ro13-9904 and Enterobacteriaceae-Infections

Outbreaks of vancomycin-resistant enterococci have been increasingly reported in France over the last three years. We report here, the emergence of a vancomycin-dependent enterococci isolate following glycopeptide therapy.. An Enterococcus faecium isolate that required vancomycin for growth was cultured from the stools of a liver transplant recipient who was colonised with vancomycin-resistant enterococci and who received vancomycin treatment for methicillin-resistant Staphylococcus aureus infection. The resistant isolate and the dependent isolate were typed by pulsed-field gel electrophoresis. The sequence of the ddl gene coding for the D-Ala: D-Ala ligase was analysed.. The dependent isolate was primary cultured onto a vancomycin-containing screening medium and could not be subcultured in the absence of vancomycin. Both the resistant and dependent isolates harboured the vanA gene and they had the same DNA restriction pattern after pulsed-field gel electrophoresis. Dependence on vancomycin was associated with a 1-bp deletion in the D-Ala: D-Ala ligase gene leading to an early stop odon.. Cultures onto vancomycin-containing media are warranted for clinical specimens from patients, who are known to carry vancomycin-resistant enterococci and receive vancomycin therapy.

Topics: Bacterial Proteins; Bacteriuria; Carbon-Oxygen Ligases; Cecal Diseases; Ceftriaxone; Citrobacter freundii; Codon, Nonsense; Drug Resistance, Multiple, Bacterial; Drug Therapy, Combination; Electrophoresis, Gel, Pulsed-Field; Enterobacteriaceae Infections; Enterococcus faecium; Female; Gram-Positive Bacterial Infections; Humans; Intestinal Perforation; Liver Transplantation; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Norfloxacin; Peritonitis; Postoperative Complications; Staphylococcal Infections; Teicoplanin; Vancomycin; Vancomycin Resistance

CTX-M-type enzymes are a group of class A extended-spectrum beta-lactamases (ESBLs) that are rapidly spreading among Enterobacteriaceae worldwide. More that 50 allotypes are known, clustered into six sub-lineages. The CTX-M-encoding genes have been captured from the chromosome of Kluyvera spp. on conjugative plasmids that mediate their dissemination among pathogenic enterobacteria. CTX-M-type ESBLs exhibit powerful activity against cefotaxime and ceftriaxone but generally not against ceftazidime, which has important implications for laboratory detection. However, several CTX-M variants with enhanced ceftazidimase activity have been detected. The rapid and massive spread of CTX-M-type ESBLs is rapidly changing the ESBL epidemiology and, in some geographical areas, these enzymes are now the most prevalent ESBLs in Enterobacteriaceae.

Topics: Anti-Bacterial Agents; beta-Lactam Resistance; beta-Lactamases; Cefotaxime; Ceftazidime; Ceftriaxone; Cephalosporins; Enterobacteriaceae; Enterobacteriaceae Infections; Humans; Models, Molecular; Prevalence

Citrobacter infection is commonly reported in neonates and immunocompromised patients. Citrobacter koseri (diversus) is an important cause of neonatal meningitis and brain abscess formation. It adults, however, Citrobacter infection with central nervous system involvement is rare, and is usually associated with an underlying disorder. This report describes a 12-y-old previously healthy girl with Citrobacter koseri meningitis. Intravenous treatment with ceftriaxone for 10 d led to complete recovery. Head computed tomography and brainstem-evoked response audiometry were normal. On follow-up, the patient was completely healthy. Previously reported cases of C. koseri meningitis in the adult population were associated with underlying predisposing factors. In this case a normal, healthy adolescent was treated with intravenous ceftriaxone without any of the known neurological complications observed in the neonatal cases.

Topics: Ceftriaxone; Child; Citrobacter koseri; Enterobacteriaceae Infections; Female; Follow-Up Studies; Humans; Immunocompetence; Infusions, Intravenous; Severity of Illness Index; Treatment Outcome

The new cephalosporin compounds have increased in vitro activity against gram-negative enteric bacilli and penetrate well into cerebrospinal fluid. Moreover, their pharmacokinetic properties are favorable and their safety seems adequate, although insufficiently evaluated to date. Interest has been focused on them as therapeutic agents for neonatal sepsis and meningitis caused by Enterobacteriaceae. In this review the third generation cephalosporins are evaluated for their possible use in the neonates; opinions are based on currently available data. It is concluded that moxalactam and cefotaxime and probably also ceftriaxone and ceftazidime represent valuable alternatives to aminoglycosides for therapy of severe neonatal infection.

Topics: Cefotaxime; Ceftazidime; Ceftriaxone; Cephalosporins; Enterobacteriaceae Infections; Humans; Infant, Newborn; Meningitis; Moxalactam; Sepsis

Topics: Anti-Bacterial Agents; beta-Lactams; Cefmenoxime; Cefmetazole; Cefoperazone; Cefotaxime; Cefotiam; Cefsulodin; Ceftazidime; Ceftizoxime; Ceftriaxone; Cephalosporins; Cephamycins; Drug Interactions; Drug Resistance, Microbial; Enterobacteriaceae; Enterobacteriaceae Infections; Humans; Imipenem; Moxalactam

The efficacy of ertapenem, 1 g once a day, for treatment of adults with serious infections caused by Enterobacteriaceae was compared with ceftriaxone 1 g once a day [complicated urinary tract infection (CUTI) and community-acquired pneumonia (CAP)] or piperacillin-tazobactam, 3.375 g every 6 h (complicated intra-abdominal, complicated skin/skin structure and acute pelvic infections).. This combined analysis included the subgroup of all 1167 treated patients infected with Enterobacteriaceae from seven randomized double-blind studies.. Escherichia coli was the most common pathogen, accounting for 65.3% of all Enterobacteriaceae. Among evaluable patients with deep tissue (intra-abdominal, skin and pelvic) infections, the combined clinical cure rates were 84.8% (223 of 263) for ertapenem and 82.9% (194 of 234) for piperacillin-tazobactam [95% confidence interval (CI) for the difference, adjusting for infection, -4.9% to 8.9%]. Cure rates by infection for ertapenem and piperacillin-tazobactam, respectively, were: intra-abdominal, 85.1% (143 of 168) and 79.9% (119 of 149); pelvic, 86.8% (46 of 53) and 94% (47 of 50); skin/skin structure, 81% (34 of 42) and 80% (28 of 35). Among patients with CUTI, microbiological cure rates were 90.5% (220 of 243) for ertapenem and 92% (196 of 213) for ceftriaxone (95% CI for the difference, -7.1% to 4.1%). In patients with CAP, clinical cure rates were 95% (19 of 20) for ertapenem and 88.9% (16 of 18) for ceftriaxone.. Ertapenem therapy was as effective as either piperacillin-tazobactam or ceftriaxone for serious infections caused by Enterobacteriaceae.

Topics: Adult; Aged; beta-Lactams; Ceftriaxone; Cephalosporins; Community-Acquired Infections; Double-Blind Method; Drug Therapy, Combination; Enterobacteriaceae Infections; Ertapenem; Escherichia coli Infections; Humans; Lactams; Middle Aged; Multicenter Studies as Topic; Penicillanic Acid; Piperacillin; Tazobactam; Treatment Outcome; Urinary Tract Infections

Treating complicated urinary tract infections (cUTIs) caused by ESBL-producing Enterobacterales represents a significant clinical challenge. The present study was thus developed to explore the relative efficacy of β-lactam/β-lactamase inhibitors (BLBLIs) and carbapenems for the treatment of hospitalized patients suffering from cUTIs caused by BLBLI-susceptible ceftriaxone-non-susceptible Enterobacterales.. Data from 557 patients from four Chinese teaching hospitals diagnosed with cUTIs caused by ceftriaxone-non-susceptible Enterobacterales from January 2017 to May 2022 were retrospectively assessed.. The 30 day rate of treatment failure, defined by unresolved symptoms or mortality, was 10.4% (58/557). Independent predictors of 30 day treatment failure included immunocompromised status, bacteraemia, septic shock, lack of infection source control and appropriate empirical treatment. When data were controlled for potential confounding variables, BLBLI treatment exhibited a comparable risk of 14 day (OR 1.61, 95% CI 0.86-3.00, P = 0.133) and 30 day treatment failure (OR 1.45, 95% CI 0.66-3.15, P = 0.354) relative to carbapenem treatment for the overall cohort of patients. In contrast, BLBLI treatment in immunocompromised patients was associated with an elevated risk of both 14 day (OR 3.18, 95% CI 1.43-7.10, P = 0.005) and 30 day treatment failure (OR 3.06, 95% CI 1.07-8.80, P = 0.038) relative to carbapenem treatment.. These results suggested that carbapenem treatment may be superior to BLBLI treatment for immunocompromised patients suffering from cUTIs caused by ceftriaxone-non-susceptible Enterobacterales species. However, these results will need to be validated in appropriately constructed randomized controlled trials to ensure appropriate patient treatment.

Topics: Anti-Bacterial Agents; beta-Lactamase Inhibitors; beta-Lactamases; beta-Lactams; Carbapenems; Ceftriaxone; Enterobacteriaceae; Enterobacteriaceae Infections; Gammaproteobacteria; Humans; Lactams; Retrospective Studies; Urinary Tract Infections

Fecal carriage of extended-spectrum beta-lactamase and Carbapenemase-producing Enterobacteriaceae is a potential risk for the transmission of infection with resistant strains. Understanding the burden of these resistant strains in asymptomatic people is essential to reduce the chain of infection transmission. However, data on the fecal carriage of Extended-spectrum Beta-lactamase and Carbapenemase-producing Enterobacteriaceae among food handlers were limited in developing countries especially in Ethiopia. The aim of the present study is, therefore, to assess fecal carriage rate, associated factors, and antimicrobial resistance patterns of Extended-spectrum Beta-lactamase and Carbapenemase-producing Enterobacteriaceae among food handlers at the University of Gondar Cafeterias, Northwest Ethiopia.. An institution-based cross-sectional study was conducted from February to June 2021 at the University of Gondar cafeterias. A total of 290 stool samples were collected, transported using Cary Blair transport medium, and processed. All isolates were cultured and identified by using MacConkey agar, and routine biochemical tests. Antimicrobial susceptibility testing was done to each isolate following the Kirby Bauer disk diffusion method. If the zone of inhibition was ≤ 22 mm for ceftazidime, ≤25 mm for ceftriaxone, and ≤27 for cefotaxime they were considered as potential ESBL strain and selected for a further phenotypic confirmatory. Moreover, the double-disc diffusion test and the modified carbapenem inactivation method were used for confirmations of Extended-spectrum β-lactamase and Carbapenemase-producing Enterobacteriaceae respectively. If a ≥5mm difference in zone diameter for either antimicrobial agent in combination with clavulanic acid versus the zone diameter of the agent when tested alone (without B-lactamase inhibitor), was confirmed as ESBL-PE and if the zone of inhibition diameter between 6-15mm and 16- 18mm with a pinpoint colony, it was considered as carbapenem resistance Enterobacteriaceae. Data were entered using Epi-data version 4.6 and then exported to SPSS version 26 for analysis. Potential risk factors were assessed using multivariable logistic regression and a p-value less than 0.05 was considered statistically significant.. Out of 290 stool samples, 63 (21.7%) and 7 (2.4%) were confirmed as Extended-spectrum β-lactamase and Carbapenemase-producing Enterobacteriaceae. The most predominant ESBL-PE was E. coli 43 (14.8%) followed by K. pneumoniae 17 (5.9%). Most of the Extended-spectrum β-lactamase and Carbapenemase-producing isolates were resistant to tetracycline, cefotaxime, ceftazidime, and ceftriaxone (100% each). In contrast, a low resistance level was recorded for Meropenem and cefoxitin. The overall Multi-drug resistant Enterobacteriaceae (MDR) was 147 (42.3%). Antibiotics usage in the last 3 months and drinking unpasteurized milk were associated with the carriage of the Extended-spectrum beta-lactamase-Producing Enterobacteriaceae.. The high fecal carriage rate of Multi-drug resistance isolate, Extended-spectrum β-lactamase, and Carbapenemase-producing Enterobacteriaceae were recorded among food handlers. Therefore, this study gives signals in the spread of drug-resistant bacteria easily to the community. Hence, the need for adjusting and promotion of infection prevention measures to prevent the spread of drug-resistant bacteria should not be underestimated.

Topics: Anti-Bacterial Agents; beta-Lactamases; Carbapenem-Resistant Enterobacteriaceae; Cefotaxime; Ceftazidime; Ceftriaxone; Cross-Sectional Studies; Enterobacteriaceae; Enterobacteriaceae Infections; Escherichia coli; Ethiopia; Humans; Klebsiella pneumoniae; Meropenem; Microbial Sensitivity Tests; Prevalence

Edwardsiella tarda, an Enterobacteriaceae family member, is prevalent in different aquatic settings and rarely infects humans. As a result of eating raw or undercooked seafood, humans become infected through their intestinal tracts. Extraintestinal infections have been reported infrequently, mostly in immunocompromised and chronically ill patients.. Our report describes a case of urinary tract infection caused by E. tarda in a 4-year-old female patient with a history of urinary tract infection and a complaint of fever, dysuria, and frequency. E. tarda was identified as the pathogen isolated from the urine culture. The patient's symptoms were alleviated after receiving ceftriaxone and then nitrofurantoin.. This case demonstrates that even in immunocompetent patients, E. tarda can infect extraintestinal organs, including urinary tract. Our patient represents the first case of E. tarda infection in Iran and due to the fact that this pathogen is transmitted by aquatic animals, there is a possibility of infecting more aquatic animals and humans in Iran; therefore, the necessary precautions should be taken.

Topics: Animals; Ceftriaxone; Child, Preschool; Edwardsiella tarda; Enterobacteriaceae; Enterobacteriaceae Infections; Female; Humans; Iran; Urinary Tract Infections

There is minimal data on the optimal treatment of lower inoculum infections such as urinary tract infections (UTIs) caused by SPICE organisms which encode the betalactamase enzyme, AmpC. This single-center, retrospective review of adult hospitalized patients with UTIs caused by a SPICE organism compared outcomes amongst patients treated with drugs susceptible to AmpC hydrolysis versus drugs stable against AmpC. Of 156 patients, similar rates of clinical response, 30-day infection related readmission, 30-day infection recurrence, 30-day mortality rates, and median length of hospital stay were found between the two groups. Notably, 44% of patients with ceftriaxone resistance reported had recent β-lactam exposure versus only 11% of patients without ceftriaxone resistance (P = 0.002). Based on our data, there does not appear to be a difference in clinical response or any of the secondary outcomes in patients with UTIs treated with AmpC stable and AmpC susceptible agents.

Topics: Aged; Aged, 80 and over; Anti-Bacterial Agents; beta-Lactamases; beta-Lactams; Ceftriaxone; Enterobacteriaceae; Enterobacteriaceae Infections; Female; Hospitalization; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Urinary Tract Infections

Topics: Aged; Aged, 80 and over; Anti-Bacterial Agents; beta-Lactam Resistance; Ceftriaxone; Enterobacteriaceae; Enterobacteriaceae Infections; Female; Fosfomycin; Humans; Male; Retrospective Studies; Treatment Outcome; Urinary Tract Infections

Epidemiological data suggest that ceftriaxone may promote the emergence of commensal AmpC-overproducing Enterobacteriaceae because of a high biliary excretion. We tested this hypothesis in hospitalized patients either treated by ceftriaxone alone or receiving no antibiotics. Hospitalized patients with no previous antibiotics or hospitalization in the last 3 months, treated only with ceftriaxone, were prospectively included. For each ceftriaxone-treated patient, a control patient receiving no antibiotics was included. Clinical data and stools were collected at T0 (before antibiotics) and T1 (at the end of ceftriaxone treatment or at discharge) and T2 (3-6 months after T1) for the ceftriaxone-treated patients and at T0 and T1 for control patients. Third-generation cephalosporin-resistant Enterobacteriaceae were detected, identified by matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF), and characterized genetically. Clonal relatedness was evaluated by random amplified polymorphic DNA-polymerase chain reaction (RAPD-PCR). Fifteen ceftriaxone and 22 control patients were included. Patients' characteristics did not differ. At T0, 2/15 ceftriaxone-treated versus 1/22 control patients carried third-generation cephalosporin-resistant Enterobacteriaceae (p = 0.6). At T1, 4/15 (27%) ceftriaxone-treated patients carried AmpC producers versus 0/22 control patients (p = 0.02). Additionally, two and three subjects carried extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae in the ceftriaxone and control groups, respectively (p = 1). At T2, three ceftriaxone-treated patients still carried AmpC-producing Enterobacteriaceae with the same RAPD profile as at T1. In hospitalized subjects with no other selective pressure, treatment by ceftriaxone alone promotes the gut colonization by AmpC-overproducing Enterobacteriaceae in over a quarter of patients, with a persistent carriage after the end of antibiotic exposure. The ecological impact of ceftriaxone should not be underestimated.

Topics: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Bacterial Proteins; beta-Lactam Resistance; beta-Lactamases; Ceftriaxone; Enterobacteriaceae; Enterobacteriaceae Infections; Feces; Female; Gastrointestinal Microbiome; Hospitalization; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Prospective Studies

Topics: Anti-Bacterial Agents; beta-Lactamases; Cefotaxime; Ceftriaxone; Cross Infection; Enterobacteriaceae; Enterobacteriaceae Infections; Humans; Intensive Care Units; Microbial Sensitivity Tests

Ceftaroline fosamil was approved by the United States Food and Drug Administration in 2010 and by the European Medicines Agency in 2012. As of April 2017, only one commercial antimicrobial susceptibility testing device offered a Gram-negative panel that included ceftaroline. This circumstance is unfortunate, as many clinical microbiology laboratories rely solely on commercial devices to generate

Topics: Anti-Bacterial Agents; beta-Lactam Resistance; beta-Lactams; Cefotaxime; Ceftazidime; Ceftriaxone; Enterobacteriaceae; Enterobacteriaceae Infections; Humans; Microbial Sensitivity Tests

Healthcare exposure may increase drug-resistant Enterobacteriaceae colonization risk. Nascent antimicrobial stewardship efforts in low- and middle-income countries require setting-specific data. We aimed to evaluate risk factors for inpatient drug resistant Enterobacteriaceae colonization in a resource-limited setting in India.. Patients age ≥ 6 months admitted with ≥24 h of fever to a tertiary hospital in Pune, India were enrolled in a prospective cohort. Perirectal swabs, collected on admission and hospitalization day 3 or 4, were cultured in vancomycin- and ceftriaxone-impregnated media to assess for ceftriaxone-resistant Enterobacteriaceae (CTRE) and carbapenem-resistant Enterobacteriaceae (CPRE). Multivariable analyses assessed risk factors for drug-resistant Enterobacteriaceae colonization among participants without admission colonization.. Admission perirectal swabs were collected on 897 participants; 87 (10%) had CTRE and 14 (1.6%) had CPRE colonization. Admission CTRE colonization was associated with recent healthcare contact (p < 0.01). Follow-up samples were collected from 620 participants, 67 (11%) had CTRE and 21 (3.4%) had CPRE colonization. Among 561 participants without enrollment CTRE colonization, 49 (9%) participants were colonized with CTRE at follow-up. Detection of CTRE colonization among participants not colonized with CTRE at admission was independently associated with empiric third generation cephalosporin treatment (adjusted odds ratio [OR] 2.9, 95% CI 1.5-5.8). Follow-up transition to CPRE colonization detection was associated with ICU admission (OR 3.0, 95% CI 1.0-8.5).. Patients who receive empiric third generation cephalosporins and are admitted to the ICU rapidly develop detectable CTRE and CPRE colonization. Improved antimicrobial stewardship and infection control measures are urgently needed upon hospital admission.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Ceftriaxone; Cephalosporins; Child; Child, Preschool; Cross Infection; Drug Resistance, Bacterial; Enterobacteriaceae; Enterobacteriaceae Infections; Female; Humans; India; Inpatients; Intensive Care Units; Male; Middle Aged; Prospective Studies; Young Adult

We analyzed the effects of different cefepime MIC breakpoints on Enterobacteriaceae cefepime susceptibility and the presence of AmpC and extended-spectrum β-lactamase (ESBL) genes within the cefepime MIC interpretative categories.. Using Enterobacteriaceae susceptibility data from 2013 comparisons of MIC breakpoints were performed using Pearson's chi-squared test. Molecular testing on a subset of isolates was done.. Among 3784 non-duplicate clinical isolates, cefepime susceptibility decreased from 97.6% to 96.1% to 93.7% for CLSI 2013, CLSI 2014, and EUCAST 2011, respectively. In ceftriaxone non-susceptible isolates, cefepime susceptibility decreased from 79% to 66% (P<0.0001) using CLSI 2013 and 2014, respectively, which was greater and statistically significant for Escherichia coli and Klebsiella spp. but not for Enterobacter spp. (P=0.06). Isolates with MIC ≤1μg/mL more often harbored AmpC (77%) than ESBL (18%) genes.. Lower cefepime MIC breakpoints decrease cefepime susceptibility for isolates harboring ESBLs, while sparing the majority of those with AmpCs.

Topics: Anti-Bacterial Agents; Bacterial Proteins; beta-Lactamases; Cefepime; Ceftriaxone; Cephalosporins; Drug Resistance, Multiple, Bacterial; Enterobacteriaceae; Enterobacteriaceae Infections; Escherichia coli; Humans; Klebsiella; Microbial Sensitivity Tests; Retrospective Studies

Topics: Aged; Anti-Bacterial Agents; Ceftriaxone; Drainage; Enterobacteriaceae; Enterobacteriaceae Infections; Hand; Humans; Levofloxacin; Male; Plaque, Atherosclerotic

Third-generation cephalosporins (3GCs) [ceftriaxone (CRO) and cefotaxime (CTX)] have remarkable potency against Enterobacteriaceae and are commonly prescribed for the treatment of community-onset bacteraemia. However, clinical evidence supporting the updated interpretive criteria of the Clinical and Laboratory Standards Institute (CLSI) is limited. Adults with community-onset monomicrobial Enterobacteriaceae bacteraemia treated empirically with CRO or CTX were recruited. Clinical information was collected from medical records and CTX MICs were determined using the broth microdilution method. Eligible patients (n=409) were categorised into de-escalation (260; 63.6%), no switch (115; 28.1%) and escalation (34; 8.3%) groups according to the type of definitive antibiotics. Multivariate regression revealed five independent predictors of 28-day mortality: fatal co-morbidities based on McCabe classification [odds ratio (OR)=19.96; P<0.001]; high Pitt bacteraemia score (≥4) at bacteraemia onset (OR=13.91; P<0.001); bacteraemia because of pneumonia (OR=5.45; P=0.007); de-escalation after empirical therapy (OR=0.28; P=0.03); and isolates with a CTX MIC≤1mg/L (OR=0.17; P=0.02). Of note, isolates with a CTX MIC≤8mg/L (indicated as susceptible by previous CLSI breakpoints) were not associated with mortality. Furthermore, clinical failure and 28-day mortality rates had a tendency to increase with increasing CTX MIC (γ=1.00; P=0.01). Conclusively, focusing on patients with community-onset Enterobacteriaceae bacteraemia receiving empirical 3GC therapy, the present study provides clinically critical evidence to validate the proposed reduction in the susceptibility breakpoint of CTX to MIC≤1mg/L.

Topics: Aged; Aged, 80 and over; Anti-Bacterial Agents; Bacteremia; Cefotaxime; Ceftriaxone; Community-Acquired Infections; Enterobacteriaceae Infections; Female; Humans; Male; Microbial Sensitivity Tests; Retrospective Studies; Survival Analysis; Treatment Outcome

Edwardsiella tarda is an Enterobacteriaceae found in aquatic environments. Extraintestinal infections caused by Edwardsiella tarda in humans are rare and occur in the presence of some risk factors. As far as we know, this is the first case of near-drowning-associated pneumonia with bacteremia caused by coinfection with methicillin-susceptible Staphylococcus aureus and Edwardsiella tarda in a healthy patient.. A 27-year-old previously healthy white man had an episode of fresh water drowning after acute alcohol consumption. Edwardsiella tarda and methicillin-sensitive Staphylococcus aureus were isolated in both tracheal aspirate cultures and blood cultures.. This case shows that Edwardsiella tarda is an important pathogen in near drowning even in healthy individuals, and not only in the presence of risk factors, as previously known.

Topics: Adult; Bacteremia; Ceftriaxone; Ciprofloxacin; Clindamycin; Coinfection; Edwardsiella tarda; Enterobacteriaceae Infections; Humans; Male; Methicillin; Near Drowning; Oxacillin; Pneumonia; Staphylococcal Infections; Staphylococcus aureus

We report a case of severe Citrobacter koseri folliculitis of the face in a boy with acne. A 15-year-old boy affected by acne was admitted because of a rash located on the face. Dermatological examination revealed two large plaques, with numerous pustules, eschars and crusts, located bilaterally and symmetrically on the cheeks. Three bacteriological examinations were positive for C. koseri. The patient was successfully treated with i.m. ceftriaxone. C. koseri is a Gram-negative, aerobic, mobile, nonsporulating bacillus belonging to the Enterobacteriaceae family. It can cause meningitis, central nervous system abscess and sepsis, almost exclusively in infants and immunocompromised hosts. Respiratory tract and urinary infections have been reported in elderly people. Furthermore, rare cases of skin infections have been described.

Topics: Adolescent; Anti-Bacterial Agents; Ceftriaxone; Citrobacter koseri; Enterobacteriaceae Infections; Face; Folliculitis; Humans; Male; Treatment Outcome

Considering the hypothesis that the high biliary elimination of ceftriaxone could be responsible for the selection of Enterobacteriaceae harbouring high-level AmpC β-lactamase (HL-CASE), the use of ceftriaxone was discontinued in our hospital in 2006 and replaced with cefotaxime.. Antibiotic consumption, expressed as defined daily dose (DDD)/1000 patient-days (PD), and HL-CASE incidence, expressed as the number of patients carrying HL-CASE/1000 PD, were compared between the pre-intervention period (Period 1, 2001-05) and the post-intervention period (Period 2, 2006-12) using an interrupted time series analysis.. The incidence of HL-CASE increased significantly from 0.32 to 0.69/1000 PD during Period 1 (coefficient = 0.082, P < 0.01). A significant inflection of the slope in the incidence curve occurred in Period 2 (coefficient = -0.061, P = 0.05), mainly owing to the stabilization of the HL-CASE incidence of Enterobacteriaceae harbouring chromosomally inducible cephalosporinase (Period 1, 0.27 to 0.64/1000 PD; Period 2, 0.58 to 0.61/1000 PD) and especially for Enterobacter cloacae (Period 1, 0.09 to 0.30/1000 PD; Period 2, 0.26 to 0.27/1000 PD). This deceleration was observed despite a significant increase in the slope of cefotaxime consumption over Period 2 (coefficient = 2.97, P < 0.01).. Despite the disadvantages of using cefotaxime compared with ceftriaxone (administration three times daily versus once a day), the ecological benefits of this substitution seem sufficiently convincing to preferentially use cefotaxime. Control of HL-CASE incidence is crucial to limiting carbapenem use and preventing the selection of carbapenemase-producing Enterobacteriaceae.

Topics: Anti-Bacterial Agents; Bacterial Proteins; beta-Lactamases; Cefotaxime; Ceftriaxone; Drug Utilization; Enterobacteriaceae; Enterobacteriaceae Infections; Humans; Incidence; Retrospective Studies

Topics: Anti-Bacterial Agents; Bacterial Proteins; beta-Lactamases; Cefotaxime; Ceftriaxone; Enterobacteriaceae; Enterobacteriaceae Infections; Humans

In 2010, the Clinical and Laboratory Standards Institute (CLSI) revised and lowered the ceftriaxone minimum inhibitory concentration breakpoints for Enterobacteriaceae and removed the requisite extended spectrum β-lactamase phenotypic testing for organisms with elevated minimum inhibitory concentrations. The impact that these recommendations have on clinical outcomes of children have not been previously evaluated.. We conducted a retrospective study to compare clinical outcomes between children treated with ceftriaxone and those treated with broader spectrum β-lactams for Enterobacteriaceae bacteremia with reduced susceptibility (minimum inhibitory concentrations 4-8 µg/mL) to ceftriaxone according to the new CLSI interpretive criteria. Mortality and microbiological relapse were evaluated using a multivariable logistic regression model.. There were a total of 783 unique children with Enterobacteriaceae bacteremia during the study period. Using the CLSI breakpoints before 2010, 76 children would have had clinical isolates resistant to ceftriaxone. With the revised breakpoints, 229 Enterobacteriaceae isolates would no longer be susceptible to ceftriaxone (>300% increase). Of the 136 children who met eligibility criteria, 63 children received ceftriaxone and 73 children received broader spectrum β-lactams. There was no difference in 30-day mortality (odds ratio 0.81, 95% confidence interval: 0.31-2.59) or microbiological relapse (odds ratio 0.97, 95% confidence interval: 0.36-2.66) between the groups.. Our findings do not support the proposed clinical benefit of more conservative CLSI breakpoints. The revised breakpoints promote increased broad-spectrum β-lactam use. The need for lowered ceftriaxone breakpoints against Enterobacteriaceae in children needs to be reevaluated in larger prospective studies.

Topics: Adolescent; Anti-Bacterial Agents; Bacteremia; Ceftriaxone; Child; Child, Preschool; Cohort Studies; Drug Resistance, Bacterial; Enterobacteriaceae; Enterobacteriaceae Infections; Female; Humans; Infant; Male; Microbial Sensitivity Tests; Recurrence; Retrospective Studies; Survival Analysis; Treatment Outcome

Topics: Anti-Bacterial Agents; Bacteremia; Ceftriaxone; Enterobacteriaceae Infections; Female; Humans; Male

Necrotizing soft tissue infections are rapidly progressive infections with a high rate of mortality. One type of necrotizing soft tissue infection is caused by marine gram-negative bacteria and commonly occurs in immunocompromised hosts. These types of infections are more common in patients with chronic liver disease, possibly because of impaired iron metabolism. We present the case of a rapidly progressive necrotizing soft tissue infection caused by Edwardsiella tarda, a marine gram-negative pathogen common in catfish. Few extraintestinal infections of E tarda have been described previously. Our patient had hepatitis C and was exposed to the bacteria by a puncture injury from a wild catfish. His infection required multiple debridements and ultimately required a transhumeral amputation for local control of the infection.

Topics: Amputation, Surgical; Animals; Anti-Bacterial Agents; Catfishes; Ceftriaxone; Comorbidity; Debridement; Disease Progression; Edwardsiella tarda; Enterobacteriaceae Infections; Fascia; Hand Injuries; Hepatitis C; Humans; Male; Middle Aged; Muscle, Skeletal; Necrosis; Soft Tissue Infections; Upper Extremity; Wounds, Penetrating

A man in his early 80s presented to our emergency department with painless redness and swelling in his right leg. One week prior, he cleaned up floodwater in his basement after Hurricane Irene passed the Mid-Atlantic region of the USA in August 2011. Physical examination included large purple bullae and raised concern for necrotising fasciitis. Wound culture revealed a polymicrobial infection including Leclercia adecarboxylata.

Topics: Aged, 80 and over; Anti-Bacterial Agents; Ceftriaxone; Clindamycin; Cyclonic Storms; Diagnosis, Differential; Enterobacteriaceae; Enterobacteriaceae Infections; Fasciitis, Necrotizing; Floods; Humans; Leg; Male; Microbial Sensitivity Tests; Rare Diseases; Water Microbiology; Wound Infection

Yokenella regensburgei belongs to the Enterobacteriaceae and shares some biochemical characteristics with Hafnia alvei. A few case reports have suggested that it is an opportunistic pathogen, but there is no strong evidence to support its clinical importance. Until recently, it was difficult to accurately differentiate between Y. regensburgei and H. alvei by use of routine identification techniques. Here, we present a case of soft tissue infection and bacteremia caused by Y. regensburgei, which was successfully treated by intravenous administration of ceftriaxone for three weeks, and review the previous literature.

Topics: Adult; Anti-Bacterial Agents; Bacteremia; Ceftriaxone; Diagnosis, Differential; Enterobacteriaceae; Enterobacteriaceae Infections; Hafnia alvei; Humans; Immunocompromised Host; Infusions, Intravenous; Leg; Male; Opportunistic Infections; Soft Tissue Infections; Taiwan; Treatment Outcome

Septic pylephlebitis or purulent thrombosis of the portal venous system generally results from a progressive extension of suppurated thrombophlebitis, secondary to an intrabdominal infection. Germs most often found are Escherichia coli and Streptococcus, isolation of Enterobacter cloacae is unusual. We report a particular observation of septic pylephlebitis associated with E. cloacae bacteremia, without biliary, digestive or pancreatic lesion on the CT-scan. The antibiotic sensitivity pattern of the isolated germ and the negative epidemiologic investigation pled in favour of community acquired infection. The infection resolved with antibiotics and anticoagulation, followed by total repermeation of the portal system.

Topics: Abdominal Pain; Adult; Anti-Bacterial Agents; Anticoagulants; Bacteremia; Ceftriaxone; Community-Acquired Infections; Drug Therapy, Combination; Enoxaparin; Enterobacter cloacae; Enterobacteriaceae Infections; Fever; Gentamicins; Humans; Magnetic Resonance Imaging; Male; Metronidazole; Portal Vein; Tomography, X-Ray Computed; Venous Thrombosis

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

CTX-M-3 is the most common extended-spectrum beta-lactamase produced by Enterobacteriaceae in Taiwan. The present study was conducted to characterise the genetic environment surrounding bla(CTX-M-3). A total of 11 ceftriaxone-resistant isolates were studied: Escherichia coli (n=4), Klebsiella pneumoniae (n=5) and Salmonella enterica serotypes Anatum (SA831R) and Potsdam (SC72). Molecular methods used included polymerase chain reaction, sequencing, DNA-DNA hybridisation, conjugation, physical mapping and restriction fragment length polymorphism (RFLP) analysis. All isolates examined carried bla(CTX-M-3) on large plasmids (>70kb). The resistance plasmids of the two Salmonella and two K. pneumoniae strains (KP104 and KP116) were confirmed to be conjugative in vitro. RFLP analysis indicated that the plasmids were different. Physical mapping also revealed the difference between the two Salmonella plasmids, pSA831R (82kb) and pSC72 (74kb). An insertion sequence, ISEcp1, was found upstream of each bla(CTX-M-3) gene. However, sequencing of downstream regions of the bla genes showed two different patterns: the presence of orf477 in pSA831R and of orf1-mucA in pSC72, pKP104 and pKP116. IncI1-type oriT and nikA sequences were present in the plasmids of all the clinical isolates tested, except S. Anatum. Different bla(CTX-M-3)-carrying plasmids were identified among the enterobacteria studied. The presence of ISEcp1 in all isolates may be associated with the widespread resistance among Enterobacteriaceae. Although the plasmids were not identical, they appeared to belong to the same incompatibility group (IncI1-like plasmids), suggesting that they are genetically related but may have evolved divergently over time.

Topics: beta-Lactamases; Ceftriaxone; Conjugation, Genetic; DNA Transposable Elements; Drug Resistance, Bacterial; Enterobacteriaceae; Enterobacteriaceae Infections; Hospitals, University; Humans; Plasmids; Restriction Mapping; Taiwan

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

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

To enumerate and characterize extended-spectrum beta-lactamases (ESBLs) amongst ceftriaxone-resistant coliforms in Blantyre, Malawi, where third-generation cephalosporin use is currently highly restricted.. Over the period April 2004-March 2005 all ceftriaxone-resistant isolates from blood cultures were examined for the presence of ESBLs. Isoelectric focusing was performed on enzyme extracts. PCR and DNA sequencing of amplicons were used to identify the underlying genetic determinants responsible for the ESBL phenotypes. Transferability of the ESBL phenotypes was tested by conjugation to a susceptible Escherichia coli J53.. Enterobacteriaceae were isolated from 1191 blood cultures, of which 19 (1.6%) were ceftriaxone resistant. Ten isolates (0.7% of all isolates) demonstrated an ESBL phenotype but only eight were characterized as three isolates were from the same patient. Genotypes SHV-11 (n = 1), SHV-12 (n = 3), SHV-27 (n = 1), TEM-63 (n = 2) and CTX-M-15 (n = 1) were detected. Plasmid transfer of the ESBL resistance phenotype was successful for all the isolates.. In a clinical setting of minimal cephalosporin usage there is already a diversity of ESBL genotypes. Increased use of cephalosporins in this setting is likely to result in a rapid expansion of ESBLs and their prevalence will need to be carefully monitored.

Topics: Adult; Anti-Bacterial Agents; Bacteremia; beta-Lactamases; Blood; Ceftriaxone; Cephalosporin Resistance; Child; Child, Preschool; Conjugation, Genetic; Culture Media; Enterobacteriaceae; Enterobacteriaceae Infections; Escherichia coli; Humans; Malawi; Microbial Sensitivity Tests; Molecular Epidemiology

Topics: beta-Lactam Resistance; beta-Lactamases; Cefotaxime; Ceftriaxone; Colombia; Enterobacteriaceae; Enterobacteriaceae Infections; Genes, Bacterial; Humans

Laminaria placement is seldom thought to be associated with postabortal sepsis.. A nulliparous woman presented with high fever, low blood pressure, and signs of infection during artificial legal abortion with laminaria placement for cervical dilatation. Broad-spectrum antibiotics were given. Cultures of blood, placenta, and arterial line all yielded Enterobacter cloacae. The patient responded to antibiotics and supportive care.. The use of laminaria still places patients at risk for infection because there is a certain risk of ascending colonization with potentially pathogenic microorganisms from the vaginal and cervical microflora, as in our patient. Surgical disinfection, prophylactic antibiotics, and shortened duration of laminaria placement are helpful to prevent infectious insult. Once signs of infection are noted, physicians should take action as soon as possible, such as initiating broad-spectrum antibiotics and intensive care.

Topics: Abortion, Induced; Adult; Anti-Bacterial Agents; Bacteremia; Ceftriaxone; Cervix Uteri; Enterobacter cloacae; Enterobacteriaceae Infections; Female; Humans; Laminaria; Pregnancy; Shock, Septic

Though the pathogenic significance and the reservoir of Ewingella americana have not been clarified, this organism has caused several pathogenic infections, especially in immunocompromised patients. We report a pneumonia in a patient with chronic renal failure, who had chronic rejection of transplanted kidney. E. americana was identified to be the pathogen of pneumonia with clinical symptoms and signs and radiological examination. As soon as he was treated with ceftriaxone and isepamicin, clinical improvement was followed with no further growth of E. americana or other pathogenic isolates from sputum culture. This suggests to be the case of pneumonia caused by E. americana for the first time in the Korean literature.

Topics: Adult; Anti-Bacterial Agents; Ceftriaxone; Enterobacteriaceae; Enterobacteriaceae Infections; Gentamicins; Humans; Kidney Failure, Chronic; Kidney Transplantation; Male; Pneumonia; Sputum; Time Factors

This is the second report of a Citrobacter-associated brain abscess in an adult and the first report of its association with an intradural tumor. Excluding those associated with trauma, neurosurgical procedures, and proximity to the skull base, only seven other cases of abscesses associated with intracranial tumors have been published. Five of seven tumor-associated abscesses with a microbiological diagnosis involved gram-negative bacteria, a finding that may indicate a predilection of these microorganisms for intracranial tumors.. A 78-year-old female patient presented with a 6-month history of confusion and personality changes. Her medical history included paroxysmal atrial fibrillation and a 10-day course of high-dose dexamethasone but no other predisposing conditions for sepsis. She was afebrile, had no focal neurological deficits, and had no systemic abnormalities on examination. Computed tomographic imaging revealed a noncalcified, homogeneously enhancing, 3-cm-diameter, extra-axial tumor associated with the right anterior falx cerebri. The tumor did not extend to the skull base.. At craniotomy, 10 to 20 ml of thick pus was found around the posteroinferior surface of the tumor. On extended culture, this material demonstrated Citrobacter koseri growth, which was effectively treated with ceftriaxone followed by meropenem and one repeated abscess aspiration. No systemic source of the infection was found.. The characteristic endothelial invasiveness of Citrobacter and related gram-negative bacteria may predispose to the formation of abscesses in association with intracranial tumors.

Topics: Aged; Brain Abscess; Ceftriaxone; Citrobacter koseri; Craniotomy; Enterobacteriaceae Infections; Female; Frontal Bone; Humans; Magnetic Resonance Imaging; Meningeal Neoplasms; Meningioma; Meropenem; Thienamycins

To investigate the potential correlation between the use of extended-spectrum cephalosporins (ESCs) and resistance to this antibiotic class among clinical isolates of Enterobacter cloacae in a university-affiliated hospital.. Data on antimicrobial resistance and antimicrobial use concerning E. cloacae and ESCs were collected over a 4 year period. Various statistical tools were used to explore the potential relationship.. From 1999 to 2002, the proportion of E. cloacae isolates resistant to ESCs increased from 24.3% to 29.6%. (P=0.04), and the quantity of ESCs prescribed and given did not change. Within the subclass constituted by first-line ESCs, the proportion of ceftriaxone increased from 64.3% to 77.6% and the proportion of cefotaxime decreased accordingly, from 35.7% to 22.4%. Statistical analyses showed that E. cloacae resistance to ESCs correlated with ceftriaxone use regardless of the other ESCs. For every defined daily dose of ceftriaxone per 1000 patient days used in our hospital, resistance of E. cloacae isolates to ESCs increased by 1.36%.. This study demonstrates a specific correlation between ceftriaxone use and the development of resistance in E. cloacae clinical isolates. The high biliary elimination of ceftriaxone compared with other ESCs may be responsible for a greater impact of this antibiotic on the digestive flora.

Topics: Cefotaxime; Ceftriaxone; Cephalosporin Resistance; Cephalosporins; Data Interpretation, Statistical; Drug Utilization; Enterobacter cloacae; Enterobacteriaceae Infections; Hospitals, University; Humans; Microbial Sensitivity Tests; Spain

The incidence of infection due to extended spectrum beta-lactamases (ESBLs) producing Enterobacteriaceae has markedly increased in recent years. The traditional susceptibility methods lack sensitivity and/or specificity and this issue has prompted the search for an accurate test to detect the presence of ESBL. The present study included 300 bacterial strains and was undertaken to determine the prevalence of ESBL-producing strains. Here, compared three tests: a double disk synergy test (DDS), a three-dimensional test (3-D), and an inhibitor potentiated disk diffusion test (IPT); each test employed three different antibiotic discs, i.e., ceftazidime, ceftriaxone, and cefotaxime, in order to screen for ESBL strains. A strain was said to be an ESBL producer if it showed positive result(s) on any one of the three tests. The prevalence rate of ESBL in our hospital was 12.6% (38/300). IPT detected the most strains (34/38), followed by 3-D (23/38), and then DDS (15/38). The ceftriaxone disc was found to detect more ESBLs than either the ceftazidime or the cefotaxime disc.

Topics: Anti-Bacterial Agents; beta-Lactamases; beta-Lactams; Cefotaxime; Ceftazidime; Ceftriaxone; Enterobacteriaceae; Enterobacteriaceae Infections; Hospitals; Humans; India; Microbial Sensitivity Tests; Prevalence

Receipt of a broad-spectrum cephalosporin is a strong risk factor for isolation of broad-spectrum cephalosporin-resistant Enterobacter species, and yet the risk from other broad-spectrum beta-lactams hydrolyzed by group 1 beta-lactamases has not been well characterized. We compared the risk conferred by broad-spectrum cephalosporins to that conferred by piperacillin-tazobactam, alone or in combination with an aminoglycoside or a fluoroquinolone. A retrospective cohort was monitored from treatment onset until a broad-spectrum cephalosporin-resistant Enterobacter strain was isolated or the patient was discharged. There were 447 patients in the piperacillin-tazobactam group and 2,341 patients in the broad-spectrum cephalosporin group. Groups were similar in age (mean, 62.5 years). The piperacillin-tazobactam group had a smaller percentage of men (32% versus 44%, P < 0.001) and a lower rate of intensive care unit stay (25% versus 38%, P < 0.001) but a higher rate of surgery (41% versus 26%, P < 0.001). Groups differed in the distribution of comorbidities. Resistant Enterobacter strains were isolated from 62 patients, 2% in each group (hazard ratio [RR] = 1.02 [P = 0.95]). In multivariable analysis, risk was similar among treatment groups (RR = 0.71 [P = 0.32]). Intensive care unit stay and surgery were associated with increased risk (RR = 4.53 [P < 0.001] and RR = 1.97 [P = 0.015], respectively), fluoroquinolones were protective (RR = 0.24 [P = 0.003]), and aminoglycosides did not affect risk (RR = 0.98 [P = 0.95]). The protective effect of fluoroquinolones against isolation of broad-spectrum cephalosporin-resistant Enterobacter spp. and the equivalence in risk associated with piperacillin-tazobactam and broad-spectrum cephalosporins may have important clinical and epidemiologic implications.

Topics: Anti-Bacterial Agents; beta-Lactam Resistance; Ceftazidime; Ceftriaxone; Cohort Studies; Drug Therapy, Combination; Enterobacter; Enterobacteriaceae Infections; Female; Humans; Male; Middle Aged; Multivariate Analysis; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination; Proportional Hazards Models; Retrospective Studies; Risk Factors

The report of purple discoloration in a urinary drainage system, known as Purple Urine Bag Syndrome (P.U.B.S.) is rarely described in the literature.. In an 85 year-old woman, with permanent indwelling urinary catheter, the appearance of purple coloration in the urine collecting bag, without change in the colour of the urine, was observed four times in one year. During these different episodes, a Gram negative lower urinary infection diagnoses. The germs identified were Providencia stuartii and Citrobacter koseri. Symptoms resolved completely after treatment with ceftriaxone.. The clinical and biological symptoms usually described in cases of P.U.B.S. are observed in the medical history of this elderly woman: indwelling catheter with delay before onset of coloration greater than 15 days following catheterization, alkaline urinary pH, Gram negative lower urinary tract infection. However, during one of the episodes of PUBS in our patient, Citrobacter koseri was identified, germ not mentioned, as far as we know, in the literature. Moreover, in the published cases, Proteus species was identified as potentially associated with P.U.B.S., but a Proteus mirabilis urinary infection with was diagnosed in our patient, without any purple coloration of the urine in the collection bag.

Topics: Aged; Aged, 80 and over; Anti-Bacterial Agents; Catheters, Indwelling; Ceftriaxone; Citrobacter koseri; Enterobacteriaceae Infections; Female; Humans; Providencia; Urinary Tract Infections

Antimicrobial resistance is an emerging problem among nosocomial bacteria. Risk factors for the recovery of ceftriaxone-resistant (CRCF) or -susceptible (CSCF) Citrobacter freundii in clinical cultures from hospitalized patients were determined by using a case-case-control study design. CRCF was isolated from 43 patients (case group 1) and CSCF was isolated from 87 patients (case group 2) over a 3-year period. Risk factors for CRCF were exposure to imipenem (odds ratio [OR], 7.5; 95% confidence interval [CI], 1.2 to 45.4), broad-spectrum cephalosporins (OR, 6.9; 95% CI, 1.8 to 26.7), vancomycin (OR, 3.0; 95% CI, 1.2 to 7.4), or piperacillin-tazobactam (OR, 2.6; 95% CI, 1.1 to 6.2), as well as hospital length of stay >or=1 week (OR, 3.6; 95% CI, 1.3 to 10.2) and intensive care unit (ICU) stay (OR, 2.6; 95% CI, 1.1 to 6.2). Risk factors for CSCF were peripheral vascular disease (OR, 23.2; 95% CI, 4.3 to 124.6), AIDS (OR, 9.5; 95% CI, 1.6 to 55.5), cerebrovascular disease (OR, 4.2; 95% CI, 1.6 to 10.8), and ICU stay (OR, 3.1; 95% CI, 1.8 to 5.4).

Topics: Case-Control Studies; Ceftriaxone; Cephalosporin Resistance; Cephalosporins; Cerebrovascular Disorders; Citrobacter freundii; Critical Care; Cross Infection; Enterobacteriaceae Infections; Female; Humans; Length of Stay; Male; Middle Aged; Risk Factors

Using a diffusion chamber in rabbits, we evaluated therapy with the combination of ceftriaxone plus the beta-lactamase inhibitor tazobactam in comparison with ceftriaxone alone. One sensitive and one resistant strain of Escherichia coli, Enterobacter cloacae and Klebsiella pneumoniae were inoculated into one of the six diffusion chambers, implanted in the same animal. In order to simulate pharmacokinetics in humans, both substances were administered in decreasing doses. Ceftriaxone was given 0, 2, 4 and 6 h after infection in dosages of 45, 35, 25 and 15 mg/kg of body weight, while tazobactam was administered either in one dose at 0 h, or divided into two doses at 0 and 1 h or 0 and 4 h, or divided into three doses at 0, 1 and 4 h after infection. The ratio of ceftriaxone:tazobactam was fixed at 8:1. Ceftriaxone, in combination with tazobactam, given in one dose immediately after infection showed a significant reduction in bacterial count. All other combinations of ceftriaxone and tazobactam did not differ from ceftriaxone in monotherapy. Co-administration of the beta-lactamase inhibitor tazobactam significantly enhanced the activity of ceftriaxone against all three tested species.

Topics: Animals; Ceftriaxone; Cephalosporin Resistance; Cephalosporins; Colony Count, Microbial; Diffusion Chambers, Culture; Drug Therapy, Combination; Enterobacter; Enterobacteriaceae; Enterobacteriaceae Infections; Enzyme Inhibitors; Escherichia coli; Humans; Klebsiella pneumoniae; Microbial Sensitivity Tests; Penicillanic Acid; Rabbits; Tazobactam

Topics: Adult; Ceftriaxone; Cephalosporins; Clostridium Infections; Diagnosis, Differential; Echocardiography; Endocarditis; Enterobacteriaceae Infections; Escherichia; Heart Injuries; Humans; Male; Wounds, Gunshot

Topics: Ceftriaxone; Cephalosporins; Child; Duodenal Ulcer; Duodenum; Endoscopy, Gastrointestinal; Enterobacter cloacae; Enterobacteriaceae Infections; Follow-Up Studies; Humans; IgA Vasculitis; Injections, Intravenous; Male; Peptic Ulcer Hemorrhage; Sepsis

Topics: Acquired Immunodeficiency Syndrome; Adult; AIDS-Related Opportunistic Infections; Anti-Bacterial Agents; Bacteremia; Ceftriaxone; Cellulitis; Enterobacteriaceae; Enterobacteriaceae Infections; Fatal Outcome; Female; Humans

Septic arthritis in an 8 month old infant due to Citrobacter freundii was treated successfully with a third generation cephalosporin. Infections due to Citrobacter are uncommon in this age group and are almost unknown as a cause of septic arthritis.

Topics: Arthritis, Infectious; Ceftriaxone; Citrobacter freundii; Enterobacteriaceae Infections; Female; Humans; Infant

Isolation of Edwardsiella tarda in humans has been associated with an asymptomatic carrier state as well as mild, self-limited diarrheal illness. Extraintestinal manifestations have included soft-tissue infections, meningitis, osteomyelitis, cholangitis, and sepsis. Only three cases of patients who had documented hepatic abscess due to E. tarda have been reported in the English-language literature; two patients died, and the third required a laparotomy and drainage. We report what is, to our knowledge, the first autochthonous case of hepatic abscess due to E. tarda in the United States and the first case that was successfully managed with antibiotic therapy alone.

Topics: Adult; Ceftriaxone; Cilastatin; Ciprofloxacin; Drug Therapy, Combination; Enterobacteriaceae Infections; Humans; Imipenem; Liver Abscess; Male

We conducted a retrospective clinical evaluation to assess the efficacy of a 1-gram once-daily regimen of intravenously administered ceftriaxone in the treatment of a variety of bacterial infections. Of the 250 patients studied, 167 had infections of the lower respiratory tract, approximately 70% of which were diagnosed as community-acquired pneumonias. The principal identified pathogens were Staphylococcus aureus and Haemophilus influenzae. Forty per cent of community-acquired pneumonias occurred in patients over 69 years of age, who showed a 13% mortality compared to a mortality rate of 4% in younger patients. Once-daily ceftriaxone was effective and well tolerated as empiric therapy for pneumonia likely to be caused by susceptible organisms.

Topics: Aged; Bronchitis; Ceftriaxone; Drug Administration Schedule; Enterobacteriaceae Infections; Female; Haemophilus Infections; Haemophilus influenzae; Humans; Injections, Intravenous; Male; Pneumonia; Pneumonia, Staphylococcal; Retrospective Studies

Citrobacter meningitis is an uncommon enteric gram-negative infection that afflicts neonates and young children. Approximately 30 percent of children treated or untreated die from the infection. We report a case of C. freundii meningitis that was resistant to ampicillin and was successfully treated with ceftriaxone, a third-generation cephalosporin. A 13-day-old, full-term baby was admitted to the hospital with a one-day history of fever up to 38.8 degrees C. On admission the infant had a temperature of 39.2 degrees C, pulse of 140 beats/min, and a respiratory rate of 32 breaths/min. Except for a slightly bulging fontanelle, the rest of the physical examination was within normal limits. Complete blood count revealed a white blood cell (WBC) count of 12.5 x 10(9)/L, with 0.66 polymorphonuclear cells, 0.10 bands, 0.18 lymphocytes, and 0.06 monocytes. A stat lumbar puncture showed 10 WBCs per high-power field with gram-negative rods. Empiric therapy with ampicillin 225 mg q12h and gentamicin 11 mg q8h was started. Both antibiotics were discontinued after culture and sensitivity results were positive for C. freundii in the blood and spinal fluid. The patient was successfully treated with nine days of ceftriaxone 250 mg q12h.

Topics: Ceftriaxone; Citrobacter; Drug Resistance, Microbial; Enterobacteriaceae Infections; Humans; Infant, Newborn; Male; Meningitis

We have reported a case of E sakazakii primary bacteremia in an elderly patient in whom evaluation failed to reveal a source of infection. This patient had an uneventful recovery after intravenous administration of a third-generation cephalosporin for 7 days followed by 1 week of oral ciprofloxacin. This excellent response supports the previous suggestion that agents more active against gram-negative bacilli should be considered, despite apparent susceptibility to less active agents. Since this case attests to the pathogenicity of this organism in adults, isolation of the organism from clinical specimens should not be dismissed as contamination.

Topics: Aged; Ceftriaxone; Enterobacteriaceae Infections; Female; Humans; Sepsis

Fleroxacin and cefetamet were evaluated in vitro against 38 infrequently encountered species (250 strains) of the family Enterobacteriaceae and compared with four established compounds. For all the strains tested, the fleroxacin MIC was less than or equal to 0.5 mg/liter, and for 98% of strains the cefetamet MIC was less than or equal to 8 mg/liter; even though the two new compounds did not quite reach the activities (on a weight-by-weight basis) of ciprofloxacin and ceftriaxone, respectively, they nonetheless clearly surpassed trimethoprim-sulfamethaxazole and amoxicillin-clavulanic acid. The very potent new oral compounds tested in this study appear to be promising for the treatment of clinically relevant infections due to uncommon species of Enterobacteriaceae.

Topics: Amoxicillin; Anti-Bacterial Agents; Ceftizoxime; Ceftriaxone; Ciprofloxacin; Clavulanic Acid; Clavulanic Acids; Enterobacteriaceae; Enterobacteriaceae Infections; Fleroxacin; Humans; Microbial Sensitivity Tests; Trimethoprim, Sulfamethoxazole Drug Combination

Endophthalmitis is a well-recognized complication of intraocular surgery, penetrating ocular trauma and systemic infection. Metastatic bacterial endophthalmitis is rare. However, once it happens, the visual outcome is very poor. In order to prevent visual damage, early diagnosis and treatment is essential. Due to the blood-ocular barrier, intravitreal drug concentrations are low after systemic administration. Strong antibiotics with good penetration into the vitrous humor are needed to obtain adequate bactericidal concentrations. We report two cases with liver abscess complicated by septic events to the eye. One was uveitis, and the other was endophthalmitis. They were diagnosed early and were successfully treated with parenteral ceftriaxone and good vision was preserved.

Topics: Adult; Ceftriaxone; Endophthalmitis; Enterobacteriaceae Infections; Fluorescein Angiography; Humans; Klebsiella Infections; Liver Abscess; Male; Middle Aged; Sepsis; Sulfamethoxazole; Trimethoprim; Ultrasonography; Uveitis; Visual Acuity

Tigemonam, an oral monobactam that exhibits beta-lactamase stability similar to that of aztreonam, was tested in vitro against 240 species of Enterobacteriaceae (50 Escherichia coli, 48 Klebsiella pneumoniae, 52 Enterobacter cloacae, 32 Proteus mirabilis, 22 Proteus indole-positive [Providencia sp.], 24 Serratia sp., and 12 Citrobacter sp. All strains were resistant to ampicillin and first-generation cephalosporins. In addition, 77.4% were resistant to amoxicillin plus clavulanic acid, 46.8% to cefuroxime, 23.3% to ceftriaxone, 22.2% to aztreonam, 46.9% to cotrimoxazole, and 0.9% to norfloxacin. Tigemonam at a concentration of 4 micrograms/mL or less inhibited 72.7% of the strains with minimum inhibitory concentrations ranging from 0.03 or less to more than 512 micrograms/mL. The highest intrinsic activity was observed against Proteus sp. Tigemonam proved to be a bactericidal antibiotic. Cross-resistance was chiefly observed with aztreonam and ceftriaxone. It is concluded that tigemonam should play an important role in the treatment of nosocomial infections that do not require parenteral therapy and in the treatment of multiresistant community-acquired infections.

Topics: Aztreonam; Ceftriaxone; Cross Infection; Drug Resistance, Microbial; Enterobacteriaceae Infections; Humans; Microbial Sensitivity Tests; Monobactams

Topics: Aged; Aged, 80 and over; Ceftriaxone; Enterobacteriaceae Infections; Humans; Male; Pneumonia; Postoperative Complications; Serratia marcescens

Topics: Ceftriaxone; Enterobacteriaceae Infections; Humans; Infant, Newborn; Sepsis; Staphylococcal Infections

The ability of antibiotic combinations to limit the emergence of resistance during therapy was evaluated in a murine model. Peritonitis was produced by injecting a mixture containing 10(8) colony-forming units of bacteria and sterilized talcum into the peritoneum. Two hours later, a single antibiotic dose was administered subcutaneously. The next day, peritoneal bacterial populations were analyzed on Szybalski's gradients. Acquired resistance was recorded when there was at least a fourfold increase in minimum inhibitory concentrations compared with untreated animals. No resistance emerged after amikacin monotherapy (15 mg/kg); however, resistance was frequently observed after monotherapy with ceftriaxone (50 mg/kg) or pefloxacin (25 mg/kg). Resistance to ceftriaxone and pefloxacin emerged, respectively, in 15 percent and 83 percent of animals with Klebsiella pneumoniae, 71 percent and 54 percent with Enterobacter cloacae, 0 percent and 83 percent with Serratia marcescens, 25 percent and 100 percent with Pseudomonas aeruginosa, and 0 percent with both Escherichia coli and Staphylococcus aureus. In mice with K. pneumoniae or E. cloacae infections, any dual combination of amikacin, pefloxacin, and ceftriaxone produced less acquired resistance than did monotherapy. In these animals, the combination of ceftriaxone and pefloxacin abolished all resistance, whereas the combinations of amikacin plus ceftriaxone or amikacin plus pefloxacin reduced the frequency of resistance by more than half. In animals with P. aeruginosa or S. marcescens infections, resistance to pefloxacin diminished or disappeared after treatment with the combinations of pefloxacin plus ceftriaxone or pefloxacin plus amikacin. However, combinations with ceftriaxone resulted in more frequent resistance to ceftriaxone than did ceftriaxone alone. This was the case in P. aeruginosa infections treated with ceftriaxone plus amikacin (p less than 0.01), and in S. marcescens infections treated with ceftriaxone plus pefloxacin (p less than 0.05). Despite these certain notable exceptions, our data confirm that in most cases combination therapy does limit the emergence of resistance.

Topics: Amikacin; Animals; Anti-Bacterial Agents; Ceftriaxone; Drug Resistance, Microbial; Drug Therapy, Combination; Enterobacter; Enterobacteriaceae Infections; Escherichia coli; Escherichia coli Infections; Female; Klebsiella Infections; Klebsiella pneumoniae; Mice; Mice, Inbred ICR; Norfloxacin; Pefloxacin; Pseudomonas aeruginosa; Pseudomonas Infections; Serratia marcescens; Staphylococcal Infections; Staphylococcus aureus; Time Factors

Twenty patients with severe nosocomial bacterial infections hospitalized in an intensive care unit were treated by ceftriaxone alone, in a single daily IV injection of 2 g. Clinical and bacteriological results show that ceftriaxone has good activity against enterobacteria. The four patients (20%) who failed to respond had superinfection by Pseudomonas aeruginosa, a finding that suggests that ceftriaxone should be used in combination with another antibiotic for the treatment of nosocomial infections. Pharmacokinetic results in our patients show that with the dosage used peak and trough serum levels are greater than the MICs of susceptible pathogens.

Topics: Adult; Aged; Bronchopneumonia; Ceftriaxone; Critical Care; Cross Infection; Enterobacteriaceae Infections; Female; Humans; Male; Middle Aged; Pseudomonas Infections

An in vitro study of the sensitivity of three cephalosporins of the third generation was performed on 119 wild strains of enterobacteriae selected because of their resistance to cefalotine and cefoxitine. Cefotaxime, latamoxef and cetriaxone remain very active on such strains since almost all of the strains were inhibited by a dose of 4 micrograms/ml and CI 50 p. cent was below 0.20 micrograms/ml. The activity of these three cephalosporins was comparable on groups E. coli, Klebsiella-Enterobacter-Serratia and C. freudii. Ceftriaxone appeared clearly more active than latamoxef and cefotaxime on Proteus stains.

Topics: Cefotaxime; Cefoxitin; Ceftriaxone; Cephalosporins; Cephalothin; Drug Resistance, Microbial; Enterobacteriaceae; Enterobacteriaceae Infections; Humans; Microbial Sensitivity Tests; Moxalactam; Species Specificity

One hundred sequential Gram-negative rod isolates from patients with hospital-acquired bloodstream infections were tested against seven new cephalosporins. Duplicate broth microdilution tests indicated superior activity for ceftazidime with 97% of strains susceptible to 16 mg/l. Less in-vitro activity was demonstrated cefotaxime (91% susceptible to 16 mg/l, P = 0.07), latamoxef (moxalactam) (90%, P = 0.04), cefoperazone (90%, P = 0.04), ceftriaxone (87%, P = 0.008), cefmenoxime (80%, P = 0.0001), and ceftizoxime (79%, P less than 0.0001). With the exception of cefoperazone, the newer drugs had mean MICs of less than or equal to 0.6 mg/l against Enterobacteriaceae. Ceftazidime and cefoperazone had highest activities against Pseudomonas aeruginosa with MIC90S of 4 and 16 mg/l, respectively. A comparison of recently published data shows important geographic differences in MIC90 data for the new cephalosporins against specific species.

Topics: Cefmenoxime; Cefoperazone; Cefotaxime; Ceftazidime; Ceftizoxime; Ceftriaxone; Cephalosporins; Cross Infection; Enterobacteriaceae; Enterobacteriaceae Infections; Gram-Negative Bacteria; Humans; Microbial Sensitivity Tests; Pseudomonas aeruginosa; Pseudomonas Infections; Sepsis

MIC of ceftriaxone, moxalactam and cefotaxime is determined for 827 strains of Enterobacteriaceae isolated in the Central Laboratory of the Pitié-Salpêtrière Hospital between december 1981 and september 1982. Results are distributed according to the species involved and the pattern of sensitivity (S) and resistance (R) to ampicillin (A), carbenicilline (Ca) and cephalotin (Ct). Among the strains ASCaSCtS and ARCaRCtS cefotaxime and ceftriaxone have the lowest MICs. Among the most sensitive strains ARCaSCtR and ARCaRCtR cefotaxime, ceftriaxone and moxalactam have the similar MICs, whereas among the less sensitive ones moxalactam has the lowest MICs. The latter might be the cephalosporin of choice for the treatment of serious infection due to the less sensitive Enterobacteriaceae. On the other hand, cefotaxime and ceftriaxone might be the cephalosporins of choice for the treatment of serious infections due to the most sensitive Enterobacteriaceae.

Topics: Anti-Bacterial Agents; Cefotaxime; Ceftriaxone; Cross Infection; Enterobacteriaceae; Enterobacteriaceae Infections; Humans; Microbial Sensitivity Tests; Moxalactam; Phenotype

Topics: Aged; Bacterial Infections; Cefotaxime; Ceftriaxone; Enterobacteriaceae Infections; Female; Humans; Male; Middle Aged