ro13-9904 and Diabetes-Mellitus--Type-1

The risk of wound contamination in diabetic patients after abdominal operations is well known. Preincisional intraparietal injection of antibiotics is used for the prophylaxis of postoperative surgical infections. Whether topically injected antibiotics remain primarily in the surgical wound or are systematically absorbed is uncertain, however. The pharmacokinetics of a preincisional, intraparietal injection of 2 g ceftriaxone was studied in 50 consecutive diabetic (type I and II) patients undergoing abdominal surgery, with determination of serum, wound tissue, and wound fluid antibiotic concentrations. Preincisional intraparietal injection of ceftriaxone resulted in high antibiotic concentrations in the wound fluid. The highest plasma concentrations were achieved at 1.5 h (98.45 microg/ml, SD = 14.54). Plasma concentrations exceeded the minimal inhibitory concentrations of most aerobic gram positive and gram negative organisms with the exception of Pseudomonas aeruginosa, Acinetobacter species, and Streptococcus faecalis for 24 h (10.35 microg/ml, SD = 4.10). No long-lasting or general complications arose in any of the diabetic patients. Our results suggest that preincisional intraparietal administration of ceftriaxone for prophylaxis of wound sepsis in diabetic patients with high risk of infection is effective.

Topics: Abdomen; Adult; Aged; Anti-Bacterial Agents; Antibiotic Prophylaxis; Ceftriaxone; Diabetes Mellitus, Type 1; Diabetes Mellitus, Type 2; Humans; Middle Aged; Preoperative Care; Prospective Studies; Surgical Wound Infection

Biliary pseudolithiasis is a ceftriaxone (CTRX)-induced complication, but the risk in cases of elderly type 1 diabetes mellitus (T1DM) is unclear. Case 1: A 78-year-old woman with T1DM complicated by diabetic autonomic neuropathy was admitted with pneumonia and treated with CTRX. On day 8, biliary pseudolithiasis and cholecystitis were observed. Case 2: an 80-year-old woman with T1DM was suspected of having a urinary tract infection and treated with CTRX. After a week, she developed asymptomatic biliary pseudolithiasis with gastroparesis. CTRX-associated biliary pseudolithiasis was thus noted in these cases of elderly T1DM. CTRX should be cautiously administered, especially in elderly T1DM patients with diabetic autonomic neuropathy.

Topics: Aged; Aged, 80 and over; Anti-Bacterial Agents; Ceftriaxone; Cholecystitis; Diabetes Mellitus, Type 1; Diabetic Neuropathies; Female; Humans

This is a case of hyperglycaemic hyperosmolar state (HHS) as first presentation of type 1 diabetes mellitus in a 14-year-old girl with background complex medical needs. She presented with marked hyperglycaemia (56 mmol/L) without significant ketonaemia (2.6 mmol/L) and serum hyperosmolality (426 mOsm/kg). Managing her profound hypernatraemic (>180 mmol/L) dehydration was challenging but resulted in good outcome. Paediatric patients with HHS will likely be treated with the diabetes ketoacidosis (DKA) protocol because of perceived rarity of HHS leading to inadequate rehydration and risk of vascular collapse. Hence, emphasis on the differences in the management protocols of DKA and HHS is paramount. Prompt recognition and adequate management are crucial to avert complications. The undesirable rate of decline of hypernatraemia due to the use of hypotonic fluid was captured in this case. We describe the pivotal role of liberal fluid therapy with non-hypotonic fluids.

Topics: Adolescent; Anti-Bacterial Agents; Ceftriaxone; Cerebral Palsy; Dehydration; Diabetes Mellitus, Type 1; Female; Fluid Therapy; Humans; Hyperglycemic Hyperosmolar Nonketotic Coma; Insulin; Polyuria

Topics: Adenocarcinoma; Amikacin; Anti-Bacterial Agents; Antineoplastic Combined Chemotherapy Protocols; Bacteremia; Ceftriaxone; Chemotherapy, Adjuvant; Colostomy; Diabetes Mellitus, Type 1; Disease Susceptibility; Drug Therapy, Combination; Gardnerella vaginalis; Gram-Positive Bacterial Infections; Humans; Male; Metronidazole; Middle Aged; Peritoneal Neoplasms; Sigmoid Neoplasms

This lesson describes an unusual case of a man who was recently diagnosed with type 1 diabetes and who presented with severe orthostatic hypotension. As his diabetes was recent in onset, well controlled, and he had no other signs of microvascular disease, other causes of orthostatic hypotension were sought. His serum and cerebrospinal fluid were strongly positive for Borrelia burgdorferi IgG, suggesting a diagnosis of Lyme neuroborreliosis. Autonomic instability in Lyme, while rare, has been previously reported.

Topics: Adult; Animals; Anti-Bacterial Agents; Borrelia burgdorferi; Ceftriaxone; Diabetes Mellitus, Type 1; Diabetic Neuropathies; Humans; Hypotension, Orthostatic; Lyme Neuroborreliosis; Male; Severity of Illness Index; Ticks; Treatment Outcome

Corynebacterium pseudodiphteriticum has been considered a very infrequent respiratory pathogen. We report three cases of pneumonia due to C. pseudodiphteriticum, describing their clinical and microbiological features. There were two patients with pre-existing chronic respiratory disease, one of their with steroidal therapy, and other associated with endotracheal intubation. The diagnostic was made by Gram stain and quantitative cultures from respiratory tract specimens. All patients were cured after treatment with amoxicillin-clavulanate, ceftriaxone and vancomycin respectively. C. pseudodiphteriticum must be consider as a possible causal agent of pneumonia in patients with underlying respiratory disease or endotracheal intubation. Antimicrobial susceptibility testing of C. pseudodiphteriticum may be useful for correct treatment of infected patients, but beta-lactam antibiotics are an appropriate therapeutic option against this bacteria.

Topics: Aged; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Ceftriaxone; Corynebacterium; Corynebacterium Infections; Diabetes Mellitus, Type 1; Drug Resistance, Multiple, Bacterial; Drug Therapy, Combination; Female; Humans; Immunosuppressive Agents; Intubation, Intratracheal; Male; Multiple Trauma; Ofloxacin; Pneumonia, Bacterial; Prednisone; Pulmonary Disease, Chronic Obstructive; Sjogren's Syndrome; Smoking; Vancomycin

Chryseobacterium indologenes is a non-fermentative Gram-negative bacillus that is a rare pathogen in humans. Its occurrence in diabetic children has not been previously reported. In this report, a case is described of C. indologenes bacteraemia possibly associated with the use of a peripheral venous catheter. A 2-year-old boy with type I diabetes mellitus was admitted due to a coma caused by cerebral oedema and was successfully treated for his neurological condition but presented on the tenth day after admission with fever of 40 degrees C, agitation, restlessness, lack of appetite, somnolence and fatigue. His pulse rate was 90 min(-1) and his respiratory rate was 20 min(-1). Laboratory studies revealed a white blood cell count of 4900 mm(-3) with 67% neutrophils and 27% lymphocytes. Two separate blood cultures yielded C. indologenes. Treatment with ceftriaxone was started before the culture results were obtained, and was continued after susceptibility test results were obtained. The patient became afebrile after 48 h, and his general condition improved within 36 h. The infection did not recur. This is believed to be the third case of bacteraemia outside of Asia due to C. indologenes and the first in a diabetic child not otherwise immunocompromised. This case indicates that C. indologenes infection can occur in diabetic children without ventilator or central venous catheter and might be treated with a single agent after in vitro susceptibility tests have been performed.

Topics: Anti-Bacterial Agents; Bacteremia; Catheterization, Peripheral; Ceftriaxone; Child, Preschool; Chryseobacterium; Diabetes Mellitus, Type 1; Flavobacteriaceae Infections; Humans; Male

Human infections due to Yersinia enterocolitica have been reported worldwide, predominantly in Europe. However, there have been few reports of Yersinia enterocolitica infection in Taiwan. We report a case of Y. enterocolitica sepsis in a 15-year-old Taiwanese girl with Cooley's anemia and insulin-dependent diabetes mellitus. She presented at admission with fever, shock and consciousness disturbance. She had symptoms of abdominal pain, vomiting and diarrhea for three days before admission. Blood pressure stabilized after intravenous normal saline rescue. Blood culture yielded Y. enterocolitica 2 days later and ceftriaxone was administered according to the results of sensitivity tests. She recovered well after a course of antibiotic treatment. Though Y. enterocolitica sepsis is rare in Taiwan, clinicians should be aware of its tendency to develop in patients with Cooley's anemia, fever and enterocolitis and that its clinical course may include sepsis leading to shock.

Topics: Adolescent; Anti-Bacterial Agents; beta-Thalassemia; Ceftriaxone; Diabetes Mellitus, Type 1; Female; Humans; Shock, Septic; Yersinia enterocolitica; Yersinia Infections

The case of a 72-year-old woman suffering from chronic otitis media is presented. This insulin dependent diabetic patient was under steroid therapy for collagenosis and suffered from chronic polysinusitis. After two preceding drainages of the mastoid (antrotomy and mastoidectomy), the patient developed putrid mastoiditis followed by Bezold's abscess, an epidural abscess and thrombosis of the sigmoid sinus. Lateral petrosectomy and drainage of the neck were performed, but the patient again developed an abscess with extension to the lateral skull base, the foramen magnum and the upper cervical spine. After a further operation with extensive drainage and a three-month course of antibiotic treatment with ceftriaxon, the infection finally healed. A germ of the Streptococcus milleri group was identified.

Topics: Aged; Ceftriaxone; Cephalosporins; Chronic Disease; Diabetes Mellitus, Type 1; Epidural Abscess; Female; Humans; Mastoiditis; Neck; Otitis Media; Sinusitis; Skull Base; Streptococcal Infections

The objectives of this pilot study were to identify the bacterial flora of neurotrophic ulcers, and to determine whether treatment with ceftriaxone improves the clinical picture. Twenty-five patients (15 male, 10 female, mean age 70 +/- 11 years) with mal perforant were treated with 2 g ceftriaxone once daily until the ulcer was healed, or for a period of 6 weeks. Biopsies were taken from the ulcer floor before and after therapy. Initially, the following bacteria were found, in order of frequency: Staphylococcus aureus, enterobacteria, coagulase-negative staphylococci, enterococci and streptococci as well as Pseudomonas aeruginosa. Under therapy with ceftriaxone, the lesions of 11 patients were healed; in 5 patients improvement > 50% was observed and in 4 patients improvement was < 50%. In 3 patients there was no change in the condition. Two patients had to stop treatment due to diarrhea. Asepsis was achieved in 5 patients despite persistence of the ulcer. The control group (25 patients without antibiotic therapy) showed the following results: healing in 6, improvement > 50% in 5, improvement < 50% in 10, and no change in 4. The results for the treatment group have to be compared with a historical control group since, for ethical reasons, the implementation of a double-blind study would not be feasible.

Topics: Aged; Aged, 80 and over; Bacteria; Ceftriaxone; Diabetes Mellitus, Type 1; Diabetes Mellitus, Type 2; Female; Foot Ulcer; Humans; Male; Pilot Projects