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

The case of a 22 months old child with no previous medical history hospitalised for an acute infection with pyrexia, arthritis, meningitis and leukocytosis with polynucleosis is reported. All bacteriological investigations were sterile; the search for soluble antigen and serological tests were negative. Antibiotic therapy (Ampicillin and Thiamphenicol) cured the meningitis and arthritis. On the 10th day of treatment the temperature rose, a systolic murmur was detected and echocardiography showed the presence of a large vegetation on the anterior mitral leaflet. Three weeks later (on Ampicillin and Amikacine), asymptomatic abolition of the femoral pulses and disappearance of the vegetation on echocardiography were observed. Angiography confirmed obstruction at the bifurcation of the aorta. Surgical removal of the embolism resulted in revascularisation of the femoral artery and was followed by apyrexia. This infant probably developed endocarditis on a healthy heart. It was complicated by systemic embolism and mitral regurgitation which at present is well tolerated.
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PMID:[Infectious endocarditis of a healthy heart in an infant]. 681 95

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

A prospective, observational study of 110 patients with serious infections due to Enterococcus spp. in 6 university and community teaching hospitals in Connecticut was conducted to define the epidemiology of community and nosocomial serious enterococcal infections and to determine risk factors, including antibiotic resistances, that contribute to outcome. Serious community and nosocomial enterococcal infections involved a variety of sites, and antibiotic resistance was common. Types of infection by major organ system were cardiovascular, 54% (catheter-related bacteremia 28%, primary bacteremia 18%, endocarditis 6%, septic thrombophlebitis 1%); intra-abdominal, 13% (including cholangitis, 6%); renal, 13%; skin and soft tissue, 5%; bone and joint, 4%; pleuropulmonary, 4%; central nervous system, 3%; deep surgical wound, 3%; and endometritis, 2%. Sixty-one percent of infections were nosocomial; 48% of these occurred in the intensive care unit. Enterococcus faecium was responsible for 20% of all infections. Antibiotic resistances among the infections included high-level gentamicin resistance (26%), ampicillin resistance (10%), and vancomycin resistance (8%). Clinical cure was achieved in 64% of patients; 6.8% of patients relapsed, 6.8% had recurrence of the infection with a different pathogen, and overall mortality was 23%. Ampicillin resistance and a high acute physiology and chronic health evaluation (APACHE) II score were highly predictive of lack of cure.
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PMID:An analysis of 110 serious enterococcal infections. Epidemiology, antibiotic susceptibility, and outcome. 762 54

Ampicillin or amoxicillin at 625-800 mg/kg/day, in combination with a beta-lactamase inhibitor, each is as effective as vancomycin in animal models of methicillin-resistant Staphylococcus aureus endocarditis. Studies were done to determine whether the addition of rifampin would permit lowering the dose of ampicillin into the range recommended for use in humans without loss of efficacy. The efficacy of ampicillin/sulbactam (300/150 or 150/75 mg/kg/day intramuscularly, in three divided doses) in combination with rifampin (5 mg/kg intramuscularly, three times daily) was compared with that of vancomycin (25 mg/kg intravenously, twice daily, or 30 mg/kg intramuscularly, three times daily) in the rabbit model of methicillin-resistant S. aureus aortic valve endocarditis. Neither ampicillin/sulbactam nor rifampin alone was effective. The ampicillin/sulbactam/rifampin regimen was as effective as vancomycin. This regimen may be an alternative to vancomycin in treatment of methicillin-resistant S. aureus infections.
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PMID:Ampicillin, sulbactam, and rifampin combination treatment of experimental methicillin-resistant Staphylococcus aureus endocarditis in rabbits. 770 17

Enterococci do not possess the common virulence factors found in many other bacteria, but they have a number of other characteristics which make them particularly pathogenic. These organisms are intrinsically resistant to a number of antimicrobial agents, including beta-lactams (penicillins and cephalosporins), polymyxins and the lincosamides. They are also tolerant to the bactericidal activity of penicillins and glycopeptides, and some of the group have acquired resistance to a number of other clinically important antimicrobial agents including ampicillin, aminoglycosides, chloramphenicol and erythromycin. Numerous national and international studies have demonstrated the changes in the antibiotic resistance of enterococci. Many strains now exhibit multiple drug resistance, the most important being high-level resistance to streptomycin and gentamicin. Organisms exhibiting this high-level resistance are usually resistant to all synergistic combinations of beta-lactam antibiotics and aminoglycosides. Ampicillin-resistant strains are now emerging, some of which are beta-lactamase producers. While resistance to glycopeptides remains rare, it is increasing dramatically in many areas of the world. As nosocomial isolates of enterococci have displayed resistance to essentially every useful antimicrobial agent, it is likely to become increasingly difficult to treat and control enterococcal infections. The glycopeptide antibiotics vancomycin and, particularly, teicoplanin are the only alternatives currently available. Although a bactericidal combination of antibiotics appears necessary only in endocarditis and meningitis and although knowledge of the prevalence of resistant strains can be used to guide the selection of appropriate therapy, optimal regimens for the treatment of infections caused by multiresistant strains have yet to be determined.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Enterococci: susceptibility patterns and therapeutic options. 772 70

We report a case of successful mitral valve replacement performed on the patient who is an infective endocarditis due to MRSA. She was 27-year-old female and treated by antibiotics medication because of remittent fever two years ago. On August 1995, cerebral infarction occurred and she was pointed out endocarditis. After high fever continued, blood cultures demonstrated MRSA. Furthermore, echocardiography showed vegetation on posterior mitral valve leaflet and moderate mitral regurgitation so, mitral valve replacement with a S.J.M. 25 mm performed to control MRSA sepsis condition. During operation, we used VCM 2 g into the extracorporeal circulation and after operation 0.5 g intravenously every 6 hours. Two weeks later we changed antibiotics to FOM, Viccillin and ABK according to the result of minimum inhibitory concentration (MIC) obtained through blood culture. The patient was discharged on the 44 th postoperative day because of her uneventful postoperative course.
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PMID:[A case report of an infective endocarditis caused by methicillin-resistant Staphylococcus aureus with successful mitral valve replacement]. 874 44

Optimal strategies for the prophylaxis and therapy of endocarditis caused by oxacillin-resistant, coagulase-negative staphylococci in patients with native or prosthetic valvular heart disease are not well defined. We compared the in vivo efficacies of ampicillin-sulbactam-based regimens with those of vancomycin-based oxacillin-resistant, beta-lactamase-producing coagulase-negative staphylococcal isolate (Staphylococcus haemolyticus SE220). Ampicillin-sulbactam (100 and 20 mg/kg of body weight, respectively, given intramuscularly in a two-dose regimen) was equivalent to vancomycin (30 mg/kg given intravenously in a two-dose regimen) in its prophylactic efficacy against the coagulase-negative staphylococcal strain (93 and 80%, respectively). The combination of ampicillin-sulbactam plus either rifampin or vancomycin did not enhance the prophylactic efficacy compared with that of ampicillin-sulbactam or vancomycin alone. In the therapy of established aortic valve endocarditis in rabbits caused by this same coagulase-negative staphylococcal strain, animals received 7-day ampicillin-sulbactam-based or vancomycin-based regimens with or without rifampin. All treatment regimens were effective at lowering intravegetation coagulase-negative staphylococcal densities and rendering vegetations culture negative compared with the coagulase-negative staphylococcal densities and vegetations of untreated controls, with ampicillin-sulbactam in combination with rifampin or vancomycin being the most active regimen. However, only the regimen of ampicillin-sulbactam in combination with vancomycin effectively prevented relapse of endocarditis posttherapy after a 5-day antibiotic-free period. For animals receiving rifampin-containing regimens, relapses of endocarditis were associated with the in vivo development of rifampin resistance among coagulase-negative staphylococcal isolates in the vegetation. Ampicillin-sulbactam was highly effective in the prevention of experimental endocarditis caused by a beta-lactamase-producing, oxacillin-resistant coagulase-negative staphylococcal strain. Ampicillin-sulbactam was also efficacious for the therapy of coagulase-negative staphylococcal endocarditis, especially when it was combined with vancomycin to prevent posttherapeutic relapses.
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PMID:Ampicillin-sulbactam is effective in prevention and therapy of experimental endocarditis caused by beta-lactamase-producing coagulase-negative staphylococci. 878 87

We compared the efficacy of ampicillin, both alone and in combination with gentamicin given once a day (q.d.) or three times a day (t.i.d.), in the treatment of experimental enterococcal endocarditis. Ampicillin was administered by using humanlike pharmacokinetics that simulated the profiles of this drug in human serum. An open one-compartment mathematical model developed in this study was used to estimate the decreasing doses administered with a computer-controlled infusion pump that simulated in rabbits the human serum pharmacokinetics after intravenous administration of 2 g of ampicillin every 4 h. Animals with catheter-induced endocarditis were infected intravenously with 10(8) CFU of Enterococcus faecalis J4 (MICs and MBCs of ampicillin and gentamicin, 2 and 128 and 16 and 64 micrograms/ml, respectively) and were treated for 3 days with ampicillin alone or in combination with gentamicin at 2 mg/kg of body weight subcutaneously t.i.d. or at 6 mg/kg subcutaneously q.d. The serum ampicillin levels and pharmacokinetic parameters of the humanlike pharmacokinetics of ampicillin in rabbits were similar to those found in humans treated with 2 g of ampicillin intravenously. The results of therapy for experimental endocarditis caused by E. faecalis J4 showed that the residual bacterial concentration in aortic valve vegetation was significantly lower in the animals treated with combinations of ampicillin plus gentamicin given q.d. or t.i.d. than in those treated with ampicillin alone (P < 0.01). The dosing interval of gentamicin did not significantly affect (q.d. versus t.i.d.; P = 0.673) the therapeutic efficacy of the combination of ampicillin plus gentamicin.
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PMID:Treatment of experimental endocarditis due to Enterococcus faecalis using once-daily dosing regimen of gentamicin plus simulated profiles of ampicillin in human serum. 878 1

Infective endocarditis caused by Kingella denitrificans occurs rarely. A review of the literature reveals only 6 cases of endocarditis caused by the bacillus. K. denitrificans is normally a commensal of the upper respiratory airways, may exceptionally be responsible for endocarditis. A case of possible prosthetic endocarditis caused by K. denitrificans is presented. A 78-year-old male with Type II diabetes was admitted to the hospital complaining of fever, a sore throat and arthralgia. He underwent replacement surgery of a St. Jude medical prosthesis for aortic stenosis at the age of 75. The only physical findings at admission were a temperature of 38.2 degrees C and murmurs of mild mitral regurgitation. The liver and spleen were not palpable, and there were no skin or eye lesions. Laboratory findings were as follows: white blood cell count 9500/microliters with 77% neutrophils, erythrocyte sedimentation rate 71 mm/h (Westergren), blood urea nitrogen 50.2 mg/dl, serum creatinine 1.7 mg/dl and C-reactive protein 22.2 mg/dl. The Gram-negative bacillus isolated from the blood was identified as K. denitrificans by the identification system, namely ID test.FN-20 rapid (Nissui, Japan). Although an echocardiogram detected no vegetation, infective endocarditis was diagnosed because the same bacillus was detected by separate blood cultures and an obvious source of infection was not found other than the prosthetic valve. Initial treatment was flomoxef, which was changed to Ampicillin 2 g/day after K. denitrificans was identified. Ampicillin continued for 6 weeks. The clinical course was good and he did not require further surgery. He has been afebrile for 2 years after completing treatment. This case represents the first report of prosthetic valve endocarditis caused by K. denitrificans in Japan.
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PMID:[Prosthetic endocarditis caused by Kingella denitrificans in a patient with diabetes mellitus]. 928 46

We compared the pharmacodynamic activities of vancomycin and ampicillin with or without gentamicin once daily or thrice daily in an in vitro infection model with fibrin-platelet clots (FPCs) infected with Enterococcus faecalis. Antibiotics were administered as a bolus to simulate human pharmacokinetics with regimens consisting of vancomycin 1 g q12h, ampicillin 2 g q6h and gentamicin 1.3 mg/kg q8h and 5 mg/kg qd. Model experiments were performed in duplicate over 72 h. FPCs were removed from the models in triplicate at 0, 8, 24, 32, 48 and 72 h, weighed, homogenized, diluted and plated to determine colony counts. Additional FPCs were removed at over 72 h post-antibiotic dose to determine antibiotic concentrations. The inoculum density at 72 h was used to compare bactericidal activity between the regimens. Overall, all antibiotic regimens containing either ampicillin or vancomycin significantly (P < 0.01) decreased the bacterial load at 72 h compared with the growth control although monotherapy regimens with either vancomycin or gentamicin had little impact. Ampicillin was superior to vancomycin with or without the addition of gentamicin (P < 0.01). There were no significant differences in reduction of bacterial density at 72 h between the combination of ampicillin or vancomycin plus gentamicin q8h and ampicillin or vancomycin plus gentamicin once daily. This was despite achieving unmeasurable FPC gentamicin concentrations after the 8 h time point during the once-daily aminoglycoside regimen. Vancomycin plus gentamicin either every 8 h or once daily was significantly (P < 0.01) better than vancomycin alone. Ampicillin plus either of the two gentamicin regimens was also better than ampicillin alone but this did not reach statistical significance. Our data suggest that once-daily gentamicin in combination with ampicillin or vancomycin demonstrates equivalent bacterial reductions to combination therapy with thrice-daily gentamicin. Once-daily aminoglycoside combination therapy for the treatment of enterococcal endocarditis warrants further investigation.
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PMID:Pharmacodynamics of vancomycin and ampicillin alone and in combination with gentamicin once daily or thrice daily against Enterococcus faecalis in an in vitro infection model. 1088 93


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