trimethoprim--sulfamethoxazole-drug-combination and Postoperative-Complications

The purpose of this study was to describe the clinical features of nocardiosis after allogeneic hematopoietic stem cell transplantation (allo-HSCT), focusing on new Nocardia species.. We retrospectively reviewed data from patients with nocardiosis after allo-HSCT treated at our hospital and documented cases in the medical literature.. Fifty-seven cases were identified from our institution and the literature review. Although 51 patients (89.5%) responded to initial treatment, 28 (49.1%) patients were switched over to other treatment regimens due to the recurrence of nocardiosis or adverse events of antimicrobials. Nocardiosis-attributed mortality occurred in ten patients (17.5%). Antimicrobial susceptibilities varied among intra- and inter-species except linezolid (LZD). In the present study, five species were newly discovered after 2000, including N. cyriacigeorgica, N. veterana, N. abscessus, N. aobensis, and N. mexicana. All isolates of N. cyriacigeorgica, N. veterana, N. abscessus, and N. aobensis were sensitive to trimethoprim/sulfamethoxazole, amikacin (AMK), imipenem (IPM), and LZD; however, N. mexicana was resistant to AMK and IPM.. Newly identified Nocardia species have various antimicrobial susceptibility patterns. Long-term maintenance therapy could be challenging due to the adverse events of antimicrobials, especially in the allo-HSCT setting. Prudent evaluation is crucial for selecting a second-line or further treatment options.

Topics: Anti-Bacterial Agents; Hematopoietic Stem Cell Transplantation; Humans; Nocardia; Nocardia Infections; Postoperative Complications; Retrospective Studies; Trimethoprim, Sulfamethoxazole Drug Combination

Pneumocystis jirovecii is the only fungus of its kind to be pathogenic in humans. It is primarily responsible for pneumonia (PJP). The key to understanding immune defences has focused on T-cells, mainly because of the HIV infection epidemic. Patients presenting with PJP all have a CD4 count below 200/mm(3). The introduction of systematic primary prophylaxis and the use of new anti-retroviral drugs have significantly reduced the incidence of this disease in the HIV-infected population, mainly in developed countries. The increasingly frequent use of corticosteroids, chemotherapy, and other immunosuppressive drugs has led to an outbreak of PJP in patients not infected by HIV. These patients presenting with PJP have more rapid and severe symptoms, sometimes atypical, leading to delay the initiation of a specific anti-infective therapy, sometimes a cause of death. However, the contribution of new diagnostic tools and a better understanding of patients at risk should improve their survival.

Topics: Adrenal Cortex Hormones; Antineoplastic Agents; beta-Glucans; Connective Tissue Diseases; Drug Therapy, Combination; Early Diagnosis; HIV Seronegativity; Humans; Immunocompromised Host; Immunologic Deficiency Syndromes; Immunologic Factors; Immunosuppressive Agents; Neoplasms; Organ Transplantation; Pneumocystis carinii; Pneumocystis Infections; Pneumonia, Pneumocystis; Polymerase Chain Reaction; Postoperative Complications; Prognosis; Radiography; Trimethoprim, Sulfamethoxazole Drug Combination

We reviewed medical records of all patients (n = 4) who underwent facial composite tissue allotransplantation (FCTA) at our center between April 2009 and May 2011; data were censored in June 2012. We searched for FCTA publications and reviewed them for infectious complications and prophylaxis strategies. Three patients received full and one partial FCTA at our institution. Two recipients were cytomegalovirus (CMV) Donor (D)+/Recipient (R)- and two CMV D+/R+. Perioperative prophylaxis included vancomycin, cefazolin and micafungin and was adjusted based on peritransplant cultures. Additional prophylaxis included trimethoprim-sulfamethoxazole and valganciclovir. Two recipients developed surgical site infection and two developed pneumonia early after transplantation. Both CMV D+/R- recipients developed CMV disease after discontinuation of prophylaxis, recovered with valganciclovir treatment and did not experience subsequent rejection. Other posttransplant infections included bacterial parotitis, polymicrobial bacteremia, invasive dermatophyte infection and Clostridium difficile-associated diarrhea. Nine publications described infectious complications in another 9 FCTA recipients. Early posttransplant infections were similar to those observed in our cohort and included pulmonary, surgical-site and catheter-associated infections. CMV was the most frequently described opportunist. In conclusion, infections following FCTA were related to anatomical, technical and donor/recipient factors. CMV disease occurred in D+/R- recipients after prophylaxis, but was not associated with rejection.

Topics: Adult; Anti-Infective Agents; Catheter-Related Infections; Cytomegalovirus; Cytomegalovirus Infections; Face; Female; Graft Rejection; Graft Survival; Humans; Male; Middle Aged; Pneumonia; Postoperative Complications; Prognosis; Surgical Wound Infection; Tissue Transplantation; Transplantation, Homologous; Trimethoprim, Sulfamethoxazole Drug Combination

Accompanying the increased use of biologic and non-biologic antirheumatic agents, patients with RA have been exposed to an increased risk of Pneumocystis jirovecii infection, which causes acute fulminant P. jirovecii pneumonia (PCP). Mortality in this population is higher than in HIV-infected individuals. Several guidelines and recommendations for HIV-infected individuals are available; however, such guidelines for RA patients remain less clear. Between 2006 and 2008 we encountered a clustering event of P. jirovecii infection among RA outpatients. Through our experience with this outbreak and a review of the recent medical literature regarding asymptomatic colonization and its clinical significance, transmission modes of infection and prophylaxis of PCP, we have learned the following lessons: PCP outbreaks among RA patients can occur through person-to-person transmission in outpatient facilities; asymptomatic carriers serve as reservoirs and sources of infection; and short-term prophylaxis for eradication of P. jirovecii is effective in controlling PCP outbreaks among RA outpatients.

Topics: Anti-Infective Agents; Arthritis, Rheumatoid; Contact Tracing; Disease Reservoirs; Humans; Immunologic Deficiency Syndromes; Immunosuppressive Agents; Infectious Disease Transmission, Professional-to-Patient; Kidney Transplantation; Opportunistic Infections; Pneumocystis carinii; Pneumonia, Pneumocystis; Postoperative Complications; Risk Factors; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Pneumocystis jiroveci is an important pathogen in patients undergoing SOT and HSCT. Universal prophylaxis is recommended for all adults and children with SOT and HSCT, considering that its use significantly reduces the occurrence and mortality associated with pneumonia by this agent. The drug of choice is cotrimoxazole (A1) three times a week, low-dose scheme, that has proved equally effective and better tolerated than the daily regimen and/or at high doses. Prophylaxis starts 7 to 14 days post transplant in SOT recipients and post-implant in HSCT, with an average duration of 6 months except in liver and lung transplant as in HSCT with significant degree of immunosuppression, that lasts for 1 year. Alternatives for prophylaxis are dapsone (B2), aerosolized pentamidine (B2) and atovaquone (C2).

Topics: Adult; Anti-Infective Agents; Child; Dapsone; Drug Administration Schedule; Evidence-Based Medicine; Humans; Incidence; Organ Transplantation; Pentamidine; Pneumocystis carinii; Pneumonia, Pneumocystis; Postoperative Complications; Practice Guidelines as Topic; Risk Factors; Stem Cell Transplantation; Trimethoprim, Sulfamethoxazole Drug Combination

Toxoplasmosis is a widely distributed zoonosis produced by the parasite T. gondii. In Chile the seroprevalence has been estimated between 20-37% in general population. Defined risk groups acquire or reactivate the infection by T. gondii in patients undergoing SOT and HSCT are: heart transplant or heart-lung with D (+) and R (-), allogeneic HSCT with R (+), HSCT with cord cells, GVHD, history of previous clinical toxoplasmosis and use of corticosteroids for prolonged periods or in high doses. Hand washing, hygiene in food handling and weekly post-transplant surveillance since day 15 post transplant for six months, are universally recommended. All patients with SOT and HSCT, regardless of risk, should receive prophylaxis with cotrimoxazole and require no another specific prophylaxis against T. gondii (A2). It is particularly important in high-risk patients who cannot receive cotrimoxazole prophylaxis establish specific alternative against T. gondii (B3).

Topics: Adult; Anti-Infective Agents; Child; Drug Administration Schedule; Humans; Incidence; Organ Transplantation; Postoperative Complications; Practice Guidelines as Topic; Risk Factors; Stem Cell Transplantation; Toxoplasmosis; Trimethoprim, Sulfamethoxazole Drug Combination

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

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

Pediatric heart transplantation is a surgical therapy for dilated cardiomyopathy and for complex congenital heart defects with low pulmonary artery resistance. However, it is still discussed as controversial because of uncertain long-term results. We report our experience with pediatric heart transplantation in a heterogeneous population.. Since 1988, 50 heart transplants were performed in 47 patients (30 with dilated cardiomyopathy, 17 with congenital heart disease). Mean age was 9.4 +/- 6.9 years (range, 4 days to 17.9 years). Twenty-three patients had a total of 36 previous operations. Clinical outcome was evaluated retrospectively.. Perioperative mortality was 6% due to primary graft failure. Late mortality (12%) was caused by acute rejection (n = 2), pneumonia (n = 2), intracranial hemorrhage (n = 1), and suicide (n = 1). Mean follow-up was 5.24 +/- 3.6 years. Actuarial 1, 5, and 10 year survival was 86%, 86%, and 80% and improved significantly after 1995 (92% [1 year]; 92% [5 years]). There was no significant difference between patients with dilated or congenital heart disease (1 year: 86% vs 82%; 5 years: 83% vs 74%; 10 years 83% vs 74%; p = 0.62). Three patients with therapy resistant acute or chronic rejection and assisted circulation underwent retransplantation and are alive. Freedom from acute rejection after 5 years was 40% with primary cyclosporine immunosuppression regime and 56% with tacrolimus. Since the introduction of mycophenolate mofetil, freedom from acute rejection increased to 62%. All survivors are at home and in good cardiac condition.. Pediatric heart transplantation is the treatment of choice for end-stage dilated cardiomyopathy as for congenital heart disease with excellent clinical midterm results. It is a valid alternative to reconstructive surgery in borderline patients. However, further follow-up is necessary to evaluate the long-term side effects of immunosuppressants.

Topics: Adolescent; Antiviral Agents; Bacterial Infections; Cardiomyopathy, Dilated; Child; Child, Preschool; Cyclosporine; Cytomegalovirus Infections; Extracorporeal Membrane Oxygenation; Female; Follow-Up Studies; Ganciclovir; Germany; Graft Rejection; Heart Defects, Congenital; Heart Failure; Heart Transplantation; Heart-Assist Devices; Humans; Immunosuppressive Agents; Life Tables; Lymphoma, Non-Hodgkin; Male; Mycophenolic Acid; Pneumonia, Pneumocystis; Postoperative Complications; Reoperation; Retrospective Studies; Survival Analysis; Survival Rate; Tacrolimus; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Vascular Resistance; Virus Diseases

In our series of 1374 renal transplantations performed between February 1970 and December 2002, we observed 6 cases of infection due to Nocardia asteroides. There were 4 males and 2 females, aged 49.8 +/- 12 years (29 to 63 years). One patient received his first transplantation and the 5 others retransplants. Three patients had PRA > 80%, one 28% and one 40%. One patient was diabetic and two had HCV infection. Two of 6 patients experienced acute rejection episodes. Nocardiosis localisation was pulmonary in 5 cases, cerebral in two and mediastinal in one. All patients recovered after reduction of immunosuppression and appropriate antibiotherapy with trimethoprim-sulfamethoxasole (TMP-SMX). When we analyzed the role of immunosuppression, we observed that only two cases were observed in the 933 recipients transplanted between 1985 and 2002 and receiving cyclosporin, contrasting with 4 cases among 174 recipients transplanted between 1996 and 2002 and receiving tacrolimus. Our data suggest that high immunologic risk patients, heavy immunosuppression, and perhaps tacrolimus-based immunosuppression are risk factors of nocardial infection. Early diagnosis of this severe infection, reduction of immunosuppression and appropriate therapy with TMP-SMX resulted in complete recovery in all our patients.

Topics: Adrenal Cortex Hormones; Adult; Aged; Antilymphocyte Serum; Azathioprine; Cyclosporine; Diabetes Complications; Disease Susceptibility; Female; Graft Rejection; Hepatitis C, Chronic; Humans; Immunocompromised Host; Immunosuppressive Agents; Kidney Transplantation; Male; Middle Aged; Mycophenolic Acid; Nocardia asteroides; Nocardia Infections; Postoperative Complications; Reoperation; Risk Factors; Tacrolimus; Trimethoprim, Sulfamethoxazole Drug Combination

A report is made here of five patients who underwent solid organ transplantation, were not infected with the human immunodeficiency virus, and suffered Pneumocystis carinii pneumonia while receiving immunosuppressive drugs. The figure represents a prevalence of 0.43% among patients with solid organ transplantation at the Clínica Puerta de Hierro. Some features of this infection are reported in patients without AIDS, both transplanted patients and with other clinical conditions, the possible predisposing factors and the necessity to keep a high suspect index when individuals treated with immunosuppressive drugs present with respiratory symptoms. Likewise, a suggestion is made to consider the use of chemoprophylaxis with cotrimoxazole in these cases.

Topics: Adult; Aged; Anti-Infective Agents; Drug Therapy, Combination; Fatal Outcome; Female; Ganciclovir; Humans; Immunosuppression Therapy; Male; Middle Aged; Opportunistic Infections; Organ Transplantation; Pneumonia, Pneumocystis; Postoperative Complications; Trimethoprim, Sulfamethoxazole Drug Combination

Xanthomonas maltophilia is being increasingly recognized as an opportunistic pathogen in debilitated patients. We report a case of postoperative meningitis due to X. maltophilia and review the cases of X. maltophilia meningitis reported in the literature. Because X. maltophilia is often resistant to multiple beta-lactam agents, including cephalosporins and imipenem, trimethoprim-sulfamethoxazole appears to be the drug of choice for treatment of X. maltophilia meningitis.

Topics: Cerebrospinal Fluid; Gram-Negative Bacterial Infections; Humans; Hydrocephalus; Male; Meningeal Neoplasms; Meningioma; Meningitis, Bacterial; Middle Aged; Postoperative Complications; Trimethoprim, Sulfamethoxazole Drug Combination; Ventriculoperitoneal Shunt; Xanthomonas

A standard protocol for perioperative antibiotic prophylaxis in radical retropubic prostatectomy has not been established until now. The present pilot study compared the perioperative single-dose of piperacillin/tazobactam to the administration of ciprofloxacin or cotrimoxazol for 5 days with regard to postoperative infections. For the first time these antibiotic regimes were described in radical retropubic prostatectomy.. The patients were divided into three groups, each consisting of 17 patients: group 1: a single-dose of piperacillin / tazobactam 4.5 g i. v., group 2: ciprofloxacin 500 mg or cotrimoxazol 960 mg i. v. / p. o. and group 3: varying administration and duration of different kinds of antibiotics as control group. The basic characteristics of the patients such as age, body-mass-index, risk factors, diseases, former surgeries and medication were similar between all three groups. Also there were no significant differences in intraoperative parameters such as operation time, blood loss and other postoperative complications.. The piperacillin / tazobactam group showed a significantly lower body temperature on postoperative days (POD) 1-3. The laboratory values were not significantly different among the groups, except the piperacillin / tazobactam group showed a significantly lower CRP level on POD 1-3 than group 3. All antibiotic regimes could afford an efficient protection: None of the patients died and there were no cases of serious consequences such as pneumonia, urosepsis or bacteriuria. Although not statistically significant, the piperacillin / tazobactam group showed better clinical outcomes: here the length of hospitalisation was two days less than in the other groups, no cases of wound infection occurred, the antimicrobial resistance rates were lower and fewer patients were treated with antibiotics in the postoperative course.. Comparable to similar studies with a larger number of patients our pilot study demonstrated, although statistically not significant, better clinical results overall. We therefore conclude that a single-dose of piperacillin / tazobactam appears to be an efficient antibiotic prophylaxis in radical retropubic prostatectomy and even in some clinical parameters piperacillin / tazobactam seems to be equivalent or better than the usual 5-day administration of antimicrobial prophylaxis.

Topics: Administration, Oral; Aged; Anti-Bacterial Agents; Antibiotic Prophylaxis; Body Temperature; C-Reactive Protein; Ciprofloxacin; Drug Administration Schedule; Drug Therapy, Combination; Humans; Infusions, Intravenous; Length of Stay; Male; Middle Aged; Neoplasm Staging; Penicillanic Acid; Perioperative Care; Pilot Projects; Piperacillin; Postoperative Complications; Prostatectomy; Prostatic Neoplasms; Retrospective Studies; Surgical Wound Infection; Tazobactam; Trimethoprim, Sulfamethoxazole Drug Combination

Shunt infection represents a particularly morbid condition, which can also result in mortality. In order to decrease the high morbidity and mortality rates, prevention is an essential step. The purpose of this study was to compare the prophylactic use of ceftriaxone and trimethoprim-sulfamethoxazole (SXT) for the prevention of ventriculoperitoneal (VP) shunt infection.. In this prospective, single-institution, randomized clinical trial, 107 children with hydrocephalus and an indication for shunting were randomly assigned to prophylaxis with ceftriaxone (n = 50) or SXT (55), each administered as a single dose during anesthesia and two divided doses postoperatively. Patients were followed up for at least one year.. The mean age of patients was 15 months, and 85% were aged 6 months or younger. During the first postoperative year, meningitis occurred in 13.5% of patients receiving ceftriaxone and 14.5% of the SXT group, with no statistically significant difference between the groups. Younger age, presence of cerebrospinal fluid leakage and aqueductal stenosis as a cause of hydrocephalus showed significant correlation with meningitis occurrence on univariate analysis. However, only the latter 2 factors were associated with meningitis on multivariate analysis. The risk of shunt infection did not correlate with the gender of the patient, time of VP shunt surgery, or duration of hospitalization for shunting.. Ceftriaxone and SXT showed similar efficacy in preventing shunt infection. Cerebrospinal fluid leakage before or after VP shunt placement and aqueductal stenosis were independent risk factors for meningitis after VP shunt.

Topics: Anti-Bacterial Agents; Ceftriaxone; Child, Preschool; Female; Humans; Infant; Male; Meningitis, Bacterial; Postoperative Complications; Surgical Wound Infection; Trimethoprim, Sulfamethoxazole Drug Combination; Ventriculoperitoneal Shunt

Urinary tract infection (UTI), a major cause of morbidity in renal transplant recipients, has also been found to increase mortality. The first month post-kidney transplantation is considered the critical time, with most UTI episodes during this period. The aim of this study was to compare the efficacy of various doses of trimethoprim-sulfamethoxazole (TMP/SXT) for the prophylaxis of the posttransplant UTI within the first month after kidney transplantation. In a prospective, double-blind, randomized, clinical trial, 95 kidney allograft recipients were divided into two groups: group 1 (n = 63) received low to moderate doses of TMP/SXT (either 80/400 mg or 160/800 mg, daily) and group 2 (n = 32), high doses of TMP/SXT (320/1600 mg, daily in two divided doses). These groups were comparable regarding age, gender, type of donor, and ureteral anastomosis and immunosuppressive therapy. UTI was defined as a urine culture containing more than 10(5) colonies. The mean age of the patients was 37 +/- 12.2 years with a male/female ratio of 0.98/1. The urine culture was positive in 39 patients (41.1%). UTI was more common among female than male patients (P = .003). Escherichia coli was the most common isolated organism in both groups (53.8%). UTI was observed in about 25% of patients on the high-dose versus 49.2% of those on low- to moderate-dose prophylaxis (P < .05). In conclusion, prophylaxis with high-dose TMP/SXT (320/1600 mg, daily) is preferred for renal transplant recipients during the first month posttransplantation.

Topics: Adult; Anti-Infective Agents; Dose-Response Relationship, Drug; Double-Blind Method; Escherichia coli Infections; Female; Humans; Iran; Kidney Transplantation; Male; Middle Aged; Postoperative Complications; Prospective Studies; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Urine

The aim of this study was to evaluate the efficacy of trimethoprim-sulfamethoxazole (TMP/SMZ) and neomycin as the prophylactic agents against the recurrence of cholangitis in children with biliary atresia (BA) after a Kasai portoenterostomy.. Nineteen BA patients aged 0 to 2 years, who had one episode of cholangitis after a Kasai portoenterostomy, were recruited in this study. Patients were assigned randomly into 2 groups: one (9 cases) with TMP/SMZ (TMP 4 mg/kg/d and SMZ 20 mg/kg/d, divided in 2 doses) and the other (10 cases) with neomycin (25 mg/kg/d, qid, 4 days a week). Another 18 BA patients aged 0 to 2 years, with cholangitis but not put on long-term prophylaxis, served as the historical control group.. The mean prophylactic periods were 14.6 months and 14.7 months in the TMP/SMZ and neomycin groups. Patients who received prophylaxis with either TMP/SMZ or neomycin had lower recurrence rates of cholangitis than those in the control group (P =.042 and.011). There was no difference in the recurrence rates of cholangitis between the TMP/SMZ and neomycin groups (P =.641). The survival rates were higher in the TMP/SMZ and neomycin groups than in the control group (P =.09 and.018).. Use of TMP/SMZ or neomycin is effective as a prophylactic agent against the recurrence of cholangitis after the Kasai portoenterostomy, but there is no difference in efficacy between these 2 regimens.

Topics: Antibiotic Prophylaxis; Biliary Atresia; Child, Preschool; Cholangitis; Drug Therapy, Combination; Female; Humans; Infant; Infant, Newborn; Life Tables; Male; Neomycin; Portoenterostomy, Hepatic; Postoperative Complications; Prospective Studies; Recurrence; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Although the reported incidence of Pneumocystis carinii pneumonia after heart transplantation in adults ranges from 3% to 40%, data are lacking regarding the incidence in the pediatric heart transplantation population. A retrospective review was performed on 152 infants (0 to 12 months of age) undergoing transplantation from November 1985 through December 1993 who survived at least 6 months after heart transplantation. Patients did not receive postoperative Pneumocystis carinii prophylaxis. Ten episodes (7%) were diagnosed in four neonates and six infants. The mean postoperative time to Pneumocystis carinii diagnosis was 5 months (range 3 to 9 months). Features of Pneumocystis carinii included hypoxia and tachypnea (10 of 10), progressive interstitial infiltrates (8 of 10), and persistent right middle lobe consolidation (1 of 10). Pneumocystis carinii was diagnosed with the use of bronchoscopy in eight cases and by open lung biopsy in two cases. Mean CD4 count available on five patients at the time of Pneumocystis carinii diagnosis was 413/mm3 (range 158 to 1358); 5 of 37 patients receiving antithymocyte induction had Pneumocystis carinii versus 5 of 115 patients who did not receive induction (p = 0.05). Patients were at increased risk for the development of Pneumocystis carinii if they had more than two episodes of rejection during the first year after heart transplantation (p = 0.04). All cases were successfully treated with trimethoprim/sulfamethoxazole. The incidence of Pneumocystis carinii in infant heart transplantation recipients is approximately 7% and appears most frequently in the first 6 months after the operation. Increased risk for Pneumocystis carinii may be related to early antithymocyte induction and increased episodes of rejection.

Topics: Anti-Infective Agents; Bronchoscopy; CD4 Lymphocyte Count; Follow-Up Studies; Graft Rejection; Heart Transplantation; Humans; Immunocompromised Host; Immunosuppressive Agents; Incidence; Infant; Infant, Newborn; Pneumocystis; Pneumonia, Pneumocystis; Postoperative Complications; Prospective Studies; Risk Factors; Trimethoprim, Sulfamethoxazole Drug Combination

In a prospective clinical trial the pre- and postoperative presence of S. aureus was examined in 130 patients undergoing nasal septal surgery. The patients were randomized into three groups. The first group received no perioperative antibiotics, the second group was given oral amoxicillin plus clavulanic acid, while the third group was treated with oral sulfamethoxazol and trimethoprim. A significant decrease in the incidence of S. aureus was observed in post-operative cultures, but the difference was not attributable to the antibiotic use. Overall, 18.9% of the S. aureus carriers harbored toxic shock syndrome toxin-1 positive strains. However, the decrease in the presence of S. aureus and the risk for toxic shock syndrome was not influenced by the antibiotics administered. These findings show that the routine use of oral prophylactic antibiotics for patients undergoing nasal surgery seems not indicated.

Topics: Adolescent; Adult; Aged; Amoxicillin; Antibiotic Prophylaxis; Clavulanic Acid; Clavulanic Acids; Colony Count, Microbial; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Nasal Septum; Postoperative Complications; Prospective Studies; Rhinoplasty; Risk Factors; Shock, Septic; Staphylococcal Infections; Staphylococcus aureus; Trimethoprim, Sulfamethoxazole Drug Combination

This study was designed to determine whether treatment with prednisone and trimethoprim-sulfamethoxazole would reduce first year post-operative morbidity in children with chronic otitis media with effusion undergoing tympanostomy tube insertion (intubation). Eighty children ages 6 months to 8 years were enrolled at intubation and randomized from age strata to receive active drugs or placebos for 14 days after surgery. They were examined with pneumatic otoscopy and tympanometry preoperatively and at 3 weeks and 3, 6, 9 and 12 months after surgery. Active drug treatment significantly reduced tube obstruction or extrusion in the first 3 postoperative months compared with placebos (4% vs. 17%, P = .01). However, rates of repeat intubation, otorrhea and recurrence of otitis media did not differ significantly in the two groups. Children with chronic otitis media with effusion treated with intubation may benefit from a 2-week course of prednisone and trimethoprim-sulfamethoxazole at the time of surgery. However, there is no apparent long term benefit of this treatment.

Topics: Anti-Infective Agents; Anti-Inflammatory Agents; Child; Child, Preschool; Double-Blind Method; Drug Therapy, Combination; Female; Humans; Infant; Male; Middle Ear Ventilation; Minnesota; Morbidity; Otitis Media with Effusion; Postoperative Complications; Prednisone; Recurrence; Trimethoprim, Sulfamethoxazole Drug Combination

We studied 599 evaluable patients with benign prostatic hypertrophy at 7 urological units. Before transurethral prostatectomy the patients were randomized into 3 groups: group 1--197 patients given single-dose ceftriaxone (2 gm.), group 2--203 patients given 160/800 mg. trimethoprimsulfamethoxazole and group 3--199 controls given no antimicrobial prophylaxis. Patients with a preoperative indwelling catheter, positive urine culture, signs of active infection or preoperative antibiotic treatment were excluded. Postoperative infectious complications were demonstrated in 15 of 197 (7.6%), 25 of 203 (12.3%) and 43 of 199 (21.6%) patients in the study groups, respectively. The difference in infectious complications between groups 1 and 3 was statistically highly significant (p < 0.01) and between groups 2 and 3 it was significant (p < 0.05). Single-dose antibiotic prophylaxis proved to be useful in the prevention of serious infectious complications after transurethral prostatectomy.

Topics: Aged; Aged, 80 and over; Bacterial Infections; Ceftriaxone; Humans; Male; Middle Aged; Postoperative Complications; Premedication; Prospective Studies; Prostatectomy; Prostatic Hyperplasia; Trimethoprim, Sulfamethoxazole Drug Combination

Prophylaxis with low-dose trimethoprim-sulfamethoxazole has been shown to be cost-effective in the prevention of urinary tract infections, pyelonephritis, urosepsis, and pneumocystis pneumonia in renal transplant recipients. Ciprofloxacin, effective against almost all urinary tract pathogens in this patient population, represents a promising alternative prophylactic agent for patients unable to tolerate trimethoprim-sulfamethoxazole due to toxicity.. We conducted a randomized, double-blind trial to compare low-dose trimethoprim-sulfamethoxazole with ciprofloxacin for the prevention of urinary tract infections in renal transplant recipients. Patients received either ciprofloxacin (250 mg) or trimethoprim-sulfamethoxazole (80 mg trimethoprim, 400 mg sulfamethoxazole) daily for 6 months following transplantation. Treatment was considered successful if patients completed the 6-month course and 3-month follow-up period without evidence of urinary tract infection or drug-related toxicities.. Of 103 eligible patients, 51 received ciprofloxacin and 52 received trimethoprim-sulfamethoxazole. At 6 months, treatment was successful in 75% (38 of 51) receiving ciprofloxacin and 71% (37 of 52) treated with trimethoprim-sulfamethoxazole (P = 0.87, relative risk 1.04, 95% confidence limits 0.83 to 1.33). Thirteen patients (25%) receiving trimethoprim-sulfamethoxazole withdrew from the study-4 for resistant urinary tract infection and 9 for drug-related toxicity, while 3 (6%) of the patients receiving ciprofloxacin withdrew because of drug-related toxicity (P = 0.016, relative risk of urinary tract infection or adverse event 0.24, 95% confidence limits 0.07 to 0.78). At 9 months, all 38 patients who completed the 6-month course of ciprofloxacin remained free of urinary tract infection, while an additional 4 patients who had received trimethoprim-sulfamethoxazole prophylaxis (total of 8 patients over the 9 months) developed urinary tract infections (P = 0.006, Fisher's exact test for urinary tract infection alone). Pneumocystis pneumonia occurred in a total of 7 (14%) patients who were randomized to ciprofloxacin, but 2 of the 7 had withdrawn from the study at least 2 weeks prior to the diagnosis of pneumocystis pneumonia. There were no cases of pneumocystis pneumonia in patients receiving trimethoprim-sulfamethoxazole (P = 0.006). Following completion of the study, monthly aerosolized pentamidine administered in conjunction with ciprofloxacin has provided complete protection against urinary tract infection and pneumocystis pneumonia in 30 transplant recipients unable to tolerate trimethoprim-sulfamethoxazole therapy.. Ciprofloxacin is at least as effective as trimethoprim-sulfamethoxazole in the prevention of urinary tract infection in renal transplant recipients, and is better tolerated. Ciprofloxacin prophylaxis is associated with a higher incidence of pneumocystis pneumonia than is trimethoprim-sulfamethoxazole therapy. An uncontrolled follow-up study suggests that ciprofloxacin prophylaxis combined with monthly aerosolized pentamidine may be efficacious in preventing both urinary tract infection and pneumocystis pneumonia in renal transplant recipients.

Topics: Adult; Aerosols; Ciprofloxacin; Double-Blind Method; Drug Therapy, Combination; Female; Humans; Kidney Transplantation; Male; Middle Aged; Pentamidine; Pneumonia, Pneumocystis; Postoperative Complications; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Questions have been raised regarding the safety of trimethoprim-sulfamethoxazole (TMP-SMZ) in organ transplantation, particularly adverse interactions with azathioprine and cyclosporine. In a prospective randomized, double-blind, trial in 132 patients that encompassed 33,876 patient-days, long-term prophylaxis with TMP-SMZ was found to significantly reduce the incidence of bacterial infection after renal transplantation. Prophylaxis was very well tolerated; none of the 66 recipients of TMP-SMZ, who took the drug for an average of 8.9 months, was withdrawn from the study because of hypersensitivity or toxic side effects. Serial measurements of hematologic parameters and liver function tests after transplantation in the two groups showed no significant differences. Recipients of cadaveric transplants, who were all given cyclosporine, randomized to receive TMP-SMZ had serum creatinine levels approximately 15% higher than those in control patients receiving cyclosporine (p less than 0.01); comparison of renal function by 24-hour endogenous creatinine clearances and technetium 99m-labeled diethylenetriamine-penta-acetic acid glomerular filtration rates in 17 patients crossed over to the alternate treatment group for 7 weeks, however, shows that the observed differences are reversible and represent inhibition of tubular excretion of creatinine by TMP in the presence of cyclosporine. Prophylaxis with TMP-SMZ had no discernable effect on cyclosporine pharmacokinetics: recipients of TMP-SMZ had blood levels of cyclosporine similar to those in patients in the placebo group. Episodes of graft rejection occurred at a similar frequency in the two groups (placebo, 50; TMP-SMZ, 44). We conclude that long-term prophylaxis with TMP-SMZ does not produce discernable hematologic, renal, or hepatic toxicity in renal transplant recipients nor does it augment nephrotoxicity with cyclosporine or increase the risk of rejection. TMP-SMZ may be used safely and is highly cost-beneficial for prophylaxis of infection in renal transplantation.

Topics: Creatinine; Cyclosporine; Double-Blind Method; Drug Interactions; Humans; Infections; Kidney Diseases; Kidney Transplantation; Patient Compliance; Postoperative Complications; Prospective Studies; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Amoxicillin; Bacterial Infections; Clinical Trials as Topic; Drug Combinations; Fosfomycin; Humans; Male; Postoperative Complications; Premedication; Prostate; Random Allocation; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

The effectiveness and drawbacks of cefoperazone and cotrimoxazole in the prevention of postoperative infections following percutaneous removal of renal stones were studied comparatively. 60 patients were divided at random into two groups. 30 subjects were given 1 g cefoperazone IV every 8 hours for 5 consecutive days starting on the day before the procedure. The 30 other patients had an infusion of 800 mg sulfamethoxazole and 160 mg trimethoprim every 12 hours on the same 5 days. Age, sex and type of surgical procedure were comparable in both groups. Results were as follows: in the cefoperazone group, one patient had intraoperative septic shock due to a stone infected by a resistant Pseudomonas aeruginosa; in the cotrimoxazole group, 2 patients had postoperative fever due to stones infected by resistant Gram negative rods (Pseudomonas aeruginosa) and three patients had a urinary tract infection (Candida albicans in 1 case, Escherichia coli in 1 and Pseudomonas aeruginosa in 1). Tolerance was satisfactory for both regimens. The authors conclude that intravenous cefoperazone in the more effective drug and should be continued throughout the first three postoperative days.

Topics: Adolescent; Adult; Aged; Bacterial Infections; Cefoperazone; Drug Combinations; Female; Humans; Kidney Calculi; Male; Middle Aged; Nephrostomy, Percutaneous; Postoperative Complications; Random Allocation; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

The author reports the results of a study to assess the effectiveness of a trimethoprim-sulfamethoxazole combination as prophylaxis in ventriculostomy or shunting operations. Between 1980 and 1983, 122 patients undergoing shunting procedures were randomly assigned to receive trimethoprim-sulfamethoxazole (Group 1, 62 cases) or a placebo (Group 2, 60 cases). The same regimen was followed at each operation, and the patients were followed for a minimum of 6 months. There was a higher infection rate in the placebo group (14 of 60 patients compared with 4 of 62 patients in the antibiotic group, p less than 0.01). The antibiotic protected against early infections (nine of the 60 patients in Group 2 against none of the patients in Group 1), but not against late infections (four of the 62 in Group 1 compared with five of the 60 in Group 2). During the same period, 52 patients undergoing ventriculostomy only were also randomly assigned to receive trimethoprim-sulfamethoxazole (Group 3) or placebo (Group 4). There were no differences in the infection rates between these groups (one of 25 in Group 3 as against one of 27 in Group 4).

Topics: Bacterial Infections; Cerebral Ventricles; Cerebrospinal Fluid Shunts; Clinical Trials as Topic; Double-Blind Method; Drug Combinations; Humans; Intraoperative Complications; Postoperative Complications; Premedication; Random Allocation; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

We conducted a randomized, double-blind, placebo-controlled study during a 30-month period to determine whether sulfamethoxazole and trimethoprim would decrease the incidence of infections occurring after ventriculoperitoneal shunt surgery. Of the 120 patients who completed the study according to protocol, 55 received sulfamethoxazole and trimethoprim and 65 received placebo. The incidence of CSF infection in the group receiving sulfamethoxazole and trimethoprim (4/55) was similar to that in the control group (5/65). There was a trend toward earlier identification of infections in the sulfamethoxazole and trimethoprim group (mean, 24.5 days) compared with the control group (mean, 47 days). There was no difference between infected and uninfected patients with respect to frequency of purported risk factors for infection, including history of shunt infection, history of recent myelomeningocele repair, and type and duration of shunt surgery. The incidence of shunt malfunction was similar in uninfected patients receiving antibiotic prophylaxis (18/51) compared with that of patients receiving placebo (23/60). We did not find that the perioperative use of sulfamethoxazole and trimethoprim reduced the incidence of shunt infection or malfunction.

Topics: Bacterial Infections; Cerebrospinal Fluid Shunts; Child; Child, Preschool; Clinical Trials as Topic; Double-Blind Method; Drug Combinations; Female; Humans; Infant; Male; Peritoneal Cavity; Postoperative Complications; Premedication; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Many patients with Crohn's disease present with the complications of infection. Hence, antibiotics play an important role in the medical management of acute inflammatory disease, persistent perianal disease and as prophylaxis for surgical operations. The author's group has demonstrated that bacteria colonize the serosa of the bowel in patients with Crohn's disease in 27% of cases. Furthermore, pathogenic bacteria could be recovered from the lymph nodes in 33% of patients with Crohn's disease, compared with only 5% in a controlled population. Extraintestinal bacterial colonization was, therefore, present in approximately half of all patients requiring an operation for Crohn's disease. The principal bacteria isolated at these sites were Escherichia coli, Streptococcus faecalis, Bacteroides fragilis, Proteus sp and diphtheroids. A prospective controlled trial on the use of 1 month's antimicrobial therapy in patients with relapse of Crohn's disease revealed that metronidazole was associated with a 57% response rate, compared with a response of only 17% in patients receiving no metronidazole. These interim findings suggest that metronidazole may have a role in the management of acute relapse in patients with Crohn's disease.

Topics: Abscess; Anus Diseases; Bacterial Infections; Clinical Trials as Topic; Crohn Disease; Drug Combinations; Gentamicins; Humans; Intestinal Fistula; Metronidazole; Postoperative Complications; Prospective Studies; Random Allocation; Recurrence; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Two hundred patients undergoing prostatic surgery at 2 hospitals were randomly allocated into 4 equal groups. The groups were a control, cephalexin, co-trimoxazole and carfecillin treated groups. The incidence of urinary tract infections and other complications of prostatic surgery were studied in each group after a short-term prophylactic regime of 3 doses of the antibiotic. The incidence of urinary infection was significantly improved from 28% in the control group to 8% and 16% in the co-trimoxazole and cephalexin groups respectively. Carfecillin was not effective in reducing urinary infection. However, all 3 antibiotics reduced the incidence of other infective sequelae.

Topics: Anti-Bacterial Agents; Carfecillin; Cephalexin; Clinical Trials as Topic; Drug Combinations; Humans; Male; Postoperative Complications; Premedication; Prostatectomy; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Pneumocystis pneumonia is a common opportunistic infection in kidney transplant recipients caused by the ascomycetous fungi Pneumocystis jirovecii. Its clinical presentation of a progressive nonproductive cough, shortness of breath, and fever is nonspecific and often delays diagnosis and appropriate treatment. Moreover, the plain radiograph may show a spectrum of findings from normal to bilateral diffuse infiltrates. Detection of serum (1,3)-β-D-glucan along with consistent clinical findings can be used as early screening tools to diagnose and initiate treatment for Pneumocystis pneumonia pending confirmation by bronchoscopy.. This case series describes 6 kidney transplant recipients who were diagnosed as having Pneumocystis pneumonia. The baseline demographic variables, presenting symptoms, radiographic findings, laboratory findings including lactate dehydrogenase and serum (1,3)-β-D-glucan levels, bronchoscopy findings, and its timing in relation to a positive serum (1,3)-β-D-glucan test, and response to treatment were collected.. All 6 patients who completed the first 3 months of prophylaxis against Pneumocystis pneumonia with sulfamethoxazole-trimethoprim were diagnosed as having Pneumocystis pneumonia between 2 to 24 years post transplant. They initiated treatment early based on a positive serum (1,3)-β-D-glucan and negative Histoplasma antigen and serum galactomannan test with a presumptive diagnosis of Pneumocystis pneumonia, which was later confirmed with a positive polymerase chain reaction on bronchoalveolar lavage fluid.. Pneumocystis pneumonia is a common opportunistic fungal infection in immunosuppressed kidney transplant recipients, and use of serum (1,3)-β-D-glucan can be used as an initial screening test for its early diagnosis and treatment.

Topics: Adult; Aged; Diagnosis, Differential; Female; Humans; Immunocompromised Host; Kidney Transplantation; Male; Middle Aged; Opportunistic Infections; Pneumocystis carinii; Pneumonia, Pneumocystis; Postoperative Complications; Proteoglycans; Trimethoprim, Sulfamethoxazole Drug Combination; Young Adult

Pneumocystis jiroveci pneumonia (PCP) is a life-threatening pulmonary infection after kidney transplantation (KTx). Its onset in the current era of modern immunosuppression and of routine use of universal PCP prophylaxis seems to differ from its onset in previous decades in terms of late onset with subtle clinical presentation, indicating a need for increased vigilance.. We retrospectively studied all KTx recipients from our center who underwent bronchoscopy and bronchoalveolar lavage (BAL) between 2009 and 2018. Of these, all cases with confirmed PCP any time after the first post-KTx year were included in the analysis.. Among 60 patients with KTx who had undergone bronchoscopy and BAL, 12 cases with late-onset PCP were identified. PCP appeared late at a median of 10.8 (interquartile range, 2.4-15.8) years after transplantation. Patients' mean age was 59 years, and all were receiving stable low-dose immunosuppression. Most of the patients (67%) had received PCP prophylaxis after KTx. Five out of 12 patients (42%) had concomitant cytomegalovirus (CMV) reactivation at the time of PCP. In almost all cases, clinical presentation was mild. Treatment consisted of trimethoprim-sulfamethoxazole (TMP-SMX) and intravenous corticosteroid administration, and concomitant immunosuppression was temporarily reduced or withdrawn. Outcome was generally good. None of the patients developed respiratory insufficiency or required mechanical ventilation. One patient died as a result of sepsis, and 3 more with preexisting advanced chronic kidney disease subsequently lost their grafts.. Renal transplant recipients are at risk of late-onset PCP, even at a steady state of low-dose maintenance immunosuppression. Because of its subtle clinical presentation, high suspicion of the disease is warranted. Its early recognition and proper management are essential for a successful outcome.

Topics: Adult; Aged; Female; Humans; Immunosuppression Therapy; Kidney Transplantation; Male; Middle Aged; Pneumocystis carinii; Pneumonia, Pneumocystis; Postoperative Complications; Retrospective Studies; Time Factors; Trimethoprim, Sulfamethoxazole Drug Combination

Pneumocystis jirovecii pneumonia (PJP) prophylaxis after pediatric solid organ transplant (SOT) is routinely recommended, but practice varies. Online survey was sent in 2018 to 707 members of the International Pediatric Transplant Association. A total of 105 responded, representing 47 institutions in 18 countries consisting of transplant physicians (66%), transplant surgeons (19%), nurse practitioners (6%), infectious disease physicians (5%), or pharmacists (4%). PJP prophylaxis was reported by 88%, while 12% did not routinely give prophylaxis. The majority not using PJP prophylaxis performed renal transplants (67%) citing low incidence of PJP (62%). Trimethoprim/sulfamethoxazole was first-line agent (95%). PJP prophylaxis for 4-6 months was the most frequent duration following kidney (48%, 27/56), liver (42%, 13/31), and heart (40%, 10/25) transplant. Abdominal multivisceral providers equally gave 10-12 months (47%) or lifelong (47%); most lung transplant providers gave lifelong prophylaxis (85%). Across all organs, 21% provided lifetime prophylaxis. After completion of prophylaxis, 32% do not restart for any reason; majority of the rest would restart for treatment of acute graft rejection. 83% reported no PJP cases in the prior 12 months; 14% reporting 1-5 infections. Only 3% reported a case of PJP infection on prophylaxis; none in SOT. PJP prophylaxis is routinely provided to pediatric SOT patients though practice and duration vary by center and organ type. Durations of 4-6 months were most common for renal, liver, and heart transplant recipients, while 10-12 months or lifelong prophylaxis were commonly reported for abdominal multivisceral recipients and most lung transplant recipients are given lifelong prophylaxis.

Topics: Anti-Infective Agents; Child; Guideline Adherence; Health Care Surveys; Healthcare Disparities; Humans; Organ Transplantation; Pediatrics; Pneumocystis carinii; Pneumonia, Pneumocystis; Postoperative Care; Postoperative Complications; Practice Guidelines as Topic; Practice Patterns, Physicians'; Trimethoprim, Sulfamethoxazole Drug Combination

Lung transplantation (LT) is an identified risk factor for Pneumocystis pneumonia (PCP). However, PCP management and outcomes remain poorly described in LT recipients and PCP incidence is rarely documented in this population.. PCP episodes that occurred in 9 French LT centers between January 2010 and October 2017 were included in this analysis. PCP was defined as compatible clinical and radiologic findings associated with fungal identification.. Forty-seven PCP were included. The annual incidence rate of PCP was 2.7/1000 patients/year. Patients had a mean age of 53 ± 14 years. Median time from LT was 2.4 ± 3.0 years. Sixty-five percent of patients were not on prophylaxis at the time of PCP while all patients were receiving steroids at the time of PCP. Diagnosis was obtained by bronchoalveolar lavage in 91% (direct examination: 47%, PCR: 62%). The majority of patients were treated with trimethoprim-sulfamethoxazole (78%). Fifty-five percent of patients were hospitalized in ICU for organ failure (for which non-invasive ventilation was used for 21% and mechanical ventilation for 23%). Mortality rate was 15% at day 28 and reached 23% at day 90. Mortality was associated with decreased FEV1, everolimus treatment, Pseudomonas aeruginosa coinfection, fungal coinfection (especially Aspergillus sp.), mechanical ventilation and vasopressors. PCP primary prophylaxis, steroid modification during PCP and the number of immunosuppressive molecules were not associated with mortality.. PCP is associated with a high mortality in LT. Our data suggest the need for a lifetime PCP prophylaxis in LT recipients. The benefit of adjuvant steroids remains unclear.

Topics: Adult; Aged; Cohort Studies; Female; France; Humans; Lung Transplantation; Male; Middle Aged; Multicenter Studies as Topic; Pneumonia, Pneumocystis; Postoperative Complications; Retrospective Studies; Time Factors; Trimethoprim, Sulfamethoxazole Drug Combination

The risk of urinary tract infection (UTI) development after flexible cystoscopy (FC) is not well described. It remains difficult to assess the role of pre-FC antimicrobial prophylaxis to reduce UTI risk.. In fall 2017, the urology service at the Providence Veterans Affairs Medical Center implemented routine oral antimicrobial prophylaxis in its outpatient FC clinic. Outpatients were randomly selected for a retrospective chart review to compare patients who received pre-FC antimicrobials (cefuroxime 500 mg tablet or sulfamethoxazole/trimethoprim [800 mg/160 mg] tablet) and those who underwent FC prior to fall 2017 and did not receive prophylaxis. The primary outcome was presence of symptomatic UTI within 30 days post FC. Secondary outcomes included symptomatic UTI that met colony-forming unit (CFU)/mL guideline requirements, and UTI treatment received. Potential risk factors for UTI were also assessed.. A total of 296 patients were included in the final analysis: 139 who did not receive and 157 who received a prophylactic antimicrobial before FC. Rates of symptomatic UTI, symptomatic UTI meeting CFU/mL guideline requirements, and postprocedure treatment for UTI were similar with and without antimicrobial prophylaxis (2.5% vs 2.2% [P > 0.99], 1.9% vs 1.4% [P > 0.99], and 2.5% vs 4.3% [P = 0.53], respectively). The mean number of days from FC to the start of UTI treatment was 7.9 (range, 1-18 days). Age over 65 years was the only risk factor present in all patients with a post-FC UTI, irrespective of antimicrobial prophylaxis.. The rate of post-FC symptomatic UTI was lower than rates previously described in the literature. The role of antimicrobial prophylaxis prior to FC warrants further exploration.

Topics: Age Factors; Aged; Aged, 80 and over; Anti-Bacterial Agents; Antibiotic Prophylaxis; Cefuroxime; Colony Count, Microbial; Cystoscopy; Female; Humans; Male; Middle Aged; Postoperative Complications; Practice Guidelines as Topic; Preoperative Care; Retrospective Studies; Risk Assessment; Risk Factors; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Brucellosis is being increasingly recognized after solid organ transplantation but has not been reported after orthotopic heart transplantation. We present the case of a 51-year-old farmer who underwent orthotopic heart transplantation and was readmitted after 3 months in a severely immunosuppressed state with significant nonspecific complaints. He posed a diagnostic and management dilemma to all disciplines, but finally turned out to be harboring Brucella infection. He responded well to medical management and was discharged in a stable clinical status. Although rare, brucellosis should be included in the investigative workup for nonspecific symptoms after cardiac transplantation.

Topics: Agricultural Workers' Diseases; Animals; Anti-Bacterial Agents; Antibodies, Bacterial; Brucella; Brucellosis; C-Reactive Protein; Cattle; Dairy Products; Delayed Diagnosis; Doxycycline; Drug Therapy, Combination; Heart Transplantation; Humans; Immunocompromised Host; Immunoglobulin M; Immunosuppressive Agents; Leukocytosis; Male; Middle Aged; Postoperative Complications; Trimethoprim, Sulfamethoxazole Drug Combination

Listeria monocytogenes is a rare cause of potentially lethal infection and sepsis in transplant recipients. Listeriosis is usually described after kidney or bone marrow transplant, and has been less frequently reported after liver transplantation. Here, the authors present two cases of severe Listeria infection occurring within 4 months after complicated liver transplantation in patients still recovering on the ward. The patients were successfully treated by intravenous ampicillin. These cases should remind transplant physicians that listeriosis may develop in liver transplant recipients, that food safety advice should be provided, and that intravenous ampicillin might be an effective treatment for systemic listeriosis in solid organ recipients. It is likely that trimethoprim-sulfamethoxazole prophylaxis might help prevent early listeriosis after solid organ transplantation.

Topics: Ampicillin; Anti-Bacterial Agents; Female; Humans; Listeria monocytogenes; Listeriosis; Liver Transplantation; Male; Middle Aged; Postoperative Complications; Sepsis; Trimethoprim, Sulfamethoxazole Drug Combination

Kidney transplant recipients who are switched to atovaquone (ATO) from trimethoprim-sulfamethoxazole (TMP/SMX) for Pneumocystis jirovecii pneumonia (PJP) prophylaxis because of adverse events or complications may miss opportunities to be re-challenged with TMP/SMX, the first-line agent. This single-site, retrospective study assessed kidney transplant recipients for documented reasons for switching from TMP/SMX to alternate PJP prophylaxis and outcomes of TMP/SMX re-challenge. Out of 166 patients, 155 initially received TMP/SMX; of these, 31 were switched to ATO for various reasons. Fourteen patients receiving ATO were re-challenged with TMP/SMX; all were successfully re-initiated on TMP/SMX therapy. Most patients switched to ATO post kidney transplant secondary to non-hypersensitivity reasons should be re-challenged with TMP/SMX because of the advantages it provides over other agents.

Topics: Adult; Anti-Infective Agents; Antibiotic Prophylaxis; Atovaquone; Drug Substitution; Humans; Kidney Transplantation; Pneumocystis carinii; Pneumonia, Pneumocystis; Postoperative Complications; Retrospective Studies; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Young Adult

The echinocandins have shown anti-Pneumocystis jiroveci activity in nonhuman animal models; however, the corresponding human clinical experience has been rarely reported. We report a clinical picture of P jiroveci pneumonia (PJP) and determine the effects of concomitant therapy with echinocandins and trimethoprim (TMP)-sulfamethoxazole (SMZ).. We investigated a retrospective case series of heart transplantation (HT) recipients with PJP from July 1988 to December 2015. Recipient charts were reviewed for their demographic characteristics, underlying conditions, concomitant infections, PJP prophylaxis, TMP-SMZ dosages, adverse events, echinocandin use, oxygenation, and outcomes.. Eleven of 451 HT recipients developed PJP after a median duration of 2.8 years after transplantation. All 11 were treated with TMP-SMZ; 5 of them were treated with echinocandins added to the standard TMP-SMZ regimen. The longest interval between transplantation and PJP development was 16.3 years. The mortality rate was 33.3% in recipients receiving TMP-SMZ alone, whereas it was 20% in those receiving echinocandins as well. The most common side effects of TMP-SMZ include nausea and vomiting, metabolic acidosis, and hyperkalemia. Five recipients developed acute psychosis after a median duration of 6 days of TMP-SMZ therapy. The incidence of psychosis increased from 25% in recipients receiving TMP at ≤15 mg/kg/d to 100% in those receiving TMP at >15 mg/kg/d.. Echinocandins along with the standard TMP-SMZ regimen may effectively alleviate PJP developed after HT. The ideal prophylaxis duration is lifelong owing to the late onset of PJP. The typically intolerable adverse effects of TMP-SMZ therapy for PJP may necessitate dosage adjustments in some cases.

Topics: Adult; Aged; Antifungal Agents; Drug Therapy, Combination; Echinocandins; Female; Heart Transplantation; Humans; Immunocompromised Host; Male; Middle Aged; Pneumocystis carinii; Pneumonia, Pneumocystis; Postoperative Complications; Psychoses, Substance-Induced; Retrospective Studies; Trimethoprim, Sulfamethoxazole Drug Combination

We report the case of a 61 year-old male who underwent heart transplantation eight months before developing a systemic condition with central nervous system, lung, kidney, colonic, cutaneous, and hematologic involvement, found to be secondary to a systemic toxoplasmosis despite co-trimoxazole prophylaxis in a previous-to-transplant seronegative patient receiving a heart from a seropositive donor. A review of prophylactic options in our environment is discussed.

Topics: Antibodies, Protozoan; Antiviral Agents; Combined Modality Therapy; Cytomegalovirus Infections; Disease Progression; Heart Transplantation; Humans; Immunoglobulins, Intravenous; Immunosuppressive Agents; Male; Middle Aged; Plasma Exchange; Postoperative Complications; Recurrence; Seroconversion; Tissue Donors; Toxoplasmosis; Trimethoprim, Sulfamethoxazole Drug Combination; Viremia

We present an isolate of Klebsiella pneumoniae OXA-48 isolated in a 68-year-old\ man who underwent radical prostatectomy due to prostate cancer. The antibiotic susceptibility testing\ to a wide range of antibiotics was performed by disk diffusion method and determination of minimal\ inhibitory concentrations. The isolate was classified as multidrug-resistant. It showed intermediate\ susceptibility to imipenem and meropenem, resistance to ertapenem, and sensitivity only to colistin,\ amikacin, and trimethoprim-sulfamethoxazole. The isolate was positive for ESBLs, negative for\ AmpC. Polymerase chain reaction and sequencing revealed bla(OXA-48)', bla(CTX-M-15) and bla(SHV-11). The plasmid\ encoding OXA-48 ß-lactamase did not belong to any known PCR-based replicon typing. According\ to genotyping, the isolate belonged to ST37.

Topics: Aged; Anti-Bacterial Agents; beta-Lactamases; Drug Resistance, Multiple, Bacterial; Genotype; Humans; Klebsiella Infections; Klebsiella pneumoniae; Male; Microbial Sensitivity Tests; Polymerase Chain Reaction; Postoperative Complications; Prostatectomy; Prostatic Neoplasms; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Urinary tract infections (UTIs) are the commonest infectious complication in kidney transplant recipients (KTRs). No recommendations exist regarding treatment of asymptomatic bacteriuria. We aimed to identify potential risk factors and microbiological profile for UTIs, the role of treatment of asymptomatic bacteriuria, and effects on graft outcomes of bacteriuria within the first year post-transplantation.. We performed a retrospective analysis of UTIs in KTRs transplanted between January 2012 and December 2013 in 2 transplantation centers. Patients were routinely commenced on prophylactic sulfamethoxazole-trimethoprim. Clinical and microbiological data were analyzed for the first year following transplantation.. In all, 276 KTRs were evaluated; 67% were men, with a mean age of 51 years. At 12 months post-transplantation 158 (57%) KTRs had no bacteriuria, 75 (27%) had asymptomatic bacteriuria, 21 (8%) had symptomatic UTIs without further complication, and 22 (8%) with UTIs developed either pyelonephritis or urosepsis. Most frequent pathogens identified were Enterococcus faecalis and Escherichia coli, and 36% of organisms were multidrug resistant. Female sex was a risk factor for infection (P = .002), and presence of a double-J ureteral stent significantly increased the risk of asymptomatic bacteriuria and symptomatic UTIs (P = .003). Diabetes, age, and prior transplantation did not increase risk. Presence of infection was not associated with increased rejection, with similar renal function at 12 months. For episodes of bacteriuria (n = 420, asymptomatic n = 324), untreated asymptomatic bacteriuria (n = 185) followed by symptomatic UTI with the same organism was significantly higher (P = .002) compared with cases of treated asymptomatic bacteriuria (n = 139).. Bacteriuria post-kidney transplantation is common, affecting nearly half of KTRs in the first year after transplantation. Treatment of asymptomatic bacteriuria may be beneficial to prevent subsequent episodes of symptomatic UTIs.

Topics: Adult; Bacterial Infections; Bacteriuria; Enterococcus faecalis; Escherichia coli; Female; Humans; Kidney Transplantation; Male; Middle Aged; Postoperative Complications; Pyelonephritis; Retrospective Studies; Risk Factors; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Amputation, Surgical; Animals; Anti-Bacterial Agents; Delayed Diagnosis; Disease Susceptibility; Fingers; Fishes; Hand Dermatoses; Humans; Levofloxacin; Male; Middle Aged; Mycobacterium Infections, Nontuberculous; Mycobacterium marinum; Pneumonia; Postoperative Complications; Trimethoprim, Sulfamethoxazole Drug Combination

Transurethral resection of the prostate (TURP) surgery is standard treatment for symptomatic benign prostatic hyperplasia when medical therapy has failed. We describe a rare case of osteitis pubis secondary to a prostato-symphocoele sinus after standard bipolar TURP surgery. We also discuss diagnostic techniques and management strategies, and provide an insight into the aetiology of this rare phenomenon. Conservative management with intravenous antibiotics and an indwelling catheter was successful in our case. Treatment in more severe cases may include laparotomy with peritoneal or omental interposition or open retropubic radical prostatectomy to remove the entire sinus tract.

Topics: Anti-Bacterial Agents; Diagnosis, Differential; Doxycycline; Humans; Magnetic Resonance Imaging; Male; Osteitis; Postoperative Complications; Prostatic Hyperplasia; Pubic Bone; Transurethral Resection of Prostate; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Catheterization; Vancomycin

The international guidelines recommend the administration of trimethoprim-sulfamethoxazole (TMP-SMX) as Pneumocystis jiroveci pneumonia (PJP) prophylaxis for six months after transplantation. The aim of this study is to evaluate the influence of TMP-SMX prophylaxis on the occurrence of asymptomatic bacteriuria (ASB) and urinary tract infections (UTIs) as cystitis and allograft pyelonephritis (AGPN) and its impact on the antimicrobial resistance pattern of causative microorganisms.. We have conducted a retrospective before-after study in adult renal allograft recipients with one year follow-up after transplantation. We compared the ("after") group that received TMP-SMX as PJP prophylaxis to the ("before") group that did not receive it.. In total, 343 renal allograft recipients were analysed, of whom 212 (61.8 %) received TMP-SMX as PJP prophylaxis. In this study, 63 (18.4 %) did only develop ASB without UTI, 26 (7.6 %) developed cystitis and 43 (12.5 %) developed AGPN. The remaining 211 (61.5 %) renal allograft recipients did not develop any bacteriuria at all. Multivariable Cox proportional regression analysis indicated that TMP-SMX as PJP prophylaxis was not associated with reduced prevalence of ASB (Hazard ratio (HR) = 1.52, 95 % CI = 0.79-2.94, p = 0.213), nor with reduced incidence of cystitis (HR = 2.21, 95 % CI = 0.76-6.39, p = 0.144), nor AGPN (HR = 1.12, 95 % CI = 0.57-2.21, p = 0.751). Among the group receiving TMP-SMX as PJP prophylaxis there was a trend was observed in increase of both amoxicillin (86 % versus 70 %) and TMP-SMX (89 % versus 48 %) resistance which already appeared within the first 30 days after TMP-SMX exposure.. Among renal allograft recipients, administration of TMP-SMX as PJP prophylaxis does not prevent ASB nor UTI, however it is associated with tendency towards increased amoxicillin and TMP-SMX resistance.

Topics: Adult; Anti-Bacterial Agents; Asymptomatic Diseases; Bacteriuria; Controlled Before-After Studies; Cystitis; Drug Resistance, Bacterial; Female; Follow-Up Studies; Humans; Kidney Transplantation; Male; Middle Aged; Pneumocystis carinii; Pneumonia, Pneumocystis; Postoperative Complications; Pyelonephritis; Retrospective Studies; Transplantation, Homologous; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

To evaluate outcomes and complications of pars plana vitrectomy in patients with epiretinal membrane secondary to toxoplasmic retinochoroiditis.. Retrospective evaluation of the records of 14 patients who underwent pars plana vitrectomy for epiretinal membrane secondary to toxoplasmic retinochoroiditis. The best-corrected visual acuity, intraoperative and postoperative complications, and macular optical coherence tomography were analysed. All patients received postoperative prophylactic treatment with trimethoprim/sulfamethoxazole.. Fourteen patients, 5 men and 9 women, were included. Mean follow-up period after surgery was 6.07 ± 2.64 months. Preoperative mean best-corrected visual acuity was 20/200, and postoperative mean best-corrected visual acuity was 20/60. There were no intraoperative complications. Three patients developed posterior capsule opacification, and one patient developed cataract.. Pars plana vitrectomy is a safe and effective procedure in patients with epiretinal membrane secondary to toxoplasmic retinochoroiditis, improving both visual acuity and anatomical result on macular optical coherence tomography. The most frequent postoperative complications were posterior capsule opacification and cataract. No recurrences of the disease were recorded.

Topics: Adult; Anti-Bacterial Agents; Chorioretinitis; Epiretinal Membrane; Eye Infections, Parasitic; Female; Humans; Intraoperative Complications; Male; Middle Aged; Postoperative Complications; Recurrence; Retrospective Studies; Tomography, Optical Coherence; Toxoplasmosis, Ocular; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Visual Acuity; Vitrectomy; Young Adult

Nocardia is a genus of gram-positive Actinomycetes that are ubiquitous in decaying organic material, soil, and water. Some Nocardia species can infect humans, mainly by airborne transmission. Several reports describe disseminated infections, which are rare and mostly affect strongly immunocompromised patients because intact T-cell-mediated immunity is the major protective mechanism.. We report a case of disseminated pulmonary, cerebral, and cutaneous infection with Nocardia farcinica in a 66-year-old kidney transplant recipient treated with low-dose triple immunosuppression. The patient was initially admitted because of severe hyponatremia and pneumonia with radiologic signs of pleural effusion. The infectious agent was isolated when cutaneous lesions developed. Oral trimethoprim/sulfamethoxazole treatment led to severe hyponatremia; therefore, long-term treatment with parenteral amikacin and minocycline was initiated. After 7 months of consistent intravenous treatment, the lesions completely resolved and treatment was stopped, against some expert suggestions. The patient had remained free of relapse at the time of writing.. Disseminated Nocardia infection in immunocompromised patients is a rare but life-threatening disease. Owing to its infrequency, the variety of clinical patterns, antimicrobial resistance, and often fatal complications of standardized therapy, the diagnosis and treatment of this infection remain challenging and protracted.

Topics: Administration, Intravenous; Aged; Brain Diseases; Female; Humans; Hyponatremia; Immunocompromised Host; Immunosuppressive Agents; Kidney Transplantation; Male; Nocardia; Nocardia Infections; Opportunistic Infections; Pleural Effusion; Pneumonia, Bacterial; Postoperative Complications; Skin Diseases, Bacterial; Trimethoprim, Sulfamethoxazole Drug Combination

Pneumocystis pneumonia (PCP) in solid organ transplant (SOT) recipients becomes rare in the immediate posttransplantation period thanks to generalized prophylaxis. We aimed to identify the predictive factors for PCP in the era of universal prophylaxis and to propose a strategy for preventing PCP beyond the first year after transplantation. In a retrospective case-control study, 33 SOT cases with PCP diagnosed between 2004 and 2010 were matched with two controls each to identify risk factors for PCP by uni- and multivariate analysis. All the patients benefited from 6 months of posttransplantation trimethoprim-sulfamethoxazole prophylaxis. Most PCP in SOT patients occurred during the second year posttransplantation (33%). By univariate analysis, age, nonuse of tacrolimus, total and CD4 lymphocyte counts, gamma-globulin concentration and cytomegalovirus (CMV) infection appeared to be PCP risk factors. In the final multivariate analysis, age (adjusted odds ratio [OR] 3.7, 95% confidence interval [CI]: 1.3-10.4), CMV infection (OR: 5.2, 95% CI: 1.8-14.7) and total lymphocyte count (OR: 3.9, 95% CI: 1.4-10.7) were found to be independently associated with PCP. The second year posttransplantation appeared to be the new period of highest risk of PCP. Age, CMV viremia and lymphocytes were the most pertinent predictive criteria to evaluate the risk of PCP in clinical practice.

Topics: Antibiotic Prophylaxis; Antifungal Agents; Case-Control Studies; Cytomegalovirus; Cytomegalovirus Infections; Female; Follow-Up Studies; Graft Rejection; Graft Survival; Humans; Immunocompromised Host; Male; Middle Aged; Organ Transplantation; Pneumocystis carinii; Pneumonia, Pneumocystis; Postoperative Complications; Retrospective Studies; Risk Factors; Tissue Donors; Transplant Recipients; Trimethoprim, Sulfamethoxazole Drug Combination

Medical leech therapy (MLT) with Hirudo medicinalis is well established as a treatment for venous congestion of tissue flaps, grafts, and replants. Unfortunately, this treatment is associated with surgical site infections with bacterial species, most commonly Aeromonas hydrophila, which is an obligate symbiot of H. medicinalis. For this reason, prophylactic antibiotics are recommended in the setting of MLT. After culturing Aeromonashydrophila resistant to ciprofloxacin from a tissue specimen from a patient with a failed replant of three digits post-MLT, we performed environmental surveillance cultures and antibiotic susceptibility testing on water collected from leech tanks. This surveillance was performed twice weekly for 2.5 months. Fourteen surveillance cultures demonstrated 21 isolates of Aeromonas species, 71.4% of which were ciprofloxacin susceptible. All isolates were sulfamethoxazole-trimethoprim (SXT) susceptible. The prophylactic antibiotic regimen of choice for leech therapy at our institution is SXT, with culture of tank water to refine antimicrobial choice if necessary. This study demonstrates the importance of regular surveillance to detect resistant Aeromonas species in medical leeches; however optimal practice has not been established.

Topics: Aeromonas hydrophila; Amputation, Traumatic; Animals; Anti-Bacterial Agents; Antibiotic Prophylaxis; Ciprofloxacin; Drug Resistance, Bacterial; Finger Injuries; Fingers; Gram-Negative Bacterial Infections; Hirudo medicinalis; Humans; Infection Control; Leeching; Male; Microbial Sensitivity Tests; Postoperative Complications; Replantation; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Acetamides; Adult; Ciprofloxacin; Drug Resistance, Multiple, Bacterial; Heart Transplantation; Humans; Imipenem; Immunocompromised Host; Linezolid; Male; Nocardia; Nocardia Infections; Oxazolidinones; Pneumonia, Bacterial; Postoperative Complications; Tomography, X-Ray Computed; Trimethoprim, Sulfamethoxazole Drug Combination

Stenotrophomonas (S.) maltophilia is an uncommon pathogen of adult bacterial meningitis (ABM).. The clinical characteristics of six S. maltophilia ABM cases, collected during a study period of nine years (2001-2009) were included. In the related literature, 13 S. maltophilia ABM cases were reported, and their clinical data were also collected.. The 19 S. maltophilia ABM cases included 11 men and 8 women, aged 28-70 years. Of these 19 cases, 89.5% (17/19) had underlying neurosurgical (NS) conditions as the preceding event. Before the development of S. maltophilia ABM, 52.6% (10/19) of them had long stays in hospital and 63.2% (12/19) had undergone antibiotic treatment. Among the implicated S. maltophilia cases, three strains were found to have a resistance to sulfamethoxazole-trimethoprim (SMZ-TMP). Two of our five cases had resistant strains to levofloxacin. Among the antibiotics chosen for treatment, SMZ-TMP was the most common followed by quinolone (ciprofloxacin, levofloxacin, moxifloxacin). The therapeutic results showed 2 cases expired while the other 17 cases survived.. S. maltophilia ABM usually develops in patients with a preceding neurosurgical condition, a long hospital stay and antibiotic use. SMZ-TMP and quinolones, especially the ciprofloxacin, are the major antibiotic used. This study also shows the emergence of clinical S. maltophilia strains which are not susceptible to SMZ-TMP and quinolones and this development may pose a more serious threat in the near future because treatment options may become depleted and limited despite the mortality rate of this specific group of ABM not being high at this time.

Topics: Adult; Aged; Anti-Bacterial Agents; Central Nervous System Infections; Drug Resistance, Bacterial; Female; Fluoroquinolones; Gram-Negative Bacterial Infections; Hospitalization; Humans; Incidence; Length of Stay; Male; Meningitis, Bacterial; Microbial Sensitivity Tests; Middle Aged; Neurosurgical Procedures; Postoperative Complications; Retrospective Studies; Stenotrophomonas maltophilia; Trimethoprim, Sulfamethoxazole Drug Combination

Urinary tract infections (UTI), the most common infectious complications after kidney transplantation, are associated with poor allograft survival. Identifying its predisposing factors is therefore remarkably important in order to optimize prevention strategies.. A retrospective study was performed in a cohort of patients who received kidney transplantation between June 2007 and June 2009. Factors associated with development of UTI were assessed.. The population consisted of 301 patients, with majority receiving allograft from living donors (85%). A total of 101 patients (34%) developed at least one episode of UTI, and 25% of the episodes occurred during the first year after transplantation. Risk factors associated with increased risk of UTI were female gender, recurrent UTI prior to transplant, and presence of urological abnormalities. Trimethoprim-sulfamethoxazole (TMP-SMZ) use was associated with a lower risk of UTI, including a lower risk of recurrent UTI.. In this cohort of predominantly living donor kidney transplant recipients, we report a high incidence of UTI, despite our practice of early ureteral and Foley catheter removal. Female gender and prior recurrent UTI or urological abnormalities were predisposing factors, while TMP-SMZ use had a protective role. These clinical relevant findings should guide clinicians in optimizing prevention strategies against UTI in kidney transplant recipients.

Topics: Aged; Anti-Infective Agents, Urinary; Cohort Studies; Female; Humans; Kidney Transplantation; Male; Middle Aged; Postoperative Complications; Retrospective Studies; Risk Factors; Sex Factors; Time Factors; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Topics: Anti-Infective Agents; Antitubercular Agents; Brucellosis; Child; Female; Humans; Immunocompromised Host; Liver Transplantation; Opportunistic Infections; Postoperative Complications; Recurrence; Rifampin; Trimethoprim, Sulfamethoxazole Drug Combination

Esophageal replacement surgery has been used to treat long-gap esophageal atresia, caustic esophageal stricture, and esophageal avulsion. Here, we report total esophageal transplantation in rats without vascular anastomosis as an option for esophageal replacement surgery.. Fourteen total segments of esophageal transplants were harvested from 24-week-old male Sprague-Dawley rats using a harvesting procedure. The segments were transplanted through the mediastinum in the esophageal bed of 15-week-old male Sprague-Dawley rats without adjacent vascular anastomosis using the transhiatal pull-up technique. The ends of the transplanted esophagus were ostomized using cervical and abdominal esophagostomies. An immunosuppressive-treated (IT) group (n = 7) received cyclosporine and cotrimoxazole for 10 days, while an untreated (UT) group (n = 7) received only cotrimoxazole for 10 days. On post-operative day 10, the rats were sacrificed, and the transplant and recipient esophagi were evaluated macroscopically and histopathologically.. All transplantations were successful and all transplanted rats survived. Upon macroscopic evaluation, no evidence of complications was observed and all transplanted esophagi in the two groups appeared to exhibit excellent firm tissue; however, mild necrosis was observed in the cervical end of the transplant in one rat in the IT group. Histopathologic examination showed a viable esophageal structure in all rats. Inflammation and muscular atrophy were lower in the IT group than in the UT group, whereas vascularity was higher in the IT group than in the UT group.. Total esophageal transplantation was performed directly without vascular anastomosis into recipients in a rat model. This procedure should be done in larger animal models before being attempted in humans.

Topics: Anastomosis, Surgical; Animals; Anti-Bacterial Agents; Atrophy; Cyclosporine; Esophagitis; Esophagus; Immunosuppressive Agents; Male; Postoperative Complications; Rats; Rats, Sprague-Dawley; Transplants; Trimethoprim, Sulfamethoxazole Drug Combination; Vascular Surgical Procedures; Wound Healing

A 76-year-old man was admitted to our hospital because of severe anemia. Routine screening revealed a sigmoid adenocarcinoma, and he underwent sigmoidectomy. Post-operatively, he developed rapidly progressive glomerulonephritis. He was positive for myeloperoxidase anti-neutrophil cytoplasmic antibody. A renal biopsy revealed idiopathic crescentic glomerulonephritis of the pauci-immune type. He was treated with methylprednisolone semi-pulse therapy with clinical improvement. After the steroid pulse therapy, he was given oral prednisolone, 40 mg per day, and oral trimethoprim (TMP), 160 mg, and sulfamethoxazole (SMX), 800 mg twice weekly for chemoprophylaxis against pneumocystis pneumonia. One month after the initiation of TMP/SMX, he developed hyperkalemia and hyponatremia. His transtubular K gradient was low, and urinary potassium excretion was decreased. On the other hand, plasma renin activity and plasma aldosterone concentrations were within normal limits. These results suggested that TMP acted similarly to a potassium-sparing diuretic amiloride and reduced renal potassium excretion. Administration of calcium polystyrene sulfonate resulted in correction of the hyperkalemia without discontinuation of TMP/SMX. We emphasize that patients with impaired renal function are at the significant risk of developing trimethoprim-induced hyperkalemia even with chemoprophylaxis.

Topics: Adenocarcinoma; Aged; Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis; Antibiotic Prophylaxis; Glomerulonephritis; Humans; Hyperkalemia; Immunocompromised Host; Male; Pneumonia, Pneumococcal; Postoperative Complications; Sigmoid Neoplasms; Trimethoprim, Sulfamethoxazole Drug Combination

Risk stratification-based duration of trimethoprim-sulfamethoxazole (TMP-SMX) chemoprophylaxis to prevent Pneumocystis pneumonia (PCP) in kidney transplant recipients is not a universally adapted strategy and supporting evidence-based sources are limited. We performed a large retrospective study to identify risk factors for PCP in kidney transplant recipients and to define parameters for use in clinical prophylaxis guidelines. Fifty consecutive patients with confirmed PCP and 2 time-matched controls per case were enrolled. All patients were participants of the kidney transplantation program of the Leiden University Medical Center, a tertiary care hospital in the Netherlands. Potential risk factors were compared between groups by uni- and multivariate matched analyses. At transplantation, age >55 years (adjusted odds ratio [OR] 2.7, 95% confidence interval [CI] 1.3-5.9) and not receiving basiliximab induction therapy (adjusted OR 4.3, 95% CI 1.1-17.1) predicted development of PCP. In the final multivariate analysis, only cytomegalovirus infection (adjusted OR 3.0, 95% CI 1.2-7.9) and rejection treatment (adjusted OR 5.8, 95% CI 1.9-18) were found to be independently associated with PCP. Using the variables identified by the multivariate analyses, effects of different hypothetical chemoprophylaxis strategies were systematically evaluated. Exploring different scenarios showed that chemoprophylaxis in the first 6 months for all renal transplant patients - and during the first year posttransplantation for patients >55 years of age or those treated for rejection - would result in very low PCP incidence and optimal avoidance of TMP-SMX toxicity. The results provide a rationale for further prospective study on targeted provision of chemoprophylaxis to prevent PCP in kidney transplant patients.

Topics: Adult; Age Factors; Antibiotic Prophylaxis; Antibodies, Monoclonal; Basiliximab; Cohort Studies; Cytomegalovirus; Cytomegalovirus Infections; Female; Graft Rejection; Humans; Immunocompromised Host; Immunosuppressive Agents; Kidney Transplantation; Male; Middle Aged; Multivariate Analysis; Pneumocystis carinii; Pneumonia, Pneumocystis; Postoperative Complications; Recombinant Fusion Proteins; Retrospective Studies; Risk Factors; Trimethoprim, Sulfamethoxazole Drug Combination

Prophylaxis against Pneumocystis jirovecii pneumonia (PCP) is recommended for at least 4-12 months after solid organ transplant. In our center, renal transplant recipients receive only 1 month of post-transplant trimethoprim-sulfamethoxazole, which also may provide limited protection against Nocardia. We identified only 4 PCP cases and 4 Nocardia cases in 1352 patients receiving renal and renal-pancreas transplant from 2003 to 2009 at the University of Michigan Health System. Two PCP cases were identified <1 year after transplant, and 2 PCP cases were identified >1 year after transplant (gross attack rate 4/1352, 0.3%). Two Nocardia cases were identified <1 year after transplant, and 2 cases were identified >1 year after transplant. All identified cases received induction therapy (7 of 8 with anti-thymocyte globulin), whereas about one-half of all renal transplant patients received induction therapy at our institution. No patient was treated for rejection within 6 months of PCP; 2 of 4 patients with PCP had recent cytomegalovirus infection. All patients with PCP and 3 of 4 patients with Nocardia survived. The benefits of prolonged PCP prophylaxis should be weighed against the adverse events associated with prolonged use of antimicrobials.

Topics: Anti-Bacterial Agents; Antibiotic Prophylaxis; Drug Administration Schedule; Humans; Immunocompromised Host; Immunosuppression Therapy; Kidney Transplantation; Nocardia Infections; Opportunistic Infections; Pneumocystis carinii; Pneumonia, Pneumocystis; Postoperative Complications; Retrospective Studies; Trimethoprim, Sulfamethoxazole Drug Combination

Urinary tract infection (UTI) is a common complication among kidney transplant patients. UTI caused by multi-resistant extended-spectrum beta-lactamase producing bacteria (ESBL) have largely increased among the hospitalized patient population and especially kidney transplant recipients. We retrospectively studied 83 kidney transplant patients to evaluate the incidence and possible causative conditions of ESBL-related UTI over the last 6 years. ESBL production was determined by the antibiotic susceptibility profile of urine cultures. We compared the incidence in two 3-year periods, 2003-2005 (period 1) and 2006-2008 (period 2). An high incidence of ESBL-related UTI (16.8%) was observed in the posttransplant period performing 31% of the overall UTI incidence, with an increase over the last 3 years from 23.8% to 37.5%. ESBL-related UTI was related to previous episodes of UTI (78.6% vs 29.0%; P < .01) and reoperations (50.0% vs 12.9%; P < .05). We observed a progressively increasing incidence of 13%, 38%, and 45% of ESBL-related UTI among first, second, and third episodes, respectively. Age, gender, HLA mismatches, etiology of chronic kidney disease, diabetes mellitus, acute rejection, induction treatment, and type/level of immunosuppressants were similiar between the groups with or without ESBL-related UTI. We observed a high increased incidence of ESBL-related UTI among kidney transplant recipients, and particularly patients with recurrent UTI.

Topics: Adult; Anti-Bacterial Agents; beta-Lactamases; Cefazolin; Escherichia coli; Escherichia coli Infections; Female; Glomerulonephritis; Graft Rejection; Histocompatibility Testing; Humans; Kidney Transplantation; Male; Microbial Sensitivity Tests; Middle Aged; Postoperative Complications; Recurrence; Retrospective Studies; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Recently, the applicability of lungs from drowned victims for transplantation has been anecdotically described in literature. However, no data exist about hazards or limitations. Herein, we describe a case of lung transplantation from a submersion victim and the subsequent development of an Aeromonas hydrophila infection in the implanted organ. Based on this case we propose standard procedures, which should be followed when considering drowned donor lungs, in order to minimize risks for infectious complications.

Topics: Adult; Aeromonas hydrophila; Bronchoalveolar Lavage Fluid; Donor Selection; Drowning; Female; Gram-Negative Bacterial Infections; Humans; Lung Transplantation; Postoperative Complications; Pulmonary Disease, Chronic Obstructive; Staphylococcal Infections; Tissue and Organ Procurement; Tissue Donors; 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

Bartonella henselae is the causative agent of cat-scratch disease and other disorders, including hepatosplenic granulomatosis. This infection has only rarely been reported after solid organ transplantation, where it can mimic the more common post-transplant lymphoproliferative disease. Here we present a case of asymptomatic B. henselae hepatic and lymph nodal granulomatosis in a pediatric patient who had received orthotopic liver transplant 2 months before; we hypothesize that the causative agent was transmitted from the donor. This infection developed early in the post-transplant period; the disease involved only the graft liver and the regional lymph nodes, and the patient did not have a cat or any history of contact, scratches, or bites by a cat. In our patient this infection resolved successfully with a combination of 2 associated antibiotics and reduction of immunosuppressive therapy.

Topics: Amikacin; Anti-Infective Agents; Antibodies, Bacterial; Azithromycin; Bartonella henselae; Cat-Scratch Disease; Child; Humans; Immunosuppressive Agents; Liver; Liver Neoplasms; Liver Transplantation; Lymph Nodes; Lymphomatoid Granulomatosis; Male; Postoperative Complications; RNA, Bacterial; RNA, Ribosomal, 16S; RNA, Ribosomal, 23S; Tacrolimus; Tissue Donors; Transplants; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Ultrasonography

Nocardia infection occurs in 2.1-3.5% of lung transplant recipients, and may involve cavitary nodular pulmonary lesions, soft tissue infection, or other sites of dissemination. Nocardiosis can pose challenging clinical problems in the areas of diagnosis and treatment. Diagnostic delays may occur, and adverse reactions to therapy are common. This study reviews clinical and epidemiological aspects of nocardiosis in lung transplant recipients, with special attention to pitfalls in management. Clinicians should be alert for these possibilities in order to institute prompt therapy and to achieve successful outcomes.. A retrospective cohort study was conducted of 577 lung transplant recipients from January 1991 to May 2007. Demographics, reason for transplant, recent rejection, time from transplantation, site of infection, hypogammaglobulinemia, and/or neutropenia shortly before onset, Pneumocystis jiroveci prophylaxis, Nocardia species, radiographic findings, extrapulmonary lesions, nature and duration of treatment, adverse reactions, and outcomes were recorded.. Nocardia infection occurred in 1.9% (11/577). Mean onset was 14.3 months after transplant (range 1.5-39 months). N. asteroides was isolated in 55% (6/11). Emphysema was the most common reason for transplant (7/11, 64%). Six patients were receiving trimethoprim-sulfamethoxazole (TMP-SMX) prophylaxis at the time of diagnosis. Three patients had immune globulin G levels <400 mg/dL and 2 were neutropenic in the 3 months preceding diagnosis. Diagnosis was made by bronchoalveolar lavage (55%), skin abscess culture (18%), open lung biopsy (9%), pleural fluid (9%), and sputum culture (9%). Definitive diagnosis required a median of 9 days and a mean of 13.6 days (range 3-35 days) from the time of diagnostic sampling. Soft tissue lesions occurred in 3 and central nervous system involvement in 1 patient. Adverse reactions to therapy occurred in 9/10 (90%) of patients for whom information was available. Nocardia-related mortality occurred in 2/11 patients (18%).. Nocardiosis occurred in 1.9% of lung transplant recipients and was associated with a mean of nearly 2 weeks to diagnosis and frequent adverse effects on therapy. TMP-SMX prophylaxis on a thrice weekly basis did not prevent all episodes of nocardiosis. Despite utilization of protocol bronchoscopies with cultures for Nocardia, this organism remains a source of clinical complexity in the lung transplant population.

Topics: Abscess; Adult; Anti-Infective Agents; Biopsy; Cohort Studies; Female; Humans; Lung; Lung Transplantation; Male; Middle Aged; Nocardia asteroides; Nocardia Infections; Ohio; Pleural Cavity; Postoperative Complications; Retrospective Studies; Skin; Sputum; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Pyogenic spondylodiscitis associated with epidural abscess is a rare but serious problem in spinal surgery, because it may cause a severe morbidity or mortality, if the diagnosis is established late and the treatment is inadequate. A case of pyogenic thoracic spondylodiscitis associated with epidural abscess whose symptoms progressed over two months from back pain to acute paraplegia was presented. Magnetic resonance imaging of the spine suggested the presence of T9-10 spondylodiscitis with partial destruction of the T9 and T10 vertebral bodies and concomitant epidural abscess. Treatment consisting of surgical debridement of infected vertebrae and disc material, fusion and anterior spinal instrumentation was performed. Microbiological culture of the material revealed infection with Staphylococcus aureus and after 3 months of antibiotic treatment, recovery was almost complete. Based on a thorough review of the literature and the case presented in this report, it is concluded that accurate and prompt diagnosis requires high index of suspicion followed by a combination of adequate surgical and conservative treatment prevents severe morbidity in cases of nonspecific pyogenic spondylodiscitis associated with epidural abscess.

Topics: Acute Disease; Administration, Oral; Cefazolin; Debridement; Discitis; Diskectomy; Epidural Abscess; Follow-Up Studies; Humans; Infusions, Intravenous; Magnetic Resonance Imaging; Male; Middle Aged; Neurologic Examination; Paraplegia; Postoperative Care; Postoperative Complications; Recovery of Function; Spinal Cord Compression; Spinal Fusion; Staphylococcal Infections; Thoracic Vertebrae; Trimethoprim, Sulfamethoxazole Drug Combination

Posttransplant lymphoproliferative disorder (PTLD) is a serious complication after solid organ transplantation. An elevated serum lactate dehydrogenase (LDH) is a marker of PTLD activity. We report the case of a 58-year-old female renal transplant patient with a prior history of extranodal PTLD, which developed 19 years after a second transplant. She was successfully treated with rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone (R-CHOP) and maintained subsequently on sirolimus and prednisone. She presented 3 years later with fever, dyspnea, cough, lung infiltrates and elevated serum LDH concerning for recurrence of PTLD. Bronchoscopy revealed Pneumocystis carinii (jiroveci) pneumonia. The patient was treated with trimethoprim-sulfamethoxazole, but developed nausea and was converted to dapsone. The patient was readmitted 4 weeks later with increasing dyspnea and hypoxemia and found to have a methemoglobin level of 16%. Dapsone was discontinued with resolution of all symptoms. We discuss the diagnostic and clinical challenges in this complex case.

Topics: Anti-Infective Agents; Biomarkers; Dapsone; Female; Humans; Kidney Transplantation; L-Lactate Dehydrogenase; Lymphoproliferative Disorders; Middle Aged; Pneumocystis Infections; Postoperative Complications; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

To report a cluster of Nocardia asteroides keratitis cases after LASIK.. Retrospective review of the history and examination of three patients (four eyes) operated on the same day at a single center who developed postoperative keratitis. All patients underwent lifting of the superficial flap for microbiologic evaluation of the corneal scrapings. The operating surgeon was contacted to identify the possible source of contamination.. Two patients underwent simultaneous bilateral LASIK; however, only one developed postoperative keratitis in both eyes. One patient had unilateral surgery and developed keratitis in the operated eye. Microscopic examination of smears from all eyes revealed thin, branching, acid-fast, filamentous bacteria that were identified as Nocardia asteroides after culture. The infiltrates resolved with topical administration of amikacin sulphate (2.5%) and topical and oral trimethoprim-sulfamethoxazole. Final visual acuity ranged between 20/25 and 20/80. The operating surgeon had used the same blade and microkeratome in all patients.. Nocardia, a relatively unusual organism, can cause an epidemic of infection after LASIK.

Topics: Amikacin; Cefazolin; Cluster Analysis; Corneal Ulcer; Drug Therapy, Combination; Equipment Contamination; Eye Infections, Bacterial; Humans; Keratomileusis, Laser In Situ; Nocardia asteroides; Nocardia Infections; Postoperative Complications; Refractive Surgical Procedures; Retrospective Studies; Surgical Flaps; Trimethoprim, Sulfamethoxazole Drug Combination

We describe the first case of isosporiasis in a liver transplant patient. Watery diarrhea due to Isospora belli was observed in a woman who had undergone liver transplantation 8 months prior. She was successfully treated with trimethoprim-sulfamethoxazole. This parasite should be taken into consideration as an opportunistic infection in transplant patients who need increased hygienic awareness.

Topics: Adult; Animals; Antiparasitic Agents; Female; Humans; Immunocompromised Host; Isospora; Isosporiasis; Liver Transplantation; Postoperative Complications; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Anti-Bacterial Agents; Arthralgia; Arthritis; Arthritis, Infectious; Arthroplasty, Replacement, Knee; Atorvastatin; Combined Modality Therapy; Debridement; Diagnosis, Differential; Doxycycline; Drug Interactions; Female; Heptanoic Acids; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Hyperlipoproteinemia Type II; Levofloxacin; Middle Aged; Ofloxacin; Postoperative Complications; Prosthesis-Related Infections; Pyrroles; Recurrence; Reoperation; Rifampin; Thyroiditis, Autoimmune; Thyroxine; Trimethoprim, Sulfamethoxazole Drug Combination

To investigate the early diagnosis, treatment and prevention of pneumocystosis complicated after renal transplantation.. Data from 12 cases of kidney transplant recipients who developed pneumocystosis were analyzed by clinical symptoms and signs, results of laboratory examination, imaging, bronchoscopy and biopsy. Combined TMP/SMZ was used for the prevention and treatment.. Pneumocystis carinii (Pc) detection rate was 16.7% from alveolar douche, 66.7% with bronchoscopy and biopsy. Two cases was diagnosed by PCR method with sputum. Plain chest film showed 58.3% of lung cirrhosis. CT showed 50% frosted glass-like change in lungs and 25% with lung consolidation. Eleven cases were cured but one died.. Pc detection by bronchoscopy and biopsy, and PCR are most helpful in the diagnosis of pneumocystosis complicated with renal transplantation, in addition to plain chest film and CT scaning. Combined TMP/SMZ is effective in the prevention and treatment of pneumocystosis.

Topics: Adolescent; Adult; Anti-Infective Agents; Female; Glomerulonephritis; Humans; Immunosuppressive Agents; Kidney Transplantation; Male; Middle Aged; Pneumonia, Pneumocystis; Postoperative Complications; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Biopsy; Drug Eruptions; Exanthema; Humans; Keratinocytes; Male; Middle Aged; Postoperative Complications; Prostatectomy; Skin; Skin Diseases, Vesiculobullous; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

The efficacy of trimethoprim-sulfamethoxazole (TMP/SMX) in the prevention of toxoplasmosis after orthotopic cardiac transplantation has been the subject of some controversy, with many transplant groups preferring to use the combination of pyrimethamine and sulfadiazine. Although effective, this latter regimen does not offer equal protection against other pathogens, such as or. To assess the value of TMP/SMX, we reviewed the experience in our heart transplant patients, all of whom received TMP/SMX (160/800 mg) three times weekly for approximately 8 months after transplantation.. We report on 417 orthotopic cardiac transplants during a 17-year period. We have 100% one-year patient follow-up after transplantation. Data was collected on pretransplantation donor and recipient anti- serology, immunosuppression, allograft rejection, survival, yearly posttransplantation anti- serology, development of acute toxoplasmosis, and the occurrence of other infections.. In this cohort, acute toxoplasmosis developed after transplantation in one case (0.2%). Among the highest risk patients (D+R-) who were treated for at least one episode of rejection, the risk of acute toxoplasmosis was 5% (1 of 22 patients). No change in survival was found between the different anti- IgG serogroups (D-R-, D-R+, D+R-, or D+R+). Anti- IgG seroconversion occurred in eight -seronegative recipients after transplantation; all patients, except the case already noted, were asymptomatic and required no specific anti- therapy. No cases of, or infections were identified. Five proven and two suspected cases of pneumonia were found (only 2 of these 7 patients were receiving TMP/SMX at the time of pneumonia diagnosis).. These data demonstrate that TMP/SMX prophylaxis (160/800 mg) three times per week is effective prophylaxis after orthotopic cardiac transplantation and has prophylactic benefits against other posttransplantation opportunistic pathogens.

Topics: Anti-Infective Agents; Female; Follow-Up Studies; Heart Transplantation; Humans; Male; Postoperative Complications; Prevalence; Retrospective Studies; Risk Factors; Survival Analysis; Toxoplasmosis; Trimethoprim, Sulfamethoxazole Drug Combination

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

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

Topics: Ceftazidime; Drug Therapy, Combination; Humans; Kidney Transplantation; Male; Melioidosis; Middle Aged; Postoperative Complications; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Anti-Infective Agents; Graft Rejection; Humans; Immunosuppressive Agents; Postoperative Complications; Premedication; Transplantation; Trimethoprim, Sulfamethoxazole Drug Combination

Opportunist central nervous system infections occur in about 5% to 10% of all renal transplant recipients, but reports of brain abscesses are very rare (1). Nocardia asteroides cerebral abscesses are scarce intracranial lesions. They account for only 2% of brain abscesses (2). Published data about these lesions have taken the form of short reports, small cases series and reviews. A universally accepted and effective treatment approach has not yet been established. We present a renal transplant patient with a cerebral abscess caused by Nocardia asteroides.

Topics: Adult; Anti-Bacterial Agents; Brain Abscess; Humans; Immunocompromised Host; Kidney Transplantation; Magnetic Resonance Imaging; Male; Nocardia asteroides; Nocardia Infections; Opportunistic Infections; Postoperative Complications; Trimethoprim, Sulfamethoxazole Drug Combination

Nocardia is responsible for infection in both normal and immunocompromised hosts. Organ transplant recipients are increasingly recognized as a sub-group of immunocompromised patients in whom nocardia is an important pathogen. The frequency of nocardia in organ transplant recipients varies between 0.7% and 3%. Nocardia infection has largely been reported in heart, kidney and liver transplant recipients. Presentations of nocardia in lung transplant recipients have been restricted primarily to case reports. The present study reviews the clinical and epidemiologic characteristics of nocardia infection in lung transplant recipients at our institution.. A retrospective cohort study of 473 lung transplant recipients from January 1991 to November 2000 was done at a university hospital. Patient demographics, immunosuppressive regimen at the time of isolation of nocardia species, use of trimethoprim-sulfamethoxazole for Pneumocystis carinii prophylaxis, rejection episodes in the preceding 6 months, concurrent pathogens, site of infection, radiologic findings and treatment and outcome were recorded.. Nocardia infection was found in 2.1% (10 of 473) of our lung transplant recipients. Median time of onset was 34.1 months after transplantation. Nocardia species included N farcinica in 30% (3 of 10), N nova in 30% (3 of 10), N asteroides complex in 30% (3 of 10) and N brasiliensis in 10% (1 of 10) of patients. Post-transplant diabetes was present in 50% (5 of 10) of patients. The primary indication for lung transplantation was emphysema in 40% (4 of 10). Native lung involvement was noted in 75% (3 of 4) of patients with single lung transplant. Breakthrough nocardia infection were noted in 6 patients who were receiving trimethoprim-sulfamethoxazole prophylaxis for P carinii pneumonia; all breakthrough isolates remained susceptible to trimethoprim-sulfamethoxazole. Overall mortality was 40% (4 of 10). All patients (3 of 3) with infection due to N farcinica, except 1 (1 of 7) with infection due to other nocardia species, died. Seventy-five percent (3 of 4) of deaths were attributable to nocardia infection.. Nocardia infection tended to involve the native lung in single lung transplant recipients. Trimethoprim-sulfamethoxazole for P carinii prophylaxis at the doses given was not protective against nocardiosis in these patients. Infection with N farcinica was associated with poor outcome. Thus, species identification and extended courses of antibiotics based on antimicrobial susceptibility testing are important in management of these patients.

Topics: Adult; Anti-Infective Agents; Female; Humans; Lung Transplantation; Male; Middle Aged; Nocardia Infections; Pneumonia, Pneumocystis; Postoperative Complications; Retrospective Studies; Trimethoprim, Sulfamethoxazole Drug Combination

To evaluate oral single dose prophylaxis in colorectal surgery.. Prospective study.. University hospital, Sweden.. 24 patients (13 women; 11 men; mean age 57 years, range 27-81) listed for elective colorectal operations.. At 0630 on the day of the operation all patients were given an oral dose of trimethoprim-sulphamethoxazole (TMP 160 mg and SMZ 800 mg) and metronidazole (2 g). The serum concentrations of TMP and SMZ were analysed in venous samples taken at the start and end of each operation.. The earliest operation started at 0830 and the last finished at 1700. The median (range) serum concentrations of TMP were 1.4 (0.7-2.6) mg/L (start) and 1.3 (1.0-2.8) mg/L (end), and of SMZ 35 (15-65) mg/L (start) and 33 mg (13-70) mg/L (end). The individual values were above or equal to the minimal inhibitory concentration (TMP 0.8 mg/L; SMZ 15.2 mg/L) for relevant gram-negative species.. Oral TMP/SMZ in the morning gives satisfactory serum concentrations independently of when the operation is done during the day. The regimen is simple and has the potential for being an effective alternative to intravenous prophylaxis.

Topics: Administration, Oral; Adult; Aged; Anti-Infective Agents; Biological Availability; Colorectal Surgery; Costs and Cost Analysis; Female; Humans; Male; Metronidazole; Middle Aged; Postoperative Complications; Prospective Studies; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Abscess; Drug Therapy, Combination; Humans; Immunocompromised Host; Immunosuppressive Agents; Kidney Transplantation; Nocardia asteroides; Nocardia Infections; Ofloxacin; Opportunistic Infections; Postoperative Complications; Recurrence; Skin Diseases, Bacterial; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adolescent; Adult; Antibiotic Prophylaxis; Child; Female; Humans; Iran; Kidney Transplantation; Male; Middle Aged; Postoperative Complications; Prevalence; Reproducibility of Results; Retrospective Studies; Stents; Trimethoprim, Sulfamethoxazole Drug Combination; Ureter; Urinary Tract Infections

Pulmonary nocardiosis is an infrequent but insidious disease in transplant patients. It has occurred in our centre in 3 out of 233 heart-transplant recipients since 1988. Common clinical features were mild symptoms and a severe nodular lung involvement. Early diagnosis was based upon cultures of bronchoalveolar lavage or fine-needle aspirate specimens of the lung lesions. Susceptibility studies and tests of antibiotic synergism guided the therapy. Two patients were treated with a combination of piperacillin-tazobactam and ciprofloxacin, and one with imipenem and amikacin, for 3-4 wk followed by a 3-month course of trimethoprim-sulphamethoxazole. The nocardial disease was successfully treated in the 3 patients; however, one died of subsequent invasive pulmonary aspergillosis. In the absence of consensus on the length of therapy, this experience suggests that a synergistic combination of a beta-lactam/beta-lactamase inhibitor with ciprofloxacin or amikacin followed by a short course of trimethoprim-sulphamethoxazole may be effective in eradicating nocardial disease and may reduce the need for long-term treatment.

Topics: Adult; Anti-Bacterial Agents; Bronchoalveolar Lavage; Ciprofloxacin; Female; Heart Transplantation; Humans; Lung Diseases; Male; Microbial Sensitivity Tests; Middle Aged; Nocardia; Nocardia Infections; Penicillanic Acid; Piperacillin; Postoperative Complications; Tazobactam; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adult; Amikacin; Cataract; Cataract Extraction; Ceftriaxone; Drug Therapy, Combination; Eye Infections, Fungal; Humans; Immunosuppressive Agents; Kidney Transplantation; Male; Nocardia Infections; Postoperative Complications; Transplantation, Homologous; Trimethoprim, Sulfamethoxazole Drug Combination

Drug-induced acute interstitial nephritis is a common cause of dysfunction in native kidneys, but is rarely reported in renal allografts. This report describes six renal transplant recipients with acute renal allograft dysfunction or delayed allograft function in whom a renal transplant biopsy showed histopathologic features of drug-induced interstitial nephritis with no diagnostic evidence of acute rejection, cyclosporine or tacrolimus nephrotoxicity, or other lesion that could account for the graft dysfunction. In five of the six patients, interstitial nephritis occurred within 4 weeks of transplantation. All the patients were receiving trimethaprim-sulfamethoxazole and/or other drugs associated with interstitial nephritis. After discontinuation of these drugs and short-term corticosteroid treatment, all patients showed improvement in renal function, although the time course of this improvement varied considerably, with three patients showing a return to baseline serum creatinine level within 2 weeks and two patients showing a gradual improvement over 8 weeks. Four of the five patients followed up for more than 1 year (range, 14 to 33 months) after the episode of interstitial nephritis had good allograft function (serum creatinine level

Topics: Acute Disease; Adult; Biopsy; Diagnosis, Differential; Drug Therapy, Combination; Female; Graft Rejection; Humans; Kidney; Kidney Transplantation; Male; Middle Aged; Nephritis, Interstitial; Postoperative Complications; Risk Factors; 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

Idiopathic pulmonary fibrosis (cryptogenic fibrosing alveolitis) is a disorder with a very poor prognosis for patients who do not respond to therapy with corticosteroids alone or in combination with immunosuppressive drugs, e.g. cyclophosphamide or azathioprine. For patients with end-stage disease, lung transplantation remains the only possibility for long-term survival. We describe a patient who received a left single lung transplant for end-stage desquamative interstitial pneumonitis. One year later, the patient again began complaining of exertional dyspnoea and a gradual decline in the transfer factor of the lung for carbon monoxide (TL,CO) was apparent. A recurrence of the primary disease in the transplanted lung was suspected on transbronchial biopsies. During treatment with high doses of steroids, a Pneumocystis carinii pneumonia developed, which was treated with co-trimoxazole. The patient completely recovered and, after a period of over 2 yrs, remained in an excellent condition, after which time he was lost from follow-up.

Topics: Adult; Anti-Infective Agents; Glucocorticoids; Humans; Lung Transplantation; Male; Methylprednisolone; Pneumonia, Pneumocystis; Postoperative Complications; Pulmonary Fibrosis; Recurrence; Trimethoprim, Sulfamethoxazole Drug Combination

We report a case of Alcaligenes xylosoxidans keratitis following penetrating keratoplasty in a rigid gas permeable (RGP) lens wearer.. A 61 year old RGP lens wearer with a history of nonresponsive keratitis of the right eye which involved the graft margin was referred to us for treatment. Corneal cultures revealed growth of a gram-negative rod on the fifth day and the organism was subsequently identified as Alcaligenes xylosoxidans, which was resistant to most antibiotics and sensitive only to Bactrim, Timentin, and imipenem.. Clinical improvement was observed within 24 hours after treatment with the use of topical i.v. Bactrim and topical i.v. Timentin 2% alternating every 30 minutes. Complete resolution of the infection with mild scarring was observed 6 weeks after treatment.. Alcaligenes xylosoxidans is a potential cause of bacterial keratitis which should be considered in cases of nonresponsive gram-negative keratitis. The addition of topical Bactrim or Timentin may need to be considered in such cases.

Topics: Administration, Topical; Alcaligenes; Anti-Bacterial Agents; Bacterial Infections; Clavulanic Acids; Contact Lenses; Cornea; Drug Therapy, Combination; Gases; Humans; Keratitis; Keratoplasty, Penetrating; Male; Middle Aged; Permeability; Postoperative Complications; Ticarcillin; Trimethoprim, Sulfamethoxazole Drug Combination

A 53-year-old patient had a prosthetic valve (St. Jude Medical 25) 9 years ago because of a Staphylococcus aureus endocarditis with severe aortic regurgitation. An initially mild, progressively more severe, aortic regurgitation then developed as a result of an empty paravalvular abscess cavity, requiring another valve replacement. Fever started on the 3rd postoperative day and persisted despite combined treatment with beta-lactam antibiotics and aminoglycoside.. At first no infectious focus could be identified radiologically or by echocardiography. But transoesophageal echocardiography revealed vegetations in the old abscess cavity. Several blood cultures were negative, while serological tests gave markedly raised antibody titers against Coxiella burnetii.. Assuming Coxiella burnetii endocarditis the patient was given doxycycline, 2 x 100 mg daily and cotrimoxazole, 1 x 960 mg daily. The fever subsided and the vegetations had disappeared after four weeks. Because of the high risk of recurrence the antibiotic treatment was to be continued for two years.. Coxiella burnetii should be considered as a possible cause of fever of unknown origin, especially in patients with existing or operated cardiac valvar defects, when endocarditic vegetations have been demonstrated and several blood cultures have been negative.

Topics: Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Antibodies, Bacterial; Aortic Valve; Aortic Valve Insufficiency; Coxiella burnetii; Doxycycline; Drug Therapy, Combination; Echocardiography, Transesophageal; Endocarditis, Bacterial; Gentamicins; Heart Valve Prosthesis Implantation; Humans; Male; Middle Aged; Postoperative Complications; Q Fever; Recurrence; Reoperation; Treatment Failure; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: ABO Blood-Group System; Adolescent; Adult; Antibiotic Prophylaxis; Bacterial Infections; Blood Group Incompatibility; Child; Communicable Diseases; Cytomegalovirus Infections; Female; Fever; Graft Survival; Humans; Kidney Transplantation; Male; Middle Aged; Postoperative Complications; Retrospective Studies; Survival Rate; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Desensitization, Immunologic; Drug Hypersensitivity; Female; Humans; Lung Transplantation; Middle Aged; Postoperative Complications; Trimethoprim, Sulfamethoxazole Drug Combination

To evaluate the efficacy and safety of cotrimoxazol plus rifampicin in staphylococcal osteoarticular infection.. Open, non-comparative study of adult hospitalized patients with documented staphylococcal bone infection.. From Feb 1989 to Dec 1993 28 episodes of staphylococcal bone infection were treated in 14 men and 13 women; the mean age was 48 +/- 21 years (range, 11-84). They received cotrimoxazol (7 mg/kg/day of trimethoprim) plus rifampicin (600-1200 mg/day), both orally, every 8 to 12 h with a mean duration of treatment of 34.2 +/- 8.2 days (range, 21 to 55 days). This antibiotic regimen was initiated at the same time that appropriate surgery for each specific condition was undertaken. Diagnoses were postsurgical osteomyelitis (10 cases), infected total hip prostheses (4 cases, one with 2 episodes), osteomyelitis secondary to external pin fixation (5 cases), soft tissue infections linked to orthopedic implants (3 cases), two cases of metatarsal osteomyelitis (one diabetic foot and one patient with polineuropathy), and one case each of chronic osteomyelitis of femur, hematogenous lumbar spondylitis and posttraumatic osteomyelitis. Four patients had bacteremia. The duration of the infection, prior to surgery was less than one month in 12 episodes, 1 month to 2 years in 14, and in 2 cases, of 10 and 13 years, respectively. In 23 episodes the causal agent was Staphylococcus aureus and in 5 cases it was coagulase-negative staphylococci. Patients had received previous parenteral therapy with other antimicrobials during 2-40 days (X: 18.6 +/- 10.2 days). All patients but one had resolution of the infection and are currently asymptomatic 6 months to 5 years posttreatment in the 21 evaluable cases (X: 38 +/- 13.1 months). Five patients had adverse effects secondary to the antibiotic combination and in three these were severe enough to discontinue the antimicrobials. In no case of the 11 patients with post-treatment control cultures were staphylococci recovered from the wound.. The combination of cotrimoxazole plus rifampicin, both given orally, was highly effective in this selected group of patients. This combination should be considered as a useful alternative therapy of staphylococcal bone infection and deserves further study.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Bacteremia; Child; Drug Therapy, Combination; Female; Humans; Lumbar Vertebrae; Male; Middle Aged; Osteomyelitis; Postoperative Complications; Retrospective Studies; Rifampin; Spondylitis; Staphylococcal Infections; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adult; Antibiotic Prophylaxis; Bacteriuria; Ciprofloxacin; Female; Humans; Kidney Transplantation; Postoperative Complications; Retrospective Studies; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Urography; Vesico-Ureteral Reflux

Topics: Adult; Anti-Bacterial Agents; Erythromycin; Humans; Kidney Transplantation; Lung Abscess; Male; Nocardia asteroides; Nocardia Infections; Postoperative Complications; Radiography, Thoracic; Sputum; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adult; Amoxicillin; Cefotaxime; Humans; Kidney Transplantation; Male; Middle Aged; Nocardia; Nocardia asteroides; Nocardia Infections; Postoperative Complications; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adult; Anti-Bacterial Agents; Azathioprine; Bacterial Infections; Cyclosporine; Drug Therapy, Combination; Female; Humans; Incidence; Kidney Transplantation; Male; Morbidity; Postoperative Complications; Prednisone; Retrospective Studies; Tissue Donors; Trimethoprim, Sulfamethoxazole Drug Combination

For prevention of postoperative cystitis the authors tested currently used drugs which influence the adherence of bacteria to the urothelium, nitrofurantoin (FurantoinR), 3 x 1 tabl. per day and trimetroprim with clotrimoxazole (BiseptolR), one tablet in the evening before operation. They found that Furantoin reduced the frequency of the inflammation in patients subjected to abdominal operations from 12.3% in the control group to 2.3% and in those subjected to vaginal operations from 46.1% to 9.6%. The disadvantage of the drug is that it must be taken every day and that it is poorly tolerated by the patients. Biseptol is excreted more slowly and therefore 1 tablet before operation blocks the development for a maximum of 48 hours. In patients with abdominal operations the frequency of inflammation was similarly as in controls, 12%, in patients with vaginal operations the number of inflammations declined to 24.5%. Biseptol, 1 tablet before operation, is suitable only in patients where it is not assumed that the catheter will be inserted for a prolonged period.

Topics: Cystitis; Drug Therapy, Combination; Female; Genital Diseases, Female; Humans; Nitrofurantoin; Postoperative Complications; Premedication; Trimethoprim, Sulfamethoxazole Drug Combination

A 74 year old woman became progressively confused and developed visual hallucinations and delusions over a six day period, after the institution of routine oral trimethoprim-sulfamethoxazole therapy for a urinary tract infection. The medication was discontinued, and a marked improvement was noted 36 hours later. There was a complete return to normal mental functioning 60 hours after therapy was discontinued. The relationship between the patient's symptoms with the initiation and discontinuation of the medication suggests that the drug had a causal effect.

Topics: Aged; Delusions; Dose-Response Relationship, Drug; Escherichia coli Infections; Female; Hallucinations; Hip Prosthesis; Humans; Mental Status Schedule; Postoperative Complications; Psychoses, Substance-Induced; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

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

Topics: Acyclovir; Antilymphocyte Serum; Cause of Death; Clotrimazole; Combined Modality Therapy; Dose-Response Relationship, Drug; Drug Administration Schedule; Follow-Up Studies; Graft Rejection; Humans; Immunosuppressive Agents; Kidney Function Tests; Kidney Transplantation; Muromonab-CD3; Opportunistic Infections; Pentamidine; Postoperative Complications; Survival Analysis; Survival Rate; Trimethoprim, Sulfamethoxazole Drug Combination

Three groups of patients with single hemispheric brain abscesses or subdural empyemas, from 1 to 5 cm large, with similar initial prognosis, have been treated either by medical treatment alone (20), aspiration (21), or excision (15). Differences in survival were not found, but medical treatment alone was better for long term sequelae. Surgical procedures (either aspiration or excision) were better for both isolation of the organism and the hospital stay before discharge. In spite of good results, it is unwise to conclude too strongly in favour of no surgical treatment as this study was not randomised.

Topics: Adult; Ampicillin; Anti-Bacterial Agents; Brain Abscess; Cause of Death; Ceftriaxone; Combined Modality Therapy; Empyema, Subdural; Female; Humans; Male; Metronidazole; Pefloxacin; Postoperative Complications; Suction; Trimethoprim, Sulfamethoxazole Drug Combination

A case of life-endangering post-operative haemorrhage due to thrombocytopenia resulting from administration of trimethoprim-sulphamethoxazole is described. Withdrawal of the drug led to complete recovery. This side effect should be kept in mind, especially in patients scheduled for surgical intervention. As thrombocytopenia may develop insidiously and gradually, it is highly recommended to perform full blood tests immediately prior to surgery and repeat them in the post-operative period.

Topics: Aged; Ameloblastoma; Humans; Male; Mandibular Neoplasms; Oral Hemorrhage; Postoperative Complications; Thrombocytopenia; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Aged; Aged, 80 and over; Anti-Infective Agents; Bronchitis; Drug Combinations; Humans; Male; Postoperative Complications; Stevens-Johnson Syndrome; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

The authors analysed the results of bacteriological examinations of 600 urine samples with special regard to the sensitivity of the different pathogenic agents to Sumetrolim (400 mg sulphamatoxazole + 80 mg trimethoprim per each tablet). Their observations were also summarized in tables. The effectiveness of Sumetrolim treatment (for 5 days daily 2 x 3 tablets, from the subsequent 10 days daily 2 x 1 tablet) used in 100 chronic prostatitis patients and in 100 patients suffering temporarily from chronic infection (who had undergone prostatectomy) has been analyzed. Sumetrolim has been found to be valuable in the urological practice especially in the treatment of chronic infections of long duration. Teh eventual side-effects of Sumetrolim have been discussed on the basis of references and own observations referring to the treatment of 200 patients. The therapy had to be discontinued in 21 cases, in 1 case because of toxicoderma responding well to therapy, in 3 cases because of mild cutaneous alteration, in 10 cases due to intensive diarrhoea, and in 7 cases because of other side-effects.

Topics: Bacteriuria; Humans; Male; Postoperative Complications; Prostatectomy; Prostatitis; Trimethoprim Resistance; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

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

Topics: Adolescent; Adult; Ampicillin; Drug Combinations; Female; Humans; Kidney Transplantation; Male; Middle Aged; Postoperative Complications; Salmonella enteritidis; Salmonella Infections; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Basic glutathione transferase released from the proximal tubular epithelium in the kidney was monitored in the urine of 69 recipients of renal allografts. The enzyme was isolated from human liver and the urinary analysis performed with radioimmunoassay. Patients receiving cyclosporine A without toxicity or rejection did not excrete this enzyme in their urine; whereas the urine of patients with cyclosporine A-induced nephrotoxicity contained significant amounts of the transferase (P less than 0.001). Patients with allograft rejection also showed increased urinary concentrations of the basic glutathione transferase, but had significantly lower values than patients with cyclosporine induced nephrotoxicity (P less than 0.001). During aminoglycoside and co-trimoxazole treatment, the urinary concentration of this transferase also increased. Patients with renal infarction showed a sudden increase in urinary transferase to very high levels. The results indicate that quantitative analysis of the basic glutathione transferase in urine is useful for monitoring renal tubular lesions present in various complications following transplantation, such as cyclosporine and antibiotic induced nephrotoxicity and renal infarction.

Topics: Adolescent; Adult; Aged; Child; Clinical Enzyme Tests; Cyclosporins; Drug Combinations; Drug Therapy, Combination; Female; Glutathione Transferase; Graft Rejection; Humans; Kidney Diseases; Kidney Transplantation; Male; Middle Aged; Netilmicin; Postoperative Complications; Radioimmunoassay; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Drug Combinations; Humans; Immunosuppression Therapy; Kidney Transplantation; Norway; Pneumonia, Pneumocystis; Postoperative Complications; Pulmonary Fibrosis; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adolescent; Disulfiram; Drug Combinations; Drug Interactions; Humans; Male; Metronidazole; Postoperative Complications; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Six episodes of Pneumocystis carinii pneumonia in five renal transplant patients on low dose maintenance prednisolone are described. The infection was rare, occurring in 3 per cent of the recipients transplanted between 1978 and 1984. Diagnosis and treatment were not straightforward. Fever was the earliest evidence of illness, and in three episodes the chest radiograph was normal at presentation. At diagnosis, two to 16 days later, all had pulmonary infiltrates and severe hypoxia. Diagnosis was confirmed by cytological examination of bronchial lavage (two), transbronchial biopsy (one), open lung biopsy (one), and for two episodes clinically, from the rapid and complete resolution of fever, pulmonary infiltrates and hypoxia following a therapeutic trial of high dose cotrimoxazole. Pneumocystis antibody titres were low during the illness and in convalescence and did not contribute to diagnosis. Three patients had serological evidence of recent cytomegalovirus infection. All episodes responded to treatment with high dose cotrimoxazole. All the patients survived the illness but one died a year after recovery. The major complications of treatment were thrombocytopenia (three cases) and neutropenia (two cases) which did not respond to folinic acid.

Topics: Drug Combinations; Humans; Kidney Transplantation; Lung; Male; Middle Aged; Pneumonia, Pneumocystis; Postoperative Complications; Prognosis; Radiography; Sulfamethoxazole; Time Factors; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Acyclovir; Bacterial Infections; Cryptococcosis; Cytomegalovirus Infections; Drug Combinations; Humans; Infection Control; Infections; Kidney Transplantation; Pneumonia, Pneumocystis; Postoperative Complications; Prognosis; Sulfamethoxazole; Toxoplasmosis; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Virus Diseases

Fifty male children, aged between 3 and 10 years, were treated for a 12-day period with either trimethoprim (80-160 mg) plus sulphamethoxazole (400-800 mg) daily (co-trimoxazole) or 50-125 mg/day flurbiprofen rectally. The patients had been treated surgically for criptorchidism. Flurbiprofen showed good effectivity in controlling post-operative inflammation in urology. It is concluded that antimicrobial agents such as cotrimoxazole, because of their potential risks of damage at the cell's level, should be used only in presence of a bacterial infection.

Topics: Anti-Inflammatory Agents; Child; Child, Preschool; Cryptorchidism; Drug Combinations; Edema; Flurbiprofen; Humans; Male; Postoperative Complications; Propionates; Random Allocation; Scrotum; Sulfamethoxazole; Suppositories; Therapeutic Equivalency; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Acute cholecystitis is initially a chemical inflammation, but regularly complicated by bacterial invasion from the gut. Escherichia coli, Klebsiella and Streptococcus faecalis dominate among aerobic bacteria, whereas Bacteroides fragilis and clostridia are commonly encountered anaerobes. Mixed infections are prevalent. Bactibilia occurs in at least 60% of the early stage of acute cholecystitis and is particularly prevalent in the elderly. Also, bactibilia is very common in recurrent cholecystitis. A close connection is found between the presence of bactibilia and infectious complications. Although antimicrobial treatment does not sterilize the bile of an obstructed gall bladder, most authors favour such treatment in cases of febrile cholecystitis, particularly in the elderly, in order to prevent septic complications. Various regimens of preoperative antimicrobial prophylaxis have significantly reduced the infectious complications, in spite of persistent bactibilia. Prophylactic courses should not exceed one or two days, one single preoperative dose is probably adequate. The choice of antimicrobial drugs for prophylaxis varies with local experience and patterns of bacterial resistance. A combination of broad spectred betalactam antibiotics and nitroimidazole would generally seem to provide an appropriate and atoxic coverage.

Topics: Adult; Aged; Aminoglycosides; Ampicillin; Anti-Bacterial Agents; Bacterial Infections; Bile; Cephalosporins; Chloramphenicol; Cholecystectomy; Cholecystitis; Drug Combinations; Humans; Mezlocillin; Middle Aged; Postoperative Complications; Premedication; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Eighty-one patients with proved preoperative sterile urine and undergoing transurethral resection of the prostate were studied. The patients were divided into 3 groups: group A received sulfamethoxazole-trimethoprim (ST) preoperatively and postoperatively for ten days; group B received ST in 2 divided doses, one pre- and one postoperatively; group C received no prophylaxis. In groups A and B, we found urinary infection in 3.8 per cent of patients compared with 32 per cent in group C. Performing prostatic chip cultures, we found that most urinary infections were unrelated to a prostatic source. When the prostate was infected, 75 per cent had infected urine postoperatively. We believe that prophylactic antimicrobial treatment should be given to all patients undergoing transurethral prostatectomy. However, it seems that immediate perioperative treatment suffices.

Topics: Aged; Anti-Infective Agents, Urinary; Drug Combinations; Humans; Male; Middle Aged; Postoperative Complications; Premedication; Prostatectomy; Sulfamethoxazole; Time Factors; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

An antibiotic policy for a urological ward was largely implemented by restrictive antibiotic sensitivity reporting, and indications for prophylaxis were derived from the feature of 40 episodes of bacteraemia associated with urological procedure. Of 510 patients admitted to this ward, 30-8 per cent received antibiotics. Of 187 antibiotic courses, 53 per cent were for treatment and 43 per cent for prophylaxis. The stated indications were considered dubious in 28 per cent of courses of treatment and irrational in 13 per cent of courses of prophylaxis. Of 1368 days of antibiotic use, co-trimoxazole and amoxycillin/ampicillin accounted for 84.6 per cent, and gentamicin for 5.6 per cent. The modal duration of courses of co-trimoxazole, amoxycillin/ampicillin, and gentamicin were 5, 5 and 1 days respectively. Antibiotics whose sensitivities were not reported were rarely used, and there was no prescription of cephradine, cefoxitin, cefuroxime or amikacin. In general, antibiotic administration corresponded well with policy guidelines.

Topics: Amoxicillin; Ampicillin; Anti-Bacterial Agents; Bacterial Infections; Drug Combinations; Drug Utilization; Gentamicins; Hospital Departments; Humans; Male; Microbial Sensitivity Tests; Postoperative Complications; Premedication; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urologic Diseases; Urology Department, Hospital

Topics: Drug Combinations; Humans; Postoperative Complications; Respiratory Tract Infections; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adult; Aged; Digestive System Surgical Procedures; Drug Combinations; Female; Humans; Male; Middle Aged; Postoperative Complications; Respiratory Tract Infections; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections