rifampin and Postoperative-Complications

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

Infection of penile prostheses, estimated to occur in 3% of cases, represent the major complication of this type of prosthesis. Early sepsis occurs during the first week and presents in the form of frank clinical features (pain, erythema, penile discharge); highly virulent bacteria are isolated, such as Staphylococcus aureus. Late sepsis occurs after an interval of several weeks to several months with less specific clinical features; Staphylococcus epidermidis is isolated in more than 50% of cases. Conventional treatment of these infections consists of antibiotics adapted to the local flora and removal of the prosthesis, sometimes followed by deferred reimplantation. Prosthetic material salvage procedures are now proposed. Patient-related risk factors for infection include diabetes, urinary tract infection and immunodepression, while procedure-related risk factors include the length of hospital stay, poor operative technique, prolonged operating time and iatrogenic urethral injuries. Prevention of sepsis of penile prostheses is based on prevention of these risk factors and prophylactic antibiotics or prolonged antibiotic therapy.

Topics: Bacterial Infections; Diabetes Complications; Drug Therapy, Combination; Erectile Dysfunction; Humans; Male; Penile Prosthesis; Penis; Postoperative Complications; Rifampin; Risk Factors; Vancomycin

Because of the increasing number of renal transplantations performed and the rarity of reported cases of infective endocarditis in these patients, we studied the clinical characteristics of this infection in this population. We report on two cases from our experience and review reported cases of infective endocarditis in renal transplant recipients retrieved from the MEDLINE system. In addition, we reviewed a large series of infective endocarditis looking for patients with renal transplants. In addition to our 2 cases, 12 previously reported cases were found. The mean time from transplantation to diagnosis of infective endocarditis was 3.5 years (range 2 months to 15 years). Causative organisms included fungi, Staphylococcus aureus (3 cases each), Corynebacterium sp. (2 cases), Streptococcus viridans, VRE, Brucella sp., Clostridium sp., Nocardia sp. and Erysipelothrix sp. (one case each). Skin manifestations of endocarditis and/or splenomegaly were not reported in these patients. Septic emboli and mycotic aneurysms were relatively common. The overall mortality rate was 50% (7 of 14 patients died). Infective endocarditis seems to be rare in renal transplant recipients. The few reported cases are characterized by unusual causative micro-organisms and atypical clinical presentation. Further studies are needed to delineate the magnitude and scope of this association.

Topics: Adult; Brucella melitensis; Brucellosis; Ceftriaxone; Cephalosporins; Doxycycline; Drug Therapy, Combination; Endocarditis, Bacterial; Erysipelothrix; Erysipelothrix Infections; Female; Humans; Kidney Transplantation; Male; MEDLINE; Postoperative Complications; Rifampin

Following the discovery of Legionella pneumophila as the cause of an epidemic of pneumonia at an American Legion Convention in Philadelphia, a group of related bacteria were recognized as additional human pathogens. This newly established bacteria genus, Legionella, includes the agents of Legionnaires' Disease, Pittsburgh pneumonia and several related infections. A number of researches have been performed in the past few years about these bacteria; many of these data are here summarized to give an idea of the most important characteristics of Legionella and of the diseases they cause.

Topics: Antibody Formation; Bacterial Infections; Disease Outbreaks; Erythromycin; Humans; Legionella; Legionnaires' Disease; Phenotype; Pneumonia; Postoperative Complications; Rifampin; Serotyping; Tetracycline

Topics: Adult; Antifungal Agents; Aspergillosis; Azoles; Candidiasis; Cyclosporine; Drug Interactions; Erythromycin; Female; Humans; Kidney Transplantation; Legionnaires' Disease; Male; Middle Aged; Opportunistic Infections; Postoperative Complications; Rifampin; Streptococcal Infections; Tuberculosis, Pulmonary

Topics: Aged; Antitubercular Agents; Aortic Aneurysm; Blood Vessel Prosthesis; Drug-Eluting Stents; Endovascular Procedures; Female; Humans; Isoniazid; Male; Middle Aged; Postoperative Complications; Retrospective Studies; Rifampin; Survival Rate; Treatment Outcome; Tuberculosis

To treat organ transplant patients with mycobacterial infection, physicians need to pay attention to interaction between drugs used against mycobacteria and immunosuppressants. The purpose of this report is to describe the clinical features of and treatment for mycobacterial infection in lung transplant (LTx) recipients.. To investigate the incidence, treatment, and outcome for mycobacterial infection, we retrospectively reviewed 100 LTx recipients in our program since 2000.. Four recipients (4.0%) developed mycobacterial infection. Three recipients took tacrolimus, and 1 received cyclosporine with mycophenolate mofetil and a steroid for immunosuppression. Tuberculosis (TB) was isolated from 2 recipients, and non-tuberculous mycobacteriosis (NTM) was detected in the other 2. We treated the patients with levofloxacin + isoniazid + pyrazinamide + ethambutol (EB) for TB and clarithromycin (CLM) + EB for NTM to avoid interaction of calcineurin inhibitors (CNI: 8-10 ng/mL in trough level) with rifampicin (RFP). In treating the patients with NTM, we were able to maintain an adequate blood concentration of CNI by decreasing the dosage from one-half to one-quarter. All mycobacterial infections were controlled with treatment. In 1 patient with chronic obstructive pulmonary disease (COPD) infected with TB in the native lung, the forced expiratory volume in 1 second (FEV1) unexpectedly increased from 1890 mL before infection to 2320 mL possibly due to organization of the native lung.. We were able to manage the mycobacterial infections using drugs other than RFP without any cases of acute rejection under adequate immunosuppression. Organization of the native lung with TB infection unexpectedly resulted in improvement of FEV1 in a COPD patient.

Topics: Adult; Anti-Bacterial Agents; Calcineurin Inhibitors; Cyclosporine; Drug Interactions; Drug Therapy, Combination; Female; Humans; Immunosuppression Therapy; Immunosuppressive Agents; Incidence; Lung Transplantation; Male; Middle Aged; Mycobacterium Infections; Mycobacterium Infections, Nontuberculous; Mycobacterium tuberculosis; Mycophenolic Acid; Nontuberculous Mycobacteria; Postoperative Complications; Retrospective Studies; Rifampin; Tacrolimus; Tuberculosis

The current recommendation for the treatment of latent tuberculosis infection (LTBI) in solid organ transplant candidates is isoniazid for 9 months, but this treatment has the main problem of frequently reaching the posttransplant period.. This is the study of efficacy and safety of a 3-month regimen with isoniazid and rifampicin (3HR) in lung transplant candidates in the Reina Sofía Hospital in Córdoba.. Three hundred and ninety-eight lung transplant patients were evaluated. Ninety-two (24.9%) had LTBI and just 22 received the 3HR treatment. One additional patient was treated because he had a history of previous incomplete treatment for active TB. None of the treated patients developed posttransplant tuberculosis compared to three of the 62 patients with LTBI who were not treated (4.8%). Three patients could not conclude the 3HR treatment (13%), but only two had adverse effects (8.7%).. Treatment of LTBI in lung transplant candidates using a short course of 3HR appears to be effective and safe in preventing posttransplant TB in lung transplant recipients.

Topics: Antibiotics, Antitubercular; Antitubercular Agents; Female; Follow-Up Studies; Humans; Isoniazid; Latent Tuberculosis; Lung Transplantation; Male; Middle Aged; Postoperative Complications; Prognosis; Retrospective Studies; Rifampin; Risk Factors

The rapid determination of pathogenic agent is very important to clinician for guiding their clinical medication. However, current diagnostic methods are of limitation in many aspects, such as detecting range, time-consuming, specificity and sensitivity. In this report, we apply our new-developing pathogen detection method to clarify that Propionibacterium acnes is the causative agent of a two-year-old boy with juvenile myelomonocytic leukemia presenting clinical symptoms including serious rash and hyperpyrexia while traditional clinical methods of diagnosis fail to detect the pathogenic agent and multiple antimicrobial drugs are almost ineffective Propionibacterium acnes is confirmed to be the infectious agent by quantitative real-time polymerase chain reaction.. After haploidentical hematopoietic stem cell transplantation, a two-year-old boy with juvenile myelomonocytic leukemia presented to a pediatrist in a medical facility with hyperpyrexia and red skin rash which later changed to black skin rash all over his body. Traditional diagnostic assays were unrevealing, and several routine antimicrobial treatments were ineffective, including the vancomycin, meropenem, tobramycin, cefepime and rifampin. In this case, pediatrist resorted to the next-generation sequencing technology for uncovering potential pathogens so as to direct their use of specific drugs against pathogenic bacteria. Therefore, based on the BGISEQ100 (Ion Proton System) which performed sequencing-by-synthesis, with electrochemical detection of synthesis, and each such reaction coupled to its own sensor, which are in turn organized into a massively parallel sensor array on a complementary metal-oxidesemiconductor chip, we detect and identify the potential pathogens. As a result, we detected a significantly higher abundance of skin bacteria Propionibacterium acnes in patient's blood than controls. It had been reported that patients infected by Propionibacterium acnes almost always had history of immunodeficiency, trauma or surgery. Considering this possible cause, antimicrobial treatment was adjusted to target this rare opportunistic pathogen. Fever and black skin rashes were rapidly reduced after administrating specific drugs against Propionibacterium acnes.. This case showed our new-developing pathogen detection method was a powerful tool in assisting clinical diagnosis and treatment. And it should be paid more attention to Propionibacterium acnes infection in clinical cases.

Topics: DNA, Bacterial; Fever; Gram-Positive Bacterial Infections; Hematopoietic Stem Cell Transplantation; Humans; Male; Postoperative Complications; Propionibacterium acnes; Real-Time Polymerase Chain Reaction; Rifampin; Sequence Analysis, DNA

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

Non-crosslinked porcine acellular dermal grafts (NCPADG) are currently the mainstay biomaterial for abdominal wall reconstruction (AWR) in complex hernia patients. We report early clinical outcomes using a novel rifampin/minocycline-coated NCPADG for AWR.. A multi-institutional retrospective review was performed of patients who underwent ventral hernia repair using XenMatrix AB Surgical Graft (CR Bard, Inc [Davol]). Patient demographics, hernia and procedure characteristics, and surgical site occurrences/postoperative complications were reviewed up to 6 months after AWR.. Seventy-four patients underwent AWR using XenMatrix AB Surgical Graft. Open AWR was performed in 52 patients (70.3%), and 22 patients (29.7%) underwent laparoscopic VHR. Median hernia size/area was 66.0 cm(2) (range 9.4 to 294.5 cm(2)). Sixteen patients (21.6%) had previous wound infections, and 16 patients (21.6%) had violation of the gastrointestinal tract during hernia repair. The most common locations of NCPADG placement were within the intraperitoneal (32.4%) and onlay (21.6%) positions, respectively. Median hospital length of stay was 4 days. Within 30 days after AWR, 6 (8.1%) patients were readmitted, postoperative seroma formation developed in 4 (5.4%) patients, 1 patient required percutaneous drainage, and surgical site infections developed in 5 (6.8%) patients. At 6 months follow-up, hernia recurrence had developed in 4 (5.4%) patients.. Data suggest that use of a novel rifampin/minocycline-coated NCPADG was associated with a low rate of postoperative surgical site occurrences/postoperative complications during the first 30 days of follow-up in complex AWR patients. In addition, data suggest a low rate of hernia recurrence at 6-month follow-up. Additional study is warranted to determine whether early antimicrobial protection of the device translates into longer-term protection of the repair.

Topics: Abdominal Wall; Acellular Dermis; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Drug Combinations; Female; Follow-Up Studies; Hernia, Ventral; Herniorrhaphy; Humans; Male; Middle Aged; Minocycline; Postoperative Complications; Recurrence; Retrospective Studies; Rifampin; Treatment Outcome

We describe a case of successful treatment of mycotic pseudoaneurysm of the transverse aortic arch in a male infant. The aneurysm was resected and the defect was repaired using a patch made from a rifampicin-impregnated Dacron graft.

Topics: Airway Obstruction; Aneurysm, False; Aneurysm, Infected; Antibiotics, Antitubercular; Aorta, Thoracic; Follow-Up Studies; Humans; Infant; Male; Polyethylene Terephthalates; Postoperative Complications; Retrospective Studies; Rifampin; Treatment Outcome; Vascular Surgical Procedures

Screening and therapy of latent tuberculosis infection (LTBI) is recommended in solid organ transplant (SOT). However, there are limited data on the tolerability of LTBI therapy pretransplant and posttransplant. We studied the tolerability of LTBI therapy and effectiveness of a centralized LTBI treatment program in a low-risk population.. Provincial TB and transplant databases were retrospectively reviewed for LTBI therapy referrals in SOT candidates and recipients over a 10-year period. Using univariate logistic regression, we examined factors associated with failure to complete therapy and followed patients for active TB.. From 2001 to 2010, 200/461 SOT candidates referred to the TB program (43.4%) were eligible for therapy for LTBI. Eleven patients refused therapy. The remaining patients (n=189) were initially prescribed isoniazid (73%), rifampin (12.7%), or another regimen (14.3%). Adequate LTBI therapy occurred in 122 (64.5%). Patients who were liver transplant candidates or recipients were less likely to complete therapy than nonliver transplant patients (OR, 0.20; P<0.001) as were patients treated in the posttransplant phase (OR, 0.47; P=0.034). Liver enzyme elevation led to discontinuation of therapy more often in liver transplant candidates and recipients (OR, 10.48; P<0.001) and posttransplant treatment (OR, 3.50; P=0.019). In 599.4 patient-years of follow-up posttransplant (mean, 4.9 year/patient), there were no cases of active TB.. A centralized referral program for LTBI therapy in transplant candidates is effective to prevent TB reactivation posttransplant. A significant proportion of liver transplant candidates and recipients do not tolerate standard LTBI therapy. Alternative therapies for these patients should be evaluated.

Topics: Adult; Aged; Antitubercular Agents; Cohort Studies; Female; Follow-Up Studies; Humans; Kidney Transplantation; Latent Tuberculosis; Liver; Liver Transplantation; Male; Middle Aged; Mycobacterium tuberculosis; Organ Transplantation; Postoperative Complications; Regression Analysis; Retrospective Studies; Rifampin; Risk Factors; Transplant Recipients; Treatment Outcome; Tuberculin Test

Little is known about optimal management of prosthetic vascular graft infections, which are a rare but serious complication associated with graft implants. The goal of this study was to compare and characterize these infections with respect to the location of the graft and to identify factors associated with outcome.. This was a retrospective study over more than a decade at a tertiary care university hospital that has an established multidisciplinary approach to treating graft infections. Cases of possible prosthetic vascular graft infection were identified from the hospital's infectious diseases database and evaluated against strict diagnostic criteria. Patients were divided into groups according to the locations of their grafts: thoracic-aortic, abdominal-aortic, or peripheral-arterial. Statistical analyses included evaluation of patient and infection characteristics, time to treatment failure, and factors associated specifically with cure rates in aortic graft infections. The primary endpoint was cure at one year after diagnosis of the infection.. Characterization of graft infections according to the graft location did show that these infections differ in terms of their characteristics and that the prognosis for treatment seems to be influenced by the location of the infection. Cure rate and all-cause mortality at one year were 87.5% and 12.5% in 24 patients with thoracic-aortic graft infections, 37.0% and 55.6% in 27 patients with abdominal-aortic graft infections, and 70.0% and 30.0% in 10 patients with peripheral-arterial graft infections. In uni- and multivariate analysis, the type of surgical intervention used in managing infections (graft retention versus graft replacement) did not affect primary outcome, whereas a rifampicin-based antimicrobial regimen was associated with a higher cure rate.. We recommend that future prospective studies differentiate prosthetic vascular graft infections according to the location of the grafts and that rifampicin-based antimicrobial regimens be evaluated in clinical trials involving vascular graft infections caused by staphylococci.

Topics: Aged; Antibiotics, Antitubercular; Aortic Diseases; Blood Vessel Prosthesis; Female; Humans; Infections; Male; Middle Aged; Postoperative Complications; Retrospective Studies; Rifampin; Vascular Surgical Procedures

Topics: Anti-Infective Agents; Antitubercular Agents; Brucellosis; Child; Female; Humans; Immunocompromised Host; Liver Transplantation; Opportunistic Infections; Postoperative Complications; Recurrence; Rifampin; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adult; Anti-Bacterial Agents; Bacterial Typing Techniques; Communicable Diseases, Emerging; Community-Acquired Infections; Endocarditis, Bacterial; Female; Gastrectomy; Genes, Bacterial; Gentamicins; Humans; Lymphoma, B-Cell, Marginal Zone; Methicillin-Resistant Staphylococcus aureus; Mitral Valve Insufficiency; Multiple Sclerosis; Neoplasms, Second Primary; Ovarian Neoplasms; Postoperative Complications; Rifampin; Staphylococcal Infections; Stomach Neoplasms; Vancomycin

Topics: Aged; Anticoagulants; Antitubercular Agents; Comorbidity; Cyclosporine; Drug Substitution; Drug Therapy, Combination; Female; Hemorrhage; Heparin; Humans; Immunosuppressive Agents; Kidney Transplantation; Lung Diseases, Interstitial; Pericarditis; Phenindione; Polypharmacy; Postoperative Complications; Rifampin; Sirolimus; Venous Thrombosis; Vitamin K

Topics: Anti-Bacterial Agents; Antibiotic Prophylaxis; Bacterial Infections; Humans; Male; Minocycline; Penile Prosthesis; Postoperative Complications; Rifampin

Topics: Anti-Bacterial Agents; Antibiotic Prophylaxis; Bacterial Infections; Humans; Male; Minocycline; Penile Prosthesis; Postoperative Complications; Rifampin

Topics: Acinetobacter Infections; Anti-Bacterial Agents; Drug Resistance, Multiple, Bacterial; Humans; Lumbar Vertebrae; Male; Meropenem; Military Personnel; Postoperative Complications; Rifampin; Spinal Fractures; Spinal Fusion; Thienamycins; Young Adult

Chronic central serous retinopathy (CSR) is characterised by frequent exacerbations and a poor visual prognosis. Very few therapies exist for chronic CSR, and the existing therapies are often ineffective. Thus, novel therapies to combat this frustrating disorder are needed. Presented here is a case detailing a patient with chronic CSR with persistent subfoveal fluid of 2 years' duration that completely resolved with 1 month of oral rifampin therapy. As a cytochrome P450, 3A4 inducer, rifampin is thought to favourably alter the metabolism of endogenous steroids, thereby leading to an improvement in CSR manifestations.

Topics: Administration, Oral; Aged; Cataract Extraction; Central Serous Chorioretinopathy; Chronic Disease; Cytochrome P-450 CYP3A; Humans; Male; Nucleic Acid Synthesis Inhibitors; Postoperative Complications; Remission Induction; Rifampin

We report a case of postsurgical meningitis caused by multiresistant Acinetobacter baumannii successfully treated with high doses of ampicillin/sulbactam combined with rifampicin and fosfomycin.

Topics: Accidents, Traffic; Acinetobacter baumannii; Acinetobacter Infections; Adult; Ampicillin; Anti-Bacterial Agents; Drug Resistance, Multiple, Bacterial; Fosfomycin; Humans; Male; Meningitis, Bacterial; Postoperative Complications; Rifampin; Sulbactam

Patients who undergo device revision surgery are at higher risk for infection than virgin implant recipients. The revision rate due to virgin implant infection is statistically significantly lower for minocycline/rifampin impregnated than for nonimpregnated inflatable penile prostheses. We determined whether the frequency of infection revision events after device replacement surgery would also be lower for minocycline/rifampin impregnated inflatable penile prostheses.. Patient information forms voluntarily submitted to AMS® after replacement inflatable penile prosthesis implantation between 2001 and 2007 were retrospectively reviewed to compare secondary infection related revision events for antibiotic impregnated vs nonimpregnated implants. Only men who received an inflatable penile prosthesis at a first recorded operation to replace a previously implanted penile prosthesis were included in the study. Life table survival analysis was done between the groups to compare infection related events resulting in a second surgical revision after replacement implantation. Survival function extrapolation was based on parametric analysis using the Weibull distribution model.. On life table survival analysis secondary revision due to infection was significantly less common in the minocycline/rifampin impregnated group than in the nonimpregnated group (log rank p = 0.0252). At up to 6.6 years of followup 2.5% of 9,300 men with vs 3.7% of 1,764 without an impregnated device underwent secondary revision due to infection.. This long-term device survival analysis provides clinical evidence of a significant decrease in infection related secondary revisions using minocycline/rifampin impregnated prostheses vs nonimpregnated inflatable penile prostheses at replacement implant surgery.

Topics: Anti-Bacterial Agents; Antibiotic Prophylaxis; Bacterial Infections; Humans; Male; Middle Aged; Minocycline; Penile Prosthesis; Postoperative Complications; Prosthesis Design; Reoperation; Retrospective Studies; Rifampin; Time Factors; Treatment Outcome

Although some studies suggest that most infections associated with inflatable penile prosthesis implantation develop within year 1 after surgery, device related infections have been reported 5 years after implantation or later and the infection risk with time is not well characterized. We previously reported a statistically significantly lower infection rate for original inflatable penile prostheses impregnated with antibiotic treatment with minocycline and rifampin vs nonimpregnated inflatable penile prostheses at 1-year followup. Long-term data are now available on infection revision after initial implantation of antibiotic impregnated vs nonimpregnated prostheses.. We retrospectively reviewed patient information forms voluntarily filed with the manufacturer after the initial implantation of more than 39,000 inflatable penile prostheses to compare the revision rate due to infection for antibiotic impregnated vs nonimpregnated implants between May 1, 2001 and December 31, 2008. Life table analysis was used to evaluate device survival from revision surgery.. On life table survival analysis initial revision events due to infection were significantly less common in the impregnated vs the nonimpregnated group (log rank p <0.0001). At up to 7.7 years of followup 1.1% of 35,737 vs 2.5% of 3,268 men with impregnated vs nonimpregnated implants underwent initial revision due to infection.. To our knowledge this long-term outcome analysis provides the first substantial clinical evidence of a decrease in costly infection related revision using an antibiotic impregnated inflatable penile prosthesis.

Topics: Anti-Bacterial Agents; Chi-Square Distribution; Cohort Studies; Drug Delivery Systems; Erectile Dysfunction; Follow-Up Studies; Humans; Male; Middle Aged; Minocycline; Penile Prosthesis; Postoperative Complications; Prosthesis Design; Prosthesis Failure; Prosthesis Implantation; Prosthesis-Related Infections; Reference Values; Reoperation; Retrospective Studies; Rifampin; Risk Assessment; Treatment Outcome

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

Post-arthroplasty infections represent a devastating complication of total joint replacement surgery, resulting in multiple reoperations, prolonged antibiotic use, extended disability and worse clinical outcomes. As the number of arthroplasties in the U.S. will exceed 3.8 million surgeries per year by 2030, the number of post-arthroplasty infections is projected to increase to over 266,000 infections annually. The treatment of these infections will exhaust healthcare resources and dramatically increase medical costs.. To evaluate novel preventative therapeutic strategies against post-arthroplasty infections, a mouse model was developed in which a bioluminescent Staphylococcus aureus strain was inoculated into a knee joint containing an orthopaedic implant and advanced in vivo imaging was used to measure the bacterial burden in real-time. Mice inoculated with 5x10(3) and 5x10(4) CFUs developed increased bacterial counts with marked swelling of the affected leg, consistent with an acute joint infection. In contrast, mice inoculated with 5x10(2) CFUs developed a low-grade infection, resembling a more chronic infection. Ex vivo bacterial counts highly correlated with in vivo bioluminescence signals and EGFP-neutrophil fluorescence of LysEGFP mice was used to measure the infection-induced inflammation. Furthermore, biofilm formation on the implants was visualized at 7 and 14 postoperative days by variable-pressure scanning electron microscopy (VP-SEM). Using this model, a minocycline/rifampin-impregnated bioresorbable polymer implant coating was effective in reducing the infection, decreasing inflammation and preventing biofilm formation.. Taken together, this mouse model may represent an alternative pre-clinical screening tool to evaluate novel in vivo therapeutic strategies before studies in larger animals and in human subjects. Furthermore, the antibiotic-polymer implant coating evaluated in this study was clinically effective, suggesting the potential for this strategy as a therapeutic intervention to combat post-arthroplasty infections.

Topics: Animals; Anti-Bacterial Agents; Arthroplasty; Disease Models, Animal; Humans; Joint Diseases; Joints; Male; Mice; Mice, Inbred C57BL; Minocycline; Postoperative Complications; Prostheses and Implants; Rifampin; Staphylococcal Infections; Staphylococcus aureus

Methicillin-resistant Staphylococcus aureus (MRSA) is a rare cause of cerebral abscesses, however it is a relatively more common etiologic agent in post-neurosurgical abscesses and the main antibacterial therapy option is vancomycin. In this report, a case of brain abscess due to MRSA which did not respond neither to moxifloxacin + vancomycin nor vancomycin + rifampin combination therapies, and merely treated by linezolid + rifampin combination, has been presented. Fifty-one years old female patient who was operated 40 days ago for subarachnoid bleeding and aneurysm in middle cerebral artery bifurcation, was hospitalized due to purulent leakage from the operation area. She did not have fever and her physical examination, including the neurologic system, was normal. Computerized tomography revealed an approximately 1 cm lesion compatible with subdural empyema and cerebral abscess in the right frontoparietal area in supratentorial sections. The patient was operated for wound revision and moxifloxacin was initiated. Since the operation materials revealed MRSA growth, vancomycin (4 x 500 mg, IV) was added to the treatment. The isolate was identified by conventional methods, and antibiotic susceptibility test performed by disk diffusion method showed that it was susceptible to levofloxacin, linezolid, rifampin, vancomycin and teicoplanin. Since no clinical response was obtained in two weeks, moxifloxacin was switched to rifampin (300 mg 1 x 2). On the 10th day of vancomycin + rifampin therapy, radiological findings showed development of cerebritis and therefore vancomycin was changed with linezolid (2 x 600 mg, IV). The control CT of the patient revealed regression of the brain lesion and linezolid + rifampin treatment continued for six weeks. The patient did not develop any hematological, liver or renal toxicity during the therapy and the radiological findings regressed. No relapse were detected in the one year follow-up period. This case suggested that linezolid might be a treatment alternative in the therapy of vancomycin-refractory MRSA brain abscess.

Topics: Acetamides; Anti-Infective Agents; Brain Abscess; Drug Therapy, Combination; Female; Humans; Linezolid; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Middle Aged; Oxazolidinones; Postoperative Complications; Rifampin; Staphylococcal Infections; Tomography, X-Ray Computed; Treatment Failure

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

Opportunistic infections contribute to morbidity and mortality of patients undergoing hematopoietic stem cell transplantation and treatment for malignancies. Rothia mucilaginosa, a gram-positive bacterium, is responsible for rare, but often fatal meningitis in severely immunocompromised patients. We describe two cases of meningitis from discrete strains of R. mucilaginosa on our pediatric bone marrow transplant unit, summarize the published cases of R. mucilaginosa meningitis in oncology and stem cell transplant patients, and provide updated recommendations regarding the use of antibiotic therapy in this patient population.

Topics: Actinomycetales Infections; Adolescent; Anti-Bacterial Agents; Ceftazidime; Cerebrospinal Fluid Shunts; Child; Cord Blood Stem Cell Transplantation; Drug Therapy, Combination; Fatal Outcome; Female; Humans; Immunocompromised Host; Leukemia, Megakaryoblastic, Acute; Male; Meningitis, Bacterial; Meropenem; Micrococcaceae; Opportunistic Infections; Postoperative Complications; Rifampin; Sepsis; Thienamycins; Vancomycin

Shunt infection is a common and serious complication of cerebrospinal fluid (CSF) shunting most commonly caused by skin flora contamination at surgery. Recent studies indicate that the use of antibiotic-impregnated (AI) shunt systems may reduce the risk of postoperative shunt infections. We evaluated the incidence of shunt infections associated with the use of AI shunt catheters and compared it with the incidence associated with standard non-AI catheters.. All shunt procedures performed by one surgeon using AI catheters were reviewed. An equal number of consecutive shunt procedures performed by the same surgeon using non-AI catheters were reviewed from the period immediately before the introduction of the AI system. Patients with <9 months of follow-up were excluded; all shunt infections and shunt-related complications were recorded. The proportions of infected shunts in the AI and control groups were compared using a chi (2) analysis.. We reviewed 160 shunt procedures (80 per group). The infection rate was 5.0% among patients with AI catheters compared with 8.8% in the control group (P = 0.534, Fischer's exact). The average time to infection was similar between the two groups. Among the AI group, the shunt infection rate did not differ between ventricular catheter, distal catheter revisions, and revisions of ventricular and peritoneal tubing. In contrast with other reports, we found no significant reduction in the pediatric CSF shunt infection rate with the use of AI shunt systems. Any recommendation for or against the routine use of AI systems in children requires a prospective, blinded, randomized-controlled trial with adequate power.

Topics: Adolescent; Anti-Bacterial Agents; Catheters, Indwelling; Cerebrospinal Fluid Shunts; Chi-Square Distribution; Child; Child, Preschool; Clindamycin; Cohort Studies; Female; Humans; Infant; Male; Postoperative Complications; Prosthesis-Related Infections; Rifampin; Staphylococcal Infections; Treatment Outcome

Treatment of latent tuberculosis infection with isoniazid (INH) or rifampin (RIF) is controversial in liver transplant candidates due to potential hepatotoxicity. In this study, treatment of latent tuberculosis during transplant candidacy period is explored, and relevant literature is reviewed.. Liver transplant candidates with latent tuberculosis infection by positive tuberculin skin test (>5 mm) were prospectively enrolled and treated with 9 months of INH or 4 months of RIF, and were monitored monthly for their liver enzyme profiles, adverse effects, compliance, and completion rate.. Four of nine patients with INH had asymptomatic, mild elevations of aspartate aminotransferase (AST) or alanine aminotransferase (ALT) versus none of five patients in the RIF group. Two cases of elevations were attributed to INH. Two other cases were attributed to alcoholism or active chronic hepatitis B virus infection. Only one patient in the INH group experienced symptoms possibly attributed to INH hepatotoxicity. Compliance was 100% per patient reporting. Completion rates were 79% for INH and 100% for RIF. No fulminant hepatic failure or death was observed.. Treatment of latent tuberculosis in liver transplant patients during their candidacy with INH or RIF appears to be a safe, viable option, if carefully monitored for adverse effects and liver enzymes.

Topics: Adolescent; Adult; Alanine Transaminase; Antitubercular Agents; Aspartate Aminotransferases; Comorbidity; Female; Humans; Isoniazid; Liver Cirrhosis; Liver Transplantation; Male; Postoperative Complications; Preoperative Care; Rifampin; Safety; Treatment Outcome; Tuberculin Test; Tuberculosis

Topics: Anti-Bacterial Agents; Arthralgia; Arthritis; Arthritis, Infectious; Arthroplasty, Replacement, Knee; Atorvastatin; Combined Modality Therapy; Debridement; Diagnosis, Differential; Doxycycline; Drug Interactions; Female; Heptanoic Acids; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Hyperlipoproteinemia Type II; Levofloxacin; Middle Aged; Ofloxacin; Postoperative Complications; Prosthesis-Related Infections; Pyrroles; Recurrence; Reoperation; Rifampin; Thyroiditis, Autoimmune; Thyroxine; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adult; Antibiotics, Antitubercular; Decompression, Surgical; Humans; Injections, Spinal; Medication Errors; Postoperative Complications; Rifampin

Infection can be a devastating complication after implantation of a cortical bone allograft. The allograft could act as a vehicle for local antibiotic prophylaxis.. We studied the release of antibiotics in vitro from cortical bone allografts impregnated with antibiotics for different periods of time. We also studied whether cortical allografts impregnated with antibiotics could eradicate Staphylococcus aureus from an experimentally infected graft in vivo. In the in vitro study, pieces of cortical bone were impregnated with netilmicin, vancomycin, ciprofloxacin and rifampicin for 1 h, 10 h and 100 h. The antibiotics were eluted into phosphate-buffered saline (PBS) for 7 days, with daily transfer of the bone into fresh PBS. In the in vivo study, cortical allografts impregnated with antibiotics were placed in rats intramuscularly. 10 microL of an S. aureus suspension (0.6 x 10(5) CFU) was placed in the intramedullary cavity. After 15 days, the allografts were removed and examined for bacterial growth.. The amount of antibiotics released in vitro was influenced by the time used for antibiotic impregnation of the bone. Allografts impregnated with netilmicin, vancomycin and rifampicin effectively eradicated perioperative contamination with S. aureus in vivo.. This study shows that a cortical bone allograft would be an effective vehicle for local antibiotic delivery.

Topics: Animals; Anti-Bacterial Agents; Antibiotic Prophylaxis; Bone Transplantation; Femur; Netilmicin; Postoperative Complications; Rats; Rats, Wistar; Rifampin; Staphylococcal Infections; Staphylococcus aureus; Transplantation, Homologous; Vancomycin

Topics: Aged; Arthritis, Infectious; Arthritis, Rheumatoid; Arthroplasty, Replacement, Knee; Autoimmune Diseases; Ciprofloxacin; Cloxacillin; Drug Therapy, Combination; Fatal Outcome; Humans; Immunocompromised Host; Knee Prosthesis; Male; Phlebitis; Postoperative Complications; Prosthesis-Related Infections; Pulmonary Embolism; Recurrence; Rifampin; Staphylococcal Infections; Staphylococcus; Virulence

The conventional therapeutic approach to bone infection associated with osteosynthesis is based on the idea that microbial eradication is most readily achieved by removal of the foreign material together with adequate antimicrobial therapy. This strategy usually requires implantation of external fixation devices with additional discomfort to the patient. We report our experience with conservative medical and antimicrobial therapy without removal of the osteosynthesis until adequate bone callus deposition is documented by bone radiography scan. Twenty patients with infections associated with intramedullary nailing (9 patients), screws and plate (9 patients) or screws (2 patients) were treated between 1995 to 2000. Osteosynthesis implantation sites were tibia (7 patients), femur (6 patients), femur and tibia (1 patient), humerus (1 patient), others (5 patients). Diagnosis of infection was based on clinical-microbiological evidence and confirmed by 99Tc-labeled leukocyte scan studies. Offending pathogens were Staphylococcus aureus 17 cases, Staphylococcus aureus + Escherichia coli, Staphylococcus epidermidis, unknown, 1 case each. Most infections were initially treated with intravenous or intramuscular teicoplanin +/- ciprofloxacin or rifampin followed by oral antimicrobial therapy usually with ciprofloxacin or minocycline plus rifampin. Mean duration of antimicrobial therapy was 27.7 weeks (range 12-64 weeks). All patients (100%) were cured, and none complained of side-effects requiring antibiotic therapy discontinuation. We conclude that conservative medical therapy is feasible for osteosynthesis-associated bone infection.

Topics: Adolescent; Adult; Aged; Ciprofloxacin; Drug Therapy, Combination; Escherichia coli; Escherichia coli Infections; Female; Follow-Up Studies; Fracture Fixation, Internal; Humans; Injections, Intramuscular; Injections, Intravenous; Male; Middle Aged; Postoperative Complications; Retrospective Studies; Rifampin; Staphylococcal Infections; Staphylococcus aureus; Staphylococcus epidermidis; Surgical Wound Infection; Teicoplanin

We report a case of chronic wound infection (abscess, fistula) after a Lichtenstein repair of inguinal hernia. After surgical treatment (mesh explantation), a small-colony variant (SCV) of Staphylococcus aureus was cultured microbiologically. SCV represent subpopulations of Staphylococcus aureus which are associated with chronic infections and which respond poorly to usual treatment regimes. In this case surgery and specific antibiotic treatment with flucloxacillin and rifampicin were successful.

Topics: Abscess; Chronic Disease; Combined Modality Therapy; Cutaneous Fistula; Floxacillin; Hernia, Inguinal; Humans; Male; Middle Aged; Postoperative Complications; Rifampin; Staphylococcal Infections; Staphylococcus aureus; Surgical Wound Infection

Topics: Adult; Antitubercular Agents; Drug Therapy, Combination; Ethambutol; Female; Follow-Up Studies; Humans; Incidence; India; Isoniazid; Kidney Transplantation; Living Donors; Male; Postoperative Complications; Pyrazinamide; Pyridoxine; Retrospective Studies; Rifampin; Time Factors; Tuberculosis; Tuberculosis, Pulmonary

Topics: Adult; Antitubercular Agents; Disease Progression; Drug Therapy, Combination; Ethambutol; Female; Humans; Immunosuppressive Agents; Isoniazid; Kidney Transplantation; Living Donors; Mycobacterium tuberculosis; Postoperative Complications; Pyrazinamide; Rifampin; Tomography, X-Ray Computed; Tuberculosis, Pulmonary

To report a case of pill-induced esophagitis caused by oral rifampin.. English-language references identified via a MEDLINE search from January 1966 to May 1998 and a bibliographic review of pertinent articles.. A large number of oral medications have been reported to cause pill-induced esophagitis. This case represents the second report attributed to rifampin. A 70-year-old white man receiving vancomycin, gentamicin, and oral rifampin for treatment of Staphylococcus epidermidis prosthetic valve endocarditis reported dysphagia immediately after swallowing a rifampin capsule on the fourth day of therapy. The following day, fiberoptic laryngoscopy and esophagoscopy demonstrated a red capsule partially embedded in the neopharynx. A day later, upper esophageal obstruction consistent with edema related to pill-induced esophagitis was identified by barium swallow. Following the procedure, the patient was placed on total parenteral nutrition and took nothing by mouth. Sixteen days after first reporting dysphagia, he was placed on a full liquid diet. Several factors may have increased the patient's risk for pill-induced esophagitis, including age, bedridden state, gastroesophageal reflux disease, simultaneous administration of several medications, and neopharyngeal stricture.. Oral rifampin may cause esophagitis. Healthcare providers should be alert to the possibility of pill-induced esophagitis in susceptible patients. Patients with predisposing factors for the development of pill-induced esophagitis should be educated about proper swallowing of oral medications.

Topics: Administration, Oral; Aged; Anti-Bacterial Agents; Endocarditis, Bacterial; Esophagitis; Heart Valve Prosthesis Implantation; Humans; Male; MEDLINE; Mitral Valve; Postoperative Complications; Rifampin; Staphylococcal Infections; Staphylococcus epidermidis; Tablets

Secondary aortoenteric fistulas remain challenging diagnostic and therapeutic problems. Although the duodenum is most frequently involved, other intestinal segments are possible sites for fistulization. We report here a case of graft-appendiceal fistula revealed by recurrent gastrointestinal bleeding 11 years after abdominal aortic aneurysm replacement. The preoperative diagnosis was not achieved by endoscopy or imaging assessment. Despite recommended principles of total graft excision and extraanatomic bypass, appendectomy and in situ rifampin-bonded graft reconstruction were performed because of the advanced age and poor arterial runoff. The postoperative course was uneventful and the patient remains well 17 months after operation.

Topics: Aged; Aged, 80 and over; Aortic Aneurysm, Abdominal; Aortic Diseases; Appendix; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Cecal Diseases; Gastrointestinal Hemorrhage; Humans; Intestinal Fistula; Male; Polyethylene Terephthalates; Postoperative Complications; Rifampin; Time Factors; Vascular Fistula

In April 1997, a 58-year-old renal transplant recipient presented with abscess-like nodules in his left calf and on his right foot. Furuncular disease was suspected and the patient was treated with flucloxacillin. However, the lesions increased in size and became ulcerative. In the following 3 months, cultures of punctuated material, blood, and urine remained negative and gram stains did not reveal micro-organisms. In June 1997, acid-fast stains were positive. A diagnosis of a nontuberculous mycobacterium (NTM) infection was made and empirical antimycobacterial therapy was started. The combination of relatively minor symptoms with enlarged purulent lesions, causing severe morbidity, raises the possibility of NTM infection in the immunocompromised patient.

Topics: Clarithromycin; Drug Therapy, Combination; Ethambutol; Foot; Humans; Kidney Transplantation; Male; Middle Aged; Mycobacterium Infections, Nontuberculous; Nontuberculous Mycobacteria; Ofloxacin; Postoperative Complications; Rifampin; Skin Diseases, Bacterial

Treatment of aortic graft infection with graft excision and axillofemoral bypass may carry an increased risk of limb loss, aortic stump blowout, and pelvic ischemia. A review of patients with aortic graft infection treated with in situ prosthetic graft replacement was undertaken to determine if mortality, limb loss, and reinfection rates were improved with this technique.. The clinical data of 25 patients, 19 males and 6 females, with a mean age of 68 years (range 35 to 83), with aortic graft infection, treated between January 1, 1989, and December 31, 1998, by in situ prosthetic graft replacement were reviewed. Follow-up was complete in the 23 surviving patients and averaged 36 months (range 4 to 103).. Twenty aortofemoral, 3 aortoiliac, and 2 straight aortic graft infections were treated with excision and in situ replacement with standard polyester grafts in 16 patients (64%), or with rifampin-soaked collagen or gelatin-impregnated polyester grafts in 9 patients (36%). Fifteen patients (60%) had aortic graft enteric fistulas, 8 patients (32%) had abscesses or draining sinuses, and 2 patients (8%) had bacterial biofilm infections. Thirty-day mortality was 8% (2 of 25). There were no early graft occlusions or amputations. There was one late graft occlusion. There were no late amputations. The reinfection rate was 22% (5 grafts). All reinfections occurred in patients operated upon for occlusive disease. Only one reinfection occurred in the rifampin-soaked graft group (11% versus 29%, P = NS). Reinfection tended to be lower in patients with aortoenteric fistulas and without abscess. Autogenous tissue coverage provided statistically significant protection against reinfection. There were no late deaths related to in situ graft infection.. Patients treated with in situ graft replacement had an 8% mortality and 100% limb salvage rate. Reinfection rates were similar to those of extra-anatomic bypass, but a trend of lower reinfection rates with rifampin-impregnated grafts was apparent. Patients with aortoenteric fistula and without abscess appear to be well treated by the technique of in situ prosthetic grafting and autogenous tissue coverage.

Topics: Abscess; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Aorta; Biofilms; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Collagen; Female; Femoral Artery; Follow-Up Studies; Gelatin; Graft Occlusion, Vascular; Humans; Iliac Artery; Intestinal Fistula; Male; Middle Aged; Polyesters; Postoperative Complications; Prosthesis-Related Infections; Recurrence; Reoperation; Retrospective Studies; Rifampin; Survival Rate; Treatment Outcome

Topics: Adult; Aged; Antifungal Agents; Candidiasis; Drug Interactions; Erythromycin; Female; Humans; Immunosuppressive Agents; Ketoconazole; Kidney Transplantation; Male; Phenytoin; Postoperative Complications; Rifampin; Tacrolimus

Topics: Adolescent; Adult; Antitubercular Agents; Drug Therapy, Combination; Ethambutol; Female; Follow-Up Studies; Humans; Isoniazid; Male; Mycobacterium Infections; Organ Transplantation; Postoperative Complications; Pyrazinamide; Retrospective Studies; Rifampin; Rural Population; Socioeconomic Factors; Time Factors; Turkey

Topics: Adult; Antitubercular Agents; Ethambutol; Fatal Outcome; Female; Humans; Isoniazid; Kidney Transplantation; Liver; Liver Function Tests; Postoperative Complications; Pyrazinamide; Rifampin; Tuberculin Test; Tuberculosis

To clarify the prevalence and factors associated with tuberculosis, as well as patient survival in heart transplant recipients.. A retrospective review of case records of all heart transplant recipients from March 1989 to February 1996 during a 7-year period.. During the period reviewed, 727 orthotopic heart transplantations were performed in 716 patients at the Heart Center Northrhine-Westphalia, Germany.. Tuberculosis was proved in seven (1%) patients (four men/three women; age, 33 to 71 years; two miliary lesions, three pulmonary lesions, and two urogenital lesions). None of them had primary history of tuberculosis. Tuberculin skin tests were not performed before transplantation because there were no lesions indicating primary infection of turberculosis. The immunosuppressive regimen was based on double-drug (cyclosporine + azathioprine) therapy. Immunosuppression had been intensified by methylprednisolone pulses at least three times in those seven patients, and prednisone had been used orally in six of seven patients. Tuberculosis developed from 2.5 to 41 months after transplantation. Tuberculosis was found by routine examinations in four of seven patients. Diagnoses were made with both direct microscopy and cultures in six patients, and by histologic study in one. Treatment consisted of isoniazid, rifampicin, ethambutol, and pyrazinamide. Two patients with miliary lesions were treated with four drugs, and the others were treated with three drugs. Isoniazid was used in all patients. Rifampicin, which decreases cyclosporine serum levels, was not used from the beginning in one patient and treatment with it was stopped halfway in another patient because low cyclosporine level had induced rejection. Six of the seven patients are doing well while receiving antituberculous therapy. One patient died with miliary tuberculosis as a cause of death.. The prevalence of tuberculosis in heart transplant recipients was higher than that in the general population. We recommend that a high degree of clinical suspicion is maintained for tuberculosis in heart transplant recipients with meticulous follow-up, and that the treatment of tuberculosis has to be with meticulous care, especially during the use of rifampicin.

Topics: Adult; Aged; Antibiotics, Antitubercular; Female; Heart Transplantation; Humans; Immunosuppressive Agents; Male; Middle Aged; Postoperative Complications; Retrospective Studies; Rifampin; Tuberculosis

Exclusion of occult diseases in the donor organ and prevention of infectious disease transmission are minimal requirements in organ transplantation. We report here a case of hepatic graft tuberculosis, which was most likely transmitted by the graft from the living-related donor. The course of the recipient included tuberculosis, rejection, and other infections, which led to vanishing bile duct syndrome. Due to various infections and tuberculosis, as well as a strong interaction between rifampicin and tacrolimus, the patient died of pneumonia on day 273 after transplantation. This case emphasizes the importance of care in the selection of a living-related donor for liver transplantation.

Topics: Adult; Drug Interactions; Fatal Outcome; Female; Follow-Up Studies; Graft Rejection; Humans; Immunosuppressive Agents; Infant; Liver Diseases; Liver Function Tests; Liver Transplantation; Living Donors; Mothers; Postoperative Complications; Rifampin; Tacrolimus; Tuberculosis

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

To describe the diagnosis and management of bacterial pericarditis after heart transplantation.. Two patients with Staphylococcus aureus pericarditis after heart transplantation were successfully treated conservatively with closed catheter drainage and antibiotics.. The patients were alive three and six years, respectively, following surgery. At follow-up, right heart catheterization demonstrated normal hemodynamics in one patient and a pattern of constrictive pericarditis in the other patient which was man-aged with furosemide.. Conservative management of bacterial pericarditis by closed catheter drainage and antibiotics can be considered in selected patients after heart transplantation.

Topics: Adult; Anti-Bacterial Agents; Cardiac Catheterization; Cefazolin; Cloxacillin; Drainage; Heart Transplantation; Humans; Male; Middle Aged; Pericarditis; Postoperative Complications; Rifampin; Staphylococcal Infections

Topics: Adult; Antibiotics, Antitubercular; Drug Interactions; Ethambutol; Female; Histocompatibility Testing; Humans; Immunosuppressive Agents; Infant; Isoniazid; Liver Transplantation; Living Donors; Mycobacterium tuberculosis; Postoperative Complications; Rifampin; Streptomycin; Tacrolimus; Tuberculosis

Topics: Adult; Antitubercular Agents; Drug Therapy, Combination; Ethambutol; Follow-Up Studies; Humans; Isoniazid; Kidney Transplantation; Male; Postoperative Complications; Pyrazinamide; Retrospective Studies; Rifampin; Time Factors; Tuberculosis

To investigate causes and clinical findings of non-tuberculous mycobacterial keratitis, and to study its response to topical antibiotic therapy and surgical extirpative keratectomy.. A single centre, retrospective review of 22 patients with non-tuberculous mycobacterial keratitis seen in a 3 year period. Laboratory diagnoses were established with Ziehl-Nielsen acid fast staining and Löwenstein-Jensen cultures.. In 20 patients (91%), there was an antecedent history of foreign body eye trauma (18 patients) or elective surgery (two patients). There were 19 cases of Mycobacterium chelonei, and three of M fortuitum. Clinical signs included epithelial defects, satellite or ring stromal infiltrates, crystalline keratopathy, and hypopyon. For topical antibiotic therapy, 20 patients received amikacin, while one patient received rifampin and another received ciprofloxacin, each in accordance with the results of the in vitro drug sensitivities. An extirpative keratectomy was performed in 15 cases; four of these cases additionally required a temporary conjunctival flap in order to finally eradicate the infection. At the end of the follow up period (median 18 months; range 3 months to 3 years) all eyes were stable and free of infection, with 19 (86%) having final visual acuities of 20/200 or better.. Early clinical recognition and prompt laboratory diagnosis, together with aggressive topical antibiotic therapy and early keratectomy, may shorten morbidity and improve the clinical outcome of non-tuberculous mycobacterial keratitis.

Topics: Adult; Aged; Amikacin; Anti-Bacterial Agents; Ciprofloxacin; Eye Injuries; Female; Follow-Up Studies; Humans; Keratitis; Male; Microbial Sensitivity Tests; Middle Aged; Mycobacterium chelonae; Mycobacterium Infections, Nontuberculous; Nontuberculous Mycobacteria; Postoperative Complications; Retrospective Studies; Rifampin; Treatment Outcome; Visual Acuity

Topics: Adult; Drug Therapy, Combination; Ethambutol; Humans; Isoniazid; Kidney Transplantation; Lymph Nodes; Male; Middle Aged; Mycobacterium tuberculosis; Postoperative Complications; Rifampin; Sputum; Tuberculosis, Pulmonary

Following cardiac transplantation bacterial mediastinitis is a severe early complication. Between March 1986 and September 1993, cardiac transplant operations were performed in 101 patients, of whom six developed purulent mediastinitis. Treatment consisted of surgical débridement, closed local irrigation, drainage and systemic antibiotics. No patient died as a result of bacterial mediastinitis. Low cardiac output and requirements for resternotomy for bleeding and prolonged artificial ventilation were significantly higher in the group with sternal infection. In contrast, since January 1991 the dose of corticosteroid was decreased from 5 mg/kg per day to 1.5 mg/kg per day beginning on the first day after operation. A total of 51 heart transplant operations have been subsequently performed without sign of mediastinal infection.

Topics: Adult; Bacterial Infections; Combined Modality Therapy; Debridement; Dose-Response Relationship, Drug; Enterococcus; Female; Heart Transplantation; Humans; Immunosuppressive Agents; Male; Mediastinitis; Middle Aged; Postoperative Complications; Povidone-Iodine; Reoperation; Rifampin; Serratia Infections; Staphylococcal Infections; Surgical Wound Infection; Therapeutic Irrigation

Topics: Drug Therapy, Combination; Ethambutol; HIV Seropositivity; Humans; Immunosuppressive Agents; Isoniazid; Kidney Transplantation; Mycobacterium Infections; New York; Postoperative Complications; Pyrazinamide; Rifampin; Transplantation, Homologous

Topics: Ethambutol; Female; Humans; Immunosuppression Therapy; Isoniazid; Kidney Failure, Chronic; Kidney Transplantation; Middle Aged; Pancreatic Diseases; Postoperative Complications; Rifampin; Transplantation, Homologous; Tuberculosis

This study examines the efficacy of rifampin bonding to a gelatin-sealed knitted Dacron graft to prevent perioperative bacteremic vascular graft infection. Antibiotic bonding was obtained by soaking grafts for 15 minutes in a 1 mg/ml saline solution of rifampin at 37 degrees C. Nineteen dogs had thoracoabdominal aortic bypass: seven (group I) received a rifampin treated graft; six (group II) received an untreated gelatin-coated graft; and six (group III) received an uncoated Dacron graft. Two days later bacteremic challenge was produced by rapid intravenous injection of 5 x 10(5) colony forming units of methicillin resistant Staphylococcus aureus. Grafts were harvested five days after this challenge and cut into 10 fragments, each submitted to bacterial counts. Results were expressed as CFU/cm2 of graft material. In group I, no graft was infected, whereas all grafts in groups II and III were infected (p less than 0.05). Median bacterial counts from the infected fragments (median +/- SD) were similar in groups II (2.5 x 10(5) CFU/cm2) and III (4 x 10(4) CFU/cm2). Blood cultures at time of sacrifice were negative in all dogs in group I and positive in five of six dogs in groups II and III. Cultures of liver, spleen, kidney, and lung specimens were always negative in group I and positive in 22 of 24 specimens in group II and 23 of 24 specimens in group III. Soaking a gelatin-sealed Dacron graft in rifampin solution evidently prevents early bacteremic graft infection and secondary foci of infection in this model.

Topics: Animals; Blood Vessel Prosthesis; Dogs; Gelatin; Polyethylene Terephthalates; Postoperative Complications; Rifampin; Staphylococcal Infections

Shunt infections in children have become a serious problem. In order to solve this, we have been using antibiotic therapy with Rifampicin (Rifampin) for the last 2 years; the dosage is 20 mg/kg per day 1 h before surgery and then for 48 h after the surgical procedure. We have had experience with 203 children operated on between January 1987 and December 1988. The result was a significant decrease in the number of children with shunt infections. In 1980 we reported an incidence of 10%, while by 1988 the rate had gone down to 1%.

Topics: Dose-Response Relationship, Drug; Drug Administration Schedule; Equipment Contamination; Escherichia coli Infections; Follow-Up Studies; Humans; Hydrocephalus; Infant; Infant, Newborn; Infection Control; Klebsiella Infections; Postoperative Complications; Premedication; Pseudomonas aeruginosa; Pseudomonas Infections; Rifampin; Staphylococcal Infections; Surgical Wound Infection; Ventriculoperitoneal Shunt

Topics: Aminoglycosides; Anti-Bacterial Agents; Cross Infection; Disinfectants; Humans; Lactams; Macrolides; Methicillin Resistance; Postoperative Complications; Quinolones; Rifampin; Staphylococcal Infections; Staphylococcus aureus; Tetracyclines; Vancomycin

Topics: Aortic Valve; Aortic Valve Stenosis; Endocarditis, Bacterial; Heart Valve Prosthesis; Humans; Male; Middle Aged; Postoperative Complications; Rifampin; Staphylococcal Infections; Staphylococcus epidermidis; Time Factors; Vancomycin

The cases of 8 heart transplant recipients with legionnaires' disease are reviewed. The diagnosis in each patient was made by fluorescent antibody stains or direct culture of the sputum, transtracheal aspirate, or fine needle aspirate of the lung. All patients were successfully treated with erythromycin alone or in combination with rifampin. Radiographic and clinical variations of legionnaires' disease as seen in the immunocompromised host are presented.

Topics: Adolescent; Adult; Child; Drug Therapy, Combination; Erythromycin; Female; Heart Transplantation; Humans; Immunosuppression Therapy; Legionnaires' Disease; Lung; Male; Middle Aged; Postoperative Complications; Radiography; Rifampin

Topics: Antitubercular Agents; Ethambutol; Female; Humans; Ileum; Isoniazid; Jejunum; Middle Aged; Obesity; Postoperative Complications; Rifampin; Tuberculosis, Pulmonary

Topics: Adult; Aortic Valve; Colistin; Drug Therapy, Combination; Endocarditis, Bacterial; Heart Valve Prosthesis; Humans; Male; Postoperative Complications; Pseudomonas Infections; Rifampin; Tobramycin

A strain of Bacteroides fragilis with high-level chromosomal resistance to rifampicin was isolated by blood culture from a patient with bacteraemia after gastrointestinal surgery. He had been receiving antituberculous therapy with rifampicin for nine months. This resistance led to some difficulty in the recognition and identification of the isolate by methods that depended upon antibiotic sensitivity patterns.

Topics: Adult; Bacteroides fragilis; Bacteroides Infections; Drug Resistance, Microbial; Humans; Male; Postoperative Complications; Rifampin; Sepsis; Tuberculosis, Pulmonary

A 24-year-old man developed a severe pleuropulmonary infection with Mycobacterium kansasii 18 months after receiving a kidney transplant from his mother. Intestinal malabsorption with severe diarrhea and a skin abscess disappeared and his pneumonia was cured when Rifampin was administered. This suggested that generalized dissemination with M. kansasii may have been present.

Topics: Adult; Humans; Immunosuppression Therapy; Kidney Transplantation; Male; Mycobacterium Infections, Nontuberculous; Postoperative Complications; Rifampin; Transplantation, Homologous; Tuberculosis, Pulmonary

Staphylococcus epidermidis endocarditis occurred four days following aortic valve replacement with a Björk-Shiley prosthesis. Antimicrobial therapy, shown to be effective by in vitro and in vivo studies, failed to eradicate the infection. When rifampin was added to the existing antibiotic regimen, peak serum bactericidal activity increased, the patient defervesced, and blood cultures became negative.

Topics: Adult; Aortic Valve; Endocarditis, Bacterial; Female; Heart Valve Prosthesis; Humans; Postoperative Complications; Rifampin; Staphylococcal Infections

Topics: Humans; Immunosuppressive Agents; Isoniazid; Kidney Transplantation; Postoperative Complications; Rifampin; Transplantation, Homologous; Tuberculosis

Of more than 400 patients who received renal transplants in Cambridge, five subsequently developed tuberculosis. All had pulmonary involvement. Radiological abnormalities included miliary opacities, bilateral lower zone shadowing or typical upper zone shadowing with cavitation. Lung biopsy was required for diagnosis in two cases. Three patients recovered after treatment with antituberculosis drugs and none has relapsed. One died during chemotherapy despite drug-susceptible organisms. The problems encountered during chemotherapy are discussed.

Topics: Adult; Drug Administration Schedule; Female; Humans; Isoniazid; Kidney Failure, Chronic; Kidney Transplantation; Male; Middle Aged; Postoperative Complications; Rifampin; Transplantation, Homologous; Tuberculosis, Pulmonary

Rifampin was added to existing antibiotic regimens in two patients with Staphylococcus epidermidis infections; one patient had prosthetic valve endocarditis and the other had an infection of a CSF shunt. The addition of rifampin increased serum or CSF bactericidal titers 16-fold or greater and was correlated with a favorable clinical response. The results of tests for tube-dilution antibiotic susceptibility showed rifampin to be the most active of all antibiotics tested against the patients' organisms. The combinations of gentamicin sulfate, nafcillin sodium, or vancomycin hydrochloride with rifampin prevented the emergence of rifampin resistance in vitro and promoted enhanced killing when compared with either antibiotic alone.

Topics: Adolescent; Cerebrospinal Fluid; Cerebrospinal Fluid Shunts; Drug Synergism; Endocarditis, Bacterial; Female; Gentamicins; Heart Valve Prosthesis; Humans; Infant; Male; Microbial Sensitivity Tests; Middle Aged; Nafcillin; Postoperative Complications; Rifampin; Staphylococcal Infections; Staphylococcus; Vancomycin

Topics: Adult; Aged; Bacterial Infections; Female; Humans; Lung Diseases; Male; Middle Aged; Postoperative Complications; Rifampin; Sepsis; Urinary Tract Infections

A patient with hydrocephalus and a ventriculojugular shunt presented with acute nephritis, nephrotic syndrome (proteinuria 10 g/24 hours), decreased complement levels, circulating immune complexes and diminished creatinine clearance (41 ml/min). Seven blood cultures grew Corynebacterium bovis. A renal biopsy specimen revealed mesangiocapillary glomerulonephritis by light microscopy, and thickened glomerular basement membranes with areas of increased granular density by electron microscopy. Immunofluorescent examination of the biopsy specimen demonstrated 2+ granular glomerular basement membrane deposits of immunoglobulin M (IgM), with trace third component of complement (C-3), fourth component of complement (C-4) and immunoglobulin G (IgG). Rabbits immunized with C. bovis produced a line of partial identity in agar with patient serum against a sonicate of C. bovis. Indirect fluorescein staining of the biopsy specimen with the rabbit antiserum demonstrated 1+ granular glomerular basement membrane deposits. Potassium thiocyanate microelution of sections prior to examination markedly diminished staining with antihuman antiserum, but did not affect staining with rabbit antiserum. Following initial therapy with intravenous penicillin for six weeks the bacteremia cleared, serum complement levels returned to normal, proteinuria decreased and creatinine clearance increased. A relapse occured four weeks later with decreased complement levels, increased proteinuria and decreased creatinine clearance. Blood cultures were again positive for C. bovis. Following therapy with erythromycin and rifampin, the bacteremia cleared and there was a sustained improvement of all parameters. To our knowledge, this is the first time an association has been noted between C. bovis ventriculojugular shunt infection and glomerulonephritis. These findings support the potential role of C. bovis as an etiologic agent in human renal disease and further define the immune complex nature of shunt nephritis.

Topics: Adult; Animals; Biopsy; Cerebrospinal Fluid Shunts; Complement C3; Complement C4; Corynebacterium Infections; Erythromycin; Glomerulonephritis; Humans; Immunoglobulin G; Immunoglobulin M; Kidney; Male; Microbial Sensitivity Tests; Penicillins; Postoperative Complications; Rabbits; Recurrence; Rifampin

Topics: Adult; Blood Transfusion; Ethionamide; Hepatitis B; Humans; Liver; Liver Function Tests; Postoperative Complications; Rifampin; Time Factors; Tuberculosis, Pulmonary

Topics: Aged; Alanine Transaminase; Anesthesia, Inhalation; Aspartate Aminotransferases; Biopsy; Chemical and Drug Induced Liver Injury; Cholecystectomy; Drug Therapy, Combination; Female; Halothane; Humans; Liver; Liver Function Tests; Postoperative Complications; Rifampin; Surgical Wound Dehiscence; Tuberculoma

Topics: Adult; Azathioprine; Bacteriuria; Ethambutol; Humans; Isoniazid; Kidney Transplantation; Male; Mycobacterium tuberculosis; Postoperative Complications; Prednisone; Rifampin; Sputum; Transplantation, Homologous; Tuberculin Test; Tuberculosis, Pulmonary

Topics: Adolescent; Adult; Aged; Child; Drug Resistance, Microbial; Female; Humans; Isoniazid; Kanamycin; Male; Middle Aged; Mycobacterium tuberculosis; Pneumonectomy; Postoperative Complications; Rifampin; Streptomycin; Tuberculosis, Pulmonary

Determination of the minimum inhibitory concentrations of rifamide necessary to inhibit organisms isolated from the biliary tract showed that the organisms were almost invariably sensitive to concentrations which are readily attainable in the biliary tract. Three cases of severe acute inflammation of the biliary tract were treated and this led to rapid clinical improvement. In 61 patients undergoing biliary surgery a random group was given rifamide 150 mg twice daily, beginning 24 hours before operation and continuing for three days afterwards. In the untreated group eight patients had infected bile at operation and five subsequently developed a wound infection. In the rifamide group three had infected bile at operation and only one developed a wound infection. A similar number of postoperative chest infections occurred in each group of patients. There is some evidence of reduction in length of hospital stay in the treated patients.

Topics: Acute Disease; Aged; Bile; Cholangitis; Cholecystitis; Cholelithiasis; Female; Gallbladder; Humans; Length of Stay; Male; Microbial Sensitivity Tests; Postoperative Complications; Respiratory Tract Infections; Rifampin; Surgical Wound Infection

Topics: Adolescent; Bronchiectasis; Child; Child, Preschool; Female; Humans; Infant; Pediatrics; Postoperative Complications; Rifampin; Surgical Procedures, Operative

Topics: Anti-Bacterial Agents; Biliary Tract Diseases; Cholangitis; Humans; Pancreatitis; Postoperative Complications; Rifampin