ro13-9904 and Intestinal-Perforation

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

This prospective, randomized, open, international, multicenter study of adults with complicated intra-abdominal infections (cIAI) compared the efficacy and safety of sequential intravenous (i.v.) to oral (p.o.) moxifloxacin 400 mg once daily, with that of i.v. ceftriaxone 2 g once daily, plus metronidazole 500 mg three times daily, followed by p.o. amoxicillin/clavulanate 625 mg three times daily. The primary efficacy variable was clinical cure at test of cure (TOC) (day 28-42 after study entry) in the per protocol (PP) population. Of 595 patients in the study, 511 patients were valid for PP analysis (246 moxifloxacin, 265 ceftriaxone/metronidazole). Sequential moxifloxacin was noninferior to the comparator regimen--clinical cure rates at TOC were 80.9% versus 82.3% (moxifloxacin versus ceftriaxone/metronidazole; 95% CI -8.9, 4.2%). The incidence of adverse events was comparable between the two treatment groups. Therefore, sequential moxifloxacin monotherapy is as effective and safe as combination therapy with i.v. ceftriaxone plus i.v. metronidazole followed by oral amoxicillin/clavulanate for the treatment of cIAI.

Topics: Abdominal Abscess; Administration, Oral; Adult; Aged; Amoxicillin-Potassium Clavulanate Combination; Anti-Infective Agents; Appendicitis; Aza Compounds; Bacterial Infections; Ceftriaxone; Drug Therapy, Combination; Female; Fluoroquinolones; Gastrointestinal Diseases; Humans; Infusions, Intravenous; Intestinal Perforation; Male; Metronidazole; Microbial Sensitivity Tests; Middle Aged; Moxifloxacin; Peritonitis; Prospective Studies; Quinolines

To compare the therapeutic efficacy of four antibiotic regimens: penicillin, tobramycin, and clindamycin; penicillin, tobramycin, and ornidazole; piperacillin alone; and ceftriaxone and ornidazole in the treatment of children operated on for perforated appendicitis.. Prospective randomised study.. Teaching hospital, Turkey.. 200 patients aged between 1 and 16 years treated from December 1991 to December 1995 who were randomly assigned to one of four groups each consisting of 50 patients.. Preoperative antibiotics given intravenously, peritoneal drainage by Penrose drains without irrigation, appendicectomy with the inversion of the stump by a purse string, taking peritoneal swabs, and primary skin closure.. Comparability of the groups, duration of fever, leucocytosis, antibiotic treatment, stay in hospital, nasogastric intubation, and drainage, as well as results of cultures and complications.. There were no significant differences between the groups for any variable studied. The predominant bacterial species were Escherichia coli, Klebsiella spp, Pseudomonas spp, Fusobacteria, and Peptostreptococci which were appropriately covered by all the antibiotic regimens. Fourteen patients had complications including wound infections (n = 10), prolonged ileus (n = 2) and intra-abdominal abscess (n = 2) all of which were treated conservatively. There was no mortality and no major complications. All regimens had the same clinical and bacteriological efficacy.. There is no gold standard for antimicrobial chemotherapy in perforated appendicitis. Different antibiotic combinations or a single broad spectrum antibiotic, which include both aerobic and anaerobic coverage, can safely be used in children with perforated appendicitis.

Topics: Adolescent; Amebicides; Anti-Bacterial Agents; Antibiotic Prophylaxis; Appendicitis; Ceftriaxone; Cephalosporins; Child; Child, Preschool; Clindamycin; Drug Therapy, Combination; Female; Humans; Injections, Intravenous; Intestinal Perforation; Male; Ornidazole; Penicillins; Piperacillin; Prospective Studies; Rupture, Spontaneous; Tobramycin; Treatment Outcome

Two hundred and forty adults undergoing acute appendicectomy were randomised to receive either cefoxitin or ceftriaxone 1 g intravenously at induction of anaesthesia. Patients were monitored daily while in hospital, and at least 4 weeks after discharge for evidence of wound, urinary or lower respiratory tract infection. We evaluated 167 patients at follow up and found no significant difference in infection rates between the two antibiotic groups. Thirty-four had normal appendices and 1 of 16 (6.3%) given cefoxitin and 2 of 18 (11.1%) given ceftriaxone developed wound infections. Ninety-seven had acute appendicitis and 3 of 48 (6.3%) given cefoxitin and 3 of 49 (6.1%) given ceftriaxone developed infections including 2 wound infections in each group. Thirty-six had gangrenous perforated or abscessed appendices: 31 were given additional antibiotics postoperatively, and 4 of 18 (22.2%) in each prophylactic antibiotic group developed infections, including wound infection in 3 given cefoxitin and in 4 given ceftriaxone. None of the infections were serious. Sixty-one percent presented after discharge from hospital. The mean hospital stay was 4.6 days for each antibiotic group. Neither antibiotic caused adverse effects.

Topics: Abscess; Adolescent; Adult; Appendectomy; Appendicitis; Cefoxitin; Ceftriaxone; Humans; Intestinal Perforation; Middle Aged; Premedication; Random Allocation; Rupture, Spontaneous; Surgical Wound Infection

Few data reported non-typhoidal

Topics: Anti-Bacterial Agents; Ceftriaxone; Humans; Intestinal Perforation; Male; Metronidazole; Middle Aged; Peritonitis; Salmonella enteritidis; Salmonella Infections

Topics: Anti-Bacterial Agents; Ceftriaxone; Escherichia coli; Female; Foreign Bodies; Humans; Intestinal Perforation; Liver Abscess; Middle Aged; Stomach; Tomography, X-Ray Computed

Topics: Aged; Anal Canal; Anti-Bacterial Agents; Anti-Infective Agents; Anus Diseases; Ceftriaxone; Female; Humans; Intestinal Perforation; Intestine, Small; Metronidazole; Rectal Diseases; Rectum; Rupture, Spontaneous; Time Factors

The efficacy and the safety of sequential intravenous/oral (i.v./p.o.) ciprofloxacin (CIPX) plus i.v./p.o. metronidazole (MTR) was compared with i.v. ceftriaxone (CTRX) plus i.v./p.o. MTR in the treatment of complicated intra-abdominal infections. One hundred and forty two patients received study medications. Of these, 135 could be studied. Sixty-nine patients were randomized in the CIPX arm of the study and 66 in the CTRX arm. In the CIPX group 58 patients were switched to oral treatment and 11 patients remained in the intravenous arm. In the CTRX group 57 patients switched to oral MTR continuing i.v. CTRX and 9 patients remained in the i.v. branch. Success rates at the end of treatment in patients who switched to oral were 100% in both the CIPX group and the CTRX group. For validated patients continuing on oral, the success rates at the end of treatment were 63.6 and 33.3% in the CIPX and CTRX groups respectively. Overall success rates at the end of treatment and follow-up in all patients were 94.2% in the CIPX group and 89.4% in the CTRX group. Overall success rates at the end of treatment in patients with proven bacterial infection were 92.9% in the CIPX group and 88.3% in the CTRX group. Duration of hospitalization (days) for studied patients was 22.7+/-8.2 in the CIPX and 19.6+/-14.5 in the CTRX group. There was no statistical difference between the CIPX and CTRX groups in both the intent to treat and in the modified intent to treat populations. Conversion to oral therapy with CIPX/MTR was as effective as continued intravenous therapy with CTRX and oral MTR in those patients able to tolerate oral feeding.

Topics: Abdominal Abscess; Adult; Aged; Bacterial Infections; Ceftriaxone; Ciprofloxacin; Double-Blind Method; Drug Therapy, Combination; Female; Humans; Intestinal Perforation; Male; Metronidazole; Middle Aged; Peritonitis; Prospective Studies

Topics: Achilles Tendon; Adult; Ceftriaxone; Ciprofloxacin; Crohn Disease; Drug Therapy, Combination; Humans; Intestinal Perforation; Levofloxacin; Male; Methylprednisolone; Metronidazole; Ofloxacin; Rupture; Tendinopathy

The incidence and mortality of sepsis increase with age, consequently, 80% of the clinical mortality from sepsis occurs in patients over age 65. Despite this aged clinical population, most research models of sepsis use 6- to 16-week-old mice as patient surrogates. This age range of mice corresponds to human ages 10 to 17 years. To assess the influence of age on rodent CLP and on antibiotic therapy, we studied young (4 month), mature (12 month), and aged (24 month) mice. Male C57BL/6 mice (n = 27-30 in each age group) were subjected to cecal ligation and puncture (CLP), two punctures with a 25-gauge needle. Mice were observed untreated for 10 days. Young mice had 20% mortality, mature mice had 70% mortality (P = 0.0013 vs. young), and aged mice had 75% mortality (P = 0.0001 vs. young). To assess the effects of age on antibiotic therapy, mice were subjected to CLP as above (n = 38-40 in each age group). Mice were then randomized to treatment with intraperitoneal injections of ceftriaxone and metronidazole or normal saline. Therapy was initiated 12 h after CLP, and injections were repeated every 12 h for 7 days. Young mice saw a 56% decrease in mortality from CLP with antibiotic therapy (P = 0.001), and mature mice had a 30% decrease in mortality (P = 0.06). Aged mice saw no benefit from antibiotic therapy. We also compared plasma cytokine levels between young and aged mice after CLP. When compared with young mice, aged mice had higher levels of IL-6 and TNF-alpha 24 h after CLP. However, high IL-6 was predictive of mortality at any age. Mice appear to have age-dependent responses to intra-abdominal sepsis and to appropriate therapy.

Topics: Age Factors; Aging; Animals; Cecum; Ceftriaxone; Disease Susceptibility; Drug Therapy, Combination; Intestinal Perforation; Ligation; Male; Metronidazole; Mice; Mice, Inbred C57BL; Models, Animal; Sepsis; Tumor Necrosis Factor-alpha; Wounds, Penetrating