ABSTRACT
This is a protocol for PPROM-AZM Study, phase II, nonblinded, randomized controlled trial. Bronchopulmonary dysplasia (BPD) at a postmenstrual age of 36 weeks (BPD36) is often observed in infants with preterm premature rupture of the membranes (pPROM). A regimen of ampicillin (ABPC) intravenous infusion for 2 days and subsequent amoxicillin (AMPC) oral administration for 5 days plus erythromycin (EM) intravenous infusion for 2 days followed by EM oral administration for 5 days is standard treatment for pPROM. However, the effect on the prevention of moderate/severe BPD36 using the standard treatment has not been confirmed. Recently, it is reported that ampicillin/sulbactam (ABPC/SBT) plus azithromycin (AZM) was effective for the prevention of moderate/severe BPD36 in pPROM patients with amniotic infection of Ureaplasma species. Therefore, our aim is to evaluate the occurrence rate of the composite outcome of "incidence rate of either moderate/severe BPD36 or intrauterine fetal death, and infantile death at or less than 36 weeks 0 days" comparing subjects to receive ABPC/SBT for 14 days plus AZM for 14 days (intervention group) and those to receive ABPC/SBT for 14 days plus EM for 14 days (control group), in a total of 100 subjects (women with pPROM occurring at 22-27 weeks of gestation) in Japan. The recruit of subjects was started on April 2022, and collection in on-going. We also investigate the association between the detection of Ureaplasma species and occurrence of BPD36. In addition, information on any adverse events for the mother and fetus and serious adverse events for infants are collected during the observation period. We allocate patients at a rate of 1:1 considering two stratification factors: onset of pPROM (22-23 or 24-27 weeks) and presence/absence of a hospital policy for early neonatal administration of caffeine. Trial registration: The trial number in the Japan Registry of Clinical Trials is jRCTs031210631.
Subject(s)
Ampicillin , Anti-Bacterial Agents , Azithromycin , Bronchopulmonary Dysplasia , Erythromycin , Fetal Membranes, Premature Rupture , Adult , Female , Humans , Infant, Newborn , Pregnancy , Amoxicillin/therapeutic use , Amoxicillin/administration & dosage , Ampicillin/administration & dosage , Ampicillin/therapeutic use , Anti-Bacterial Agents/administration & dosage , Anti-Bacterial Agents/therapeutic use , Azithromycin/administration & dosage , Azithromycin/therapeutic use , Bronchopulmonary Dysplasia/prevention & control , Bronchopulmonary Dysplasia/drug therapy , Drug Therapy, Combination , Erythromycin/therapeutic use , Erythromycin/administration & dosage , Fetal Membranes, Premature Rupture/drug therapy , Gestational Age , Japan/epidemiology , Sulbactam/administration & dosage , Sulbactam/therapeutic use , Randomized Controlled Trials as Topic , Multicenter Studies as Topic , Clinical Trials, Phase II as TopicABSTRACT
OBJECTIVES: We evaluated the efficacies of human-simulated regimens (HSRs) of two clinically utilized sulbactam regimens: 1 g q6h 0.5 h infusion (maximum FDA-approved dosage) and 3 g q8h 4 h infusion (high-dose, prolonged-infusion regimen), against Acinetobacter baumannii in a translational murine model. METHODS: Thirty-two clinical A. baumannii isolates were investigated, of which 16 were sulbactam resistant (MICâ≥â16 mg/L), 6 were sulbactam intermediate (MICâ=â8 mg/L) and 10 were sulbactam susceptible (MICâ≤â4 mg/L). Efficacies of the two sulbactam HSRs were assessed in the neutropenic murine pneumonia model. Changes in log10 cfu/lungs at 24 h compared with 0 h controls were measured, and efficacy was defined as achieving 1 log kill relative to baseline. WGS of the isolates and bioinformatics analysis were performed to explore potential associations between the genomic backgrounds and the in vivo responses. RESULTS: Eleven isolates harboured blaOXA-23, of which 10 were sulbactam resistant, 1 was sulbactam intermediate while none was sulbactam susceptible. Both sulbactam HSRs achieved >1 log kill against sulbactam-susceptible isolates. Against sulbactam-intermediate and sulbactam-resistant isolates, lack of efficacy correlated with the presence of the blaOXA-23 gene; sulbactam 1 g HSR and 3 g HSR did not show efficacy against 11/11 and 9/11 blaOXA-23-positive isolates, respectively, while efficacy was observed against all 11 blaOXA-23-negative sulbactam-intermediate and sulbactam-resistant isolates (i.e. harbouring other resistance genes). CONCLUSIONS: A sulbactam high-dose prolonged-infusion regimen provides comparable activity to the standard dose against isolates currently considered sulbactam susceptible. However, the activity against isolates with intermediate and resistant susceptibility could be predicted by the detection of blaOXA-23. Enhancing detection capabilities of common diagnostic modalities to include OXA-23 can improve patient outcome.
Subject(s)
Acinetobacter Infections , Acinetobacter baumannii , Anti-Bacterial Agents , Microbial Sensitivity Tests , Sulbactam , beta-Lactamases , Acinetobacter baumannii/drug effects , Acinetobacter baumannii/genetics , Sulbactam/administration & dosage , Sulbactam/therapeutic use , Sulbactam/pharmacology , Acinetobacter Infections/drug therapy , Acinetobacter Infections/microbiology , Animals , Anti-Bacterial Agents/administration & dosage , Anti-Bacterial Agents/pharmacology , Anti-Bacterial Agents/therapeutic use , Mice , beta-Lactamases/genetics , Humans , Pneumonia, Bacterial/drug therapy , Pneumonia, Bacterial/microbiology , Disease Models, Animal , Female , Treatment Outcome , Drug Resistance, BacterialABSTRACT
BACKGROUND: Sulbactam dosing for Acinetobacter baumannii infections has not been standardized due to limited available pharmacokinetics/pharmacodynamics (PK/PD) data. Herein, we report a comprehensive PK/PD analysis of ampicillin-sulbactam against A. baumannii pneumonia. METHODS: Twenty-one A. baumannii clinical isolates were tested in the neutropenic murine pneumonia model. For dose-ranging studies, groups of mice were administered escalating doses of ampicillin-sulbactam. Changes in log10cfu/lungs relative to 0 h were assessed. Dose-fractionation studies were performed. Estimates of the percentage of of time during which the unbound plasma sulbactam concentrations exceeded the MIC (%fTâ>âMIC) required for different efficacy endpoints were calculated. The probabilities of target attainment (PTA) for the 1-log kill plasma targets were estimated following clinically utilized sulbactam regimens. RESULTS: Dose-fractionation studies demonstrated time-dependent kill. Isolates resistant to both sulbactam and meropenem required three times the exposures to achieve 1-log kill; median [IQR] %fTâ>âMIC of 60.37% [51.6-66.8] compared with other phenotypes (21.17 [16.0-32.9] %fTâ>âMIC). Sulbactam standard dose (1 g q6h, 0.5 h infusion) provided >90% PTA up to MIC of 4 mg/L. Sulbactam 3 g q8h, 4 h inf provided greater PTA for isolates with sulbactam-intermediate susceptibility (8 mg/L, 100% versus 86% following the standard dose). Despite the higher exposure following 3 g q8h, 4 h inf, PTA was ≤57% among sulbactam-resistant/meropenem-resistant isolates. CONCLUSION: Sulbactam standard dose is a valuable regimen across sulbactam-susceptible isolates while the high-dose extended-infusion provides additional benefit against sulbactam-intermediate isolates. Given that most of the sulbactam-resistant A. baumannii isolates are meropenem-resistant, high-dose prolonged-infusion regimens are not expected to be effective as monotherapy against infections due to these isolates.
Subject(s)
Acinetobacter Infections , Acinetobacter baumannii , Ampicillin , Anti-Bacterial Agents , Microbial Sensitivity Tests , Sulbactam , Acinetobacter baumannii/drug effects , Sulbactam/pharmacokinetics , Sulbactam/administration & dosage , Sulbactam/pharmacology , Sulbactam/therapeutic use , Anti-Bacterial Agents/pharmacokinetics , Anti-Bacterial Agents/administration & dosage , Anti-Bacterial Agents/pharmacology , Acinetobacter Infections/drug therapy , Acinetobacter Infections/microbiology , Animals , Ampicillin/pharmacokinetics , Ampicillin/administration & dosage , Ampicillin/pharmacology , Mice , Female , Disease Models, Animal , Pneumonia, Bacterial/drug therapy , Pneumonia, Bacterial/microbiology , HumansABSTRACT
BACKGROUND: Severe infections caused by carbapenem-resistant Acinetobacter baumannii (CRAB) have been reported increasingly over the past few years. Many in-vivo and in-vitro studies have suggested a possible role of intravenous fosfomycin for the treatment of CRAB infections. METHODS: This multi-centre, retrospective study included patients treated with intravenous fosfomycin for severe infections caused by CRAB admitted consecutively to four hospitals in Italy from December 2017 to December 2022. The primary goal of the study was to evaluate the risk factors associated with 30-day mortality in the study population. A propensity score matched analysis was added to the model. RESULTS: One hundred and two patients with severe infections caused by CRAB treated with an intravenous fosfomycin-containing regimen were enrolled in this study. Ventilator-associated pneumonia (VAP) was diagnosed in 59% of patients, primary bacteraemia in 22% of patients, and central-venous-catheter-related infection in 16% of patients. All patients were treated with a regimen containing intravenous fosfomycin, mainly in combination with cefiderocol (n=54), colistin (n=48) or ampicillin/sulbactam (n=18). Forty-eight (47%) patients died within 30 days. Fifty-eight (57%) patients experienced clinical therapeutic failure. Cox regression analysis showed that diabetes, primary bacteraemia and a colistin-containing regimen were independently associated with 30-day mortality, whereas adequate source control of infection, early 24-h active in-vitro therapy, and a cefiderocol-containing regimen were associated with survival. A colistin-based regimen, A. baumannii colonization and primary bacteraemia were independently associated with clinical failure. Conversely, adequate source control of infection, a cefiderocol-containing regimen, and early 24-h active in-vitro therapy were associated with clinical success. CONCLUSIONS: Different antibiotic regimens containing fosfomycin in combination can be used for treatment of severe infections caused by CRAB.
Subject(s)
Acinetobacter Infections , Acinetobacter baumannii , Administration, Intravenous , Anti-Bacterial Agents , Carbapenems , Fosfomycin , Pneumonia, Ventilator-Associated , Sulbactam , Humans , Fosfomycin/therapeutic use , Fosfomycin/administration & dosage , Acinetobacter baumannii/drug effects , Acinetobacter Infections/drug therapy , Acinetobacter Infections/mortality , Acinetobacter Infections/microbiology , Retrospective Studies , Male , Female , Anti-Bacterial Agents/therapeutic use , Anti-Bacterial Agents/administration & dosage , Aged , Middle Aged , Carbapenems/therapeutic use , Sulbactam/therapeutic use , Sulbactam/administration & dosage , Pneumonia, Ventilator-Associated/drug therapy , Pneumonia, Ventilator-Associated/microbiology , Pneumonia, Ventilator-Associated/mortality , Colistin/therapeutic use , Colistin/administration & dosage , Italy , Ampicillin/therapeutic use , Ampicillin/administration & dosage , Cefiderocol , Aged, 80 and over , Drug Therapy, Combination , Bacteremia/drug therapy , Bacteremia/microbiology , Bacteremia/mortality , Drug Resistance, Multiple, BacterialABSTRACT
BACKGROUND: Rat bite fever is a rare but potentially fatal bacterial zoonosis. The symptoms can be unspecific, but severe sepsis can be associated with involvement of different organs. CASE REPORT: A 27-year-old homeless man presented with fever, suspected meningitis, acute renal failure, unclear skin lesions as well as joint problems and muscular pain. Bite wounds were not detected. Meningitis could be excluded after lumbar puncture, and there was no evidence of endocarditis as the cause of the skin lesions. After 72â¯h, growth of Streptobacillus moniliformis in blood cultures was detected. Clinical symptoms were compatible with the diagnosis of rat bite fever. Calculated antibiosis with ampicillin sulbactam and doxycycline led to regression of the symptoms. CONCLUSION: Rat bite fever poses a diagnostic challenge due unspecific symptoms, diverse differential diagnostic options, and challenging microbiological detection. Patient history is of the utmost importance. Due to the rarity of the disease, this case report is intended to raise awareness.
Subject(s)
Rat-Bite Fever , Streptobacillus , Zoonoses , Male , Adult , Rat-Bite Fever/diagnosis , Rat-Bite Fever/drug therapy , Rat-Bite Fever/microbiology , Humans , Animals , Streptobacillus/isolation & purification , Zoonoses/diagnosis , Zoonoses/microbiology , Zoonoses/transmission , Anti-Bacterial Agents/therapeutic use , Doxycycline/therapeutic use , Diagnosis, Differential , Rats , Sulbactam/therapeutic use , Sulbactam/administration & dosage , Ampicillin/therapeutic useABSTRACT
We report a rare case of suppurative thrombophlebitis of the posterior neck caused by Streptococcus constellatus. A 69-year-old female patient was admitted to the hospital with neck pain and fever, which had persisted for 16 days prior to hospitalization. On day 1 (day of admission), blood cultures (later identifying S. constellatus) were performed, and ceftriaxone (CTRX) IV (2 g SID) was started. On day 3, suppurative thrombophlebitis of the posterior neck was diagnosed by CT scan. The antimicrobials were changed from CTRX to ampicillin/sulbactam IV (12 g QID) to guard against the possibility of complicated infection with Fusobacterium spp. or Prevotella spp. On day 17, a CT scan revealed that the thrombus remained. Therefore, oral edoxaban (30 mg SID) was started. On day 27, the patient was discharged after her medication was changed to oral amoxicillin/clavulanate (1500 mg/375 mg TID). On day 33, the amoxicillin/clavulanate was changed to oral cefaclor (1500 mg TID) and edoxaban was discontinued due to itching. On day 45, the course of cefaclor was completed. The patient went on to follow an uneventful course with no relapses or complications for two years since the conclusion of treatment. These results suggest that when a patient presents with persistent neck pain accompanied by fever, suppurative thrombophlebitis of the posterior neck should be considered. In antimicrobial therapy, the treatment could be switched from intravenous to oral. In addition, direct-acting oral anticoagulants may be an alternative to other forms of anticoagulants.
Subject(s)
Amoxicillin-Potassium Clavulanate Combination/administration & dosage , Anti-Bacterial Agents/administration & dosage , Cefaclor/administration & dosage , Neck , Streptococcal Infections , Streptococcus constellatus/pathogenicity , Thrombophlebitis/drug therapy , Thrombophlebitis/microbiology , Administration, Oral , Aged , Ampicillin/administration & dosage , Deoxyuridine/administration & dosage , Deoxyuridine/adverse effects , Deoxyuridine/analogs & derivatives , Drug Substitution , Female , Humans , Infusions, Intravenous , Streptococcus constellatus/isolation & purification , Sulbactam/administration & dosage , Suppuration , Thrombophlebitis/diagnosis , Thrombophlebitis/pathology , Treatment OutcomeABSTRACT
To provide direction for clinical application and pharmaceutical exploitation, the in vitro activity of sulbactam compounds and PIP/TAZ 8 : 1 against clinical isolates of Gram-negative bacteria (GNB, n = 976) was evaluated according to Clinical and Laboratory Standards Institute (CLSI) 2019. By minimal inhibitory concentrations (MICs), the resistance rate of all GNB to AMP/SBT 2 : 1 (56.9-100%) was significantly higher than other drugs, except the resistance rate of Acinetobacter baumannii (Aba, n = 204) to piperacillin/tazobactam (PIP/TAZ 8 : 1, 78.4%) which was close to it (76.5%). Additionally, the resistance rate of Aba to other compounds except AMP/SBT 2 : 1 differed greatly, but that of Klebsiella pneumonia (Kpn, n = 205) varied rarely. In addition, Escherichia coli (Eco, n = 204) and Kpn demonstrated low and high resistance rates, respectively. Compared with cefoperazone/sulbactam (CPZ/SBT 2 : 1), PIP/TAZ 8 : 1 had advantage in anti-Eco (RR = 0.5and OR = 2.17) and anti-Kpn activity (RR = 0.88and OR = 1.27), while its activity against Pseudomonas aeruginosa (Pae: n = 194, RR = 0.91, and OR = 1.12), Aba (RR = 1.31 and OR = 0.41), and other Enterobacteriaceae (other Ebc: n = 169, RR = 1.40, and OR = 0.62) was not better than CPZ/SBT 2 : 1. Although it had advantage against Eco (RR = 0.60 and OR = 1.78), Pae (RR = 0.67 and OR = 1.63), and Aba (RR = 0.70 and OR = 2.05), the inhibition effect of piperacillin/sulbactam (PIP/SBT 2 : 1) against Kpn (RR = 0.94 and OR = 1.12) and other Ebc was just similar with CPZ/SBT 2 : 1 (RR = 0.93 and OR = 1.10). Furthermore, the anti-Eco (RR = 0.70 and OR = 1.50), anti-Kpn (RR = 0.89 and OR = 1.24), and anti-Pae (RR = 0.74 and OR = 1.46) activities of ceftazidime/sulbactam (CAZ/SBT 1 : 1) had a weak advantage, while its activity against Aba (RR = 0.94 and OR = 1.15) and other Ebc (RR = 0.79 and OR = 1.36) was just close to CPZ/SBT 2 : 1. Moreover, the inhibitory effect of PIP/SBT 1 : 1 against all tested clinical species was more active than CPZ/SBT 2 : 1, while that of CAZ/SBT 2 : 1 against all species of bacteria analyzed was weaker than the controls.
Subject(s)
Gram-Negative Bacteria/drug effects , Piperacillin, Tazobactam Drug Combination/pharmacology , Sulbactam/pharmacology , Adult , Aged , Anti-Bacterial Agents/pharmacology , Cefoperazone/administration & dosage , Cefoperazone/pharmacology , Ceftazidime/administration & dosage , Ceftazidime/pharmacology , Child , China , Computational Biology , Drug Combinations , Drug Resistance, Bacterial , Female , Gram-Negative Bacteria/isolation & purification , Humans , In Vitro Techniques , Male , Microbial Sensitivity Tests , Sulbactam/administration & dosageABSTRACT
Glutamate transporter-1 (GLT-1) removes most glutamate in the synaptic cleft. Sulbactam confers neuronal protection against ischemic insults in the hippocampal CA1 region accompanied by the upregulation of GLT-1 expression in rats. The present study further investigates the effect of sulbactam on the binding property and uptake capacity of GLT-1 for glutamate, and the change in extracellular glutamate concentration in the hippocampal CA1 region of rats with global brain ischemia. The binding property and uptake capacity of GLT-1 were measured using a radioligand binding and uptake assay, respectively, with L-3H-glutamate. The extracellular glutamate concentration was detected using microdialysis and high-performance liquid chromatography-mass spectrometry. Neuropathological evaluation was performed based on thionin staining. It was shown that sulbactam pre-treatment changed GLT-1 binding property, including increased Bmax and decreased Kd values, increased GLT-1 uptake capacity for glutamate, and inhibited the elevation of extracellular glutamate concentration in rats with global cerebral ischemia. These effects of sulbactam were accompanied by its neuronal protection on the hippocampal CA1 neurons against delayed neuronal death resulted from ischemic insult. Furthermore, administration of GLT-1 antisense oligodeoxynucleotides, which inhibited the expression of GLT-1, blocked the aforementioned sulbactam-related effects, which suggested that GLT-1 upregulation mediated the above effect although other mechanisms independent of the upregulation of GLT-1 expression could not be excluded. It could be concluded that sulbactam improves the binding property and uptake capacity of GLT-1 for glutamate and then reduces the glutamate concentration and excitotoxicity during global cerebral ischemia, which contributes to the neuroprotection of sulbactam against brain ischemia.
Subject(s)
Brain Ischemia/drug therapy , Brain Ischemia/metabolism , CA1 Region, Hippocampal/metabolism , Excitatory Amino Acid Transporter 2/metabolism , Glutamic Acid/metabolism , Sulbactam/administration & dosage , Animals , Biological Transport/drug effects , Brain Ischemia/genetics , CA1 Region, Hippocampal/drug effects , Excitatory Amino Acid Transporter 2/genetics , Humans , Male , Neurons/drug effects , Neurons/metabolism , Protein Binding/drug effects , Rats , Rats, WistarABSTRACT
Ampicillin-sulbactam is a first-line therapy for pneumonia and is mainly excreted by the kidney. It is important to optimize the dose and dosing interval of ampicillin-sulbactam because in patients with decreased renal function and low skeletal muscle mass, such as the elderly, excess drug may burden renal function. In this study, we evaluated indices of renal function and optimized the dose and dosing interval of ampicillin-sulbactam based on pharmacokinetics (PK) and pharmacodynamics theory in elderly patients. The serum concentrations of ampicillin and sulbactam were measured by HPLC, and PK parameters were calculated. Correlations between the clearance of ampicillin or sulbactam and renal function were evaluated, and dosing optimization was calculated based on PK parameters. The PK parameters of ampicillin were CL = 6.5 ± 4.0 L/h, Vd = 19.3 ± 0.2 L, Ke = 0.4 ± 0.2, and t1/2 = 2.7 ± 1.6 h. The most correlated renal function index was estimated glomerular filtration rate (eGFRcys-c) calculated by serum cystatin-c (r = 0.7374, correlation formula; CL of ampicillin = 0.1937 × eGFRcys-c-0.6726). Based on this formula, we calculated the clearance of ampicillin and developed dosing regimens for the elderly. Serum cystatin-c concentration is an ideal index to optimize ampicillin-sulbactam antimicrobial therapy in elderly patients with pneumonia.
Subject(s)
Anti-Bacterial Agents/administration & dosage , Cystatin C/blood , Pneumonia/drug therapy , Aged , Aged, 80 and over , Aging/physiology , Ampicillin/administration & dosage , Ampicillin/pharmacokinetics , Anti-Bacterial Agents/pharmacokinetics , Dose-Response Relationship, Drug , Drug Dosage Calculations , Female , Glomerular Filtration Rate/physiology , Humans , Kidney/physiology , Male , Models, Biological , Pneumonia/blood , Renal Elimination , Sulbactam/administration & dosage , Sulbactam/pharmacokineticsABSTRACT
Early detection of the site of infection non-invasively with radiolabeled molecules is important for the success of treatment. Technetium-99m labeled antibiotics have the potential to discriminate between bacterial infection and sterile inflammation. Sultamicillin is the tosylate salt of the double ester of sulbactam plus ampicillin. In this study, sultamicillin was labeled with 99m Tc according to the stannous chloride method. Quality control studies of radiolabeled sultamicillin were performed by radiochromatographic methods. In vitro binding assays were performed in live and heat-killed gram-positive Staphylococcus aureus and gram-negative Escherichia coli strains. The radiolabeling yield of 99m Tc-sultamicillin was determined as 97.8% ± 3.1% (n = 5). The maximum bacterial uptake of 99m Tc-sultamicillin was 80.7% ± 11.00% at 4 h for living S. aureus and 93.2% ± 4.40% at 2 h for E. coli. Bacterial uptake study results show that sultamicillin has the potential to be a nuclear imaging agent, especially in infections caused by gram-negative E. coli and gram-positive S. aureus.
Subject(s)
Anti-Bacterial Agents/administration & dosage , Escherichia coli/metabolism , Staphylococcus aureus/metabolism , Technetium , Ampicillin/administration & dosage , Escherichia coli Infections/diagnostic imaging , Staphylococcal Infections/diagnostic imaging , Sulbactam/administration & dosage , Tin CompoundsABSTRACT
This study sought to investigate whether dosing frequency (the number of doses per day) affects the antimicrobial efficacy and safety of ampicillin/sulbactam (ABPC/SBT) in Japanese elderly pneumonia patients treated with ABPC/SBT at 6 g/day. This was a retrospective observational study that included hospitalized elderly patients (aged ≥75 years, 10 ml/min ≤CLcr <50 ml/min) who received 3 g every 12 h (BID; n = 61) or 1.5 g every 6 h (QID; n = 45) for the treatment of pneumonia. The primary endpoint was clinical response, assessed by measuring body temperature, white blood cell count, and C-reactive protein levels. Pharmacokinetic and pharmacodynamic simulations were conducted in silico to rationalize the clinical findings. The clinical response rates (extremely effective and effective) in the BID and QID groups were 36.1% and 55.6%, respectively (p = .0459). QID tended to be more effective in patients with gram-negative rods detected (p = .0563). According to the simulated minimum plasma ABPC concentrations at steady state for BID and QID were 2.5 and 7.3 µg/ml, respectively (p < .0001). Based on the simulated time above minimum inhibitory concentration (MIC), pharmacological (not clinical) efficacy was predicted to be higher with QID. Both groups had similar safety profiles. The main adverse event in both groups was liver damage. The present retrospective survey demonstrated that ABPC/SBT treatment for elderly patients with pneumonia and renal dysfunction was more effective with QID than with BID. Therefore, the QID regimen is worthy of consideration to improve the clinical outcomes of ABPC/SBT therapy in the present patient population.
Subject(s)
Anti-Bacterial Agents/administration & dosage , Chemical and Drug Induced Liver Injury/epidemiology , Pneumonia, Bacterial/drug therapy , Aged , Aged, 80 and over , Ampicillin/administration & dosage , Ampicillin/adverse effects , Ampicillin/pharmacokinetics , Anti-Bacterial Agents/adverse effects , Anti-Bacterial Agents/pharmacokinetics , Chemical and Drug Induced Liver Injury/etiology , Computer Simulation , Dose-Response Relationship, Drug , Drug Administration Schedule , Female , Glomerular Filtration Rate , Humans , Injections, Intravenous , Male , Renal Elimination , Retrospective Studies , Sulbactam/administration & dosage , Sulbactam/adverse effects , Sulbactam/pharmacokinetics , Treatment OutcomeABSTRACT
Glyphosate is the most commonly used broad-spectrum, non-selective herbicide in the world. The toxicity is supposed to be due to uncoupling of oxidative phosphorylation and the surfactant polyoxyethylene amine (POEA)- mediated cardiotoxicity. Clinical features of this herbicide poisoning are varied, ranging from asymptomatic to even death. There is no antidote and aggressive supportive therapy is the mainstay of treatment for glyphosate poisoning. We present a 69-year-old female patient with suicidal consumption of around 500 ml of Glycel®. Initially, gastric lavage was done and intravenous fluids were given. Within two hours of presentation, the patient developed respiratory distress needing intubation, hypotension needing vasopressor support, and severe lactic acidosis. She also developed acute respiratory distress syndrome, hypokalemia, hypernatremia, and aspiration pneumonia. Our patient was critically ill with multiple poor prognostic factors, but with timely aggressive supportive management, the patient gradually recovered.
Subject(s)
Glycine/analogs & derivatives , Herbicides/poisoning , Hypernatremia/etiology , Hypokalemia/etiology , Pneumonia, Aspiration/etiology , Respiratory Distress Syndrome/etiology , Aged , Cefamandole/administration & dosage , Cefamandole/analogs & derivatives , Cefamandole/therapeutic use , Cefoperazone/administration & dosage , Cefoperazone/therapeutic use , Clindamycin/administration & dosage , Clindamycin/therapeutic use , Dietary Supplements , Female , Glycine/poisoning , Humans , Hypernatremia/drug therapy , Hypokalemia/drug therapy , Pneumonia, Aspiration/drug therapy , Potassium/administration & dosage , Potassium/therapeutic use , Respiratory Distress Syndrome/drug therapy , Suicide, Attempted , Sulbactam/administration & dosage , Sulbactam/therapeutic use , Treatment Outcome , GlyphosateABSTRACT
Background: ABO blood type incompatibility hemolytic disease of newborn (ABO-HDN) and drug-induced immune hemolytic anemia (DIIHA) due to non-immunologic protein adsorption (NIPA) mainly cause extravascular hemolysis. All the reported severe DIIHA were caused by drug-induced antibodies, and rare report of acute intravascular hemolysis was caused by the NIPA mechanism or ABO-HDN. Case presentation: We report the first case of acute intravascular hemolysis induced by cefotaxime sodium - sulbactam sodium (CTX - SBT) in a case of ABO-HDN which resulted in death at 55 h after birth. The mother's blood type was O and RhD-positive, and the newborn's blood type was B and RhD-positive. No irregular red blood cell (RBC) antibodies or drug-dependent antibodies related to CTX or SBT was detected in the mother's plasma and the plasma or the RBC acid eluent of the newborn. Before the newborn received CTX - SBT treatment, the result of direct antiglobulin test (DAT) was negative while anti-B was positive (2 +) in both plasma and acid eluent. After the newborn received CTX - SBT treatment, the results of DAT for anti-IgG and anti-C3d were both positive, while anti-B was not detected in plasma, but stronger anti-B (3 +) was detected in acid eluent. In vitro experiments confirmed that NIPA of SBT promoted the specific binding of maternal-derived IgG anti-B to B antigen on RBCs of the newborn, thereby inducing acute intravascular hemolysis. Conclusion: The NIPA effect of SBT promoted the specific binding of mother-derived IgG anti-B in newborn's plasma to the newborn's RBC B antigens and formed an immune complex, and then activated complement, which led to acute intravascular hemolysis. Drugs such as SBT with NIPA effect should not be used for newborns with HDN.
Subject(s)
ABO Blood-Group System/immunology , Anemia, Hemolytic/chemically induced , Blood Group Incompatibility/complications , Cefotaxime/adverse effects , Erythroblastosis, Fetal/etiology , Hemolysis , Immunoglobulin G/immunology , Isoantibodies/immunology , Sulbactam/adverse effects , Acute Disease , Adsorption , Anemia, Hemolytic/blood , Antigen-Antibody Reactions , Blood Group Incompatibility/blood , Cefotaxime/administration & dosage , Complement Activation , Coombs Test , Erythroblastosis, Fetal/blood , Erythrocyte Membrane/chemistry , Erythrocyte Membrane/immunology , Fatal Outcome , Female , Humans , Infant, Newborn , Male , Maternal-Fetal Exchange , Pregnancy , Sulbactam/administration & dosage , Young AdultSubject(s)
Actinomycosis/diagnosis , Cervix Uteri/pathology , Fallopian Tubes/pathology , Actinomyces/isolation & purification , Actinomycosis/drug therapy , Actinomycosis/pathology , Adult , Ampicillin/administration & dosage , Anti-Bacterial Agents/administration & dosage , Cervix Uteri/diagnostic imaging , Diagnosis, Differential , Doxycycline/administration & dosage , Fallopian Tubes/diagnostic imaging , Female , Humans , Magnetic Resonance Imaging , Ovarian Neoplasms/diagnosis , Sulbactam/administration & dosage , Tomography, X-Ray Computed , Uterine Cervical Neoplasms/diagnosisABSTRACT
Exposure to ethanol commonly manifests neuroinflammation. Beta (ß)-lactam antibiotics attenuate ethanol drinking through upregulation of astroglial glutamate transporters, especially glutamate transporter-1 (GLT-1), in the mesocorticolimbic brain regions, including the nucleus accumbens (Acb). However, the effect of ß-lactam antibiotics on neuroinflammation in animals chronically exposed to ethanol has not been fully investigated. In this study, we evaluated the effects of ampicillin/sulbactam (AMP/SUL, 100 and 200 mg/kg, i.p.) on ethanol consumption in high alcohol drinking (HAD1) rats. Additionally, we investigated the effects of AMP/SUL on GLT-1 and N-methyl-d-aspartate (NMDA) receptor subtypes (NR2A and NR2B) in the Acb core (AcbCo) and Acb shell (AcbSh). We found that AMP/SUL at both doses attenuated ethanol consumption and restored ethanol-decreased GLT-1 and NR2B expression in the AcbSh and AcbCo, respectively. Moreover, AMP/SUL (200 mg/kg, i.p.) reduced ethanol-increased high mobility group box 1 (HMGB1) and receptor for advanced glycation end-products (RAGE) expression in the AcbSh. Moreover, both doses of AMP/SUL attenuated ethanol-elevated tumor necrosis factor-alpha (TNF-α) in the AcbSh. Our results suggest that AMP/SUL attenuates ethanol drinking and modulates NMDA receptor NR2B subunits and HMGB1-associated pathways.
Subject(s)
Alcohol Drinking/adverse effects , Encephalitis/drug therapy , Receptors, N-Methyl-D-Aspartate/metabolism , Alcohol Drinking/metabolism , Ampicillin/administration & dosage , Ampicillin/pharmacology , Animals , Disease Models, Animal , Dose-Response Relationship, Drug , Encephalitis/chemically induced , Encephalitis/metabolism , Excitatory Amino Acid Transporter 2/metabolism , Gene Expression Regulation/drug effects , HMGB1 Protein/metabolism , Male , Rats , Receptor for Advanced Glycation End Products/metabolism , Sulbactam/administration & dosage , Sulbactam/pharmacologyABSTRACT
Acinetobacter infection, especially the drug-resistant strain, is a common cause of nosocomial infection. However, community-acquired Acinetobacter infection is uncommon. We reported three cases of community-acquired Acinetobacter pneumonia. All three cases had histories of regular home-brewed alcohol consumption presented with severe acute respiratory symptoms requiring ventilatory support and had low total white cell count. They succumbed to the illness within 2 to 10 days of admission. They had positive blood or endotracheal aspirate cultures of sensitive-strain Acinetobacter sp. which was only sensitive to high dose sulbactam. Early recognition and correct antibiotic can help reduce mortality.
Subject(s)
Acinetobacter Infections , Acinetobacter/isolation & purification , Community-Acquired Infections , Acinetobacter Infections/diagnosis , Acinetobacter Infections/drug therapy , Acinetobacter Infections/physiopathology , Aged , Anti-Bacterial Agents/administration & dosage , Fatal Outcome , Humans , Male , Middle Aged , Sulbactam/administration & dosageABSTRACT
Campylobacter upsaliensis is an enteropathogenic bacterium in animals, and is also rarely isolated from humans, where it can cause enteritis and bacteremia. This report describes the first case of isolation of C. upsaliensis from an infected giant hepatic cyst. This bacterium could not be cultured from abscess punctuate in a usual Campylobacter-selection medium (charcoal cefoperazone deoxycholate agar medium), because of high concentration of cefoperazone as a selection agent. It could not identified by matrix-assisted laser desorption ionization-time of flight mass spectrum. Rather, it was identified as C. upsaliensis by whole genome sequencing, including by multilocus sequence typing.
Subject(s)
Campylobacter Infections/diagnosis , Campylobacter upsaliensis/isolation & purification , Cysts/diagnosis , Liver Abscess/diagnosis , Aged , Anti-Bacterial Agents/administration & dosage , Campylobacter Infections/microbiology , Campylobacter Infections/therapy , Campylobacter upsaliensis/genetics , Catheters , Cefoperazone/administration & dosage , Cysts/microbiology , Cysts/therapy , DNA, Bacterial/genetics , DNA, Bacterial/isolation & purification , Drug Therapy, Combination , Humans , Liver/diagnostic imaging , Liver/microbiology , Liver Abscess/microbiology , Liver Abscess/therapy , Male , Multilocus Sequence Typing , Paracentesis/instrumentation , Sulbactam/administration & dosage , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
The aim of this study was to compare the effectiveness of cefoperazone-sulbactam alone and combined with tigecycline in the treatment of multi-drug resistant acinetobacter baumannii pulmonary infection. It was an experimental study carried out from April 2016 to September 2018. One hundred and fourteen patients with multi-drug resistant acinetobacter baumannii pulmonary infection were randomly divided into group A and group B with 57 cases in each group. Group A was treated with cefoperazone-sulbactam sodium alone, and group B was treated with cefoperazone-sulbactam combined with tigecycline. After 14 days of treatment, serum levels of PCT, CRP, TNF-a and IL-6 in group B were lower than those in group A (all p <0.001); APACHE II scores of group B were lower than those of group A (p <0.001). Compared with cefoperazone-sulbactam sodium alone, cefoperazone-sulbactam combined with tigecycline can effectively reduce the inflammatory response of patients with multi-drug resistant acinetobacter baumannii pulmonary infection; and thus a better prognosis can be obtained.
Subject(s)
Acinetobacter Infections/drug therapy , Anti-Bacterial Agents/administration & dosage , Cefoperazone/administration & dosage , Pneumonia, Bacterial/drug therapy , Sulbactam/administration & dosage , Tigecycline/administration & dosage , Acinetobacter baumannii , Adult , Aged , China , Drug Resistance, Multiple, Bacterial , Drug Therapy, Combination , Female , Humans , Male , Middle Aged , Treatment OutcomeABSTRACT
Cefoperazone-sulbactam (CS) and piperacillin-tazobactam (TZP) are used in the treatment of Gram-negative nosocomial infections (NIs). We aimed to compare the effects of these two antibiotics on mortality and treatment success. Patients treated with CS or TZP empirically for at least three days with suspicion of NI were included in this retrospective study. In total, 308 (154 patients in both treatment arms) patients were analyzed. Treatment success rate in CS and TZP group respectively (50% vs 51.2%, p = 0.18), 28-day mortality rate (46.1% vs 42.8%, p = 0.56) and antibiotic-related side effects (50.6% vs 46.1%, p = 0.42) were similar except prolonged prothrombin time (19.4% vs 6.4%; p = 0.001). According to this study results, CS and TZP have equal effectivity and safety for the empirical treatment of Gram-negative NIs. CS may be an appropriate alternative to TZP for antibiotic cycling or mixing strategy to reduce antibiotic resistance.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Cefoperazone/therapeutic use , Gram-Negative Bacterial Infections/drug therapy , Gram-Negative Bacterial Infections/mortality , Piperacillin, Tazobactam Drug Combination/therapeutic use , Sulbactam/therapeutic use , Aged , Aged, 80 and over , Anti-Bacterial Agents/administration & dosage , Anti-Bacterial Agents/adverse effects , Cefoperazone/administration & dosage , Cefoperazone/adverse effects , Cross Infection , Drug Combinations , Drug Resistance, Multiple, Bacterial , Female , Humans , Male , Microbial Sensitivity Tests , Middle Aged , Piperacillin, Tazobactam Drug Combination/administration & dosage , Piperacillin, Tazobactam Drug Combination/adverse effects , Retrospective Studies , Sulbactam/administration & dosage , Sulbactam/adverse effectsABSTRACT
Acinetobacter baumannii has evolved as a major pathogen of outbreaks in the healthcare setting with increased morbidity and mortality. In neonates, treatment can be quite challenging due to the resistance profile of A. baumannii as well as limited data on pharmakokinetics and pharmakodynamics of antibiotics in this age group. We present an outbreak of eight cases of extensively-drug resistant (XDR) A. baumannii bacteremias successfully managed with the combination of colistin with high dose ampicillin/sulbactam.