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PubMed2006

Gemella endocarditis: consider the colon.

Gemella species, including Gemella morbillorum, are part of the normal flora of the human oropharynx, upper respiratory tract and gastrointestinal tract. Differentiation of Gemella from viridans streptococci in the laboratory may be difficult. Although uncommonly pathogenic, they have been implicated in a variety of human infections, most notably infective endocarditis. Dental instrumentation appears to be the usual source of infection. The case is reported of Gemella morbillorum native valve endocarditis, which was associated with an underlying colonic carcinoma. An association with colonic neoplasm has been described in three previous cases of endocarditis attributed to Gemella. It is well documented that Streptococcus bovis endocarditis may occur in the setting of colonic neoplasia. It is suggested that colonic investigation should be considered in patients with Gemella endocarditis, in whom no other source is apparent.

Colonic Neoplasms↗

PubMed2005

Improved outcomes in the recent management of secondary aortoenteric fistula.

OBJECTIVE: We reviewed the presentation, management, and late events in a recent experience with aortic graft-enteric communications (secondary aortoenteric fistula) to identify variables associated with poor outcomes. METHODS: Since 1991, 29 patients (19 men, 10 women; mean age, 70) presented with a secondary aortoenteric fistula. The duration from aortic graft implantation to aortoenteric fistula development ranged from 8 months to 180 months (mean, 47 months). Presenting symptoms included gastrointestinal bleeding (n = 25), sepsis and retroperitoneal abscess (n = 3), and ruptured para-anastomotic aneurysm (n = 1). One third (10/29) of patients were hypotensive at presentation. Repair was accomplished by graft excision with axillobifemoral bypass (17 simultaneous, 8 staged), graft excision with in situ deep vein replacement (n = 2), or graft excision with rifampin-treated prosthetic replacement (n = 2). Mean follow-up was 51 months, and the incidence of late events was reported by life table methods. RESULTS: The operative (< or = 30-day) mortality rate was 21%, with shock at presentation (P < .01), the need for preoperative transfusion (P < .01), and use of suprarenal aortic clamping during aortoenteric fistula repair (P = .03) associated with lethal outcome. Cumulative mortality related to aortoenteric fistula management was only 24% within an overall 5-year survival rate of 61%. Freedom from recurrent infection or amputation was 86% and 88% at 5 years, respectively, and assisted graft patency was 79%. Presence of staphylococcal species in 22% of patients and occasional operative findings of adjacent perigraft "biofilm" suggests that underlying indolent graft infection may contribute to the development of aortoenteric fistula in some cases. CONCLUSION: Outcomes associated with aortoenteric fistula repair were surprisingly favorable in the absence of preoperative hemodynamic instability.

Aged↗

PubMed1989

Septic arthritis in the newborn--a 17 years' clinical experience.

Septic arthritis is an uncommon, yet serious disorder in the newborn. Most patients survive with permanent handicaps. We encountered 11 cases of neonatal septic arthritis in the Hospital over the past 17 years (1971-87), an incidence of 0.12 per 1000 livebirths or 0.67 per 1000 admissions to the neonatal nursery. The clinical experience is presented. The diagnosis of septic arthritis in the newborn is more difficult than in the older children. Joint swelling (10/11), tenderness (9/11) and limitations of joint movement (8/11) were the common presenting clinical signs. Constitutional symptoms (fever, leucocytosis, gastrointestinal disturbances) were unremarkable. More than half of the babies (6/11) were prematurely born. The knees and the hips were frequently infected, many had multiple joint involvement (6/11). Septic arthritis commonly manifested between 20-40 days of life. The causative agents viz. Staphylococcus aureus (4/11), Candida (2/11), Citrobacter (1/11) and Methicillin Resistant Staphylococcus aureus MRSA (4/11) showed that septic arthritis was a nosocomial infection. Many babies (9/11) had insertion of intravascular catheter for 1-3 weeks and 9/11 babies had concomitant positive blood culture, 2/11 coexisting osteomyelitis and 1, meningitis. Though there was no death, majority of the babies had joint destruction and severe handicap. Early diagnosis including frequent examinations of joints, prompt treatment and control of nosocomial infection are important in management.

Arthritis, Infectious↗

PubMed1993

Synthesis and biological activity of 3'-hydroxy-5'-aminobenzoxazinorifamycin derivatives.

As a part of our studies on the syntheses of benzoxazinorifamycin derivatives, 3'-hydroxy-5'-aminobenzoxazinorifamycin derivatives were synthesized, and tested for their antimicrobial activities. The antimicrobial activities of these compounds against gram-positive and gram-negative bacteria were almost identical to those of rifampicin (RFP) and rifabutain (RFB), however, antimicrobial activities against Mycobacterium tuberculosis were superior to RFP, while being similar to RFB. 3'-Hydroxy-5'-(4-alkyl-1-piperazinyl)benzoxazinorifamycin derivatives also had in vitro potent activities against Mycobacterium avium complex (MAC). Their minimal inhibitory concentration values against MAC were 2-256 times greater than RFP and RFB. Their in vivo efficacies against M. tuberculosis and MAC, after oral administration to mice, were superior to RFP and RFB, except for RFB against M. tuberculosis activity in vivo. Although they were absorbed from the gastrointestinal tract, their plasma levels were lower than that of RFP. Among these 5'-(4-alkyl-1-piperazinyl) derivatives, 3'-hydroxy-5'-(4-isobutyl-1-piperazinyl)benzoxazinorifamycin, compound 19 (KRM-1648), was selected as the most promising and its preliminary pharmacokinetic characteristics in mice were investigated. Compound 19 was distributed much more in tissues, especially in spleen and lung, than in plasma and had a long elimination time from tissues.

Animals↗

PubMed1991

Azithromycin and amoxicillin in the treatment of acute maxillary sinusitis.

Seventy-eight patients participated in this multicenter, third-party-blinded study comparing a single daily dose of azithromycin for 5 days (500 mg on day 1 followed by 250 mg/day for days 2-5) with amoxicillin (500 mg three times daily) for 10 days in the treatment of acute bacterial maxillary sinusitis. A total of 38 evaluable patients contributed to the efficacy analysis. The overall clinical response rate was 100% for both antibiotics. The clinical cure rate, as determined by the investigator, was 73.9% for azithromycin and 73.3% for amoxicillin; improvement was seen in 26.1% and 26.7% of patients, respectively. The bacteriologic cure rate in these 38 patients was 100% in both groups. Both antibiotics were well tolerated; side effects were reported by 4.9% of patients in the azithromycin group compared with 8.1% in the amoxicillin group. Most of these side effects were gastrointestinal disturbances that were reported by four of five (three amoxicillin, one azithromycin) patients experiencing side effects. All side effects were mild, and in both groups only minor abnormalities in laboratory data were detected. No patient discontinued the study because of treatment-related side effects. In this study, a 5-day course (one dose per day) of azithromycin proved to have efficacy, safety, and tolerability that was equal to a 10-day course (three doses per day) of amoxicillin in the treatment of acute bacterial sinusitis.

Acute Disease↗

PubMed2002

Intravenous cyclosporine-rifampin interaction in a pediatric bone marrow transplant recipient.

A 10-year-old girl with chronic myelogenous leukemia began receiving cyclosporine the day before bone marrow transplant surgery Three days after the transplant, she developed fever and neutropenia due to a Staphylococcus aureus bacteremia. Despite treatment with various antibiotics, the patient's fever persisted over the next 4 days. Intravenous rifampin was added to her antibiotic regimen of piperacillin, tobramycin, cloxacillin, and amphotericin. On day 12, the patient's blood cultures were negative and her fever had resolved; rifampin was discontinued. On day 16, the patient engrafted; she subsequently developed a grade II graft-versus-host disease of the skin and gastrointestinal tract, which responded to methylprednisolone. Her cyclosporine blood levels, which had been subtherapeutic since day 5 despite increasing intravenous dosages, were within the therapeutic range on day 21, and she was discharged 12 days later. To our knowledge, this is the first documented case of an intravenous cyclosporine-rifampin interaction that resulted in subtherapeutic cyclosporine concentrations in a child receiving a bone marrow transplant who subsequently developed acute graft-versus-host disease.

Antibiotics, Antitubercular↗

PubMed2000

Nosocomial blood stream infection in Auckland Healthcare hospitals.

AIM: To report the epidemiology of nosocomial bloodstream infections in Auckland Healthcare Hospitals. METHODS: From January 1995 to December 1997 every positive blood culture result was followed up by an infection control nurse who recorded relevant clinical, laboratory and treatment information on a data collection sheet. The clinical significance of each isolate was determined and the most likely source recorded. RESULTS: During the three year study period, there were 1,046 nosocomial blood stream infections yielding 1,147 isolates. The most common isolates/groups were: coagulase negative staphylococci 19%, S. aureus 18%, E. coli 12%, streptococci 10%, other Enterobacteriaceae 10%, Enterobacter spp. 7%, Pseudomonas spp. 5%, anaerobes 2%, and yeasts 4%. The most common sources were: intravascular lines 40%, urinary tract 8%, skin/soft tissue 8%, gastrointestinal 7%, and unknown 25%. The overall results were strongly influenced by the neonatal intensive care unit at National Women's Hospital where 58% of blood stream infections had intravascular-lines as the source and 53% of the isolates were coagulase negative staphylococci. The overall blood stream infection rate was approximately 6/1,000 admissions. Rates per 1,000 inpatient days for haematology, intensive care, oncology, neonatal and all other patients were 13, 11, 3, 3 and 1 respectively. CONCLUSIONS: Surveillance data that are clinically relevant are useful in identifying areas where infection prevention strategies can be implemented. Because of the importance of lines as a source of nosocomial blood stream infections all aspects of line care are being reviewed with the aim of reducing these devices as a source of blood stream infection.

Cross Infection↗

PubMed1980

Absence of nafcillin-associated nephritis. A prospective analysis of 210 patients.

In a prospective study of 210 consecutively seen patients receiving nafcillin, no patient's therapy was discontinued because of clinically manifested or suspected nephritis. Administration of nafcillin was discontinued because of an adverse reaction in only two patients, one with a rash and one with neutropenia. In seven of the ten patients in whom renal dysfunction developed during treatment, renal function improved while the patients continued to receive nafcillin. In the remaining three patients, renal failure was attributed to other factors including rhabdomyolysis and myoglobinuria, gastrointestinal hemorrhage and hypotension, and what appeared to be aminoglycoside toxicity. No renal biopsy studies were done because none were clinically indicated. Although the results of this study do not rule out the possibility that nafcillin may induce nephritis, if it does occur it appears in such a mild form-manifested solely as urinary sediment abnormalities-or so infrequently that it was not detected in this group of patients. In four patients, leukopenia could not be explained on any basis other than nafcillin administration.

Adolescent↗

PubMed1987

Molecular aspects on pathogenesis of wound and foreign body infections due to staphylococci.

Rapid progress has been made in our understanding how various mucosal bacteria and virus pathogens bind to specific epithelial cell receptors and cause infections in respiratory gastrointestinal and the urogenital tracts, during the last decade. In the present review, I summarize our understanding how pathogens can colonize subepithelial tissues in open wounds and burns by binding to specific subepithelial matrix components such as collagen, laminin, fibronectin and to fibrin in blood clots and cause pyogenic infections. Serum and tissue fibronectin show a high affinity for various surfaces compared to other body fluid proteins. Based on the recent discovery of specific fibronectin binding surface proteins (FNBP) of S. aureus recently cloned and expressed in E. coli a new concept is presented how S. aureus, coagulase-negative staphylococci (CNS) and other wound pathogens bind to wound sutures, intravascular catheters and various prosthesis materials and initiate foreign body infections. Finally, new principles for treating wound infections with hydrophobized and fibronectin substituted wound dressings to decrease the critical bacterial numbers (approx. 10(5) per mg tissue (7] to spead up healing of infected wounds is presented.

Animals↗

PubMed1979

Epidemics of infectious diseases in newborn nurseries.

The newborn nursery is a frequent site of epidemics of infectious disease. The unique susceptibility of neonates to colonization, their intimate exposure to hospital personnel, and their frquent contact with possibly contaminated inanimate objects are major factors contributing to the risk of nursery epidemics. Most of the epidemics described have been caused by bacteria; the role of viruses in nosocomial infections is not well defined but is undoubtedly greater than presently appreciated. All bacteria implicated in nursery epidemics have the capacity to survive or even multiply in the environment or on human skin or to cause gastrointestinal disease. Analysis of the etiologic bacteria, the epidemiology of outbreaks studied, and extensive clinical research indicate that bacterial transmission in this setting occurs primarily by manual contact and very infrequently by the respiratory route. The cornerstone of a program to prevent infectious diseases in the nursery consists of active, disease-oriented surveillance by specially trained personnel; microbiologic surveillance is important only when specifically indicated. Practical technical considerations for prevention of infectious diseases in nurseries are available. Programs to eradicate an ongoing epidemic must be individualized.

Cross Infection↗

PubMed1995

[Susceptibility to infections in diabetes--effects on metabolism].

Diabetic patients suffer from recurrent episodes of infections. The cellular and the humoral elements of the defense system against germ invasion are disturbed by the diabetic metabolism. Neuropathy and vascular damage promote the development of wounds and inhibit their healing. Altered motility of the gastrointestinal and the urinary tract lead to increased penetration of bacteria even there. Rare bacteria, atypical courses and frequent complications of infections result in delayed diagnosis and therapy. Dehydration, electrolyte disturbances, malnutrition, and reduced general conditions even increase susceptibility to an infection. On the other hand, an infection deteriorates the metabolic situation in diabetes, resulting in the need for higher insulin doses, or insulin injections in patients normally on oral medication. Altered every-day-life with modified food intake and reduced physical activity complicate diabetes therapy. Neuropathy, angiopathy, retinopathy, nephropathy and other diabetic complications can be triggered and aggravated during the course of an infection. To disrupt this vitious circle of hyperglycemia enforcing infections, which then raise blood glucose, it is necessary to know about the characteristic features of the interactions of diabetes and infection.

Bacterial Infections↗

PubMed1998

Comparison of roxithromycin with co-amoxiclav in patients with sinusitis.

In an open, randomized study of 60 patients with acute or recurrent sinusitis, the bacteriological and clinical efficacy of roxithromycin 150 mg bd were compared with those of po co-amoxiclav (625 mg) tds. Of 52 patients who underwent sinus puncture for isolation of causative organisms, 48 had pathogens sensitive to both antibiotics. Satisfactory clinical response was obtained in 93.1% (27/29) evaluable patients receiving roxithromycin and 88.8% (24/27) receiving co-amoxiclav. Tolerability was significantly better in the roxithromycin group, with 1/29 (3.4%) patients in this group experiencing gastrointestinal side-effects, compared with 7/27 (25.9%) patients in the co-amoxiclav group (P < 0.05). Although the study had limited power to detect differences, roxithromycin demonstrated clinical, bacteriological and overall efficacy similar to that of co-amoxiclav, but with better tolerability. Roxithromycin thus appears to be an effective and well-tolerated drug for the treatment of acute and recurrent sinusitis.

Adolescent↗

PubMed1995

Erythema migrans and early Lyme disease.

Erythema migrans (EM) must be distinguished from other entities including streptococcal and staphylococcal cellulitis, hypersensitivity reactions to arthropod bites, plant dermatitis, tinea, and granuloma annulare. Although EM lesions may be pruritic or painful, these complaints are generally mild. Central clearing may be absent in > 50% of patients. Multiple lesions, formerly present in 50% of U.S. patients, now occur in approximately 20%. EM develops days to 1 month after a tick bite (median 7-10 days), and lesion diameter increases with duration. Most patients have associated complaints, with fatigue (54%), myalgia (44%), arthralgia (44%), headache (42%), and fever and/or chills (39%) being the most common. Respiratory and gastrointestinal complaints are infrequent. Symptoms may begin prior to the onset of, concomitant with, or after resolution of the rash. The incidence of viral-like illness due to Lyme disease without EM is unknown. Antibodies to Borrelia burgdorferi are absent in up to 50% of patients at presentation, with initial seropositivity most likely in those with EM of longer duration. The vast majority of patients will become seropositive within the first month of illness, even with treatment. Although there is evidence that B. burgdorferi can spread to the blood and central nervous system soon after onset of infection, oral therapy is highly effective in preventing objective extracutaneous complications of Lyme disease. The most appropriate choice, route of administration, and duration of therapy require further study. Because of variations in the etiologic agent between North America and Europe, comparisons of disease manifestations, treatment, and prognosis of Lyme disease must be made cautiously.

Borrelia burgdorferi Group↗

PubMed2005

Oral delivery and gastrointestinal absorption of soluble glucans stimulate increased resistance to infectious challenge.

Glucans are immunomodulatory carbohydrates found in the cell walls of fungi and certain bacteria. We examined the pharmacokinetics of three water-soluble glucans (glucan phosphate, laminarin, and scleroglucan) after oral administration of 1 mg/kg doses in rats. Maximum plasma concentrations for glucan phosphate occurred at 4 h. In contrast, laminarin and scleroglucan showed two plasma peaks between 0.5 and 12 h. At 24 h, 27 +/- 3% of the glucan phosphate and 20 +/- 7% of the laminarin remained in the serum. Scleroglucan was rapidly absorbed and eliminated. The liver did not significantly contribute to the clearance of plasma glucan. Biological effects were further studied in mice. Following oral administration of 1 mg, glucans were bound and internalized by intestinal epithelial cells and gut-associated lymphoid tissue (GALT) cells. Internalization of glucan by intestinal epithelial cells was not Dectin-dependent. GALT expression of Dectin-1 and toll-like receptor (TLR) 2, but not TLR4, increased following oral administration of glucan. Oral glucan increased systemic levels of interleukin (IL)-12 (151 +/- 15%) in mice. Oral glucan administration also increased survival in mice challenged with Staphylococcus aureus or Candida albicans. These data demonstrate that orally administered water-soluble glucans translocate from the gastrointestinal (GI) tract into the systemic circulation. The glucans are bound by GI epithelial and GALT cells, and they modulate the expression of pattern recognition receptors in the GALT, increase IL-12 expression, and induce protection against infectious challenge.

Administration, Oral↗

PubMed1983

Antimicrobial prophylaxis in acute leukaemia: prospective randomized study comparing two methods of selective decontamination.

In a prospective study the efficacy of two regimens for selective decontamination of the digestive tract was studied in patients with acute leukaemia during remission induction therapy. Seventy-eight patients were randomized to receive either a combination of cotrimoxazole, polymyxin B and nystatin (group A) or a combination of nalidixic acid, polymyxin B, neomycin and nystatin. With both regimens the gastrointestinal tract could be decontaminated equally effectively from potential pathogens. In the oropharyngeal region the decontamination from Enterobacteriaceae was significantly better in group A (P less than 0.01). In both groups less than 10% of the acquired infections were caused by gram-negative bacilli and no gram-negative septicaemia occurred in either group. The median time interval until the first acquired infection was 17 days in group A and 36 days in group B, respectively (P less than 0.05). It is concluded that regimen A might be more effective than regimen B though both regimens prevent reliably severe gram-negative infections.

Acute Disease↗

PubMed1988

Contemporary issues: diseases with a food vector.

Foodborne disease has become a contemporary issue. Several large, well-publicized outbreaks of foodborne disease have heightened public awareness that harmful microorganisms may be present in food and that chronic as well as acute disease may be caused by foodborne microbes. The field of food microbiology has likewise experienced a resurgence of interest. New tools, such as recombinant deoxyribonucleic acid technology and monoclonal antibody production, used to elucidate microbial virulence factors have facilitated identification of disease-causing microbes once thought to be harmless and demonstrated the complexity of individual virulence mechanisms previously considered to be well understood. Foodborne pathogens are also causing disease via some surprising food vectors, such as chopped, bottled garlic and sauteed onions. In addition to acute gastrointestinal disturbances, certain microorganisms may, through complex interactions with the human immune response, cause chronic diseases that affect several major organ systems. These microbes are serving as models in studies of molecular mimicry and genetic interrelatedness of procaryotes and eucaryotes. Other recently recognized attributes of foodborne microorganisms, such as the heat shock phenomenon and the possible nonculturability of some bacteria, may affect their ability to cause disease in humans. Because foodborne disease is a major cause of morbidity and mortality, the study of these diseases and their causative microorganisms presents a unique challenge to many professionals in the subdisciplines of microbiology, epidemiology, and clinical medicine.

Bacterial Toxins↗

PubMed1996

Catheter-related complications of cancer therapy.

Although the management of CVC-related infection appears complex and at times the literature seems to be contradictory, simple guidelines can direct the clinician in a stepwise fashion. Knowledge of the pathogenesis of each organism and the immune status of the host is crucial to decide whether catheter removal or retention is indicated. For example, in general, GNB bacteremia does not immediately prompt catheter removal in a neutropenic patient but does in a nonneutropenic host because of the gastrointestinal source of the former and a primary catheter source in the latter. In summary, as more CVCs are inserted in patients undergoing chemotherapeutic, antimicrobial, transfusional, and nutritional supportive care, novel approaches to prevention and treatment of the associated infectious complications inherent with such devices are needed. A multifaceted approach from impregnated catheters to local catheter-site antisepsis was reviewed. We may find, however, that as simple handwashing between patients is crucial to infection control, so too is a trained catheter-care team using total barrier precautions and ensuring proper local catheter maintenance critical to preventing CVC-related infections.

Anti-Bacterial Agents↗

PubMed1997

History of macrolide use in pediatrics.

Erythromycin, the prototypical macrolide, has been widely used since the 1950s in the management of pediatric infections. Erythromycin is the drug of choice for infants and children with Legionnaire's disease, pertussis, diphtheria, lower respiratory tract infections caused by Mycoplasma pneumoniae, Chlamydia pneumoniae and Chlamydia trachomatis and enteritis caused by Campylobacter jejuni. It is also indicated for treatment of syphilis; for streptococcal, staphylococcal and pneumococcal infections; genital infections caused by Ureaplasma urealyticum; and for the prevention of rheumatic fever and endocarditis in patients who are allergic to beta-lactam antibiotics. The new macrolides azithromycin and clarithromycin are also active against Borrelia burgdorferi, Helicobacter pylori, Mycobacterium avium-intracellulare complex, Cryptosporidium spp. and Toxoplasma gondii. Erythromycin is associated with a low risk of serious side effects, although gastric distress occurs in a significant proportion of patients. Drug interactions with theophylline, carbamazepine, warfarin, cyclosporine, terfenadine and digoxin limit erythromycin use. The newer macrolides azithromycin and clarithromycin are more stable, better absorbed and better tolerated than erythromycin. Azithromycin is more active than erythromycin against Haemophilus influenzae. Excellent tissue and intracellular penetration may contribute to their clinical efficacy. In children both azithromycin and clarithromycin are indicated for acute otitis media caused by Streptococcus pneumoniae, H. influenzae and Moraxella catarrhalis and for pharyngitis/tonsillitis caused by Streptococcus pyogenes. (As of December, 1996, azithromycin for oral suspension was approved for community-acquired pneumonia in children caused by C. pneumoniae, H. influenzae, M. pneumoniae and S. pneumoniae.) Claritromycin is also indicated for acute maxillary sinusitis, uncomplicated skin and skin structure infections, pneumonia and disseminated mycobacterial infections. Azithromycin and clarithromycin are associated with a lower incidence of gastrointestinal side effects, a low rate of drug discontinuation caused by side effects and a low potential for interaction with other drugs.

Adolescent↗