Our library of drug research abstracts drawn from the medical literature is updated on a regular schedule, and you can be assured that new septrin research articles will be listed here shortly after becoming available to us.
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Cluster of Stenotrophomonas maltophilia endocarditis after prosthetic valve replacement.
Wien Klin Wochenschr. 2008 Sep; 120(17-18): 566-570
Müller-Premru M, Gabrijelčič T, Geršak B, Kolman J, Svent-Kucina N, Spik V, Lejko-Zupanc T
Early postoperative prosthetic valve endocarditis due to Stenotrophomonas maltophilia was diagnosed in seven patients (two men) aged from 68 to 84 years (mean age 78.1 years) over a three-year period. All patients had undergone aortic valve replacement. S. maltophilia was isolated from at least two blood cultures per patient. Four patients experienced CNS embolic complications. Three patients died. All patients were treated with ceftazidime, one in combination with amikacin, one with ciprofloxacin and one with levofloxacin. Because a common source of infection in the operating theater was suspected, 24 environmental samples were taken, of which two contained S. maltophilia. Six of the seven clinical isolates from the patients and two isolates from the environment were analyzed using molecular typing by pulsed-field gel electrophoresis (PFGE). The patients' isolates were resistant to gentamicin, ciprofloxacin, trimethoprim/sulfamethoxazole and, except in one case, to amikacin and piperacillin/tazobactam and susceptible to ceftazidime and levofloxacin. In contrast, the environmental isolates were resistant to ceftazidime, showed intermediate susceptibility to ciprofloxacin, and were susceptible to trimethoprim/sulfamethoxazole. PFGE demonstrated indistinguishable or closely related (1-3 band difference) PFGE patterns in isolates from the patients, but a different pattern in the environmental isolates. No common source of infection was found despite intensive investigation. Extensive cleaning and other measures of infection control were carried out and no new cases were recorded in the two year follow-up period.
Optimizing use of oral antibiotics in acne vulgaris.
Dermatol Clin. 2009 Jan; 27(1): 33-42
Del Rosso JQ, Kim G
Oral antibiotics are commonly used to treat acne vulgaris, primarily in patients presenting with moderate to severe facial or truncal disease severity. These agents are most appropriately used in combination with a topical regimen containing benzoyl peroxide and a topical retinoid. The most common oral antibiotics for treating acne vulgaris are the tetracycline derivatives, although macrolide agents such as erythromycin have also been used extensively. Over the past 4 decades, as the sensitivity of Propionibacterium acnes to several oral and topical antibiotics has decreased, the efficacy of oral tetracycline and erythromycin has markedly diminished, leading to increased use of doxycycline, minocycline, and other agents, such as trimethoprim/sulfamethoxazole.
Splenic pneumocystosis: an atypical presentation of extrapulmonary Pneumocystis infection.
AIDS Read. 2008 Oct; 18(10): 503-8
O'Neal CB, Ball SC
Brucellosis in Egyptian female patients.
J Egypt Soc Parasitol. 2008 Aug; 38(2): 671-8
Sabah AA, Aly AM, Tawab AH, Arafa WA
Over six months, 129 consecutive brucellosis cases were diagnosed in females attending the outpatients' clinics the females in Al-Azhar and Ain Shams Universities Hospitals. Their ages ranged between 12-65 years old. 113 (87.6%) gave history of raw milk consumption, 13 (10%) gave history of home slaughtering of sheep, 2 (1.5%) gave history of animal contact, and one patient gave history of abortion, that partner had brucellosis. A total of 61.2% of patients gave serum agglutination test of 1: 640, who suffered acute or subacute infection. Titers of 1:320 (38.8%) were found in the majority of chronic cases. Causes of endemic parasitosis were excluded. Symptoms were fever (79.5%), headache (72.4%), generalized arthralgia (65.3%), sweating (65.3%), chills (63.8%), backache (34.6%), abdominal pain (27.5%), loss of appetite (25.5%), lassitude (17.2%), myalgia (14.2%), monoarthralgia (7.9%). Spinal involvement was in 15% patients, who had chronic brucellosis. 32/35 were successfully treated with a combination of streptomycin and tetracycline, 17/21 with streptomycin and septrin, 38/43 with tetracycline and septrin, and 26/26 (100%) with rifampicin and tetracycline or septrin, which treated all resistant patients.
Prophylaxis after exposure to Coxiella burnetii.
Emerg Infect Dis. 2008 Oct; 14(10): 1558-66
Moodie CE, Thompson HA, Meltzer MI, Swerdlow DL
Coxiella burnetii is a category B bioterrorism agent. We numerically evaluated the risks and benefits from postexposure prophylaxis (PEP) after an intentional release of C. burnetii to the general population, pregnant women, and other high-risk populations. For each group, we constructed a decision tree to estimate illness and deaths averted by use of PEP/100,000 population. We calculated the threshold points at which the number of PEP-related adverse events was equal to the cases averted. PEP was defined as doxycycline (100 mg 2x/day for 5 days), except for pregnant women, where we assumed a PEP of trimethoprim-sulfamethoxazole (160 mg/800 mg 2x/day) for the duration of the pregnancy. PEP would begin 8-12 days postexposure. On the basis of upper-bound probability estimates of PEP-related adverse events for doxycycline, we concluded that the risk for Q fever illness outweighs the risk for antimicrobial drug-related adverse events when the probability of C. burnetii exposure is >or=7% (pregnant women using trimethoprim-sulfamethoxazole = 16%).
The history holds the key in this gardener with a skin infection.
JAAPA. 2008 Sep; 21(9): 35-7
Lykowski TA, Orpilla ER, Hayek RJ
Cornea. 2008 Oct; 27(9): 1074-6
Ramos-Esteban JC, Bamba S, Jeng BH
PURPOSE: To describe the history, clinical presentation, and successful medical management of a case of multidrug-resistant Flavobacterium indologenes keratitis. METHODS: An 83-year-old pseudophakic female presented with a 2-day history of decreased visual acuity, light sensitivity and dull ocular pain in her right eye. Two weeks before presentation, the patient had been treated for a red eye with combination topical loteprednol etabonate (0.5%) and tobramycin (0.3%) eye drops. Corneal scrappings were performed by the referring ophthalmologist, and hourly administration of gatifloxacin 0.3% eye drops was started. Evaluation consisted of slit lamp examination, organism identification, and antibiotic sensitivity testing. RESULTS: Examination of the right eye revealed a central 5-mm X 2-mm anterior stromal infiltrate with an overlying epithelial defect. Gatifloxacin 0.3% eye drops were stopped, and hourly topical fortified vancomycin (50 mg/mL) and ceftazidime (50 mg/mL) eye drops were instituted. Oxidase-positive gram-negative bacilli were identified in the thioglycollate broth on day 3, and therefore, vancomycin was discontinued and hourly ciprofloxacin 0.3% eye drops were added to the regimen. The cultures ultimately grew F. indologenes, which was highly resistant to all antibiotics tested except for trimethoprim-sulfamethoxazole. Accordingly, ciprofloxacin 0.3% and ceftazidime were discontinued. The patient was started on hourly topical trimethoprim (16 mg/mL)/sulfamethoxazole (80 mg/mL) eye drops, resulting in clinical control of the infection over a period of 1 month. CONCLUSIONS: Flavobacterium indologenes keratitis can be resistant to treatment with many medications, and antibiotic susceptibility profile testing in these cases may provide crucial information to help eradicate the infection.
Community infections caused by extended-spectrum beta-lactamase-producing Escherichia coli.
Arch Intern Med. 2008 Sep 22; 168(17): 1897-902
Rodríguez-Baño J, Alcalá JC, Cisneros JM, Grill F, Oliver A, Horcajada JP, Tórtola T, Mirelis B, Navarro G, Cuenca M, Esteve M, Peña C, Llanos AC, Cantón R, Pascual A
BACKGROUND: Extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli is an increasingly important group of community pathogens worldwide. These organisms are frequently resistant to many of the antimicrobial agents usually recommended for the treatment of infections caused by E coli, such as penicillins, cephalosporins, fluoroquinolones, and trimethoprim-sulfamethoxazole. Data concerning risk factors, clinical features, and therapeutic options for such infections are scarce. METHODS: A case-control study was performed to investigate the risk factors for all types of community-acquired infections caused by ESBL-producing E coli in 11 Spanish hospitals from February 2002 to May 2003. Controls were randomly chosen from among outpatients with a clinical sample not yielding ESBL-producing E coli. The clinical features of these infections were investigated in the case patients. The efficacy of fosfomycin tromethamine and amoxicillin-clavulanate potassium was observationally studied in patients with cystitis. RESULTS: A total of 122 cases were included. Risk factors selected by multivariate analysis included the following: age older than 60 years; female sex; diabetes mellitus; recurrent urinary tract infections (UTIs); previous invasive procedures of the urinary tract; follow-up in outpatient clinic; and previous receipt of aminopenicillins, cephalosporins, and fluoroquinolones. Urinary tract infections accounted for 93% of the cases; 6% of the patients were bacteremic and 10% needed hospitalization. The cure rate of patients with cystitis was 93% with fosfomycin therapy (all isolates were susceptible); among patients treated with amoxicillin-clavulanate, cure rates were 93% for those with susceptible isolates (minimum inhibitory concentration < or =8 microg/mL) and 56% for those with intermediate or resistant isolates (minimum inhibitory concentration > or =16 microg/mL) (P = .02). CONCLUSIONS: In predisposed patients, ESBL-producing E coli is a notable cause of community-acquired infection, and particularly UTI. Fosfomycin and amoxicillin-clavulanate appear to be effective for cystitis caused by susceptible isolates.
Clin Infect Dis. 2008 Nov 1; 47(9): 1150-8
Talan DA, Krishnadasan A, Abrahamian FM, Stamm WE, Moran GJ,
BACKGROUND: High rates of resistance to trimethoprim-sulfamethoxazole (TMP-SMX) among uropathogenic Escherichia coli are recognized, and concerns exist about emerging fluoroquinolone resistance. METHODS: Adults presenting to 11 US emergency departments with (1) flank pain and/or costovertebral tenderness, (2) temperature >38 degrees C, and (3) a presumptive diagnosis of pyelonephritis were enrolled; patients for whom 1 uropathogen grew on culture were analyzed. Epidemiologic and clinical data were collected at the time of care. The prevalence of E. coli in vitro antibiotic resistance and risk factors associated with TMP-SMX-resistant E. coli infection were determined. RESULTS: Among 403 women with uncomplicated pyelonephritis caused by E. coli, the mean site rate of E. coli resistance to TMP-SMX was 24% (range, 13%-45%). Mean site rates of E. coli resistance to ciprofloxacin and levofloxacin were 1% and 3%, respectively. Only TMP-SMX exposure within 2 days before presentation and Hispanic ethnicity were associated with E. coli resistance to TMP-SMX (compared with resistance rates of approximately 20% among women lacking these risk factors); antibiotic exposure within 3-60 days before presentation, health care setting exposure within 30 days before presentation, history of urinary tract infections, and age >55 years were not associated with E. coli resistance to TMP-SMX. Among 207 patients with complicated pyelonephritis, mean site rates of E. coli resistance to ciprofloxacin and levofloxacin were 5% and 6%, respectively. CONCLUSIONS: These results suggest that the prevalence of TMP-SMX-resistant infection among patients with uncomplicated pyelonephritis is > or =20% in many areas of the United States, and risk stratification cannot identify patients at low risk of infection. Rates of fluoroquinolone-resistant E. coli infection appear to be low among patients with uncomplicated pyelonephritis but higher among those with complicated infections. Fluoroquinolones should remain to be the preferred empirical treatment for women with uncomplicated pyelonephritis.
Finding the path of least antimicrobial resistance in pyelonephritis.
Clin Infect Dis. 2008 Nov 1; 47(9): 1159-61
Lautenbach E