[Community-acquired bacterial infections among type 2 diabetic and non-diabetic patients hospitalized on a general medical ward: a clinical comparison]. / 2-es típusú diabetesesek és nem cukorbetegek területen szerzett, belgyógyászati osztályos felvételt igénylo bakteriális infekcióinak klinikai összehasonlítása.

Introduction: Previous data showed bacterial infections among diabetic patients to be more serious and frequent, with higher mortality rates in comparison with non-diabetics. Recent investigations, however, are contradictory. Aim: The goal of our prospective, observational study was to compare patients hospitalized on a general medical ward due to community-acquired bacterial infections with type 2 diabetes mellitus (T2DM) to those of non-diabetics (K) by 1) infection localization, 2) spectrum of pathogens, 3) three-month mortality rates. Method: Patients were consecutively involved (T2DM: n = 205, K: n = 202). We characterized the infections, clinical parameters, mortalities of the two groups, and matched them to international data. Results: No difference regarding clinical details of the groups were found except for glycemic parameters and BMI. In the T2DM group the skin- and soft tissue- (37.1%), in the K patients respiratory infections (37.1%) were the most common, followed by urinary ones (31.2% and 31.7%, respectively). Skin- and soft tissue infection incidence among T2DM subjects were higher compared to international results (37.1% vs. 16%). Co-presence of Gram positive and Gram negative bacteria in the skin- and soft tissue infections (23/76 vs. 5/46, p = 0.0149), and polymicrobial origin in the urinary tract infections (34.0% vs. 15.1%, p = 0.0335) were found to be more frequent in T2DM than in K. No difference regarding mortality rates were detected. In T2DM the skin- and soft tissue while in the K group the respiratory infections had the most death counts. Conclusions: We found higher rates of skin- and soft tissue infections among T2DM patients hospitalized on a general medical ward compared to international data. In total we did not find difference regarding three-month mortality between the groups. Our results highlight the importance of primary prevention and shows its inadequacy concerning skin and soft tissue infections among type 2 diabetics in Hungary. Orv Hetil. 2019; 160(41): 1623-1632.

The effect of amikacin and imipenem alone and in combination against an extended-spectrum beta-lactamase-producing Klebsiella pneumoniae strain.

In vitro and in vivo activities of amikacin and imipenem alone, and in combination, were studied against an extended-spectrum beta-lactamase-producing Klebsiella pneumoniae strain. The strain was in vitro susceptible to both antimicrobials at 10(5) and 10(7) CFU/mL. In time-kill studies amikacin, imipenem, and amikacin plus imipenem decreased the bacterial counts; difference between the bactericidal effects was not observed. Chequerboard technique showed no interaction between the tested drugs. Mice infected with 10(7) CFU/g of the K. pneumoniae were treated by amikacin (15 mg/kg every 8 h), imipenem (40 mg/kg every 4 h), or amikacin plus imipenem for 24 h. Blood bacterial counts in the group treated with amikacin plus imipenem did not differ significantly from the groups treated with amikacin or imipenem alone. Combination of amikacin and imipenem did not demonstrate any advantage over imipenem alone either in vitro or in vivo.

The effect of different doses of cisplatin on the pharmacokinetic parameters of cefepime in mice.

The simulation of human serum levels is essential in animal models to extrapolate the experimental results to clinical practice. Administration of a nephrotoxic drug such as cisplatin can be used to cause renal dysfunction as an approach to mimic human serum levels of renally excreted drugs. We aimed to determine the dose of cisplatin that did not affect the survival rate of mice and to achieve human-like serum concentrations of cefepime. Different doses of cisplatin (0, 10, 14, 18, 22 and 26 mg/kg) were given by intraperitoneal (i.p.) injection to mice three days prior to the i.p. administration of 80 mg/kg cefepime. With cisplatin doses of 18 and 22 mg/kg, the half-life of cefepime was significantly prolonged (P < 0.001) and all mice survived. The pretreatment with 26 mg/kg cisplatin significantly decreased survival (P = 0.001), but the half-life of cefepime was not significantly longer than of 18 mg/kg cisplatin. Serum levels of cefepime after the pretreatment with 18 mg/kg cisplatin were comparable to published human data. The administration of cisplatin appears to be a suitable method in mice for simulating human serum concentrations of renally excreted drugs.

[Role of moxifloxacin in the treatment of community-acquired pneumonia]. / A moxifloxacin szerepe a területen szerzett pneumonia kezelésében.

INTRODUCTION: Community-acquired pneumonia is a common cause of morbidity and mortality throughout the world. Moxifloxacin, a new generation fluoroquinolone have become an attractive therapeutic alternative in the treatment of community-acquired pneumonia because of its excellent pharmacokinetic parameters and wide antimicrobial spectrum. AIMS: The authors reviewed the role of moxifloxacin in the treatment of community-acquired pneumonia based on their experience and the data of the literature. METHODS: The authors studied the clinical outcome of the patients treated with moxifloxacin due to community-acquired pneumonia in their hospital ward between May 1, 2002 and May 1, 2003. RESULTS: Four patients with pneumonia were treated ineffectively by moxifloxacin during a year. Serious clinical and radiological progression occurred to each patient despite moxifloxacin therapy, and two patients had to be admitted to intensive care unit. Three patients were successfully treated by 2nd or 3rd generation cephalosporin and clarithromycin, but one patient died. CONCLUSIONS: The authors call attention with these cases to the fact that in clinical trials oral moxifloxacin therapy was not more efficient either clinically or microbiologically than standard therapy in the treatment of community-acquired pneumonia. Moxifloxacin therapy is recommended to be reserved to patients allergic or not responsive to other antibiotics, and in the case of infections due to penicillin-resistant pneumococci.

In vitro and in vivo activities of ciprofloxacin and levofloxacin against an SHV-5 extended-spectrum beta-lactamase-producing Klebsiella pneumoniae strain.

Activities of ciprofloxacin and levofloxacin against an SHV-5 extended-spectrum beta-lactamase (ESBL)-producing Klebsiella pneumoniae strain were studied in vitro and in vivo in septic mice using a high inoculum. Susceptibility to ciprofloxacin and levofloxacin was independent of the inoculum size. In killing curve studies, after 24 hours the initial 7.69 log10 CFU/ml increased in the control to 9.34, while it was reduced to 4.83 by ciprofloxacin and to 4.25 by levofloxacin. Mice were infected with 10(7) CFU/g of K. pneumoniae intraperitoneally. Treatment started 2 hours later, when the mean blood bacterial counts were 7.33 log10 CFU/ml, and lasted for 26 hours from the time of infection. Blood bacterial count was reduced from 7.33 log10 CFU/ml to 4.08 log10 CFU/ml by ciprofloxacin (20 mg/kg/6 hours), and to 3.60 log10 CFU/ml by levofloxacin (50 mg/kg/6 hours) 8 hours after the infection, which differed significantly from the infected untreated group. Ciprofloxacin and levofloxacin prolonged significantly the survival of mice compared with the infected untreated group (p<0.001 for both groups). There were not significant differences either in the survival (p=1.0) or in the blood bacterial counts (p=0.216 after 8 hours) between ciprofloxacin and levofloxacin group. Based on these results both ciprofloxacin and levofloxacin could be alternative therapeutic agents for the infection caused by ESBL-producing Klebsiella strains.