[Acute gastrointestinal diseases of staphylococcal etiology in children].
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Acute Disease↗
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Results for “STAPHYLOCOCCAL INFECTIONS, GASTROINTESTINAL”
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Infectious complications of neoplastic disease.
Progress has been made in the diagnosis and treatment of infection in patients with neoplastic disease. Among the advances is the appreciation that certain opportunistic infections occur in association with particular host immune defects and epidemiologic factors. Such immune defects are seen secondary to or as a consequence of treatment for the patient's basic disease. Improved methods such as serology, open lung biopsy, and fiberoptic bronchoscopy have allowed for earlier diagnosis and treatment of opportunistic infections. The development of empiric antibiotic regimens, particularly aminoglycosides and the antipseudomonal penicillins, have improved the outcome in the febrile neutropenic patient. The benefits of protective environments have been challenged; prophylactic antibiotics and various forms of immunotherapy are of interest but remain investigational.
Aspergillosis↗
Septicaemia in the newborn and elderly.
Analysis of 5304 episodes of septicaemia at St Thomas' Hospital showed that both the elderly (> 65 years) and neonates accounted for increasing proportions between 1969 and 1992. In particular the increase was greatest for patients aged over 84 years who accounted for 3% of episodes in adults with community-acquired septicaemia in the 1970s compared with 13% in the 1990s. The change may be explained partly by demographic factors. The majority (85-90%) of elderly patients presented with fever, or leucocytosis or both. The urinary and gastrointestinal tracts were the most common foci for the elderly and they were less likely than other adults to have iv access associated sepsis. Among neonates Escherichia coli septicaemia became less common whereas there was little changes in the incidence of group B streptococcal septicaemia; coagulase-negative staphylococcal infection became more common. Overall mortality declined for both neonates and elderly patients. Poor outcome appeared related to the focus of infection, febrile response and age in the elderly and to the time of onset and organism in neonates.
Adolescent↗
Comparison of bacampicillin twice daily and ampicillin four times daily in treatment of acute exacerbations of chronic bronchitis.
Sixteen patients with chronic bronchitis were treated in a single-blind crossover study during two separate acute exacerbations caused by bacterial infections. During one of the episodes a regimen consisting of two 800-mg doses of bacampicillin per day was given; therapy for the other episode was four 500-mg doses of ampicillin per day. Each drug was given for 14 days. Patients were observed once before therapy was started, twice a week during therapy, and weekly after therapy; the investigator did not know which drug the patients were receiving. Graded clinical observations included frequency and severity of cough, wheezing, rales, rhonchi, breath sounds, and prolongation of expiration. Objective sputum measurements included daily volume, qualitative and quantitative cytology, and quantitative bacterial counts. Paired t-test analyses revealed that before therapy was begun the group receiving bacampicillin was sicker. Both agents effectively decreased inflammation and counts of bacterial flora. Clinical symptoms cleared 11 days after institution of therapy with either drug, but patients tended to favor bacampicillin in overall clinical effects. Adverse effects were similar with both agents, but bacampicillin was associated with fewer upper and more lower gastrointestinal symptoms.
Acute Disease↗
[The study of cases with infection by methicillin-resistant Staphylococcus aureus].
The purpose of this study was to evaluate the risk factors which lead to death due to highly critical staphylococcic enteritis manifested by high fever, large amount of watery diarrhea and gastric secretion with leukopenia and lymphocytopenia after surgical procedures. We experienced eight cases of severe staphylococcic enteritis by methicillin-resistant Staphylococcus aureus (MRSA) occurred in the early days after operation from 1986 to 1990. Seven out of eight cases underwent gastrectomy due to gastric cancer. Oral antibiotics were administered in five out of eight cases as the preparation of gastrointestinal tract. Five had been injected the third-generation cephalosporin (CZX) as prophylactic antibiotic administration. In hematological examination, leukopenia and lymphocytopenia were observed in five cases (62.5%) who died soon after operation. So as to prevent the occurrence of MRSA enteritis, it is important to avoid using third-generation cephalosporin after gastrectomy.
Aged↗
Prevalence of nosocomial infections in Italy: result from the Lombardy survey in 2000.
A one-day survey was carried out in 88 out of 113 public hospitals in Lombardy to obtain prevalence rates of hospital-acquired infections (HAIs) by hospital departments and to identify the pathogens more frequently involved. In total 18667 patients were surveyed, representing 72% of the average daily total of occupied beds in public hospitals in Lombardy. The overall prevalence of HAI was 4.9%. The highest prevalence was observed in intensive care units and in spinal units. The prevalence of bloodstream infections was 0.6%; pneumonia 1.1%; urinary tract infections 1.6% and gastrointestinal infections 0.4%. In surgical patients the prevalence of surgical site infections was 2.7%. The most frequently isolated pathogen from all sites of infections was Escherichia coli (16.8%), followed by Staphylococcus aureus (15.0%), Pseudomonas aeruginosa (13.2%) and Candida spp. (8.7%). Methicillin-resistant S. aureus accounted for 23% of all isolated S. aureus. The results provide baseline data for rational priorities in allocation of resources, for further studies and for infection control activities.
Candidiasis↗
Sternoclavicular septic arthritis in a patient with end-stage liver disease.
Sternoclavicular septic arthritis is an uncommon clinical entity that is often misdiagnosed on initial presentation. It has generally been described in IV heroin users and immunocompromised hosts. We report the case of a 43-year-old woman with endstage liver disease who presented with a fever, a painful sternoclavicular joint, and gastrointestinal bleeding. The clinical presentation, diagnosis, and treatment of sternoclavicular septic arthritis are reviewed.
Adult↗
Continuous peritoneal dialysis-associated peritonitis of nosocomial origin.
OBJECTIVE: To describe our experience with nosocomial continuous peritoneal dialysis (CPD)-associated peritonitis focusing on the incidence, possible risk factors, spectrum of organisms, and outcome. DESIGN: Retrospective review of the medical records of our CPD patients admitted to an acute-care hospital between November, 1993 and December, 1994. SETTING: University-associated acute-care hospitals in New Haven, Connecticut. PATIENTS: One hundred and eighty-eight patients maintained on CPD therapy and admitted to an acute-care hospital. RESULTS: Nineteen patients (5%) developing nosocomial peritonitis (NP) were identified from the 408 admissions occurring during the study period. Patients developing NP were older than the hospitalized CPD patients not developing NP (65.5 +/- 14.6 vs 58.4 +/- 14.7 years, p < 0.05). Comorbid diseases including diabetes, peripheral vascular disease, gastrointestinal disease, cardiovascular disease, and human immunodeficiency virus seropositivity were not more common in the patients developing NP. Patients developing NP were hospitalized significantly longer than the CPD patients not developing NP (39.5 +/- 46.5 days vs 12.7 +/- 12.4 days, p < 0.001). The mean serum albumin was lower in the NP patients than in the CPD patients not developing NP (2.35 +/- 0.52 g/dL vs 3.02 +/- 0.60 g/L, p < 0.001). Antecedent antibiotic use and performance of invasive procedures were noted in 89% and 68% of the patients developing NP, respectively. Staphylococcal species, enterococcal species, and gram-negative organisms accounted for 26%, 21%, and 53% of the episodes of NP, respectively. Furthermore, two strains of Enterococcus resistant to vancomycin were cultured. Eight patients developing NP expired, 8 patients continued CPD therapy, 2 patients transferred to hemodialysis, and one patient recovered renal function. CONCLUSION: We conclude that NP is uncommon. Increased age, increased length of hospital stay, and hypoalbuminemia may predispose patients to the development of NP. Further studies with case controls should help to clarify whether antecedent antibiotics or prior performance of invasive procedures predispose patients to the development of nosocomial peritonitis. The spectrum of organisms accounting for NP is different than the spectrum of organisms causing community-acquired CPD-associated peritonitis. Some of these organisms may be resistant to standard antibiotic therapies. Patients developing NP do poorly, with 42% expiring while being treated for NP.
Age Factors↗
[Cefotaxime in digestive tract infections (author's transl)].
Cefotaxime was administered alone to 25 patients, with serious infectious diseases secondary to a gastrointestinal lesion. The largest group consisted of pancreatic and biliary infections, or infectious complication in cirrhotic patients. The daily dose was 2 or 3 g, sometime 4 g of cefotaxime. In the 15 cases where the infecting organisms could be identified: E. coli: 6, Staphylococcus aureus: 4, Klebsiella: 2, Haemophilus: 1, Proteus: 1 and Pseudomonas: 1, the pathogen was eradicated bacteriologically within two to six days after the onset of therapy. The infection was controlled in all 25 cases within 2 to 8 days even though, in 11 cases, previous antibiotic therapy had been insufficient, no complementary antibiotic treatment was associated and 8 of the cases with very severe infection were a serious problem to the intensive care unit. The use of cefotaxime is justified in the treatment of gastrointestinal infection even though pathogens are identified with difficulty in these diseases.
Adult↗
Effects of antibiotics on the gastrointestinal tract.
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Anti-Bacterial Agents↗
Postoperative toxic shock syndrome after lumbar laminectomy in a male patient.
OBJECTIVES: Postoperative toxic shock syndrome in a male patient who underwent a lumbar laminectomy has not been reported. This case report identifies a rare, and potentially fatal, postoperative complication. RESULTS: Early diagnosis and aggressive medical management were successful in this patient and are the cornerstone of treatment in toxic shock syndrome. CONCLUSION: Spine surgeons should consider postoperative toxic shock syndrome as a diagnosis in a patient with fever, gastrointestinal symptoms, and hypotension in the presence of a benign-appearing lumbar laminectomy wound.
Diskectomy↗
Efficacy and tolerability of erythromycin acistrate and erythromycin stearate in acute skin infections of patients with atopic eczema.
The efficacy and tolerability of a new erythromycin derivative, erythromycin acistrate (EA), were compared with that of erythromycin stearate (ES) in 42 patients with infected atopic eczema. The dosage of EA was 400 mg tid and that of ES 500 mg tid. The duration of treatment ranged from five to 12 days. The patients were hospitalized and evaluated before treatment and on the last day in hospital. The infective pathogen was usually Staphylococcus aureus in both groups. Without local antibacterial treatment both drugs eradicated the bacteria in more than 60% of the cases. Gastrointestinal side effects were frequently reported with both drugs, more often in the ES- than in the EA-group, but the difference was only statistically significant (p less than 0.05) with respect to diarrhoea. One patient in each group discontinued treatment because of gastrointestinal side effects. No elevations in liver enzymes of clinical significance were reported in either group.
Administration, Cutaneous↗
[Clinical study on postoperative infections caused by methicillin-resistant Staphylococcus aureus after gastrointestinal surgery].
We studied 308 postoperative infections (216 patients) after gastrointestinal surgery during 1987-1991, to elucidate the incidence of postoperative infections caused by methicillin-resistant Staphylococcus aureus (MRSA) and its correlation to clinical background factors. Results were as follows: (1) MRSAs were isolated from 25.9% out of 216 patients or 22.4% out of 308 infections. (2) The isolation rate of MRSA was significantly high in infectious enterocolitis (64.7%, p < 0.001), intraabdominal infections (52.5%, p < 0.001) and respiratory tract infections (35.3%, p < 0.05). On the other hand, it was significantly low in bacteremias (9.28%, p < 0.001), wound infections (13.6%, p < 0.05) and urinary tract infections (3.33%, p < 0.05). (3) MRSAs were found more frequently in male (p < 0.05), younger patients (p < 0.05) and patients with malignant disease (p < 0.10). Whereas no difference was recognized between patients with or without complication. (4) The isolation rate of MRSA by the kind of antibiotics used after surgery, was 0% (0/20, the 1st generation cephems), 17.2% (10/58, the 2nd generation cephems) and 54.5% (48/88, the 3rd generation cephems). Significant differences were found among each group (p < 0.05, p < 0.001). (5) During 1990-1991 when the 1st generation cephems were used frequently, MRSAs were found significantly lower in frequency than during 1987-1989 (p < 0.05). Especially a marked decrease in the rate of MRSA (51.4% to 8.33%, p < 0.05) was seen among patients after upper gastrointestinal surgery.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
[Josamycin in bronchopulmonary and otorhinological diseases in pediatrics].
Josamycin, one of the more recent macrolide antibiotics, was evaluated in 29 children aged from 2 months to 13 years with bronchopulmonary or otorhinological disease. With a daily dose in the range 30 to 60 mg/kg bodyweight, and an average treatment period of 7.7 days, 24 children were cured and 5 markedly improved. In only 4 children were minor side effects, such as gastrointestinal disturbances, observed, which in no case necessitated interruption of therapy. By virtue of its spectrum of activity josamycin seems to be an ideal antibiotic for the treatment of bacterial respiratory tract infections. In addition, josamycin displays a high degree of activity against mycoplasmas and chlamydiae. Only a very low percentage, reported as 6%, of staphylococcal are primarily resistant to the antibiotic, and the rapid development of resistance to other macrolides, has not been reported for josamycin. No cross resistance exists between josamycin and penicillins, cephalosporins, tetracycline or aminoglycosides. These characteristics represents josamycin for the treatment of respiratory tract infections. The pleasant taste of the preparation used in this study ensured its ready acceptance by the children treated.
Acute Disease↗
Ceftazidime: aspects of efficacy and tolerance.
Clinical trial results have been analysed from 2607 patients (2953 infections, of which 38% were severe) treated with ceftazidime alone and from 466 patients (507 infections - 24% severe) treated with one or more comparative antibiotics. Of 235 staphylococcal infections (all sites) treated with ceftazidime alone 84% cleared and 16% relapsed or failed; of 28 infections treated with other antibiotics, 82% cleared and 18% relapsed or failed. Of 541 pseudomonas infections (all sites) treated with ceftazidime 60% cleared and 40% relapsed or failed; of 76 infections treated with other agents 43% cleared and 57% relapsed or failed. Adverse events were seen in 8.9% of the 2,607 ceftazidime treated and in 8.2% of the 466 patients treated with other agents and included local and gastrointestinal intolerance and hypersensitivity reactions. Changes in laboratory tests included eosinophilia, Coombs' positivity and liver enzyme increases. Superinfection occurred in 2.5% of patients treated with ceftazidime and in 5.2% of patients treated with other antibiotics. Deaths from all causes during or shortly after treatment were reported in 3.3% of the 2607 ceftazidime-treated and in 5.8% of the 466 patients treated with other agents. Factors, including neutropenia, influencing these differences are analysed.
Bacterial Infections↗
Hospital-acquired pneumonia: risk factors, clinical features, management, and antibiotic resistance.
PURPOSE OF REVIEW: The aim of this review is to summarize recent developments regarding risks factors, clinical features, management and antimicrobial resistance, and prevention of hospital-acquired pneumonia. RECENT FINDINGS: Risk factors for hospital-acquired pneumonia developing in specific ICUs (neurologic and cardiovascular surgery) were reported. Characteristics of pneumonia acquired in general wards but requiring ICU admission were studied. Analysis of the impact of reintubation on pneumonia occurrence demonstrated that only reintubation after accidental extubation increases the risk. Early administration of adequate antibiotic(s), associated with a deescalating strategy, remains the only measure directly amenable to modification by clinicians that decreases the infection-related mortality. Numerous data emphasized the recommendation that guidelines for hospital-acquired pneumonia therapy should be updated and customized to local patterns to improve the level of adequacy of antimicrobial treatment. A 8-day treatment regimen could be proposed when pneumonia is not caused by a nonfermenting, gram-negative bacilli. In cases of pneumonia caused by methicillin-resistant Staphylococcus aureus, linezolid, compared with vancomycin, significantly increases the rates of cure and survival. Semirecumbent positioning in all eligible patients, sucralfate rather than H2 antagonists in patients at low to moderate risk of gastrointestinal bleeding, and, in selected patients, aspiration of subglottic secretions and oscillating beds are the measures proposed to prevent the development of ventilator-associated pneumonia. Conversely, the routine or indiscriminate use of selective digestive decontamination is not recommended. SUMMARY: In our opinion, the optimization of the length of treatment and the reduction of mortality with linezolid in staphylococcal pneumonia are two major recent developments.
Cross Infection↗
Gastrointestinal carriage of methicillin-resistant Staphylococcus aureus.
Nasal and rectal cultures were taken from all patients with methicillin-resistant Staphylococcus aureus identified on routine cultures obtained because of clinical indications. Of 117 patients studied over a 3-year period, 70 (60%) had rectal colonization and 62 (53%) had nasal colonization. Rectal colonization, probably reflecting gastrointestinal carriage, may be a source of transmission of methicillin-resistant S. aureus in hospitalized patients and may be difficult to eradicate.
Cross Infection↗
Nosocomial infections in a developing Middle East hospital.
The prevalence and pattern of nosocomial infections in a new hospital in the United Arab Emirates is presented. During an 18-month period in which there were 6,544 discharges, 379 nosocomial infections occurred in 310 patients, representing an attack rate of 4.7%. The commonest site of infection was the urinary tract which accounted for 42.2% of the total. This was followed by surgical wound infections, cutaneous infections, bloodstream infections, lower and upper respiratory infections, infected burns and gastrointestinal infections. The most common organisms were Escherichia coli (22.7% of isolates), Pseudomonas species (17.5%) and Staphylococcus aureus (16.7%). Escherichia coli was the most common cause of urinary tract infections and bacteremia; Staphylococcus aureus was the most common cause of surgical wound and cutaneous infections. There was only one Serratia marcescens infection. We observed a high incidence of Pseudomonas infections, particularly of the urinary tract, and Staphylococcal surgical wound and other cutaneous infections, but otherwise our data are similar to nosocomial infection data from US hospitals.
Anti-Bacterial Agents↗