sultamicillin and Cross-Infection

Mediastinitis resulting from surgical site infection may occur in 1% of patients undergoing median sternotomy.. Case report and review of the pertinent English-language literature.. We report a case of mediastinitis caused by Acinetobacter baumannii, in a patient with multiple comorbidities who underwent cardiopulmonary bypass. Successful treatment consisted of surgical debridement, reconstruction, and ampicillin-sulbactam.. Acinetobacter baumannii should be recognized as a potential causative agent of severe postoperative mediastinitis.

Topics: Acinetobacter baumannii; Acinetobacter Infections; Ampicillin; Anti-Bacterial Agents; Cardiopulmonary Bypass; Cross Infection; Debridement; Female; Humans; Mediastinitis; Middle Aged; Sulbactam; Surgical Wound Infection

The increased incidence of multidrug-resistant (MDR) Acinetobacter baumannii ventilator-associated pneumonia in critically ill patients poses a severe therapeutic problem. The aim of this study was to evaluate the efficacy and safety of 2 high-dose treatment regimens of ampicillin-sulbactam (A/S) for MDR Acinetobacter baumannii VAP. We undertook a randomized, prospective trial of critically ill patents with (MDR) Acinetobacter baumannii VAP. Patients were randomly assigned to 1 of 2 treatment regimens of A/S (at a rate 2:1 every 8 h): 1) group A, 18/9 g daily dose (n = 14); and 2) group B, 24/12 g daily dose (n = 13). The duration of therapy was 8+/-2 d for both groups. A total of 27 patients were enrolled in the study. Clinical improvement was seen in 66.7% of the study population in 9/14 (64.3%) of group A patients and 9/13 (69.2%) of group B patients, respectively. Bacteriological success was achieved in 77.8% of the study population (12/14, 85.7% of group A) and in 9/13 (69.2%) of group B patients. The 14-d mortality rate was 25.9% and the all cause 30-d mortality was 48.1%. Both mortality rates did not differ significantly between the 2 groups. No major adverse reactions were recorded. We concluded that clinical and bacteriological results of the study support the use of high-dose regimen of ampicillin-sulbactam for MDR Acinetobacter baumannii VAP.

Topics: Acinetobacter baumannii; Acinetobacter Infections; Aged; Ampicillin; Anti-Bacterial Agents; Bronchoalveolar Lavage Fluid; Cross Infection; Disk Diffusion Antimicrobial Tests; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Resistance, Multiple, Bacterial; Female; Humans; Intensive Care Units; Male; Middle Aged; Pneumonia, Ventilator-Associated; Sulbactam; Treatment Outcome

The bacterial infections constitute a serious problem for the surgeon: the choice of antibiotic drugs is really important and, as often as possible, should be guided by antibiotic sensitivity tests. In this study we used sulbactam-ampicillin (Unasyn) who is an antibiotic combination between sulbactam, inhibitor of beta lactam and ampicillin. The preliminary results were as follows: Unasyn was administered to 21 hospitalized selected patients, 16 women and 5 man, who had clinical signs of intraabdominal infection, wound infection and subphrenic abscess after digestive surgery. In these patients were isolated the following organisms: Staphylococcus epidermidis (8), Staphylococcus aureus (11), serratia (1), streptococcus (3), E. coli (3). The daily dosage of Unasyn was 3-12 g/die administered in three to four divided doses, and was determined by the severity of infection, the antibiotic susceptibility of the causative organism(s) and the condition of the patient. Each dose was given by slow i.v. infusion in 15-30 minutes. Our success rate was 100%, and neither systemic nor local side effects were recorded.

Topics: Adult; Aged; Ampicillin; Cross Infection; Drug Therapy, Combination; Female; Humans; Infusions, Intravenous; Male; Middle Aged; Sulbactam; Surgical Procedures, Operative; Time Factors

Topics: Acinetobacter baumannii; Acinetobacter Infections; Ampicillin; Anti-Bacterial Agents; Bacteremia; Cross Infection; Dose-Response Relationship, Drug; Drug Resistance, Multiple, Bacterial; Drug Therapy, Combination; Female; Humans; Infant; Infant, Newborn; Male; Microbial Sensitivity Tests; Retrospective Studies; Sulbactam

The prevalence and antibiotic resistance of Acinetobacter spp. from fifty samples of meat (chicken, turkey, beef and pork) were evaluated. Acinetobacter spp. was recovered from all samples and the clonal relatedness of 223 isolates identified to belong to the genus Acinetobacter was established by PFGE. A high genetic diversity was observed and 166 isolates from different samples, 141 representing different PFGE profiles, were further identified to the species level by rpoB gene sequencing. Thirteen distinct Acinetobacter species were identified among 156 isolates. The remaining ten isolates may represent three putatively novel species since rpoB sequence homologies with type strains of all available described Acinetobacter species, were <95%. The most common species was Acinetobacter guillouiae with a prevalence of 34.9%. However 18.7% of the strains belong to the Acinetobacter baumannii group (n=31) which include the species Acinetobacter baumannii (n=7), Acinetobacter pittii (n=12), Acinetobacter seifertii (n=8) and Acinetobacter nosocomialis (n=4) that are the species most frequently associated with nosocomial infections worldwide. In general, strains were resistant to some of the antimicrobials most frequently used to treat Acinetobacter infections such as piperacillin-tazobactam (64.9% of strains resistant), ceftazidime (43.5%), ciprofloxacin (42.9%), as well as to colistin (41.7%) and polymyxin B (35.1%), the last-resort drugs to treat infections caused by multidrug-resistant Acinetobacter. The percentage of resistant strains to trimethoprim-sulfamethoxazole, tetracycline, aminoglycosides (amikacin and tobramycin) and ampicillin-sulbactam was >10% (23.2%, 23.2%, 14.3%, 12.5%, 12.5%, respectively). However, resistances to meropenem, imipenem and minocycline were only sporadically observed (8.3%, 1.2% and 1.2%, respectively). Overall, 51.2% of the strains were considered as multidrug-resistant (MDR) and 9.6% as extensively drug-resistant (XDR). The prevalence of MDR strains within the A. baumannii group (38.7%) was lower than the prevalence within the others species identified (54.1%). Therefore, food of animal origin may be a vehicle of spread Acinetobacter strains resistant to several antibiotics in the community and in the hospital setting environment. This may led to nosocomial and community-acquired infections in susceptible individuals.

Topics: Acinetobacter baumannii; Acinetobacter Infections; Ampicillin; Animals; Anti-Bacterial Agents; Cattle; Ceftazidime; Chickens; Ciprofloxacin; Cross Infection; DNA-Directed RNA Polymerases; Drug Resistance, Multiple, Bacterial; Humans; Microbial Sensitivity Tests; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination; Prevalence; Red Meat; Sulbactam; Swine; Trimethoprim, Sulfamethoxazole Drug Combination

Acinetobacter baumannii (AB) has evolved a variety of resistance mechanisms and exhibits unpredictable susceptibility patterns, making it difficult to select empiric therapy.. To examine US secular trends in the resistance of AB in respiratory infections and blood stream infections (BSI) to antimicrobial agents whose effectiveness is supported in the literature. Survey.. We analyzed 3 time periods (2003-2005, 2006-2008, 2009-2012) in Eurofins' The Surveillance Network for resistance of AB to the following antimicrobials: carbapenems (imipenem, meropenem, doripenem), aminoglycosides (tobramycin, amikacin), tetracyclines (minocycline, doxycycline), polymyxins (colistin, polymyxin B), ampicillin-sulbactam, and trimethoprim-sulfamethoxazole. Resistance to ≥3 drug classes defined multidrug resistance (MDR).. We identified 39,320 AB specimens (81.1% respiratory, 18.9% BSI). The highest prevalence of resistance was to doripenem (90.3%) followed by trimethoprim-sulfamethoxazole (55.3%), and the lowest to colistin (5.3%). Resistance to carbapenems (21.0% in 2003-2005 and 47.9% in 2009-2012) and colistin (2.8% in 2006-2008 to 6.9% in 2009-2012) more than doubled. Prevalence of MDR AB rose from 21.4% in 2003 to 2005 to 33.7% in 2006 to 2008, and remained stable at 35.2% in 2009 to 2012. In contrast, resistance to minocycline diminished from 56.5% (2003-2005) to 30.5% (2009-2012). MDR organisms were most frequent in nursing homes (46.5%), followed by general ward (29.2%), intensive care unit (28.7%), and outpatient setting (26.2%).. Resistance rates among AB to such last-resort antimicrobials as carbapenems and colistin are on the rise, whereas that to minocycline has declined. Nursing homes are a reservoir of resistant AB. These trends should inform not only empiric treatment of serious infections, but also approaches to infection control.

Topics: Acinetobacter baumannii; Acinetobacter Infections; Ampicillin; Anti-Bacterial Agents; Bacteremia; Carbapenems; Cross Infection; Drug Resistance, Bacterial; Humans; Intensive Care Units; Microbial Sensitivity Tests; Respiratory Tract Infections; Sulbactam; Surveys and Questionnaires; Trimethoprim, Sulfamethoxazole Drug Combination; United States

To evaluate the antimicrobial susceptibility of Gram-negative bacilli that caused hospital-acquired and community-acquired intra-abdominal infections (IAIs) in China between 2012 and 2013, we determined the susceptibilities to 12 antimicrobials and the extended-spectrum β-lactamase (ESBL) statuses of 3,540 IAI isolates from seven geographic areas in China in a central laboratory using CLSI broth microdilution and interpretive standards. Most infections were caused by Escherichia coli (46.3%) and Klebsiella pneumoniae (19.7%). Rates of ESBL-producing E. coli (P = 0.031), K. pneumoniae (P = 0.017), and Proteus mirabilis (P = 0.004) were higher in hospital-acquired IAIs than in community-acquired IAIs. Susceptibilities of enterobacteriaceae to ertapenem, amikacin, piperacillin-tazobactam, and imipenem were 71.3% to 100%, 81.3% to 100%, 64.7% to 100%, and 83.1% to 100%, respectively, but imipenem was ineffective against P. mirabilis (<20%). Although most ESBL-positive hospital-acquired isolates were resistant to third- and fourth-generation cephalosporins, the majority were susceptible to cefoxitin (47.9% to 83.9%). Susceptibilities of ESBL-positive isolates to ampicillin-sulbactam (<10%) were low, whereas susceptibilities to ciprofloxacin (0% to 54.6%) and levofloxacin (0% to 63.6%) varied substantially. The prevalences of cephalosporin-susceptible E. coli and K. pneumoniae were higher in the northeastern and southern regions than in the central and eastern regions, reflecting the ESBL-positive rates in these areas, and were lowest in the Jiangsu-Zhejiang (Jiang-Zhe) area where the rates of carbapenem resistance were also highest. Ertapenem, amikacin, piperacillin-tazobactam, and imipenem are the most efficacious antibiotics for treating IAIs in China, especially those caused by E. coli or K. pneumoniae. Resistance to cephalosporins and carbapenems is more common in the Jiang-Zhe area than in other regions in China.

Topics: Amikacin; Ampicillin; Anti-Bacterial Agents; beta-Lactamases; beta-Lactams; Cefoxitin; China; Ciprofloxacin; Community-Acquired Infections; Cross Infection; Drug Resistance, Multiple, Bacterial; Enterobacteriaceae; Enterobacteriaceae Infections; Ertapenem; Gene Expression; Humans; Imipenem; Intraabdominal Infections; Levofloxacin; Microbial Sensitivity Tests; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination; Sulbactam

Acinetobacter baumannii is one of the most prevalent causes of severe hospital-acquired infections and is responsible for the dramatic increase in carbapenem resistance in Croatia in the last 5 years. Such data have encouraged multicenter research focused on the organism's ability to form biofilm, susceptibility to antibiotics, and particular genotype lineage.. Biofilm formation in 109 unrelated clinical isolates of A. baumannii recovered in six cities of Southern Croatia was investigated. Genotyping was performed by pulsed-field gel electrophoresis and antibiotic profile was tested by applying the disc diffusion method and confirmed by determining the minimum inhibitory concentrations. The ability to form biofilm in vitro was determined from overnight cultures of the collected isolates on microtiter plates, after staining with crystal violet, and quantified at 570 nm after solubilization with ethanol. The statistical relevance was calculated in an appropriate program with level of statistical confidence.. There was no significant difference in biofilm formation due to the genotype lineage. Isolates collected from intensive care units (ICUs) and isolated from respiratory samples were more likely to create a biofilm compared with isolates from other departments and other samples. There was a significant difference in the ability to produce biofilm in relation to antibiotic resistance pattern. A large proportion of A. baumannii isolates that were resistant to ampicillin/sulbactam, carbapenems, and amikacin were found to be biofilm-negative. In contrast, isolates susceptible and intermediately susceptible to ampicillin/sulbactam, carbapenems, and amikacin were biofilm producers.. Clinical isolates of A. baumannii from respiratory samples in ICUs with a particular susceptibility pattern are more prone to form biofilm.

Topics: Acinetobacter baumannii; Acinetobacter Infections; Amikacin; Ampicillin; Anti-Bacterial Agents; Biofilms; Carbapenems; Croatia; Cross Infection; Drug Resistance, Multiple, Bacterial; Electrophoresis, Gel, Pulsed-Field; Genotype; Humans; Intensive Care Units; Microbial Sensitivity Tests; Monte Carlo Method; Respiratory System; Respiratory Tract Infections; Sulbactam; Urine; Wounds and Injuries

Antibiotic concentrations must be maintained at an adequate level throughout cardiovascular surgery to prevent surgical site infection. This study aimed to determine the most appropriate timing for intraoperative repeated dosing of ampicillin-sulbactam, a commonly used antibiotic prophylaxis regimen, to maintain adequate concentrations throughout the course of cardiovascular surgery with cardiopulmonary bypass (CPB). The total plasma concentrations of ampicillin were monitored in 8 patients after ampicillin (1 g)-sulbactam (0.5 g) administration via initial intravenous infusion and subsequent CPB priming. Pharmacokinetic parameters were estimated and used to predict the free plasma concentrations of ampicillin. The mean values for the volume of distribution, elimination rate constant, elimination half-life, and total clearance of ampicillin were 15.8±4.1 L, 0.505±0.186 h(-1), 1.52±0.47 h, and 7.72±2.72 L/h, respectively. When ampicillin (1 g)-sulbactam (0.5 g) was intravenously administered every 3, 4, 6, and 12 h after the start of CPB, the predicted free trough plasma concentrations of ampicillin were 15.20, 8.25, 2.74, and 0.13 µg/mL, respectively. Therefore, an every-6-h regimen was needed to maintain the free ampicillin concentration at more than 2 µg/mL during cardiovascular surgery with CPB. We suggest that the dose and dosing interval for ampicillin-sulbactam should be adjusted to optimize the efficacy and safety of treatment, according to the minimum inhibitory concentrations for methicillin-sensitive Staphylococcus aureus isolates at each institution.. UMIN000007356.

Topics: Aged; Ampicillin; Anti-Bacterial Agents; Cardiopulmonary Bypass; Cross Infection; Drug Administration Schedule; Female; Half-Life; Humans; Infusions, Intravenous; Injections, Intravenous; Male; Microbial Sensitivity Tests; Middle Aged; Postoperative Complications; Staphylococcal Infections; Staphylococcus aureus; Sulbactam

The risk of central line associated blood stream infections (CLABSI) related to cooling catheters used for therapeutic hypothermia (TH) is unclear.. We performed a retrospective analysis on 131 cardiac arrest survivors between 2007 and 2010, who underwent TH by femorally placed endovascular cooling catheter. All patients received prophylactic intravenous ampicillin-sulbactam for 72 hours to reduce the risk of aspiration pneumonia. Cooling catheter related CLABSI and other infections over a period of seven days from initiation of TH were estimated.. Of a total 131 patients, 16 (12%) patients had bacteremia or infection prior to initiation of TH and were excluded. Of the remaining 115 (88%) patients, zero (0%) patients had cooling catheter related CLABSI and 23 (20%) patients had other infections during the study period.. In cardiac arrest survivors undergoing TH, femorally placed endovascular cooling catheter is not associated with an increased incidence of CLABSI.

Topics: Aged; Ampicillin; Anti-Bacterial Agents; Catheter-Related Infections; Catheterization, Central Venous; Cross Infection; Endovascular Procedures; Female; Heart Arrest; Humans; Hypothermia, Induced; Male; Middle Aged; Retrospective Studies; Sepsis; Sulbactam

In recent years, owing to the presence of multi-drug resistant nosocomial bacteria, combination therapies are more frequently applied. Thus there is more need to investigate the in vitro activity of drug combinations against multi-drug resistant bacteria. Checkerboard synergy testing is among the most widely used standard technique to determine the activity of antibiotic combinations. It is based on microdilution susceptibility testing of antibiotic combinations. Although this test has a standardised procedure, there are many different methods for interpreting the results. In many previous studies carried out with multi-drug resistant bacteria, different rates of synergy have been reported with various antibiotic combinations using checkerboard technique. These differences might be attributed to the different features of the strains. However, different synergy rates detected by checkerboard method have also been reported in other studies using the same drug combinations and same types of bacteria. It was thought that these differences in synergy rates might be due to the different methods of interpretation of synergy test results. In recent years, multi-drug resistant Acinetobacter baumannii has been the most commonly encountered nosocomial pathogen especially in intensive-care units. For this reason, multidrug resistant A.baumannii has been the subject of a considerable amount of research about antimicrobial combinations. In the present study, the in vitro activities of frequently preferred combinations in A.baumannii infections like imipenem plus ampicillin/sulbactam, and meropenem plus ampicillin/sulbactam were tested by checkerboard synergy method against 34 multi-drug resistant A.baumannii isolates. Minimum inhibitory concentration (MIC) values for imipenem, meropenem and ampicillin/sulbactam were determined by the broth microdilution method. Subsequently the activity of two different combinations were tested in the dilution range of 4 x MIC and 0.03 x MIC in 96-well checkerboard plates. The results were obtained separately using the four different interpretation methods frequently preferred by researchers. Thus, it was aimed to detect to what extent the rates of synergistic, indifferent and antagonistic interactions were affected by different interpretation methods. The differences between the interpretation methods were tested by chi-square analysis for each combination used. Statistically significant differences were detected between the four diff

Topics: Acinetobacter baumannii; Acinetobacter Infections; Ampicillin; Anti-Bacterial Agents; Bacterial Infections; Cross Infection; Drug Resistance, Multiple, Bacterial; Drug Synergism; Drug Therapy, Combination; Humans; Imipenem; Meropenem; Microbial Sensitivity Tests; Sulbactam; Thienamycins

Nosocomial infections caused by multidrug-resistant (MDR) Acinetobacter baumannii have been increasing in recent years, posing a threat to public health worldwide. The susceptibility to eight antimicrobial agents of 35 clinical A. baumannii isolates from Taiwan was tested. Isolates were examined by polymerase chain reaction (PCR) and sequencing for beta-lactamase genes and mutations in the gyrA and parC genes. Expression of AdeB, an efflux pump protein, was evaluated by real-time quantitative PCR. The level of adeB expression correlated with resistance to ciprofloxacin and ampicillin/sulbactam in A. baumannii isolates. Almost all isolates with full resistance to ciprofloxacin had both high adeB expression and point mutations in parC and gyrA, but 4 intermediate-resistant isolates had only high adeB expression without point mutations in gyrA or parC, in contrast to 18 susceptible isolates with low adeB expression and without mutations in gyrA or parC. Sixteen isolates (45.7%) carrying a type 1 integron were MDR as well as being more resistant to imipenem, amikacin, gentamicin, ceftazidime or cefepime than those without the integron. The class 1 integron in A. baumannii carried different resistance gene cassettes, including 5'CS-bla(IMP-1)-aadA4-3'CS, 5'CS-aacA4-aadA1-3'CS and 5'CS-aacC1-aadA1-3'CS. In conclusion, expression of the adeB gene was associated with resistance to ciprofloxacin and ampicillin/sulbactam in A. baumannii. Multiple mutations in gyrA and parC also played a role in ciprofloxacin resistance. The major metallo-beta-lactamase contributing to imipenem resistance in A. baumannii in Taiwan was bla(IMP-1), which was carried by the class 1 integron. The class 1 integron was associated with the MDR phenotype in A. baumannii.

Topics: Acinetobacter baumannii; Acinetobacter Infections; Ampicillin; Anti-Bacterial Agents; Bacterial Proteins; Ciprofloxacin; Cross Infection; DNA, Bacterial; Drug Resistance, Bacterial; Gene Expression; Humans; Imipenem; Integrons; Point Mutation; Polymerase Chain Reaction; Sequence Analysis, DNA; Sulbactam; Taiwan

Acinetobacter baumannii is an important pathogen which causes severe nosocomial infections such as meningitis. Multidrug resistance is a growing problem throughout the world. In this report a case of multidrug resistant A.baumannii meningitis, treated with high dose of ampicillin-sulbactam (SAM) was presented. Rhinorrhea and confusion developed on the postoperative seventh day in a 67 years old male patient operated for macroadenoma of the hyphophysis gland. Since the cerebrospinal fluid (CSF) findings indicated a central nervous system infection, nosocomial meningitis was diagnosed and intravenous ceftazidime and vancomycin have started. Blood and CSF cultures of the patient revealed no growth and his general condition has improved. However, fever and confusion emerged again on the 21st day of therapy and the repeat CSF sample revealed increased pressure, purulent appearance, 510/mm3 leukocytes (90% PMNL), 58 mg/dl glucose (simultaneous blood glucose was 144 mg/dl) and 49 mg/dl protein. Direct microscopic examination of CSF revealed gram-negative coccobacilli and A.baumannii was identified in the culture. The isolate was resistant to piperacillin-tazobactam, third generation cephalosporins, aztreonam, ciprofloxacin, carbapenems and aminoglycosides, susceptible to sulbactam ampicillin and colistin. Ampicillin (12 gr) and sulbactam (6 gr) treatment was initiated and at the 72nd hour of the therapy the temperature and conciousness level of the patient returned to normal. Control CSF sample obtained on the 14th day of treatment revealed no leukocytes and no bacterial growth. The treatment was continued for 21 days and the patient recovered without any sequela. Since colistin which is one of the alternative antimicrobial treatment choices for resistant Acinetobacter infections, is not found in Turkey, sulbactam-ampicillin might be an effective and safe choice for the treatment of multi-resistant A. baumannii meningitis if the isolate was proven to be susceptible by antibiotic susceptibility tests.

Topics: Acinetobacter baumannii; Acinetobacter Infections; Aged; Ampicillin; Anti-Bacterial Agents; Cerebrospinal Fluid; Cross Infection; Drug Resistance, Multiple, Bacterial; Humans; Male; Meningitis, Bacterial; Microbial Sensitivity Tests; Sulbactam; Treatment Outcome

There has been an increase in worldwide infections caused by carbapenem-resistant Acinetobacter. This poses a therapeutic challenge as few treatment options are available.. The aim of this study was to evaluate the efficacy and safety of polymyxins and ampicillin/sulbactam for treating infections caused by carbapenem-resistant Acinetobacter spp. and to evaluate prognostic factors.. This was a retrospective review of patients from two teaching hospitals who had nosocomial infections caused by carbapenem-resistant Acinetobacter spp. from 1996 to 2004. Diagnosis of infection was based on CDC criteria plus the isolation of Acinetobacter from a usually sterile site or from bronchoalveolar lavage. Urinary tract infections were not included. Data on demographic and clinical features and treatment were collected from medical records. Prognostic factors associated with two outcomes (mortality during treatment and in-hospital mortality) were evaluated.. Eighty-two patients received polymyxins and 85 were treated with ampicillin/sulbactam. Multiple logistic regression analysis revealed that independent predictors of mortality during treatment were treatment with polymyxins, higher Acute Physiological and Chronic Health Evaluation II (APACHE II) score, septic shock, delay in starting treatment and renal failure. On multivariate analysis, prognostic factors for in-hospital mortality were older age, septic shock and higher APACHE II score.. This is the first study comparing current therapeutic options for infections due to carbapenem-resistant Acinetobacter. The most important finding of the present study is that ampicillin/sulbactam appears to be more efficacious than polymyxins, which was an independent factor associated with mortality during treatment.

Topics: Acinetobacter; Acinetobacter Infections; Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Ampicillin; APACHE; beta-Lactam Resistance; Bronchoalveolar Lavage Fluid; Carbapenems; Child; Child, Preschool; Cross Infection; Female; Hospitals, Teaching; Humans; Infant; Logistic Models; Male; Middle Aged; Multivariate Analysis; Polymyxins; Prognosis; Renal Insufficiency; Retrospective Studies; Risk Factors; Shock, Septic; Sulbactam; Time Factors; Treatment Outcome

We investigated an outbreak of Acinetobacter baumannii in the intensive care unit (ICU) of a hospital in Rome, Italy. The outbreak involved 14 patients whose isolates were most frequently recovered from bronchoalveolar lavage. All isolates were multidrug-resistant and showed diminished susceptibility or resistance to carbapenems. A. baumannii strains with a similar antibiotic susceptibility pattern were isolated from the environment. Pulsed-field gel electrophoresis identified a single clone from both the patients' and environmental isolates. Because of the lack of a single source of infection, the eradication of the epidemic required a broad approach, including contact isolation and cohorting, aggressive environmental disinfection, and close monitoring of the ward staff's performance. Infected patients were successfully treated with combined therapy. Although considered of low virulence, A. baumannii can be particularly aggressive and difficult to treat in ICU patients.

Topics: Acinetobacter baumannii; Acinetobacter Infections; Adult; Aged; Aged, 80 and over; Ampicillin; Anti-Bacterial Agents; Bronchoalveolar Lavage Fluid; Carbapenems; Colistin; Cross Infection; Disease Outbreaks; Disinfection; Drug Resistance, Multiple, Bacterial; Electrophoresis, Gel, Pulsed-Field; Female; Humans; Intensive Care Units; Male; Middle Aged; Patient Isolation; Rifampin; Rome; Sulbactam

Topics: Acinetobacter baumannii; Acinetobacter Infections; Ampicillin; Brazil; Cross Infection; Drug Resistance, Microbial; Drug Therapy, Combination; Drug Utilization Review; Humans; Infection Control; Sulbactam

Forty consecutive patients with nosomial infections caused by multidrug-resistant Acinetobacter baumannii were treated with intravenous ampicillin/sulbactam. The infections were primary bloodstream (32.5%), pneumonia (30%), urinary tract (15%), peritonitis (7.5%), surgical site (7.5%), meningitis (5%) and sinusitis (2.5%). Most were severe infections with underlying conditions (median APACHE II score: 14.5) and 72.5% occurred in the ICU. Twenty-seven (67.5%) were improved/cured, seven (17.5%) were failures and six (15%) were considered to have an indeterminate outcome because patients died within the first 48 h of treatment. Two cases of meningitis were treated and did not respond. The median daily dose of ampicillin/sulbactam was 6 g/3 g and six patients received 12 g/6 g. No adverse effects were observed. This study indicates that ampicillin/sulbactam may be a good and safe therapeutic option to treat severe nosocomial infections caused by multi-drug resistant A. baumannii.

Topics: Acinetobacter baumannii; Acinetobacter Infections; Adolescent; Adult; Aged; Aged, 80 and over; Ampicillin; Child; Cross Infection; Drug Resistance, Bacterial; Drug Therapy, Combination; Female; Humans; Imipenem; Male; Middle Aged; Sulbactam

To investigate most common pathogens isolated from the hospital-acquired pneumonia patients bronchoalveolar lavage fluid in Kaunas University of Medicine Hospital according to the previous antibiotic use and to estimate pathogens antibacterial susceptibility.. Results of 87 hospital-acquired pneumonia patients bronchoalveolar lavage fluid quantitative cultures were analyzed. Microorganisms isolated in clinically significant amount were considered as the etiological agents and included into analysis. Susceptibility was tested using the standard methods. Previously untreated patients were considered if the antibacterials were not administered at all or were used less than for 24 hours.. H. influenzae isolation in significant amount rates were higher in previously untreated patients group comparing to previously treated (29.2%. (n=14) and 5.1% (n=2), respectively, p<0.05). Non-fermenters (P. aeruginosa and Acinetobacter spp.) isolation rates were higher in those previously treated comparing to untreated patients - (31.0% (n=13) and 4.2% (n=2), respectively, p<0.05). All H. influenzae strains were susceptible to ampicillin and cefuroxime. 22.2-44.4% of P. aeruginosa strains were resistant to ceftazidime, amikacin and ciprofloxacin. Estimated Acinetobacter spp. resistance to ciprofloxacin and gentamycin was 83.3% and to ampicillin/sulbactam - 16.7%. All methicillin-susceptible S.aureus were also susceptible to gentamycin and fucidin and methicillin resistant to rifampicin and vancomycin.. Previous antibiotic treatment has an impact on pneumonia etiology testing. H. influenzae strains are more common isolated hospital-acquired pneumonia etiologic agents in previously untreated patients. The low antibacterial resistance was found enabling the use of aminopenicillins for treatment if H. influenzae infection suggested. The use of antibacterials increases non-fermenters isolation rates and combined antipseudomonal treatment is reasonable in these patients.

Topics: Acinetobacter; Acinetobacter Infections; Amikacin; Ampicillin; Anti-Bacterial Agents; Anti-Infective Agents; Bacteria; Bronchoalveolar Lavage Fluid; Ceftazidime; Cefuroxime; Ciprofloxacin; Cross Infection; Drug Resistance, Bacterial; Drug Therapy, Combination; Female; Fusidic Acid; Gentamicins; Haemophilus Infections; Haemophilus influenzae; Humans; Male; Methicillin; Microbial Sensitivity Tests; Middle Aged; Penicillins; Pneumonia, Bacterial; Pneumonia, Staphylococcal; Pseudomonas aeruginosa; Pseudomonas Infections; Rifampin; Staphylococcus aureus; Sulbactam; Vancomycin Resistance

The emergence of multidrug-resistant (MDR) Acinetobacter baumannii poses a therapeutic problem. The aim of this study was to assess the risk factors for nosocomial MDR-A. baumannii bloodstream infection (BSI) and the efficacy of ampicillin-sulbactam (A/S) in its treatment. Of 94 nosocomial A. baumannii BSI during the year 2000, 54% involved MDR strains, 81% of which were genetically related. Various risk factors for MDR-A. baumannii were found, of which intensive-care unit admission and prior aminoglycoside therapy were independently associated with MDR-A. baumannii acquisition on multivariate analysis. Of MDR-A. baumannii BSI cases, 65% received A/S and 35% inadequate antibiotic therapy, whereas of 43 non-MDR cases, 86% were treated according to susceptibility and 14% inappropriately with antibiotics to which these organisms were resistant. Crude mortality was comparable in the adequately treated groups. Respective mortalities among patients treated adequately and inadequately were 41.4 and 91.7% (p<0.001). Among severely ill patients, A/S therapy significantly decreased the risk of death (P=0.02 OR=7.64). MDR-A. baumannii has become highly endemic in our institution. A/S appears to be one of the last effective and safe empirical resorts for treatment of MDR A. baumannii BSI.

Topics: Acinetobacter baumannii; Acinetobacter Infections; Aged; Ampicillin; Cross Infection; DNA, Bacterial; Drug Resistance, Multiple, Bacterial; Drug Therapy, Combination; Female; Hospital Bed Capacity, 500 and over; Humans; Intensive Care Units; Israel; Male; Medical Records; Microbial Sensitivity Tests; Middle Aged; Outcome Assessment, Health Care; Polymerase Chain Reaction; Retrospective Studies; Risk Factors; Sulbactam

Roseomonas species have been increasingly noted as causes of human infection. We present what we believe is the first case of left ventricular assist device (LVAD) infection secondary to Roseomonas. The clinical characteristics of Roseomonas infection and the pertinent features of LVAD infection are reviewed.

Topics: Ampicillin; Anti-Bacterial Agents; Aortic Valve Insufficiency; Cardiomyopathies; Cefuroxime; Cross Infection; Drug Resistance; Drug Therapy, Combination; Gram-Negative Bacterial Infections; Heart Transplantation; Heart-Assist Devices; Humans; Methylobacteriaceae; Michigan; Middle Aged; Sulbactam

The incidence of extended-spectrum beta-lactamase (ESbetaL)-mediated resistance has increased markedly during the past decade. Risk factors for colonization with ESbetaL-producing Escherichia coli and Klebsiella species (ESbetaL-EK) remain unclear, as do methods to control their further emergence.. Case-control study.. Two hospitals within a large academic health system: a 725-bed academic tertiary-care medical center and a 344-bed urban community hospital.. Thirteen patients with ESbetaL-EK fecal colonization were compared with 46 randomly selected noncolonized controls.. Duration of hospitalization was the only independent risk factor for ESbetaL-EK colonization (odds ratio, 1.11; 95% confidence interval, 1.02 to 1.21). Of note, 8 (62%) of the patients had been admitted from another healthcare facility. In addition, there was evidence for dissemination of a single K oxytoca clone. Finally, the prevalence of ESbetaL-EK colonization decreased from 7.9% to 5.7% following restriction of third-generation cephalosporins (P = .51).. ESbetaL-EK colonization was associated only with duration of hospitalization and there was no significant reduction following antimicrobial formulary interventions. The evidence for nosocomial spread and the high percentage of patients with ESbetaL-EK admitted from other sites suggest that greater emphasis must be placed on controlling the spread of such organisms within and between institutions.

Topics: Academic Medical Centers; Adult; Aged; Aged, 80 and over; Ampicillin; Anti-Bacterial Agents; beta-Lactam Resistance; Carrier State; Case-Control Studies; Cefepime; Cephalosporins; Cross Infection; Drug Therapy, Combination; Drug Utilization Review; Escherichia coli Infections; Feces; Female; Formularies, Hospital as Topic; Gentamicins; Hospitals, Community; Hospitals, Urban; Humans; Infection Control; Klebsiella Infections; Length of Stay; Male; Middle Aged; Pennsylvania; Prevalence; Risk Factors; Sulbactam

The clinical features and the outcomes of eight cases of nosocomial Acinetobacter baumannii meningitis treated with ampicillin/sulbactam are reported. All the patients had fever, neck stiffness or meningeal signs, and a low consciousness level, and in their cerebrospinal fluid (CSF), pleocytosis, a low glucose level, and an elevated protein level were noted. For all CSF isolates of A. baumannii, the MIC of ampicillin/sulbactam was < or = 8/4 microg/mL. The MICs of sulbactam by microdilution in two cases were 4 microg/mL. All isolates were resistant to cefotaxime, ceftriaxone, ceftazidime, ureidopenicillins, ciprofloxacin, and gentamicin. Seven isolates were resistant to imipenem. A. baumannii was isolated from other samples in seven episodes. All patients were treated with ampicillin/sulbactam (seven with 2 g/l g every 6 hours and one with 2 g/l g every 8 hours). Six patients were cured and two patients died of meningitis. There were no side effects with the ampicillin/sulbactam treatment. In conclusion, ampicillin/sulbactam may be effective as therapy for meningitis caused by A. baumanii resistant to imipenem and other beta-lactam drugs.

Topics: Acinetobacter; Acinetobacter Infections; Adult; Aged; Ampicillin; Cross Infection; Drug Resistance, Multiple; Drug Therapy, Combination; Evaluation Studies as Topic; Female; Humans; Male; Meningitis, Bacterial; Microbial Sensitivity Tests; Middle Aged; Retrospective Studies; Sulbactam; Survival Rate; Treatment Outcome

A recent outbreak of multiresistant strains of Acinetobacter calcoaceticus biotype anitratus was observed mostly, but not exclusively, in the surgical intensive care unit in our hospital. Disk diffusion and microdilution susceptibility studies demonstrated resistance to imipenem, all aminoglycosides, and all individual beta-lactam antibiotics. Only ampicillin plus sulbactam, cefoperazone plus sulbactam, and polymyxin produced zone sizes and MICs in the susceptible ranges. Determination of MICs and MBCs demonstrated that sulbactam was the antimicrobial agent responsible for the killing of these organisms. Nine of 10 patients who were infected with imipenem-resistant Acinetobacter strains and received ampicillin plus sulbactam for > 3 days improved clinically, and in many cases organisms were eradicated from the site of isolation.

Topics: Acinetobacter calcoaceticus; Acinetobacter Infections; Ampicillin; Cross Infection; Disease Outbreaks; Drug Resistance, Microbial; Drug Therapy, Combination; Humans; Imipenem; Microbial Sensitivity Tests; Retrospective Studies; Sulbactam

A total 16 patients with moderate and serious surgical and urogenital infections were treated intravenously with the Unasyn IM/IV inj., combination of ampicillin and sulbactam, which is a beta-lactamase inhibitor. In this combination, sulbactam saves the ampicillin against the effects of beta-lactamases and extends the susceptibility to ampicillin of previously ampicillin-resistant strains. Clinical cure was observed in 69% of the patients, improvement in 19%, and failure in 12%. Microbiological elimination was proved in 50% of the patients, persistence in 6%, a in the rest of the patients (44%) were microbiological response unevaluable. The evaluation of subjective and objective tolerance of Unasyn IM/IV inj. was excellent. It follows from this study that the combination of ampicillin with sulbactam can be considered an effective and safe treatment of nosocomial infections, especially in the departments with an increasing rate of ampicillin-resistant strains due to production of the beta-lactamases.

Topics: Acute Disease; Adult; Aged; Ampicillin; Cross Infection; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Sulbactam; Surgical Wound Infection

A prospective audit of 644 patients undergoing biliary tract operations has been conducted in ten district general hospitals. All patients received a single dose of ampicillin 2 g and sulbactam 1 g as antibiotic prophylaxis. Bacteria were cultured from the bile of 121 patients. In patients with sterile bile the incidence of postoperative infection was 2.5%, while in those with colonized bile it was 22% (P less than 0.0001). The 35 patients from whose bile bacteria of two or more species were isolated, had a higher incidence of wound infection (34%) than those whose bile yielded only one species of bacterium (17%; P less than 0.05). Seventeen of the 27 patients with colonized bile who developed postoperative infection were shown to be infected by the same organisms that had been isolated from their bile. The patients whose bile yielded organisms resistant to the prophylactic antibiotic combination did not have a significantly higher rate of infection than those from whose bile only sensitive organisms were obtained. A marked difference in sensitivity patterns between the participating hospitals was observed.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Ampicillin; Bacterial Infections; Biliary Tract Surgical Procedures; Cross Infection; Drug Resistance, Microbial; Drug Therapy, Combination; Enterobacteriaceae; Enterococcus faecalis; Female; Humans; Male; Middle Aged; Postoperative Complications; Premedication; Prospective Studies; Risk Factors; Sulbactam