piperacillin--tazobactam-drug-combination and Postoperative-Complications

The incidence of endophthalmitis after pars plana vitrectomy is low. Silicone oil is a tamponading agent which has anti-microbial activity. Post-operative endophthalmitis following vitrectomy with silicone oil tamponade has been rarely reported. We describe the case of a young male who underwent pars plana vitrectomy with silicone oil for retinal detachment with a giant retinal tear. He developed a clinical picture suggestive of endophthalmitis on the first post-operative day, and vitreous culture grew multidrug-resistant Pseudomonas aeruginosa. He was treated with intravitreal piperacillin/tazobactam, along with appropriate surgical management. This was followed by resolution of the infection with a remarkable improvement in visual acuity. This is the first case of multidrug-resistant Pseudomonas aeruginosa endophthalmitis following pars plana vitrectomy with silicone oil treated successfully with piperacillin/tazobactam.

Topics: Anti-Bacterial Agents; Drug Resistance, Multiple, Bacterial; Endophthalmitis; Humans; Male; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination; Postoperative Complications; Pseudomonas aeruginosa; Pseudomonas Infections; Retinal Detachment; Retinal Perforations; Silicone Oils; Visual Acuity; Vitrectomy; Young Adult

The authors had for aim to assess the effectiveness and toxicity of a piperacillin-tazobactam-netilmicin combination, and the possibility of avoiding using glycopeptide, in children with febrile neutropenic episodes induced by chemotherapy.. A retrospective study was made, including children treated for a febrile neutropenic episode (absolute neutrophile count < 0.5 x 10(9)/l) by a piperacillin-tazobactam-netilmicin combination. If fever persisted 48 hours after the beginning of antibiotic therapy, a glycopeptide could be added. The responses to the treatment were defined as follows: 1) total success (no fever or documented infection) at 48 hours and at 72 hours following the beginning of treatment; 2) partial success (apyrexia beyond 72 hours without any therapeutic change); 3) failure (persistent infectious signs 48 hours after the introduction of glycopeptide).. Sixty-nine episodes were assessable, corresponding to 41 patients, treated for a solid tumour (29), an acute leukaemia in remission (11), or a metabolic disease (1). The febrile episodes were divided into fever of unknown origin (71%), microbiologically documented fever (12%), and clinically documented fever (17%). No death occurred, no toxicity was reported. With this antibiotic therapy, total success at 72 hours was observed in 72% in case of fever of unknown origin and 45% in case of documented infections. The success rate reached 84% when a glycopeptide was added (30% of the cases).. The piperacillin-tazobactam-netilmicin combination is very effective and well tolerated in probabilistic treatment of febrile neutropenia induced by chemotherapy, but does not allow to decreasing the frequency of glycopeptide administration.

Topics: Adolescent; Anti-Bacterial Agents; Antineoplastic Agents; Bacterial Infections; Child; Child, Preschool; Clinical Trials as Topic; Drug Combinations; Drug Evaluation; Escherichia coli Infections; Female; Fever; Fever of Unknown Origin; Hematopoietic Stem Cell Transplantation; Humans; Immunocompromised Host; Infant; Male; Neoplasms; Netilmicin; Neutropenia; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination; Postoperative Complications; Retrospective Studies; Treatment Outcome; Urinary Tract Infections

An optimum antimicrobial regimen for bacterial infection after orthotopic liver transplantation has not been identified. In this prospective 4 year study of patients undergoing liver transplantation, patients were randomized to receive either piperacillin-tazobactam (112 patient episodes) or ciprofloxacin plus amoxicillin (105 patient episodes) for empirical treatment of infective episodes in the first 3 months after transplant. Metronidazole was added to the ciprofloxacin-amoxicillin regimen where anaerobic infection was suspected. Patient groups were comparable with respect to clinical, biochemical and haematological parameters. At the 72 h primary efficacy end-point, the overall response rate for the intention-to-treat group was 74/112 (66.1%) for piperacillin-tazobactam and 63/105 (60.0%) for ciprofloxacin plus amoxicillin (P=0.399); the corresponding figures for the per-protocol (PP) group were 73/82 (89.0%) (piperacillin-tazobactam) and 61/80 (76.3%) (ciprofloxacin plus amoxicillin) (P=0.038). At the end-of-study assessment, 58.9% of episodes in the piperacillin-tazobactam group had a successful clinical outcome, compared with 50.5% in the ciprofloxacin plus amoxicillin group (P=0.222); the corresponding figures for the PP group were 83.5% (piperacillin-tazobactam) and 68.8% (ciprofloxacin plus amoxicillin) (P=0.038). Staphylococci and aerobic Gram-negative bacilli were the predominant pathogens in both groups. Bacteria resistant to the study drugs were encountered, including methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus faecium and multiply-resistant Klebsiella spp. Empirical monotherapy with piperacillin-tazobactam is an effective treatment for infective episodes in liver transplant patients.

Topics: Adolescent; Adult; Aged; Amoxicillin; Anti-Bacterial Agents; Bacterial Infections; Ciprofloxacin; Double-Blind Method; Drug Therapy, Combination; Enterobacteriaceae; Female; Fever; Humans; Liver Transplantation; Male; Metronidazole; Middle Aged; Penicillanic Acid; Penicillins; Piperacillin; Piperacillin, Tazobactam Drug Combination; Postoperative Complications; Prospective Studies; Staphylococcus aureus

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

Narrow-spectrum antibiotics have been found to be equivalent to anti-Pseudomonal agents in preventing organ space infections (OSI) in children with uncomplicated appendicitis. Comparative effectiveness data for children with complicated appendicitis remains limited. This investigation aimed to compare outcomes between the most common narrow-spectrum regimen (ceftriaxone with metronidazole: CM) and anti-Pseudomonal regimen (piperacillin/tazobactam: PT) used perioperatively in children with complicated appendicitis.. Multicenter retrospective cohort study using clinical data from the NSQIP-Pediatric Appendectomy Collaborative database merged with antibiotic utilization data from the Pediatric Health Information System database. Mixed-effects multivariate regression was used to compare NSQIP-defined outcomes and resource utilization between treatment groups after adjusting for patient characteristics, disease severity, and clustering of outcomes within hospitals.. 654 patients from 14 hospitals were included, of which 37.9% received CM and 62.1% received PT. Following adjustment, patients in both groups had similar rates of OSI (CM: 13.3% vs. PT: 18.0%, OR 0.88 [95%CI 0.38, 2.03]), drainage procedures (CM: 8.9% vs. PT: 14.9%, OR 0.76 [95%CI 0.30, 1.92]), and postoperative imaging (CM: 19.8% vs. PT: 22.5%, OR 1.17 [95%CI 0.65, 2.12]). Treatment groups also had similar rates of 30-day cumulative post-operative length of stay (CM: 6.1 vs. PT: 6.0 days, RR 1.01 [95%CI 0.81, 1.25]) and hospital cost (CM: $19,235 vs. PT: $20,552, RR 0.92 [95%CI 0.69, 1.23]).. Rates of organ space infection and resource utilization were similar in children with complicated appendicitis treated with ceftriaxone plus metronidazole and piperacillin/tazobactam.. Level III: Treatment study - Retrospective comparative study.

Topics: Anti-Bacterial Agents; Appendectomy; Appendicitis; Ceftriaxone; Child; Humans; Metronidazole; Piperacillin, Tazobactam Drug Combination; Postoperative Complications; Retrospective Studies

Patients with complicated appendicitis frequently develop postoperative septic complications. There are no uniform standards for the choice of perioperative antibiotic prophylaxis and the duration of postoperative antibiotic treatment. The purpose of this study was to investigate associations between microbiological samples and postoperative complications.. Patients with appendectomy and positive intraoperative swabs during 2013-2018 were included in this case-control study. Pathogen classes and their resistance patterns were evaluated in initial and follow-up swabs and compared in each of the groups with and without complications.. A total of 870 patients underwent surgery during the period studied. Pathogen detection succeeded in 102 of 210 cases (48.6%) with suspected bacterial peritoneal contamination. Conversion from laparoscopic to open intra-abdominal perforation and the presence of an abscess were independent risk factors for wound infections in the multivariate analysis. The combination of different classes of pathogens resulted in significantly increased overall resistance to ampicillin/sulbactam in both the initial swabs (57%) and the follow-up swabs (73%). Resistant E. coli strains combined with certain anaerobes were also regularly detected in postoperative intra-abdominal abscesses. Piperacillin/tazobactam was effective against 83% of positive swabs in our resistance tests.. Surgical treatment for complicated appendicitis remains the central therapeutic column. A regular review of the existing resistance patterns in perforated appendicitis can help to adjust and improve antibiotic treatment. Piperacillin/tazobactam should be used cautiously as a reserve antibiotic. A valid alternative is second or third generation cephalosporins in combination with metronidazole.. HINTERGRUND: Patienten mit komplizierter Appendizitis entwickeln postoperativ häufig septische Komplikationen. Für die Wahl der perioperativen Antibiotikaprophylaxe und die Dauer der postoperativen Antibiotikatherapie gibt es keine einheitlichen Standards. In dieser Studie sollen Zusammenhänge zwischen mikrobiologischen Abstrichen und postoperativen Komplikationen aufgezeigt werden.. Es wurden Patienten mit Appendektomie und positivem intraoperativen Abstrich im Zeitraum von 2013 bis 2018 in diese Fall-Kontroll-Studie eingeschlossen. Erregerklassen und deren Resistenzmuster wurden in Erst- und Folgeabstrichen ausgewertet und jeweils in den Gruppen mit und ohne Komplikationen verglichen.. Insgesamt wurden im untersuchten Zeitraum 870 Patienten operiert. Ein intraoperativer Erregernachweis gelang in 102 von 210 Fällen (48,6 %) mit Verdacht auf bakterielle, peritoneale Kontamination. Die Konversion von laparoskopisch zu offen, intraabdominelle Perforation und das Vorhandensein eines Abszesses waren in der multivariaten Analyse unabhängige Risikofaktoren für Wundinfekte. Die Kombination verschiedener Erregerklassen führte zu einer deutlich erhöhten Gesamtresistenz gegenüber Ampicillin/Sulbactam sowohl in den Erstabstrichen (57 %) als auch in den Folgeabstrichen (73 %). Resistente E.-coli-Stämme kombiniert mit bestimmten Anaerobiern ließen sich auch regelhaft in postoperativen intraabdominellen Abszessen nachweisen. Piperacillin/Tazobactam war in unseren Resistenztestungen effektiv gegen 83 % der positiven Abstriche.. Die chirurgische Fokussanierung bei komplizierter Appendizitis ist weiterhin die zentrale Therapiesäule. Eine regelmäßige Überprüfung der vorliegenden Resistenzlage bei perforierter Appendizitis kann dazu beitragen, die kalkulierte antibiotische Therapie anzupassen und zu verbessern. Piperacillin/Tazobactam sollte als Reserveantibiotikum zurückhaltend eingesetzt werden. Eine valide Alternative stellen Cephalosporine der 2. oder 3. Generation in Kombination mit Metronidazol dar.

Topics: Ampicillin; Anti-Bacterial Agents; Appendicitis; Case-Control Studies; Cephalosporins; Escherichia coli; Humans; Metronidazole; Piperacillin, Tazobactam Drug Combination; Postoperative Complications; Sulbactam

Topics: Aged, 80 and over; Anti-Bacterial Agents; Bandages; Conservative Treatment; Cutaneous Fistula; Gastric Fistula; Gastrostomy; Humans; Male; Piperacillin, Tazobactam Drug Combination; Postoperative Complications; Proton Pump Inhibitors

Topics: Adult; Aged; Aged, 80 and over; Aminoglycosides; Anastomotic Leak; Anti-Bacterial Agents; Ascitic Fluid; Clavulanic Acids; Cohort Studies; Culture Techniques; Digestive System Surgical Procedures; Disk Diffusion Antimicrobial Tests; Drug Resistance, Multiple, Bacterial; Female; Fluoroquinolones; Hospital Mortality; Humans; Imipenem; Male; Microbial Sensitivity Tests; Middle Aged; Multivariate Analysis; Peritonitis; Piperacillin, Tazobactam Drug Combination; Postoperative Complications; Prognosis; Retrospective Studies; Surgical Wound Infection; Ticarcillin; Treatment Outcome; Vancomycin

Topics: Aged; Anti-Bacterial Agents; Craniotomy; Drug Resistance, Multiple, Bacterial; Empyema; Enterobacteriaceae Infections; Humans; Male; Meningeal Neoplasms; Meropenem; Piperacillin, Tazobactam Drug Combination; Postoperative Complications; Seizures; Spinal Puncture; Staphylococcal Infections; Surgical Wound Infection; Treatment Outcome; Vancomycin

The purpose of this study was to investigate the association between prophylactic antibiotic administration (PAA) and postoperative infection after radical cystectomy with urinary diversion in patients with invasive bladder cancer.. Forty-nine consecutive cases were analyzed prospectively. Postoperative infections were categorized as surgical site infection (SSI) and remote infection (RI). We used the antibiotics tazobactam/piperacillin (TAZ/PIPC) as PAA (48 h).. A total of 18 (36.7%) patients had postoperative infections, 4/18 (22.2%) patients had wound infections, and 12/18 (66.7%) patients had RI. In the risk factor study for SSI and RI occurrences, we found that the surgical time was significantly shorter in the non-infection group (p = 0.031). Taken together, these results suggest that TAZ/PIPC with shorter PAA duration (48 h) might lead to a lower rate of postoperative infections.. Our data showed that PAA with TAZ/PIPC with a shorter duration PAA (48 h) might be recommended for RC with urinary diversion. We found that the surgical time was significantly shorter in the non-infection group. A prospective study based on our data is desirable to establish or revise PAA strategy for prophylactic medication to prevent postoperative infection after RC with urinary diversion.

Topics: Aged; Aged, 80 and over; Anti-Bacterial Agents; Anti-Infective Agents; Bacterial Infections; Cystectomy; Female; Humans; Male; Middle Aged; Neoplasm Invasiveness; Piperacillin, Tazobactam Drug Combination; Postoperative Complications; Postoperative Period; Prospective Studies; Stents; Surgical Wound Infection; Urinary Bladder Neoplasms; Urinary Diversion

Acute appendicitis is one of the most common surgical emergencies, and it is treated definitively with appendectomy. Recurrent appendicitis is a rare entity, being reported after approximately 1 in 50,000 appendectomies. It is typically caused by inflammation of the appendiceal stump. Inflammation of a retained appendiceal tip is a unique entity that can also cause recurrent appendicitis and presents similarly to primary appendicitis.. We present a case of a 50-year-old man who had undergone laparoscopic appendectomy 1 year earlier and who subsequently presented with a chief complaint of right lower quadrant abdominal pain. The diagnosis of recurrent appendicitis caused by a retained appendiceal tip was made after a computed tomography scan. The patient underwent successful laparoscopic removal of the retained appendiceal fragment. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: The etiology of recurrent appendicitis is separate from the stump appendicitis that has been well described in the literature. Retained tip appendicitis poses a diagnostic dilemma because it is uncommon and, if missed, can lead to complications, such as perforation and severe sepsis. Recurrent appendicitis must be in the differential diagnosis for patients who are post-appendectomy and who present with right lower quadrant abdominal pain.

Topics: Abdominal Pain; Appendicitis; Emergency Service, Hospital; Humans; Laparoscopy; Male; Middle Aged; Piperacillin, Tazobactam Drug Combination; Postoperative Complications; Recurrence; Tomography, X-Ray Computed

Pancreaticoduodenectomy (PD) remains a morbid surgery. Preoperative biliary drainage (PBD) is often necessary before surgery but is associated with biliary contamination. We compared the postoperative complications of patients undergoing PBD who received the usual prophylactic antibiotics (PAs) or systematic antibiotherapy (ABT).. All patients who underwent surgery between 2008 and 2017 were included. Systematic perioperative ABT with piperacillin + tazobactam (ABT group) was implemented in 2014 as the standard of care for PBD. Patients treated in the period before such implementation, during which standard cefazolin was given, served as the controls (PAs group). The primary outcomes were postoperative complications.. We included 122 patients with PBD who underwent surgery. There were no demographic differences between the two groups. Perioperative ABT was associated with a reduction in deep abdominal abscesses (36% vs 10%, P = .0008), respiratory tract infections (15% vs 3%; P = .02), bacteremia (41% vs 6%; P < .0001), and a shorter length of hospital stay (17 [13-27] vs 13 [10-14] days; P < .0001). ABT was a protective factor against the development of deep abdominal abscesses (odds ratio [OR] = 0.16; P = .001) whereas smoking (OR = 3.9) and pancreatic fistula (OR = 19.1) were risk factors.. Systematic perioperative ABT in patients undergoing PD preceded by PBD may reduce deep surgical infections and the length of hospital stay.

Topics: Aged; Anti-Bacterial Agents; Antibiotic Prophylaxis; Drainage; Female; Follow-Up Studies; Humans; Male; Middle Aged; Pancreatic Neoplasms; Pancreaticoduodenectomy; Perioperative Care; Piperacillin, Tazobactam Drug Combination; Postoperative Complications; Preoperative Care; Prognosis; Surgical Wound Infection

Acute appendicitis in children requires early surgery and short-course antibiotics active against Enterobacteriaceae and anaerobes. Although an aminoglycoside-containing three-drug regimen has been used successfully for decades, simpler regimens with similar efficacy are increasingly used. This study evaluated the impact of a switch from the combination of cefotaxime, metronidazole and gentamicin (regimen 1) to piperacillin/tazobactam (regimen 2) as first-line regimen for complicated acute appendicitis in children. In total, 171 children were enrolled [median (IQR) age, 10 (6-13) years], treated with regimen 1 (n = 80) or regimen 2 (n = 91) following surgery for complicated acute appendicitis. The two groups were comparable except for surgical approach (through laparoscopy in 46% vs. 88% for regimens 1 and 2, respectively; P < 0.001). Post-operative complications and duration of hospital stay were similar. Deviations from antibacterial treatment protocol decreased from 36% (29/80) to 14% (13/91) (P < 0.001), with a dramatic reduction in antibacterial treatment duration from median (IQR) of 15 (12-16) days to 5 (5-8) days (P < 0.001). Post-operative intra-abdominal abscess developed in 32 children (18.7%). Female sex (OR = 2.76, 95% CI 1.18-6.48; P = 0.02) and sepsis/septic shock on admission (OR = 4.72, 95% CI 1.12-19.97; P = 0.035) were independently associated with post-operative intra-abdominal abscess, but not antibacterial regimen. This study shows that simplification of first-line antibacterial regimen for complicated appendicitis in children was associated with reduced protocol deviation, reduced duration of antibiotics, and similar outcomes (post-operative complications and duration of hospital stay).

Topics: Adolescent; Anti-Bacterial Agents; Appendicitis; Cefotaxime; Child; Drug Therapy, Combination; Female; Gentamicins; Guideline Adherence; Humans; Length of Stay; Male; Metronidazole; Penicillanic Acid; Peritonitis; Piperacillin; Piperacillin, Tazobactam Drug Combination; Postoperative Complications; Practice Guidelines as Topic; Retrospective Studies

Though acute kidney injury (AKI) is often multifactorial, investigators are now emphasizing the specific contribution of nephrotoxins. This study examines the epidemiology of nephrotoxin exposure and nephrotoxin-associated AKI among children undergoing congenital heart surgery (CHS).. This is a retrospective cohort study of children admitted following CHS between June 1, 2014, and September 30, 2014. Nephrotoxins were defined according to the Nephrotoxic Injury Negated by Just-in-time-Action (NINJA) collaborative; high nephrotoxin exposure was defined as receipt of ≥ 3 nephrotoxins concurrently. AKI was diagnosed according to KDIGO creatinine criteria. Severe AKI was defined as KDIGO stage ≥ 2. Poisson models were used to compute adjusted relative risk (aRR) of high nephrotoxin exposure for AKI.. One hundred fifty-four children (median age 20.4 months, IQR 2.3-59.5) were included. One hundred thirty-one (85.1%) received at least one nephrotoxin; 32 (20.8%) received ≥ 3 nephrotoxins. The most commonly administered medications were ketorolac (n = 74, 48.1%), aspirin (n = 62, 40.3%), ibuprofen (n = 51, 33.1%), vancomycin (n = 39, 25.3%), piperacillin/tazobactam (n = 35, 22.7%), and enalapril (n = 14, 9.1%). AKI occurred more commonly in those exposed to ≥ 3 nephrotoxins (62.5 vs. 50.8%); this was not statistically significant after adjusting for confounders (aRR = 1.2, 95% CI 0.9-1.7). Severe AKI was similar between those with and without high nephrotoxin exposure (21.9 vs. 19.7%, p = 0.78).. Nephrotoxin use is common following pediatric CHS. While we found no association between high nephrotoxin exposure and AKI, this may be related to the multifactorial nature of AKI in this population. For many common nephrotoxins, less injurious agents exist and nephrotoxin exposure may represent a modifiable risk factor for AKI.

Topics: Acute Kidney Injury; Adolescent; Aspirin; Cardiac Surgical Procedures; Child; Child, Preschool; Critical Illness; Enalapril; Female; Heart Defects, Congenital; Humans; Ibuprofen; Infant; Ketorolac; Male; Piperacillin, Tazobactam Drug Combination; Postoperative Complications; Retrospective Studies; Vancomycin

Topics: Anti-Bacterial Agents; Comorbidity; Diabetes Mellitus; Diabetic Ketoacidosis; Drug Therapy, Combination; Emphysema; Humans; Hypertension; Kidney Transplantation; Male; Middle Aged; Norepinephrine; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination; Postoperative Complications; Pyelonephritis; Tomography, X-Ray Computed; Transplantation, Homologous; Vancomycin

Stapled anopexy is considered the gold standard in treating haemorroidal disease associated to mucosal prolapse, but severe complications have been described. Among these, a minimal anastomotic leakage may lead to gas spreading into surrounding soft tissues.. We report the case of a 61 year old male who developed pneumoretroperitoneum and pneumomediastinun two days after a Stapled Anopexy. CT scans showed a minimal leakage with no abscess. The patient was successfully treated by bowel rest, antibiotics and total parenteral nutrition, avoiding surgical approach.. A minimal anastomotic leakage following Stapled Anopexy, when leading to air diffusion into soft tissues and not associated to abscess or peritonitis may be treated conservatively avoiding ileostomy or colostomy.. Anastomotic leakage, Pneumoretroperitoneum, Stapled Anopexy.. La stapled anopexy è considerata il gold standard nel trattamento della malattia emorroidaria associata a prolasso mucoso. In letteratura sono state descritte gravi complicanze. Tra queste, una minimo leakage anastomotico può portare ad un retropneumoperitoneo e alla sepsi grave. Generalmente questi sono casi in cui il chirurgo opta per il confezionamento di una stomia escludente (associato eventualmente al drenaggio di eventuali ascessi). Tuttavia in alcuni casi è possibile una gestione conservativa. In questo lavoro, riportiamo il caso di un un uomo di 61 anni che ha sviluppato pneumoperitoneo e pneumomediastino due giorni dopo una mucoprolassectomia. Il paziente è stato trattato con successo mediante digiuno, antibioticoterapia e nutrizione parenterale totale, evitando un approccio chirurgico. Il caso clinico è corredato da una revisione della letteratura precedente che riporta come siano pochissimi i casi simili già descritti.

Topics: Anastomotic Leak; Anti-Bacterial Agents; Combined Modality Therapy; Conservative Treatment; Hemorrhoids; Humans; Male; Mediastinal Emphysema; Metronidazole; Middle Aged; Parenteral Nutrition, Total; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination; Postoperative Complications; Retropneumoperitoneum; Surgical Stapling; Tomography, X-Ray Computed

Drug fever is frequently underrecognized by clinicians despite its common occurrence. Fever induced by piperacillin/tazobactam has not been reported in scoliosis correction surgery.Drug fever caused by piperacillin/tazobactam in a scoliosis patient was described.A 36-year-old woman with adult scoliosis undergoing correction surgery was reported. She developed a fever after an intake of piperacillin/tazobactam for 3 days. Eosinophil count, erythrocyte sedimentation rate, and C-reactive proteins were increased in her blood examination. Thorough history, chest radiography, blood cultures, physical examination, and urinalysis revealed no evidences of fever. A drug fever is therefore considered. The fever lasted for 2 weeks and her body temperature come back to normal 4 days after piperacillin/tazobactam cessation.Fever could be caused by piperacillin/tazobactam. The drug fever's diagnosis is easily confounded by a co-occurring infection. Therefore, it is crucial for clinicians to doubt drugs as a reason when no other origin of fever could be identified in a patient.

Topics: Adult; Anti-Bacterial Agents; Drug Combinations; Female; Fever; Humans; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination; Postoperative Complications; Scoliosis

Drug-induced thrombocytopenia is a rare but serious adverse event that has been associated with multiple drugs including β-lactams. Although it mostly occurs with prolonged medication use, some cases of rapid-onset thrombocytopenia have been reported. We describe the case of a 69-year-old man who developed severe and immediate thrombocytopenia following reexposure to piperacillin-tazobactam in the critical care setting. He received a 6-day course of piperacillin-tazobactam for a possible pneumonia immediately after cardiac surgery. During this course of therapy, his platelet count decreased (fluctuating between 69 × 10(3) /mm(3) and 104 × 10(3) /mm(3) ) and then progressively increased after completion of the antibiotic to 340 × 10(3) /mm(3) on postoperative day 15. Ten days after the antibiotic course was completed (postoperative day 16), the patient developed new signs of infection (fever and neutrophilia), and piperacillin-tazobactam was restarted. Eight hours after reintroducing the antibiotic, his platelet count dropped from 317 × 10(3) /mm(3) to 7 × 10(3) /mm(3) . After reviewing all the medications administered to the patient as well as other potential causes of thrombocytopenia, and given the chronology of events, piperacillin-tazobactam was suspected as the most likely offending agent and was therefore replaced by meropenem on postoperative day 17. The patient's platelet count began to rise 2 days after discontinuation of piperacillin-tazobactam and reached 245 × 10(3) /mm(3) by postoperative day 30. No spontaneous bleeding or thrombosis occurred while the patient was thrombocytopenic. Use of the Naranjo Adverse Drug Reaction Probability Scale indicated a probable relationship (score of 6) between the patient's development of thrombocytopenia and piperacillin-tazobactam therapy. This case highlights the severity and swiftness in which drug-induced thrombocytopenia may present in the context of cardiac surgery.

Topics: Aged; Anti-Bacterial Agents; Coronary Artery Bypass; Diagnosis, Differential; Humans; Hypersensitivity, Delayed; Male; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination; Pneumonia; Postoperative Complications; Thrombocytopenia

Patients with asplenia are prone to overwhelming infections due to encapsulated organisms. We report a 62-year-old man presenting with fever and weakness. His medical history was significant for splenectomy and owning a dog as pet. The patient on examination had evidence of animal bite and scratch marks on his lower extremity and developed dry gangrene of multiple digits of his upper extremity soon after admission. The patient's initial blood cultures were positive for Gram-negative rods, but no organism was identified. Capnocytophaga canimorsus was the suspected organism and the patient's antibiotics were tailored accordingly, with good clinical recovery. The patient' blood cultures finally grew C canimorsus on day 20 for which the patient had already been treated with prior clinical judgement. Physicians should be aware of this organism in the setting of sepsis in patients with asplenia and use appropriate antibiotics until further results are obtained.

Topics: Animals; Anti-Bacterial Agents; Capnocytophaga; Dogs; Gram-Negative Bacterial Infections; Humans; Immunocompromised Host; Male; Middle Aged; Penicillanic Acid; Pets; Piperacillin; Piperacillin, Tazobactam Drug Combination; Postoperative Complications; Splenectomy; Zoonoses

It has been reported in many studies that one of the main factors influencing morbidity and mortality in patients receiving transplants is infection after transplantation.. The study included 190 adult patients undergoing orthotopic liver transplantation (OLT) between September 2001 and December 2007. All the patients were followed prospectively for infections from the OLT date and during the first 4 weeks after surgery. Immunosuppression consisted of steroids and tacrolimus. Antimicrobial prophylaxis included piperacillin/tazobactam, fluconazole, and selective bowel decontamination (SBD) was performed. Samples of clinical materials were investigated for microbiological cultures. The micro-organisms were cultured and identified in accordance with standard bacteriological procedures. Susceptibility testing was performed using Clinical and Laboratory Standards Institute procedures.. From 190 OLT recipients, 2213 clinical samples were obtained for microbiological examination. Positive cultures were found in 27.2% (n = 603) of all samples tested; 1252 strains were collected. Gram-positive bacteria were found in 64.1% (n = 802), Gram-negative bacteria were found in 31.6% (n = 396), and fungal strains were isolated in 4.3% (n = 54). Surgical site specimens (n = 1031) were obtained from 190 recipients during the first month after transplantation. Positive cultures accounted for 29.2% (n = 301) of all samples tested. Among the isolated microbial strains (n = 677), most common were Gram-positive bacteria (73.7%; n = 499). Gram-negative bacteria comprised 25.1% (n = 170). There were fungal strains in 1.2% (n = 8). There were 539 urine specimens. Positive cultures accounted for 16.7% (n = 90) of those. Among the isolated microbial strains (n = 210), most common were Gram-negative bacteria (62.4%; n = 131). Gram-positive bacteria comprised 28.6% (n = 60) and fungi 9% (n = 19). There were 549 blood specimens. Positive cultures were found in 30.6% (n = 168) of all samples tested. Among the isolated microbial strains (n = 263), most common were Gram-positive bacteria in 72.3% (n = 190); Gram-negative bacteria were found in 26.2% (n = 69), and fungal strains were isolated in 1.5% (n = 4). There were 69 respiratory tract specimens. Positive cultures were found in 46.4% (n = 32) of all samples tested. Among the isolated microbial strains (n = 84), most common were Gram-positive bacteria (51.2%; n = 43); Gram-negative bacteria comprised 27.4% (n = 23) and fungi 21.4% (n = 18).. (1) Surgical site samples were predominated samples after LTx. (2) Our study showed Gram-positive bacteria were 64.1% (n = 802), Gram-negative bacteria, 31.6% (n = 396) and fungal strains isolated in 4.3% (n = 54). (3) The increased proportion of isolates of multi-drug-resistant bacterial strains (methicillin resistant coagulase negative Staphylococcus, vancomycin-resistant Enterococcus, high-level aminoglycoside resistance, and extended- spectrum β-lactamase). (4) These data indicate strict cooperation infection control procedures in these patients.

Topics: Adult; Anti-Bacterial Agents; Antibiotic Prophylaxis; Antifungal Agents; Bacterial Infections; Female; Fluconazole; Fungi; Gram-Negative Bacteria; Gram-Positive Bacteria; Humans; Intestines; Liver Transplantation; Male; Middle Aged; Mycoses; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination; Postoperative Complications; Prospective Studies

Topics: Acute Generalized Exanthematous Pustulosis; Amputation, Surgical; Anti-Bacterial Agents; Diagnosis, Differential; Drug Eruptions; Drug Therapy, Combination; Humans; Intensive Care Units; Male; Middle Aged; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination; Postoperative Complications; Vancomycin

We report the case of a 52-year-old man, ASA 3-4, malnourished, heavy smoker and drinker at the stage of chronic obstructive pulmonary disease and cirrhosis. The postoperative course of a cervical cancer surgery was complicated by a pneumonia with fatal outcome in the intensive care unit. Taking into account the patient's history and surgical requirements, this nosocomial infection did not appear easily preventable. The multiple risk factors and the few preventive measures usable were analyzed. In this context, the media and legal trend to make the doctors responsible for the nosocomial infections should be revised.

Topics: Alcoholism; Amoxicillin-Potassium Clavulanate Combination; Antibiotic Prophylaxis; Carcinoma, Squamous Cell; Ciprofloxacin; Cross Infection; Disease Susceptibility; Fatal Outcome; Humans; Iatrogenic Disease; Immunocompromised Host; Liver Cirrhosis, Alcoholic; Male; Malnutrition; Malpractice; Middle Aged; Mouth; Neck Dissection; Neoplasm Recurrence, Local; Oxygen; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination; Pneumonia; Postoperative Complications; Pulmonary Disease, Chronic Obstructive; Risk Factors; Smoking; Tongue Neoplasms

Clostridium scindens has not been previously associated with human infection. We describe a case of an adolescent female with Crohn's disease presenting with a post-surgical intra-abdominal abscess from which this organism was isolated in pure culture. This is the first documented report of human infection caused by this micro-organism.

Topics: Abdominal Abscess; Adolescent; Anti-Bacterial Agents; Clostridium; Clostridium Infections; Crohn Disease; Female; Gentamicins; Humans; Microbial Sensitivity Tests; Molecular Sequence Data; Penicillanic Acid; Phylogeny; Piperacillin; Piperacillin, Tazobactam Drug Combination; Postoperative Complications; RNA, Ribosomal, 16S; Tomography, X-Ray Computed

Children with perforated appendicitis often have a prolonged hospital course complicated by surgical site or intra-abdominal infections. Treatment with multiple intravenous (IV) antibiotics after appendectomy has been the standard of care for these patients. We have recently adopted a protocol using piperacillin-tazobactam (PT) as a single agent in lieu of the standard multi-drug regimen (MD). We hypothesized that PT would be as effective as MD in reducing postoperative complications and would result in decreased resource utilization.. We reviewed the medical records of all children admitted to our hospital between January 1, 1998 and December 31, 2001 with the diagnosis of perforated appendicitis. Patients who underwent operation within the first 24 h of admission were divided into two groups based on their antibiotic regimen: PT versus MD. Demographic data, duration of presenting symptoms, initial WBC, length of stay, and infectious complications were abstracted. Categorical data were compared using Chi square analysis; continuous variables were compared using Student's t-test when the data were normally distributed and the Mann-Whitney U test when the data were skewed.. There was no difference between the PT (n = 51) and MD (n = 43) groups with respect to age, duration of presenting symptoms, initial WBC, or length of hospital stay. However, patients in the MD group had a significantly higher overall complication rate than those in the PT group (14/43 vs. 4/51, p = 0.002). Antibiotic-related complications including surgical site infections, venous catheter-related infections, intra-abdominal abscesses, and drug reactions were also higher in the MD group (10/43 vs. 4/51, p = 0.04). The outpatient charges for each patient based on an average of seven days of home antibiotics were $2,460 for the PT group and $4,349 for the MD group.. Children with perforated appendicitis can be managed effectively with a single broad-spectrum antibiotic after appendectomy. Monotherapy is not only more efficacious than multi-drug therapy, but may be more cost effective. The use of monotherapy for children with perforated appendicitis after adequate source control should be considered the treatment of choice.

Topics: Ampicillin; Appendectomy; Appendicitis; Child; Clindamycin; Drug Combinations; Drug Therapy, Combination; Female; Gentamicins; Humans; Male; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination; Postoperative Complications; Retrospective Studies