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Query: UMLS:C0032285 (pneumonia)
 54,520 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The present study confirms that CBA/J mice are susceptible to several clinical isolates of Streptococcus pneumoniae, including four of five penicillin-susceptible and all five penicillin-resistant strains tested, thus providing the first noncompromised animal model for penicillin-resistant S. pneumoniae pneumonia. In this model, doses of penicillin G of 0.6 mg/kg of body weight given six times at 1-h intervals produced effective pulmonary clearance of a penicillin-susceptible strain (penicillin G MIC, 0.015 microgram/ml), while doses of 40 mg/kg given six times at 1-h intervals were required to clear a penicillin-resistant strain (penicillin G MIC, 1 microgram/ml). Imipenem (MIC, 0.25 microgram/ml) was the most active antibiotic tested against the penicillin-resistant strain, with a calculated dose of 0.42 mg/kg given six times at 1-h intervals, resulting in a 2-log decrease in the number of pulmonary bacteria. Comparable effects were seen with vancomycin (MIC, 0.5 microgram/ml), cefotaxime (MIC, 0.5 microgram/ml), and penicillin G at doses of 3.3, 5.5, and 31.0 mg/kg given six times at 1-h intervals, respectively. The pharmacokinetic profile of vancomycin in infected lungs was superior to those of the other antibiotics, especially in regard to the elimination half-life (215.4 min for vancomycin versus 15.0, 14.5, and 14.5 min for penicillin G, cefotaxime, and imipenem, respectively). Both imipenem and vancomycin allowed 90% survival when 40-mg/kg doses were administered twice a day beginning 5 days after infection. Survival rates with penicillin G (160-mg/kg doses) and cefotaxime (40-mg/kg doses) were 40 and 30%, respectively, while no saline-treated mice survived. The present study shows that the CBA/J mouse pneumonia model may be useful for evaluating antibiotic efficacies against penicillin-resistant pneumococcal pneumonia in immunocompetent individuals. Our data suggest that imipenem and vancomycin may be the most active agents against penicillin-resistant S. pneumoniae pneumonia.
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PMID:Noncompromised penicillin-resistant pneumococcal pneumonia CBA/J mouse model and comparative efficacies of antibiotics in this model. 872 30

A 35-year-old woman was admitted to our hospital because of a fever and a productive cough. She had undergone renal transplantation and had taken immunosuppressive drugs, a steroid, inhaled amphotericin-B, and pentamidine. She was treated with ganciclovir, because infection with cytomegalovirus was suspected but her symptoms did not resolve. A chest X-ray film and a computed tomogram showed an infiltrative shadow in the right lower lung field. Specimens obtained by transbronchial lung biopsy showed lipid-laden macrophages and oil droplets in alveolar spaces. Organisms of the genus nocardia were isolated from bronchial lavage fluid. The final diagnosis was lipoid pneumonia combined with pulmonary nocardiosis. After treatment with Imipenem.cilastatin sodiom, Exacin and Sulfamethoxazole.trimethoprim, her symptoms and the infiltrative shadows on the chest X-ray film resolved. We believe that this patient had an exogenous lipoid pneumonia caused by inhalation of deoxycholic acid in amphotericin-B solubilized liquid, in addition to pulmonary nocardiosis.
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PMID:[Lipoid pneumonia combined with pulmonary nocardiosis caused by inhalation of amphotericin-B after renal transplantation]. 874 45

Acinetobacter baumannii is responsible for severe nosocomial pneumonia. To evaluate new therapeutic regimens for infections due to multiresistant strains and to study the pharmacodynamic properties of various antibiotics, we developed an experimental mouse model of acute A. baumannii pneumonia. C3H/HeN mice rendered transiently neutropenic were infected intratracheally with 5 x 10(6) CFU of A. baumannii. The mean log10 CFU/g of lung homogenate (+/- the standard deviation) were 9 +/- 0.9, 9.4 +/- 0.8, 8.6 +/- 1.2, and 7.7 +/- 1.4 on days 1, 2, 3, and 4 postinoculation. The lung pathology was characterized by pneumonitis with edema and a patchy distribution of hemorrhages in the peribronchovascular spaces of both lungs. Abscesses formed on days 3 and 4. Four days after inoculation, subacute pneumonitis characterized by alveolar macrophage proliferation and areas of fibrosis was observed. The cumulative mortality on day 4 was 85%. This new model was used to study the effects of 1, 2, or 3 50-mg/kg doses of imipenem. Imipenem concentrations in lungs were above the MIC for 2 h after the last dose. The in vivo postantibiotic effect (PAE) was determined during the 9-h period following the last dose; it decreased in duration with the number of doses: 9.6, 6.4, and 4 h after 1, 2, and 3 50-mg/kg doses, respectively. In contrast, no in vitro PAE was observed. This model offers a reproducible acute course of A. baumannii pneumonia. The presence of a prolonged in vivo PAE supports the currently recommended dosing intervals of imipenem for the treatment of human infections due to A. baumannii, i.e., 15 mg/kg three times a day.
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PMID:Use of a new mouse model of Acinetobacter baumannii pneumonia to evaluate the postantibiotic effect of imipenem. 902 Nov 90

One hundred and nine patients with infections concurrent with hematopoietic disorders were treated with imipenem/cilastatin sodium (IPM/CS) either alone (IPM/CS monotherapy) or in combination with other antimicrobial drugs (IPM/CS combination therapy). The following results were obtained. 1. One hundred and nine patients were allocated at random to two groups: 53 patients to IPM/CS monotherapy and 56 patients to IPM/CS combination therapy. Fourteen patients (6 and 8 in the 2 groups, respectively) were excluded from the clinical evaluation. There were not significant differences between the two groups with respect to the background. 2. The efficacy rates of the 2 treatments against bacterial infections were as follows: in the IPM/CS monotherapy group, 62.5% in 8 patients with sepsis, 75.0% in 23 patients with fever of undetermined origin (FUO), 50.0% in 10 patients with pneumonia, and 68.3% in the 47 patients, and in the IPM/CS combination group, 85.7% in 7 patients with sepsis, 63.6% in 24 patients with FUO, 50.5% in 8 patients with pneumonia, and 67.4% in the 48 patients. The differences between the two groups were not significant. 3. Among the drugs used in combination with IPM/CS, antibiotics other than penicillins, cephalosporins, and aminoglycosides were used in 12 patients and a high efficacy rate of 91.7% was obtained. 4. Bacteriologically, 19 and 17 strains were isolated from the IPM/CS monotherapy and combination therapy groups respectively, and the eradication rates were 100% and 88.9% respectively. 5. Side effects were noted in 2 patients in the IPM/CS monotherapy group and 7 in the combination therapy group, but all of these resolved after discontinuation or completion of the treatment. The efficacies against severe bacterial infections in the presence of hematopoietic disorders were not different between IPM/CS alone and IPM/CS in combination with other antibiotics. Adverse reactions were uncommon with the monotherapy.
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PMID:[Comparison between monotherapy with imipenem/cilastatin sodium (IPM/CS) and combinations of IPM/CS and other drugs for treating bacterial infections in patients with hematopoietic disorders]. 903 92

Imipenem was registered for clinical use in Germany in 1985. It is recommended for initial treatment in either severe nosocomial infections or infections in ICU or immunocompromised patients. In this study, we evaluated 1,215 patients who were prescribed imipenem at our Zentrum der Inneren Medizin-a major tertiary care university hospital-over a 6 year period. 650 of 1,215 patients (53.5%) had rapidly fatal disease; and the main indication for imipenem was pneumonia and fever of unknown origin. 56.2% received 500 mg imipenem t.i.d., 40.4% 500 mg b.i.d., 0.9% 1000 mg b.i.d.; and 2.5% 1000 mg t.i.d. Average duration of treatment was 11 days. Lower dose (500 mg b.i.d.) was used in patients with renal insufficiency; highest dose was used in severe infections or infections caused by moderately sensitive organisms. Imipenem was used as a single initial antibacterial agent in the majority of the patients. Success was seen in 80% of the episodes, irrespective of the dosage used; 89% at 500 mg b.i.d., 74% at 500 mg t.i.d., 77% at 1,000 mg b.i.d.; and 69% at 1,000 mg t.i.d. We observed the highest favourable response (91.5%) in the episodes treated initially with imipenem monotherapy. Overall, imipenem was well tolerated. The majority of the patients with untoward effects was on multiple-drug regimens. The most frequent untoward event observed involved the gastrointestinal tract.
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PMID:Experience with imipenem in internal medicine--a postmarketing surveillance study. 911 96

We identified 17 cases of pneumococcal bacteremia among 340 neutropenic cancer patients with bacteremia. Pneumonia was more frequent in patients with pneumococcal bacteremia than in those with bacteremia due to other organisms: 12 (71%) of 17 patients with pneumococcal bacteremia had pneumonia, whereas only 23 (7%) of 323 patients with nonpneumococcal bacteremia had pneumonia (P < .001). Eight (47%) of the 17 episodes of pneumococcal bacteremia were caused by penicillin-resistant strains (MICs ranged from 0.12 microg/mL to 4 microg/mL); these penicillin-resistant pneumococci showed varying degrees of diminished susceptibility to all beta-lactams studied, especially ceftazidime (MICs of this drug ranged from 1 microg/mL to 64 microg/mL). Imipenem was the beta-lactam agent most active against these organisms (MICs ranged from 0.03 microg/mL to 0.25 microg/mL). Patients with penicillin-resistant pneumococcal bacteremia received inappropriate empirical antibiotic therapy more often than did patients with bacteremia due to susceptible strains (i.e., 4 (50%) of 8 patients vs. 0 of 9, respectively; P < .05). Eight (47%) of the 17 patients with pneumococcal bacteremia died. In areas where penicillin-resistant pneumococci are highly endemic, these findings should be considered in selecting empirical antibiotic therapy for neutropenic patients with cancer who are suspected of having pneumonia.
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PMID:Treatment of penicillin-resistant pneumococcal bacteremia in neutropenic patients with cancer. 911 39

Therapeutic efficacy of the combined regimen, imipenem/cilastatin (IPM/CS) plus vancomycin (VCM), was examined in a total of 13 patients infected with MRSA (10 patients with pneumonia, 2 with sepsis and 1 with urinary tract infection). Based on the results of determination of FIC indices, in vitro combined effects were synergistic in 4 strains and additive in 3 strains. There was, however, no apparent correlation between the in vitro combined effect in terms of FIC index and clinical outcome. No side effects or abnormal laboratory findings were observed. The average daily doses of IPM/CS and VCM were 1.2 g and 1.25 g and the average administration periods were 17.5 and 14.9 days, respectively. The present results suggested that simultaneous use of IPM/CS and VCM at the standard doses could yield an enhancement of both bacteriological and clinical efficacies in treatment of the patients with MRSA infection.
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PMID:[Effect of imipenem/cilastatin combined with vancomycin for MRSA infection]. 919 47

An epidemiological investigation for penicillin-resistant Streptococcus pneumonia (PRSP) was performed at 18 medical institutes in Kinki area by the questionnaire from Kinki Infection Working Group 1995. This investigation was the first report that was performed for a long term (one year) and a large area. The most frequent specimen was sputum from out-patients (50.3%) and inpatients (48.8%), and especially from spinal fluid of 3 cases were detected. Polymicrobial infection with more than 3 pathogens was 15.7%, and it was more frequent than MRSA previously investigated. Simultaneous pathogens detected with PRSP were Candida species, Haemophilus influenzae and Staphylococcus aureus. In terms of chemosusceptibility, VCM (100%), FMOX (97.9%), IPM/CS (85.9%), CEZ (93.4%) and CDTR-PI were determined to be high by sensitive. However, the sensitivity of CCL, which was one of the most common antibiotics, was only 37.7%.
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PMID:[An epidemiological investigation for gram-positive coccus, especially PRSP, in Kinki area]. 933 24

Carbapenems are active beta-lactam antibiotics versus most of the gram positive and gram negative microorganisms and anaerobes although their activity is lacking in the case of Staphylococcus sp. resistant to methicillin, Enterococcus faecium and Streptococcus pneumoniae with high resistance to penicillin and some gram negative bacilli which naturally produce an methaloenzyme able to hydrolyze them such as Stenotrophomonas maltophilia. Imipenem, the first synthetized carbapenem requires administration with cilastatin to avoid inactivation by renal dehydropeptidase 1. Meropenem does not require being taken with the renal enzyme inhibitor, with its activity being similar to that of imipenem. In abdominal infection the carbapenems have shown to be the authentic monotherapy in this type of infections being as effective as the different schedules of antibiotic associations normally used. Treatment with carbapenems in bacterial meningitis should be currently limited to the cases produced by gram negative bacilli producers of wide spectrum beta-lactamases (WSBL), cases of meningitis by Pseudomonas aeruginosa or gram negative bacilli producers of inducible cephalosporinase. Meropenem is the carbapenem of choice probably in these cases because the carbapenems are often the only active antibiotics and meropenem, specifically, does not have the risk of convulsions observed with imipenem-cilastatin. The carbapenems have shown to be useful in skin and soft tissue infections as well as in obstetric and gynecologic infections as monotherapy similar to the schedules of the currently used antibiotic associations. In the case of nosocomial pneumonias, all the studies have evaluated the carbapenems in monotherapy as useful and effective, specially in the case of pneumonia by gram negative bacilli. Finally, in non filiated nosocomial sepsis and specially in the case of neutropenic patients, the use of carbapenems is particularly attractive in gram negative sepsis in intensive care units. The appearance in the last few years of strains of gram negative bacilli, producers of wide spectrum beta-lactamase or stable repressed hyperproducers of class I chromosomic cephalosporinase, as well as other multiresistant gram negative bacilli, such as Acinetobacter baumanii make the carbapenems, in many cases, the only effective antibiotic in this type of infections.
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PMID:[The role of carbapenems in the treatment of nosocomial infection]. 941 75

To clarify the clinical features of nosocomial pneumonia during mechanical ventilation (ventilator-associated pneumonia) and to select the appropriate antibiotic therapy for patients, we performed a clinical analysis of 19 patients (26 episodes) with this condition. The following results were obtained. 1, The average age of the patients was 68 years old (male 16, female 3). 2, VAP occurred three times in 2 cases, twice in 3 cases, and once in 14 cases. 3, The duration of mechanical ventilation was from 7 days to 11 years and 5 months (the average was 2.1 years). 4, The microorganism isolated from the aspiration sputum of the VAP patients was Pseudomonas aeruginosa frequently, but it was difficult to determine whether this microorganism was the causative microorganism. Ten strains of Staphylococcus aureus (MRSA seven strains and MSSA three strains) were newly isolated at the same time as VAP and especially in the cases in which these were thought to be causative microrganisms, all the patients died within a short time. 5, Antibiotics were clinically effective for 53.8% of all the VAP patients and carbapenem antibiotics (for example, IPM/CS) were also used for the effective group. 6, Regarding the risk factors for VAP, factors such as the duration of mechanical ventilation, the existence of chronic obstructive pulmonary disease, a hyponutritional state, prior antibiotics, aspiration of gastric contents, histamine-type-2 receptor antagonist, and multiple organ failure showed significant differences and were suspected to be associated with the appearance of VAP.
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PMID:[Clinical analysis of patients with nosocomial pneumonia during mechanical ventilation (so-called ventilator-associated pneumonia)]. 979 88


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