Antimicrobial Therapy (antimicrobial + therapy)

Distribution by Scientific Domains
Distribution within Medical Sciences


Selected Abstracts


Antimicrobial therapy for multidrug resistant pathogens

EQUINE VETERINARY EDUCATION, Issue 6 2009
J. S. Weese
Summary Multidrug resistant bacteria are tremendous causes of morbidity and mortality in human medicine, and emerging pathogens in equine medicine. A variety of organisms, such as methicillin-resistant Staphylococcus aureus (MRSA), vancomycin resistant Enterococcus spp. (VRE) and multidrug resistant Acinetobacter spp., Pseudomonas spp. and Enterobacteriaceae are of concern in equine medicine. Veterinary practitioners need to be aware of key diagnostic, clinical, therapeutic, epidemiological and infection control aspects to limit the impact of these organisms on the equine, and perhaps human, population. [source]


Antimicrobial therapy in Dermatology

JOURNAL DER DEUTSCHEN DERMATOLOGISCHEN GESELLSCHAFT, Issue 1 2006
Cord Sunderkötter
Antiseptika; Antibiotika; ,-Laktam-Resistenz; Weichteilinfektion Summary The extensive and sometimes indiscriminate use of antibiotics sometimes without strict indications has led to increases in both bacterial resistance and sensitization of patients. Systemic antibiotics in skin infections are indicated when a severe local infection occurs which spreads into the surrounding tissue or when there are signs of systemic infection. There are special indications in patients with peripheral arterial occlusive disease,diabetes or immunosuppression. Topical use of antibiotics should be abandoned and replaced by antiseptics. The ,-lactam antibiotics are the antibiotics of first choice for many skin infections. They are usually effective, have a well-defined profile of adverse events and most are affordable. Penicillin G or V are the first line treatment for erysipelas. Infections with Staphylococcus aureus are usually treated with isoxazolyl penicillins or second generation cephalosporins. In mixed infections in patients with diabetes or peripheral arterial occlusive disease,the treatment of choice is metronidazole plus ,-lactam-/,-lactamase inhibitor antibiotics, but quinolones or second generation cephalosporins can also be used, once again with metronidazole. The aim of this review is to define the indications for antibiotics in dermatology, to highlight their modes of action and adverse effects and to make suggestions for rational antibiotic therapy in cutaneous infections frequently encountered in the practice of dermatology. Zusammenfassung Der bisweilen unkritische Einsatz von Antibiotika hat die Resistenzentwicklung beschleunigt und die Sensibilisierungsrate bei Patienten erhöht. Systemische Antibiotika sind bei kutanen Superinfektionen in der Regel dann indiziert, wenn eine schwere lokale Infektion mit Ausbreitung in das umgebende Gewebe vorliegt oder wenn sich gleichzeitig Zeichen einer systemischen Infektion einstellen. Bei peripherer arterieller Verschlusskrankheit, Diabetes mellitus oder Immunsuppression kann die Indikation auch früher gestellt werden. Lokale Antibiotika sollten in der Regel gemieden und durch moderne Antiseptika ersetzt werden. ,-Laktam-Antibiotika stellen für viele bakterielle Infektionserkrankungen in der ambulanten und klinischen Dermatologie die Antibiotika der ersten Wahl dar. Sie sind häufig ausreichend wirksam, besitzen ein gut definiertes Nebenwir-kungsprofil und sind zumeist preisgünstig. So wird das klassische Streptokokken-Erysipel mit Penicillin G oder V therapiert, bei Infektionen durch S. aureus kommen primär Isoxazolyl-Penicilline oder Zweit-Generations-Cephalosporine zum Einsatz. Im Falle von Mischinfektionen bei Diabetes mellitus oder pAVK sind ,-Laktam/,-Laktamaseinhibitoren indiziert, alternativ auch Chinolone oder Zweitgenerations-Cephalosporine, jeweils in Kombination mit Metronidazol. Diese Übersicht möchte die Indikationen für Antibiotika in der Dermatologie aufzeigen, das Wichtigste zu deren Wirkungsweise und Nebenwirkungen aufzählen und Therapievorschläge für häufige Infektionen der Haut in der dermatologischen Praxis geben. [source]


Resistant Pathogens in Urinary Tract Infections

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 2002
Lindsay E. Nicolle MD
Antimicrobial susceptibility of bacteria causing urinary tract infection (UTI) has evolved over several decades as antimicrobial exposure has repeatedly been followed by emergence of resistance. Older populations in the community, long-term care facilities, or acute care facilities have an increased prevalence of resistant bacteria isolated from UTI. Resistant isolates are more frequent in long-term care populations than the community. Resistant isolates include common uropathogens, such as Escherichia coli or Proteus mirabilis, and organisms with higher levels of intrinsic resistance, such as Pseudomonas aeruginosa or Providencia stuartii. Isolation of resistant organisms is consistently associated with prior antimicrobial exposure and higher functional impairment. The increased likelihood of resistant bacteria makes it essential that a urine specimen for culture and susceptibility testing be obtained before instituting antimicrobial therapy. Therapy for the individual patient must be balanced with the possibility that antimicrobial use will promote further resistance. Antimicrobial therapy should be avoided unless there is a clear clinical indication. In particular, asymptomatic bacteriuria should not be treated with antimicrobials. Where symptoms are mild or equivocal, urine culture results should be obtained before initiating therapy. This permits selection of specific therapy for the infecting organism and avoids empiric, usually broad-spectrum, therapy. Where empirical therapy is necessary, prior infecting organisms should be isolated, and recent antimicrobial therapy, as well as regional or facility susceptibility patterns, should be considered in antimicrobial choice. Where empirical therapy is used, it should be reassessed 48 to 72 hours after initiation, once pretherapy cultures are available. [source]


Neutrophil regeneration precedes healing of tissue destruction, as indicated by serum C-reactive protein, in children with cancer recovering from neutropenic fever

ACTA PAEDIATRICA, Issue 8 2002
K Vettenranta
Aim: To evaluate the relationship between absolute neutrophil count and C-reactive protein (CRP) in the recovery phase of neutropenic fever among paediatric patients with cancer. Methods: A total of 102 paediatric oncology patients with 177 episodes of fever and neutropenia was studied prospectively in a two-centre setting. Antimicrobial therapy was discontinued 9 d (mean) post-initiation with a mean absolute neutrophil count of 1.8 ± 109l -1 and CRP of 32 mg l -1. Results: The mean level of CRP below 20 mg l -1 was reached on day 12. The level of CRP peaked on the day following the commencement of antimicrobial therapy. Throughout the episodes of fever and neutropenia higher levels of CRP were associated with a lower absolute neutrophil count. Following defervescence the pace of marrow recovery as evidenced by an increasing absolute neutrophil count to < 0.2 and < 0.5 ± 109l -1 was more rapid than the normalization of serum CRP. There was a 2,3 d lag period between absolute neutrophil count exceeding the level of 200 ± 106l -1 and the return of CRP to a baseline level. All episodes were treated successfully and there were no fatalities. Conclusion: Among patients recovering from neutropenia and fever the signs of marrow recovery remain the key criterion in evaluating the safety of discontinuing antimicrobial therapy, with serum CRP remaining more of an indicator of ongoing tissue repair. [source]


Induction of complement sensitivity in Escherichia coli by citric acid and low pH

JOURNAL OF APPLIED MICROBIOLOGY, Issue 5 2001
C. Ocaña-Morgner
Aims:,The lytic functions of the complement system play an important role in the control of Gram-negative infections. Complement-resistant Escherichia coli LP1395 (O18) grown under normal conditions can survive the bactericidal action of complement present in human serum. Towards elucidating the mechanisms of complement resistance, the resistance of E. coli LP1395 grown under conditions of low pH and in the presence of citric acid was tested. Methods and Results:,E. coli LP1395 becomes sensitive to complement after growth in the presence of citric acid at pH 5. Complement resistance could be restored when the cells were transferred to pH 7 media. However, this recovery was greatly impaired when the cells were transferred to pH 7 media with chloramphenicol. This implies that protein synthesis may be involved in complement resistance. The cells exposed to citric acid at pH 5 showed no indication of a generalized outer membrane (OM) permeability when compared with those grown under normal conditions in terms of sensitivity to lysozyme, uptake of lipophilic dye, or sensitivity to a number of antibiotics. Conclusions:,Complement-resistant LP1395 may acquire a sensitivity to complement due not to a generalized disruption of the OM barrier, but possibly to the alteration of the activity of one or more normal complement resistance factors. Significance and Impact of the Study:,The elucidation of the echanisms of complement resistance of Gram-negative pathogens would bring important information about bacterial infections. Complement resistance factors could also be potential targets in antimicrobial therapies. [source]


Role of Transesophageal Echocardiography in Detecting Implantable Cardioverter Defibrillator Lead Infection

ECHOCARDIOGRAPHY, Issue 3 2003
Sanjeev Wasson
Implantable cardioverter defibrillator (ICD) lead infection is a rare condition with reported incidence of 0.2% to 16%. It usually presents with persistent bacteremia or fever of unknown origin and requires high clinical suspicion for diagnosis. Whenever ICD lead infection is suspected, transesophageal echocardiography is the diagnostic technique of choice for detection and characterization of the lesions. Lead infections are extremely difficult to manage conservatively and surgical removal of the entire defibrillator system is recommended along with antimicrobial therapy. We describe a case of recurrent staphylococci bacteremia due to an ICD lead infection in a patient with arrhythmogenic right ventricular dysplasia. (ECHOCARDIOGRAPHY, Volume 20, April 2003) [source]


Original Article: Pulmonary function, airway cytology and bronchoalveolar lavage fluid drug concentration after aerosol administration of cefquinome to horses

EQUINE VETERINARY EDUCATION, Issue 9 2010
T. Art
Summary The administration of antibiotics by aerosol to horses suffering from respiratory infections may partially circumvent the limitations of antimicrobial therapy, e.g. large injection volumes, low bioavailability and risk of diarrhoea. Only injectable formulations are available currently and usually contain other substances that could irritate the mucosa and induce coughing and bronchospasm. In addition, the quality of the aerosol, particularly in terms of the delivery of antibiotics to the deep parts of the lung, is unknown. Although used under field conditions, cefquinome delivered by aerosol has never been studied in horses. This study examined the safety of cefquinome injectable solution, administered by aerosol at a dose of 225 mg/inhalation to 7 healthy horses, by assessing (1) pulmonary function before and 15 min after a single inhalation, at the first day (Day 1) and the fifth day (Day 5) of a 5 day period treatment; and (2) the inflammatory status of the lung, i.e. percentage neutrophils and myeloperoxidase concentration, based on bronchoalveolar lavage (BAL) at D1 and D5. In addition, cefquinome concentrations were measured in bronchoalveolar lavage fluid after aerosol, intravenous (i.v.) and intramuscular (i.m.) administrations. A single aerosol of cefquinome injectable solution did not induce any immediate nor delayed pulmonary side effects in healthy horses and produced cefquinome concentrations in bronchoalveolar lavage (BAL) within 30 min that were higher than the minimal inhibitory concentration of the main equine respiratory pathogens. These results should stimulate further studies, especially in horses suffering from bronchial hyper-reactivity. Aerosol delivery of antibiotics may well have a role in equine therapeutics. [source]


Cryopreservation of semen from a stallion with seminal vesiculitis

EQUINE VETERINARY EDUCATION, Issue 5 2010
L. C. Fennell
Summary A 6-year-old Warmblood stallion was admitted for semen collection and cryopreservation. On the seventh and subsequent collection days semen samples were contaminated with purulent debris. A diagnosis of seminal vesiculitis was made following ultrasonography and endoscopy of the seminal vesicles. The stallion was treated with systemic and topical antimicrobial therapy and, although this did not cure the condition, subsequent ejaculates were suitable for cryopreservation. [source]


Glycolipid receptor depletion as an approach to specific antimicrobial therapy

FEMS MICROBIOLOGY LETTERS, Issue 1 2006
Majlis Svensson
Abstract Mucosal pathogens recognize glycoconjugate receptors at the site of infection, and attachment is an essential first step in disease pathogenesis. Inhibition of attachment may prevent disease, and several approaches have been explored. This review discusses the prevention of bacterial attachment and disease by agents that modify the glycosylation of cell surface glycoconjugates. Glycosylation inhibitors were tested in the urinary tract infection model, where P-fimbriated Escherichia coli rely on glycosphingolipid receptors for attachment and tissue attack. N -butyldeoxynojirimycin blocked the expression of glucosylceramide-derived glycosphingolipids and attachment was reduced. Bacterial persistence in the kidneys was impaired and the inflammatory response was abrogated. N -butyldeoxynojirimycin was inactive against strains which failed to engage these receptors, including type 1 fimbriated or nonadhesive strains. In vivo attachment has been successfully prevented by soluble receptor analogues, but there is little clinical experience of such inhibitors. Large-scale synthesis of complex carbohydrates, which could be used as attachment inhibitors, remains a technical challenge. Antibodies to bacterial lectins involved in attachment may be efficient inhibitors, and fimbrial vaccines have been developed. Glycosylation inhibitors have been shown to be safe and efficient in patients with lipid storage disease and might therefore be tested in urinary tract infection. This approach differs from current therapies, including antibiotics, in that it targets the pathogens which recognize these receptors. [source]


Anaerobic thyroid abscess from a thyroid cyst after fine-needle aspiration

HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 1 2002
Jui-Hung Sun MD
Abstract Background Anaerobic abscess formation within a thyroid cyst is rare but still possible, although aerobic thyroid abscess formation in the thyroid gland after fine-needle aspiration (FNA) has been observed in immunocompromised patients. Methods This study describes the clinical manifestations, thyroid echography, cytologic finding, culture outcome, and treatment course of an anaerobic abscess formation within a thyroid cyst after FNA in a healthy subject. Results A 53-year-old male subject had rapid enlargement of a left thyroid cyst develop after second FNA. Frank pus was obtained through third FNA. The culture outcome was Propionibacterium acnes, which was rich in saliva and one of the pathogens causing periodontitis and gingivitis. After adequate antimicrobial therapy, the abscess gradually diminished. Conclusions This article reported, for the first time, on the formation of an anaerobic thyroid abscess after FNA in a healthy subject. We recommended careful aseptic procedure and adequate isolation processes, such as wearing a mask to avoid an unfavorable outcome as a result of a bacterial infection. © 2002 John Wiley & Sons, Inc. Head Neck 24: 84,86, 2002. [source]


Incidence and risk factors of bacterial pneumonia requiring hospitalization in HIV-infected patients started on a protease inhibitor-containing regimen

HIV MEDICINE, Issue 4 2006
V Le Moing
Objectives To describe the incidence and risk factors of bacterial pneumonia occurring in patients treated with antiretrovirals. Methods In the ongoing APROCO (Anti-proteases) cohort, 1281 patients at the initiation of a protease inhibitor (PI)-containing antiretroviral regimen were enrolled from 1997,1999. All events requiring hospitalization during follow up are recorded. Of these, bacterial pneumonia was defined as the occurrence of a new pulmonary infiltrate with fever and either evidence of a bacteriological cause (definite cases) or favourable outcome with antimicrobial therapy (presumptive cases). Risk factors of bacterial pneumonia were studied using survival analyses. Results During a median follow up of 43 months, 29 patients had at least one episode of bacterial pneumonia, giving an incidence of 0.8/100 patient years. The 11 definite cases were attributable to Streptococcus pneumoniae (n=9), Legionella pneumophila (n=1) and Haemophilus influenzae (n=1). In multivariate analysis, bacterial pneumonia was significantly more frequent in older patients, injecting drug users, patients having a CD4 cell count>500 cells/,L at baseline and patients who initiated PI therapy with nonboosted saquinavir. It was significantly less frequent in nonsmokers. The occurrence of bacterial pneumonia was also associated with lower self-reported adherence to antiretroviral therapy and to higher plasma HIV-1 RNA levels during follow-up. Conclusions Bacterial pneumonia occurs rarely in patients treated with a PI-containing regimen and may be associated with virological failure. [source]


Community-acquired methicillin-resistant Staphylococcus aureus skin infections: a review of epidemiology, clinical features, management, and prevention

INTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 1 2007
Philip R. Cohen MD
Community-acquired methicillin-resistant Staphylococcus aureus (CAMRSA) infection is a global problem of epidemic proportions. Many of the patients who develop CAMRSA skin lesions do not have infection-associated risk factors. Abscess, abscess with accompanying cellulitis, and cellulitis are the most common presentations of cutaneous CAMRSA infection; occasionally, these CARMSA-related lesions are misinterpreted as spider or insect bites. Other manifestations of cutaneous CAMRSA infection include impetigo, folliculitis, and acute paronychia. The management of CAMRSA skin infection includes incision and drainage, systemic antimicrobial therapy, and adjuvant topical antibacterial treatment. In addition, at the initial visit, bacterial culture of the lesion should be considered. Direct skin-to-skin contact, damage to the skin surface, sharing of personal items, and a humid environment are potential mechanisms for the acquisition and transmission of cutaneous CAMRSA infection. Measures that strive to eliminate these causes are useful for preventing the spread of CAMRSA skin infection. [source]


Tuberculosis verrucosa cutis: antitubercular therapy, a well-conceived diagnostic criterion

INTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 3 2005
Virendra N. Sehgal MD
A 39-year-old housewife sustained inadvertent trauma to the right index finger about 6 years ago, whilst stitching clothes. A couple of weeks later, the site of trauma became hard and gritty. Ever since, it has progressed slowly, without any appreciable outward sign. It was not associated with any discomfort/pain. Consequent on an opinion from a surgeon, it was decided to operate on the right index finger. During the operation, under local anesthesia, a hard and gritty material was removed. The material was subjected to histopathologic study. Several stitches were applied to the wound. It failed to respond to antimicrobial therapy over a 4-week period, prompting the patient to seek another opinion. Examination of the skin surface revealed a plaque with an irregular configuration on and around the distal interphalangeal joint of the right index finger. It was erythematous and pigmented. The top of the plaque was irregular and had alternating elevations and depressions (Fig. 1). Diascopy was negative for apple jelly nodule. A bacillus Calmette,Guérin (BCG) vaccination scar was identified on the left deltoid. There was no regional lymphadenopathy or systemic abnormality. Mantoux test with intradermal injection of 0.1 mL SPAN's tuberculin (purified protein derivative/5 tuberculin units/0.1 mL) (Span Diagnostic Ltd., Murat, India) was negative after 72 h. Investigations, including total and differential leukocyte count, erythrocyte sedimentation rate, serum biochemistry, and renal and liver function tests, were within the normal range, as was a chest X-ray. Figure 1. Tuberculosis verrucosa cutis before (a) and after (b) antitubercular therapy (ATT) Hematoxylin and eosin-stained sections prepared from the biopsy taken from the lesion revealed noteworthy changes in the epidermis and the dermis. The former was marked by the presence of hyperkeratosis, acanthosis, and papillomatosis, whilst the latter contained tubercle granulomas. Each of the granulomas was well formed and consisted of large numbers of lymphocytes, histiocytes, and foreign body (Langerhans') giant cells (Fig. 2). Caseation necrosis and acid-fast bacilli could not be demonstrated. The preceding revelations were fairly conducive to the diagnosis. Accordingly, antitubercular therapy (ATT), comprising 450 mg of rifampicin, 300 mg of isonicotinic acid hydrazide, and 800 mg of ethambutol, was recommended for oral administration each day for 60 days. The outcome of the treatment was satisfactory, resulting in perceptible regression of the skin lesion (Fig. 1b). The patient was advised to continue the treatment for another 30 days, after which 450 mg of rifampicin and 300 mg of isonicotinic acid hydrazide were to be continued for another 6 months. Figure 2. Tuberculosis verrucosa cutis depicting well-formed tubercle(s) comprising lymphocytes, histiocytes, neutrophils, and a few giant cells (hematoxylin and eosin, × 100) [source]


Fournier's gangrene: Report of thirty-three cases and a review of the literature

INTERNATIONAL JOURNAL OF UROLOGY, Issue 7 2006
LUTFI TAHMAZ
Background:, Fournier's gangrene (FG) is an extensive fulminant infection of the genitals, perineum or the abdominal wall. The aim of this study is to share our experience with the management of this difficult infectious disease. Methods:, Thirty-three male patients were admitted to our clinic with the diagnosis of FG between February 1988 and December 2003. The patient's age, etiology and predisposing factors, microbiological findings, duration of hospital stay, treatment, and outcome were analyzed. The patients were divided into two groups. The first 21 patients (Group I) were treated with broad-spectrum triple antimicrobial therapy, broad debridement, exhaustive cleaning, and then they underwent split-thickness skin grafts or delayed closure as needed. The other 12 patients (Group II) were treated with unprocessed honey (20,50 mL daily) and broad-spectrum triple antimicrobial therapy without debridement. Their wounds were cleaned with saline and then dressed with topical unprocessed honey. The wounds were inspected daily and the honey was reapplied after cleaning with normal saline. Then, the patients' scrotum and penis were covered with their own new scrotal skin. Results:, The mean age of the patients was 53.9 ± 9.56 years (range = 23,71). The source of the gangrene was urinary in 23 patients, cutaneous in seven patients, and perirectal in three patients. The predisposing factors included diabetes mellitus for 11 patients, alcoholism for 10 patients, malnutrition for nine patients, and medical immunosuppression (chemotherapy, steroids, malignancy) for three patients. The mean duration of hospital stay was 41 ± 10.459 (range = 14,54) days. Two patients in Group I died from severe sepsis. The clinical and cosmetic results were better in Group II than Group I. Conclusions:, Necrotizing fasciitis of the perineum and genitalia is a severe condition with a high morbidity and mortality. Traditionally, good management is based on aggressive debridement, broad-spectrum antibiotics, and intensive supportive care but unprocessed honey might revolutionize the treatment of this dreadful disease by reducing its cost, morbidity, and mortality. [source]


Scalp necrosis and giant cell arteritis: case report and issues in wound management

INTERNATIONAL WOUND JOURNAL, Issue 4 2005
Stefan J Landis
Abstract Scalp necrosis is rare in patients with giant cell arteritis. Here, we report the case of an 81-year-old woman who presented with a management problem that required a truly multidisciplinary approach to treatment. A combined approach of effective wound bed preparation with selective debridement, prolonged antimicrobial therapy, corticosteroid use and careful dressing choices resulted in a successful outcome in a potentially disastrous situation. [source]


Systemic Inflammatory Response Syndrome in Nosocomial Bloodstream Infections with Pseudomonas aeruginosa and Enterococcus Species: Comparison of Elderly and Nonelderly Patients

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 5 2006
Alexandre R. Marra MD
OBJECTIVES: To determine whether the systemic inflammatory response syndrome (SIRS), clinical course, and outcome of monomicrobial nosocomial bloodstream infection (BSI) due to Pseudomonas aeruginosa or Enterococcus spp. is different in elderly patients than in younger patients. DESIGN: Historical cohort study. SETTING: An 820-bed tertiary care facility. PARTICIPANTS: One hundred twenty-seven adults with P. aeruginosa or enterococcal BSI. MEASUREMENTS: SIRS scores were determined 2 days before the first positive blood culture through 14 days afterwards. Elderly patients (,65, n=37) were compared with nonelderly patients (<65, n=90). Variables significant for predicting mortality in univariate analysis were entered into a logistic regression model. RESULTS: No difference in SIRS was detected between the two groups. No significant difference was noted in the incidence of organ failure, 7-day mortality, or overall mortality between the two groups. Univariate analysis revealed that Acute Physiology And Chronic Health Evaluation (APACHE) II score of 15 or greater at BSI onset; adjusted APACHE II score (points for age excluded) of 15 or greater at BSI onset; and respiratory, cardiovascular, renal, hematological, and hepatic failure were predictors of mortality. Age, sex, use of empirical antimicrobial therapy, and infection with imipenem-resistant P. aeruginosa or vancomycin-resistant enterococci did not predict mortality. Multivariate analysis revealed that hematological failure (odds ratio (OR)=8.1, 95% confidence interval (CI)=2.78,23.47), cardiovascular failure (OR=4.7, 95% CI=1.69,13.10), and adjusted APACHE II , 15 at BSI onset (OR=3.1, 95% CI=1.12,8.81) independently predicted death. CONCLUSION: Elderly patients did not differ from nonelderly patients with respect to severity of illness before or at the time of BSI. Elderly patients with pseudomonal or enterococcal BSIs did not have a greater mortality than nonelderly patients. [source]


Resistant Pathogens in Urinary Tract Infections

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 2002
Lindsay E. Nicolle MD
Antimicrobial susceptibility of bacteria causing urinary tract infection (UTI) has evolved over several decades as antimicrobial exposure has repeatedly been followed by emergence of resistance. Older populations in the community, long-term care facilities, or acute care facilities have an increased prevalence of resistant bacteria isolated from UTI. Resistant isolates are more frequent in long-term care populations than the community. Resistant isolates include common uropathogens, such as Escherichia coli or Proteus mirabilis, and organisms with higher levels of intrinsic resistance, such as Pseudomonas aeruginosa or Providencia stuartii. Isolation of resistant organisms is consistently associated with prior antimicrobial exposure and higher functional impairment. The increased likelihood of resistant bacteria makes it essential that a urine specimen for culture and susceptibility testing be obtained before instituting antimicrobial therapy. Therapy for the individual patient must be balanced with the possibility that antimicrobial use will promote further resistance. Antimicrobial therapy should be avoided unless there is a clear clinical indication. In particular, asymptomatic bacteriuria should not be treated with antimicrobials. Where symptoms are mild or equivocal, urine culture results should be obtained before initiating therapy. This permits selection of specific therapy for the infecting organism and avoids empiric, usually broad-spectrum, therapy. Where empirical therapy is necessary, prior infecting organisms should be isolated, and recent antimicrobial therapy, as well as regional or facility susceptibility patterns, should be considered in antimicrobial choice. Where empirical therapy is used, it should be reassessed 48 to 72 hours after initiation, once pretherapy cultures are available. [source]


Extraintestinal focal infections in adults with nontyphoid Salmonella bacteraemia: predisposing factors and clinical outcome

JOURNAL OF INTERNAL MEDICINE, Issue 1 2007
P.-L. Chen
Abstract. Background., Nontyphoid Salmonella (NTS) isolates lead to not only self-limited, acute gastrointestinal infections, but also bacteraemia with or without extraintestinal focal infections (EFIs). The risk factors associated with EFIs in adults with NTS bacteraemia were not clearly elucidated. Methods., In a medical center in southern Taiwan, patients aged ,18 years with NTS bacteraemia between January 1999 and June 2005 were included for analysis. Results., Of 129 patients, 51 (39.5%) were complicated with EFIs. The most common EFI was mycotic aneurysm, followed by pleuropulmonary infections and spinal osteomyelitis. Compared to patients with primary bacteraemia, those with EFIs had higher leucocyte counts (P = 0.004) and higher serum levels of C-reactive protein (P < 0.0001). The development of EFIs was associated with a higher mortality, more severe septic manifestations, longer hospital stays and duration of antimicrobial therapy. Univariate analysis revealed that diabetes mellitus (P = 0.02), hypertension (P = 0.02) and chronic lung disease (P = 0.006) were significantly associated with EFIs. However, patients with malignancy (P = 0.01) and immunosuppressive therapy (P = 0.03) were less likely to develop EFIs. On the basis of multivariate analysis, an independent factor for the occurrence of EFIs was age [adjusted odds ratio (aOR) 1.05; 95% confidence interval (CI) 1.02,1.07; P < 0.0001], whilst malignancy was negatively associated with EFIs (aOR 0.16; 95% CI 0.14,0.78; P = 0.01). Conclusion., Amongst patients with NTS bacteraemia, EFIs often occurred in the aged, and were associated with a higher mortality and morbidity. Recognition of specific host factors is essential for identification of EFIs which often demand early surgical interventions and prolonged antimicrobial therapy. [source]


Resident bacteria in a mixed population of rhesus macaque (Macaca mulatta) monkeys: a prevalence study

JOURNAL OF MEDICAL PRIMATOLOGY, Issue 6 2009
C.A. Carrier
Abstract Background, Microflora populations residing in oropharyngeal and gastrointestinal sites defend against pathogenic bacterial colonization. Perturbations in these microbial communities may allow opportunistic pathogenic bacteria to establish themselves and cause morbidity and mortality from sepsis particularly after stressful experimental procedures. This study determined the prevalent facultative bacteria in a resident population of Macaca mulatta prior to use in experimentally induced immunosuppressive radiation studies. Methods, Standard microbiological methods were used to assess prevalent facultative bacteria in the oropharynx and rectum of 24 male M. mulatta. Results, The majority of the bacteria isolated from the oropharyngeal and rectal sites were gram-positive cocci. Species of Staphylococcus and Streptococcus predominated in all samples. Few gram-negative bacteria were isolated. Conclusions, Bacteriological assessment is recommended to identify predominant bacterial species to be prepared to provide appropriate antimicrobial therapy in non-human primates that are expected to undergo stressful immunocompromising procedures. [source]


Yeast of the oral cavity is the reservoir of Heliobacter pylori

JOURNAL OF ORAL PATHOLOGY & MEDICINE, Issue 6 2008
Ali-Hatef Salmanian
Background:, Frequent occurrence of Helicobacter pylori in the human gastrointestinal tract and its persistence due to unsuccessful antimicrobial therapy might be related to a stage in the life cycle of H. pylori in which the bacterium establishes itself as an intracellular symbiont in yeast. In this study, occurrence of non-culturable H. pylori in the oral yeast was assessed by targeting vacuolating cytotoxin A (vacA s1s2) and ureAB genes in the total DNAs of yeasts. Methods:, DNAs were extracted from 13 oral yeasts in which bacterium-like bodies, suspected to be H. pylori, were observed microscopically. Primers were recruited to amplify vacA s1s2 and ureAB genes. DNAs from H. pylori and E. coli were used as controls. The amplicons from one yeast and H. pylori were sequenced. Yeasts were identified as Candida albicans. Results:, Fragments of vacA s1s2 and ureAB genes were amplified from 13 yeasts. The size of PCR products was 286 bp for vacA s1s2 gene and 406 bp for ureAB gene. Similar bands were obtained from the control H. pylori, and the results for E. coli were negative. The data from sequencing of PCR products showed about 98% homology between the genes amplified from yeast and those from H. pylori. Conclusions:, The results of this study showed the intracellular occurrence of H. pylori in yeast. This endosymbiotic relationship might explain the persistence of H. pylori in the oral cavity, the consequence of which could be reinoculation of the stomach by the bacterium and spread of infection among human populations. [source]


The management of fistulizing oral Crohn's disease with infliximab

JOURNAL OF ORAL PATHOLOGY & MEDICINE, Issue 7 2007
K. S. Staines
A 20-year-old female patient with oral Crohn's disease developed a fistula in her neck from a focus of intra-oral infection. Despite repeated courses of antimicrobial therapy over a period of several months, the fistula failed to resolve. However, following administration of infliximab, a monoclonal antitumour necrosis factor- , antibody, the fistula resolved spontaneously without the need for any further treatment. [source]


The pharmacology of radiolabeled cationic antimicrobial peptides

JOURNAL OF PHARMACEUTICAL SCIENCES, Issue 5 2008
Carlo P.J.M. Brouwer
Abstract Cationic antimicrobial peptides are good candidates for new diagnostics and antimicrobial agents. They can rapidly kill a broad range of microbes and have additional activities that have impact on the quality and effectiveness of innate responses and inflammation. Furthermore, the challenge of bacterial resistance to conventional antibiotics and the unique mode of action of antimicrobial peptides have made such peptides promising candidates for the development of a new class of antibiotics. This review focuses on antimicrobial peptides as a topic for molecular imaging, infection detection, treatment monitoring and additionally, displaying microbicidal activities. A scintigraphic approach to studying the pharmacokinetics of antimicrobial peptides in laboratory animals has been developed. The peptides were labeled with technetium-99m and, after intravenous injection into laboratory animals, scintigraphy allowed real-time, whole body imaging and quantitative biodistribution studies of delivery of the peptides to the various body compartments. Antimicrobial peptides rapidly accumulated at sites of infection but not at sites of sterile inflammation, indicating that radiolabeled cationic antimicrobial peptides could be used for the detection of infected sites. As the number of viable micro-organisms determines the rate of accumulation of these peptides, radiolabeled antimicrobial peptides enabled to determine the efficacy of antibacterial therapy in animals to be monitored as well to quantify the delivery of antimicrobial peptides to the site of infection. The scintigraphic approach provides to be a reliable method for investigating the pharmacokinetics of small cationic antimicrobial peptides in animals and offers perspective for diagnosis of infections, monitoring antimicrobial therapy, and most important, alternative antimicrobial treatment infections with multi-drug resistant micro-organisms in humans. © 2007 Wiley-Liss, Inc. and the American Pharmacists Association J Pharm Sci [source]


Canine and feline pyothorax: a retrospective study of 50 cases in the UK and Ireland

JOURNAL OF SMALL ANIMAL PRACTICE, Issue 9 2002
J. L. Demetriou
Fifty cases (36 dogs and 14 cats) with a confirmed diagnosis of pyothorax were evaluated from five referral institutions in the UK and Ireland. Aetiology, clinical presentation, diagnosis, treatment and outcome of all cases were examined. The underlying cause of pyothorax was determined in 18 per cent of cases. Positive bacteriological cultures of the pleural fluid were obtained in 68·7 per cent of the animals. Treatment modalities included surgery and medical management, involving thoracostomy tube placement, thoracic aspiration, thoracic lavage and antimicrobial therapy. A successful outcome was achieved in 86 per cent of patients. [source]


High prevalence and level of resistance to metronidazole, but lack of resistance to other antimicrobials in Helicobacter pylori, isolated from a multiracial population in Kuwait

ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 9 2006
M. JOHN ALBERT
Summary Background The primary treatment regimen for Helicobacter pylori infection for Kuwaitis does not contain metronidazole, but that for expatriates does. There is also increasing failure of antimicrobial therapy. Aim To determine the susceptibility of H. pylori from upper gastrointestinal biopsies of Kuwaitis and non-Kuwaitis to find out if differences existed in the susceptibilities of the isolates from the two different populations. Methods The susceptibilities of 96 H. pylori isolates were tested against metronidazole, amoxicillin, clarithromycin and tetracycline by the E test. The rdxA gene was analysed from selected metronidazole-susceptible and metronidazole-resistant strains to find out polymorphism and the basis of metronidazole resistance. Results Approximately, 70% of isolates from both populations were metronidazole resistant with 65% isolates showing high minimum inhibitory concentration values of >256 ,g/mL. No resistance to the other three antimicrobials was found. There were novel nonsense and missense mutations with no deletion in the rdxA gene by insertion of mini-IS605. Conclusions The prevalence and level of metronidazole resistance in H. pylori in the two populations was high with no difference, in spite of different treatment regimens. Metronidazole resistance in this transitional country appeared to be independent of prior metronidazole use for treatment of H. pylori infection. [source]


Living liver donor death related to complications of myeloma

LIVER TRANSPLANTATION, Issue 3 2009
Emmanuel Melloul
We report a donor death after right hepatectomy for living donor transplantation due to an undiagnosed myeloma. The 47-year-old donor, who was the 147th case performed in our department, was in excellent health without any abnormalities in the preoperative investigations. Despite an uneventful right hepatectomy without transfusion, the patient developed a partial thrombus of the inferior vena cava with a right proximal pulmonary trunk embolism on postoperative day 6. Subsequently, he developed multiorgan dysfunction leading to a coagulopathy, respiratory distress, and renal failure requiring hemodialysis and mechanical ventilation. This clinical scenario led us to suspect a hematological disorder. Immune electrophoresis showed a monoclonal peak of immunoglobulin G (8.7 g/L), a myelogram revealed an abnormally high level of dystrophic plasmocytes (more than 7%), and biopsies of salivary glands confirmed the diagnosis of immunoglobulin G kappa myeloma. The patient progressively deteriorated because of simultaneous hemorrhagic and infectious pulmonary complications resulting in septic shock. Despite an adequate combination of antimicrobial therapy and pleural drainage, the donor died on postoperative day 57 from multiple organ failure. This unusual cause of donor death after right hepatectomy reinforces the need for an extensive preoperative assessment. We advocate the addition of urinary protein loss and electrophoresis to the standard donor assessment protocol. Liver Transpl 15:326,329, 2009. © 2009 AASLD. [source]


Pichia anomala fungaemia in immunocompromised children

MYCOSES, Issue 5-6 2004
M. Bak
Pichia anomala; Fungämie; Immunsuppression; Kindern Summary Pichia anomala is an emerging yeast causing serious nosocomial infections in newborn and immunocompromised children. We describe nosocomial port catheter infection due to P. anomala in three children who were receiving cancer chemotherapy, bloodstream infection in a preterm infant and in an infant with severe combined immunodeficiency. All patients were treated with amphotericin B. All isolates were susceptible to amphotericin B and fluconazole. No recurrence was observed during follow-up in four of five patients. The common clinical feature in all of our patients was the presence of prior antimicrobial therapy. Zusammenfassung Pichia anomala gilt als opportunistischer Erreger nosokomialer Infektionen bei Neugeborenen und immunsupprimierten Kindern. Wir beschreiben nosokomiale Katheterinfektionen durch P. anomala bei drei Kindern mit Krebs, bei einer Frühgeburt und bei einem immunsupprimierten Säugling. Alle fünf Patienten hatten vorab antibakterielle Therapie erhalten und wurden durch Amphotericin B erfolgreich behandelt. Alle Isolate waren empfindlich für Amphotericin B und Fluconazol. In der Nachbeobachtungszeit wurde an vier fünf Patienten kein Rezidiv beobachtet. [source]


Periodontal diseases: current and future indications for local antimicrobial therapy

ORAL DISEASES, Issue 2003
L Trombelli
The microbial etiology of gingivitis and periodontitis provides the rationale for use of adjunctive antimicrobial agents in the prevention and treatment of periodontal diseases. Although mechanical removal of supra- and subgingival calcified and non-calcified plaque deposits has been proved effective to control the gingival inflammatory lesions as well as to halt the progression of periodontal attachment loss, some patients may experience additional benefits from the use of systemic or topical antimicrobial agents. Such agents are able to significantly affect supra- and subgingival plaque accumulation and/or suppress or eradicate periodontal pathogenic microflora. Currently, properly selected local antiseptic and systemic antibiotic therapies can provide periodontal treatment that is generally effective, low-risk and affordable. This paper will briefly review the host-related conditions in which the periodontal preventive and therapeutic approaches may be effectively assisted by a local antimicrobial regimen. Potential future indications for adjunctive local antimicrobial therapy will also be discussed. [source]


Adjuvant effect of vitamin A on recurrent lower urinary tract infections

PEDIATRICS INTERNATIONAL, Issue 3 2007
AYGEN YILMAZ
Abstract Background: The purpose of the present paper was to investigate the effects of vitamin A supplementation on recurrent lower urinary tract infections (RUTI). Methods: Twenty-four patients with non-complicated RUTI were included in a placebo-controlled, double-blinded study. Twelve patients received a single dose of 200 000 IU vitamin A in addition to antimicrobial therapy. Patient and control groups (each containing 12 patients) were followed for up to 1 year and were evaluated for eradication and frequency of lower urinary tract infections (UTI). Serum levels of vitamin A and ,-carotene were determined periodically. Results: During the first 6 months follow-up period the infection rate of the vitamin A-supplemented group reduced from 3.58 to 0.75 per 6 months, and in the subsequent 6 months the infection rate was 1.75 per 6 months. These values were calculated as 2.75, 2.83 and 2.66, respectively, in the placebo group. Conclusion: Vitamin A supplementation may have an adjuvant effect on the treatment of RUTI. [source]


Bloodstream infections in hospitalized adults with sickle cell disease: A retrospective analysis

AMERICAN JOURNAL OF HEMATOLOGY, Issue 10 2006
Lalita Chulamokha
Abstract Bloodstream infections (BSI) are a common cause of morbidity and mortality in people with sickle cell disease (SCD). In children with SCD, BSI are most often caused by encapsulated organisms. There is a surprising paucity of medical literature that is focused on evaluating SCD adults with BSI. We reviewed the charts of adults with SCD and BSI who were admitted to our hospital between April 1999 and August 2003. During this period a total of 1,692 hospital admissions for 193 adults with SCD were identified and 28% of these patients had at least 1 episode of positive blood cultures, with 69 episodes (17%) considered true BSI. Nosocomial BSI occurred in 34 episodes (49%). Among community BSI, in contrast to BSI in children with SCD, Streptococcus pneumoniae was rarely encountered. A high incidence of staphylococcal BSI in adults with SCD was noted. Twenty-eight percent of all BSI were caused by Staphylococcus aureus, and 15 of 22 isolates (68%) of these were methicillin-resistant. Gram-negative organisms, anaerobes, and yeast were found in 21 (27%), 3 (4%), and 4 isolates (5%) of BSI, respectively. Since over 80% of BSI were considered catheter-related, the higher incidence of gram-positive bacterial infections was likely due to the presence of indwelling central venous catheters. Empiric therapy for adults with SCD suspected of having BSI, especially in the presence of indwelling central venous catheters, should include antimicrobial therapy targeted at gram-positive bacteria (especially MRSA) and gram-negative bacteria. Also, if patients are critically ill, consideration should be made to include antifungal agents. Additional research into the adult SCD population appears necessary to further define this problem. Am. J. Hematol., 2006. © 2006 Wiley-Liss, Inc. [source]


CHAPTER 15: Cautions when antimicrobial therapy is administered to elderly patient

RESPIROLOGY, Issue S3 2006
The committee for The Japanese Respiratory Society guidelines for the management of respiratory infections
No abstract is available for this article. [source]