piperacillin--tazobactam-drug-combination and Diarrhea

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

A 33-year-old man presented repeatedly with severe abdominal pain and diarrhoea. Renal colic was suspected, and he was admitted for pain management. Questioning elicited an additional history of sore throat and mild, dry cough. Inflammatory markers were mildly raised (C reactive protein (CRP) 40 mg/L). Initial nasopharyngeal swabs were negative for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) by PCR. CT of the kidneys, ureters and bladder (CT KUB) was normal; however, CT of the thorax showed multifocal bilateral peripheral areas of consolidation consistent with COVID-19 infection. He developed respiratory compromise and was transferred to the intensive care unit (ICU). Sputum was positive for SARS-CoV-2 by PCR, and culture grew

Topics: Abdominal Pain; Adult; Anti-Bacterial Agents; Betacoronavirus; Coronavirus Infections; COVID-19; Critical Care; Diagnosis, Differential; Diarrhea; Humans; Lung; Male; Pandemics; Piperacillin, Tazobactam Drug Combination; Pneumonia, Viral; SARS-CoV-2; Sputum; Tomography, X-Ray Computed; Treatment Outcome; Yersinia enterocolitica

A heart transplant 62-year-old patient referred for coronavirus-19 disease (COVID-19) pneumonia. At admission, he was febrile, tachypnoeic, and mild hypoxic with dry cough; during hospitalization, a diffuse morbilliform skin rash appeared. He was treated with tocilizumab with symptoms improvement, without a complete pulmonary function recovery. Skin rash, highly suggestive for COVID-19 cutaneous involvement, persisted for ten days despite tocilizumab administration.

Topics: Anti-Bacterial Agents; Antibodies, Monoclonal, Humanized; Anticoagulants; Cardiomyopathy, Dilated; Cough; COVID-19; COVID-19 Drug Treatment; Diarrhea; Enoxaparin; Enzyme Inhibitors; Exanthema; Fever; Glucocorticoids; Heart Transplantation; Humans; Hydroxychloroquine; Hypoxia; Immunocompromised Host; Immunosuppressive Agents; Male; Methylprednisolone; Middle Aged; Nausea; Piperacillin, Tazobactam Drug Combination; Pulmonary Disease, Chronic Obstructive; Renal Insufficiency, Chronic; SARS-CoV-2; Tachypnea; Treatment Outcome

Topics: Aged; Cholecalciferol; Clonazepam; Diarrhea; Esomeprazole; Female; Fluconazole; Humans; Nausea; Ondansetron; Piperacillin, Tazobactam Drug Combination; Syncope; Torsades de Pointes; Vancomycin

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

Patients with toxigenic Clostridium difficile colonization (tCDC) are at risk of developing C. difficile-associated diarrhea (CDAD). However, the risk factors of hospitalized patients with tCDC developing CDAD are not clear.. We conducted an 18-month prospective study at a medical ward in a district hospital in southern Taiwan. Within 48 hours of admission, weekly stool samples from asymptomatic hospitalized patients were obtained to detect fecal CDC. A polymerase chain reaction for tcdB was performed to determine toxigenic isolates. CDAD was diagnosed if the patient had diarrhea and toxigenic C. difficile present in a stool sample.. A total 483 patients with stool samples were eligible for the study. Eighty-six (17.8%) patients had tCDC after screening, of whom 14 (16.3%) developed CDAD during follow-up. Among those with tCDC, patients with subsequent CDAD were more likely to have diabetes mellitus (p = 0.01) and to have received piperacillin-tazobactam (p = 0.04), or proton-pump inhibitors (PPIs; p = 0.04) than those without developing CDAD. The variables were statistically significant as determined by multivariate analysis. However, the 60-day crude mortality rates among tCDC patients with and without subsequent development of CDAD were similar.. Diabetes mellitus and recent receipt of piperacillin-tazobactam or PPIs are independent risk factors for the development of CDAD among hospitalized patients with tCDC.

Topics: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Bacterial Proteins; Bacterial Toxins; Clostridioides difficile; Clostridium Infections; Diabetes Complications; Diarrhea; Feces; Female; Hospitalization; Hospitals, District; Humans; Male; Middle Aged; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination; Polymerase Chain Reaction; Prospective Studies; Proton Pump Inhibitors; Risk Factors; Taiwan

To investigate the prevalence and antibiotic resistance of Shigella isolated from children with diarrhea for the guidance of clinical treatment and prevention and control of bacillary dysentery.. A total of 156 strains of Shigella were isolated from feces of children with diarrhea in Zhejiang Xiaoshan Hospital from January 2008 to December 2010. The antimicrobial resistance of the strains was detected by disk diffusion method and the extended-spectrum beta-lactamases (ESBLs) in these isolates were determined using phenotypic confirmatory test; the isolates of ESBLs producing Shigella sonnei were analyzed by REP-PCR.. Among 156 strains of Shigella isolated, the most common groups were Shigella sonnei (130 strains, accounting for 83.3%) and Shigella fleaneri (26 strains, accounting for 16.7%), and 81 (51.9%) strains were identified as ESBLs producers, and the positive rates in 2008, 2009 and 2010 were 32.0%, 41.4% and 59.8%, respectively. The results of antibiotic susceptibility test displayed that the resistance rates of ESBLs producing Shigella to ampicillin, cotrimoxazole, cefotaxime, piperacillin were higher than 90%. However, the resistance rates to cefepime, ceftazidime, levofloxacin and ciprofloxacin were low; The resistance of ESBLs producing strains to piperacillin (100% vs. 77.3%), cefotaxime (100% vs. 0), ceftazidime (14.8% vs. 0), cefepime (28.4% vs. 0), cotrimoxazole (95.1% vs. 86.7%) was significantly higher than that of non-ESBLs producing strains (χ(2) = 20.605, 156.000, 12.037, 24.979, 45.040, respectively; P < 0.05). No isolate was resistant to piperacillin/tazobactam and imipenem. There were 7 genotypes among 74 ESBLs producing Shigella sonnei, respectively type A (50), type B (12), type C (8), type D (1), type E (1), type F (1), and type G (1).. The isolation rate of ESBLs-producing isolate was high in Shigella from pediatric patients with diarrhea, and the number is going up year by year, and these ESBLs producing Shigella sonnei strains in genotype A are dominant in recent years, Piperacillin/tazobactam is the drug of choice for children with ESBLs producing Shigella infection.

Topics: Adolescent; Anti-Bacterial Agents; beta-Lactamases; Child; Child, Preschool; Diarrhea; Drug Resistance, Multiple, Bacterial; Feces; Female; Genotype; Humans; Male; Microbial Sensitivity Tests; Molecular Epidemiology; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination; Polymerase Chain Reaction; Sequence Analysis, DNA; Shigella

We followed the effects of changes to a new antibiotic policy favouring a ureidopenicillin as opposed to a third-generation cephalosporin on the long-term incidence of Clostridium difficile diarrhoea (CDD) and antibiotic utilization in a large Elderly Medicine Unit.. In 1999, piperacillin-tazobactam was added to the formulary in Elderly Medicine and its use promoted in preference to cefotaxime. Following review and feedback to clinicians of surveillance data, cefotaxime prescribing was actively restricted during 2000-2001. An audit of prescriber adherence to antibiotic policy was carried out by reviewing the records of 159 patients during February-April 2001. In December 2001, due to manufacturer production problems, supply of piperacillin-tazobactam was stopped. We performed standardized period prevalence surveillance (February-April) allowing comparisons of antibiotic utilization and CDD incidence during the 5 year study period (1998-2002).. CDD incidence did not change significantly (P>0.1) during 1998-1999 despite a marked increase in piperacillin-tazobactam prescribing. However, when cefotaxime prescribing was curtailed in 2001, CDD rates decreased (in four of five wards) and overall by 52% (P=0.008). When piperacillin-tazobactam became unavailable in 2002, despite advice to the contrary cefotaxime prescribing rose five-fold, and CDD rates increased in four of five wards and by 232% (P<0.01) overall. Adherence to antibiotic policy introduced in 2000 was good (81% accordance); 94%, 88% and 73% of patients with cellulitis, urinary tract and respiratory tract infection, respectively, received appropriate antibiotics.. Long-term prescribing of piperacillin-tazobactam in Elderly Medicine in preference to cefotaxime is associated with reduced rates of CDD. However, unless cephalosporin prescribing is curtailed, the beneficial effects on CDD rates may be missed. This is one of few studies to document adverse effects due to loss of antibiotic supply.

Topics: Aged; Anti-Bacterial Agents; Cefotaxime; Cephalosporins; Clostridioides difficile; Diarrhea; Drug Prescriptions; Drug Resistance; Drug Utilization; Humans; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination; Public Policy; Retrospective Studies; United Kingdom