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

The mechanisms responsible for emergence of resistance during antimicrobial therapy were investigated in isolates obtained from a patient suffering from Pseudomonas aeruginosa endocarditis. The strain was first isolated from blood cultures obtained upon admission of the patient. It was sensitive to piperacillin, ticarcillin and tobramycin. Piperacillin-tobramycin therapy was therefore instituted and led to a rapid improvement of the patient's condition. Unfortunately, the patient subsequently became febrile again and blood cultures continued to yield P. aeruginosa. However, the organism isolated was now resistant to piperacillin and other penicillins tested. Cell-free extracts of the pre- and post-therapy isolates were analyzed for their beta-lactamase activity. The susceptible pre-therapy strain did not produce significant levels of beta-lactamase. In contrast, the post-therapy strain produced high levels of the enzyme. Induction experiments indicated that the production of beta-lactamase was constitutive in the post-therapy isolate. Thus, piperacillin therapy has led to the selection of resistant mutants which produced high levels of beta-lactamase constitutively. This was associated with relapse of the infection and therapeutic failure.
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PMID:Selection of resistance by piperacillin during Pseudomonas aeruginosa endocarditis. 314 26

The potential synergistic effect of piperacillin with gentamicin was examined against five isolates each of Pseudomonas aeruginosa, Staphylococcus aureus and Streptococcus faecalis isolated from patients with endocarditis. Piperacillin and gentamicin synergistically inhibited all strains of P. aeruginosa and S. aureus tested. They exerted no synergistic effect against S. faecalis. Piperacillin and gentamicin synergism may be clinically tested in the treatment of serious pseudomonas and staphylococcal infections but not against infections caused by S. faecalis.
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PMID:Antimicrobial synergism of piperacillin and gentamicin against pseudomonas aeruginosa, Staphylococcus aureus and Streptococcus faecalis. 676 72

New immunosuppressive protocols and advanced surgical technique resulted in an improved outcome of pancreatic transplantation (PTx) with infection remaining the most common complication. Seventy-two enteric-drained whole PTxs performed at the Innsbruck University Hospital between September 2002 and October 2004 were retrospectively analyzed. Prophylactic immunosuppression consisted of either the standard protocol consisting of single bolus antithymocyteglobulin (ATG) (Thymoglobulin, Sangstat or ATG Fresenius) induction (9 mg/kg), tacrolimus (TAC), mycophenylate mofetil (MMF) and steroids (38 patients) or a 4-day course of ATG (4 mg/kg) tacrolimus and steroids with MMF (n = 19), or Sirolimus (n = 15). Perioperative antimicrobial prophylaxis consisted of Piperacillin/Tazobactam (4.5 g q 8 h) in combination with ciprofloxacin (200 mg q 12 h) and fluconazole (400 mg daily). Ganciclovir was used for cytomegalovirus (CMV) prophylaxis if donor was positive and recipient-negative. Patient, pancreas, and kidney graft survival at 1 year were 97.2%, 88.8%, and 93%, respectively, with no difference between the groups. All retransplants (n = 8) and single transplants (n = 8) as well as all type II diabetics and nine of 11 patients older 55 years received standard immunosuppression (IS). The rejection rate was 14% and infection rate 46% with no difference in terms of incidence or type according to the three groups. Severe infectious complications included intra-abdominal infection (n = 12), wound infection (n = 7), sepsis (n = 13), respiratory tract infection (n = 4), urinary tract infection (n = 12), herpes simplex/human herpes virus 6 infection (n = 5), CMV infection/disease (n = 7), post-transplant lymphoproliferative disorder (PTLD, n = 3), invasive filamentous fungal infection (n = 4), Clostridial/Rotavirus colitis (n = 1), and endocarditis (n = 1). All four patients in this series died of infectious complications (invasive aspergillosis n = 2) (one with Candida glabrata superinfection), invasive zygomycosis (n = 1), PTLD (n = 1). Five grafts were lost (vascular thrombosis n = 3, pancreatitis n = 1, noncompliance n = 1). Infection represented the most frequent complication in this series and all four deaths were of infectious origin. Better prophylaxis and management of infections now should be the primary target to be addressed in the field of pancreas transplantation.
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PMID:Infectious complications following 72 consecutive enteric-drained pancreas transplants. 1676 33

We report a case of infective endocarditis caused by Acinetobacter baumannii complex in a 27-year-old male patient. The patient presented with fever of five days duration, palpitation, dyspnea, cough and chest pain. He had undergone a surgical repair of ruptured aneurysm of sinus of valsalva a month before. The transthoracic echocardiogram revealed a large vegetation on the aortic valve. Three samples of blood for culture grew gram-negative pleomorphic coccobacilli within 24 hours which were identified by cultural and biochemical characteristics to be Acinetobacter baumannii complex. Antimicrobial susceptibility was performed by Kirby-Bauer method and the isolate were found to be resistant to ampicillin, Ciprofloxacin, Ceftriaxone, Gentamicin, Amikacin, Augmentin, Levofloxacin, Piperacillin-Tazobactam, Netilimicin and sensitive to Imipenem. Patient was initially treated with Ceftraixone and Gentamicin and subsequently with Ampicillin and Amikacin but did not respond to treatment and died of sepsis before therapy with Imipenem could be started.
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PMID:Infective endocarditis due to Acinetobacter baumannii complex--a case report. 1718 61

Aerococcus viridans is a gram-positive, catalase and oxidase negative, microaerophylic and non-motile coccus which is rarely associated with human infections such as endocarditis, meningitis, artritis and bacteremia. We report a case of bacteremia due to A. viridans in a 61-years-old man with malignant gall bladder neoplasm. The patient underwent a surgical operation and on the 5th day of operation he had severe abdominal pain, vomiting, high fever and discharge from operation site. He was transferred to intensive care unit and blood cultures were obtained. Piperacillin-tazobactam was initiated as empirical therapy. Blood cultures performed in Bactec system (Becton Dickinson, USA) yielded catalase negative, gram-positive cocci in tetrads. The isolate was pyrrolidonyl aminopeptidase (PYR) positive and produced alfa-hemolysis on sheep blood agar. These cocci were identified as A. viridans by Vitek 2 Compact System (BioMerieux, France) and identification was confirmed by using mini API System (BioMerieux, France). Antibiotic susceptibility testing performed with Kirby-Bauer disk diffusion method revealed that the isolate was susceptible to trimethoprim-sulfamethoxazole, tigecycline and vancomycin and resistant to penicillin, ampicillin, piperacillin-tazobactam, ceftriaxone, erythromycin, clindamycin and amikacin. The patient was successfully treated with vancomycin (2 x 1 g/day) and completely recovered without complication. In conclusion, A. viridans should be suspected as an opportunistic pathogen in immunocompromised patients and these patients should be treated according to the antibiotic susceptibility test results.
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PMID:[Post-operative bacteremia caused by multidrug-resistant Aerococcus viridans in a patient with gall bladder cancer]. 2045 8