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1.
Arch. argent. pediatr ; 118(1): e30-e33, 2020-02-00. ilus, tab
Artigo em Espanhol | LILACS, BINACIS | ID: biblio-1095858

RESUMO

El síndrome de la escaldadura estafilocócica es una entidad dermatológica poco frecuente que, en fases iniciales, puede ser confundida con una reagudización de un brote de dermatitis atópica. Se presenta el caso de un niño de 8 años, con antecedentes de dermatitis atópica y alergia al huevo, que acudió al Servicio de Urgencias por lesiones eritematoampollosas en la piel. La sintomatología comenzó como un eritema en áreas de flexuras, que asociaba conjuntivitis y eritema palpebral bilateral. A las 24 horas, apareció un eritema generalizado con ampollas flácidas de predominio en áreas flexurales, acompañado de hiperqueratosis y xerosis perioral. Ante la sospecha clínica de síndrome de escaldadura estafilocócica, se inició el tratamiento empírico con cloxacilina, con respuesta favorable. Con este caso, se destaca la importancia de realizar un correcto diagnóstico diferencial de las lesiones cutáneas de los pacientes con dermatitis atópica, con el objetivo de aplicar el tratamiento más adecuado.


The staphylococcal scalded skin syndrome is a rare dermatological entity that in early stages may be confused with a flare-up of a rush of atopic dermatitis. We present the case of an 8-year-old boy with a history of atopic dermatitis and egg allergy that went to the Emergency Department for erythematous-bullous lesions on the skin. Symptoms began as an erythema in areas of flexures, which associated conjunctivitis and bilateral eyelid erythema. After 24 hours, a generalized erythema appeared with flaccid blisters predominating in flexural areas, accompanied by hyperkeratosis and perioral xerosis. Due to the clinical suspicion of staphylococcal scalded skin syndrome, empirical treatment with cloxacillin with favorable response was initiated. This case highlights the importance of making a correct differential diagnosis of skin lesions of patients with atopic dermatitis in order to apply the most appropriate treatment.


Assuntos
Humanos , Masculino , Criança , Síndrome da Pele Escaldada Estafilocócica , Dermatite Atópica , Staphylococcus aureus , Cloxacilina/uso terapêutico , Diagnóstico Diferencial
2.
JAMA ; 323(6): 527-537, 2020 02 11.
Artigo em Inglês | MEDLINE | ID: mdl-32044943

RESUMO

Importance: Methicillin-resistant Staphylococcus aureus (MRSA) bacteremia is associated with mortality of more than 20%. Combining standard therapy with a ß-lactam antibiotic has been associated with reduced mortality, although adequately powered randomized clinical trials of this intervention have not been conducted. Objective: To determine whether combining an antistaphylococcal ß-lactam with standard therapy is more effective than standard therapy alone in patients with MRSA bacteremia. Design, Setting, and Participants: Open-label, randomized clinical trial conducted at 27 hospital sites in 4 countries from August 2015 to July 2018 among 352 hospitalized adults with MRSA bacteremia. Follow-up was complete on October 23, 2018. Interventions: Participants were randomized to standard therapy (intravenous vancomycin or daptomycin) plus an antistaphylococcal ß-lactam (intravenous flucloxacillin, cloxacillin, or cefazolin) (n = 174) or standard therapy alone (n = 178). Total duration of therapy was determined by treating clinicians and the ß-lactam was administered for 7 days. Main Outcomes and Measures: The primary end point was a 90-day composite of mortality, persistent bacteremia at day 5, microbiological relapse, and microbiological treatment failure. Secondary outcomes included mortality at days 14, 42, and 90; persistent bacteremia at days 2 and 5; acute kidney injury (AKI); microbiological relapse; microbiological treatment failure; and duration of intravenous antibiotics. Results: The data and safety monitoring board recommended early termination of the study prior to enrollment of 440 patients because of safety. Among 352 patients randomized (mean age, 62.2 [SD, 17.7] years; 121 women [34.4%]), 345 (98%) completed the trial. The primary end point was met by 59 (35%) with combination therapy and 68 (39%) with standard therapy (absolute difference, -4.2%; 95% CI, -14.3% to 6.0%). Seven of 9 prespecified secondary end points showed no significant difference. For the combination therapy vs standard therapy groups, all-cause 90-day mortality occurred in 35 (21%) vs 28 (16%) (difference, 4.5%; 95% CI, -3.7% to 12.7%); persistent bacteremia at day 5 was observed in 19 of 166 (11%) vs 35 of 172 (20%) (difference, -8.9%; 95% CI, -16.6% to -1.2%); and, excluding patients receiving dialysis at baseline, AKI occurred in 34 of 145 (23%) vs 9 of 145 (6%) (difference, 17.2%; 95% CI, 9.3%-25.2%). Conclusions and Relevance: Among patients with MRSA bacteremia, addition of an antistaphylococcal ß-lactam to standard antibiotic therapy with vancomycin or daptomycin did not result in significant improvement in the primary composite end point of mortality, persistent bacteremia, relapse, or treatment failure. Early trial termination for safety concerns and the possibility that the study was underpowered to detect clinically important differences in favor of the intervention should be considered when interpreting the findings. Trial Registration: ClinicalTrials.gov Identifier: NCT02365493.


Assuntos
Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Daptomicina/uso terapêutico , Staphylococcus aureus Resistente à Meticilina , Infecções Estafilocócicas/tratamento farmacológico , Vancomicina/uso terapêutico , beta-Lactamas/uso terapêutico , Adulto , Idoso , Antibacterianos/efeitos adversos , Bacteriemia/microbiologia , Bacteriemia/mortalidade , Cefazolina/uso terapêutico , Cloxacilina/uso terapêutico , Quimioterapia Combinada , Endocardite Bacteriana/tratamento farmacológico , Feminino , Floxacilina/uso terapêutico , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Infecções Estafilocócicas/microbiologia , Infecções Estafilocócicas/mortalidade , Falha de Tratamento , beta-Lactamas/efeitos adversos
3.
Indian J Med Microbiol ; 37(1): 19-23, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31424005

RESUMO

Background: Culture-negative infections in open long bone fractures are frequently encountered in clinical practice. We aimed to identify the rate and outcome of culture-negative infections in open long bone fractures of lower limb. Methodology: A prospective cohort study was conducted from November 2015 to May 2017 on Gustilo and Anderson Grade III open long bone fractures of the lower limb. Demographic data, injury details, time from injury to receiving antibiotics and index surgical procedure were noted. Length of hospital stay, number of additional surgeries and occurrence of complications were also noted. Patients with infected open fractures were grouped as culture positive or culture negative depending on the isolation of infecting microorganisms in deep intraoperative specimen. The clinical outcome of these two groups was statistically analysed. Results: A total of 231 patients with 275 open fractures involving the femur, tibia or fibula were studied. There was clinical signs of infection in 84 patients (36.4%) with 99 fractures (36%). Forty-three patients (51.2%) had positive cultures and remaining 41 patients had negative cultures (48.8%). The rate of culture-negative infection in open type III long bone fractures in our study was 17.7%. There was no statistical difference in the clinical outcome between culture-negative and culture-positive infections. Conclusion: Failure to identify an infective microorganism in the presence of clinical signs of infection is routinely seen in open fractures and needs to be treated aggressively.


Assuntos
Antibacterianos/uso terapêutico , Fraturas Ósseas/microbiologia , Fraturas Expostas/microbiologia , Extremidade Inferior/microbiologia , Infecção dos Ferimentos/tratamento farmacológico , Infecção dos Ferimentos/epidemiologia , Adolescente , Adulto , Idoso , Técnicas de Tipagem Bacteriana , Ciprofloxacino/uso terapêutico , Cloxacilina/uso terapêutico , Desbridamento , Feminino , Fêmur/lesões , Fêmur/microbiologia , Fíbula/lesões , Fíbula/microbiologia , Fraturas Ósseas/patologia , Fraturas Ósseas/cirurgia , Fraturas Expostas/patologia , Fraturas Expostas/cirurgia , Gentamicinas/uso terapêutico , Humanos , Extremidade Inferior/lesões , Extremidade Inferior/patologia , Masculino , Pessoa de Meia-Idade , Penicilinas/uso terapêutico , Estudos Prospectivos , Tíbia/lesões , Tíbia/microbiologia , Resultado do Tratamento , Infecção dos Ferimentos/microbiologia , Adulto Jovem
4.
Int J Low Extrem Wounds ; 18(2): 135-142, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31012368

RESUMO

Due to the consistently high proportion of surgical site infections (SSI) after vascular surgery, a change of prophylactic antibiotic therapy from cloxacillin/cefotaxime to trimethoprim/sulfamethoxazole (TMP-SMX) was conducted in 2016. The study included consecutive patients undergoing lower extremity revascularization due to acute or chronic lower extremity arterial disease. The antibiotic regime was changed in between the two sampling periods (2014 -2016 versus 2016 -2017). The diagnosis of SSI was based on clinical examination and microbiological results, and severity was classified according to the Szilagyi classification. One hundred and twenty-two patients in the cloxacillin/cefotaxime and 67 patients in the TMP-SMX group were included. The SSI rates were 32.0% and 40.3%, respectively (p=0.25). The proportion of women were higher in the TMP-SMX group (32.8% versus 47.8%, respectively, p=0.043). No other differences between the two groups were found regarding patient, vascular surgery procedure characteristics or severity of SSI. Groin infection rate was higher in the TMP-SMX group (15.4% versus 30.5%, respectively, p=0.022). When adjusting for gender, groin infection was more common in the TMP-SMX group (Odds Ratio 2.5, 95% CI 1.1 -5.4). The groin SSI rate was higher after elective surgery in the TMP-SMX group (13.0% versus 27.8%, respectively, p=0.027), and also after adjusting for gender (Odds Ratio 2.6, 95% CI 1.1 -6.2). The change in antibiotic prophylaxis from Cloxacillin/Cefotaxime to TMP-SMX was associated with an increased rate of inguinal SSI in patients undergoing lower extremity revascularization, despite a possible Hawthorne effect.


Assuntos
Antibioticoprofilaxia/métodos , Cefotaxima/uso terapêutico , Cloxacilina/uso terapêutico , Infecção da Ferida Cirúrgica/prevenção & controle , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Adulto , Estudos de Coortes , Bases de Dados Factuais , Quimioterapia Combinada , Feminino , Virilha/microbiologia , Virilha/fisiopatologia , Humanos , Incidência , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Doença Arterial Periférica/cirurgia , Prognóstico , Estudos Retrospectivos , Medição de Risco , Infecção da Ferida Cirúrgica/epidemiologia , Suécia , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/métodos
5.
PLoS One ; 14(4): e0216091, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31022270

RESUMO

A randomized clinical trial was conducted to assess efficacy of intramammary cloxacillin and ampicillin (CLOXIMM), intramammary cefquinome (CEFIMM), and intramuscular cefquinome (CEFIM) to treat Streptococcus agalactiae intramammary infections (Trial 1). Subsequently, two treatment groups were extended to assess whether CLOXIMM was not inferior to CEFIMM (Trial 2). Nine farms were included in the study. Milk samples were collected from all quarters of all lactating cows for microbiological identification of S. agalactiae. Positive cows were randomly allocated into four groups: CLOXIMM, CEFIMM, CEFIM, or negative control (CONTROL). Study outcomes were bacteriological cure at 14 (CURE14), 21 (CURE21), and 14 and 21 (CURE1421) days after treatment onset, and somatic cell count. Logistic regression was used to estimate the odds of cure between each treatment and CONTROL. Non-inferiority analysis was performed considering a one-sided 95% confidence interval (CI) and non-inferiority margins (Δ) of 0.10, 0.15, 0.20, and 0.25. Adjusted S. agalactiae bacteriological cure for CLOXIMM, CEFIMM, CEFIM, and CONTROL was 86, 98, 55, and 25% at day 14; 82, 93, 52, and 0% at day 21; and 82, 92, 40, and 0% at days 14 and 21, respectively. Treatment with CLOXIMM and CEFIMM resulted in greater bacteriological cure rates, as compared with CEFIM or CONTROL, which does not justify the use of CEFIM in S. agalactiae eradication programs. The CURE14 difference between CEFIMM and CLOXIMM was of 12.1 percentage points (95% CI: 0.056-0.184). CLOXIMM was considered not inferior to CEFIMM for Δ = 0.20 or 0.25 and inconclusive for Δ = 0.10 or 0.15. Thus, it should be pondered by veterinarians whether an expected 12.1 (5.6-18.4) percentage points increase in cure rate would justify the use of a fourth-generation cephalosporin, as opposed to a combination of traditional IMM drugs (cloxacillin and ampicillin) to treat S. agalactiae subclinical mastitis.


Assuntos
Ampicilina/uso terapêutico , Cefalosporinas/uso terapêutico , Cloxacilina/uso terapêutico , Indústria de Laticínios , Mastite Bovina/tratamento farmacológico , Mastite Bovina/microbiologia , Streptococcus agalactiae/fisiologia , Animais , Bovinos , Contagem de Células , Quimioterapia Combinada , Feminino , Fatores de Risco , Resultado do Tratamento
6.
BMC Infect Dis ; 19(1): 58, 2019 Jan 17.
Artigo em Inglês | MEDLINE | ID: mdl-30654745

RESUMO

BACKGROUND: Iliopsoas abscess is a collection of pus in the iliopsoas muscle compartment. It can be primary or secondary in origin. Primary iliopsoas abscess occurs as a result of hematogenous or lymphatic seeding from a distant site. This is commonly associated with a chronic immunocompromised state and tends to occur in children and young adults. Secondary iliopsoas abscess occurs as a result of the direct spread of infection to the psoas muscle from an adjacent structure, and this may be associated with trauma and instrumentation in the inguinal region, lumbar spine, or hip region. The incidence of iliopsoas abscess is rare and often the diagnosis is delayed because of non-specific presenting symptoms. CASE PRESENTATION: We describe a patient with iliopsoas abscess who presented to the Emergency Department at X Hospital on three separate occasions with non-specific symptoms of thigh pain and fever before finally being admitted for treatment. This case illustrates how the diagnosis can be delayed due to its atypical presentation. Hence, highlighting the need for clinicians to have a high index of clinical suspicion for iliopsoas abscess in patients presenting with thigh pain and fever. CONCLUSION: The classic triad of fever, flank pain, and hip movement limitation is presented in only 30% of patients with iliopsoas abscess. Clinicians should consider iliopsoas abscess as a differential diagnosis in patients presenting with fever and thigh pain. The rare condition with the varied clinical presentation means that cross-sectional imaging should be considered early to reduce the risk of fulminant sepsis.


Assuntos
Mialgia/diagnóstico , Abscesso do Psoas/diagnóstico , Infecções Estafilocócicas/diagnóstico , Adulto , Cloxacilina/uso terapêutico , Diagnóstico Diferencial , Drenagem , Humanos , Masculino , Mialgia/etiologia , Mialgia/terapia , Abscesso do Psoas/complicações , Abscesso do Psoas/terapia , Infecções Estafilocócicas/terapia , Coxa da Perna
7.
BMJ Open ; 8(8): e023151, 2018 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-30173161

RESUMO

INTRODUCTION: Methicillin-susceptible Staphylococcus aureus (MSSA) bacteraemia is a common and severe disease responsible for approximately 65 000 deaths every year in Europe. Intravenous antistaphylococcal penicillins (ASP) such as cloxacillin are the current recommended antibiotics. However, increasing reports of toxicity and recurrent stock-outs of ASP prompted healthcare providers to seek for alternative antibiotic treatment. Based on retrospective studies, cefazolin, a first-generation cephalosporin, is recommended in patients at risk of severe ASP-associated toxicity.We hypothesised that cefazolin has a non-inferior efficacy in comparison to cloxacillin, with a better safety profile for the treatment of MSSA bacteraemia. METHODS AND ANALYSIS: The CloCeBa trial is an open-label, randomised, controlled, non-inferiority trial conducted in academic centres throughout France. Eligible patients are adults with MSSA bacteraemia without intravascular device or suspicion of central nervous system infection. Patients will be randomised (1:1) to receive either cloxacillin or cefazolin by the intravenous route, for the first 14 days of therapy. The evaluation criteria is a composite criteria of negative blood cultures at day 5, survival, absence of relapse and clinical success at day 90 after randomisation. Secondary evaluation criteria include both efficacy and safety assessments. Three ancillary studies are planned to describe the epidemiology of ß-lactamase encoding genes, the ecological impact and pharmacokinetic/pharmacodynamic parameters of cefazolin and cloxacillin. Including 300 patients will provide 80% power to demonstrate the non-inferiority of cefazolin over cloxacillin, assuming 85% success rate with cloxacillin and taking into account loss-to-follow-up, with a 0.12 non-inferiority margin and a one-sided type I error of 0.025. ETHICS AND DISSEMINATION: This protocol received authorisation from the ethics committee Sud-Est I on 13 November 2017 (2017-87-PP)and French National Agency for Medicines and Health Products (170661A-43). Results will be disseminated to the scientific community through congresses and publication in peer-reviewed journals. TRIAL REGISTRATION NUMBER: NCT03248063 and 2017-003967-36.


Assuntos
Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Cefazolina/uso terapêutico , Cloxacilina/uso terapêutico , Infecções Estafilocócicas/tratamento farmacológico , Staphylococcus aureus/efeitos dos fármacos , Adulto , Protocolos Clínicos , Humanos
8.
Artigo em Inglês | MEDLINE | ID: mdl-29610194

RESUMO

We investigated whether the addition of fosfomycin or cloxacillin to daptomycin provides better outcomes in the treatment of methicillin-resistant Staphylococcus aureus (MRSA) experimental aortic endocarditis in rabbits. Five MRSA strains were used to perform in vitro time-kill studies using standard (106) and high (108) inocula. Combined therapy was compared to daptomycin monotherapy treatment in the MRSA experimental endocarditis model. A human-like pharmacokinetics model was applied, and the equivalents of cloxacillin at 2 g/4 h, fosfomycin at 2 g/6 h, and daptomycin at 6 to 10 mg/kg/day were administered intravenously. A combination of daptomycin and either fosfomycin or cloxacillin was synergistic in the five strains tested at both inocula. A bactericidal effect was detected in four of five strains tested with both combinations. The MRSA-277 strain (vancomycin MIC, 2 µg/ml) was used for the experimental endocarditis model. Daptomycin plus fosfomycin significantly improved the efficacy of daptomycin monotherapy at 6 mg/kg/day in terms of both the proportion of sterile vegetations (100% versus 72%, P = 0.046) and the decrease in the density of bacteria within the vegetations (P = 0.025). Daptomycin plus fosfomycin was as effective as daptomycin monotherapy at 10 mg/kg/day (100% versus 93%, P = 1.00) and had activity similar to that of daptomycin plus cloxacillin when daptomycin was administered at 6 mg/kg/day (100% versus 88%, P = 0.48). Daptomycin nonsusceptibility was not detected in any of the isolates recovered from vegetations. In conclusion, for the treatment of MRSA experimental endocarditis, the combination of daptomycin plus fosfomycin showed synergistic and bactericidal activity.


Assuntos
Antibacterianos/uso terapêutico , Daptomicina/uso terapêutico , Endocardite Bacteriana/tratamento farmacológico , Endocardite Bacteriana/microbiologia , Fosfomicina/uso terapêutico , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Animais , Antibacterianos/farmacocinética , Cloxacilina/farmacocinética , Cloxacilina/uso terapêutico , Daptomicina/farmacocinética , Sinergismo Farmacológico , Feminino , Fosfomicina/farmacocinética , Humanos , Coelhos
9.
J Infect Chemother ; 24(7): 555-562, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29628387

RESUMO

PURPOSE: To analyze the influence of adding gentamicin to a regimen consisting of ß-lactam or vancomycin plus rifampicin on survival in patients suffering from Staphylococcal prosthetic valve endocarditis (SPVE). METHODS: From January 2008 to September 2016, 334 patients with definite SPVE were attended in the participating hospitals. Ninety-four patients (28.1%) received treatment based on ß-lactam or vancomycin plus rifampicin and were included in the study. Variables were analyzed which related to patient survival during admission, including having received treatment with gentamicin. RESULTS: Seventy-seven (81.9%) were treated with cloxacillin (or vancomycin) plus rifampicin plus gentamicin, and 17 patients (18.1%) received the same regimen without gentamicin. The causative microorganism was Staphylococcus aureus in 40 cases (42.6%) and coagulase-negative staphylococci in 54 cases (57.4%). Overall, 40 patients (42.6%) died during hospital admission, 33 patients (42.9%) in the group receiving gentamicin and 7 patients in the group that did not (41.2%, P = 0.899). Worsening renal function was observed in 42 patients (54.5%) who received gentamicin and in 9 patients (52.9%) who did not (p = 0.904). Heart failure as a complication of endocarditis (OR: 4.58; CI 95%: 1.84-11.42) and not performing surgery when indicated (OR: 2.68; CI 95%: 1.03-6.94) increased mortality. Gentamicin administration remained unrelated to mortality (OR: 1.001; CI 95%: 0.29-3.38) in the multivariable analysis. CONCLUSIONS: The addition of gentamicin to a regimen containing vancomycin or cloxacillin plus rifampicin in SPVE was not associated to better outcome.


Assuntos
Antibacterianos/administração & dosagem , Endocardite Bacteriana/tratamento farmacológico , Endocardite Bacteriana/mortalidade , Gentamicinas/administração & dosagem , Próteses Valvulares Cardíacas/microbiologia , Infecções Relacionadas à Prótese/tratamento farmacológico , Infecções Relacionadas à Prótese/mortalidade , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/mortalidade , Idoso , Antibacterianos/uso terapêutico , Cloxacilina/administração & dosagem , Cloxacilina/uso terapêutico , Endocardite Bacteriana/complicações , Feminino , Gentamicinas/uso terapêutico , Insuficiência Cardíaca/induzido quimicamente , Insuficiência Cardíaca/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Estudos Prospectivos , Insuficiência Renal/induzido quimicamente , Insuficiência Renal/etiologia , Rifampina/administração & dosagem , Rifampina/uso terapêutico , Staphylococcus aureus/efeitos dos fármacos , Vancomicina/administração & dosagem , Vancomicina/uso terapêutico
10.
Int J Antimicrob Agents ; 52(3): 344-349, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29665445

RESUMO

BACKGROUND: International guidelines recommend high-dose cloxacillin for endocarditis or osteoarticular infections due to methicillin-susceptible staphylococci. However, data on the tolerability of these regimens are scarce. METHODS: We used the computerized registry of suspected drug-related adverse events in our institution. Cases of acute kidney injury (AKI), as defined by KDIGO, in patients receiving high-dose cloxacillin were retrospectively reviewed. Data were collected from medical charts on a standardized questionnaire. RESULTS: From 2009 to 2015, 23 consecutive patients (16 men, 7 women) with a median age of 75 years (interquartile range [IQR], 66-80) fulfilled inclusion criteria. By the time of AKI diagnosis, patients were treated with a median cloxacillin dose of 12 g/day (IQR, 10-12) after a median duration of 7 days (IQR, 4-10). Most patients (n=20) fulfilled RIFLE criteria for failure, with a median peak serum creatinine concentration of 339 µmol/L (IQR, 249-503). Urinalysis was indicative of tubular disease in 7 patients, 3 had hypereosinophilia and 8 had abnormal liver function tests. All patients presented at least one risk factor for AKI, including concomitant nephrotoxic drugs: gentamicin (n=19), diuretics (n=15), angiotensin-converting enzyme inhibitors (n=8) and angiotensin II receptor-blockers (n=6). Thirteen patients (57%) had cloxacillin plasma concentrations >50 µg/mL. Thirteen patients (57%) had complete recovery of renal function. CONCLUSIONS: AKI during high-dose cloxacillin treatment mostly occurs in elderly patients taking concomitant nephrotoxic drugs. The outcome is usually favourable after cloxacillin discontinuation. Therapeutic drug monitoring may decrease the risk of AKI in patients treated with high-dose cloxacillin.


Assuntos
Lesão Renal Aguda/induzido quimicamente , Antibacterianos/efeitos adversos , Cloxacilina/efeitos adversos , Lesão Renal Aguda/terapia , Idoso , Idoso de 80 Anos ou mais , Bloqueadores do Receptor Tipo 1 de Angiotensina II/efeitos adversos , Inibidores da Enzima Conversora de Angiotensina/efeitos adversos , Antibacterianos/uso terapêutico , Cloxacilina/uso terapêutico , Creatinina/sangue , Diuréticos/efeitos adversos , Endocardite/tratamento farmacológico , Feminino , Gentamicinas/efeitos adversos , Humanos , Rim/efeitos dos fármacos , Rim/patologia , Masculino , Estudos Retrospectivos , Fatores de Risco
11.
Sci Rep ; 8(1): 5081, 2018 03 23.
Artigo em Inglês | MEDLINE | ID: mdl-29572457

RESUMO

Bovine mastitis affects the health of dairy cows and the profitability of herds worldwide. Coagulase-negative staphylococci (CNS) are the most frequently isolated pathogens in bovine intramammary infection. Based on the wide range of antimicrobial, mucoadhesive and immunostimulant properties demonstrated by chitosan, we have evaluated therapy efficiency of chitosan incorporation to cloxacillin antibiotic as well as its effect against different bacterial lifestyles of seven CNS isolates from chronic intramammary infections. The therapeutic effects of combinations were evaluated on planktonic cultures, bacterial biofilms and intracellular growth in mammary epithelial cells. We found that biofilms and intracellular growth forms offered a strong protection against antibiotic therapy. On the other hand, we found that chitosan addition to cloxacillin efficiently reduced the antibiotic concentration necessary for bacterial killing in different lifestyle. Remarkably, the combined treatment was not only able to inhibit bacterial biofilm establishment and increase preformed biofilm eradication, but it also reduced intracellular bacterial viability while it increased IL-6 secretion by infected epithelial cells. These findings provide a new approach to prophylactic drying therapy that could help to improve conventional antimicrobial treatment against different forms of bacterial growth in an efficient, safer and greener manner reducing multiresistant bacteria generation and spread.


Assuntos
Antibacterianos/uso terapêutico , Quitosana/uso terapêutico , Cloxacilina/uso terapêutico , Mastite Bovina/tratamento farmacológico , Infecções Estafilocócicas/veterinária , Staphylococcus/efeitos dos fármacos , Animais , Antibacterianos/administração & dosagem , Antibacterianos/farmacologia , Biofilmes/efeitos dos fármacos , Bovinos , Quitosana/administração & dosagem , Quitosana/farmacologia , Cloxacilina/administração & dosagem , Cloxacilina/farmacologia , Feminino , Mastite Bovina/microbiologia , Testes de Sensibilidade Microbiana , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/microbiologia , Staphylococcus/isolamento & purificação , Staphylococcus/fisiologia
14.
Lakartidningen ; 1152018 01 16.
Artigo em Sueco | MEDLINE | ID: mdl-29337337

RESUMO

Automatic infectious disease consultant alert is associated with decreased mortality and readmission rate in Staphylococcus aureus bacteriemia A management plan was implemented at a 2000 bed teaching hospital where positive blood cultures with growth of Staphylococcus aureus were reported simultaneously to the ordering unit and to the Infectious Disease Consultant. Readmission rate and 30-day mortality were compared one year before and one year after introduction of the management plan. Out of totally 320 respectively 321 patients with SAB 252 and 244 were included in the study. 30-day mortality decreased from 26/252 (10%) to 14/244 (5,7%) (p=0.059) when all patients with SAB were included and to 9/193 (4,7%) (p=0,026) when only patients who received a formal consultation after introduction of the management plan were included. The rate of readmission within 30 days declined from 38/227 (17%) in 2014-2015 to 24/230 (10%) in 2015-2016 (p=0,049).


Assuntos
Bacteriemia/mortalidade , Profissionais Controladores de Infecções , Readmissão do Paciente/estatística & dados numéricos , Infecções Estafilocócicas/mortalidade , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Criança , Pré-Escolar , Cloxacilina/uso terapêutico , Comorbidade , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Infecções Estafilocócicas/tratamento farmacológico , Staphylococcus aureus/isolamento & purificação , Fatores de Tempo , Adulto Jovem
17.
J Vet Pharmacol Ther ; 41(1): 22-27, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28600854

RESUMO

Three hundred subclinically infected quarters of 259 Holstein cows infected with gram-positive bacteria were selected via quota sampling based on the California Mastitis Test (CMT) result and were divided randomly and equally into treatment and test groups. Quarters of test group (n = 150 in 128 cows) were treated with an intramammary infusion of tilmicosin, and quarters of the control group (n = 150 in 131 cows) were treated with cloxacillin as a traditional intramammary infusion of dry cow (DC) ointment. Cows with more than one infected quarter were randomly assigned to the same group, and adjacent quarters were treated the same. The milk samples of all quarters were obtained, and bacterial cultures and somatic cell count (SCC) were tested before dry cow therapy (DCT) (50 ± 15 days before parturition), and finally on day 2 of the next lactation. Results have shown that total bacteriological cure rates on day 2 of the next lactation were 45% and 78%, (p = .01), new infection rates were 43.3% and 56.6%, and SCC was (6.732 × 105  ± 3.124 × 105 ) and (5.025 × 105  ± 2.935 × 105 ), (p > .05) in test and control groups, respectively. Tilmicosin had less effect on reducing IMI due to Corynebacterium bovis, and had no effect on Streptococcus agalactiae, but had a potent effect against Staphylococcus aureus. It was concluded that tilmicosin alone should not be infused as an alternative to conventional dry cow therapy. However, it had a significant effect against S. aureus, and the potential of tilmicosin to treat S. aureus IMI should be confirmed in further studies.


Assuntos
Antibacterianos/uso terapêutico , Mastite Bovina/tratamento farmacológico , Tilosina/análogos & derivados , Animais , Antibacterianos/administração & dosagem , Infecções Assintomáticas , Bovinos , Contagem de Células/veterinária , Cloxacilina/administração & dosagem , Cloxacilina/uso terapêutico , Vias de Administração de Medicamentos/veterinária , Feminino , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Infecções por Bactérias Gram-Positivas/microbiologia , Infecções por Bactérias Gram-Positivas/veterinária , Glândulas Mamárias Animais , Mastite Bovina/microbiologia , Tilosina/administração & dosagem , Tilosina/uso terapêutico
19.
Int J Immunopathol Pharmacol ; 30(3): 297-301, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28786715

RESUMO

Cloxacillin, a semisynthetic penicillin is a potent inhibitor of most penicillinase-producing Staphylococci. Use of high doses of Cloxacillin for 6 weeks is recommended for the treatment of infective endocarditis caused by methicillin-susceptible Staphylococcus aureus (MSSA). Here, we report a case of Cloxacillin-induced agranulocytosis in a patient treated for MSSA native tricuspid valve endocarditis, which was resolved after discontinuation of the antibiotic. This case report highlights a rare adverse event of a commonly used antibiotic.


Assuntos
Agranulocitose/induzido quimicamente , Antibacterianos/efeitos adversos , Cloxacilina/efeitos adversos , Adulto , Antibacterianos/uso terapêutico , Cloxacilina/uso terapêutico , Endocardite Bacteriana/tratamento farmacológico , Feminino , Humanos , Infecções Estafilocócicas/tratamento farmacológico , Staphylococcus aureus , Adulto Jovem
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