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[Staphylococcal infection of the face. 52 cases].

Severe staphylococcal infections, and notably those affecting the face, are frequent in Tunisia. We report 52 cases observed between December 1981 and September 1989. The epidemiological, clinical and therapeutic features of the disease are presented. New antibiotics have reduced the mortality rate to 4%. Lethal cases and sequelae are due to delayed treatment. This demonstrates the importance of an early treatment and, above all, of prevention by vigorous chemotherapy of even the mildest facial skin infections.

Adrenal Cortex Hormones↗

[Immune response in a nonfatal staphylococcal infection in guinea pigs].

The model of nonlethal staphylococcal infection in guinea pigs was used to demonstrate that at an early period after inoculation chemotaxis of neutrophiles enhanced only in response to the specific antigen, the percentage of phagocytes with receptors for IgG increased, while immune phagocytosis by receptors for IgM decreased; at a later period the decrease of phagocytosis by receptors for IgG occurred. Besides, at a later period after inoculation a slight decrease in the total T-lymphocyte population and at an early period the increase of the content of TG were observed. The dynamics of lymphocytes with receptors for staphylococci was subject to cyclic fluctuations.

Animals↗

Management of serious staphylococcal infections in the outpatient setting.

Patients with serious staphylococcal infections, e.g. endocarditis and osteomyelitis, need prompt and prolonged parenteral antibiotic treatment to ensure eradication of the causative pathogen. The major cost in the treatment of these infections is the long period of hospitalisation required for the administration of intravenous antibiotics. To shorten the hospitalisation period, outpatient treatment can be given to some patients. In this study, patients with acute exacerbations of chronic osteomyelitis (n = 44) or endocarditis (n = 10) were treated with intravenous teicoplanin. The pathogens were Staphylococcus aureus (n = 41, 13 of which were methicillin resistant) and coagulase-negative staphylococci (n = 13, one of which was methicillin resistant). After a mean loading dose of 15 mg/kg for 3 to 10 days, patients received teicoplanin 3 times a week at a dose (mean 15 mg/kg) individualised to achieve serum trough concentrations of approximately 10 mg/L for osteomyelitis and 20 mg/L for endocarditis. Treatment duration ranged from 28 to 150 (mean 62) days for patients with osteomyelitis and from 28 to 88 (mean 49) days for patients with endocarditis. 37 (84%) patients with osteomyelitis and 8 (80%) patients with endocarditis were treated successfully. Adverse events were observed in 9 patients and included rash (n = 3), thrombocytopenia (n = 3), and drug fever, pseudomembranous colitis, nausea, leucopenia and transient hearing impairment (one patient each). In conclusion, this study demonstrates that teicoplanin can be administered successfully in an outpatient setting according to a 3-times weekly schedule for the treatment of patients with staphylococcal osteomyelitis and endocarditis.

Adolescent↗

[Changes in the membrane lipids and lymphocyte function in staphylococcal infection and the development of delayed hypersensitivity].

Experimental staphylococcal infection was reproduced in rats by the intraperitoneal injection of S. aureus strain 75. The degree of the development of delayed hypersensitivity (DH) to staphylococci, microviscosity, the levels of free radical oxidation and antioxidation resistance were evaluated in the dynamics of the infectious process by the methods of chemiluminometry and fluorescent probing with pyrene. The functional activity of lymphocytes was determined by the inclusion of 3H-thymidine into DNA as the consequence of stimulation with phytohemagglutinin. The development of DH was found to depend on the microviscosity and antioxidation resistance of membrane lipids. The increase of microviscosity and the simultaneous decrease of the induction time of chemifluorescent rapid flash inhibit the development of DH, leading to the aggravation of the infectious process. The increase of fluidity and the accumulation of antioxidants facilitate the development of DH and lead to a milder course of the infectious process.

Animals↗

Therapy of staphylococcal infections: (a comparative study of cephaloridine and gentamicin).

Two groups of 38 patients have been treated for staphylococcal infection with either cephaloridine (4 gm daily) or gentamicin (320 mg daily) by the intramuscular route. The rate of favorable clinical response was higher among the patients who received cephaloridine (78.8 per cent) than among those who were treated with gentamicin (60.5 per cent). No death related to the infection occurred in the cephaloridine-treated patients. The mean peak and trough antibacterial activity reached in the serum of the patients after injection of the antibiotics was higher in patients receiving cephaloridine (1/64 and 1/16) than in those treated with gentamicin (1/16 and 1/4). Patients who failed to respond to therapy had often a low antibacterial activity of the serum. These studies suggest that the 1/8 level of bactericidal activity should be attained in the serum one hour after the administration of the antibiotics to allow optimal results in staphylococcal infections.

Adult↗

Staphylococcal infection under a LASIK flap.

PURPOSE: To report a staphylococcal infection under a laser in situ keratomileusis (LASIK) flap and to discuss the management of this rare and potentially devastating complication. METHODS: A patient was referred to our practice having had bilateral LASIK. She was found to have abscesses under the left corneal flap. Staphylococcus aureus was identified as the infecting organism by corneal scrape and treated with appropriate antibiotics. The cornea improved, and then the abscess recurred. The abscess was again scraped and intensive treatment reinstituted. RESULTS: After successful treatment, the patient recovered excellent visual acuity with only a minimal astigmatic error. CONCLUSION: The possible reasons for the apparent improvement and then recurrence of the abscess are discussed. The management of this case including the need for corneal scrape and antibiotic prophylaxis is discussed in relation to previously reported cases.

Abscess↗

The treatment of staphylococcal infections with special reference to pharmacokinetic, pharmacodynamic and pharmacoeconomic considerations.

The choice of antibiotics for the treatment of staphylococcal infections depends to a high degree on the susceptibility patterns in the hospital in question. These may be highly variable and considerable differences between countries and hospitals exist. The insight into the pharmacodynamic aspects of antimicrobial agents has increased considerably in the last 5 years, resulting in new treatments, such as once daily administration of aminoglycosides and continuous infusion of betalactam antibiotics. The antibiotic policy in Dutch hospitals for the treatment of staphylococcal infections is discussed. In most Western countries with a relatively low incidence of MRSA, penicillin-derivatives, such as flucloxacillin (or cloxacillin, methicillin and nafcillin) will be the drug of choice, because of their good in-vitro activity, low toxicity, good clinical efficacy and relatively low cost. If the incidence of MRSA increases, drugs such as the glycopeptides will be of more importance. This will of course have a clear economic impact, as both vancomycin and teicoplanin are considerably more expensive than agents such as flucloxacillin and oral treatment is not possible. Pharmacoeconomic aspects also play a role. As a rule, intravenous antimicrobial agents are considerably more expensive than the oral formulations. Before oral administration can be recommended, a reliable oral absorption, also in seriously ill patients, must have been demonstrated. Other aspects that influence the cost of therapy are hospital stay and the possibility of outpatient treatment.

Ambulatory Care↗

Effect of sodium diclofenac on serum and tissue concentration of amoxicillin and on staphylococcal infection.

The effect of sodium diclofenac on serum and tissue amoxicillin concentration as well as their effect against staphylococcal infection was observed. Four polyurethane sponges were placed in the back of thirty rats. After 14 d, two granulomatous tissues received 0.5 ml of 10(8) cfu/ml (Staphylococcus aureus). Two days later, the rats were divided into five groups: group 1 received amoxicillin 50 mg/kg/p.o., group 2 received amoxicillin 25 mg/kg/p.o., group 3 received sodium diclofenac 2.5 mg/kg/i.m. and amoxicillin 50 mg/kg/p.o., group 4 received sodium diclofenac 2.5 mg/kg/i.m., and group 5 (control group) received NaCl 1 ml/p.o. After six hours of drug administration, blood serum (10 microl) and noninfected granulomatous tissues were placed on Mueller-Hinton agar inoculated with 10(8) cfu/ml (S. aureus). Infected tissues were dispersed in a sonic system and were spread (10 microl) on salt mannitol agar. Microorganisms were counted and the inhibition zones were measured after 18 h of incubation at 37 degrees C. Amoxicillin tissue concentration was 6.27 microg/g for group 1, 2.18 microg/g for group 2, and 0.72 microg/g for group 3. The serum concentrations were 11.56 microg/ml for group 1, 5.36 microg/ml for group 2, and 1.34 microg/ml for group 3. No differences were observed among group 1, 2, and 3 regarding staphylococci counts (Kruskall-Wallis test p>0.05). Group 4 reduced (p<0.05) staphylococci counts comparing to group 5. It was concluded that sodium diclofenac reduced serum and tissue amoxicillin concentration and, even in large doses, amoxicillin was not effective in eradicating the staphylococcal infection after 6 h of administration.

Amoxicillin↗

Subcutaneous staphylococcal infections in mice: the influence of antibiotics on staphylococcal extracellular products.

Using a mouse subcutaneous abscess model the effect of subinhibitory concentrations of antibiotics upon alpha-hemolysin, nuclease, lipase and esterase production was investigated. Infected mice treated with erythromycin (10 mg/kg), chloramphenicol (10 mg/kg) and fucidin (5 mg/kg) were compared with those given lincomycin (10 mg/kg) and clindamycin (5 mg/kg). In reference to the first three drugs, early blanching occurred at the inoculation site and necrosis appeared within 18 h, whereas wit the other two agents, lesion progressed more slowly with a slight induration only at the site of injection becoming apparent after 24 h. Neither alpha-hemolysin nor nuclease was elaborated in the lesion of mice treated with lincomycin and clindamycin. Histological examinations of skin of mice treated with the latter antibiotics revealed a localized abscess with little or no spreading of the bacteria as compared to untreated mice and to mice treated with the other antibiotics. Evidence is presented which suggests significant involvement of the extracellular products in the pathogenesis of staphylococcal infection.

Animals↗

Anti-staphylococcal activity of indolmycin, a potential topical agent for control of staphylococcal infections.

OBJECTIVES: We sought to investigate the anti-staphylococcal activity of indolmycin, with particular emphasis on comparing its activity with fusidic acid and mupirocin. METHODS: Established procedures were used to examine the activity of indolmycin against a range of clinical isolates, including strains resistant to fusidic acid and mupirocin. Indolmycin-resistant mutants were recovered and characterized phenotypically and genotypically. RESULTS: Indolmycin was bacteriostatic and demonstrated good activity against MSSA (methicillin-susceptible Staphylococcus aureus), MRSA (methicillin-resistant S. aureus) and VISA (vancomycin-intermediate S. aureus), including strains resistant to mupirocin or fusidic acid. Spontaneous indolmycin-resistant mutants occurred at a lower frequency than those selected by mupirocin or fusidic acid and exhibited no cross-resistance with the comparative drugs. High-level resistance (indolmycin MIC 128 mg/L) that was associated with an H43N mutation in tryptophanyl-tRNA synthetase (TrpS), the target enzyme of indolmycin, resulted in loss of bacterial fitness. However, the locus responsible for low-level indolmycin resistance (indolmycin MICs 8-32 mg/L) was not identified. CONCLUSIONS: Indolmycin is a potent anti-staphylococcal agent, which exhibits activity against mupirocin- and fusidic acid-resistant strains. Indolmycin might be a candidate for development as a topical agent in the treatment of staphylococcal infections and nasal carriage of MRSA.

Anti-Infective Agents, Local↗

[Effect of lincomycin, chymotrypsin and their combinations on the splenic plasmacytic reaction and the antibody titer in experimental staphylococcal infection].

The effect of lincomycin, chymotrypsin and their combinations on the plasmocytic reaction of the spleen and agglutinin titer in mice with experimental staphylococcal infection was studied. The infected mice were divided into 4 groups: the 1st group included untreated infected animals, the 2nd, 3rd and 4th groups consisted of the mice treated with lincomycin, chymotrypsin and their combinations respectively. Lincomycin and chymotrypsin were used in doses of 150 and 2 mg/kg respectively. By the 3rd, 7th, 14th and 21st day of the infection and treatment the animals were decapitated, th blood was collected for determination of the staphylococcal agglutinin titers in the serum, the spleens were removed for investigation of the plasmocytic reaction. It was shown that the treatment of the experimental staphylococcal infection with lincomycin resulted in decreased proliferation of the plasmatic cells and antibody formation. The use of chymotrypsin resulted in increased proliferation of the plasmatic cells and specific antibody titer. The use of chymotrypsin in conjunction with lincomycin lowered the suppressing effect of the latter on the above indices.

Animals↗