trimethoprim--sulfamethoxazole-drug-combination and Corynebacterium-Infections

Topics: Achromobacter; Aged; Anti-Bacterial Agents; Bordetella; Ceftazidime; Coinfection; Corynebacterium Infections; Diabetic Foot; Female; Gram-Negative Bacterial Infections; Humans; Microbial Sensitivity Tests; Trimethoprim, Sulfamethoxazole Drug Combination; Vancomycin; Wound Infection

Corynebacterium aquaticum was the cause of peritonitis in a 33-year-old diabetic woman on continuous ambulatory peritoneal dialysis (CAPD). This case represents the first reported instance of CAPD peritonitis due to this organism. Moreover, the organism was recovered from fibrin clots removed from dialysate bags when the patient was on antibiotic therapy. Routine cultural methods failed to reveal the organism at that time. The organism is described and key points differentiating it from similar organisms are emphasised. The world literature on C. aquaticum infections is reviewed.

Topics: Adult; Anti-Bacterial Agents; Corynebacterium; Corynebacterium Infections; Diabetic Nephropathies; Drug Combinations; Female; Humans; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis; Recurrence; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Infections of 12 cerebrospinal fluid (CSF) shunts in 11 children were treated with oral systemic antibiotic therapy plus daily intrashunt injections of antibiotics. Eight patients were infected with Staphylococcus epidermidis (four patients) or Staphylococcus aureus (four patients), and were treated with intrashunt vancomycin, plus oral trimethoprim/sulfamethoxazole (T/S), plus oral rifampin. One of these eight patients was later changed to a course of intrashunt cephapirin and oral cephalexin plus oral rifampin. One patient with Micrococcus varians infection was treated with oral T/S and rifampin, without intrashunt therapy, another patient with Pseudomonas cepacia infection was treated with intrashunt kanamycin plus oral T/S, and a third with Corynebacterium sp. infection was treated with intrashunt vancomycin plus oral T/S. Eight of the 11 patients required some form of shunt surgery, the most common being temporary externalization of the peritoneal end of the catheter. Only two shunts were completely replaced (both were ventriculojugular shunts which were changed to ventriculoperitoneal shunts). Nine of 10 evaluable cases were considered cured of their infections. The patient treated with cephalosporins had an uncorrected shunt malfunction and relapsed 1 month after completing therapy. The authors have shown that CSF shunts infected with Staphylococci can be effectively cleared with daily intrashunt vancomycin plus systemic therapy with oral T/S and rifampin. Less common infections may also be amenable to this form of therapy. Revision surgery, if necessary, should be carried out during the antibiotic therapy.

Topics: Administration, Oral; Cerebrospinal Fluid Shunts; Child; Child, Preschool; Corynebacterium Infections; Drug Combinations; Female; Humans; Infant; Kanamycin; Male; Micrococcus; Pseudomonas Infections; Staphylococcal Infections; Streptococcal Infections; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Vancomycin