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Biomedical subjects

L Coppens

Publications and source records attributed to L Coppens.

At least 37 records · Page 2Linked to original sources
PubMed1983

Vancomycin therapy of oxacillin-resistant Staphylococcus aureus infections.

Infections caused by oxacillin-resistant staphylococci were studied in 27 patients, who received vancomycin therapy as soon as the resistance of the pathogenic staphylococcal strain to oxacillin was documented. Therapy with vancomycin was usually started not later than 48 h after the onset of empiric therapy with oxacillin or cefamandole. In spite of high bactericidal activity in the serum of the patients receiving vancomycin, only 16 (59%) out of 27 patients responded to the treatment. Favourable clinical responses were usually associated with bacteriological cure, but super-infection by Gram-negative bacillary rods was a common complication in this series; it occurred in eight (30%) of the 27 patients studied. The overall death rate was 33% (9/27); death was associated in six patients with persisting staphylococcal infection and in three patients with Gram-negative bacillary superinfection of the bronchopulmonary tract, with or without persistent staphylococcal infection.

Adolescent↗
PubMed1983

Therapy of staphylococcal infections with cefamandole or vancomycin alone or with a combination of cefamandole and tobramycin.

Eighty adult patients with microbiologically demonstrated staphylococcal infections were included in a comparative trial of cefamandole and cefamandole plus tobramycin. Patients with cefamandole-resistant pathogens were treated with vancomycin, if the initial therapy consisted of cefamandole, but were continued on cefamandole plus tobramycin if already started on that combination. Of the patients infected with cefamandole-susceptible strains, 91% (20/22) responded favorably to treatment with cefamandole alone, and 88% (30/34) responded favorably to cefamandole plus tobramycin. Of the patients infected with cefamandole-resistant staphylococci, 70% (7/10) responded to treatment with cefamandole plus tobramycin, and 86% (12/14) responded to treatment with vancomycin, even though vancomycin therapy was started 24 to 48 h later than cefamandole-plus-tobramycin therapy. No major side effects were observed; however, cefamandole plus tobramycin was associated with a rise in the serum creatinine level in 11% (4/44) of the patients. The bactericidal activity of the serum in cefamandole-treated patients and in cefamandole-plus-tobramycin-treated patients was identical against cefamandole-susceptible strains. Against cefamandole-resistant strains, 87% of the vancomycin-containing sera were bactericidal at a dilution of 1:8, whereas only 57% of the cefamandole-plus-tobramycin-containing sera were active at that dilution.

Anti-Bacterial Agents↗
PubMed1983

Gram-negative bacillary meningitis in neurosurgical patients.

The authors report 34 cases of Gram-negative bacillary meningitis related to traumatic cranial lesions or neurosurgery observed between 1973 and 1980 at two neurosurgical units (Institut J. Bordet, Brussels, and Inselspital, Bern). As a typical nosocomial infection, meningitis developed after prolonged hospitalization in most patients, and was mainly due to highly resistant organisms, such as P. aeruginosa and Klebsiella sp. At least 65% of the patients were colonized with the pathogen responsible for the meningitis before the onset of the infection. Ventriculitis, including four cases of ventricular empyema, complicated meningitis in all the 17 patients in whom a ventricular tap was performed. The results of treatment were unsatisfactory. Fifty percent of the patients were cured of their infection, but only 30% survived; 15% of the patients died within 48 hours following diagnosis. The optimum treatment of postsurgical Gram-negative meningitis remains in doubt. The choice of initial antibiotics should take into account the sensitivity patterns of colonizing microorganisms. Chloramphenicol is ineffective against most pathogens commonly involved in this infection. Intrathecal aminoglycosides may fail in the presence of ventriculitis. Intraventricular aminoglycosides are probably justified in critically ill patients. The role of the newer cephalosporins and of co-trimoxazole remains to be defined.

Adolescent↗
PubMed1981

[Bactericidal activity against P. aeruginosa in serum and bronchial secretion in patients under continuous infusion of azlocillin].

The azlocillin level and killing activity in serum and bronchial secretions against 10 strains of P. aeruginosa were studied in 7 intubated or tracheotomized patients with severe bronchial infection who were receiving the drug as continuous i.v. infusion. In 5 out of 7 patients azlocillin was absent or present only in traces in bronchial secretions in spite of plasma levels ranging between 170 to 340 micrograms/ml. In the other 3 patients azlocillin levels of 23 and 39 micrograms/ml and moderate bactericidal activity against P. aeruginosa could be detected in bronchial secretions. Penicillinase producing strains of Staph. aureus were isolated from the sputum of the 5 patients with extremely low azlocillin level in bronchial secretions. The strain of Staph. aureus isolated from one patient was shown to destroy azlocillin rapidly. In bronchopulmonary infections, Staph. aureus may not only be directly pathogenic but also interfere with the action of beta-lactamase unstable drugs against other microorganisms.

Azlocillin↗
PubMed1981

Post neurosurgery Gram-negative bacillary meningitis.

The findings of a retrospective analysis of 20 patients who developed Gram-negative bacillary meningitis (GNBM) following neurosurgery are reported. The predisposing causes included surgery for skull fracture or cerebral contusion (9 patients), neoplasm (6) and vascular disease (2). Nine of the patients (45 per cent) had a cerebrospinal fluid (CSF) leak from a fistula. The organisms isolated, which included Pseudomonas aeruginosa (6), Klebsiella spp. (5) and Escherichia coli (4), had, in 75 per cent of cases, been isolated from other sites prior to the onset of GNBM. Initial diagnosis was achieved by Gram-stain of CSF in 15 of 19 cases (78 per cent). Culture of lumbar CSF was positive in 19 of the patients (95 per cent) and concommittant ventriculitis was confirmed by positive culture of ventricular CSF in 10 of 11 cases (91 per cent) from whom it was obtained. The overall mortality was 80 per cent, 11 patients dying of causes directly related to GNBM. Eradication of the infecting organism from CSF was achieved in 79 per cent of patients receiving intraventricular aminoglycoside therapy, but in only 40 per cent of those receiving intralumbar therapy. Deaths in the latter group were associated with ventriculitis whereas those in patients receiving intraventricular therapy resulted from intracranial abscess formation. These findings, plus the observation of chloramphenicol resistance in 80 per cent of the isolates, suggest that systemic and intraventricular aminoglycoside administration is indicated in patients with post-neurosurgical GNBM.

Adolescent↗
PubMed1981

Anti-Pseudomonas activity in bronchial secretions of patients receiving amikacin or tobramycin as a continuous infusion.

The penetration of amikacin and tobramycin into bronchial secretions and the resulting anti-Pseudomonas activity were assessed in two groups of tracheostomized or intubated patients with tracheobronchial infection and purulent bronchial secretions. The aminoglycosides were administered as continuous, high-dose intravenous infusions. The mean drug concentrations in serum and bronchial secretions were 12.8 and 2.0 microgram/ml for amikacin and 3.6 and 0.7 microgram/ml for tobramycin. The bronchial secretion/serum ratios varied over a wide range: from 9.6 to 22.8% (average, 14.9%) for amikacin and from 3 to 39.3% (average, 17.5%) for tobramycin. Sustained anti-Pseudomonas activities in bronchial secretions were achieved only in patients with very high aminoglycoside levels in serum. In most patients, however, no anti-Pseudomonas activity could be detected within bronchial secretions despite therapeutic levels of amikacin and tobramycin and adequate bactericidal activities in serum.

Amikacin↗
PubMed1980

Carbenicillin plus cefazolin with or without mecillinam as an early treatment of bacteremia caused by gram-negative organisms: randomized double-blind study.

Mecillinam or a placebo was added to a combination of cefazolin and carbenicillin as an early therapy of septicemia caused by gram-negative organisms in patients with serious underlying diseases, none of whom was neutropenic, however. Patients in whom infection was caused by pathogens against which mecillinam and cefazolin or mecillinam and carbenicillin were synergistic might have responded more often than patients treated with nonsynergistic combinations. However, overall results did not show any benefit from combining mecillinam with cefazolin and carbenicillin. This study suggests that in nonneutropenic patients with septicemia caused by gram-negative organisms, there is no need to intensify antimicrobial therapy beyond a certain point of efficacy. The measurement of the bactericidal activity in the serum of treated patients might serve as guide for adequate therapy.

Amdinocillin↗
PubMed1979

Comparative study of anti-pseudomonas activity of azlocillin, mezlocillin, and ticarcillin.

The anti-pseudomonas activities of azlocillin and mezlocillin were compared with that of ticarcillin. We measured the minimal inhibitory and minimal bactericidal concentrations of the three drugs against 20 different strains of Pseudomonas aeruginosa and found significantly lower values for azlocillin than for the other two drugs. We then infused 5 g of each drug into 10 volunteers on three consecutive days and determined the serum levels of the three antibiotics at 1-h intervals from 1 to 6 h after injection. The levels of azlocillin were significantly higher than those of mezlocillin and ticarcillin (at 1 h: 236.55 mug/ml +/- 12.9 for azlocillin, 192.45 mug/ml +/- 28.8 for mezlocillin, and 131.5 mug/ml +/- 10.9 for ticarcillin). The inhibitory and bactericidal activities of the sera obtained 1 and 6 h after the injection against the same 20 strains of P. aeruginosa demonstrated a significantly greater anti-pseudomonas activity of azlocillin when compared with mezlocillin and ticarcillin; mezlocillin and ticarcillin had approximately the same activity. The mean values for bactericidal activity against the strains tested were 1/32 for azlocillin, 1/8 for mezlocillin, and 1/8 for ticarcillin. Azlocillin thus appears to be a promising anti-pseudomonas drug and should be tested in clinical trials.

Humans↗
PubMed1979

Anaerobic infection in cancer patients: comparative evaluation of clindamycin and cefoxitin.

Clindamycin and cefoxitin with or without gentamicin were administered to cancer patients having localized infections presumably caused by anaerobic pathogens. The rates of favorable response were 89% in patients receiving clindamycine alone and 78% in patients receiving cefoxitin alone. When the total experience is considered (clindamycin or cefoxitin with and without gentamicin), 20 of 24 patients (83%) responded to clindamycin and 18 of 22 (82%) responded to cefoxitin. Both therapies were well tolerated. Clindamycin was found to be more effective than cefoxitin in eradicating the offending anaerobic pathogens from the site of infection. Aerobic pathogens were frequently isolated along with anaerobes from the infectious sites in this series; their susceptibility or resistance to clindamycin or cefoxitin did not influence the therapeutic response.

Anaerobiosis↗