Assuntos
Antibacterianos/farmacologia , Colistina/farmacologia , Meios de Cultura/química , Testes de Sensibilidade a Antimicrobianos por Disco-Difusão/métodos , Sinergismo Farmacológico , Klebsiella pneumoniae/efeitos dos fármacos , beta-Lactamases/metabolismo , Ágar , Farmacorresistência Bacteriana , Humanos , Klebsiella pneumoniae/enzimologiaRESUMO
Two different approaches are described for rapid detection of intestinal carriage of Klebsiella pneumoniae producing KPC-type carbapenemase (KPC-KP), based on PCR amplification of DNA extracts from rectal swabs (K-PCR), and on direct plating of rectal swabs on to MacConkey agar with a meropenem disc and a meropenem plus 3-aminophenylboronic acid disc (direct KPC screening test, DKST). K-PCR and DKST were tested with a total of 101 samples from 65 patients, during an outbreak. Although less sensitive, DKST could detect high-level carriage, which appears to be common among infected and colonised patients, while being very cheap and easy to perform, and requiring only basic facilities.
Assuntos
Proteínas de Bactérias/metabolismo , Portador Sadio/diagnóstico , Portador Sadio/epidemiologia , Trato Gastrointestinal/microbiologia , Infecções por Klebsiella/diagnóstico , Infecções por Klebsiella/epidemiologia , Klebsiella pneumoniae/enzimologia , beta-Lactamases/metabolismo , Proteínas de Bactérias/genética , Portador Sadio/microbiologia , Surtos de Doenças , Humanos , Infecções por Klebsiella/microbiologia , Klebsiella pneumoniae/isolamento & purificação , Testes de Sensibilidade Microbiana/economia , Testes de Sensibilidade Microbiana/métodos , Reação em Cadeia da Polimerase/métodos , Sensibilidade e Especificidade , Fatores de Tempo , beta-Lactamases/genéticaAssuntos
Bacteriemia/tratamento farmacológico , Daptomicina/uso terapêutico , Endocardite Bacteriana/tratamento farmacológico , Enterococcus faecium/efeitos dos fármacos , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Minociclina/análogos & derivados , Idoso de 80 Anos ou mais , Bacteriemia/microbiologia , Quimioterapia Combinada/métodos , Endocardite Bacteriana/microbiologia , Infecções por Bactérias Gram-Positivas/microbiologia , Humanos , Masculino , Minociclina/uso terapêutico , Tigeciclina , Resistência a VancomicinaAssuntos
Antibacterianos/sangue , Antibacterianos/uso terapêutico , Cateterismo Venoso Central/efeitos adversos , Cateteres de Demora/microbiologia , Daptomicina/sangue , Daptomicina/uso terapêutico , Sepse/tratamento farmacológico , Corynebacterium/isolamento & purificação , Infecções por Corynebacterium/sangue , Infecções por Corynebacterium/tratamento farmacológico , Feminino , Humanos , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Pessoa de Meia-Idade , Infecções Estafilocócicas/sangue , Infecções Estafilocócicas/tratamento farmacológico , Falha de TratamentoRESUMO
This randomized trial was done to test the effectiveness and safety of using a novel antiseptic solution (Dermacyn(R) Wound Care [DWC], Oculus Innovative Sciences, Petaluma, CA) in the management of the postoperative lesions on the infected diabetic foot. 40 patients with postsurgical lesions wider than 5 cm2 left open to heal by secondary intention were randomized into 2 groups. Group A was locally treated with DWC, whereas group B received povidone iodine as local medication, both in adjunct to systemic antibiotic therapy and surgical debridement if needed. Ischemia, renal failure, bilateral lesions, or immunodepression were considered as exclusion criteria. Patients were followed up weekly for 6 months. The primary endpoint was healing rate at 6 months, while secondary endpoints were healing time, time to achieve negative cultures, duration of antibiotic therapy, number of reinterventions, and adverse events. Healing rates at 6 months were significantly shorter in group A (90%) than in group B (55%; P < .01). The time taken for cultures to become negative and duration of antibiotic therapy were also significantly (P < .05) shorter in group A than in group B, whereas the number of reinterventions was significantly higher in group B (P < .05). No difference was noted in the adverse events except that for reinfections, which were more frequent in group B than in group A (P < .01). DWC is as safe as and more effective than standard local antiseptics in the management of wide postsurgical lesions in the infected diabetic foot.
Assuntos
Anti-Infecciosos Locais/uso terapêutico , Pé Diabético , Peróxido de Hidrogênio/uso terapêutico , Higiene da Pele/métodos , Cicatrização/efeitos dos fármacos , Infecção dos Ferimentos/prevenção & controle , Idoso , Anti-Infecciosos Locais/farmacologia , Contagem de Colônia Microbiana , Desbridamento , Pé Diabético/complicações , Pé Diabético/cirurgia , Seguimentos , Humanos , Peróxido de Hidrogênio/farmacologia , Controle de Infecções , Estimativa de Kaplan-Meier , Pessoa de Meia-Idade , Cuidados Pós-Operatórios , Povidona-Iodo/uso terapêutico , Recidiva , Segurança , Fatores de Tempo , Resultado do Tratamento , Infecção dos Ferimentos/etiologiaAssuntos
Antibacterianos/administração & dosagem , Antibacterianos/efeitos adversos , Daptomicina/administração & dosagem , Daptomicina/efeitos adversos , Rabdomiólise/induzido quimicamente , Idoso , Esquema de Medicação , Enterococcus faecalis/isolamento & purificação , Feminino , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , HumanosAssuntos
Antifúngicos/uso terapêutico , Equinocandinas/uso terapêutico , Fungemia/tratamento farmacológico , Fungemia/imunologia , Hospedeiro Imunocomprometido , Transplante de Fígado/efeitos adversos , Sistema ABO de Grupos Sanguíneos , Anfotericina B/administração & dosagem , Antibacterianos/uso terapêutico , Infecções Bacterianas/tratamento farmacológico , Infecções Bacterianas/imunologia , Caspofungina , Quimioterapia Combinada , Feminino , Fusarium , Rejeição de Enxerto/prevenção & controle , Histocompatibilidade , Humanos , Imunossupressores/uso terapêutico , Lipopeptídeos , Transplante de Fígado/imunologia , Meropeném , Pessoa de Meia-Idade , Teicoplanina/administração & dosagem , Tienamicinas/administração & dosagemRESUMO
A case of bla(VIM-1) producing E. cloacae disseminated infection in a patient submitted to orthotopic liver transplantation is described. Synergism between colistin, rifampin and imipenem was studied in vitro and this combination of three drugs was used to treat E. cloacae infection. The synergistic activity of this combination was demonstrated showing an increased activity of the serum bactericidal activity in comparison with the bactericidal activity of the serum taken during the previous therapy.
Assuntos
Antibacterianos/administração & dosagem , Colistina/administração & dosagem , Enterobacter cloacae , Infecções por Enterobacteriaceae/tratamento farmacológico , Imipenem/administração & dosagem , Transplante de Fígado/efeitos adversos , Rifampina/administração & dosagem , Sinergismo Farmacológico , Quimioterapia Combinada , Enterobacter cloacae/enzimologia , Humanos , Masculino , Pessoa de Meia-Idade , beta-Lactamases/biossínteseRESUMO
A 16 year-old girl underwent a multifocal (lungs, skin, soft tissues) infection due to multiresistant Acinetobacter baumannii after a car crash. To treat such a severe disease we used a combination therapy of colistin (2 millions Units twice/day), rifampicin (600 mg/day), meropenem (1 g 3 times a day) after a synergistic activity test was performed (checkerboard method on Mueller-Hinton broth and 5x10(5) cfu/mL inoculum). After 24 days, when a significant clinical improvement was gained, the 3-drugs combination therapy was replaced with i.v. levofloxacin 500 mg twice/day but, after 10 days of quinolones therapy, fever started again and the same multidrug resistant (MDR) A. baumannii was isolated from the skin grafts, central venous catheter tip and bronchial alveolar lavage. A combination therapy with colistin and meropenem was therefore started and definitive defervescence was obtained after 10 days. This therapy was continued for 70 days even if the patient was apyretic because A. baumannii was still present in the skin secretions. After 109 days of hospitalization in our intensive care unit, the patient was transferred to a rehabilitative unit. This case shows how useful is, in selected cases, rediscovering old antibiotic drugs, specially when they are adopted as a combination therapy, and highlights the importance of the clinical microbiological laboratory as it may help clinicians in choosing the best drugs combination.
Assuntos
Infecções por Acinetobacter/tratamento farmacológico , Acinetobacter baumannii , Antibacterianos/uso terapêutico , Colistina/uso terapêutico , Rifampina/uso terapêutico , Tienamicinas/uso terapêutico , Acidentes de Trânsito , Infecções por Acinetobacter/microbiologia , Acinetobacter baumannii/efeitos dos fármacos , Adolescente , Amputação Traumática/complicações , Farmacorresistência Bacteriana Múltipla , Quimioterapia Combinada , Feminino , Humanos , Meropeném , Testes de Sensibilidade MicrobianaRESUMO
The evaluation of the safety and effectiveness of colistin in association with rifampin and imipenem in 1 diabetic patient with severe diabetic foot infection (DFI) due to multidrug-resistant (MDR) Pseudomonas aeruginosa, complicated by osteomyelitis, is presented in this "Case Report". The patient received colistin after other ineffective antimicrobial treatment when an MDR P aeruginosa strain was isolated by cultural examination, together with a multidisciplinary care approach including surgical debridement and adequate offloading. The efficacy of combination colistin plus rifampin plus imipenem was observed with a checkerboard method and bactericidal activity of the serum. The patient received colistin combination therapy for 6 weeks with cure of the infection and without renal toxicity. These data suggest that colistin, in combination with rifampin and imipenem, is safe and effective, in promoting healing in DFI due to MDR P aeruginosa and suggest the need for controlled clinical studies.
Assuntos
Colistina/uso terapêutico , Pé Diabético/complicações , Imipenem/uso terapêutico , Osteomielite/complicações , Infecções por Pseudomonas/complicações , Pseudomonas aeruginosa/efeitos dos fármacos , Rifampina/uso terapêutico , Idoso , Antibacterianos/uso terapêutico , Farmacorresistência Bacteriana Múltipla , Quimioterapia Combinada , Seguimentos , Humanos , Masculino , Ossos do Metatarso , Osteomielite/tratamento farmacológico , Osteomielite/microbiologia , Infecções por Pseudomonas/tratamento farmacológico , Infecções por Pseudomonas/microbiologia , Pseudomonas aeruginosa/isolamento & purificaçãoRESUMO
Pacemakers (PMs) and implantable cardioverter defibrillators (ICDs) have become life-saving therapeutic tools for patients with cardiac arrhythmia. Complications include thrombosis, embolism and infections at a highly variable rate. Surgical removal of the infected device has been perceived as the only way to guarantee a successful outcome and to reduce the high risk of mortality. Recently, a transvenous extraction method has been developed to remove infected intracardiac leads without sternotomy. This survey was designed to evaluate the outcome of an approach combining antibiotic therapy with non-surgical transvenous complete removal for the management of cardiac device infections (CDIs). We reviewed case-histories of 121 patients (105 with PM and 16 with ICD infections). The aim of our retrospective survey was to ascertain that a non-invasive transvenous complete removal of the infected devices is safe and effective when associated with appropriate antibiotic therapy starting 10 days before the procedure and extending to at least three weeks after. The infected devices were successfully removed in all patients with a non-surgical transvenous technique. The infections were most frequently caused by coagulase-negative staphylococci (70%), Staphylococcus aureus (14%), and Gram-negative rods (12%). Polymicrobial infections were documented in 19 patients and represent 16% of all device-related infections. The removal of the devices was done during antibiotic therapy, administered for a median of 26 days (range 23 to 45 days). Neither fatalities nor relapse of infections were recorded in the patient population during the one-year follow-up visits. According to our experience, CDIs can be treated with antibiotic therapy and non-surgical removal of the entire infected device, thus allowing a successful reimplantation. This procedure prevents recurrent infections and operative mortality.
Assuntos
Antibacterianos/uso terapêutico , Infecções Bacterianas/terapia , Desfibriladores Implantáveis/efeitos adversos , Remoção de Dispositivo , Endocardite Bacteriana/terapia , Marca-Passo Artificial/efeitos adversos , Infecções Relacionadas à Prótese/terapia , Infecções Bacterianas/etiologia , Terapia Combinada , Endocardite Bacteriana/etiologia , Humanos , Testes de Sensibilidade Microbiana , Infecções Relacionadas à Prótese/etiologia , Estudos Retrospectivos , Resultado do TratamentoAssuntos
Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Antifúngicos/uso terapêutico , Diabetes Mellitus Tipo 1/complicações , Fluconazol/uso terapêutico , Fusarium/isolamento & purificação , Micoses/microbiologia , Pneumonia/microbiologia , Infecções Oportunistas Relacionadas com a AIDS/microbiologia , Candidíase/tratamento farmacológico , Infecções por Citomegalovirus/complicações , Evolução Fatal , Fungemia/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia por Pneumocystis/tratamento farmacológicoRESUMO
We retrospectively evaluated the safety and effectiveness of colistin alone or in combination with other antimicrobials in eight diabetic patients with severe diabetic foot infections due to multidrug resistant (MDR) Pseudomonas aeruginosa, complicated in 4 cases by osteomyelitis. All patients received colistin after other ineffective antimicrobial treatment, when MDR P. aeruginosa strains were isolated by cultural examination and together with a multidisciplinary care approach including revascularization, surgical debridement and adequate offloading. The mean duration of therapy was 72 +/- 52.9 days. Six out of 8 patients (75%) successfully benefited from colistin therapy, while 2 patients failed and/or experienced side effects that led to discontinuation of therapy. Serious adverse events (i.e. acute renal failure and pulmonary edema) were observed in 1 patient. Our data allow us to conclude that colistin, alone or in combination with other antimicrobials, is safe and effective when administered as part of a multidisciplinary approach, to promote healing of diabetic foot infection due to MDR P. aeruginosa.
Assuntos
Colistina/uso terapêutico , Pé Diabético/terapia , Farmacorresistência Bacteriana Múltipla , Osteomielite/terapia , Infecções por Pseudomonas/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Colistina/administração & dosagem , Terapia Combinada , Desbridamento/métodos , Pé Diabético/complicações , Pé Diabético/microbiologia , Sinergismo Farmacológico , Quimioterapia Combinada , Feminino , Humanos , Imipenem/uso terapêutico , Masculino , Pessoa de Meia-Idade , Osteomielite/complicações , Osteomielite/microbiologia , Infecções por Pseudomonas/complicações , Infecções por Pseudomonas/microbiologia , Estudos Retrospectivos , Rifampina/uso terapêutico , Resultado do TratamentoAssuntos
Endocardite/etiologia , Pulmão/microbiologia , Micetoma/complicações , Marca-Passo Artificial/microbiologia , Scedosporium/isolamento & purificação , Idoso , Antifúngicos/farmacologia , Antifúngicos/uso terapêutico , Remoção de Dispositivo , Endocardite/tratamento farmacológico , Humanos , Pulmão/efeitos dos fármacos , Pulmão/patologia , Masculino , Micetoma/tratamento farmacológico , Micetoma/microbiologia , Complicações Pós-Operatórias/tratamento farmacológico , Complicações Pós-Operatórias/etiologia , Pirimidinas/farmacologia , Pirimidinas/uso terapêutico , Scedosporium/efeitos dos fármacos , Resultado do Tratamento , Triazóis/farmacologia , Triazóis/uso terapêutico , VoriconazolRESUMO
The aim of the study was to assess the microbiological activity and clinical efficacy of colistin and rifampin combination against multidrug-resistant (MDR) Pseudomonas aeruginosa infections. The antimicrobial activity of the colistin/rifampin combination was evaluated using the checkerboard and time-kill curve methods against different MDR P. aeruginosa strains. The combination of rifampin and colistin resulted fully (1 strain) or partially (5 strains) synergistic for 6/7 strains and minimum inhibitory concentrations (MICs) in combination were reduced to easily obtainable therapeutic levels. The time-kill curves showed that the combination was bactericidal against the strains tested. The clinical efficacy of the combination was tested in four patients with difficult-to treat infections (sepsis or pneumonia) caused by MDR P. aeruginosa. All infections were successfully treated. Our microbiological and clinical observations suggest that the addition of rifampin to colistin may result in a synergistic bactericidal combination that may be useful in patients with infections caused by MDR P. aeruginosa which are difficult to cure.
Assuntos
Colistina/administração & dosagem , Farmacorresistência Bacteriana Múltipla , Infecções por Pseudomonas/tratamento farmacológico , Pseudomonas aeruginosa/efeitos dos fármacos , Rifampina/administração & dosagem , Adulto , Sinergismo Farmacológico , Quimioterapia Combinada , Feminino , Humanos , Itália , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Infecções por Pseudomonas/diagnóstico , Pseudomonas aeruginosa/isolamento & purificação , Estudos de Amostragem , Sensibilidade e Especificidade , Resultado do TratamentoRESUMO
The case of a patient with highly gentamicin-resistant Enterococcus faecalis endocarditis treated with an ampicillin + ceftriaxone combination is described. We have designed a method to evaluate synergism between the antibacterial activity of patient's serum taken during a given antibiotic regimen (ampicillin) to which another antibiotic (ceftriaxone) is added in vitro. In this patient the two-drug combination was able to stop the bacteremia and prevent the infection of the prosthetic valve.
Assuntos
Ampicilina/administração & dosagem , Ceftriaxona/administração & dosagem , Quimioterapia Combinada/administração & dosagem , Endocardite Bacteriana/tratamento farmacológico , Enterococcus faecalis/efeitos dos fármacos , Gentamicinas/farmacologia , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Idoso , Farmacorresistência Bacteriana , Endocardite Bacteriana/microbiologia , Enterococcus faecalis/isolamento & purificação , Seguimentos , Infecções por Bactérias Gram-Positivas/diagnóstico , Humanos , Masculino , Testes de Sensibilidade Microbiana , Medição de Risco , Resultado do TratamentoAssuntos
Anfotericina B/administração & dosagem , Aspergilose/tratamento farmacológico , Itraconazol/administração & dosagem , Peptídeos Cíclicos , Peptídeos/administração & dosagem , Adulto , Caspofungina , Sinergismo Farmacológico , Quimioterapia Combinada , Equinocandinas , Humanos , Lipopeptídeos , MasculinoAssuntos
Antibacterianos/farmacologia , Farmacorresistência Bacteriana Múltipla , Endocardite Bacteriana/tratamento farmacológico , Endocardite Bacteriana/microbiologia , Enterococcus faecalis/isolamento & purificação , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Sinergismo Farmacológico , Quimioterapia Combinada/administração & dosagem , Enterococcus faecalis/efeitos dos fármacos , Seguimentos , Infecções por Bactérias Gram-Positivas/diagnóstico , Humanos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Valva Mitral , Medição de Risco , Resultado do TratamentoRESUMO
The broad resistance to antibody-mediated neutralization of lentiviruses recently isolated from infected hosts is a poorly understood feature which might contribute to the ability of these viruses to persist and to the failure of experimental vaccines to protect against virulent viruses. We studied the underlying molecular mechanisms by examining the evolution of a neutralization-sensitive, tissue culture-adapted strain of feline immunodeficiency virus upon reinoculation into specific-pathogen-free cats. Reversion to broad neutralization resistance was observed in seven of seven inoculated animals and, in individual hosts, started to develop between less than 4 and more than 15 months from infection. After comparison of the envelope sequences of the inoculum virus, of an additional 4 neutralization-sensitive in vitro variants, and of 14 ex vivo-derived variants (6 neutralization sensitive, 5 resistant, and 3 with intermediate phenotype), a Lys-->Asn or -->Glu change at position 481 in the V4 region of the surface glycoprotein appeared as a key player in the reversion. This conclusion was confirmed by mutagenesis of molecularly cloned virus. Analysis of viral quasispecies and biological clones showed that the intermediate phenotype was due to transient coexistence of neutralization-sensitive and -resistant variants. Since the amino acid position involved was the same in four of four recent revertants, it is suggested that the number of residues that control reversion to broad neutralization resistance in FIV might be very limited. Amino acid 481 was found to be changed only in one of three putative long-term revertants. These variants shared a Ser-->Asn change at position 557 in region V5, which probably collaborated with other mutations in long-term maintenance of neutralization resistance, as suggested by the study of mutagenized virus.