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

The penicillinase-resistant penicillins (methicillin, oxacillin, nafcillin) have been the mainstay of antibiotic therapy for S. aureus septicaemia and endocarditis. In experimental rabbit S. aureus endocarditis, these three antibiotics were equally effective. There has been no prospective comparative clinical studies to determine the relative effectiveness of these antibiotics. In experimental rabbit S. aureus endocarditis, cephalothin and cefazolin are less effective than methicillin and nafcillin. The results of therapy with cephalosporins in patients with S. aureus endocarditis are variable. Clindamycin therapy of S. aureus endocarditis has been associated with clinical relapse. Vancomycin has been used to treat S. aureus septicaemia and endocarditis with good results. Fusidic acid has been used in combination with another effective drug in treating S. aureus septicaemia and endocarditis. Although the combination of a cell-wall acting antibiotic with an aminoglycoside has been shown to have an enhanced anti-staphylococcal activity in vitro and in animal studies, there is no evidence that such a combination reduces morbidity or mortality clinically. Rifampin in combination with a cell-wall acting antibiotic is antagonistic against S. aureus in vitro and in experimental endocarditis in rabbits. The use of such a combination has not shown consistent benefits clinically. The clinical importance of tolerance (MBC/MIC greater than or equal to 32) of cell-wall acting antibiotics to S. aureus is not clear. It appears not to be important in animal studies. Cephalosporins appear not to be effective in the treatment of methicillin-resistant S. aureus infections. The treatment of choice of sepsis and endocarditis due to such strains is vancomycin which is effective against all strains of methicillin-resistant S. aureus.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:A general survey of antibiotic treatment of staphylococcal septicaemia and endocarditis. 658 52

In a retrospective study covering the years 1977 to 1981, the results of antibiotic treatment in 123 patients with staphylococcal septicaemia with or without endocarditis have been analysed. 80 patients (mean age 60 years) were non-drug addicts (Group I) and 43 (mean age 28 years) were drug addicts (Group II). Underlying conditions other than drug abuse were noted in 74 patients in Group I and in only 7 in Group II.S. aureus was isolated from 117 patients and S. epidermidis in 6, all of them in Group I. 91 strains were penicillinase producers, but all susceptible to isoxazolyl-penicillins. In Group I verified or highly suspected endocarditis was registered in 12 patients (15%), always left-sided, as against in 31 (72%) in Group II, of whom 25 had tricuspid valve engagement. In the multivariate pattern of antibiotic treatment 3 groups may be discerned; 1) Cloxacillin, alone (35 patients) or in a combination (57), 2) Penicillin G, alone (6) or in a combination (12), and 3) Lincomycin or clindamycin, a cephalosporin or co-trimoxazole, alone (4) or in combination (9). Additive agents were mostly an aminoglycoside or fusidic acid. Out of the 45 patients in the whole material who received single therapy 9 patients (20%) died, and out of the 78 patients who received combined therapy 13 patients (16.6%) died. In the cloxacillin group 11.8% died, compared to 35% who initially received other antibiotics. In 70 patients the initial therapy had to be changed, in 39 due to adverse drug reactions and in 31 due to therapeutic failures or for unexplained reasons. In these cases linco- or clindamycin, more rarely rifampicin or vancomycin, were used. In Group I, 20 patients (25%) died, 8 of them with endocarditis. Sequels, relapses or reinfections were noted in 21 (25%), and 39 (50%) had an uneventful course. In Group II, 2 patients (5%) died, both with endocarditis. Sequels, relapses or reinfections occurred in 11 (25%), and 30 (70%) had an uneventful course. From this unstructured material no definite conclusions can be drawn. However, the lower mortality rate in the cloxacillin group suggests this regimen to be superior. The addition of other antibiotics did not appear to influence the clinical outcome. There was a more favourable outcome in addicts than in non-addicts, despite the same general principles of antibiotic treatment. Thus, for the outcome the characteristics of the patient group seemed to have more influence than the choice of antibiotic treatment.
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PMID:Antibiotic treatment of staphylococcal septicaemia and endocarditis in a Swedish hospital. 658 54

During the period 1976-1980 Staphylococcus aureus was found in 265 blood cultures from 13 clinics for adult patients at Lund Hospital. Criteria of septicaemia were fulfilled in 169 patients, 65 had transient bacteremia and 31 cases were not evaluable. Concerning bacteriological data no Staphylococcus phage type dominated and strains resistant to antibiotics other than penicillin were very few. On the average 74% of the strains produced penicillinase with a successive increase during the study period. The incidence of septicaemia was highest in the decade 61-70 years of age. In patients with hospital-acquired septicaemia (n = 99) the main portals of entry for infection were vascular and/or surgical wounds (confirmed by phage typing in 93%). Patients with community-acquired septicaemia (n = 70) often had skin lesions but only a few cultures were taken. Only 4 patients were drug addicts. In 28 patients with no obvious portal of entry 14 nasal cultures were performed. Eight of ten positive cultures showed the same strain in nares as in blood at onset of sepsis. Secondary infectious foci were most frequent (26%) in patients with community-acquired infection. Endocarditis were found in 19 patients, 11 were diagnosed at autopsy. In staphylococcal endocarditis the mortality was 68% compared to 10% in septicaemia without endocarditis. In septic shock, compromised hosts and in connection with chronic diseases the mortality rates were 39%, 26% and 29%, respectively.
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PMID:Staphylococcus aureus septicaemia and endocarditis at the University Hospital in Lund 1976-1980. 658 60

High-level resistance to gentamicin, tobramycin, and kanamycin was transferred between staphylococci of the same and different species by filter mating. Resistance and transfer proficiency were mediated by plasmids ranging from 38 to 54 kilobases in size. All of the plasmids encoded intermediate resistance to amikacin and netilmicin and resistance to ethidium bromide; some encoded beta-lactamase production. None of these plasmids carried resistance to other antibiotics or heavy metals. Transfer of antibiotic resistance occurred by a mechanism similar to that of conjugation, because it was DNase resistant, required cell-to-cell contact, and did not appear to involve phage. The participation of phage in transfer appeared to be unlikely because mijtomicin C-induced lysates of donor isolates did not mediate transfer, filter mating transfer proceeded at high frequency between nonlysogenic donor and recipient cells, and transfer of the aminoglycoside resistance plasmid mobilized the transfer of as many as five additional plasmids. All 17 gentamicin-resistant Staphylococcus aureus and all 6 Staphylococcus epidermidis isolates obtained from an outbreak of staphylococcal infections in a newborn nursery contained conjugative plasmids, as did all 6 gentamicin-resistant S. aureus isolates from bacteremic adults. However, only 3 of 10 gentamicin-resistant S. epidermidis isolates from colonized cardiac surgery patients and 1 of 2 S. epidermidis isolates from patients with prosthetic valve endocarditis transferred gentamicin resistance by filter mating. The recent increase in nosocomial infections caused by gentamicin-resistant staphylococci may be partially explained by the evolution of self-transmissible plasmids in these isolates.
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PMID:Self-transmissible plasmids in staphylococci that encode resistance to aminoglycosides. 662 57

Enterococci cause urinary tract infection (usually asymptomatic), 5% to 15% of cases of endocarditis, and rare cases of meningitis. Their role in polymicrobial infection in the abdomen and pelvis is difficult to assess. Ninety percent of enterococci are inhibited by 4 mg/L of penicillin G, by 2 mg/L of ampicillin, and by 6 mg/L of vancomycin. The penicillinase-resistant penicillins, cephalosporins, carbenicillin, and ticarcillin are at least fourfold less active against enterococci than penicillin G, whereas piperacillin has activity equivalent to penicillin G. The addition of an aminoglycoside to penicillin, ampicillin, vancomycin or piperacillin--which are not bactericidal against most strains of enterococci--results in more rapid and complete bacterial activity (ie, synergistic activity).
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PMID:Enterococci. Biologic and epidemiologic characteristics and in vitro susceptibility. 681 24

Vancomycin is a narrow-spectrum bactericidal antistaphylococcal antibiotic that was introduced in 1956 because of its efficacy against resistant penicillinase-producing staphylococci. It was effective for serious staphylococcal infections for which no satisfactory alternative to penicillin G was available at the time. When methicillin and the other semisynthetic penicillins and the cephalosporins were introduced, the role of vancomycin was relegated to the alternative therapy of choice when the penicillins and the cephalosporins could not be used. In the future, vancomycin may be used more frequently in (1) methicillin-resistant Staphylococcus aureus infections, (2) streptococcal endocarditis in conjunction with an aminoglycoside in patients intolerant to penicillin or ampicillin, (3) infections associated with prosthetic devices caused by organisms with multiple antibiotic resistance, and (4) antibiotic-induced enterocolitis associated with Clostridium difficile.
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PMID:Vancomycin. 682 62

A 79-year-old female developed endocarditis and meningitis due to an ampicillin-resistant, non-beta-lactamase-producing strain of Haemophilus influenzae. Carbenicillin and gentamicin therapy resulted in bacteriological and clinical cure. The mechanism of resistance of ampicillin-resistant, non-beta-lactamase-producing strains of H. influenzae is unknown.
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PMID:Isolation of an ampicillin-resistant, non-beta-lactamase-producing strain of Haemophilus influenzae. 696 43

To test the hypothesis that cephalosporins resistant to beta-lactamase are preferred in the treatment of serious staphyloccal infections, the ability of four cephalosporins to eradicate bacteria from the cardiac vegetations of rabbits with experimental endocarditis was examined. Two strains of Staphylococcus aureus were chosen as pathogens: one that rapidly and completely inactivated 50 micrograms of cefazolin in vitro (beta-lactamase-positive) and another that did not inactivate any cephalosporin (beta-lactamase-negative). Rabbits with a polyethylene catheter in the left ventricle were reliably infected witih 10(5) bacteria. Similar numbers of S. aureus were recovered from the cardiac vegetations of rabbits inoculated with the beta-lactamase-positive strain after 24 hr of treatment with each of four cephalosporins. However, when the animals were treated at intervals of 6 hr for four days, significantly fewer rabbits survived after treatment with cefazolin than with cephalothin. No difference in survival was observed in the treatment of rabbits with endocarditis due to the beta-lactamase-negative strain. The failure of cefazolin in the treatment of staphylococcal endocarditis in rabbits may be due to inactivation of the drug by beta-lactamase in vivo.
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PMID:Importance of beta-lactamase inactivation in treatment of experimental endocarditis caused by Staphylococcus aureus. 696 78

Ampicillin resistance among strains of Hemophilus is usually due to production of beta-lactamase. This paper reports the isolation of a strain of H. parainfluenzae resistant to ampicillin with no detectable beta-lactamase or amidase activity. The organism, isolated from the blood of a patient who had aortic valve endocarditis, gave a zone diameter consistent with ampicillin sensitivity when tested by disc diffusion in Mueller-Hinton agar supplemented with 1% IsoVitaleX and 1% hemoglobin. Broth dilution testing in Levinthal medium, however, revealed the following minimal inhibitory cencentrations: ampicillin, 32 micrograms/ml; penicillin, 256 micrograms/ml; methicillin, 128 micrograms/ml; carbenicillin, 128 micrograms/ml; and cephalothin and chloramphenicol, 1.0 micrograms/ml. The results of acidimetric, iodometric, and chromogenic cephalosporin methods for detection of beta-lactamase were negative. Beta-lactamase activity could not be demonstrated in cell sonicates or induced by growth of the cells in antibiotic-containing medium. In addition, no extracellular degradation of either ampicillin or penicillin could be demonstrated.
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PMID:Ampicillin resistance in Hemophilus parainfluenzae. 696 94

The efficacy of cefazolin or cefpirome alone or combined with rifampin was compared with that of vancomycin alone or combined with rifampin in an experimental model of methicillin-resistant, beta-lactamase-producing, coagulase-negative staphylococcal endocarditis. Phenotypically, the mecA gene-positive strain used in vivo did not exhibit methicillin resistance by the agar dilution or disk susceptibility method but was resistant in vitro (oxacillin MIC, 64 micrograms/ml) by the microtiter dilution method with 2% NaCl supplementation. Macrodilution broth susceptibilities of standard inocula failed to demonstrate cross-resistance of staphylococci to cefazolin (MIC, 8 micrograms/ml) or cefpirome (MIC, 4 micrograms/ml). In vivo, vancomycin and cefpirome had similar activities, and both regimens were more effective than was cefazolin alone. While the MIC of rifampin was low (0.031 micrograms/ml), monotherapy with rifampin resulted in a bimodal distribution of outcomes due to the expected emergence of resistant mutants. The results in vitro of time-kill synergy studies using rifampin in combination with cefazolin or cefpirome varied with the antimicrobial concentrations tested and did not reliably predict activities in vivo of rifampin-beta-lactam combination therapies. Cefpirome, but not cefazolin or vancomycin, in combination with rifampin was synergistic in vivo. Cefpirome in combination with rifampin was more effective than was cefazolin in combination with rifampin. Both cephalosporin-rifampin regimens were significantly more effective than was cephalosporin or vancomycin monotherapy and were as effective as vancomycin combined with rifampin. These data support further evaluation of rifampin-beta-lactam combinations as possible alternative therapies to vancomycin-containing regimens for selected methicillin-resistant coagulase-negative staphylococcal infections.
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PMID:Effective treatment of cephalosporin-rifampin combinations against cryptic methicillin-resistant beta-lactamase-producing coagulase-negative staphylococcal experimental endocarditis. 748 24


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