piperacillin--tazobactam-drug-combination and Abscess

Complicated intra-abdominal infections usually mandate prompt surgical intervention supplemented by appropriate antimicrobial therapy. The aim of this study was to demonstrate that ertapenem was not inferior to piperacillin-tazobactam for the treatment of community-acquired intra-abdominal infections. A randomized open-label active-comparator clinical trial was conducted at 48 medical centers on four continents from December 2001 to February 2003. Adult patients with intra-abdominal infections requiring surgery were randomized to receive either ertapenem 1 g daily or piperacillin/tazobactam 13.5 g daily in 3-4 divided doses. The primary analysis of efficacy was the clinical response rate in clinically and microbiologically evaluable patients at the test-of-cure assessment 2 weeks after completion of therapy. All treated patients were included in the safety analysis. Patient demographics, disease characteristics, and treatment duration in both treatment groups were generally similar. The most commonly isolated pathogens at baseline were E coli (greater than 50% of cases in each group) and B fragilis ( approximately 9%). Favorable clinical response rates were 107/119 (90%) for ertapenem recipients and 107/114 (94%) for piperacillin/tazobactam recipients. The frequencies of drug-related adverse events, most commonly diarrhea and elevated serum alanine aminotransferase levels, were similar in both treatment groups. Six of 180 ertapenem recipients (3%) and two of 190 piperacillin/tazobactam recipients (1%) had serious drug-related adverse experiences. In this study, ertapenem and piperacillin/tazobactam were comparably safe and effective treatments for adult patients with complicated intra-abdominal infections.

Topics: Abdomen; Abscess; Adolescent; Adult; Aged; Aged, 80 and over; Alanine Transaminase; Anti-Bacterial Agents; Bacterial Infections; Bacteroides fragilis; Bacteroides Infections; beta-Lactams; Diarrhea; Ertapenem; Escherichia coli Infections; Female; Gastrointestinal Diseases; Humans; Male; Middle Aged; Penicillanic Acid; Peritonitis; Piperacillin; Piperacillin, Tazobactam Drug Combination; Prospective Studies; Treatment Outcome

Recent studies are discordant regarding postoperative use of piperacillin/tazobactam (PT) versus ceftriaxone/metronidazole (CM) for pediatric complicated appendicitis. Some argue that the broader spectrum PT decreases intraabdominal abscess formation; however, antibiotic stewardship, and once-a-day dosing favor CM. We aim to compare outcomes of postoperative antibiotic utilization using a large administrative database.. We queried the Pediatric Health Information System for patients 2-18 years old who underwent laparoscopic appendectomy for complicated appendicitis between 2016 and 2021. Patients were grouped into PT, CM, or other using the first postoperative day antibiotics. Adverse events and antibiotic use trends were evaluated.. We included 29,015 children from 45 hospitals. CM was used in 51.9% and 31.3% received PT. Wide variation was seen among hospitals with PT use decreasing over the years. Overall rate of abscess was 9.2%. On multivariable regression, PT was associated with higher risk for abscess formation (RR 1.35, 99% CI 1.04-1.75) and readmission (RR 1.38, 99% CI 1.13-1.68) compared to the CM group. However, following adjustment for hospitals with high CM prevalence, these associations were no longer significant.. Postoperative use of PT for complicated appendicitis is associated with higher rates of readmissions and intraabdominal abscess when compared to CM. However, this effect is mitigated when adjusting for common practice patterns.. Level III.. Retrospective Comparative Study.

Topics: Abdominal Abscess; Abscess; Adolescent; Anti-Bacterial Agents; Appendectomy; Appendicitis; Ceftriaxone; Child; Child, Preschool; Humans; Metronidazole; Piperacillin, Tazobactam Drug Combination; Postoperative Complications; Retrospective Studies; Treatment Outcome

Topics: Abdominal Abscess; Abscess; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Ciprofloxacin; Colectomy; Diverticulitis, Colonic; Diverticulosis, Colonic; Drainage; Humans; Metronidazole; Piperacillin, Tazobactam Drug Combination; Retrospective Studies

Topics: Abscess; Anal Canal; Anti-Bacterial Agents; Granulomatous Disease, Chronic; Humans; Infant; Infections; Lymphadenitis; Male; Mutation; NADPH Oxidase 2; Neutrophils; Piperacillin, Tazobactam Drug Combination; Tracheostomy; Wound Healing

Nasal septal abscess (NSA) is a rare condition most commonly seen as a complication of nasal trauma. The diagnosis of NSA requires emergent treatment, because delayed management can result in significant morbidity. Typically, NSA presents as a purulent collection that can be managed with drainage, either surgically or at bedside.. We report an unusual presentation of a spontaneous NSA in a 7-year-old boy as a solid nasal mass eroding the nasal septum. The solid, tumor-like nature of the mass necessitated intervention beyond drainage and was ultimately excised. Imaging initiated in the emergency department revealed a partially cystic mass and erosion of the septum, which was key to the diagnosis. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Given the ease with which a diagnosis of NSA may be missed and the need for urgent management upon diagnosis of a NSA, we aim to highlight the clinical, radiologic, and histopathologic aspects that aid in diagnosis of NSA. Imaging, obtaining culture results, and initiation of antibiotics are paramount in management. In addition, NSAs may also necessitate bedside drainage given their emergent nature.

Topics: Abscess; Amoxicillin; Anti-Bacterial Agents; Child; Emergency Service, Hospital; Epistaxis; Fever; Humans; Magnetic Resonance Imaging; Male; Methicillin-Resistant Staphylococcus aureus; Nasal Septum; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination; Rupture, Spontaneous; Tomography, X-Ray Computed; Vancomycin

Topics: Abscess; Anti-Bacterial Agents; Debridement; Diabetes Mellitus, Type 2; Disease Susceptibility; Empyema, Pleural; Hematoma; Humans; Male; Middle Aged; Obesity, Morbid; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination; Pleural Effusion; Smoking; Streptococcal Infections; Streptococcus agalactiae; Thoracic Injuries; Wound Infection; Wounds, Nonpenetrating

Tubo-ovarian abscess (TOA) is a common acute complication of pelvic inflammatory disease (PID). It can also develop as a complication of pelvic or abdominal surgery, malignancy, and intra-abdominal processes such as appendicitis. In premenopausal women, PID is the most common cause of tubo-ovarian abscess. We report a case of tubo-ovarian abscess in a virginal adolescent female with no past surgical history and no known history of appendicitis, inflammatory bowel disease, or cancer. Cultures of the tubo-ovarian abscess drainage grew Abiotrophia/Granulicatella species. This case supports including TOA in the broad differential diagnosis for abdominal pain with fever in adolescent females regardless of sexual history.

Topics: Abscess; Aerococcaceae; Anti-Bacterial Agents; Carnobacteriaceae; Drug Therapy, Combination; Female; Gram-Positive Bacterial Infections; Humans; Metronidazole; Ovarian Cysts; Ovariectomy; Pelvic Inflammatory Disease; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination; Tomography, X-Ray Computed; Young Adult

Tuberculosis is a public health problem worldwide. Between 19% and 43% of the world's population is infected with Mycobacterium tuberculosis. Tubercular sternal osteomyelitis is a rare manifestation of tuberculosis. Tuberculous sternal osteomyelitis manifests with fever, weight loss, and chest wall lesions. Computed tomography (CT) scan defines the extent of the thoracic extension, and standard microbiologic methods diagnose this entity. Four-drug anti-tuberculous therapy is effective. The authors report a case of tuberculous osteomyelitis of the sternum not associated with pulmonary tuberculosis.

Topics: Abscess; Adult; Anti-Bacterial Agents; Antitubercular Agents; Drug Therapy, Combination; Humans; Male; Mycobacterium Infections; Mycobacterium tuberculosis; Ofloxacin; Osteomyelitis; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination; Sternum; Thorax; Tomography, X-Ray Computed; Tuberculosis; Vancomycin

A 43-year-old female with Staphyloccocus-induced perianal abscess, was admitted to hospital because of a clinical picture of acute renal failure and thrombotic microangiopathy. Schistocytes, thrombopenia, a negative Coombs test and no detectable plasma haptoglobin were diagnostic for thrombotic microangiopathy. Antibiotics, surgical drainage, plasmapheresis and fresh frozen plasma were given with a favourable evolution. We review the prognostic factors determining recovery of renal function and hematological abnormalities.

Topics: Abscess; Acute Kidney Injury; Adult; Amoxicillin-Potassium Clavulanate Combination; Anal Canal; Debridement; Drug Therapy, Combination; Female; Hemolytic-Uremic Syndrome; Humans; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination; Plasma; Plasmapheresis; Staphylococcal Infections; Thrombocytopenia

Topics: Abscess; Anti-Bacterial Agents; Child, Preschool; Drainage; Female; HIV Infections; Humans; Lymph Nodes; Parotid Diseases; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination; Pneumococcal Infections; Streptococcus pneumoniae; Treatment Outcome

Renal absceeses in childhood are rare and require hospitalization, antibiotic therapy and drainage.. Two cases of renal abscess in childhood are described. In both cases there was no history of either antecedent skin infection or urinary tract infection or reflux. Flank pain and fever had a sudden onset.. The diagnosis was made in the first case by ultrasound and gadolinium-enhnaced magnetic resonance, in the second case ultrasound and computerized axial tomography were used. The patients were successfully treated at home with antibiotic therapy but without drainage.. Renal abscesses must be suspected in children with loin pain, fever and leukocytosis. They may heal even without hospitalization and drainage.

Topics: Abscess; Adolescent; Anti-Bacterial Agents; Ceftriaxone; Child; Drainage; Female; Hospitalization; Humans; Kidney; Kidney Diseases; Male; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination; Radiography; Staphylococcal Infections; Ultrasonography