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PubMed2002

[In vitro combination effect of pazufloxacin with various antibiotics against Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus].

The in vitro combination effects of pazufloxacin (PZFX) with various antibiotics were investigated by the checkerboard dilution method using piperacillin (PIPC), tazobactam/piperacillin (TAZ/PIPC), ceftazidime (CAZ), cefozoprane (CZOP), imipenem/cilastatin (IPM/CS), meropenem (MEPM), panipenem/betamipron (PAPM/BP), amikacin (AMK) and isepamicin (ISP) for clinical isolates of 27 Pseudomonas aeruginosa strains, vancomycin (VCM), teicoplanin (TEIC) and arbekacin (ABK) for clinical isolates of methicillin-resistant 26 Staphylococcus aureus (MRSA) strains, respectively. The following results were obtained. 1. For 27 P. aeruginosa strains, the synergistic effects were observed with the combination of PZFX and CAZ or MEPM (11.1%: 3 strains), and PZFX and CZOP or PAPM/BP (3.7%: 1 strain), respectively. The additive and synergistic effects of PZFX were observed with the combination in all beta-lactams tested in the strains more than 50%. No antagonistic effect was observed. The additive effects were also observed with the combination of PZFX and AMK or ISP in the strains more than 50% of the test strains and no antagonistic effect was observed. 2. For 26 MRSA strains, no antagonistic effect was observed with the combination of all antibiotics tested. The indifference was observed with the combination of PZFX and VCM or ABK in the strains more than 60%, and the additive effects were observed with the combination of TEIC in the strains more than 80%. In conclusion, no antagonistic effect was observed in PZFX with the combination of beta-lactams and anti-MRSA agents, suggesting that the combination therapy of PZFX with these antibiotics would be possible to use for the infections caused by P. aeruginosa and MRSA.

Anti-Bacterial Agents↗

PubMed2002

[Fibrin-collagen substance as a vehicle for local application of antibacterial agents].

Inhibitory activity of fibrin-collagen substance (FCS) impregnated by various antibacterial agents against various microorganisms was investigated. It was demonstrated that antibacterials bind well with FCS, providing its sufficient antibacterial activity. Determination of growth-inhibition zones showed that antibacterial agents diffuse into medium well and demonstrated the same activity as discs with antibiotics. For clinical practice it is recommended to use for impregnation the following drugs: gentamycin, meropenem, cefriaxone and ciprofloxacin.

Administration, Topical↗

PubMed2002

Recombinant human activated protein C for severe sepsis in a neonate.

BACKGROUND: Neonatal sepsis is frequently associated with pathological activation of the coagulation system, leading to multiple organ dysfunction. Activated protein C has been shown to prevent thrombin generation during this process and improve microcirculation. CASE REPORT: We present the case of a full term septic neonate admitted for tertiary intensive care with multiple organ failure, including ARDS with severe pulmonary hypertension, renal failure, and disseminated intravascular coagulation. After initial resuscitation with volume expansion, catecholamines, pentoxifylline and nitric oxide, a diagnosis of severe systemic enteroccocal sepsis was made and vancomycin-meropenem therapy was started. Because available standard treatment, including platelet transfusion, did not improve the coagulation status, it was decided to give recombinant human activated protein C (drotrecogin alpha Xigris, Elli Lilly, USA - rhAPC) in 24 mcg kg(-1) h(-1) continuous four-day infusion. Six hours after the start of infusion all coagulation parameters returned to normal. No side effects were observed. Renal function was restored after 36-hr hemofiltration. Treatment success was due to several factors, including resuscitation from cardiogenic shock, effective antibiotic therapy, hemofiltration, and combined rhAPC-pentoxifylline therapy CONCLUSIONS: The positive outcome of this case indicates that rhAPC can be safely used in infants. A large-scale study of the effectiveness of drotrecogin alpha in pediatric population is indicated.

Catecholamines↗

PubMed2002

Neonatal sepsis: high antibiotic resistance of the bacterial pathogens in a neonatal intensive care unit in Karachi.

OBJECTIVE: To study the bacterial pathogens causing neonatal sepsis and their sensitivity pattern so that guidelines can be prepared for empirical antibiotic therapy. SETTING: The study was conducted in the neonatal intensive care unit (NICU) at PNS Shifa (Naval Hospital), Karachi during January 1997 to June 1999. METHODS: Blood specimens for culture were drawn from 520 newborns admitted in a NICU with sepsis. The specimens were inoculated into brain heart infusion broth. Subcultures were performed on days 1, 2, 3, 5, 7 and 10. The isolates were identified by standard biochemical tests. Antibiotic resistance pattern of the isolates was studied by Modified Kirby Baur disc diffusion technique. RESULTS: A total of 212 organisms were isolated. These included Staphylococcus aureus (n = 65), Klebsiella pneumoniae (n = 73), Acinetobacter baumannii (n = 23), Escherichia coli (n = 22), Enterobacter cloacae (n = 18), Citrobacter diversus (n = 5), Pseudomonas aeruginosa (n = 4) and group B Streptococcus (n = 2). On antibiotic sensitivity testing, 61.54% of Staphylococcus aureus isolates were found to be methicillin resistant. Susceptibility to the other common drugs was also quite low while 89.23% of these were susceptible to amikacin and 100% to vancomycin. More than 90% gram negative rods were resistant to ampicillin and co-trimoxazole. Resistance to gentamicin was as high as 90.4% for Klebsiella pneumoniae; 60.87% for Acinetobacter baumannii. Resistance to the third generation cephalosporins and the quinolone tested (ciprofloxacin) varied between 25-75%. Majority of the isolates were susceptible to meropenem and amikacin. CONCLUSION: In view of the isolation of highly antibiotic resistant organisms, vancomycin in combination with amikacin or a carbapenem is the drug of choice for empirically treating neonatal sepsis.

Anti-Bacterial Agents↗

PubMed2002

[Antimicrobial susceptibility of Streptococcus pneumoniae and Haemophilus influenzae isolated in major hospitals in Nagano Prefecture].

We determined the minimum inhibitory concentration (MIC) of various antimicrobial agents against 108 strains of Streptococcus pneumoniae and 144 strains of Haemophilus influenzae isolated from respiratory organs in the First Department of Internal Medicine, Shinshu University, and affiliated hospitals between January 2000 and February 2001. The following results were obtained. 1. Fifty-one (47.2%), 56 (51.9%), and 1 (0.9%) of 108 strains of S. pneumoniae were classified as penicillin-susceptible S. pneumoniae (PSSP), penicillin-intermediate S. pneumoniae (PISP), and penicillin-resistant S. pneumoniae (PRSP), respectively. 2. Three carbapenems had potent antimicrobial activity against PISP and PRSP. Furthermore, none of the strains were highly resistant (MIC > 2 micrograms/ml) to benzylpenicillin, ampicillin (ABPC), sulbactam/ampicillin (SBT/ABPC), cefotaxime (CTX), or cefepime (CFPM). 3. Eleven (7.6%) and 6 (4.2%) of 144 strains of H. influenzae were classified as beta-lactamase-producing ABPC-resistant strains and beta-lactamase negative ABPC-resistant H. influenzae (BLNAR), respectively. Levofloxacin, sulfamethoxazole/trimethoprim, and meropenem had potent antimicrobial activity against these resistant strains. 4. BLNAR strains were more highly resistant to CTX, CFPM, SBT/ABPC, and cefaclor than beta-lactamaseproducing strains. 5. In our surveillance study regarding clinical isolates of S. pneumoniae and H. influenzae from respiratory organs in Nagano prefecture, there were regional differences in the isolation rate and antimicrobial susceptibility. The isolation rates of resistant strains were lower than those reported in a nationwide survey.

Ampicillin Resistance↗

PubMed2003

Analysis of an outbreak due to Chryseobacterium meningosepticum in a neonatal intensive care unit.

The aim of this study was to describe the epidemiological and clinical features of an outbreak due to Chryseobacterium meningosepticum. During a 11-day period, the outbreak was observed among four newborns in a neonatal intensive care unit (NICU) in a teaching hospital. All patients yielded C. meningosepticum in their blood cultures, in addition one was colonised in the throat. Antimicrobial susceptibility assay showed complete resistance to penicillins, cephalosporins, aminoglycosides, imipenem, aztreonam, and tetracycline, sensitivity to ciprofloxacin and trimethoprim-sulfamethoxazole. All patients were empirically treated with amikacin and meropenem. The neonate who was the first to develop sepsis died before the culture result. When C. meningosepticum was identified, antimicrobial therapy was changed to a combination of ciprofloxacin, rifampicin and vancomycin, and three neonates were treated successfully. Environmental screening recovered C. meningosepticum from two venous catheter lines and one nutritional solution that was opened by health care staff and used for two neonates. Arbitrary primed polymerase chain reaction and antibiogram typing indicated that all isolates were epidemiologically related. This study demonstrates that rapid selection of appropriate antibiotics is critical for clinical cure and standard precautions should be reconsidered to limit the spread of this bacterium on the NICU in our hospital.

Cross Infection↗

PubMed2002

[Antibacterial activity of panipenem against clinical isolates in 2000 and 2001].

As the post-marketing surveillance of panipenem/betamipron (Carbenin), MICs of panipenem (PAPM) against 1355 clinical isolates of 28 species from 15 medical institutions all over Japan from June 2000 to March 2001 were measured using the broth microdilution method approved by the Japanese Society of Chemotherapy and compared with those of parenteral carbapenem antibacterials, imipenem (IPM) and meropenem (MEPM), and parenteral cephem antibacterials, cefozopran, cefepime, and sulbactam/cefoperazone. The activity of PAPM was comparable to that of IPM against almost all species tested. Compared with MEPM, PAPM was more active against Gram-positive bacteria and Bacteroides spp., and less active against Gram-negative bacteria. Compared with the parenteral cephems, PAPM was more active against most of species tested and its MIC ranges were narrower than those of the cephems as were those of other carbapenems. In this surveillance study, the incidence of resistance in various species were as follows: 39.3% for methicillin-resistant Staphylococcus aureus, 47.3% for penicillin-intermediate Streptococcus pneumoniae (PISP), 15.1% for penicillin-resistant S. pneumoniae (PRSP), 0.9% for extended-spectrum beta-lactamase (ESBL) producing Escherichia coli, 3.4% for ESBL producing Klebsiella pneumoniae, 19.2% for beta-lactamase producing Haemophilus influenzae, 24.0% for beta-lactamase-negative ampicillin-resistant (BLNAR) H. influenzae, and 1.0% for metallo-beta-lactamase producing Pseudomonas aeruginosa. Against these resistant strains, carbapenems including PAPM showed generally more potent activity than cephems. It was noted that PAPM showed the most potent activity against PISP and PRSP, which showed high incidence of 62.4% totally, among tested drugs. Metallo-beta-lactamase producing P. aeruginosa exhibited high resistance and BLNAR H. influenzae also exhibited low susceptibility against all tested drugs. But no remarkable change in the activity of PAPM against other species was observed in this study compared with that in the studies before the marketing of Carbenin. Furthermore, it is necessary to pay much attention to the trend of resistant strains such as PRSP, metallo-beta-lactamase producing bacteria, and BLNAR H. influenzae.

Adolescent↗

PubMed2000

[Clinical and molecular epidemiology of an outbreak of infusion-related Acinetobacter baumannii bacteremia in an Intensive Care Unit]

Objective: To describe the clinical and molecular epidemiology of an outbreak of infusion-related Acinetobacter baumannii bacteremia in an intensive care unit (ICU). Methods: Six cases of A. baumannii bacteremia identified in the Foligno Hospital ICU, Italy, were peer reviewed. Antibiotic susceptibility and genotyping (PFGE and RAPD) of A. baumannii isolates were carried out. Results: All A. baumannii blood isolates and a strain isolated from parenteral solution had an identical genotype. The strains were susceptible to carbapenems and the combination of meropenem plus amikacin or piperacillin/ tazobactam plus netilmicin was synergistic. A. baumannii bacteremia persisted for several days in almost all patients; catheter tip cultures were always positive for A. baumannii. Three patients, with an elevated Apache II score, died of sepsis. Conclusions: The outbreak was related to contaminated parenteral solutions improperly prepared in the ward. Aseptic preparation in the hospital pharmacy allowed for an interruption of the outbreak.

Journal Article↗

PubMed2002

Antibiotic sensitivity patterns of Pseudomonas aeruginosa strains isolated from various clinical specimens.

1567 clinical samples were obtained for the study; 494 strains of Pseudomonas aeruginosa were isolated (isolation rate of 31.52) and their antibiotic sensitivity patterns tested using Kirby Bauer disk diffusion method. The antibiotic sensitivity testing revealed that Pseudomonas aeruginosa strains were highly resistant to most anti-pseudomonal antibiotics; Amikacin was found to be most suitable for routine use with a sensitivity of 68.01% and the most resistant antibiotic was Netilmicin showing 70.04% resistance. Surprisingly, Gentamycin showed a relatively higher sensitivity of 55.87%. Sensitivity to Imipenem and Meropenem was 100%.

Anti-Bacterial Agents↗

PubMed2003

[Pseudomonas aeruginosa: a multicenter study in 136 hospitals in Spain].

A cooperative group of 136 Spanish hospitals identified 1014 isolates of P. aeruginosa in one week. It was estimated that Spanish microbiology laboratories identified 168 P. aeruginosa isolates per 100,000 inhabitants population and year (25 isolates for every 1,000 hospital admissions/year). P. aeruginosa was recovered in 5.3% of all the samples with bacterial isolates. Seventy-five percent of samples containing P. aeruginosa came from the lower respiratory tract, wound exudates, abscesses and urine. The three most common serotypes present in Spain were found to be 0:1, 0:4 and 0:11 and constituted more than 50% of all isolates. The antimicrobials active against more than 85% of all the isolates included: ceftazidime (85.2%), piperacillin-tazobactam (92.8%), imipenem (86.2%), meropenem (92.2%) amikacin (91.4%) and tobramycin (91.2%). The study showed a high rate of resistance to ciprofloxacin (22.7%) and gentamicin (31.1%). Of the 529 patients who underwent clinical follow-up, 25.5% showed P. aeruginosa colonization and the remaining 74.5% had clinical infections. We estimated an incidence rate of 88.4 patients infected with P. aeruginosa per 100,000 inhabitants and year (13.8 cases per 1000 hospital admissions and year). Overall, 42% were community acquired. The overall mortality in this study was 15%, and mortality attributable to P. aeruginosa infections was 5%. After logistical regression analysis, the two independent predictors of mortality were the presence of a rapidly fatal underlying condition and the presence of bacteremia. In Spain, P. aeruginosa is much more than a cause of severe nosocomial infections in immunocompromised patients.

Anti-Bacterial Agents↗

PubMed2002

A preliminary study on metallo-beta-lactamase producing Pseudomonas aeruginosa in hospitalized patients.

Metallo beta-lactamase (MBL) producing Pseudomonas aeruginosa is an emerging threat and a cause of concern for the physicians treating such infections. The present study was undertaken to know the resistance pattern of P. aeruginosa to beta-lactamase inhibitors and carbapenems, and to detect the presence of MBL among resistant isolates to both groups of antibiotics. Between June-November 2001, 50 P. aeruginosa isolates from clinical specimens were tested for susceptibility to beta-lactamase inhibitors and carbapenems by Kirby-Bauer disc diffusion method. Isolates resistant to both groups of antibiotics were screened for the presence of MBLs by disc diffusion method using 2-mercaptoethanol. Of the 50 isolates, 6 (12%) were resistant to both beta-lactamase inhibitors and carbapenems. All 6 isolates were MBL producers were resistant to all the antibiotics tested. Resistance to piperacillin-tazobactam, cefoperazone-sulbactam and ticarcillin-clavulanic acid was 12, 20 and 36 per cent respectively. Resistance of 12 per cent each was noted to imipenem and meropenem respectively. This is to the best of our knowledge the first report of MBL producing P. aeruginosa from India and suggests the need for early detection, notification and control of spread.

Anti-Bacterial Agents↗

PubMed2003

[In vitro sensitivity to antimicrobial agents of Haemophilus influenzae strains isolated from clinical specimens].

In-vitro activity of several antimicrobial agents were evaluated against Haemophilus influenzae (n:127) isolated from clinical specimens within the years 2000 and 2002 in a children's hospital. Antimicrobial susceptibility tests were performed by disk diffusion method according to the recommendations of the NCCLS standards and beta-lactamase activity was investigated by nitrocefin test. Resistance rates for the antibiotics were as follows: ampicillin 5.6%, trimethoprim-sulfamethoxazole (TMP/SMX) 27.5%, tetracycline 8.6%, clarithromycin 7%, chloramphenicol 4.7%. Five isolates (3.9%) were found multiple resistant. Beta-lactamase activities were detected in all of the ampicillin resistant isolates. None of the isolates were resistant to ampicillin-sulbactam, cefaclor, cefuroxime, cefprozil, cefpodoksim, cefotaxime, meropenem or ciprofloxacin. According to these results, resistance to ampicillin is low in our H. influenzae isolates compared to other European countries but resistance to TMP/SMX is very high and this finding has to be taken into account in the empirical therapy of community acquired respiratory tract infections.

Anti-Bacterial Agents↗

PubMed2003

[Microbiological approach to antibiotic therapy against multidrug-resistant bacteria].

Many severe infections that occur after gastrointestinal surgery are caused by multidrug-resistant bacteria such as methicillin-resistant staphylococcus aureus and Pseudomonas aeruginosa. (P. aeruginosa,) which has been isolated from such cases, is resistant to many beta-lactamantibiotics, including imipenem (IPM). IPM-resistant P. aeruginosa lacks the outer membrane proteins (Opr) D, OprD2, OprC, and OprE1, which together normally form an opening in the outer membrane. Therefore IPM cannot pass through the outer membrane. But it is also known that meropenem, caftazidime, and ciprofloxacin are not restricted by this effect and that they can easily pass through the outer membrane. Therefore if we can identify these genes by using the polymerase chain reaction, appropriate antibiotics can be swiftly administered without waiting for the results of drug sensitivity tests.

Anti-Bacterial Agents↗

PubMed2003

[Susceptibilities of bacteria isolated from patients with lower respiratory infectious diseases to antibiotics (2001)].

From October 2001 to September 2002, we collected the specimen from 370 patients with lower respiratory tract infections in 16 institutions in Japan, and investigated the susceptibilities of the isolated bacteria to various antibacterial agents and antibiotics and patients' characteristics. Of 458 strains that were isolated from specimen (mainly from sputum) and assumed to be bacteria causing in inflammation, 456 strains were investigated. The breakdown of the isolated bacteria were: Staphylococcus aureus 69, Streptococcus pneumoniae 72, Haemophilus influenzae 85, Pseudomonas aeruginosa (non-mucoid) 44, P. aeruginosa (mucoid) 13, Klebsiella pneumoniae 32, Moraxella subgenus Branhamella catarrhalis 32, and others. Of 69 S. aureus strains, those with 4 micrograms/mL or more of MIC of oxacillin (methicillin-resistant S. aureus: MRSA) occupied 43.5%. Vancomycin and arbekacin showed the most potent activities against MRSA as observed in 2000. The frequency of S. pneumoniae exhibiting low sensitivity to penicillin (penicillin-intermediate S. pneumoniae: PISP + penicillin-resistant S. pneumoniae: PRSP) was 59.7% and both rates of PISP and PRSP were the highest after 1992. Carbapenems had strong activities against S. pneumoniae. Especially, panipenem and imipenem inhibited the growth of all 72 strains at 0.125 and 0.5 microgram/mL, respectively. Generally, all drugs had strong activities against H. influenzae with MIC90s of 16 micrograms/mL or less. The drug that had the strongest activity against H. influenzae was levofloxacin, which inhibited the growth of 80 of the 85 strains at 0.063 microgram/mL. Against P. aeruginosa mucoid strain, meropenem had a strong activity with MIC90 of 0.5 microgram/mL while, against non-mucoid strain, tobramycin had a strong activity with MIC90 of 2 micrograms/mL. K. pneumoniae showed good susceptibilities to all drugs except ampicillin and minocycline, and the MIC90s were 4 micrograms/mL or less. Particularly, cefmenoxime, cefpirome, and imipenem had the strongest activity (MIC90: 0.125 microgram/mL), and cefozopran had a strong activity, inhibiting the growth of all strains at 0.25 microgram/mL. Also, all drugs generally had strong activities against M. (B.) catarrhalis. MIC90s of all drugs were 4 micrograms/mL or less. The drug that had the strongest activity was minocycline and levofloxacin inhibiting all 32 strains at 0.063 microgram/mL. Most of the patients with respiratory infection were aged 70 years or older, accounting for approximately a half of the total (40.5%). As for the incidence by the diseases, bacterial pneumonia and chronic bronchitis were the highest, being noted in 39.2% and 37.3% of all the patients, respectively. The bacteria frequently isolated from the patients with bacterial pneumonia were S. aureus (19.3%) and S. pneumoniae (19.9%). In contrast, H. influenzae (22.0%) were frequently isolated from the patients with chronic bronchitis. Before the drug administration, the bacteria frequently isolated from the patients were S. pneumoniae (20.8%) and H. influenzae (21.5%). S. pneumoniae and H. influenzae decreased after the initiation of drug administration while S. aureus increased. The isolation frequency of P. aeruginosa was higher after than before the initiation of drug administration. The bacteria were frequently isolated from the patients who had already treated with cephems were S. aureus and P. aeruginosa. From the patients who had already treated with macrolides, S. pneumoniae was the most frequently isolated while S. aureus was the most frequently isolated from the patients pre-treated with quinolones.

Adult↗

PubMed2003

[Comparative studies on activities of antimicrobial agents against causative organisms isolated from patients with urinary tract infections (2001). 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 September and December 2001. Then, the susceptibilities of them to a variety of antimicrobial agents were investigated. The number of them were 496 strains. The breakdown of these strains was Gram-positive bacteria as 29.6% and Gram-negative bacteria as 70.4%. Susceptibilities of these bacteria to antimicrobial agents were as follows; against Staphylococcus aureus, vancomycin (VCM) showed a strong activity, and this drug also had a strong activity against MRSA in preventing growth of all strains at 1 microgram/mL. In addition, arbekacin (ABK) showed strong activity with the MIC90 of 2 micrograms/mL against MRSA and prevented growth of all strains at 4 micrograms/mL. ABK also showed a strong activity against Staphylococcus epidermidis in preventing growth of all strains at 0.5 microgram/mL. Ampicillin (ABPC) and cefozopran (CZOP) showed a relatively strong activity against S. epidermidis (MIC90: 8 micrograms/mL). ABPC, imipenem (IPM), and VCM showed strong activities against Enterococcus faecalis. No increase of low-susceptible strains in E. faecalis was observed against these antimicrobial agents. Against Escherichia coli, carbapenems showed the highest activities: meropenem (MEPM) prevented growth of all strains at 0.25 microgram/mL; IPM prevented growth of all strains at 0.5 microgram/mL. CZOP and cefotiam (CTM) also showed strong activities against E. coli: MIC90 of CZOP was within 0.125 microgram/mL; MIC90 of CTM was within 0.5 microgram/mL. Quinolone-resistant E. coli was detected at frequency of 9.3%, which was lower than that in the last year, and was higher level than those in up to 1999. MEPM showed the strongest activity against Citrobacter freundii in preventing growth of all strains at 0.125 microgram/mL. 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 Serratia marcescens, the MIC90 of gentamicin (GM) was the lowest value being 2 micrograms/mL, and those of IPM and carumonam were 8 and 16 micrograms/mL, respectively. Against Pseudomonas aeruginosa, almost all drugs were not so active. The MIC90 of GM was 8 micrograms/mL, those of IPM and amikacin were 16 micrograms/mL, and those of all other drugs were over than 32 micrograms/mL.

Anti-Bacterial Agents↗

PubMed2003

[Molecular-epidemiological evaluation of Serratia marcescens isolates from patient specimens in one Japanese hospital during the three years from April 1999 to March 2002].

One hundred fifty-six isolates of Serratia marcescens from patient specimens in Showa University Fujigaoka Hospital between April 1999 and March 2002 were investigated in this study. Forty-two isolates with serotype O2, detected mainly from patient respiratory specimens, were susceptible to the antimicrobial agents tested, whereas 30 isolates with serotype O14, detected mainly from patient urine, were resistant. Moreover, 19 isolates with serotype O14 susceptible to imipenem were intermediate or resistant to meropenem, while they did not produce metallo beta-lactamase. Both serotypes were significantly distributed in the ICU and surgical wards, compared with other wards. Ten isolates with O2/B (bacteriocin type) 16 and 14 isolates with O14/B76J, showing identical or closely-related clones by pulsed-field gel electrophoresis (PFGE) analysis of Spe I-restricted chromosome, were detected from different inpatients' specimens during approximately 2 and a half years. The existence of such long-lasting microorganisms suggested the possibility of hospital-acquired infection caused by inadequate use of antimicrobial agents and disinfection procedures for medical tools such as bite blocks and catheters.

Drug Resistance, Bacterial↗

PubMed2003

[Trends in antimicrobial resistance of Pseudomonas aeruginosa, Escherichia coli and Bacteroides fragilis (1997-2001)].

A study was conducted from 1997 to 2001 on the trends of the antibiotic resistance of Pseudomonas aeruginosa, Escherichia coli and Bacteroides fragilis in a Spanish multicenter study involving 26 hospitals. During the five years of the study the susceptibility by 81,779 strains of P. aeruginosa, 306,689 strains of E. coli and 2866 strains of B. fragilis to at least one antibiotic were studied. When the three microorganisms were considered together, meropenem (3.49%), piperacillin-tazobactam (5.54%) and imipenem (5.27%) were the antibiotics to which they showed the lowest resistance rate.

Anti-Bacterial Agents↗

PubMed1997

[The choice of antibiotic therapy for bacterial infections in patients with cirrhosis of the liver].

Patients with liver cirrhosis have an impaired function of reticuloendothelial system; moreover they exhibit several defects of cellular and humoral immunity. These deficiencies enhance their susceptibility to bacterial infections. The prognosis is better if the infection is detected as early as possible and treated adequately. Except in cases of septicemia, empirical monotherapy is effective. Broad-spectrum beta-lactam antibiotics have proved efficient for the treatment of severe infections; a limitation of third-generation cephalosporins is their ineffectiveness against Enterococci; the acylureidopenicillins may be a good choice since they are active against Enterococci and most enteric, pulmonary and urinary pathogens, including Escherichia coli and Streptococcus pneumoniae which are the pathogens most frequently isolated from cirrhotic patients with severe infection. Similarly, the combination of a beta-lactamase inhibitor with a penicillin may offer an adequate antibacterial spectrum. Piperacillin, like other beta-lactam antibiotics, can induce leukopenia in patients with cirrhosis; the more severe the hepatic dysfunction, the greater the risk; a reduction in dosages is necessary. Meropenem monotherapy is effective and safe for the initial therapeutic regimen of bacterial infection. The fluoroquinolones may be useful for the treatment of infections in liver cirrhosis; however, the marginal activity against S. pneumoniae is a drawback. Oral long-term fluoroquinolone administration is utilized for the prevention of spontaneous bacterial peritonitis recurrence; selective intestinal decontamination with fluoroquinolones is useful in preventing bacterial infections in cirrhosis with gastrointestinal hemorrhage. Given the high risk of nephrotoxicity due to aminoglycosides in liver cirrhosis, these antibiotics should be used only in cases of severe infection with septicemia, in which beta-lactam-aminoglycoside combination is indicated for rapid bactericidal effect and enhanced killing afforded by synergism. Perhaps a short course (no more than 3 days) and a once-daily schedule of administration would minimize the risk of aminoglycoside-induced nephrotoxicity.

English Abstract↗