trimethoprim--sulfamethoxazole-drug-combination and Cross-Infection

Pneumocystis jirovecii pneumonia (PCP) is an important cause of morbidity in immunocompromised patients, with a higher mortality in non-HIV than in HIV patients. P. jirovecii is one of the rare transmissible pathogenic fungi and the only one that depends fully on the host to survive and proliferate. Transmissibility among humans is one of the main specificities of P. jirovecii. Hence, the description of multiple outbreaks raises questions regarding preventive care management of the disease, especially in the non-HIV population. Indeed, chemoprophylaxis is well codified in HIV patients but there is a trend for modifications of the recommendations in the non-HIV population. In this review, we aim to discuss the mode of transmission of P. jirovecii, identify published outbreaks of PCP and describe molecular tools available to study these outbreaks. Finally, we discuss public health and infection control implications of PCP outbreaks in hospital setting for in- and outpatients.

Topics: Chemoprevention; Cross Infection; Disease Outbreaks; HIV Infections; Humans; Immunocompromised Host; Infection Control; Mycological Typing Techniques; Pneumocystis carinii; Pneumonia, Pneumocystis; Public Health; Trimethoprim, Sulfamethoxazole Drug Combination

The gap between the emergence of antibiotic resistance and new antibiotic development has drawn attention to old antibiotics whose spectrum of coverage frequently comprises highly resistant bacteria. However, these antibiotics have frequently not undergone the structured process of antibiotic development of modern antibiotics, from pharmacokinetic/pharmacodynamic (PK/PD) studies establishing safe and effective dosing, establishment of susceptibility breakpoints, to clinical trials establishing clinical safety and effectiveness. In this review, we highlight the gaps for which we need old antibiotics in community- and hospital-acquired infections. Reviewing recently published and ongoing randomised controlled trials (RCTs) shows advances in our understanding of the efficacy and effectiveness of oral fosfomycin, mecillinam and nitrofurantoin for cystitis, and of trimethoprim/sulfamethoxazole for complicated skin infections caused by methicillin-resistant Staphylococcus aureus (MRSA) in the community. Summarising older evidence shows the inferiority of chloramphenicol versus modern antibiotics for severe infections. We lack studies on severe infections caused by carbapenem-resistant Gram-negative bacteria and other multidrug-resistant (MDR) bacteria in hospitalised and critically ill patients; ongoing studies assessing colistin and intravenous fosfomycin might fill in some gaps. In the re-development process of old antibiotics, we mandate modern PK/PD studies comprising special populations as well as RCTs addressing the target population of patients in need of these antibiotics powered to examine patient-relevant outcomes. Structured antibiotic re-development from the laboratory to evidence-based treatment recommendations requires public funding, multidisciplinary collaboration, international co-ordination, and methods to streamline the recruitment of critically ill patients infected by MDR bacteria.

Topics: Amdinocillin; Anti-Bacterial Agents; Carbapenem-Resistant Enterobacteriaceae; Cross Infection; Drug Combinations; Drug Resistance, Multiple, Bacterial; Evidence-Based Medicine; Fosfomycin; Humans; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Nitrofurantoin; Staphylococcal Skin Infections; Sulfamethizole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Pneumocystis jirovecii pneumonia (PCP) remains an important cause of morbidity and mortality in immunocompromised renal transplant recipients. In recent years, PCP outbreaks in renal transplant centers have been reported in many countries. Person-to-person transmission between PCP patients and other recipients lacking prophylaxis is one of the possible sources of infection. To prevent infection, effective prophylaxis in susceptible patients is recommended. Trimethoprim-sulfamethoxazole (TMP-SMX) is the most effective drug for PCP prophylaxis, but its recommended duration of use after transplantation varies among the different guidelines. The European Renal Association recommends a prophylaxis period of 4 months after transplantation, the American Society of Transplantation (AST) 6-12 months, and the Kidney Disease Improving Global Outcomes guidelines 3-6 months. Lifelong prophylaxis with TMP-SMX is not recommended in renal transplant recipients; however, in many cases, PCP has occurred after the recommended prophylaxis periods after transplantation. In this minireview, we discuss the risk factors including environmental-nosocomial exposure; state-of-the-art diagnosis, treatment, prophylaxis and isolation; and references to the AST 2009 guidelines with the aim of integrating our experience with PCP outbreaks into recent reports, and we discuss how renal transplant recipients can be protected from PCP.

Topics: Anti-Bacterial Agents; Antibiotic Prophylaxis; Cross Infection; Humans; Immunocompromised Host; Kidney Transplantation; Pneumocystis carinii; Pneumonia, Pneumocystis; Postoperative Complications; Trimethoprim, Sulfamethoxazole Drug Combination

Methicillin-resistant Staphylococcus aureus (MRSA) has a gene that makes it resistant to methicillin as well as to other beta-lactam antibiotics including flucloxacillin, beta-lactam/beta-lactamase inhibitor combinations, cephalosporins, and carbapenems. MRSA can be part of the normal body flora (colonisation), especially in the nose, but it can cause infection, especially in people with prolonged hospital admissions, with underlying disease, or after antibiotic use. About 20% of S aureus in blood cultures in England, Wales, and Northern Ireland is resistant to methicillin.. We conducted a systematic review and aimed to answer the following clinical question: What are the effects of treatment for MRSA infections at any body site? We searched: Medline, Embase, The Cochrane Library and other important databases up to November 2009 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).. We found 11 systematic reviews, RCTs, or observational studies that met our inclusion criteria.. In this systematic review we present information relating to the effectiveness and safety of the following interventions: clindamycin, daptomycin, fusidic acid, glycopeptides (teicoplanin, vancomycin), linezolid, macrolides (azithromycin, clarithromycin, erythromycin), quinolones (ciprofloxacin, levofloxacin, moxifloxacin), quinupristin-dalfopristin, pristinamycin, rifampicin, tetracyclines (doxycycline, minocycline, oxytetracycline), tigecycline, trimethoprim, and trimethoprim-sulfamethoxazole (co-trimoxazole).

Topics: Administration, Oral; Anti-Bacterial Agents; beta-Lactamase Inhibitors; Cross Infection; Humans; Methicillin-Resistant Staphylococcus aureus; Staphylococcus aureus; Trimethoprim, Sulfamethoxazole Drug Combination; Vancomycin

Stenotrophomonas maltophilia (formerly Xanthomonas maltophilia) is a Gram-negative bacillus increasingly associated with serious nosocomial infections. Here, we describe a 30-year-old male patient who developed meningitis associated with this organism after several neurosurgical procedures. A review of the literature revealed only 15 previous reports. Most cases were associated with neurosurgical procedures. Antimicrobial therapy is complicated by multiple drug resistance of the organism, and trimethoprim-sulfamethoxazole is the recommended agent for treatment.

Topics: Adult; Anti-Bacterial Agents; Cross Infection; Drug Resistance, Bacterial; Female; Gram-Negative Bacterial Infections; Humans; Male; Meningitis, Bacterial; Stenotrophomonas maltophilia; Surgical Wound Infection; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Anti-Bacterial Agents; Chronic Disease; Clindamycin; Community-Acquired Infections; Cross Infection; Diagnosis, Differential; Drainage; Humans; Methicillin Resistance; Patient Education as Topic; Staphylococcal Infections; Staphylococcus aureus; Trimethoprim, Sulfamethoxazole Drug Combination

We review the hospital-acquired gram-negative organisms commonly encountered among patients in the intensive care unit and discuss pertinent surveillance data, resistance mechanisms and patterns, and optimal treatment regimens for these pathogens.. There has been a notable increase in antibiotic resistance among gram-negative intensive care unit pathogens. Data from surveillance programs such as National Nosocomial Infections Surveillance System, Intensive Care Antimicrobial Resistance Epidemiology, and others have documented undesirable trends in antibiotic resistance, indicating decreasing efficacy of antibiotic classes such as third-generation cephalosporins, carbapenems, and fluoroquinolones, The increased prevalence of extended-spectrum beta-lactamases has contributed to the finding of multidrug resistance among bacteria such as Klebsiella and Escherichia coli. Furthermore, organisms such as Acinetobacter baumannii, Pseudomonas aeruginosa, and Stenotrophomonas maltophilia display intrinsic resistance to many antibiotics, making selection of optimal therapy difficult. Studies have correlated infection by these organisms with prior antibiotic exposure, and containment of the spread of infection can be achieved by careful antibiotic use and infection control practices.. Antibiotic resistance continues to rise among hospital-acquired gram-negative pathogens. Optimal management of these infections requires knowledge of local epidemiology and practices to control their spread.

Topics: Anti-Bacterial Agents; Anti-Infective Agents; Cross Infection; Drug Resistance, Microbial; Enterobacter; Gram-Negative Bacteria; Gram-Negative Bacterial Infections; Humans; Intensive Care Units; Risk Factors; Stenotrophomonas maltophilia; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; United States

Mycobacterium fortuitum is one of the rapidly growing mycobacteria found in soil, dust, and water. It can be isolated as a normal colonizing organism, but as a pathogen this organism causes mainly skin and soft tissue infection preceded by trauma. A wide variety of infections can occur in individuals with predisposing conditions. Central nervous system infection with M fortuitum is rare, and meningitis occurs after surgery or trauma. We believe that ventriculoperitoneal (VP) shunt infection with this organism has not been reported in the literature. Practitioners should be aware of this rare entity and should suspect it in the presence of cerebrospinal fluid pleocytosis with sterile culture, and after trauma, surgery, or manipulation of the VP shunt hardware. Mycobacterium fortuitum is resistant to most first-line and second-line antituberculous drugs, and treatment should include surgical debridement in addition to prolonged antimicrobial therapy.

Topics: Adolescent; Amikacin; Anti-Bacterial Agents; Causality; Central Nervous System Infections; Cross Infection; Debridement; Drainage; Drug Resistance, Microbial; Drug Therapy, Combination; Humans; Male; Mycobacterium fortuitum; Mycobacterium Infections, Nontuberculous; Trimethoprim, Sulfamethoxazole Drug Combination; Ventriculoperitoneal Shunt

Pneumonia is an important cause of morbidity and mortality in the United States. The provision of effective prophylaxis for pneumonia has become a major goal for both public health officials and individual physicians. Prophylaxis for community-acquired pneumonia is pathogen-specific and is directed toward the most common microorganisms that cause it. The 23-valent pneumococcal polysaccharide vaccine; the trivalent influenza vaccine; the Haemophilus b conjugate vaccine; and either trimethoprim-sulfamethoxazole, dapsone, or aerosolized pentamidine are recommended to prevent Streptococcus pneumoniae, influenza viruses, H. influenzae type b, and Pneumocystis carinii respectively. Except for the microorganisms listed above, the prevention of nosocomial pneumonia is not pathogen-specific. Rather, prevention of nosocomial pneumonia requires the use of infection control procedures, including patient and staff education; isolation of patients with highly contagious respiratory pathogens; vigorous hand washing; cleaning and sterilizaton of respiratory equipment; and use of sterile water in nebulizers and humidifiers. It also requires procedures to limit pooling and aspiration of secretions, such as positioning and rotation of the bed-bound patient; frequent suctioning of respiratory secretions using gloves and sterile suction catheters; and limiting enteral alimentation. Finally, selective decontamination of the digestive tract may be considered for intubated patients.

Topics: Anti-Bacterial Agents; Antifungal Agents; Bacterial Vaccines; Community-Acquired Infections; Cross Infection; Dapsone; Equipment Contamination; Haemophilus Vaccines; Hand Disinfection; Humans; Infection Control; Influenza Vaccines; Intubation, Intratracheal; Patient Education as Topic; Patient Isolation; Pentamidine; Personnel, Hospital; Pneumonia; Pneumonia, Bacterial; Pneumonia, Pneumococcal; Pneumonia, Pneumocystis; Pneumonia, Viral; Public Health; Sterilization; Streptococcus pneumoniae; Trimethoprim, Sulfamethoxazole Drug Combination; United States

Human immunodeficiency virus-infected patients are exposed to more or less specific iatrogenic diseases. The main characteristics of the risks encountered in this field are described: drug intolerance, mostly to sulfamethoxazole-trimethoprim, is extremely frequent; nucleoside analogue antiviral toxicity is reminiscent of that of chemotherapy; nosocomial infections, in general, are more prominent than in HIV-non infected patients. Intravenous line infections are particularly frequent, but these devices are necessary for prolonged intravenous therapies such as anti-CMV treatment of parenteral nutrition. An improved understanding of different etiopathogenic mechanisms and a better approach of the toxicity/efficacy ratio for each treatment would allow to reduce the excessive morbidity due to iatrogenicity.

Topics: AIDS-Related Opportunistic Infections; Antiviral Agents; CD4-CD8 Ratio; Cross Infection; HIV Infections; Humans; Iatrogenic Disease; Risk Factors; Trimethoprim, Sulfamethoxazole Drug Combination

Prevention of infection from bowel-derived organisms in neutropenic patients requires both the appropriate use of chemoprophylaxis and close attention to the prevention of cross-colonization or cross-infection with resistant Enterobacteriaceae and pseudomonads. Control of common-source infection and control of Gram-positive infection are also important. The objectives of chemoprophylaxis should be considered and their efficacy regularly assessed. Non-absorbable antibiotics may have an important place in minimizing selection of resistant strains, but absorbed agents such as cotrimoxazole (trimethoprim/sulphamethoxazole) and 4-quinolones offer advantages over these and nalidixic acid as prophylactic agents. Ciprofloxacin prophylaxis is probably more effective at reducing Gram-negative bacteraemia than co-trimoxazole but overall mortality may be higher. Further confirmation and investigation of the reasons for this are needed. Protocols of rational antibiotic prophylaxis and treatment involving these agents can be modified to cover only the Gram-negative superinfections that are likely.

Topics: 4-Quinolones; Anti-Bacterial Agents; Anti-Infective Agents; Bacterial Infections; Cross Infection; Enterobacteriaceae Infections; Humans; Intestine, Large; Neutropenia; Pseudomonas Infections; Trimethoprim, Sulfamethoxazole Drug Combination

P. cepacia is reported to be an increasing cause of infection and colonization of patients in hospitals. Historically it is an important contaminant in the pharmaceutical industry. Its nutritional versatility, ability to survive and multiply in water, high intrinsic resistance to antibiotics, and ability to multiply in the majority of traditional disinfectants make it a superb agent for causing nosocomial infection. Recognition of its differences from P. aeruginosa and its ability to contaminate agents used in hospitals is important in proper treatment and infection control.

Topics: Anti-Bacterial Agents; Cross Infection; Disinfectants; Drug Combinations; Drug Contamination; Drug Resistance, Microbial; Endocarditis, Bacterial; Foot Dermatoses; Humans; Pigments, Biological; Pseudomonas; Pseudomonas Infections; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Virulence

Topics: Amoxicillin; Ampicillin; Anti-Bacterial Agents; Anti-Infective Agents, Urinary; Cross Infection; Drug Combinations; Escherichia coli Infections; Female; Humans; Penicillin Resistance; Premedication; Proteus Infections; Pseudomonas Infections; Pyelonephritis; Sulfamethoxazole; Surgical Wound Infection; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Patients with severe burns are at increased risk of developing methicillin-resistant Staphylococcus aureus (MRSA) ventilator-associated pneumonia. This study was designed to determine whether MRSA pneumonia can be prevented by prophylactic administration of trimethoprim-sulfamethoxazole (TMP-SMX).. We conducted a prospective, randomized, placebo-controlled study in patients with severe burns (> or = 20%), who required ventilator support. Prophylaxis was done with oral TMP-SMX (80 mg/400 mg) three times daily for 10 days from 4 to 6 days after burn injury. The incidence of MRSA pneumonia and the side effects were evaluated during the administration period.. Twenty-one patients were assigned to receive TMP-SMX, and 19 patients to receive placebo. The incidence of MRSA pneumonia was 4.8% in the TMP-SMX group and 36.8% in the placebo group, showing a significant difference (p = 0.017). No major side effects of therapy were seen in the TMP-SMX group.. Prophylactic treatment with TMP-SMX can prevent MRSA pneumonia in severely burned patients.

Topics: Administration, Oral; Adolescent; Adult; Aged; Aged, 80 and over; Anti-Infective Agents; Burns; Child; Cross Infection; Drug Monitoring; Female; Humans; Incidence; Male; Methicillin Resistance; Microbial Sensitivity Tests; Middle Aged; Pneumonia, Staphylococcal; Prospective Studies; Respiration, Artificial; Trimethoprim, Sulfamethoxazole Drug Combination

The efficacy of an absorbable antimicrobial agent trimethoprim-sulphamethoxazole (TMP-SMX) in the management of children with persistent diarrhoea was evaluated in a double blind, randomised, and placebo controlled trial. Of the 55 patients studied, 28 received TMP-SMX, and 27 received placebo. A trend in stool weight reduction was observed from the third day after the drug was started, and the reduction was statistically significant on day 6 and day 7. However, the difference in total stool output (g/kg) up to day 7 was not significantly different between the two groups. The proportion of children whose diarrhoea resolved by day 7 (therapeutic success) was significantly more in the treatment group compared with the placebo group (23 v 15). Additionally, mean duration of diarrhoea in the group that received TMP-SMX was less compared with the placebo group (6.0 v 8.3 days); this difference, however, was not significant. Hospital infection (probably nosocomial infection) was significantly less in the TMP-SMX treated group (1 v 10). The results of our study indicate that TMP-SMX has a clinical benefit in respect of reducing the stool output, and higher recovery rate within seven days of treatment. In addition, it prevented possible hospital acquired infection.

Topics: Child; Cross Infection; Defecation; Diarrhea; Double-Blind Method; Female; Humans; Male; Time Factors; Trimethoprim, Sulfamethoxazole Drug Combination

Mupirocin is a topically applied drug that is very active in the eradication of nasal carriage of methicillin-resistant Staphylococcus aureus (MRSA). However, studies designed to compare mupirocin treatment with other antimicrobial regimens are lacking. We therefore conducted an open, prospective, randomized, controlled trial to compare the efficacy and safety of mupirocin versus those of oral co-trimoxazole plus topical fusidic acid (both regimens with a clorhexidine scrub bath) for the eradication of MRSA from nasal and extranasal carriers of MRSA. The eradication rates with mupirocin and co-trimoxazole plus fusidic acid at 2, 7, 14, 21, 28, and 90 days were 93 and of 93, 100 and 100, 97 and 94, 100 and 92, 96 and 95, and 78 and 71%, respectively, for nasal carriage. At 7, 14, and 28 days the eradication rates for extranasal carriage by the two regimens were 23 and 74, 83 and 76, and 45 and 69%, respectively. The efficacies and safety of both regimens were similar. The MRSA isolates were not resistant to the study drugs either at the baseline or at follow-up. These results suggest that mupirocin and co-trimoxazole plus fusidic acid, both used in conjunction with a chlorhexidine soap bath, are equally effective and safe for the eradication of MRSA from nasal and extranasal MRSA carriers. Mupirocin was easier to use but was more expensive.

Topics: Administration, Oral; Administration, Topical; Cross Infection; Drug Therapy, Combination; Female; Fusidic Acid; Humans; Male; Methicillin Resistance; Middle Aged; Mupirocin; Nasal Cavity; Prospective Studies; Staphylococcal Infections; Staphylococcus aureus; Trimethoprim, Sulfamethoxazole Drug Combination

We initiated a randomized, single-blinded trial of ciprofloxacin plus rifampin vs sulfamethoxazole and trimethoprim plus rifampin in the therapy for patients who underwent colonization with methicillin-resistant Staphylococcus aureus (MRSA). Patients who were colonized with MRSA received 2 weeks of either regimen. The study was terminated after the enrollment of 21 subjects due to the recognition of ciprofloxacin resistance in 10 of 21 new MRSA isolates during the last 2 months of the study. Five of the 10 patients with ciprofloxacin-resistant MRSA isolates had never received ciprofloxacin. Long-term (6-month) eradication had been achieved in only three of 11 ciprofloxacin plus rifampin and four of 10 sulfamethoxazole and trimethoprim plus rifampin recipients. The use of this new fluoroquinolone for the eradication of MRSA colonization is usually not effective and may risk the development of ciprofloxacin resistance in MRSA within the hospital environment.

Topics: Anti-Bacterial Agents; Ciprofloxacin; Cross Infection; Drug Resistance, Microbial; Drug Therapy, Combination; Humans; Methicillin Resistance; Rifampin; Single-Blind Method; Staphylococcal Infections; Staphylococcus aureus; Time Factors; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Aged; Ampicillin; Antibodies, Bacterial; Antibodies, Viral; Cross Infection; Drug Combinations; Female; Hospital Departments; Humans; Long-Term Care; Male; Middle Aged; Peak Expiratory Flow Rate; Prospective Studies; Random Allocation; Respiratory Tract Infections; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Stenotrophomonas maltophilia is an emerging multidrug-resistant organism with an increasing frequency of hospital-acquired infections predominantly in developing countries. The purpose of this study was to determine the antibiotic resistance and frequency of the smeD, class 1 integron, and sul1 genes in clinical isolates of S. maltophilia in two Iranian provinces. From January 2020 to September 2021, 38 clinical isolates of S. maltophilia were collected from patients in hospitals in Tabriz and Sanandaj provinces of Iran. S. maltophilia isolates were confirmed by standard bacteriological tests and 16S rRNA gene PCR. Disk diffusion and the MIC test strip methods were used to determine the antibiotic resistance patterns. PCR was performed to investigate the presence of smeD, class 1 integron, and sul1 genes. The antimicrobial test for the isolated S. maltophilia showed a high level of sensitivity against most of the antibiotics used. Maximum sensitivity was recorded for ciprofloxacin (100% (38/38)) and levofloxacin 100% (38/38), followed by ceftazidime (97.36% (37/38)), trimethoprim-sulfamethoxazole (81.57% (31/38)), ticarcillin-clavulanate (60.52% (23/38)), and piperacillin-tazobactam (55.26% (21/38)). We observed a high prevalence of smeD (100% (38/38)) and class 1 integron (94.73% (36/38)) genes in the isolates, and none of the isolates carried the sul1 gene. The findings from this study indicate that resistance to trimethoprim-sulfamethoxazole was not observed, and still, trimethoprim-sulfamethoxazole is the best drug with desirable antimicrobial effect in the treatment of nosocomial infections caused by S. maltophilia strains. Despite the observation of a high number of class 1 integron, the sul1 gene was not observed, which indicates the role of this gene in high-level trimethoprim-sulfamethoxazole resistance and not having a role in low-level resistance. Based on our results, clinical microbiology laboratories need continuous surveillance of resistance rates to trimethoprim-sulfamethoxazole, because of the possibility of S. maltophilia acquiring trimethoprim-sulfamethoxazole-resistance by mobile gen elements.

Topics: Anti-Bacterial Agents; Anti-Infective Agents; Cross Infection; Drug Resistance, Bacterial; Humans; Integrons; Iran; RNA, Ribosomal, 16S; Stenotrophomonas maltophilia; Trimethoprim, Sulfamethoxazole Drug Combination

Owing to the resistance of nosocomial pathogens to antibiotics, the need for herbal medicines is felt. The aim of this study was to identify the chemical composition of bark essential oils of Campsis radicans and the effect of its free and encapsulated form on resistant nosocomial pathogens. This plant is a native of Northern Iran. The Bark essential oils of Campsis radicans was first extracted and its antimicrobial effects were investigated. Then, its phytochemical compounds were determined using Gas Chromatography-Mass Spectrometry (GC/MS). Guaiacol (2-methoxy phenol) was selected as the active ingredient among 32 compounds (2.40%). It was encapsulated and the encapsulation efficiency (EE), the particle size, polydispersity index (pdi), Fourier transform infrared (FTIR), release, and stability were determined. Then, the antimicrobial effect of both free and encapsulated forms was evaluated on cotrimoxazole-resistant Pseudomonas aeruginosa, cefixime-resistant Escherichia coli, and fluconazole-resistant Candida albicans. It was observed that both free and encapsulated forms of Guaiacol had an antimicrobial effect on the studied resistant strains, but the encapsulated form had a more antimicrobial effect due to more stability and a more targeted effect. MBC (MFC) ranged from 0.270 to 0.439 µg/ml in the free form and from 0.055 to 0.133 µg/ml in the encapsulated form, EE was 86%, particle size, and pdi were 138 nm and 0.26, respectively. This study showed that this plant can be a suitable alternative to chemical drugs due to its antimicrobial effects.

Topics: Anti-Bacterial Agents; Anti-Infective Agents; Bacteria; Cefixime; Cross Infection; Fluconazole; Guaiacol; Humans; Microbial Sensitivity Tests; Oils, Volatile; Phenols; Phytochemicals; Plant Oils; Trimethoprim, Sulfamethoxazole Drug Combination

Concern about Haemophilus influenzae infection has been increasing over recent decades. Given the emergence of H. influenzae with severe drug resistance, we assessed the prevalence of as well as risk factors and potential therapies for extensively drug-resistant (XDR) H. influenzae infection in Taiwan.. In total, 2091 H. influenzae isolates with disk diffusion-based antibiotic susceptibility testing from 2007 to 2018 were enrolled. H. influenzae strains resistant to ampicillin, chloramphenicol, levofloxacin, and trimethoprim-sulfamethoxazole tended to be isolated from patient wards (≧41%), whereas those resistant to amoxicillin-clavulanate, cefotaxime, and cefuroxime were more likely to be isolated from intensive care units (approximately 50%). XDR H. influenzae was first identified in 2007, and its incidence did not significantly change thereafter. Overall prevalence of single, multiple, and extensively drug-resistant H. influenzae over 2007-2018 was 21.5% (n = 450), 26.6% (n = 557), and 2.5% (n = 52), respectively. A stepwise logistic regression analysis revealed that blood culture (odds ratio: 4.069, 95% confidence intervals: 1.339-12.365, P = 0.013) was an independent risk factor for XDR H. influenzae infection. No nosocomial transmission of XDR H. influenzae observed. Antibiotic susceptibility testing results demonstrated that cefotaxime was effective against 78.8% (n = 41) of the XDR strains.. The presence of XDR H. influenzae strains was identified in Taiwan, and cefotaxime was efficacious against most of these strains.

Topics: Ampicillin; Anti-Bacterial Agents; Cefotaxime; Cefuroxime; Chloramphenicol; Cross Infection; Drug Resistance, Bacterial; Female; Haemophilus Infections; Haemophilus influenzae; Humans; Incidence; Intensive Care Units; Levofloxacin; Logistic Models; Male; Microbial Sensitivity Tests; Taiwan; Trimethoprim, Sulfamethoxazole Drug Combination

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Topics: Anti-Bacterial Agents; Asia; Australia; Cross Infection; Drug Resistance, Bacterial; England; Flavobacteriaceae; Flavobacteriaceae Infections; Fluoroquinolones; Genome, Bacterial; Genomics; Humans; Microbial Sensitivity Tests; Tetracyclines; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Aged; Anti-Bacterial Agents; Cross Infection; Drug Resistance, Multiple, Bacterial; Female; Gram-Negative Bacterial Infections; Humans; Levofloxacin; Male; Microbial Sensitivity Tests; Middle Aged; Retrospective Studies; Stenotrophomonas maltophilia; Trimethoprim, Sulfamethoxazole Drug Combination

BACKGROUND We investigated the factors affecting antibiotic resistance in the intensive care unit (ICU)-related hospital-acquired infections caused by Klebsiella pneumoniae (KP-HAI) and the effects of antibiotics used for high-level antibiotic resistance on patient survival. MATERIAL AND METHODS This retrospective study was performed at the adult ICU of Bezmialem Vakif University Hospital. Patients who were followed up between 01 January 2012 and 31 May 2017 were evaluated. Each KP strain was categorized according to resistance patterns and analyzed. The efficiency of antibiotic therapy for highly-resistant KP-HAI was determined by patients' lifespans. RESULTS We evaluated 208 patients. With the prior use of carbapenem, antibiotics against resistant Gram-positives, and tigecycline, it was observed that the resistance rate of the infectious agents had a significant increase. As the resistance category increases, a significant decrease was seen in the survival time. We observed that if the treatment combination included trimethoprim-sulfamethoxazole, the survival time became significantly longer, and tigecycline-carbapenem-colistin and tigecycline-carbapenem combination patients showed significantly shorter survival times. CONCLUSIONS When the resistance increases, delays will occur in starting suitable and effective antibiotic treatment, with increased sepsis frequency and higher mortality rates. Trimethoprim-sulfamethoxazole can be an efficient alternative to extend survival time in trimethoprim-sulfamethoxazole-susceptible KP infections that have extensive drug resistance.

Topics: Adult; Aged; Anti-Bacterial Agents; Carbapenems; Colistin; Cross Infection; Drug Resistance, Bacterial; Drug Resistance, Microbial; Female; Humans; Intensive Care Units; Klebsiella Infections; Klebsiella pneumoniae; Male; Middle Aged; Pneumonia; Retrospective Studies; Risk Factors; Survival Rate; Tigecycline; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Elizabethkingia meningoseptica is a non-fermentative Gram-negative bacillus that has emerged as an important pathogen in nosocomial infections and is usually associated with high mortality. E. meningoseptica is inherently resistant to many broad-spectrum antibiotics, and appropriate antibiotic selection is crucial for survival. Data about the therapeutic efficacy of fluoroquinolone in E. meningoseptica bacteraemia are limited. We retrospectively enrolled patients with E. meningoseptica bacteraemia who were treated with a single antimicrobial agent with in vitro activity against E. meningoseptica for at least 48 hours in a Taiwanese medical centre between January 2011 and June 2016. We compared the therapeutic efficacy of fluoroquinolone and non-fluoroquinolone treatment. A logistic regression and a propensity score-adjusted model were used to evaluate the risk factors for 14-day mortality. A total of 66 patients were identified, 24 who received fluoroquinolone treatment (ciprofloxacin, n = 9; levofloxacin, n = 15) and 42 who received non-fluoroquinolone treatment (piperacillin/tazobactam, n = 26; trimethoprim/sulfamethoxazole, n = 15; minocycline, n = 1). The fluoroquinolone group had significantly lower 14-day mortality than the non-fluoroquinolone group (8.3% vs. 33.3%, P = 0.023). The APACHE II score was significantly higher in the non-fluoroquinolone group than in the fluoroquinolone group. In a propensity-adjusted analysis, fluoroquinolone use was an independent factor associated with 14-day survival. After stratification using the APACHE II score, treatment with fluoroquinolone was associated with 14-day survival, but did not reach statistical significance in both groups with greater and lesser severity. Therefore, fluoroquinolone is a suitable antimicrobial agent for treating E. meningoseptica bacteraemia.

Topics: Aged; Anti-Bacterial Agents; Bacteremia; Chryseobacterium; Cross Infection; Female; Flavobacteriaceae Infections; Fluoroquinolones; Humans; Male; Microbial Sensitivity Tests; Minocycline; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination; Retrospective Studies; Taiwan; Trimethoprim, Sulfamethoxazole Drug Combination

Stenotrophomonas maltophilia (SM) has emerged as an important nosocomial pathogen with high morbidity and mortality. Because of its unique antimicrobial susceptibility pattern, appropriate antimicrobial therapy for SM bacteremia is still challenging, especially in immunocompromised patients. The present study was performed to assess clinical predictors of SM bacteremia in adult patients with hematologic malignancy. From 2006 through 2016, a case-control study was performed at a tertiary-care hospital. Case patients were defined as SM bacteremia in patients with hematologic malignancy. Date- and location-matched controls were selected from among patients with gram-negative bacteremia (GNB) other than SM. A total of 118 cases of SM bacteremia were identified and compared to 118 controls. While pneumonia was the most common source of SM bacteremia, centralline-associated infection was most common in the controls. The overall 30-day mortality rate of cases with SM bacteremia was significantly higher than that of the controls (61.0 and 32.2%, respectively; P < 0.001). A multivariable analysis showed that polymicrobial infection, previous SM isolation, the number of antibiotics previously used ≥ 3, and breakthrough bacteremia during carbapenem therapy were significantly associated with SM bacteremia (all P < 0.01). Previous use of trimethoprim/sulfamethoxazole (TMP/SMX) was negatively association with SM bacteremia (P = 0.002). Our data suggest that SM is becoming a significant pathogen in patients with hematologic malignancy. Several clinical predictors of SM bacteremia can be used for appropriate antimicrobial therapy in hematologic patients with suspected GNB.

Topics: Adult; Aged; Anti-Bacterial Agents; Carbapenems; Case-Control Studies; Cross Infection; Female; Gram-Negative Bacterial Infections; Hematologic Neoplasms; Humans; Immunocompromised Host; Male; Middle Aged; Multivariate Analysis; Pneumonia; Prognosis; Stenotrophomonas maltophilia; Survival Analysis; Tertiary Care Centers; Trimethoprim, Sulfamethoxazole Drug Combination

The emergence of extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) infections requires re-assessment of therapeutic choices. Here we report the efficacy of cefoxitin-based antibiotic therapy for ESBL-E prostatitis. A prospective study including patients with ESBL-E prostatitis resistant to trimethoprim/sulfamethoxazole and fluoroquinolones from January 2014 to March 2016 was conducted. Cefoxitin was administered by continuous infusion for 3 weeks in the case of acute bacterial prostatitis or 6 weeks in the case of chronic bacterial prostatitis (CBP), with intravenous fosfomycin for the first 5 days. Urological investigations were performed to diagnose underlying urinary tract pathology. Clinical and microbiological efficacy were evaluated 3 months (M3) and 6 months (M6) after the end of therapy. A total of 23 patients were included in the study. The median patient age was 74 years (range 48-88 years). Of the 23 infections, 14 (61%) were CBP and 12 (52%) were healthcare-associated infections. The bacteria involved were Escherichia coli in 11 cases, Klebsiella pneumoniae in 10 cases and Klebsiella oxytoca in 2 cases. Clinical cure was observed in 19/23 patients (83%) at M3 and in 17/22 patients (77%) at M6. Urocultures were sterile in 13/23 patients (57%) at M3 and in 9/19 patients (47%) and M6. Urinary colonisation was observed in 6/19 patients (32%) with clinical cure at M3 and 5/14 patients (36%) with clinical cure at M6. No resistance to cefoxitin was detected. Surgical treatment was required for 7/23 patients (30%). In conclusion, cefoxitin-based antibiotic therapy is suitable for difficult-to-treat ESBL-E infections such as prostatitis.

Topics: Aged; Aged, 80 and over; Anti-Bacterial Agents; beta-Lactamases; Cefoxitin; Cross Infection; Escherichia coli; Escherichia coli Infections; Fluoroquinolones; Fosfomycin; Humans; Klebsiella Infections; Klebsiella oxytoca; Klebsiella pneumoniae; Male; Microbial Sensitivity Tests; Middle Aged; Pilot Projects; Prospective Studies; Prostatitis; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Leech therapy in plastic/reconstructive microsurgery significantly improves a successful outcome of flap salvage but the drawback is a risk of severe infection that results in a drop of the salvage rates from 70-80% to below 30%. We report the results of a national survey conducted in all the French university hospitals to assess the current extent of use of leech for medical practices in the hospital and to investigate maintenance, delivery practices and prevention of the risk of infection.. Data concerning conditions of storage, leech external decontamination, microbiological controls, mode of delivery and antibiotic prophylaxis were collected from all the French university hospitals in practicing leech therapy, on the basis of a standardized questionnaire.. Twenty-eight of the 32 centers contacted filled the questionnaire, among which 23 practiced leech therapy, mostly with a centralized storage in the pharmacy; 39.1% of the centers declared to perform leech external decontamination and only 2 centers recurrent microbiological controls of the water storage. Leech delivery was mostly nominally performed (56.5%), but traceability of the leech batch number was achieved in only 39.1% of the cases. Only 5 centers declared that a protocol of antibiotic prophylaxis was systematically administered during leech therapy: either quinolone (2), sulfamethoxazole/trimethoprim (2) or amoxicillin/clavulanic acid (1).. Measures to prevent infectious complications before application to patient have to be better applied and guidelines of good practices are necessary.

Topics: Amoxicillin-Potassium Clavulanate Combination; Animals; Anti-Bacterial Agents; Antibiotic Prophylaxis; Cross Infection; Drug Delivery Systems; France; Hospitals, University; Humans; Leeches; Leeching; Microsurgery; Plastic Surgery Procedures; Salvage Therapy; Surgical Flaps; Surveys and Questionnaires; Trimethoprim, Sulfamethoxazole Drug Combination

Stenotrophomonas maltophilia is a life-threatening nosocomial pathogen with profound multidrug-resistant attributes. It is associated with high mortality, particularly in immunocompromised patients. Data on therapy for S. maltophilia infections are scarce, especially in children hospitalized in intensive care settings (pediatric intensive care unit).. A retrospective chart review of pediatric patients with isolates of S. maltophilia hospitalized over a 5-year period in 2 pediatric intensive care units.. Thirty-one patients and 91 isolates from blood, respiratory secretions and soft tissues were identified and reviewed. The overall incidence of S. maltophilia infections increased during the study period (P = 0.003). The all-cause crude mortality was 61%, and the attributed mortality was approximately 16%. Risk factors associated with mortality included longer hospitalization before infection (P = 0.002), septic shock (P = 0.003), mechanical ventilation (P = 0.004), an indwelling central vein catheter (P = 0.03) and prior use of steroids (P = 0.04) and carbapenems (P = 0.004). On multivariate analysis, mortality was associated with mechanical ventilation (P = 0.02) and preinfection hospitalization days (P = 0.01). Combination treatment of trimethoprim and sulfamethoxazole, ciprofloxacin and/or minocycline significantly extended survival time (P < 0.001). The method of treatment did not significantly affect the interval between S. maltophilia isolation to resolution of infection (P = 0.200).. Combinations of trimethoprim and sulfamethoxazole, ciprofloxacin and minocycline are proposed for pediatric intensive care unit patients harboring S. maltophilia. Meticulous evaluation of central vascular access and prior treatment with carbapenems are indicated, especially for mechanically ventilated and septic children.

Topics: Anti-Bacterial Agents; Child; Child, Preschool; Critical Illness; Cross Infection; Disease Management; Female; Gram-Negative Bacterial Infections; Hospitalization; Humans; Incidence; Infant; Intensive Care Units, Pediatric; Israel; Male; Medical Records; Microbial Sensitivity Tests; Retrospective Studies; Risk Factors; Stenotrophomonas maltophilia; Trimethoprim, Sulfamethoxazole Drug Combination

Carbapenem resistance in. We analysed 2011-2016 data from the German Antimicrobial Resistance Surveillance (ARS) System, which contains routine data of antimicrobial susceptibility testing from voluntarily participating German laboratories.. We included 154,734 isolates from 655 hospitals in the analysis. Carbapenem non-susceptibility in. Carbapenem non-susceptibility in

Topics: Adult; Anti-Bacterial Agents; Carbapenem-Resistant Enterobacteriaceae; Carbapenems; Colistin; Cross Infection; Drug Resistance, Multiple, Bacterial; Female; Gentamicins; Germany; Hospitals; Humans; Intensive Care Units; Klebsiella Infections; Klebsiella pneumoniae; Male; Microbial Sensitivity Tests; Tertiary Care Centers; Tigecycline; Trimethoprim, Sulfamethoxazole Drug Combination; Young Adult

An outbreak of Pneumocystis jirovecii pneumonia (PCP) occurred among heart transplant recipients (HTR) at the outpatient clinic of a university hospital, from March to September 2015. Clinical, therapeutic, biological, and molecular data were analyzed to determine its origin and control the outbreak.. Clinical and biological data regarding all HTR followed in the outpatient clinic were collected. PCP diagnosis was based on microscopy and real-time polymerase chain reaction (PCR). Investigations were performed by building a transmission map, completed by genotyping Pneumocystis isolates and by a control of chemoprophylaxis observance. Asymptomatic exposed patients were screened for colonization using real-time PCR.. Among 124 HTR, 7 PCP cases were confirmed. Screening identified 3 additional patients colonized by P. jirovecii. All patients were cured, and no further cases were identified after trimethoprim-sulfamethoxazole prophylaxis was introduced in the entire cohort. Genotyping demonstrated the same strain in all PCP cases and colonized patients. All cases were linked with possible transmission chains from 2 possible index patients. Interhuman transmission was significantly associated with more frequent visits in the outpatient clinic. Six cases were receiving atovaquone as a prophylaxis. The occurrence of PCP was significantly associated with atovaquone prophylaxis.. This is the first outbreak with detailed molecular analysis in HTR so far. Genotyping and transmission chain confirmed interhuman transmission in all colonized/infected PCP cases. Outpatient clinic layout and high encounters probably caused this PCP cluster, which was controlled after systematic trimethoprim-sulfamethoxazole prophylaxis in exposed patients.

Topics: Adult; Aged; Atovaquone; Chemoprevention; Cross Infection; Disease Outbreaks; Female; Genotype; Heart Transplantation; Humans; Male; Middle Aged; Pneumocystis carinii; Pneumonia, Pneumocystis; Trimethoprim, Sulfamethoxazole Drug Combination

Stenotrophomonas maltophilia has emerged as an important opportunistic pathogen, especially in patients who are immunocompromised, suffering from malignancy or have been hospitalized for a prolonged period. Information of this bacterium in Thailand has not been elucidated.. To investigate the phenotype and genotype of environmental and clinical isolates of S. maltophilia in Songklanagarind Hospital, southern Thailand.. Isolates of S. maltophilia were collected from various environmental sources on three hospital wards and clinical samples from seven wards. Antibiotic susceptibility and minimum inhibitory concentration (MIC) testing were performed using disk diffusion and E-test, respectively. Isolates were genotyped by pulsed-field gel electrophoresis.. The majority of S. maltophilia environmental isolates were from sink drains (67.5%), followed by drinking water (18.7%) and tap water (7.5%). Clinical isolates of the bacterium mainly originated from sputum samples (56.2% of all isolates). Antibiotic resistance was more common in clinical isolates than in environmental isolates; resistance to co-trimoxazole was associated with the presence of the sul1 gene. The MIC values for ciprofloxacin and co-trimoxazole correlated closely with the results obtained from disk diffusion assay. DNA profile analysis revealed seven clusters with high diversity among the isolates.. No genotypic relationship was detected between isolates from environmental and clinical samples. As such, acquisition of this bacterium may occur outside the hospital.

Topics: Anti-Bacterial Agents; Cross Infection; Drug Resistance, Bacterial; Electrophoresis, Gel, Pulsed-Field; Equipment Contamination; Genes, MDR; Genotype; Humans; Polymerase Chain Reaction; Stenotrophomonas maltophilia; Thailand; Trimethoprim, Sulfamethoxazole Drug Combination; Water Microbiology

Stenotrophomonas maltophilia is a multidrug-resistant opportunistic pathogen causing an increasing number of nosocomial infections. Our aim was to evaluate the risk factors and mechanisms associated with trimethoprim-sulfamethoxazole (SXT) resistance in S. maltophilia infections in Mexico.. Clinical isolates and patients' demographic and clinical data were collected from February 2007 to August 2015 in two tertiary-care hospitals in Mexico. Antimicrobial susceptibility and analysis of sul and SmeABC and SmeDEF efflux pump overexpression were performed in all isolates.Results/Key findings. In the 9-year period, 196 patients infected with S. maltophilia were identified. Most patients were male, and the mean age was 46.2 years. The mean Charlson score was 1.42, and the most frequent comorbidities were arterial hypertension (26.7 %), type 2 diabetes (21.2 %) and cerebral infarction (11.6 %). High drug resistance to meropenem (93.4 %), gentamicin (55.1 %), ceftazidime (52.3 %), cefotaxime (51.5 %), amikacin (42.3 %) and cefepime (32.1 %), and lower resistance to ciprofloxacin (26.0 %), SXT (25.0 %), chloramphenicol (14.3 %) and levofloxacin (2.6 %) were detected. SXT resistance was not associated with the sul genes. SmeABC overexpression was associated with gentamicin (P=0.001) and levofloxacin resistance (P=0.041), whereas SmeDEF overexpression was associated with ceftazidime resistance (P=0.003). Prolonged hospitalization (≥15 days) was an independent risk factor for SXT-resistant S. maltophilia infections (OR=3.05; 95 % CI=1.12-8.86; P=0.029).. Given the high SXT resistance rate, SXT is not an effective first-line therapy for our patients; instead, levofloxacin could be used as an appropriate therapeutic option against S. maltophilia infections.

Topics: Adult; Anti-Bacterial Agents; Bacterial Proteins; Cross Infection; Drug Resistance, Multiple, Bacterial; Female; Gram-Negative Bacterial Infections; Humans; Male; Mexico; Microbial Sensitivity Tests; Middle Aged; Stenotrophomonas maltophilia; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Burkholderia sp. infections are extremely complex in cystic fibrosis (CF) patients, especially considering the lack of knowledge regarding its behavior, its relationship with prognosis, as well as its transmissibility and multidrug resistance features. This study evaluated the frequency of chronic infection by Burkholderia, using microbiological and clinical data. Ninety-eight patients with CF attended from July 2011 to April 2014 in a Brazilian reference hospital were included. Antimicrobial activity, molecular epidemiology, Shwachman score, body mass index, exacerbations, and lung function were analyzed. Nine patients had chronic colonization, and all of them showed preserved pulmonary function levels, body mass index, and Shwachman score. Meropenem was the most effective antibiotic; however, divergent results were shown by other studies. Cross-contamination may have occurred in only two unrelated patients of different ages, who were colonized by B. vietnamiensis, which does not occur frequently. Twelve new sequence types (STs) were identified and three STs have presented intercontinental distribution. None of the patients presented known epidemic strains. In conclusion, a relatively low number of patients with chronic colonization and suspected cross-infection were identified. Different from other studies that have found CF patients chronically colonized with Burkholderia sp. having a greater deterioration of lung function, more frequent antibiotic therapy, and increased mortality, in the current study, the patients showed good clinical outcomes and favorable options for antibiotics therapy. This study also updated the epidemiological database, which facilitates the multicentric collaborative analysis and assists in the control of global infection by these pathogens.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Brazil; Burkholderia cepacia complex; Burkholderia Infections; Ceftazidime; Child; Child, Preschool; Cross Infection; Cystic Fibrosis; Electrophoresis, Gel, Pulsed-Field; Female; Hospitals; Humans; Infant; Lung; Male; Meropenem; Microbial Sensitivity Tests; Molecular Typing; Respiratory Function Tests; Thienamycins; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Young Adult

Acinetobacter baumannii cause opportunistic nosocomial infections and is often multidrug resistant. It has ability to form biofilm. The possession of drug resistance mechanism and ability of biofilm formation seems to be the different way to enhancement of viability in stressful environment. In this study, we evaluate relation between these two factors. The biofilm formation was investigated in M63 medium with casein in microtiter plates, and the drug susceptibility was performed by disk diffusion methods. We found that 80-98% strains formed a biofilm. Strains showing sensitivity to amikacin and tobramycin from ICU produced more biofilm than strains showing resistance to these antibiotics. Ceftazidime-sensitive strains formed a smaller biofilm than resistant. The logistic regression shows association between drug resistance and strains originating from ICU. In case of ceftazidime, strong biofilm formation and descending from ICU reduced the likelihood of drug sensitivity. For other drugs such as aminoglycosides, fluoroquinolones, trimethoprim/sulfamethoxazole, and tetracycline, we found opposite relation (but it was not statistically significance). However, generally it seems that strong biofilm producers from ICUs are often more susceptible to antibiotics. This situation can be explained by the fact that bacteria protected in biofilm do not need mechanisms responsible for resistance of planktonic cells.

Topics: Acinetobacter baumannii; Acinetobacter Infections; Aged; Aminoglycosides; Anti-Bacterial Agents; Biofilms; Cephalosporins; Cross Infection; Culture Media; Drug Resistance, Multiple, Bacterial; Female; Fluoroquinolones; Humans; Intensive Care Units; Male; Microbial Sensitivity Tests; Middle Aged; Plankton; Trimethoprim, Sulfamethoxazole Drug Combination

The aim of the current study was to compare community-acquired acute pyelonephritis (CA-APN) with health care-associated acute pyelonephritis (HCA-APN), describe the outcomes, and identify variables that could predict antimicrobial susceptibility. We conducted an observational study that included all consecutive episodes of acute pyelonephritis (APN) in adults during 2014 at a Spanish university hospital. From each episode, demographic data, comorbidities, clinical presentation, microbiological data, antimicrobial therapy, and outcome were recorded. A multivariable logistic regression model was performed to define the variables associated with antimicrobial resistance. A total of 607 patients, 503 (82.9%) with CA-APN and 104 (17.1%) with HCA-APN, were included in the study. Patients with HCA-APN were older than patients with CA-APN (70.4 versus 50.6 years;

Topics: Acute Disease; Adult; Aged; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Cefotaxime; Cefuroxime; Ciprofloxacin; Cohort Studies; Community-Acquired Infections; Cross Infection; Drug Resistance, Bacterial; Empirical Research; Escherichia coli; Escherichia coli Infections; Female; Hospitals, University; Humans; Logistic Models; Male; Microbial Sensitivity Tests; Middle Aged; Pyelonephritis; Risk Factors; Spain; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Stenotrophomonas maltophilia, an opportunistic pathogen usually connected with healthcare-associated infections, is an environmental bacterium. Intrinsic resistance to multiple antibiotics, with different virulence determinants in the last decade classified this bacterium in the group of global multiple drug resistant (MDR) organism. S. maltophilia clinical isolates, were collected from tertiary care pediatric hospital in Belgrade, Serbia to investigate influence of different factors on biofilm formation, kinetics of biofilm formation for strong biofilm producers and effect of trimethoprim-sulfamethoxazole (TMP/SMX) on formed biofilm. Most of the isolates (89.8%) were able to form a biofilm. Analysis of biofilm formation in different growth conditions showed that changing of temeperature and pH had the stronggest effect on biofilm formation almost equally in group of cystic fibrosis (CF) and non-CF strains. TMP/SMX in concentration of 50 μg/ml reduced completely 24 h old biofilms while concentration of 25 μg/ml effects formed biofilms in a strain dependent manner. Among strains able to form strong biofilm CF isolates formed biofilm slower than non-CF isolates, while shaking conditions did not affect biofilm formation. Swimming motility was detected in both CF and non-CF isolates, however more motile strain formed stronger biofilms. This study suggests that temperature, pH and TMP/SMX had the strongest influence on biofilm formation in analyzed collection of S. maltophilia. A positive correlation between motility and strength of formed biofilm was demonstrated.

Topics: Anti-Bacterial Agents; Biofilms; Cross Infection; Cystic Fibrosis; Gram-Negative Bacterial Infections; Hospitals, Pediatric; Humans; Hydrogen-Ion Concentration; Microbial Sensitivity Tests; Serbia; Stenotrophomonas maltophilia; Temperature; Trimethoprim, Sulfamethoxazole Drug Combination

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

Stenotrophomonas maltophilia is an emerging nosocomial pathogen responsible for several infections in immunocompromised patients. To characterize the antimicrobial resistance and virulence potential of this microorganism in a Brazilian hospital, a total of 936 samples were collected from a nosocomial environment and medical devices, and 100 isolates from clinical specimens were obtained in the same hospital. S. maltophilia was found in 3% of the samples collected, especially in bed rails from hospital rooms. The smf-1 gene was detected in 23% and 42% of the clinical and hospital environment isolates, respectively, and almost all (96.8%) isolates that harbored smf-1 were able to form biofilm. All isolates were susceptible to minocycline and chloramphenicol, and the majority of isolates were susceptible to levofloxacin. High resistance to ceftazidime was detected in both groups of isolates. Resistance to trimethoprim-sulfamethoxazole (TMP/SMX) was found in 14.8% of the isolates. All TMP/SMX-resistant isolates presented class 1 integron and sul1 gene, and 47.4% of them also harbored the sul2 gene, which was inserted into a 7.3 kb plasmid. Genetic relatedness among the isolates was evaluated by enterobacterial repetitive intergenic consensus-PCR, and eight genetic patterns were identified. One pattern comprised 54.7% of isolates and was spread among clinical and environmental (furniture and medical devices) sources. The presence of S. maltophilia in the hospital environment indicates that it can act as a reservoir of this microorganism. In addition, hospital isolates resistant to TMP/SMX showed that the genetic determinants were present in mobile elements, which can constitute great concern, as it may indicate a tendency to spread.

Topics: Anti-Bacterial Agents; Bacterial Typing Techniques; Biofilms; Brazil; Ceftazidime; Chloramphenicol; Cross Infection; Drug Resistance, Bacterial; Fomites; Gene Expression Regulation, Bacterial; Genes, Bacterial; Gram-Negative Bacterial Infections; Hospitals; Humans; Integrons; Levofloxacin; Minocycline; Phylogeny; Plasmids; Polymerase Chain Reaction; Stenotrophomonas maltophilia; Trimethoprim, Sulfamethoxazole Drug Combination

Acinetobacter calcoaceticus-A. baumannii complex (ACB complex) is a nosocomial pathogen. Due to its high ability to develop antibiotic resistance, it has become a problematic challenge in the modern healthcare system. The molecular and genetic mechanisms of gaining multidrug resistance in ACB complex are well known. This study focuses on providing an overview of the antibiotic resistance profiles, genetic similarities and resistotypes, and general characteristics of carbapenem-resistant ACB complex (CRACB) in Bosnia and Herzegovina (BiH). In light of the data collected in this study, together with the already known information concerning antibiotic resistance of ACB complex, we intend to further elucidate the antibiotic therapy for CRACB strain resistotypes in BiH.

Topics: Acinetobacter baumannii; Acinetobacter calcoaceticus; Acinetobacter Infections; Aminoglycosides; Anti-Bacterial Agents; Bacterial Typing Techniques; beta-Lactam Resistance; Bosnia and Herzegovina; Carbapenems; Clone Cells; Cross Infection; Drug Resistance, Multiple, Bacterial; Humans; Phylogeny; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Anti-Bacterial Agents; Cross Infection; Disease Notification; Heroin; Humans; Infection Control; Male; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Quality of Health Care; Staphylococcal Infections; Substance Abuse, Intravenous; Trimethoprim, Sulfamethoxazole Drug Combination

Infection is a major determinant of clinical outcome among patients in the intensive care unit. However, these data are lacking in most developing countries; hence, we set out to describe the profile of nosocomial infection in one of the major tertiary hospitals in northern Nigeria.. Case records of patients who were admitted into the intensive care unit over a 4-year period were retrospectively reviewed. A preformed questionnaire was administered, and data on clinical and microbiological profile of patients with documented infection were obtained.. Eighty-our episodes of nosocomial infections were identified in 76 patients. Road traffic accident (29/76, 38.2%) was the leading cause of admission. The most common infections were skin and soft tissue infections (30/84, 35.7%) followed by urinary tract infection (23/84, 27.4%). The most frequent isolates were Staphylococcus aureus (35/84, 41.7%), Klebsiella pneumoniae (18/84, 21.4%), and Escherichia coli (13/84, 15.5%). High rate of resistance to cloxacillin (19/35, 54.3%) and cotrimoxazole (17/26, 65.4%) was noted among the S aureus isolates. All the Enterobacteriaceae isolates were susceptible to meropenem, whereas resistance rate to ceftriaxone was high (E coli, 55.6%; K pneumoniae, 71.4%; Proteus spp, 50%).. Infection control practice and measures to curtail the emergence of antimicrobial resistance need to be improved.

Topics: Adult; Anti-Bacterial Agents; Bacteremia; Catheter-Related Infections; Ceftriaxone; Cloxacillin; Cross Infection; Drug Resistance, Bacterial; Escherichia coli; Escherichia coli Infections; Female; Humans; Intensive Care Units; Klebsiella Infections; Klebsiella pneumoniae; Male; Meropenem; Microbial Sensitivity Tests; Middle Aged; Nigeria; Pneumonia, Bacterial; Retrospective Studies; Staphylococcal Infections; Staphylococcus aureus; Surgical Wound Infection; Tertiary Care Centers; Thienamycins; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Young Adult

Staphylococcus aureus particularly MRSA strains are one of the major causes of community and hospital acquired bacterial infections. They are also becoming increasingly multi-drug resistant and have recently developed resistance to vancomycin, which has been used successfully to treat MRSA for many years. In-vitro determination of drug resistance patterns of S. aureus is critical for the selection of effective drugs for the treatment of staphylococci infections. The main aim of this study was to determine the prevalence of methicillin resistant S. aureus strains from different clinical specimens from patients referred for routine culture and sensitivity testing.. A cross sectional study was conducted among 1360 participants at Yekatit 12 Hospital Medical College in Ethiopia from September 2013 to April 2014. Clinical samples from various anatomical sites of study participants were cultured on blood agar and mannitol salt agar and identified to be S. aureus by using catalase, coagulase and DNAse tests. S. aureus isolates then were screened for MRSA using 30 μg cefoxitin disc and other 11 antimicrobial drugs by disc diffusion procedure, and agar dilution and E tests for vancomycin. All S. aureus isolates examined for beta-lactamase production by employing nitrocefin. Data were analyzed using SPSS version 20 software and logistic regressions were applied to assess any association between dependent and independent variables.. Of 1360 clinical specimens analyzed S. aureus was recovered from (194, 14.3 %). Rate of isolation of S. aureus with regard to clinical specimens was the highest in pus (118, 55.4 %).No S. aureus was isolated from CSF and urethral discharge. Out of 194 S. aureus isolates, (34, 17.5 %) were found out to be MRSA and the remaining (160, 82.5 %) were MSSA. Ninety eight (50.5 %) S. aureus were multi drug resistant and the highest isolates were resistant to penicillin (187, 96.4 %) and least resistant for clindamycin (23, 11.9 %) and vancomycin (10, 5.1 %). MRSA strains were 100 % resistant to penicillin G, erythromycin, trimethoprim-sulfamethoxazole and least resistant to vancomycin (10, 29.4 %). Out of 194 S. aureus isolates (153, 79.0 %) were beta-lactamase producers.. In this study S. aureus isolates exhibited very high degree of resistance to different antibiotics. The isolates were also multidrug resistant to several combinations of the tested antibiotics. The emergence of vancomycin resistant S. aureus highlights the value of prudent prescribing of antibiotics and avoiding their irrational use.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; beta-Lactamases; Child; Child, Preschool; Clindamycin; Coagulase; Cross Infection; Cross-Sectional Studies; Drug Resistance, Multiple, Bacterial; Ethiopia; Female; Hospitals; Humans; Infant; Male; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Middle Aged; Staphylococcal Infections; Trimethoprim, Sulfamethoxazole Drug Combination; Vancomycin; Young Adult

With the increasing use of carbapenems, carbapenem-resistant Gram-negative bacteria have become a major concern in health care-associated infections. The present study was performed to evaluate the clinical and microbiological features of breakthrough Gram-negative bacteremia (GNB) during carbapenem therapy and to assess risk factors for development of breakthrough GNB. A case-control study was performed at a tertiary hospital from 2005 to 2014. Case patients were defined as individuals whose blood cultures grew Gram-negative bacteria while the patients were receiving carbapenems for at least 48 h before breakthrough GNB. Age-, sex-, and date-matched controls were selected from patients who received carbapenem for at least 48 h and did not develop breakthrough GNB during carbapenem treatment. A total of 101 cases of breakthrough GNB were identified and compared to 100 controls. The causative microorganisms for breakthrough GNB were Stenotrophomonas maltophilia (n = 33), Acinetobacter baumannii (n = 32), Pseudomonas aeruginosa (n = 21), and others (n = 15). Approximately 90% of S. maltophilia isolates were susceptible to levofloxacin and trimethoprim-sulfamethoxazole. The most common infection types were primary bacteremia (38.6%) and respiratory infections (35.6%). More than half of the patients died within a week after bacteremia, and the 30-day mortality rate was 70.3%. In a multivariate analysis, a longer hospital stay, hematologic malignancy, persistent neutropenia, immunosuppressant use, and previous colonization by causative microorganisms were significantly associated with breakthrough GNB. Our data suggest that S. maltophilia, A. baumannii, and P. aeruginosa are the major pathogens of breakthrough GNB during carbapenem therapy, in association with a longer hospital stay, hematologic malignancy, persistent neutropenia, immunosuppressant use, and previous colonization.

Topics: Acinetobacter baumannii; Adult; Aged; Anti-Bacterial Agents; Bacteremia; Case-Control Studies; Cross Infection; Female; Gram-Negative Bacterial Infections; Hematologic Neoplasms; Humans; Immunosuppressive Agents; Intensive Care Units; Length of Stay; Levofloxacin; Male; Middle Aged; Neutropenia; Pseudomonas aeruginosa; Respiratory Tract Infections; Risk Factors; Stenotrophomonas maltophilia; Survival Analysis; Tertiary Care Centers; Trimethoprim, Sulfamethoxazole Drug Combination

This study aimed to quantify the risks of Pneumocystis pneumonia (PCP) among adult T-cell leukaemia (ATL) patients without prophylaxis. We used hospital administrative data collected nationwide in Japan over 4 years. The research design was a retrospective cohort study. Subjects were 4369 patients diagnosed with ATL aged 18 years or older. The subjects were categorized into four treatment groups: no agent, chemotherapy, chemotherapy + steroids and steroids. We described the risks of PCP among ATL patients without prophylaxis. Risks of PCP were 3·2% for the no agent group, 9·7% for the chemotherapy group, 10·0% for the chemotherapy + steroids group and 16·6% for the steroids group. Logistic regression analyses showed that the chemotherapy, chemotherapy + steroids and steroids groups had significantly higher risk of PCP than did the no agent group [adjusted odds ratio (AOR) 3·30 (1·55-7·02), P = 0·002 for the chemotherapy group; AOR 3·35 (2·18-5·17), P < 0·001 for the chemotherapy + steroids group; AOR 6·12 (3·99-9·38), P < 0·001 for the steroids group]. In conclusion, the chemotherapy, chemotherapy + steroids and steroids groups had significantly higher risks of PCP. Prophylaxis for PCP among ATL patients being treated with chemotherapy, chemotherapy + steroids and steroids is highly recommended.

Topics: Adrenal Cortex Hormones; Aged; Antifungal Agents; Antineoplastic Combined Chemotherapy Protocols; Chemotherapy-Induced Febrile Neutropenia; Comorbidity; Cross Infection; Drug Synergism; Female; Humans; Japan; Leukemia-Lymphoma, Adult T-Cell; Male; Middle Aged; Pentamidine; Pneumocystis carinii; Pneumonia, Pneumocystis; Trimethoprim, Sulfamethoxazole Drug Combination

Stenotrophomonas maltophilia is an opportunistic emergent pathogen causing hospital-acquired infections. It is resistant to majority of the broad spectrum antibiotics due to several mechanisms which significantly limit the treatment options. Although the relationship between integrons, mobile genetic elements which play role in transferring resistance genes, and the antibiotic resistance in different gram-negative bacteria have been investigated, the data are limited in Turkey especially for S.maltophilia. The aims of this study were to detect the presence of different classes of integrons and plasmids in clinical isolates of S.maltophilia and to investigate the antibiotic resistance profiles of those isolates. One hundred S.maltophilia strains isolated from various clinical samples (32 sputum, 25 tracheal aspirates, 9 urine and blood, 7 exudates and catheters, 4 sterile body fluids and wounds, 2 CSF, 1 conjunctiva) in our microbiology laboratory during January 2011-September 2012, were included in the study. The isolates were identified by VITEK2 Compact (BioMerieux, France) or Phoenix 100 (BD, USA) automatized systems, and the susceptibilities of the strains to levofloxacin, chloramphenicol, ceftazidime and trimethoprim/sulfamethoxazol (SXT) were evaluated via broth microdilution method according to the CLSI recommendations. Class 1 (intI-1), class 2 (intI-2), class 3 (intI-3) integron gene cassettes and integron 5'-3' conserved gene regions (intI-5'-3'CS) were investigated by polymerase chain reaction (PCR) using specific primers in all of the strains. Nucleotide sequence analysis of PCR products was performed in case of positive result, and the presence and size of plasmids were further investigated. The susceptibility rates of S.maltophilia strains to ceftazidime, chloramphenicol, SXT and levofloxacin were found as 24%, 66%, 93% and 95%, respectively, while MIC(50) and MIC(90) values were 64-128 µg/ml, 8-16 µg/ml, 1/19-2/38 µg/ml and 1-2 µg/ml, respectively. In PCR amplification with intI-1, intI-2 and intI-3 primers, 12%, 2% and 10% of the isolates yielded expectative bands, respectively. DNA sequence analysis of the amplified products revealed five isolates to harbour intI-1 gene, while intI class 2 and class 3 genes were not detected in any of the strains. Furthermore in PCR amplification with intI-5'CS and 3'CS primers, 20% of the strains yielded expected bands. Sequence analysis of these amplicons revealed the presence of quaternary ammonium com

Topics: Anti-Infective Agents; Ceftazidime; Chloramphenicol; Communicable Diseases, Emerging; Cross Infection; Drug Resistance, Bacterial; Gram-Negative Bacterial Infections; Humans; Integrons; Levofloxacin; Opportunistic Infections; Plasmids; Stenotrophomonas maltophilia; Trimethoprim, Sulfamethoxazole Drug Combination

Stenotrophomonas maltophilia is an emerging nosocomial pathogen responsible for serious human infections. This study was carried out to determine antibiotic susceptibility, resistance mechanisms (integrons, sul1 and sul2), and genetic relatedness (Enterobacterial Repetitive Intergenic Consensus [ERIC]-PCR) among 106 clinical isolates of S. maltophilia from India. Twenty-four (22.6%) of S. maltophilia isolates exhibited resistance to mainstay antibiotic trimethoprim-sulfamethoxazole (TMP-SMX). Except for 2 isolates which contained both TMP-SMX resistance determinants sul1 and sul2 genes, all other 22 TMP-SMX-resistant isolates carried either sul1 (10 isolates) or sul2 (12 isolates) genes. Class 1 integrons were present in 8.5% (9 out of 106) of S. maltophilia isolates, and only 5 out of these isolates were TMP-SMX resistant and positive for sul1 gene. The same isolates also carried resistance cassettes containing qac/smr gene. Minocycline and levofloxacin exhibited the maximum in vitro activity against S. maltophilia. ERIC-PCR revealed high diversity among S. maltophilia isolates. The present study demonstrated high (22.4%) TMP-SMX resistance in clinical isolates of S. maltophilia from India. TMP-SMX-resistant isolates carried relatively higher percentage of sul2 gene than sul1 gene as against the reported literature. Majority (58.3%) of sul1 gene positive were not associated with class 1 integrase gene.

Topics: Anti-Bacterial Agents; Cross Infection; Drug Resistance, Bacterial; Gram-Negative Bacterial Infections; Humans; India; Integrons; Levofloxacin; Microbial Sensitivity Tests; Minocycline; Molecular Typing; Polymerase Chain Reaction; Stenotrophomonas maltophilia; Tertiary Care Centers; Trimethoprim, Sulfamethoxazole Drug Combination

A case-control study to determine risk factors for clinical infection with Escherichia coli was conducted among nursing home residents colonized with fluoroquinolone-resistant E. coli. Among 94 subjects, 11 (12%) developed infections with E. coli. Risk factors included the presence of a urinary catheter or tracheostomy, diabetes mellitus, and trimethoprim-sulfamethoxazole exposure.

Topics: Aged; Aged, 80 and over; Anti-Bacterial Agents; Case-Control Studies; Cross Infection; Diabetes Complications; Drug Resistance, Bacterial; Escherichia coli; Escherichia coli Infections; Female; Fluoroquinolones; Humans; Male; Middle Aged; Nursing Homes; Risk Factors; Tracheostomy; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Catheters

Stenotrophomonas maltophilia, which is a non-fermentative gram-negative bacillus, has an increasing importance in nosocomial and opportunistic infections. Since it exhibits resistance to numerous broad-spectrum antibiotics such as aminoglycosides, beta-lactams and tetracyclines, it may considerably limit empirical treatment options. Trimethoprim-sulfamethoxazole (SXT) is recommended as the first-line therapy in the treatment of S.maltophilia infections thanks to its high potency and usefulness in a range of patients. In recent years, however, studies in different geographical regions have started to report resistance to SXT. In this study, we aimed to investigate the genes sul1, sul2, dfrA9, dfrA10, dfrA20 and class I, class II integron gene cassettes which are known to play role in SXT resistance among SXT-resistant S.maltophilia strains. A total of 618 S.maltophilia strains isolated from various clinical samples of 339 patients between January 2006 and October 2011 at the laboratory of Medical Microbiology Department, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey, were included in the study. The isolates were identified by both conventional methods and the Phoenix automated identification system (Becton Dickinson, USA). SXT resistance was determined in the isolates of 32 patients (32/339, 9.4%) by both the automated system and agar dilution method of them 29 (90.6%) were hospital-acquired, and 3 (9.4%) were community-acquired. The genes which are known as SXT resistance determining genes including sul1, sul2, dfr genes, and class I and class II integron gene cassettes were analyzed by using specific primers with polymerase chain reaction in the 32 SXT-resistant isolates. Subsequently, nucleotide sequence analysis of the amplified materials was performed. As a result of this assay, the presence of class I integron gene cassette and sul1 gene were detected in one isolate. Nucleotide sequence analysis of the gene cassette revealed oxacilinase (oxa2) type of beta-lactamase, an aminoglycoside 6'-N-acetyltransferase [aac(6')-IIc], leading to resistance of aminoglycosides, and a quaternary ammonium compounds resistance gene (qacF), respectively. In conclusion, to best of our knowledge the sequences of class I integron gene cassette including oxa2, aac(6')-IIc, qacF genes were identified in S.maltophilia for the first time. It should be kept in mind that the co-presence of a class I integron gene cassette and the sul1 gene in S.maltophili

Topics: Anti-Infective Agents; Bacterial Proteins; Community-Acquired Infections; Cross Infection; Drug Resistance, Bacterial; Gram-Negative Bacterial Infections; Humans; Integrons; Stenotrophomonas maltophilia; Trimethoprim, Sulfamethoxazole Drug Combination

The aim of this study was to determine the prevalence, SCCmec types, presence of the Panton-Valentine leukocidin (PVL) gene, and susceptibility to antibiotics of methicillin-resistant Staphylococcus aureus (MRSA) strains isolated from hospitalized children.. From August 2009 to September 2011, 291 S. aureus strains were isolated from normally sterile body sites, of which 190 (65%) were MRSA. One hundred and two of the MRSA strains were genetically evaluated. SCCmec genotypes were identified by M-PCR and the PVL gene (pvl) by end-point PCR. Resistance to erythromycin, rifampicin, clindamycin, and trimethoprim-sulfamethoxazole (SXT) was assessed by Kirby-Bauer disk diffusion method in accordance with the Clinical and Laboratory Standards Institute guidelines of 2012.. Of the 102 strains evaluated, 97 (95%) were SCCmec type II, 5 (5%) were SCCmec type IVa, and all (100%) were pvl-negative. Resistance to erythromycin, clindamycin, rifampicin, and SXT was 97%, 95%, 0%, and 0%, respectively.. The prevalence of hospital-acquired MRSA was high. SCCmec type II was predominant and the pvl gene appeared not to play any role in the virulence of the MRSA strains from hospitalized children.

Topics: Anti-Bacterial Agents; Child; Clindamycin; Cross Infection; Disk Diffusion Antimicrobial Tests; Erythromycin; Genes, Bacterial; Hospitalization; Humans; Methicillin Resistance; Methicillin-Resistant Staphylococcus aureus; Mexico; Molecular Typing; Prevalence; Rifampin; Staphylococcal Infections; Tertiary Healthcare; Trimethoprim, Sulfamethoxazole Drug Combination

Stenotrophomonas maltophilia (SM) is an important nosocomial pathogen. Due to its intrinsic resistance to various therapeutic drugs, the optimal antimicrobial therapy is often delayed. From January 2005 to September 2012, we retrospectively compared drug susceptibilities, clinical backgrounds, and outcome of SM bacteremic patients (SM group) with these of other non fermentative gram negative bacilli bacteremic patients (non-SM group), at a tertiary-care hospital in Kyoto, Japan. Among the SM group, risk factors of 30-day mortality were evaluated. The SM group and non-SM group included 54 and 237 cases, respectively. Among the non-SM group, bacteremic patients due to Pseudomonas aeruginosa, Acinetobacter species, and other non-fermentative gram negative bacilli included 156, 68, and 13 patients, respectively. SM isolates were susceptible to trimethoprim-sulfamethoxazole and minocycline (82.0% and 100%, respectively). Non-SM isolates were susceptible to meropenem (88.6%), ceftazidime (88.6%), cefepime (85.2%), and amikacin (97.0%). Both SM and non-SM isolates were susceptible to levofloxacin (87.5% and 82.0%, respectively). The use of carbapenems, antipseudomonal cephalosporins, and isolation of SM within 30 days represented an independent risk factor for SM bacteremia. The 30 day mortality rate among the SM group was significantly higher compared with the non-SM group (35% vs 18%, odds ratio: 2.2, 95% CI: 1.2-4.3 p = 0.012). Among the SM group, an independent factor which was associated with 30-day mortality was the SOFA score. SM bacteremia showed a worse outcome compared with bacteremia due to non-SM. For the patients who present risk factors for SM bacteremia, empirical antimicrobial therapy including trimethoprim-sulfamethoxazole, minocycline or levofloxacin should be considered.

Topics: Adult; Anti-Bacterial Agents; Cross Infection; Female; Gram-Negative Bacterial Infections; Humans; Male; Middle Aged; Prognosis; Retrospective Studies; Risk Factors; Stenotrophomonas maltophilia; Trimethoprim, Sulfamethoxazole Drug Combination

As the number of CA-MRSA skin and soft tissue infections continues to grow, it's important to know which patients are at greatest risk and which evidence-based treatment protocols to turn to when needed.

Topics: Acetamides; Administration, Topical; Anti-Bacterial Agents; Clindamycin; Community-Acquired Infections; Continuity of Patient Care; Cross Infection; Ethnicity; Humans; Linezolid; Medical History Taking; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Oxazolidinones; Patient Education as Topic; Physical Examination; Practice Guidelines as Topic; Rifampin; Risk Factors; Secondary Prevention; Skin; Staphylococcal Infections; Trimethoprim, Sulfamethoxazole Drug Combination

The objectives of this study are to examine antibiotic resistance rates and to determine appropriate empiric oral antibiotic for patients with urinary tract infections (UTIs) evaluated and discharged from the ED.. A retrospective, single-institution chart review study from August 2008 to March 2009 was conducted. Adult patients seen in the ED with UTI were identified for study inclusion from review of microbiology records. Hospitalized or asymptomatic bacteriuria cases were excluded. Health care-associated (HA)-UTI was defined as UTI with indwelling urinary catheters, health care exposure, or urologic procedures within 3 months. Prevalence of causative bacteria, antibiotic resistance rates, and risk factors for quinolone resistance were determined.. There were 337 eligible patients with 83% women. The most common uropathogens among 357 bacterial isolates were Escherichia coli (71%) and Klebsiella spp. (9%). Overall levofloxacin resistance rate was 17%. Resistance rates for HA-UTIs were significantly greater than those for community-associated-UTI: levofloxacin, 38% vs 10%; trimethoprim-sulfamethoxazole, 26% vs 17%; amoxicillin, 53% vs 45%; and amoxicillin-clavulanate, 16% vs 6%. Nitrofurantoin resistance rates were similar (9%). Independent risk factors for levofloxacin resistance were long-term medical conditions (adjusted odds ratio [aOR], 4.23; P = .001), HA-UTI (aOR, 2.56; P = .006), and prior quinolone use within 1 week (aOR, 14.90; P = .02) and within 1 to 4 weeks (aOR, 4.62; P = .04).. We report high rates of quinolone resistance in ED patients with UTIs at our institution. For patients with risk factors for quinolone resistance, empiric therapy with cephalosporins or nitrofurantoin may be preferred. Urine culture and susceptibility testing should be performed to guide definitive therapy for HA-UTIs.

Topics: Adult; Aged; Aged, 80 and over; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Cross Infection; Drug Resistance, Bacterial; Emergency Service, Hospital; Female; Humans; Levofloxacin; Male; Microbial Sensitivity Tests; Middle Aged; Ofloxacin; Quinolones; Retrospective Studies; Risk Factors; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Young Adult

Methicillin-resistant Staphylococcus aureus (MRSA) pneumonia poses a deadly threat due to the pathogen's remarkable resistance and virulence factors. Evidence suggests that the epidemiology and sensitivity to antibiotics for MRSA pneumonia is changing extremely fast, creating the potential for it to become a "super bug.". To assess the incidence of community-acquired and hospital-acquired MRSA pneumonia in the community hospital at Christus Spohn during a period of 3 years and its reactivity to antibiotic therapy.. The retrospective study was performed using data collected from Christus Spohn Memorial Hospital Corpus Christi inpatient charts between 2006 and 2008. Patients were identified and selected based on positive sputum cultures for MRSA and using Center of Disease Control, American Thoracic Society and Infectious Diseases Society of America guidelines. Patients were then categorized into 2 groups: community-acquired MRSA (CA-MRSA) pneumonia and hospital acquired MRSA (HA-MRSA) pneumonia.. Our results indicated increase resistance to clindamycin among both CA-MRSA and HA-MRSA, whereas the sensitivity to trimethoprim/sulfamethoxazole (TMP/SMX) is preserved for both CA-MRSA and HA-MRSA.. Resistance to clindamycin has increased over time, but TMP/SMX has preserved its sensitivity against MRSA. TMP/SMX should be revisited as a viable antibiotic option against CA-MRSA and HA-MRSA, specifically against CA-MRSA.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Clindamycin; Community-Acquired Infections; Cross Infection; Drug Resistance, Bacterial; Female; Humans; Incidence; Male; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Pneumonia, Staphylococcal; Retrospective Studies; Trimethoprim, Sulfamethoxazole Drug Combination

Pneumocystis jirovecii pneumonia (PCP) and cytomegalovirus (CMV) infection represent possible complications of medical immunosuppression. Between 2005 and 2010, non-human immunodeficiency virus (HIV) PCP patients admitted to a nephrology unit were analyzed for outcome, CMV comorbidity, and patient-to-patient contacts prior to PCP. In contrast to 2002-2004 (no cases) and 2008-2010 (10 cases), a PCP outbreak of 29 kidney-transplant recipients and one patient with anti-glomerular basement membrane disease occurred between 2005 and 2007. None of the patients were on PCP chemoprophylaxis. In four PCP patients, the genotyping data of bronchoalveolar lavage specimen showed an identical Pneumocystis strain. PCP cases had a higher incidence of CMV infection (12 of 30 PCP patients) and CMV disease (four patients) when compared to matched PCP-free controls (p < 0.05). Cotrimoxazole and, if applicable, ganciclovir were started 2.0 ± 4.0 days following admission, and immunosuppressive medication was reduced. In-hospital mortality was 10% and the three-year mortality was 20%. CMV co-infection did not affect mortality. CMV co-infection more frequently occurred during a cluster outbreak of non-HIV PCP in comparison to PCP-free controls. Here, CMV awareness and specific therapy of both CMV infection and PCP led to a comparatively favorable patient outcome. The role of patient isolation should be further investigated in incident non-HIV PCP.

Topics: Adult; Aged; Antifungal Agents; Antiviral Agents; Case-Control Studies; Coinfection; Cross Infection; Cytomegalovirus; Cytomegalovirus Infections; Disease Outbreaks; Female; Ganciclovir; Genotype; Humans; Immunocompromised Host; Kidney Transplantation; Male; Middle Aged; Molecular Typing; Mycological Typing Techniques; Pneumocystis carinii; Pneumonia, Pneumocystis; Trimethoprim, Sulfamethoxazole Drug Combination

Catheter-associated urinary tract infections (CAUTIs) constitute the majority of nosocomial urinary tract infections (UTIs) and pose significant clinical challenges. These infections are polymicrobial in nature and are often associated with multidrug-resistant pathogens, including uropathogenic Escherichia coli (UPEC). Urinary catheterization elicits major histological and immunological alterations in the bladder that can favor microbial colonization and dissemination in the urinary tract. We report that these biological perturbations impact UPEC pathogenesis and that bacterial reservoirs established during a previous UPEC infection, in which bacteriuria had resolved, can serve as a nidus for subsequent urinary catheter colonization. Mannosides, small molecule inhibitors of the type 1 pilus adhesin, FimH, provided significant protection against UPEC CAUTI by preventing bacterial invasion and shifting the UPEC niche primarily to the extracellular milieu and on the foreign body. By doing so, mannosides potentiated the action of trimethoprim-sulfamethoxazole in the prevention and treatment of CAUTI. In this study, we provide novel insights into UPEC pathogenesis in the context of urinary catheterization, and demonstrate the efficacy of novel therapies that target critical mechanisms for this infection. Thus, we establish a proof-of-principle for the development of mannosides to prevent and eventually treat these infections in the face of rising antibiotic-resistant uropathogens.

Topics: Adhesins, Escherichia coli; Animals; Bacterial Adhesion; Biofilms; Catheter-Related Infections; Cross Infection; Drug Therapy, Combination; Escherichia coli Infections; Female; Fimbriae Proteins; Gene Deletion; Mannosides; Mice; Mice, Inbred C57BL; Molecular Weight; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Bladder; Urinary Catheters; Urinary Tract Infections; Uropathogenic Escherichia coli

Topics: Adult; Anti-Bacterial Agents; Arthritis, Infectious; Cross Infection; Drug Resistance, Bacterial; Gram-Negative Bacterial Infections; Humans; Male; Microbial Sensitivity Tests; Stenotrophomonas maltophilia; Trimethoprim, Sulfamethoxazole Drug Combination

Stenotrophomonas maltophilia is becoming a more and more common cause of infections. In this study, the minimal inhibitory concentrations of trimethoprim/sulfamethoxazole (SXT), ceftazidime, minocycline, levofloxacin, chloramphenicol and ticarcillin/clavulanic acid were determined and the distribution of integrons and sul1, sul2 and dfrA genes was investigated in 102 S. maltophilia isolates collected from patients treated in 31 hospitals in Anhui, China, in the month of September in 2006-2008. The rate of resistance to SXT was up to 30.4%, and 64.7% of isolates were class 1 integron-positive. Sequencing data revealed the following novel gene cassettes embedded in class 1 integrons: dfrA17-aadA5; dfrA12-aadA2; aacA4-catB8-aadA1; aadB-aac(6')-II-bla(CARB-8); and arr-3-aacA4. This is the first report of the gene cassettes dfrA17-aadA5 and dfrA12-aadA2 and of sul2 genes in SXT-resistant S. maltophilia isolates in China. None of the SXT-susceptible S. maltophilia isolates were positive for sul2 or dfrA gene products by polymerase chain reaction (PCR), but PCR products for sul1 were detected in 27 SXT-susceptible and 25 SXT-resistant isolates. The findings from this study indicate that the sul1 gene, in combination with dfrA17 and dfrA12 gene cassettes and sul2 genes located within a 7.3kb plasmid, lead to a high rate of SXT resistance and also confirm the need for ongoing resistance surveillance.

Topics: Anti-Bacterial Agents; Bacterial Proteins; Base Sequence; Carrier Proteins; China; Cross Infection; Drug Resistance, Bacterial; Genes, Bacterial; Gram-Negative Bacterial Infections; Humans; Integrons; Microbial Sensitivity Tests; Molecular Sequence Data; Plasmids; Polymerase Chain Reaction; Sequence Analysis, DNA; Stenotrophomonas maltophilia; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Aeromonas hydrophila; Animals; Anti-Infective Agents; Ciprofloxacin; Cross Infection; Drug Resistance, Multiple, Bacterial; Gram-Negative Bacterial Infections; Humans; Leeches; Leeching; Male; Middle Aged; Necrosis; Surgical Flaps; Trimethoprim, Sulfamethoxazole Drug Combination

The aim of this study was to define the epidemiological, clinical, and antibiotic susceptibility patterns of Shigella gastroenteritis cases occurring during the years 2003-2009 and to compare results with those of the years 1987-2002.. A hospital-based study was conducted over a 22-year period. All 238 Shigella strains isolated between 2003 and 2009 were compared to 618 isolates from the period 1987-1994 and 218 Shigella strains isolated during 1995-2002 with regard to antimicrobial resistance patterns and patient clinical characteristics.. The predominant species during all periods was Shigella sonnei, with an increasing predominance across the periods (64.0%, 71.5%, and 87.8%, respectively; p<0.001). Neither the prevalence of bloody diarrhea nor other clinical characteristics changed across the study periods, except for the prevalence of dehydration, which increased (11.0%, 20.6%, and 28.6%, respectively; p<0.001). During the period 2003-2009, 69.9% of Shigella were resistant to trimethoprim/sulfamethoxazole, 35.8% to ampicillin, and 4.7% to nalidixic acid. No case resistant to ciprofloxacin was detected. Multidrug resistance was also found to be similar in the last two periods (24.0% vs. 28.1%, respectively).. There was both a microbiological and a clinical change in childhood Shigella gastroenteritis cases over the 22 years. The antibiotic resistance pattern appears to have remained stable over the last two periods. There is a need to re-examine the criteria and clinical management guidelines for suspected shigellosis cases.

Topics: Adolescent; Ampicillin; Anti-Bacterial Agents; Child; Child, Preschool; Cross Infection; Dehydration; Drug Resistance, Multiple, Bacterial; Dysentery, Bacillary; Female; Gastroenteritis; Humans; Infant; Male; Microbial Sensitivity Tests; Nalidixic Acid; Prevalence; Shigella; Shigella sonnei; Trimethoprim, Sulfamethoxazole Drug Combination; Turkey

Recipients of hematopoietic stem-cell transplantation (HSCT) are at high risk for infections caused by Stenotrophomonas maltophilia.. We conducted a retrospective analysis of all infections caused by S. maltophilia in HSCT recipients in a single center in Israel during a 4 year period.. Of 570 patients undergoing HSCT, 19 patients with an invasive S. maltophilia infection were identified. Sixteen had allogeneic HSCT and 3 had autologous HSCT. Seventeen patients (90%) had an indwelling central venous catheter (CVC) at the time of infection. S. maltophilia infections were detected in three clinical settings: as a complication of prolonged neutropenia (n = 9), as a CVC-related non-neutropenic infection occurring after CVC manipulation (n = 8) and as a respiratory tract infection (n = 2). Eleven patients (58%) had a polymicrobial infection. Ten patients (52.6%) received carbapenems during the previous month. The treatment for all patients included broad spectrum antibiotics, which were switched according to susceptibilities upon identification of the isolates. All isolates were susceptible in vitro to TMP-SMX. CVCs were removed in 12 patients (70%). Six patients, all after allogeneic HSCT, died. The CVC was removed in only two of the five patients with CVCs who died.. Stenotrophomonas maltophilia is an emerging nosocomial pathogen in HSCT recipients, both in the early neutropenic phase and in the non-neutropenic phase. It is commonly associated with the presence and manipulation of an indwelling CVC. Removal of the CVC in addition to appropriate antibiotic therapy (TMP-SMX) is crucial for infection control.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bacteremia; Catheterization, Central Venous; Catheters, Indwelling; Communicable Diseases, Emerging; Cross Infection; Female; Gram-Negative Bacterial Infections; Hematopoietic Stem Cell Transplantation; Humans; Male; Middle Aged; Neutropenia; Retrospective Studies; Stenotrophomonas maltophilia; Trimethoprim, Sulfamethoxazole Drug Combination

Pediatric patients are rarely infected with metallo-β-lactamase-producing Enterobacteriaceae. We describe 3 cases of children infected with VIM-1-producing clonal Enterobacter cloacae. Patients were treated with amikacin and cotrimoxazole. The blaVIM-1 gene was carried into a class 1 integron and an IncHI2 incompatibility group plasmid. Emergence of pediatric infections caused by carbapenemases-producing Enterobacteriaceae is a critical issue as they are resistant to most β-lactam antibiotics.

Topics: Amikacin; Anti-Bacterial Agents; beta-Lactamases; Child; Cross Infection; Disease Outbreaks; Enterobacter cloacae; Enterobacteriaceae Infections; Female; Humans; Infant; Integrons; Intensive Care Units, Pediatric; Male; Plasmids; Trimethoprim, Sulfamethoxazole Drug Combination

To determine the extent of elimination of trimethoprim (TMP) and sulfamethoxazole (SMX) via continuous venovenous hemodiafiltration (CVVHDF) in 2 critically ill patients with renal failure.. A 62-year-old woman with Pneumocystis jirovecii pneumonia (PCP) was admitted to our intensive care unit for severe acute respiratory distress syndrome. A 77-year-old man was admitted for aortic root replacement and developed septic shock and nosocomial pneumonia due to Stenotrophomonas maltophilia. Both patients developed acute renal failure, necessitating CVVHDF. They were treated with intravenous TMP/SMX adapted to renal function. The first patient received TMP 6.4 mg/kg/day and SMX 32 mg/kg/day, corresponding to 50% of the recommended high-dose TMP/SMX regimen in PCP patients. The second patient received TMP 1.7 mg/kg/day and SMX 8.6 mg/kg/day, corresponding to 50% of the usual dose in bacterial infections. We determined peak and trough serum TMP and SMX concentrations and the extent of TMP/SMX CVVHDF clearance at steady-state while the patients were still anuric and oliguric.. Data on TMP and SMX pharmacokinetics in CVVHDF are lacking and dosing recommendations are inconclusive. In both patients, CVVHDF clearance of TMP ranged from 21.5 to 28.9 mL/min, corresponding with normal renal clearance (20-80 mL/min). SMX clearance in CVVHDF showed high variability (18.7, 26.7, and 42.6 mL/min) and exceeded renal clearance values in normal renal function (1-5 mL/min). Accordingly, peak TMP serum concentrations were within the recommended range in the patient treated with a reduced TMP/SMX dose for PCP, whereas her SMX peak concentrations were only one third of recommended target concentrations.. Our data indicate that both TMP and SMX are removed by CVVHDF to a significant degree, and dose reduction of TMP/SMX in CVVHDF bears the risk of underdosing. Given variability in drug exposure in critically ill patients, therapeutic drug monitoring is advisable in anuric or oliguric patients undergoing continuous renal replacement therapy to ensure optimal TMP/SMX dosing.

Topics: Acute Kidney Injury; Aged; Anti-Infective Agents; Critical Illness; Cross Infection; Female; Gram-Negative Bacterial Infections; Hemodiafiltration; Humans; Infusions, Intravenous; Male; Middle Aged; Pneumonia, Bacterial; Pneumonia, Pneumocystis; Stenotrophomonas maltophilia; Trimethoprim, Sulfamethoxazole Drug Combination

Prophylactic antibiotics are commonly used for prevention of urinary tract infections (UTIs) in children. It was postulated that the organisms and resistance patterns of breakthrough infections would differ with the choice of antimicrobial prophylaxis. This was a retrospective descriptive study of all breakthroughs UTI from 2000 to 2006 in children over 1 month of age discharged from a referral children's hospital in Tehran, Iran on continuous antibiotic prophylaxis for UTIs. Fifty-seven children discharged on prophylaxis had breakthrough UTIs of which 32 (56%) had a previously diagnosed urinary tract anomaly. Escherichia coli was responsible for the majority of infections irrespective of choice of prophylaxis. Thirty-three of 56 breakthrough UTIs (59%) were with organisms that were resistant to the prophylactic antibiotic. There was an increased incidence of resistance to prophylaxis in children on cefixime (16 of 22; 78%) when compared with children on cephalexin (7 of 19; 37%; p=0.02) and a trend toward increased resistance when compared with children on trimethoprim-sulfamethoxasole (3 of 8; 37%) (p=0.10). In conclusion, the resistance pattern of organisms causing breakthrough UTIs varies with the choice of prophylaxis which should be taken into consideration in chosing empiric therapy for such infections.

Topics: Adolescent; Anti-Bacterial Agents; Anti-Infective Agents, Urinary; Cefixime; Child; Child, Preschool; Cross Infection; Cross-Sectional Studies; Drug Resistance, Bacterial; Female; Hospitals, Pediatric; Humans; Infant; Iran; Male; Retrospective Studies; Secondary Prevention; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Urine

Stenotrophomonas maltophilia is an emerging pathogen in nosocomial infections that may result in high mortality. S. maltophilia often present as part of a polymicrobial culture and it is not well established when treatment is indicated. We aimed to identify predictors of mortality in patients with positive cultures of S. maltophilia.. A retrospective cohort study in a tertiary care medical centre was performed in 150 adult patients with positive cultures of S. maltophilia. Patients' demographics, underlying diseases, severity of illness, length of hospitalisation, prior antibiotic exposure, number/types of indwelling catheters, culture sites, and appropriateness of empiric therapy were collected. Logistic regression was used to determine the independent risk factor(s) for infection-attributed mortality.. Ninety-nine males and 51 females were studied. The mean (SD) age and APACHE II score of the patients were 61.9 (16.0) and 14.0 (6.1), respectively. The respiratory tract was the most frequent site (55.3%) where S. maltophilia was isolated. Infection-attributed mortality was observed in 22 of the 150 patients (14.7 %). Admission to ICU [Odds ratio (OR), 3.767; 95% confidence interval (CI), 1.277-11.116, P = 0.016], and delayed effective treatment (OR, 18.684; 95% CI, 4.050-86.188; P <0.001) were identified as independent risk factors for mortality.. Predictors of mortality in patients with positive cultures of S. maltophilia were identified, which may guide clinicians in patient assessment and devising therapeutic decisions. Further studies are needed to validate our results.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Infective Agents; APACHE; Cohort Studies; Confidence Intervals; Cross Infection; Female; Gram-Negative Bacterial Infections; Humans; Intensive Care Units; Logistic Models; Male; Middle Aged; Odds Ratio; Predictive Value of Tests; Respiratory System; Retrospective Studies; Risk Factors; Singapore; Stenotrophomonas maltophilia; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Stenotrophomonas maltophilia has emerged as an important cause of morbidity and mortality in hospitalized patients. Because trimethoprim-sulfamethoxazole (TMP-SMX) remains the most effective drug for the treatment of S. maltophilia infections, desensitization should be considered in patients with hypersensitivity to TMP-SMX.

Topics: Bacteremia; Cholangitis; Cross Infection; Desensitization, Immunologic; Drug Resistance, Bacterial; Gram-Negative Bacterial Infections; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Stenotrophomonas maltophilia; Trimethoprim, Sulfamethoxazole Drug Combination

We experienced three cases of nocardiosis by Nocardia farcinica in the same ward within a six-month period. The result of gene analysis by randomly amplified polymorphic DNA gave the same pattern. Thus, these three cases were considered to be caused by the same strain of N. farcinica, implying the presence of nosocomial infection.

Topics: Adult; Aged; Anti-Infective Agents; Cross Infection; Disease Outbreaks; Female; Humans; Japan; Male; Nocardia; Nocardia Infections; Random Amplified Polymorphic DNA Technique; Trimethoprim, Sulfamethoxazole Drug Combination

We describe a case of nosocomial maternal transmission of Bordetella pertussis to a very-low-birth-weight (VLBW) neonate in whom treatment was unsuccessful. This case underscores the need for rapid and sensitive PCR diagnosis in VLBW neonates and in parents with clinical signs of pertussis and suggests that standard treatment may not be appropriate for VLBW neonates.

Topics: Anti-Bacterial Agents; Azithromycin; Cross Infection; Diphtheria-Tetanus-acellular Pertussis Vaccines; Humans; Infant, Newborn; Infant, Very Low Birth Weight; Josamycin; Male; Treatment Failure; Trimethoprim, Sulfamethoxazole Drug Combination; Whooping Cough

Infection due to extended-spectrum beta-lactamase (ESBL)-producing microorganisms is an emerging problem in the community; a high proportion of these microorganisms have been isolated from urine samples of women with uncomplicated urinary tract infections (UTI). The options for oral treatment of uncomplicated UTI are limited because of the multiple drug resistance typical of ESBL-producing strains.. The in vitro activity of fosfomycin (FOS) was determined against 428 ESBL-producing strains, including 290 (68%) E. coli and 138 (32%) K. pneumoniae. Activity of fosfomycin was compared with that of amoxicillin-clavulanate (AMC), ciprofloxacin (CIP) and cotrimoxazole (SxT). MICs of AMC, CIP, and SxT, and detection of ESBL production were tested by the broth microdilution method, whereas FOS MICs were determined by the agar dilution method. ESBLs were characterized by isoelectric focusing, polymerase chain reaction (PCR) and direct sequencing of encoding genes. The genetic relationship among the isolates was determined by REP-PCR.. Among the 428 ESBL-producing isolates studied, 417 (97.4%) were susceptible to FOS (MIC < or = 64 microg/mL). The resistance rate of E. coli to FOS was 0.3%, and was lower than resistance to AMC (11.7%), whereas the resistance rate of K. pneumoniae was 7.2% and was equal to resistance to AMC. SxT and CIP were the least active antibiotic agents against ESBL-producing isolates (sensitivity < 50%). There were no differences in fosfomycin activity against strains expressing different types of ESBLs.. Fosfomycin showed maintained activity against ESBL-producing strains and did not present co-resistance with other antimicrobial groups.

Topics: Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; beta-Lactam Resistance; beta-Lactamases; Ciprofloxacin; Cross Infection; Escherichia coli; Escherichia coli Infections; Fosfomycin; Klebsiella Infections; Klebsiella pneumoniae; Microbial Sensitivity Tests; Multicenter Studies as Topic; Substrate Specificity; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Twenty-five plasmid-specified antimicrobial resistance determinants common to gram-negative bacilli from nosocomial infection were investigated from 31 Stenotrophomonas maltophilia isolates. Twenty-four clones were identified by pulsed-field gel electrophoresis, and in three clones that exhibited an increased trimethoprim-sulfamethoxazole MIC, the sul1 determinant was found. These results support not only the higher spread of class 1 integrons compared to other mechanisms but also the potential limitation of using trimethoprim-sulfamethoxazole for therapy of severe S. maltophilia infections.

Topics: Cross Infection; Genes, Bacterial; Genotype; Gram-Negative Bacterial Infections; Humans; Integrons; Microbial Sensitivity Tests; Multigene Family; Plasmids; Reverse Transcriptase Polymerase Chain Reaction; Stenotrophomonas maltophilia; Trimethoprim, Sulfamethoxazole Drug Combination

The aim of this study was to investigate the molecular epidemiology of Stenotrophomonas maltophilia in a university hospital in Turkey. Thirty nine clinical isolates were collected from 37 patients and one from an environmental source between 1998 and 2001. Susceptibility to 11 antimicrobials was studied. The isolates were categorised into six groups: A through F. Trimethoprim sulfamethoxazole was the most active agent against the tested isolates. Genotypic analysis by pulsed-field gel electrophoresis (PFGE) of clinical isolates identified 21 different PFGE patterns. Three most common clusters were composed of 11, seven and four strains. Antimicrobial susceptibility identified multi-resistant phenotype in all S. maltophilia PFGE clones. All the remaining 18 isolates (45%) revealed unique PFGE patterns. Resistance was not lower in unique strains. The clones mainly with two unique macrorestriction profiles strongly suggests nosocomial transmission of these strains from either a common source and/or between patients.

Topics: Anti-Bacterial Agents; Cluster Analysis; Cross Infection; Deoxyribonucleases, Type II Site-Specific; DNA Fingerprinting; DNA, Bacterial; Drug Resistance, Multiple, Bacterial; Electrophoresis, Gel, Pulsed-Field; Gram-Negative Bacterial Infections; Hospitals, Pediatric; Hospitals, University; Humans; Microbial Sensitivity Tests; Molecular Epidemiology; Polymorphism, Restriction Fragment Length; Stenotrophomonas maltophilia; Trimethoprim, Sulfamethoxazole Drug Combination; Turkey

1. to assess the impact of highly active antiretroviral therapy (HAART) on the occurrence of bacteraemia in HIV-infected patients and their clinical and microbiological characteristics. 2. to identify risk factors for bacteraemia in this setting.. The files of all HIV-infected patients hospitalized for an episode of bacteraemia in a 28-bed infectious diseases unit between January 1995 and December 1998 were reviewed. Cases occurring during HAART were compared to cases occurring in patients not receiving HAART. Furthermore, in a case-control study, patients with bacteraemia occurring during HAART were compared with other patients receiving HAART.. There were 74 episodes of bacteraemia in patients not receiving HAART and 31 episodes in patients receiving HAART. The occurrence of bacteraemia fell from 10.5/100 hospitalizations in 1995 to 5.5/100 in 1998 (P = 0.02 trend test). The occurence of P. aeruginosa bacteraemia fell sharply (9/398 vs 1/273, P = 0.05). A significant fall in catheter-related infections was observed between 1995 and 1998 (5.5% vs 1.8%). The two-thirds/one-third distribution of hospital-acquired and community-acquired infections remained stable throughout the period study. In patients receiving HAART, the case-control study showed by multivariate analysis, that a CD4 cell count of less than 100/ micro L [OR = 7.3 (1.9-49.7)], and the use of exogenous devices [OR = 13.3 (2.5-71)] were significantly associated with the risk of bacteraemia.. The introduction of HAART has been associated with a significant fall in the occurrence of bacteraemia. However, patients with a low CD4 cell count remain at risk of bacteraemia with similar microbiological and epidemiological characteristics than in the pre-HAART era.

Topics: Adult; Anti-Bacterial Agents; Antiretroviral Therapy, Highly Active; Bacteremia; Case-Control Studies; CD4 Lymphocyte Count; Chi-Square Distribution; Cross Infection; Female; HIV Infections; HIV-1; Humans; Male; Middle Aged; Retrospective Studies; Risk Factors; Trimethoprim, Sulfamethoxazole Drug Combination

Nosocomial infections at a department of neurosurgery were followed prospectively. In 1999, a high incidence of nosocomial lower respiratory tract infections (NLRTI) was observed in patients after intracranial artery aneurysm surgery (ICAAS). From February to December 2000, a short course of ciprofloxacin and co-trimoxazole was given prophylactically to all patients with ICAAS. The incidence of nosocomial infections in patients after ICAAS fell from 78.4 to 30.9% (P<0.0001). The incidence of NLRTI fell from 43.3 to 13.6% (P<0.0001) and the incidence of urinary tract infections from 12.4 to 2.5% (P=0.015). No significant change in antibiotic sensitivity at the department was observed. Antibiotic use decreased from 100.4 defined daily doses (DDD) to 85.4 DDD per 100 bed-days.

Topics: Anti-Infective Agents; Ciprofloxacin; Cross Infection; Female; Humans; Intracranial Aneurysm; Male; Middle Aged; Pneumonia, Bacterial; Postoperative Complications; Respiratory Tract Infections; Trimethoprim, Sulfamethoxazole Drug Combination

Among bloodstream methicillin-resistant Staphylococcus aureus (MRSA) isolates from adult patients in a single hospital, susceptibility to co-trimoxazole increased progressively from 31% in 1988 to 92% in 1997 (p<0.0001). If also observed in other institutions, these findings should encourage the performance of a clinical trial of sufficient size to compare co-trimoxazole to vancomycin in treating MRSA infections.

Topics: Adult; Anti-Bacterial Agents; Cross Infection; Humans; Israel; Methicillin Resistance; Microbial Sensitivity Tests; Staphylococcal Infections; Staphylococcus aureus; Trimethoprim, Sulfamethoxazole Drug Combination

A 46-year-old morbidly obese man was admitted to the medical intensive care unit with respiratory failure. He required pressure-control ventilation and high levels of sedation with continuous-infusion lorazepam. He developed Stenotrophomonas maltophilia pneumonia; treatment included scheduled intravenous trimethoprim-sulfamethoxazole. Each of these drugs contain several hundred milligrams/milliliter of propylene glycol. On day 17 of his hospital course, 3 days after starting the trimethoprim-sulfamethoxazole, the patient developed acute renal failure consistent with acute tubular necrosis. Propylene glycol toxicity was suspected; therefore, all drugs containing propylene glycol were discontinued, and laboratory data were collected. A marked osmol gap, metabolic acidosis, and renal toxicity were attributed to both continuous and large intermittent doses of intravenous propylene glycol. Particular attention should be paid to the total amount of propylene glycol provided to patients from administered drugs. Patients in the intensive care setting who require high doses of intravenous lorazepam for sedation, as well as antimicrobial therapy with trimethoprim-sulfamethoxazole for treatment of either Stenotrophomonas maltophilia or Pneumocystis carinii pneumonia, may be at increased risk for propylene glycol toxicity and should be monitored closely.

Topics: Acute Kidney Injury; Cross Infection; Humans; Injections, Intravenous; Lorazepam; Male; Middle Aged; Pharmaceutical Solutions; Pneumocystis carinii; Pneumonia, Bacterial; Propylene Glycols; Solvents; Stenotrophomonas maltophilia; Trimethoprim, Sulfamethoxazole Drug Combination

Stenotrophomonas maltophilia is characterized by intrinsic resistance to a variety of antimicrobials. Therapeutic options are often limited particularly after the emergence of isolates resistant to trimethoprim/sulfamethoxazole. The application of colistin for infections caused by multidrug-resistant Gram-negative pathogens is limited due to its toxicity. In order to evaluate the activity of the interaction of colistin with rifampin or trimethoprim/sulfamethoxazole on S. maltophilia, 24 different isolates resistant to trimethoprim/sulfamethoxazole were in vitro exposed over-time to the combination of 1x and 4 x MIC of colistin with 2 microg/ml of rifampin or 2/38 microg/ml of trimethoprim/sulfamethoxazole. The applied concentrations for rifampin and trimethoprim/sulfamethoxazole reflect their mean serum levels. Synergy of colistin and rifampin was documented after the first two hours of bacterial growth for approximately 60% of isolates and it occurred with both applied concentrations of colistin. The interaction of colistin and rifampin prevented regrowth observed when single colistin was applied. Synergy of colistin and trimethoprim/sulfamethoxazole was mainly found when colistin was applied at a concentration of 4 x MIC involving 41.7% of isolates after 24 h of growth. In the presence of trimethoprim/sulfamethoxazole bacterial regrowth, observed when single colistin was applied, was prevented. It is concluded that growth of multidrug-resistant S. maltophilia is significantly inhibited by the interaction of colistin and rifampin and to a lesser extent of colistin and trimethoprim/sulfamethoxazole. These results merit further study in both the animal model and the clinical setting.

Topics: Anti-Bacterial Agents; Colistin; Colony Count, Microbial; Cross Infection; Drug Resistance, Multiple, Bacterial; Drug Synergism; Gram-Negative Bacterial Infections; Humans; Microbial Sensitivity Tests; Rifampin; Stenotrophomonas maltophilia; Trimethoprim, Sulfamethoxazole Drug Combination

Methicillin-resistant Staphylococcus aureus (MRSA) isolates recovered from a general hospital in Oporto, Portugal, during two periods (1992-1993 and 1996-2000) were characterized by pulsed-field gel electrophoresis (PFGE) of SmaI fragments, and by hybridization of ClaI digests with mecA and Tn554 probes, discriminating the isolates in mecA::Tn554::PFGE genotypes. In addition, a representative sample of the defined genotypes was characterized by multilocus sequence typing (MLST) and SCCmec (staphylococcal cassette chromosome mec) typing, generating the corresponding ST-SCCmec types. In 1992-1993, 77% of MRSA belonged to the Iberian clone (genotype I::E::A or ST247-IA). In 1996-2000, the frequency of this clone decreased to 19% and the majority (69%) of the isolates belonged to another international clone, the Brazilian MRSA (genotype XI::B::B or ST239-IIIA). Trimethoprim/sulfamethoxazole (SXT) was confirmed to be an important phenotypic marker to distinguish the Iberian (SXT-susceptible) and the Brazilian (SXT-resistant) clones in MRSA isolates from Portugal. Our observations document major shifts in the dominant MRSA clonal types that occurred in this hospital since 1992, suggesting a selective advantage of the Brazilian relatively to the Iberian clone. In addition to these two MRSA clones that are the most frequent in Portuguese hospitals since the early 1990s, sporadic MRSA clones (representing 14% of the total) were identified and characterized.

Topics: Anti-Bacterial Agents; Cross Infection; Drug Resistance; Electrophoresis, Gel, Pulsed-Field; Genotype; Humans; In Situ Hybridization; Methicillin Resistance; Phenotype; Portugal; Staphylococcal Infections; Staphylococcus aureus; Time Factors; Trimethoprim, Sulfamethoxazole Drug Combination

Little information exists on risk factors for Pseudomonas aeruginosa infection in persons with HIV. We assessed the incidence and factors associated with P aeruginosa among persons with HIV enrolled in a large observational cohort study in Los Angeles.. Data were analyzed from 4825 persons aged > or =13 years with HIV infection enrolled from 4 outpatient facilities from 1990 to 1998. The association between P aeruginosa infection and demographic, risk behavior, and clinical factors was assessed.. P aeruginosa was diagnosed in 72 (1.5%) patients representing a crude incidence rate of 0.74 per 100 person-years. The most frequent site of infection was pulmonary (47%). In multivariate analysis, prior hospitalization (adjusted rate ratio = 7.9, 95% CI, 3.8-16.2), and both dapsone (adjusted rate ratio = 4.0, 95% CI, 2.2-7.4) and trimethoprim-sulfamethoxazole (adjusted rate ratio = 2.5, 95% CI, 1.2-5.3) use were independently associated with higher rates of infection. Increasing days of inpatient stay (P <.01) and decreasing CD4(+) counts (P <.01) were strongly associated with P aeruginosa. Azithromycin use decreased the risk of infection by nearly 70%.. Although the overall observed incidence of P aeruginosa was low, hospital exposure, declining CD4(+) levels, and the use of dapsone or trimethoprim-sulfamethoxazole increased the risk of P aeruginosa disease, and azithromycin use was protective in this population. These findings may assist in the early recognition and diagnosis of persons likely to be at increased risk of P aeruginosa infection.

Topics: Adolescent; Adult; AIDS-Related Opportunistic Infections; Anti-Bacterial Agents; Azithromycin; CD4 Lymphocyte Count; Cohort Studies; Cross Infection; Dapsone; Female; Health Behavior; Hospitalization; Humans; Incidence; Infection Control; Length of Stay; Los Angeles; Male; Middle Aged; Multivariate Analysis; Pseudomonas aeruginosa; Pseudomonas Infections; Risk Factors; Risk-Taking; Trimethoprim, Sulfamethoxazole Drug Combination

Although the therapy of infected pancreatic collections or organized pancreatic necrosis remains surgical, we have demonstrated that infected organized pancreatic necrosis can be treated endoscopically.. Stenotrophomonas (Xanthomonas) maltophilia has been increasingly recognized as a nosocomial pathogen associated with meningitis, pneumonia, conjunctivitis, soft tissue infections, endocarditis, and urinary tract infections. This organism is consistently resistant to imipenem, a drug commonly employed in patients with necrotizing pancreatitis to prevent local and systemic infections.. We report the first case of infected pancreatic necrosis by S. (X.) maltophilia. Our patient was treated successfully with endoscopic drainage of the pancreatic fluid collection and appropriate antibiogram-based antibiotic therapy. Endoscopic drainage has emerged as one of the treatment modalities for pancreatic fluid collections.

Topics: Bacterial Infections; Cross Infection; Drainage; Endoscopy; Humans; Male; Middle Aged; Pancreatitis, Acute Necrotizing; Tomography, X-Ray Computed; Trimethoprim, Sulfamethoxazole Drug Combination; Xanthomonas

The prevalence of methicillin-resistant Staphylococcus aureus (MRSA) strains in Trinidad and the extent of their resistance to other antimicrobial agents in hospital-acquired and community-acquired infections were evaluated over a 2-year period. A total of 450 S. aureus strains were isolated from different patients. The prevalence of methicillin resistance among S. aureus strains was 9.8% (44/450). The proportion of MRSA isolated from hospital sources and community sources was 12.5% (38/305) and 4.1% (6/145), respectively (P < 0.05). The resistant rates of MRSA to the non-beta-lactam antibiotics were as follows: 93.2% resistance to tetracycline, 68.2% to erythromycin, 61.4% to gentamicin, 45.5% to co-trimoxazole, and 20.5% to ciprofloxacin. No MRSA resistant to vancomycin was observed in this study. Study results showed significant increases in MRSA in hospital, 2% in 1995 to 12.5% in 1998 (P < 0.05), and community, 0% in 1995 to 4.1% in 1998 (P < 0.05). It has become apparent that infection control and surveillance initiatives must be focused now on the community in order to monitor and limit the spread of this new and expanding reservoir of MRSA.

Topics: Ciprofloxacin; Community-Acquired Infections; Cross Infection; Drug Resistance, Microbial; Erythromycin; Gentamicins; Humans; Methicillin Resistance; Microbial Sensitivity Tests; Staphylococcal Infections; Staphylococcus aureus; Tetracycline Resistance; Trimethoprim, Sulfamethoxazole Drug Combination; Trinidad and Tobago; Vancomycin

This case control study assessed risk factors and prognostic indicators of 350 episodes of bacterial pneumonia in 285 HIV-infected patients. On univariate analysis, intravenous drug abuse (i.v.DA; p < .001 versus controls), regular cigarette smoking (p < .001), cirrhosis (p = .04), and history of a previous episode of pneumonia (p = .04) were risk factors for community-acquired episodes of bacterial pneumonia, whereas length of hospitalization (p = .01) was a risk factor only for nosocomial bacterial pneumonia. The small amount of circulating T CD4+ cells (<100/ mm3) was a risk factor in both groups of pneumonia (p < .05). Stepwise logistic regression analysis revealed that i.v.DA in community-acquired episodes and low levels of circulating T CD4+ cells, both in community-acquired and hospital-acquired episodes, were independent risk factors for the development of bacterial pneumonia. The case-fatality rate observed in our study was 27%. On stepwise logistic regression analysis, T CD4+ cell counts < or = 100/mm3 (p = .02), neutropenia (p = .04), PO2 arterial level < or = 70 mm Hg (p = .01), and Karnofsky score < or = 50 (p = .04) were independent indicators of mortality. According to a personally developed prognostic score, 211 episodes of pneumonia (60%) were classified as mild, 63 (18%) as moderate, and 76 (22%) as severe. Clinicians must carefully evaluate those variables that can influence the prognosis of bacterial pneumonia to make early identification of affected patients and to promptly establish the most appropriate therapeutic strategy in each case.

Topics: Adult; AIDS-Related Opportunistic Infections; Anti-Infective Agents; Case-Control Studies; CD4 Lymphocyte Count; Community-Acquired Infections; Confidence Intervals; Cross Infection; Female; Humans; Karnofsky Performance Status; Length of Stay; Liver Cirrhosis; Logistic Models; Male; Odds Ratio; Pneumonia, Bacterial; Pneumonia, Pneumocystis; Prognosis; Retrospective Studies; Risk Factors; Smoking; Substance Abuse, Intravenous; Survival Analysis; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

To report a case of trimethoprim/sulfamethoxazole (TMP/SMX)-induced hypoglycemia in a patient with acute renal failure.. English-language references identified via a MEDLINE search from January 1966 to August 1996 and a bibliographic review of pertinent articles.. Similar to sulfonylureas, sulfonamides are thought to cause hypoglycemia by increasing pancreatic secretion of insulin. To date, nine cases of TMP/SMX-induced hypoglycemia have been reported in the literature. This case represents the second report in which a patient experienced TMP/SMX-induced hypoglycemia that resolved after the dosage was adjusted for the patient's decreased renal function. This case involved a 73-year-old comatose white man initiated on high-dose TMP/SMX for nosocomial pneumonia caused by Stenotrophomonas maltophilia. After 5 days of therapy, the patient presented with severe hypoglycemia that persisted over 8 hours despite multiple intravenous bolus doses and infusions of dextrose. The patient had several risk factors that may have compounded his risk for hypoglycemia, including food deprivation and acute renal failure. After management with dextrose and dose adjustment of the patient's TMP/SMX regimen according to renal function, the hypoglycemia resolved.. TMP/SMX may cause reversible hypoglycemia that may be prolonged (approximately 12 h), particularly in patients with risk factors for hypoglycemia. Common risk factors include compromised renal function, prolonged fasting conditions, malnutrition, and the use of excessive doses. Patients with these risk factors should be monitored closely and, more importantly, initiated on a dosing regimen adjusted for renal impairment.

Topics: Acute Kidney Injury; Aged; Anti-Infective Agents; Cross Infection; Gram-Negative Bacterial Infections; Humans; Hypoglycemia; Male; Pneumonia, Bacterial; Trimethoprim, Sulfamethoxazole Drug Combination

To describe an outbreak of trimethoprim-sulfamethoxazole (cotrimoxazole)-resistant and methicillin-resistant Staphylococcus aureus (CMRSA) in a unit housing patients infected with the human immunodeficiency virus (HIV).. Prospective study involving patients colonized or infected with CMRSA.. 15 hospitalized patients with cultures positive for CMRSA.. Isolates of CMRSA were collected and characterized. Molecular typing of the epidemic strains was carried out after total DNA extraction by restriction endonuclease analysis and random amplification of polymorphic DNA.. The epidemic was brought under control with the reinforcement of nosocomial transmission measures and with systematic nasal decontamination with mupirocin of all patients admitted to the HIV unit. Molecular typing techniques showed the existence of two epidemic strains: strain A was present in the 12 patients admitted to the HIV unit and strain B in the remaining 3 patients hospitalized elsewhere.. Cotrimoxazole may no longer be a reliable and effective alternative for glycopeptides in patients with infection caused by MRSA strains, and HIV units should be particularly alert for CMRSA strains.

Topics: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Anti-Infective Agents; Cross Infection; Disease Outbreaks; Drug Resistance, Microbial; Female; HIV Infections; Humans; Male; Methicillin Resistance; Microbial Sensitivity Tests; Middle Aged; Prospective Studies; Spain; Staphylococcal Infections; Staphylococcus aureus; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Administration, Oral; Anti-Bacterial Agents; Cross Infection; Humans; Lung; Nursing Homes; Pneumonia; Radiography; Trimethoprim, Sulfamethoxazole Drug Combination

To describe methods of preventing nosocomial pertussis in patients, employees, and visitors to a hospital during a communitywide epidemic in Greater Cincinnati.. Six-month descriptive study of the methods, effectiveness, and cost of a program to prevent nosocomial pertussis.. Three hundred sixty-one bed, tertiary-care, university, pediatric hospital.. We educated 3,764 hospital employees about pertussis. We evaluated 206 employees with respiratory illnesses, based on clinical presentation, pertussis exposure, and work setting. Eighty-seven had pertussis: 84 coughed for > or = 2 weeks (outbreak clinical case definition), 65 had paroxysms, 27 whooped, 22 had posttussive emesis, and 13 were positive by direct fluorescent antibody or culture for Bordetella pertussis. Seventy-nine employees were sent on 5-day furloughs. Six hundred twenty-two employees received 14 days of erythromycin (579) or trimethoprim-sulfamethoxazole (43). Symptomatic patients were identified at triage in the emergency department and placed in respiratory isolation. Suspect pertussis cases were admitted in respiratory isolation. Among 49 toddlers who were given erythromycin and managed in "coughing respiratory cohorts," eight had proven pertussis. Inpatients were restricted to assigned nursing units. Respiratory masks were required for those entering the test referral center, where more than 3,500 pertussis cultures were performed. Hospitalwide visitor restriction was enforced for those aged 14 years or younger and for those with respiratory symptoms. Only parents and guardians were permitted to visit the newborn intensive care unit. A child-care service managed 488 inpatient sibling visitors. Four symptomatic children in the employees' child-care center were excluded pending physician evaluation; one had pertussis.. Control measures appeared effective. Pertussis occurred in 87 (2%) employees. Among 102 children hospitalized with pertussis, respiratory isolation was delayed in nine cases, and one case was nosocomial. Program expenses totalled $85,400. Adult booster immunization with acellular pertussis vaccine might represent the safest and least expensive strategy for preventing epidemic pertussis, and controlled trials of acellular pertussis vaccine in hospital employees are needed.

Topics: Adult; Anti-Bacterial Agents; Anti-Infective Agents; Cross Infection; Disease Outbreaks; Erythromycin; Female; Hospitals, Pediatric; Hospitals, University; Humans; Infection Control; Male; Masks; Middle Aged; Ohio; Patient Isolation; Personnel, Hospital; Population Surveillance; Trimethoprim, Sulfamethoxazole Drug Combination; Visitors to Patients; Whooping Cough

To determine the period prevalence of Clostridium difficile disease and asymptomatic carriage in the residents of long-term care facilities (LTCF) and to characterize the risk factors for colonization or associated disease.. Period prevalence survey.. Two long-term care facilities in St. Paul, MN.. Specimens were collected from 225 LTCF residents.. The dependent variable was the culture result for C. difficile, which was isolated and identified using selective culture media and a commercial anaerobe identification kit. Tissue culture assay was used to detect the ability of each C. difficile isolate to produce toxin. Independent variables (including gender, age, race, current medical diagnoses, severity of underlying disease, case mix, current clinical symptoms, current medications, antibiotic use within 4 weeks prior to specimen procurement, and other pertinent history) were obtained from the current medical record of each participant.. Of 225 stool cultures that were obtained, 16 (7.1%) were positive for C. difficile. None of the residents with a positive culture was symptomatic. History of nosocomial infection and the use of antibiotics in general, cephalosporins, trimethoprim/sulfamethoxazole (TMP/SMX), and histamine-2 blockers were significantly associated with positive C. difficile culture (P < or = 0.05) by univariate analyses. Trends towards significance (0.05 < 0.10) were noted for narcotic use, previous hospitalization, LTCF, and non-insulin-dependent diabetes mellitus. Logistic regression analysis revealed significant, independent predictors of positive culture: antibiotic use in general (P = 0.028; relative risk = 3.31), histamine-2 antagonist use (P = 0.038; relative risk = 3.27), cephalosporin use (P = 0.038; relative risk = 4.66), and TMP/SMX use (P = 0.007; relative risk = 8.45).. The use of antibiotics, particularly cephalosporins and TMP/SMX, is a significant risk factor for asymptomatic carriage of C. difficile in long-term care facilities. The use of H-2 blockers was also a significant risk factor for carriage; however, this finding has not been reported previously and should be confirmed by independent studies. These medications should be used judiciously in the LTCF population. When diarrheal diseases are encountered in LTCF residents, a high index of suspicion for C. difficile infection should be maintained and the appropriate diagnostic and therapeutic measures taken.

Topics: Aged; Aged, 80 and over; Carrier State; Cephalosporins; Clostridioides difficile; Cross Infection; Diabetes Mellitus, Type 2; Diagnosis-Related Groups; Enterocolitis, Pseudomembranous; Environmental Monitoring; Epidemiological Monitoring; Feces; Female; Health Surveys; Histamine H2 Antagonists; Hospitalization; Humans; Infection Control; Logistic Models; Male; Narcotics; Prevalence; Risk Factors; Severity of Illness Index; Skilled Nursing Facilities; Trimethoprim, Sulfamethoxazole Drug Combination

We studied 961 clinical Salmonella isolates (one per patient) seen in one Spanish hospital from 1988 to 1991. The incidence of non-Salmonella typhi Salmonella infections per 100,000 admissions increased from 3.93 to 5.98. Overall rates of resistance to ampicillin, chloramphenicol, and co-trimoxazole were 32, 11, and 2%, respectively. Resistance to chloramphenicol increased from 9 to 16% during the study period, while resistance to each of the other drugs remained stable. Variations related to serogroups were observed.

Topics: Ampicillin; Ampicillin Resistance; Anti-Bacterial Agents; Chloramphenicol; Cross Infection; Drug Resistance, Microbial; Humans; Microbial Sensitivity Tests; Salmonella; Salmonella Infections; Spain; Trimethoprim, Sulfamethoxazole Drug Combination

An elderly lady was admitted to hospital for elective resection of an adenocarcinoma of the colon. Following an anastomotic leak she developed intra-abdominal sepsis and underwent abdominal drainage of pus. During recovery from her second operation, she developed pneumonia and a bacteraemia due to methicillin-resistant Staphylococcus aureus (MRSA). She was treated with vancomycin and co-trimoxazole and survived without further sequelae. Details of the development and treatment of this case are discussed. Procedures for the control and eradication of MRSA infections in hospitals are reviewed.

Topics: Adenocarcinoma; Aged; Bacteremia; Colonic Neoplasms; Cross Infection; Disease Outbreaks; Female; Humans; Methicillin Resistance; Pneumonia, Staphylococcal; Postoperative Complications; Staphylococcal Infections; Staphylococcus aureus; Trimethoprim, Sulfamethoxazole Drug Combination; Vancomycin

Thirty-two cases of Xanthomonas maltophilia bacteremia have been identified over the last two years at the Veterans General Hospital, Taipei. Among them, 27 cases (84%) were due to hospital-acquired infections, and 14 cases (44%) were polymicrobial bacteremia. One case was confirmed as prosthetic valve endocarditis and one case was complicated by recurrent attacks of ecthyma gangrenosum. Most cases had severe debilitating conditions. Twelve cases (38%) had a malignancy, 19 cases (59%) were resident in the Intensive Care Unit and 16 cases (50%) had undergone major surgery. The main predisposing factors included central venous catheterization, endotracheal intubation or tracheostomy, prior antibiotic therapy and prolonged hospitalization. Moxalactam, chloramphenicol and trimethoprim-sulfamethoxazole were the most effective agents in vitro against X. maltophilia. Twenty-two cases (69%) died during hospitalization; 13 cases (41%) were directly attributed to septicemia. Factors that adversely influenced mortality included inappropriate antimicrobial therapy and prior antibiotic treatment. Of particular interest is the fact that none of the patients who did not receive appropriate antimicrobial therapy survived. Early diagnosis and appropriate antibiotic therapy are critical for improving the prognosis of X. maltophilia infection.

Topics: Adult; Aged; Aged, 80 and over; Bacteremia; Cross Infection; Drug Resistance, Microbial; Female; Humans; Male; Middle Aged; Retrospective Studies; Trimethoprim, Sulfamethoxazole Drug Combination; Xanthomonas

Following implementation of special measures to control a nosocomial outbreak of methicillin-resistant Staphylococcus aureus (MRSA), we used immunoblot typing in conjunction with antimicrobial susceptibility testing to investigate the epidemiology of this event and to determine whether this outbreak represented the failure of infection control measures to limit the spread of previously endemic MRSA strains or the introduction of a new strain of MRSA.. Isolates of MRSA recovered from hospitalized patients were initially categorized on the basis of antimicrobial susceptibility results. Organisms susceptible to ciprofloxacin and/or trimethoprim/sulfamethoxazole were recovered from patients at a relatively constant rate prior to December 1988 and were categorized as endemic isolates. Subsequently, there was an outbreak due to organisms resistant to both of these antibiotics; these were therefore categorized as outbreak isolates. Isolates were later characterized by immunoblot typing. Prior to this analysis, isolates were given code numbers so that clinical and epidemiologic data as well as resistance patterns were not known until this testing was complete.. Between January 1986 and November 1988, an average of 3.9 patients per month acquired nosocomial MRSA in the Sepulveda Veterans Administration Medical Center. In contrast, from December 1988 to October 1989, 369 MRSA isolates were collected from 125 patients (an average of 11.4 patients per month). Prior to December 1988, all tested nosocomial isolates of MRSA were susceptible to ciprofloxacin and/or to trimethoprim/sulfamethoxazole. In contrast, the outbreak was due to spread of MRSA isolates resistant to these antibiotics. Immunoblot typing of 204 isolates from 98 individuals identified five distinct immunoblot types of which types B and C were by far the most common. Type B was highly associated with outbreak isolates, whereas type C was associated with endemic isolates (p less than 0.001). All sequential isolates from single patients that belonged to different susceptibility categories demonstrated discordant immunoblot types. In contrast, concordant immunoblot types were observed for 25 of 27 sequential isolates that displayed minor variations in antimicrobial resistance. The institution of more stringent infection control measures was followed by the return of nosocomial MRSA acquisition rates to pre-outbreak levels. Although novobiocin and trimethoprim/sulfamethoxazole were extensively used to treat patients harboring outbreak and endemic isolates, respectively, in no instance was the initial MRSA isolate from any patient resistant to novobiocin and only 6% of initial endemic isolates displayed trimethoprim/sulfamethoxazole resistance. A modest, significant increase in the resistance of endemic isolates to various other antimicrobial agents was noted however.. Immunoblot analyses provided strong, corroborative evidence that at least two separate strains of MRSA were present during the outbreak and that a newly introduced strain with a distinctive antimicrobial resistance pattern was primarily responsible for the rapid spread of MRSA during the outbreak. The observation that previously effective infection control measures failed to prevent the nosocomial spread of a newly introduced community-acquired MRSA strain suggests that a single set of control measures may not be equally efficacious against all strains of MRSA. In this regard, previously reported variations in resistance to topical antimicrobials and/or antiseptics, and differences in virulence factors such as colonization potential, invasiveness, and survival on fomites, may warrant further study. Control of the outbreak strain of MRSA in our institution did occur after the implementation of more strenuous isolation procedures.(ABSTRACT TRUNCATED)

Topics: California; Carrier State; Cross Infection; Disease Outbreaks; Evaluation Studies as Topic; Hospitals, Veterans; Humans; Immunoblotting; Incidence; Infection Control; Methicillin Resistance; Microbial Sensitivity Tests; Novobiocin; Occupational Diseases; Organizational Policy; Personnel, Hospital; Prevalence; Seasons; Serotyping; Staphylococcal Infections; Staphylococcus aureus; Trimethoprim Resistance; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Acquired Immunodeficiency Syndrome; Adult; Allied Health Personnel; Anti-Infective Agents; Child; Cross Infection; Drugs, Investigational; Female; HIV-1; Humans; Infections; Male; Neoplasms; Pneumonia, Pneumocystis; Sarcoma, Kaposi; Substance-Related Disorders; Trimethoprim, Sulfamethoxazole Drug Combination; United States; Viral Vaccines

The majority of the 78 enteropathogenic (EPEC) and the 151 non-EPEC Escherichia coli strains isolated from preterm neonates during an outbreak of gastroenteritis in a hospital in Nairobi, Kenya, were resistant to trimethoprim-sulfamethoxaxole, chloramphenicol, oxytetracycline and ampicillin, but only a few strains were resistant to cefazolin, cefamandole, cefotaxime, amikacin and nalidixic acid. Fourteen different antimicrobial resistance patterns were observed in the 229 strains of E. coli analysed. Eighty-two percent of the EPEC strains belonged to two resistance pattern compared with 79% of non-EPEC strains which exhibited three resistance patterns. There was no consistent relationship between plasmid profile group and antimicrobial resistance pattern, although one resistance pattern was more frequently observed in EAF-positive strains belonging to the dominant plasmid profile group. Nine percent of the EPEC strains were resistant to gentamicin compared to 37% in the non-EPEC group. No correlation was observed between administration of gentamicin and percentage of resistant strains isolated. None of the nine neonates receiving gentamicin died during the outbreak. Gentamicin resistance was observed in E. coli strains from six out of these nine neonates. Five out of fourteen neonates who received other antimicrobials, or no antibiotic treatment at all, died.

Topics: Ampicillin; Chloramphenicol; Cross Infection; Drug Resistance, Microbial; Escherichia coli; Escherichia coli Infections; Gentamicins; Humans; Infant, Newborn; Kenya; Oxytetracycline; Trimethoprim, Sulfamethoxazole Drug Combination

Factors predisposing to clinically significant nosocomial infection with Xanthomonas maltophilia were examined in a matched case-control study using multivariate techniques. Sixteen cases occurred among cancer patients in a six-month period, including an apparent cluster of three cases in an intensive care unit. These infections were unusually serious; eight patients had disseminated infection caused by X maltophilia and six died as a result of their infections. Among the 64 factors that were examined, therapy with broad-spectrum antibiotics and central venous catheterization were found to significantly increase susceptibility to infection. Therapy with imipenem was more than ten times more frequent among cases than among controls (p less than .001). All fatal infections occurred in patients who had received imipenem, including two patients who died before the organism could be identified and appropriate therapy instituted. Infection with X maltophilia should be suspected in patients who develop superinfection while receiving imipenem, and prompt therapy should be instituted to improve chances of survival. Because a common environmental source of X maltophilia was not identified, further study is necessary to determine specific preventive measures.

Topics: Bacterial Infections; Case-Control Studies; Cross Infection; Female; Hospitalization; Humans; Imipenem; Male; Middle Aged; Retrospective Studies; Risk Factors; Sex Factors; Trimethoprim, Sulfamethoxazole Drug Combination; Xanthomonas

Pneumocystis carinii is an organism of uncertain taxonomy that causes diffuse pneumonitis in malnourished infants and immunocompromised hosts. In transplant recipients, the infection most commonly presents from 2 to 6 months after transplantation with symptoms of dyspnea, fever, and dry cough lasting from a few days to a few weeks. A diagnosis is most readily and safely achieved by examination of material obtained by bronchoalveolar lavage for cyst forms of the organism. The therapy of choice is intravenous trimethoprim-sulfamethoxazole. Patients allergic to sulfa drugs are usually given parenteral pentamadine. Prophylaxis with oral trimethoprim-sulfamethoxazole is able to prevent pneumonia due to P carinii and is recommended for most transplant recipients, although the lowest effective dose and the optimal duration of therapy have not been determined. The currently high level of interest in this pathogen, stimulated by the epidemic of acquired immunodeficiency syndrome, should foster research that will increase our understanding and enhance our control over this pathogen.

Topics: Bronchoalveolar Lavage Fluid; Cross Infection; Humans; Pneumonia, Pneumocystis; Transplantation; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adult; Anti-Infective Agents; Azathioprine; Cross Infection; Cyclosporins; Drug Combinations; Drug Therapy, Combination; Female; Graft Rejection; Hospital Units; Humans; Immunosuppressive Agents; Kidney Transplantation; Male; Middle Aged; Nocardia Infections; Prednisolone; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Cross Infection; Cyclosporins; Cytomegalovirus Infections; Disease Outbreaks; Drug Combinations; Humans; Kidney Transplantation; Pneumonia, Pneumocystis; Postoperative Complications; Puerto Rico; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Retrospective review of 197 patients with methicillin-resistant Staphylococcus aureus (MRSA) identified 47 in whom a regimen for eradication of MRSA colonization could be evaluated. The patients were elderly (mean age, 67.7 years), with 53% transferred from another institution and 53% treated in an intensive care unit. A mean of 47.1 days of hospitalization with an average of 4.9 antibiotics preceded the first MRSA culture. The usual regimen (mean, 6.0 days) was oral trimethoprim-sulfamethoxazole, 160/800 mg twice daily, oral rifampin, 600 mg once daily, and bacitracin ointment three times a day. Eradication succeeded in 40 patients, 9 relapsed, and MRSA persisted in 7. Twenty-four of 25 nares sites were cleared but only 16 of 22 other sites. MRSA infection eventually developed in 36%. No adverse reactions to the eradication regimen were noted. Although this treatment for MRSA carriage was safe and effective, decreased efficacy outside the nares and relapse limited its value.

Topics: Aged; Bacitracin; Carrier State; Cross Infection; Drug Combinations; Drug Therapy, Combination; Hospital Bed Capacity, 300 to 499; Humans; Methicillin; Middle Aged; Nebraska; Penicillin Resistance; Retrospective Studies; Rifampin; Staphylococcal Infections; Staphylococcus aureus; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

At the Ann Arbor Veterans Administration Medical Center, 30 patients over a 6-month period became nosocomially infected or colonized by methicillin-resistant Staphylococcus aureus. Immediate institution of strict infection control measures, in conjunction with surveillance cultures of personnel and treatment of carriers, did not limit spread of the outbreak strain of MRSA. Multiple nonoutbreak strains, phenotypically exhibiting heteroresistance, were also uncovered. Thirteen hospital personnel were identified as MRSA carriers. Trimethoprim-sulfamethoxazole (TMP-SMX) and rifampin initially eradicated the carrier state, documented by anterior nares cultures in 13 courses of treatment in 11 employees. However, three employees were recolonized, one at one month, one at both one and four months, and one at four months. Treatment of the carrier state reservoir among personnel appeared to have no effect on the emergence and spread of nosocomial MRSA.

Topics: Carrier State; Cross Infection; Disease Outbreaks; Disease Reservoirs; Drug Combinations; Hospitals, General; Hospitals, Veterans; Humans; Methicillin; Michigan; Penicillin Resistance; Recurrence; Rifampin; Staphylococcal Infections; Staphylococcus aureus; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Cefixime, a broad-spectrum, orally active cephalosporin, was more active in vitro than ampicillin, cefaclor, cephalothin, and trimethoprim/sulfamethoxazole against 194 nosocomial pathogens of the family Enterobacteriaceae. Activity was especially good against Klebsiella spp, Proteus spp, Serratia spp, and Providencia stuartii. Although gentamicin had equivalent or better activity against Citrobacter spp, Enterobacter spp, Escherichia coli, and Morganella morganii, all 23 of the gentamicin-resistant strains studied were susceptible to cefixime. Isolates tested were from urinary tract infections, abdominal infections, wounds, vascular infections, and respiratory infections; they were sequentially collected nosocomial pathogens from a single institution. This orally active cephalosporin should be considered for therapy of a variety of nosocomial infections involving gram-negative bacillary pathogens.

Topics: Ampicillin; Anti-Bacterial Agents; Cefaclor; Cefixime; Cefotaxime; Cephalothin; Cross Infection; Drug Combinations; Enterobacteriaceae; Enterobacteriaceae Infections; Gentamicins; Humans; Microbial Sensitivity Tests; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

For a total of 396 hospitalized urological patients with complicated and/or hospital-acquired urinary tract infections (UTI) urinary pathogens with colony counts of 10(5)/ml or more were determined, several species were then subclassified by epidemiological markers. The minimal inhibitory concentrations (MIC) were measured using the agar dilution method for seven penicillins and for four penicillin combinations, for six oral and 14 parenteral cefalosporins, for three older and five newer quinolones, for two aminoglycosides, for two monobactams, for trimethoprim alone and in combination with sulfamethoxazole, for fosfomycin and for imipenem. Sensitivity and resistance of the strains were defined using breakpoints according to DIN 58.940 or analogous concentrations. The bacterial spectrum and the rate of resistant strains were correlated to clinical aspects pertaining to sexual status, age and underlying abnormalities within the urinary tract. There was a statistical difference in the frequency of E. coli and enterococci between patients with (complicated UTI) and without (uncomplicated UTI) abnormalities. Within the group of complicated UTI Proteus spp. were found significantly more often in patients with urolithiasis, Klebsiella spp. and staphylococci in patients with prostatic tumours (benign and malignant), enterococci in patients with prostatic and other tumours and E. coli in patients with abnormalities other than urolithiasis or tumours. Almost all antibiotics tested could be used in patients with uncomplicated UTI for empiric or calculated therapy if a rate of resistance of up to 10% is acceptable. In patients with urolithiasis only the newer acylaminopenicillins, the newer (fluoro-)quinolones, trimethoprim in combination with sulfamethoxazole, fosfomycin and imipenem fulfill this criterion. In order to treat complicated UTI with underlying tumours within the urinary tract empirically only piperacillin, apalcillin, imipenem and some of the newer quinolones (ofloxacin, ciprofloxacin and pefloxacin) could be recommended. The same was true for patients with indwelling catheters still present or recently removed.

Topics: Aminoglycosides; Anti-Bacterial Agents; Anti-Infective Agents, Urinary; Cephalosporins; Cross Infection; Drug Combinations; Female; Hospitalization; Humans; Male; Microbial Sensitivity Tests; Penicillins; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

In order to investigate the frequency of the emergence of resistance during treatment, 1,403 episodes of lower respiratory infection were studied in a General Hospital with three departments of Chest Medicine in a period of four years. In 650 episodes the pathogen was isolated and in 82 of those failure of therapy was accompanied by emergence of resistance to the agent used. Factors associated with this phenomenon were: intensive care, tracheostomy, involvement of Pseudomonas aeruginosa, Enterobacter spp., Serratia marcescens, Staphylococcus aureus or Acinetobacter calcoaceticus, use of antipseudomonas penicillins, cefotaxime (especially when used in P. aeruginosa infections) and co-trimoxazole and monotherapy as opposed to appropriate combination therapy in patients with nosocomial pneumonia.

Topics: Acinetobacter; Anti-Bacterial Agents; Bacteria; Cefotaxime; Cross Infection; Drug Combinations; Drug Therapy, Combination; Drug Utilization; Enterobacteriaceae; Humans; Intensive Care Units; Penicillin Resistance; Penicillins; Pneumonia; Pseudomonas aeruginosa; Respiratory Tract Infections; Retrospective Studies; Staphylococcus aureus; Sulfamethoxazole; Tracheotomy; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

We studied the spectrum of clinical disease in 99 patients with nosocomial Pseudomonas maltophilia isolates at the University of Virginia Hospital from 1981 through 1984. The annual rate of isolation increased from 7.1 to 14.1 per 10,000 patient discharges. A crude mortality rate of 43% was documented in all patients from whom the organism was cultured, and the data include 12 patients with nosocomial bacteremia (four deaths). Risk factors associated with death for patients having a P. maltophilia isolate included the following: requirement for care in any intensive care unit during hospitalization (P = 0.0001), patient age over 40 years (P = 0.002), and a pulmonary source for the P. maltophilia isolate (P = 0.003). All P. maltophilia isolates were susceptible to trimethoprim-sulfamethoxazole, 60% of the isolates were resistant to all aminoglycosides (amikacin, tobramycin, and gentamicin), and more than 75% of the isolates were resistant to all beta-lactam antibiotics. The antibiotic susceptibility pattern allows for a niche exploitable in the hospital microbial environment by an organism with a marked associated mortality.

Topics: Adolescent; Adult; Age Factors; Aged; Aminoglycosides; Anti-Bacterial Agents; Child; Child, Preschool; Cross Infection; Drug Combinations; Female; Humans; Infant; Lactams; Male; Middle Aged; Pseudomonas; Pseudomonas Infections; Risk; Sepsis; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Seventy-one strains of Serratia marcescens obtained from hospitalized patients of the Instituto Nacional de la Nutricion in Mexico City and two Virginia hospitals (University of Virginia Medical Center and Norfolk General Hospital) were analyzed to find markers useful for the epidemiologic investigation of outbreaks with this organism. Biotyping with commercial microwell systems (API 20# system [Analytab Products, Plainview, N.Y.] and DMS Rapid NFT [DMS Laboratories, Inc., Flemington, N.J.]) was not useful. Biotyping with the system designed by Grimont (assimilation tests, pigment production, and the ability to reduce tetrathionate broth) was helpful to characterize all strains. Of the 37 Mexican strains, 36 belonged to biogroup A 5/8 and 32 were biotype A8b. The 34 strains from the Virginia hospitals were distributed among six different biogroups and 12 biotypes. Significant differences in antimicrobial susceptibility (50% MIC, microgram/ml) between Mexican and Virginia strains were seen with carbenicillin (256 versus 8), piperacillin (64 versus 4), amikacin (16 versus 2), gentamicin (2 versus 0.5), and tobramycin (16 versus 2). Some Mexican strains showed variability in the susceptibility to amikacin because they were low producers of 6'-N-acetyltransferase type I. The Mexican strains seemed to come from a hospital with cross-infection problems because most were isolated from urine, were multiresistant, and more nonpigmented; in contrast, the strains isolated at University of Virginia Medical Center represent the experience of a hospital with scattered S. marcescens infections. The Grimont biotyping scheme is a useful epidemiologic tool for the clinical microbiologist.

Topics: Aminoglycosides; Anti-Bacterial Agents; Cross Infection; Drug Combinations; Enterobacteriaceae Infections; Humans; Lactams; Mexico; Microbial Sensitivity Tests; Serratia marcescens; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Virginia

Among 185 patients with nonneutropenic, community-acquired gram-negative bacillary bacteremias, clinical risk factors for cefoxitin resistance included any antibiotic taken within the last three weeks (25.6% cefoxitin resistance), long-term bladder catheterization or surgical urinary diversion (23.3%), hospitalization within the last 30 days (22.9%), and nursing home residence before admission (20.8%). Patients with none of these risk factors were less likely to have cefoxitin-resistant bacteremias (0.9%). When these risk factors were examined in the subgroups of urinary tract and non-urinary tract sources of community-acquired gram-negative bacillary bacteremia, they were also helpful in predicting sensitivity to trimethoprim-sulfamethoxazole and gentamicin. The presence of one or more of the risk factors identified may be a useful adjunct in determining initial empiric antimicrobial therapy for community-acquired gram-negative bacillary bacteremia.

Topics: Cefoxitin; Child; Clindamycin; Cross Infection; Drug Combinations; Drug Resistance, Microbial; Gentamicins; Gram-Negative Bacteria; Humans; Retrospective Studies; Risk; Sepsis; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Catheterization; Urinary Diversion; Urinary Tract Infections

Pseudomonas cepacia, considered a phytopathogenic organism for many years, has been shown recently to be widely distributed geographically. The hospital environment has become an important source of this organism but the resistance of Ps. cepacia to most antibiotics has made the treatment of infections a problem. One hundred per cent of the strains tested have proved to be sensitive to the sulphonamides and to novobiocin, 93.0% to the combination of trimethoprim and sulfamethoxazole (co-trimoxazole); 85.2% to minocycline; 77.8% to chloramphenicol and dibekacin and 44.4% to nalidixic acid. One hundred per cent of the strains exhibit resistance to ampicillin, cephalothin, cefamandole, cefoxitin, colistin, cefuroxime, tetracycline and cefazolin; 88.9% to amikacin, tobramycin and sisomycin; 85.2% to carbenicillin. The new beta-lactams, apalcillin, ceftazidime, N-formimidoyl-thienamycin, piperacillin, cefotaxime and azlocillin proved to be the most potent of the molecules tested, inhibiting 90% of the strains, at concentrations of 4, 8, 8, 8, 32 and 16 mg/l and 100% of the strains at 8, 16, 16, 32, 32 and 64 mg/l, respectively. In contrast to the usual sensitivity patterns of Pseudomonas spp, Ps. cepacia has been shown to be resistant to colistin, cefsulodin and the aminoglycosides. However, unlike Ps. aeruginosa, Ps. cepacia has been shown, by the dilution method, to be sensitive to co-trimoxazole, 92.3% of the strains being inhibited by 16 mg/l.

Topics: Anti-Bacterial Agents; Ceftazidime; Cross Infection; Drug Combinations; Drug Resistance, Microbial; Humans; Microbial Sensitivity Tests; Minocycline; Novobiocin; Pseudomonas; Pseudomonas Infections; Species Specificity; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

The clinical and laboratory characteristics of 27 patients during an outbreak of pneumonia due to Legionella micdadei were reviewed. These patients were compared with a group of 46 patients who had other causes of nosocomial acquired pneumonia. Patients with pneumonia due to L micdadei typically had nosocomial acquisition of the disease and were immunosuppressed. Symptoms, physical findings, and laboratory tests were nonspecific; however, patients with pneumonia due to L micdadei had an increased frequency of pleuritic pain in the chest, dyspnea, cough, and changes in mental status compared to the nosocomial group. Direct fluorescent antibody staining and culture of sputum and other respiratory secretions established the diagnosis of infection with L micdadei. Unusual features included dual infections in three patients and pulmonary cavitation in five patients. Therapy with erythromycin, when instituted early, decreased mortality. Trimethoprim-sulfamethoxazole, used as alternative therapy in patients with persistent infection, was also curative. Because of the high mortality associated with a delay in diagnosis, it is important to consider the diagnosis of pneumonia due to L micdadei in immunosuppressed patients.

Topics: Adult; Aged; Bacterial Infections; Cross Infection; Diagnosis, Differential; Drug Combinations; Erythromycin; Female; Humans; Immunosuppression Therapy; Legionella; Male; Middle Aged; Pneumonia; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

An outbreak caused by a highly resistant strain of Salmonella typhimurium occurred in a nursery at a university medical center. The outbreak strain, which was resistant to ampicillin, chloramphenicol, and trimethoprim-sulfamethoxazole, was apparently imported from the Far East by a Cambodian refugee. The five patients involved had severe underlying diseases, and bacteremia and meningitis developed in one of these patients. The only reservoir identified was the gastrointestinal tracts of the infected patients, and infection was probably transmitted by the contaminated hands of hospital personnel. The outbreak was rapidly brought under control by isolating cases outside of the nursery and by instituting enteric precautions for infants who remained in the nursery. When compared by disk diffusion susceptibility tests with 353 strains of S. typhimurium tested at the Centers for Disease Control, the imported strain had a unique antibiogram. Bacteriophage typing of the strains revealed that all were untypable; this, in itself, was a good marker, because only 5 to 10% of S. typhimurium isolates in this country have this property. Agarose gel electrophoresis of isolates from the five patients revealed an identical plasmid banding pattern consisting of three large and three small plasmids. Highly resistant strains of S. typhimurium imported from the Far East may spread rapidly when introduced into a hospital nursery. Prompt institution of control measures may limit the outbreak and prevent systemic infections for which there are few effective therapeutic agents.

Topics: Ampicillin; Bacteriophage Typing; Chloramphenicol; Cross Infection; Disease Outbreaks; Drug Combinations; Gastroenteritis; Humans; Infant; Infant, Newborn; Nurseries, Hospital; Penicillin Resistance; Salmonella Infections; Salmonella typhimurium; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

During a hospital outbreak of methicillin-resistant Staphylococcus aureus (MRSA) disease in 30 patients we studied the use of rifampin and trimethoprim/sulfamethoxazole (TMP/SMX) in managing asymptomatic carriers. The outbreak persisted despite control measures including "barrier" precautions, screening cultures, identification of affected persons and rapid hospital discharge of affected patients. The MRSA strain was susceptible to both rifampin and TMP/SMX and in vitro the combination was not antagonistic. Fourteen carriers received a five-day course of rifampin and TMP/SMX given by mouth. Twelve patients were evaluable. Cultures remained persistently positive in four patients, three of whom had foreign bodies that could not be removed. Among the eight with an initial response, two relapsed to the carrier state more than six months after treatment. During the study the outbreak resolved. These data suggest that rifampin and TMP/SMX may decrease the number of MRSA-colonized patients, but may not permanently eradicate the MRSA carrier state.

Topics: Adult; Aged; Carrier State; Cross Infection; Drug Combinations; Drug Therapy, Combination; Humans; Methicillin; Middle Aged; Penicillin Resistance; Rifampin; Staphylococcal Infections; Staphylococcus aureus; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

During an outbreak of Flavobacterium meningosepticum septicaemia in a neonatal intensive care unit 9 infants were treated with intravenous trimethoprim sulphamethoxazole. Bacteriological cure was achieved in 8 patients; one infant died of massive intraventricular haemorrhage on the first day of treatment. Apart from prolonged persistence of pre-existing thrombocytopenia there was no evidence of side effects. Trimethoprim sulphamethoxazole should be considered in the treatment of neonatal F meningosepticum sepsis in view of its activity against this organism, good penetration of the blood brain barrier, and the absence of serious side effects.

Topics: Bacterial Infections; Cross Infection; Drug Combinations; Female; Flavobacterium; Humans; Infant, Newborn; Intensive Care Units, Neonatal; Male; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Aged; Anti-Infective Agents, Urinary; Bacteriuria; Catheters, Indwelling; Cross Infection; Drug Combinations; Female; Humans; Male; Middle Aged; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Catheterization; Urinary Incontinence

Topics: Acinetobacter Infections; Cross Infection; Drug Combinations; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Meningitis; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination