tetracycline and Pneumonia--Bacterial

We describe the laboratory-confirmed etiologies of illness among participants in a hospital-based febrile illness cohort study in northern Tanzania who retrospectively met Integrated Management of Adolescent and Adult Illness District Clinician Manual (IMAI) criteria for septic shock, severe respiratory distress without shock, and severe pneumonia, and compare these etiologies against commonly used antimicrobials, including IMAI recommendations for emergency antibacterials (ceftriaxone or ampicillin plus gentamicin) and IMAI first-line recommendations for severe pneumonia (ceftriaxone and a macrolide). Among 423 participants hospitalized with febrile illness, there were 25 septic shock, 37 severe respiratory distress without shock, and 109 severe pneumonia cases. Ceftriaxone had the highest potential utility of all antimicrobials assessed, with responsive etiologies in 12 (48%) septic shock, 5 (14%) severe respiratory distress without shock, and 19 (17%) severe pneumonia illnesses. For each syndrome 17-27% of participants had etiologic diagnoses that would be non-responsive to ceftriaxone, but responsive to other available antimicrobial regimens including amphotericin for cryptococcosis and histoplasmosis; anti-tuberculosis therapy for bacteremic disseminated tuberculosis; or tetracycline therapy for rickettsioses and Q fever. We conclude that although empiric ceftriaxone is appropriate in our setting, etiologies not explicitly addressed in IMAI guidance for these syndromes, such as cryptococcosis, histoplasmosis, and tetracycline-responsive bacterial infections, were common.

Topics: Acute Disease; Adolescent; Adult; Aged; Aged, 80 and over; Amphotericin B; Ampicillin; Anti-Infective Agents; Bacterial Infections; Ceftriaxone; Child; Cohort Studies; Cryptococcosis; Emergencies; Female; Gentamicins; Histoplasmosis; Humans; Infections; Macrolides; Male; Microbial Sensitivity Tests; Middle Aged; Pneumonia, Bacterial; Respiratory Distress Syndrome; Shock, Septic; Tanzania; Tetracycline; Young Adult

Antibiotic selection is challenging in patients with severe β-lactam allergy due to declining reliability of alternate antibiotics. Organisms isolated from these patients may exhibit unique resistance phenotypes. The objective of this study was to determine which alternate antibiotics or combinations provide adequate empirical therapy for patients with β-lactam allergy who develop Gram-negative infections at our institution. We further sought to determine the effects of risk factors for drug resistance on empirical adequacy. A retrospective analysis was conducted for adult patients hospitalized from September 2009 to May 2010 who had a severe β-lactam allergy and a urine, blood, or respiratory culture positive for a Gram-negative organism and who met predefined criteria for infection. Patient characteristics, culture and susceptibility data, and predefined risk factors for antibiotic resistance were collected. Adequacies of β-lactam and alternate antibiotics were compared for all infections and selected subsets. The primary outcome was adequacy of each alternate antibiotic or combination for all infections. One hundred sixteen infections (40 pneumonias, 67 urinary tract infections, and 9 bacteremias) were identified. Single alternate agents were adequate less frequently than β-lactams and combination regimens. Only in cases without risk factors for resistance did single-agent regimens demonstrate acceptable adequacy rates; each factor conferred a doubling of risk for resistance. Resistance risk factors should be considered in selecting empirical antibiotics for Gram-negative pathogens in patients unable to take β-lactams due to severe allergy.

Topics: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Bacteremia; beta-Lactams; Drug Hypersensitivity; Drug Resistance, Multiple, Bacterial; Drug Therapy, Combination; Empirical Research; Female; Fluoroquinolones; Gram-Negative Bacteria; Gram-Negative Bacterial Infections; Humans; Middle Aged; Pneumonia, Bacterial; Retrospective Studies; Risk; Tetracycline; Urinary Tract Infections

We report retrospective analysis of the clinical and antimicrobial susceptibility data of 140 Streptococcus pseudopneumoniae isolates. Strains were isolated mostly from respiratory tract samples from patients with underlying diseases. In the case of infection, pneumonia, mainly aspiration pneumonia, was the most frequent (27.1% of the patients). We documented high rates of decreased susceptibilities and resistance to erythromycin and tetracycline (57% and 43% of the isolates, respectively), as well as reduced susceptibility to penicillin in 21% of the isolates.

Topics: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Bronchoalveolar Lavage Fluid; Child; Erythromycin; Female; France; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Penicillins; Pneumonia, Bacterial; Respiratory Tract Infections; Retrospective Studies; Sputum; Streptococcal Infections; Streptococcus; Tetracycline; Young Adult

Prior to the implementation of Haemophilus influenzae type b vaccination worldwide, H. influenzae has been one of the main causative agents of community acquired pneumonia and meningitis in children. Due to the lack of information on the characteristics of the H. influenzae isolates that have previously been collected in Malaysia, the H. influenzae were assessed of their microbial susceptibility to commonly used antibiotics. Emphasis was made on strains that were resistance to co-trimoxazole (SXT) and their mode of transfer of the antibiotic resistance determinants were examined. A collection of 34 H. influenzae isolates was serotyped and antimicrobial susceptibility tests were performed to 11 antibiotics. To the isolates that were found to be resistant to co-trimoxazole, minimum inhibition concentration (MIC) to SXT was performed using Etest while agar dilution method was used to measure the individual MICs of trimethoprim (TMP) and sulfamethoxazole (SUL). These isolates were also examined for presence of plasmid by PCR and isolation method. Conjugal transfers of SXT-resistant genes to SXT-susceptible hosts were performed to determine their rate of transfer. Result showed that 20.6% of the total number of isolates was serotype B while the remaining was non-typeable. Antimicrobial susceptibility profile of all the isolates revealed that 58.8% was resistant to at least one antibiotic. Majority of these isolates were equally resistant to ampicillin and tetracycline (29.4% each), followed by resistance to SXT (26.5%). From nine isolates that were found to be SXT-resistant, five contained plasmid/s. Conjugal transfer experiment showed that these five isolates with plasmid transferred SXT-resistance determinants at a higher frequency than those without. From these observations, it is postulated that plasmid is not involved in the transfer of SXT-resistance genes but presence of plasmid facilitates their transfer. The information obtained from this study provides some basic knowledge on the antimicrobial susceptibility pattern of the H. influenzae isolates and their mode of transfer of SXT-resistance genes.

Topics: Ampicillin; Anti-Bacterial Agents; Child; Community-Acquired Infections; DNA, Bacterial; Drug Resistance, Multiple, Bacterial; Haemophilus Infections; Haemophilus influenzae; Humans; Malaysia; Microbial Sensitivity Tests; Phenotype; Plasmids; Pneumonia, Bacterial; Serotyping; Tetracycline; Trimethoprim, Sulfamethoxazole Drug Combination

Legionella species other than Legionella pneumophila may cause pneumonias and extrapulmonary infections. Most infections are nosocomial or observed in immunocompromised patients and often remain undiagnosed because of the failure of confirmatory culture methods. The therapy is based on macrolides and fluoroquinolones; rifampin and tetracycline are also used.

Topics: Anti-Bacterial Agents; Cross Infection; Fluoroquinolones; Humans; Immunocompromised Host; Legionella; Legionellosis; Macrolides; Pneumonia, Bacterial; Rifampin; Tetracycline

We investigated the clinical characteristics separating pneumonia as a complication in elderly lung cancer patients into obstructive and non-obstructive pneumonia. Two hundred and five patients with pneumonia as a complication in elderly lung cancer patients were classified into two groups; 64 patients with obstructive pneumonia and 141 patients with non-obstructive pneumonia. Most of the patients in both groups were male. Concerning histological findings, while most of the patients with obstructive pneumonia had squamous cell carcinoma, those with non-obstructive pneumonia had the same proportion of squamous cell carcinoma as all elderly patients with lung cancer. Most of the patients with obstructive pneumonia were in good general condition including their nutritional condition, but the patients with non-obstructive pneumonia were in significantly poor condition. A low percent of microorganisms were isolated from the sputum obtained from the patients with non-obstructive pneumonia, but a high percentage were obtained from those with non-obstructive pneumonia. Frequent involvement of gram-negative bacilli such as Pseudomonas aeruginosa and Klebsiella pneumoniae or Staphylococcus aureus containing MRSA was also found in these patients. Regarding treatment, although carbapenem was used either alone or in combination therapy as the regimen of treatment for pneumonia as a complication in elderly lung cancer patients with both the obstructive and non-obstructive pneumonia patients, the efficacy rate was poor in 50% with obstructive pneumonia and in 26% with non-obstructive pneumonia. The mortality rate was 11% in the patients with obstructive pneumonia, while it was 61% in the patients with non-obstructive pneumonia. The prognosis was significantly poorer in the patients with non-obstructive pneumonia. We concluded that although the prognosis was not so poor for patients with obstructive pneumonia if the appropriate treatment was given, in the patients with non-obstructive pneumonia, the treatment for underlying diseases and the improvement of their general condition, including the determination of causative microorganisms, was important.

Topics: Aged; Carbapenems; Drug Therapy, Combination; Female; Humans; Lung Neoplasms; Male; Penicillins; Pneumonia, Bacterial; Prognosis; Tetracycline

From January 1988 to December 1992, 143 Streptococcus pneumoniae strains have been isolated at a significant level from 136 patients hospitalized in the pulmonary care unit of CHI Créteil. The clinical presentations were: 83 pneumonia (P), 48 acute bronchitis (B) and 12 colonizations (C). Fourteen strains were found to be penicillin resistant (MIC > 0.125 mg. l-1): 11 P, 2 B, 1 C. Two patients were lost of view after the beginning of the treatment: a pneumonia (Serotype 23F, MIC = 2 mg. l-1) and a bronchitis (Serotype 23F, MIC = 2 mg. l-1). Treatment was pristinamycine for one and amoxicilline alone or associated to clavulanic acid for the other 13. We observed the failure of the treatment in two. A pneumonia (Serotype 23, MIC = 2 mg. l-1) was treated before hospitalization by josamycine (3 days), then cefpodoxime (4 days) and amoxicillin-clavulanic acid (1.5 gr/d during 7 days). Healing was obtained with the increase to 3 gr/d. The other failure was a pneumonia without improvement after 11 days with 3 gr/d of amoxicilline. The treatment was stopped during 5 days and a protected brushing was performed. A Streptococcus Pneumoniae (Serotype 23F, MIC = 8 mg. l-1) was isolated. The clinical status rapidly improved with erythromycine (3 gr/d) to which the strain was susceptible. "Bacteriological" Resistance to penicillin is demonstrated (10 percent in our sample, 17 percent in France during 1991). However amoxicillin to a sufficient dosage is still enough ("Clinical" Resistance < 1 percent in our sample) for the treatment of respiratory infections except when the MIC is at a high level.

Topics: Adult; Aged; Aged, 80 and over; Drug Resistance, Microbial; Erythromycin; Female; Humans; In Vitro Techniques; Male; Middle Aged; Penicillin Resistance; Penicillins; Phenols; Pneumonia, Bacterial; Retrospective Studies; Streptococcal Infections; Streptococcus pneumoniae; Tetracycline

Topics: Adolescent; Anti-Bacterial Agents; Antibody Formation; Drug Resistance; Drug Resistance, Microbial; Hemolysis; Humans; Kanamycin; Microbiology; Mycoplasma; Mycoplasma pneumoniae; Penicillins; Pneumonia; Pneumonia, Bacterial; Pneumonia, Viral; Sulfonamides; Tetracycline

Topics: Anti-Bacterial Agents; Child; Humans; Infant; Pneumonia; Pneumonia, Bacterial; Protein Synthesis Inhibitors; Tetracycline