trimethoprim--sulfamethoxazole-drug-combination and Clostridium-Infections

A 55-year old man developed a hemorrhagic pneumonia, likely due to infection with Kytococcus sedentarius during neutropenia following induction chemotherapy for acute myeloid leukemia. Severe mucosal barrier injury and the selective pressure of broad-spectrum antibiotics probably made it possible for this normally harmless commensal to penetrate the gut, spread through the blood stream, and invade the lungs.

Topics: Actinomycetales; Actinomycetales Infections; Acyclovir; Antineoplastic Combined Chemotherapy Protocols; Bacteremia; Bacterial Translocation; Cefepime; Cephalosporins; Clostridium Infections; Colistin; Cytarabine; Daunorubicin; Drug Therapy, Combination; Etoposide; Fatal Outcome; Hemoptysis; Humans; Hydroxyurea; Immunocompromised Host; Intestinal Mucosa; Leukemia, Myeloid, Acute; Male; Metronidazole; Middle Aged; Neutropenia; Pneumonia, Bacterial; Superinfection; Teicoplanin; Trimethoprim, Sulfamethoxazole Drug Combination

Clostridium difficile infection (CDI) is a significant complication of allogeneic hematopoietic stem cell transplantation (allo-HSCT). Our primary objective was to determine risk factors for the development of CDI during the first year following allo-HSCT.. A matched case-control study nested in a cohort of allo-HSCT at a single hospital in Montréal, Québec, Canada, was conducted from 2002 through 2011.. Sixty-five of 760 patients who underwent allo-HSCT between 2002 and 2011 developed CDI, representing an incidence of 8.6%. We selected 123 controls matched for year of transplant for risk factor analyses. In the multivariable analysis, receipt of trimethoprim-sulfamethoxazole (TMP-SMX) prior to transplantation (adjusted odds ratio [aOR] 0.07, 95% confidence interval [CI] 0.02-0.27), mucositis (aOR 5.90, 95% CI 2.08-16.72), and reactivation of cytomegalovirus (CMV) (aOR 6.17, 95% CI 2.17-17.57) and of other Herpesviridae viruses (aOR 3.04, 95% CI 1.13-8.16) were the variables that remained statistically associated with CDI. High-risk antibiotic use in the late post-transplant period (aOR 7.63, 95% CI 2.14-27.22) was associated with development of late CDI.. This study revealed reactivation of CMV and other Herpesviridae viruses as novel risk factors for CDI. Administration of TMP-SMX prior to transplantation was independently associated with a decreased risk of CDI. Early and late CDI after HSCT may have distinct risk factors.

Topics: Adult; Anti-Bacterial Agents; Case-Control Studies; Clostridioides difficile; Clostridium Infections; Cytomegalovirus; Cytomegalovirus Infections; Female; Hematopoietic Stem Cell Transplantation; Humans; Incidence; Male; Middle Aged; Mucositis; Quebec; Retrospective Studies; Risk Factors; Transplantation Conditioning; Transplantation, Homologous; Trimethoprim, Sulfamethoxazole Drug Combination; Virus Activation

Topics: Anti-Bacterial Agents; Australia; Cephalosporins; Clostridioides difficile; Clostridium Infections; Drug Hypersensitivity; Drug Resistance, Multiple, Bacterial; Female; Humans; Liver Transplantation; Male; Nitroimidazoles; Penicillins; Retrospective Studies; Trimethoprim, Sulfamethoxazole Drug Combination

Lengthier antimicrobial therapy is associated with increased costs, antimicrobial resistance, and adverse drug events. Therefore, establishing minimum effective antimicrobial treatment durations is an important public health goal. The optimal treatment duration and current treatment patterns for urinary tract infection (UTI) in men are unknown. We used Veterans Affairs administrative data to study male UTI treatment and outcomes.. Male UTI episodes in the Veterans Affairs system (fiscal year 2009) were identified by combining International Classification of Diseases, Ninth Revision codes with UTI-relevant antimicrobial prescriptions. Episodes were categorized as index, early recurrence (<30 days), or late recurrence (≥30 days) cases. Drug name, treatment duration, and outcomes (recurrence and Clostridium difficile infection during 12 months) were recorded for index cases. Demographic, clinical, and treatment characteristics were assessed for associations with outcomes in univariate and multivariate analyses.. Among 4 854 765 outpatient male veterans, 39 149 UTI episodes involving 33 336 unique patients were identified, including 33 336 index cases (85.2%), 1772 early recurrences (4.5%), and 4041 late recurrences (10.3%). Highest-use antimicrobial agents were ciprofloxacin (62.7%) and trimethoprim-sulfamethoxazole (26.8%); 35.0% of patients received shorter-duration treatment (≤7 days), and 65.0% of patients received longer-duration treatment (>7 days). Of the index cases, 4.1% were followed by early recurrence and 9.9% by late recurrence. Longer-duration treatment was not associated with a reduction in early or late recurrence but was associated with increased late recurrence compared with shorter-duration treatment (10.8% vs 8.4%, P < .001), including in multivariate analysis (odds ratio, 1.20; 95% CI, 1.10-1.30). In addition, C difficile infection risk was significantly higher with longer-duration vs shorter-duration treatment (0.5% vs 0.3%, P = .02) and exhibited a similar suggestive trend in multivariate analysis (odds ratio, 1.42; 95% CI, 0.97-2.07).. Longer-duration treatment (>7 days) for male UTI in the outpatient setting was associated with no reduction in early or late recurrence.

Topics: Aged; Anti-Infective Agents; Ciprofloxacin; Clostridium Infections; Comorbidity; Drug Administration Schedule; Drug Resistance, Microbial; Episode of Care; Humans; Male; Medication Therapy Management; Outcome Assessment, Health Care; Secondary Prevention; Time Factors; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; United States; United States Department of Veterans Affairs; Urinary Tract Infections; Veterans

Co-trimoxazole is infrequently prescribed in the UK due to concerns regarding adverse events. However, it has a low association with Clostridium difficile-associated disease (CDAD) and may represent an alternative to higher-risk agents. This retrospective study examines the efficacy and safety of intravenous co-trimoxazole in treatment of bacterial infection in a UK inpatient population of 50 inpatients. Outcome was determined to be successful in 58% of treatment episodes; in hospital-acquired pneumonia the response rate was 52%. Two treatment episodes were terminated due to adverse events: these resolved on discontinuation of co-trimoxazole. No significant change in renal function, evaluated by serum creatinine, was observed during therapy; blood platelet count was not affected by treatment with intravenous co-trimoxazole. One patient developed CDAD within one month of cessation of therapy. Intravenous co-trimoxazole was clinically effective with a low rate of adverse events and may represent a useful alternative antimicrobial agent in UK institutions with high rates of CDAD.

Topics: Anti-Infective Agents; Bacterial Infections; Clostridioides difficile; Clostridium Infections; Female; Humans; Male; Retrospective Studies; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Antibiotic-associated colitis (pseudomembranous colitis) developed in four patients with spinal cord injury and taking oral trimethoprim-sulfamethoxazole. One hundred forty-eight (59%) of 251 patients with spinal cord injury who were evaluated had received this drug. Two of the four patients with pseudomembranous colitis did not promptly respond to therapy, and all four suffered significant further immobilization because of the disease. Pseudomembranous colitis readily occurs in at least certain population groups receiving trimethoprim-sulfamethoxazole.

Topics: Adult; Anti-Infective Agents, Urinary; Clostridium Infections; Diarrhea; Drug Combinations; Enterocolitis, Pseudomembranous; Humans; Male; Middle Aged; Premedication; Spinal Cord Injuries; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

During the last two years eight children aged 3 months to 7 years were treated successfully for contaminated small bowel syndrome (CSBS). All patients had a history of a laparotomy in the neonatal period and showed bile stained vomiting and diarrhoea. On examination, a painful distended abdomen with hyperactive bowel sounds was found. Plain abdominal x-rays showed signs of mechanical intestinal obstruction. The diagnosis of CSBS was made by positive gram stain and cultures of samples taken via a nasogastric tube. After antibiotic treatment the symptoms disappeared within a few days. We therefore believe that CSBS should always be considered in the differential diagnosis of abdominal emergencies. Our views agree with those of other authors in so far as we feel that antibiotic therapy may help to avoid unnecessary laparotomies in such cases.

Topics: Child; Child, Preschool; Clostridium; Clostridium Infections; Drug Combinations; Escherichia coli; Escherichia coli Infections; Gram-Negative Bacteria; Gram-Positive Bacteria; Humans; Infant; Infant, Newborn; Intestinal Obstruction; Intestine, Small; Laparotomy; Ornidazole; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination