sultamicillin and Stomach-Neoplasms

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

Open total gastrectomy carries a high risk of surgical-site infection (SSI). This study evaluated the non-inferiority of antimicrobial prophylaxis for 24 compared with 72 h after open total gastrectomy.. An open-label, randomized, non-inferiority study was conducted at 57 institutions in Japan. Eligible patients were those who underwent open total gastrectomy for gastric cancer. Patients were assigned randomly to continued use of β-lactamase inhibitor for either 24 or 72 h after surgery. The primary endpoint was the incidence of SSI, with non-inferiority based on a margin of 9 percentage points and a 90 per cent c.i. The secondary endpoint was the incidence of remote infection.. A total of 464 patients (24 h prophylaxis, 228; 72 h prophylaxis, 236) were analysed. SSI occurred in 20 patients (8·8 per cent) in the 24-h prophylaxis group and 26 (11·0 per cent) in the 72-h group (absolute difference -2·2 (90 per cent c.i. -6·8 to 2·4) per cent; P < 0·001 for non-inferiority). However, the incidence of remote infection was significantly higher in the 24-h prophylaxis group.. Antimicrobial prophylaxis for 24 h after total gastrectomy is not inferior to 72 h prophylaxis for prevention of SSI. Shortened antimicrobial prophylaxis might increase the incidence of remote infection. Registration number: UMIN000001062 ( http://www.umin.ac.jp).

Topics: Aged; Ampicillin; Antibiotic Prophylaxis; beta-Lactamase Inhibitors; Drug Administration Schedule; Female; Gastrectomy; Humans; Japan; Logistic Models; Male; Middle Aged; Prospective Studies; Respiratory Tract Infections; Stomach Neoplasms; Sulbactam; Surgical Wound Infection

Pantoea calida is a gram-negative bacillus that was first identified in 2010. Here, we describe the first known case of P. calida bacteremia in a 77-year-old woman with end-stage stomach cancer under inpatient care. The patient was admitted to our hospital for pain after receiving anti-cancer therapy at outpatient facility. Thirteen days after admission, her temperature rose to 39.6 °C. A blood culture was ordered for suspected bacterial infection, and the patient was treated empirically with ampicillin/sulbactam. Cultures showed white pitting colonies later identified as a Pantoea sp. by biochemical analysis. The isolate's 16S rRNA sequence was identical to that of P. calida (100%), and showed 99.1% similarity with that of Pantoea gaviniae. Matrix-assisted laser desorption/ionization-time of flight mass spectrometry (MALDI-TOF MS) confirmed the species as P. calida with an average spectral score >2.0. The primary isolate was ampicillin-resistant, but susceptible to other antibiotics and the bacteremia was cleared after three days of antibiotic therapy. Since P. calida infection is relatively rare, limited information exists on the pathogen's portal of entry and bacterial characteristics; thus, further studies are necessary to establish the pathophysiological mechanisms P. calida infection.

Topics: Aged; Ampicillin; Anti-Bacterial Agents; Bacteremia; Enterobacteriaceae Infections; Female; Hospitalization; Humans; Microbial Sensitivity Tests; Pantoea; Stomach Neoplasms; Sulbactam

The present study was designed to investigate the effects of prophylactic antibiotic therapy and the cost-effectiveness of Cefazolin (CEZ) and Sulbactam/Ampicillin (SBT/ABPC) in gastric cancer surgery employing clinical pathway. 157 patients (62 in the CEZ group and 95 in the SBT/ABPC group), who underwent surgery for gastric cancer at the First Department of Surgery of our hospital, were investigated. There was no significant difference between the groups with regard to sex, age, incidence of complication, stage of cancer, surgical method, operative time and blood loss, length of hospitalization, the appearance of systemic inflammatory response syndrome (SIRS), changes body temperature, white blood cell count (WBC), C-reactive protein (CRP), or clinical outcome of postoperative care by a nurse during post-operation for 7 days. The prophylactic effect of infection was also no different between the CEZ (69.4%) and SBT/ABPC (69.5%) groups. In contrast, decision analysis strongly indicated that the anticipate cost of antibiotics was higher in the latter group (yen 20402) than in the CEZ group (yen 15556), suggesting that the prophylactic effect of CEZ may be more cost-effective. Thus, evaluations of pharmacotherapy from the aspect of cost may be one of the important responsibility of hospital pharmacists in the future.

Topics: Aged; Ampicillin; Antibiotic Prophylaxis; Cefazolin; Cost-Benefit Analysis; Critical Pathways; Female; Gastrectomy; Gram-Positive Bacterial Infections; Humans; Male; Middle Aged; Postoperative Complications; Retrospective Studies; Stomach Neoplasms; Sulbactam