piperacillin--tazobactam-drug-combination and Candidiasis

Coronavirus disease 2019 (COVID-19) has been demonstrated to be the cause of pneumonia. Nevertheless, it has not been reported as the cause of acute myocarditis or fulminant myocarditis.. A 63-year-old male was admitted with pneumonia and cardiac symptoms. He was genetically confirmed as having COVID-19 according to sputum testing on the day of admission. He also had elevated troponin I (Trop I) level (up to 11.37 g/L) and diffuse myocardial dyskinesia along with a decreased left ventricular ejection fraction (LVEF) on echocardiography. The highest level of interleukin-6 was 272.40 pg/ml. Bedside chest radiographs showed typical ground-glass changes indicative of viral pneumonia. Laboratory test results for viruses that cause myocarditis were all negative. The patient conformed to the diagnostic criteria of the Chinese expert consensus statement for fulminant myocarditis. After receiving antiviral therapy and mechanical life support, Trop I was reduced to 0.10 g/L, and interleukin-6 was reduced to 7.63 pg/mL. Moreover, the LVEF of the patient gradually recovered to 68%. The patient died of aggravation of secondary infection on the 33rd day of hospitalization.. COVID-19 patients may develop severe cardiac complications such as myocarditis and heart failure. This is the first report of COVID-19 complicated with fulminant myocarditis. The mechanism of cardiac pathology caused by COVID-19 needs further study.

Topics: Acute Disease; Antiviral Agents; Bacteroides Infections; Betacoronavirus; Biomarkers; Candidiasis; Coronavirus Infections; COVID-19; Drug Combinations; Echocardiography; Fatal Outcome; Humans; Interleukin-6; Lopinavir; Male; Middle Aged; Myocarditis; Pandemics; Piperacillin, Tazobactam Drug Combination; Pneumonia, Viral; Ritonavir; SARS-CoV-2; Stroke Volume; Tomography, X-Ray Computed; Troponin I

To analyze the clinical characteristics of continuous ambulatory peritoneal dialysis (CAPD) associated peritonitis in the tertiary hospitals and to discuss the preventive and therapeutic strategy.
 Methods: The clinical characteristics, pathogens, resistance and outcomes of 126 CAPD associated peritonitis in 104 patients from Jan, 2013 to June, 2016, were retrospectively analyzed.
 Results: Among the patients, the incidence rates of abdominal pain, fever, diarrhea and emesis were 104 (82.54%), 56 (44.44%), 49 (38.89%), and 31 (23.60%), respectively. Among them, 88 patients suffered peritonitis once, other 16 patients suffered multiple peritonitis or recurrent peritonitis for 38 times. Among the 38 times, the numbers for recurrent, repeated or catheter-associated peritonitis were 2, 2, or 3, respectively. Peritoneal fluids from 103 cases were cultured, and 64 cases were positive in bacteria, with a rate of 62.14%. A total of 70 strains of bacteria were separated, including 42 strains of gram-positive bacteria, 21 strains of gram-negative bacteria, and 7 strains of fungus. The most common gram-positive pathogens were Staphylococcus epidermidis, Enterococcus faecalis and Staphylococcus haemolyticus, while Escherichia coli, Klebsiella pneumoniae and Klebsiella pneumoniae were the most common gram-negative bacteria. Candida albicans was the major fungal pathogens. Gram-positive cocci showed resistance to gentamycin, levofloxacin, moxifloxacin, vancomycin and linezolid, with a rate at 20.00%, 36.11%, 5%, 0%, and 0%, respectively. The gram-negative bacilli were resistent to cefoperazone/sulbactam, gentamycin, cephazolin, and ceftazidime, with a rate at 6.25%, 10.53%, 64.29%, and 15.38%, respectively. There were no imipenem, amikacin, piperacillin/tazobactam-resistant strains were found.
 Conclusion: The most common pathogen causing CAPD associated peritonitis is gram-positive bacteria. It is crucial to take the anti-infection therapy for CAPD associated peritonitis early. The positive rates for bacterial culture need to be enhanced through improvement of methods. At the same time, doctors could improve the outcome of CAPD associated peritonitis by adjusting the medication according to the drug sensitivity results.. 目的：探讨某三甲医院持续性非卧床腹膜透析(continuous ambulatory peritoneal dialysis，CAPD)相关性腹膜炎临床特点、致病菌分布及耐药性情况，为临床防治CAPD相关性腹膜炎总结经验。方法：回顾性调查该院2013年1月至2016年6月42个月中，104人126例次CAPD相关性腹膜炎患者的临床特点、致病菌分布、耐药性等情况。
结果：在126例次CAPD相关性腹膜炎中，患者出现腹痛104例次(82.54%)，发热56例次(44.44%)，腹泻49例次(38.89%)，呕吐31例次(23.60%)。126例次CAPD相关性腹膜炎中，发生一次腹膜炎的88人次，多次和反复发作的腹膜炎16人38例次，其中复发性腹膜炎2例，腹膜炎重现2例，导管相关性腹膜炎3例。在103例送检的腹水标本中，培养阳性64例次，阳性率达62.14%。共分离出致病菌70株，其中革兰阳性细菌42株，革兰阴性细菌21株，真菌7株。主要的革兰阳性菌包括表皮葡萄球菌、粪肠球菌、溶血葡萄球菌；主要的革兰阴性菌包括大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌；真菌以白假丝酵母菌为主。革兰阳性菌对庆大霉素、左氧氟沙星、莫西沙星、万古霉素、利奈唑胺的耐药率分别为20.00%，36.11%，5.00%，0%，0%；革兰阴性菌对头孢哌酮/舒巴坦、庆大霉素、头孢唑啉、头孢他啶的耐药率分别为6.25%，10.53%，64.29%，15.38%，对亚胺培南、阿米卡星、哌拉西林/他唑巴坦的耐药率均为0%。结论：革兰阳性菌是CAPD相关性腹膜炎的主要致病菌，临床不仅应尽早开始经验性治疗，而且要考虑如何通过改善培养方法以提高阳性检出率；可以根据药敏结果调整用药，以促进患者CAPD相关性腹膜炎的治愈和腹膜功能的恢复。.

Topics: Abdominal Pain; Anti-Bacterial Agents; Bacteria; Bacterial Infections; Candidiasis; Catheters; Diarrhea; Drug Resistance, Bacterial; Enterococcus faecalis; Escherichia coli; Fever; Gram-Negative Bacteria; Gram-Positive Bacteria; Humans; Imipenem; Klebsiella pneumoniae; Microbial Sensitivity Tests; Mycoses; Penicillanic Acid; Peritoneal Dialysis; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis; Piperacillin; Piperacillin, Tazobactam Drug Combination; Recurrence; Retrospective Studies; Staphylococcus epidermidis; Staphylococcus haemolyticus; Vomiting

Immunosuppressive patients are at risk of fungal and bacterial infections. Therefore, these patients receive prophylactic, preemptive, empirical or target antifungal and concomitant antibiotic therapy. To this end, caspofungin (CAS) or voriconazole (VRC) antifungals and cefoperazone-sulbactam (CPZ/SAM) or piperacillin-tazobactam (PIP/TAZ) antibiotics may be used. Here, we aimed to investigate the interaction between these antifungals and antibiotics by in vitro and in vivo methods. The interaction was tested by chequerboard analysis and fractional inhibitory concentration index (FICI). It was also tested in a neutropenic mice-invasive candidiasis model and evaluated by fungal burden in kidney tissue of infected animals from the first day to the fifth day of treatment with 24 h intervals. A synergism was detected between CAS and CPZ/SAM (FICI = 0.1) and PIP/TAZ (FICI = 0.3). Fungal burden in tissues of drug-treated mice was reduced compared with controls in a time-dependent manner. In comparison with CAS-alone treated group, there were 1.32 log10 reductions of fungal burden in CAS + CPZ/SAM (p = 0.002) and in CAS + PIP/TAZ group (p = 0.14). The same interactions were not found with VRC and antibiotics. CPZ/SAM had stronger synergistic interaction with CAS than PIP/TAZ. The mechanism of synergism is not well understood. This is most likely due to an increase in the anticandidal effect of CAS plus antibiotics.

Topics: Animals; Anti-Bacterial Agents; Antifungal Agents; Bacterial Infections; Candida albicans; Candidiasis; Caspofungin; Cefoperazone; Drug Interactions; Echinocandins; Female; Lipopeptides; Mice; Mice, Inbred BALB C; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination; Pyrimidines; Sulbactam; Triazoles; Voriconazole

Candida species are a common cause of bloodstream infection among hospitalized patients. Increasingly these infections are caused by strains resistant to commonly used antifungal agents. The aim of this study was to assess the association between exposure to specific antimicrobial agents and subsequent bloodstream infection with fluconazole-non-susceptible and fluconazole-susceptible Candida strains. A retrospective case-case-control study was performed. From 2002 to 2006, 50 consecutive patients with hospital-acquired bloodstream infection caused by Candida strains not fully susceptible to fluconazole were identified (case group 1). For comparison, 54 patients with fluconazole-susceptible candidaemia (case group 2) and a control group of 104 patients without candidaemia were studied. Models were adjusted for demographic and clinical risk factors. The risk for candidaemia associated with exposure to specific antimicrobial agents was assessed. Piperacillin/tazobactam (odds ratio (OR) 6.8, 95% confidence interval (CI) 1.4-32.2) and ciprofloxacin (OR 8.0, 95% CI 1.5-42.5), but not fluconazole, were significant risk factors for bloodstream infection with fluconazole-non-susceptible Candida. Only ciprofloxacin (OR 7.8, 95% CI 1.2-50.7) was associated with bloodstream infection with fluconazole-susceptible Candida. Despite adjustment for prior exposure to fluconazole, exposure to specific antibacterial agents was associated with hospital-acquired bloodstream infection with fluconazole-non-susceptible Candida.

Topics: Adult; Antifungal Agents; Candida; Candidiasis; Ciprofloxacin; Drug Resistance, Fungal; Fluconazole; Fungemia; Humans; Logistic Models; Odds Ratio; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination; Retrospective Studies; Risk Factors

Severe granulocytopenia predispose patients with Felty's syndrome to severe infectious diseases. The following report deals with an occurrence of chronic disseminated candidiasis in a patient with Felty's syndrome who presented with prolonged and severe granulocytopenia. To the best of our knowledge this coexistence has never been described before.

Topics: Anti-Bacterial Agents; Anti-Inflammatory Agents; Blood Transfusion; Candidiasis; Felty Syndrome; Female; Filgrastim; Granulocyte Colony-Stimulating Factor; Humans; Middle Aged; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination; Prednisone; Recombinant Proteins; Spleen; Splenectomy; Treatment Outcome

The incidence of infections caused by Candida glabrata and Candida krusei, which are generally more resistant to fluconazole than Candida albicans, is increasing in hospitalized patients. However, the extent to which prior exposure to specific antimicrobial agents increases the risk of subsequent C. glabrata or C. krusei candidemia has not been closely studied. A retrospective case-case-control study was performed at a university hospital. From 1998 to 2003, 60 patients were identified with hospital-acquired non-C. albicans candidemia (C. glabrata or C. krusei; case group 1). For comparison, 68 patients with C. albicans candidemia (case group 2) and a common control group of 121 patients without candidemia were studied. Models were adjusted for demographic and clinical risk factors, and the risk for candidemia associated with exposure to specific antimicrobial agents was assessed. After adjusting for both nonantimicrobial risk factors and receipt of other antimicrobial agents, piperacillin-tazobactam (odds ratio [OR], 4.15; 95% confidence interval [CI], 1.04 to 16.50) and vancomycin (OR, 6.48; CI, 2.20 to 19.13) were significant risk factors for C. glabrata or C. krusei candidemia. For C. albicans candidemia, no specific antibiotics remained a significant risk after adjusted analysis. Prior fluconazole use was not significantly associated with either C. albicans or non-C. albicans (C. glabrata or C. krusei) candidemia. In this single-center study, exposure to antibacterial agents, specifically vancomycin or piperacillin-tazobactam, but not fluconazole, was associated with subsequent hospital-acquired C. glabrata or C. krusei candidemia. Further studies are needed to prospectively analyze specific antimicrobial risks for nosocomial candidemia across multiple hospital centers.

Topics: Anti-Infective Agents; Candida glabrata; Candidiasis; Case-Control Studies; Cross Infection; Female; Fluconazole; Fungemia; Humans; Male; Middle Aged; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination; Retrospective Studies; Risk Factors; Vancomycin