ro13-9904 and Peritonitis

The majority of aorto-caval fistulae occur spontaneously, either as a result of rupture of an existing atherosclerotic abdominal aortic aneurysm into the vena cava or secondary to iatrogenic injuries during peripheral angiography or surgery. Aorto-caval fistula from an infected aortic aneurysm is a rare scenario, but potentially lethal.. Case report and review of the literature.. A 63-year-old female with diabetes mellitus and liver cirrhosis was admitted for intractable abdominal pain with rebound tenderness. A computed tomography scan demonstrated an abdominal aortic aneurysm and ill-defined peri-aortic fluid with air density and evidence of a fistula between the aorta and the inferior vena cava. Salmonella cholerasuis had been isolated from a blood culture at a previous admission. Urgent endovascular exclusion of the aorto-caval fistula was carried out, and the infra-renal abdominal aneurysm was repaired using a Cook Zenith TX2 aortic stent graft. She received parenteral ceftriaxone for four weeks.. This case shows acceptable short-term results after endovascular repair of a Salmonella-infected aorto-caval fistula.

Topics: Administration, Intravenous; Anti-Bacterial Agents; Aortic Aneurysm, Abdominal; Arteriovenous Fistula; Ceftriaxone; Diabetes Complications; Female; Humans; Liver Cirrhosis; Middle Aged; Peritonitis; Radiography, Abdominal; Salmonella enterica; Salmonella Infections; Tomography, X-Ray Computed

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

The primary fallopian tube invader adenocarcinoma is a preoperative diagnosis rarely reported in the literature, because is the most uncommon of all gynecological tumors, with prevalence from 0.3 to 1.8%. Since its clinical evolution is very unspecific, in general this tumor is diagnosed during a laparothomy for other purpose or by the pathologist in the final histopathological report. The most frequent signs and symptoms are abdominal pain or a pelvic mass in 80% of cases; transvaginal bleeding in 50%, intense transvaginal serohematic discharge (hidrops tubae profluens) in 11.1%, and peritonitis in pelvis in 3.7%. In 25 to 60% of the cases a report of adenocarcinoma in the pap smear with negative endometrial biopsy can be found. The treatment is predominantly surgical, as that of epithelial ovarian carcinoma, and consists of an intraperitoneal washing, total abdominal hysterectomy with bilateral salpingo-oophorectomy and a proper staging. It is required an omentectomy with pelvic and paraaortic lymphadenectomy in systematic way. In the more advanced stages III and IV that required a radical debulking, we have to be very emphatic in citoreduction. In some cases, as the persistence or recurrence of illness, it can be necessary adjuvant chemotherapy. In some patients in early stage I or II with low risk, the complete staging could not be necessary. There is controversy about administration criteria of adjuvant treatment, since there is not evidence of survival increase related to its use. The five years survival rate was 64% for stage I, 42% for stage II, 32% for stage III, and 17% for stage IV. Fallopian tube malignancies are rare and involve a poor prognosis.

Topics: Abdomen, Acute; Acute Kidney Injury; Adenocarcinoma; Anti-Bacterial Agents; Anuria; Ceftriaxone; Clindamycin; Fallopian Tube Neoplasms; Female; Humans; Hysterectomy; Middle Aged; Ovariectomy; Pelvic Inflammatory Disease; Peritonitis

For the treatment of spontaneous bacterial peritonitis (SBP), cefotaxime, ceftriaxone, and ciprofloxacin were used as first-line agents. However, considering the increasing rate of antibiotic resistance, it is unclear which of these drugs can be initially recommended. This study aimed to compare the current efficacy of the 3 antibiotics, namely cefotaxime, ceftriaxone, and ciprofloxacin, for the treatment of SBP in patients with cirrhosis with ascites, when guided by therapeutic responses.. This study was a multicenter, prospective, randomized controlled trial. The inclusion criteria were 16- to 75-year-old patients with liver cirrhosis with ascites, having polymorphonuclear cell count of >250/mm 3 . We performed a follow-up paracentesis at 48 hours to decide continuing or changing the assigned antibiotics and then assessed the resolution rates at 120 and 168 hours of treatment.. A total of 261 patients with cirrhosis who developed SBP were enrolled. Most of the patients were diagnosed as those with SBP within 48 hours of admission. The resolution rates at 120 hours, which is the primary endpoint, were 67.8%, 77.0%, and 73.6% in the cefotaxime, ceftriaxone, and ciprofloxacin groups, respectively ( P = 0.388), by intension-to-treat analysis. The 1-month mortality was similar among the groups ( P = 0.770). The model for end-stage liver disease score and the SBP resolution were significant factors for survival.. The efficacy of empirical antibiotics, such as cefotaxime, ceftriaxone, and ciprofloxacin, against SBP was not significantly different. In addition, these antibiotics administered based on response-guided therapy were still efficacious as initial treatment for SBP, especially in those with community-acquired infections.

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Ascites; Bacterial Infections; Cefotaxime; Ceftriaxone; Ciprofloxacin; End Stage Liver Disease; Humans; Liver Cirrhosis; Middle Aged; Peritonitis; Prospective Studies; Severity of Illness Index; Young Adult

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

Management of community-origin complicated intra-abdominal infections (cIAIs) requires surgical intervention and antimicrobial therapy. This multinational, randomised, double-blind clinical trial carried out in Asia compared the efficacy and safety of moxifloxacin monotherapy and ceftriaxone/metronidazole combination therapy in adults with confirmed or suspected cIAI. Patients received surgical intervention and either intravenous (i.v.) moxifloxacin 400 mg once daily or i.v. ceftriaxone 2 g once daily plus i.v. metronidazole 500 mg twice daily. A total of 364 patients were randomised [intent-to-treat (ITT), moxifloxacin N=180, comparator N=181; per-protocol (PP), moxifloxacin N=174, comparator N=171]. The most common cIAI diagnosis was complicated appendicitis. Moxifloxacin was non-inferior to ceftriaxone/metronidazole in terms of clinical response at test-of-cure in the PP population [clinical cure, 90.2% for moxifloxacin vs. 96.5% for ceftriaxone/metronidazole; 95% confidence interval (CI) of the difference -11.7 to -1.7] and in the ITT population (87.2% for moxifloxacin vs. 91.2% for ceftriaxone/metronidazole; 95% CI -10.7 to 1.9). Bacteriological cure rates in the microbiologically evaluable population support the clinical results (89.4% for moxifloxacin vs. 95.9% for ceftriaxone/metronidazole; 95% CI -13.3 to -0.6). The incidence of treatment-emergent adverse events was similar for both treatment groups (moxifloxacin 31.7% vs. comparator 24.3%). These results confirm previous findings that moxifloxacin plus adequate source control is an appropriate treatment of cIAI.

Topics: Adult; Anti-Bacterial Agents; Asia; Aza Compounds; Ceftriaxone; Community-Acquired Infections; Double-Blind Method; Drug Therapy, Combination; Female; Fluoroquinolones; Humans; Male; Metronidazole; Middle Aged; Moxifloxacin; Peritonitis; Quinolines; Treatment Outcome

The addition of molgramostim (recombinant human granulocyte-macrophage colony-stimulating factor) to antibiotic therapy for nontraumatic and generalized abdominal sepsis is effective and has a significant impact on length of hospitalization, direct medical costs, and mortality.. Randomized, double-blind, placebo-controlled clinical trial.. Tertiary referral center.. Fifty-eight patients with abdominal sepsis.. Patients were allocated to receive, in addition to ceftriaxone sodium, amikacin sulfate, and metronidazole, molgramostim in a daily dosage of 3 microg/kg for 4 days (group 1) or placebo (group 2). Antibiotics were administered for at least 5 days and discontinued after clinical improvement had occurred and white blood cell count had been normal for 48 hours.. Time to improvement, duration of antibiotic therapy, hospital stay, complications, mortality, and adverse reactions to drugs.. Median time to improvement was 2 days in group 1 and 4 days in group 2 (P<.005). Median length of hospitalization was 9 and 13 days, respectively (P<.001), and median duration of antibiotic therapy was 9 and 13 days, respectively (P<.001). Numbers of infectious complications in the 2 groups were, respectively, 6 and 16 (P = .02); of residual abscesses, 3 and 5; and of deaths, 2 and 2. Costs per patient were 12,333 dollars and 16,081 dollars (US dollars), respectively.. Addition of molgramostim to antibiotic therapy reduces the rate of infectious complications, the length of hospitalization, and costs in patients with nontraumatic abdominal sepsis.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Amikacin; Anti-Bacterial Agents; Antineoplastic Agents; Ceftriaxone; Double-Blind Method; Drug Therapy, Combination; Female; Follow-Up Studies; Granulocyte-Macrophage Colony-Stimulating Factor; Humans; Length of Stay; Male; Metronidazole; Middle Aged; Peritonitis; Recombinant Proteins; Sepsis; Survival Rate; Treatment Outcome

Oral norfloxacin is the standard of therapy in the prophylaxis of bacterial infections in cirrhotic patients with gastrointestinal hemorrhage. However, during the last years, the epidemiology of bacterial infections in cirrhosis has changed, with a higher incidence of infections caused by quinolone-resistant bacteria. This randomized controlled trial was aimed to compare oral norfloxacin vs intravenous ceftriaxone in the prophylaxis of bacterial infection in cirrhotic patients with gastrointestinal bleeding.. One hundred eleven patients with advanced cirrhosis (at least 2 of the following: ascites, severe malnutrition, encephalopathy, or bilirubin >3 mg/dL) and gastrointestinal hemorrhage were randomly treated with oral norfloxacin (400 mg twice daily; n = 57) or intravenous ceftriaxone (1 g/day; n = 54) for 7 days. The end point of the trial was the prevention of bacterial infections within 10 days after inclusion.. Clinical data were comparable between groups. The probability of developing proved or possible infections, proved infections, and spontaneous bacteremia or spontaneous bacterial peritonitis was significantly higher in patients receiving norfloxacin (33% vs 11%, P = .003; 26% vs 11%, P = .03; and 12% vs 2%, P = .03, respectively). The type of antibiotic used (norfloxacin), transfusion requirements at inclusion, and failure to control bleeding were independent predictors of infection. Seven gram-negative bacilli were isolated in the norfloxacin group, and 6 were quinolone resistant. Non-enterococcal streptococci were only isolated in the norfloxacin group. No difference in hospital mortality was observed between groups.. Intravenous ceftriaxone is more effective than oral norfloxacin in the prophylaxis of bacterial infections in patients with advanced cirrhosis and hemorrhage.

Topics: Administration, Oral; Aged; Anti-Bacterial Agents; Anti-Infective Agents; Antibiotic Prophylaxis; Bacteremia; Bacterial Infections; Ceftriaxone; Female; Gastrointestinal Hemorrhage; Humans; Injections, Intravenous; Liver Cirrhosis; Male; Middle Aged; Norfloxacin; Peritonitis; Risk Factors; Treatment Outcome

The administration of albumin improves circulatory function, prevents hepatorenal syndrome, and reduces hospital mortality in patients with cirrhosis and spontaneous bacterial peritonitis. This randomized unblinded pilot study compared the effect of albumin (10 patients) and the synthetic plasma expander hydroxyethyl starch 200/0.5 (10 patients) on the systemic hemodynamics of patients with spontaneous bacterial peritonitis. Baseline measurements were performed within 12 hours after diagnosis of infection. Patients then received 2 doses of the volume expander (1.5 g/kg body weight after baseline measurements and 1 g/kg body weight on day 3). Measurements were repeated after infection resolution. Treatment with albumin was associated with a significant increase in arterial pressure and a suppression of plasma renin activity, indicating an improvement in circulatory function. This occurred in the setting of a significant expansion of central blood volume (increase in cardiopulmonary pressures and atrial natriuretic factor) and an increase in systolic volume and systemic vascular resistance. In contrast, no significant changes were observed in these parameters in patients treated with hydroxyethyl starch. Von Willebrand-related antigen plasma levels significantly decreased in patients treated with albumin but not in those treated with hydroxyethyl starch. Serum nitrates and nitrites increased in patients treated with hydroxyethyl starch but not in those treated with albumin. These data suggest an effect of albumin on endothelial function. In conclusion, albumin but not hydroxyethyl starch improves systemic hemodynamics in patients with spontaneous bacterial peritonitis. This effect is due not only to volume expansion but also to an action on the peripheral arterial circulation.

Topics: Anti-Bacterial Agents; Bacterial Infections; Ceftriaxone; Female; Hemodynamics; Humans; Hydroxyethyl Starch Derivatives; Kidney Function Tests; Liver Function Tests; Male; Middle Aged; Peritonitis; Pilot Projects; Plasma Substitutes; Serum Albumin; von Willebrand Factor

Albumin administration prevents renal failure and improves survival in spontaneous bacterial peritonitis. This study characterizes the mechanisms of action of albumin in this condition.. Systemic and splanchnic hemodynamics, plasma renin activity and plasma concentration of interleukin-6, serum concentration of nitric oxide and ascitic fluid levels of nitric oxide and interleukin-6 were assessed at diagnosis and resolution of infection in 12 patients with spontaneous bacterial peritonitis treated with ceftriaxone plus albumin. At infection resolution there was a significant improvement in circulatory function, as indicated by a significant increase in mean arterial pressure (+8%, P=0.02), a fall in heart rate (-10%, P=0.01), a suppression of plasma renin activity (-67%, P=0.002) and a decrease in creatinine levels. These changes were related to both an increase in cardiac work (stroke work index: +18%, P=0.005) and in peripheral vascular resistance (+14%, P=0.05). The improvement in cardiac function was due to an increase in filling. No significant changes were observed in portal pressure or hepatic blood flow.. These results indicate that the beneficial effects of albumin administration on systemic hemodynamics and renal function in spontaneous bacterial peritonitis are related to both an improvement in cardiac function and a decrease in the degree of arterial vasodilation.

Topics: Adult; Aged; Albumins; Anti-Bacterial Agents; Ascitic Fluid; Bacterial Infections; Ceftriaxone; Female; Hemodynamics; Humans; Injections, Intravenous; Interleukin-6; Liver Circulation; Liver Cirrhosis; Male; Middle Aged; Nitric Oxide; Peritonitis; Renin

The aim of this study was to determine whether a short course of ceftriaxone was sufficient to cure spontaneous bacterial peritonitis (SBP) in cirrhotic patients.. We studied 33 cirrhotic patients with SBP. All of them were treated with ceftriaxone, 1.0 g IV, every 12 h for 5 days. Twenty-one variables were recorded to evaluate their relationship to the resolution of SBP.. The mean age of the patients was 45 years. Twenty-three were males and 10 females. The etiology of cirrhosis was alcoholic in 42% of the patients, and 82% of the patients belonged to Child-Pugh Class C. Hepatic encephalopathy was present in 39% of the patients. The most frequent organism causing SBP was Escherichia coli (60%). Resolution of SBP on day 5 of treatment was achieved in 73% of the patients. Total resolution of SBP after prolonged therapy with ceftriaxone or another agent. selected according to antibiotic susceptibility, was achieved in 94% of the patients. Hospital mortality was 12%. Multivariate analysis showed no factor that was significantly related to the resolution of SBP, but univariate analysis showed that renal impairment and positive culture tended to be related.. A short course (5 days) of ceftriaxone is useful therapy for SBP. If the polymorphonuclear differential count in ascitic fluid is less than 250 cells/mm3 on day 5 of treatment, the antibiotic can be discontinued.

Topics: Adolescent; Adult; Aged; Ceftriaxone; Cephalosporins; Drug Administration Schedule; Escherichia coli; Escherichia coli Infections; Female; Hospital Mortality; Humans; Liver Cirrhosis; Logistic Models; Male; Middle Aged; Peritonitis

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

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

In a prospective, controlled, double-blind study, 496 patients undergoing abdominal surgery were given antibiotic prophylaxis with a single dose of either ceftriaxone or ampicillin + metronidazole. No significant intergroup difference was found between the respective overall rates of infectious complications (3.2% and 4.9%). Analysis of the microbiologic findings showed incisional wound infections, mainly caused by gram-negative rods, to be more common in the ampicillin-metronidazole group, whereas deep wound infections were more frequent in the ceftriaxone group. It is concluded that ceftriaxone seems to be more efficient than ampicillin-metronidazole as prophylaxis against incisional wound infection, but should preferably be supplemented with an antianaerobic agent to prevent deep wound infections.

Topics: Abdomen; Aged; Aged, 80 and over; Ampicillin; Bacterial Infections; Ceftriaxone; Digestive System Surgical Procedures; Double-Blind Method; Drug Combinations; Humans; Metronidazole; Middle Aged; Peritonitis; Prospective Studies; Sepsis; Surgical Wound Infection

The authors studied the peritoneal diffusion of ceftriaxone in the four quadrants of the abdomen (right and left inguinal and right and left hypochondrium) in 50 adult patients divided into 4 groups: pre-operative IVD administration of ceftriaxone in patients with healthy peritoneum, 1 g (group I), 2 g (group II): pre-operative IVD administration of ceftriaxone in patients presenting peritonitis 1 g (group III), 2 g (group IV). After laparotomy, a fragment of peritoneal membrane was resected from each of the four quadrants, the product was extracted from the peritoneum by a crushing technique and the assayed by HPLC with concomitant blood level assay. The mean assayed concentrations in situ are respectively in groups I to IV: 27.2, 31.2, 31.36 and 43.65 micrograms/g, with a rapid time of appearance (30 minutes) and a homogeneous topographic distribution for all peritoneal sample sites. In cases of peritonitis, the concentrations are higher by a factor of 1.15 and 1.39 for the dosages of 1 and 2 g as compared to healthy peritoneum. Beyond the third hour after injection, peritoneal concentrations remained high at 9.8 micrograms/g in patients having received 1 g of ceftriaxone and very high at 22.6 micrograms/g in patients having received 2 g. These levels are therefore effective whatever the posology in antibioprophylaxis, taking into account the MIC of the product on Gram- bacilli.

Topics: Ceftriaxone; Drug Administration Schedule; Female; Humans; Male; Peritoneum; Peritonitis; Premedication

Topics: Ceftriaxone; Chloramphenicol; Clinical Trials as Topic; Drug Therapy, Combination; Female; Humans; Pelvic Inflammatory Disease; Penicillin G; Peritonitis; Random Allocation

During a 7 month trial for therapy of polymicrobial surgical sepsis, intravenous antibiotic treatment was randomized between gentamicin (1 mg/kg every 8 hours) plus clindamycin (8 mg/kg every 6 hours), and the cephalosporin, ceftriaxone (1 g every 12 hours) in 197 patients, of whom 99 were being treated for peritonitis, 93 for soft tissue sepsis, and 5 for other forms of infection. No significant differences were noted in patient demographics, type of sepsis, associated disease states, surgical procedure, or causative aerobic or anaerobic pathogens. Results demonstrated approximately equivalent efficacy, although cure rates obtained with ceftriaxone in patients with soft tissue sepsis or intraabdominal abscess were superior to those achieved with combination gentamicin and clindamycin. There were no significant side effects with ceftriaxone therapy, such as the renal failure noted in six of the patients treated with gentamicin and clindamycin. We conclude that single agent treatment with ceftriaxone is preferable because of the greater safety and the longer dosing intervals.

Topics: Abdomen; Abscess; Adolescent; Adult; Aged; Bacterial Infections; Cefotaxime; Ceftriaxone; Clindamycin; Clinical Trials as Topic; Drug Therapy, Combination; Female; Gentamicins; Humans; Kidney Diseases; Male; Microbial Sensitivity Tests; Middle Aged; Peritonitis; Postoperative Complications; Random Allocation; Recurrence

Topics: Ceftriaxone; Diverticulitis; Enterococcus faecium; Humans; Incidence; Peritonitis

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

Intraperitoneal ceftriaxone administration in healthy horses results in high and prolonged peritoneal concentrations. Recent findings suggest that intraperitoneal ceftriaxone might increase survival rates in horses affected by peritonitis. The present study aimed to evaluate plasma and peritoneal concentrations of ceftriaxone after intraperitoneal administration in horses with septic peritonitis. Twenty-six horses presenting clinical, laboratorial, and sonographic findings compatible with the disease were included. All horses received daily intraperitoneal ceftriaxone (25 mg/kg bwt) in addition or not with other antibiotics and support therapies. High-performance liquid chromatography was used to determine plasma and peritoneal ceftriaxone concentrations before and after 12 and 24 hours of ceftriaxone administration. Mean plasma concentrations 12 and 24 hours after administration were, respectively, 1.84 ± 0.43 and 0.37 ± 0.07 μg/mL, and mean peritoneal concentrations were 5.7 ± 2.84 and 0.42 ± 0.13 μg/mL. Ceftriaxone concentration was lower in comparison with previous studies in healthy horses and presented under the minimal inhibitory concentration for enterobacteria (≤1 μg/mL) and for gram-positive isolates (≤0.5 μg/mL) at 24 hours. The variation of the results obtained between healthy horses and with septic peritonitis demonstrated that pharmacokinetics/dynamics are different between these patients and suggests the use of an interval of dose of 12 hours.

Topics: Animals; Ceftriaxone; Horse Diseases; Horses; Injections, Intraperitoneal; Peritoneum; Peritonitis; Plasma

Staphylococcus sciuri is an occasional cause of human infection that has been described in the flora of numerous animal species and in environmental specimens. Here, we report a rare case of S. sciuri peritonitis in a dialysis patient who had exposure to peridomestic animals.

Topics: Aged; Anti-Bacterial Agents; Ceftriaxone; Humans; Male; Peritoneal Dialysis; Peritonitis; Staphylococcal Infections; Staphylococcus; Vancomycin

Intraperitoneal administration of ceftriaxone maintains therapeutic abdominal concentrations for 24 hours in healthy horses. Therefore, it is a possible treatment for septic peritonitis. The aim of this study was to evaluate the efficacy of ceftriaxone as an adjuvant treatment in horses with septic peritonitis.. Twenty-six horses with clinical signs, sonography and/or laboratory findings of septic peritonitis were included. Peritoneal fluid was collected for microbiological culture and in vitro microbial sensitivity profile assessment. Daily intraperitoneal administration of ceftriaxone (25 mg/kg) was initiated with supportive and systemic antimicrobial treatment. The animals were divided into three groups: group 1-gastrointestinal tract injuries and abdominal surgery (excluding perforations/ruptures); group 2-not related to changes in the gastrointestinal tract; group 3-secondary to intestinal rupture and/or faeces contamination.. The mean success rate of the treatment was 77 per cent (20/26 animals), with success rates of 84.6 per cent in group 1; 87.5 per cent, group 2; and 40 per cent, group 3.. This is the first study to report adjuvant intraperitoneal treatment ceftriaxone for septic peritonitis in horses and indicates that this treatment can successfully treat septic peritonitis in horses.

Topics: Animals; Anti-Bacterial Agents; Ceftriaxone; Chemotherapy, Adjuvant; Female; Horse Diseases; Horses; Infusions, Parenteral; Male; Peritonitis; Sepsis; Treatment Outcome

The Gram-negative diplococcus Neisseria macacae is a commensal bacterium of the mucosal surfaces in humans. A 52-year-old woman receiving continuous ambulatory peritoneal dialysis was admitted because of abdominal pain and turbid peritoneal fluid. N. macacae was isolated from peritoneal fluid culture and showed susceptibility to ceftriaxone. Despite appropriate antibiotics, the peritonitis was refractory, leading to the removal of the peritoneal dialysis catheter. We herein report the first case of peritoneal dialysis peritonitis caused by Neisseria macacae and review previous case reports of N. macacae infection in humans.

Topics: Anti-Bacterial Agents; Ceftriaxone; Female; Humans; Middle Aged; Neisseria; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis

BACKGROUND A Neisseria gonorrhoea infection is one of the most common sexually transmitted diseases and can present both urogenitally and extragenitally. CASE DESCRIPTION A 55-year-old woman presented at the emergency room with general malaise, abdominal pain and fever. Despite extensive surgical, gynaecological and radiological investigations no clear cause could initially be found. She was subsequently admitted to the surgical unit for observation. During the admission period the patient developed diffuse peritonitis and her infection parameters were rising. Diagnostic laparoscopy revealed extensive terminal ileitis with a reactive infiltrate of the uterine fundus and purulent peritonitis. A PCR test of the abdominal exudate was strongly positive for Neisseria gonorrhoeae, but cultures remained negative. Following an 8-day course of antibiotic treatment with intravenous ceftriaxone, the patient recovered from her symptoms. CONCLUSION Terminal ileitis with peritonitis is an unusual extragenital manifestation of a gonococcal infection. In order to make a diagnosis, surgical exploration with cultures is sometimes indicated.

Topics: Anti-Bacterial Agents; Ceftriaxone; Diagnosis, Differential; Female; Gonorrhea; Humans; Ileitis; Middle Aged; Neisseria gonorrhoeae; Peritonitis; Treatment Outcome

Commonly used antibiotics exert their effects predominantly on rapidly growing bacterial cells; yet, the growth dynamics taking place during infection in a complex host environment remain largely unknown. Hence, a means to measure

Topics: Animals; Anti-Bacterial Agents; Ceftriaxone; Ciprofloxacin; Disease Models, Animal; Escherichia coli; Escherichia coli Infections; Gentamicins; Mice; Peritonitis

There are few studies addressing the impact of cephalosporin and quinolone resistance on hospital length of stay and mortality in spontaneous bacterial peritonitis (SBP). We aim to describe the shifting epidemiology of SBP at our institution and its impact on clinical outcomes.. We performed a single-center retrospective cohort study of all cases of SBP from 2005 to 2015 at a transplant center. Cases were identified using hospital billing data. Patient data were confirmed using the electronic medical record. Univariate and multivariate logistic regression and Cox proportional hazards models were used to identify factors that were associated with prolonged hospital length of stay and reduced survival. Culture-positive cases (N = 56) were compared to culture-negative cases (N = 104). Subpopulation analysis of the culture-positive cases compared ceftriaxone-resistant (N = 25) to ceftriaxone-susceptible (N = 31) cases.. We identified 160 cases of SBP (56 culture positive and 104 culture negative; 21 nosocomial, 79 hospital associated, and 60 community acquired). Forty-five percent (N = 25 total, 13 hospital associated and 6 nosocomial) of bacterial isolates were resistant to ceftriaxone, with 37.5% (N = 21) being gram positive, including 8 methicillin-resistant staphylococcus and 6 vancomycin-resistant enterococcus. Multivariate analysis identified hospital-associated SBP, age, alcoholic cirrhosis, and MELD-Na score as variables associated with worse survival (P < 0.05), with a trend toward worse survival in culture-positive cases (P = 0.123). Only MELD-Na was associated with prolonged length of stay.. The burden of resistant pathogens causing SBP is significant, notably in hospital-associated SBP. Culture-positive SBP may represent a higher risk group compared to culture-negative SBP.

Topics: Adult; Aged; Anti-Bacterial Agents; Bacterial Infections; Boston; Ceftriaxone; Drug Resistance, Bacterial; Female; Humans; Length of Stay; Liver Cirrhosis; Male; Middle Aged; Peritonitis; Quinolones; Retrospective Studies; Risk Assessment; Risk Factors; Time Factors; Treatment Outcome

Few data reported non-typhoidal

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

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

Topics: Adult; Anti-Bacterial Agents; Ceftriaxone; Cesarean Section; Female; Fertilization in Vitro; Humans; Infant, Newborn; Infant, Premature; Infant, Very Low Birth Weight; Male; Ornidazole; Pelvic Infection; Peritonitis; Pregnancy; Pregnancy Complications, Infectious; Pregnancy, Twin; Sclerosis

Topics: Animals; Anti-Bacterial Agents; Ascitic Fluid; Ceftriaxone; Horses; Injections, Intraperitoneal; Injections, Intravenous; Peritonitis

The epidemiology of spontaneous bacterial peritonitis (SBP) due to ceftriaxone-resistant organisms has not been well studied in the USA. The primary objective of this study was to assess the prevalence and predictors of ceftriaxone-resistant SBP at a large US tertiary-care centre.. This 1:1:4 case-case-control study included 141 adults with liver cirrhosis admitted from November 2011 to March 2016. Case group 1 were patients with SBP with a ceftriaxone-resistant organism (n=21). Case group 2 were patients with SBP with a ceftriaxone-susceptible organism (n=26). The control group were patients without SBP (n=94). Multiple logistic regression analysis was used to identify predictors of ceftriaxone-resistant SBP.. Fifty isolates were identified from 47 patients with culture-positive SBP (case groups 1 and 2). Of these 50 isolates, 32 (64%) were Gram-negatives [mostly Enterobacteriaceae (91%)], 15 (30%) were Gram-positives and 3 (6%) were Candida spp. The prevalence of ceftriaxone resistance in patients with culture-positive SBP was 45% (21/47). The most common ceftriaxone-resistant organisms were ESBL-producing Enterobacteriaceae (45%). Independent predictors of ceftriaxone-resistant SBP included duration of β-lactam therapy in the past 90days (aOR=1.07, 95% CI 1.01-1.13) and recent invasive gastrointestinal procedure (aOR=12.47, 95% CI 2.74-56.67).. The prevalence of ceftriaxone-resistant SBP was significant at a US tertiary centre. Local epidemiological data and identification of risk factors associated with ceftriaxone-resistant SBP, e.g. increased usage of previous β-lactam therapy and invasive gastrointestinal procedure, may help clinicians identify patients requiring alternative empirical antibiotics.

Topics: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Bacteria; Bacterial Infections; Case-Control Studies; Ceftriaxone; Drug Resistance, Bacterial; Female; Humans; Male; Middle Aged; Peritonitis; Prevalence; Tertiary Care Centers; United States

A 70-year-old man with a history of hepatic cirrhosis presented with abdominal discomfort and distention. Physical examination revealed abdominal distention, positive fluid wave and abdominal tenderness. Due to concerns for spontaneous bacterial peritonitis (SBP), paracentesis was performed. Fluid analysis revealed 5371 total nucleated cells with 48% neutrophils. Ceftriaxone was then initiated for the treatment of SBP. Bacterial cultures of the fluid, however, grew

Topics: Abdomen, Acute; Abscess; Aged; Anti-Bacterial Agents; Ceftriaxone; Clostridioides difficile; Diagnosis, Differential; Drainage; Female; Humans; Male; Pelvic Infection; Peritonitis; Tomography, X-Ray Computed

Bacterial biofilms provoke and/or promote the most chronic and recurrent infectious diseases. Previously, experimental models of purulent peritonitis and meningoencephalitis revealed positive antibiofilm effect of metallic nanoparticles and the absence of resistance against such nanoparticles in microorganisms. This study examines the combined effect of silver nanoparticles with ceftriaxone and methyluracil on recovery mechanisms during inflammatory diseases exemplified by purulent peritonitis in experimental animals.

Topics: Animals; Anti-Bacterial Agents; Biofilms; Ceftriaxone; Infectious Disease Medicine; Inflammation; Male; Meningoencephalitis; Metal Nanoparticles; Peritonitis; Rats; Rats, Wistar; Recurrence; Silver; Uracil

Topics: Anti-Bacterial Agents; Antiviral Agents; Bacterial Translocation; Benzimidazoles; Ceftriaxone; Coinfection; Disease Susceptibility; Esophageal and Gastric Varices; Esophagoscopy; Female; Fluorenes; Gastrointestinal Hemorrhage; Hepatitis C, Chronic; HIV Infections; Humans; Immunocompromised Host; Middle Aged; Peritonitis; Sofosbuvir; Streptococcus salivarius; Substance Abuse, Intravenous

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

There are few reports of in vivo muscle strength measurements in animal models of ICU-acquired weakness (ICU-AW). In this study we investigated whether the Escherichia coli (E. coli) septic peritonitis mouse model may serve as an ICU-AW model using in vivo strength measurements and myosin/actin assays, and whether development of ICU-AW is age-dependent in this model.. Young and old mice were injected intraperitoneally with E. coli and treated with ceftriaxone. Forelimb grip strength was measured at multiple time points, and the myosin/actin ratio in muscle was determined.. E. coli administration was not associated with grip strength decrease, neither in young nor in old mice. In old mice, the myosin/actin ratio was lower in E. coli mice at t = 48 h and higher at t = 72 h compared with controls.. This E. coli septic peritonitis mouse model did not induce decreased grip strength. In its current form, it seems unsuitable as a model for ICU-AW.

Topics: Actins; Age Factors; Aging; Animals; Anti-Bacterial Agents; Body Weight; Ceftriaxone; Disease Models, Animal; Escherichia coli; Intensive Care Units; Male; Mice; Mice, Inbred C57BL; Muscle Weakness; Muscle, Skeletal; Myosins; Peritonitis

A 23-year-old Japanese woman, previously a commercial sex worker, presented with a 2-day history of right upper quadrant (RUQ) abdominal pain, worse on deep inspiration. She had noticed increased vaginal discharge 2 months earlier and had developed dull, lower abdominal pain 3 weeks prior to presentation. Although pelvic examination and transvaginal ultrasonography revealed neither a tubal nor ovarian pathology, abdominal CT scan with contrast demonstrated early enhancement of the hepatic capsule, a finding pathognomonic for Fitz-Hugh-Curtis syndrome (FHCS). Cervical discharge PCR assay confirmed Chlamydia trachomatis infection. This case highlights that normal gynaecological evaluation may be insufficient to rule out FHCS, for which physicians should have a high index of suspicion when seeing any woman of reproductive age with RUQ pain.

Topics: Abdominal Pain; Adult; Anti-Bacterial Agents; Ceftriaxone; Chlamydia Infections; Chlamydia trachomatis; Contact Tracing; Directive Counseling; Doxycycline; Drug Therapy, Combination; Female; Hepatitis; Humans; Pelvic Inflammatory Disease; Peritonitis; Sex Work; Tomography, X-Ray Computed; Treatment Outcome

Topics: Abdominal Pain; Adult; Anti-Bacterial Agents; Ceftriaxone; Chlamydia Infections; Chlamydia trachomatis; DNA, Bacterial; Doxycycline; Drug Therapy, Combination; Female; Hepatitis; Humans; Laparoscopy; Pelvic Inflammatory Disease; Peritonitis; Polymerase Chain Reaction; Treatment Outcome

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

Chronic kidney disease, including end-stage renal disease, has been identified as a possible risk factor for primary septicemia and wound infection by Vibrio vulnificus. However, cases of severe septicemia, necrotizing fasciitis, and peritonitis caused by V. vulnificus in patients undergoing continuous ambulatory peritoneal dialysis (CAPD) have not been described. We report a case of severe septicemia, necrotizing fasciitis, and peritonitis due to V. vulnificus in a patient undergoing CAPD after ingesting raw seafood.. A 37-year-old woman undergoing CAPD was admitted to the emergency room due to general weakness, fever, diarrhea, and abdominal pain. Although empirical intraperitoneal antibiotics were administered for the diagnosis of CAPD-related peritonitis, her fever did not subside. On hospital day 3, she had hemorrhagic bullae on both lower legs. We evaluated her recent food history, and found that she ate raw seafood before admission. She underwent emergency fasciotomy on the suspicion of necrotizing fasciitis by V. vulnificus infection. Finally, V. vulnificus was confirmed by 16S ribosomal ribonucleic acid gene sequencing using blood and peritoneal effluent fluid cultures. The administration of intraperitoneal ceftazidime and intravenous ciprofloxacin/ceftriaxone was continued for 4 weeks, and the patient completely recovered.. Suspicion of V. vulnificus infection in vulnerable patients who ingest raw seafood is essential for prompt diagnosis, which could significantly improve patient outcomes.

Topics: Adult; Anti-Bacterial Agents; Ceftazidime; Ceftriaxone; Fasciitis, Necrotizing; Female; Humans; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis; RNA, Ribosomal, 16S; Sepsis; Vibrio Infections; Vibrio vulnificus

Spontaneous bacterial peritonitis (SBP) is a life-threatening complication of liver cirrhosis. Recently, rifaximin, a non-absorbable antibiotic which is used to prevent recurrent hepatic encephalopathy, has been proposed as effective prophylaxis for SBP. Here, we present an unusual case of SBP under treatment with rifaximin. A 50-year-old woman with liver cirrhosis was admitted because of tense ascites and abdominal pain. She was under long-term oral prophylaxis with rifaximin due to hepatic encephalopathy. Paracentesis revealed SBP caused by Pasteurella multocida, which was sensitive to multiple antibiotics, including rifaximin. Treatment with ceftriaxone resulted in rapid resolution of the peritonitis and restoration of the patient. Since P. multocida is usually transmitted from pets, the patient's cat was tested and could be identified as the most likely source of infection. This case should elicit our awareness that uncommon pathogens and unusual routes of transmission may lead to SBP, despite antibacterial prophylaxis with non-absorbable antibiotics. Nevertheless, such infections may still remain sensitive to systemic therapy with conventional antibiotics.

Topics: Anti-Infective Agents; Antibiotic Prophylaxis; Ceftriaxone; Female; Humans; Liver Cirrhosis; Microbial Sensitivity Tests; Middle Aged; Pasteurella Infections; Pasteurella multocida; Peritonitis; Rifamycins; Rifaximin; Treatment Outcome

We aimed to evaluate the microbiological and immunological effects of tissue plasminogen activator (tPA) in a rat model of peritonitis.. Twenty-four male Wistar albino rats were divided equally into three groups. Peritonitis and thereafter laparotomy and partial omentectomy were performed in all rats. The control group (C) had no further treatment. The antibiotics group (A) received metronidazole and ceftriaxone. The antibiotic and tPA group (A+T) received the same antibiotics as well as tPA. For microbiological and immunological analysis, blood samples were obtained at the 24th hour, and peritoneal fluid samples were obtained at the 24th and 72nd hours. On the fifth day after surgery, all rats were sacrificed, and the macroscopic findings of the peritoneal cavity were recorded.. The mean number of intraperitoneal abscesses was significantly higher in the control group and the lowest in the two treatment group (A+T). The levels of cytokines were not significantly different between groups. Giving tPA reduced the number and sizes of the abscesses with no significant difference in inflammatory response.. In this experimental peritonitis model, it can be postulated that tPA decreased abscess formation without exaggerating the inflammatory response.

Topics: Abdominal Abscess; Animals; Anti-Bacterial Agents; Ascitic Fluid; Ceftriaxone; Cytokines; Disease Models, Animal; Male; Metronidazole; Peritonitis; Rats; Rats, Wistar; Tissue Plasminogen Activator

Previously it was reported that combining antibiotics with L-97-1, an adenosine A1 receptor antagonist, significantly improves survival and blocks acute lung injury induced by Yersinia pestis CO 99 in a rat model of pneumonic plague. In the current studies using a conscious rat model of cecal ligation and puncture (CLP) sepsis, L-97-1 was administered in daily intravenous infusions in combination with antibiotics to simulate the use of L-97-1 as an anti-sepsis therapeutic in the clinical setting. In these studies, when administered at 12 h following CLP, in combination with broad spectrum antibiotics, ceftriaxone and clindamycin, L-97-1 improves 7 day (d) survival [25%, 35%, and 75% for L-97-1 (10 mg/kg/h, 12.5 mg/kg/h, and 15 mg/kg/h, respectively) versus (vs.) 25% for antibiotics alone] in a dose-dependent manner. The addition of L-97-1, 15 mg/kg/h to antibiotics significantly increased 7 d survival following CLP compared to therapy with either antibiotics alone (P=0.002) or L-97-1 at 15 mg/kg/h alone (P<0.001) and was not significantly different than survival in sham CLP animals (Log-rank (Mantel-Cox) test with Bonferroni׳s correction for multiple comparisons). Moreover, in these studies, in combination with antibiotics L-97-1 dose-dependently protects the kidney, significantly improving renal function at 24 h post CLP at 10 mg/kg/h (P<0.001), 12.5 mg/kg/h (P<0.0001), and 15 mg/kg/h (P<0.0001) vs. antibiotics alone (ANOVA followed by Tukey׳s post-hoc test for pair-wise comparisons). The results of these studies support efficacy for L-97-1 as an anti-sepsis therapeutic.

Topics: Adenosine A1 Receptor Antagonists; Animals; Anti-Bacterial Agents; Blood Urea Nitrogen; Cecum; Ceftriaxone; Clindamycin; Cytokines; Disease Models, Animal; Drug Therapy, Combination; Kidney; Ligation; Male; Peritonitis; Protective Agents; Purines; Rats, Sprague-Dawley; Sepsis

To investigate the therapeutic effect of E5564 (a clinically used TLR4 inhibitor) in murine abdominal sepsis elicited by intraperitoneal infection with a highly virulent Escherichia coli in the context of concurrent antibiotic therapy.. Mice were infected with different doses (~2 × 10(4)-2 × 10(6) CFU) of E. coli O18:K1 and treated after 8 h with ceftriaxone 20 mg/kg i.p. combined with either E5564 10 mg/kg i.v. or vehicle. For survival studies this treatment was repeated every 12 h. Bacterial loads and inflammatory parameters were determined after 20 h in peritoneal lavage fluid, blood, liver and lung tissue. Plasma creatinin, AST, ALT and LDH were determined to assess organ injury.. E5564 impaired bacterial clearance under the antibiotic regime after infection with a low dose E. coli (1.7 × 10(4) CFU) while renal function was slightly preserved. No differences were observed in bacterial load and organ damage after infection with a tenfold higher (1.7 × 10(5) E. coli) bacterial dose. While treatment with E5564 slightly attenuated inflammatory markers provoked by the sublethal doses of 104-105 E. coli under the antibiotic regime, it did not affect lethality evoked by infection with 1.7 × 106 E. coli.. The impact of TLR4 inhibition during abdominal sepsis by virulent E. coli bacteria is only beneficial at low infection grade at cost of bactericidal activity.

Topics: Animals; Anti-Bacterial Agents; Anti-Inflammatory Agents; Ascitic Fluid; Bacterial Load; Ceftriaxone; Cytokines; Escherichia coli; Escherichia coli Infections; Female; Lipid A; Liver; Lung; Mice, Inbred C57BL; Peritoneal Lavage; Peritonitis; Sepsis; Toll-Like Receptor 4

Bacterial peritonitis is a severe complication in patients with cirrhosis and ascites and despite antibiotic treatment, the inflammatory response to infection may induce renal dysfunction leading to death. This investigation evaluated the effect of TNF-α blockade on the inflammatory response and mortality in cirrhotic rats with induced bacterial peritonitis treated or not with antibiotics. Sprague-Dawley rats with carbon-tetrachloride-induced cirrhosis were treated with an intraperitoneal injection of 10(9) CFU of Escherichia coli diluted in 20 mL of sterile water to induce bacterial peritonitis and randomized to receive subcutaneously-administered placebo, ceftriaxone, anti-TNF-α mAb and ceftriaxone, or anti-TNF-α mAb alone. No differences were observed between groups at baseline in respect to renal function, liver hepatic tests, serum levels of nitrite/nitrate and TNF-α. Treatment with ceftriaxone reduced mortality (73.3%) but differences did not reach statistical significance as compared to placebo. Mortality in rats treated with ceftriaxone and anti-TNF-α mAb was significantly lower than in animals receiving placebo (53% vs. 100%, p<0.01). Serum TNF-α decreased significantly in surviving rats treated with ceftriaxone plus anti-TNF-α mAb but not in treated with antibiotics alone. Additional studies including more animals are required to assess if the association of antibiotic therapy and TNF-α blockade might be a possible approach to reduce mortality in cirrhotic patients with bacterial peritonitis.

Topics: Animals; Antibodies, Monoclonal; Carbon Tetrachloride; Ceftriaxone; Escherichia coli; Immunoassay; Liver Cirrhosis; Male; Peritonitis; Rats; Rats, Sprague-Dawley; Statistics, Nonparametric; Treatment Outcome; Tumor Necrosis Factor-alpha

The recent emergence of third-generation cephalosporin resistance in spontaneous bacterial peritonitis is of great concern, although neither the risk factors for resistance nor its real impact on mortality have been well defined.. We conducted a retrospective study of all spontaneous bacterial peritonitis episodes with positive blood and/or ascitic culture at our center (2001-2009). Episodes were classified according to the place of acquisition: community, healthcare system, or nosocomial.. Two hundred and forty-six episodes were analyzed in 200 patients (150 males, 57.3 years): 34.6% community-acquired, 38.6% healthcare system-acquired, and 26.8% nosocomially-acquired. Third-generation cephalosporin resistance occurred in 21.5% (7.1% community-acquired, 21.1% healthcare system-acquired, 40.9% nosocomially-acquired). These resistant cases were categorized as extended-spectrum β-lactamase-producing Gram-negative bacilli, other resistant Gram-negative bacilli, and Enterococci. Risk factors for resistance were previous use of cephalosporins, diabetes mellitus, upper gastrointestinal bleeding, nosocomial acquisition, and a low polymorphonuclear count in ascites. Regarding third-generation cephalosporin resistance, adequate empirical treatment was 80.7%. Independent predictors of mortality were nosocomial acquisition, poor hepato-renal function, immunosuppressive therapy, a marked inflammatory response during the episode and either third-generation cephalosporin-resistance or low rates of adequate empirical treatment.. The risk of third-generation cephalosporin resistance was particularly high in nosocomially-acquired episodes of spontaneous bacterial peritonitis, but also occurred in healthcare system-acquired cases. The extent of resistance and the adequacy of empirical antibiotics had a significant effect on mortality along with the patient's hepato-renal function. These data can help determine the most suitable empirical antimicrobial treatments in these patients.

Topics: Adult; Aged; Anti-Bacterial Agents; Ceftriaxone; Community-Acquired Infections; Cross Infection; Drug Resistance, Bacterial; Enterococcus; Female; Gram-Negative Bacteria; Gram-Positive Bacteria; Humans; Incidence; Infectious Disease Transmission, Professional-to-Patient; Male; Middle Aged; Peritonitis; Retrospective Studies; Risk Factors; Treatment Outcome

Topics: Ceftriaxone; Community-Acquired Infections; Cross Infection; Drug Resistance, Bacterial; Female; Humans; Infectious Disease Transmission, Professional-to-Patient; Male; Peritonitis

Salmonella is an important, worldwide food-borne pathogen. Resistance to fluoroquinolones and cephalosporins has been increasingly reported, and new therapeutic agents are desperately needed. In this study, we evaluated the in vitro antimicrobial susceptibility of clinical nontyphoidal Salmonella isolates to tigecycline. Antibacterial activity of tigecycline, ceftriaxone, and ciprofloxacin were investigated by time-kill studies and the murine peritonitis model. The MIC₅₀/MIC₉₀ values of tigecycline, ceftriaxone, and ciprofloxacin against 76 Salmonella isolates were 0.25/0.5, 1/8, and 0.125/0.5 μg/ml, respectively. The intracellular inhibitory activity of tigecycline at 0.5 μg/ml (1 × MIC) against Salmonella isolates in human peripheral blood mononuclear cells was sustained for 24 h. In a mouse peritonitis model, tigecycline reduced the extracellular and intracellular bacterial counts from 10⁷ CFU/ml and 10⁵ CFU/ml, respectively, to an undetectable level within 96 h. The results were similar to those obtained with ceftriaxone. The survival rate of mice exposed to tigecycline after being infected by an inoculum of 1 × 10⁵ CFU was 80%, and that of mice exposed to ceftriaxone was 100%. When the inoculum was increased to 1.3 × 10⁶ CFU, the survival rate of mice treated by tigecycline was 20%, and that of mice exposed to ceftriaxone was 0% (P = 0.2). When a ceftriaxone- and ciprofloxacin-resistant but tigecycline-susceptible isolate was tested, mice treated by tigecycline had a higher survival rate than those treated by ceftriaxone (15/20 [75%] versus 6/20 [30%]; P = 0.011). Our results suggest that tigecycline is at least as effective as ceftriaxone for murine Salmonella infections and warrants further clinical investigations to delineate its potential against human Salmonella infections.

Topics: Animals; Anti-Bacterial Agents; Ceftriaxone; Humans; Mice; Microbial Sensitivity Tests; Minocycline; Peritonitis; Salmonella; Salmonella Infections; Survival Rate; Tigecycline

Topics: Agricultural Workers' Diseases; Anti-Bacterial Agents; Ascites; Ceftriaxone; Humans; Leptospirosis; Male; Middle Aged; Peritonitis; Treatment Outcome

Cirrhotic patients with spontaneous bacterial peritonitis (SBP) have elevated rates of renal impairment and mortality. It has been shown that cefotaxime plus albumin infusion decrease renal impairment compared with antibiotic treatment alone, in patients with serum bilirubin >4 mg/dL or creatinine >1 mg/dL.. To assess clinical outcomes of high-risk cirrhotic patients with SBP who were treated with antibiotics associated with Gelafundin (polygeline) 4%.. Twenty nine cirrhotic patients with SBP and serum bilirubin >4 mg/dL or creatinine >1 mg/dL were enrolled. Ceftriaxone was administered in doses of 2 g/day and Gelafundin 4% was given intravenously at 1.5 g/kg of body weight at the time of the diagnosis, followed by 1 g/kg on day 3. Renal impairment was defined as nonreversible deterioration of renal function during hospitalization.. Eight patients (27.5%) had basal renal failure. Infection resolved in 28 (96.6%) patients. Renal impairment occurred in four patients (13.8%), and three patients (10.4%) died during hospitalization. Mortality within 90 days after discharge was 34.5% (10 patients).. The rates of renal impairment and mortality in high-risk patients with SBP suggest that Gelafundin 4% administration given with ceftriaxone may be a less expensive therapeutic alternative to albumin.

Topics: Anti-Bacterial Agents; Bacterial Infections; Ceftriaxone; Drug Therapy, Combination; Female; Humans; Liver Cirrhosis; Male; Middle Aged; Multivariate Analysis; Peritonitis; Pilot Projects; Plasma Substitutes; Polygeline; Risk Assessment; Treatment Outcome

Since the beginning of the 1990s, the prevalence of isolates of non-typhoidal Salmonella species resistant to antimicrobial agents, including those commonly used for the treatment of Salmonella infections such as fluoroquinolones, trimethoprim-sulfamethoxazole or beta-lactams, has increased substantially. Infections caused by multidrug-resistant strains of non-typhoidal Salmonella are now frequently encountered. In order to consider an appropriate role of Ertapenem in Salmonella-due intraabdominal infections, in the present study we compare the efficacy of Ertapenem versus that of Ceftriaxone in a mouse peritonitis model. Bacteriological eradication from blood, liver and mesenteric lymph nodes was observed after 5 and 7 days of treatment in all infected mice receiving ceftriaxone. Although both antimicrobial agents -Ertapenem and Ceftriaxone- were observed to be effective in reducing mortality in inoculated mice, our data suggests a reduced efficacy of Ertapenem in the bacteriological eradication of Salmonella enterica serotype Typhimurium in a mouse peritonitis model.

Topics: Animals; Anti-Bacterial Agents; beta-Lactams; Ceftriaxone; Dose-Response Relationship, Drug; Ertapenem; Male; Mice; Peritonitis; Salmonella enterica; Salmonella Infections

Intra-abdominal abscesses are sources of recurrent or ongoing abdominal sepsis. They are an important target for prevention and treatment during or after surgical treatment of peritonitis. Experimental data suggest that fibrinolytic therapy may be effective when antibiotics are not.. Peritonitis was induced via intra-abdominal injection of a faeces and bacteria mixture in male Wistar rats. Surgical debridement was performed after 1 h. Next to untreated controls, animals were treated with antibiotics (ceftriaxone plus metronidazole), recombinant tissue plasminogen activator (rtPA) or both. Abdominal fluid samples were taken at 24, 72 and 120 h for interleukin 6, interleukin 10 and tumour necrosis factor alpha measurements and cell counts. After 5 days the abdomen was inspected for the presence of abscesses.. Antibiotics did not significantly affect abscess formation. However, giving rtPA significantly reduced the number of rats with abscesses and the abscess load per rat, both in the absence and presence of concomitant antibiotic therapy. No adverse side-effects were observed and no meaningful differences in the local inflammatory response were found.. In this rat model, rtPA consistently reduced abscess formation after surgical treatment of secondary peritonitis. It therefore represents a promising adjuvant to conventional therapy.

Topics: Abdominal Abscess; Animals; Anti-Bacterial Agents; Ceftriaxone; Debridement; Fibrinolytic Agents; Male; Metronidazole; Peritonitis; Rats; Rats, Wistar; Recombinant Proteins; Tissue Plasminogen Activator

The accelerative effect of EMLA (eutectic mixture of lidocaine 2.5% and prilocaine 2.5%) in the wound healing process is known. We hypothesised that post-operative peritoneal adhesions may be reduced with intra-peritoneal EMLA administration in a model of bacterial peritonitis.. Bacterial peritonitis was induced in 24 rats by cecal ligation and puncture. The rats were randomly assigned to one of four groups. Group 1 (n=6)) received EMLA intraperitoneally, group 2 (n=6) received 2% lidocaine hcl solution intraperitoneally, the third group received one dose (100 mg/kg) of ceftriaxone sodium (Rocephin, Roche, 1 g) intraperitoneally one day after cecal ligation and puncture procedure, and in control group (group 4, n=6), no fluid or medicine was introduced into the abdomens of the rats. All animals were killed 14 days later in order to assess the adhesion score. Tissue antioxidant levels were measured in 1 g tissue samples taken from the abdominal wall.. The adhesion score was significantly lower in the EMLA group than in the lidocaine and control groups. The catalase levels were higher in the lidocaine and control groups than in EMLA group.. Intraperitoneal EMLA inhibited the formation of postoperative intra-abdominal adhesions without compromising the wound healing in this bacterial peritonitis rat model. EMLA also decreased the oxidative stress during peritonitis (Tab. 1, Fig. 7, Ref. 27). Full Text (Free, PDF) www.bmj.sk.

Topics: Anesthetics, Combined; Anesthetics, Local; Animals; Anti-Bacterial Agents; Ceftriaxone; Female; Lidocaine; Lidocaine, Prilocaine Drug Combination; Oxidative Stress; Peritoneal Diseases; Peritonitis; Prilocaine; Rats; Rats, Wistar; Tissue Adhesions; Wound Healing

Topics: Ceftriaxone; Ciprofloxacin; Drug Therapy, Combination; Female; Gonorrhea; Humans; Middle Aged; Peritonitis; Sexually Transmitted Diseases, Bacterial

Spontaneous bacterial peritonitis (SBP) is a severe complication of cirrhotic patients associated with a high mortality.. To develop an available experimental model of induced bacterial peritonitis in cirrhosis.. Sprague-Dawley rats with carbon-tetrachloride-induced cirrhosis with (N=22) or without (N=101) ascites were randomized to receive an intraperitoneal administration of different concentrations of Escherichia coli (E. coli) diluted in 1 mL of sterile water in ascitic rats and in different volumes in nonascitic rats. A subgroup of nonascitic animals received ceftriaxone 4 h after E. coli inoculation. Mortality of rats was evaluated 24 h after bacterial inoculation.. None of the rats receiving sterile water alone and only one infected with 10(7) cfu of E. coli died. Ascitic rats showed a lower mortality rate than nonascitic rats infected with 10(8) or 10(9) cfu of E. coli (P<0.05). Mortality was higher with 10(9) cfu than with 10(8) cfu of E. coli in ascitic (P NS) and nonascitic (P<0.01) rats. A trend was noted to ward higher mortality in nonascitic rats inoculated with 10(8) cfu with increasing water volumes. A marked peritoneal polymorphonuclear cell response was observed 4 h after E. coli injection in both ascitic and nonascitic rats. Antibiotic therapy significantly reduced the mortality rate of rats infected with 10(8) cfu (P<0.01).. This experimental model of induced bacterial peritonitis in cirrhosis with or without ascites may represent a useful tool for the study of pathogenic events postinfection and for the design of new therapeutic strategies to treat patients with SBP.

Topics: Animals; Anti-Bacterial Agents; Ascites; Bacterial Infections; Carbon Tetrachloride; Ceftriaxone; Disease Models, Animal; Escherichia coli Infections; Liver Cirrhosis, Experimental; Male; Peritonitis; Random Allocation; Rats; Rats, Sprague-Dawley

Neisseria mucosa is part of the normal nasopharyngeal flora and rarely pathogenic in humans. Reports of serious infections associated with this pathogen are very unusual. A 17-year-old boy with end-stage renal disease due to IgA nephropathy presented with acute, spontaneous, symptomatic peritoneal dialysis-associated peritonitis without reported break in sterility or PD catheter exit site infection. beta-lactamase-negative N. mucosa was isolated from the dialysate effluent. Intraperitoneal antibiotic treatment with cephalothin/gentamicin for 5 days and subsequent ceftriaxone led to complete resolution of the infection. This case demonstrates that "non-pathogenic" Neisseria species can cause clinically severe peritonitis with high intraperitoneal neutrophil counts, elevated C-reactive protein levels in the peritoneal effluent (in the presented case, 27,600/mul and 3.6 mg/l, respectively) and impaired peritoneal membrane transport function. To our knowledge, this is the first case of N. mucosa peritonitis complicating chronic peritoneal dialysis in an adolescent patient.

Topics: Adolescent; Anti-Bacterial Agents; Ceftriaxone; Cephalothin; Gentamicins; Glomerulonephritis, IGA; Humans; Injections, Intraperitoneal; Male; Neisseria mucosa; Neisseriaceae Infections; Peritoneal Dialysis; Peritonitis

To observe the effects of short-term antibiotic treatment in patients with hepatic failure and spontaneous bacterial peritonitis (SBP).. In this prospective study short-term antibiotic treatment was given to 67 cases diagnosed as hepatic failure with spontaneous bacterial peritonitis. Ceftriaxone 2 g, iv drip, q12h for 10 d or ofloxacin 0.2 g, iv drip, q12h for 10 d was given to the patients at random and the efficacy was evaluated on the basis of clinical symptoms, medical examination and ascites after 3, 7, 10 days of therapy.. Seven cases (10.44%) were cured and 57 cases (85%) were improved after 3 days therapy, the total effective rate was 95.52%, but in 3 cases the therapy had no effect. The results of ascites bacterial culture and drug susceptibility test showed that one case had drug resistance to ceftriaxone and two cases had drug resistance to ofloxacin, so antibiotics were changed in time. After 7 days therapy, the results showed that 65 cases (97.01%) cured and 2 cases (2.99%) were improved, the total effective rate was 100%. When the therapy lasted for 10 days, all patients were cured. One patient had oral mucous membrane. Candida albicans infection after 3 days therapy; two cases got thrush and one patient got fungal intestinal infection after 7 days therapy; when the therapy lasted for 10 days, 4 cases had thrush and 2 cases had fungal infection of intestines and one patient had pulmonary fungal infection.. The optimal period of antibiotic treatment of hepatic failure with SBP should be from 7 days to 10 days.

Topics: Adult; Anti-Bacterial Agents; Bacterial Infections; Ceftriaxone; Drug Therapy, Combination; Female; Humans; Liver Failure; Male; Middle Aged; Ofloxacin; Peritonitis; Prospective Studies; Treatment Outcome

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

To investigate the effect of granulocyte colony-stimulating factor (G-CSF) in the treatment of Escherichia coli peritonitis with and without ceftriaxone in a nonneutropenic rat model.. The rats were divided into five groups: control group (C) receiving physiological saline; peritonitis group (P) infected intraperitoneally with a live bacterial suspension of E. coli; peritonitis and antibiotic group (PA) receiving ceftriaxone 3 h after being infected; peritonitis, antibiotic, and G-CSF group (PAG) receiving G-CSF and antibiotic 3 h after infection; and peritonitis and G-CSF group (PG).. All rats in group C survived. Any animals which did not survive died within 24h after inoculation. A significantly higher rate of survival, 95%, was observed with antibiotic treatment alone (PA), in comparison to the G-CSF-treated groups, PAG and PG, 52% and 57%, respectively.. No beneficial effect of G-CSF treatment was seen in the E. coli peritonitis and antibiotic therapy remains the basic treatment for this disease.

Topics: Animals; Anti-Bacterial Agents; Ceftriaxone; Escherichia coli Infections; Granulocyte Colony-Stimulating Factor; Leukocyte Count; Male; Neutrophils; Peritonitis; Rats; Survival Rate

Cephalosporins and broad-spectrum penicillins in combination with metronidazole are suitable for treatment of secondary peritonitis. The aim of this study was to compare the clinical and bacteriological efficacy, length of hospital stay (LOS), treatment costs of ceftriaxone (CRO) in combination with metronidazole vs standard regimens (SR) 1 and 2.. Patient data were subjected to matched-pairs analysis according to four different categories of the Mannheim peritonitis index. RESULTS. From January 1998 to March 2000, a total of 365 patients from 59 surgical wards in German hospitals were included. Clinical efficacy was 90.2% vs 70.4% ( P=0.004) for CRO/SR 1 and 78.3% vs 82.6% for CRO/SR 2. Bacteriological efficacy was comparable. Antibiotic treatment costs were 593/539 Euros for CRO/SR 1 and 466/750 Euros for CRO/SR 2, i.e., costs for CRO were 37.9% lower than with SR 2.. Based on clinical, bacteriological, and pharmacoeconomic results, ceftriaxone in combination with metronidazole can be regarded as a first-line antimicrobial treatment of secondary peritonitis.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Ceftriaxone; Child; Drug Costs; Drug Therapy, Combination; Female; Humans; Length of Stay; Male; Metronidazole; Middle Aged; Peritonitis; Prospective Studies; Time Factors

Topics: Ceftriaxone; Cephalosporins; Drug Administration Schedule; Humans; Leukocyte Count; Liver Cirrhosis; Neutrophils; Peritonitis; Prognosis; Risk Factors; Survival Rate

Spontaneous bacterial peritonitis (SBP) is a frequent infection in cirrhotic patients with ascites, with a poor prognosis. The aims of this study were to determine the long-term survival of cirrhotic patients with SBP treated with ceftriaxone and to identify predictive factors related to survival. We studied 47 first episodes of SBP treated with ceftriaxone with a mean follow-up of 272 days. Nineteen variables were recorded to evaluate their relation to survival. The most frequent organism that caused SBP was Escherichia coli (40%). Spontaneous bacterial peritonitis resolution was achieved in 67% of patients. After resolution, SBP recurrence was observed in 44% of patients. The cumulative probability of survival was 68.1% at 1 month and 30.8% at 6 months. After uni-and multivariate analyses of all cases, SBP resolution ( p = 0.0001) and international normalized ratio (INR) ( p = 0.0057) were found to be related to survival. Another analysis performed after SBP resolution and SBP recurrence showed that ascitic fluid-positive culture ( p = 0.0344) and INR ( p = 0.0218) had statistical significance as variables predictive of long-term survival. We conclude that the survival of cirrhotic patients is very short after the first episode of SBP, a fact probably related to advanced liver disease, as liver dysfunction (INR) is the most important factor related to long-term patient survival.

Topics: Adult; Aged; Aged, 80 and over; Ascitic Fluid; Bacterial Infections; Ceftriaxone; Confidence Intervals; Female; Follow-Up Studies; Humans; Liver Cirrhosis; Male; Middle Aged; Multivariate Analysis; Peritonitis; Probability; Prospective Studies; Regression Analysis; Risk Assessment; Survival Analysis; Treatment Outcome

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

Topics: Ceftriaxone; Child, Preschool; Female; Humans; Peritonitis; Shock, Septic; Streptococcal Infections; Tomography, X-Ray Computed

Topics: Anti-Bacterial Agents; Cefoxitin; Ceftriaxone; Ciprofloxacin; Clindamycin; Contact Tracing; Female; Genital Diseases, Male; Humans; Male; Ofloxacin; Pelvic Inflammatory Disease; Peritonitis; Pregnancy; Pregnancy Complications, Infectious; Sexually Transmitted Diseases

Topics: Adult; Amoxicillin; Ceftriaxone; Cephalosporins; Female; Follow-Up Studies; Humans; Penicillins; Peritonitis; Pneumococcal Infections; Salpingitis; Time Factors; Tomography, X-Ray Computed

Forty patients with spontaneous bacterial peritonitis, three of whom had complicating acute hepatitis syndrome, eight late-onset hepatic failure, and 29 with cirrhosis, were treated with ceftriaxone 2 g intravenously once daily for 5 days. Ascitic fluid culture was positive in 28 patients, with Escherichia coli and Klebsiella as common isolates. All the bacteria isolated were sensitive to ceftriaxone except Enterococcus faecalis, which was isolated in a cirrhotic patient. All culture-positive patients sensitive to ceftriaxone showed bacteriological cure and 26 (65%) patients showed cytological cure after 48 hours of treatment. A total of 95% were cured of their infection after 5 days of treatment. Twelve (30%) patients died during hospitalisation after documented cure of their spontaneous bacterial peritonitis (renal failure, gastrointestinal bleed and cerebral oedema were the primary causes of death). Infection-related mortality due to Pseudomonas septicaemia was seen in one cirrhotic patient.

Topics: Adolescent; Adult; Ceftriaxone; Cephalosporins; Escherichia coli Infections; Female; Humans; Klebsiella Infections; Liver Diseases; Male; Middle Aged; Peritonitis; Prospective Studies

Topics: Anuria; Ceftriaxone; Child; Female; Humans; Peritonitis; Postoperative Care; Postoperative Complications; Urinary Calculi

Topics: Adult; Ceftriaxone; Humans; Male; Microbial Sensitivity Tests; Neisseria; Neisseriaceae Infections; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis

Treatment of fecal peritonitis includes administration of antibiotics, physical removal of contaminants, and restoration of gastrointestinal integrity. The temporal relationship of parenteral antibiotics and peritoneal irrigation with varied antibiotic solutions was studied in a peritonitis model. Antibiotics in high concentrations may actually inhibit host immune cells; therefore, dilute solutions used were MIC (minimum inhibitory concentration) (micrograms per millimeter) equivalent to usually achieved standard therapeutic blood levels. Sprague-Dawley rats were given a quantitative intraperitoneal challenge of 2 x 10(10) CFU/kg Escherichia coli and 10 mg autoclaved rat feces. Rats were randomized to receive 30 mg/kg intramuscular ceftriaxone (CTRX) either at the time of challenge (T = 0) or 2 hr later (T = 2). Two hours after peritonitis, rats received peritoneal irrigation with 30 cc of (1) normal saline, (2) dilute (10 mg/liter) CTRX solution, or (3) concentrated (1000 mg/liter) CTRX solution or (4) no irrigation. Survival and intraperitoneal pathology were then assessed. Parenteral CTRX given concurrently with peritoneal contamination improved survival (67%) compared with parenteral administration given 2 hr later (33%) (P < 0.05). Intraperitoneal CTRX irrigation improved survival (100%) in animals that received parenteral CTRX concurrently with contamination; this beneficial effect was present with both dilute and concentrated solutions and was significantly better than saline irrigation alone. Parenteral antibiotics given early after contamination of the peritoneum associated later with peritoneal lavage with antibiotic solutions improved survival.

Topics: Abscess; Animals; Ceftriaxone; Escherichia coli; Escherichia coli Infections; Feces; Injections, Intramuscular; Male; Peritoneal Diseases; Peritoneal Lavage; Peritonitis; Random Allocation; Rats; Rats, Sprague-Dawley

Pulmonary infection complicating intra-abdominal sepsis is a major clinical problem. An experimental model for intra-abdominal sepsis was created with implantation of gelatin capsules, containing 3 x 10(8) cfu E. coli strain no. 2554, in the peritoneal cavity of 20 rats (10 animals received and 10 did not receive antibiotic therapy with ceftriaxone) in order to verify the role of the primary site of infection in the pathogenesis of pneumonia. Ten rats were sacrificed to determine the relative pulmonary weight and 10 were submitted to simple laparotomy and insertion of a germ-free capsule (sham-operated group). In this group of animals there was only one death (10%). All the rats that received antibiotic therapy survived until sacrifice while all the rats that did not receive ceftriaxone died, 7 within the 2nd and 3 on the 6th postoperative day. Pneumonia and peritonitis developed only in the animals that did not receive ceftriaxone. Bacteriological findings of material obtained from peritoneal and pleural cavities revealed the same strain of E. coli used for the experiment, suggesting that bacteria involved in the pleuro-pulmonary infections may originate in the primary site of infection and that antibiotic therapy started at the moment of contamination, can prevent this major complication.

Topics: Abdomen; Abscess; Animals; Ceftriaxone; Colony Count, Microbial; Male; Organ Size; Peritonitis; Pleural Effusion; Pneumonia; Rats; Rats, Sprague-Dawley

Sixty-two episodes of bacterial infection were studied in 51 cirrhotic patients. 2 g of ceftriaxone (active ingredient of Rocephin) were given intravenously once daily for 7-10 days. The infections were pneumonia, bacteremia, spontaneous bacterial peritonitis, urinary infection and others. Good responses were seen in 90% of the cases.

Topics: Adult; Aged; Aged, 80 and over; Bacterial Infections; Ceftriaxone; Female; Humans; Liver Cirrhosis; Male; Middle Aged; Peritonitis; Pneumonia; Sepsis; Urinary Tract Infections

In 16 patients under CAPD, 29 cases of bacterial peritonitis were observed, with clinical manifestations in 23. The mean cell count in peritoneal dialysis fluid was 5608/mm3 with 4991/mm3 polymorphonuclear, Leukocytes Causative pathogens were Staphylococcus in 14 cases, Streptococcus in 6, Bacillus in one, Enterobacteria in 5, Pseudomonas aeruginosa in 1 and Moraxella in 1. Three cultures were negative. First choice treatment was a daily intraperitoneal injection of 1 g of ceftriaxone. 79.3% of patients recovered within 5 days. Failure were due to a Methicillin-resistant Staphylococcus epidermidis in one case, a Streptococcus faecalis in two cases, and a Staphylococcus aureus in three observations, which two were responsible of abscess round catheter peritoneal. Mean ceftriaxone concentrations 24 hours after the intraperitoneal injection were 50.6 mg/l (range: 3.3-141 mg/l) in serum and 58.1 mg/l (range: 4.3-180 mg/l) in dialysate. These concentrations are greater than most of ceftriaxone's MICs for susceptible bacteria, a finding that confirm the value of treatment with a single daily intraperitoneal injection of ceftriaxone.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bacteria; Ceftriaxone; Child; Drug Evaluation; Female; Humans; Injections, Intraperitoneal; Male; Microbial Sensitivity Tests; Middle Aged; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis

Topics: Ceftriaxone; Humans; Infusions, Intravenous; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis

Topics: Bacteria; Bacterial Infections; Ceftriaxone; Humans; Microbial Sensitivity Tests; Peritonitis; Pneumonia; Urinary Tract Infections

Topics: Abscess; Bacteria; Ceftriaxone; Cholangitis; Female; Humans; Liver Abscess; Male; Middle Aged; Pancreatic Diseases; Pancreatitis; Peritonitis

A murine model of peritonitis allowing detection and quantification of in-vivo acquired resistance during short term therapy has been used in order to evaluate the capacity of antimicrobial combinations to limit emergence of resistance, as compared to individual components of the regimens. Mice were challenged intraperitoneally with 10(8) cfu of bacteria. Two hours later, a single antibiotic dose was injected subcutaneously: amikacin (15 mg/kg), ceftriaxone (50 mg/kg), pefloxacin (25 mg/kg), amikacin + ceftriaxone, amikacin + pefloxacin or ceftriaxone + pefloxacin. Escherichia coli and Staphylococcus aureus never became resistant. Single drug therapy yielded resistant mutants in Enterobacter cloacae, Serratia marcescens, Klebsiella pneumoniae and Pseudomonas aeruginosa as follows: 74% of ceftriaxone-treated animals, 57% of pefloxacin treated animals and 27% of amikacin treated animals. All the tested combinations reduced the frequency of in-vivo acquired resistance produced by single drugs, and no combination selected resistance when the separate agents of the combination did not. Combining antimicrobial agents limits the risk of emergence of resistance during antibiotic therapy.

Topics: Amikacin; Animals; Bacteria; Bacterial Infections; Ceftriaxone; Drug Resistance, Microbial; Drug Therapy, Combination; Enterobacter; Escherichia coli; Female; Kanamycin; Klebsiella pneumoniae; Mice; Norfloxacin; Pefloxacin; Peritonitis; Pseudomonas aeruginosa; Serratia marcescens; Staphylococcus aureus

The efficacy of ceftriaxon (Rocephin Roche) therapy has been studied by our team in two groups of patients. The first one consisted of 10 children suffering from a diffuse purulent appendical peritonitis brought about by a mixed aerobe and anaerobe microbial flora, the second one comprising 7 patients with severe infections caused by problematic aerobe pathogens. The clinical effect of the treatment was good in 16 out of the 17 cases, in one patient it could not be evaluated. Even though a high degree of sensitivity to Rocephin could be demonstrated bacteriologically by the disc method in all the aerobe germs present, the results of titration of the bactericide capacity of the sera during treatment indicate the need for laboratory monitoring of the course of therapy of severe infections due to pseudomonas aeruginosa. Parenteral administration of Rocephin was well tolerated and the laboratory alterations seemin the course of therapy of severe infections due to Pseudomonas aeruginosa. Parenteral administration of Recephin was well tolerated and the laboratory alterations seen in the postoperative ileus due to strangulation and adhesions--cannot be recommended.

Topics: Adolescent; Adult; Bacterial Infections; Blood Bactericidal Activity; Ceftriaxone; Child; Child, Preschool; Female; Humans; Male; Middle Aged; Peritonitis; Suppuration; Urinary Tract Infections

An effort was made to elucidate the limits of drug-activity tests in small animals. Human plasma kinetics of gentamicin, netilmicin, ticarcillin, ceftazidime, and ceftriaxone were approximated in normal and in granulocytopenic mice infected with various strains of Pseudomonas aeruginosa in the thigh muscle or intraperitoneally. The effect of such dosing on bacterial time-kill curves and on survival was compared with the effect of identical amounts of drug given as a single-bolus injection. With beta-lactams, a highly significant superiority of fractionated dosing (simulated human kinetics) over bolus injections (murine plasma kinetics) was demonstrated, whereas with aminoglycosides it was a single-bolus injection that tended to be more active. Thus, when tested in conventional small-animal models, aminoglycoside activity may be overestimated, whereas beta-lactam activity may be underestimated in respect to humans. These differences found in vivo most probably reflect the different pharmacodynamics between aminoglycosides and beta-lactam drugs (time-kill curves, dose-response curves, and postantibiotic effect) similar to those previously observed in vitro.

Topics: Agranulocytosis; Aminoglycosides; Animals; Anti-Bacterial Agents; Ceftazidime; Ceftriaxone; Female; Gentamicins; Humans; Metabolic Clearance Rate; Mice; Netilmicin; Peritonitis; Pseudomonas Infections; Ticarcillin

Topics: Amoxicillin; Bacteria; Cefotaxime; Ceftriaxone; Child; Humans; Osteomyelitis; Penicillin Resistance; Peritonitis; Premedication; Surgical Wound Infection; Urinary Tract Infections; Wounds and Injuries

Topics: Adolescent; Adult; Aged; Cefotaxime; Ceftriaxone; Female; Humans; Male; Middle Aged; Peritonitis; Pneumonia; Surgical Wound Infection

Topics: Cefotaxime; Ceftriaxone; Clindamycin; Drug Therapy, Combination; Gentamicins; Half-Life; Humans; Peritonitis; Postoperative Complications