ro13-9904 and Gram-Positive-Bacterial-Infections

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

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

Carnobacterium species are lactic acid-producing Gram-positive bacteria that have been approved by the US Food and Drug Administration and Health Canada for use as a food bio-preservative. The use of live bacteria as a food additive and its potential risk of infections in immunocompromised patients are not well understood.. An 81-year-old male with a history of metastatic prostate cancer on androgen deprivation therapy and chronic steroids presented to our hospital with a 2-week history of productive cough, dyspnea, altered mentation, and fever. Extensive computed tomography imaging revealed multifocal pneumonia without other foci of infection. He was diagnosed with pneumonia and empirically treated with ceftriaxone and vancomycin. Blood cultures from admission later returned positive for Carnobacterium inhibens. He achieved clinical recovery with step-down to oral amoxicillin/clavulanic acid for a total 7-day course of antibiotics.. This is the fourth reported case of bacteremia with Carnobacterium spp. isolated from humans. This case highlights the need to better understand the pathogenicity and disease spectrum of bacteria used in the food industry for bio-preservation, especially in immunocompromised patients.

Topics: Aged, 80 and over; Amoxicillin-Potassium Clavulanate Combination; Androgen Antagonists; Anti-Bacterial Agents; Bacteremia; Blood Culture; Canada; Carnobacterium; Ceftriaxone; Food Microbiology; Gram-Positive Bacterial Infections; Humans; Immunocompromised Host; Male; Pneumonia, Bacterial; Prostatic Neoplasms; Vancomycin

To establish testing and treatment recommendations for a ceftriaxone once-daily dose regimen for systemic infections with Cutibacterium acnes.. A review of the literature and a retrospective evaluation of patients diagnosed with C. acnes spondylodiscitis and treated with ceftriaxone were performed. Ceftriaxone and penicillin MICs were determined for C. acnes isolates from blood and biopsies and the epidemiological cut-off (ECOFF) was determined with surveillance data from the UK Anaerobe Reference Laboratory in Cardiff.. Limited clinical data exist from endocarditis and prosthetic joint infections using treatment with ceftriaxone 2 g once daily for C. acnes with ceftriaxone MICs ≤0.5 mg/L. In this case study, five patients were successfully treated with ceftriaxone as part of the treatment for spondylodiscitis with C. acnes. Ceftriaxone and penicillin MICs of the C. acnes isolates from the patients were 0.016-0.125 mg/L and 0.012-0.032 mg/L, respectively. The ceftriaxone ECOFF was 0.5 mg/L and the penicillin ECOFF was 0.25 mg/L based on available surveillance data.. From the data presented in this study it would be acceptable to consider treatment with a once-daily dose of ceftriaxone 2 g for systemic infections, including endocarditis, spondylodiscitis and prosthetic joint infections with C. acnes using a clinical breakpoint of ≤0.5 mg/L (the ECOFF). However, clinical data are still limited and the response of patients treated with ceftriaxone for serious infections with C. acnes should be monitored closely.

Topics: Ceftriaxone; Discitis; Gram-Positive Bacterial Infections; Humans; Propionibacterium acnes; Retrospective Studies

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

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

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

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

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

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

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

Intracranialabscesses are serious, life-threatening infections despite recent advances in diagnosis and treatment. We report the case of a child with metastatic brain abscesses and a chronic, sharp foreign body of the bronchus. Its presentation and endoscopic appearance and the microbiology of the abscesses are detailed. The detection of bacteria of respiratory origin should lead to a search for a bronchopulmonary source of contamination.

Topics: Brain Abscess; Bronchi; Bronchoscopy; Ceftriaxone; Child, Preschool; Contrast Media; Drug Therapy, Combination; Follow-Up Studies; Foreign Bodies; Foreign-Body Reaction; Gram-Positive Bacterial Infections; Humans; Infusions, Intravenous; Male; Metronidazole; Nafcillin; Risk Assessment; Tomography, X-Ray Computed; Treatment Outcome

Stomatococcus mucilaginosus, a normal inhabitant of the human oral cavity and upper respiratory tract, can cause fatal sepsis and meningitis in neutropenic patients. We identified eight cases of bacteremia due to S. mucilaginosus in children with cancer, of whom five developed complications despite receiving appropriate antibiotics. At the time cultures were positive, seven patients had profound neutropenia (< 100 neutrophils and band forms/mm3) and four had mucositis; five had central venous catheters. In two cases, there was unequivocal evidence of catheter-related sepsis. Bacteremia was eradicated in all patients within 48 hours after initiation of antibiotics. Despite prompt instigation of effective antibiotic therapy, the complication rates in this series were high: septic shock (50%), pneumonia (50%), dermatologic manifestations (38%), altered neurological status (25%), meningitis (13%), and adult respiratory distress syndrome (13%). No fatalities were attributable to S. mucilaginosus infection. These cases illustrate the virulence of S. mucilaginosus organisms in neutropenic children and suggest a substantial risk of sequelae even when adequate antibiotic therapy is given.

Topics: Adolescent; Bacteremia; Ceftazidime; Ceftriaxone; Child; Child, Preschool; Female; Gram-Positive Bacterial Infections; Humans; Male; Meningitis, Bacterial; Micrococcaceae; Neoplasms; Neutropenia; Pneumonia; Respiratory Distress Syndrome; Shock, Septic; Skin Diseases; Vancomycin

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

Gram-positive organisms, including vancomycin-resistant enterococci (VRE), have emerged as major pathogens on the organ transplant service at our institution. We hypothesized that our use of vancomycin as part of routine surgical prophylaxis increased the risk of VRE colonization and infection; conversely, there was concern that failure to use vancomycin prophylaxis would increase peri-operative morbidity due to gram-positive organisms.. Renal transplant recipients (n = 88) were randomized to receive either a) vancomycin/ceftriaxone or b) cefazolin; and pancreas transplants (n = 24) to receive either a) vancomycin/gentamicin or b) cefazolin/gentamicin. Stool samples or rectal swabs were obtained for culture for enterococci within 24 h of transplantation and weekly while hospitalized.. Enterococci were isolated on stool culture from 38 (34%) of 102 patients at the time of transplantation; 4 (11%) of the isolates were VRE. The percentage of patients who subsequently acquired VRE was low (1-7% per wk) but remained constant during hospitalization. There was no association between new VRE detection and vancomycin use for either prophylactic or therapeutic purposes. Forty-four patients (39%) had a post-operative infection with 46% of these infections due to gram-positive organisms; rates were unaffected by prophylactic vancomycin use. Pancreas transplant patients who did not receive vancomycin prophylaxis had a significantly longer initial hospitalization (p = 0.03); however, differences were not statistically significant when total length of stay (LOS) within the first 90 d of transplantation was compared.. Vancomycin surgical prophylaxis does not appear to have an effect on VRE colonization or infection, or on rates of infection with gram-positive bacteria. Elimination of vancomycin prophylaxis in renal transplant patients may be a reasonable part of an overall program to limit vancomycin usage, although as a single measure, its impact may be minimal. Vancomycin surgical prophylaxis may be of greater importance in pancreas transplants.

Topics: Adult; Anti-Bacterial Agents; Antibiotic Prophylaxis; Cefazolin; Ceftriaxone; Cephalosporins; Chi-Square Distribution; Cross Infection; Drug Resistance, Microbial; Enterococcus; Female; Gentamicins; Gram-Positive Bacterial Infections; Humans; Kidney Transplantation; Length of Stay; Male; Microbial Sensitivity Tests; Middle Aged; Pancreas Transplantation; Postoperative Complications; Risk Factors; Statistics, Nonparametric; Treatment Outcome; Vancomycin

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

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

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

Our objective was to assess the incidence of bacteraemic Aerococcus urinae cases at Helsinki metropolitan area, Finland, from a 6-year study period (2013 to 2018) and to further characterize available cases. The study evaluates the outcome of commonly used cefuroxime treatment and determinate a set of A. urinae in vitro antimicrobial susceptibilities for benzylpenicillin, cefuroxime, and ceftriaxone. Clinical records of A. urinae bacteraemic patients were reviewed retrospectively. Antimicrobial susceptibility testing was performed by disk diffusion, gradient test, and broth microdilution for 139-141 clinical A. urinae isolates. Clinical data of 72/77 patients were combined with the in vitro susceptibilities. We found an increasing number of bacteraemic A. urinae cases within 6-year study period (p = 0.01). The patients were mainly elderly males, and all suffered from underlying conditions. A total of 27.3% of cases (21/77) showed polymicrobial blood cultures. Thirty-day mortality was 22.1%. Cefuroxime was the initial empiric antimicrobial agent given for 66/76 of the patients and treatment outcome was favorable for 20/22 patients who received cefuroxime at least up to day 5. All isolates were susceptible to benzylpenicillin and cefuroxime interpreted by EUCAST breakpoints for Aerococci and PK-PD breakpoints, respectively. MIC determinations gave variable results for ceftriaxone, 2.1-2.9% of the isolates were resistant. To conclude, it seems that the number of bacteraemic Aerococcus urinae cases is increasing at Helsinki metropolitan area, Finland, reflecting the growing blood culture sampling. Clinical A. urinae isolates were susceptible to cefuroxime in vitro. Treatment data indicate that empirical cefuroxime started for possibly urinary tract -derived community-acquired bacteraemia covers A. urinae.

Topics: Aerococcus; Aged; Anti-Bacterial Agents; Bacteremia; Ceftriaxone; Cefuroxime; Disease Susceptibility; Finland; Gram-Positive Bacterial Infections; Humans; Male; Microbial Sensitivity Tests; Retrospective Studies

Cutibacterium (C) acnes, a Gram-positive bacterium that is part of the commensal flora, is increasingly noticed as an opportunistic pathogen in serious infections in both immunocompromised and immunocompetent patients. The indolent character and often difficult identification because of its slow growth contribute to delayed diagnosis or underdiagnosis. This report highlights a unique case of a lung transplant recipient with a C acnes intracerebral abscess, and we recommend including this organism in such differential diagnosis. A 66-year-old woman, 2 years after bilateral lung transplantation for chronic obstructive pulmonary disease, presented with frontal headache, without other complaints, and with normal neurological examination. Magnetic resonance imaging showed an extensive lesion in the right frontal lobe with extensive perilesional edema. Given the broad differential diagnosis, stereotactic brain biopsy was performed and culture became positive for C acnes. She was treated with intravenous ceftriaxone for 8 weeks and per oral clindamycin for 6 months, as well as corticosteroids in tapered dose. There was a rapid favorable clinical and radiographic evolution.

Topics: Aged; Brain Abscess; Ceftriaxone; Female; Gram-Positive Bacterial Infections; Humans; Lung Transplantation; Propionibacterium acnes

We report a rare case of an infective endocarditis by Aerococcus spp in a bioprosthetic aortic valve following a prostate biopsy, in an asymptomatic adult with no additional risk factor for prostate cancer, excepting for age. The diagnosis was based on the presence of vegetations on the bioprosthesis seen on the echocardiogram, positive blood cultures and fever, and a favorable clinical outcome following the treatment with ceftriaxone and gentamicin.

Topics: Aerococcus; Aged; Biopsy; Ceftriaxone; Echocardiography; Endocarditis; Female; Fever; Gentamicins; Gram-Positive Bacterial Infections; Humans; Male; Prostate; RNA, Ribosomal, 16S; Treatment Outcome

Topics: Anti-Bacterial Agents; Bacillus pumilus; Ceftriaxone; Doxycycline; Foodborne Diseases; Gastroenteritis; Gram-Positive Bacterial Infections; Humans; Immunocompromised Host; Immunosuppression Therapy; Kidney Transplantation; Levofloxacin; Male; Middle Aged; MTOR Inhibitors; Pancreas Transplantation

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

There are scarce data describing the etiology and clinical sequelae of sepsis in low- and middle-income countries (LMICs). This study describes the prevalence and etiology of sepsis among critically ill patients at a referral hospital in Malawi. We conducted an observational prospective cohort study of adults admitted to the intensive care unit or high-dependency unit (HDU) from January 29, 2018 to March 15, 2018. We stratified the cohort based on the prevalence of sepsis as defined in the following three ways: quick sequential organ failure assessment (qSOFA) score ≥ 2, clinical suspicion of systemic infection, and qSOFA score ≥ 2 plus suspected systemic infection. We measured clinical characteristics and blood and urine cultures for all patients; antimicrobial sensitivities were assessed for positive cultures. During the study period, 103 patients were admitted and 76 patients were analyzed. The cohort comprised 39% male, and the median age was 30 (interquartile range: 23-40) years. Eighteen (24%), 50 (66%), and 12 patients (16%) had sepsis based on the three definitions, respectively. Four blood cultures (5%) were positive, two from patients with sepsis by all three definitions and two from patients with clinically suspected infection only. All blood bacterial isolates were multidrug resistant. Of five patients with urinary tract infection, three had sepsis secondary to multidrug-resistant bacteria. Hospital mortality for patients with sepsis based on the three definitions ranged from 42% to 75% versus 12% to 26% for non-septic patients. In summary, mortality associated with sepsis at this Malawi hospital is high. Bacteremia was infrequently detected, but isolated pathogens were multidrug resistant.

Topics: Adult; Anti-Bacterial Agents; Antifungal Agents; Bacteremia; Burkholderia Infections; Candida glabrata; Candidiasis, Invasive; Ceftriaxone; Cohort Studies; Critical Illness; Drug Resistance, Multiple, Bacterial; Escherichia coli Infections; Female; Gram-Positive Bacterial Infections; Hospital Mortality; Humans; Intensive Care Units; Klebsiella Infections; Malawi; Male; Metronidazole; Microbial Sensitivity Tests; Middle Aged; Prevalence; Prospective Studies; Proteus Infections; Sepsis; Staphylococcal Infections; Urinary Tract Infections; Young Adult

The unfavourable safety profile of aminoglycosides and the synergistic effects observed in vitro have prompted the development of novel dual β-lactam therapies, e.g. ampicillin/ceftriaxone or ampicillin/ceftaroline, for the treatment of Enterococcus faecalis endocarditis.. For comparison with in vitro chequerboard assay results, a partial chequerboard setup of ampicillin/gentamicin, ampicillin/ceftriaxone and ampicillin/ceftaroline against E. faecalis was established in the Galleria mellonella larval infection model.. Discrimination of synergistic and additive interactions was based on the evaluation of larval survival, bacterial quantity in the haemolymph and a pathology score index (internal to the workgroup). Single and multiple dosing schemes based on the half-life of ampicillin were applied. Pharmacokinetic data of the antibiotics in the larvae were determined via agar plate diffusion assays.. Ampicillin and ceftriaxone exhibited strain-specific synergistic interactions in the larvae under both dosing regimens, while the other two combinations showed additive effects. Ampicillin/ceftaroline was inferior to ampicillin/ ceftriaxone. Not all synergistic effects observed in vitro could be replicated in the larvae.. Our results suggest superior efficacy of ampicillin/ceftriaxone for the treatment of high-inoculum enterococcal infections, for at least some strains, but question the benefit of the current standard of adding the nephrotoxic gentamicin compared with the safer ceftriaxone. This is the first study to develop a scheme for differentiation between additive and synergistic effects in larvae and apply a multiple-antibiotic dosing scheme based on the pharmacokinetics of ampicillin. The model allows the analysis of synergistic effects of antimicrobials in an in vivo setting, but the clinical correlation warrants further study.

Topics: Ampicillin; Anti-Bacterial Agents; Ceftaroline; Ceftriaxone; Cephalosporins; Drug Synergism; Drug Therapy, Combination; Enterococcus faecalis; Gentamicins; Gram-Positive Bacterial Infections; Humans; Microbial Sensitivity Tests

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

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

Topics: Aged, 80 and over; Anti-Bacterial Agents; Arthroplasty, Replacement, Hip; Cefazolin; Ceftriaxone; Female; Gram-Positive Bacterial Infections; Hip Joint; Humans; Lacticaseibacillus paracasei; Prosthesis-Related Infections; Reoperation; Tomography, X-Ray Computed

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

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

Panspinal epidural abscesses are an extremely rare yet potentially fatal condition. Whether cases are best managed surgically or medically is currently controversial. A 63-year-old patient with diabetes presented initially with abdominal pain, back pain, urinary retention and constipation. He subsequently developed fevers, radicular pain and new-onset weakness in the right leg. MRI confirmed a panspinal epidural abscess extending from C7 to L5, with group B

Topics: Anti-Bacterial Agents; Ceftriaxone; Diabetes Mellitus, Type 2; Epidural Abscess; Gram-Positive Bacterial Infections; Humans; Linezolid; Magnetic Resonance Imaging; Male; Middle Aged; Treatment Outcome

Spinal intramedullary abscesses are rare and potentially devastating lesions. Infection is mostly caused by staphylococci. Anaerobes are rare and often polymicrobial. We report an unusual case of spinal cord intramedullary abscess in a 7-month-old infant with monomicrobial infection due to Finegoldia magna. She was found to have a missed congenital thoracic dermal sinus. The patient was treated with metronidazole and ceftriaxone for 8 weeks, and improvement of the infection was documented. Clinical awareness of patients at risk is crucial for early diagnosis and intervention. As detection methods continue to improve for Finegoldia magna, it is important to increase awareness of the pathogenic role of this organism.

Topics: Abscess; Anti-Bacterial Agents; Ceftriaxone; Female; Firmicutes; Gram-Positive Bacterial Infections; Humans; Infant; Metronidazole; Spina Bifida Occulta; Spinal Cord Diseases; Treatment Outcome; Yemen

Topics: Anti-Bacterial Agents; Carbapenems; Ceftriaxone; Enterococcus faecalis; Gram-Positive Bacterial Infections; Microbial Sensitivity Tests; Polysaccharides

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

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

To assess activity of the combination of ceftriaxone and ampicillin against clinical isolates of ampicillin-susceptible Enterococcus faecium.. Ampicillin-susceptible E. faecium (n = 29) and Enterococcus faecalis (n = 10) collected from locations in the USA and France were used for this analysis. Susceptibility testing was performed by gradient diffusion strip (GDS) and broth microdilution (BMD). Synergy with the combination of ceftriaxone and ampicillin was assessed in all isolates using GDS crossing and double disc diffusion methods. Selected isolates (nine E. faecium and three E. faecalis) were assessed for synergy in time-kill studies using ampicillin alone and in combination with ceftriaxone.. In isolates of E. faecium, the median (range) ampicillin MIC by BMD was 0.5 (0.25-4) mg/L and by GDS it was 2 (1-8)  mg/L. In E. faecalis, the median (range) ampicillin MIC by BMD was 0.5 (0.5-1) mg/L and by GDS it was 2 (0.75-3) mg/L. A total of 24/29 (82.8%) isolates of E. faecium displayed synergy by GDS and 22/29 (75.9%) by double disc diffusion. Seven of 10 (70%) isolates of E. faecalis displayed synergy by GDS and 4/10 (40%) by double disc diffusion. Time-kill studies found synergy in 3/9 (33.3%) E. faecium and 3/3 (100%) E. faecalis.. In contrast to the demonstrated synergy in time-kill models of ceftriaxone and ampicillin for E. faecalis, this combination does not appear to provide uniform synergy in E. faecium. Antagonism was not observed. Clinical correlation is necessary and caution should be used when considering ampicillin and ceftriaxone for the treatment of infections caused by ampicillin-susceptible E. faecium.

Topics: Ampicillin; Anti-Bacterial Agents; Ceftriaxone; Drug Synergism; Enterococcus faecalis; Enterococcus faecium; France; Gram-Positive Bacterial Infections; Humans; Microbial Sensitivity Tests; Microbial Viability; Time Factors; United States

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

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

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

Topics: Adenocarcinoma; Amoxicillin-Potassium Clavulanate Combination; Bacteria, Anaerobic; Ceftriaxone; Combined Modality Therapy; Drainage; Drug Resistance, Microbial; Fever; Firmicutes; Gram-Positive Bacterial Infections; Gram-Positive Cocci; Humans; Lymph Node Excision; Lymphocele; Male; Middle Aged; Postoperative Complications; Prostatectomy; Prostatic Neoplasms

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

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

Topics: Aged; Anti-Bacterial Agents; Bacteremia; Ceftriaxone; Gram-Positive Bacteria; Gram-Positive Bacterial Infections; Humans; Liver Abscess, Pyogenic; Male; Metronidazole

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

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

A frequent complication during hospital stay of patients with urinary tract infections (UTIs) is a re-infection of the urinary tract after the initial improvement. In this study, we investigated the impact of two empirical antibiotic therapies on the outcomes of complicated bacterial UTIs. We retrospectively evaluated 325 adult patients hospitalized during 6 years period with a diagnosis of complicated bacterial UTIs. The patients were classified into two groups according to the antibiotic therapy: ceftriaxone- and co-amoxiclav+gentamicin-treated group. Clinical data were collected from the patient records into a designed form. Output data included information on the treatment outcome, length of stay (LOS), development of complications, and cause of re-infections. The patients treated with ceftriaxone had significantly longer LOS (p = 0.012), as well as higher occurrence of complications (p = 0.023) and urinary tract re-infections (p < 0.001), compared to co-amoxiclav+gentamicin-treated group. No significant difference was observed in the treatment outcome between the two groups (p = 0.137). The most common complication in both investigated groups were re-infections of the urinary tract, and Enterococcus spp. was detected as the cause of re-infections only in patients from ceftriaxone-treated group (40/69 patients). Out of the 40 ceftriaxone-treated patients with enterococcal urinary tract re-infections, 35 patients had one or more chronic diseases and 29 patients had urinary catheter inserted. Ceftriaxone therapy should be considered carefully in patients with complicated UTIs due to the possibility of enterococcal re-infection and consequent prolonged hospital stay.

Topics: Aged; Aged, 80 and over; Amoxicillin-Potassium Clavulanate Combination; Anti-Infective Agents, Urinary; Ceftriaxone; Cross Infection; Enterococcus; Female; Gentamicins; Gram-Positive Bacterial Infections; Hospitalization; Humans; Length of Stay; Male; Middle Aged; Retrospective Studies; Risk Factors; Treatment Outcome; Urinary Tract Infections

Dual β-lactam therapy and a penicillin-aminoglycoside combination are first line regimens in the treatment of penicillin-susceptible Enterococcus faecalis infective endocarditis (EFIE). Our aim was to compare ampicillin plus ceftriaxone (A+C) to ampicillin plus gentamicin (A+G) in the treatment of EFIE.. This was a retrospective cohort study of adults (≥18 years) patients diagnosed with EFIE at Mayo Clinic campuses in Rochester, Minnesota, and Phoenix, Arizona and treated with either A+C or A+G. Main outcome measurements were 1 year mortality, nephrotoxicity, and EFIE relapse rates.. Eighty-five cases of EFIE were included in this investigation. The majority (n=67, 79%) of patients received A+G while 18 (21%) patients received A+C as initial treatment. On admission, patients who received A+C had a higher Charlson Comorbidity Index (median [IQR], 4 [3, 4 vs. 2 [1, 4]; P=.008) and a higher baseline serum creatinine (median [IQR], 1.2 [0.9, 1.6] vs. 0.9 [0.8, 1.2] mg/dL, P=.020). The 1 year mortality rates were similar for both treatment groups, 17% vs. 17%, P=.982. Each group had 1 case of relapsing EFIE. Patients who received A+G had worse kidney function outcome demonstrated by a greater increase in serum creatinine at end of therapy (median [IQR] difference, +0.4 [0.2, 0.8] vs. -0.2 [-0.3, 0.1] mg/dL, P≤.001).. A+C appears to be a safe and efficacious regimen in the treatment of EFIE. Patients treated with A+C had lower rates of nephrotoxicity and no differences in relapse rate and 1-year mortality as compared to that of the A+G group.

Topics: Aged; Ampicillin; Anti-Bacterial Agents; Ceftriaxone; Drug Therapy, Combination; Electronic Health Records; Endocarditis; Enterococcus faecalis; Female; Gentamicins; Gram-Positive Bacterial Infections; Humans; Male; Middle Aged; Recurrence; Retrospective Studies

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

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

A 69-year-old man developed

Topics: Aged; Anti-Bacterial Agents; Arthroplasty, Replacement, Knee; Ceftriaxone; Epistaxis; Gram-Positive Bacterial Infections; Humans; Male; Nail Diseases; Nails; Platelet Count; Postoperative Complications; Propionibacterium acnes; Thrombocytopenia; Treatment Outcome; Vancomycin

Enterococci are Gram-positive commensals of the mammalian intestinal tract and harbor intrinsic resistance to broad-spectrum cephalosporins. Disruption of colonization resistance in humans by antibiotics allows enterococci to proliferate in the gut and cause disseminated infections. In this study, we used

Topics: Animals; Anti-Bacterial Agents; Bacterial Translocation; Ceftriaxone; Enterococcus faecalis; Gastrointestinal Microbiome; Gram-Positive Bacterial Infections; Homeostasis; Intestines; Male; Mice; Mice, Inbred C57BL; Symbiosis

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

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

Spontaneous bacterial peritonitis (SBP) can be life threatening in patients with liver cirrhosis. In contrast to community-acquired SBP, no standard treatment has been established for healthcare-related and nosocomial SBP.. We prospectively collected healthcare-related and nosocomial SBP cases from March 2012 till February 2016 at the Department of Internal Medicine I of the University of Bonn and analysed the prevalence of antibiotic resistance among the isolated bacteria. SBP was diagnosed according to international guidelines. Ciprofloxacin, ceftriaxone and meropenem were used as reference substance for resistance to quinolones, third-generation cephalosporins and carbapenems, respectively.. Ninety-two SBP episodes in 86 patients were identified: 63 episodes (69%) were nosocomial. Escherichia coli, Klebsiella species, enterococci and streptococci were most frequently isolated. Frequencies of these microorganisms were comparable for healthcare-related and nosocomial SBP (14% vs. 11%, 14% vs. 8%, 14% vs. 5% and 10% vs. 6%, respectively). In general, antibiotic resistance was higher in isolates from nosocomial than from healthcare-related SBP (50% vs. 18% for quinolones, 30% vs. 11% for piperacillin-tazobactam; P > 0·05), but comparable concerning third-generation cephalosporins (30% vs. 33%). All microorganisms were sensitive to carbapenems apart from nosocomial infections with Enterococcus faecium (n = 3) and Candida albicans (n = 1) due to intrinsic resistance or lack of microbiological efficacy, respectively. No multidrug-resistant microorganisms were detected. Resistance to initial antibiotic treatment affected 30-day survival negatively (18% vs. 68%; P = 0·002).. Resistance to initial antibiotic treatment was associated with increased mortality. With resistance to cephalosporins being frequent, piperacillin-tazobactam or carbapenems might be preferred as treatment of SBP.

Topics: Aged; Anti-Bacterial Agents; Bacterial Infections; Ceftriaxone; Ciprofloxacin; Cross Infection; Drug Resistance, Bacterial; Enterococcus; Escherichia coli Infections; Female; Gram-Positive Bacterial Infections; Humans; Klebsiella Infections; Liver Cirrhosis; Male; Meropenem; Middle Aged; Peritonitis; Prospective Studies; Streptococcal Infections; Thienamycins

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

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

A 40-year-old man with chronic myelogenous leukemia presented multiple times over a period of 3 years with episodes of confusion, wide-based gait and falls because of recurrent hydrocephalus despite repeated therapeutic lumbar punctures. These problems occurred in the context of persistent cerebrospinal fluid (CSF) pleocytosis and leptomeningeal enhancement. Extensive diagnostic workups and therapeutic trials had failed to identify a clinically plausible cause or produce any significant improvement in the CSF and neuroimaging abnormalities.. We used high-throughput metagenomic shotgun sequencing to identify microbes in 2 CSF samples collected from the patient during his illness. These results were compared to sequence data from 1 CSF sample collected during treatment and 5 control CSF samples from other patients.. We found sequences representing 53% and 67% of the Propionibacterium acnes genome in 2 CSF samples collected from the patient during his illness. Directed antimicrobial therapy was administered for 6 weeks with resolution of CSF and neuroimaging abnormalities. Sequencing of a sample obtained during treatment demonstrated that the P. acnes levels were decreased to background levels. After insertion of a ventriculo-peritoneal shunt, the patient returned to baseline status.. High-throughput metagenomic shotgun sequencing revealed P. acnes as the cause of chronic meningitis that had eluded conventional attempts at diagnosis. Treatment directed at this organism resulted in cure of the infection and clinical improvement.

Topics: Adult; Anti-Bacterial Agents; Ceftriaxone; Chronic Disease; Gram-Positive Bacterial Infections; High-Throughput Nucleotide Sequencing; Humans; Immunocompromised Host; Leukemia, Myelogenous, Chronic, BCR-ABL Positive; Male; Meningitis, Bacterial; Propionibacterium acnes; Stem Cell Transplantation; Transplantation, Homologous

A previously healthy 3-year-old boy presented to the emergency department with abdominal pain, fever, and emesis. Laboratory and radiologic evaluation for causes of acute abdomen were negative; however, review of the abdominal x-ray demonstrated cardiomegaly with the subsequent diagnosis of pericardial cyst by echocardiogram and computed tomography. The patient underwent surgical decompression and attempted removal of the cystic structure revealing that the cyst originated from the epicardium. His abdominal pain and fever resolved postoperatively and he completed a 3-week course of ceftriaxone for treatment of Propionibacterium acnes infected congenital epicardial cyst. Emergency department physicians must maintain a broad differential in patients with symptoms of acute abdomen to prevent complications from serious cardiac or pulmonary diseases that present with symptoms of referred abdominal pain.

Topics: Abdomen, Acute; Anti-Bacterial Agents; Ceftriaxone; Child, Preschool; Decompression, Surgical; Diagnosis, Differential; Echocardiography; Emergency Service, Hospital; Gram-Positive Bacterial Infections; Humans; Male; Mediastinal Cyst; Propionibacterium acnes; Radiography, Abdominal; Tomography, X-Ray Computed; Treatment Outcome

Lactococcus garvieae (LG) endocarditis is a rare disease in humans. There are only about 16 reported cases in the world. We report a 76-year-old male patient with LG endocarditis. In depth interview with the patient revealed that 2 weeks prior to admission, he had eaten sushi containing raw fish. Unlike many of the other infections reported, which were on a native mitral valve, our patient's vegetation was on a prosthetic aortic valve.

Topics: Aged; Animals; Anti-Bacterial Agents; Aortic Valve; Bioprosthesis; Ceftriaxone; Endocarditis; Fishes; Food Microbiology; Gram-Positive Bacterial Infections; Heart Valve Prosthesis; Humans; Lactococcus; Male; Raw Foods; Seafood

A 61-year-old man with chronic hepatitis B and dyslipidemia visited the emergency department with a fever and severe headache. He was diagnosed with bacterial meningitis after a lumbar puncture, and blood culture revealed Parvimonas micra bacteremia. Although he had a history of extraction of a molar two weeks before symptom onset, there was no evidence of abscess formation on physical examination or imaging studies. He was successfully treated with oral metronidazole for 12 days after 9 days of treatment with IV ceftriaxone and vancomcycin. This is the first report of primary bacterial meningitis caused by this organism, which indicates that this organism is capable of being a bacterial meningitis pathogen.

Topics: Anti-Bacterial Agents; Bacteremia; Bacteria, Anaerobic; Ceftriaxone; Dyslipidemias; Firmicutes; Gram-Positive Bacterial Infections; Hepatitis B, Chronic; Humans; Male; Meningitis, Bacterial; Metronidazole; Middle Aged; Treatment Outcome; Vancomycin

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

Topics: Administration, Intravenous; Anti-Bacterial Agents; Arthrobacter; Ceftriaxone; Gram-Positive Bacterial Infections; Humans; Kidney Failure, Chronic; Male; Middle Aged; Peritoneal Dialysis; Peritonitis; Ribotyping; Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization; Treatment Outcome

Topics: Adult; Anti-Bacterial Agents; Azithromycin; Bacteremia; Ceftriaxone; Ciprofloxacin; Drug Resistance, Multiple, Bacterial; Gardnerella vaginalis; Gram-Positive Bacterial Infections; Humans; Immunocompetence; Male; Metronidazole; Recurrence; Sex Distribution; Urethritis

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

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

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

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

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

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

Acute focal bacterial nephritis (AFBN) is a localized bacterial infection of the kidney presenting as an inflammatory mass without frank abscess formation. We report a case of acute focal bacterial nephritis without pyuria in a five-month-old boy presenting with high urinary β2-microglobulin (β2-MG) and N-Acetyl-β-(D)-Glucosaminidase (NAG) levels. The infant initially presented with high-grade fever, and plain computed tomography (CT) showed a nearly isodense mass, and contrast-enhanced abdominal CT showed a wedge-shaped hypodense lesion. Enterococcus was detected in the subsequent urine culture. A diagnosis of AFBN was made on the basis of his high inflammatory reaction, contrast-enhanced abdominal CT findings and high urinary β2-MG and NAG levels. He was treated with Ceftriaxone and subsequent improvement in inflammatory reaction and contrast-enhanced CT findings were observed. Voiding cystourethrogram (VCUG) showed a grade V right VUR. This case suggests that urinary β2-MG and NAG levels may be useful additional markers for the diagnosis of AFBN without pyuria.

Topics: Acetylglucosaminidase; Anti-Bacterial Agents; beta 2-Microglobulin; Biomarkers; Ceftriaxone; Enterococcus; Focal Infection; Gram-Positive Bacterial Infections; Humans; Infant; Male; Nephritis; Radiography

The aim of this study was to assess changes in antibiotic resistance, epidemiology and outcome among patients with Enterococcus faecalis infective endocarditis (EFIE) and to compare the efficacy and safety of the combination of ampicillin and gentamicin (A+G) with that of ampicillin plus ceftriaxone (A+C). The study was a retrospective analysis of a prospective cohort of EFIE patients treated in our centre from 1997 to 2011. Thirty patients were initially treated with A+G (ampicillin 2 g/4 h and gentamicin 3 mg/kg/day) and 39 with A+C (ampicillin 2 g/4 h and ceftriaxone 2 g/12 h) for 4-6 weeks. Increased rates of high-level aminoglycoside resistance (HLAR; gentamicin MIC ≥512 mg/L, streptomycin MIC ≥1024 mg/L or both) were observed in recent years (24% in 1997-2006 and 49% in 2007-2011; p 0.03). The use of A+C increased over time: 1997-2001, 4/18 (22%); 2002-2006, 5/16 (31%); 2007-2011, 30/35 (86%) (p <0.001). Renal failure developed in 65% of the A+G group and in 34% of the A+C group (p 0.014). Thirteen patients (43%) in the A+G group had to discontinue treatment, whereas only one patient (3%) treated with A+C had to discontinue treatment (p <0.001). Only development of heart failure and previous chronic renal failure were independently associated with 1-year mortality, while the individual antibiotic regimen (A+C vs. A+G) did not affect outcome (OR, 0.7; 95% CI, 0.2-2.2; p 0.549). Our study shows that the prevalence of HLAR EFIE has increased significantly in recent years and that alternative treatment with A+C is safer than A+G, with similar clinical outcomes, although the sample size is too small to draw firm conclusions. Randomized controlled studies are needed to confirm these results.

Topics: Aged; Aged, 80 and over; Ampicillin; Anti-Bacterial Agents; Ceftriaxone; Cohort Studies; Drug Resistance, Bacterial; Drug Therapy, Combination; Endocarditis; Enterococcus faecalis; Female; Gentamicins; Gram-Positive Bacterial Infections; Humans; Male; Middle Aged; Prospective Studies; Renal Insufficiency; Spain; Survival Analysis; Treatment Outcome; Withholding Treatment

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

Topics: Ampicillin; Anti-Bacterial Agents; Ceftriaxone; Endocarditis; Female; Gentamicins; Gram-Positive Bacterial Infections; Humans; Male

Topics: Ampicillin; Anti-Bacterial Agents; Ceftriaxone; Endocarditis; Female; Gentamicins; Gram-Positive Bacterial Infections; Humans; Male

Topics: Ampicillin; Anti-Bacterial Agents; Ceftriaxone; Endocarditis; Female; Gentamicins; Gram-Positive Bacterial Infections; Humans; Male

Topics: Ampicillin; Anti-Bacterial Agents; Ceftriaxone; Endocarditis; Female; Gentamicins; Gram-Positive Bacterial Infections; Humans; Male

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

Topics: Anti-Bacterial Agents; Aorta; Bacteremia; Ceftriaxone; Female; Gram-Positive Bacterial Infections; Hematoma; Humans; Immunocompromised Host; Middle Aged; Phylogeny; RNA, Ribosomal, 16S; Sequence Analysis, DNA; Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization; Tomography, X-Ray Computed; Weissella

The aim of this study was to compare the effectiveness of the ampicillin plus ceftriaxone (AC) and ampicillin plus gentamicin (AG) combinations for treating Enterococcus faecalis infective endocarditis (EFIE).. An observational, nonrandomized, comparative multicenter cohort study was conducted at 17 Spanish and 1 Italian hospitals. Consecutive adult patients diagnosed of EFIE were included. Outcome measurements were death during treatment and at 3 months of follow-up, adverse events requiring treatment withdrawal, treatment failure requiring a change of antimicrobials, and relapse.. A larger percentage of AC-treated patients (n = 159) had previous chronic renal failure than AG-treated patients (n = 87) (33% vs 16%, P = .004), and AC patients had a higher incidence of cancer (18% vs 7%, P = .015), transplantation (6% vs 0%, P = .040), and healthcare-acquired infection (59% vs 40%, P = .006). Between AC and AG-treated EFIE patients, there were no differences in mortality while on antimicrobial treatment (22% vs 21%, P = .81) or at 3-month follow-up (8% vs 7%, P = .72), in treatment failure requiring a change in antimicrobials (1% vs 2%, P = .54), or in relapses (3% vs 4%, P = .67). However, interruption of antibiotic treatment due to adverse events was much more frequent in AG-treated patients than in those receiving AC (25% vs 1%, P < .001), mainly due to new renal failure (≥25% increase in baseline creatinine concentration; 23% vs 0%, P < .001).. AC appears as effective as AG for treating EFIE patients and can be used with virtually no risk of renal failure and regardless of the high-level aminoglycoside resistance status of E. faecalis.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Ampicillin; Anti-Bacterial Agents; Ceftriaxone; Cohort Studies; Drug Therapy, Combination; Endocarditis; Enterococcus faecalis; Female; Gentamicins; Gram-Positive Bacterial Infections; Hospitals; Humans; Italy; Male; Middle Aged; Spain; Treatment Outcome; Young Adult

Topics: Ampicillin; Anti-Bacterial Agents; Ceftriaxone; Endocarditis; Female; Gentamicins; Gram-Positive Bacterial Infections; Humans; Male

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

Enterococcus faecalis is a low-GC Gram-positive bacterium that is intrinsically resistant to cephalosporins, antibiotics that target cell wall biosynthesis. To probe the mechanistic basis for intrinsic resistance, a library of transposon mutants was screened to identify E. faecalis strains that are highly susceptible to ceftriaxone, revealing a transposon mutant with a disruption in murAA. murAA is predicted to encode a UDP-N-acetylglucosamine 1-carboxyvinyl transferase that catalyzes the first committed step in peptidoglycan synthesis: phosphoenolpyruvate (PEP)-dependent conversion of UDP-N-acetylglucosamine to UDP-N-acetylglucosamine-enolpyruvate. In-frame deletion of murAA, but not its homolog in the E. faecalis genome (murAB), led to increased susceptibility of E. faecalis to cephalosporins. Furthermore, expression of murAA enhanced cephalosporin resistance in an E. faecalis mutant lacking IreK (formerly PrkC), a key kinase required for cephalosporin resistance. Further genetic analysis revealed that MurAA catalytic activity is necessary but not sufficient for this role. Collectively, our data indicate that MurAA and MurAB have distinct roles in E. faecalis physiology and suggest that MurAA possesses a unique property or activity that enables it to enhance intrinsic resistance of E. faecalis to cephalosporins.

Topics: Alkyl and Aryl Transferases; Bacterial Proteins; Ceftriaxone; Cephalosporin Resistance; DNA Transposable Elements; Enterococcus faecalis; Escherichia coli; Gene Deletion; Gram-Positive Bacterial Infections; Humans; Isoenzymes; Microbial Sensitivity Tests; Mutation; Phosphotransferases; Plasmids; Transformation, Bacterial

Late prosthetic valve endocarditis is usually caused by streptococci, staphylococci, gram-negative bacilli and candida. The authors report the first case of prosthetic valve endocarditis caused by Gemella sanguinis. The patient's risk factors for the development of Gemella endocarditis were the persistent severe dental caries and the presence of prosthetic valves. The patient required surgical replacement of the infected valve but had a good outcome with preservation of cardiac and valvular function. Evaluation and treatment of the persistent dental infection before initial valvular surgery may have prevented secondary infection of the prosthetic valve.

Topics: Adult; Amoxicillin; Anti-Bacterial Agents; Ceftriaxone; Dental Caries; Drug Administration Schedule; Echocardiography; Endocarditis; Female; Gemella; Gram-Positive Bacterial Infections; Heart Valve Prosthesis; Humans; Transplantation, Homologous; Treatment Outcome

In 2004-2008, the epidemiological and clinical Infective Endocarditis Study Group (SEI) evaluated 852 cases of infective endocarditis. Staphylococcus aureus was the main involved pathogen (24.5%) and Enterococcus faecalis etiology was described in 11% of the cases. The aim of this study was to evaluate the in vitro activity of 12 antibiotics alone and in association against 27 strains of E. faecalis isolated from blood cultures of patients with infective endocarditis.. The results showed high in vitro activity of tigecycline, daptomycin and linezolid. A high synergistic effect was obtained with the association ceftriaxone-fosfomycin [fractional inhibitory concentration (FIC)(50) = 0.34, FIC(90) = 0.78]. Furthermore, ceftriaxone plus ampicillin presented additive results (FIC(50) = 0.66, FIC(90) = 1.00), and ceftriaxone plus fosfomycin and ceftriaxone plus ampicillin were significantly more active in vitro than each drug alone. The efficacy of ceftriaxone plus fosfomycin was confirmed by the association testing using the broth dilution technique.. Fosfomycin seems particularly significant and its association with ceftriaxone could be considered as a useful therapeutic option in medical treatment of E. faecalis infective endocarditis.

Topics: Animals; Anti-Bacterial Agents; Ceftriaxone; Drug Synergism; Drug Therapy, Combination; Endocarditis; Enterococcus faecalis; Fosfomycin; Gram-Positive Bacterial Infections; Humans; Italy; Microbial Sensitivity Tests; Sheep

We present a case of a 42-year-old man with a solitary liver abscess and Gemella haemolysans bacteraemia. No other focus of infection was identified. The patient did not have any predisposing factors. He was treated with antibiotics for 6 weeks and the abscess was drained. He made a complete recovery.

Topics: Adult; Anti-Bacterial Agents; Bacteremia; Ceftriaxone; Gemella; Gram-Positive Bacterial Infections; Humans; Liver Abscess; Male

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

Serious Enterococcus faecalis infections usually require combination therapy to achieve a bactericidal effect. In orthopedic infections, the prognosis of enterococcal etiology is considered poor, and the use of aminoglycosides is questioned. The ampicillin-ceftriaxone combination has recently been accepted as alternative therapy for enterococcal endocarditis. After one of our patients with endocarditis and vertebral osteomyelitis was cured with ampicillin-ceftriaxone, we started a pilot study of orthopedic infections. Patients with infections due to E. faecalis (with two or more surgical samples or blood cultures) diagnosed during 2005 to 2008 were recruited. Polymicrobial infections with ampicillin- and ceftriaxone-resistant microorganisms were excluded. Patients received ampicillin (8 to 16 g/day)-ceftriaxone (2 to 4 g/day) and were followed up prospectively. Of 31 patients with E. faecalis infections, 10 received ampicillin-ceftriaxone. Including the first patient, 11 patients were treated with ampicillin-ceftriaxone: 3 with prosthetic joint infections, 3 with instrumented spine arthrodesis device infections, 2 with osteosynthesis device infections, 1 with foot osteomyelitis, and 2 with vertebral osteomyelitis and endocarditis. Six infections (55%) were polymicrobial. All cases except the vertebral osteomyelitis ones required surgery, with retention of foreign material in six cases. Ampicillin-ceftriaxone was given for 25 days (interquartile range, 15 to 34 days), followed by amoxicillin (amoxicilline) being given to seven patients (64%). One patient with endocarditis died within 2 weeks (hemorrhagic stroke) and was not evaluable. For one patient with prosthesis retention, the infection persisted; 9/10 patients (90%) were cured, but 1 patient was superinfected. Follow-up was for 21 months (interquartile range, 14 to 36 months). Ampicillin-ceftriaxone may be a reasonable synergistic combination to treat orthopedic infections due to E. faecalis. Our experience, though limited, shows good outcomes and tolerability and may provide a basis for further well-designed comparative studies.

Topics: Adult; Aged; Aged, 80 and over; Ampicillin; Anti-Bacterial Agents; Ceftriaxone; Drug Therapy, Combination; Enterococcus faecalis; Female; Gram-Positive Bacterial Infections; Humans; Male; Middle Aged; Prospective Studies; Young Adult

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

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

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

Topics: Aged; Ceftriaxone; Electrophoresis, Gel, Pulsed-Field; Enterococcus faecium; Fatal Outcome; Female; Gram-Positive Bacterial Infections; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Treatment Outcome; Tunisia; Vancomycin Resistance

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

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

This report describes the first case of deep neck infection resulting from Lactococcus lactis subsp. cremoris. The case is associated with the consumption of unpasteurized milk and occurred in a patient with a buccal mucosa tumor. Anti-infective therapy with ceftriaxone and metronidazole resulted in complete resolution.

Topics: Aged; Animals; Anti-Infective Agents; Biopsy; C-Reactive Protein; Ceftriaxone; Gram-Positive Bacterial Infections; Humans; Lactococcus lactis; Leukocyte Count; Male; Metronidazole; Milk; Mouth Mucosa; Mouth Neoplasms; Neck; Tomography, X-Ray Computed; Treatment Outcome

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

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

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

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

We compared ceftriaxone and piperacillin-tazobactam at doses ranging from 0.1 to 2 times the human equivalent daily dose (HEDD), to determine their impact on gastrointestinal colonization by ampicillin- and vancomycin-resistant Enterococcus faecium C68 in a mouse model. Ceftriaxone failed to promote colonization at doses up to 0.25 times the HEDD, whereas piperacillin-tazobactam promoted colonization at doses up to 0.5 times the HEDD. Ceftriaxone promoted colonization at doses at least 0.5 times the HEDD, whereas piperacillin-tazobactam inhibited colonization at doses at least 0.75 times the HEDD. Both piperacillin-tazobactam and ceftriaxone inhibited colonization by an enterococcal strain devoid of low-affinity penicillin-binding protein-5 (significantly increasing its susceptibility to these agents), at doses that promoted colonization by E. faecium C68. These results support a model in which the impact that different beta -lactam agents have on colonization by VRE is related to the level of the beta -lactam agent's intrinsic antienterococcal activity against the colonizing strain.

Topics: Animals; Anti-Bacterial Agents; Carrier State; Ceftriaxone; Colony Count, Microbial; Disease Models, Animal; Dose-Response Relationship, Drug; Drug Resistance, Multiple, Bacterial; Enterococcus faecium; Feces; Female; Gastrointestinal Tract; Gram-Positive Bacterial Infections; Mice; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination

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

Aerococcus viridans, a catalase-negative gram-positive coccus rarely causing bacteremia, was isolated from blood cultures of a 52-yr-old man under the granulocytopenic condition. The isolate showed the typical characteristics of A. viridans, i.e., tetrad arrangements in gram stain, positive pyrrolidonyl aminopeptidase (PYR) and negative leucine aminopeptidase (LAP) reactions, and no growth at 45 degrees C. The isolate was revealed to be highly resistant to penicillin, erythromycin, clindamycin, and ceftriaxone, although most strains of A. viridans isolated from the previously reported patients were susceptible to penicillin and other commonly used antibiotics. Even though A. viridans is rarely associated with human infections, it could be a potential causative agent of bacteremia, especially in immunocompromised patients.

Topics: Agranulocytosis; Bacteremia; Ceftriaxone; Clindamycin; Drug Resistance, Multiple, Bacterial; Erythromycin; Gram-Positive Bacterial Infections; Humans; Male; Middle Aged; Penicillins; Streptococcaceae

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

A mouse model of intestinal colonization with vancomycin-resistant enterococci (VRE) was used to study the effect of different beta-lactam antibiotics on establishment of VRE colonization. A clinical VanB VRE isolate, Enterococcus faecium C68 (102 or 104 cfu), was inoculated by gastric gavage in conjunction with subcutaneous administration of antibiotics. The MIC of ceftriaxone and ticarcillin against VRE strain C68 is >10,000 microg/mL, and the MIC of piperacillin is 1250 microg/mL. Ceftriaxone and ticarcillin-clavulanate treatment groups developed persistently high levels of stool VRE compared with both the saline and the piperacillin-tazobactam (Pip-Taz) groups (P<.008). The level of stool VRE in the Pip-Taz group did not differ from that for the saline group. Thus, in this mouse model, beta-lactam antibiotics with minimal anti-enterococcal activity promoted establishment of high-level VRE colonization, but Pip-Taz (a beta-lactam antibiotic with more potent activity against VRE) did not.

Topics: Animals; Anti-Bacterial Agents; Ceftriaxone; Clavulanic Acid; Enterococcus faecium; Feces; Female; Gram-Positive Bacterial Infections; Humans; Infusions, Parenteral; Intestinal Mucosa; Mice; Microbial Sensitivity Tests; Ticarcillin; Vancomycin Resistance

A time-series prospective study of patients admitted to the hospital for treatment of community-acquired pneumonia was undertaken to determine vancomycin-resistant enterococcal perianal colonization rates among patients who received ceftriaxone with or without erythromycin versus those who received levofloxacin. A colonization rate of 16% (8/51) was found in the ceftriaxone-erythromycin group versus 0% (0/52) in the levofloxacin group .

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Anti-Infective Agents; Ceftriaxone; Cephalosporins; Community-Acquired Infections; Drug Therapy, Combination; Enterococcus; Erythromycin; Female; Gram-Positive Bacterial Infections; Humans; Levofloxacin; Male; Middle Aged; Ofloxacin; Pneumonia, Bacterial; Prospective Studies; Risk Factors; Vancomycin Resistance

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

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

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

Topics: Anti-Bacterial Agents; Antibiotic Prophylaxis; Ceftriaxone; Enterococcus; Gram-Positive Bacterial Infections; Humans; Preoperative Care; Streptococcal Infections; Streptococcus