Seventy-nine patients were enrolled in a study comparing cefmetazole and cefoxitin as single agent antibiotic therapy for intra-abdominal infection. Thirty-seven patients had appendicitis, 16 patients had perforated peptic ulcer while 26 patients had a variety of other infectious processes. The clinical response to both antibiotics was good and tolerance was equivalent. Four patients with Pseudomonas aeruginosa isolated from the initial culture experienced microbiological failure. Three patients treated with cefmetazole had prolongation of the prothrombin time.

Abdomen↗

PubMed1987

Ciprofloxacin for eradication of methicillin-resistant Staphylococcus aureus colonization.

Ciprofloxacin (750 mg orally twice a day) was used to treat 22 episodes of methicillin-resistant Staphylococcus aureus (MRSA) colonization among 20 patients. Most patients had serious, progressive underlying medical diseases and had multiple sites of colonization. Eleven had previously received parenteral vancomycin therapy. Duration of ciprofloxacin therapy was from seven to 28 days. Therapy was discontinued in eight patients because of minor adverse reactions (two patients) or serious events attributed to underlying diseases (six patients). These serious events included seizures in two patients with known seizure disorders. Of the remaining 14 courses of therapy, 11 (79 percent) were associated with eradication of MRSA colonization. For the 18 patients who received at least two weeks of therapy, results of cultures from 47 of the 56 colonized sites became negative. Recolonization with MRSA occurred in four patients within one month. Increased resistance to ciprofloxacin was observed in seven of the 22 treatment episodes; this was associated with treatment failure in three patients and successful therapy in one patient; therapy was discontinued for other reasons in three patients. For comparison, medical records of 31 patients whose clinical specimens revealed MRSA but who did not receive ciprofloxacin were reviewed. MRSA colonization (as opposed to infection) was not eradicated in any patient who received only a single drug or no specific therapy directed against MRSA; four of seven patients given combination therapy had colonization eradicated. Although there is the potential for increased resistance, ciprofloxacin is an important new option that can be used as a single agent for eradication of MRSA colonization. Additional study is needed to define the optimum use of ciprofloxacin as a single agent and in combination therapy for MRSA colonization and infection.

Adult↗

PubMed1987

Outpatient therapy of bite wounds. Demographic data, bacteriology, and a prospective, randomized trial of amoxicillin/clavulanic acid versus penicillin +/- dicloxacillin.

Thirty patients received penicillin (17 of these also received dicloxacillin) and 31 received amoxicillin/clavulanic acid in a randomized study of the outpatient management of bite wounds. A wide variety of aerobic (185 strains) and anaerobic (47 strains) bacteria were isolated from these wounds. The control and study regimens were equally effective. There were four therapeutic failures in all. Aggressive wound management along with antimicrobial therapy led to a 87-96% cure rate. Loose stools or diarrhea was a more frequent side effect with amoxicillin/clavulanic acid than with penicillin +/- dicloxacillin.

Adolescent↗

PubMed1987

Comparison of blood culture methods for recovery of Legionella pneumophila from the blood of guinea pigs with experimental infection.

Blood was cultured from guinea pigs with experimental Legionella pneumophila serogroup 1 pneumonia, using four different methods. A 0.03-ml amount was spread onto each of several plates of buffered charcoal-yeast extract supplemented with alpha-ketoglutarate (BCYE) (direct plate); 1.5 ml each was inoculated into a BCYE agar-yeast extract broth bottle (biphasic), a pediatric Isolator tube (E. I. du Pont de Nemours & Co., Inc., Wilmington, Del.), and a glass tube containing 0.025% sodium polyanethanolsulfonate. Blood processed in the Isolator tube was plated on BCYE, as was the buffy coat blood fraction, which was obtained by centrifugation of the tube containing sodium polyanethanolsulfonate and blood. Observations were made of the number of positive cultures, the time to detection of positive cultures, and the absolute bacterial concentrations. Each system was equally sensitive in detecting bacteremia. The biphasic method required 5 days for cultures to become positive, whereas the other systems required 2 to 3 days to detect all positive cultures (P = 1.3 X 10(-5) by Friedman group statistic, and P less than 10(-5) for comparison of the biphasic and other methods). The direct plating method demonstrated the best quantitative recovery of L. pneumophila in comparison to the other methods tested (P = 2.0 X 10(-5) by analysis of variance group statistic and P less than 0.05 for comparison between each of the methods). Quantitative recovery by the Isolator method was intermediate between the direct plating and buffy coat methods. The biphasic and Isolator blood culture methods performed poorly in comparison to the other methods, indicating the need for caution in choosing blood culture methods for Legionella isolation.

Animals↗

PubMed1987

Treatment and long-term follow-up of foot infections in patients with diabetes or ischemia: a randomized, prospective, double-blind comparison of cefoxitin and ceftizoxime.

The efficacy and safety of ceftizoxime and cefoxitin were compared in a randomized, double-blind study of therapy for lower extremity infections in patients with diabetes mellitus or peripheral vascular disease. Overall clinical responses were satisfactory in 82% (23/28) of patients treated with ceftizoxime and in 68% (17/25) of patients treated with cefoxitin. The difference was not statistically significant. Ceftizoxime had superior in vitro activity against Enterobacteriaceae, especially Enterobacter cloacae, whereas cefoxitin had better activity against the Bacteroides fragilis group. Relapses of infection were common in both groups during long-term follow-up; only about one third of patients in either group maintained satisfactory outcomes after one year. More than half of the patients in both groups responded to one or more courses of medical therapy and avoided major amputations for one year following entry into the study.

Aged↗

PubMed1986

In vitro activities of 17 antimicrobial agents against the formate/fumarate-requiring, anaerobic gram-negative bacilli.

The in vitro activities of 17 antimicrobial agents were evaluated against 46 clinical isolates of formate/fumarate-requiring anaerobic gram-negative bacilli. Strains of Bacteroides ureolyticus (23) were almost uniformly susceptible to the tested antimicrobials, whereas strains of Bacteroides gracilis (18) showed some striking resistance with penicillin active against only 67%, the cephalosporins active against 67%-89%, and clindamycin active against 67%. Although few strains of Wolinella species/C. concisus (5) were available for testing, these isolates tended to be more resistant than B. ureolyticus but less resistant than B. gracilis.

Anti-Bacterial Agents↗

PubMed1986

Infectious disease emergencies.

Patient visits to the primary care physician are prompted most often by an infectious disease. The clinician must be aware of the common and serious infections present in the community and must institute proper diagnostic and therapeutic measures. Diagnosis and treatment of streptococcal infections, staphylococcal infections, pneumonia and upper respiratory tract infection, bone and joint infections, sinusitis, clostridial infections, and tetanus are discussed.

Anti-Bacterial Agents↗

PubMed1985

Safety and efficacy of ticarcillin plus clavulanic acid in the treatment of infections of soft tissue, bone, and joint.

The efficacy and safety of ticarcillin plus clavulanic acid in the treatment of patients with infections of soft tissue, bone, and joint were evaluated in this open study. Clinical diagnoses included osteomyelitis, soft tissue abscess or ulcer, cellulitis, bite wound, traumatic or postoperative cellulitis, necrotizing fasciitis, septic arthritis, septic bursitis, and septic thrombophlebitis. Trauma or underlying disease such as diabetes mellitus or vascular insufficiency was common (more than 50 percent) in the patient population. Clinical efficacy was evaluable in 66 patients who received 3 g of ticarcillin and 0.1 g of clavulanic acid every four or six hours for a mean of 23.4 days. A satisfactory clinical response was observed in 92 percent of the patients. Major pathogens isolated were Enterobacteriaceae, anaerobic cocci, Staphylococcus aureus, and beta-hemolytic Streptococcus. Of the 143 isolates recovered from 55 bacteriologically evaluable cases, 87 percent were eradicated by therapy. Overall, a satisfactory bacteriologic outcome occurred in 93 percent of the patients, and the pathogen(s) persisted in 7 percent. More than 98 percent of the isolates were susceptible to ticarcillin plus clavulanic acid in vitro. Emergence of resistance during therapy occurred with three strains of Pseudomonas aeruginosa. Adverse drug-related reactions required discontinuation of treatment in two patients, although other minor abnormal laboratory findings were common. These results indicate that ticarcillin plus clavulanic acid offers safe and effective therapy for infections of soft tissue, bone, and joint.

Adult↗

PubMed1985

Plesiomonas shigelloides-associated diarrhea.

Plesiomonas shigelloides was thought to be the cause of diarrhea in six patients seen in Los Angeles. Although this organism is considered to be a cause of diarrhea in the Orient, it has infrequently been noted to be associated with diarrhea in North America.

Adult↗

PubMed1985

Comparative in vitro activities of selected antimicrobial agents against Aeromonas species and Plesiomonas shigelloides.

The in vitro antimicrobial susceptibilities of fecal isolates of Aeromonas caviae, Aeromonas hydrophila, Aeromonas sobria, and Plesiomonas shigelloides were tested by agar dilution. This in vitro study suggested that ciprofloxacin, enoxacin, norfloxacin, tetracycline, and trimethoprim-sulfamethoxazole might be effective oral agents for treatment of diarrhea involving Aeromonas spp. or P. shigelloides.

Aeromonas↗

PubMed1985

Comparative in vitro activities of selected antimicrobial agents against Edwardsiella tarda.

MICs of 14 antimicrobial agents for 29 strains of Edwardsiella tarda were determined by an agar dilution method. Of the agents tested, ciprofloxacin, enoxacin, and norfloxacin were the most active on a weight basis. All strains were also susceptible to clinically achievable concentrations of ampicillin, chloramphenicol, tetracycline, trimethoprim, sulfamethoxazole, trimethoprim plus sulfamethoxazole, cefotaxime, and gentamicin. Ninety percent of the strains demonstrated high-level resistance to polymyxin B and colistin.

Anti-Bacterial Agents↗

PubMed1985

Bacteroides gracilis, an important anaerobic bacterial pathogen.

Clinical isolates of agar-pitting, formate-fumarate-requiring, anaerobic gram-negative bacilli were recharacterized in consideration of the species descriptions of Bacteroides ureolyticus and the newly described B. gracilis, Campylobacter concisus, and Wolinella sp. During an 11-year period, 7.5% (101 of 1,341) of all specimens yielding anaerobes were found to contain an organism in this group. Of the 71 isolates that were available for study, 43 were B. ureolyticus, 23 were B. gracilis, and 5 were in the Wolinella-C. concisus group. The role in infection and patterns of antimicrobial susceptibility for B. ureolyticus and B. gracilis were studied. Review of the clinical data indicated that 83% of B. gracilis strains were recovered from patients with serious visceral or head and neck infection, whereas 73% of B. ureolyticus isolates were recovered from superficial soft-tissue or bone infections. The strains of B. ureolyticus were uniformly susceptible to the tested antimicrobial agents. B. gracilis, however, showed some striking resistance, with penicillin active against only 67% and the cephalosporins active against 67 to 84% of the isolates tested. The association of B. gracilis with serious deep-tissue infection, coupled with the relatively high frequency of antibiotic resistance, indicates that it is an important, previously unrecognized, pathogen.

Bacillus↗

PubMed1985

Intravenous catheter-associated fungemia due to Candida rugosa.

We report a case of intravenous catheter-associated fungemia caused by Candida rugosa; this is the first report of such an infection in a human. Multiple cultures of blood taken over a 24-h period and of the intravenous catheter tip were positive for this unusual isolate. The patient was treated with intravenous amphotericin B and made an uneventful recovery. Intravenous cannulae and other intravascular devices are well recognized as potential sites of intravascular infection by a variety of microorganisms, including several Candida species; however, fungemia caused by C. rugosa has not been reported.

Amphotericin B↗

PubMed1984

Serratia marcescens pyarthrosis and osteomyelitis.

We have reported a case of Serratia marcescens arthritis and osteomyelitis in a young man whose source of infection appeared to be a single episode of intravenous amphetamine use. Multiple antibiotics and aggressive surgical management were necessary to effect a cure. He eventually responded to a three-week course of amikacin and moxalactam given in conjunction with surgical debridement of all involved areas.

Adult↗