fatal Outcome; Germany; Humans; Magnetic Resonance Imaging; Male; Meropenem; Osteomyelitis; Quadriplegia; Radiography; Spinal Cord Diseases; Streptococcal Infections; Streptococcus agalactiae; Thienamycins

We reported a case of meningitis caused by group B Streptococcus treated with high dose of meropenem (MEPM). A 67-year-old male was suffering from lumbago, fever up, vomiting and convulsion. He had received tumor resection of spinal cord at 40 years old. At the first consultation to our hospital, he had felt strong neck stiffness with Glasgow Coma Scale 5 (El, V1, M3), and his body temperature was 37.0 degrees C. His laboratory findings were as follows; white blood cell count 14600/microL, C-reactive protein 4.39mg/dL, and marked elevation of the cell count in the cerebrospinal fluid. We had administered high dose of meropenem, 6 g/day, and also vancomycin (VCM) on therapeutic drug monitoring. Since his clinical symptoms and laboratory findings had not shown adequate response after 4 days later, we had changed VCM to linezolid 1200 mg/day, and had also continued MEPM, which had resulted in prompt resolution of the clinical symptoms and laboratory findings. Microbiological examination for cerebrospinal fluid has yielded a growth of serotype III group B Streptococcus (Streptococcus agalactiae). Since there have been few data on 6 g/day MEPM against meningitis in spite of recommendation in several guidelines, further studies would be necessary including pharmacokinetic-pharmacodynamic analysis.

Topics: Acetamides; Aged; Anti-Bacterial Agents; Drug Therapy, Combination; Humans; Linezolid; Male; Meningitis, Bacterial; Meropenem; Oxazolidinones; Pulse Therapy, Drug; Serotyping; Streptococcal Infections; Streptococcus agalactiae; Thienamycins; Treatment Outcome; Vancomycin

Infections caused by antibiotics-resistant Gram-positive bacteria have been reported from many pediatric hematology-oncology centers.. The susceptibility profiles to meropenem, piperacillin, and vancomycin among oral flora isolates of alpha-hemolytic streptococci (AHS) obtained from six children with cancer who received several empirical therapies (ET) against febrile neutropenia, were investigated.. Meropenem minimum inhibitory concentration (MIC) of AHS isolated from ET patients was 2.167 +/- 0.258 microg/mL (mean +/- SD), which was significantly higher than the MIC of AHS isolated from control groups. Intriguingly, AHS isolated approximately 6 months after hospital discharge indicated recovery of susceptibility to meropenem.. AHS isolates from neutropenic children with cancer should be checked for antibiotic susceptibility, even against carbapenems.

Topics: Adolescent; Anti-Bacterial Agents; Child; Child, Preschool; Drug Resistance, Multiple, Bacterial; Humans; Infant; Infant, Newborn; Meropenem; Neoplasms; Neutropenia; Streptococcal Infections; Streptococcus; Thienamycins

Group B streptococci (GBS; Streptococcus agalactiae) are the leading cause of neonatal invasive diseases and are also important pathogens for adults. Penicillins are the drugs of first choice for the treatment of GBS infections, since GBS have been regarded to be uniformly susceptible to penicillins so far. Here we characterize the first strains of GBS with reduced penicillin susceptibility (PRGBS) identified in Japan. Fourteen PRGBS strains were clinically isolated from the sputa of elderly patients from 1995 to 2005; and the MICs of penicillin, oxacillin, and ceftizoxime ranged from 0.25 to 1 microg/ml, 2 to 8 microg/ml, and 4 to 128 microg/ml, respectively. Moreover, some strains were also insusceptible to ampicillin, cefazolin, cefepime, and cefotaxime. All the PRGBS isolates tested possessed a few amino acid substitutions adjacent to the conserved SSN and KSG motifs (amino acids 402 to 404 and 552 to 554, respectively) of PBP 2X, and the amino acid substitutions could be classified into two types, Q557E and V405A. Western blotting analysis of the 14 clinical isolates with anti-PBP 2X-specific serum suggested that the amount of PBP 2X among the 14 PRGBS isolates was reduced, although the 2 ATCC strains produced a significant amount of PBP 2X. The introduction of PRGBS-derived PBP 2X genes into penicillin-susceptible strains through allelic exchange elevated their penicillin insusceptibility, suggesting that these altered PBP 2X genes are responsible for the penicillin insusceptibility in PRGBS strains. In this study, we characterized for the first time PRGBS strains on a molecular basis, although several reports have so far mentioned the existence of beta-lactam-insusceptible GBS from a phenotypic standpoint.

Topics: Amino Acid Sequence; Amino Acid Substitution; Ampicillin; Anti-Bacterial Agents; Bacterial Proteins; Blotting, Western; Cefepime; Cefotaxime; Ceftizoxime; Cephalosporins; Electrophoresis, Gel, Pulsed-Field; Humans; Japan; Microbial Sensitivity Tests; Molecular Sequence Data; Oxacillin; Penicillin Resistance; Penicillin-Binding Proteins; Penicillins; Sequence Analysis, DNA; Sequence Homology, Amino Acid; Streptococcal Infections; Streptococcus agalactiae

Responsible for many childhood diseases, group A Streptococcus (GAS) is a rare cause of central nervous system infections. We report the case of a previously healthy boy with brain abscesses caused by M/emm type 12 GAS and review the case in the context of the published literature and recent epidemiological data.

Topics: Anti-Bacterial Agents; Anti-Inflammatory Agents; Brain Abscess; California; Dexamethasone; Drainage; Humans; Infant; Male; Meropenem; Streptococcal Infections; Streptococcus pyogenes; Thienamycins; Vancomycin

A total of 105 clinical strains of Group C and Group G streptococci were examined for their susceptibility to penicillin, cefotaxime, erythromycin, meropenem and vancomycin using a broth microdilution method. Minimum bactericidal concentrations of the antimicrobial agents and phenotypes of strains resistant to erythromycin were also evaluated. No resistance to penicillin, cefotaxime, meropenem and vancomycin was found in years 1995-2002, but there was 6.7% resistance to erythromycin. No tolerance was seen for penicillin and vancomycin, but there were strains tolerant to cefotaxime, erythromycin and meropenem. The resistance phenotypes of erythromycin-resistant isolates were determined by the double disc test with erythromycin and clindamycin which showed inducible MLS (57.1%) and M phenotype (42.8%) resistance. This in vitro finding shows that classical antimicrobial agents used for the treatment of GCS and GGS have good activity against clinically significant isolates, but the presence of macrolide resistance and tolerant isolates suggests that careful surveillance of the streptococcal isolates should be carried out.

Topics: Anti-Bacterial Agents; Cefotaxime; Cephalosporin Resistance; Drug Resistance, Bacterial; Erythromycin; Humans; In Vitro Techniques; Meropenem; Microbial Sensitivity Tests; Penicillin Resistance; Phenotype; Streptococcal Infections; Streptococcus; Thienamycins; Turkey; Vancomycin Resistance

The 2alpha-functionalized 1beta-methylcarbapenems 3 were synthesized from the 2-formyl 1beta-methylcarbapenem intermediate 5. The best compound in the series of 2alpha-(hydroxy)alkylcarbapenems, KR-21012, displayed well balanced in vitro and in vivo activity as a parent compound of oral carbapenem.

Topics: Animals; Anti-Bacterial Agents; Bacteria; Carbapenems; Drug Stability; Escherichia coli Infections; Gram-Negative Bacteria; Gram-Positive Bacteria; Mice; Mice, Inbred ICR; Microbial Sensitivity Tests; Streptococcal Infections; Structure-Activity Relationship; Survival Rate

A total of 68 viridans group streptococci, including 31 Streptococcus sanguis, 12 S. mitis, 3 S. salivarius, and 8 S. milleri from blood, and an additional 14 S. milleri from abscesses and normally sterile sites, were tested against penicillin, amoxicillin, cefazolin, ceftriaxone, meropenem, clindamycin, quinupristin/dalfopristin, rifampin, levofloxacin, ofloxacin, vancomycin, and gentamicin with the microdilution method. The susceptibility rates for S. sanguis were: penicillin, 74%; amoxicillin, 84%; ceftriaxone, 94%; clindamycin, 87%, and vancomycin, 100%. The susceptibility rates for S. mitis were: penicillin, 42%; amoxicillin, 67%; ceftriaxone, 58%; clindamycin, 100%; and vancomycin, 100%. The susceptibility rates for S. milleri were: penicillin, 100%, amoxicillin. 100%; ceftriaxone, 100%, clindamycin, 100%; and vancomycin, 100%. Two of the three isolates of S. salivarius were susceptible to penicillin, amoxicillin, and ceftriaxone; all were susceptible to clindamycin and vancomycin. Levofloxacin, quinupristin/dalfopristin, and rifampin were highly active against all isolates.

Topics: Amoxicillin; Anti-Bacterial Agents; Cefazolin; Ceftriaxone; Clindamycin; Drug Resistance, Microbial; Gentamicins; Humans; Levofloxacin; Meropenem; Microbial Sensitivity Tests; Ofloxacin; Penicillins; Rifampin; Streptococcal Infections; Streptococcus; Thienamycins; Vancomycin; Virginiamycin

Forty-five children were treated with meropenem (MEPM) and the clinical efficacy and side effects were evaluated. The ages of the patients ranged from 1 month to 9 years and their body weights from 5.2 to 25 kg. Doses given were 17.2-45.5 mg/kg every 6 to 8 hours for 2 to 24.5 days. Those patients who responded to the MEPM treatment included 15 children with pneumonia, 7 with pharyngitis, 3 with cervical lymphadenitis, 3 with cellulitis, 10 with urinary tract infections and 4 with other infections. Among 42 children, the results were excellent in 29, good in 12 and fair in 1. The drug was well tolerated, although slightly elevated serum concentrations of transaminases occurred in 5 patients, eosinophilia in 2 patients, and neutropenia in 1 patient among 45 patients examined. The pharmacokinetic studies on MEPM were done in 6 patients. Their ages ranged from 2 to 9 years and body weights from 14.5 to 23.2 kg. In 4 patients, plasma concentrations at the end of 30 minutes drip infusion of 20 mg/kg were 29.28 +/- 10.29 micrograms/ml and those 3 hours later were 0.49 +/- 0.26 micrograms/ml. Serum elimination half-lives of the drug were 0.66 +/- 0.12 hours in these patients. Excretion rates of this drug into urine in the first 6 hours after initiation of drug administration were 53 and 40% in 2 of these patients. In 2 patients with 35 and 44 mg/kg of drug administration, plasma concentrations were higher than those given 20 mg/kg of the drug.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Bacterial Infections; Bifidobacterium; Child; Child, Preschool; Enterobacteriaceae; Escherichia coli Infections; Feces; Female; Haemophilus Infections; Haemophilus influenzae; Humans; Infant; Male; Meropenem; Staphylococcal Infections; Streptococcal Infections; Streptococcus pyogenes; Thienamycins

Bacteriological and clinical studies have been performed on meropenem (MEPM, SM-7338), a newly developed carbapenem antibiotic, in the pediatric field. 1. Antibacterial activities of MEPM against 24 clinical isolates were determined. MEPM showed excellent activity against Gram-positive bacteria including Staphylococcus aureus and Gram-negative bacteria, especially Escherichia coli and Branhamella catarrhalis. Against Haemophilus influenzae, MEPM had a higher activity than imipenem and flomoxef, but had a lower activity than piperacillin and cefoperazone. 2. Clinical efficacies of MEPM were evaluated in 32 cases with bacterial infections. A poor efficacy was observed in 1 patient with phlegmon but excellent or good efficacies were obtained in other 31 patients with tonsillitis (1), pneumonia (17), UTI (12), or SSSS (1). The overall efficacy rate was 96.9%. All strains except 1 of S. aureus were eradicated by the administration of MEPM, and a high eradication rate of 95.8% (23 out of 24 strains) was obtained. 3. No side effects were observed in 35 evaluated cases. As abnormal laboratory test results, elevated GOT, elevated GPT, eosinophilia and neutropenia were noted in 4, 4, 4 and 2 patients, respectively. 4. Influences on blood coagulation parameters were studied. PIVKA II was elevated upon administration of MEPM in some cases, but no changes in ATT, TT, HPT or Fbg were observed during the treatment. Based on the above results, it has been concluded that MEPM is a safe and effective drug to use in the treatment of pediatric infections. The usual recommended dosage and administration should be 10 to 20 mg/kg of MEPM at a time, using intravenous drip infusion, 3 times a day.

Topics: Adolescent; Bacterial Infections; Child; Child, Preschool; Escherichia coli Infections; Female; Haemophilus Infections; Haemophilus influenzae; Humans; Infant; Male; Meropenem; Moraxella catarrhalis; Neisseriaceae Infections; Pneumococcal Infections; Staphylococcal Infections; Streptococcal Infections; Streptococcus pyogenes; Thienamycins