Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0023241 (Legionella)
 6,990 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Pneumonia is the leading cause of death due to nosocomial infections with mortality ranging from 30 to 70%. Because imipenem has potent in vitro activity against virtually all major causes of nosocomial pneumonia, including P. aeruginosa, S. aureus, members of the family Enterobacteriaceae, and anaerobic organisms, it is used by many physicians as the empirical therapy of choice in severe nosocomial pneumonias. Recognition of Legionella species as nosocomial pathogens has been increasing. The incidence of Legionnaires' disease among patients with nosocomial pneumonia is reported to be as high as 30% (1), but the real prevalence is unknown. Imipenem has bactericidal activity against Legionella in vitro but has not previously been tested for efficacy against intracellular Legionellae.
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PMID:Bactericidal activity of imipenem compared to erythromycin against intracellular Legionella pneumophila. 130 51

Imipenem (N-formimidoyl thienamycin) is a new carbapenem beta-lactam antibiotic with a broad antibacterial spectrum. Forty-five patients were treated with either 500 or 1,000 mg of imipenem/cilastatin four times daily, the duration varying according to clinical response. The diagnoses were urinary tract infection, 10 patients; septicemia, six; intraabdominal sepsis, six; pneumonia, six (two cases of Legionnaires' disease); skin and soft tissue infection, four; and other diagnoses, 13. Of the 32 clinically assessable patients, 17 were cured, nine improved, three died, and three were withdrawn from the trial. Of 21 patients who were microbiologically assessable, 13 were cured. In six cases of complicated urinary tract infection, the organism--which had been eradicated from the urine during treatment--reappeared after completion of antibiotic therapy. Two patients developed adverse clinical reactions that were thought to be drug-related (drug-induced fever and nausea plus vomiting, respectively). Both patients had mildly abnormal results in liver function tests, and one developed a positive direct Coombs' test. Fifty-seven percent of the patients developed some degree of phlebitis, which was moderate to severe in 19%. In this study imipenem/cilastatin proved to be a highly effective agent for the treatment of a variety of serious bacterial infections.
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PMID:Imipenem/cilastatin in the treatment of serious bacterial infections. 390 Dec 12

Development of antimicrobial testing for Legionella spp. has been technically compromised by the fastidious growth requirements of this organism and by the most commonly used medium, buffered charcoal yeast extract agar (BCYE) that contains substances known to inhibit some antimicrobial agents. This study validated the potency of two newer antimicrobials (sparfloxacin and imipenem) and their Etest strip. The comparisons of antimicrobial minimum inhibitory concentration (MIC) values as determined by Etest on BCYE agar (98 Legionella pneumophila) demonstrated that sparfloxacin was the most potent drug (MIC90, 0.19 microgram/ml) among the fluoroquinolones, macrolides, tetracyclines, and beta-lactams tested. Imipenem MICs (MIC90, < or = 0.38 microgram/ml) were also determined by a reference agar dilution method and validated Etest strips on buffered yeast extract agar, buffered charcoal yeast extract agar, and buffered charcoal yeast extract agar with defined supplements. The non-Legionella control strains used to demonstrate medium component influences on the imipenem MICs demonstrated the addition of supplements (particularly L-cysteine) markedly elevated the MICs. These data indicate that the Etest was a simple and accurate quantitative method for susceptibility tests with Legionella isolates. Sparfloxacin among the fluoroquinolones and imipenem among the beta-lactams require further clinical studies for legionellosis therapy.
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PMID:Evaluations of the Etest for antimicrobial susceptibility testing of Legionella pneumophila, including validation of the imipenem and sparfloxacin strips. 787 83

Thirty-five clinical isolates of Legionella species were tested against 7 antimicrobial agents using an agar dilution technique. Results obtained on charcoal-supplemented (BCYE) and charcoal-free agar (BSYE) were compared. On BCYE, the most active agent was rifampicin; the minimal inhibitory concentration inhibiting 90% of the strains (MIC90) was 0.008 mg/L. Imipenem was the next most active in vitro (MIC90 0.06 mg/L). The macrolide antibiotics and ciprofloxacin also inhibited the organisms at low concentrations (MIC90 < or = 2 mg/L). In general, MIC's obtained on BCYE agar were at least twofold higher than on BSYE agar except for that of imipenem. BSYE agar is a suitable alternative medium for susceptibility testing of most Legionella species. Erythromycin and rifampicin continue to demonstrate good in vitro activity against legionellae in Australia. On the basis of in vitro susceptibility tests, the other macrolides and ciprofloxacin are likely to be suitable alternatives for the treatment of legionellosis.
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PMID:Susceptibility of Legionella species to antimicrobial agents. 836 99

Carbapenems are beta-lactam antibiotics characterised by the presence of a beta-lactam ring with a carbon instead of sulfone in the 4-position of the thyazolidinic moiety. The first carbapenem to be utilised in therapy was imipenem, the N-formimidoyl derivative of thienamycin. Imipenem is coadministered with cilastatin, an inhibitor of human renal dehydropeptidase I, as imipenem is hydrolysed by this enzyme. Meropenem was the first carbapenem with a 1-beta-methyl group and 2-thio pyrrolidinyl moiety, which renders this antibiotic stable to renal dehydropeptidase I. Other carbapenems for parenteral administration later discovered include biapenem, panipenem, ertapenem, lenapenem, E-1010, S-4661 and BMS-181139. Carbapenems which are orally administered include sanfetrinem, DZ-2640, CS-834 and GV-129606. Carbapenems have an ultra-broad spectrum of antibacterial activity and stability to almost all clinically relevant beta-lactamases. This differentiates them from all other currently available classes of beta-lactam antibiotics. However, Class B beta-lactamases, along with some rare Class A and D enzymes, are able to hydrolyse these antibiotics. Although Class B enzymes are generally chromosomally-encoded (isolated from Stenotrophomonas maltophilia, Aeromonas spp., Bacillus cereus, Bacteroides fragilis, Flavobacterium spp. and Legionella gormanii), plasmid-metallo-beta-lactamases now are appearing in B. fragilis, Pseudomonas aeruginosa, Acinetobacter baumannii and members of Enterobacteriaceae such as Serratia marcescens and Klebsiella pneumoniae. The number of these enzymes compared to the number of other beta-lactamase types is still low, however, it is likely that they will spread due to the increased selective pressure of carbapenem use. The very broad spectrum of antimicrobial activity associated with a good clinical efficacy and a favourable safety profile makes the carbapenems valuable as 'first-line' antibiotics in initial empirical therapy for the treatment of severe infections.
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PMID:Recent developments in carbapenems. 1192 61

The patient was an 83-year-old man hospitalized for Haemophilus influenzae pneumonia, who developed recurrent pneumonia after improvement of the initial episode. Legionella pneumophila serogroup 12 was isolated from the sputum, accompanied by increased serum antibody titers to L. pneumophila serogroup 12. Therefore, the patient was diagnosed as having Legionella pneumonia caused by L. pneumophila serogroup 12. Case reports of pneumonia caused by L. pneumophila serogroup 12 are rare, and the case described herein is the first report of clinical isolation of this organism in Japan. When the genotype was determined by the protocol of The European Working Group for Legionella Infections (Sequence-Based Typing [SBT] for epidemiological typing of L. pneumophila, Version 3.1), the sequence type was ST68. Imipenem/cilastatin therapy was found to be effective for the treatment of Legionella pneumonia in this patient.
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PMID:A case of pneumonia caused by Legionella pneumophila serogroup 12 and treated successfully with imipenem. 2545 17