trimethoprim--sulfamethoxazole-drug-combination and Hepatitis-C

To ensure the safety of high-dose chemotherapy and autologous stem cell transplantation (HDC/ASCT), evidence-based recommendations on infectious complications after HDC/ASCT are given. This guideline not only focuses on patients with haematological malignancies but also addresses the specifics of HDC/ASCT patients with solid tumours or autoimmune disorders. In addition to HBV and HCV, HEV screening is nowadays mandatory prior to ASCT. For patients with HBs antigen and/or anti-HBc antibody positivity, HBV nucleic acid testing is strongly recommended for 6 months after HDC/ASCT or for the duration of a respective maintenance therapy. Prevention of VZV reactivation by vaccination is strongly recommended. Cotrimoxazole for the prevention of Pneumocystis jirovecii is supported. Invasive fungal diseases are less frequent after HDC/ASCT, therefore, primary systemic antifungal prophylaxis is not recommended. Data do not support a benefit of protective room ventilation e.g. HEPA filtration. Thus, AGIHO only supports this technique with marginal strength. Fluoroquinolone prophylaxis is recommended to prevent bacterial infections, although a survival advantage has not been demonstrated.

Topics: Germany; Hematologic Neoplasms; Hematology; Hematopoietic Stem Cell Transplantation; Hepacivirus; Hepatitis B; Hepatitis B Antibodies; Hepatitis B virus; Hepatitis C; Humans; Medical Oncology; Pneumocystis carinii; Pneumonia, Pneumocystis; Practice Guidelines as Topic; RNA, Viral; Societies, Medical; Transplantation, Autologous; Trimethoprim, Sulfamethoxazole Drug Combination

Large cardiac vegetation carries a poor prognosis and high mortality risk, especially if associated with methicillin-resistant Staphylococcus aureus (MRSA) infection. We share our experience of a rare and complicated large cardiac vegetation which had a favourable outcome with combination antibiotic treatment alone. A 35-year-old HIV-negative, HCV-positive male patient with a previous history of methicillin-susceptible S. aureus endocarditis showed MRSA mitral valve endocarditis with large vegetation, complicated by embolic stroke. The strain was soon identified by PCR but only after culture did the patient receive efficacious antibiotics. A combination of daptomycin plus trimethoprim/sulfamethoxazole (TMP/SMX) was administered for six weeks, followed by a high dosage of TMP/SMX for a further six weeks. Effectiveness of the treatment was demonstrated by the patient's clinical improvement and instrumental evidence of cardiac mitral vegetation clearance. Innovative antibiotic strategies in patient management are needed to fight Staphylococcus aureus endocarditis because strains show varying antimicrobial susceptibility patterns in different geographic areas. Timely initiation of targeted antimicrobial therapy remains a crucial step to reduce morbidity and mortality but culture is crucial for appropriate fine-tuning of antibiotic therapy.

Topics: Adult; Anti-Bacterial Agents; Daptomycin; Drug Therapy, Combination; Endocarditis, Bacterial; Hepatitis C; Humans; Male; Methicillin-Resistant Staphylococcus aureus; Staphylococcal Infections; Stroke; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Infections are associated with secondary forms of vasculitis. However, there is increasing evidence that microbial agents play a role also in primary systemic vasculitides. For a long time it has been noted that Hepatitis B virus (HBV) is involved in polyarteritis nodosa (PAN) although the incidence of HBV-associated PAN seems to decline. Cryoglobulinemic vasculitis has been shown to be strongly associated with Hepatitis C Virus (HCV) infection, but this is most striking in Southern Europe and less in Northern Europe. Different microbial agents have been suggested to influence disease expression in other primary vasculitides but no specific association has been established. In Wegener's Granulomatosis (WG) chronic carriage of Staphylococcus aureus (S. aureus) is associated with a strongly increased risk for relapsing disease. Various pathogenic pathways for this association have been suggested by clinical and experimental observations. Recent studies even suggest that S. aureus derived peptides, amongst others, may induce proteinase 3-ANCA via idiotypic-anti-idiotypic interactions. Treatment with co-trimoxazole in WG localized to the upper airways may result in (temporary) remission of the disease.

Topics: Anti-Infective Agents; Antibodies, Antineutrophil Cytoplasmic; Antigens, Bacterial; Arthritis; Cryoglobulinemia; Europe; Granulomatosis with Polyangiitis; Hepatitis B; Hepatitis B virus; Hepatitis C; Humans; Staphylococcal Infections; Staphylococcus aureus; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adult; Anti-Infective Agents; Azathioprine; Contraindications; Creatinine; Dose-Response Relationship, Drug; Drug Resistance; Female; Follow-Up Studies; Ganciclovir; Graft Rejection; Graft Survival; Hepatitis B; Hepatitis C; Humans; Immunosuppressive Agents; Kidney Transplantation; Male; Muromonab-CD3; Steroids; Tacrolimus; Time Factors; Trimethoprim, Sulfamethoxazole Drug Combination

We present a 43-year-old man with a history of intravenous drug abuse who presented to the emergency department with a 5-week history of lower urinary tract symptoms. On digital rectal examination, a firm prostate with exquisite tenderness was noted. Computed tomography scan of the pelvis with contrast demonstrated a 4.4 by 2.7-cm prostatic abscess in the right lobe. Suppurative fluid was expressed from the right prostatic lobe during transurethral resection of the prostate. Cultures of blood and suppurative prostatic fluid grew methicillin-resistant Staphylococcus aureus.

Topics: Abscess; Adult; Bacteremia; Ciprofloxacin; Combined Modality Therapy; Community-Acquired Infections; Disease Susceptibility; Doxycycline; Drug Resistance, Multiple, Bacterial; Drug Therapy, Combination; Hepatitis C; Humans; Male; Methicillin Resistance; Nafcillin; Orchitis; Prostatitis; Recurrence; Staphylococcal Infections; Staphylococcus aureus; Substance Abuse, Intravenous; Suppuration; Transurethral Resection of Prostate; Trimethoprim, Sulfamethoxazole Drug Combination; Vancomycin