RESUMEN
This study investigates the pathophysiology of mucormycosis caused by Rhizopus, which has been reported in 46 dialysis patients, while treated with deferoxamine (DFO). This drug aggravates mucormycosis, which we experimentally induced in guinea pigs and which lead to a shortened animal survival (P < or = 0.01). The drug's effect on Rhizopus is not mediated through the polymorphonuclear cells. Fe.DFO, the iron chelate of DFO, abolishes the fungistatic effect of serum on Rhizopus and increases the in vitro growth of the fungus (P < or = 0.0001). This effect is present at Fe.DFO concentrations > or = 0.01 microM, at which fungal uptake of radioiron from 55Fe.DFO is observed. A 1,000-fold higher concentration of iron citrate is required to achieve a similar rate of radioiron uptake and of in vitro growth stimulation as observed with Fe.DFO. These in vitro effects of Fe.DFO (1 microM) in serum on radioiron uptake and on growth stimulation are more striking for Rhizopus than for Aspergillus fumigatus and are practically absent for Candida albicans. For these three fungal species, the rates of radioiron uptake from 55Fe.DFO and of growth stimulation in the presence of Fe.DFO in serum are directly related (r = 0.886). These results underscore the major role of Fe.DFO in the pathogenesis of DFO-related mucormycosis. Pharmacokinetic changes in uremia lead to a prolonged accumulation of Fe.DFO after DFO administration, which helps explain the increased sensitivity of dialysis patients to DFO-related mucormycosis.
Asunto(s)
Deferoxamina/efectos adversos , Deferoxamina/farmacología , Mucormicosis/etiología , Neutrófilos/fisiología , Diálisis Renal , Rhizopus/crecimiento & desarrollo , Animales , Fenómenos Fisiológicos Sanguíneos , Candida albicans/efectos de los fármacos , Candida albicans/crecimiento & desarrollo , Candidiasis/fisiopatología , Cobayas , Humanos , Técnicas In Vitro , Mucormicosis/fisiopatología , Neutrófilos/microbiología , Rhizopus/citología , Rhizopus/efectos de los fármacos , Esporas Fúngicas/fisiologíaRESUMEN
The susceptibility patterns of gram-negative aerobic organisms to aminoglycosides differ widely from one European health care center to another and depend upon local antibiotic prescribing policies. Reports of the susceptibility of Pseudomonas aeruginosa to gentamicin and tobramycin have ranged from as low as 49.8 percent and 77.7 percent, respectively, in Greece, to as high as 96.6 percent and 99.2 percent, respectively, in the United Kingdom. The susceptibility of P. aeruginosa to gentamicin, tobramycin, and amikacin decreased in our hospital from 73.1 percent, 94.8 percent, and 95.6 percent, respectively, in 1982, to 43.1 percent, 70.6 percent, and 74.3 percent, respectively, in 1984. A prospective surveillance study of the susceptibility of gram-negative aerobic bacilli to four aminoglycosides (gentamicin, tobramycin, amikacin, and netilmicin) was performed over a period of 17 months. Gentamicin and tobramycin were freely used, while the use of amikacin was restricted throughout the hospital during a four-month baseline period (May through August 1984). Gentamicin and tobramycin accounted for 94 percent of the aminoglycoside use. During the following 13 months (September 1984 through September 1985), amikacin was used as the first-line aminoglycoside and accounted for more than 97 percent of the aminoglycoside usage. A total of 1,866 organisms were analyzed during the baseline period; 5,429 were analyzed during the amikacin-usage period. The overall susceptibility to gentamicin, tobramycin, amikacin, and netilmicin increased from 86.9 percent, 90.4 percent, 94.2 percent, and 88.3 percent, respectively, to 92.3 percent, 94.0 percent, 97.3 percent, and 92.3 percent, respectively. P. aeruginosa isolates had the most striking changes, with the susceptibility to gentamicin, tobramycin, amikacin, and netilmicin increasing from 43.1 percent, 70.6 percent, 74.3 percent, and 50.6 percent, respectively, during the baseline period, to 64.5 percent, 81.6 percent, 90.8 percent, and 65.1 percent, respectively, during the amikacin-usage period. The use of amikacin as a first-line aminoglycoside, while use of the other aminoglycosides was restricted, seemed to have a favorable influence on the susceptibility pattern of gram-negative aerobic isolates in our hospital.
Asunto(s)
Antibacterianos/farmacología , Bacterias Gramnegativas/efectos de los fármacos , Amicacina/farmacología , Aminoglicósidos/farmacología , Aminoglicósidos/uso terapéutico , Antibacterianos/uso terapéutico , Infecciones Bacterianas/tratamiento farmacológico , Bélgica , Farmacorresistencia Microbiana , Europa (Continente) , Gentamicinas/farmacología , Humanos , Pruebas de Sensibilidad Microbiana , Netilmicina/farmacología , Estudios Prospectivos , Pseudomonas aeruginosa/efectos de los fármacos , Tobramicina/farmacologíaRESUMEN
The minimum inhibitory concentrations of temocillin against more than 1000 clinical isolates were determined by an agar dilution method. Temocillin showed excellent activity against Haemophilus influenzae, pathogenic Neisseria species and Branhamella catarrhalis, including beta-lactamase producing strains, but showed very low activity or was inactive against Gram-positive cocci and Campylobacter, Bacteroides, Acinetobacter and Pseudomonas species. Good activity was obtained against 702 Enterobacteriaceae, including isolates resistant to the other penicillins and first- and second-generation cephalosporins, with 92% of all the strains inhibited at a concentration of 8 mg/L. However, the most striking property of temocillin was its high beta-lactamase stability which resulted in both a very narrow range of MICs within which all the isolates were inhibited, and a small influence of inoculum size on the MICs.
Asunto(s)
Bacterias/efectos de los fármacos , Penicilinas/farmacología , Cefotaxima/farmacología , Cefuroxima/farmacología , Cefalotina/farmacología , Bacterias Grampositivas/efectos de los fármacos , Técnicas In Vitro , Pruebas de Sensibilidad Microbiana , Moxalactam/farmacologíaRESUMEN
The effectiveness of temocillin in the treatment of culture-proven Gram-negative septicaemia was investigated in 22 adult patients, most of whom were elderly with serious underlying diseases. Administration of temocillin 2g twice daily to 15 patients or 1g twice daily to 7 patients resulted in clinical cure in 15 patients (68%), while 4 responded partially (18%) and 3 were considered failures (14%). The original pathogen was eradicated from 20 of 21 assessable patients (95%), 1 patient was unassessable and 1 was considered a failure. Superinfection was documented in 4 patients, originating twice in a central venous catheter, once in the urinary tract and once in an unidentified source. No clinical nor biological side effects were observed except for pain at the injection site in 1 patient who received the drug intramuscularly. We conclude that temocillin in monotherapy can be used effectively for proven Gram-negative septicaemia, and that the safety of the drug makes it particularly valuable in the elderly.
Asunto(s)
Penicilinas/uso terapéutico , Sepsis/tratamiento farmacológico , Anciano , Infecciones por Escherichia coli/tratamiento farmacológico , Bacterias Gramnegativas , Humanos , Infecciones por Klebsiella/tratamiento farmacológico , Klebsiella pneumoniaeRESUMEN
Temocillin pharmacokinetics in renal impairment were investigated following an intravenous bolus injection of 15 mg/kg. The 28 patients were divided into 5 groups of varying renal function, from normal to uraemic [including a group being treated with haemodialysis and a group on continuous ambulatory peritoneal dialysis (CAPD)]. The distribution of temocillin into the tissues was not affected by renal dysfunction. Uraemia as compared to normal renal function resulted in a 4.3-fold decrease in temocillin clearance and a 3.1-fold decrease in urinary recovery over 24 hours, as well as a 5- and 3.7-fold increase in the beta half-life and the area under the curve (AUC), respectively. Haemodialysis doubled the serum clearance and halved the beta half-life of temocillin in the uraemic subject, but CAPD over 24 hours eliminated only 8% of the temocillin dose, resulting in a minimal change in pharmacokinetics. Temocillin dosage adjustments in renal failure are proposed.
Asunto(s)
Fallo Renal Crónico/metabolismo , Riñón/metabolismo , Penicilinas/metabolismo , Humanos , Enfermedades Renales/metabolismo , Cinética , Diálisis Peritoneal Ambulatoria Continua , Diálisis RenalRESUMEN
Fifteen of 20 hemodialysis patients who carried Staphylococcus aureus in their nares also carried the organism on their hands; 2 of 20 patients who did not carry S aureus in their nares carried S aureus on their hands (P < .001). Eighty-seven percent of patients who carried S aureus in their nares and on their hands carried the same strain at both sites. Intranasal mupirocin eliminated S aureus from both sites.
Asunto(s)
Antibacterianos/uso terapéutico , Portador Sano/tratamiento farmacológico , Mupirocina/uso terapéutico , Mucosa Nasal/microbiología , Piel/microbiología , Infecciones Estafilocócicas/tratamiento farmacológico , Staphylococcus aureus , Administración Intranasal , Estudios de Seguimiento , Humanos , Control de Infecciones , Diálisis RenalRESUMEN
OBJECTIVE: To determine the epidemiology of Staphylococcus aureus infections in hemodialysis patients. METHOD: S aureus isolates from surveillance cultures and from sites of infection were evaluated by both bacteriophage typing and restriction endonuclease digestion of plasmid DNA. SETTING: A hemodialysis unit in Brugge, Belgium. ORGANISMS: S aureus isolates from 11 chronic hemodialysis patients who had participated in the placebo arm of a previously reported placebo-mupirocin comparative study. RESULTS: Of 75 S aureus isolates evaluated, 63 were from cultures of nares and 12 from infections (three arteriovenous fistula infections, four wound infections, and five bacteremias). All isolates were typed by bacteriophages and 56 (75%) had plasmids. Three patients developed 12 infections. Eleven infections were caused by isolates previously identified in surveillance cultures. Only one infection was caused by a strain not identified previously in surveillance cultures. CONCLUSION: These results support the hypothesis that S aureus isolates causing infections in hemodialysis patients are of endogenous origin.
Asunto(s)
Fístula Arteriovenosa , Bacteriemia/epidemiología , Bacteriemia/etiología , Portador Sano/epidemiología , Infección Hospitalaria/epidemiología , Infección Hospitalaria/etiología , Control de Infecciones , Diálisis Renal/efectos adversos , Infecciones Estafilocócicas/epidemiología , Infecciones Estafilocócicas/etiología , Staphylococcus aureus , Infección de Heridas/epidemiología , Infección de Heridas/etiología , Anciano , Anciano de 80 o más Años , Tipificación de Bacteriófagos , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Mucosa Nasal/microbiología , Mapeo Restrictivo , Staphylococcus aureus/clasificaciónRESUMEN
Chryseobacterium indologenes was isolated from the blood cultures of an oncological patient with a totally implantable device. Because a catheter-related infection was suspected, the Port-A-Cath was removed after a 10-day course of piperacillin-tazobactam. Differences in susceptibility may exist if either the criteria for either Pseudomonas or Enterobacteriaceae are used.
Asunto(s)
Bacteriemia/etiología , Catéteres de Permanencia/efectos adversos , Flavobacterium/crecimiento & desarrollo , Infecciones por Bacterias Gramnegativas/etiología , Neoplasias/complicaciones , Adulto , Bacteriemia/tratamiento farmacológico , Farmacorresistencia Microbiana , Femenino , Flavobacterium/efectos de los fármacos , Infecciones por Bacterias Gramnegativas/tratamiento farmacológico , Humanos , Pruebas de Sensibilidad Microbiana , Neoplasias/tratamiento farmacológico , Recurrencia , Resultado del TratamientoRESUMEN
Nasal carriage of Staphylococcus aureus is a risk factor for the development of infections caused by S. aureus in haemodialysis patients. This study compared the incidence of bacteraemia caused by S. aureus during 6 months of use of nasal 2% calcium mupirocin ('Nasal Bactroban') 3-times a week for nasal carriers with the incidence observed previously in the same dialysis unit without the use of mupirocin. Nasal mupirocin led to the total eradication of nasal carriage of S. aureus, a 4.26-fold reduction in the incidence of S. aureus bacteraemia, and a substantial cost saving. After a cumulative experience of nasal mupirocin in haemodialysis patients of more than 43 patient-years, the development of mupirocin resistance was not observed.
Asunto(s)
Bacteriemia/prevención & control , Mupirocina/uso terapéutico , Diálisis Renal , Infecciones Estafilocócicas/prevención & control , Administración Intranasal , Adulto , Anciano , Bacteriemia/economía , Análisis Costo-Beneficio , Infección Hospitalaria/prevención & control , Humanos , Persona de Mediana Edad , Mupirocina/administración & dosificación , Estudios Prospectivos , Infecciones Estafilocócicas/economíaRESUMEN
Staphylococcus aureus is the most frequently (42%) isolated micro-organism during bacteraemic episodes in haemodialysis patients. Nasal carriage of S. aureus is of major importance in determining the risk of subsequent infections. Indeed, nasal carriage of S. aureus is highly prevalent in uraemic patients from the onset of maintenance dialysis therapy. The strains isolated simultaneously from the nares and the hands are usually the same. Likewise, infecting S. aureus strains and those isolated from nasal surveillance cultures obtained in the same patient are usually similar. S. aureus infections in haemodialysis patients are thus mostly to be considered as auto-infections. The nares are therefore an elective site for the prevention of S. aureus infections in haemodialysis patients. This has been demonstrated with oral rifampin, and more recently with nasal mupirocin, which is highly effective. Long-term application of nasal mupirocin (e.g. once per week) is cost-effective and is only rarely associated with the emergence of mupirocin-resistance in S. aureus.
Asunto(s)
Antibacterianos/uso terapéutico , Mupirocina/uso terapéutico , Nariz/microbiología , Diálisis Renal/efectos adversos , Infecciones Estafilocócicas/etiología , Staphylococcus aureus/efectos de los fármacos , Humanos , Infecciones Estafilocócicas/prevención & controlAsunto(s)
Complemento C5/deficiencia , Meningitis Meningocócica/genética , Adulto , Femenino , Humanos , Masculino , LinajeRESUMEN
Cefotaxime is more active than six other cephalosporins against 150 cephalothin-resistant Enterobacteriaceae strains and is the only drug which is more active than ampicillin against Haemophilus. It shows a potentially useful activity against Pseudomonas.
Asunto(s)
Bacterias/efectos de los fármacos , Cefalosporinas/farmacología , Cefalotina/farmacología , Enterobacteriaceae/efectos de los fármacos , Farmacorresistencia Microbiana , Haemophilus/efectos de los fármacos , Pseudomonas/efectos de los fármacosRESUMEN
The bioavailability of ofloxacin in tonsil tissue, after a single oral dose of 200 mg 2 h before surgery, was evaluated in 14 patients undergoing tonsillectomy for recurrent or chronic infection. A blood specimen was obtained just before drug administration and at the time of tonsillectomy, together with a specimen of tonsil tissue. The mean values of the serum and tonsil concentrations 2 h after a single dose of 200 mg were 1.17 mg/l +/- 0.47 and 1.61 mg/l +/- 0.62 respectively with a mean tonsil/serum ratio of 1.40 +/- 0.19. These values indicate good penetration of ofloxacin into tonsil tissue. No clinical or biological side-effects were observed.
Asunto(s)
Ofloxacino/farmacocinética , Tonsila Palatina/metabolismo , Administración Oral , Adulto , Disponibilidad Biológica , Humanos , Ofloxacino/administración & dosificación , Ofloxacino/sangre , Premedicación , TonsilectomíaRESUMEN
New quinolones have obtained a definite position in the treatment of certain sexually transmitted diseases, urinary tract infections, prostatitis, gastrointestinal infections, nosocomially acquired pulmonary infections with resistant organisms, pseudomonas infections in cystic fibrosis, and osteomyelitis. The role of the new quinolones in upper respiratory tract infections, acute or chronic bronchitis and community acquired pneumonia is far less established. Their role in selective decontamination of the gastrointestinal tract in neutropenic patients is under investigation. Future modifications may increase their usefulness for treatment of mycobacterial infections, chlamydial infections, and mycoplasma and ureaplasma infections. The structural relationship of the new quinolones with antimalarial drugs may open new perspectives for the treatment of falciparum malaria.
Asunto(s)
Antiinfecciosos/uso terapéutico , 4-Quinolonas , Humanos , Enfermedades Intestinales/tratamiento farmacológico , Neutropenia/prevención & control , Infecciones del Sistema Respiratorio/tratamiento farmacológico , Enfermedades de Transmisión Sexual/tratamiento farmacológico , Infecciones Urinarias/tratamiento farmacológicoRESUMEN
A blood-free medium for the recovery of thermophilic Campylobacter was compared with Butzler Medium Virion during a one-year study using 2,893 human feces samples. Ninety Campylobacter strains (3.1%) were isolated after incubation for 48 h at 42 degrees C in a candle jar atmosphere. Three strains of Campylobacter jejuni were isolated on the blood-free medium only and one on Butzler Medium Virion only. Fecal flora was equally well inhibited on both media except for gram-positive organisms, which were completely inhibited only on the blood-free medium.
Asunto(s)
Campylobacter/aislamiento & purificación , Medios de Cultivo , Sangre , Campylobacter fetus/aislamiento & purificación , Heces/microbiología , Calor , HumanosRESUMEN
A hemoglobin-supplemented medium composed of Columbia agar base supplemented with 1% hemoglobin and 1% Polyvitex was used to investigate the in vitro activity of 29 antimicrobial agents against Capnocytophaga species. Clindamycin was the most active agent, with all strains being inhibited by 0.06 microgram/ml or less. Amoxicillin-clavulanic acid and imipenem were the most active among the beta-lactam antibiotics (MIC for 90% of strains tested [MIC90], 0.50 microgram/ml); other very active drugs were BMY 28142, cefpirome, cefotaxime, ceftazidime, and ceftriaxone (MIC90, 0.06 to 0.50 micrograms/ml), although at least one strain showed resistance to each of these antibiotics (MIC, greater than or equal to 16 micrograms/ml). Ciprofloxacin was the most active among the quinolones, with all strains being inhibited by 0.50 microgram/ml. The MICs of the other four drugs ranged from 0.12 to 4 micrograms/ml. Ampicillin, penicillin G, ticarcillin, aztreonam, and temocillin were moderately active (MIC90, 1 to 8 micrograms/ml; MIC range, less than or equal to 0.03 to greater than 128 micrograms/ml). All strains were uniformly resistant to the aminoglycosides, polymyxin B, vancomycin, trimethoprim, and amphotericin B. Three strains produced beta-lactamase. No significant difference was found between the susceptibility of strains isolated from various sources or patients.
Asunto(s)
Antibacterianos/farmacología , Capnocytophaga/efectos de los fármacos , Cytophagaceae/efectos de los fármacos , Pruebas de Sensibilidad MicrobianaRESUMEN
Capnocytophaga canimorsus (DF-2) is a newly described gram-negative bacterium that can produce serious infections following dog bites in the immunocompromised host. We are reporting a case of C. canimorsus infection in an elderly patient with a history of chronic respiratory disease and alcohol abuse. We also give a review of the clinical spectrum of the infection, discuss the difficulty in establishing the diagnosis and the preferential treatment.
Asunto(s)
Capnocytophaga/aislamiento & purificación , Infecciones por Bacterias Gramnegativas/microbiología , Sepsis/microbiología , Lesión Renal Aguda/etiología , Anciano , Alcoholismo/complicaciones , Coagulación Intravascular Diseminada/etiología , Humanos , Enfermedades Pulmonares Obstructivas/complicaciones , Masculino , Sepsis/complicacionesRESUMEN
Prototheca zopfii, an alga-like organism, was isolated from subungual material in a patient with onycholysis. This organism seldom causes human infections. Clinical and laboratory aspects are described. The literature is reviewed.