RESUMO
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.
Assuntos
Isquemia Encefálica/tratamento farmacológico , Isquemia Encefálica/metabolismo , Região CA1 Hipocampal/metabolismo , Transportador 2 de Aminoácido Excitatório/metabolismo , Ácido Glutâmico/metabolismo , Sulbactam/administração & dosagem , Animais , Transporte Biológico/efeitos dos fármacos , Isquemia Encefálica/genética , Região CA1 Hipocampal/efeitos dos fármacos , Transportador 2 de Aminoácido Excitatório/genética , Humanos , Masculino , Neurônios/efeitos dos fármacos , Neurônios/metabolismo , Ligação Proteica/efeitos dos fármacos , Ratos , Ratos WistarRESUMO
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.
Assuntos
Antibacterianos/administração & dosagem , Cistatina C/sangue , Pneumonia/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Envelhecimento/fisiologia , Ampicilina/administração & dosagem , Ampicilina/farmacocinética , Antibacterianos/farmacocinética , Relação Dose-Resposta a Droga , Cálculos da Dosagem de Medicamento , Feminino , Taxa de Filtração Glomerular/fisiologia , Humanos , Rim/fisiologia , Masculino , Modelos Biológicos , Pneumonia/sangue , Eliminação Renal , Sulbactam/administração & dosagem , Sulbactam/farmacocinéticaRESUMO
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.
Assuntos
Glicina/análogos & derivados , Herbicidas/intoxicação , Hipernatremia/etiologia , Hipopotassemia/etiologia , Pneumonia Aspirativa/etiologia , Síndrome do Desconforto Respiratório/etiologia , Idoso , Cefamandol/administração & dosagem , Cefamandol/análogos & derivados , Cefamandol/uso terapêutico , Cefoperazona/administração & dosagem , Cefoperazona/uso terapêutico , Clindamicina/administração & dosagem , Clindamicina/uso terapêutico , Suplementos Nutricionais , Feminino , Glicina/intoxicação , Humanos , Hipernatremia/tratamento farmacológico , Hipopotassemia/tratamento farmacológico , Pneumonia Aspirativa/tratamento farmacológico , Potássio/administração & dosagem , Potássio/uso terapêutico , Síndrome do Desconforto Respiratório/tratamento farmacológico , Tentativa de Suicídio , Sulbactam/administração & dosagem , Sulbactam/uso terapêutico , Resultado do Tratamento , GlifosatoRESUMO
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.
Assuntos
Antibacterianos/administração & dosagem , Escherichia coli/metabolismo , Staphylococcus aureus/metabolismo , Tecnécio , Ampicilina/administração & dosagem , Infecções por Escherichia coli/diagnóstico por imagem , Infecções Estafilocócicas/diagnóstico por imagem , Sulbactam/administração & dosagem , Compostos de EstanhoRESUMO
Durlobactam (DUR; ETX2514) is a novel ß-lactamase inhibitor with broad-spectrum activity against Ambler class A, C, and D ß-lactamases. Durlobactam restores the in vitro activity of sulbactam (SUL) against members of the Acinetobacter baumannii-A. calcoaceticus complex (ABC). Sulbactam (SUL)-durlobactam (SUL-DUR) is under development for the treatment of ABC infections. Eighty patients with complicated urinary tract infection (cUTI), including acute pyelonephritis (AP), were randomized 2:1 to receive SUL-DUR at 1 g/1 g intravenously (i.v.) or placebo every 6 h (q6h) for 7 days and background therapy with imipenem-cilastatin (IMI) at 500 mg i.v. q6h to evaluate the tolerability of SUL-DUR in hospitalized patients. Patients with bacteremia could receive up to 14 days of therapy. SUL-DUR tolerability and the values of various pharmacokinetic (PK) parameters were determined. Efficacy was recorded at the test-of-cure (TOC) visit. SUL-DUR was well tolerated, with no serious adverse events (AEs) being reported. Headache (5.7%), nausea (3.8%), diarrhea (3.8%), and vascular pain (3.8%) were the most common drug-related AEs with SUL-DUR and were mostly of mild or moderate severity. The PK profile of DUR and SUL in hospitalized patients was consistent with observations in healthy volunteers. Overall success in the microbiological modified intent-to-treat (m-MITT) population was similar between the groups, as would be expected with IMI background therapy in all patients (overall success at the TOC visit, 76.6% [n = 36] with SUL-DUR and 81.0% [n = 17] with placebo). SUL-DUR in combination with IMI was well tolerated in patients with cUTIs. The pharmacokinetics of SUL-DUR observed in hospitalized patients was similar to that observed in healthy volunteers. (This study has been registered at ClinicalTrials.gov under identifier NCT03445195.).
Assuntos
Antibacterianos/farmacocinética , Antibacterianos/uso terapêutico , Combinação Imipenem e Cilastatina/farmacocinética , Combinação Imipenem e Cilastatina/uso terapêutico , Pielonefrite/tratamento farmacológico , Pielonefrite/microbiologia , Sulbactam/farmacocinética , Sulbactam/uso terapêutico , Infecções Urinárias/tratamento farmacológico , Doença Aguda , Administração Intravenosa , Adulto , Idoso , Antibacterianos/administração & dosagem , Combinação Imipenem e Cilastatina/administração & dosagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Efeito Placebo , Sulbactam/administração & dosagemRESUMO
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.
Assuntos
Infecções por Campylobacter/diagnóstico , Campylobacter upsaliensis/isolamento & purificação , Cistos/diagnóstico , Abscesso Hepático/diagnóstico , Idoso , Antibacterianos/administração & dosagem , Infecções por Campylobacter/microbiologia , Infecções por Campylobacter/terapia , Campylobacter upsaliensis/genética , Catéteres , Cefoperazona/administração & dosagem , Cistos/microbiologia , Cistos/terapia , DNA Bacteriano/genética , DNA Bacteriano/isolamento & purificação , Quimioterapia Combinada , Humanos , Fígado/diagnóstico por imagem , Fígado/microbiologia , Abscesso Hepático/microbiologia , Abscesso Hepático/terapia , Masculino , Tipagem de Sequências Multilocus , Paracentese/instrumentação , Sulbactam/administração & dosagem , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
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.
Assuntos
Infecções por Acinetobacter , Acinetobacter/isolamento & purificação , Infecções Comunitárias Adquiridas , Infecções por Acinetobacter/diagnóstico , Infecções por Acinetobacter/tratamento farmacológico , Infecções por Acinetobacter/fisiopatologia , Idoso , Antibacterianos/administração & dosagem , Evolução Fatal , Humanos , Masculino , Pessoa de Meia-Idade , Sulbactam/administração & dosagemRESUMO
Sulbactam-durlobactam is being developed for the treatment of infections caused by Acinetobacter baumannii, including those caused by multidrug- and carbapenem-resistant isolates. This was a phase 1 study to evaluate the effects of various degrees of renal impairment, including subjects with end-stage renal disease (ESRD) on hemodialysis (HD), on the pharmacokinetics and safety profile of durlobactam (also known as ETX2514) and sulbactam after single intravenous (i.v.) dose administration. For healthy subjects and those with mild or moderate renal impairment (RI), single 1,000-mg doses each of durlobactam and sulbactam via a 3-h i.v. infusion were administered, and for severe renal impairment, 500-mg doses were administered. For subjects with ESRD and HD, 500-mg i.v. doses each of durlobactam and sulbactam were administered post-HD and pre-HD, with a 1-week washout between doses. Among 34 subjects, decreasing renal function increased systemic exposure (peak plasma concentration [Cmax] and area under the concentration-time curve [AUC]) to durlobactam and sulbactam in a generally linear manner. In healthy subjects and in those with mild or moderate renal impairment, the majority of durlobactam and sulbactam was excreted in the urine, while approximately 40% or less was excreted in urine in subjects with severe renal impairment or ESRD. In subjects with ESRD, hemodialysis was effective at removing both durlobactam and sulbactam from plasma. Renal impairment had no effect of the safety/tolerability profile of durlobactam and sulbactam. In summary, RI and ESRD had a predictable effect on the pharmacokinetic (PK) profile of durlobactam and sulbactam with no adverse effects on the safety/tolerability profile. Durlobactam and sulbactam are cleared to a similar extent by renal elimination and are impacted similarly by renal impairment. The results from this study have been used with population PK modeling and nonclinically derived PK/PD (pharmacodynamic) exposure targets to establish dosage recommendations for durlobactam and sulbactam in patients with various degrees of RI. The dosing regimen of durlobactam-sulbactam will require adjustment in patients with severe renal insufficiency and in those with ESRD.
Assuntos
Compostos Azabicíclicos/administração & dosagem , Compostos Azabicíclicos/efeitos adversos , Sulbactam/administração & dosagem , Sulbactam/efeitos adversos , Acinetobacter baumannii/efeitos dos fármacos , Acinetobacter baumannii/patogenicidade , Administração Intravenosa , Idoso , Área Sob a Curva , Compostos Azabicíclicos/uso terapêutico , Feminino , Humanos , Falência Renal Crônica/tratamento farmacológico , Falência Renal Crônica/metabolismo , Masculino , Taxa de Depuração Metabólica/efeitos dos fármacos , Pessoa de Meia-Idade , Diálise Renal , Insuficiência Renal/tratamento farmacológico , Insuficiência Renal/metabolismo , Sulbactam/uso terapêuticoRESUMO
AIM: The optimal antibiotic regimen for preterm premature rupture of membrane (pPROM) is still unclear. This study aimed to determine the effects of ampicillin-sulbactam (SBT/ABPC) and azithromycin (AZM) on the incidence of bronchopulmonary dysplasia (BPD). METHODS: This retrospective study included women with singleton gestations and a diagnosis of pPROM between 22 and 27 weeks of gestation. In patients presenting with a high risk of intra-amniotic infection between January 2011 and May 2013, piperacillin or cefmetazole + clindamycin (regimen 1 group; n = 11) was administered, whereas SBT/ABPC and AZM (regimen 2 group; n = 11) were administered in patients presenting a similar risk between June 2013 and May 2016. RESULTS: The incidence of moderate or severe infant BPD in the regimen 2 group was significantly lower than that in the regimen 1 group, even when adjusted for gestational age at the time of rupture of membrane, with an odds ratio (95% confidence interval) of 0.02 (1.8 × 10-5 -0.33). The incidence of BPD and total days on mechanical ventilation were significantly lower in the regimen 2 group than in the regimen 1 group. No significant differences were seen in other morbidities. CONCLUSION: In patients with pPROM between 22 and 27 weeks of gestation, the administration of SBT/ABPC and AZM may improve the perinatal outcomes.
Assuntos
Antibacterianos/farmacologia , Azitromicina/farmacologia , Displasia Broncopulmonar/prevenção & controle , Ruptura Prematura de Membranas Fetais/tratamento farmacológico , Avaliação de Resultados em Cuidados de Saúde , Adulto , Ampicilina/administração & dosagem , Ampicilina/farmacologia , Antibacterianos/administração & dosagem , Azitromicina/administração & dosagem , Displasia Broncopulmonar/epidemiologia , Cefmetazol/farmacologia , Clindamicina/farmacologia , Quimioterapia Combinada , Feminino , Ruptura Prematura de Membranas Fetais/epidemiologia , Humanos , Incidência , Piperacilina/farmacologia , Gravidez , Estudos Retrospectivos , Sulbactam/administração & dosagem , Sulbactam/farmacologiaRESUMO
OBJECTIVE: Recent evidence supports the use of ampicillin-sulbactam as a favored choice for antibiotic prophylaxis following head and neck free flap reconstructive surgery. However, there is a paucity of evidence guiding the optimal duration of antibiotic prophylaxis. The aim of this study is to compare the infection rates of short courses of ampicillin-sulbactam versus extended courses of various antibiotics in head and neck free flap reconstructive surgery. METHODS: This is a retrospective cohort study conducted from 2012 to 2017 at a tertiary academic center on 266 consecutive patients undergoing head and neck surgery with free flap reconstruction. The primary outcome measure was the rate of any infection within 30â¯days of surgery. RESULTS: There were 149 patients who received antibiotic prophylaxis for an extended duration of at least seven days. 117 patients received a short course of antibiotics defined as 24â¯h for non-radiated patients and 72â¯h for radiated patients. Postoperative infections occurred in 45.9% of patients, of which 92.6% occurred at surgical sites. There was no significant difference in terms of postoperative infection rate between patients receiving an extended duration of antibiotics versus a short duration (pâ¯=â¯0.80). This held true for subgroups of surgical site infections (pâ¯=â¯0.38) and distant infections (pâ¯=â¯0.59 for pneumonia and pâ¯=â¯0.76 for UTI). Risk factors for infections were identified as hypothyroidism (pâ¯=â¯0.047) and clean contaminated wound classification (pâ¯=â¯0.0002). CONCLUSION: Shorter duration of ampicillin-sulbactam prophylaxis in free flap reconstruction of head and neck defects does not negatively affect postoperative infection rates. LEVEL OF EVIDENCE: Level 2b.
Assuntos
Antibacterianos/administração & dosagem , Antibioticoprofilaxia , Retalhos de Tecido Biológico , Neoplasias de Cabeça e Pescoço/cirurgia , Procedimentos de Cirurgia Plástica , Ampicilina/administração & dosagem , Protocolos Clínicos , Esquema de Medicação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sulbactam/administração & dosagem , Infecção da Ferida Cirúrgica/prevenção & controleRESUMO
ETX2514 is a novel ß-lactamase inhibitor that broadly inhibits Ambler class A, C, and D ß-lactamases. ETX2514 combined with sulbactam (SUL) in vitro restores sulbactam activity against Acinetobacter baumannii ETX2514-sulbactam (ETX2514SUL) is under development for the treatment of A. baumannii infections. The objective of this study was to determine and compare plasma, epithelial lining fluid (ELF), and alveolar macrophage (AM) concentrations following intravenous (i.v.) ETX2514 and sulbactam. Plasma, ELF, and AM concentrations of ETX2514 and sulbactam were measured by liquid chromatography-tandem mass spectrometry (LC-MS/MS) in 30 healthy adult subjects following repeated dosing (ETX2514 [1 g] and sulbactam [1 g] every 6 h [q6h], as a 3-h i.v. infusion, for a total of 3 doses). A bronchoalveolar lavage (BAL) was performed once in each subject at either 1, 2.5, 3.25, 4, or 6 h after the start of the last infusion. Penetration ratios were calculated from area under the concentration-time curve from 0 to 6 h (AUC0-6) values for total plasma and ELF using mean and median concentrations at the BAL fluid sampling times. Respective ELF AUC0-6 values, based on mean and median concentrations, were 40.1 and 39.4 mg · h/liter for ETX2514 and 34.7 and 34.5 mg · h/liter for sulbactam. Respective penetration ratios of ELF to total/unbound plasma concentrations, based on mean and median AUC0-6 values, of ETX2514 were 0.37/0.41 and 0.36/0.40, whereas these same ratio values were 0.50/0.81 and 0.50/0.80 for sulbactam. ETX2514 and sulbactam concentrations in AM were measurable and fairly constant throughout the dosing interval (median values of 1.31 and 1.01 mg/liter, respectively). These data support further study of ETX2514SUL for the treatment of pneumonia caused by multidrug-resistant A. baumannii (This study has been registered at ClinicalTrials.gov under identifier NCT03303924.).
Assuntos
Compostos Azabicíclicos/sangue , Compostos Azabicíclicos/metabolismo , Sulbactam/sangue , Sulbactam/metabolismo , Infecções por Acinetobacter/sangue , Infecções por Acinetobacter/tratamento farmacológico , Infecções por Acinetobacter/metabolismo , Acinetobacter baumannii/efeitos dos fármacos , Administração Intravenosa , Adulto , Antibacterianos/administração & dosagem , Antibacterianos/sangue , Antibacterianos/metabolismo , Compostos Azabicíclicos/administração & dosagem , Lavagem Broncoalveolar/métodos , Líquido da Lavagem Broncoalveolar/microbiologia , Feminino , Voluntários Saudáveis , Humanos , Macrófagos Alveolares/microbiologia , Masculino , Pessoa de Meia-Idade , Alvéolos Pulmonares/microbiologia , Sulbactam/administração & dosagemRESUMO
PURPOSE: Beta lactams are standard empirical therapy for febrile neutropenia (FN). The aim of this study was to evaluate the efficacy and safety of cefepime monotherapy compared with cefoperazone/sulbactam plus amikacin (CS + A) for empirical treatment of high risk FN. METHODS: One hundred seventy-five patients with 336 FN episodes were randomized to receive either cefepime (2 g q8h for adults and 50 mg/kg q8h for children) or CS (2 g q8h for adults and 50 mg/kg q8h for children) plus amikacin (15 mg/kg once a day). Positive response was defined as afebrile within 72 h of starting antibiotics, persistent afebrile status more than 48 h and no requirement of second-line antibiotics and antifungal agents. RESULTS: Three hundred thirty-six episodes were assessable for efficacy (168 cefepime, 168 CS + A). The positive response to antibiotics was identical for cefepime (53%) and CS + A (53%). Positive response was similar in MDI (microbiologically documented infection), 50 vs. 35% (p = 0.248), CDI (clinically documented infection), 50 vs. 35% (p = 0.259), combination CDI + MDI, 25 vs. 15% (p = 0.400), FUO (fever of unknown origin), 68 vs. 72% (p = 0.577) respectively in the two groups. The successful discontinuation of antibiotics at 72 h in FUO was similar in both groups (60 vs. 59%, p = 0.544). Total drug-related adverse events were similar in both groups (8 vs. 6%) except renal dysfunction was high in CS + A (1 vs. 7 events). Mortality was the same between two groups (8 vs 7%). CONCLUSIONS: Cefepime monotherapy and CS + A had similar efficacy as first-line therapy for FN. Discontinuation of empirical antibiotics is safe and feasible approach in selected group of FUO patients.
Assuntos
Amicacina/administração & dosagem , Antibacterianos/administração & dosagem , Cefoperazona/administração & dosagem , Cefalosporinas/administração & dosagem , Neutropenia Febril Induzida por Quimioterapia/tratamento farmacológico , Sulbactam/administração & dosagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Amicacina/efeitos adversos , Antibacterianos/efeitos adversos , Antibioticoprofilaxia/efeitos adversos , Antibioticoprofilaxia/métodos , Antineoplásicos/uso terapêutico , Cefepima , Cefoperazona/efeitos adversos , Cefalosporinas/efeitos adversos , Neutropenia Febril Induzida por Quimioterapia/epidemiologia , Criança , Pré-Escolar , Quimioterapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/tratamento farmacológico , Neoplasias/mortalidade , Sulbactam/efeitos adversos , Análise de Sobrevida , Suspensão de Tratamento , Adulto JovemRESUMO
OBJECTIVE: The present study examined the effect of high-dose cefoperazone-sulbactam combined with tigecycline against ventilator-associated pneumonia (VAP) caused by extensively drug-resistant Acinetobacter baumannii(XDR-AB). MATERIALS AND METHODS: 42 patients with VAP due to XDR-AB infection were randomized into two groups: the TIG group (received tigecycline injection) and the TIG+CFS group (received tigecycline and cefoperazone-sulbactam (1 : 1) injection). Pulsed field gel electrophoresis (PFGE) was used for genotyping the isolated XDR-AB. The microdilution method was used to test the minimum inhibitory concentration (MIC) of cefoperazone-sulbactam or tigecycline in vitro and the combined effect was determined with the checkerboard method. RESULTS: The total combined effectiveness rate (including all patients who demonstrated an improved condition) was significantly higher in the TIG+CFS group (85.7%) compared with the TIG group (47.6%) (p = 0.010). No significant differences were noted with regard to the adverse reactions between the two groups. The 42 isolated XDR-AB strains were classified into four types. The MIC of the two drugs in combination was significantly lower than that of each drug used alone (p < 0.05). CONCLUSION: High dose of cefoperazone-sulbactam can improve the antimicrobial activity of tigecycline against XDR-AB.â©.
Assuntos
Infecções por Acinetobacter/tratamento farmacológico , Antibacterianos/administração & dosagem , Minociclina/análogos & derivados , Pneumonia Associada à Ventilação Mecânica/tratamento farmacológico , Infecções por Acinetobacter/microbiologia , Acinetobacter baumannii/efeitos dos fármacos , Idoso , Cefoperazona/administração & dosagem , Estudos de Coortes , Relação Dose-Resposta a Droga , Farmacorresistência Bacteriana Múltipla , Quimioterapia Combinada , Eletroforese em Gel de Campo Pulsado , Feminino , Genótipo , Humanos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Minociclina/administração & dosagem , Pneumonia Associada à Ventilação Mecânica/microbiologia , Estudos Prospectivos , Sulbactam/administração & dosagem , Tigeciclina , Resultado do TratamentoRESUMO
The case deals with an anaphylactoid reaction to intravenous ampicillin/sulbactam resulting in cardiogenic syncope and myocardial damage. Symptoms and ECG modifications promptly disappeared after corticosteroids administration. The Kounis syndrome is an acute coronary syndrome, including coronary spasm, acute myocardial infarction and stent thrombosis, resulting from an anaphylactic or anaphylactoid or allergic or hypersensitivity insult. First described in 1991, it can be caused by a lot of substances, particularly antibiotics. The management should be directed to both the allergic reaction and the myocardial damage. The Kounis syndrome is a not rare disease that every physician should know because of the wideness of triggers and the possible fatal evolution if not promptly recognized.
Assuntos
Ampicilina/efeitos adversos , Anafilaxia/induzido quimicamente , Síndrome de Kounis/diagnóstico , Sulbactam/efeitos adversos , Síndrome Coronariana Aguda/diagnóstico , Síndrome Coronariana Aguda/etiologia , Doença Aguda , Idoso , Ampicilina/administração & dosagem , Ampicilina/uso terapêutico , Anafilaxia/complicações , Anafilaxia/tratamento farmacológico , Vasoespasmo Coronário/etiologia , Humanos , Síndrome de Kounis/etiologia , Masculino , Infarto do Miocárdio/etiologia , Infarto do Miocárdio com Supradesnível do Segmento ST/fisiopatologia , Stents , Sulbactam/administração & dosagem , Sulbactam/uso terapêutico , Trombose/etiologia , Resultado do Tratamento , Inibidores de beta-Lactamases/efeitos adversos , Inibidores de beta-Lactamases/uso terapêuticoRESUMO
BACKGROUND: Open total gastrectomy carries a high risk of surgical-site infection (SSI). This study evaluated the non-inferiority of antimicrobial prophylaxis for 24 compared with 72 h after open total gastrectomy. METHODS: An open-label, randomized, non-inferiority study was conducted at 57 institutions in Japan. Eligible patients were those who underwent open total gastrectomy for gastric cancer. Patients were assigned randomly to continued use of ß-lactamase inhibitor for either 24 or 72 h after surgery. The primary endpoint was the incidence of SSI, with non-inferiority based on a margin of 9 percentage points and a 90 per cent c.i. The secondary endpoint was the incidence of remote infection. RESULTS: A total of 464 patients (24 h prophylaxis, 228; 72 h prophylaxis, 236) were analysed. SSI occurred in 20 patients (8·8 per cent) in the 24-h prophylaxis group and 26 (11·0 per cent) in the 72-h group (absolute difference -2·2 (90 per cent c.i. -6·8 to 2·4) per cent; P < 0·001 for non-inferiority). However, the incidence of remote infection was significantly higher in the 24-h prophylaxis group. CONCLUSION: Antimicrobial prophylaxis for 24 h after total gastrectomy is not inferior to 72 h prophylaxis for prevention of SSI. Shortened antimicrobial prophylaxis might increase the incidence of remote infection. Registration number: UMIN000001062 ( http://www.umin.ac.jp).
Assuntos
Antibioticoprofilaxia , Gastrectomia , Neoplasias Gástricas/cirurgia , Infecção da Ferida Cirúrgica/prevenção & controle , Idoso , Ampicilina/administração & dosagem , Esquema de Medicação , Feminino , Humanos , Japão/epidemiologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Infecções Respiratórias/epidemiologia , Sulbactam/administração & dosagem , Infecção da Ferida Cirúrgica/epidemiologia , Inibidores de beta-Lactamases/administração & dosagemRESUMO
BACKGROUND: ß-D-glucan (BDG) is a helpful diagnostic marker for many invasive fungal infections, but not for nocardiosis. Here, we reported the first case of nocardial infection with high serum level of BDG. CASE PRESENTATION: A 73-year-old man was hospitalized because of fever, headache, and appetite loss after 10 months of steroid and immunosuppressive therapy for cryptogenic organizing pneumonia. With a diagnosis of bacterial pneumonia, treatment with ampicillin/sulbactam was initiated. There was improvement on chest radiograph, but fever persisted. Further work-up revealed multiple brain abscesses on cranial magnetic resonance imaging (MRI). Serum galactomannan and BDG were elevated at 0.6 index and 94.7 pg/ml, respectively. Voriconazole was initiated for presumed aspergillus brain abscess. However, fever persisted and consciousness level deteriorated. Drainage of brain abscess was performed; based on the Gram stain and Kinyoun acid-fast stain, disseminated nocardiosis was diagnosed. Voriconazole was then shifter to trimethoprim/sulfamethoxazole. The presence of Nocardia farcinica was confirmed by the 16S rRNA gene sequence. Treatment course was continued; BDG level normalized after 1 month and cranial MRI showed almost complete improvement after 2 months. CONCLUSION: BDG assay is widely used to diagnose invasive fungal infection; therefore, clinicians should be aware that Nocardia species may show cross-reactivity with BDG assay on serum.
Assuntos
Abscesso Encefálico/microbiologia , Nocardiose/sangue , beta-Glucanas/sangue , Idoso , Ampicilina/administração & dosagem , Anti-Infecciosos/uso terapêutico , Abscesso Encefálico/diagnóstico , Abscesso Encefálico/tratamento farmacológico , Drenagem , Humanos , Masculino , Nocardiose/diagnóstico , Nocardiose/tratamento farmacológico , Sulbactam/administração & dosagem , Combinação Trimetoprima e Sulfametoxazol/administração & dosagemRESUMO
BACKGROUND: Japan has an aging population and an increasing number of patients who reside in long-term care and mental health facilities. Both pneumococcal pneumonia and influenza B infection outbreaks have been observed in these populations, although no reports have described concurrent outbreaks of pneumococcal pneumonia and influenza B infection in these facilities. CASE PRESENTATION: Six patients and two staffs were initially diagnosed with influenza B infection at a mental health facility on March 14, 2015. By March 21, influenza B infection was diagnosed in 26 patients and 10 staff; all individuals received anti-influenza drugs. On March 19, two patients were diagnosed with pneumococcal pneumonia, and seven patients had developed pneumococcal pneumonia by March 24. Six of these seven patients also had influenza B infection. All individuals who developed pneumococcal pneumonia were hospitalized and treated using ampicillin/sulbactam at our hospital, and their symptoms subsequently subsided. Among the seven pneumococcal strains that were frozen and stored, two strains were type 3 and five strains were type 11A/E. Pulsed-field gel electrophoresis testing revealed that each of the serum types were from the same clone. CONCLUSION: It appears that an outbreak of influenza B infection was followed by the spread of multi-clone pneumococcal pneumonia among elderly patients at a mental health facility. Therefore, it may be prudent to use vaccinations to prevent the spread of pneumococcal pneumonia among elderly patients and this diagnosis should be actively considered during outbreaks of influenza infection at elder care facilities.
Assuntos
Surtos de Doenças/prevenção & controle , Vírus da Influenza B/isolamento & purificação , Influenza Humana/epidemiologia , Pneumonia Pneumocócica/epidemiologia , Idoso , Ampicilina/administração & dosagem , Antibacterianos/administração & dosagem , Antivirais/uso terapêutico , Humanos , Vírus da Influenza B/genética , Influenza Humana/terapia , Japão/epidemiologia , Assistência de Longa Duração , Pessoa de Meia-Idade , Pneumonia Pneumocócica/tratamento farmacológico , Enfermagem Psiquiátrica , Sorotipagem , Streptococcus pneumoniae/efeitos dos fármacos , Sulbactam/administração & dosagemRESUMO
Bifidobacterium species, a normal commensal of the human gastrointestinal tract, female genitourinary tract and vagina is usually considered non-pathogenic and is being used therapeutically as probiotic due to its beneficial effects. However, there are several case reports implicating Bifidobacteria as the causative agent in various infectious conditions. Infections with Bifidobacteria are often ignored or underreported as they are part of the normal gut microbiome. Here we discuss a case of pyometrocolpos with Bifidobacterium species. Clinical outcome of the patient was good after emergency drainage and antibiotic treatment with Cefoperazone sulbactam and Metronidazole.
Assuntos
Infecções por Bifidobacteriales/diagnóstico , Infecções por Bifidobacteriales/microbiologia , Bifidobacterium/isolamento & purificação , Piometra/diagnóstico , Piometra/microbiologia , Antibacterianos/administração & dosagem , Infecções por Bifidobacteriales/patologia , Infecções por Bifidobacteriales/terapia , Cefoperazona/administração & dosagem , Pré-Escolar , Drenagem , Feminino , Humanos , Metronidazol/administração & dosagem , Piometra/patologia , Piometra/terapia , Sulbactam/administração & dosagemRESUMO
Finegoldia magna (formerly called Peptostreptococcus magnus) is a Gram-positive anaerobic coccus which is increasingly recognized as an opportunistic pathogen. We present a case of F. magna associated non-valvular cardiovascular device-related infection in an 83 year-old male who received a permanent pacemaker for sick sinus syndrome seven weeks prior to his presentation. Five weeks after the implantation, the pacemaker and leads were explanted because of clinical evidence of pacemaker pocket infection. He was initially treated with sulfamethoxazole-trimethoprim based on the Gram stain results from the removed pacemaker. However, two weeks later, he was readmitted with sepsis and was successfully treated with ampicillin-sulbactam. Culture results from the pacemaker and pocket as well as blood cultures grew F. magna. Clinicians should be aware of the possibility of F. magna infection when initial gram stain results show "gram positive cocci".
Assuntos
Firmicutes/isolamento & purificação , Infecções por Bactérias Gram-Positivas/diagnóstico , Infecções por Bactérias Gram-Positivas/patologia , Marca-Passo Artificial/efeitos adversos , Infecções Relacionadas à Prótese/diagnóstico , Infecções Relacionadas à Prótese/patologia , Idoso de 80 Anos ou mais , Ampicilina/administração & dosagem , Animais , Antibacterianos/administração & dosagem , Firmicutes/classificação , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Humanos , Masculino , Infecções Relacionadas à Prótese/tratamento farmacológico , Sulbactam/administração & dosagem , Resultado do Tratamento , Combinação Trimetoprima e Sulfametoxazol/administração & dosagemRESUMO
Objective: To evaluate the reliability of using imipenem, meropenem, cefoperazone-sulbactam, piperacillin-tazobactam in the treatment of hospital-acquired Gram-negative bacterial infections with Monte Carlo simulation(MCS). Methods: The MIC of the four agents collected from hospital-acquired infections were detected in accordance with broth dilution method of Clinical and Laboratory Standard Institute (CLSI). MCS were conducted with MICs and the pharmacokinetics parameters of the four agents based on conventional dose regimens.The cumulative fraction of response (CFR) of time over MIC target attainment in different dosing regimen were generated. Results: A total of 2 541 strains, including 2 093 strains of Enterobacteriaceae and 448 strains of glucose non-fermentative bacilli were collected.The MIC(90) of imipenem and meropenem against Enterobacteriaceae were less than 1 mg/L in general, whereas MIC(90) of two agents with ß-lactamase inhibitors was around 64 mg/L.As to glucose non-fermenting bacteria, MICs of all the four agents were very high, especially to Acinetobacter baumannii, which indicated MIC(50) more than 32 mg/L.MCS revealed that carbapenems had significantly higher CFR than those with ß-lactamase inhibitors.Imipenem and meropenem (1 g, q8 h) obtained CFRs of 74.69% and 81.42%, respectively.The CFR of cefoperazone-sulbactam (2 g, q8 h) and piperacillin-tazobactam (4 g, q6 h) (both excluding ß-lactamase inhibitors) were just 49.59% and 27.66% respectively, which increased after excluding A. baumannii in piperacillin-tazobactam. Conclusions: The conventional dose regimens of imipenem and meropenem are reliable for the empiric therapy of Gram-negative hospital-acquired bacterial infections.Piperacillin-tazobactam is suggested to use with higher doses or prolonged infusion time to satisfy the time of drug concentration exceeded the MIC(T>MIC)requirement.More clinical studies of cefoperazone-sulbactam should be conducted to optimize its regimen and guarantee its efficacy.