Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0014118 (endocarditis)
 15,629 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The development of resistance to ciprofloxacin in nine clinical isolates of Pseudomonas aeruginosa was investigated. Isolates had increases in minimal inhibitory concentrations (MICs) from 0.25 to 16 micrograms/ml. The isolates also became resistant to ofloxacin and norfloxacin, but did not show increases in MICs to aminoglycosides, antipseudomonas penicillins, or cephalosporins. One isolate from a patient with endocarditis showed a reduction in a 43-kD outer membrane protein and simultaneous increase in the imipenem MIC. This isolate also showed impaired uptake of ciprofloxacin. Respiratory isolates from cystic fibrosis patients did not show loss of outer membrane protein. MICs were lowered by ethylene diaminetetra-acetic acid, suggesting changes in lipopolysaccharide. Resistant isolates were synergistically inhibited by combinations of ciprofloxacin plus tobramycin or ceftazidime, but MICs remained beyond the achievable serum level.
 ...
PMID:Resistance to ciprofloxacin appearing during therapy. 251 60

Combinations of beta-lactam and aminoglycoside antibiotics are frequently used in the treatment of pediatric infections. At our institution, amikacin has been the sole aminoglycoside utilized for the past five years. Such regimens are used empirically in specific patient populations to treat the pathogens most likely to be responsible for a symptom complex, e.g., sepsis in the immunocompromised host, pneumonitis in patients with cystic fibrosis, neonatal infections such as sepsis or meningitis, and infections in patients with intestinal perforations. Beta-lactam and aminoglycoside combinations are employed as definitive therapy when synergistic interactions can be predicted, such as in systemic Pseudomonas infections, viridans streptococcal endocarditis, or enterococcal infections. In all of these circumstances, we have utilized amikacin extensively as the sole aminoglycoside, with highly satisfactory results. In vitro antibiotic synergy studies, including those employing aminoglycosides such as amikacin, may be used to predict in vivo antibiotic interactions. However, definitions of in vitro synergy vary with the laboratory method used to evaluate synergy. Furthermore, recent data from our laboratory suggest that the absence of demonstrated in vitro synergy between amikacin and imipenem may not correlate with improved survival of neutropenic rats with gram-negative sepsis that are treated with both agents. Thus, in vitro studies of synergy may underestimate the frequency of improved outcomes with combination antibiotics, especially with amikacin and imipenem. There are potential risks associated with the use of multiple, broad-spectrum antibiotics, including fungal or bacterial superinfection and increased drug toxicity. Although the former is common in pediatric patients, aminoglycoside (amikacin) toxicity has rarely been a problem. Combination antibiotic regimens that include an aminoglycoside such as amikacin continue to have an important role in pediatrics and should be used empirically or definitively for the specific indications discussed.
 ...
PMID:Combination antibiotic therapy in pediatrics. 372 28

Pseudomonas aeruginosa has emerged as an important pathogen during the past two decades. It causes between 10% and 20% of infections in most hospitals. Pseudomonas infection is especially prevalent among patients with burn wounds, cystic fibrosis, acute leukemia, organ transplants, and intravenous-drug addiction. P. aeruginosa is a common nosocomial contaminant, and epidemics have been traced to many items in the hospital environment. Patients who are hospitalized for extended periods are frequently colonized by this organism and are at increased risk of developing infection. The most serious infections include malignant external otitis, endophthalmitis, endocarditis, meningitis, pneumonia, and septicemia. The likelihood of recovery from pseudomonas infection is related to the severity of the patient's underlying disease process. The introduction of the antipseudomonal aminoglycosides and penicillins has improved substantially the prognosis of these infections. Ticarcillin and carbenicillin have been especially beneficial in neutropenic patients; however, prompt institution of therapy is mandatory for optimal benefit. Many new drugs with antipseudomonal activity, including penicillins, cephalosporins, and other beta-lactams, have been introduced in recent years and offer the potential for new approaches to therapy for these infections.
 ...
PMID:Infections caused by Pseudomonas aeruginosa. 640 75

The growth and survival mechanisms used by Pseudomonas aeruginosa in human infections are similar to those used by the organism in aquatic systems. P. aeruginosa attaches to inert solid or tissue surfaces and grows predominantly in biofilms that release mobile swarmer cells into the surrounding fluid phase. These natural and pathogenic biofilms are covered by an exopolysaccharide matrix (glycocalyx) that serves as a barrier against hostile environmental factors, such as host defense mechanisms and antibiotics. Glycocalyx-enclosed biofilms of P. aeruginosa or other bacteria have been identified in experimental or clinical infections arising from contaminated prostheses and in chronic refractory infections, such as endocarditis, osteomyelitis, and P. aeruginosa pneumonia associated with cystic fibrosis. Conventional in vitro antibiotic susceptibility tests are directed against unprotected, mobile, swarmer cells. Antibiotics used to treat sequestered infections should be tested against populations of pathogens in intact biofilms to determine the ability of the antibiotics to penetrate the glycocalyces and to kill the component bacteria.
 ...
PMID:The etiology and persistence of cryptic bacterial infections: a hypothesis. 644 63

The effects of a home care program with 102 courses (2336 patient-days) of intravenous antibiotic therapy were evaluated. Home care nurses changed the intravenous cannula site every 3 days. The initial hospital stay averaged 11.8 days and the duration of home therapy averaged 22.9 days. The diseases treated included osteomyelitis, septic arthritis, endocarditis, cystic fibrosis and pneumonia, staphylococcal bacteremia, blastomycosis, actinomycosis and other soft tissue infections. All classes of commonly used antibiotics, including penicillins, cephalosporins, aminoglycosides and amphotericin B, were administered, alone or in combination. There were no side effects that necessitated discontinuation of home treatment or readmission to hospital. The average cost per patient-day was $58, compared with an estimated $193 for in-hospital therapy; in addition, 2336 hospital bed-days were made available. Most patients were able to resume many or all of their daily activities while receiving intravenous antibiotic therapy.
 ...
PMID:Self-administration of intravenous antibiotics: an efficient, cost-effective home care program. 680 5

The dosing frequency of aminoglycoside antibiotics may alter efficacy and toxicity independent of total daily dose. Once-daily tobramycin dosing was compared with continuous infusion in three models of efficacy. Acute pneumonia due to Pseudomonas aeruginosa in guinea pigs responded better to once-daily dosing, and chronic pneumonia in rats and endocarditis in rabbits responded equally to both regimens. Dogs given gentamicin, tobramycin, or netilmicin once daily, with maximum serum concentrations of greater than 100 mg/liter, had less nephrotoxicity than dogs given continuous infusions. Tobramycin was given once daily or continuously to 52 patients with cystic fibrosis who in 10 days had no change in creatinine clearance or hearing despite maximum serum tobramycin concentrations of 40 mg/liter. Intermittent dosing of aminoglycosides, causing infrequent large maximum serum concentrations, may be less toxic and equally efficacious as frequent dosing.
 ...
PMID:Once-daily vs. continuous aminoglycoside dosing: efficacy and toxicity in animal and clinical studies of gentamicin, netilmicin, and tobramycin. 686 Apr 16

Stenotrophomonas (Xanthomonas) maltophilia has recently emerged as an important nosocomial pathogen in immunocompromised cancer patients and transplant recipients. S. maltophilia has been documented as a cause of bacteraemia, infections of the respiratory and urinary tracts, meningitis, serious wound infections, mastoiditis, epididymitis, conjunctivitis and endocarditis. The reservoir of S. maltophilia and the mechanisms by which it is transmitted, remain largely unknown. Risk analysis has shown that mechanically ventilated intensive care unit patients, receiving antibiotics especially carbapenems, are at increased risk of colonization/infection. Because of the in vitro resistance to many commonly used agents, it is essential that S. maltophilia is isolated and identified correctly. Over the last decade Burkholderia (Pseudomonas) cepacia has become a major threat to the management of patients with cystic fibrosis (CF). The spread of B. cepacia through previously stable CF clinic populations, is an increasing cause for concern. Anxiety has arisen following the observation that some patients with previously mild disease, experience an accelerated and fatal deterioration in pulmonary function with fever, necrotizing pneumonia, and in some cases septicaemia. Early UK surveillance studies suggested a maximum prevalence of 7%, though this has risen in recent reports to approach the 40% described in the US. Mounting evidence of person-to-person transmission has led the Cystic Fibrosis Trust to issue guidelines for the management of colonized patients. In an attempt to monitor and understand the spread of B. cepacia, typing techniques such as ribotyping have been employed. Because of these problems, together with multiple-antibiotic resistance, there is an urgent need to identify the major routes of transmission, colonizing, pathophysiological and immunological factors.
 ...
PMID:The emergence of epidemic, multiple-antibiotic-resistant Stenotrophomonas (Xanthomonas) maltophilia and Burkholderia (Pseudomonas) cepacia. 888 May 54

The serum bactericidal test has been used for many years for optimal assessment of the efficacy of antibiotic therapy in patients with infective endocarditis and other bacterial infections. Its capacity to predict the bacteriological outcome of acute pulmonary exacerbations in patients with cystic fibrosis was evaluated. A total of 54 courses of intravenous antibiotic therapy were analyzed in 22 patients, whose ages ranged from 4 months to 24 years (mean age: 10 years). The serum bactericidal activity of blood samples, taken at expected peak and trough antibiotic levels on day 4 of therapy, were determined against the potentially pathogenic strains isolated in sputum at the time of admission. For 104 isolates (64 Pseudomonas aeruginosa, 28 Staphylococcus aureus, and 12 Haemophilus influenzae strains), the peak and trough bactericidal titers were compared to bacteriological outcome. Bacteriological success was defined as a decrease of 2 log10 units or more in the bacterial density in sputum between days 0 and 7 of therapy. At peak antibiotic levels, serum bactericidal titers of 1:128 or more were 96% (all isolates) and 89% (P aeruginosa isolates), predictive of cure, whereas serum bactericidal titers of less than 1:16 were 100% predictive of failure for all infecting bacteria. In patients aged less than 18 years, the best peak titer for predicting success was 1:64, with a predictive value of 96% for titers of 1:64 or greater. The peak titer that best predicted success in patients aged 18 years or more was 1:128, with a predictive value of only 83% for titers of 1:128 or greater.(ABSTRACT TRUNCATED AT 250 WORDS)
 ...
PMID:Serum bactericidal test as a prognostic indicator in acute pulmonary exacerbations of cystic fibrosis. 842 26

There is ample evidence that once-daily dosing of aminoglycosides is preferable to the conventional regimens during the treatment of serious infections. Experimental and clinical studies also provide evidence that this regimen can be safely used in children, neutropenic patients and endocarditis. The use of once-daily tobramycin in cystic fibrosis merits further study, as the pharmacokinetics of the aminoglycosides are altered in these patients. The dose-adjustment strategy in patients with renal failure is still controversial, but reducing the daily dose whilst maintaining the q24-h interval has been demonstrated to be safe. Although the value of serum level monitoring in ensuring efficacy and avoiding toxicity has been overestimated in the past, especially in patients with renal failure, an undesirable accumulation of the aminoglycosides can occur. The best way to detect accumulation remains to be defined.
 ...
PMID:Once-daily aminoglycosides: practical guidelines. 957 35

Eleven days after double lung transplantation for cystic fibrosis, an 18-year-old patient developed a disseminated Fusarium solani infection with tricuspid valve endocarditis. This infection occurred under fluconazole and immunosuppressive therapy with cyclosporin, prednisone and azathioprine, with a normal leucocyte count. Liposomal amphotericin B allowed blood culture negativation. The patient died from a bacterial septic shock.
 ...
PMID:Disseminated Fusarium solani infection with endocarditis in a lung transplant recipient. 961 Jan 36


1 2 3 4 5 Next >>