Comparison of in vitro activities of ceftazidime, piperacillin-tazobactam, and cefoperazone-sulbactam, and the implication on empirical therapy in patients with cancer.

Background: Infection is a common cause of morbidity and mortality in cancer patients. In most of these cases empirical treatment is provided because the focus of infection is not identified. Empiric antibiotics provided to these patients are based on isolates, sensitivity, and on guidelines. Here we have compared three antibiotics recommended as empirical treatment by the Infectious Disease Society of America (IDSA). Aims: To compare the three antibiotic sensitivities for gram negative isolates at our institute. Objective: To choose the optimal antibiotic as the empirical treatment for cancer patients developing infections. Materials and Methods: We collected the data on isolates and antibiotic sensitivity patterns of isolates for ceftazidime, piperacillin + tazobactum, and cefoperazone from the medical oncology department. We subsequently compared the sensitivity of these three antibiotics. Statistical Methods: The isolates were mapped using the WHONET 5.4 software. The analysis was conducted using SPSS 15.0 for Windows. McNemar Chi-square test was used to compare the sensitivity percentages between any two antibiotics. The agreement between the antibiotic and the gold standard was calculated using the Kappa statistic. Two tailed p values were reported. Results: The results showed that there was a difference among sensitivities for these antibiotics. It appears that the sensitivity of ceftazidime was inferior to the two other antibiotics. Also cefoperazone has better sensitivity as compared to piperacillin + tazobactum. Conclusion: In spite of these three antibiotics being recommended by IDSA our data suggest that it should not be followed blindly and local sensitivity data is important for formulating institutional guidelines for using antibiotics.

Aislamientos microbiológicos en el Hospital Patrocinio Peñuela Ruíz: Estado Táchira 2005 / Microbiological isolation in the Hospital Patrocinio Peñuela Ruíz: Tachira State 2005

El cultivo de microorganismos es un proceso que permite el aislamiento de los gérmenes causantes o asociados a una infección. Con el aislamiento del germen no solamente se documenta el agente etiológico, sino que éste se tiene disponible para realizar pruebas de tipificación, determinación de sensibilidad a antibióticos y capacidad bactericida de líquidos corporales. En el Hospital Patrocinio Peñuela Ruíz, durante el año 2005, se realizaron 850 aislamientos microbiológicos, por lo que se plantea realizar una investigación de tipo transversal, retrospectivo, descriptivo y observacional, que tiene como objetivo determinar la prevalencia de los microorganismos aislados, a través de los cultivos secreciones, durante enero-diciembre 2005. Los principales resultados son que el mayor porcentaje (50,42) fue realizado en mujeres. La tendencia a realizar toma de muestra para aislamiento microbiológico es en los extremos de la vida, con un 23,05 por ciento en las personas mayores de 60 años y un 11,16 por ciento en los menores de 12 años. El 43,17 por ciento resultaron positivos para algún microorganismo aislado. El principal microorganismo aislado por servicio y otros departamentos fue: en pediatría Staphylococcus aureus (8.03 por ciento), en la Emergencia pediátrica Staphylococcus aureus (8.33 por ciento). En Medicina Interna Staphylococcus aureus 11,73 por ciento, en la Emergencia de Adultos staphylococcus aureus 18,07 por ciento, en Traumatología pseudomona aeurinosa y el staphylococcus aureos con 7,69 por ciento cada una. En Cirugía pseudomona aeruginosa (17,05 por ciento), en gineco-obstetricia e.coli (23,53 por ciento), y para terminar, en la Unidad de Cuidados Intensivos, Pseudomona aeruginosa 15,97 por ciento. También gracias a esta investigación, se pudo determinar la sensibilidad o resistencia antibiótica de los principales microorganismos aislados.

Comparative in vitro activity of beta-lactam/beta-lactamase inhibitor combinations against gram negative bacteria.

BACKGROUND & OBJECTIVE: Currently, the use of beta-lactamase inhibitors in combination with beta-lactam antibiotics represents an effective measure to combat a specific resistance mechanism of beta-lactamase producing organisms. Knowledge about the susceptibility profile of bacteria to different combination agents available is essential to guide appropriate treatment of severe infections in hospitalized patients. The present study compares the in vitro activity of three commercially available beta-lactam/beta-lactamase inhibitor combinations (piperacillin/tazobactam, cefoperazone/sulbactam, ticarcillin/clavulanic acid) against beta-lactamase producing gram negative bacteria in a tertiary care hospital in north India. METHODS: A total of 9004 consecutively isolated extended spectrum beta-lactamase (ESBL) producing gram negative bacteria isolated from various clinical samples from patients admitted to the All India Institute of Medical Sciences, New Delhi, from September 2003 to August 2004 were included in the study. These isolates were screened for ESBL production by the inhibitor based test recommended by the National Committee for Clinical Laboratory Standards (NCCLS). Antibiotic susceptibility testing was carried out by disc diffusion method as per NCCLS guidelines. RESULTS: Of the 9004 isolates tested, 3232 (35.89%) were sensitive and 568 (6.31%) were resistant to all three combination agents, and rest 5204 (57.80%) were resistant to at least one of the combinations. Susceptibility to piperacillin/tazobactam, cefoperazone/sulbactam, and ticarcillin/clavulanic acid was 81.37, 76.06 and 45.48 per cent respectively. Piperacillin/tazobactam exhibited significantly (P<0.05) greater antimicrobial activity against Pseudomonas spp., Escherichia coli and Klebsiella spp. compared to cefoperazone/sulbactam. INTERPRETATION & CONCLUSION: Overall piperacillin/tazobactam was observed to be the best combination agent followed by cefoperazone/sulbactam in our setting. This difference in activities of these combination agents needs to be evaluated further by ascertaining their efficacy in clinical studies.

Susceptibilidad antimicrobiana de cepas de Pseudomonas aeruginosa aisladas en el laboratorio del Hospital Regional Dr. Leonardo Guzmán de Antofagasta, Chile / In vitro antimicrobial susceptibility of Pseudomonas aeruginosa strains isolated at Hospital Dr. Leonardo Guzmán, Antofagasta, Chile

Pseudomonas aeruginosa es un patógeno nosocomial frecuente que presenta elevada resistencia a los antimicrobianos y causa infecciones graves cuando hay alteración de los mecanismos defensivos del paciente. Así, conocer los patrones locales de sensibilidad es importante para la elección del tratamiento antimicrobiano adecuado en cada institución. En este trabajo determinamos la susceptibilidad antimicrobiana de cepas de P. aeruginosa aisladas desde pacientes atendidos en el Hospital Regional de Antofagasta. La mayoría de los pacientes tenía alguna condición predisponente a la infección y 48% tenía una infección grave. Las cepas mostraron mayor resistencia a los antimicrobianos que lo reportado en trabajos nacionales previos. Las cepas fueron altamente resistentes a amikacina (36,8%), ceftazidima (36,8%) y ciprofloxacina (68,4%), moderadamente resistentes a imipenem (26,3%), mientras que eran escasamente resistentes a piperacilina/tazobactam (5,3%) y cefoperazona/sulbactam (15,8%), Este es el primer trabajo, realizado en nuestra región, que estudia la susceptibilidad de P. aeruginosa frente a distintos grupos de antimicrobianos utilizados en clínica.

Pseudomonas aeruginosa is a nosocomial pathogen that often displays a high degree of antibiotic resistance. This pathogen causes also serious infections specially in patients with severe diseases or immunodeficiency. To offer the best treatment in every institution it is necessary to know the local pattern of antimicrobial susceptibility, then we studied the antibiotic susceptibility of P. aeruginosa strains isolated from patients attended in the Regional Hospital of Antofagasta. Most of them had an underlying disease that predisposed them to the infection and 48% had a severe infection. The strains showed higher drug resistance than that reported by other chilean researchers. P. aeruginosa displayed high resistance to amikacin (36,8%), ceftazidime (36,8%) and ciprofloxacin (68,4%) intermediate resistance to imipenem (26,3%), but low resistance to piperacillin/tazobactam (5,3%) and cefoperazone/sulbactam (15,8%). This is the first drug susceptibility study conducted in the Second Region of Chile, where P. aeruginosa was assayed against those antibiotics used in the clinical practice.

Susceptibility of clinical isolates of Bacteroides fragilis group strains to cefoxitin, cefoperazone and ticarcillin/clavulanate

A total of 40 strains of the B. fragilis group was isolated from clinical specimens in two hospital centers in Fortaleza from 1993 to 1997. The most frequently isolated species was Bacteroides fragilis (19 strains) and most isolates came from intra-abdominal and wound infections. The susceptibility profile was traced for cefoxitin, cefoperazone and ticarcillin-clavulanate by using the agar dilution reference method. All isolates were susceptible to ticarcillin-clavulanate (128/2mug/ml). Resistance rates of 15 and 70 percent were detected to cefoxitin (64mug/ml) and cefoperazone (64mug/ml), respectively. Such regional results permit a better orientation in choosing this group of antibiotics for prophylaxis and therapy especially in relation to cefoxitin, which is frequently used in the hospital centers studied.

In vitro activity of cefoperazone-sulbactam: Singapore experience.

In vitro activity of commonly used antimicrobial agents against consecutively isolated 521 strains of Gram negative bacilli causing serious infections in the National University Hospital, Singapore were tested in parallel with cefoperazone-sulbactam combination. With the combination complete resistance of 2% and intermediate resistance of 5% were noted among the 521 strains tested. Resistance to imipenem was low (5%) but resistance against other antimicrobial agents varied from 12% (amikacin) to 80% (ampicillin). In vitro data demonstrated a possible future role for cefoperazone-sulbactam in the treatment of sepsis caused by Gram negative bacilli in our hospital.

Cefoperazone monotherapy for serious infections in hospitalized patients--an initial Indian experience.

Cefoperazone sodium is a broad spectrum third generation Cephalosporin recently introduced in India. This was used as a monotherapy to treat severe infections in hospitalized patients. These infections were due to various gram positive and gram negative organisms. Of the 22 evaluable patients, 21 (95%) were clinically cured and 1 (5%) improved. 18 pathogens were isolated from 17 patients. Microbiologic eradication was 100%. Symptomatic improvement occurred within 48-72 hours of onset of therapy with complete relief by 4-5 days. Dual mode of excretion makes this drug safe in presence of renal insufficiency. Anti-microbial activity against a wide spectrum of organisms and twice daily dosage schedule qualify Cefoperazone as a single antibiotic of choice in severe infections in critically ill patients.

Susceptibilidad de escherichia coli frente a 13 drogas antimicrobiana / Susceptibility of escherichia coli against 13 antimicrobial drugs

Escherichia coli es uno de los bacilos gram negativos más aislados en nuestras clínicas, provocando diversos cuadros de tipo infeccioso. Por este motivo es importante conocer la susceptibilidad antimicrobiana de esta especie, con el fin de poder administrar drogas antimicrobianas realmente efectivas. Este trabajo determina la sensibilidad cuantitativa "in vitro" de 245 cepas de Escherichia coli, aisladas de diversas muestras clínicas frente a 13 drogas antimicrobianas para lo cual se utilizó el método de dilución en agar de Ericsson y Sherris. Los resultados obtenidos muestran que alrededor del 90 por ciento de las cepas fueron sensibles a Enoxacino, Cefotaxima, Aztreonam, Gentamicina, Ceftriaxzona, Amikacina, Cefuroximo, Cefoperazona y Nitrofurantoina y alrededor del 50 por ciento de las cepas fueron sensibles a Cefradina. Frente a los restantes antimicrobianos-Cloramfenicol, Cotrimoxazol y Ampicilina- se obtuvo un alto nivel de resistencia

Eficacia clínica de la cefoperazona en infecciones severas / Clinical efficacy of cefoperazone in severe infections

Se evaluó la eficacia clínica y la tolerancia de la cefoperazona (2-6 g/día por 12 días en promedio) en 14 pacientes hospitalizados con las infecciones siguientes: infección de herida operatoria, celulitis, antrax, bronconeumonía, neumonía, infeccion urinaria y osteomielitis. Se encontró un 100% de efectividad en la curación clínica de las mismas y un 92.9% de erradicación bacteriológica. Los microorganismos aislados fueron S. aureus (2), P. aeruginosa (1), S. epidermidis (1), C. diversus (1), E. agglomerans (5), E. coli (4) y dos no identificados. En dos pacientes se aislaron dos especies bacterianas del sitio de infección. Los efectos colaterales observados fueron leves y no ameritaron la suspensión del tratamiento y fueron los siguientes: elevación de fosfatasa alcalina (1), descenso de hemoglobina (1) eritema nodoso (1), en estos tres casos es difícil establecer si fueron provocados por la cefoperazona o por la enfermedad concurrente. Un leve aumento del tiempo de protrombina fue observado en dos casos. En conclusión la cefoperazona resultó un antibiótico de alta eficacia y de excelente tolerancia en infecciones severas causadas por organismos susceptibles

Evaluación del espectro y actividad in vitro de cefoperazona en relación a 9 antimicrobianos frente a diversas bacterias patógenas / Evaluation of spectrum and in vitro activity of cefoperazone in relation of 9 antimicrobial agents in different pathogenical bacteria

Se comparó la actividad in vitro de Cefoperazone en relación a Cefotaxima, Ceftriaxona, Amikacina, Gentamicina, Dibekacina, Cotrimoxazol, Cloramfenicol, Ampicilina (se incluyó en determinadas instancias Carbenicilina, Cloxacilina y Cefazolina) frente a 967 cepas de bacterias patógenas de las cuales 749 bacilos Gram negativos y 218 cocáceas en placa determinando la concentración inhibitoria mínima (CIM). Los resultados mostraron actividad similar a Cefotaxima, Ceftriaxona y Amikacina frente a E. coli, S. typhi y Pseudomonas aeruginisa; una relativa menor efectividad sobre Klebsiella, S. Typhimurium y Proteus mirabilis. En relación a S. aureus su actividad fue inferior a Cloxacilina pero con un rango de cobertura del 84 por ciento. Destaca efectividad de Cefoperazona sobre Streptococcus grupo D tipo enterococo (82,2 por ciento de cepas sensibles) significativamente superior a las otras cefalosporinas y a los aminoglicósidos