minocycline and Osteomyelitis

"Madura foot" or pedal mycetoma is a rare destructive infection of the skin and subcutaneous tissues of the foot, progressing to involve muscle and bone. The infection can be caused by both bacteria and fungi. Infection typically follows traumatic implantation of bacteria or fungal spores, which are present in soil or on plant material. Clinically, this entity can be difficult to diagnose and can have an indolent and progressive course. Early diagnosis is important to prevent patient morbidity and mortality. We present two cases of pedal mycetoma, review the literature, review new developments in diagnosis, and discuss magnetic resonance imaging (MRI) features of this unusual entity.

Topics: Adult; Antifungal Agents; Foot Dermatoses; Humans; Magnetic Resonance Imaging; Male; Minocycline; Osteomyelitis; Treatment Outcome

Topics: Acetamides; Animals; Anti-Bacterial Agents; Bone Diseases, Infectious; Daptomycin; Humans; Linezolid; Minocycline; Osteomyelitis; Oxazolidinones; Tigecycline

Tigecycline is the first commercially available member of the glycylcyclines, a new class of antimicrobial agents. The glycylcyclines are derivatives of the tetracycline antibiotics, with structural modifications that allow for potent gram-positive, gram-negative, and anaerobic activity, including certain multidrug-resistant strains. The enhanced activity can be attributed to stronger binding affinity and enhanced protection against several mechanisms of resistance that affect other antibiotic classes such as tetracyclines. Tigecycline exhibits generally bacteriostatic action by reversibly binding to the 30S ribosomal subunit and inhibiting protein translation. In vitro activity has been demonstrated against multidrug-resistant gram-positive pathogens including methicillin-resistant and glycopeptide-intermediate and -resistant Staphylococcus aureus, as well as vancomycin-resistant enterococci. Multidrug-resistant gram-negative pathogens, such as Acinetobacter baumannii and extended-spectrum beta-lactamase-producing Klebsiella pneumoniae and Escherichia coli, are typically highly susceptible to tigecycline. The drug also has displayed significant activity against many clinically important anaerobic organisms. This agent demonstrates a predictable pharmacokinetic profile and minimal drug interactions, and is generally well tolerated, with nausea being the most common adverse event. It was approved in June 2005 for the treatment of complicated skin and skin structure infections (SSSIs) and complicated intraabdominal infections. Currently, a limited number of broad-spectrum antimicrobials are available to combat multidrug-resistant organisms. The addition of new agents is essential to limiting the spread of these pathogens and improving outcomes in patients with these types of infections. Tigecycline has demonstrated promising results in initial in vitro and clinical studies for SSSIs and complicated intraabdominal infections; however, further clinical experience will clarify its role as a broad-spectrum agent.

Topics: Animals; Anti-Infective Agents; Bacteria, Anaerobic; Bacterial Infections; Drug Administration Schedule; Drug Interactions; Drug Resistance, Multiple, Bacterial; Endocarditis, Bacterial; Gram-Negative Bacteria; Gram-Positive Bacteria; Humans; Microbial Sensitivity Tests; Minocycline; Osteomyelitis; Randomized Controlled Trials as Topic; Skin Diseases, Bacterial; Tigecycline

Pyogenic vertebral osteomyelitis (PVO) is a severe infection that requires prolonged antimicrobial therapy and/or surgical interventions. Limited data are available on the safety and clinical efficacy of tigecycline in PVO. The objective of this study was to describe the clinical outcomes of patients treated with tigecycline for culture-negative PVO that was unresponsive to empirical antibiotic therapy including intravenous ampicillin-sulbactam plus ciprofloxacin or ampicillin-sulbactam alone.. We retrospectively reviewed 15 patients with culture-negative PVO from 2009 through 2014. The patients received tigecycline as secondary empirical therapy, after not responding to the first empirical therapy. Clinical success was defined as recovery from symptoms and normalization of laboratory parameters at the end of therapy. Continued clinical success at 24 weeks after the end of the therapy was defined as sustained clinical success.. Tigecycline treatment was completed in 14 patients and discontinued in 1 due to severe nausea and vomiting. The mean age of the patients was 67.7 years (range 58-77 years), and 57.1% (8/14) were women. In all, 78.6% (11/14) of patients had risk factors for probable resistant staphylococcal and gram-negative infections such as diabetes mellitus, presence of hemodialysis catheters, and prior antibiotic usage. The average duration of tigecycline treatment was 8.3 weeks (range 6-11 weeks). Sustained clinical success was obtained in all patients.. Tigecycline should be considered as an alternative agent for the treatment of PVO in selected patients due to microbiological activity against resistant gram-positive and gram-negative bacteria.

Topics: Aged; Anti-Bacterial Agents; Female; Follow-Up Studies; Humans; Male; Middle Aged; Minocycline; Osteomyelitis; Retrospective Studies; Tigecycline; Treatment Outcome

A phase 3, randomized, double-blind trial was conducted in subjects with diabetic foot infections without osteomyelitis (primary study) or with osteomyelitis (substudy) to determine the efficacy and safety of parenteral (intravenous [iv]) tigecycline (150 mg once-daily) versus 1 g once-daily iv ertapenem ± vancomycin. Among 944 subjects in the primary study who received ≥1 dose of study drug, >85% had type 2 diabetes; ~90% had Perfusion, Extent, Depth/tissue loss, Infection, and Sensation infection grade 2 or 3; and ~20% reported prior antibiotic failure. For the clinically evaluable population at test-of-cure, 77.5% of tigecycline- and 82.5% of ertapenem ± vancomycin-treated subjects were cured. Corresponding rates for the clinical modified intent-to-treat population were 71.4% and 77.9%, respectively. Clinical cure rates in the substudy were low (<36%) for a subset of tigecycline-treated subjects with osteomyelitis. Nausea and vomiting occurred significantly more often after tigecycline treatment (P = 0.003 and P < 0.001, respectively), resulting in significantly higher discontinuation rates in the primary study (nausea P = 0.007, vomiting P < 0.001). In the primary study, tigecycline did not meet criteria for noninferiority compared with ertapenem ± vancomycin in the treatment of subjects with diabetic foot infections.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; beta-Lactams; Diabetic Foot; Drug-Related Side Effects and Adverse Reactions; Ertapenem; Female; Humans; Male; Middle Aged; Minocycline; Nausea; Osteomyelitis; Tigecycline; Treatment Outcome; Vancomycin; Vomiting; Young Adult

Topics: Aged; Anti-Bacterial Agents; Female; Humans; Hyperpigmentation; Minocycline; Osteomyelitis; Skin Pigmentation; Sunlight

Actinomycosis is a rare, chronic, slowly progressive granulomatous disease caused by filamentous gram-positive anaerobic bacteria from the Actinomycetaceae family (genus Actinomyces). It has become a rare condition because of the widespread use of antibiotics. When clinical symptoms are not typical, diagnosis of this condition becomes difficult. This report describes a case involving an 82-year-old woman who was diagnosed with actinomycotic osteomyelitis of the mandible using matrix assisted laser desorption ionization-time-of-flight mass spectrometry (MALDI-TOF MS). The patient was referred to the authors' department with chief complaints of swelling, multiple fistulae in the left preauricular region, and trismus. The authors performed fine-needle aspiration microbiology (FNAM) and identified Actinomyces oris using MALDI-TOF MS. A diagnosis of actinomycotic osteomyelitis of the mandible was made and the patient was treated with minocycline and extraction of the culprit tooth. The findings from this case have 2 important implications. First, for patients with clinically suspected actinomycosis, bacteriologic examinations should include not only surface swab tests but also FNAM; moreover, communication with the laboratory medical technologist is important to improve detection of the causative organisms. Second, MALDI-TOF MS could be an effective tool for improving the diagnosis and treatment outcomes of actinomycosis.

Topics: Actinomycosis; Aged, 80 and over; Anti-Bacterial Agents; Female; Humans; Magnetic Resonance Imaging; Mandibular Diseases; Minocycline; Osteomyelitis; Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization; Tomography, X-Ray Computed; Treatment Outcome

Salmonella osteomyelitis is extremely rare; only a few cases have been reported in healthy adults. We describe a case of salmonella osteomyelitis in an otherwise healthy 20-year-old Japanese woman who presented with distal tibial pain. X-ray and magnetic resonance imaging showed a lesion suspected to be a bone cyst. Osteomyelitis was diagnosed when pus was observed during an open biopsy. The bacterial culture examination yielded salmonella. Surgical drainage and antibiotic treatment were performed, after which no recurrence was observed. To our best knowledge, this is the first report of salmonella osteomyelitis of the distal tibia in an otherwise healthy individual.

Topics: Anti-Bacterial Agents; Drainage; Female; Humans; Levofloxacin; Minocycline; Osteomyelitis; Salmonella Infections; Young Adult

Chronic osteomyelitis is a chronic inflammatory disease induced by bone infection. It may be limited to a single portion of bone or involve several areas such as marrow, cortical, periosteum and adjacent soft tissues. Being able to persist for weeks, months or even years, it remains a therapeutic challenge in spite of the important medical and surgical advances, with a prolonged and complex management given the nature of the surgical interventions and the antibiotherapies required. We report a case of chronic osteomyelitis treated by long-term suppressive antibiotic therapy, which may be a reasonable alternative to surgery in inoperable clinical situations, but taking into account the risks associated with it in terms of side effects and selection of resistant organisms, as well as the cost of treatment and the quality of life of the patient.. L’ostéomyélite chronique est une pathologie inflammatoire chronique induite par une infection osseuse. Elle peut être limitée à une seule portion d’os ou impliquer plusieurs zones telles que la moelle, la corticale, le périoste et les tissus mous adjacents. Pouvant persister pendant des semaines, des mois voire des années, elle reste un challenge thérapeutique en dépit des importantes avancées médicales et chirurgicales, avec une prise en charge prolongée et complexe compte tenu de la nature des interventions chirurgicales et des antibiothérapies requises. Nous rapportons un cas d’ostéomyélite chronique pris en charge par antibiothérapie suppressive au long cours, qui peut être une alternative raisonnable à la chirurgie dans des situations cliniques inopérables, mais en prenant en considération les risques qui y sont associés en termes d’effets secondaires et de sélection des germes résistants, ainsi que le coût du traitement et la qualité de vie du patient.

Topics: Aged; Anti-Bacterial Agents; Chronic Disease; Drug Administration Schedule; Floxacillin; Humans; Male; Minocycline; Osteomyelitis; Rifampin

A 16-year-old boy developed left foot pain of unknown cause that was unresponsive to conservative treatment, associated with fever and difficulty walking. He was admitted to our hospital with osteomyelitis of the accessory and body of the navicular bone. Surgery could not be performed because the patient had been diagnosed with Wiskott-Aldrich syndrome. After antibiotic therapy, laboratory abnormalities and pain had resolved. One year after treatment, the patient had returned to his original level of sports activity. Both an accessory navicular and the body of the navicular bone may develop osteomyelitis in immunocompromised patients; early diagnosis is important for prescribing effective conservative treatment.

Topics: Administration, Intravenous; Adolescent; Anti-Bacterial Agents; Clindamycin; Diagnosis, Differential; Foot; Foot Diseases; Humans; Immunocompromised Host; Magnetic Resonance Imaging; Male; Minocycline; Osteomyelitis; Pain; Physical Therapy Modalities; Tarsal Bones; Treatment Outcome; Wiskott-Aldrich Syndrome

Implant-associated methicillin-resistant Staphylococcus aureus (MRSA) infections are challenging to treat. We compared antimicrobial activities in a rat model of chronic osteomyelitis in the context of retention of the foreign body without débridement.. MRSA was inoculated into the proximal tibia and a wire implanted. Four weeks after infection, treatment with vancomycin 50 mg/kg every 12 h, tigecycline 14 mg/kg every 12 h, rifampin 25 mg/kg every 12 h, or the combination of vancomycin or tigecycline plus rifampin was administered intraperitoneally for 21 days.. MRSA was cultured from all tibias in the control group (median, 6.06 log10 CFU/g bone). Median bacterial counts (log10 CFU/g) at 48 h post-treatment were 6.16 for vancomycin (p = 0.753), 2.29 for vancomycin plus rifampin (p < 0.001), 5.90 for tigecycline (p = 0.270), 0.10 for tigecycline plus rifampin (p < 0.001), and 0.91 for rifampin (p = 0.044) treatment. Three deaths were observed in the tigecycline plus rifampin group. Median bacterial counts (log10 CFU/g) at two weeks post-treatment were 5.65 for vancomycin (p = 0.6), 4.05 for vancomycin plus rifampin (p = 0.105), 5.68 for tigecycline (p = 0.401), 4.05 for tigecycline plus rifampin (p = 0.028), and 5.98 for rifampin (p = 0.297) treatment.. Tigecycline plus rifampin resulted in a significant bacterial count decrease, an effect more prominent at 48 h than two weeks after treatment completion. Tigecycline was not well tolerated at the dose studied.

Topics: Animals; Anti-Bacterial Agents; Disease Models, Animal; Humans; Male; Methicillin; Methicillin Resistance; Methicillin-Resistant Staphylococcus aureus; Minocycline; Osteomyelitis; Rats; Rats, Wistar; Rifampin; Staphylococcal Infections; Tigecycline; Vancomycin

In the fields of traumatology and orthopaedics staphylococci are the most frequently isolated pathogens. Staphylococcus aureus and Staphylococcus epidermidis are known to be the major causative agents of osteomyelitis. The increasing number of multiresistant Staphylococcus aureus and resistant coagulase-negative staphylococci as a trigger of complicated osteomyelitis and implant-associated infections is a major problem. Antibiotic therapy fails in 20% of cases. Therefore the development of novel antibiotics becomes necessary.. This study analyses tigecyclin, the first antibiotic of the glycylines, as a potential therapy for osteomyelitis caused by multiresistant Staphylococcus aureus. Therefore its intracellular activity and the potential use in polymethylmetacrylate-bone cement are examined. The intracellular activity of tigecyclin is determined by a human osteoblast infection model. The investigation of the biomechanical characteristics is conducted concerning the ISO 5833-guidelines.. Tigecyclin shows in vitro an intracellular activity that ranges between the antimicrobial activity of gentamicin and rifampicin. A significant negative effect on the biomechanical characteristics with an impaired stability is detected after adding tigecyclin to polymethylmetacrylate-bone cement with a percentage of 1.225% per weight.. This study shows that tigecyclin might be a potent alternative for the systemic therapy of osteomyelitis and implant-associated infections whereas the local application has to be reconsidered individually.

Topics: Anti-Bacterial Agents; Biomechanical Phenomena; Bone Cements; Cells, Cultured; Humans; Intracellular Space; Materials Testing; Minocycline; Models, Biological; Osteoblasts; Osteomyelitis; Prosthesis-Related Infections; Staphylococcal Infections; Staphylococcus aureus; Tigecycline

Tigecycline is approved for cutaneous infections, intra-abdominal infections, and community-acquired pneumonia. However, pharmacokinetic data suggest therapeutic concentrations in additional sites, such as bone, despite exiguous clinical data supporting such use. Thus, the objective of this study was to analyze patients with osteomyelitis treated with tigecycline to ascertain its utility in this malady. Our database of osteomyelitis patients was surveyed for instances treated with tigecycline. Cases were evaluated in terms of adverse events and clinical success. Nineteen patients received tigecycline for osteomyelitis. Thirteen met criteria for evaluation of the primary endpoint of clinical success. The most common dose employed was 50 mg twice daily. Adverse events, however, were not statistically more likely with 100 mg administered once daily. Eleven patients (85%) achieved clinical success. Thus, congruent with pharmacokinetic data, tigecycline appeared efficacious for osteomyelitis in the majority of patients who received it. Adverse events were not correlated with dosing strategy.

Topics: Adult; Anti-Bacterial Agents; Drug-Related Side Effects and Adverse Reactions; Female; Humans; Male; Middle Aged; Minocycline; Osteomyelitis; Tigecycline; Treatment Outcome

Daptomycin is licensed in adults for the management of Staphylococcus aureus methicillin-resistant infections, including bone and skin complicated infections. We describe for the first time its use in a renal transplant recipient for Fabry-Anderson Disease with right heel osteomyelitis. The patient was unresponsive to first-line Teicoplanin and second-line Tigecycline, whereas he was successfully treated with third-line Daptomycin monotherapy at 4 mg/Kg/qd for 4 weeks. Local debridement was performed in advance of each line of treatment.

Topics: Adult; Anti-Bacterial Agents; Anti-Infective Agents; Calcaneus; Daptomycin; Fabry Disease; Heel; Humans; Kidney Transplantation; Male; Methicillin Resistance; Methicillin-Resistant Staphylococcus aureus; Metronidazole; Minocycline; Osteomyelitis; Renal Insufficiency; Salvage Therapy; Staphylococcal Infections; Teicoplanin; Tigecycline; Tomography, X-Ray Computed

The aim of this study was to determine the efficacy of tigecycline-impregnated hydroxyapatite in the local treatment of chronic osteomyelitis experimentally induced in rat tibias with methicillin-resistant Staphylococcus aureus.. Monocortical defects were established in the left tibias of 32 adult Wistar albino rats. Five rats were randomly selected and injected intramedullarly with saline solution (group 1), whereas chronic osteomyelitis was induced in other rats by intramedullary injection of S. aureus. Infected rats were then randomized and divided into 4 groups: group 2, no further treatment; group 3, debridement only; group 4, debridement followed by implantation of calcium hydroxyapatite; and group 5, debridement followed by implantation of tigecycline-impregnated calcium hydroxyapatite. On day 21 after induction, all rats in groups 2-5 showed signs of osteomyelitis. Rats in groups 1 and 2 were killed on day 21 after induction, whereas rats in groups 3, 4, and 5 underwent debridement surgery on day 21 after induction and were killed 21 days after debridement surgery. Tibias were analyzed histopathologically and cultured for S. aureus.. Compared with group 2, histopathologic disease severity scores in groups 3, 4, and 5 were 37%, 44%, and 83% lower, respectively. Nontreated infected rats had the highest bacteria count (mean 5 × 10(5) colony-forming units/g bone), and bacterial count was 26%, 29%, and 79% lower in groups 3, 4, and 5, respectively, compared with group 2.. Tigecycline-impregnated hydroxyapatite can have a potential in the treatment of chronic osteomyelitis of methicillin-resistant S. aureus origin, which may be considered as a therapeutic alternative by surgeons dealing with osteomyelitis.

Topics: Animals; Anti-Bacterial Agents; Anti-Infective Agents, Local; Biocompatible Materials; Chronic Disease; Colony Count, Microbial; Debridement; Drug Carriers; Durapatite; Male; Methicillin-Resistant Staphylococcus aureus; Minocycline; Osteomyelitis; Random Allocation; Rats; Rats, Wistar; Tibia; Tigecycline

Topics: Acetamides; Aminoglycosides; Anti-Bacterial Agents; Daptomycin; Humans; Linezolid; Lipoglycopeptides; Methicillin-Resistant Staphylococcus aureus; Minocycline; Osteomyelitis; Oxazolidinones; Staphylococcal Infections; Tigecycline; Vancomycin

Optimal antimicrobial therapy for infections due to ertapenem-resistant Enterobacteriaceae remains undetermined. In this study, a diabetic patient with recurrent pyomyositis and osteomyelitis caused by extended-spectrum β-lactamase (ESBL)-producing Klebsiella pneumoniae developed ertapenem resistance after imipenem/cilastatin treatment, which was a currently recommended therapy. He was finally treated successfully using tigecycline. Ertapenem resistance was in part explained by the production of SHV-type ESBL and the absence of an outer membrane protein, OmpK36. Our observation suggests that tigecycline may be an alternative for invasive infections caused by ESBL-producing Enterobacteriaceae with decreased susceptibility to carbapenem.

Topics: Anti-Bacterial Agents; beta-Lactams; Diabetes Complications; Ertapenem; Humans; Klebsiella Infections; Klebsiella pneumoniae; Male; Middle Aged; Minocycline; Osteomyelitis; Pyomyositis; Recurrence; Salvage Therapy; Tigecycline; Treatment Outcome

Topics: Animals; Anti-Infective Agents; Drug Delivery Systems; Drug Resistance, Bacterial; Minocycline; Osteomyelitis; Prosthesis-Related Infections; Rabbits; Rifampin; Staphylococcal Infections

Topics: Acinetobacter baumannii; Acinetobacter Infections; Anti-Bacterial Agents; Drug Resistance, Multiple, Bacterial; Humans; Iraq; Male; Middle Aged; Minocycline; Osteomyelitis; Tigecycline; Vancomycin

We evaluated the efficacy of tigecycline and teicoplanin in a rat model of MRSA osteomyelitis. Osteomyelitis was induced with an intramedullary injection of 10(8 )colony-forming units (cfu) of MRSA. After osteomyelitis formation was confirmed on Day 14, infected rats were randomly divided into three groups: tigecycline (n=13), teicoplanin (n=13), and no-treatment control (n=14). A 28-day antibiotic therapy with a subcutaneous injection of tigecycline (14 mg/kg twice daily) or intramuscular administration of teicoplanin (20 mg/kg daily) was administered. Rats were then sacrificed, and the tibias were harvested. The bones were weighed and then cultured. Our results indicated that bacterial growth was significantly reduced in teicoplanin and tigecycline groups, compared to the control group (p=0.019 and p=0.006, respectively). However, no difference was detected between the two antibiotic groups (p=1.000). No bacterial growth was detected in 7 out of 13 and 9 out of 13 specimens of the teicoplanin and tigecycline treated groups, respectively. Although this result was numerically in favor of tigecycline, the difference was not statistically significant (p=0.427). In conclusion, tigecycline, a novel antibiotic, appears as an effective alternative to teicoplanin in the treatment of osteomyelitis caused by MRSA.

Topics: Animals; Anti-Bacterial Agents; Disease Models, Animal; Female; Methicillin Resistance; Minocycline; Osteomyelitis; Rats; Rats, Sprague-Dawley; Staphylococcal Infections; Staphylococcus aureus; Teicoplanin; Tigecycline; Treatment Outcome

Topics: Acinetobacter baumannii; Acinetobacter calcoaceticus; Aged; Anti-Bacterial Agents; Bacteremia; Calcaneus; Colistin; Humans; Male; Microbial Sensitivity Tests; Osteomyelitis

Since device colonization is a prelude to infection, an antimicrobial-coated device that reduces bacterial colonization can potentially protect against infection. The objective of this animal study was to assess the efficacy of a coating with minocycline and rifampin to prevent colonization of a grit-blasted titanium implant and subsequent osteomyelitis.. Twenty-five rabbits underwent implantation of a titanium-alloy pin, either coated with minocycline and rifampin (thirteen rabbits) or uncoated (twelve rabbits), into the right femoral medullary canal. The implanted devices were inoculated with 500 CFU (colony-forming units) of Staphylococcus aureus prior to wound closure. The rabbits were killed one week later, and the removed device, femoral bone, a specimen obtained by swabbing the track surrounding the device, and blood were cultured. The rates of device colonization, osteomyelitis, and device-related osteomyelitis were compared between the two groups of rabbits.. The antimicrobial-coated devices had a significantly lower rate of colonization than the uncoated devices (five of thirteen compared with twelve of twelve, p = 0.0016) and were associated with significantly lower rates of osteomyelitis (six of thirteen compared with twelve of twelve, p = 0.005) and device-related osteomyelitis (five of thirteen compared with twelve of twelve, p = 0.0016). Bacteremia did not develop in any rabbit.. Orthopaedic devices coated with minocycline and rifampin significantly protected against device colonization and infection due to Staphylococcus aureus in this in vivo rabbit model.. It is possible that orthopaedic devices coated with this unique combination of antimicrobial agents may protect against the development of clinical infection in humans.

Topics: Animals; Anti-Infective Agents; Drug Delivery Systems; Minocycline; Osteomyelitis; Prosthesis-Related Infections; Rabbits; Rifampin; Staphylococcal Infections

A 53-year-old woman experienced a multidrug-resistant (MDR) Acinetobacter baumannii urinary tract infection 5 months after undergoing kidney and liver transplantation. The tigecycline minimum inhibitory concentration (MIC) for her A. baumannii isolate was 1.5 microg/ml; the patient received 2 weeks of therapy with intravenous tigecycline as a 100-mg loading dose followed by 50 mg every 12 hours, with no lapses in treatment and with resolution of the infection. Three weeks later, MDR A. baumannii was isolated from her sputum in the setting of clinical evidence of pneumonia, and tigecycline was restarted; the tigecycline MIC for the A. baumannii isolate was 2 microg/ml. At approximately the same time, the patient was found to have a paraspinal abscess and spinal osteomyelitis. Cultures of the abscess fluid grew A. baumannii with a tigecycline MIC of 24 microg/ml. A follow-up sputum culture again yielded A. baumannii, but with a tigecycline MIC of 24 microg/ml. Urine culture at that time also grew A. baumannii with a tigecycline MIC of 24 microg/ml. Clinicians should be aware that tigecycline MICs for A. baumannii isolates may increase during therapy with tigecycline after only brief exposure to the drug. Patients receiving tigecycline for Acinetobacter should be monitored for the development of clinical resistance, and isolates should be monitored for evidence of microbiologic resistance.

Topics: Acinetobacter baumannii; Acinetobacter Infections; Anti-Bacterial Agents; Drug Resistance, Bacterial; Female; Humans; Kidney Transplantation; Liver Transplantation; Microbial Sensitivity Tests; Middle Aged; Minocycline; Osteomyelitis; Pneumonia, Bacterial; Spinal Diseases; Tetracycline Resistance; Tigecycline; Urinary Tract Infections

A case of osteomyelitis caused by multidrug-resistant Pseudomonas aeruginosa is reported in a patient who underwent allogeneic bone marrow transplantation for acute lymphoblastic leukaemia. The patient was successfully treated by prolonged administration of a full dose of colistin and tigecycline, and surgical curettage with the positioning of resorbable calcium sulfate pellets loaded with colistin.

Topics: Adult; Anti-Bacterial Agents; Bone Marrow Transplantation; Colistin; Drug Resistance, Multiple, Bacterial; Drug Therapy, Combination; Female; Humans; Minocycline; Osteomyelitis; Pseudomonas aeruginosa; Pseudomonas Infections; Tigecycline; Transplantation, Homologous

Staphylococcus aureus is the most common organism isolated in osteomyelitis. Methicillin-resistant S. aureus (MRSA) infections are particularly difficult to treat. We evaluated the efficacy of tigecycline and vancomycin with and without rifampicin in a rabbit model of MRSA osteomyelitis.. A 28 day antibiotic therapy with a subcutaneous injection of tigecycline (14 mg/kg twice daily), with and without oral rifampicin (40 mg/kg twice daily); or subcutaneous administration of vancomycin (30 mg/kg twice daily), with and without oral rifampicin (40 mg/kg twice daily) were compared. Osteomyelitis was induced with an intramedullary injection of 10(6) colony-forming units of MRSA. Infected rabbits were randomly divided into six groups: tigecycline, tigecycline with oral rifampicin, vancomycin, vancomycin with oral rifampicin, and no treatment control and tigecycline bone penetration groups. Treatment began 2 weeks after infection. After 4 weeks of therapy, the rabbits were left untreated for 2 weeks. Rabbits were then euthanized, and the tibias were harvested. The bones were cultured, and bacterial counts of MRSA were performed.. Rabbits that received tigecycline and oral rifampicin therapy (n=14) showed a 100% infection clearance. Rabbits treated with tigecycline (n=10) showed a 90% clearance. Rabbits treated with vancomycin and oral rifampicin (n=10) also showed a 90% clearance. Rabbits treated with vancomycin (n=11) showed an 81.8% clearance. Untreated controls (n=15) demonstrated only a 26% clearance. For the tigecycline bone penetration group, the bone concentrations of tigecycline in the infected tibia were significantly higher than the non-infected ones.. Tigecycline may be an effective alternative to vancomycin in the treatment of MRSA osteomyelitis.

Topics: Animals; Bone and Bones; Disease Models, Animal; Drug Therapy, Combination; Methicillin Resistance; Minocycline; Osteomyelitis; Rabbits; Radiography; Rifampin; Staphylococcal Infections; Staphylococcus aureus; Tigecycline; Vancomycin

Mycobacterium haemophilum is a fastidious species that has been isolated from skin and subcutaneous nodules. The authors describe a case of Mycobacterium haemophilum osteomyelitis and skin infection in an AIDS patient and successful treatment with minocycline.

Topics: Acquired Immunodeficiency Syndrome; Adult; Diagnosis, Differential; Didanosine; Drug Therapy, Combination; Female; Humans; Minocycline; Mycobacterium Infections, Nontuberculous; Opportunistic Infections; Osteomyelitis; Tuberculosis, Osteoarticular; Zidovudine

A 47-year-old man with chronic osteomyelitis of the mandible is described. The patient had frequent episodes of acute and subacute exacerbation at varying intervals for a period of six years in spite of extended antibiotic therapy. Intraarterial infusion of antibiotics through the superficial temporal artery also failed to cause any improvement. He was finally treated successfully by surgical intervention.

Topics: Cephalexin; Chronic Disease; Drug Resistance; Humans; Injections, Intra-Arterial; Male; Mandibular Diseases; Middle Aged; Minocycline; Necrosis; Osteomyelitis; Tetracyclines

Topics: Adult; Drug Resistance, Microbial; Erythromycin; Humans; Male; Minocycline; Osteomyelitis; Penicillin Resistance; Staphylococcal Infections; Tetracycline