trimethoprim--sulfamethoxazole-drug-combination and Enterobacteriaceae-Infections

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

Trimethoprim/sulfamethoxazole is currently considered the treatment of choice for shigellosis and severe travelers' diarrhea. The problem with this combination regimen is inactivity against Campylobacter jejuni strains and other bacterial enteropathogens showing in vitro resistance to the drug. Resistance to trimethoprim/sulfamethoxazole among enteric pathogens has occurred frequently in certain areas of the world. A study of the in vitro susceptibility of enteric bacterial pathogens isolated from multiple countries was recently performed. The minimal inhibitory concentration of ciprofloxacin required to inhibit 90 percent of the 210 bacterial enteropathogens ranged from 0.25 micrograms/ml for C. jejuni to 0.016 micrograms/ml for enterotoxigenic Escherichia coli, Salmonella, and Shigella. In a clinical trial carried out in a United States student population that acquired diarrhea while in Mexico, it was shown that ciprofloxacin was as effective as trimethoprim/sulfamethoxazole and both were significantly (p less than 0.001) more effective than placebo. The average duration of diarrhea was 29 or 20 hours after initiation of treatment with ciprofloxacin or trimethoprim/sulfamethoxazole, respectively, compared with 81 hours in the placebo group. The antimicrobial agents were more efficacious than placebo in treating diarrhea caused by enterotoxigenic E. coli, invasive enteropathogens, and unknown pathogens. Ciprofloxacin and the quinolone derivatives are uniquely suited to the therapy of acute bacterial diarrhea in areas where C. jejuni is commonly found and where trimethoprim/sulfamethoxazole-resistant strains regularly occur.

Topics: Anti-Bacterial Agents; Ciprofloxacin; Clinical Trials as Topic; Diarrhea; Drug Combinations; Drug Resistance, Microbial; Enterobacteriaceae Infections; Humans; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Trimethoprim-sulfamethoxazole has excellent microbiologic activity against most pathogens that produce meningitis; both components of this drug have high penetration into tissues, including the cerebrospinal fluid. Clinical experience shows that trimethoprim-sulfamethoxazole may be beneficial in the treatment of gram-negative bacillary meningitis caused by organisms only moderately susceptible to third-generation cephalosporins (Enterobacter cloacae, Serratia marcescens) or resistant to these antibiotic agents (Pseudomonas cepacia, Acinetobacter). The success of trimethoprim-sulfamethoxazole in the treatment of four patients with Staphylococcus aureus and two patients with Listeria monocytogenes meningitis shows that this drug may also be useful in treating infrequent types of gram-positive meningitis.

Topics: Adolescent; Adult; Animals; Bacteria; Child, Preschool; Drug Combinations; Enterobacteriaceae Infections; Female; Gram-Negative Bacteria; Gram-Positive Bacteria; Humans; Infant; Infant, Newborn; Kinetics; Male; Meningitis; Microbial Sensitivity Tests; Middle Aged; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Data were collected from 14 French centres which participated in a randomized study to compare the safety and efficacy of 400 mg lomefloxacin taken orally once daily by 62 patients with 160/800 mg trimethoprim/sulphamethoxazole (TMP/SMX) taken orally twice daily by 64 patients with uncomplicated urinary tract infections. Most patients were infected with Escherichia coli at baseline (72.4% in the lomefloxacin group and 69.0% in the TMP/SMX group) and all patients were treated for 5 days. At 5-9 days post-treatment, lomefloxacin had eradicated the causative organism of infection in 100% of evaluable patients treated with lomefloxacin compared with 86.7% of those treated with TMP/SMX. At 4-6 weeks post-treatment, there were no marked differences in eradication rates between the two treatment groups: 83.3% and 80.0% for the lomefloxacin and TMP/SMX groups, respectively. Clinical cure rates showed no marked differences between treatment groups at 5-9 days or at 4-6 weeks post-treatment. At 5-9 days post-treatment, lomefloxacin achieved a clinical cure rate of 78.6% compared with 86.7% for TMP/SMX evaluable patients. At 4-6 weeks post-treatment, the clinical cure rates were 66.7% and 86.7% for the evaluable lomefloxacin- and TMP/SMX-treated patients, respectively. Both treatment regimens were well tolerated with a low incidence of adverse events. In conclusion, once-daily oral dosing with lomefloxacin is a safe and efficacious alternative to twice-daily dosing with TMP/SMX in the treatment of uncomplicated urinary tract infections.

Topics: Administration, Oral; Adolescent; Adult; Aged; Aged, 80 and over; Anti-Infective Agents; Drug Administration Schedule; Enterobacteriaceae Infections; Escherichia coli Infections; Female; Fluoroquinolones; Humans; Male; Middle Aged; Prospective Studies; Quinolones; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

To compare single-dose and 10-day treatment regimens of trimethoprim-sulfamethoxazole in women with acute dysuria, urgency, or urinary frequency.. Double-blind, randomized, placebo-controlled trial.. Student health center at a major university.. Consecutive sample of 255 young women including 216 with a bacteriologically documented urinary tract infection.. Single-dose treatment (trimethoprim, 320 mg and sulfamethoxazole, 1600 mg) given to 116 women and 10-day treatment (trimethoprim, 160 mg and sulfamethoxazole, 800 mg, twice daily) given to 125 women. Women with a history of sulfonamide allergy were given trimethoprim alone: 10 received single-dose treatment (200 mg) and 5 received 10-day treatment (100 mg, twice daily).. The rates for resolution of symptoms at 3 days, 13 days, and 6 weeks after entry into the study were not significantly different between treatment groups. Among women with urinary tract infections, cumulative crude rates of recurrence in the single-dose and 10-day treatment groups, respectively, were 24% compared with 5% at 13 days after entry (P = 0.0002; 95% confidence interval [CI] for difference in proportions, 10%, 28%) and 32% compared with 21% at 6 weeks after entry (P = 0.07; 95% Cl, -2%, 24%). Factors independently associated with lower cure rates were a history of a urinary tract infection within the previous 6 weeks (adjusted odds ratio [OR], 3.8; 95% Cl, 1.4 to 10.6) and presence of 10(5) bacteria/mL or greater in an initial midstream culture (adjusted OR, 2.9; 95% Cl, 1.2 to 7.0). After controlling for these factors, the risk of failure after single-dose treatment was not statistically significantly different from 10-day treatment at 6 weeks (adjusted OR, 1.6; 95% Cl, 0.8 to 3.2; P = 0.21). Compared to 10-day treatment, single-dose treatment less effectively eradicated Escherichia coli from the vaginal flora (P less than 0.001) and led more often to early same-strain recurrences (P = 0.003). Meaningful adverse effects occurred in 12% of women given single-dose treatment compared with 25% of women receiving 10-day treatment (P = 0.009).. Compared with single-dose treatment, 10-day treatment yields a superior cure rate at 2 weeks after the start of treatment, but by 6 weeks the advantage of longer treatment no longer exists. This effect may be explained by the lesser effectiveness of single-dose treatment in eradicating vaginal E. coli, resulting in more frequent same-strain recurrences within 2 weeks of treatment.(ABSTRACT TRUNCATED AT 400 WORDS)

Topics: Adult; Double-Blind Method; Drug Administration Schedule; Drug Combinations; Enterobacteriaceae Infections; Female; Follow-Up Studies; Humans; Random Allocation; Recurrence; Staphylococcal Infections; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Urination Disorders

We compared the efficacy of orally administered ampicillin, 2 g/d, with that of trimethoprim-sulfamethoxazole, 320 mg/d-1600 mg/d, given for 2 or 6 weeks for outpatient management of acute uncomplicated renal infection in women. Of 98 women participating in the trial, 60 had renal infections with susceptible strains, complied with drug therapy, and completed 6 weeks of follow-up. Before treatment, 39 women had symptoms and signs of acute pyelonephritis; 21 had symptoms of cystitis but positive tests for antibody-coated bacteria. All 60 women had alleviation of symptoms and resolution of bacteriuria after 7 days of therapy. Subsequent recurrences occurred in 12 of 27 women given ampicillin, compared with 4 of 33 given trimethoprim-sulfamethoxazole (p = 0.008). Serotyping showed that most recurrences were reinfections with ampicillin-resistant strains. With each drug, a 2-week regimen of therapy proved as efficacious as a 6-week regimen, but the longer regimen was less well tolerated. We conclude that a 2-week treatment regimen is sufficient to manage acute pyelonephritis in outpatients and that trimethoprim-sulfamethoxazole is preferable to ampicillin therapy.

Topics: Adult; Ampicillin; Drug Administration Schedule; Drug Combinations; Enterobacteriaceae Infections; Female; Humans; Random Allocation; Recurrence; Staphylococcal Infections; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Trimethoprim/sulfamethoxazole is currently considered the treatment of choice for shigellosis and severe travelers' diarrhea. The problem with this combination regimen is inactivity against Campylobacter jejuni strains and other bacterial enteropathogens showing in vitro resistance to the drug. Resistance to trimethoprim/sulfamethoxazole among enteric pathogens has occurred frequently in certain areas of the world. A study of the in vitro susceptibility of enteric bacterial pathogens isolated from multiple countries was recently performed. The minimal inhibitory concentration of ciprofloxacin required to inhibit 90 percent of the 210 bacterial enteropathogens ranged from 0.25 micrograms/ml for C. jejuni to 0.016 micrograms/ml for enterotoxigenic Escherichia coli, Salmonella, and Shigella. In a clinical trial carried out in a United States student population that acquired diarrhea while in Mexico, it was shown that ciprofloxacin was as effective as trimethoprim/sulfamethoxazole and both were significantly (p less than 0.001) more effective than placebo. The average duration of diarrhea was 29 or 20 hours after initiation of treatment with ciprofloxacin or trimethoprim/sulfamethoxazole, respectively, compared with 81 hours in the placebo group. The antimicrobial agents were more efficacious than placebo in treating diarrhea caused by enterotoxigenic E. coli, invasive enteropathogens, and unknown pathogens. Ciprofloxacin and the quinolone derivatives are uniquely suited to the therapy of acute bacterial diarrhea in areas where C. jejuni is commonly found and where trimethoprim/sulfamethoxazole-resistant strains regularly occur.

Topics: Anti-Bacterial Agents; Ciprofloxacin; Clinical Trials as Topic; Diarrhea; Drug Combinations; Drug Resistance, Microbial; Enterobacteriaceae Infections; Humans; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

We evaluated the following five treatment regimens for acute cystitis in nonpregnant women: cefadroxil, 1,000 mg single-dose; cefadroxil, 500 mg twice a day for three days; cefadroxil, 500 mg twice a day for seven days; trimethoprim-sulfamethoxazole (TMP-SMZ), 320-1,600 mg single-dose, and TMP-SMZ, 160-800 mg twice a day for three days. At four weeks after the end of treatment, 25%, 58%, 70%, 65%, and 88% of patients, respectively, remained cured of infection. The results indicated that three-day treatment (1) might improve cure rates (over single-dose), (2) would reduce incidence of relapse (vs. single-dose), and (3) may be as curative as seven-day treatment. The results of the antibody-coated bacteria test did not predict treatment failure or relapse.

Topics: Administration, Oral; Antibody-Coated Bacteria Test, Urinary; Bacteriuria; Cefadroxil; Cystitis; Drug Combinations; Enterobacteriaceae Infections; Female; Humans; Random Allocation; Recurrence; Staphylococcal Infections; Streptococcal Infections; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

A new chemotherapeutic drug oriprim was used for therapy of 36 patients with bronchopulmonary pathology. Its therapeutic efficacy was noted in 83.3% of the cases. In 6 patients oriprim therapy turned out to be ineffective as a result of early side-effects. The drug was effective in pneumococcal infection. In suspicion of anaerobic infection (B. fragilis, etc) oriprim was given in combination with metronidazole.

Topics: Administration, Oral; Bacterial Infections; Bronchitis; Clinical Trials as Topic; Drug Combinations; Enterobacteriaceae Infections; Haemophilus Infections; Haemophilus influenzae; Humans; Injections, Intramuscular; Pneumonia; Pneumonia, Pneumococcal; Pneumonia, Staphylococcal; Staphylococcus epidermidis; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Forty women with uncomplicated urinary tract infections were assigned randomly to receive 400 mg. norfloxacin or 160 mg. trimethoprim and 800 mg. sulfamethoxazole twice daily for 10 days. Of the 20 patients receiving norfloxacin none had bacteriuria during or 7 days after therapy and 5 patients were reinfected within 6 weeks of therapy discontinuation. Of the 20 patients receiving trimethoprim-sulfamethoxazole therapy 1 presented with a strain resistant to trimethoprim-sulfamethoxazole and was excluded from the study. The remaining 19 patients were uninfected during and 7 days after therapy, and 6 patients were reinfected 6 weeks after therapy. All documented recurrences were caused by bacteria sensitive to the initial therapeutic agent. Anal and vaginal Enterobacteriaceae maintained their sensitivity to norfloxacin. One patient on trimethoprim-sulfamethoxazole presented with and 2 patients acquired resistant anal and vaginal Enterobacteriaceae. No adverse reactions occurred in either treatment group. Norfloxacin was as effective and safe as trimethoprim-sulfamethoxazole without emergence of resistant bacteria associated with trimethoprim-sulfamethoxazole.

Topics: Adult; Anal Canal; Anti-Infective Agents, Urinary; Bacteriuria; Drug Combinations; Drug Resistance, Microbial; Enterobacteriaceae; Enterobacteriaceae Infections; Feces; Female; Humans; Nalidixic Acid; Norfloxacin; Sulfamethoxazole; Time Factors; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Vagina

The comparative efficacy of antibacterial therapy with pivmecillinam or cotrimoxazole and general supportive care only was studied in patients with severe bacterial gastroenteritis. Overall, treatment with antibiotics proved significantly superior to rehydration alone in 42 children. Active therapy also had a statistically beneficial effect in children infected with Vibrio cholerae and V. parahaemolyticus. Pivmecillinam and co-trimoxazole were equally effective. Pivmecillinam and oral mecillinam appeared to be of equal value in a further 22 adults infected by Vibrio spp. No side-effects were recorded in any of the subjects treated. Further investigations with pivmecillinam and oral mecillinam are advocated.

Topics: Adult; Amdinocillin; Amdinocillin Pivoxil; Child, Preschool; Cholera; Drug Combinations; Enterobacteriaceae Infections; Gastroenteritis; Humans; Penicillanic Acid; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Vibrio Infections; Vibrio parahaemolyticus

Of 545 patients expected to develop prolonged neutropenia and randomized to received trimethoprim-sulfamethoxazole (TMP-SMZ) or placebo, 342 were evaluable for occurrence of infection or bacteremia. Some centers used oral nonabsorbable antibiotics in addition. Infection occurred in 64 (39%) of 165 placebo recipients and 46 (26%) of 177 TMP-SMZ recipients (P = .016), whereas bacteremia occurred in 32 (19%) and 22 (12%), respectively (P = .106, difference not significant [NS]). In the 139 patients with acute nonlymphocytic leukemia (ANLL), infection occurred in 35 (55%) of 64 placebo-treated patients and 31 (41%) of 75 TMP-SMZ-treated patients (P = .162, NS), whereas bacteremia occurred in 15 (23%) and 18 (24%; NS), respectively. Excluding patients with ANLL, infection occurred in 29 (29%) of 101 placebo-treated patients and 15 (15%) of 102 TMP-SMZ recipients (P = .038), whereas bacteremia occurred in 17 (17%) and four (4%; P = .005), respectively. Gram-positive cocci were isolated less frequently from TMP-SMZ-treated, bacteremic patients, but more of their isolates were resistant to TMP-SMZ than were those from placebo recipients.

Topics: Agranulocytosis; Anti-Bacterial Agents; Bacterial Infections; Clinical Trials as Topic; Drug Combinations; Enterobacteriaceae Infections; Granulocytes; Humans; Leukemia; Leukocyte Count; Neutropenia; Sepsis; Staphylococcal Infections; Streptococcal Infections; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

For several years, we applied an internal guideline for community-acquired urinary tract infections (cUTI), targeting the reduction of fluoroquinolone use (FQ) and thereby favouring cotrimoxazole (CTM) prescription. Our aim was to report adverse effects (AE) and outcome for patients presenting with cUTI and treated with these compounds.. This cohort study was based on the dashboard of our department, bringing together 28 parameters for all patients, including diagnosis, microbiological data, antibiotic therapy, AE, length of hospital stay (LHS) and outcome. We included all patients with cUTI due to Enterobacteriaeae treated with CTM or FQ, and compared these 2 groups on in-hospital AE, LHS, and unfavourable outcome defined as intensive care requirement or death.. From June 2008 to June 2019, 640 cUTI due to Enterobacteriaeae were observed, among which 295 (46%) treated with CTM and 345 (54%) with a FQ. There were 25 AE (3.9%): 17 (5.7%) in the CTM group, and 8 (2.3%) in the FQ group (P=0.025). Adverse effects were associated with increased LHS compared to patients without AE: 11±6 vs. 7±4 days respectively, P<0.001, 11.4±6.2 days in the CTM group vs. 9.2±5.8 in the FQ group (relative LHS increase of 73.5% and 29.5%, respectively). Unfavorable outcome occurred for 1 patient (0.3%) in the CTM group, and 5 (1.4%) in the FQ group, P=0.297.. Favouring cotrimoxazole for cUTI due to Enterobacteriaceae was associated compared to FQ with more AE and prolonged LHS. A cost-effectiveness analysis to validate such therapeutic strategy is warranted.

Topics: Aged; Aged, 80 and over; Anti-Bacterial Agents; Cohort Studies; Community-Acquired Infections; Enterobacteriaceae; Enterobacteriaceae Infections; Female; Fluoroquinolones; Humans; Intensive Care Units; Length of Stay; Male; Middle Aged; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Oral β-lactam antibiotics are traditionally not recommended to treat Enterobacterales bacteremia because of concerns over subtherapeutic serum concentrations, but there is a lack of outcomes data, specifically after initial treatment with parenteral antibiotics. Given the limited data and increasing limitations of fluoroquinolones or trimethoprim-sulfamethoxazole (TMP-SMX), oral β-lactam antibiotics may be a valuable additional treatment option.. To compare definitive therapy with oral β-lactam antibiotics vs fluoroquinolones or TMP-SMX for Enterobacterales bacteremia from a suspected urine source.. A retrospective cohort study was conducted from January 1, 2007, to September 30, 2015, at 114 Veterans Affairs hospitals among 4089 adults with Escherichia coli, Klebsiella spp, or Proteus spp bacteremia and matching urine culture results. Additional inclusion criteria were receipt of active parenteral antibiotic(s) followed by conversion to an oral antibiotic. Exclusion criteria were previous Enterobacterales bacteremia, urologic abscess, or chronic prostatitis. Data were analyzed from April 15, 2019, to July 26, 2020.. Conversion of therapy to an oral β-lactam antibiotic vs fluoroquinolones or TMP-SMX after 1 to 5 days of parenteral antibiotics.. The main outcome was a composite of either 30-day all-cause mortality or 30-day recurrent bacteremia. Propensity-based overlap weights were used to adjust for differences between groups. Log binomial regression models were used to estimate adjusted relative risks (aRRs) and adjusted risk differences (aRDs).. Of the 4089 eligible patients (3731 men [91.2%]; median age, 71 years [interquartile range, 63-81 years]), 955 received an oral β-lactam antibiotic, and 3134 received fluoroquinolones or TMP-SMX. The primary outcome occurred for 42 patients (4.4%) who received β-lactam antibiotics and 94 patients (3.0%) who received fluoroquinolones or TMP-SMX (aRD, 0.99% [95% CI, -0.42% to 2.40%]; aRR, 1.31 [95% CI, 0.87-1.95]). Mortality rates were 3.0% (n = 29) for patients receiving β-lactam antibiotics vs 2.6% (n = 82) for those receiving fluoroquinolones or TMP-SMX (aRD, 0.06% [95% CI, -1.13% to 1.26%]; aRR, 1.02 [95% CI, 0.67-1.56]). Recurrent bacteremia rates were 1.5% (n = 14) among those receiving β-lactam antibiotics vs 0.4% (n = 12) among those receiving fluoroquinolones or TMP-SMX (aRD, 1.03% [95% CI, 0.24%-1.82%]; aRR, 3.43 [95% CI, 0.42-27.90]).. In this cohort study of adults with E coli, Klebsiella spp, or Proteus spp bacteremia from a suspected urine source, the relative risk of recurrent bacteremia was not significantly higher with β-lactam antibiotics compared with fluoroquinolones or TMP-SMX, and the absolute risk and risk difference were small (ie, <3%). No significant difference in mortality was observed. Oral β-lactam antibiotics may be a reasonable step-down treatment option, primarily when alternative options are limited by resistance or adverse effects. Further study is needed because statistical power was limited owing to a low number of recurrent bacteremia events.

Topics: Aged; Aged, 80 and over; Anti-Bacterial Agents; Anti-Infective Agents, Urinary; beta-Lactams; Cohort Studies; Drug Resistance, Multiple, Bacterial; Enterobacteriaceae Infections; Female; Humans; Male; Middle Aged; Retrospective Studies; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Adult; Anti-Bacterial Agents; Carbapenem-Resistant Enterobacteriaceae; Enterobacteriaceae Infections; Female; Humans; Male; Middle Aged; Retrospective Studies; Trimethoprim, Sulfamethoxazole Drug Combination

Although the frequency of bone and joint infections caused by Enterobacter spp. is increasing, studies regarding the optimal antibiotic therapy are scarce. The objective of this retrospective study was to assess the clinical outcomes and safety of a fluoroquinolone-cotrimoxazole combination for the treatment of bone and joint infections caused by Enterobacter cloacae. Between 2010 and 2017, 30 patients with bone and joint infections caused by E. cloacae were treated with a fluoroquinolone-cotrimoxazole combination for 8-12 weeks. There were 26 cases (87%) of infection of an internal fixation device, two cases (6.6%) of pseudarthrosis with chronic osteomyelitis, and two cases (6.6%) of infection of knee and ankle prosthetic devices. The cure rate of the fluoroquinolone-cotrimoxazole combination was 80% by intention-to-treat analysis, with a mean follow-up of 29.3 ± 19.1 months. The fluoroquinolone-cotrimoxazole combination for 8-12 weeks is effective for the treatment of bone and joint infections caused by E. cloacae.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Arthritis; Drug Therapy, Combination; Drug-Related Side Effects and Adverse Reactions; Enterobacter cloacae; Enterobacteriaceae Infections; Female; Fluoroquinolones; Humans; Male; Middle Aged; Osteomyelitis; Prosthesis-Related Infections; Retrospective Studies; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Young Adult

Topics: Aged; Enterobacteriaceae Infections; Female; Humans; Melanosis; Morganella morganii; Nail Diseases; Nails; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

In a study of 39 isolates of Edwardsiella piscicida made from Korean aquaculture sites, sul genes were detected in 16 isolates and dfr genes in 19. Ten isolates were shown to contain both sul and dfr genes. MIC and disc diffusion zones assays were performed to measure the phenotypic susceptibilities of the 39 isolates. Normalized resistance interpretation was applied to these data to categorize isolates as either fully susceptible or as manifesting reduced susceptibility. The standard CLSI protocols specify the use of a mixture of sulfamethoxazole/trimethoprim (20:1) in both MIC and disc diffusion tests. Using the CLSI MIC protocol, 100% of the isolates containing dfr genes, but only 75% of the isolates containing sul genes, were categorized as manifesting reduced susceptibility. Using the CLSI disc diffusion protocol, only 58% of the isolates containing dfr genes and 69% of those containing sul genes were categorized as manifesting reduced susceptibility. When the single agent trimethoprim was substituted for the combined mixture in both the MIC and disc diffusion protocols, 100% of the dfr-positive isolates were categorized as NWT. When the single-agent sulfamethoxazole was substituted, the analysis of the MIC characterized 100% and the disc zone data 94% of the sul-positive isolates as manifesting reduced susceptibility. It is argued that the use of trimethoprim and sulfamethoxazole as single agents in phenotypic susceptibility tests would provide more meaningful data than the currently recommended use of these two agents combined.

Topics: Animals; Anti-Bacterial Agents; Disk Diffusion Antimicrobial Tests; Drug Resistance, Bacterial; Edwardsiella; Eels; Enterobacteriaceae Infections; Escherichia coli; Escherichia coli Infections; Genotype; Microbial Sensitivity Tests; Phenotype; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

The antibiotic, trimethoprim-sulfamethoxazole (TMP-SMX), is generally used for prophylaxis in HIV individuals to protect them from Pneumocystis jiroveci infection. Long-term use of TMP-SMX develops drug resistance among bacteria in HIV patients. The study was aimed to detect the TMP-SMX resistance genes among gram-negative bacteria from HIV patients. TMP-SMX-resistant isolates were detected by the Kirby-Bauer disc diffusion method. While TMP resistance genes such as dfrA1, dfrA5, dfrA7, and dfrA17 and SMX resistance genes such as sul1 and sul2 were detected by multiplex PCR, class 1 and class 2 integrons were detected by standard monoplex PCR. Of the 151 TMP-SMX-resistant bacterial isolates, 3 were positive for sul1 alone, 48 for sul2 alone, 11 for dfrA7 alone, 21 for sul1 and sul2, 1 for sul1 and dfrA7, 23 for sul2 and dfrA7, 2 for sul2 and dfrA5, 41 for sul1, sul2, and dfrA7, and 1 for sul2, dfrA5, and dfrA7. Of 60 TMP-SMX-resistant isolates positive for integrons, 44 had class 1 and 16 had class 2 integrons. It was found that the prevalence of sul genes (n = 202; p < 0.001) was higher compared with dfr genes (n = 80; p < 0.001), and 87.4% (n = 132; p < 0.001) of TMP-SMX-resistant isolates also were positive for β-lactamase production. This type of study is reported for the first time from HIV patients in India. Therefore, this study indicates that dissemination of TMP-SMX resistance genes and class 1 and class 2 integrons along with β-lactamase production among gram-negative bacteria in HIV patients will certainly make their treatment to bacterial infections more complicated in clinical settings.

Topics: Anti-Bacterial Agents; beta-Lactamases; Coinfection; Disk Diffusion Antimicrobial Tests; Drug Resistance, Multiple, Bacterial; Enterobacteriaceae; Enterobacteriaceae Infections; Gene Expression Regulation, Bacterial; Genes, Bacterial; HIV Infections; Humans; India; Integrons; Pneumocystis carinii; Pneumonia, Pneumocystis; Primary Prevention; Trimethoprim, Sulfamethoxazole Drug Combination

To determine the prevalence, risk factors, treatments, and outcomes of bloodstream infections (BSIs) due to carbapenem-resistant Enterobacteriaceae (CRE) in adult neutropenic patients with hematologic malignancies.. We reviewed all BSIs between 2008 and 2012 in this population at two New York City oncology centers. A case-control study was conducted to identify CRE BSI risk factors, using three controls of non-CRE BSIs per case.. CRE caused 43 (2.2%) of 1992 BSIs overall and 4.7% of Gram-negative bacteremias. Independent risk factors for CRE BSI were prior β-lactam/β-lactamase inhibitor (adjusted odds ratio [aOR] 3.2; P = 0.03) or carbapenem (aOR 3.0; P = 0.05) use, current trimethoprim-sulfamethoxazole (aOR 24; P = 0.001) or glucocorticoid (aOR 5.4, P = 0.004) use, and having a prior CRE culture (aOR 12; P = 0.03). Patients with CRE bacteremia had a median of 52 h from culture collection until receipt of active therapy. They had a 51% BSI-related mortality rate, with a median of 4 days from bacteremia onset until death. CRE-active empirical therapy was associated with a lower 30-day mortality rate (17% vs. 59%; P = 0.08).. CRE are lethal emerging causes of bacteremia in neutropenic patients. New strategies are needed to shorten the delay in administration of CRE-active agents and improve outcomes in this vulnerable population.

Topics: Adult; Anti-Bacterial Agents; Bacteremia; beta-Lactam Resistance; Carbapenems; Case-Control Studies; Enterobacteriaceae; Enterobacteriaceae Infections; Female; Hematologic Neoplasms; Humans; Male; Middle Aged; Neutropenia; New York City; Prevalence; Risk Factors; Trimethoprim, Sulfamethoxazole Drug Combination; Young Adult

OBJECTIVE To evaluate risk factors for and molecular characteristics of community-onset extended-spectrum cephalosporin-resistant (ESC-R) Enterobacteriaceae (EB) urinary tract infections (UTIs) in a US health system. DESIGN Case-control study. PARTICIPANTS All patients presenting to the emergency department or outpatient practices with EB UTIs from December 21, 2010, through April 22, 2013, were included. Case patients had ESC-R EB UTIs. Control patients had ESC-susceptible EB UTIs and were matched 1:1 on study year. METHODS Risk factors for ESC-R EB UTI were assessed using multivariable conditional logistic regression. A subset of case isolates was evaluated for extended-spectrum beta-lactamases. RESULTS A total of 302 patients with community-onset EB UTI were included, of which 151 were cases. On multivariable analysis, risk factors for ESC-R EB UTI included trimethoprim-sulfamethoxazole use in the prior 6 months (odds ratio, 2.40 [95% CI, 1.22-4.70]; P=.01), older age (1.03 [1.01-1.04]; P<.001), diabetes (2.91 [1.32-6.41]; P=.008), and presentation to the emergency department ( 2.42 [1.31-4.46]; P=.005). The prevalence of extended-spectrum beta-lactamases among 120 case isolates was 52% CTX-M, 29% TEM, 20% OXA, and 13% SHV. The prevalence of AmpC was 25%. Pulsed-field gel electrophoresis of the CTX-M Escherichia coli isolates showed no distinct clusters. CONCLUSIONS Use of trimethoprim-sulfamethoxazole, older age, diabetes, and presentation to the emergency department were associated with community-onset ESC-R EB UTI. There was a high prevalence of CTX-M among our community isolates. Further studies are needed to determine strategies to limit emergence of these organisms in the community. Infect Control Hosp Epidemiol 2016;1433-1439.

Topics: Academic Medical Centers; Adult; Aged; Anti-Bacterial Agents; Case-Control Studies; Cephalosporin Resistance; Cephalosporins; Community-Acquired Infections; Drug Resistance, Bacterial; Emergency Service, Hospital; Enterobacteriaceae; Enterobacteriaceae Infections; Female; Gram-Negative Facultatively Anaerobic Rods; Humans; Logistic Models; Male; Middle Aged; Pennsylvania; Polymerase Chain Reaction; Risk Factors; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

The spread of Extended-Spectrum beta (β)-Lactamases (ESBL)-producing Enterobacteriaceae has become a serious global problem. ESBL-producing Enterobacteriaceae vary based on differences in antibiotic use, nature of patients and hospital settings. This study was aimed at determining ESBL and antibiogram in Enterobacteriaceae isolates from clinical and drinking water sources in Bahir Dar City, Northwest Ethiopia.. Enterobacteriaceae species were isolated from clinical materials and tap water using standard culturing procedures from September 2013 to March 2015. ESBL-producing-Enterobacteriaceae were detected using double-disk method by E-test Cefotaxim/cefotaxim+ clavulanic acid and Ceftazidime/ceftazidime+ clavulanic acid (BioMerieux SA, France) on Mueller Hinton agar (Oxoid, UK).. Overall, 274 Enterobacteriaceae were isolated. Of these, 210 (44%) were from patients and 64 (17.1%) were from drinking water. The median age of the patients was 28 years. Urinary tract infection and blood stream infection accounted for 60% and 21.9% of Enterobacteriaceae isolates, respectively. Klebsiella pneumoniae was isolated from 9 (75%) of neonatal sepsis. The overall prevalence of ESBL-producing Enterobacteriaceae in clinical and drinking water samples were 57.6% and 9.4%, respectively. The predominant ESBL-producers were K. pneumoniae 34 (69.4%) and Escherichia coli 71 (58.2%). Statistically significant associations were noted between ESBL-producing and non- producing Enterobacteriaceae with regard to age of patients, infected body sites and patient settings (P = 0.001). ESBL-producing Enterobacteriaceae showed higher levels of resistance against chloramphenicol, ciprofloxacin and cotrimoxazole than non-ESBL producers (P = 0.001).. ESBL-producing Enterobacteriaceae coupled with high levels of other antimicrobials become a major concern for treatment of patients with invasive infections such as blood stream infections, neonatal sepsis and urinary tract infections. ESBL-producing Enterobacteriaceae were also detected in drinking water sources.

Topics: Adult; Age Factors; Anti-Bacterial Agents; Bacteremia; beta-Lactamases; Child, Preschool; Chloramphenicol; Ciprofloxacin; Cross-Sectional Studies; Drinking Water; Drug Resistance, Multiple, Bacterial; Enterobacteriaceae; Enterobacteriaceae Infections; Ethiopia; Female; Gene Expression; Humans; Infant; Infant, Newborn; Male; Microbial Sensitivity Tests; Neonatal Sepsis; Prevalence; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

To investigate the risk factors for recurrent urinary tract infections (UTIs) in infants with vesicoureteral reflux (VUR) and whether bacterial pathogen affected breakthrough UTI or not.. We compared children with infantile VUR with recurrent UTI (33 males, 11 females, mean age 3.2 months) and without recurrent UTI (40 males, 7 females, mean age 4.8 months). The following were compared between the 2 groups: sex, timing of UTI episode, bacterial growth on urine culture, degree and bilaterality of the reflux, hydronephrosis, renal scar, and delayed ureteral excretion of refluxed contrast on voiding cystourethrogram (VCUG).. Univariate Cox survival-time regression showed that younger age at first UTI, a non-Escherichia coli strain, bilateral and VUR, high-grade VUR, and hydronephrosis on initial ultrasonography (USG) significantly increased the risks of recurrent UTI (P <.05 each). In multivariate analysis, timing of the UTI episode (P = .015), a non-E. coli strain (P = .003), high grade (P = .012), and bilateral VUR (P = .002) were independently associated with increased risk of recurrent UTI. Non-E. coli strains were identified in 60% and 33% of infants with and without recurrent UTI, respectively.. During the first year of life, the earlier the first UTI then the higher the chance is for recurrent UTIs. Higher grades of reflux, bilateral VUR, and the first infection by a non-E. coli strain all significantly increase the risk of recurrent UTIs.

Topics: Antibiotic Prophylaxis; Candida albicans; Candidiasis; Citrobacter freundii; Enterobacter cloacae; Enterobacteriaceae Infections; Escherichia coli; Female; Fever; Humans; Hydronephrosis; Infant; Klebsiella oxytoca; Klebsiella pneumoniae; Male; Multivariate Analysis; Proportional Hazards Models; Proteus mirabilis; Proteus vulgaris; Recurrence; Risk Factors; Staphylococcal Infections; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Vesico-Ureteral Reflux

CTX-M-type extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae have been previously reported in Venezuela. We assessed the frequency and diversity of CTX-M enzymes among 97 ESBL-producing Enterobacteriaceae isolates as well as to establish the genetic relationship among CTX-M producers collected from six hospitals in Caracas. Polymerase chain reaction (PCR) assays identified the bla(CTX-M) genes in 42 isolates (43.3%). The bla(CTX-M-1) group was the most common in Escherichia coli (91 %) and the bla(CTX-M-2) in Klebsiella pneumoniae (56.6%). Presence of bla(CTX-M-1), bla(CTX-M-2), bla(CTX-M-15), and bla(CTX-M-14) was revealed by sequencing analysis. The CTX-M producers were mainly isolated from urine samples (46%). Antimicrobial susceptibility tests showed that a high proportion of CTX-M-producing isolates was resistant to ciprofloxacin and trimethoprim-sulfamethoxazole. Analysis of enterobacterial repetitive intergenic consensus PCR and repetitive extragenic palindromic PCR profiles revealed several genetic clusters between isolates carrying the bla(CTX-M-1) group, while complete genotypic diversity among isolates carrying the bla(CTX-M-2) group was observed. This study documented that CTX-M has achieved a citywide distribution, with the CTX-M-1 group as the most frequent (66.7%). The CTX-M clusters detected suggest that patient-patient transmission may have played an important role in the widespread and high prevalence of the CTX-M-1 group. To our knowledge, this is the first report of the CTX-M-15 in Venezuela.

Topics: Anti-Bacterial Agents; beta-Lactamases; Ciprofloxacin; Drug Resistance, Multiple, Bacterial; Enterobacteriaceae; Enterobacteriaceae Infections; Genotype; Humans; Microbial Sensitivity Tests; Trimethoprim, Sulfamethoxazole Drug Combination; Venezuela

Edwardsiella tarda, a catalase-positive bacillus widely distributed throughout nature, is generally susceptible to trimethoprim/sulfamethoxazole. We describe osteomyelitis due to trimethoprim/sulfamethoxazole-resistant E. tarda in a patient with chronic granulomatous disease (CGD). Once E. tarda acquires antibiotic resistance, infected CGD patients may develop severe infections with unforeseeable consequences.

Topics: Adolescent; Anti-Bacterial Agents; Drug Resistance, Bacterial; Edwardsiella tarda; Enterobacteriaceae Infections; Granulomatous Disease, Chronic; Humans; Infant, Newborn; Leg; Magnetic Resonance Imaging; Male; Osteomyelitis; Radiography; Trimethoprim, Sulfamethoxazole Drug Combination

The association of in vitro resistance with bacteriologic, clinical, and health-related quality of life (HRQoL) outcomes for acute uncomplicated cystitis is unclear.. We conducted a prospective study of women aged 18-40 years with acute uncomplicated cystitis symptoms for ≤7 days who subsequently grew an Enterobacteriaceae sp. and initially received trimethoprim/sulfamethoxazole (TMP/SMX) and phenazopyridine. We conducted telephone follow-up evaluating clinical cure at 1-3 days and in-person follow-up evaluating clinical, bacteriologic, and HRQoL outcomes at 3-7 days and 4-6 weeks post-treatment.. An Enterobacteriaceae sp. was isolated in 139 (96.5%) patients (25.2% TMP/SMX-resistant). At 1-3 days post-treatment, clinical cure occurred in 56/81 (69.1%) and 14/31 (45.2%) of cases with susceptible and resistant strains, respectively (difference 23.9%; 95% confidence interval [CI], 1.5-46.4%). At 3-7 days post-treatment, bacteriologic cure occurred in 70/73 (95.9%) and 15/25 (60%) of cases with susceptible and resistant strains, respectively (difference 35.9%; 95% CI, 13.5-58.3%). Sustained clinical cure rates at 3-7 days and 4-6 weeks post-treatment were 65.4 and 56.8% with susceptible strains, and 45.2 and 45.2% with resistant strains, respectively. The HRQoL scale assessing role limitations due to physical health problems was lower in TMP/SMX-resistant versus TMP/SMX-susceptible infections, with twice as many hours of missed activities reported (mean, 18.4 vs. 9.1 h). Differences in HRQoL appeared to be largely related to differences in clinical cure rates.. Among women treated for acute uncomplicated cystitis with TMP/SMX, in vitro TMP/SMX resistance was associated with lower bacteriologic and clinical cure rates, and had greater impact on the time lost from daily activities compared to those with TMP/SMX-susceptible infections.

Topics: Adolescent; Adult; Anti-Infective Agents; Cystitis; Drug Resistance, Bacterial; Enterobacteriaceae; Enterobacteriaceae Infections; Female; Humans; Interviews as Topic; Phenazopyridine; Prospective Studies; Quality of Life; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Young Adult

Topics: Anti-Infective Agents, Urinary; Citrobacter; Color; Enterobacteriaceae Infections; Humans; Indoles; Infant; Male; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Tryptophan; Urine

The aim of this study was to describe the distribution of the trimethoprim-sulfamethoxazole resistance genes and their association with class 1 integrons in a collection of clinical isolates of Enterobacteriaceae recovered at the University Hospital Sahloul in Tunisia. A total of 80 isolates of Enterobacteriaceae were studied, including six different species. There were 35 extended-spectrum beta-lactamases (ESBL)-producing isolates. Resistance to trimethoprim-sulfamethoxazole was assessed by the disk diffusion method. Polymerase chain reaction (PCR) with primers specific for sul1, sul2, and sul3 was used to detect the three known sulphonamide resistance genes. The presence of class 1 integrons in the studied isolates was detected using PCR and the resistance gene cassettes were characterized by directly sequencing the PCR products obtained with 5'conserved segment (5'CS) and 3'conserved segment (3'CS) primers. The int1 gene was found in 68 out of 80 enterobacterial isolates. The sul1 gene was found in 22 isolates (27.5%), sul2 gene in 5 isolates (6.25%), and both genes in 49 isolates (61.25%). Eight of the studied isolates had no dfr alleles, and in the remaining 72 isolates, 7 dfr genes were identified. The most prevalent were dfrA7 (40%) and dfrA17 (33%). Class 1 integrons were found to be an important genetic element of resistance to trimethoprim-sulfamethoxazole among the clinical isolates of Enterobacteriaceae. The types, combinations, and frequency of the gene cassettes in integrons provide useful data for the surveillance of antimicrobial resistance in our hospital and for the prescription practice of cotrimoxazole.

Topics: Anti-Infective Agents; Bacterial Proteins; Carrier Proteins; DNA, Bacterial; Drug Resistance, Multiple, Bacterial; Enterobacteriaceae; Enterobacteriaceae Infections; Genes, Bacterial; Hospitals, University; Humans; Integrons; Microbial Sensitivity Tests; Polymerase Chain Reaction; Sequence Analysis, DNA; Trimethoprim, Sulfamethoxazole Drug Combination; Tunisia

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

In our study of nursing home residents with clinically suspected urinary tract infection who did not require the use of an indwelling catheter, we identified bacteria isolated from urine samples, the resistance patterns of these isolated bacteria, and the antibiotic therapy prescribed to the residents. Escherichia coli, the predominant organism isolated, frequently was resistant to commonly prescribed oral antibiotics. Trimethoprim-sulfamethoxazole remains the best empiric antimicrobial therapy for a urinary tract infection, but nitrofurantoin should be considered if E. coli is identified.

Topics: Aged, 80 and over; Anti-Bacterial Agents; Drug Resistance, Bacterial; Enterobacteriaceae; Enterobacteriaceae Infections; Escherichia coli; Escherichia coli Infections; Female; Homes for the Aged; Humans; Male; Microbial Sensitivity Tests; Nitrofurantoin; Nursing Homes; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Urine

Empiric treatment of community-acquired urinary tract infections (CA-UTI) is determined by the antibiotic sensitivity patterns of uropathogens in a population. This study was conducted to determine patterns of resistance amongst CA-uropathogens in India, to help establish local guidelines on treatment of CA-UTI.. 531 consecutive positive urine cultures taken from adult non-pregnant females attending outpatient clinics of five hospitals in Delhi, India, were analysed. Sensitivity testing was done for ciprofloxacin, trimethoprim-sulphamethoxazole (SXT), amoxicillin, amoxicillin-clavulanate, amikacin, nitrofurantoin, piperacillin-tazobactam and meropenem in each isolate.. E. coli comprised 68%; Klebsiella 16.9%; Proteus 5.5%; Enterobacter 5.3%; Staphylococcus saprophyticus 2.8%; and others 1.5% of the isolates. Furthermore, 26.9% of the gram negative isolates were ESBL producers. Antibiotic sensitivity of all the gram negative organisms showed that 35.8% were sensitive to ciprofloxacin; 30% to SXT; 17.7% to amoxicillin; 41.6% to amoxicillin/clavulanate; 75.6% to amikacin; 65.7% to nitrofurantoin; 90.2% to piperacillin-tazobactam; and 100% to meropenem.. High levels of ESBL producers among gram negative CA-uropathogens was seen in our country. This, along with the alarming rate of resistance to ciprofloxacin, SXT and amoxicillin, precludes the use of these commonly used antibiotics for empiric treatment of CA-UTI in India.

Topics: Adolescent; Adult; Aged; Ampicillin; Anti-Infective Agents, Urinary; Ciprofloxacin; Community-Acquired Infections; Drug Resistance, Multiple, Bacterial; Enterobacteriaceae; Enterobacteriaceae Infections; Female; Humans; India; Middle Aged; Nitrofurantoin; Retrospective Studies; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Emerging antimicrobial resistance among uropathogens makes the management of acute uncomplicated cystitis increasingly challenging. Few prospective data are available on the risk factors for resistance to trimethoprim-sulfamethoxazole (TMP-SMX), the drug of choice in most settings. In order to evaluate this, we prospectively enrolled women 18 to 50 years of age presenting to an urban primary care practice with symptoms of cystitis. Potentially eligible women provided a urine sample for culture and completed a questionnaire regarding putative risk factors for TMP-SMX resistance. Escherichia coli isolates were tested for clonal group A (CGA) membership by a fumC-specific PCR. Of 165 women with cystitis symptoms, 103 had a positive urine culture and were eligible for participation. E. coli was the predominant uropathogen (86%). Fifteen (14.6%) women had a TMP-SMX-resistant (TMP-SMX r) organism (all of which were E. coli). Compared with the women who had a TMP-SMX-susceptible organism, women in the TMP-SMX r group were more likely to have traveled (odds ratio [OR], 15.4; 95% confidence interval [CI], 4.4 to 54.3; P < 0.001) and to be Asian (OR, 6.1; 95% CI, 1.0 to 36.4; P = 0.048). CGA was also independently associated with TMP-SMX resistance (OR, 105; 95% CI, 6.3 to 1,777.6; P = 0.001). No association with TMP-SMX resistance was demonstrated for the use of either TMP-SMX or another antibiotic in the past 3 months or with having a child in day care. Among these women with acute uncomplicated cystitis, Asian race and recent travel were independently associated with TMP-SMX resistance. TMP-SMX r isolates were more likely to belong to CGA. Knowledge of these risk factors for TMP-SMX resistance could facilitate the accurate selection of empirical therapy.

Topics: Acute Disease; Adolescent; Adult; Anti-Infective Agents, Urinary; Cystitis; Drug Resistance, Bacterial; Enterobacteriaceae; Enterobacteriaceae Infections; Escherichia coli; Escherichia coli Infections; Female; Humans; Microbial Sensitivity Tests; Middle Aged; Risk Factors; Trimethoprim, Sulfamethoxazole Drug Combination; Urine

There is little information on nasopharyngeal (NP) flora or bacteremia in HIV-infected children. Our aim was to describe the organisms and antimicrobial resistance patterns in children enrolled in a prospective study comparing daily and three times weekly trimethoprim-sulfamethoxazole (TMP-SMX) and isoniazid (INH) or placebo prophylaxis.. NP swabs were taken at baseline from HIV-infected children enrolled in the study. Standard microbiological techniques were used. Children were grouped according to previous or current exposure to TMP-SMX and whether enrolled to the study during a period of hospitalization. Blood culture results were also recorded within 12 months of baseline.. Two hundred and three children, median age 1.8 (Interquartile [IQ]: 0.7-4) years had NP swabs submitted for culture. One hundred and eighty-four (90.7%) had either stage B or C HIV disease. One hundred and forty-one (69.8%) were receiving TMP-SMX and 19 (9.4%) were on antiretroviral therapy. The majority, 168 (82%) had a history of hospitalization and 91 (44.8%) were enrolled during a period of hospitalization. Thirty-two subjects (16.2%) died within 12 months of study entry. One hundred and eighty-one potential pathogens were found in 167 children. The most commonly isolated organisms were Streptococcus pneumoniae (48: 22.2%), Gram-negative respiratory organisms (Haemophilus influenzae and Moraxella catarrhalis) (47: 21.8%), Staphylococcus aureus (44: 20.4%), Enterobacteriaceae 32 (14.8%) and Pseudomonas 5 (2.3%). Resistance to TMP-SMX occurred in > 80% of pathogens except for M. catarrhalis (2: 18.2% of tested organisms). TMP-SMX resistance tended to be higher in those receiving it at baseline (p = 0.065). Carriage of Methicillin resistant S. aureus (MRSA) was significantly associated with being on TMP-SMX at baseline (p = 0.002). Minimal inhibitory concentrations (MIC) to penicillin were determined for 18 S. pneumoniae isolates: 7 (38.9%) were fully sensitive (MIC or=2 microg/ml). Fifty percent of Enterobacteriaceae produced extended spectrum beta-lactamases (ESBL) (resistant to third generation cephalosporins) and 56% were resistant to gentamicin. Seventy-seven percent of S. aureus were MRSA. Carriage of resistant organisms was not associated with hospitalization.On multivariate logistic regression, risk factors for colonization with Enterobacteriaceae were age

Topics: Anti-Infective Agents; Bacteremia; beta-Lactam Resistance; beta-Lactamases; Carrier State; Child; Child, Preschool; Drug Resistance, Bacterial; Enterobacteriaceae; Enterobacteriaceae Infections; Female; HIV Infections; Humans; Incidence; Infant; Isoniazid; Logistic Models; Male; Methicillin Resistance; Nasopharynx; Prospective Studies; Risk Factors; South Africa; Staphylococcal Infections; Staphylococcus aureus; Trimethoprim, Sulfamethoxazole Drug Combination

To identify predictors of in-hospital mortality among patients with bacteremia caused by Enterobacter cloacae, Enterobacter aerogenes, or Citrobacter freundii.. Retrospective cohort study.. 1300-bed tertiary academic medical center.. One hundred twenty-four patients who had bloodstream infections caused by E. cloacae (3), E. aerogenes (71), or C. freundii (50) between 1998 and 2004.. Data from patients with bloodstream infections caused by Enterobacter sp or C. freundii were retrospectively segregated according to hospital survival (98 survivors, 26 nonsurvivors). Multiple patient characteristics and processes of care were evaluated to identify factors contributing to in-hospital mortality. Multiple logistic regression was performed based on univariate comparisons to determine independent risk factors for in-hospital mortality. Among the 124 cases of bacteremia, the crude in-hospital mortality rate was 21% (26 cases). Univariate analysis revealed that survivors were more likely to receive an aminoglycoside as part of their empiric antimicrobial regimen (40% [39/98]) compared with nonsurvivors (19% [5/26], p=0.05). Other factors related to antimicrobial therapy including choice and number of agents used did not differ between survivors and nonsurvivors (p>0.05). Vasopressor use (31% [30/98] vs 62% [16/26]), care in an intensive care unit (19% [19/98] vs 54% [14/26]), and acute renal failure (13% [13/98] vs 31% [8/26]) occurred more frequently in nonsurvivors (p<0.05). Multiple logistic regression identified resistance to second- or third-generation cephalosporins (adjusted odds ratio [OR] 5.16, 95% confidence interval [CI] 2.66-10.0, p=0.013), trimethoprim-sulfamethoxazole resistance (adjusted OR 5.44, 95% CI 2.53-11.7, p=0.027), and mechanical ventilation (adjusted OR 12.2, 95% CI 5.99-24.5, p<0.001) as independent determinants of mortality.. Among patients with Enterobacter sp or C. freundii bloodstream infections, those with trimethoprim-sulfamethoxazole-resistant or second or third-generation cephalosporin-resistant strains or those who required mechanical ventilation had an increased risk of mortality.

Topics: Aged; Bacteremia; Cephalosporins; Citrobacter freundii; Cohort Studies; Drug Resistance; Enterobacter; Enterobacteriaceae Infections; Female; Hospital Mortality; Humans; Male; Middle Aged; Predictive Value of Tests; Respiration, Artificial; Retrospective Studies; Statistics as Topic; Trimethoprim, Sulfamethoxazole Drug Combination

The ancient method of larval therapy for treatment of acute and chronic infections has become a revival and a new dimension with introduction of the Biobag (Vitapad). With use of this therapy trauma patients suffering infectious complications can be treated very effective, which can reduce the overall time needed for treatment and can result in diminished invalidity.

Topics: Animals; Athletic Injuries; Bone Plates; Debridement; Device Removal; Enterobacter cloacae; Enterobacteriaceae Infections; Floxacillin; Fracture Fixation, Internal; Humans; Larva; Male; Middle Aged; Osteomyelitis; Staphylococcal Infections; Surgical Wound Infection; Tibial Fractures; Trimethoprim, Sulfamethoxazole Drug Combination; Wound Healing

Integrons in gentamicin- and cotrimoxazole-resistant Enterobacteriaceae from dogs and horses with clinical infections were analyzed by conserved segment PCR-RFLP. Five distinct integron types were found, most of which have previously been reported in Enterobacteriaceae isolated from humans and farm animals, indicating that resistance genes are exchanged between the reservoirs in humans, farm animals, and companion animals.

Topics: Amino Acid Sequence; Animals; Anti-Bacterial Agents; Dog Diseases; Dogs; Drug Resistance, Multiple, Bacterial; Enterobacteriaceae; Enterobacteriaceae Infections; Gentamicins; Horse Diseases; Horses; Integrons; Microbial Sensitivity Tests; Netherlands; Phenotype; Polymerase Chain Reaction; Trimethoprim, Sulfamethoxazole Drug Combination

The management of urinary tract infection in children faces the problem of the emergence of resistant strains to antibiotics. The aim of this study is to precise the frequency of the different germs and their susceptibility to antibiotics.. We report a retrospective study concerning 200 cases of urinary tract infection hospitalised in the paediatric department of Monastir between January 1995 and December 2000. There were 58 boys and 142 girls aged between two months and 14 years with a mean age of 5 years. The frequency of urinary tract infection is 1.85%.. The most common causative agent is Escherichia coli in 75.5% of cases, followed by Proteus mirabilis (10%) then by Klebsiella pneumoniae (6%). Escherichia coli is predominant in girls, whereas Proteus mirabilis and Klebsiella pneumoniae are likely encountred in boys. Of all the strains, 96% are resistant to ampicillin, amoxicillin and cefalotin, 67% to amoxicillin + clavulanic acid and 34% to cotrimoxazole. A resistance to ampicillin, amoxicillin and cefalotin is noted in 96% of the germs. The resistance is of 67% for amoxicillin + clavulanic-acid and of 34% for cotrimoxazole. However, third generation cephalosporins and aminoglycosides remain usually active on the majority of strains incriminated in these infections a part from Pseudomonas.

Topics: Adolescent; Age Factors; Aminoglycosides; Amoxicillin; Ampicillin; Ampicillin Resistance; Anti-Bacterial Agents; Anti-Infective Agents, Urinary; Bacteria; Cephalosporin Resistance; Cephalosporins; Cephalothin; Child; Child, Preschool; Clavulanic Acid; Drug Resistance, Bacterial; Enterobacteriaceae Infections; Escherichia coli; Female; Humans; Infant; Klebsiella pneumoniae; Male; Penicillin Resistance; Proteus mirabilis; Retrospective Studies; Sex Factors; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Mycoplasma contamination of the licensed anthrax vaccine administered to military personnel has been suggested as a possible cause of Persian Gulf illness. Vaccine samples tested by nonmilitary laboratories were negative for viable mycoplasma and mycoplasma DNA and did not support its survival. Mycoplasma contamination of anthrax vaccine should not be considered a possible cause of illness.

Topics: Adult; Anti-Bacterial Agents; Child; Diarrhea; Dysentery, Bacillary; Enterobacteriaceae; Enterobacteriaceae Infections; Feces; Female; HIV Infections; Humans; Male; Microbial Sensitivity Tests; Prevalence; Salmonella Infections; Sepsis; Trimethoprim, Sulfamethoxazole Drug Combination; Zambia

In the United States, trimethoprim-sulphamethoxazole (TMP-SMX) is the recommended first-line treatment for uncomplicated urinary tract infections (UTIs) in females, in regions with resistance rates of <10-20%. Unfortunately, current data on regional resistance is often not readily available to physicians and regional variability in resistance remains largely unknown. This report presents antimicrobial susceptibility data for TMP-SMX and three other commonly tested antimicrobials organized by state and region to demonstrate current regional variability in resistance in the US. In the last quarter of 1999, 5739 fresh clinical isolates of Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis and Staphylococcus saprophyticus were collected from 202 laboratories throughout the US. Susceptibility testing was performed against TMP-SMX, cephalothin, nitrofurantoin and ciprofloxacin using broth microdilution. Data were analyzed by patient age and specimen source, and by state and region. In the US as a whole, resistance to TMP-SMX was 16.8% for E. coli, 7.8% for K. pneumoniae, 12.1% for P. mirabilis and 3.0% for S. saprophyticus, but these rates showed considerable regional variation. By state, E. coli resistance ranged from 7.4% in Pennsylvania to 33.3% in Iowa (among states with > or =50 isolates tested). Regionally, resistance for all uropathogens taken together ranged from 8.5% in East South-Central to 22.8% in West South-Central. Ciprofloxacin demonstrated the broadest activity of the antimicrobials tested and was more active than TMP-SMX against all pathogens. Resistance to TMP-SMX among E. coli now approaches or exceeds 20% in some areas. As resistance among uropathogens reaches clinically significant levels in many areas, continued regional surveillance is essential to ensure the provision of effective empiric therapy for urinary tract infections.

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Drug Resistance, Bacterial; Enterobacteriaceae; Enterobacteriaceae Infections; Female; Humans; Microbial Sensitivity Tests; Middle Aged; Prevalence; Staphylococcal Infections; Staphylococcus; Trimethoprim, Sulfamethoxazole Drug Combination; United States; Urinary Tract Infections

This prospective study, performed in Fann University Teaching Hospital from January 1st to December 31st 1998, concern 1446 samples of urine. Enterobacteria (87.56%) were the most frequent aetiology, and Escherichia coli (48.7%) was the leading species in this family. The strains of E. coli present more resistant profil to beta-lactams (70.27%). Fluoroquinolons are active on more than 80% of the strains responsible of urinary tract infection in Dakar.

Topics: Anti-Infective Agents, Urinary; beta-Lactam Resistance; DNA, Bacterial; Drug Resistance, Bacterial; Enterobacteriaceae Infections; Female; Fluoroquinolones; Hospitals, University; Humans; Klebsiella Infections; Male; Microbial Sensitivity Tests; Nitroquinolines; Phenotype; Population Surveillance; Prevalence; Prospective Studies; Senegal; Sex Distribution; Trimethoprim, Sulfamethoxazole Drug Combination; Urban Health; Urinary Tract Infections

Topics: Anti-Bacterial Agents; Ciprofloxacin; Discitis; Drug Therapy, Combination; Enterobacter aerogenes; Enterobacteriaceae Infections; Humans; Male; Middle Aged; Trimethoprim, Sulfamethoxazole Drug Combination

Trimethoprim-sulfamethoxazole (TMP-SMX) is widely used for Pneumocystis carinii pneumonia prophylaxis in human immunodeficiency virus (HIV)-infected patients, but little is known about the effects of this practice on the emergence of TMP-SMX-resistant bacteria. A serial cross-sectional study of resistance to TMP-SMX among all clinical isolates of Staphylococcus aureus and 7 genera of Enterobacteriaceae was performed at San Francisco General Hospital. Resistance among all isolates was <5.5% from 1979 to 1986 but then markedly increased, reaching 20.4% in 1995. This was most prominent in HIV-infected patients: resistance increased from 6.3% in 1988 to 53% in 1995. The largest increases in resistance were in Escherichia coli (24% in 1988 to 74% in 1995) and S. aureus (0% to 48%) obtained from HIV-infected patients. A rapid increase in the use of prophylactic TMP-SMX in HIV disease was also observed during this time in San Francisco and is likely responsible for the increase in TMP-SMX resistance.

Topics: Adult; Anti-Bacterial Agents; Anti-Infective Agents; Child; Cross-Sectional Studies; Drug Resistance, Microbial; Enterobacteriaceae; Enterobacteriaceae Infections; HIV Infections; Humans; Microbial Sensitivity Tests; Pneumonia, Pneumocystis; Staphylococcal Infections; Staphylococcus aureus; Trimethoprim, Sulfamethoxazole Drug Combination

A large majority of urinary tract infections are caused by coliform organisms. Trimethoprim-sulfamethoxazole (TMP-SMX) resistance among uropathogens is increasing in many areas. The objective of this study was to determine risk factors for TMP-SMX-resistant coliforms in patients with urinary tract infections.. Retrospective case-control study.. Emergency department of a tertiary care university hospital.. We studied 448 emergency department patients aged 14 years or older with a urinary tract infection caused by a coliform organism. Cases consisted of all patients with a culture-documented urinary tract infection caused by a TMP-SMX-resistant coliform, while control patients were those with a TMP-SMX-sensitive organism.. A univariate analysis of clinical variables associated with TMP-SMX resistance was performed. Multiple logistic regression was performed to determine independent predictors of TMP-SMX resistance. Resistance to TMP-SMX was seen in 15% of isolates. Numerous variables were associated with TMP-SMX resistance on the univariate screen. Independent predictors of resistance were diabetes (odds ratio [OR] 3.1; 95% confidence interval [CI] 1.2, 8.4), recent hospitalization (OR 2.5; 95% CI 1.1, 5.7), current use of antibiotics (OR 4.5; 95% CI 2.0, 10.2), and recent use of TMP-SMX (OR 5.1; 95% CI 2.2, 11.5). When those with recent hospitalization were excluded from analysis, independent predictors were current use of any antibiotic (OR 3.5; 95% CI 1.4, 8. 4) and recent use of TMP-SMX (OR 5.9; 95% CI 2.4, 14.3).. Coliforms resistant to TMP-SMX are common in our emergency department. Diabetes, recent hospitalization, and the use of antibiotics, particularly the use of TMP-SMX, are independent risk factors for TMP-SMX resistance. Clinicians should consider these findings when deciding on antimicrobial therapy for patients with urinary tract infections.

Topics: Adult; Anti-Infective Agents, Urinary; Case-Control Studies; Enterobacteriaceae; Enterobacteriaceae Infections; Female; Humans; Male; Retrospective Studies; Risk Factors; Trimethoprim Resistance; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Anti-Infective Agents, Urinary; Drug Resistance, Microbial; Enterobacteriaceae; Enterobacteriaceae Infections; Humans; Trimethoprim Resistance; Trimethoprim, Sulfamethoxazole Drug Combination

Trimethoprim-sulfamethoxazole (TMP-SMX) is a widely administered antibiotic that is well tolerated by most patients. Hypersensitivity reactions and gastrointestinal intolerance are the most common adverse events associated with it. Central nervous system adverse effects such as tremors are less common and occur primarily in patients with acquired immune deficiency syndrome. A 29-year-old immunocompetent man developed a tremor while taking TMP-SMX. The tremor resolved within 2 days after the drug was discontinued.

Topics: Adult; Anti-Infective Agents; Enterobacteriaceae Infections; Humans; Immunocompetence; Male; Postoperative Complications; Tremor; Trimethoprim, Sulfamethoxazole Drug Combination

An unusual case of acute cellulitis of the foot in a child is reported. The child failed to respond to standard treatment even after removal of an occult foreign body. Wound cultures revealed Klebsiella oxytoca and Citrobacter freundii. This is the first documented report on Klebsiella oxytoca in cellulitis. The cellulitis resolved after being treated with the appropriate antibiotics.

Topics: Cellulitis; Child; Citrobacter freundii; Enterobacteriaceae Infections; Female; Follow-Up Studies; Foot Injuries; Foreign Bodies; Humans; Klebsiella; Klebsiella Infections; Trimethoprim, Sulfamethoxazole Drug Combination; Wound Healing; Wound Infection; Wounds, Penetrating

Enterobacter meningitis is an uncommon form of meningitis whose treatment poses a therapeutic dilemma because of the development of resistance to the third-generation cephalosporins while the patient receives therapy. In recent years, we have been using trimethoprim-sulfamethoxazole (TMP-SMZ) as treatment for this infection. In this report, we reviewed 13 episodes of enterobacter meningitis that were treated with various antibiotic regimens and 33 episodes from the literature. We found that the development of resistance to beta-lactam agents may be much higher than that seen in bacteremias (approximately 30%), that the case-fatality rate is lower among our patients than among those described previously, and that all patients who received TMP-SMZ were cured, compared with about 70% of those receiving beta-lactam agents. TMP-SMZ appears to be an acceptable alternative to the cephalosporins for the treatment of enterobacter meningitis.

Topics: 4-Quinolones; Adult; Aged; Aminoglycosides; Anti-Bacterial Agents; Anti-Infective Agents; Cephalosporins; Child; Drug Resistance, Microbial; Enterobacter; Enterobacteriaceae Infections; Female; Follow-Up Studies; Humans; Male; Meningitis, Bacterial; Middle Aged; Retrospective Studies; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Acute Disease; Child; Child, Preschool; Enterobacteriaceae; Enterobacteriaceae Infections; Feces; Gastroenteritis; Humans; Male; Trimethoprim, Sulfamethoxazole Drug Combination

The case is reported of a patient who developed a vertebral osteomyelitis caused by Enterobacter cloacae. The organism was isolated in cultures of blood and vertebral puncture biopsy samples. The patient was satisfactorily treated with trimethroprim and sulphamethoxazole. Enterobacter cloacae, a Gram negative organism, has been confirmed as the cause of bacteremia in patients with burns, urinary infections, in adults with pneumonia, and in children with joint infections. Spondylodiscitis caused by Enterobacter cloacae has not previously been described.

Topics: Aged; Discitis; Enterobacter cloacae; Enterobacteriaceae Infections; Female; Humans; Radiography; Thoracic Vertebrae; Trimethoprim, Sulfamethoxazole Drug Combination

Fleroxacin and cefetamet were evaluated in vitro against 38 infrequently encountered species (250 strains) of the family Enterobacteriaceae and compared with four established compounds. For all the strains tested, the fleroxacin MIC was less than or equal to 0.5 mg/liter, and for 98% of strains the cefetamet MIC was less than or equal to 8 mg/liter; even though the two new compounds did not quite reach the activities (on a weight-by-weight basis) of ciprofloxacin and ceftriaxone, respectively, they nonetheless clearly surpassed trimethoprim-sulfamethaxazole and amoxicillin-clavulanic acid. The very potent new oral compounds tested in this study appear to be promising for the treatment of clinically relevant infections due to uncommon species of Enterobacteriaceae.

Topics: Amoxicillin; Anti-Bacterial Agents; Ceftizoxime; Ceftriaxone; Ciprofloxacin; Clavulanic Acid; Clavulanic Acids; Enterobacteriaceae; Enterobacteriaceae Infections; Fleroxacin; Humans; Microbial Sensitivity Tests; Trimethoprim, Sulfamethoxazole Drug Combination

Sulfonamide (Su) and trimethoprim (Tp) resistance are known to caused by the production of drug resistant dihydropteroate synthase (DHPS) and dihydrofolate reductase (DHFR), respectively. Sulfonamide and trimethoprim are often used in combination under the name cotrimoxazole. Cotrimoxazole resistance in various enteric bacteria isolated at Ramathibodi Hospital was studied. The rate of resistance from 1984-1989 of many genera was rather constant at 40%-60% except in Shigella spp in which the rate increased rapidly in 1987 till 1989. Seventy-five percent of Su-Tp resistant (Sur-Tpr) bacteria were also found to be resistant to other drugs such as ampicillin, aminoglycosides, tetracycline and chloramphenicol in addition to cotrimoxazole. Two hundred and forty Su-Tp resistant strains were analysed for the presence of type I and II dihydropteroate synthase as well as type I and V dihydrofolate reductase genes by hybridization with the corresponding gene probes. Type I DHPS gene predominated in Su-Tp resistant bacteria at 60.8% whereas type II DHPS was found in only 25%. Some strains (11.7%) had both genotypes but 2.5% did not have any. In the trimethoprim resistance study, the DHFR type I gene was also found more frequently (30%) whereas type V DHFR was only 19%. The remaining of Tp resistance (51%) was unclassified. The coexistence of Su and Tp resistance genes of each type was investigated among 118 Su and Tp resistant strains. It was found that type I DHPS gene was found together with either type I or V DHFR gene and type II DHPS was found with type I DHFR gene at about the same rate (28.9%, 27.1% and 26.3%, respectively). However, the presence of type II DHPS together with type V DHFR was rather low, only 5.9% of isolates were found to have both types of genes.

Topics: Dihydropteroate Synthase; DNA Probes; Drug Resistance, Microbial; Enterobacteriaceae; Enterobacteriaceae Infections; Humans; Microbial Sensitivity Tests; Plasmids; Tetrahydrofolate Dehydrogenase; Thailand; Trimethoprim Resistance; 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

Topics: Drug Combinations; Drug Resistance, Microbial; Enterobacteriaceae; Enterobacteriaceae Infections; Humans; Jamaica; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

The incidence of trimethoprim resistance was correlated with changes in prescription behaviour in the Nottingham area from 1978-1985. The prevalence of trimethoprim resistance among Enterobacteriaceae isolated from patients with urinary tract infection rose from 5% to 15% of total strains examined. Strains resistant to trimethoprim but susceptible to sulfamethoxazole appeared from 1980 onward and represented 35% of the total trimethoprim-resistant strains examined in 1985. Co-trimoxazole (trimethoprim + sulfamethoxazole) has been generally available for prescription in the United Kingdom since 1969, whereas trimethoprim alone was released in October 1979. By 1983, prescriptions in the form of trimethoprim alone accounted for approximately 50% (in hospitals) and 15% (in the community) of total trimethoprim usage in the Nottingham area. Although the introduction of trimethoprim alone seems to have had only a minor effect on overall resistance levels, it has greatly increased the proportion of trimethoprim-resistant strains which are susceptible to sulfamethoxazole. This was particularly evident in strains of Proteus spp., in which 52% of the total trimethoprim-resistant strains were sulfamethoxazole-susceptible in 1985.

Topics: Drug Combinations; Drug Resistance, Microbial; England; Enterobacteriaceae; Enterobacteriaceae Infections; Humans; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Adult; Drug Combinations; Enterobacteriaceae Infections; Homosexuality; Humans; Male; Penile Diseases; Sexually Transmitted Diseases; Shigella flexneri; Skin Diseases, Infectious; 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

In the course of a study to determine the nature and type of secondary bacterial infection in dracunculiasis. The most common organisms cultured from lesions were Escherichia coli, Enterobacter and Staphylococcus aureus. E. coli and Enterobacter which were found to carry high morbidity were sensitive to Gentamycin, Claforan and Septrin.

Topics: Cefotaxime; Dracunculiasis; Drug Combinations; Enterobacter; Enterobacteriaceae Infections; Escherichia coli; Escherichia coli Infections; Female; Gentamicins; Humans; Skin Diseases, Infectious; Skin Ulcer; Staphylococcal Skin Infections; Staphylococcus aureus; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

We explored the antibacterial activity of phosphanilic acid (P), an analog of sulfanilic acid, alone and in combination with trimethoprim (T; TP, 1:5) with sulfamethoxazole (S) and co-trimoxazole, the combination of this sulfonamide with trimethoprim (TS, 1:5) as the reference. P resembled S in spectrum but, in addition, had significant activity against Pseudomonas aeruginosa. The overall frequency and degree of synergism with TP were lower than with co-trimoxazole. P, like S, was strongly affected by changes in inoculum size and was not bactericidal. P was well absorbed parenterally but not orally in mice. Despite low (but prolonged) blood levels, P, given orally to mice, was effective in treating infections caused by P. aeruginosa. However, against most experimental infections the therapeutic effectiveness of P, as well as that of TP, administered either intramuscularly or orally was unimpressive. Based on in vivo data, the therapeutic application of P or TP would appear to be limited.

Topics: 4-Aminobenzoic Acid; Administration, Oral; Aniline Compounds; Animals; Anti-Infective Agents; Bacterial Infections; Drug Combinations; Drug Evaluation, Preclinical; Enterobacteriaceae Infections; Injections, Intramuscular; Male; Mice; Microbial Sensitivity Tests; Pseudomonas Infections; Staphylococcal Infections; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

The bacterial flora in the urine samples of 15 nursing home patients with long-term, indwelling catheters were examined monthly for one year. There was a rapidly changing polymicrobial flora averaging 2.0 changes per month in species with colony counts greater than 100,000/mL, and 3.2 changes per month when changes in species, biogram, and quantity of bacteria were considered. The flora changed significantly more frequently, and cultures of Pseudomonas aeruginosa, Providencia stuartii, and Citrobacter diversus were significantly more frequent in those receiving sulfamethoxazole and trimethoprim prophylaxis than in those who did not. There was no difference in incidence of urinary tract infection (UTI) between those patients who received sulfamethoxazole and trimethoprim prophylaxis and those who did not. Ampicillin or gentamicin was effective against 99% of species cultured that are of established UTI pathogenicity. Owing to the rapidity of bacterial flora changes, routine monthly cultures are of little predictive value in patients with indwelling catheters. This study does not support the efficacy of sulfamethoxazole and trimethoprim prophylaxis in such patients.

Topics: Adult; Aged; Anti-Infective Agents, Urinary; Bacteriuria; Catheters, Indwelling; Citrobacter; Drug Combinations; Enterobacteriaceae Infections; Female; Humans; Male; Middle Aged; Nursing Homes; Prospective Studies; Providencia; Streptococcal Infections; Sulfamethoxazole; Time Factors; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Catheterization

Topics: Drug Combinations; Enterobacteriaceae Infections; Female; Humans; Kidney Diseases, Cystic; Middle Aged; Suction; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Drug Combinations; Enterobacteriaceae Infections; Gram-Negative Bacteria; Humans; Male; Meningitis; Middle Aged; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Aged; Amoxicillin; Cystitis; Drug Combinations; Enterobacteriaceae Infections; Female; Humans; Injections, Intramuscular; Kanamycin; Middle Aged; Nitrofurantoin; Recurrence; Staphylococcal Infections; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urethritis

A better understanding of the pathophysiology of urinary infection has markedly altered treatment programs. Single-dose therapy should be used for infections limited to the bladder. In contrast, treatment periods of 4-6 wk are needed to yield the best cure rates in upper tract infections. TMP/SMX thrice weekly has proved to be a successful prophylactic program for women with recurrent urinary infection. In contrast to the female, young children and men require longer therapy periods for urinary infection and should always have a detailed radiologic and urologic evaluation to eliminate the possibility of structural abnormalities.

Topics: Adolescent; Adult; Age Factors; Aged; Anti-Bacterial Agents; Bacteriuria; Child; Child, Preschool; Drug Combinations; Drug Therapy, Combination; Enterobacteriaceae Infections; Female; Humans; Infant; Infant, Newborn; Male; Middle Aged; Sex Factors; Staphylococcal Infections; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Acute Disease; Adult; Bacteriuria; Diagnosis, Differential; Drug Combinations; Enterobacteriaceae Infections; Humans; Lymphogranuloma Venereum; Male; Nitrofurantoin; Pain; Pain Management; Prostatectomy; Prostatic Diseases; Prostatitis; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

There are increasing reports of citrobacter central nervous system infections in neonates. These organisms cause brain abcesses in a high percentage of patients. They may be resistant to commonly used antibiotics. We report a term male infant with underlying meningo-myelocoele and hydrocephalus in whom Citrobacter diversus meningitis and ventriculitis developed. Initial antibiotic therapy including intraventricular amikacin failed to sterilize the ventricles or alter a deteriorating clinical course. Adding intravenous trimethoprim-sulfamethoxazole to the therapeutic regimen resulted in reversal of a progressively worsening condition and eventual recovery. Trimethoprim-sulfamethoxazole should be considered as a potentially useful alternative antibiotic for susceptible central nervous system infections.

Topics: Amikacin; Cerebral Ventricles; Citrobacter; Drug Combinations; Encephalitis; Enterobacteriaceae Infections; Humans; Infant, Newborn; Infant, Newborn, Diseases; Male; Meningitis; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

We first noted the appearance of thymidine-requiring, gram-negative bacilli in clinical specimens 2 years ago. Since then we have seen 10 patients colonized or infected with these organisms. These strains do not grow on Mueller-Hinton media, growth on MacConkey agar is variable, and growth in API 20E (Analytab Products) and Enterobacteriaceae-Plus Cards (AutoMicrobic system; Vitek Systems Inc.) is inadequate for reliable identifications. Thymidine-requiring organisms are routinely resistant to sulfonamides and trimethoprim. Infection or colonization is associated with previous sulfamethoxazole-trimethoprim therapy in most cases. Of 10 patients, 1 had septicemia of urinary tract origin, 5 had urinary tract colonization or infection, 2 had wound colonization, and two had colonization of respiratory secretions. Thymidine-requiring, gram-negative bacilli can be pathogens and present potential problems in diagnosis, identification, and susceptibility testing.

Topics: Adult; Aged; Drug Combinations; Drug Resistance, Microbial; Enterobacteriaceae; Enterobacteriaceae Infections; Female; Humans; Male; Middle Aged; Sulfamethoxazole; Thymidine; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Acute prostatitis usually is caused by aerobic gram-negative organisms or, to a lesser extent, the enterococci. The treatment of acute prostatitis requires the use of an antimicrobial with the appropriate spectrum for ten to fourteen days. However, treatment of chronic prostatitis is a more difficult therapeutic problem because of the relative impermeability of the noninflamed prostate to the majority of antimicrobial agents. The organisms most commonly responsible for chronic prostatitis include the aerobic gram-negative organisms, as well as chlamydia. Chlamydia may be the sole pathogens, or may be found as a copathogen with gram-negative organisms. Relatively few antibiotics have the appropriate physiochemical characteristics to penetrate the subacutely inflamed prostate. The most important determinant of tissue penetration in chronic prostatitis is the lipid solubility of the antibiotic, to a lesser extent its pKa (ionization potential), and the molecular size of the antibiotic. In general, penicillins, cephalosporins, and aminoglycosides do not penetrate well into the chronically inflammed prostate tissue. At the present time, the preferred agents in treating chronic prostatitis are trimethoprim or doxycycline. Doxycycline has the advantage of being active against chlamydia as well as the usual organisms that are responsible for chronic prostatitis. Therapy should be continued for two to three months.

Topics: Anti-Bacterial Agents; Anti-Infective Agents, Urinary; Cephalosporins; Chlamydia Infections; Drug Combinations; Enterobacteriaceae Infections; Erythromycin; Humans; Hydrogen-Ion Concentration; Leucomycins; Male; Penicillins; Prostatitis; Sulfamethoxazole; Tetracyclines; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

It is impossible to test accurately bacterial susceptibility to the trimethoprim-sulfamethoxazole combination co-trimoxazole with a single combined susceptibility disk. However, a variety of factors still affect the result even when separate trimethoprim and sulfamethoxazole disks are used. Experiments with separate disks showed that the optimum conditions for testing the susceptibilities of enterobacteria to these drugs were to flood-seed an agar plate with an inoculum of 10(4) to 10(5) organisms per ml, take off the excess liquid, and place a disk of 1 microgram of trimethoprim and another of 50 micrograms of sulfamethoxazole on the surface of the agar with their centers exactly 25 mm apart. This method not only allowed the determination of resistance but also distinguished synergy.

Topics: Drug Combinations; Drug Resistance, Microbial; Enterobacteriaceae; Enterobacteriaceae Infections; Escherichia coli; Humans; Microbial Sensitivity Tests; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination