warfarin and Gram-Positive-Bacterial-Infections

Aminoglycosides are useful antimicrobial agents for treating infective endocarditis; however, they occasionally cause troublesome side effects, such as nephrotoxicity and ototoxicity. We herein report a case of infective endocarditis caused by Enterococcus faecalis that was treated successfully with continuous infusion of ampicillin without adjunctive aminoglycosides. The serum ampicillin concentrations were higher than the minimal inhibitory concentration for the target strain. Although the use of ampicillin monotherapy is currently avoided because double β-lactam therapy is reportedly more effective, continuous penicillin administration remains an effective therapeutic choice for treating infective endocarditis.

Topics: Aged; Aminoglycosides; Ampicillin; Anti-Bacterial Agents; Anticoagulants; Arthroplasty, Replacement, Hip; Atrial Fibrillation; Contraindications; Diagnosis, Differential; Endocarditis, Bacterial; Enterococcus faecalis; Femoral Neck Fractures; Gram-Positive Bacterial Infections; Humans; Infusions, Intravenous; Male; Microbial Sensitivity Tests; Mitral Valve; Postoperative Complications; Practice Guidelines as Topic; Pyelonephritis; Streptomycin; Warfarin

Topics: Aged, 80 and over; Anti-Bacterial Agents; Anticoagulants; Cholangiopancreatography, Endoscopic Retrograde; Enterococcus faecium; Gram-Positive Bacterial Infections; Hematoma; Humans; Liver Diseases; Male; Pulmonary Embolism; Warfarin

A 26-year-old man was admitted with fever and abdominal pain. Abdominal ultrasonography and Doppler ultrasound eventually revealed portal vein thrombosis and a pyogenic liver abscess (17x11x11 cm). Lactococcus lactis was isolated from a culture of the abscess material. This organism is not a common pathogen in humans. This is the first published description of portal vein thrombosis and pyogenic liver abscess due to L. lactis.

Topics: Adult; Anti-Bacterial Agents; Anticoagulants; Catheterization; Drainage; Gram-Positive Bacterial Infections; Heparin; Humans; Lactococcus lactis; Liver Abscess; Male; Meropenem; Microbial Sensitivity Tests; Portal Vein; Thienamycins; Ultrasonography, Doppler; Venous Thrombosis; Warfarin

A 57-year-old woman with pulmonary sarcoidosis was admitted to the hospital because of an elevation of serum creatinine and blood urea nitrogen. On admission, the laboratory data suggested interstitial nephritis without proteinuria and hematuria, whereas a renal biopsy showed granulomatous interstitial nephritis and mild mesangial proliferative glomerulonephritis. Immunoglobulin and C1q deposits were negative, but mannose-binding lectin, C3, C4d, and C5b-9 deposits were marked in the glomerular mesangial areas. The lectin pathway of complement activation may have contributed to the development of glomerular injury in this patient. DNA of Propionibacterium acnes , which is now strongly suspected as the pathogen of sarcoidosis, was detected in the patient's glomerular mesangial cells; tubular epithelial cells, which were involved in granulomatous inflammation; and mononuclear cells in epithelioid granulomas by in situ hybridization. These findings may add new insights to the pathogenesis of renal sarcoidosis, including its relation to infection, because mannose-binding lectin plays a crucial role in the host defense against various pathogens. From this case of renal sarcoidosis, it is hypothesized that P acnes may be involved in pathogenesis of granulomatous interstitial nephritis and that it plays a role in glomerular complement activation via the lectin pathway.

Topics: Anti-Inflammatory Agents; Anticoagulants; Complement Activation; Complement C3; Complement C4b; Complement Membrane Attack Complex; DNA, Bacterial; Drug Therapy, Combination; Female; Glomerular Mesangium; Glomerulonephritis, Membranoproliferative; Gram-Positive Bacterial Infections; Heparin; Histiocytosis, Langerhans-Cell; Humans; Lung; Lung Diseases, Interstitial; Mannose-Binding Lectin; Methylprednisolone; Middle Aged; Nephritis, Interstitial; Peptide Fragments; Prednisone; Propionibacterium acnes; Sarcoidosis; Warfarin