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

Aminoglycoside bactericidal activity during the first 24 h of treatment probably is a determining parameter in the prognosis of severe gram-negative infections in immunocompromised patients. To identify the predictive factors involved in the definition of the best therapeutic regimen for Enterobacter cloacae and Serratia marcescens infections, we studied different gentamicin, tobramycin, and amikacin regimens by using an experimental model of rabbit endocarditis. Two factors appear to play an important role in predicting in vivo efficacy: (i) the level of in vivo bactericidal activity, which can differ widely from one aminoglycoside to another for the same bacterial strain and from one strain to another of the same species, and (ii) the critical serum drug concentration (CSC, in milligrams per liter), defined as the lowest serum antibiotic concentration capable of producing a significant CFU reduction (P less than 0.05) in endocarditis vegetations 24 h after the beginning of a continuous infusion. Stepwise regression analysis showed that for gentamicin and S. marcescens, the area under the concentration-time curve above the CSC and then the time above the CSC are the determining parameters for efficacy (R = 0.69; F = 13.5; P = 0.001), whereas for amikacin and S. marcescens, the time above the CSC and then the area under the concentration-time curve above the CSC predict efficacy (R = 0.74; F = 24.0; P = 0.0001). The lowest CSC is that of amikacin (about 8 mg/liter); those of gentamicin and tobramycin are about 15 mg/liter. In severe S. marcescens infections, intermittent amikacin dosing offers excellent bactericidal activity within the first 24 h.
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PMID:Identification of factors affecting in vivo aminoglycoside activity in an experimental model of gram-negative endocarditis. 150 36

The clinical and radiological manifestations were correlated with the necropsy findings in the lungs of 18 patients who died of Serratia marcescens infection. Ten died during a hospital epidemic affecting 74 patients. In 14, only Serratia was identified at autopsy; in 4, other organisms were also cultured. Ten patients had septicemia. The predominant radiological findings were focal bronchopneumonia in 13, lobar consolidation in 2, and diffuse nonhomogeneous infiltrates in 10. Small radiolucent areas within the infiltrates were seen in 5, a large pulmonary abscess in 1, and pleural effusion in 7. The predominant pathological findings were focal necrotizing bronchopneumonia (sometimes with microscopic abscesses) in 14 and diffuse hemorrhage in 3. Three patients had endocarditis and 3 others showed dissemination to the brain or kidneys.
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PMID:Serratia pneumonia. 700 38