rifampin and Bacteremia

To assess whether the addition of rifampicin to conventional treatment of Staphylococcus aureus bacteraemia (SAB) reduces bacteriological or clinical failure or death.. PubMed, Embase and Cochrane CENTRAL databases were searched from inception to 31 December 2022. Reference lists and PubMed citations of eligible studies were checked.. Two study authors independently identified randomized controlled trials (RCTs) involving adult participants with SAB, in which an intervention group received adjunctive rifampicin and the control group received usual care with or without a placebo. Dichotomous data (bacteriological and clinical failure and deaths) were analysed and pooled across studies using risk ratio (RR) with 95% confidence intervals (CI) using a Mantel-Haenszel random-effect model. The key variable of interest being whether rifampicin was used.. Six RCTs including 894 participants-of which 758 (85%) were from one trial-met the inclusion criteria. The addition of rifampicin to conventional treatment of SAB significantly reduced bacteriological failure by 59% (RR 0.41, 95% CI 0.21-0.81, I2 = 0%, number need to treat 27). However, it did not reduce clinical failure (RR 0.70, 95% CI 0.47-1.03, I2 = 0%) or deaths (RR 0.96, 95% CI 0.70-1.32, I2 = 0%). Further, it did not reduce the duration of bacteraemia, or the length of hospital stay. Adjunctive rifampicin reduced SAB recurrences (1% versus 4%, P = 0.01). Emergence of rifampicin resistance during treatment was uncommon (<1%).. Although adjunctive rifampicin reduced the risk of bacteriological failure and recurrences, we found no mortality benefit to support its use in SAB.

Topics: Adult; Bacteremia; Humans; Randomized Controlled Trials as Topic; Rifampin; Staphylococcal Infections; Staphylococcus aureus

Staphylococcus aureus (S. aureus) bacteremia (SAB) has high morbidity and mortality, with the development of methicillin-resistant S. aureus (MRSA) and the recognized shortcomings of vancomycin, its management is becoming more complicated. Considering the capability to penetrate cells, tissues and biofilms, rifampin has been used as adjunctive agent to against staphylococcal activity.. We performed this meta-analysis, aimed to explore the efficacy of adjunctive rifampin for the treatment of SAB.. Medical literatures were searched in the Pubmed, Medline, Embase and Cochrane databases up to October 2018. Patients with SAB received treatment with or without rifampin were included. The risk ratio (RR) and 95% confidence intervals (CI) of mortality, rate of bacteriological failure and relapse were estimated.. Seven articles (five randomized controlled trials and two retrospective cohort studies) enrolling 979 and 636 patients of SAB treated with and without rifampin, respectively, were included. There was no difference of mortality between the adjunctive rifampin therapy and standard therapy on SAB (RR: 0.771, 95% CI: 0.442 to 1.347, I2 = 70.4%). In the subgroup analyses, the decreased mortality was observed in the adjunctive rifampin treatment for patients without MRSA infection (RR: 0.509, 95% CI: 0.372 to 0.697, I2 = 8.8%). In addition, there was no difference of the rate of bacteriologic failure (RR: 0.602, 95% CI: 0.198 to 1.825, I2 = 0.0%) or relapse (RR: 0.574, 95% CI: 0.106 to 3.112, I2 = 77.9%) between the adjunctive rifampin therapy and standard therapy on SAB.. In general, insufficient evidence supported the efficacy of adjunctive use of rifampin for treatment of SAB, adding rifampin to standard therapy didn't decrease the incidence of death, rate of bacteriologic failure and relapse.

Topics: Bacteremia; Humans; Publication Bias; Randomized Controlled Trials as Topic; Rifampin; Risk; Staphylococcal Infections; Staphylococcus aureus; Treatment Outcome

Haemophilus influenzae remains a common cause of illness in children throughout the world. Before the introduction of vaccination, H influenzae type b (Hib) disease was the leading cause of bacterial meningitis in young children and a frequent cause of pneumonia, epiglottitis, and septic arthritis. Clinicians should remain diligent in counseling parents on the dangers of Hib and provide vaccination starting at 2 months of age. The epidemiology of invasive H influenzae disease is shifting. It is imperative that clinicians recognize the changing epidemiology and antibiotic resistance patterns for H influenzae to optimize care in hospital and ambulatory settings.

Topics: Anti-Bacterial Agents; Bacteremia; Cephalosporins; Child; Child, Preschool; Female; Haemophilus Infections; Haemophilus influenzae type b; Humans; Incidence; Infant; Male; Meningitis, Bacterial; Pneumonia; Post-Exposure Prophylaxis; Rifampin; Vaccination

The efficacy of antimicrobial central venous catheters (CVCs) remains questionable. In this network meta-analysis, we aimed to assess the comparative efficacy of antimicrobial CVC impregnations in reducing catheter-related infections in adults.. We searched 4 electronic databases (Medline, the Cochrane Central Register of Controlled Trials, Embase, CINAHL) and internet sources for randomized controlled trials, ongoing clinical trials, and unpublished studies up to August 2016. Studies that assessed CVCs with antimicrobial impregnation with nonimpregnated catheters or catheters with another impregnation were included. Primary outcomes were clinically diagnosed sepsis, catheter-related bloodstream infection (CRBSI), and all-cause mortality. We performed a network meta-analysis to estimate risk ratio (RR) with 95% confidence interval (CI).. Sixty studies with 17255 catheters were included. The effects of 14 impregnations were investigated. Both CRBSI and catheter colonization were the most commonly evaluated outcomes. Silver-impregnated CVCs significantly reduced clinically diagnosed sepsis compared with silver-impregnated cuffs (RR, 0.54 [95% CI, .29-.99]). When compared to no impregnation, significant CRBSI reduction was associated with minocycline-rifampicin (RR, 0.29 [95% CI, .16-.52]) and silver (RR, 0.57 [95% CI, .38-.86]) impregnations. No impregnations significantly reduced all-cause mortality. For catheter colonization, significant decreases were shown by miconazole-rifampicin (RR, 0.14 [95% CI, .05-.36]), 5-fluorouracil (RR, 0.34 [95% CI, .14-.82]), and chlorhexidine-silver sulfadiazine (RR, 0.60 [95% CI, .50-.72]) impregnations compared with no impregnation. None of the studies evaluated antibiotic/antiseptic resistance as the outcome.. Current evidence suggests that the minocycline-rifampicin-impregnated CVC appears to be the most effective in preventing CRBSI. However, its overall benefits in reducing clinical sepsis and mortality remain uncertain. Surveillance for antibiotic resistance attributed to the routine use of antimicrobial-impregnated CVCs should be emphasized in future trials.

Topics: Adult; Anti-Bacterial Agents; Bacteremia; Catheter-Related Infections; Catheterization, Central Venous; Central Venous Catheters; Chlorhexidine; Humans; Network Meta-Analysis; Rifampin; Silver; Treatment Outcome

Elizabethkingia meningoseptica, a Gram-negative pathogen once deemed clinically insignificant, tends to cause infections among low-birth-weight infants and immunocompromised patients. Previously, vancomycin was reported to cure several patients with bacteraemia caused by E. meningoseptica. Nevertheless, some laboratory investigations also showed considerable discordance between in vitro vancomycin susceptibility results obtained by the disk diffusion and broth microdilution methods against clinical E. meningoseptica isolates as determined using the criteria for staphylococci recommended by the Clinical and Laboratory Standards Institute (CLSI). In this review, the PubMed database (1960-2017) was searched for studies that reported mainly cases with E. meningoseptica bacteraemia or meningitis treated with vancomycin alone or with regimens that included vancomycin. In addition, the in vitro synergy between vancomycin and other agents against isolates of E. meningoseptica was reviewed. Elizabethkingia meningoseptica bacteraemia appears not to universally respond to intravenous (i.v.) vancomycin-only therapy, especially in patients who require haemodialysis. If i.v. vancomycin is the favoured therapy against E. meningoseptica meningitis, the addition of ciprofloxacin, linezolid or rifampicin might be an option to effectively treat this difficult-to-treat infection. Further clinical studies are needed to determine the clinical efficacy of these combination regimens for the treatment of E. meningoseptica meningitis.

Topics: Anti-Bacterial Agents; Bacteremia; Ciprofloxacin; Disk Diffusion Antimicrobial Tests; Drug Synergism; Drug Therapy, Combination; Flavobacteriaceae; Flavobacteriaceae Infections; Humans; Immunocompromised Host; Infant, Low Birth Weight; Infant, Newborn; Linezolid; Meningitis, Bacterial; Rifampin; Treatment Outcome; Vancomycin

We report the first Italian case of Mycobacterium chimaera disseminated infection in a patient with a history of cardiac surgery. The patient was initially diagnosed with sarcoidosis and started on immunosuppressive therapy. Ten months later she developed a vertebral osteomyelitis: M. chimaera was isolated from bone specimen. A review of the literature shows that M. chimaera infection occurs specifically in this population of patients, due to contamination of heater-cooler units used during cardiosurgery. Devices responsible for the transmission were produced by Sorin Group Deutschland. Mycobacterium chimaera infection should be included in the differential diagnosis for patients undergoing cardiac surgery.

Topics: Acinetobacter Infections; Aged; Bacteremia; Diagnostic Errors; Drug Therapy, Combination; Equipment Contamination; Female; Heart Valve Prosthesis Implantation; Heating; Humans; Linezolid; Lumbar Vertebrae; Mycobacterium avium Complex; Mycobacterium avium-intracellulare Infection; Osteomyelitis; Postoperative Complications; Prednisone; Rifampin; Sarcoidosis; Spondylitis; Vertebroplasty; Water Microbiology

Staphylococcus aureus bacteraemia (SAB) is associated with substantial morbidity and mortality. By surviving within leukocytes, S. aureus can evade both immunological defences and antimicrobial drugs, thus facilitating haematogenous dissemination. We performed a systematic review to determine whether antimicrobials with intracellular activity improve outcomes in SAB when used as an adjunct to β-lactam or glycopeptide monotherapy. The Pubmed/MEDLINE, Embase and Cochrane databases were systematically searched for eligible studies that reported on the use of first-line antimicrobials plus a single additional antimicrobial of interest in patients with SAB (any cause). Six relevant studies were identified, all reporting on rifampicin use. Four studies (three randomized controlled trials and one cohort) reported on adults with SAB, including 54 patients treated with adjunctive rifampicin and 44 standard-therapy controls. Estimated across all of these studies, adjunctive rifampicin was associated with trends towards reduced all-cause mortality and reduced clinical or bacteriological failure. The fifth study indicated that adjunctive rifampicin accelerates the resolution of persistent SAB in neonates. Data from the sixth study were considered flawed owing to differences in co-morbidities between groups. Limited data suggest that rifampicin-induced hepatitis is not clinically significant but that drug interactions are. In conclusion, adjunctive rifampicin may improve outcomes in SAB when used as an adjunct to β-lactam or glycopeptide monotherapy.

Topics: Animals; Anti-Bacterial Agents; Bacteremia; Humans; Rifampin; Staphylococcal Infections; Staphylococcus aureus

Bartonella spp. are responsible for emerging and re-emerging diseases around the world. The majority of human infections are caused by Bartonella henselae, Bartonella quintana and Bartonella bacilliformis, although other Bartonella spp. have also been associated with clinical manifestations in humans. The severity of Bartonella infection correlates with the patient's immune status. Clinical manifestations can range from benign and self-limited to severe and life-threatening disease. Clinical conditions associated with Bartonella spp. include local lymphadenopathy, bacteraemia, endocarditis, and tissue colonisation resulting in bacillary angiomatosis and peliosis hepatis. Without treatment, Bartonella infection can cause high mortality. To date, no single treatment is effective for all Bartonella-associated diseases. In the absence of systematic reviews, treatment decisions for Bartonella infections are based on case reports that test a limited number of patients. Antibiotics do not significantly affect the cure rate in patients with Bartonella lymphadenopathy. Patients with Bartonella spp. bacteraemia should be treated with gentamicin and doxycycline, but chloramphenicol has been proposed for the treatment of B. bacilliformis bacteraemia. Gentamicin in combination with doxycycline is considered the best treatment regimen for endocarditis, and erythromycin is the first-line antibiotic therapy for the treatment of angioproliferative lesions. Rifampicin or streptomycin can be used to treat verruga peruana. In this review, we present recent data and recommendations related to the treatment of Bartonella infections based on the pathogenicity of Bartonella spp.

Topics: Angiomatosis, Bacillary; Anti-Bacterial Agents; Bacteremia; Bartonella; Bartonella Infections; Chloramphenicol; Doxycycline; Drug Administration Schedule; Endocarditis; Gentamicins; Humans; Lymphatic Diseases; Rifampin; Streptomycin; Treatment Outcome; Virulence

Topics: Adult; Bacteremia; Drug Therapy, Combination; Emergencies; Female; Humans; Levofloxacin; Magnetic Resonance Imaging; Pregnancy; Psoas Abscess; Puerperal Disorders; Rifampin; Sacroiliitis; Staphylococcal Infections

High-dose interleukin-2 (HDIL-2) has proven to be an effective treatment for metastatic renal cell carcinoma and melanoma. Previous studies have shown an increase in catheter-related bacteremia (CRB) in patients on HDIL-2. The primary objective of this study was to evaluate the effectiveness of minocycline and rifampin-coated catheters (M/R-C) in reducing CRB in cancer patients on HDIL-2. This was a retrospective study where non-coated catheters (NC-C) and M/R-C were used for the administration of HDIL-2 before and after December 2004, respectively. Data collected included demographics, cancer type, catheter type, antibiotic prophylaxis, and infection rates. A total of 107 episodes of catheter use for HDIL-2 were evaluated in 78 patients (30 episodes in patients with M/R-C vs. 77 with NC-C). A total of nine episodes of CRB were identified, all in patients with NC-C (M/R-C 0% vs. NC-C 12%; p=0.06). The median time to bacteremia was 11 days (range 1-315 days). A log-rank test showed a trend that the M/R-C group had lower probability of getting CRB than the NC-C group (p=0.06). The use of M/R-C in patients on HDIL-2 therapy for advanced melanoma and renal cell carcinoma may have reduced the risk of CRB to nil. CRB still occurred despite antibiotic prophylaxis in patients with NC-C.

Topics: Adult; Aged; Anti-Bacterial Agents; Antineoplastic Agents; Bacteremia; Catheterization, Central Venous; Catheters, Indwelling; Female; Humans; Interleukin-2; Male; Middle Aged; Minocycline; Neoplasms; Rifampin; Treatment Outcome

Topics: Adult; Bacteremia; Brucellosis; Female; Humans; Mastitis; Pregnancy; Pregnancy Complications, Infectious; Rifampin; RNA, Ribosomal, 16S; Trimethoprim, Sulfamethoxazole Drug Combination; Ultrasonography

The use of antimicrobial-impregnated central venous catheters (CVCs) for the prevention of CVC microbial colonization and catheter-related bloodstream infection (CRBSI) remains controversial.. We performed a meta-analysis of randomized controlled trials (RCTs) evaluating CRBSI and colonization of CVCs impregnated with rifampicin-based antimicrobial combinations. Our main analysis compared the occurrence of CRBSI with rifampicin/minocycline-impregnated CVCs with that of non-rifampicin-impregnated CVCs. The PubMed and Cochrane Central Register of Controlled Trials databases were searched (until October 2006).. Eight RCTs were included in the analysis. The main analysis (seven RCTs) demonstrated that rifampicin/minocycline-impregnated CVCs were associated with fewer CRBSIs compared with catheters not impregnated with rifampicin/minocycline (OR 0.23, 95% CI 0.14-0.40). The same was true regarding colonization (OR 0.46, 95% CI 0.31-0.69). Further analysis, comparing rifampicin-based CVCs with non-rifampicin-impregnated CVCs, demonstrated superiority of rifampicin-based CVCs in reducing colonization (OR 0.38, 95% CI 0.24-0.62) and CRBSI (OR 0.24, 95% CI 0.14-0.40). Similar results, suggesting superiority of rifampicin/minocycline-impregnated CVCs, were noted in a subgroup analysis of colonization and CRBSIs in which rifampicin/minocycline-impregnated CVCs were compared with simple, non-tunnelled, non-antimicrobially impregnated CVCs, a subgroup analysis that was performed by excluding low quality RCTs, and a subgroup analysis for colonization comprising studies in which the sonication technique was used. No serious adverse events and no difference in mortality between the two treatment groups were reported. No clear conclusions can be made regarding the impact of the use of rifampicin/minocycline-impregnated CVCs on the development of antimicrobial resistance based on the available data.. The available evidence suggests that rifampicin/minocycline-impregnated CVCs are safe and effective in reducing the rate of catheter colonization and CRBSI. Further research should focus on the possible development of resistance and on pharmacoeconomic issues related to the use of rifampicin/minocycline-impregnated CVCs.

Topics: Bacteremia; Catheterization, Central Venous; Chlorhexidine; Humans; Minocycline; Randomized Controlled Trials as Topic; Rifampin; Silver Sulfadiazine

Neonatal brucellosis following blood transfusion has not previously been reported. A premature male infant born at 24 weeks gestation developed low grade fever and decreased activity and showed poor weight gain at 45 weeks post-menstrual age. Blood culture grew Brucella melitensis and the brucella antibody titre was positive. He received a 6-week course of septrin and rifampicin and made a full recovery. The infant had received a blood transfusion 5 days prior to his illness. The blood donor had symptoms suggestive of brucellosis, and it was suspected that the blood transfusion was the source of infection but this could not be confirmed as the donor was not traceable. It is suggested that, in areas endemic for brucellosis, prospective blood donors should be questioned about symptoms of brucellosis, and serological tests to screen for brucellosis might be indicated.

Topics: Agglutination Tests; Anti-Bacterial Agents; Antibiotics, Antitubercular; Bacteremia; Brucella melitensis; Brucellosis; Erythrocyte Transfusion; Humans; Infant, Newborn; Infant, Premature, Diseases; Male; Rifampin; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Vascular catheters impregnated with antimicrobial agents have been shown to decrease the risk of catheter-related colonization and bloodstream infections. Various antimicrobials and antiseptics have been used. In a recent meta-analysis of 12 studies, catheters coated with chlorhexidine and silver sulfadiazine (CH/SS) were shown to be significantly less likely to be associated with catheter-related bloodstream infections than uncoated catheters. However, these catheters were coated only on the external surface and they are associated with short antimicrobial durability (3-7 days). In addition, anaphylactic reactions to them were reported in Japan. Vascular catheters impregnated with minocycline and rifampin (M/R) were found to be highly efficacious in preventing catheter-related infections. In a recent prospective, randomized trial, the likelihood of catheter-related bloodstream infections associated with the use of M/R catheters was one-twelfth of that observed with catheters coated with CH/SS. The M/R catheters are coated on the external and internal surfaces and have an antimicrobial durability of 4 weeks. Although no resistance to either minocycline or rifampin has been seen in two trials, further studies are required to determine whether the risk of resistance outweighs the benefits derived from their use. In conclusion, antimicrobial catheters have been shown to be highly cost effective in decreasing the risk of catheter-related bloodstream infection.

Topics: Anaphylaxis; Anti-Bacterial Agents; Anti-Infective Agents; Anti-Infective Agents, Local; Bacteremia; Bacterial Infections; Catheters, Indwelling; Chlorhexidine; Coated Materials, Biocompatible; Enzyme Inhibitors; Humans; Minocycline; Rifampin; Risk Assessment; Risk Factors; Silver Sulfadiazine

We have reported a case of isolated bacteremia due to Rhodococcus equi in an immunocompromised, non-HIV-infected patient with acute leukemia. This patient's illness demonstrates a rare presentation of an emerging opportunistic pathogen that may be potentially acquired via exposure to domestic horses or their habitat during periods of aggressive chemotherapeutic administration. The infection was successfully eradicated by treatment with erythromycin and rifampin. Counseling immunocompromised patients inclined to participate in recreational activities involving potential risks of exposure to this pathogen would seem to be a reasonable, but unproven, preventive intervention.

Topics: Actinomycetales Infections; Adult; Animals; Antineoplastic Agents; Bacteremia; Erythromycin; Horses; Humans; Karyotyping; Leukemia, Promyelocytic, Acute; Leukocyte Count; Male; Neutropenia; Remission Induction; Rhodococcus equi; Rifampin

Staphylococcus aureus bacteraemia is a common cause of severe community-acquired and hospital-acquired infection worldwide. We tested the hypothesis that adjunctive rifampicin would reduce bacteriologically confirmed treatment failure or disease recurrence, or death, by enhancing early S aureus killing, sterilising infected foci and blood faster, and reducing risks of dissemination and metastatic infection.. In this multicentre, randomised, double-blind, placebo-controlled trial, adults (≥18 years) with S aureus bacteraemia who had received ≤96 h of active antibiotic therapy were recruited from 29 UK hospitals. Patients were randomly assigned (1:1) via a computer-generated sequential randomisation list to receive 2 weeks of adjunctive rifampicin (600 mg or 900 mg per day according to weight, oral or intravenous) versus identical placebo, together with standard antibiotic therapy. Randomisation was stratified by centre. Patients, investigators, and those caring for the patients were masked to group allocation. The primary outcome was time to bacteriologically confirmed treatment failure or disease recurrence, or death (all-cause), from randomisation to 12 weeks, adjudicated by an independent review committee masked to the treatment. Analysis was intention to treat. This trial was registered, number ISRCTN37666216, and is closed to new participants.. Between Dec 10, 2012, and Oct 25, 2016, 758 eligible participants were randomly assigned: 370 to rifampicin and 388 to placebo. 485 (64%) participants had community-acquired S aureus infections, and 132 (17%) had nosocomial S aureus infections. 47 (6%) had meticillin-resistant infections. 301 (40%) participants had an initial deep infection focus. Standard antibiotics were given for 29 (IQR 18-45) days; 619 (82%) participants received flucloxacillin. By week 12, 62 (17%) of participants who received rifampicin versus 71 (18%) who received placebo experienced treatment failure or disease recurrence, or died (absolute risk difference -1·4%, 95% CI -7·0 to 4·3; hazard ratio 0·96, 0·68-1·35, p=0·81). From randomisation to 12 weeks, no evidence of differences in serious (p=0·17) or grade 3-4 (p=0·36) adverse events were observed; however, 63 (17%) participants in the rifampicin group versus 39 (10%) in the placebo group had antibiotic or trial drug-modifying adverse events (p=0·004), and 24 (6%) versus six (2%) had drug interactions (p=0·0005).. Adjunctive rifampicin provided no overall benefit over standard antibiotic therapy in adults with S aureus bacteraemia.. UK National Institute for Health Research Health Technology Assessment.

Topics: Administration, Intravenous; Administration, Oral; Aged; Antibiotics, Antitubercular; Bacteremia; Community-Acquired Infections; Cross Infection; Double-Blind Method; Drug Administration Schedule; Female; Humans; Male; Middle Aged; Rifampin; Staphylococcal Infections; Treatment Failure

The evidence for using combination antimicrobial therapy (CoRx) in Staphylococcus aureus bacteraemia (SAB) is limited. We aimed to investigate whether CoRx is associated with higher survival or lower SAB-related late complications.. We performed a post hoc analysis of a prospective SAB cohort study. CoRx was defined as a cell wall-active antistaphylococcal agent plus either rifampicin, a fluoroquinolone, fosfomycin or an aminoglycoside. To adjust for survivor bias multivariable Cox models that included CoRx as a time-dependent covariable were calculated.. Of 964 evaluable patients, 512 (53%) received CoRx, most of them (301/512, 59%) rifampicin-containing CoRx. All-cause mortality after 30 and 90 days was similar for the two groups, although the patients in the CoRx group had more often endocarditis, deep-seated or disseminated infections and severe sepsis/septic shock. For the entire cohort, only age, comorbidity and severe sepsis/septic shock were associated with a higher mortality and infectious disease consultation, but not CoRx with a lower mortality. However, in the subgroup of patients with implanted foreign bodies or devices CoRx was independently associated with a lower mortality at 30 days (hazard ratio 0.6, 95% confidence interval 0.3-1.1) and at 90 days (hazard ratio 0.6, 95% confidence interval 0.4-0.9). SAB-related late complications in this subgroup occurred in 15 (10.6%) of 142 patients in the monotherapy group vs. nine (4.5%) of 202 patients in the CoRx group (p 0.03).. In a setting of optimized management of adult patients with SAB secured by infectious disease consultations, this observational study could not prove CoRx to be independently associated with improved survival or reduced late complications in the entire cohort. However, administration of CoRx may be associated with lower mortality and fewer SAB-related late complications in the subgroup of patients with implanted foreign bodies or devices. Prospective randomized trials should be performed to prove this benefit.

Topics: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Bacteremia; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Prospective Studies; Rifampin; Staphylococcal Infections; Staphylococcus aureus; Survival Analysis; Treatment Outcome; Young Adult

Impregnated central venous catheters are recommended for adults to reduce bloodstream infections but not for children because there is not enough evidence to prove they are effective. We aimed to assess the effectiveness of any type of impregnation (antibiotic or heparin) compared with standard central venous catheters to prevent bloodstream infections in children needing intensive care.. We did a randomised controlled trial of children admitted to 14 English paediatric intensive care units. Children younger than 16 years were eligible if they were admitted or being prepared for admission to a participating paediatric intensive care unit and were expected to need a central venous catheter for 3 or more days. Children were randomly assigned (1:1:1) to receive a central venous catheter impregnated with antibiotics, a central venous catheter impregnated with heparin, or a standard central venous catheter with computer generated randomisation in blocks of three and six, stratified by method of consent, site, and envelope storage location within the site. The clinician responsible for inserting the central venous catheter was not masked to allocation, but allocation was concealed from patients, their parents, and the paediatric intensive care unit personnel responsible for their care. The primary outcome was time to first bloodstream infection between 48 h after randomisation and 48 h after central venous catheter removal with impregnated (antibiotic or heparin) versus standard central venous catheters, assessed in the intention-to-treat population. Safety analyses compared central venous catheter-related adverse events in the subset of children for whom central venous catheter insertion was attempted (per-protocol population). This trial is registered with ISRCTN number, ISRCTN34884569.. Between Nov 25, 2010, and Nov 30, 2012, 1485 children were recruited to this study. We randomly assigned 502 children to receive standard central venous catheters, 486 to receive antibiotic-impregnated catheters, and 497 to receive heparin-impregnated catheters. Bloodstream infection occurred in 18 (4%) of those in the standard catheters group, 7 (1%) in the antibiotic-impregnated group, and 17 (3%) assigned to heparin-impregnated catheters. Primary analyses showed no effect of impregnated (antibiotic or heparin) catheters compared with standard central venous catheters (hazard ratio [HR] for time to first bloodstream infection 0.71, 95% CI 0.37-1.34). Secondary analyses showed that antibiotic central venous catheters were better than standard central venous catheters (HR 0.43, 0.20-0.96) and heparin central venous catheters (HR 0.42, 0.19-0.93), but heparin did not differ from standard central venous catheters (HR 1.04, 0.53-2.03). Clinically important and statistically significant absolute risk differences were identified only for antibiotic-impregnated catheters versus standard catheters (-2.15%, 95% CI -4.09 to -0.20; number needed to treat [NNT] 47, 95% CI 25-500) and antibiotic-impregnated catheters versus heparin-impregnated catheters (-1.98%, -3.90 to -0.06, NNT 51, 26-1667). Nine children (2%) in the standard central venous catheter group, 14 (3%) in the antibiotic-impregnated group, and 8 (2%) in the heparin-impregnated group had catheter-related adverse events. 45 (8%) in the standard group, 35 (8%) antibiotic-impregnated group, and 29 (6%) in the heparin-impregnated group died during the study.. Antibiotic-impregnated central venous catheters significantly reduced the risk of bloodstream infections compared with standard and heparin central venous catheters. Widespread use of antibiotic-impregnated central venous catheters could help prevent bloodstream infections in paediatric intensive care units.. National Institute for Health Research, UK.

Topics: Adolescent; Anti-Bacterial Agents; Bacteremia; Candidemia; Catheter-Related Infections; Catheterization, Central Venous; Central Venous Catheters; Child; Child, Preschool; Female; Fibrinolytic Agents; Heparin; Humans; Infant; Male; Minocycline; Rifampin

Staphylococcus aureus bacteraemia is a common and serious infection, with an associated mortality of ~25%. Once in the blood, S. aureus can disseminate to infect almost any organ, but bones, joints and heart valves are most frequently affected. Despite the infection's severity, the evidence guiding optimal antibiotic therapy is weak: fewer than 1,500 patients have been included in 16 randomised controlled trials investigating S. aureus bacteraemia treatment. It is uncertain which antibiotics are most effective, their route of administration and duration, and whether antibiotic combinations are better than single agents. We hypothesise that adjunctive rifampicin, given in combination with a standard first-line antibiotic, will enhance killing of S. aureus early in the treatment course, sterilise infected foci and blood faster, and thereby reduce the risk of dissemination, metastatic infection and death. Our aim is to determine whether adjunctive rifampicin reduces all-cause mortality within 14 days and bacteriological failure or death within 12 weeks from randomisation.. We will perform a parallel group, randomised (1:1), blinded, placebo-controlled trial in NHS hospitals across the UK. Adults (≥ 18 years) with S. aureus (meticillin-susceptible or resistant) grown from at least one blood culture who have received ≤ 96 h of active antibiotic therapy for the current infection and do not have contraindications to the use of rifampicin will be eligible for inclusion. Participants will be randomised to adjunctive rifampicin (600-900 mg/day; orally or intravenously) or placebo for the first 14 days of therapy in combination with standard single-agent antibiotic therapy. The co-primary outcome measures will be all-cause mortality up to 14 days from randomisation and bacteriological failure/death (all-cause) up to 12 weeks from randomisation. 940 patients will be recruited, providing >80% power to detect 45% and 30% reductions in the two co-primary endpoints of death by 14 days and bacteriological failure/death by 12 weeks respectively.. This pragmatic trial addresses the long-standing hypothesis that adjunctive rifampicin improves outcome from S. aureus bacteraemia through enhanced early bacterial killing. If proven correct, it will provide a paradigm through which further improvements in outcome from S. aureus bacteraemia can be explored.

Topics: Anti-Bacterial Agents; Bacteremia; Clinical Protocols; Humans; Rifampin; Sample Size; Staphylococcal Infections

To study whether levofloxacin, added to standard treatment, could reduce the high mortality and complication rates in Staphylococcus aureus bacteraemia.. A prospective randomized multicentre trial from January 2000 to August 2002.. Thirteen tertiary care or university hospitals in Finland.. Three hundred and eighty-one adult patients with S. aureus bacteraemia. Patients with meningitis, and those with fluoroquinolone- or methicillin-resistant S. aureus were excluded.. Standard treatment (mostly semisynthetic penicillin) (n = 190) or that combined with levofloxacin (n = 191). Supplementary rifampicin was recommended if deep infection was suspected.. Primary end-points were mortality at 28 days and at 3 months. Clinical and laboratory parameters were analysed as secondary end-points.. Adding levofloxacin to the standard treatment offered no survival benefit. Case fatality rates were 14% in both groups at 28 days, and 21% in the standard treatment and 18% in the levofloxacin group at 3 months. Levofloxacin combination did not differ from the standard treatment in the number of complications, time to defervescence, decrease in serum C-reactive protein concentration or length of antibiotic treatment. Deep infection was found in 84% of patients within 1 week following randomization with no difference between the treatment groups. At 3 months, the case fatality rate for patients with deep infection was 17% amongst those who received rifampicin versus 38% for those without rifampicin (P < 0.001, odds ratio = 3.06, 95% confidence intervals = 1.69-5.54).. Levofloxacin combined with standard treatment in S. aureus bacteraemia did not decrease mortality or the incidence of deep infections, nor did it speed up recovery. Interestingly, deep infections in S. aureus bacteraemia appeared to be more common than previously reported.

Topics: Adult; Aged; Anti-Bacterial Agents; Bacteremia; Chi-Square Distribution; Drug Therapy, Combination; Female; Finland; Humans; Levofloxacin; Male; Middle Aged; Odds Ratio; Ofloxacin; Penicillins; Prospective Studies; Rifampin; Sepsis; Staphylococcal Infections; Staphylococcus aureus; Treatment Failure

Central venous catheters are the predominant cause of nosocomial bacteremia; however, the effectiveness of different antimicrobial central venous catheters remains uncertain. We compared the infection rate of silver-platinum-carbon (SPC)-impregnated catheters with rifampicin-minocycline (RM)-coated catheters.. A large, single-center, prospective randomized study.. Twenty-two-bed adult general intensive care unit in a large tertiary metropolitan hospital in Brisbane, Australia (2000-2001).. Consecutive series of all central venous catheterizations in intensive care unit patients.. Randomization, concealment, and blinding were carefully performed. Catheter insertion and care were performed according to published guidelines. Blood cultures were taken at central venous catheter removal, and catheter-tip cultures were performed by both roll-plate and sonication techniques. Pulsed field gel electrophoresis was used to establish shared clonal origin for matched isolates.. Central venous catheter colonization and catheter-related bloodstream infection were determined with a blinded technique using the evaluation of the extensive microbiological and clinical data collected and a rigorous classification system. Six hundred forty-six central venous catheters (RM 319, SPC 327) were inserted, and 574 (89%) were microbiologically evaluable. Colonization rates were lower for the RM catheters than SPC catheters (25 of 280, 8.9%; 43 of 294, 14.6%; p=.039). A Kaplan-Meier analysis that included catheter time in situ did not quite achieve statistical significance (p=.055). Catheter-related bloodstream infection was infrequent for both catheter-types (RM 4, 1.4%; SPC 5, 1.7%).. The SPC catheter is a clinically effective antimicrobial catheter; however, the RM catheter had a lower colonization rate. Both catheter types had low rates of catheter-related bloodstream infection. These results indicate that future studies will require similar rigorous methodology and thousands of central venous catheters to demonstrate differences in catheter-related bloodstream infection rates.

Topics: Anti-Infective Agents, Local; Bacteremia; Carbon; Catheterization, Central Venous; Catheters, Indwelling; Cross Infection; Equipment Contamination; Female; Humans; Logistic Models; Male; Middle Aged; Minocycline; Platinum; Prospective Studies; Queensland; Rifampin; Silver

To evaluate the efficacy of long-term nontunneled silicone catheters impregnated with minocycline and rifampin (M-R) in reducing catheter-related bloodstream infections.. This prospective, randomized, double-blind clinical trial was conducted at M.D. Anderson Cancer Center, a tertiary care hospital in Houston, TX. All patients in the trial had a malignancy.. Between September 1999 and May 2002, 356 assessable catheters were used: 182 M-R and 174 nonimpregnated. The patients' characteristics were comparable between the two study groups. The mean (+/- standard deviation) duration of catheterization with M-R catheters was comparable to that of nonimpregnated catheters (66.21 +/- 30.88 v 63.01 +/- 30.80 days). A total of 17 catheter-related bloodstream infections occurred during the course of the study. Three were associated with the use of M-R catheters and 14 were associated with the nonimpregnated catheters, with a rate of catheter-related bloodstream infection of 0.25 and 1.28/1,000 catheter-days, respectively (P = .003). Gram-positive cocci accounted for the majority of the organisms causing the infections. There were no allergic reactions associated with M-R catheters.. Long-term nontunneled central venous catheters impregnated with minocycline and rifampin are efficacious and safe in reducing catheter-related bloodstream infections in cancer patients.

Topics: Anti-Bacterial Agents; Bacteremia; Catheterization, Central Venous; Catheters, Indwelling; Double-Blind Method; Female; Humans; Male; Middle Aged; Minocycline; Neoplasms; Prospective Studies; Rifampin; Silicones

Oral combination therapy with fluoroquinolones plus rifampicin is a promising alternative to standard parenteral therapy for staphylococcal infections.. In a multicenter, randomized trial, we compared the efficacy, safety, and length of hospital stay for patients with staphylococcal infections treated either with an oral combination of a fluoroquinolone (fleroxacin) plus rifampicin or with standard parenteral treatment (flucloxacillin or vancomycin). Patients were included if cultures showed the presence of bacteremia or deep-seated infections with Staphylococcus aureus (104 patients) or catheter-related bacteremia due to drug-susceptible, coagulase-negative staphylococci (23 patients).. The cure rate in the intention-to-treat analysis was 78% for the fleroxacin-rifampicin group (68 patients) and 75% for the standard therapy group (59 patients; 47 received flucloxacillin, and 12 received vancomycin); in the population of clinically evaluable patients (n=119), the cure rate was 82% and 80%, respectively; and in the population of microbiologically evaluable patients (n=103), the cure rate was 86% and 84%, respectively. Clinical and bacteriological failures after S. aureus infections were documented in similar proportions of patients. The median length of hospital stay after study entry was 12 days in the fleroxacin-rifampicin group, compared with 23 days in the standard treatment group (P=.006). More adverse events probably related to the study drug were reported in the fleroxacin-rifampicin group than in the standard therapy group (15 of 68 vs. 5 of 59 patients; P=.05).. This study suggests that an oral regimen containing a fluoroquinolone plus rifampicin may be effective for treating staphylococcal infections, allowing earlier discharge from the hospital.

Topics: Administration, Oral; Adult; Aged; Bacteremia; Catheters, Indwelling; Drug Therapy, Combination; Female; Fleroxacin; Floxacillin; Humans; Male; Methicillin Resistance; Middle Aged; Prospective Studies; Rifampin; Safety; Staphylococcal Infections; Staphylococcus; Staphylococcus aureus; Treatment Outcome; Vancomycin

To determine the cost-effectiveness of the newer antiseptic and antibiotic-impregnated central venous catheters (CVCs) relative to uncoated CVCs and to each other.. Decision model analysis of the cost and efficacy of CVCs coated with either chlorhexidine silver sulfadiazine (CSS) or rifampin-minocycline (RM) at preventing catheter-related bloodstream infections (CRBSIs). The primary outcome is the incremental cost (or savings) to prevent one additional CRBSI. Model estimates are derived from prospective trials of the CSS and RM CVCs and from other studies describing the costs of CRBSIs.. Hypothetical cohort of 1,000 patients requiring placement of a CVC.. In the model, patients were managed with either an uncoated CVC, CSS CVC, or RM CVC.. The incremental cost-effectiveness of the treated CVCs was calculated as the savings resulting from CRBSIs averted less the additional costs of the newer devices. Sensitivity analysis of the effect of the major clinical inputs was performed. For the base case analysis, we assumed the incidence of CRBSIs was 3.3% with traditional catheters and that the CSS and RM CVC conferred a relative risk reduction for the development of CRBSIs of 60% and 85%, respectively. Despite their significantly higher cost than older catheters, both novel CVCs yield significant savings. Employing either of the treated CVCs saves approximately $10,000 per CRBSI prevented (relative to standard catheters). Comparing the RM CVC to the CSS CVC revealed the RM product to be economically superior, saving nearly $9,600 per CRBSI averted and $81 per patient in the cohort. For sensitivity analysis, we adjusted all model variables by 50% individually and then simultaneously. This demonstrated the model to be most sensitive to the cost of a CRBSI; however, with all inputs skewed by 50% against both the CSS CVC and the RM CVC, these devices remained economically attractive. Under this scenario, use of either treated device was less costly.. Utilization of antiseptic and antibiotic-impregnated CVCs represent an attractive alternative for the prevention of CRBSIs and may lead to significant savings. Of the two newer, coated devices, the RM CVC performs better financially. These observations hold over a range of estimates for our model inputs.

Topics: Bacteremia; Catheterization, Central Venous; Chlorhexidine; Cost-Benefit Analysis; Costs and Cost Analysis; Decision Support Techniques; Humans; Minocycline; Rifampin; Sensitivity and Specificity; Silver Sulfadiazine

Our objective was to compare the effect of 2 regimens for treatment of Mycobacterium avium complex (MAC) bacteraemia in an HIV-positive population on symptoms and health status outcomes using a substudy of an open-label randomized controlled trial. The study was conducted in 24 hospital-based human immunodeficiency virus (HIV) clinics in 16 Canadian cities. Patients had HIV infection and MAC bacteraemia and were given either rifampin 600 mg, ethambutol 15 mg/kg daily, clofazimine 100 mg daily and ciprofloxacin 750 mg twice daily (4-drug arm) or rifabutin 600 mg daily (amended to 300 mg daily in mid-trial), ethambutol 15 mg/kg daily and clarithromycin 1000 mg twice daily (3-drug arm). The primary health status outcome was the change on the 8-item symptom subscale of the Medical Outcome Study (MOS)-HIV Health Survey adapted for MAC. Changes on other MOS-HIV subscales and on the Karnofsky score were also evaluated. Patients on the 3-drug arm had better outcomes on the MOS-HIV symptom subscale at 16 weeks (P=0.06), with statistically significant differences restricted to night sweats and fever and chills (P < 0.001). The proportion of patients improving on the symptom subscale relative to baseline was 55% on the 3-drug arm and 40% on the 4-drug arm. Patients on the 3-drug arm also had better Karnofsky score at 16 weeks (P < 0.001) and better outcomes on the social function, mental health, energy/fatigue, health distress and cognitive function subscales of the MOS-HIV. The 3-drug arm is superior to the 4-drug arm in terms of impact on MAC-associated symptoms, functional status and other aspects of health status.

Topics: Adolescent; Adult; AIDS-Related Opportunistic Infections; Antitubercular Agents; Bacteremia; Canada; Ciprofloxacin; Clarithromycin; Clofazimine; Drug Therapy, Combination; Ethambutol; Health Status; Humans; Mycobacterium avium-intracellulare Infection; Outcome and Process Assessment, Health Care; Rifabutin; Rifampin; Treatment Outcome

The use of central venous catheters impregnated with either minocycline and rifampin or chlorhexidine and silver sulfadiazine reduces the rates of catheter colonization and catheter-related bloodstream infection as compared with the use of unimpregnated catheters. We compared the rates of catheter colonization and catheter-related bloodstream infection associated with these two kinds of antiinfective catheters.. We conducted a prospective, randomized clinical trial in 12 university-affiliated hospitals. High-risk adult patients in whom central venous catheters were expected to remain in place for three or more days were randomly assigned to undergo insertion of polyurethane, triple-lumen catheters impregnated with either minocycline and rifampin (on both the luminal and external surfaces) or chlorhexidine and silver sulfadiazine (on only the external surface). After their removal, the tips and subcutaneous segments of the catheters were cultured by both the roll-plate and the sonication methods. Peripheral-blood cultures were obtained if clinically indicated.. Of 865 catheters inserted, 738 (85 percent) produced culture results that could be evaluated. The clinical characteristics of the patients and the risk factors for infection were similar in the two groups. Catheters impregnated with minocycline and rifampin were 1/3 as likely to be colonized as catheters impregnated with chlorhexidine and silver sulfadiazine (28 of 356 catheters [7.9 percent] vs. 87 of 382 [22.8 percent], P<0.001), and catheter-related bloodstream infection was 1/12 as likely in catheters impregnated with minocycline and rifampin (1 of 356 [0.3 percent], vs. 13 of 382 [3.4 percent] for those impregnated with chlorhexidine and silver sulfadiazine; P<0.002).. The use of central venous catheters impregnated with minocycline and rifampin is associated with a lower rate of infection than the use of catheters impregnated with chlorhexidine and silver sulfadiazine.

Topics: Analysis of Variance; Anti-Bacterial Agents; Anti-Infective Agents, Local; Bacteremia; Bacteria; Catheterization, Central Venous; Chlorhexidine; DNA Fingerprinting; Equipment Contamination; Female; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Minocycline; Prospective Studies; Rifampin; Risk Factors; Silver Sulfadiazine

Rifampicin has been successfully used as an adjunct to vancomycin therapy in several clinical conditions of MRSA infections such as endocarditis, ventriculoperitoneal shunts and septicaemia. However, very little information is available in the literature regarding its use in MRSA septicaemia in burns. The present prospective study was conducted to evaluate the efficacy of rifampicin as an adjunct therapy in burn cases with MRSA septicaemia not responding well to vancomycin. Fourteen out of 36 MRSA septicaemia patients with burns who either did not or only partially responded to therapeutic doses of vancomycin within 5-6 days were treated with rifampicin as an adjunct therapy (600 mg, i.v., o.d) for 5 days during the study period between January 1995 to December 1998. All the patients had burns due to flame and the TBSA varied between 20-90% with a mean of 64%. Eleven patients had deep and three had mixed burns. MRSA septicaemic episodes usually followed 2 3 days of detection of the organism in burn wounds. All the isolates were sensitive to vancomycin with an MIC of < or = 1.0 mg/L and were treated with vancomycin, (500 mg, i.v., 6 hourly). The serum vancomycin levels in all the patients were within the therapeutic range. However, blood cultures still remained positive even after 5-6 days of therapy. Institution of rifampicin, as an adjunct to vancomycin therapy to which the MRSA isolates were susceptible, showed a dramatic clinical response and survival of grafts. Thirteen patients survived and one died who had 70% deep burns and blood cultures revealed a multiresistant Acinetobacter in addition to MRSA. The present study thus confirms the efficacy of clinical use of rifampicin as an adjunct in vancomycin nonresponding cases of MRSA septicaemia in burns.

Topics: Adolescent; Adult; Bacteremia; Burn Units; Burns; Child; Child, Preschool; Drug Therapy, Combination; Female; Humans; Infant; Kuwait; Male; Methicillin Resistance; Middle Aged; Prognosis; Prospective Studies; Rifampin; Staphylococcal Infections; Survival Rate; Treatment Outcome; Vancomycin

The aim of this study was to determine the efficacy of novobiocin and rifampin as oral antibiotic prophylaxis for the prevention of catheter-related infection in melanoma patients treated with interleukin-2 (IL-2) plus interferon-alpha and chemotherapy (biochemotherapy).. Patients with advanced melanoma who were treated with biochemotherapy at the University of Texas M. D. Anderson Cancer Center were randomized in a crossover study to receive either oral antibiotic prophylaxis consisting of novobiocin and rifampin or observation alone over a 35-day course period. Patients were subsequently "crossed over" to the opposite arm of the study for an additional 35-day period, with each serving as his or her own control.. Twenty-six patients were enrolled. Nine patients (35%) failed to tolerate oral antibiotics because of severe nausea and vomiting; 17 patients (65%) were crossed over and considered evaluable. During the control patient courses, 71% of evaluable patients had infectious complications, 41% had a catheter-associated bacteremia, and 53% had a local catheter infection. In contrast, of the patients treated with antibiotic prophylaxis, only 12% had an infectious complication (P = 0.001), 12% had a local catheter infection (P = 0.008), and 6% had catheter-associated bacteremias (P = 0.04). Thirty-six episodes of catheter infections occurred during the 17 control courses, whereas only 3 episodes occurred during antibiotic prophylaxis (P < 0.001).. Although more than one-third of patients receiving IL-2 treatment with biochemotherapy failed to tolerate novobiocin and rifampin, this oral antibiotic regimen was efficacious in preventing the infectious complications, especially those associated with vascular catheters, in this high risk patient population.

Topics: Administration, Oral; Adult; Anti-Bacterial Agents; Antineoplastic Agents; Antineoplastic Combined Chemotherapy Protocols; Bacteremia; Bacterial Infections; Catheterization, Central Venous; Catheterization, Peripheral; Catheters, Indwelling; Chemoprevention; Cross-Over Studies; Equipment Contamination; Female; Humans; Immunologic Factors; Interferon-gamma; Interleukin-2; Male; Melanoma; Middle Aged; Nausea; Novobiocin; Prospective Studies; Rifampin; Vomiting

An open study was carried out on 16 patients with hospital-acquired, bacteraemic Staphylococcus aureus infections to evaluate the safety and efficacy of teicoplanin plus rifampicin. Patients received teicoplanin 400 mg bd for the first 24 h followed by 400 mg od thereafter, and rifampicin 600 mg bd. Both agents were given intravenously. Serum samples were collected to determine trough and peak antibiotic concentrations. The MIC of teicoplanin and rifampicin and the MBC of teicoplanin were determined for all S. aureus isolates. Time-kill curves were performed for the drugs individually and in combination. Clinical efficacy was assessed by the APACHE II scoring system. Bacteriological success was evaluated by elimination, persistence or recurrence of S. aureus. Safety was carefully monitored by regular biochemical and haematological testing and recording of adverse events. Fifteen patients were evaluable, of whom 13 (86.7%) were clinically cured with elimination of S. aureus. One patient died, but death was not attributed to the study drugs. Treatment failed in another patient who relapsed with a high fever. S. aureus was recovered from blood cultures from this patient, and resistance to rifampicin had developed. Time-kill curves all showed adequate killing of S. aureus at the drug concentrations measured in vivo. Neither synergy nor antagonism between teicoplanin and rifampicin was demonstrated. The combination of teicoplanin and rifampicin is an effective and well-tolerated treatment for bacteraemic S. aureus infections, but in deep-seated foci of infection resistance to rifampicin may develop.

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Bacteremia; Colony Count, Microbial; Cross Infection; Drug Therapy, Combination; Humans; Microbial Sensitivity Tests; Middle Aged; Rifampin; Staphylococcal Infections; Staphylococcus aureus; Teicoplanin; Treatment Outcome

To determine the clinical and microbiologic benefit of adding amikacin to a four-drug oral regimen for treatment of disseminated Mycobacterium avium infection in HIV-infected patients.. A randomized, open-labeled, comparative trial.. Outpatient clinics.. Seventy-four patients with HIV and symptomatic bacteremic M. avium infection.. Rifampin 10 mg/kg daily, ciprofloxacin 500 mg twice daily, clofazimine 100 mg every day, and ethambutol 15 mg/kg orally daily for 24 weeks, with or without amikacin 10 mg/kg intravenously or intramuscularly 5 days weekly for the first 4 weeks.. Clinical and microbiologic response at 4 weeks; quantitative level of bacteremia with M. avium.. No difference in clinical response was noted with the addition of amikacin to the four-drug oral regimen, and only 25% in either group had a complete or partial response at 4 weeks. A comparable quantitative decrease in bacteremia was noted in both treatment groups, with 16% of patients being culture-negative at 4 weeks and 38% at 12 weeks. Toxicities were mainly gastrointestinal. Amikacin was well tolerated. Median survival was 30 weeks in both groups.. The addition of amikacin to a four-drug oral regimen of rifampin, ciprofloxacin, clofazimine, and ethambutol did not provide clinical or microbiologic benefit.

Topics: Adult; AIDS-Related Opportunistic Infections; Amikacin; Bacteremia; Ciprofloxacin; Clofazimine; Colony Count, Microbial; Drug Therapy, Combination; Ethambutol; Female; Humans; Male; Microbial Sensitivity Tests; Mycobacterium avium Complex; Mycobacterium avium-intracellulare Infection; Rifampin

The ability of various in vitro methods of antibiotic susceptibility testing to predict therapeutic outcome in patients infected with Mycobacterium avium complex (MAC) was evaluated. Pretreatment bloodstream MAC isolates from 38 patients with AIDS, previously treated in a randomized fashion with either ethambutol, rifampin, or clofazimine, were tested by three conventional methods using broth or agar, as well as by cocultivation with macrophages. The results obtained with each method were compared with the quantitatively determined bacteriologic response to the administration of the single agent in humans. None of the conventional in vitro susceptibility methods was predictive of therapeutic outcome, while the results of cocultivation with macrophages were of moderate predictive value. The positive predictive value of a response in humans based on a response in macrophages (defined by > or = to 1.0 log reduction in baseline colony counts after 5 days of treatment) was 74%. The negative predictive value was 82%.

Topics: AIDS-Related Opportunistic Infections; Antibiotics, Antitubercular; Antitubercular Agents; Bacteremia; Clofazimine; Ethambutol; Humans; In Vitro Techniques; Macrophages; Microbial Sensitivity Tests; Mycobacterium avium Complex; Mycobacterium avium-intracellulare Infection; Rifampin

Bacteremia with the Mycobacterium avium complex is common in patients with the acquired immunodeficiency syndrome (AIDS), but the most effective treatment for this infection remains unclear.. We randomly assigned 229 patients with AIDS and M. avium complex bacteremia to receive either rifampin (600 mg daily), ethambutol (approximately 15 mg per kilogram of body weight daily), clofazimine (100 mg daily), and ciprofloxacin (750 mg twice daily) (the four-drug group) or rifabutin (600 mg daily), ethambutol (as above), and clarithromycin (1000 mg twice daily) (the three-drug group). In the three-drug group the dose of rifabutin was reduced by half after 125 patients were randomized, because 24 of 63 patients had uveitis.. Among 187 patients who could be evaluated, blood cultures became negative more often in the three-drug group than in the four-drug group (69 percent vs. 29 percent, P<0.001). Among patients treated for at least four weeks, the bacteremia resolved more frequently in the three-drug group (78 percent vs. 40 percent, P<0.001). In the three-drug group, bacteremia resolved more often with the 600-mg dose of rifabutin than with the 300-mg dose (P=0.025), but the latter regimen was more effective than the four-drug regimen (P<0.05). The median survival was 8.6 months in the three-drug group and 5.2 months in the four-drug group (P = 0.001). The median Karnofsky performance score was higher in the three-drug group than in the four-drug group from week 2 to week 16 (P<0.05). Mild uveitis developed in 3 of the 53 patients receiving the 300-mg dose of rifabutin, an incidence about one quarter that observed with the 600-mg dose (P<0.001).. In patients with AIDS and M. avium complex bacteremia, treatment with the three-drug regimen of rifabutin, ethambutol, and clarithromycin leads to resolution of the bacteremia more frequently and more rapidly than treatment with rifampin, ethambutol, clofazimine, and ciprofloxacin, and survival rates are better.

Topics: Adult; AIDS-Related Opportunistic Infections; Anti-Bacterial Agents; Antitubercular Agents; Bacteremia; Ciprofloxacin; Clarithromycin; Clofazimine; Drug Therapy, Combination; Ethambutol; Female; Humans; Male; Mycobacterium avium Complex; Mycobacterium avium-intracellulare Infection; Rifabutin; Rifampin; Survival Analysis; Treatment Outcome; Uveitis

To determine whether augmented quinolone-based antibacterial prophylaxis in neutropenic patients with cancer reduces infections caused by gram-positive cocci and preserves the protective effect against aerobic gram-negative bacilli.. Open, randomized, controlled, multicenter clinical trial.. Centers participating in the National Cancer Institute of Canada Clinical Trials Group.. 111 eligible and evaluable patients hospitalized for severe neutropenia (neutrophil count < 0.5 x 10(9)/L lasting at least 14 days) who were receiving cytotoxic therapy for acute leukemia or bone marrow autografting.. One of three oral antibacterial prophylactic regimens (norfloxacin, 400 mg every 12 hours; ofloxacin, 400 mg every 12 hours; or ofloxacin, 400 mg, plus rifampin, 300 mg every 12 hours) beginning with cytotoxic therapy.. Incidence and cause of suspected or proven infection.. Microbiologically documented overall infection rates for norfloxacin, ofloxacin, and ofloxacin plus rifampin were 47%, 24%, and 9%, respectively (P < 0.001). Corresponding rates were 24%, 13%, and 3%, respectively for staphylococcal bacteremia (P = 0.03) and, 21%, 3%, and 3%, respectively for streptococcal bacteremia (P < 0.01). The pattern of bacteremia suggested that rifampin played a role in suppressing staphylococcal infection. Both ofloxacin alone and ofloxacin plus rifampin had a clinically significant antistreptococcal effect. Aerobic gram-negative rods were cleared from rectal surveillance cultures in all patients after a median of 5.5 days and caused infection in only one patient (0.9%). The reductions in the number of microbiologically documented infections among ofloxacin recipients and ofloxacin plus rifampin recipients were offset by concomitant increases in the number of unexplained fevers (24% of norfloxacin recipients, 53% of ofloxacin recipients, and 49% of ofloxacin plus rifampin recipients; P = 0.02). No statistically significant difference was found among the treatment arms with respect to the overall incidence of febrile neutropenic episodes as defined for this trial (79% for the norfloxacin group, 82% for the ofloxacin group, and 77% for the ofloxacin plus rifampin group).. Quinolone-based antibacterial chemoprophylaxis protected patients from aerobic gram-negative bacillary infections. Augmentation of the gram-positive activity reduced the incidence of gram-positive infections but did not influence the overall incidence of febrile neutropenic episodes.

Topics: Adult; Aged; Anti-Infective Agents; Antineoplastic Agents; Bacteremia; Colony Count, Microbial; Female; Humans; Male; Middle Aged; Neutropenia; Norfloxacin; Ofloxacin; Rifampin; Staphylococcal Infections; Streptococcal Infections; Treatment Outcome

The individual antibacterial activities of clofazimine, ethambutol, and rifampin in the treatment of Mycobacterium avium complex bacteremia in patients with AIDS were determined. Sixty human immunodeficiency virus 1-infected patients who had at least one blood culture positive for M. avium complex were randomized to receive either clofazimine (200 mg), ethambutol (15 mg/kg), or rifampin (600 mg) once daily for 4 weeks. Only ethambutol resulted in a statistically significant reduction in the level of mycobacteremia. The median change in individual baseline colony counts was -0.60 log10 cfu/mL after 4 weeks of ethambutol (P = .046). In contrast, median changes in individual baseline colony counts were -0.2 log10 cfu/mL and +0.2 log10 cfu/mL for clofazimine and rifampin, respectively (both, P > .4). Ethambutol had greater antibacterial activity, as determined by changes in the level of mycobacteremia, than either rifampin or clofazimine, supporting its continued use in combination with other agents in the treatment of M. avium infection.

Topics: Adolescent; Adult; AIDS-Related Opportunistic Infections; Bacteremia; Clofazimine; Ethambutol; Female; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Mycobacterium avium-intracellulare Infection; Rifampin

It is generally assumed that Mycobacterium avium complex (MAC) bacteremia, once it develops, is unremitting. On the basis of this presumption, changes in the level of mycobacteremia are used to gauge therapeutic response. In 7 (12%) of 60 patients enrolled in a prospective trial of MAC bacteremia and AIDS, bacteremia became undetectable before the initiation of antimycobacterial therapy. Patients with transient bacteremia reported fewer and shorter symptoms and survived longer than those with sustained bacteremia (59 vs. 31 weeks; P = .022). There was no difference in the duration of AIDS, CD4+ cell count, hematocrit, or body weight between groups. Two additional patients with transient bacteremia were identified outside this study setting. Despite disappearance of detectable mycobacteremia and subsequent administration of antimycobacterial agent(s), bacteremia once again became detectable in 6 patients 4-45 weeks after their negative pretreatment cultures. Patients with disseminated MAC may have fluctuating levels of mycobacteremia that become undetectable in the absence of antimycobacterial therapy.

Topics: Adult; AIDS-Related Opportunistic Infections; Bacteremia; Clofazimine; Drug Therapy, Combination; Ethambutol; Humans; Life Tables; Mycobacterium avium-intracellulare Infection; Prospective Studies; Recurrence; Rifampin; Risk Factors; Survival Analysis

A multicenter, prospective randomized trial was conducted to determine if the addition of rifampin to a combination therapy of an antipseudomonal beta-lactam agent and aminoglycoside improves the outcome of patients with Pseudomonas aeruginosa bacteremia. The Zelen protocol for randomized-consent design was used. Consent was sought only from patients randomized to the experimental therapy (rifampin+). If the experimental therapy was refused, the patient would then receive the standard combination therapy (control); however, when outcome was evaluated, all patients randomized to the rifampin+ group, including those that declined rifampin, were compared with the control group. One hundred twenty-one consecutive hospitalized patients with positive blood cultures for P. aeruginosa were enrolled. Entry was stratified for prior use of empiric antipseudomonal antibiotics, neutropenia, severity of illness, and presence of pneumonia. Fifty-eight patients were randomized to receive rifampin (600 mg orally every 8 h for the first 72 h and then every 12 h for a total of 10 days) plus a beta-lactam agent plus an aminoglycoside. Sixty-three received the standard therapy of a beta-lactam plus an aminoglycoside agent (control). Bacteriologic cure occurred significantly more frequently in patients randomized to the rifampin+ regimen. Breakthrough or relapsing bacteremias occurred in 2% of the three-drug (rifampin+) group, compared with 14% for the two-drug (standard therapy) group. Despite this favorable trend in bacteriological response, no significant differences in survival were seen for the two treatment groups. Rifamycin derivatives warrant further clinical study as antipseudomonal agents. The Zelen protocol appears well suited for comparative trials of antimicrobial agents.

Topics: Aged; Aminoglycosides; Anti-Bacterial Agents; Bacteremia; Drug Therapy, Combination; Humans; Middle Aged; Penicillins; Pseudomonas aeruginosa; Pseudomonas Infections; Rifampin; Severity of Illness Index

To determine the quantitative microbiologic response and the clinical response of patients with Mycobacterium avium complex bacteremia and AIDS to an oral antimycobacterial regimen.. A phase II, multicenter clinical trial.. Four university-affiliated medical centers.. Forty-one patients with HIV infection who had at least two consecutive blood cultures positive for M. avium complex and who had not received previous antimycobacterial therapy were enrolled in the study. Thirty-one patients were evaluable with regard to the efficacy of the oral regimen.. Patients received a combination of orally administered rifampin (600 mg), ethambutol (15 mg/kg body weight), clofazimine (100 mg once daily), and ciprofloxacin (750 mg twice daily) for 12 weeks. Parenterally administered amikacin, 7.5 mg/kg daily for 4 weeks after the first 4 weeks of oral therapy, was used at the discretion of the individual investigator.. Clinical symptoms, Karnofsky scores, and adverse events were monitored. Colony counts for M. avium complex were determined.. The mean logarithmic (log) baseline colony count decreased from 2.1 to 0.7 after 4 weeks of oral therapy (P less than 0.001). Suppression of bacteremia was sustained throughout therapy. Thirteen patients (42%) became culture negative during therapy. The mean duration of treatment was 9.7 weeks. Nineteen evaluable patients (61%) completed 12 weeks of therapy. Adverse reactions to one or more agents were common.. A rapid reduction in symptoms and bacteremia can be achieved as early as week 2 of therapy using an oral regimen of rifampin, ethambutol, clofazimine, and ciprofloxacin. Colony counts rose dramatically after therapy was discontinued, suggesting that more prolonged periods of therapy are necessary to eradicate systemic infection.

Topics: Acquired Immunodeficiency Syndrome; Administration, Oral; Adult; Amikacin; Anti-Infective Agents; Bacteremia; Ciprofloxacin; Clofazimine; Colony Count, Microbial; Drug Evaluation; Drug Therapy, Combination; Ethambutol; Female; Follow-Up Studies; Humans; Male; Middle Aged; Mycobacterium avium-intracellulare Infection; Prospective Studies; Rifampin

To determine the median response time to therapy with vancomycin alone or with vancomycin plus rifampin in patients with methicillin-resistant Staphylococcus aureus (MRSA) endocarditis.. Cohort analysis of a randomized study.. University medical center.. Forty-two consecutive patients with MRSA endocarditis were randomly assigned to receive either vancomycin (group I) or vancomycin plus rifampin (group II) for 28 days.. Clinical signs and symptoms were recorded, and blood cultures were obtained daily to determine the duration of bacteremia.. The median duration of bacteremia was 9 days (7 days for group I and 9 days for group II). The median duration of fever for all patients and for each treatment group was 7 days. Six patients failed therapy, including three patients who died 5, 6, and 9 days after therapy was started, respectively. The other three patients who failed therapy required valve surgery on days 2, 22, and 27, respectively. Although patients had sustained bacteremia, no unusual complications were seen in either treatment group, and most patients responded to continued antibiotic therapy.. Slow clinical response is common among patients with MRSA endocarditis who are treated with vancomycin or vancomycin plus rifampin. Nevertheless, few complications appear to be related solely to this sustained bacteremia.

Topics: Adult; Bacteremia; Drug Therapy, Combination; Endocarditis, Bacterial; Female; Fever; Gentamicins; Humans; Male; Methicillin Resistance; Middle Aged; Prospective Studies; Rifampin; Staphylococcal Infections; Statistics as Topic; Time Factors; Vancomycin

The clinical significance of rifampicin resistance in Staphylococcus aureus infections has not been demonstrated. Here, we evaluated the clinical characteristics of rifampicin-resistant S. aureus infection.. Data were collected from adult patients who were hospitalized with MRSA bacteraemia between March 2007 and May 2020 at a tertiary hospital in South Korea. The clinical characteristics and treatment outcomes of patients infected with rifampicin-resistant MRSA were compared with those of rifampicin-susceptible isolates. All-cause death and recurrence of MRSA infection were assessed for 90 days.. Of the 961 patients with MRSA bacteraemia, 61 (6.3%) were infected by rifampicin-resistant isolates. The type of infection focus and duration of bacteraemia did not significantly differ between the two groups. Rifampicin-resistant MRSA isolates were more likely to have multidrug resistance and a higher vancomycin MIC relative to the rifampicin-susceptible isolates. The 90-day recurrence rate was higher in the patients infected with rifampicin-resistant MRSA compared with those with rifampicin-susceptible MRSA (18.0% versus 6.2%, P < 0.001), whereas the 90-day mortality was comparable between the two groups (27.9% versus 29.2%, P = 0.94). After adjusting for potential confounding factors, rifampicin resistance was significantly associated with 90-day recurrence (subdistributional HR: 2.31; 95% CI: 1.05-5.10; P = 0.04).. Rifampicin-resistant MRSA isolates showed distinct microbiological features in terms of multidrug resistance and a high vancomycin MIC. Although the management of MRSA bacteraemia was not significantly different between the two groups, recurrence was significantly more common in the rifampicin-resistant group. Rifampicin resistance may play a significant role in infection recurrence.

Topics: Adult; Anti-Bacterial Agents; Bacteremia; Humans; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Rifampin; Staphylococcal Infections; Vancomycin

Methicillin-sensitive

Topics: Anti-Bacterial Agents; Bacteremia; beta-Lactams; Biofilms; Humans; Methicillin; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Rifampin; Staphylococcal Infections; Staphylococcus aureus

Although several clinical variables have been reported as risk factors for recurrence of Staphylococcus aureus infection, most studies have not considered competing risk events that may overestimate the risk. In this study, we performed competing risk analysis to identify risk factors related to 90-day recurrence in patients with S. aureus bacteremia (SAB) using a large cohort data from a single tertiary hospital in South Korea. All adults who experienced SAB during admission were prospectively enrolled from August 2008 to December 2019. After the day of the first positive blood culture, recurrence and all-cause mortality were assessed for 90 days. Recurrence was defined as a development of symptoms or signs of infection with or without repeated bacteremia after >7 days of negative blood culture and clinically apparent improvement. Subdistribution hazard ratios (sHR) for recurrence and all-cause mortality were estimated using Fine and Gray models. Of 1,725 SAB patients, including 885 cases (51.3%) of methicillin-resistant S. aureus (MRSA) bacteremia, 85 (5.0%) experienced recurrence during the study period. In a multivariate Fine and Gray regression model, the presence of a vascular graft (subdistribution HR [sHR], 3.48; 95% confidence interval [CI], 1.90-6.40), nasal MRSA carriage (sHR, 2.10; 95% CI, 1.28-3.44), methicillin resistance (sHR, 1.69; 95% CI, 1.00-2.84), and rifampicin resistance (sHR, 2.20; 95% CI, 1.12-4.33) were significantly associated with 90-day recurrence. In a large cohort of SAB patients with a high prevalence of MRSA, indwelling vascular graft, nasal MRSA carriage, methicillin resistance, and rifampicin resistance were potential risk factors for recurrence of S. aureus infection.

Topics: Adult; Bacteremia; Humans; Methicillin-Resistant Staphylococcus aureus; Reinfection; Rifampin; Risk Assessment; Risk Factors; Staphylococcal Infections; Staphylococcus aureus

To determine clinical practice variation and identify knowledge gaps in antibiotic treatment of Staphylococcus aureus bacteraemia (SAB).. A web-based survey with questions addressing antibiotic treatment of SAB was distributed through the ESGAP network among infectious disease specialists, clinical microbiologists and internists in Croatia, France, Greece, the Netherlands and the UK between July 2021 and November 2021.. A total number of 1687 respondents opened the survey link, of whom 677 (40%) answered at least one question. For MSSA and MRSA bacteraemia, 98% and 94% preferred initial monotherapy, respectively. In patients with SAB and non-removable infected prosthetic material, between 80% and 90% would use rifampicin as part of the treatment. For bone and joint infections, 65%-77% of respondents would consider oral step-down therapy, but for endovascular infections only 12%-32% would. Respondents recommended widely varying treatment durations for SAB with different foci of infection. Overall, 48% stated they used 18F-fluorodeoxyglucose positron emission tomography/CT (18F-FDG-PET/CT) to guide antibiotic treatment duration. Persistent bacteraemia was the only risk factor for complicated SAB that would prompt a majority to extend treatment from 2 to 4-6 weeks.. This survey in five European countries shows considerable clinical practice variation between and within countries in the antibiotic management of SAB, in particular regarding oral step-down therapy, choice of oral antibiotic agents, treatment duration and use of 18F-FDG-PET/CT. Physicians use varying criteria for treatment decisions, as evidence from clinical trials is often lacking. These areas of practice variation could be used to prioritize future studies for further improvement of SAB care.

Topics: Anti-Bacterial Agents; Bacteremia; Fluorodeoxyglucose F18; Humans; Positron Emission Tomography Computed Tomography; Rifampin; Staphylococcal Infections; Staphylococcus aureus; Surveys and Questionnaires

Infective endocarditis is associated with a variety of clinical signs, but its association with multisystem vasculitis is rarely reported. A high index of suspicion is necessary to differentiate a primary autoimmune vasculitis from an infectious cause as the wrong treatment can lead to significant morbidity and mortality. We present a 71-year-old female patient with negative blood cultures, on antibiotics for recent bacteraemia, who presented with cutaneous and renal leucocytoclastic vasculitis. Workup revealed a vegetation adjacent to her right atrial pacemaker lead consistent with infective endocarditis and her vasculitis completely resolved with appropriate antibiotics.

Topics: Acute Kidney Injury; Aged; Anti-Bacterial Agents; Antibodies, Antineutrophil Cytoplasmic; Bacteremia; Ceftriaxone; Endocarditis, Bacterial; Female; Humans; Pulmonary Edema; Renal Dialysis; Respiratory Insufficiency; Rifampin; Skin Diseases, Vascular; Staphylococcal Infections; Vasculitis

Anti-interferon-gamma (IFN-γ) autoantibodies has been recognised as an adult-onset immunodeficiency in the past decade in people who originate from Southeast Asia. These patients are susceptible to particular opportunistic infections, especially non-tuberculous mycobacteria (NTM). We present the case of a woman whom originally came from Thailand with disseminated

Topics: Adult; Anti-Bacterial Agents; Asian People; Autoantibodies; Azithromycin; Bacteremia; Disease Progression; Ethambutol; Female; Humans; Immunologic Deficiency Syndromes; Immunologic Factors; Interferon-gamma; Mycobacterium avium Complex; Mycobacterium avium-intracellulare Infection; Pericarditis; Pleurisy; Pneumonia, Bacterial; Recurrence; Rifampin; Rituximab; Thailand

Complicated methicillin-resistant Staphylococcus aureus bloodstream infections (MRSA-BSIs), particularly those with delayed culture clearance, are associated with high mortality. Combination therapy with daptomycin and ceftaroline (DAP+CPT) represents a novel therapeutic approach to MRSA-BSI owing to synergistic bactericidal activity. This study aimed to compare DAP+CPT with historical standard of care (SoC) for treatment of complicated MRSA-BSI. This single-centre retrospective cohort study included patients with complicated MRSA-BSI at University of Colorado Hospital. Patients receiving DAP+CPT for ≥48 h between November 2013 and March 2020 or SoC with vancomycin or DAP ± gentamicin and/or rifampicin from November 2011 to December 2013 were compared. The primary outcome was clinical failure defined as a composite of MRSA-related mortality and recurrent infection at 60 days. A total of 60 patients received DAP+CPT (n = 30) or SoC (n = 30). Median age was 56 years and median Pitt bacteremia score was 3. Common infectious sites were endovascular (63%) and musculoskeletal (40%). DAP+CPT was associated with a numerically lower incidence of clinical failure compared with SoC (20% vs. 43%; P = 0.052). Multivariable analysis controlling for immunocompromised status (OR, 6.90, 95% CI 1.08-44.15), Charlson comorbidity index (OR, 1.12, 95% CI 0.90-1.39) and source control (OR, 0.35, 95% CI 0.08-1.46) associated DAP+CPT with 77% lower odds of clinical failure (OR, 0.23, 95% CI 0.06-0.89). In patients with complicated MRSA-BSI with delayed clearance, DAP+CPT trended towards lower rates of clinical failure than SoC and was significantly associated with decreased clinical failure after adjustment for baseline differences.

Topics: Adult; Aged; Anti-Bacterial Agents; Bacteremia; Ceftaroline; Cephalosporins; Daptomycin; Drug Synergism; Drug Therapy, Combination; Female; Gentamicins; Humans; Male; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Middle Aged; Retrospective Studies; Rifampin; Salvage Therapy; Standard of Care; Staphylococcal Infections; Treatment Outcome; Vancomycin

Topics: Anti-Bacterial Agents; Bacteremia; Bacterial Typing Techniques; Ceftaroline; Cephalosporins; Drug Resistance, Multiple, Bacterial; Electrophoresis, Gel, Pulsed-Field; Gene Expression; Genes, Bacterial; Humans; Linezolid; Methicillin; Methicillin Resistance; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Phylogeny; Rifampin; Staphylococcal Infections; Tetracycline; Turkey; Vancomycin; Vancomycin Resistance; Virginiamycin

To investigate whether Staphylococcus aureus bloodstream infection (SAB) patients at high risk for complications or relapse benefit from combination therapy with adjunctive rifampicin or fosfomycin.. In this post hoc analysis, SAB patients with native valve infective endocarditis, osteoarticular infections or implanted foreign devices were included. The co-primary endpoints were all-cause 90 day mortality and death or SAB-related late complications within 180 days. To overcome treatment selection bias and account for its time dependence, inverse probability of treatment weights were calculated and included in marginal structural Cox proportional hazard models (MSCMs).. A total of 578 patients were included in the analysis, of which 313 (54%) received combination therapy with either rifampicin (n = 242) or fosfomycin (n = 58). In the multivariable MSCM, combination therapy was associated with a better outcome, that is, a lower rate of death or SAB-related late complications within 180 days (HR 0.65, 95% CI 0.46-0.92). This beneficial effect was primarily seen in patients with implanted foreign devices, in which combination therapy was associated with a lower rate of death or SAB-related late complications within 180 days (HR 0.53, 95% CI 0.35-0.79) and a lower 90 day mortality (HR 0.57, 95% CI 0.36-0.91). Upon agent-specific stratification, we found no significant differences in outcomes between combination therapy containing rifampicin and fosfomycin; however, the number of patients in most subgroups was not large enough to draw firm conclusions.. In patients with implanted foreign devices, combination therapy was associated with a better long-term outcome. Larger prospective studies are needed to validate these findings.

Topics: Anti-Bacterial Agents; Bacteremia; Fosfomycin; Humans; Prospective Studies; Recurrence; Rifampin; Staphylococcal Infections; Staphylococcus aureus

Adjunctive rifampicin did not reduce failure/recurrence/death as a composite endpoint in the ARREST trial of Staphylococcus aureus bacteraemia, but did reduce recurrences. We investigated clinically-defined 14-day treatment failure, and recurrence and S. aureus-attributed/unattributed mortality by 12-weeks to further define their predictors.. A post-hoc exploratory analysis using competing risks models was conducted to identify sub-groups which might benefit from rifampicin. A points-based recurrence risk score was developed and used to compare rifampicin's benefits.. Recurrence was strongly associated with liver and renal failure, diabetes and immune-suppressive drugs (p < 0.005); in contrast, failure and S. aureus-attributed mortality were associated with older age and higher neutrophil counts. Higher SOFA scores predicted mortality; higher Charlson scores and deep-seated initial infection focus predicted failure. Unexpectedly, recurrence risk increased with increasing BMI in placebo (p = 0.04) but not rifampicin (p = 0.60) participants (p. Rifampicin reduces recurrences overall; those with greatest absolute risk reductions were identified using a simple risk score. Source control and adequate duration of antibiotic therapy remain essential to prevent recurrence and improve outcomes.

Topics: Aged; Aged, 80 and over; Anti-Bacterial Agents; Bacteremia; Female; Humans; Male; Middle Aged; Recurrence; Rifampin; Staphylococcal Infections; Staphylococcus aureus; Treatment Failure

Topics: Aneurysm, Infected; Anti-Bacterial Agents; Bacteremia; Clindamycin; Conservative Treatment; Drug Combinations; Drug Therapy, Combination; Echocardiography; Female; Heart Septal Defects, Ventricular; Humans; Infant; Linezolid; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Pulmonary Artery; Radiography; Rifampin; Staphylococcal Infections; Sulfamethizole; Trimethoprim

Antibiotic-impregnated central venous catheters (CVCs) decrease the incidence of infection in high-risk patients. However, use of these catheters carries the hypothetical risk of inducing antibiotic resistance. We hypothesized that routine use of minocycline and rifampin-impregnated catheters (MR-CVC) in a single intensive care unit (ICU) would change the resistance profile for Staphylococcus aureus.. We reviewed antibiotic susceptibilities of S. aureus isolates obtained from blood cultures in a large urban teaching hospital from 2002-2015. Resistance patterns were compared before and after implementation of MR-CVC use in the surgical ICU (SICU) in August 2006. We also compared resistance patterns of S. aureus obtained in other ICUs and in non-ICU patients, in whom MR-CVCs were not used.. Data for rifampin, oxacillin, and clindamycin were available for 9,703 cultures; tetracycline resistance data were available for 4,627 cultures. After implementation of MR-CVC use in the SICU, rifampin resistance remained unchanged, with rates the same as in other ICU and non-ICU populations (3%). After six years of use of MR-CVCs in the SICU, the rate of tetracycline resistance was unchanged in all facilities (1%-3%). The use of MR-CVCs was not associated with any change in S. aureus oxacillin-resistance rates in the SICU (66% vs. 60%). However, there was a significant decrease in S. aureus clindamycin resistance (59% vs. 34%; p < 0.05) in SICU patients.. Routine use of rifampin-minocycline-impregnated CVCs in the SICU was not associated with increased resistance of S. aureus isolates to rifampin or tetracyclines.

Topics: Anti-Bacterial Agents; Bacteremia; Catheterization, Central Venous; Drug Resistance, Bacterial; Hospitals, Teaching; Humans; Intensive Care Units; Microbial Sensitivity Tests; Minocycline; Retrospective Studies; Rifampin; Staphylococcal Infections; Staphylococcus aureus; Urban Population

Topics: Anti-Bacterial Agents; Bacteremia; Humans; Rifampin; Staphylococcal Infections; Staphylococcus aureus

Topics: Adult; Anti-Bacterial Agents; Bacteremia; Double-Blind Method; Humans; Methicillin-Resistant Staphylococcus aureus; Rifampin; Staphylococcal Infections; Staphylococcus aureus

Topics: Anti-Bacterial Agents; Bacteremia; Humans; Methicillin-Resistant Staphylococcus aureus; Rifampin; Staphylococcal Infections

Topics: Anti-Bacterial Agents; Bacteremia; Humans; Methicillin-Resistant Staphylococcus aureus; Rifampin; Staphylococcal Infections

An infant aged 6 weeks presented with failure to thrive since birth, fever and lethargy for 4 days. The child was fed on unpasteurised diluted goat's milk after birth. She was diagnosed to have brucellosis both by blood culture and serology. Her mother's Brucella serology was negative. She was successfully treated with injection amikacin and tablet rifampicin and had satisfactory weight gain thereafter. Acquired brucellosis should be considered in the differential diagnosis of failure to thrive in young infants.

Topics: Amikacin; Animals; Anti-Bacterial Agents; Bacteremia; Brucellosis; Female; Goats; Humans; Infant; Milk; Rifampin; Treatment Outcome

Topics: Anti-Bacterial Agents; Bacteremia; Bone and Bones; Drug Administration Routes; Drug Resistance, Bacterial; Enterocolitis, Pseudomembranous; Humans; Joints; Malaria Vaccines; Plasmids; Pneumococcal Vaccines; Randomized Controlled Trials as Topic; Rifampin; Staphylococcal Infections

Catheter-related bloodstream infections (CRBSIs) are among the most common hospital-acquired infections. We aimed to survey methicillin resistance, biofilm production and susceptibility to vancomycin, linezolid and other antibiotics for staphylococci isolated from CRBSIs.. Fifty-eight isolates [20 S. aureus and 38 coagulase-negative staphylococci (CoNS; 20 Staphylococcusepidermidis, nine Staphylococcushaemolyticus, three Staphylococcusschleiferi, two Staphylococcuswarneri and four Staphylococcuslugdunensis)] were tested for methicillin resistance by cefoxitin disk diffusion and detection of the mecA gene by PCR; biofilm-forming ability using Congo red agar and tissue culture plate methods; susceptibility to ciprofloxacin, clindamycin, cotrimoxazole, erythromycin, gentamicin, linezolid, rifampicin and tetracycline; and MIC determination for vancomycin.Results/Key findings. Cefoxitin resistance was detected among 40 % (8/20) S. aureus isolates, 70 % (14/20) S. epidermidis isolates and 16.7 % (3/18) of other CoNS, although the mecA gene was detected in 45 % (9/20) S. aureus isolates, 35 % (7/20) S. epidermidis isolates and 16.7 % (3/18) of other CoNS. Biofilm-forming ability ranged from 45 to 75 %. Methicillin-resistant S. aureus and other CoNS were considered to be more virulent than methicillin-resistant S. epidermidis due to the higher biofilm forming abilities of the former. All tested isolates exhibited 100 % sensitivity to vancomycin and linezolid, irrespective of their methicillin resistance or biofilm-forming ability. Rifampicin showed overall sensitivity of 75.9 %. Varying degrees of multi-resistance were found for the other antibiotics.. Vancomycin, linezolid and rifampicin could be used effectively against methicillin-resistant staphylococci isolated from CRBSIs.

Topics: Anti-Bacterial Agents; Bacteremia; Bacterial Proteins; Biofilms; Catheter-Related Infections; Catheters; Drug Resistance, Bacterial; Egypt; Humans; Linezolid; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Penicillin-Binding Proteins; Polymerase Chain Reaction; Rifampin; Staphylococcal Infections; Staphylococcus; Staphylococcus aureus; Tertiary Care Centers; Vancomycin

Papers concerning the treatment of periprosthetic infections and acute hematogenous infections often concern inhomogeneous treatment concepts or low numbers of patients; this results in inconsistent rates of treatment success.. Thirty-nine patients with early periprosthetic infections and 28 patients with acute hematogenous infections were treated with a homogeneous concept and followed with a mean period of 41.8 (24-132) months in order to investigate the success rate and influencing factors. All patients were treated with open surgical debridement, a revision of all removable components and irrigation with an antiseptic solution (octinedine). All patients received a systemic vancomycin/rifampicin antibiotic therapy until the microorganism causing the infection could be identified; a specific antibiotic therapy then followed until the end of the sixth week.. This unified treatment regimen resulted in an overall success rate of 71.6%, an 82.1% success for early infections and 57.1% for acute hematogenous infections. Variables that influenced the recurrence of an infection were the timespan between revision and first appearance of symptoms (<2 days), the number of previous operations, the American Society of Anesthesiologists classification, and nicotine abuse.. It appears that, in cases of early postoperative infection, a reproducibly high rate of success in retaining an implant can be achieved with this specific therapy regime if surgical intervention can be carried out within 2 days of first symptoms.

Topics: Acute Disease; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Bacteremia; Clinical Protocols; Debridement; Female; Humans; Male; Middle Aged; Postoperative Period; Prosthesis-Related Infections; Reoperation; Retrospective Studies; Rifampin; Therapeutic Irrigation; Treatment Outcome; Vancomycin

The objective of this study was to compare the incidence of catheter-related bloodstream infection (CRBSI) with the use of second-generation chlorhexidine-silver sulfadiazine (CHSS)-impregnated catheters, rifampicin-miconazole (RM)-impregnated catheters, and standard catheters.. Retrospective study of patients admitted to an intensive care unit who received CHSS, RM, or standard catheters in femoral venous access.. We diagnosed 18 CRBSIs in 245 patients with standard catheters in 2,061 days, zero CRBSI in 169 patients with CHSS-impregnated catheters in 1,489 days, and zero CRBSI in 227 patients with RM-impregnated catheters in 2,009 days. Patients with standard catheters compared with CHSS- and RM-impregnated catheters showed a higher rate of CRBSI (7.3%, 0%, and 0%, respectively; P < .001) and higher incidence density of CRBSI (8.7, 0, and 0 per 1,000 catheter days, respectively; P < .001). We found in the exact Poisson regression that standard catheters were associated with a higher CRBSI incidence than CHSS-impregnated catheters (P < .001) and RM-impregnated catheters (P < .001), controlling for catheter duration. We found in survival analysis that standard catheters were associated with a lower CRBSI-free time than CHSS-impregnated catheters (P < .001) and RM-impregnated catheters (P < .001).. We found that CHSS- and RM-impregnated catheters decreased similarly the risk of CRBSI.

Topics: Aged; Anti-Infective Agents; Bacteremia; Catheter-Related Infections; Catheterization, Central Venous; Central Venous Catheters; Chlorhexidine; Female; Humans; Incidence; Intensive Care Units; Male; Miconazole; Middle Aged; Retrospective Studies; Rifampin; Risk; Silver Sulfadiazine

Topics: Anti-Infective Agents, Local; Bacteremia; Catheterization, Central Venous; Chlorhexidine; Humans; Miconazole; Rifampin; Silver Sulfadiazine

Topics: Anti-Infective Agents; Bacteremia; Catheterization, Central Venous; Chlorhexidine; Humans; Miconazole; Rifampin; Silver Sulfadiazine

Methicillin-resistant Staphylococcus aureus (MRSA) is one of the most important pathogens in the hospital environment. Monitoring of this pathogen by molecular characterization and phenotypic methods is important for the development of suitable infection control measures and proper therapy design. In this study, our aim was to investigate the molecular epidemiological characteristics of MRSA bloodstream isolates obtained from patients hospitalized at Ankara University Ibn-i Sina Hospital in a 10-year period (2002-2012) and monitor the possible changes. A total of 134 isolates were characterized according to their antimicrobial susceptibility profiles, biofilm formation capabilities, accessory gene regulator (agr) locus types, presence of genes encoding Panton-Valentine leukocidin (PVL), staphylococcal enterotoxins A-J (SEs A-J), toxic shock syndrome toxin, sasX, and genes associated with biofilm formation (icaD, icaA, IS256) by polymerase chain reaction. The staphylococcal cassette chromosome mec (SCCmec) types of isolates were also defined and their clonal relationships were investigated by pulsed-field gel electrophoresis (PFGE) analysis and multilocus sequence typing was performed for representative isolates obtained by PFGE.. The majority of the isolates were resistant to rifampin (100%), ciprofloxacin (97%), tetracycline (97.7%), and gentamicin (94.7%); 100% carried type-III SCCmec and 89.5% were agr type-1. All the isolates were negative for PVL, and sasX genes while all of them carried the icaD, icaA, and IS256 genes. The most common SE was enterotoxin A (97%). Four major PFGE patterns with the dominance of one pattern and seven unique patterns were obtained. All the representative PFGE isolates (n = 11) belonged to sequence type 239.. We have documented the characteristics of the dominant MRSA clone in our hospital, which was a PVL (-), sasX (-) ST239 clone carrying sea (+) with type-III SCCmec, and type-1 agr locus.

Topics: Anti-Bacterial Agents; Bacteremia; Bacterial Typing Techniques; Chromosomes, Bacterial; Ciprofloxacin; Drug Resistance, Multiple, Bacterial; Electrophoresis, Gel, Pulsed-Field; Genes, Bacterial; Genetic Loci; Gentamicins; Hospitals, University; Humans; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Molecular Epidemiology; Phylogeny; Retrospective Studies; Rifampin; Staphylococcal Infections; Tetracycline; Turkey

We report the successful use of daptomycin in a child with methicillin-resistant Staphylococcus aureus endocarditis with persistent bacteremia and clinical deterioration, despite treatment with vancomycin and rifampicin. She had acute kidney injury, requiring daptomycin dosage adjustment.

Topics: Anti-Bacterial Agents; Bacteremia; Child, Preschool; Daptomycin; Endocarditis, Bacterial; Female; Humans; Methicillin-Resistant Staphylococcus aureus; Rifampin; Staphylococcal Infections; Treatment Outcome; Vancomycin

Topics: Administration, Oral; Arteries; Arthralgia; Bacteremia; Brucella melitensis; Brucellosis; Child; Diagnosis, Differential; Doxycycline; Drug Therapy, Combination; Femoral Fractures; Fractures, Open; Gentamicins; Germany; Hip; Humans; Infusions, Intravenous; Knee; Male; Postoperative Complications; Refugees; Rifampin; Syria; Thigh; Ultrasonography; Veins

Donor-derived tuberculosis (TB) is an increasingly recognized complication of solid organ transplantation. We report a case of isoniazid-resistant pulmonary TB in a lung transplant recipient. The patient acquired the infection from the lung donor who was previously empirically treated with isoniazid for latent TB. The case highlights the caveat that, while adequate treatment of latent TB with isoniazid is presumed, meticulous screening of donors is required.

Topics: Adult; Allografts; Anti-Bacterial Agents; Antibiotic Prophylaxis; Antitubercular Agents; Bacteremia; Bronchoalveolar Lavage Fluid; Bronchoscopy; Cystic Fibrosis; Drug Resistance, Bacterial; Female; Fluoroquinolones; Humans; Immunosuppression Therapy; Isoniazid; Latent Tuberculosis; Lung Transplantation; Microbial Sensitivity Tests; Moxifloxacin; Mycobacterium tuberculosis; Pseudomonas aeruginosa; Rifampin; Tissue Donors; Tuberculosis, Pulmonary

Emerging resistance to colistin in clinical Acinetobacter baumannii isolates is of growing concern. Since current treatment options for these strains are extremely limited, we investigated the in vitro activities of various antimicrobial combinations against colistin-resistant A. baumannii Nine clinical isolates (8 from bacteremia cases and 1 from a pneumonia case) of colistin-resistant A. baumannii were collected in Asan Medical Center, Seoul, South Korea, between January 2010 and December 2012. To screen for potential synergistic effects, multiple combinations of two antimicrobials among 12 commercially available agents were tested using the multiple-combination bactericidal test (MCBT). Checkerboard tests were performed to validate these results. Among the 9 colistin-resistant strains, 6 were pandrug resistant and 3 were extensively drug resistant. With MCBT, the most effective combinations were colistin-rifampin and colistin-teicoplanin; both combinations showed synergistic effect against 8 of 9 strains. Colistin-aztreonam, colistin-meropenem, and colistin-vancomycin combinations showed synergy against seven strains. Colistin was the most common constituent of antimicrobial combinations that were active against colistin-resistant A. baumannii Checkerboard tests were then conducted in colistin-based combinations. Notably, colistin-rifampin showed synergism against all nine strains (100%). Both colistin-vancomycin and colistin-teicoplanin showed either synergy or partial synergy. Colistin combined with another β-lactam agent (aztreonam, ceftazidime, or meropenem) showed a relatively moderate effect. Colistin combined with ampicillin-sulbactam, tigecycline, amikacin, azithromycin, or trimethoprim-sulfamethoxazole demonstrated limited synergism. Using MCBT and checkerboard tests, we found that only colistin-based combinations, particularly those with rifampin, glycopeptides, or β-lactams, may confer therapeutic benefits against colistin-resistant A. baumannii.

Topics: Acinetobacter baumannii; Acinetobacter Infections; Anti-Bacterial Agents; Aztreonam; Bacteremia; Ceftazidime; Colistin; Drug Combinations; Drug Resistance, Multiple, Bacterial; Drug Synergism; Humans; Meropenem; Microbial Sensitivity Tests; Pneumonia, Bacterial; Retrospective Studies; Rifampin; Teicoplanin; Thienamycins; Vancomycin

Ustekinumab (Stelara®), a human monoclonal antibody targeting the p40-subunit of interleukin (IL)-12 and IL-23, is indicated for moderate to severe plaque psoriasis and psoriatic arthritis. In large multicenter, prospective trials assessing efficacy and safety of ustekinumab increased rates of severe infections have not been observed so far.. Here, we report the case of a 64-year old woman presenting with chills, pain and swelling of her right foot with dark maculae at the sole, and elevated inflammatory markers. She had received a third dose of ustekinumab due to psoriatic arthritis three days before admission. Blood cultures revealed growth of Staphylococcus aureus and imaging showed a thickening of the aortic wall ventral the bifurcation above the right internal iliac artery, resembling an acute bacterial endarteritis. Without the evidence of aneurysms and in absence of foreign bodies, the decision for conservative management was made. The patient received four weeks of antibiotic therapy with intravenous flucloxacillin, followed by an oral regime with levofloxacin and rifampicin for an additional four weeks. Inflammatory markers resolved promptly and the patient was discharged in good health.. To our knowledge, this is the first report of a severe S. aureus infection in a patient receiving ustekinumab. Albeit ustekinumab is generally regarded as a safe drug, severe bacterial infections should always be included in the differential diagnosis of elevated inflammatory markers in patients receiving biologicals as these might present with nonspecific symptoms and fever might be absent. Any effort to detect deep-seated or metastatic infections should be made to prevent complications and to secure appropriate treatment. Although other risk factors for an invasive staphylococcal infection like psoriasis, recent corticosteroid injection, or prior hospitalisations were present, and therefore a directive causative link between the S. aureus bacteraemia and ustekinumab can not be drawn, we considered the reporting of this case worthwhile to alert clinicians as we believe that ongoing pharmacovigilance to detect increased risks for rare but severe infections beyond phase II and phase III trials in patients treated with biologicals is essential.

Topics: Administration, Intravenous; Administration, Oral; Arthritis, Psoriatic; Bacteremia; Dermatologic Agents; Endarteritis; Female; Floxacillin; Humans; Iliac Artery; Levofloxacin; Middle Aged; Rifampin; Staphylococcal Infections; Staphylococcus aureus; Ustekinumab

Human granulocytic anaplasmosis (HGA) is an acute nonspecific febrile illness caused by the bacterium Anaplasma phagocytophilum. Although usually transmitted via tick bite, HGA may rarely also be acquired through transfusion. HGA during pregnancy may pose significant gestational risks due to altered maternal immune status and the potential for perinatal transmission.. A pregnant 34-year-old Massachusetts woman with β-thalassemia trait was diagnosed at 32 weeks of gestation with transfusion-associated HGA (TAHGA) after receiving nine leukoreduced red blood cell transfusions. She was successfully treated with rifampin therapy and gave birth to a healthy child who tested negative for HGA after delivery. An implicated blood donor was subsequently identified through physician collaboration with the regional American Red Cross and Massachusetts Department of Public Health.. This is the 11th reported case of HGA in pregnancy and is at least the sixth known case in which leukoreduction did not prevent TAHGA. As seen in this case, nonspecific symptomatology of variable onset can impede diagnosis and treatment. This may increase risk of poor outcomes in maternal HGA patients. Cases of TAHGA, although currently uncommon, may increase as the incidence of HGA in certain parts of the country increases.. Heightened cross-institutional awareness of the potential risk of TAHGA is warranted. Clinicians need to consider transfusion-associated infections when fever occurs in a transfusion recipient. This case provides additional evidence that leukoreduction does not obviate risk of A. phagocytophilum contamination of donated blood components.

Topics: Anaplasma phagocytophilum; Anti-Bacterial Agents; Antibodies, Bacterial; Bacteremia; beta-Thalassemia; Blood Donors; Blood Safety; Delayed Diagnosis; Ehrlichiosis; Erythrocyte Transfusion; Female; Fluorescent Antibody Technique, Indirect; Humans; Infant, Newborn; Leukocyte Reduction Procedures; Male; Massachusetts; Pregnancy; Pregnancy Complications, Hematologic; Pregnancy Complications, Infectious; Rifampin

Prosthetic vascular graft infection although a rare complication of vascular reconstruction surgery; has been associated with significant morbidity and mortality. The author presents two patients with prosthetic aortic graft presenting as fever and methicillin sensitive Staphylococcus aureus bacteraemia without any other localising sign of infection. Both patients had a history of postoperative wound infection after their graft placement. Patients remained persistently bacteraemic on appropriate antimicrobial therapy making the clinician suspicious of a vascular graft infection. A [18 F] fluoro-2-deoxy-d glucose positron emission tomography associated to CT scan was used to identify the prosthetic vascular graft infection and since both patients were high-risk surgical candidates, a conservative medical approach was used. They were treated with 6 weeks of nafcillin and rifampin, followed by long-term doxycycline for suppression. This highlights the importance of considering vascular graft infection in patients with recurrent and persistent bacteraemia despite adequate therapy.

Topics: Anti-Infective Agents; Aorta; Bacteremia; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Fluorodeoxyglucose F18; Humans; Male; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Positron-Emission Tomography; Prosthesis-Related Infections; Radiopharmaceuticals; Rifampin; Surgical Wound Infection; Tomography, X-Ray Computed; Treatment Outcome

Rifampicin has been used as adjunctive therapy in Staphylococcus aureus bacteraemia (SAB) with a deep infection focus. However, data for prognostic impact of rifampicin therapy is unestablished including the optimal initiation time point. We studied the impact of rifampicin therapy and the optimal initiation time for rifampicin treatment on prognosis in methicillin-sensitive S. aureus bacteraemia with a deep infection.. Retrospective, multicentre study in Finland including 357 SAB patients with a deep infection focus. Patients with alcoholism, liver disease or patients who died within 3 days were excluded. Patients were categorised according to duration of rifampicin therapy and according to whether rifampicin was initiated early (within 7 days) or late (7 days after) after the positive blood cultures. Primary end point was 90 days mortality.. Twenty-seven percent of patients received no rifampicin therapy, 14% received rifampicin for 1-13 days whereas 59% received rifampicin ≥14 days. The 90 day mortality was; 26% for patients treated without rifampicin, 16% for rifampicin therapy of any length and 10% for early onset rifampicin therapy ≥14 days. Lack of rifampicin therapy increased (OR 1.89, p=0.026), rifampicin of any duration decreased (OR 0.53, p=0.026) and rifampicin therapy ≥14 days with early onset lowered the risk for a fatal outcome (OR 0.33, p<0.01) during 90 days follow-up.. Rifampicin adjunctive therapy for at least 14 days and initiated within 7 days of positive blood culture associated with improved outcome among SAB patients with a deep infection.

Topics: Aged; Anti-Bacterial Agents; Bacteremia; Ciprofloxacin; Cloxacillin; Drug Therapy, Combination; Female; Finland; Humans; Male; Methicillin; Microbial Sensitivity Tests; Middle Aged; Retrospective Studies; Rifampin; Secondary Prevention; Staphylococcal Infections; Staphylococcus aureus; Survival Analysis; Time-to-Treatment; Treatment Outcome

This case report describes the treatment of a rare infection caused by Staphylococcus lugdunensis with cefazolin and rifampin.. A 48-year-old man with significant comorbidities was admitted to our institution with complaints of malaise, shortness of breath, and vague persistent pain. He was diagnosed with S. lugdunensis infective endocarditis and was treated with cefazolin continuous infusion for 10 days without resolution of bacteremia. As surgical intervention was deemed inappropriate, rifampin was added to the treatment regimen for its antibiofilm activity. After rifampin initiation, resolution of bacteremia was rapidly achieved. Subsequent blood cultures remained negative, and the patient was discharged home in stable condition to complete six weeks of i.v. cefazolin and rifampin therapy. The patient continued treatment, as documented by the infusion center, weekly for five weeks. The patient was rehospitalized during his sixth week of treatment due to impending respiratory failure, whereupon he was intubated and admitted to the intensive care unit. The patient's cardiac status gradually worsened over the following days, and he ultimately died. Blood cultures from days 1 and 2 of hospitalization revealed no bacterial growth at five days.. Cefazolin and rifampin therapy in a hospitalized patient with bacteremia and aortic valve endocarditis caused by S. lugdunensis resulted in rapid eradication of the bacteremia. After more than five weeks of cefazolin-rifampin treatment, the patient was rehospitalized with worsening cardiac function and died. Blood cultures during the second admission were negative.

Topics: Anti-Bacterial Agents; Bacteremia; Cefazolin; Drug Therapy, Combination; Endocarditis, Bacterial; Fatal Outcome; Humans; Infusions, Intravenous; Liver Function Tests; Male; Middle Aged; Rifampin; Staphylococcal Infections; Staphylococcus lugdunensis

Hemophagocytic lymphohistiocytosis (HLH) is a rare syndrome of excessive inflammation and tissue destruction due to abnormal immune activation and inflammation. HLH can occur primarily due to genetic etiology, or secondarily associated with malignancies, autoimmmune diseases or infections. There are a number of reports that revealed the relationship of hemophagocytosis with brucellosis. In this report, we described a brucellosis-related HLH case. A 73-year-old male who work as farmer was admitted to our hospital with the complaints of fever continuing for 10 days, loss of appetite and back pain. Physical examination revealed right upper quadrant tenderness and hepatomegaly. Since the patient exhibited five of the diagnostic criteria for HLH (fever, hepatosplenomegaly, bicytopenia, hypertriglyceridemia and high ferritin level), he was diagnosed as secondary HLH. PCR, microscopic agglutination and indirect fluorescent antibody tests gave negative results for the diagnosis of Crimean-Congo hemorrhagic fever, leptospirosis and Q fever, respectively. On the other hand, Rose Bengal test for brucellosis was positive, while standard tube agglutination test (STA) was negative. The patient's serum yielded a very high positive (1/1280) result when Coombs' test was performed in terms of the possibility of blocking antibodies or prozone phenomenon. Additionally, B.melitensis was isolated from his blood culture on the sixth day. The patient was treated with doxycycline and rifampicin, and on the 10th day of antibiotic therapy the patient was discharged and recommended to complete his treatment up to 6 weeks. In conclusion, in patients with secondary HLH symptoms especially in the endemic areas, brucellosis should be considered as a predisposing infection.

Topics: Aged; Agricultural Workers' Diseases; Anti-Bacterial Agents; Bacteremia; Brucella melitensis; Brucellosis; Causality; Coombs Test; Doxycycline; Humans; Lymphohistiocytosis, Hemophagocytic; Male; Rifampin

Use of chlorhexidine and silver sulfadiazine-impregnated (CSS) central venous catheters (CVCs) has not been shown to decrease the catheter-related bloodstream infection rate in an ICU. The purpose of this study was to determine if use of minocycline and rifampin-impregnated (MR) CVCs would decrease central line-associated bloodstream infection (CLABSI) rates compared with those observed with use of CSS-impregnated CVCs.. A total of 7,181 patients were admitted to a 24-bed university hospital surgical ICU: 2,551 between March 2004 and August 2005 (period 1) and 4,630 between April 2006 and July 2008 (period 2). All patients requiring CVC placement in period 1 had a CSS catheter inserted, and in period 2 all patients had MR CVCs placed.. Twenty-two CLABSIs occurred during 7,732 catheter days (2.7 per 1,000 catheter days) in the 18-month period when CSS lines were used. After the introduction of MR CVCs, 21 catheter-related bloodstream infections occurred during 15,722 catheter days (1.4 per 1,000 catheter days). This represents a significant (p < 0.05) decrease in the CLABSI rate after introduction of MR CVCs. Mean length of time to infection developing after catheterization (8.6 days for CSS vs 6.1 days for MR) was also different (p = 0.04). The presence of MR did not alter the microbiologic profile of catheter-related infections, and it did not increase the incidence of resistant organisms.. The CLABSI rate decreased more with the use of MR CVCs compared with CSS CVCs in an ICU where the CLABSI rate was already low. The types of organisms causing infection were similar. With continued use of MR-impregnated CVCs in our ICU in the subsequent 5 years, we have seen sustained low rates of CLABSIs.

Topics: Academic Medical Centers; Anti-Infective Agents; Bacteremia; Catheter-Related Infections; Central Venous Catheters; Chlorhexidine; Female; Humans; Intensive Care Units; Male; Middle Aged; Minocycline; Rifampin; Silver Sulfadiazine; Treatment Outcome

Topics: Anti-Infective Agents; Bacteremia; Catheter-Related Infections; Female; Humans; Male; Minocycline; Rifampin

Topics: Anti-Infective Agents; Bacteremia; Catheter-Related Infections; Female; Humans; Male; Minocycline; Rifampin

Respiratory anthrax is a fatal disease in the absence of early treatment with antibiotics. Rabbits are highly susceptible to infection with Bacillus anthracis spores by intranasal instillation, succumbing within 2 to 4 days postinfection. This study aims to test the efficiency of antibiotic therapy to treat systemic anthrax in this relevant animal model. Delaying the initiation of antibiotic administration to more than 24 h postinfection resulted in animals with systemic anthrax in various degrees of bacteremia and toxemia. As the onset of symptoms in humans was reported to start on days 1 to 7 postexposure, delaying the initiation of treatment by 24 to 48 h (time frame for mass distribution of antibiotics) may result in sick populations. We evaluated the efficacy of antibiotic administration as a function of bacteremia levels at the time of treatment initiation. Here we compare the efficacy of treatment with clarithromycin, amoxicillin-clavulanic acid (Augmentin), imipenem, vancomycin, rifampin, and linezolid to the previously reported efficacy of doxycycline and ciprofloxacin. We demonstrate that treatment with amoxicillin-clavulanic acid, imipenem, vancomycin, and linezolid were as effective as doxycycline and ciprofloxacin, curing rabbits exhibiting bacteremia levels of up to 10(5) CFU/ml. Clarithromycin and rifampin were shown to be effective only as a postexposure prophylactic treatment but failed to treat the systemic (bacteremic) phase of anthrax. Furthermore, we evaluate the contribution of combined treatment of clindamycin and ciprofloxacin, which demonstrated improvement in efficacy compared to ciprofloxacin alone.

Topics: Amoxicillin-Potassium Clavulanate Combination; Animals; Anthrax; Anti-Bacterial Agents; Bacillus anthracis; Bacteremia; Ciprofloxacin; Clarithromycin; Disease Models, Animal; Doxycycline; Drug Combinations; Drug Synergism; Humans; Imipenem; Linezolid; Male; Microbial Sensitivity Tests; Rabbits; Respiratory Tract Infections; Rifampin; Spores, Bacterial; Survival Analysis; Vancomycin

Brucellosis is the most common bacterial zoonosis, and causes a considerable burden of disease in endemic countries. Cardiovascular involvement is the main cause of mortality due to infection with Brucella spp, and most commonly manifests as endocarditis, peripheral and cerebrovascular aneurysms, or arterial and venous thromboses. We report a case of brucellosis presenting as bacteraemia and aortic endarteritis 18 years after the last known exposure to risk factors for brucella infection. The patient was treated with doxycycline, rifampicin, and gentamicin, and underwent surgical repair of a penetrating aortic ulcer, with a good clinical recovery. We review the signs and symptoms, diagnostic approach, prognosis, and treatment of brucella arteritis. We draw attention to the absence of consensus about the optimum therapy for vascular brucellosis, and the urgent need for additional studies and renewed scientific interest in this major pathogen.

Topics: Abattoirs; Aged; Animals; Anti-Bacterial Agents; Aortic Diseases; Bacteremia; Blood Vessel Prosthesis; Brucella abortus; Brucellosis; Doxycycline; Ecuador; Endarteritis; Endocarditis, Bacterial; Gentamicins; Humans; Male; Occupational Exposure; Prognosis; Rifampin; Ulcer

Combination therapy is recommended for the treatment of KPC-producing Klebsiella pneumoniae (KPC-Kp), but the optimal regimen for colistin-resistant strains is unknown. We compared the synergistic activity and post-antibiotic effect (PAE) of colistin in combination with other antimicrobials against colistin-susceptible and -resistant KPC-Kp bloodstream isolates.. The genotypes of nine colistin-susceptible and eight colistin-resistant KPC-Kp bloodstream isolates were analysed using PCR and amplicon sequencing. Combinations of colistin, meropenem, tigecycline, rifampicin and teicoplanin were then screened using the Etest, a chequerboard assay and time-kill studies. Synergistic combinations were also analysed with respect to the PAE in time-kill curves and the PAE at clinically achievable concentrations.. Insertional inactivation of the PhoQ/PhoB two-component regulatory system by mgrB-IS5 was identified in 6/8 (75%) colistin-resistant KPC-Kp. Colistin/rifampicin combinations resulted in no interactions [fractional inhibitory concentration (FIC) indices 1.5-2] for colistin-susceptible strains, but were uniformly synergistic (FIC indices 0.1-0.4) against colistin-resistant KPC-Kp. Time-kill kinetic analysis, at clinically achievable fixed concentrations of rifampicin and colistin, confirmed synergy and produced persistent growth inhibition (3 h) of colistin-resistant KPC-Kp strains exposed to colistin/rifampicin or colistin/rifampicin/tigecycline combinations.. Combinations of colistin plus rifampicin, and less frequently tigecycline, exhibited synergistic activity in vitro against colistin-resistant KPC-Kp strains.

Topics: Anti-Bacterial Agents; Bacteremia; beta-Lactamases; Colistin; DNA, Bacterial; Drug Resistance, Bacterial; Drug Synergism; Genotype; Humans; Klebsiella Infections; Klebsiella pneumoniae; Microbial Sensitivity Tests; Minocycline; Polymerase Chain Reaction; Rifampin; Sequence Analysis, DNA; Tigecycline

Topics: Aged; Aged, 80 and over; Anti-Bacterial Agents; Bacteremia; Drug Resistance, Multiple, Bacterial; Female; Humans; Male; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Rifampin; Rifamycins; Rifaximin; Staphylococcal Infections

We herein report a case of persistent methicillin-resistant Staphylococcus aureus (MRSA) bacteremia that was successfully treated with combination therapy consisting of high-dose daptomycin (DAP, 10 mg/kg) and rifampicin. The patient's condition was complicated with multiple infectious foci, including an iliopsoas abscess and epidural abscess, as well as discitis and spondylitis at the cervical, thoracic and lumbar levels. Monotherapy treatments with vancomycin, linezolid and usual-dose DAP were all ineffective. It has been shown that usual-dose DAP administration may result in the emergence of a resistant strain and treatment failure. We would like to emphasize the importance of high-dose DAP therapy for MRSA bacteremia, a condition with a potentially high mortality rate.

Topics: Aged; Anti-Bacterial Agents; Antibiotics, Antitubercular; Bacteremia; Daptomycin; Dose-Response Relationship, Drug; Drug Therapy, Combination; Humans; Male; Methicillin-Resistant Staphylococcus aureus; Rifampin; Staphylococcal Infections

Central venous catheters (CVC) removal and reinsertion of a new CVC in the setting of central line associated bloodstream infections (CLABSI) is not always possible in septic patients. The purpose of this study was to evaluate the outcome of patients with Staphylococcus aureus-CLABSI (SA-CLABSI) who had their CVCs exchanged over guidewire for minocycline/rifampin-coated (M/R)-CVC within seven days of bacteremia.. Each case was matched with two control patients who had SA-CLABSI and had their CVC removed within seven days and two control patients who had their CVC retained beyond seven days. In addition, an in vitro model was developed for exchange of catheters.. We identified 40 patients with SA-CLABSI. Eight patients had their CVC exchanged over guidewire with M/R-CVC and were compared to 16 patients who had their CVC removed and 16 other patients who had their CVC retained. Patients who had their CVC exchanged over guidewire had a similar clinical response and relapse rates compared to patients whose CVC was removed or retained. However the rate of overall mortality was higher in patients who retained their CVC compared to those whose CVC was exchanged or removed (p = 0.034). The in vitro catheter exchange model showed that catheter exchange over guidewire using M/R-CVC completely prevented biofilm colonization compared to exchange using uncoated CVC (p < 0.0001).. In the setting of SA-CLABSI, exchanging the CVC over guidewire with M/R-CVC could be an alternative to removing the CVC and reinserting another CVC at a different site and may be associated with a lower rate of overall mortality. Further large prospective randomized clinical trials are warranted.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Bacteremia; Catheter-Related Infections; Catheterization, Central Venous; Central Venous Catheters; Child; Child, Preschool; Female; Humans; Male; Middle Aged; Minocycline; Recurrence; Retrospective Studies; Rifampin; Staphylococcal Infections; Young Adult

Topics: Aged, 80 and over; Anti-Bacterial Agents; Bacteremia; Chest Pain; Confusion; Cough; Diagnosis, Differential; Dyspnea; Dysuria; Female; Floxacillin; Humans; Methicillin-Resistant Staphylococcus aureus; Rifampin; Risk Factors; Staphylococcal Infections; Treatment Outcome

A 67-year-old gentleman developed persistent Staphylococcus epidermidis bacteraemia following transjugular intrahepatic portal shunting. 'Endotipsitis' was diagnosed. Conventional therapy with a vancomycin infusion, amikacin and rifampicin failed after 17 days. He was cured with a 6-week course of high-dose (8 mg/kg) daptomycin monotherapy.

Topics: Aged; Amikacin; Anti-Bacterial Agents; Bacteremia; Catheterization, Central Venous; Catheters; Daptomycin; Drug Resistance, Multiple, Bacterial; Humans; Male; Rifampin; Staphylococcal Infections; Staphylococcus epidermidis; Treatment Failure; Vancomycin

Cerebritis y abscesos cerebrales por Streptococcus pneumoniae en un recien nacido.

Topics: Anti-Bacterial Agents; Anticonvulsants; Bacteremia; Brain Abscess; Bronchiolitis; Cardiotonic Agents; Cerebral Hemorrhage; Drug Therapy, Combination; Fatal Outcome; Humans; Immunocompromised Host; Infant, Newborn; Magnetic Resonance Imaging; Male; Meningitis, Pneumococcal; Pneumococcal Infections; Respiratory Syncytial Virus Infections; Rifampin; Spleen; Streptococcus pneumoniae; Vancomycin

Topics: Actinomycetales Infections; Aged; Anti-Bacterial Agents; Bacteremia; Ciprofloxacin; Diagnosis, Differential; Drug Therapy, Combination; Fertilizers; Humans; Imipenem; Immunocompromised Host; Leukemia, Myelomonocytic, Chronic; Lung Abscess; Lung Neoplasms; Male; Manure; Opportunistic Infections; Rhodococcus equi; Rifampin; Shock, Septic; Tomography, X-Ray Computed

Received 29 November 2012; returned 20 February 2013; revised 16 May 2013; accepted 18 May 2013 OBJECTIVES: Raised vancomycin MICs have been associated with poor outcomes for methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia in the USA and mainland Europe. We investigated if this also applies in the UK, where EMRSA-15 (clonal complex 22) dominates.. Isolates from UK patients receiving vancomycin therapy for MRSA bacteraemia in 2008-10 were collected, along with clinical details. Outcomes (i.e. patient survival or bacteraemia resolution) were reported 28 days after vancomycin therapy ended. The relationship between clinical outcome and MIC--as determined by CLSI and BSAC agar dilution methods--was assessed.. Among 228 MRSA bacteraemias, 82% were caused by EMRSA-15; 65% of the patients were male and the median age was 70.5 years. MICs correlated between methods, but CLSI agar dilution testing gave a mode at 1 mg/L with only 12% of results either side, whereas the BSAC method gave a mode straddling 0.7-1 mg/L with <4% outliers. Twenty-three percent of patients died, with MRSA contributory in half; another 17% had unresolved bacteraemia at 28 days. Neither death nor unresolved bacteraemia was significantly associated with higher vancomycin MICs by either method. Rifampicin co-therapy had no quantifiable effect on outcome. The patient's age was the only significant correlate of patient outcome (P < 0.01); the underlying medical condition of the patient was important for the resolution of bacteraemia (P < 0.01), though not for overall mortality.. Subtle vancomycin MIC differences did not correlate with worse outcomes for vancomycin monotherapy or for vancomycin/rifampicin co-therapy in MRSA bacteraemia. Regardless of the exact MIC-outcome relationship, detecting such small MIC differences seems unlikely to be reliable in routine laboratories.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Bacteremia; Child; Child, Preschool; Female; Humans; Infant; Infant, Newborn; Male; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Middle Aged; Prognosis; Rifampin; Staphylococcal Infections; Treatment Outcome; United Kingdom; Vancomycin; Young Adult

Topics: Aged; Animals; Anti-Bacterial Agents; Bacteremia; Braces; Cattle; Combined Modality Therapy; Discitis; Drug Therapy, Combination; Endocarditis, Bacterial; Female; Food Contamination; Gentamicins; Gram-Positive Bacterial Infections; Humans; Lactococcus; Lumbar Vertebrae; Milk; Ofloxacin; Pasteurization; Rifampin

Coagulase-negative staphylococci are the most common cause of late-onset sepsis in premature neonates. The optimal approach in persistent coagulase-negative staphylococcal bacteremia, despite adequate treatment with glycopeptides, is not well established. A retrospective study was conducted on preterm neonates with persistent coagulase-negative staphylococcal bacteremia treated with the combination of vancomycin-rifampicin. Ten cases were included, with a median gestational age of 26 weeks (range 24 weeks + 3 days-31 weeks + 4 days, interquartile range 25 weeks + 3 days-29 weeks + 3 days) and a median birth weight of 715 g (range 555-2,030). The median age at the onset of infection was 9 days (range 5-37). The most frequent clinical presentation was apnea or increased ventilatory support. Bacteremia persisted for a median of 9 (range 6-19) days until rifampicin initiation. Bacteremia was resolved in all cases on vancomycin-rifampicin with no serious side effects.. Our study provides data supporting the safety and efficacy of vancomycin-rifampicin combination for the treatment of persistent coagulase-negative staphylococcal bacteremia in preterm neonates.

Topics: Anti-Bacterial Agents; Bacteremia; Coagulase; Drug Therapy, Combination; Female; Humans; Infant, Newborn; Infant, Premature; Male; Retrospective Studies; Rifampin; Staphylococcal Infections; Staphylococcus; Treatment Outcome; Vancomycin

Topics: Adult; Amikacin; Anti-Bacterial Agents; Antibiotic Prophylaxis; Bacteremia; Cefuroxime; Cesarean Section; Female; Humans; Methicillin-Resistant Staphylococcus aureus; Metronidazole; Pregnancy; Pregnancy Complications, Infectious; Rifampin; Staphylococcal Infections; Teicoplanin; Trimethoprim; Wound Infection

The objective of this report is to discuss the efficacy of in situ replacement for treating mycotic aneurysm, particularly using rifampicin-bonded grafts and omental pedicle grafts, on the basis of our 7 years of experience.. Between December 2003 and December 2010, we performed surgical treatments in 23 patients (for the thoracic aorta in 6 patients, for the thoracoabdominal aorta in 8 patients, and for the abdominal aorta in 9 patients; 7 emergency, 10 urgent, and 6 elective operations) with mycotic aneurysm by using rifampicin-bonded grafting and omental pedicle grafting.. One patient died in hospital because of local recurrent infection. One patient required an additional operation on another aortic site, and 3 patients had spinal cord injuries (2 transient and 1 permanent). Overall survival at 5 years was 95%, and the rate of freedom from aortic events at 5 years was 86%.. In situ replacement using rifampicin-bonded grafting and omental pedicle grafting is effective for treating mycotic aneurysms of the thoracic and abdominal aorta.

Topics: Aged; Aged, 80 and over; Aneurysm, Infected; Anti-Bacterial Agents; Aortic Aneurysm, Abdominal; Aortic Aneurysm, Thoracic; Bacteremia; Blood Vessel Prosthesis Implantation; Combined Modality Therapy; Elective Surgical Procedures; Enterobacteriaceae Infections; Female; Gram-Positive Bacterial Infections; Humans; Male; Middle Aged; Omentum; Polyethylene Terephthalates; Retrospective Studies; Rifampin; Stents; Surgical Flaps; Treatment Outcome

Topics: Adult; AIDS-Related Opportunistic Infections; Antitubercular Agents; Arthritis, Infectious; Bacteremia; Candidiasis, Oral; Clarithromycin; Drug Therapy, Combination; Ethambutol; Humans; Immunocompromised Host; Isoniazid; Knee Joint; Male; Mycobacterium Infections, Nontuberculous; Mycobacterium kansasii; Radiography; Rifampin; Tuberculosis, Osteoarticular

Catheters coated with minocycline and rifampin are proven to decrease the rates of central line-associated bloodstream infection; however, it is unclear whether success occurs independent of other infection control precautions. We evaluated the effect of catheters coated with minocycline and rifampin with and without other infection control precautions on our rates of central line-associated bloodstream infection in critically ill patients and on antibiotic resistance throughout the hospital and in the intensive care unit.. Retrospective clinical cohort study conducted during 1999-2006 with an observational laboratory component.. A tertiary university-based cancer center.. All 8009 patients admitted to the medical intensive care unit were subjects for the surveillance of central line-associated bloodstream infection. All Staphylococcus aureus and coagulase-negative staphylococci clinical isolates cultured at our institution during the same period were subjects for laboratory testing.. Using catheters coated with minocycline and rifampin and implementing infection control precautions.. Incidence of central line-associated bloodstream infection in the medical intensive care unit. Change in resistance to tetracycline and rifampin in clinically relevant staphylococcal isolates in the intensive care unit and hospitalwide. During the study period, 9200 catheters coated with minocycline and rifampin were used hospitalwide over a total of 511,520 catheter days. The incidence of central line-associated bloodstream infection per 1000 patient days in the medical intensive care unit significantly and gradually decreased from 8.3 in 1998 to 1.2 in 2006 (p ≤ .001). The resistance of S. aureus and coagulase negative staphylococci clinical isolates to tetracycline or rifampin in the intensive care unit and on a hospitalwide level remained stable or decreased significantly during the same period.. Catheters coated with minocycline and rifampin significantly decreased the incidence of central line-associated bloodstream infection in the medical intensive care unit in a manner that was independent and complementary to the infection control precautions. Although this study strongly suggests an association between catheters coated with minocycline and rifampin use and a decrease in central line-associated bloodstream infection, because of multiple other concurrent interventions, the results should be interpreted cautiously until a prospective study is conducted. Furthermore, long-term use of these devices is not associated with increased resistance of staphylococcal isolates to tetracycline and rifampin in the intensive care unit or throughout the hospital.

Topics: Adult; Aged; Anti-Bacterial Agents; Bacteremia; Blood-Borne Pathogens; Catheter-Related Infections; Catheterization, Central Venous; Catheters, Indwelling; Chi-Square Distribution; Cohort Studies; Cross Infection; Drug Delivery Systems; Drug Resistance, Multiple, Bacterial; Female; Follow-Up Studies; Humans; Infection Control; Intensive Care Units; Male; Microbial Sensitivity Tests; Middle Aged; Minocycline; Retrospective Studies; Rifampin; Risk Assessment; Statistics, Nonparametric; Time Factors; Treatment Outcome

The incidence of carbapenem-resistant Acinetobacter baumannii infection is increasing, which might be associated with high morbidity and mortality among critically ill patients with limited therapeutic options. This study was conducted to evaluate the clinical and microbiological features of carbapenem-resistant A. baumannii bacteraemia. The medical records of 28 adult patients with this bacteraemia admitted to Korea University Guro Hospital, from January 2005 through December 2010, were reviewed. Using the 28 bloodstream isolates, we intended to detect genes encoding carbapenemases, and investigate the inoculum effect on each of the antimicrobial agents rifampicin, imipenem, colistin and tigecycline. With one blood isolate from a patient with pneumonia, rifampicin-inducible resistance was examined using the experimental mouse pneumonia model. Out of 28 carbapenem-resistant A. baumannii bloodstream infections (BIs), the most common primary focus was the central venous catheter (35.7 %) and then the lung (32.1 %). The 30 day overall mortality was 53.6 %; in most cases (80 %) the patients died within 10 days after the onset of the bacteraemia. By univariate analysis, inappropriate antimicrobial therapy (73.3 vs 30.8 %, P = 0.02), mechanical ventilation (53.3 vs 15.4 %, P = 0.04) and a high Pitt bacteraemia score (4.9±1.9 vs 2.2±1.2, P<0.01) were statistically significant risk factors for mortality, while only a high Pitt bacteraemia score (odds ratio 2.6; 95 % confidence interval 1.1-6.5) was independently associated with 30 day mortality by multivariate analysis. All 28 isolates had the bla(OXA-51)-like gene with upstream ISAbaI, 2 of which additionally had the bla(OXA-58)-like gene and the bla(OXA-23)-like gene. Inoculum effect and rifampicin inducible resistance were not detected. Considering the rapid progression to death in carbapenem-resistant A. baumannii BIs, early empirical antibiotic therapy would be warranted based on the local microbiological data in each hospital.

Topics: Acinetobacter baumannii; Acinetobacter Infections; Adult; Aged; Animals; Bacteremia; beta-Lactam Resistance; beta-Lactamases; Carbapenems; Disease Models, Animal; Female; Genes, Bacterial; Humans; Male; Mice; Mice, Inbred ICR; Microbial Sensitivity Tests; Middle Aged; Pneumonia, Bacterial; Republic of Korea; Rifampin; Risk Factors

Topics: Aged, 80 and over; Anti-Bacterial Agents; Bacteremia; Biofilms; Combined Modality Therapy; Device Removal; Drug Resistance, Multiple, Bacterial; Drug Therapy, Combination; Electrodes, Implanted; Endocarditis, Bacterial; Equipment Failure; Female; Humans; Pacemaker, Artificial; Postoperative Complications; Radiography, Interventional; Rifampin; Staphylococcal Infections; Staphylococcus epidermidis; Ultrasonography; Vancomycin

To study the incidence of rifampicin-resistant Staphylococcus aureus in Gipuzkoa, Northern Spain, and to characterize representative resistant isolates and mutations associated with resistance.. For rifampicin-resistant isolates, the rpoB gene fragment that includes the most frequent mutations conferring rifampicin resistance in S. aureus was amplified and sequenced. The role of new mutations responsible for rifampicin resistance was confirmed by cloning and complementation in trans. Resistant isolates were characterized by multilocus sequence typing and PFGE.. Between 1999 and 2008, 0.59% (96/16 348) of S. aureus clinical isolates studied showed rifampicin resistance. Rifampicin resistance was higher in methicillin-resistant S. aureus (MRSA) than in methicillin-susceptible S. aureus (MSSA) (3.26% versus 0.26%; P < 0.001). Twenty-two randomly selected rifampicin-resistant isolates were studied in depth, 11 showing low-level and 11 showing high-level rifampicin resistance (rifampicin MICs of 2-4 mg/L and ≥8 mg/L, respectively). Overall, 12 different mutations in the rpoB gene were detected, including a newly described N474K mutation followed by the insertion of a glycine residue at position 475. Among the eight different sequence types (STs) found, the most frequent were ST8 and ST863, the latter being associated with respiratory infections. Ten of the 11 low-level rifampicin-resistant isolates were MRSA ST8 and had the same H481N mutation, while the 11 high-level rifampicin-resistant isolates, 6 MSSA and 5 MRSA, belonged to eight different STs and had distinct rpoB mutations.. Low-level rifampicin-resistant isolates were mainly clonal while high-level resistant isolates showed a high genetic diversity. Most mutations observed coincided with those found in other studies, but a new mutation conferring rifampicin resistance was detected.

Topics: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Bacteremia; Bacterial Typing Techniques; Child; Cloning, Molecular; DNA-Directed RNA Polymerases; DNA, Bacterial; Drug Resistance; Electrophoresis, Gel, Pulsed-Field; Female; Genetic Complementation Test; Genotype; Humans; Incidence; Male; Middle Aged; Multilocus Sequence Typing; Polymorphism, Genetic; Respiratory Tract Infections; Rifampin; Sequence Analysis, DNA; Spain; Staphylococcal Infections; Staphylococcus aureus; Wound Infection; Young Adult

The aim of this study was to determine the rifampicin (RIF) resistance rate of meticillin-resistant Staphylococcus aureus (MRSA) amongst patients with MRSA bacteraemia who have or have not been exposed to RIF-containing antituberculous (anti-TB) treatment. From 2000 to 2008, patients with MRSA bacteraemia and previous exposure to RIF-containing anti-TB therapy were selected. Patients matched for sex, age and time of culture of MRSA bacteraemia but without exposure to anti-TB therapy were selected as a control group. A total of 139 patients, comprising 49 with RIF exposure and 90 without RIF exposure, were analysed. The RIF resistance rate was higher in patients with previous RIF exposure (61.2% vs. 20.0%; P<0.001). The minimum inhibitory concentration of RIF that inhibited 50% of MRSA isolates (MIC(50)) for the study group was also higher (128 mg/L vs. 0.015 mg/L; P<0.001). The mortality rate was higher in the study group (59.2% vs. 41.1%; P=0.041). MRSA isolates recovered from patients with current usage of a RIF-containing anti-TB regimen were more likely to be resistant to RIF (87.5% vs. 36%; P=0.001), with higher MIC(50) values (256 mg/L vs. 1mg/L; P=0.002), and resulted in a higher mortality rate than isolates from patients with remote usage of an anti-TB regimen (79.2% vs. 40%; P=0.005). Multivariate analysis showed that current anti-TB drug usage was the only risk factor for RIF resistance [odds ratio (OR)=7.457, 95% confidence interval (CI) 1.581-35.167] and mortality (OR=7.201, 95% CI 1.583-32.766). Given the high rate of RIF resistance in patients with prior anti-TB treatment, RIF susceptibility testing should be performed before considering combination treatment of RIF in MRSA infection.

Topics: Aged; Aged, 80 and over; Anti-Bacterial Agents; Bacteremia; Blood; Drug Resistance, Bacterial; Female; Humans; Male; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Middle Aged; Rifampin; Staphylococcal Infections; Tuberculosis

Previous cost-effectiveness analyses found that antibiotic-impregnated catheters decrease the incidence of catheter-related bloodstream infection (CRBSI) as well as the costs related to central venous catheter (CVC) use, including increased hospital length of stay. The effect varied greatly among the studies, however. In this retrospective cohort study, compared with standard catheters, the use of rifampicin-miconazole-impregnated catheters was associated with lower CRBSI incidence and immediate CVC-related costs (taking into account only the costs of CVC, diagnosis, and treatment of CRBSI) (P < .001). Our data indicate that the use of rifampicin-miconazole-impregnated catheters can save associated costs.

Topics: Adult; Aged; Anti-Bacterial Agents; Bacteremia; Catheter-Related Infections; Catheters; Cohort Studies; Cross Infection; Female; Health Care Costs; Humans; Incidence; Male; Miconazole; Middle Aged; Retrospective Studies; Rifampin

Methicillin-resistant Staphylococcus aureus (MRSA) meningitis is associated with a high mortality rate. Treatment is challenging in patients with allergy to vancomycin. Herein, we describe a case of MRSA bacteremia secondary to medical device infection with MRSA that was complicated by MRSA meningitis. This case provides evidence for a possible role of combination therapy of daptomycin, linezolid, and rifampin in cases of MRSA meningitis and bacteremia.

Topics: Acetamides; Anti-Bacterial Agents; Bacteremia; Daptomycin; Drug Therapy, Combination; Humans; Linezolid; Male; Meningitis, Bacterial; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Middle Aged; Oxazolidinones; Rifampin; Staphylococcal Infections; Treatment Outcome

Topics: Anti-Bacterial Agents; Bacteremia; Blood; Cerebrospinal Fluid; Female; Flavobacteriaceae; Flavobacteriaceae Infections; Humans; Meningitis; Microscopy; Middle Aged; Rifampin; Stem Cell Transplantation; Transplantation; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

After primary infection, some bacteria can remain in a latent state for several years before a new bacteremia, often due to a weakened immune status. This is common for Mycobacterium tuberculosis, less for other pathogens more difficult to have in mind when facing patients with fever. We report the case of an 84-year-old female patient presenting with fever in the months following antilymphoma chemotherapy, due to bacteremic brucellosis (with a hemophagocytic syndrome) probably latent after primary infection as a child.

Topics: Aged, 80 and over; Antibodies, Monoclonal; Antibodies, Monoclonal, Murine-Derived; Antineoplastic Combined Chemotherapy Protocols; Bacteremia; Brucella melitensis; Brucellosis; Combined Modality Therapy; Cyclophosphamide; Doxycycline; Drug Therapy, Combination; Female; France; Humans; Immunocompromised Host; Immunoglobulins, Intravenous; Lymphoma, Non-Hodgkin; Recurrence; Rifampin; Rituximab; Spain; Time Factors; Vidarabine

We describe the clinical course of a previously healthy 20-month-old toddler admitted with high fever and leukocytosis. Blood culture grew Streptococcus pneumoniae serotype 19A, belonging to the ST663 clone, highly resistant to penicillin, ceftriaxone, and erythromycin. The same clone with identical antibiogram was isolated from the nasopharynx of another three of the other five healthy children attending the same daycare center as the patient. This case exemplifies the potential problems posed by highly-resistant S. pneumoniae serotype 19A, an emerging pathogen worldwide.

Topics: Anti-Bacterial Agents; Bacteremia; Carrier State; Child Day Care Centers; Community-Acquired Infections; Drug Resistance, Multiple, Bacterial; Female; Humans; Infant; Israel; Pneumococcal Infections; Rifampin; Serotyping; Streptococcus pneumoniae; Vancomycin

Corynebacterium jeikeium, frequently encountered in clinical specimens, is part of the normal skin flora. Nevertheless, a few cases of C. jeikeium bacteremia followed by severe clinical manifestations have been reported. C. jeikeium has been reported to cause endocarditis, septicemia, meningitis, pneumonia and osteomyelitis, along with soft tissue and trauma infections. Herein we describe a case of C. jeikeium bacteremia in Greece. The isolation of a coryneform bacterium from a clinical specimen should not immediately be considered a superinfection by the skin flora. Clinical and laboratory investigations are essential in order to evaluate such cases before applying appropriate treatment. On the other hand, the association of coryneform bacteria and disease should be critically investigated, with a thorough identification of the strain, ideally beyond the classical methods, at a specialized center.

Topics: Aged; Anti-Bacterial Agents; Bacteremia; Corynebacterium; Corynebacterium Infections; Female; Greece; Humans; Microbial Sensitivity Tests; Renal Dialysis; Rifampin; Skin; Vancomycin

There are reports that rifampicin-bonded prosthetic grafts might be a suitable alternative to autologous grafts in vascular graft infections and infectious vascular complications. We characterize the spectrum of microbial agents and susceptibility to antibiotic treatment, especially to rifampicin, in these patients. We carried out a retrospective analysis of wound-swaps and blood cultures in 48 patients with infected prosthetic vascular grafts or primary infectious vascular complications. In 15 of 48 patients (31%), the analysis showed that the microbial organism causing the infection was resistant or not susceptible to rifampicin. Rifampicin-bonded prosthetic grafts should be used with caution in acute infectious complications in vascular surgery, because in about 30% of the cases, the initiating microbial organisms are resistant or not susceptible to rifampicin. Without preoperative confirmation of susceptibility to rifampicin, autologous reconstruction should be preferred.

Topics: Adult; Aged; Aged, 80 and over; Antibiotics, Antitubercular; Bacteremia; Blood Vessel Prosthesis; Dose-Response Relationship, Drug; Drug Resistance, Bacterial; Female; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Prosthesis-Related Infections; Reoperation; Retrospective Studies; Rifampin; Secondary Prevention

Topics: Anti-Bacterial Agents; Bacteremia; Drug Resistance, Bacterial; Drug Therapy, Combination; Endocarditis; Fatal Outcome; Humans; Infant; Male; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Rifampin; Staphylococcal Infections; Vancomycin

To report a case in which daptomycin-nonsusceptible methicillin-resistant Staphylococcus aureus (MRSA) bacteremia was successfully treated with the addition of rifampin to daptomycin.. An 84-year-old male presented with fever and chills following cystoscopy. After culturing was conducted, the patient received single doses of vancomycin and gentamicin and then continued on vancomycin plus ceftazidime. Blood cultures grew MRSA, with vancomycin and daptomycin minimum inhibitory concentrations (MICs) of < or =1 microg/mL and 0.25 microg/mL, respectively. Vancomycin was continued, with trough concentrations maintained >15 microg/mL, but results of blood cultures remained positive. On day 10, therapy was switched to daptomycin 6 mg/kg/day, but culture results remained positive. On day 13, testing for vancomycin heteroresistance was negative, with the MIC unchanged. The vancomycin MIC remained unchanged on day 19, but the daptomycin MIC had increased to 2 microg/mL. Rifampin 300 mg orally twice daily was added on day 20; blood cultures obtained 2 days later were sterile. The patient was discharged to complete a 6-week course of antibiotics and was doing well 4 months following therapy.. Analysis of MRSA isolates obtained on days 1 and 19 showed an increase in the daptomycin MIC from 0.25 to 2 microg/mL. Because intervening isolates were not available for susceptibility testing, it is not possible to associate this increase with exposure to either vancomycin or daptomycin. Although in vitro synergy was not seen in this case, addition of rifampin to daptomycin therapy resolved the bacteremia.. In patients with persistent MRSA bacteremia, isolates should be retested for susceptibility to both daptomycin and vancomycin, including assessment for vancomycin heteroresistance. Addition of rifampin to daptomycin may be effective for persistent MRSA bacteremia, even if daptomycin MICs are elevated. Prospective studies are needed to define the role of combination therapy.

Topics: Aged, 80 and over; Anti-Bacterial Agents; Bacteremia; Daptomycin; Drug Therapy, Combination; Humans; Male; Methicillin Resistance; Microbial Sensitivity Tests; Rifampin; Staphylococcal Infections; Staphylococcus aureus; Treatment Outcome; Urine

Topics: Aged; Aged, 80 and over; Bacteremia; Drug Resistance, Bacterial; Female; Humans; Male; Methicillin Resistance; Rifampin; Staphylococcal Infections; Staphylococcus aureus

Coagulase negative staphylococci (CoNS) are the most common cause of neonatal sepsis in the Neonatal Intensive Care Unit (NICU). A minority of neonates does not respond to vancomycin therapy and develops persistent bacteremia, which may be treated with rifampin. We evaluated the use of rifampin in persistent CoNS bacteremia.. Retrospective study of 137 neonates with CoNS bacteremia during admission to a tertiary NICU between July 2006 and July 2009. Main outcome measures were total duration of bacteremia and the adequacy of vancomycin and rifampin therapy.. 137/1696 (8.0%) neonates developed a CoNS bacteremia. Eighteen were treated with rifampin because of persistent bacteremia (3 positive blood cultures at least 48 hours apart with clinical symptoms) or (a serious suspicion of) an intravascular thrombus. Duration of bacteremia prior to rifampin therapy (8.0 ± 3.6 days) was positively correlated (p < 0.001) to the total duration of bacteremia (10.3 ± 3.7 days). After starting rifampin therapy C-reactive protein (CRP) levels of all neonates declined and blood cultures became sterile after 2.3 ± 1.6 days. Vancomycin levels were not consistently measured in all neonates, resulting in late detection of subtherapeutic trough levels.. Rifampin may be effective in the treatment of persistent CoNS infections in neonates. Outcome may be improved by adequate monitoring of vancomycin trough levels.

Topics: Bacteremia; C-Reactive Protein; Coagulase; Dose-Response Relationship, Drug; Enzyme Inhibitors; Female; Follow-Up Studies; Gestational Age; Humans; Infant, Newborn; Intensive Care Units, Neonatal; Male; Retrospective Studies; Rifampin; Staphylococcal Infections; Staphylococcus; Treatment Outcome

This study evaluated vancomycin susceptibility and activity alone and in combination with rifampicin and tigecycline against low-biofilm- and high-biofilm-producing methicillin-resistant Staphylococcus aureus (MRSA) clinical isolates.. Forty MRSA isolates recovered from bloodstream infections were analysed. Susceptibilities were performed in planktonic and biofilm cultures by microbroth dilution. Biofilm production was determined using an adherent plate assay. Time-kill analysis was performed on six low- and six high-biofilm-producing isolates with 15 mg/L vancomycin alone and in combination with rifampicin or tigecycline at 4x MIC.. Vancomycin susceptibility displayed a 4-fold and an 8-fold increase in the MIC(50) and MIC(90), respectively, in the presence of biofilm. Rifampicin and tigecycline susceptibilities also increased in biofilms, but still remained within the susceptibility breakpoints except for a tigecycline MIC(90) of 1 mg/L. High biofilm production was detected in 60% of the isolates. In time-kill analysis, 15 mg/L vancomycin achieved bactericidal activity against only low-biofilm-producing strains with a 1.8 log(10) cfu/mL difference in bacterial kill compared with high-biofilm-producing strains (P < 0.001). Rifampicin alone had minimal activity, resulting in resistance. Tigecycline was minimally effective and was not bactericidal, but no difference was observed in the comparison of biofilm-producing strains. Vancomycin in combination with rifampicin or tigecycline was bactericidal against all strains (mean kill 4.5 +/- 0.5 log(10) cfu/mL), regardless of biofilm production.. Vancomycin exposures at 15 mg/L may not be adequate in eradicating biofilm-producing S. aureus. Alternative treatments or combination therapy should be explored to optimize outcomes in biofilm-associated infections.

Topics: Anti-Bacterial Agents; Bacteremia; Biofilms; Colony Count, Microbial; Drug Synergism; Humans; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Microbial Viability; Minocycline; Rifampin; Staphylococcal Infections; Tigecycline; Vancomycin

Topics: Anti-Bacterial Agents; Bacteremia; Catheterization; Cross Infection; Disinfection; Humans; Miconazole; Rifampin

Staphylococcus lugdunensis is an infrequent cause of infective endocarditis (IE) and usually involves native valves of the heart. It causes life-threatening events such as rupture of cardiac valve or cerebral or pulmonary embolism due to necrosis on the endocardial tissue involved by the bacteria. Antibiotic therapy without cardiac surgery or delayed cardiac surgery usually follows a fatal course in S. lugdunensis endocarditis. In this report the first case of S. lugdunensis endocarditis from Turkey was presented. A 37-year-old man was admitted to the emergency department with a 2-weeks history of fever chills and accompanying intermittent pain on the left side of the thorax. Other than recurrent folliculitis continuing for 20 years, his history was unremarkable. Echocardiography revealed vegetation on the mitral valve of the patient and vancomycin plus gentamicin were initiated with the diagnosis of IE. All blood cultures (5 sets) taken on admission and within the initial 48 hours of the antibiotic therapy yielded S. lugdunensis. According to the susceptibility test results, the antibiotic therapy was switched to ampicillin-sulbactam plus rifampin. Blood cultures became negative after the third day of therapy, however, cardiac failure was emerged due to rupture of mitral valve and chorda tendiniea on the 12th day of the therapy. Cardiac surgery revealed that mitral valve and surrounding tissue of the valve were evidently necrotic and fragile, anterior leaflet of the mitral valve was covered with vegetation, posterior leaflet and chorda tendiniea were ruptured. Vegetation was removed and the destructed mitral valve was replaced with a mechanical valve. Vegetation culture remained sterile, however, antibiotics were switched to vancomycin plus rifampin due to persistent fever on the 21st day of the therapy (9th day of operation). Fever resolved four days after the antibiotic switch. Antibiotics were stopped on the 9th weeks of admission and the patient was discharged. He had no problem in follow-up controls for one year. In conclusion, proper antibiotic therapy combined with early cardiac surgery seems to be the optimal therapeutic approach in IE caused by S. lugdunensis.

Topics: Adult; Ampicillin; Anti-Bacterial Agents; Bacteremia; Chemotherapy, Adjuvant; Drug Therapy, Combination; Endocarditis, Bacterial; Gentamicins; Heart Valve Prosthesis Implantation; Humans; Male; Mitral Valve; Necrosis; Rifampin; Staphylococcal Infections; Staphylococcus; Sulbactam; Ultrasonography; Vancomycin

Brucellosis is a major public health problem in Turkey and all over the world. Joint pain, night sweats, anorexia, weakness, loss of weight and headache are the basic symptoms of brucellosis and the illness can affect many organs. Genitourinary involvement is reported in 2-20% of cases, epididimoorchitis being the most frequent complication, however, prostatic involvement is far more uncommon. In this paper, a case of Brucella prostatitis misdiagnosed as prostate carcinoma has been presented. A 50-years-old man who was a microbiology laboratory staff has been admitted to our outpatient clinic with the complaints of joint pain, weakness, fever, urgency, difficulty and pain during urination. Since prostate specific antigen (PSA) was 23.6 ng/ml (normal value < 4 ng/ml) and free PSA (fPSA) was 3.89 ng/ml (normal value < 1 ng/ml), needle biopsy from the prostate was performed. Blood cultures performed by BACTEC 9200 (Becton Dickinson, Sparks, Md.) system yielded Brucella melitensis, and the pathological examination of the prostate biopsy revealed prostatic hyperplasia and prostatitis. Brucella standard tube agglutination titer was 1/320. Upon the diagnosis of Brucella prostatitis the patient was treated with a combination of 200 mg doxycycline and 600 mg rifampicin daily for 6 months. During the follow-up period no complication was detected in the patient and the PSA level decreased to 1.57 ng/ml and fPSA to 0.43 ng/ml. This case was reported to withdraw attention to prostatic involvement during brucellosis. Elevated PSA values with the signs and symptoms of brucellosis in endemic areas should be evaluated accordingly and appropriate therapy should be initiated without any delay.

Topics: Anti-Bacterial Agents; Bacteremia; Biopsy, Needle; Brucella melitensis; Brucellosis; Diagnosis, Differential; Doxycycline; Drug Therapy, Combination; Humans; Male; Middle Aged; Prostate; Prostate-Specific Antigen; Prostatic Hyperplasia; Prostatic Neoplasms; Prostatitis; Rifampin

Topics: Asepsis; Bacteremia; Catheterization, Central Venous; Catheters, Indwelling; Chlorhexidine; Cross Infection; Equipment Contamination; Humans; Minocycline; Rifampin; Silver Sulfadiazine

The guidelines of the Centers for Disease Control and Prevention do not recommend the use of an antimicrobial- or antiseptic-impregnated catheter for short-term use. In previous studies, we have found a higher incidence of central venous catheter-related bacteremia among patients with femoral and central jugular accesses than among patients with other venous accesses.. The objective of our study was to determine the incidence of central venous catheter-related bacteremia associated with rifampicin-miconazole-impregnated catheters and standard catheters in patients with femoral and central jugular venous accesses.. This was a cohort study, conducted in the 24-bed polyvalent medical-surgical intensive care unit of a university hospital. We included patients who were admitted to the intensive care unit from 1 June 2006 through 30 September 2007 and who underwent femoral or central jugular venous catheterization.. We inserted 184 femoral (73 rifampicin-miconazole-impregnated catheters and 111 standard catheters) and 241 central jugular venous catheters (114 rifampicin-miconazole-impregnated catheters and 127 standard catheters). We found a lower rate of central venous catheter-related bacteremia associated with rifampicin-miconazole-impregnated catheters than with standard catheters among patients with femoral access (0 vs. 8.62 cases per 1000 catheter-days; odds ratio, 0.13; 95% confidence interval, 0.00-0.86; P = .03) and among patients with central internal jugular access (0 vs. 4.93 cases per 1000 catheter-days; odds ratio, 0.13; 95% confidence interval, 0.00-0.93; P = .04).. Rifampicin-minonazole-impregnated catheters are associated with a statistically significant reduction in the incidence of catheter-related bacteremia in patients with short-term catheter use at the central jugular and femoral sites.

Topics: Adult; Aged; Anti-Bacterial Agents; Bacteremia; Catheterization, Central Venous; Catheters, Indwelling; Coated Materials, Biocompatible; Cohort Studies; Female; Femoral Vein; Humans; Jugular Veins; Male; Miconazole; Middle Aged; Rifampin

Topics: Abscess; Aged; Amoxicillin; Anti-Bacterial Agents; Aortic Valve; Bacteremia; Combined Modality Therapy; Device Removal; Endocarditis, Bacterial; Gentamicins; Gram-Positive Bacterial Infections; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Male; Pacemaker, Artificial; Propionibacterium acnes; Prosthesis-Related Infections; Reoperation; Rifampin

Topics: Aged; Bacteremia; Catheterization, Central Venous; Chronic Disease; Daptomycin; Discitis; Humans; Jugular Veins; Male; Methicillin-Resistant Staphylococcus aureus; Pancreatitis; Rifampin; Staphylococcal Infections; Vancomycin; Virginiamycin

Topics: Acetamides; Aged, 80 and over; Anesthesia; Anti-Bacterial Agents; Bacteremia; Bone Marrow Diseases; Comorbidity; Contraindications; Daptomycin; Drug Administration Schedule; Drug Therapy, Combination; Gentamicins; Hip Prosthesis; Humans; Linezolid; Male; Methicillin-Resistant Staphylococcus aureus; Oxazolidinones; Prosthesis-Related Infections; Rifampin; Staphylococcal Infections; Systemic Inflammatory Response Syndrome; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Aged; Anti-Bacterial Agents; Bacteremia; Combined Modality Therapy; Daptomycin; Device Removal; Drug Therapy, Combination; Endocarditis, Bacterial; Fatal Outcome; Female; Gentamicins; Hip Prosthesis; Humans; Methicillin-Resistant Staphylococcus aureus; Mitral Valve; Postoperative Complications; Prosthesis-Related Infections; Respiratory Distress Syndrome; Rifampin; Staphylococcal Infections; Thrombocytopenia; Vancomycin

Community-associated strains of methicillin-resistant Staphylococcus aureus (CA-MRSA) have recently emerged as a major cause of serious infections among older children and are now being seen in NICU patients. We present the case of a preterm infant with CA-MRSA necrotizing pneumonia and secondary bacteremia.

Topics: Anti-Bacterial Agents; Antitubercular Agents; Bacteremia; Community-Acquired Infections; Drug Administration Schedule; Gentamicins; Humans; Infant, Newborn; Methicillin Resistance; Necrosis; Pneumonia, Staphylococcal; Rifampin; Staphylococcus aureus; Twins; Vancomycin

An elderly patient with methicillin-resistant Staphylococcus aureus (MRSA) bacteremia was treated sequentially with vancomycin plus rifampin then daptomycin plus gentamicin. The MRSA strain developed diminished susceptibility to vancomycin (MIC increase and tolerance), daptomycin, and gentamicin, and resistance to rifampin during therapy.

Topics: Aged, 80 and over; Anti-Bacterial Agents; Bacteremia; Daptomycin; Female; Humans; Methicillin Resistance; Microbial Sensitivity Tests; Rifampin; Staphylococcal Infections; Staphylococcus aureus; Vancomycin

Topics: Anti-Bacterial Agents; Bacteremia; Humans; Infant, Newborn; Infant, Premature, Diseases; Infusions, Intravenous; Male; Nucleic Acid Synthesis Inhibitors; Rifampin; Staphylococcal Infections; Vancomycin

Staphylococcus aureus is a common cause of native valve infective endocarditis (IE). Rifampin is often added to traditional therapy for the management of serious S. aureus infections. There are no large, prospective studies documenting the safety and efficacy of adjunctive therapy with rifampin for treatment of native valve S. aureus IE. We reviewed all cases of definite native valve S. aureus IE confirmed by modified Duke criteria in a large urban hospital between 1 January 2004 and 31 December 2005. A retrospective cohort analysis was used to assess the impact of the addition of rifampin to standard therapy. There were 42 cases of S. aureus IE treated with the addition of rifampin and 42 controls. Cases received a median of 20 days of rifampin (range, 14 to 48 days). Rifampin-resistant S. aureus isolates developed in nine cases who received rifampin before clearance of bacteremia (56%), while significant hepatic transaminase elevations also occurred in nine cases, all of whom had hepatitis C infection. Unrecognized significant drug-drug interactions with rifampin occurred frequently (52%). Cases were more likely to have a longer duration of bacteremia (5.2 versus 2.1 days; P < 0.001) and were less likely to survive (79% versus 95%; P = 0.048) than controls. Our results suggest that the potential for hepatotoxicity, drug-drug interactions, and the emergence of resistant S. aureus isolates warrants a careful risk-benefit assessment before adding rifampin to standard antibiotic treatment of native valve S. aureus IE until further clinical studies are performed.

Topics: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Bacteremia; Cohort Studies; Drug Interactions; Drug Resistance, Bacterial; Endocarditis, Bacterial; Female; Heart Valve Diseases; Humans; Liver; Male; Middle Aged; Retrospective Studies; Rifampin; Staphylococcal Infections; Staphylococcus aureus

In the setting of catheter-related bloodstream infections, intraluminal antibiotic lock therapy could be useful for the salvage of vascular catheters. In this in vitro study, we investigated the efficacies of the newer antibiotics daptomycin, linezolid, and tigecycline, in comparison with those of vancomycin, minocycline, and rifampin, against methicillin-resistant Staphylococcus aureus (MRSA) embedded in biofilm. We also assessed the emergence of MRSA strains resistant to these antibiotics, alone or in combination with rifampin, after 4-hour daily use for catheter lock therapy. Minocycline, daptomycin, and tigecycline were more efficacious in inhibiting MRSA in biofilm than linezolid, vancomycin, and the negative control (P < 0.001) after the first day of exposure to these antibiotics, with minocycline being the most active, followed by daptomycin and then tigecycline, and with vancomycin and linezolid lacking activity, similar to the negative control. After 3 days of 4-hour daily exposures, daptomycin was the fastest in eradicating MRSA from biofilm, followed by minocycline and tigecycline, which were faster than linezolid, rifampin, and vancomycin (P < 0.001). When rifampin was used alone, it was the least effective in eradicating MRSA from biofilm after 5 days of 4-hour daily exposures, as it was associated with the emergence of rifampin-resistant MRSA. However, when rifampin was used in combination with other antibiotics, the combination was significantly effective in eliminating MRSA colonization in biofilm more rapidly than each of the antibiotics alone. In summary, daptomycin, minocycline, and tigecycline should be considered further for antibiotic lock therapy, and rifampin should be considered for enhanced antistaphylococcal activity but not as a single agent.

Topics: Acetamides; Anti-Bacterial Agents; Bacteremia; Biofilms; Catheterization, Central Venous; Daptomycin; Humans; Linezolid; Methicillin Resistance; Minocycline; Oxazolidinones; Staphylococcus aureus; Tigecycline

Only 3 cases of infective endocarditis (IE) due to methicillin-resistant Staphylococcus haemolyticus (MRSH) have been reported in English literature. Here we report 4 cases of IE due to MRSH encountered in a single university hospital. Population analysis of the strains was performed to assess the presence of vancomycin/teicoplanin heteroresistant subpopulations. Pulsed-field gel electrophoresis was used for molecular typing of isolates. IE was defined in 3 cases as health care associated, and in 1 case, as community acquired. A causative strain was lost. Two strains were heteroresistant to teicoplanin, and 1 also to vancomycin. Genome macrorestriction profile studies demonstrated that 2 MRSH isolates belonged to clones A and E, possessing a class C1 mecDNA, whereas 1 clone was sporadic. All patients were treated with vancomycin plus rifampin. Two patients were cured with antibiotic therapy alone, 1 patient needed surgery, and 1 patient died. Methicillin-resistant multiresistant S. haemolyticus may represent a difficult-to-treat cause of both community and nosocomially acquired IE.

Topics: Aged; Anti-Bacterial Agents; Aortic Valve; Bacteremia; Drug Therapy, Combination; Electrophoresis, Gel, Pulsed-Field; Endocarditis, Bacterial; Female; Humans; Male; Methicillin Resistance; Rifampin; Staphylococcal Infections; Staphylococcus haemolyticus; Vancomycin

The adequate treatment of methicillin-resistant Staphylococcus aureus (MRSA) osteomyelitis has intrigued clinicians for some time. As the resistance of these pathogens, coupled with the increase in community-acquired cases, continues steadily to rise, clinicians are finding it useful to employ multi-modal approaches for efficacious treatment. The authors present a single case report of a patient with recurrent MRSA osteomyelitis, lumbar paraspinal and epidural abscess. He was found to have decreased muscle strength and was hyporeflexic in the involved extremity. Serum testing demonstrated MRSA bacteremia. Neuroimaging studies revealed evidence of paraspinal abscess and a presumed herniated nucleus pulposus at the L5/S1 interspace with significant nerve root compromise. Despite antimicrobials, his symptoms persisted, necessitating surgical exploration. At surgery, paraspinal and epidural abscesses were encountered and debrided; however, no herniated disc was visualized. This case demonstrates the diagnostic and therapeutic dilemmas with which these lesions present. We postulate that the MRSA osteomyelitis/discitis pathogens were walled off in the disc space and subsequently inoculated the soft tissues with ensuing bacteremia. We concur that antimicrobial treatment should be the first line of therapy for these patients; however, surgical debridements and cautious spinal instrumentation should be employed where appropriate.

Topics: Abscess; Acetamides; Adult; Anti-Bacterial Agents; Bacteremia; Debridement; Drug Therapy, Combination; Humans; Intervertebral Disc Displacement; Laminectomy; Linezolid; Lumbar Vertebrae; Male; Methicillin Resistance; Osteomyelitis; Oxazolidinones; Recurrence; Rifampin; Staphylococcal Infections; Staphylococcus aureus; Time Factors; Treatment Outcome; Vancomycin

Since prozone is a well known phenomenon in the serologic diagnosis of Brucella infections, it is necessary to prepare higher serum dilutions in the standard tube agglutination (STA) test for the brucellosis suspected patients. However, due to limited economical support, the serum dilutions generally last at 1/320-1/640 titers in some laboratories in Turkey. In this report, a brucellosis case whose STA test was found negative until the titer of 1/1280, has been presented. A 36-year-old female was admitted to our hospital with the complaints of fever, sweating, fatigue, generalized arthralgia and weight loss, lasting for 45 days. Hepatosplenomegaly was detected in the physical examination, and laboratory tests yielded anemia, leucopenia, elevated erythrocyte sedimentation rate and high C-reactive protein levels. Although brucellosis was suspected, Brucella STA test was found negative at 1/640 titer. On the sixth day of admission, Brucella melitensis was isolated from her blood culture. Since a positive result at 1/40 titer was detected in Brucella STA test with the use of Coombs antiserum, the patient's serum was retested at higher dilutions than 1/640, and positive result was obtained starting from 1/1280 dilution and extended to 1/5120 titer. The patient was treated with rifampin and doxycyline and discharged with complete cure. In conclusion, in countries endemic for brucellosis, STA test should be performed at 1/1280 or higher titrations in suspected patients especially in the presence of negative culture results, for the prevention of false negative results due to prozone phenomenon.

Topics: Adult; Agglutination Tests; Anti-Bacterial Agents; Bacteremia; Brucella melitensis; Brucellosis; Doxycycline; False Negative Reactions; Female; Humans; Rifampin; Treatment Outcome

We assessed the in vitro effect of exposing various bacteria to minocycline/rifampicin-impregnated vascular catheters on the antimicrobial activity of the catheters and the antimicrobial susceptibility of tested organisms.. Segments of minocycline/rifampicin-impregnated catheters were placed in agar plates inoculated with methicillin-susceptible Staphylococcus aureus (MSSA), methicillin-resistant S. aureus (MRSA), methicillin-resistant Staphylococcus epidermidis (MRSE) and vancomycin-resistant Enterococcus (VRE). Zones of inhibition were measured at 24 h, and colonies from the edge of this zone were retrieved after 72 h and inoculated onto new agar plates. A total of seven 72 h cycles were completed. We then measured the MICs of minocycline, rifampicin, vancomycin and linezolid for the collected strains.. The zones of inhibition of the four organisms remained stable after 21 days of sequential exposure to the impregnated catheters. The MICs of the antimicrobials remained constant, except for the MICs of rifampicin for MRSA and linezolid for MRSE, which increased slightly but remained within the susceptible range.. Minocycline/rifampicin-impregnated catheters remain effective against MSSA, MRSA, MRSE and VRE, as evidenced by stable zones of inhibition following 21 day sequential exposure to these catheters. The increase in MIC of rifampicin for MRSA may be clinically relevant if the catheter remains in place for >12 days though the strain remained susceptible to minocycline, there was no concurrent increase in the MIC of other tested drugs, and the zones of inhibition remained stable.

Topics: Anti-Bacterial Agents; Bacteremia; Catheterization, Central Venous; Drug Resistance, Bacterial; Equipment Contamination; Gram-Positive Bacterial Infections; Gram-Positive Cocci; Humans; Microbial Sensitivity Tests; Minocycline; Rifampin; Time Factors

Topics: Anti-Bacterial Agents; Bacteremia; Child, Preschool; Exocrine Pancreatic Insufficiency; Gram-Positive Bacterial Infections; Humans; Male; Microbial Sensitivity Tests; Micrococcaceae; Osteochondrodysplasias; Rifampin; Syndrome

Catheter-associated bloodstream infections (CABSI) are among the most common and serious adverse events experienced by critically ill children. Randomized trials have demonstrated that the use of central venous catheters (CVC) coated with antiseptic solutions reduces rates of CABSI in adult patients; however, their efficacy in children has not been evaluated.. To compare the incidence of CABSI, rate of complications, and microbiology of infection in critically ill children treated with antibiotic-coated or noncoated CVC (NC-CVC).. A prospective observational trial was conducted in the pediatric intensive care unit (PICU) during a 13-month period. A minocycline-rifampin-coated CVC (MR-CVC) or NC-CVC was placed by PICU physicians who nonpreferentially selected CVC type.. We studied the outcomes associated with the first CVC placed in 225 patients, including 69 MR-CVC and 156 NC-CVC. Patients who received MR-CVC, as compared with NC-CVC, were similar in gender, age, and severity of illness at time of PICU admission. The incidence density of CABSI did not vary by catheter type [MR-CVC: 7.53 per 1000 catheter-days (95% confidence interval 2.05-19.17); NC-CVC: 8.64 CABSI per 1000 catheter-days (95% confidence interval 3.74-16.96)]. However, the median time to infection in children with MR-CVC was 3-fold longer than in children with NC-CVC [18 versus 5 days (P = 0.053)]. No difference was seen in the incidence of complications, including thrombosis and catheter site reaction, between MR- and NC-CVC. No significant difference was observed in the types of organisms recovered from patients with MR- and NC-CVC.. The use of MR-CVC significantly delayed the onset of CABSI in PICU patients. Larger, randomized trials are needed to better define potential differences in the incidence of CABSI, rate of complications, and microbiology of infection among pediatric patients treated with antiseptic-coated CVC and NC-CVC.

Topics: Anti-Bacterial Agents; Antibiotics, Antitubercular; Bacteremia; Blood; Catheterization, Central Venous; Child; Child, Preschool; Female; Humans; Intensive Care Units, Pediatric; Male; Medical Records; Minocycline; Philadelphia; Rifampin; Survival Analysis; Treatment Outcome

Topics: Adult; Arthroplasty, Replacement, Hip; Bacteremia; Cefotaxime; Device Removal; Drug Therapy, Combination; Focal Infection, Dental; Gram-Positive Bacterial Infections; Hip Prosthesis; Humans; Legg-Calve-Perthes Disease; Male; Penicillin G; Prosthesis-Related Infections; Reoperation; Rifampin; Staphylococcaceae; Teicoplanin

Brucellosis is a significant public health problem particularly in developing countries. People are frequently infected through milk, milk products, urine and pregnancy material of animals with brucellosis. Epididymoorchitis is the most frequent genitourinary complication of brucellosis and is often unilateral. In this report, a 35 years old male patient who was diagnosed as epididymoorchitis based on clinical presentation, laboratory findings and imaging techniques, has been presented. Brucella melitensis was isolated from blood, bone marrow and ejaculate cultures of the patient. The patient was treated with rifampicine and doxycycline combination therapy for six weeks and no complication has developed in the one year follow-up period. In areas where brucellosis is endemic, such as our country, Brucella infection should be considered in the differential diagnosis of epididymoorchitis and in addition to blood and bone marrow cultures, ejaculate cultures should also be evaluated.

Topics: Adult; Anti-Bacterial Agents; Bacteremia; Bone Marrow; Brucella melitensis; Brucellosis; Diagnosis, Differential; Doxycycline; Epididymitis; Humans; Male; Orchitis; Rifampin; Semen

A 54-y-old morbidly obese male presented with methicillin-resistant Staphylococcus aureus (MRSA) bacteremia secondary to chronic right hip arthroplasty infection. Bacteremia persisted despite prolonged vancomycin-based therapy (MIC < or = 1 microg/ml) and prosthetic removal. Adding daptomycin-rifampin resolved bacteremia within 48 h; hip cultures remained negative post-discharge. This case describes alternative treatment for chronic MRSA infections.

Topics: Anti-Bacterial Agents; Arthroplasty, Replacement, Hip; Bacteremia; Daptomycin; Equipment Failure; Humans; Joint Diseases; Male; Methicillin Resistance; Middle Aged; Rifampin

Topics: Anti-Infective Agents, Local; Bacteremia; Carbon; Catheterization, Central Venous; Catheters, Indwelling; Cross Infection; Equipment Contamination; Humans; Minocycline; Platinum; Rifampin; Silver

Cellulosimicrobium cellulans (formerly known as Oerskovia xanthineolytica) rarely causes human infection. Infections have been reported in immunocompromised hosts or in patients with foreign bodies, such as catheters, where treatment has generally involved removal of the foreign body. We report on a case in which the organism was isolated in multiple blood cultures from a 13-year-old male. After initial therapy failed, treatment with vancomycin and rifampin resulted in infection clearance without removal of the central venous catheter.

Topics: Actinomycetales; Actinomycetales Infections; Adolescent; Anti-Bacterial Agents; Bacteremia; Blood; Catheterization, Central Venous; Catheters, Indwelling; Drug Therapy, Combination; Humans; Male; Rifampin; Vancomycin

Topics: Aged; Anti-Bacterial Agents; Bacteremia; Catheters, Indwelling; Diabetes Complications; Discitis; Endocarditis, Bacterial; Fever; Heart Valve Prosthesis; Humans; Hyperparathyroidism, Secondary; Incidence; Kidney Failure, Chronic; Lumbar Vertebrae; Methicillin Resistance; Prognosis; Renal Dialysis; Rifampin; Spain; Staphylococcal Infections; Staphylococcus aureus; Vancomycin

Rifampin-resistant meningococcal disease occurred in a child who had completed rifampin chemoprophylaxis for exposure to a sibling with meningococcemia. Susceptibility testing of 331 case isolates found only 1 other case of rifampin-resistant disease in Minnesota, USA, during 11 years of statewide surveillance. Point mutations in the RNA polymerase Beta subunit (rpoB) gene were found in isolates from each rifampin-resistant case-patient.

Topics: Anti-Bacterial Agents; Bacteremia; Child; DNA-Directed RNA Polymerases; Drug Resistance, Bacterial; Female; Humans; Infant; Male; Meningococcal Infections; Microbial Sensitivity Tests; Minnesota; Neisseria meningitidis; Point Mutation; Population Surveillance; Rifampin

A 60-year-old man presented with ureteric obstruction secondary to a mycotic right common iliac artery aneurysm complicating methicillin-resistant Staphylococcus aureus (MRSA) bacteremia. The diagnosis of MRSA was not known at the time of surgery, and in situ replacement of the aneurysm using a rifampicin-bonded prosthesis was performed. The patient made a full recovery, and to date there is no evidence of residual or recurrent infection. To our knowledge, this is the first reported case of mycotic iliac aneurysm infected with MRSA in the literature. We discuss the consequences and the considerable diagnostic and therapeutic problems that arise.

Topics: Aneurysm, Infected; Antibiotics, Antitubercular; Bacteremia; Humans; Iliac Aneurysm; Male; Methicillin Resistance; Middle Aged; Rifampin; Staphylococcal Infections; Staphylococcus aureus; Ureteral Obstruction

Catheter-related bloodstream infections are costly and associated with substantial morbidity and mortality. Trials suggest that central venous catheters impregnated with minocycline/rifampin, although more expensive, are clinically superior to chlorhexidine/silver sulfadiazine impregnated catheters. It remains unclear whether minocycline/rifampin catheters are cost-effective for all high-risk patients or only those requiring longer-term catheterization.. We developed a series of decision models with patient-level clinical trial data to determine whether minocycline/rifampin catheters are cost-effective for patients requiring various durations of catheterization. We calculated incremental cost-effectiveness ratios for patients catheterized for durations ranging from 1 to 25 days.. The data were too sparse to estimate cost-effectiveness for patients catheterized less than 8 days. The probability that minocycline/rifampin catheters were cost-effective compared with chlorhexidine/silver sulfadiazine catheters in patients catheterized for 8 days was 91%. The probability that the minocycline/rifampin catheters in patients catheterized 13 days or longer resulted in cost savings was more than 95%.. Our analysis suggests that central venous catheters coated with minocycline/rifampin are cost-effective for patients catheterized for at least 1 week and lead to overall cost savings when patients are catheterized for 2 weeks or longer. Policies for the use of antimicrobial catheters in high-risk patients should reflect patients' expected duration of catheterization.

Topics: Anti-Infective Agents; Bacteremia; Catheterization, Central Venous; Catheters, Indwelling; Chlorhexidine; Cost-Benefit Analysis; Decision Support Techniques; Drug Delivery Systems; Humans; Middle Aged; Minocycline; Quality-Adjusted Life Years; Rifampin; Sensitivity and Specificity; Silver Sulfadiazine; Time Factors; United States

Disseminated mycobacterial disease was diagnosed in an eight-year-old domestic shorthaired cat, with involvement of the skin, lungs, lymph nodes and one eye. Mycobacterium simiae was cultured from skin biopsies on solid agar and in liquid media. This organism is known to cause pulmonary, cutaneous or disseminated infection in human patients with acquired immunodeficiency syndrome but has never been encountered as a pathogen in companion animals. Combination treatment with rifampicin, enrofloxacin and clarithromycin resulted in complete clinical remission within six months, with no side effects. No recurrence was observed in a 22-month follow-up period.

Topics: Animals; Anti-Infective Agents; Antitubercular Agents; Bacteremia; Cat Diseases; Cats; Clarithromycin; Diagnosis, Differential; Diagnostic Techniques, Ophthalmological; Drug Therapy, Combination; Enrofloxacin; Fluoroquinolones; Male; Mycobacterium; Mycobacterium Infections; Quinolones; Radiography; Rifampin; Tuberculosis, Ocular

We characterized two new gene cassettes in an Acinetobacter isolate: one harbored the metallo-beta-lactamase (IMP-4) gene bla(IMP-4), the other harbored the rifampin ADP-ribosyltransferase (ARR-2) gene arr-2, and both arrayed with the aminoglycoside acetyltransferase [AAC(6')-Ib(7)] gene cassette aacA4 in two separate class 1 integrons. The epidemiology of these gene cassettes in isolates from blood cultures obtained from 1997 to 2000 was studied. Isolates bearing either the bla(IMP-4) or the arr-2 gene cassette or both represented 17.5% (10 of 57) of isolates in 1997, 16.1% (10 of 62) in 1998, 2.5% (1 of 40) in 1999, and 0% (0 of 58) in 2000. These two gene cassettes, probably borne on two separate integrons, were found in at least three genomic DNA groups, with evidence of clonal dissemination in the intensive care unit during 1997 to 1998. Seventeen of the 52 Acinetobacter baumannii (genomic DNA group 2) isolates from 1997 to 2000 harbored intI1, but only one was positive for these gene cassettes, whereas 20 of the 21 intI1-positive isolates of all other genomic DNA groups were positive for either or both of them. Reduced susceptibility to imipenem and rifampin was seen only in isolates harboring the bla(IMP-4) and arr-2 cassettes, respectively. The aminoglycoside phosphotransferase [APH(3')-VIa] gene aph(3')-VIa was detected in all 21 isolates for which the MIC of amikacin was >/=8 micro g/ml, with or without aacA4, whereas aacA4 alone was found in isolates for which the MIC of amikacin was 0.5 to 2 micro g/ml. Significant differences between the 17 intI1-positive and 47 intI1-negative isolates belonging to genomic DNA group 3 from 1997 to 1998 in the MICs of amikacin, gentamicin, imipenem, sulfamethoxazole, and ceftazidime were observed (Mann-Whitney test, P < 0.001 to 0.01).

Topics: Acinetobacter; ADP Ribose Transferases; Bacteremia; Base Sequence; beta-Lactamases; Humans; Integrons; Microbial Sensitivity Tests; Molecular Sequence Data; Rifampin; Time Factors

Brucella bacteremia is not uncommon in children living in endemic areas. Reports on brucella bacteremia, however, are scarce. Its clinical features and complications are unknown. This retrospective review describes the clinical and laboratory characteristics, the relapse rate, and response to different regimens of antimicrobials in children with brucella bacteremia over a 5-year period. Antimicrobial susceptibility testing was performed on all isolates. Data on 62 children with brucella bacteremia were collected between 1996 and 2000. All isolates were of Brucella melitensis species. Most children were between five and 10 years of age; males were twice as affected as females (66% vs 34%). Fever and arthralgia were the most common presenting symptoms, 81% and 48% respectively. Fever and arthritis were the most common physical findings, 81% and 19% respectively. Forty-five (73%) patients presented within 10 days of illness onset. Brucella titers were measured in all patients; 95% had a positive titer of 1:320 or more. Resistance to co-trimoxazole (sulfamethoxazole + trimethoprim) increased from 22% in 1996 to 66% in year 2000. Rifampicin and co-trimoxazole were the most commonly used combination in 50%, rifampicin, co-trimoxazole, supplemented with gentamicin or streptomycin in 27%. The median duration of therapy was 6 weeks. The overall relapse rate was 13% (95% CI, 4.6%-21.2%) but was higher among those with symptoms lasting >10 days (P<0.001). There was a high relapse rate among patients infected with co-trimoxazole-resistant species and treated with co-trimoxazole compared to patients infected with sensitive species who also received co-trimoxazole (22% vs. 8%), but this was not statistically significant (P = 0.16). Patients with brucella bacteremia present early in their course of illness. Their clinical features, however, did not differ from brucellosis patients who did not have bacteremia. Despite the high rate of in-vitro resistance to co-trimoxazole, this did not correlate with a significant relapse rate.

Topics: Adolescent; Anti-Bacterial Agents; Bacteremia; Brucella melitensis; Brucellosis; Child; Child, Preschool; Drug Resistance, Microbial; Drug Therapy, Combination; Enzyme Inhibitors; Female; Humans; Infant; Infant, Newborn; Male; Recurrence; Retrospective Studies; Rifampin; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

During the last 8.5 years, authors observed only 3 bacteremias out of 249 catheters in place in different sites corresponding to a total of 10,063 days with central venous catheterization in hemodialysis (0.30/1000 catheter days). This good result seems to be correlated mainly with the preventive application, on catheter insertion-site, of a rifampin and protamine sulphate mixture. This protocol appears worthy to be known because, at the present time, whatever the new preventive strategies, infection rates reported in the literature are generally more consequent and it is necessary to consider all the possibilities of decreasing them.

Topics: Administration, Topical; Adult; Bacteremia; Catheterization, Central Venous; Female; Humans; Male; Middle Aged; Protamines; Renal Dialysis; Rifampin

To evaluate the impact of using central venous catheters (CVCs) impregnated with the combination of minocycline and rifampin on nosocomial bloodstream infections (BSIs), morbidity, and mortality in cancer patients in the ICU.. Prospective surveillance study consisting of the following two time periods: September 1997 through August 1998 (ie, fiscal year [FY] 1998); and from September 1998 through August 1999 (ie, FY 1999).. ICUs of a tertiary care hospital in Houston, TX.. Cancer patients in the medical ICU (MICU) and surgical ICU (SICU).. ICUs started using CVCs impregnated with the minocycline-rifampin combination at the beginning of FY 1999.. The rates of nosocomial BSIs and other patients' characteristics were compared for the two study periods to determine the impact of using the impregnated catheters in the ICU. Patients' characteristics, including antibiotic use, were comparable for the two study periods in both the MICU and the SICU. The rate of nosocomial BSIs in the MICU unit decreased from 8.3 to 3.5 per 1,000 patient-days (p < 0.01), and decreased in the SICU from 4.8 to 1.3 per 1,000 patient-days (p < 0.01) in FY 1999. Nosocomial vancomycin-resistant enterococcus (VRE) bacteremia also decreased significantly (p = 0.004). Length of stay in the MICU and SICU significantly decreased in FY 1999 (p < 0.01 and p = 0.03, respectively). The duration of hospitalization decreased for MICU and SICU patients (p = 0.06 and p < 0.01, respectively). The rate of catheter-related infections decreased from 3.1 to 0.7 per 1,000 patient-days in FY 1999 (p = 0.02). The decrease in infections resulted in net savings of at least $1,450,000 for FY 1999.. The use of antibiotic-impregnated CVCs in the MICU and SICU was associated with a significant decrease in nosocomial BSIs, including VRE bacteremia, catheter-related infections, and lengths of hospital and ICU stays.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bacteremia; Catheterization, Central Venous; Catheters, Indwelling; Cause of Death; Child; Child, Preschool; Coated Materials, Biocompatible; Critical Care; Cross Infection; Drug Resistance, Multiple; Drug Therapy, Combination; Enterococcus; Female; Hospital Mortality; Humans; Male; Middle Aged; Minocycline; Neoplasms; Opportunistic Infections; Prospective Studies; Rifampin; Survival Rate; Texas; Vancomycin Resistance

Addition of intravenous rifampin is reported to be useful in prompt clearance of persistent coagulase negative staphylococcal (CONS) bacteraemia in high-risk neonates. Four neonates (mean birthweight 823 g, mean gestation 25 wk) with persistent CONS bacteraemia for > 7-10 d (mean 11) were treated with i.v. rifampicin (10 mg/kg/12 h x 10 d) while continuing vancomycin (15 mg/kg/24 h). Their age at time of infection ranged from 2 to 11 d. The mean (range) vancomycin peak and trough concentrations were 29 (25-35) and 6 (4-10) microg/ml, respectively. The blood isolates were Staphylococcus epidermidis, S. hominis, and S. haemolyticus. Addition of rifampicin was associated with prompt clearance of bacteraemia within 48 h (n = 3) and 5 d (n - 1). Rifampicin-related adverse effects such as abnormal liver function tests and thrombocytopenia did not occur.. Addition of i.v. rifampicin to vancomycin may optimize the outcome of persistent CONS bacteraemia and the risk of bacterial resistance related to prolonged exposure to vancomycin.

Topics: Bacteremia; Cross Infection; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Follow-Up Studies; Humans; Infant, Newborn; Infant, Premature; Infusions, Intravenous; Intensive Care Units, Neonatal; Male; Rifampin; Severity of Illness Index; Staphylococcal Infections; Treatment Outcome

Staphylococcus aureus strains resistant to a variety of antimicrobial agents are often found in the hospital environment and are responsible for many life-threatening infections. The activity of quinupristin/dalfopristin against 84 Staphylococcus aureus bloodstream isolates (both methicillin resistant and methicillin sensitive) was compared to the activity of vancomycin, teicoplanin, erythromycin, oxacillin, clindamycin, gentamicin, rifampicin. The Minimum Inhibitory Concentrations of these agents was evaluated with the Epsilometer Test. Quinupristin/dalfopristin inhibited all methicillin-sensitive strains at 1mg/L, and 75% of methicillin-resistant strains at 1.5mg/L. According to these results, quinupristin-dalfopristin shows promising in-vitro activity and may be a welcome alternative treatment for methicillin-resistant staphylococcal infections, resulting in reduced use of glycopeptides.

Topics: Anti-Bacterial Agents; Bacteremia; Clindamycin; Cross Infection; Erythromycin; Gentamicins; Humans; Methicillin Resistance; Microbial Sensitivity Tests; Oxacillin; Rifampin; Staphylococcal Infections; Staphylococcus aureus; Teicoplanin; Vancomycin; Virginiamycin

A 10-year-old girl with chronic myelogenous leukemia began receiving cyclosporine the day before bone marrow transplant surgery Three days after the transplant, she developed fever and neutropenia due to a Staphylococcus aureus bacteremia. Despite treatment with various antibiotics, the patient's fever persisted over the next 4 days. Intravenous rifampin was added to her antibiotic regimen of piperacillin, tobramycin, cloxacillin, and amphotericin. On day 12, the patient's blood cultures were negative and her fever had resolved; rifampin was discontinued. On day 16, the patient engrafted; she subsequently developed a grade II graft-versus-host disease of the skin and gastrointestinal tract, which responded to methylprednisolone. Her cyclosporine blood levels, which had been subtherapeutic since day 5 despite increasing intravenous dosages, were within the therapeutic range on day 21, and she was discharged 12 days later. To our knowledge, this is the first documented case of an intravenous cyclosporine-rifampin interaction that resulted in subtherapeutic cyclosporine concentrations in a child receiving a bone marrow transplant who subsequently developed acute graft-versus-host disease.

Topics: Antibiotics, Antitubercular; Bacteremia; Bone Marrow Transplantation; Child; Cyclosporine; Drug Interactions; Female; Fever; Graft vs Host Disease; Humans; Immunosuppressive Agents; Infusions, Intravenous; Leukemia, Myelogenous, Chronic, BCR-ABL Positive; Neutropenia; Rifampin; Staphylococcal Infections; Staphylococcus aureus

The psoas abscess is a rare complication in obstetric and gynaecology. Two types of psoas abscess are recognized. The primary psoas abscess is generally following haematogenous dissemination of an infectious agent and the source is usually occult. The most frequently isolated pathogen is Staphylococcus aureus. On the other hand, the secondary abscess is the result of local extension of an infectious process near the psoas muscle. We report the case of a patient who develops a bacteremia from an infected cesarean section wound. The complications were thigh and psoas abscesses with left sacroiliitis. Medical management with prolonged antibiotherapy permit clinical, biological and radiological improvement. Although it required a long hospital stay, medical treatment alone was effective. More experience is required to determine which therapeutic option: medical treatment and/or surgery, is the best choice for this type of complication.

Topics: Adult; Bacteremia; Cesarean Section; Female; Fever; Humans; Klebsiella Infections; Klebsiella pneumoniae; Magnetic Resonance Imaging; Oxacillin; Penicillins; Pregnancy; Psoas Abscess; Rifampin; Staphylococcal Infections; Staphylococcus aureus; Surgical Wound Infection; Tomography, X-Ray Computed

We report on the first case of documented Helicobacter cinaedi septic arthritis in an immunocompetent heterosexual young man. The patient presented no identified risk factor except for contact with animals that have been incriminated as a possible source of infection, particularly for these patients. Despite prolonged bacteremia, the response to long-term therapy with ciprofloxacin and rifampin was excellent.

Topics: Adult; Anti-Infective Agents; Arthritis, Infectious; Bacteremia; Ciprofloxacin; Helicobacter; Helicobacter Infections; Humans; Immunocompetence; Male; Rifampin; Synovitis

Patients who undergo splenectomy and recipients of allogeneic marrow (alloBMT) or peripheral stem cell transplantation are at increased risk of overwhelming infection from encapsulated organisms such as Streptococcus pneumoniae, Haemophilus influenzae and Neisseria meningitidis. As prophylaxis against these pathogens splenectomised patients are immunised and may also receive antibiotics for life. We report relapsing overwhelming sepsis caused by penicillin-resistant pneumococcus in a patient who was immunised and received prophylactic phenoxymethylpenicillin for 8 months following splenectomy and matched unrelated donor (MUD) marrow transplantation for refractory T cell lymphoma. No obvious focus of sepsis was found during any of the three episodes and S. pneumoniae serogroup 6, subtype 6B was isolated from blood cultures on each occasion. He was treated with i.v. cephalosporins, as the organisms were resistant to penicillin with a minimum inhibitory concentration (MIC) of 2.0, and there was complete resolution of symptoms each time. In the light of recurrent sepsis with this penicillin-resistant organism the decision was made to give prophylactic levofloxacin for the next 12 months. This case illustrates that the choice of prophylactic regimen and the treatment of sepsis in immunocompromised patients remain difficult and challenging issues.

Topics: Adult; Antineoplastic Combined Chemotherapy Protocols; Bacteremia; Bone Marrow Transplantation; Carmustine; Cefotaxime; Combined Modality Therapy; Cyclophosphamide; Cytarabine; Cytomegalovirus Infections; Doxorubicin; Drug Therapy, Combination; Etoposide; Humans; Idarubicin; Immunocompromised Host; Immunosuppressive Agents; Levofloxacin; Lymphoma, T-Cell; Male; Melphalan; Ofloxacin; Penicillin Resistance; Pneumococcal Infections; Prednisone; Recurrence; Rifampin; Splenectomy; Streptococcus pneumoniae; Transplantation Conditioning; Vincristine

Topics: Anti-Bacterial Agents; Anti-Infective Agents, Local; Bacteremia; Catheterization, Central Venous; Chlorhexidine; Equipment Contamination; Humans; Minocycline; Rifampin; Silver Sulfadiazine

Topics: Anti-Bacterial Agents; Anti-Infective Agents, Local; Bacteremia; Bacteria; Catheterization, Central Venous; Chlorhexidine; Equipment Contamination; Humans; Minocycline; Rifampin; Silver Sulfadiazine

To analyse the impact of intensified prophylaxis with ofloxacin plus rifampin (O+R) in neutropenic patients we used this combination in 40 consecutive cycles of ifosfamide, cytarabine, prednisolone and etoposide (IAPVP-16). This salvage chemotherapy regimen for lymphoma usually produces four to six days of severe neutropenia without significant extrahematologic toxicities. We compared the infectious morbidity during neutropenia under O+R with 58 consecutives cycles using either norfloxacin or no prophylaxis (control group). Fifty-three percent of control group patients and 20% of the O+R group developed febrile neutropenia that required hospital admission (p<0.001, 95% CI for the difference between both proportions of 16% to 51%). Bacteremia was documented in two patients in the O+R group and six in the control group (p=0.08). Gram-positive cocci (GPC) accounted for all six bacteremias in the control group, while both cases in O+R group were due to a quinolone-resistant gram-negative bacteria (GNB) (p<0.01 for GPC). Five patients (13%) who received O+R and 23 (40%) in control group developed fever of unknown origin, p<0.001, while the total duration of hospitalization due to febril neutropenia was 42 days and 158 days, respectively (p<0.001). In conclusion, intensified prophylaxis with O+R appears to reduce the rate of febrile neutropenia and GPC bacteremia in patients with short and severe neutropenia, which translates into a reduction in the need for hospitalization.

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Antineoplastic Combined Chemotherapy Protocols; Bacteremia; Carmustine; Cyclophosphamide; Etoposide; Female; Fever; Hodgkin Disease; Humans; Length of Stay; Lymphoma; Male; Middle Aged; Neutropenia; Ofloxacin; Opportunistic Infections; Rifampin; Salvage Therapy

To evaluate the efficacy and safety of cotrimoxazol plus rifampicin in staphylococcal osteoarticular infection.. Open, non-comparative study of adult hospitalized patients with documented staphylococcal bone infection.. From Feb 1989 to Dec 1993 28 episodes of staphylococcal bone infection were treated in 14 men and 13 women; the mean age was 48 +/- 21 years (range, 11-84). They received cotrimoxazol (7 mg/kg/day of trimethoprim) plus rifampicin (600-1200 mg/day), both orally, every 8 to 12 h with a mean duration of treatment of 34.2 +/- 8.2 days (range, 21 to 55 days). This antibiotic regimen was initiated at the same time that appropriate surgery for each specific condition was undertaken. Diagnoses were postsurgical osteomyelitis (10 cases), infected total hip prostheses (4 cases, one with 2 episodes), osteomyelitis secondary to external pin fixation (5 cases), soft tissue infections linked to orthopedic implants (3 cases), two cases of metatarsal osteomyelitis (one diabetic foot and one patient with polineuropathy), and one case each of chronic osteomyelitis of femur, hematogenous lumbar spondylitis and posttraumatic osteomyelitis. Four patients had bacteremia. The duration of the infection, prior to surgery was less than one month in 12 episodes, 1 month to 2 years in 14, and in 2 cases, of 10 and 13 years, respectively. In 23 episodes the causal agent was Staphylococcus aureus and in 5 cases it was coagulase-negative staphylococci. Patients had received previous parenteral therapy with other antimicrobials during 2-40 days (X: 18.6 +/- 10.2 days). All patients but one had resolution of the infection and are currently asymptomatic 6 months to 5 years posttreatment in the 21 evaluable cases (X: 38 +/- 13.1 months). Five patients had adverse effects secondary to the antibiotic combination and in three these were severe enough to discontinue the antimicrobials. In no case of the 11 patients with post-treatment control cultures were staphylococci recovered from the wound.. The combination of cotrimoxazole plus rifampicin, both given orally, was highly effective in this selected group of patients. This combination should be considered as a useful alternative therapy of staphylococcal bone infection and deserves further study.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Bacteremia; Child; Drug Therapy, Combination; Female; Humans; Lumbar Vertebrae; Male; Middle Aged; Osteomyelitis; Postoperative Complications; Retrospective Studies; Rifampin; Spondylitis; Staphylococcal Infections; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adult; Bacteremia; Cefotaxime; Cerebral Infarction; Cerebrospinal Fluid; Epilepsies, Partial; Female; Humans; Immunocompetence; Meningitis, Haemophilus; Meningitis, Pneumococcal; Recurrence; Rifampin

Urban county medical center.. To compare clinical outcomes associated with two treatment regimens for AIDS-associated disseminated Mycobacterium avium complex (DMAC). From 1989 to mid-1992, patients were treated with rifampin, ethambutol, and clofazimine; in mid-1992 clarithromycin replaced rifampin.. A retrospective review of patients with DMAC; the main outcome measures assessed were toxicity associated with DMAC treatment, transfusions after the diagnosis of DMAC, and survival.. 88 patients received the rifampin-based regimen and 86 were treated with the clarithromycin-based regimen. Drug-related adverse events were recorded less frequently with clarithromycin treatment (21% vs. 42%, P = 0.005), and additional antimycobacterial agents were used less often (28% vs. 44%, P = 0.04). In a multivariate logistic regression model, severe anemia at the time of DMAC diagnosis was associated with transfusion-dependence (relative risk [RR] 5.6, 95% confidence interval [CI] 2.2, 13.8, P < 0.001) and clarithromycin treatment was inversely associated with transfusion dependence (RR 0.4, 95% CI 0.1, 0.98, P = 0.04). In a multivariate Cox regression model including other factors affecting survival, clarithromycin treatment did not confer a survival advantage (P = 0.74).. The clarithromycin-containing regimen was better tolerated and was associated with substantially lower transfusion requirements than the rifampin-based regimen; survival was not affected.

Topics: Adult; Aged; AIDS-Related Opportunistic Infections; Anti-Bacterial Agents; Antibiotics, Antitubercular; Bacteremia; Blood Transfusion; Clarithromycin; Colorado; Community Health Centers; Drug Therapy, Combination; Evaluation Studies as Topic; Female; Humans; Male; Middle Aged; Mycobacterium avium-intracellulare Infection; Retrospective Studies; Rifampin; Survival Rate; Treatment Outcome

Topics: Bacteremia; Cefotaxime; Child, Preschool; Drug Therapy, Combination; Female; Hemodiafiltration; Humans; Male; Meningococcal Infections; Penicillin G; Rifampin

This study examines the effectiveness of prophylactic ciprofloxacin and rifampin following high-dose chemotherapy and autologous stem cell rescue (HDC/ ASCR). Specific endpoints included the incidence of fever, clinically documented infection, bacteremia, and readmission rates from an outpatient bone marrow transplant setting following infection or fever. A group of 97 patients receiving 134 cycles of HDC/ASCR were studied. Patients were given ciprofloxacin 750 mg p.o. twice daily and rifampin 300 mg p.o. twice daily beginning on the day of stem cell reinfusion (24-48 h after completion of high-dose chemotherapy). Most patients were either discharged to an outpatient setting following completion of their chemotherapy or received all of their chemotherapy in an outpatient setting. Febrile neutropenia was treated with empirical antibiotics in an outpatient setting unless it was complicated by hypotension, renal failure, severe mucositis or other problems. The median duration of neutropenia (absolute neutrophil count below 500/mm3) was 7 days. Neutropenic fever occurred in 62% of patients but clinically documented bacterial infection occurred in only 2 (1.5%) patients during their neutropenic period. No bacteremia was noted. Readmission to the hospital following fever or infection occurred in 26% of patients maintained in the outpatient setting. There were no deaths from a bacterial infection in this study although 1 patient (0.7%) died from aspergillosis. Prophylactic ciprofloxacin and rifampin is a well-tolerated and highly effective combination that effectively decreases the risk of both gram-positive and gram-negative bacterial infection following HDC/ASCR. It facilitates outpatient management of myelosuppressed patients receiving autologous stem cell rescue.

Topics: Ambulatory Care; Anti-Infective Agents; Antibiotic Prophylaxis; Antineoplastic Combined Chemotherapy Protocols; Bacteremia; Ciprofloxacin; Combined Modality Therapy; Dose-Response Relationship, Drug; Female; Hematopoietic Stem Cell Transplantation; Humans; Male; Neoplasms; Rifampin; Transplantation, Autologous; Treatment Outcome

The susceptibility of clinical isolates of methicillin-susceptible and -resistant staphylococci from cancer patients with central venous catheter bacteremia to quinupristin/dalfopristin, a semisynthetic streptogramin, was determined in vitro. Susceptibility of these isolates to nine other antistaphylococcal antibiotics was also determined for comparison. A total of 197 staphylococcal strains were tested from 1983 to 1992. Quinupristin/dalfopristin was bactericidal against all isolates, independent of their resistance to methicillin. Its activity was similar to that of vancomycin but superior to that of teicoplanin. Quinupristin/dalfopristin may prove to be an important addition to our armamentarium against catheter-related staphylococcal infections.

Topics: Anti-Bacterial Agents; Anti-Infective Agents; Antibiotics, Antitubercular; Bacteremia; Catheterization, Central Venous; Cefamandole; Cephalosporins; Ciprofloxacin; Clindamycin; Daptomycin; Humans; Methicillin; Methicillin Resistance; Microbial Sensitivity Tests; Neoplasms; Novobiocin; Oxacillin; Penicillins; Rifampin; Staphylococcal Infections; Staphylococcus aureus; Staphylococcus epidermidis; Teicoplanin; Vancomycin; Virginiamycin

Three cases of recrudescence and relapse of Neisseria meningitidis group B meningitis and septicaemia are reported. The recrudescence and relapses could not be explained by infectious foci, increased bacterial penicillin resistance or immunological defects. As a supplement to antibiotic treatment, all three patients received corticosteroids for the initial 2 days of treatment, and this may have contributed to the unusual course of the disease in our patient.

Topics: Administration, Oral; Anti-Bacterial Agents; Bacteremia; Child, Preschool; Chloramphenicol; Ciprofloxacin; Female; Follow-Up Studies; Humans; Hydrocortisone; Infant; Injections, Intravenous; Male; Meningitis, Meningococcal; Methylprednisolone; Penicillin G; Penicillin V; Recurrence; Rifampin; Time Factors

Infections of Rhodococcus equi, a well-known pathogen in animals which causes cavitated pneumonia similar to that caused by mycobacteria, were studied in three HIV-infected patients. This microorganism was isolated in the bronchoalveolar washings of two patients and in the sputum of the third. In two patients, Rh. equi represented the first clinical opportunistic manifestation of HIV disease. One patient died of concomitant Pneumocystis infection. The eradication of the microorganism occurred in two out of three patients. It was found that no isolates were resistant to erythromycin, claritromycin, rifampin, vancomycin, teicoplanin, imipenem, gentamycin or azithromycin (MIC values < or = 0.1 microgram/ml). Moreover, the quinolones (ciprofloxacin and ofloxacin) were found to be less effective, whereas neither the beta-lactam antibiotics nor chloramphenicol were effective therapy for this microrganism. At least two antimicrobial agents should be given contemporaneously to treat these infections for a period of up to several months. Our results suggest that the combinations erythromycin + rifampin or imipenem + teicoplanin are the most effective treatments in Rh. equi infections.

Topics: Actinomycetales Infections; Adult; AIDS-Related Opportunistic Infections; Anti-Bacterial Agents; Azithromycin; Bacteremia; Bronchoalveolar Lavage Fluid; Clarithromycin; Drug Resistance, Microbial; Drug Synergism; Drug Therapy, Combination; Erythromycin; Female; Gentamicins; HIV Infections; Humans; Imipenem; Male; Pleurisy; Pneumonia, Bacterial; Rhodococcus equi; Rifampin; Sputum; Teicoplanin; Vancomycin

We report a patient with AIDS who presented with community-acquired cavitary Legionella pneumophila pneumonia. The patient recovered after an extended course of treatment with macrolide antibiotics. He returned to the hospital 4 months later with a febrile illness. Chest radiograms appeared normal. Cultures of blood yielded L. pneumophila. The isolate from blood was indistinguishable from the isolate from sputum taken during the first infection, as shown by restriction-endonuclease analysis and pulsed-field gel electrophoresis. These data suggest that the second infection represented reactivation of a persistent focus of infection that was not apparent when the patient had pneumonia.

Topics: Adult; AIDS-Related Opportunistic Infections; Anti-Bacterial Agents; Bacteremia; DNA, Bacterial; Drug Therapy, Combination; Electrophoresis, Gel, Pulsed-Field; Humans; Legionnaires' Disease; Macrolides; Male; Recurrence; Rifampin

Topics: Acquired Immunodeficiency Syndrome; Adult; AIDS-Related Opportunistic Infections; Bacteremia; Drug Resistance, Microbial; Humans; Male; Rifabutin; Rifampin; Staphylococcal Infections; Staphylococcus aureus; Staphylococcus epidermidis

A case of sepsis and meningitis caused by Neisseria meningitidis with relative resistance to penicillin occurred in North Carolina in August 1992. This isolate was relatively resistant due to decreased affinity of its penicillin-binding protein 2 for penicillin. Such isolates have been reported in Spain, elsewhere in Europe, in South Africa, and in Canada, but invasive disease caused by meningococcal isolates relatively resistant to penicillin was not recognized in the United States before a preliminary report of this case in October 1992. The Centers for Disease Control and Prevention recently retrospectively identified 3 additional cases from 1991. A fifth case occurred in Kentucky in 1993. Surveillance studies of penicillin susceptibility of N. meningitidis isolates suggest such meningococci have existed sporadically in the past. Increases in prevalence and magnitude of penicillin resistance among strains of N. meningitidis would require reconsideration of current clinical practice with regard to treatment of meningococcal disease.

Topics: Amoxicillin; Bacteremia; Bacterial Proteins; Carrier Proteins; Ceftriaxone; Drug Therapy, Combination; Female; Hexosyltransferases; Humans; Infant; Meningitis, Meningococcal; Meningococcal Infections; Multienzyme Complexes; Muramoylpentapeptide Carboxypeptidase; Neisseria meningitidis; North Carolina; Otitis Media; Penicillin G; Penicillin Resistance; Penicillin-Binding Proteins; Peptidyl Transferases; Rifampin

To investigate a cluster of invasive pneumococcal disease in children 8 to 26 months of age, using standard microbiological procedures and ribosomal DNA gene-restriction patterns to characterize the outbreak strain.. Outbreak investigation.. A family child-care home with six children in Baltimore, Md.. During an 8-day period, three of the six children in the family child-care home had febrile illnesses with pneumococcal bacteremia, and a fourth had purulent pneumococcal conjunctivitis. Type 12F Streptococcus pneumoniae was isolated from the four ill children and from the nasopharynges of the two healthy children. Ribotyping revealed all outbreak isolates had an identical ribotype pattern. Administration of rifampin to the children did not eradicate carriage of the organism.. Our data demonstrate that child care provides an opportunity for outbreak of invasive pneumococcal disease in young children. This observation suggests a need for increased alertness for clusters of pneumococcal disease in young children in child-care facilities and underscores the necessity for a pneumococcal vaccine that is effective in infants and young children.

Topics: Bacteremia; Child Day Care Centers; Cluster Analysis; Disease Outbreaks; Drug Resistance, Microbial; Family Characteristics; Female; Humans; Infant; Male; Pneumococcal Infections; Restriction Mapping; Rifampin; Serotyping; Streptococcus pneumoniae

Ten neonates with persistent staphylococcal bacteremia (positive blood cultures for > or = 5 days despite appropriate antibiotic therapy) received intravenous (i.v.) rifampin in combination with vancomycin with or without aminoglycoside. Their mean birth weight and length of gestation were 900 g and 27 weeks, respectively. Their ages at the time of infection ranged from 6 to 64 days (mean, 26 days). The staphylococcal isolates were methicillin-resistant Staphylococcus aureus (five isolates), methicillin-susceptible S. aureus (two isolates), and coagulase-negative staphylococci (three isolates). The mean number of bacteremia days prior to administration of i.v. rifampin was 8.3 (range, 5 to 15 days), despite a mean peak vancomycin concentration of 33 micrograms/ml. The dosing of rifampin varied from 2.5 to 10 mg/kg of body weight every 12 h. The mean duration of the rifampin course was 9.7 days (range, 3 to 16 days). Of the 10 neonates, 8 (80%) had sterile blood cultures within 24 h, 1 (10%) had a sterile blood culture within 48 h, and 1 (10%) had a sterile blood culture within 5 days of being placed on i.v. rifampin. No adverse effects were noted in this small group of infants. Seven of the 10 neonates survived; three died from unrelated complications. The MIC ranges of amikacin, vancomycin, and rifampin for the isolates were 2.0 to 16, 0.5 to 2.0, and 0.0013 to 0.04 micrograms/ml, respectively. We also studied eight infants, with a mean age of 23 days, who were receiving i.v. or oral rifampin at a dose of 10 mg/kg/day. For i.v. administration, the peak serum concentration of rifampin (mean +/- standard deviation) was 4.02 +/- 1.22 microgram/ml. The mean trough level at 12 h postifution was 1.11 +/- 0.48 micrograms/ml. For oral administration, the concentrations of rifampin in serum ranged from 0.59 to 2.86 micrograms/ml (mean, 1.86 +/- 0.96 microgram/ml) at 2 h postingestion, increasing to a peak concentration of 2.8 micrograms/ml at 8 h postingestion. The mean 12-h postingestion level was 0.77 +/- 0.03 microgram/ml. From the study of this limited series of neonates, rifampin appears to be a safe and effective addition to therapy when staphylococcal bacteremia is persistent despite vancomycin treatment.

Topics: Amikacin; Bacteremia; Chromatography, High Pressure Liquid; Drug Synergism; Drug Therapy, Combination; Humans; Infant; Infant, Low Birth Weight; Infant, Newborn; Methicillin Resistance; Microbial Sensitivity Tests; Rifampin; Staphylococcal Infections; Staphylococcus; Vancomycin

Topics: Bacteremia; Catheterization, Central Venous; Drug Therapy, Combination; Humans; Protamines; Renal Dialysis; Rifampin

Epidemiological features of an outbreak of group B:15:P1.16 meningococcal disease (MD) in Frederiksborg county, Denmark, 1987-9, were investigated. The study comprised 149 cases notified during the outbreak and the two preceding years; 115 were confirmed by the isolation of Neisseria meningitidis. In 1989 the incidence had increased to 14.1 per 100,000 population. Among group B strains, B:15:P1.16 accounted for 80% (77/97). The overall mortality rate was 10% (15/149). Regarding cases due to group B:15:P1.16 strains a significant time-space clustering, which exclusively occurred within the 10-19 years age group, was demonstrated. The link between cases within clusters was indirect or unknown, except for ten patients with contact to one particular school. The prophylactic measures used included administration of rifampicin to household contacts. During the outbreak the proportion of secondary cases was high (6-15%). All secondary cases occurred outside the household indicating that the household had been protected.

Topics: Adolescent; Adult; Age Factors; Bacteremia; Child; Child, Preschool; Cluster Analysis; Denmark; Disease Outbreaks; Female; Humans; Infant; Male; Meningitis, Meningococcal; Meningococcal Infections; Neisseria meningitidis; Prevalence; Rifampin; Seasons; Serotyping; Sex Factors; Suburban Population

In Norway, the use of chemoprophylaxis after cases of meningococcal disease is not recommended. Instead, household members less than 15 years are treated with penicillin for 7 days. Failures of this treatment have been reported. We therefore used DNA fingerprinting to identify the disease-causing strain in healthy contacts combined with selective rifampicin prophylaxis to these carriers to prevent secondary cases. During a 2-year period (1987-89) there were 13 cases of meningococcal disease in the County of Telemark (165000 inhabitants). 65 (14.7%) out of 441 contacts to these 13 patients harbored meningococci in their throat; 16 (3.6%) carried the disease-causing strain. Only 1 carrier fulfilled the criteria for being treated with penicillin; 8 were adults and the remaining 7 were not household members. No secondary cases of meningococcal disease occurred during the study period or the following 12 months. During the 4-year period (1984-87) preceding the study period there were 39 cases of meningococcal disease in Telemark; 7 of them were index cases for 12 bacteriologically verified and 4 clinically suspected secondary cases of meningococcal disease. We conclude that selective prophylaxis with rifampicin seems to be more efficient that penicillin treatment of household members less than 15 to prevent secondary cases of meningococcal disease.

Topics: Adolescent; Adult; Aged; Bacteremia; Carrier State; Child; Child, Preschool; DNA Fingerprinting; DNA, Bacterial; Female; Humans; Infant; Male; Meningitis, Meningococcal; Meningococcal Infections; Middle Aged; Neisseria meningitidis; Norway; Penicillins; Pharynx; Rifampin; Serotyping

The objective of this study was to test the efficacy of bonding rifampin to double-velour Dacron grafts with collagen to prevent graft sepsis. Fifty 6.0 mm Dacron grafts (length 5.0 cm) impregnated with either collagen (control) or collagen plus rifampin (experimental) were implanted in dogs end-to-end into the infrarenal aorta. The dogs were divided into four groups (each with an experimental and control subdivision) as a function of time between grafting and bacterial challenge. At 2, 7, 10, or 12 days after graft implantation, sequential groups were challenged with 1.2 x 10(8) colony forming units of Staphylococcus aureus (clinical isolate) intravenously suspended in 250 ml normal saline. Three weeks after hematogenous seeding, the grafts were sterilely harvested. One-tailed Fisher's exact test was used to compare the patency and culture-proven infection of control and antibiotic coated grafts as a function of implantation time before bacteremic challenge. In the 2-day group, four of six control grafts were infected compared with zero of six experimental grafts (p less than 0.030). In the 7-day group, five of six control grafts were infected with S. aureus versus zero of six in the experimental group (p less than 0.008). In the 10-day group, one of six experimental grafts was infected, but the control group had only two of six graft infections. In the 12-day group two of six experimental grafts and one of five control grafts were infected. These results indicate that rifampin bonded with collagen to knitted Dacron grafts will protect the graft from bacteremic infection for 7 days after implantation in a highly challenging model.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Anastomosis, Surgical; Animals; Aorta, Abdominal; Bacteremia; Blood Vessel Prosthesis; Collagen; Dogs; Polyethylene Terephthalates; Prosthesis Design; Rifampin; Staphylococcal Infections; Time Factors; Vascular Patency