piperacillin--tazobactam-drug-combination and Osteomyelitis

Bile cast nephropathy is a condition of renal dysfunction in the setting of hyperbilirubinemia. There are very few cases of this condition reported in the last decade and a lack of established treatment guidelines. While the exact etiology remains unknown, bile cast nephropathy is presumed to be secondary to multiple concurrent insults to the kidney including direct toxicity from bile acids, obstructive physiology from bile casts, and systemic hypoperfusion from vasodilation. Therapy directed at bilirubin reduction may improve renal function, but will likely need dialysis or plasmapheresis as well. We report our case of bile cast nephropathy and the therapeutic measures undertaken in a middle-aged male with chronic renal insufficiency that developed hyperbilirubinemia and drug-induced liver injury secondary to antibiotic use. He developed acute renal injury in the setting of rising bilirubin. He subsequently had a progressive decline in renal and hepatic function, requiring dialysis and plasmapheresis with some improvement, ultimately requiring transplantation.

Topics: Acute Kidney Injury; Adrenal Cortex Hormones; Anion Exchange Resins; Anti-Bacterial Agents; Biopsy; Chemical and Drug Induced Liver Injury, Chronic; Cholagogues and Choleretics; Cholestyramine Resin; Humans; Hyperbilirubinemia; Jaundice, Obstructive; Male; Middle Aged; Osteomyelitis; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination; Plasmapheresis; Renal Dialysis; Renal Insufficiency, Chronic; Ursodeoxycholic Acid

Topics: Anti-Bacterial Agents; Antifungal Agents; beta-Lactamase Inhibitors; Candida albicans; Drug Hypersensitivity Syndrome; Eosinophilia; Fluconazole; Humans; Lymphohistiocytosis, Hemophagocytic; Osteomyelitis; Piperacillin, Tazobactam Drug Combination; Pseudomonas aeruginosa; Staphylococcus aureus

Topics: Actinomyces; Actinomycosis; Aged; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Doxycycline; Humans; Male; Mandibular Diseases; Osteomyelitis; Piperacillin, Tazobactam Drug Combination

Topics: Administration, Intravenous; Chronic Disease; Female; Floxacillin; Fractures, Bone; Humans; Mandibular Diseases; Metronidazole; Middle Aged; Osteomyelitis; Parotitis; Piperacillin, Tazobactam Drug Combination; Salivary Calculi; Tomography, X-Ray Computed; Ultrasonography

We present an elderly diabetic man with left hallux pain and drainage who was initially diagnosed with acute gouty arthritis using the diagnostic rule for acute gout and monosodium urate crystals presented on synovial fluid analysis. Further investigation with surgical debridement, plain X-ray, MRI and wound culture revealed concomitant

Topics: Aged, 80 and over; Anti-Bacterial Agents; Arthritis, Gouty; Citrobacter koseri; Debridement; Diabetic Foot; Enterobacteriaceae Infections; Ertapenem; Humans; Male; Osteomyelitis; Piperacillin, Tazobactam Drug Combination; Treatment Outcome; Vancomycin

Topics: Aged; Anti-Bacterial Agents; Ciprofloxacin; Diabetes Mellitus, Type 2; Diabetic Foot; Humans; Male; Osteomyelitis; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination; Treatment Outcome

Few data are available on the nephrotoxic potential of vancomycin when combined with certain β-lactam antibiotics for the treatment of osteomyelitis (OM). A retrospective cohort study was conducted of all diabetic patients with OM treated with vancomycin plus piperacillin-tazobactam (VPT) or vancomycin plus cefepime (VC) for at least 72 h at a VA Medical Center between 1 January 2006 and 31 December 2011. All patients with a creatinine clearance (CrCl) of ≤ 40 mL/min, a blood urea nitrogen/serum creatinine (SCr) ratio of ≥ 20 : 1 or an absolute neutrophil count of <500 cells/mm(3) were excluded. The primary outcome was development of acute renal failure (ARF), defined as an increase in SCr of 0.5 mg/dL or 50% of baseline. One hundred and thirty-nine patients met the inclusion criteria; 109 in the piperacillin-tazobactam group and 30 in the cefepime group. Among patients receiving VPT, 29.3% (32/109) developed ARF, as compared with 13.3% (4/30) receiving VC (p 0.099). Among patients receiving high-dose therapy (≥ 18 g of piperacillin-tazobactam daily or ≥ 3 g of cefepime daily), 37.5% (9/24) receiving VPT and 17.6% (3/17) receiving VC developed ARF (p 0.29). A multiple logistic regression analysis identified weight and average vancomycin trough as the only significant predictors of ARF; the choice of VPT as therapy yielded an OR of 3.45 (95% CI 0.96-12.40; p 0.057). The authors were unable to detect a statistically significant difference in ARF between groups; however, the power requirement was not met. Further study with a larger patient population seems warranted.

Topics: Acute Kidney Injury; Anti-Bacterial Agents; Cefepime; Cephalosporins; Cohort Studies; Diabetes Complications; Drug Therapy, Combination; Humans; Incidence; Middle Aged; Osteomyelitis; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination; Retrospective Studies; Vancomycin

Morganella morganii is a gram-negative, facultative anaerobic bacillus whose natural habitat is the gastrointestinal system. While it rarely causes infection alone, it is generally encountered in people with suppressed immunity and in cases of hospital infection. It may also manifest itself as a superinfection. Morganella morganii often demonstrates a course characterized by slow-paced progression with occasional attacks and remissions. Osteoarticular pathologies are not commonly observed in Morganella morganii infections and it has a high mortality rate. We present a 56-year-old male patient with Morganella morganii osteomyelitis in the distal femur and proximal tibia, complicated by septic arthritis in the knee joint.

Topics: Anti-Bacterial Agents; Arthritis, Infectious; Enterobacteriaceae Infections; Fatal Outcome; Femur; Humans; Knee Joint; Magnetic Resonance Imaging; Male; Middle Aged; Morganella morganii; Osteomyelitis; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination; Tibia

Topics: Cervical Vertebrae; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Osteomyelitis; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination; Pseudomonas aeruginosa; Pseudomonas Infections; Radiography; Smoking

Topics: Acute Disease; Anti-Bacterial Agents; Drug Interactions; Drug Therapy, Combination; Humans; Male; Meropenem; Middle Aged; Nephritis, Interstitial; Osteomyelitis; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination; Thienamycins

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

Chronic bone and soft tissue suppurations have become more frequent recently due to the increasing number of high-energy injuries. There are certain antibiotic beads available for local administration, but they cannot always be applied specifically against the pyogenic microorganisms. In the present study, a new technique of local antibiotic therapy for the treatment of infections is described. Polymethylmethacrylate (PMMA) capsules were produced and filled with 0.1 ml Tazocin (0.02 g piperacillin sodium + 0.005 g tazobactam). The efficacy of these Tazocin-filled capsules was examined in vivo using a rabbit osteomyelitis model. Chronic osteomyelitis was induced in rabbit tibia by local injection of Staphylococcus aureus. The treatment included surgical debridement and implantation of Tazocin-containing PMMA capsules into the medullar cavity (n = 12). Simple surgical debridement with no antibiotic implantation was performed in control animals (n = 7). Results were evaluated using microbiological, radiological and histological methods 14 weeks after induction of osteomyelitis. Eight weeks after the implantation of PMMA capsules, complete physical, radiological and histological healing was achieved in 7 animals, initiation of the reparative phase was observed histologically in 3 cases and no reparative signs were detected in 2 rabbits. In the control group, no significant sign of reparation could be seen in any of the cases.

Topics: Animals; Anti-Bacterial Agents; Capsules; Chronic Disease; Delayed-Action Preparations; Disease Models, Animal; Drug Implants; Male; Osteomyelitis; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination; Polymethyl Methacrylate; Rabbits; Staphylococcal Infections; Staphylococcus aureus; Tibia

Of 41 patients with bone-related infections who were treated for > or =10 days with piperacillin-tazobactam, 14 (34%) developed neutropenia. Cumulative doses of piperacillin administered to neutropenic patients were higher than those administered to nonneutropenic ones (330 vs. 237 g; P=.008), and an inverse correlation was detected between the absolute neutrophil count at the end of treatment and the cumulative dose of piperacillin (r=-0.47, P=.002). Moreover, the incidence of piperacillin-tazobactam-induced neutropenia increased with an increase in the cumulative dose of piperacillin: 0% of patients in the first quartile of cumulative piperacillin doses, 33.3% in the second quartile, 40% in the third quartile, and 66.7% in the fourth quartile.

Topics: Age Factors; Aged; Drug Therapy, Combination; Female; Fever; Humans; Incidence; Male; Middle Aged; Neutropenia; Osteomyelitis; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination