ro13-9904 and Abdominal-Abscess

Development of secondary haemophagocytic lymphohistiocytosis (sHLH) in the context of typhoid fever (TF) is a very rare but serious complication.. Description of the first pediatric case of typhoid fever acquired in a non-endemic area complicated by sHLH. A systematic literature review of sHLH in the context of TF was performed with extraction of epidemiological, clinical and laboratory data.. The literature search revealed 17 articles (22 patients). Fifteen patients were eligible for data analysis (53.4% children). All patients had fever and pancytopenia. Transaminases and LDH were frequently elevated (46.6%). Salmonella typhi was detected mainly by blood culture (64.3%). All the patients received antibiotics whereas immunomodulation (dexamethasone) was used in two cases.. A high suspicion index for this condition is needed even in non-endemic areas. The addition of immunmodulation to standard antimicrobial therapy should be considered in selected cases.

Topics: Abdominal Abscess; Abdominal Pain; Age Distribution; Appendicitis; Asia; Ceftriaxone; Child; Developed Countries; Diagnosis, Differential; Endemic Diseases; Fever; Hepatomegaly; Humans; Lymphohistiocytosis, Hemophagocytic; Male; Methylprednisolone; Middle East; Sex Distribution; Spain; Splenomegaly; Typhoid Fever

Emerging data suggest instillation of tissue plasminogen activator (tPA) is safe and potentially efficacious in the treatment of intra-abdominal abscess. To date, prospective comparative data are lacking in children. Therefore, we conducted a randomized trial comparing abscess irrigation with tPA and irrigation with saline alone.. After IRB approval, children with an abscess secondary to perforated appendicitis who had a percutaneous drain placed for treatment were randomized to twice-daily instillation of 13 mL 10% tPA or 13 mL normal saline. All patients were treated with once-daily dosing of ceftriaxone and metronidazole throughout their course. The primary end point variable was duration of hospitalization after drain placement. Using a power of 0.8 and an α of 0.05, a sample size of 62 patients was calculated.. Sixty-two patients were enrolled between January 2009 and February 2013. There were no differences in demographics, abscess size, abscess number, admission WBC, or duration of symptoms. Duration of hospitalization after drainage was considerably longer with the use of tPA. There was no difference in total duration of hospitalization, days of drainage, or days of antibiotics. However, medication charges were higher with tPA.. There are no advantages to routine tPA flushes in the treatment of abdominal abscess secondary to perforated appendicitis in children.

Topics: Abdominal Abscess; Adolescent; Anti-Infective Agents; Appendicitis; Ceftriaxone; Child; Child, Preschool; Combined Modality Therapy; Drainage; Drug Administration Schedule; Drug Therapy, Combination; Female; Fibrinolytic Agents; Follow-Up Studies; Humans; Male; Metronidazole; Prospective Studies; Single-Blind Method; Sodium Chloride; Therapeutic Irrigation; Tissue Plasminogen Activator; Treatment Outcome

This prospective, randomized, open, international, multicenter study of adults with complicated intra-abdominal infections (cIAI) compared the efficacy and safety of sequential intravenous (i.v.) to oral (p.o.) moxifloxacin 400 mg once daily, with that of i.v. ceftriaxone 2 g once daily, plus metronidazole 500 mg three times daily, followed by p.o. amoxicillin/clavulanate 625 mg three times daily. The primary efficacy variable was clinical cure at test of cure (TOC) (day 28-42 after study entry) in the per protocol (PP) population. Of 595 patients in the study, 511 patients were valid for PP analysis (246 moxifloxacin, 265 ceftriaxone/metronidazole). Sequential moxifloxacin was noninferior to the comparator regimen--clinical cure rates at TOC were 80.9% versus 82.3% (moxifloxacin versus ceftriaxone/metronidazole; 95% CI -8.9, 4.2%). The incidence of adverse events was comparable between the two treatment groups. Therefore, sequential moxifloxacin monotherapy is as effective and safe as combination therapy with i.v. ceftriaxone plus i.v. metronidazole followed by oral amoxicillin/clavulanate for the treatment of cIAI.

Topics: Abdominal Abscess; Administration, Oral; Adult; Aged; Amoxicillin-Potassium Clavulanate Combination; Anti-Infective Agents; Appendicitis; Aza Compounds; Bacterial Infections; Ceftriaxone; Drug Therapy, Combination; Female; Fluoroquinolones; Gastrointestinal Diseases; Humans; Infusions, Intravenous; Intestinal Perforation; Male; Metronidazole; Microbial Sensitivity Tests; Middle Aged; Moxifloxacin; Peritonitis; Prospective Studies; Quinolines

Recent studies are discordant regarding postoperative use of piperacillin/tazobactam (PT) versus ceftriaxone/metronidazole (CM) for pediatric complicated appendicitis. Some argue that the broader spectrum PT decreases intraabdominal abscess formation; however, antibiotic stewardship, and once-a-day dosing favor CM. We aim to compare outcomes of postoperative antibiotic utilization using a large administrative database.. We queried the Pediatric Health Information System for patients 2-18 years old who underwent laparoscopic appendectomy for complicated appendicitis between 2016 and 2021. Patients were grouped into PT, CM, or other using the first postoperative day antibiotics. Adverse events and antibiotic use trends were evaluated.. We included 29,015 children from 45 hospitals. CM was used in 51.9% and 31.3% received PT. Wide variation was seen among hospitals with PT use decreasing over the years. Overall rate of abscess was 9.2%. On multivariable regression, PT was associated with higher risk for abscess formation (RR 1.35, 99% CI 1.04-1.75) and readmission (RR 1.38, 99% CI 1.13-1.68) compared to the CM group. However, following adjustment for hospitals with high CM prevalence, these associations were no longer significant.. Postoperative use of PT for complicated appendicitis is associated with higher rates of readmissions and intraabdominal abscess when compared to CM. However, this effect is mitigated when adjusting for common practice patterns.. Level III.. Retrospective Comparative Study.

Topics: Abdominal Abscess; Abscess; Adolescent; Anti-Bacterial Agents; Appendectomy; Appendicitis; Ceftriaxone; Child; Child, Preschool; Humans; Metronidazole; Piperacillin, Tazobactam Drug Combination; Postoperative Complications; Retrospective Studies; Treatment Outcome

Topics: Abdominal Abscess; Adult; Anti-Bacterial Agents; Ceftriaxone; Ciprofloxacin; Humans; Male; Salmonella Infections; Splenic Diseases

Appendicitis is a common surgical emergency in pediatric patients, and broad-spectrum antibiotic therapy is warranted in their care. A simplified once-daily regimen of ceftriaxone and metronidazole (CTX plus MTZ) is cost effective in perforated patients. The goal of this evaluation is to compare a historic regimen of cefoxitin (CFX) in nonperforated cases and ertapenem (ERT) in perforated and abscessed cases with CTX plus MTZ for all cases in terms of efficacy and cost.. A retrospective review compared outcomes of nonperforated, perforated, and abscessed cases who received the historic regimen or CTX plus MTZ. Length of stay, time to afebrile, time to full feeds, postoperative abscess, and wound infection rates, inpatient readmissions, and antibiotic costs were evaluated.. There were a total of 841 cases reviewed (494 nonperforated, 247 perforated, and 100 abscessed). Overall, the CTX plus MTZ group had a shorter time to afebrile (P < .001). Treatment groups did not differ in length of stay. Postoperative abscess rates were similar between groups (4.1% vs 3.3%, not significant). Other postoperative complications were similar between groups. Total antibiotic cost savings were over $110 000 during the study period (from November 2010 to June 2013).. Both CFX and/or ERT and CTX plus MTZ result in low abscess and complication rates, suggesting both are effective strategies. Treatment with CTX plus MTZ results in a shorter time to afebrile, while also providing significant antibiotic cost savings. Ceftriaxone plus MTZ is a streamlined, cost-effective regimen in the treatment of nonperforated, perforated, and abscessed appendicitis.

Topics: Abdominal Abscess; Adolescent; Appendectomy; Appendicitis; beta-Lactams; Cefoxitin; Ceftriaxone; Child; Child, Preschool; Cost Savings; Cost-Benefit Analysis; Drug Administration Schedule; Drug Substitution; Drug Therapy, Combination; Ertapenem; Female; Humans; Infant; Laparoscopy; Male; Metronidazole; Retrospective Studies; Treatment Outcome; Young Adult

We aimed to evaluate the microbiological and immunological effects of tissue plasminogen activator (tPA) in a rat model of peritonitis.. Twenty-four male Wistar albino rats were divided equally into three groups. Peritonitis and thereafter laparotomy and partial omentectomy were performed in all rats. The control group (C) had no further treatment. The antibiotics group (A) received metronidazole and ceftriaxone. The antibiotic and tPA group (A+T) received the same antibiotics as well as tPA. For microbiological and immunological analysis, blood samples were obtained at the 24th hour, and peritoneal fluid samples were obtained at the 24th and 72nd hours. On the fifth day after surgery, all rats were sacrificed, and the macroscopic findings of the peritoneal cavity were recorded.. The mean number of intraperitoneal abscesses was significantly higher in the control group and the lowest in the two treatment group (A+T). The levels of cytokines were not significantly different between groups. Giving tPA reduced the number and sizes of the abscesses with no significant difference in inflammatory response.. In this experimental peritonitis model, it can be postulated that tPA decreased abscess formation without exaggerating the inflammatory response.

Topics: Abdominal Abscess; Animals; Anti-Bacterial Agents; Ascitic Fluid; Ceftriaxone; Cytokines; Disease Models, Animal; Male; Metronidazole; Peritonitis; Rats; Rats, Wistar; Tissue Plasminogen Activator

Topics: Abdominal Abscess; Abdominal Pain; Aged; Anti-Bacterial Agents; Ceftriaxone; Combined Modality Therapy; Drainage; Emphysema; Female; Flank Pain; Gases; Humans; Klebsiella Infections; Pyelonephritis; Radiography, Abdominal; Rupture, Spontaneous; Tomography, X-Ray Computed

Intra-abdominal abscesses are sources of recurrent or ongoing abdominal sepsis. They are an important target for prevention and treatment during or after surgical treatment of peritonitis. Experimental data suggest that fibrinolytic therapy may be effective when antibiotics are not.. Peritonitis was induced via intra-abdominal injection of a faeces and bacteria mixture in male Wistar rats. Surgical debridement was performed after 1 h. Next to untreated controls, animals were treated with antibiotics (ceftriaxone plus metronidazole), recombinant tissue plasminogen activator (rtPA) or both. Abdominal fluid samples were taken at 24, 72 and 120 h for interleukin 6, interleukin 10 and tumour necrosis factor alpha measurements and cell counts. After 5 days the abdomen was inspected for the presence of abscesses.. Antibiotics did not significantly affect abscess formation. However, giving rtPA significantly reduced the number of rats with abscesses and the abscess load per rat, both in the absence and presence of concomitant antibiotic therapy. No adverse side-effects were observed and no meaningful differences in the local inflammatory response were found.. In this rat model, rtPA consistently reduced abscess formation after surgical treatment of secondary peritonitis. It therefore represents a promising adjuvant to conventional therapy.

Topics: Abdominal Abscess; Animals; Anti-Bacterial Agents; Ceftriaxone; Debridement; Fibrinolytic Agents; Male; Metronidazole; Peritonitis; Rats; Rats, Wistar; Recombinant Proteins; Tissue Plasminogen Activator

Complicated appendicitis has significant infective postoperative morbidity. There is no universally-accepted antibiotic regime, although traditionally, triple antibiotics are recommended. Our complicated appendicitis clinical pathway recommends ceftriaxone and metronidazole. The study aimed to determine if choice of antibiotics influenced the risk of infective complications.. We reviewed all paediatric appendicectomy patients between January 1, 2005 and December 31, 2005. All patients with intraoperative diagnosis of perforated appendicitis were recruited, excluding infants, immunocompromised patients, and patients allergic to the guideline antibiotics. All operations were performed by registrar/consultant surgeons and were laparoscopic, unless technically not feasible.. There were 82 patients with perforated appendicitis. 62 patients (76 percent) followed pathway antibiotics, and 20 patients (24 percent) deviated from the pathway by receiving additional empiric gentamycin. We compared the pathway compliant and deviation groups, and found no significant differences in patient characteristics, clinical presentation, operation, length of stay and infective complications. Overall there was one wound infection and five (six percent) postoperative abscesses. Initial peritoneal cultures and subsequent drainage cultures of patients who developed abscesses were sensitive to treatment antibiotics.. In complicated appendicitis, empirical perioperative addition of gentamycin to ceftriaxone and metronidazole did not reduce the risk of developing intra-abdominal abscess, compared to changing antibiotics on clinical grounds. Patients developed postoperative abscesses despite initial peritoneal cultures growing organisms sensitive to treatment antibiotics.

Topics: Abdominal Abscess; Anti-Bacterial Agents; Appendectomy; Appendicitis; Ceftriaxone; Child; Female; Humans; Male; Metronidazole; Postoperative Complications; Postoperative Period; Surgical Wound Infection

Topics: Abdominal Abscess; Appendicitis; Cefoxitin; Ceftriaxone; Cefuroxime; Child; Community-Acquired Infections; Drug Resistance, Microbial; Enterobacteriaceae; Enterobacteriaceae Infections; Humans; Metronidazole; Pseudomonas; Pseudomonas Infections; Randomized Controlled Trials as Topic

Topics: Abdominal Abscess; Anti-Bacterial Agents; Ceftriaxone; Humans; Male; Metronidazole; Ofloxacin; Salmonella typhi; Spleen; Splenic Diseases; Typhoid Fever; Young Adult

We describe a diabetic patient who was chronically hemodialyzed due to end-stage renal disease and developed a gas-forming splenic abscess and bacteremia caused by Salmonella enterica serotype Enteritidis. Fever persisted despite urgent splenectomy and intravenous ceftriaxone and metronidazole for 14 days. He recovered completely after intravenous ciprofloxacin/metronidazole treatment for a further 14 days. The isolate was susceptible to ciprofloxacin and ceftriaxone and did not exhibit extended-spectrum beta-lactamase phenotype.

Topics: Abdominal Abscess; Anti-Bacterial Agents; Bacteremia; Ceftriaxone; Ciprofloxacin; Humans; Male; Middle Aged; Renal Dialysis; Salmonella enteritidis; Salmonella Infections; Splenectomy; Splenic Diseases

We report a case of diffuse subacute muscle infection caused by enteric bacteria, diagnosed two months after laparoscopic colectomy for a sigmoid abscess and successfully treated with antibiotics alone.

Topics: Abdominal Abscess; Aged; Anti-Bacterial Agents; Ceftriaxone; Colectomy; Colon, Sigmoid; Diverticulitis, Colonic; Drug Therapy, Combination; Enterobacteriaceae; Enterobacteriaceae Infections; Female; Humans; Laparoscopy; Metronidazole; Microbial Sensitivity Tests; Muscle, Skeletal; Postoperative Complications; Pyomyositis; Sigmoid Diseases; Treatment Outcome

Topics: Abdominal Abscess; Anti-Bacterial Agents; Antitubercular Agents; Ceftriaxone; Female; Humans; Klebsiella Infections; Klebsiella pneumoniae; Liver Abscess; Male; Middle Aged; Mycobacterium tuberculosis; Splenic Diseases; Tomography, X-Ray Computed; Tuberculosis, Hepatic; Tuberculosis, Splenic

The efficacy and the safety of sequential intravenous/oral (i.v./p.o.) ciprofloxacin (CIPX) plus i.v./p.o. metronidazole (MTR) was compared with i.v. ceftriaxone (CTRX) plus i.v./p.o. MTR in the treatment of complicated intra-abdominal infections. One hundred and forty two patients received study medications. Of these, 135 could be studied. Sixty-nine patients were randomized in the CIPX arm of the study and 66 in the CTRX arm. In the CIPX group 58 patients were switched to oral treatment and 11 patients remained in the intravenous arm. In the CTRX group 57 patients switched to oral MTR continuing i.v. CTRX and 9 patients remained in the i.v. branch. Success rates at the end of treatment in patients who switched to oral were 100% in both the CIPX group and the CTRX group. For validated patients continuing on oral, the success rates at the end of treatment were 63.6 and 33.3% in the CIPX and CTRX groups respectively. Overall success rates at the end of treatment and follow-up in all patients were 94.2% in the CIPX group and 89.4% in the CTRX group. Overall success rates at the end of treatment in patients with proven bacterial infection were 92.9% in the CIPX group and 88.3% in the CTRX group. Duration of hospitalization (days) for studied patients was 22.7+/-8.2 in the CIPX and 19.6+/-14.5 in the CTRX group. There was no statistical difference between the CIPX and CTRX groups in both the intent to treat and in the modified intent to treat populations. Conversion to oral therapy with CIPX/MTR was as effective as continued intravenous therapy with CTRX and oral MTR in those patients able to tolerate oral feeding.

Topics: Abdominal Abscess; Adult; Aged; Bacterial Infections; Ceftriaxone; Ciprofloxacin; Double-Blind Method; Drug Therapy, Combination; Female; Humans; Intestinal Perforation; Male; Metronidazole; Middle Aged; Peritonitis; Prospective Studies

Intra-abdominal abscess is seldom adequately treated by systemic antibiotics alone and often requires surgical or computed tomography-guided drainage for resolution. Abscess penetration of six currently used antibiotics was examined in a murine intra-abdominal abscess model. Ampicillin/sulbactam, cefmetazole, clindamycin, and trospectomycin penetrated intra-abdominal abscesses to a greater degree than cefoxitin and ceftriaxone. Abscess pus antibiotic levels were not significantly higher after multiple doses than after a single dose. Pus antibiotic levels below the MIC90 for Bacteroides and E. coli within intra-abdominal abscess were observed for most antibiotics with the doses used in this study. Selection of antibiotics with a greater ability to penetrate abscess may be important in optimally treating patients with abdominal infection.

Topics: Abdominal Abscess; Ampicillin; Animals; Anti-Bacterial Agents; Bacteroides fragilis; Bacteroides Infections; Cefmetazole; Cefoxitin; Ceftriaxone; Clindamycin; Drug Evaluation, Preclinical; Drug Therapy, Combination; Escherichia coli Infections; Hydrogen-Ion Concentration; Male; Mice; Microbial Sensitivity Tests; Spectinomycin; Sulbactam