ro13-9904 and Endocarditis--Bacterial

Trueperella pyogenes (T. pyogenes) is a bacterium that colonizes the skin and mucosal surfaces of various domestic and wild animals. It rarely leads to infections in humans, with only a few descriptions available in the literature.. A 71-year-old Swiss farmer with a history of recurring basal cell carcinoma and metastasized pancreatic neuroendocrine tumor presented with signs of sepsis after a three-day history of general weakness, malaise and fever. Clinical and echocardiographic findings, as well as persistent bacteremia were consistent with mitral valve endocarditis caused by T. pyogenes. The patient's condition gradually improved under antibiotic treatment with piperacillin/tazobactam (empiric therapy of sepsis), and later penicillin G based on resistance testing. He was discharged after 13 days and continued outpatient antibiotic therapy with ceftriaxone, resulting in a total antibiotic treatment duration of six weeks. This is the first literature review of T. pyogenes endocarditis in humans. Among nine cases of T. pyogenes endocarditis, three patients had documented contact with farm animals and five had an underlying condition that compromised the immune system. While antibiotic resistance of T. pyogenes is an emerging concern, susceptibility to beta-lactam antibiotics seems to persist. The mortality of T. pyogenes endocarditis described in the literature was high, with 66% of patients not surviving the disease.. T. pyogenes is a rare causative organism of infectious endocarditis in humans and descriptions are mainly restricted to case reports. In our review of the literature, we found that both an impaired immune system and contact with farm animals might be risk factors. Growth of T. pyogenes in blood cultures is unlikely to be missed during routine analysis, as it shows marked beta-hemolysis on blood agar culture plates, which generally leads to further characterization of the bacteria. Susceptibility to penicillin, ceftriaxone, and macrolides seems to be retained and the reported mortality in the few patients with T. pyogenes endocarditis is high.

Topics: Aged; Animals; Animals, Domestic; Anti-Bacterial Agents; Ceftriaxone; Endocarditis; Endocarditis, Bacterial; Farmers; Humans; Sepsis; Switzerland

Current guidelines recommend either ampicillin plus ceftriaxone (AC) or amoxicillin/ampicillin plus gentamicin (AG) with an equivalent class IB recommendation in Enterococcus faecalis endocarditis. However, previous observational studies suggest that AC might be favourable in terms of adverse events.. To investigate whether AC is non-inferior to AG, and if it is associated with less adverse events.. In June 2021, a systematic literature search using the databases PubMed/MEDLINE, CDSR, CENTRAL, CCAs, EBM Reviews, Web of Science and LILACS was conducted by two independent reviewers. Studies were considered eligible if (P) patients included were ≥ 18 years of age and had IE with E. faecalis, (I) treatment with AC was compared to (C) treatment with AG and (O) outcomes on in-hospital mortality, nephrotoxicity and adverse events requiring drug withdrawal were reported. Odds ratios and 95% confidence intervals were calculated using random-effects models with the Mantel-Haenszel method, the Sidik-Jonkman estimator for τ. Treatment with AC was non-inferior to AG, as depicted by no significant differences in-hospital mortality, 3-month mortality, relapses or treatment failure. Furthermore, AC was associated with a lower prevalence of nephrotoxicity (OR 0.45 [0.26-0.77], p = 0.0182) and drug withdrawal due to adverse events (OR 0.11 [0.03-0.46], p = 0.0160) than AG.. Treatment with AC was non-inferior to treatment with AG, and it was associated with a reduced prevalence of nephrotoxicity and drug withdrawal due to adverse events. Thus, combination therapy with AC appears favourable over AG in patients with E. faecalis IE.

Topics: Amoxicillin; Ampicillin; Anti-Bacterial Agents; Ceftriaxone; Drug Therapy, Combination; Endocarditis; Endocarditis, Bacterial; Enterococcus faecalis; Gentamicins; Gram-Positive Bacterial Infections; Heart Diseases; Humans; Renal Insufficiency

Enterococcus hirae is rarely identified in humans and may be a commensal pathogen in psittacine birds. We present the fifth known case of E. hirae endocarditis.. A 64-year-old Caucasian female presented with fever, hypotension, atrial fibrillation with rapid ventricular response, and a two-week history of lightheadedness. Her previous medical history included COPD, recurrent DVT, atrial fibrillation (on warfarin), hypertension, hypothyroidism, and Hodgkin's lymphoma. Physical exam was notable for expiratory wheezes and a 2/6 systolic ejection murmur at the right sternal border. 2D echocardiogram revealed severe aortic stenosis. The patient underwent right and left heart catheterization, where she was found to have severe aortic stenosis and mild pulmonary hypertension. She subsequently underwent minimally invasive aortic valve replacement with a bovine pericardial valve, bilateral atrial cryoablation, and clipping of the left atrial appendage. Her aortic valve was found to have a bicuspid, thickened appearance with calcifications, multiple small vegetations, and a root abscess beneath the right coronary cusp. With a new suspicion of infective endocarditis, the patient was placed on broad-spectrum IV antibiotics. Intra-operative blood cultures were negative. A tissue culture from the aortic valve vegetations identified Enterococcus hirae susceptible to ampicillin through MALDI-TOF. Antibiotic treatment was then switched to IV ampicillin and ceftriaxone; she declined aminoglycoside treatment due to toxicity concerns. The patient had an uncomplicated postoperative course and was discharged with 6 weeks of antibiotics. To date, she continues to be followed with no signs of relapsing disease.. To our knowledge, this case constitutes the fifth known case of E. hirae endocarditis, and the second case to have been identified with MALDI-TOF and treated with ampicillin and ceftriaxone. This case reinforces the efficacy of ampicillin and ceftriaxone for the treatment of E. hirae endocarditis.

Topics: Aminoglycosides; Ampicillin; Animals; Anti-Bacterial Agents; Cattle; Ceftriaxone; Endocarditis, Bacterial; Enterococcus hirae; Female; Gram-Positive Bacterial Infections; Heart Valve Diseases; Heart Valve Prosthesis; Humans; Middle Aged; Transcatheter Aortic Valve Replacement

A 68-year-old Japanese man was admitted to our hospital with right eye pain, a sudden worsening of his eyesight, and a fever. He was diagnosed with endogenous bacterial endophthalmitis due to infectious endocarditis (IE) of Group B Streptococcus (GBS) on the day of admission. He recovered systemically, but his right eye became phthisical only with the administration of antibiotics. We conducted a review of the reported cases of IE caused by GBS complicated with endogenous bacterial endophthalmitis. IE should be considered when an undetermined etiology of endogenous endophthalmitis is encountered. The prompt diagnosis and treatment of IE will improve patients' outcomes.

Topics: Aged; Anti-Bacterial Agents; Ceftriaxone; Early Diagnosis; Endocarditis, Bacterial; Endophthalmitis; Eye Infections, Bacterial; Humans; Male; Streptococcal Infections; Streptococcus agalactiae; Treatment Outcome; Vancomycin

Endocarditis is a rare but serious manifestation of Listeria monocytogenes (LM). However, the optimal treatment strategy for LM endocarditis has yet to be established. Current antibiotic strategies for listeriosis include penicillin G or ampicillin (AMP) monotherapy, or AMP + gentamicin combination therapy which is often favored for endocarditis. The primary objective of our investigation was to assess the utility of AMP + ceftriaxone (CRO) and AMP + daptomycin (DAP) against LM, modeling less nephrotoxic antibiotic combinations traditionally used to manage resistant enterococcal endocarditis. Here we report a case of LM endocarditis, review the world literature, and evaluate alternative treatment strategies for listeriosis utilizing in vitro and ex vivo studies. The combination of AMP + CRO and AMP + DAP were each noted to have synergistic activity against a LM endocarditis isolate. Additionally, co-incubation of the isolate with sub-lethal concentrations of antibiotics (AMP, CRO, DAP, AMP + CRO or AMP + DAP) sensitized the bacterium to whole blood killing while pretreatment with CRO and DAP (at 1/4 MIC) sensitized the bacterium to neutrophil killing. However, these effects did not reflect potentiation of antibiotic activity to human cathelicidin peptide LL-37, which is abundant in neutrophils and highly active against LM. Interestingly, AMP pretreatment of the LM endocarditis isolate resulted in increased DAP binding to the bacterium when assessed by fluorescence microscopy. These in vitro and ex vivo studies suggest further investigation of combination therapy using AMP + CRO or AMP + DAP as an alternative treatment for LM infection is warranted.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Ampicillin; Anti-Bacterial Agents; Ceftriaxone; Child; Child, Preschool; Daptomycin; Drug Synergism; Drug Therapy, Combination; Endocarditis, Bacterial; Female; Humans; Listeria monocytogenes; Listeriosis; Male; Microbial Sensitivity Tests; Middle Aged; Young Adult

Enterococci, one of the most common causes of hospital-associated infections, are responsible for substantial morbidity and mortality. Enterococcus faecalis, the more common and virulent species, causes serious high-inoculum infections, namely infective endocarditis, that are associated with cardiac surgery and mortality rates that remained unchanged for the last 30 years. The best cures for these infections are observed with combination antibiotic therapy; however, optimal treatment has not been fully elucidated. It is the purpose of this review to highlight treatment options and their limitations, and provide direction for future investigative efforts to aid in the treatment of these severe infections. While ampicillin plus ceftriaxone has emerged as a preferred treatment option, mortality rates continue to be high, and from a safety standpoint, ceftriaxone, unlike other cephalosporins, promotes colonization with vancomycin resistant-enterococci due to high biliary concentrations. More research is needed to improve patient outcomes from this high-mortality disease.

Topics: Ampicillin; Anti-Bacterial Agents; Bacteremia; Ceftriaxone; Cephalosporins; Clinical Trials as Topic; Drug Synergism; Drug Therapy, Combination; Endocarditis, Bacterial; Enterococcus faecalis; Gram-Positive Bacterial Infections; Humans; Microbial Sensitivity Tests; Vancomycin-Resistant Enterococci

Topics: Actinomycetales Infections; Anti-Bacterial Agents; Aortic Valve Stenosis; Bacteremia; Brevibacterium; Ceftriaxone; Disease Susceptibility; Drug Therapy, Combination; Emergencies; Endocarditis, Bacterial; Facial Dermatoses; Gentamicins; Humans; Levofloxacin; Liver Cirrhosis, Alcoholic; Male; Middle Aged; Recurrence; Tetracycline; Vancomycin; Wound Infection

The aim of this systematic review is to review all human trials assessing the efficacy and safety of ampicillin and ceftriaxone for enterococcal endocarditis and to discuss the clinical implications of the findings.. MEDLINE (1946-), EMBASE (1974-), CENTRAL, Google Scholar, and the World Health Organization Clinical Trials Registry Platform were searched through January 2017 using the search terms ampicillin, penicillin, ceftriaxone, cephalosporin, enterococ*, and endocarditis. Unpublished studies were eligible for inclusion. Additional references were identified from literature citations.. Clinical trials in humans that reported on clinical efficacy or adverse outcomes with ceftriaxone and ampicillin therapy in patients with enterococcal endocarditis were included. Case reports, nonhuman, and non-English studies were excluded.. Four observational clinical studies were identified. One examined the effects of ceftriaxone and ampicillin alone, and 3 compared the therapy to the current standard of care, ampicillin and gentamicin. The studies had small sample sizes and were not adequately designed or powered to establish noninferiority or equivalence to the current standard of care. Rates of clinical cure with ampicillin 2 g every 4 hours and ceftriaxone 2 g every 12 hours were similar to those of ampicillin and gentamicin. Ampicillin and ceftriaxone therapy was well tolerated with low rates of renal failure (0%-33%).. The evidence to support the use of ampicillin and ceftriaxone for enterococcal endocarditis is not definitive. In the absence of compelling evidence, clinicians may consider ampicillin and ceftriaxone in patients with Enterococcus faecalis infection at high risk for nephrotoxicity or those with aminoglycoside-resistant pathogens.

Topics: Ampicillin; Anti-Bacterial Agents; Ceftriaxone; Drug Therapy, Combination; Endocarditis, Bacterial; Enterococcus faecalis; Gentamicins; Humans; Renal Insufficiency

Topics: Anti-Bacterial Agents; Arthritis, Infectious; Ceftriaxone; Central Nervous System Infections; Doxycycline; Endocarditis, Bacterial; Enteritis; Gentamicins; Humans; Microscopy, Electron, Transmission; Penicillins; Periodic Acid-Schiff Reaction; Polymerase Chain Reaction; Streptomycin; Trimethoprim, Sulfamethoxazole Drug Combination; Tropheryma; Vancomycin; Whipple Disease

The Enterococcus species is the third main cause of infective endocarditis (IE) worldwide, and it is gaining relevance, especially among healthcare-associated cases. Patients with enterococcal IE are older and have more comorbidities than other types of IE. Classical treatment options are limited due to the emergence of high-level aminoglycosides resistance (HLAR), vancomycin resistance and multidrug resistance in some cases. Besides, few new antimicrobial alternatives have shown real efficacy, despite some of them being recommended by major guidelines (including linezolid and daptomycin). Ampicillin plus ceftriaxone 2 g iv./12 h is a good option for Enterococcus faecalis IE caused by HLAR strains, but randomized clinical trials are essential to demonstrate its efficacy for non-HLAR EFIE and to compare it with ampicillin plus short-course gentamicin. The main mechanisms of resistance and treatment options are also reviewed for other enterococcal species.

Topics: Adult; Ampicillin; Anti-Bacterial Agents; Ceftriaxone; Clinical Trials as Topic; Drug Therapy, Combination; Endocarditis, Bacterial; Enterococcus; Enterococcus faecalis; Gram-Positive Bacterial Infections; Humans; Linezolid

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Ceftriaxone; Echocardiography; Endocarditis, Bacterial; Female; Humans; Immunosuppressive Agents; Infant, Newborn; Male; Microbial Sensitivity Tests; Micrococcaceae; Middle Aged; Republic of Korea; RNA, Ribosomal, 16S

Topics: Adult; Anti-Bacterial Agents; Ceftriaxone; Endocarditis, Bacterial; Gram-Negative Bacterial Infections; Heart Valve Diseases; Humans; Male; Metronidazole; Risk Factors; Substance Abuse, Intravenous; Veillonella

Enterococcus faecalis infective endocarditis (IE) is a disease of increasing importance, with more patients infected, increasing frequency of health-care associated infections and increasing incidence of antimicrobial resistances. The typical clinical presentation is a subacute course with fever, malaise and generalized aches, difficult to distinguish from other more common diseases. Of paramount importance is transthoracic- and transesophageal-echocardiography to establish the diagnosis. At the moment, the predominant strategies recommend ampicillin in combination with either gentamicin or ceftriaxone. E. faecalis infective endocarditis continues to be a very serious disease with considerable percentages of high-level gentamicin resistant strains and in-hospital mortality around 20%. Strategies to prevent E. faecalis IE, improve diagnostics, optimize treatment and reduce morbidity will be necessary to improve the overall prognosis.

Topics: Ampicillin; Anti-Bacterial Agents; Ceftriaxone; Drug Therapy, Combination; Endocarditis, Bacterial; Enterococcus faecalis; Humans

Whipple's disease is a multisystemic infection caused by the ubiquitous bacterium Tropheryma whipplei. Immunological host factors enable classical Whipple's disease; however, T. whipplei can be found in three other clinical conditions: healthy colonization, self-limiting infections, and isolated endocarditis. The genetic predisposition of the host rather than the genotype of the bacterium influences the infection. Modern diagnostic methods elucidate the many facets of Whipple's disease. In particular, isolated T. whipplei-induced infective endocarditis can only be diagnosed after valve resection. The sole treatment of Whipple's disease evaluated prospectively comprises intravenous induction therapy with ceftriaxone or meropenem, followed by continuation therapy with oral TMP-SMX. In the case of Immune reconstitution inflammatory syndrome (IRIS) or inflammatory lesions of the CNS in the setting of Whipple's disease, additional treatment with corticosteroids should be considered to avoid severe tissue damage.

Topics: Adrenal Cortex Hormones; Adult; Algorithms; Anti-Bacterial Agents; Biopsy; Carrier State; Ceftriaxone; Central Nervous System Diseases; Child; Diagnosis, Differential; Drug Therapy, Combination; Duodenum; Endocarditis, Bacterial; Gastroscopy; Genetic Predisposition to Disease; Heart Valves; Humans; Immune Reconstitution Inflammatory Syndrome; Meropenem; Thienamycins; Trimethoprim, Sulfamethoxazole Drug Combination; Tropheryma; Whipple Disease

Infective endocarditis is significantly more common in haemodialysis patients as compared with the general population, the causative pathogen is generally Staphylococcus aureus; there have been no previously reported cases of infective endocarditis caused by a Salmonella species in haemodialysis patients.. We report the case of a 68 year-old woman on haemodialysis who developed infective endocarditis as a result of Salmonella enteritidis. Although we treated the patient with ceftriaxone combined with ciprofloxacin, infective endocarditis was not detected early enough and unfortunately developed into cerebral septic emboli, which ultimately resulted in death.. Although there are several reports that Salmonella endocarditis without cardiac failure can be successfully treated with antibiotics alone, early surgical intervention is essential for some cases to prevent life-threatening complications. Transesophageal echocardiography should be performed in any patient with high clinical suspicion of infective endocarditis. To the best of our knowledge, this is the first case-report of Salmonella endocarditis in a haemodialysis patient.

Topics: Aged; Anti-Bacterial Agents; Ceftriaxone; Ciprofloxacin; Endocarditis, Bacterial; Female; Humans; Renal Dialysis; Salmonella enteritidis; Salmonella Infections

Streptococcus pneumoniae endocarditis is most commonly associated with pneumonia. It is relatively uncommon disease but its severity makes it clinically relevant. We present a case and review of sinusitis complicated by both pneumococcal endocarditis and cavernous sinus thrombosis. Both endocarditis and dural sinus thrombosis are known complications of facial infections. To our knowledge, this is the first reported case of both S. pneumoniae endocarditis and dural sinus thrombosis complicating sinusitis. A case report and review of the literature is presented.

Topics: Adult; Cavernous Sinus Thrombosis; Ceftriaxone; Endocarditis, Bacterial; Humans; Male; Pneumococcal Infections; Sinusitis

Infections by Bartonella spp. include a wide spectrum of emerging and re-emerging infectious diseases, such as culture-negative endocarditis.. Description of 3 cases of endocarditis due to Bartonella spp. and review of those previously reported in Spain.. Including these 3 new cases of endocarditis due to Bartonella spp., a total of 6 cases have been reported in Spain. The median age of the patients was 51.6 years and 83.3% were men. There was history of contact with cats in 66.7%, and 50% were alcoholic. Only one patient had prior valvular disease. There were no clinical manifestations typical to any of the Bartonella species. The aortic valve was the one most commonly affected. In all cases, B. henselae was the agent implicated. The diagnosis was made by serology in 5 cases (83.3%). The outcome was favorable in all patients, although 4 of them (66.7%) required valve replacement.. Endocarditis due to Bartonella spp. is present in Spain and is likely to be underestimated. We should suspect this pathogen in patients with negative blood cultures and a history of chronic alcoholism, homeless patients, and those who have had contact with cats or who have been bitten by fleas or lice, as well as patients with endocarditis and positive serology against Chlamydia spp.

Topics: Actinobacillus Infections; Adult; Aged; Aggregatibacter actinomycetemcomitans; Alcoholism; Animals; Anti-Bacterial Agents; Antibodies, Bacterial; Aortic Valve; Bartonella henselae; Bartonella Infections; Blood; Cardiomyopathy, Hypertrophic; Cat-Scratch Disease; Cats; Ceftriaxone; Chlamydia; Ciprofloxacin; Combined Modality Therapy; Disease Susceptibility; Doxycycline; Endocarditis, Bacterial; Endocarditis, Subacute Bacterial; False Negative Reactions; Female; Gentamicins; Heart Valve Prosthesis Implantation; Humans; Male; Middle Aged; Spain; Vancomycin

We report 2 cases of Haemophilus parainfluenzae endocarditis and review 34 cases of HACEK endocarditis from the literature. HACEK organisms are the most common cause of Gram-negative endocarditis in children. They have a propensity to form friable vegetations (especially H. parainfluenzae) that break off and cause symptomatic emboli. HACEK endocarditis (from a review of the 36 published cases) may involve previously normal hearts (33%), may be complicated by embolization (31%) and may require vegetectomy or other surgery (31%). Mortality with HACEK endocarditis was 14%. HACEK organisms may be resistant to penicillins but are susceptible to third generation cephalosporins.

Topics: Ceftriaxone; Child; Endocarditis, Bacterial; Female; Follow-Up Studies; Haemophilus; Haemophilus Infections; Humans; Infant; Risk Assessment; Severity of Illness Index; Survival Rate; Treatment Outcome

Salmonella are a rare cause of infective endocarditis. This report describes a case where Salmonella typhi was isolated from the blood and urine of a patient with echocardiographically documented aortic valve disease and endocarditis. The patient was treated with two weeks of ceftriaxone (3 g/day) and amikacin (15 mg/kg/day), followed by a further two weeks of ceftriaxone (3 g/day) alone. He made a complete recovery.

Topics: Adult; Amikacin; Aortic Valve; Ceftriaxone; Drug Therapy, Combination; Echocardiography; Endocarditis, Bacterial; Heart Valve Diseases; Humans; Male; Salmonella typhi; Typhoid Fever

Infective endocarditis has a high morbidity and lethality. Therefore antibiotic treatment has to be intravenous to achieve high blood levels and has to last several weeks without an interruption of treatment at the weekends.. It is therefore crucial to select the patient group that is suited for an outpatient, antibiotic therapy very carefully. In general only hemodynamically stable patients without complications in whom the responsible organism has been identified should be considered.. From a pharmacological point of view intravenous or intramuscular application for the complete duration of therapy is obligatory. Endocarditis caused by penicillin-susceptible streptococci, the biggest group of organisms responsible for endocarditis, can be treated with Ceftriaxon once daily for 4 weeks. For other organisms there are at present no data available which support the feasibility of an outpatient therapy. In particular antibiotic therapy with a complex regimen for those organisms is not practicable for outpatient usage. Possibly, in the near future computer controlled pumps might overcome this disadvantage.. Every outpatient therapy should be initiated under inpatient conditions and only after an initial response to the antibiotic therapy continued in an outpatient setting. Today reliable outpatient therapy and follow-up 7 days a week under the given outpatient infrastructure is problematic and remains an exception. However, considering cost-effectiveness outpatient as compared to inpatient antibiotic therapy could be an interesting economically advantageous alternative.

Topics: Adult; Anti-Bacterial Agents; Ceftriaxone; Cephalosporins; Echocardiography; Endocarditis, Bacterial; Follow-Up Studies; Humans; Injections, Intramuscular; Injections, Intravenous; Outpatients; Patient Compliance; Patient Selection; Streptococcal Infections; Time Factors

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

The major cost in the treatment of infective endocarditis (IE) is the length of hospitalization required for the administration of intravenous antibiotics. This can be reduced by substituting shorter regimens and by the introduction of outpatient parenteral antibiotic therapy (OPAT). Careful selection of patients is vital for the success of OPAT in IE. The patients should be hemodynamically stable and without clinical complications. The delivery of OPAT for IE followed a clinical and home-based program involving an endocarditis team whose members included an infectious diseases physician, a microbiologist, a cardiologist and a nurse trained in intravenous techniques. Among the antimicrobial agents used in OPAT of IE, single-agent ceftriaxone for four weeks followed by a short course of amoxicillin or ceftriaxone in combination with an aminoglycoside for two weeks (short course) are effective modes of treatment for streptococcal endocarditis, the most common cause of IE. This treatment is also effective for carefully selected patients with other types of endocarditis, such as those due to the HACEK group (Haemophilus aphrophilus/paraphrophilis, Actinobacillus actinomycetem comitans, Caradiobacterium hominis, Eikenella corrodens and Kingella kingae). Staphylococcus aureus, enterococci and late prosthetic valve endocarditis associated with a streptococcus may also be treated on an outpatient basis after stabilization (approximately 2 weeks). As a result of their need for prolonged treatment periods, these patients are also very good candidates for OPAT. In conclusion, new regimens utilizing ceftriaxone once daily and short-term therapy on a clinical or home basis offer the potential benefits of cheaper safer and more convenient treatment for patients with IE.

Topics: Ambulatory Care Facilities; Ceftriaxone; Endocarditis, Bacterial; Humans

Endocarditis is a rare manifestation of Yersinia enterocolitica infection. The case of a 45-year-old man who presented with high fever and in whom prosthetic valve Yersinia enterocolitica endocarditis was diagnosed is described. The patient was successfully treated with ceftriaxone plus tobramycin, as proved by negative cultures of the prosthesis removed at the end of therapy. Including the patient reported, only 12 cases of Yersinia enterocolitica endocarditis have been published to date, two of which describe prosthetic cardiac valve endocarditis. The clinical characteristics do not distinguish septicemia from involvement limited to the cardiac valves. Diagnosis, however, has been improved by progress in echocardiography. Prognosis is grave but can be ameliorated if appropriate antimicrobial agents are administered, i.e. the combination of a third-generation cephalosporin plus an aminoglycoside. Fluroquinolones may also constitute an attractive therapeutic alternative.

Topics: Ceftriaxone; Drug Therapy, Combination; Endocarditis, Bacterial; Gentamicins; Heart Valve Prosthesis; Humans; Male; Middle Aged; Mitral Valve; Prosthesis-Related Infections; Yersinia enterocolitica; Yersinia Infections

There are a total of 8000 cases of infective endocarditis yearly in the United States. Central nervous system metastatic infections are not uncommon in infective endocarditis. Because ceftriaxone is highly bound to serum proteins, there is concern that the drug is highly bound to serum proteins, there is concern that the drug might not penetrate well in the core of an infected vegetation. To date, there are two published studies on the treatment of nonenterococcal streptococcal endocarditis by ceftriaxone in humans. Ceftriaxone appears to be an attractive alternative antibiotic therapy to conventional regimens in the treatment of streptococcal endocarditis.

Topics: Ambulatory Care; Aneurysm, Infected; Animals; Ceftriaxone; Costs and Cost Analysis; Drug Therapy, Combination; Echocardiography; Embolism; Endocarditis, Bacterial; Heart Failure; Humans; Staphylococcal Infections; Streptococcal Infections

Neisseria sicca, a commensal organism of the oropharynx, has rarely been implicated as a pathogen responsible for causing bacterial endocarditis. A pregnant woman developed N sicca endocarditis at 32 weeks' gestation. Although there was an initial delay in diagnosis and therapy, the maternal and fetal outcomes were excellent.

Topics: Adult; Ceftriaxone; Endocarditis, Bacterial; Female; Humans; Microbial Sensitivity Tests; Neisseria; Neisseriaceae Infections; Pregnancy; Pregnancy Complications, Infectious

Several recent small studies have suggested a causal link between Lyme disease and dilated cardiomyopathy (DCM) by demonstrating the presence of the Borrelia burgdorferi (Bb) genome in the myocardium of patients with recent-onset DCM. The aim of this study was to further investigate the effect of targeted antibiotic treatment of Bb-related recent-onset DCM in a larger cohort of patients.. We performed endomyocardial biopsy (EMB) in 110 individuals (53 ± 11 years, 34 women) with recent-onset unexplained DCM, and detected the Bb genome in 22 (20 %) subjects. Bb-positive patients were subsequently treated with intravenous ceftriaxone for 21 days in addition to conventional heart failure medication.. At the 1-year follow-up, a significant improvement in left ventricular (LV) ejection fraction (26 ± 6  vs. 44 ± 12 %; p < 0.01) and a decrease in LV end-diastolic (69 ± 7 vs. 63 ± 11 mm; p < 0.01) and end-systolic (61 ± 9 vs. 52 ± 4 mm; p < 0.01) diameters were documented. Moreover, a significant improvement in heart failure symptoms (NYHA class 3.4 ± 0.6 vs. 1.5 ± 0.7; p < 0.01) was also observed.. Targeted antibiotic treatment of Bb-related recent-onset DCM in addition to conventional heart failure therapy is associated with favorable cardiac remodeling and improvement of heart failure symptoms.

Topics: Anti-Bacterial Agents; Borrelia burgdorferi; Cardiomyopathy, Dilated; Cardiotonic Agents; Ceftriaxone; Drug Therapy, Combination; Endocarditis, Bacterial; Female; Humans; Injections, Intravenous; Lyme Disease; Male; Middle Aged; Treatment Outcome

High-level aminoglycoside resistance (HLAR) that precludes bactericidal synergism with penicillins or glycopeptides and nephrotoxicity related to aminoglycoside treatment are major problems in treating Enterococcus faecalis endocarditis.. To evaluate the efficacy and safety of ampicillin plus ceftriaxone for treating endocarditis due to E. faecalis with and without HLAR.. Observational, open-label, nonrandomized, multicenter clinical trial.. 13 centers in Spain.. 21 patients with HLAR E. faecalis endocarditis and 22 patients with non-HLAR E. faecalis endocarditis. All were at risk for nephrotoxicity related to aminoglycoside use.. 6-week course of intravenous ampicillin, 2 g every 4 hours, plus intravenous ceftriaxone, 2 g every 12 hours.. Clinical and microbiological outcomes.. The clinical cure rate at 3 months was 67.4% (29 of 43 patients) among all episodes. During treatment, 28.6% of patients with HLAR E. faecalis endocarditis and 18.2% of patients with non-HLAR E. faecalis endocarditis died of infection-related causes. The rate of clinical and microbiological cure in patients who completed the protocol was 100% in the HLAR E. faecalis endocarditis group. No episodes of breakthrough bacteremia occurred, although there were 2 relapses in the non-HLAR E. faecalis endocarditis group. Treatment was withdrawn in 1 case because of fever and skin rash.. The study had a small sample and was observational.. The combination of ampicillin and ceftriaxone is effective and safe for treating HLAR E. faecalis endocarditis and could be a reasonable alternative for patients with non-HLAR E. faecalis endocarditis who are at increased risk for nephrotoxicity.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Aminoglycosides; Ampicillin; Anti-Bacterial Agents; Ceftriaxone; Child; Child, Preschool; Drug Resistance, Microbial; Drug Therapy, Combination; Endocarditis, Bacterial; Enterococcus faecalis; Female; Humans; Infant; Male; Middle Aged; Treatment Failure

Efficacy and safety of ceftriaxone (Oframax, Ranbaxy, India) in the treatment of 25 patients with Staphylococcus endocarditis (SE) were studied. The drug was administered intravenously in a dose of 2-4 g a day for 4 weeks and simultaneously gentamicin was used intramuscularly in a dose of 2-3 mg/kg body weight a day every 8 hours for 2 weeks. The treatment was followed by observation of the patients for up to 2 years under the hospital or dyspensary conditions. The disease was due to S. epidermidis (17 patients) or S.aureus (8 patients). The efficacy was controlled in the dynamics. The criteria of the therapy efficacy were disappearance of the disease clinical signs, normalization of the blood count and urinalysis and the pathogen eradication by the results of the control bacteriological blood analysis. The cure without any surgical correction was observed in 68 per cent of the patients and that with the valve replacement was stated in 24 per cent of the patients. The lethal outcome due to bacteriotoxic shock was recorded in 8 per cent of the patients. The SE relapsing was stated in 28 per cent of the patients 3 or more months after the ceftriaxone therapy completion. 10 patients (40 per cent) with evident clinicolaboratory improvement were discharged from the hospital 2 (4 patients) and 3 (6 patients) weeks after the therapy start for the treatment with ceftriaxone as outpatients. In 2 patients nausea as the adverse reaction was observed. Therefore, the complex clinicolaboratory investigation showed that the combined use of ceftriaxone and gentamicin was efficient and safe in the treatment of SE. Ceftriaxone may be considered as a basic drug for the therapy of SE. In some patients with SE the treatment with ceftriaxone may be completed under outpatient conditions.

Topics: Adolescent; Adult; Ceftriaxone; Cephalosporins; Colony Count, Microbial; Drug Therapy, Combination; Endocarditis, Bacterial; Female; Gentamicins; Humans; Injections, Intravenous; Male; Middle Aged; Nausea; Recurrence; Staphylococcal Infections; Staphylococcus aureus; Treatment Outcome

This randomized, multicenter, open-label study compared the efficacy and safety of monotherapy with 2 g of intravenous ceftriaxone once daily for 4 weeks with those of combination therapy with 2 g of intravenous ceftriaxone and 3 mg of intravenous gentamicin/kg once daily for 2 weeks as therapy for endocarditis due to penicillin-susceptible streptococci. Sixty-one patients were enrolled in the study. Clinical cure was observed for 51 evaluable patients both at termination of therapy and at the 3-month follow-up: 25 (96.2%) of 26 monotherapy recipients and 24 (96%) of 25 combination therapy recipients. Of the 23 patients in each treatment group who were microbiologically evaluable, 22 (95.7%) in each group were considered cured. No patient had evidence of relapse. Fourteen patients (27.5%) required cardiac surgery after initiation of treatment, including five monotherapy recipients and nine combination therapy recipients. Adverse effects were minimal in both treatment groups. We conclude that 2 g of ceftriaxone once daily for 4 weeks and 2 g of ceftriaxone in combination with 3 mg of gentamicin/kg once daily for 2 weeks are both effective and safe for the treatment of streptococcal endocarditis.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Ceftriaxone; Cephalosporins; Drug Therapy, Combination; Endocarditis, Bacterial; Gentamicins; Humans; Middle Aged; Penicillins; Streptococcal Infections; Streptococcus

A 2-week course of ceftriaxone (2 g) plus netilmicin (4 mg/kg), administered as one short daily iv infusion, was evaluated for the treatment of streptococcal endocarditis in an open multicenter study. Of the 52 patients, 31 were infected with viridans streptococci, 18 with Streptococcus bovis, two with Gemella morbillorum, and one with group C Streptococcus; 48 patients were assessable. Infection was cured in 42 cases, 35 treated medically and seven treated both medically and surgically. Five patients died without evidence of active infection, and one relapsed. The bacteriologic failure was due to a strain of G. morbillorum against which no synergy of ceftriaxone and netilmicin was evident in vitro. The serum creatinine level increased during treatment in four cases, all involving patients > 65 years old who had renal risk factors; in two of these cases, values did not return to baseline during follow-up. Of 40 patients assessed for auditory function, only one developed decreased perception of borderline significance. Other adverse reactions were mild. This regimen was efficacious, safe, and cost-effective for the treatment of streptococcal endocarditis. However, it must be used with caution for patients with preexisting renal impairment or concomitant exposure to other potentially nephrotoxic agents.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Ceftriaxone; Drug Therapy, Combination; Endocarditis, Bacterial; Female; Follow-Up Studies; Humans; Male; Middle Aged; Netilmicin; Prospective Studies; Streptococcal Infections; Treatment Outcome

OBJECTIVE--To evaluate the efficacy and safety of ceftriaxone sodium in the treatment of streptococcal endocarditis. DESIGN--An open, multicenter, noncomparative study with a follow-up of patients for 4 months to 5 years. SETTING--Internal medicine wards and outpatient clinics of hospitals of various sizes in three European countries. PATIENTS--Fifty-nine patients with defined criteria for streptococcal endocarditis. INTERVENTION--Ceftriaxone sodium administered at a once-daily dose of 2 g for 4 weeks. MAIN OUTCOME MEASURES--Clinical outcome and microbiological cure rate. RESULTS--Among the 59 patients, 55 completed the treatment and were followed up for 4 months to 5 years. No patients showed evidence of relapse. Treatment was completely uneventful in 42 patients (71%). A cardiac valve was replaced in four patients (7%) receiving antimicrobial therapy and in six patients (10%) who had completed antimicrobial therapy. One of the 10 valves taken for culture at surgery was positive, but only for microorganisms that were different from the microorganism isolated before the treatment. The treatment had to be interrupted in four patients because of drug allergy. Other side effects were mild except for two cases of reversible neutropenia. The treatment was easy to administer: 27 patients (46%) had no permanent intravenous catheter at any time, seven patients (12%) had such a catheter for less than 4 days. Twenty-three patients (39%) were discharged from the hospital less than 2 weeks after admission.. --Ceftriaxone sodium administered at a once-daily dose of 2 g appears to be an effective and safe treatment of streptococcal endocarditis. In hospitals, this agent may be more convenient to administer than penicillin G with or without aminoglycosides. Some patients may even be treated as outpatients.

Topics: Adult; Aged; Aged, 80 and over; Ambulatory Care; Ceftriaxone; Drug Administration Schedule; Endocarditis, Bacterial; Female; Humans; Infusions, Intravenous; Injections, Intramuscular; Length of Stay; Male; Middle Aged; Streptococcal Infections

Topics: Cefotaxime; Ceftriaxone; Clinical Trials as Topic; Endocarditis, Bacterial; Humans; Streptococcal Infections

Topics: Ampicillin; Anti-Bacterial Agents; Ceftriaxone; Drug Therapy, Combination; Endocarditis; Endocarditis, Bacterial; Enterococcus faecalis; Gentamicins; Gram-Positive Bacterial Infections; Humans; Penicillins

Whipple's disease is known to cause multiple varied systemic symptoms, and is a well-documented cause of culture-negative endocarditis. Endocarditis secondary to Whipple disease, however, has rarely been known to present primarily as a cause of acute limb ischemia. We describe such a case here.. A previously healthy 40 year old man presented to the emergency department with acute-onset right arm paresthesias. On exam, he was found to be tachycardic with a VI/VI systolic ejection murmur. He was diagnosed with critical limb ischemia and severe aortic regurgitation, and echocardiography showed a large mass on his bicuspid aortic valve. Thrombectomy was performed urgently, with aortic valve repair the following day. As blood cultures and valvular tissue culture remained unrevealing, the patient remained on empiric vancomycin and ceftriaxone for culture-negative endocarditis. 16 s rRNA nucleic acid amplification testing (NAAT) of his formalin-fixed, paraffin-embedded valvular tissue detected T. whipplei, after which the patient was transitioned to ceftriaxone and trimethoprim-sulfamethoxazole for a year of therapy. He continues to do clinically well.. We report an unusual presentation of Whipple endocarditis as an acute upper limb ischemia, absent other classic symptoms of Whipple's disease, and with diagnosis made by 16 s rRNA NAAT of valvular tissue in the setting of culture-negative endocarditis.

Topics: Adult; Anti-Bacterial Agents; Ceftriaxone; Endocarditis; Endocarditis, Bacterial; Humans; Ischemia; Male; Rare Diseases; Tropheryma; Whipple Disease

Nosocomial infective endocarditis is a relatively rare, but critical disease. A Japanese man in his 80s with psoriatic arthritis that was being treated with prednisolone was admitted for dyspnea. The first diagnosis was healthcare-associated pneumonia, and piperacillin/tazobactam was started. The patient's blood culture was negative at the time of admission. During the treatment, acute kidney injury occurred due to the use of antibiotics. Hemodialysis was performed via a central venous catheter in the internal jugular vein. After treatment of pneumonia, the patient experienced a sudden onset of fever accompanied by a loss of consciousness. Blood cultures from the peripheral vein and the central venous catheter were positive for methicillin-susceptible Staphylococcus aureus. A transthoracic echocardiography revealed stringy strands of vegetation attached to the native mitral valve. Magnetic resonance imagings also showed a shower of emboli to the brain. Ceftriaxone and vancomycin were administered; however, the patient died following a massive cerebral infarction. Instances of in-hospital mortality from nosocomial endocarditis are higher than the rates of community-acquired endocarditis. Clinicians should pay close attention to risk factors for nosocomial infective endocarditis. These risk factors include long-term indwelling vascular devices, psoriatic arthritis and corticosteroid therapy.

Topics: Aged, 80 and over; Arthritis, Psoriatic; Ceftriaxone; Central Venous Catheters; Cerebral Infarction; Cross Infection; Endocarditis, Bacterial; Fatal Outcome; Humans; Magnetic Resonance Imaging; Male; Mitral Valve; Staphylococcal Infections; Staphylococcus aureus; Vancomycin

We present a case of a 75-year-old woman with Austrian syndrome: pneumonia, meningitis and endocarditis all due to

Topics: Aged; Agranulocytosis; Anti-Bacterial Agents; Ceftriaxone; Comorbidity; COVID-19; Echocardiography, Transesophageal; Endocarditis, Bacterial; Female; Humans; Meningitis, Bacterial; Pandemics; Pneumococcal Infections; SARS-CoV-2; Streptococcus pneumoniae; Syndrome

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

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

HACEK organisms (Haemophilus, Aggregatibacter, Cardiobacterium, Eikenella, and Kingella species) are rare causes of endocarditis. HACEK organisms are fastidious and may escape detection by culture techniques, but the use of molecular studies may aid diagnosis. A 10-year review of pediatric HACEK endocarditis cases at Texas Children's Hospital identified 10 patients, with 2 cases recognized by next-generation sequencing, highlighting potential benefits of these assays.

Topics: Adolescent; Anti-Bacterial Agents; Ceftriaxone; Child; Endocarditis, Bacterial; Heart Defects, Congenital; High-Throughput Nucleotide Sequencing; Humans; Infant; Kingella; Male; Retrospective Studies; Tertiary Care Centers

Treatment regimens requiring multiple daily dosing for enterococcal endocarditis are challenging to deliver in the outpatient setting. Continuous-infusion benzylpenicillin via a 24 h elastomeric infusor, combined with either once-daily gentamicin or ceftriaxone, requires only one nursing encounter daily and is commonly used in New Zealand.. To assess the therapeutic success and adverse antibiotic effects of these regimens.. A retrospective observational case series from multiple hospitals of patients aged 15 years or over with enterococcal endocarditis diagnosed between July 2013 and June 2019 who received at least 14 days of outpatient continuous-infusion benzylpenicillin combined with either gentamicin or ceftriaxone for synergy.. Forty-three episodes of enterococcal endocarditis in 41 patients met inclusion criteria. The primary synergy antibiotic was gentamicin in 20 episodes and ceftriaxone in 23 episodes. For the 41 initial treatment courses, 31 (76%) patients were cured, 3 (7%) patients developed relapsed endocarditis during or following antibiotic treatment and 7 (17%) patients continued with long-term suppressive oral amoxicillin following IV antibiotic treatment. There was no difference in the relapse rate between the two groups (P = 0.59). Seven (35%) adverse antibiotic effects were documented in the gentamicin group and none in the ceftriaxone group (P < 0.01). Two deaths (5%) occurred within the 6 month follow-up period.. Outpatient treatment of enterococcal endocarditis with continuous-infusion benzylpenicillin combined with either once-daily gentamicin or ceftriaxone following a period of inpatient treatment is usually effective. A significantly higher rate of adverse effects was seen with gentamicin, favouring ceftriaxone as the initial synergy antibiotic.

Topics: Anti-Bacterial Agents; Ceftriaxone; Drug Therapy, Combination; Endocarditis; Endocarditis, Bacterial; Gentamicins; Humans; Outpatients; Penicillin G; Retrospective Studies

Topics: Aged; Aged, 80 and over; Anti-Bacterial Agents; Ceftriaxone; Endocarditis, Bacterial; Enterococcus faecalis; Gram-Positive Bacterial Infections; Humans; Male; Middle Aged; Penicillin G; Treatment Outcome

Topics: Ceftriaxone; Child, Preschool; Endocarditis, Bacterial; Haemophilus Infections; Haemophilus influenzae; Humans; Male; Treatment Outcome

Enterococcus faecalis infective endocarditis (EFIE) is a severe disease of increasing incidence. The objective was to analyze whether the outcome of patients with native valve EFIE (NVEFIE) treated with a short course of ampicillin plus ceftriaxone (4wAC) was similar to patients treated according to international guidelines (6wAC). Between January 2008 and June 2018, 1,978 consecutive patients with definite native valve IE were prospectively included in a national registry. Outcomes of patients with NVEFIE treated with 4wAC were compared to those of patients who received 6wAC. Three hundred and twenty-two patients (16.3%) had NVEFIE. One hundred and eighty-three (56.8%) received AC. Thirty-nine patients (21.3%) were treated with 4wAC for four weeks and 70 patients (38.3%) with 6wAC. There were no differences in age or comorbidity. Patients treated 6wAC presented a longer duration of symptoms before diagnosis (21 days, IQR 7-60 days vs. 7 days, IQR 1-22 days; p = 0.002). Six patients presented perivalvular abscess and all of these received 6wAC. Surgery was performed on 14 patients (35.9%) 4wAC and 34 patients (48.6%) 6wAC (p = 0.201). In-hospital mortality, one-year mortality and relapses among 4wAC and 6wAC patients were 10.3% vs. 11.4% (p = 0.851); 17.9% vs. 21.4% (p = 0.682) and 5.1% vs. 4.3% (p = 0.833), respectively. In conclusion, a four-week course of AC may be considered as an alternative regimen in NVEFIE, notably in patients with shorter duration of symptoms and those without perivalvular abscess. These results support the performance of a randomized clinical trial to evaluate the efficacy of this short regimen.

Topics: Aged; Aged, 80 and over; Ampicillin; Anti-Bacterial Agents; Ceftriaxone; Cohort Studies; Drug Therapy, Combination; Endocarditis; Endocarditis, Bacterial; Enterococcus faecalis; Female; Gentamicins; Gram-Positive Bacterial Infections; Humans; Male; Prospective Studies; Time Factors

Central retinal artery occlusion (CRAO) is a rare but blinding disorder. We present a case of a 81-year-old woman with multiple cardiovascular comorbidities admitted to the emergency department due to sudden, painless vision loss on left eye (oculus sinister (OS)) on awakening. The patient also reported long standing fatigue associated with effort that started 4 months before admission. She presented best corrected visual acuity of counting fingers OS. Funduscopy OS revealed macular oedema with cherry red spot pattern. Blood cultures came positive for

Topics: Acetazolamide; Administration, Intravenous; Administration, Ophthalmic; Administration, Oral; Aged, 80 and over; Anti-Bacterial Agents; Antihypertensive Agents; Ceftriaxone; Echocardiography; Endocarditis, Bacterial; Female; Humans; Hypothalamic Area, Lateral; Isosorbide Dinitrate; Mitral Valve; Retina; Retinal Artery Occlusion; Streptococcal Infections; Streptococcus gallolyticus; Tomography, Optical Coherence; Treatment Outcome

The combination of ampicillin (AMP) and ceftriaxone (CRO) is considered synergistic against Enterococcus faecalis based on in vitro tests and the rabbit endocarditis model, however, in vitro assays are limited by the use of fixed antibiotic concentrations and the rabbit model by poor bacterial growth, high variability, and the use of point dose-effect estimations, that may lead to inaccurate assessment of antibiotic combinations and hinder optimal translation. Here, we tested AMP+CRO against two strains of E. faecalis and one of E. faecium in an optimized mouse thigh infection model that yields high bacterial growth and allows to define the complete dose-response relationship. By fitting Hill's sigmoid model and estimating the parameters maximal effect (Emax) and effective dose 50 (ED50), the following interactions were defined: synergism (Emax increase ≥2 log10 CFU/g), antagonism (Emax reduction ≥1 log10 CFU/g) and potentiation (ED50 reduction ≥50% without changes in Emax). AMP monotherapy was effective against the three strains, yielding valid dose-response curves in terms of dose and the index fT>MIC. CRO monotherapy showed no effect. The combination AMP+CRO against E. faecalis led to potentiation (59-81% ED50 reduction) and not synergism (no changes in Emax). Against E. faecium, the combination was indifferent. The optimized mouse infection model allowed to obtain the complete dose-response curve of AMP+CRO and to define its interaction based on pharmacodynamic parameter changes. Integrating these results with the pharmacokinetics will allow to derive the PK/PD index bound to the activity of the combination, essential for proper translation to the clinic.

Topics: Ampicillin; Animals; Ceftriaxone; Disease Models, Animal; Drug Therapy, Combination; Endocarditis, Bacterial; Enterococcus faecalis; Enterococcus faecium; Gram-Positive Bacterial Infections; Mice; Rabbits

Capnocytophaga canimorsus is a gram-negative bacterium and an oral commensal in dogs and cats, but occasionally causes serious infections in humans. Septicemia is one of the most fulminant forms, but diagnosis of C. canimorsus infection is often difficult mainly because of its very slow growth. C. canimorsus infective endocarditis (IE) is rare and is poorly understood. Since quite a few strains produce β-lactamase, antimicrobial susceptibility is pivotal information for adequate treatment. We herein report a case with C. canimorsus IE and the results of drug susceptibility test.. A 46-year-old man had a dog bite in his left hand 3 months previously. The patient was referred to our hospital for fever (body temperature > 38 °C), visual disturbance, and dyspnea. Echocardiography showed aortic valve regurgitation and vegetation on the leaflets. IE was diagnosed, and we initially administered cefazolin and gentamycin assuming frequently encountered microorganisms and the patient underwent aortic valve replacement. C. canimorsus was detected in the aortic valve lesion and blood cultures. It was also identified by 16S ribosome DNA sequencing. Ceftriaxone were started and continued because disk diffusion test revealed the isolate was negative for β-lactamase and this case had cerebral symptoms. The patient successfully completed antibiotic treatment following surgery.. We diagnosed C. canimorsus sepsis and IE by extended-period blood cultures and 16S ribosome DNA sequencing by polymerase chain reaction, and successfully identified its drug susceptibility.

Topics: Animals; Anti-Bacterial Agents; beta-Lactamases; Bites and Stings; Blood Culture; Capnocytophaga; Cefazolin; Ceftriaxone; Dogs; Endocarditis, Bacterial; Gentamicins; Gram-Negative Bacterial Infections; Heart Valve Prosthesis; Humans; Male; Middle Aged; Polymerase Chain Reaction; Sepsis

Lactococcus garvieae is an unusual cause of infective endocarditis (IE). No current diagnostic and therapeutic guidelines are available to treat IE caused by these organisms. Based on a case report, we provide a review of the literature of IE caused by L. garvieae and highlight diagnostic and treatment challenges of these infections and implications for management.. A 50-year-old Asian male with mitral prosthetic valve presented to the hospital with intracranial haemorrhage, which was successfully treated. Three weeks later, he complained of generalized malaise. Further work up revealed blood cultures positive for Gram-positive cocci identified as L. garvieae by MALDI-TOF. An echocardiogram confirmed the diagnosis of IE. Susceptibility testing showed resistance only to clindamycin. Vancomycin plus gentamicin were started as empirical therapy and, subsequently, the combination of ceftriaxone plus gentamicin was used after susceptibility studies were available. After two weeks of combination therapy, ceftriaxone was continued as monotherapy for six additional weeks with good outcome.. Twenty-five cases of IE by Lactococcus garvieae have been reported in the literature. Compared to other Gram-positive cocci, L. garvieae affects more frequently patients with prosthetic valves. IE presents in a subacute manner and the case fatality rate can be as high as 16%, comparable to that of streptococcal IE (15.7%). Reliable methods for identification of L. garvieae include MALDI-TOF, 16S RNA PCR, API 32 strep kit and BD Automated Phoenix System. Recommended antimicrobials for L. garvieae IE are ampicillin, amoxicillin, ceftriaxone or vancomycin in monotherapy or in combination with gentamicin.

Topics: Anti-Bacterial Agents; Ceftriaxone; Drug Therapy, Combination; Echocardiography; Endocarditis, Bacterial; Gentamicins; Gram-Positive Bacterial Infections; Heart Valve Prosthesis; Humans; Lactococcus; Male; Microbial Sensitivity Tests; Middle Aged; Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization; Vancomycin

Enterococcus faecalis is the third most common causal agent of infective endocarditis. Currently, the treatment recommended is a combination of ampicillin (2 g/4 h) plus ceftriaxone (2 g/12 h), so patients must remain hospitalized for almost 6 weeks to receive the treatment. They are not generally included in outpatient parenteral antimicrobial therapy programs because 2 different electronic pumps are required to administer these 2 antibiotics. To enable the treatment of patients with E. faecalis IE at home, we designed a continuation combination regimen of ceftriaxone 4 g once daily in a short infusion plus ampicillin 2 g/4 h using a programmable pump.. We analyzed a cohort of patients attended in an outpatient parenteral antimicrobial therapy program that has been working since 2012 in 2 tertiary hospitals. We selected patients attended in this program for E. faecalis IE treated with a continuation regimen of ampicillin 12 g daily (2 g/4 h) and ceftriaxone 4 g every 24 hours between July 2012 and March 2017.. Of the 720 patients included in the outpatient parenteral antimicrobial therapy program, 42 had infective endocarditis, and 4 (9.52%) were treated using the combination regimen described above. All patients were men, and all had left-sided native-valve infective endocarditis. All 4 patients received ampicillin 2 g every 4 hours and ceftriaxone 2 g every 12 hours in hospital, for a median duration of 25 days (IQR 15-32). Thereafter, in the program, they received the following regimen: a 30-minute infusion of ceftriaxone 4 g in 250 mL of saline solution, followed by ampicillin 12 g daily in 500 mL of saline solution delivered by a pump programmed to administer 2 g every 4 hours. Patients received this treatment at home for a median of 22.5 days (IQR 13-32). All patients achieved clinical and microbiological cure with no recurrences or complications after a lengthy follow-up period (median 365 days, IQR 221-406). No drug-related adverse events or problems with the pump system were reported.. Use of ceftriaxone 4 g in a single dose yields a mean plasma concentration of 30 μg/mL. Ceftriaxone also has a high plasma protein binding capability, and once this binding is saturated, there is no reason to administer higher doses. Therefore, it seems reasonable to use a dose of 4 g of ceftriaxone once daily to have a synergist effect with ampicillin within the vegetation, and enable the treatment of patients with E. faecalis infective endocarditis at home. In conclusion, the administration of ampicillin (2 g/4 h) plus ceftriaxone (4 g/24 h) as a continuation regimen in an outpatient parenteral antimicrobial therapy program may be as effective and safe as the usual lengthy in-hospital regimen (ampicillin 2 g/4 h and ceftriaxone 2 g/12 h) in patients with E. faecalis infective endocarditis.

Topics: Aged; Aged, 80 and over; Ampicillin; Anti-Bacterial Agents; Ceftriaxone; Cohort Studies; Drug Synergism; Drug Therapy, Combination; Endocarditis; Endocarditis, Bacterial; Enterococcus faecalis; Gentamicins; Gram-Positive Bacterial Infections; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Outpatients

Topics: Administration, Intravenous; Anti-Bacterial Agents; Ceftriaxone; Endocarditis, Bacterial; Heart Valve Prosthesis; Humans; Male; Middle Aged; Prosthesis-Related Infections; Salmonella enteritidis; Salmonella Infections; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Advancements in rapid diagnostics have helped to identify nutritionally variant streptococci (NVS) as an increasing cause of infective endocarditis (IE). This case report highlights the challenges in susceptibility testing and the importance of appropriate empiric treatment for Granulicatella adiacens, and provides considerations for future practice guideline recommendations. Guidelines for treatment of IE caused by NVS are currently limited to patients with native valve disease. We present a patient with presumed prosthetic valve endocarditis caused by G. adiacens, with clinically relevant resistance to recommended first-line agents (penicillin and ceftriaxone), who was successfully treated with 8 weeks of intravenous (IV) vancomycin. Vancomycin is currently recommended as an alternate therapy for patients intolerant of penicillins, but we believe vancomycin should be considered a first-line empiric treatment option for IE when the identified organism is G. adiacens and susceptibility testing is not readily available.

Topics: Administration, Intravenous; Aged; Anti-Bacterial Agents; beta-Lactam Resistance; Carnobacteriaceae; Ceftriaxone; Endocarditis, Bacterial; Gram-Positive Bacterial Infections; Humans; Male; Penicillins; Prosthesis-Related Infections; Treatment Outcome; Vancomycin

International guidelines recommend 4 weeks of treatment with ampicillin plus gentamicin (A+G) for uncomplicated native valve Enterococcus faecalis infective endocarditis (EFIE) and 6 weeks in the remaining cases. Ampicillin plus ceftriaxone (A+C) is always recommended for at least 6w, with no available studies assessing its suitability for 4w. We aimed to investigate differences in the outcome of EFIE according to the duration (4 versus 6 weeks) of antibiotic treatment (A+G or A+C).. Retrospective analysis from a prospectively collected cohort of 78 EFIE patients treated with either A+G or A+C.. 32 cases (41%) were treated with A+G (9 for 4w, 28%) and 46 (59%) with A+C (14 for 4w, 30%). No significant differences were found in 1-year mortality according to the type of treatment (31% and 24% in A+G and A+C, respectively; P = 0.646) or duration (26% and 27% at 4 and 6w, respectively; P = 0.863). Relapses were more frequent among survivors treated for 4w than in those treated for 6w (3/18 [17%] at 4w and 1/41 [2%] at 6w; P = 0.045). Three out of 4 (75%) relapses occurred in cirrhotic patients.. A 4-week course of antibiotic treatment might not be suitable neither for A+G nor A+C for treating uncomplicated native valve EFIE.

Topics: Aged; Ampicillin; Anti-Bacterial Agents; Ceftriaxone; Cohort Studies; Drug Therapy, Combination; Endocarditis, Bacterial; Enterococcus faecalis; Female; Humans; Male; Middle Aged; Recurrence; Treatment Outcome

Enterococci frequently cause severe biofilm-associated infections such as endocarditis. The combination of ampicillin/ceftriaxone has recently been clinically evaluated as non-inferior compared with the standard therapy of ampicillin/gentamicin for treatment of Enterococcus faecalis endocarditis. Ceftaroline is a novel cephalosporin with enhanced activity against Gram-positive bacteria.. To compare the in vitro effectiveness of the ceftaroline/ampicillin combination with those of gentamicin/ampicillin and ceftriaxone/ampicillin in planktonic and biofilm cultures of clinical E. faecalis isolates.. Synergistic effects at the planktonic level were analysed by chequerboard assays in 20 E. faecalis isolates. Biofilm-eradicating and biofilm-preventing activities of the antibiotics and their combinations were determined by confocal laser scanning microscopy with quantification by quantitative biofilm analysis (qBA) algorithm and cfu/mL determination.. Comparable synergistic effects were observed for both β-lactam combinations in most isolates, in contrast to gentamicin/ampicillin. However, none of the antibiotic combinations succeeded in eradicating mature biofilms. Gentamicin showed promising biofilm-preventing activity, but at concentrations above those clinically tolerable. The β-lactams showed a U-shape dose-response relationship in biofilm prevention. Only exposure to cephalosporins caused alterations in cell morphology, which resulted in cell elongation and reclustering in a concentration-dependent manner. Reclustering was associated with high occurrences of small colony variants (SCVs), especially at high ceftriaxone concentrations.. This study suggests that combinations of cephalosporins or gentamicin with ampicillin may be advantageous only while bacteraemia persists, whereas combinations have no advantage over monotherapy regarding the treatment of mature biofilms. The selection of SCVs at high ceftriaxone concentrations is worth further study.

Topics: Adult; Aged; Aged, 80 and over; Ampicillin; Anti-Bacterial Agents; Biofilms; Ceftaroline; Ceftriaxone; Cephalosporins; Cohort Studies; Drug Synergism; Endocarditis, Bacterial; Enterococcus faecalis; Female; Gentamicins; Gram-Positive Bacterial Infections; Humans; Male; Microbial Sensitivity Tests; Middle Aged

Isolated pulmonary valve endocarditis (PVE) is a rare condition. Known risk factors in previous case reports were intravenous drug abuse and congenital heart disease. Epidemiology of PVE has been changing. It is now being reported specially following invasive healthcare-related procedures even in patients with structurally normal heart. Vast majority of patients present with respiratory symptoms and diagnosis of endocarditis may be challenging unless there is high index of suspicion. Various microorganisms had been isolated as aetiological agents; however,

Topics: Anti-Bacterial Agents; C-Reactive Protein; Ceftriaxone; Chest Pain; Echocardiography; Endocarditis, Bacterial; Enterococcus faecalis; Fever of Unknown Origin; Gram-Positive Bacterial Infections; Humans; Male; Middle Aged; Pulmonary Valve

BACKGROUND Drug-induced immune hemolytic anemia (DIIHA) is a rare condition that may result from the administration of an antibiotic, most notably the cephalosporin class, commonly used in both the adult and pediatric populations. A delay in recognition by a provider may lead to continuation of the offending agent and possibly result in fatal outcomes. CASE REPORT We report the case of a 65-year-old woman on ceftriaxone infusions after being diagnosed with acute mitral valve endocarditis 3 weeks prior, which presented with severe anemia and bilateral transient vision loss. Being a Jehovah's Witness, the patient refused blood product transfusions and was managed with alternative therapies. The etiology of the symptoms was suspected to be a hemolytic anemia directly related to her ceftriaxone infusions. CONCLUSIONS This report demonstrates the importance of close vigilance while prescribing drugs known to cause hemolytic anemia. Although rare, drug-induced immune hemolytic anemia caused by ceftriaxone may be a potentially fatal condition, but with early recognition and withdrawal of the offending agent, successful treatment may ensue. Serological tests should be utilized to obtain a definitive diagnosis.

Topics: Aged; Anemia, Hemolytic; Anti-Bacterial Agents; Ceftriaxone; Endocarditis, Bacterial; Epoetin Alfa; Female; Ferrous Compounds; Folic Acid; Hematinics; Humans; Jehovah's Witnesses; Vitamin B 12

An 88-year-old man with history of bioprosthetic aortic valve replacement was hospitalised with fever, chills, malaise and right lower extremity cellulitis. Laboratory investigations revealed leucocytosis and blood cultures grew

Topics: Aged, 80 and over; Anti-Bacterial Agents; Aortic Valve; Ceftriaxone; Cellulitis; Diagnosis, Differential; Echocardiography, Transesophageal; Endocarditis, Bacterial; Firmicutes; Gram-Positive Bacterial Infections; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Lower Extremity; Male; Prosthesis-Related Infections

Topics: Adult; Anti-Bacterial Agents; Atrioventricular Block; Ceftriaxone; Cystic Fibrosis; Endocarditis, Bacterial; Humans; Lung Transplantation; Lyme Disease; Male; Mitral Valve; Tricuspid Valve

Topics: Adult; Anti-Bacterial Agents; Bacteriological Techniques; Ceftriaxone; Endocarditis, Bacterial; Female; Humans; Infant; Male; Meningitis, Bacterial; Microbial Sensitivity Tests; Middle Aged; Salmonella; Salmonella Infections; Treatment Outcome

Neisseria macacae is a Gram-negative diplococcus, found in the oropharynx of healthy Rhesus Monkeys. Infections caused by N. macacae in humans are extremely rare.. We present here the first case of N. macacae infective endocarditis in a 65-year-old man with a native aortic valve infection complicated by a peri-aortic abscess. N. macacae was isolated from blood culture and was found on the cardiac valve using 16S rDNA detection. Despite an appropriate antibiotic therapy, and aortic homograft replacement, and mitral repair, the patient died 4 days after surgery from a massive hemorrhagic stroke.

Topics: Abscess; Aged; Anti-Bacterial Agents; Aortic Valve; Ceftriaxone; Endocarditis, Bacterial; Fatal Outcome; France; Gentamicins; Gram-Negative Bacterial Infections; Humans; Male; Neisseria; RNA, Bacterial; RNA, Ribosomal, 16S

Previous studies showed development of daptomycin non-susceptibility (DNS: MIC >4 mg/L) in Enterococcus faecalis infections. However, no studies have assessed the efficacy of the combination of daptomycin/ampicillin against E. faecalis strains developing DNS in the experimental endocarditis (EE) model.. To assess the in vitro and in vivo efficacy of daptomycin at 10 mg/kg/day, daptomycin/ampicillin and ampicillin/ceftriaxone against two high-level aminoglycoside-resistant E. faecalis strains, one developing DNS after in vitro exposure to daptomycin and another that did not (DS).. Subculture of 82 E. faecalis strains from patients with endocarditis with daptomycin MICs, time-kill and in vivo experiments using the EE model.. 33% of the strains (27 of 82) displayed DNS after subculture with daptomycin. Daptomycin MIC rose from 0.5-2 to 8-16 mg/L. In time-kill experiments, when using a high inoculum (10 8 cfu/mL), daptomycin/ampicillin was synergistic for one-third of DS strains and none of DNS strains, while ampicillin/ceftriaxone retained synergy in all cases. In the EE model, daptomycin did not significantly reduce cfu/g from vegetations compared with control against either strain, while daptomycin/ampicillin reduced significantly more cfu/g than daptomycin against the DS strain, but not against the DNS strain [2.9 (2.0-4.1) versus 6.1 (4.5-8.0); P  =   0.002]. Ampicillin/ceftriaxone was synergistic and bactericidal against both strains, displaying the same activity as daptomycin/ampicillin against the DS strain.. Performance of an Etest for daptomycin MIC after subculture with daptomycin inhibitory doses on strains of high-level aminoglycoside-resistant E. faecalis endocarditis may be an easy test to predict the in vivo efficacy of daptomycin/ampicillin.

Topics: Aminoglycosides; Ampicillin; Animals; Anti-Bacterial Agents; Ceftriaxone; Daptomycin; Dose-Response Relationship, Drug; Drug Resistance, Bacterial; Drug Synergism; Drug Therapy, Combination; Endocarditis, Bacterial; Enterococcus faecalis; Gram-Positive Bacterial Infections; Humans; Microbial Sensitivity Tests; Rabbits

The urgent need of effective therapies for methicillin-resistant Staphylococcus aureus (MRSA) infective endocarditis (IE) is a cause of concern. We aimed to ascertain the in vitro and in vivo activity of the older antibiotic fosfomycin combined with different beta-lactams against MRSA and glycopeptide-intermediate-resistant S. aureus (GISA) strains. Time-kill tests with 10 isolates showed that fosfomycin plus imipenem (FOF+IPM) was the most active evaluated combination. In an aortic valve IE model with two strains (MRSA-277H and GISA-ATCC 700788), the following intravenous regimens were compared: fosfomycin (2 g every 8 h [q8h]) plus imipenem (1 g q6h) or ceftriaxone (2 g q12h) (FOF+CRO) and vancomycin at a standard dose (VAN-SD) (1 g q12h) and a high dose (VAN-HD) (1 g q6h). Whereas a significant reduction of MRSA-227H load in the vegetations (veg) was observed with FOF+IPM compared with VAN-SD (0 [interquartile range [IQR], 0 to 1] versus 2 [IQR, 0 to 5.1] log CFU/g veg; P = 0.01), no statistical differences were found with VAN-HD. In addition, FOF+IPM sterilized more vegetations than VAN-SD (11/15 [73%] versus 5/16 [31%]; P = 0.02). The GISA-ATCC 700788 load in the vegetations was significantly lower after FOF+IPM or FOF+CRO treatment than with VAN-SD (2 [IQR, 0 to 2] and 0 [IQR, 0 to 2] versus 6.5 [IQR, 2 to 6.9] log CFU/g veg; P < 0.01). The number of sterilized vegetations after treatment with FOF+CRO was higher than after treatment with VAN-SD or VAN-HD (8/15 [53%] versus 4/20 [20%] or 4/20 [20%]; P = 0.03). To assess the effect of FOF+IPM on penicillin binding protein (PBP) synthesis, molecular studies were performed, with results showing that FOF+IPM treatment significantly decreased PBP1, PBP2 (but not PBP2a), and PBP3 synthesis. These results allow clinicians to consider the use of FOF+IPM or FOF+CRO to treat MRSA or GISA IE.

Topics: Animals; Anti-Bacterial Agents; Aortic Valve; Area Under Curve; Ceftriaxone; Drug Administration Schedule; Drug Combinations; Drug Resistance, Bacterial; Drug Synergism; Endocarditis, Bacterial; Fosfomycin; Gene Expression; Imipenem; Infusion Pumps; Methicillin-Resistant Staphylococcus aureus; Penicillin-Binding Proteins; Protein Isoforms; Rabbits; Staphylococcal Infections; Vancomycin

Beta-lactams enhance the in vitro activity of daptomycin against methicillin-resistant strains of Staphylococcus aureus Experiments were performed in a rabbit model of aortic valve endocarditis caused by methicillin-resistant daptomycin-nonsusceptible S. aureus strain CB5054 to determine if a cephalosporin, ceftriaxone, administered as a once-daily dose of 100 mg/kg of body weight, or a carbapenem, ertapenem, administered as a once-daily dose of 40 mg/kg, improved the efficacy of daptomycin, administered as a once-daily dose of 12 mg/kg. Daptomycin was ineffective alone in reducing organism densities compared to untreated controls in vegetations and spleen, but densities were 1.4 log10 CFU/g lower in kidney. The combination of daptomycin plus ceftriaxone or daptomycin plus ertapenem reduced bacterial densities in all tissues compared to single agents, with 0.6 to 1.0 log10 CFU/g fewer organisms in vegetations, 1.5 to 2.5 log10 CFU/g fewer organisms in spleen, and 1.8 to 2.5 log10 CFU/g fewer organisms in kidney, although differences were statistically significant only in spleen for daptomycin plus ceftriaxone and in kidney for daptomycin plus ertapenem. Drug exposures in rabbits were less than those achievable in humans, which may have limited the in vivo activity, particularly in vegetations.

Topics: Animals; beta-Lactams; Ceftriaxone; Cephalosporins; Daptomycin; Endocarditis, Bacterial; Ertapenem; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Rabbits

A 43-year-old male with a history of bioprosthetic aortic valve replacement and tricuspid valve annuloplasty presented with vertigo and was found to have an acute infarct in the left superior cerebellum, as well as a left-middle cerebral artery mycotic aneurysm. Blood cultures grew Cardiobacterium hominis and bioprosthetic aortic valve vegetation was found on transthoracic echocardiogram.

Topics: Adult; Aneurysm, Infected; Anti-Bacterial Agents; Aortic Valve; Bicuspid Aortic Valve Disease; Bioprosthesis; Cardiobacterium; Ceftriaxone; Cerebral Infarction; Endocarditis, Bacterial; Gram-Negative Bacterial Infections; Heart Defects, Congenital; Heart Valve Diseases; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Intracranial Aneurysm; Male; Postoperative Complications; Tomography, X-Ray Computed; Treatment Outcome

The HACEK group of organisms are one of the infrequent causes of infective endocarditis. Infective endocarditis should be recognized and treated promptly to prevent excessive morbidity and mortality associated with the disease. Sometimes the diagnosis is delayed due to vague and subtle presentation. Through this case report, risk factors of Cardiobacterium hominis endocarditis and its atypical presentation is illustrated to increase the recognition of infective endocarditis as one of the differential diagnosis. [Full article available at http://rimed.org/rimedicaljournal-2016-07.asp, free with no login].

Topics: Administration, Intravenous; Aged, 80 and over; Alzheimer Disease; Anti-Bacterial Agents; Cardiobacterium; Ceftriaxone; Echocardiography; Endocarditis, Bacterial; Gram-Negative Bacterial Infections; Humans; Male; Stroke

Infective endocarditis caused by Proteus mirabilis is a rare and poorly reported disease, with no well-defined effective antibiotic regimen. Here, we present a case of P. mirabilis aortic valve endocarditis. We reviewed prior cases and treatment regimens, and devised effective treatment, which was guided by in vitro sensitivity and synergy testing on the pathogen. Our patient survived without complications or the need for a surgical intervention.

Topics: Anti-Bacterial Agents; Aortic Valve; Ceftriaxone; Drug Synergism; Drug Therapy, Combination; Echocardiography; Endocarditis, Bacterial; Gentamicins; Humans; In Vitro Techniques; Male; Microbial Sensitivity Tests; Middle Aged; Proteus Infections; Proteus mirabilis

Topics: Ceftriaxone; Daptomycin; Endocarditis, Bacterial; Enterococcus faecalis; Vancomycin-Resistant Enterococci

Topics: Ceftriaxone; Daptomycin; Endocarditis, Bacterial; Enterococcus faecalis; Vancomycin-Resistant Enterococci

Topics: Acute Kidney Injury; Aged; Anti-Bacterial Agents; Aortic Valve; Aortic Valve Stenosis; Ceftriaxone; Echocardiography, Transesophageal; Endocarditis, Bacterial; Exanthema; Heart Valve Prosthesis Implantation; Hematuria; Humans; IgA Vasculitis; Male; Proteinuria; Treatment Outcome; Viridans Streptococci

The best treatment for Tropheryma whipplei infections is controversial. We report a patient who suffered from T. whipplei aortic native valve endocarditis that relapsed despite surgery and four weeks of intravenous ceftriaxone followed by several months of oral trimethoprim/sulfamethoxazole. Cure was achieved after replacement of the prosthesis with a homograft and 18 months of oral doxycycline-hydroxychloroquine. We discuss the need for a change in treatment guidelines for T. whipplei infections.

Topics: Anti-Bacterial Agents; Aortic Valve; Ceftriaxone; Doxycycline; Drug Therapy, Combination; Endocarditis, Bacterial; Heart Valve Diseases; Humans; Hydroxychloroquine; Male; Middle Aged; Recurrence; Trimethoprim, Sulfamethoxazole Drug Combination; Tropheryma; Whipple Disease

Topics: Ceftriaxone; Daptomycin; Endocarditis, Bacterial; Enterococcus faecalis; Vancomycin-Resistant Enterococci

Topics: Aortic Valve; Aortic Valve Stenosis; Ceftriaxone; Endocarditis, Bacterial; Heart Valve Prosthesis Implantation; Humans; IgA Vasculitis; Male; Viridans Streptococci

Topics: Aortic Valve; Aortic Valve Stenosis; Ceftriaxone; Endocarditis, Bacterial; Heart Valve Prosthesis Implantation; Humans; IgA Vasculitis; Male; Viridans Streptococci

The incidence of infective endocarditis is underestimated in solid organ transplant recipients. The spectrum of pathogens is different from the general population. The authors report the successful treatment of a 58-year-old woman with infective endocarditis caused by atypical microorganism and presented with atypical manifestations. Past history of the patient included alcoholic liver cirrhosis and cadaver liver transplantation in February 2000. One year after liver transplantation hepatitis B virus infection was diagnosed and treated with antiviral agents. In July 2007 hemodialysis was started due to progressive chronic kidney disease caused by calcineurin toxicity. In November 2013 the patient presented with transient aphasia. Transesophageal echocardiography revealed vegetation in the aortic valve and brain embolization was identified on magnetic resonance images. Initial treatment consisted of a 4-week regimen with ceftriaxone (2 g daily) and gentamycin (60 mg after hemodialysis). Blood cultures were all negative while serology revealed high titre of antibodies against Chlamydia pneumoniae. Moxifloxacin was added as an anti-chlamydial agent, but neurologic symptoms returned. After coronarography, valvular surgery and coronary artery bypass surgery were performed which resulted in full clinical recovery of the patient.

Topics: Anti-Bacterial Agents; Antibodies, Bacterial; Aortic Valve; Aphasia; Brain; Calcineurin; Ceftriaxone; Chlamydia; Coronary Artery Bypass; Drug Administration Schedule; Echocardiography, Transesophageal; Endocarditis, Bacterial; Female; Fluoroquinolones; Gentamicins; Heart Valve Prosthesis Implantation; Humans; Intracranial Embolism; Liver Transplantation; Magnetic Resonance Imaging; Middle Aged; Moxifloxacin; Renal Dialysis; Renal Insufficiency, Chronic; Treatment Outcome

Topics: Aged, 80 and over; Anti-Bacterial Agents; Aortic Valve; Bioprosthesis; Ceftriaxone; Endocarditis, Bacterial; Gram-Positive Bacterial Infections; Gram-Positive Cocci; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Male; Microbial Sensitivity Tests; Prosthesis-Related Infections; Reoperation

Moraxella catarrhalis, once considered a non-pathogenic coloniser of the oropharynx, has now been recognised as a true pathogen and is reported in cases of bacteraemia. A 63-year-old man with an aortic bioprosthetic valve was brought to the emergency room with altered mental status. Initial blood cultures revealed Gram-negative diplococci on Gram stain; echocardiogram showed a 5 mm vegetation on the aortic bioprosthetic valve. The blood cultures grew M. catarrhalis and the patient was treated medically for prosthetic valve endocarditis with 6 weeks of ceftriaxone and had a favourable clinical outcome. M. catarrhalis has a high prevalence of β-lactamase production and hence the patient was treated with ceftriaxone. This case highlights the importance of considering M. catarrhalis as a pathogen in cases of invasive disease.

Topics: Anti-Bacterial Agents; Aortic Valve; Bacteremia; Ceftriaxone; Diagnosis, Differential; Endocarditis, Bacterial; Heart Valve Prosthesis; Humans; Male; Middle Aged; Moraxella catarrhalis; Moraxellaceae Infections; Prosthesis-Related Infections

A 31-year-old Argentinian woman presented with a 3-week history of fever, night sweats, myalgia and lethargy following a work trip to Uganda where she ran a marathon. Malarial screens were negative but C reactive protein, erythrocyte sedimentation rate and neutrophil count were raised and she was anaemic. A new pansystolic murmur was heard over the mitral valve and the transthoracic echocardiogram showed a large vegetation (>1 cm) with at least moderate mitral regurgitation. Blood cultures grew Neisseria elongata, subsp elongata treated initially with ceftriaxone then oral ciprofloxacin to complete 4 weeks of treatment. CT scan revealed a wedge-shaped area of low attenuation in the spleen in keeping with a splenic infarct. Seven days postadmission, the patient underwent a successful mitral valve repair. Recovery was complicated by a likely embolic infarct in the right frontal lobe, but the patient was discharged 12 days postoperative with no neurological sequelae.

Topics: Adult; Anti-Bacterial Agents; Ceftriaxone; Ciprofloxacin; Echocardiography; Endocarditis, Bacterial; Female; Humans; Mitral Valve Annuloplasty; Mitral Valve Insufficiency; Neisseria elongata; Neisseriaceae Infections; Physical Endurance; Running; Splenic Infarction; Travel; Uganda; United Kingdom

This case report details the second described case of Whipple's disease-related thrombocytopenia in the medical literature. Whipple's disease is a rare multisystem infection caused by the actinomycete Tropheryma whipplei, first described by George Whipple in 1907. The key clinical manifestations are weight loss, diarrhoea and malabsorption, but arthralgia and endocarditis are also well described.. A 62-year-old Caucasian female presented with weight loss, anaemia and behavioural changes but denied any abdominal symptoms. Thrombocytopenia subsequently developed rapidly. Bone marrow examination showed abundant megakaryocytes in keeping with peripheral platelet sequestration. In addition, there was significant polyclonal plasmacytosis. She was also found to have a 1.6 cm tricuspid vegetation. The diagnosis was confirmed by presence of foamy macrophages on duodenal biopsy, positive periodic acid-Schiff staining and visualisation of T whipplei actinomycetes on electron microscopy. Tissue PCR performed mid-treatment showed traces of T whipplei DNA. The infection was treated with a 2-week intravenous course of ceftriaxone followed by 12 months of oral co-trimoxazole. The thrombocytopenia and anaemia resolved rapidly with antibiotic therapy, her behaviour returned to normal and she remains clinically well.. This report confirms the association of thrombocytopenia with Whipple's disease, likely due to peripheral platelet sequestration, which resolves rapidly with treatment. In patients with a long history of unintended weight loss, Whipple's disease is a rare but important differential diagnosis as it is ultimately fatal if left untreated.

Topics: Anti-Bacterial Agents; Ceftriaxone; Endocarditis, Bacterial; Female; Humans; Middle Aged; Predictive Value of Tests; Risk Factors; Thrombocytopenia; Time Factors; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Tropheryma; Whipple Disease

Endocarditis due to Propionibacterium acnes is a rare disease. Scant data on treatment of these infections is available and is based on case reports only. If the disease is complicated by abscess formation, surgical intervention combined with an antibiotic therapy might improve clinical outcome. In some cases, cardiac surgeons are reluctant to perform surgery, since they consider the intervention as high risk. Therefore, a conservative therapy is required, with little, if any evidence to choose the optimal antibiotic. We report the first case of a successfully treated patient with P. acnes prosthetic valve endocarditis without surgery.. We report the case of a 29-year-old patient with a prosthetic valve endocarditis and composite graft infection with abscess formation of the left ventricular outflow tract due to P. acnes. Since cardiac surgery was considered as high risk, the patient was treated intravenously with ceftriaxone 2 g qd and rifampin 600 mg bid for 7 weeks and was switched to an oral therapy with levofloxacin 500 mg bid and rifampin 600 mg bid for an additional 6 months. Two sets of blood cultures collected six weeks after completion of treatment remained negative. The patient is considered to be cured based on absence of clinical signs and symptoms, normal laboratory parameters, negative radiology scans and negative blood cultures, determined at site visits over two years after completion of treatment.. To our knowledge, this is the first successfully managed patient with P. acnes prosthetic valve endocarditis with abscess formation of the left ventricular outflow tract who was treated with antibiotics alone without a surgical intervention. A six month treatment with a rifampin and levofloxacin combination was chosen, based on the excellent activity against stationary-phase and adherent bacteria.

Topics: Abscess; Adult; Anti-Bacterial Agents; Ceftriaxone; Communicable Diseases; Endocarditis, Bacterial; Gram-Positive Bacterial Infections; Heart Valve Prosthesis; Humans; Levofloxacin; Male; Middle Aged; Propionibacterium acnes; Prosthesis-Related Infections; Rifampin; Treatment Outcome

Daptomycin has demonstrated synergy with β-lactams against Enterococcus faecium and this combination has been used successfully to treat infections refractory to daptomycin. We investigated daptomycin alone and combined with ceftriaxone against vancomycin-resistant enterococci (VRE) in an in vitro pharmacokinetic/pharmacodynamic simulated endocardial vegetation (SEV) model.. Daptomycin (6 and 12 mg/kg/day) with and without 2 g of ceftriaxone every 24 h were evaluated against two clinical E. faecium strains (8019 and 5938) and one Enterococcus faecalis (6981) in a 96 h in vitro pharmacokinetic/pharmacodynamic SEV model. FITC-labelled poly-l-lysine was used to assess β-lactam-induced changes in cell surface charge.. For 8019 and 6981, daptomycin 6 mg/kg with ceftriaxone and daptomycin 12 mg/kg alone and in combination with ceftriaxone displayed significantly more activity than daptomycin 6 mg/kg alone from 48 to 96 h (P ≤ 0.005). The addition of ceftriaxone significantly enhanced activity of daptomycin 6 mg/kg against both strains at 96 h (8019, reductions -0.55 versus 3.64 log10 cfu/g; 6981, reductions 1.11 versus 5.67 log10 cfu/g; P < 0.001) and improved daptomycin 12 mg/kg against 8019 at 96 h. Daptomycin 12 mg/kg plus ceftriaxone displayed no appreciable activity against 5938 (daptomycin MIC 32 mg/L). Daptomycin non-susceptibility developed in 8019 and 6981 versus daptomycin 6 mg/kg by 96 h. Ampicillin or ceftriaxone exposure reduced daptomycin surface charge in 8019, resulting in significantly increased FITC-poly-l-lysine binding.. The combination of daptomycin and ceftriaxone may be promising for eradicating high-inoculum, deep-seated enterococcal infections. Further research is warranted to examine the enhancement of daptomycin and innate immunity killing of VRE by ceftriaxone and other β-lactams.

Topics: Ampicillin; Anti-Bacterial Agents; Ceftriaxone; Daptomycin; Drug Resistance, Bacterial; Drug Synergism; Drug Therapy, Combination; Endocarditis, Bacterial; Enterococcus faecalis; Enterococcus faecium; Gram-Positive Bacterial Infections; Microbial Sensitivity Tests; Vancomycin; Vancomycin Resistance; Vancomycin-Resistant Enterococci

A 76-year-old man presented with a 3-week history of intermittent fevers and dyspnoea on exertion after a dental bridge placement 2 months ago. The patient's medical history was significant for mild to moderate mitral valve prolapse. Initial evaluation was notable for a 3/6 systolic apical murmur. Laboratory investigations revealed leucocytosis and elevated erythrocyte sedimentation rate, C reactive protein and cardiac biomarkers. Patient was treated initially for non-ST elevation myocardial infarction. A 2-dimensional echocardiography was concerning for a new mitral regurgitation and a questionable vegetation adjacent to the mitral valve annulus. Transoesophageal echocardiography study confirmed the diagnosis. Subsequent microbial identification was notable for Peptostreptococci and he was started on intravenous penicillin therapy. The unexplained illness with underlying valve disease prompted consideration of infective endocarditis. This case describes a rare occurrence of anaerobic endocarditis imitating an acute coronary event.

Topics: Acute Coronary Syndrome; Aged; Anti-Bacterial Agents; Ceftriaxone; Diagnosis, Differential; Drug Therapy, Combination; Echocardiography, Transesophageal; Endocarditis, Bacterial; Gram-Positive Bacterial Infections; Humans; Male; Mitral Valve Insufficiency; Myocardial Infarction; Peptostreptococcus; Vancomycin

Aggregatibacter bacteria are a rare cause of endocarditis in adults. They are part of a group of organisms known as HACEK--Haemophilus, Aggregatibacter, Cardiobacter, Eikenella, and Kingella. Among these organisms, several Haemophilus species have been reclassified under the genus Aggregatibacter. Very few cases of Aggregatibacter endocarditis in patients with pacemaker devices have been reported.. We present here what we believe to be the first case of Aggregatibacter aphrophilus pacemaker endocarditis. A 62-year-old African American male with a medical history significant for dual-chamber pacemaker placement in 1996 for complete heart block with subsequent lead manipulation in 2007, presented to his primary care doctor with fever, chills, night sweats, fatigue, and ten-pound weight loss over a four-month period. Physical examination revealed a new murmur and jugular venous distension which prompted initiation of antibiotics for suspicion of endocarditis. Both sets of initial blood cultures were positive for A. aphrophilus. Transesophageal echocardiogram revealed vegetations on the tricuspid valve and the right ventricular pacemaker lead (Figure 1). This case highlights the importance of identifying rare causes of endocarditis and recognizing that treatment may not differ from the standard treatment for typical presentations. The patient received intravenous ceftriaxone for his endocarditis for a total of six weeks. Upon device removal, temporary jugular venous pacing wires were placed. After two weeks of antibiotic treatment and no clinical deterioration, a new permanent pacemaker was placed and the patient was discharged home.. This is the first case of A. aphrophilus endocarditis in a patient with a permanent pacemaker. Our patient had no obvious risk factors other than poor dentition and a history of repeated pacemaker lead manipulation. This suggests that valvulopathies secondary to repeated lead manipulation can be clinically significant factors in morbidity and mortality in this patient population.

Topics: Aggregatibacter aphrophilus; Anti-Bacterial Agents; Ceftriaxone; Echocardiography, Transesophageal; Endocarditis, Bacterial; Humans; Male; Middle Aged; Pacemaker, Artificial

During recent years, transcatheter aortic valve implantation (TAVI) has become an alternative therapeutic option for patients with severe symptomatic aortic stenosis who are at high surgical risk. Although infective endocarditis (IE) is a potential and serious complication in this group of patients, the best therapeutic approach for IE in patients with TAVI has not been well established. Here, the case is reported of a patient with a giant vegetation after TAVI infection that was successfully treated without surgery. The hope is to provide some clinical insight into this new group of patients with IE.

Topics: Ampicillin; Anti-Bacterial Agents; Aortic Valve; Aortic Valve Stenosis; Ceftriaxone; Endocarditis, Bacterial; Humans; Transcatheter Aortic Valve Replacement; Ultrasonography

Topics: Aged; Anti-Bacterial Agents; Aortic Valve; Ceftriaxone; Ciprofloxacin; Discitis; Endocarditis, Bacterial; Humans; Intervertebral Disc Degeneration; Male; Neisseria sicca; Neisseriaceae Infections; Penicillinase; Thoracic Vertebrae

A 61-year-old patient with diabetes had a bio-prosthetic aortic valve replacement 3 years before admission. He complained of lethargy, night sweats, decreased appetite and erratic blood glucose with no weight loss. He had splinter haemorrhage and a systolic ejection murmur at the aortic area. Chest and abdominal examination revealed no abnormality. The erythrocyte sedimentation rate and C reactive protein were raised. He had several sets of blood cultures and he was started on empirical vancomycin, rifampicin and gentamicin. Transthoracic echocardiography showed vegetation on the base of the anterior mitral leaflet, which was confirmed by a trans-oesophageal echocardiography. Blood culture was positive for Haemophilus aphrophilus, and he was started on ceftriaxone for 6 weeks instead of vancomycin and rifampicin and continued gentamicin for 2 weeks. Follow-up echocardiography showed no evidence of vegetations. The patient recovered completely and he was discharged home.

Topics: Aggregatibacter aphrophilus; Anti-Bacterial Agents; Ceftriaxone; Endocarditis, Bacterial; Humans; Male; Middle Aged; Pasteurellaceae Infections

Topics: Adult; Anti-Bacterial Agents; Aortic Valve; Aortic Valve Stenosis; Cardiac Surgical Procedures; Ceftriaxone; Coronary Occlusion; Drug Therapy, Combination; Echocardiography; Endocarditis, Bacterial; Female; Heart Valve Prosthesis Implantation; Humans; Monitoring, Intraoperative; Staphylococcal Infections; Staphylococcus hominis; Treatment Outcome; Vancomycin

Topics: Brucella; Brucellosis; Ceftriaxone; Endocarditis, Bacterial; Female; Humans; Male

We describe the case of a 70-year-old woman who presented with symptoms of cardiac failure, and was found on clinical examination to have a purpuric rash over her lower extremities. Further evaluation of cardiac failure revealed tricuspid regurgitation with two large tricuspid valve vegetations. Blood cultures yielded a growth of Streptococcus viridans. She was treated with an intravenous ceftriaxone and gentamicin and made a complete recovery with resolution of the rash.

Topics: Aged; Anti-Bacterial Agents; Ceftriaxone; Endocarditis, Bacterial; Female; Gentamicins; Heart Failure; Humans; Purpura; Streptococcal Infections; Tricuspid Valve; Viridans Streptococci

Topics: Aged; Anti-Bacterial Agents; Ceftriaxone; Combined Modality Therapy; Debridement; Device Removal; Echocardiography, Transesophageal; Endocarditis, Bacterial; Female; Humans; Prosthesis-Related Infections; Reoperation; Salmonella; Salmonella Food Poisoning; Salmonella Infections; Salmonella typhimurium; Spouses

Topics: Aged; Anti-Bacterial Agents; Arthroplasty, Replacement, Knee; Bacteremia; Ceftriaxone; Cross Infection; Diabetes Mellitus, Type 2; Endocarditis, Bacterial; Female; Gentamicins; Humans; Klebsiella Infections; Klebsiella pneumoniae; Mitral Valve; Prosthesis-Related Infections; Ultrasonography

Topics: Anti-Bacterial Agents; Bacteria; Ceftriaxone; Endocarditis, Bacterial; Female; Humans; India; Young Adult

Brucella endocarditis (BE) is a rare but life-threatening complication of human brucellosis. The aim of this study was to investigate the course of BE along with the therapeutic interrelations. A total of 53 patients with BE hospitalised in 19 health institutions between 2006 and 2011 were included in the Gulhane study. Diagnosis of brucellosis was established by either isolation of Brucella sp. or the presence of antibodies, and the definition of endocarditis was made according to Duke's criteria. There were four treatment groups: ceftriaxone combined with oral antibiotics (Group 1); aminoglycosides combined with oral antibiotics (Group 2); oral antibiotic combinations (Group 3); and aminoglycoside plus ceftriaxone combined with an oral antibiotic (Group 4). Involvement rates of the aortic, mitral and tricuspid valves were 49.1%, 43.4% and 5.7%, respectively. Thirty-two patients (60.4%) had an underlying cardiac valvular problem, including previous prosthetic valve replacement (n=18). Medical treatment was provided to 32 patients (60.4%), whilst concordant medical and surgical approaches were provided to 21 patients (39.6%). Mortality in Group 1 was 15% (3/20), whilst in Group 2 it was 5.3% (1/19). In Group 3, 25.0% (3/12) of the cases died, whereas none of the cases in Group 4 died. In conclusion, mortality increased 47-fold with pericardial effusion and 25-fold due to congestive heart failure that developed after BE. Although mortality was lower in the aminoglycoside-containing arm (Groups 2 and 4), statistical analysis could not be performed owing to the small number of patients.

Topics: Adult; Aged; Aged, 80 and over; Aminoglycosides; Aortic Valve; Brucella; Brucellosis; Ceftriaxone; Drug Therapy, Combination; Endocarditis, Bacterial; Female; Humans; Leukocyte Count; Male; Middle Aged; Mitral Valve; Retrospective Studies; Treatment Outcome; Tricuspid Valve; Turkey; Young Adult

Although the presence of brucella endocarditis is encountered rarely, it is the most fetal complication of brucellosis, which is shown to affect the aortic valve primarily and the mitral valve secondarily. Involvement of the tricuspid valve is extremely rare. A 62-year-old female was admitted with complaints of fever, fatigue, difficulty in breathing, and swellings in her legs. A transthoracic echocardiogram was performed since acute right heart failure was considered due to her symptoms. The echocardiogram showed enlarged right heart chambers, serious tricuspid valve insufficiency, and a mass on the tricuspid valve compatible with a vegetation moving in and out of the right ventricle. Although no growths were observed in the blood culture, antibody titration for brucellosis was found to be 1/640 (+) in the serological examination. The patient was diagnosed with brucella endocarditis and placed on doxycycline, rifampicin, and ceftriaxone treatment for eight weeks. At the end of the eight-week treatment, the symptoms of right heart failure receded and the patient recovered from the endocarditis. Tricuspid valve brucella endocarditis should be considered in patients suffering from acute right heart failure accompanied by systemic infection findings since brucellosis is presently endemic in Turkey.

Topics: Acute Disease; Anti-Bacterial Agents; Brucellosis; Ceftriaxone; Diagnosis, Differential; Doxycycline; Echocardiography; Electrocardiography; Endocarditis, Bacterial; Female; Heart Failure; Humans; Middle Aged; Rifampin; Treatment Outcome; Tricuspid Valve

Since microbial gene sequencing was utilized for etiologic diagnosis of culture-negative endocarditis, cases of Bartonella endocarditis have been reported in various countries. Herein we report the first case of Bartonella quintana endocarditis, which was confirmed for the first time in Korea by 16S rRNA gene sequencing from the excised valve. A 75-yr-old woman was hospitalized due to dyspnea. Echocardiography demonstrated large oscillating vegetation at the aortic valve. Blood culture was negative. She underwent valve replacement and sequencing of the 16S rRNA gene from excised valve identified Bartonella quintana. She was successfully treated with combined use of ceftriaxone and gentamicin.

Topics: Aged, 80 and over; Anti-Bacterial Agents; Aortic Valve; Bartonella quintana; Ceftriaxone; Drug Therapy, Combination; Dyspnea; Echocardiography; Endocarditis, Bacterial; Female; Gentamicins; Humans; Republic of Korea; RNA, Ribosomal, 16S; Sequence Analysis, RNA

Enterococci have recently been recognized as a causative organism of intractable infections, including severe sepsis and infective endocarditis, in immunocompromised patients. This study investigated the epidemiological, microbiological, and prognostic characteristics of high-level gentamicin-resistant (HLGR) enterococcal bacteremia, including severe cases of infective endocarditis, in Japan. A total of 155 enterococcal bacteremia episodes were identified between July 2007 and December 2009. HLGR strains accounted for 28% of all enterococcal strains: HLGR Enterococcus faecalis/Enterococcus faecium strains accounted for 32%/24%. The 30-day mortality rate was 31%. There was no significant difference in the 30-day mortality rates between HLGR and non-HLGR enterococcal bacteremia. There were two cases of HLGR enterococcal endocarditis, which were successfully treated with ampicillin plus ceftriaxone. We consider it important to examine the presence or absence of HLGR strains in all cases of intractable enterococcal infection, especially infective endocarditis.

Topics: Ampicillin; Anti-Bacterial Agents; Bacteremia; Bacterial Infections; Ceftriaxone; Drug Resistance, Bacterial; Endocarditis, Bacterial; Enterococcus; Gentamicins; Humans; Japan

Topics: Anti-Bacterial Agents; Anticoagulants; Arteriovenous Fistula; Atrial Fibrillation; Bacteremia; Ceftriaxone; Combined Modality Therapy; Coronary Disease; Coronary Sinus; Coronary Vessel Anomalies; Endocarditis, Bacterial; Heart Valve Diseases; Humans; Ligation; Male; Middle Aged; Mitral Valve; Pulmonary Embolism; Streptococcal Infections; Streptococcus mitis; Tricuspid Valve; Ultrasonography

Erysipelothrix rhusiopathiae is the causative agent of swine erysipelas. Systemic infections caused by E. rhusiopathiae are rare, but often (90%) associated with endocarditis. In about 60% of cases endocarditis develops on normal heart valves, and despite appropriate antibiotic therapy about one-third of the patients requires valve replacement. We report the case of a housewife, who developed a mitral valve endocarditis due to E. rhusiopathiae after preparing meat for the Turkish "Festival of Sacrifice".

Topics: Animals; Anti-Bacterial Agents; Bacteremia; Bacteriological Techniques; Ceftriaxone; Echocardiography, Transesophageal; Emigrants and Immigrants; Endocarditis, Bacterial; Erysipeloid; Erysipelothrix; Female; Finger Injuries; Follow-Up Studies; Food Microbiology; Heart Valve Diseases; Holidays; Humans; Infusions, Intravenous; Meat; Microbial Sensitivity Tests; Middle Aged; Mitral Valve; Penicillin G; Sheep; Switzerland; Turkey

Topics: Actinomycetales Infections; Adult; Anti-Bacterial Agents; Ceftriaxone; Cholecystectomy; Endocarditis, Bacterial; Humans; Male; Micrococcaceae; Mitral Valve Prolapse; Postoperative Complications; Treatment Outcome

Erysipelothrix rhusiopathiae is a gram-positive bacillus which is found worldwide. Although bloodstream infections caused by E. rhusiopathiae are not common, there is a strong association between bacteremia and the development of infective endocarditis. The risk of human infection with Erysipelothrix is closely related to the opportunity for exposure to the organisms. We report a case of community-acquired meningitis as an initial manifestation of E. rhusiopathiae endocarditis in a 56-year-old woman, who had no history of exposure to animals.

Topics: Acute Disease; Aged; Anti-Bacterial Agents; Ceftriaxone; Endocarditis, Bacterial; Erysipelothrix; Erysipelothrix Infections; Female; Humans; Male; Meningitis, Bacterial; Middle Aged

Cardiobacterium hominis, a member of the HACEK group of organisms, is a rare cause of endocarditis. We report a case of infective endocarditis caused by C. hominis in a male child who had undergone right ventricular outflow tract (RVOT) reconstruction using an expanded polytetrafluoroethylene conduit for tetralogy of Fallot with pulmonary atresia. Two days before admission, the patient suffered from exertional shortness of breath. Right ventricular hypertension was confirmed and RVOT stenosis was suspected based on the echocardiography findings. A CT scan revealed vegetation above the cusp of the conduit. An emergency operation was performed to avoid a pulmonary embolism due to large friable vegetation. C. hominis was cultured from the blood and the vegetation, prompting a diagnosis of prosthetic valve endocarditis. The patient was discharged after a 6-week course of intravenous ceftriaxone therapy.

Topics: Anti-Bacterial Agents; Cardiac Surgical Procedures; Cardiobacterium; Ceftriaxone; Child, Preschool; Diagnosis, Differential; Endocarditis, Bacterial; Fluorocarbons; Follow-Up Studies; Gram-Negative Bacterial Infections; Humans; Injections, Intravenous; Male; Prosthesis-Related Infections; Tomography, X-Ray Computed; Ventricular Outflow Obstruction

Culture-negative endocarditis is most often the result of prior antimicrobial therapy. Tropheryma whipplei is the etiologic agent of Whipple's disease, which is typically characterized by diarrhea, weight loss, and intra-abdominal lymphadenopathy. We present the case of a 48-year-old male with Whipple's endocarditis of the aortic valve who did not develop signs of systemic Whipple's disease. Our patient was treated with a regimen that included ceftriaxone for 6 weeks prior to his cardiac surgery, yet valve pathology demonstrated abundant T. whipplei, suggesting that a prolonged antibiotic course is necessary for the treatment of Whipple's endocarditis.

Topics: Anti-Bacterial Agents; Aortic Valve; Ceftriaxone; Endocarditis, Bacterial; Heart Valve Diseases; Humans; Lymphatic Diseases; Male; Middle Aged; Tropheryma; Whipple Disease

A 26-year-old male intravenous drug user (IDU) presented twice within 6 months with relapsed polymicrobial infective endocarditis (IE) due to Eikenella corrodens and Streptococcus constellatus after completing two courses of appropriate antimicrobial therapy. This report points to relapsing endocarditis as a clinical entity that warrants attention in IDUs when E. corrodens or S. constellatus are causative agents of IE.

Topics: Adult; Ceftriaxone; Coinfection; Eikenella corrodens; Endocarditis, Bacterial; Gram-Negative Bacterial Infections; Humans; Male; Metronidazole; Oxacillin; Recurrence; Streptococcal Infections; Streptococcus constellatus; Substance-Related Disorders

Topics: Aged; Anti-Bacterial Agents; Aortic Coarctation; Bacteremia; Cardiomegaly; Ceftriaxone; Disease Susceptibility; Drug Therapy, Combination; Endocarditis, Bacterial; Female; Gentamicins; Humans; Streptococcal Infections; Ultrasonography; Viridans Streptococci

Disseminated gonococcal infection (DGI) occurs in 1-3% of all gonococcal infections; endocarditis is a complication in 1-2% of patients with DGI. We present the fourth reported case of gonococcal tricuspid valve endocarditis, this one occurring in a 53-year-old male with a 2-month history of shortness of breath.

Topics: Anti-Bacterial Agents; Ceftriaxone; Endocarditis, Bacterial; Gonorrhea; Humans; Male; Middle Aged; Tricuspid Valve; Tricuspid Valve Insufficiency

Topics: Anti-Bacterial Agents; Aortic Valve; Cardiomyopathy, Dilated; Ceftriaxone; Endocarditis, Bacterial; Female; Heart Valve Prosthesis Implantation; Humans; Middle Aged; Reverse Transcriptase Polymerase Chain Reaction; Trimethoprim, Sulfamethoxazole Drug Combination; Tropheryma; Ultrasonography; Whipple Disease

This study included 31 patients who had definite or possible infectious endocarditis as defined by the modified Duke's criteria Of these patients, 27 were treated with ceftriaxone plus gentamycin combination therapy and four with ceftriaxone monotherapy. Of these 31 cases, 29 had infections with Streptococcus species, and showed good responses to penicillin G and cefotaxime. Excluding one patient who died because of the underlying disease, all patients achieved clinical cure after treatment with either of the two regimens, showing no recurrence during a follow-up period of 6 months after completion of drug treatment. Although valve replacement was performed in 10 patients during the follow-up period, there were no recurrences in any of these patients 6 months postoperatively. Ceftriaxone allows a simple regimen of once-daily administration. Although indications are limited, ceftriaxone therapy is feasible on an outpatient basis, offering favorable medical economics. Consistent with previous reports, the therapeutic effect of ceftriaxone was equivalent to that of penicillin G in this study, showing this agent to be an alternative first-line drug for infectious endocarditis.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Ceftriaxone; Drug Therapy, Combination; Endocarditis, Bacterial; Female; Gentamicins; Humans; Japan; Male; Microbial Sensitivity Tests; Middle Aged; Streptococcal Infections; Streptococcus

Bacterial endocarditis secondary to jet lesions from congenital heart disease is not uncommon, and has been reported on numerous occasions in the literature. These cases usually involve one or more cardiac valves. Our case is that of isolated intracardiac right-sided mural infective endocarditis associated with ventricular septal defect. Importantly, this patient had preceding dental work treated with antibiotic prophylaxis. This case highlights bacteraemia secondary to dental instrumentation versus routine oral hygiene. His presentation was predominantly that of respiratory symptoms and sepsis, and he was culture negative throughout his admission. The lesion was detailed on echocardiography and transoesophageal echocardiography, and treated conservatively. He has subsequently been referred for VSD closure.

Topics: Amoxicillin; Anti-Bacterial Agents; Antibiotic Prophylaxis; Ceftriaxone; Denture, Partial; Echocardiography, Transesophageal; Endocarditis, Bacterial; Heart Septal Defects, Ventricular; Heart Ventricles; Humans; Male; Penicillin G; Young Adult

We report a possible and rare case of drug-induced organizing pneumonia in a patient receiving daptomycin. A 75-year-old man with acute infective aorta valve endocarditis due to Enterococcus faecalis developed organizing pneumonia following treatment with intravenous daptomycin and ceftriaxone. The patient could have acquired an infectious agent which was resistant to ceftriaxone, such as Legionella, and he was thus treated with ciprofloxacin and rifampicin. However, no antigen was found in the urine, and the patient's symptoms subsided after daptomycin was discontinued.

Topics: Aged; Anti-Bacterial Agents; Ceftriaxone; Daptomycin; Endocarditis, Bacterial; Enterococcus faecalis; Eosinophilia; Humans; Male; Pneumonia

The present report describes a very rare case of an aortic homograft valve endocarditis caused by Cardiobacterium hominis. The case was complicated by an agranulocytosis after 3 weeks of antibiotic treatment induced by ceftriaxone. Alternative oral treatment with ciprofloxacin and rifampicin was successful, no surgical intervention was needed and homograft function could be preserved.

Topics: Agranulocytosis; Anti-Bacterial Agents; Aortic Valve; Aortic Valve Insufficiency; Bacteremia; Bioprosthesis; Cardiobacterium; Ceftriaxone; Drug Therapy, Combination; Endocarditis, Bacterial; Follow-Up Studies; Gram-Negative Bacterial Infections; Heart Valve Prosthesis; Humans; Infant, Newborn; Male; Middle Aged; Prosthesis Failure; Recurrence; Reoperation; Transplantation, Homologous

Non-HACEK Gram-negative endocarditis is a rare but severe illness, and the diagnosis can be difficult to establish. Here, we report the case of a 72-year-old woman with Turner syndrome suffering from non-typhoid Salmonella endocarditis of the triscupid valve, who benefited from prompt antibiotic treatment allowing a quick and complete recovery.

Topics: Aged; Anti-Bacterial Agents; Ceftriaxone; Cross Infection; Diagnosis, Differential; Endocarditis, Bacterial; Female; Humans; Salmonella Infections; Treatment Outcome; Turner Syndrome

A 54-year-old female patient with a congenital ventricular septal defect (VSD) was admitted to the authors' hospital for an investigation of mild fever of four months' duration. Her history revealed pulmonary valve endocarditis contracted 18 years previously. Echocardiography revealed an echogenic mobile mass on the pulmonic valve that caused mild regurgitation, while blood cultures were positive for Streptococcus viridans. The patient was administered ceftriaxone and gentamycin, and had an uneventful clinical course. She was advised to undergo surgical closure of the VSD in order to avoid any recurrence of endocarditis.

Topics: Anti-Bacterial Agents; Ceftriaxone; Echocardiography, Transesophageal; Endocarditis, Bacterial; Female; Gentamicins; Heart Septal Defects, Ventricular; Humans; Middle Aged; Pulmonary Valve; Recurrence; Streptococcal Infections; Viridans Streptococci

A 67-year-old woman was admitted with aortic valve endocarditis and aortic wall thickening (AWT). Physical examination and laboratory findings yielded infective endocarditis. Echocardiography revealed several small vegetations on the aortic valve, leading to moderate aortic insufficiency together with a small ventricular septal defect. We also became aware of the AWT on and over the aortic root by transesophageal echocardiography (Figure 1). At the one month follow-up period, we also noticed an abscess formation originating from the AWT, which grew into a mature abscess form, day by day (Figure 2). The aortic valve endocarditis, with destruction of the aortic annulus and abscess formation, in this patient, is considered as a grave condition which, essentially, requires an aggressive combined surgical and medical approach. We would like to intimate here with this patient that AWT needs to be considered seriously important in aortic valve endocarditis and, even if the detected vegetations are small, a close follow-up for a possible abscess formation is essential.

Topics: Abscess; Aged; Anti-Bacterial Agents; Aortic Valve; Aortic Valve Insufficiency; Ceftriaxone; Endocarditis, Bacterial; Female; Gentamicins; Heart Valve Prosthesis Implantation; Humans; Penicillin G; Staphylococcal Infections; Streptococcus; Ultrasonography

Moraxella catarrhalis is a gram-negative, catalase and oxidase positive diplococcus. While it causes otitis media, sinusitis, bronchitis and conjunctivitis in children and adults, it has a tendency to cause lower respiratory tract infections in older ages. More severe clinical pictures with the range of sepsis to endocarditis are also seen in immunocompromised patients. In this report, a case of M. catarrhalis endocarditis in an immunocompetent host who needed valve replacement has been presented. Forty three years old female patient was admitted to our hospital with the complaints of fever, nausea, night sweating and arthralgia for 20 days. Physical examination revealed systolic murmurs on the apex, and vegetation on the atrial surface of mitral valve was detected by transthoracic echocardiography. Intravenous (IV) ampicillin (4 x 3 g/day) and gentamicin (3 x 80 mg/day) treatment was started empirically with prediagnosis of infective endocarditis. The treatment was modified to IV ceftriaxone (1 x 2 g/day) and gentamicin (3 x 80 mg/day) due to the reporting of gram-negative bacilli in blood culture (BacT/ALERT 3D, bioMérieux, France) on the next day. Gram-negative cocobacilli/diplococci were detected with Gram stain on the smear prepared from the blood culture bottle. Simultaneous subcultures to blood agar and eosin methylene blue agar yielded white colored, S-type, non-hemolytic colonies on only blood agar. Catalase and oxidase tests were positive, while beta-lactamase activity was negative. The isolate was identified as M. catarrhalis by using API NH (bioMérieux, France) identification strips. M. catarrhalis was isolated from five different blood culture specimens of the patient. The focus for bacteremia could not be detected. The patient underwent mitral valve replacement operation as an emergency since the vegetation exhibited rapid growth on the fifth day of medical treatment. Antibacterial therapy was completed for 6 weeks. Control echocardiography revealed that artificial mitral valve was open and functional, thus the patient recovered completely without sequela. In conclusion, M. catarrhalis should be considered as a possible cause of infective endocarditis even in immunocompetent patients.

Topics: Adult; Anti-Bacterial Agents; Bacteremia; Ceftriaxone; Drug Therapy, Combination; Echocardiography; Endocarditis, Bacterial; Female; Gentamicins; Heart Valve Prosthesis Implantation; Humans; Immunocompetence; Injections, Intravenous; Mitral Valve; Moraxella catarrhalis; Moraxellaceae Infections

Drug-induced haemolytic anaemia can be life threatening. We report a case of ceftriaxone-induced severe haemolytic anaemia in a previously healthy 68-year-old woman. The patient had a positive direct antiglobulin test (anti-C3d positive, anti-immunoglobulin G negative). Serological tests showed ceftriaxone-specific antibodies. The patient recovered after cessation of the drug. This complication may cause milder anaemia and thus be poorly recognized.

Topics: Aged; Anemia, Hemolytic; Anti-Bacterial Agents; Antibodies; Ceftriaxone; Endocarditis, Bacterial; Female; Follow-Up Studies; Hemolysis; Humans; Injections, Intravenous

Primary actinomycotic endocarditis is extremely rare. The author reported a case who suffered from endocarditis due to Actinomyces georgiae which the portal of entry for the organism could not be determined The author also reviewed the literature which described similar conditions. In addition, to the author's knowledge, there have been no reported cases of actinomyces georgiae endocarditis. Thus, this is the first report in the world. Clinical features of this rare condition are indistinguishable from other bacterial endocarditis. Actinomyces spp. is usually susceptible to a wide range of antibiotics, and endocarditis caused by this genus needs a prolonged course of antimicrobial treatment. However the optimal duration of therapy is still unknown. Prognosis is good with early detection and proper management.

Topics: Actinomyces; Actinomycosis; Amoxicillin; Ampicillin; Anti-Bacterial Agents; Antihypertensive Agents; Ceftriaxone; Enalapril; Endocarditis, Bacterial; Humans; Male; Middle Aged; Penicillin G

We report a patient with Enterococcus faecalis native-valve endocarditis who relapsed after 4 weeks of treatment with ampicillin plus gentamicin. The relapse was cured with ampicillin plus ceftriaxone, which was introduced after gentamicin-induced acute renal failure. This double beta-lactam combination showed a bactericidal effect in time-killing curve studies.

Topics: Aged; Ampicillin; Anti-Bacterial Agents; beta-Lactam Resistance; Ceftriaxone; Dose-Response Relationship, Drug; Drug Therapy, Combination; Endocarditis, Bacterial; Enterococcus faecalis; Female; Gram-Positive Bacterial Infections; Humans; Microbial Sensitivity Tests

Topics: Agricultural Workers' Diseases; Animals; Anti-Bacterial Agents; Australia; Ceftriaxone; Drug Therapy, Combination; Endocarditis, Bacterial; Female; Gentamicins; Humans; Male; Middle Aged; Penicillin G; Streptococcal Infections; Streptococcus suis; Swine; Treatment Outcome

The case report of a young male with Endocarditis caused by Moraxella lacunata is presented. Although a well recognized cause of keratitis, conjunctivitis, and sinusitis; very few cases of endocarditis by this rare pathogen are reported in literature. Patient showed a prompt response when empirical therapy was de-escalated to penicillin, after receiving culture and sensitivity report from Microbiology department.

Topics: Adult; Anti-Bacterial Agents; Anti-Infective Agents; Ceftriaxone; Endocarditis, Bacterial; Gentamicins; Humans; Male; Meropenem; Metronidazole; Moraxellaceae Infections; Penicillins; Protein Synthesis Inhibitors; Thienamycins; Vancomycin

Topics: Animals; Anti-Bacterial Agents; Antibiotics, Antitubercular; Aortic Valve; Brucellosis; Ceftriaxone; Doxycycline; Endocarditis, Bacterial; Heart Valve Prosthesis; Humans; Male; Middle Aged; Mitral Valve; Rifampin; Zoonoses

Topics: Aged; Anti-Bacterial Agents; Ceftriaxone; Echocardiography, Transesophageal; Endocarditis, Bacterial; Female; Gentamicins; Humans; Immunocompetence; Moraxella catarrhalis; Moraxellaceae Infections; Time Factors

Topics: Aminoglycosides; Ampicillin; Anti-Bacterial Agents; Ceftriaxone; Drug Resistance, Bacterial; Drug Therapy, Combination; Endocarditis, Bacterial; Enterococcus faecalis; Humans

We present the clinical case of a man of 68 years who was admitted for dizziness and sensation of loss of conscience. The clinical examination revealed a body temperature of 37.5 degrees C and a murmur of mitral regurgitation. The echocardiogram showed a severe mitral regurgitation and left cavitie's dilatation; transesophageal echocardiogram showed a vegetation in the anterior leaflet of the mitral valve. In blood cultures grew a Gram-negative bacteria identified as Bartonella spp. A PCR demonstrated that it was a Bartonella quintana. The patient was treated with gentamicin, doxiciclin and ceftriaxone with satisfactory evolution. The remaining mitral insufficiency awaits surgical treatment.

Topics: Aged; Anti-Bacterial Agents; Bartonella quintana; Bartonellaceae Infections; Ceftriaxone; Endocarditis, Bacterial; Gentamicins; Humans; Male; Mitral Valve Insufficiency; Polymerase Chain Reaction

Viridans streptococci are a major cause of infective endocarditis, and penicillin non-susceptibility is increasing in these organisms. We present the initial reported case of infective endocarditis due to penicillin non-susceptible viridans streptococci successfully treated with ceftriaxone monotherapy. The lack of evidence supporting the recommendations for treatment of endocarditis due to penicillin non-susceptible viridans streptococci is discussed.

Topics: Anti-Bacterial Agents; Ceftriaxone; Endocarditis, Bacterial; Humans; Male; Middle Aged; Penicillin Resistance; Streptococcal Infections; Treatment Outcome; Viridans Streptococci

A prosthetic aortic valve was implanted in a 41-year-old patient with connatal aortic stenosis. 14 months later a bacterial endocarditis was diagnosed and treated with ceftriaxone. 6 weeks later he had a relapse. Satellite streptococci could be cultivated from three blood cultures, later identified as Granulicatella adiacens. The patient was treated with penicillin and gentamicin.. In a short review of the literature the most important aspects of pathogenesis, diagnostics and therapy of endocarditis due to satellite streptococci are presented.

Topics: Adult; Aortic Valve; Aortic Valve Stenosis; Bacteremia; Bacteriological Techniques; Ceftriaxone; Drug Therapy, Combination; Endocarditis, Bacterial; Gentamicins; Heart Valve Prosthesis Implantation; Humans; Male; Mitral Valve; Penicillin G; Postoperative Complications; Recurrence; Streptococcal Infections; Streptococcus

Topics: Aged; Anti-Bacterial Agents; Bacteremia; Ceftriaxone; Combined Modality Therapy; Endocarditis, Bacterial; Escherichia coli Infections; Female; Gastroenteritis; Gentamicins; Heart Valve Prosthesis Implantation; Humans; Imipenem; Middle Aged; Urinary Tract Infections

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Aminoglycosides; Ampicillin; Anti-Bacterial Agents; Ceftriaxone; Child; Child, Preschool; Drug Resistance, Microbial; Drug Therapy, Combination; Endocarditis, Bacterial; Enterococcus faecalis; Female; Humans; Infant; Male; Middle Aged; Treatment Failure

Native valve endocarditis resulting from Proteus mirabilis is an exceptionally rare entity. To date, 10 cases have been reported. We present a case of a 58-y-old female with fevers, bacteremia, and embolic phenomenon. Unlike previous cases, early antibiotic treatment precluded valvular repair or death, leading to a favorable outcome.

Topics: Anti-Bacterial Agents; Ceftriaxone; Endocarditis, Bacterial; Female; Humans; Middle Aged; Proteus Infections; Proteus mirabilis; Treatment Outcome

Aerococcus urinae is a rarely reported pathogen that often causes mild urinary tract infection (UTI), although serious complications such as endocarditis and septicemia have also been described. The organism may easily be missed or misidentified when using commercial detection systems. A. urinae is resistant to sulfonamides and, therefore, a typical treatment for UTI may be inappropriate. To date, 14 cases of A. urinae infective endocarditis (IE) have been reported, most of which were elderly males with predisposing conditions to UTI. Of these patients, eight died and 50% of survivors had severe neurological problems. The case is reported of blood culture-negative IE in a 69-year-old male. The patient recovered fully after undergoing aortic valve replacement and receiving a nine-day course of intravenous ceftriaxone, followed by peroral cefuroxime for the next 11 weeks. The causative agent was identified from the excised valve by bacterial broad-range PCR and direct sequencing of the 16S rRNA gene.

Topics: Aged; Anti-Bacterial Agents; Aortic Valve Insufficiency; Ceftriaxone; Endocarditis, Bacterial; Gram-Positive Bacterial Infections; Heart Valve Prosthesis Implantation; Humans; Male; Streptococcaceae

A case is reported of prosthetic valve endocarditis due to Neisseria elongata subsp. elongata in a patient with Klinefelter's syndrome. This is believed to be only the third case of endocarditis reported due to this subspecies. N. elongata is difficult to identify, and is morphologically and biochemically similar to Kingella spp. Sequencing of the 16S rRNA gene is useful for identification. The patient was successfully treated with amoxicillin and gentamicin, followed by ceftriaxone.

Topics: Aged; Amoxicillin; Ceftriaxone; Diagnosis, Differential; DNA, Bacterial; DNA, Ribosomal; Endocarditis, Bacterial; Gentamicins; Heart Valve Prosthesis; Humans; Kingella; Klinefelter Syndrome; Male; Molecular Sequence Data; Neisseria elongata; Neisseriaceae Infections; Prosthesis-Related Infections; RNA, Ribosomal, 16S; Sequence Analysis, DNA

Propionibacterium acnes endocarditis is an uncommon infection in pediatrics. We describe a case of P. acnes endocarditis in a 16-year-old boy that occurred 6 months after recurrent surgery for a congenital cardiopathy. Molecular identification of P. acnes was obtained. He recovered from this infection after a surgical treatment and with a prolonged antibiotic regimen including ceftriaxone.

Topics: Adolescent; Anti-Bacterial Agents; Cardiomyopathies; Ceftriaxone; Endocarditis, Bacterial; France; Humans; Male; Propionibacterium acnes; Prosthesis-Related Infections; Treatment Outcome

Human cases due to Salmonella enterica subsp. arizonae are especially rare, but it may affect immunocompromised patients and infants. We present a case of endocarditis in a patient with sickle cell disease and a review of earlier cases caused by this rare human pathogen. The patient was successfully treated with ceftriaxone and ciprofloxacin. There are only few cases of salmonella endocarditis reported in the last six decades and it is the first case of Salmonella enterica subsp. arizonae endocarditis in the literature to the best of our knowledge.

Topics: Anemia, Sickle Cell; Anti-Bacterial Agents; Ceftriaxone; Ciprofloxacin; Echocardiography; Endocarditis, Bacterial; Female; Humans; Immunocompromised Host; Kidney Function Tests; Middle Aged; Salmonella arizonae

A 68-year-old man with septic discitis of low lumbar spine is presented. The patient suffered an acute hemorrhagic stroke due to rupture of mycotic aneurysm. Streptococcus bovis biotype I was found in blood cultures. Echocardiography showed bioprosthesis aortic endocarditis. Cardiac surgery was not performed because of normal bioprosthesis function and absence of peri-annular complications. The patient was discharged after 6 weeks of antibiotic treatment.

Topics: Aged; Anti-Bacterial Agents; Bioprosthesis; Ceftriaxone; Discitis; Drug Therapy, Combination; Endocarditis, Bacterial; Gentamicins; Humans; Lumbar Vertebrae; Male; Streptococcal Infections; Streptococcus bovis; Treatment Outcome

Patients with endocarditis who present after embolism from a large, mobile vegetation pose a clinical dilemma: should they be managed with early surgery with the aim of preventing further emboli, or should a medical strategy be employed that avoids the morbidity and mortality associated with surgery but which risks further emboli? The management of such a patient is discussed in the context of the published literature regarding embolic risk in endocarditis.

Topics: Adult; Anti-Bacterial Agents; C-Reactive Protein; Ceftriaxone; Echocardiography, Transesophageal; Embolism; Endocarditis, Bacterial; Female; Follow-Up Studies; Humans; Streptococcus agalactiae; Time Factors; Tomography, X-Ray Computed; Treatment Outcome; Tricuspid Valve

Endocarditis due to Abiotrophia sp. is rare and often associated with negative blood cultures. The rates of treatment failure, infection relapse and mortality are higher than in endocarditis caused by other viridans streptococci.. A retrospective review of A. defectiva endocarditis in a patient with prosthetic aortic valve and in a patient with Marfan syndrome was performed.. A. defectiva, susceptible to penicillin (MIC 0.064 mg/l and 0.016 mg/l, respectively) was isolated from blood cultures of both patients. Treatment with penicillin and gentamicin was started in both patients. Since the first patient developed a macular rash and leukopenia, penicillin was substituted with ceftriaxone. Both patients responded well to antibiotic treatment, did not need prosthetic valve insertion or reinsertion, and were without any sequelae at one year follow up.. Standard treatment of bacterial endocarditis with penicillin and gentamicin was effective in both patients. In contrast to previous reports, the present patients had a favorable outcome on completion of treatment and at one-year follow up.

Topics: Adult; Anti-Bacterial Agents; Aortic Valve; Ceftriaxone; Drug Therapy, Combination; Endocarditis, Bacterial; Gentamicins; Heart Valve Prosthesis; Humans; Male; Marfan Syndrome; Middle Aged; Penicillins; Prosthesis-Related Infections; Streptococcal Infections

To compare the in vitro and in vivo activity of penicillin, cefotaxime and ceftriaxone, using three strains of Streptococcus pneumoniae with different susceptibilities to penicillin (MICs of 0.015, 0.25 and 2 mg/L, respectively).. Time-kill curves and an experimental model of endocarditis in rabbits.. Penicillin was efficacious in clearing bacteria from vegetations and blood irrespective of whether infections were caused by penicillin-susceptible or penicillin-resistant strains (P < 0.01 with respect to control groups). The same efficacy was shown with cefotaxime and ceftriaxone. Comparing the results of the in vivo model with those obtained in time-kill curves, penicillin showed the best results.. These results confirm that penicillin is efficacious in the treatment of pneumococcal infections, including those produced by strains with MICs < or = 2 mg/L (with the exception of pneumococcal meningitis). These results also suggest that the breakpoints to define susceptibility and resistance of S. pneumoniae to penicillin must be reviewed, as has been done with amoxicillin and third-generation cephalosporins.

Topics: Animals; Anti-Bacterial Agents; beta-Lactams; Cefotaxime; Ceftriaxone; Endocarditis, Bacterial; Half-Life; Microbial Sensitivity Tests; Penicillin Resistance; Penicillins; Pneumococcal Infections; Rabbits; Streptococcus pneumoniae

A case of native valve endocarditis caused by Enterococcus durans in a patient with transposition of the great vessels is reported. The patient was treated initially with gentamicin and ceftriaxone; after isolation of enterococci, ceftriaxone was switched to ampicillin. The only virulence factors established in the strain were haemolytic activity and biofilm formation.

Topics: Adult; Ampicillin; Biofilms; Ceftriaxone; Drug Therapy, Combination; Endocarditis, Bacterial; Enterococcus; Gentamicins; Gram-Positive Bacterial Infections; Hemolysis; Humans; Male; Microbial Sensitivity Tests; Transposition of Great Vessels; Virulence

Severe thrombocytopenia is a life-threatening condition. It is often associated with immune-mediated platelet destruction or myeloablative chemotherapy. Infective endocarditis has been associated with thrombocytopenia, which, as in sepsis, tends to be mild and is often the result of several pathological mechanisms. We report a case of Cardiobacterium hominis endocarditis associated with very severe thrombocytopenia and bleeding in a patient who refused platelet transfusion. Platelet autoantibodies directed against glycoprotein (Gp) IIb/IIIa and Gp Ib/IX were detected during active infection using a glycoprotein-specific assay. Successful treatment of C. hominis endocarditis was associated with loss of platelet autoantibodies and recovery of the platelet count. This report illustrates that the development of platelet autoantibodies can contribute to very severe thrombocytopenia in occasional patients with infective endocarditis.

Topics: Ampicillin; Antigens, Human Platelet; Aortic Valve Stenosis; Autoantibodies; Autoimmune Diseases; Bacteremia; Bone Marrow; Cardiobacterium; Ceftriaxone; Ciprofloxacin; Diagnostic Errors; Drug Therapy, Combination; Endocarditis, Bacterial; Gentamicins; Gram-Negative Bacterial Infections; Heart Valve Prosthesis; Histiocytosis, Non-Langerhans-Cell; Humans; Jehovah's Witnesses; Male; Middle Aged; Platelet Transfusion; Postoperative Complications; Purpura, Thrombocytopenic; Splenic Infarction; Thrombocytopenia; Treatment Refusal

The case of a patient with highly gentamicin-resistant Enterococcus faecalis endocarditis treated with an ampicillin + ceftriaxone combination is described. We have designed a method to evaluate synergism between the antibacterial activity of patient's serum taken during a given antibiotic regimen (ampicillin) to which another antibiotic (ceftriaxone) is added in vitro. In this patient the two-drug combination was able to stop the bacteremia and prevent the infection of the prosthetic valve.

Topics: Aged; Ampicillin; Ceftriaxone; Drug Resistance, Bacterial; Drug Therapy, Combination; Endocarditis, Bacterial; Enterococcus faecalis; Follow-Up Studies; Gentamicins; Gram-Positive Bacterial Infections; Humans; Male; Microbial Sensitivity Tests; Risk Assessment; Treatment Outcome

Topics: Actinobacillus Infections; Adult; Anti-Bacterial Agents; Ceftriaxone; Ciprofloxacin; Drug Therapy, Combination; Endocarditis, Bacterial; Follow-Up Studies; Haemophilus Infections; Haemophilus parainfluenzae; Humans; Male; Middle Aged; Pleural Effusion; Rifampin; Time Factors; Treatment Outcome

Topics: Adult; Anti-Bacterial Agents; Aortic Valve; Ceftriaxone; Endocarditis, Bacterial; Gammaproteobacteria; Humans; Injections, Intravenous; Male; Pain; Prosthesis-Related Infections

This study tests the usefulness of ceftriaxone combined with ampicillin as an alternative to ampicillin plus gentamicin for the treatment of experimental endocarditis due to Enterococcus faecalis without high-level resistance to aminoglycosides. It also determines whether adding ceftriaxone to ampicillin and gentamicin increases the effectiveness against experimental enterococcal endocarditis resulting from E. faecalis.. Animals with catheter-induced endocarditis were infected intravenously with 108 cfu of the EF91 strain of E. faecalis and were treated for 3 days with ampicillin 2 g every 4 h administered as 'human-like' (H-L) pharmacokinetics, plus gentamicin 1 mg/kg every 8 h H-L, or ceftriaxone 2 g every 12 h H-L alone or combined with gentamicin 6 mg/kg every 24 h administered subcutaneously.. The results of therapy for experimental endocarditis resulting from EF91 showed that the combination of ampicillin plus ceftriaxone was as effective as ampicillin plus gentamicin. The triple combination did not improve on the overall efficacies of the two-drug combinations.. Because of its lower nephrotoxicity, ampicillin plus ceftriaxone may be a useful alternative therapy for E. faecalis endocarditis in selected patients.

Topics: Aminoglycosides; Ampicillin; Animals; Anti-Bacterial Agents; Area Under Curve; Ceftriaxone; Cephalosporins; Drug Resistance, Bacterial; Drug Synergism; Drug Therapy, Combination; Endocarditis, Bacterial; Enterococcus faecalis; Gentamicins; Half-Life; Humans; Microbial Sensitivity Tests; Penicillins; Rabbits

Topics: Anti-Bacterial Agents; Ceftriaxone; Endocarditis, Bacterial; Female; Haemophilus; Haemophilus Infections; Humans; Middle Aged; Treatment Outcome

The bacterial species Erysipelothrix rhusiopathiae is found worldwide as a commensal or a pathogen in a variety of animals. One well-defined pattern of human infection is an uncommon bacteremic form, with or without cutaneous involvement, usually complicated by endocarditis. We report the case of a 38-year-old male butcher with E. rhusiopathiae bacteremia, native aortic valve endocarditis and perivalvular abscess. The patient was released after six weeks of intravenous ceftriaxone and aortic valve replacement because of severe regurgitation.

Topics: Abscess; Adult; Aortic Valve; Aortic Valve Insufficiency; Bacteremia; Ceftriaxone; Cephalosporins; Endocarditis, Bacterial; Erysipelothrix Infections; Heart Valve Diseases; Heart Valve Prosthesis Implantation; Humans; Male

A 59-year-old female patient with mitral valve prolapse and a previous history of lumbosacral spondyloarthrosis and lumbar disk hernia had an episode of infective endocarditis due to Streptococcus viridans, which evolved with peripheral embolism to the left kidney, spleen, and left iliac artery, and intraventricular cerebral hemorrhage. Her clinical manifestations were low back pain and hematuria, which were initially attributed to an osteoarticular condition. Infective endocarditis is a severe polymorphic disease with multiple clinical manifestations and it should always be included in the differential diagnosis by clinicians.

Topics: Amikacin; Ceftriaxone; Cephalosporins; Embolism; Endocarditis, Bacterial; Female; Hematuria; Humans; Low Back Pain; Middle Aged; Mitral Valve Prolapse; Streptococcus; Vancomycin

Viridans streptococci are the commonest cause of native valve infective endocarditis (IE). The taxonomy of this group is evolving allowing new disease associations to be made. Streptococcus vestibularis is a recently described member of the viridans group, first isolated from the vestibular mucosa of the human oral cavity. It has rarely been associated with human disease. Streptococcus oralis, another member of the viridans group resident in the human oral cavity is a well known cause of IE and bacteraemia in neutropenic patients. We report the first case of native mitral valve endocarditis due to S. vestibularis in a patient with co-existing S. oralis endocarditis.

Topics: Aged; Anti-Bacterial Agents; Ceftriaxone; Endocarditis, Bacterial; Female; Gentamicins; Humans; Mitral Valve; Streptococcal Infections; Streptococcus; Vancomycin

We compared the efficacy of ceftriaxone combined with gentamicin, both given once a day, with that of cloxacillin given every 4 h plus gentamicin given once a day or in three daily doses (t.i.d.) for the treatment of experimental methicillin-susceptible staphylococcal endocarditis. The antibiotics were administered by using human-like (H-L) pharmacokinetics that simulated the profiles of these drugs in human serum. Animals with catheter-induced endocarditis were infected intravenously with 10(5) CFU of Staphylococcus aureus S5 (MICs and minimal bactericidal concentrations of cloxacillin, ceftriaxone, and gentamicin, 0.5 and 2 microg/ml, 4 and 8 microg/ml, and 0.5 and 1 microg/ml, respectively). The animals were then treated for 24 h with cloxacillin at a dose of 2 g that simulated H-L pharmacokinetics (H-L 2 g) every 4 h alone or combined with gentamicin (administered at doses of H-L 1 mg/kg of body weight every 8 h or H-L 4.5 mg/kg every 24 h) or with ceftriaxone at H-L 2 g every 24 h alone or combined with gentamicin (administered at doses of H-L 1 mg/kg every 8 h or H-L 4.5 mg/kg every 24 h). The results of therapy for experimental endocarditis due to the S5 strain showed that (i) cloxacillin alone is more effective than ceftriaxone alone in reducing the bacterial load (P < 0.01), (ii) the combination of cloxacillin or ceftriaxone with gentamicin is more effective than each of these drugs alone (P < 0.01), and (iii) Ceftriaxone H-L plus gentamicin H-L 4.5 mg/kg, both administered every 24 h, showed efficacy similar to that of the "gold standard," cloxacillin H-L plus gentamicin H-L 1 mg/kg t.i.d. (P > 0.05). An increase in the interval of administration of gentamicin to once daily resulted in a reduction in the numbers of bacteria in the vegetations equivalent to that achieved with the recommended regimen of cloxacillin plus gentamicin t.i.d. in the treatment of experimental endocarditis due to methicillin-susceptible S. aureus. Ceftriaxone plus gentamicin, both administered once a day, may be useful for home-based therapy for selected cases of staphylococcal endocarditis.

Topics: Animals; Anti-Bacterial Agents; Ceftriaxone; Cephalosporins; Disease Models, Animal; Drug Therapy, Combination; Endocarditis, Bacterial; Gentamicins; Microbial Sensitivity Tests; Rabbits; Staphylococcus aureus; Treatment Outcome

Topics: Actinobacillus Infections; Adult; Aggregatibacter actinomycetemcomitans; Anti-Infective Agents; Ceftriaxone; Cephalosporins; Ciprofloxacin; Drug Therapy, Combination; Endocarditis, Bacterial; Female; Humans

Topics: Ceftriaxone; Cephalosporin Resistance; Endocarditis, Bacterial; Humans; Infant; Male; Penicillin Resistance; Streptococcal Infections; Streptococcus

The efficacy of different antibiotics was compared in an experimental model of aortic valve endocarditis in rabbits, using a serotype 19 strain of Streptococcus pneumoniae resistant to penicillin (MIC 12 mg/L) and ceftriaxone (MIC 12 mg/L). The results were compared with those of a control group, which received no treatment. One hundred and nineteen animals were treated with one of the following antibiotic regimens: im procaine penicillin G at a dosage of 300,000 U/kg weight/12 h (16 animals); iv trovafloxacin, 13.3 mg/kg/12 h (31 animals); iv ceftriaxone, 75 mg/kg/24 h (21 animals); iv vancomycin, 20 mg/kg/12 h (15 animals) and im quinupristin-dalfopristin, 30 mg/kg/8 h (20 animals). All the antibiotics used in this study proved to be efficient in reducing numbers of S. pneumoniae and in increasing the percentage of aortic vegetations that were rendered sterile compared with the control group. Penicillin at the dosage used in our study was capable of achieving serum concentrations two or three times greater than the MIC, thus demonstrating its effectiveness as an antibiotic for this endocarditis model. No significant difference was observed between the effects of vancomycin, quinupristin-dalfopristin and penicillin. Vancomycin proved to be more efficient than trovofloxacin in reducing the bacterial load and increasing the numbers sterilized. There was also a tendency for this antibiotic to be more effective than ceftriaxone in reducing the bacterial load of the vegetations. There was a statistically significant correlation between the weight of the vegetations and their bacterial load. In the light of these results, vancomycin and quinupristin-dalfopristin may be considered suitable alternatives to penicillin for the treatment of penicillin-resistant S. pneumoniae endocarditis.

Topics: Animals; Anti-Infective Agents; Ceftriaxone; Disease Models, Animal; Drug Resistance, Multiple; Endocarditis, Bacterial; Fluoroquinolones; Humans; Male; Naphthyridines; Penicillin Resistance; Penicillins; Pneumococcal Infections; Rabbits; Streptococcus pneumoniae; Vancomycin; Virginiamycin

We present a case of endocarditis caused by Salmonella in a patient with newly diagnosed diabetes and preexisting rheumatic heart disease. Despite sterilization of the blood with a fluoroquinolone and a third-generation cephalosporin, the patient required surgical intervention.

Topics: Aged; Anti-Infective Agents; Cardiac Catheterization; Ceftriaxone; Cephalosporins; Combined Modality Therapy; Diabetes Mellitus, Type 2; Drug Therapy, Combination; Echocardiography, Transesophageal; Endocarditis, Bacterial; Fatal Outcome; Fever; Headache; Heart Valve Prosthesis Implantation; Humans; Male; Nausea; Ofloxacin; Rheumatic Heart Disease; Salmonella Infections; Vomiting

Neisseria elongata subsp. elongata, previously considered nonpathogenic, is a potential agent of human endocarditis. We report the second case of human endocarditis caused by this organism. The patient was successfully treated with Ceftriaxone alone for a total of six weeks.

Topics: Aged; Ceftriaxone; Cephalosporins; Endocarditis, Bacterial; Female; Gram-Negative Bacterial Infections; Humans; Neisseria

Topics: Aged; Agranulocytosis; Ceftriaxone; Cephalosporins; Drug Administration Schedule; Endocarditis, Bacterial; Epilepsy, Tonic-Clonic; Humans; Male; Streptococcal Infections; Streptococcus bovis; Time Factors

Topics: Adult; Ceftriaxone; Cephalosporins; Drug Resistance, Microbial; Endocarditis, Bacterial; Humans; Immunocompetence; Male; Microbial Sensitivity Tests; Streptococcal Infections; Streptococcus

We describe a 66-year-old woman with infective endocarditis due to Cardiobacterium hominis whose condition, complicated by severe aortic regurgitation and congestive heart failure, necessitated aortic valve replacement despite treatment with ceftriaxone followed by ciprofloxacin. The blood isolate of C. hominis produced beta-lactamase and exhibited high-level resistance to penicillin (MIC, >==256 microgram/ml) and reduced susceptibility to vancomycin (MIC, 8 microgram/ml).

Topics: Aged; Aortic Valve; Aortic Valve Insufficiency; beta-Lactamases; Ceftriaxone; Ciprofloxacin; Endocarditis, Bacterial; Female; Gram-Negative Bacterial Infections; Gram-Negative Facultatively Anaerobic Rods; Heart Failure; Heart Valve Prosthesis Implantation; Humans; Microbial Sensitivity Tests; Penicillin Resistance; Penicillins; Taiwan; Vancomycin

The purpose of this work was to evaluate the in vitro possibilities of ampicillin-ceftriaxone combinations for 10 Enterococcus faecalis strains with high-level resistance to aminoglycosides (HLRAg) and to assess the efficacy of ampicillin plus ceftriaxone, both administered with humanlike pharmacokinetics, for the treatment of experimental endocarditis due to HLRAg E. faecalis. A reduction of 1 to 4 dilutions in MICs of ampicillin was obtained when ampicillin was combined with a fixed subinhibitory ceftriaxone concentration of 4 micrograms/ml. This potentiating effect was also observed by the double disk method with all 10 strains. Time-kill studies performed with 1 and 2 micrograms of ampicillin alone per ml or in combination with 5, 10, 20, 40, and 60 micrograms of ceftriaxone per ml showed a > or = 2 log10 reduction in CFU per milliliter with respect to ampicillin alone and to the initial inoculum for all 10 E. faecalis strains studied. This effect was obtained for seven strains with the combination of 2 micrograms of ampicillin per ml plus 10 micrograms of ceftriaxone per ml and for six strains with 5 micrograms of ceftriaxone per ml. Animals with catheter-induced endocarditis were infected intravenously with 10(8) CFU of E. faecalis V48 or 10(5) CFU of E. faecalis V45 and were treated for 3 days with humanlike pharmacokinetics of 2 g of ampicillin every 4 h, alone or combined with 2 g of ceftriaxone every 12 h. The levels in serum and the pharmacokinetic parameters of the humanlike pharmacokinetics of ampicillin or ceftriaxone in rabbits were similar to those found in humans treated with 2 g of ampicillin or ceftriaxone intravenously. Results of the therapy for experimental endocarditis caused by E. faecalis V48 or V45 showed that the residual bacterial titers in aortic valve vegetations were significantly lower in the animals treated with the combinations of ampicillin plus ceftriaxone than in those treated with ampicillin alone (P < 0.001). The combination of ampicillin and ceftriaxone showed in vitro and in vivo synergism against HLRAg E. faecalis.

Topics: Algorithms; Aminoglycosides; Ampicillin; Animals; Anti-Bacterial Agents; Ceftriaxone; Cephalosporins; Colony Count, Microbial; Drug Resistance, Microbial; Drug Synergism; Drug Therapy, Combination; Endocarditis, Bacterial; Enterococcus faecalis; Infusion Pumps; Injections, Intravenous; Models, Biological; Penicillins; Rabbits

Levofloxacin was investigated against viridans group streptococci in vitro and in rats with experimental aortic endocarditis. The MIC(90)s of levofloxacin and ciprofloxacin for 20 independent isolates of such bacteria were 1 and 8 mg/L, respectively. Rats were infected with two types of organism: either fully susceptible to levofloxacin MIC < or = 0.5 mg/L) or borderline susceptible (MIC 1-2 mg/L). Fully levofloxacin-susceptible bacteria comprised one penicillin-susceptible (MIC 0.004 mg/L) Streptococcus gordonii, and one penicillin-tolerant as well as one intermediate penicillin-resistant (MIC 0.125 mg/L) isogenic strains. Borderline levofloxacin-susceptible bacteria comprised one penicillin-susceptible Streptococcus sanguis and one highly penicillin-resistant Streptococcus mitis (MIC 2 mg/L). Rats were treated for 5 days with drug dosages simulating the following treatments in humans: (i) levofloxacin 500 mg orally once a day (q24 h), (ii) levofloxacin 500 mg orally twice a day (q12 h), (iii) levofloxacin 1 g orally q24 h, (iv) ciprofloxacin 750 mg orally q12 h, and (v) ceftriaxone 2 g iv q24 h. Levofloxacin was equivalent or superior to ceftriaxone, and was successful in treating experimental endocarditis irrespective of penicillin resistance. Nevertheless, standard levofloxacin treatment equivalent to 500 mg q24 h in human was less effective than twice daily 500 mg or once daily 1 g doses against borderline-susceptible organisms. Ciprofloxacin, used as a negative control, was ineffective and selected for resistant isolates. This underlines the importance of MIC determinations when treating severe streptococcal infection with quinolones. In the case of borderline-susceptible pathogens, total daily doses of 1 g of levofloxacin should be considered.

Topics: Animals; Anti-Infective Agents; Catheterization; Ceftriaxone; Ciprofloxacin; Endocarditis, Bacterial; Levofloxacin; Microbial Sensitivity Tests; Ofloxacin; Penicillin Resistance; Rats; Streptococcal Infections; Streptococcus; Streptococcus sanguis; Treatment Outcome

The emergence of antibiotic resistance in Streptococcus pneumoniae poses a particular threat to HIV-infected patients. These patients are at increased risk of invasive pneumococcal disease and may respond poorly to pneumococcal vaccination. We describe an HIV-infected patient with recurrent aortic valve endocarditis due to the same serotype of S. pneumoniae (19A) despite appropriate treatment with penicillin and immunoprophylaxis. The pneumococcus responsible for the second episode of endocarditis was susceptible to cefotaxime (MIC of 0.06 microg/ml), but was no longer susceptible to penicillin (MIC of 0.25 microg/ml). The patient was treated successfully with 4 weeks of intravenous ceftriaxone.

Topics: Aortic Valve; Bacterial Vaccines; Ceftriaxone; Echocardiography; Endocarditis, Bacterial; Heart Valve Diseases; HIV Infections; Humans; Male; Middle Aged; Penicillin G; Penicillin Resistance; Penicillins; Pneumococcal Infections; Pneumococcal Vaccines; Recurrence; Streptococcus pneumoniae

The authors report a case of biliary colic secondary to gallstones formed during a course of therapy with Ceftriaxone. Three weeks after cessation of therapy the gallstones dissolved.

Topics: Adult; Ceftriaxone; Cephalosporins; Cholelithiasis; Colic; Endocarditis, Bacterial; Humans; Iatrogenic Disease; Male

Topics: Aged; Agranulocytosis; Ceftriaxone; Cephalosporins; Diagnosis, Differential; Endocarditis, Bacterial; Humans; Male; Streptococcal Infections; Streptococcus sanguis

A 2-year-old child, non immunodeficient, presented with septicemia due to Kingella kingae successively complicated by meningitis, arthritis of one knee and endocarditis. Outcome was favourable after a long and adjusted antibiotherapy, involving in particular for the endocarditis ceftriaxone (100 mg/kg/d) and amikacin (20 mg/kg/d) during 3 weeks, then amoxicillin per os (200 mg/kg/d) during 3 weeks.. Bacteriologic characteristics of the bacteria, the culture of which requires medium base with additional nutrient are reviewed. The tropism of Kingella kingae is essentially osteoarticular and cardiac as shown by the cases reported in the literature. Its susceptibility to antibiotics explains the frequent favourable outcome.

Topics: Amikacin; Amoxicillin; Arthritis, Infectious; Bacteremia; Ceftriaxone; Child, Preschool; Drug Therapy, Combination; Echocardiography; Endocarditis, Bacterial; Female; Humans; Infant; Kingella kingae; Meningitis, Bacterial; Neisseriaceae Infections

Topics: Aged; Ceftriaxone; Cephalosporins; Echocardiography; Endocarditis, Bacterial; Humans; Middle Aged; Risk Factors

The role of granulocyte colony-stimulating factor with and without antibiotics in the treatment of catheter-related infection and infective endocarditis caused by methicillin-susceptible Staphylococcus aureus was assessed in the experimental rabbit model. Granulocyte colony-stimulating factor stimulated leukocytosis in infected animals but did not increase the clearance of methicillin-susceptible S. aureus from peripheral blood, subcutaneous port catheters, intravascular cardiac catheters, or aortic valve vegetations.

Topics: Animals; Cardiac Catheterization; Ceftriaxone; Cephalosporins; Drug Combinations; Endocarditis, Bacterial; Granulocyte Colony-Stimulating Factor; Leukocyte Count; Rabbits; Staphylococcal Infections; Staphylococcus aureus; Survival Analysis

Topics: Ceftriaxone; Cephalosporin Resistance; Endocarditis, Bacterial; Female; Humans; Middle Aged; Penicillin Resistance; Penicillins; Rifampin; Streptococcus pneumoniae; Vancomycin

The efficacy of ceftriaxone or penicillin alone or combined with gentamicin at different dosing intervals was evaluated in experimental endocarditis due to a penicillin-susceptible, ceftriaxone-tolerant strain of Streptococcus sanguis I. The difference between monotherapy with ceftriaxone and procaine penicillin approached statistical significance (P = 0.052). Ceftriaxone combined with gentamicin administered as a single daily dose was less effective than was procaine penicillin combined with gentamicin administered in a single daily dose or in three divided doses.

Topics: Animals; Anti-Bacterial Agents; Ceftriaxone; Drug Resistance, Microbial; Drug Therapy, Combination; Endocarditis, Bacterial; Gentamicins; Microbial Sensitivity Tests; Penicillin G Procaine; Rabbits; Streptococcal Infections; Streptococcus sanguis

A synergistic bactericidal effect between penicillin, vancomycin, and gentamicin has been described against enterococci highly resistant to beta-lactams and glycopeptides. Since such a synergy was also observed in vitro between ceftriaxone, teicoplanin, and gentamicin against Enterococcus faecium 70/90, the efficacy of different combinations including penicillin or ceftriaxone, vancomycin or teicoplanin, and gentamicin was compared in vivo in experimental endocarditis. In vitro, all four triple combinations provided a bactericidal effect. In rabbits, after a 5-day treatment, the ceftriaxone-vancomycin-gentamicin combination was the most effective, both in reducing the total bacterial titers and in eradicating the subpopulation resistant to the synergy. Compared with the 5-day regimen, 10- and 20-day regimens of ceftriaxone-vancomycin-gentamicin, each followed by a 3-day antibiotic-free period, increased the number of sterilized animals but failed to avoid the emergence of resistant bacteria, which occurred in 10%-20% of animals.

Topics: Animals; Ceftriaxone; Drug Resistance, Microbial; Drug Synergism; Drug Therapy, Combination; Endocarditis, Bacterial; Enterococcus faecium; Female; Gentamicins; Gram-Positive Bacterial Infections; Penicillins; Rabbits; Random Allocation; Recurrence; Teicoplanin; Vancomycin

A new, investigational, parenteral form of sparfloxacin was compared with ceftriaxone in the treatment of experimental endocarditis caused by either of three penicillin-susceptible streptococci or one penicillin-resistant streptococcus. Both drugs have prolonged half-lives in serum, allowing single daily administration to humans. Sparfloxacin had relatively low MICs (0.25 to 0.5 mg/liter) for all four organisms and was also greater than or equal to eight times more effective than the other quinolones against 21 additional streptococcal isolates recovered from patients with bacteremia. Ceftriaxone MICs were 0.032 to 0.064 mg/liter for the penicillin-susceptible strains and 2 mg/liter for the resistant isolate. Both antibiotics resulted in moderate bacterial killing in vitro. Rats with catheter-induced aortic vegetations were inoculated with 10(7) CFU of the test organisms. Antibiotic treatment was started 48 h later and lasted either 3 or 5 days. The drugs were injected at doses which mimicked the kinetics in human serum produced by one intravenous injection of 400 mg of sparfloxacin (i.e., the daily dose expected to be given to human adults) and 2 g of ceftriaxone. Both antibiotics significantly decreased the bacterial densities in the vegetations. However, sparfloxacin was slower than ceftriaxone in its ability to eradicate valvular infection caused by penicillin-susceptible bacteria. While this difference was quite marked after 3 days of therapy, it tended to vanish when treatment was prolonged to 5 days. In contrast, sparfloxacin was very effective against the penicillin-resistant isolate, an organism against which ceftriaxone therapy failed in vivo. No sparfloxacin-resistant mutant was selected during therapy. Thus, in the present experimental setting, this new, investigational, parenteral form of sparfloxacin was effective against severe infections caused by both penicillin-susceptible and penicillin-resistant streptococci.

Topics: Animals; Anti-Infective Agents; Ceftriaxone; Endocarditis, Bacterial; Female; Fluoroquinolones; Microbial Sensitivity Tests; Penicillin Resistance; Quinolones; Rats; Rats, Wistar; Streptococcal Infections

We performed experiments in rats aimed at determining whether a combination of ceftriaxone (CRO) and netilmicin (NET), by using once-daily administration in rats, which simulated profiles of drug in human serum, was more effective than either agent alone in the treatment of endocarditis caused by viridans group streptococci. A programmable infusion pump system enabled the production of profiles of CRO in serum that simulate those found in humans after the intravenous administration of 2 g. The subcutaneous administration of 18 mg of NET per kg of body weight produced levels in the sera of rats comparable to those after the intravenous administration of a dose of 5 mg of NET per kg in humans. Rats with catheter-induced aortic vegetations were infected intravenously with two test strains, a CRO-susceptible Streptococcus sanguis strain (MICs of CRO and NET, 0.064 and 8 mg/liter, respectively) and a relatively CRO-resistant Streptococcus mitis strain (MICs of CRO and NET, 2 and 8 mg/liter, respectively). Against both strains, the combination of CRO and NET was synergistic in vitro as determined by time-kill curves. Treatment of rats was started 48 h postinfection and lasted for 3 days. CRO alone was effective against the susceptible strain (P < 0.001 compared with control animals) but was not effective against the resistant organism. A significantly enhanced antibacterial activity of the CRO-NET combination in reducing the valvular bacterial counts was observed with both test strains (P < 0.001). The synergistic effect was obtained with a single daily injection of NET which provided detectable levels in serum for only 8 h, suggesting that in vivo synergism in the treatment of infections caused by viridans group streptococci can be obtained without 24 h of aminoglycoside coverage. These experimental data might provide a rationale for clinical trials of a once-a-day dosing regimen in the treatment of streptococcal but nonenterococcal endocarditis.

Topics: Animals; Ceftriaxone; Endocarditis, Bacterial; Female; Humans; Infusion Pumps; Microbial Sensitivity Tests; Netilmicin; Rats; Rats, Wistar; Serum Bactericidal Test; Streptococcal Infections; Streptococcus; Streptococcus sanguis

We have conducted experiments to determine if one daily injection of netilmicin (NET) would be synergistic with the broad-spectrum cephalosporin ceftriaxone (CRO) in the treatment of experimentally induced endocarditis. Rats with catheter-induced aortic vegetations were infected intravenously with 3 x 10(7) CFU of a beta-lactam-sensitive strain of Streptococcus sanguis or a beta-lactam-resistant strain of Streptococcus mitis. Treatment with the antibiotics alone (CRO, 10 mg/kg of body weight every 8 h; NET, 18 mg/kg every 24 h) or in combinations which had proved synergistic in in vitro time-kill curves was commenced 48 h postinfection and continued for 72 h. The results show that the combination was markedly effective against S. sanguis and moderately effective against S. mitis, while, with the protocol used here, the agents alone were not. The results suggest that CRO-NET should be an effective combination for treating streptococcal endocarditis in humans and may permit a shorter duration of treatment and once-a-day dosing to be used.

Topics: Animals; Ceftriaxone; Drug Resistance, Microbial; Drug Synergism; Drug Therapy, Combination; Endocarditis, Bacterial; Female; Microbial Sensitivity Tests; Netilmicin; Rats; Rats, Wistar; Serum Bactericidal Test; Streptococcal Infections; Streptococcus; Streptococcus sanguis

Topics: Actinobacillus Infections; Adult; Aggregatibacter actinomycetemcomitans; Ceftriaxone; Cholelithiasis; Endocarditis, Bacterial; Female; Humans

Topics: Administration, Oral; Amoxicillin; Ceftriaxone; Endocarditis, Bacterial; Female; Humans; Injections, Intramuscular; Injections, Intravenous; Middle Aged; Streptococcal Infections; Streptococcus bovis

Topics: Ambulatory Care; Ceftriaxone; Endocarditis, Bacterial; Humans; Penicillin G; Penicillin Resistance; Streptococcal Infections

The in-vitro post-antibiotic effect (PAE) of amikacin alone and in combination with ceftazidime, ceftriaxone and piperacillin was studied for two strains of Enterococcus faecalis using a bioluminescent assay of bacterial ATP. The two strains of E. faecalis were resistant to amikacin, ceftazidime and ceftriaxone but sensitive to piperacillin. The bacterial cultures were incubated with the beta-lactam antibiotics for 1 h and concentrations of amikacin between 2-64 mg/l were then added. Thereafter, incubation continued with the combinations for one more hour. After dilution, regrowth was monitored by measuring bacterial ATP every hour. Increasing concentrations of amikacin (2-64 mg/l), ceftazidime (8-32 mg/l) and ceftriaxone (32-128 mg/l) resulted in little or no PAE (0-0.3 h) on these strains. PAEs of 0.5 to 1.6 h resulted from exposure to piperacillin (4-32 mg/l). In combination amikacin and piperacillin increased the PAE to 5.5 h. A synergistic PAE was also seen when the enterococci were exposed to amikacin combined with ceftazidime or ceftriaxone in concentrations close to the MICs of the latter antibiotics.

Topics: Amikacin; Anti-Bacterial Agents; Ceftazidime; Ceftriaxone; Drug Synergism; Drug Therapy, Combination; Endocarditis, Bacterial; Enterococcus faecalis; Humans; Microbial Sensitivity Tests; Piperacillin; Streptococcal Infections

Heterogeneous diffusion of some antibiotics into fibrin rich infectious processes is one explanation of the difficulty to cure infections such as endocarditis. Ceftriaxone is a beta lactam antibiotic, potentially useful due to a broad spectrum of activity and its long elimination half-life. We investigated by means of autoradiography the diffusion of labelled ceftriaxone into large infected cardiac vegetations obtained in a rabbit model of endocarditis. Ten d after infection 250 microCi 14C ceftriaxone was injected over 30 min. Thirty min after the end of infusion (T30) vegetation/blood radioactivity ratio was 0.58 +/- 0.4 (n = 3). At T200, radioactivity decreased approximatively 3-fold, in blood and in vegetations simultaneously. Autoradiography showed that at T30, ceftriaxone was 20-30 times more concentrated at the periphery of vegetation than in the core. Autoradiography obtained at T200 showed a progressive diffusion toward the core. The diffusion gradient may explain the fact that high local concentrations are necessary to sterilize vegetations. The pattern of diffusion of antibiotics in fibrin is an important pharmacokinetic parameter for predicting in vivo activity.

Topics: Animals; Autoradiography; Carbon Radioisotopes; Ceftriaxone; Diffusion; Drug Evaluation, Preclinical; Endocarditis, Bacterial; Extracellular Matrix; Female; Fibrin; Myocardium; Rabbits

We studied the activity of the combination of sulbactam and ceftriaxone against a Klebsiella pneumoniae strain producing TEM-3, a new extended-broad-spectrum beta-lactamase, in an endocarditis model. In vitro, ceftriaxone was strongly inactivated in the presence of TEM-3 (MBC, 128 micrograms/ml with an inoculum of 5 x 10(5) CFU/ml). A marked inoculum effect was demonstrated with sulbactam: effective concentrations of inhibitor needed to reduce the MIC and MBC of ceftriaxone to similar levels increased from 1 microgram/ml in the presence of an inoculum of 5 x 10(5) CFU/ml to 20 micrograms/ml in the presence of an inoculum of 1 x 10(7) CFU/ml. In vivo, sulbactam given at 200 mg/kg of body weight every 12 h, a dosage higher than that previously reported to be effective against rabbit endocarditis caused by other microorganisms, was not sufficient to restore the complete activity of ceftriaxone given at 30 mg/kg once daily for 4 days. This insufficient activity may be correlated with the presence of a high level of beta-lactamase inside the vegetations, as indicated by a quantitative in vitro assay of beta-lactamase activity in the cardiac vegetation, suggesting an insufficient inactivation of the extended-broad-spectrum beta-lactamase in vivo.

Topics: Animals; beta-Lactamases; Ceftriaxone; Drug Resistance, Microbial; Drug Therapy, Combination; Endocarditis, Bacterial; Female; Half-Life; Klebsiella Infections; Klebsiella pneumoniae; Microbial Sensitivity Tests; Rabbits; Sulbactam

We studied the efficacy of sulbactam, a beta-lactamase inhibitor, in combination with ceftriaxone in vitro and in experimental endocarditis due to an Escherichia coli strain producing an extended-spectrum beta-lactamase most similar to SHV-2, a new mechanism of resistance to broad-spectrum cephalosporins among members of the family Enterobacteriaceae. In vitro, ceftriaxone demonstrated an important inoculum effect (MICs were 2 and 256 micrograms/ml with 5 X 10(5) and 5 X 10(7) CFU of inoculum per ml, respectively). Sulbactam inhibited the beta-lactamase degradation of ceftriaxone and enhanced the killing by ceftriaxone with both inocula tested. In vivo, sulbactam (100 mg/kg every 8 h) or ceftriaxone (15 or 30 mg/kg every 24 h) alone were ineffective after a 4-day therapy. The addition of sulbactam to ceftriaxone (15 mg/kg) or to the ceftriaxone (15 mg/kg)-netilmicin (6 mg/kg every 24 h) combination produced a reduction of 2 log10 CFU/g of vegetation greater than that produced by therapy without sulbactam. The sulbactam-ceftriaxone (30 mg/kg) combination produced a reduction of almost 5 log10 CFU/g of vegetation greater than that produced by single-drug therapy (P less than 0.01), sterilized five of eight vegetations (versus none of seven for ceftriaxone [30 mg/kg] alone; P less than 0.05), and was as effective as the ceftriaxone (15 mg/kg)-sulbactam-netilmicin combination. We concluded that (i) SHV-2 production was responsible for ceftriaxone failure in vivo, probably because of the high inoculum present in vegetations; (ii) sulbactam used in a regimen which provided levels in serum constantly above 4 micrograms/ml and a vegetation/serum peak ratio of approximately 1:3 enhanced the activity of a broad-spectrum cephalosporin in a severe experimental infection; and (iii) the highest dose of ceftriaxone in combination with sulbactam was as effective as the lowest dose of ceftriaxone plus sulbactam plus an aminoglycoside.

Topics: Animals; beta-Lactamase Inhibitors; Ceftriaxone; Drug Combinations; Endocarditis, Bacterial; Escherichia coli; Escherichia coli Infections; Female; Microbial Sensitivity Tests; Netilmicin; Rabbits; Sulbactam

A case of infective endocarditis due to Streptococcus agalactiae was treated conservatively by means of cefotaxime sodium given intravenously at a dose of 1 g every six hours supplemented with gentamycin sulphate, also given intravenously, with the dose adjusted according to concentrations of the drug in the plasma. The treatment was successful.

Topics: Ceftriaxone; Drug Therapy, Combination; Endocarditis, Bacterial; Female; Gentamicins; Humans; Middle Aged; Streptococcal Infections; Streptococcus agalactiae

Topics: Adolescent; Adult; Aged; Cameroon; Ceftriaxone; Child; Echocardiography; Endocarditis, Bacterial; Female; Follow-Up Studies; Humans; Male; Middle Aged; Rheumatic Heart Disease; Staphylococcal Infections

We evaluated the activities of ceftriaxone (15 mg/kg), netilmicin (6 mg/kg), and their combination given intramuscularly once daily for 4 days for the treatment of experimental Escherichia coli endocarditis in rabbits. In vitro, a greater rate of killing and an increased trough serum bactericidal titer (P less than 0.01) were achieved with the combination. In vivo, the combination had a greater bactericidal effect (P less than 0.01) and resulted in a greater number of sterile vegetations (P less than 0.05) than single-drug therapy. Thus, in vivo, an increased effect can be obtained despite a single daily dose of a long-acting cephalosporin and an aminoglycoside.

Topics: Animals; Ceftriaxone; Drug Combinations; Endocarditis, Bacterial; Escherichia coli Infections; Female; Half-Life; Humans; Male; Netilmicin; Rabbits

We determined the bactericidal activity of ceftriaxone on 20 streptococci isolated from patients with infective endocarditis and that of penicillin G on 5 strains. The MICs of ceftriaxone were less than or equal to 2 micrograms/ml and the MBCs were low for 5 nontolerant strains (less than or equal to 2 micrograms/ml) and high for 15 tolerant strains (greater than or equal to 16 micrograms/ml). The maximal reduction of the viable bacterial counts after 24 h of exposure to antibiotic was achieved for a concentration of ceftriaxone of 4, 32 and 256 micrograms/ml, respectively for 5, 10 and 19 strains. The activity of penicillin G was similar.

Topics: Ceftriaxone; Colony Count, Microbial; Endocarditis, Bacterial; Humans; Kinetics; Microbial Sensitivity Tests; Penicillin G; Streptococcal Infections; Streptococcus

We studied the effect of a nonsteroidal anti-inflammatory drug, diclofenac, in rabbits on the kinetics of three cephalosporins: cefotiam, cefmenoxime and ceftriaxone, and compared the antibacterial effect of these antibiotics, given alone or with diclofenac, in experimental endocarditis. Diclofenac significantly increased (P less than .05) the area under the curve in tissue-cage fluid of ceftriaxone and cefotiam-treated animals, and the terminal half-life of ceftriaxone in their sera (3.45 +/- 0.4 vs. 2.8 +/- 0.5 hr). Diclofenac reduced urinary excretion of cefotiam only. Cefmenoxime pharmacokinetics remained unchanged by diclofenac. The alteration of ceftriaxone kinetics appeared to be due to nonrenal mechanisms and could suggest reduction of biliary excretion. In Escherichia coli endocarditis, diclofenac enhanced the concentration (P less than .05) of cefotiam (23 +/- 16 vs. 8.9 +/- 5 micrograms/g) and ceftriaxone (13.2 +/- 3 vs. 8.5 +/- 4 micrograms/g) in infected vegetations, but not that of cefmenoxime. The antibacterial effect of ceftriaxone increased with diclofenac (5.5 +/- 1 vs. 7.2 +/- 1 log10 colony forming unit/g of vegetation). In vitro, neither protein binding to rabbit serum proteins nor intrinsic activity on the E. coli strain of each antibiotic was modified by diclofenac. These results suggest that anti-inflammatory drugs could increase antibiotic efficacy by altering their pharmacokinetics. The renal and nonrenal site of interaction may be involved for drugs belonging to the same class. Results obtained in tissue-cage fluid were predictive of the interference at the infected site.

Topics: Animals; Cefmenoxime; Cefotaxime; Cefotiam; Ceftriaxone; Diclofenac; Drug Synergism; Endocarditis, Bacterial; Escherichia coli Infections; Injections, Intramuscular; Microbial Sensitivity Tests; Rabbits

Topics: Adult; Ceftriaxone; Endocarditis, Bacterial; Gonorrhea; Humans; Male

To determine the influence of in vitro activity, pharmacokinetic properties, and therapeutic regimen on the antibacterial effect in vivo, we compared three cephalosporins, cefotiam, cefmenoxime, and ceftriaxone, in a rabbit model of experimental Escherichia coli endocarditis after 4 days of treatment. The MBCs of cefotiam, cefmenoxime, and ceftriaxone for the E. coli strain were 0.5, 0.125, and 0.06 microgram/ml, respectively. Killing curves at 10 times the MBC were similar for the three cephalosporins. In serum, the elimination half-life of ceftriaxone was twice as much as the elimination half-life of cefotiam or cefmenoxime (2.8 +/- 0.45 versus 1.4 +/- 0.25 or 1.3 +/- 0.4 h, respectively). Ceftriaxone was much more effective than cefotiam. The bacterial titer in the vegetations (log10 CFU per gram of vegetation) was 7.56 +/- 1 with cefotiam and 2.41 +/- 2.6 with ceftriaxone, as their concentrations were 18 and 466 times higher, respectively, than their MBCs. Although ceftriaxone and cefmenoxime exhibited a similar rate of killing and percentage of protein binding, ceftriaxone was more effective than cefmenoxime at the same regimen of 15 mg/kg twice a day (3.08 +/- 1.1 versus 4.82 +/- 3.2 log10 CFU/g of vegetation). When antibiotic was given as a single daily injection of 30 mg/kg, the antibacterial effect persisted for ceftriaxone, but not for cefmenoxime. The longer elimination half-life and the higher local concentration/MBC ratio of ceftriaxone explained these results. The bacterial titer measured 24 h after the fourth injection of 30 mg of ceftriaxone per kg confirmed that this regimen prevented regrowth of bacteria. These results suggest that the local antibiotic level/MBC ratio roughly correlated with the antibacterial effect and could represent an adequate basis to explain the differences observed between the drugs in vivo. They also demonstrate that, provided that the dose is sufficient, a long-acting broad-spectrum cephalosporin may be effective in severe gram-negative infections, even when given at relatively long dosing intervals, in contrast with a rapidly cleared drug with the same intrinsic activity.

Topics: Animals; Cefmenoxime; Cefotaxime; Cefotiam; Ceftriaxone; Drug Evaluation, Preclinical; Endocarditis, Bacterial; Escherichia coli; Escherichia coli Infections; Kinetics; Rabbits

In a rabbit model of Escherichia coli endocarditis, we studied the penetration into infected vegetations and the antibacterial effect of ceftriaxone. Ceftriaxone was given at different dosages, alone or with an interfering agent, diclofenac, a nonsteroidal anti-inflammatory drug, to determine the predictive value of the antibiotic levels in serum or infected vegetations on the antibacterial efficacy. Diclofenac increased the serum terminal half-life of ceftriaxone and increased its extravascular diffusion in tissue cage fluid, as well as in infected vegetations, allowing us to obtain various antibiotic concentrations in the infected site. Two hours after the fourth injection, around the time of peak level in serum, we observed a linear relationship between (i) serum and local antibiotic levels in vegetations, (ii) local antibiotic levels in a range of 142 to 600 X MBC and bacterial titer (log10 CFU/g) in vegetations, and (iii) serum antibiotic levels in a range of 800 to 1,400X MBC and bacterial titer in vegetations. In vivo, antibacterial effect was obtained only with high antibiotic levels in vegetations (greater than or equal to 220X MBC). This was confirmed by incubating vegetations sampled from infected animals in rabbit serum containing ceftriaxone (ex vivo experiment). Given once daily at a therapeutic dosage (30 mg/kg) for 4 days, ceftriaxone exhibited good efficacy (log10 CFU/g of vegetation = 2.41 +/- 2.7 versus 7.41 +/- 0.92 in control animals) and prevented regrowth of bacteria until 24 h after the last injection. We concluded that (i) provided the dose is sufficient, a long-acting cephalosporin can prove effective in severe gram-negative infections even when given infrequently, and (ii) serum antibiotic levels around the peak value, reflecting high effective local levels, could predict the therapeutic efficacy and represent a simple test to monitor the clinical course of a severe infectious process.

Topics: Animals; Ceftriaxone; Diclofenac; Diffusion; Endocarditis, Bacterial; Escherichia coli Infections; Myocardium; Protein Binding; Rabbits