Community-acquired pneumonia caused by methicillin-resistant Staphylococcus aureus in a Chinese adult: A case report.

RATIONALE: Methicillin-resistant Staphylococcus aureus (MRSA) has been established as an important cause of severe community-acquired pneumonia (CAP) with very high mortality. Panton-Valentine leukocidin (PVL) producing MRSA has been reported to be associated with necrotizing pneumonia and worse outcome. The incidence of community-acquired MRSA (CA-MRSA) pneumonia is very low, as only a few CA-MRSA pneumonia cases were reported in the last few years. We present a case of severe CAP caused by PVL-positive MRSA with ensuing septic shock. PATIENT CONCERNS: A 68-year-old male with no concerning medical history had developed a fever that reached 39.0°C, a productive cough that was sustained for 5 days, and hypodynamia. He was treated with azithromycin and alexipyretic in a nearby clinic for 2 days in which the symptoms were alleviated. However, 1 day later, the symptoms worsened, and he was taken to a local Chinese medicine hospital for traditional medicine treatment. However, his clinical condition deteriorated rapidly, and he then developed dyspnea and hemoptysis. DIAGNOSIS: CA-MRSA pneumonia and septic shock. The sputum culture showed MRSA. Polymerase chain reaction of MRSA isolates was positive for PVL genes. INTERVENTIONS: Mechanical ventilation, fluid resuscitation, and antibiotic therapy were performed. Antibiotic therapy included mezlocillin sodium/sulbactam sodium, linezolid, and oseltamivir. OUTCOMES: He died after 12 hours of treatment. LESSONS: This is a report of severe pneumonia due to PVL-positive CA-MRSA in a healthy adult. CA-MRSA should be considered a pathogen of severe CAP, especially when combined with septic shock in previously healthy individuals.

Pyoderma gangrenosum around an ileostoma: A case report.

RATIONALE: Pyoderma gangrenosum (PG) is a rare postoperative complication of enterostomy, mostly developing from dermatitis, which may have serious consequence. PATIENT CONCERNS: A patient with lower rectal cancer receiving low anterior resection (LAR) and protective ileostomy was initially diagnosed with dermatitis, which very quickly developed to PG, though no medical or familial history was found. DIAGNOSIS: We diagnosed the patient with peristoaml dermatitis starting from a tiny skin ulceration, but corrected the diagnosis to PG because of the rapid development and severe consequences. INTERVENTIONS: Routine stoma care did not improve the condition, so we performed 2 terms of debridement, the closure of the stoma and autologous skin transplantation before finally solving the problem. OUTCOMES: The patient was discharged 60 days after the first surgery and 5 days after the last one. After 18 months of follow-up, the patient kept in a stable condition. LESSONS: Medical staff should not neglect peristoaml dermatitis because of its common occurrence. Once the situation develops beyond the doctors' expectation, more efforts should be made to treat it, even expand debridement if possible.

Antibiotic therapy for preterm premature rupture of membranes - results of a multicenter study.

AIMS: To evaluate whether primary application of mezlozillin in preterm premature rupture of membranes (pPROM) prolongs pregnancy and lowers neonatal morbidity. METHODS: In this prospective, randomized, double blind, placebo-controlled multicenter study a total of 105 pregnant women with pPROM between 24 + 0 and 32 + 6 weeks of gestation were examined receiving i.v. injections of corticoids and tocolytics as well as mezlocillin (3 x 2 g/d) or placebo. Assessed factors were prolongation of pregnancy and neonatal morbidity such as neonatal infection, respiratory distress syndrome (RDS), intraventricular hemorrhage (IVH) and necrotizing enterocolitis (NEC). RESULTS: Prolongation of pregnancy by more than 7 days was achieved in 63.8% of the mezlocillin group versus 44.8% of the placebo group (P < 0.05). The babies of mothers treated with anibiotics had fewer neonatal infections, RDS, IVH and NEC. Total morbidity was significantly lowered in the verum group (P = 0.02). CONCLUSIONS: Antibiotic administration following preterm premature rupture of membranes is associated with a prolongation of pregnancy and a reduction of neonatal infectious morbidity.

[Analysis of prophylactic antibiotics for cesarean section].

OBJECTIVE: To study the appropriate antibiotic for prophylactic use in cesarean section. METHODS: The effects and side effects of prophylatic antibiotics in 1 266 cesarean section were studied retrospectively. Six regiems were engaged: (1) Penicillin and Ampicillin; (2) Mezlocillin sodium; (3) Sulbactam and Ampicillin; (4) Ciprofloxacin; (5) Clindamycin; (6) Cefacidal. RESULTS: The duration of postoperative body temperature return to normal of 1 - 6 group is (54.0 +/- 28.4) hours, (48.9 +/- 27.8) hours, (49.9 +/- 23.9) hours, (58.6 +/- 33.7) hours, (52.5 +/- 25.2) hours, (63.1 +/- 51.1) hours respectively. It was longer in cefazolin group than the others. There were less puerperal morbidity and side effects of Mezlocillin. CONCLUSIONS: Penicillin and Ampicillin are still the most common choices as prophylatic antibiotic in cesarean section. Mezlocillin is appropriate as well.

Efficacy of oral ofloxacin for single-dose perioperative prophylaxis in general surgery--a controlled randomized clinical study.

BACKGROUND: Perioperative antibiotic prophylaxis surely reduces surgical infection rate. Pharmacokinetic data of oral ofloxacin in combination with its antibacterial spectrum suggest effective protection against perioperative infection. In addition, costs, adverse effects, and induction of microbial resistance are low. Therefore we performed a controlled randomized study comparing oral and intravenous single dose prophylaxis. METHODS: A total of 61 patients undergoing colonic or pancreatic resection randomly received either a single dose standard intravenous prophylaxis or ofloxacin 400 mg and metronidazole 500 mg orally 2 h before surgery. Postoperative infections were recorded for 3 weeks. RESULTS: Groups were very well comparable regarding age, overweight, concomitant disease, type and duration of surgery, blood loss, and volume support. Infectious complications occurred in 14.8% after parenteral and 3.3% after enteral antibiotic prophylaxis. There was no difference in post-operative hospital stay. CONCLUSION: The data demonstrate that single-dose oral ofloxacin is at least as effective as a standard intravenous prophylaxis in patients with colonic or pancreatic resection. It offers significant advantages regarding costs and ease of administration.

Pharmacokinetic basis for oral perioperative prophylaxis with ofloxacin in general surgery.

BACKGROUND: Perioperative prophylaxis is recommended to be administered intravenously which, compared to oral prophylaxis, is more expensive. However, pharmacokinetic data on oral perioperative prophylaxis in patients with preoperative surgical and anesthesiological preparation are not available. PATIENTS AND METHODS: 40 patients with open hernial repair or cholecystectomy (low-risk group), colonic or pancreatic resection (high-risk group) received a standard single-dose perioperative prophylaxis with 4.5 g mezlocillin and 0.5 g metronidazole intravenously in addition to 400 mg ofloxacin orally 2 h prior to surgery. Antibiotic concentrations were measured perioperatively and pharmacokinetic data calculated. RESULTS: Serum and tissue concentrations of ofloxacin were above the MIC90 of the potential bacterial spectrum for surgical infection throughout the entire operation. Pharmacokinetic data were not influenced by preoperative surgical or anesthesiological preparation. CONCLUSION: Tissue and serum concentrations and the antibacterial spectrum of orally administered ofloxacin suggest effective protection against perioperative infection. Pharmacokinetic data confirm that oral ofloxacin may be used effectively as single-dose perioperative antibiotic prophylaxis. Since there are no clinical data comparing oral and intravenous singLe-dose prophylaxis, a prospective randomized clinical trial should be performed.

Ultrasound-guided fine needle aspiration of ovarian cysts during pregnancy.

OBJECTIVE: To evaluate the safety and efficacy of ultrasound-guided fine needle aspiration in the treatment of ovarian cysts during pregnancy. STUDY DESIGN: Nine out of twenty-nine patients between the 6th and the 16th week of gestation with unilateral ovarian cysts ranging between 65 and 540 cm3 in volume were selected for sonographically-guided fine needle aspiration. RESULTS: No complications were observed at either short or long-term follow-up; all patients delivered healthy infants at term. Clinical and sonographic post-partum follow-up was uneventful in all cases. In three cases it was necessary to repeat the procedure once and in one case twice during pregnancy. In one case a recurrent serous cyst was excised at operative laparoscopy performed 3 months after delivery. CONCLUSIONS: Ultrasound-guided fine needle aspiration was safely performed in nine patients as an alternative treatment to surgery when persistent monolateral and unilocular ovarian cysts with regular borders and completely anechoic structure are detected during pregnancy.

[Antibiotic prophylaxis with mezlocillin in elective biliary surgery]. / Profilassi antibiotica con mezlocillina in chirurgia biliare elettiva.

The authors report their experience of antibiotic prophylaxis in elective biliary surgery pertinent to 246 operated patients treated with short-term prophylaxis with mezlocillin. This method has turned out to be efficacious in reducing postoperative infections incidence, particularly in simple cholecystectomy. Therefore the authors advise using such a procedure in this frequent operation too.

[Validation trial of a neonatal prophylactic antibiotic protocol in the delivery room]. / Essai de validation d'un protocole d'antibioprophylaxie néonatale en salle de travail.

Maternofetal infection occurs in 1 to 10 of every 1,000 newborns. Prognosis is poor and an extremely rapid the clinical course is sometimes observed. The situation suggests that widespread use of antibiotics and more than 90% of the newborns receiving antibiotics are not infected. A prospective study based on simple, recognized criteria predictive of maternal-fetal infection was conducted in 3,392 deliveries to evaluate the effect of an antibiotic prophylaxy protocol. Specificity, sensitivity, positive and negative predictive value were evaluated for each of the eleven criteria retained with the goal of increasing sensitivity and decrease the use of unnecessary antibiotics. Among the 3,392 infants delivered from January 1989 to December 1990, 286 (8.4%) newborns entered the study and were given mezlocillin (150 mg/kg/12 h). This treatment was stopped at 48 hours of life if the infant was not infected. RESULTS. Infection was confirmed in 48 of 3,392 infants (1.4%). All were in the risk group: 48/286 (16.7%). The germs the most often found were group B Streptococcus (n = 16), Escherichia coli (n = 8) and Listeria monocytogenes (n = 3). Nine criteria were well correlated with maternal-fetal infection. The two most important criteria were maternal pyrexia above 39 degrees C and Apgar score below 7 to 5 min (poor neonatal adaptation), with a 99% and 90% and a positive predictive value of 80% and 37% respectively. Inversely, Two criteria were poorly correlated with maternal-fetal infection: labour duration above 12 hours and instrumental extraction (positive predictive value from 10% to 17%).(ABSTRACT TRUNCATED AT 250 WORDS)

Single-dose antibiotic prophylaxis in maxillofacial surgery.

The clinical efficacy of short-term antimicrobial prophylaxis with either one shot of ceftriaxone (1 g) or a course of 3 injections of a fixed combination of mezlocillin (2 g) and oxacillin (1 g) administered over 24 h was studied in a prospective randomized clinical study of 100 patients undergoing elective maxillofacial surgery. Tissue and plasma concentrations of the antibiotics were determined by high-pressure liquid chromatography in 6 tumor surgery patients from each treatment group. Statistical analysis showed the treatment group to be comparable both demographically and with respect to the types of surgery performed and the durations of the procedures. Only 1 patient in each group developed a postoperative wound infection. It is concluded that 1 g ceftriaxone given 30 min preoperatively meets the pharmacokinetic requirements for perioperative antimicrobial prophylaxis in maxillofacial surgery.

Infections following nail puncture wound of the foot: case reports and review of the literature.

Between July 1989 and August 1990, five children (four boys and one girl, age 10-14 years) were hospitalized due to foot infection following nail puncture wound. Symptoms and signs at presentation included cellulitis and deep tissue abscess in all five, fever in three, high erythrocyte sedimentation rate in four, and leukocytosis in two patients. Pseudomonas aeruginosa was grown in pus culture that was taken from all the children at presentation. In three children who were initially treated by local debridement and drainage followed by anti-pseudomonal agents, plantar Pseudomonas osteochondritis later developed. In two children extensive debridement of affected tissues and drainage of pus were performed followed by 2 weeks of parenteral anti-Pseudomonas antibiotics. No further complication occurred. The clinician should be aware that any complication of nail puncture wound of the foot may require surgery.

A randomized study of cefepime versus the combination of gentamicin and mezlocillin as an adjunct to surgical treatment in patients with acute cholecystitis.

In patients with acute cholecystitis, antibiotics are used as an adjunct to cholecystectomy to reduce the incidence of postoperative septic complications thought to be related to bactibilia. Combinations of penicillins, or cephalosporins or aminoglycosides, or both, are often used. Cefepime is a fourth-generation cephalosporin with excellent activity against gram-positive and gram-negative bacteria, including Pseudomonas species. It has a prolonged serum half-life, allowing twice-daily dosing, and is not nephrotoxic. This study was undertaken to determine whether or not cefepime was as effective as the combination of gentamicin and mezlocillin in patients with acute cholecystitis. One hundred and forty-nine patients were randomized, two to one, to receive cefepime or gentamicin and mezlocillin. Cefepime was given intravenously at 2 grams every 12 hours; gentamicin, 1.0 to 1.5 milligrams per kilograms every eight hours, and mezlocillin, 3 to 4 grams every four to six hours. All patients underwent cholecystectomy. Bile cultures were obtained, and concentrations of cefepime in blood, bile, peritoneal fluid and gallbladder were determined in a subset of patients. There were 56 evaluable cefepime-treated and 34 evaluable gentamicin and mezlocillin-treated patients. Bactibilia was present in 17 of 56 cefepime-treated patients (30.4 percent) and ten of 34 gentamicin and mezlocillin-treated patients (29.4 percent). Enterococci were recovered in six cefepime-treated patients. Clinical and bacteriologic responses were similar for the cefepime-treated and gentamicin and mezlocillin-treated groups, with one failure in each group, a wound infection in a patient receiving cefepime and a subhepatic abscess in a patients receiving gentamicin and mezlocillin. Other measures of outcome, such as the number of days of fever, days nothing by mouth, days of hospitalization and days of antibiotic therapy were similar in both groups. Cefepime, with every 12 hour dosing, achieved extremely high concentrations in all tissues assayed at the time of the operation, a mean of eight hours after administration. Adverse clinical events were similar in both treatment groups. Cefepime is as effective as gentamicin and mezlocillin in preventing septic complications after cholecystectomy for acute cholecystitis. Cefepime requires fewer doses, does not require drug monitoring, is not associated with nephrotoxicity and may therefore prove to be a cost-effective alternative to combination therapy that uses an aminoglycoside.

Cefepime for infections of the biliary tract.

Antibiotic treatment of biliary tract infections is widely accepted. An open, prospective, randomized, multicenter trial comparing cefepime (2 grams every 12 hours) with gentamicin (1.5 milligrams per kilograms every eight hours) plus mezlocillin (3 grams every four hours) for a minimum of five days was undertaken. Of the 149 patients enrolled, 120 were evaluable; 80 were randomized to receive cefepime and 40 were randomized to receive gentamicin plus mezlocillin (two to one randomization schedule). The diagnosis was acute cholecystitis in 101 patients and acute cholangitis in the remainder. There were no differences between the two treatment groups with regard to gender, age, disease, signs and symptoms, admitting temperature or laboratory values. All patients (100 percent) treated with gentamicin and mezlocillin were cured of the infection, as were 78 (97.5 percent) of the patients treated with cefepime (difference not significant). The incidence and spectrum of adverse events and complications were similar between the two groups (8.8 percent for cefepime versus 10 percent for gentamicin and mezlocillin). Our data show that the efficacy and safety of cefepime administered every 12 hours is equivalent to that of gentamicin and mezlocillin combination for treating patients with acute infections of the biliary tract. In addition, twice-daily administration of cefepime may be more cost-effective than the aminoglycoside-based combination.

Injury severity dictates individualized antibiotic therapy in penetrating abdominal trauma.

Antibiotics play a crucial role in reducing the risk of postoperative infection in patients suffering penetrating abdominal trauma. The infection rate for patients with these injuries ranges from 7% to 16%. Single agents with broad-spectrum activity have proven efficacy, but dosage and duration are still controversial. A prospective, double-blinded study was performed on 102 patients randomized to receive one of three antibiotics for a total of 12 hours: cefoxitin (3 doses, 31 patients); ceftizoxime (2 doses, 36 patients); or mezlocillin (3 doses, 35 patients). Two distinct groups at risk for postoperative infection were evident depending on the severity of injury: Group A were those with no colon injury or a colon injury that could be repaired, no evidence of shock, or fewer than 3 organs injured; Group B were those requiring a colostomy, evidence of shock on presentation, or three or more organs injured. All comparisons of the patient populations receiving the different antibiotics showed the two groups to be equivalent. The mean penetrating abdominal trauma index for Group A was 8.8 and 28.2 for Group B. The overall infection rate for Group A was 10.3% and 42.3% for Group B. There was a significant increase in infection rate for all antibiotics except ceftizoxime in Group B compared with group A. The penetrating abdominal trauma index was significantly higher in all patients who developed infection for all antibiotics. In addition, if the surgical wound was closed primarily, patients with colon injuries developed wound infections 71% of the time, and those with small-bowel injuries did so 30% of the time.(ABSTRACT TRUNCATED AT 250 WORDS)

Medical treatment of chronic suppurative otitis media without cholesteatoma in children--a two-year follow-up.

A prospective long-term study was carried out in 48 infants and children with chronic suppurative otitis media without cholesteatoma treated initially with wide spectrum intravenous antibiotics and suction and debridement. Patients were followed for a period of two years. All children were cured after completion of therapy. At 3 and 6 months follow-up 75% of the children were still free of discharge and at 12, 18 and 24 months the proportion of dry ears dropped to 71%, 66% and 52%, respectively. Eighty percent of all recurrences developed already during the first 6 months of follow-up. Pseudomonas aeruginosa was the most common pathogen isolated, both in the initial and recurrent bouts of the disease, and was commonly associated with other pathogens. Children with early reappearance of ear discharge were less likely to benefit from further antimicrobial or surgical treatment. The recurrence rate was not affected by the antibiotic regimen, age, duration of drainage before treatment or the presence of granulation tissue. No intracranial or intratemporal complications were observed during the follow-up period.

The efficacy of mezlocillin-amikacin combination in febrile neutropenic children with oncologic disease.

The efficacy of mexlocillin-amikacin combination as empirical therapy for febrile neutropenic patients was studied in 30 children (21 males, 9 females) with various oncologic diseases aged 1-15 years (mean age 7.3 +/- 4.4) in the Istanbul Medical School, Oncologic Disease Research and Treatment Center, and Department of Pediatric Hematology-Oncology between January 1 and May 31, 1988. The response rate was 76.6%. Profound persistent granulocytopenia (fewer than 100 ml) was present in 70% of the patients. In 63.3% of patients, the infections were microbiologically documented (60%) Gram(+) and 40% Gram(-). The combination was well tolerated with hepatic and/or renal disturbances in 8 cases (26.6%). We conclude that mezlocillin-amikacin is an effective empirical combination in the initial treatment of infections in febrile neutropenic children with various oncologic diseases.

[An open comparative study of sulbactam/ampicillin vs mezlocillin in adult and pediatric patients. Efficacy and tolerability]. / Studio aperto comparativo sulbactam/ampicillina vs mezlocillina in pazienti in età adulta e pediatrica. Efficacia e tollerabilità.

Sulbactam is a beta-lactamase inhibitor that, when combined with ampicillin, extends its antibacterial activity against beta-lactamases producing organisms. The clinical efficacy and safety of the sulbactam/ampicillin (S/A) combination versus mezlocillin (M), was assessed in a prospective comparative randomised study. Sixty-five patients (12 children), with lower respiratory tract infections (40), UTIs (20), and skin/soft tissue infections (5), were treated with S/A (32) or M (33 patients), given IV or IM. The two treatment groups did not significantly differ in types of infection, infecting organisms, and severity of underlying disease. Explicit criteria were used to define infections, clinical response, local and systemic tolerability, and adverse effects. A total of 33 organisms were isolated; 3/33 were resistant to S/A, 7/33 to M, and 15/33 to A alone. A successful clinical outcome (cure + improvement), was obtained in 29 out of 30 assessable patients in the S/A group, and in 30/31 in the M group. Both treatments resulted 100% effective in eradicating infecting pathogens: this confirms their high bactericidal activity, also against bacterial species showing remarkable antibiotic resistance patterns, and in variously immunocompromised hosts. Both S/A and M; therapeutic courses were well tolerated; only four out of the 61 assessable patients (2 in S/A, and 2 in M group), experimented mild, transient side-effects, that did not require modification of the treatment regimens. We conclude that both S/A and M appeared very safe and effective drugs; in regard to clinical and microbiological effectiveness and local and systemic tolerability, no statistically significant differences (p greater than 0.05) between the two groups were observed, in treating various bacterial infections, in both adult and paediatric age.

Adequate function of the immune system and physiological microflora are closely correlated.

It is already known that physiological microflora of the digestive system plays an important role in local immunity. Studies on immunomodulating activity of some autoantibodies have shown that drugs affecting intestinal microflora possess potent immunosuppressive effect on systemic immunity. These observations inspired to recent investigation on the mechanisms of the influence of digestive tract bacteria on the immune system.