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PubMed2002

The efficacy and safety of linezolid as treatment for Staphylococcus aureus infections in compassionate use patients who are intolerant of, or who have failed to respond to, vancomycin.

OBJECTIVE: The incidence of infections caused by methicillin-resistant Staphylococcus aureus continues to increase annually. Unfortunately, only a few therapeutic agents are available for the treatment of patients with such infections and all of the existing drugs have limitations. A pressing need exists, therefore, to identify new antibiotics for use in this clinical setting. The efficacy and safety of linezolid were studied in a compassionate use treatment programme and the results of treating a subset of patients with S. aureus infections are presented here. METHODS: Patients received linezolid in a dosage of 600 mg intravenously (iv) and/or orally twice daily. Clinical and bacteriological responses were assessed after a minimum of 7 days and following completion of therapy. RESULTS: Seven hundred and ninety-six patients who suffered 828 episodes of infection were enrolled in the linezolid compassionate use protocol. Of these, 183 patients received linezolid for 191 infections caused by S. aureus; in 151 cases, patients were intolerant of vancomycin, had a mixed S. aureus/vancomycin-resistant enterococcal infection or had no iv access, and, in 40 cases, patients had failed to respond to treatment with vancomycin. The median age of the patients was 57 years (range 14-93 years) and 53.9% were female. The predominant sites of infection were as follows: bone or joint (27.2%); skin and skin structure (25.1%); bloodstream (20.9%); and lower respiratory tract (12.6%). The clinical success rates in the clinically evaluable and all-treated populations were 83.9% and 62.3%, respectively, whereas the bacteriological eradication rates were 76.9% and 70.2% in the bacteriologically evaluable and all-treated populations, respectively. Linezolid was well tolerated. In 76 (39.8%) of the 191 episodes of infection, patients experienced one or more adverse events or exhibited one or more abnormal laboratory results; in 35 (18.3%) of the 191 cases it was necessary to discontinue treatment. Gastrointestinal tract-related symptoms (nausea, vomiting and diarrhoea) were the most common possibly or probably related adverse events and the most common reasons for drug discontinuation. CONCLUSIONS: Linezolid was effective and well tolerated in patients with S. aureus infections who were enrolled in this compassionate use protocol.

Acetamides↗

PubMed1976

The epidemiology of 2056 remote site infections and 1966 surgical wound infections occurring in 1865 patients: a four year study of 40,923 operations at Rush-Presbyterian-St. Luke's Hospital, Chicago.

Over a 4-year period 40,923 operations and 44,716 surgical admissions were monitored for both community and hospital onset infections. One thousand eight hundred sixty-five patients had 1966 surgical wound infections and 2056 remote infections including 1652 hospital onset and 404 community onset infections. One thousand one hudnred forty-four patients with multiple infections averaged 40 days in the hospital contrasted with 24 days for 721 patients with a single wound infection. The total excess cost of hospitalization for these patients was $951,150. A statistically significant reduction occurred for urinary tract infections, lower respiratory infections and clean and contaminated surgical wound infections. It is suggested that these are all inter-related and a significant reduction in surgical wound infections can be achieved through control of infections at remote sites, particularly those associated with medical devices. The coagulase positive staphylococcus is still the most important single bacterial species in the primary etiology of surgical wound infections. When the gastrointestinal tract is entered or "supra" infecting organisms appear, gram negative bacteria and mixed gram negative and gram positive infections are dominant. Reduction in remote site infections occurring in surgical patients is necessary to reduce the incidence of surgical wound infections, suggest preventive and control measures, and document the effectiveness of such measures.

Adolescent↗

PubMed1975

Staphylococcal food poisoning aboard a commercial aircraft.

On Feb. 3, 1975, 196 (57%) of 344 passengers and 1 steward aboard a commercial aircraft contracted a gastrointestinal illness characterised by nausea, vomiting, abdominal cramps, and diarrhoea; 142 passengers and the steward were admitted to hospital. Symptoms developed shortly after a ham and omelette breakfast had been served. An investigation strongly incriminated ham as the vehicle of the outbreak, and the source seems to have been a cook with lesions on his fingers. The attack-rate was 86% for passengers who ate the ham handled by this cook and 0% for passengers who ate ham handled exclusively by another food preparer. Before being served, the ham and omelette had been held at room temperature for 14 h and at 10 degrees C (50 degrees F) for 14 1/2 h Specimens of stool and vomitus from ill passengers, left-over food, and the finger lesions of the cook were positive for Staphylococcus aureus of identical phage types and antibiotic sensitivities. Preformed enterotoxin was detected in the left-over ham and omelette. This outbreak re-emphasises that people with infected lesion should not handle food and that foods must be stored at temperatures low enough to inhibit the growth of bacteria. To ensure against a common foodborne illness incapacitating the entire flight crew, cockpit crew members should eat different meals prepared by different cooks.

Adult↗

PubMed2001

Antibacterials for the prophylaxis and treatment of bacterial endocarditis in children.

Although the overall incidence of infective endocarditis in the paediatric population is considered to be low, over the last 20 years a rising trend in infective endocarditis has been observed among children. This could be due to several reasons including the availability of improved diagnostic techniques, use of continuous central venous catheters and cardiac implants increasing the risk of infection, and the survival of a greater number of infants with congenital heart disease as a result of improved medical management. The predominant causative organisms of paediatric endocarditis include staphylococci and streptococci. There is increased concern surrounding the emergence of endocarditis in children caused by methicillin-resistant Staphylococcus aureus and drug resistant strains of Streptococcus pneumoniae. The treatment approach to paediatric endocarditis is similar to that for adult patients with endocarditis because of similarities in disease pathogenesis and aetiology. The therapeutic goal is to achieve sterilisation of the cardiac vegetations. The choice of antibacterial is dependent upon the susceptibility profile of the causative organism. Vancomycin or gentamicin is recommended for enterococcal endocarditis, according to guidelines from the American Heart Association. For staphylococcal endocarditis in patients with no prosthetic valve, oxacillin or nafcillin with or without gentamicin is the treatment of choice. In the case of endocarditis caused by methicillin-resistant S. aureus, vancomycin is commonly used in patients with no prosthetic valve and a combination of vancomycin, gentamicin and rifampicin (rifampin) for patients with prosthetic material. Cefazolin or ceftriaxone is the treatment of choice for penicillin allergic paediatric patients with endocarditis caused by viridans streptococci. While there have been no major changes in endocarditis therapy for the last decade, the current focus is on the recognition of multiple-drug resistant pathogens and the use of newer agents such as quinupristin/dalfopristin in the treatment of resistant bacterial endocarditis. Prophylactic antibacterial therapy is recommended for procedures thought to be associated with the occurrence of bacteraemia involving organisms commonly associated with endocarditis. These include dental extractions and oral, respiratory tract, genitourinary, gastrointestinal or oesophageal procedures. Prophylactic antibacterials recommended by the American Heart Association during genitourinary and gastrointestinal surgical procedures in high risk patients include ampicillin + gentamicin or vancomycin + gentamicin in high risk patients with penicillin allergy. Ampicillin has been recommended for prophylaxis of bacterial endocarditis in children undergoing oral, respiratory tract or oesophageal procedures. In the case of penicillin allergy in these patients, cephalosporins, clindamycin, azithromycin or clarithromycin have been recommended. The general consensus is that antibacterial prophylaxis during dental procedure is unnecessary, and in fact propagates bacterial resistance.

Anti-Bacterial Agents↗

PubMed1982

The clinical and laboratory correlates of nasal polyps in cystic fibrosis.

The clinical histories, chest X-ray appearances, skin prick test results, pulmonary function and IgE levels of 20 patients with cystic fibrosis (C.F.) complicated by nasal polyps have been compared with those of 97 C.F. controls. The patients who had developed polyps had a different clustering of symptoms to the controls with heavier birthweights, later presentations, milder gastrointestinal symptoms in infancy, less infection with Staphylococcus aureus and better vital capacities. There was no evidence on history, skin testing or IgE levels that the polyps patients were more allergic. It is likely, therefore, that nasal polyps in C.F. are due to a primary effect of the C.F. gene, although they could also be the effect of chronic nasal infection.

Birth Weight↗

PubMed1992

[Schoenlein-Henoch syndrome in adults and skin infection].

Schoenlein-Henoch purpura is a rare disease in adults clinically characterized by palpable purpura, mainly on the legs, with varying degrees of gastrointestinal, articular and renal involvement. This syndrome is also characterized by IgA-vasculitis and its pathogenesis is still unclear, although it appears frequently after a viral or bacterial infection especially in the ORL sphere. We report here the cases of three adult patients who developed Schoenlein-Henoch purpura shortly after a bacterial infection of the skin, notably by Staphylococcus aureus.

Aged↗

PubMed1991

Recurrent buccal space abscesses: a complication of Crohn's disease.

A patient is described with generalized gastrointestinal involvement by Crohn's disease. Symptoms of recurrent ulceration and mucosal tags are well-described oral manifestations of Crohn's disease; however, in our patient recurrent facial abscesses, which required extraoral drainage, also developed. This complication has not previously been reported.

Abscess↗

PubMed1962

Dangers in the use of some potent drugs.

The chief dangers reported with some common drugs are reviewed. Hazards of antibiotic therapy include: the increasing incidence of sensitization to penicillin with occasional anaphylactic reactions; aplastic anemia with chloramphenicol, and the poor tolerance of infants for chloramphenicol; staphylococcal enterocolitis; unnecessary "prophylactic" use of antibiotics. Thiazide diuretics may precipitate potassium depletion, skin reactions, pancreatitis, blood dyscrasias, gout, diabetes mellitus and hepatic coma. Reserpine can increase gastric acidity, induce mental depression, and when used with digitalis lead to ventricular premature beats. Hydralazine may aggravate angina pectoris, cause tachycardia, and bring about a syndrome resembling disseminated lupus erythematosus. Guanethidine may result in loose stools, impotence, and postural hypotension. Hazards of phenothiazines include jaundice, parkinsonian states and tremors, convulsions, hypotension, and blood dyscrasias. The butanediols have numerous side effects including gastrointestinal, cutaneous and hypotensive reactions. Prolonged corticosteroid therapy introduces a new danger in surgical treatment. The progesterone-like drugs may induce masculinization of the female fetus.

Adrenal Cortex Hormones↗

PubMed2005

Possible risk for re-colonization with methicillin-resistant Staphylococcus aureus (MRSA) by faecal transmission.

An increase in the frequency of methicillin-resistant Staphylococcus aureus (MRSA) as an important causative agent of nosocomial infections is observed worldwide. Unfortunately, in spite of optimal hygienic conditions (barrier isolation, screening, decontamination), patients often remain MRSA positive or are detected as "re-colonized" at readmission. The objective of our study was to clarify if this is due to an undetected colonization of the gastrointestinal tract, which could possibly lead to re-colonization after primary successful decontamination. Therefore, all MRSA strains were collected from 290 in-patients of a university hospital over a period of 2 years. A surprisingly high number (24.1% of all) was isolated from stool samples. Even 13.1% of the total collection could be first observed in this material before detecting MRSA in other materials of these patients. To evaluate the epidemiology of these isolates, pulsed-field gel electrophoresis (PFGE) was used. On the basis of PFGE restriction types one main clone and 11 singular clones could be identified. Additionally, for six individual patients MRSA isolates from stool specimens were indistinguishable from other isolates from different locations. We show here that colonization of the gastrointestinal tract with MRSA apparently could play an important role in spreading MRSA via faecal contamination. Hence, we suggest that stool colonization with MRSA could be the source of a so far unrecognized transmission of MRSA within individual patients and within the population. Therefore, our findings imply a modification in the hygienic strategies for handling decontamination and therapy of MRSA patients.

Bacterial Typing Techniques↗

PubMed1990

The role of continuous ambulatory peritoneal dialysis in end-stage renal failure due to multiple myeloma.

A study in 10 patients (eight male, two female; mean age 61.9 +/- 10.7 years) suffering from multiple myeloma (MM) and end-stage renal failure (ESRF) is detailed. Continuous ambulatory peritoneal dialysis (CAPD) was the preferred mode of chronic dialysis in all the patients. Survival after diagnosis was 32.2 +/- 23.9 months. Survival after starting dialysis was 24.6 +/- 20.6 months. All patients on CAPD were adequately dialyzed and in good fluid control. Peritonitis was the main problem on CAPD (one episode per 5.6 patient-months). The majority of peritonitis episodes responded to intraperitoneal antibiotic therapy. One patient with Staphylococcus aureus peritonitis, septicemia, and neutropenia secondary to chemotherapy, died. Recommendations for prophylaxis and treatment of peritonitis are given. Three patients were transferred to hemodialysis. The use of subclavian vein catheters during hemodialysis was associated with a high incidence of gram-positive septicemia. Alkylating agent-based chemotherapy resulted in hematological responses in five patients. Survival after diagnosis in those responders was 47.4 +/- 25.6 months, compared with 17.0 +/- 7.2 months in the nonresponders (P less than 0.05). All responders subsequently relapsed. Four patients died with progressive myeloma. Bone marrow suppression resulted in a high blood transfusion requirement, neutropenia, and thrombocytopenia associated with bleeding into the gastrointestinal tract and central nervous system. Uremic myeloma patients can be adequately dialyzed using CAPD. Those patients who do not have an initial hematological response have a poor prognosis.

Adult↗

PubMed1970

Clinical and bacteriological studies with clindamycin.

Fifty patients have been treated with clindamycin, a chemical analogue of lincomycin. Forty-four responded satisfactorily to treatment. Gastrointestinal side-effects were rare though five patients developed rashes. Most recently isolated staphylococci are clindamycin-sensitive.

Adolescent↗

PubMed1998

[Epidemiology of infectious inflammatory diseases and role of Candida in newborns].

The results of a 20-year microbiological monitoring of full-term newborns with infectious inflammatory diseases hospitalized from maternity homes of Moscow are presented. The incidence of candidiasis within that period was shown to increase 7 times at the account of the events of cutaneous and mucocutaneous candidiasis, gastrointestinal candidiasis and candidiasis of the central nervous system. One of the sources of the endogenic contamination of the newborns and infants was their intestinal microflora. In 4.6 per cent of the patients the meconium contamination by Candida was stated during the first days after the birth.

Candidiasis↗

PubMed1976

Wound infection following laryngectomy. The effect of topical ampicillin and carbenicillin.

A study of twenty-two consecutive laryngectomies performed in one unit is reported. In eleven controls, seven (67%) developed a wound infection. In eleven patients, IG of Ampicillin and IG of Carbenicillin were used topically, and three (18%) developed a wound infection (P less than 0-04). Studies of the bacterial flora at the time of operation suggest that the major source of wound contamination is colonization of the upper gastrointestinal and respiratory tract. The ease with which a small innoculum of pathogens produces wound infection in these patients is discussed, and it is suggested that the underlying defect is depression of host cellular immunity resulting in failure of bacterial destruction by activated macrophages.

Administration, Topical↗

PubMed1993

Infectious sequelae after endoscopic sclerotherapy of oesophageal varices: role of antibiotic prophylaxis.

In order to determine the incidence of infection following sclerotherapy and the role of antimicrobial prophylaxis, a prospective randomized control study was performed comparing i.v. imipenem/cilastatin, with an infusion of dextrose-saline as a control group. One hundred patients with bleeding esophageal varices were included. All episodes of infection were documented during admission to the unit. Ninety-seven patients were evaluable. Post-sclerotherapy bacteremia developed in six (5.6%) of 107 sclerotherapy sessions in the control group and one (1.1%) of the 88 sclerotherapy sessions in the imipenem/cilastatin group (P < or = 0.1, NS): six of these seven post-sclerotherapy bacteremias occurred after emergency sclerotherapy. Infection within 7 days of the procedure was documented after 43 (22.1%) of the 195 sclerotherapy sessions, 18 (20.5%) in the imipenem/cilastatin group and 25 (23.4%) in the control group (P = NS). These infections were significantly more common after emergency sclerotherapy, 40 (34.8%) of 115 sessions, than after elective sclerotherapy, three (3.8%) of 80 sessions (P < or = 0.0001). A short prophylactic antibiotic regime does not reduce the risk of early bacteremia or the frequency of infection after sclerotherapy. The higher risk of infection after emergency sclerotherapy may be therefore related more to the gastrointestinal hemorrhage and its associated effects than to sclerotherapy.

Adolescent↗

PubMed1993

Comparison of azithromycin versus clarithromycin in the treatment of patients with upper respiratory tract infections.

The efficacy and safety of azithromycin and clarithromycin were compared in an open multicentre study involving 380 adult patients with acute otitis media, acute sinusitis, or acute streptococcal pharyngitis or tonsillitis. Patients were assigned randomly to receive azithromycin as a single dose of 500 mg daily for three days, or clarithromycin 250 mg bid for ten days. Overall clinical efficacy was found to be similar in each treatment group at day 10-14, with a satisfactory outcome (cured or improved) in 95% of azithromycin and 96% of clarithromycin patients. Bacteriological efficacy was also similar, with eradication of the pathogen in 94% and 95% of isolates, respectively, in the azithromycin and clarithromycin groups. In otitis media, a satisfactory clinical response was seen in 97% of patients in each treatment group. Azithromycin therapy resulted in a clinical response rate of 93% in sinusitis patients, with bacteriological eradication in 93% of patients. Two patients (who were cured clinically) had persistent pathogens. Similarly, clarithromycin achieved clinical response and bacteriological eradication in 95% and 92% of sinusitis patients, respectively. Pathogens persisted in two patients with clinical cure, and in one case of clinical failure. In pharyngitis or tonsillitis, Streptococcus pyogenes was eradicated successfully in 95% of patients in both groups, and the clinical success rates were 96% and 97% for azithromycin and clarithromycin, respectively. No case of clinical failure was associated with persistence of S. pyogenes infection. At the follow-up assessment of this diagnosis group, reinfection had occurred in three (8%) azithromycin patients and one (3%) clarithromycin patient, and all but one patient remained asymptomatic. Both drugs were well-tolerated, with 8.4% of patients on azithromycin and 7.4% on clarithromycin reporting adverse events, mainly gastrointestinal. It was concluded that a three-day course of azithromycin was as effective and well-tolerated as a ten-day course of clarithromycin in adults with acute upper respiratory tract infections.

Acute Disease↗

PubMed1984

Imipenem therapy of Pseudomonas aeruginosa and other serious bacterial infections.

Imipenem is the first of a new class of beta-lactam antimicrobial agents with remarkable and extremely potent in vitro activity against most commonly isolated bacterial pathogens, including Staphylococcus aureus, enterococcus, members of the family Enterobacteriaceae, Pseudomonas aeruginosa, Bacteroides fragilis, and Hemophilus influenzae. The clinical efficacy and toxicity of imipenem were evaluated in 35 patients with 38 different infections. The overall clinical response was favorable (infections cured or improved) in 89% of the infections (34 of 38). Of the 17 infections with P. aeruginosa, 15 were cured or improved. However, P. aeruginosa isolates resistant to imipenem emerged during the therapy of six infections, and two cases of P. aeruginosa septicemia later relapsed after imipenem therapy. Gastrointestinal toxicity (nausea with or without emesis) occurred in 17% of the patients (6 of 35) but was ameliorated by slowing the rate of intravenous infusion or lowering the dose of imipenem. Except for certain severe P. aeruginosa infections, imipenem is effective and relatively safe therapy for infections caused by susceptible organisms.

Adolescent↗

PubMed1987

Prospective assessment of risk of bacteremia with colonoscopy and polypectomy.

A prospective assessment was made of the frequency of positive blood cultures in patients undergoing colonoscopy with or without polypectomy. A total of 270 patients underwent 280 colonoscopies, of these, there were 105 patients that had 111 polypectomies. Blood cultures were taken prior to and within 15 min following each procedure. Six of 280 (2.1%) preprocedural blood cultures were positive. Seven of 169 (4%) blood cultures were positive within 15 min of insertion of the colonoscope in the colonoscopy only group. Eight of 223 (3.6%) blood cultures were positive within 10 min of the polypectomy. There was no clinical evidence of sepsis during the 24 hr following these procedures. In order to determine appropriate postprocedural sampling intervals, we induced a Staphylococcus epidermidis bacteremia with a mean of 1.16 X 10(6) colony forming units/ml on 10 occasions in seven dogs. Within 30 min of inoculation, we were able to detect only one colony forming unit/ml. The rate of positive blood cultures during colonoscopy alone and following polypectomy during colonoscopy is comparable to other gastrointestinal endoscopy procedures. The most optimal time to collect blood cultures in order to detect transient bacteremia is as soon after the procedure as is feasibly possible.

Animals↗

PubMed1981

Intrasplenic abscess: two case reports and review of the literature.

The occurrence of splenic abscess, sickle cell trait, and drug addiction is described in two patients. The coincidence of sickle cell disease and drug addiction in the possible etiology of splenic abscess should be noted. The first patient had a splenic abscess in the inferior pole of the spleen with signs and symptoms of left upper quadrant peritoneal irritation. The second patient had an intrasplenic abscess in the superior pole with pleuritic type chest pain and large left pleural effusion. In both cases, the upper gastrointestinal series was of aid in establishing the diagnosis. In one case, a splenic scan was helpful. Clostridium perfringens were cultured from the abscess of one patient; and Clostridium species, Staphylococcus aureus and Propionibacterium acnes were cultured from the other. Both patients were successfully treated with splenectomy and drainage of the splenic bed.

Abscess↗