rifampin and Pneumonia--Staphylococcal

To investigate whether adding rifampicin to vancomycin could cure more patients with nosocomial methicillin-resistant Staphylococcus aureus pneumonia compared with vancomycin-only.. Prospective randomized open-label study.. Medical intensive care unit in Seoul, Korea.. Ninety-three of 183 patients with Gram-positive nosocomial pneumonia.. The enrolled patients with subsequently documented methicillin-resistant Staphylococcus aureus pneumonia (modified intention-to-treat population) were treated with vancomycin (1 g intravenous every 12 hrs) plus rifampicin (300 mg twice daily by mouth) (n = 41) or with vancomycin-only (n = 42). The intended treatment (at least 5 days) was completed in 30 patients in the vancomycin plus rifampicin group and 34 patients in the vancomycin-only group (per protocol population).. The primary outcome was the clinical cure rate on day 14 of treatment. The secondary outcomes were intensive care unit mortality on days 28 and 60, and microbiological eradication on day 14. The clinical cure rate in the modified intention-to-treat population was 53.7% (22 of 41) in the vancomycin plus rifampicin group, and 31.0% (13 of 42) in the vancomycin-only group (p = .047), and the respective rates in the per protocol population were 63.3% (19 of 30) and 38.2% (13 of 34) (p = .079). The respective mortality rates were nine (22.0%) of 41 and 16 (38.1%) of 42 on day 28 (p = .151), and 11 (26.8%) of 41 and 21 (50.0%) of 42 on day 60 (p = .042). The microbiological eradication rate did not differ between groups (p = .472).. Vancomycin plus rifampicin seems to be more effective than vancomycin alone in the treatment of nosocomial methicillin-resistant Staphylococcus aureus pneumonia.

Topics: Academic Medical Centers; Adult; Aged; Aged, 80 and over; Critical Care; Cross Infection; Drug Therapy, Combination; Female; Follow-Up Studies; Hospital Mortality; Humans; Intensive Care Units; Korea; Male; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Pneumonia, Staphylococcal; Probability; Prospective Studies; Rifampin; Risk Assessment; Severity of Illness Index; Statistics, Nonparametric; Survival Analysis; Treatment Outcome; Vancomycin

We report here the first pharmacokinetic-pharmacodynamic relationship for ceftaroline in a preterm infant born at <28 weeks' gestational age who was given ceftaroline (8.5 mg/kg every 8 hours) for pneumonia attributable to methicillin-resistant Staphyloccocus aureus. This dose of ceftaroline was adequate to achieve the pharmacodynamic endpoint associated with efficacy for methicillin-resistant Staphyloccocus aureus.

Topics: Anti-Bacterial Agents; Ceftaroline; Cephalosporins; Drug Therapy, Combination; Fatal Outcome; Female; Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Methicillin-Resistant Staphylococcus aureus; Pneumonia, Staphylococcal; Rifampin

The prevalence of MRSA in patients with CF is increasing. There is no consensus as to the optimum treatment.. An observational cohort study of all patients with MRSA positive sputum, 2007-2012. All eradication attempts with subsequent culture results were reviewed. Single vs dual antibiotic regimens were compared for both new and chronic infections.. 37 patients (median FEV1 58.7 (27.6-111.5)% predicted) were identified, of which 67.6% (n = 25) had newly acquired MRSA. Compared with single regimens, a high proportion of dual regimens achieved MRSA eradication (84.6% vs 50%; p = 0.1) for new infections. Rifampicin/Fusidic acid was associated with high success rates (100% vs 60% for other dual regimens (p = 0.13)). Compared with new infections, chronic MRSA was much less likely to be eradicated (18.2%, p = 0.01).. Combined antibiotic therapy, particularly Rifampicin/Fusidic acid, is a well-tolerated and effective means of eradicating MRSA in patients with cystic fibrosis.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Body Mass Index; Cystic Fibrosis; Disease Eradication; Drug Therapy, Combination; Female; Fusidic Acid; Humans; Male; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Outpatient Clinics, Hospital; Pneumonia, Staphylococcal; Prevalence; Respiratory Tract Infections; Retrospective Studies; Rifampin; Treatment Outcome; United Kingdom

Topics: Aged; Anti-Bacterial Agents; Arthroplasty, Replacement, Hip; Combined Modality Therapy; Device Removal; Diagnosis, Differential; Drug Therapy, Combination; Dyspnea; Femoral Neck Fractures; Hip Prosthesis; Humans; Male; Ofloxacin; Pneumonia, Staphylococcal; Prosthesis-Related Infections; Rifampin; Staphylococcal Infections; Tomography, X-Ray Computed; Tuberculosis, Miliary

Topics: Critical Care; Cross Infection; Drug Therapy, Combination; Female; Humans; Intensive Care Units; Male; Methicillin-Resistant Staphylococcus aureus; Pneumonia, Staphylococcal; Prognosis; Rifampin; Severity of Illness Index; Survival Rate; Treatment Outcome; Vancomycin

We present a case of community-acquired methicillin-resistant Staphylococcus aureus necrotizing pneumonia, Panton-Valentine leukocidin positive, in a woman at 14 weeks of pregnancy. To our knowledge, this is the first case reporting this critical lung infection occurring during an early phase of pregnancy. This case study alerts physicians to the increasing worldwide spread of these uncommon yet virulent and potentially lethal infections. In our patient, antibiotic therapy with linezolid plus rifampin started at 14 weeks of pregnancy had a successful outcome without inducing toxicity or teratogenesis in the fetus.

Topics: Acetamides; Anti-Bacterial Agents; Bacterial Toxins; Drug Therapy, Combination; Exotoxins; Female; Humans; Leukocidins; Linezolid; Lung; Methicillin-Resistant Staphylococcus aureus; Necrosis; Oxazolidinones; Pneumonia, Staphylococcal; Pregnancy; Pregnancy Complications, Infectious; Pregnancy Trimester, First; Radiography; Rifampin; Treatment Outcome; Young Adult

Topics: Critical Care; Cross Infection; Drug Resistance, Bacterial; Drug Therapy, Combination; Female; Follow-Up Studies; Humans; Intensive Care Units; Male; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Pneumonia, Staphylococcal; Rifampin; Risk Assessment; Treatment Outcome; 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

The number of Methicillin-resistant Staphylococcus aureus (MRSA) pneumonia cases is increasing in many European countries. In this observational study in one medical and three surgical ICUs multiple interventions for the treatment and eradication of nosocomial MRSA-pneumonia were used.. Twenty-one critically ill patients (age: 59 +/- 14 years, 15 males/6 females, 18 ventilator-associated, 3 nosocomial, clinical pulmonary infection score > 6 in all patients, APACHE II 18 +/- 5) were enrolled. The patients were treated with a 7-day course of iv linezolid (600 mg bid) plus rifampicin (600 mg bid), endotracheal vancomycin 100 mg qid, thrice daily mouth and throat washing with chlorhexidine 1% fluid and nasal mupirocin ointment, twice daily skin and hair washings with chlorhexidine gluconate 4% and tracheostomy (n = 8) wound care with povidone-iodine spray. Control samples (endotracheal secretions, nose, wound, and pharyngeal swabs) were taken 2, 3, 4, 7 days and 2 months thereafter. Multilobular pneumonia was seen in 16, pleural effusion in 12, and MRSA bacteremia in 4 patients.. One patient died during the follow-up period due to cerebral bleeding. In the remaining 20 patients, pneumonia was clinically cured in all patients and all patients were free of MRSA after eradication. Six patients died due to myocardial infarction (n = 3), gram-negative septic shock (n = 2), herpes encephalitis (n = 1) > 7 days after eradication. No MRSA reinfection occurred during the control period.. We conclude that in patients with MRSA pneumonia an approach using a 7-day course of intravenous linezolid plus rifampicin, intratracheal vancomycin, nasal mupirocin, cutaneous and oropharyngeal chlorhexidin plus povidone-iodine cures pneumonia and is effective for MRSA eradication.

Topics: Acetamides; Aged; Anti-Bacterial Agents; Critical Illness; Cross Infection; Drug Utilization; Female; Humans; Infection Control; Intensive Care Units; Linezolid; Male; Methicillin Resistance; Middle Aged; Oxazolidinones; Pneumonia, Staphylococcal; Rifampin; Staphylococcal Infections; Staphylococcus aureus; Treatment Outcome; Vancomycin

To investigate most common pathogens isolated from the hospital-acquired pneumonia patients bronchoalveolar lavage fluid in Kaunas University of Medicine Hospital according to the previous antibiotic use and to estimate pathogens antibacterial susceptibility.. Results of 87 hospital-acquired pneumonia patients bronchoalveolar lavage fluid quantitative cultures were analyzed. Microorganisms isolated in clinically significant amount were considered as the etiological agents and included into analysis. Susceptibility was tested using the standard methods. Previously untreated patients were considered if the antibacterials were not administered at all or were used less than for 24 hours.. H. influenzae isolation in significant amount rates were higher in previously untreated patients group comparing to previously treated (29.2%. (n=14) and 5.1% (n=2), respectively, p<0.05). Non-fermenters (P. aeruginosa and Acinetobacter spp.) isolation rates were higher in those previously treated comparing to untreated patients - (31.0% (n=13) and 4.2% (n=2), respectively, p<0.05). All H. influenzae strains were susceptible to ampicillin and cefuroxime. 22.2-44.4% of P. aeruginosa strains were resistant to ceftazidime, amikacin and ciprofloxacin. Estimated Acinetobacter spp. resistance to ciprofloxacin and gentamycin was 83.3% and to ampicillin/sulbactam - 16.7%. All methicillin-susceptible S.aureus were also susceptible to gentamycin and fucidin and methicillin resistant to rifampicin and vancomycin.. Previous antibiotic treatment has an impact on pneumonia etiology testing. H. influenzae strains are more common isolated hospital-acquired pneumonia etiologic agents in previously untreated patients. The low antibacterial resistance was found enabling the use of aminopenicillins for treatment if H. influenzae infection suggested. The use of antibacterials increases non-fermenters isolation rates and combined antipseudomonal treatment is reasonable in these patients.

Topics: Acinetobacter; Acinetobacter Infections; Amikacin; Ampicillin; Anti-Bacterial Agents; Anti-Infective Agents; Bacteria; Bronchoalveolar Lavage Fluid; Ceftazidime; Cefuroxime; Ciprofloxacin; Cross Infection; Drug Resistance, Bacterial; Drug Therapy, Combination; Female; Fusidic Acid; Gentamicins; Haemophilus Infections; Haemophilus influenzae; Humans; Male; Methicillin; Microbial Sensitivity Tests; Middle Aged; Penicillins; Pneumonia, Bacterial; Pneumonia, Staphylococcal; Pseudomonas aeruginosa; Pseudomonas Infections; Rifampin; Staphylococcus aureus; Sulbactam; Vancomycin Resistance

Topics: Adult; Community-Acquired Infections; Drug Therapy, Combination; Female; Humans; Legionnaires' Disease; Ofloxacin; Pneumonia, Staphylococcal; Rifampin; Staphylococcus aureus

Topics: Adolescent; Female; Heroin Dependence; Humans; Injections, Intravenous; Peritonitis; Pneumonia, Staphylococcal; Rifampin; Staphylococcal Infections; Vancomycin

Topics: Adult; Drug Resistance, Microbial; Emergencies; Emergency Service, Hospital; Female; Germany, West; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Pneumonia, Staphylococcal; Rifampin

Topics: Adolescent; Adult; Aged; Child; Child, Preschool; Endocarditis, Bacterial; Erythromycin; Female; Fusidic Acid; Humans; Infant; Infant, Newborn; Male; Methicillin; Middle Aged; Novobiocin; Penicillin Resistance; Pneumonia, Staphylococcal; Rifampin; Sepsis; Staphylococcal Infections