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PubMed2000

[Antimicrobial susceptibility and serotypes of Streptococcus pneumoniae isolated from the patients with respiratory tract infections in Hokusetsu Area of Osaka].

One hundred and thirteen strains of Streptococcus pneumoniae (S. pneumoniae) were isolated from the clinical specimens of patients with respiratory tract infections between January and December 1998 in three hospitals in Hokusetsu area of Osaka. We investigated susceptibility of 113 strains of S. pneumoniae to benzylpenicillin (PCG) and other antimicrobial agents and their serotypes. 1) Of the 113 strains of S. pneumoniae isolated, 25.7% were susceptible (PSSP), 51.3% were intermediate (PISP) and 23% were resistant to benzylpenicillin (PRSP). 2) The MICs of cefaclor, cefditoren, cefpodoxime, cefdinir, erythromycin, clindamycin and minocycline were elevated, but the MIC values of cefditoren ranged from < or = 0.03 to 1.0 microgram/ml. The susceptibility of 113 strains to cefditoren was comparatively high. 3) The MIC values of imipenem, meropenem and vancomycin for 81 strains of PISP and PRSP ranged from < or = 0.015 to 1.0 microgram/ml, from < or = 0.015 to 2.0 micrograms/ml and from 0.13 to 0.5 microgram/ml, respectively. The susceptibility of these strains to three antimicrobial agents was superior to that to the other antimicrobial agents examined. 4) Of the 60 strains examined, 19, 6, and 23 serotypes were 30, 25 and 18.3%, respectively. The three serotypes were observed in PISP and PRSP with a high frequency. 5) Isolates of S. pneumoniae were 37.2% for children under 2 years of age and 30.9% for children from 2 to 6 years of age. Most of the strains isolated from these children were resistant.

Anti-Bacterial Agents↗

PubMed2000

Antibiotic susceptibility of invasive Streptococcus pneumoniae in Wisconsin, 1999.

BACKGROUND: Streptococcus pneumoniae is a major cause of community acquired infections in the United States, and rates of antibiotic resistance have increased dramatically in the past decade. Statewide rates of pneumococcal resistance to penicillin and other antibiotics have not been previously reported in Wisconsin. To determine these rates, we assessed invasive pneumococcal isolates for reduced susceptibility to nine different antibiotics. METHODS: Pneumococcal isolates from blood, cerebrospinal fluid or other normally sterile body sites were submitted by 91% of laboratories that perform invasive bacterial cultures. Isolates were tested for susceptibility to penicillin, cefotaxime, ceftriaxone, levofloxacin, meropenem, erythromycin, vancomycin, sulfamethoxazole-trimethoprim and chloramphenicol. RESULTS: There were 409 invasive pneumococcal isolates identified in 1999 among Wisconsin residents, including 385 (94%) isolates from blood. The mean patient age was 42.5 years (range, < 1 year to 96 years), and 213 (52%) were male. Of the pneumococcal isolates, 24% were not susceptible to penicillin, including 10% with high level resistance. Isolates with reduced penicillin susceptibility were also likely to have reduced susceptibility to other antibiotics. Patients with penicillin nonsusceptible (intermediate and fully resistant) pneumococcal isolates were significantly younger (mean, 37.0 years) than those with susceptible isolates (mean, 44.3 years) (p = .04). The proportion of patients with a penicillin nonsusceptible isolate varied by region, ranging from 12.8% in northeastern Wisconsin to 35.5% in northern Wisconsin. CONCLUSIONS: The proportion of invasive pneumococcal isolates with penicillin resistance in Wisconsin is similar to other regions of the United States. Inappropriate antibiotic use contributes to the emergence of resistant pneumococcal infections, and educational efforts are underway to promote judicious antibiotic use in Wisconsin.

Adolescent↗

PubMed1999

Bacterial Pathogens Isolated from Patients with Bloodstream Infections in Latin America, 1997: Frequency of Occurrence and Antimicrobial Susceptibility Patterns from the SENTRY Antimicrobial Surveillance Program.

We report the antimicrobial susceptibility of 736 organisms isolated from bloodstream infections in 10 Latin American medical centers during the first six months of 1997. The data presented here is from the SENTRY Antimicrobial Surveillance Program, a comprehensive surveillance study involving 72 medical centers worldwide. The isolates ivere tested for in in vitro susceptibility to 35 antimicrobial agents by the broth microdilution method. The five most frequently isolated species were (n/%): Staphylococcus aureus (1 65/22.4%), Escherichia coli(118/16.0%), coagulase-negative staphylococci (CoNS - 115/15.6%), Pseudomonas aeruginosa (51/6.9%), Klebsiella spp. (46/ 6.3%). Susceptibility to oxacillin was 70.9% for S. aureus and only 33.9% for CoNS. Vancomycin was active against all of staphylococci, while teicoplanin was active against 99.4% of S. aureus and only 90.4% of CoNS. The new fluoroquinolones sparfloxacin, gatifloxacin, and trovafloxacin, and the streptogramin, quinupristin/dalfopristin, were very active against these species. Only one vancomycin-resistant enterococcus was detected; however, high-level aminoglycoside resistance rates were common (66.7%). E. coli and Klebsiella spp. showed low susceptibilities for cefotaxime (90.7% and 41.3%) and for cefoxitin (85.6% and 78.3% respectively), indicating a high frequency of isolates that produce ESBL and/or stably derepressed ampC enzymes. These strains, phenotypically consistent with extended-spectrum beta-lactamase (ESBL) production, were typed using ribotyping and pulsed-field gel electrophoresis. The most active compounds (M IC90 in µg/mL /% susceptibility) against P. aeruginosa were meropenem (2 /94.1%), followed by amikacin (>32 / 86.3%), and piperacillin alone or with tazobactam (128/84.3%). Ceftazidime and cefepime showed similar activity (70.6% susceptibility) and levofloxacin was the most active fluoroquinolone (MI C50 &lte; 0.5; 76.5% susceptibility) against this gram-negative species. These results show the unique pattern of bloodstream isolates for Latin America and they demonstrate the present utility of several classes of compounds against emerging antimicrobial-resistant species in this region.

Journal Article↗

PubMed1997

Antimicrobial Susceptibility of Klebsiella pneumoniae Producing Extended-Spectrum beta-lactamase (ESBL) Isolated in Hospitals in Brazil.

The prevalence of klebsiella pneumoniae producing extended-spectrum beta-lactamase (ESBL) has been increasing all over the world. Infections caused by ESBL producing isolates are difficult to detect with current susceptibility tests, and are difficult to treat. ESBLs confer resistance to all currently available beta-lactam, except carbapenems. In addition, ESBL production is usually associated with resistance to other classes of antimicrobial agents such as aminoglycosides and quinolones. The objective of this study was to evaluate the in vitro susceptibility patterns of ESBL producing K pneumoniae isolated in Brazil. Seventy-two strains were tested using E test against 30 antimicrobial agents, including carbapenems, second and third generation cephalosporins, aminoglycosides, quinolones, and some new compounds. The most active compounds (i.e. 100% susceptibility) were meropenem (MIC90, 0.125µg/mL), imipenem (MIC90, 0.25µg/mL), and cefotetan (MIC90, 2µg/mL). Ciprofloxacin (MIC90, 1µg/mL, 94% susceptibility) and cefepime (MIC90, 6µg/mL, 92% susceptibility), were also very active against our collection of ESBL producing K pneumoniae. None of the six aminoglycosides showed good activity against these strains (16% to 41% susceptibility) and only 39% of the isolates were susceptible to piperacillin/tazobactam. The results of our study indicated that the carbapenems are the most active compounds against ESBL producing L pneumoniae in Brazil, and ciprofloxacin remains very active against these strains. Cefotetan and cefepime were also very active against ESBL producing K.pneumoniaein Brazil; however, further studies are necessary to evaluate the role of these cephalosporins in the treatment of infections due to ESBL producing strains.

Journal Article↗

PubMed2000

[Beta-lactamases with a wide substrate spectrum in gram negative strictly anaerobic rods].

This study was performed to determine the susceptibility of the clinical strains of Gram-negative strictly anaerobic rods to newer beta-lactam antibiotics. Also, the trial was undertaken to detect strains producing extended-spectrum beta-lactamases (ESBLs) and inducible beta-lactamases (IBLs) among Bacteroides spp. and Prevotella spp. rods isolated from hospitalized patients. One hundred strains of Gram-negative, obligatory anaerobic rods were applied in the study. The strains were identified in automatic ATB system using API 20 A strips. beta-lactamase-positive strains were determined with disc nitrocefin test. ESBL-producing strains were detected with double disc test according to Jarlier et al. (1988). Clavulanate was applied as the inhibitor of these beta-lactamases (AMO/CLAV disc). ESBL-positive strains were confirmed with the use of E test (TZ/TZL strip). Inducible beta-lactamases were determined by double disc method according to Sanders and Sanders (1979). Cefoxitin was the inducer of these beta-lactamases (FOX disc). Among 93 Bacteroides spp. strains and 7 Prevotella spp. strains, 91 strains (91%) produced beta-lactamases. Two ESBL-producing strains (2%) were detected. Strains producing inducible beta-lactamases (IBL) were not found. A high activity of the examined beta-lactam antibiotics against strains of Gram-negative anaerobes was found. The majority of strains were susceptible to piperacillin (95%), piperacillin combined with tazobactam (99%), ticarcillin combined with clavulanic acid (99%), meropenem (97%) and imipenem (99%). The obtained results indicate the necessity of ESBL determination among strains of the genus Bacteroides, isolated from clinical specimens. Newer beta-lactam antibiotics, especially penicillins in combination with beta-lactamase inhibitors and carbapenems, are useful in empiric therapy of infections caused by Bacteroides spp. and Prevotella spp. anaerobic rods.

Anti-Bacterial Agents↗

PubMed2000

[Susceptibility to antibiotics of some species of Enterobacter isolated from various clinical materials].

We investigated 185 strains of Enterobacter spp. (E. cloacae--143 strains, E. agglomerans--15 strains, E. sakazakii--14 strains and E. aerogenes--13 strains) isolated from several clinical materials. An agar diffusion assay on Mueller-Hinton Agar was performed (according to NCCLS procedure and National Reference Center of Microorganisms' Drug-sensitiveness at Central Laboratory of Sera and Vaccinations in Warsaw Poland). E. cloacae: about 90% of the strains were sensitive to carbapenems. 85.3% of the isolates were susceptible to piperacillin + tazobactam. About 80% of the strains were susceptible to cotrimoxazole and ciprofloxacin. E. agglomerans: all strains were susceptible to imipenem, and 86.7%--to meropenem. 86.7% of the strains were susceptible to ureidopenicillins + inhibitors of beta-lactamases. About 80% of the isolates were susceptible to cotrimoxazole and ciprofloxacin. E. sakazakii: all isolates were susceptible to carbapenems. About 90% of the strains were susceptible to cotrimoxazole and 50%--to ciprofloxacin. E. aerogenes: all of the strains were susceptible to carbapenems and ciprofloxacin, 92.3%--to cotrimoxazole.

Drug Resistance, Microbial↗

PubMed2000

Transient factor VIII inhibitor in a hemophilia patient after staphylococcal septic shock syndrome.

We report a transient type I factor VIII inhibitor that arose in a 30-year-old hemophilia patient just after staphylococcal septicemia. This situation usually occurs early in the course of substitution therapy with factor VIII concentrate in hemophilia patients. Although disseminated intravascular coagulation and acute respiratory distress syndrome developed after septic shock, the patient recovered following intravenous administration of antibiotics (meropenem and gentamycin), an antithrombin preparation, high-dose methylprednisolone, and recombinant factor VIII concentrate (rFVIII). During this therapy, however, activated partial thromboplastin time gradually lengthened. On the seventh day of hospitalization, intracranial hemorrhage occurred with right hemiplegia, even though the substitution therapy had continued at the same dosage (30 U/kg per day) of rFVIII. At that point, 4 Bethesda units of the type I inhibitor against factor VIII were detected in the plasma. Increased amounts (46 U/kg per day) of rFVIII and prednisolone were administered, and hypothermic therapy was initiated. Following these treatments, the patient's general condition gradually improved, and within 25 days the inhibitor titer dropped to undetectable levels and did not recur during treatment. These clinical findings suggest that the staphylococcal septic shock may have acted as a trigger in the development of transient factor VIII inhibitor in this patient.

Adult↗

PubMed2000

Comparison of antimicrobial susceptibility of Citrobacter freundii isolates in two different time periods.

Citrobacter freundii was first identified in 1932, since then it has been reported to cause a variety of infections in aged, immunocompromised, and debilitated patients. With the use of broad-spectrum antibiotics, C. freundii has become increasingly resistant to antimicrobial agents. In order to determine the chronological changes in susceptibility and current susceptibility status of C. freundii, we compared the antimicrobial susceptibility of C. freundii in two different time periods, from 1987 to 1988 and from 1997 to 1998. In both time periods, 61 isolates of C. freundii were randomly selected for study from all clinical isolates at National Taiwan University Hospital. The minimum inhibitory concentrations and susceptible rates of 15 antimicrobial agents were compared, and it was found that most C. freundii isolates were resistant to anti-pseudomonal penicillins, first, second, and third generation cephalosporins, gentamicin, tobramycin, and aztreonam. The results indicate that the susceptible rates of C. freundii to aminoglycosides and ciprofloxacin decreased markedly during the period from 1987 to 1998. Cefepime, cefpirome, imipenem, and meropenem remained the most active agents against C. freundii.

Citrobacter freundii↗

PubMedDate not supplied

[Prevalence of Moraxella catarrhalis colonization in asymptomatic carriers under 6 years of age].

OBJECTIVE: To determine the prevalence of upper respiratory tract colonization by Moraxella catarrhalis in children under six years of age. MATERIAL AND METHODS: A survey was conducted between January and December 1998 in Mexico City, among children aged 2 months to 5 years, selected through cluster sampling. Pharyngeal samples were taken for M. catarrhalis identification. The minimal inhibitory concentration to different antibiotics was obtained and beta-lactamases were determined by the iodometric test. Statistical analysis consisted of frequency distributions, odds ratios, 95% confidence intervals, and Mantel-Haenszel chi 2. Statistical significance was set at p < 0.05. RESULTS: After excluding 37 children, the study population was 604 children from Mexico City; M. catarrhalis was present in 130 pharyngeal specimens (22.9%). Most of the strains were positive for beta-lactamase production (75.4%). Eighty percent of the strains was resistant to penicillin and 70% to ampicillin and amoxicillin. None were resistant to cefotaxime, imipenem, meropenem and erythromycin. CONCLUSIONS: Prevalence of M. catarrhalis upper respiratory tract colonization is similar to that of other respiratory pathogens. These findings warrant future research on the role of M. catarrhalis as an etiologic agent in acute and chronic respiratory infections in Mexico.

Age Distribution↗

PubMed2001

Antibiotic therapy in intra-abdominal infections--a review on randomised clinical trials.

There have been 79 randomised antibiotic studies in intra-abdominal infections retrieved. The overall success rate of the studied antibiotics ranges from 70-100%. Unfortunately only about one fourth of the studies have used a disease severity classification, e.g., APACHE II score, despite clear recommendations by the Surgical Infections Society of North America. The mortality rate in the published antibiotic studies is still rather low (approximately 4%) and does not correspond to the average mortality in peritonitis (30-40%). Failure analysis is not uniform and only performed in about 1/5 of retrieved studies. Failure analysis included data on diagnosis, type of operation, pathogen isolated at first operation, susceptibility and persistence of pathogen, re-operation or change of antibiotic regimen, and follow-up (ICU duration, death or survival, hospitalisation). Only one study has performed an analysis of the adequacy of the surgical treatment (source control). The clinical success rate of the antibiotics studied in a larger population is comparable for gentamicin + clindamycin (80%), tobramycin + clindamycin (83%), meropenem (89%), imipenem (85%), aztreonam + clindamycin (89%), cefoxitin (88%), cefotetan (92%), moxalactam (83%), cefotaxime + metronidazole (87%), ampicillin/sulbactam (87%). Piperacillin/tazobactam has in most studies a success rate of approximately 90%. The aggregated data on adverse events and clinical failure rate do not show a major advantage for any of these antibiotics. It is striking that the adverse event rate reported for ticarcillin/clavulanic acid is low when compared to all other antibiotics, which is in contrast to severe adverse events reported for clavulanic acid. The data of quinolone studies in intra-abdominal infections do not yet allow a recommendation, even when it is acknowledged that two studies were performed with good results and a good study plan. In conclusion, the comparability of antibiotic studies in intra-abdominal infections is limited due to a lack of disease severity stratification and a relatively small study population for most antibiotics. The clinical success rate of the best-studied antibiotics is similar and the choice which antibiotic is used depends on the expected pathogens and the resistance rate in a clinical setting.

APACHE↗

PubMed2001

[Comparative studies on activities of antimicrobial agents against causative organisms isolated from patients with urinary tract infections (1999). I. Susceptibility distribution].

The bacterial strains isolated from patients diagnosed as having urinary tract infections (UTIs) in 9 institutions in Japan were supplied between the period of August 1999 to July 2000. Then, the susceptibilities of them to many kinds of antimicrobial agents were investigated. The number of them were 499 strains. The breakdown of these strains was Gram-positive bacteria as 31.3% and Gram-negative bacteria as 68.7%. Susceptibilities of these bacteria to antimicrobial agents were as follows; vancomycin (VCM), ampicillin (ABPC) and imipenem (IPM) showed strong activities against Enterococcus faecalis. The increase of low-susceptible strains which was noticed in the former year showed a slight recovery in this year. VCM showed a strong activity against MRSA preventing growth of all strains with 1 microgram/ml. In addition, the activity of arbekacin (ABK) was also strong with the MIC90 of 2 micrograms/ml against MRSA. However, MSSA and MRSA showing low susceptibilities were detected in one strain each (MIC: 16 micrograms/ml and 32 micrograms/ml, respectively). Carbapenems showed high activities against Citrobacter freundii and Escherichia coli. Meropenem (MEPM) prevented growth of all strains within 0.125 microgram/ml. Quinolone resistant E. coli decreased in this year compared with those in the last year, that percentage was less than 5%. Almost all drugs showed strong activities against Klebsiella pneumoniae and Proteus mirabilis. MEPM and carumonam (CRMN) prevented growth of all strains within 0.125 microgram/ml. On the other hand, one strain of K. pneumoniae showing resistance to cefaclor (CCL) and one strain of P. mirabilis showing low susceptibility to most of cephems were detected. Against Pseudomonas aeruginosa, almost drugs were not so active. The MIC90s of carbapenems were 8 micrograms/ml and those of all other drugs were more than 16 micrograms/ml.

Anti-Bacterial Agents↗

PubMed2001

[Comparative studies on activities of antimicrobial agents against causative organisms isolated from patients with urinary tract infections (1999). III. Secular changes in susceptibility].

The bacteria (Enterococcus faecalis, Staphylococcus aureus, Escherichia coli, Klebsiella spp. and Pseudomonas aeruginosa) isolated from patients diagnosed as having urinary tract infections (UTIs) in 9 institutions in Japan were supplied between the period of August 1999 to July 2000. Then, the susceptibilities of these bacteria to various antimicrobial agents were examined and the results were compared with those obtained between 1991 and 1998. Comparison was made by classifying strains isolated from patients into those with uncomplicated UTIs and those with complicated UTIs (including with or without indwelling catheter). About E. faecalis, increase of low sensitive strains noted in the former year showed a decreasing tendency, however, one strain each with MIC of 4 micrograms/ml to vancomycin (VCM) was detected in patients with both uncomplicated and complicated UTIs. As for S. aureus, many sensitive strains to cephems, imipenem (IPM) and VCM were noted, and each MIC50 was better than that in the former years. S. aureus strains showing low susceptibility to arbekacin (ABK) were detected in patients with complicated UTIs in this year as well as in the former year, and one strain each with MIC of 16 micrograms/ml and 32 micrograms/ml was detected. Susceptibilities of E. coli were effective to all drugs except for penicillins and minocycline (MINO). Decrease of low sensitive strains was also noted in all drugs except for quinolones. Each MIC90 of ciprofloxacin (CPFX) and sparfloxacin (SPFX) in patients with complicated UTIs against E. coli was 3 degrees classes lower than that in patients with uncomplicated UTIs. As for Klebsiella pneumoniae, decrease of low sensitive strains to cephems was noted in patients with uncomplicated UTIs in 1998. In 1999, low sensitive strains decreased also in patients with complicated UTIs, and few were detected. Susceptibilities of K. pneumoniae to quinolones were effective as compared with those in the former years with the MIC80s of 0.125 microgram/ml or below without detection of low sensitive strains. One low sensitive strain of K. pneumoniae with MIC of 8 micrograms/ml was detected for gentamicin (GM). Susceptibilities of P. aeruginosa to carbapenems were notable. The MIC90 of meropenem (MEPM) and IPM was 4 micrograms/ml each which was 2 degrees better than that in 1998. Resistant P. aeruginosa strains to other drugs except for monobactams decreased in 1999.

Anti-Bacterial Agents↗

PubMed2001

[Antibiotic therapy of cystic fibrosis in children].

It is postulated that P. aeruginosa in monoculture or in association with Staphylococcus aureus keeps its leading position in chronic bacterial inflammatory broncho-pulmonary processes in children with cystic fibrosis. Antibiotic resistant strains of Burkholderia cepacia, Stenotrophomonas maltophila, Alcaligenes xylosoxidans were revealed (7.1% of the strains). P. aeruginosa strains were susceptible to aminoglycosides, ciprofloxacin, and polymixin B. Susceptibility of smooth and mucoid forms of P. aeruginosa to ceftazidime stayed at the level of 49.6-57.1%. Such microbial associations as P. aeruginosa sm. + S. aureus, P. aeruginosa sm. + P. aeruginosa muc. + S. aureus were mainly susceptible to ciprofloxacin, aminoglycosides and resistant to ceftasidime. Meropenem, cefepim and ciprofloxacin are highly effective antibiotics for the treatment of broncho-pulmonary processes exacerbations at children with chronic P. aeruginosa cystic fibrosis. Intravenous use of antibiotics out of hospital for the treatment of the children with cystic fibrosis is clinically effective, and is economically and psychologically reasonable. It should be used more widely in medical practice.

Anti-Bacterial Agents↗

PubMed2001

[Susceptibility to penicillin and 13 antimicrobial agents in erythromycin-resistant viridans group streptococci isolated from blood cultures].

From March 1998 to June 1999, we studied 63 sequential blood culture isolates of viridans group streptococci which showed a 49% resistance to erythromycin. A high level of resistance to penicillin (46%) was also found. A statistically significant correlation was detected between the two types of resistance. The erythromycin-resistant strains were phenotypically and genotypically characterized, and no differences were found between the resistance to penicillin and the M or MLS(B) phenotypes. The penicillin-erythromycin-resistant strains included: 16 S. mitis, five S. sanguis and one S. salivarius. The rank order of activity (% of susceptibility) for all 14 agents against 31 erythromycin- resistant isolates was the following: vancomycin = rifampicin (100) > chloramphenicol (98) > meropenem (65) > cefotaxime (61) > amoxicillin- clavulanic acid (42) > cefepime = ciprofloxacin (39) > tetracycline = trimethoprim-sulfamethoxazole (36) > cefuroxime (32) > penicillin = ampicillin = cefaclor (29). The species S. milleri and S. bovis were the most susceptible. The most resistant strains were two S. mitis and one S. sanguis and showed multiresistance to six different groups of antimicrobial agents. The frequent association between macrolide resistance and resistance to other antimicrobial agents suggests that the susceptibility of all clinically significant isolates needs to be evaluated and alternative agents for the prevention and treatment of viridans group streptococci infections should be identified.

Drug Resistance↗

PubMed2001

[A case of eosinophilic pneumonia possibly due to ifenprodil].

A 69-year-old woman with a history of subarachnoid hemorrhage was started on ifenprodil for dizziness. Three weeks later, fever, cough, chills, dyspnea and skin eruption developed. A chest radiograph showed bilateral ground-glass shadows. Blood tests showed a white cell count of 14,400/mm3 with 32% eosinophils and a C reactive protein (CRP) level of 20 mg/dl. The arterial blood gases on room air were as follows: pH 7.45, PaCO2 33 torr, and PaO2 56 torr (Table 1). Ifenprodil was withdrawn and intravenous meropenem and minocycline administration was started on admission. Her fever improved rapidly and the CRP decreased, but hypoxemia and hypereosinophilia persisted. On the third hospital day, she underwent bronchoscopy with bronchoalveolar lavage (BAL). The differential count of BAL cells was 63% eosinophils, 15% lymphocytes, 21% macrophages, and 1% neutrophils. Intravenous methylprednisolone 250 mg/day for 3 days was commenced, leading to a clinical improvement. She received oral prednisolone (30 mg/day) for the next 4 days, and was then discharged without any symptoms. She has had no recurrence since. Both the drug lymphocyte stimulation test and the skin test for ifenprodil were negative.

Aged↗

PubMed1997

Therapy of sepsis.

The term 'sepsis' is often used synonymously with 'infection' or 'bacteremia'. Additional definitions, e.g. 'systemic inflammatory response syndrome', have been proposed. These terms have been employed to establish entry criteria for clinical trials of antibiotic therapy and adjunctive therapies. It may be appropriate to utilize these descriptions when initiating therapy of suspected bacterial infections, since culture confirmation is often not available for days after initial clinical presentation. Empiric antibiotic therapy is now the rule rather than the exception for febrile hospitalized patients. No antimicrobial agent is superior for all major clinical situations and thus history and physical examination are critical factors which guide the clinician. Guidelines have been derived for the initial empiric management of serious infection. While these were initially refined for the immunocompromized host, they may be considered generally applicable for the hospitalized patient with a suspected serious systemic bacterial infection. Currently, monotherapy with agents such as cefepime, ceftazidime, imipenem/cilastatin and meropenem has been sanctioned on the basis of their broad antimicrobial coverage and stability to clinically important beta-lactamases (although there is considerable variation from one compound to another). Perception of local epidemiologic patterns is a major factor in the selection of initial antibacterial therapy for hospital-acquired infection.

Journal Article↗

PubMed2001

[Bactericidal activity of biapenem against various bacteria].

The bactericidal activity of biapenem (BIPM), a new carbapenem agent, against Staphylococcus aureus, Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa and Serratia marcescens was compared with those of imipenem (IPM), panipenem (PAPM), meropenem (MEPM) and ceftazidime (CAZ). The bactericidal activity of BIPM against S. aureus was equal to those of IPM, PAPM and MEPM. Against E. coli and K. pneumoniae, BIPM showed higher bactericidal activity than IPM and PAPM. Against P. aeruginosa, BIPM showed excellent bactericidal activity campared with IPM. The killing speeds of BIPM and IPM were obviously the most rapid among four carbapenems. BIPM showed a strong bactericidal activity against 5 species of bacteria including P. aeruginosa.

Bacteria↗

PubMed2002

[Comparative studies on activities of antimicrobial agents against causative organisms isolated from patients with urinary tract infections (2000). I. Susceptibility distribution].

The bacterial strains isolated from patients diagnosed as having urinary tract infections (UTIs) in 10 institutions in Japan were supplied between the period of August 2000 and July 2001. Then, the susceptibilities of them to many kinds of antimicrobial agents were investigated. The number of them were 511 strains. The breakdown of these strains was Gram-positive bacteria as 29.0% and Gram-negative bacteria as 71.0%. Susceptibilities of these bacteria to antimicrobial agents were as follows; vancomycin (VCM), ampicillin (ABPC) and imipenem (IPM) showed strong activities against Enterococcus faecalis. No increase in low-susceptible strains of E. faecalis observed against these antimicrobial agents. VCM showed a strong activity against MRSA preventing growth of all strains with 1 microgram/ml. In addition, the activity of arbekacin (ABK) was strong with the MIC90 of 2 micrograms/ml against MRSA and prevented growth of all strains with 4 micrograms/ml. ABK showed a strong activity against Staphylococcus epidermidis preventing growth of all strains with 0.5 microgram/ml. ABPC, cefotiam (CTM) and cefozopran (CZOP) also showed a relatively strong activity against S. epidermidis (MIC90: 4 to 8 micrograms/ml). Against Escherichia coli, carbapenems showed high activities: meropenem (MEPM) prevented growth of all strains within 0.125 microgram/ml; IPM prevented growth of all strains with 0.25 microgram/ml. CZOP and CTM also showed strong activities against E. coli: MIC90 of CZOP was within 0.125 microgram/ml; MIC80 and MIC90 of CTM were 0.25 and 0.5 microgram/ml, respectively. Quinolone resistant E. coli was detected at frequency of 14.0%, which was significantly higher than that in the last year. Almost all drugs showed strong activities against Klebsiella pneumoniae and Proteus mirabilis, and MEPM prevented growth of all strains within 0.125 microgram/ml. Against Pseudomonas aeruginosa, almost drugs were not so active. The MIC90 of carbapenems and gentamicin (GM) were 16 micrograms/ml and those of all other drugs were more than 32 micrograms/ml. Against Serratia marcescens, the MIC90 of IPM and GM were the lowest value being 2 micrograms/ml, and that of MEPM was 4 micrograms/ml.

4-Quinolones↗