ro13-9904 and Streptococcal-Infections

A 68-year-old Japanese man was admitted to our hospital with right eye pain, a sudden worsening of his eyesight, and a fever. He was diagnosed with endogenous bacterial endophthalmitis due to infectious endocarditis (IE) of Group B Streptococcus (GBS) on the day of admission. He recovered systemically, but his right eye became phthisical only with the administration of antibiotics. We conducted a review of the reported cases of IE caused by GBS complicated with endogenous bacterial endophthalmitis. IE should be considered when an undetermined etiology of endogenous endophthalmitis is encountered. The prompt diagnosis and treatment of IE will improve patients' outcomes.

Topics: Aged; Anti-Bacterial Agents; Ceftriaxone; Early Diagnosis; Endocarditis, Bacterial; Endophthalmitis; Eye Infections, Bacterial; Humans; Male; Streptococcal Infections; Streptococcus agalactiae; Treatment Outcome; Vancomycin

Maternal rectovaginal colonization with Streptococcus agalactiae (Group B Streptococcus or GBS) is the most common route for the GBS disease in the perinatal period. The knowledge of maternal colonization, antibiotic resistance and serotype profiles is substantially needed to formulate the broad vaccine. However, it has not been estimated in Africa. This meta-analysis was aimed to determine the pooled prevalence of colonization, antibiotic resistance and serotype profiles of GBS reported in Africa.. Potentially relevant studies from 1989 to 31th January, 2019 were retrieved from the Medline/PubMed, EMBASE, HINARI online databases, periodicals and by requesting authors. Unpublished studies retrieved from grey literature through Google and Google Scholar. Pooled estimates were calculated using the random effect model. Subgroup analysis was done to investigate the burden of colonization across sub-regions, sampling site and countries. Summary estimates were presented using words, Forest plots and Tables. Heterogeneity was assessed using the I. Eighty-three articles were assessed, of which 57 studies conducted in five sub-regions with 21 countries (22,206 pregnant women) met pre-specified inclusion criteria. The overall estimate of recto-vaginal colonization was 19.3% (95% CI 16.9, 21.7). The highest estimate was observed in Southern Africa, 23.8% (95% CI 18.7, 28.9), followed by Northern Africa, 22.7% (95% CI 18.2, 27.2) while the lowest was driven from the Eastern Africa, 15.4% (95% CI 12.1, 18.7). Considerable heterogeneity across and within regions, sampling site, screening methods and countries (I. The pooled estimate of the maternal colonization with GBS was 19.3% which is equivalent with other many primary and review reports worldwide. The most antibiotic resistance estimate was recorded in the tetracycline followed by penicillin. Five serotypes were the most prevalent in Africa and more data on the antibiotic résistance and serotype distribution patterns are needed from developing countries to devise the effective preventive measures. In addition, the antibiotic susceptibility test methods used in the Africa shall be assessed for its quality. Trial registration Prospero Registration Number CRD42018094525.

Topics: Ampicillin; Anti-Bacterial Agents; Ceftriaxone; Clindamycin; Drug Resistance, Bacterial; Erythromycin; Female; Humans; Pregnancy; Pregnancy Complications, Infectious; Serogroup; Streptococcal Infections; Streptococcus agalactiae; Tetracycline; Vancomycin

A 39-year-old previously healthy man was referred to our hospital because of acute onset of fever and consciousness disturbance. Neurological examinations revealed deteriorated consciousness, nuchal rigidity and Kernig's sign. A lumbar puncture yielded clouded fluid with a WBC 1,012/μl (polynuclear cell 96%), 147.3 mg/dl of protein, 44 mg/dl of glucose and Gram positive cocci. At first, he was treated with ceftriaxon and ampicillin. At Day 2, meropenem was added. Streptococcus agalactiae was isolated from blood and cerebrospinal fluid. He responded promptly to antimicrobial therapy, and within 2 days, he became lucid and afebrile. S. agalactiae was sensitive to ceftriaxone, ampicillin and meropenem. After Day 3, he was treated with meropenem only. We diagnosed his condition as S. agalactiae meningitis and was discharged from our hospital at Day 18. Many cases of S. agalactiae meningitis are known to occur in neonates, pregnant women, elderly, and persons with underlying disease such as diabetes, malignant disorders, liver dysfunction. But cases occurring in a previously healthy adult are rare. Neurologists should be aware that S. agalactiae may be cause bacterial meningitis in a previously healthy adults.

Topics: Adult; Ampicillin; Anti-Bacterial Agents; Ceftriaxone; Consciousness Disorders; Drug Therapy, Combination; Fever; Humans; Immunocompetence; Male; Meningitis, Bacterial; Meropenem; Streptococcal Infections; Streptococcus agalactiae; Treatment Outcome

To describe an unusual clinical presentation of puerperal meningitis by Streptococcus agalactiae (S. agalactiae).. We report a case of puerperal meningitis for S. agalactiae, a rare form of infection in a healthy puerperal and with an atypical presentation.. We deeply report the clinical case, the procedures performed to exclude other diseases and management differences. It is compared with meningitis cases reported in the literature, and as in these, we opt for and early diagnosis and a rapid onset of antibiotic treatment.. Meningitis caused by S. agalactiae is not a frequent complication in the postpartum period, that requires early diagnosis and treatment of which depends the patient's prognosis.

Topics: Adult; Amoxicillin; Ceftriaxone; Dexamethasone; Diagnosis, Differential; Early Diagnosis; Female; Humans; Meningitis, Bacterial; Pregnancy; Puerperal Disorders; Streptococcal Infections; Streptococcus agalactiae; Vancomycin

A 73-year old man was brought to our hospital because of acute onset of fever and consciousness disturbance. He had been hemodialyzed three times a week because of chronic renal failure since 13 years ago. Neurological examination revealed deteriorated consciousness and neck stiffness. A lumbar puncture yielded clouded fluid with a WBC 7,912/mm³ (polymorphonuclear cells 88%, mononuclear cells 12%), 786 mg/dl of protein and 4 mg/dl of glucose (blood glucose 118 mg/dl). Brain CT and MRI were unremarkable. He was treated with ceftriaxone and ampicillin. Streptococcus salivarius was isolated from the blood sample, but not from cerebrospinal fluid. The patient responded promptly to antibiotics therapy (ampicillin 3g/day, ceftriaxone 1g/day), and within several days he became lucid and afebrile. Isolated S. salivarius was sensitive for ampicillin and ceftriaxone. We diagnosed this case as S. salivarius bacteremia/meningoencephalitis. A gastrointestinal diagnostic workup revealed an asymptomatic gastric adenocarcinoma. S. salivarius is a common inhabitant of the oral mucosa that has been associated with infection in different sites. Meningeal infection by S. salivarius generally related to neoplasia of colon or iatrogenia, has been described on few occasions. This is the first report of S. salivarius bacteremia/meningoencephalitis associated with gastric neoplasm. Neurologist should be aware of the association of S. salivarius bacteremia/meningoencephalitis and gastrointestinal disease.

Topics: Aged; Ampicillin; Anti-Bacterial Agents; Bacteremia; Ceftriaxone; Early Diagnosis; Gastroscopy; Humans; Kidney Failure, Chronic; Male; Meningoencephalitis; Renal Dialysis; Stomach Neoplasms; Streptococcal Infections; Sulbactam

Viridans streptococcus, an indigenous bacterial species of the mouth and gastrointestinal tract, is thought to be a rare cause of bacterial meningitis. The type of streptococcus involved is important because each type causes a different kind of meningitis and is associated with a different outcome. A 39-year-old previously healthy man was admitted due to the onset of acute purulent meningitis. A cerebrospinal fluid culture grew Streptococcus sanguis (S. sanguis). Although the patient was asymptomatic for dental caries, odontogenic maxillary sinusitis was found to be the cause of the meningitis. Treatment with intravenous antibiotics was successful. Following a review of the pertinent literature, we discuss the characteristics of S. sanguis meningitis.

Topics: Adult; Anti-Bacterial Agents; Ceftriaxone; Dental Caries; Humans; Male; Maxillary Sinusitis; Meningitis, Bacterial; Streptococcal Infections; Streptococcus sanguis

Streptococcus equi subsp. zooepidemicus rarely causes meningitis in humans by contact with domestic animals or their unpasteurized products. In this paper we reviewed the literature pertaining to the epidemiological and clinical aspects relating to this infection on previously reported cases of human disease. Additionally, the case of a 51-year-old female who acquired meningitis with this organism after contact with a horse is described. This patient was successfully treated with ceftriaxone, yet penicillin remains the treatment of choice. This aetiological agent should be considered in the proper epidemiological context.

Topics: Animals; Anti-Bacterial Agents; Ceftriaxone; Female; Horses; Humans; Meningitis, Bacterial; Middle Aged; Streptococcal Infections; Streptococcus equi; Treatment Outcome; Zoonoses

We report a case of Lemierre syndrome secondary to Streptococcus pyogenes in a 22-month-old girl. This case report and literature review took place at a pediatric intensive care unit at a freestanding tertiary children's hospital. Diagnosis occurred after the discovery of left internal jugular thrombus and multiple metastatic infection sites including the right knee, kidneys, lungs, and brain. Lemierre syndrome can occur in young children secondary to S. pyogenes, and a classic presentation may not occur. A high index of suspicion is crucial to the diagnosis.

Topics: Ampicillin; Anti-Bacterial Agents; Arthritis, Infectious; Bacteremia; Ceftriaxone; Child, Preschool; Female; Fever; Genetic Predisposition to Disease; Heterozygote; Humans; Jugular Veins; Lemierre Syndrome; Methylenetetrahydrofolate Reductase (NADPH2); Osteomyelitis; Pharyngitis; Streptococcal Infections; Streptococcus pyogenes; Thrombophilia

Deafness is a common and often permanent neurological sequel of Streptococcus (S.) suis meningitis. Suppurative labyrinthitis, rather than direct auditory nerve infection, has been found to be the site responsible for deafness. Neuroimaging is important to localise the site involved in hearing loss and to assess the feasibility of a cochlear implantation. S. suis is very sensitive to penicillin. Although a relapse of S. suis meningitis is uncommon, it can occur despite an adequate duration of appropriate antibiotic therapy. We describe a patient with S. suis meningitis, who developed permanent deafness from haemorrhagic labyrinthitis, as shown on magnetic resonance imaging. She suffered a relapse despite a seven-week course of intravenous antibiotics. A review on six cases of relapse reported in the literature shows that relapses occurred despite two to four weeks of antibiotics being administered to the patients. The clinical implications and treatment of relapse are discussed.

Topics: Aged; Anti-Bacterial Agents; Ceftriaxone; Cochlea; Cochlear Implants; Female; Hearing Loss; Hemorrhage; Humans; Labyrinthitis; Magnetic Resonance Imaging; Meningitis, Bacterial; Recurrence; Streptococcal Infections; Streptococcus suis

Group B Streptococcus (Streptococcus agalactiae) is a well-known cause of early and late onset infections in neonates and very young infants. Recently attention has focused on the changing spectrum of invasive Group B Streptococcus (GBS) disease, including children beyond early infancy and non-pregnant adults. There is very little information available on invasive GBS infection especially meningitis in pediatric population older than three months of age. We report a case of uncomplicated meningitis due to GBS in a previously healthy 5-year-old boy. The literature on infection especially meningitis caused by Group B Streptococcus beyond infancy is reviewed.

Topics: Anti-Bacterial Agents; Ceftriaxone; Child, Preschool; Humans; Male; Meningitis, Bacterial; Streptococcal Infections; Streptococcus agalactiae; Treatment Outcome

Infective endocarditis has a high morbidity and lethality. Therefore antibiotic treatment has to be intravenous to achieve high blood levels and has to last several weeks without an interruption of treatment at the weekends.. It is therefore crucial to select the patient group that is suited for an outpatient, antibiotic therapy very carefully. In general only hemodynamically stable patients without complications in whom the responsible organism has been identified should be considered.. From a pharmacological point of view intravenous or intramuscular application for the complete duration of therapy is obligatory. Endocarditis caused by penicillin-susceptible streptococci, the biggest group of organisms responsible for endocarditis, can be treated with Ceftriaxon once daily for 4 weeks. For other organisms there are at present no data available which support the feasibility of an outpatient therapy. In particular antibiotic therapy with a complex regimen for those organisms is not practicable for outpatient usage. Possibly, in the near future computer controlled pumps might overcome this disadvantage.. Every outpatient therapy should be initiated under inpatient conditions and only after an initial response to the antibiotic therapy continued in an outpatient setting. Today reliable outpatient therapy and follow-up 7 days a week under the given outpatient infrastructure is problematic and remains an exception. However, considering cost-effectiveness outpatient as compared to inpatient antibiotic therapy could be an interesting economically advantageous alternative.

Topics: Adult; Anti-Bacterial Agents; Ceftriaxone; Cephalosporins; Echocardiography; Endocarditis, Bacterial; Follow-Up Studies; Humans; Injections, Intramuscular; Injections, Intravenous; Outpatients; Patient Compliance; Patient Selection; Streptococcal Infections; Time Factors

Iatrogenic meningitis following lumbar puncture is a rare event. We present a 52-y-old man who developed symptoms of meningitis within 12 h after spinal anaesthesia. Cerebrospinal fluid cultures grew Streptococcus salivarius partially resistant to penicillin and ceftriaxone. The patient was successfully treated with ceftriaxone and vancomycin and left the hospital with minor sequelae. A literature review of 60 cases revealed the median age of the patients to be 44 y. The median incubation period was 24 h. Most cases occurred after spinal anaesthesia (n = 27), myelography (n = 20) and diagnostic lumbar puncture (n = 5). Organisms were isolated in 52 cases, and streptococcal species were responsible for 33 (63%) of them. An upward trend in resistance of S. viridans isolates is cause for concern and may change empirical treatment strategies. Death was reported in 3 cases (5%) and was associated with Pseudomonas and staphylococcal isolates. The recognition of this entity and the importance of proper infection control measures are underlined.

Topics: Anesthesia, Spinal; Anti-Bacterial Agents; Ceftriaxone; Cephalosporins; Drug Resistance, Multiple, Bacterial; Humans; Iatrogenic Disease; Male; Meningitis, Bacterial; Middle Aged; Spinal Puncture; Streptococcal Infections; Streptococcus; Vancomycin

There are a total of 8000 cases of infective endocarditis yearly in the United States. Central nervous system metastatic infections are not uncommon in infective endocarditis. Because ceftriaxone is highly bound to serum proteins, there is concern that the drug is highly bound to serum proteins, there is concern that the drug might not penetrate well in the core of an infected vegetation. To date, there are two published studies on the treatment of nonenterococcal streptococcal endocarditis by ceftriaxone in humans. Ceftriaxone appears to be an attractive alternative antibiotic therapy to conventional regimens in the treatment of streptococcal endocarditis.

Topics: Ambulatory Care; Aneurysm, Infected; Animals; Ceftriaxone; Costs and Cost Analysis; Drug Therapy, Combination; Echocardiography; Embolism; Endocarditis, Bacterial; Heart Failure; Humans; Staphylococcal Infections; Streptococcal Infections

The third-generation cephalosporins are highly active against nonenterococcal streptococci. The subgroup of ceftizoxime, ceftriaxone, and cefotaxime are similar to penicillin in their activities by weight; and the drug with the longest half-life, ceftriaxone, offers the potential for home therapy for selected patients with endocarditis.

Topics: Adult; Aged; Animals; Ceftriaxone; Cephalosporins; Clinical Trials as Topic; Endocarditis, Subacute Bacterial; Female; Humans; Male; Streptococcal Infections; Streptococcus

Clinical and bacteriological evaluation was performed as follows on ceftriaxone (CTRX) at a dose of 50 mg/kg once daily to pediatric patients with community-acquired pneumonia. Of 48 subject patients, CTRX was markedly effective in 36 (75.0%), effective in 9 (18.7%), slightly effective in 2 (4.2%), and failure in 1 (2.1%), indicating the overall effective rate of 93.7%. In 47 (97.9%) patients with the exception of 1, it was observed during the period of administration that fever was resolved and clinical symptoms as well as radiographically abnormal shadows were found relieved or improved. Patients infected by an isolated strain accounted for 34 (70.8%), while those by multiple strains 14 (29.2%), indicating that either Streptococcus pneumoniae or Haemophilus influenzae, or both were detected in almost all patients (45 cases). Of the 48 patients, bacteriological effect was eliminated in 44 (91.7%), and replacement of the bacteria in the remaining 4 (8.3%). MIC90 of CTRX against detected bacteria was 0.2 microgram/ml with H. influenzae, < or = 0.025 microgram/ml with PSSP, 0.1 microgram/ml with PISP, and 0.39 microgram/ml with PRSP. Blood concentration of CTRX at 50 mg/kg upon completion of 1-hour drip intravenous infusion was 89.7 +/- 25.2 micrograms/ml, and 6.6 +/- 0.9 micrograms/ml at 24 hours after the completion, indicating that the concentrations had been well above the levels of MIC90 throughout the 24 hours. Abnormal symptoms, which were most likely adverse drug reactions, were not observed in any patients, and no abnormal changes were noted in patients, whose clinical lab values were taken before or after the administration. Situations may differ by region in Japan, however, infants under 3 are generally exempted from medical payment regardless of inpatients or outpatients. When hospitalized, psychological burden upon pediatric patients without guardians attended must be enormous. If they are over 3, there is a difference in medical costs between inpatients and outpatients, with greater economic burden on inpatients. Thus, it was considered worth attempting the outpatient treatment as one of new therapies for community-acquired pneumonia, though the outpatient treatment should not be encouraged without due consideration. Based on these results, CTRX dosed once daily to pediatric patients with community-acquired pneumonia is clinically and bacteriologically superior in usefulness. Further review may be necessary, however, it is considered that outp

Topics: Ceftriaxone; Cephalosporins; Child; Child, Preschool; Community-Acquired Infections; Drug Resistance, Microbial; Female; Haemophilus Infections; Haemophilus influenzae; Humans; Infant; Infusions, Intravenous; Male; Pneumonia, Bacterial; Streptococcal Infections; Streptococcus pneumoniae

This randomized, multicenter, open-label study compared the efficacy and safety of monotherapy with 2 g of intravenous ceftriaxone once daily for 4 weeks with those of combination therapy with 2 g of intravenous ceftriaxone and 3 mg of intravenous gentamicin/kg once daily for 2 weeks as therapy for endocarditis due to penicillin-susceptible streptococci. Sixty-one patients were enrolled in the study. Clinical cure was observed for 51 evaluable patients both at termination of therapy and at the 3-month follow-up: 25 (96.2%) of 26 monotherapy recipients and 24 (96%) of 25 combination therapy recipients. Of the 23 patients in each treatment group who were microbiologically evaluable, 22 (95.7%) in each group were considered cured. No patient had evidence of relapse. Fourteen patients (27.5%) required cardiac surgery after initiation of treatment, including five monotherapy recipients and nine combination therapy recipients. Adverse effects were minimal in both treatment groups. We conclude that 2 g of ceftriaxone once daily for 4 weeks and 2 g of ceftriaxone in combination with 3 mg of gentamicin/kg once daily for 2 weeks are both effective and safe for the treatment of streptococcal endocarditis.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Ceftriaxone; Cephalosporins; Drug Therapy, Combination; Endocarditis, Bacterial; Gentamicins; Humans; Middle Aged; Penicillins; Streptococcal Infections; Streptococcus

The authors studied efficacy and safety of ceftriaxone given intravenously for 3-4 weeks in a dose 2-4 g/day to patients with streptococcal endocarditis (SE). Of them, 8, 8 and 1 patients were infected with Streptococcus viridans, Streptococcus pyogenes, Pneumococcus, respectively. Hospital trial and follow-up lasted up to 2 years. Cure without surgical correction occurred in 7 patients, valvular replacement was needed in 4 patients, 1 patient died, 4 patients developed recurrences 3 and more months after therapy with ceftriaxone. The drug was safe and well tolerated. 33% of the patients were discharged from hospital with obvious improvement after 2-3 week treatment to continue it outpatiently for 1-2 weeks.

Topics: Adult; Ceftriaxone; Cephalosporins; Endocarditis, Subacute Bacterial; Female; Humans; Infusions, Intravenous; Male; Recurrence; Safety; Streptococcal Infections; Streptococcus; Treatment Outcome

A 2-week course of ceftriaxone (2 g) plus netilmicin (4 mg/kg), administered as one short daily iv infusion, was evaluated for the treatment of streptococcal endocarditis in an open multicenter study. Of the 52 patients, 31 were infected with viridans streptococci, 18 with Streptococcus bovis, two with Gemella morbillorum, and one with group C Streptococcus; 48 patients were assessable. Infection was cured in 42 cases, 35 treated medically and seven treated both medically and surgically. Five patients died without evidence of active infection, and one relapsed. The bacteriologic failure was due to a strain of G. morbillorum against which no synergy of ceftriaxone and netilmicin was evident in vitro. The serum creatinine level increased during treatment in four cases, all involving patients > 65 years old who had renal risk factors; in two of these cases, values did not return to baseline during follow-up. Of 40 patients assessed for auditory function, only one developed decreased perception of borderline significance. Other adverse reactions were mild. This regimen was efficacious, safe, and cost-effective for the treatment of streptococcal endocarditis. However, it must be used with caution for patients with preexisting renal impairment or concomitant exposure to other potentially nephrotoxic agents.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Ceftriaxone; Drug Therapy, Combination; Endocarditis, Bacterial; Female; Follow-Up Studies; Humans; Male; Middle Aged; Netilmicin; Prospective Studies; Streptococcal Infections; Treatment Outcome

OBJECTIVE--To evaluate the efficacy and safety of ceftriaxone sodium in the treatment of streptococcal endocarditis. DESIGN--An open, multicenter, noncomparative study with a follow-up of patients for 4 months to 5 years. SETTING--Internal medicine wards and outpatient clinics of hospitals of various sizes in three European countries. PATIENTS--Fifty-nine patients with defined criteria for streptococcal endocarditis. INTERVENTION--Ceftriaxone sodium administered at a once-daily dose of 2 g for 4 weeks. MAIN OUTCOME MEASURES--Clinical outcome and microbiological cure rate. RESULTS--Among the 59 patients, 55 completed the treatment and were followed up for 4 months to 5 years. No patients showed evidence of relapse. Treatment was completely uneventful in 42 patients (71%). A cardiac valve was replaced in four patients (7%) receiving antimicrobial therapy and in six patients (10%) who had completed antimicrobial therapy. One of the 10 valves taken for culture at surgery was positive, but only for microorganisms that were different from the microorganism isolated before the treatment. The treatment had to be interrupted in four patients because of drug allergy. Other side effects were mild except for two cases of reversible neutropenia. The treatment was easy to administer: 27 patients (46%) had no permanent intravenous catheter at any time, seven patients (12%) had such a catheter for less than 4 days. Twenty-three patients (39%) were discharged from the hospital less than 2 weeks after admission.. --Ceftriaxone sodium administered at a once-daily dose of 2 g appears to be an effective and safe treatment of streptococcal endocarditis. In hospitals, this agent may be more convenient to administer than penicillin G with or without aminoglycosides. Some patients may even be treated as outpatients.

Topics: Adult; Aged; Aged, 80 and over; Ambulatory Care; Ceftriaxone; Drug Administration Schedule; Endocarditis, Bacterial; Female; Humans; Infusions, Intravenous; Injections, Intramuscular; Length of Stay; Male; Middle Aged; Streptococcal Infections

To compare the efficacy and safety of ciprofloxacin and ceftriaxone in patients with nursing home-acquired lower respiratory tract infections requiring initial hospitalization.. Prospective, randomized trial.. Extended care nursing homes affiliated with a teaching hospital.. Fifty patients aged 60 years or older with normal or mildly impaired renal function admitted to the hospital for treatment of lower respiratory tract infections.. Twenty-four patients received initial therapy with intravenous ciprofloxacin, 200 mg every 12 hours (19 patients) or 400 mg every 12 hours (5 patients) during the acute phase followed by 750 mg orally every 12 hours during the convalescence phase. Twenty-six patients received initial therapy with intravenous ceftriaxone, 2 g every 24 hours during the acute phase followed by 1 g administered intramuscularly every 24 hours during the convalescent phase. The total duration of therapy was 14 days.. Successful outcome was defined as resolution or marked improvement in clinical signs and symptoms of lower respiratory tract infection upon completion of the treatment course.. Twelve (50%) of the ciprofloxacin-treated and 14 (54%) of ceftriaxone-treated patients had successful outcomes. Recurrent oropharyngeal aspiration was the reason for treatment failure in most patients refractory to either antibiotic. Mortality during therapy was 8% in each group. From 21 satisfactory sputum specimens collected, S. pneumoniae was the most common isolate, followed by H. influenzae and other Gram-negative bacteria. Ciprofloxacin therapy was well tolerated; ceftriaxone therapy was discontinued in two patients (8%) due to adverse reactions (intramuscular pain and drug fever).. Sequential intravenous/oral ciprofloxacin appears to be as safe and effective as sequential intravenous/intramuscular ceftriaxone. The optimal dosage of intravenous ciprofloxacin in this patient population appears to be 400 mg every 12 hours; however, additional clinical and pharmacokinetic studies with this regimen are warranted.

Topics: Administration, Oral; Aged; Aged, 80 and over; Bronchitis; Ceftriaxone; Ciprofloxacin; Cross Infection; Drug Administration Schedule; Female; Haemophilus Infections; Haemophilus influenzae; Homes for the Aged; Humans; Injections, Intravenous; Male; Nursing Homes; Pneumonia; Sputum; Streptococcal Infections; Survival Rate

To assess the comparative efficacy of cefuroxime and ceftriaxone for the treatment of bacterial meningitis, we reviewed the records from four prospective efficacy trials conducted at our institution. One hundred seventy-four infants and children received ceftriaxone and 159 received cefuroxime. The clinical characteristics of the two groups were comparable at admission. After 24 hours of therapy, routine cerebrospinal fluid cultures for all patients treated with ceftriaxone were sterile, whereas 9% of cerebrospinal fluid cultures were positive in cefuroxime-treated patients (p less than 0.001). More cefuroxime-treated patients had abnormal physical examinations at the time of discharge than did ceftriaxone-treated patients (39/159 vs 25/174, p = 0.02). At 6-week and 1-year follow-up examinations, there was no longer a statistically significant difference in the incidence of neurologic abnormalities between the two therapy groups, but the incidence of hearing impairment in one or both ears was higher in the cefuroxime (18%) than in the ceftriaxone (11%) treatment group. Both regimens are efficacious for the treatment of bacterial meningitis, but some patients may not respond as satisfactorily to cefuroxime as to ceftriaxone.

Topics: Adolescent; Ceftriaxone; Cefuroxime; Cephalosporins; Child; Child, Preschool; Clinical Trials as Topic; Female; Follow-Up Studies; Hearing Disorders; Humans; Infant; Male; Meningitis; Meningitis, Haemophilus; Meningitis, Meningococcal; Meningitis, Pneumococcal; Random Allocation; Streptococcal Infections

In a prospective study 105 children hospitalized with soft tissue infection, 11 children with suppurative arthritis and 9 children with osteomyelitis were treated with either parenterally administered ampicillin/sulbactam or ceftriaxone. Treatment was randomized using a computer-generated table in a 2:1 fashion: 84 patients received ampicillin/sulbactam and 41 patients received ceftriaxone. Organisms isolated from wound site or blood cultures included Staphylococcus aureus (33), Streptococcus pyogenes (19), Haemophilus influenzae (9) including 4 beta-lactamase-positive organisms, Streptococcus pneumoniae (5), Neisseria gonorrhoeae (3) and 9 other organisms. Clinical and bacteriologic response was satisfactory in 100% of the ampicillin/sulbactam-treated patients and in 93% of the ceftriaxone-treated patients. Two patients with S. aureus infections treated with ceftriaxone had a delayed response and required change in therapy to parenterally administered oxacillin. Ampicillin/sulbactam represents a potentially useful single agent for the treatment of cellulitis and bone or joint infections in pediatric patients.

Topics: Acinetobacter Infections; Adolescent; Ampicillin; Arthritis, Infectious; Ceftriaxone; Cellulitis; Child; Child, Preschool; Drug Therapy, Combination; Escherichia coli Infections; Female; Gonorrhea; Haemophilus Infections; Humans; Infant; Male; Osteomyelitis; Prospective Studies; Random Allocation; Staphylococcal Infections; Streptococcal Infections; Sulbactam

The short-term therapy of streptococcal pharyngotonsillitis and scarlet fever with ceftriaxone (Rocephin) is reported. Sixty children, in whom the clinical diagnosis was confirmed by rapid enzyme immunoassay and smear test, were divided into two randomized groups and treated with a single dose of 50 mg/kg ceftriaxone or 50 mg/kg ceftriaxone on 3 consecutive days. Clinical cure was obtained in 100% of the patients and pharyngeal sterilization in 95%, with no significant differences between the two groups.

Topics: Ceftriaxone; Child; Child, Preschool; Drug Administration Schedule; Female; Humans; Male; Pharyngitis; Random Allocation; Scarlet Fever; Streptococcal Infections; Tonsillitis

Seventy-nine children were enrolled in a study to compare seven vs ten days of ceftriaxone therapy for bacterial meningitis. On the basis of a computer-generated list of therapy assignments, 35 children with Haemophilus, pneumococcal, or group B streptococcal meningitis each were assigned to seven- or ten-day treatment regimens; nine children with meningococcal meningitis received seven days of therapy. The population characteristics and etiologic agents were similar for the two treatment groups, as were also the findings on examination and culture of cerebrospinal fluid at completion of therapy. There were no significant differences in the frequency and types of neurological complications between the two treatment groups; four patients in each group had two or more neurological abnormalities. The rates of nosocomial infections and prolonged and secondary fever were similar in those who received seven days of therapy compared with patients treated for the conventional ten days. Diarrhea occurred in 44% of those receiving the drug. Patients treated with the seven-day regimen were discharged from the hospital approximately two days earlier than those with the ten-day regimen.

Topics: Bacterial Infections; Cefotaxime; Ceftriaxone; Child, Preschool; Female; Humans; Infant; Male; Meningitis; Meningitis, Haemophilus; Meningitis, Meningococcal; Streptococcal Infections; Streptococcus agalactiae

Topics: Cefotaxime; Ceftriaxone; Clinical Trials as Topic; Endocarditis, Bacterial; Humans; Streptococcal Infections

Ceftriaxone effectively inhibited 332 out of 452 (73.45%) bacterial strains in vitro tests. 291 out of 365 (79.69%) gram negative and 41 out of 87 (47.12%) gram positive strains were inhibited. The tests showed ceftriaxone to be more effective than cephalothin, cephotaxime, cephuroxime, cephamandol and cephoxitin. Kinetic tests showed that cephtriaxone has a plasmatic half life of 7.25 hrs. 24 hours after administration of a 1000 mg venous bolus the drug was still present in the blood. Urinary elimination over a 24 hr. period amounted to means 486.8 mg (48.68%). The drug has liquor transfer capacity. 37 of the 38 patients treated showed complete clinical or clinicobacteriological cure. Improvement was noted in the 38th.

Topics: Adolescent; Adult; Aged; Cefotaxime; Ceftriaxone; Child; Child, Preschool; Clinical Trials as Topic; Female; Gram-Negative Bacteria; Gram-Positive Bacteria; Half-Life; Humans; Kinetics; Klebsiella Infections; Male; Meningitis; Middle Aged; Respiratory Tract Infections; Staphylococcal Infections; Streptococcal Infections

Streptococcus suis is an emerging zoonotic pathogen. Human infections with S suis have been identified in Europe, North America, South America, Oceania, Africa and Asia. As the most common clinical symptom of human S suis, meningitis develops in 50% to 60% of infected patients, and approximately 60% of the patients with meningitis symptoms have neurologic sequelae. The cost of infection with S suis imposes a tremendous burden on patients' families.. A 56-year-old woman was infected with S suis. The patient reared pigs in her backyard. At admission, her blood examination showed a leukocyte count of 27.28 × 109/L with 94.20% neutrophils. Cerebrospinal fluid was cloudy with a leukocyte count of 2700 × 106/L. Cerebrospinal fluid cultures revealed gram-positive cocci identified as S suis type II. Ceftriaxone was then administered.. Human infections with S suis highlights the need for health education, prevention and surveillance it.

Topics: Animals; Ceftriaxone; China; Humans; Meningitis; Meningitis, Bacterial; Middle Aged; Streptococcal Infections; Streptococcus suis; Swine

Rhinosinusitis-induced brain abscesses are rare but can result in devastating long-term sequalae and mortality; they require a high index of suspicion with early imaging to start early empiric parenteral antibiotic treatment covering aerobes and anaerobes.. Our study was a retrospective analysis on 32 patients who were treated at Oxford University Hospitals for rhinosinusitis-induced brain abscess between February 2013 and June 2020.. Mean age of presentation was 45.83 for adults and 11.14 for children. Subdural collection was the most frequent abscess but 25% of patients had multiple sites of collection; the majority were in the frontal lobe. The most commonly identified pathogens were Streptococcus milleri group and Staphylococcus aureus; 93.75% of the patients were treated with combined Ceftriaxone and Metronidazole for an average of 8 weeks.. In our series most patients received also a prompt and aggressive surgical treatment with combined neurosurgical and ENT procedures in the majority; this was especially important in case of subdural empyema, Streptococcus milleri infection and direct intracranial spread of infection. More than half of the patients were treated with a single surgical procedure. Despite aggressive treatment, one third of patients experienced long-term neurological sequelae; there were no deaths.

Topics: Adult; Anti-Bacterial Agents; Brain Abscess; Ceftriaxone; Child; Humans; Metronidazole; Retrospective Studies; Review Literature as Topic; Sinusitis; Streptococcal Infections

Group B Streptococci (GBS) colonize almost one third of human gastrointestinal and genitourinary tracts, particularly in females. The aim of this study is to evaluate the epidemiology, microbiological characteristics, and clinical outcomes of invasive GBS disease in Qatar from all age groups.. A retrospective study was conducted on patients with confirmed GBS blood stream infections during the period between January 2015 and March 2019. Microbiological identification was performed using automated BD PhoenixTM system, while additional antimicrobial susceptibility tests were performed using E test and disc diffusion methods.. During the four years period, the incidence steadily rose from 1.48 to 2.09 cases per 100.000 population. Out of 196 confirmed cases of invasive GBS infections, the majority were females (63.7%, 125/196) of which 44.8% were pregnant and 53.6% were colonized. Three distinct affected age groups were identified: children ≤ 4 years of age (35.7%), young adults 25-34 (20.9%) and the elderly ≥ 65 year (17.4%). Presenting symptoms were mild with fever in 53% of cases while 89% of cases had Pitt bacteraemia score of ≤ 2. Isolates were universally sensitive to penicillin, ceftriaxone, and vancomycin at 100% but with significant resistance to erythromycin (49%) and clindamycin (28.6%) while 16.8% had inducible clindamycin resistance. Clinical outcomes showed cure rate of 87.25% with complications in (8.76%) and 4% mortality.. There is a rising trend of Group B Streptococcal blood stream infections in Qatar with significantly high clindamycin and erythromycin resistance rates. Universal susceptibility rates were demonstrated for penicillin, ceftriaxone, and vancomycin.

Topics: Aged; Anti-Bacterial Agents; Ceftriaxone; Child; Child, Preschool; Clindamycin; Erythromycin; Female; Humans; Male; Microbial Sensitivity Tests; Penicillins; Pregnancy; Qatar; Retrospective Studies; Streptococcal Infections; Streptococcus agalactiae; Vancomycin; Young Adult

BACKGROUND We present a case of Group B Streptococcus (Streptococcus agalactiae or GBS) meningitis in a non-pregnant woman that likely originated from acute otitis media. Although invasive Group B Streptococcal infections are increasing in the United States, GBS meningitis is still rare in non-pregnant adults. At the end, we discuss risk factors for this disease and data that suggest that invasive GBS infection is increasing in the adult and elderly populations of the United States. CASE REPORT Our patient was a 55-year-old woman with a history of juvenile rheumatoid arthritis who presented with altered mental status after failure of outpatient treatment of otitis media with oral doxycycline and steroids. Upon admission, she was initially afebrile and hemodynamically stable, but she had a rapid decline and required emergent intubation. Blood cultures grew GBS. CSF PCR analysis performed by BioFire® FilmArray® Meningitis/Encephalitis Panel revealed GBS. Middle-ear fluid and CSF cultures drawn after 1 day of antibiotic therapy did not grow any organisms. Treatment was achieved with high-dose intravenous ceftriaxone for 14 days, and tympanoplasty. At the end of 14 days of antibiotic therapy, the patient had full neurological recovery, without any residual neurological deficits. CONCLUSIONS GBS meningitis is classically associated with neonatal disease, but invasive GBS infection is fairly common in adults and appears to be increasing in incidence secondary to increasing populations living with diabetes, immunosuppressed conditions, and advanced age. Central nervous system infection with this organism is still rare. In this case report we describe a non-pregnant woman who presented with GBS meningitis.

Topics: Adult; Aged; Ceftriaxone; Female; Humans; Infant, Newborn; Meningitis, Bacterial; Middle Aged; Otitis Media; Streptococcal Infections; Streptococcus agalactiae

Streptococcus equi subspecies zooepidemicus is a Gram-positive, P-hemolytic coccus considered part of the commensal flora in horses and an opportunistic pathogen in other animals. Infection in humans is rare, but it usually manifests as serious symptoms, it has been associated with contact with animals, especially horses, and the consumption of unpasteurized dairy products. In this report we describe a case of bacteremia of the mother-child binomial by this agent, associated with the consumption of artisan cheeses. Although penicillin is the treatment of choice, the newborn was successfully treated with ampicillin and the mother with ceftriaxone, none of them presented complications associated with bacteremia. To our knowledge, this is the first report of connatal infection by this agent.

Topics: Animals; Bacteremia; Ceftriaxone; Horses; Humans; Mother-Child Relations; Streptococcal Infections; Streptococcus equi

Topics: Anti-Bacterial Agents; Ceftriaxone; Child Abuse; Diagnosis, Differential; Female; Humans; Infant; Liver Failure, Acute; Lung; Pleural Effusion; Pneumonia; Radiography; Rib Fractures; Streptococcal Infections

Constrictive pericarditis is a relatively uncommon form of cardiac failure and presents due to scarring and consequent loss of the normal elasticity of the pericardial sac. This results in abnormal/limited ventricular filling and symptoms of heart failure. The aetiology is varied, from infective causes to idiopathic causes, or can manifest after cardiothoracic surgery. This case involves a 46-year-old man presenting with acute group A beta haemolytic streptococcus infection, and over the subsequent 6 months develops constrictive pericarditis due to what is believed to be a rheumatic aetiology. The patient subsequently underwent pericardiectomy and had restoration of normal filling dynamics confirmed on follow-up echocardiography. This case provides a subject matter for the review of the features of constrictive pericarditis and its investigation and management. This case is that it highlights the fact that pericarditis is not a benign condition. Emerging evidence suggests that pericarditis is due to a failure in inflammatory regulatory mechanisms, and patients suffering this condition have a preponderance to 'autoinflammation'. Pericarditis should be recognised early and treated fully with anti-inflammatory agents.

Topics: Anti-Bacterial Agents; Antistreptolysin; Bacteremia; Blood Culture; C-Reactive Protein; Cardiac Catheterization; Ceftriaxone; Electrocardiography; Hospitalization; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Pericardiectomy; Pericarditis, Constrictive; Piperacillin, Tazobactam Drug Combination; Rheumatic Heart Disease; Streptococcal Infections; Streptococcus pyogenes; Ventricular Pressure

Topics: Amoxicillin; Ceftriaxone; Central Nervous System Cysts; Diagnosis; Fever; Humans; Infant; Male; Meningitis, Aseptic; Neck Pain; Streptococcal Infections; Vaccination Refusal; Vancomycin

Topics: Adult; Anti-Bacterial Agents; Azithromycin; Bacteremia; Biomarkers; Ceftriaxone; Diagnosis, Differential; Drug Therapy, Combination; Enzyme Inhibitors; Humans; Male; Oseltamivir; Pneumonia, Bacterial; Streptococcal Infections; Streptococcus

Streptococcus suis is a zoonotic pathogen that causes serious systemic infections in pigs and occupation-related infections in humans who contact with pigs or pork products. In China, it has caused two outbreaks of human infection and surveillance for S.suis has been ongoing since last time.. Two cases of meningitis and sepsis caused by S. suis were reported in this study. Both patients work in relation to the pork trade, a risk factor for S. suis infection. The outcome was favorable after a prolonged ceftriaxone therapy but one patient was left with mild hearing loss. Two isolates were identified as sequencing type (ST) 7, S. suis serotype 2 (SS2), which is one the most prevalent and cause two outbreaks in China. Whole-genome sequencing (WGS) revealed that a high degree identity was noted in the genome organizations and sequences between two sporadic ST7 SS2 isolates in this study and representative epidemic virulent isolates. Major differences among them are two sporadic ST7 SS2 isolates lacked a virulence factor called agglutinin receptor and an 89 K pathogenicity island (PAI), which plays important role in the pathogenesis of streptococcal toxic shock syndrome (STSS). A summary about STs of human infection with S. suis in China was completed. The result showed ST1 and ST7 were still the major STs and several novel STs were successfully discovered in different provinces.. Our results enhanced the understanding of the ability to cause life-threatening infections in humans and the distribution and evolution of the S. suis in China.

Topics: Aged; Animals; Anti-Bacterial Agents; Ceftriaxone; China; Epidemics; Genome, Bacterial; Humans; Male; Middle Aged; Occupational Diseases; Serogroup; Shock, Septic; Streptococcal Infections; Streptococcus suis; Swine; Swine Diseases; Treatment Outcome; Virulence Factors

The early shortage of novel coronavirus disease (COVID-19) tests in the United States led many hospitals to first screen for common respiratory pathogens, and only if this screen was negative to proceed with COVID-19 testing. We report a case of a 56-year-old woman with severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) coinfection with group A

Topics: Antibodies, Monoclonal, Humanized; Azithromycin; Betacoronavirus; Ceftriaxone; Chicago; Chronic Pain; Coinfection; Coronavirus Infections; COVID-19; Extracorporeal Membrane Oxygenation; Female; Humans; Hydroxychloroquine; Hypertension; Lung; Middle Aged; Pandemics; Pneumonia, Viral; SARS-CoV-2; Streptococcal Infections; Streptococcus pyogenes; Tomography, X-Ray Computed; Treatment Outcome

Central retinal artery occlusion (CRAO) is a rare but blinding disorder. We present a case of a 81-year-old woman with multiple cardiovascular comorbidities admitted to the emergency department due to sudden, painless vision loss on left eye (oculus sinister (OS)) on awakening. The patient also reported long standing fatigue associated with effort that started 4 months before admission. She presented best corrected visual acuity of counting fingers OS. Funduscopy OS revealed macular oedema with cherry red spot pattern. Blood cultures came positive for

Topics: Acetazolamide; Administration, Intravenous; Administration, Ophthalmic; Administration, Oral; Aged, 80 and over; Anti-Bacterial Agents; Antihypertensive Agents; Ceftriaxone; Echocardiography; Endocarditis, Bacterial; Female; Humans; Hypothalamic Area, Lateral; Isosorbide Dinitrate; Mitral Valve; Retina; Retinal Artery Occlusion; Streptococcal Infections; Streptococcus gallolyticus; Tomography, Optical Coherence; Treatment Outcome

Topics: Aged; Anti-Bacterial Agents; Anticonvulsants; Ceftriaxone; Diabetes Mellitus, Type 2; Electroencephalography; Female; Humans; Levetiracetam; Meningitis, Bacterial; Seizures; Streptococcal Infections; Streptococcus agalactiae

Aggregatibacter aphrophilus and Beta haemolytic Streptococci Lancefield group F are part of the normal oral flora and are known to cause endocarditis, sinusitis, empyema, meningitis and septic arthritis. They are now emerging as a cause of brain abscess particularly in patients with congenital heart diseases. We report a case of a 10-year-old boy with Tetralogy of Fallot (TOF), who presented with fever, headache and drowsiness. Culture yielded the growth of Aggregatibacter aphrophilus and Beta hemolytic streptococci Lancefield group F. He became clinically stable after treatment with ceftriaxone.

Topics: Aggregatibacter aphrophilus; Anti-Bacterial Agents; Brain Abscess; Ceftriaxone; Child; Coinfection; Craniotomy; Culture Techniques; Humans; Male; Pasteurellaceae Infections; Streptococcal Infections; Streptococcus milleri Group; Tetralogy of Fallot; Tomography, X-Ray Computed

Streptococcus oralis belongs to the Streptococcus mitis group and is part of the normal flora of the nasal and oropharynx (Koneman et al., The Gram-positive cocci part II: streptococci, enterococci and the 'Streptococcus-like' bacteria. Color atlas and textbook of diagnostic microbiology, 1997). Streptococcus oralis is implicated in meningitis in patients with decreased immune function or from surgical manipulation of the central nervous system. We report a unique case of meningitis by Streptococcus oralis in a 58-year-old patient with cerebral spinal fluid leak due to right sphenoid meningoencephalocele.. A 58-year-old female presented in the emergency department due to altered mental status, fevers, and nuchal rigidity. Blood cultures were positive for Streptococcus oralis. Magnetic resonance stereotactic imaging of head with intravenous gadolinium showed debris in lateral ventricle occipital horn and dural thickening/enhancement consistent with meningitis. There was also a right sphenoidal roof defect, and meningoencephalocele with cerebrospinal fluid leak as a result. The patient was treated with ceftriaxone and had endoscopic endonasal repair of defect. She had complete neurologic recovery 3 months later.. Cerebrospinal fluid leak puts patients at increased risk for meningitis. Our case is unique in highlighting Streptococcus oralis as the organism implicated in meningitis due to cerebrospinal fluid leak.

Topics: Anti-Bacterial Agents; Ceftriaxone; Cerebrospinal Fluid Leak; Encephalocele; Endoscopy; Female; Humans; Meningitis, Bacterial; Meningocele; Middle Aged; Nasal Surgical Procedures; Sphenoid Bone; Streptococcal Infections; Streptococcus oralis; Treatment Outcome

BACKGROUND Although left atrial myxoma is the most common benign primary cardiac tumor, infected atrial myxoma is rare. This report presents a case of infected left atrial myxoma with embolization to the left anterior descending (LAD) coronary artery, which was identified following an initial presentation with ST-elevation myocardial infarction (STEMI). CASE REPORT A 34-year-old man with a history of smoking tobacco and intravenous cocaine use presented to the emergency room with symptoms of a feeling of pressure on the chest and symptoms in the left arm. An electrocardiogram (ECG) showed ST elevation in leads II, III, aVF, and V3-V5, consistent with an anterior-inferior STEMI. He underwent percutaneous intervention (PCI) with two drug-eluting stents to the mid-distal LAD coronary artery. The patient also had fever, chills, a history of weight loss, and signs of peripheral emboli. Blood cultures identified Gram-positive Streptococcus parasanguinis, a member of the Streptococcus viridans group. Transesophageal echocardiogram (TEE) identified a large, mobile, pedunculated left atrial mass protruding into the mitral valve in diastole and mitral valve vegetations. Surgical excision and the histology confirmed a diagnosis of benign left atrial myxoma containing Gram-positive cocci. The patient required mitral valve replacement and a postoperative two-week course of gentamicin and a six-week course of ceftriaxone CONCLUSIONS A rare case is reported of infected left atrial myxoma presenting as STEMI secondary to coronary artery embolization, which was treated with PCI, antibiotics, and mitral valve replacement.

Topics: Adult; Anti-Bacterial Agents; Ceftriaxone; Coronary Angiography; Coronary Thrombosis; Diagnosis, Differential; Echocardiography, Transesophageal; Electrocardiography; Gentamicins; Heart Neoplasms; Humans; Male; Myxoma; Percutaneous Coronary Intervention; ST Elevation Myocardial Infarction; Streptococcal Infections; Streptococcus

Topics: Aged; Anti-Bacterial Agents; Ceftriaxone; Humans; Male; Meningitis, Bacterial; Streptococcal Infections; Streptococcus salivarius; Treatment Outcome

Topics: Adenocarcinoma; Aged; Anti-Bacterial Agents; Bacteremia; Cefazolin; Ceftriaxone; Colectomy; Colorectal Neoplasms; Combined Modality Therapy; Female; Humans; Streptococcal Infections; Streptococcus gallolyticus

We have previously identified group B Streptococcus (GBS) clinical isolates with reduced penicillin susceptibility (PRGBS) that were non-susceptible to cefotaxime; however, the rates of cefotaxime and ceftriaxone non-susceptibility among PRGBS isolates have never been reported. Therefore, we first determined the MICs of 22 antibacterial drugs/compounds for 74 PRGBS isolates and then determined the rates of cefotaxime and ceftriaxone non-susceptibility among these isolates.. We used 74 clinical PRGBS isolates, previously collected in Japan and confirmed to harbour relevant amino acid substitutions in PBP2X. We also used 80 penicillin-susceptible GBS (PSGBS) clinical isolates as controls. The MICs of 22 antibacterial drugs/compounds for all 154 GBS isolates were determined via microdilution and/or agar dilution methods, as recommended by the CLSI.. The rates of non-susceptibility/resistance to ampicillin, cefotaxime, ceftriaxone and levofloxacin for the 80 PSGBS isolates were 0%, 0%, 0% and 30%, respectively, but were 15% (P = 0.0003), 28% (P < 0.0001), 36% (P < 0.0001) and 93% (P < 0.0001) for the 74 PRGBS isolates, respectively. No PRGBS isolates were identified to be non-susceptible to meropenem, doripenem, vancomycin, quinupristin/dalfopristin, daptomycin or linezolid.. We found that cefotaxime- and ceftriaxone-non-susceptible PRGBS isolates occur at relatively high rates in Japan. Importantly, this finding suggests that the range of drugs likely to be effective in treating PRGBS infections may be limited compared with those available for PSGBS infections; therefore, clinicians should exercise care when considering drug choice and efficacy for PRGBS infections.

Topics: Anti-Bacterial Agents; beta-Lactam Resistance; Cefotaxime; Ceftriaxone; Humans; Japan; Microbial Sensitivity Tests; Mutation, Missense; Penicillin-Binding Proteins; Penicillins; Prevalence; Streptococcal Infections; Streptococcus agalactiae

Topics: Anti-Bacterial Agents; Ceftriaxone; Diagnosis, Differential; Epiglottitis; Female; Haemophilus Infections; Haemophilus influenzae; Humans; Influenza A virus; Influenza, Human; Microbiological Techniques; Middle Aged; Nasal Cavity; Pharynx; Streptococcal Infections; Streptococcus pyogenes; Treatment Outcome

Topics: Aged; Anti-Bacterial Agents; Aortic Valve; Aortic Valve Insufficiency; Ceftriaxone; Echocardiography, Transesophageal; Endocarditis, Subacute Bacterial; Fatal Outcome; Heart Valve Diseases; Heart Valve Prosthesis; Humans; Male; Shock, Cardiogenic; Streptococcal Infections; Vasculitis, Leukocytoclastic, Cutaneous; Viridans Streptococci

An 80-year-old man who had chronic heart failure and atrial fibrillation was refered to our hospital because of acute onset of fever and consciousness disturbance. Neurological examinations revealed deteriorated consciousness, nuchal rigidity and Kernig's sign. A lumber puncture yielded clouded fluid with a WBC 11,200/μl (polynuclear cell 94%), 758 mg/dl of protein, 1 mg/dl of glucose, 0.007 of cerebrospinal fluid-blood glucose ratio and Gram positive cocci. Diffusion-weighted images on brain MRI showed no signal intensity in bilateral ventricles at admission. He was treated with ceftriaxon, vancomycin and ampicillin. Streptococcus salivarius (S. salivarius) was isolated from blood and cerebrospinal fluid. He responded promptly to antibiotics therapy, and within 5 days, he became lucid and afebrile. S. salivarius was sensitive for ceftriaxone, vancomycin and ampicillin. After Day 6, he was treated with ceftriaxone only. We diagnosed his condition as S. salivarius meningitis. He discharged from our hospital at Day 22. Many cases of S. salivarius meningitis were occurred in second and fifth decade. But elderly case was rare. Neurologist should consider that elderly case with bacterial meningitis was caused by S. salivarius.

Topics: Age Factors; Aged, 80 and over; Ampicillin; Anti-Bacterial Agents; Ceftriaxone; Diffusion Magnetic Resonance Imaging; Drug Therapy, Combination; Humans; Male; Meningitis, Bacterial; Streptococcal Infections; Streptococcus salivarius; Treatment Outcome; Vancomycin

Invasive S. pyogenes diseases are uncommon, serious infections with high case fatality rates (CFR). There are few publications on this subject in the field of pediatrics. This study aimed at characterizing clinical and laboratory aspects of this disease in Chinese children.. A retrospective study was conducted and pediatric in-patients with S. pyogenes infection identified by cultures from normally sterile sites were included, who were diagnosed and treated in 9 tertiary hospitals during 2010-2017.. A total of 66 cases were identified, in which 37 (56.1%) were male. The median age of these patients, including 11 neonates, was 3.0 y. Fifty-nine (89.4%) isolates were determined from blood. Fever was the major symptom (60/66, 90.9%) and sepsis was the most frequent presentation (64/66, 97.0%, including 42.4% with skin or soft tissue infections and 25.8% with pneumonia. The mean duration of the chief complaint was (3.8 ± 3.2) d. Only 18 (27.3%) patients had been given antibiotics prior to the hospitalization. Among all patients, 15 (22.7%) developed streptococcal toxin shock syndrome (STSS). No S. pyogenes strain was resistant to penicillin, ceftriaxone, or vancomycin, while 88.9% (56/63) and 81.4% (48/59) of the tested isolates were resistant to clindamycin and erythromycin respectively. Most of the patients were treated with β-lactams antibiotics and 36.4% had been treated with meropenem or imipenem. Thirteen (19.7%) cases died from infection, in which 9 (13.6%) had complication with STSS.. Invasive S. pyogenes infections often developed from skin or soft tissue infection and STSS was the main cause of death in Chinese children. Ongoing surveillance is required to gain a greater understanding of this disease.

Topics: Ceftriaxone; Child, Preschool; China; Clindamycin; Drug Resistance, Bacterial; Erythromycin; Female; Fever; Humans; Infant; Infant, Newborn; Male; Penicillins; Pneumonia, Pneumococcal; Retrospective Studies; Sepsis; Shock, Septic; Skin Diseases, Bacterial; Soft Tissue Infections; Streptococcal Infections; Streptococcus pyogenes; Tertiary Care Centers; Vancomycin

We report an extremely rare case of purulent pericarditis caused by the normally commensal oral flora,

Topics: Aged; Anti-Bacterial Agents; Ceftriaxone; Diagnosis, Differential; Echocardiography; Female; Humans; Pericardial Effusion; Pericarditis; Pericardium; Streptococcal Infections; Streptococcus constellatus; Tomography, X-Ray Computed

The ancient infectious diseases, Lemierre's Syndrome and Bezold's Abscesses are rare.. A 70-year-old Japanese woman with a 15-year history of Parkinson's disease was referred to our hospital due to fever, occipital headache and bilateral shoulder pain that had continued for three months. She had been prescribed prednisolone due to a diagnosis of polymyalgia rheumatica.. A blood culture revealed bacteremia of Streptococcus constellatus. In addition, computed tomography revealed Bezold's abscesses and Lemierre's syndrome.. We administered ceftriaxone for 31 days, followed by oral amoxicillin.. The patient recovered and the abscesses improved.. This case underscores the importance of blood culture tests and cross-referencing with radiological imagings in the diagnoses of these rare critical infectious diseases that mimic polymyalgia rheumatica.

Topics: Abscess; Aged; Amoxicillin; Anti-Bacterial Agents; Blood Culture; Ceftriaxone; Comorbidity; Female; Humans; Lemierre Syndrome; Streptococcal Infections; Streptococcus constellatus; Tomography, X-Ray Computed

Pyogenic liver abscesses (PLAs) are an uncommon, but potentially life threatening infection. We report a case of PLA due to Streptococcus constellatus, a member of the Streptococcus anginosus group (SAG) bacteria, commonly found as commensals of the oropharyngeal, gastrointestinal and genitourinary flora.. The patient, a 42-year-old man with no premorbidities, non-smoker and non-alcoholic, presented to our hospital with high-grade fever associated with chills and rigors and right upper quadrant pain of one month duration. Culture of the ultrasound-guided liver aspirate yielded a pure growth of S. constellatus subspecies constellatus identified by conventional biochemical tests. In a standard antimicrobial disk-diffusion test, the isolate was susceptible to cefepime, cefotaxime, ceftriaxone, vancomcyin, levofloxacin, clindamycin and linezolid. Treatment with parenteral ceftriaxone alongwith appropriate surgical management led to resolution of the abscess with no recurrence of infection at three months follow-up.. The pathogenic potential of SAG has generally been disregarded because of the commensal nature of these microorganisms; however, streptococci belonging to this group have been increasingly reported as relevant pathogens in abscesses and blood cultures. An underlying condition, such as diabetes, cirrhosis or cancer or some medical manipulation, such as dental extraction, acupuncture, or hemorrhoidectomy is associated with the majority of patients with SAG abscess. However, the present case highlights the need to include S. constellatus and other members of the SAG while investigating for etiology of PLA, even in immunocompetent adults.

Topics: Adult; Anti-Bacterial Agents; Ceftriaxone; Disk Diffusion Antimicrobial Tests; Humans; Immunocompetence; Liver Abscess; Male; Streptococcal Infections; Streptococcus constellatus

We described a rare case of meningitis and infective endocarditis (IE) due to

Topics: Aged, 80 and over; Anti-Bacterial Agents; Ceftriaxone; Endocarditis; Female; Humans; Meningitis; Streptococcal Infections; Streptococcus pyogenes; Treatment Outcome

This study investigated the prevalence of recto-vaginal Group B Streptococcus (GBS) colonization, serotype distribution, and antimicrobial susceptibility patterns among pregnant women in Dongguan, China. Recto-vaginal swabs were collected from pregnant women at gestational age 35-37 weeks between January 1st 2009 and December 31st 2014. Isolates were serotyped by latex-agglutination and were tested against seven antimicrobials by disk diffusion. Of 7,726 pregnant women who completed GBS testing, 636 (8.2%) were GBS carriers. Of 153 GBS isolates available for typing, 6 serotypes (Ia, Ib, III, V, VI and VIII) were identified with type III being predominant, while 9 (5.9%) were non-typable isolates. All isolates were sensitive to penicillin, ceftriaxone, linezolid and vancomycin, whereas 52.4% were resistant to clindamycin, 25.9% were resistant to levofloxacin and 64.9% were resistant to erythromycin. This study showed the recto-vaginal colonization prevalence of GBS in Dongguan is significant. Due to 100% susceptibility to penicillin of all GBS samples, penicillin remains the first recommendation for treatment and prevention against GBS infection. Susceptibility testing should be performed for women allergic to penicillin in order to choose the most appropriate antibacterial agents for treatment and prevention of vertical transmission to neonates. In addition, we suggest establishing standard processes for GBS culture and identification in China as early as possible.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Ceftriaxone; China; Erythromycin; Female; Humans; Linezolid; Microbial Sensitivity Tests; Middle Aged; Penicillins; Pregnancy; Prevalence; Streptococcal Infections; Streptococcus agalactiae; Vancomycin; Young Adult

Topics: Anti-Bacterial Agents; Cardiac Surgical Procedures; Ceftriaxone; Echocardiography, Transesophageal; Endocarditis; Humans; Intracranial Embolism; Male; Middle Aged; Occipital Lobe; Parietal Lobe; Secondary Prevention; Skin Diseases; Streptococcal Infections; Streptococcus gordonii; Treatment Outcome

We report a case of recrudescent Streptococcus suis meningitis requiring a prolonged treatment course. A few similar cases can be found in the burgeoning literature on what remains a relatively uncommon disease in humans, and these patients should be monitored carefully upon completion of therapy.

Topics: Adult; Anti-Bacterial Agents; C-Reactive Protein; Ceftriaxone; Female; Follow-Up Studies; Humans; Meningitis, Bacterial; Recurrence; Streptococcal Infections; Streptococcus suis; United States

Topics: Administration, Oral; Botulinum Toxins, Type A; Ceftriaxone; Diagnosis, Differential; Esophageal Achalasia; Female; Humans; Infusions, Intravenous; Injections, Intralesional; Liver Abscess; Metronidazole; Middle Aged; Streptococcal Infections; Streptococcus intermedius; Tomography, X-Ray Computed; Treatment Outcome

We report a case of Streptococcus suis human disease in Ontario, Canada, caused by a serotype 2 strain genotypically similar to those commonly isolated from pigs in North America. Initially, the isolate was misidentified as a viridans group Streptococcus. Human S. suis infections may be underdiagnosed in North America.

Topics: Aged; Animals; Anti-Bacterial Agents; Ceftriaxone; Farmers; Humans; Immunoglobulins, Intravenous; Male; Ontario; Phylogeny; Serogroup; Streptococcal Infections; Streptococcus suis; Swine; Swine Diseases; Treatment Outcome

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

Topics: Anti-Infective Agents; Ceftriaxone; Endoscopy; Humans; Magnetic Resonance Imaging; Male; Metronidazole; Middle Aged; Pott Puffy Tumor; Sinusitis; Streptococcal Infections; Streptococcus anginosus; Tomography, X-Ray Computed

To analyze the clinical characteristics of blood stream infection caused by Streptococcus agalactiae in children and the drug-resistance of the isolates.. All cases with Streptococcus agalactiae growth in blood or cerebrospinal fluid cultures from January 1, 2011 to December 31, 2015 were enrolled by checking the laboratory information system (LIS) from 7 Class 3 Grade A hospitals (4 in Zhejiang, 2 in Shanghai and 1 in Chongqing). Clinical data were collected for analysis. χ(2) test, t test and non parametric test were used in the study.. One hundred and eighty-one pediatric cases of blood stream infection caused by Streptococcus agalactiae were included in current study. Eighty-six cases (47.5%) were male, and with age range from one day to 9 years (media 13 days). Thirty cases (16.6%) were premature infants and 127 cases (70.2%) were born via vaginal delivery. Seventy-one cases (39.2%) had early onset (<7 d) infections, and 106 cases (58.6%) had late onset (7-89 d) infections. Seventy-eight cases (43.1%) were complicated with purulent meningitis. Incidences of vaginal delivery(81.7%(58/71) vs. 62.3%(66/106)), shortness of breath moaning (43.7%(31/71) vs. 15.1%(16/106)) and preterm premature rupture of membranes (25.4%(18/71) vs. 3.8%(4/106)) were higher in the early onset infection group compared with the late onset group(P all<0.05). However, the number of cases who had fever(25.4%(18/71)vs.85.8%(91/106)) and complicated with purulent meningitis (29.6%(21/71) vs. 53.8%(57/106)) in early onset infections group was less than that in the late onset group(P both<0.05). The blood cultures of most patients (87.8%) were performed before the use of antibiotics. Drug-resistant tests showed that the sensitive rates to penicillin G, ceftriaxone and cefotaxime were 98.9%, 99.0% and 99.0% respectively. All strains were sensitive to vancomucine. The rates of resistance to clindamycin and erythromycin were 68.0% and 34.0%, respectively. Only 39 cases (22.0%) were treated with single antibiotics of either penicillins or cephalosporins, 80 cases (45.2%) were treated with antibiotics containing β lactamase inhibitor, 61 cases (34.5%) were treated with either meropenem or cefoperazone-sulbactam. One hundred and fifty-four cases were cured, while 19 died (including 13 complicated with purulent meningitis) and 8 lost to follow up after giving up of treatment.. The incidence and mortality of blood stream infection caused by Streptococcus agalactiae complicated with purulent meningitis are high in children. Penicillin is the first choice in treatment. Antibiotics should be selected accorrding to the drug-resistance test.

Topics: Anti-Bacterial Agents; Bacteremia; Cefotaxime; Ceftriaxone; Cephalosporins; Child; China; Clindamycin; Drug Resistance, Bacterial; Erythromycin; Female; Humans; Infant; Infant, Newborn; Male; Meningitis, Bacterial; Penicillins; Retrospective Studies; Streptococcal Infections; Streptococcus agalactiae

An 84-year-old man was admitted to our hospital with bloody sputum. He was found to have a right lower lobe wedge-shaped nodular lesion with chest X-ray and computed tomography of the chest. Ceftriaxone and minocycline were started empirically based on a working diagnosis of community-acquired pneumonia. Streptococcus parasanguinis was isolated with sputum cultures obtained on three consecutive days and was identified based on its biochemical properties. S. parasanguinis is a member of the sanguinis group of viridans Streptococci. It is known as a causative pathogen for endocarditis. There are very few reports of S. parasanguinis associated with pulmonary infections. The present report describes the association of S. parasanguinis with a wedge-shaped nodular lesion in the lungs.

Topics: Aged, 80 and over; Anti-Bacterial Agents; Ceftriaxone; Community-Acquired Infections; Humans; Male; Pneumonia; Streptococcal Infections; Streptococcus

An 84-year old woman came to the emergency department with sharp back pain on her left side that she'd had for 4 days. The pain radiated to her posterior hips when standing. She said her whole body felt achy and she was experiencing weakness in both legs.

Topics: Aged, 80 and over; Anti-Bacterial Agents; Back Pain; Ceftriaxone; Diagnosis, Differential; Female; Humans; Intervertebral Disc Degeneration; Muscle Weakness; Osteomyelitis; Streptococcal Infections; Streptococcus

Streptococcus agalactiae (GBS) has been implicated in urinary tract infections but the microbiological characteristics and antimicrobial susceptibility of these strains are poorly investigated. In this study, 87 isolates recovered from urine samples of patients who had attended the Spedali Civili of Brescia (Italy) and had single organism GBS cultured were submitted to antimicrobial susceptibility testing, molecular characterization of macrolide and levofloxacin resistance, PCR-based capsular typing and analysis of surface protein genes. By automated broth microdilution method, all isolates were susceptible to penicillin, cefuroxime, cefaclor, and ceftriaxone; 80%, 19.5% and 3.4% of isolates were non-susceptible to tetracycline, erythromycin, and levofloxacin, respectively. Macrolide resistance determinants were iMLS(B) (n=1), cMLS(B) (n=10) and M (n=5), associated with ermTR, ermB and mefA/E. Levofloxacin resistance was linked to mutations in gyrA and parC genes. Predominant capsular types were III, Ia, V, Ib and IX. Type III was associated with tetracycline resistance, while type Ib was associated with levofloxacin resistance. Different capsular type-surface protein gene combinations (serotype V-alp2, 3; serotype III-rib; serotype Ia-epsilon) were detected. A variety of capsular types are involved in significant bacteriuria. The emergence of multidrug resistant GBS may become a significant public health concern and highlights the importance of careful surveillance to prevent the emergence of these virulent GBS.

Topics: Anti-Bacterial Agents; Cefaclor; Ceftriaxone; Cefuroxime; Disk Diffusion Antimicrobial Tests; DNA Gyrase; Drug Resistance, Bacterial; Erythromycin; Humans; Levofloxacin; Penicillins; Streptococcal Infections; Streptococcus agalactiae; Tetracycline; Urinary Tract Infections

Topics: Aged; Anti-Infective Agents; Anticonvulsants; Brain Abscess; Ceftriaxone; Craniotomy; Drainage; Epilepsy; Epilepsy, Tonic-Clonic; Humans; Infusions, Intravenous; Magnetic Resonance Imaging; Male; Metronidazole; Paresis; Phenytoin; Streptococcal Infections; Tomography, X-Ray Computed; Viridans Streptococci

Topics: Anti-Bacterial Agents; Ceftriaxone; Cerebrospinal Fluid; Cerebrospinal Fluid Rhinorrhea; Cerebrospinal Fluid Shunts; Community-Acquired Infections; Dexamethasone; DNA, Bacterial; Drug Therapy, Combination; Female; Fistula; Humans; Magnetic Resonance Imaging; Meningitis; Middle Aged; Respiratory Tract Fistula; Ribotyping; Sphenoid Sinusitis; Streptococcal Infections; Streptococcus; Subarachnoid Space; Tomography, X-Ray Computed

Invasive group A streptococcal (GAS) strains often have genetic differences compared to GAS strains from nonsterile sites. Invasive, "hypervirulent" GAS strains can arise from a noninvasive progenitor following subcutaneous inoculation in mice, but such emergence has been rarely characterized in humans. We used whole genome analyses of multiple GAS isolates from the same patient to document the molecular basis for emergence of a GAS strain with an invasive phenotype during human infection. In contrast to previous theories, we found that elimination of production of the cysteine protease SpeB was not necessary for emergence of GAS with an invasive, "hypervirulent" phenotype.

Topics: Aged; Anti-Bacterial Agents; Ceftriaxone; Genetic Variation; Humans; Male; Sepsis; Skin Ulcer; Streptococcal Infections; Streptococcus pyogenes

Topics: Animals; Ceftriaxone; Dexamethasone; Drug Resistance, Multiple, Bacterial; Emergencies; Food Handling; Hearing Loss, Bilateral; Hearing Loss, Sensorineural; Humans; Labyrinthitis; Male; Meat; Meningitis, Bacterial; Middle Aged; Streptococcal Infections; Streptococcus suis; Swine

Bacteremia with streptococcus group G is a rare infection, particularly in the post-partum, but of which the incidence has been increasing since the end of the 20th century. The objective of our work is to report the clinical and the bacteriologic aspects, as well as the therapeutic modalities of an exceptional case of bacteremia with streptococcus group G, after a normal vaginal delivery, in a 26-year-old woman. Streptococcus group G being a part of the normal flora of the female genital tract, the endogenous contamination probably took place by passage in the blood circulation during the episiotomy.

Topics: Adult; Anti-Bacterial Agents; Bacteremia; Ceftriaxone; Drug Therapy, Combination; Episiotomy; Female; Gentamicins; Humans; Postpartum Period; Streptococcal Infections; Streptococcus; Treatment Outcome

A child with polyarthritis is always a diagnostic challenge for the treating physician. Polyarthritis can be a clinical manifestation of diverse disease processes, and the differential diagnosis is understandably very broad. We present a case of polyarticular septic arthritis, which is osteomyelitis complicated, caused by Streptococcus pyogenes identified by 16S polymerase chain reaction (PCR) in a healthy child, with previous synovial fluid cultures negative. This case underlines the importance of early aggressive therapy and the role of PCR/16S ribosomal bacterial DNA amplification to detect the causative microorganisms in septic arthritis when cultures remain negative.

Topics: Anti-Bacterial Agents; Arthritis, Infectious; Ceftriaxone; Child; Clindamycin; Humans; Male; Streptococcal Infections; Streptococcus pyogenes

We report a 60-year-old woman who presented with orbital cellulitis, restricted ocular motility, proptosis, and visual acuity of counting fingers in her left eye 3 days after strabismus surgery. Although she initially responded well to antibiotic and anti-inflammatory therapy, visual acuity in the left eye again decreased on postoperative day 5. Radiographic imaging revealed an intraconal orbital abscess, and she underwent left lateral orbitotomy with abscess drainage, with continued antibiotics and a tapering dose of steroids. To our knowledge, this is the first case of orbital cellulitis and intraconal abscess after strabismus surgery in an adult.

Topics: Abscess; Anti-Bacterial Agents; Ceftriaxone; Clindamycin; Drainage; Drug Therapy, Combination; Eye Infections, Bacterial; Female; Humans; Magnetic Resonance Imaging; Meropenem; Middle Aged; Oculomotor Muscles; Ophthalmologic Surgical Procedures; Orbital Cellulitis; Strabismus; Streptococcal Infections; Thienamycins; Tomography, X-Ray Computed; Visual Acuity

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

Spondylodiscitis, which is most commonly caused by Staphylococcus aureus, is an uncommon infection in adults. The diagnosis of spondylodiscitis is often delayed by its vague and non-specific presentations. As part of the normal flora in human mouth and sinuses, Streptococcus mitis is a very rare cause of spondylodiscitis. We report a case of thoracic spondylodiscitis caused by S. mitis in a patient with chronic sinusitis. The patient atypically presented with a sharp chest pain that radiated to the back and the imaging studies were initially negative. He failed outpatient pain management and the diagnosis of spondylodiscitis was confirmed by bone biopsy 6 weeks later. Treatment with antibiotics completely alleviated the pain. Increased awareness and a high index of suspicion are essential for early diagnosis of spondylodiscitis with an atypical presentation.

Topics: Anti-Bacterial Agents; Biopsy, Needle; Ceftriaxone; Chest Pain; Chronic Disease; Diagnosis, Differential; Discitis; Emergency Service, Hospital; Humans; Immunohistochemistry; Infusions, Intravenous; Magnetic Resonance Imaging; Male; Middle Aged; Pain Measurement; Severity of Illness Index; Sinusitis; Streptococcal Infections; Streptococcus mitis; Thoracic Vertebrae; Treatment Outcome; Vancomycin

We report a case of acute purulent meningitis caused by Streptococcus sanguinis after endoscopic ligation for oesophageal variceal haemorrhage in a cirrhotic patient without preceding symptoms of meningitis. Initial treatment with flomoxef failed. The patient was cured after 20 days of intravenous penicillin G. This uncommon infection due to S. sanguinis adds to the long list of infectious complications among patients with oesophageal variceal haemorrhage.

Topics: Aged; Anti-Bacterial Agents; Ceftriaxone; Cephalosporins; Esophageal and Gastric Varices; Esophagoscopy; Gastrointestinal Hemorrhage; Humans; Ligation; Liver Cirrhosis; Male; Meningitis, Bacterial; Penicillin G; Streptococcal Infections; Streptococcus sanguis

Topics: Anti-Bacterial Agents; Cardiotonic Agents; Ceftriaxone; Combined Modality Therapy; Communicable Diseases, Emerging; Drug Therapy, Combination; Humans; Immunocompetence; Male; Meningitis, Bacterial; Middle Aged; Pharyngitis; Respiration, Artificial; Sepsis; Streptococcal Infections; Streptococcus agalactiae; Vancomycin

Topics: Aged; Anti-Bacterial Agents; Aortic Valve; Bicuspid Aortic Valve Disease; Ceftriaxone; Endocarditis; Heart Defects, Congenital; Heart Valve Diseases; Humans; Male; Streptococcal Infections; Streptococcus oralis; Treatment Outcome

A 91-year-old dog-owning woman with a history of hypertension and femoral neck fracture consulted our hospital with fever and femur pain with redness. Laboratory test results showed leukocytosis with 85% neutrophils and high values of C-reactive protein and procalcitonin. In addition, growth of Gram-positive streptococcus was observed in two independent blood culture sets. The isolated bacterium was identified as Streptococcus canis on the basis of biochemical properties and sequencing analyses of the 16S rRNA gene. The patient recovered completely without critical illness following prompt antimicrobial treatment with ceftriaxone. S. canis, a β-hemolytic Lancefield group G streptococcus, is in general isolated from various animal sources, but its isolation from a human clinical sample is extremely rare. Since β-hemolytic streptococci can cause severe infectious diseases such as necrotizing fasciitis, it is absolutely necessary to start antimicrobial treatment immediately. It is necessary to identify pathogenic bacteria carefully and to obtain information on a patient's background, including history of contact with an animal, when S. canis is isolated.

Topics: Aged, 80 and over; Animals; Anti-Bacterial Agents; Ceftriaxone; Dogs; Female; Humans; Japan; Microbial Sensitivity Tests; Pets; Sepsis; Streptococcal Infections; Streptococcus; Zoonoses

Topics: Abscess; Adult; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Ceftriaxone; Clindamycin; Diagnosis, Differential; Humans; Male; Neck Pain; Soft Tissue Infections; Streptococcal Infections; Streptococcus pyogenes; Thyroid Diseases; Thyroid Gland; Tomography, X-Ray Computed; Ultrasonography

Infection of the central nervous system by streptococci is known to result in severe bacterial meningitis, however some strains have low pathogenic potential and affect the brain only in immunocompromised patients. Here we report the first case of an otherwise healthy non immunocompromised young adult woman who developed meningitis caused by Streptococcus dysgalactiae subspecies equisimilis. The patient was in the 17th week of her 3rd pregnancy. The course of the disease was quickly remittent under antibiotic treatment.

Topics: Adult; Ampicillin; Anti-Bacterial Agents; Ceftriaxone; Female; Humans; Meningitis, Bacterial; Pregnancy; Pregnancy Complications, Infectious; RNA, Ribosomal, 16S; Streptococcal Infections; Streptococcus

Liquid injectable silicone has been used to increase volume in determined cutaneous districts, particularly in aesthetical reconstructive surgery. Although considered biologically inert for a long time this substance produced various complications as granulomatous foreign body reaction (siliconomas), secondary limphedema, tissue destruction and lethal embolism. A 35-year-old Caucasian woman came to our department with erithema and edema on the right leg, fever and chills. A thorough examination of the patient's history revealed injection of liquid silicone 7 years before for cosmetic volume increase of both legs. A closer observation revealed a small fistulous element from which came out white-yellow puruloid material. Antibiotic therapy and drainage of the abscess were undertaken. Within few days of treatment erithema and swelling essentially improved and the patient was discharged. After two months she came back to our department due to the same disease on her left leg that we treated with the therapy previously used. We highlight the long time, 7 years, elapsed between liquid silicone injection and onset of cutaneous symptoms.

Topics: Abscess; Adrenal Cortex Hormones; Adult; Anti-Bacterial Agents; Ceftriaxone; Cosmetic Techniques; Cutaneous Fistula; Drainage; Drug Therapy, Combination; Edema; Erythema; Female; Humans; Injections, Subcutaneous; Leg Injuries; Rifamycins; Silicones; Streptococcal Infections; Streptococcus agalactiae; Time Factors; Wound Infection

A Pott's puffy tumour is a subperiosteal abscess and osteomyelitis of the frontal bone secondary to frontal sinusitis. Intracranial complications are seen in approximately 40 per cent of cases and are potentially life-threatening; such complications have not previously been reported in pregnancy.. A 21-year-old woman at 35 weeks' gestation presented with a history of frontal headaches and swelling, periorbital oedema, pain and chemosis. Imaging confirmed Pott's puffy tumour with right-sided epidural empyema and periorbital cellulitis. A multidisciplinary team was involved in the patient's management. Intravenous antibiotics were commenced and initial percutaneous drainage through the frontal sinus skin was performed, followed by endoscopic sinus drainage. A caesarean section was performed 3 days later. Complete resolution of the sinus and intracranial collections was noted on imaging performed six weeks later.. This case highlights the challenges of managing rare intracranial complications of sinusitis in pregnancy, and the importance of multidisciplinary care.

Topics: Anti-Bacterial Agents; Catheterization; Ceftriaxone; Cesarean Section; Drainage; Drug Therapy, Combination; Endoscopy; Female; Frontal Sinusitis; Headache; Humans; Magnetic Resonance Imaging; Meropenem; Orbital Cellulitis; Patient Care Team; Pott Puffy Tumor; Pregnancy; Pregnancy Complications, Infectious; Streptococcal Infections; Thienamycins; Treatment Outcome; Vancomycin; Young Adult

We describe the case of a 70-year-old woman who presented with symptoms of cardiac failure, and was found on clinical examination to have a purpuric rash over her lower extremities. Further evaluation of cardiac failure revealed tricuspid regurgitation with two large tricuspid valve vegetations. Blood cultures yielded a growth of Streptococcus viridans. She was treated with an intravenous ceftriaxone and gentamicin and made a complete recovery with resolution of the rash.

Topics: Aged; Anti-Bacterial Agents; Ceftriaxone; Endocarditis, Bacterial; Female; Gentamicins; Heart Failure; Humans; Purpura; Streptococcal Infections; Tricuspid Valve; Viridans Streptococci

To compare the prevalence, phenotypes, and genes responsible for erythromycin resistance among Streptococcus pyogenes isolates from Mexico and the USA.. Eighty-nine invasive and 378 non-invasive isolates from Mexico, plus 148 invasive, 21 non-invasive, and five unclassified isolates from the USA were studied. Susceptibilities to penicillin, erythromycin, clindamycin, ceftriaxone, and vancomycin were evaluated according to Clinical and Laboratory Standards Institute (CLSI) standards. Phenotypes of erythromycin resistance were identified by triple disk test, and screening for mefA, ermTR, and ermB genes was carried out by PCR.. All isolates were susceptible to penicillin, ceftriaxone, and vancomycin. Erythromycin resistance was found in 4.9% of Mexican strains and 5.2% of USA strains. Phenotypes in Mexican strains were 95% M and 5% cMLS; in strains from the USA, phenotypes were 33.3% iMLS, 33.3% iMLS-D, and 33.3% M. Erythromycin resistance genes in strains from Mexico were mefA (95%) and ermB (5%); USA strains harbored ermTR (56%), mefA (33%), and none (11%). In Mexico, all erythromycin-resistant strains were non-invasive, whereas 89% of strains from the USA were invasive.. Erythromycin resistance continues to exist at low levels in both Mexico and the USA, although the genetic mechanisms responsible differ between the two nations. These genetic differences may be related to the invasive character of the S. pyogenes isolated.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Bacterial Proteins; Ceftriaxone; Child; Child, Preschool; Clindamycin; Drug Resistance, Bacterial; Erythromycin; Genotype; Humans; Infant; Membrane Proteins; Methyltransferases; Mexico; Microbial Sensitivity Tests; Middle Aged; Penicillins; Phenotype; Prevalence; Streptococcal Infections; Streptococcus pyogenes; United States; Vancomycin; Young Adult

Topics: Anti-Bacterial Agents; beta-Lactam Resistance; Ceftriaxone; Female; Humans; Penicillin G; Prosthesis-Related Infections; Streptococcal Infections; Streptococcus agalactiae

Topics: Abscess; Aged; Anti-Bacterial Agents; Ceftriaxone; Coinfection; Combined Modality Therapy; Drainage; Humans; Klebsiella Infections; Klebsiella pneumoniae; Magnetic Resonance Imaging; Male; Peripheral Arterial Disease; Pyomyositis; Quadriceps Muscle; Streptococcal Infections; Viridans Streptococci

Streptococcus agalactiae is not only a well-known cause of severe infections in the first 3 months of life but also an unusual organism to be isolated in case of septic arthritis, especially in children. We report a case of a monoarticular arthritis in a 6-month-old girl.

Topics: Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Arthralgia; Arthritis, Infectious; Ceftriaxone; Female; Humans; Infant; Knee Joint; Rifampin; Streptococcal Infections; Streptococcus agalactiae; Ultrasonography

Topics: Anti-Bacterial Agents; Anticoagulants; Arteriovenous Fistula; Atrial Fibrillation; Bacteremia; Ceftriaxone; Combined Modality Therapy; Coronary Disease; Coronary Sinus; Coronary Vessel Anomalies; Endocarditis, Bacterial; Heart Valve Diseases; Humans; Ligation; Male; Middle Aged; Mitral Valve; Pulmonary Embolism; Streptococcal Infections; Streptococcus mitis; Tricuspid Valve; Ultrasonography

Topics: Anti-Bacterial Agents; Brain Abscess; Ceftriaxone; Drug Therapy, Combination; Endophthalmitis; Eye Infections, Bacterial; Frontal Lobe; Humans; Infusions, Intravenous; Magnetic Resonance Imaging; Male; Metronidazole; Middle Aged; Streptococcal Infections; Streptococcus constellatus; Visual Acuity; Vitrectomy

A 26-year-old male intravenous drug user (IDU) presented twice within 6 months with relapsed polymicrobial infective endocarditis (IE) due to Eikenella corrodens and Streptococcus constellatus after completing two courses of appropriate antimicrobial therapy. This report points to relapsing endocarditis as a clinical entity that warrants attention in IDUs when E. corrodens or S. constellatus are causative agents of IE.

Topics: Adult; Ceftriaxone; Coinfection; Eikenella corrodens; Endocarditis, Bacterial; Gram-Negative Bacterial Infections; Humans; Male; Metronidazole; Oxacillin; Recurrence; Streptococcal Infections; Streptococcus constellatus; Substance-Related Disorders

Streptococcus pyogenes or group A streptococcus (GAS) is responsible for serious invasive infections with a risk of secondary infection in patients with more contact than in the general population. Regardless of clustering, few intrafamilial invasive infections have been reported despite a recent increase in the incidence of invasive GAS disease. We report the cases of two brothers, one a boy of 8.5 years with toxic shock syndrome with no bacteria identified and the second, 1 week later, his 14.5-year-old brother in hospital for sepsis due to GAS. The occurrence of a confirmed case of invasive GAS and a probable case within such a short period met the definition of clustered cases. Both brothers showed no risk factors for invasive disease and no gateway including skin was found. Antibiotic therapy was initiated in the family as recommended by the French Higher Council of Public Hygiene.

Topics: Adolescent; Anti-Bacterial Agents; Azithromycin; Bacteremia; Ceftriaxone; Chemoprevention; Child; Clindamycin; Cluster Analysis; Drug Therapy, Combination; Emergencies; Family; Humans; Male; Risk Factors; Severity of Illness Index; Shock, Septic; Siblings; Streptococcal Infections; Streptococcus pyogenes; Treatment Outcome

Topics: Aged; Anti-Bacterial Agents; Aortic Coarctation; Bacteremia; Cardiomegaly; Ceftriaxone; Disease Susceptibility; Drug Therapy, Combination; Endocarditis, Bacterial; Female; Gentamicins; Humans; Streptococcal Infections; Ultrasonography; Viridans Streptococci

Neurological symptoms of patients suffering from neurodegenerative diseases such as Alzheimer's dementia (AD), Parkinson's disease (PD), or amyotrophic lateral sclerosis (ALS) often worsen during infections. We assessed the disease-modulating effects of recurrent systemic infections with the most frequent respiratory pathogen, Streptococcus pneumoniae, on the course of AD, PD, and ALS in mouse models of these neurodegenerative diseases [transgenic Tg2576 mice, (Thy1)-[A30P]alpha SYN mice, and Tg(SOD1-G93A) mice]. Mice were repeatedly challenged intraperitoneally with live S. pneumoniae type 3 and treated with ceftriaxone for 3 days. Infection caused an increase of interleukin-6 concentrations in brain homogenates. The clinical status of (Thy1)-[A30P]alpha SYN mice and Tg(SOD1-G93A) mice was monitored by repeated assessment with a clinical score. Motor performance was controlled by the tightrope test and the rotarod test. In Tg2576 mice, spatial memory and learning deficits were assessed in the Morris water maze. In none of the three mouse models onset or course of the disease as evaluated by the clinical tests was affected by the recurrent systemic infections performed. Levels of alpha-synuclein in brains of (Thy1)-[A30P]alpha SYN mice did not differ between infected animals and control animals. Plaque sizes and concentrations of A beta 1-40 and A beta 1-42 were not significantly different in brains of infected and uninfected Tg2576 mice. In conclusion, onset and course of disease in mouse models of three common neurodegenerative disorders were not influenced by repeated systemic infections with S. pneumoniae, indicating that the effect of moderately severe acute infections on the course of neurodegenerative diseases may be less pronounced than suspected.

Topics: Acute Disease; alpha-Synuclein; Alzheimer Disease; Amyloid beta-Peptides; Amyotrophic Lateral Sclerosis; Animals; Anti-Bacterial Agents; Ceftriaxone; Disease Models, Animal; Disease Progression; Interleukin-6; Maze Learning; Memory Disorders; Mice; Mice, Transgenic; Neurodegenerative Diseases; Neuropsychological Tests; Parkinson Disease; Plaque, Amyloid; Pneumonia, Bacterial; Recurrence; Streptococcal Infections; Streptococcus pneumoniae; Up-Regulation

Topics: Anti-Bacterial Agents; beta-Lactam Resistance; Ceftriaxone; Female; Hip Joint; Humans; Microbial Sensitivity Tests; Middle Aged; Penicillin G; Prosthesis-Related Infections; Streptococcal Infections; Streptococcus agalactiae

Topics: Aged; Anti-Bacterial Agents; Anti-Inflammatory Agents; Ceftriaxone; Dexamethasone; Female; Humans; Incidence; Penicillin G; Postoperative Complications; Practice Guidelines as Topic; Registries; Splenectomy; Streptococcal Infections; Streptococcus pneumoniae; Time Factors; Vancomycin; Victoria

This study included 31 patients who had definite or possible infectious endocarditis as defined by the modified Duke's criteria Of these patients, 27 were treated with ceftriaxone plus gentamycin combination therapy and four with ceftriaxone monotherapy. Of these 31 cases, 29 had infections with Streptococcus species, and showed good responses to penicillin G and cefotaxime. Excluding one patient who died because of the underlying disease, all patients achieved clinical cure after treatment with either of the two regimens, showing no recurrence during a follow-up period of 6 months after completion of drug treatment. Although valve replacement was performed in 10 patients during the follow-up period, there were no recurrences in any of these patients 6 months postoperatively. Ceftriaxone allows a simple regimen of once-daily administration. Although indications are limited, ceftriaxone therapy is feasible on an outpatient basis, offering favorable medical economics. Consistent with previous reports, the therapeutic effect of ceftriaxone was equivalent to that of penicillin G in this study, showing this agent to be an alternative first-line drug for infectious endocarditis.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Ceftriaxone; Drug Therapy, Combination; Endocarditis, Bacterial; Female; Gentamicins; Humans; Japan; Male; Microbial Sensitivity Tests; Middle Aged; Streptococcal Infections; Streptococcus

Bacterial meningitis is associated with intense inflammation and also linked to the production of reactive oxygen species. To this aim, animals underwent a magna cistern tap and received either sterile saline as a placebo or an equivalent volume of a Streptococcus pneumoniae suspension. The animals began antibiotic therapy 16h after induction. The animals were sacrificed at 24 or 48h post-infection and the hippocampus and cortex were harvested. The activity of the enzymes superoxide dismutase, catalase, and thiobarbituric acid reactive species, protein carbonyls, and free sulphydryl groups were altered, but reversed, in part, by the antibiotic treatment. Our results support the hypothesis that antibiotic treatment prevents, in part, the oxidative stress in the bacterial meningitis induced by Streptococcus pneumoniae.

Topics: Animals; Anti-Bacterial Agents; Brain; Ceftriaxone; Cerebral Cortex; Hippocampus; Male; Meningitis, Bacterial; Oxidative Stress; Rats; Rats, Wistar; Streptococcal Infections; Streptococcus pneumoniae

Lemierre's syndrome is characterized by acute oropharyngeal infection with secondary internal jugular vein thrombophlebitis and subsequent metastatic infections. The anaerobe Fusobacterium necrophorum is the usual etiologic agent, although other microorganisms, including Streptococcus, Staphylococcus, Enterococcus, Bacteroides, and Lactobacilli, may be present alone or in combination with F. necrophorum. Common sites of metastatic infection include the lungs and joints. Thromboembolic complications, such as septic pulmonary embolism, persistent jugular vein occlusion, hepatic abscesses, and nephropathy, may occur. We report a case of Lemierre's syndrome in a 3-year-old Caucasian boy who subsequently presented with manifestations of a fourth (trochlear) nerve palsy.

Topics: Anti-Bacterial Agents; Ceftriaxone; Child, Preschool; Clindamycin; Humans; Male; Streptococcal Infections; Trochlear Nerve Diseases; Viridans Streptococci

Deep face and neck infections are potentially life threatening if they are not diagnosed in time and then treated quickly. This report describes a case of face and deep neck infection, associated with a semi-impacted and decayed wisdom tooth in a cardiopathic, immunosuppressed patient suffering from, diabetes, hypothyroidism, osteoporosis, breathlessness, chronic bronchitis, with oral, cutaneous and vaginal erythematous lichen, Cushing's Syndrome, penicillin allergy, subjected to past hypophysectomy. The swelling was, first of all, treated in urgency, with an intravenous antibiotic therapy and, immediately afterwards, the phlegmonous infiltration linked to the avulsion of the lower third molar was surgically drained. The patient was then treated with intravenous multiple antibiotics, with the aim of eradicating the predominating bacteria that was encountered in the microbiological culture test. A complete remission of the pathological picture was obtained .

Topics: Aged; Airway Obstruction; Anti-Bacterial Agents; Ceftriaxone; Cellulitis; Combined Modality Therapy; Comorbidity; Emergencies; Face; Female; Humans; Immunocompromised Host; Mediastinitis; Molar, Third; Myositis; Neck; Periodontal Abscess; Streptococcal Infections; Tooth Extraction; Tooth, Impacted

A 54-year-old female patient with a congenital ventricular septal defect (VSD) was admitted to the authors' hospital for an investigation of mild fever of four months' duration. Her history revealed pulmonary valve endocarditis contracted 18 years previously. Echocardiography revealed an echogenic mobile mass on the pulmonic valve that caused mild regurgitation, while blood cultures were positive for Streptococcus viridans. The patient was administered ceftriaxone and gentamycin, and had an uneventful clinical course. She was advised to undergo surgical closure of the VSD in order to avoid any recurrence of endocarditis.

Topics: Anti-Bacterial Agents; Ceftriaxone; Echocardiography, Transesophageal; Endocarditis, Bacterial; Female; Gentamicins; Heart Septal Defects, Ventricular; Humans; Middle Aged; Pulmonary Valve; Recurrence; Streptococcal Infections; Viridans Streptococci

Orbital cellulitis is a rare complication of strabismus surgery. We report a case of a 4-year-old boy with bilateral orbital cellulitis after uneventful surgery to correct esotropia. Concomitant sinusitis was the likely source of infection. To our knowledge, this is the first case of bilateral orbital cellulitis following strabismus surgery.

Topics: Anti-Bacterial Agents; Ceftriaxone; Child, Preschool; Humans; Male; Orbital Cellulitis; Postoperative Complications; Sinusitis; Strabismus; Streptococcal Infections; Streptococcus pyogenes; Tomography, X-Ray Computed

A rare case of parapharyngeal abscess caused by Streptococcus pneumoniae presenting as neck abscess is reported. The patient had 20 days history of cough, fever and swelling behind right ear. He had not responded to multiple antibiotic treatments given earlier. On the basis of clinical examination and CT scan finding, he was diagnosed as having parapharyngeal abscess pointing in the neck. The abscess was drained and the patient was treated with injectable Ceftriaxone, due to identification of penicillin - resistant Streptococcus pneumoniae.

Topics: Abscess; Acute Disease; Aged; Anti-Bacterial Agents; Ceftriaxone; Combined Modality Therapy; Drainage; Humans; Male; Mastoiditis; Pharyngeal Diseases; Streptococcal Infections

We report a 47 year-old diabetic male, admitted due to metabolic decompensation, malaise, purulent pharyngeal discharge and a mass in the posterior cervical region. Blood glucose was 270 mg/dl, a nasopharyngoscopy showed a pharyngeal phlegmon and CT scan confirmed the presence of a phlegmon in the retropharyngeal region. He was treated with sodium penicillin, cloxacillin and ceftriazone and the phlegmon was drained surgically. The culture of the purulent discharge gave growth to a Group B Streptococcus. The evolution was favorable and the patient completed seven days with intravenous antimicrobials and additional seven days with oral ampicillin/sulbactam.

Topics: Anti-Bacterial Agents; Ceftriaxone; Cellulitis; Cloxacillin; Diabetes Complications; Humans; Male; Middle Aged; Neck; Retropharyngeal Abscess; Streptococcal Infections; Streptococcus agalactiae

Topics: Adult; Anti-Bacterial Agents; Ceftriaxone; Clindamycin; Female; Humans; Immunoglobulins, Intravenous; Pyomyositis; Shock, Septic; Streptococcal Infections; Streptococcus pyogenes; Time Factors

A 90-year-old man was diagnosed with monoarticular arthritis due to pseudogout and Abiotrophia defectiva infection. A. defectiva is recognized as a cause of endocarditis, but is rarely described in septic arthritis. To our knowledge, this is one of the few case reports of septic arthritis due to this organism, and the first in association with pseudogout. This report supports the routine culture of synovial fluid and is further evidence for the role of A. defectiva in septic arthritis.

Topics: Aged, 80 and over; Anti-Bacterial Agents; Arthritis, Infectious; Calcium Pyrophosphate; Ceftriaxone; Chondrocalcinosis; Drug Therapy, Combination; Humans; Knee Joint; Male; Ofloxacin; Streptococcal Infections; Streptococcus

Topics: Agricultural Workers' Diseases; Animals; Anti-Bacterial Agents; Australia; Ceftriaxone; Drug Therapy, Combination; Endocarditis, Bacterial; Female; Gentamicins; Humans; Male; Middle Aged; Penicillin G; Streptococcal Infections; Streptococcus suis; Swine; Treatment Outcome

To describe the first case of a group A beta-hemolytic streptococcus laryngotracheobronchitis as well as the other possible etiologies in a case of acute dyspnea.. We report the case of a 46-year-old woman with a doubtful vaccination status who presented clinical features of croup (laryngotracheobronchitis). She developed respiratory distress and required endotracheal intubation.. The endoscopy demonstrated a great deal of crust and pseudomembrane detachment. Bacterial culture grew group A beta-hemolytic streptococcus. Progression was good with antibiotics and corticosteroid treatment.. Bacterial acute pseudomembranous croup (laryngotracheobronchitis) is rare. We must search for the most frequent diagnoses such as diphtheria and epiglottitis. This is the first case to be reported in the literature.

Topics: Acute Disease; Amoxicillin; Anti-Bacterial Agents; Anti-Infective Agents; Anti-Inflammatory Agents; Bronchitis; Ceftriaxone; Ciprofloxacin; Croup; Drug Therapy, Combination; Female; Follow-Up Studies; Humans; Laryngitis; Laryngoscopy; Methylprednisolone; Middle Aged; Streptococcal Infections; Streptococcus pyogenes; Time Factors; Tracheitis; Treatment Outcome

Topics: Adult; Anaphylaxis; Anti-Bacterial Agents; Ceftriaxone; Cesarean Section; Chorioamnionitis; Female; Fetal Membranes, Premature Rupture; Gestational Age; Humans; Obstetric Labor Complications; Pregnancy; Streptococcal Infections

S. pneumoniae continues to be a major cause of invasive disease worldwide with considerable mortality and morbidity. Here we report the emergence of penicillin intermediate resistance to S. pneumoniae in India, which may predispose for an increased incidence of invasive pneumococcal disease in both children and adults with multi-drug resistance profile resulting in clinical failure.

Topics: Adult; Anti-Bacterial Agents; Ceftriaxone; Drug Therapy, Combination; Humans; India; Male; Oxacillin; Penicillin Resistance; Streptococcal Infections; Streptococcus pneumoniae; Vancomycin

Topics: Adult; Anti-Bacterial Agents; Anti-Inflammatory Agents; Ceftriaxone; Humans; Male; Methylprednisolone; Skin Diseases, Bacterial; Streptococcal Infections; Streptococcus pyogenes

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

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

Viridans streptococci are a major cause of infective endocarditis, and penicillin non-susceptibility is increasing in these organisms. We present the initial reported case of infective endocarditis due to penicillin non-susceptible viridans streptococci successfully treated with ceftriaxone monotherapy. The lack of evidence supporting the recommendations for treatment of endocarditis due to penicillin non-susceptible viridans streptococci is discussed.

Topics: Anti-Bacterial Agents; Ceftriaxone; Endocarditis, Bacterial; Humans; Male; Middle Aged; Penicillin Resistance; Streptococcal Infections; Treatment Outcome; Viridans Streptococci

A prosthetic aortic valve was implanted in a 41-year-old patient with connatal aortic stenosis. 14 months later a bacterial endocarditis was diagnosed and treated with ceftriaxone. 6 weeks later he had a relapse. Satellite streptococci could be cultivated from three blood cultures, later identified as Granulicatella adiacens. The patient was treated with penicillin and gentamicin.. In a short review of the literature the most important aspects of pathogenesis, diagnostics and therapy of endocarditis due to satellite streptococci are presented.

Topics: Adult; Aortic Valve; Aortic Valve Stenosis; Bacteremia; Bacteriological Techniques; Ceftriaxone; Drug Therapy, Combination; Endocarditis, Bacterial; Gentamicins; Heart Valve Prosthesis Implantation; Humans; Male; Mitral Valve; Penicillin G; Postoperative Complications; Recurrence; Streptococcal Infections; Streptococcus

Topics: Acute Disease; Ceftriaxone; Child; Enalapril; Female; Glomerulonephritis; Humans; Salmonella Infections; Streptococcal Infections; Time Factors

Streptococcus acidominimus resembles Streptococcus viridans, but they can now be differentiated by phenotypic studies. Only a single previous case of pneumonia, pericarditis, and meningitis has been reported.. We recently encountered a patient with brain abscess from which S acidominimus was isolated after initially being recorded as S viridans. Because 49% of all S viridans isolated from abscesses are resistant to beta-lactam antimicrobials, speciation is important as well as in vitro sensitivity testing. Streptococcus acidominimus is ordinarily sensitive to beta-lactams, and the use of ceftriaxone for 6 weeks successfully resulted in cure of the brain abscess.. The use of speciation in treatment of S viridans should improve clinical outcomes.

Topics: Anti-Bacterial Agents; Brain Abscess; Ceftriaxone; Humans; Male; Middle Aged; Streptococcal Infections

Topics: Adult; Agricultural Workers' Diseases; Bacteremia; Ceftriaxone; Diagnosis, Differential; Humans; Magnetic Resonance Imaging; Male; Meningitis, Bacterial; Microbial Sensitivity Tests; Sinusitis; Streptococcal Infections; Streptococcus equi; Tomography, X-Ray Computed; Virulence

We report the case of an elderly woman presenting with group G streptococcal septicaemia associated with osteomyelitis and endophthalmitis.

Topics: Administration, Topical; Aged, 80 and over; Anti-Bacterial Agents; Bacteremia; Blindness; Ceftriaxone; Chloramphenicol; Clindamycin; Dexamethasone; Endophthalmitis; Eye Enucleation; Female; Humans; Injections, Intravenous; Metatarsal Bones; Ofloxacin; Osteomyelitis; Streptococcal Infections; Streptococcus; Treatment Outcome

Streptococcus equi subspecies equi is involved in human infection. We present a case of meningitis in a 75-year-old patient with a favorable outcome after ceftriaxone and dexamethasone therapy. To our knowledge, it is the first case reported in an adult.

Topics: Aged; Anti-Bacterial Agents; Anti-Inflammatory Agents; Ceftriaxone; Dexamethasone; Drug Therapy, Combination; Fatal Outcome; Female; Follow-Up Studies; Humans; Meningitis, Bacterial; Streptococcal Infections; Streptococcus equi

A 68-year-old man with septic discitis of low lumbar spine is presented. The patient suffered an acute hemorrhagic stroke due to rupture of mycotic aneurysm. Streptococcus bovis biotype I was found in blood cultures. Echocardiography showed bioprosthesis aortic endocarditis. Cardiac surgery was not performed because of normal bioprosthesis function and absence of peri-annular complications. The patient was discharged after 6 weeks of antibiotic treatment.

Topics: Aged; Anti-Bacterial Agents; Bioprosthesis; Ceftriaxone; Discitis; Drug Therapy, Combination; Endocarditis, Bacterial; Gentamicins; Humans; Lumbar Vertebrae; Male; Streptococcal Infections; Streptococcus bovis; Treatment Outcome

Topics: Abscess; Adolescent; Anti-Infective Agents; Ceftriaxone; Drainage; Glomerulonephritis; Humans; Male; Mastoid; Metronidazole; Otitis Media, Suppurative; Sinus Thrombosis, Intracranial; Streptococcal Infections; Streptococcus milleri Group

Endocarditis due to Abiotrophia sp. is rare and often associated with negative blood cultures. The rates of treatment failure, infection relapse and mortality are higher than in endocarditis caused by other viridans streptococci.. A retrospective review of A. defectiva endocarditis in a patient with prosthetic aortic valve and in a patient with Marfan syndrome was performed.. A. defectiva, susceptible to penicillin (MIC 0.064 mg/l and 0.016 mg/l, respectively) was isolated from blood cultures of both patients. Treatment with penicillin and gentamicin was started in both patients. Since the first patient developed a macular rash and leukopenia, penicillin was substituted with ceftriaxone. Both patients responded well to antibiotic treatment, did not need prosthetic valve insertion or reinsertion, and were without any sequelae at one year follow up.. Standard treatment of bacterial endocarditis with penicillin and gentamicin was effective in both patients. In contrast to previous reports, the present patients had a favorable outcome on completion of treatment and at one-year follow up.

Topics: Adult; Anti-Bacterial Agents; Aortic Valve; Ceftriaxone; Drug Therapy, Combination; Endocarditis, Bacterial; Gentamicins; Heart Valve Prosthesis; Humans; Male; Marfan Syndrome; Middle Aged; Penicillins; Prosthesis-Related Infections; Streptococcal Infections

As increasing numbers of patients are being treated with outpatient parenteral antimicrobial therapy (OPAT), it becomes ever more important to ascertain the risks and benefits of such treatment for patients.. We conducted a retrospective analysis of 1,515 patients with methicillin-sensitive Staphylococcus aureus infections who were treated with outpatient parenteral antimicrobial monotherapy. All patients were included in the adverse drug reaction analysis; 1,252 were evaluable for purposes of evaluating treatment efficacy.. The six antibiotics most frequently used in this study (ceftriaxone, cefazolin, vancomycin, oxacillin, nafcillin, and clindamycin) appeared to be equivalent in achieving the desired efficacy outcome.. Vancomycin was associated with a significantly greater number of side effects than was ceftriaxone, cefazolin, or oxacillin, and nafcillin was associated with a significantly greater number of adverse events than ceftriaxone.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Cefazolin; Ceftriaxone; Child; Child, Preschool; Clindamycin; Drug Monitoring; Female; Home Infusion Therapy; Humans; Infant; Infusions, Parenteral; Male; Middle Aged; Nafcillin; Oxacillin; Retrospective Studies; Streptococcal Infections; Treatment Outcome; Vancomycin

Epidural abscess following epidural analgesia is an unusual event especially in pediatric patients. Two patients presented with fever and local signs of infection without neurological deficit on day 4 after the initiation of epidural analgesia. Neuro-imaging studies revealed epidural abscess. Both pediatric patients were treated successfully with intravenous antibiotics. One of the patients' initial MRI was normal. However, the symptoms persisted and a followed-up scan revealed epidural abscess. The other patient presented with worsening local indurations over the epidural insertion site and positive blood culture with Hemolytic streptococcus. Our experience suggests that neuro-imaging study should be strongly considered to evaluate pediatric patients with suspicion of epidural abscess.

Topics: Analgesia, Epidural; Anti-Bacterial Agents; Ceftriaxone; Cephalosporins; Child; Epidural Abscess; Female; Fundoplication; Humans; Infant; Magnetic Resonance Imaging; Male; Reflex Sympathetic Dystrophy; Spinal Cord; Streptococcal Infections; Vancomycin

To explore pharmacokinetic factors underlying the poor bacteriologic eradication rate with a single 500-mg dose of ceftriaxone for streptococcal tonsillopharyngitis and to identify the minimum ceftriaxone dose required for effective treatment.. Population modeling techniques were applied to pharmacokinetic data derived from paired plasma and tonsil samples from 153 children to assess the contribution of pharmacokinetic variability to patients' responses to ceftriaxone. In addition, a Monte Carlo simulation was performed to determine (1) the amount of time that free ceftriaxone concentrations must exceed the minimum inhibitory concentration (MIC) of group A Streptococcus to achieve bacteriologic eradication and (2) the ceftriaxone dose required to maintain free drug concentrations above the target MIC for the requisite amount of time. Ceftriaxone MICs for group A Streptococcus were obtained from a previous trial, in which all MICs (n = 115) were < or = 0.064 mg/L; 33.9% were susceptible at < or = 0.016 mg/L, 66.4% were susceptible at 0.032 mg/L, and 1.7% were susceptible at 0.064 mg/L.. Mean population pharmacokinetic parameters and their variances reflected substantial variability of clearance and half-life in the target population. Tonsillar ceftriaxone protein binding was 89.1%. The proportions of 1000 simulated patients with free ceftriaxone concentrations that exceeded MICs of 0.016 mg/L, 0.032 mg/L, and 0.064 mg/L at 24 hours were 71.7%, 65.4%, and 57.2%, respectively, and at 48 hours were 41.8%, 35.8%, and 28.6%, respectively. The amount of time that free ceftriaxone concentrations need to exceed MIC to achieve bacteriologic success was estimated to be 36 hours. Using this time criterion, two 500-mg doses of ceftriaxone separated by 18 hours should achieve a bacteriologic cure rate of approximately 95%.. Pharmacokinetic variability and high ceftriaxone tonsillar protein binding explain the high microbiologic failure rate for a single 500-mg dose of ceftriaxone in group A streptococcal tonsillopharyngitis. Monte Carlo simulation suggests that a second dose administered 18 hours after the first will be required to achieve an acceptable bacteriologic cure rate.

Topics: Anti-Bacterial Agents; Ceftriaxone; Child; Child, Preschool; Drug Administration Schedule; Female; Humans; Injections, Intramuscular; Male; Microbial Sensitivity Tests; Models, Biological; Monte Carlo Method; Palatine Tonsil; Pharyngitis; Protein Binding; Streptococcal Infections; Streptococcus pyogenes; Tonsillitis

Bacteria in the Streptococcus milleri group (S. anginosus, S. constellatus, and S. intermedius) are associated with bacteremia and abscess formation. While most reports of Streptococcus milleri group (SMG) infection occur in patients with underlying medical conditions, SMG infections during pregnancy have been documented. However, SMG infections in pregnant women are associated with either neonatal or maternal puerperal sepsis. Albeit rare, S. milleri spinal-epidural abscess in pregnancy has been reported, always as a complication of spinal-epidural anesthesia. We report a case of spinal-epidural abscess caused by SMG in a young, pregnant woman without an antecedent history of spinal epidural anesthesia and without any underlying risk factors for invasive streptococcal disease.. A 25 year old pregnant woman developed neurological symptoms consistent with spinal cord compression at 20 weeks gestation. She underwent emergency laminectomy for decompression and was treated with ceftriaxone 2 gm IV daily for 28 days. She was ambulatory at the time of discharge from the inpatient rehabilitation unit with residual lower extremity weakness.. To our knowledge, this is the first reported case of a Streptococcus milleri epidural abscess in a healthy, pregnant woman with no history of epidural anesthesia or invasive procedures. This report adds to the body of literature on SMG invasive infections. Treatment of SMG spinal-epidural abscess with neurologic manifestations should include prompt and aggressive surgical decompression coupled with targeted anti-infective therapy.

Topics: Adult; Anti-Bacterial Agents; Ceftriaxone; Epidural Abscess; Female; Humans; Pregnancy; Streptococcal Infections; Streptococcus milleri Group

Topics: Anti-Bacterial Agents; Bronchoscopy; Ceftriaxone; Diagnosis, Differential; Discitis; Follow-Up Studies; Humans; Liver Abscess; Lung Abscess; Male; Middle Aged; Pneumonia, Bacterial; Radiography, Thoracic; Streptococcal Infections; Streptococcus intermedius; Time Factors; Tomography, X-Ray Computed

Topics: Anti-Bacterial Agents; Aortic Valve; Ceftriaxone; Chronic Disease; Cough; Diagnosis, Differential; Echocardiography, Transesophageal; Endocarditis, Subacute Bacterial; Humans; Male; Middle Aged; Streptococcal Infections; Streptococcus bovis; Treatment Outcome

Topics: Adult; Anti-Bacterial Agents; Ceftriaxone; Chorioamnionitis; Fatal Outcome; Female; Fetal Death; Humans; Infant, Newborn; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Recurrence; Streptococcal Infections; Streptococcus agalactiae

Group B Streptococcus (GBS) continues to be the most important bacterial cause of sepsis, meningitidis in newborns. American consensus guidelines have been published. They recommended the use of either risk-based strategy or screening-based approach for GBS colonization in pregnant women to identify candidates for intrapartum prophylaxis. Screening consists of obtaining vaginal and anorectal specimens for culture at 35 to 37 weeks' gestation. The aim of this prospective study was to assess the usefulness of systematic and concomitant GBS screening by rectal and vaginal swab in pregnant women. A questionnaire designed to determine the risk factors for colonization by GBS was completed.. We have screened 370 pregnant women with rectal and vaginal swab.. Fifty seven (15.4%) women had positive GBS cultures. Of those women, the rectum and the vagina were the only site of colonization in 16 (4.3%) and 8 (2.2%) women respectively. None of the factors studied was significantly associated with GBS colonization.. Detection of GBS is enhanced by 40% by using vaginal and anorectal swabs compared to a vaginal swab alone. No studied factor appeared to predict GBS colonization, which incited us to screen all pregnant women.

Topics: Adult; Amoxicillin; Anti-Bacterial Agents; Antibiotic Prophylaxis; Ceftriaxone; Erythromycin; Female; France; Humans; Mass Screening; Penicillins; Pregnancy; Prospective Studies; Rectum; Risk Factors; Streptococcal Infections; Streptococcus agalactiae; Surveys and Questionnaires; Vagina

Viridans streptococci are the commonest cause of native valve infective endocarditis (IE). The taxonomy of this group is evolving allowing new disease associations to be made. Streptococcus vestibularis is a recently described member of the viridans group, first isolated from the vestibular mucosa of the human oral cavity. It has rarely been associated with human disease. Streptococcus oralis, another member of the viridans group resident in the human oral cavity is a well known cause of IE and bacteraemia in neutropenic patients. We report the first case of native mitral valve endocarditis due to S. vestibularis in a patient with co-existing S. oralis endocarditis.

Topics: Aged; Anti-Bacterial Agents; Ceftriaxone; Endocarditis, Bacterial; Female; Gentamicins; Humans; Mitral Valve; Streptococcal Infections; Streptococcus; Vancomycin

Cases of arthritis caused by Streptococcus agalactiae are infrequent and in our knowledge there are no case reports of tenosynovitis caused by S. agalactiae. A 46-year-old woman presented with fever, polyarthralgia, myalgia, diarrhea and vomiting. She had a history of papillary thyroid carcinoma and functional hyposplenia. She was febrile, with arthritis in hands, wrists, elbows, right shoulder and left ankle joints, and presented tenosynovitis in both feet and left hand. Blood and right olecranon bursa sample cultures were positive for S. agalactiae. An ultrasound scan made at the musculus tibialis anterior of left foot revealed signs of tenosynovitis. She was treated with intravenous cefazolin for 20 days and oral cefuroxime for 12 days. The joint involvement completely subsided in 60 days. Streptococcus agalactiae can cause, infrequently, a polyarthritis and tenosynovitis syndrome similar to disseminated gonococcal infection.

Topics: Arthritis; Cefazolin; Ceftriaxone; Cephalosporins; Female; Humans; Middle Aged; Splenic Diseases; Streptococcal Infections; Streptococcus agalactiae; Tenosynovitis

A review of suppurative intracranial complications of sinusitis in children.. Case series review over a two-year period from 1998 to 1999 in a children's hospital, Singapore.. There were seven cases, all male, and age range 9 to 14. Six had subdural empyemas and one had meningitis. The most common presenting symptoms included fever, headache and vomiting. Sinusitis was suspected as the cause in only one patient initially. The intracranial infections were not apparent from the initial brain CT of two patients and were only confirmed later on repeated imaging. Four patients had lumbar punctures without any adverse effects. All seven children had infections involving the frontal, ethmoid and maxillary sinuses and two also had sphenoid involvements. All were treated with high-dose intravenous antibiotics together with drainage of both the intracranial (n=six) and sinus (n=seven) suppurations. Five needed repeated intracranial drainages. Streptococcus species were isolated in five cases. Three patients developed seizures post-operatively which resolved on follow-up. One patient needed a ventriculo-peritoneal shunt for hydrocephalus. All patients had a good Glasgow Outcome Score. The hospital stay ranged from 30 to 89 days with a median of 43 days.. Only males were identified in this review, collaborating the feeling that teenage males are at greatest risk of developing intracranial infections from sinusitis. We recommend that radiologic imaging of the brain for suspected intracranial infection should always include the sinuses as this aids early identification of actual cause. Initial CT imaging may be negative and hence repeated scans are warranted if the index of suspicion is high. The successful outcome of the children in this series supports the opinion that combined aggressive surgical and medical treatment is preferable in this patient population.

Topics: Adolescent; Anti-Bacterial Agents; Ceftriaxone; Child; Empyema, Subdural; Humans; Male; Meningitis; Metronidazole; Penicillins; Radiography; Retrospective Studies; Sinusitis; Streptococcal Infections; Streptococcus; Treatment Outcome

The proportion of penicillin and ceftriaxone resistant Streptococcus pneumoniae isolates and associated risk factors varies by geographic areas in the world. We conducted a retrospective study to determine the extent of penicillin and ceftriaxone non-susceptible Streptococcus pneumoniae bacteremia in a tertiary care medical center in the city of Riyadh, Kingdom of Saudi Arabia.. We reviewed 172 episodes of Streptrococcus pneumoniae bacteremic diseases involving 160 hospitalized patients at King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia, over a 5 year period between January 1995 through to December 1999. Patients' characteristics and underlying illnesses of those patients with bacteremias and meningitis caused by Streptococccus pneumoniae as well as antimicrobial susceptibility were examined.. The majority of patients affected with Streptococcus pneumoniae bacteremia were children <5 years of age (number=91, 53%). Malignant diseases were the main underlying diagnosis in our patient population affected with pneumoncoccal bacteremia (number=46, 27%). Overall (51%) of the isolates were penicillin non-susceptible; of these (7%) were highly resistant. The overall resistance rate to ceftriaxone was 7%.. With the high prevalence in Streptococcus pneumoniae antimicrobial resistance to penicillin and ceftriaxone, it is important to continue surveillance of infections caused by Streptococcus pneumoniae, and also we recommend that guidelines for treatment and prevention of pneumococcal infection must be addressed by health care and public health agencies.

Topics: Adolescent; Bacteremia; Ceftriaxone; Cephalosporins; Child; Child, Preschool; Drug Resistance, Microbial; Female; Humans; Infant; Male; Penicillins; Retrospective Studies; Saudi Arabia; Streptococcal Infections; Streptococcus pneumoniae

Topics: Adult; Anti-Bacterial Agents; Ceftriaxone; Clarithromycin; Female; Humans; Meningitis, Pneumococcal; Otitis Media; Pneumococcal Infections; Streptococcal Infections; Streptococcus pneumoniae

Topics: Ceftriaxone; Cephalosporin Resistance; Endocarditis, Bacterial; Humans; Infant; Male; Penicillin Resistance; Streptococcal Infections; Streptococcus

Topics: Aged; Agranulocytosis; Ceftriaxone; Cephalosporins; Drug Administration Schedule; Endocarditis, Bacterial; Epilepsy, Tonic-Clonic; Humans; Male; Streptococcal Infections; Streptococcus bovis; Time Factors

Topics: Adult; Ceftriaxone; Cephalosporins; Drug Resistance, Microbial; Endocarditis, Bacterial; Humans; Immunocompetence; Male; Microbial Sensitivity Tests; Streptococcal Infections; Streptococcus

Spinal epidural abscess (SEA) due to Streptococcus pneumoniae is rare and has never been reported in an HIV-infected patient, despite the higher risk of invasive disease in this group. We describe here the first case of pneumococcal epidural abscess, presenting with fever and back pain in a 60-year-old man infected with HIV. Blood cultures were positive for S. pneumoniae and magnetic resonance imaging (MRI) confirmed the suspicion of diskitis and SEA at the L4-S1 level. The patient was successfully treated with iv ceftriaxone without surgical intervention. The clinical characteristics of this case are compared with existing literature on pneumococcal SEA.

Topics: AIDS-Related Opportunistic Infections; Ceftriaxone; Cephalosporins; Epidural Abscess; Humans; Male; Middle Aged; Streptococcal Infections; Streptococcus pneumoniae; Treatment Outcome

The case of a 72-year-old woman suffering from chronic otitis media is presented. This insulin dependent diabetic patient was under steroid therapy for collagenosis and suffered from chronic polysinusitis. After two preceding drainages of the mastoid (antrotomy and mastoidectomy), the patient developed putrid mastoiditis followed by Bezold's abscess, an epidural abscess and thrombosis of the sigmoid sinus. Lateral petrosectomy and drainage of the neck were performed, but the patient again developed an abscess with extension to the lateral skull base, the foramen magnum and the upper cervical spine. After a further operation with extensive drainage and a three-month course of antibiotic treatment with ceftriaxon, the infection finally healed. A germ of the Streptococcus milleri group was identified.

Topics: Aged; Ceftriaxone; Cephalosporins; Chronic Disease; Diabetes Mellitus, Type 1; Epidural Abscess; Female; Humans; Mastoiditis; Neck; Otitis Media; Sinusitis; Skull Base; Streptococcal Infections

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

A 48-y-old woman with an acute Group A streptococcal brain abscess is described. The abscess enlarged rapidly with neurological deterioration and required open drainage and excision. The patient was treated with antibiotics for 6 weeks and recovered completely. Group A streptococcus is a rare cause of brain abscess in the antibiotic era and may require urgent neurosurgical intervention.

Topics: Brain Abscess; Ceftriaxone; Cephalosporins; Drug Therapy, Combination; Female; Humans; Middle Aged; Penicillins; Streptococcal Infections; Streptococcus pyogenes

Levofloxacin was investigated against viridans group streptococci in vitro and in rats with experimental aortic endocarditis. The MIC(90)s of levofloxacin and ciprofloxacin for 20 independent isolates of such bacteria were 1 and 8 mg/L, respectively. Rats were infected with two types of organism: either fully susceptible to levofloxacin MIC < or = 0.5 mg/L) or borderline susceptible (MIC 1-2 mg/L). Fully levofloxacin-susceptible bacteria comprised one penicillin-susceptible (MIC 0.004 mg/L) Streptococcus gordonii, and one penicillin-tolerant as well as one intermediate penicillin-resistant (MIC 0.125 mg/L) isogenic strains. Borderline levofloxacin-susceptible bacteria comprised one penicillin-susceptible Streptococcus sanguis and one highly penicillin-resistant Streptococcus mitis (MIC 2 mg/L). Rats were treated for 5 days with drug dosages simulating the following treatments in humans: (i) levofloxacin 500 mg orally once a day (q24 h), (ii) levofloxacin 500 mg orally twice a day (q12 h), (iii) levofloxacin 1 g orally q24 h, (iv) ciprofloxacin 750 mg orally q12 h, and (v) ceftriaxone 2 g iv q24 h. Levofloxacin was equivalent or superior to ceftriaxone, and was successful in treating experimental endocarditis irrespective of penicillin resistance. Nevertheless, standard levofloxacin treatment equivalent to 500 mg q24 h in human was less effective than twice daily 500 mg or once daily 1 g doses against borderline-susceptible organisms. Ciprofloxacin, used as a negative control, was ineffective and selected for resistant isolates. This underlines the importance of MIC determinations when treating severe streptococcal infection with quinolones. In the case of borderline-susceptible pathogens, total daily doses of 1 g of levofloxacin should be considered.

Topics: Animals; Anti-Infective Agents; Catheterization; Ceftriaxone; Ciprofloxacin; Endocarditis, Bacterial; Levofloxacin; Microbial Sensitivity Tests; Ofloxacin; Penicillin Resistance; Rats; Streptococcal Infections; Streptococcus; Streptococcus sanguis; Treatment Outcome

The effect of CSF filtration on inflammation and neuronal damage was studied in experimental Streptococcus pneumoniae meningitis. New Zealand white rabbits received either antibiotic therapy alone (ceftriaxone i.v., 20 mg/kg bolus, 10 mg/kg maintenance dose; n = 10) or ceftriaxone plus CSF filtration (n = 11) 12 h after intracisternal infection. Immediately after the onset of antibiotic therapy 300 microliters cisternal CSF was removed, passed through a miniaturized CSF-1 filter at a constant flow of 20 microliters/min, and then reinjected. This procedure was repeated six times at intervals of 20 min. Antibiosis plus CSF filtration caused a transient reduction in CSF bacterial titers and leukocyte counts compared with antibiosis alone (P = 0.04 and 0.02 5 h after initiation of therapy). CSF lipoteichoic acid concentrations were not reduced. The concentration of neuron-specific enolase in CSF and the density of apoptotic neurons in the dentate gyrus were almost equal 12 h after the onset of treatment. Adjuvant CSF filtration accelerated the elimination of viable bacteria from CSF in comparison to antibiotic treatment alone. Parameters of neuronal destruction, however, were not reduced.

Topics: Animals; Ceftriaxone; Cephalosporins; Cerebrospinal Fluid; Filtration; Leukocyte Count; Meningitis, Bacterial; Neurons; Phosphopyruvate Hydratase; Rabbits; Streptococcal Infections

Topics: Adult; Ceftriaxone; Cephalosporins; Female; Humans; Injections, Intravenous; Meningitis, Bacterial; Streptococcal Infections; Streptococcus bovis

Topics: Anti-Bacterial Agents; Anti-Infective Agents; Ceftriaxone; Cephalosporins; Drug Synergism; Fluoroquinolones; Humans; Naphthyridines; Penicillin Resistance; Streptococcal Infections; Streptococcus pneumoniae; Vancomycin

Topics: Adult; Biopsy; Ceftriaxone; Cephalosporins; Follow-Up Studies; Humans; Liver; Liver Abscess; Male; Streptococcal Infections; Time Factors; Tomography, X-Ray Computed

Topics: Aged; Agranulocytosis; Ceftriaxone; Cephalosporins; Diagnosis, Differential; Endocarditis, Bacterial; Humans; Male; Streptococcal Infections; Streptococcus sanguis

Streptococci continue to be prevalent causes of mild as well as of serious, life-threatening infections. Furthermore, some species harbor antimicrobial resistances (pneumococcus, viridans gr. streptococci) that compromise effective chemotherapy with beta-lactam drugs or other antimicrobial classes. In this study, the potency and spectrum of 12 beta-lactams was assessed versus 274 contemporary isolates of viridans group and beta-haemolytic streptococci using reference methods. Cefotaxime and ceftriaxone (MIC90s, 0.015 to 2 micrograms/ml, 84 to 100% susceptible) were consistently most potent among the agents tested. Ceftazidime (MIC90s, 0.25 to 8 micrograms/ml) and ticarcillin (MIC90s, 0.5 to > 32 micrograms/ml) were least active among the cephalosporins and penicillins, respectively. When 25% pooled serum was added to the reference test medium, ceftriaxone activity decreased fourfold, and cefotaxime remained highly active. As penicillin/beta-lactam-resistant streptococci with altered penicillin-binding protein target sites become more prevalent, only a few "third-generation" cephems seem to have sustained activity when used alone or possibly with a carefully selected co-drug. Routine testing of these species against beta-lactams and alternative drugs should be encouraged to detect emerging resistance patterns.

Topics: Ampicillin; Anti-Bacterial Agents; Cefotaxime; Ceftazidime; Ceftriaxone; Cephalosporins; Drug Resistance, Microbial; Microbial Sensitivity Tests; Penicillins; Streptococcal Infections; Streptococcus; Ticarcillin

Topics: Animals; Antibodies, Monoclonal; Bacteremia; Ceftriaxone; Cephalosporins; Cytokines; Disease Models, Animal; Female; Humans; Lymphotoxin-alpha; Male; Papio; Streptococcal Infections; Streptococcus pyogenes

Nosocomial blood stream infections due to streptococci represent an increasingly important problem, particularly among neutropenic cancer patients. This problem is compounded by the emerging resistance to antimicrobial agents commonly used for empiric or prophylactic treatment of hospitalized patients. In this study, we examined the species distribution and antimicrobial susceptibility profile of 295 streptococcal nosocomial blood stream isolates from more than 30 U.S. medical centers (SCOPE National Surveillance Program). Streptococci accounted for 5.9% of all nosocomial blood stream isolates reported. The viridans group streptococci (VGS) were the most frequently isolated streptococci (50.8%), followed by the beta-haemolytic streptococci (31.9%) and pneumococci (13.2%). The beta-haemolytic streptococci were dominated by serogroup B strains (63%), followed by serogroups A and G. Of these organisms, 193 strains were referred for subsequent monitor susceptibility testing. Approximately 14% of S. pneumoniae, 9.2% of VGS, and 0% of beta-haemolytic streptococci were resistant to penicillin. Ceftriaxone was highly active against virtually all isolates (93-100% susceptible) except the VGS (77% susceptible). The rank order for activity of the four agents tested against the 193 isolates was vancomycin > ceftriaxone > penicillin > erythromycin. Importantly, 69% of the penicillin intermediate and resistant strains of VGS were also resistant to at least one additional antimicrobial (31% resistant to ceftriaxone, 51% resistant to erythromycin, 15% resistant to both ceftriaxone and erythromycin). The relatively poor activity of erythromycin against virtually all streptococci and the frequent association of macrolide resistance with penicillin resistance among the VGS suggests that both macrolides and beta-lactam agents might have limited value as prophylactic agents for dental procedures and in empiric or prophylactic use in neutropenic patients.

Topics: Anti-Bacterial Agents; Bacteremia; Ceftriaxone; Cohort Studies; Cross Infection; Drug Resistance, Microbial; Erythromycin; Humans; Microbial Sensitivity Tests; Penicillins; Prevalence; Streptococcal Infections; Streptococcus; United States; Vancomycin

The increasing prevalence of streptococci as causes of potentially fatal nosocomial bacteremia requires that antimicrobial agents used for empiric therapy in hospitalized patients include both pneumococci and viridans group streptococci as well as beta-hemolytic streptococci in their activity profile. In this study, the in vitro activity of cefepime, a new fourth-generation cephalosporin, was compared with other cephalosporins versus 197 nosocomial blood stream isolates of streptococci (20 Streptococcus pneumoniae, 104 viridans group, and 73 beta-hemolytic) isolated from patients at more than 30 medial centers from 1995 to 1997. Additional agents tested included penicillin, erythromycin, and vancomycin. Overall, cefepime inhibited 83% of the isolates at concentrations < or = 0.5 microgram/mL and 100% at < or = 8 micrograms/mL. By comparison, ceftazidime inhibited 35 and 88% of isolates at the same concentrations. Cefepime was approximately eightfold more potent than ceftazidime against S. pneumoniae, viridans group streptococci, and beta-hemolytic streptococci. Among the 42 isolates with penicillin MICs > 0.12 microgram/mL, 100% were inhibited by cefepime and only 48% by ceftazidime at < or = 8 micrograms/mL. The rank order of activity for all six agents against the 197 isolates was vancomycin > ceftriaxone > cefepime > penicillin > erythromycin > ceftazidime. Based on the results of the present study, cefepime and ceftriaxone were the superior cephalosporins in potency and spectrum for empiric coverage of patients at risk for streptococcal blood stream infections.

Topics: Anti-Bacterial Agents; Bacteremia; Cefepime; Ceftazidime; Ceftriaxone; Cephalosporins; Cross Infection; Erythromycin; Humans; Penicillins; Streptococcal Infections; Streptococcus; Vancomycin

A total of 68 viridans group streptococci, including 31 Streptococcus sanguis, 12 S. mitis, 3 S. salivarius, and 8 S. milleri from blood, and an additional 14 S. milleri from abscesses and normally sterile sites, were tested against penicillin, amoxicillin, cefazolin, ceftriaxone, meropenem, clindamycin, quinupristin/dalfopristin, rifampin, levofloxacin, ofloxacin, vancomycin, and gentamicin with the microdilution method. The susceptibility rates for S. sanguis were: penicillin, 74%; amoxicillin, 84%; ceftriaxone, 94%; clindamycin, 87%, and vancomycin, 100%. The susceptibility rates for S. mitis were: penicillin, 42%; amoxicillin, 67%; ceftriaxone, 58%; clindamycin, 100%; and vancomycin, 100%. The susceptibility rates for S. milleri were: penicillin, 100%, amoxicillin. 100%; ceftriaxone, 100%, clindamycin, 100%; and vancomycin, 100%. Two of the three isolates of S. salivarius were susceptible to penicillin, amoxicillin, and ceftriaxone; all were susceptible to clindamycin and vancomycin. Levofloxacin, quinupristin/dalfopristin, and rifampin were highly active against all isolates.

Topics: Amoxicillin; Anti-Bacterial Agents; Cefazolin; Ceftriaxone; Clindamycin; Drug Resistance, Microbial; Gentamicins; Humans; Levofloxacin; Meropenem; Microbial Sensitivity Tests; Ofloxacin; Penicillins; Rifampin; Streptococcal Infections; Streptococcus; Thienamycins; Vancomycin; Virginiamycin

Topics: Acute Disease; Adolescent; Ampicillin; Ceftriaxone; Cephalosporins; Female; Humans; Pancreatitis; Penicillins; Shock, Septic; Streptococcal Infections; Streptococcus pyogenes; Tomography, X-Ray Computed; Ultrasonography

A case of group A streptococcal meningitis in a normally healthy pregnant woman is described, with a review of the literature. Streptococcus pyogenes is a very rare cause of bacterial meningitis and especially affects immunocompetent subjects. The evolution is often associated with severe neurologic deficits, but the prognosis is favourable under treatment with penicillin. In the light of the recrudescence of invasive infections, this germ could assume a more important role in bacterial meningitis comparable to that in the pre-antibiotic era.

Topics: Adult; Anti-Inflammatory Agents; Ceftriaxone; Cephalosporins; Dexamethasone; Female; Humans; Infant, Newborn; Male; Meningitis, Bacterial; Pregnancy; Pregnancy Complications, Infectious; Pregnancy Outcome; Streptococcal Infections; Streptococcus pyogenes

The efficacy of ceftriaxone or penicillin alone or combined with gentamicin at different dosing intervals was evaluated in experimental endocarditis due to a penicillin-susceptible, ceftriaxone-tolerant strain of Streptococcus sanguis I. The difference between monotherapy with ceftriaxone and procaine penicillin approached statistical significance (P = 0.052). Ceftriaxone combined with gentamicin administered as a single daily dose was less effective than was procaine penicillin combined with gentamicin administered in a single daily dose or in three divided doses.

Topics: Animals; Anti-Bacterial Agents; Ceftriaxone; Drug Resistance, Microbial; Drug Therapy, Combination; Endocarditis, Bacterial; Gentamicins; Microbial Sensitivity Tests; Penicillin G Procaine; Rabbits; Streptococcal Infections; Streptococcus sanguis

We have characterized the pattern of brain injury in a rat model of meningitis caused by group B streptococci (GBS). Infant rats (12-14 days old; n = 69) were infected intracisternally with 10 microliters of GBS (log10(2.3) to 4.5 colony-forming units). Twenty hours later, illness was assessed clinically and cerebrospinal fluid was cultured. Animals were either immediately euthanized for brain histopathology or treated with antibiotics and examined later. Early GBS meningitis was characterized clinically by severe obtundation and seizures, and histopathologically by acute inflammation in the subarachnoid space and ventricles, a vasculopathy characterized by vascular engorgement, and neuronal injury that was most prominent in the cortex and often followed a vascular pattern. Incidence of seizures, vasculopathy and neuronal injury correlated with the inoculum size (p < 0.01). Early injury was almost completely prevented by treatment with dexamethasone. Within days after meningitis, injured areas became well demarcated and showed new cellular infiltrates. Thirty days post-infection, brain weights of infected animals treated with antibiotics were decreased compared to uninfected controls (1.39 +/- 0.18 vs 1.64 +/- 0.1 g; p < 0.05). Thus, GBS meningitis in this model caused extensive cortical neuronal injury resembling severe neonatal meningitis in humans.

Topics: Animals; Animals, Newborn; Brain Damage, Chronic; Ceftriaxone; Cerebral Cortex; Cerebral Ventricles; Consciousness Disorders; Dexamethasone; Granulocytes; Meningitis, Bacterial; Neurons; Organ Size; Rats; Rats, Sprague-Dawley; Seizures; Severity of Illness Index; Streptococcal Infections; Streptococcus agalactiae; Subarachnoid Space; Vasculitis

A new, investigational, parenteral form of sparfloxacin was compared with ceftriaxone in the treatment of experimental endocarditis caused by either of three penicillin-susceptible streptococci or one penicillin-resistant streptococcus. Both drugs have prolonged half-lives in serum, allowing single daily administration to humans. Sparfloxacin had relatively low MICs (0.25 to 0.5 mg/liter) for all four organisms and was also greater than or equal to eight times more effective than the other quinolones against 21 additional streptococcal isolates recovered from patients with bacteremia. Ceftriaxone MICs were 0.032 to 0.064 mg/liter for the penicillin-susceptible strains and 2 mg/liter for the resistant isolate. Both antibiotics resulted in moderate bacterial killing in vitro. Rats with catheter-induced aortic vegetations were inoculated with 10(7) CFU of the test organisms. Antibiotic treatment was started 48 h later and lasted either 3 or 5 days. The drugs were injected at doses which mimicked the kinetics in human serum produced by one intravenous injection of 400 mg of sparfloxacin (i.e., the daily dose expected to be given to human adults) and 2 g of ceftriaxone. Both antibiotics significantly decreased the bacterial densities in the vegetations. However, sparfloxacin was slower than ceftriaxone in its ability to eradicate valvular infection caused by penicillin-susceptible bacteria. While this difference was quite marked after 3 days of therapy, it tended to vanish when treatment was prolonged to 5 days. In contrast, sparfloxacin was very effective against the penicillin-resistant isolate, an organism against which ceftriaxone therapy failed in vivo. No sparfloxacin-resistant mutant was selected during therapy. Thus, in the present experimental setting, this new, investigational, parenteral form of sparfloxacin was effective against severe infections caused by both penicillin-susceptible and penicillin-resistant streptococci.

Topics: Animals; Anti-Infective Agents; Ceftriaxone; Endocarditis, Bacterial; Female; Fluoroquinolones; Microbial Sensitivity Tests; Penicillin Resistance; Quinolones; Rats; Rats, Wistar; Streptococcal Infections

Ceftriaxone, a third-generation cephalosporin, is known to induce reversible precipitations in the gallbladder of children. In general, radiologic signs and symptoms will develop after 9-11 days of treatment. The authors report a case where 48 h of therapy were sufficient to develop a biliary pseudolithiasis. Clinicians and radiologists should be aware of this complication which mimics true cholelithiasis.

Topics: Ceftriaxone; Cholelithiasis; Diagnosis, Differential; Humans; Infant; Male; Streptococcal Infections

We performed experiments in rats aimed at determining whether a combination of ceftriaxone (CRO) and netilmicin (NET), by using once-daily administration in rats, which simulated profiles of drug in human serum, was more effective than either agent alone in the treatment of endocarditis caused by viridans group streptococci. A programmable infusion pump system enabled the production of profiles of CRO in serum that simulate those found in humans after the intravenous administration of 2 g. The subcutaneous administration of 18 mg of NET per kg of body weight produced levels in the sera of rats comparable to those after the intravenous administration of a dose of 5 mg of NET per kg in humans. Rats with catheter-induced aortic vegetations were infected intravenously with two test strains, a CRO-susceptible Streptococcus sanguis strain (MICs of CRO and NET, 0.064 and 8 mg/liter, respectively) and a relatively CRO-resistant Streptococcus mitis strain (MICs of CRO and NET, 2 and 8 mg/liter, respectively). Against both strains, the combination of CRO and NET was synergistic in vitro as determined by time-kill curves. Treatment of rats was started 48 h postinfection and lasted for 3 days. CRO alone was effective against the susceptible strain (P < 0.001 compared with control animals) but was not effective against the resistant organism. A significantly enhanced antibacterial activity of the CRO-NET combination in reducing the valvular bacterial counts was observed with both test strains (P < 0.001). The synergistic effect was obtained with a single daily injection of NET which provided detectable levels in serum for only 8 h, suggesting that in vivo synergism in the treatment of infections caused by viridans group streptococci can be obtained without 24 h of aminoglycoside coverage. These experimental data might provide a rationale for clinical trials of a once-a-day dosing regimen in the treatment of streptococcal but nonenterococcal endocarditis.

Topics: Animals; Ceftriaxone; Endocarditis, Bacterial; Female; Humans; Infusion Pumps; Microbial Sensitivity Tests; Netilmicin; Rats; Rats, Wistar; Serum Bactericidal Test; Streptococcal Infections; Streptococcus; Streptococcus sanguis

We have conducted experiments to determine if one daily injection of netilmicin (NET) would be synergistic with the broad-spectrum cephalosporin ceftriaxone (CRO) in the treatment of experimentally induced endocarditis. Rats with catheter-induced aortic vegetations were infected intravenously with 3 x 10(7) CFU of a beta-lactam-sensitive strain of Streptococcus sanguis or a beta-lactam-resistant strain of Streptococcus mitis. Treatment with the antibiotics alone (CRO, 10 mg/kg of body weight every 8 h; NET, 18 mg/kg every 24 h) or in combinations which had proved synergistic in in vitro time-kill curves was commenced 48 h postinfection and continued for 72 h. The results show that the combination was markedly effective against S. sanguis and moderately effective against S. mitis, while, with the protocol used here, the agents alone were not. The results suggest that CRO-NET should be an effective combination for treating streptococcal endocarditis in humans and may permit a shorter duration of treatment and once-a-day dosing to be used.

Topics: Animals; Ceftriaxone; Drug Resistance, Microbial; Drug Synergism; Drug Therapy, Combination; Endocarditis, Bacterial; Female; Microbial Sensitivity Tests; Netilmicin; Rats; Rats, Wistar; Serum Bactericidal Test; Streptococcal Infections; Streptococcus; Streptococcus sanguis

Topics: Administration, Oral; Amoxicillin; Ceftriaxone; Endocarditis, Bacterial; Female; Humans; Injections, Intramuscular; Injections, Intravenous; Middle Aged; Streptococcal Infections; Streptococcus bovis

Newborn infants minimally symptomatic with non-central nervous system (CNS) infections due to Streptococcus agalactiae (group B streptococcus [GBS]) and other pathogens may not require skilled nursing care during the entire course of parenteral antibiotic therapy. In 1985, treatment guidelines were made available to private practitioners in Oregon for therapy of newborn infants at low risk of complications from their infections. In 1988, patient data were collected and analyzed retrospectively. Outpatient management during convalescence of 51 infants (21 with culture-positive infections due to GBS) was accomplished with once-daily physician follow-up examinations and IM injection of ceftriaxone. Long-term (greater than or equal to two months) follow-up data were available for 67% of GBS-infected infants, with no complication of infection or significant complication of therapy reported. Outpatient parenteral antibiotic management of selected, low-risk infants may offer the clinician an alternative to hospitalization for a portion of the duration of parenteral antibiotic therapy.

Topics: Ceftriaxone; Drug Administration Schedule; Female; Follow-Up Studies; Humans; Infant, Newborn; Injections, Intramuscular; Male; Retrospective Studies; Streptococcal Infections; Streptococcus agalactiae; Treatment Outcome

Topics: Ambulatory Care; Ceftriaxone; Endocarditis, Bacterial; Humans; Penicillin G; Penicillin Resistance; Streptococcal Infections

The in-vitro post-antibiotic effect (PAE) of amikacin alone and in combination with ceftazidime, ceftriaxone and piperacillin was studied for two strains of Enterococcus faecalis using a bioluminescent assay of bacterial ATP. The two strains of E. faecalis were resistant to amikacin, ceftazidime and ceftriaxone but sensitive to piperacillin. The bacterial cultures were incubated with the beta-lactam antibiotics for 1 h and concentrations of amikacin between 2-64 mg/l were then added. Thereafter, incubation continued with the combinations for one more hour. After dilution, regrowth was monitored by measuring bacterial ATP every hour. Increasing concentrations of amikacin (2-64 mg/l), ceftazidime (8-32 mg/l) and ceftriaxone (32-128 mg/l) resulted in little or no PAE (0-0.3 h) on these strains. PAEs of 0.5 to 1.6 h resulted from exposure to piperacillin (4-32 mg/l). In combination amikacin and piperacillin increased the PAE to 5.5 h. A synergistic PAE was also seen when the enterococci were exposed to amikacin combined with ceftazidime or ceftriaxone in concentrations close to the MICs of the latter antibiotics.

Topics: Amikacin; Anti-Bacterial Agents; Ceftazidime; Ceftriaxone; Drug Synergism; Drug Therapy, Combination; Endocarditis, Bacterial; Enterococcus faecalis; Humans; Microbial Sensitivity Tests; Piperacillin; Streptococcal Infections

Topics: Ceftriaxone; Chickenpox; Child; Female; Humans; Meningitis; Streptococcal Infections; Streptococcus pyogenes

A case of infective endocarditis due to Streptococcus agalactiae was treated conservatively by means of cefotaxime sodium given intravenously at a dose of 1 g every six hours supplemented with gentamycin sulphate, also given intravenously, with the dose adjusted according to concentrations of the drug in the plasma. The treatment was successful.

Topics: Ceftriaxone; Drug Therapy, Combination; Endocarditis, Bacterial; Female; Gentamicins; Humans; Middle Aged; Streptococcal Infections; Streptococcus agalactiae

Topics: Ceftriaxone; Child; Haemophilus Infections; Humans; Pneumonia; Streptococcal Infections

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

We determined the bactericidal activity of ceftriaxone on 20 streptococci isolated from patients with infective endocarditis and that of penicillin G on 5 strains. The MICs of ceftriaxone were less than or equal to 2 micrograms/ml and the MBCs were low for 5 nontolerant strains (less than or equal to 2 micrograms/ml) and high for 15 tolerant strains (greater than or equal to 16 micrograms/ml). The maximal reduction of the viable bacterial counts after 24 h of exposure to antibiotic was achieved for a concentration of ceftriaxone of 4, 32 and 256 micrograms/ml, respectively for 5, 10 and 19 strains. The activity of penicillin G was similar.

Topics: Ceftriaxone; Colony Count, Microbial; Endocarditis, Bacterial; Humans; Kinetics; Microbial Sensitivity Tests; Penicillin G; Streptococcal Infections; Streptococcus

The bactericidal quotient (BQ) assessed in the site of infection represents an essential parameter for evaluating the real bactericidal potency of an antibiotic in vivo. The assessment and knowledge of BQ values allow us to set up a more accurate and appropriate antibacterial therapy. The two drugs--ceftriaxone (Rocephin) and imipenem plus cilastatin (Tienam)--that have been taken into consideration in this study, having a similar antibacterial spectrum though with different kinetics, may have the same BQ values in bronchial secretion versus Haemophilus influenzae, Klebsiella pneumoniae and Streptococcus pneumoniae, when administered at different dosages, i.e. ceftriaxone 1 g (i.v.) every 24 h, imipenem 0.5 g (i.v.) every 8 h.

Topics: Aged; Bronchial Diseases; Ceftriaxone; Cilastatin; Drug Administration Schedule; Drug Combinations; Haemophilus Infections; Haemophilus influenzae; Humans; Imipenem; Klebsiella Infections; Klebsiella pneumoniae; Middle Aged; Sputum; Streptococcal Infections; Streptococcus pneumoniae

The antibacterial efficacy of ceftriaxone (CTRX) against group B Streptococcus and its clinical efficacy in newborns were examined, and the results obtained are summarized as follows. 1. MIC's of CTRX against 55 strains of B group Streptococcus from the pregnant vagina were 0.10 micrograms/ml or lower. 2. Efficacies of CTRX were good to excellent in 8 cases administered for treatment, 3 cases for prophylaxis and 1 for observation of adverse reactions. Observed adverse reactions included diarrhea in 4 cases and vomiting in 2 cases. As abnormal laboratory parameters, eosinophilia and thrombocytosis were observed in 1 case each. 3. An examination of intestinal bacteria in 9 cases revealed that CTRX gave as much influence to the flora as other third-generation cephems. 4. An examination for the vitamin K deficiency in 11 cases found a prolongation of prothrombin time (PT) in 3 cases and protein induced by vitamin K absence (PIVKA) II positive in 2 cases. 5. Testing of platelet aggregation with adenosine diphosphate (ADP) in 7 cases showed little influence of CTRX.

Topics: Ceftriaxone; Humans; Infant, Newborn; Intestines; Pneumonia; Sepsis; Streptococcal Infections; Streptococcus agalactiae

Ceftriaxone (CTRX) was administered to the newborn and its clinical effectiveness as well as its blood and cerebrospinal fluid levels were studied. 1. Average blood levels of CTRX 1 hour after single intravenous administration were 39 micrograms/ml in 2 cases receiving about 10 mg/kg, 70 micrograms/ml in 2 other cases receiving 20 mg/kg and 208 micrograms/ml in one receiving 52.6 mg/kg. As is apparent from these cases data, blood levels of CTRX were dose dependent. Blood levels of the drug were between 3.7 to 12.4 micrograms/ml 24 hours later. Half-lives of the drug in blood in the 5 newborns ranged from 7.13 to 10.6 hours. In a 53-day-old patient receiving 43.4 mg/kg of CTRX via intravenous injection, the one-hour blood level of the drug was 140 micrograms/ml and the half-life was 3.68 hours. The blood level of the drug 36 hours after single intravenous administration with 17.3 to 20.0 micrograms/ml to 5 other cases 0 to 5 days of age ranged from 4.6 to 13.7 micrograms/ml. 2. The cerebrospinal fluid level of CTRX 4 hours after intravenous administration with 49.6 mg/kg to cases of Escherichia coli meningitis was 9.7 micrograms/ml on the first day following the start of the treatment. It increased to 23.6, 25.2 and 31.0 micrograms/ml on the third, fourth and fifth days, respectively, and then gradually decreased. Cerebrospinal level was still 5.8 micrograms/ml on the 22nd day during the recovery period. These levels were far more than 1,000 times as much as the MIC for the pathogen at the highest level, and more than 100 times even at the lowest level. 3. CTRX was administered via intravenous injection once or twice a day (11.0-39.5 mg/kg in total) to 13 newborns and 3 infants. The efficacy of CTRX was good to excellent in 10 cases for treatment of 11 diseases (sepsis 1, pneumonia 4, urinary tract infection 4 and fetal infection 2) and all the pathogens (Streptococcus agalactiae 1, E. coli 3, Klebsiella pneumoniae 2, Citrobacter diversus 1) disappeared. In 6 cases where CTRX was used prophylactically, infection did not occur at all. The efficacy was excellent in another newborn with E. coli meningitis intravenously receiving 49.6 mg/kg of CTRX twice daily for 25 days. 4. No adverse reactions were observed. Mild eosinophilia was observed in 4 cases. Follow-up examinations of 3 of the 4 cases showed that these abnormal levels were returned to normal.(ABSTRACT TRUNCATED AT 400 WORDS)

Topics: Bacterial Infections; Ceftriaxone; Escherichia coli Infections; Female; Humans; Infant, Newborn; Injections, Intravenous; Male; Streptococcal Infections; Urinary Tract Infections

Laboratory studies and clinical evaluation of ceftriaxone (CTRX) were carried out with mothers and infants in perinatal period. The presence of synergistic effect between CTRX and amniotic fluid were studied using a broth dilution method. Stronger effects were recognized when both agents were present together compared to each agent alone by the fact that values of MIC and MBC became closer together for Escherichia coli as well as for Streptococcus agalactiae. Against the growth of E. coli, a synergism was observed, but for S. agalactiae, only an additive effect was found. The placental transmission of CTRX upon the administration was rapid, and the blood CTRX level reached its peak shortly after the intravenous administration of the drug. The transport of the drug into the fetus through placenta was excellent and one dose of 1 g of CTRX gave drug concentrations in the umbilical cord serum and amniotic fluid higher than MIC's against main pathogenic organisms. According to these results, it should be possible to treat or prevent perinatal infections by a dose of one gram per day of CTRX, once or twice daily. Cases of perinatal infections were treated with CTRX. An effective treatment without side effects was obtained. No physical abnormalities nor unusual laboratory test results were recognized in neonates delivered from mothers who received CTRX administration. The penetration of CTRX into mothers' milk was low, thus the drug transfer into neonates through the breast-feeding should not be a problem. It appears, from the above study, that CTRX is a clinically useful antibiotic for the prophylaxis and the treatment of perinatal infections.

Topics: Adult; Amniotic Fluid; Ceftriaxone; Drug Resistance, Microbial; Endometritis; Escherichia coli; Female; Fetal Blood; Humans; Milk, Human; Pregnancy; Puerperal Infection; Streptococcal Infections; Streptococcus agalactiae

In an effort to develop more effective antimicrobial therapy, we evaluated three alternative regimens currently available to clinicians for their efficacy against experimental bacteremia and meningitis due to group B Streptococcus (GBS) in newborn rats: various doses of penicillin G (100, 200, 400, or 800 mg/kg per day), combined penicillin G-gentamicin vs. penicillin G, and ceftriaxone vs. penicillin G. Higher doses of penicillin G and ceftriaxone exhibited significantly greater bactericidal activity in blood and cerebrospinal fluid (CSF), whereas the bactericidal activity of penicillin G plus gentamicin was not significantly different from that of penicillin G. Clearance of GBS from blood was significantly more rapid in animals receiving ceftriaxone. However, differences in death rates were not apparent with any single regimen. These findings suggest that clearance of GBS from blood and CSF can be improved by more potent antimicrobial agents, but further reduction in the death rate may be difficult to achieve by antimicrobial therapy alone.

Topics: Animals; Animals, Newborn; Ceftriaxone; Drug Therapy, Combination; Gentamicins; Meningitis; Penicillin G; Rats; Rats, Inbred Strains; Sepsis; Streptococcal Infections; Streptococcus agalactiae

Cefonicid (Monocid) and ceftriaxone (Rocephin) are long half-life cephalosporins that may be used for serious infections in the outpatient setting. They may be used as an extension of initial hospital treatment, or therapy can be initiated and completed in many cases with the patient remaining at home. Sufficient clinical experience exists with both ceftriaxone and cefonicid to recommend these agents for selected patients having pyelonephritis, osteomyelitis, or soft tissue infections. Cefonicid, perhaps in combination with erythromycin, will provide excellent coverage for complicated community-acquired pneumonias. Ceftriaxone is effective as single-dose therapy for even complicated gonococcal infections. The use of long half-life cephalosporins in ambulatory practice may result in substantial cost savings for certain patients.

Topics: Ambulatory Care; Bacterial Infections; Cefamandole; Cefonicid; Ceftriaxone; Cellulitis; Cephalosporins; Gonorrhea; Half-Life; Humans; Injections, Intramuscular; Osteomyelitis; Pyelonephritis; Respiratory Tract Infections; Staphylococcal Infections; Streptococcal Infections

The in vitro activity of new cephalosporins, oxacephems and penicillins against pathogens involved in respiratory and gastrointestinal tract infections is practically equivalent. However, in experimental infections with the same pathogens the superior efficacy of ceftriaxone over all comparative cephems and penicillins, expressed in low 50% effective doses after multiple and particularly after single dosage schedules, and caused by a longer maintenance of blood and tissue levels can be demonstrated. Although mice have an altered pharmacokinetics these experimental results reflect the observed clinical advantage of ceftriaxone in human infections: long plasma half-life, low dosage and single daily administration.

Topics: Animals; Anti-Bacterial Agents; Bacteria; Cefotaxime; Ceftriaxone; Dose-Response Relationship, Drug; Haemophilus Infections; Metabolic Clearance Rate; Mice; Microbial Sensitivity Tests; Salmonella Infections; Streptococcal Infections

The efficacy of ceftriaxone against group B streptococci was studied in vitro and in vivo with an infant rat model of group B streptococci bacteraemia and meningitis. Twenty-four strains demonstrated minimal inhibitory concentrations of ceftriaxone of 0 . 05-0 . 1 mg/l and minimal bactericidal concentrations of 0 . 1-0 . 4 mg/l. Four strains were selected to induce bacteraemia and meningitis in infant rats by intraperitoneal inoculation. All 45 bacteraemic animals with or without meningitis that were treated with ceftriaxone 2 mg/kg/dose every eight hours for five doses survived, while all 12 control animals died (P less than 0 . 001). When recultured 54 h after the last dose of ceftriaxone, both CSF and blood remained sterile in all treated animals. These results indicate group B streptococci to be sensitive to ceftriazone in vitro and that, in the low dosage used, ceftriaxone effectively eradicates group B streptococcal bacteraemia and meningitis in infant rats.

Topics: Animals; Animals, Newborn; Cefotaxime; Ceftriaxone; Meningitis; Microbial Sensitivity Tests; Rats; Rats, Inbred Strains; Sepsis; Streptococcal Infections; Streptococcus agalactiae