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Query: UMLS:C0014118 (endocarditis)
 15,629 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Twenty adult surgical patients aged between 15 and 83 years (mean:45), 10 of whom had wound infections (one complicated with septicaemia), 2 with septicaemia, 1 with gynecological infection complicated with endocarditis, 5 with urinary tract infections and 2 with lower respiratory tract infections, were treated with parentally-administered cefotaxime. Aetiology was Proteus 7, E. coli 4, Pseudomonas 3, Enterobacter 2, Klebsiella 2 and 2 Serratia. Susceptibility testing was determined by the agar dilution method, with MIC values ranging from 0.01 to 5 microgram/ml, with two urinary isolates of Pseudomonas with MIC of 20 microgram/ml. Clinical responses were excellent in 13 (65 per cent) cases, moderate in 2 (10 per cent) and 3 (15 per cent) failed to respond to therapy. Clinical assessment was not possible in three patients. Bacteriological responses were excellent in 14 (70 per cent) cases, poor in 4 (20 per cent) and in two there was no follow-up. Systemic tolerance was good in all patients except one.
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PMID:Clinical experience with cefotaxime (HR-756) in surgical patients. 626 19

All investigators apparently agree that the most common and compelling reason for using more than one antibiotic to treat a single organism is to achieve a bactericidal effect. Most studies, both retrospective and prospective, have demonstrated that two effective antibiotics yield better results than one in neutropenic patients and/or those with rapidly fatal underlying disease, despite the absence of consistent in vitro synergy. Bacteremias caused by Pseudomona aeruginosa or Klebsiella pneumoniae may be benefited most by synergistic combinations. This may not be true for patients with non-neoplastic disease and normal granulocyte counts, or for patients infected with other species of gram-negative bacilli. Synergistic bactericidal activity is necessary for the successful therapy of endocarditis due to P. aeruginosa, but it may not assure success. The systemic immunodeficiency of neutropenic patients may parallel a localized immunodeficiency in endocarditis, since leukocytes are not effectively mobilized to the site of infection in endocarditis. Antagonistic antibiotic combinations are likely to be particularly harmful in neutropenic patients.
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PMID:Rationale for use of antimicrobial combinations in treatment of gram-negative infections. A review of recent reviews. 635 6

The in vitro activity, pharmacokinetics, adverse effects, and clinical efficacy of cefonicid are reviewed. Also discussed are formulary considerations and bacterial resistance. Cefonicid, an investigational agent near approval, is less active than other currently available first- and second-generation cephalosporins against gram-positive cocci, particularly Staphylococcus. Cefonicid and cefamandole have similar activity that is superior to the first-generation cephalosporins against Escherichia coli, Klebsiella, Citrobacter spp., Enterobacter spp., indole-negative Proteus spp., and Providencia spp. Organisms such as Serratia marcescens, Acinetobacter, Pseudomonas, and Bacteroides fragilis are resistant to cefonicid. Despite a small volume of distribution and high protein binding, cefonicid achieves high tissue concentrations. Approximately 90% of an administered dose is excreted unchanged in the urine, and the elimination half-life is approximately four hours. Cefonicid is usually well tolerated. In treating skin infections, cefonicid was usually less effective than cefazolin against Staphylococcus aureus. In genitourinary infections, cefonicid 1 g daily (as the sodium salt) in a single dose has shown comparable efficacy to cefamandole or amoxicillin given in multiple daily doses. Based on available data, single daily dosing of cefonicid in the therapy of Staph. aureus endocarditis is not effective. In studies of patients undergoing hysterectomy, cesarean section, cholecystectomy, and colorectal surgery, cefonicid 1 g given as a single preoperative dose has produced results comparable with those of cefoxitin 1-2 g (as the sodium salt) given preoperatively and for several doses postoperatively. The major clinical uses of cefonicid will probably be as a possible cost-reducing alternative (based on a single daily dose) to currently available first- and second-generation cephalosporins for the treatment of community-acquired pneumonia and infections caused by enteric organisms. It may also be useful as a possible cost-reducing alternative to cefoxitin for prophylaxis in hysterectomy and biliary tract surgery.
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PMID:Review of cefonicid, a long-acting cephalosporin. 636 14

Gram negative bacilli endocarditis are unfrequent. Nevertheless we encountered 28 cases of them (8.8%) among 320 endocarditis of which 10 were primitive and 7 cases (10.9%) among 65 prosthetic endocarditis. Bacterial species were 12 Pseudomonas aeruginosa, 2 Ps, stutzeri, 1 Ps. maltophilia, 2 Klebsiella pneumoniae, 2 Escherichia coli, 3 Serratia marcescans, 1 Enterobacter cloacae, 1 Brucella, 1 Hemophilus aphrophilus, 1 Fusobacterium funduliformis, 18 cases were hospital acquired infections related to cardiac surgery (4 cases), intracardiac catheterization (5 cases), intravenous catheter (4 cases). Uncontrolled infection or cardiac insufficiency underwent respectively in 14 and 18 cases. The overall mortality was 50 p. cent. The death occurred more frequently in primitive endocarditis (70%) than in secondary native endocarditis (45%) or prosthetic endocarditis (29%). It was also more frequent in Pseudomonas endocarditis (59%) than with other species (36%) and more frequent when cardiac sufficiency was present (50%). 15 patients underwent surgical procedure of which 6 died (40%). The results were better if the infection was cured before surgical procedures: 5 deaths occurred when the culture of the valves remained positive (9 cases) but none when it was negative. The 5 most recent cases of prosthetic endocarditis were cured. Since 1979, no death occurred among treated patients. we concluded that surgery is usually necessary but after an effective antibiotic therapy over a 4 or 6 week period.
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PMID:[Gram negative bacilli endocarditis ]. 675 May 26

Ceforanide is a new cephalosporin with a longer elimination half-life than any currently available cephalosporin. Its activity is very similar to that of cefamandole, a second-generation cephalosporin, except that ceforanide is less active against most gram-positive organisms. Many coliforms, including Escherichia coli, Klebsiella, Enterobacter, and Proteus, are susceptible to ceforanide, as are most strains of Salmonella, Shigella, Hemophilus, Citrobacter and Arizona species. However, most strains of Serratia marcescens and all Pseudomonas aeruginosa are resistant to this compound. Peak serum concentrations in excess of 100 micrograms/ml are achieved after a 1 g intravenous dose. The elimination half-life of ceforanide is about 3 hrs in patients with normal renal function; this allows twice daily dosing for the majority of patients. As renal excretion amounts for 85-90% of drug elimination, the serum half-life increases to approximately 20 hours in anuric patients. Tissue penetration studies demonstrate inhibitory concentrations in cardiac tissue, bone, and joint fluid. Minor adverse effects have been reported after large doses of ceforanide. Clinical trials indicate that ceforanide is effective in the treatment of skin and soft tissue, pulmonary and urinary tract infections, bone and joint infections, and endocarditis. Ceforanide also has been shown to be as effective as cephalothin or cephaloridine when given prophylactically for vaginal hysterectomy.
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PMID:Ceforanide: antibacterial activity, pharmacology, and clinical efficacy. 676 29

A case of common iliac mycotic aneurysm that presumably developed secondary to Klebsiella endocarditis was described. Recently, reports on gram negative septicemia and endocarditis have been on the increase. However, mycotic aneurysms secondary to bacterial endocarditis and particularly to Klebsiella endocarditis are rare. Inadequately treated serious gram negative septicemias have a high mortality rate. Early diagnosis and adequate combination chemotherapy with prompt surgical intervention were proven to be important factors in the successful management of such a complication.
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PMID:Successful management of iliac mycotic aneurysm secondary to Klebsiella endocarditis--report of a case. 689 92

A man with stenosis of the aortic valve acquired endocarditis after abdominal surgery. Klebsiella pneumoniae and Acinetobacter calcoaceticus were cultured from his blood. The blood cultures remained positive despite intravenous gentamicin and cephalothin to which the organisms were sensitive in vitro. Ultimately, the blood was sterilized by a combination of gentamicin and trimethoprim-sulfamethoxazole taken orally. The course of the patient was complicated by cardiac arrest and pericardial tamponade caused by a valve ring abscess and a dissecting mycotic aneurysm of the coronary sinus of Valsalva. Aortic valve replacement and right coronary artery bypass were performed. A prolonged course of trimethoprim-sulfamethoxazole was given postoperatively, and the patient has had no evidence of recurrent infection after five years. Trimethoprim-sulfamethoxazole, in combination with other antibiotics, has been successfully used to treat other patients with bacterial endocarditis and thus may be an alternative for patients in whom conventional therapy has failed.
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PMID:Trimethoprim-sulfamethoxazole therapy for infective endocarditis. 702 18

A pathological study has been performed on 10 infected Hancock bioprostheses removed from nine patients who died of prosthetic endocarditis. The devices had been in place from 2 to 87 months (average 37.5), the interval between operation and onset of infection averaging 30 months. The offending organisms were Gram negative bacteria in three patients (Klebsiella pneumoniae, Enterobacter cloacae, and Serratia marcescens), Gram positive bacteria in two (Staphylococcus aureus and Streptococcus viridans), and fungi in four (Candida species in three and Aspergillus species in one). Gross examination of the explants revealed in most cases a vegetative endocarditis of one porcine valve leaflets. Septic embolization occurred in five cases owing to the high friability of the vegetations. Prosthetic valve incompetence was the commonest type to dysfunction observed because of tears, perforations, and even complete destruction of the cusps. Prosthetic valve stenosis following obstruction of the valve orifice by infected polypous masses was noted in two cases. Clumps of infective organisms were detected deep in the cusp tissue in most cases on histologic examination. Infection located on the paraprosthetic tissues, associated with ring abscess, valve detachment, and insufficiency, was observed only once. According to the results of investigation, endocarditis on porcine bioprostheses is associated with a better preserved native valvular ring as viewed at reoperation. Therefore surgical intervention appears appropriate in the presence of severe hemodynamic complications after adequate antibiotic treatment. However, infection of these particular prostheses still carries an extremely high mortality. In the present series, this poor outcome might be explained by the frequently associated septic and thromboembolic events.
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PMID:Pathological study of infective endocarditis on Hancock porcine bioprostheses. 723 Aug 61

Concentrations of gentamicin in plasma, heart valves, subcutaneous tissue and muscle were determined in 38 patients undergoing open heart surgery. Gentamicin reached peak levels in plasma and tissue within 60 min after a 5 min intravenous bolus injection of 1.5 mg/kg body weight. Subcutaneous and muscle concentrations varied between 0.51 microgram/g and 2.1 microgram/g. Gentamicin peak concentrations in cardiac valvar tissue wre 3.6 mug/g between 2 and 5 hours after administration; gentamicin heart valve concentrations varied between 1.2 microgram/g and 1.59 microgram/g. Gentamicin tissue concentrations during open heart surgery are high enough to inhibit most Klebsiella/Enterobacter and Staphylococcus aureus and epidermidis strains. However Gentamicin heart valve concentrations do not exceed 1.5 microgram/g for more than 1 h, which may explain treatment failures of patients with endocarditis.
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PMID:Penetration of gentamicin into heart valves, subcutaneous and muscular tissue of patients undergoing open heart surgery. 732 55

Splenic abscesses may be solitary or multiple and are unusual infections. Signs and symptoms are variable and do not always include left upper quadrant pain or tenderness, as the Case Report illustrate. Abscesses of the spleen may occur as a result of endocarditis or from hematogenous seeding from a distant focus of infection. Computed tomographic scan of the spleen is the diagnostic method of choice. We report a case of multiple splenic abscesses caused by Klebsiella pneumoniae that resulted from a Klebsiella urinary tract infection and was successfully managed with antibiotic therapy and splenectomy.
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PMID:Klebsiella pneumoniae splenic abscess. 803 97


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