Identification of ACT-1 Plasmid-Mediated AmpC beta-Lactamase Producing Citrobacter freundii from a Chinese Patient

No abstract available.

Wound infections and culture sensitivity pattern in pediatric burn patients

To identify common organisms causing burn infection and their antimicrobial sensitivity pattern. A retrospective study of sixty patients with burn wound infection was carried out at burn unit of Khyber Teaching Hospital Peshawar from September 2006 to August 2007. Children who received burn injuries with signs and symptoms of septicemia were included in this study. Age, sex, percentage of burn wound and etiology of burn wounds was recorded. Culture and sensitivity tests were performed from burn wounds of those patients who were having fever and other features of septicemia by tissue culture of all patients[from infective sites] and their results were noted. Out of sixty patients, fourty were male and twenty were female pediatric burn patients. The most frequent organism isolated was staphylococcus aureus [25%], followed by pseudomonas [21.6%]. Other organisms included mix pseudomonas and staphylococcus aureus [23.5%], E-coli [13%], proteus [3%], Klebsiella [3%]. All these organisms were resistant to most routine antibiotics. This study highlights that staphylococcus aureus [25%] and pseudomonas [21.6%] are the most common organisms and cefoperazone/sulbactam and imipenem/cilastatin are the most effective empirical therapy in our setup

Cumplimiento sobre las recomendaciones de uso y evaluación del impacto económico de un programa de uso restringido de imipenem-cilastatina / Imipenem-cilastatin use in a university hospital in Chile

Imipenem is an expensive broad-spectrum antimicrobial, reserved for infections caused by multi-resistant nosocomial pathogens. Since 2001 our university hospital applies a restriction policy that allows rejecting or authorizing its use after a supervising evaluation whith pre-specified criteria for appropriate or inappropriate use. An audit was performed for all the supervisions made during the periods of March-April and September-October, 2004, totalizing 136 treatments. In global terms, 58.1 percent of treatments were considered appropriate and 11.8 percent inappropriate; other 20.6 percent had been discontinued by physicians in charge prior to evaluation. Susceptibility to other antimicrobials compounds was the main reason for inappropriate use. The remaining fraction involved deceased or discharged patients. Discontinuation of treatments by supervising physicians allowed to save 75 days and 362 vials of imipenem equivalent to US $ 6,777 during this period after discounting administrative and human resources costs.

Imipenem-cilastatina es un compuesto de amplio espectro y de alto costo, reservado para el manejo de infecciones nosocomiales y que requiere ser restringido para evitar la emergencia de agentes resistentes a esta alternativa y para contener costos. Desde el año 2001 existe un programa de uso restringido y supervisión de este compuesto en nuestro hospital que permite aprobar o rechazar su uso. Se efectuó una auditoria de todas las supervisiones efectuadas durante marzo-abril y septiembre-octubre del año 2004, totalizando 136 tratamientos. En términos globales, 58,1 por ciento de los tratamientos fue considerado apropiado, 11,8 por ciento inapropiado y 20,6 por ciento ya había sido suspendido por médicos tratantes al momento de la visita de supervisión. La fracción restante incluye pacientes de alta, fallecidos o trasladados. Las interrupciones de tratamiento implicaron un ahorro de imipenem-cilastatina de 75 días, 362 frascos y 3.524.133 de pesos (US 6,777) en los 4 meses de supervisión al incluir gastos en recursos humanos y costos administrativos.

Comparison of Efficacy of Cefoperazone/Sulbactam and Imipenem/Cilastatin for Treatment of Acinetobacter Bacteremia

Multiple antibiotic reisistance threatens successful treatment of Acinetobacter baumannii infections worldwide. Increasing interest in the well-known activity of sulbactam against the genus Acinetobacter has been aroused. The purpose of this study was to compare the outcomes for patients with Acinetobacter bacteremia treated with cefoperazone/sulbactam versus imipenem/cilastatin. Forty-seven patients with Acinetobacter baumannii bacteremia were analyzed through a retrospective review of their medical records for antibiotic therapy and clinical outcome. Thirty-five patients were treated with cefoperazone/sulbactam, and twelve patients with imipenem/ cilastatin. The percentage of favorable response after 72 hours was not statistically different between cefoperazone/ sulbactam group and imipenem/ cilastatin group. The mortality rate was not statistically different, too. Cefoperazone/sulbactam was found to be as useful as imipenem/cilastatin for treating patients with Acinetobacter bacteremia.

Effects of manipulation of N-methyl-D-aspartate receptors on imipenem/cilastatin-induced seizures in rats.

BACKGROUND & OBJECTIVES: Epileptic seizures have been reported in patients on imipenem/cilastatin (Imi/Cil) therapy. To investigate contribution of N-methyl-D-aspartate (NMDA) receptors in inducing imipenem/cilastatin (Imi/Cil) seizures, the effects of competitive NMDA antagonist, APV [(+/-)-2-amino-5-phosphonovaleric acid], non-competitive NMDA antagonist remacemide [(+/-)-2-amino-N-(1-methyl-1,2-diphenylethyl)-acetamidel, and glycine receptor partial agonist HA-966 [(+/-)-(3-amino-1-hydroxypyrrolid-2-one)] on electroencephalographic (EEG) activity and behaviour were studied in rats. METHODS: Adult male Wistar albino rats were implanted with electrodes and cannulae were placed into the right lateral ventricle. Animals were divided into five groups: (i) saline (icv)+Imi/Cil (ii) APV (0.2 micromol)+Imi/Cil, (iii) APV (0.4 micromol)+Imi/Cil, (iv) remacemide (100 mg/kg, ip)+Imi/Cil, and (v) HA-966 (200 microg, icv)+Imi/Cil. The drugs were administered 30 min before icv injection of Imi/Cil (100/100 microg), and their effects on incidence of seizures, latencies to EEG changes and convulsions, severity, lethality and time to lethal outcome were studied. RESULTS: Imi/Cil provoked complete seizure response in all rats and all animals died within 10-18 min after the injection. EEG epileptiform activity preceded behavioral seizures. Clonic-tonic seizures were characterized by continuous bursts of high frequency high amplitude spikes in the EEG. The dose of 0.2 micromol of APV prolonged only the latency to the first EEG changes, while 0.4 micromol dose significantly influenced all seizure parameters. HA-966 increased only the latency to Imi/Cil-induced convulsions, while remacemide had no significant effect on seizure parameters. INTERPRETATION & CONCLUSION: The results suggested that excitatory neurotransmission contributed to the generation and/or propagation of Imi/Cil-induced seizures in rats, and that the effects of NMDA antagonists depended on a particular binding site within the NMDA receptor complex, and affinity to that site.

Investigation on the antibiotic resistance and risky factors of nosocomial infections caused by Stenotrophomonas maltophilia / 中华烧伤杂志

<p><b>OBJECTIVE</b>To investigate the antibiotic resistance and risky factors of nosocomial infections caused by Stenotrophomonas maltophilia, so as to help elucidate the difference of drug resistance between metallic beta-lactamase (MBL) producing and non-MBL producing strains.</p><p><b>METHODS</b>Standard agar dilution method of NCCLS was employed in the isolation of 36 strains of Stenotrophomonas maltophilia from patients with nosocomial infection with respect to their in vitro antibiotic resistance to 18 kinds of antibiotics. MBL strains were identified by MBL-E test method.</p><p><b>RESULTS</b>Stenotrophomonas maltophilia in our hospital was mainly identified in the lower respiratory tract (88.9%), in which 88.2% (30/34) of the patients had serious original diseases, 50% of whom had received Imipenem/cilastatin sodium treatment. Thirty-six strains of Stenotrophomonas maltophilia were susceptible to new types of fluoquinolone antibiotics, i.e. Sparfloxacin, levofloxacin, gatifloxacin and doxycycline, with inhibitory rate ranging 97.2%, 94.4%, 91.7% to 83.3%, respectively. They could also be inhibited by SMZ/TMP and Ticarcillin/Lavulanic acid with inhibitory rate of 63.9% and 58.3%, respectively. There were 16 strains out of 36 of MBL bacteria with complete resistance to Imipenem/cilastatin sodium, but with higher susceptibility to aztreonam than those non-MBL producing strains.</p><p><b>CONCLUSION</b>The nosocomial infection in our hospital caused by Stenotrophomonas maltophilia seemed to be related with severe primary disease and the use of Imipenem/cilastatin sodium. The newly developed fluoroquinolones possessed powerful antibacterial potency on Stenotrophomonas maltophilia found in nosocomial infection.</p>

Clinical analysis of 29 children with early infectious complications following hematopoietic stem cells transplantation / 中华儿科杂志

<p><b>OBJECTIVE</b>To study the clinical features and the incidence of early infectious complications following children hematopoietic stem cells transplantation (HSCT).</p><p><b>METHODS</b>The clinical data of 29 cases with early infectious complications following HSCT was retrospectively analyzed.</p><p><b>RESULTS</b>The incidence of early infectious complications following HSCT in 31 children (including 22 cord blood transplantation and 9 peripheral blood stem cells transplantation) was 94% (29/31). The first occurrence of the early infectious complications was at a median of 6 (0 - 22) days, the peak time of incidence was at a median of 4 - 7 days post transplantation. The duration of the first early infectious complications was at a median of 9 (3 - 20) days. The occurrence of the second early infectious complications was at a median of 19 (13 - 27) days. For all of the 29 children, when they developed early infectious complications their absolute neutrophil counts (ANC) were all > 0.5 x 10(9)/L. The most common infectious sites were the digestive tract (oral and gastro-intestinal mucositis) and then the respiratory tract. Gram negative blood infections were quite frequent and Pseudomonas aeruginosa was common in the oral-pharynx discharge cultures. Two children had Mycoplasma pneumonia infections and there were 4 incidences with fever but no definite infectious foci. The incidence and duration of early infectious complications following hematopoietic stem cells transplantation were associated with the duration of neutropenia. The source and the MNCs dose of the graft, the difference of conditioning regimen and GVHD prophylaxis method did not have a significant impact on the incidence and duration of early infectious complications. Antibiotic prophylaxis (including Tienam) could delay the occurrence of the early infections significantly.</p><p><b>CONCLUSION</b>The incidence and duration of early infectious complications following hematopoietic stem cells transplantation were directly associated with the duration of neutropenia. Tienam regimen could postpone the early infections incidence and had effect of preventing the early infectious complications.</p>

Comparação das atividades antimicrobianas de meropenem e imipenem/cilastatina: o laboratório necessita testar rotineiramente os dois antimicrobianos? / Comparative antimicrobial activity between meropenem and imipenem/cilastatina: does the clinical laboratory need to test both imipenem and meropenem routinely?

O meropenem e o imipenem representam os ßðlactâmicos com maior espectro e potência antimicrobiana, e são os únicos carbapenêmicos disponíveis para uso clínico no Brasil, nos Estados Unidos e na Europa. O meropenem apresenta atividade in vitro superior contra gramðnegativos, enquanto que o imipenem é discretamente mais ativo contra gramðpositivos. Os objetivos deste estudo são comparar as atividade in vitro destes dois carbapenêmicos e avaliar a necessidade de o laboratório clínico testáðlos em sua rotina. Os resultados da avaliação dos padrões de sensibilidade de 2.144 bacilos gramðnegativos pela técnica de microdiluição em caldo foram analisados. Contra enterobactérias, o meropenem apresentou atividade pelo menos oito vezes maior que o imipenem. Contra Pseudomonas aeruginosa, o meropenem (CIM50 de 1 µg/ml) também apresentou atividade superior à do imipenem (CIM50 de 1 µg/ml para ambos). Somente 2,7 por cento das amostras avaliadas apresentaram resultados discordantes entre os dois carbapenêmicos em termos de categoria de sensibilidade ð isto é, foram sensíveis a um e resistentes ao outro. Quarenta e seis amostras (2,14 por cento) foram sensíveis ao meropenem e resistentes ao imipenem, enquanto que somente 12 amostras (0,55 por centro) apresentaram sensibilidade ao imipenem e resistência ao meropenem. A grande maioria dos resultados discordantes (91,4 por centro) ocorreu entre as amostras de bacilos gramðnegativos nãoðfermentadores da glicose (BGNðNF). Entre as 1.350 enterobactérias testadas houve apenas cinco resultados discordantes (0,37 por cento), enquanto que entre os BGNðNF ocorreram 53 (6,67 por cento). Além disso, em cerca de 80 por cento, as amostras foram sensíveis ao meropenem e resistentes ao imipenem. Os resultados deste estudo indicam que o laboratório de microbiologia pode testar apenas um dos carbapenêmicos contra enterobactérias, considerando para o outro o mesmo resultado. É importante que os resultados dos dois carbapenêmicos sejam colocados no relatório, para que o médico possa escolher aquele que achar mais adequado. Por outro lado, para os BGNðNF, o laboratório deve realizar o teste de sensibilidade com os dois carbapenêmicos separadamente

A randomized, controlled clinical trial on meropenem versus imipenem/cilastatin for the treatment of bacterial infections / 中华医学杂志(英文版)

<p><b>OBJECTIVE</b>To evaluate the efficacy and safety of meropenem in Chinese patients, we conducted a study for the treatment of patients with lower respiratory tract infections, urinary tract infections and other infections.</p><p><b>METHODS</b>A total of 182 hospitalized patients were enrolled in the study. 90 patients received 500 mg meropenem every 12 hours (or 1 g every 12 hours if necessary) and 92 patients received imipenem/cilastatin 500 mg/500 mg every 12 hours (or 1 g every 12 hours if necessary) by intravenous infusion. The duration of treatment was 7 - 14 days for both groups.</p><p><b>RESULTS</b>Seventy of 90 cases receiving meropenem and 70 of 92 cases receiving imipenem/cilastatin were assessable for clinical efficacy. The overall efficacy rates were 90% for the meropenem group and 87% for the imipenem/cilastatin group, and the bacterial eradication rates were 86% in both groups. 93 (76%) of 123 strains isolated from patients produced beta-lactamases. Adverse drug reactions were evaluated in 72 cases in the meropenem group and 70 cases in the imipenem/cilastatin group. The adverse drug reaction rates were 9.7% and 8.6%, respectively. The results showed that there were no statistical differences between these two groups (P > 0.05).</p><p><b>CONCLUSION</b>Meropenem is effective and safe for the treatment of bacterial infections caused mainly by beta-lactamase-producing strains.</p>

Incidencia de bacteriemia y neumonía nosocomial en una unidad de pediatría / Incidence of nosocomial bacteremia and pneumonia in a pediatric ward

Objetivo. Determinar la incidencia de bacteriemia relacionada con catéter y neumonía asociada a ventilador en niños hospitalizados. Material y métodos. Estudio prospectivo. En el servicio de Pediatría del Hospital General Regional (HGR) No 1 del Instituto Mexicano del Seguro Social (IMSS), de Durango, México, durante 18 meses, de enero de 1999 a junio del 2000, se implementó un sistema de vigilancia epidemiológica activa para identificar episodios de neumonía y bacteriemia nosocomial de acuerdo a las definiciones ope-racionales de la Norma Oficial Mexicana (NOM). A los pacientes hospitalizados que por su patología requirieron de ventilación mecánica o de catéter intravenoso central se les hizo seguimiento desde el primer día de exposición hasta la detección del episodio de infección o su retiro. Se efectuaron hemocultivos y cultivos de aspirado traqueal. Se calcularon tasas de incidencia para la neumonía asociada a ventilador y de bacteriemia/sepsis por 1 000 días de exposición con sus respectivos intervalos de confianza al 95 po ciento. También se presenta la tasa mensual de la infección por días de exposición por medio de gráficas de control estadístico. Resultados. Se identificaron 47 episodios de bacteriemia/sepsis relacionada con catéter y 44 de neumonía asociada a ventilador. La tasa de incidencia de neumonía fue de 28 eventos por 1 000 días de exposición a ventilador y la de bacteriemia/sepsis fue de 26 eventos por 1 000 días de exposición a catéter intravenoso central. Los microrganismos gram positivos (61.11 po ciento) predominaron sobre los gram negativos (38.88 po ciento). Conclusiones. Este estudio documentó tasas de neumonía y bacteriemia en niños, sustancialmente más elevadas que en otros informes, lo que hace necesario establecer lineamientos para la prevención de infecciones en niños con catéteres intravasculares y sobre los cuidados que requieren los niños sometidos a ventilación mecánica. El texto completo en inglés de este artículo está disponible en: http://www.insp.mx/salud/index.html

Imipenem-cilastatin versus sulbactam-cefoperazone plus amikacin in the initial treatment of febrile neutropenic cancer patients

The treatment of infectious complications in cancer patients has evolved as a consequence of the developments in the chemotherapy of cancer patients. In this prospective, randomized study, we compared imipenem-cilastatin and sulbactam-cefoperazone with amikacin in the empiric therapy of febrile neutropenic ( 0.05). No major adverse effects occurred. This study demonstrated that imipenem-cilastatin monotherapy and combination therapy of sulbactam-cefoperazone plus amikacin were equally effective empiric therapy for febrile granulocytopenic cancer patients.

Neonatal Klebsiella pneumonia sepsis and imipenem/cilastatin.

Efficacy and safety of imipenem/cilastatin in neonatal Klebsiella pneumonia sepsis was investigated in 45 infants compared to 39 control infants on conventional antibiotic regimen. Sensitivity to imipenem was 94% followed by cephoxitin (88%), quinolons (80%), and amikacin (52%) according to susceptibility results in the study group. Treatment duration of surviving infants was 16.5 +/- 4.6 and 20.3 +/- 6.4 days in the study and control groups respectively (p < 0.05). Five infants (11%) vs 27 (69%) were unresponsive (septic deaths) to treatment in the study and control groups respectively (p < 0.001). The cure rates were 73% and 28% respectively (p < 0.001). Sequelae free discharge rates were 67% and 23% respectively (p < 0.001). The most frequent adverse effects of imipenem/cilastatin were Candida albicans superinfection (20%); Candida albicans colonisation (10%); impairment of liver and renal functions (19% and 10% respectively); seizures (5%); thrombocytosis (3%); thrombophlebitis (3%); urine discoloration (3%); and Staphylococcus epidermidis colonisation (2%). Imipenem is considered a good alternative for neonatal Klebsiella pneumonia sepsis with these results, however, one must be aware of the increased risk of Candida albicans superinfection.

Tratamiento exitoso de abscesos cerebrales múltiples por nocardia en paciente sometido a transplante renal / Successful therapy of nocardial multiple brain abscesses in a renal transplant recipient

Se presenta un caso de abscesos cerebrales múltiples en un paciente sometido a transplante renal. El drenaje quirúrgico combinado con una terapia antimicrobiana prolongada fueron exitosos y el paciente está actualmente en buenas condiciones, sin secuelas neurológicas

Imipenem - cilastatina versus ceftazidima - amikacina para el tratamiento de pacientes neutropénicos febriles / Imipenem - cilastatine versus ceftazidime - amikacin in the treatment of febril neutropenic patients

Aim: To compare the efficacy of imipenem - cilastatine and ceftazidime - amikacin in the treatment of febril neutropenic patients. Design: Open prospective and randomized clinical study. Patients: 52 patients (26 females) aged 16 to 80 years old with 60 episodes of neutropenia were studied. They were randomly assigned to receive Imipenem - cilastatine in doses of 500 mg iv qid or the combination of ceftazidime 1 to 1.5 g iv tid and amikacin 7.5 mg/kg iv bid. Results: Global response to initial therapy was 53 percent in patients receiving imipenem - cilastatine and 37 percent in those receiving ceftazidime - amikacin (p=ns). When other antimicrobial were added, a 90 and 85 percent infection eradication success was achieved respectively. Six febrile episodes in the group receiving imipenem - cilastatine and 12 episodes in tha group receiving ceftazidime - amikacin had Gram positive cocci as the sole treatment outcome. Three patients receiving imipenem - cilastatine (10 percent) and 4 receiving ceftazidime - amikacin (13 percent) died. Superinfections and toxicity related to antibiotics were minimal in both groups. Conclusions: imipenem - cilastatine and the combination of ceftazidime with amikacin were equally effective in the treatment of febril episodes in neutropenic patients

Uso de imipenem-cilastatin / Imipenem-cilastatin use

El Imipenem-Cilastatín es un nuevo antibiótico ß-lactámico que pertenece a la familia de los carbapenem. Se trata de una combinación fija (1:1) de un derivado de la tienamicina (imipenenm) con un inhibidor de una dipeptidasa renal; la dehidropeptidasa I (Cilastatín), la combinación del abtibiótico con esta última sustancia, impide su hidrólisis e inactivación renal. Este antimicrobiano tiene la actividad antibacterial más amplia de todos los antibióticos disponibles para uso en humanos. Es activo contra estreptococos (incluyendo enterecocos), estafilococos y los aerobios gram-negativos, incluso P.aeruginosa. Las principales reacciones adversas han sido náuseas y vómitos los cuales ocurren durante la infusión intravenosa; además de convulsiones. La dosis pediátrica varía de 60 a 100 mg/kg/día cada 6 horas. El imipenem no debe ser utilizado rutinariamente. Su uso está justificado en infecciones producidas por gérmenes multiresistentes, no susceptibles a otros ß-lactámicos.

Clinical evaluation of imipenem/cilastatin a brazilian multicenter study on intravenous administration followed by intramuscular administration in acute infections

E apresentado estudo multicentrico brasileiro onde foram estudados 118 pacientes portadores de infeccoes agudas diversas, clinicas e/ou cirurgicas. A terapeutica antibiotica unica utilizada, associada ou nao a remocao do foco infeccioso, foi o imipenem/cilastatina sob duas vias de administracao. Na via endovenosa foram aplicadas doses de 500mg a cada oito horas ate a melhora clinica inicial do paciente, passando, entao, para a via intramuscular com 500mg a cada 12 horas. O periodo de aplicacao foi ate a cura clinica ou incapacidade de controle clinico de infeccao. Os resultados mostraram necessidade de aplicacao da via endovenosa por tres dias e de igual tempo para a via intramuscular no controle de 89,0 por cento dos casos. Concluem que a associacao da via endovenosa a intramuscular traz vantagens do manuseio do paciente sem comprometer a eficacia medicamentosa do antibiotico.

A multicenter randomized clinical trial comparing the clinical efficacy of Imipenem/Cilastin and Ceftazidime plus Metronidazole in surgically treated serious intra-abdominal infections

An open, prostective, randomized multicenter clinical trial randomly allocated successive patient who were scheduled for a surgical procedure for serious intra-abdominal infections to receive either treatment CM (ceftazidine plus metronidazole) or monotherapy with treatment IC (imipenem/cilastatin). Out of 90 eligible patients, 87 were clinically evaluable of which 71 were clinically and bacteriologically evaluable (CBE). Cases allocated to each treatment group were comparable as to age, sex, diagnostic group distribution, mean APACHE II scores, and bacteriologic evaluability. Among the 87 clinically evaluable patients, there were 4 (9.1%) and 2 (4.7%) treatment failures among those who received treatments CM and IC respectively (p=0.486). For all eligible patients, the mean fever days was 2.07, mean treatment days was 6.01, and mean hospital days was 11.57, and was not significantly different between the two treatment groups. Among clinically evaluable cases, the mean APACHE II scores of patients with succesful outcomes (5.8) was very significantly lower (p=0.000) than that of patients whose treatment failed (13.8). This was also true for CBE cases. Logistic regression analysis showed that among six variables (diagnostic group, APACHE II score, antibiotic used, fever days, hospital days and treatment days) only the APACHE II score signficantly contributed to treatment failure (p=0.001).

Evaluation of intramuscular formulation of imipenem-cilastatin in obstetrics and gynecological cases

Imipenem [N-formimidoyl thienamycin] is a new carbapenem Beta-lactam antibiotic with a broad antibacterial spectrum. Thirty patients with moderate to severe infections were treated with the intramuscular formulation of imipenem/cilastatin [500mg twice daily], the duration varying according to clinical response. Out of 30 cases 56.6% had received prior antibiotics with no clinical response, majority having received a triple regime therapy. All cases were bacteriologically proven and cultures were repeated during and at end of therapy. Of the 30 clinically assessable patients, bacteriologic eradication was achieved in 29 [96.7%] cases. One case was a failure due to emergence of a resistant pathogen. Adverse effects were not encountered and imipenem/cilastatin was well tolerated. In this study imipenem/cilastatin proved to be a highly effective monotherapy for the treatment of avariety of serious bacterial infections