ro13-9904 and Gram-Negative-Bacterial-Infections

This article aims to give a state-of-the-art assessment of treatment options for bloodstream infection because of ceftriaxone-resistant Gram-negative bacilli, especially those caused by extended-spectrum beta-lactamase (ESBL) or AmpC-producing Enterobacteriaceae. In particular, this review assesses whether current data support 'carbapenem-sparing options' for treatment of these serious infections.. The MERINO trial refuted earlier observational studies some of which showed equivalence in outcomes between beta-lactam/beta-lactamase inhibitor combinations and carbapenems for treatment of bloodstream infection because of ceftriaxone-resistant Escherichia coli or Klebsiella spp. Although numerous factors influence mortality following bloodstream infection, the variability in piperacillin/tazobactam MICs observed in the MERINO trial make this a less secure option than meropenem. However, the search for carbapenem-sparing options continues with four randomized controlled trials (RCTs) in progress and a number of other options in clinical development.. Hard outcomes from RCTs are still needed before intravenous carbapenems can be displaced as the treatment of choice for ceftriaxone-resistant Gram-negative bacilli.

Topics: Anti-Bacterial Agents; Bacteremia; beta-Lactamase Inhibitors; beta-Lactamases; Carbapenems; Ceftriaxone; Cephalosporin Resistance; Gram-Negative Bacteria; Gram-Negative Bacterial Infections; Humans; Randomized Controlled Trials as Topic

Invasive infections caused by Capnocytophaga canimorsus are rare. Immunocompromised patients, who report being bitten by or having a close contact with an animal, represent a high-risk group for this infection. There are only few dozens of infections by this bacteria manifesting as purulent meningitis reported worldwide. The reported case is a first reported case of purulent meningitis caused by by Capnocytophaga canimorsus in Czech Republic with only a limited risk factor history.. The patient, a 74 years old man, was referred to the infectious diseases department of a teaching hospital with clear signs of developing purulent meningitis. His anamnestic data did not show any unusual findings. He was treated for compensated diabetes mellitus type II. The blood cultures were negative and the etiological agent did not grow from the cerebrospinal fluid (CSF) on common media. Eventually, it was identified by detecting pan-bacterial DNA and DNA sequencing. Subsequently, the pathogen was confirmed by anaerobic cultivation from CSF. Only after then the patient recalled being bitten by his German shepherd puppy during play. The patient was successfully treated intravenously by ceftriaxone.. Purulent meningitis caused by Capnocytophaga spp. is a rare disease, but it needs to be considered in patients at risk with pre-existing conditions, who report close contact with or being bitten by an animal. It is important to test for this microbe in cases with negative microbiological results for the more common agents.

Topics: Aged; Animals; Bites and Stings; Blood Culture; Capnocytophaga; Ceftriaxone; Czech Republic; Dogs; Gram-Negative Bacterial Infections; Humans; Immunocompromised Host; Male; Meningitis, Bacterial

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

In this article we review the available data concerning meningitis caused by Capnocytophaga canimorsus. The clinical presentation of this rare condition is described with the emphasis on associated conditions and management issues. Two additional cases, illustrating the difficulties in recognizing this rare disease, are presented. Reviewing a total of 28 reported cases, a preceding bite-incident by a cat or dog, or close contact with these animals, was described in the majority of cases (89%). Patients had a median age of 58 years; splenectomy and alcohol abuse were noted in, respectively, 18% and 25% of patients. Only in one case immune suppressive drug use was reported. The diagnosis C. canimorsus meningitis should be considered in healthy and immunocompromised adults, especially after splenectomy, who present with symptoms attributable to meningitis and a history of recent exposure to dogs or cats. The possibility of this condition has implications for both the diagnostic work-up and the treatment of the patient.

Topics: Alcohol-Related Disorders; Animals; Bites and Stings; Capnocytophaga; Cats; Ceftriaxone; Dexamethasone; Diagnosis, Differential; Dogs; Drug Therapy, Combination; Gram-Negative Bacterial Infections; Humans; Male; Meningitis, Bacterial; Middle Aged; Opportunistic Infections; Risk Factors; Splenectomy

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Cefotaxime; Ceftriaxone; Cephalosporins; Female; Gram-Negative Bacterial Infections; Humans; Male; Middle Aged; Randomized Controlled Trials as Topic; Respiratory Tract Infections

Ceftriaxone is active against many gram-negative bacillary uropathogens. It achieves very high levels in urine and proximate tissue following single daily doses. Clinical and bacteriologic results in infections due to susceptible organisms have been excellent. Additional comparative studies with longer follow-up may assist in further delineating the relative role of ceftriaxone in management of infections of the urinary tract.

Topics: Bacterial Infections; Ceftriaxone; Drug Resistance, Microbial; Gram-Negative Bacterial Infections; Humans; Infant, Newborn; Multicenter Studies as Topic; Urinary Tract Infections

Ceftriaxone has a higher biliary elimination than cefotaxime (40% versus 10%), which may result in a more pronounced impact on the intestinal microbiota. We performed a monocenter, randomized open-label clinical trial in 22 healthy volunteers treated by intravenous ceftriaxone (1 g/24 h) or cefotaxime (1 g/8 h) for 3 days. We collected fecal samples for phenotypic analyses, 16S rRNA gene profiling, and measurement of the antibiotic concentration and compared the groups for the evolution of microbial counts and indices of bacterial diversity over time. Plasma samples were drawn at day 3 for pharmacokinetic analysis. The emergence of 3rd-generation-cephalosporin-resistant Gram-negative enteric bacilli (

Topics: Adolescent; Adult; Anti-Bacterial Agents; Cefotaxime; Ceftriaxone; Cephalosporins; Feces; Female; Gastrointestinal Microbiome; Gram-Negative Bacteria; Gram-Negative Bacterial Infections; Healthy Volunteers; Humans; Male; Middle Aged; RNA, Ribosomal, 16S; Young Adult

Outpatient oral therapy is infrequently used in pediatric low-risk febrile neutropenia (LRFN) as there is insufficient data regarding its equivalence as compared with parenteral therapy.. This is a single institutional, randomized control trial in pediatric LRFN aged 2 to 15 years, in which 123 episodes in 88 patients were randomized to outpatient oral ofloxacin 7.5 mg/kg 12 hourly and amoxycillin-clavulanate 12.5 mg/kg 8 hourly or outpatient intravenous (IV) ceftriaxone 75 mg/kg and amikacin 15 mg/kg once daily after blood cultures.. Out of 119 evaluable episodes, one-third were leukemia patients in maintenance and rest were solid tumors. Success was achieved in 55/61 (90.16%) and 54/58 (93.1%) in oral and IV arms, respectively, (P=0.56). There were 3 hospitalizations but no mortality. Median days to resolution of fever, absolute neutrophil count >500/mm(3) and antibiotic use were 3, 5, and 6 days in both arms. There were 5 blood culture isolates (3 gram-positive and 2 gram-negative bacteria). Failure of outpatient therapy was associated with perianal infections, bacteremia, febrile neutropenia onset before day 9 of chemotherapy in solid tumors and Vincristine, actinomycin-D, and cyclophosphamide chemotherapy for rhabdomyosarcoma. All gram-positive isolates were successes, whereas both gram-negative isolates were failures. Diarrhea in IV arm and Vincristine, actinomycin-D, and cyclophosphamide chemotherapy in the oral arm predicted failure in subgroup analysis.. Outpatient therapy is efficacious and safe in pediatric LRFN. There was no difference in outcome in oral versus IV outpatient therapy. Amoxycillin-clavulanate and ofloxacin may be the oral regimen of choice.

Topics: Administration, Oral; Adolescent; Ambulatory Care; Amikacin; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Antineoplastic Combined Chemotherapy Protocols; Ceftriaxone; Child; Child, Preschool; Drug Therapy, Combination; Female; Fever; Gram-Negative Bacterial Infections; Gram-Positive Bacterial Infections; Humans; Injections, Intravenous; Male; Neoplasms; Neutropenia; Ofloxacin; Treatment Outcome

To investigate the efficacy, tolerability and cost effectiveness of three antibiotics in a short-term antibiotic regimen in patients undergoing elective implant surgery.. 89 patients who underwent 101 implantation procedures were enrolled during a period of five years and randomly divided into three groups to receive: (a) Rocephin (Ceftriaxone) 1g intravenously at induction and 1g 12 hours later (Group 1). (b) Zinacef (Cefuroxime) 1.5 g intravenously at induction and 750 mg six hourly for 12 hours (Group 2). Ciprotab (ciprofloxacine) 400mg intravenously at induction and 200mg six hourly for 12 hours (group 3).. The patients in the three groups were comparable regarding age, gender, pre-operative length of hospitalization and duration of surgery. The overall surgical site infection rate was 6.9% (7/101) with gram-negative organisms being the most common causative organisms (71.4%). The infection rates of 6.3% in group 1,7.3% in group 2 and 7.1% in group 3 show no statistical significance (P>0.05). The cost benefit ratio for the three drugs showed that treatment with Ciprotab was cheaper than that with Rocephin or Zinacef. Severe complications warranting discontinuation of therapy did not occur in any of the three groups of patients.. While we can safely conclude that all the drugs have similar efficacy and safely in preventing post-operative wound complications, it appears that Ciprotab is most cost-effective. We recommend that a larger study be undertaken to confirm the predominance of gram-negative organisms in implant surgery.

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Antibiotic Prophylaxis; Ceftriaxone; Cefuroxime; Ciprofloxacin; Cross Infection; Drug Administration Schedule; Female; Gram-Negative Bacterial Infections; Humans; Male; Middle Aged; Prosthesis-Related Infections; Treatment Outcome

The selection of resistant gram-negative bacilli by broad-spectrum antibiotic use is a major issue in infection control. The aim of this comparative study was to assess the impact of different antimicrobial regimens commonly used to treat intra-abdominal infections on the susceptibility patterns of gram-negative bowel flora after completion of therapy. In two international randomized open-label trials with laboratory blinding, adults with complicated intra-abdominal infection requiring surgery received piperacillin-tazobactam (OASIS 1) or ceftriaxone/metronidazole (OASIS II) versus ertapenem for 4-14 days. Rectal swabs were obtained at baseline, end of therapy, and 2 weeks post-therapy. Escherichia coli and Klebsiella spp. were tested for production of extended-spectrum beta-lactamase (ESBL). Enterobacteriaceae resistant to the agent used were recovered from 19 of 156 (12.2%) piperacillin-tazobactam recipients at the end of therapy compared to 1 (0.6%) patient at baseline (p<0.001) in OASIS I, and from 33 of 193 (17.1%) ceftriaxone/metronidazole recipients at the end of therapy compared to 5 (2.6%) patients at baseline (p<0.001) in OASIS II. Ertapenem-resistant Enterobacteriaceae were recovered from 1 of 155 and 1 of 196 ertapenem recipients at the end of therapy versus 0 and 1 ertapenem recipients at baseline in OASIS I and II, respectively. Resistant Enterobacteriaceae emerged significantly less often during treatment with ertapenem than with the comparator in both OASIS I (p<0.001) and OASIS II (p<0.001). The prevalence of ESBL-producers increased significantly during therapy in OASIS II among 193 ceftriaxone/metronidazole recipients (from 4 [2.1%] to 18 [9.3%]) (p<0.001), whereas no ertapenem recipient was colonized with an ESBL-producer at the end of therapy in either study. Selection for imipenem-resistant Pseudomonas aeruginosa was uncommon in all treatment groups. In these studies, the frequency of bowel colonization with resistant Enterobacteriaceae substantially increased in patients treated with either piperacillin-tazobactam or ceftriaxone/metronidazole, but not in patients treated with ertapenem.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; beta-Lactams; Carrier State; Ceftriaxone; Digestive System Surgical Procedures; Drug Resistance, Bacterial; Drug Therapy, Combination; Ertapenem; Female; Gram-Negative Bacteria; Gram-Negative Bacterial Infections; Humans; Intestines; Lactams; Male; Metronidazole; Middle Aged; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination

The objective of this multicentre, randomized, prospective and comparative study was to evaluate and compare the efficacy and safety of 1 g intravenous ceftriaxone (active ingredient of Rocephin), 3 g intravenous cefoiaxime (active ingredient of clafron), and 2.25 g intavenous cefuroxime (active ingredient of Zinacef).. In this multicentre, randomized, prospective and comparative study, patients received 1 g of ceftriaxone intravenously once a day (group A), or 1 g of cefotaxime intravenously three times a day (group B), or 0.75 g of cefuroxime intravenously three time a day (group C). 197 patients were enrolled in the study, and in 142 (48 in group A, 46 in group B and 48 in group C) we were able to make an evaluation.. The overall efficacy (bacteriological eradication plus clinical cure or clear improvement) of ceftriaxone, cefotaxime and cefuroxime were 81%, 83%, 79% respectively (P > 0.05). The eradication rate for three groups were 80%, 78%, 75% (P > 0.05). No adverse events occured.. Data obtained in our study indicate that for the majority of patients with lower respiratory tract infections, 1 g ceftriaxone, 3 g cefotaxime and 2.25 g cefuroxime are effective and safe, and 7 days therapy is enough, but the use of 1 g ceftriaxone is more convenient.

Topics: Adolescent; Adult; Aged; Bronchitis; Cefotaxime; Ceftriaxone; Cefuroxime; Cephalosporins; Female; Gram-Negative Bacterial Infections; Humans; Injections, Intravenous; Male; Middle Aged; Pneumonia; Prospective Studies

The combination of penicillin with an aminoglycoside has been recommended as an initial treatment of choice for patients with acute infections of the biliary tract. However, many patients have incidence of renal problems and for this reason aminoglycosides must be avoided. Newer antimicrobial agents with lesser nephrotoxic effects will be tried. We, therefore, performed a prospective, randomized trial of ofloxacin, a new quinolone and ceftriaxone in patients with acute biliary tract infections. Fifty-two patients with severe biliary tract infections (cholecystitis and cholangitis) were randomly assigned to receive either ofloxacin (n = 28) or ceftriaxone (n = 24). The 2 groups receiving antibiotics were similar with respect to all clinical and laboratory parameters. Bacteria were documented in 48% of patients in the ofloxacin group and in 46% in the ceftriaxone group. The percentage of patients with a clinical cure or significant improvement was the same in the 2 groups. No significant difference was noted between the 2 treatment groups with respect to drug toxicity. These data suggest that intravenous ofloxacin followed by oral administration is an effective and safe single drug for the therapy of patients with acute biliary tract infections.

Topics: Anti-Infective Agents; Bacteremia; Ceftriaxone; Cephalosporins; Cholangitis; Cholecystitis; Escherichia coli Infections; Female; Gram-Negative Bacterial Infections; Humans; Klebsiella Infections; Klebsiella pneumoniae; Male; Middle Aged; Ofloxacin; Phlebitis

We compared ceftazidime monotherapy with ceftriaxone/tobramycin in a prospective, randomized clinical trial that included 580 patients with serious hospital-acquired infections. One-half of the patients had an underlying disease with a rapidly or ultimately fatal prognosis; 40% were nursed in intensive care units. Clinical response among patients with pneumonia (73% in the ceftazidime group vs. 65% in the ceftriaxone/tobramycin group), septicemia (73% vs. 59%), and complicated urinary tract infections (80% vs. 76%) showed that there were no significant differences in efficacy between the two regimens. Pseudomonas aeruginosa was the most prevalent pathogen and was effectively eradicated by both treatments. The odds of bacteriologic cure with either study regimen were equal. Mortality was similar in both treatment groups. Ceftazidime monotherapy was not associated with a higher incidence of development of resistance or superinfection. Both regimens were well tolerated; no patients receiving ceftazidime evidenced nephrotoxicity, compared with nine who received the combination. We conclude that ceftazidime may be used as monotherapy in the empirical treatment of patients with serious nosocomial infections.

Topics: Adult; Aged; Ceftazidime; Ceftriaxone; Cross Infection; Drug Therapy, Combination; Female; Gram-Negative Bacterial Infections; Humans; Male; Middle Aged; Prospective Studies; Tobramycin

Topics: Adult; Amoxicillin; Aztreonam; Ceftriaxone; Cloxacillin; Drug Therapy, Combination; Female; Follow-Up Studies; Gram-Negative Bacterial Infections; Gram-Positive Bacterial Infections; Histocompatibility Testing; Humans; Kidney Transplantation; Male; Postoperative Complications; Urinary Tract Infections

In a randomized comparative study, adult patients suffering from Gram-negative septicemia or pyemia were treated either with a single daily dose of 1.5g of ceftriaxone in most patients or 6g of cefotaxime divided into four daily doses. K. pneumoniae and E. coli were commonly isolated in both groups. Altogether 17 patients treated with ceftriaxone and 14 with cefotaxime completed the treatment with a success rate of 88.2% and 85.6% respectively. There were two deaths in patients treated with ceftriaxone (12%) and one with cefotaxime (7.2%). Despite the severity of the disease, antibiotic treatment was relatively short: 7 patients (41%) were treated with ceftriaxone for only 7 days, 2 with cefotaxime for 7 days, 5 for 10 days. Others were treated for a longer period with a maximum duration of 22 days. This study confirms in Asian patients the previous reports that a single daily dose of ceftriaxone is as efficacious as four daily doses with cefotaxime in treating patients with severe infections.

Topics: Adult; Aged; Bacteremia; Cefotaxime; Ceftriaxone; Chi-Square Distribution; Drug Administration Schedule; Female; Gram-Negative Bacterial Infections; Humans; Male; Middle Aged; Suppuration

Isepamicin is a new aminoglycoside with in-vitro activity superior to amikacin. It is a poor substrate for the 6'-aminoacetyltransferase-I enzyme which inactivates amikacin and therefore organisms possessing this enzyme are not resistant to isepamicin. The aim of this study was to compare the efficacy and safety of co-administration of isepamicin once daily plus ceftriaxone to amikacin twice daily plus ceftriaxone to amikacin twice daily plus ceftriaxone in febrile neutropenic cancer patients. Febrile episodes in 235 patients (156 in isepamicin group and 79 in amikacin group) were treated in this study. They occurred in 218 different patients. Fifteen patients were enrolled twice and one three times. Response rates to the two treatment regimens for microbiologically documented episodes, clinically documented episodes and further unexplained fever were similar. Tolerance of the treatment regimens, as measured by serum creatinine levels, hypoaccousia and cutaneous allergy was also similar in both treatment groups. In conclusion, isepamicin given once daily when combined with ceftriaxone in the treatment of febrile episodes in neutropenic cancer patients was as effective and no more toxic than amikacin.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Amikacin; Anti-Bacterial Agents; Bone Marrow Transplantation; Ceftriaxone; Drug Administration Schedule; Drug Therapy, Combination; Female; Fever; Gentamicins; Gram-Negative Bacterial Infections; Gram-Positive Bacterial Infections; Humans; Male; Middle Aged; Neoplasms; Neutropenia; Superinfection

We compared cefonicid (2 g every 12 h) and ceftriaxone (2 g every 24 h) for their efficacy and safety in treating spontaneous bacterial peritonitis in cirrhotic patients in an open randomized clinical trial (30 patients in each group). Clinical, laboratory, and bacteriologic characteristics were similar in both groups. Ceftriaxone-susceptible strains were isolated on 44 occasions (94%), and cefonicid-susceptible strains were isolated on 43 occasions (91.5%). The antibiotic concentration in ascitic fluid/MIC ratio for ceftriaxone was > 100 throughout the dose interval (24 h), while it was lower for cefonicid (between 1 and 18). A total of 100% of patients treated with ceftriaxone, and 94% of those treated with cefonicid were cured of their infections (P was not significant). Hospitalization mortality was 37% in the cefonicid group and 30% in the ceftriaxone group (P was not significant). The time that elapsed between the initiation of treatment and the patient's death was shorter in the cefonicid group patients (5.3 +/- 3.90 days) than in the ceftriaxone group patients (11.8 +/- 9.15 days) (P < 0.05). None of the patients presented with superinfections, and only two patients treated with cefonicid and three patients treated with ceftriaxone developed colonizations with Enterococcus faecalis or Candida albicans. Ceftriaxone and cefonicid are safe and useful agents for treating cirrhotic spontaneous bacterial peritonitis, although the pharmacokinetic characteristics of ceftriaxone seem to be more advantageous than those of cefonicid.

Topics: Aged; Ascites; Cefonicid; Ceftriaxone; Drug Administration Schedule; Female; Gram-Negative Bacteria; Gram-Negative Bacterial Infections; Humans; Liver Cirrhosis; Male; Microbial Sensitivity Tests; Middle Aged; Peritonitis; Prospective Studies

Topics: Adolescent; Ceftriaxone; Drainage; Female; Gram-Negative Bacterial Infections; Humans; Male; Stenotrophomonas maltophilia; Vancomycin; Young Adult

Capnocytophaga canimorsus infection happens frequently in immunosuppressed patients with reported domestic animal bites. Clinical presentation ranges from simple cellulitis to fulminant septic shock with disseminated intravascular coagulopathy, with an overall mortality of 30%. Conventional blood culture is often negative as this is a slow-growing pathogen. Nevertheless, the increasing use of 16S rRNA gene amplification and Sanger sequencing allows a much more rapid diagnostic confirmation. We present two case reports where 16S rRNA gene sequencing helped to diagnose Capnocytophaga canimorsus infection.. Case 1: A 53-year-old man with a history of non-cirrhotic chronic alcohol consumption was admitted to the intensive care unit (ICU) for septic shock and disseminated intravascular coagulopathy (DIC) of unknown origin. Blood cultures remained negative and a 16S rRNA PCR was performed leading to the identification of Capnocytophaga Canimorsus on day 4. Targeted antibiotic therapy with ceftriaxone for 14 days lead to overall recovery. Afterwards, the patient recalled a dog bite 2 days before hospitalization with a punctiform necrotic wound localized on a finger, which was not obvious at admission. Case 2: A 38-year-old man arrived to the emergency department for acute alcohol intoxication and history of a dog bite 2 days before. At admission, septic shock with purpura fulminans was diagnosed and required ICU hospitalization, invasive mechanical ventilation, vasopressor support and renal replacement therapy due to the rapid clinical deterioration. In the context of septic shock with purpura fulminans, DIC and recent dog bite, the diagnosis of Capnocytophaga canimorsus septic shock was suspected, and early confirmed by 16S rRNA PCR coupled to Sanger sequencing on day 2. Blood cultures became only positive for Capnocytophaga canimorsus 5 days after admission. Ceftriaxone alone was infused for 10 days in total, and the patient was discharged from the ICU on day 25.. 16S rRNA gene PCR proves an important diagnostic tool when facing a sepsis of unknown origin. In these two cases of septic shock related to Capnocytophaga canimorsus, initial blood cultures remained negative at 24 h, whereas the diagnosis was achieved by 16S rRNA PCR sequencing performed from blood samples obtained at admission.

Topics: Animals; Bites and Stings; Capnocytophaga; Ceftriaxone; Dogs; Gram-Negative Bacterial Infections; Humans; Polymerase Chain Reaction; Purpura Fulminans; RNA, Ribosomal, 16S; Shock, Septic

Topics: Anti-Bacterial Agents; Ceftriaxone; Gram-Negative Bacterial Infections; Humans; Male; Middle Aged; Paracoccus; Peritoneal Dialysis; Peritonitis

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

Topics: Anti-Bacterial Agents; Bacteremia; Ceftriaxone; Escherichia coli; Gram-Negative Bacterial Infections; Humans; Klebsiella pneumoniae; Meropenem; Microbial Sensitivity Tests; Tazobactam

Topics: Anti-Bacterial Agents; Bacteremia; Ceftriaxone; Escherichia coli; Gram-Negative Bacterial Infections; Humans; Klebsiella pneumoniae; Meropenem; Microbial Sensitivity Tests; Tazobactam

Topics: Anti-Bacterial Agents; Bacteremia; Ceftriaxone; Gram-Negative Bacterial Infections; Humans; Microbial Sensitivity Tests

Peritoneal dialysis-associated peritonitis (PDAP) is one of the major causes of peritoneal dialysis (PD) failure and death. Therefore, it is important to determine how to effectively treat patients with PDAP.. We analyzed the pathogen spectrum and bacterial resistance in 203 PDAP cases that were enrolled in this study from January 1, 2015 to December 31, 2017. All patients were infected with peritonitis and had been treated with antibiotics while at our center. Bacterial culture results of PD fluid and pathogen drug resistance were collected and analyzed. A total of 159 cases (78.3%) had a positive bacterial culture of PD fluid.. A total of 47 pathogens were identified, including 19 (40.4%) Gram-positive cocci strains (the most common was. Gram-positive cocci are still the primary pathogen of PDAP cases in our center, but demonstrate a high resistance to first-generation cephalosporin, which is the suggested treatment per International Society for Peritoneal Dialysis 2016 Peritonitis Recommendations. Therefore, an individualized treatment based on the distribution of pathogens and drug resistance in different centers is more conducive to improve the cure rate of PDAP.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Antifungal Agents; Bacterial Infections; Cefazolin; Ceftriaxone; Drug Resistance, Bacterial; Female; Gram-Negative Bacteria; Gram-Negative Bacterial Infections; Gram-Positive Bacterial Infections; Gram-Positive Cocci; Humans; Imipenem; Itraconazole; Male; Microbial Sensitivity Tests; Middle Aged; Mycoses; Peritoneal Dialysis; Peritonitis; Vancomycin; Voriconazole; Young Adult

Intestinal colonization resistance is mainly exerted by commensal anaerobes.. To assess whether exposure to non-carbapenem antibiotics with activity against intestinal anaerobes (namely, piperacillin/tazobactam, amoxicillin/clavulanate and metronidazole) may promote the acquisition of gut colonization with ceftriaxone-resistant Gram-negative bacteria (CFR-GNB) in ICU patients.. All patients with a first stay >3 days in a single surgical ICU over a 30 month period were retrospectively included. Rectal carriage of CFR-GNB (i.e. ESBL-producing Enterobacteriaceae, AmpC-hyperproducing Enterobacteriaceae, Pseudomonas aeruginosa, Stenotrophomonas maltophilia and CFR Acinetobacter baumannii) was routinely screened for at admission then weekly. The impact of anti-anaerobe antibiotics was investigated in propensity score (PS)-matched cohorts of patients exposed and not exposed to these drugs and through PS-based inverse probability of treatment weighting on the whole study cohort, treating in-ICU death or discharge as competing risks for CFR-GNB acquisition.. Among the 352 included patients [median ICU stay 16 (9-30) days, in-ICU mortality 12.2%], 120 (34.1%) acquired one or more CFR-GNB, mostly AmpC-hyperproducing Enterobacteriaceae (17.6%) and P. aeruginosa (14.8%). Exposure to anti-anaerobe antibiotics was the main predictor of CFR-GNB acquisition in both the PS-matched cohorts [adjusted HR (aHR) 3.92, 95% CI 1.12-13.7, P = 0.03] and the whole study cohort (aHR 4.30, 95% CI 1.46-12.63, P = 0.01). Exposure to other antimicrobials-especially ceftriaxone and imipenem/meropenem-exerted no independent impact on the likelihood of CFR-GNB acquisition.. Exposure to non-carbapenem antibiotics with activity against intestinal anaerobes may predispose to CFR-GNB acquisition in ICU patients. Restricting the use of these drugs appears to be an antibiotic stewardship opportunity.

Topics: Aged; Anti-Bacterial Agents; Bacteria, Anaerobic; Carbapenems; Ceftriaxone; Cross Infection; Drug Resistance, Bacterial; Female; Gram-Negative Bacteria; Gram-Negative Bacterial Infections; Humans; Imipenem; Intensive Care Units; Intestines; Male; Meropenem; Middle Aged; Propensity Score; Retrospective Studies

Gram-negative bacilli are the causative organisms in a significant proportion of patients with severe community-acquired pneumonia (CAP) admitted to the intensive care unit (ICU). Clinical guidelines recommend broad-spectrum antimicrobials for empirical treatment despite alarming global trends in antimicrobial resistance. In this study, we aimed to assess the safety and efficacy of gentamicin, an aminoglycoside with potent bactericidal activity, for empirical Gram-negative coverage of severe CAP in patients admitted to the ICU. A retrospective cohort study was performed at a university teaching hospital where the severe CAP guideline recommends penicillin, azithromycin and gentamicin as empirical cover. Ceftriaxone plus azithromycin is used as an alternative. Adults with radiologically-confirmed severe CAP were included, comparing those who received gentamicin in the first 72 h of admission with those who did not. Participants were identified using ICD-10 codes for bacterial pneumonia and data manually extracted from electronic medical records. Of 148 patients admitted with severe pneumonia, 117 were given at least one dose of gentamicin whereas the remaining 31 were not. The two groups were well matched in terms of demographics, co-morbidities and disease severity. There were no significant differences between the gentamicin and no-gentamicin groups in the incidence of acute kidney injury [60/117 (51%) vs. 16/31 (52%), respectively], hospital mortality [20/117 (17%) vs. 7/31 (23%)] and secondary outcomes including relapse and length of hospital stay. In conclusion, gentamicin is safe and has similar outcomes to alternative Gram-negative antimicrobial regimens for empirical coverage in severe CAP patients admitted to the ICU.

Topics: Acute Kidney Injury; Aged; Anti-Bacterial Agents; Azithromycin; Ceftriaxone; Community-Acquired Infections; Female; Gentamicins; Gram-Negative Bacteria; Gram-Negative Bacterial Infections; Hospital Mortality; Humans; Length of Stay; Male; Middle Aged; Pneumonia, Bacterial; Retrospective Studies

We report a case of ceftriaxone-resistant Aeromonas hydrophila infection in a 32-year-old man after medicinal leech therapy. The patient underwent a free gracilis muscle flap for dorsal foot soft tissue reconstruction. Because of persistent congestion after venous revision, medicinal leech therapy was initiated to aid in flap salvage. Intravenous ceftriaxone was administered prior to application of leeches for prophylaxis against A. hydrophila. Leech therapy was discontinued after 1 week, and ceftriaxone was discontinued 24 hours thereafter. An infection developed despite being on appropriate antibiotics. Culture sensitivities indicated that A. hydrophila was resistant to ceftriaxone.

Topics: Adult; Aeromonas hydrophila; Anti-Bacterial Agents; Ceftriaxone; Drug Resistance, Bacterial; Gram-Negative Bacterial Infections; Humans; Leeching; Male; Microbial Sensitivity Tests

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

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

Sphingomonas paucimobilis is an aerobic gram-negative bacillus. The bacteria can cause infections, which can be devastating and, therefore, the patients need adequate and early antibiotic cover. We are presenting an interesting case of meningitis secondary to an unusual S. paucimobilis infection. This is the second case to our knowledge in the literature on meningitis due to S. paucimobilis. The 31-year-old previously healthy man presented with 2 months' history of weight loss and loss of appetite. He had fever and headache for 3 weeks. He was also speaking irrelevantly for 3 weeks. He had change of behaviour for 1 day. The patient was a farmer and worked in the soil. On examination, he was not responding to questions and was not obeying commands. Computed tomography (CT) brain with contrast revealed meningeal enhancement and cerebral oedema. Lumbar puncture was performed. Cerebrospinal fluid (CSF) opening pressure was more than 50 cm H2O. CSF analysis showed meningitis picture with raised white cell count of 210/μL (predominantly neutrophils), glucose 3.1 mmol/L, and raised protein 2.47 g/L. He was given intravenous ceftriaxone. The following day, his condition deteriorated. CSF culture grew S. paucimobilis sensitive to ceftriaxone. S. paucimobilis causes severe meningitis. This can lead to hydrocephalus, which results in a need for extraventricular drainage. A good occupational history is important with regard to finding the aetiology of serious meningitis (including rare bacteria) even before the culture result is known. Appropriate treatment can be given early and adequately to prevent mortality.

Topics: Adult; Agricultural Workers' Diseases; Anti-Bacterial Agents; Brain Edema; Ceftriaxone; Cerebrospinal Fluid; Emergencies; Fatal Outcome; Gram-Negative Bacterial Infections; Humans; Hydrocephalus; Male; Meningitis, Bacterial; Sphingomonas; Tomography, X-Ray Computed

Aeromonas dhakensis, often phenotypically identified as Aeromonas hydrophila, is an important human pathogen. The present study aimed to compare the clinical and biological features of A. dhakensis and A. hydrophila isolates from human wounds. A total of 80 Aeromonas wound isolates collected between January 2004 and April 2011 were analysed. The species was identified by the DNA sequence matching of rpoD and gyrB (or rpoB if necessary). Most of the Aeromonas isolates were identified as A. dhakensis (37, 46.3%), and 13 (16.3%) as A. hydrophila. Both species alone can cause severe skin and soft-tissue infections. More A. dhakensis isolates were found in wounds exposed to environmental water (32.4% vs 0%, p 0.042). More biofilm formation was noted among A. dhakensis isolates (mean optical density at 570 nm, 1.23 ± 0.09 vs 0.78 ± 0.21, p 0.03). The MICs of ceftriaxone, imipenem and gentamicin for A. dhakensis isolates were higher (p <0.0001, <0.04, and <0.01, respectively). The survival rates of Caenorhabditis elegans co-incubated with A. dhakensis from day 1 to day 3 were lower than those of worms infected with A. hydrophila in liquid toxicity assays (all p values <0.01). Isolates of A. dhakensis exhibited more cytotoxicity, as measured by the released leucocyte lactate dehydrogenase levels in human normal skin fibroblast cell lines (29.6 ± 1.2% vs 20.6 ± 0.6%, p <0.0001). The cytotoxin gene ast was primarily present in A. hydrophila isolates (100% vs 2.7%, p <0.0001). In summary, A. dhakensis is the predominant species among Aeromonas wound isolates, and more virulent than A. hydrophila.

Topics: Adult; Aeromonas; Aged; Animals; Anti-Bacterial Agents; Biofilms; Caenorhabditis elegans; Ceftriaxone; Cell Survival; DNA Gyrase; DNA-Directed RNA Polymerases; Female; Fibroblasts; Gentamicins; Gram-Negative Bacterial Infections; Humans; Imipenem; Male; Microbial Sensitivity Tests; Middle Aged; Molecular Sequence Data; Prevalence; Sequence Analysis, DNA; Soft Tissue Infections; Survival Analysis; Taiwan; Wound Infection

Topics: Anti-Bacterial Agents; Arthritis, Infectious; Bone Diseases, Infectious; Ceftriaxone; Gram-Negative Bacterial Infections; Humans; Staphylococcal Infections; Streptococcal Infections

Topics: Ceftaroline; Ceftriaxone; Cephalosporins; Community-Acquired Infections; Cross Infection; Gram-Negative Bacterial Infections; Gram-Positive Bacterial Infections; Humans; Microbial Sensitivity Tests

Nosocomial pneumonia remains an important cause of mortality and morbidity worldwide. Surveillance programs play an important role in the identification of common etiologic agents and local patterns of antimicrobial resistance.. In this study we determined the frequency and antimicrobial susceptibility of pathogens isolated from patients with nosocomial pneumonia during 2009 to 2011.. A total of 642 bacteria were isolated from 516 suspected samples. Acinetobacter baumannii (21.1%, n = 136), was the commonest isolated pathogen followed by Pseudomonas aeruginosa (17.4%, n = 112), Staphylococcus aureus (15.8%, n = 102) and enterococci (8.4% n = 54). The most effective therapeutic agents against A. baumannii were polymyxin B (95.5% susceptible), ceftriaxone/tazobactam (72% susceptible) and levofloxacin (52.9% susceptible). Polymixin B (89.2% susceptible), ceftriaxone/tazobactam (89.2% susceptible) and piperacillin-tazobactam (80.3% susceptible) were found to be the most active agents against P. aeruginosa. Extended-spectrum beta-lactamases were detected among isolates of K. pneumoniae (45.4%) and E. coli (20.3%). Overall, the prevalence of methicillin-resistant S. aureus and vancomycin resistant enterococci were 80.4% and 40.7% respectively. Linezolid was found to be the most active antibiotic against these pathogens. The etiology of 50% of the nosocomial infection cases was polymicrobial.. The combination of ceftriaxone/tazobactam seems to be beneficial agent against multidrug-resistant Gram-negative bacilli isolated form respiratory tract infections. The results of our study can be used for guiding appropriate empiric therapy in this geographic region.

Topics: Acinetobacter baumannii; Anti-Bacterial Agents; Ceftriaxone; Cross Infection; Drug Resistance, Multiple, Bacterial; Gram-Negative Bacterial Infections; Gram-Positive Bacterial Infections; Hospitals; Humans; Iran; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination; Pneumonia, Bacterial; Polymyxin B; Prevalence; Pseudomonas aeruginosa; Respiratory Tract Infections; Sputum; Staphylococcus aureus

Antibiotic prophylaxis with norfloxacin, intravenous ciprofloxacin, or ceftriaxone has been recommended for cirrhotic patients with gastrointestinal hemorrhage but little is known about intravenous cefazolin. This study aimed to compare the outcome of intravenous cefazolin and ceftriaxone as prophylactic antibiotics among cirrhotic patients at different clinical stages, and to identify the associated risk factors. The medical records of 713 patients with acute variceal bleeding who had received endoscopic procedures from were reviewed. Three hundred and eleven patients were entered for age-matched adjustment after strict exclusion criteria. After the adjustment, a total of 102 patients were enrolled and sorted into 2 groups according to the severity of cirrhosis: group A (Child's A patients, n = 51) and group B (Child's B and C patients, n = 51). The outcomes were prevention of infection, time of rebleeding, and death. Our subgroup analysis results failed to show a significant difference in infection prevention between patients who received prophylactic cefazolin and those who received ceftriaxone among Child's A patients (93.1% vs. 90.9%, p = 0.641); however, a trend of significance in favor of ceftriaxone prophylaxis (77.8% vs. 87.5%, p = 0.072) was seen among Child's B and C patients. More rebleeding cases were observed in patients who received cefazolin than in those who received ceftriaxone among Child's B and C patients (66.7% vs. 25.0%, p = 0.011) but not in Child's A patients (32% vs. 40.9%, p = 0.376). The risk factors associated with rebleeding were history of bleeding and use of prophylactic cefazolin among Child's B and C patients. In conclusion, this study suggests that prophylactic intravenous cefazolin may not be inferior to ceftriaxone in preventing infections and reducing rebleeding among Child's A cirrhotic patients after endoscopic interventions for acute variceal bleeding. Prophylactic intravenous ceftriaxone yields better outcome among Child's B and C patients.

Topics: Acute Disease; Administration, Intravenous; Aged; Anti-Bacterial Agents; Antibiotic Prophylaxis; Cefazolin; Ceftriaxone; Esophageal and Gastric Varices; Female; Gastrointestinal Hemorrhage; Gram-Negative Bacterial Infections; Humans; Kaplan-Meier Estimate; Liver Cirrhosis; Male; Middle Aged; Multivariate Analysis; Pneumonia; Retrospective Studies; Sepsis; Treatment Outcome

Topics: Adenocarcinoma; Adrenal Cortex Hormones; Aged; Anti-Bacterial Agents; Antineoplastic Agents; Arthritis, Infectious; Arthritis, Rheumatoid; Ceftriaxone; Colonic Neoplasms; Diabetes Mellitus, Type 2; Female; Gram-Negative Bacterial Infections; Hip Joint; Humans; Immunocompromised Host; Immunosuppressive Agents; Paracoccus; Ribotyping; RNA, Bacterial; RNA, Ribosomal, 16S; Synovial Fluid

To evaluate resistances mediated by extended-spectrum β-lactamases (ESBLs) and AmpC β-lactamases among Gram-negative bacteria recovered from ocular infections.. As per the Clinical Laboratory Standards Institute M100-S-16 document, a total of 135 Gram-negative bacilli were recovered from ocular specimens and were subjected to phenotypic confirmation for ESBL production by the double-disc synergy test, cephalosporin and clavulanate combination disc test and E test, and, for AmpC β-lactamase, the modified double-disc approximation method and AmpC disc test.. In the double-disc synergy test, 21 (15.5%) isolates showed positive results against the cefpodoxime disc, 19 (14%) against cefpodoxime and cefotaxime, 15 (11%) against cefpodoxime, cefotaxime and ceftriaxone and 10 (7%) isolates were against cefpodoxime, cefotaxime, ceftriaxone and ceftazidime discs. In the cephalosporin/clavulanate combination disc test, 19 (14%) isolates showed positive results against cefotaxime with clavulanic acid and 10 (7%) isolates against ceftazidime with clavulanic acid. In the E test, 10 (7%) isolates displayed positive results against ceftazidime and 19 (14%) against cefotaxime. In the AmpC disc test for phenotypic confirmation, indentations were observed in 15 (11%) isolates with flattening also occurring in 10 (7%) isolates.. The incidences of ESBL- and AmpC β-lactamase-mediated resistances are found to be 7 and 18.5% among ocular isolates, respectively, and are more prevalent among the strains of Escherichia coli and Klebsiella pneumoniae.

Topics: Anti-Bacterial Agents; Bacterial Proteins; beta-Lactamases; Cefotaxime; Cefpodoxime; Ceftazidime; Ceftizoxime; Ceftriaxone; Cephalosporin Resistance; Cephalosporins; Drug Resistance, Multiple, Bacterial; Eye Infections, Bacterial; Gram-Negative Bacteria; Gram-Negative Bacterial Infections; Humans; Microbial Sensitivity Tests; Prospective Studies

Necrotizing fasciitis is a true surgical emergency. This study was undertaken to determine whether clinical indicators could be used to initiate early surgery, and to compare the characteristics observed on initial examination of necrotizing fasciitis in patients who died and those who survived.. We retrospectively reviewed the medical records of 143 patients with surgically confirmed necrotizing fasciitis of the extremities over a period of 3.5 years at a tertiary hospital of southwest Taiwan. Differences in mortality, patient characteristics, laboratory findings, and hospital course were compared between patients who died and those who survived, and between patients with Gram-positive infections and those with Gram-negative infections.. A patient with a fungal infection died. Nine of the 58 patients in the Gram-positive group (15.5%) and 12 of the 60 cases in the Gram-negative group (20%) died. Hence a total of 22 patients died, giving a mortality rate of 15.4%. Hypotension, lower counts of total and segmented leukocytes, higher counts of banded leukocytes, and lower levels of serum albumin were significantly associated with mortality. Monomicrobial infections had a stake of 70.6%, and Vibrio spp were the predominant causative agents (26.6%).. Hypotensive shock, severe hypoalbuminemia, and increased counts of banded leukocytes can be considered the clinical and laboratory risk indicators to initiate early surgery and to predict mortality for all types of necrotizing fasciitis. The clinical characteristics of Gram-negative infections were more fulminant than those of Gram-positive infections.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Ceftriaxone; Fasciitis, Necrotizing; Female; Gram-Negative Bacterial Infections; Gram-Positive Bacteria; Gram-Positive Bacterial Infections; Hospitals; Humans; Hypotension; Leukocyte Count; Leukocytes; Male; Medical Records; Middle Aged; Mycoses; Retrospective Studies; Risk Factors; Serum Albumin; Taiwan; Vibrio; Young Adult

Shewanella putrefaciens is a gram-negative, non-fermentative, oxidase positive, motile bacillus that produces hydrogen sulphide. It is found widely in the nature especially in marine environments. Although it is accepted as saprophytic, different clinical syndromes, most commonly skin or soft tissue infections, have been associated with S.putrefaciens, mainly in immunocompromised cases and patients with underlying diseases. However, pneumonia cases due to S.putrefaciens are quite limited in the literature. In this report, a case of pneumonia caused by S.putrefaciens was presented. A 43-year-old female patient was admitted to our hospital with the complaints of fever, cough, sputum and weakness. The patient has had brochiectasis since childhood and has used periodical antibiotic therapies due to pneumoniae episodes. She was diagnosed to have pneumonia based on the clinical, radiological and laboratory findings, and empirical antibiotic treatment with ciprofloxacin and ceftazidime combination was initiated. Gram-stained smear of sputum yielded abundant leucocytes and gram-negative bacteria, and the isolate grown in the sputum culture was identified as S.putrefaciens by conventional methods and API 20 NE (BioMerieux, France) system. The isolate was found susceptible to ceftriaxone, ceftazidime, cefepime, ciprofloxacin, piperacillin-tazobactam, cephoperazon-sulbactam, imipenem, amikacin, gentamicin and trimethoprime-sulphametoxazole; whereas resistant to ampicillin, amoxycillin-clavulanate, cefazolin and cefuroxime, by Kirby-Bauer disk diffusion method. According to the antibiogram results, the therapy was changed to ceftriaxone (1 x 2 g, intravenous). The patient was discharged with complete cure after 14 days of therapy. In conclusion, S.putrefaciens should be considered in patients with predisposing factors as an unusual cause of pneumonia and the characteristics such as H2S production and sensitivity to third generation cephalosporins and penicillins should be used to differentiate it from Pseudomonas aeruginosa and prevent the unnecessary use of antipseudomonal antibiotics.

Topics: Adult; Anti-Bacterial Agents; Anti-Infective Agents; Bronchiectasis; Ceftazidime; Ceftriaxone; Ciprofloxacin; Drug Therapy, Combination; Female; Gram-Negative Bacterial Infections; Humans; Microbial Sensitivity Tests; Pneumonia, Bacterial; Shewanella putrefaciens; Sputum

To identify bacterial agents of chronic discharging ear and determine their antibiotic sensitivities pattern in Ido - Ekiti, Nigeria.. Swab specimens of each chronically (>8 weeks) discharging ears of patients with chronic suppurative otitis media (CSOM) presenting to the Ear, Nose and Throat (ENT) clinic of the Federal Medical Centre, Ido Ekiti were bacteriologically cultured aerobically and the antibiotic sensitivity pattern of the recovered organisms determined by the modified Kirby-Bauer disc-diffusion method over a three year period starting from January 2005.. Seventy eight patients with CSOM whose age ranged between 3 months and 85 years were seen during the study period with 73.1% of them having unilateral disease and majority were children < 15 years (71.8%). Out of 99 ear swabs that were examined, 87.9% were culture positive with 90.8% yielding a single isolate. Coliforms (34.7%) were the most frequent isolated group of organisms. Other isolates included Staphylococcus aureus (26.3%), Proteus spp (24.2%), Pseudomonas spp (9.5%) and Klebsiella spp (5.3%). Sparfloxacin and ciprofloxacin showed highest activity on all the isolates unlike cefuroxime and ceftiaxone to which all isolates were resistant.. Chronic discharging ear is caused by bacteria agents most sensitive to quinolones but resistant to cefuroxime and ceftiaxone. Treatment of patients with CSOM in Ido-Ekiti with the quinolones is recommended except where contraindicated.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Ceftriaxone; Cefuroxime; Child; Child, Preschool; Ciprofloxacin; Drug Resistance, Bacterial; Enterobacteriaceae; Female; Fluoroquinolones; Gram-Negative Bacterial Infections; Humans; Infant; Klebsiella; Male; Microbial Sensitivity Tests; Middle Aged; Nigeria; Otitis Media, Suppurative; Prospective Studies; Proteus; Pseudomonas; Staphylococcus aureus; Young Adult

We read with interestingly the paper named "A Rare Cause of Pneumonia: Shewanella putrefaciens" presented by Durdu et al. published in Mikrobiyol Bul 2012; 46(1): 117-21. S.putrefaciens is a gram-negative, facultative anaerobic and non-fermentative rod that rarely causes infections in humans. First, the authors reported that antibotic sensitivity tests of S.putrefaciens in the presented case were performed by Kirby-Bauer disc diffusion method. However, there is no recommendation about the antibiotic susceptibility testing by disc diffusion test for this bacteria in Clinical and Laboratory Standards Institute (CLSI), European Committee on Antimicrobial Susceptibility Testing (EUCAST), and British Society for Antimicrobial Chemotherapy (BSAC) guidelines. According to CLSI criteria, antibiotic susceptibility tests for S.putrefaciens should be done by a method which detects minimal inhibitory concentration. Second, this paper reported that S.putrefaciens was sensitive to third generation cephalosporins and penicillins. Besides, the authors suggested that susceptibility of these bacteria to these antibiotics was helpful for the differential diagnosis of Pseudomonas aeruginosa and S.putrefaciens. However, in the literature, S.putrefaciens had been reported as resistant to penicillin. We thought that these additional information would be helpful in the future studies related to S.putrefaciens.

Topics: Anti-Bacterial Agents; Ceftriaxone; Female; Gram-Negative Bacterial Infections; Humans; Pneumonia, Bacterial; Shewanella putrefaciens

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

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

Lymphadenitis can be caused by different gram positive and gram negative bacteria and non-tuberculous mycobacteria. Cervical lymphadenitis in children is thought to result from ingestion of or contact with environmental microrganisms. Chromobacterium violaceum is a common inhabitant of soil and water in tropical and sub tropical countries. In these parts of the world Chromobacterium violaceum is able to cause skin infection with diffuse pustular lesions and also multiple liver abscess with often fatal evolution in sepsis. We describe a case of cervical lymphadenitis caused by Chromobacterium violaceum in a 14-year-old boy, born in Guinea and resident in Italy for 7 years in a fair condition with general measurable swelling in the right lateral cervical region and with blood tests that showed increased inflammatory indices. The patient was subjected to surgical incision. Antibiotic therapy with ceftriaxone was continued for 10 days, then replaced successfully with oral ciprofloxacin on the basis of purulent material culture positive for Chromobacterium violaceum sensitive to fluoroquinolones.

Topics: Adolescent; Anti-Bacterial Agents; Ceftriaxone; Child, Hospitalized; Chromobacterium; Gram-Negative Bacterial Infections; Humans; Italy; Lymphadenitis; Male; Microbiological Techniques; Soil Microbiology

To determine whether restricting the use of ceftriaxone and ciprofloxacin could significantly reduce colonization and infection with resistant Gram-negative bacilli (r-GNB).. A two-phase prospective study (before/after design) was conducted in an intensive care unit in two time periods (2004-2006). During phase 1, there was no antibiotic restriction. During phase 2, use of ceftriaxone or ciprofloxacin was restricted.. Atotal of 200 patients were prospectively evaluated. In phase 2, the use of ceftriaxone was reduced by 93.6% (P = 0.0001) and that of ciprofloxacin by 65.1% (P = 0.041), accompanied by a 113.8% increase in use of ampicillin-sulbactam (P = 0.002).During phase 1, 48 GNB were isolated [37 r-GNB (77.1%) and 11 non-r-GNB (22.9%)], compared with a total of 64 during phase 2 [27 r-GNB (42.2%) and 37 non-r-GNB (57.8%)](P = 0.0002). Acinetobacter spp. was isolated 13 times during phase 1 and 3 times in phase 2 (P = 0.0018). The susceptibility of Pseudomonas aeruginosa to ciprofloxacin increased from 40.0% in phase 1 to 100.0% in phase 2 (P = 0.0108).. Restriction of ceftriaxone and ciprofloxacin reduced colonization by Acinetobacter spp. and improved the susceptibility profile of P. aeruginosa.

Topics: Acinetobacter baumannii; Acinetobacter Infections; Adult; Aged; Ceftriaxone; Ciprofloxacin; Cross Infection; Diagnosis-Related Groups; Drug and Narcotic Control; Drug Prescriptions; Drug Resistance, Microbial; Drug Resistance, Multiple, Bacterial; Female; Gram-Negative Bacteria; Gram-Negative Bacterial Infections; Hospitals, Public; Hospitals, University; Humans; Incidence; Intensive Care Units; Male; Middle Aged; Prospective Studies; Pseudomonas aeruginosa; Pseudomonas Infections; Superinfection; Uruguay

Agrobacteria are Gram-negative tumorigenic plant pathogens that rarely cause infections in humans.. The authors describe a 7-year-old boy with acute lymphoblastic leukemia who carried a central venous catheter and developed bacteremia due to Agrobacterium radiobacter (A. radiobacter).. Microbiological cure was achieved after administration of systemic ceftriaxone along with gentamicin lock therapy to the central venous catheter for 10 days. Catheter removal was not required, and the patient has not relapsed with bacteremia due to the same pathogen for more than 6 months.. A. radiobacter is an emerging pathogen affecting immunocompromised children, particularly those with leukemia who carry central venous catheters. Although it has a low virulence, erratic susceptibility patterns, and high frequency of resistance to many antibiotics, ceftriaxone appears to be successful in treatment of most cases. Catheter removal for the clearance of bloodstream infections due to A. radiobacter may not be required in selected patients like the present case.

Topics: Anti-Bacterial Agents; Bacteremia; Catheter-Related Infections; Catheterization, Central Venous; Ceftriaxone; Child; Gram-Negative Bacterial Infections; Humans; Immunocompromised Host; Male; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Rhizobium

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

Shewanella putrefaciens is a Gram negative opportunistic pathogen which causes skin and soft tissue infections and bacteriemia in immunocompromized patients. We report a 86-year-old man, who presented with an infectious cellulitis of the leg associated with Shewanella putrefaciens bacteriemia. This patient was treated by mycophenolate mofetil for a bullous pemphigoid resistant to corticotherapy.

Topics: Aged, 80 and over; Anti-Bacterial Agents; Anti-Infective Agents; Bacteremia; Ceftriaxone; Cellulitis; Ciprofloxacin; Dermatologic Agents; Drug Therapy, Combination; Follow-Up Studies; Gram-Negative Bacterial Infections; Humans; Immunocompromised Host; Male; Mycophenolic Acid; Pemphigoid, Bullous; Shewanella putrefaciens; Time Factors; Treatment Outcome

Sinusitis can rarely be latent and present directly with intracranial complications. We present the case of an 11-year-old girl who presented with typical features of meningitis. She underwent neuroimaging because of slow improvement and concern for a brain abscess. Despite no history or examination findings suggestive of sinusitis, she was found to have pansinusitis with intracranial extension causing meningitis and epidural abscess.

Topics: Bacteroidaceae Infections; Cefotaxime; Ceftriaxone; Child; Combined Modality Therapy; Consciousness Disorders; Diagnostic Imaging; Drug Therapy, Combination; Eikenella; Emergencies; Endoscopy; Epidural Abscess; Female; Fusobacterium Infections; Gram-Negative Bacterial Infections; Gram-Positive Bacterial Infections; Humans; Meningitis, Bacterial; Metronidazole; Otorhinolaryngologic Surgical Procedures; Peptostreptococcus; Prevotella intermedia; Sinusitis; Staphylococcal Infections; Vancomycin

Sphingomonas paucimobilis, is a yellow-pigmented, aerobic, non-fermentative, non-spore-forming, gram-negative bacillus. Infections by S. paucimobilis which is widely found in nature and hospital environments are rarely serious or life threatening. In this report we present a case of hospital acquired bloodstream infection due to S. paucimobilis. The patient had a history of hydrocephalus diagnosed at sixth months of his birth and had experienced two ventriculoperitoneal shunt surgery. He was hospitalized and been treated for bronchopneumonia. On the 47th day of hospitalization, blood cultures (BACTEC, Becton Dickinson, USA) were taken because of a body temperature of 38.5 degrees C. One of the blood cultures was positive for gram-negative rods. After 48 h of incubation, the sub-cultures on blood agar medium yielded pure growth of a yellow, non-fermentative, gram-negative, rod-shaped bacterium. The microorganism was positive for oxidase, and esculin hydrolysis, while negative for urea and nitrate reduction and citrate utilisation. Motility was negative as well. The isolate has been identified as S. paucimobilis by using mini API (bioMerieux, France) system. The antibiotic susceptibility test was also performed with the same system and the strain was found susceptible to ceftazidime, ceftriaxone, cefoperazone, cefepime, cefotaxime, ciprofloxacin, imipenem, piperacillin-tazobactam, aztreonam, amikasin and gentamicin. Treatment with intravenous ceftriaxone (2 x 750 mg/day) was initiated. He responded well to the treatment and discharged on the tenth day. This case was reported to emphasize that S. paucimobilis should be kept in mind as a nosocomial infectious agent and the infections should be treated according to the sensitivity test results.

Topics: Anti-Bacterial Agents; Bacteremia; Ceftriaxone; Child, Preschool; Cross Infection; Gram-Negative Bacterial Infections; Humans; Male; Microbial Sensitivity Tests; Sphingomonas

Topics: Aeromonas hydrophila; Anti-Bacterial Agents; Ceftriaxone; Epiglottitis; Fasciitis, Necrotizing; Gram-Negative Bacterial Infections; Humans; Male; Middle Aged; Soft Tissue Infections

A 35-year-old Chinese female has a large thigh abscess without a clear source. No underlying diseases were revealed in the patient. The combination of clindamycin and cefazolin or vancomycin was administered but without a clinical response. Eikenella corrodens and Streptococcus intermedius were isolated from puncture drainage. Then, ceftriaxone was administered and a surgery of incision and further draining was carried. Eventually, the patient recovered. To our knowledge, this is the first case of thigh abscess in a previous healthy adult.

Topics: Abscess; Adult; Anti-Bacterial Agents; Ceftriaxone; China; Eikenella corrodens; Female; Gram-Negative Bacterial Infections; Humans; Streptococcal Infections; Streptococcus intermedius; Thigh

A contemporary collection of 12737 strains from pediatric patients (<18 years) isolated over a 7-year period (1998-2004) from 52 sentinel hospitals in North America was tested to determine the comparative antimicrobial potency of broad-spectrum parenteral cephalosporins and selected comparator agents. Most of the strains (84.1%) were isolated from blood stream or respiratory tract infections. The rank order of the top 10 pediatric pathogens analyzed was Streptococcus pneumoniae (15.5%) >Haemophilus influenzae (14.6%) >Staphylococcus aureus (13.8%) >Moraxella catarrhalis = coagulase-negative staphylococci (8.0%) >Escherichia coli (7.8%) >Pseudomonas aeruginosa (5.2%) >Klebsiella spp. (4.8%) >Enterococcus spp. (4.7%) > beta-hemolytic streptococci (4.4%). Both cefepime and ceftriaxone (MIC(90), 1 microg/mL; 93.9% and 93.7% susceptible, respectively) were highly active against S. pneumoniae. However, the S. pneumoniae strains showed reduced susceptibility to ceftazidime (56.6%), as well as penicillin (56.6%) < trimethoprim-sulfamethoxazole (57.1%) < erythromycin (66.2%) < tetracycline (71.4%). beta-Hemolytic streptococci showed 100.0% susceptibility to penicillin, cefepime, and ceftriaxone. Cefepime and ceftriaxone exhibited high activity against oxacillin (methicillin)-susceptible S. aureus, (MIC(90), 4 microg/mL; 100.0% and 99.8% susceptible, respectively), whereas ceftazidime (MIC(90), 16 microg/mL) was active against only 86.7% of strains. H. influenzae strains showed complete susceptibility to cefepime, ceftriaxone, and levofloxacin (MIC(90), < or =0.5 microg/mL; 100.0%), and 34.0% of H. influenzae and 99.2% of M. catarrhalis strains produced beta-lactamase. Although the 3 cephalosporins tested (cefepime, ceftriaxone, and ceftazidime) were very active (98.6-99.6% susceptible) against E. coli, cefepime (99.0% susceptible) was slightly more active than ceftriaxone and ceftazidime (96.4% and 95.1% susceptible, respectively) against Klebsiella spp. Cefepime was also the most active beta-lactam agent tested against Enterobacter spp. (MIC(90), 2 microg/mL; 99.3% susceptible), whereas the susceptibility rates of other broad-spectrum beta-lactams (ceftriaxone, ceftazidime and piperacillin-tazobactam) were significantly lower (78.4-81.5%). Against P. aeruginosa, imipenem and piperacillin-tazobactam showed the highest susceptibility rates (94.4% and 93.3%, respectively), whereas imipenem and cefepime showed the lowest resistance rates (1.4% and 2.3%, respectively)

Topics: Adolescent; Anti-Bacterial Agents; Cefepime; Ceftriaxone; Cephalosporins; Child; Child, Preschool; Gram-Negative Bacteria; Gram-Negative Bacterial Infections; Gram-Positive Bacteria; Gram-Positive Bacterial Infections; Humans; Infant; Infant, Newborn; Microbial Sensitivity Tests; North America; Sentinel Surveillance

A recent study indicated that Neisseria subflava, one of the commensal Neisseria species, may play an important role in the emergence of Neisseria gonorrhoeae strains with chromosomally mediated resistance to penicillin or cephalosporin by the horizontal genetic exchange of penA genes encoding the target site for penicillin or cephalosporin. The present investigation examined the antimicrobial susceptibility of 45 isolates of N. subflava from the oral cavities of Japanese men and women to various agents used for the treatment of gonococcal infections. Of the 45 isolates, 40 (88.9%) and 4 (8.8%) were intermediately resistant and resistant to penicillin, respectively, with the minimal inhibitory concentration (MIC)(50) and MIC(90) of penicillin being 0.5 mg/l and 1 mg/l, respectively. Of the 45 isolates, 13 (28.9%) and 14 (31.1%) were resistant to tetracycline and ciprofloxacin, respectively, and 3 (6.7%) showed reduced susceptibility to cefixime (although the susceptibility category was not determined). These results indicate that several isolates of N. subflava have acquired resistance or intermediate resistance to various antimicrobial agents, including penicillin, cephalosporin, tetracycline, and ciprofloxacin. The present study may thus confirm that N. subflava may be involved in the emergence of N. gonorrhoeae strains with either intermediate or total resistance to penicillin or cephalosporin by the horizontal genetic exchange of the penA gene.

Topics: Anti-Bacterial Agents; Cefixime; Ceftriaxone; Ciprofloxacin; Drug Resistance, Multiple, Bacterial; Female; Gram-Negative Bacterial Infections; Humans; Japan; Male; Microbial Sensitivity Tests; Mouth; Neisseria; Penicillins; Tetracycline

Human infection caused by Chromobacterium violaceum is rare but when it occurs, it is associated with a high mortality rate. This is a report of a young adult male who presented as a surgical emergency and succumbed soon after. The most common feature of this infection is sepsis, followed by cutaneous involvement and liver abscesses. Chromobacterium infection as a differential in a case of sepsis is important for clinicians to suspect, especially in tropical countries.

Topics: Adult; Ceftriaxone; Chromobacterium; Fatal Outcome; Gram-Negative Bacterial Infections; Humans; Male; Metronidazole; Sepsis

Topics: Anti-Bacterial Agents; Base Sequence; Capnocytophaga; Ceftriaxone; Gram-Negative Bacterial Infections; Humans; Male; Meningitis, Bacterial; Middle Aged; Molecular Sequence Data; Polymerase Chain Reaction; RNA, Ribosomal, 16S

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

We report a case of septic arthritis due to Ralstonia pickettii in an intravenous drug user with unfavorable clinical course under antibiotic therapy with ceftriaxone despite in vitro susceptibility to the drug. The treatment failure may have been due to a discrepancy between in vitro and in vivo susceptibility of R. pickettii, or to resistance development mediated by a recently described inducible beta-lactamase.

Topics: Adult; Anti-Bacterial Agents; Arthritis, Infectious; Ceftriaxone; Drug Resistance, Bacterial; Gram-Negative Bacterial Infections; Humans; In Vitro Techniques; Male; Microbial Sensitivity Tests; Ralstonia; Reproducibility of Results; Substance Abuse, Intravenous

Topics: Anti-Infective Agents; Ceftriaxone; Child, Preschool; Female; Gram-Negative Bacterial Infections; Gram-Positive Bacterial Infections; Humans; Leukemia, Myelogenous, Chronic, BCR-ABL Positive; Male; Medical Audit; Neutropenia; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Retrospective Studies

Ceftriaxone was introduced into clinical practice in the USA in 1985 and was the first extended-spectrum (third-generation) cephalosporin approved for once-daily treatment of patients with Gram-positive or Gram-negative infections. Review of ceftriaxone activity is important given its continued use since the mid-1980s and reports of emerging resistance among all antimicrobial agent classes. We reviewed the activity of ceftriaxone and relevant comparative agents against five Gram-positive and 11 Gram-negative species for a 5-year period, 1996-2000, using data from The Surveillance Network (TSN) Database-USA. All MIC results were interpreted using NCCLS breakpoint criteria. Ceftriaxone resistance among isolates of Streptococcus pneumoniae (n=17219) remained essentially unchanged over the 5 years studied and in fact was lower from 1998 to 2000 (5.0-5.1%) than in 1996 (6.3%) and 1997 (6.6%). Ceftriaxone resistance (range, 5.1-6.9%) among viridans group streptococci (n=6621) varied by <2% from 1997 to 2000. Beta-lactam-resistant Streptococcus pyogenes (n=935) and group B beta-haemolytic streptococci (n=2267) were not identified in any year. Among methicillin-susceptible Staphylococcus aureus (n=39 284) ceftriaxone resistance was 0.1-0.3% per year from 1996 to 2000. Ceftriaxone resistance among Escherichia coli (n=472407; range, 0.2-0.4%), Klebsiella oxytoca (n=16231; range, 3.5-4.8%), Klebsiella pneumoniae (n=117754; range, 1.9-2.6%), Proteus mirabilis (n=67692; range, 0.2-0.3%), Morganella morganii (n=11251; range, 0.3-2.1%) and Serratia marcescens (n=26519; range, 1.6-3.8%) was low and consistent from 1996 to 2000. Resistance to ceftriaxone among Enterobacter cloacae (n=48114; range, 21.7-23.9%) was relatively high, compared with other Enterobacteriaceae, but unchanged from 1996 to 2000. Rates of resistance to ceftriaxone among Acinetobacter spp. (n=20813) increased from 24.8% in 1996 to 45.1% in 2000. All Haemophilus influenzae (n=7911) and Neisseria gonorrhoeae (n=218) were susceptible to ceftriaxone, as were 99.7% of Moraxella catarrhalis (n=312) tested in 1996 and 1997. In summary, ceftriaxone has retained its potent activity against the most commonly encountered Gram-positive and Gram-negative human pathogens despite widespread and ongoing clinical use for more than 15 years.

Topics: Anti-Bacterial Agents; Ceftriaxone; Databases, Factual; Drug Resistance, Bacterial; Gram-Negative Bacteria; Gram-Negative Bacterial Infections; Gram-Positive Bacteria; Gram-Positive Bacterial Infections; Humans; Microbial Sensitivity Tests; Population Surveillance; United States

Topics: Anti-Bacterial Agents; Azithromycin; Ceftriaxone; Cefuroxime; Cephalosporins; Gram-Negative Anaerobic Bacteria; Gram-Negative Bacterial Infections; Humans; Infant; Male; Pneumonia

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: Antibiotic Prophylaxis; Cefazolin; Ceftriaxone; Cephalosporins; Cesarean Section; Female; Gram-Negative Bacterial Infections; Gram-Positive Bacterial Infections; Humans; Injections, Intravenous; Pregnancy; Risk Factors; Time Factors

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

Topics: Adult; Alcaligenes; Ceftriaxone; Cephalosporins; Gram-Negative Bacterial Infections; Humans; Liver Diseases, Alcoholic; Male; Peritonitis; Time Factors

Human bite injuries, while less frequent than cat or dog bites, usually stem from aggressive behavior, sports, or sexual activity. It has been thought that human bites have a higher rate of infection than animal bites, but this view is likely skewed because of the frequency of closed fist injuries presenting to emergency rooms. Human bites to the genitalia also occur, but are not often reported because of embarrassment.. We report a genital ulceration after a human bite to the penis and review appropriate diagnostic and therapeutic maneuvers.. This article reports the development of a severe genital ulcer associated with a human bite to the penis secondarily infected, as verified by culture, with an oral flora organism Eikenella corrodens.. The genital ulceration healed after appropriate antibiotic therapy.. Treatment of human bites focuses on obtaining an accurate history and performing a salient physical examination, as well as early irrigation and debridement. Transmission of communicable disease should be considered as a possible consequence. Prophylactic antibiotic treatment and primary closure of wounds continue to be areas of controversy.

Topics: Aged; Amoxicillin-Potassium Clavulanate Combination; Bites, Human; Ceftriaxone; Drug Therapy, Combination; Eikenella corrodens; Gram-Negative Bacterial Infections; Humans; Male; Penile Diseases; Penis; Ulcer

To compare a recombinant bactericidal/permeability-increasing protein variant and a recombinant endotoxin-neutralizing protein.. Randomized, blinded, controlled study, using a rat model of sepsis.. Animal research facility.. Male Wistar rats.. An inoculum of 1.5 x 10(7) to 1.8 x 10(8) Escherichia coli O18ac K1, implanted in the peritoneum, produced bacteremia in 95% of animals after 1 hr. One hour after E. coli challenge, animals received recombinant bactericidal/permeability-increasing protein variant, recombinant endotoxin-neutralizing protein, or saline intravenously, followed by ceftriaxone and gentamicin intramuscularly.. Twenty-four (85.7%) of 28 animals receiving recombinant endotoxin-neutralizing protein (p < .001 vs. control) survived 7 days compared with nine (33.3%) of 27 recombinant bactericidal/permeability-increasing protein variant-treated (p < .001 vs. control) and two (6.5%) of 31 control animals.. Both recombinant endotoxin-neutralizing protein and recombinant bactericidal/permeability-increasing protein variant improved survival. Recombinant endotoxin-neutralizing protein was superior to recombinant bactericidal/permeability-increasing protein variant in its protective effect at the doses tested. Our results suggest that both proteins may be useful in the treatment of human Gram-negative sepsis.

Topics: Animals; Anti-Infective Agents; Ceftriaxone; Disease Models, Animal; Drug Therapy, Combination; Escherichia coli Infections; Gentamicins; Gram-Negative Bacterial Infections; Male; Rats; Rats, Wistar; Recombinant Proteins; Sepsis; Survival Analysis

Topics: Ankle; Anti-Bacterial Agents; Ceftriaxone; Cellulitis; Gram-Negative Bacterial Infections; Humans; Male; Middle Aged

Topics: Anti-Bacterial Agents; Ceftriaxone; Cephalosporins; Child, Preschool; Gram-Negative Bacterial Infections; Humans; Infusions, Intravenous; Meningitis, Bacterial; Vancomycin

Topics: Adult; Aeromonas; Bacteremia; Ceftriaxone; Cephalosporins; Cholera; Cross Infection; Drug Resistance, Microbial; Female; Gram-Negative Bacterial Infections; Humans

Topics: Adult; AIDS-Related Opportunistic Infections; Anti-HIV Agents; CD4 Lymphocyte Count; Ceftriaxone; Cephalosporins; Female; Gentamicins; Gram-Negative Bacterial Infections; HIV Infections; Humans; Microbial Sensitivity Tests; Netilmicin; Pneumonia, Bacterial; Rhizobium; Stavudine

Spaceflight personnel need treatment options that would enhance survival from radiation and would not disrupt task performance. Doses of prophylactic or therapeutic agents known to induce significant short-term (30-day) survival with minimal behavioral (locomotor) changes were used for 180-day survival studies. In protection studies, groups of mice were treated with the phosphorothioate WR-151327 (200 mg/kg, 25% of the LD(10)) or the immunomodulator, synthetic trehalose dicorynomycolate (S-TDCM; 8 mg/kg), before lethal irradiation with reactor-generated fission neutrons and gamma-rays (n/gamma=1) or 60Co gamma-rays. In therapy studies, groups of mice received either S-TDCM, the antimicrobial ofloxacin, or S-TDCM plus ofloxacin after irradiation. For WR-151327 treated-mice, survival at 180 days for n/gamma=1 and gamma-irradiated mice was 90% and 92%, respectively; for S-TDCM (protection), 57% and 78%, respectively; for S-TDCM (therapy), 20% and 25%, respectively; for ofloxacin, 38% and 5%, respectively; for S-TDCM combined with ofloxacin, 30% and 30%, respectively; and for saline, 8% and 5%, respectively. Ofloxacin or combined ofloxacin and S-TDCM increased survival from the gram-negative bacterial sepsis that predominated in n/gamma=1 irradiated mice. The efficacies of the treatments depended on radiation quality, treatment agent and its mode of use, and microflora of the host.

Topics: Adjuvants, Immunologic; Animals; Anti-Infective Agents; Ceftriaxone; Cephalosporins; Cord Factors; Female; Gamma Rays; Gram-Negative Bacterial Infections; Liver; Mice; Mice, Inbred Strains; Neutrons; Ofloxacin; Organothiophosphorus Compounds; Radiation Injuries, Experimental; Radiation Tolerance; Radiation-Protective Agents; Survival Rate

Bacteremias by gram negative bacilli (BGNB) are serious diseases which normally require hospital admission. In accordance with the pharmacokinetic characteristics of ceftriaxone, the possibility of treating such processes with home care (HC) and the existence of advantages for both the patient and the hospital were evaluated.. Twenty patients were prospectively studied. Upon obtaining clinical stability in the hospital the possibility of following home care (HC) treatment was evaluated. Ceftriaxone was administrated at intramuscular doses of 1g/24 h. The clinical and bacteriologic response, patient satisfaction and treatment time were estimated.. The origin of the bacteremia was varied as was the type of gram negative bacilli responsible. All the patients evolved favorably with no relevant secondary effects. The mean length of treatment was 12.75 days per patient. The antibiotic was mainly administered at home (83%), permitting a mean reduction of 10.5 hospital stays per patient. The social and psychologic advantages for the patients were evident.. This study confirms the possibility of treating stable phase gram negative bacilli bacteremias at home efficiently with the supervision of home care teams leading to a substantial reduction in hospital expenses and patient satisfaction.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bacteremia; Ceftriaxone; Gram-Negative Bacterial Infections; Home Care Services; Humans; Injections, Intramuscular; Middle Aged; Prospective Studies

Topics: Adult; Aged; Ambulatory Care; Anti-Bacterial Agents; Ceftriaxone; Clinical Trials as Topic; Gram-Negative Bacterial Infections; Gram-Positive Bacterial Infections; Humans; Injections, Intramuscular; Middle Aged