trimethoprim--sulfamethoxazole-drug-combination and Pneumonia--Staphylococcal

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

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

A community-based prospective surveillance and case management study of acute respiratory infection (ARI) in children aged 2-60 months of age was carried out over a 12-month period in Pakata, a semi-urban community in Ilorin, Kwara State, Nigeria. A cohort of 481 children was followed by trained community health assistants with thrice weekly home visits to record all symptoms and signs of ARI, and institute treatment based on WHO recommendations. There were three episodes of mild, moderate, or severe ARI per child per year, including 1.3 pneumonia episodes per child per year. The peak of infection corresponded to the rainy season (July-November), and a smaller peak to the dry season (February-April). Most of the health worker decisions were considered appropriate, although there was a tendency toward over-treatment with antibiotic drugs. An effective referral system was established from the community to a tertiary centre. There were no ARI-related deaths during the study period. These data indicate that a system of case management using trained community health workers can improve case management of ARI and may prevent severe ARI-related disease and deaths.

Topics: Acute Disease; Child, Preschool; Cloxacillin; Cohort Studies; Community Health Services; Female; Gentamicins; Health Promotion; Home Care Services; Humans; Infant; Male; Managed Care Programs; Nigeria; Pleural Effusion; Pneumonia, Staphylococcal; Prospective Studies; Respiratory Tract Infections; Severity of Illness Index; Staphylococcus aureus; Surveys and Questionnaires; Trimethoprim, Sulfamethoxazole Drug Combination; Workforce; World Health Organization

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

Therapeutic options available to treat MRSA pneumonia are limited. Trimethoprim/sulfamethoxazole is an attractive treatment because of its bactericidal anti-MRSA activity, oral and parenteral formulations and good penetration to the lung tissue. We aimed to compare the efficacy and safety of trimethoprim/sulfamethoxazole with vancomycin in the treatment of healthcare/ventilator-associated MRSA pneumonia.. We carried out a retrospective case-control study of all consecutive hospitalized adult patients diagnosed with MRSA pneumonia at Beilinson Hospital during 2010-15 and treated with either vancomycin or trimethoprim/sulfamethoxazole. The primary outcomes were all-cause mortality at 30 days and clinical failure at the end of treatment. In order to reduce bias affecting the decision to use a specific antibiotic and as a sensitivity analysis, a propensity-score model for choosing between vancomycin and trimethoprim/sulfamethoxazole was used.. We identified 42 patients with MRSA pneumonia treated with trimethoprim/sulfamethoxazole and 39 treated with vancomycin. There were no significant differences in the baseline characteristics between the groups. Vancomycin-treated patients showed significantly higher 30 day mortality on both multivariate analysis (HR = 5.28; 95% CI = 1.50-18.60; P  < 0.05) and sensitivity analysis with propensity score [vancomycin 13/24 (54.1%) versus trimethoprim/sulfamethoxazole 4/24 (16.7%); P  < 0.05], and higher clinical failure rates [vancomycin 23/39 (59%) versus trimethoprim/sulfamethoxazole 15/42 (35.7%); P  < 0.05], also in the sensitivity analysis with propensity score [vancomycin 14/24 (58.3%) versus trimethoprim/sulfamethoxazole 6/24 (25%); P  < 0.05]. The rates of side effects in both arms were comparable.. Trimethoprim/sulfamethoxazole appears to be superior to vancomycin in the treatment of MRSA pneumonia. A large-scale randomized controlled trial is needed to evaluate these findings.

Topics: Adult; Aged; Anti-Bacterial Agents; Case-Control Studies; Female; Humans; Male; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Middle Aged; Pneumonia, Staphylococcal; Pneumonia, Ventilator-Associated; Retrospective Studies; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Vancomycin

The prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in cystic fibrosis (CF) patients in the United States is approximately 25%. Little is known about the relative proportion of hospital- versus community-associated strains or the antimicrobial susceptibility of MRSA in different CF centers. We hypothesized that the majority of MRSA isolates obtained from children with CF are those endemic in the hospital and that those associated with community acquisition (SCCmec IV) would be more resistant than typically seen in non-CF MRSA isolates.. We studied MRSA strains from seven pediatric CF centers to determine the clonal distribution based on DNA sequencing of the staphylococcal protein A gene (spa typing), the type of staphylococcal chromosomal cassette mec (SCCmec), and the proportion of strains with Panton-Valentine leukocidin (PVL). Antimicrobial susceptibility to systemic and topical antibiotics was compared between different MRSA types.. We analyzed 277 MRSA isolates from unique patients (mean age 11.15 ± 4.77 years, 55% male). Seventy % of isolates were SCCmec II PVL negative and the remainder SCCmec IV. Overall 17% MRSA strains were PVL positive (all SCCmec IV). Spa typing of 118 isolates showed most of the SCCmec II strains being t002, while SCCmec IV PVL positive isolates were t008, and SCCmec IV PVL negative isolates represented a variety of spa-types. The proportions of SCCmec II strains and spa-types were similar among centers. Overall rates of resistance to trimethoprim-sulfamethoxazole (4%), tetracycline (7%), tigecycline (0.4%), linezolid (0.4%) as well as fosfomycin (0.4%), fusidic acid (3%), and mupirocin (1%) were low. No strains were resistant to vancomycin. SCCmec II strains had higher rates of resistance to ciprofloxacin and clindamycin (P < 0.001) than SCCmec IV strains.. In this U.S. study, most MRSA isolates in the pediatric CF population were SCCmec II PVL negative. Rates of resistance were low, including to older and orally available antibiotics such as trimethoprim-sulfamethoxazole.

Topics: Acetamides; Adolescent; Anti-Bacterial Agents; Bacterial Proteins; Bacterial Toxins; Bronchoscopy; Child; Child, Preschool; Cohort Studies; Cystic Fibrosis; DNA, Bacterial; Exotoxins; Female; Fosfomycin; Fusidic Acid; Humans; Leukocidins; Linezolid; Male; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Minocycline; Molecular Typing; Mupirocin; Oxazolidinones; Penicillin-Binding Proteins; Pharynx; Pneumonia, Staphylococcal; Sequence Analysis, DNA; Sputum; Staphylococcal Infections; Staphylococcal Protein A; Tetracycline; Tigecycline; Trimethoprim, Sulfamethoxazole Drug Combination; United States

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

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

Topics: Aged; Anti-Bacterial Agents; Antineoplastic Combined Chemotherapy Protocols; Brain Neoplasms; Carcinoma, Small Cell; Ceftriaxone; Cisplatin; Combined Modality Therapy; Cranial Irradiation; Etoposide; Fatal Outcome; Female; Humans; Immunocompromised Host; Lung Neoplasms; Opportunistic Infections; Pneumonia, Pneumocystis; Pneumonia, Staphylococcal; Staphylococcus aureus; Trimethoprim, Sulfamethoxazole Drug Combination

The authors describe a one-year-old girl with a fronto-ethmoidal encephalomeningocele who developed wound infection, purulent meningitis and septic shock 5 hours after operation. The patient was treated with intravenous ceftazidime and vancomycin empirically. The cerebrospinal fluid (CSF) and eye discharge grew Streptococcus pneumoniae (S. pneumoniae). The minimal inhibitory concentration (MIC) by E-test of penicillin and cefotaxime were 1.0 and 0.38 ug/ml respectively so the antibiotics were switched to cefotaxime 300 mg/kg/day. She recovered completely after appropriate treatment. Penicillin-non-susceptible S. pneumoniae should be considered as one of the causes of post-operative serious infection of the face and neck in the era of increasing prevalence of penicillin-resistant S. pneumoniae.

Topics: Anti-Bacterial Agents; Cefotaxime; Chloramphenicol; Drug Resistance, Bacterial; Female; Humans; Infant; Lincomycin; Meningoencephalitis; Pneumonia, Staphylococcal; Postoperative Complications; Trimethoprim, Sulfamethoxazole Drug Combination; Vancomycin

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

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